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Standardized aseptic dressing change procedure: Optimizations and adherence in a prospective pre- and postintervention cohort study

Published online by Cambridge University Press:  24 May 2021

Meike M. Neuwirth*
Witten/Herdecke University, Division of Hygiene and Environmental Medicine, Cologne, Germany Institute for Hygiene, Cologne Merheim Medical Centre, University Hospital Witten/Herdecke Cologne, Germany
Swetlana Herbrandt
TU Dortmund, Center for Statistical Consulting and Analysis, Dortmund, Germany
Frauke Mattner
Witten/Herdecke University, Division of Hygiene and Environmental Medicine, Cologne, Germany Institute for Hygiene, Cologne Merheim Medical Centre, University Hospital Witten/Herdecke Cologne, Germany
Robin Otchwemah
Witten/Herdecke University, Division of Hygiene and Environmental Medicine, Cologne, Germany Institute for Hygiene, Cologne Merheim Medical Centre, University Hospital Witten/Herdecke Cologne, Germany
Author for correspondence: Meike M. Neuwirth, E-mail:



The “HygArzt” project investigated the effectiveness of hygiene measures introduced by an infection prevention link physician (PLP).


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.


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).


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.


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.

Original Article
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Petrosyan, Y, Thavorn, K, Maclure, M, et al. Long-term health outcomes and health system costs associated with surgical site infections: a retrospective cohort study. Ann Surg 2021;273:917923.CrossRefGoogle Scholar
Jenks, PJ, Laurent, M, McQuarry, S, Watkins, R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect 2014;86:2433.CrossRefGoogle ScholarPubMed
Whitehouse, JD, Friedman, ND, Kirkland, KB, Richardson, WJ, Sexton, DJ. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 2002;23:183189.CrossRefGoogle Scholar
Owens, CD, Stoessel, K. Surgical site infections: epidemiology, microbiology, and prevention. J Hosp Infect 2008;70:310.CrossRefGoogle Scholar
Nachtigall, I, Bonsignore, M. Ökonomische Auswirkungen der Hygiene. Krankenhaushygiene up2date 2018;13:419431.Google Scholar
Khodyakov, D, Ridgely, MS, Huang, C, DeBartolo, KO, Sorbero, ME, Schneider, EC. Project JOINTS: what factors affect bundle adoption in a voluntary quality improvement campaign? BMJ Qual Saf 2015;24:3847.CrossRefGoogle Scholar
Schneider, EC, Sorbero, ME, Haas, A, et al. Does a quality improvement campaign accelerate take-up of new evidence? A ten-state cluster-randomized controlled trial of the IHI’s Project JOINTS. Implement Sci 2017;12:51.CrossRefGoogle Scholar
Compliance-Beobachtungen_Referenzdaten_2018.pdf n.d. Aktion Sauberer Hände website. Accessed June 8, 2020.Google Scholar
Berríos-Torres, SI, Umscheid, CA, Bratzler, DW, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 2017;152:784791.CrossRefGoogle ScholarPubMed
Prävention postoperativer Wundinfektionen: Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 2018;61:448473.CrossRefGoogle Scholar
Global guidelines on the prevention of surgical site infection. World Health Organization website. Accessed July 2, 2020.Google Scholar
Allegranzi, B, Sax, H, Pittet, D. Hand hygiene and healthcare system change within multimodal promotion: a narrative review. J Hosp Infect 2013;83 suppl 1:S3S10.CrossRefGoogle Scholar
Willy, C, Rieger, H, Stichling, M. Prävention postoperativer Infektionen. Unfallchirurg 2017;120:472485.CrossRefGoogle Scholar
Behnke, M, Hansen, S, Leistner, R, et al. Nosokomiale Infektionen und Antibiotika-Anwendung. Deutsches Ärzteblatt 2013:627633.Google Scholar
Rüden, H, Gastmeier, P, Daschner, FD, Schumacher, M. Nosocomial and community-acquired infections in Germany: summary of the results of the First National Prevalence Study (NIDEP). Infection 1997;25:199202.CrossRefGoogle Scholar
Damschroder, LJ, Aron, DC, Keith, RE, Kirsh, SR, Alexander, JA, Lowery, JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009;4:50.CrossRefGoogle ScholarPubMed
von Lengerke, T, Lutze, B, Krauth, C, Lange, K, Stahmeyer, TJ, Freya Chaberny, I. Promoting hand hygiene compliance. Dtsch Arztebl Int 2017;114:2936.Google ScholarPubMed
Alefelder, C. Verbandwechsel. Krankenh.hyg up2date 2017;12:399411.Google Scholar
Ferrari, S, Cribari-Neto, F. Beta regression for modelling rates and proportions. J Appl Statist 2004;31:799815.CrossRefGoogle Scholar
Benton, C. Hand hygiene-meeting the JCAHO safety goal: can compliance with CDC hand hygiene guidelines be improved by a surveillance and educational program? Plast Surg Nurs 2007;27:4044.CrossRefGoogle ScholarPubMed
Maskerine, C, Loeb, M. Improving adherence to hand hygiene among healthcare workers. J Contin Educ Health Prof 2006;26:244–51.CrossRefGoogle Scholar
Naikoba, S, Hayward, A. The effectiveness of interventions aimed at increasing handwashing in healthcare workers—a systematic review. J Hosp Infect 2001;47:173180.CrossRefGoogle ScholarPubMed
Pittet, D. Improving compliance with hand hygiene in hospitals. Infect Control Hosp Epidemiol 2000;21:381386.CrossRefGoogle ScholarPubMed
Chan, BP, Homa, K, Kirkland, KB. Effect of varying the number and location of alcohol-based hand rub dispensers on usage in a general inpatient medical unit. Infect Control Hosp Epidemiol 2013;34:987989.CrossRefGoogle Scholar
Giannitsioti, E, Athanasia, S, Antoniadou, A, et al. Does a bed rail system of alcohol-based handrub antiseptic improve compliance of healthcare workers with hand hygiene? Results from a pilot study. Am J Infect Control 2009;37:160163.CrossRefGoogle ScholarPubMed
Akca, S, Strybos, M, Otchwemah, R, et al. Identification of Adherence Predictors for Effective Implementation of Infection Prevention Measures in Trauma Surgery and Orthopedics. Göttingen, Germany: 2019:49.Google Scholar
Aaltonen, P, Ikävalko, H. Implementing strategies successfully. Integrated Mfg Syst 2002;13:415418.CrossRefGoogle Scholar
Greenhalgh, T, Robert, G, Bate, S, Kyriakidou, O, Macfarlane, F. How to spread good ideas: a systematic review of the literature on diffusion, spread and sustainability of innovations in health service delivery and organisation. National Institute for Health Research website. Accessed July 3, 2020).Google Scholar
Kastner, M, Schmidt, B. Innovative Präventionskonzepte-wirtschaftlicher Arbeitsschutz. Die BG 2011:108–12.Google Scholar
Schon, DA. Champions for radical new inventions. Harv Bus Rev 1963;41.Google Scholar
Mar, che, B, Neuwirth, M, Kugler, C, Bouillon, B, Mattner, F, Otchwemah, R. Systematic review of literature on implementation of infection prevention measures in orthopedics and traumatology. Eur J Trauma Emergency Surg Accepted on August 19, 2020. Google Scholar
Eckmanns, T, Bessert, J, Behnke, M, Gastmeier, P, Ruden, H. Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect. Infect Control Hosp Epidemiol 2006;27:931934.CrossRefGoogle ScholarPubMed
Hagel, S, Reischke, J, Kesselmeier, M, et al. Quantifying the Hawthorne effect in hand hygiene compliance through comparing direct observation with automated hand hygiene monitoring. Infect Control Hosp Epidemiol 2015;36:957962.CrossRefGoogle ScholarPubMed
Campbell, DJ. Task complexity: a review and analysis. Acad Manag Rev 1988;13:4052.CrossRefGoogle Scholar
Liu, P, Li, Z. Toward understanding the relationship between task complexity and task performance. In: Rau, PLP, editor. Internationalization, Design and Global Development. Berlin, Heidelberg: Springer; 2011:192200.CrossRefGoogle Scholar
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