Introduction: Infection control in animal health care is, as in human health care, most important to prevent and fight antibiotic resistance. Animal health can also influence public health. Basic hygiene routines; hand hygiene, routines for proper attire, and routines for personal protective equipment (PPE), such as protective aprons and gloves, represent the simplest and most important infection control and prevention measures. High compliance to these routines is important to achieve. However, due to few scientific publications in the animal health care arena, customized and efficient efforts have not been fully identified for this environment. Therefore, optimal oversight and compliance assessments are difficult to achieve. Similar to human health care, several infection control and prevention measures and responsibilities are addressed by nurses. Objectives: To study compliance to basic hygiene routines and assess whether compliance differs between different animal health care professions, such as nurses versus veterinarians. Method: A quantitative web-based survey about basic hygiene routines, was used to investigate compliance to basic hygiene routines among animal healthcare providers. The eligible respondent sample was comprised of 360-2600 providers. Difference in compliance among professions within animal health care was estimated using SPSS statistical analysis software. Results: Of a possible 360-2600 possible respondents, 313 animal healthcare providers responded to our web-based survey. Significant differences in compliance among professions were not found (between veterinarians and veterinary nurses with a degree, and veterinarians versus nurses without a degree). Higher compliance was observed at larger animal hospitals and among personnel educated at their work place in basic hygiene routines. Hand disinfectant use before contact with patients was most often missed, as well as not wearing a protective apron or coat if risk for contact with body fluids was evident. Conclusion: In contrast to previous practical experience and reports, our results showed no significant difference in compliance between animal healthcare veterinarians and nurses. Given our null findings, more studies are needed to identify hidden factors influencing compliance among animal health care workers, as well as attention to representative sampling. Even so, based on our results, potential interventions include enhanced work-based education programs on infection control and prevention, with attention to smaller (small to medium sized) animal health care clinics. Focus for such interventions should also address hand disinfection before contact with patients. In addition, more effective monitoring is required. / Introduktion: Vårdhygien inom djursjukvården är liksom inom sjukvården viktigt för att förebygga och motverka utvecklingen av antibiotikaresistens vilken kan påverka folkhälsan. Basala hygienrutiner är en av de viktigaste vårdhygieniska åtgärderna för att förhindra smitta inom sjukvården och djursjukvården. En god följsamhet till basala hygienrutiner är mycket viktig att uppnå men på grund av liten kunskap om hur det förhåller sig inom djursjukvården är det svårt att skräddarsy insatser. Traditionellt riktas många vårdhygieniska insatser och ansvar till sköterskor i djursjukvården. Syfte: Undersöka om följsamheten till basala hygienrutiner skiljer sig mellan olika yrkeskategorier inom djursjukvården. Metod: Genom kvantitativ ansats utifrån 313 svar på en webenkät med ett utskick på 360-2600 enkäter om basala hygienrutiner undersöka självskattad följsamhet och med hjälp av statistikprogrammet SPSS beräkna om skillnader finns mellan olika yrkeskategorier inom djursjukvården. Resultat: Signifikanta skillnader i följsamhet till basala hygienrutiner mellan yrkeskategorierna veterinärer och sköterskor (djurvårdare och djursjukskötare) fanns inte. Bättre följsamhet sågs på större arbetsplatser samt om personalen fått utbildning på arbetsplatsen. Handdesinfektion före patientkontakt var svårast att följa samt användning av skyddsförkläde/rock vid risk för kontakt med kroppsvätskor. Slutsats: I motsats till tidigare praktisk erfarenhet visade resultaten att signifikant skillnad i följsamhet mellan veterinärer och djurvårdare eller mellan veterinärer och djursjukskötare inte kunde ses. Därmed kan konstateras att fler studier behövs för att identifiera dolda faktorer som påverkar följsamheten bland djursjukvårdens personal. Utifrån resultaten kan dock konstateras att interventioner som innebär förbättrade utbildningsprogram i vårdhygien på arbetsplatsen, särskilt på små till medelstora kliniker, bör genomföras. Dessa bör fokusera på handdesinfektion före patientkontakt. Mer effektiv övervakning behövs.

Le vieillissement de la population et les différentes réformes du système de santé au Québec ont mené à divers bouleversements, et à un déplacement des soins et des services vers le domicile. Les groupes professionnels travaillant dans le secteur du maintien à domicile ont vu leur travail se transformer et évoluer au fil des ans. Selon R. Bourque (1992), qui s’est intéressée à la professionnalisation du métier d’auxiliaire familiale et sociale dans les années 1980 et au début des années 1990, les auxiliaires familiales et sociales font partie des travailleuses ayant connu le plus de changement dans la nature de leurs tâches depuis leur intégration à l’intérieur de la santé et des services sociaux en 1972. Notre recherche s’intéresse à l’évolution des pratiques professionnelles des auxiliaires familiales et sociales en CLSC au Québec depuis les années 1990. L’étude réalisée à l’aide de huit entretiens semi-dirigés portant sur l’évolution des pratiques des AFS depuis les années 1990, a permis de saisir et de comprendre l’évolution des tâches et des fonctions de ces AFS à partir de leur quotidien. Les résultats démontrent une spécialisation accrue du travail vers les soins d’hygiène et les actes délégués de type infirmier. Toutefois, l’hétérogénéité des pratiques de ces AFS témoigne de la survie de certaines tâches, notamment au niveau des activités de la vie domestique (AVD). L’enjeu majeur de ce groupe professionnel se situe dans la consolidation d’une association plus forte et plus inclusive afin de faire valoir leurs revendications et faire face aux défis qu’elles doivent surmonter au quotidien afin de faire reconnaître leur travail. / The aging population and the various reforms within the health system in Quebec have led to various changes over the years. Professional groups working in the field of home care services have seen their work transformed and evolved over the past decades. According to Bourque (1992), who was interested in the professionalization of home-care workers in the 1980s and the early 1990s, home-care workers are among the workers who experienced the most change in the nature of their tasks since their integration in the Health and Social Services in 1972. Our research focuses on the evolution of the professional practices of home-care workers in CLSC in Quebec since 1990. This study that was realized with semi-structured interviews with eight home-care workers led to understand the evolution of the tasks and functions of these workers. The result of this research shows a growing specialization of their work as well as increased tasks related to nursing care. However, the heterogeneity of these practices demonstrates the survival of certain tasks, particularly in terms of the activities of daily living. The major challenge in this group lies in the consolidation of a stronger and more inclusive association to assert their claims and to meet the challenges they face every day in order to recognize their work.

Thesis (MPhil)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Nigeria has the second highest disease burden of HIV/AIDS in sub Saharan Africa after South Africa with adult HIV prevalence of 4.1%, with an estimated 3,130 million people living with HIV (Male-1,320,000: Female-1,820,000-2010) (FMOH, 2010). The HIV epidemic in Cross River state is 7.1% in 2010; and ranks as the 9th highest in the country. General Hospital Ogoja is one of the secondary level hospitals in Cross River State of Nigeria that offers Comprehensive HIV/AIDS services. Although the prevalence of HIV is very high in Cross River state (7%) that of General Hospital is not readily known. The uptake of HIV Counseling and Testing (HCT) among health care workers is relatively low, despite the fact that the awareness of HIV and AIDS in Nigeria by adult population is said to be generally very high (93.8%).The use of condom in the last sex act was low (16%) despite the fact that sexual transmission is the predominant mode of HIV spread in Nigeria (NARHS 2007) To determine whether the knowledge health care workers in GH Ogoja have about HIV/AIDS affect their sexual behaviour; a quantitative approach of research design was used through a questionnaire A total of one hundred and thirty questionnaires were distributed and all were returned. There were few abstentions on some of the questions possibly due to its private nature but generally the overall responses were devoid of inconsistencies and the response rate was well over 98%. The findings from the study showed that greater that 90% of the respondents are quite knowledgeable with the cause of HIV, modes of transmission and prevention of HIV. While the respondents exhibit a high knowledge with respect to modes of transmission through sexual intercourse(96.8%); their knowledge with respect to safer sex practices with use of condom in penetrative sex calls for further review. It would be expected that 100% of all respondent will be fully abreast with information on the modes of transmission of HIV and its prevention. Condom use in stable relationship connotes different meanings to the respondents. While 109(85.2%) of the 128 respondents agreed to the use of condom among couples when the status of one of their partner is unknown. The response to the question on whether the use of condom affects sexual relationship portrays an interesting finding. 71(55.4%) of the total respondents disagreed with the fact that condom use affect sexual relationship while 42(32.8%) respondents agreed. It may not be out of place to assume that a lot of HCWs may not be condomizing effectively based on the impression that condom use during sex affect sexual relationship. Health care workers live and interact freely with other members of the society and are potential bridging group for disseminating HIV into the larger population. The finding from GH Ogoja portrays the fact that though the knowledge of HIV among them is very high their full application of the knowledge with respect to sexual behavioural change is still doubtful. A more qualitative study like focus group discussion will assist in unraveling this observation. / AFRIKAANSE OPSOMMING: Nigerië het die tweede grootste voorkoms van MIV in Afrika suid van die Sahara. ‘n Beraamde 3,130 miljoen mense leef na beraming met MIV en die voorkoms in die Cross River Staat van die land was 7.1% in 2010; die negende grootste voorkoms in die land. Die doel van die studie was die bepalin van die kennisvlakke van werkers in die Algemene Hospitaal van Ogoda en ‘n kwantitatiewe benadering en navorsingsontwerp is vir die studie gebruik. ‘n Totaal van 130 vraelyste is geadministreer en ongeveer 90% s terug ontvang. Bevindings van die studie het aangetoon dat meer as 90% van die respondente ‘n bevredigende kennis van MIV het en dat hulle ook goed ingelig is oor die wyses waarop die epidemie versprei word en die metodes waarvolgens verspreiding van die epidemie beperk kan word. Die data van die studie word verder ontleed en meer spesifiekebevindings word gerapporteer. Aabeveling vir die beter opleiding van werkers by die Ogoda Hospitaal word gemaak en voorstelle vir verdere studies word ook gemaak.

Thesis (MPhil (Industrial Psychology. Africa Centre for HIV/AIDS Management))--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: “Treatment failure, defaulter rate, patients lost to follow up”. These are the words usually spoken by health care workers at the CCMT clinics in the country. These are words that they try at all times to come with solutions to, without much success. Much as both the health care workers and patients know the importance of taking medication, often medication is not taken as required. Adherence is defined as the degree to which a patient follows a treatment regimen which has been designed in the context of a consultative partnership between the client and the health care worker. This obligation is comprehensive as it tends to examine all factors that can affect adherence. It includes characteristics such as the treatment regimen, the provider behaviour, social and environmental factors that may hinder adherence on the patient. There are several factors that lead to non-adherence to treatment. The factors may be classified as Biomedical, Psychological and Social factors. The major tool that can be used to address such issues is adequate training of all staff members working at the CCMT clinics. The researcher explored training needs and gaps at a CCMT site that will assist to combat problems of non-adherence to treatment. Health care works at an identified site where questioned on the level of training they have received and on what they need to improve their management of patients and adherence. It was realised that some categories of staff at the clinic do not receive training as expected and that others do not receive adequate training that will assist them in adherence counselling. Recommendations made by staff members were that training should be readily available to all staff members and that it should also be rolled out to other departments and sections within the hospital so there is continuum of care of HIV positive patients. Non adherence to antiretroviral treatment is a challenge faced by health care providers as well as patients themselves. It results in treatment failure, a decrease in the quality of life of the patient and an increase in morbidity and mobility. Non-adherence means any reason where the patient is not taking recommended doses, not sticking to the recommended time or not taking it in the recommended way. / AFRIKAANSE OPSOMMING: Navolging word gedefinieer as die mate waarop die pasiënt die behandeling wat voorgeskryf is in samewerking tussen die pasiënt en die gesondheidsorgwerker, nakom. Hierdie vepligting is omvattend omdat dit geneig is om alle faktore wat die nakoming kan beinvloed, ondersoek. Dit sluit eienskappe in soos die behandeling regimen, die verskaffersgedrag, sosiale en omgewingsfaktore wat ‘n struikelblok kan wees vir die nakoming van die pasiënt. Daar is verskeie faktore wat kan lei tot nie-nakoming van behandeling. Die faktore kan geklassifiseer word as bio-mediese, sielkundige en sosiale faktore. Die belangrike instrument wat gebruik word om sulke sake aan te spreek, is voldoende opleiding van alle personeellede wat by CCMT klinieke werk. Die navorser ondersoek opvoedkundige behoeftes en leemtes by ‘n CCMT perseel, wat sal help om probleme van nie-nakoming van behandeling sal bestry. Gesondheidsorgwerkers by ‘n geïdentifiseerde perseel, was ondervra oor die vlak van opleiding wat hulle ontvang het en wat hulle nodig het vir beter bestuur van pasiënte en nakoming van behandeling deur pasiënte. Daar is gevind dat sommige kategorieë van personeel by die klinkiek nie die opleiding ontvang het wat nodig is nie en dat ander personeellede nie voldoende opleiding ontvang het wat hulle sal help met nakoming van berading nie. Personeellede het aanbeveel dat opleiding geredelik beskikbaar gemaak moet word aan alle personneel en dat dit na ander departemente en afdelings binne die hospitaal uitgebrei moet word om die voortsetting van sorg vir MIV/VIGS-positiewe pasiënte te verseker. Nie-nakoming van antiretrovirale behandeling is ‘n uitdaging vir beide gesondheidsorgwerkers en pasiënte. Dit lei tot die mislukking van behandeling, ‘n afname in die kwaliteit van die pasiënt se lewe en ‘n verhoging in morbiditeit en mobiliteit.

Dans le contexte social actuel, l’identification et la compréhension de la représentation que les intervenants ont des soins palliatifs constituent l’un des points d’ancrage de l’agir professionnel, de la formation et des modifications de structures de soins. Le but de cette étude était de décrire et de comprendre la représentation qu’un groupe d’intervenants travaillant en CLSC a des soins palliatifs, puis de proposer des interventions éducatives et organisationnelles susceptibles de favoriser une plus forte adhésion à la philosophie qui sous-tend ce type particulier de soins. Des entretiens semi dirigés et une analyse de contenu ont révélé un univers de représentations à la fois similaires et différents dans chaque sous-groupe. On constate que chaque thème exploré peut prendre des sens divers. On peut dire que la représentation des soins palliatifs chez le groupe de professionnels de CLSC ayant participé à la présente étude constitue un ensemble de savoirs à portée pratique très élevée faisant intervenir en grande majorité des savoirs de sens commun. Un point se révèle crucial : celui de la formation dans l’appropriation de la philosophie des soins palliatifs qui devrait être à la base de cette pratique; une formation qui doit prendre en compte les multiples composantes non scientifiques et les ambiguïtés du travail quotidien en soins palliatifs comme faisant partie intégrante des dynamiques du processus d’appropriation de la philosophie des soins palliatifs. / In the present social context, the identification and the comprehension of palliative care workers representations is at the base of their professional education and behaviours as well as of the many changes occurring in health care institutions. The aim of the present research is to describe and better comprehend the representations of a group of health care professionals working in a continuum of palliative care services in the Quebec health care and social services network. It is also to propose educational and organizational interventions in order to bring workers closer to the palliative care philosophy. Semi directed interviews and a content analysis revealed a large variety of representations that were both similar and different in each group as well as in the different groups. Many different meanings were given to each theme explored. The health care workers palliative care representations contain a variety of highly practical knowings and knowledges that bring together a vast majority of common sense meanings. One point is crucial: palliative care philosophy education should be at the base of palliative care interventions. The education content should take into account the multiple non scientific and ambiguous components of daily work in a palliative care settings since they are part of the process conducting to the appropriation of the palliative care philosophy.

This dissertation examines how perceptions of competence affect the care of older persons, and the values ​​and vocational conceptions of care work and care recipients that are tied to the perceptions of what skills that are needed and why. Competence is defined by three parts with relevance for the content of care work: what knowledge the care workers should have, what tasks they should perform and how they should respond to care recipients. The aim of this dissertation is to analyse how the care managers' and care workers' perceptions of competence form the direction of the care work and how that direction relates to the care recipients’ perceptions of and expectations on the care work.   The care work is characterised by what is analysed as an activation of the recipients - that the recipients themselves should perform as much of the care work as possible. The activation aims at managing the decay of the aging body and is motivated by a vocational conception of the care recipients as different from others, with designations as grateful and passive. This conception is analysed as generation character based on an idea among the care managers and care workers that the society in which the recipients grew up gave them certain cognitive prerequisites that have to be managed in the practical care work.   The care recipients in the study have opposing conceptions and perceptions of care work compared with the care managers and care workers. The recipients’ central objective with the care work is to prevent what has been interpreted as the disrepair of the home. The care recipients’ position in the organisation raises the problem of loyalty towards the care workers and in some sense the care managers. Their loyalty reduces their ability to complain and to influence their situation to the better.   Keywords: care of older persons, care needs, care work, care relationship, care receivers, care workers, care managers, competence, technologies, activation, generation character

The purpose of this study is to explore and describe the knowledge, attitudes and experiences of health care workers who care for patients receiving treatment under DOTS strategy at public health facilities in the Windhoek District of the Khomas Region. A qualitative explorative, descriptive and contextual research design was used in this study. A purposive sampling was used to select participants who met the inclusion criteria for the study. The inclusion criteria was to be a health care worker who at the time of the study was working with patients who are on DOT for at least 6 months. A semi-structured interview guide was used to collect data. The study was conducted in the Windhoek district of the Khomas region, with a sample of 14 health care workers. Data was analysed by means of content analysis, a process of organizing and integrating narrative, qualitative data according to emerging themes and concepts. The three themes, which emerged from data analysis, were the knowledge of health care workers regarding the implementation of DOTS, the attitudes of health care workers towards patients on DOT which may affect the success of their treatments, and the experiences of health care workers when attending to patients on DOTS. The findings from the study may be used to engage stakeholders to address the shortcomings that exist in the implementation of the DOTS strategy in the district. / Health Studies / M.A. (Nursing Science)

The research focused on employee wellness and explored and described the role of spirituality in the wellbeing of CHCWs of HIV/AIDS patients. It was important to determine how CHCWs dealt with the stress of caregiving, due to the increasing number of HIV infections and burden on government resources. The approach was a phenomenological qualitative study using faceto- face interviews to collect data from a purposive sample of eight CHCWs from a population of 250 at Temba. The audio-recorded interviews were transcribed verbatim and analysed for emerging themes using thematic analyses. The research findings provided evidence that spirituality impacted positively on the wellbeing of the CHCWs by providing the coping mechanism to deal with stress. The conclusions drawn were that personal and organisational wellbeing operated at an optimal level due to the influence of spirituality. Recommendations were that formalised spiritual programmes were offered as a tool to equip CHCWs in their duties. / Industrial and Organisational Psychology / M. Com.

Background: Accidental exposure to patients’ body fluids (BFs) is an occupational hazard among health care workers (HCWs). The study aimed at describing the patterns of exposure to patients’ BFs among HCWs at a university hospital in Ethiopia. Methods: A contextual descriptive cross-sectional design was used for this study. Self-administered questionnaires were used to collect data. Results: The one year and professional life prevalence of occupational exposure to patients’ BFs among HCWs was 33.5% and 66.5% respectively. Circumstances that led to participants’ exposures to patients’ BFs include needle stick injuries to fingers and splashes to the eyes (82.4%); conducting procedures included blood withdrawal (10.8%) and inserting intravenous infusions (8.1%) and recapping of used needles (12.2%). Conclusion: Findings of this study generally indicated that occupational exposures to patients’ BF of different types and circumstances were common among all categories of HCWs in the study site. This high finding of BF exposure should not be over looked. HCWs should follow the universal precaution protocol and PEP need to be strengthened / Health Studies / M.A. (Public Health)

Healthcare-associated infections (HAIs) represent a great risk factor to patient well-being, which in turn brings a significant economic factor onto health services worldwide. Hand hygiene (HH) is considered a high impact measure with the least expense incurred when it comes to controlling infections related to health care, as it avoids the cross transmission of microorganisms. This study aimed to evaluate the effectiveness of the multimodal strategy to improve the HH from the World Health Organization (WHO) in a Brazilian University hospital. This is an ecological study, prospective, pre and post-intervention type, conducted between December 2012 and October 2013. Data were collected by direct observation and employment self-administered instrument to health professionals from seven inpatient units: Adult Intensive Care Unit (AICU), Pediatric Intensive Care Unit (PICU), Kidney Transplant Sector (SECTRAN), Internal Medicine (IM), Clinical Surgery 1 (SC1), Clinical Surgery 2 (SC2), Burn Unit (BU). HAI rates were evaluated, joining the HM and the knowledge and perception of health professionals in relation to IRAS and HM. There were 2.297 hand hygiene opportunities observed. The adherence rate was of 54.86% during the pre-intervention period and 51.02% for post-intervention (p>0.05). The authors did not find any direct relationship between the rates of adherence of hand hygiene with infections related to health care. One of the failures detected in the implementation design, was the fact that feedback of infection rates related to health care did not include that of health care professionals. It is concluded that the implementation of the multimodal strategy to improve the HM the WHO is not necessarily effective. / As infecções relacionadas à assistência à saúde (IRAS) representam um grande risco para a segurança do paciente e causam um impacto econômico significativo sobre os sistemas de saúde no mundo todo. A higienização das mãos (HM) é considerada a medida de maior impacto e menos dispendiosa para prevenir e controlar as IRAS, uma vez que evita a transmissão cruzada de microrganismos. Este estudo objetivou avaliar a efetividade da estratégia multimodal de HM da Organização Mundial de Saúde (OMS) em um hospital universitário brasileiro. Trata-se de um estudo ecológico, prospectivo, do tipo pré e pós-intervenção, realizado entre dezembro de 2012 e outubro de 2013. Os dados foram coletados por observação direta e emprego de instrumento autoaplicável aos profissionais de saúde de sete unidades de internação: Unidade de Terapia Intensiva para Adultos (UTIA), Unidade de Terapia Intensiva Pediátrica (UTIP), Setor de Transplante Renal (SETRAN), Clínica Médica (CM), Clínica Cirúrgica 1 (CC1), Clínica Cirúrgica 2 (CC2), Unidade de Queimados (UQ). Foram avaliadas as taxas de IRAS, a adesão à HM e o conhecimento e percepção dos profissionais de saúde em relação às IRAS e HM. Foram observadas 2.297 oportunidades para HM. A adesão foi de 54,86% no período pré-intervenção e de 51,02% após a intervenção (p>0,05). Não encontramos relação direta das taxas de adesão à HM com as IRAS. Uma das falhas detectáveis na forma de implantação foi a não utilização do feedback das taxas de IRAS e do teste de conhecimento para os profissionais de saúde. Conclui-se que a implantação da estratégia multimodal de melhoria da HM da Organização Mundial de Saúde não é necessariamente efetiva. / Mestre em Ciências da Saúde