Staphylococcus aureus resistente à meticilina (MRSA, Methicillin-Resistant Staphylococcus aureus) é um dos principais responsáveis por infecções nosocomiais, sendo identificado também em infecções associadas à comunidade. Embora potentes fármacos anti-estafilocócicos estejam disponíveis, as infecções causadas por este patógeno continuam a apresentar significativa morbidade e mortalidade devido ao aparecimento de cepas com resistência a múltiplos fármacos, incluindo vancomicina e teicoplanina. Compostos 5-nitro-heterocíclicos com estrutura análoga à nifuroxazida, antimicrobiano utilizado em infecções gastrintestinais, têm apresentado satisfatória atividade in vitro frente a estas cepas multirresistentes, sendo importante e necessária a avaliação de sua biodisponibilidade oral como próximo estágio no desenvolvimento de um novo fármaco, visando à seleção eficiente e ao aprimoramento da estrutura molecular. Neste contexto, o presente estudo tem por objetivo empregar ensaios in vitro, utilizando células Caco-2, e métodos in silico, utilizando descritores moleculares VolSurf, a fim de analisar a permeabilidade de análogos à nifuroxazida com atividade antimicrobiana apresentando, principalmente, atividade potencial frente a cepas multirresistentes de S. aureus. Empregou-se o método de MTT (brometo de 3-(4,5-dimetiltiazol-2-il)-2,5-difenil tetrazólio) para a avaliação da citotoxicidade. Nos estudos de permeabilidade in vitro foram utilizadas membranas de células Caco-2 cultivadas em placas Transwel® por 21 dias. A quantificação das frações permeadas foi realizada por cromatografia a líquido de alta eficiência com detecção UV (CLAE-UV), com métodos validados de acordo com a Resolução 899/03. Os estudos in silico foram realizados por meio de análise exploratória, pelo método de consenso de análise de componentes principais (CPCA, Consensus Principal Component Analysis), e análise de regressão, por quadrados mínimos parciais (PLS, Partial Least Squares). As células Caco-2 apresentaram viabilidade adequada para a realização dos estudos de permeabilidade frente a todos os derivados da nifuroxazida, exceto o derivado MeTIO (5-nitro-2-tiofilideno 4-metilbenzidrazida). Os valores de permeabilidade aparente (Papp) obtidos para os análogos à nifuroxazida indicam que estes possuem alta permeabilidade. Os modelos obtidos por CPCA e PLS foram capazes de separar as moléculas em grupos de compostos de baixa, média e alta permeabilidade, sendo os análogos à nifuroxazida classificados como compostos de alta permeabilidade. Para os compostos em estudo, as propriedades determinantes da permeabilidade através de células Caco-2, de acordo com os modelos, seriam de natureza topológica e estérica, sendo possível a previsão externa qualitativa e quantitativa da permeabilidade através de células Caco-2. / Methicillin-resistant Staphylococcus aureus (MRSA) is one of the main pathogens responsible for nosocomial infections, also identified in community-associated infections. Although potent anti-staphylococcal drugs are available, infections caused by this bacteria continues to show significant morbidity and mortality due to the emergence of strains with resistance to multiple drugs, including vancomycin and teicoplanin. The 5-nitro-heterocyclic derivatives of nifuroxazide, which is an antimicrobial used to treat gastrointestinal infections, have shown satisfactory in vitro activity against multidrug-resistant strains of S. aureus. As a next step in the development of a new drug, it is important and necessary the evaluation of the oral bioavailability to achieve an efficient selection and refinement of the molecular structure. In this context, this study aims to develop in vitro assays through Caco-2 cells, and in silico approaches, using VolSurf molecular descriptors, in order to analyze the permeability of 5-nitro-heterocyclic compounds analogues to nifuroxazide with antimicrobial activity, especially showing promising activity against multidrug-resistant Staphylococcus aureus. The MTT (bromide 3-(4,5-dimethyltiazol-2-yl)-2,5-diphenyl tetrazolium) method was employed to perform the cytotoxicity evaluation. Caco-2 cell monolayers cultivated for 21 days in Transwel® plates were used for the in vitro permeability assays. The quantification of the permeated fractions was done by High Performance Liquid Chromatography with UV detection (HPLC-UV), with validated methods according to the Resolution 899/03. In silico studies were performed through exploratory analysis by consensus principal component analysis (CPCA) and regression analysis by partial least squares (PLS). Caco-2 cells showed suitable cell viability for the permeability studies against all nifuroxazide analogues except the MeTIO (5-nitro-2-thiophilydene 4-methylbenzidrazide). The nifuroxazide derivatives apparent permeability values (Papp) obtained indicate these are high permeable compounds. The models obtained by CPCA and PLS were able to separate the molecules into groups of low, medium and high permeabilities, and the nifuroxazide analogues were classified as high permeable substances. The identified properties for the permeability through Caco-2 cells to the studied compounds were topologic and sterical, and it is possible to perform qualitative and quantitative external predictions with these models for the permeability through Caco-2 cells.

O sistema de saúde é desafiado diariamente por complicações infecciosas relacionadas à assistência, que constituem grave problema de saúde pública mundial, aumentando a morbidade e a mortalidade dos pacientes assistidos e elevando os custos hospitalares. O Staphylococcus aureus resistente à meticilina (MRSA), endêmico em várias instituições de saúde no mundo, é um dos principais agentes etiológicos de infecção relacionada à assistência à saúde. A colonização é um importante fator na patogênese das infecções causadas pelo MRSA, elevando o risco de uma infecção em portadores nasais desta bactéria. Além disso, sabe-se que pacientes colonizados ou infectados representam um importante reservatório desta bactéria. Atualmente, a descolonização dos portadores de MRSA é uma medida recomendada para o controle da disseminação desta bactéria. A mupirocina tem sido amplamente utilizada para a descolonização nasal, no entanto cepas de MRSA resistentes à mupirocina tem se tornado mais frequente na última década. Além disso, a formulação de mupirocina disponível no Brasil é inadequada para aplicação em mucosas, causando efeitos adversos intoleráveis. Uma vez que a sulfadiazina de prata é bastante ativa contra o MRSA in vitro, este estudo se propôs avaliar a efetividade da aplicação intranasal dessa substância para a descolonização de pacientes hospitalizados e colonizados por MRSA. Trata-se de um ensaio clínico randomizado, duplamente cego, controlado com placebo, cuja intervenção consistiu na terapia de descolonização nasal, com a aplicação intranasal de gel de sulfadiazina de prata a 1%, duas vezes por dia, associado a utilização de clorexidina degermante a 2% para o banho diário, por 5 dias consecutivos nos pacientes internados em um hospital terciário, com colonização nasal por MRSA, demonstrada por meio de cultura seletiva de swab nasal. O desfecho primário do estudo foi a identificação de swab nasal negativo para MRSA coletado imediatamente após o fim do tratamento. A comparação da taxa de descolonização nasal entre os grupos foi feita usando-se o teste do Qui quadrado, com correção de Person, e por meio de um modelo de regressão logística. Foram identificados 279 pacientes colonizados por MRSA, no entanto 156 apresentavam critérios de exclusão e 79 não estavam mais internados no momento da inclusão, sendo incluídos 44 pacientes. A mediana de idade dos incluídos foi de 57,5 anos. Após a randomização, restaram 22 pacientes em cada grupo. Oito pacientes não completaram o protocolo, e foram excluídos da análise. A descolonização nasal foi obtida em 10/16 pacientes (62,50%) no grupo controle e 10/20 (50,00%) no grupo experimental (p=0,453). A descolonização corporal global ocorreu em 8/16 (50,00%) no grupo controle e 9/20 (45,00%) no grupo experimental (p=0,765). Na análise multivariada, nenhuma das variáveis independentes incluídas, a saber sexo, idade, uso de sulfadiazina de prata, e uso de antimicrobianos sistêmicos com atividade anti-MRSA exibiu associação com o desfecho primário. Não houve diferença, entre os grupos, na incidência de infecções por MRSA após o término da terapia. Dois pacientes apresentaram irritação nasal no grupo experimental. De acordo com os nossos resultados, a sulfadiazina de prata a 1% não foi superior ao placebo para a descolonização de pacientes com colonização nasal por MRSA. / The health system is daily challenged by health-care associated infections, which constitute a global public health problem, increasing morbidity and mortality of assisted patients as well as hospital costs. The methicillin-resistant Staphylococcus aureus (MRSA), endemic in several facilities worldwide, is a major etiologic agent of health-care associated infections. MRSA colonization is a relevant risk factor in the pathogenesis of infections caused by MRSA. Moreover, it is known that colonized or infected patients represent an important reservoir of this pathogen. Currently, the decolonization of MRSA carriers is a recommended measure to control the spread of this pathogen. Mupirocin has been widely used for nasal decolonization, however MRSA strains resistant to mupirocin has become more common over the last decade. In addition, mupirocin formulation available in Brazil is inappropriate for application to mucosal causing intolerable side effects. Once silver sulfadiazine is active against MRSA in vitro, this study aimed to evaluate the effectiveness of intranasal application of this substance for decolonizing hospitalized patients harboring MRSA. This is a randomized, double-blind, placebo-controlled trial, which intervention consisted in intranasal application of silver sulfadiazine gel 1%, twice a day, associated with the use of chlorhexidine soap 2% for daily bath for 5 consecutive days in patients admitted to a tertiary hospital with nasal MRSA colonization, demonstrated by selective culture of nasal swab. The primary endpoint of the study was the identification of negative nasal swab for MRSA collected immediately after the end of treatment. Comparison of decolonization rate between groups was performed using Person\'s corrected chi square, and through a logistic regression model. From 279 patients colonized by MRSA identified, 156 met exclusion criteria and 79 were no longer in hospital at the time of inclusion, so 44 patients were included. The median age of those included was 57.5 years. After randomization, 22 patients remained in each group. Eight patients did not complete the protocol and were excluded from analysis. Nasal decolonization was achieved in 10/16 patients (62.50%) in the control group and 10/20 (50.00%) in the experimental group (p = 0.453). The global body decolonization occurred in 8/16 (50.00%) in the control group and 9/20 (45.00%) in the experimental group (p = 0.765). In multivariate analysis, none of the included independent variables, namely sex, age, use of silver sulfadiazine, and use of systemic antibiotics with anti-MRSA activity showed association with primary endpoint. There was no difference between groups in the incidence of MRSA infections after the end of therapy. Two patients had nasal irritation in the experimental group. According to our results, silver sulfadiazine 1% was not superior to placebo for decolonizing patients with nasal MRSA colonization.

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.

Current state: The goal of nursing is a quality of nursing healthcare. Each department has its own specific features and therefore has its own quality indicator. This work focuses on two quality indicators related to healthcare, specifically on patients with MRSA infection and their falls. Methodology: In the research were applied three methods of data collection: 1) statistical data from the hospital system; 2) intentional structured observation; 3) structured interviews. Research file: In order to evaluate the incidence of falls and cause of falls, were examined a total of 85 patients and a total of 98 patients for evaluation of decolonized patients with MRSA infection. The investigated group of people for observation and in-depth interviews were ONP nurses from the 6th floor of České Budějovice Hospital, plc. Results: The hypothesis that the most common cause of the fall is leaving the bed without any accompaniment has not been confirmed and the incidence of falls at the patients throughtout the observation period of the year 2015 dropped down significantly in comparison with the year 2014. The most common source of MRSA infection was a wound. Also, has not been confirmed the hypothesis that the number of decolonized patients with MRSA infection who were observing in the year 2015 will be statistically higher than in the year 2014. Most nurses know the cause of MRSA infection, but the problems they have are the precise definitions. By observing the practical activities and skills of nurses during the treatment of patients with MRSA infection were revealed certain shortages, especially the improper use of protective equipment and the improper disinfection of aids after their use. Conclusion: The results of the research show the need for more nursing education in this subject. Adverse events are a serious complication of the nursing process. The number of falls as well as the number of decolonized patients with MRSA infection is not successful significantly decrease in comparison year-on-year. The research also found inadequate theoretical preparedness of the nurses in the area of infectious diseases and a certain discrepancy between verbally presented experiences and the results of observation real activities.

Title of the thesis: Specifics of the nursing care of patients with MRSA in the operating room from an anesthesiology nurse perspective. The aim of this thesis was to identify the specifics of nursing care of a patient with the MRSA in the operating room from the perspective of nurses working in the operating room. In the theoretical part focus is given to nursing care and its specifics for a patient with MRSA. Chapters relating to the regime measures, barrier nursing procedures and the use of specific aids, instruments and tools are treated in detail. The nursing care provided by anesthesia nurses and perioperative nurses in the operating room is defined. To reach the goals the quantitative research through questionnaires was chosen. The research sample consisted of anesthesia nurses and perioperative care nurses. Two types of standardized questionnaires were used, consisted of closed questions where respondents chose an appropriate answer, and from semi-open questions where respondents could specify their answers, and in one case open questions. Both questionnaires were completed by 12 test questions, where respondents had the choice of three possible answers, where one answer was correct. The results of the investigation are summarized in two types of graphs. Bar charts were used in questions where more answers were possible to mark, and for a better clarity the results were supplemented by tables. Results to other questions, where options were limited by one answer, are shown in percentages in pie graphs. Our thesis is very narrowly focused, because we concentrated on specifics of nursing care in a patient with MRSA in the operating room. We have determined the specifics of barrier nursing, nursing problems in a patient with MRSA in the operating room. We have discovered barrier nursing procedures in a patient with MRSA in the operating room. We have also succeeded in assessing the knowledge of nurses working in the operating room. The goal was met. An interesting finding was that most of anesthetic nurses and perioperative nurses had responded that the structural and technical arrangement in the operating room was not satisfactory in terms of barrier nursing of a patient with MRSA. This problem was expected, owing to the author´s experience in operating theaters. Thus Hypothesis 1 is confirmed. In total five hypotheses were stated, four of which were confirmed and one was disproved. The aim of the thesis was to draw attention to problems in the operating room during nursing a patient with MRSA. In the course of the research work there were no problems, however, it is necessary to mention the lack of literature on MRSA with regard to nursing care in operating theaters. The theoretical section of this thesis could be recommended as a resource for the education plan created on the basis of information collected and the results of this research. The results of the research survey may serve for general public, anesthesia and perioperative nurses who could benefit from the educational plan in practice while providing nursing care for a patient with MRSA.

Bakgrund: Utveckling av antibiotikaresistenta bakterier är ett globalt folkhälsoproblem. Meticillinresistenta Staphylococcus aureus (MRSA) är en av dom vanligaste antibiotikaresistenta bakterien och smittas vanligtvis via kontaktsmitta. I Sverige ses MRSA som en allmänfarlig sjukdom som kan innebära livshotande tillstånd samt lidande hos patienten. Smittspridning av MRSA kan minskas genom följsamhet av basala hygienrutiner. Sjuksköterskans ansvar är att arbeta smittförebyggande, patientsäkert, lindra lidande samt hålla sig uppdaterad med ny kunskap. Trots detta upplever sjuksköterskor kunskapsbrist gällande MRSA och rädsla över att själva bli smittade. Syfte: Studiens syfte är att belysa patienters upplevelser av att vårdas med MRSA inom slutenvården. Metod: Studien är gjord som en litteraturöversikt som baseras på 15 vetenskapliga artiklar med kvalitativ-, kvantitativ- och mixad metod. Datasökning har gjorts i databaserna CINAHL och PubMed. Resultat: I resultatet framkom tre teman där patienternas upplevelser av att vårdas med MRSA inom slutenvården belyses: Upplevelser av bemötande från vårdpersonal, Upplevelser av information samt kunskap hos vårdpersonal och Upplevelser av att vårdas i isoleringsrum. Resultatet visade att patienter med MRSA upplever stigmatisering, kränkning och oprofessionellt bemötande av vårdpersonal på grund av kunskapsbrist vilket medför psykiskt lidande hos patienterna. Det visade sig även att vårdande i isoleringsrum upplevs negativt och att den fysiska vårdmiljöns utformning har en betydande inverkan på upplevelse och välmående. Slutsats: Vårdpersonal behöver mer fortbildning för att öka kunskap om vårdandet av patienter med MRSA samt en god fysisk vårdmiljö i isoleringsrum skapar förutsättningar för att lindra lidande samt säkerhetsställa god och säker vård i vården av patienter med MRSA inom slutenvård. / Background: The development of antibiotic resistant bacteria is a global health problem. Methicillin-resistant Staphylococcus Aureus (MRSA) is one of the most common antibiotic resistant bacteria and is usually transmitted through contact infection. In Sweden MRSA is referred to as a dangerous disease that can cause life-threatening conditions as well as patient suffering. The spread of infection may be reduced by adherence to basic hygiene practices. The nurse’s responsibility involves infection prevention, patient safety, alleviation of suffering and maintaining current knowledge of the disease. Despite this, nurses may lack knowledge concerning MRSA and fear contracting it. Aim: The aim of this study is to highlight the patient’s experience during inpatient treatment of MRSA. Methods: The study was conducted as a literature review based on fifteen scientific articles with qualitative-, quantitative- and mixed method. The article search was conducted via the CINAHL and PubMed databases. Results: The result highlighted three themes involving patient experiences during isolated inpatient care of MRSA: Experience related to treatment by healthcare professionals, Experiences concerning the depth and correctness of information and knowledge by healthcare professionals and Experiences of being cared for in an isolation room. The result indicated that MRSA patients experience stigma experiences psychological distress as they felt stigmatized, violated and unprofessionally treated by healthcare professional due a lack of knowledge. Furthermore, it also showed that isolation room care was negatively experienced and that the care environment design significantly impacted the patient’s experiences and feelings of well-being. Conclusion: Healthcare professionals need further education to increase their knowledge of MRSA patient care and how the maintenance of a good care environment in isolation rooms is important for alleviation of suffering and ensuring the good and safe care of inpatient MRSA patients.

Systemische Infektionen mit S. aureus (MSSA und MRSA) und Infektionen des Gefäßzugangs bei HD-Patienten sind eine der wichtigsten Ursachen für Morbidität und Mortalität in dieser speziellen Population. Infektionsrisikos stellen die zunehmende Verwendung von Fremdkörpern, wie Katheter und Graft als Gefäßzugänge, sowie die intensivmedizinische Behandlung bei älteren und multimorbiden Patienten dar. Unter den bakteriell bedingten Infektionen bleiben Staphylokokken der am häufigsten nachgewiesene Stamm. Mit dem zunehmenden Gebrauch von Vancomycin zur Behandlung von MSSA-Infektionen hat das Vorkommen von MRSA zugenommen. Dies macht die Entwicklung von alternativen Antibiotikaregimen nötig, die eine Selektion von MRSA-Spezies verhindern. Unter dieser Überlegung wurde auf die Behandlung mit Vancomycin bei Zugangs-bezogenen Infektionen verzichtet. Es wurde im Jahr 2000 durch ein Standardregime bestehend aus Flucloxacillin und Rifampicin ersetzt. Mithilfe eines Screeningprogramms wurde nach MSSA- (n=88) und MRSA- (n=1) Kolonisationen gesucht. Dies gelang mit Hilfe von Querschnitts-Screenings und Indikations-Screeninguntersuchungen bei Aufnahme über den Zeitraum von 2000 bis 2010. Eine Besiedlung mit MRSA wurde bei nur einem Patienten während des 10-Jahres-Screenings registriert. Die gefundenen MSSA-Kolonisationen bei HD-Patienten beeinflussten die Morbidität und Mortalität nicht. Die Anzahl an HD-Patienten mit MSSA-Kolonisation nahm während des Beobachtungszeitraums von zehn Jahren ab Behandlungen mit dem Vancomycin-freien Regime waren generell erfolgreich und resultierten in einem Rückgang der klinischen und laborativen Infektionsmarker und/oder negativen Blutkulturen. Es konnte gezeigt werden, dass mit dem Gebrauch von vancomycinfreien Antibiotikaregimen ein erfolgreiches Management von Staphylokokkus-assoziierten Zugangsinfektionen bei HD-Patienten möglich ist.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a multidrug-resistant bacterium that causes serious infections. Specific measures to prevent the spread of MRSA are required within health care, and insufficient knowledge and lack of compliance to these measures have been identified in healthcare professionals. The need to adhere to special guidelines in order to prevent the spread of infection have been shown to create negative feelings for carriers of multidrug-resistant bacterium. Aim: The aim of this study was to investigate different aspects of living and being cared for with known carriage of MRSA. The fist aspect aimed to investigate how people experience their knowledge and the information they receive from the healthcare. The second aspect aimed to investigate their feelings and existence in relation to their carriage. The third aspect aimed investigate their experiences and encounters with health care. Method: Literature study with systematic approach and inductive method. The results were analysed with inspiration from thematic synthesis and based on ten qualitative original articles.  Results: Getting MRSA was shocking and shameful, and many blamed the health care for contracting MRSA. Living with MRSA had a negative impact on daily life. Life felt lonely and isolated, and people were scared to infect others. Being cared for with MRSA was described with experiences of lack knowledge from the health care professionals, inconsistencies in adherence to hygiene measures and unprofessional behaviour. Being cared for in isolation had a negative impact on the persons’ independence, their relations with the health care professionals and the quality of care. Conclusion: Getting MRSA is perceived as stigmatising and frightening, and the health care fails to provide adequate information to counteract these feelings. People feel sadness, abandonment and uncertainty about the future. The behaviour of health care professionals and their compliance with hygiene measures is inconsistent. This results in people feeling extradited to health care, which contributes to enhanced feelings of shame and stigmatisation, and people with MRSA do not receive health care on equal terms. / Bakgrund: Meticillinresistenta Staphylococcus aureus (MRSA) är en multiresistent bakterie som orsakar allvarliga infektioner. För att förhindra spridning av MRSA krävs särskilda hygienrutiner inom vården, och otillräcklig kunskap och bristande följsamhet till dessa har identifierats hos vårdpersonal. För att inte sprida smitta behöver personer med bärarskap av multiresistenta bakterier förhålla sig till särskilda riktlinjer, vilket har visat sig skapa negativa känslor för personerna. Syfte: Syftet var att undersöka olika aspekter av att leva och vårdas med känt bärarskap av MRSA. Den första aspekten syftade till att undersöka hur personerna upplever sin kunskap och informationen de får från vården. Den andra aspekten syftade till att undersöka deras känslor och tillvaro i relation till bärarskapet. Den tredje aspekten syftade till att undersöka deras erfarenheter och upplevelser av mötet med vården. Metod: Litteraturstudie med systematisk ansats och induktiv metod. Resultatet analyserades med inspiration av tematisk syntes och baseras på tio kvalitativa originalartiklar. Resultat: Att få MRSA var chockartat och skamfyllt, och många beskyllde vården för att ha fått MRSA. Att leva med MRSA påverkade vardagen negativt. Livet kändes begränsat, ensamt och isolerat och personerna var rädda för att smitta andra. Att vårdas med MRSA beskrevs med upplevelser av bristande kunskap hos vårdpersonalen, inkonsekvens i följsamhet till hygienrutiner och oprofessionellt bemötande. Att vårdas under isolering för MRSA inverkade negativt på personernas upplevelse av självständighet, relationen till vårdpersonalen och kvaliteten på omvårdnaden. Slutsats: Att få MRSA upplevs stigmatiserande och skrämmande och vården misslyckas med att ge adekvat information för att motverka dessa känslor. Personerna känner sorg, övergivenhet och framtiden känns osäker. Vårdpersonalens beteende och följsamhet till hygienrutiner är inkonsekvent, vilket gör att personerna känner sig utlämnade till vården. Detta bidrar till förstärkta känslor av skam och stigmatisering, och personer med MRSA får inte vård på lika villkor.

Bakgrund: Sjukdom kan innebära en påverkan på något mer än det fysiska, sjukdom kan även innebära något annat än ohälsa. Sjuksköterskans kunskap samt relationen mellan sjuksköterska och patient är en viktigdel i skapandet av trygghet i hälsoprocesserna. För somligakan sjukdom ha en positiv effekt på hälsan. Penicillinet kom med stora möjligheter att behandla infektioner, men snabbt började bakterier utveckla resistens. Idag är de vanligaste, anmälningspliktiga multiresistenta bakterierna i Sverige MRSA, ESBL och VRE. Det innebär förhållningsregler för patienter och gör att hälso-och sjukvården behöver genomföra smittskyddsåtgärder för att minska spridning. Sjuksköterskan kan känna osäkerhet och rädsla i omvårdnaden av dessa patienter vilket kan ha en inverkan på den jämlika vård som enligt lagen ska ges. Syfte: Syftet var att belysa patienters upplevelser av att leva med multiresistenta bakterier (MRSA, ESBL eller VRE). Metod: En litteraturöversikt där informationssökning har gjorts i PubMed, CINAHL och SwePub. Artiklar inkluderades om de svarade på syftet, var orginalartiklar, publicerade mellan 2010-2020, skrivna på engelska, hade kvalitativ eller mixad metod, var granskade av referenter och hade ett etiskt godkännande. Den insamlade datan analyserades av författarna och sammanställdes i tre teman och tillhörande underteman. Resultat: Tre teman vilka rubricerades som känslomässig påverkan, upplevelser i mötet med hälso-och sjukvård och förändringar i relationen till andra. Diskussion: Litteraturöversiktens resultat diskuteras gentemot Livsvärldsteorin, bakgrunden, andra referenser och författarnas egna tankar. / Background: Disease can have impact on something more than the physical, disease can be something else than illness. The nurse’s knowledge and the relationship between nurse and patient is an importantpart in creating safety in the health processes. For some, disease can have a positive effecton the health. The penicillin came with great possibilities in treating infections, but the bacteria quickly began to develop resistance. Today, the most common notifiable multidrug-resistant bacteria in Sweden are MRSA, ESBL and VRE. It induces instructions for patients and the health care has to conduct disease control to reduce spread. The nurse can feel uncertainty and fear in the caring of these patients, which can have an impact on the equal care which is to be given according to the law. Aim: The aim was to illustrate patients’ experiences of living with multidrug-resistant bacteria (MRSA, ESBL or VRE). Method: A literature review where the information search has been conducted in PubMed, CINAHL and SwePub. Articles were included if they answered to the aim, was original articles, published between 2010-2020, written in English, had qualitative or mixed method, were peer-reviewed and had an ethical approval. The collected data were analysed by the authors and compiled in to three themes and belonging sub-themes. Results: Three themes who were labelled emotional impact, experiences in the encounter with health care and change in the relationship with others. Discussion: The result of the literaturereview was discussed towards Life World Theory, the background, other references and the authors’ own thoughts.

Bakgrund:Innebörden av multiresistenta bakterier beskrivs samt de vanligaste orsaker till smittspridning inom sluten vården. Sjuksköterskans har ett ansvar i sin roll gällande vårdmiljö, omvårdnad och teamarbete för att förhindra spridning av multiresistenta bakterier där en stor vikt ligger i de basala hygienrutinerna. Upplevelsen hos patienter som bär på en smitta samt vårdpersonalens uppfattning av att vårda patienter med bekräftad smitta lyfts.Syfte:Syftet är att beskriva sjuksköterskans arbete för att begränsa och förebygga smittspridning av MRSA inom slutenvården.Metod:Arbetet har utförts som en litteraturöversikt innehållande 15 vetenskapliga artiklar varav sex kvantitativa artiklar och nio kvalitativa artiklar.Resultat:Ett tema som är kopplat till de flesta delar i resultatet är goda basala hygienrutiner, och att vikten av en följsamhet till det är av stor betydelse för att förhindra smittspridningen. Det finns behov av mer kunskap som krävs för att en god och säkervård ska vara möjligt hos vårdpersonal och för att kunna arbeta förebyggande för smittspridning.Slutsats:Det visade sig i litteraturöversikten att det finns en stor okunskap hos vårdpersonalen gällande MRSA, smittvägar och rutiner kring vård av patienter som är bärare av MRSA.Dessa patienter behöver få rätt kunskap för att kunna förhindra smitta. Tydliga rutiner, utbildningar och bredare kunskap inom ämnet behövs hos vårdpersonalen. Det kan vara aktuellt att lyfta ämnet inom samtliga vårdavdelningar och ge interna utbildningar så att vårdpersonal ges möjlighet till rätt kunskap för att kunna ge en säker vård och även känna sig trygga i vårdandet av patienter med MRSA. / Background:The meaning of multi-resistant bacteria is described as well as the most common causes of infection in inpatient care. The nurse has a responsibility in the role regarding the care environment, nursing and teamwork to prevent the spread of multi-resistant bacteria where a great importance lies in the basic hygiene routines. The experience of patients carrying an infection and the care staff's perception of caring for patients with confirmed infection is raised.Aim:The purpose is to describe the nurse's work to limit and prevent the spread of MRSA in inpatient care.Method:This literature review was based on 15 scientific articles, of which six are quantitative articles and nine qualitative articles.Results:A theme that is linked to most parts of the result is good basic hygiene routines, and that the importance of compliance with it is of great importance to prevent the spread of infection. There is a need for more knowledge that is required for good and safe care to be possible with healthcare staff and to be able to work preventively for the spread of infection.Conclusion:The literature review show a lack of knowledge among healthcare professionals regarding MRSA, spread of infection and routines regarding care of patients carrying MRSA. These patients need correct information and knowledge to be able to prevent infection. Clear routines, training and broader knowledge in the subject are needed among the care staff. It may be relevant to raise the topic in all care departments and provide internal training so that care staff are given the opportunity for the right knowledge to be able to provide safe care and feel safe in the care of patients with MRSA.