Bakgrund: Den stigande åldern bland befolkningen medför att fler drabbas av demenssjukdom.Demenssjukdom är ett samlingsnamn på många olika sjukdomar och skador som, primärt eller sekundärt, påverkar hjärnan. De främsta symtomen vid demenssjukdom är kognitiv och språklig svikt. Då personer med demenssjukdom har svårt att förmedla önskemål och behov verbalt, ställs krav på vårdpersonalen för att kunna uppfatta, tolka och förstå det personen förmedlar. Metoder för interaktion och kommunikation kan bli en väg att uttrycka trygghet, kontakt och bekräftelse för personer med demenssjukdom. Syfte: Syftet med studien är att beskriva vårdpersonalens erfarenheter av metoder för att interagera och kommunicera med personer som har demenssjukdom. Metod: En litteraturstudie baserad på åtta kvalitativa studier. Databassökningen genomfördes i CINAHL och PubMed. Fribergs femstegsmodell användes i analysen av artiklarna. Resultat: Utifrån analysen formades tre huvudteman och sex subteman. Huvudtemana var: ‘Tänka nytt’, ‘Skapa relationer’, ‘Kunna stimulera till kommunikation’ och ‘Förutsättningar för arbetstrivsel’. Konklusion: Vårdpersonalens erfarenheter av metoder för att interagera och kommunicera med personer som har demenssjukdom var överlag positiv. De upplevde en ökad insikt i vikten av ett individualiserat förhållningssätt, förstod personerna bättre och relationen ökade dem emellan. Personalens perspektiv kan i förlängningen bidra till ökat välmående hos personer med demenssjukdom. Vidare forskning bör bedrivas inom ämnet, då endast få studier svarar mot litteraturstudiens syfte. / Background: The rising age of the population will result in that more people will suffer from dementia. Dementia disease is a collective name for many different diseases and injuries that, primarily or secondarily, affect the brain. The main symptoms of dementia disease are cognitive and language impairment. As individuals with dementia have difficulty communicating wishes and needs verbally, demands are made on the care staff to be able to perceive, interpret and understand what the person is conveying. Methods of interaction and communication can be a way to express safety, contact and confirmation for individuals with dementia. Aim: The aim of this study is to describe care staff´s experiences of methods to interact and communicate with individuals with dementia disease. Methods: Literature study based on eight qualitative studies. Database search was conducted in CINAHL and PubMed. The analysis was conducted using Friberg's five-stage model. Results: Based on the analysis, three main themes and six sub themes were formed. The main themes were: ‘Thinking new’, ‘Creating relationships & friendships’, ‘Being able to stimulate communication’ and ‘Pay attention to job satisfaction’. Conclusion: The care staff’s experiences of methods for interacting and communicating with individuals with dementia were overall positive. They experienced an increased insight into the importance of an individualized approach, understood the persons better and the relationship between them increased. The staff´s perspective in the long term, can contribute to increased well- being in individuals with dementia. Further research should be conducted in the subject, as only a few studies correspond to the purpose of the literature study.

Bakgrund: Sjuksköterskan i ambulansen har ett brett arbetsfält med stor variation på arbetsuppgifter. Sjuksköterskor inom prehospital vård utsätts för stress i sin arbetssituation. Vid obalans mellan arbetsförmågan och arbetsbelastningen kan stressen leda till ohälsa. Ohälsan kan leda till psykiska besvär som sömnstörningar och depression samt kan det leda till fysiska sjukdomar som hjärt- och kärlsjukdomar. Syfte: Att beskriva sjuksköterskor erfarenhet av stress vid prehospital vård. Metod: Den valda metoden för studien är en kvalitativ litteraturstudie med induktiv ansats. Resultat: Åtta artiklar ingick i resultatet. Sjuksköterskor inom den prehospitala vården upplever stress. Faktorer som utlöser stress är tidsbrist, bristande kunskap och erfarenhet av hot och våld, förlossningar, svårt sjuka eller skadade barn är stressutlösande faktorer. Resultatet visar på vikten av stöd i form av formellt stöd men också stöd av kollegor. Sjuksköterskor använder strategier för att hantera upplevd stress i sitt arbete. Konklusion: Stress ses som komplext och individuellt. Stressfaktorer kan bland annat vara svårt sjuka patienter, vård av barn, tidsbrist, bristande erfarenhet, förlossningar samt hot och våld. Genom denna uppsats skulle en ökad medvetenhet kunna leda till en godare upplevd hälsa och förebyggande av ohälsa för sjuksköterskor inom prehospital vård. / Background: The nurses in the ambulance has a wide field of work with a great variety of tasks. Nurses in pre-hospital healthcare are exposed to stress in their work situation. When there is an imbalance between the ability to work and the workload, this can lead to illness. This illnes can lead to psychological problems such as sleep disorders and depression, and it can lead to physical diseases such as cardiovascular diseases. Aim: To describe nurses' experience of stress in prehospital care. Method: The chosen method for the study is a qualitative literature study with an inductive approach. Findings: Eight articles were included in the result. Nurses in prehospital healthcare experience stress. Factors that trigger stress are lack of time, lack of knowledge and experience, threats and violence, caring for childbirth or seriously ill or injured children are stress-triggering factors. The result shows the importance of support in the form of formal support from the employer but also support from colleagues. Nurses use strategies to manage stress in their work. Conclusion: Stress is seen as complex and individual. Stress factors can include seriously ill patients, caring for children, lack of time, lack of experience, childbirth and threats and violence. Through this essay, an increased awareness could lead to a better perceived health and prevention of ill-health for nurses in pre-hospital care

Bakgrund: Inhämtning av kunskap om och kvantifiering av belastning i ländryggen är en essentiell aspekt för att adressera den belastning och ländryggssmärta som finns bland vårdpersonal som utför fysiskt krävande arbete. Mätningen och utvärderingen av denna belastning utgör en betydande del av det preventiva arbetet för att identifiera riskfaktorer och främja en hälsosam arbetsmiljö.  Syfte: Denna översiktsstudie syftar till att granska den aktuella vetenskapliga litteraturen om kompressions- och skjuvkrafter som påverkar ländryggen hos vårdpersonal under patienthantering. Studien undersöker de vanligaste mätmetoderna för att mäta dessa krafter, den kompressions- och skjuvkraft ländryggen utsätts för hos vårdpersonal under patienthantering, efterlevnaden av riktlinjer för tunga lyft samt effekterna av olika interventioner på uppmätt ländryggsbelastning.  Metod: Denna översiktsstudie har genomförts i enlighet med Statens beredning för medicinsk och social utvärderings (SBU) metodbok. Bedömning av BIAS-risk utfördes med hjälp av SBU;s bedömningsmallar baserade på en modifierad version av QUADAS-2. Vetenskapliga artiklar samlades in via sökningar i PubMed-databasen.  Resultat: Totalt inkluderades 14 studier i denna studie. Dessa studier omfattade sammanlagt 337 deltagare. Alla inkluderade studier utvärderade både kompressionskrafter och skjuvkrafter som utfallsmått och använde reliabla samt validerade mätmetoder som mätinstrument. Resultaten tyder på att belastningen på vårdarnas ländryggar ofta överstiger de rekommenderade nivåerna för kompressions- och skjuvkrafter.  Slutsats: Studien ger signifikant bevisning för en potentiell positiv effekt av olika hjälpmedel på ländryggsbelastning, men det finns även motstridig forskning som pekar på motsatt resultat. Det finns tydliga indikationer på att använda rätt teknik under lyft och att bibehålla en ergonomisk kroppsställning kan bidra till att minska risken för belastningsrelaterade skador och främja hälsa och välbefinnande.

Syfte: Studiens syfte var att studera munhygien- och kostvanor hos individer som arbetar natt inom vården. Metod: En kvantitativ tvärsnittsstudie med pappersenkäter som datainsamlingsverktyg genomfördes. Urvalet var nattarbetare inom vård- och omsorgssektorn på sju arbetsplatser i södra Sverige. Analys av materialet genomfördes i form av deskriptiv statistik som redovisas i text och tabeller. Resultat: Totalt deltog 73 nattarbetare. Studien visade att majoriteten borstade tänderna två gånger om dagen i två minuter med fluoridtandkräm. Cirka hälften av deltagarna (n=36, 49,3%) använde sig av extra fluoridtillskott, och 69,9% (n=51) utförde regelbundet approximal rengöring. Gällande kostvanorna visade resultatet en hög konsumtion av småätande mellan måltider och intag av sötade drycker. Dessutom missade en majoritet dagligen frukost, middag eller lunch. Slutsats: Studien visar att nattarbetare har goda munhygienvanor, men missar huvudmåltider vilket ger upphov till frekvent småätande som kan vara en risk för den orala hälsan. Det visar också behovet av ytterligare forskning för att förstå de underliggande faktorerna bakom nattarbetares hälsobeteenden. / Purpose: The aim of the study was to examine oral hygiene and dietary habits among individuals working night shifts in healthcare. Method: A quantitative cross-sectional study utilizing paper surveys as data collection instrument was conducted. The sample consisted of night-shift workers in the healthcare and social care sector at seven workplaces in southern Sweden. The material was analyzed using descriptive statistics, presented in text and tables. Results: A total of 73 night shift workers participated. The study showed that the majority brushed their teeth twice a day for two minutes using fluoride toothpaste. Approximately half of the participants (n=36, 49,3%) used additional fluoride supplements, and 69,9% (n=51) performed regular interdental cleaning. Regarding the dietary habits the results showed a high consumption of snacks between meals and intake of sweet beverages. Additionally, a majority missed breakfast, dinner or lunch daily. Conclusion: The study demonstrates that night-shift workers have good oral hygiene habits but tend to miss main meals, leading to frequent snacking, which may pose a risk to their oral health. It also highlights the need for further research to understand the underlying factors behind the health behaviors of night-shift workers.

Bakgrund: Utskrivning från en intensivvårdsavdelning (IVA) till vårdavdelning kan vara ett kritiskt moment för patienten och involverad personal då det är mycket som kan gå fel i utskrivningsprocessen. Att bibehålla patientsäkerheten i samband med utskrivning ses idag som en utmaning då det är flera olika aktörer som är med i vårdkedjan, vilket ställer höga krav på samarbetet sinsemellan. Brister i utskrivningsprocessen ökar risken för återinläggningar till intensivvården vilket är förknippat med ökad mortalitet. Syfte: Att undersöka vårdpersonalens upplevelse kring vad som påverkarpatientsäkerheten i utskrivningsprocessen från IVA till vårdavdelning. Metod: En systematisk litteraturstudie baserad på analys av kvalitativ data utifrån Bettany-Saltikov och McSherry metod (2016). Resultat: Vårdpersonalen upplevde en skillnad i vårdnivå mellan IVA och vårdavdelning, vilket påverkade patientsäkerheten då det orsakade glapp ivårdkedjan vid utskrivning. En nivå mellan IVA och vårdavdelning upplevdes som fördelaktigt - men existerade sällan. Vårdavdelningen kunde upplevas som en sårbar destination på grund av mindre resurser och kompetens. Brister i informationsöverföringen i samband med utskrivning upplevdes äventyra patientsäkerheten. Planering och uppföljning i samband med utskrivningsprocessen upplevdes betydelsefullt för att minska glappet i vårdkedjan. Slutsats: Utskrivning från IVA till vårdavdelning innefattar ett glapp i vårdkedjan vilket upplevs äventyra patientsäkerheten då det kan leda till vårdskador i samband med utskrivning. Utifrån systemteorin så hade mycket kunnat undvikas genom att se över den organisatoriska strukturen i sjukvården. Utskrivningsprocessen är komplex och alla delar i systemet påverkar varandra cirkulärt. Ingen (vård)kedja är starkare än sin svagaste länk. / Background: Discharge from intensive care unit (ICU) to a general ward might be a critical moment for both the patients and staff involved and there’s a lot that can go wrong in the discharge process. To maintain patient safety in the connection of discharge is a great challenge because the numbers of actors involved. This requires a high ability to cooperate. Deficiencies in the discharge process increases the risk for readmissions which is associated with increased mortality. Aim: To investigate healthcare personnel experience about what affects patient safety in the discharge process from ICU to ward. Method: A systematic review based on analysis of qualitative data after Bettany-Saltikov and McSherry (2016) method. Result: The ward personnel experienced a difference in the level of care between ICU and ward, which caused a gap that affected patient safety in the discharge process. An in-between level of care could reduce the gap, but seldom existing. The ward could be experienced as vulnerable, because lack of resources and competence. Shortcomings in the information transfer occurred during the discharge process, which was experienced to jeopardize patient safety. Planning and follow-upservice were experienced as important to avoid a gap in the care of chain. Conclusion: Discharge from ICU to ward comprises a gap in the care of chain which is experienced to jeopardize patient safety. This could lead to adverse events.The framework of system theory shows that much could be avoided by overlooking the organizational structures in healthcare, which often is the underlying cause to failure in patient safety. The discharge process is complex and all the parts affects each other circularly. No care of chain is stronger than the weakest link.

Introdução: A prevenção de infecções relacionadas com a assistência à saúde (IRAS) é universalmente considerada relevante para os sistemas de saúde, pois afetam tanto os pacientes quanto os profissionais da assistência. As mãos dos profissionais constituem o elo importante na cadeia de transmissão de microrganismos entre o paciente colonizado e aquele que não tem tal status. A higienização das mãos (HM) é o meio mais efetivo para minimizar o risco de transmissão e envolve a escolha de um produto eficaz e bem aceito pelo profissional. Atualmente há indicação preferencial para o uso de produto alcoólico para HM para a maioria das situações. Entretanto, na prática, outros produtos germicidas também têm sido indicados. Entre eles, o gluconato de clorexidina (GCX), que é uma biguanida catiônica que tem sua atividade antimicrobiana atribuída à invasão na membrana e posterior ruptura das membranas citoplasmáticas, resultando na precipitação do conteúdo. O GCX tem sido utilizado em situações específicas, porém ainda sem evidências que justifiquem sua indicação prioritária. Objetivo: O objetivo deste estudo é selecionar e analisar as evidências científicas para fundamentar a indicação prioritária do uso de sabonete com GCX para HM na assistência à saúde. O estudo propõe como objetivos específicos identificar as evidências científicas disponíveis referentes a HM realizada com sabão contendo GCX quanto: a associação com a redução das IRAS, a relação do uso contínuo com a seleção de microrganismos resistentes a GCX e a relação com a saúde da pele das mãos dos profissionais. Método: Trata-se de um estudo de revisão sistemática, finalizada em abril de 2017, cujo método seguiu as recomendações do Instituto Joanna Briggs (JBI) e do Systematic Review and Meta-analysis Protocols (PRISMA-P) 2015. A aplicação da estratégia PICO buscou responder os objetivos específicos. Incluiu-se como base de dados para a pesquisa: Medline, Cinahl, Lilacs, Embase, Cochrane Library, Scopus, Web of Science, ProQuest, Google Scholar e Teses como literatura cinzenta, sem restrição de linguagem e publicadas a partir de 1985. A seleção dos artigos contou com dois revisores que utilizaram instrumentos de avaliação do JBI. Análise dos dados: Este estudo gerou três revisões, uma para cada pergunta de pesquisa. A revisão relacionada a transmissão de infecção incluiu 764 artigos, 40 para leitura integral e quatro estudos incluídos na revisão, 75% dos artigos com desenho quase-experimental, nenhum artigo foi excluído pelo instrumento de avaliação JBI. Os quatro artigos não mostraram diferença significativa de taxas de infecção quando relacionados ao uso do GCX. A revisão relacionada com a seleção de microrganismos resistentes a GCX incluiu 533 artigos, 27 foram para leitura integral e 12 artigos foram selecionados, dois dos quais foram excluídos ao serem avaliados pelos critérios JBI. Entre os 10 artigos, 60 % eram estudos descritivos. A análise dos resultados dos 10 estudos científicos mostra que três não relacionam o uso do GCX com a seleção de microrganismos resistentes enquanto sete estudos sugerem que o uso contínuo pode selecionar microrganismos resistentes a este princípio ativo. A revisão relacionada com a aceitação dermatológica captou 611 artigos, 27 para leitura integral e oito artigos foram selecionados, dos quais 75% eram estudos experimentais. O estudo E6 foi excluído por não atender questão eliminatória do instrumento JBI. A análise dos resultados dos sete estudos sugere que o uso do GCX está associado à maior número de eventos de reação de pele. Conclusão: o uso do GCX para HM não mostrou impacto na redução das IRAS. Os dados sugerem que o uso indevido ou prolongado pode selecionar microrganismos resistentes à GCX e a aplicação do produto está relacionada a eventos de pele, o que pode impactar nas taxas de adesão de HM. / Introduction: The prevention of health care-related infections (HCI) is universally considered relevant for health systems, as they affect both patients and healthcare workers (HCW). In the chain of microorganism transmission the hands of HCW are an important link between the colonized patient and the one who does not have such status. Hand hygiene (HH) is the most effective method to reduce the transmission risk of infection and it involves the selection of an effective product that is well accepted by the HCW. Currently, alcohol-based products are the preferred option for HH for most situations. In practice, however, a range of other microbial products have also been recommended. Among them chlorhexidine gluconate (CHG), a cationic biguanide that has its antimicrobial activity attributed to membrane invasion, and subsequent rupture of cytoplasmic membranes, resulting in precipitation of the content. CHG has been used in specific situations, but it still has no evidence to justify its preferred recommendation. Objective: The aim of this study is to recognize and to summarize scientific evidence to support preferred recommendation of the use of CHG-based soap for hand hygiene in healthcare. The study proposes specific objectives as to identify available scientific evidence regarding CHG-containing soap for HH and determine: its association with the reduction of health care-associated infections (HAIs) transmission, the association of the routine use of CHG and selection of CHG resistant strains, and the association of CHG-based hand washing as well the integrity of HCW hand skin. Method: This is a systematic review study accomplished in April 2017, which was based on the protocol of the Institute Joanna Briggs (JBI) and the recommendations from Systematic Review and Meta- analysis Protocols (PRISMA-P) 2015. PICO strategy was applied in order to address some specific objectives. The database for the research consisted of: Medline, Cinahl, Lilacs, Embase, Cochrane Library, Scopus, Web of Science, ProQuest, Scholar Google and Theses as gray literature without language restriction and published since 1985. The studies selection was carried out by two researchers who used assessment tools from the Institute Joanna Briggs. Data analysis: This study originated three distinct reviews aiming to answer three questions derived from the main research question. The first one, regarding infection transmission included 764 articles, 40 to be entirely read and four studies to be included in the review, 75% of articles with quasi-experimental design, no studies were excluded by JBI assessment instrument. Four articles did not show any significant difference in infection rates associated to the use of CHG. The revision regarding the selection of CHG-resistant microorganisms included 533 articles, 27 to be entirely read and 12 were selected, two of which were excluded after being assessed by JBI criteria. Among 10 articles, 60% were of descriptive studies. Analysis of outcomes of 10 scientific studies showed that three of them did not relate the continuous use of CHG with the selection of resistant microorganisms while seven suggest that long-term use may select resistant strains to this active ingredient. The last one, regarding dermatological acceptance included 611 articles, 27 to be entirely read and eight were selected, being 75% of experimental studies. Study E6 was excluded because it did not address the pré-defined elimination question of JBI instrument. The analysis of outcomes of seven studies suggests that the use of CHG is associated with the higher number of skin reaction events. Conclusion: the use of CHG for HH has not shown any impact on the reduction of IRAS. Data suggest that inappropriate or long-term use of it may select CHG-resistant strains and skin events have been more frequently related to its application when compared to other products, which may have an impact on HH adherence rates.

För att språket ska fungera normalt krävs ett samspel mellan uttrycksförmåga och förståelse av språk. Afasi är en språkstörning som kommer sig av en skada i de delar av hjärnan som påverkar språket. Att få afasi kan innebära en stor omställning i livet och ofta uppstår ett behov av anpassning av kommunikationen både för personen som fått afasi och personer i dess omgivning. Detta inkluderar även den vårdpersonal som arbetar nära personen med afasi. För att nå förståelse och kunna ge vård och omsorg av god kvalitet, måste tillräcklig kunskap om afasi finnas hos vårdpersonalen. Tidigare forskning visar att det finns brister hos vårdpersonal i deras kunskap om afasi. Utifrån detta kan det anses viktigt att kunna mäta vårdpersonals kunskap om afasi. Denna studies syfte har varit att ta fram relevanta frågor (items) som kan mäta kunskapsnivån hos vårdpersonal. För att besvara frågeställningarna användes kvalitativ metod för materialinsamling. För att samla erfarenheter av hur vårdpersonalens kunskap om afasi upplevs vara idag, genomfördes intervjuer med tre separata grupper: fem personer med afasi, fem anhöriga till personer med afasi och tre logopeder med erfarenhet av arbete med personer med afasi. Intervjuerna analyserades med hjälp av kvalitativ innehållsanalys. Resultatet visade att informanternas erfarenheter var att det hos vårdpersonal existerar kunskapsbrister om afasi, varför studien ansågs vara motiverad. Utifrån det analyserade materialet togs 32 items fram, med syfte att mäta vårdpersonals kunskap om afasi. Som alltid vid kvalitativ forskning finns det risker att olika faktorer, exempelvis forskarnas förförståelse, påverkar informanterna. Största möjliga hänsyn har tagits till detta. Framtida nytta med studien är att de framtagna items kan användas i ett bedömningsinstrument för att mäta vårdpersonals kunskap om afasi. Därmed ges nya möjligheter att kvalitetssäkra vård av personer med afasi, att motivera utbildning för vårdpersonal och att exempelvis mäta vårdpersonals kunskap i relation till rehabilitering.   Nyckelord: afasi, kunskap, vårdpersonal, items, bedömningsinstrument, kommunikation / In order for the language to function normally, the expression- and comprehension of language must work together. Aphasia is a language impairment caused by damage to the language areas of the brain. Getting aphasia can mean a big change in life and often requires adaptation regarding communication both for the person with aphasia and the persons around them. Adaptation regarding communication also includes healthcare staff working close to the person with aphasia. In order to reach understanding and to give care of good quality, knowledge about aphasia is necessary.  Previous research shows that health care staff lacks efficient understanding about aphasia. Considering that, a tool for measuring knowledge about aphasia would be desirable. This study's aim has been to produce questions (items) which can measure the level of knowledge in healthcare personnel. Qualitative research method was used in order to find material for the production of items. In order to gather experiences of how the health care staff's understanding of  aphasia are experienced by interested people today, interviews with three separate groups were performed: five persons with aphasia, five relatives to persons with aphasia and three speech and language pathologists with experience of working with persons with aphasia. The interviews were analyzed through qualitative content analysis. The result showed that all the participants' had various experiences of knowledge deficiencies regarding aphasia within the healthcare staff. The analyzed material resulted in 32 items, with the purpose of measuring the understanding of aphasia in healthcare staff. Since the material indicated that a deficiency in knowledge of aphasia exists in healthcare staff, the study was considered to be justified. Within qualitative research method, there are always risks that different elements, for example the researcher´s viewpoint, can affect the participants. Maximum consideration regarding this issue has been considered. Future benefits of this study could be an assessment instrument containing the items produced in this study. The purpose of an assessment instrument could be to measure health care staff´s knowledge about aphasia. Thereby, new opportunities are given to assure the quality of care for persons with aphasia, to justify education for healthcare staff and to evaluate the health care staff´s understanding in relation to the results of rehabilitation.   Keywords: aphasia, knowledge, understanding, healthcare staff, items, assessment instruments, communication, healthcare personnel

Nearly 70 % of adverse events could be prevented. Observing of adverse events is one way for improving the quality of health services and patient safety. The adverse event reporting systems in České Budějovice hospital was mainly subject in the research portion. A mixed research method (qualitatively quantitative) was used for the research portion. The research results are interpreted using tables and graphs.

Introdução: A prevenção de infecções relacionadas com a assistência à saúde (IRAS) é universalmente considerada relevante para os sistemas de saúde, pois afetam tanto os pacientes quanto os profissionais da assistência. As mãos dos profissionais constituem o elo importante na cadeia de transmissão de microrganismos entre o paciente colonizado e aquele que não tem tal status. A higienização das mãos (HM) é o meio mais efetivo para minimizar o risco de transmissão e envolve a escolha de um produto eficaz e bem aceito pelo profissional. Atualmente há indicação preferencial para o uso de produto alcoólico para HM para a maioria das situações. Entretanto, na prática, outros produtos germicidas também têm sido indicados. Entre eles, o gluconato de clorexidina (GCX), que é uma biguanida catiônica que tem sua atividade antimicrobiana atribuída à invasão na membrana e posterior ruptura das membranas citoplasmáticas, resultando na precipitação do conteúdo. O GCX tem sido utilizado em situações específicas, porém ainda sem evidências que justifiquem sua indicação prioritária. Objetivo: O objetivo deste estudo é selecionar e analisar as evidências científicas para fundamentar a indicação prioritária do uso de sabonete com GCX para HM na assistência à saúde. O estudo propõe como objetivos específicos identificar as evidências científicas disponíveis referentes a HM realizada com sabão contendo GCX quanto: a associação com a redução das IRAS, a relação do uso contínuo com a seleção de microrganismos resistentes a GCX e a relação com a saúde da pele das mãos dos profissionais. Método: Trata-se de um estudo de revisão sistemática, finalizada em abril de 2017, cujo método seguiu as recomendações do Instituto Joanna Briggs (JBI) e do Systematic Review and Meta-analysis Protocols (PRISMA-P) 2015. A aplicação da estratégia PICO buscou responder os objetivos específicos. Incluiu-se como base de dados para a pesquisa: Medline, Cinahl, Lilacs, Embase, Cochrane Library, Scopus, Web of Science, ProQuest, Google Scholar e Teses como literatura cinzenta, sem restrição de linguagem e publicadas a partir de 1985. A seleção dos artigos contou com dois revisores que utilizaram instrumentos de avaliação do JBI. Análise dos dados: Este estudo gerou três revisões, uma para cada pergunta de pesquisa. A revisão relacionada a transmissão de infecção incluiu 764 artigos, 40 para leitura integral e quatro estudos incluídos na revisão, 75% dos artigos com desenho quase-experimental, nenhum artigo foi excluído pelo instrumento de avaliação JBI. Os quatro artigos não mostraram diferença significativa de taxas de infecção quando relacionados ao uso do GCX. A revisão relacionada com a seleção de microrganismos resistentes a GCX incluiu 533 artigos, 27 foram para leitura integral e 12 artigos foram selecionados, dois dos quais foram excluídos ao serem avaliados pelos critérios JBI. Entre os 10 artigos, 60 % eram estudos descritivos. A análise dos resultados dos 10 estudos científicos mostra que três não relacionam o uso do GCX com a seleção de microrganismos resistentes enquanto sete estudos sugerem que o uso contínuo pode selecionar microrganismos resistentes a este princípio ativo. A revisão relacionada com a aceitação dermatológica captou 611 artigos, 27 para leitura integral e oito artigos foram selecionados, dos quais 75% eram estudos experimentais. O estudo E6 foi excluído por não atender questão eliminatória do instrumento JBI. A análise dos resultados dos sete estudos sugere que o uso do GCX está associado à maior número de eventos de reação de pele. Conclusão: o uso do GCX para HM não mostrou impacto na redução das IRAS. Os dados sugerem que o uso indevido ou prolongado pode selecionar microrganismos resistentes à GCX e a aplicação do produto está relacionada a eventos de pele, o que pode impactar nas taxas de adesão de HM. / Introduction: The prevention of health care-related infections (HCI) is universally considered relevant for health systems, as they affect both patients and healthcare workers (HCW). In the chain of microorganism transmission the hands of HCW are an important link between the colonized patient and the one who does not have such status. Hand hygiene (HH) is the most effective method to reduce the transmission risk of infection and it involves the selection of an effective product that is well accepted by the HCW. Currently, alcohol-based products are the preferred option for HH for most situations. In practice, however, a range of other microbial products have also been recommended. Among them chlorhexidine gluconate (CHG), a cationic biguanide that has its antimicrobial activity attributed to membrane invasion, and subsequent rupture of cytoplasmic membranes, resulting in precipitation of the content. CHG has been used in specific situations, but it still has no evidence to justify its preferred recommendation. Objective: The aim of this study is to recognize and to summarize scientific evidence to support preferred recommendation of the use of CHG-based soap for hand hygiene in healthcare. The study proposes specific objectives as to identify available scientific evidence regarding CHG-containing soap for HH and determine: its association with the reduction of health care-associated infections (HAIs) transmission, the association of the routine use of CHG and selection of CHG resistant strains, and the association of CHG-based hand washing as well the integrity of HCW hand skin. Method: This is a systematic review study accomplished in April 2017, which was based on the protocol of the Institute Joanna Briggs (JBI) and the recommendations from Systematic Review and Meta- analysis Protocols (PRISMA-P) 2015. PICO strategy was applied in order to address some specific objectives. The database for the research consisted of: Medline, Cinahl, Lilacs, Embase, Cochrane Library, Scopus, Web of Science, ProQuest, Scholar Google and Theses as gray literature without language restriction and published since 1985. The studies selection was carried out by two researchers who used assessment tools from the Institute Joanna Briggs. Data analysis: This study originated three distinct reviews aiming to answer three questions derived from the main research question. The first one, regarding infection transmission included 764 articles, 40 to be entirely read and four studies to be included in the review, 75% of articles with quasi-experimental design, no studies were excluded by JBI assessment instrument. Four articles did not show any significant difference in infection rates associated to the use of CHG. The revision regarding the selection of CHG-resistant microorganisms included 533 articles, 27 to be entirely read and 12 were selected, two of which were excluded after being assessed by JBI criteria. Among 10 articles, 60% were of descriptive studies. Analysis of outcomes of 10 scientific studies showed that three of them did not relate the continuous use of CHG with the selection of resistant microorganisms while seven suggest that long-term use may select resistant strains to this active ingredient. The last one, regarding dermatological acceptance included 611 articles, 27 to be entirely read and eight were selected, being 75% of experimental studies. Study E6 was excluded because it did not address the pré-defined elimination question of JBI instrument. The analysis of outcomes of seven studies suggests that the use of CHG is associated with the higher number of skin reaction events. Conclusion: the use of CHG for HH has not shown any impact on the reduction of IRAS. Data suggest that inappropriate or long-term use of it may select CHG-resistant strains and skin events have been more frequently related to its application when compared to other products, which may have an impact on HH adherence rates.

Background: Healthcare personnel (HCP) often experience undesirable working conditions. Risk behaviours for organism transmission can lead to healthcare associated infections and risk behaviours has been described to be influenced by working conditions. Research is lacking regarding HCPs working conditions and its relation to risk behaviours for organism transmission which this thesis aims to investigate.  Methods: Study I had a mixed-methods convergent design. Observations and interviews were performed with 79 HCP, i.e., registered nurses (RNs) and assistant nurses (ANs). First-line managers were interviewed about the unit´s overall working conditions. The qualitative and quantitative data were analysed separately and then merged. Study II was a cross-sectional study with 417 RNs and ANs. The questionnaire included: self-efficacy to aseptic care, structural empowerment (SE), work engagement (WE) and work-related stress (WRS). Correlational analysis and group comparisons were performed.  Results: In Study I risk behaviours frequently occurred regardless of measurable and perceived working conditions. The HCP described e.g. staffing levels and interruptions to influence risk behaviours. In the statistical analyses, risk behaviours were more frequent in interrupted activities and when the HCP worked together. In Study II the HCP rated high levels of self-efficacy to aseptic care. Differences were found between self-efficacy and some of the grouped working condition variables and definite but small relationships were found between self-efficacy to aseptic care and SE/WE/WRS.  Conclusion: The HCP rated high levels of self-efficacy to aseptic care, but on the other hand, risk behaviours frequently occurred irrespective of working conditions. Healthcare managers are responsible for HCPs work environment and should continuously work to promote sufficient working conditions and to increase HCPs understanding of risk behaviours, which consequently also promote patient safety.