Händedesinfektionsverhalten in deutschen Krankenhäusern. Eine Analyse von Surveillance-Daten

In deutschen Krankenhäusern werden im Rahmen der nationalen Interventionskampagne "Aktion Saubere Hände" (ASH) seit 2008 Daten zum Händedesinfektionsverhalten in der Patientenversorgung erfasst. Um das erklärte Kampagnenziel, die Verbesserung der Compliance der Händedesinfektion und die Erhöhung der Patientensicherheit, zu verfolgen, werden mithilfe der Surveillance-Daten Benchmarks ermittelt und die Daten jährlich ausgewertet. Die vorliegende Arbeit soll auf einen Überblick über den aktuellen Stand des Händedesinfektionsverhaltens und die Entwicklung des Händedesinfektionsmittelverbrauchs (HDMV) im Langzeitverlauf geben. Es wurden Referenzdaten des Krankenhaus-Infektions-Surveillance-Systems KISS und aus der Beobachtung zur Bestimmung der Compliance der Händedesinfektion zusammengefasst, stratifiziert, verglichen und statistisch analysiert. Für 2014 wurde im gesamten Jahresverlauf die Rate der Händedesinfektions-Compliance betrachtet und das Benchmarking des HDMV nach Beatmungsraten auf Intensivstationen getestet. Weiterhin wurde die Entwicklung des HDMV von 2007 bis 2015 untersucht. 2014 lag der Median für die Händedesinfektions-Compliance auf Intensivstationen mit 74% minimal über dem auf Normalstationen (72%). Ebenfalls für 2014 konnte eine positive Korrelation des HDMV und der Beatmungsrate auf Intensivstationen festgestellt werden. Von 2007 bis 2015 hat sich der Gesamtverbrauch an Händedesinfektionsmittel fast verdoppelt. Auf allen Ebenen und in allen Quartilen wurde im Vergleich zum Ausgangswert der Datenerhebung (2007) im Verlauf von 9 Jahren ein signifikanter Anstieg gemessen. Das Händedesinfektionsverhalten in deutschen Krankenhäusern hat sich seit 2007 verbessert. In bestimmten Bereichen der Patientenversorgung ist die Compliance mit den geltenden Hygieneleitlinien jedoch stärker ausgeprägt als in anderen. Durch die Evaluation der Surveillance-Daten werden Erfolge und Schwachstellen deutlich, an denen sich die weiterführende Optimierung des Händedesinfektionsverhaltens zukünftig ausrichten kann. Das gilt sowohl für das Management jedes einzelnen Krankenhauses als auch für gesundheitspolitische Entscheidungen auf nationaler Ebene.Introduction: In the German intervention campaign "Action Clean Hands" (ASH), data on the hand disinfection behavior in patient care have been recorded since 2008 in German hospitals. In order to pursue the stated campaign goal of improved hand disinfection compliance and increased patient safety, benchmarks are determined from the surveillance data and data are evaluated annually. The intention of this paper is to provide an overview of the current state of hand disinfection behavior and the development of disinfectant consumption in the long term at the national level. Methods: Reference data of the hospital infection surveillance system KISS and from direct observation were summarized, stratified, compared and statistically analyzed. For the year 2014, the rate of hand disinfection compliance was determined. Benchmarking of alcohol-based hand-rub consumption (AHRC) according to ventilator utilization ratio in intensive care was tested. In addition, AHRC was analyzed from 2007 to 2015. Results: In 2014, the median for hand disinfection compliance at the intensive care units was 74%, for non-intensive care units it was slightly lower (72%). A positive correlation of the AHCR and the ventilator utilization ratio on intensive care units could be determined. Between 2007 and 2015, the total consumption of hand disinfectants almost doubled. At all levels and in all quartiles of the AHCR at baseline (2007), a significant increase in AHCR was observed over 9 years. Conclusion: Hand disinfection in German hospitals has improved since 2007. However, in certain areas of patient care, compliance with the applicable guidelines is more pronounced than in others. The evaluation of the surveillance data reveals successes and weaknesses, on which the further optimization of the hand disinfection behavior can be based in the future. This is valid for each individual hospital and at the national level

The role of risk communication in public health interventions. An analysis of risk communication for a community quarantine in Germany to curb the SARS-CoV-2 pandemic

Background: Separating ill or possibly infectious people from their healthy community is one of the core principles of non-pharmaceutical interventions. However, there is scarce evidence on how to successfully implement quarantine orders. We investigated a community quarantine for an entire village in Germany (Neustadt am Rennsteig, March 2020) with the aim of better understanding the successful implementation of quarantine measures. Methods: This cross-sectional survey was conducted in Neustadt am Rennsteig six weeks after the end of a 14-day mandatory community quarantine. The sample size consisted of 562 adults (64% of the community), and the response rate was 295 adults, or 52% (33% of the community). Findings: National television was reported as the most important channel of information. Contact with local authorities was very limited, and partners or spouses played a more important role in sharing information. Generally, the self-reported information level was judged to be good (211/289 [73.0%]). The majority of participants (212/289 [73.4%]) approved of the quarantine, and the reported compliance was 217/289 (75.1%). A self-reported higher level of concern as well as a higher level of information correlated positively with both a greater acceptance of quarantine and self-reported compliant behaviour. Interpretation: The community quarantine presented a rare opportunity to investigate a public health intervention for an entire community. In order to improve the implementation of public health interventions, public health risk communication activities should be intensified to increase both the information level (potentially leading to better compliance with community quarantine) and the communication level (to facilitate rapport and trust between public health authorities and their communities). © 2021 Scholz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Challenges to the Fight against Rabies-The Landscape of Policy and Prevention Strategies in Africa.

Nearly 59,000 human deaths worldwide are attributable to rabies annually, of which more than a third occur in Africa. In recent years, progress has been made in both action and collaboration including implementation of surveillance and prevention measures. In this review we assess the scale of surveillance, preventive, and control efforts of canine-transmitted human rabies in African countries. We reviewed literature published from 2014 to 2018, retrieved from electronic databases including MEDLINE, Global Index Medicus, BIOSIS, Science Citation Index, and EMBASE. WHO reports, national disease control program reports, and conference proceedings were also reviewed. The database search was conducted using keywords including rabies, control, and prevention. In forty countries (40/54), some level of rabies control and prevention strategy was available while in fourteen (14/54) countries, no specific national control and prevention strategy for human rabies could be retrieved. Thirty-four (34/54) countries utilized the Stepwise Approach towards Rabies Elimination (SARE) tool to monitor the national rabies control efforts-five of these countries were at the lowest tier (0/5) of the SARE scoring system while no country had achieved the highest score (5/5). High burden countries need to step up the implementation of context specific national rabies control, prevention, and monitoring strategies. As a zoonosis, rabies control and elimination require coordination between human and veterinarian health sectors under the "One Health" umbrella and with national master plans on the prevention and control of neglected tropical diseases ending in 2020, the time to act is now

Extended-Spectrum Beta-Lactamase (ESBL)-Producing <i>Escherichia coli</i> Isolated from Flies in the Urban Center of Berlin, Germany

Background: The monitoring of antimicrobial resistance (AMR) in microorganisms that circulate in the environment is an important topic of scientific research and contributes to the development of action plans to combat the spread of multidrug-resistant (MDR) bacteria. As a synanthropic vector for multiple pathogens and a reservoir for AMR, flies can be used for surveillance. Methods: We collected 163 flies in the inner city of Berlin and examined them for extended-spectrum &#946;-lactamase (ESBL)-producing Escherichia coli genotypically and phenotypically. Results: The prevalence of ESBL-producing E. coli in flies was 12.9%. Almost half (47.6%) of the ESBL-positive samples showed a co-resistance to ciprofloxacin. Resistance to carbapenems or colistin was not detected. The predominant ESBL-type was CTX-M-1, which is associated with wildlife, livestock, and companion animals as a potential major source of transmission of MDR E. coli to flies. Conclusions: This field study confirms the permanent presence of ESBL-producing E. coli in an urban fly population. For continuous monitoring of environmental contamination with multidrug-resistant (MDR) bacteria, flies can be used as indicators without much effort

Public health risk communication through the lens of a quarantined community: Insights from a coronavirus hotspot in Germany.

BackgroundQuarantine is one of the most effective interventions to contain an infectious disease outbreak, yet it is one of the most disruptive. We investigated the quarantine of an entire village to better understand risk communication requirements for groups.MethodsWe conducted a cross-sectional, mixed-methods survey study on a single cohort of adult residents in Neustadt am Rennsteig, Germany, six weeks after the removal of a 14-day mandatory community quarantine. The survey response rate was 33% (289/883 residents).FindingsSurvey participants reported a lack of information on the quarantine implementation process. What authorities communicated was not necessarily what residents desired to know. While inhabitants used social media and telephones to communicate with each other, the official information sources were regional radio, television, newspapers and official websites. Public health authorities did not employ social media communication to engage with their communities. Despite a lack of information, the majority of respondents stated that they had complied with the quarantine and they expressed little sympathy for those who violated the quarantine. After lifting the quarantine, many respondents continued to avoid places where they suspected a significant risk of infection, such as family and friends' homes, doctor's offices and grocery stores.InterpretationThe survey participants utilised existing social networks to disseminate vital information and stabilise its group identity and behaviour (quarantine compliance). The authorities communicated sparsely in a unidirectional, top-down manner, without engaging the community. Despite the lack of official information, the social coherency of the group contributed to considerate and compliant conduct, but participants expressed dissatisfaction with official leadership and asked for more attention.ConclusionPublic health risk communication must engage with communities more effectively. This necessitates a deeper comprehension of groups, their modes of communication and their social needs

Madagascar's EPI vaccine programs: A systematic review uncovering the role of a child's sex and other barriers to vaccination.

Peer reviewed: TrueBACKGROUND: Immunizations are one of the most effective tools a community can use to increase overall health and decrease the burden of vaccine-preventable diseases. Nevertheless, socioeconomic status, geographical location, education, and a child's sex have been identified as contributing to inequities in vaccine uptake in low- and middle-income countries (LMICs). Madagascar follows the World Health Organization's Extended Programme on Immunization (EPI) schedule, yet vaccine distribution remains highly inequitable throughout the country. This systematic review sought to understand the differences in EPI vaccine uptake between boys and girls in Madagascar. METHODS: A systematic literature search was conducted in August 2021 through MEDLINE, the Cochrane Library, Global Index Medicus, and Google Scholar to identify articles reporting sex-disaggregated vaccination rates in Malagasy children. Gray literature was also searched for relevant data. All peer-reviewed articles reporting sex-disaggregated data on childhood immunizations in Madagascar were eligible for inclusion. Risk of bias was assessed using a tool designed for use in systematic reviews. Data extraction was conducted with a pre-defined data extraction tool. Sex-disaggregated data were synthesized to understand the impact of a child's sex on vaccination status. FINDINGS: The systematic search identified 585 articles of which a total of three studies were included in the final data synthesis. One additional publication was included from the gray literature search. Data from included articles were heterogeneous and, overall, indicated similar vaccination rates in boys and girls. Three of the four articles reported slightly higher vaccination rates in girls than in boys. A meta-analysis was not conducted due to the heterogeneity of included data. Six additional barriers to immunization were identified: socioeconomic status, mother's education, geographic location, supply chain issues, father's education, number of children in the household, and media access. INTERPRETATION: The systematic review revealed the scarcity of available sex-stratified immunization data for Malagasy children. The evidence available was limited and heterogeneous, preventing researchers from conclusively confirming or denying differences in vaccine uptake based on sex. The low vaccination rates and additional barriers identified here indicate a need for increased focus on addressing the specific obstacles to vaccination in Madagascar. A more comprehensive assessment of sex-disaggregated vaccination status of Malagasy children and its relationship with such additional obstacles is recommended. Further investigation of potential differences in vaccination status will allow for the effective implementation of strategies to expand vaccine coverage in Madagascar equitably. FUNDING AND REGISTRATION: AH, BT, FM, GN, and RR are supported by a grant from the Bill and Melinda Gates Foundation (grant number: OPP1205877). The review protocol is registered in the Prospective Register of Systematic Reviews (PROSPERO ID: CRD42021265000)

Persistent avoidance of places and people.

BackgroundQuarantine is one of the most effective interventions to contain an infectious disease outbreak, yet it is one of the most disruptive. We investigated the quarantine of an entire village to better understand risk communication requirements for groups.MethodsWe conducted a cross-sectional, mixed-methods survey study on a single cohort of adult residents in Neustadt am Rennsteig, Germany, six weeks after the removal of a 14-day mandatory community quarantine. The survey response rate was 33% (289/883 residents).FindingsSurvey participants reported a lack of information on the quarantine implementation process. What authorities communicated was not necessarily what residents desired to know. While inhabitants used social media and telephones to communicate with each other, the official information sources were regional radio, television, newspapers and official websites. Public health authorities did not employ social media communication to engage with their communities. Despite a lack of information, the majority of respondents stated that they had complied with the quarantine and they expressed little sympathy for those who violated the quarantine. After lifting the quarantine, many respondents continued to avoid places where they suspected a significant risk of infection, such as family and friends’ homes, doctor’s offices and grocery stores.InterpretationThe survey participants utilised existing social networks to disseminate vital information and stabilise its group identity and behaviour (quarantine compliance). The authorities communicated sparsely in a unidirectional, top-down manner, without engaging the community. Despite the lack of official information, the social coherency of the group contributed to considerate and compliant conduct, but participants expressed dissatisfaction with official leadership and asked for more attention.ConclusionPublic health risk communication must engage with communities more effectively. This necessitates a deeper comprehension of groups, their modes of communication and their social needs.</div

Reasons given for quarantine non-compliance.

BackgroundQuarantine is one of the most effective interventions to contain an infectious disease outbreak, yet it is one of the most disruptive. We investigated the quarantine of an entire village to better understand risk communication requirements for groups.MethodsWe conducted a cross-sectional, mixed-methods survey study on a single cohort of adult residents in Neustadt am Rennsteig, Germany, six weeks after the removal of a 14-day mandatory community quarantine. The survey response rate was 33% (289/883 residents).FindingsSurvey participants reported a lack of information on the quarantine implementation process. What authorities communicated was not necessarily what residents desired to know. While inhabitants used social media and telephones to communicate with each other, the official information sources were regional radio, television, newspapers and official websites. Public health authorities did not employ social media communication to engage with their communities. Despite a lack of information, the majority of respondents stated that they had complied with the quarantine and they expressed little sympathy for those who violated the quarantine. After lifting the quarantine, many respondents continued to avoid places where they suspected a significant risk of infection, such as family and friends’ homes, doctor’s offices and grocery stores.InterpretationThe survey participants utilised existing social networks to disseminate vital information and stabilise its group identity and behaviour (quarantine compliance). The authorities communicated sparsely in a unidirectional, top-down manner, without engaging the community. Despite the lack of official information, the social coherency of the group contributed to considerate and compliant conduct, but participants expressed dissatisfaction with official leadership and asked for more attention.ConclusionPublic health risk communication must engage with communities more effectively. This necessitates a deeper comprehension of groups, their modes of communication and their social needs.</div