Aim Quality of life is an essential outcome parameter in geriatric research and presents an important indicator for the evaluation of care treatments. The present study analyses potential impact factors on health-related quality of life (HRQOL) of nursing home residents (NHR) who are in pain. Methods Data came from the cRCT 'PIASMA'. Statistical analyses of 146 respondents were carried out by multiple linear regressions based on the EQ-5D index (Euroquol Quality of Life) as dependent variable. Potential impact factors were applied and categorised in five blocks: pain intensity and interference (according to the Brief Pain Inventory), intervention effect, sex and age, pain-related diagnoses, and scales regarding depressive symptoms and cognitive impairment (based on the Geriatric Depression Scale and the Mini-Mental State Examination). Results On average, residents showed a pain intensity of 18.49, a pain interference of 29.61, a MMSE score of 22.84, a GDS score of 5.65 and an EQ-5D index of 0.52. Residents with more diagnoses, more depressive symptoms, and a higher pain interference showed a significantly reduced HRQOL. Conclusion Findings underline the importance of identifying and applying treatment options for both pain (especially interference) and depressive disorders to maintain HRQOL of NHR.

Purpose: Pain management in nursing homes is challenging and pain prevalence remains high. The objective of this study was to improve the pain situation of nursing home residents following a nursing-related educational intervention within a cluster-randomized controlled trial (2016-2018). Participants: Clusters were nursing homes from one nursing home operator in Bavaria, Germany. Nursing home residents who were permanently registered in the facilities, at least 60 years of age, and who themselves or their legal guardians provided informed consent were included. Intervention: In addition to the implementation of pain nurses and pain care assistants, staff of the intervention group received an educational intervention in pain management, containing classroom (quality circles) and web-based training for nurses. Methods: Based on the Mini-Mental State Examination (MMSE), residents were either interviewed (MMSE 10-30) using self-report instruments or observed (MMSE 0-9) by proxy assessment. The primary outcome in residents able to self-report was maximum pain intensity according to Brief Pain Inventory (BPI); in those not able to self-report treatmentrelevant pain above cutoff (≥2) on the Pain Assessment in Advanced Dementia (PAINAD). Results: Out of 20 randomly selected clusters, 9 nursing homes from the control, and 6 nursing homes from the intervention group participated. Multilevel linear (n=347 residents, MMSE 10-30) and logistic regression (n=222 residents, MMSE 0-9) analyses were conducted. Maximum pain intensity was higher after intervention (B=1.32, p<0.01), decreased with a better quality of life (B=−0.07, p<0.001), and was lower when dementia diagnoses were present (B=−1.12, p<0.01). PAINAD scores before and after intervention did not differ significantly (OR=0.89, p=0.724), but chances to exhibit treatment-related pain were higher with decreasing MMSE (OR=0.94, p<0.05). Conclusion: While no significant positive intervention effect was measured, findings suggest nurses' raised awareness towards pain management. Overall results indicate that large-scale educational interventions seem to be less effective in complex nursing home settings without also including specific individual-based intervention measures.

Background Evidence and recommendations for hygiene management in home mechanical ventilation (HMV) are rare. In Germany, few regionally limited studies show poor hygiene management or a lack of its implementation. This scoping review of international literature identified the evidence in hygiene management for ventilated patients in the home care setting which has to be implemented for infection prevention and control. Methods A review of international literature was conducted in CINAHL, PubMed and Web of Science. The search focused on four key domains: HMV, hygiene management, home care setting, and methicillin-resistant Staphylococcus aureus (MRSA). Data of included studies were extracted using a data charting sheet. Extracted data were assigned to the categories (1) study description, (2) setting and participants, and (3) hygiene management. Results From 1,718 reviewed articles, n = 8 studies met inclusion criteria. All included studies had a quantitative study design. The approaches were heterogeneous due to different settings, study populations and types of ventilation performed. Regarding aspects of hygiene management, most evidence was found for infectious critical activities (n = 5), quality management for hygiene (n = 4), and training and education (n = 4). This review identified research gaps concerning kitchen hygiene, relatives and visitors of HMV patients, and waste management (n = 0). Discussion Overall evidence was rather scarce. Consequently, this review could not answer all underlying research questions. No evidence was found for measures in hygiene management relating to ventilated patients’ relatives. Evidence for kitchen hygiene, waste management and interaction with relatives is available for inpatient care settings. However, this may not be transferable to outpatient care. Binding legal requirements and audits may help regulate the implementation of HMV hygiene measures. Conclusion Infection control programmes included qualified personnel, hygiene plans, and standards for MRSA and multidrug-resistant organisms (MDRO). The appropriateness of hygiene management measures for outpatient care is the basis for their application in practice.

Zusammenfassung Hintergrund Das Thema Wissen zu Hygiene und Hygienemanagement von Pflegefachkräften in der außerklinischen Intensivpflege zeigt sich in der Literatur als unterrepräsentiert. Gleichzeitig spielt das Hygienemanagement in der außerklinischen Intensivpflege eine wichtige Rolle. Ziel der Arbeit Die Studie untersucht den von den Pflegefachkräften selbst eingeschätzten Wissensstand zum Thema Hygiene und Infektionen bei Menschen mit Beatmungsbedarf, den Einfluss personenbezogener Charakteristika sowie Setting- und Klient*innenbezogene Herausforderungen und Informationsbedarfe im außerklinischen Pflegealltag. Methode Eine standardisierte Befragung von Pflegefachkräften fand online und papierbasiert statt. Die Analyse erfolgte deskriptiv und mittels multipler linearer Regressionen. Ergebnisse Die Ergebnisse machen deutlich, dass der Wissensstand zu hygienespezifischen Themen von den Pflegefachkräften selbst zwischen sehr gut und gut eingeschätzt wird. Je mehr Fort- und Weiterbildungen eine Person hat, desto besser wird das subjektive Wissen zu Personalhygiene, medizinisch-pflegerischen Maßnahmen und Infektionsinterventionen eingeschätzt. Als die drei häufigsten Herausforderungen im Pflegealltag nennen Pflegefachkräfte Kommunikation und Abstimmung mit Angehörigen, die Versorgung von Klient*innen mit multiresistenter Keimbesiedelung und die Verfügbarkeit von Materialressourcen. Schlussfolgerung Die Ergebnisse zeigen die Relevanz von Fortbildungen für Pflegefachkräfte im Bereich des Hygienemanagements. Setting-spezifische Angebote sollten daher entwickelt, adaptiert und umgesetzt werden.

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