Background: In the United States, it is estimated that 1 in 20 patients become infected with a healthcare acquired infection (HAI). Some of the complications of HAIs include increased morbidity and mortality, and drug-resistant infections. Clostridium difficile has replaced methicillin-resistant Staphylococcus aureus (MRSA) as the most important HAI in the United States by doubling its prevalence during the last decade. Significance of the study: This study is grounded on the subdiscipline of macroergonomics and highly detailed simulation. The Macroergonomic Analysis and Design (MEAD) model is utilized to identify and correct deficiencies in work systems. The MEAD process was applied to develop possible sociotechnical interventions that can be used against HAIs. Highly detailed simulation can evaluate infection exposure, interventions, and individual behavior change for populations in large populations. These two methods provide the healthcare system stakeholders with the ability to test interventions that would otherwise be impossible to evaluate. Objective/Purpose: The purpose of this study is to identify the factors that reduce HAI infections in healthcare facility populations, and provide evidence-based best practices for these facilities. The central research question is: What type of interventions can help reduce Clostridium difficile infections? Methods: We collected one year of patient archival information to include activities, locations and contacts through electronic patient records from two Virginia regional hospitals. Healthcare worker activities were obtained through direct observation (shadowing) at the two Virginia regional hospitals. Experiments were designed to test the different types of interventions using EpiSimdemics, a highly-resolved simulation software. A Clostridium difficile disease model was developed to evaluate interventions. Results: We observed a significant drop in infection cases at a regional Hospital. There is significant evidence to link this drop in HAI infections to a sociotechnical intervention. However, there is not enough information to pinpoint the specific action that caused the drop. We additionally conducted simulation experiments with two hospital simulations. Simulated sociotechnical interventions such as hand washing, room cleaning, and isolation caused significant reductions in the infection rates. Conclusions: The combined use of macroergonomics and simulation can be beneficial in developing and evaluating interventions against HAIs. The use of statistical control charts as an epidemiology tool can help hospitals detect outbreaks or evaluate the use of interventions. Use of systemic interventions in an in-silico environment can help determine cheaper, more flexible, and more effective actions against HAIs. / Ph. D.

Transmissions based precautions are measures implemented in various clinical health care settings as a means to prevent the transmission of infectious diseases and decrease instances of healthcare acquired infections (HAI). HAI’s result in increased cost to hospitals, longer hospitalization for patients, increased patient suffering, and fatal patient outcomes. While staff member adherence to transmissions based precautions are mandated through various organizations and hospital policies, a review of literature indicates little research has been conducted regarding visitor compliance with transmission-based precautions. The potential implications in healthcare from visitor non-adherence acquired infections are unknown; revealing a gap in literature and supporting the need for further research to describe the phenomenon. Through utilization of a descriptive online survey instrument, the purpose of this descriptive study is to gain insight into why nurses believe visitors may or may not be compliant with transmission-based precautions. To collect the data, an online descriptive survey instrument was developed and distributed via email to all graduate students’ enrolled East Tennessee State University’s College of Nursing. Only ten participants met the eligibility requirements to participate in this study. Data was analyzed though a predictive analytics software and grouping responses into themes. Responses suggest that nurses feel visitors are not complying with transmission-based precautions because of a lack in education, not perceiving the infection as a threat, prior exposure to loved one at home, and inconvenience.

No description available.

Healthcare-associated infections present an escalating worldwide issue, further intensified by the emergence of antimicrobial resistance and the spread of pathogens on surfaces. Current infection prevention methods have shown limited effectiveness, leading to several health issues, an overuse of antibiotics, and a continuous threat of surface recontamination. In response, extensive research has focused on bioinspired omniphobic smart coatings that effectively reduce the contact area available for pathogen attachment, achieved through an increase in surface roughness and apparent surface energy. This thesis introduces a new class of an omniphobic spray-coating, featuring hierarchical structured polydimethylsiloxane (PDMS) microparticles coated with gold nanoparticles, encompassing primary microscale (~0.23 𝜇m) and secondary nanoscale (~5 nm) buckyball and labyrinth wrinkles. This substrate-independent coating efficiently repels a wide range of liquids, including pathogens, even under harsh conditions like high temperatures, ultraviolet (UV) exposure, and abrasions. Repellency tests comparing coated and uncoated gloves revealed that uncoated gloves spread contamination to 50 secondary surfaces, while coated gloves transferred fewer bacteria and viruses to just three and two surfaces, respectively. The investigation extended to the coating's biocidal capabilities, incorporating gold nanoparticles functionalized with mercapto-silane to create a "Repel and Kill" coating. This process initiates chemisorption through thiol-gold bonding, allowing for the formation of diverse surface structures, including three-dimensional self-assembly, multilayers, and island structures. These modifications significantly enhance the roughness and hydrophobicity of the gold nanoparticles, amplifying their biocidal effectiveness. The wrinkled structure of PDMS contribute to repellency, while the functionalized gold nanoparticles play a crucial role in the antimicrobial property. This enhancement was evident in the antibacterial tests, which exhibited an immediate 99.90% reduction in bacterial adhesion for both MRSA and Pseudomonas aeruginosa (P. aeruginosa), followed by an additional 99.70% and 99.90% reduction in bacterial growth after 8 hours for MRSA and P. aeruginosa, respectively. Moreover, the coating's antiviral properties were confirmed, demonstrating a 98% reduction in the transfer of the bacterial virus Phi6. Recognizing the role of hospital fabrics as potential reservoirs for infection transmission, primarily due to their ability to sustain bacterial growth for extended periods, especially in the presence of bodily fluids, we took further steps to modify the wrinkled PDMS microparticles. This involved the incorporation of silver nanoparticles, capped with a positively charged ligand known as branched polyethyleneimine (bPEI). Additionally, we integrated a colorimetric sensor, giving rise to the "Repel, Kill, and Detect" smart coating. The transition of color from blue to green-yellow provided a tangible indicator of contamination detection based on the acidic mileu of the biofilms. To evaluate its realworld effectiveness, we conducted simulations of infection transmission in hospital environments, resulting in a remarkable reduction in pathogen adhesion from urine and feces by 99.88% and 99.79%, respectively, compared to uncoated fabrics. To further enhance the validation of our results, we employed a powerful deep learning network architecture, that determined whether the surfaces are contaminated or safe. In the face of evolving health challenges, this coating emerges as a resilient and adaptable solution, promising to enhance overall safety and alleviate the burden of infectious diseases. / Thesis / Doctor of Engineering (DEng) / The prolonged survival of pathogens on surfaces, significantly highlighted by the COVID-19 global pandemic, has intensified the urgency of addressing contamination on high-touch surfaces. Engineered surface coatings with repellent properties have emerged as a long-lasting and health-conscious solution for infection prevention and control. In this thesis, we introduce a new class of multifunctional engineered coatings featuring hierarchical structures adorned with biocidal nanoparticles and an integrated colorimetric sensor. We comprehensively investigate these coatings' multifunctional capabilities to repel, exterminate, and detect contaminants. Through specific characterization tests involving a wide range of pathogens, including viruses, bacteria, and fungi, within complex biological fluids like urine and feces, this research culminates in the development of surface coatings equipped with both antimicrobial and pathogen-sensing capabilities. In addition to advancing our understanding of surface hierarchy and chemical modifications for repellency and biocidal activity, this thesis yields insights into the dynamics of biofouling and pathogen transfer, with the overarching goal of reducing pathogen transmission via surfaces.

Background: A healthcare associated infection (HCAI) is an infection which is acquired from any healthcare establishment or context. In Sweden, one HCAI costs 107 000 SEK for the Swedish healthcare, but 50 percent of those are avoidable. The two most common HCAI are surgical site infections and urinary tract infections. Aim: The aim of this study was to describe patients experiences of suffering from healthcare associated infections. Method: The study was literature-based. Eight qualitative articles from the year 2010 to 2022 were included in the result. The articles needed to be based on describing the patients experience or perspective of suffering from a healthcare associated infection. Infections who were acquired from society were excluded. Results: The analysis of the articles resulted in three main themes and was then divided into two subthemes each. Main theme ”healthcare is failing” describes patients experienced lack of information and lack of trust in the healthcare professionals. “Physical exertion” was described as aches and pains, as well as physical limitation. “Psychological suffering” described patients experience of negative emotions and deteriorating social relationships.  Conclusion: HCAI showed substantial consequences for the patients, from distrust of the healthcare system, to suffering within emotional aspects as well as physical aspects due to pain and physical limitations. For practical implications, the authors are of the opinion that distinct information is essential to enable patients' participation in their healthcare.

The aim of this thesis is summarising the issue of hospital related infections on intensive care units in district hospitals. This issue is greatly underestimated. The background section discusses the different types of healthcare acquired infection, where they are most commonly found and the most common types. They use statistical data to confirm these points. Within this section risk factors and preventive measures are also discussed. The researchers use a questionnaire to assess the intensive care units staff's knowledge of the procedures to prevent a healthcare acquired infection. The data is expressed using tables and graphs to aid clarity. The results of research reveal, that the staff all downgrade the prevalence and prevention of hospital acquired infections. Key words: Healthcare acquired infections / Nosocomial disease Prevention of hospital related diseases Hand hygiene Intensive care