Pan European Networks - Horizon 2020 - page 188

The results of this demonstrated a large variation
at baseline, but overtime “there was a significant
decrease, which was a reduction from 2.4 per
1,000 catheter-days to 0.9 per 1,000 catheter-
days, which was highly significant”.
Zingg added that an increase in the use of hand
hygiene was also observed. Though there was
progress, such statistics did not constitute a major
improvement, he said, but they are an indication
of “what you can achieve if you have a well-
established hand hygiene promotion strategy”.
Implementation obstacles
Zingg then delivered an outline to the fourth and
final work package, ‘Qualitative study about
barriers and facilitators in the implementation
process’, as noted in his onscreen presentation.
The speaker drew attention to the project
undertaking interviews and observations in six
hospitals that were investigated as part of the
third work package before and during the
multimodal intervention. The aim was to define
what factors were “contributing to the success
or failure”, yet the Zingg said the conclusion
was that there was “success in all the hospitals
– there was no failure”.
He added: “We identified staff issues as a
theme that was brought up; staffing shortage
was common in infection control, and this was
really a challenge of most hospitals.
“High staff turnover was considered basically a
barrier, because it needed retraining of staff. On
the other hand, we also saw that when you
have young teams emerging in hospitals, this
can be a positive factor as well, because those
young teams are often more open to change
and innovation.
“What we also saw specifically in eastern
European countries was that nurses’ salaries
are generally very low; for instance, in one
country wages were lower than a cashier in a
supermarket for an ICU (intensive care unit)
nurse doing shifts. What we also perceived is
an emigration to western Europe – there is a
true brain drain of well-trained nurses and
physicians,” Zingg continued.
“Resources: this theme, of course, was
omnipresent and almost always referred to as
a barrier to implementation. We also saw that
some resource problems in some of the
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This recommendation was made by “an American landmark study which
was published in 1985, which is 30 years ago, with numbers coming
from the 1970s”. Zingg described this as “a little bit outdated, but at
least there is some hope”.
“Most hospitals defined infection control objectives, which is the good
news. Most of those objectives addressed hand hygiene, some have
reduction of healthcare-associated infections, which was not further
specified, and not so many hospitals have established antibiotic
stewardship as one of their IPC (Organisation of Infection Prevention and
Control) objectives.
“We also asked about the use of alcohol-based hand rub and we have
identified similar numbers … to those established by ECDC PPSs.”
Zingg told delegates that the project’s findings indicated a lack of the
use of hand rub when considering the number of patients who saw
interaction with medical practitioners between hand rub applications.
The project co-ordinator commented that “there are some major
improvements to be done”.
Attention was then turned to how much money was spent on hand rub:
“Countries spending more than the European average of 6.5% of their
GDP on healthcare had significantly higher consumption of hand rub.
Those countries also … more often provided hand rub at the point
of care.”
Catheter infections
The PROHIBIT project also assessed ‘Multimodal intervention for CRBSI
(catheter-related bloodstream infections) reduction in different
socioeconomic contexts’, according to the presentation slides, and Zingg
detailed this third work package: “We had this intervention study in which
14 hospitals participated. It was a randomised stepped-wedge designed
trial about the prevention of central venous CRBSI …using hand hygiene
alone, a catheter ‘bundle’, or a combination of the two.”
The project undertook
a review of hospital
guidelines in Europe
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