Research for infection protection

Abstract: Quality over quantity: Greater patient protection through optimised working processes.
Intervention study at the University Medical Center Hamburg-Eppendorf (UKE), Germany.

Since 2006, WHO has established its “5 Moments for Hand Hygiene” through national campaigns, for example the “Aktion Saubere Hände” (Clean Hands Campaign) in Germany. The objective is to increase hand disinfection compliance in the situations that involve a concrete risk of pathogen transmission.

However, this is not only about a general increase in hand disinfection rates: hand disinfection should only be performed when it is reasonable in terms of patient protection, i.e. in moments that hold the risk of pathogens being spread.

Recent compliance research suggests that it is difficult for healthcare workers to identify the right moments for hand disinfection directly during nursing or medical activities. Additionally, many of these activities comprise further steps that involve the risk of infection and thus also require appropriate hygiene behaviour.

The basis of the BODE SCIENCE CENTER’s intervention study is the assumption that medical or nursing measures do not adequately consider all steps that involve a risk of infection and should be optimised, for healthcare workers to carry them out easier and safer.

Together with the UKE, the researchers identified the operating procedure for one of the most frequent activities in hospital patients – placing a peripheral venous catheter – that is considered optimal from an infection control point of view. This procedure comprised five steps that involved the risk of infection.

The objective of the study was to improve the patient safety by an increased process compliance during all hygiene-relevant steps, including hand disinfection.

From November 2012 to March 2013, the intervention study was carried out in four specialist departments and comprised three phases: first, the authors developed an ideal procedure based on national and international evidence-based recommendations. The actual intervention included training sessions, dummy training, illustrations of the steps on tray stickers, an e-learning module, and direct individual feedback when mistakes were observed. During the observation phase, 207 catheter insertions were observed and documented, during the intervention phase 202.

After the intervention, a significant increase in the compliance was observed for four of the five steps. Compliance with hand disinfection before catheter insertion, for instance rose by 45 %. Adherence to all steps relevant to infection increased from 0 % to 22 %. And 100 % of the employees, who performed all individual steps, adhered to the right order. Almost all employees considered the intervention as positive or neutral.

Optimal procedures for medical and nursing activities that take into account all hygiene-relevant steps enhance the compliance and hygiene safety significantly. Thus, the rate of nosocomial infection, for example of bloodstream infection can be further reduced.

Speech by Prof. Dr. med Günter Kampf, Member of the Medical Faculty, University of Greifswald, Germany. Lunchtime Symposium: Simple Processes – Improved Hygiene. New research results to protect patients in daily hospital routine, Berlin, Germany, 19 September 2013, arranged by the BODE SCIENCE CENTER, Hamburg, Germany, scientific centre of excellence of PAUL HARTMANN AG, Heidenheim, Germany.