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Background Effective hand hygiene is one of the most important measures for protecting nursing home residents from nosocomial infections. Infections with multi-resistant bacteria’s, associated with healthcare, is a known problem. The nursing home setting differs from other healthcare environments in individual and organisational factors such as knowledge, behaviour, and attitude to improve hand hygiene and it is therefore difficult to research the influential factors to improve hand hygiene. Studies have shown that increasing knowledge, behaviour and attitudes could enhance hand hygiene compliance in nursing homes. Therefore, it may be important to examine individual and organisational factors that foster improvement of these factors in hand hygiene. We aim to explore these influences of individual and organisational factors of hand hygiene in nursing home staff, with a particular focus on the function of role modelling by nursing managers. Methods We conducted a mixed-methods study surveying 165 nurses and interviewing 27 nursing managers from nursing homes in Germany. Results Most nurses and nursing managers held the knowledge of effective hand hygiene procedures. Hygiene standards and equipment were all generally available but compliance to standards also depended upon availability in the immediate work area and role modelling. Despite a general awareness of the impact of leadership on staff behaviour, not all nursing managers fully appreciated the impact of their own consistent role modelling regarding hand hygiene behaviours. Conclusion These results suggest that improving hand hygiene should focus on strategies that facilitate the provision of hand disinfectant materials in the immediate work area of nurses. In addition, nursing managers should be made aware of the impact of their role model function and they should implement this in daily practice.

Hand hygiene measures are essential to protect nursing home residents against nosocomial infections. Evidence on the prevention of nosocomial infections for nursing home residents by general practitioners during their medical visits in nursing homes or how they enable nursing home residents to perform hand hygiene measures is lacking. This study aimed to explore hand hygiene behaviors of general practitioners in nursing homes, their attitudes toward infection prevention measures, and the enablement of nursing home residents in performing hand hygiene measures. Semi-structured interviews were conducted with general practitioners and nursing home residents in Germany. Interviews were audio-recorded and transcribed. Data were analyzed using thematic content analysis. Overall, 12 general practitioners and 12 nursing home residents participated in the study. The general practitioners expressed the fact that the possibilities for practicing hand hygiene differ in individual nursing homes. For nursing home residents, the availability of hand rub solutions was limited. Instructions for residents on hand disinfection from general practitioners was not described. Due to the lack of enablement, the residents' knowledge on how to correctly perform hand hygiene was low, although some of the nursing home residents have experience with multidrug-resistant organisms. The nursing home residents varied in their needs for active participation and enablement during the general practitioners visit. Nursing home residents require continuous enablement by their general practitioners to maintain adequate hand hygiene. Therefore, general practitioners should consider the different needs of nursing home residents to ensure adequate individual hand hygiene and safety for the residents. Existing guidelines for infection prevention and control do not adequately cover the nursing home care setting for the enablement of residents to enquire about hand hygiene.

Inter-professional teamwork is a prominent factor in quality of care and may lead to improved patient safety. Although team members' points of view are highly relevant when trying to improve inpatient procedures, there is a lack of systematic assessment of their perceptions. Therefore, study aims were to explore inter-professional teamwork, safety-related behavior, and patient safety in German hospitals from team members' point of view. Furthermore, we wanted to examine the association between inter-professional teamwork and safety-related behavior as well as the association between inter-professional teamwork and patient safety. We used cross-sectional pre-intervention data of a multicenter longitudinal study (German KOMPAS project). We gathered descriptive statistics for sample characteristics and to describe the current state of inter-professional teamwork, safety-related behavior, and patient safety. We used one-way variance analyses to assess differences between groups, and linear regression analyses to examine the association between inter-professional teamwork and the outcomes safety-related behavior, and patient safety. 326 inpatient care team members participated in the study. Participants perceived a moderate to high level of inter-professional teamwork, and a moderate level of patient safety. Moreover, they reached rather high values in safety-related behavior. Professional group, work experience, and period of employment had an impact on the perceptions of inter-professional teamwork, and patient safety. Higher inter-professional teamwork was associated with better patient safety. We did not find an association between inter-professional teamwork and safety-related behavior. Based on the association between inter-professional teamwork and patient safety, we recommend the implementation of team interventions. Because professional group, period of employment, and work experience had an impact on the perceptions of inter-professional teamwork and patient safety, we suggest future qualitative research to explore reasons for caregivers' critical evaluation. Moreover, we recommend longitudinal studies to reveal causal relationships, and subsequently to determine areas of improvement for a safer health care.

Aim To measure safety performance, situational judgement test, which is a method composed of job‐related situations, can be used. This study aimed to develop and test its psychometric properties by measuring the safety performance of healthcare professionals in German hospitals. Design An explorative cross‐sectional study. Methods A team of researchers, nurses and physicians developed seven items, which focus on different safety areas. Descriptive statistics were calculated for each item. Cronbach's alpha was calculated as an indication of internal consistency. Spearman's correlation between the items was evaluated as analysis of construct validity. A cross‐sectional survey with healthcare professionals in three German hospitals was conducted to test the developed instrument. Results A total of 168 healthcare professionals participated (response rate: 39.1%). 70.2% were women, and 38.7%, 33.9%, 15.5% and 11.3% were registered nurses, nurses in training, physicians and other healthcare professionals respectively. The situational judgement test demonstrated an acceptable psychometric performance.

Improving patient safety and reducing occupational accidents are two of the main challenges in healthcare. Instruments to measure safety performance and occupational safety are rare. This study aimed to prepare and validate a German version of the adapted workplace health and safety instrument to assess the safety performance of healthcare professionals. Overall, 168 healthcare professionals participated in this explorative cross-sectional study. The instrument consists of 16 items related to safety performance in four dimensions. We calculated mean values and standard deviations for each individual item and those of the four dimensions of the instrument. We evaluated internal consistency and construct validity, explored the dimensionality of the instrument through exploratory factor analysis, and tested how our data fit with the original model with confirmatory factor analysis. Among the participants, 73.8% were nurses and nurses in training, with the majority of the sample being female (71.9%) and younger than 30 (52.5%). Cronbach’s alpha for all four dimensions was >0.7. All items were loaded on factors according to the original theoretical model. Confirmatory factor analysis showed good model fit (normed χ²/df = 1.43 (≤2.5), root mean square error of approximation = 0.06 (≤0.07), goodness of fit index = 0.90 (>0.90), comparative fit index = 0.95 (≥0.90), and Tucker–Lewis index = 0.93 (>0.90). The German version of the instrument demonstrated acceptable properties and was a good fit to the original theoretical model, allowing measurement of healthcare professionals’ safety knowledge, motivation, compliance, and participation.

Nosocomial infections and multidrug-resistant organisms are an increasing problem in nursing homes worldwide; therefore, new approaches for infection control need to be developed. This article gives an overview of infections in nursing homes, their medical treatment and previous measures for infection prevention. The article is based on a selective literature search including the literature database PubMed. In particular, scientific studies on the prevalence of nosocomial infections in German nursing homes, publications for medical care in long-term care facilities in Europe and international studies for infection prevention were evaluated. The basis for an effective reduction of infections is the establishment of a surveillance system. All participating medical professionals provide feedback about local infections and resistance situations and the presence of risk factors, such as urinary catheters or chronic wounds. Only then can targeted antibiotic strategies be adapted and the effectiveness of preventive measures, such as hand disinfection is continuously reviewed. So far, in particular multimodal, multidisciplinary prevention projects were successful. These included frequent staff training, reduction of urinary catheters and a rational use of antibiotics. Most prevention models have been previously tested in hospitals. A possible applicability of the results to the infection prevention in long-term care facilities has so far hardly been studied. Accordingly, further studies on infection control in nursing homes are absolutely necessary.

Healthcare professionals need specific safety performance skills in order to maintain and improve patient safety. The purpose of this study is to get a deeper understanding of healthcare professionals’ perspective in acute care on the topic of safety performance. This study was conducted using a qualitative approach. Healthcare professionals working in nursing were interviewed using semi-structured interviews. Using content analyzing, categories were identified which present aspects of safety performance; subcategories were developed deductively. A total of 23 healthcare professionals were interviewed, of which 15 were registered nurses, five were nursing students and three were pedagogical personnel. Nine (39.1%) were <30 years old, 17 (73.9%) were female, and 9 (39.1%) had a leadership function. Results highlight the importance of safety performance as a construct of occupational health rather than of patient safety, and the role of the organization, as well as the self-responsibility of healthcare professionals. Healthcare professionals should be more conscious of their role, have a deeper understanding of the interaction of individual, team, patient, organization and work environment factors.

Zusammenfassung Hintergrund Nosokomiale Infektionen und multiresistente Erreger sind weltweit eine zunehmende Problematik in Altenpflegeheimen. Daher müssen neue Konzepte zur Infektkontrolle entwickelt werden. Ziel der Arbeit Dieser Artikel zeigt einen Überblick über Infektionen in Altenpflegeheimen, deren medizinische Versorgung und bisherige Maßnahmen zur Infektionsprävention. Material und Methoden Die Arbeit basiert auf einer selektiven Literaturrecherche unter Einbeziehung der Literaturdatenbank PubMed . Dabei wurden insbesondere wissenschaftliche Untersuchungen zur Prävalenz von nosokomialen Infektionen in deutschen Altenpflegeheimen, Publikationen zur medizinischen Versorgung von Langzeitpflegeeinrichtungen und internationale Studien zur Infektionsprävention ausgewertet. Ergebnisse Die Grundlage für eine effektive Reduzierung von Infektionen ist die Einführung eines Surveillance-Systems. Dabei geben alle beteiligten medizinischen Fachkräfte regelmäßig eine Rückmeldung zur lokalen Infektions- und Resistenzlage und dem Vorhandensein von Risikofaktoren wie z. B. Harnwegskatheter oder chronische Wunden. Nur so können gezielt Antibiotikastrategien angepasst und die Effektivität von Präventionsmaßnahmen wie Händedesinfektion kontinuierlich überprüft werden. Bisher waren insbesondere multimodale, interdisziplinäre Präventionsvorhaben erfolgreich. Dazu gehörten regelmäßige Personalschulungen, Reduzierung von Harnwegskathetern sowie ein rationaler Einsatz von Antibiotika. Diskussion Die meisten Präventionsmodelle wurden bisher in Krankenhäusern getestet. Eine mögliche Übertragbarkeit der Ergebnisse auf die Infektionsprävention in Langzeitpflegeeinrichtungen ist bisher kaum untersucht. Daher sind unbedingt weitere Studien zur Infektkontrolle in Altenpflegeheimen notwendig.

Zusammenfassung Hintergrund Nosokomiale Infektionen und multiresistente Erreger sind weltweit eine zunehmende Problematik in Altenpflegeheimen. Daher müssen neue Konzepte zur Infektkontrolle entwickelt werden. Ziel der Arbeit Dieser Artikel zeigt einen Überblick über Infektionen in Alten pflegeheimen, deren medizinische Versorgung und bisherige Maßnahmen zur Infektionsprävention. Material und Methoden Die Arbeit basiert auf einer selektiven Literaturrecherche unter Einbeziehung der Literaturdatenbank PubMed. Dabei wurden insbesondere wissenschaftliche Untersuchungen zur Prävalenz von nosokomialen Infektionen in deutschen Altenpflegeheimen, Publikationen zur medizinischen Versorgung von Langzeitpflegeeinrichtungen und internationale Studien zur Infektionsprävention ausgewertet. Ergebnisse Die Grundlage für eine effektive Reduzierung von Infektionen ist die Einführung eines Surveillance-Systems. Dabei geben alle beteiligten medizinischen Fachkräfte regelmäßig eine Rückmeldung zur lokalen Infektions- und Resistenzlage und dem Vorhandensein von Risikofaktoren wie z. B. Harnwegskatheter oder chronische Wunden. Nur so können gezielt Antibiotikastrategien angepasst und die Effektivität von Präventionsmaßnahmen wie Händedesinfektion kontinuierlich überprüft werden. Bisher waren insbesondere multimodale, interdisziplinäre Präventionsvorhaben erfolgreich. Dazu gehörten regelmäßige Personalschulungen, Reduzierung von Harnwegskathetern sowie ein rationaler Einsatz von Antibiotika. Diskussion. Die meisten Präventionsmodelle wurden bisher in Krankenhäusern getestet. Eine mögliche Übertragbarkeit der Ergebnisse auf die Infektionsprävention in Langzeitpflegeeinrichtungen ist bisher kaum untersucht. Daher sind unbedingt weitere Studien zur Infektkontrolle in Altenpflegeheimen notwendig.

Background Filamentous cyanobacteria that differentiate multiple cell types are considered the peak of prokaryotic complexity and their evolution has been studied in the context of multicellularity origins. Species that form true-branching filaments exemplify the most complex cyanobacteria. However, the mechanisms underlying the true-branching morphology remain poorly understood despite of several investigations that focused on the identification of novel genes or pathways. An alternative route for the evolution of novel traits is based on existing phenotypic plasticity. According to that scenario – termed genetic assimilation – the fixation of a novel phenotype precedes the fixation of the genotype. Results Here we show that the evolution of transcriptional regulatory elements constitutes a major mechanism for the evolution of new traits. We found that supplementation with sucrose reconstitutes the ancestral branchless phenotype of two true-branching Fischerella species and compared the transcription start sites (TSSs) between the two phenotypic states. Our analysis uncovers several orthologous TSSs whose transcription level is correlated with the true-branching phenotype. These TSSs are found in genes that encode components of the septosome and elongasome (e.g., fraC and mreB ). Conclusions The concept of genetic assimilation supplies a tenable explanation for the evolution of novel traits but testing its feasibility is hindered by the inability to recreate and study the evolution of present-day traits. We present a novel approach to examine transcription data for the plasticity first route and provide evidence for its occurrence during the evolution of complex colony morphology in true-branching cyanobacteria. Our results reveal a route for evolution of the true-branching phenotype in cyanobacteria via modification of the transcription level of pre-existing genes. Our study supplies evidence for the ‘plasticity-first’ hypothesis and highlights the importance of transcriptional regulation in the evolution of novel traits.