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Projects from April 2005 PSBH workshop on nosocomial infections 




A PSBH Workshop on Hospital Hygiene and Nosocomial Infections was held in Dobritch on November 11-13, 2005. The workshop was organized by Dreyfus Health Foundation, New York, USA, the Association for Better Health - Pleven, the Regional Hospital in Dobritch, the Bulgarian-Swiss Hospital Hygiene Project and the Medical University - Pleven. Doctors, nurses, midwives, epidemiologists from the hospital participated.  

The participants were addressed by Dr. Zhanina Kalinkova - executive director of the hospital, Dame Sheila Quinn - international nursing program consultant - Dreyfus Health Foundation, and Mrs. Yanka Tzvetanova - president of the Associaton for Better Health. The presentation of Dr. Emilia Kanyovska of Pleven University Hospital was focused on problems and solutions regarding hospital hygiene and the role of each member of hospital staff in the maintenance of high standards of hygiene and prevention of in-hospital infections.  

With the assistance of Dame Sheila Quinn, and the local facilitators Assoc. Prof. Maria Alexandrova, Assoc. Prof. Angelika Velkova, Mrs. Yanka Tzvetanova, Dr. Emilia Kanyovska (Medical University - Pleven), Mrs. Polya Zhivkova (Alexandrovska Hosptal - Sofia), Assoc. Prof. Lyudmila Angelova and Mrs. Gergana Momova (Medical University - Varna) and Dr. Zhanina Kalinkova and Mrs. Zhana Angelova (Dobritch Regional Hospital) the participants prepared the following plans of action:   

  • Improving patient compliance in an orthopedic unit Mrs. Atanaska Atanasova 

  • Decreasing the risk of transfection in ophthalmologic unit - Atanaska Nikolova 

  • Decreasing the rate of sexually transmitted infections - Dr. Borislav Darlenski 

  • Health education program for patients with chronic renal failure - Valentina Zhelyazkova 

  • Decreasing the risk of postoperative complications in eye surgery - Ghinka Petkova 

  • Prevention of bed ulcers in patients after extensive abdominal surgery - Diana Angelova 

  • Decreasing the rate of in-hospital infections in risk full-term and premature newborns - Dimitrichka Sariiska 

  • Prevention of secondary healing of operative and lacerative wounds - Dr. Diyan Dekov 

  • Improving on the quality of hand disinfection of patients and staff - Dobrinka Toncheva 

  • Increasing the level of knowledge of rehabilitators on in-hospital infections in ICU patients on artificial breathing - Donka Angelova 

  • A program to decrease inexpedient use of consumables - Elena Marinkova 

  • Prevention of decubital ulcers in elderly orthopedic patients - Elenka Petrova 

  • Improvement of nursing care quality through a training program on timely recognition of in-hospital infections - Zhana Angelova 

  • A program to regulate delivery of instruments for sterilization - Zhivka Stefanova 

  • A program for stress management in newly diagnosed cancer patients - Dr. Zyuhal Kassimova 

  • A training program to decrease the risk of transmission of infections when working with an intravenous pathway - Ivelina Nikolova 

  • A health-education program for tuberculosis patients to reduce the risk for medical staff - Yordanka Darlenska 

  • Decreasing the number of newborns carriers of E.coli  - Yordanka Stoyaova-Vassileva 

  • Improvement of communication between hospital wards and the clinical laboratory - Kamelia Petrova 

  • A rehabilitation program for diabetics and patients with metabolic disorders to increase blood sugar level control and prevent late complications - Kitchka Ivanova 

  • Improvement of skills of staff to recognize in-hospital infections in risk words  

  • Margarita Petrova, Dr. Krassimir Stoilov 

  • A health-education program for medical staff on self-protection from acute respiratory infections - Marina Vassileva 

  • Prevention of decubital ulcers in coma patients - Maria Georgieva 

  • A program to provide proper hand disinfection among in-hospital patients of an infectious disease unit - Milena Ivanova 

  • A training program on elementary physical rehabilitation skill in nurses of an ICU to prevent decubital ulcers in patients on artificial breathing - Dr. Michail Michailov 

  • A program to decrease uroinfections in postoperative patients - Nedyalka Ilieva 

  • Optimizing the use of consumables in the ICU to reduce costs and nosocomial infections - Nikolinka Dobreva 

  • A program to increase the rate of early registration of in-hospital infections in an ICU - Dr. Nina Beshkova 

  • Introduction of sterile disposable consumables to prevent infections in patients after eye surgery - Dr. Nina Nyagolova 

  • A program to improve on hand disinfection among medical staff of a dermatology unit - Petar Shishkov 

  • A program to improve on the rates of early diagnosis of urology problems I n men over 50 - Dr. Plamen Kirilov, Martina Pavlova 

  • An information program regarding the rules of admission to the operating areas - Raina Stoeva 

  • Improving on skills for proper hand disinfection of operating nurses - Rouska Vassileva 

  • A health education program for syphilis patients - Svetla Indjieva 

  • A health education program for pregnant women not attending prenatal clinics on the risks of infections newborns - Svetlana Todorova 

  • Reduction of improper collection of urocultures in patients on artificial breathing - Sibilla Vassileva 

  • Reduction of late detection of in-hospital infections in ENT unit patients - Snezhana Velikova 

  • Improvement of adaptation of patients after brain incidents - Tanya Georgieva 

  • Regulation of access of outpatients to the orthopedic hospital unit - Dr. Timothey Zlatkov 

  • A health education program to motivate the families of stroke patients to prevent decubital ulcers and severe complications - Yanka Gospodinova 

  • Reduction of stress among children under seven, admitted for treatment in hospital - Yanka Kostadinova 

  Note! You can visit www.livebg.net/psbh-digest, where you can see some pictures from workshops and projects, as well as all previous issues of the digest.  


Please send your suggestions and materials which you find useful for improving health, or send materials with experience you would like to share with the recipients of the Digest  - workshop participants, medical schools and nursing colleges, to abh-psbh-bg@el-soft.com 


The board of the Association for Better Health will appreciate your comments, recommendations and consideration for future collaboration. 



Projects from April 2005 PSBH workshop on nosocomial infections 



Providing enough sterile cannulas for patients undergoing surgery at the eye clinic of University Hospital Pleven 

Mrs. Boyanka Groshevska 


For two months, a group of 120 patients operated on in the clinic were covered by the project activities. The team built the head of the clinic, the senior nurse and all the nurses at the clinic made sure sterile disposable cannules were provided. The team is to evaluate the results by comparing the rate of postoperative complications in the target group with that of a control group of patients operated on in a six-month period before the implementation of the project.  



Introduction of transparent fixing pads for children with permanent peripheral venous catheters treated at the pediatric clinic 

Mrs. Vanya Dobreva  


The project was implemented by a team of six nurses in the pediatric clinic of the University Hospital in Pleven. Transparent fixing pads ensure safe and aseptic placement of the catheter, allowed for better control, reduced trauma and reduced costs. 

The implementation of the project helped to reduce replacements of intravenous catheters in children treated at the clinic by 50%. 



A training program to introduce standard protocols for proper hand washing and disinfection for health personnel of the risk pregnancy clinic 

Mrs. Vanya Zacharieva 


All midwives at the clinic were informed about the aims of the project. An information brochure was prepared and printed, and two information boards with materials on the risks for staff when treating patients with infections and on the importance of proper hand disinfection in such cases.  The projects activities are still carried out, and currents estimates show that such infections among medical personnel have been reduced by 50%.  



A training program for improving compliance of staff with protocols for carrying out intravenous procedures on risk patients 

Mrs. Daniela Georgieva   


The project was implemented by a team of eight nurses at the clinic of narcology, department of psychiatry. A standard protocol was prepared with detailed instructions on rules for intravenous procedures (blood sample collection, infusions) in patients suspected for or diagnosed with hepatitis B and C. Two training sessions were organized with the nurses, and quality of performance during procedures carried out was then measured by the senior nurse. Properly performed procedures were observed in 97% of the cases. In addition, proper disposal of waste after procedures was achieved at the clinic. 



Health education program for new hemodialysis patients on proper hygiene of peritoneal catheter 

Mrs. Dechka Nikolova 


So far, the project activities have covered ten patients on peritoneal hemodialysis. An individual follow-up chart was made for each patient. An information brochure was prepared, printed and handed to the patients, with explanations as to proper handling the catheter in peritoneal dialysis. Individual talks and training sessions were carried out with each of these patients.  

Of the ten patients in the target group, only two were readmitted to hospital on account of catheter-related infection. The evaluation sheet, including questions on project activities and their relevance showed all the ten patients were positive that the program was useful.  

The education and training program is to continue as routine practice in the treatment and nursing care for patients on peritoneal dialysis.  



A training program to improve compliance with proper hand disinfection protocol 

  Dr. Ghinka Ivanova 


The project was implemented with the assistance of the senior midwife and the whole team of doctors at the clinic of the clinic of gynecology. An initial inquiry was carried out with 60 patients to measure the level of their knowledge on in-hospital infections and the way they can be transmitted. The same group of women were instructed by the midwives how to use the dispensers with fluid for hand disinfection.  

Improvement of hand disinfection hygiene habits in these sixty women was found. In addition, the medical staff has demonstrated positive attitude to proper hand disinfection and following the protocols for both patients and staff.  



A training program for link-doctors on definition and registration of nosocomial infections 

Dr. Emilia Kanyovska, Hospital Epidemiologist  


The project was implemented by a team of the hospital epidemiologist and the two nurses responsible for hospital hygiene activities.  

The program activities were addressed to 36 link-doctors, responsible for prevention an control of in-hospital infections at their respective clinics.  

A handbook on prevention and control of in-hospital infections was written and printed. A standardized system definitions and criteria for hospital infections was introduced.  

As a result of the project activities, all link doctors have demonstrated excellent knowledge on criteria and definitions of in-hospital infections.  



Introduction of routine antiseptic treatment of delivery pathways for women admitted to the clinic to prevent perinatal and postnatal infections in babies 

Dr. Michail Tzvetkov 


The project was started in October 2005, with the participation of all doctors and midwives at the maternity clinic. Antiseptic treatment was introduced for the soft delivery pathways with 0.25% solution of chlorhexidine at every vaginal examination during delivery.  

Registration was made of each case of puerperal infections in women, and early neonatal infections in newborns.  

The final results are to be known by the end of April 2006. 



A training program for general practitioners on proper techniques of urinary cathetherization in male patients 

Dr. Orlin Michailov 


A brochure with instructions and illustrations was prepared and distributed among 300 general practitioners in the Pleven region. The team also presented the effective antibacterial agents for treatment of uroinfections.  Follow-up proved 30% reduction of urinary infections in patients catheterized by general practitioners included in the program.  



Health education on the risks of promiscuous sex for 100 girls and 50 young women 

Mrs. Roumyana Koleva 


Lectures and talks were given to 100 girls in the eighth grade (15 years old) attending a dress-making vocational school in Pleven, regarding risks of casual sex and the importance of regular gynecological check-ups. Brochures on the hygiene of sex and risks of late detection of cancer of cancer of female sex organs were prepared, printed and distributed to gynecology consulting rooms in Pleven.  

In collaboration with the general practitioner in Bukovlak (a village near Pleven), 50 females in reproductive age were included in the program. With the assistance of Dr. Chavdar Tzvetkov (a gynaecologist and oncosurgeon) women were given consultations.  

Results demonstrating increase in the level of knowledge on the problem of reproductive health, and the team plans to expand the program to all women in fertile age in Pleven region to increase the rate of turn up for gynecological examinations with pap-smear tests.  



An information program to reduce non-compliance with disinfection of bronchoscopy equipment 

Dr. Stefan Stanimirov  


The project was implemented with the support of the management of the lung disease clinic in Pleven. Funds were provided to purchase a new biopsy set and a device for cleansing the canal bronchoscope after each patient. 

A standard protocol was prepared on disinfection procedures and regular supplies of disinfection agents are provided to the team carrying out biopsy at the clinic.  



Regulating the admission of visitors to surgical patients 

Mrs. Emilia Minkova 


The project team introduced a program to reduce the risks of infections in surgical patients due to uncontrolled flow of visitors. Instructions were printed for visitors, and dispensers with hand disinfection fluid were installed. A new disinfection schedule was introduced on days and during hours when visitors are allowed to the clinic. Protocols were introduced for partial regulation of visits to surgical patients depending on the risk of passing of infections from outside the hospital to newly operated patients.  

The project activities are carried out by all nurses, cleaners and the link doctor. During the period following the implementation of the project, the rate of infections transferred to surgical patients by visitors was reduced by 25%.  


Raising compliance of staff with standardized protocols for delivery of sterilized gear from sterilization unit to clinics 

Mrs. Iliana Vitanova 


The project aims to introduce a new system of collection and delivery of materials for sterilization at the Central Sterilization Unit. A record of proceedings was introduced that allows to follow-up the hand-overs and deliveries of materials. The introduction of the new system covered ten consecutive departments, providing enough time to overcome negative attitudes to the new system.  

The project helped achieve better follow-up of activities regarding connections of clinics with the central sterilization unit, as well as providing enough sterilized materials needed by these clinics. 



A training program on proper disinfection procedures for nurses and hygiene support workers at the clinic  

Mrs. Yordanka Stoyanova 


An anonymous inquiry was carried out at the clinic of gastroenterology to measure the level of knowledge and skills of nurses and cleaners regarding disinfection and prevention of in-hospital infections .On the basis of information from the inquiry, a training program was made including lectures, practical training and printed materials with readings on new methods of disinfection of equipment.  

The second test showed good level of knowledge in all members of the staff participating in the training. As a result of the project, all rules for hygiene and disinfection are strictly abided to. 

Microbiological tests carried out by the hospital epidemiology and hygiene control unit did not detect pathological organisms. 



A health educational program on prevention of postoperative infections 

Mrs. Mariyana Dimitrova 


The project was implemented at the second clinic of surgery at the university hospital. Forty patients with sterile surgical wounds were included, with whom waterproof sterile stickers were used. The stickers allowed for better control on the wound, significantly reduced the risk of infections and did not provoke allergic reactions. Current evaluation showed that 40% reduction of secondary wound infections is expected, as compared to the cases in which routine dressing materials were used.  



Prevention of decubital ulcers in ICU patients 

Mrs. Margarita Yakova 


The project is implemented by all the nurses at the unit. One bed was provided with an antidecubital mattress, and additional materials were provided for prevention of decubital ulcers. 

A program was designed for day-to day nursing care of patients expected to be treated at the unit for more than ten days.  

Of the 25 patients covered by the project and whose mean length of stay was more than ten days, none had decubital ulcers at the end of their stay. 



Health education on proper hygiene for postoperative ENT clinic patients to prevent complications 

Mrs. Mariana Dimitrova 

  The program aimed to reduce in-hospital infections in surgical patients. A brochure with recommendations regarding personal hygiene of patients was prepared, printed and handed to patients. Individual talks with both patients and, in some cases, their family members were carried out.  

The printed health education materials were found to facilitate the work of unit medical staff engaged in post-operative care. After the project was implemented, and project activities became part of routine nursing care, in-hospital infections occurred in only 2 of the 47 patients operated on. 



A health education program on proper hygiene and diet for mothers accompanying infants during the hospital stay 

 Mrs. Maria Milanova Zlatanova 


The project was implemented at the pediatric clinic. A brochure was prepared with advice how to prevent intestinal infections in infants and what diet and hygiene is appropriate during the acute stage of the infection.  

All mothers accompanying infants during a period of six months received the brochures. Comparison with the average number of days in hospital during a previous period of six months in 2004 and six months, in which the project activities were carried out, showed a reduction in the length of hospital stay. The number of cases with severe form of intestinal infections also decreased.  



A training program for nurses to improve management of permanent peripheral intravenous infusion pathway 


Mrs. Minka Geteva 


The project was implemented by 15 nurses at the clinic of cardiology. A protocol on nursing care for patients with intravenous catheter was prepared and introduced. Besides that, transparent 3M stickers for the catheter were used instead of old ones.  

Of the 140 patients included in the program, no complications associated with the catheter occurred. An assessment of the quality of care and costs was made and presented to the management of the hospital, and a decision made by the management to provide only this type of stickers for the clinic. 

The application of transparent stickers in patients with an intravenous catheter proved to save time, reduce pain and the rate of infections. This is why a proposal was made to introduce these stickers in all intensive care units of the hospital. 



Providing proper disinfection and handling of sterile dressing materials 

 Mrs. Nezabravka Lazarova 


The project aimed at reducing the rate of in-hospital infections through improving nursing care in aseptic environment.  

A training program for nurses was designed on how to provide care for aseptic urology unit patients. New equipment (a trolley for dressing materials and instruments) was provided used in everyday nursing procedures. 

The training program and the new equipment helped reduce the in-hospital infections by 62.8%, as compared to the same 6-month period during the previous year.