L’hygiène des mains (HDM) est déterminante dans la prévention du risque infectieux associé aux soins. Les pratiques actuelles privilégient l’utilisation de produits hydro-alcooliques (PHA), généralement formulés avec de l’éthanol, de l’isopropanol et/ou du n-propanol, en présence de co-formulants pour une meilleure acceptabilité cutanée. L’efficacité antimicrobienne sur un temps court, nécessaire en raison des situations fréquentes de pratique d’HDM, est atteinte par des teneurs élevées en alcools pouvant excéder 80 % p/p. Cela soulève la question de la toxicité cutanée et respiratoire associée à l’utilisation des PHA. L’évaluation de la toxicité cutanée basée sur les données publiées et des essais in vitro d’irritation cutanée (OCDE 439) et de phototoxicité (OCDE 432) conclut à l’absence d’irritation cutanée aiguë et de phototoxicité en relation avec l’exposition cutanée à ces alcools, y compris en présence de co-formulants, tels que fournis dans les PHA. Il est ressorti de nos essais le possible manque de spécificité, déjà décrit dans la littérature, des modèles d’épidermes humains reconstitués (RhE) vis-à-vis de certaines substances, qu’il convient de garder à l’esprit dans le cadre de l’évaluation de l’irritation cutanée in vitro. Des investigations complémentaires et une évaluation par l’approche Weight of Evidence peuvent être utiles avant de conclure aux propriétés irritantes d’un item d’essai. En termes de génotoxicité, une différence entre les alcools ressort de la revue bibliographique, avec des propriétés génotoxiques décrites uniquement pour l’éthanol. Dans une certaine mesure, nos essais ont confirmé une différence de profil. L’isopropanol et le n-propanol testés dans une batterie de tests in vitro permettant d’appréhender les différents mécanismes génotoxiques (test d’Ames et test du micronoyau (MN) sur cellules humaines p53 compétentes : cellules lymphoblastoïdes TK6 et cellules pulmonaires NCI H292) ont donné des résultats négatifs, y compris lorsqu’ils étaient formulés avec des co-formulants, ou administrés sous forme de vapeurs sur les cellules NCI H292 cultivées en interface air-liquide (IAL). Pour l’éthanol, la réalisation de la même batterie de tests a conduit à des résultats équivoques uniquement dans le test du MN sur cellules TK6 avec l’éthanol seul. Un test du MN supplémentaire sur cellules TK6 en co-culture avec un RhE mimant la barrière cutanée a donné des résultats négatifs. Par ailleurs, aucune exposition systémique significative aux alcools induite par les pratiques d’HDM ne ressort des études publiées chez l’homme, avec des taux indiscernables des valeurs endogènes existantes pour l’éthanol et l’isopropanol. L’ensemble de ces données est en faveur de l’absence de risque génotoxique systémique consécutif à l’utilisation des PHA, et de l’absence de génotoxicité pulmonaire locale liée à l’exposition aux vapeurs d’alcools. En conclusion, en situation d’utilisation des PHA pour l’HDM, aucun risque pour la santé humaine en termes d’irritation cutanée aiguë, de phototoxicité et de génotoxicité ne ressort de ce travail de recherche. / Hand hygiene (HH) is a key factor in preventing healthcare-associated infections. Current practices favor the use of alcohol-based hand rubs (AbHR), generally formulated with ethanol, propan-2-ol and/or propan-1-ol, in the presence of co-formulants for a better skin acceptability. The antimicrobial efficiency within a short time, essential because of the frequent situations of HH practice, is achieved by high levels of alcohols which can exceed 80% w/w. This raises the question of dermal and respiratory toxicity associated with the use of AbHR. The assessment of dermal toxicity based on published data and in vitro skin irritation (OECD 439) and phototoxicity tests (OECD 432) conclude to non acute dermal irritation and phototoxicity risk linked to dermal exposure to these alcohols, even in the presence of co-formulants, as provided in the AbHR. We encountered in our trials the possible lack of specificity, already described in the literature, of the reconstructed human epidermis (RhE) models for some substances, which should be kept in mind in the context of the evaluation of skin irritation in vitro. Additional investigations and an assessment using the Weight of Evidence approach may be useful before concluding the irritant properties of a test item. In terms of genotoxicity, a difference between the alcohols emerges from the bibliographic review, with genotoxic properties described only for ethanol. To a certain extent, our tests confirmed a difference in profile. Propan-2-ol and propan-1-ol tested in a battery of in vitro tests to explore the various genotoxic mechanisms (Ames test and micronucleus test (MN) on p53 competent human cells: lymphoblastoid cells TK6 and pulmonary cells NCI H292) gave negative results, even in the presence of co-formulants, or administered as vapors on air-liquid interface (ALI) NCI H292 cells. For ethanol, the same battery of tests gave equivocal results only in the MN test on TK6 cells with ethanol alone. An additional MN test on TK6 cells co-cultured with a RhE mimicking the existing skin barrier gave negative results. In addition, no significant systemic exposure to alcohols induced by HH practices is apparent from published studies in humans, with indiscernible levels of existing endogenous values for ethanol and isopropanol. All of these data support the absence of an increased systemic genotoxic risk resulting from the use of AbHR and the absence of local pulmonary genotoxicity due to exposure to alcohol vapors. In conclusion, during AbHR use for HH, no risk to human health in terms of acute skin irritation, phototoxicity and genotoxicity is apparent from this research.

This diploma thesis is focused on the prevention and monitoring of healthcare-associated infections at the Hospital Prachatice, a.s. The main objective was to describe current situation in the field of prevention of nosocomial infections in this hospital. I focused on verification of medical personnel knowledge of nosocomial infections, the work of cleaners and the quality of hand hygiene of medical personnel. Diploma thesis is focused on the 4 selected departments of the hospital department of internal medicine, gynecology-obstetric department, surgical department and ARO and ICU. Thesis is divided into theoretical and practical part. The present knowledge about the healthcare-associated infections are processed in the theoretical part. To obtain all needed information was used domestic and foreign professional literature. The practical part was about the observation and the short research in the Hospital Prachatice, a.s. The research part was combined. The qualitative method including short interviews with the cleaners was combined with a quantitative method. Within this quantitative method have been used short questionnaires, which were intended for nurses. With these questionnaires I tried to find out their basic knowledge about nosocomial diseases and how they prevent them. The microbiological department of the Hospital Prachatice, a.s. was helpful in monitoring the quality of hand hygiene through method of microbiological fingerprinting. The questionnaires were handed out to nurses which worked on shift in that time on four mentioned departments of hospital. I return total 32 questionnaires back. Questionnaire had 11 questions and my plan was find out the basic knowledge of nurses about the issue. Interviews were conducted with cleaners working on focused departments where the research took place. The microbial fingerprints of hands were collected from medical staff on current work shift including doctors and cleaners. The fingerprints were made on blood agar where after 24-hours of incubation the colonies of bacteria were evaluated. None of the fingerprints was completely negative. I determined totaly 4 research questions: 1. Are all workers of selected hospital departments well informed about nosocomial diseases? 2. What is the hygiene quality of hands among medical staff? 3. On what hygienic level is job of cleaners how often they are cleaning, which way and how often they are changing the working equipment and are the all hygiene criterions followed? 4. How is manipulated with laundry? The results of the questionnaires was surprised for me because most of the medical personnel correctly answered all the asked questions. It was found a total 16 kinds of gram+ and gram microorganisms during a hand hygiene by microbial fingerprints. Most occurred findings was Staphylococcus epidermidis and Microccocus species. In two cases occurred a epidemiologically significant Staphylococcus aureus, which in both cases was found among cleaners. From my observation, investigation and interviews with cleaners I can infer that the work they are doing, they do really conscientiously and normally the health regulations are not violated. Further was found that the manipulation with laundry in Hospital Prachatice, a.s. is in accordance with the hygiene requirements for medical devices. What is important is the effective education of personnel in the prevention of infections and supervision of compliance of mandated procedures.

The diploma thesis deals with problems of healthcare-associated infection in selected nursing activities. The thesis is a theoretical one; it has been processed by means of review and synthesis. In this thesis, four objectives were set, namely to create a comprehensive overview of the problems of healthcare-associated infection in selected nursing activities. Other objectives were to map and analyze clinically relevant sites of transmission and possibilities of prevention of healthcare-associated infection in selected nursing activities and to propose recommendations for the prevention of these infections. The thesis is divided into several chapters that deal with the characteristics of healthcare-associated infection, focusing on the causative agents, formation, spreading and prevention. It also deals with particular nursing activities. The first chosen activity was the care of medical devices intended for repeated use, with a particular focus on the implementation of their disinfection. Secondly, hand sanitation as a basic factor affecting the transmission of healthcare-associated infection activity was selected. This chapter deals primarily with the hygienic hand disinfection, its indications, methods and implementation of disinfection products. It also deals with strategies for improving hand hygiene and glove use in providing nursing care. As the third nursing activity, aseptic techniques, which are an essential part in providing nursing care, were chosen. The thesis describes three specific clinical nursing procedures: aseptic collection of venous blood from a peripheral vein, preparation and administration of a drug into an existing peripheral venous catheter, and uncomplicated (aseptic) wounds dressing. Processing of the thesis was based on a range of relevant sources from the Czech Republic but also from abroad. It also contains various recommendations of national and international institutions. The thesis can serve as a basis for more effective prevention of healthcare-associated infection in certain areas.

Handwashing frequency may result in harmful effects on the skin, promoting the increase of the prevalence of nosocomial important microorganisms. This study purpose was to assess the quantitative and qualitative changes of the total microbiota (both permanent and transient) from hands of nursing professionals and university laboratory technicians and students due to the irritant action provoked by frequent washing and/or wearing gloves. Sixty health professionals were enrolled from whom collections were performed by the sterile polyethylene bag, before and after washing hands with 3 mL of nonantimicrobial soap for 30 seconds. In the group formed by students and laboratory technicians (n=30), these collections were performed before and after consecutive washings with water and soap. Damaged hands health professionals hands contamination was higher when compared with healthy hands. Hygiene proved to be efficient in both students and laboratory technicians without complaints of irritation after successive washings, a fact not seen among health care workers. Nurses with damaged hands presented higher frequency of S. aureus, Gram negative bacteria and yeast than the healthy ones (P>0.05), as well as the sum of these microorganisms (P=0.07) and presence of S. haemolyticus (P=0.02). The frequency of S. aureus and antimicrobial resistant Gram negative bacteria was higher among nurses damaged hands. The irritation caused on the skin by the frequent washing and/or wearing of gloves may cause changes of hands microbiota and should be considered when choosing hygiene products. / A freqüência da lavagem de mãos pode resultar em efeitos prejudiciais na pele promovendo aumento da prevalência de microrganismos de importância hospitalar. Os objetivos deste trabalho foram avaliar quantitativa e qualitativamente as alterações na microbiota total (residente e transitória) das mãos de profissionais de enfermagem e estudantes universitários e técnicos de laboratório associadas à ação irritante provocada pela freqüente lavagem e/ou uso de luvas. Foram incluídos 60 profissionais de saúde, nos quais foram realizadas coletas, pelo método do saco estéril de polietileno, antes e após a lavagem com 3 mL de sabão não medicamentoso, por 30 segundos. No grupo constituído por estudantes e técnicos de laboratório (n=30), estas coletas foram realizadas antes e após lavagens consecutivas com água e sabão. A contaminação das mãos de profissionais de saúde com danos na pele foi maior em relação às sadias. A higiene se mostrou eficiente nos estudantes e técnicos de laboratório sem queixas de irritação após lavagens sucessivas, fato não observado entre profissionais de saúde. Enfermeiras com mãos com danos apresentaram maior freqüência de S. aureus, bacilos Gram-negativos e fungos leveduriformes do que as sadias (P>0,05), assim como quanto à soma destes microrganismos (P=0,07) e a presença de S. haemolyticus (P=0,02). A freqüência de S. aureus e bacilos Gram-negativos resistentes aos antibióticos foi maior nas mãos lesadas de enfermeiras. A irritação causada na pele devido à lavagem freqüente e/ou uso de luvas pode provocar alterações da microbiota das mãos e deve ser considerada pelas instituições quando da escolha de produtos de higiene. / Mestre em Imunologia e Parasitologia Aplicadas

Introdução. Afastamentos associados com as doenças infecciosas estão entre as principais causas de absenteísmo de escolares. A legislação atual não dispõe sobre os conteúdos ou as disciplinas que deveriam abordar a importância da higiene das mãos para se evitar a transmissão de doenças infecciosas, tornando necessário investigar como as escolas lidam com o assunto. Objetivo. Expor algumas reflexões sobre os Parâmetros Normativos e Matrizes Curriculares, especificamente o tema transversal relacionado à saúde e contextualizar as condições de infraestrutura para higiene nas escolas do ensino fundamental do Município de Uberaba, MG. Material e métodos. Primeiramente, realizou-se uma análise documental seguida de uma revisão integrativa da literatura. Posteriormente, conduziu-se um estudo observacional-seccional (diagnóstico situacional). Para a busca foram utilizadas as bases de dados periódicos CAPES, SciELO, LILACS, MEDLINE, PubMed, CINAHL e Ministério da Educação. A observação estruturada ocorreu em visitas agendadas nas escolas, e foi utilizado um instrumento de observação validado. Os dados foram submetidos à análise descritiva. Resultados. A educação é garantida pela Constituição de 1.988 a todos os brasileiros, demonstrando uma preocupação do Estado em manter as crianças nas escolas. Entretanto, a legislação relacionada com o ensino dos temas transversais e questões de saúde surgiu somente dezenove anos mais tarde. Atualmente, as matrizes escolares tratam do tema higiene nos conteúdos de Ciências e Educação Física, porém esse assunto também foi encontrado em Geografia e História. Pesquisas internacionais mostram que as crianças têm baixa adesão na higienização das mãos, o que pode favorecer o surgimento de doenças infecciosas e parasitárias. As escolas do município de Uberaba que foram visitadas possuíam infraestrutura adequada, porém os insumos para a higiene das mãos não eram, em sua maioria, disponibilizados nos banheiros. Conclusão. A legislação mostra a preocupação do Estado com a Educação e a Saúde dos escolares, entretanto, parece haver um hiato na aplicabilidade entre essas leis e a prática. A revisão da literatura internacional revela que as intervenções educativas no ensino fundamental acarretam redução do absenteísmo por infecções. Todavia, as publicações nacionais não permitiram estabelecer tal associação. As escolas estudadas oferecem a infraestrutura física para a higiene dos escolares, entretanto, serão necessários esforços adicionais para conscientizar profissionais e escolares para a disponibilização e uso adequado dos insumos requeridos para a higiene das mãos / Introduction. Clearances associated with infectious diseases are among the leading causes of school absenteeism. The current legislation does not dispose of the contents and subjects that should address the importance of hand hygiene to prevent the transmission of infectious diseases, making it necessary to investigate how schools deal with this issue. Objective. Expose some reflections on the Regulatory Parameters and Course curricula, specifically health related cross-cutting themes, and contextualize the infrastructure conditions for hygiene in primary schools of the city of Uberaba, Minas Gerais, Brazil. Methodology. First, we carried out a document analysis followed by an integrative literature review. Subsequently it was conducted an observational-sectional study (situation analysis). For the search we used the CAPES databases (journals and theses and dissertations), SciELO, LILACS, MEDLINE, PubMed, CINAHL, Ministry of Education and the Brazilian Digital Library of Theses and Dissertations (BDTD). The structured observation occurred in scheduled visits in schools, and we used a validated instrument of observation. Data were submitted to descriptive analysis. Results. Education is guaranteed by the Constitution of 1988 to all Brazilians, demonstrating a concern of the state to keep children in schools. However, the legislation related to the teaching of cross-cutting issues and health issues emerged only nineteen years later. Currently, the school headquarters deal with the subject hygiene in content Sciences and Physical Education, but this subject has also been found in Geography and History. International research shows that children have lower compliance in hand hygiene, which can encourage the emergence of infectious and parasitic diseases. Schools in the city of Uberaba that were visited had adequate infrastructure, but the inputs for hand hygiene were not mostly available in the bathrooms. Conclusion. The Brazilian law shows the state\'s concern for the Education and the Health of school, however, there seems to be a gap in the applicability of these laws and practice. The international literature review reveals that educational interventions in primary education entails reducing absenteeism infections. However, national publications have failed to establish such an association. The studied schools provide the physical infrastructure for the hygiene of the students, however, additional efforts are needed to educate professionals and school for the appropriate provision and use of items necessary for hand hygiene

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No. of bitstreams: 2 Dissertação - Jeenna Louhanna Umbelina Spagnoli - 2017.pdf: 3013325 bytes, checksum: 416656815a7b09d6a4930653323bfeaf (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-04-24 / Hand hygiene (HH) is an indispensable practice for the prevention and control of infections and, although adherence is still low, graduation is the right moment for the future professional to acquire skills. The objective this study was to evaluate the competence about hand hygiene among undergraduates in nursing. A cross-sectional, analytical study was conducted between may and november, 2015, conducted in six of the 33 Higher Education Institutions (HEI) in the central region of Brazil, which offered a nursing degree with a grade above three in the Preliminary Course Concept (PCC) and National Student Proficiency Exam (NSPE) 2013, in classroom mode and in healthcare facilities, place of supervised internship of academics the HEI with maximum grade in PCC and NSPE. After ethical approval, the data were collected in three stages using instruments evaluated and tested. In the first one, a questionnaire was applied, followed by individual observation of the performance of the HH technique (second stage). The third one was performed at the health services to observe attitude to hand hygiene. Informed consent form was applied in all stages. The data were analyzed in SPSS® software with descriptive and analytical statistics. Out of the 179 academics, about 90.0% were female and were up to 30 years of age. The majority of HEI obtained a regular score (27.0% to 48.0%) in knowledge, except for HEI 6 with a maximum score that obtained better rates. As for HH moments, the majority of HEI reached an average between 29.3% and 53.7%, except for HEI 6 (74.9%). In the observation of the ability the majority had long nails (52.4%) and natural (73.1%). These conditions were similar to observation in clinical practice. The majority of HEI achieved the average time to HH as recommended, in skill observation and attitude for HEI 6 and only academics this HEI performed the friction of most of the steps' technique higher than 85.0%. The compliance to HH observed in HEI 6 was 33.7%. The highest adhesion rates were in the opportunities after contact with patients and after risk of contact with fluids and the percentage of friction was above 80.0% for most of the recommended steps. It was concluded that knowledge about hand hygiene obtained low rates of success, except for one institution; the ability to perform the correct technique reached average rates of 60.0% for most HEI, which allows to identify deficits in training about basic principles for HH. In the attitude of hand hygiene according to the world health organization guidelines, a very low adherence rate was observed in HEI 6. The discrepancy between the percentage of knowledge/ability and attitude of HH in this HEI, reveals that the challenge to improve adherence is not restricted to theoretical-practical formation, but, likely, the strategies of the formative process that are capable of transferring the formation to the care, considered in that study, the committal of the academic that result in attitude of the hand hygiene. / A Higienização das Mãos (HM) é uma prática indispensável à prevenção e controle das infecções, entretanto a adesão ainda é baixa, e a graduação é o momento propício para o futuro profissional adquirir competências. O objetivo deste estudo foi avaliar a competência acerca da HM entre concluintes da graduação em enfermagem. Estudo transversal, analítico, realizado entre maio e novembro de 2015, conduzido em seis, das 33 Instituições de Educação Superior – IES da região central do Brasil, que ofereciam graduação em enfermagem com nota acima de três no Conceito Preliminar de Curso (CPC) e Exame Nacional de Desempenho dos Estudantes (ENADE) de 2013, na modalidade presencial e em serviços de saúde, local de estágio supervisionado dos graduandos da IES com nota máxima no CPC e ENADE. Após aprovação ética, os dados foram coletados em três etapas utilizando instrumentos avaliados e testados. Na primeira, aplicou-se questionário, seguida de observação individual do desempenho da técnica de HM (segunda etapa). A terceira foi realizada nos serviços de saúde para observação da atitude de higienização das mãos. Foi aplicado termo de consentimento livre e esclarecido em todas as etapas. Os dados foram analisados no software SPSS® com estatística descritiva e analítica. Dos 179 acadêmicos, aproximadamente 90,0% eram do sexo feminino e tinham até 30 anos de idade. A maioria das IES obteve score regular (27,0% a 48,0%) no conhecimento, exceto a IES 6 com nota máxima que obteve melhores índices. Quanto aos momentos de HM, a maioria das IES alcançou média de acerto entre 29,3% e 53,7%, exceto para a IES 6 (74,9%). Na observação da habilidade a maioria estava com unhas longas (52,4%) e naturais (73,1%). Essas condições foram semelhantes à observação na prática clínica. A maioria das IES obteve média de tempo para HM dentro do recomendado, na observação da habilidade e na atitude para IES 6 e apenas os graduandos desta IES alcançaram índices superiores a 85,0% para o cumprimento de todos os passos recomendados. A adesão à HM observada na IES 6 foi de 33,7%. As maiores taxas de adesão foram nas oportunidades após contato com paciente e após risco de contato com fluidos, e o percentual de fricção foi acima de 80,0% para a maioria dos passos preconizados. Concluiu-se que o conhecimento sobre higienização das mãos obteve baixos índices de acerto, exceto em uma instituição; a habilidade para o desempenho da técnica correta alcançou índices médios de 60,0% na maioria das IES, o que permite identificar déficit na formação acerca de princípios básicos para a HM. Na atitude de higienizar as mãos conforme as indicações da Organização Mundial de Saúde, observou-se taxa de adesão muito baixa na IES 6. A discrepância entre os percentuais de conhecimento/habilidade e atitude de HM nesta IES revela que o desafio para melhorar a adesão não está restrito à formação teórico-prática, mas, provavelmente, às estratégias do processo formativo que sejam capazes de transferir a formação para o cuidado, considerada neste estudo, a entrega do graduando que resulte na atitude de higienizar as mãos.

Abstract Viral infections are common in childhood and a usual cause for hospitalization. Viruses are easily transmitted among children both in pediatric wards and in other child care facilities, like child day-care centers. Hand hygiene is an important part of prevention of the transmission of viruses. Since hospitalization times are getting shorter, hospital-associated infections often manifest after discharge. The aim of the study was to evaluate the magnitude of hospital-associated infections during and after hospitalization in pediatric wards with a focus on the effect of the ward structure. Data were collected during two periods of two years in the pediatric infectious diseases ward in Oulu University Hospital; data collection in the latter period was done using electronic follow-up methods. A two-year study period was also carried out in University Children’s hospital in Basel and in North Karelia Central Hospital in Joensuu. Paper questionnaires and electronic questionnaires were compared as methods of doing continuous surveillance of hospital-associated infections during and after hospitalization. The safety of alcohol-based hand gels in children’s use was studied using alcometer measurements after hand rub. Experiences on the use of alcohol-based hand gels in child day-care centers were collected by interviewing the personnel with questionnaires. Altogether 5.8 to 17.5% of hospitalized children (N=7046) got a hospital-associated infection; 65 to 93% of the infections became evident after discharge. The number of hospital-associated infections was lowest in wards where single rooms and cohorting based on infection etiology were used. Increased risk for hospital-associated infection was associated with young age, longer hospitalization time and a shared room. A higher response rate was achieved with electronic follow-up compared with questionnaires on paper, 84 vs. 61%. The costs of follow-up were €13.61 and €15.07 per patient in electronic and conventional follow-up, respectively. Electronic follow-up decreased annual expenses by 17.1%. Alcohol-based hand gels were found to be safe in children’s use, as no absorption was detected despite several contacts between hands and mucous membranes. Personnel in child day-care centers were active in using hand rubs and found them useful and easy to use. Earlier, there had been one incident with fire when using matches while hands were still wet with alcohol. The majority of hospital-associated infections in children become evident after discharge, and electronic follow-up is useful in evaluating their magnitude. The number of hospital-associated infections can be decreased with single room bedding and careful infection control. Alcohol-based hand gels are safe in children’s hand hygiene. / Tiivistelmä Lapset sairastavat usein virusinfektioita, jotka ovat yleinen sairaalahoidon syy. Virukset leviävät herkästi lasten keskuudessa, lastentautien osastoilla ja lapsiryhmissä, kuten päiväkodeissa. Virusten leviämistä voidaan estää hyvällä käsihygienialla. Lyhyiden hoitoaikojen vuoksi osa virusten aiheuttamista sairaalainfektioista ilmenee vasta kotona. Tutkimuksen tarkoituksena oli selvittää sairaalainfektioiden määrä hoidon aikana ja kotiutuksen jälkeen sekä osastorakenteen vaikutus sairaalainfektioihin lastentautien osastoilla. Sairaalainfektioaineisto kerättiin Oulun yliopistollisen sairaalan lasten infektio-osastolla kahtena kahden vuoden jaksona, joista jälkimmäisessä käytettiin sähköistä seurantajärjestelmää. Lisäksi kahden vuoden aineistot kerättiin Pohjois-Karjalan keskussairaalan lastentautien osastolla ja Baselin yliopistollisen sairaalan lastenosastoilla. Paperikyselylomakkeilla ja sähköisesti tehdyn sairaalainfektioseurannan toteutusta verrattiin. Lisäksi tutkittiin alkoholikäsihuuhteiden käytön turvallisuutta lapsilla päiväkotiolosuhteissa. Alkoholin imeytymistä tutkittiin poliisin tarkkuusalkometrillä käsihuuhteen käytön jälkeen. Oulun kaupungin päiväkodeista kysyttiin käsihuuhteiden käyttökokemuksista kyselylomakkeilla. Sairaalainfektion sai 5,8-17,1 % sairaalassa hoidetuista lapsista (N=7046). Infektioista 65-93 % tuli oireisiksi kotiutuksen jälkeen. Sairaalainfektioiden määrä oli pienin osastoilla, jossa käytettiin yhden hengen huoneita ja potilaiden kohortointia taudinaiheuttajan mukaan. Sairaalainfektion riskiä lisäsivät lapsen nuori ikä, pitkä sairaalahoitoaika ja jaettu potilashuone. Sähköisessä sairaalainfektioseurannassa oli parempi kotiutuksen jälkeinen vastausprosentti kuin paperilomakkeilla, 84 % vrt. 61 %. Potilasta kohden kuluja tuli sähköisessä seurannassa 13,61 euroa ja paperilomakkeilla tehdyssä seurannassa 15,07 euroa. Sähköisen seurannan käyttö laski vuosikuluja 17,1 %. Alkoholikäsihuuhteiden käyttö todettiin turvalliseksi lapsilla. Useista limakalvokontakteista huolimatta käsihuuhteen käytön jälkeen alkoholia ei imeytynyt verenkiertoon. Käsihuuhteiden käyttö päiväkodeissa on aktiivista, ja henkilökunta koki sen helpoksi ja hyödylliseksi. Aiemmin oli tapahtunut yksi vaaratilanne tulen kanssa tulitikkua sytytettäessä käsien ollessa vielä käsihuuhteesta märät. Lasten sairaalainfektioista suuri osa ilmenee kotiutuksen jälkeen, ja näiden infektioiden määrää voidaan arvioida sähköisellä seurantajärjestelmällä. Sairaalainfektioiden määrää voidaan vähentää käyttämällä yhden hengen huoneita ja huolehtimalla hyvästä hygieniasta. Alkoholihuuhteiden käyttö lasten käsihygieniassa on turvallista.

Plusieurs approches ont été proposées au fil du temps pour améliorer les taux d’adhésion à l’hygiène des mains des infirmières dans un contexte de prévention des infections associées aux soins de santé. Néanmoins, ces taux sont et demeurent faibles au Québec (Lacoursière, 2018) comme partout ailleurs (Stella et al., 2019). Depuis le milieu des années 1980, une approche de changement de comportement – la déviance positive - a fait son apparition dans les écrits en santé publique. Ladite approche propose de déterminer la présence de déviants positifs - personnes ou groupes plus performants que d’autres - puis d’explorer les facteurs qui expliquent cette meilleure performance afin de développer des moyens d’amener un changement à d’autres personnes ou d’autres groupes (Bradley et al., 2009). Même si des recherches utilisant l’approche de la déviance positive ont été publiées en sciences infirmières, il n’est pas clair si cette approche peut être utile et appliquée à la pratique infirmière au regard de l’hygiène des mains. Le but de cette étude était d’explorer, sous l’angle de l’approche de la déviance positive, les pratiques cliniques d’infirmières au regard de l’hygiène des mains et les facteurs qui les influencent en contexte hospitalier québécois ainsi que de discuter l’applicabilité de ladite approche à la pratique infirmière en lien avec l’hygiène des mains. Pour répondre à ce but, nous avons effectué deux ethnographies focalisées auprès de 21 infirmières sur deux unités de soins (unité de médecine-chirurgie et unité de soins palliatifs) d’un centre hospitalier universitaire de la région de Montréal. Ces deux unités ont été choisies sur la base des taux d’adhésion à l’hygiène des mains des infirmières plus élevés comparativement à ceux de leurs collègues des autres unités de soins du même centre hospitalier. La collecte des données s’est déroulée de janvier à octobre 2015, principalement lors de 18 entrevues individuelles et 14 périodes d’observation de type shadowing. Une grille d’observation a été utilisée afin d’y consigner les détails relatifs au contexte. Selon la méthode d’analyse décrite par Patton (2002, 2015), toutes les données colligées ont été codées et regroupées sous des catégories puis une analyse de fréquence des codes a été effectuée afin d’en permettre l’interprétation. Les résultats de cette étude montrent que les pratiques cliniques sont similaires sur les deux unités de soins; les participantes utilisent principalement les solutions hydro-alcooliques avant d’entrer et en sortant de la chambre des patients. Quant aux facteurs qui explicitent les taux plus élevés d’adhésion à l’hygiène des mains des infirmières, certains d’entre eux sont communs aux deux équipes de soins. Au niveau individuel, les participantes reconnaissent l’importance d’avoir les connaissances sur le rôle de l’hygiène des mains pour prévenir la transmission des infections, de se protéger soi-même et de protéger les patients; au niveau organisationnel, on constate une pratique collaborative à l’intérieur de chacune des équipes; au niveau environnemental, l’accessibilité et la disponibilité des distributeurs de solution hydro-alcoolique facilitent grandement la pratique de l’hygiène des mains; au niveau sociopolitique, les deux équipes sont confrontées aux compressions survenues suite à la réforme du réseau de la santé et à l’incertitude face à un déménagement vers un nouveau centre hospitalier; au niveau culturel, les membres des deux équipes travaillent ensemble vers un but commun, ce que nous avons nommé cohésion sociale telle que décrite par Kwok, Harris et McLaws (2017). Cependant, ce qui favorise cette cohésion diffère selon l’équipe de soins. Sur l’unité de médecine-chirurgie, l’équipe s’est mobilisée sous le leadership de son infirmier-chef afin d’améliorer les taux d’adhésion à l’hygiène des mains. Sur l’unité des soins palliatifs, l’équipe partage une pratique de soins empreinte d’humanisme afin de protéger des patients qui sont en fin de vie. Ce qui nous amène à postuler que la déviance positive s’applique à une équipe de soins - et non seulement à des individus - qui travaille ensemble afin de protéger les patients des infections associées aux soins de santé. Les connaissances découlant de cette étude permettent de comprendre qu’afin d’améliorer l’adhésion à l’hygiène des mains des infirmières, il serait préférable de cibler les équipes de soins qui performent le mieux, d’élaborer des interventions qui intègrent des facteurs à plusieurs niveaux, non seulement au niveau individuel, et d’ajouter des ressources humaines et financières. / Many approaches have been advocated over time to improve nurses’ hand hygiene adherence rates in order to prevent healthcare-associated infections – nosocomial infections. Nevertheless, these rates have been and continue to be low in Québec (Lacoursière, 2018), as they are everywhere else (Stella et al., 2019). In the mid-1980s, a behavioural change approach – positive deviance – appeared in public health literature. This approach proposes to identify the presence of positive deviants – individuals or groups who outperform others – and to explore the factors that explain the better performance, in order to develop ways to encourage change among other individuals or groups (Bradley et al., 2009). Although studies using the positive deviance approach have been published in the nursing literature, it is unclear whether this approach can be applied to nursing practice with regard to hand hygiene. The purpose of this study was to explore, from the perspective of the positive deviance approach, the clinical nursing practices related to hand hygiene and the factors that influence them in a Québec hospital setting, as well as to examine the applicability of this approach to hand hygiene in nursing practice. To this end, we conducted two focused ethnographies with 21 nurses on two care units (a medical surgery unit and a palliative care unit) at a university hospital centre in the Montréal region. These two units were chosen because the nurses’ hand hygiene adherence rates were higher than their colleagues’ rates on other care units at the same hospital centre. The data were collected from January to October 2015, mainly through 18 individual interviews and 14 shadowing periods. An observation grid was used to record the contextual details. According to the method described by Patton (2002, 2015), all the collected data were coded and grouped under categories and then a frequency analysis of the codes was carried out in order to allow interpretation. The results of this study show that the clinical practices are similar on both healthcare units; the participants use mainly hydro-alcoholic solutions before entering and leaving the patients’ rooms. Some of the factors that explain the higher hand hygiene adherence rates are shared by both care teams. On the individual level, the participants recognize the importance of having knowledge about the role of hand hygiene to prevent the transmission of infections, protect themselves and protect the patients; on the organizational level, there is a collaborative practice within each team; on the environmental level, the accessibility and availability of the hydro-alcoholic solution distributors greatly facilitate hand hygiene practices; on the sociopolitical level, both teams are facing cuts under the health reform and uncertainty related to a move to a new hospital; on the cultural level, the members of both teams work together toward a common goal, which we called “social cohesion” as described by Kwok et al. (2017). However, the factors that lead to this cohesion differ in each team. On the medical surgery unit, the leadership of the head nurse mobilizes the team to improve their hand hygiene adherence rates. On the palliative care unit, the team shares a humanist care practice to protect patients who are at the end of their lives. This led us to postulate that positive deviance applies to a care team – not just to individuals – who are working together to protect patients from healthcare-associated infections. The knowledge from this study suggests that to improve nurses’ hand hygiene adherence, it would be preferable to target the care teams that perform best, to develop interventions that include factors on several levels, not just the individual level, and to increase human and financial resources.

Introduktion: Det är väl känt världen över att god handhygien är en av de enskilt mest effektiva insatserna för att hindra smittspridning. Trots detta visar flera studier på låg följsamhet till denna viktiga företeelse och orsakerna för försummandet varierar. Syfte: Denna studie kartlägger kunskaper om basal hygien samt uppskattar hur följsamheten uppfattas av personal med ett vårdnära arbete inom kommunal vård och omsorg. Metod: Personalen fick i en tvärsnittsstudie svara på kunskapsfrågor om basala hygienrutiner och uppskatta sin egen följsamhet till dem i en webbaserad enkät. Prestationerna på varje fråga bedömdes individuellt i fyra svarskategorier. Respondenterna tilldelades sedan gruppen låg, mellan eller hög nivå på kunskapsblocket. Resultat: Studien visar att de allra flesta uppskattade sig ha bra eller mycket bra kunskaper i basal hygien, samt ha en hög följsamhet till rutinerna. Personalens egen uppfattning om följsamhet är dock högre än vad den senaste prevalensmätningen visar (73 % jämfört med 54 %). Respondenternas svar visade på tydliga kunskapsluckor. Nära hälften av respondenterna uppger till exempel felaktigt att handskar ska användas vid all patientkontakt. Samma resultat gäller för användning av visir. Det finns dock goda kunskaper om reglerna kring arbetskläders utformning och hantering. Det förekommer vidare en signifikant skillnad i kunskaperna mellan personal inom de olika boendeformerna särskilda boenden [SÄBO] och andra särskilda boenden som omfattas av lagen om stöd och service [LSS], (58 % respektive 44 % uppvisar en hög kunskapsnivå). Följsamheten uppges dessutom vara lägre på LSS, och de största hindren enligt personal verkar vara tidspress och placering av hygienmaterial. / Introduction: It is widely known that good hand hygiene is one of the single most effective efforts to prevent spread of infection. Despite this, several studies show low compliance to this important practice and causes vary. The aim: The study maps knowledge of and compliance to hygiene routines among health professionals at close-to-care jobs in municipal health care. Methods: Via a cross-sectional study the respondents answered questions of basic hygiene routines and compliance to them via a web-based questionnaire. Quiz answers were assessed over four levels per question and respondents were assigned one of three categories of understanding for the entire block of basic hygiene routine awareness. Results: The majority consider themselves having good or very good knowledge of basic hygiene and representing high level of compliance. However, compliance levels were perceived higher than the most recent prevalence survey conveyed (73% vs 54%). There is an apparent knowledge gap around hygiene routines. Around half of the participants for example reported unjustified use of gloves and visors during all contact with patients. There is, however, good perception of routines around design and handling of workwear. Furthermore, level of knowledge was quite different for health professionals employed in nursing homes [SÄBO] versus those employed in group homes for persons with certain functionals impairments [LSS, Swedish entitlement law] (58% and 44% were assigned to a high level of knowledge respectively). Compliance was also lower in LSS, and the major obstacles according to the employees seems to be time constraints and placement of hygiene material.

Waterborne diseases are illnesses caused by microscopic organisms, like viruses, bacteria and  parasites, that transmitted via the fecal-oral route through ingestion of contaminated water or food or by direct person to person contact. The transmission cycle can be broken through safe water supplies, maintaining standards of sanitation and proper handwashing practices. Two waterborne diseases are considered in this study: hepatitis A and amebic dysentery. The study aimed to understand the important factors for preventing waterborne diseases in order to improve public health. A descriptive cross-sectional study was conducted to assess the effect of different drinking water sources, sewage systems and different active practices of soap use for hand washing on incidence of waterborne diseases in different regions in Saudi Arabia. Data was obtained from Ministry of Health and Household Environment Survey provided by General Authority for Statistics. Statistical analysis performed by using general linear model and type II Analysis of Variance. In comparison of different drinking water sources, this study showed borderline rise in incidence of waterborne diseases with the use of private well water. Whereas different sewage systems had no clear effect on the incidence of waterborne diseases. The study also revealed that not using soap for hand washing would increase the risk for hepatitis A infection. Moreover, the study showed significant decline in waterborne diseases incidence when access to filtered water combined with regular soap use in the same linear model.