Patients with cancer who receive bone marrow transplants (BMT) are at increased risk for central line-associated blood stream infections (CLABSI), a serious complication leading to increased costs, length of stay, and even death. Recognition of an increased CLABSI rate at one BMT unit in the southwestern United States prompted development of an evidence-based staff development education program to improve nurses’ knowledge of central line maintenance and CLABSI prevention practices. Guided by Lewin change theory, the program was developed based on a nurse-led analysis and synthesis of the evidence, and a formative evaluation of the educational program conducted by a 3-member expert panel made up of the BMT director, a BMT clinical nurse specialist and vascular access team member. The review confirmed the lack of standardized evidence-based guidelines for central venous catheter care, that any patient who has a central line is at risk for CLABSI, and BMT patients are at particular risk due to frequency of catheter manipulation. Findings reinforced the need for the recommendations to educate nurses in BMT settings on evidence-based central line practices, evaluate knowledge gained, and audit practice techniques post education. The social change implication of this DNP project will be the potential decrease in healthcare costs, length of stay, and mortality associated with central line infections when nursing staff are provided an educational program that aims to improve their knowledge and skills of evidence-based central line care and CLABSI prevention practices.

Contaminated blood cultures constitute diagnostic challenges and place a burden on healthcare services. An observational retrospective study was undertaken to evaluate the effect of routine labelling of blood culture bottles with the initials of the healthcare worker who drew them, followed by individualized feedback, on blood culture contamination rates. The contamination rate of the entire facility was 2.6% before the procedural change, and this decreased significantly to 1.5% after the procedural change (P < 0.001) over the first 12 months of the intervention. Routine labelling of blood culture bottles with the initials of the healthcare worker who drew them, followed by individualized feedback, was effective in reducing blood culture contamination rates.

No description available.

Submitted by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-19T15:51:38Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação de Mestrado Jaqueline Abel - versão final (1).pdf: 1209039 bytes, checksum: eed9b8980c55578d399792746ea7274d (MD5) / Approved for entry into archive by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-19T15:52:52Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação de Mestrado Jaqueline Abel - versão final (1).pdf: 1209039 bytes, checksum: eed9b8980c55578d399792746ea7274d (MD5) / Made available in DSpace on 2017-09-19T15:52:52Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação de Mestrado Jaqueline Abel - versão final (1).pdf: 1209039 bytes, checksum: eed9b8980c55578d399792746ea7274d (MD5) Previous issue date: 2016 / Universidade Federal Fluminense. Hospital Universitário Antonio Pedro / As infecções primárias de corrente sanguínea (IPCS) estão entre as infecções relacionadas à assistência à saúde (IRAS) mais frequentemente adquiridas no ambiente hospitalar. Essas infecções aumentam o tempo de internação, o custo e a mortalidade intra-hospitalar. No entanto, o impacto deste agravo em perda de saúde permanece desconhecido. Método: foi conduzida uma coorte de IPCS com comprovação microbiológica (IPCS-CM) com objetivo de estimar a carga de doença das IPCS-CM detectadas no Hospital Universitário Antônio Pedro (HUAP), de dezembro de 2013 a dezembro de 2014. Os anos de vida perdidos por morte prematura e os vividos sem condições plenas de saúde foram calculados conforme metodologia do Global Burden of Disease de 2010. O DALY (Disabilty-ajusted Life Year) foi calculado através de planilha da Organização Mundial de Saúde (OMS). Resultados: o DALY das IPCS-CM foi 20,44/1000 pacientes internados. Os anos de perdidos por morte prematura (YLL) contribuíram com a maior fração do DALY (YLL = 20,42/1000), comparado com os anos vividos sem condições ideais de saúde (YLD = 0,02/1000). Quando comparadas as infecções por microrganismos multirresistentes com aquelas por germes multissensíveis, as infecções por multirresistentes contribuíram mais para o DALY (multirresistentes: 13,42 DALYs/1000; multissensíveis: 7,18 DALYs/1000; DALY GAP: 6,24/1000). Conclusão: esses resultados demonstram através da elevada carga de doença o impacto em perda de saúde das IPCS-CM, principalmente naquelas infecções causadas por microrganismos multirresistentes. / Central line-associated bloodstream infections (CLABSI) are among the most often health care associated infections (HAIs) acquired in the hospital. CLABSI increase the length of stay, cost and hospital mortality. However, its impact on health loss remains unknown. This study was a cohort of CLABSI episodes in order to estimate the burden of CLABSI detected in a Brazilian public university-affiliated hospital from December 2013 to December 2014. The Disability-adjusted Life Year (DALY) was calculated based on the Global Burden of Disease methodology of 2010, through Excel spreadsheet of the World Health Organization (WHO). The DALY of CLABSI in HUAP was 20.44 / 1,000 inpatients. The Years of Life Lost due to premature death (YLL) contributed with the largest DALYs fraction (YLL=20.42/1,000), when compared with the Years Lost due to Disability (YLD) (YLD=0.02/1,000). Multiresistant infections contribute more to the DALY than those caused by non-multiresistant agents (multiresistant: 13.42 DALYs/1,000; non-multiresistant: 7.18 DALYs/1,000; DALY GAP: 6.24/1,000). These results demonstrate the great impact on loss of health due to CLABSI caused by multiresistant microorganisms.

Introdução: estudos de farmacocinética/farmacodinâmica (FC/FD) observaram que a probabilidade de alcançar o alvo FC/FD é maior quando a dose do beta-lactâmico é otimizada. Porém, poucos estudos demonstraram que a otimização de dose resulta em melhores desfechos clínicos. Métodos: Fatores associados com mortalidade em 30 dias foram avaliados em 100 pacientes com bacteremia por enterobactérias tratados com cefepime, piperacilina-tazobactam ou meropenem em um estudo de coorte prospectivo. Posologia dos antibióticos foi classificada em otimizada, apropriada e potencialmente inapropriada. Resultados: Cinquenta e dois (52%) episódios foram causados por E. coli, seguidos por K. pneumoniae (10%). Dezesseis (16%) episódios foram causados por isolados resistentes à cefepime e não houve nenhum caso de resistência à carbapenêmicos. A maioria dos isolados apresentou concentrações inibitórias mínimas (CIMs) baixas para as drogas prescritas (≤0.5, ≤1.0, ≤1/4 mg/L, para meropenem, cefepime e piperacilina-tazobactam respectivamente). Cefepime foi o antimicrobiano mais frequentemente prescrito para tratamento empírico e definitivo. Terapia otimizada foi observada em 42% dos pacientes e terapia adequada em 58%. A mortalidade em 30 dias foi 37%. Escore de Pitt, Charlson e apresentação com sepse severa foram independentemente associados à mortalidade. Não houve diferença em mortalidade entre os pacientes que receberam terapia otimizada e terapia adequada. Conclusões: os resultados mostram que a otimização das doses de cefepime, piperacilina-tazobactam e meropenem não teve impacto em mortalidade Em pacientes recebendo terapia empírica apropriada para bacteremias por Enterobacteriaceae. Este achado pode ser devido aos baixos valores de CIM apresentados pelas bactéria. Comorbidades e a severidade da apresentação são fatores associados à pior evolução. / Background: Pharmacokinetic/pharmacodynamic (PK/PD) studies have shown that the probability of PK/PD target attainment is higher when optimized dosage regimes of beta-lactams are employed, but few studies have shown clinical benefit of such strategy. Methods: We investigated the effect of dosage regimes in 30-day mortality in 100 patients with Enterobacteriaceae bloodstream infections (BSIs) receiving appropriate empirical therapy with cefepime, piperacillin-tazobactam or meropenem. Posology of antibiotic was classified as optimized, adequate and possibly inadequate. Results: Most isolates presented relatively low MIC for the prescribed drugs (≤0.5, ≤1.0, ≤1/4 μg/mL, for meropenem, cefepime and piperacillin-tazobactam respectively). Cefepime was the most common prescribed drug for empirical and main therapy. Optimized posology was prescribed in 42% of patients and adequate in 58%. The overall 30-day mortality was 27.0%. Charlson score, Pitt score and presentation with severe sepsis were independently associated with the 30-day mortality. Patients receiving optimized dosage regime presented no distinct 30-day mortality of those with adequate ones (25.0% versus 28.3%, P=0.89), even after inclusion in multivariate model. Conclusion: Our results suggest that dosage regime optimization of cefepime, piperacillin-tazobactam and meropenem may have no effect on mortality when infecting bacteria with low MICs for these drugs. In patients receiving appropriate empirical therapy for Enterobacteriaceae BSI, baseline comorbidity is an independent predictor of death and the severity of BSI presentation is also significantly associated with this outcome is such patients. Studies in population with higher MIC heterogeneity are required to evaluate the role of optimized doses in clinical setting.

Made available in DSpace on 2015-07-22T20:50:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-09-28 / A familia Enterobacteriaceae e uma importante causa de infeccao da corrente sanguinea (ICS). O aumento da resistencia microbiana e um fator complicador no tratamento dessas infeccoes, fazendo com que a concentracao inibitoria minima (CIM) tenha um papel importante na analise do antibiograma. No Hospital Sao Paulo - UNIFESP, ate agosto de 2007, os testes de susceptibilidade antimicrobiana (TSA) de hemoculturas para enterobacterias eram realizados atraves do metodo de discodifusao. A partir desta data, os TSA passaram a ser realizados atraves do sistema microbiologico automatizado Phoenix., que fornece uma CIM aproximada por microdiluicao. Embora a importancia da CIM seja bem documentada em estudos com Staphylococcus aureus meticilino-resistente (MRSA), nao ha estudo analisando o impacto que esses sistemas automatizados teriam sobre a evolucao clinica dessas infeccoes. Objetivos: comparar a evolucao clinica das ICS hospitalares por enterobacterias no periodo nao-automatizado versus periodo automatizado, determinar a prevalencia de enterobacterias causadoras de ICS no periodo de estudo e analisar os fatores associados a mortalidade em 14 dias das ICS hospitalares por enterobacterias. Metodo: trata-se de um estudo tipo coorte retrospectivo, onde foram avaliadas as ICS hospitalares por enterobacterias nos periodos nao-automatizado (agosto de 2006 a julho de 2007) e automatizado (agosto de 2008 a julho de 2009) do Hospital Sao Paulo - UNIFESP. Na segunda etapa do estudo, os pacientes foram realocados e divididos em obitos e sobreviventes ate 14 dias do diagnostico da infeccao para analisar os preditores de mortalidade dessas infeccoes. Resultados: foram avaliados 90 e 106 pacientes nos periodos nao-automatizado e automatizado, respectivamente. Houve a prevalencia do sexo masculino e a media de idade de 60 anos em ambos periodos. No periodo com automacao, os pacientes apresentaram maior escore APACHE II (p< 0,001), fizeram mais uso de imunossupressores (p < 0,001) e ocorreu maior incidencia de ICS associada a cateter venoso central (p = 0,002). As enterobacterias mais prevalentes foram a Klebsiella spp (36,6% e 43,3%) e Proteus spp (13,3% e 18,8%), respectivamente, no periodo nao-automatizado e automatizado. Nao houve diferenca significativa quanto a adequacao do tratamento (p = 0,45), resposta clinica (p= 0,75) e obito . 7 dias (p= 0,79), . 14 dias (p= 0,94) e . 28 dias (p= 0,12) entre periodos. Quando realocamos os pacientes que apresentaram obito ate 14 dias do diagnostico da infeccao (n= 46) em comparacao com sobreviventes em 14 dias (n= 150), os preditores que se associaram independentemente com a mortalidade foram: choque séptico (OR = 7,04; IC 95%= 2,92 – 17,01; p < 0,001) e uso de imunossupressores (OR= 2,23; IC 95%= 1,01 – 4,93; p= 0,01). Conclusão: A introdução do sistema microbiológico automatizado Phoenix™ não demonstrou impacto na evolução clínica das infecções de corrente sanguínea hospitalares por enterobactérias. Klebsiella spp e Proteus spp foram os agentes etiológicos mais prevalentes em ambos os períodos. Choque séptico e uso de imunossupressores foram os únicos fatores associados a mortalidade em 14 dias das ICS hospitalares por enterobactérias. / The family Enterobacteriaceae is an important cause of bloodstream infections (BSI). The increasing antimicrobial resistance is a complicating factor in treating these infections, thus the minimum inhibitory concentration (MIC) plays a key role in the analysis of susceptibility. Until August 2007, the antimicrobial susceptibility testing (AST) of blood cultures for Enterobacteriaceae were performed by disk diffusion method at Hospital Sao Paulo - UNIFESP. As of this date, the AST began to be performed through the Phoenix. automated microbiology system, which provides an approximated MIC by microdilution. Although the importance of MIC is well documented in studies with methicillin-resistant Staphylococcus aureus (MRSA), there is no study analyzing the impact of automated systems on clinical outcomes of these infections. Objectives: To compare the clinical outcomes of nosocomial BSI caused by Enterobacteriaceae during the non-automated versus automated period; to determine the prevalence of Enterobacteriaceae species causing BSI during the study period and analyze the factors associated with 14-day mortality. Method: This is a retrospective cohort study that evaluated nosocomial BSIs caused by Enterobacteriaceae in the periods non-automated (August 2006 to July 2007) and automated (August 2008 to July 2009) at Hospital Sao Paulo - UNIFESP. In the second part of the study, patients were realocated and divided into deaths and survivors within 14 days of diagnosis of infection to analyze the predictors of mortality. Results: We evaluated 90 and 106 patients in non-automated and automated periods, respectively. There was a male prevalence and the average age was 60 years in both periods. During the automated period, patients had higher APACHE II score (p <0.001), higher use of immunosuppressive drugs (p <0.001) and there was a greater incidence of central venous catheter-related BSI (p = 0.002). Klebsiella spp (36.6% and 43.3%) and Proteus spp (13.3% and 18.8%) respectively, during the non-automated and automated period were the most prevalent Enterobacteriaceae species. There was no significant difference regarding the adequacy of treatment (p = 0.45), clinical response (p = 0.75) and death . 7 days (p = 0.79), . 14 days (p = 0.94) and . 28 days (p = 0.12) between the periods. The predictors independently associated with mortality were septic shock (OR = 7.04; IC 95%= 2,92 . 17,01; p <0.001) and use of immunosuppressive therapy (OR = 2.23; IC 95%= 1,01 . 4,93; p = 0.01). Conclusion: The introduction of Phoenix. automated microbiology system showed no impact on clinical outcomes of bloodstream infections caused by Enterobacteriaceae. Klebsiella spp and Proteus spp were the most prevalent pathogens in both periods. Septic shock and the use of immunosuppressive drugs were the only factors associated with 14-day mortality among those patients. / TEDE / BV UNIFESP: Teses e dissertações

Introdução: estudos de farmacocinética/farmacodinâmica (FC/FD) observaram que a probabilidade de alcançar o alvo FC/FD é maior quando a dose do beta-lactâmico é otimizada. Porém, poucos estudos demonstraram que a otimização de dose resulta em melhores desfechos clínicos. Métodos: Fatores associados com mortalidade em 30 dias foram avaliados em 100 pacientes com bacteremia por enterobactérias tratados com cefepime, piperacilina-tazobactam ou meropenem em um estudo de coorte prospectivo. Posologia dos antibióticos foi classificada em otimizada, apropriada e potencialmente inapropriada. Resultados: Cinquenta e dois (52%) episódios foram causados por E. coli, seguidos por K. pneumoniae (10%). Dezesseis (16%) episódios foram causados por isolados resistentes à cefepime e não houve nenhum caso de resistência à carbapenêmicos. A maioria dos isolados apresentou concentrações inibitórias mínimas (CIMs) baixas para as drogas prescritas (≤0.5, ≤1.0, ≤1/4 mg/L, para meropenem, cefepime e piperacilina-tazobactam respectivamente). Cefepime foi o antimicrobiano mais frequentemente prescrito para tratamento empírico e definitivo. Terapia otimizada foi observada em 42% dos pacientes e terapia adequada em 58%. A mortalidade em 30 dias foi 37%. Escore de Pitt, Charlson e apresentação com sepse severa foram independentemente associados à mortalidade. Não houve diferença em mortalidade entre os pacientes que receberam terapia otimizada e terapia adequada. Conclusões: os resultados mostram que a otimização das doses de cefepime, piperacilina-tazobactam e meropenem não teve impacto em mortalidade Em pacientes recebendo terapia empírica apropriada para bacteremias por Enterobacteriaceae. Este achado pode ser devido aos baixos valores de CIM apresentados pelas bactéria. Comorbidades e a severidade da apresentação são fatores associados à pior evolução. / Background: Pharmacokinetic/pharmacodynamic (PK/PD) studies have shown that the probability of PK/PD target attainment is higher when optimized dosage regimes of beta-lactams are employed, but few studies have shown clinical benefit of such strategy. Methods: We investigated the effect of dosage regimes in 30-day mortality in 100 patients with Enterobacteriaceae bloodstream infections (BSIs) receiving appropriate empirical therapy with cefepime, piperacillin-tazobactam or meropenem. Posology of antibiotic was classified as optimized, adequate and possibly inadequate. Results: Most isolates presented relatively low MIC for the prescribed drugs (≤0.5, ≤1.0, ≤1/4 μg/mL, for meropenem, cefepime and piperacillin-tazobactam respectively). Cefepime was the most common prescribed drug for empirical and main therapy. Optimized posology was prescribed in 42% of patients and adequate in 58%. The overall 30-day mortality was 27.0%. Charlson score, Pitt score and presentation with severe sepsis were independently associated with the 30-day mortality. Patients receiving optimized dosage regime presented no distinct 30-day mortality of those with adequate ones (25.0% versus 28.3%, P=0.89), even after inclusion in multivariate model. Conclusion: Our results suggest that dosage regime optimization of cefepime, piperacillin-tazobactam and meropenem may have no effect on mortality when infecting bacteria with low MICs for these drugs. In patients receiving appropriate empirical therapy for Enterobacteriaceae BSI, baseline comorbidity is an independent predictor of death and the severity of BSI presentation is also significantly associated with this outcome is such patients. Studies in population with higher MIC heterogeneity are required to evaluate the role of optimized doses in clinical setting.

Introdução: estudos de farmacocinética/farmacodinâmica (FC/FD) observaram que a probabilidade de alcançar o alvo FC/FD é maior quando a dose do beta-lactâmico é otimizada. Porém, poucos estudos demonstraram que a otimização de dose resulta em melhores desfechos clínicos. Métodos: Fatores associados com mortalidade em 30 dias foram avaliados em 100 pacientes com bacteremia por enterobactérias tratados com cefepime, piperacilina-tazobactam ou meropenem em um estudo de coorte prospectivo. Posologia dos antibióticos foi classificada em otimizada, apropriada e potencialmente inapropriada. Resultados: Cinquenta e dois (52%) episódios foram causados por E. coli, seguidos por K. pneumoniae (10%). Dezesseis (16%) episódios foram causados por isolados resistentes à cefepime e não houve nenhum caso de resistência à carbapenêmicos. A maioria dos isolados apresentou concentrações inibitórias mínimas (CIMs) baixas para as drogas prescritas (≤0.5, ≤1.0, ≤1/4 mg/L, para meropenem, cefepime e piperacilina-tazobactam respectivamente). Cefepime foi o antimicrobiano mais frequentemente prescrito para tratamento empírico e definitivo. Terapia otimizada foi observada em 42% dos pacientes e terapia adequada em 58%. A mortalidade em 30 dias foi 37%. Escore de Pitt, Charlson e apresentação com sepse severa foram independentemente associados à mortalidade. Não houve diferença em mortalidade entre os pacientes que receberam terapia otimizada e terapia adequada. Conclusões: os resultados mostram que a otimização das doses de cefepime, piperacilina-tazobactam e meropenem não teve impacto em mortalidade Em pacientes recebendo terapia empírica apropriada para bacteremias por Enterobacteriaceae. Este achado pode ser devido aos baixos valores de CIM apresentados pelas bactéria. Comorbidades e a severidade da apresentação são fatores associados à pior evolução. / Background: Pharmacokinetic/pharmacodynamic (PK/PD) studies have shown that the probability of PK/PD target attainment is higher when optimized dosage regimes of beta-lactams are employed, but few studies have shown clinical benefit of such strategy. Methods: We investigated the effect of dosage regimes in 30-day mortality in 100 patients with Enterobacteriaceae bloodstream infections (BSIs) receiving appropriate empirical therapy with cefepime, piperacillin-tazobactam or meropenem. Posology of antibiotic was classified as optimized, adequate and possibly inadequate. Results: Most isolates presented relatively low MIC for the prescribed drugs (≤0.5, ≤1.0, ≤1/4 μg/mL, for meropenem, cefepime and piperacillin-tazobactam respectively). Cefepime was the most common prescribed drug for empirical and main therapy. Optimized posology was prescribed in 42% of patients and adequate in 58%. The overall 30-day mortality was 27.0%. Charlson score, Pitt score and presentation with severe sepsis were independently associated with the 30-day mortality. Patients receiving optimized dosage regime presented no distinct 30-day mortality of those with adequate ones (25.0% versus 28.3%, P=0.89), even after inclusion in multivariate model. Conclusion: Our results suggest that dosage regime optimization of cefepime, piperacillin-tazobactam and meropenem may have no effect on mortality when infecting bacteria with low MICs for these drugs. In patients receiving appropriate empirical therapy for Enterobacteriaceae BSI, baseline comorbidity is an independent predictor of death and the severity of BSI presentation is also significantly associated with this outcome is such patients. Studies in population with higher MIC heterogeneity are required to evaluate the role of optimized doses in clinical setting.

Background: Critically ill patients are at particular risk of developing bloodstream infection. Such infections are associated with the development of sepsis, leading to a marked increase in mortality rate. Early detection of the causative organism and appropriate antibiotic treatment are therefore critical for optimum outcome of patients with nosocomial infection. Current infection diagnosis is based on standard blood culture techniques. However, microbiological culture has a number of limitations, not least that it takes several days to confirm infection and is therefore not useful in directing the early treatment with antibiotics. New techniques based on the detection of pathogen DNA using real-time polymerase chain reaction (PCR) technology have the potential to address these limitations but their clinical utility is still to be proved. Objectives: Develop and evaluate novel PCR-based approaches to bloodstream infection diagnosis in critical illness based on detection and identification of bacterial and fungal DNA in blood. Methods: A range of commercial and 'in-house' PCR-based assays for detection of bacterial and fungal DNA were developed and/or optimised for use in clinical blood samples. These included LightCycler SeptiFast, a CE-marked multi-pathogen assay for common bloodstream pathogens, BactScreen and GramScreen, broad spectrum bacterial assays based on 16S rRNA gene and real-time PCR assays developed to detect a range of clinically important fungal pathogens. Novel approaches to speciation of pathogen DNA using melting temperature (Tm) profiling and high resolution melting analysis (HRMA) were developed. Clinical evaluation of assays was either on blinded clinical isolates or blood samples from critically ill patients with clinical suspicion of bloodstream infection against conventional microbiological culture. Several techniques aimed at improving extraction of pathogen DNA from blood were also investigated. Results: The CE-marked commercial assay SeptiFast showed analytical sensitivity and specificity of 79% and 83% respectively. Concordance with positive culture results was good but high levels of 'false positives' were detected possibly attributed to detection of free pathogen DNA not associated with viable pathogens. The predictive value of a negative SeptiFast test was 98% suggesting that absence of pathogen DNA is a strong indicator of absence of infection. Further studies were aimed at detailed optimisation and validation of 16S rRNA gene real-time PCR assays for bacterial DNA. BactScreen and GramScreen were able to detect a broad range of clinically important bacteria down to <50 CFU/ml blood. A preliminary comparative evaluation against SeptiFast showed BactScreen gave excellent concordance with blood culture results with minimal false positive results compared to SeptiFast. Efficient extraction of pathogen DNA was shown to be a key factor in determining analytical sensitivity and several protocols were evaluated. Low cost approaches to speciation of bacterial DNA were developed by combining broad range real-time PCR with HRMA. A novel HRMA method based on Tm profiling was shown to identify 89% and 96% of blinded clinical isolates at species or genus level respectively. Real-time PCR/HRMA approaches were also successfully developed for detection and identification of fungal pathogens including a range of Candida and Aspergillus species associated with bloodstream fungal infection. Conclusions: These studies have highlighted some of the key factors that need to be considered when developing and validating PCR based assays for pathogen DNA detection in blood. A set of novel tools have been developed for rapid detection and identification of bacterial and fungal pathogens that could address the challenges of infection diagnosis based on pathogen DNA detection. Further work is required, not least in development of more efficient pathogen DNA extraction and detailed clinical validation but the tools described here have the potential to provide cost effective solutions to aid infection diagnosis that would be complementary to current culture-based methods. The provision of time critical information could have a positive impact on clinical decision-making leading to more effective management and treatment of patients with suspected bloodstream infection.

Ensuring the bloodstream is one of the most frequently indicated invasive procedures, especially in the pre-hospital emergency and intensive care. All invasive inputs are nowadays an integral part of intensive care. Despite careful daily care, vascular accesses are at risk of complications, which annually effects many patients institutionalized at intensive care units. Catheter sepsis is undoubtedly one of the most serious. Although a significant proportion of these infections are considered highly preventable, they still contribute to high morbidity and mortality among these patients. The aim of this diploma thesis is to analyse nursing care for vascular inputs. One of the partial goals is to evaluate and compare the relevance of the nursing standard of a medical facility with scientific knowledge and current recommendations of professional societies. The research method is a quantitative questionnaire survey focused on nursing staff working in the Department of Anesthesiology and Reanimation. The analysis of the vascular inputs re-dressings was performed in patients hospitalized in the same ward, where the research itself took place. The results of the research survey show a discrepancy between the given procedure in the nursing standard and common practice in the ward. In view of the...