[Medical quality standards for selected urological aids and devices : Consensus for patients with neurogenic urinary bladder dysfunction]. / Medizinische Qualitätsstandards ausgewählter urologischer Hilfsmittel : Konsens für Patienten mit neurogenen Harnblasenfunktionsstörungen.

BACKGROUND: Using the CE mark of therapeutic appliances is, on its own, not sufficient enough for their appropriate and effective application. In order to treat the patient successfully, not jeopardizing the success of the treatment, medical quality criteria for therapeutic appliances care are necessary to acceptably compensate for a patient's disabilities. OBJECTIVES: Medical quality criteria are formulated for the most frequently used urological aids and devices, considering hygienic requirements, international literature and the practical experience of physicians and nurses with regard to the care of patients with neurogenic urinary bladder dysfunction. METHODS: An expert group of urologists, surgeons, rehabilitation physicians and nurses has developed medical quality criteria via a structured consensus procedure. Developing these criteria, the group has taken into account current jurisprudence, the current resource directory of neurourological relevant aids, data from international literature and hygiene requirements. RESULTS: Medical quality requirements are discussed and defined for selected groups of urological devices (single use catheters, indwelling catheters, external catheters, urine bags, templates and diapers as well as devices for the electrostimulation of nerves). CONCLUSION: The presented quality requirements offer the possibility to stabilize quality of care with neurourological relevant therapeutic appliances. The catalogue of therapeutic appliances must be urgently updated. Urinal catheters for single use must be classified as an individual product group. Devices for anterior root stimulation and neuromodulation must be included in the resource directory. The incontinence severity classification needs to be reviewed.

[Objective and subjective requirement of aids and appliances in patients with neurogenic lower urinary tract dysfunction : Multicenter study to determinate the daily necessity of urological aids and appliances]. / Objektiver und subjektiver Hilfsmittelbedarf bei Patienten mit neurogenen Harnblasenfunktionsstörungen : Multicenterstudie zur Ermittlung des täglichen Bedarfs an urologischen Hilfsmitteln.

BACKGROUND: The provision of urological appliances for patients with neurogenic lower urinary tract dysfunction (NLUTD) is essential. Hitherto existing standard guidelines for the estimation of monthly material requirements are based solely on estimates. OBJECTIVE: The goal of this work was to define the objective and subsequently subjective requirements for urological appliances on a scientifically validated basis. MATERIALS AND METHODS: Data concerning bladder management and daily consumption of urological appliances for patients with NLUTD were collected through a standardized survey at six different centers in Germany during the period of October to December 2014 and statistically evaluated. RESULTS: In all, 767 patient records were analyzed: 543 men and 221 woman (N/A = 3). The daily disposable catheter consumption of 577 patients who exclusively used intermittent catheterization was 5.13. Patients who used other means of bladder emptying (n = 31) in addition to catheterization consumed on average 3.17 catheters. The margin of deviation was larger for children. Of the 608 patients with intermittent catheterization, 94 (15.5 %) required additional paddings as absorbent aids (on average 2.29 paddings per day), 34 patients (5.6 %) additionally used pants (2.55 per day) and 46 patients (7.6 %) utilized condom catheters (3.81 per day) between catheterization. Among all surveyed patients, 126 (16.4 %) used paddings (5.03 per day) and 51 patients (6.6 %) pants (3.03 per day). Of all male respondents 82 (15.1 %) used condom catheters (2.80 urinary sheaths per day). CONCLUSION: Applying twice the standard deviation of the mean as a measure of assessing the objective requirement of urological appliances and aids for adult patients with NLUTD allows the following daily thresholds to be defined: 1-9 disposable catheters, 0-7 urinary sheaths, 1-9 paddings and 0-7 pants. These thresholds can serve as a basis for estimating the subjective need. They allow for a scientifically validated benchmark for an economically feasible and patient-tailored supply with urological aids and appliances. Individually required appliances and aids have to be recognized. Verifiable quality standards need to be developed.

[S2k guidelines of the German Society of Urology. Management and implementation of intermittent catheterization in neurogenic bladder dysfunction]. / S2k-Leitlinie der Deutschen Gesellschaft für Urologie. Management und Durchführung des intermittierenden Katheterismus bei neurogenen Blasenfunktionsstörungen.

BACKGROUND: As a considerable heterogeneity in the procedure of intermittent catheterization (IC) was identified by a questionnaire survey conducted in hospitals and institutions for the treatment of patients with spinal cord injury in 2010, it became necessary to standardize the IC procedure (i.e. self-catheterization and assisted catheterization). METHOD: These guidelines were developed within a structured consensus process (e.g. several consensus conferences and nominal group process) by members of the working group on neurourology (Arbeitskreis Neuro-Urologie) and the working group on nursing (Arbeitskreis Pflege) of the German-speaking Medical Society of Paraplegia (DMGP), a section of the German Society for Orthopedics and Traumatology (DGOU) and were published as S2k guidelines of the German Society of Urology (DGU). The guidelines developer group consisted of representatives from the following professional groups: neurourology, surgery, health and nursing, nursing science, urotherapy and hygiene. RESULTS: Firstly, the indications for IC are presented and concepts such as sterile, aseptic and hygienic catheterization are defined. The materials necessary for the IC (e.g. quality of the customized single-use catheter and approved disinfectants for disinfection of the meatus) are presented in detail. The disinfection and catheterization techniques are described and a detailed explanation of the potential complications and their management is given. Finally, the legal aspects and issues of eligibility of catheter material and disinfectants are discussed. CONCLUSIONS: The purpose of this consensus is to contribute to the standardization of IC. It should remove uncertainty and offer assistance to users (i.e. patients, staff and care providers). A particular focus is placed on practical instructions for carrying out the IC. The intention is to support the realization of IC in various settings (e.g. hospital, rehabilitation, long-term care institutions and home-based care). A wide implementation of the guidelines should lead to a reduction of the risks and complications of IC, which in most cases is a procedure that will be necessary throughout life.

Successful control of methicillin-resistant Staphylococcus aureus in a spinal cord injury center: a 10-year prospective study including molecular typing.

STUDY DESIGN: Prospective cohort study with medical record review. OBJECTIVE: To evaluate the clinical utility of an infection control program in a patient cohort at high risk for methicillin-resistant Staphylococcus aureus (MRSA) infection and to identify risk factors interfering with successful decolonization of MRSA. SETTING: All spinal cord injured (SCI) patients hospitalized at the Swiss Paraplegic Center (SPC) Nottwil from April 1991 to April 2001. METHODS: Patients whose medical records indicated laboratory-confirmed MRSA colonization or infection were included. Incidence of MRSA colonization or infection was classified as community acquired, nosocomial or transferred based on standardized criteria. Risk factors for community-acquired MRSA colonization in SCI patients were determined. MRSA subtyping and identification of nosocomial spread was performed through pulse-field gel electrophoresis (PFGE). RESULTS: Of 5992 admissions, 100 episodes of MRSA (colonization 22 cases, infection 78 cases) were identified among 76 patients. Overall incidence (1991-2001) per 1000 patient days was 0.26 cases on admission compared to 0.08 at discharge (P<0.001). Community-acquired MRSA was most frequent (56%) followed by nosocomial acquisition (34%). PFGE subtyping identified two nosocomial clusters with six and three cases, respectively. Most of community-acquired MRSA isolates were genetically unrelated and also distinct from epidemic strains identified in Switzerland during the study period. Decolonization was successful in 60 of 76 (78.9%) MRSA-positive patients. CONCLUSION: In the largest European SCI center, MRSA controlling is feasible if infection control policies are vigorously applied.

Sensation of defecation in patients with spinal cord injury.

STUDY DESIGN: For this study, a descriptive, explorative design was used. OBJECTIVES: As a result of spinal cord injury (SCI) patients may have a partial or complete loss of the sensations of defecation. To compensate this impairment, nurses initiate bowel management programs. Therefore, they need information about sensations of defecation. Accordingly, the research questions explore which sensations of defecation are reported by patients with SCI and whether they can be used to improve bowel care. SETTING: The Gemeinschaftskrankenhaus Herdecke and the Berufsgenossenschaftlichen Kliniken Bergmannsheil in Bochum, Germany. METHODS: A convenience sample of 27 patients with SCI was interviewed using a semistructured questionnaire. For data analysis, the frequency of the reported sensations was counted. RESULTS: The results of the study show that the participants' defecation was indicated by abdominal sensations (n=20) or a prickling sensation (n=11) emerging mainly in the head. Additional signals comprised increased spasticity (n=10), cutis anserina (n=8) and sweating (n=6). Seventeen participants sensed actual defecation and 15 perceived its cessation. Six participants were able to initiate defecating according to their sensations. CONCLUSIONS: The assessment of sensations of defecation in patients with SCI may indicate whether a bowel-management program with a consistent schedule for defecation is needed or if physiological defecation can be trained.

Bowel management in patients with spinal cord injury -- a multicentre study of the German speaking society of paraplegia (DMGP).

STUDY DESIGN: A descriptive, cross-sectional, multicentre design was used. OBJECTIVE: To analyse bowel management in patients with spinal cord injury (SCI) especially the occurrence of unplanned bowel evacuations and duration of planned bowel evacuation. SETTING: In total, 29 rehabilitation facilities for SCI patients in Austria, Germany, the Netherlands and Switzerland, with a total of 837 hospitalized SCI patients. METHOD: Data were collected by nurses within 1 week in November 2001 using a quantitative questionnaire containing 14 questions. For data analysis, a chi (2)-test was used for differences in the outcome of bowel evacuation procedures associated with different interventions. Stepwise multiple logistic regression was used to analyse the relationship between the outcome of bowel management and the interventions as well as intervening factors. RESULTS: More unplanned bowel evacuations were associated with usage of oral laxatives (n=444, P<0.001) as well as bowel evacuation every day (n=270, P<0.05) or every second day (n=368, P<0.05). The outcome of less unplanned bowel evacuations was associated with manual removal of stool combined with digital stimulation (n=35, P<0.05) and spontaneous bowel evacuations (n=104, P<0.001). Short duration of bowel evacuation (<60 min) was associated with manual removal of stool (n=64, P<0.05), the sitting position at defecation (n=494, P<0.001) and low frequency of bowel evacuation (>or=3 days) (n=638, P<0.05). Duration >60 min was associated with the use of oral laxatives (n=444, P<0.001) and complete loss of sensory function (n=349, P<0.05). Stool of hard consistency was associated with the manual removal of stool (n=64, P<0.001), the manual removal of stool in combination with digital stimulation (n=53, P<0.001) and the sitting position at defecation (n=494, P<0.05). Stool of soft consistency (n=341) was associated with the complete motor lesion (n=443, P<0.05). CONCLUSION: Manual removal of stool was combined with low risk of unplanned bowel evacuations and short duration of evacuation time. These results are useful to improve the outcomes of bowel management in SCI patients.

[Measures to promote hygiene in geriatric and long-term care]. / Hygienemassnahmen in der Alten- und Langzeitpflege.

For hospitals, the Directives for Hospital Hygiene and Prevention of Infection issued by the Robert Koch Institute represent clear and well formulated hygiene guidelines in terms of a set of rules. However, for long-term care facilities there are no standard hygiene procedures, and the above mentioned guideline recommendations are difficult to apply to geriatric and long-term care as well as to rehabilitation. It is left to the institutions themselves to determine the role of hygiene and prevention of infection. Framework guidelines are provided in the Protective Law on Infections and the hygiene requirements contained therein. However, there are no suggestions on how to actually implement the hygiene requirements. This article demonstrates one way in which the protective law might be transferred and used in practice based on the classic procedures of quality management. This is explained as a step-by-step, planned process. The appendix contains one possible structure and excerpts from a control checklist.

[Central and decentralized aspects of the development and implementation of a concept of quality]. / Entwicklung und Umsetzung eines Qualitätskonzeptes mit zentralen und dezentralen Aspekten.

This article presents component parts of quality concepts of the nursing administration in the Swiss Paraplegic Centre Nottwil. These concepts are based on centralised and decentralised methods of quality assurance and improvement. Both methods were modified so as to compensate for their disadvantages. Thereby the demand for systematic scientific control, which is set out in the Swiss health insurance laws, can be achieved. For this purpose a general framework of quality requirements specific to the institution for rehabilitative nursing was developed along with nursing quality standards for specific topics. By both methods, the emphasis is on the inclusion of staff in the development as well as in scrutiny of quality criteria/requirements. In this way a high level of acceptance of quality criteria will be reached among the staff. The quality concept presented here reflects the vision that quality should not be seen as a heavy burden but as an every-day necessity.