[Infection Control Professionals' Views on the Handling of MRSA-Colonised Healthcare Workers]. / Der Umgang mit MRSA bei Beschäftigten im Gesundheitsdienst aus Sicht der Krankenhaushygiene.

Background: Colonisation with methicillin-resistant Staphylococcus aureus (MRSA) is a particular challenge for medical staff and their facilities, with a key role being played by physicians alongside infection control and hospital hygiene professionals. Methods: In 2014, infection control and hygiene staff were surveyed on the handling of hospital staff with MRSA colonisation. The questionnaire queried on MRSA management in hospitals and on the cooperation between hygiene staff and hospital physicians and was compared to a survey of physicians' experience with the care of MRSA-positive hospital staff. Results: 124 hospital hygiene professionals participated in the survey. General screenings of staff members were reported mainly for cases of MRSA outbreak. Temporary colonisation is differentiated from permanent colonisation (47%). 2 unsuccessful attempts at decolonisation are normally regarded as an indicator for a permanent colonisation. Generally there was cooperation between hospital physicians and hygiene staff. The responsibility for screening and decolonisation of staff members is shared by both groups with the groups placing emphasis on different focal points. Different approaches for the handling of MRSA-positive staff were reported and recommendations for the work ability vary from merely observing the standard hygiene regulation to refraining from close patient contact or even complete absence from work. Conclusion: MRSA colonisation in hospital staff is being dealt with in different manners. Infection control and hospital hygiene professionals are equally involved in the treatment. Clear regulations would benefit the handling of MRSA in staff members.

Causes of needlestick injuries in three healthcare settings: analysis of accident notifications registered six months after the implementation of EU Directive 2010/32/EU in Germany.

BACKGROUND: Needlestick injuries (NSIs) are the most common cause of sharps injuries and pose a serious risk to healthcare workers (HCWs). In 2014, 'Technical rule for biological agents in healthcare and welfare facilities' (TRBA 250) was modified in Germany in order to promote the prevention of sharps injuries. AIMS: To examine the epidemiology of NSIs among HCWs in hospitals, doctor's offices and in- and outpatient care; to collect information on the causes of the accidents when safety-engineered devices (SEDs) are used; and to compare the results with the main principles of TRBA 250. METHODS: The survey was based on HCWs' compensation claims for NSIs, as notified within a four-week period in November 2014. Detailed information on the NSI was collected by telephone interview. FINDINGS: In total, 533 HCWs participated. Subcutaneous needles were most often involved in NSIs, regardless of the healthcare setting (39% of all NSIs). Insulin pens were involved in 48% of NSIs in in- and outpatient care. Disposal of sharps devices accounted for 38% of the injuries. SEDs were used in 20% of NSIs. Lack of activation was the most important cause of failure when SEDs were used. CONCLUSION: Despite the binding recommendations of TRBA 250, more efforts are needed to increase the experience of HCWs in terms of working with SEDs. All professional groups must be encouraged to be more aware of the risks associated with sharps disposal. Safe handling practices for disposal of insulin pens are needed in in- and outpatient care settings.

Prevention of occupational skin disease: a workplace intervention study in geriatric nurses.

BACKGROUND: Health care workers have an increased risk of occupational dermatosis. OBJECTIVES: To determine whether a skin care programme reduces skin disease on the hands of geriatric nurses and increases protective behaviour and the provision of skin care products at the workplace. The intervention was based on a 2-h skin care training session and an occupational advisory service. METHODS: The study design was a randomized intervention study with a control group. Three hundred and eighty-eight geriatric nurses were included in the intervention group exposed to a skin care programme (IG; n = 146) and in the control group (CG; n = 242). Both groups completed questionnaires on exposure and underwent clinical examinations of their hands at the beginning and after a 12-month period. Preventive measures initiated by the employer at the workplace were documented at baseline and at 3 months after the intervention. RESULTS: At baseline, no difference between the IG and the CG was found with respect to skin changes or work-related behaviour. At follow-up, the frequency of skin disease was significantly reduced in the IG, from 26% at baseline to 17% at follow-up, whereas the frequency remained almost unchanged in the CG. Effects on behaviour in the IG included significant increases in the use of moisturizers and hand disinfection instead of hand washing. The provision of cotton gloves and barrier cream products increased at intervention workplaces. CONCLUSIONS: Effective implementation of an occupational skin care programme for geriatric nurses should include both the training of the nurses and an occupational advisory service for management.

Validity and responsiveness of the Osnabrück Hand Eczema Severity Index (OHSI): a methodological study.

BACKGROUND: The Osnabrück Hand Eczema Severity Index (OHSI) is a scoring system for the assessment of the severity of hand eczema (HE). OBJECTIVE: To assess the clinimetric value of the OHSI and to validate the longitudinal responsiveness of the OHSI using the Manuscore as a gold standard. METHODS: OHSI and Manuscore scores were compared before and after 3 weeks' inpatient treatment of 62 patients with occupational HE. Correlation coefficients and 95% limits of agreement were calculated and the ability of OHSI to identify severe HE was analysed. The responsiveness of the OHSI in monitoring skin changes over time was evaluated by calculating effect sizes. RESULTS: High correlation was found between the OHSI and Manuscore at both scoring occasions (around r(s) = 0.77). Differences between both measurements were within the 95% limits of agreement for 94% of patients, with a tendency for the OHSI to underestimate the severity at very low and at very high values compared with the Manuscore. Responsiveness to change was good. Both instruments showed significant improvement between the scoring occasions. Using the OHSI values, the proportion of classification to the correct tertile of score change was 69%. Effect size from untreated to treated was 0.6 for the Manuscore and 1.1 for the OHSI, with higher effect sizes in individuals with severe HE. CONCLUSIONS: Even though the OHSI allows less differentiation than the Manuscore, it shows adequate validity and responsiveness to change. Thus the OHSI is suitable for both monitoring the severity of HE and the effects of treatment.

[Health indicators and preventive behaviour of older employees in geriatric care]. / Gesundheitsindikatoren und Präventionsverhalten bei älteren Beschäftigten in der Altenpflege.

STUDY OBJECTIVE: As a consequence of the demographic transition, the proportion of geriatric nurses aged over 50 is increasing. The present study examines whether the prevalence of skin and back diseases and preventive behaviour differ between this group and younger employees. An additional objective was to record the proportion of older employees with a health- and occupation-related impairment. METHODS: 2 149 nurses working in home care settings and nursing homes were questioned in written form about their working ability, their preventive behaviour and their health situation. They were also subjected to dermatological investigation (with the Osnabrück Hand Eczema Severity Index - OHSI) and orthopaedic investigation (based on the multiple-step inventory of examinations). RESULTS: Older nurses more often rated their working ability as "(fairly) poor" than did younger nurses. This applied both to physical demands (11 vs. 4%) and to psychological demands (10 vs. 5%). They were also more affected by symptoms in the cervical spine (28 vs. 13%) and the lumbar spine (56 vs. 37%). Hand eczema was not more prevalent in older nurses. The state of health of 10% of the nurses aged over 50 indicated a health- and occupation-related impairment in regard to work ability and back complaints. Roughly equal proportions of the younger and older groups participated in measures for the primary prevention of back symptoms. The older nurses participated more often in advisory sessions on skin protection and more frequently applied cream to their hands. The younger nurses were in skin contact with water or fluids for shorter periods and more often exclusively used disinfectants after patient contact. CONCLUSION: Geriatric nurses with a health- and occupation-related impairment require intensive measures to support their health and to prevent health damage and to stop them from leaving work prematurely. If at all possible, these measures should not be restricted to a single social insurance agency. The individual preventive behaviour to avoid occupational back symptoms is not dependent on age. An age effect was observed for individual measures to protect the skin. Nevertheless, these had no effect on the risk of disease. The results indicate that more attention should be given to older employees during occupational training.

[Secondary individual prevention and rehabilitation in female hairdressers suffering from skin diseases]. / Sekundäre Individualprävention bei FriseurInnen.

The risk of contracting occupational skin diseases is highest in hairdressers. A job-specific secondary prevention programme was created to enable hairdressers to stay on the job despite their skin problems. The effect of this prevention programme on both, the severity of skin disorders and the hairdressers' behaviour regarding skin protection are evaluated in this paper. Between 1997 and 2002 a total of 2437 hairdressers participated in the programme. Complete data for the evaluation are available for 635 hairdressers (26 %). This selection is partly due to the fact that the evaluation is restricted to certain regions in Germany. The percentage of hairdressers with severe skin symptoms dropped from 49 % at the start of the rehabilitation programme to 11 % after completion of the programme. The proportion of hairdressers using gloves and applying skin care doubled. Therefore the rehabilitation programme appears to be successful regarding the ability of hairdressers to cope with skin problems.

[Assessing social inequality in microcensus data and German national health examination survey]. / Zur Messung der sozialen Ungleichheit im Mikrozensus und Bundes-Gesundheitssurvey.

To analyse the impact of social inequality on health and illness public health officials in Germany request for more data on socio-demographic indicators in official population statistics at Federal and State level. The aim of the study was to examine whether the national sample census Microcensus is suitable for scaling social inequality. For this purpose, coding instructions for calculating social strata index by Winkler were applied to databases of the Microcensus. The results were compared with the German Health Survey, because social data of this survey are already scaled according to the coding instruction for social strata index by Winkler. Data analyses were based on subgroups of North Rhine-Westphalia originated from national samples of Microcensus and German Health Survey. For index indicators "education" and "income" coding structure was transferred to databases of Microcensus without any problems. For index indicator "occupational status" occupational groups were less comparable. This refers to the classification of the occupational status of formerly employed people. However this limitation applies also to employees because the model for "occupational status" is assessed only on a four-year basis. From a methodical point of view it seems to be a problem that "household" has a different meaning in the index by Winkler and Microcensus and is only partly transferable to Microcensus databases. Additionally, identification of the main income earner of the household proved extremely difficult. Therefore, at the present conceptional stage of Microcensus it seems appropriate to classify occupational status as an individual criterion.

Breastfeeding promotion in non-UNICEF-certified hospitals and long-term breastfeeding success in Germany.

AIM: To assess breastfeeding practices using the World Health Organization/United Nations Children's Fund (WHO/UNICEF) Ten Steps to Successful Breastfeeding for Baby-Friendly Hospitals in unselected non-UNICEF certified German hospitals and to examine the influences of breastfeeding promotion on long-term breastfeeding success as assessed by WHO criteria. METHODS: Information on the fulfilment of the Ten Steps was collected in 177 randomly chosen maternity hospitals by a postal questionnaire. Breastfeeding duration was assessed in 1487 mothers delivering in these hospitals. Multiple logistic regression was used to estimate the association between a low breastfeeding promotion index, defined as fulfilment of fewer than five steps, and the risk of short-term breastfeeding, less than 4 mo. RESULTS: A higher breastfeeding promotion index was not associated with early breastfeeding but was significantly associated with full breastfeeding at 4 and 6 mo. After adjusting for confounding factors, delivering in a hospital with a low breastfeeding promotion index was associated with an increased risk of short-term breastfeeding [odds ratio (OR) 1.24], although associations with maternal demographic variables (young age: OR 3.34), low educational level (OR 2.81) and upbringing in East Germany (OR 2.27) were stronger. CONCLUSION: In unselected German hospitals even moderate levels of breastfeeding promotion identified by WHO/UNICEF criteria were associated with long-term breastfeeding success.

Duration of breastfeeding and associated factors in Western and Eastern Germany.

UNLABELLED: Ten years after the German political reunification, specific lifestyle habits still vary between the former Western (FRG) and Eastern (GDR) sectors of Germany. We have analysed data from the first nationwide SuSe Study on breastfeeding 1997-1998 (n = 1593 healthy, term German infants) stratified in a Western (80.3%) and Eastern (19.7%) subgroup. In the Eastern subgroup, breastfeeding was higher for the first 2 wk but decreased more rapidly thereafter. The adjusted relative risk (odds ratios, OR) for short-term breastfeeding was strongly associated (OR >2) with maternal age, supplementary feeding, single parent status, maternal educational status, breastfeeding problems and partner's attitude towards breastfeeding. In the multivariate model, not the geographical location where the mother grew up but the different distribution of risk factors was associated with short-term breastfeeding. Moreover, mothers from both the Western and Eastern sectors mentioned different reasons for giving up breastfeeding. CONCLUSION: More breastfeeding promotion is necessary for women from the former GDR.