Florian Salm

Relationship between hospital ward design and healthcare-associated infection rates: a systematic review and meta-analysis

BackgroundThe influence of the hospital’s infrastructure on healthcare-associated colonization and infection rates has thus far infrequently been examined. In this review we examine whether healthcare facility design is a contributing factor to multifaceted infection control strategies.MethodsWe searched PubMed/MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) from 1990 to December 31st, 2015, with language restriction to English, Spanish, German and French.ResultsWe identified three studies investigating accessibility of the location of the antiseptic hand rub dispenser. Each of them showed a significant improvement of hand hygiene compliance or agent consumption with the implementation of accessible dispensers near the patient bed. Nine eligible studies evaluated the impact of single-patient rooms on the acquisition of healthcare-associated colonization and infections in comparison to multi-bedrooms or an open ward design. Six of these studies showed a significant benefit of single-patient bedrooms in reducing the healthcare-associated colonization and infection rate, whereas three studies found that single-patient rooms are neither a protective nor risk factor. In meta-analyses, the overall risk ratio for acquisition of healthcare-associated colonization and infection was 0.55 (95% CI: 0.41 to 0.74), for healthcare-associated colonization 0.52 (95% CI: 0.32 to 0.85) and for bacteremia 0.64 (95% CI: 0.53 to 0.76), all in favor of patient care in single-patient bedrooms.ConclusionImplementation of single-patient rooms and easily accessible hand rub dispensers located near the patient’s bed are beneficial for infection control and are useful parts of a multifaceted strategy for reducing healthcare-associated colonization and infections.

Antibiotic use, knowledge and health literacy among the general population in Berlin, Germany and its surrounding rural areas

Objectives Knowledge concerning antibiotic use in the general population is insufficient. The way health literacy is related to antibiotic use aside from knowledge needs further investigation. Our aim was to compare the levels of knowledge of antibiotics and health literacy in individuals who had taken antibiotics in recent years compared with those who not had taken antibiotics. Methods A population-based cross-sectional survey of 2,000 individuals aged 35 and older from Berlin, Germany and its surrounding rural and suburban areas (response rate 59%) with strata urban/rural, sex, age, and education. Computer-assisted personal interviews were conducted by external, trained interviewers during home visits. Knowledge, health literacy, and antibiotic use were assessed using standardized questionnaires. Results In all, 33.3% (666/2,000) of the participants indicated having had an antimicrobial therapy during the previous 12 months. Adjusting for sex, age, educational level and health literacy, individuals with four correct answers regarding antibiotics were 1.70 times and those with three correct answers 1.94 more likely to have had a history of recent antibiotic use than those who did not have any correct answers. Individuals with sufficient health literacy were 0.57 times less likely to have had a recent history of antibiotic use than individuals with insufficient health literacy. Conclusion Patients who have used antibiotics might have more knowledge as a result of their recent involvement with the topic of antibiotic use; health literacy may be a preventive mechanism to use antibiotics more critically. Besides improving the health knowledge of the general population and of vulnerable groups such as patients with low levels of health literacy, intervention strategies should focus on providers as well.

The Implementation of an Evidence-Based Bundle for Bloodstream Infections in Neonatal Intensive Care Units in Germany: A Controlled Intervention Study to Improve Patient Safety.

OBJECTIVE To improve the patient safety of very-low-birthweight infants in neonatal departments in Germany. DESIGN Multicenter cohort study with a baseline (24 months), an intervention (12 months), and a postinterventional follow-up period (12 months) and time series analysis. STUDY POPULATION Very-low-birthweight patients from 32 neonatal departments in Germany. METHODS Neonatal departments showing a standardized infection ratio of bloodstream infection 10% higher than the expected number (standardized infection ratio ≥1.1) were invited to participate in the study. To reduce the occurrence of primary bloodstream infections, evidence-based bundles to improve catheter maintenance routines, insertion practice, and hand-hygiene compliance were implemented in the participating infirmaries. RESULTS Thirty-four departments participated in the study and 32 reported data. In total, 6,222 very-low-birthweight infants with 231,868 patient-days and 1,405 cases of bloodstream infections were analyzed. In the baseline period the pooled mean bloodstream infection rate was 6.63 (95% CI, 6.17-7.12) per 1,000 patient-days. The bloodstream infection rate decreased in the intervention period to 5.68 (relative risk, 0.86 [95% CI, 0.76-0.97]) and in the 1-year follow-up period to 5.31 per 1,000 patient-days (relative risk, 0.80 [95% CI, 0.70-0.92]). The multivariable time series analysis of monthly aggregated data showed a significant change in the slope for the frequency of bloodstream infections from the start to the end of the intervention (change in slope incidence rate ratio, 0.97; P=.001). CONCLUSION The implementation of an intervention bundle is feasible and can reduce bloodstream infections in neonatal departments. Infect Control Hosp Epidemiol 2016;37:798-804.

Disease-specific knowledge in individuals with and without chronic conditions

AimKnowledge about chronic conditions may be a basis to enable coping with them more effectively. However, more research is needed to examine whether knowledge levels in chronically ill individuals are superior to levels of those without chronic conditions. Our aim was to investigate differences in disease-specific knowledge in individuals with and without specific chronic conditions.Subject and methodsA stratified and population-based sample of 4,144 individuals from Germany aged 35 and older with and without chronic conditions formed the basis of the investigation. Knowledge was measured using a validated health knowledge test with six subscales on specific conditions, namely cardiovascular disease, cancer, respiratory diseases, conditions of the musculoskeletal system, major depression, and chronic pain.ResultsWe found better knowledge in those suffering from respiratory diseases and musculoskeletal system conditions, no difference in those with cardiovascular diseases and depression, and lower values of disease-specific knowledge in individuals with chronic pain compared to those without the respective chronic condition. Results were adjusted for gender, age, education, health literacy, and other conditions.ConclusionPeople suffering from chronic conditions do not necessarily know more about their conditions. Better knowledge in individuals with respiratory diseases and diseases of the musculoskeletal system may be due to tailored health education. The unexpected effect in chronic pain patients may be related to false beliefs about the nature of their condition. Health education programs should address disease-specific barriers.

Perceptions and attitudes regarding antibiotic resistance in Germany: a cross-sectoral survey amongst physicians, veterinarians, farmers and the general public

Background Drivers of antibiotic (AB) resistance (ABR) include outpatient treatment, hospital care and animal husbandry. During the first phase of the One Health project RAI (Responsible Antibiotic Use via Information and Communication) surveys were conducted in these sectors. Objectives To compare perceptions and attitudes towards ABR among general practitioners (GPs), hospital physicians, veterinarians, pig farmers and the general public. Methods Cross-sectional questions on AB use and ABR were integrated in group-specific surveys of GPs, hospital physicians, veterinarians, pig farmers and the German general population. Results A total of 1789 participants (340 GPs, 170 hospital physicians, 215 pig farmers, 60 veterinarians and 1004 members of the public) responded. Each group tended to identify drivers of ABR as being from outside its own area of activity. Guidelines were shown to be an important information source for AB therapy for all prescriber groups, but the frequency of routine use differed (39% of GPs, 65% of hospital physicians and 53% of veterinarians). Regarding further information sources, hospital physicians preferred smartphone apps and e-learning, GPs preferred non-sponsored training and veterinarians preferred multidisciplinary networks and e-learning. Farmers were predominantly satisfied with existing solutions. Farmers had three times better basic knowledge of ABR and knew twice as many people with MDR organism problems than the general public. They also received information on ABR more often from their veterinarians than patients did from their doctors. Conclusions This study reveals considerable differences in perceptions and attitudes to ABR among the groups investigated. The results can help to tailor future interventions. Furthermore, they promote mutual understanding and thus support the One Health approach.

Rationale Antibiotikatherapie in der ambulanten Versorgung

Kaum ein anderes gesundheitspolitisches Thema wird derzeit so intensiv und auf höchster politischer Ebene diskutiert wie die Antibiotikaresistenzentwicklung und die Gefahren, die sich daraus ergeben. Welche Konsequenzen hat die fortschreitende Resistenz- entwicklung für die tägliche Praxis und wie lässt sich eine rationale Antibiotikatherapie in der ambulanten Versorgung häufiger Infektionen gestalten?

Rationale Antibiotikatherapie bei Atemwegsinfekten

Kaum ein anderes gesundheitspolitisches Thema wird derzeit so intensiv und auf höchster politischer Ebene diskutiert wie die Antibiotikaresistenzentwicklung und die Gefahren, die sich daraus ergeben. Welche Konsequenzen hat die fortschreitende Resistenzentwicklung für die tägliche Praxis und wie lässt sich eine rationale Antibiotikatherapie in der ambulanten Versorgung der wichtigsten Atemwegsinfektionen gestalten?

Hausärzte müssen das Thema Antibiotika-Resistenzen angehen

Die fortschreitende Resistenzentwicklung gegenüber Antibiotika gehört zu den großen bevölkerungsweiten Gesundheitsgefahren. Längst hat die Politik das Risiko zum Thema gemacht — gefordert sind aber letztlich die Ärzte in der täglichen Praxis. Gerade Hausärzte müssen bei den häufigen Infektionen eine kalkulierte Therapie umsetzen.

Rationale Antibiotikatherapie in der HNO-ärztlichen ambulanten Versorgung

Kaum ein anderes gesundheitspolitisches Thema wird derzeit so intensiv und auf höchster politischer Ebene diskutiert wie die Antibiotikaresistenzentwicklung und die Gefahren, die sich daraus ergeben. Welche Konsequenzen hat die fortschreitende Resistenzentwicklung für die tägliche Praxis und wie lässt sich eine rationale Antibiotikatherapie in der ambulanten Versorgung häufiger Infektionen im HNO-Bereich gestalten?