Austrian hospitals use an average of 75 liters of alcohol-based handrub per 1,000 patient days. In Hungary, the average is 37 liters over the same period.

In Germany, hospital staff takes 51 blood samples to test patients for hospital-acquired infections in 1000 patient days. In Hungary, this is done less than 13 times.

In Estonia, 20 percent of hospital rooms are suitable for isolating infectious patients. In Hungarian hospitals, the figure is 3 percent.

These are just some of the statistics that show how far the Hungarian healthcare system lags behind other European countries. These indicators are particularly important: all three factors – hand disinfection, sampling and patient isolation – are key to preventing dangerous and even fatal hospital-acquired infections. Hospitals that fall short in these areas are less likely to prevent infections.

“These numbers are a reflection of an underdeveloped public health system,” András Csilek infectious decease specialist and president of the Hungarian Medical Chamber’s Borsod-Abaúj-Zemplén County branch, told Direkt36.

The data come from a survey conducted every few years by the European Centre for Disease Prevention and Control (ECDC). Last year, when Direkt36 revealed in a series of articles that the situation of hospital-acquired infections in Hungary was getting worse, we quoted from the ECDC’s 2017 survey. It showed that Hungarian hospitals were performing very poorly in these indicators by European standards.

This year, a new analysis has been published, which shows that although progress has been made, results have still not caught up with the majority of European countries. For example, the ECDC report published in May clearly shows that Hungarian hospitals continue to perform low amounts of the tests needed to identify infections. Blood and stool test rates are below the European average, even compared to the survey five years ago.

Direkt36 also found out which Hungarian hospitals are particularly poor in these aspects. We asked the National Centre for Public Health and Pharmacy (NCPHP) for data and found that, for example, the Szent János Hospital and the Jahn Ferenc Hospital in Budapest have relatively few tests that can tell whether a patient has contracted a hospital-acquired infection. In addition, these are hospitals where our previous analyses have shown that, even with low sampling rates, infections were frequently identified.

We also looked at the liters of alcohol-based handrub used in each hospital and found that at least 50 Hungarian hospitals fall below the level recommended by the World Health Organization (WHO). Among them are the Bajcsy-Zsilinszky and Szent Margit hospitals, which according to our calculations also have a high incidence of infections.

Join the Direkt36 supporters’ group and get insight into investigative journalism! Details →
Direkt36 did not receive responses to questions from the Ministry of the Interior responsible for public healthcare, the NCPHP or the National Directorate General for Hospitals.

Even in 2024, Hungary still does not reach the European standard from 2017

As we detailed in our series of articles last year, hospital-acquired infections are diseases that can be contracted mainly by weakened patients during their hospital stay. If not treated correctly, these illnesses can be fatal. Pathogens can be spread by droplet transmission, feces, wound drainage, through medical equipment and to a significant extent by the insufficiently disinfected hands of a doctor, nurse or visitor.

In Hungary, hospital staff are required to report three types of hospital-acquired infections to the NCPHP, the institution responsible for data collection:

• clostridium difficile, a bacterium that causes severe diarrhea, dehydration and, if not treated in time, even severe inflammation of the intestines,
• multidrug-resistant bacteria, which are resistant to strong antibiotics and can cause wound infections, pneumonia and urinary tract infections,
• bloodstream infections, also known as sepsis. This disease can cause irreversible damage to a patient’s organs in a matter of hours.

Every four to five years, the ECDC conducts a detailed survey in collaboration with hospitals in the region to assess each country’s performance on healthcare-associated infections. The survey covered Hungary in 2022, from April to June. The analysis published a few months ago, showed that although some statistics have improved compared to the previous study, there are still serious gaps in the Hungarian healthcare system in this respect.

Sampling rates to identify infections are particularly low in Hungary, ranking among the lowest in Europe. The ECDC’s analysis does not show how individual Hungarian hospitals perform, but Direkt36 has conducted a study on this.

We asked the NCPHP for the number of laboratory tests on hospital-acquired infections to see which Hungarian hospitals are testing relatively low. We did not include some hospitals in our analysis due to the limited data available (e.g. they had too few patient days), so we reviewed samples from 91 hospitals. The reports did not use the exact number of samples but instead their rate per 1000 patient days. A patient day is equivalent to one full day of hospital care for an in-patient.

Let’s look at the ratio of blood samples needed to identify multidrug-resistant pathogens and bloodstream infections. Hungary ranked among the worst in Europe in this indicator, with only 9 out of more than 90 Hungarian hospitals we analyzed reaching the European average.

Some large county hospitals, such as the B.A.Z. County Central Hospital, the Békés County Central Hospital, and the Hetényi Géza Hospital in Szolnok had low testing rates, even though these hospitals perform high-risk procedures, such as surgery.

The Szent János Centrum Hospital is nowhere near the European average. Our analyses based on reports to the NCPHP show that this hospital has a high incidence of infections that blood samples can confirm. This means that many infections are reported despite the low number of samples taken. We have asked the hospital and the NCPHP if they are aware of this situation, but neither has responded.

The Dél-pesti Centrum Hospital (DPC) tested most frequently. This is not surprising, as the DPC has an infectious diseases department so more frequent testing is reasonable. According to our previously published analysis, the DPC had the highest incidence of bloodstream infections in 2022, which could be simply because it was the place where most samples were taken and therefore most infections detected. However, the prevalence of multidrug-resistant pathogens was not outstanding, despite the high number of blood samples.

The Clinical Centre of the University of Szeged seems to be a positive example. Blood samples were taken frequently, but our previous analyses showed that despite this, there were not many cases of infections detected by these tests.

We also looked at the proportion of stool samples, where Hungary is also among the worst performers in a European comparison. These tests detect a hospital-acquired infection called clostridium difficile, which causes diarrhea and dehydration.

Among the large county hospitals, the Szent Rafael Hospital in Zalaegerszeg, the Central Hospital of Békés County and the Csolnoky Ferenc Hospital in Veszprém perform low rates of tests. The Gottsegen György Cardiovascular Institute also samples below the European average, although according to our previous analyses, they had a high incidence of clostridial infections in 2022, which can be identified precisely by stool samples. So, this institution reports frequent infections with few tests to detect them. The hospital did not respond to our question about whether they are addressing this situation, and we did not receive a response from the NCPHP either.

Our previous analyses have also shown a very high incidence of clostridium difficile infections at the Toldy Ferenc Hospital in Cegléd. However, we now know that testing was also frequent in this institution, so this could partly explain the high prevalence of reported infections. The clinical center of the University of Szeged also sampled frequently, but despite the large number of samples, clostridial infections were not frequent.

The low number of samples is problematic because hospitals and the authorities cannot see the real data of the infections occurred in hospitals. Our series of articles published last year also showed that the NCPHP is aware that low sampling rates affect the accuracy of the data, as the smaller the sample, the less likely it is to be found that a patient has a hospital-acquired infection.

According to infectious disease specialist András Csilek, the shortage of staff in the health sector is the main reason why Hungarian hospitals are lagging behind more advanced European hospitals in terms of testing frequency.

"Acute lifesaving and fighting emergencies are working in the healthcare system, but there is no capacity left for assessment and prevention activities," Csilek told Direkt36.  He said that doctors and nurses are so overwhelmed that they are less likely to notice that a patient needs to be tested for a hospital-acquired infection.

Problems at the weekend

The European analysis also reveals that few microbiology laboratories in Hungary are available on weekends to process patient samples.

This is a problem because a hospital-acquired infection can cause serious damage in a few days or even a few hours, and spreads rapidly among weakened patients. For this reason, it is important that if a patient is suspected of having an infection, they are tested as soon as possible. However, the ECDC report shows that only about a third of Hungarian hospitals have this service at weekends.

Infections can easily spread in hospitals if there are not enough single rooms to isolate infectious patients.

Hungary has one of the lowest proportions of single-room beds, with 3% of rooms suitable for patients to recover without a roommate. In France and Sweden, every second hospital room is suitable for separation.

Join the Direkt36 supporters' group and get insight into investigative journalism! Details →
According to Csilek, single rooms would be important not just for isolating already infected patients. "By default, it would be important that patients have as little contact with each other as possible," he explained.

Few hand sanitizers are used in intensive care units

According to the ECDC survey, Hungarian hospitals are performing around the average in the use of alcohol-based handrub, which is an important factor in stopping the spread of not only hospital-acquired infections but any disease. More than half of the Hungarian hospitals we analyzed are still below the WHO recommendation of 20 liters per 1000 patient days.

Among them were the Bajcsy-Zsilinszky, Jahn Ferenc and Szent Margit Hospitals in Budapest. According to our previous analyses these institutions had high incidences of hospital-acquired infections.

Major hospitals such as the Clinical Centre of the University of Pécs, the Central Hospital of Békés County and the Markusovszky Hospital in Szombathely are not meeting the WHO recommendation.

At the other end of the scale are less busy, smaller hospitals, like the University of Debrecen and Semmelweis University Clinical Centres with more than 100,000 patients in a year, and the University of Szeged Clinical Centre with almost 70,000 patients where they used relatively high proportion of hand sanitizers. (Of the three, Semmelweis University was the only one to respond to our inquiry, stressing that they even use a tool that „uses artificial intelligence to help improve hand hygiene and teach proper hand disinfection.”)

The research also measured alcohol-based handrub consumption by intensive care units.

This was highlighted because intensive care units treat critically ill patients, who often have tubes and cannulas attached to them, increasing the risk of catching infections. Although Hungary did not provide the ECDC information on this, it can be calculated from the data requested by Direkt36.

Our analysis shows that 45 Hungarian intensive care units failed to achieve the European average of nearly 100 liters per 1000 patient days.

The intensive care unit of the Jahn Ferenc Hospital in Budapest used relatively the least amount of alcohol-based hand sanitizer. Our previous article showed that the Jahn Ferenc Hospital performed particularly poorly in the fight against hospital-acquired infections for several types of infections. As we wrote at the time, this institution has an outdated infrastructure, severe staff shortages and overcrowding. This was the hospital where it went unnoticed for days that a dead body was lying in one of the visitors' toilets. Although the hospital launched an investigation after the incident, two years later the same cleaning service was contracted to do the cleaning because they offered a cheap price.

The intensive care units of Szent Margit Hospital in Budapest, Szent Rókus Hospital in Baja and the Gróf Esterházy Hospital in Pápa also used little hand sanitizer during the same number of patient days. They used less than a quarter of the European average.

The highest rates of hand disinfection were found in the intensive care units of the Hetényi Géza Hospital in Szolnok, the clinical center of the University of Szeged and the Szent Rafael Hospital in Zala county.

You can find the detailed data here

If you are interested in how many blood and stool samples a hospital performed in 2022, you can download the data here. These were provided by the NCPHP from which we have made our calculations. Data on hand sanitizer use by hospitals and their intensive care units can be found here.

It’s important to note that hospitals should not be directly compared based on these indicators alone. Differences between hospitals can be because one hospital treats more serious patients or performs more serious operations, which may be the reason for more frequent sampling and use of hand sanitizers. Although we asked the NCPHP to provide us with more detailed data that would allow us to produce a ranking, they did not do so. However, the tables we have published do give an idea of how each hospital compares to the European average in terms of each indicator.

Illustration: Török Virág / Telex