Background Hospital-acquired infections are significant cause of morbidity and mortality among hospitalized patients worldwide. Healthcare workers during job are exposed to blood borne pathogens through contact with infected body parts, blood and body fluids. World health organization (WHO) estimated that globally about 2.5% of HIV and 40% of hepatitis viral infected cases are among health workers due to exposures. The most important mechanism of spread of these pathogens is through contaminated hands of the healthcare workers. Standard precautions measures are essential to prevent and control healthcare associated infection among healthcare workers and patients. In developing countries despite the development of detailed guideline for infection control the knowledge of standard precautions is low and not properly applied. The aim of this study is to assess the knowledge and practice of health care workers regarding standard precautions and hand hygiene to infectious disease control.  Aim The aim of this study was to assess the knowledge and practice of health care workers regarding hand wash and standard precautions to control infectious diseases in BMCH. In addition create awareness among participants and encourage them to practice regularly hand hygiene and standard precautions to control or reduce nosocomial infections in health care facilities Methods The study design is cross-sectional evaluation of healthcare worker knowledge and practices about standard precautions and hand hygiene for infectious disease control. A questionnaire administered to health care workers (doctors and nurses). The questionnaire was divided in two parts and the first part concerns demographic information, asking knowledge and practice. The second part asked opinions about risk and prevention of HAIs. The questionnaire was developed with consultation of other studies of the same kind. It has been pre tested and is finalized for survey. The ethical approval was given by hospital superintendent and informs consent from all study participants. Statistic analysis was done on Excel and statistical software SPSS version 20. Data was described in numbers, percentages and Chi Square test done for association among categorical variables, significant level was considered P= <0.05. Results Two hundred questionnaires were distributed to HCWs in BMCH and 169 completely fill questionnaire were returned. The male gender respondents were 42% and female respondents were 58%. The basic questions about knowledge of hand hygiene and standard precautions were answered well in both categories; about 73% were with sufficient knowledge. The practice of hand hygiene and standard precautions was not satisfactory among both categories; about 47% found with good practice. Differences found in sub groups, young age none trained doctors and nurses answered wrong and shown lack of knowledge. This study found an association of age, profession and job experience with knowledge and practice regarding hand hygiene and standard precautions. Open handed questions described well the major issue regarding HAIs and participants emphasized on risk and prevention methods.  Conclusions The respondents were HCWs (doctors and nurses) of both sex and this study found that majority of HCWs have good knowledge and practice about control of HAIs but difference were found in age groups, sex and profession. Above half of the HCWs were not trained for infection control in health facilities, thus getting training of infection control is important but more important is implementation of it during practice.

Bakgrund: Ett flertal studier visar på att följsamhet i handhygien bland sjukvårdspersonal är låg. Syfte: Den föreliggande studien syftade till att identifiera vilka hinder som försvårar följsamheten i handdesinfektion för sjuksköterskor och undersköterskor. Metod: Undersökningen utfördes på tre slumpmässigt utvalda vårdavdelningar på ett sjukhus i Mellansverige i mars 2014. Sjuksköterskor och undersköterskor besvarade en enkät som konstruerats för studien. Resultat: Av studiens tilltänkta undersökningsgrupp (n=110) svarade 70 vilket motsvarar en svarsfrekvensen på 64 %. Resultatet visar att det var vanligare att desinfektera händerna efter patientkontakt än före.  Det som i störst utsträckning angavs som hinder till att utföra handdesinfektion var tidsbrist och brist på tillgängligt handdesinfektionsmedel. Sjuksköterskor angav att de utför handdesinfektion i lägre utsträckning till följd av brist på tillgängligt handdesinfektionsmedel än undersköterskorna. Vidare framkom att de med kortare arbetserfarenhet än genomsnittet (14,3 år) angav i större utsträckning än de med längre arbetserfarenhet att de inte utförde handdesinfektion. Slutsats: Vårdpersonal uppger att det är vanligare att desinfektera händerna efter patientkontakt än före, liksom att tidsbrist och brist på tillgängliga handdesinfektionsmedel utgör tydliga hinder för god följsamhet i handdesinfektion. Den föreliggande studien medför kunskap kring hinder och kan även utgöra inspiration inför framtida studier som syftar till att identifiera andra hinder, då det visat sig att dessa kan variera mellan olika vårdinrättningar. För att interventioner med syfte att förbättra handhygien ska bli framgångsrika krävs det att de specifika hindren först identifieras. / Background: Several previous studies show that compliance with hand disinfection is low among medical staff. Aim: This study, therefore, aims to investigate what factors make it difficult for registered nurses and certified nursing assistants to comply with use of hand disinfection.    Methods: A survey was carried out at three randomly selected wards at a hospital in Sweden in March 2014. A questionnaire was developed and answered by registered nurses and certified nursing assistants. Results: The study received 70 replies out of the 110 questionnaires distributed – a response rate of 64%. The results show that it was more common to disinfect after than before contact with a patient. The main reasons for not disinfecting their hands were lack of time and availability of hand disinfection agents. The results also show that it was more prevalent among the registered nurses than the certified nursing assistants to skip the disinfection if the hand disinfection agent was not available. Furthermore the results showed that the senior staff, which had more than 14.3 years of practise, were better at disinfecting their hands than their less experienced colleagues. Conclusions: Medical staff report that it is more common to disinfect their hands after than before patient contact. The lack of time and availability of hand disinfection are obvious factors that influence compliance. This study highlights the need for awareness and may encourage future studies aiming at identifying other possible factors, since there is variation between wards. Interventions with the purpose to increase compliance with hand disinfection need to be adapted to these specific circumstances.

Thesis (MSc.(Medical Microbiology)--Faculty of Health Sciences)-University of Pretoria, 2008. / Summary in English and Afrikaans. Includes bibliographical references.

Nosocomial infections are one of serious problems of modern medicine and nursing also nosocomial infections mean real serious problems for future. Prevention of nosocomial infections, applied together with pointed and meaningful antimicrobial therapy is the only causal solution now. This work was aimed primarily at a comparison of knowledge of common nurses working in intensive care wards and common nurses in standard wards. In general, it could be said that the aim of this work was to map the scope of knowledge of common nurses as for nosocomial infections as well as aseptic care for central venous catheters including catheter sepses. The found deficit in knowledge of common nurses pointed out the occurrence of mistakes in nursing practices. Quality of nursing is connected closely with standardisation of nursing procedures. Quantitative research inquiry was realised in 4 medical facilities: Regional hospital Liberec, a.s., Masaryk city hospital in Jilemnice, Hospital České Budějovice, a.s. and Hospital with polyclinic in Semily. As the research method there was chosen a non-standardised questionnaire. The sample of respondents was chosen as an intentional selectionand and in to statistic processing included 290 relevantly filled out forms. The research investigation also included a comparison and quantification of nursing standards. In view of the performed comparison of standards in nursing we concluded that creation of incomplete or even inconsistent standards occurs here. We have prepared a "Proposal on a standard of nursing care for inserted venous catheter", of which form could enable to implement it in medical care facilities within the Czech Republic and define clearly basic nursing procedures within the scope of these problems.

Paez JIG. Fatores associados à mortalidade em infecções nosocomiais por Stenotrophomonas maltophilia [dissertação]. São Paulo: Faculdade de Medicina, Universidade de São Paulo; 2007. 154p. Infecção de corrente sanguínea (ICS) e pneumonia por S. maltophilia são associadas á alta mortalidade. A identificação de fatores relacionados à mortalidade em pacientes com infecções por esse agente pode permitir intervenções no sentido de diminuir a sua mortalidade. Realizamos um estudo retrospectivo com 60 pacientes com ICS ou pneumonia de origem hospitalar no Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICHC-FMUSP) durante o período de 30 de julho de 1999 a 30 de julho de 2005. Analisamos os fatores de risco relacionados à mortalidade global e a mortalidade nos primeiros 14 dias da infecção por meio de um estudo de coorte retrospectivo comparando os pacientes que apresentaram óbito com os que não apresentaram óbito.As seguintes características foram encontradas na população estudada no momento da infecção, 57 (85%) dos pacientes receberam antibióticos prévios, 88% tinham cateter venoso central, 57% estavam em uso de ventilação mecânica, 35% em uso de quimioterapia e 75% estavam internados em unidade de cuidado intensivo. Neoplasia foi a principal doença de base presente em 45%. Choque séptico foi descrito em 30% dos casos, a média de pontuação na escala de APACHE II foi de 17 pontos e a média de pontuação da escala SOFA foi de 7 pontos. Foram diagnosticadas 8 pneumonias e 52 ICS, 47% foram ICS primárias, entre estas 13% foram ICS relacionadas ao cateter. Foram diagnosticadas também 40% ICS secundárias, sendo o principal foco pulmonar (18%). 27% das infecções foram polimicrobianas. Os fatores de risco independentes associados à mortalidade nos primeiros 14 dias identificados na análise multivariada foram, pontuação maior que 6 no índice SOFA (RR=18,9. IC95%=2,4-146,2) e presença de choque séptico (RR=11,6. IC95%=1,3-105,9). O fator de risco associado à mortalidade global na análise multivariada foi, pontuação maior que 6 no índice SOFA (RR=37,1. IC95%=2,8-494,3). A instituição de terapia antimicrobiana inadequada para o tratamento das infecções por S. maltophilia foi freqüente, sendo observada em 40 (85%) pacientes, principalmente por atraso no inicio e por tempo curto de tratamento. Não houve diferença estatística quando comparado o tratamento adequado do tratamento inadequado. A curva de sobrevida de Kaplan-Meier mostrou que pacientes com APACHE II >20 e SOFA > 10 tinham respectivamente uma chance de sobrevida menor que 8% e menor que 10% (P=<0.001) até 21 dias após a primeira cultura positiva. A mortalidade global foi de 75% e a mortalidade nos primeiros 14 dias de infecção foi de 38%. Estes resultados mostram que infecções por S. maltophilia acontecem em pacientes gravemente doentes com múltiplos fatores de risco e que os fatores associados à mortalidade são principalmente relacionados ao estado da condição clínica de base e gravidade do paciente. / Paez JIG. Factors associated with mortality in Nosocomial infections with Stenotrophomonas maltophilia [dissertation]. São Paulo: ?Faculdade de Medicina, Universidade de São Paulo?; 2007. 154p. Bloodstream infections (BSI) and pneumonia caused by Stenotrophomonas maltophilia are associated with high mortality. A retrospective study with 60 patients with nosocomial BSI and pneumonia was done at the Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICHC-FMUSP). Cases were selected from July 30, 1999 through July 30, 2005. Risk factors associated with overall mortality and 14-day mortality after the onset of infection were accessed. 57 (85%) patients had received previous antimicrobial therapy, 88% had CVC, 57% mechanical ventilation and 75% stay in intensive care unit in the onset of infection. Malignancy (45%) was the most frequent underlying diseases. From 60 patients, 30% had septic shock, the mean of APACHE II score was 17 points and the mean of SOFA index was 7 points. A total of 60 infections were identified. Among these, 8 were pneumonias and 52 BSI, that for this turn, 33% were primary BSI, 13% were CVC-related and 40% secondary. 35% of the infections were polymicrobial. Risk factors associated with 14-day mortality after the onset of infections in the multivariate analysis were, SOFA index > 6 points (RR=18.9. 95%CI=2.4-146.2) and septic shock (RR=11.6. 95%IC=1.3-105.9). Risk factor associated with overall mortality was SOFA index > 6 points, (RR=37.1. 95%IC=2.8-494.3). Used of inappropriate antimicrobial therapy was observed in 40 (85%) patients, of whom received therapy with more 72 hours and received therapy for an insufficient length of time and there was no difference when compared appropriated and non-appropriated therapy. Kaplan-Meier estimations curves showed that patients with APACHE II >20 and SOFA > 10 had respectively a survival chance less than 8% and less than 10% (P=<0.001) at 21 days after the first positive S. maltophilia culture. The overall mortality and 14-day mortality after the onset of infections rates were 75% and 38% respectively. Our results showed that infections caused by S. maltophilia occur in critically ill patients with multiple risk factors and that the most important risk factors associated with mortality are the initial clinical condition and severity of diseases.

Orientador: Maria Isabel Pedreira de Freitas Ceribelli / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T01:00:38Z (GMT). No. of bitstreams: 1 NegrideSousa_AnaClaudia_M.pdf: 10758939 bytes, checksum: 1e275b80f25f5c6d9e3ab12d3eee6c94 (MD5) Previous issue date: 2012 / Resumo: Lâminas e cabos de laringoscópios têm sido analisados evidenciando presença de sangue, fluídos corpóreos e microrganismos, podendo apresentar-se potencialmente contaminados durante seu uso clínico. A forma de utilização destes equipamentos na prática diária pode estar colocando o paciente e a equipe de saúde em risco devido à maneira como vem sendo feita sua limpeza e desinfecção. Neste estudo estabeleceu-se a hipótese de que a lâmina e o cabo de laringoscópio, prontos para serem usados no paciente, sejam potenciais fontes de contaminação. O objetivo geral foi determinar a presença de sangue e de microrganismos neste equipamento. Foram analisados cabos e lâminas de laringoscópios, prontos para uso, em dois hospitais universitários públicos do interior de São Paulo. A amostra foi definida considerandose os equipamentos prontos para uso nas seções selecionadas em cada hospital, totalizando para análise microbiológica na Instituição I, 42 lâminas e na Instituição II 41 lâminas. Para a fase de presença de sangue, respectivamente, foram avaliadas 48 e 50 amostras, sendo estes distribuidos entre lâminas e cabos de laringoscópios. As análises microbiológicas foram realizadas no Laboratório de Microbiologia da Divisão de Patologia Clínica da Instituição II, utilizando-se técnicas laboratoriais quantitativas e qualitativas. Para a identificação de sangue oculto foi utilizado o teste para o monitoramento de sua presença em superfícies com metodologia em conformidade com a norma EM ISO 15883, com nome comercial de HemoCheck-S®. Os dados foram analisados descritivamente. Os resultados para o teste de sangue oculto nas lâminas e cabos dos laringoscópios foram de 14,3% e 46,0% positivos na Intituição I e II, respectivamente. Para o crescimento de microrganismos na Instituição I o resultado foi positivo para 76,2% das amostras, na Instituição II, um total de 92,7%. Na contagem de UFC mais de 101 UFC foram encontradas em 31,3% amostras na Instiutição I e na Instituição II em 44,7%. O estudo concluiu que a lâminas e o cabos dos laringoscópios nestas duas intituições pesquisadas oferecem riscos aos pacientes, apresentando crescimento de microrganismos e presença de sangue oculto. Urge providências para que seja possível sua utilização, garantindo-se a segurança dos pacientes e dos profissionais que tem contato direto com este equipamento / Abstract: Laryngoscope blades and handles have been analyzed showing the presence of blood, body fluids and microorganisms, which may present as potentially contaminated during its clinical use. The daily practical utilization of devices can be exposing patients and health professionals to risk, due to ineffective cleaning and disinfecting methods. This study established the hypothesis that the laryngoscope blade and handle, when ready to use, are potential sources of contamination. Thus, the overall objective is to determine the presence of microorganisms and blood in the equipment. Laryngoscope handles and blades was analyzed, when ready to use, in two public school hospital in the country side of São Paulo. The sample size was defined considering the equipment readiness in specific areas of each hospital, summarizing 42 blades at institution I and 41 blades at institution II for microbiological analysis. For the presence of blood testing phase, 48 and 50 samples were evaluated respectively, considering laryngoscope blades and handles. Microbiological analysis was performed at the Laboratory of Microbiology, Division of Clinical Pathology, Institution II, using qualitative and quantitative laboratory techniques. For occult blood finding, the surface test methodology in accordance with standard EN ISO 15883 was used, commercial name HemoCheck-S ® and data was analyzed descriptively. The results for occult blood test in the blades and handles of laryngoscopes were positive for 14.3% and 46.0%, for institutions I and II, respectively. For microorganisms' growth test, institution I indicated positive to 76.2% of the samples and institution II showed positive for a total of 92.7% of the samples. For UFC counting, UFC higher than 101 UFC was found in 31.3% of samples for institution I and 44.7% for institution II. This study revealed that the laryngoscope blades and handles of two evaluated institutions shows risks to patients, indicating a growth of microorganisms and the presence of occult blood. Urgent steps should be taken to allow their utilization, guaranteeing the safety of patients and health professionals who have direct contact with this equipment / Mestrado / Enfermagem e Trabalho / Mestre em Ciências da Saúde

Antimicrobial resistance is a significant global health problem. Misuse of antibiotics is associated with antimicrobial resistance which presents clinicians with treatment challenges and increases the complexity of the decision making process related to the selection of appropriate antibiotic therapy. Antibiotic resistant organisms can often lead to nosocomial infections (NIs) and undoubtedly causes patient harm and increases healthcare costs. According to the National Institute of Allergy and Infectious Diseases (NIAID), at least 70% of the nosocomial infections are caused by antibiotic-resistant organisms. In addition to the problem of inappropriate prescribing, the decreased production of antimicrobial agents over the past 25 years has restricted the arsenal of available antimicrobial agents. The combination of inappropriate antibiotic prescribing practices and reduced research and development of new antimicrobial agents have promoted concerns that society may soon return to a pre-antibiotic era. Addressing the attitudes and behaviours that contribute to inappropriate antibiotic prescribing is a potentially effective and immediate solution to the growing antimicrobial resistance problem. Modifying clinicians' prescribing behaviour with antibiotic decision guidelines and highlighting the problematic side of this issue can promote judicious antibiotic prescribing practices. Representing the existing data regarding the use and misuse of antimicrobials in a Lebanese hospital can support and encourage initiating and complying with antibiotic stewardship programs and prescription guidelines. Purpose: The objectives of this study were to determine current levels and trends in prescribing antibiotics to patients in a Lebanese hospital, (2) to identify the factors that physicians considered when deciding to start antibiotics, (3) to explore whether antimicrobial use (empiric, prophylactic, targeted) will change when physicians fill out a form to document why they prescribed antibiotics, (4) to explore whether an increase in bacterial resistance occurs when antimicrobial consumption increases, (5) to explore the clinicians' perception towards antimicrobial use and antimicrobial stewardship program pre- and post- implementation of an antibiotic assessment form, (6) to explore the effect of the implemented antimicrobial stewardship intervention combined with hand hygiene (HH) on healthcare associated infection rate (HAIs) in the hospital. One-year retrospective study in a Lebanese hospital was conducted to determine the percentage of patients who received antimicrobial treatment and to identify the inappropriateness of their use in different hospital departments. A 12-months intervention was then implemented during which all attending physicians were asked to fill an antimicrobial assessment form (AAF) to document their rationale for starting antimicrobial therapy. In addition, this AAF was used to identify factors physicians considered when deciding to prescribe antimicrobials. Data from the AAFs suggested that physicians in the hospital often considered elevated C-reactive protein, elevated white blood cell counts, and elevated temperatures when deciding to start antimicrobial therapy. Data showed that antibiotic consumption and the median duration of empiric and targeted therapies decreased significantly during the intervention period when compared to the pre-intervention period. Antibiotic appropriateness was also increased significantly after the intervention was conducted. In addition, a better understanding of antimicrobial stewardship strategies was also noted by physicians after the implementation of the intervention. On the basis of these results, AAF filling was a successful intervention to reduce antibiotic use and to urge physicians to refer to antibiotic guidelines when initiating an antimicrobial agent. However, additional measures such as automatic stop orders and computer decision support may be easier and useful for reducing the duration of therapy in hospitals.

Master of Science / Department of Architectural Engineering and Construction Science / Julia A. Keen / Health care facilities are responsible for treating highly infected and contagious patients at the same time as patients who are most susceptible to disease. Therefore, it is important that every available technology and application to be strategically applied to protect each and every occupant. In particular, ultraviolet germicidal irradiation (UVGI) technologies are being used in today's industry as infection control devices, primarily in health care facilities. This paper addresses the effectiveness and economic impact of applying UVGI to remove harmful airborne pathogens and outlines background information on infectious airborne pathogens such as viruses, bacteria, and fungi. Besides UVGI, other engineering control methods covered in this paper include mechanical ventilation and air distribution, filtration, and differential pressure control. Consequently, an economic evaluation of a diagnostic and treatment area was created to compare UVGI technologies and other control methods. The evaluation consists of a baseline system designed to meet code requirements; an upper-room UVGI system; a heating, ventilating, and air-conditioning (HVAC) system with an increased air changes per hour (ACH); and a UVGI system in an AHU. First costs, energy costs, and maintenance costs were the basis of economic comparison. The predicted effectiveness of all the alternatives was held constant and the time required to achieve the desired effectiveness was determined. As a result, the upper-room UVGI system and HVAC system with an increased ACH yielded much higher comparative annual costs as well as significantly better room disinfection effectiveness. The UVGI system in the AHU resulted in a lower comparative annual cost than the baseline system with the same room disinfection effectiveness. By designing infection control systems with UVGI, HVAC engineers will be more capable and successful in providing the optimal control system to these critical facilities.

M.Cur / According to data from the Centers for Disease Control and Prevention’s(CDC) National Nosocomial Infections Surveillance System of 1996, Pseudomonas aeruginosa(P. aeruginosa) can be rated as the number two cause of nosocomial pneumonia(Chen & Rudoy,2006). Nosocomial pneumonia increases hospital cost and morbidity and mortality in patients. Most of the patients in the critical care unit are immune compromised because of underlying illnesses. Antibiotics eliminates the patient’s normal flora which causes opportunity for pathogens to colonise. Indwelling procedures like endotracheal intubation cause a point of entrance for pathogens like P.aeruginosa. The endotracheal tube bypasses the normal physiological processes and inhibits the cough reflex. It is the nurse’s responsibility to remove secretion through endotracheal suctioning. During the past ten years the closed suction method was increasingly implemented to remove secretions because studies showed closed suction caused less infection than open suction. In a spesific critical care unit in a private hospital in Pretoria the nurses are of the opinion that closed suctioning does not effectively remove secretion. Patients are therefore suctioned open which can cause air contamination because the colonised ventilator circuit is opened. The following question can be asked in view of the above arguments and problem statement: Is there a difference in aircontamintion between open and closed suctioning? The aim of the study is to determine whether any difference in air contamination exists between open and closed suctioning in a spesific critical care unit in Pretoria. v A comparitive contextual design with crossover methods was used. Patients are allocated to group 1 or group 2 through random sampling. An air exstractor is used to take airsamples before, during and after suctioning. There was no significant difference in terms of air contamination for open and closed suction. This is probably because of too small a sample. The null hypothesis is accepted and that is there is no significant difference in air contamination between open and closed suction.

ESKAPE pathogens are notorious in causing nosocomial infections and escaping current antibiotic treatments. There has been a dramatic increase in nosocomial infections accompanied with a decrease in the number of antibiotics developed, leading to significant increase in morbidity and mortality among patients. In an attempt to combat this problem, derivatives of ciprofloxacin, rifabutin and beta-lactam antibiotics were synthesized and tested against the ESKAPE pathogens. From minimum inhibitory concentration assays, 4 ciprofloxacin analogs and 8 beta-lactam analogs were found to be effective against multiple bacterial species. Additionally, 12 rifabutin analogs and 23 beta-lactam analogs were potent against single bacterial species, primarily toward methicillin-resistant Staphylococcus aureus (MRSA) at a concentration of ≤ 25 µg mL-1. Based on the effectiveness against methicillin-resistant Staphylococcus aureus (MRSA), three rifabutin analogs were selected for further testing. Two rifabutin analogs (DU644 and DU645) were found to possess between a one to twofold mean increase of inhibitory activities, while the other rifabutin analogs (DU650) demonstrated up to a twofold decrease of inhibitory activity when compared to the parent drug. These compounds were then examined for their bactericidal and antibiofilm activities against MRSA. From these assays, we found that DU644 and DU645 were 4 times more bactericidal and antibiofilm against MRSA when compared to the parent drug. In addition, rpoB mutation validation results confirmed that modification of these rifabutin derivatives at the C3 and C4 positions, and bearing an imidazolyl ring carrying substituted spiropiperidyl ring, did not change their mechanism of action towards the beta-subunit of RNA polymerase. Cytotoxicity testing performed using human hepatocellular carcinoma epithelial cells (hepG2) showed that at concentrations ranged from 1.25 µg mL-1 to 25 µg mL-1, DU644 and DU645 showed very low toxicity. Collectively, structural drugs modifications of these obsolete drugs are able to restore their antibacterial activities against MRSA, which is notable as the most infectious nosocomial pathogen. Therefore, further development and application of rifabutin analogs might be beneficial for medical use to combat MRSA infections.