Magister Curationis - MCur / Infections (including healthcare-associated infections) are one of the leading causes of neonatal morbidity and mortality, yet these deaths could be prevented by cost-effective interventions. Handwashing (HW) is crucial to preventing the spread of antimicrobial resistance and reducing healthcare-associated infections (HCAIs). However, healthcare workers' compliance with optimal practices remains low in most settings.The purpose of this study was to determine the compliance with HW among nurses and midwives caring for newborn babies at Rwamagana Health Facilities, and the extent to which demographic and cognitive characteristics predict nurses' HW compliance. The study’s methodology involved a cross-sectional approach encompassing descriptive and quantitative methods. The data was collected over a period of 3 weeks from a total sample of 139 nursemidwives. An anonymous self-administered questionnaire was used to collect data; out of 139 questionnaires distributed 134 were returned back completed, giving a rate of 96.4%. The data analysis was done using SPSS software version 21.The results demonstrate that a mean self-reported HW compliance rate was 82.00% (SD= 13.60). A compliance rate of 80% or greater was confirmed by most of the participants in the study (79.1%). The highest reported rate of hand washing was HW after exposure to the newborn's body fluids (M= 89.33%; SD= 14.878),while results revealed that nurses tend to perform less HW after touching an object in the vicinity of the patient(73.43%; SD=22.81). A multiple regression analysis revealed that attitudes, subjective norms and intentions were unique independent predictors of HW compliance. However, results did not show any relationship between HW and nurses' demographic characteristics.This study recommends that, strategies aiming to improve HW compliance must be focused on concepts that predict HW. Further research ought to be conducted using observational approach.

Background: Healthcare-associated pneumonia (HCAP) guidelines were first proposed in 2005 but have not yet been validated. The objective of this study was to compare 30-day mortality and length of stay (LOS) in HCAP patients treated with either guideline-concordant HCAP (GC-HCAP) therapy or guideline-concordant community-acquired pneumonia (GC-CAP) therapy. Methods: We performed a retrospective cohort study of >150 hospitals in the Veterans Health Administration. Patients were included if they had ≥1 HCAP risk factor and received antibiotic therapy within 48 hours of admission. Patients were excluded if they received ICU care, had cardiovascular or respiratory organ failure, or received invasive mechanical ventilation and/or vasopressors. We determined independent risk factors for 30-day mortality with a multivariable logistic regression model including baseline characteristics, individual HCAP risk factors, comorbidities, and organ failure as dichotomous covariates. Propensity scores were calculated for the probability to receive GC-HCAP therapy and incorporated into a second logistic regression model. Results: A total of 15,071 patients met study criteria and received GC-HCAP therapy (8.0%), GC-CAP therapy (75.7%), or non-guideline-concordant therapy (16.3%). GC-HCAP patients were more likely to have neoplastic disease; whereas, GC-CAP patients had a higher prevalence of other comorbidities, tobacco use, and recent medication use. In multivariable regression, recent hospital admission (OR 2.47, 95% CI 2.10-2.91) and GC-HCAP therapy (2.13, 1.82-2.48) were the strongest predictors of 30-day mortality. Hematologic organ failure, non-invasive mechanical ventilation, neoplastic disease, renal organ failure, and cerebrovascular disease were also independent risk factors. Use of cardiovascular medications, inhaled corticosteroids, and tobacco were protective. GC-HCAP therapy continued to be an independent risk factor for 30-day mortality (OR 2.12, 95% CI 1.82-2.48) in the propensity score analysis. Conclusions: GC-HCAP therapy is not associated with improved survival in HCAP patients. / text

Clostridium difficile infection (CDI) is the leading cause of bacterial infectious diarrhea in nosocomial settings and approximately 25% of patients with CDI experience disease recurrence. Prior CDI epidemiological investigations are limited though. They do not reflect the burden of CDI in federal facilities, nor do they capture recent estimates on patient health outcomes. Furthermore, few studies have integrated CDI recurrence risk factors into a tool that clinicians can use to identify patients at risk for CDI recurrence. This study 1) described the epidemiology of CDI in the national Veterans Health Administration (VHA), 2) derived and validated a clinical prediction rule for 60-day CDI first recurrence, and 3) derived and validated a clinical prediction rule for 60-day CDI second recurrence. This was a retrospective cohort study of VHA beneficiaries with CDI between October 1, 2001 and September 30, 2012. VHA clinical and pharmacy data were integrated to develop several independent variables, including patient baseline demographics, CDI characteristics, comorbidities, concomitant medications, prior medications, prior hospitalization, hospital length of stay (LOS), and CDI severity. The dependent variables included 30/60/90-day mortality, and 30/60/90-day CDI recurrence. CDI incidence and outcomes were presented descriptively and compared using generalized linear regression models. CDI recurrence prediction rules were derived using multivariable logistic regression models and validated using the area under the receiver-operating-characteristic curve (AUROC), sensitivity, specificity, positive predictive value, and negative predictive value. Our study demonstrated that CDI first episodes, recurrences, and severity increased over the study period, while mortality decreased. Our CDI first recurrence prediction rule included the following predictor variables: dyslipidemia, CDI type, renal disease, hospital LOS <7 days, principal CDI diagnosis, concomitant gastric acid suppressors, and concomitant antibiotics. This model demonstrated moderate 60-day first recurrence discrimination (AUROC=0.62). Our CDI second recurrence prediction rule was similar in predictor variables and validity. In conclusion, CDI is an important, rapidly-emerging public health problem in the VHA. A clinical prediction rule might aid clinicians in directing preventative therapies to patients at high risk for CDI recurrence. / text

Healthcare-associated infections occur commonly in hospitals and have a major impact on patient well-being. The occurrence of the healthcare-associated infection, Clostridium difficile, has been occurring more frequently among hospitalized patients due to an epidemic strain, and is an important cause of antibiotic-associated diarrhea and colitis. This study examined the impact of several organizational factors on the occurrence of C. difficile infection (CDI) in hospitals using an institutional theory perspective. Administrative claims were utilized from University HealthSystem Consortium hospitals to obtain hospital-level data for the calendar year 2011. Data were available for 89 hospitals. Hospital-level analyses, negative binomial regression models, were conducted to test eight developed hypotheses and the associations between organizational factors and the incidence of CDI in hospitals. Cases of CDI were risk-adjusted for known factors associated with CDI. After controlling for factors known to be associated with CDI, the results of the analyses showed that one study hypothesis was supported. That is, hospitals with higher Leapfrog Group Safety Scores had CDI rates that were no different than hospitals with lower Safety Scores. Further, it was found that U.S. News and World Report Best Hospital Honor Roll member hospitals had significantly higher occurrence of CDI as compared to non-Honor Roll member hospitals, though it was predicted that there would be no difference in CDI rates. The organizational factors state-led CDI prevention collaboratives, state mandatory CDI reporting, Magnet status, the rate of central line-associated bloodstream infections and catheter-associated urinary tract infections, and CDI physician champions, were not significantly associated with CDI occurrence.

The purpose of this work was to investigate the adherence to basic hygiene routines among staff and to investigate if there is any difference between the adherences in diverse professions. The purpose was also to study how staff rates their own adherence to current guidelines. Data for the study were collected through observations and questionnaires. Altogether 35 people were observed and 15 answered the questionnaire. Maximum adherence was found in the category of "hand disinfection after patient contact" with a score of 96%. In the observation task “proper use of protective apron” a total adherence of 86 % was found. The observations in the category of "hand disinfection before patient contact" showed an adherence of 74 %. In the observation category "proper use of gloves" a total adherence of 52% was found. The greatest difference between professions was seen in the observation category of "proper use of gloves", where physicians’ observed adherence was 100% and the nurses observed adherence was 48%. In the observation category "proper use of apron” adherence varied between 76-91%. Adherence to “hand disinfection before patient contact” are lower in comparison with adherence to “hand disinfection after patient contact”. An awareness of this is seen in the responses also, with the majority indicating that their own routine deficiencies in this particular moment. Otherwise the compilation of the responses shows that staff rates their adherence lower than the observed adherence. We believe that our presence may have affected the staff during the observations with the consequence that adherence to the basic hygiene routines influenced in a positive direction. / Syftet med detta arbete var att undersöka följsamhet till basala hygienrutiner hos personal på en vårdavdelning samt undersöka eventuella skillnader i följsamhet mellan olika yrkeskategorier. Syftet med studien var också att undersöka hur personalen skattar sin egen följsamhet till gällande riktlinjer. Data till studien insamlades genom observationer och enkäter. Totalt observerades 35 personer och enkäten besvarades av 15 personer. Högst observerad följsamhet fanns i kategorin ”handdesinfektion efter patientkontakt” med ett resultat på 96 %. Observationsmomentet ”korrekt användning av skyddsförkläde” visade en total följsamhet på 86 %. Observationerna i kategorin ”handdesinfektion före patientkontakt” visade en följsamhet på 74 %. I observationsmomentet ”korrekt användning av handskar” fanns en total följsamhet på 52 %. Störst skillnad mellan personalkategorierna sågs i observationskategorin ”korrekt användning av handskar” där läkarnas observerade följsamhet var 100 % och undersköterskornas observerade följsamhet var 48 %.  I observationsmomentet ”korrekt användning av skyddsförkläde” varierade följsamheten mellan 76 – 91 %. Personalens observerade följsamhet till ”handdesinfektion före patientkontakt” är lägre i jämförelse med den observerade följsamheten till ”handdesinfektion efter patientkontakt”. En medvetenhet om detta syns i enkätsvaren där flertalet anger att deras egen rutin brister i just detta moment. I övrigt visar sammanställningen av enkätsvaren att personalen skattar sin följsamhet lägre än den observerade följsamheten. Vi anser att vår närvaro kan ha påverkat personalen vid observationerna med konsekvensen att följsamheten till de basala hygienrutinerna påverkats i positiv riktning.

Background: Healthcare associated infection (HCAI) is a global issue and one of the most frequent adverse events in healthcare. HCAI is a major burden for patients’ and leads to added pain and higher cost for the society. The most important measure to prevent the transmission of HCAI is hand hygiene. In developing countries can insufficient equipment and supplies, lack of financial support and understaffed hospital units have a negative effect for the patients safety and makes it difficult to reduce HCAI. Aim: The aim of the study was to get knowledge about Kenyan nurses’ experiences of healthcare-associated infections. Method: The author used a qualitative method. Individual semi-structured interviews were made with four nurses at a government financial hospital in Eldoret, Kenya. The interviews were analyzed with a manifest analysis. Result: The analysis of the transcribed text made five categories, Education for healthcare workers, students and patients, Lack of equipment and supplies, The issues with crosscontamination, Prevention of HCAI and Understaffed hospital. The results were discussed with Dorothea Orem’s Self-care Theory with a focus on the Theory of Nursing system and other studies relating to the results. Conclusion: Knowledge about HCAI is one of the first steps to be able to reduce infections. Cross-contamination is the main risk factor for HCAI and multiple interventions are an effective strategy to successfully increase hand hygiene.

Healthcare-associated infections is the most common healthcare related injury and affect almost every tenth patient. With the purpose of reducing these infections Infektionsverktyget, The Anti-Infection Tool, was developed for registration and feedback of infection data. The tool is now used in all Swedish county councils resulting in a wealth of data. The purpose of this thesis was thus to investigate how data mining can be applied to describe patterns in this data and predict patient outcomes regarding healthcare-associated infections that need to be treated with antibiotics. Data mining was performed with Microsoft SQL Server 2008 in which models based on six different data mining algorithms with different parameter settings were developed. They used the attributes gender, age and previous diagnoses and medical actions as inputs and antibiotic treated healthcare-associated infection outcome as output. The predictive performance of the models was evaluated using 5-fold cross validation and macro averaged measures of recall, precision and F-measure. Patterns generated by selected models were extracted. Models based on the Naive Bayes algorithm showed the highest predictive capabilities with respect to recall and models based on the Decision Trees algorithm with low pruning had the highest precision. Although, none were considered to perform sufficiently well and several areas of improvement were identified. The most important factor in the inadequate performance is believed to be the relatively rare occurrences of infections in the dataset. Extracted patterns based on the Association Rules algorithm were considered the easiest to interpret. Patterns included clinically valid and invalid as well as trivial relationships. Future studies should be focused on further model improvements and gathering of more patient data. The idea is that data mining in Infektionsverktyget in the future could be used both to provide ideas for further medical research and to identify risk patients and prevent healthcare-associated infections in daily clinical work. / Vårdrelaterade infektioner är den vanligaste vårdskadan och drabbar nästan var tionde patient. Med syfte att minska antalet vårdrelaterade infektioner utvecklades Infektionsverktyget för registrering och återkoppling av infektionsdata. Verktyget används nu i alla Sveriges landsting vilket resulterar i stora mängder data. Syftet med detta examensarbete var därför att undersöka hur data mining kan användas för att beskriva mönster i denna data och för att förutsäga om patienter kommer att drabbas av en vårdrelaterad infektion som behöver antibiotikabehandlas. Data mining genomfördes med Microsoft SQL Server 2008 där modeller baserade på sex olika data mining-algoritmer med olika parameterinställningar utvecklades. De hade inputattributen kön, ålder och tidigare diagnoser och medicinska åtgärder, och outputattributet utfall av antibiotikabehandlad vårdrelaterad infektion. Förutsägelseförmågan hos modellerna utvärderades med 5-delad korsvalidering och makrogenomsnitt av måtten recall, precision och F-measure. Fyra modeller användes även för att ta fram mönster ur datamängden. Modeller baserade på Naive Bayes-algoritmen hade den bästa förutsägelseförmågan med avseende på recall och modeller baserade på Decision Trees-algoritmen med en låg beskärningsnivå uppnådde bäst precision. Trots detta ansågs ingen av modellerna prestera tillräckligt bra och flera möjliga förbättringsområden hittades. Den viktigaste anledningen till den otillräckliga förutsägelseförmågan tros vara att infektioner är relativt ovanliga i datamängden. Mönster som tagits fram med Association Rules-algoritmen ansågs vara lättast att tolka. Mönstren innehöll både kliniskt relevanta och irrelevanta såväl som triviala samband. Framtida studier bör fokuseras på att förbättra modellerna ytterligare och att samla in mer patientdata. Idén är att data mining i Infektionsverktyget i framtiden skulle kunna användas för att ge uppslag till medicinsk forskning och för att identifiera riskpatienter och därmed förebygga vårdrelaterade infektioner i den dagliga kliniska verksamheten.

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<p><strong>ABSTRACT</strong><strong></strong></p> <p><strong>Background</strong>: Healthcare-associated infections (HAIs) and HAI disease outbreaks present challenges for healthcare facilities. In 2008, a <em>Clostridium difficile</em> outbreak in Ontario resulted in the deaths of 91 patients and raised awareness of HAIs. Over the last 5 years, the outbreak rate has risen dramatically. Traditionally, HAI research has focused on epidemiology, healthcare systems, and the economic burden. Little is known about the impact HAI disease outbreaks have on the work of healthcare professionals.</p> <p><strong>Purpose</strong>: The purpose of this study was to examine the effects of HAI outbreaks on healthcare professionals in a large acute care hospital in Ontario.</p> <p><strong>Methods</strong>:<strong> </strong>A retrospective exploratory case study approach was used, including individual interviews, document analysis, and incidence analysis of HAIs hospital data. The sample was frontline nurses, clinical managers, infection control professionals, and environmental service staff. Document analysis included hospital policies and protocols related to infectious diseases and HAI disease outbreaks.</p> <p><strong>Findings</strong>: The incidence rates of Methicillin-resistant s<em>taphylococcus aureus</em>, <em>Clostridium difficile</em>, and Vancomycin-resistant<em> </em>enterococci<em> </em>have decreased but remained above the provincial benchmarks. The daily work of healthcare professionals was impacted by HAI outbreaks. Nurses experienced workload challenges, time pressures, and increased documentation. Infection control professionals' responsibilities have expanded. The environmental services staffs' cleaning processes have become more intensive. In response, several unique innovations were developed by hospital staff.</p> <p><strong>Conclusion</strong>: The daily work of healthcare professionals at the study site has been affected by HAI outbreaks. Implications for future research include the need to review healthcare professionals’ workloads and evaluate contributing factors to HAI outbreaks.</p> / Master of Science in Nursing (MSN)

Bakgrund: Vårdrelaterade infektioner (VRI) ses som en av de främsta vårdskadorna i världen och beskrivs ge ett enormt lidande för patienten. Basala hygienrutiner började utvecklas redan på 1800-talet och är idag den huvudsakliga åtgärden för att minska VRI. Sjuksköterskor och övrig vårdpersonal har en skyldighet att följa lagar, författningar och riktlinjer så att omvårdnaden av patienter blir patientsäker. Syfte: Var att undersöka vårdpersonalens följsamhet till basala hygienrutiner. Metod: En kvantitativ retrospektiv longitudinell studie som byggde på observationer av vårdpersonal samt punkprevalensmätningar av VRI. Resultat: Det sågs en högre följsamhet till basala hygienrutiner hos vårdpersonalen på medicinkliniken. Medicinkliniken hade även en signifikant förbättring av följsamhet till basala hygienrutiner. Båda klinikerna hade en lägre följsamhet till desinfektion av händer före en patientkontakt än efteråt. Studerande hade högre följsamhet än sjuksköterskor och läkare. Medicinkliniken hade som mest 5 (n=43; 11,6%) patienter med en VRI och kirurgkliniken hade som mest 9 (n=63; 14,3%) patienter. Diskussion: Tidigare forskning visar att det är lägre följsamhet till desinfektion av händer före en patientkontakt än efteråt, något som även setts i resultatet. Tidigare forskning tar även upp möjliga orsaker till en låg följsamhet samt verktyg för att skapa en högre följsamhet till basala hygienrutiner / Background: Healthcare-associated infections (HAI) are one of the leading health damage in the world and described provides immense suffering to the patient. Basic hygiene began to develop early in the 1800s and is today the main arrangements for reducing HAI. Nurses and other health care workers has an obligation to comply with laws, regulations and guidelines so that the care of patients become safe. Objective: To investigate the health care workers’ adherence to basic hygiene routines. Method: A quantitative retrospective longitudinal study based on observations of health care workers and point prevalence surveys of HAI. Results: Showed a higher adherence to basic hygiene among health professionals in the medical clinic. Medical clinic had a significant improvement in adherence to basic hygiene. Both clinics had a lower adherence to hand disinfection before a patient contact than afterwards. Students had higher adherence than nurses and doctors. Medical clinic had at most 5 (n = 43, 11.6%) patients with a HAI and surgery clinic had at most 9 (n = 63, 14.3%) patients. Discussion: Past research shows that there is less adherence to hand disinfection before a patient contact then afterwards, which is also shown in the result. Previous research also mentions possible causes of a low adherence and tool to create a higher adherence to basic hygiene.