Correspondence (reply): In Reply

As Prof. Popp explains, the Zero Infection campaign has the long-term goal of anchoring awareness of hospital-acquired infections in our society in order to progressively reduce the number of infections. The campaign does not, however, actually have reduction to zero as an endpoint. Prof. Popp therefore voices the criticism that elimination of nosocomial infections is a political demand and not amenable to substantiation or testing with evidence. In point of fact, we are also of the opinion that such a demand is inevitably primarily political in nature.

Nevertheless, we fear that without supportive evidence there may be negative consequences. For example, creation of exaggerated expectations (infection-free surgery) on the part of the general public may lead to prosecutions based on the “zero infections maxim”. This, in turn, could have a negative impact on medical practice—e.g., increased or prolonged prophylactic administration of antibiotics to avoid postoperative infections because of the fear of legal consequences. Resistance rates could increase, resulting in nosocomial infections with bacteria significantly more difficult to treat.

Another alarming scenario—one that has already arisen in the USA as the result of a zero infection policy with penalties if nosocomial infections occur—is the reduction or complete discontinuation of microbiological diagnostics. In this way nosocomial infections are no longer diagnosed and penalties are avoided. The patients, however, suffer, because the nosocomial infections they actually have go undiagnosed and thus cannot be properly treated.

We share the opinion of Prof. Popp and the DGKH that discussion in the political arena is long overdue and are grateful to our colleagues for raising this demand and opening the discussion. Our publication (1) contributes to the scientific debate and provides, for the first time, data on the realistic potential for reduction of postoperative wound infections. We therefore believe that politically motivated demands and visions should stay within the boundaries of what can realistically be achieved by the medical profession and not arouse expectations among the general public that cannot be fulfilled.

As Prof. Dunkelberg rightly says, a sterility rating of ≤ 1:1 000 000 is assumed for sterile medical devices and sterile products. This means that “zero infections” can never be achieved when such devices are, for example, used in surgery (e.g., total hip replacement). Prof. Dunkelberg also lucidly explains how other factors (storage conditions and transport) can have a negative impact on sterility and thus increase the risk that medical devices are no longer sterile at the point of use.