Bakgrund: CVK-relaterade infektioner i blodbanan är förenat med förlängd sjukhusvistelse, ökad mortalitet, ökade ekonomiska kostnader samt ökat lidande för patienten. Användningen av centrala venösa katetrar ökar och därmed är risken att drabbas av infektion större. Det finns en bristande kunskap hos sjuksköterskan gällande förebyggandet av dessa infektioner och en bristande följsamhet till riktlinjer. Syfte: Beskriva hur sjuksköterskan kan förebygga CVK-relaterade infektioner i blodbanan. Metod: Allmän litteraturstudie av kvantitativa artiklar. Resultat: En kombination av utbildning, praktiska åtgärder såsom skötsel, hygienrutiner och checklistor samt feedback minskade antalet CVK-relaterade infektioner i blodbanan. Slutsatser: Utbildning, olika typer av praktiska åtgärder samt feedback minskar antalet CVK-relaterade infektioner i blodbanan och är viktigt för sjuksköterskans förebyggande vård. En stor del av vad som framkom i resultat stämmer överens med riktlinjerna för förebyggandet av CVK-relaterade infektioner, dock bör utbildning och feedback prioriteras i högre utsträckning. Det är känt sedan tidigare att följsamhet till riktlinjer bland sjuksköterskor skulle underlätta utförandet av evidensbaserad omvårdnad. Mer fokus bör därför ligga på att få sjuksköterskor att följa riktlinjer. Klinisk betydelse: Studien kan bidra med ökad kunskap hos sjuksköterskor om hur CVK-relaterade infektioner i blodbanan kan förebyggas vilket i sin tur skulle kunna generera bättre vård, minskat lidande för patienten, minskad mortalitet samt ekonomiska besparingar. / Background: CVC-related bloodstream infections often lead to prolonged hospitalization, increased mortality, higher economical cost and more suffering for the patient. The usage of central venous catheters increases and therefore the risk of infection is also higher. When it comes to prevention of these infections there is a lack of knowledge amongst nurses and compliance with the guidelines. Aim: Describe how the nurse can prevent CVC-related bloodstream infections. Method: General literature review of quantitative studies. Results: A combination of education, hands-on initiatives such as management, hygieneroutines and checklists as well as feedback turned out to reduce CVC-related bloodstream infections. Conclusions: Education, different hands-on initiatives and feedback decreases the number of CVC-related bloodstream infection and is essential for the nurse’s preventive care. Most of the results correlate with the guidelines for the prevention of CVC-related bloodsteam infections, nevertheless education and feedback should be prioritized in higher extent. It is known that adherence to guidelines among nurses would facilitate the execution of evidence-based nursing. Therefore more focus should be on having nurses follow the guidelines. Clinical importance: This study would contribute with increased knowledge amongst nurses regarding prevention of CVC-related bloodstream infections which would give better care, diminish the suffering of the patient, decrease mortality and lead to economical benefits.

Bakgrunn: Sentralvenøse katetre (SVK) er et tilbud til mange pasientgrupper når det foreligger indikasjoner. Dette medfører at SVK håndteres av helsepersonell på alle enheter i helsetjenesten. Samtidig som SVK er livgivende, kan anvendelse av katetre i blodbanen resultere i alvorlige blodbaneinfeksjoner (SVK-BBI). Blodbaneinfeksjoner assosiert med innleggelse og håndtering av SVK, er en av de alvorligste komplikasjonene som kan oppstå. Fokus på forebygging av SVK-BBI har spredd seg fra å gjelde intensivavdelinger tilå gjelde hele helsetjenesten. Hensikten med denne studien erå se på etterlevelse av infeksjonsforebyggende retningslinjer for å forebygge SVK-BBI utenom intensivavdelinger. Fokuseropplæring, aseptisk teknikk, håndhygiene ogdesinfeksjon av koblingene. Metode: Studien er en tverrsnittsstudie hvor det gjennomføres observasjoner av etterlevelse av håndtering og stell av SVK,samten spørreundersøkelse som kartlegger opplæringav helsepersonelli forhold tildette. 40 sykepleiere deltar i observasjonsstudien og 112 helsepersonelldeltar i spørreundersøkelsen. Hovedresultat: Etterlevelse av aseptisk teknikk under prosedyre var 72,5 %.Etterlevelse av håndhygiene før SVK-prosedyre var 42%. Etterlevelse av desinfeksjon før tilgang/ skifte av koblinger var 89,6 %. 96 % av desom håndterte SVK,har fått opplæring. 68 % er opplært med multimodale metoder. Konklusjon: Studien viser at defleste som håndterteSVK har hatt opplæring. Kommentarene til spørreundersøkelsen viser likevel at det etterlyses bedre opplæring hvor praktisk trening og oppdatering av kunnskap er vektlagt. Til tross for stort fokus på opplæring viser observasjonene av etterlevelse av SVK-prosedyren at vesentlige infekjsonsforebyggende tiltak svikter. / Background:Central venous catheters (CVCs) are usedfor a wide range of indications and handled by health care professionals throughout the hospital. While CVCsare life-giving, their use may result in serious bloodstream infections. Catheter-related bloodstream infections (CRBSIs) are among the most serious complications in health care. Consequently, hospitals now focus on CRBSIs prevention throughout the entire hospital. Aim. The purpose of this study is to look at adherence to infection control guidelines for preventing CRBSIs outside intensive care units. Studied issues are education/ training of health care workers, aseptic technique, hand hygiene and disinfection of the hubs/ connections prior to use. Method.This cross-sectional study aimed to observe guideline compliance by 40 nurses during handling procedures and care of CVCs. We also conducted a sample survey of healthcare workers (n=112) to map the training of healthcare workers handling CVCs. Main results. Adherence to aseptic technique during the procedure was 72.5%, and compliance with hand hygiene before CVCs procedure was 42%. Compliance with use of disinfectant prior to access/change of hubs/connections was 89.6%. The survey revealed that 96% of respondents had been trained in properly handling CVCs; 68 % were trained with multimodal methods. Conclusion. Most healthcare workers were trained to handle CVCs. Some workers requested better training that emphasizes practical issues and updated knowledge. Despite a strong focus on education/training, our observations show that many healthcare workersremain noncompliant in CVC procedure / <p>ISBN 978-91-86739-76-8</p>

Orientador: Carlos Magno Castelo Branco Fortaleza / Resumo: Seasonality of healthcare-associated infections (HCAIs) has been recently reported, especially involving Gram-negative bacilli (GNB). Factors underlying this phenomenon were not elucidated. It is theoretically conceivable it reflects seasonal variations in traditional risk factors for those infections. With this in mind, we conducted a study to analyze the interplay of season, weather and usual predictors of healthcare-associated bloodstream infections caused by Gram-negative bacilli (GNB-BSI). The study had a retrospective, case-only desing. It was conducted in the teaching hospital from Botucatu School of Medicine (450 beds). The study enrolled 446 patients with GNB-BSI caused by Escherichia coli, Enterobacter spp., Klebsiella spp., Pseudomonas aeruginosa or Acinetobacter baumannii, diagnosed from July 2012 through June 2016. Demographic data, comorbidities, invasive procedures and use of antimicrobials were reviewed in medical charts. The season in which GNB-BSI occurred, as well as weather parameters of the day of diagnosis, were recorded. We analyzed factors associated with occurrence of GNB-BSI in different seasons (with winter as reference category) and caused by different GNB (reference category, E. coli). Univariate and multivariable models of polytomous (multinomial) logistic regressions were used for analysis. In multivariable analysis, GNB-BSI diagnosed in summer were more likely to be caused by Klebsiella spp. (OR, 5.33; 95%CI, 2.04-13.96) or A. baumannii (OR, 2.... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Seasonality of healthcare-associated infections (HCAIs) has been recently reported, especially involving Gram-negative bacilli (GNB). Factors underlying this phenomenon were not elucidated. It is theoretically conceivable it reflects seasonal variations in traditional risk factors for those infections. With this in mind, we conducted a study to analyze the interplay of season, weather and usual predictors of healthcare-associated bloodstream infections caused by Gram-negative bacilli (GNB-BSI). The study had a retrospective, case-only desing. It was conducted in the teaching hospital from Botucatu School of Medicine (450 beds). The study enrolled 446 patients with GNB-BSI caused by Escherichia coli, Enterobacter spp., Klebsiella spp., Pseudomonas aeruginosa or Acinetobacter baumannii, diagnosed from July 2012 through June 2016. Demographic data, comorbidities, invasive procedures and use of antimicrobials were reviewed in medical charts. The season in which GNB-BSI occurred, as well as weather parameters of the day of diagnosis, were recorded. We analyzed factors associated with occurrence of GNB-BSI in different seasons (with winter as reference category) and caused by different GNB (reference category, E. coli). Univariate and multivariable models of polytomous (multinomial) logistic regressions were used for analysis. In multivariable analysis, GNB-BSI diagnosed in summer were more likely to be caused by Klebsiella spp. (OR, 5.33; 95%CI, 2.04-13.96) or A. baumannii (OR, 2.... (Complete abstract click electronic access below) / Mestre

Pre-clinical evaluation of novel antimicrobial coatings for blood-contacting devices commonly relies on the performance of animal studies since alternative in vitro models do not adequately represent the interactions between blood, bacteria, and material surfaces as they occur in vivo. To reduce the need of these cost-intensive and controversial animal tests, this project was dedicated to the development of a new model setup that overcomes this limitation and allows in vitro evaluation under in vivo-like conditions. This newly developed model was intended to be directly applied to evaluate recently in-house developed antimicrobial coatings, so-called anchor polymers. Therefore, the project was divided into two parts. The first part of the project focused on the evaluation of the anchor polymer coatings concerning their applicability in blood-contacting devices. For this purpose, the PEGylated styrene-maleic acid copolymers were intensively studied using established laboratory tests. These examinations showed very promising results regarding adsorption and stability on relevant polymer substrates, antimicrobial efficacy, and biological safety of the coatings, thus revealing their great potential for future applications in medical devices. Moreover, this basic characterization was meant to allow a subsequent comparison of the new in vitro model with state-of-the-art in vitro tests. The second part of the thesis focused on the development of the realistic in vitro model. Here, a single-pass flow system realized the implementation of adjustable flow conditions. Furthermore, incubation with freshly drawn human blood provided a physiological nutrient environment and included the influence of an immune response. Staphylococcus aureus were chosen as representative microorganisms, as they are responsible for a majority of device-related blood stream infections. The resulting blood flow model was validated with one anti-adhesive and one contact-killing anchor polymer coating, confirming the model’s ability to differentiate the investigated surfaces. Inflammatory and coagulant blood activation correlated slightly with bacterial coverage, which in turn was strongly dependent on the investigated material surface. Incubation with varying flow conditions demonstrated the model’s capability to reflect the well-documented dependence of bacterial colonization and occurring flow conditions. In contrast to the state-of-the-art in vitro tests, the simultaneous incubation of test surface, bacteria and whole blood allowed the analysis of mutual interactions of the three parameters. Thus, the model represents an excellent method for pre-clinical evaluation of novel antimicrobial coatings for blood-contacting devices.

Les cathéters veineux centraux sont utilisés pour des traitements dont la chimiothérapie, l’hydratation, l’antibiothérapie et la nutrition parentérale chez les patients ayant un cancer. Cependant, ces cathéters sont responsables de graves complications dont les infections. Elles peuvent entraîner la suspension ou l’arrêt des traitements et peuvent engager le pronostic vital des patients. Le taux d’incidence et les facteurs de risque des infections liées aux cathéters veineux centraux (ILCVC) en oncologie restent mal connus. Une étude prospective menée pendant 5 ans à l’hôpital Edouard Herriot et à l’hôpital de la Croix Rousse nous a permis de décrire les ILCVC chez 425 patients ayant un cancer digestif. Nous avons d’abord estimé le taux d’incidence des ILCVC selon la localisation du cancer primitif. Ensuite, nous avons analysé les facteurs de risque. Pour mieux estimer l’impact de la nutrition parentérale sur le risque d’ILCVC, nous avons utilisé le score de propension pour imiter certaines caractéristiques d’un essai randomisé. Enfin, nous avons analysé la mortalité dans les 30 jours qui ont suivi l’ILCVC. Les résultats ont montré que le taux d’incidence des ILCVC était plus élevé chez les patients ayant un cancer pancréas ou un cancer de l’œsophage que ceux qui ont un cancer colorectal. Les facteurs de risque indépendamment associés à une ILCVC étaient le performance status, les journées d’utilisation du cathéter, le cancer du pancréas et la nutrition parentérale. Le risque d’ILCVC était supérieur à 5 chez les patients qui recevaient de la nutrition parentérale associée à la chimiothérapie intraveineuse. Le diabète était un facteur de risque indépendamment associé à la mortalité dans les 30 jours qui suivent la survenue l’ILCVC. / Central venous catheters are commonly used in cancer patients for administration of chemotherapy, hydration, parenteral nutrition and antibiotic. However, their use is associated with complications such as infections. An often serious complication is bloodstream infections. This can cause a suspending of cancer treatment. Central venous catheter-related bloodstream infections also contribute to increased mortality in theses patients. The incidence rates and CVC-RBSI risk factors are not well known in patients with cancer. Then in a prospective study conducted during 5 years, we have analysed data from 425 patients with digestive cancer. Study took place at Edouard Herriot Hospital and Croix Rousse Hospital in Lyon. First, we estimated rate of CVC-RBSI according to the location of primary cancer. To the best estimation of parenteral nutrition effect on the risk of CVC-RBSI, we performed the propensity score analysis, which can mimic some characteristics of randomized trial. Finally, we analyzed the 30-day mortality after CVC-BSI. The results showed that the infection rate was higher in pancreatic and oesophageal cancer patients, compared with colorectal cancer patients. The risk factors independently associated with CVC-RBSI were pancreatic cancer, performance status, cumulative catheter utilization-days and parenteral nutrition. The risk of CVC-RBSI was at least 5 times greater in patients with parenteral nutrition. Attributable mortality rate within 1 month of CVC-RBSI was 16.6%. Diabetes mellitus was independently associated with death.