title: [Strategies to prevent the transmission of multidrug-resistant pathogens and their practical implementation in oupatient care].
abstract: BACKGROUND
  Multidrugresistant pathogens which are highly relevant for infection control in hospitals and other health-care facilities are a serious public health problem and a big challenge for all players in the health sector. In order to prevent the spread of multi-resistant pathogens the Commission for Hospital Hygiene of the Robert Koch-Institute (RKI) has published guidelines. These recommendations refer to the consequent implementation of an infection control management in all health care settings, including outpatient care. In Germany there are only few data available concerning infection control management and the implementation of preventive strategies in outpatient care.
  
  
  METHODS
  To what extent are national guidelines concerning infection control of multidrugresistant pathogens (i.e. methicillin-resistant Staphylococcus aureus, MRSA) feasible and practicable in outpatient care? And what are the reasons not to practice these strategies.
  
  
  METHODS
  In outpatient care the status of the infection control management and the implementation of prevention strategies was surveyed and assessed. Data were collected by structured interviews - a face to face method.
  
  
  RESULTS
  Guidelines concerning infection control management are not always sufficiently implemented in outpatient care. There are multiple reasons for this, such as, e.g., lack of compliance with the recommendations as well as structural problems in the health-care system, and special challenges of outpatient care.
  
  
  CONCLUSIONS
  Implementation of an infection control management concerning multidrug-resistant pathogens in outpatient care is problematic. Prevention strategies are commonly not known or not adequately implemented into daily practice. Actions to improve the situation should focus at the individual level (e.g., trainings in the context of the initiative "clean hands" ), the institutional level (improving networking, bonus schemes) and the social level (financial and legal support for outpatient care centres to bear the expenses of infection control management, "search and destroy").
authors.affiliation: Landratsamt Berchtesgadener Land, Bad Reichenhall. alexandra.adler@lra-bgl.de
authors.forename: A C
authors.initials: AC
authors.lastname: Adler
authors.forename: H
authors.initials: H
authors.lastname: Spegel
authors.forename: J
authors.initials: J
authors.lastname: Wilke
authors.forename: C
authors.initials: C
authors.lastname: Höller
authors.forename: C
authors.initials: C
authors.lastname: Herr
mesh_terms: D001424:Bacterial Infections / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission*; D057189:Checklist; D003140:Communicable Disease Control / Q000191:economics / Q000458:organization & administration* / Q000592:standards*; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission*; D024901:Drug Resistance, Multiple, Bacterial; D005240:Feasibility Studies; D005378:Financial Support; D005858:Germany; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000191:economics; D019538:Health Care Surveys; D006699:Home Care Services; D006707:Homes for the Aged; D006801:Humans; D007318:Inservice Training / Q000191:economics; D055624:Methicillin-Resistant Staphylococcus aureus; D009735:Nursing Homes; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission; D011795:Surveys and Questionnaires