Publications by authors named "Iris Chaberny"

53 Publications

[Hygienic-Microbiological Evaluation of Tissue Dispensing Systems for Surface Disinfection in Hospitals].

Gesundheitswesen 2020 Jun 5. Epub 2020 Jun 5.

Institut für Hygiene, Krankenhaushygiene und Umweltmedizin, Universitätsklinikum Leipzig, Leipzig.

Background: Surface disinfection is one of the elementary measures of infection prevention in healthcare facilities. However, the current widely used tissue dispenser systems can be microbially contaminated as a result of various causes and play a decisive role in the spread of pathogens. For this reason, these systems must be considered both as a source of infection in routine surveillance and as part of nosocomial outbreaks.

Methods: Tissue dispenser systems used at the University Hospital Leipzig (UKL) were extensively analyzed between 2016 and 2018 in accordance with the recommendations of the German Association for Applied Hygiene (VAH). Within this period, 1096 disinfectant solutions from dispenser systems were tested. Areas without or with infection risk were represented with equal distribution. To exclude the possibility of contamination by dosing units (DU), the microbial-hygienic tests were extended to the 135 decentralized DU at the UKL.

Results: Overall, a decline in contaminated disinfectant solutions was recorded over the study period (31% in 2016, 18% in 2017 and 8% in 2018). However, in 2017 as well as in 2018, more contaminants were recorded in high-risk areas. Specific follow-up examinations after training in handling and preparation of the systems resulted in a decrease of contaminated disinfection solutions at hospitals. The dominant microbial contamination was with . (81%), followed by . (10%), vancomycin-resistant enterococci (VRE) (4%) and apathogenic environmental microorganisms (5%). The solutions taken from the dosing units (n=135) did not show any growth (91.1%). . were detected in 8.2% and molds in 0.7% of solutions.

Conclusion: Contaminated dosing units as well as drinking water used for this purpose could be excluded as source of the pathogens detected in tissue dispenser systems. It is assumed that a lack of knowledge and a false sense of security led to incorrect handling of tissue dispenser systems when dealing with disinfectants.
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http://dx.doi.org/10.1055/a-1152-4800DOI Listing
June 2020

[Multi-Resistant Bacteria in Patients in Hospitals and Medical Practices as well as in Residents of Nursing Homes in Saxony - Results of a Prevalence Study 2017/2018].

Gesundheitswesen 2020 May 7. Epub 2020 May 7.

Institut für Hygiene, Krankenhaushygiene und Umweltmedizin, Universitatsklinikum Leipzig, Leipzig.

Objective: The aim of this study was to determine the prevalence of methicillin-resistant (MRSA), multi-resistant gram-negative bacteria (MRGN) and vancomycin-resistant enterococci (VRE) in three study groups (hospital patients, residents in nursing homes for the elderly and patients in GP practices) and additionally, risk factors for carriage of multidrug-resistant organisms (MDRO).

Methods: Screening for MDRO was performed as a point prevalence study by obtaining nasal, pharyngeal and rectal swabs or stool samples from voluntary participants in 25 hospitals, 14 nursing homes for the elderly as well as 33 medical practices in 12 of 13 districts of Saxony. Suspicious isolates were further examined phenotypically and partially by molecular methods. The participants completed a questionnaire on possible risk factors for MDRO colonisation; the data were statistically evaluated by correlation analyses.

Results: In total, 1,718 persons, 629 from hospitals, 498 from nursing homes and 591 from medical practices, were examined. MDRO was detected in 8.4% of all participants; 1.3% persons tested positive for MRSA, 5.2% for 3MRGN, 0.1% for 4MRGN and 2.3% for VRE. Nine persons were colonized with more than one MDRO. The following independent risk factors could be significantly associated with the detection of MDRO: presence of a degree of care (MDRO), male sex (MDRO/VRE), current antibiosis (MDRO/VRE), antibiosis within the last 6 months (MDRO/MRSA/MRGN/VRE), current tumour disease (MDRO/3MRGN), peripheral artery disease (PAD) (MRSA) as well as urinary incontinence (3MRGN).

Conclusions: To our knowledge, this study represents the first survey of prevalence of different multiresistant pathogen groups in 3 study groups including outpatients in Germany. 3MRGN were the pathogens most frequently detected and were also found in patients of younger age groups. VRE were found almost exclusively in specific clinics. In addition to current and past antibiotic therapy, in particular the presence of PAD for MRSA detection, urinary incontinence for 3MRGN detection and a current tumour disease for MDRO and 3MRGN detection were determined as independent risk factors.
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http://dx.doi.org/10.1055/a-1138-0489DOI Listing
May 2020

Implementation interventions in preventing surgical site infections in abdominal surgery: a systematic review.

BMC Health Serv Res 2020 Mar 20;20(1):236. Epub 2020 Mar 20.

Hannover Medical School, Centre for Public Health and Healthcare, Department of Medical Psychology, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.

Background: Surgical site infections (SSIs) are highly prevalent in abdominal surgery despite evidence-based prevention measures. Since guidelines are not self-implementing and SSI-preventive compliance is often insufficient, implementation interventions have been developed to promote compliance. This systematic review aims to identify implementation interventions used in abdominal surgery to prevent SSIs and determine associations with SSI reductions.

Methods: Literature was searched in April 2018 (Medline/PubMed and Web of Science Core Collection). Implementation interventions were classified using the implementation subcategories of the EPOC Taxonomy (Cochrane Review Group Effective Practice and Organisation of Care, EPOC). Additionally, an effectiveness analysis was conducted on the association between the number of implementation interventions, specific compositions thereof, and absolute and relative SSI risk reductions.

Results: Forty studies were included. Implementation interventions used most frequently ("top five") were audit and feedback (80% of studies), organizational culture (70%), monitoring the performance of healthcare delivery (65%), reminders (53%), and educational meetings (45%). Twenty-nine studies (72.5%) used a multimodal strategy (≥3 interventions). An effectiveness analysis revealed significant absolute and relative SSI risk reductions. E.g., numerically, the largest absolute risk reduction of 10.8% pertained to thirteen studies using 3-5 interventions (p < .001); however, this was from a higher baseline rate than those with fewer or more interventions. The largest relative risk reduction was 52.4% for studies employing the top five interventions, compared to 43.1% for those not including these. Furthermore, neither the differences in risk reduction between studies with different numbers of implementation interventions (bundle size) nor between studies including the top five interventions (vs. not) were significant.

Conclusion: In SSI prevention in abdominal surgery, mostly standard bundles of implementation interventions are applied. While an effectiveness analysis of differences in SSI risk reduction by number and type of interventions did not render conclusive results, use of standard interventions such as audit and feedback, organizational culture, monitoring, reminders, and education at least does not seem to represent preventive malpractice. Further research should determine implementation interventions, or bundles thereof, which are most effective in promoting compliance with SSI-preventive measures in abdominal surgery.
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http://dx.doi.org/10.1186/s12913-020-4995-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7083020PMC
March 2020

Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients.

PLoS One 2020 24;15(1):e0227772. Epub 2020 Jan 24.

Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany.

Non-implanted central vascular catheters (CVC) are frequently required for therapy in hospitalized patients with hematological malignancies or solid tumors. However, CVCs may represent a source for bloodstream infections (central line-associated bloodstream infections, CLABSI) and, thus, may increase morbidity and mortality of these patients. A retrospective cohort study over 3 years was performed. Risk factors were determined and evaluated by a multivariable logistic regression analysis. Healthcare costs of CLABSI were analyzed in a matched case-control study. In total 610 patients got included with a CLABSI incidence of 10.6 cases per 1,000 CVC days. The use of more than one CVC per case, CVC insertion for conditioning for stem cell transplantation, acute myeloid leukemia, leukocytopenia (≤ 1000/μL), carbapenem therapy and pulmonary diseases were independent risk factors for CLABSI. Hospital costs directly attributed to the onset of CLABSI were 8,810 € per case. CLABSI had a significant impact on the overall healthcare costs. Knowledge about risk factors and infection control measures for CLABSI prevention is crucial for best clinical practice.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0227772PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6980604PMC
April 2020

[Infection control training for physicians to improve hand hygiene on surgical rounds : The more the better?]

Unfallchirurg 2020 Jul;123(7):541-546

Institut für Hygiene, Krankenhaushygiene und Umweltmedizin, Universitätsklinikum Leipzig AöR, Liebigstraße 22, 04103, Leipzig, Deutschland.

Background And Objective: A high level of hand hygiene compliance is the best way to prevent postoperative wound infections and is therefore an important starting point for interventions. Despite different campaigns the hand hygiene compliance of physicians remains to be improved. The aim was to analyze the effect of tailored and innovative interventions on the hand hygiene compliance of physicians.

Methods: At first the hand hygiene compliance of physicians was monitored during their ward rounds at three different wards. Afterwards two different interventions were performed and 6 weeks after each intervention the hand hygiene compliance was monitored again.

Results: The hand hygiene compliance of the control group (no intervention) did not change throughout the study. The ward where a small intervention was used showed an increase of hand hygiene compliance. Tailored intervention, however, resulted in a significant improvement of hand hygiene compliance in the ward where it was used.

Discussion And Prospects: Training concerning hand hygiene has to be improved to increase the prevention of infections. Tailored interventions with a high amount of practical relevance are suited to increase the compliance with preventive procedures (e.g. hand hygiene compliance). To improve the infection prevention for physicians in the long term, a firm knowledge about the indications for hand hygiene procedures is needed. This can be ensured by infection control training with a practical focus, small memory aids and permanent support from infection prevention professionals.
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http://dx.doi.org/10.1007/s00113-019-00760-yDOI Listing
July 2020

Incidence and risk factors of surgical site infection after total knee arthroplasty: Results of a retrospective cohort study.

Am J Infect Control 2019 10 30;47(10):1270-1272. Epub 2019 May 30.

Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany. Electronic address:

Knee arthroplasty is commonly performed in the case of advanced osteoarthritis, and deep joint infections represent a severe complication following surgery. A 4-year retrospective cohort study was conducted to determine the incidence and risk factors for such surgical site infections. Of the 2439 patients included in the study, 84 of them (3.4%) developed infections. Postoperative bleeding, Ahlbäck's disease, obesity, smoking, and male gender were independent risk factors that should be considered when caring for those patients.
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http://dx.doi.org/10.1016/j.ajic.2019.04.010DOI Listing
October 2019

Hygiene in medical education - Increasing patient safety through the implementation of practical training in infection prevention.

GMS J Med Educ 2019 15;36(2):Doc15. Epub 2019 Mar 15.

University Hospital Leipzig, Centre for Infection Medicine (ZINF), Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany.

Insufficient hygiene knowledge increases the risk of hospital-acquired infections through insufficient compliance and therefore poses a potential risk to patient safety. Therefore in 2015 the teaching project "OT Training" was introduced at the Faculty of Medicine (MF) Leipzig and a restructuring of the series of lectures and practical training on the topic of "Hygiene" was developed and integrated in the medical study curriculum. The "OT Training" in the pre-clinical component and the didactic restructuring of the hygiene workshops in the hospital semester were comprehensively developed by means of the currently applicable learning objective catalogues and have already been tested in existing teaching (per year N=320 students; 2015-17: N= 960). The "OT Training" and the series of lectures and practical training are evaluated externally by the Faculty of Medicine. In addition a self-developed questionnaire (for "OT Training") and an internal evaluation (for practical stations as part of the practical training series) were used. Overall the "OT Training" was evaluated as "very good" (N=492; RR=51%). Alongside the high importance of hygiene in the hospital and operating area (Overall=97% and Overall=98%) the salient feature of hygiene for self-protection and in particular for patient safety was also recognised at an early stage. Through the series of lectures and practical training which were also evaluated positively, the self-reported level of knowledge and the importance of hygiene for the students improved significantly (level of knowledge M=2.8 vs. M=3.9; p>0.000; importance M=3.3 vs. M=4.2; p>0.000; 5 point Likert scale; t-Test). Hygiene errors constitute a potential risk to patients. Consequently the early and continuous focus on hygiene in student education makes a contribution to increasing patient safety in the healthcare sector.
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http://dx.doi.org/10.3205/zma001223DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6446469PMC
September 2019

Impact of psychologically tailored hand hygiene interventions on nosocomial infections with multidrug-resistant organisms: results of the cluster-randomized controlled trial PSYGIENE.

Antimicrob Resist Infect Control 2019 25;8:56. Epub 2019 Mar 25.

2Hannover Medical School, Centre for Laboratory Medicine, Institute of Medical Microbiology and Hospital Epidemiology, Carl-Neuberg-Str. 1, OE 5214, 30625 Hannover, Germany.

Background: Professional hand hygiene compliance represents a multifaceted behaviour with various determinants. Thus, it has been proposed to apply psychological frameworks of behaviour change to its promotion. However, randomized controlled trials of such approaches, which also assess nosocomial infections (NIs), are rare. This study analyses data of the PSYGIENE-trial (PSYchological optimized hand hyGIENE promotion), which has shown improvements in compliance after interventions tailored based on the Health Action Process Approach (HAPA), on rates of NIs with multidrug-resistant organisms (MDROs).

Methods: A parallel-group cluster-randomized controlled trial was conducted on all 10 intensive care units and two hematopoietic stem cell transplantation units at Hannover Medical School, a German tertiary care hospital. Educational training sessions for physicians and nurses (individual-level intervention) and feedback discussions with clinical managers and head nurses (cluster-level) were implemented in 2013. In the "Tailoring"-arm ( = 6 wards), interventions were tailored based on HAPA-components, which were empirically assessed and addressed by behaviour change techniques. As active controls,  = 6 wards received untailored educational sessions of the local "Clean Care is Safer Care"-campaign (Aktion Saubere Hände: "ASH"-arm). From 2013 to 2015 compliance was assessed by observation following the World Health Organization, while alcohol-based hand rub usage (AHRU) and NIs with multidrug-resistant gram-negative bacteria, Methicillin-resistant or Vancomycin-resistant were assessed following national surveillance protocols. Data were analysed at cluster-level.

Results: In the "Tailoring"-arm, interventions led to a decrease of 0.497 MDRO-infections per 1000 inpatient days from 2013 to 2015 ( = 0.015). This trend was not found in the "ASH"-arm (- 0 . 022 infections;  = 0.899). These patterns corresponded inversely to the trends in compliance but not in AHRU.

Conclusions: While interventions tailored based on the HAPA-model did not lead to a significantly lower incidence rate of MDRO-infections compared to control wards, a significant reduction, compared to baseline, was found in the second follow-up year in the "Tailoring"- but not the "ASH"-arm. This indicates that HAPA-tailored hand hygiene interventions may contribute to the prevention of NIs with MDRO. Further research should focus on addressing compliance by interventions tailored not only to wards, but also leaders, teams, and individuals.

Trial Registration: German Clinical Trials Register/International Clinical Trials Registry Platform, DRKS00010960. Registered 19 August 2016-Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00010960. http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00010960.
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http://dx.doi.org/10.1186/s13756-019-0507-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6434638PMC
April 2020

The Role of Bundle Size for Preventing Surgical Site Infections after Colorectal Surgery: Is More Better?

J Gastrointest Surg 2018 04 24;22(4):765-766. Epub 2018 Jan 24.

Centre of Public Health and Healthcare, Medical Psychology Unit, Hannover Medical School, OE 5430, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.

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http://dx.doi.org/10.1007/s11605-018-3670-8DOI Listing
April 2018

Economic burden of nosocomial infections caused by vancomycin-resistant enterococci.

Antimicrob Resist Infect Control 2018 5;7. Epub 2018 Jan 5.

Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.

Background: Nosocomial infections due to vancomycin-resistant (VRE) have become a major problem during the last years. The purpose of this study was to investigate the economic burden of nosocomial VRE infections in a European university hospital.

Methods: A retrospective matched case-control study was performed including patients who acquired nosocomial infection with either VRE or vancomycin-susceptible enterococci (VSE) within a time period of 3 years. 42 cases with VRE infections and 42 controls with VSE infections were matched for age, gender, admission and discharge within the same year, time at risk for infection, Charlson comorbidity index (±1), stay on intensive care units and non-intensive care units as well as for the type of infection, using criteria of the Centers for Disease Control and Prevention.

Results: The median overall costs per case were significantly higher than for controls (EUR 57,675 vs. EUR 38,344;  = 0.030). Costs were similar between cases and controls before onset of infection (EUR 17,893 vs. EUR 16,600;  = 0.386), but higher after onset of infection (EUR 37,971 vs. EUR 23,025;  = 0.049). The median attributable costs per case for vancomycin-resistance were EUR 13,157 ( = 0.036). The most significant differences in costs between cases and controls turned out to be for pharmaceuticals (EUR 6030 vs. EUR 2801;  = 0.008) followed by nursing staff (EUR 8956 vs. EUR 4621;  = 0.032), medical products (EUR 3312 vs. EUR 1838;  = 0.020), and for assistant medical technicians (EUR 3766 vs. EUR 2474;  = 0.023). Furthermore, multivariate analysis revealed that costs were driven independently by vancomycin-resistance (1.4 fold;  = 0.034).

Conclusions: This analysis suggested that nosocomial VRE infections significantly increases hospital costs compared with VSE infections. Therefore, hospital personal should implement control measures to prevent VRE transmission.
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http://dx.doi.org/10.1186/s13756-017-0291-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755438PMC
June 2019

[Decolonization of Health Care Workers In a Neonatal Intensive Care Unit Carrying a Methicillin-Susceptible Staphylococcus aureus Isolate].

Gesundheitswesen 2018 01 27;80(1):54-58. Epub 2017 Dec 27.

Institut für Hygiene, Krankenhaushygiene und Umweltmedizin, Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig.

Background: In 2016, an increased rate of methicillin-susceptible colonization was detected on a neonatal intensive care unit at the Leipzig University Hospital. Typing results showed a predominant -type t091. Considering nosocomial clustering, several infection prevention measures (e. g. intensified standard precautions, single-occupancy room, cohorted patients, continuing education of staff) were introduced, including staff screening followed by decolonization of colonized health care workers.

Methods: Staff members showing positive on screening carried out a 5-day decolonization program at home. Decolonization products containing octenidine as active ingredient were used first. At the earliest, 48 h after completing the procedure, the success of the intervention was tested (3 buccal and nasal swabs were taken on consecutive days). If 2 attempts at decolonization were not successful, staff members were provided with a mupirocin-containing nasal ointment instead of octenidine.

Results: Of 128 employees examined, 43 (33.6%) were identified as carriers of . In 9 cases (20.9%; 9/43) the matched with type t091. 2 carriers (4.7%; 2/43) of MRSA were detected as well. The first decolonization attempt against t091 and MRSA failed altogether. After a second decolonization, 3 cases became negative. Finally, 8 remaining staff members were decolonized successfully with mupirocin containing nasal ointment.

Conclusions: Various reasons might explain the difficulties of decolonization such as the challenge of managing decolonization at home, inhibitory factors as well as inconsistent performance of decolonization measures. Additionally, differences between the preparations for the nasal decontamination may be considered.
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http://dx.doi.org/10.1055/s-0043-122277DOI Listing
January 2018

EFFECT of daily antiseptic body wash with octenidine on nosocomial primary bacteraemia and nosocomial multidrug-resistant organisms in intensive care units: design of a multicentre, cluster-randomised, double-blind, cross-over study.

BMJ Open 2017 Nov 8;7(11):e016251. Epub 2017 Nov 8.

Institute of Hygiene/Hospital Epidemiology, Medical Faculty of the University of Leipzig, Leipzig, Saxony, Germany.

Introduction: Nosocomial infections are serious complications that increase morbidity, mortality and costs and could potentially be avoidable. Antiseptic body wash is an approach to reduce dermal micro-organisms as potential pathogens on the skin. Large-scale trials with chlorhexidine as the antiseptic agent suggest a reduction of nosocomial infection rates. Octenidine is a promising alternative agent which could be more effective against Gram-negative organisms. We hypothesise that daily antiseptic body wash with octenidine reduces the risk of intensive care unit (ICU)-acquired primary bacteraemia and ICU-acquired multidrug-resistant organisms (MDRO) in a standard care setting.

Methods And Analysis: EFFECT is a controlled, cluster-randomised, double-blind study. The experimental intervention consists in using octenidine-impregnated wash mitts for the daily routine washing procedure of the patients. This will be compared with using placebo wash mitts. Replacing existing washing methods is the only interference into clinical routine.Participating ICUs are randomised in an AB/BA cross-over design. There are two 15-month periods, each consisting of a 3-month wash-out period followed by a 12-month intervention and observation period. Randomisation determines only the sequence in which octenidine-impregnated or placebo wash mitts are used. ICUs are left unaware of what mitts packages they are using.The two coprimary endpoints are ICU-acquired primary bacteraemia and ICU-acquired MDRO. Endpoints are defined based on individual ward-movement history and microbiological test results taken from the hospital information systems without need for extra documentation. Data on clinical symptoms of infection are not collected. EFFECT aims at recruiting about 45 ICUs with about 225 000 patient-days per year.

Ethics And Dissemination: The study was approved by the ethics committee of the University of Leipzig (number 340/16-ek) in November 2016. Findings will be published in peer-reviewed journals.

Trial Registration Number: DRKS-ID: DRKS00011282.
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http://dx.doi.org/10.1136/bmjopen-2017-016251DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695441PMC
November 2017

Promoting Hand Hygiene Compliance.

Dtsch Arztebl Int 2017 01;114(3):29-36

Centre for Public Health and Healthcare, Medical Psychology Unit, Hannover Medical School; Department of Diagnostics, Institute of Hygiene/Hospital Epidemiology, Leipzig University Hospital; Center for Public Health and Healthcare, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School; Centre for Laboratory Medicine, Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School.

Background: The German "Clean Hands Campaign" (an adaptation of the WHO "Clean Care is Safer Care" programme) to promote hand hygiene among hospital personnel at Hannover Medical School (MHH, Medizinische Hochschule Hannover), known as Aktion Saubere Hände (ASH), met with initial success. By 2013, however, compliance rates with hygienic hand disinfection in the hospital's ten intensive care units (ICUs) and two hematopoietic stem cell transplantation units (HSCTUs) had relapsed to their initial levels (physicians: 48%; nurses: 56%). The cluster- randomized controlled trial PSYGIENE was conducted to investigate whether interventions tai - lored in ways suggested by research in behavioral psychology might bring about more sustainable improvements than the ASH.

Methods: The "Health Action Process Approach" (HAPA) compliance model specifies key psychological determinants of compliance. These determinants were assessed among health care workers in the ICUs and HSCTUs of the MHH by questionnaire (response rates: physicians: 71%; nurses: 63%) and by interviews of the responsible ward physicians and head nurses (100%). In 2013, 29 tailored behavior change techniques were implemented in educational training sessions and feedback discussions in the six wards that constituted the intervention arm of the trial, while ASH training sessions were provided in the control arm. The compliance rates for 2014 and 2015 (the primary outcomes of the trial) were determined by nonparticipating observation of hygienic hand disinfection, in accordance with the World Health Organization's gold standard.

Results: The two groups did not differ in their baseline compliance rates in 2013 (intervention: 54%, control: 55%, p = 0.581). The tailored interventions led to increased compliance in each of the two follow-up years (2014: 64%, p<0.001; 2015: 70%, p = 0.001), while the compliance in the control arm increased to 68% in 2014 (p<0.001) but fell back to 64% in 2015 (p = 0.007). The compliance increases from 2013-2015 and the compliance rate in 2015 were higher in the intervention arm (p<0.005). This was mainly attributable to the nurses' behavior, as the corresponding parameters for physicians did not differ significantly between the two study arms in stratified analysis.

Conclusion: Tailored interventions based on behavioral psychology principles led to more sustainable increases in compliance with hand hygiene guidelines than ASH training sessions did. This was true among nurses, and thus also for hospital ward personnel as a whole (i.e., nurses and physicians combined). Further studies are needed to identify more target group-specific interventions that may improve compliance among physicians.
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http://dx.doi.org/10.3238/arztebl.2017.0029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5551068PMC
January 2017

Deep Surgical Site Infections after Open Radical Cystectomy and Urinary Diversion Significantly Increase Hospitalisation Time and Total Treatment Costs.

Urol Int 2017 14;98(3):268-273. Epub 2016 Sep 14.

Department of Urology and Urological Oncology, Hannover Medical School, Hannover, Germany.

Introduction: Deep surgical site infections (DSSI) usually require secondary treatments. The aim of this study was to compare the total length of hospitalisation (LOH), intensive care unit (ICU) duration, and total treatment costs in patients with DSSI versus without DSSI after open radical cystectomy (ORC) and urinary diversion.

Material And Methods: Prospective case-control study in a tertiary care hospital in patients after ORC with urinary diversion during April 2008 to July 2012. DSSI was defined based on Centers for Disease Control and Prevention criteria. Matched-pair analysis for patients with versus without DSSI was done in 1:2 ratios. Patients with superficial surgical site infections (SSI) were excluded from analysis.

Results: In total, 189 operations were performed. Thirty-eight patients (20.1%) developed SSI of which 28 patients (14.8%) had DSSI. Out of 28 patients, 27 (96.4%) were with DSSI and required surgical re-intervention. Due to insufficient matching criteria, 11 patients with DSSI were excluded from analyses. Consequently, 17 patients with DSSI were matched with 34 patients without DSSI. Significant differences were seen for median overall LOH (30 vs. 18 days, p < 0.001), median ICU duration (p = 0.024), and median overall treatment costs (€17,030 vs. €11,402, p = 0.011).

Conclusions: DSSI significantly increases LOH (67%) and treatment costs (49%), adding up to a financial loss for the hospital of approximately €5,500 in patients with DSSI.
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http://dx.doi.org/10.1159/000449472DOI Listing
October 2017

[Prevention of catheter-associated urinary tract infections: established and new aspects for the clinical routine : Revised recommendations on "prevention and control of catheter-associated urinary tract infections" of the commission for hospital hygiene and infection prevention at the Robert Koch Institute].

Anaesthesist 2015 12 19;64(12):953-957. Epub 2015 Oct 19.

Institut für Hygiene/Krankenhaushygiene, Universitätsklinikum Leipzig, Johannisallee 34, 04103, Leipzig, Deutschland.

Catheter-associated urinary tract infections (CAUTI) are one of the most common healthcare-associated infections (HAI) in Germany and are of particular relevance for intensive and standard care units. The revised guidelines of the commission for hospital hygiene and infection prevention (KRINKO) provide an update on prevention of CAUTI. The guidelines consider and evaluate the new literature published after the initial publication in 1999. The KRINKO recommendations should be implemented to protect patients from such infections, especially as CAUTIs are one of the most preventable types of HAI. In this respect tailor-made infection prevention bundles seem to be most effective and continuous infection surveillance procedures are of particular importance. Thus, a comparison with the reference data provided by the (German) National Reference Center for surveillance of nosocomial infections is possible. This article explains the recommendations for prevention measures included in the new KRINKO guidelines.
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http://dx.doi.org/10.1007/s00101-015-0103-xDOI Listing
December 2015

Intensive care physicians' and nurses' perception that hand hygiene prevents pathogen transmission: Belief strength and associations with other cognitive factors.

J Health Psychol 2017 01 9;22(1):89-100. Epub 2016 Jul 9.

1 Hannover Medical School, Medical Psychology Unit, Germany.

Besides habituation, conscious decision-making remains important for healthcare workers' hand hygiene compliance. This study compared 307 physicians and 348 nurses in intensive care at a German university medical centre regarding their belief that hand disinfection prevents pathogen transmission. Physicians perceived less risk reduction ( p < 0.001; variance explained: 4%), a comparison outscored only by lower self-rated guideline knowledge (8%). In both groups, the transmission-preventive belief was associated with high response efficacy, behavioural intention and self-efficacy, but not with self-rated knowledge. Consistent with the Health Action Process Approach, hand hygiene interventions targeting risk reduction beliefs may promote high motivation, but not action control.
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http://dx.doi.org/10.1177/1359105315595123DOI Listing
January 2017

The prevalence of nosocomial and community acquired infections in a university hospital: an observational study.

Dtsch Arztebl Int 2013 Aug 5;110(31-32):533-40. Epub 2013 Aug 5.

Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School.

Background: Nosocomial infections (NI) increase morbidity and mortality. Studies of their prevalence in single institutions can reveal trends over time and help to identify risk factors.

Methods: In March and April 2010, data were prospectively recorded from all inpatients at the Hannover Medical School (Germany) except those treated in the pediatric, psychosomatic, and psychiatric services. The data were acquired systematically by chart review and by interviews with the medical staff. Infections were classified according to the definitions of the Centers for Disease Control and Prevention (CDC). Information was obtained on underlying diseases, invasive procedures, the use of antibiotics, devices (the application of specific medical techniques such as drainage, vascular catheters, etc.), and detected pathogens.

Results: Of the 1047 patients studied, 117 (11.2%) had a total of 124 nosocomial infections, while 112 (10.7%) had 122 community-acquired infections. The most common NI were surgical site infections (29%), infections of the gastrointestinal tract (26%) and respiratory tract (19%), urinary tract infections (16%), and primary sepsis (4%). The most common pathogens were Escherichia coli, coagulase-negative staphylococci, Candida spp., Enterococcus spp., and Pseudomonas aeruginosa. Multivariable regression analysis revealed the following independent risk factors for NI: antibiotic treatment in the last 6 months (odds ratio [OR] = 2.9), underlying gastrointestinal diseases (OR = 2.3), surgery in the last 12 months (OR = 1.8), and more than two underlying diseases (OR = 1.7). Each additional device that was used gave rise to an OR of 1.4. Further risk factors included age, length of current or previous hospital stay, trauma, stay on an intensive care unit, and artificial ventilation.

Conclusion: In this prevalence study, NI were a common complication. Surgical site infections were the single most common type of NI because of the large number of patients that underwent surgical procedures in our institution. More investigation will be needed to assess the benefit of prevalence studies for optimizing appropriate, effective preventive measures.
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http://dx.doi.org/10.3238/arztebl.2013.0533DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782020PMC
August 2013

Hand hygiene compliance in transplant and other special patient groups: an observational study.

Am J Infect Control 2013 Jun 20;41(6):503-8. Epub 2013 Jan 20.

Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany.

Background: This study evaluates hand hygiene behavior of health care workers in a German university hospital stratified for treatment of special patient groups (eg, transplant patients).

Methods: From 2008 to 2010, comprehensive education and training of all health care workers was implemented to improve hand hygiene compliance. Consumption rates of alcohol-based hand rub and gloves were collected and evaluated.

Results: Of the 5,647 opportunities of hand disinfection evaluated, 1,607 occurred during care for transplant patients. To our knowledge, this is the largest survey of hand hygiene compliance in special patient groups on intensive care units in a university hospital in Germany. Health care workers on surgical intensive care units showed lower hand hygiene compliance compared with health care workers on other types of intensive care units. Compliance toward hand hygiene was significantly higher on hemato-oncologic and pediatric wards. In general, hand disinfection was performed significantly more frequently after an intervention than before (P < .05, 95% confidence interval: 1.24-1.84). Overall, there was no significant difference in hand hygiene compliance when caring for transplant patients or other patients (odds ratio, 1.16; 95% confidence interval: 0.95-1.42). Nurse's and physician's hand hygiene compliance improved because of education.

Conclusion: Hand hygiene compliance is not increased in the care for transplant patients (despite their predisposition for nosocomial infections) compared with other patients. Additional studies will be necessary to further investigate these findings.
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http://dx.doi.org/10.1016/j.ajic.2012.09.009DOI Listing
June 2013

Quantitative contributions of target alteration and decreased drug accumulation to Pseudomonas aeruginosa fluoroquinolone resistance.

Antimicrob Agents Chemother 2013 Mar 28;57(3):1361-8. Epub 2012 Dec 28.

Department of Molecular Bacteriology, Helmholtz Centre for Infection Research, Braunschweig, Germany.

Quinolone antibiotics constitute a clinically successful and widely used class of broad-spectrum antibiotics; however, the emergence and spread of resistance increasingly limits the use of fluoroquinolones in the treatment and management of microbial disease. In this study, we evaluated the quantitative contributions of quinolone target alteration and efflux pump expression to fluoroquinolone resistance in Pseudomonas aeruginosa. We generated isogenic mutations in hot spots of the quinolone resistance-determining regions (QRDRs) of gyrA, gyrB, and parC and inactivated the efflux regulator genes so as to overexpress the corresponding multidrug resistance (MDR) efflux pumps. We then introduced the respective mutations into the reference strain PA14 singly and in various combinations. Whereas the combined inactivation of two efflux regulator-encoding genes did not lead to resistance levels higher than those obtained by inactivation of only one efflux regulator-encoding gene, the combination of mutations leading to increased efflux and target alteration clearly exhibited an additive effect. This combination of target alteration and overexpression of efflux pumps was commonly observed in clinical P. aeruginosa isolates; however, these two mechanisms were frequently found not to be sufficient to explain the level of fluoroquinolone resistance. Our results suggest that there are additional mechanisms, independent of the expression of the MexAB-OprM, MexCD-OprJ, MexEF-OprN, and/or MexXY-OprM efflux pump, that increase ciprofloxacin resistance in isolates with mutations in the QRDRs.
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http://dx.doi.org/10.1128/AAC.01581-12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3591863PMC
March 2013

Individual units rather than entire hospital as the basis for improvement: the example of two Methicillin resistant Staphylococcus aureus cohort studies.

Antimicrob Resist Infect Control 2012 Feb 13;1(1). Epub 2012 Feb 13.

Institute of Hygiene and Environmental Medicine Charité-University Hospital Berlin, Hindenburgdamm 27, 12203 Berlin, Germany.

Unlabelled:

Background: Two MRSA surveillance components exist within the German national nosocomial infection surveillance system KISS: one for the whole hospital (i.e. only hospital based data and no rates for individual units) and one for ICU-based data (rates for each individual ICU). The objective of this study was to analyze which surveillance system (a hospital based or a unit based) leads to a greater decrease in incidence density of nosocomial MRSA METHODS: Two cohort studies of surveillance data were used: Data from a total of 224 hospitals and 359 ICUs in the period from 2004 to 2009. Development over time was described first for both surveillance systems. In a second step only data were analyzed from those hospitals/ICUs with continuous participation for at least four years. Incidence rate ratios (IRR) with 95% confidence intervals were calculated to compare incidence densities between different time intervals.

Results: In the baseline year the mean MRSA incidence density of hospital acquired MRSA cases was 0.25 and the mean incidence density of ICU-acquired MRSA was 1.25 per 1000 patient days. No decrease in hospital-acquired MRSA rates was found in a total of 111 hospitals with continuous participation in the hospital- based system. However, in 159 ICUs with continuous participation in the unit-based system, a significant decrease of 29% in ICU-acquired MRSA was identified.

Conclusions: A unit-based approach of surveillance and feedback seems to be more successful in decreasing nosocomial MRSA rates, compared to a hospital-based approach. Therefore each surveillance system should provide unit-based data to stimulate activities on the unit level.
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http://dx.doi.org/10.1186/2047-2994-1-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3436609PMC
February 2012

Preventing the spread of multidrug-resistant gram-negative pathogens: recommendations of an expert panel of the German Society For Hygiene and Microbiology.

Dtsch Arztebl Int 2012 Jan 20;109(3):39-45. Epub 2012 Jan 20.

Institut für Hygiene, Universitätsklinikum Witten-Herdecke, Campus Köln-Merheim.

Background: Infections with multidrug-resistant gram-negative bacteria are hard to treat and cause high morbidity and mortality. The direct transmission of such pathogens is well documented, and measures to protect other patients would seem indicated. Nonetheless, evidence-based recommendations are not yet available because of insufficient data from clinical trials.

Methods: An expert panel was convened by two sections of the German Society for Hygiene and Microbiology (the permanent committee on general and hospital hygiene and the special committee on infection prevention and antibiotic resistance in hospitals) to review existing data on the epidemiology and diagnostic evaluation of multidrug-resistant gram-negative pathogens. The panel carried out a selective review of the relevant literature, with special attention to national guidelines.

Results And Conclusion: In this paper, the expert panel presents a definition of multidrug-resistant gram-negative pathogens and recommends measures for presenting the spread of infection from colonized and infected patients in non-outbreak situations. These measures depend on the risk profile of the clinical setting. They are mostly to be considered "expert opinion," rather than "evidence-based."
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http://dx.doi.org/10.3238/arztebl.2012.0039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3272589PMC
January 2012

Beliefs about hand hygiene: a survey in medical students in their first clinical year.

Am J Infect Control 2011 Dec;39(10):885-8

Insitute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany.

Medical students were asked regarding knowledge and beliefs on hand hygiene before entering the clinical phase of education. By this, we noticed a lack of knowledge concerning the correct indications for hand disinfection. Regardless of previous experience in hospitals, the medical students expected that the compliance towards hand hygiene would be worse in more experienced physicians and senior consultants--who are often considered to be role models for medical students.
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http://dx.doi.org/10.1016/j.ajic.2010.08.025DOI Listing
December 2011

Antibiotic pretreatment of heart valve prostheses to prevent early prosthetic valve endocarditis.

J Heart Valve Dis 2011 Sep;20(5):582-6

Department of Thoracic, Transplant and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.

Background And Aim Of The Study: Prosthetic valve endocarditis (PVE), a rare but major complication after heart valve replacement surgery, has potentially catastrophic consequences despite maximal treatment. Thus, preventive measures are essential. The study aim was to investigate the effect of pretreating heart valve prostheses with the antibiotics baneomycin and daptomycin, with and without surgical sealant fibrin glue as a drug-releasing substance. The biocompatibility of baneocin and daptomycin was also investigated.

Methods: Samples of polyethylene terephthalate (PTE), as used for the sewing cuffs of prosthetic heart valves, were tested; untreated samples served as controls. All samples were contaminated with Staphylococcus epidermidis, and colony-forming units (CFUs) then counted. Cytotoxicity tests were performed using the MTT-assay to evaluate the effects of baneomycin and daptomycin on cell proliferation and wound healing.

Results: Untreated and fibrin glue-coated samples were directly infected with a bacterial count of 2.82 +/- 0.63 x 10(5) CFU/ml and 2.80 +/- 1.07 x 10(5) CFU/ml, on average. Baneocin-impregnated samples were sterile for 1.9 +/- 0.38 days, with a subsequent bacterial count of 2.26 +/- 0.6 x 10(5) CFU/ml, while daptomycin-impregnated samples were sterile for 2.9 +/- 0.38 days, with a subsequent bacterial count of 1.81 +/- 0.53 x 10(5) CFU/ml. Samples coated with a fibrin glue-baneocin mixture were sterile for 3.14 +/- 0.38 days, after which the bacterial count was 0.74 +/- 0.47 x 10(5) CFU/ml. After coating with a fibrin glue-daptomycin mixture, samples were sterile for 7.0 +/- 0.58 days, and the bacterial count was 0.70 +/- 0.56 x 10(5) CFU/ml.

Conclusion: In this in-vitro study, the pretreatment of prosthetic heart valves with antibiotics reduced the risk of bacterial adhesion and consequent infection. The combination of antibiotics with fibrin glue prolonged this preventive effect, with baneocin demonstrating a better biocompatibility than daptomycin. On the basis of its antibacterial efficacy, daptomycin appears to be a more suitable antibiotic to prevent early PVE with Gram-positive bacteria. The soaking of prosthetic heart valves in antibiotic solutions prior to implantation, in combination with fibrin glue in cases of suspected endocarditis, can prevent the development of early PVE. This preventive strategy should be investigated for use as a standard procedure in clinical practice.
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September 2011

Five-years surveillance of invasive aspergillosis in a university hospital.

BMC Infect Dis 2011 Jun 8;11:163. Epub 2011 Jun 8.

Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Germany.

Background: As the most common invasive fungal infection, invasive aspergillosis (IA) remains a serious complication in immunocompromised patients, leading to increased mortality. Antifungal therapy is expensive and may result in severe adverse effects.The aim of this study was to determine the incidence of invasive aspergillosis (IA) cases in a tertiary care university hospital using a standardized surveillance method.

Methods: All inpatients at our facility were screened for presence of the following parameters: positive microbiological culture, pathologist's diagnosis and antifungal treatment as reported by the hospital pharmacy. Patients fulfilling one or more of these indicators were further reviewed and, if appropriate, classified according to international consensus criteria (EORTC).

Results: 704 patients were positive for at least one of the indicators mentioned above. Applying the EORTC criteria, 214 IA cases were detected, of which 56 were proven, 25 probable and 133 possible. 44 of the 81 (54%) proven and probable cases were considered health-care associated. 37 of the proven/probable IA cases had received solid organ transplantation, an additional 8 had undergone stem cell transplantation, and 10 patients were suffering from some type of malignancy. All the other patients in this group were also suffering from severe organic diseases, required long treatment and experienced several clinical complications. 7 of the 56 proven cases would have been missed without autopsy. After the antimycotic prophylaxis regimen was altered, we noticed a significant decrease (p = 0.0004) of IA during the investigation period (2003-2007).

Conclusion: Solid organ and stem cell transplantation remain important risk factors for IA, but several other types of immunosuppression should also be kept in mind. Clinical diagnosis of IA may be difficult (in this study 13% of all proven cases were diagnosed by autopsy only). Thus, we confirm the importance of IA surveillance in all high-risk patients.
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http://dx.doi.org/10.1186/1471-2334-11-163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3128051PMC
June 2011

Surgical site infections--economic consequences for the health care system.

Langenbecks Arch Surg 2011 Apr 15;396(4):453-9. Epub 2011 Mar 15.

Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, D-30625, Germany.

Purposes: Unfortunately, surgical site infections (SSIs) are a quite common complication and represent one of the major causes of postoperative morbidity and mortality, and may furthermore lead to enormous additional costs for hospitals and health care systems.

Methods: In order to determine the estimated costs due to SSIs, a MEDLINE search was performed to identify articles that provide data on economic aspects of SSIs and compared to findings from a matched case-control study on costs of SSIs after coronary bypass grafting (CABG) in a German tertiary care university hospital.

Results: A total of 14 studies on costs were found. The additional costs of SSI vary between $3,859 (mean) and $40,559 (median). Median costs of a single CABG case in the recently published study were $49,449 (€36,261) vs. $18,218 (€13,356) in controls lacking infection (p < 0.0001). The median reimbursement from health care insurance companies was $36,962 (€27,107) leading to a financial loss of $12,482 (€9,154) each.

Conclusion: Costs of SSIs may almost triple the individual overall health care costs and those additional charges may not be sufficiently covered. Appropriate measures to reduce SSI rates must be taken to improve the patient's safety. This should also diminish costs for health care systems which benefits the entire community.
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http://dx.doi.org/10.1007/s00423-011-0772-0DOI Listing
April 2011

Methicillin-resistant Staphylococcus pseudintermedius among dogs admitted to a small animal hospital.

Vet Microbiol 2011 May 21;150(1-2):191-7. Epub 2010 Dec 21.

Small Animal Clinic, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany.

The aim of this study was to determine the frequency of carriage of methicillin-resistant Staphylococcus pseudintermedius (MRSP) among dogs admitted to a small animal hospital during a 17-month period, to characterize these isolates and to initially screen for possible factors associated with MRSP carriage. Swabs were taken from the nose/pharynx and the perineum as well as from wounds and skin infections (if present) of 814 dogs before entering the small animal hospital. A questionnaire for background information was completed. The staphylococcal species and methicillin resistance were confirmed pheno- and genotypically. The identified MRSP isolates were characterized by SCCmec typing, testing for susceptibility to 25 antimicrobial agents and SmaI-directed pulsed-field gel electrophoresis. A first screening for possible risk factors for MRSP carriage was performed by means of unifactorial contingency tables and CART analysis. Sixty (7.4%) dogs were positive for MRSP. All MRSP isolates harboured a type II-III SCCmec cassette and showed extended resistance to antimicrobial agents. Fifteen different SmaI patterns were observed. The major factors that clustered with MRSP carriage were former hospitalization and antibiotic treatment within the last six months before sampling. This study showed that only a minor part of the sampled dogs carried multi-resistant MRSP isolates. The facts that prior hospitalization and/or antibiotic therapy are potential associated factors for MRSP carriage underline the necessity of a judicious use of antibiotics in small animal medicine.
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http://dx.doi.org/10.1016/j.vetmic.2010.12.018DOI Listing
May 2011

Antibiotics: MRSA prevention measures in German hospitals: results of a survey among hospitals, performed as part of the MRSA-KISS module.

Dtsch Arztebl Int 2010 Sep 17;107(37):631-7. Epub 2010 Sep 17.

Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule Hannover, Hannover, Germany.

Background: In this study, we investigated the measures currently being taken in German hospitals to prevent infection with methicillin-resistant strains of Staphylococcus aureus (MRSA). To this end, we circulated a questionnaire among hospitals participating in the MRSA-KISS module. "KISS" in the name of this project stands for "hospital infection surveillance system" (in German, Krankenhaus-Infektions-Surveillance-System).

Methods: The questionnaire was sent to all MRSA-KISS participants. A study doctor visited a representative sample of hospitals to validate the responses. The study doctor checked the questionnaire responses with a systematic on-site interview of the contact person in each hospital, then evaluated the information contained in them by recording all of the MRSA patients who were present in the hospital on the day of the visit in a point-prevalence study (PPS).

Results: All 134 participants filled out the questionnaire. The screening of patients at risk on admission is an established part of the clinical routine in all of the surveyed hospitals, as are MRSA decolonization procedures. These preventive measures have been recommended for routine use in Germany by the Robert Koch Institute (RKI, the German counterpart of the Centers for Disease Control and Prevention). The surveyed hospitals also used further preventive strategies, including, for example, an alerting system for the identification, upon hospital admission, of patients with a known history of MRSA positivity (72%); pre-admission screening of all patients (13%); universal screening on admission in some hospital wards (19%); and the prophylactic isolation of patients suspected of having MRSA with pending microbiological test results (21%). 35 hospitals were visited for validation. Most of the responses in each hospital were internally consistent and adequately reflected the real situation on site. Less consistency was seen in responses regarding the detection of MRSA by clinical testing and the measures that were taken after MRSA was detected.

Conclusion: The surveyed hospitals are, in fact, implementing many of the RKI's recommendations, as well as other preventive measures against MRSA.
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http://dx.doi.org/10.3238/arztebl.2010.0631DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2956199PMC
September 2010