Can quality circles improve hospital-acquired infection control?

It is a fundamental principle of continuous quality improvement (CQI) that processes should be the objects of quality improvement. The objective of this study was to improve process quality concerning the prevention of hospital-acquired infections in surgical departments and intensive care units by a continuous quality improvement (CQI) approach based mainly on quality circles. This approach was evaluated in a prospective controlled intervention study in medium-size acute care hospitals (four intervention and four control hospitals). During two intervention periods (each 10 months) four external physicians with training in hospital epidemiology and infection control introduced and supervised quality circles in the intervention hospitals. Process quality was assessed by interviewing senior staff members before the first and after the second intervention period using standardized questionnaires. The gold standard process quality was defined on the basis of the CDC/HICPAC-guidelines for the prevention of hospital-acquired infections. Most of the evaluated aspects of process quality belonged to the HICPAC-categories IA and IB respectively, the CDC category I. Fifty quality circle sessions were performed in the four intervention hospitals of which 28 were dealing directly with key subjects in infection control. In the intervention hospitals, 19.8% of evaluated aspects of process quality which concerned the prevention of hospital-acquired infections were improved compared to only 6.9% in the control hospitals (P<0.05). Sixty-six point seven percent of positive changes in process quality were initiated by the results of the quality circles. Our study demonstrates that a CQI approach based on infection control quality circles can lead to a substantial improvement of process quality regarding the prevention of hospital-acquired infections.     

Hygiene in der Praxis

According to the German Protection Against Infection Act, facilities for outpatient surgery are subject to supervise by the Health Authority to monitor hygienic conditions regarding infectious agents. This task is fulfilled by inspecting the practice premises, checking the hygiene plans and records, and advising the practice owner on questions relevant to hygiene. It is important that consideration always be given to ensuring that there are no differences in hygiene adherence between inpatient and outpatient interventions. The recommendations of the Commission on Hospital Hygiene and Infection Prevention of the Robert Koch Institute can be downloaded free of charge from their website. This contribution presents constructional/functional and operational/organizational aspects important for practices offering outpatient surgeries. The article closes with an example of how the Health Authority of Charlottenburg-Wilmersdorf conducts the surveillance of hygiene and infection control.     

Legionellen im Trinkwasserbereich

Although much is known about Legionella and the illness they cause, the relationship between their concentration in water and the risk of infection remains unclear. A comprehensive body of experience shows that the growth of Legionella in heated water distribution systems can be effectively controlled by following the preventive measures described in the generally acknowledged codes of practice. As orientation to trigger action, a technical action level of 100 colony-forming units in 100?ml water has found wide acceptance as the maximally tolerable concentration of Legionella in drinking water hygiene. However, this value as well as the concept for controlling the growth of Legionella in installations has developed historically. In part, the focus differs between drinking water hygiene and hospital hygiene. Also, there is no harmonized European approach for controlling Legionella. In spite of such differences, there are important international parallels in the assessment of the occurrence of Legionella, in experience with controlling them, and in recommendations for prevention. There is a need particularly for adequate studies to clarify the risk of infection as well as for the publication of existing data and experience showing the efficacy of measures for prevention, disinfection and system upgrading. Such data are necessary to support evidence-based prevention of Legionella infections and to create a better epidemiological data base in Germany. One chance for reaching this target would be to improve practices in diagnosis, reporting and central data evaluation-not only of illness, but including also data on Legionella occurrence. More frequent Legionella testing of pneumonia patients is a prerequisite for this, but particularly also for the rapid identification and removal of the source of infection. Further requirements include better training of planers, plumbers, and operators of drinking water installations about the approach to preventing Legionella contamination of drinking water installations described in standards and guidelines. The further development of practicable concepts for effective Legionella prevention requires good collaboration between public authorities responsible for drinking water and hospital hygiene on the federal and state levels and experts for the prevention of infection, hygiene, and sanitary installations.     

Healthcare-associated infections in long-term care facilities (HALT)

The development of infections in elderly people living in long-term care facilities may have manifold causes. Infections are often treated with an antibiotic which can trigger the selection of multirestistant microorganisms and, therefore, represents an additional risk factor. In Germany as well as in other European countries, only a few prevalence studies on healthcare-associated infections (HCAI) in long-term care facilities have been performed and there is no continuous surveillance established for HCAI and antibiotic treatment. Therefore, the European prevalence study HALT (healthcare-associated infections in long-term care) was initiated to collect data of HCAI, antibiotic use, and the antibiotic resistance of microorganisms in long-term care facilities. From Germany, 73 institutions participated in the HALT project. The overall prevalence for an optional HCAI (at least one symptom) was 1.6 (CI 1.09-2.03) and for HCAI identified by the modified McGeer criteria 0.79 (CI 0.62-1.04). The overall prevalence for antibiotic use was 1.15 (CI 0.73-1.57). In the present paper, the German results of the HALT project are presented.     

Hygiene in der Praxis

Trauma und Berufskrankheit - Einrichtungen zum ambulanten Operieren unterliegen laut Infektionsschutzgesetz (IfSG) der infektionshygienischen Überwachung durch das Gesundheitsamt. Dieses kommt...     

Where to Look Next? Combining Static and Dynamic Proto-objects in a TVA-based Model of Visual Attention

To decide “Where to look next ?” is a central function of the attention system of humans, animals and robots. Control of attention depends on three factors, that is, low-level static and dynamic visual features of the environment (bottom-up), medium-level visual features of proto-objects and the task (top-down). We present a novel integrated computational model that includes all these factors in a coherent architecture based on findings and constraints from the primate visual system. The model combines spatially inhomogeneous processing of static features, spatio-temporal motion features and task-dependent priority control in the form of the first computational implementation of saliency computation as specified by the “Theory of Visual Attention” (TVA, [7]). Importantly, static and dynamic processing streams are fused at the level of visual proto-objects, that is, ellipsoidal visual units that have the additional medium-level features of position, size, shape and orientation of the principal axis. Proto-objects serve as input to the TVA process that combines top-down and bottom-up information for computing attentional priorities so that relatively complex search tasks can be implemented. To this end, separately computed static and dynamic proto-objects are filtered and subsequently merged into one combined map of proto-objects. For each proto-object, attentional priorities in the form of attentional weights are computed according to TVA. The target of the next saccade is the center of gravity of the proto-object with the highest weight according to the task. We illustrate the approach by applying it to several real world image sequences and show that it is robust to parameter variations.