Improving hospital hygiene to reduce the impact of multidrug-resistant organisms in health care–a prospective controlled multicenter study

BMC Infectious Diseases

Wolfgang Hoffmann³  Axel Kramer⁴  Steffen Flessa⁶  Walter Ried⁵  Claudia Hübner⁶  Franziska Claus⁵  Ralf Ewert²  Georg Engel¹  Susanne Reuter¹  Florian Wilke⁴  Nils-Olaf Hübner⁴  Christian Schäfer³  Jens Piegsa³  Miriam G. Gerlich³ 

[1] Universitätsapotheke, Ernst-Moritz-Arndt-Universität, Friedrich-Ludwig-Jahn-Straße 20, Greifswald, 17475, Germany;Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin B, Ernst-Moritz-Arndt-Universität, Ferdinand-Sauerbruch-Straße, Greifswald, 17475, Germany;Institut für Community Medicine, Ernst-Moritz-Arndt-Universität, Ellernholzstraße 1-2, Greifswald, 17487, Germany;Institut für Hygiene und Umweltmedizin, Ernst-Moritz-Arndt-Universität, Walter-Rathenau-Straße 49a, Greifswald, 17475, Germany;Lehrstuhl für Allgemeine Volkswirtschaftslehre und Finanzwissenschaft, Ernst-Moritz-Arndt-Universität, Friedrich-Loeffler-Straße 70, Greifswald, 17487, Germany;Lehrstuhl für Allgemeine Betriebswirtschaftslehre und Gesundheitsmanagement, Ernst-Moritz-Arndt-Universität, Friedrich-Loeffler-Straße 70, Greifswald, 17487, Germany

关键词: Health-related quality of life;    Costs;    Hospital hygiene;    Antibiotic use;    MRGN;    VRE;    MRSA;    Multidrug-resistant organisms;    Nosocomial infections;   

Others  :  1232908
DOI  :  10.1186/s12879-015-1184-5

 received in 2014-10-05, accepted in 2015-10-06,  发布年份 2015

【 摘 要 】

Background

Nosocomial infections are the most common complication during inpatient hospital care. An increasing proportion of these infections are caused by multidrug-resistant organisms (MDROs). This report describes an intervention study which was designed to address the practical problems encountered in trying to avoid and treat infections caused by MDROs. The aim of the HARMONIC (Harmonized Approach to avert Multidrug-resistant Organisms and Nosocomial Infections) study is to provide comprehensive support to hospitals in a defined study area in north-east Germany, to meet statutory requirements. To this end, a multimodal system of hygiene management was implemented in the participating hospitals.

Methods/design

HARMONIC is a controlled intervention study conducted in eight acute care hospitals in the ‘Health Region Baltic Sea Coast’ in Germany. The intervention measures include the provision of written recommendations on methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE) and multi-resistant Gram-negative bacteria (MRGN), supplemented by regional recommendations for antibiotic prescriptions. In addition, there is theoretical and practical training of health care workers (HCWs) in the prevention and handling of MDROs, as well as targeted and critically gauged applications of antibiotics.

The main outcomes of the implementation and analysis of the HARMONIC study are: (i) screening rates for MRSA, VRE and MRGN in high-risk patients, (ii) the frequency of MRSA decolonization, (iii) the level of knowledge of HCWs concerning MDROs, and (iv) specific types and amounts of antibiotics used.

The data are predominantly obtained by paper-based questionnaires and documentation sheets. A computer-assisted workflow-based documentation system was developed in order to provide support to the participating facilities. The investigation includes three nested studies on risk profiles of MDROs, health-related quality of life, and cost analysis. A six-month follow-up study investigates the quality of life after discharge, the long-term costs of the treatment of infections caused by MDROs, and the sustainability of MRSA eradication.

Discussion

The aim of this study is to implement and evaluate an area-wide harmonized hygiene program to control the nosocomial spreading of MDROs. Comparability between the intervention and control group is ensured by matching the hospitals according to size (number of discharges per year / number of beds) and level of care (standard or maximum). The results of the study may provide important indications for the implementation of regional MDRO management programs.

【 授权许可】

   
2015 Gerlich et al.

【 图 表 】

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【 参考文献 】

• [1]Report on the burden of endemic health care-associated infection worldwide. WHO, Geneva; 2011.
• [2]Antimicrobial resistance surveillance in Europe 2012. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). ECDC, Stockholm; 2013.
• [3]European Centre for Disease Prevention and Control. Point Prevalence Survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. Stockholm: ECDC; 2013.
• [4]Behnke M, Hansen S, Leistner R, Peña Diaz LA, Gropmann A, Sohr D et al.. Nosocomial infection and antibiotic use: a second national prevalence study in Germany. Dtsch Arztebl Int. 2013; 110(38):627-633.
• [5]Köck R, Becker K, Cookson B, van Gemert-Pijnen JE, Harbarth S, Kluytmans J, et al. (2010). Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe. Euro Surveill 2010, 15 (41); available online:. http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=19688 webcite
• [6]European Centre for Disease Prevention and Control/European Medicines Agency (ECDC/EMEA): Joint technical report: The bacterial challenge: time to react. Stockholm: ECDC/EMEA; 2009; available online:. http://www. ecdc.europa.eu/en/publications/Publications/0909_TER_The_Bacterial_Challenge_Time_to_React.pdf webcite
• [7]Köck R, Mellmann A, Schaumburg F, Friedrich AW, Kipp F, Becker K. The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in Germany. Dtsch Arztebl Int. 2011; 108(45):761-767.
• [8]Meyer E, Schröder C, Gastmeier P, Geffers C. The reduction of nosocomial MRSA infection in Germany — an analysis of data from the Hospital Infection Surveillance System (KISS) between 2007 and 2012. Dtsch Arztebl Int. 2014; 111:331-336.
• [9]Hygienemaßnahmen bei Infektion oder Besiedlung mit multiresistenten gramnegativen Stäbchen. Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention. Bundesgesundheitsbl. 2012; 55:1311-1354.
• [10]Mattner F, Bange FC, Meyer E, Seifert H, Wichelhaus TA, Chaberny IF. 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; 109(3):39-45.
• [11]Meyer E, Schwab F, Schroeren-Boersch B, Gastmeier P. Dramatic increase of third-generation cephalosporin-resistant E. Coli in German intensive care units: secular trends in antibiotic drug use and bacterial resistance, 2001 to 2008. Crit Care. 2010; 14:R113. BioMed Central Full Text
• [12]Gastmeier P. Zur Entwicklung nosokomialer Infektionen im Krankenhausinfektions-Surveillance-System (KISS). Epid Bull. 2011; 5:35-37.
• [13]Vancomycin-resistente Enterokokken (VRE): Aktuelle Daten und Trends zur Resistenzentwicklung aus dem NRZ für Staphylokokken und Enterokokken, 2011–2012. Epid Bull. 2013; 33:1-7.
• [14]Harbath S, Sax H, Gastmeier P. The preventable proportion of nosocomial infections. An overview of published reports. J Hosp Infect. 2003; 54:258-266.
• [15]Sydnor ERM, Perl TM. Hospital epidemiology and Infection control in acute-care settings. Clin Microbiol Rev. 2011; 24(1):141-173.
• [16]Donker T, Wallinga J, Slack R, Grundmann H. Hospital Networks and Dispersal of Hospital Acquired Pathogens by Patient Transfer. PLoS One. 2012; 7:4.
• [17]vom 20. Juli 2000 (BGB l.I S. 1045), das zuletzt durch Artikel 2 Absatz 36 u. Artikel 4 Absatz 21 des Gesetzes vom 7. August 2013 (BGBl. I S. 3154) geändert worden ist. 2013.
• [18]Empfehlung zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in Krankenhäusern und anderen medizinischen Einrichtungen. Bundesgesundheitsbl. 1999; 42:954-958.
• [19]Kommentar zu den “Empfehlungen zur Prävention und Kontrolle von MRSA-Stämmen in Krankenhäusern und anderen medizinischen Einrichtungen”. Hinweise zu Risikopopulationen für die Kolonisation mit MRSA. Epid Bull. 2008; 42:363-364.
• [20]Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in Krankenhäusern und anderen medizinischen Einrichtungen. Bundesgesundheitsbl. 2014; 57(6):695-732.
• [21]Ergänzung zu den “Hygienemaßnahmen bei Infektion oder Besiedlung mit multiresistenten gramnegativen Stäbchen” (2012) im Rahmen der Anpassung an die epidemiologische Situation. Epid Bull. 2014; 21:183-184.
• [22]Korczak D, Schöffmann C. Medical and health economic evaluation of prevention- and control measures related to MRSA infections or–colonisations at hospitals. GMS Health Technol Assess. 2010;6:Doc04. doi:10.3205/hta000082,URN: urn:nbn:de:0183-hta0000821.
• [23]Tübbicke A, Hübner C, Hübner NO, Wegner C, Kramer A, Fleßa S. Cost comparison of MRSA screening and management–a decision tree analysis. BMC Health Serv Res. 2013; 12:438. BioMed Central Full Text
• [24]A guide to the implementation of the WHO Multimodal Hand Hygiene Improvement Strategy. WHO, Geneva; 2009.
• [25]Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A et al.. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf health Care. 2005; 14:26-33.
• [26]French SD, Green SE, O’Connor DA, McKenzie JE, Francis JJ, Michie S et al.. Developing theory-informed behaviour change interventions: a systematic approch using the Theoretical Domains Framework. Implement Sci. 2012; 7(38):1-8.
• [27]Boscart VM, Ferni GR, Lee JH, Jaglal SB. Using psychological theory to inform methods to optimize the implementation of a hand hygiene intervention. Implement Sci. 2012; 7(77):1-12.
• [28]Grimshaw JM, Shirran, Thomas R, Graham M, Fraser C, Bero L et al.. Changing Provider Behavior. An Overview of Systematic Reviews on Interventions. Med Care. 2001; 39(8):S2:II2-45.
• [29]Mueller H, Franke A, Schuck P, Resch KL. A hospital suited version of the German SF-36 and its psychometric comparison with the original questionnaire. Soz Präventivmedizin. 2001; 46(2):96-105.
• [30]Reng M, Debold P, Specker C, Pommerening K. Generische Lösungen zum Datenschutz für die Forschungsnetze in der Medizin, Schriftenreihe der TMF–Bd. 1. MWV Medizinisch Wissenschaftliche Verlagsgesellschaft, Berlin; 2006. report in German
• [31]Pommering K, Ganslandt T, Sax U, Müller T, Drepper J, Speer R, et al. Integrating eHealth and Medical Research: The TMF Data Protection Scheme. In: Blobel B et al., editors. eHealth: Combining Health Telematics, Telemedicine, Biomedical Engineering and Bioinformatics to the Edge. Aka, Berlin. 2008. p. 5–10.
• [32]Zum Aufwand von MRSA-Screeninguntersuchungen in deutschen Krankenhäusern. Epid Bull. 2013; 5:41-44.
• [33]Robert Koch-Institut. Zum Umgang mit MRSA-Patienten in deutschen Krankenhäusern. Epid Bull. 2011;15:119-121. (article in German)
• [34]Wegner C, Hübner NO, Gleich S, Thalmaier U, Krüger CM, Kramer A. One day point prevalence of emerging bacterial pathogens in a nationwide sample of 62 German hospitals in 2012 and comparison with the results of the one-day point prevalence of 2010. GMS Hygiene Infection Control. 2013; 8(1)):Doc12.
• [35]Kramer A, Ryll S, Wegner C, Jatzwauk L, Popp W, Hübner NO. One-day point prevalence of emerging bacterial pathogens in four secondary and five tertiary care German hospitals–results from a pilot study of the German Society for Hospital Hygiene. GMS Krankenhaushygiene Interdisziplinär. 2011; 6(1):Doc20.
• [36]Balm MND, Lover AA, Salmon S, Tambyah PA, Fisher DA. Progression from new methicillin-resistant Staphylococcus aureus colonisation to infection: an observational study in a hospital cohort. BMC Infect Dis. 2013;13:491.