Programmpunkt

Titel: Standardized observations to identify non-adherent hand hygiene compliance during the dressing change process in a pre-intervention phase of a planned intervention study
ID: 248/PRP
Art: Abstractautor
Session: P2
Antimicrobial Resistence and Drugs, Infection Prevention (FG PR)

Referent: Meike Strybos (Köln)


Abstract - Text

Introduction
The project "HygArzt" (ZMVI1-2516FSB111), funded by the Federal Ministry of Health (BMG), intends to reduce the infection rate of nosocomial infections, especially postoperative wound infections, in the long term by introducing evidence-based infection prevention measures. In the pre-intervention phase, hygiene-relevant processes in orthopedics and trauma surgery were examined. The dressing change is an essential hygiene-relevant process to avoid nosocomial postoperative wound infections. During the process, non-disinfected hands of clinical staff are the most important carrier of pathogens to the patient. To identify hygiene-relevant deviations, the dressing changes were examined more closely by standardized observations.

Methods
In the pre-intervention phase of the study, 337 dressing changes were observed on three orthopedics and trauma surgery normal wards as part of the morning visit and morning patient care. A checklist with 26 items was compiled for this purpose. Particular attention was paid to hand hygiene compliance before and after the dressing change as well as to the transition between the impure and pure phase of the dressing change.

Results
A total of 1348 indications for hand hygiene during dressing changes were observed during the rounds and during normal ward routine. With 80%, the highest total compliance rate was, as expected, at hand disinfection after dressing change (ASH indication after contact with potentially infectious material). A value of 63% could be determined for the compliance rate before the start of dressing change. This is composed of the indication before the start of dressing change (ASH indication before aseptic activity) with a compliance of 36% and the indication immediately before the start of dressing change with a compliance of 14%. The total compliance of 63% has a higher value than the two individual indications, since persons who performed both hand disinfections correctly were additionally considered. The lowest compliance rate (42%) could be determined between impure and pure phase of the dressing change. Based on this data, the pre-indications and the transition between pure and impure phase could be identified as problem areas. The most frequently observed errors were incorrect storage of sterile dressing materials, incorrect disposal of dressing waste.

Summary
Through the observations in the pre-intervention phase, the largest non-adherencies in the dressing change process could be identified. Based on these findings, a new dressing change concept was developed, which will be implemented in the following intervention phase of the HygArzt study.