C. Reichardt

Costs of nosocomial Clostridium difficile-associated diarrhoea.

Nosocomial Clostridium difficile-associated disease (CDAD) is a common infection in hospitals. A matched case-control study was carried out to determine hospital-wide excess costs due to CDAD. Cases were assessed by prospective hospital-wide surveillance in a tertiary care university hospital in 2006. Nosocomial cases of CDAD (>72h after admission) were matched to control patients without CDAD in a ratio 1:3 using the same diagnosis-related group in the same year, for a hospital stay at least as long as the time of risk of the CDAD cases before infection and a Charlson comorbidity index +/-1. Data on overall costs per case were provided by the finance department. Matching was possible for 45 nosocomial CDAD cases. The difference in the length of stay showed that CDAD cases stayed significantly longer (median 7 days; P=0.006) than their matched controls. The average cost per CDAD patient was euro 33,840. The difference in the cost per patient showed that the cost for CDAD patients was significantly more than for their matched controls (median euro 7,147; 95% confidence interval: 4,067-9,276). Nosocomial CDAD is associated with high costs for healthcare systems. Clinicians should be aware of the financial impact of this disease and the application of appropriate infection control measures is recommended to reduce spread.

Establishment of a national surveillance system for alcohol-based hand rub consumption and change in consumption over 4 years.

Germany established a national surveillance system for alcohol-based hand rub consumption (AHC) in 2008. In 2010, the median AHC was 83 mL/patient-day in 543 intensive care units (ICUs) and 18 mL/patient-day in 4,638 non-ICUs. There was a median increase in AHC of 35.9% (P < .01) in 159 hospitals that participated in the surveillance system for 4 years.

The role and utilisation of public health evaluations in Europe: a case study of national hand hygiene campaigns

BackgroundEvaluations are essential to judge the success of public health programmes. In Europe, the proportion of public health programmes that undergo evaluation remains unclear. The European Centre for Disease Prevention and Control sought to determine the frequency of evaluations amongst European national public health programmes by using national hand hygiene campaigns as an example of intervention.MethodsA cohort of all national hand hygiene campaigns initiated between 2000 and 2012 was utilised for the analysis. The aim was to collect information about evaluations of hand hygiene campaigns and their frequency. The survey was sent to nominated contact points for healthcare-associated infection surveillance in European Union and European Economic Area Member States.ResultsThirty-six hand hygiene campaigns in 20 countries were performed between 2000 and 2012. Of these, 50% had undergone an evaluation and 55% of those utilised the WHO hand hygiene intervention self-assessment tool. Evaluations utilised a variety of methodologies and indicators in assessing changes in hand hygiene behaviours pre and post intervention. Of the 50% of campaigns that were not evaluated, two thirds reported that both human and financial resource constraints posed significant barriers for the evaluation.ConclusionThe study identified an upward trend in the number of hand hygiene campaigns implemented in Europe. It is likely that the availability of the internationally-accepted evaluation methodology developed by the WHO contributed to the evaluation of more hand hygiene campaigns in Europe. Despite this rise, hand hygiene campaigns appear to be under-evaluated. The development of simple, programme-specific, standardised guidelines, evaluation indicators and other evidence-based public health materials could help promote evaluations across all areas of public health.

Alcohol-based hand rub consumption surveillance in German hospitals – latest results.

HAND-KISS is a unit-based surveillance system of alcohol-based hand rub consumption (AHC). It is part of the German national nosocomial infection surveillance system (KISS).

Qualitätsmanagement zur Infektionsprävention im Krankenhaus

Healthcare acquired (nosocomial) infections are one of the most frequent complications of medical care. The management to prevent such nosocomial infections is a typical example of the use of the general principles of quality management in healthcare institutions: each institution should compare their own nosocomial infection rates for defined patient risk groups with reference data and identify problems concerning specific infection types or units/departments. This comparison should stimulate a careful analysis of the process of care and the options to improve the situation. Structured interventions, such as the introduction of bundles of infection control measures or checklists, are very helpful to increase compliance with infection control measures and to decrease nosocomial infection rates. However, often only interventions individually designed according to the specific needs in a particular unit/department are successful to improve infection rates. Therefore, the employment of experienced infection control personnel and surveillance strategies designed according to the specific needs of the institution are key elements of a good infection control management within healthcare institutions.ZusammenfassungNosokomiale oder Krankenhausinfektionen sind eine der häufigsten Komplikationen medizinischer Behandlung. Das Management zur Prävention dieser Infektionen ist ein typisches Beispiel für die Anwendung der allgemeinen Prinzipien des Qualitätsmanagements in Gesundheitseinrichtungen. Jedes Krankenhaus sollte die eigenen Infektionsraten für die wichtigsten Infektionen in den wichtigsten Risikogruppen regelmäßig bestimmen und mit den Referenzdaten vergleichen, um auf diese Weise Probleme bei bestimmten Infektionen bzw. in bestimmten Stationen/Abteilungen zu identifizieren. Dieser Vergleich soll eine sorgfältige Analyse der Arbeitsabläufe und der Möglichkeiten zur Situationsverbesserung stimulieren. Strukturierte Interventionen wie die Einführung von Maßnahmenbündeln oder Checklisten sind zusätzliche wichtige Hilfsmittel, um die Compliance bei der Umsetzung der Präventionsmaßnahmen zu steigern und Infektionsraten zu senken. Allerdings sind oft nur solche Interventionen erfolgreich, die ganz gezielt den Notwendigkeiten in den einzelnen Krankenhäusern angepasst sind. Deshalb ist die Beschäftigung von gut ausgebildetem Hygienefachpersonal und von Krankenhaushygienikern ein Schlüsselelement für gutes Infektionsmanagement in Krankenhäusern.AbstractHealthcare acquired (nosocomial) infections are one of the most frequent complications of medical care. The management to prevent such nosocomial infections is a typical example of the use of the general principles of quality management in healthcare institutions: each institution should compare their own nosocomial infection rates for defined patient risk groups with reference data and identify problems concerning specific infection types or units/departments. This comparison should stimulate a careful analysis of the process of care and the options to improve the situation. Structured interventions, such as the introduction of bundles of infection control measures or checklists, are very helpful to increase compliance with infection control measures and to decrease nosocomial infection rates. However, often only interventions individually designed according to the specific needs in a particular unit/department are successful to improve infection rates. Therefore, the employment of experienced infection control personnel and surveillance strategies designed according to the specific needs of the institution are key elements of a good infection control management within healthcare institutions.

Krankenhaushygiene –„AKTION Saubere Hände”: Keine Chance den Krankenhausinfektionen!

About 500,000 healthcare associated infections can be observed each year in Germany, about 20-30 %, that means 100,000 to 150,000 cases, are avoidable. Healthcare associated infections lead to increased mortality and prolongation of stay. The average prolongation of stay are 4 days, therefore about 2 Million additional hospital days can be determined. In other words about 6 hospitals with 1000 beds each are only caring for patients with healthcare associated infections. Experts agree that careful hand disinfection is the most important procedure to avoid transmission of pathogens. Studies demonstrate that an increasing compliance to hand disinfection leads to a reduction of healthcare associated infections. The clean hands campaign is a joint effort of the National Reference Centre for Surveillance of Nosocomial Infections, the German Society for Quality Management in Healthcare and the Patient Safety Campaign has the objective to achieve a significant improvement of hand hygiene.

Hand Rub Consumption Has Almost Doubled in 132 German Hospitals Over 9 Years

Annual surveillance data (2007-2015), collected continuously in 132 German hospitals, was evaluated for development of alcohol-based hand-rub consumption (AHC) as a surrogate parameter for hand hygiene adherence. Overall, the median increase in AHC was 94%. The increases over 9 years were significant in all units and quartiles of AHC at baseline. Infect Control Hosp Epidemiol 2017;38:870-872.

Use of ventilator utilization ratio for stratifying alcohol-based hand-rub consumption data to improve surveillance on intensive care units

BACKGROUND Germany has established a nationwide surveillance system of alcohol-based hand-rub consumption (AHC) per patient-day in hospital settings as a surrogate parameter for hand hygiene (HH) compliance. Analysis of AHC data in intensive care units (ICUs) shows not only a wide range of consumption between units of different specialties, but also within units of one specialty. This seems to reflect variation in the number of HH opportunities per patient-day between ICUs due to variation in complexity of care. AIM To investigate whether ventilator utilization ratio (VUR) might be a good surrogate for describing complexity and intensity of care on ICUs and whether stratification by VUR works as a new method of setting benchmarks for AHC data. METHODS Data from 365 ICUs participating in the German national nosocomial infection surveillance system (KISS) were used. VUR was calculated by dividing the number of ventilator-days per unit by the number of patient-days per unit. AHC was stratified according to VUR in quartiles. FINDINGS The median AHC was 107mL/patient-day [interquartile range (IQR): 86-134] and the median VUR was 33% (IQR: 22-45%). The Spearman rank correlation coefficient was 0.28 (P<0.0001). After stratifying AHC according to VUR, the AHC in quartile I was significantly lower compared to quartile IV. There was also significant difference between quartile I and quartiles II and III. CONCLUSION Stratification of AHC data according to VUR is suggested to improve the quality of benchmark parameters based on AHC data as surrogate parameter for HH compliance in ICUs.

Compliance in der Händedesinfektion – 5 Jahre „AKTION Saubere Hände“

Die „AKTION Saubere Hände“ (ASH) ist eine seit dem 1. Januar 2008 durch das Bundesministerium für Gesundheit geförderte nationale Kampagne. Die Kampagne basiert auf der WHO Kampagne „Clean Care is Safer Care“ und hat die Verbesserung des Händehygieneverhaltens in deutschen Gesundheitseinrichtungen zum Ziel. Zu Recht ist die nosokomiale Infektion ein hochaktuelles Thema, gilt sie doch als die häufigste Komplikation für einen Patienten während eines Krankenhausaufenthaltes. Die Hände von Klinikpersonal stehen in der Transmissionskette bei den nosokomialen Infektionen an der ersten Stelle. Es gilt, diese Kette an den örtlichen und in den zeitlichen übertragungsrelevanten Momenten zu unterbrechen. Mit über 1000 teilnehmenden Einrichtungen ist die ASH im internationalen Maßstab eine der größten Händehygienekampagnen der Welt und bietet:

O078: 6 years of national German hand hygiene campaign-where do we come from and where are we heading to?

The national German hand hygiene (HH) campaign “AKTION Saubere Hande” started at January 1st 2008. The campaign is based on the WHO “Clean Care is Safer Care” campaign and is funded for six years be the German ministry of health. By March 2013, over 1300 health care institutions are actively participating.