Hospital acquired pneumonia (HAP) causes significant mortality and morbidity and is now no longer reimbursed by Centers for Medicare and Medicaid (CMS). For all of these reasons, hospitals want to minimize their HAP rates. Aggressive oral care (tooth brushing 3 times a day) has been shown to reduce the incidence of HAP in the intensive care unit setting, but this has not been tested in the acute care setting, in which patients are more stable, less sick, and more ambulatory. In an attempt to address HAP rates in acute care settings, this clinical trial entailed providing all patients in four wards with a 3 times per day tooth-brushing oral care protocol, which was implemented or supervised by the nurses on each ward. Six matched wards on a separate campus that received normal standard of care served as controls. The goal of this clinical trial was to cut the pneumonia rate in half, from 2% to 1%. This clinical trial was conducted to determine whether an oral care regimen would reduce the incidence of aspiration pneumonia over the three months of intervention in the experimental group (HAC) versus the control group (ENC) from Nov 5, 2012 to Feb 15, 2013.

The purpose of this research was to determine the relationship of the slime layer antigen(s) to the "101" or LPS antigens and to attempt to evaluate the role of antibodies against the latter in protection against experimental infections in mice with the homologous strain of Pseudomonas aeruginosa. Results from agglutination tests, chromatographic separations, passive protection tests, and characterizations of the antigens by gel double diffusion do not support the concept that LPS is a necessary portion of the immunogenic material. The immunogenicity of LPS can be attributed to co-purification of residual amounts of slime layer antigens on the washed cells from which LPS was extracted.

Made available in DSpace on 2014-06-11T19:24:15Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-12-09Bitstream added on 2014-06-13T20:31:20Z : No. of bitstreams: 1 franchi_eplp_me_botfm.pdf: 4815496 bytes, checksum: 1dc26a3719261d8f1f4551fbb04a10f4 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Universidade Estadual Paulista (UNESP) / O gênero Staphylococcus está envolvido em infecções adquiridas tanto na comunidade como em hospitais, sobressaindo-se atualmente como um dos maiores problemas clínicos e epidemiológicos em infecções nosocomiais. Diante da importância do S.aureus como um dos microrganismos mais freqüentemente isolados de infecções de pele e tecidos moles e a crescente disseminação dos S. aureus resistentes a oxacilina (MRSA), este estudo objetiva identificar a presença de MRSA em feridas de pacientes atendidos em unidades básicas de saúde da cidade de Botucatu, caracterizar o cassete cromossômico mec e identificar fatores de risco para aquisição de S aureus e MRSA. Foram incluídas no estudo 126 amostras isoladas de 107 pacientes atendidos no período de março de 2010 à fevereiro de 2011. As amostras foram submetidas à identificação e detecção de resistência a oxacilina pelo método de difusão com disco de oxacilina e cefoxitina, penicilina, levofloxacina, clindamicina, eritromicina, gentamicina, sulfametazol/Trimetropim, tigeciclina, ácido fusídico, quinupristina/dalfopristina, linezolida e vancomicina. Foi realizada a caracterização do SCCmec por PCR multiplex nas amostras de S. aureus com gene mecA. Foi investigada a presença dos genes codificadores da Leucocidina Panton-Valentine (PVL). As amostras de Staphylococcus spp. também foram submetidas detecção de produção de -lactamase. Das 126 amostras estudadas, 73(58%) foram identificadas como genero Staphylococcus spp., sendo 49/73(67,1%) isolados S. aureus e 24/73(32,9%) estafilococos coagulase-negativa (ECN). A produção de -lactamase foi positiva em 65/73(89%) das amostras de Staphylococcus spp. Foi encontrado 7/49(14,2%) isolados de S. aureus e 13/24(54,1%) isolados de ECN com presença do gene mec A... / The genus Staphylococcus is involved in both community and hospital-acquired infections, currently standing out as major clinical and epidemiological problems in nosocomial infections. Given the importance of S. aureus as one of the most frequently microorganism isolated from skin and soft tissue infections and the increasing spread of methicillin-resistant S. aureus (MRSA), the aims of this study were to identify the presence of MRSA in wounds of patients treated at basic health units in Botucatu, characterize the cassette chromosome mec (SCCmec) and identify risk factors for acquisition of S aureus and MRSA. The study included 126 isolates from 107 patients treated from March 2010 to February 2011. The samples were identified and the disk diffusion method with cefoxitin and oxacillin disks was carried out in order to detect the resistance to oxacillin. The disk diffusion method was also carried out to set the susceptibility profile for the following antibiotics: penicillin, levofloxacin, clindamycin, erythromycin, gentamicin, sulfamethoxazole/trimethoprim, tigecycline, fusidic acid, quinupristin/dalfopristin, linezolid and vancomycin. mecA positive samples were submitted to SCCmec characterization using multiplex PCR. We also investigated the presence of genes encoding Panton-Valentine Leukocidin (PVL) as far as the - lactamase production. From the 126 samples studied, 73 (58%) were identified as genus Staphylococcus spp., and 49/73 (67.1%) isolates were identified as S.aureus and 24/73 (32.9%) as coagulase-negative Staphylococcus (CoNS). The -lactamase production was positive in 65/73 (89%) samples of Staphylococcus spp. The mecA gene was detected in 7/49 (14.2%) isolates of S. aureus and 13/24 (54.1%) isolates of CoNS. Among MRSA, 4/7 (57.2%) isolates were SCCmec type... (Complete abstract click electronic access below)

Problem detection is a critical component in nursing, such that superior detection could lead to quicker intervention, even if the nature of the problem is not yet clear. A critical problem intensive care nurses typically engage in is detecting the threat of an impending hospital-acquired infection. The purpose of this study was to investigate the effects of the presence of risk factors, expertise, and time pressure on problem detection. The results suggested that time pressure seemed to have a detrimental effect on problem detection, and nurses benefitted from the presence of more risk factors. When not under time pressure, nurses were more sensitive in their problem detection judgments, and only needed one risk factor to trigger problem detection. Experienced nurses were more sensitive to the type of infection at detection, and were more likely to identify the problem correctly after information had been accumulated. These results suggest that problem detection was differentially affected by risk factors based on the presence or absence of time pressure. In addition, experienced nurses took a different approach to problem detection when compared to novices. Finally, problem detection and problem identification can in some situations occur simultaneously, but are distinct processes.

Clostridium difficile infection (CDI) has proven to be a constantly evolving disease periodically posing new diagnostic and clinical dilemmas. Different regions of the world have reported specific local genomic characteristics of the infecting strains, which may be related to variation in disease presentation and outcome. This study was performed to determine the clinical and molecular features of severe, recurrent and community-associated disease in the Lothian region of Scotland, UK among patients diagnosed from August 2010-July 2011. Three hundred and thirty-five patients with laboratory confirmed CDI were studied for epidemiological features, clinical presentation, and laboratory markers. They were followed up for one year to determine recurrence and mortality. Four hundred and thirty-two episodes were recorded. Ribotypes, presence of toxin genes and MLVA subtypes of isolates from these episodes were determined. During the course of the study, PCR ribotype 078 was identified as an important emerging type and concerns of “hypervirulence” were raised when an outbreak was recorded in 2012. This ribotype was studied to compare its clinical and molecular characteristics with other endemic ribotypes and between its own outbreak-related and endemic subtypes. Asymptomatic children were also sampled to determine their role as pools of potential pathogens. Severe episodes accounted for 40.4% of total and 29.3% patients had multiple episodes on record. One-year mortality was 32.8% of which CDI was listed on 25.5% death certificates. Ribotype 078 was confirmed in 6.8% episodes. Community-associated disease was identified in 25.3% patients, which differed significantly from hospital-associated disease in the number of antibiotics and gastrointestinal manipulation prior to CDI. Endemic PCR ribotype 078 caused significantly less recurrent disease and more community- associated disease when compared to the most prevalent ribotype 001. Patients who died from ribotype 078 within 30d had a lower Charlson comorbidity index than ribotype 001 counterparts suggesting that the former may infect healthier patients. MLVA subtyping of ribotype 078 proved useful in identifying epidemiological relationships during the outbreak. CDI had contributed to the death of 50% of all patients infected with the outbreak related ribotype 078 strain compared to 14.3% of those infected with the endemic strains. This study documents the changing epidemiology of CDI in the region and demonstrates differences in epidemic and endemic disease.

Hospital-acquired Legionnaires¡¦ Disease (LD) is a bacterial pneumonia caused by the genus of Legionella. It is an opportunistic pathogen with the characteristic of widespread distribution in the environment. Its source of infection associates with potable water systems. Proactively culturing hospital water supply for Legionella as a strategy for prevention of nosocomial LD has been widely adopted in other countries. Nosocomial LDs has been hardly reported in Taiwan. In addition, environmental cultures of Legionella in potable water systems in hospitals have not been systematically implemented. Thus, the purpose of the research is to confirm if LD presents in the hospital in Taiwan, and developing risk management strategy in hospital-acquired LD. To practice one-year prospective surveillance program for LD, we choose a military hospital in Southern Taiwan, collecting the specimens from the nosocomial and community-acquired pneumonia patients for legionella investigations. In the meanwhile, we collect water samples for hospital epidemiological investigation every 3 months. Isolated Legionella pneumophila is serotyped and analyzed by pulsed-field gel electrophoresis. From Nov 1, 2006 to Oct 30, 2007, within 54 cases of nosocomial and 300 cases of community-acquired pneumonia, only one case of nosocomial LD was found. Environmental investigations detected L. pneumophila in 17(20.7%) of the 84 water samples, of which 82.4% (14/17) belonged to serogroup 1. The result demonstrated the infection source of the only positive case of nosocominal pneumonia is the potable water supply system of another hospital. In conclusion: 1. The infection source of nosocomial LD is the potable water supply system of the hospital. 2. The positive rate of distal outlets for L. pneumophila is a reasonable and reliable indicator in risk management for nosocomial LD. 3. Uncovered cases of nosocomial LD will be found in prospective clinical surveillance for LD. Suggestions: 1. Routine water-quality monitoring should be added in environmental water culture for L. pneumophila in the institution, such as hospital, nursing home, hotel, restaurant, SPA, swimming pool, hot spring, school, army, etc. 2. We advise that government health department carries out national surveillance for hospital water environment in determining the risk of hospital-acquired LD. 3. Education and training program need to be provided for medical staffs in the diagnostic skills of nosocomial LD to avoid misdiagnosing and delaying the treatment.

Orientador: Maria de Lourdes Ribeiro de Souza da Cunha / Banca: Carlos Magno Castelo Branco Fortaleza / Banca: Maria Clara Padoveze / Resumo: O gênero Staphylococcus está envolvido em infecções adquiridas tanto na comunidade como em hospitais, sobressaindo-se atualmente como um dos maiores problemas clínicos e epidemiológicos em infecções nosocomiais. Diante da importância do S.aureus como um dos microrganismos mais freqüentemente isolados de infecções de pele e tecidos moles e a crescente disseminação dos S. aureus resistentes a oxacilina (MRSA), este estudo objetiva identificar a presença de MRSA em feridas de pacientes atendidos em unidades básicas de saúde da cidade de Botucatu, caracterizar o cassete cromossômico mec e identificar fatores de risco para aquisição de S aureus e MRSA. Foram incluídas no estudo 126 amostras isoladas de 107 pacientes atendidos no período de março de 2010 à fevereiro de 2011. As amostras foram submetidas à identificação e detecção de resistência a oxacilina pelo método de difusão com disco de oxacilina e cefoxitina, penicilina, levofloxacina, clindamicina, eritromicina, gentamicina, sulfametazol/Trimetropim, tigeciclina, ácido fusídico, quinupristina/dalfopristina, linezolida e vancomicina. Foi realizada a caracterização do SCCmec por PCR multiplex nas amostras de S. aureus com gene mecA. Foi investigada a presença dos genes codificadores da Leucocidina Panton-Valentine (PVL). As amostras de Staphylococcus spp. também foram submetidas detecção de produção de -lactamase. Das 126 amostras estudadas, 73(58%) foram identificadas como genero Staphylococcus spp., sendo 49/73(67,1%) isolados S. aureus e 24/73(32,9%) estafilococos coagulase-negativa (ECN). A produção de -lactamase foi positiva em 65/73(89%) das amostras de Staphylococcus spp. Foi encontrado 7/49(14,2%) isolados de S. aureus e 13/24(54,1%) isolados de ECN com presença do gene mec A... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The genus Staphylococcus is involved in both community and hospital-acquired infections, currently standing out as major clinical and epidemiological problems in nosocomial infections. Given the importance of S. aureus as one of the most frequently microorganism isolated from skin and soft tissue infections and the increasing spread of methicillin-resistant S. aureus (MRSA), the aims of this study were to identify the presence of MRSA in wounds of patients treated at basic health units in Botucatu, characterize the cassette chromosome mec (SCCmec) and identify risk factors for acquisition of S aureus and MRSA. The study included 126 isolates from 107 patients treated from March 2010 to February 2011. The samples were identified and the disk diffusion method with cefoxitin and oxacillin disks was carried out in order to detect the resistance to oxacillin. The disk diffusion method was also carried out to set the susceptibility profile for the following antibiotics: penicillin, levofloxacin, clindamycin, erythromycin, gentamicin, sulfamethoxazole/trimethoprim, tigecycline, fusidic acid, quinupristin/dalfopristin, linezolid and vancomycin. mecA positive samples were submitted to SCCmec characterization using multiplex PCR. We also investigated the presence of genes encoding Panton-Valentine Leukocidin (PVL) as far as the - lactamase production. From the 126 samples studied, 73 (58%) were identified as genus Staphylococcus spp., and 49/73 (67.1%) isolates were identified as S.aureus and 24/73 (32.9%) as coagulase-negative Staphylococcus (CoNS). The -lactamase production was positive in 65/73 (89%) samples of Staphylococcus spp. The mecA gene was detected in 7/49 (14.2%) isolates of S. aureus and 13/24 (54.1%) isolates of CoNS. Among MRSA, 4/7 (57.2%) isolates were SCCmec type... (Complete abstract click electronic access below) / Mestre

Title: Vietnamese nursing students’ knowledge and attitudes to hospital-acquired infections and hygiene guidelines. Background: Increased hospital-acquired infections are a global concern. Compliance to hygiene guidelines is essential to prevent infections in health care. Knowledge and attitudes are important factors that affect implementations of precautions in health care. Aim: The aim of this study was to describe the knowledge and attitudes of Vietnamese nursing students’ in year 2, 3 and 4 regarding hospital-acquired infections and hygiene guidelines. Method: An empirical cross-sectional study were 2 questionnaires with set responses was answered by 235 nursing students at a Vietnamese university. Result: The result showed that the students’ knowledge was overall at a moderate level. The 3rd year students reported best amount of knowledge, 2nd year the next best and 4th year students reported the lowest. Students’ attitudes regarding hand hygiene were mostly positive. Questions students reported negative attitudes into were regarded priorities due to lack of time and resources, the effort of remember hand hygiene actions and comfort in reminding other health care workers. Students in 4th year were the ones with the least positive attitudes while year 2 and 3 were more equal. Conclusion: The scores on the hand hygiene (HH) knowledge test improved from year 2 to year 3 but decreased in year 4. The amount of positive attitudes in the subject was equal in year 2 and 3 but less positive in year 4. This indicates that infection control training needs to be ongoing during all the education. We also think it should be highlighted to clinical supervisors and other HCWs that they have a responsibility to emphasize the importance of hand hygiene when teaching future nurses.

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Bakgrund: Vårdrelaterad pneumoni är en av de vanligaste vårdrelaterade infektionerna inom svensk sjukvård. Att drabbas av vårdrelaterad pneumoni ökar risken för sjuklighet samt dödlighet. Munvård är en basal omvårdnadsåtgärd som sjuksköterskan ansvarar över. I dagsläget är munvård en åtgärd som genomförs för patientens välbefinnande snarare än som en preventiv åtgärd. När munvård inte utförs kan det leda till förändringar i munhålan som i sin tur ger ökad risk för pneumoni. Syfte: Att undersöka effekterna av munvård som prevention mot vårdrelaterad pneumoni hos patienter inlagda på sjukhus. Metod: En litteraturstudie baserad på åtta kvantitativa interventionsstudier. Databassökningen genomfördes i Cinahl och PubMed. Analysen genomfördes med hjälp av Popenoes analysmodell för att sedan sammanställas till ett resultat. Resultat: I sju av åtta studier minskade insjuknandet av vårdrelaterad pneumoni efter implementering av en munvårdsintervention. Konklusion: Det finns ett samband mellan minskat insjuknande i vårdrelaterad pneumoni och munvårdsinterventioner. För att fastställa munvårdens effekt mot vårdrelaterad pneumoni krävs vidare forskning. / Background: Hospital acquired pneumonia is one of the most common healthcare associated infections in Sweden. Suffering from hospital acquired pneumonia increases the risk of morbidity and mortality. Oral care is basic nursing care. Oral care is often considered a comfort arrangement in caring for patients, rather than a preventive one. The risk of pneumonia increases due to changes in the oral cavity which is a cause of not receiving oral care. Aim: To investigate the effects of oral care as prevention of hospital acquired pneumonia in patients admitted to hospitals. Methods: The analysis was conducted using Popenoe's analysis model. Eight quantitative studies were analyzed, which were identified in the databases PubMed and Cinahl. Using Popenoe´s model a result could be concluded. Results: The analysis of the eight studies presented a decreased incidence of hospital acquired pneumonia in seven studies after an implementation of an oral care intervention. Conclusion: It was found to be a relationship between reduction in the incidence of hospital acquired pneumonia and oral care intervention. In order to determine the effect of oral care due to hospital acquired pneumonia, supplementary research is required.