A few days ago, the coronavirus death rate in Germany was just under 4 per 1 000. The UK rate then was around 50 and in Scotland it was 18 but in Italy it was 90!
These differences are of huge importance in understanding what should be done to reduce deaths. I’ve already suggested that outsourced cleaning and catering services may, in part, explain the higher rate in England than in Scotland and there is research evidence from the University of Oxford for this view:
The difference between Germany and Italy may also be influenced by this factor but the picture is more complex. Germany has many private hospitals with, by definition, privatised cleaning and catering but what matters, it seems, from the Oxford research, is that management of these services is located within the hospital and not in an external corporate HQ.
More striking in reflecting on the huge difference in patient outcomes is the evidence from recent research in Germany.
Published in 2018, a survey based in Frankfurt concluded:
‘Compared to 2014, a clear improvement was seen in 2016, especially in the qualification of the foremen and in terms of clearly defining the interface between cleaning and care services as well as the quality of process and outcome.’Cleaning and disinfection of surfaces in hospitals. Improvement in quality of structure, process and outcome in the hospitals in Frankfurt/Main, Germany, in 2016 compared to 2014
In 2017, across several German hospitals:
‘German hand hygiene campaign nearly doubles hand rub use in hospitals. The use of alcohol-based hand rub has nearly doubled in some German hospitals thanks to a national hand hygiene campaign, study data showed. Overall, the researchers reported a 94% median increase in consumption of hand rub from 2007 to 2015. In non-ICU units (n = 913), the increase was 101% from baseline, compared with 75% in 179 ICUs.’
I could find no comparable positive evidence from Italy but only this disturbing report from 2007 suggesting that improvement, along the lines of that in Germany, was much needed:
‘Inspections were carried out in hospitals across Italy on Monday [1/9/2007] amid a hygiene scare sparked by a journalistic expose’ of deplorable conditions inside the country’s biggest hospital. The health ministry said spot checks were being made on hospitals by the Carabinieri police’s health and hygiene unit NAS. The move followed last week’s publication of a shocking report written by an Italian journalist who spent a month working undercover as a cleaner at Rome’s Umberto I hospital – the largest hospital in Europe. Using a small hidden camera, journalist Fabrizio Gatti photographed and filmed dirty floors and corridors, hazardous refuse that had been abandoned inside the hospital, staff smoking outside the children’s intensive care unit and cleaning mops and brooms that were old and soiled. The report, which appeared in news weekly L’Espresso, painted a picture of filth and negligence which jeopardised patients’ health. Between 4,500-7,000 patients die each year in Italy because of infections contracted while in hospital. Hospital infections are considered a factor in another 21,000 patient deaths per year while up to 700,000 patients contract non-fatal infections. In 2005, 6.7% of all hospital patients were hit by infections which in at least 30% of cases could have been avoided.’