<p>Background Nightingale attention that hygiene was an important task to prevent health- related infection. Today there are guidelines how hand hygiene should be followed, to prevent health- related infection. Good knowledge and education in hand hygiene and its consequences if it’s not followed is of great importance. Hand hygiene should be performed before and after the clean and the unclean work with patients and materials. Health- related infection is an infection which can affect both employees and patients as a result of care, regardless of care service. Good compliance is when hand hygiene is carried out at an appropriate time, but several studies show that this is not followed. Aim The aim with the study was to describe nurse’s knowledge and compliance to hand hygiene. Method A literature review was used to analyze scientific articles related to the topic. Results The result showed that knowledge and education was an important factor to retain compliance to hand hygiene. Hand hygiene was performed as a routine, but this could be lacking when nurses where interrupted in their working moment. Another reason why hand hygiene was not performed was that some nurses experienced skin irritation as a result. Nurses used soap and water instead of hand disinfection. Compliance was better after than before patient contact. Conclusion The authors have noted that after the hygiene education increases compliance to hand hygiene. Regular education is seen as an important part to create and maintain procedures for hand hygiene.</p>

<p>Inom operationssjukvård förebyggs postoperativa infektioner genom att operationspersonalen utför preoperativ handdesinfektion. Det finns två handdesinfektionsmetoder som rekommenderas att använda, Metod 1 för alkoholbaserad handdesinfektion (Sterillium) och Metod 2 för antiseptisk handdesinfektion (Hibiscrub). Syftet med studien var att studera och jämföra olika preoperativa handdesinfektionsmetoder inom operationssjukvård. Metoden var en litteraturstudie som baserades på 11 vetenskapliga studier. Systematiska sökningar gjordes i databaserna CINAHL och Medline samt via manuella sökningar. Sökorden användes enskilt och i kombination. Jämförelse gjordes av de två rekommenderade handdesinfektionsmetoderna utifrån evidens samt framkomna kategorier: effekter, hudens tolerans och tid. Den preoperativa alkoholbaserade handdesinfektionsmetoden med Sterillium (Metod 1) var betydligt mer effektiv än den preoperativa antiseptiska handdesinfektionsmetoden med Hibiscrub (Metod 2). Den visade även bättre resultat gällande hudens tolerans, operationstidens längd samt att den var mer tidssparande och smidigare att utföra. Det visade sig också ha betydelse på effekten hur den preoperativa alkoholbaserade handdesinfektionen utfördes. I studiens resultat framkom inget som styrkte Metod 2.</p> / Uppsatsseminarium utfördes 2008-05-16

Purpose: To examine the effectiveness of a community-based intensive multifactorial clinical intervention for patients with Type 2 diabetes, to evaluate the feasibility of achieving clinical targets for glycemic control in a community setting, and to identify factors that are predictive of glycemic control in this cohort (age, gender, disease duration, continuity of care, pharmacologic treatment, diabetes self-care and smoking status). Methods: Participants with Type 2 diabetes referred to the Diabetes Clinic following dissemination of the 2003 Clinical Practice Guidelines of Canadian Diabetes Association and who attended a minimum of two physician visits within a twelve month period were deemed eligible for participation. 70 patients were included in this retrospective study. Baseline and twelve month values for the following biomedical outcomes were collected via chart audit: BMI, hemoglobin A1c, blood pressure (systolic, diastolic) and lipid profile (HDL, LDL, triglycerides, total cholesterol, TC:HDL ratio). Data for identification of predictive factors for glycemic control were also retrieved by chart audit. Results: The results of the paired t-test yielded a significant improvement in hemoglobin A1c (p<0.05), systolic blood pressure (p<0.01), HDL-cholesterol (p<0.05), LDL-cholesterol (p<0.01), total cholesterol (p<0.05) and total cholesterol:HDL ratio (p<0.05) over twelve months. No significant difference in BMI, diastolic blood pressure or triglycerides was reported over twelve months. Over half the sample (52.9%) achieved clinical targets for glycemic control (hemoglobin A1c <7.0%) at twelve months. Logistic regression analysis identified disease duration (O.R. = 0.90, 95% CI Exp(B) = 0.079 - 0.773, p = 0.01) and continuity of care (O.R. = 0.25, 95% CI Exp(B) = 0.831 - 0.969, p = 0.02) as significant predictors of glycemic control at twelve months. Conclusions: These findings demonstrate the effectiveness of this community-based intensive multifactorial clinical intervention for patients with Type 2 diabetes and show that the implementation of CPGs related to glycemic control is feasible in a community-based setting. Additionally, patients in this cohort with increased disease duration and increased continuity of care were less likely to achieve clinical targets for glycemic control following a twelve month intensive multifactorial clinical intervention for Type 2 diabetes. In summary, health professionals should strive to implement similar intensive multifactorial interventions in community practice in order to decrease the likelihood of diabetes-related complications and improve the patients quality of life.

Research reports that the search for health information is the fourth most popular activity being done on the web (Pew Internet & American Life Project, 2004). However, for disabled persons, barriers experienced when interfacing with the Internet may cause healthcare websites to be inaccessible to them. This study explores the level of accessibility of healthcare websites and the relationship between accessibility and usability by determining how compliant state department of health and human services websites are with accessibility and usability guidelines. A content analysis of each state’s department of health and human services website was conducted. Results revealed that state department of health and human services websites are not very compliant with accessibility guidelines, are somewhat compliant with usability guidelines, and overall are not very accessible. The findings also indicate that there is a significant moderate relationship between accessibility and usability which suggests that the two concepts are interconnected.

Background Nightingale attention that hygiene was an important task to prevent health- related infection. Today there are guidelines how hand hygiene should be followed, to prevent health- related infection. Good knowledge and education in hand hygiene and its consequences if it’s not followed is of great importance. Hand hygiene should be performed before and after the clean and the unclean work with patients and materials. Health- related infection is an infection which can affect both employees and patients as a result of care, regardless of care service. Good compliance is when hand hygiene is carried out at an appropriate time, but several studies show that this is not followed. Aim The aim with the study was to describe nurse’s knowledge and compliance to hand hygiene. Method A literature review was used to analyze scientific articles related to the topic. Results The result showed that knowledge and education was an important factor to retain compliance to hand hygiene. Hand hygiene was performed as a routine, but this could be lacking when nurses where interrupted in their working moment. Another reason why hand hygiene was not performed was that some nurses experienced skin irritation as a result. Nurses used soap and water instead of hand disinfection. Compliance was better after than before patient contact. Conclusion The authors have noted that after the hygiene education increases compliance to hand hygiene. Regular education is seen as an important part to create and maintain procedures for hand hygiene.

Inom operationssjukvård förebyggs postoperativa infektioner genom att operationspersonalen utför preoperativ handdesinfektion. Det finns två handdesinfektionsmetoder som rekommenderas att använda, Metod 1 för alkoholbaserad handdesinfektion (Sterillium) och Metod 2 för antiseptisk handdesinfektion (Hibiscrub). Syftet med studien var att studera och jämföra olika preoperativa handdesinfektionsmetoder inom operationssjukvård. Metoden var en litteraturstudie som baserades på 11 vetenskapliga studier. Systematiska sökningar gjordes i databaserna CINAHL och Medline samt via manuella sökningar. Sökorden användes enskilt och i kombination. Jämförelse gjordes av de två rekommenderade handdesinfektionsmetoderna utifrån evidens samt framkomna kategorier: effekter, hudens tolerans och tid. Den preoperativa alkoholbaserade handdesinfektionsmetoden med Sterillium (Metod 1) var betydligt mer effektiv än den preoperativa antiseptiska handdesinfektionsmetoden med Hibiscrub (Metod 2). Den visade även bättre resultat gällande hudens tolerans, operationstidens längd samt att den var mer tidssparande och smidigare att utföra. Det visade sig också ha betydelse på effekten hur den preoperativa alkoholbaserade handdesinfektionen utfördes. I studiens resultat framkom inget som styrkte Metod 2. / Uppsatsseminarium utfördes 2008-05-16

Organizational theory can assist in better understanding how changes made in clinical practice can be sustained in healthcare organizations. Organizational learning and knowledge transfer theories were used to develop and test a theoretical model, “Sustaining in Memory” (SIM) model, to explore how organizations disperse or distribute newly transferred knowledge in knowledge reservoirs situated in the organization. Three hypotheses were generated from the theoretical model and tested with data from a cross sectional postal survey of 148 patient/resident care units in one large Canadian province where a CPG on prevention of falls was widely disseminated. Findings confirmed that fall prevention practice knowledge was transferred and embedded in all six knowledge reservoirs; however, there were three specific knowledge reservoirs that were found to be significant predictors of perceived CPG adherence (activities consistent with the CPG recommendations). These were staff, policy and role expectation knowledge reservoirs. There was variation in the adherence to the eight CPG recommendations with greater adherence to recommendations that were mandatory. Additionally, findings showed that the relationship between staff knowledge reservoir and CPG adherence was the only relationship moderated by the practices that helped to prevent/address knowledge loss through various activities designed for reviewing and updating practice knowledge. Interestingly, although CPG adherence was reported significantly greater in LTC resident care units, its association with patient outcomes was much weaker than in hospital patient care units. Hospital units had significantly greater correlation between perceived CPG adherence and all four of the falls prevention outcomes reported by study participants. Lastly, quality management culture as managed by senior leaders in the organization was also found to be a significant predicator of adherence to the CPG. The research study validated key assumptions made in the theoretical model while helping to clarify the distinct influence of different knowledge reservoirs. The SIM model provided an alternate perspective within which to study knowledge transfer and sustainability of clinical practices and has potential to apply to other change initiatives. This study answered the call for greater theoretically driven studies of CPG implementation as well as attention on the organizational influences of CPG implementation and sustainability.

Organizational theory can assist in better understanding how changes made in clinical practice can be sustained in healthcare organizations. Organizational learning and knowledge transfer theories were used to develop and test a theoretical model, “Sustaining in Memory” (SIM) model, to explore how organizations disperse or distribute newly transferred knowledge in knowledge reservoirs situated in the organization. Three hypotheses were generated from the theoretical model and tested with data from a cross sectional postal survey of 148 patient/resident care units in one large Canadian province where a CPG on prevention of falls was widely disseminated. Findings confirmed that fall prevention practice knowledge was transferred and embedded in all six knowledge reservoirs; however, there were three specific knowledge reservoirs that were found to be significant predictors of perceived CPG adherence (activities consistent with the CPG recommendations). These were staff, policy and role expectation knowledge reservoirs. There was variation in the adherence to the eight CPG recommendations with greater adherence to recommendations that were mandatory. Additionally, findings showed that the relationship between staff knowledge reservoir and CPG adherence was the only relationship moderated by the practices that helped to prevent/address knowledge loss through various activities designed for reviewing and updating practice knowledge. Interestingly, although CPG adherence was reported significantly greater in LTC resident care units, its association with patient outcomes was much weaker than in hospital patient care units. Hospital units had significantly greater correlation between perceived CPG adherence and all four of the falls prevention outcomes reported by study participants. Lastly, quality management culture as managed by senior leaders in the organization was also found to be a significant predicator of adherence to the CPG. The research study validated key assumptions made in the theoretical model while helping to clarify the distinct influence of different knowledge reservoirs. The SIM model provided an alternate perspective within which to study knowledge transfer and sustainability of clinical practices and has potential to apply to other change initiatives. This study answered the call for greater theoretically driven studies of CPG implementation as well as attention on the organizational influences of CPG implementation and sustainability.

Purpose: To examine the effectiveness of a community-based intensive multifactorial clinical intervention for patients with Type 2 diabetes, to evaluate the feasibility of achieving clinical targets for glycemic control in a community setting, and to identify factors that are predictive of glycemic control in this cohort (age, gender, disease duration, continuity of care, pharmacologic treatment, diabetes self-care and smoking status). Methods: Participants with Type 2 diabetes referred to the Diabetes Clinic following dissemination of the 2003 Clinical Practice Guidelines of Canadian Diabetes Association and who attended a minimum of two physician visits within a twelve month period were deemed eligible for participation. 70 patients were included in this retrospective study. Baseline and twelve month values for the following biomedical outcomes were collected via chart audit: BMI, hemoglobin A1c, blood pressure (systolic, diastolic) and lipid profile (HDL, LDL, triglycerides, total cholesterol, TC:HDL ratio). Data for identification of predictive factors for glycemic control were also retrieved by chart audit. Results: The results of the paired t-test yielded a significant improvement in hemoglobin A1c (p<0.05), systolic blood pressure (p<0.01), HDL-cholesterol (p<0.05), LDL-cholesterol (p<0.01), total cholesterol (p<0.05) and total cholesterol:HDL ratio (p<0.05) over twelve months. No significant difference in BMI, diastolic blood pressure or triglycerides was reported over twelve months. Over half the sample (52.9%) achieved clinical targets for glycemic control (hemoglobin A1c <7.0%) at twelve months. Logistic regression analysis identified disease duration (O.R. = 0.90, 95% CI Exp(B) = 0.079 - 0.773, p = 0.01) and continuity of care (O.R. = 0.25, 95% CI Exp(B) = 0.831 - 0.969, p = 0.02) as significant predictors of glycemic control at twelve months. Conclusions: These findings demonstrate the effectiveness of this community-based intensive multifactorial clinical intervention for patients with Type 2 diabetes and show that the implementation of CPGs related to glycemic control is feasible in a community-based setting. Additionally, patients in this cohort with increased disease duration and increased continuity of care were less likely to achieve clinical targets for glycemic control following a twelve month intensive multifactorial clinical intervention for Type 2 diabetes. In summary, health professionals should strive to implement similar intensive multifactorial interventions in community practice in order to decrease the likelihood of diabetes-related complications and improve the patients quality of life.

Pirater är ett ämne som berör många med anknytning till sjöfarten. Det har tagits upp en del i media under de senaste åren då det har skickats ner militära fartyg till Adenviken för att bekämpa pirater.Syftet med undersökningen är att få fram vad Svenska rederier vidtar för åtgärder för att motverka piratattacker. Följer rederierna de gällande riktlinjer som finns? För att få svar på frågeställningen har vi använt oss av en kvalitativ metod. Den information som är till grund för resultatet har samlats in från fyra olika personer som ansvarat för säkerheten på respektive rederis fartyg. I sammanställningen av resultatet har vi jämfört gällande rekommendationer och hur rederierna i undersökningen agerar. Samtliga rederier i undersökningen är anonyma av säkerhetsskäl.Resultatet av undersökningen visar att samtliga rederi som medverkat vidtar åtgärder för att motverka eventuella piratattacker. / Piracy is a subject that concerns many people with connection to shipping. It has also been brought up in media lately because naval vessels have been sent down to Gulf of Aden for protection against pirate attacks.The purposes with this paper is to establish what measures the shipping companies are taking to prevent piracy attacks and if shipping companies are following existing guidelines? To answer the questions we have used a qualitative method. The information we used as a base for the results has been collected from four responsible officers working for Swedish shipping companies. In the summery of our results we have compared the guidelines and how the companies act. The shipping companies who have been surveyed for this paper is anonymous because of safety reasons.The result of the paper shows that all companies are taking measures to prevent piracy attack.