published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important pathogens affecting the human race in our time. In spite of recent medical advances, our therapeutic choices for MRSA infections remain limited due to the propensity of this organism to develop resistance to antimicrobials. Therefore, there is a continuing need to develop newer methods of treating MRSA infections. This dissertation examines the effects of bacteriophages 88 and 92 on ten clinical isolates of MRSA from the central Florida area. . For the majority of the MRSA isolates, bacteriophages 88 and 92 were unable to induce lysis. However, bacteriophage 88 was found to lyse MRSA Sample 94. Reduced cytotoxicity and apoptosis due to MRSA Sample 94 was also observed. This protective effect was most notable in the 1:10-6 concentration of MRSA 94 and bacteriophage 88. In addition, this effect was observable with both immediate inoculation of the cell culture with the MRSA concurrent with the bacteriophage and with bacteriophage applied one hour after initial inoculation of the MRSA. This effect was likely due to the increased replication of the bacteriophage in the actively growing bacteria found in the 1:10-6 samples. The bacteria in the 1:10-6 concentration were likely more able to replicate in comparison to the higher bacterial concentrations because of less competition between the bacteria for the limited nutrients in the 1:10-6 concentration. The long-term goal of this study is the development of a bacteriophage-containing ointment for the control of MRSA nasal carriage. In addition, the concept of bacteriophage therapy may open a new horizon in controlling infections such as those caused by MRSA. Finally, as for future studies, it would be informative to be able compare these results with other MRSA isolates and bacteriophages samples to examine the effects across a wider sample of bacteria and bacteriophages. In addition, it would be interesting to examine the possibility of being able to modify the bacteriophage in order to allow lysis of the previously resistant bacterial strains.

Bakgrund: Vårdrelaterade infektioner skapar stora påfrestningar i vården på samhälls-,organisations och individnivå. Vårdpersonalens tillämpning och följsamhet tillbefintliga evidensbaserade riktlinjer är det mest effektiva sättet att förbygga VRI. För attsjuksköterskor skall kunna bedriva ett preventivt arbete och möjliggöra en patientsäkervård är det av vikt att undersöka de faktorer som påverkar följsamheten till dessariktlinjer.Syfte: Syftet med litteraturstudien var att beskriva faktorer som kan leda till attsjuksköterskor inte följer evidensbaserade riktlinjer för att förebygga vårdrelateradeinfektioner. Vidare har syftet varit att granska artiklarna avseende dess datainsamlingsmetod.Metod: En deskriptiv litteraturstudie med fjorton artiklar som underlag. Artiklarna haräven granskats utifrån dess datainsamlingsmetodHuvudresultat: Flera olika faktorer samverkar till varför sjuksköterskor inte följerevidensbaserade riktlinjer, där både inre och yttrefaktorer ingår. Tydligt framkommer attsjuksköterskor saknar kunskap och praktiska färdigheter. Sjuksköterskansföreställningar om den egna kapaciteten och den faktiska tillämpningen av riktlinjernaöverensstämmer med verkligheten. Vidare framkom att sjuksköterskornasföreställningar om konsekvenser, där sjuksköterskan har en tendens att minimeraomfattningen av de konsekvenser, som deras handlande eller underlåtelse av handlande,kan medföra.Slutsats: Sjuksköterskor saknar kunskap kring evidensbaserade riktlinjer för attförebygga vårdrelaterade infektioner. Dock finns det flera faktorer som kan förklaravarför inte riktlinjerna efterföljs. / Background: Healthcare associated infections creates great strains in healthcare at asocietal-, organizational- and individual level. Healthcare workers implementation andadherence to existing evidence-based guidelines is the most effective way to preventnosocomial infections. For nurses to conduct preventive work and enabling a safe carefor patients, it is important to examine the cause of deficiencies in adherence to theseguidelines.Aim: The aim of this survey was to describe factors that can explain why nurses do notfollow evidence-based guidelines for preventing healthcare-associated infections.Furthermore, the aim has been to examine the articles regarding the data collection method.Method: A descriptive literature survey based on fourteen articles. Articles have beenexamined in terms of the data collection method.Main result: Several different factors contribute to why nurses do not follow evidence-based guidelines, where both internal and external factors interact. It’s clearly revealedthat nurses lack knowledge and practical skills. Nurses' beliefs about their own capacityand actual application of the guidelines correspond poorly with reality. It has alsoemerged that according to the nurses' beliefs about consequences, the nurse has atendency to minimize the extent of the consequences of their act or omission of action. Conclusion: Nurses lack knowledge about evidence-based guidelines for preventinghealthcare-associated infections. However, there are several factors that could explainwhy the guidelines are not applied.

Les spores fongiques sont à l'origine d'infections nosocomiales affectant le pronostic vital de patients immunodéprimés, et peuvent se transmettre par l'air. C'est pourquoi nous nous sommes intéressé à la déposition et au réenvol de spores d'"Aspergillus", responsables de pathologies gravissimes comme l'aspergillose pulmonaire invasive. Nous avons lors de nos expérimentations utilisé deux méthodes d'aérosolisation : le nébuliseur Collison standard, nécessitant la mise en solution des spores, ainsi qu'un prototype permettant de souffler directement sur les cultures fongiques Ceci nous a permis de mesurer la vitesse de sédimentation des spores, et d'évaluer l'efficacité et la rémanence de traitements fongicides en utilisant un protocole original mettant en œuvre des conditions réalistes.Un dispositif expérimental a été mis au point afin de soumettre des spores déposées sur une surface à un flux d'air tangentiel, et de filmer leur réenvol ( http://tinyurl.com/bla9ynz ), et un critère prédictif théorique de détachement a été exhibé. Des simulations numériques de l'écoulement autour de sphères idéales ont complété cette étude en nous donnant accès à des paramètres critiques inaccessibles expérimentalement.Nous avons finalement appliqué les résultats de nos investigations à la problématique des infections nosocomiales aérotransmises, et découvert que les ventilateurs de refroidissement d'appareils électroniques sont un réservoir de pathogènes et une source de contamination croisée potentielle. Des expériences en milieu contrôlé associées à une campagne de prélèvements en milieu hospitalier ont mis à jour ce nouveau et important risque de contamination.

Darbo tikslas- įvertinti hospitalinės infekcijos paplitimą bei valdymo galimybes rajonų ir apskričių ligoninėse. Uždaviniai: 1) įvertinti hospitalinių infekcijų struktūrą ir paplitimą Lietuvos rajonų ir apskričių ligoninėse, 2) nustatyti ir palyginti rizikos veiksnius ir objektus rajoninėse ir apskričių ligoninėse, 3) teikti pasiūlymus hospitalinių infekcijų valdymo tobulinimui. Tyrimo metodika. Tyrimo objektai –bendrosios chirurgijos, ortopedijos- traumatologijos, reanimacijos- intensyvios terapijos, akušerijos – ginekologijos skyriai. Hospitalinių infekcijų paplitimas įvertintas 4 rajonų ligoninėse ir 2 apskričių ligoninėse. Tyrimas buvo atliekamas naudojantis hospitalinių infekcijų registravimo protokolais, kurie buvo ligos istorijose. Už 2005 m. ištirta 2002 hospitalinių infekcijų atvejai. Duomenys apie hospitalinės infekcijos atvejus buvo gretinami su įrašais hospitalinių infekcijų žurnaluose ir pranešimais Visuomenės sveikatos centruose. Tyrimo duomenų matematinė ir statistinė analizė atlikta, naudojantis skaičiuoklės Microsoft EXCEL statistinėmis funkcijomis bei uždavinių analizės posistemės “Data Analysis”funkcijomis. Rezultatai: Tyrime dalyvavusių rajonų ligoninėse hospitalinių infekcijų paplitimas 3,1%; 3,2%; 2,8%; 3,3%, o apskričių – 4,0%; 4,6%. Rizikos veiksnių paplitimas : operacija 24%; intraveninė priemonė 22,9% ; pneumonija 16,8 %, kitos kvėpavimo takų infekcijos 13,9 %. Hospitalinių infekcijų atvejai registracijos žurnaluose ir VSC tirtose rajonų... [toliau žr. visą tekstą] / Aim: to assess the incidence of nosocomial infections and possibilities of their management in district and county hospitals. Objectives: 1) to assess the incidence and structure of nosocomial infections in district and county hospitals in Lithuania, 2) to determine and compare the risk factors of nosocomial infections in district and county hospitals, 3) to develop proposals for the improvement of nosocomial infection management. Methodology. The analysis was carried out in 4 district and 2 county hospitals, at the departments of general surgery, orthopedics and traumatology, reanimation and intensive therapy, obstetrics and gynaecology.. Nosocomial infection registration records presented in case histories served as a primary source of information. 2002 cases of nosocomial infections that occurred in 2005 were investigated. The data of the cases of nosocomial infections were compared with the records in nosocomial infection registers and reports in Public Health Centres. Statistical analysis of the research data was performed applying statistical functions of the Microsoft EXCEL spreadsheet and the functions of the task analysis subsystem Data Analysis. Results: The incidence of nosocomial infections was 3.1%, 3.2%, 2.8%, and 3.3% in the district hospitals, and 4.0%, 4.6% in the county hospitals. The major risk factors were surgery (24%), intravenous implement (22.9%), pneumonia (16.8%), and other respiratory infections (13.9%). The cases of nosocomial infections... [to full text]

Darbo tikslas – atlikti sergamumo hospitalinėmis infekcijomis, jų rizikos veiksnių, hospitalinių infekcijų sąlygoto mirštamumo bei ekonominį įvertinimą Lietuvos vaikų intensyviosios terapijos skyriuose. Tikslui pasiekti iškelti šie uždaviniai: 1) ištirti sergamumą hospitalinėmis infekcijomis, nustatyti dažniausią jų lokalizaciją bei sukėlėjus; 2) įvertinti hospitalinių infekcijų rizikos veiksnius; 3) nustatyti sergamumo bei rizikos įgyti hospitalines infekcijas pokyčius, įdiegus intervencijos programą; 4) įvertinti hospitalinių infekcijų ir ligos baigties sąsajas; 5) įvertinti hospitalinę infekciją įgijusių ir neįgijusių tiriamųjų gulėjimo trukmę bei gydymo išlaidas ir apskaičiuoti gulėjimo trukmės pailgėjimo dėl įgytos hospitalinės infekcijos sąlygotas išlaidas; 6) įvertinti intervencijos metodo ekonominę naudą, išvengus hospitalinės infekcijos. Perspektyvusis analitinis stebėjimo tyrimas vyko Lietuvos vaikų intensyviosios terapijos skyriuose 2003 - 2007 m. Į tyrimą įtraukti visi nuo 1 mėn. iki 18 m. amžiaus ligoniai, kurie gydėsi VITS > 48 val. Iš viso dalyvavo 1831 tiriamasis. Tyrimo duomenimis, sergamumas hospitalinėmis infekcijomis sudarė 15,0 atvejų 100-ui ligonių arba 24,5 atvejo 1000-čiui lovadienių. Sukurtas ir išbandytas unikalus ventiliacinės pneumonijos profilaktikos priemonių paketas. Išnagrinėtos hospitalinės infekcijos ir ligos baigties sąsajos bei ekonominiai šios problemos aspektai, remiantis šalyje patvirtintais vaikų reanimacijos paslaugų įkainiais... [toliau žr. visą tekstą] / The objectives of the study were as follows: 1) to investigate and to assess the incidence rates of nosocomial infections, their distribution by site and causative microorganisms; 2) to assess the risk factors of nosocomial infections; 3) to evaluate the changes of the risk of acquisition of nosocomial infections and the changes of the incidence of nosocomial infections after the implementation of the intervention programme; 5) to assess the association between nosocomial infection and outcomes; 6) to evaluate the increase of length of stay and the costs of patients with and without nosocomial infections, and to calculate the cost of single case of nosocomial infection and single patient with noscomial infection; 7) to make cost-benefit analysis of the intervention programme. The prospective surveillance study was carried out between March 2003 and December 2007. The paediatric intensive care unit patients aged between 1 month and 18 years and stayed in the units for more than 48 hours were eligible for inclusion in this study. The incidence of 15.0 cases per 100 patients and incidence density of 24.5 cases per 1000 patient-days was observed. Also the unique intervention programme was designed and implemented, which resulted in significant decrease of the incidence rates. No mortality attributable to nosocomial infections was found in the study. The minimal direct costs due to increase in length-of-stay was calculated in the study, as well as benefit of the intervention... [to full text]

This thesis presents results from three studies conducted in a veterinary teaching hospital (VTH). Study 1 retrospectively examined a collection of enterococci from clinical infections. Five recurring strains of Enterococcus faecium, and one strain of Enterococcus faecalis were identified using pulsed-field gel electrophoresis (PFGE) as causing clinical infections. Study 2 examined the gastrointestinal tract enterococci as a source of enteroccocal infections in dogs. Enterococcal catheter-associated bacteriuria (CA-bacteriuria) rate was 8%. In 3 of 4 sets of bacteriuria and rectal isolates, CA-bacteriuria isolates were indistinguishable from rectal isolates suggesting that the patient’s fecal enterococci represented the infection source. In all 3 sets of wound and rectal isolates, fecal carriage of the infection isolate was observed. Study 3 examined the prevalence of bacterial species and the overall CA-bacteriuria rate. CA-bacteriuria rate was 24%, with Enterococcus spp., E. coli, Staphylococcus spp., Streptococcus spp. and Enterobacter spp., as the most prevalent bacteria in listed order. / PetTrust

Emerging multidrug-resistant tuberculosis (MDR/XDR-TB) has become a major public health problem, placing millions at risk. Further, nosocomial transmission of MDR/XDR-TB places both patients and healthcare workers at an even higher risk. Effective tuberculosis (TB) infection prevention and control (IPC) policies in high-risk settings must use evidence-based science and should be customized to the setting. However, the growing incidence of MDR/XDR-TB in some global settings raises questions about whether adequate healthcare-related TB IPC policies are in place and whether they are implemented effectively. The purpose of this systematic literature review was to catalogue healthcare-related TB IPC policy research conducted in high-prevalence settings and draw a picture of existing evidence-based TB IPC policies and their implementation, with a focus on preventing and controlling nosocomial transmission of MDR/XDR-TB. Two databases (PubMed and Embase) were searched from 1990 – 2013 and outputs were categorized by region/country, income, MDR/XDR-TB incidence, level of IC intervention, and time period. None of the 20 captured research studies were conducted in TB high-prevalence, low-income settings. Most (12/20) were implemented within the Pan American Health Organization region, followed by the African (4/20) and European (4, 20%) regions. Most studies reviewed (70%) were undertaken because of an outbreak and most (70%) were published between 1990 – 2000. This systematic literature review showed a gap in research on TB IPC policies addressing nosocomial transmission of MDR/XDR-TB in high-prevalence, low-income settings. TB IPC policy development and implementation should be routinely undertaken as a part of effective and efficient public health practice. Development of TB IPC global best practices should be guaranteed and a concerted effort to promote, distribute, train, and implement these TB IPC best practices in low-resource countries would help mitigate the growing incidence of MDR/XDR-TB worldwide.

Background Hospital-acquired infections are significant cause of morbidity and mortality among hospitalized patients worldwide. Healthcare workers during job are exposed to blood borne pathogens through contact with infected body parts, blood and body fluids. World health organization (WHO) estimated that globally about 2.5% of HIV and 40% of hepatitis viral infected cases are among health workers due to exposures. The most important mechanism of spread of these pathogens is through contaminated hands of the healthcare workers. Standard precautions measures are essential to prevent and control healthcare associated infection among healthcare workers and patients. In developing countries despite the development of detailed guideline for infection control the knowledge of standard precautions is low and not properly applied. The aim of this study is to assess the knowledge and practice of health care workers regarding standard precautions and hand hygiene to infectious disease control.  Aim The aim of this study was to assess the knowledge and practice of health care workers regarding hand wash and standard precautions to control infectious diseases in BMCH. In addition create awareness among participants and encourage them to practice regularly hand hygiene and standard precautions to control or reduce nosocomial infections in health care facilities Methods The study design is cross-sectional evaluation of healthcare worker knowledge and practices about standard precautions and hand hygiene for infectious disease control. A questionnaire administered to health care workers (doctors and nurses). The questionnaire was divided in two parts and the first part concerns demographic information, asking knowledge and practice. The second part asked opinions about risk and prevention of HAIs. The questionnaire was developed with consultation of other studies of the same kind. It has been pre tested and is finalized for survey. The ethical approval was given by hospital superintendent and informs consent from all study participants. Statistic analysis was done on Excel and statistical software SPSS version 20. Data was described in numbers, percentages and Chi Square test done for association among categorical variables, significant level was considered P= <0.05. Results Two hundred questionnaires were distributed to HCWs in BMCH and 169 completely fill questionnaire were returned. The male gender respondents were 42% and female respondents were 58%. The basic questions about knowledge of hand hygiene and standard precautions were answered well in both categories; about 73% were with sufficient knowledge. The practice of hand hygiene and standard precautions was not satisfactory among both categories; about 47% found with good practice. Differences found in sub groups, young age none trained doctors and nurses answered wrong and shown lack of knowledge. This study found an association of age, profession and job experience with knowledge and practice regarding hand hygiene and standard precautions. Open handed questions described well the major issue regarding HAIs and participants emphasized on risk and prevention methods.  Conclusions The respondents were HCWs (doctors and nurses) of both sex and this study found that majority of HCWs have good knowledge and practice about control of HAIs but difference were found in age groups, sex and profession. Above half of the HCWs were not trained for infection control in health facilities, thus getting training of infection control is important but more important is implementation of it during practice.

Bakgrund: Ett flertal studier visar på att följsamhet i handhygien bland sjukvårdspersonal är låg. Syfte: Den föreliggande studien syftade till att identifiera vilka hinder som försvårar följsamheten i handdesinfektion för sjuksköterskor och undersköterskor. Metod: Undersökningen utfördes på tre slumpmässigt utvalda vårdavdelningar på ett sjukhus i Mellansverige i mars 2014. Sjuksköterskor och undersköterskor besvarade en enkät som konstruerats för studien. Resultat: Av studiens tilltänkta undersökningsgrupp (n=110) svarade 70 vilket motsvarar en svarsfrekvensen på 64 %. Resultatet visar att det var vanligare att desinfektera händerna efter patientkontakt än före.  Det som i störst utsträckning angavs som hinder till att utföra handdesinfektion var tidsbrist och brist på tillgängligt handdesinfektionsmedel. Sjuksköterskor angav att de utför handdesinfektion i lägre utsträckning till följd av brist på tillgängligt handdesinfektionsmedel än undersköterskorna. Vidare framkom att de med kortare arbetserfarenhet än genomsnittet (14,3 år) angav i större utsträckning än de med längre arbetserfarenhet att de inte utförde handdesinfektion. Slutsats: Vårdpersonal uppger att det är vanligare att desinfektera händerna efter patientkontakt än före, liksom att tidsbrist och brist på tillgängliga handdesinfektionsmedel utgör tydliga hinder för god följsamhet i handdesinfektion. Den föreliggande studien medför kunskap kring hinder och kan även utgöra inspiration inför framtida studier som syftar till att identifiera andra hinder, då det visat sig att dessa kan variera mellan olika vårdinrättningar. För att interventioner med syfte att förbättra handhygien ska bli framgångsrika krävs det att de specifika hindren först identifieras. / Background: Several previous studies show that compliance with hand disinfection is low among medical staff. Aim: This study, therefore, aims to investigate what factors make it difficult for registered nurses and certified nursing assistants to comply with use of hand disinfection.    Methods: A survey was carried out at three randomly selected wards at a hospital in Sweden in March 2014. A questionnaire was developed and answered by registered nurses and certified nursing assistants. Results: The study received 70 replies out of the 110 questionnaires distributed – a response rate of 64%. The results show that it was more common to disinfect after than before contact with a patient. The main reasons for not disinfecting their hands were lack of time and availability of hand disinfection agents. The results also show that it was more prevalent among the registered nurses than the certified nursing assistants to skip the disinfection if the hand disinfection agent was not available. Furthermore the results showed that the senior staff, which had more than 14.3 years of practise, were better at disinfecting their hands than their less experienced colleagues. Conclusions: Medical staff report that it is more common to disinfect their hands after than before patient contact. The lack of time and availability of hand disinfection are obvious factors that influence compliance. This study highlights the need for awareness and may encourage future studies aiming at identifying other possible factors, since there is variation between wards. Interventions with the purpose to increase compliance with hand disinfection need to be adapted to these specific circumstances.