published_or_final_version / Nursing Studies / Master / Master of Nursing

Master of Dental Surgery / This work was digitised and made available on open access by the University of Sydney, Faculty of Dentistry and Sydney eScholarship . It may only be used for the purposes of research and study. Where possible, the Faculty will try to notify the author of this work. If you have any inquiries or issues regarding this work being made available please contact the Sydney eScholarship Repository Coordinator - ses@library.usyd.edu.au

No description available.

Isolation of those ill with contagious disease has been a fundamental infection control concept for hundreds of years. However, recent studies suggest that fewer than 50% of health—care workers comply with their hospitals' isolation precaution policies and that efficacy of some of those policies is questionable. In response, two new systems, based upon fundamentally different goals, were promoted. The Centers for Disease Control, prompted by health—care worker& concerns about occupational risk of human immunodeficiency virus (HIV) from a growing number of patients with acquired immunodeficiency disease syndrome (AIDS), issued formal guidelines in 1987. This formed the basis for Universal Precautions (UP), a unifying strategy for precautions with all patients regardless of diagnosis intended to reduce risk to hospital staff members. Also in 1987, one hospital issued guidelines for Body Substance Isolation (BSI), hygienic precautions to be used with all patients based on recognition that colonized body substances are important reservoirs for cross—infection to both patients and staff members. These new strategies have been promoted widely, but there have been no formal assessments to reconcile controversies they raised nor to confirm their effectiveness. Further, necessary assessment tools have not been validated. This thesis provides new tools and new information to address three vital questions: Have hospitals adopted Universal Precautions or Body Substance Isolation? Do their staff members use the new system of precautions in daily practice? Has reliable use of a new system led to decreased risk of infection? A confidential mailed survey of all acute—care Canadian hospitals was conducted to measure rates of guideline receipt and adoption. It also obtained information on motivations for and perceived effectiveness of strategies adopted. A self—selected group of responding hospitals subsequently participated in standardized covert observation of their nurses infection control practices, then had the observed nurses complete a test examining their knowledge and beliefs. Employee health records were also examined to determine whether needlestick injury rates had changed since adoption of a new infection control strategy. Most Canadian hospitals adopted and modified new strategies based upon reasonable but unproven extensions of logic to protect health—care workers from HIV. 74% claimed UP (65%) or BSI (9%) but only 5% of 359 claiming UP and 0 of 50 claiming BSI adopted all policies expected. Many hospitals had not received key guideline publications. Guideline source, hospital size, and other variables were significantly associated with receipt. Nurses in 35 hospitals were observed to wear gloves during only z60% of procedures in which gloving was expected; rates varied widely among hospitals. Direct examination of sharps disposal containers confirmed compliance with a policy to not recap used needles (taken as recapping rate of 25%) in only 47% of 32 hospitals. Paired analysis of needlestick injury rates in 11 hospitals during comparable 90—day periods before versus after implementing UP/BSI showed no significant difference. 489 nurses completing a written test achieved their highest scores and least discordance among questions regarding procedural issues established long before UP/BSI, and lower scores or greater discordance on UP/BSJ concepts of philosophy, risk recognition and newer procedures. Positive correlation between knowledge and practice was not evident. UP and BSI now mean different things in different hospitals and have not been effective in harmonizing health—care workers’ infection control practices. Carefully standardized assessment methods are needed to guide their evolution to cost—effectiveness.

Master of Dental Surgery / This work was digitised and made available on open access by the University of Sydney, Faculty of Dentistry and Sydney eScholarship . It may only be used for the purposes of research and study. Where possible, the Faculty will try to notify the author of this work. If you have any inquiries or issues regarding this work being made available please contact the Sydney eScholarship Repository Coordinator - ses@library.usyd.edu.au

Isolation of those ill with contagious disease has been a fundamental infection control concept for hundreds of years. However, recent studies suggest that fewer than 50% of health—care workers comply with their hospitals' isolation precaution policies and that efficacy of some of those policies is questionable. In response, two new systems, based upon fundamentally different goals, were promoted. The Centers for Disease Control, prompted by health—care worker& concerns about occupational risk of human immunodeficiency virus (HIV) from a growing number of patients with acquired immunodeficiency disease syndrome (AIDS), issued formal guidelines in 1987. This formed the basis for Universal Precautions (UP), a unifying strategy for precautions with all patients regardless of diagnosis intended to reduce risk to hospital staff members. Also in 1987, one hospital issued guidelines for Body Substance Isolation (BSI), hygienic precautions to be used with all patients based on recognition that colonized body substances are important reservoirs for cross—infection to both patients and staff members. These new strategies have been promoted widely, but there have been no formal assessments to reconcile controversies they raised nor to confirm their effectiveness. Further, necessary assessment tools have not been validated. This thesis provides new tools and new information to address three vital questions: Have hospitals adopted Universal Precautions or Body Substance Isolation? Do their staff members use the new system of precautions in daily practice? Has reliable use of a new system led to decreased risk of infection? A confidential mailed survey of all acute—care Canadian hospitals was conducted to measure rates of guideline receipt and adoption. It also obtained information on motivations for and perceived effectiveness of strategies adopted. A self—selected group of responding hospitals subsequently participated in standardized covert observation of their nurses infection control practices, then had the observed nurses complete a test examining their knowledge and beliefs. Employee health records were also examined to determine whether needlestick injury rates had changed since adoption of a new infection control strategy. Most Canadian hospitals adopted and modified new strategies based upon reasonable but unproven extensions of logic to protect health—care workers from HIV. 74% claimed UP (65%) or BSI (9%) but only 5% of 359 claiming UP and 0 of 50 claiming BSI adopted all policies expected. Many hospitals had not received key guideline publications. Guideline source, hospital size, and other variables were significantly associated with receipt. Nurses in 35 hospitals were observed to wear gloves during only z60% of procedures in which gloving was expected; rates varied widely among hospitals. Direct examination of sharps disposal containers confirmed compliance with a policy to not recap used needles (taken as recapping rate of 25%) in only 47% of 32 hospitals. Paired analysis of needlestick injury rates in 11 hospitals during comparable 90—day periods before versus after implementing UP/BSI showed no significant difference. 489 nurses completing a written test achieved their highest scores and least discordance among questions regarding procedural issues established long before UP/BSI, and lower scores or greater discordance on UP/BSJ concepts of philosophy, risk recognition and newer procedures. Positive correlation between knowledge and practice was not evident. UP and BSI now mean different things in different hospitals and have not been effective in harmonizing health—care workers’ infection control practices. Carefully standardized assessment methods are needed to guide their evolution to cost—effectiveness. / Graduate and Postdoctoral Studies / Graduate

No abstract available. / Thesis (MMed)-University of KwaZulu-Natal, Durban, 2006.

The HIV and AIDS epidemic continues to affect communities worldwide particularly so in South Africa. Youth, also the so-called Coloured youth, continue to remain at risk of infection, in spite of having been exposed to information about HIV and AIDS. This study explores the views of Coloured secondary school youth in a rural town in the Eastern Cape, on HIV and AIDS. Fifteen secondary school learners, both boys and girls, from Grades 10 to 12 were purposively selected. This qualitative study, framed within an interpretivist paradigm, draws on a phenomenological methodology. The data was generated from using drawing and focus group interviews and analysed using thematic analysis. The research adhered to ethical principles and trustworthiness was ensured. Constructivism and Bronfenbrenner’s bio-ecological systems theory were used to frame the study and to make meaning of the findings. In response to the primary research question, What views do Coloured youth attending a secondary school in a rural town have of HIV and AIDS?, five themes emerged, namely: individuals spread HIV, impoverished family life increases youth vulnerability to HIV, youth under pressure from peers knowingly engage in risky behaviour, misconceptions fuel the epidemic, and HIV and AIDS “captures the community in its net”. Drawing on the findings and in response to the secondary research question, What guidelines can be developed to assist educators to facilitate learners taking action against the spread of HIV and AIDS?, several guidelines were developed. They suggest that teachers should use participatory pedagogies to engage secondary school learners when teaching HIV and AIDS, build self-esteem in their learners, assist learners in dealing with peer pressure, engage learners in erasing misconceptions, and enable learners to break free from being “caught in the net” of HIV and AIDS. Collectively these guidelines could enable learners to take action in protecting themselves and their community against the spread of the HI virus. The study concludes that the views that Coloured secondary school learners from a rural town have about HIV and AIDS show their awareness of the realities of the epidemic affecting the individual, the family, the school and their community. They have constructed their views of HIV and AIDS in a way which shows their understanding of the complexities of the epidemic.

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As you probably know, to board the B777-300ERi in Geneva for Anchorage via London, is not just that simple. With your ticket you bought several days before, you come to the airport, check in, pay airport's fees, go through the customs and security checks, walk in the terminal following signs, maybe you stop in the duty free shops, and finally find your gate. By this time, you are ready to board, about one hour after you enter the airport. / We will be essentially interested in air law that is why, the purpose of this master's thesis is to consider the legal aspect of facilitation in civil aviation. The term facilitation refers to the process that passengers, crew, luggage, cargo and mail have to go through when they cross borders to fly from a point A to a point B. / Recently, an aspect of facilitation took an outstanding importance: health issues. At the end of last year, the Severe Acute Respiratory Syndrome (SARS) outbreak was a real threat to international civil aviation because passengers (and crews) could have been exposed to an infected person inside the terminal or on board the plane, also, aircrafts were considered a fast vector of this disease through the world. The economic consequences for airlines and airports were very painful. / iBoeing 777-300 Extended Range.