Infectious Diseases, University Hospital Tübingen, Tübingen, Germany.
Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy.
BMJ Open. 2019 May 19;9(5):e027683. doi: 10.1136/bmjopen-2018-027683.
The main objective of the study was to investigate major differences among European countries in implementing infection prevention and control (IPC) measures and reasons for reduced compliance.
An online survey including experts in IPC and a gap analysis were conducted to identify major limitations in implementing IPC guidelines.
Europe.
Four areas were targeted: (1) healthcare structure, (2) finances, (3) culture and (4) education and awareness. Perceived compliance to IPC measures was classified as low (<50%), medium (50% to 80%) and high (>80%). Countries were classified in three regions: North-Western Europe (NWE), Eastern Europe (EE) and Southern Europe (SE).
In total, 482 respondents from 34 out of 44 (77.3%) European countries participated. Respondents reported availability of national guidelines to control multidrug-resistant Gram-negatives (MDR-GN) in 20 countries (58.0%). According to participants, compliance with IPC measures ranged from 17.8% (screening at discharge) to 96.0% (contact precautions). Overall, three areas were identified as critical for the compliance rate: (1) number of infection control staff, (2) IPC dedicated educational programmes and (3) number of clinical staff. Analysis of reasons for low compliance showed high heterogeneity among countries: participants from NWE and SE deemed the lack of educational programmes as the most important, while those from EE considered structural reasons, such as insufficient single bed rooms or lacking materials for isolation, as main contributors to the low compliance.
Although national guidelines to reduce the spread of MDR-GN are reported in the majority of the European countries, low compliance with IPC measures was commonly reported. Reasons for the low compliance are multifactorial and vary from region to region. Cross-country actions to reduce the spread of MDR-GN have to consider structural and cultural differences in countries. Locally calibrated interventions may be fruitful in the future.
本研究的主要目的是调查欧洲各国在实施感染预防和控制（IPC）措施方面的主要差异，以及导致合规性降低的原因。
进行了一项在线调查，包括 IPC 专家和差距分析，以确定在实施 IPC 指南方面的主要限制。
欧洲。
针对四个领域：（1）医疗结构，（2）财务，（3）文化和（4）教育和意识。将 IPC 措施的感知合规性分为低（<50%）、中（50%至 80%）和高（>80%）。将国家分为三个区域：西北欧（NWE）、东欧（EE）和南欧（SE）。
共有来自欧洲 44 个国家中的 34 个国家的 482 名受访者参加了这项研究。20 个国家（58.0%）报告了国家指南以控制多药耐药革兰氏阴性菌（MDR-GN）。根据参与者的报告，IPC 措施的合规率从 17.8%（出院时筛查）到 96.0%（接触预防）不等。总体而言，有三个领域被认为是合规率的关键：（1）感染控制人员的数量，（2）IPC 专用教育计划，以及（3）临床人员的数量。对低合规性原因的分析表明，各国之间存在高度异质性：来自 NWE 和 SE 的参与者认为缺乏教育计划是最重要的原因，而来自 EE 的参与者则认为结构原因，如不足的单人病房或缺乏隔离材料，是导致低合规性的主要原因。
尽管大多数欧洲国家都报告了减少 MDR-GN 传播的国家指南，但 IPC 措施的合规性普遍较低。低合规性的原因是多方面的，并且因地区而异。减少 MDR-GN 传播的跨国行动必须考虑到各国的结构性和文化差异。在未来，有针对性的干预措施可能会产生成效。
