Heudorf U, Gasteyer S, Samoiski Y, Voigt K
Abteilung Medizinische Dienste und Hygiene, Amt für Gesundheit, Breite Gasse 28, 60313, Frankfurt am Main, Deutschland.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2012 Aug;55(8):961-9. doi: 10.1007/s00103-012-1513-4.
Due to the Infectious Disease Prevention Act, public health services in Germany are obliged to check the infection prevention in hospitals and other medical facilities as well as in nursing homes. In Frankfurt/Main, Germany, standardized control visits have been performed for many years. In 2011 focus was laid on cleaning and disinfection of surfaces. All 41 nursing homes were checked according to a standardized checklist covering quality of structure (i.e. staffing, hygiene concept), quality of process (observation of the cleaning processes in the homes) and quality of output, which was monitored by checking the cleaning of fluorescent marks which had been applied some days before and should have been removed via cleaning in the following days before the final check. In more than two thirds of the homes, cleaning personnel were salaried, in one third external personnel were hired. Of the homes 85% provided service clothing and all of them offered protective clothing. All homes had established hygiene and cleaning concepts, however, in 15% of the homes concepts for the handling of Norovirus and in 30% concepts for the handling of Clostridium difficile were missing. Regarding process quality only half of the processes observed, i.e. cleaning of hand contact surfaces, such as handrails, washing areas and bins, were correct. Only 44% of the cleaning controls were correct with enormous differences between the homes (0-100%). The correlation between quality of process and quality of output was significant. There was good quality of structure in the homes but regarding quality of process and outcome there was great need for improvement. This was especially due to faults in communication and coordination between cleaning personnel and nursing personnel. Quality outcome was neither associated with the number of the places for residents nor with staffing. Thus, not only quality of structure but also quality of process and outcome should be checked by the public health services.
根据《传染病预防法》，德国的公共卫生服务机构有义务检查医院、其他医疗设施以及养老院的感染预防情况。在德国美因河畔法兰克福，多年来一直开展标准化的检查访问。2011年的重点是表面的清洁和消毒。所有41家养老院都按照一份标准化清单进行检查，该清单涵盖结构质量（即人员配备、卫生概念）、过程质量（观察养老院中的清洁过程）和产出质量，产出质量通过检查几天前涂抹的荧光标记的清洁情况来监测，这些标记应在最终检查前的接下来几天通过清洁去除。超过三分之二的养老院中，清洁人员是有薪水的，三分之一雇佣的是外部人员。85%的养老院提供工作服，所有养老院都提供防护服。所有养老院都制定了卫生和清洁概念，然而，15%的养老院缺少诺如病毒处理概念，30%的养老院缺少艰难梭菌处理概念。关于过程质量，所观察到的过程中只有一半是正确的，即手部接触表面（如扶手、洗涤区域和垃圾桶）的清洁。只有44%的清洁检查是正确的，各养老院之间存在巨大差异（0 - 100%）。过程质量与产出质量之间的相关性显著。养老院的结构质量良好，但在过程质量和结果方面有很大的改进需求。这尤其归因于清洁人员和护理人员之间沟通与协调的失误。质量结果既与居民居住场所数量无关，也与人员配备无关。因此，公共卫生服务机构不仅应检查结构质量，还应检查过程质量和结果质量。
