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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*
Affiliation:
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
Affiliation:
TU Dortmund, Center for Statistical Consulting and Analysis, Dortmund, Germany
Frauke Mattner
Affiliation:
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
Affiliation:
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: neuwirthm@kliniken-koeln.de

Abstract

Background:

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.

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

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