Résumé : L’Ordre des infirmières et infirmiers du Québec (OIIQ) a créé en 2011 une spécialisation pour les infirmières en PCI qui doivent maintenant suivre une formation de 2e cycle pour l’obtention de leur titre d’infirmière clinicienne spécialisée en PCI. Au sein de cette formation figure un cours de microbiologie et infectiologie (MI) qui vise à parfaire les connaissances et l’expertise en la matière. Jusqu’à présent, aucune étude n’avait été réalisée pour évaluer l’influence de ce cours sur le savoir infirmier des infirmières en PCI. Cette étude vise à décrire l’évolution du savoir infirmier des infirmières en PCI qui participent au cours de MI du programme de 2e cycle en PCI. Un devis qualitatif descriptif a été utilisé au cours de cette étude pour décrire l’évolution du savoir infirmier. Le modèle de réflexion structurée (MRS) de Johns (1995) a servi à l’élaboration d’entrevues semi-dirigées individuelles avant et après le cours de MI, afin de permettre l’identification du savoir infirmier selon un processus déductif. La méthode de codification de Miles et Huberman (2003) a ensuite favorisé un processus semi-inductif. Une analyse horizontale a finalement permis de repérer les récurrences ou les changements dans le savoir infirmier entre les entrevues de chaque participante ainsi qu’entre les participantes elles-mêmes. Des manifestations des dimensions du savoir infirmier telles que définies par Johns et influencées par Carper (1978) sont décrites, ainsi que l’évolution du savoir infirmier suite à la participation au cours de MI. Les thèmes qui ont découlé des entrevues sont : le développement d’un vocabulaire favorisant la communication dans l’équipe, la capacité d’aller au-delà des protocoles, une meilleure confiance en leurs capacités et l’élargissement d’une vision éthique qui comprend tous les acteurs de la communauté. Les retombées de l’étude se retrouvent au plan de la formation par la mise en valeur de la perspective infirmière dans le cours de MI et par l’évolution du savoir infirmier après avoir suivi ce cours. Sur le plan de la recherche, cette étude présente une nouvelle approche, pour de futures recherches, permettant d’évaluer la contribution d’un cours universitaire. / Abstract : As the Ordre des infirmières et infirmiers du Québec (OIIQ) has created in 2011 a specialty, making it possible for nurses to develop their expertise in infection prevention and control (IPC). In order to become an IPC clinical nurse specialist, nurses must fulfil a graduate program, which includes a course in microbiology and infectious diseases (MID), among others. Until now, there has been no study evaluating the influence of this training or course on patterns of knowing in nursing for IPC nurses. The goal of this study was to determine the evolution of the patterns of knowing in nursing for IPC nurses who have completed an MID course as part of a graduate program in IPC. A qualitative descriptive evaluation made it possible to determine the evolution of the patterns of knowing. Johns’ model (1995) for structured reflection (MSR) which was used in semi-structured, individual interviews before and after an MID course, helped identify patterns of knowing through a deductive process. Furthermore, Miles and Huberman’s (2003) codification method ensured a semi-inductive process. A horizontal analysis allowed for the detection of recurrence or change in patterns of knowing between each participant’s interviews, as well as between participants. The illustration of the scope of the patterns of knowing in nursing, as defined by Johns and influenced by Carper (1978), as well as the evolution of the patterns of knowing after completing an MID course, were described. The topics that surfaced during the interviews were: the development of a vocabulary fostering team communication, the capacity to go beyond protocols, a greater confidence in their abilities, and the expansion of an ethical view that includes all stakeholders in the community. The benefits of the study are at the level of training and research. Training is represented by the development of nursing perspective in the MID courses and the development of nursing knowledge after completing a course in MID. Finally, towards the research, this has put forward a new approach to assess the contribution of a university course.

The threat of antimicrobial resistance particularly in the intensive care unit has become a global issue. This study aimed to evaluate the effectiveness of antimicrobial stewardship in limiting the spread of antimicrobial resistance in the hospital’s ICU. The study further determined the deficiencies of the ASP and recommended strategies to remedy the identified deficiencies. A quasi-experimental descriptive quantitative design was used in this study. The study was conducted at the intensive care unit of an academic hospital. A structured questionnaire was used to extract information from patients’ medical records. This evaluation showed that the antimicrobial stewardship program had a sufficient impact on the appropriate use of antimicrobials in the hospital’s ICU. While there were a small (19.05 %) number of patients inappropriately prescribed antimicrobials, a moderate (35.59%) number of patients developed hospital acquired infections during the study period. In addition, the results revealed a lack of the facility’s leadership commitment to antimicrobial stewardship, which is crucial for ensuring the availability of human, financial and information technology resources Through the evaluation of the program the deficiency in the program’s performance can be identified and optimised. For the studied facility, the performance of the program could be improved by gaining the support of the facility leadership. The present study endorses the evaluation of health promotion initiatives to improve patients’ safety and outcome in healthcare institutions. Keywords / Health Studies / D. Litt. et Phil. (Health Studies)

Introdução: a derivação ventricular externa (DVE) envolve um cateter colocado no espaço ventricular cerebral para drenar o liquor (LCR) excessivo. As complicações mais comuns dessa prática incluem hemorragia em sítio de inserção, obstrução do cateter, desconexão do sistema e infecção com indicadores que variam de 1% a mais de 27%. Objetivo: analisar os indicadores de infecção relacionada à DVE e avaliar o impacto da intervenção na rotina de cuidados com cateter de DVE. Casuística e Método: estudo quase-experimental realizado na UTI Neurológica do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foram avaliados os dados de infecção em pacientes submetidos à DVE em duas etapas: pré-intervenção que ocorreu de abril de 2007 a julho de 2008 e intervenção que ocorreu de agosto de 2008 a julho de 2010. Na primeira etapa, foram realizadas observações do cuidado com DVE e aplicado questionário para avaliar o conhecimento dos profissionais. Na segunda etapa, foram realizados treinamentos da rotina de cuidados, higiene das mãos e biossegurança com intervalos de cinco, seis e sete meses e após um ano de intervenção foi realizado uma observação da higiene das mãos. Foram excluídos todos os pacientes que apresentaram traumatismo cranioencefálico com fratura exposta, presença de fístula liquórica, hidrocefalia congênita e presença de infecção ativa no sistema nervoso central. Os pacientes foram acompanhados por 30 dias após a retirada da DVE e considerou-se infecção relacionada à DVE os agentes microbiologicamente identificados em LCR de acordo com o critério do CDC. Foram realizadas cinco observações do cuidado com DVE, uma observação da higiene das mãos, uma elaboração da rotina de cuidados, três treinamentos com aulas expositivas e uma intervenção na redução do tempo de permanência do cateter de DVE, totalizando cinco intervenções. Resultados: Durante o estudo, 178 pacientes foram submetidos a 194 procedimentos correspondendo a 1217 cateteres-dia. A média de idade dos pacientes foi de 48 anos, sendo 62,4% do gênero feminino. A mortalidade global entre os pacientes foi de 34,8%. Antibioticoprofilaxia foi administrada em 80,4% dos procedimentos. Os agentes Gram-negativos foram identificados em 71,4% no período pré-intervenção e de 60% no período de intervenção. Os agentes Gram-positivos foram identificados em 14,3% no período pré-intervenção, de 20% no período de intervenção e infecção polimicrobiana foi identificada em 14,3% no período pré-intervenção e de 20% no período de intervenção. Os indicadores de infecção relacionada à DVE durante o estudo foram reduzidos de 9,5% para 4,8% por paciente (redução de 50,5%), de 8,8% para 4,4% por procedimento (redução de 50%) e a densidade de incidência de 14,0 para 6,9 infecções por 1.000 cateteresdia (redução de 49,2%) (p=0,027). Após a quarta intervenção, não foi identificada nenhuma infecção microbiologicamente confirmada durante doze meses consecutivos. Conclusão: Observou-se redução sustentada dos indicadores de infecção relacionada à DVE e diante desses resultados, a intervenção educacional continuada mostrou ser uma ferramenta útil na redução desses indicadores. / Introduction: an external ventricular drain (EVD) involves the placement of a catheter into the cerebral ventricular space in order to drain excessive cerebrospinal fluid (CSF). The most common complications of this practice include hemorrhage at the insertion site, obstruction of the catheter, disconnection of the system, and infection with indicator values that vary from 1% to more than 27%. Objective: to analyze the indicators of EVD-related infection and assess the impact of intervention on the routine of care of the EVD catheter. Cases and Method: the quasi-experimental study was carried out at the Neurological Intensive Care Unit of the Central Institute at the Clinics Hospital of the University of São Paulo School of Medicine. Data regarding infection from patients submitted to EVD were analyzed in two phases: pre-intervention, which occurred from April 2007 to July 2008, and intervention, which occurred from August 2008 to July 2010. During the first stage, observations were made as to the care given to the EVD and a questionnaire was applied to evaluate the level of knowledge of the healthcare professionals. During the second stage, training was given as to a routine of care, hand hygiene, and biosafety, with intervals of five, six, and seven months; one year after the intervention, observation of hand hygiene was performed. Excluded were all patients presenting with cranioencephalic trauma with exposed fractures, presence of CSF leakage, congenital hydrocephalus, and presence of active infection of the central nervous system. Patients were followed for 30 days after EVD removal and EVDrelated infections were considered those caused by agents microbiologically identified in the CSF according to CDC criteria. We conducted five observations of the care taken with the EVD, one observation of hand hygiene, one preparation of a routine of care, three training sessions with expository classes, and one intervention to reduce the time the EVD catheter remained in place, with a total of five interventions. Results: during the study, 178 patients were submitted to 194 procedures, corresponding to 1217 catheters-day. The mean age of the patients was 48 years, and 62.4% of them were females. Global mortality among the patients was 34.8%. Prophylaxis with antibiotics was given in 80.4% of the procedures. Gramnegative agents were identified in 71.4% of the cases during the preintervention period, and 60% during the intervention period. Gram-positive agents were identified in 14.3% of the cases during the pre-intervention period, and 20% during the intervention period, and 14.3% of them were polymicrobial infection in the pre-intervention period, and 20% during the intervention period. The values of EVD-related infection indicators during the study fell from 9.5% to 4.8% per patient (a 50.5% reduction), from 8.8% to 4.4% per procedure (a 50% reduction), and the density of incidence dropped from 14.0 to 6.9 infections per 1,000 catheters-day (a 49.2% reduction) (p=0.027). After the fourth intervention, no microbiologically confirmed infection was identified throughout twelve consecutive months. Conclusion: we observed a sustained reduction in EVD-related infection and in light of these results, continued educational intervention proved to be a useful tool in reducing these indicators.

O objetivo desse estudo foi avaliar os efeitos da administração prévia de antibiótico na incidência de complicações infecciosas em procedimentos de estimulação cardíaca artificial. Os pacientes foram selecionados em um estudo duplo-cego e randomizado (1:1). Grupo I Cefazolina (1,0g dose única) versus grupo II placebo. O comitê de segurança interrompeu o estudo após a inclusão de 649 pacientes devido à diferença entre os grupos (group I 314; grupo II 335 pacientes) em favor do uso de antibiótico: 2 infectados (0,63%) versus 11 infectados no grupo placebo (3,28%); p=0,016. Marcadores identificados por análise univariada: não uso de antibiótico; procedimentos de implantes (versus trocas); hematoma pós-operatório e duração do procedimento. O não uso de antibiótico e hematoma pós-operatório foram significantes em análise multivariada / The objective of this study was to evaluate the effects of the previous venous antibiotic administration in the incidence of infectious complications in cardiac stimulation surgical procedures. Patients were selected in a double blind, randomized (1:1) trial. Group I Cefazolin (1,0g one dose) versus group II placebo. The security committee interrupted the trial after inclusion of 649 patients due to differences between groups (group I 314; group II 335 patients) in favor of the antibiotic arm: 2 infected patients (0,63%) versus 11 infected patients in the placebo arm (3,28%); p=0,016. Markers identified by univariate analysis: non-use of preventive antibiotic; implant procedures (versus replacement); post-operative haematoma and procedure duration. The non-use of antibiotic and the post-operative haematoma were independent predictors of infection in multivariate analysis

Introdução: a derivação ventricular externa (DVE) envolve um cateter colocado no espaço ventricular cerebral para drenar o liquor (LCR) excessivo. As complicações mais comuns dessa prática incluem hemorragia em sítio de inserção, obstrução do cateter, desconexão do sistema e infecção com indicadores que variam de 1% a mais de 27%. Objetivo: analisar os indicadores de infecção relacionada à DVE e avaliar o impacto da intervenção na rotina de cuidados com cateter de DVE. Casuística e Método: estudo quase-experimental realizado na UTI Neurológica do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foram avaliados os dados de infecção em pacientes submetidos à DVE em duas etapas: pré-intervenção que ocorreu de abril de 2007 a julho de 2008 e intervenção que ocorreu de agosto de 2008 a julho de 2010. Na primeira etapa, foram realizadas observações do cuidado com DVE e aplicado questionário para avaliar o conhecimento dos profissionais. Na segunda etapa, foram realizados treinamentos da rotina de cuidados, higiene das mãos e biossegurança com intervalos de cinco, seis e sete meses e após um ano de intervenção foi realizado uma observação da higiene das mãos. Foram excluídos todos os pacientes que apresentaram traumatismo cranioencefálico com fratura exposta, presença de fístula liquórica, hidrocefalia congênita e presença de infecção ativa no sistema nervoso central. Os pacientes foram acompanhados por 30 dias após a retirada da DVE e considerou-se infecção relacionada à DVE os agentes microbiologicamente identificados em LCR de acordo com o critério do CDC. Foram realizadas cinco observações do cuidado com DVE, uma observação da higiene das mãos, uma elaboração da rotina de cuidados, três treinamentos com aulas expositivas e uma intervenção na redução do tempo de permanência do cateter de DVE, totalizando cinco intervenções. Resultados: Durante o estudo, 178 pacientes foram submetidos a 194 procedimentos correspondendo a 1217 cateteres-dia. A média de idade dos pacientes foi de 48 anos, sendo 62,4% do gênero feminino. A mortalidade global entre os pacientes foi de 34,8%. Antibioticoprofilaxia foi administrada em 80,4% dos procedimentos. Os agentes Gram-negativos foram identificados em 71,4% no período pré-intervenção e de 60% no período de intervenção. Os agentes Gram-positivos foram identificados em 14,3% no período pré-intervenção, de 20% no período de intervenção e infecção polimicrobiana foi identificada em 14,3% no período pré-intervenção e de 20% no período de intervenção. Os indicadores de infecção relacionada à DVE durante o estudo foram reduzidos de 9,5% para 4,8% por paciente (redução de 50,5%), de 8,8% para 4,4% por procedimento (redução de 50%) e a densidade de incidência de 14,0 para 6,9 infecções por 1.000 cateteresdia (redução de 49,2%) (p=0,027). Após a quarta intervenção, não foi identificada nenhuma infecção microbiologicamente confirmada durante doze meses consecutivos. Conclusão: Observou-se redução sustentada dos indicadores de infecção relacionada à DVE e diante desses resultados, a intervenção educacional continuada mostrou ser uma ferramenta útil na redução desses indicadores. / Introduction: an external ventricular drain (EVD) involves the placement of a catheter into the cerebral ventricular space in order to drain excessive cerebrospinal fluid (CSF). The most common complications of this practice include hemorrhage at the insertion site, obstruction of the catheter, disconnection of the system, and infection with indicator values that vary from 1% to more than 27%. Objective: to analyze the indicators of EVD-related infection and assess the impact of intervention on the routine of care of the EVD catheter. Cases and Method: the quasi-experimental study was carried out at the Neurological Intensive Care Unit of the Central Institute at the Clinics Hospital of the University of São Paulo School of Medicine. Data regarding infection from patients submitted to EVD were analyzed in two phases: pre-intervention, which occurred from April 2007 to July 2008, and intervention, which occurred from August 2008 to July 2010. During the first stage, observations were made as to the care given to the EVD and a questionnaire was applied to evaluate the level of knowledge of the healthcare professionals. During the second stage, training was given as to a routine of care, hand hygiene, and biosafety, with intervals of five, six, and seven months; one year after the intervention, observation of hand hygiene was performed. Excluded were all patients presenting with cranioencephalic trauma with exposed fractures, presence of CSF leakage, congenital hydrocephalus, and presence of active infection of the central nervous system. Patients were followed for 30 days after EVD removal and EVDrelated infections were considered those caused by agents microbiologically identified in the CSF according to CDC criteria. We conducted five observations of the care taken with the EVD, one observation of hand hygiene, one preparation of a routine of care, three training sessions with expository classes, and one intervention to reduce the time the EVD catheter remained in place, with a total of five interventions. Results: during the study, 178 patients were submitted to 194 procedures, corresponding to 1217 catheters-day. The mean age of the patients was 48 years, and 62.4% of them were females. Global mortality among the patients was 34.8%. Prophylaxis with antibiotics was given in 80.4% of the procedures. Gramnegative agents were identified in 71.4% of the cases during the preintervention period, and 60% during the intervention period. Gram-positive agents were identified in 14.3% of the cases during the pre-intervention period, and 20% during the intervention period, and 14.3% of them were polymicrobial infection in the pre-intervention period, and 20% during the intervention period. The values of EVD-related infection indicators during the study fell from 9.5% to 4.8% per patient (a 50.5% reduction), from 8.8% to 4.4% per procedure (a 50% reduction), and the density of incidence dropped from 14.0 to 6.9 infections per 1,000 catheters-day (a 49.2% reduction) (p=0.027). After the fourth intervention, no microbiologically confirmed infection was identified throughout twelve consecutive months. Conclusion: we observed a sustained reduction in EVD-related infection and in light of these results, continued educational intervention proved to be a useful tool in reducing these indicators.

O objetivo desse estudo foi avaliar os efeitos da administração prévia de antibiótico na incidência de complicações infecciosas em procedimentos de estimulação cardíaca artificial. Os pacientes foram selecionados em um estudo duplo-cego e randomizado (1:1). Grupo I Cefazolina (1,0g dose única) versus grupo II placebo. O comitê de segurança interrompeu o estudo após a inclusão de 649 pacientes devido à diferença entre os grupos (group I 314; grupo II 335 pacientes) em favor do uso de antibiótico: 2 infectados (0,63%) versus 11 infectados no grupo placebo (3,28%); p=0,016. Marcadores identificados por análise univariada: não uso de antibiótico; procedimentos de implantes (versus trocas); hematoma pós-operatório e duração do procedimento. O não uso de antibiótico e hematoma pós-operatório foram significantes em análise multivariada / The objective of this study was to evaluate the effects of the previous venous antibiotic administration in the incidence of infectious complications in cardiac stimulation surgical procedures. Patients were selected in a double blind, randomized (1:1) trial. Group I Cefazolin (1,0g one dose) versus group II placebo. The security committee interrupted the trial after inclusion of 649 patients due to differences between groups (group I 314; group II 335 patients) in favor of the antibiotic arm: 2 infected patients (0,63%) versus 11 infected patients in the placebo arm (3,28%); p=0,016. Markers identified by univariate analysis: non-use of preventive antibiotic; implant procedures (versus replacement); post-operative haematoma and procedure duration. The non-use of antibiotic and the post-operative haematoma were independent predictors of infection in multivariate analysis

The purpose of this project was to develop an instructional manual on in-service education for Certified Nurses' Aides. It provides examples of classes for staff developers to use when teaching continuing education classes. Topics covered include caring for the elderly, Alzheimer's disease, infection control, adult cardiopulmonary resuscitation, and end of life care.

This licentiate thesis aims to understand how infection preventionists (IPs) continuously find problems and implement solutions related to health care-associated infections (HAIs) in hospital settings. HAIs are infections acquired by patients during the process of care and are among the main causes of deaths worldwide. Recently, practices for HAIs prevention and control have challenged IPs due to pandemics (e.g. COVID-19), antimicrobial resistance, population aging and limited resources in health care facilities. Such challenges demand actions to find, solve problems and implement solutions. However, IPs often fail to address these problems. The reasons stem from their inability to timely identify valuable problems and implement new solutions. Although the literature on infection prevention and control is well developed, previous studies have largely investigated how IPs implement preconceived practices to solve given problems as a single event, rather than on how to continuously find problems and implement solutions.  This licentiate thesis comprises two empirical papers. Paper I investigates how infection prevention and control teams find problems with HAIs, and is based on a multiple case study of three infection prevention and control teams from one Swedish and two Brazilian hospitals. Paper II investigates how IPs continuously implement changes in infection prevention and control practices during pandemics, and is based on a qualitative descriptive study. The data in both papers were collected from 44 semi-structured interviews with health care professionals enrolled as IPs in Brazilian and Swedish hospitals. The key theories and literatures covered include Problem-Finding and Problem-Solving Perspective and Implementation research. This licentiate thesis contains three main contributions. First, it advances the Problem-Finding and Problem-Solving Perspective literature by providing empirical evidence on how to create valuable knowledge from ill-structured and complex problems. Second, this licentiate thesis suggests a distinction between HAI prevention and HAI control based on two modes of decision-making for finding valuable problems with HAIs. Third, the licentiate thesis describes and categorizes sets of practices that allow to continuously implement changes of infection prevention and control practices during pandemics.

Background: Catheter-associated urinary tract infections (CAUTIs) are a major source of avoidable hospital-acquired infections. The scientific evidence supports utilization of nurse-driven protocols to reduce CAUTIs. Purpose: The purpose of this quality improvement project was to update and implement an evidence-based CAUTI prevention protocol for the nursing staff on a medical-surgical unit in an adult acute care hospital to decrease the utilization of indwelling urinary catheters and CAUTIs. Theoretical Framework: Donabedian’s structures, processes, and outcomes (SPO) model was utilized as the framework for this project. Donabedian’s SPO model focuses on strong healthcare structures and processes to improve nurse, patient, and organizational outcomes. Methods: This project utilized a quantitative design. A convenience sample of 28 nurses from the medical-surgical unit of a South Florida hospital participated in the project. An educational intervention was delivered on CAUTI prevention based on guidelines from regulatory agencies, and the hospital existing protocol was updated and revised to reflect the guidelines. The sample was administered a short demographic survey, and 10-item pretests and posttests on CAUTI prevention before and after implementation of the standardized evidence-based protocol. To determine possible differences in nurses’ knowledge and perceptions of indwelling urinary catheters before and after the implementation, paired t tests were conducted. To determine if the proportions of days with urinary catheters were statistically significantly different 30 days before and after implementation of the standardized evidence-based guideline, a 2-proportion z-test was conducted. Results: On analysis of the pretests and posttests, a statistically significant difference was found in 6 of the 10 questions, indicating that nurses’ knowledge and perceptions of CAUTIs improved after the intervention (p < .001 to p < .043). After the intervention, urinary catheter days relative to patient days also decreased significantly (z = 5.562, p < 0.001). Conclusion: Implementation of an evidence-based nurse-driven protocol in a hospital in South Florida improved nurses’ knowledge and perceptions of CAUTI prevention. Nursing practice and healthcare delivery can benefit from development of such guidelines and educational interventions to empower nurses to better manage patients’ indwelling urinary catheters, and decrease the incidence of CAUTIs in hospitals.

Introduktion: Infektionsprevention är de insatser som vården kan utföra för att förebygga vårdrelaterade infektioner [VRI]. Följsamhet till basala hygienrutiner är den mest grundläggande åtgärden. VRI är den vanligaste vårdskadan globalt och bidrar till det globala folkhälsohotet antibiotikaresistens genom ett ökat antibiotikatryck. Sjukvård i hemmet blir allt vanligare och avancerad hemsjukvård bedrivs i Stockholms län som avancerad sjukvård i hemmet [ASIH]. Internationella studier har visat att följsamhet till rutiner för handhygien inom hemsjukvården är bristfällig. Syfte: att undersöka sjuksköterskors erfarenheter av hur föreskrifter och riktlinjer efterföljs i det infektionspreventiva arbetet inom ASIH. Metod: En kvalitativ studie med semistrukturerade intervjuer. Sju sjuksköterskor verksamma inom ASIH i Stockholms län intervjuades. En kvalitativ innehållsanalys genomfördes. Resultat: Temana 1) attityder, 2) normer och värderingar och 3) upplevd beteendekontroll redovisades. Attityder visade på konflikt mellan vårdhygieniska krav och sjuksköterskors erfarenheter. Normer och värderingar uttrycktes genom grad av följsamhet till föreskrifter och riktlinjer. ”Good enough” var en norm som intervjuade gav uttryck för. Den upplevda beteendekontrollen bestod av flertalet hinder som kunde påverka följsamheten till föreskrifter och riktlinjer. Diskussion: Sjuksköterskorna hade intentionen att inte orsaka VRI, men inte alltid genom följsamhet till föreskrifter och riktlinjer, då det lagstadgade kravet på god hygienisk standard ansågs vara svårt att upprätthålla i en okontrollerad miljö. Patientens hemmiljö är sjuksköterskans arbetsmiljö och målkonflikter kan uppstå. Sjuksköterskan behöver ta hänsyn till många aspekter, bland annat patientens integritet. Slutsats: ASIH möter särskilda utmaningar i det infektionspreventiva arbetet. Detta bör uppmärksammas i vårdhygieniska utbildningar för personal inom hemsjukvård. I framtiden bör punktprevalensmätningar av basala hygienrutiner och VRI inom hemsjukvården utföras. / Introduction: Infection prevention is the efforts that healthcare can carry out to prevent healthcare-associated infections [HAIs]. Adherence to basic hygiene routines is the most fundamental measure. HAIs are the most frequent healthcare injury globally and contributes to the global public health threat of antibiotic resistance through increased antibiotic pressure. Advanced home healthcare is provided in Stockholm County as ASIH. International studies have shown that adherence to routines for hand hygiene in home healthcare is deficient. Aim: To investigate nurses' experiences of how regulations and guidelines are followed regarding infection prevention within ASIH. Methods: A qualitative study with semi-structured interviews. Seven nurses working within ASIH in Stockholm County were interviewed. A qualitative content analysis was carried out. Results: The themes 1) Attitudes, 2) Subjective norms and values and 3) Perceived behavioral control were reported. Attitudes showed conflict between health care hygiene requirements and nurses' experiences. Norms and values were expressed through degree of adherence to regulations and guidelines. "Good enough" was a norm expressed by interviewees. The perceived behavioral control consisted of several obstacles that could affect compliance. Discussion: The nurses had the intention of not causing HAIs, but not always through adherence to regulations and guidelines, as the statutory requirement for good hygienic standards was considered difficult to maintain. The patient's home environment is the nurse's work environment and goal conflicts can arise. The nurse needs to take many aspects into account, including the patient's integrity. Conclusion: ASIH faces special challenges regarding infection prevention. This should be acknowledgedin healthcare hygiene training for staff in home healthcare. In the future, point prevalence measurements of basic hygiene routines and HAIs in home healthcare should be carried out.