Grenzen der Händehygiene

Die Händehygiene ist für die Patientensicherheit essenziell. Ihre Durchführung trifft jedoch immer wieder auf Hürden, die Hygienefachpersonal und Anwender vor Probleme stellen. In einer Untersuchung der Risiken für eine unterlassene oder unzureichende Händedesinfektion war dieser vermeintlich „einfache“ Prozess einer Vielzahl von Distraktoren und Unsicherheiten u.a. aus den Bereichen Herstellung, Logistik, Psychologie und Pharmazie unterworfen.

Kernaussagen

• Der Gesamtprozess der Händedesinfektionsmittel-Herstellung und -Logistik ist komplex und fehleranfällig bei jedem Prozessschritt.

• Die Motivation der Anwendung von Händedesinfektionsmittel hängt stark mit den Umgebungsfaktoren wie der Funktionalität und Verfügbarkeit von Spendern zusammen.

• Problemlösestrategien müssen durch Schulungen entwickelt werden, um logistische Hürden in der Händedesinfektion zu überwinden.

• Heuristische Effekte, wie der Overconfidence-Effekt, sowie Halo-Effekte spielen auch in der Händedesinfektion eine Rolle.

• Notfallnarrative in der Händedesinfektion sind kritisch zu hinterfragen und stellen relevante Hürden in der Akut- und Notfallmedizin dar.

• Kommunikationstechniken sind essenzieller Bestandteil in der Ausbildung in der Infektionsprävention und stellen eigene, zu erlernende und zu erhaltende Kompetenzen dar.

• MNEMONICs können helfen, Feedback zu geben.

Schlüsselwörter

Händedesinfektion - Desinfektionsmittel - Overconfidence - Infektionskontrolle - heuristischer Fehler

Publication History

Article published online:
22 May 2024

• Literatur

• 1 Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect 2009; 73: 305-315 DOI: 10.1016/j.jhin.2009.04.019. (PMID: 19720430)
• 2 Pittet D, Allegranzi B, Boyce J. The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations. Infect Control Hosp Epidemiol 2009; 30: 611-622 DOI: 10.1086/600379. (PMID: 19508124)
• 3 Sax H, Allegranzi B, Uçkay I. et al. ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 2007; 67: 9-21 DOI: 10.1016/j.jhin.2007.06.004. (PMID: 17719685)
• 4 KRINKO. Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (RKI). Händehygiene in Einrichtungen des Gesundheitswesens. Bundesgesundheitsbl 2016; 59: 1189-1220
• 5 Kramer TS Bunte K, Schröder C. et al. No increase in compliance before aseptic procedures in German hospitals. A longitudinal study with data from the national surveillance system over four years. J Hosp Infect 2020; 106: 71-75
• 6 Livshiz-Riven I, Azulay H, Koyfman L. et al. The long-term impact of immediate verbal feedback of hand hygiene compliance after overt observation sessions, as assessed by continuous closed-circuit television monitoring in an intensive care setting. Arch Public Health 2022; 80: 141 DOI: 10.1186/s13690-022-00887-2. (PMID: 35585634)
• 7 Bredin D, O'Doherty D, Hannigan A. et al. Hand hygiene compliance by direct observation in physicians and nurses: a systematic review and meta-analysis. J Hosp Infect 2022; 130: 20-33 DOI: 10.1016/j.jhin.2022.08.013. (PMID: 36089071)
• 8 Kramer TS, Bunte K, Schröder C. et al. No increase in compliance before aseptic procedures in German hospitals. A longitudinal study with data from the national surveillance system over four years. J Hosp Infect 2020; 106: 71-75
• 9 Chiozza ML, Ponzetti C. FMEA: a model for reducing medical errors. Clin Chim Acta 2009; 404: 75-78 DOI: 10.1016/j.cca.2009.03.015. (PMID: 19298799)
• 10 Teter J, Millin MG, Bissell R. Hand hygiene in emergency medical services. Prehosp Emerg Care 2015; 19: 313-319 DOI: 10.3109/10903127.2014.967427. (PMID: 25415186)
• 11 Kampf G, Ostermeyer C. World Health Organization-recommended hand-rub formulations do not meet European efficacy requirements for surgical hand disinfection in five minutes. J Hosp Infect 2011; 78: 123-127 DOI: 10.1016/j.jhin.2011.02.005. (PMID: 21450366)
• 12 Kampf G, Scheithauer S, Lemmen S. et al. COVID-19-associated shortage of alcohol-based hand rubs, face masks, medical gloves, and gowns: proposal for a risk-adapted approach to ensure patient and healthcare worker safety. J Hosp Infect 2020; 105: 424-427 DOI: 10.1016/j.jhin.2020.04.041. (PMID: 32360355)
• 13 Hübner NO. Händedesinfektion unter den Bedingungen der SARSCoV-2-Pandemie. Epid Bulletin 19/2020.
• 14 Kramer A. Requirements for hygienically safe, environmentally friendly dispensers for hand disinfectants and hand washing preparations. GMS Hyg Infect Control 2020; 15: Doc02 DOI: 10.3205/dgkh000337.
• 15 Meissner A, Gertler S. Hygiene: Einkauf chemischer Händedesinfektionsmittel – was man bei der Beschaffung beachten muss. Klinik Einkauf 2022; 4: 46-49
• 16 Taylor S. Understanding and managing pandemic-related panic buying. J Anxiety Disord 2021; 78: 102364 DOI: 10.1016/j.janxdis.2021.102364. (PMID: 33517219)
• 17 BVFA. Brände in Krankenhäusern und ihre Folgen – ein Überblick und bvfa-Statistik. Accessed February 04, 2024 at: www.bvfa.de/121/aktuelles/statistiken/braende-in-krankenhaeusern/
• 18 Seys D, Panella M, Russotto S. et al. In search of an international multidimensional action plan for second victim support: a narrative review. BMC Health Services Research 2023; 23: 816 DOI: 10.1186/s12913-023-09637-8. (PMID: 37525127)
• 19 Gudehus T, Kotzab H. Commissioning Systems. Comprehensive Logistics. Heidelberg: Springer; 2009
• 20 Khan IA, Rahman S. Review and analysis of blockage of Suez Canal region due to giant container ship. Marine Technol Soc J 2021; 55: 39-43
• 21 Ramos KG, Rocha ICN, Cedeño TDD. et al. Suez Canal blockage and its global impact on healthcare amidst the COVID-19 pandemic. Int Marit Health 2021; 72: 145-146 DOI: 10.5603/IMH.2021.0026. (PMID: 34212357)
• 22 Ching PL, Mutuc JE, Jose JA. Assessment of the quality and sustainability implications of FIFO and LIFO inventory policies through system dynamics. Adv Sci Technol Eng Syst 2019; 4: 69-81
• 23 Meyer H. Pharmaceutical ward stock management for nurses. Profess Nurs Today 2010; 5: 5
• 24 UKNRW. Anforderungen an die Lagerung von Desinfektionsmitteln. Sichere Feuerwehr. 2021 Accessed March 05, 2024 at: www.sichere-feuerwehr.de
• 25 Ruskin KJ, Hueske-Kraus D. Alarm fatigue: impacts on patient safety. Curr Opin Anaesthesiol 2015; 28: 685-690 DOI: 10.1097/ACO.0000000000000260. (PMID: 26539788)
• 26 Aljohani B, Burkholder J, Tran QK. et al. Workplace violence in the emergency department: a systematic review and meta-analysis. Public Health 2021; 196: 186-197 DOI: 10.1016/j.puhe.2021.02.009. (PMID: 34246105)
• 27 Eriksson J, Vogel EK, Lansner A. et al. Neurocognitive Architecture of Working Memory. Neuron 2015; 88: 33-46 DOI: 10.1016/j.neuron.2015.09.020. (PMID: 26447571)
• 28 Yarmohammadian MH, Rezaei F, Haghshenas A. et al. Overcrowding in emergency departments: A review of strategies to decrease future challenges. J Res Med Sci 2017; 22: 23-23 DOI: 10.4103/1735-1995.200277. (PMID: 28413420)
• 29 Alderson RM, Kasper LJ, Hudec KL. et al. Attention-deficit/hyperactivity disorder (ADHD) and working memory in adults: a meta-analytic review. Neuropsychology 2013; 27: 287-302 DOI: 10.1037/a0032371. (PMID: 23688211)
• 30 Veltmeyer MD, Clark CR, McFarlane AC. et al. Working memory function in post-traumatic stress disorder: an event-related potential study. Clin Neurophysiol 2009; 120: 1096-1106 DOI: 10.1016/j.clinph.2009.03.024. (PMID: 19442579)
• 31 Scheithauer S, Batzer B, Dangel M. et al. Workload even affects hand hygiene in a highly trained and well-staffed setting: a prospective 365/7/24 observational study. J Hosp Infect 2017; 97: 11-16 DOI: 10.1016/j.jhin.2017.02.013. (PMID: 28389091)
• 32 Armstrong-Novak J, Juan HY, Cooper K. et al. Healthcare Personnel Hand Hygiene Compliance: Are We There Yet?. Curr Infect Dis Rep 2023; 25: 123-129
• 33 Scheithauer S, Häfner H, Schröder J. et al. Influence of signal colored hand disinfectant dispensers on hand hygiene compliance at a medical intensive care unit. Am J Infect Control 2014; 42: 926-928 DOI: 10.1016/j.ajic.2014.05.021. (PMID: 25087148)
• 34 von Lengerke T, Schulz-Stübner S, Chaberny I. et al. Psychologie der Händehygiene-Compliance: Von der Motivation zum Verhalten. Krankenhaushygiene up2date 2016; 11: 135-150
• 35 Bloom BS. Taxonomy of Educational Objectives, Handbook I: The Cognitive Domain. New York: David McKay Co Inc; 1956
• 36 Krathwohl DR. A Revision of Bloom's Taxonomy: An Overview. Theory Into Practice 2002; 41: 212-218
• 37 Dunning D, Heath C, Suls JM. Flawed Self-Assessment: Implications for Health, Education, and the Workplace. Psychol Sci Public Interest 2004; 5: 69-106 DOI: 10.1111/j.1529-1006.2004.00018.x. (PMID: 26158995)
• 38 Muller A, Sirianni LA, Addante RJ. Neural correlates of the Dunning–Kruger effect. Eur J Neurosci 2021; 53: 460-484 DOI: 10.1111/ejn.14935. (PMID: 32761954)
• 39 Moore DA, Healy PJ. The trouble with overconfidence. Psychol Rev 2008; 115: 502-517 DOI: 10.1037/0033-295X.115.2.502. (PMID: 18426301)
• 40 Sandroni A, Squintani F. A Survey on Overconfidence, Insurance and Self-Assessment Training Programs. 2018 survey_overconfidence-libre.pdf (d1wqtxts1xzle7.cloudfront.net)
• 41 Vanhaecht K, Seys D, Russotto S. et al. An evidence and consensus-based definition of second victim: a strategic topic in healthcare quality, patient safety, person-centeredness and human resource management. Int J Environm Res Public Health 2022; 19: 16869 DOI: 10.3390/ijerph192416869. (PMID: 36554750)
• 42 Lamping J, Tomsic I, Stolz M. et al. Do task and item difficulty affect overestimation of one’s hand hygiene compliance? A cross-sectional survey of physicians and nurses in surgical clinics of six hospitals in Germany. Antimicrob Resist Infect Control 2022; 11: 147 DOI: 10.1186/s13756-022-01188-7. (PMID: 36461038)
• 43 Bushuven S, Dettenkofer M, Sippel S. et al. Speaking up behavior and cognitive bias in hand hygiene: Competences of German-speaking medical students. PLoS One 2020; 15: e0239444 DOI: 10.1371/journal.pone.0239444. (PMID: 32986726)
• 44 Bushuven S, Juenger J, Moeltner A. et al. Overconfidence in infection control proficiency. Am J Infect Control 2019; 47: 545-550 DOI: 10.1016/j.ajic.2018.10.022. (PMID: 30528170)
• 45 Bushuven S, Weidenbusch M, Mohr S. et al. Cognitive bias in professional hand hygiene and feedback: A national online-survey on overconfidence in Germany. Infect Control Hosp Epidemiol 2019; 40: 943-946 DOI: 10.1017/ice.2019.156. (PMID: 31294685)
• 46 Bushuven S, Bansbach J, Bentele M. et al. Overconfidence effects and learning motivation refreshing BLS: An observational questionnaire study. Resuscitation Plus 2023; 14: 100369 DOI: 10.1016/j.resplu.2023.100369. (PMID: 36935817)
• 47 Trifunovic-Koenig M, Bushuven S, Gerber B. et al. Correlation between Overconfidence and Learning Motivation in Postgraduate Infection Prevention and Control Training. J Environ Res Public Health 2022; 19: 5763
• 48 Kerckhoff AC, Glennie E. The Matthew effect in American education. Res Soc Educ Social 1999; 12: 35-66
• 49 Merton RK. The Matthew effect in science, II: Cumulative advantage and the symbolism of intellectual property. isis 1988; 79: 606-623
• 50 Walberg HJ, Tsai SL. Matthew Effects in Education. Am Educ Res J 1983; 20: 359-373
• 51 Forgas JP, Laham SM. Halo effects. In: Pohl RF. Cognitive illusions. London: Psychology Press; 2016: 286-300
• 52 Haac B, Rock C, Harris AD. et al. Hand Hygiene Compliance in the Setting of Trauma Resuscitation. Injury 2017; 48: 165-170 DOI: 10.1016/j.injury.2016.08.004. (PMID: 27568844)
• 53 Quach C, McArthur M, McGeer A. et al. Risk of infection following a visit to the emergency department: a cohort study. Cmaj 2012; 184: E232-E239 DOI: 10.1503/cmaj.110372. (PMID: 22271915)
• 54 Liang SY, Riethman M, Fox J. Infection prevention for the emergency department: out of reach or standard of care?. Emerg Med Clin 2018; 36: 873-887 DOI: 10.1016/j.emc.2018.06.013. (PMID: 30297010)
• 55 Bushuven S, Bansbach J, Bentele M. et al. Indications for hand and glove disinfection in Advanced Cardiovascular Life Support: A manikin simulation study. Front Med (Lausanne) 2022; 9: 1025449 DOI: 10.3389/fmed.2022.1025449. (PMID: 36687411)
• 56 Nolan JP, Sandroni C, Böttiger BW. et al. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Intensive Care Med 2021; 47: 369-421 DOI: 10.1007/s00134-021-06368-4. (PMID: 33765189)
• 57 Vadakkencherry Ramaswamy V, Abiramalatha T, Weiner GM. et al. A comparative evaluation and appraisal of 2020 American Heart Association and 2021 European Resuscitation Council neonatal resuscitation guidelines. Resuscitation 2021; 167: 151-159
• 58 von Lengerke T, Chaberny IF. Psychologie und Förderung der Händehygiene-Compliance. Krankenhaushygiene up2date 2022; 17: 57-79
• 59 DIN E. 1500 Chemische Desinfektionsmittel und Antiseptika–Hygienische Händedesinfektion–Prüfverfahren und Anforderungen (Phase 2/Stufe 2); Deutsche Fassung EN 1500:. 2013
• 60 Tschudin-Sutter S, Sepulcri D, Dangel M. et al. Simplifying the World Health Organization protocol: 3 steps versus 6 steps for performance of hand hygiene in a cluster-randomized trial. Clin Infect Dis 2019; 69: 614-620
• 61 Kampf G. Efficacy of ethanol against viruses in hand disinfection. J Hosp Infect 2018; 98: 331-338 DOI: 10.1016/j.jhin.2017.08.025. (PMID: 28882643)
• 62 Kruger J, Dunning D. Unskilled and unaware of it: how difficulties in recognizing one's own incompetence lead to inflated self-assessments. J Pers Soc Psychol 1999; 77: 1121 DOI: 10.1037//0022-3514.77.6.1121. (PMID: 10626367)
• 63 Meng M, Sorber M, Herzog A. et al. Technological innovations in infection control: A rapid review of the acceptance of behavior monitoring systems and their contribution to the improvement of hand hygiene. Am J Infect Control 2019; 47: 439-447
• 64 Meng M, Seidlein AH, Kugler C. Hand hygiene monitoring technology: A descriptive study of ethics and acceptance in nursing. Nurs Ethics 2022; 29: 436-447 DOI: 10.1177/09697330211015351. (PMID: 34525855)
• 65 Tarantini C, Brouqui P, Wilson R. et al. Healthcare workers' attitudes towards hand-hygiene monitoring technology. J Hosp Inf 2019; 102: 413-418 DOI: 10.1016/j.jhin.2019.02.017. (PMID: 30831187)
• 66 Fernandes DR, Santos BNd, Guimarães CS. et al. Educational technologies for teaching hand hygiene: Systematic review. Plos one 2024; 19: e0294725 DOI: 10.1371/journal.pone.0294725. (PMID: 38227588)
• 67 Castro-Sánchez E, Kyratsis Y, Iwami M. et al. Serious electronic games as behavioural change interventions in healthcare-associated infections and infection prevention and control: a scoping review of the literature and future directions. Antimicrob Resist Infect Control 2016; 5: 34
• 68 Ahmed M, Arora S, Russ S. et al. Operation debrief: a SHARP improvement in performance feedback in the operating room. Ann Surg 2013; 258: 958-963 DOI: 10.1097/SLA.0b013e31828c88fc. (PMID: 23478533)
• 69 Kohnen J. Crucial Conversations: Tools for Talking When Stakes Are High. Quality Manag J 2008; 15: 78
• 70 Hattie J, Timperley H. The Power of Feedback. Rev Educ Res 2007; 77: 81-112
• 71 Wagner PS, Ash KL. Creating the teachable moment. Thorofare, NJ: SLACK Incorporated; 1998
• 72 Johnson D, Goodman R, Patrinely J. et al. Assessing the Accuracy and Reliability of AI-Generated Medical Responses: An Evaluation of the Chat-GPT Model. Res Sq 2023; DOI: 10.21203/rs.3.rs-2566942/v1.
• 73 Sallam M. ChatGPT Utility in Healthcare Education, Research, and Practice: Systematic Review on the Promising Perspectives and Valid Concerns. Healthcare (Basel) 2023; 11: 887 DOI: 10.3390/healthcare11060887. (PMID: 36981544)
• 74 Li J, Dada A, Puladi B. et al. ChatGPT in Healthcare: A Taxonomy and Systematic Review. Comput Methods Programs Biomed 2024; 245: 108013
• 75 Ayers JW, Poliak A, Dredze M. et al. Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum. JAMA Intern Med 2023; 183: 589-596 DOI: 10.1001/jamainternmed.2023.1838. (PMID: 37115527)
• 76 Bushuven S, Bentele M, Bentele S. et al. “ChatGPT, can you help me save my child’s life?”-Diagnostic Accuracy and Supportive Capabilities to lay rescuers by ChatGPT in prehospital Basic Life Support and Paediatric Advanced Life Support cases – an in-silico analysis. J Med Syst 2023; 47: 123 DOI: 10.1007/s10916-023-02019-x. (PMID: 37987870)
• 77 LAGA. Vollzugshilfe zur Entsorgung von Abfällen aus Einrichtungen des Gesundheitsdienstes.. Mitt Bund/Ländergem Abfall 2015; 18: 1-35
• 78 Tacy JW. Technostress: a concept analysis. Online J Nurs Inform 2016; 20. Jg., Nr. 2.
• 79 von Lengerke T, Tomsic I, Krosta KME. et al. Tailoring implementation interventions of different order in infection prevention and control: A cascadic logic model (IPC-CASCADE). Front Health Serv 2022; 2: 960854
• 80 Bushuven S, Dettenkofer M, Kahla-Witzsch HA. et al. Aus-und Fortbildung in der Infektionsprävention: Didaktik und Risikoanalyse. Krankenhaushygiene up2date 2019; 14: 203-222
• 81 Caris MG, Kamphuis PGA, Dekker M. et al. Patient Safety Culture and the Ability to Improve: A Proof of Concept Study on Hand Hygiene. Infect Control Hosp Epidemiol 2017; 38: 1277-1283 DOI: 10.1017/ice.2017.209. (PMID: 28967350)