Implementierung und Evaluierung von Hygienemaßnahmen zur Reduktion von multiresistenten Infektionserregern und Wundinfektionen in einer Pferdeklinik
Effects of hygiene management on wound infection rates in an equine clinic
Gehlen H, Klein k-S, Stöckle S D, Lübke-Becker A, Merle R, Köck R, Walther B
DOI: 10.21836/PEM20210607
Jahr: 2021
Volume: 37
Ausgabe: 6
Seiten: 611–620
decreased by introducing a multimodal hygiene concept in a large equine clinic, an interventional study was carried out. In order to keep the six-month study periods (SP A and SP B) before and after the intervention phase comparable, horses presented with either a “colic” or an “open injury” were included in the study. Upon admission to the clinic, they were tested for MDRO by microbiological examination of a nasal swab and a faecal sample. In injured horses, a sample for microbiological examination was also collected from the centre of the wound. Hand disinfectant consumption (HDC) was assessed as an indirect indicator to evaluate hand hygiene compliance. In the intervention phase, a novel baseline hygiene concept was implemented. A clinical WI was diagnosed by the treating veterinarian considering the classic general and local inflammatory symptoms. Additionally fever, leukocytes (white blood cells = WBC > 10,000 G/l), an increased fibrinogen value (> 400 mg/dl), an increased heart rate (> 48/min.), and visible wound exudation were taken into account. A sample of every WI after colic surgery or surgically treated open injury was examined microbiologically. Considering 108 horses with “open wounds” at hospital admission, 28.7 % (31/108) developed a WI, with 31.6 % (19/60) in SP A and 25.0 % (12/48) in SP B. While 233 horses were hospitalized due to “colic”, 48 (20.6 %) were subjected to (emergency) laparotomy. Considering the 35 horses surviving 24 h following surgery, 11 developed a postoperative WI; 6/14 (42.8 %) during SP A and 5/21 (23.8 %) during SP B. Altogether, the WI detection rate decreased by 9.2 % and the MDRO detection rate in these WI was reduced by 17,2 % in SP B compared to SP A, although this reduction lacked statistical significance. A total of 50 % (21/42) of the infected wounds tested positive for ESBL-producing Enterobacterales. Acinetobacter baumannii was only detected in two cases (4.8 %). Both, the absolute HDC and the consumption of hand disinfectant per patient day increased in SP B. The absolute HDC in SP A was 27.5 liters (l) and in SP B 79.7 l. This corresponds to an absolute increase in HDC of more than 52 l (190 %) in SP B. For SP A, an absolute volume of HDC per clinic day of 148.6 ml or a consumption of 4 ml per patient day was measured. In SP B, the use of hand disinfectants increased significantly to 435.7 ml per clinic day and to 14.1 ml per patient day. This corresponds to an increase of HDC per clinic day (day in the study period) by almost three times (290 %) and more than three times (350 %) in relation to the patient day compared to SP A. The number of hand disinfections carried out per patient day also increased 3 ml average consumption per hand disinfection of 1.3 hand disinfections carried out in SP A to 4.7 hand disinfections carried out. In conclusion optimized hygiene measures, especially with regard to hand hygiene, have a clear influence on the occurrence of wound infections and the detection of MDROs in wound infections.