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.

No description available.

Health Care Associated Infections (HCAIs) are a concern especially in regards to antibiotic resistance and effective treatments. Staphylococcus aureus is often the main focus for eradication and prevention procedures, however, other bacterial species are also problematic. These include Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Staphylococcus epidermidis amongst others. Chronic infections caused by these bacteria are often biofilm related, and include dental caries, otitis media, osteomyelitis, burns & chronic wounds, and device related & prosthetic joint infections. Prosthetic joints and indwelling devices, such as catheters, are a prime environment on which biofilms can develop. This thesis aims to look at biofilms, investigating how they are established, the development of resistance against individual antibiotics and the antibiotic concentrations required to reduce biofilm load. A novel biofilm system – the alginate bead method will be used for these experiments, The alginate bead method was developed by a previous student in the Gallagher Laboratory, due to a need to have a reliable, robust and inexpensive technique to examine formation of biofilms and antibiotic resistance. There are devices and assays available, such as the Calgary Biofilm Device, which are extensively used for these purposes. However, the cost is prohibitive. This thesis found that the development of biofilms occurs much earlier than expected, with stable, fixed formation after just four hours of growth. Depending upon the antibiotic, resistance can develop within the first two hours of growth and thereafter steadily increases. By 24 hours the biofilms are fully resistant to all the tested antibiotics. In mixed species biofilms, the two species act synergistically protecting each other against the antibiotics, resulting in a much higher antibiotic concentration required. Common antibiotics used to treat staphylococcal infections are often combined to enhance their destructive effect and prevent the development of resistance. The effects of these antibiotics, when combined was explored. Biofilm resistance against gentamicin, one of the most common antibiotics used to treat staphylococcal infections develops quickly. However, when combined with other antibiotics gentamicin resistance is delayed. As antibiotic concentrations have to be extremely high in order to have any effect on established biofilms, alternative methods need to be investigated. Any alternative approaches would be employed in conjunction with conventional therapies preventing stable biofilm formation and disrupting established biofilms. Such methods may include sugar metabolites, enzymatic disruption, D-amino acids and activation of the quorum sensing system. The main conclusion which can be taken from this work are that firstly the alginate bead method of a viable, suitable alternative to the Calgary Biofilm Device and supports biofilm formation and testing. Secondly that biofilms form and are resistant to antibiotics much earlier than expected, and extreme concentrations of antibiotics are required to have an effect. Thus the inclusion of alternative methods which disrupt biofilms would be beneficial to clinical practice. However, the alternative methods investigated within this thesis (D-amino acids and sugar metabolites) failed to show any inhibition of biofilms. There are other possible choices which would need to be investigated.

The impact of an education program on perception, knowledge, and infection rate was evaluated in this study. The educational intervention consisted of a video on infection control and a World Health Organization (WHO) pamphlet for hand hygiene. The study was conducted in one nursing home in the Southeastern United States. The survey sample consisted of 66 certified nurse assistants (CNAs). A pre- and post-intervention design was employed using the WHO’s Hand Hygiene Knowledge Questionnaire and the WHO Perception Survey. Friedman’s test and central tendencies showed no statistical relationship between the educational intervention and the overall knowledge scores of the sample. There also were no statistical differences in perception of hand hygiene in the CNA sample. Infection frequency was reduced with a percent change of -42%. While results of knowledge and perception surveys were not statistically significant, multiple conclusions were derived to suggest that educational opportunities may impact hand hygiene practice in CNAs and lead to a decrease in infection.

Intresset för ämnet vårdhygien väcktes under den verksamhetsförlagda utbildningen då vi uppmärksammade att vårdpersonalen på avdelningarna ofta slarvade med handhygien och andra basala hygienrutiner. Vårdrelaterade infektioner beräknas drabba en av tio patienter. Många av dessa infektioner skulle kunna förebyggas genom följsamhet till basala hygienrutiner. Syftet med denna studie var att belysa faktorer som påverkar vårdpersonals följsamhet gällande basala hygienrutiner. En litteraturstudie genomfördes där tio artiklar med kvalitativ och kvantitativ ansats analyserades. Resultatet delades upp i två huvudkategorier och nio underkategorier. De två huvudkategorierna som skapades var Organisatoriska faktorer och Individuella faktorer. Under Organisatoriska faktorer framkom Tidsbrist och arbetsbelastning, Kunskap, Arbetsklimat och förebilder samt Tillgänglighet på material. Under de Individuella faktorerna framkom Attityd, Typ av klinisk procedur, Teknik, Hudirritation och Yrkesgrupper. Studien bidrar till ökad förståelse för dessa faktorers inverkan på följsamheten till basala hygienrutiner. Resultatet visade att brist på tid, kunskap och material försämrade följsamheten till handhygien. Vidare visade resultatet att en arbetsledning och kollegor som var goda förebilder påverkade vårdpersonalen positivt gällande följsamheten. Vårdpersonal var medvetna om riskerna med dålig handhygien men förminskade problemet och attityden till handhygien försämrades över tiden. Läkare hade generellt sett lägre följsamhet än övrig vårdpersonal. Vid vardagliga moment ansågs handhygienen inte vara lika viktig och vid moment som medförde en högrisk för smitta var följsamheten låg. / Interest in infection control developed during the work-based training when we realized that nursing staff in the departments were often careless with hand hygiene and other basic hygiene routines. Healthcare associated infections are estimated to affect one of ten patients. Many of these could be prevented by observing basic hygiene. The purpose of this study was to elucidate factors that influence healthcare staff´s observance of basic hygiene. This was done through a literature study of ten articles consisting of qualitative and quantitative data. The results were divided into two main categories and nine subcategories. The two main categories were Organizational factors and Individual factors. The Organizational factors that emerged were Lack of time and workload, Knowledge, Working environment and role models and Availability of materials. The Individual factors were Attitude, Type of clinical procedure, Techniques, Skin irritation and Professions. The study contributes to a greater understanding of these factors in the observance of basic hygiene. The results showed that lack of time, knowledge and lack of material had a negative influence on the observance of hand hygiene. Furthermore, the results showed that supervisors and colleagues who were good role models influenced medical staff in a positive way. Healthcare staff were aware of the risks of poor hand hygiene but ignored the problem to some extent and the approach to hand hygiene deteriorated with time. Doctors generally had lower observance than other health care staff. In everyday encounters hand hygiene was not considered as important and at moments with a high risk of infection there was generally low compliance.

Health care associated infections cause major challenges to the provision of health care. This isdue to the burden placed on individuals, their families, and health services. Hand hygiene actions are cost effective measures towards reducing the spread of health care associated infections and have proven very effective in preventing microbial transmission during patient care. It has beenproven that health care workers hands are the main routes of transmission of health care associated infections. Despite this, hand hygiene is still frequently overlooked by health careworkers especially in settings with limited resources. This paper therefore explores hand hygieneknowledge and behaviours of public and private health care workers in The Gambia with focuson the health belief model. The required information has been gathered from 4 public and 2 private health care facilities through the use of a questionnaire based on the WHO evaluation toolkit. Hand hygiene knowledge of health care workers corresponded with their hand hygiene behaviour. Inadequate hand hygiene performance was noted in many health care workers as wellas limited availability of hand hygiene resources from health care facilities. Private health care facilities provided better hand hygiene opportunities for their health care workers yet neither private nor public health care facilities offered adequate hand hygiene training and feedback on hand hygiene performances to their health care workers.

Vårdrelaterade infektioner kan leda till sjuklighet och för tidig död och påverkar många människor, inte bara individen själv utan även dennes familj och samhället i stort. Vårdrelaterade infektioner drabbar både patienter och sjukvårdspersonal. Med goda basala hygienrutiner och medvetenhet om hur infektioner sprids kan många fall förebyggas och mycket lidande förhindras. Denna studies syfte var att beskriva basala hygienrutiner vid sårbehandling på en avdelning vid ett sjukhus i norra Tanzania. Studien hade en kvalitativ och en kvantitativ ansats där det kvalitativa datamaterialet har bearbetats med innehållsanalys och det kvantitativa datamaterialet har redovisats med deskriptiv statistik. Innehållsanalysen resulterade i kategorierna Kontaminering av omgivning/material, smutsig rutin och ren rutin. Slutsatsen visade att de basala hygienrutinerna brast vilket kan öka risken för vårdrelaterade infektioner samt att basala hygienrutiner inte tycks vara väl implementerade på avdelningen. / Health care-associated infections can lead to morbidity and premature death and affect many people, not only the individual himself/herself but also his/her family and the society at large. Health care-associated infections affects both patients and healthcare staff. With good basic hygiene and awareness of how infection spread many cases can be prevented and much suffering be avoided. The aim of this study was to describe the basic hygiene routines of wound care at a ward at a hospital in northern Tanzania. The study had a qualitative and a quantitative approach in which the qualitative data material was processed with content analysis and the quantitative data material was presented with descriptive statistics. Content analysis resulted in the categories contamination of the environment/materials, dirty routine and clean routine. The conclusion showed that the basic hygiene routines were rarely performed properly which increased the risk of healthcare associated infections and that basic hygiene routines did not seem to be well implemented on the ward.

Orientador: Carlos Magno Castelo Branco Fortaleza / Resumo: As Infecções Relacionadas à Assistência à Saúde (IRAS) são grave problema de saúde pública em todo o mundo, tendo sua incidência especialmente alta nos países em desenvolvimento. Porém, pouco se sabe sobre a magnitude de seu impacto no Brasil. Faltam dados sobre o impacto de IRAS no pós-alta, incluindo: reinternação, consultas médicas, consumo de medicamentos, autonomia, capacidade laboral e qualidade de vida. Este trabalho objetivou investigar prospectivamente o impacto médico e social das IRAS em pacientes dispensados de um hospital de cuidados terciários no interior do estado de São Paulo, Brasil. Realizou-se um estudo de coorte pareada que incluiu pacientes dispensados do hospital de ensino da Faculdade de Medicina de Botucatu (450 leitos). Sendo 55 indivíduos que tiveram IRAS, juntamente com 110 pacientes não expostos (sem IRAS) como grupo de comparação. Estes, foram seguidos com chamadas telefônicas semanais por 24 semanas. Abordando a necessidade de consultas médicas, o número de medicamentos prescritos, a dependência de cuidadores familiares, as readmissões hospitalares e o tempo necessário para voltar ao trabalho ou às atividades habituais. Os testes estatísticos univariados incluíram testes de Qui-quadrado e Mann-Whitney, quando apropriado. Os modelos de regressão Cox multivariável para readmissão e retorno ao trabalho / atividades usuais foram aplciados. No estudo, as IRAS foram associadas a reinternações mais frequentes e precoces (Hazzard Ratio[HR]=4,84; Interval... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Submitted by Emília Carolina Oliveira De Souza (emi_carol_2@hotmail.com) on 2018-08-21T21:50:57Z No. of bitstreams: 1 DISSERTACAO EMILIA.pdf: 1565247 bytes, checksum: 493e1d829e53b388219f595e7a7e5e7d (MD5) / Approved for entry into archive by Sulamita Selma C Colnago null (sulamita@btu.unesp.br) on 2018-08-22T18:33:05Z (GMT) No. of bitstreams: 1 souza_eco_me_bot.pdf: 1565247 bytes, checksum: 493e1d829e53b388219f595e7a7e5e7d (MD5) / Made available in DSpace on 2018-08-22T18:33:05Z (GMT). No. of bitstreams: 1 souza_eco_me_bot.pdf: 1565247 bytes, checksum: 493e1d829e53b388219f595e7a7e5e7d (MD5) Previous issue date: 2018-08-21 / As Infecções Relacionadas à Assistência à Saúde (IRAS) são grave problema de saúde pública em todo o mundo, tendo sua incidência especialmente alta nos países em desenvolvimento. Porém, pouco se sabe sobre a magnitude de seu impacto no Brasil. Faltam dados sobre o impacto de IRAS no pós-alta, incluindo: reinternação, consultas médicas, consumo de medicamentos, autonomia, capacidade laboral e qualidade de vida. Este trabalho objetivou investigar prospectivamente o impacto médico e social das IRAS em pacientes dispensados de um hospital de cuidados terciários no interior do estado de São Paulo, Brasil. Realizou-se um estudo de coorte pareada que incluiu pacientes dispensados do hospital de ensino da Faculdade de Medicina de Botucatu (450 leitos). Sendo 55 indivíduos que tiveram IRAS, juntamente com 110 pacientes não expostos (sem IRAS) como grupo de comparação. Estes, foram seguidos com chamadas telefônicas semanais por 24 semanas. Abordando a necessidade de consultas médicas, o número de medicamentos prescritos, a dependência de cuidadores familiares, as readmissões hospitalares e o tempo necessário para voltar ao trabalho ou às atividades habituais. Os testes estatísticos univariados incluíram testes de Qui-quadrado e Mann-Whitney, quando apropriado. Os modelos de regressão Cox multivariável para readmissão e retorno ao trabalho / atividades usuais foram aplciados. No estudo, as IRAS foram associadas a reinternações mais frequentes e precoces (Hazzard Ratio[HR]=4,84; Intervalo de Confiança[IC]95%=2,20-10,63; p<0,001). Também se associaram a retorno mais tardio ao trabalho ou atividades usuais (HR=0,30; IC95%=0,19-0,57; p<0,001). Pacientes com IRAS também necessitaram de retornos mais frequentes ao médico e tiveram prescrição de maior número de medicamentos no momento da alta. Por fim, 20% dos sujeitos com IRAS necessitaram que um familiar se afastasse do emprego para atuar como cuidador (contra apenas um no grupo de comparação). Concluímos que as IRAS continuam a exercer impacto sobre morbidade e autonomia mesmo após a alta hospitalar. / Health Care Associated Infections (HAI) are a serious public health problem worldwide, especially in developing countries. However, little is known about the magnitude of its impact in Brazil. There is lack of data on the impact of HAI after discharge, including: readmissions, medical consultations, drug use, autonomy, work capacity, and quality of life. This study aimed to prospectively investigate the medical and social impact of IRAS in patients discharged from a tertiary care hospital in the state of São Paulo, Brazil. A matched cohort study was carried out that included patients from the Hospital of Botucatu Medical School (450 beds). We enrolled 55 subjects with HAI and 110 non-HAI subjects as comparison group. These were followed with weekly phone calls for 24 weeks. The necessity of medical consultations, the number of medications prescribed, the use of medical care, such as hospital readmission and the time needed to return to work or usual activities were analyzed. Univariate analysis included Chi-square and Mann-Whitney tests, when appropriate. Multivariable Cox regression models were used for readmission and return to work /usual activities. In our study, HAI were associated with more frequent and early readmissions (Hazzard Ratio[HR], 4.84; 95% Confidence Interval [CI], 2.20-10.63; P<.001). They were also associated with a later return to work or usual activities (HR, 0.30; 95%CI, 0.19-0.57; P<0.001). Patients with HAI also required more frequent returns to physicians and had a prescription for more medication at discharge. Finally, 20% of the subjects with IRAS needed a family member to move away from the job to act as a caregiver (finding absent in the control group). We conclude that IRAS continue to have an impact on morbidity and autonomy even after hospital discharge.

Bakgrund: Ventrikeldränage används inom neurokirurgisk vård för medicinsk behandling, dränering av likvor samt mätning av intrakraniellt tryck. En infektion relaterat till ett ventrikeldränage kan vara livshotande och ge permanenta skador hos patienten. Syfte: Att analysera dokumenterade skillnader i ventrikeldränagerelaterade infektioner, vårdtid och mortalitet, före och efter införande av nya hygienrutiner - ett åtgärdspaket. Metod: Ett åtgärdspaket med medicinska- och omvårdnadsåtgärder har med hjälp av genombrottsmetoden tagits fram för att minska de ventrikeldränagerelaterade infektionerna. Studien är kvantitativ med empirisk ansats. Konsekutivt urval av patienter som erhållit ventrikeldränage under första halvåret 2008 samt första halvåret 2009. Totalt 150 patienter har ingått i studien. Data har analyserats med deskriptiv och analytiska statistik. Resultat: De vårdrelaterade infektionerna minskade mellan de två mätperioderna. Resultatet visar inga tydliga samband mellan vilken av åtgärderna som haft effekt på minskningen av infektionerna. Däremot ses att de som haft bättre följsamhet till åtgärdspaketet har drabbats av färre infektioner. Signifikant samband finns mellan riskhandhavande som spolning av dränage och läckage vid dränaget instickställe, samt infektioner. Slutsats: Studien indikerade i att de ventrikeldränagerelaterade infektionerna har minskat efter insättande av åtgärdspaketet. / Background: External ventricular drainage (EVD) is used within neurosurgical care for medical treatment, temporary drainage of cerebrospinal fluid (CSF) and to measure intracranial pressure. An infection related to an EVD can be life threatening and cause permanent damage to the patient. Objective: To analyze the documented differences in EVD related infections, length of hospitalization and mortality, before and after the introduction of new hygiene routines – a bundle. Method: A package with medical and nursing interventions has been developed using a breakthrough method to reduce EVD related infections. The study is quantitative and has an empirical approach. A consecutive sample of patients who received an EVD during the first half of 2008 and 2009 respectively were chosen. In total 150 patients were included in the study. The data was analyzed with descriptive and analytical statistics. Results: The EVD related infections have decreased between the two time periods. No clear correlation between which actions had a direct effect on the reduction of infections was found. Those patients that had a better adherence to the package suffered fewer infections. A prevalent correlation was found between high risk actions such as flushing the EVD and CSF leaks from the site of puncture, and subsequent infections. Conclusion: The study indicates that the EVD related infections have decreased after the implementation of the package.