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

Abstract

BackgroundNosocomial 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/designHARMONIC 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.DiscussionThe 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.

Susceptibility of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) to chlorhexidine digluconate, octenidine dihydrochloride, polyhexanide, PVP-iodine and triclosan in comparison to hospital-acquired MRSA (HA-MRSA) and community-aquired MRSA (CA-MRSA): a standardized comparison

“…Strains were drawn from the national collection of the Robert Koch-Institute (RKI) to represent a broad spectrum of strains from different hosts that are prevalent in Germany, and from a collection of regional strains from northeastern Germany (HICARE Study) (Table 1) [23]. Methicillin-sensitive Staphylococcus aureus (MSSA) ATCC 6538 was used as the reference strain.…”

Pharmacist-led education-based antimicrobial stewardship interventions and their effect on antimicrobial use in hospital inpatients: a systematic review and narrative synthesis

“…A study reported significant inter-hospital variations in length of stay due to infections, and a shorter stay was found in hospitals with good hygiene [89]. Good hospital hygiene management reduces microbial colonisation and thus reduces the risk of hospital-acquired infections caused by multi-drug resistant organisms, which are the most common complication during inpatient hospital care [90]. For patient factors, hospitalised patients are more likely to be elderly, severely ill, and have more comorbidities and these were also found to be constituents with prolonged length of stay [91].…”

Reimbursement for Hospital-acquired Infections with Multidrug Resistant Organisms in German DRG System

“…The evaluation was integrated in HARMONIC (Harmonized Approach to avert Multidrug-resistant Organisms and Nosocomial Infections), an 2-years investigation study (2012-2014) of the implementation of a standardized MDRO-hygienic management in six acute care hospitals in the "Health Region Baltic Sea Coast" in Mecklenburg-Western-Pomerania in Northeast Germany. The detailed study protocol has been published elsewhere (Gerlich et al, 2015).…”