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Table 2 Constituent parts of the intervention and measures to promote the implementation

From: Improving hospital hygiene to reduce the impact of multidrug-resistant organisms in health care–a prospective controlled multicenter study

Constituent parts of the intervention Measures to promote the implementation
1. Theoretical and practical training courses for HCWs by the study team in: risk-based MDRO screening, isolation in suspected and confirmed cases of MDRO, treatment of MDRO cases including evidence-based decolonization protocol for MRSA, general measures to prevent MDROs (standard hygienic measures such as disinfection of hands and bed site surfaces, protective clothing) For each hospital, together with the coordinator on-site, several alternative appointments were set up for each training course. Thus, it was possible that nearly all HCWs of the participating wards could join the courses. The courses were registered by the medical associations as advanced training, which adds to the attractiveness of the course.
2. Instructions on treatment of MDRO including an evidence-based decolonization protocol for MRSA ( The first line therapy for MRSA decolonization in the HARMONIC intervention was Mupirocin nasal ointment. In case of Mupirocin-resistance, polihexanide nasal ointment was used. For antisepsis of buccal cavity octenidine is used, alternatively polihexanide.) The computer-assisted system ensures the implementation of the intervention by a step by step guidance. Pocket cards for the decolonization protocol for MRSA were provided.
3. Instruction courses by the study team for physicians on the recommendations for use of antibiotics Several alternative appointments were offered to achieve a high participation rate. The courses were registered by the medical associations as advanced training, which adds to the attractiveness of the course.
4. Provision of detailed information material on the intervention A folder with the course material was available on each ward. Information was additionally provided via a study website (separate log in for intervention hospitals).
5. Posters to intervention measures and application of study instruments They function as a reminder.
6. Pocket cards for screening regime and decolonization protocol, see also point 2. They function as a reminder.
7. Periodic on-site visits by the study team to provide advisory support on the implementation of the intervention measures and documentation of the improvement The documentation was done via table structure and text fields. Feedback on performance was given (sources: on-site visits and monitoring process)
8. Provision of a “hotline” for questions to the intervention measures, manned by experts in hospital hygiene, who belonged to the study team Requests of HCWs of the participating wards to single intervention measures could be answered timely. Furthermore, questions were documented anonymously and are used in the evaluation process of the study.
9. Provision of information material for patients (booklets on different MDROs) The material supports patient information and education.