Introduktion: Infektionsprevention är de insatser som vården kan utföra för att förebygga vårdrelaterade infektioner [VRI]. Följsamhet till basala hygienrutiner är den mest grundläggande åtgärden. VRI är den vanligaste vårdskadan globalt och bidrar till det globala folkhälsohotet antibiotikaresistens genom ett ökat antibiotikatryck. Sjukvård i hemmet blir allt vanligare och avancerad hemsjukvård bedrivs i Stockholms län som avancerad sjukvård i hemmet [ASIH]. Internationella studier har visat att följsamhet till rutiner för handhygien inom hemsjukvården är bristfällig. Syfte: att undersöka sjuksköterskors erfarenheter av hur föreskrifter och riktlinjer efterföljs i det infektionspreventiva arbetet inom ASIH. Metod: En kvalitativ studie med semistrukturerade intervjuer. Sju sjuksköterskor verksamma inom ASIH i Stockholms län intervjuades. En kvalitativ innehållsanalys genomfördes. Resultat: Temana 1) attityder, 2) normer och värderingar och 3) upplevd beteendekontroll redovisades. Attityder visade på konflikt mellan vårdhygieniska krav och sjuksköterskors erfarenheter. Normer och värderingar uttrycktes genom grad av följsamhet till föreskrifter och riktlinjer. ”Good enough” var en norm som intervjuade gav uttryck för. Den upplevda beteendekontrollen bestod av flertalet hinder som kunde påverka följsamheten till föreskrifter och riktlinjer. Diskussion: Sjuksköterskorna hade intentionen att inte orsaka VRI, men inte alltid genom följsamhet till föreskrifter och riktlinjer, då det lagstadgade kravet på god hygienisk standard ansågs vara svårt att upprätthålla i en okontrollerad miljö. Patientens hemmiljö är sjuksköterskans arbetsmiljö och målkonflikter kan uppstå. Sjuksköterskan behöver ta hänsyn till många aspekter, bland annat patientens integritet. Slutsats: ASIH möter särskilda utmaningar i det infektionspreventiva arbetet. Detta bör uppmärksammas i vårdhygieniska utbildningar för personal inom hemsjukvård. I framtiden bör punktprevalensmätningar av basala hygienrutiner och VRI inom hemsjukvården utföras. / Introduction: Infection prevention is the efforts that healthcare can carry out to prevent healthcare-associated infections [HAIs]. Adherence to basic hygiene routines is the most fundamental measure. HAIs are the most frequent healthcare injury globally and contributes to the global public health threat of antibiotic resistance through increased antibiotic pressure. Advanced home healthcare is provided in Stockholm County as ASIH. International studies have shown that adherence to routines for hand hygiene in home healthcare is deficient. Aim: To investigate nurses' experiences of how regulations and guidelines are followed regarding infection prevention within ASIH. Methods: A qualitative study with semi-structured interviews. Seven nurses working within ASIH in Stockholm County were interviewed. A qualitative content analysis was carried out. Results: The themes 1) Attitudes, 2) Subjective norms and values and 3) Perceived behavioral control were reported. Attitudes showed conflict between health care hygiene requirements and nurses' experiences. Norms and values were expressed through degree of adherence to regulations and guidelines. "Good enough" was a norm expressed by interviewees. The perceived behavioral control consisted of several obstacles that could affect compliance. Discussion: The nurses had the intention of not causing HAIs, but not always through adherence to regulations and guidelines, as the statutory requirement for good hygienic standards was considered difficult to maintain. The patient's home environment is the nurse's work environment and goal conflicts can arise. The nurse needs to take many aspects into account, including the patient's integrity. Conclusion: ASIH faces special challenges regarding infection prevention. This should be acknowledgedin healthcare hygiene training for staff in home healthcare. In the future, point prevalence measurements of basic hygiene routines and HAIs in home healthcare should be carried out.

Les infections associées aux soins de santé (IASS), ou infections nosocomiales, sont les effets indésirables les plus fréquemment signalés dans le monde, affectant environ 1 patient hospitalisé sur 31 chaque jour selon le Centre pour le contrôle et la prévention des maladies (CDC). La surveillance permet de mesurer, prévenir et contrôler ces infections. Toutefois, elle se doit d’être renforcée au Canada. L’objectif principal de ce projet est d’améliorer la surveillance passive des IASS au Canada en élaborant une stratégie visant à réduire l’écart entre les données de surveillance active et les données administratives, en plus de comprendre les facteurs qui expliquent cet écart. Ce mémoire présente trois articles et les résultats d’un groupe de travail qui ont chacun des objectifs rattachés au but global du mémoire. En premier lieu, une revue de la littérature vise à évaluer la validité des données administratives en comparaison aux données de surveillance active, qui sont la référence pour la surveillance des IASS. Cet article identifie les divergences entre les deux types de surveillance et démontre que la surveillance passive n’offre pas de données assez précises pour être comparables à celles de la surveillance active. Le deuxième article a pour objectif d’identifier les barrières et les facilitateurs de l’utilisation des données administratives pour la surveillance, avec un focus sur les IASS au Canada. Il analyse et met en évidence 120 barrières et facilitateurs, dont la majorité concerne la qualité des données, et identifie diverses solutions pour contrer ces barrières. Un troisième article et un groupe de travail examinent une solution pour améliorer la qualité des données codées par le département des archives médicales, soit d’utiliser les données de surveillance active en combinaison avec les dossiers médicaux pour coder les IASS. L’article évalue la validité de cette solution sur deux types d’IASS et démontre l’efficacité de cette solution. Le groupe de travail évalue les barrières et facilitateurs de cette solution et travaille sur des recommandations pour la mettre en place. Ces trois études, en plus du groupe de travail, permettent de constater qu’il y a de nombreuses barrières à l’utilisation des données administratives pour la surveillance des IASS, en particulier concernant la qualité des données, mais qu’il existe des solutions prometteuses. / Healthcare-associated infections (HAIs) are the most commonly reported adverse events worldwide, affecting approximately 1 in 31 hospitalized patients each day according to the Centers for Disease Control and Prevention (CDC). Surveillance helps to measure, prevent and control these infections, but needs to be strengthened in Canada. The main objective of this project is to improve passive surveillance of HAIs in Canada by developing a strategy to reduce the discrepancy between active surveillance data and administrative data, in addition to understanding the factors that explain this discrepancy. This work presents three articles and a working group, each of which has objectives related to the overall goal of the project. First, a review of the literature assesses the validity of administrative data compared to active surveillance data, which is the reference for HAI surveillance. This article identifies the discrepancies between the two types of surveillance and demonstrates that passive surveillance does not provide sufficiently accurate data to be comparable to that of active surveillance. The second article aims to identify the barriers and facilitators to the use of administrative data for surveillance, with a focus on HAIs in Canada. It analyzes and highlights 120 barriers and enablers, the majority of which relate to data quality, and identifies various solutions to counter the barriers. A third article and a working group examine a potential solution to improve the quality of data coded by the medical records department; to use active surveillance data in combination with medical records to code HAIs. The article evaluates the validity of this type of data for two types of IASS and demonstrates the effectiveness of this solution. The working group assesses the barriers and facilitators of this solution and works on recommendations to implement it. These three studies, in addition to the working group, show that there are many barriers to the use of administrative data for the surveillance of HAIs, in particular related to the quality of the data, but that promising solutions are available.

Submitted by Onia Arantes Albuquerque (onia.ufg@gmail.com) on 2018-10-11T15:04:28Z No. of bitstreams: 2 Dissertação - Alexsandra Gomes Resende de Souza da Silva - 2018.pdf: 3027265 bytes, checksum: 4c70a842bfa34b413b177bde613f5ba1 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-10-15T11:04:15Z (GMT) No. of bitstreams: 2 Dissertação - Alexsandra Gomes Resende de Souza da Silva - 2018.pdf: 3027265 bytes, checksum: 4c70a842bfa34b413b177bde613f5ba1 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-10-15T11:04:15Z (GMT). No. of bitstreams: 2 Dissertação - Alexsandra Gomes Resende de Souza da Silva - 2018.pdf: 3027265 bytes, checksum: 4c70a842bfa34b413b177bde613f5ba1 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-08-29 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Introduction: Central-line associated bloodstream infections (CLABSIs) are common in Intensive care units (ICUs), leading to longer hospital stays, high hospital costs and death. As such, surveillance, prevention and control are indispensable.Objective: Analyze the epidemiological and microbiological profile of central-line associated bloodstream infections in adult ICUs in the municipality of Goiânia, Brazil. Method: Analytical ecological study conducted using secondary data from reports of all clinical and laboratory central-line associated bloodstream infections in adult ICUs in Goiânia, between 2012 and 2016. SPSS-17.0 and Stata software (version 14.0) were used. Data were expressed as temporal trend, descriptive statistics and percentiles. Data analysis considered a 95% confidence interval and significance level of p<0.05. Results: We analyzed 1988 healthcare-associated infection (HAI) notifications from 42 adult ICUs. The temporal trend of central-line associated bloodstream infections incidence density was stationary. The incidence density of laboratory central-line associated bloodstream infections varied from 3.32 to 4.34 infections per 1000 catheters/day. The rate of central venous catheter use in the period was 55.36%. In relation to percentile, increase was observed in the study period, particularly in 2016 in the 90th percentile. There was no statistical association between the variables analyzed. With respect to the microbiological and antimicrobial susceptibility profile, SCon and S. aureus showed 91.8% and 71.4% resistance to oxacillin, respectively, in 2016. K. pneumoniae and Acinectobacter spp. Were resistant to 3rd and 4th generation cephalosporins and carbapenems. Conclusion: It was concluded that the temporal trend of central-line associated bloodstream infections was stationary, and incidence density and percentiles increased over the years. The primary causative agents were SCon and K. pneumoniae, with broad spectrum antimicrobial resistance. Measures should be implemented to monitor health services and provide continuing education for health workers regarding the prevention and control of these infections. / Introdução: As infecções primárias de corrente sanguínea são frequentes, em Unidade de Terapia Intensiva (UTI) ocasionando prolongamento no tempo de internação, elevados custos hospitalares e óbitos. Mediante essa situação a vigilância, prevenção e controle são imprescindíveis. Objetivo: Analisar o perfil epidemiológico e microbiológico das infecções primárias de corrente sanguínea de UTI adulto do Município de Goiânia. Método: Estudo analítico ecológico, realizado a partir de dados secundários de notificações de infecções primárias de corrente sanguínea clínicas e laboratoriais das UTI adulto no Município de Goiânia-GO, no período de 2012-2016. Utilizou-se os Softwares SPSS-17.0 e Stata, versão 14.0. Os dados foram apresentados por meio da tendência temporal, estatística descritiva e percentis. Considerou-se IC: 95% e p<0,05.de significância de p<0,05. Resultados: Analisou-se 1988 fichas de notificações de IRAS dos referentes a 42 UTI adulto. A tendência temporal da densidade de incidência das infecções primárias de corrente sanguínea foi estacionária. A densidade de incidência das infecções primárias de corrente sanguínea laboratoriais variou de 3,32 a 4,34 infecções por 1000 cateteres-dia. A taxa de utilização de cateter venoso central no período foi de 55,36%. Em relação aos percentis houve elevação no período de estudo com destaque no ano de 2016 no percentil 90. Não houve associação estatística entre as variáveis analisadas. Quanto ao perfil microbiológico e de sensibilidade antimicrobiana identificou-se: SCon e S. aureus resistentes à oxacilina em 91,8% e 71,4% respectivamente em 2016. K. pneumoniae e Acinectobacter spp. resistentes às cefalosporinas de 3ª e 4ª gerações e aos carbapenêmicos. Conclusão: Conclui-se que a tendência temporal das infecções primárias de corrente sanguínea se manteve estacionária; a densidade de incidência e os percentis apresentaram elevação no decorrer dos anos. Os principais patógenos foram os SCon e K. pneumoniae com resistência a antimicrobianos de amplo espectro. Medidas de monitoramento dos serviços de saúde e de educação permanente dos trabalhadores da área da saúde, quanto a prevenção e controle dessas infecções, devem ser instituídas.

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