Infecções hospitalares, causadas por fungos e bactérias, são responsáveis por milhares de mortes anuais e disseminam-se cada vez mais rápido em ambiente hospitalar. Estas infecções afetam principalmente pacientes que são submetidos a procedimentos invasivos ou que apresentam baixa imunidade. Este quadro tende a agravar-se devido ao surgimento de micro-organismos resistentes aos tratamentos atualmente disponíveis, decorrentes, principalmente, de excessivas prescrições, automedicação, pela utilização errônea de antibióticos bem como pela aplicação de métodos de profilaxia inadequados determinando, desta forma, a necessidade de pesquisar e de identificar novos medicamentos para esta finalidade. Neste contexto, ressalta-se que os nitrocompostos que vêm demonstrando bons resultados como agentes antimicrobianos e, sendo assim, este trabalho se propõe a planejar, sintetizar e avaliar duas séries de compostos análogos à nifuroxazida frente a bactérias Gram-positivas, Gram-negativas e fungos de importância em infecções hospitalares com caráter de multirresistência. O planejamento de modificações moleculares na estrutura da série de análogos à nifuroxazida foi auxiliado pelo diagrama de Craig, que se aplica à seleção dos grupos substituintes. A identificação dos compostos obtidos foi realizada por análise espectrofotométrica RMN 1H e RMN 13C e, como critério de pureza, foi realizado análise elementar de CHN. A melhor atividade dos análogos foi frente à S. aureus, onde 16 dos 23 compostos planejados apresentaram atividade superior aos fármacos de referência, estas quais, e composto protótipo. Vale salientar também que os compostos mais ativos foram os análogos 4-butil-N\'-[(5-nitrofuran-2-il) metileno] benzidrazida e 3-acetil-2-[5-nitro-furan-2-il]-5-[4-ciano-fenil]-2,3-diidro-1,3,4-oxadiazolínico com IC90 = 1,8 ± 0,04 µM e 3,89 ± 0,07 µM, respectivamente. Nos estudos de relações estrutura-atividade, a propriedade eletrônica se mostrou com importância fundamental para a atividade dos compostos frente aos micro-organismos considerados. Os resultados encontrados são bastantes promissores e sinalizam para a possibilidade de identificação de um novo candidato para fármaco antimicrobiano frente à infecções hospitalares com caráter de multirresistência. / Nosocomial infections are caused by bacteria and fungi and are the main reason for thousands of deaths every year in the hospital environment. The most susceptible individuals to these type of infection are the immunocompromised, highlighting old-aged and immunodeficiency people, as also patients who passed by invasive procedures. Not only do this situation is very serious, but also a huge number of multidrug-resistant microorganisms are reported worldwide, basically due to excess of prescription and wrong use of antibiotics. If this situation doesn\'t be maintained today, there will not be a bright sight in the future. In this context, there is the necessity for research and development of new antimicrobial agents, and the nitrocompounds, highlighting nifuroxazide\'s analogs, are showing excellent activity against several pathogens related to multidrug resistant nosocomial infections. Therefore, this work aims to design, to synthesize and to evaluate two series of nifuroxazide\'s analogs against strains of gram-positive and gram-negative bacteria, also fungi strains. The sets of analogs were designed based on the replacement of hydroxyl group of nifuroxazide by different substituent groups according to Craig\'s diagram, also a modification in the structure core; identification of these compounds was carried out through 1H and 13C NMR. Melting point and elementary analysis were analyzed for purity criteria. Until the moment, about 23 compounds were evaluated and the best observed activity was against S. aureus strains, which 16 analogs showed better activity than the lead compound and several other compounds, used as referential drug. It is noteworthy that the best activity were analogs 4-butyl-N\'-((5-nitrofuran-2-yl) methylene) benzohydrazide and 3-acetyl-2-[5-nitro-furan-2-yl]-5-[4-cyano-phenil]-2,3-dihydro-1,3,4 oxadiazole with IC90 = 1,8 ± 0,04 µM and 3,89 ± 0,07 µM, respectively. The chemometrics studies suggest that electronic properties are most related to the biological activity on these microorganisms. All the available results shows the potential of nitrofurans to be a new candidate for an antimicrobial drug against multidrug resistant nosocomial infections.

Hospital-acquired infections cost hospitals approximately $30.5 billion per year and also result in longer hospital stays, chronic conditions, and even death with associated malpractice costs. According to the Centers for Disease Control and Prevention, hand hygiene is a simple, effective way to prevent illness and infection. The purpose of this research was to determine if visitors to a neonatal intensive care unit (NICU) in a regional medical center comply with hand-washing policies and procedures. If NICU visitors wash their hands properly, they can prevent potentially fatal infections from spreading to patients, healthcare workers, and unaffected family members. Hand-washing compliance has been previously studied in NICU staff and other healthcare workers, but not solely visitors. The researcher observed more than 120 visitors as they entered the NICU to determine the number who washed their hands for the required three minutes. Based on the findings, NICU staff and administration will be encouraged to provide more effective education, post informative signs, and install equipment to encourage visitors to use proper hand-washing techniques. Effective hand-washing should result in lower infection rates among NICU patients and lower health care costs.

Transmissions based precautions are measures implemented in various clinical health care settings as a means to prevent the transmission of infectious diseases and decrease instances of healthcare acquired infections (HAI). HAI’s result in increased cost to hospitals, longer hospitalization for patients, increased patient suffering, and fatal patient outcomes. While staff member adherence to transmissions based precautions are mandated through various organizations and hospital policies, a review of literature indicates little research has been conducted regarding visitor compliance with transmission-based precautions. The potential implications in healthcare from visitor non-adherence acquired infections are unknown; revealing a gap in literature and supporting the need for further research to describe the phenomenon. Through utilization of a descriptive online survey instrument, the purpose of this descriptive study is to gain insight into why nurses believe visitors may or may not be compliant with transmission-based precautions. To collect the data, an online descriptive survey instrument was developed and distributed via email to all graduate students’ enrolled East Tennessee State University’s College of Nursing. Only ten participants met the eligibility requirements to participate in this study. Data was analyzed though a predictive analytics software and grouping responses into themes. Responses suggest that nurses feel visitors are not complying with transmission-based precautions because of a lack in education, not perceiving the infection as a threat, prior exposure to loved one at home, and inconvenience.

Nosocomial infections are acquired in health care settings and they can lead to catastrophic health care consequences for patients. These infections can also pose significant financial burdens on society and health care systems. Educating nurses on hand hygiene is essential to reducing infection rates. The research question for the study examined the effectiveness of hand hygiene among nurses in reduction of nosocomial infections and how can health care organizations develop educational strategies to reduce nosocomial infections to improve public confidence in health care systems. The purpose of this study was to educate nurses on how to reduce the incidence of nosocomial infections. The evidence-based practice model for this project was Florence Nightingale's environmental theory. The health belief model was used to identify the reasons for health care culture and how they inspire change. In this study, 2 licensed practical nurses and 2 registered nurses were educated on how to reduce nosocomial infections in acute care settings. Participants then completed a questionnaire to assess their knowledge of hand hygiene as a means of reducing nosocomial infections when caring for patients. All participants agreed that hand hygiene; reduces the risk of contracting a nosocomial infection, suggesting that the incidence of nosocomial infections within acute care settings maybe reduced through this education. This project has potential positive social change by educating first and second year nursing students on the importance of hand hygiene in reduction of nosocomial infections and preventing patients from sustaining further injuries while admitted in acute care settings.

Nosocomial infections are a cause of concern for hospital patients and the incidence rates of these infections are greater in intensive care units (ICUs) due to the invasive nature of treatments, additional risk factors and comorbidities, and therapies used. Invasive devices, such as vascular central lines, Foley catheters, and mechanical ventilators pose a risk for critically ill patients in the ICUs to develop device-related, healthcare-associated infections (HAI). The purpose of this study was to describe the epidemiological characteristics of patients who developed device-related HAIs within 3 ICU units (medical-surgical, cardiovascular, and neurosurgical) of an academic medical facility. The ecosocial theory of disease distribution provided the theoretical framework for the study to describe how ecological and social determinants interact and affect health variances. Secondary data were analyzed using analysis of variance (ANOVA), Pearson correlations, and chi-square statistical tests. A total of 4,213 patients admitted to the 3 ICUs from 2010-2014 were identified. According to the chi-square analysis, there was significant association between race/ethnicity and type of device-associated infection; between gender and types of infection; and between risk factors (diabetes, obesity, smoking habits) and kinds of infection, all of which the statistical significance had varied for each individual ICU. Bacterial differences were noted between device-associated infections. The potential positive social change from this study could be insight on possible new processes and interventions to reduce nosocomial infections and improve adult ICU patient outcomes such as decreased HAIs, decreased length of stay, comorbidities, and cost for both the patient and the hospital.

Bacillus anthracis and B. cereus are well known etiological agents, which cause disease in healthy and immunocompromised individuals. Considering the abundance and lethality of these organisms it is imperative that research is performed to identify and analyze new factors that may contribute to their pathogenicity. Camelysin is a membrane bound, zinc metalloprotease isolated from B. cereus. Assays performed on purified camelysin demonstrate that the protease exhibits fibrinolytic, collagenolytic, and actin degradation activity, any of which can contribute to the organisms ability to invade host tissues and cause damage. Considering the putative role of camelysin in pathogenicity, it would be beneficial to study the effects of camelysin in tissue cultures or animal models. The goal of this study focused on the cloning and expression of camelysin from B. cereus and its homolog in B. anthracis. Expression of a fusion tagged protein may assist in the purification of camelysin as well as overcoming the native proteins extreme insolubility. Primers were designed to amplify the camelysin gene from B. cereus for cloning into the prokaryotic pBAD TOPO® TA, pET100/D-TOPO®, and the eukaryotic pcDNA3.1/V5-His© TOPO[registered trademark] TA expression vectors. Primers were also designed to amplify the gene from B. anthracis for cloning into the pBAD TOPO® TA vector. The recombinant clones were induced and successful expression of the protein was confirmed by performing SDS-PAGE, Western blotting, and an azocasein protease assay. The recombinant proteins exhibited casein degradation activity which is observed with purified camelysin from B. cereus. This study successfully demonstrated the presence of the camelysin protein in B. anthracis. Furthermore, the recombinant clones obtained will be useful for purification and analysis of camelysin and delineation of its role in the pathogenicity of B. cereus and B. anthracis.

Nosocomial infections associated with implanted medical- devices are on the rise due to a growing immunocompromised patient population. The organisms of interest in this study are Pseudomonas aeruginosa and Candida albicans. These organisms are opportunistic pathogens and are frequently implicated as the cause of infection and colonization of medical devices. P. aeruginosa is a motile gram-negative bacterium that is able to suppress the growth of C. albicans. Quourm sensing mimicry and biofilm formation on the hyphal surface of C. albicans by P. aeruginosa aids in suppression. C. albicans is a dimorphic fungus capable of quorum sensing with E,E-farnesol and is a central focus in this work. The goal of this project is to determine changes in protein expression when P. aeruginosa is exposed to E,E,-farnesol using 2D DIGE®. Changes in the cytosolic proteome of P. aeruginosa expose metabolic shifts that result in suppression of C. albicans. This work summarizes the effect of growth phase and concentration of E,E-farnesol on P. aeruginosa PAO1 and GSU3. Preliminary results reveal a general response of P. aeruginosa to C. albicans as changes in relevant metabolic nodes that affect pyocyanin production and the induction of virulence factors that lead to the killing of C. albicans. The overall goal of this study was to generate a profile of protein expression where a variety of conditions to further characterize the response could be easily assayed.

Bakgrund: Trots tydliga föreskrifter om basala hygienrutiner följs dessa inte alltid av personal på vårdavdelningar. Studier visar att orsaken till detta beror på olika faktorer. Syfte: Att undersöka kunskapen om, samt följsamheten till Socialstyrelsens föreskrifter om basala hygienrutiner hos undersköterskor, sjuksköterskor och läkare på ett universitetssjukhus i Mellansverige. Metod: En kvantitativ studie med deskriptiv och jämförande design. Datainsamlingen skedde med hjälp av ett observationsprotokoll samt en enkätundersökning. Antal medverkande i observationsmomentet var 93 deltagare respektive 81 i enkätundersökningen.  Data analyserades med ANOVA samt deskriptivt statistik. Resultat: Samtliga professioner hade relativt god kunskap gällande kunskapsfrågorna samt ansåg att kunskap är viktigt. Bristande kunskaper sågs gällande handdesinfektion samt regler för naglar och armbandsur. Gällande arbetskläder och håruppsättning var följsamheten god bland samtliga professioner. Gällande följsamheten i patientnära kontakt var följsamheten relativt god men skillnader inom olika områden kunde ses. Tidspress och placering av hygienprodukter visades påverka hur följsamheten sköts. Slutsats: Studien visar att följsamheten till de basala hygienrutinerna i helhet är relativt god bland professionerna. Dock ses brister vilket tyder på att kunskapen är otillräcklig. Ökad kunskap och förbättrad följsamhet kan leda till kortare vårdtider, minskat antal vårdrelaterade infektioner samt en ökad patientsäkerhet. / Background: Despite clear basic hygiene rules, the adherence is poor among healthcare workers. Previous studies have shown that this depends on several factors. Aim: To examine certified nursing assistants´, registered nurses´ and doctors´ knowledge and adherence of the basic hygiene rules at a teaching hospital in central Sweden. Method: A quantitative study with descriptive and comparative design was chosen. The data was collected using an observation protocol and a questionnaire. Number of participants in the observation was 93 persons and 81 persons in the questionnaire. The data was analyzed using ANOVA and descriptive statistics. Results: All participants had relatively good knowledge regarding the basic hygiene rules and they found the subject important. Lack of knowledge was seen regarding the use of hand disinfectants and in the use of wristwatches and rules for nails. Regarding rules for clothes and hair, adherence was good to the basic hygiene rules among all participants. In contact with the patient, adherence was relatively good. Time pressure and placement of hygiene products have been shown to affect compliance. Conclusion: The overall result shows that adherence to the basic hygiene rules is relatively high among all professions. Faults were seen due to lack of knowledge. Increased knowledge and improved adherence to the basic hygiene rules can result in shorter hospitalization, decreased nosocomial infections and increased patient safety.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

Bakgrund: Vårdrelaterade infektioner skapar stora påfrestningar i vården på samhälls-,organisations och individnivå. Vårdpersonalens tillämpning och följsamhet tillbefintliga evidensbaserade riktlinjer är det mest effektiva sättet att förbygga VRI. För attsjuksköterskor skall kunna bedriva ett preventivt arbete och möjliggöra en patientsäkervård är det av vikt att undersöka de faktorer som påverkar följsamheten till dessariktlinjer.Syfte: Syftet med litteraturstudien var att beskriva faktorer som kan leda till attsjuksköterskor inte följer evidensbaserade riktlinjer för att förebygga vårdrelateradeinfektioner. Vidare har syftet varit att granska artiklarna avseende dess datainsamlingsmetod.Metod: En deskriptiv litteraturstudie med fjorton artiklar som underlag. Artiklarna haräven granskats utifrån dess datainsamlingsmetodHuvudresultat: Flera olika faktorer samverkar till varför sjuksköterskor inte följerevidensbaserade riktlinjer, där både inre och yttrefaktorer ingår. Tydligt framkommer attsjuksköterskor saknar kunskap och praktiska färdigheter. Sjuksköterskansföreställningar om den egna kapaciteten och den faktiska tillämpningen av riktlinjernaöverensstämmer med verkligheten. Vidare framkom att sjuksköterskornasföreställningar om konsekvenser, där sjuksköterskan har en tendens att minimeraomfattningen av de konsekvenser, som deras handlande eller underlåtelse av handlande,kan medföra.Slutsats: Sjuksköterskor saknar kunskap kring evidensbaserade riktlinjer för attförebygga vårdrelaterade infektioner. Dock finns det flera faktorer som kan förklaravarför inte riktlinjerna efterföljs. / Background: Healthcare associated infections creates great strains in healthcare at asocietal-, organizational- and individual level. Healthcare workers implementation andadherence to existing evidence-based guidelines is the most effective way to preventnosocomial infections. For nurses to conduct preventive work and enabling a safe carefor patients, it is important to examine the cause of deficiencies in adherence to theseguidelines.Aim: The aim of this survey was to describe factors that can explain why nurses do notfollow evidence-based guidelines for preventing healthcare-associated infections.Furthermore, the aim has been to examine the articles regarding the data collection method.Method: A descriptive literature survey based on fourteen articles. Articles have beenexamined in terms of the data collection method.Main result: Several different factors contribute to why nurses do not follow evidence-based guidelines, where both internal and external factors interact. It’s clearly revealedthat nurses lack knowledge and practical skills. Nurses' beliefs about their own capacityand actual application of the guidelines correspond poorly with reality. It has alsoemerged that according to the nurses' beliefs about consequences, the nurse has atendency to minimize the extent of the consequences of their act or omission of action. Conclusion: Nurses lack knowledge about evidence-based guidelines for preventinghealthcare-associated infections. However, there are several factors that could explainwhy the guidelines are not applied.