Position Infection protection is an ongoing task - targeted use of diagnostics

The coronavirus pandemic is an unprecedented reminder that infection control must be a permanent fixture on the health policy agenda. But there are also dangers lurking beyond virus-related infections that need to be countered. In Germany, for example, 75,000 people die of sepsis every year. In infection diagnostics, it is important to differentiate between viral and bacterial infections in order to avoid the unnecessary use of antibiotics.

Since 2020, we have been aware of the dramatic challenges associated with viral infections that develop into a pandemic. But bacterial infections must not be overlooked either. In the past, legislators and self-government have made selective improvements to the framework conditions for infection diagnostics. For example, adjustments have been made to the official operation and procedure codes, which form a basis for the consideration of diagnostic tests in the definition and calculation of DRG flat rates. Comprehensive consideration of infection diagnostics in hospitals must be reflected in the corresponding remuneration components of inpatient care. In addition, greater investment in hospital laboratory equipment would expand the possibilities for the use of innovative infection diagnostics.

The prevention of healthcare-associated infections must remain on the political agenda and be accompanied by the evaluation of measures that have been introduced and the testing of further measures. Effective infection prevention is a genuine quality indicator for healthcare facilities. For this reason, the quality assurance activities of hospitals and medical practices should be made even more visible, namely in cross-institutional and cross-sector quality assurance as well as in the structured quality reports of hospitals in accordance with SGB V. Targeted screening procedures on admission and discharge as well as comprehensive diagnostics during treatment are particularly important in inpatient care. Appropriate remuneration for such measures must be guaranteed.

An estimated 75,000 people die from sepsis in Germany every year. Premature babies and elderly patients are particularly at risk. According to the Sepsis Foundation, 20,000 deaths could be avoided. If the infection of the entire organism is recognized and treated at an early stage, the chances of survival improve significantly. The risk of long-term consequences is also reduced if treatment is started as early as possible. In hospitals, regular blood tests should monitor whether an infection is threatening to get out of control. Laboratory tests detect warning signs such as increased inflammation levels. A blood culture is essential to identify the pathogens and administer the right antibiotic quickly.

The fight against antibiotic resistance is a top priority for society. At the end of 2020, the WHO even warned of a possible wave of antibiotic resistance due to improper antibiotic administration in COVID-19 patients. In Germany, the 2017 Act to Strengthen Statutory Health Insurance Drug Provision (GKV-Arzneimittelversorgungsstärkungsgesetz) recognized that prompt diagnosis of infectious pathogens is the basis for fast, effective and appropriate antibiotic therapy. The self-administration must then examine the extent to which diagnostics can be used for rapid and quality-assured antibiotic therapy in SHI-accredited medical care. These new regulations were welcomed by the VDGH. Fortunately, they have also led to important tests such as the inflammation marker procalcitonin finding their way into reimbursement after many years. The procalcitonin test should definitely also be made billable for general practitioner care; further adjustments to the EBM are required for this.

Other suitable tests have been available in Germany for years and are increasingly being developed for use in the doctor's laboratory or as patient-oriented diagnostics. The accurate differentiation between a viral and a bacterial infection can significantly optimize the targeted use of antibiotics in the doctor's surgery. Panel tests, which can detect and differentiate between a whole range of pathogens in a single approach, as well as new molecular biological and immunological test procedures are also being made available by the diagnostics industry. Their hesitant use is not due to a lack of market availability, but to the reimbursement conditions in SHI-accredited medical care. Further reimbursement figures should be created here. Furthermore, it must be ensured that the contract doctor who tests his patient before deciding on antibiotic therapy does not burden his laboratory budget. Medical diagnostic services in connection with antibiotic therapy should therefore always be financed on an extra-budget basis. At the very least, it must also be possible for general practitioners or pediatricians to perform and bill for exclusion diagnostics.

Did you know?

The costs of antibiotic resistance in the European Union are estimated at 1.5 billion euros per year. Costs are expected to rise in the coming decades.

In a nutshell: The Association of the Diagnostics Industry (VDGH)

As a trade association, the German Diagnostics Industry Association (VDGH) represents the interests of more than 100 companies operating in Germany with a total turnover of 6.8 billion euros in 2022. They manufacture examination systems and reagents for the diagnosis of human diseases, which generate a turnover of more than 3.5 billion euros, as well as instruments, reagents, test systems and consumables for research in the life sciences, which generate a turnover of 3.3 billion euros.

www.vdgh.de