Vårdrelaterade infektioner (VRI) är ett av de största hoten mot patientsäkerheten. Handhygien är den viktigaste komponenten vid prevention av vårdrelaterade infektioner. Följsamhetsmätningar av de basala hygienrutinerna är betydelsefulla för följsamheten till de basala hygienrutinerna och klädreglerna. Ett förbättringsarbete gentemot hygienobservatörerna i Region Jönköpings län har genomförts där tre aulaträffar ersattes av 17 möten med färre deltagare.  Syftet med förbättringsarbetet är att öka andelen mätande enheter. Syftet med studien av förbättringsarbetet är att beskriva hygienobservatörernas upplevelser kring brister i de basala hygienrutinerna och den nya mötesstrukturen samt att urskilja faktorer som påverkar i vilken utsträckning mätningar kommer att utföras. Metod: PDSA, Nolans förbättringsmodell, enkät, kvalitativ dataanalys i form av fokusgruppsintervjuer. Resultatet av förbättringsarbetet visar en viss ökning av andelen mätande enheter. Resultat för studien av förbättringsarbetet visar brist på ledningsstöd och en otillräcklig kunskap bland personalen om hur smitta sprids. Moment som brister är framförallt handsprit före patientnära arbete, överanvändning av handskar och dålig följsamhet till klädreglerna inom primärvården. Hygienobservatörerna upplevde att den nya mötesstrukturen gav erfarenhetsutbyte och verksamhetsnära diskussioner med kollegor. Slutsatser: För att följsamhetsmätningar ska bli utförda och det vårdhygieniska arbetet prioriteras är ledningsstödet helt avgörande. En ökad andel mätande enheter skulle minska antal VRI, kostander och patienters lidande. / Healthcare associated infections (HAIs) are one of the greatest threats to patient safety. Hand hygiene is the most important component in the prevention efforts. Measurements to standard precautions are important for adherence to the basic rules of hygiene and clothing.  An improvement work focused on hygiene observers in Region Jönköping County, was implemented in which three hall gatherings was replaced by 17 meetings with fewer participants.   The aim of the improvement work is to increase the number of measuring devices.  The purpose of the study of the improvement work is to describe the hygiene observers experiences concerning deficiencies in the basic hygiene practices and the new meeting structure and to identify factors that influence the extent to which measurements will be carried out.  Method: PDSA, Nolan's improvement model, survey, qualitative data analysis in the form of focus group interviews. The result of the improvement work indicates more units performing measurements. Results of the study of the improvement work shows lack of management support and inadequate knowledge among staff about how infections spread. Other factors are lack of disinfection before patient care, overuse of gloves and poor adherence to dress rules. Conclusions: Management support is crucial for adherence to measurement. Improvements in number of HAI, costs and patients ' suffering increases as hygiene measurements are carried out.

The purpose of this study was to describe factors associated with noncompliance to hand hygiene standards among nurses in one public hospital in Windhoek, Namibia. A quantitative, descriptive, cross-sectional research design was employed using a stratified sample comprising three categories of nurses (registered, enrolled and auxiliary nurses). Data collection was done using a structured questionnaire. Based on the results, there were more institutional than individual factors associated with noncompliance to hand hygiene. Compliance to hand hygiene was found to be lowest when nurses provide care for patients in non-isolation rooms, when the perceived risk of acquiring infection from patients was low and following brief encounters with patients. Dryness of the skin caused by hand hygiene agents and lack of active participation in hand hygiene promotion at individual level contributed to noncompliance to hand hygiene among nurses. In addition, the results showed that, institutionally there were no rewards/encouragement for hand hygiene, no sanctions for non-compliers and no workshops, seminars and continuing educational courses on hand hygiene. The study produced interesting insights into the vital role that good leadership plays in the implementation of hand hygiene policy guidelines. The key recommendations for this study included development of good leadership, characterized by dedication for hygiene standards to encourage staff to maintain hygiene practice and to ensure that there are adequate resources for the implementation of hand hygiene policy as well as rewards/incentives for compliers and sanctions for noncompliers / Health Studies / M.A. (Nursing Science)

This licentiate thesis aims to understand how infection preventionists (IPs) continuously find problems and implement solutions related to health care-associated infections (HAIs) in hospital settings. HAIs are infections acquired by patients during the process of care and are among the main causes of deaths worldwide. Recently, practices for HAIs prevention and control have challenged IPs due to pandemics (e.g. COVID-19), antimicrobial resistance, population aging and limited resources in health care facilities. Such challenges demand actions to find, solve problems and implement solutions. However, IPs often fail to address these problems. The reasons stem from their inability to timely identify valuable problems and implement new solutions. Although the literature on infection prevention and control is well developed, previous studies have largely investigated how IPs implement preconceived practices to solve given problems as a single event, rather than on how to continuously find problems and implement solutions.  This licentiate thesis comprises two empirical papers. Paper I investigates how infection prevention and control teams find problems with HAIs, and is based on a multiple case study of three infection prevention and control teams from one Swedish and two Brazilian hospitals. Paper II investigates how IPs continuously implement changes in infection prevention and control practices during pandemics, and is based on a qualitative descriptive study. The data in both papers were collected from 44 semi-structured interviews with health care professionals enrolled as IPs in Brazilian and Swedish hospitals. The key theories and literatures covered include Problem-Finding and Problem-Solving Perspective and Implementation research. This licentiate thesis contains three main contributions. First, it advances the Problem-Finding and Problem-Solving Perspective literature by providing empirical evidence on how to create valuable knowledge from ill-structured and complex problems. Second, this licentiate thesis suggests a distinction between HAI prevention and HAI control based on two modes of decision-making for finding valuable problems with HAIs. Third, the licentiate thesis describes and categorizes sets of practices that allow to continuously implement changes of infection prevention and control practices during pandemics.