Bergström Karin, Grönlund Ulrika
Department of Animal Health and Antimicrobial Strategies, National Veterinary Institute, Uppsala, SE 750 89, Sweden.
Acta Vet Scand. 2014 Aug 22;56(1):52. doi: 10.1186/s13028-014-0052-4.
Detection of nosocomial methicillin-resistant Staphylococcus aureus infections in horses in Sweden has increased attention on infection control (IC) in equine hospitals. This study established baseline data on IC programmes within such settings, evaluated compliance with some IC procedures before and after an education intervention, and examined barriers to compliance.The study was carried out between 2008 and 2011 in four Swedish equine hospitals. Data on current IC of each hospital, purchase data on hand sanitisers and disposable gloves per patient, and direct observations of compliance with procedures were monitored pre- and post-intervention. The intervention comprised a lecture on common IC and a review of each hospital's current procedures. For comparison, retrospective purchase data were reviewed. A questionnaire on individual compliance, experiences and opinions of IC was issued to employees.
Three hospitals completed the study, while the fourth reported its IC procedures and completed the questionnaire. Actual numbers of procedures, content and level of documentation differed among the hospitals. Similarities were poor or absent IC implementation strategy, lack of active surveillance of compliance with procedures and no monitoring of such as nosocomial infections. Among the hospitals which completed the study, two reported pre-intervention observation of compliance, while all three reported post-intervention observations. The purchase data showed trends for changes over time, although not uniformly related to the intervention. One hospital demonstrated a significant post-intervention increase in compliance with glove procedures, accompanied by a non-significant post-intervention increase in purchases figures. Compliance with dress code and personal appearance was high in all three hospitals (92-100%), while compliance with hand hygiene procedures was generally poorer. Barriers to compliance cited in the questionnaire (data from four hospitals) included insufficient supplies of hygiene products, lack of readily accessible places for cleaning, insufficient knowledge and high workload.
Potential for easily attainable improvements in IC, such as traceability of documents, implementation strategies and surveillance of efficacy, was revealed. Attention to hand hygiene implementation and improvement of logistics appeared important. Data on purchases per patient were readily available and therefore applicable for intra-hospital surveillance of IC trends over time.
瑞典马匹医院中耐甲氧西林金黄色葡萄球菌医院感染的检测增加了对马医院感染控制（IC）的关注。本研究建立了此类环境下感染控制项目的基线数据，评估了教育干预前后对一些感染控制程序的依从性，并检查了依从性的障碍。该研究于2008年至2011年在瑞典的四家马医院进行。对每家医院当前的感染控制数据、每位患者的洗手液和一次性手套采购数据以及对程序依从性的直接观察在干预前后进行监测。干预包括一次关于常见感染控制的讲座以及对每家医院当前程序的审查。为作比较，回顾了回顾性采购数据。向员工发放了一份关于个人依从性、感染控制经验和意见的问卷。
三家医院完成了研究，第四家报告了其感染控制程序并完成了问卷。各医院实际的程序数量、内容和记录水平各不相同。相似之处在于感染控制实施策略不佳或缺失、缺乏对程序依从性的主动监测以及未对医院感染等进行监测。在完成研究的医院中，两家报告了干预前的依从性观察，而所有三家都报告了干预后的观察。采购数据显示出随时间变化的趋势，尽管并非都与干预一致相关。一家医院干预后手套程序的依从性显著增加，同时采购数据干预后也有不显著的增加。所有三家医院对着装规范和个人外表的依从性都很高（92 - 100%），而手部卫生程序的依从性总体较差。问卷（来自四家医院的数据）中提到的依从性障碍包括卫生用品供应不足、缺乏便于清洁的场所、知识不足和工作量大。
揭示了在感染控制方面易于实现改进的潜力，如文件的可追溯性、实施策略和效果监测。关注手部卫生的实施和物流改善似乎很重要。每位患者的采购数据易于获取，因此适用于医院内感染控制趋势的长期监测。
