Search

Aim: The basic assumption of this study was that the use of medical non-sterile gloves represents a barrier to correct hand hygiene behaviour. The aim of this study was to examine this assumption and detect reasons for possible incorrect behaviour. Accordingly, the hypothesis is that peri-glove compliance is lower than hand-disinfection compliance. Methods: The study involved the direct observation of the use of non-sterile, single-use medical gloves in three different wards of a university hospital. Nursing staff and physicians were observed. After the observation period, the observed persons received a custom-designed questionnaire in order to test their self-assessment, knowledge as well as structural conditions relating to the use of gloves. The results were evaluated and compared with the observation data. Results: All employees disinfected their hands in 18.6% of cases before and in 65% of cases after the use of non-sterile gloves. Gloves were changed in the event of the indication for hand disinfection/change of gloves in 27.5% of cases. When changing gloves, the employees disinfected their hands in 47.2% of cases. The respondents assessed themselves as being significantly better than the observations revealed. The respondents are aware of the rules about hand disinfection before and after the use of gloves. However, it was less commonly known that gloves are not an absolute barrier to the transmission of bacteria. Conclusion: Non-sterile single-use gloves seem to be a barrier to hand disinfection. Solutions must be found in order to improve peri-glove compliance, in particular with regard to hand disinfection before and during the wearing of gloves. Alongside the mere transfer of knowledge, the use of non-sterile gloves with regard to the current structural conditions in everyday clinical practice should be critically scrutinised, questioned, tested and developed for the users through precise instructions., Zielsetzung: Grundannahme der Untersuchung war, dass der Umgang mit medizinischen unsterilen Einmalhandschuhen eine Hürde für korrektes Händehygieneverhalten darstellt. Die Studie sollte diese Annahme überprüfen und Ursachen für mögliches Fehlverhalten detektieren. Dementsprechend ist eine Hypothese, dass die Peri-Handschuh-Compliance niedriger ist als die generelle Händedesinfektions-Compliance. Methode: Die Studie beinhaltete die direkte Beobachtung des Handschuhgebrauchs auf drei verschiedenen Stationen eines Universitätsklinikums. Beobachtet wurden sowohl Pflegepersonal als auch Ärzte. Nach der Beobachtungsphase erhielten die beobachteten Personen einen selbstkonzipierten Fragebogen, um ihre Selbsteinschätzung, ihr Wissen sowie strukturelle Gegebenheiten in Bezug auf den Handschuhgebrauch abzufragen. Die Ergebnisse wurden ausgewertet und anschließend mit den Beobachtungsdaten verglichen. Ergebnisse: In der Gesamtheit desinfizierten sich die Mitarbeiter in 18,6% der Fälle „vor“ und in 65% der Fälle nach Gebrauch unsteriler Handschuhe die Hände. Handschuhe wurden bei der Indikation zur Händedesinfektion/Handschuhwechsel in 27,5% der Fälle gewechselt. Bei Handschuhwechsel desinfizierten sich die Mitarbeiter in 47,2% der Fälle die Hände. Die Befragten schätzten sich selbst deutlich besser ein als es die Beobachtungen ergaben. Die Befragten kennen die Regeln zur Händedesinfektion „vor“ und „nach“ Handschuhgebrauch. Hingegen wurde seltener gewusst, dass Handschuhe keinen absoluten Schutz vor der Kontamination mit Bakterien darstellen. Schlussfolgerung: Es müssen Wege gefunden werden. die Peri-Handschuh-Compliance, insbesondere mit Hinblick auf Händedesinfektion „vor“ und „während“ des Handschuhtragens, zu verbessern. Neben der reinen Wissensvermittlung sollte der Gebrauch von unsterilen Einmalhandschuhen hinsichtlich der derzeitigen strukturellen Bedingungen im klinischen Alltag kritisch hinterfragt und durch passgenaue Handlungsanweisungen für die Nutzer erprobt und entwickelt werden., GMS Hygiene and Infection Control; 16:Doc08

Fragestellung: Postoperative Wundinfektionen gehören zu den häufigsten nosokomialen Infektionen, sind belastend für die betroffenen Patienten und verursachen erhebliche Kosten. Der Wundverbandswechsel (WVW) stellt eine Übertragungsgelegenheit für auslösende Bakterien dar.[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019)

Aim: Every year, millions of people around the world suffer from different infectious diseases, considerable part of which are hospital-acquired infections. WHO considers hand hygiene as a priority measure aimed to reduce the level of infection. We evaluated various aspects related to the situational behavior and prioritization regarding hand hygiene measures among the healthcare workers of Ukraine. Method: Identification of system mistakes in hand hygiene was carried out first of all by direct and indirect observation of the activities of medical and pharmaceutical personnel in their everyday practice as well as during their participation in trainings on routine hand hygiene. Questionnaires also were used to estimate the level of hand hygiene compliance of participants of the study. During this period 112 training courses, 315 master-classes and presentations on proper hand hygiene were realized. The target audience included health care workers of medical centers, clinics, maternity hospitals, health care organizations and staff of pharmacies and pharmaceutical manufacturing enterprises in all regions of Ukraine. 638 respondents took part in anonymous survey on hand hygiene practice. Results: The most common mistakes were to regard hand washing and hand disinfection equally, to wash hands before doing a hand disinfection, to neglect the five moments for hand hygiene and to ignore hand hygiene before and after wearing protective gloves. Practitioners, medical attendants, pharmacy and pharmaceutical industry workers highlighted the need for practical and understandable instructions of various hand hygiene procedures, including the clarification of the possible technical mistakes. This became a ground for us to create individual master classes on hand hygiene for each cluster of healthcare workers. Conclusions: Changing hand hygiene behavior and attitude is possible by beginning to observe clinical practice and by involving healthcare workers in teaching and training., GMS Hygiene and Infection Control; 10:Doc01; ISSN 2196-5226

Background: Peripheral venous catheters are frequently used in hospitalized patients but increase the risk of nosocomial bloodstream infection. Evidence-based guidelines describe specific steps that are known to reduce infection risk. However, the degree of guideline implementation in clinical practice is not known. The aim of this study was to determine the use of specific steps for insertion of peripheral venous catheters in clinical practice and to implement a multimodal intervention aimed at improving both compliance and the optimum order of the steps. Methods: The study was conducted at University Hospital Hamburg. An optimum procedure for inserting a peripheral venous catheter was defined based on three evidence-based guidelines (WHO, CDC, RKI) including five steps with 1A or 1B level of evidence: hand disinfection before patient contact, skin antisepsis of the puncture site, no palpation of treated puncture site, hand disinfection before aseptic procedure, and sterile dressing on the puncture site. A research nurse observed and recorded procedures for peripheral venous catheter insertion for healthcare workers in four different departments (endoscopy, central emergency admissions, pediatrics, and dermatology). A multimodal intervention with 5 elements was established (teaching session, dummy training, e-learning tool, tablet and poster, and direct feedback), followed by a second observation period. During the last observation week, participants evaluated the intervention. Results: In the control period, 207 insertions were observed, and 202 in the intervention period. Compliance improved significantly for four of five steps (e.g., from 11.6% to 57.9% for hand disinfection before patient contact; p, GMS Hygiene and Infection Control; 8(2):Doc18; ISSN 2196-5226

Aim: To assess trends in hygiene management in dental practices in comparison to an earlier survey in 2002/2003 and to point out key aspects for future efforts. Method: The infection prevention management of all dental practices in Greifswald (n=35) was determined by a questionnaire in a personal interview in 2008/2009. Results: 26% of the dentists did not use sufficient personal protective equipment during the general examination of the patient. In conservative and prosthetic dentistry, 15% still did not use adequate measures and 9% did not even in surgical interventions. Vaccination coverage was clearly too low, as only 35% of dentists were vaccinated against influenza and coverage with other vaccinations was also quite low. 11% of the dentists did not perform a documented anamnesis and in 29% of the dental practices no appointment system for risk patients existed. There were significant deficiencies in the reprocessing of medical devices and in the equipment needed for reprocessing. The opportunity to participate in further training in this field was rejected by 23% of the dentists. In 10 dental practices, the colony count in the dental unit water-conducting system was five times higher than the limit. A contamination with P. aeruginosa was discovered in 4 practices. All units were renovated. Discussion: Overall, both the hygiene management and hygiene equipment in the practices have improved considerably compared to the previous survey in 2002/2003. This demonstrates the positive effect of the KRINKO guidelines from 2006. However, the survey again showed relevant deficiences in the hygiene management of dental practices, which agrees with a Germany-wide online survey from 2009. Conclusion: While the study revealed persistent deficiencies in hygiene management, especially in reprocessing, it confirms that the KRINKO guidelines for dental practices from 2006 led to significant improvements in hygiene management. Doubts about the impact of the guidelines are not backed by evidence., GMS Krankenhaushygiene Interdisziplinär; 7(1):Doc14; ISSN 1863-5245

Einleitung/Hintergrund: Das nationale Referenzzentrum für Surveillance von nosokomialen Infektionen (NRZ) hat in den Jahren 2007/2008 ein neues Surveillancemodul HAND-KISS implementiert. In HAND-KISS wird der Verbrauch alkoholischer Händedesinfektionsmittel (VAH) in Krankenhäusern[for full text, please go to the a.m. URL], Mainz//2011; 56. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 6. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi)

An interdisciplinary working group from the German Society of Hospital Hygiene (DGKH) and the German Society for Anaesthesiology and Intensive Care (DGAI) worked out the following recommendations for infection prevention during anaesthesia by using breathing system filters (BSF). The BSF shall be changed after each patient. The filter retention efficiency for airborne particles is recommended to be >99% (II). The retention performance of BSF for liquids is recommended to be at pressures of at least 60 hPa (=60 mbar) or 20 hPa above the selected maximum ventilation pressure in the anaesthetic system. The anaesthesia breathing system may be used for a period of up to 7 days provided that the functional requirements of the system remain unchanged and the manufacturer states this in the instructions for use. The breathing system and the manual ventilation bag are changed immediately after the respective anaesthesia if the following situation has occurred or it is suspected to have occurred: Notifiable infectious disease involving the risk of transmission via the breathing system and the manual bag, e.g. tuberculosis, acute viral hepatitis, measles, influenza virus, infection and/or colonisation with a multi-resistant pathogen or upper or lower respiratory tract infections. In case of visible contamination e.g. by blood or in case of defect, it is required that the BSF and also the anaesthesia breathing system is changed and the breathing gas conducting parts of the anaesthesia ventilator are hygienically reprocessed. Observing of the appropriate hand disinfection is very important. All surfaces of the anaesthesia equipment exposed to hand contact must be disinfected after each case., GMS Krankenhaushygiene Interdisziplinär; 5(2):Doc13; ISSN 1863-5245

Introduction Methicillin-resistant Staphylococcus aureus (MRSA) are dangerous agents of nosocomial infections. In 2007 the prevalence of MRSA is 20.3% in Germany (Oxacilline-resistance according to EUCAST-criteria [EUCAST = European Committee on Antimicrobial Susceptibility Testing]). Objectives Which measurements are effective in the prevention and control of MRSA-infections in the hospital? How effective are contact precautions, screening, decolonisation, education and surveillance? Which recommendations can be given to health care politics on the basis of cost-effectiveness studies? Have there been any adverse effects on patients and clinical staff? What kind of liability problems exist? Methods Based on a systematic review of the literature studies are included which have been published in German or English language since 2004. Results 1,508 articles have been found. After having surveyed the full text, 33 medical, eight economic and four ethical/juridical studies are included for the Health Technology Assessment (HTA) report. The key result of the HTA report is that different measurements are effective in the prevention and control of MRSA-infections in hospitals, though the majority of the studies has a low quality. Effective are the conduction of differentiated screening measurements if they take into account the specific endemic situation, the use of antibiotic-control programs and the introduction and control of hygienic measurements. The break even point of preventive and control measurements cannot be defined because the study results differ too much. In the future it has to be more considered that MRSA-infections and contact precautions lead to a psycho-social strain for patients. Discussion It is hardly possible to describe causal efficacies because in the majority of the studies confounders are not sufficiently considered. In many cases bundles of measurements have been established but not analyzed individually. The internal and external validity of the studies is too weak to evaluate single interventions. Hygienic measurements prove to be effective in combination with other measurements. But it cannot be said which of the single measurements (gloves, washing hands, wearing gowns or masks) has the strongest effect on the reduction of MRSA. It is irritating that there are high differences in the compliance concerning hand hygiene between different studies. A general decolonisation is questionable for different reasons: first because of the side-effects for patients, second because of the high rate of spontaneous remissions in the untreated control group, third because of the differentiated process from colonisation to infection. Severalfold Hawthorne effects have been reported. One of them is that the competition between hospitals to reduce MRSA-rates leads already to a reduction. Conclusions It is evident that selective screening programs of risk patients considering the particular MRSA-prevalence are of use. The application of rapid tests seems to be only recommendable for risk patients and a high MRSA-prevalence. The improvement of the compliance of hand hygiene should be the basis of any prevention strategy. Training of staff members (with feedback mechanisms) is effective to improve compliance and to optimise the use of antibiotics. Antibiotic management programs are effective as well. Obviously multimodal approaches can lead to overadditive effects. Therefore the catalogue of preventive and control measurements has to be further evaluated. Good cost-efficacy studies are missing in Germany. The psychosocial effects of MRSA-infections are not researched in Germany. There is only punctual information on the risk management of hospitals., GMS Health Technology Assessment; 6:Doc04; ISSN 1861-8863

Einleitung Methicillin-resistente Staphylococcus aureus (MRSA) sind gefürchtete Erreger nosokomialer Infektionen. 2007 beträgt die Häufigkeit des Auftretens von MRSA in Deutschland 20,3% (Oxacillin-Resistenz gemäß EUCAST-Kriterien [EUCAST = European Committee on Antimicrobial Susceptibility Testing]). Fragestellungen Welche angewendeten Präventions- und Kontrollmaßnahmen stellen sich medizinisch und ökonomisch als effektiv in der Verhütung von MRSA-Infektionen im Krankenhaus heraus? Wie effektiv sind Barriere-, Screening-, Dekontaminierungs-, Schulungs- und Surveillance-Maßnahmen? Welche gesundheitspolitischen Entscheidungen legen die bisher vorliegenden Informationen zur Kosten-Effektivität nahe? Inwieweit sind adverse Effekte bei Patienten und Personal zu beobachten? Welche Haftungsprobleme gibt es? Methoden Basierend auf einer systematischen Literaturrecherche werden ab 2004 in deutscher oder englischer Sprache veröffentlichte kontrollierte Studien zur medizinischen Wirksamkeit und Kosten-Effektivität von Präventions- und Kontrollmaßnahmen in Bezug auf MRSA eingeschlossen und bewertet. Ergebnisse Insgesamt umfasst das Rechercheergebnis 1.508 Artikel aufgrund der definierten Suchbegriffe. Nach Durchsicht der Volltexte werden für den Health Technology Assessment (HTA)-Bericht 33 medizinische, acht ökonomische und vier ethische/juristische Texte aufgrund der Einschluss-/Ausschlusskriterien berücksichtigt. Zentrales Ergebnis des HTA-Berichts ist, dass Präventions- und Kontrollmaßnahmen effektiv in der Verhütung von MRSA-Infektionen im Krankenhaus sind, selbst in Anbetracht der unzureichenden Qualität der Mehrzahl der vorhandenen Studien. Dazu gehören die Durchführung differenzierter Screeningmaßnahmen unter Berücksichtigung der jeweiligen endemischen Situation, die Verwendung von Antibiotikakontrollmaßnahmen sowie die Einrichtung und Kontrolle von Hygieneschutzmaßnahmen. Ab wann die Präventions- und Kontrollmaßnahmen kosteneffektiv sind, kann nicht abschließend geklärt werden, da dazu Ergebnisse mit einer großen Bandbreite präsentiert worden sind. Stärker zu berücksichtigen ist zukünftig, dass MRSA-Infektionen und Isolationsmaßnahmen zu einer psychosozialen Belastung von Patienten führen. Diskussion Kausale Wirkungszuschreibungen sind kaum möglich, da bei der Mehrzahl der Studien Confounder nicht ausreichend berücksichtigt werden. Vielfach sind auch Maßnahmenbündel eingesetzt, aber nicht differenziert analysiert worden. Die interne und externe Validität der Studien ist zu schwach, um einzelne Interventionsmaßnahmen abschließend bewerten zu können. Hygienemaßnahmen erweisen sich in mehreren Studien im Zusammenhang mit anderen Maßnahmen als effektiv. Im Detail kann nicht nachgewiesen werden, welche der Hygienemaßnahmen (Handschuhe, Händewaschen, Kittel tragen, Mundschutz etc.) den signifikant höchsten Anteil an der Reduktion der MRSA-Rate hat. Irritierend sind die stark unterschiedlichen Compliance-Raten bei der Händehygiene. Eine generelle Dekolonisation erscheint fragwürdig, zum einen aufgrund der damit für Patienten verbundenen Nebenwirkungen, zum anderen aufgrund des offenbar vorhandenen hohen Anteils an Spontanremissionen, zum dritten aufgrund des differenzierten Ablaufs von einer Kolonisation zur Infektion. Mehrfach sind Hawthorne-Effekte beobachtet worden. Dazu gehört auch, dass offenbar allein bereits der Wettbewerb zwischen Krankenhausabteilungen und Krankenhäusern, fallende MRSA-Infektionsraten zu erzielen, ein entsprechendes Ergebnis hervorruft. Schlussfolgerung Die Evidenz bei Screeningmaßnahmen lässt den Schluss zu, dass selektive Screeningmaßnahmen von Risikopatienten unter Berücksichtigung der jeweiligen MRSA-Prävalenz zu befürworten sind. Der Einsatz von Schnelltests scheint sich nur bei Risikopatienten und einer hohen MRSA-Prävalenz zu lohnen. Die Verbesserung der Händehygiene-Compliance sollte Grundlage jeglicher Präventionsstrategie sein. Mitarbeiterschulungen (mit Rückkopplungsmechanismen) erweisen sich als effektiv, um eine verbesserte Compliance-Rate zu erzielen sowie den Antibiotikaeinsatz zu optimieren. Hierzu gehört auch die Einrichtung von Antibiotikamanagementprogrammen. Da offenbar durch multimodale Ansätze übersummative Wirkungseffekte erzielt werden, ist die Zusammensetzung des Katalogs der Präventions- und Kontrollmaßnahmen weiter zu evaluieren. Es fehlen saubere Kosten-Wirksamkeits-Studien in Deutschland. Die psychosozialen Effekte einer MRSA-Infektion sind in Deutschland völlig unzulänglich erforscht. Zur Beurteilung des Risikomanagements von Krankenhäusern liegen nur punktuelle Informationen vor., Schriftenreihe Health Technology Assessment (HTA) in der Bundesrepublik Deutschland; 100; ISSN 1864-9645