[Patient safety: The use of guidelines for dealing with multidrug resistant pathogens in outpatient care]

Due to an increasing number of care recipients with severe and multiple illnesses and their increased risk of infections, the importance of hygiene has grown steadily over the past years. In home care settings, we are increasingly faced with multidrug-resistant pathogens, resulting in new requirements for a sufficient ambulatory hygiene management. As there are only few study results relating to the prevalence and implementation of a standardized ambulatory hygiene management, our study aims to explore the extent to which both fixed MRSA decolonization measures and instructions for the handling of specific pathogens are available to care staff and whether MRSA management is documented. Finally, it was examined whether this is influenced by professional experience, qualification, working hours and hygiene trainings for care staff.

In the winter of 2016/17 a cross-sectional survey was conducted among the employees of home care services in Germany. The aim was to survey 10 employees of 10 services in each federal state. Being aware of the difficulties of this kind of study, we expected a response rate of 50 per cent. It was intended to show correlations between the existence of fixed MRSA decolonization protocols, the documentation of MRSA decolonization treatments as well as handling instructions for specific pathogens and independent variables such as professional experience in years, qualification, trainings, working hours and care patients per shift.

A total of 107 home care services participated in the study, with 656 care workers returning completed questionnaires. The results showed statistically significant differences between hygiene trainings conducted within the last 12 months and those having taken place more than a year ago. As a general principle, there was more awareness of the existence of fixed MRSA remediation protocols, procedures for handling specific pathogens, and logging of MRSA remediation when staff hygiene training had been conducted within the past 12 months.

In the light of demographic changes and the associated increase in the number of multi-morbid, chronically ill patients in need of care, adequate hygiene management should be implemented in a standardized, comprehensive manner. This includes annual trainings as well as a standardized application of hygiene procedures.