Open Access

Hannah Guckes

• Hintergrund: Der Rettungsdienst versorgt täglich viele Patient/-innen in unterschiedlichen Umgebungen und ist damit auch potentieller Überträger nosokomialer Infektionen. Zur Händehygiene, als entscheidende Säule der Infektionsprophylaxe, liegen bislang nur wenige Daten aus dem Rettungsdienst vor. Methoden: Prospektive multizentrische Studie mit Fragebogen zur Selbst- und Fremdeinschätzung der Compliance und beeinflussender Faktoren (abgeleitet von der WHO Perception Survey for Health-Care Workers) sowie direkte Compliance-Beobachtung nach WHO-Standard bei Rettungsdienstpersonal zweier Berufsfeuerwehren in Deutschland. Ergebnisse: Es wurden 207 Fragebögen eingereicht und während ca. 66h Beobachtungszeit wurden 674 Händedesinfektionsgelegenheiten protokolliert. Der präventive Effekt der HH wurde allgemein von den Mitarbeitenden anerkannt. Die Selbsteinschätzung (MW: 80%) und beobachtete Compliance-Rate (38%) zeigten eine deutliche Diskrepanz und die Compliance variierte zwischen den verschiedenen Indikationen. Besonders niedrig zeigte sich die Compliance rund um die Durchführung aseptischer Tätigkeiten. Hier zeichnete sich ein geringes Risikobewusstsein für nicht sichtbare Verunreinigungen ab. Hürden für die Umsetzung der Händehygiene stellten vor allem die Vorrangigkeit anderer Maßnahmen, Unterbrechung des Arbeitsablaufes und Zeitmangel dar. Schlussfolgerungen: Die beobachtete Compliance-Rate im Rettungsdienst lag unterhalb der innerklinischen Durchschnittswerte. Insbesondere die Compliance im Rahmen aseptischer Tätigkeiten muss dringend gesteigert werden. Dies erfordert einen multimodalen Lösungsansatz, der die Optimierung der Ausbildung, Algorithmen, Materialverfügbarkeit und Praktikabilität der Händedesinfektion im Rettungsdienst beinhaltet.
• The emergency medical services offer quick and efficient treatment and make contribution to the patient’s outcome. The implementation of hand disinfection in accordance with the indications is essential to the prevention of nosocomial infections. In contrast to the situation in hospitals, only limited data are available on compliance in paramedic led health-care. The present study allowed for the first time to examine the compliance of hand hygiene in the German emergency service in a multidimensional way. The study combined an analysis of questionnaires and direct compliance observation as well as comparing self- and external assessments. A total of 207 questionnaires were evaluated and 674 hand disinfection opportunities were documented during 91 operations with an observation period of approximately 66 hours. Believing in the effectiveness of hand hygiene for infection prevention ensures the intention to perform good hand hygiene as a prerequisite for compliance. Employees are familiar with the various indications to perform hand disinfection; However, uncertainty remains on how certain activities during patient care can be sorted into the five categories. This lead to strongly varying compliance rate depending on the indication. At 38%, the compliance rate for hand hygiene in the emergency service was well below the average for the clinical healthcare sector. Low compliance rate before performing “aseptic activities” (7%) and “after contact with potentially infectious material” (12%) was found a major problem, as these indications are essential to infection prevention. In addition, the results of the personnel’s self-assessment and compliance rate found in the obvservation were significantly different, indicating a low risk awareness. Both the general availability of hand disinfectants at the point-of-care and the use of existing resources are suboptimal. During the rescue mission, 96% of the employees used the disinfectant in the patient’s cabin, 32% from the emergency backpack and only 15% used wearable dispensers. By contrast, an extra pair of gloves was carried by 77% of the employees. During patient care a hand disinfection should take place approximately every 2.5 minutes. The main problems for the implementation of hand hygiene are the priority of other measures in patient care, disruption of the workflow due to hand disinfection and lack of time. In order to improve the conditions for carrying out hand hygiene, hand disinfectants should be available quickly and easily at the point-of-care by providing bottles for pocket carriage. In addition, glove disinfection should be considered as a time-saving and practicable solution for infection prevention in the rescue service. Staff should be taught the purpose of hand disinfection during different activities in order to improve their understanding of chains of infection. It would also be useful to conduct further studies to check whether the pre-clinical setting can deviate from the five indications according to WHO, since limiting the indications, dividing the work and disinfection at the end of each mission could also ensure good patient safety. Improving compliance requires a multimodal approach that includes optimizing training, algorithms, material availability and practicality of hand disinfection in the rescue service.