<p><strong>Introduction</strong> Every tenth patient in Sweden is affected by nosocomial infections. Among these, urinary tract infection (UTI) is the most frequently occurring within the hospital environment. Nosocomial infections lead to increasing costs for care, more suffering among the patients, increasing use of antibiotics, and longer treatment spells. The Academic hospital have engaged all wards in the so called VRISS-project (“nosocomial infections must be stopped”) in order to reduce the number of nosocomial infections.</p><p><strong>Aim</strong> In connection to the VRISS-project new routines for removal of uretrahl catheters are introduced at ward 70E2 at the Academic hospital. The new routines imply that the catheter should be removed during the first post-op day. According to the old routines the catheter was to be removed no later than on the third post-op day. The authors of this study choose to investigate whether the new routines for uretrahl catheter removal have any effect on the occurrence of nosocomial UTI’s.</p><p><strong>Methods </strong>The study is a restrospective record study with quantitative, descriptive design. 411 journals from 2007 (188) and 2009 (223) have been reviewed. All patients that underwent knee or hip operations during January, February, March, and April 2007 and 2009 are included in the sample.</p><p><strong>Results</strong> The study shows that the new routines at ward 70E2 had some, but not full, influence on the share of patients with nosocomial UTI. Among women under 71 years of age and men older than 70 years, the number of days with uretrahl catheter and the share of patients with nosocomial UTI have decreased. However, among the younger men (<71 years) and the older women (>70 years) no effects of the new routines are detected.</p><p><strong>Conclusion</strong> To summarize it can be concluded that the routines for how to use uretrahl catheters at ward 70E2 work fairly well. However, the results also show that the number of days with uretrahl catheter and the share of patients with nosocomial UTI among risk patients, above all among the older women, are the same in spite of the new routines for removal of uretrahl catheters. Thus, strategies for detecting risk patients in an early stage can be improved upon. Such measures can reduce the risk for nosocomial UTI among these patients.</p>

Introduction Every tenth patient in Sweden is affected by nosocomial infections. Among these, urinary tract infection (UTI) is the most frequently occurring within the hospital environment. Nosocomial infections lead to increasing costs for care, more suffering among the patients, increasing use of antibiotics, and longer treatment spells. The Academic hospital have engaged all wards in the so called VRISS-project (“nosocomial infections must be stopped”) in order to reduce the number of nosocomial infections. Aim In connection to the VRISS-project new routines for removal of uretrahl catheters are introduced at ward 70E2 at the Academic hospital. The new routines imply that the catheter should be removed during the first post-op day. According to the old routines the catheter was to be removed no later than on the third post-op day. The authors of this study choose to investigate whether the new routines for uretrahl catheter removal have any effect on the occurrence of nosocomial UTI’s. Methods The study is a restrospective record study with quantitative, descriptive design. 411 journals from 2007 (188) and 2009 (223) have been reviewed. All patients that underwent knee or hip operations during January, February, March, and April 2007 and 2009 are included in the sample. Results The study shows that the new routines at ward 70E2 had some, but not full, influence on the share of patients with nosocomial UTI. Among women under 71 years of age and men older than 70 years, the number of days with uretrahl catheter and the share of patients with nosocomial UTI have decreased. However, among the younger men (&lt;71 years) and the older women (&gt;70 years) no effects of the new routines are detected. Conclusion To summarize it can be concluded that the routines for how to use uretrahl catheters at ward 70E2 work fairly well. However, the results also show that the number of days with uretrahl catheter and the share of patients with nosocomial UTI among risk patients, above all among the older women, are the same in spite of the new routines for removal of uretrahl catheters. Thus, strategies for detecting risk patients in an early stage can be improved upon. Such measures can reduce the risk for nosocomial UTI among these patients.

Master of Science / The role of the microbiology laboratory is (1) to provide infection control information, so that highly transmissible isolates may be identified and appropriate control measures instigated as rapidly as possible and (2) to provide adequate information to the clinician enabling correct antibiotic choices to be made, particularly in the critically ill. Microbiological data is by definition slow as it is culture dependent: this study focused on the development of genetic, culture-independent methods for detection of resistance in nosocomial pathogens that could be introduced into the routine microbiology department and would fit into the routine workflow with a consequent reduction in time to result. Initially a duplex real-time polymerase chain reaction was developed for the rapid identification and detection of S. aureus and methicillin-resistance. This was optimised for immediate as-needs testing of positive blood cultures signalling with “Gram positive cocci, possibly staphylococcus” evident on Gram stain, on a random access real-time PCR platform. This technology, allowing early identification of S. aureus and its susceptibility to methicillin, by simple automated methodology, may soon become the standard for all microbiology laboratories servicing the critically ill. The second part of the study involved the development of a selective broth and multiplex PCR for detection of three important nosocomial isolates at this institution, methicillin-resistant S. aureus (MRSA), carbapenem-resistant Enterobacteriaceae, and multi-resistant Acinetobacter baumannii (MRAB). A multiplex PCR using four primer sets was designed to detect low colonisation levels of these isolates after overnight incubation in selective broth, significantly reducing the time to result and associated costs. This potentially useful epidemiological screening tool is practical, reproducible and sensitive with the potential of moving to an automated test (using real-time PCR, for example) in the future. The availability of early negative results judged by simple visual scanning (or by densitometry), means that the result is less operator-dependent, potentially reducing error rate. The last part of the study dealt with an important resistance phenotype, aminoglycoside resistance. There had been no recent comprehensive local surveys performed to determine the frequency of aminoglycoside resistance amongst the Enterobacteriaceae, or to identify the genetic determinants and their transmissibility. The isolates collected for the study were all resistant to at least one of gentamicin, tobramycin or amikacin. Identification of integron cassette arrays and use of specific internal primers identified at least one genetic determinant for gentamicin and tobramycin resistance in 22 of 23 isolates. Three isolates had two aminoglycoside resistance genes, and three isolates had three aminoglycoside resistance genes identified (Table 6.1). Transferable gentamicin-resistant plasmids were predominant amongst Klebsiella spp., but less so amongst Enterobacter spp. and E. coli. Gentamicin-resistant Klebsiella spp. were often ESBL positive, the genetic determinants of which were typically co-transferred on a conjugative plasmid. The importance of screening at a local level was demonstrated by the unexpected predominance of aac(6')-IIc amongst Enterobacter spp. and the detection of a new gene (aac(6')-LT). This part of the study has provided an understanding of the primary aminoglycoside resistance genes present in the local setting and their association with other resistances. This knowledge will allow development of assays for patient screening (clinical isolates and colonising flora), to better understand the epidemiology of aminoglycoside resistance and to allow better choice of antibiotic therapy related to presence or absence of these genes.

<p>Syftet med denna litteraturstudie var att beskriva varför följsamheten gällande handhygien ofta är låg bland vårdpersonal, samt hur man kan öka följsamheten för handhygien bland vårdpersonal. Metoden som använts var en litteraturstudie. Datainsamling skedde via databaserna Medline (PubMed), Cinahl (EBSCO host) och Academic Search Elite. Sökorden som använts: prevention, hand disinfection, hand washing, infection control, nosocomial infection och education. Totalt användes 15 vetenskapliga artiklar. Resultatet delades in i två huvudrubriker: Orsaker till att följsamheten ofta är låg bland vårdpersonal och faktorer som kan öka följsamheten gällande handhygien bland vårdpersonal. De två huvudrubrikerna delades in i sex underrubriker: tidsbrist, hudbekymmer, kunskapsbrist, utbildning, affisch/posters och tillgänglighet. Resultatet visade att det finns många anledningar till att följsamheten för handhygien är låg. Studien visar att tidsbrist, hudbekymmer samt kunskapsbrist gällande hand hygien är de vanligaste orsakerna. Utbildning tillsammans med affischer/posters samt ökad tillgänglighet vad gäller material har visat sig vara det mest effektiva sättet att öka följsamheten av handhygien.</p><p><strong><p>Nyckelord</p><p>.</p>: prevention, hand disinfection, hand washing, infection control, nosocomial infection och education. </strong></p>

Syftet med denna litteraturstudie var att beskriva varför följsamheten gällande handhygien ofta är låg bland vårdpersonal, samt hur man kan öka följsamheten för handhygien bland vårdpersonal. Metoden som använts var en litteraturstudie. Datainsamling skedde via databaserna Medline (PubMed), Cinahl (EBSCO host) och Academic Search Elite. Sökorden som använts: prevention, hand disinfection, hand washing, infection control, nosocomial infection och education. Totalt användes 15 vetenskapliga artiklar. Resultatet delades in i två huvudrubriker: Orsaker till att följsamheten ofta är låg bland vårdpersonal och faktorer som kan öka följsamheten gällande handhygien bland vårdpersonal. De två huvudrubrikerna delades in i sex underrubriker: tidsbrist, hudbekymmer, kunskapsbrist, utbildning, affisch/posters och tillgänglighet. Resultatet visade att det finns många anledningar till att följsamheten för handhygien är låg. Studien visar att tidsbrist, hudbekymmer samt kunskapsbrist gällande hand hygien är de vanligaste orsakerna. Utbildning tillsammans med affischer/posters samt ökad tillgänglighet vad gäller material har visat sig vara det mest effektiva sättet att öka följsamheten av handhygien. Nyckelord . : prevention, hand disinfection, hand washing, infection control, nosocomial infection och education.

Understanding the extent of infection control measures to be taken to protect immunosuppressed and other types of patients from airborne infection agents during construction is crucial knowledge for both healthcare and construction professionals. The number of aspergillosis-related fatalities due to dust transmission during construction activity has decreased with the improvement of antifungal therapy, however the illness is particularly debilitating and the treatment is not always successful. This experimental work is the first stage in a research program to develop better dust controls for construction at existing medical facilities to reduce the incidence of dust borne fungi, such as Aspergillus spp. To better protect at-risk patients from exposure to Aspergillus spp. and other airborne fungal infections, an experiment was conducted to determine what materials can be used to create a barrier for infection control to moderate particle transmission from the construction area to the treatment area. This study investigated the relationship between construction barriers and particle transmission. A new experimental procedure and equipment simulates the transmission of disturbed dust from construction activity across a barrier. The effective of the barrier is determined from measured particle count on filter. The results show that an effective barrier manufactured from simple and readily available building supplies stops the transmission of 12-micron dust particles under a standard set of conditions. The test provides a simple and cost effective method to compare transmission rates for dust.

Master of Science / The role of the microbiology laboratory is (1) to provide infection control information, so that highly transmissible isolates may be identified and appropriate control measures instigated as rapidly as possible and (2) to provide adequate information to the clinician enabling correct antibiotic choices to be made, particularly in the critically ill. Microbiological data is by definition slow as it is culture dependent: this study focused on the development of genetic, culture-independent methods for detection of resistance in nosocomial pathogens that could be introduced into the routine microbiology department and would fit into the routine workflow with a consequent reduction in time to result. Initially a duplex real-time polymerase chain reaction was developed for the rapid identification and detection of S. aureus and methicillin-resistance. This was optimised for immediate as-needs testing of positive blood cultures signalling with “Gram positive cocci, possibly staphylococcus” evident on Gram stain, on a random access real-time PCR platform. This technology, allowing early identification of S. aureus and its susceptibility to methicillin, by simple automated methodology, may soon become the standard for all microbiology laboratories servicing the critically ill. The second part of the study involved the development of a selective broth and multiplex PCR for detection of three important nosocomial isolates at this institution, methicillin-resistant S. aureus (MRSA), carbapenem-resistant Enterobacteriaceae, and multi-resistant Acinetobacter baumannii (MRAB). A multiplex PCR using four primer sets was designed to detect low colonisation levels of these isolates after overnight incubation in selective broth, significantly reducing the time to result and associated costs. This potentially useful epidemiological screening tool is practical, reproducible and sensitive with the potential of moving to an automated test (using real-time PCR, for example) in the future. The availability of early negative results judged by simple visual scanning (or by densitometry), means that the result is less operator-dependent, potentially reducing error rate. The last part of the study dealt with an important resistance phenotype, aminoglycoside resistance. There had been no recent comprehensive local surveys performed to determine the frequency of aminoglycoside resistance amongst the Enterobacteriaceae, or to identify the genetic determinants and their transmissibility. The isolates collected for the study were all resistant to at least one of gentamicin, tobramycin or amikacin. Identification of integron cassette arrays and use of specific internal primers identified at least one genetic determinant for gentamicin and tobramycin resistance in 22 of 23 isolates. Three isolates had two aminoglycoside resistance genes, and three isolates had three aminoglycoside resistance genes identified (Table 6.1). Transferable gentamicin-resistant plasmids were predominant amongst Klebsiella spp., but less so amongst Enterobacter spp. and E. coli. Gentamicin-resistant Klebsiella spp. were often ESBL positive, the genetic determinants of which were typically co-transferred on a conjugative plasmid. The importance of screening at a local level was demonstrated by the unexpected predominance of aac(6')-IIc amongst Enterobacter spp. and the detection of a new gene (aac(6')-LT). This part of the study has provided an understanding of the primary aminoglycoside resistance genes present in the local setting and their association with other resistances. This knowledge will allow development of assays for patient screening (clinical isolates and colonising flora), to better understand the epidemiology of aminoglycoside resistance and to allow better choice of antibiotic therapy related to presence or absence of these genes.

Made available in DSpace on 2014-06-11T19:28:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-15Bitstream added on 2014-06-13T19:16:06Z : No. of bitstreams: 1 garcia_pn_me_botfm.pdf: 574437 bytes, checksum: 631b71eaec9a9eb25af2a850c50c5a29 (MD5) / As Infecções Relacionadas à Assistência à Saúde (IRAS) representam um dos principais entraves na qualidade da assistência médica, sendo considerada um grave problema de saúde pública. Dentre as complicações associadas às IRAS estão a morbi-mortalidade, o aumento do tempo de internação e da quantidade dos procedimentos invasivos, elevação do consumo de antimicrobianos e a disseminação de bactérias multirresistentes. As ações de controle das infecções voltadas às precauções e isolamentos possuem dois níveis, um composto pelas precauções padrão e o outro baseado nas vias de transmissão dos agentes, podendo ser classificados em três tipos: precauções respiratórias para transmissão aérea e para gotículas e em precauções para transmissão por contato. O objetivo deste estudo foi avaliar o uso das precauções de contato pelos profissionais de saúde de uma unidade de terapia intensiva. Trata-se de um estudo descritivoexploratório, composto por duas etapas, sendo a primeira correspondente à entrevista individual, na qual foram levantados o perfil demográfico, as doenças que necessitam das precauções de contato, as medidas que devem ser utilizadas e as dificuldades na assistência aos pacientes sob esta precaução. Na segunda etapa, os participantes foram observados durante três procedimentos assistenciais a pacientes em precaução de contato. As respostas da entrevista foram transcritas para a planilha do software Microsoft Office Excel, recebendo caracterização em adequada, parcialmente adequada e inadequada, segundo a categoria de acertos e erros. A etapa observacional foi conceituada como adequada e inadequada, considerando-se adequada a realização de 75% ou mais dos itens avaliados. Participaram desta casuística 31 profissionais de saúde da UTI, representando 88,6% do número... / Infections Related to Healthcare (IRH) represent a major constraint on medical care quality, being considered a severe public health problem. Among the complications associated with IRH, are morbidity and mortality, increased hospital staying length and the number of invasive procedures, increased consumption of antimicrobials and the dissemination of multiresistant bacteria. The actions aimed at infection control precautions and isolation have two levels, one composed of standard precautions and the other based on the agents transmission routes, which can be classified into three types: respiratory precautions for airborne transmission and droplets precautions and in precautions for transmission by contact. The objective of this study was to evaluate the use of contact precautions for healthcare professionals from an intensive care unit. It is a descriptive exploratory study, consisting of two phases, the first corresponding to individual interviews, which demographic profile was raised, the illnesses that require contact precautions, what measures should be used and the difficulties in patient care in this case. In the second stage, participants were observed for three health care procedures to patients in contact precautions. The interview responses were transcribed to the spreadsheet software Microsoft Office Excel, getting characterization in adequate, in partially adequate or in inadequate, according to the hits and misses category. The observational phase was defined as adequate and inadequate, considering adequate the performance of 75% or more, of the items evaluated. Thirty one health professionals from the ICU participated in our study, representing 88.6% of the total number of the unit staff. There was female... (Complete abstract click electronic access below)

Made available in DSpace on 2014-06-11T19:28:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-24Bitstream added on 2014-06-13T18:57:23Z : No. of bitstreams: 1 almeida_mcc_me_botfm.pdf: 2151855 bytes, checksum: 5b6a8f5756af48376cdbc1921f0d64c8 (MD5) / Secretaria de Saúde do Estado de São Paulo / A hospitalização infantil acarreta fatores estressantes para a criança e sua família. É uma situação que pode trazer traumas emocionais à criança, exigindo dos profissionais da área da saúde além de tratamento terapêutico, o carinho e a atenção. Esses cuidados podem ser alcançados através do brinquedo, que proporciona à criança restabelecimento físico e emocional, contribuindo para sua recuperação. Todavia, há fatores que contribuem para que o uso do brinquedo se torne objeto de atenção especial quando se pensa em compartilhá-los e na falta de práticas de higiene para os mesmos em unidade de internação pediátrica, considerando que o brinquedo pode ser um veículo na transmissão de microrganismos. O objetivo deste estudo foi: descrever as condições bacteriológicas do brinquedo de plástico utilizados na unidade de internação pediátrica do Hospital Estadual Bauru (HEB). Utilizou-se swabs estéreis para a coleta das amostras das mãos e do brinquedo. A amostragem foi realizada utilizando swab estéril em três momentos: no primeiro momento realizou-se a coleta de swab das mãos das crianças e do brinquedo antes de iniciar a brincadeira, no segundo momento coletou-se a amostra imediatamente após a brincadeira e no terceiro momento houve a coleta de swab no brinquedo após o processo de higienização com álcool 70%. Após as coletas, as amostras foram encaminhadas para o laboratório de Análises Clínicas do HEB onde foi realizada a semeadura das amostras em meios de cultura Ágar MacConkey e Manitol. Após 24 horas, observava-se a presença ou não de crescimento bacteriano. Quando havia crescimento bacteriano, seguia-se para a identificação do achado e, quando não havia crescimento bacteriano, mantinha-se a amostra na estufa por mais 24 horas para determiná-la como presente ou ausente de crescimento bacteriano. Seguidamente realizou-se o... / Children’s hospitalization leads to stressful factors for patients and their relatives. It is a situation that can cause emotional trauma in children, thus requiring kindness and attention from health care professionals, in addition to therapeutic care. Such care can be achieved by means of toys, which help children recover physical and emotional wellness, thus contributing to their health recovery. Nevertheless, there are factors that contribute for toy use to become an object of attention when considering the fact that toys will be shared and the lack of toy hygiene practices at pediatric hospitalization units, since they may be a vehicle for microorganism transmission. The objective of this study was: to describe the bacteriological conditions of plastic toys used at the hospitalization unit of Bauru State Hospital (BSH). Sterile swabs were used to collect samples from hands and toys. Sampling was performed by using sterile swabs at three different moments: at the first moment, swab collection was performed from children’s hand and from toys before playing began; at the second moment, a sample was collected immediately after playing; and, at the third moment, swab collection from the toy took place after hygienization using 79% alcohol. Following collection, the samples were sent to the Laboratory of Clinical Analysis of BSH, where they were seeded in Agar MacConkey and Manitol culture media. The presence or not of bacterial growth was observed after 24 hours. Whenever bacterial growth occurred, the findings were identified, and when no growth was observed, the sample was kept in a stove for another 24 hours in order to determine it as present or absent of bacterial growth. Next, an antibiogram and in-vivo sensitivity tests for hospital cleaning products were performed by the Agar-Gel diffusion method. Results showed that, in most findings, bacterial growth occurred on the ... (Complete abstract click electronic access below)

Orientador: Ione Corrêa / Banca: Maria Virgínia M. F. F. Alves / Banca: Silvana Denofre Carvalho / Resumo: As Infecções Relacionadas à Assistência à Saúde (IRAS) representam um dos principais entraves na qualidade da assistência médica, sendo considerada um grave problema de saúde pública. Dentre as complicações associadas às IRAS estão a morbi-mortalidade, o aumento do tempo de internação e da quantidade dos procedimentos invasivos, elevação do consumo de antimicrobianos e a disseminação de bactérias multirresistentes. As ações de controle das infecções voltadas às precauções e isolamentos possuem dois níveis, um composto pelas precauções padrão e o outro baseado nas vias de transmissão dos agentes, podendo ser classificados em três tipos: precauções respiratórias para transmissão aérea e para gotículas e em precauções para transmissão por contato. O objetivo deste estudo foi avaliar o uso das precauções de contato pelos profissionais de saúde de uma unidade de terapia intensiva. Trata-se de um estudo descritivoexploratório, composto por duas etapas, sendo a primeira correspondente à entrevista individual, na qual foram levantados o perfil demográfico, as doenças que necessitam das precauções de contato, as medidas que devem ser utilizadas e as dificuldades na assistência aos pacientes sob esta precaução. Na segunda etapa, os participantes foram observados durante três procedimentos assistenciais a pacientes em precaução de contato. As respostas da entrevista foram transcritas para a planilha do software Microsoft Office Excel, recebendo caracterização em adequada, parcialmente adequada e inadequada, segundo a categoria de acertos e erros. A etapa observacional foi conceituada como adequada e inadequada, considerando-se adequada a realização de 75% ou mais dos itens avaliados. Participaram desta casuística 31 profissionais de saúde da UTI, representando 88,6% do número... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Infections Related to Healthcare (IRH) represent a major constraint on medical care quality, being considered a severe public health problem. Among the complications associated with IRH, are morbidity and mortality, increased hospital staying length and the number of invasive procedures, increased consumption of antimicrobials and the dissemination of multiresistant bacteria. The actions aimed at infection control precautions and isolation have two levels, one composed of standard precautions and the other based on the agents transmission routes, which can be classified into three types: respiratory precautions for airborne transmission and droplets precautions and in precautions for transmission by contact. The objective of this study was to evaluate the use of contact precautions for healthcare professionals from an intensive care unit. It is a descriptive exploratory study, consisting of two phases, the first corresponding to individual interviews, which demographic profile was raised, the illnesses that require contact precautions, what measures should be used and the difficulties in patient care in this case. In the second stage, participants were observed for three health care procedures to patients in contact precautions. The interview responses were transcribed to the spreadsheet software Microsoft Office Excel, getting characterization in adequate, in partially adequate or in inadequate, according to the hits and misses category. The observational phase was defined as adequate and inadequate, considering adequate the performance of 75% or more, of the items evaluated. Thirty one health professionals from the ICU participated in our study, representing 88.6% of the total number of the unit staff. There was female... (Complete abstract click electronic access below) / Mestre