Atualmente, no Brasil, a produção de enzimas do tipo KPC constitui o principal mecanismo de resistência aos carbapenêmicos em Klebsiella pneumoniae, contribuindo para a endemicidade hospitalar da espécie. No presente estudo, foi caracterizada a produção de KPC em 38 enterobactérias que foram diferençadas entre os grupos CESP (enterobactérias com produção induzida da βlactamase AmpC, ex., Enterobacter spp., Serratia marcescens e Morganella morganii) e não CESP (ex., Klebsiella pneumoniae, Escherichia coli e Proteus mirabilis). pertencendo a isolados recuperados de pacientes colonizados e/ou apresentando infecção urinária, pneumonia ou bacteremia, em três centros médicos de três diferentes regiões do Brasil (Amazonas, Mato grosso, Minas Gerais), durante 2008-2013. Os isolados apresentaram resistência para cefalosporinas de amplo espectro (86,8 - 94,7%), cefoxitina (86,8%), ertapenem (89,4%), imipenem (89,4%), meropenem (84,2%), amicacina (86,8%), ciprof1oxacina (84,2%), tigeciclina (42,1 %, CIM50= 2 µg/ml), sulfametoxazol/trimetoprim (SXT, 60,5%) e gentamicina (57,8%). Entre bactérias do grupo CESP, os isolados de S. marcescens apresentaram sensibilidade para fosfomicina (CIM50= 8 µg/mL) e sulfametoxazol-trimetoprim (CIM50= 1/19 µg/mL). A produção de carbapenemase foi confirmada pelo teste de Hodge modificado e por inibição por acido fenil borônico em 76,31 e 73,68% dos isolados do grupo CESP e não CESP, respectivamente. A presença do gene blaKPC-2 foi confirmada em 78,9% dos isolados clinicos e variantes do gene blaCTX-M foram identificados em 57,89% das cepas. Cepas de S. marcescens e E. aerogenes clonalmente relacionadas por ERIC-PCR foram associadas a surtos de infecção nosocomial. Resultados do presente estudo confirmam que a produção de KPC no Brasil, ocorre em uma grande variedade de espécies de enterobactérias sendo frequentemente associada com a co-produção de ESBLs do tipo CTX-M, o que poderia favorecer a endemicidade com o subseqüente estabelecimento de surtos de infecção. Um dado relevante, foi à alta resistência a fosfomicina (66,66%) associada à presença do gene fosA2 em cepas de E. aerogenes e K. pneumoniae produtores de KPC-2. / Currently, in Brazil, the production of KPC-type enzymes is considered the main mechanism of carbapenem resistance in Klebsiella pneumoniae, which has contributed for the nosocomial endemicity of this specie. In this study, the KPC production was characterized in 38 Enterobacteriaceae isolates differenced among CESP (Enterobacteriaceae with inducible production of AmpC-type β-lactamase, i.e., Enterobacter spp., Serratia marcescens and Morganella morganii) and not CESP (Klebsiella pneumoniae, Escherichia coli e Proteus mirabilis) groups recovered from colonized patients and/or with urinary tract infection, pneumonia or bacteremia, in three medicai centers from different regions of Brazil (Amazonas, Mato Grosso, Minas Gerais) during 2011-2013. The isolates were resistant to broad-spectrum cephalosporins (86.8 - 94.7%), cefoxitin (86.8%), ertapenem (89.4%), imipenem (89.4%), meropenem (84.2%), amikacin (86.8%), ciprofloxacin (84.2%), tigecycline (42.1 %, MIC50 = 2 µg/mL), trimethoprim-sulfamethoxazole (SXT, 60.5%) and gentamicin (57.8%). S. Marcescens isolates exhibited additional susceptibility to fosfomycin (MIC50 = 8 µg/mL) and sulfamethoxazole-trimethoprim (MIC50 = 1/19 µg/mL). Carbapenemase production was confirmed by Hodge modified test and inhibition by phenyl boronic acid in 76.31 and 73.68% of CESP and no CESP isolates, respectively. In fact, the presence of the blaKPC-2 gene was confirmed in 78.9% of enterobacterial isolates, whereas blaCTX-M ESBL gene variants were identified in 57.89% of the strains. S. Marcescens and E. aerogenes isolates were clonally related by ERIC-PCR being associated with outbreaks of nosocomial infection. Results of this study confirm that the production of KPC in Brazil occurs in a variety of species of Enterobacteriacea producing CTX-M-rype ESBLs, favoring the endemicity and the establisbment of outbreaks. A relevant finding was the high resistance to fosfomycin (66.66%) associated with the presence of the fosA2 gene in KPC-2-producing E. aerogenes and K. pneumoniae strains.

Bakgrund: Säker vård är ett ämne som ständigt är aktuellt inom vården. För att skapa förutsättningar för säker vård är de basala hygienrutinerna en viktig del i omvårdnadsarbete. Patienter inom slutenvården i Sverige drabbas av vårdrelaterade infektioner (VRI) som bidrar till ökade kostnader för samhället, lidande för patienten och är ett hot mot säker vård. Undersökningar gjorda av Sveriges kommuner och landsting visar ett starkt samband mellan följsamheten av de basala hygienrutinerna och VRI.   Syfte: Att undersöka vårdpersonalens följsamhet till basala hygienrutiner på en medicinsk akutvårdsavdelning, med fokus på handhygien och dess betydelse för vårdrelaterade infektioner.   Metod: En kvantitativ empirisk långtidsuppföljning (2013-2018) har genomförts. Observationer har utförts på en medicinsk akutvårdsavdelning i södra Sverige. De yrkesgrupper som observerades var undersköterskor, sjuksköterskor och läkare. Samtlig data har hämtats från registret Mätning och analys (MOA). Deskriptiv data har sammanställts och analyserats genom statistikprogrammet SPSS.   Resultat: Vid analys framkom att följsamheten till handhygien skiljer sig mellan de olika yrkesgrupperna, undersköterskorna visar på högst följsamhet. Det moment där yrkesgrupperna visar på högst följsamhet var handsprit efter patientkontakt.   Slutsats: För att en god och säkervård ska kunna utföras bör vårdpersonal få möjlighet till en bredare kunskap om handhygien och smittspridning. Analysen av långtidsuppföljningen har bekräftat vad tidigare studiers resultat har visat kring följsamhet till handhygien.

Tidigare forskning kring hygienrutiner har visat att följsamheten hos vårdpersonal är bristande samt att bristande följsamhet leder till ökad förekomst av vårdrelaterade infektioner (VRI). Syftet var att undersöka följsamheten kring basala hygienrutiner hos sjuksköterskor och undersköterskor samt jämföra hur följsamheten skiljer sig personalkategorierna emellan samt före och efter patientkontakt, på en medicinsk akutvårdsavdelning i södra Sverige under åren 2013–2018. Studien hade empirisk utformning. Data samlades in genom observationer och analyserades med stöd av Statistical Package for the Social Sciences (SPSS). Det som observerades var följsamhet till korrekt användning av handdesinfektion, handskar, platsförkläde/skyddsrock och rätt klädsel. Totalt gjordes 564 observationer mellan åren 2013–2018. Resultatet visar att det finns rum för förbättring i följsamhet. Överlag visar undersköterskor på en högre grad av följsamhet genom alla observerade år. Märkbar skillnad sågs mellan följsamhet till handdesinfektion före och efter patientkontakt, där följsamheten i sistnämnda var bristande. Vidare interventioner behövs för att förbättra följsamheten till basala hygienrutiner, minska risken för vårdrelaterade infektioner och höja patientsäkerheten. / Title: Compliance of nurses and assistant nurses to guidelines regarding basic hygiene routines in a medical intensive care unit: A quantitative long-term study. Previous research has shown that compliance to hygiene routines among healthcare professionals is inadequate and that inadequate compliance is linked to increased prevalence of healthcare-associated infections (HCAI). The aim of this study was to examine the compliance of nurses and assistant nurses to guidelines regarding basic hygiene routines and to make an occupational comparison before and after patient contact, in a medical intensive care unit in southern Sweden over a period of six years. The study had an empirical approach. Data was collected through observations and was analyzed using Statistical Package for the Social Sciences (SPSS). Observed aspects included compliance to correct usage of hand rub, plastic gloves, aprons as well as proper clothing. A total of 564 observations were made during the years 2013–2018. The result shows that there is room for improvements to compliance, with assistant nurses overall showing a higher rate of compliance throughout all observed years. Noticeable differences in compliance were found between hand rub usage before and after patient contact, with a lack of compliance in the latter. Further interventions are needed in order to improve compliance rates to guidelines regarding hygiene to prevent HCAI and increase patient safety.

Bakgrund: Handhygienrutiner är en grundläggande åtgärd i sjuksköterskans dagliga arbete för att förebygga vårdrelaterade infektioner. Över 1500 patienter dör varje år på grund av bristfällig standard på hygienrutiner. Vårdrelaterade infektioner orsakar stort vårdlidande hos patienten som kan förebyggas med god följsamhet till handhygienrutiner. Syfte: Syftet med denna studie var att beskriva orsaker som påverkar sjuksköterskors följsamhet till riktlinjer vid handhygien på sjukhus. Metod: Metoden som användes var en litteraturöversikt av artiklar med både kvalitativ och kvantitativ ansats. Resultat: Ur analysen av datamaterialet framkom tre huvudkategorier; Risk för smittspridning, omgivningens villighet att ge återkoppling, samt brister i organisationen, med åtta underkategorier. Konklusion: Brister på följsamhet till handhygienrutiner ökar risken för vårdrelaterade infektioner. Det finns ett behov av större insikt inom sjuksköterskors följsamhet till handhygienrutiner för att minska vårdlidandet hos patienten. / Background: Following guidelines for hand hygiene is a basic part of the daily routine of nurses to help prevent healthcare associated infections. Over 1500 patients die every year as the result of poor adherence to hand hygiene guidelines. Health care associated infections result in care suffering for the patient which could have been prevented with higher adherence to hand hygiene guidelines. Aim: The aim of the literature review was to identify what causes nurses adherence to hand hygiene guidelines in a hospital setting. Method: The method used was a literature review where both qualitative and quantitative articles were analyzed. Results: Three main categories emerged from the analysis; risk for infectivity, peers willingness to give feedback and organizational shortcomings, with eight subcategories. Conclusion: Poor adherence to hand hygiene guidelines increases the risk of health care associated infections. To prevent care suffering for the patient there is a need for a deeper understanding for nurses’ adherence to hand hygiene guidelines.

Patients who require mechanical ventilation (MV) are at risk for developing ventilator associated pneumonia (VAP). Nurses’ adherence to sedation vacations (SVs) has a direct impact on the development of VAP, because SVs have been shown to reduce patients’ average duration of MV and length of stay (LOS) in the intensive care unit (ICU). The purposes of this study guided by Donabedian’s (1966) model were to quantify nurses’ level of adherence to SVs, in relation to the health outcomes of critically ill patients, and identify the barriers and facilitators to performing SVs. A correlational design was used. The design included three components: abstraction of patient data from the electronic medical record (EMR) (n=79 with VAP and n=79 without VAP), administration of surveys to ICU nurses (N =34), and vignettes related to SVs. Analyses included descriptive statistics, t-tests, correlations, and analyses of covariance. Most nurses held a Bachelors degree (70.6%), had < 9 years of ICU experience (52.9%), worked in a medical ICU (47.1%), and reported high confidence in managing SVs (M =8.88, SD =1.25). The majority of patients (N =158) were Black (58.2%), males (56.3%), and on average middle-aged (M =61.5, SD =14.91), with a long ICU LOS (M =15.5, SD =11.84), extended duration of MV (M =9.5, SD =8.47), and high acuity (APACHE III) (M =70.2, SD =25.42). The nurses’ education, advanced certification, and ICU experience were not associated with the appropriate implementation of SVs in the vignettes. On average nurses’ had low scores on the vignettes (M =6.97, SD =2.21; possible range =0-14). The adherence rate of nurses’ implementation of SVs, determined using EMR data, was also low (M =24%; SD =23%). There were higher rates of SV adherence in patients without VAP (p (p < .01), and a duration of MV < 6 days (p =.04). These findings indicate that even with established protocols, nurses may not consistently implement the evidenced-based interventions that have been shown to prevent nosocomial infections. Future research is needed to improve nursing practice and the quality of care in this patient population.

Enligt Socialstyrelsen (2011) avlider cirka 1 500 människor årligen i Sverige på grund av vårdrelaterade infektioner. Den viktigaste åtgärden för att förebygga vårdrelaterade infektioner är att arbeta utifrån basala hygienrutiner (Socialstyrelsen, 2006). Det är idag oklart hur följsamheten till basala hygienrutiner ser ut inom primärvården i Sverige och bland distriktssköterskor. Syftet med studien var att undersöka distriktssköterskors följsamhet till basala hygienrutiner inom primärvården. Studien var baserad på strukturerade observationer och en enkät. Observationerna utfördes av distriktssköterskestudenter och genomfördes vid nio vårdcentraler i Uppsala. Observationsstudien visade att distriktssköterskorna hade god följsamhet till rådande hygienrutiner gällande klädregler, att hålla långt hår uppfäst och fingernaglar kortklippta samt till att inte använda färgat nagellack, lösnaglar och att inte bära ring. Det finns behov av förbättring av distriktssköterskornas följsamhet till handdesinfektion, att inte bära armbandsur samt korrekt användning av handskar och skyddskläder. Enkätstudien visade att distriktssköterskor inte har tillräckliga kunskaper om basala hygienrutiner. Det finns behov av förbättring inom den enskilda distriktssköterskans hygienarbete och inom arbetsgivarnas ansvarsområden gällande hygien. För att distriktssköterskan skall kunna arbeta med att förebygga smittspridning, behövs uppdaterade kunskaper och mer utbildning inom området. Arbetet med hygien bör lyftas fram och uppmuntras inom primärvården, i större utsträckning än vad som görs idag. / Approximately 1500 people dies, every year in Sweden, as a result of healthcare associated infections (Socialstyrelsen, 2011). The most important action for preventing healthcare associated infections is compliance to hygiene routines (Socialstyrelsen, 2006). Today there is scarce knowledge about the compliance to hygiene routines within the area of primary healthcare and among district nurses in Sweden. This study aimed to examine the compliance to hygiene routines among district nurses in primary healthcare. Data was collected through observations and a questionnaire. The observations were carried out by nurses currently studying to become district nurses and were implemented on nine primary healthcare centers in Uppsala. The study showed that the district nurses had good compliance to the prevailing hygiene regulations concerning, clothing, hair, finger nails and to not carrying fingerings. There are however needs of improvement in the district nurses compliance to handdesinfection, not carrying wristwatches and correct use of gloves and protective aprons. Data from the questionnaire shows that district nurses don’t have sufficient knowledge about basic hygiene routines. There are needs of improvement within the individual district nurse's hygiene work and within the employers' area of responsibility concerning hygiene. In order to making it possible for the district nurse to work with preventing transmission of infectious diseases, more education within the area is needed. The work with hygiene routines should be encouraged within primary healthcare, in a bigger extent than its done today.

Background: It is important to have good hygiene in healthcare. Studies have shown that bad hygiene among healthcare professionals can lead to spread of bacteria and microorganisms, which in turn can lead to healthcare-associated infections. To counteract this there are established routines, laws and regulations, as basic hygiene routines.   Purpose: To study the knowledge of hygiene aspects in patient-related work among radiographer students in Vietnam and Sweden.   Method: A quantitative study with descriptive statistics and statistical tests, data was collected through surveys and observations. The number of participants in the survey was 100 students, 50 in Vietnam and 50 in Sweden. The observations were conducted on 12 students at a hospital in Vietnam. Data was analyzed in SPSS and then described in text and tables.   Results: The students had relatively good knowledge of hygiene aspects, but the results showed that things could be improved in Sweden and Vietnam. There was insufficient knowledge about the use of plastic apron and the use of jewelry such as watches. The students were careful to fixed their hair, have clean work clothes and wear plastic gloves at risk of contact with body fluids.   Conclusion: The study shows that there are similarities and differences among the students in both countries. There are areas that can be improved in the countries because knowledge and basic hygiene routines underlie the spread of healthcare-associatedinfections / Bakgrund: Det är viktigt med god hygien inom hälso- och sjukvård. Studier har visat att dålig hygien bland sjukvårdspersonal kan leda till spridning av bakterier och mikroorganismer, vilket i sin tur kan leda till sjukvårdsrelaterade infektioner. För att motverka detta finns framtagna rutiner, lagar och regler som basala hygienrutiner.    Syfte: Att undersöka kunskapen om hygienaspekter i patientnära arbete bland röntgensjuksköterskestudenter i Vietnam och Sverige.   Metod: En kvantitativ studie med deskriptiv statistik och statistiska tester där datainsamling skedde via enkäter och observationer. Antalet medverkande i enkätstudien var 100 studenter, 50 i Vietnam och 50 i Sverige. Observationerna genomfördes på 12 studenter vid ett sjukhus i Vietnam. Data analyserades i SPSS och beskrevs sedan i text och tabeller.    Resultat: Studenterna hade relativt god kunskap gällande hygienaspekter men resultatet visade att saker kan förbättras i båda länderna. Bristande kunskap fanns gällande användandet av plastförkläde samt användandet av smycken som exempelvis klockor. Studenterna var noggranna med att ha håret uppsatt, ha rena arbetskläder och använda plasthandskar vid risk för kontakt med kroppsvätskor.   Slutsats: Studien visar att det finns likheter och skillnader bland studenternas kunskap i båda länderna. Det finns områden som kan förbättras i både Sverige och Vietnam då kunskap och basala hygienrutiner ligger till grund för minskad spridning av sjukvårdsrelaterade infektioner.

Submitted by isabela.moljf@hotmail.com (isabela.moljf@hotmail.com) on 2017-04-27T12:18:28Z No. of bitstreams: 1 osmarnascimentosilva.pdf: 3091891 bytes, checksum: 8e0f2ed0de0225b3ed16c08cdd6fee62 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-05-12T15:47:58Z (GMT) No. of bitstreams: 1 osmarnascimentosilva.pdf: 3091891 bytes, checksum: 8e0f2ed0de0225b3ed16c08cdd6fee62 (MD5) / Made available in DSpace on 2017-05-12T15:47:58Z (GMT). No. of bitstreams: 1 osmarnascimentosilva.pdf: 3091891 bytes, checksum: 8e0f2ed0de0225b3ed16c08cdd6fee62 (MD5) Previous issue date: 2010-02-24 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / As infecções relacionadas à assistência à saúde (IrAS), são uma das principais causas de mortalidade e aumento dos custos hospitalares em países desenvolvidos e em desenvolvimento. Nos casos em que um paciente adquire uma IrA e esta não é tratada adequadamente, a mesma pode evoluir para um quadro mais grave, podendo levar a sepse e consequentemente na maioria dos casos a morte. A sepse representa um importante problema de saúde pública, entretanto, um tratamento eficaz para esta síndrome ainda não foi encontrado. Peptídeos antimicrobianos foram relatados para modular a resposta à infecção bacteriana na sepse, independente dos mecanismos de resistência conhecidos para os antibióticos. Desta forma, procurou-se investigar a atividade imunomodulatória de duas formas de clavaninas sobre monócitos RAW 264.7, bem como a atividade antimicrobiana e a citotoxicidade in vitro. Em ensaios in vivo a genotoxicidade, a ação das clavaninas sobre a migração de neutrófilos e a eficácia do tratamento com as clavaninas em um modelo de infecção de ferida operatória por S. aureus e sepse polimicrobiana grave também foram avaliadas. Os estudos in vitro demostraram que as clavaninas inibiram completamente o crescimento de E. coli, K. pneumoniae e S. aureus, preveniram a secreção de citocinas pró-inflamatórias (TNF-α, IL-12) e NO, e aumentaram a secreção de IL-10. Além disso, as clavaninas não apresentaram atividade citotóxica sobre as células RAW 264.7. Nos experimentos in vivo, as clavaninas não apresentaram genotoxicidade, além de apresentarem-se quimoatraentes para neutrófilos. As clavaninas, também, reduziram significativamente as unidades formadoras de colônias de S. aureus no modelo experimental de ferida operatória, e reduziram a mortalidade dos animais sépticos em mais de 50%, quando comparados com animais controle. Devido à sua ação direta sobre células do sistema imune e microorganismos, as clavaninas aparentam ser compostos potenciais para o tratamento de infecções bacterianas graves como a sepse, demonstrando alto valor biotecnológico. / Healthcare-associated infections (HAIs) are a major cause of mortality, also increasing hospital costs in developed and developing countries. When a patient acquires HAIs and this is not properly handled, disease may clearly worst, leading to sepsis and consequently in major to death. Despite of sepsis represents an important public health problem, any effective treatment for this syndrome was obtained until now. In this view, antimicrobial peptides have been reported as modulators of immune response to bacterial infection in sepsis, with independent activity of mechanisms that lead to antibiotic. Thus, the immunomodulatory activity of two different forms of clavanins over RAW 264.7 monocytes, as well the in vitro antimicrobial and cytotoxic activities were here investigated. Furthermore, in vivo genotoxicity assays, the evaluation of clavanins activity on neutrophil migration and also the efficacy of treatment with clavanins in a wound S. aureus infection model and severe polymicrobial sepsis were also evaluated. Moreover, in vitro studies demonstrated that clavanins are able of inhibit the growth of E. coli, K. pneumoniae and S. aureus. Clavanins also prevented the secretion of proinflammatory cytokines (TNF-α, IL-12) and NO, and increased the IL-10secretion. In addition, clavanins showed none cytotoxicity on RAW 264.7 cells. During in vivo experiments, the clavanins showed no genotoxicity, showing however, a clear chemotactic effect for neutrophils. Clavanins also significantly reduced the colony-forming units of S. aureus in an experimental model of surgical wound infection and reduced the mortality of septic animals in more than 50 %, when compared to control group. Due to their direct activities over immune cells and microorganisms, clavanins are potential compounds for the treatment of serious bacterial infections such as sepsis, showing an enormous and remarkable biotechnological value.

Atualmente, no Brasil, a produção de enzimas do tipo KPC constitui o principal mecanismo de resistência aos carbapenêmicos em Klebsiella pneumoniae, contribuindo para a endemicidade hospitalar da espécie. No presente estudo, foi caracterizada a produção de KPC em 38 enterobactérias que foram diferençadas entre os grupos CESP (enterobactérias com produção induzida da &#946;lactamase AmpC, ex., Enterobacter spp., Serratia marcescens e Morganella morganii) e não CESP (ex., Klebsiella pneumoniae, Escherichia coli e Proteus mirabilis). pertencendo a isolados recuperados de pacientes colonizados e/ou apresentando infecção urinária, pneumonia ou bacteremia, em três centros médicos de três diferentes regiões do Brasil (Amazonas, Mato grosso, Minas Gerais), durante 2008-2013. Os isolados apresentaram resistência para cefalosporinas de amplo espectro (86,8 - 94,7%), cefoxitina (86,8%), ertapenem (89,4%), imipenem (89,4%), meropenem (84,2%), amicacina (86,8%), ciprof1oxacina (84,2%), tigeciclina (42,1 %, CIM50= 2 &#181;g/ml), sulfametoxazol/trimetoprim (SXT, 60,5%) e gentamicina (57,8%). Entre bactérias do grupo CESP, os isolados de S. marcescens apresentaram sensibilidade para fosfomicina (CIM50= 8 &#181;g/mL) e sulfametoxazol-trimetoprim (CIM50= 1/19 &#181;g/mL). A produção de carbapenemase foi confirmada pelo teste de Hodge modificado e por inibição por acido fenil borônico em 76,31 e 73,68% dos isolados do grupo CESP e não CESP, respectivamente. A presença do gene blaKPC-2 foi confirmada em 78,9% dos isolados clinicos e variantes do gene blaCTX-M foram identificados em 57,89% das cepas. Cepas de S. marcescens e E. aerogenes clonalmente relacionadas por ERIC-PCR foram associadas a surtos de infecção nosocomial. Resultados do presente estudo confirmam que a produção de KPC no Brasil, ocorre em uma grande variedade de espécies de enterobactérias sendo frequentemente associada com a co-produção de ESBLs do tipo CTX-M, o que poderia favorecer a endemicidade com o subseqüente estabelecimento de surtos de infecção. Um dado relevante, foi à alta resistência a fosfomicina (66,66%) associada à presença do gene fosA2 em cepas de E. aerogenes e K. pneumoniae produtores de KPC-2. / Currently, in Brazil, the production of KPC-type enzymes is considered the main mechanism of carbapenem resistance in Klebsiella pneumoniae, which has contributed for the nosocomial endemicity of this specie. In this study, the KPC production was characterized in 38 Enterobacteriaceae isolates differenced among CESP (Enterobacteriaceae with inducible production of AmpC-type &#946;-lactamase, i.e., Enterobacter spp., Serratia marcescens and Morganella morganii) and not CESP (Klebsiella pneumoniae, Escherichia coli e Proteus mirabilis) groups recovered from colonized patients and/or with urinary tract infection, pneumonia or bacteremia, in three medicai centers from different regions of Brazil (Amazonas, Mato Grosso, Minas Gerais) during 2011-2013. The isolates were resistant to broad-spectrum cephalosporins (86.8 - 94.7%), cefoxitin (86.8%), ertapenem (89.4%), imipenem (89.4%), meropenem (84.2%), amikacin (86.8%), ciprofloxacin (84.2%), tigecycline (42.1 %, MIC50 = 2 &#181;g/mL), trimethoprim-sulfamethoxazole (SXT, 60.5%) and gentamicin (57.8%). S. Marcescens isolates exhibited additional susceptibility to fosfomycin (MIC50 = 8 &#181;g/mL) and sulfamethoxazole-trimethoprim (MIC50 = 1/19 &#181;g/mL). Carbapenemase production was confirmed by Hodge modified test and inhibition by phenyl boronic acid in 76.31 and 73.68% of CESP and no CESP isolates, respectively. In fact, the presence of the blaKPC-2 gene was confirmed in 78.9% of enterobacterial isolates, whereas blaCTX-M ESBL gene variants were identified in 57.89% of the strains. S. Marcescens and E. aerogenes isolates were clonally related by ERIC-PCR being associated with outbreaks of nosocomial infection. Results of this study confirm that the production of KPC in Brazil occurs in a variety of species of Enterobacteriacea producing CTX-M-rype ESBLs, favoring the endemicity and the establisbment of outbreaks. A relevant finding was the high resistance to fosfomycin (66.66%) associated with the presence of the fosA2 gene in KPC-2-producing E. aerogenes and K. pneumoniae strains.

Bakgrund: Varje år drabbas ett flertal patienter inom slutenvården av vårdrelaterade infektioner (VRI). Det påverkar inte bara individens hälsotillstånd utan även samhället i stort genom höga kostnader. Att följa de basala hygienrutinerna är betydande för att undvika uppkomsten av VRI. Sjuksköterskan har därmed ett ansvar att följa de riktlinjer som finns kring hygienrutiner för att på så sätt kunna bedriva en säker vård och minska uppkomsten och spridning av bakterier.   Syfte: Syftet är att undersöka vilka faktorer som påverkar sjuksköterskans följsamhet till basala hygienrutiner.  Metod: Metoden som användes var litteraturöversikt och baseras på tio stycken artiklar från databaserna Cinahl Complete och PubMed.   Resultat: I litteraturöversikten framkom flera faktorer som påverkar sjuksköterskans följsamhet till basala hygienrutiner. De primära orsakerna visade sig vara kunskap och utbildning. Sjuksköterskans arbetsmiljö och hälsa visade sig även vara betydelsefulla vid hanteringen av hygienrutiner.   Sammanfattning: I resultatet framkom att kontinuerlig utbildning är viktigt för att öka kunskapen hos sjuksköterskor. Genom att skapa en arbetsmiljö där material finns att tillgå kan hygienrutinerna förbättras. / Background: Every year, a number of patients in hospital care suffer from a healthcare-associated infection (HAIs). It affects not only the individual’s state of health but also society at large through high costs.  It is necessary to follow the hygiene routines to avoid the occurrence of HAIs. The nurse thus has a responsibility to follow the guidelines that exist regarding hygiene routines in order to be able to conduct safe care and reduce the emergence and spread of bacteria.  Aim: The aim of the study is to examine which factors affecting the nurse’s compliance with basic hygiene routines.   Method: The method used was a literature review and is based on ten articles from the databases Cinahl Complete and PubMed.  Results: In the literature review, several factors emerged that affect the nurse's adherence to basic hygiene routines. The primary reasons turned out to be knowledge and education. The nurse's work environment, work culture and the impact of hygiene also proved to be important in the management of hygiene routines.  Conclusion: The result showed that continuous training is important for increasing the nurse’s knowledge. By creating a work environment where materials are available, hygiene routines can be improved.