As infecções de corrente sanguíneas relacionadas a cateter venoso central (ICS-CVC) são as causas mais freqüentes de morbidade e mortalidade em unidade de terapia intensiva (UTI). Muitos estudos mostram que educação e treinamento dos profissionais da área da saúde (PAS) sobre as práticas do cuidado com o CVC é uma importante ferramenta na prevenção e redução das ICS-CVC, entretanto o melhor modelo de educação ainda não está bem estabelecido. O objetivo desse estudo foi avaliar o impacto de dois modelos de intervenção educacional na redução das taxas de ICS-CVC, avaliar o conhecimento de boas práticas do cuidado com o CVC pelos profissionais da área da saúde (PAS) e avaliar a aderência às recomendações do cuidado com o CVC pelos PAS após aplicação dos diferentes modelos de intervenção. Realizou-se um estudo observacional, prospectivo, no período de Janeiro de 2005 a Junho de 2007 em duas unidades médicas de terapia intensiva (UTI A e UTI B) em um grande hospital escola (976 leitos sendo 120 leitos de UTI). O estudo foi dividido em três períodos: basal (somente as taxas de ICS-CVC e densidade de utilização do CVC foram avaliadas), diagnóstico (aplicação de questionário para avaliar o conhecimento dos PAS, seguido de observação das práticas realizado pelos PAS de cuidado durante a inserção, manipulação e curativo do CVC em ambas UTIs) e período de intervenção. Na UTI A, baseado nos problemas encontrados na observação, foram aplicadas aulas, dinâmicas, divulgação mensal das taxas de ICS-CVC, cartazes e etiquetas nos CVCs com lembretes sobre práticas de cuidado com esses dispositivos. Essa intervenção ocorreu para todos os PAS da unidade além de novos funcionários e residentes de medicina. Na UTI B uma única aula foi aplicada. Essa aula continha informações sobre cuidados durante a inserção, manipulação e curativo do CVC. Uma tabela foi criada e os dados foram armazenados no programa Epidata-2.1. Qui-quadrado foi calculado comparando o período de diagnóstico e de intervenção. Durante esses dois períodos, 940 e 843 CVCdias foram avaliados respectivamente na UTI A e 2175 e 1694 na UTI B. Questões sobre inserção CVC, desinfecção da conexão e curativo com solução alcoólica foi respondido corretamente por 70% a 100% dos PAS, entretanto a aderência as praticas de cuidados com o CVC durante a observação foi baixa, especialmente para a higiene das mãos (6%-35%) e desinfecção da conexão do CVC (45-68%). Após a intervenção das taxas de ICS-CVC caíram nas duas UTIs, entretanto na UTI A que ocorreu intervenção contínua, o decréscimo das taxas foi progressivo e sustentado. Na UTI B, onde uma única intervenção foi aplicada (aula) as taxas de ICS-CVC caíram inicialmente e voltaram a subir ao longo do tempo. Na UTI A, foram identificados 12 ICS-CVC por 1000 cateteresdias no período basal e nove meses após o início da intervenção contínua, não foi identificado nenhuma ICS-CVC. Na UTI B, 16,2 ICS por 1000 cateteres-dias no período basal caiu para 6,7 ICS por 1000 cateteres-dias. Em conclusão, programa educacional contínuo e personalizado parece desenvolver uma cultura de prevenção e é mais efetivo que uma única intervenção, com sustentação dos índices baixos de ICS-CVC / Central venous catheter-related bloodstream infections (CVC-BSI) are a frequent cause of morbidity and mortality in intensive care unit (ICU). Many studies have shown that education and training of health-care workers (HCW) on practices concerning CVCs are important tools to decrease and prevent CVC-BSI but the best educational model has yet to be established. The aim of this study was to evaluate the impact of two models of educational intervention on the rates of CVC-BSI in the intensive care units (ICUs), to evaluate the knowledge of HCWs regarding the recommendations of CVC care and to evaluate the adherence to practices concerning CVC for each ICU, comparing the preintervention and interventions periods. This prospective observational study was conducted from January 2005 to June 2007 in two medical intensive care units (ICU A and ICU B) in a large teaching hospital. The study was divided in 3 periods: Baseline (only CVC-BSI rates and DU were evaluated) Pre-intervention (questionnaire to evaluate the knowledge of HCWs and observation phase of CVC insertion, handling and dressing practices by the HCWs in both ICUs) and Intervention periods (in ICU A, the tailored and continuous intervention was started, in ICU B a single intervention lecture was given. A database was created using the program Epi info. Chi-square was calculated comparing the pre-intervention and intervention periods. During the pre-intervention and intervention periods 940 and 843 CVC-days were evaluated respectively in ICU A and 2175 and 1694 CVC-day in ICU B. Questions regarding CVC insertion, disinfection during manipulation and the use of an alcohol-based product during dressing were answered correctly by 70- 100% of the HCWs. Notwithstanding the compliance of HCWs to these practices in the pre-intervention period was low, especially to hand hygiene (6%-35%) and disinfection of hub (45-68%). After the intervention CVC-BSI rates declined in both units, however in the ICU in which continuous intervention was used, this decrease was progressive and sustained. In the ICU B in which a single lecture was given, the rates dropped initially and increased over time. In ICU A, 12 CVC-BSI per 1000 catheters-days in baseline period to zero after 9 months intervention. In ICU B 16.2 CVC-BSI per 1000 catheters -days in baseline period dropped to 6.7 CVC-BSI per 1000 catheters-day. In conclusion, personal customized continuous education seems to develop a culture of prevention and is more effective than single intervention, it leading to a sustained reduction of infection rates

L’impact positif des formations continues numériques dans l’amélioration de la pratique infirmière en prévention et contrôle des infections (PCI) a été documenté dans la littérature. L’analyse des besoins de formation (ABF) est recommandée comme une étape importante dans le processus de conception des formations. Malgré l’intérêt de la formation continue en PCI, il y a peu d’écrits scientifiques sur le développement de modules de formation continue numérique en PCI qui soit fondé sur une ABF des infirmières québécoises. Cette étude visait à identifier les besoins de formation ressentis en regard des compétences en PCI d’infirmières exerçant dans un centre hospitalier montréalais. Un devis descriptif quantitatif a été mené à l’aide d’une enquête de besoins de formation par questionnaire auto administré. L’ensemble des infirmières d’un établissement de santé universitaire (N=2500) a été invité à participer; 390 ont répondu au questionnaire de l’étude. Les résultats de cette étude suggèrent qu’une formation numérique hybride axée sur la gestion des risques de transmission des infections, la santé et la sécurité au travail ainsi que la gestion des déchets biologiques devrait être développée au sein de l’établissement. Les résultats de notre étude ont aussi révélé des associations significatives entre certaines caractéristiques sociodémographiques et professionnelles et le besoin de formation ressenti pour une ou plusieurs compétences en PCI. Ces résultats contribuent à l’avancement des connaissances en sciences infirmières en documentant les besoins de formation numérique en PCI d’infirmières québécoises. Cette étude contribue également à l’amélioration de la qualité de la formation continue, en adaptant celle-ci aux besoins des apprenants. / The positive impact of online continuing training in infection prevention and control (IPC) nursing practice has been documented in the literature. Training Needs Analysis (TNA) is recommended as an important step in the training design process. There is little scientific literature on TNA based online continuing training module in IPC for Quebec nurses. This study aimed to identify the training needs felt with regard to the IPC skills of nurses practicing in a Montreal hospital center. 390 nurses responded to the self-administered questionnaire survey. The results of this study suggest that a hybrid online training focused on the management of infection transmission risks, occupational health and safety as well as the management of biological waste should be developed within the establishment. The results of our study also revealed significant associations between certain socio-demographic and professional characteristics and the perceived need for training for some PCI skills. These results contribute to the advancement of knowledge in nursing sciences by documenting the online training needs in IPC of Quebec nurses. This study also contributes to improving the quality of continuing education, by adapting it to the needs of learners.

Bakgrund: Intresset för vård utanför sjukhusen har ökat till följd av den demografiska utvecklingen i världen med en ökande andel äldre och fler individer som är i behov av regelbunden vård. Samtidigt växer problemen med vårdrelaterade infektioner vilket medför nya infektionspreventiva utmaningar för vårdpersonal. Som sjuksköterska i hemsjukvård och på vårdboende förutsätts delegering till vårdpersonal, vårdtagare och närstående. I det preventiva arbetet ses därmed kunskap och delaktighet i egenvård av vikt för en säker vård. Syfte: Litteraturstudiens syfte var att sammanställa vårdpersonals erfarenheter av att arbeta med infektionsprevention inom vård i hemsjukvård och på vårdboende. Metod: Uppsatsen är baserad på en litteraturstudie med kvalitativ ansats. Litteratursökningar gjordes i databaserna PubMed och CINAHL. Kvalitetsgranskning av utvalda studier genomfördes med SBU:s granskningsmall för kvalitativa studier och innehållet analyserades med innehållsanalys. Slutligen återstod 12 studier som utgjorde resultatet i föreliggande litteraturstudie. Resultat: I resultatet framkom tre huvudtema som var Miljö och omgivning, Kunskap och utbildning samt Organisation. Utifrån dessa utvanns ytterligare sex subteman.  Konklusion: Sambandet mellan infektionsprevention och vård i hemsjukvård och på vårdboende ses som en utmaning för vårdpersonal. Hemmiljön försvårar för vårdpersonal att tillämpa basala hygienrutiner och bristen på renligheten hos vårdtagare ses utgöra en risk för infektioner. Även brist på kunskap hos både vårdtagare och vårdpersonal bidrar till ett försämrat arbete med infektionsprevention och försvåra möjligheten till egenvård. / Background: Due to the demographic development in the world with an increasing proportion of older people and thus more individuals in need of regular care the interest in home health care and nursing homes has increased. At the same time, the problems with healthcare-related infections are growing in both hospitals and in home care environment. This entails new infection prevention challenges for healthcare professionals who have an obligation to always provide safe care. As a nurse in home health care and in nursing homes, delegation to care staff, care recipients and relatives is required. In the preventive work, knowledge and participation in self-care are thus seen as important for safe care.  Aim: The aim of this study was to compile health care professionals´ experiences of infection prevention in home health care and in nursing homes.Method: Literature review with a qualitative approach. Literature searches were performed in the databases PubMed and CINAHL. Quality review of selected studies was carried out with SBU's review template for qualitative studies and the content was analyzed with content analysis. Twelve studies remained and were the result of the present literature review. Results: The results emerged three main themes which were Environment and the surroundings, Knowledge and education and Organization. Based on these, another six sub-themes were extracted. Conclusion: The connection between infection prevention and care in the home environment is seen as a challenge for care staff. The home environment makes it difficult for care staff to apply basic hygiene routines and the lack of cleanliness in care recipients is seen as a risk of infections. Lack of knowledge among both care recipients and care staff also contributes to impaired work with infection prevention and makes the possibility of self-care more difficult.

Methicillin-resistant staphylococcus aureus (MRSA) has become resistant to antibiotics. The purpose of this quantitative, retrospective cohort study was to examine the relationship between length of hospitalization and invasive MRSA infection rates among different racial and ethnic groups in the 8 service planning areas (SPAs) of Los Angeles County. Cane, O'Connor, and Michie's theoretical domain framework was used. Secondary data from the Healthcare-Associated (HA) Infections Program of the California Department of Public Health were analyzed. For the first research question, a Pearson correlation analysis was conducted to assess the relationships between length of hospitalization and invasive HA-MRSA infection rates and counts. Length of hospital stay was not correlatedwith HA-MRSA infection rates; however, it was strongly and positively correlated with HA-MRSA infection counts. For the second research question, a one-way ANOVA was conducted on the infection count rate data, with SPA as the between-subjects factor. The results were statistically significant, indicating that HA-MRSA infection counts varied among the 8 SPAs. The findings might help medical professionals better understand the risk factors associated with MRSA infections. In doing so, findings may relieve some of the burden on the U.S. health care system and improve the overall quality of life of the patients involved.

Healthcare-associated infections (HAIs) are used as a measure for federal value-based payment programs. Using data for 2015, the Centers for Disease Control and Prevention (CDC) developed newer risk adjustment models to calculate the standardized infection ratio (SIR) for various infections occurring in hospitals. New national baselines were set to compare performance among medical facilities and states. Despite adjustments for various facility-level factors that contribute to HAI risk, there are ongoing concerns that SIR calculations do not adequately account for non-hospital risk factors that have been linked to clinical outcomes. This explanatory study evaluates state-level data using simple linear regression to determine relationships between the standardized infection ratio (SIR) for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and several socioeconomic and geographic factors. Bivariate analysis produced significant correlation between SIR and high school education, with states exhibiting lower SIR relative to the percent of adults who completed high school. Higher SIRs were found relative to the percent of state populations subjected to poverty, obesity, and diagnosis of diabetes. Percent of nonprofit hospitals, adults with bachelor’s degrees, and rural residents were not significantly correlated with state measures of MRSA bacteremia. These findings can help guide efforts to reduce HAIs, improve safety of care, and advance population health efforts. The results from this study reinforce the notion that non-hospital factors may have significant effects on the incidence of MRSA bacteremia events occurring in hospitalized patients. Current risk adjustment models that predict MRSA bacteremia events for quality reporting purposes may not adequately account for these risk factors. The present study highlights some ways that hospitals, patients, and policymakers can work together to address social risk factors as a strategy for promoting better and safer care, and healthier communities. This study investigates aspects of the bigger picture of health care quality, performance measurement, and population health. This “feel for the whole” underscores the implications on state performance in infection prevention in the context of socioeconomic and medical vulnerabilities. The study emphasizes the need for greater multidisciplinary collaboration to address community health needs and reduce social and medical disparities.

La prévention et contrôle des infections (PCI) est un critère majeur pour qualifier la qualité de soins dans les services et contrôler les taux des infections nosocomiales. La formation continue demeure une des principales composantes de la prévention des infections. Malgré un intérêt pour la formation continue en PCI, des besoins à ce sujet ont été récemment exprimés par les professionnels de santé d’un établissement de santé. Cette étude qualitative descriptive a pour but de valider une proposition de modules de formation numérique continue en PCI destinées aux infirmières d’un établissement de santé à Montréal. Pour ce faire, trois entrevues de groupe ont été réalisées auprès de 8 participantes et une analyse thématique a été effectuée à partir de leurs verbatim. Quatre axes thématiques ont été dégagés, soit l’appréciation du plan de formation, les pistes d’amélioration du plan de formation, les retombées de la formation, ainsi que les barrières à la modification de la pratique clinique. Les résultats révèlent une appréciation du format numérique, de l’accessibilité et des stratégies d’enseignement choisies de la part des participantes. Des pistes d’amélioration ont également été formulées afin de bonifier le plan de formation initial. / Infection prevention and control (IPC) is a major criterion for qualifying the quality of care in the departments and controlling the rates of nosocomial infections. Continuing education in IPC remains one of the main components of infection prevention. Despite an interest in continuing education in PCI, needs on this subject have recently been expressed by health professionals in a health establishment. Based on a needs analysis, a continuous digital training plan in IPC was developed by the research team. This descriptive qualitative study aims to describe the perception of nurses regarding the validation of a proposal for continuous digital training modules in IPC intended for nurses in a health care establishment in Montreal. To do this, three virtual focus groups and group interviews were conducted with 8 participants and a thematic analysis was carried out based on their verbatim. Four thematic axes were identified, namely the assessment of the training plan, the strengths, the avenues for improving the training plan, the benefits of the training, as well as the barriers to the modification of clinical practice. The main results analyzed reveal an appreciation Participants appreciate the digital format, accessibility and the teaching strategies chosen by the participants. Areas for improvement have also been formulated to improve the initial training plan.

No description available.

This study aimed to provide evidence on knowledge of attitudes toward standard precautions (SPs) and its practice of Healthcare Workers (HCWs) in government and private hospitals in Botswana. It utilised descriptive cross-sectional methodology. A range of significant findings were revealed. Good practice of SPs was noted more amongst the HCWs in government than in private hospitals. Knowledge of SPs amongst HCWs in government hospital was significantly and positively correlated to good practice of SPs. Registered Nurses (RNs) had better knowledge of SPs than HealthcareAssistants (HCAs).There was no significant difference between RNs and HCAs practice of SPS and attitudes toward the same. No significant difference in the knowledge, attitudes and practice of SPs was noted between General Practitioners (GPs) and RNs. No significant difference in the knowledge, attitudes and practice of SPs was observed between GPs and HCAs. The study findings have implications for the application of SPs in practice / Health Studies / M.A. (Public Health)

This study aimed to provide evidence on knowledge of attitudes toward standard precautions (SPs) and its practice of Healthcare Workers (HCWs) in government and private hospitals in Botswana. It utilised descriptive cross-sectional methodology. A range of significant findings were revealed. Good practice of SPs was noted more amongst the HCWs in government than in private hospitals. Knowledge of SPs amongst HCWs in government hospital was significantly and positively correlated to good practice of SPs. Registered Nurses (RNs) had better knowledge of SPs than HealthcareAssistants (HCAs).There was no significant difference between RNs and HCAs practice of SPS and attitudes toward the same. No significant difference in the knowledge, attitudes and practice of SPs was noted between General Practitioners (GPs) and RNs. No significant difference in the knowledge, attitudes and practice of SPs was observed between GPs and HCAs. The study findings have implications for the application of SPs in practice / Health Studies / M.A. (Public Health)

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.