Following an outbreak of multi-resistant Haemophilus influenzae type b (Hib)infections in a tuberculosis hospital, this study was undertaken to determine carriage of Hib in 2 paediatric wards; to characterise all isolates of Hib, determine their antimicrobial susceptibility profile and the antibody response of the children to a conjugate vaccine. Prior to and one month after immunisation, oro- and nasopharyngeal swab specimens as well as venous blood were collected from each child. Isolates were tested for /3-lactamase and chloramphenicol acetyltransferase (CAT)production, their MIC's determined by the agar dilution method and characterisation of Hib isolates was performed by biotyping and analysis of outer membrane protein (OMP) profiles. An ELISA was also developed to determine serum antibody levels to polyribosyl-ribitol-phosphate (PRP), the capsular polysaccharide of Hib. The study population comprised a total of 135 children who had been hospitalised for treatment for tuberculosis. The patients were aged 4 months to 14 years with a median of 37,5 months. During the study period, none of the children developed invasive Hib disease. The overall carriage rate of Hib increased from 38% (51/135) before immunisation to 62% (84/135) after immunisation (P 0,15 /ig/ml. After immunisation, 34%(45) of patients increased their antibody levels to > 1,0 /xg/ml. There was no statistical difference between the mean antibody concentrations of patients who were colonised by Hib and those who were not (p = 0,58). The vaccine did not reduce carriage of Hib in this study population of children being treated for tuberculosis and the immune response to the vaccine was not optimal. Production of /3-lactamase and the prevalence of rifampicin resistance has implications for treatment and chemoprophylaxis in this population. OMP analysis showed a diversity of types. Multi-resistant strains causing invasive disease had the same OMP type as some multiresistant strains which colonised the children. / Thesis (M.Med.Sc.)-University of Natal, Durban, 1996.

Thesis (M.A.)--Northern Kentucky University, 2007. / Made available through ProQuest. Publication number: AAT 1445357. ProQuest document ID: 1372026871. Includes bibliographical references (p. 27-28)

Thesis (Ph. D.)--University of Technology, Sydney, 2004. / Bibliographic references: leaves 174-199.

Thesis (Ph.D.)--University of Western Australia, 2003.

This dissertation examines risk factors and outcomes associated with bloodstream infection (BSI). In Chapter One, the problems of BSI are introduced and their significance described. In Chapter Two, the results of a systematic review and meta-analysis synthesizing the prevalence of one of the most rapidly emerging causes of BSI among nursing home residents, multidrug resistant-gram negative bacteria are described. In Chapter Three, a retrospective cohort study identifying the prevalence and risk factors for BSI present on hospital admission (POA) is reported, including an assessment of antimicrobial resistance in isolates causing BSI-POA by admission source (i.e. private homes, other hospitals and skilled nursing facilities). In Chapter Four, a retrospective cohort study explaining risks for hospital-associated infections (HAIs) among the BSI-POA cohort is described. Length of stay and mortality among patients with a BSI-POA who develop HAI and those who do not are reported. Finally, in Chapter Five, findings of the previous chapters are synthesized and the conclusion is provided including strengths, limitations and implications for policy and practice.

Patients who experience multiple hospitalizations over short periods of time may be at greater risk of hospital-acquired infections (HAIs). While it is known that prior hospitalizations are associated with HAIs, there is a gap in knowledge regarding which factors of prior hospitalizations have an impact on the risk of HAIs in subsequent hospitalizations. HAIs caused by gram-negative bacteria (GNB) are of particular concern due to their propensity to develop drug resistance and the limited antibiotics available to treat them. The aims of this dissertation are to: 1) examine clinical and patient risk factors associated with acquiring at least one gram-negative hospital-acquired infection in adult patients with multiple hospitalizations; 2) systematically review the literature assessing the association between repeat gram-negative bacterial infections and changes in antibiotic susceptibility patterns; and 3) assess the association between repeat infections with three common gram-negative pathogens and risk of subsequent drug resistant infections with the same species among patients with multiple hospitalizations. A retrospective cohort study was conducted to identify risk factors from prior hospitalizations associated with incident HAIs caused by three common GNB. Of the 129,372 patients with multiple hospitalizations, 1,672 (1.3%) acquired K. pneumoniae, 1,127 (0.9%) acquired P. aeruginosa, and 262 (0.2%) acquired A. baumannii infections. In survival analyses, older age, mechanical ventilation, history of chronic diseases, and increasing days of use of antibiotics decreased the time to infection for all 3 pathogens. This study highlights potential modifiable risk factors for infection control. Patients with multiple hospitalizations are also inherently at greater risk for repeat HAIs which may result in decreased antibiotic susceptibility, making them more difficult to treat. A systematic review was conducted to evaluate if there is an association between repeat GNB HAIs and drug resistance. From 2000 to 2015, only seven studies explicitly examined repeat GNB HAIs and change in antibiotic susceptibility, five of which reported decreased susceptibility in later infections. The association between repeat GNB HAIs and risk of drug resistance among patients with multiple hospitalizations was then investigated with available electronic medical record data. The risk of a drug-resistant K. pneumoniae HAI increased by 1.14 times (95%CI: 1.04-1.24) with each prior K. pneumoniae HAI, after adjusting for potential confounders and antibiotic use. Similarly, patients with repeat P. aeruginosa infections had a 1.23 times increased risk of a subsequent drug-resistant infection (95%CI: 1.12-1.36) with each prior P. aeruginosa HAI as compared to patients with only one infection. Repeat A. baumannii infections were not analyzed due to limited sample size. The studies in this dissertation demonstrate that patients with multiple hospitalizations are a high-risk population for GNB HAIs. Prevention of GNB HAIs in this group is critical in order to reduce complications to medical care and limit transmission of infections to others in healthcare facilities and the community. Patient medical history can be used for infection risk assessment and to guide future medical care to reduce risk of infection in patients with multiple hospitalizations.

This research project investigated the impact of an action research intervention implemented to reducing surgical wound infection in one of the acute care hospitals in India. The study aimed to develop and implement a clinical practice improvement program in reducing surgical wound infection by improving the hand washing and wound dressing practices of nurses. The study also aimed to identify the important contributing factors to a model that predicts surgical wound infection. Pre-post evaluation measures were taken to compare the results of surgical wound infection rate before and after the implementation of the intervention. Surgical wounds of two thousand patients (one thousand before the intervention and another one thousand after) were assessed to determine the wound infection rate and severity of wound infection. The hand washing and wound dressing practices of forty nurses were observed. These same nurses were involved in the intervention using a participatory action research process. The results of the study suggest that there was a marked, significant reduction in the rate and severity of wound infection following the implementation of the intervention. By increasing the hand washing facilities in the ward, educating nurses on the importance of better hygiene, pre-operative shaving and post-operative wound care, the hand washing and wound dressing practices of nurses improved considerably. These improvements resulted in a reduction in the number and severity of patients' surgical wound infections. The study also examined the contribution of different factors to surgical wound infection in a Indian hospital. Significant predictive factors were the patients' age, longer pre-operative hospital stay, extended pre-operative shaving time before surgery, wound class, and co-morbidity of the patient. The identification of risk factors that contributed to increased surgical wound infection for example pre-operative skin preparation, pre-operative hospital stay of the patient would help in taking appropriate measures at the ward level and organisation as a whole. Nosocomial infections extends to an unnecessary lengthy hospital stay, additional treatment increased mortality and morbidity, and increased cost to the patients and the nation as a whole. This project proved that educational mentoring, data surveillance processes and involving the nurses in an action research process were effective in enabling participants to improve their clinical practice and thereby reduce the incidence of patients' surgical wound infections. Establishing infection control teams, ongoing surveillance and feedback to staff of nosocomial infection rates is an urgent need in all Indian hospitals. Organisational management, as a priority, need to provide funding and staff dedicated to undertaking this essential work. Health care professionals can no longer plead ignorance of a situation for which all have a moral and professional responsibility.

Background: Nosocomial pneumonia (NP) is a significant cause of morbidity and mortality in hospitalized patients. Objective: The objectives of this study were to describe the epidemiology of NP in adult patients hospitalized in Canadian acute care facilities and identify prognostic indicators for death. Methods: A retrospective cohort study was conducted in 114 patients with NP admitted to hospitals that participated in a 2002 Canadian point prevalence survey. Results: A high proportion of NP patients had a rapidly or ultimately fatal underlying illness. NP in non-intensive care unit (ICU) patients accounted for the larger proportion of these infections.There was no mortality difference between patients with and without ventilator-associated NP, or with and without ICU-acquired NP. Delayed initiation of appropriate antimicrobial therapy was associated with a poorer outcome. Discussion: Strategies that result in the timely administration of appropriate antimicrobial therapy should be investigated in an effort to reduce NP-associated mortality.

Background: Nosocomial pneumonia (NP) is a significant cause of morbidity and mortality in hospitalized patients. Objective: The objectives of this study were to describe the epidemiology of NP in adult patients hospitalized in Canadian acute care facilities and identify prognostic indicators for death. Methods: A retrospective cohort study was conducted in 114 patients with NP admitted to hospitals that participated in a 2002 Canadian point prevalence survey. Results: A high proportion of NP patients had a rapidly or ultimately fatal underlying illness. NP in non-intensive care unit (ICU) patients accounted for the larger proportion of these infections.There was no mortality difference between patients with and without ventilator-associated NP, or with and without ICU-acquired NP. Delayed initiation of appropriate antimicrobial therapy was associated with a poorer outcome. Discussion: Strategies that result in the timely administration of appropriate antimicrobial therapy should be investigated in an effort to reduce NP-associated mortality.

published_or_final_version / Nursing Studies / Master / Master of Nursing