The overall aim of the present thesis was to investigate experiences of living with multidrug-resistant bacteria (MDRB), using methicillin-resistant Staphylococcus aureus (MRSA) colonization as an illustration, and to develop and validate a tool to describe healthcare personnel’s attitudes towards patients with MDRB. A further objective was to study MRSA-colonized persons’ and healthcare personnel’s experiences of patient-professional interactions and responsibilities for infection prevention. Four empirical studies were conducted. A total of 18 MRSA-colonized persons and 20 healthcare personnel were interviewed regarding their experiences, and a total of 726 RNs responded the MDRB Attitude Questionnaire. The findings revealed the difficulties associated with living with MRSA colonization, which was described as something uncertain, and as an indefinable threat that has to be managed in both everyday life and in contacts with healthcare. Interactions with healthcare personnel were described as unprofessional owing to personnel’s inappropriate behaviour and insufficient information provision. According to the personnel, achieving adequate patient-professional interactions required having knowledge and experiences of MRSA. They also experienced difficulties in providing tailored information to patients. The MRSA-colonized persons described their unwanted responsibility to inform healthcare personnel about the colonization, but also felt responsible for limiting the spread of infection to others. Furthermore, responsibility for infection control was regarded as shared between healthcare personnel and patients. The personnel described such responsibility as a natural part of their daily work, although it was not always easy to adhere to hygiene precautions. The MRSA-colonized persons felt that healthcare personnel have insufficient knowledge of the bacteria and of hygiene precautions. The MDRB Attitude Questionnaire showed that registered nurses do have knowledge deficiencies. The MDRB Attitude Questionnaire has adequate psychometric properties. In conclusion, MRSA colonization constitutes a psychological strain for carriers, and interactions with healthcare personnel resulted in feelings of stigmatization. The present thesis indicates that there is a need to improve healthcare personnel’s knowledge, behaviour and emotional response in relation to patients with MDRB, in order to ensure patient safety and address patients’ needs. The heads of department is responsible for such improvements, and the MDRB Attitude Questionnaire is useful in identifying areas in need for improvement.

Bakgrund: Kolonisering och spridning av multiresistenta bakterier (MRB) är ett ökande problem både i samhället och i sjukvården idag. MRB smittar genom kontaktsmitta, genom direkt personkontakt eller kontakt av kontaminerade ytor. Frågor rörande patientsäkerhet påverkar alla inom hälso- och sjukvårdens organisationer, men huvudansvaret att utveckla ledningssystem för att ett systematiskt kvalitetsarbete ska kunna bedrivas, ligger på vårdorganisationen- och vårdgivaren. Kunskapsbrist om MRB hos vårdpersonal samt brist på tydliga riktlinjer i vården i det kliniska arbetet kan påverka attityder till och bemötande av patienter med MRB. Syfte: Att belysa vårdorganisationers ansvar, sjuksköterskans kunskaper om MRB samt hens attityder till och bemötande av patienter med MRB- smitta. Metod: Studien gjordes som en litteraturöversikt där tio vetenskapliga artiklar analyserades för att framställa resultatet. Resultat: I resultatet framkom att vårdorganisationen och ledarskapet var av stor vikt för sjuksköterskans förutsättningar att ge god och säker vård till patienter med MRB. Kunskaperna om MRB var oftast låga. Attityder och bemötande visade sig i de flesta fall också påverkas av kunskapsnivån. Dålig kunskap och brist på erfarenhet av patienter med MRB kunde även relateras till ökade rädslor hos sjuksköterskor att smittas av MRB. Diskussion: Resultatet diskuterades mot Travelbee´s teori om mellanmänskliga relationer och konsensusbegreppet vårdande. Vårdorganisationens ansvar och kunskaper hos sjuksköterskor om MRB tycks vara de faktorer som mest påverkade bemötandet gentemot och attityderna till patienter med MRB. / Background: Colonization and transmission of MDRB is an increasing problem today, both in society and in health care settings. MDRB is most commonly transmitted through cross-contamination through personal contact and contact with contaminated surfaces. Patient safety affects everybody within health care settings. Main responsibility lies with healthcare organizations and caregivers, to develop management systems for systematic quality improvement. Knowledge deficiency of MDRB among health care personnel and lack of clear guidelines in health care settings may influence the attitudes and behaviour towards patients with MDRB. Aim: To illustrate healthcare organizations responsibilities, nurses’ knowledge of MDRB and nurses’ attitudes and behaviour towards patients with MDRB. Method: The study was conducted as a literature review and ten scientific papers were analysed to generate the results. Results: The results showed that healthcare organizations and leadership were of great importance for the nurses’ ability to provide good and safe care for patients with MDRB. Knowledge about MDRB was also proved to be low. Deficient knowledge and lack of experience of caring for patients with MDRB among nurses might also influence their own fears of contracting MDRB. Discussions: The results were discussed against Travelbee’s Intrapersonal relationship- theory and the concept of caring. Healthcare organizations responsibility and nurses’ knowledge of MDRB seemed to be the eminent factors that influenced both behaviour and attitudes towards patients with MDRB.