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PLoS One. 2014 May 29;9(5):e98100. doi: 10.1371/journal.pone.0098100. eCollection 2014.

Results from the first 12 months of the national surveillance of healthcare associated outbreaks in Germany, 2011/2012.

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  • 1Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany; Postgraduate Training for Applied Epidemiology, Berlin, Germany, affiliated to the European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden.
  • 2Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.



In August 2011, the German Protection against Infection Act was amended, mandating the reporting of healthcare associated infection (HAI) outbreak notifications by all healthcare workers in Germany via local public health authorities and federal states to the Robert Koch Institute (RKI).


To describe the reported HAI-outbreaks and the surveillance system's structure and capabilities.


Information on each outbreak was collected using standard paper forms and notified to RKI. Notifications were screened daily and regularly analysed.


Between November 2011 and November 2012, 1,326 paper forms notified 578 HAI-outbreaks, between 7 and 116 outbreaks per month. The main causative agent was norovirus (nā€Š=ā€Š414/578; 72%). Among the 108 outbreaks caused by bacteria, the most frequent pathogens were Clostridium difficile (25%) Klebsiella spp. (19%) and Staphylococcus spp. (19%). Multidrug-resistant bacteria were responsible for 54/108 (50%) bacterial outbreaks. Hospitals were affected most frequently (485/578; 84%). Hospital outbreaks due to bacteria were mostly reported from intensive care units (ICUs) (45%), followed by internal medicine wards (16%).


The mandatory HAI-outbreak surveillance system describes common outbreaks. Pathogens with a particular high potential to cause large or severe outbreaks may be identified, enabling us to further focus research and preventive measures. Increasing the sensitivity and reliability of the data collection further will facilitate identification of outbreaks able to increase in size and severity, and guide specific control measures to interrupt their propagation.

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