Made available in DSpace on 2016-08-10T10:55:35Z (GMT). No. of bitstreams: 1 VANUSA CLAUDETE ANASTACIO USIER LEITE.pdf: 665457 bytes, checksum: 4cb613e88a613ece729f5d64a6eaef9d (MD5) Previous issue date: 2009-08-26 / Nosocomial infection is a problem found all over the world, being responsible for the increase of morbidity and mortality worldwide. The objective of this study is: to know the social representation (SR) of the nosocomial infection (NI) for nurses and physician who work in the intensive care unit (ICU), aiming to discover the aspects that are probably related to the adoption or not of preventive conducts against nosocomial infection. This is a transversal study carried out in hospitals of Goiania city in the years of 2007 and 2008. A hundred nurses and physicians that worked in ICU participated in the study. It was executed in two stages. In the first one, an instrument with three questions that had different approaches to the theme was elaborated: the first question evokes specifically the theme of nosocomial infection; the second is to identify the five main risk factors related to nosocomial infection found in ICU; based on the answers emitted by the concerning subjects of the second question, it was solicited in the third question that the subjects explained why they considered the two first answers, of question number two, as an important risk factor for NI. The answers to the first questioning were processed in the EVOC software, after the construction of a data base, preparation of which was preceded by the organization of the dictionary containing words brought forward by the subjects. The answers to the second and the third questions were categorized according to groups in which the significance of frequency resembled. After this stage, with the intent of verifying the centrality of the elements identified in the first stage of the study, a second instrument was built from the subjects' speech regarding the main risks of NI in ICU. This instrument consists of two questions: the first is in the form of the Likert School; and the second made with nine items and three alternatives. A table was built at the end of this stage containing the frequency of the variables. After the creation of a dada bank using the Excel software, for the first question the dada were transferred to the SPSS Version 16 software and for the second question a graphic of lines was created. Results: the words hand washing (46%), gravity / immunosuppression (43%), multiresistante bacteria (29%) and invasive procedures (18%) appeared in the evoking question, which are central in the representation. The majority of the professionals that participated in the study pointed out the hand washing (42%), immunodepression / gravity of the case (41%) and the existence of a multiresistante microorganism (39%) as the main risk factors for NI. Conclusion: In this context, the structural study of the social representation of nosocomial infection allows us to formulate a hypothesis where the subjects elaborated a evaluative type of thinking that show some risk factors that don t annul themselves completely by washing the hands, in spite of the fact that the subjects adopted the belief in which the hygienic cleaning of the hands is a determining factor of prevention. / As infecções hospitalares são problemas encontrados em todo o mundo, sendo responsáveis pelo aumento da morbidade e mortalidade. Este estudo tem por objetivo: conhecer a representação social (RS) de infecção hospitalar, para enfermeiros e médicos que trabalham em UTI, buscando identificar os aspectos provavelmente relacionados à adoção ou não de condutas preventivas contra a infecção hospitalar. Trata-se de um estudo transversal realizado em hospitais da cidade de Goiânia no ano de 2007 a 2008. Participaram do estudo 100 (cem) enfermeiros e médicos que trabalham em UTI. O estudo foi realizado em duas etapas. Na primeira, foi elaborado um instrumento com três perguntas com abordagens diferentes ao tema: a primeira com questão de evocação ao tema Infecção Hospitalar (IH), especificamente. A segunda para identificar os cinco principais fatores de risco relacionados com infecção hospitalar encontrados em UTI. Com base nas respostas emitidas pelos sujeitos referentes à segunda questão, foi solicitado, na terceira questão, que os sujeitos explicassem por que consideravam as duas primeiras respostas, da questão de número dois, como um importante fator de risco para IH. As respostas ao primeiro questionamento foram processadas no software EVOC, após a construção do banco de dados, cuja preparação foi precedida da organização do dicionário contendo palavras produzidas pelo sujeito. As respostas a segunda e a terceira questão foram categorizadas conforme grupos de semelhança de seu significado de freqüência. Após essa etapa, com intuito de verificação da centralidade de elementos identificados na primeira fase do estudo, um segundo instrumento foi construído a partir das falas dos sujeitos acerca dos principais fatores de risco para IH em UTI. Esse instrumento constou de duas questões: a primeira na forma de Escala de likert, a segunda foi feita com nove itens e três alternativas. Ao término dessa etapa foi construída uma tabela contendo as freqüências das variáveis, após a criação de um banco de dados utilizando o programa de software Excel, onde os dados foram transferidos para o programa do software SPSS Versão 16, para a primeira questão e criação de gráfico de linha , para a questão de caracterização. Resultados: na questão de evocação aparecem as palavras lavagem das mãos (46%), gravidade / imunosupressão (43%), bactérias multiresistentes (29%) e procedimentos invasivos (18%), as quais são centrais na representação. A maioria dos profissionais que participaram do estudo apontou a lavagem das mãos (42%), imunodepressão / gravidade do caso (41%) e a existência de microrganismos multiresistentes (39%) como os principais fatores relacionados ao fator de risco para IH. Conclusão: Nesse contexto, o estudo estrutural das RS de IH nos permite formular a hipótese que, apesar dos sujeitos adotarem a crença da higienização das mãos como fator determinante de prevenção, os sujeitos elaboram um raciocínio do tipo avaliativo que apontam alguns fatores de risco que não se anulam completamente pela lavagem das mãos.

Introdução: Entre os possíveis Eventos Adversos (EA) mais importantes após cirurgias de catarata estão a endoftalmite, termo que define a infecção intraocular e a Síndrome Tóxica do Segmento Anterior (TASS), que consiste na reação inflamatória aguda pós-cirúrgica. Contudo, um sistema de vigilância epidemiológica (VE) da ocorrência destes EA não é uma realidade no Brasil, o que dificulta o monitoramento da incidência, detecção precoce de surtos e as medidas de prevenção. Devido as especificidades no campo da oftalmologia, nem sempre o enfermeiro está suficientemente instrumentalizado para contribuir na detecção e monitoramento de casos. A identificação de marcadores destes EA factíveis de serem acompanhados por este profissional irá favorecer o desenvolvimento de um sistema de VE. Objetivo: Identificar os marcadores mais adequados para o diagnóstico epidemiológico de EA após cirurgias de catarata visando à instituição de um sistema de VE específico. Métodos: Trata-se de um estudo longitudinal de série de casos de pacientes submetidos a cirurgias de catarata, realizado em duas etapas. Etapa I: abordagem retrospectiva por meio de revisão de prontuários dos pacientes com diagnóstico de EA (21 casos) no período de abril/2010 a fevereiro/2013. Etapa II: abordagem prospectiva por meio de revisão de prontuários dos pacientes submetidos à cirurgia de catarata sem EA (309 controles) nos meses de maio e junho/ 2013. A amostra baseou-se em um teste de proporções entre duas amostras assumindo que a amostra de controles seria 15 vezes maior que a de casos para detectar uma diferença de pelo menos 35 pontos percentuais na incidência da apresentação de características clínicas entre os dois grupos com erro tipo I de 5% e poder do teste de 90%. As variáveis pesquisadas foram os sinais e sintomas característicos do pós-operatório de cirurgias de catarata bem como informações demográficas e clínicas destes pacientes. Foi realizada estatística descritiva por meio de frequências relativas e absolutas. Resultados: Pacientes com EA apresentaram o diagnóstico de endoftalmite e TASS, respectivamente, em 19 (90,5%) e dois casos (9,5%). Dentre os casos, os sinais mais observados foram: córnea nebulosa, reação de câmara anterior (RCA), edema de córnea (>70%) e hipópio, hiperemia conjuntival, turvação vítrea e dobras na membrana Descemet (>40%). Dor ocular foi o sintoma relatado por 14 (66,7%) dos pacientes. Dentre os controles, no primeiro dia após a cirurgia os sinais mais apresentados (>50%) foram: RCA, edema de córnea, hiperemia conjuntival e dobras na Descemet. Córnea nebulosa e edema palpebral em mais que 30% dos pacientes. Os sinais e sintomas que apresentaram diferença maior que 35% entre os casos e controles foram: presença de hipópio, vítreo turvo, córnea nebulosa. RCA, hiperemia conjuntival, edema de córnea e dor ocular. A incidência de aplicação de antibiótico intra-vítreo e número de retornos foram maiores entre os casos do que nos controles. Uma ferramenta para auxiliar no sistema de VE foi sugerida a partir dos resultados obtidos no presente estudo. Conclusões: Os marcadores clínicos e epidemiológicos considerados mais adequados para compor uma ferramenta para VE foram: dor, edema de córnea, hiperemia conjuntival, hipópio, RCA, vítreo turvo, aplicação de antibiótico intra-vítreo e número de retornos. A ferramenta proposta por este estudo tem potencialidade para subsidiar a atuação do enfermeiro no sistema de VE de EA para cirurgias de catarata. / Introduction: Amongst the most important possible Adverse Events (AE) after cataract surgeries, are the endophthalmitis, a term which defines the intraocular infection and the Toxic Anterior Segment Syndrome (TASS), which is the acute inflammatory post-surgical reaction. However, an epidemiological surveillance (ES) system of these AE isnt a reality in Brazil, which makes difficult the incidence monitoring and early detection of outbreaks and preventive measures. Due to specifics in ophthalmology, nurses are not always enable to detect and monitoring the cases. The identification of markers of these AE achievable to be monitored by nurses will facilitate the development of an epidemiological ES system. Objective: Identifying most suitable markers for epidemiological diagnosis of AE after cataract surgeries aiming at the establishment of a specific ES system. Methods: This is a longitudinal case series study of patients who underwent cataract surgery performed in two phases. Phase I: a retrospective approach through reviews of medical records of patients that were diagnosed with AE (21 cases) from April/2010 to February/2013. Phase II: prospective approach through reviews medical records of patients without AE (309 controls) in the months of May and June of 2013. The sample size was based on a test of proportion between 2 samples assuming that control sample would be 15 times greater than of the cases to detect a difference of at least 35 percentage points in the incidence of clinical characteristics between the two groups, with type I error of 5% and power of testing of 90%. The variables studied were signs and symptoms of the post-operative presentation of cataract surgeries as well as demographic information and clinics of these patients. A descriptive statistics was carried out by using relative and absolute frequencies. Results: Patients with EA were diagnosed with endophthalmitis and TASS, respectively, in 19 (90,5%) and two cases (9,5%). Among cases, the signs most frequently observed were: corneal nebulosity, anterior chamber reaction (ACR), corneal edema (>70%), and hypopyon, conjunctival hyperemia, vitreous haze e Descemet\'s membrane folds (DMF) (>40%). Ocular pain was reported by 14 (66,7%) of patients. Amongst controls, on the first day after surgery the most frequent signals (>50%) were: ACR, corneal edema, conjunctival hyperemia and DMF. Corneal nebulosity and eyelid edema in more than (30,0%) patients. The signs that showed a difference greater than 35% between the cases and controls were: hypopyon, vitreous haze, corneal nebulosity, ACR, conjunctival hyperemia, corneal edema, and eye pain. The incidence of intravitreal antibiotic injection and the number of medical consultation returns were bigger amongst the cases than in the controls. A tool to assist in the ES system was suggested from the results obtained in the present study. Conclusions: The clinical and epidemiological markers considered the most adequate to form a tool for ES is: ocular pain, corneal edema, conjunctival hyperemia, hypopyon, ACR, vitreous haze, intravitreal antibiotic injection and the number of returns. The tool suggested by this study has the potential to support the nurses roles related to ES system for monitoring EA in cataract surgeries.

by Chan Ping Lung. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (leaves 108-118). / Abstracts in English and Chinese. / Abstract (in Chinese) --- p.ii / Abstract (in English) --- p.iv / Acknowledgements --- p.vii / Table of Contents --- p.viii / List of Tables --- p.xiii / List of Figures --- p.xiv / List of Appendices --- p.xv / List of Abbreviations --- p.xvi / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Epidemiology of catheter associated infections --- p.1 / Chapter 1.1.1 --- Catheter associated infections --- p.1 / Chapter 1.1.2 --- Risk and mortality of CAI --- p.2 / Chapter 1.1.3 --- Etiology of CAI --- p.3 / Chapter 1.1.3.1 --- Venous catheters --- p.4 / Chapter 1.1.3.2 --- Urinary catheters --- p.4 / Chapter 1.2 --- Pathogenesis of CAI --- p.5 / Chapter 1.2.1 --- Central venous catheters (CVC) --- p.6 / Chapter 1.2.2 --- Urinary catheters --- p.7 / Chapter 1.3 --- Adhesion mechanisms --- p.7 / Chapter 1.3.1 --- Definition of adhesion --- p.7 / Chapter 1.3.2 --- Adhesion mechanism --- p.8 / Chapter 1.3.2.1 --- The phase one --- p.8 / Chapter 1.3.2.2 --- The phase two --- p.10 / Chapter 1.4 --- Catheters --- p.10 / Chapter 1.5 --- Biology of Candida albicans --- p.11 / Chapter 1.5.1 --- Taxonomy of Candida albicans --- p.11 / Chapter 1.5.2 --- Morphology --- p.12 / Chapter 1.5.3 --- Genome --- p.13 / Chapter 1.5.4 --- Biology of Candida albicans cell wall --- p.14 / Chapter 1.5.4.1 --- Constituting molecules of Candida albicans cell wall --- p.14 / Chapter 1.5.4.2 --- Organization of Candida albicans cell wall --- p.15 / Chapter 1.6 --- Agglutinin like sequence gene family --- p.16 / Chapter 1.6.1 --- Gene structure of agglutinin like sequence genes --- p.16 / Chapter 1.6.2 --- Sequence similarity --- p.17 / Chapter 1.6.3 --- Sequence variability --- p.18 / Chapter 1.6.4 --- Expression of ALS genes --- p.19 / Chapter 1.6.5 --- The Als proteins --- p.20 / Chapter 1.6.6 --- Functions of Als proteins --- p.21 / Chapter 1.7 --- Adhesion assay --- p.23 / Chapter 1.7.1 --- Adhesion model --- p.24 / Chapter 1.7.2 --- Factors affecting static adhesion model --- p.25 / Chapter 1.7.3 --- Quantitation methods of adherent cells --- p.27 / Chapter 1.7.3.1 --- Sonication --- p.27 / Chapter 1.7.3.2 --- Staining methods --- p.28 / Chapter 1.7.3.3 --- ATP bioluminescence --- p.28 / Chapter 1.8 --- Research model --- p.29 / Chapter Chapter 2 --- Aim of study --- p.31 / Chapter Chapter 3 --- Materials and Methods --- p.32 / Chapter 3.1 --- Preparation of bacteriological reagents --- p.32 / Chapter 3.2 --- Confirmation of identity of Candida albicans and of Saccharomyces cerevisiae --- p.33 / Chapter 3.3 --- Cell culture of fibroblasts --- p.36 / Chapter 3.3.1 --- Preparation of cell culture reagents --- p.36 / Chapter 3.3.2 --- Recovery of freezing fibroblasts --- p.37 / Chapter 3.3.3 --- Establishment of cell line --- p.37 / Chapter 3.4 --- Preliminary study of adherence of Candida albicans to fibroblasts and to catheters --- p.38 / Chapter 3.4.1 --- Adherence to fibroblasts --- p.38 / Chapter 3.4.1.1 --- Preparation of fibroblasts --- p.38 / Chapter 3.4.1.2 --- Preparation of culture of Candida albicans and of Saccharomyces cerevisiae --- p.39 / Chapter 3.4.1.3 --- Adhesion assay --- p.41 / Chapter 3.4.2 --- Adherence to catheters --- p.42 / Chapter 3.4.2.1 --- Preparation of catheters --- p.42 / Chapter 3.4.2.2 --- Adhesion assay --- p.42 / Chapter 3.5 --- "Confirmation of expression of ALS1, ALS5 smaller allele, and ALS6 of Candida albicans in YPD broth" --- p.44 / Chapter 3.5.1 --- RNA extraction of Candida albicans --- p.45 / Chapter 3.5.2 --- "RT-PCR of ALS1, ALS5 smaller allele, and ALS6" --- p.46 / Chapter 3.5.2.1 --- Primers --- p.46 / Chapter 3.5.2.2 --- RT-PCR --- p.47 / Chapter 3.6 --- Establishment of quantitation system of adhesion assay --- p.49 / Chapter 3.6.1 --- Absorbance measurement of Candida albicans stained with safranin --- p.49 / Chapter 3.6.1.1 --- Preparation of Candida albicans culture --- p.49 / Chapter 3.6.1.2 --- Staining of Candida albicans --- p.50 / Chapter 3.6.1.3 --- Viable count of Candida albicans adhered on the 6-well plate --- p.51 / Chapter 3.6.2 --- ATP bioluminescence --- p.52 / Chapter 3.7 --- Effect of inoculum size on adhesion to catheters --- p.53 / Chapter 3.7.1 --- Preparation of adhesion chambers --- p.53 / Chapter 3.7.2 --- Preparation of catheters --- p.54 / Chapter 3.7.3 --- Preparation of Candida albicans culture --- p.54 / Chapter 3.7.4 --- Adhesion assay --- p.55 / Chapter 3.8 --- "Transformation of Saccharomyces cerevisiae with ALS1, ALS5 smaller allele, and ALS6" --- p.57 / Chapter 3.8.1 --- DNA extraction of Candida albicans --- p.58 / Chapter 3.8.2 --- "PCR of ALS1, ALS5 smaller allele, and ALS6" --- p.59 / Chapter 3.8.3 --- Gel extraction --- p.60 / Chapter 3.8.4 --- Restriction digestion of PCR products of ALS genes and cloning plasmids --- p.61 / Chapter 3.8.5 --- "Ligation of ALS1, ALS5 smaller allele, ALS6 with pYES6CT cloning plasmids" --- p.62 / Chapter 3.8.6 --- Transformation of ligated plasmid into Escherichia coli --- p.63 / Chapter 3.8.7 --- Miniprep of plasmids --- p.64 / Chapter 3.8.8 --- DNA sequencing --- p.65 / Chapter 3.8.9 --- Transformation of Saccharomyces cerevisiae --- p.66 / Chapter 3.8.10 --- "Detection of Alsl，Als5, and Als6 protiens expression" --- p.68 / Chapter 3.8.10.1 --- Preparation of cultures in SC synthetic medium --- p.68 / Chapter 3.8.10.2 --- Protein extraction --- p.69 / Chapter 3.8.10.3 --- Dot blot of cell wall lysates --- p.69 / Chapter 3.9 --- Adhesion of transformed Saccharomyces cerevisiae to fibroblasts --- p.71 / Chapter 3.9.1 --- Preparation of fibroblasts and of Saccharomyces cerevisiae cultures --- p.71 / Chapter 3.9.2 --- Adhesion assay --- p.72 / Chapter 3.10 --- "Adhesion of transformed Saccharomyces cerevisiae to FEP, polyurethane, and silicone catheters" --- p.72 / Chapter 3.10.1 --- "Preparation of catheters, adhesion chambers and transformed Saccharomyces cerevisiae cultures" --- p.73 / Chapter 3.10.2 --- Adhesion to catheter fragments --- p.73 / Chapter 3.11 --- Statistical analysis --- p.74 / Chapter Chapter 4 --- Results --- p.75 / Chapter 4.1 --- Confirmation of identity of Candida albicans and of Saccharomyces cerevisiae --- p.75 / Chapter 4.1.1 --- Candida albicans --- p.75 / Chapter 4.1.2 --- Saccharomyces cerevisiae --- p.75 / Chapter 4.2 --- Cell culture of fibroblasts --- p.76 / Chapter 4.3 --- "Preliminary studies of adherence of Candida albicans to fibroblasts and to FEP, polyurethane, and silicone catheters" --- p.76 / Chapter 4.3.1 --- Adherence to fibroblasts --- p.76 / Chapter 4.3.2 --- Adherence to catheters --- p.77 / Chapter 4.4 --- "Confirmation of expression of ALSl, ALS5 smaller allele, and ALS6 of Candida albicans in YPD broth" --- p.78 / Chapter 4.5 --- Establishment of quantitation system of adhesion assay --- p.79 / Chapter 4.5.1 --- Absorbance measurement of Candida albicans stained with safranin --- p.79 / Chapter 4.5.2 --- ATP bioluminescence --- p.79 / Chapter 4.6 --- Effect of inoculum size on adhesion to catheters --- p.80 / Chapter 4.7 --- "Transformation of Saccharomyces cerevisiae with ALS1, ALS5 smaller allele, and ALS6" --- p.81 / Chapter 4.7.1 --- "PCR of ALSl, ALS5 smaller allele, and ALS6" --- p.81 / Chapter 4.7.2 --- Ligation of PCR products with pYES6CT plasmids --- p.82 / Chapter 4.7.3 --- "DNA sequencing results of ALS1, ALS5 smaller allele, and ALS6 ligated plasmids" --- p.83 / Chapter 4.7.4 --- "Detection of Alsl, Als5, and Als6 proteins expression" --- p.84 / Chapter 4.8 --- Adhesion of transformed Saccharomyces cerevisiae to fibroblasts --- p.84 / Chapter 4.9 --- "Adhesion of transformed Saccharomyces cerevisiae to FEP, polyurethane and silicone catheters" --- p.85 / Chapter Chapter 5 --- Discussion --- p.89 / Chapter 5.1 --- Limitations of static adhesion assay model --- p.89 / Chapter 5.2 --- Quantitation System --- p.90 / Chapter 5.2.1 --- Staining method --- p.90 / Chapter 5.2.2 --- ATP bioluminescence assay --- p.91 / Chapter 5.3 --- "Preliminary studies of adherence of Candida albicans to fibroblasts and to FEP, polyurethane, and silicone catheters" --- p.93 / Chapter 5.4 --- Effect of inoculum size on adhesion to catheters --- p.94 / Chapter 5.5 --- Selection of ALS genes --- p.96 / Chapter 5.6 --- Adhesion assay of transformed Saccharomyces cerevisiae to fibroblasts --- p.97 / Chapter 5.7 --- Adhesion assay of transformed Saccharomyces cerevisiae to catheters --- p.99 / Chapter 5.8 --- Alternative research model --- p.101 / Chapter 5.9 --- Implications and future work --- p.102 / Chapter Chapter 6 --- Conclusion --- p.107 / References --- p.108 / Tables --- p.119 / Figures --- p.123 / Appendices --- p.136

Bakgrund: Urinvägsinfektioner är en av de vanligaste vårdrelaterade infektionerna inom svensk sjukvård. Varje år drabbas 65 000 personer av en vårdrelaterad infektion, av dessa är 14 % urinvägsrelaterad. Detta medför onödigt lidande för patienten, men ger också upphov till förlängda vårdtider och ökade kostnader för hälso- och sjukvården. Syfte: Syftet var att beskriva hur sjuksköterskan kan arbeta preventivt för att minska förekomsten av vårdrelaterade urinvägsinfektioner. Metod: Studiens design var en litteraturöversikt innehållande 15 vetenskapliga artiklar, varav 13 stycken var kvantitativa och två stycken var kvalitativa. Datainsamlingen har skett via sökningar i databaserna PubMed och Cinahl, valda artiklar granskades med granskningsmallar och sammanställdes sedan i resultatet. Resultat: Resultatet visade att ett förebyggande arbete kring rutiner vid kateterisering innebar minskade risker för att drabbas av urinvägsinfektioner. Utbildning och ökad medvetenhet kring hygien visade sig ha en positiv effekt både hos patienter och bland personal. Det påvisades även ett positivt samband med ett ökat vätskeintag samt kosttillskott i form av tranbärskapslar. Slutsats: För att minska vårdrelaterade urinvägsinfektioner krävs det att sjuksköterskan har en följsamhet i det förebyggande arbetet. Utbildning bland personal och patienter, större medvetenhet kring basala hygienrutiner och korrekt rutiner vid kateterisering har en stor betydelse i det preventiva arbetet. / Background: Urinary tract infection is one of the most common nosocomial infections in Swedish health care. Each year, 65 000 people suffer from a nosocomial infection, of which 14 % are urinary tract related. This problem causes unnecessary suffering for the patient, prolonged waiting times and increased costs for health care. Aim: The aim of this study was to describe how nurses could prevent nosocomial urinary tract infections. Methods: This was a literature review based on 15 articles. Of these, 13 studies had a quantitative approach and two studies had a qualitative approach. The data collection has been done by searching in the databases PubMed and Cinahl. Chosen articles were reviewed by using reviewing templates, analyzed and were compiled in the result. Results: The result showed that proactive work regarding routines when catheterize amounted to less risks for patients suffering from urinary tract infections. Education and increased awareness around hygiene turned out to have a positive effect on patients in decreasing urinary tract infections and on staff behavior. There was also a positive correlation between an increased fluid intake and cranberry capsules as a supplement. Conclusion: To reduce nosocomial urinary tract infections it is required that the nurse is involved in the proactive work. Education for staff and patients, greater awareness around basic hygiene routines and correct routines when catheterizing has a big impact on the proactive work.

Thesis (MSc (Biomedical Technology))--Cape Peninsula University of Technology, 2017. / Background: It is well established that Klebsiella pneumoniae (K. pneumoniae) is an opportunistic pathogenic organism that has been frequently identified as the cause of nosocomial and community acquired infections. Furthermore, studies have shown that over the last few decades strains of the genus Klebsiella have systematically developed resistance to numerous antibiotics. Aims and Methods: The primary aim of this study was to investigate the prevalence of K. pneumoniae in nosocomial and community isolates in the Western Cape province of South Africa. Various identification techniques such as the polymerase chain reaction (PCR) using the API 20 E, the VITEK®2 system, primers specific for the 16S-23S rDNA ITS region and the Matrix-assisted laser desorption/ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) were compared for the identification of this pathogen. The VITEK 2 system was used to detect antibiotic resistant profiles of the K. pneumoniae isolates and to identify the extended spectrum beta-lactamase (ESBL) phenotypic among these isolates. The PCR was used to detect Beta-lactam genes viz. CTX-M (blaCTX-M), TEM (blaTEM) and SHV (blaSHV) respectively in both the genome and plasmid DNA of K. pneumoniae using gene specific primers. Results: In total 57 agar plate bacterial cultures or glycerol stock bacterial cultures were obtained during 2011. Of the 57 isolates, the API 20 E test identified 47 (82.5%) of the isolates (n = 57) as K. pneumoniae while 10 isolates (17.5%) were identified as Raoultella species. The VITEK 2 method and PCR identified all 57 isolates as K. pneumoniae (100%). Of the isolates, 82.5% (47/57) were positively identified as Klebsiella species, 14% (8/57) were identified as Klebsiella variicola and 3.5% (2/57) were shown as no reliable identification (NRI) when using the MALDI-TOF MS. Examination of the 57 isolates using primers specific for the CTX-M (blaCTX-M), TEM (blaTEM) and SHV (blaSHV) respectively showed the following: PCR amplicons for the TEM gene were produced successfully for 46 (81%) of the 57 isolates included in this project, while 11 (19%) of the samples did not yield any TEM amplicons; PCR amplicons for the blaSHV gene were obtained successfully for 56 (98%) of the 57 DNA samples, while 1 sample (2%) did not yield any SHV amplicons; and PCR amplicons for the blaCTX-M gene were produced successfully by 89% (n = 51) of the DNA samples included in this project, while 11% (n = 6) did not yield any CTX-M amplicon. Extended-spectrum beta-lactamase phenotypes had been confirmed in 84% (n = 48) K. pneumoniae isolates while nine isolates were found to be non-ESBL. Resistance rates for these 48 isolates were high and showed resistance patterns of: Amoxicillin/Ampicillin, Amoxycillin/Clavulanate, Ceftriaxone/Cefotaxime, Cefuroxime/Cefprozil and Ceftazidime (100%, n = 48); Piperacillin/Tazobactam and Cefoxitin (98%, 47/48); Cefepime (96%, 46/48); Aztreonam (94%; 45/48); Tobramycin (81%, 39/48); Gentamycin and Ciprofloxacin (77%, 37/48); Trimethoprim/Sulfamethoxazole (67%, 32/48); and Tigecycline (25% 12/48). Conclusion: For the analysis by all four methods employed, a total agreement of 68.4% was obtained, indicating the positive identification of K. pneumoniae in 39 of the 57 samples analysed. An average agreement of 28.1% was then obtained for the comparison of results generated for three of the methods utilised, while a 3.5% average agreement was obtained for at least two methods. Furthermore, all four methods agreed that 82.5% of the isolates were Klebsiella species while three methods agreed that 17.5% of the isolates were Klebsiella species. Based on the results obtained in the current study, PCR and VITEK 2 were the methods of choice for the identification of K. pneumoniae. The current study also showed, that ESBL-K. pneumoniae strains are present in the Western Cape province, South Africa; with high resistance profiles to numerous antibiotics including the Cephalosporins.

Abstract not available

Patients who require mechanical ventilation (MV) are at risk for developing ventilator associated pneumonia (VAP). Nurses’ adherence to sedation vacations (SVs) has a direct impact on the development of VAP, because SVs have been shown to reduce patients’ average duration of MV and length of stay (LOS) in the intensive care unit (ICU). The purposes of this study guided by Donabedian’s (1966) model were to quantify nurses’ level of adherence to SVs, in relation to the health outcomes of critically ill patients, and identify the barriers and facilitators to performing SVs. A correlational design was used. The design included three components: abstraction of patient data from the electronic medical record (EMR) (n=79 with VAP and n=79 without VAP), administration of surveys to ICU nurses (N =34), and vignettes related to SVs. Analyses included descriptive statistics, t-tests, correlations, and analyses of covariance. Most nurses held a Bachelors degree (70.6%), had < 9 years of ICU experience (52.9%), worked in a medical ICU (47.1%), and reported high confidence in managing SVs (M =8.88, SD =1.25). The majority of patients (N =158) were Black (58.2%), males (56.3%), and on average middle-aged (M =61.5, SD =14.91), with a long ICU LOS (M =15.5, SD =11.84), extended duration of MV (M =9.5, SD =8.47), and high acuity (APACHE III) (M =70.2, SD =25.42). The nurses’ education, advanced certification, and ICU experience were not associated with the appropriate implementation of SVs in the vignettes. On average nurses’ had low scores on the vignettes (M =6.97, SD =2.21; possible range =0-14). The adherence rate of nurses’ implementation of SVs, determined using EMR data, was also low (M =24%; SD =23%). There were higher rates of SV adherence in patients without VAP (p (p < .01), and a duration of MV < 6 days (p =.04). These findings indicate that even with established protocols, nurses may not consistently implement the evidenced-based interventions that have been shown to prevent nosocomial infections. Future research is needed to improve nursing practice and the quality of care in this patient population.

Les infections nosocomiales sont causées par des germes opportunistes souvent résistants aux antibiotiques et persistants sur les surfaces, représentant une source constante de risque d’infection en milieu hospitalier. Dans ce contexte, l’isolement et la caractérisation de bactériophages s’attaquant spécifiquement aux bactéries nosocomiales telles que Staphylococcus aureus résistant (SARM), Enterococcus résistant (ERV), Pseudomonas aeruginosa et Acinetobacter baumanii, pourraient fournir une alternative bactéricide naturelle contre la transmission de ces infections. Des phages isolés des eaux usées, ont été sélectionnés selon leur capacité d’amplification, leur profil génomique et leur potentiel lytique envers différentes souches bactériennes cliniques. Les meilleurs ont été caractérisés en détail pour s’assurer de leur spécificité, sécurité, stabilité et efficacité préalablement à leur utilisation in vivo. Sept phages contre SARM et trois contre Acinetobacter baumanii ont été caractérisés. Quatre phages SARM s’avèrent être de bons candidats potentiels et pourraient être testés en milieu hospitalier comme agents désinfectants dans le but de lutter contre les infections nosocomiales. / Nosocomial infections are directly related to opportunistic germs, which are often resistant to antibiotics and persistent on surfaces, representing a high infectious risk in hospitals. In this context, the isolation and characterization of bacteriophages specifically targeting nosocomial bacteria such as resistant Staphylococcus aureus (MRSA), resistant Enterococcus (VRE), Pseudomonas aeruginosa and Acinetobacter baumanii, could provide a natural bactericidal alternative against the transmission of these infections. Phages, isolated from waste water, were selected according to their capacity of amplification, their genomic profile and lytic potential towards various bacterial clinical strains. The best ones were characterized in detail to primarily ensure their specificity, safety, stability and effectiveness, before studying their in vivo usage. Seven phages against MRSA and three against Acinetobacter baumanii were characterized. Four MRSA phages proved to be good potential candidates and could be tested in hospitals as disinfectant agents with the aim of fighting nosocomial infections.

Thesis (M.Sc.)--Memorial University of Newfoundland, 1998. / Typescript. Bibliography: leaves 84-96.

Made available in DSpace on 2015-05-14T12:47:12Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 3442052 bytes, checksum: 44cbca7e641c0e88d0bf737504f1847c (MD5) Previous issue date: 2012-06-08 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Nosocomial infection is an important public health problem in recent years has contributed to increased rates of morbidity, hospital stay and greater costs. The range of invasive procedures performed in intensive care patients predisposes them to development of Nosocomial Infections. The objective of this study was analyze the incidence of nosocomial infections and the association with risk factors in the Intensive Care Unit. This is an observational study, non-concurrent cohort study, performed in the Intensive Care Unit of a Municipal Public Hospital in João Pessoa, on the period from January to October 2011. We included critically ill patients hospitalized for more than 24 hours in the Intensive Care Unit, a total sample of 244 patients. By the use of active search forms, The Hospital Department for Infection Control registration forms and Hospital Medical Records were identified cases of nosocomial infection and its main risk factors. In the data statistical analysis, showed that a total of 244 patients was observed: 51.6% (126/244) were male and 48.4% (118/244) females with a mean age of 63.02 years. The nosocomial infection rate was 23.4% (57/244). The most prevalent site was bloodstream/catheter-associated infection 38.59%, ventilation associated pneumonia 38.59% and urinary tract infection 21.05%. The main microorganisms involved in these infections were Pseudomonas aeruginosa (31.58%), Acinetobacter baumannii (15.79%) and Klebsiella pneumoniae (10.53%). The central venous access, mechanical ventilation, tracheostomy, nasogastric tube and length of Intensive Care Unit stay were considered risk factors for the occurrence of hospital infection. It is concluded that the high technology used in the Intensive Care Unit has prolonged patient survival. In contrast, there is an increased risk of cross infection in critically ill patients. Thus, urge the need for planning and implementing a process of specific protocols and measures well established, with multidisciplinary decisionmaking, with investments in continuing education to prevent and control infection thus contributing to the mitigation of risk factors and consequently reducing the rate of nosocomial infection. / A infecção hospitalar é um importante agravo de saúde pública que nos últimos anos tem contribuído no incremento das taxas de morbimortalidade, permanência hospitalar e nos custos. A gama de procedimentos invasivos realizados frequentemente nos pacientes de unidade de terapia intensiva vem predispondo os mesmos ao desenvolvimento da infecção. O objetivo do estudo foi de analisar a incidência de episódios de Infecção Hospitalar e a associação com os fatores de risco na Unidade de Terapia Intensiva. Trata-se de um estudo observacional, do tipo coorte não concorrente, realizado na Unidade de Terapia Intensiva de um Hospital Público Municipal de João Pessoa, no período de janeiro a outubro de 2011. Foram incluídos os pacientes críticos com tempo de hospitalização superior a 24 horas na Unidade de Terapia Intensiva, totalizando uma amostra de 244 pacientes. Por meio das fichas de busca ativa, das fichas de registro de notificação das infecções hospitalares do Serviço de Controle de Infecção Hospitalar e dos prontuários foram identificados os casos de infecção hospitalar e os principais fatores de risco associados. Na análise dos dados, evidenciou-se que de um total de 244 pacientes, 51,6% (126/244) era do gênero masculino e 48,4% (118/244) feminino com média de idade de 63,02 anos. A taxa de infecção hospitalar foi de 23,4% (57/244). A topografia mais prevalente foi corrente sanguínea/ infecção associada a cateter 38,59%, pneumonia associada à ventilação mecânica 38,59% e trato urinário 21,05%. Os principais microrganismos envolvidos com a etiologia destas infecções foi a Pseudomonas aeruginosa (31,58%), Acinetobacter baumanni (15,79%) e Klebsiella pneumoniae (10,53%). O acesso venoso central, ventilação mecânica, traqueostomia, sonda nasogástrica e o tempo de permanência na Unidade de Terapia Intensiva foram considerados fatores de risco para ocorrência da infecção hospitalar. Conclui-se que a alta tecnologia empregada nas Unidades de Terapia Intensiva vem prolongando a sobrevida dos pacientes. Em contrapartida, observase o aumento do risco de infecção hospitalar nos pacientes criticamente enfermos. Urge assim, a necessidade de um planejamento e um processo de implementação de protocolos específicos e medidas bem estabelecidas, com tomadas de decisões multiprofissionais, com investimentos em educação continuada para prevenir e controlar a infecção contribuindo desta forma, para a mitigação dos fatores de risco e consequentemente a redução das taxas de infecção hospitalar.