Hospital-transmitted infections in Romania are substantially under-reported, but simple measures such as the introduction of hand sanitisers in hospitals could result in a dramatic improvement, professor Karl Ekdahl, part of a team of European Centre for Disease Control (ECDC) experts who visited Romania in early July, said in an interview with bne IntelliNews.

Hospital-transmitted infections are one of the hottest issues in Romania ahead of this autumn’s general election. Infections were responsible for many of the 60 deaths among victims of the 2015 fire at the Club Colectiv nightclub in Bucharest. It was later revealed that Hexi Pharma, the supplier of disinfectants to the healthcare system, had been providing watered down and ineffective products.

Romania currently reports healthcare associated infection rates of just 2.8%, well below the EU average of over 5%. Across the EU, around 4.1mn people are believed to contract healthcare-associated infections every year, resulting in 37,000 deaths.

Ekdahl, who heads the ECDC’s public health capacity and communication unit, believes the Romanian figure reveals under-reporting in the system, and says the system discourages hospital administrators from reporting the true figures. “Under the present legislation, hospitals should have less than 2% infections and that is not an incentive to report higher figures,” he says.

Exactly how high the true figure is would be difficult to estimate, as only 10 Romanian hospitals participated in the last survey, but more clarity is expected when a new survey is carried out next year.

The team of experts from the EU body visited Romania between July 4-7, on the request of Healthcare Minister Vlad Voiculescu, a member of Prime Minister Dacian Ciolos’s interim government, which will hold office until the elections.

According to Ekdahl, “the ministry of health is aware that there is an issue with healthcare associated infections in Romania, and there is now a high political commitment to try and embrace this issue".

Bucharest has been under intense pressure to take action. The Club Colectiv tragedy - viewed by many as caused by corrupt officials who failed to ensure safety during an indoor firework display - resulted in the overthrow of the former government under Party of Social Democrats (PSD) Prime Minister Victor Ponta after around 25,000 people took to the streets in outrage over the disaster. Thousands also protested after an investigation by Gazeta Sporturilor revealed Hexi Pharma’s possible contribution to the deaths of many Club Colectiv victims.

While the current government is apparently committed to tackling the problems in the healthcare system, it has just months to do so before the election of a new government - most likely led by the PSD, polls indicate.

“We are aware that there is a short window of opportunity but we also believe that in a short-term perspective you could set a lot of things rolling and for these things you don’t need to wait,” Ekdahl says. “Also, with the recent events in this country there is a focus on the issue and a very strong political will from the minister.”

The ECDC team’s first recommendation is that there could be a change for the better with simple measures, specifically the wider use of alcohol hand sanitisers.

“You need to raise the level of awareness in hospitals of the huge importance of hand hygiene between every single patient. Today this is difficult in many hospitals because alcohol dispenders are not easily available, so an easy way to improve the situation is to make alcohol dispensers available close to patients and to have an awareness campaign among healthcare workers. This could save lives,” says Ekdahl.

Although one of the issues in Romania’s healthcare scandal is the supply of substandard products, Ekdahl believes a culture of hand hygiene would still be beneficial. “It is self evident that if you are working in a hospital setting, working with patients you should have good products, but at the same time it's important that this event should not stop or delay the implementation [of a hand hygiene campaign],” he says.

A similar campaign rolled out in UK hospitals helped to reduce the spread of drug-resistant MRSA infections.

The ECDC team also recommended a change in mindset away from a culture of “inspection and pointing fingers” towards openness and transparency, where the focus is on learning from mistakes.

In addition, the ECDC calls for new training for hospital epidemiologists. “We think there could be a shift to a new role where they are no longer counting numbers, but actively ... working on prevention and control.”

All the measures proposed by the ECDC “could be done relatively cheaply if there is a will” and would result in “tremendous change”, says Ekdahl, though he acknowledges that “In a country like Romania you also have the problems of too few isolation rooms and over-crowding in hospitals, but that is a much bigger issue.”

While the healthcare system in Romania is under scrutiny because of the deaths following the Club Colectiv fire, many of the problems faced by the sector are common not just to fellow post-communist countries (in particular corruption and procurement issues) but to West European countries as well, which made earlier reforms in both practical areas such as hygiene and in the culture within hospitals.