Hand hygiene compliance in Dutch general practice offices

BACKGROUND

Hand hygiene (HH) is considered one of the most important measures to prevent healthcare-associated infections (HAI). Most studies focus on HH compliance within the hospital setting, whereas little is known for the outpatient setting. The aim of this study was to evaluate compliance with HH recommendations in general practitioners (GPs) office, based on World Health Organization (WHO) guideline.

METHODS

An observational study was conducted at five Dutch GPs-practices in September 2017. We measured HH compliance through direct observation using WHO's 'five moments of hand hygiene' observation tool. All observations were done by one trained professional.

RESULTS

We monitored a total of 285 HH opportunities for 30 health care workers (HCWs). The overall compliance was 37%. Hand hygiene compliance was 34, 51 and 16% for general practitioners, practice assistants, and nurses, respectively. It varies between 63% after body fluid exposure and no HH performance before-, during and after home visit of a patient (defined as moment 5). The preferred method of HH was soap and water (63%) versus 37% for alcohol-based hand rub (ABHR). The median time of disinfecting hands was 8 s (range 6-11 s) for HCWs in our study.

CONCLUSIONS

HH compliance among HCWs in Dutch GPs was found to be low, especially with regard to home visits. The WHO recommended switch from hand wash to ABHR was not implemented by the majority of HCWs in 5 observed GPs offices.

Current practice of infection control in Dutch primary care: Results of an online survey

BACKGROUND

Good infection prevention is an important aspect of quality of medical care. The aim was to evaluate infection prevention and control (IPC) performance among Dutch general practitioners (GPs).

METHODS

Based on the current national IPC guidelines for GPs, a self-administered anonymous online questionnaire was developed and sent to GPs in the Nijmegen region of the Netherlands. Thirty-two questions were constructed to survey characteristics of GPs' offices and assess current performance of IPC measures.

RESULTS

One hundred questionnaires were included in our analysis. The preferred method of hand hygiene was soap and water (56%) versus alcohol-based handrub (44%). The cleaning of nondisposable, noncritical, semicritical, and critical instruments was consistent with national guideline recommendations or superior to them in 100%, 49%, and 97% of cases, respectively. An average of 57% of GPs reported environmental cleaning frequencies that were compliant with the national guidelines or superior to them. Personal protective equipment was available in 62% of GPs' practices but used in only 25% of home visits to patients.

CONCLUSIONS

Not all national IPC guidelines seem to be followed to the fullest extent. The current situation indicates there is room for potential improvement regarding implementation of IPC measures in GPs' offices. Area-specific guidelines and continuous medical education regarding IPC may help improve the situation.

Large two-centre study into the prevalence of Mycoplasma genitalium and Trichomonas vaginalis in the Netherlands

Mycoplasma genitalium and Trichomonas vaginalis are common sexually transmitted infections (STIs). In the Netherlands, testing for M. genitalium and T. vaginalis is not recommended for first-line STI screening. Recent reports about the increasing antimicrobial resistance in M. genitalium raise concern about the adequacy of current empirical treatment regimens. It is necessary to have insight in the prevalence of M. genitalium and T. vaginalis in order to evaluate current first-line STI screening and treatment protocols. During a five-month period, samples sent to two large medical microbiology diagnostic centres in the Netherlands for STI screening (Chlamydia trachomatis and Neisseria gonorrhoeae) were retrospectively tested for the prevalence of M. genitalium and T. vaginalis using the Diagenode S-DiaMGTV kit. A total of 1569 samples from 1188 unique patients (55.4% female) were tested. M. genitalium was the second most prevalent STI detected (4.5% of the patients), after C. trachomatis (8.3%). T. vaginalis was detected in 1.4% of the patients, comparable to the prevalence of N. gonorrhoeae (1.3%). Dual infections were only detected in a small number of patients (1.0%). Incorporation of M. genitalium into routine STI screening should be considered, because of its relatively high prevalence, the consequences of its detection for antibiotic treatment and because of the availability of easy-to-use molecular diagnostic tests. For T. vaginalis, routine screening may be considered, depending on local prevalence and (sub)population.