Jin, Dawei. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 83-93). / Abstracts in English and Chinese. / ABSTRACT (IN CHINESE) --- p.ii / ABSTRACT (IN ENGLISH) --- p.iv / ACKNOWLEDGEMENTS --- p.vii / CONTENTS --- p.ix / LIST OF TABLES --- p.vxiii / LIST OF FIGURES --- p.xiv / LIST OF ABBREVIATIONS --- p.xvi / Chapter CHAPTER I --- INTRODUCTION --- p.1 / Chapter 1.1 --- Biology of C. albicans --- p.2 / Chapter 1.1.1 --- Taxonomy --- p.2 / Chapter 1.1.2 --- Basic cell biology --- p.2 / Chapter 1.1.2.1 --- Cell cycle and phenotypic switch --- p.2 / Chapter 1.1.2.2 --- Cell wall --- p.3 / Chapter 1.1.3 --- "Morphological, culture and biochemical characteristics" --- p.4 / Chapter 1.1.4 --- Genomics --- p.5 / Chapter 1.1.5 --- Pathogenecity --- p.6 / Chapter 1.2 --- Catheter-related bloodstream infections (CRBSI) caused by C. albicans --- p.7 / Chapter 1.2.1 --- Intravenous catheter type --- p.7 / Chapter 1.2.2 --- Epidemiology of CRBSI caused by C. albicans --- p.8 / Chapter 1.2.3 --- Pathogenesis of intravascular catheter-related infections --- p.9 / Chapter 1.2.4 --- Diagnosis of catheter-related infections --- p.10 / Chapter 1.2.5 --- Prevention and control --- p.11 / Chapter 1.3 --- Mechanism of C. albicans adhesion to catheters --- p.12 / Chapter 1.3.1 --- The definition of microbial adhesion --- p.12 / Chapter 1.3.2 --- Relationship between microbial adhesion and biofilm formation --- p.12 / Chapter 1.4 --- Agglutinin-like sequence (ALS) gene family of C. albicans --- p.14 / Chapter 1.4.1 --- Members of ALS gene family --- p.14 / Chapter 1.4.2 --- Chromosomal location of ALS genes --- p.14 / Chapter 1.4.3 --- ALS gene organization --- p.14 / Chapter 1.4.3.1 --- Three-domain structure of ALS genes --- p.15 / Chapter 1.4.3.2 --- Characterization of ALS genes. --- p.15 / Chapter 1.4.4 --- ALS gene allelic variation --- p.17 / Chapter 1.5 --- Experimental models for catheter adhesion study of C. albicans --- p.17 / Chapter 1.5.1 --- "Static adhesion model for C, albicans" --- p.18 / Chapter 1.5.1.1 --- Advantage of static adhesion model --- p.19 / Chapter 1.5.1.2 --- Limitation of static adhesion model --- p.19 / Chapter 1.5.2 --- Dynamic adhesion model for C. albicans --- p.19 / Chapter 1.5.2.1 --- Advantage of dynamic adhesion model --- p.20 / Chapter 1.5.2.2 --- Limitation of dynamic adhesion model --- p.20 / Chapter 1.5.3 --- Quantification methods of adherent cells --- p.21 / Chapter 1.5.4 --- ALS gene expression study in the in vitro model --- p.22 / Chapter 1.6 --- Aim of study --- p.22 / Chapter CHAPTER II --- MATERIALS & METHODS --- p.24 / Chapter 2.1 --- Strains used in this study --- p.25 / Chapter 2.2 --- Design of an in vitro dynamic adhesion model for C. albicans --- p.26 / Chapter 2.2.1 --- Flask --- p.26 / Chapter 2.2.2 --- Peristaltic pump --- p.26 / Chapter 2.2.3 --- Glass tube and vascular catheters. --- p.27 / Chapter 2.2.4 --- Sterility check of in vitro dynamic adhesion model --- p.27 / Chapter 2.3 --- Construction of C. albicans growth curve --- p.27 / Chapter 2.4 --- Measurement of C. albicans adhesion to catheters --- p.29 / Chapter 2.5 --- Detection of C. albicans ALS genes --- p.30 / Chapter 2.5.1 --- DNA extraction of C. albicans --- p.30 / Chapter 2.5.2 --- ALS primers design --- p.31 / Chapter 2.5.3 --- PCR reaction --- p.32 / Chapter 2.5.4 --- Gel electrophoresis --- p.32 / Chapter 2.5.5 --- Purification of PCR products --- p.33 / Chapter 2.6 --- Construction of E. coli plasmid containing gene --- p.34 / Chapter 2.6.1 --- Ligation using the pGEM®-T Easy Vector --- p.34 / Chapter 2.6.2 --- Preparation of E. coli DH5a electro-competent cells --- p.35 / Chapter 2.6.3 --- Clean up of DNA ligation reaction for electro-transformation --- p.36 / Chapter 2.6.4 --- Electro-transformation of E. coli DH5a electro-competent cells --- p.37 / Chapter 2.6.5 --- Blue / white screening for positive transformation of E. coli DH5a. --- p.37 / Chapter 2.6.6 --- Extraction of plasmid containing ALS1 gene --- p.39 / Chapter 2.6.7 --- Plasmid validation by PCR and gel electrophoresis --- p.39 / Chapter 2.6.8 --- Serial dilution of plasmid solutions for ALS1 standard curve construction --- p.40 / Chapter 2.7 --- C. albicans ALS1 gene expression in dynamic adhesion model --- p.41 / Chapter 2.7.1 --- Design of real-time PCR primers specific for C. albicans ALS1 --- p.41 / Chapter 2.7.2 --- Validation of primers specificity --- p.42 / Chapter 2.7.3 --- RNA extraction of C. albicans cells adhered on catheters --- p.43 / Chapter 2.7.4 --- Complementary DNA (cDNA) synthesis --- p.45 / Chapter 2.7.5 --- Quantitative real-time RT-PCR --- p.46 / Chapter 2.8 --- Statistical analyses --- p.48 / Chapter CHAPTER III --- RESULTS --- p.49 / Chapter 3.1. --- Validation of the in vitro dynamic adhesion model for C. albicans --- p.50 / Chapter 3.2. --- C. albicans growth curve construction --- p.50 / Chapter 3.3. --- Measurement of C. albicans adhesion on catheters --- p.50 / Chapter 3.4. --- Detection of C. albicans SC5314 ALS genes --- p.52 / Chapter 3.5. --- Validation of E. coli plasmid containing ALS1 gene --- p.54 / Chapter 3.6. --- C. albicans ALS 1 gene expression in dynamic adhesion model --- p.54 / Chapter 3.6.1. --- Specificity validation of ALS1 real-time primers --- p.55 / Chapter 3.6.2. --- Quantitative real-time RT-PCR --- p.55 / Chapter CHAPTER IV --- DISCUSSION --- p.57 / Chapter 4.1 --- Experimental design of the in vitro dynamic adhesion model --- p.58 / Chapter 4.1.1 --- Advantages of this in vitro dynamic adhesion model --- p.58 / Chapter 4.1.2 --- Limitation of this in vitro dynamic adhesion model --- p.58 / Chapter 4.1.3 --- Catheter arrangement inside the glass tube --- p.60 / Chapter 4.1.4 --- Reproducibility of experiments in the model --- p.62 / Chapter 4.1.5 --- Identification of potential contamination in the model --- p.63 / Chapter 4.1.6 --- Advantages of removing method for C. albicans adherent cells --- p.64 / Chapter 4.1.7 --- Limitation of removing method for C. albicans adherent cells --- p.64 / Chapter 4.1.8 --- Limitation of statistical analysis --- p.66 / Chapter 4.1.9 --- Primers design --- p.67 / Chapter 4.1.9.1 --- Primers of C. albicans ALS gene detection --- p.67 / Chapter 4.1.9.2 --- Validation of ALS 1 real-time primers specificity --- p.69 / Chapter 4.2 --- C. albicans adhesion to catheters --- p.70 / Chapter 4.2.1 --- Theoretical explanation of C. albicans adhesion to different catheters --- p.71 / Chapter 4.3 --- C. albicans ALS gene expression --- p.74 / Chapter 4.3.1 --- Functions of Als proteins --- p.75 / Chapter 4.3.1.1 --- Adhesive functions --- p.75 / Chapter 4.3.1.2 --- Other functions in C. albicans pathogenesis --- p.75 / Chapter 4.3.2 --- Analysis of ALS1 gene expression pattern in the in vitro model --- p.76 / Chapter 4.4 --- Clinical application of our study --- p.78 / Chapter 4.5 --- Future study --- p.80 / Chapter 4.6 --- Conclusion --- p.81 / REFERENCES --- p.83

The aim of this thesis is to describe the use of Swan-Ganz catheter, epidural catheters and temporary pacemakers in intensive care. Another objective is to investigate the level of knowledge and their subjective evaluation of health workers operating in the post-operative cardiac surgery in nursing care of patients with implantable Swan - Ganz catheter, the epidural catheter and temporary pacemaker. The selected nursing interventions are crucial in the field of cardiac surgery. In the theoretical part deals with the definition of basic concepts to selected performances from a nursing perspective. In theory I connected the few literary sources with knowledge from my own experience. In the practical skills required are concretized and processed on a quantitative approach using statistical procedures. To obtain the data questionnaire technique was used. The level of knowledge of respondents postoperative cardiac surgery department responsible level sufficient knowledge or very good. The investigation found alarming was the fact that half of all respondents in the knowledge test erred in ruling wedge pressure measurement parameters of the pulmonary artery catheter. The nursing interventions, which often occurs in the intensive care deserves more attention from management facility that would provide...

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Bakgrund: En kateterrelaterad urinvägsinfektion är en vanlig vårdrelaterad infektion som drabbar patienter i olika åldrar och medför lidande, förlängda vårdtider samt ökade vårdkostnader. Risken ökar med långvarig kateteranvändning, ålder och andra försämrade hälsotillstånd. Sjuksköterskor har en viktig roll i att förebygga och hantera kateterrelaterade urinvägsinfektioner genom evidensbaserad omvårdnad.  Syfte: Syftet med studien var att undersöka hur sjuksköterskan kan förebygga kateterrelaterad urinvägsinfektion. Metod: En allmän litteraturstudie av tidigare forskning gjordes genom granskning av fem kvalitativa, tolv kvantitativa och en mixad metod-studie. Resultat: Fem kategorier identifierades: arbetsplatsen och samarbetets påverkan, kunskapen hos sjuksköterskor, material och tillvägagångsätt vid kateterisering, sjuksköterskors arbetsrutiner med katetrar och förebyggande åtgärder vid kateteranvändning. Resultatet visade att kunskap bland vårdpersonal och patienter behöver öka samt att valet av kateter kan minska risken att få en kateterrelaterad urinvägsinfektion. Flera olika förebyggande åtgärder identifierades, som specifika riktlinjer för hur katetern ska skötas samt användning av checklistor och bedömningsverktyg för att minska felaktigt användande av kateter. Konklusion: För att förebygga kateterrelaterad urinvägsinfektion krävs förbättrad säkerhetskultur, samarbete, trivsel på arbetsplatsen, utbildning, material och evidensbaserade riktlinjer. / Background: A catheter-associated urinary tract infection is a common healthcare-associated infection that affects patients of different ages, causing suffering, prolonged hospital stays, and increased healthcare costs. The risk increases with prolonged catheter use, age, and other health conditions. Nurses play a crucial role in preventing and managing catheter-associated urinary tract infections through evidence-based care. Aim: The aim of the study was to investigate how the nurse can prevent catheter-associated urinary tract infection. Method: A general literature review of previous research, including five qualitative, twelve quantitative, and one mixed-method study, was conducted to compile current knowledge on preventive measures. Results: Five categories were identified: workplace and collaboration impact, nurses' knowledge, materials and approaches in catheterization, nurses' catheter care routines, and nurses' and patients' impact during catheter use. The results showed that knowledge among healthcare staff and patients’ needs to increase, and the choice of catheter can reduce the risk of catheter-associated urinary tract infections. Preventive measures such as specific guidelines for catheter care and the use of checklists and assessment tools to reduce improper catheter use. Conclusion:Preventing catheter-associated urinary tract infections requires improved safety culture, collaboration, workplace satisfaction, education, materials, and evidence-based guidelines.

The present thesis deals with the issue of central venous catheter treatment in intensive and metabolic care, as well as the complications, which can accompany central venous cannulation and thus affect the possible period of using central venous catheter. The theoretical part tries to summarize the information concerning the issues of central venous catheters and their treatment. It also contains essential physiological and anatomical notes concerning central venous cannulation and a historical summary with regard to the present knowledge. The first part of the empirical section of the research follows the medical approach in various departments of the 4th Department of Internal Medicine of the General Teaching Hospital in Prague, as well as their influence on prevention and the rise of complications. The goal of the second part of the research is to make suggestions for treatment of central venous catheters, which could help to improve nursing care and the using period of catheter. The conclusion evaluates, whether the recommendations have at least partially become a part of the nursing care and if they have helped to resolve the areas of concern or not. Key words Central venous catheter, nursing care, complications of central venous catheter, central venous access.

As infecções causadas por leveduras representam um grave problema em Saúde Pública. O objetivo desta pesquisa é o estudo aderência de Candida spp. (C. albicans ATCC18804, C. albicans SC5314, C. albicans cepa de campo, C. glabrata ATCC2001) sobre cateter urinário de Látex siliconizado (LS) e Silicone total (ST); avaliação da sensibilidade ao M-EDTA® dos biofilmes formados e quantificação dos genes ALS1 e ALS3 expressos por células sésseis de C. albicans. Os biofilmes de Candida spp. foram produzidos sobre cateteres urinários (LS e ST) segmentados em 1,0 cm de comprimento e separadamente introduzidos em poços de placas de poliestireno, sendo incubados a 35±1°C em contato com as suspensões de leveduras por 6, 24 e 48 e 72 horas. Os segmentos de cateter foram examinados por MEV, por cultura microbiológica, para avaliação da viabilidade celular e redução do sal de tetrazólio (XTT), para medir a atividade metabólica das células em biofilme. A sensibilidade das células sésseis ao M-EDTA® foi determinada após a exposição dos biofilmes ao produto; a expressão dos genes ALS1 e ALS3 de C. albicans SC5314 foi analisada por reação em cadeia de polimerase quantitativo (qPCR) e o resultado da recuperação de células viáveis de biofilme de Candida spp. foi expresso em log média ± desvio-padrão. Do biofilme de C. albicans ATCC18804 formado sobre LS, a recuperação foi de 4,48±2,52 e sobre ST; 4,76±1,62. A média de recuperação do biofilme de C. albicans SC5314 sobre LS foi de 4,35±0,39 e sobre ST, de 4,21±0,22. Para C. albicans cepa de campo, a média no LS foi 5,15±0,18 e no ST; 4,79±0,17. Do biofilme de C. glabrata ATCC2001 formado sobre o LS, a recuperação média foi de 4,69±0,19 e sobre ST, de 4,75±0,68. A atividade metabólica das células em biofilme foi expressa em valores de absorbância. Células de C. albicans ATCC18804 aderidas ao LS apresentaram atividade de 0,070±0,06 e sobre ST; 0,0681±0,06. A atividade metabólica do biofilme de C. albicans SC5314 sobre o LS foi de 0,0622±0,05 e sobre ST; 0,0785±0,05. Das células de C. albicans cepa de campo aderidas ao LS detectou-se atividade de 0,1064±0,01 e sobre ST, de 0,904±0,03. Células de C. glabrata ATCC2001 aderidas ao LS apresentaram uma atividade de 0,0785±0,04 e sobre ST; 0,0755±0,03. A observação ao MEV mostrou células leveduriformes de C. albicans SC5314 aderidas ao LS e ao ST formando monocamadas. Candida albicans ATCC18804, C. albicans cepa de campo e C. glabrata ATCC2001 formaram monocamadas de células leveduriformes e produziram filamentos sobre a superfície LS e ST, sugerindo uma estrutura tridimensional do biofilme. A exposição ao M-EDTA® dos biofilmes de C. albicans ATCC18804, C. albicans SC5314, C. albicans cepa de campo e C. glabrata ATCC2001 mostrou que os mesmo foram sensíveis à ação do produto. Após o crescimento de C. albicans SC5314 em biofilme, não houve detecção de expressão dos genes ALS1 e ALS3. Em conclusão, todas as espécies de Candida formaram biofilme sobre os biomateriais. Os biofilmes foram sensíveis a ação do M-EDTA® e C. albicans SC5314 não expressou os genes ALS1 e ALS3. / Infections caused by yeasts represent a serious problem in Public Health. The aim of this research was to study the Candida spp. (C. albicans ATCC18804, C. albicans SC5314, C. albicans wild type, C. glabrata ATCC2001) attachment onto urinary catheters made of Siliconized latex (LS) and Total silicon (ST); evaluating the susceptibility of biofilms to M-EDTA® and quantifying genes ALS1 and AL3 expressed by sessile cells of C. albicans. The Candida spp. biofilms were produced over the surface of urinary catheters (LS and ST). The catheters were cut in 1.0cm in length, introduced in wells of polystyrene plates and incubated at 35±1°C in contact with yeasts suspensions during 6, 24, 48 and 72 hours. The catheter samples were examined by SEM, by microbiology culture to evaluate the viable cells and reduction of tetrazolium salt (XTT) to measure the metabolic activity of Candida spp. cells into biofilms. The sensitivity of sessile cells to M-EDTA® was determinated after the exposition of biofilms to the product. The C. albicans SC5314 expression of ALS1 and ALS3 genes was analyzed by quantitative polymerase chain reaction (qPCR). The results of Candida spp. viable cells recovery were determined in log average ± standard deviation. From C. albicans ATCC18804 biofilm cells formed onto LS, the recovery was 4.48±2.52 e onto ST; 4.76±1.62. The average of recovery from C. albicans SC5314 biofilm formed onto LS was 4.35±0.39 and onto ST; 4.21±0.22. For C. albicans wild type, the recovery onto LS was 5.15±0.18 and above ST; 4.79±0.17. C. glabrata ATCC2001 biofilm formed onto LS, the medium was 4.69±0.19 and onto ST; 4.75±0.68. The metabolic activity from cells into biofilms was determined in absorbance values. C. albicans ATCC18804 cells attachment on LS had an activity of 0.070±0.06 and on ST; 0.0681±0.06. The metabolic activity of C. albicans SC5314 biofilm formed onto LS was 0.0622±0.05 and onto ST; 0.0785±0.05. From C. albicans wild type attached onto LS, the activity detected was 0.1064±0.01 and on ST; 0.904±0.03. C. glabrata ATCC2001 cells attached on LS had an activity of 0.0785±0.04 and on ST; 0.0755±0.03. The SEM observations showed C. albicans SC5314 yeast cells attached on LS and ST forming a monolayer. C. albicans ATCC18804, C. albicans wild type and C. glabrata ATCC2001 formed yeast monolayer and produced filaments over the surface of LS and ST, suggesting the three-dimensional structure of biofilm. The M-EDTA® exposition of C. albicans ATCC18804, C. albicans SC5314, C. albicans wild type and C. glabrata ATCC2001 showed that the biofilms were sensitive to the product action. After the C. albicans SC5314 biofilm growth, there was not expression of the ALS1 and ALS3 genes. In conclusion, all the Candida species formed biofilms on the biomaterials. The biofilms were sensitive to M-EDTA® and the C. albicans SC5314 didn´t express the ALS1 and ALS3 genes.

As infecções causadas por leveduras representam um grave problema em Saúde Pública. O objetivo desta pesquisa é o estudo aderência de Candida spp. (C. albicans ATCC18804, C. albicans SC5314, C. albicans cepa de campo, C. glabrata ATCC2001) sobre cateter urinário de Látex siliconizado (LS) e Silicone total (ST); avaliação da sensibilidade ao M-EDTA® dos biofilmes formados e quantificação dos genes ALS1 e ALS3 expressos por células sésseis de C. albicans. Os biofilmes de Candida spp. foram produzidos sobre cateteres urinários (LS e ST) segmentados em 1,0 cm de comprimento e separadamente introduzidos em poços de placas de poliestireno, sendo incubados a 35±1°C em contato com as suspensões de leveduras por 6, 24 e 48 e 72 horas. Os segmentos de cateter foram examinados por MEV, por cultura microbiológica, para avaliação da viabilidade celular e redução do sal de tetrazólio (XTT), para medir a atividade metabólica das células em biofilme. A sensibilidade das células sésseis ao M-EDTA® foi determinada após a exposição dos biofilmes ao produto; a expressão dos genes ALS1 e ALS3 de C. albicans SC5314 foi analisada por reação em cadeia de polimerase quantitativo (qPCR) e o resultado da recuperação de células viáveis de biofilme de Candida spp. foi expresso em log média ± desvio-padrão. Do biofilme de C. albicans ATCC18804 formado sobre LS, a recuperação foi de 4,48±2,52 e sobre ST; 4,76±1,62. A média de recuperação do biofilme de C. albicans SC5314 sobre LS foi de 4,35±0,39 e sobre ST, de 4,21±0,22. Para C. albicans cepa de campo, a média no LS foi 5,15±0,18 e no ST; 4,79±0,17. Do biofilme de C. glabrata ATCC2001 formado sobre o LS, a recuperação média foi de 4,69±0,19 e sobre ST, de 4,75±0,68. A atividade metabólica das células em biofilme foi expressa em valores de absorbância. Células de C. albicans ATCC18804 aderidas ao LS apresentaram atividade de 0,070±0,06 e sobre ST; 0,0681±0,06. A atividade metabólica do biofilme de C. albicans SC5314 sobre o LS foi de 0,0622±0,05 e sobre ST; 0,0785±0,05. Das células de C. albicans cepa de campo aderidas ao LS detectou-se atividade de 0,1064±0,01 e sobre ST, de 0,904±0,03. Células de C. glabrata ATCC2001 aderidas ao LS apresentaram uma atividade de 0,0785±0,04 e sobre ST; 0,0755±0,03. A observação ao MEV mostrou células leveduriformes de C. albicans SC5314 aderidas ao LS e ao ST formando monocamadas. Candida albicans ATCC18804, C. albicans cepa de campo e C. glabrata ATCC2001 formaram monocamadas de células leveduriformes e produziram filamentos sobre a superfície LS e ST, sugerindo uma estrutura tridimensional do biofilme. A exposição ao M-EDTA® dos biofilmes de C. albicans ATCC18804, C. albicans SC5314, C. albicans cepa de campo e C. glabrata ATCC2001 mostrou que os mesmo foram sensíveis à ação do produto. Após o crescimento de C. albicans SC5314 em biofilme, não houve detecção de expressão dos genes ALS1 e ALS3. Em conclusão, todas as espécies de Candida formaram biofilme sobre os biomateriais. Os biofilmes foram sensíveis a ação do M-EDTA® e C. albicans SC5314 não expressou os genes ALS1 e ALS3. / Infections caused by yeasts represent a serious problem in Public Health. The aim of this research was to study the Candida spp. (C. albicans ATCC18804, C. albicans SC5314, C. albicans wild type, C. glabrata ATCC2001) attachment onto urinary catheters made of Siliconized latex (LS) and Total silicon (ST); evaluating the susceptibility of biofilms to M-EDTA® and quantifying genes ALS1 and AL3 expressed by sessile cells of C. albicans. The Candida spp. biofilms were produced over the surface of urinary catheters (LS and ST). The catheters were cut in 1.0cm in length, introduced in wells of polystyrene plates and incubated at 35±1°C in contact with yeasts suspensions during 6, 24, 48 and 72 hours. The catheter samples were examined by SEM, by microbiology culture to evaluate the viable cells and reduction of tetrazolium salt (XTT) to measure the metabolic activity of Candida spp. cells into biofilms. The sensitivity of sessile cells to M-EDTA® was determinated after the exposition of biofilms to the product. The C. albicans SC5314 expression of ALS1 and ALS3 genes was analyzed by quantitative polymerase chain reaction (qPCR). The results of Candida spp. viable cells recovery were determined in log average ± standard deviation. From C. albicans ATCC18804 biofilm cells formed onto LS, the recovery was 4.48±2.52 e onto ST; 4.76±1.62. The average of recovery from C. albicans SC5314 biofilm formed onto LS was 4.35±0.39 and onto ST; 4.21±0.22. For C. albicans wild type, the recovery onto LS was 5.15±0.18 and above ST; 4.79±0.17. C. glabrata ATCC2001 biofilm formed onto LS, the medium was 4.69±0.19 and onto ST; 4.75±0.68. The metabolic activity from cells into biofilms was determined in absorbance values. C. albicans ATCC18804 cells attachment on LS had an activity of 0.070±0.06 and on ST; 0.0681±0.06. The metabolic activity of C. albicans SC5314 biofilm formed onto LS was 0.0622±0.05 and onto ST; 0.0785±0.05. From C. albicans wild type attached onto LS, the activity detected was 0.1064±0.01 and on ST; 0.904±0.03. C. glabrata ATCC2001 cells attached on LS had an activity of 0.0785±0.04 and on ST; 0.0755±0.03. The SEM observations showed C. albicans SC5314 yeast cells attached on LS and ST forming a monolayer. C. albicans ATCC18804, C. albicans wild type and C. glabrata ATCC2001 formed yeast monolayer and produced filaments over the surface of LS and ST, suggesting the three-dimensional structure of biofilm. The M-EDTA® exposition of C. albicans ATCC18804, C. albicans SC5314, C. albicans wild type and C. glabrata ATCC2001 showed that the biofilms were sensitive to the product action. After the C. albicans SC5314 biofilm growth, there was not expression of the ALS1 and ALS3 genes. In conclusion, all the Candida species formed biofilms on the biomaterials. The biofilms were sensitive to M-EDTA® and the C. albicans SC5314 didn´t express the ALS1 and ALS3 genes.

More than 13,000 deaths and $340 million in health care costs are the result of catheter-associated urinary tract infections (CAUTIs) annually in the United States. CAUTIs can also result in acute patient discomfort and potentially preventable exposure to antibiotics. The hospital for which this quality improvement project was developed was above the National Healthcare Safety Network CAUTI bench mark. Framed within the Iowa model of evidence-based practice, a multidisciplinary team of 8 hospital stakeholders guided the project (n=8). The purpose of the project was to develop an indwelling urinary catheter maintenance checklist using evidence-based practice guidelines related to preexisting inappropriate risk factors for catheterization and appropriate indications for catheterization, as well as evidence-based maintenance practices for care of the indwelling catheter. Each piece of evidence to be included in the checklist was evaluated by 4 content experts using a 10 item 5 point Likert scale ranging from 'strongly disagree' to 'strongly agree'. Descriptive analysis showed an average of 4.8/5 for all items with 'agree' being voiced in two of the items rather than 'strongly agree'. The checklist was completed and presented to hospital senior leadership who recommended that the checklist be incorporated into the hospital CAUTI prevention plan. All project team members (n=8) completed an 8 item 5 point Likert scale summative evaluation of the purpose, goal, objectives, and my leadership which averaged as 5 or 'strongly agree' supporting the development of the project. Implications for social change include improved patient outcomes, mindful stewardship of healthcare dollars, and increased patient and family satisfaction.

Centrala venkatetrar (CVK) används både inom slutenvården och öppenvården, dock är användandet ej riskfritt. År 2018 var 12,9 % av de vårdrelaterade infektionerna i Sverige relaterade till centrala venkatetrar. Genom att följa evidensbaserade riktlinjer gällande handhavandet av CVK, sänks incidensen av dessa infektioner. Syftet med litteraturöversikten var att kartlägga vilka faktorer som påverkar sjuksköterskans följsamhet till evidensbaserade riktlinjer gällande handhavandet av CVK. Studien genomfördes som en allmän litteraturöversikt med induktiv ansats. Resultatet baserades på 13 vetenskapliga artiklar som visade att sjuksköterskans följsamhet påverkades av såväl resurser som begränsningar. Återkommande utbildning, skriftlig och muntlig återkoppling samt lättillgängligt material kunde öka följsamheten, medan brist på kunskap samt akuta situationer kunde minska sjuksköterskans följsamhet till riktlinjer. / Central venous catheters (CVC) are used both in inpatient and outpatient care, however, the use is not risk-free. In 2018, 12, 9 % of the healthcare-related infections in Sweden were related to central venous catheters. When following evidence-based guidelines of CVC maintenance, the incidence of CVC-related infections are reduced. The aim of this study was to investigate which factors affect the nurse's adherence to evidence-based guidelines regarding CVC maintenance. The study was designed as a structured literature review with an inductive approach. The result was based on 13 scientific articles and showed that the nurses’ adherence was affected by both resources and limitations. Recurrent education, written and oral feedback and easily accessible material could increase the adherence while lack of knowledge and emergencies may provide a reduced nurses’ adherence to guidelines.

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>