Surgical site infections (SSIs) place a significant burden on healthcare systems worldwide. Although surveillance is crucial for obtaining accurate data and developing effective prevention strategies, there are still significant gaps due to the frequent reliance on manual and resource-intensive processes. To gain efficient, in-depth insight, we developed an algorithm for semi-Automated Retrospective Surveillance of Surgical Site Infections (sAReS-SSI), which retrospectively identifies SSIs using existing routine hospital data. sAReS-SSI adopts a patient-centric approach to data analysis, using an ICD-10 and OPS catalogue to detect in-house SSIs through temporal linkage to prior in-house surgeries, refining the NWIF algorithm of the German Institute for Quality and Transparency in Healthcare. sAReS-SSI was evaluated against SSIs that were validated through bedside surveillance in three orthopaedic and trauma surgery wards, as published in the HygArzt study. Its performance was also evaluated in comparison with a reconstructed NWIF algorithm, and contextualised using OP-KISS surveillance reports from the German National Reference Center. sAReS-SSI correctly identified 61 of 65 in-house SSIs published in the HygArzt study. Re-analysis of initially false-positive cases revealed 10 additional true in-house SSIs not captured in HygArzt, yielding a sensitivity of 94.7

Background:The German Infection Protection Act and KRINKO recommend nominating one authorized medical specialist in every medical department as an infection prevention link physician (PLP). Detailed evidence on the contribution of PLPs to reducing infection rates is not available in Germany. Aim:The "HygArzt"-study investigated whether, and to what extent, a PLP in orthopaedics/trauma surgery is able to improve hand hygiene adherence (HHA), process steps of dressing change, nosocomial infection (NI) and surgical site infection (SSI) rates by implementing an infection prevention bundle (IPB). Methods:In consideration of a literature review on infection prevention measures in orthopaedics/trauma surgery and existing departmental hygiene standards, supported by the responsible infection control specialist, an IPB was developed by an interdisciplinary team and implemented by a PLP. The effects of IPB on NI, SSI, and HHA were determined in a pre-post study design on three trauma surgery/orthopaedic wards of a university hospital. Findings:In pre-post comparison HHA was significantly increased, and NI rates were reduced significantly. The greatest increase in adherence occurred in the pre-indications "Before touching a patient" (pre: 37.3%; post: 73.0%), "Before clean/aseptic procedure" (pre: 34.2%; post: 75.5%) and "Before surgery" (pre: 9.7%; post: 57.0%). The analysis of NI and SSI rates (NI: p=0.03; SSI: p=0.01; relative risk (RR) of 0.53 in each case) revealed rate reductions. Conclusion:The implementation of an IPB by a PLP led to an optimisation of processes and to a reduction of SSIs and NIs. PLPs seem to have the potential for targeted, group-specific implementation of complex IPBs.

Abstract Background Nosocomial infections (NI) significantly worsen patient outcomes, resulting in higher mortality rates and reduced health-related quality of life. Furthermore, they pose substantial economic strain on healthcare systems and hospitals. For instance, patients with nosocomial infections (NIs) experience prolonged hospital stays compared to those without NIs. These extended stays result in occupied bed-days, leading to opportunity costs for hospitals. This study aimed to estimate the opportunity costs for a German hospital based on hospital stays, daily revenue, and occupancy rates (OCR). Methods We analysed cost data obtained from routine records maintained by the accounting department of a German hospital's surgical and orthopedic units from 2018 to 2019 for the “HygArzt” research project. To ensure balance, we employed genetic matching. We estimated the differences in length of stay (LOS) and daily revenue between patients with and without nosocomial infections (NI) using linear regression. Finally, we calculated the opportunity cost borne by the hospital by treating NI patients instead of non-NI patients. All costs are reported in 2018 Euros. Results The final sample included 81 patients with NI matched with 207 patients without NI. The majority of the NI patients (77.0%) had surgical site infection (SSI). Compared to non-NI patients, we observed that NI patients had a longer LOS (10 days, p < 0.001) and lower daily revenue (€400, p < 0.001). We also found that comorbidities and the frequency of operations had significant impact on the LOS. Using a baseline 30 to 50% preventable NIs, successful prevention of a single NI could potentially reduce the length of hospital stay by 3 to 5 days and increase hospital revenue by approximately €120 to €200 per day per prevented NI. Consequently, the hospital saves 3 to 5 more bed-days to backfill and generate more revenue, and/or make more efficient resource allocation by changing bed-capacity and staffing. The resulting opportunity costs can potentially exceed €1,000 per preventable case. Conclusion NIs pose a substantial economic burden for hospitals. From a health economics’ perspective, there are strong economic incentives for hospitals to implement infection control interventions, such as the involvement of a prevention link physician/nurse.

Background Hand disinfection at the correct indications is generally considered to be one of the most important measures in the prevention of nosocomial infections. The COVID-19 pandemic has led to changes in the hygiene behaviour of healthcare workers, including an increased desire for self-protection, which is likely to have led to increased and inappropriate use of gloves as a substitute for hand disinfection. Aim To investigate the effect of glove use on hand hygiene compliance using the WHO Five Moments model. Methods Direct observations were made in one ICU, one IMC and one normal ward in a university hospital over a period of six months. For documentation, the WHO five moments model was extended to include glove use and contamination, and a measure of uncertainty to assess which moments could not be fully observed. Findings A total of 852 hand disinfection indications were observed. Overall compliance for all indications was 63% when uncertain or incomplete observations were included and 68% when only complete observations were considered. Gloves were worn in 32% of cases. The lowest compliance (40%) was observed before aseptic procedures, where gloves were frequently worn (77%) and frequently contaminated (24%). Glove use increased the risk to not perform a hand disinfection before an aseptic procedure (OR 4.97, CI95% 2.24; 12.48). Conclusion As both, indicated and non-indicated glove use influence hand hygiene compliance, observations of hand hygiene compliance should be extended to include observations of glove use. As glove use is frequent and often non-compliant before aseptic procedures, the most important indication for infection prevention, this phenomenon requires immediate attention from researchers and educators. When including incompletely observable hand hygiene moments hand disinfection compliance (HDC) was 5% points lower than HDC obtained by the classical WHO observation model.

AbstractBackground:The “HygArzt” project investigated the effectiveness of hygiene measures introduced by an infection prevention link physician (PLP).Objective:To investigate whether the introduction of a standardized aseptic dressing change concept (ADCC) by a PLP can increase hand hygiene adherence and adherence to specific process steps during an aseptic dressing change (ADC) in a trauma surgery and orthopedic department.Methods:We defined 4 required hand disinfection indications: (1) before the preparation of ADC equipment, (2) immediately before the ADC, (3) before the clean phase, and (4) after the ADC. A process analysis of the preintervention phase (331 ADCs) was used to develop a standardized ADCC. The ADCC was introduced and iteratively adopted during the intervention phase. The effect was evaluated during the postintervention phase (374 ADCs).Results:Hand hygiene adherence was significantly increased by the introduction of the ADCC for all indications: (1) before the preparation of the ADC equipment (from 34% before to 85% after, P <.001), (2) immediately before an ADC (from 32% before to 85% after; P < .001), (3) before the clean phase (from 42% before to 96% after; P < .001), and (4) after an ADC (from 74% before to 99% after; P < .001). Overall hand hygiene adherence was analyzed before the indications for an ADC (from 9.6% before to 74% after; P < .001). The same strategy was applied to the following process parameters: use of a clean work surface, clean withdrawal of equipment from the dressing trolley, and appropriate waste disposal.Conclusions:A PLP sufficiently implemented a standardized concept for aseptic dressing change during an iterative improvement process, which resulted in a significant improvement in hand hygiene and adherence to other specific ADCC process steps.

Introduction: SARS-CoV-2 is mainly transmitted via respiratory ingestion of virus-containing particles. In principle, the likelihood of exposure to infectious particles of any size is increased within a distance of 1-2 m to an infected person. Nurses are particularly at risk of contracting COVID-19 from patients due to the close patient contact and the number of intensive contacts. Objectives: It has not yet been investigated, how long and often nurses are exposed to a close patient contact due to the intensive care during their service. The study aimed to determine the duration and frequency of close patient contacts between nurses and COVID-19 patients during nursing activities. Methods: In the period from 14.12.2020 to 28.02.2021, 12 beds of a COVID-19 pulmonary intensive care unit were equipped with Open Access Bluetooth Low Energy (BLE) transmitters and 12 nurses were equipped with BLE wearables (Clinaris GmbH, Germany) in order to record the frequency and duration of patient contact as well as the distance of nurses to the headboard (face) of the patient bed. For the data evaluation, only the measurement data with at least two directly consecutive (chained) measurement contacts longer than 1 s. and a maximum distance of 1.5 m from the patient's head were considered as relevant. Results: Per eight-hour shift a nurse had an average of 73.6 relevant patient contacts with a mean length of stay of 45.7 s. per contact. The most frequent and longest contacts occurred during the early shift (6:00-14:00 o'clock) with an average number of 87.7 contacts and an average duration of 47.9 s. This was followed by the late shift (14:00- 22:00;85.1 contacts;duration 44.1 s.) and the night shift (22:00-6:00;42.6 contacts;44.6 s.). A nurse was closer than 1.5 m to patients' heads for an average of 60.29 min. per shift. Conclusion: The results show for the first time how many relevant contacts take place when caring for Covid-19 intensive care patients and provide initial indications for assessing the risk of infection in the daily work of intensive care nurses. In general, nurses work approx. 1/8 of their working time closer than 1.5 m to the head area of COVID-19 infected patients and are, directly exposed to SARSCoV- 2 within the typical droplet distance.

Introduction: The mandatory wearing of mouth-nose covers is, in addition to maintaining distance, a central component of the transmission prevention of COVID-19 and is intended to protect potential contact persons from ingesting pathogen-containing material. Objectives: The study examined whether the population's motivation to comply with the oral-nasal coverage requirement was higher immediately after its implementation than in the weeks that followed, as declining coronavirus disease-19 (COVID-19) case rates and the end of the initial lockdown on May 15, 2020, may have led to a decrease in risk awareness and thus noncompliance with the established behavioral rules. Methods: In a covert observational study in mask-required settings (public transportation and retail stores), mask types used and observed mask use errors were recorded over two time periods in a total of 9131 individuals. In addition, the importance of individual mask features, wearing behavior, and reasons for choosing current mouth-to-nose coverage, as well as attitudes toward COVID-19 protective measures, were collected in an online survey. Individuals observed in public and individuals in the online surveys represent two separate cohorts. Results: Over the time (07.05.-13.05.2020/12.06.-08.07.2020), the mask wear adherence increased in from 97.2% to 98.6% (p < 0.001). In addition, a percentage decrease in the number of people without mouth-nose cover (p < 0.001) and an increase in the correct mask application was observed (p = 0.024). In the online survey, 84% of respondents identified comfort/convenience and 81% of respondents identified fit as the most important mask attributes. The reasons for the choice of the mouth-nose cover used were heterogeneous and varied. The respondents stated that they found the wearing of a mouth-nose-covering annoying (57%) but useful (60%), but would not wear a mask if there was no mask obligation or recommendation to wear the masks (67%). Conclusion: Despite improvement, a high frequency of errors (31%) in wearing face masks were still observed, indicating the need for better clarification of the population on the correct wearing of a mask.

INTRODUCTION:The German Commission for Hospital Hygiene and Infection Prevention recommends nominating one authorized medical specialist in every medical department as an infection prevention link physician (PLP). It has been roughly described that a PLP serves as a link between the infection prevention team and the respective clinical departments. No detailed evidence about the contribution made by PLPs to the decrease of infection rates is available in Germany. The "HygArzt" project aims to demonstrate the medical and economic benefits of the implementation of hygiene measures by PLP in trauma surgery/orthopedics. METHODS:A multicenter interventional pre/post cohort study design was chosen. The study will run for a three-year period, including a pre-, post-, and an intervention phase, in four different hospitals, one of which will serve as pilot. A complex intervention containing evidence-based infection control measures will be developed and implemented by a PLP to proof efficacy. After the successful implementation of the preventive measures in the pilot hospital, the concept will be transposed to the three remaining trauma and orthopedic departments to confirm the transferability and generalizability. To enable the PLPs of the non-pilot departments, a subject-specific training program will be developed based on the study results of the pilot hospital and offered to the PLPs. DISCUSSION:Data are intended to provide evidence that and, if so, to which extent the implementation of specific preventive measures by a medical department-specific PLP is possible and results in a reduction of nosocomial infections in orthopedic surgery and traumatology. CONTRIBUTION TO THE LITERATURE:The present study describes a novel complex study design to prove the effectiveness of intervention measures for infection prevention. The study design and newly developed methodological approach could serve as a model for similar studies on infection prevention in the future. For the first time, the presented research project "HygArzt" focuses on the implementation of hygiene measures by an infection prevention link physician (PLP) and investigates whether nosocomial infections, especially surgical site infections, can be reduced by the measures implemented. TRIAL REGISTRATION:German clinical Trials register DRKS-ID:00013,296. Registered on March 5, 2018, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013296.

Die COVID-19 Pandemie hat erhebliche gesellschaftliche Auswirkungen. Die Transmissionsvorbeugung in der Bevölkerung beinhaltet u. a. das Tragen von textilen Mund-Nasen-Bedeckungen. Voraussetzung des Schutzeffekts ist der korrekte Maskeneinsatz, wobei Anwendungsfehler selbst unter medizinischem Fachpersonal beobachtet wurden. In der vorliegenden Arbeit wurde analysiert, welche Masken im öffentlichen Raum als Mund-Nasen-Bedeckung zum Einsatz kamen, ob der Einsatz korrekt erfolgte und welcher Art die beobachteten Anwendungsfehler waren. Es erfolgte eine prospektive Beobachtungsstudie in Bereichen, für die eine textile Mund-Nasen-Bedeckungspflicht nach der Coronaschutzverordnung NRW galt. Zwischen dem 07.05.2020 und 13.05.2020 wurden 2721 Personen in maskenpflichtigen Bereichen beobachtet. Die Gesamtcompliance zu Mund-Nasen-Bedeckungen betrug 97,2%. Am häufigsten kam der chirurgische Mund-Nasen-Schutz (MNS) (44,9%) zum Einsatz, gefolgt von Stoffmasken (39,8%), FFP-Masken (7,1%) sowie Schals (5,4%). Keine Maske trugen 2,8% der Beobachteten. In 30,4% der Fälle wurde die Mund-Nasen-Bedeckung fehlerhaft getragen. Die häufigsten Anwendungsfehler fielen in die Kategorien „Maske unter der Nase getragen“ (41,4%) und „Nasenbügel nicht angepasst“ (20,8%). Der MNS wurden deutlich häufiger fehlerhaft eingesetzt als die übrigen Masken- Typen (p<0,001). In der vorliegenden Untersuchung zeigte sich eine hohe Gesamtcompliance der Bevölkerung von 97% zum Einsatz von Mund-Nasen-Bedeckungen im Rahmen des COVID-19 Pandemie- Managements. Die Masken wurden in 30% der Fälle fehlerhaft genutzt. Hieraus ergibt sich die Notwendigkeit einer gezielten, intensivierten Wissensvermittlung zur Maskenanwendung an die Bevölkerung, die die beobachteten Defizite berücksichtigt.

A correction to this paper has been published: https://doi.org/ 10.1007/s00432-021-03543-4