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Aim To determine the level of knowledge and explore the difference of hand hygiene between nursing students and nurses. Background Annually, 3.8 million people in Europe acquire healthcare-associated infections, highlighting the importance of hand hygiene. Despite WHO's emphasis on the fact that greater hand hygiene knowledge correlates with improved hand hygiene compliance, several studies have shown knowledge gaps among nurses and nursing students regarding hand hygiene. Design Descriptive cross-sectional comparative survey. Methods A version of the WHO “Hand Hygiene Knowledge Questionnaire”, translated into Swedish, was used for data collection among nursing students in the first and last semester, and registered nurses from a university and associated hospital. Data were analyzed by descriptive statistics, and comparison between groups with Fisher's exact test, one-way ANOVA, and post-hoc tests (Pairwise Z-Tests, Tukey HSD). Results The survey, conducted between December 2020 and January 2021, received responses from 201 participants, including 71 first semester students, 46 last semester students and 84 registered nurses, showing moderate (55.7% [50–74% correct answers]) to good (43.8% [75–100% correct answers]) knowledge levels. First-semester students scored lower (17.0 ± 2.1) than last-semester students (18.8 ± 1.8) and registered nurses (18.3 ± 2.1) out of 25 questions. Discussion It is necessary for all groups to receive proper education on hand hygiene knowledge and to have an educational program that does not separate the groups but combines them with continuing education, since the students will someday be influencing future hand hygiene knowledge as a peer, together with the nurse.

Diplomová práce se zabývá vztahem textilních materiálů a mikroorganismů, popisuje v současnosti nejčastěji využívaná činidla pro ošetření antimikrobiálních textilií a jejich možné využití v rámci prevence infekcí spojených se zdravotní péčí. Závěr teoretické části je věnován metodám testování antimikrobiálních textilií. Experimentální část je zaměřena na testování antimikrobiálního účinku textilních materiálů a činidel, která by mohla být využita na ošetření textilií., The diploma thesis deals with the relationship between textile materials and microorganisms, describes the most commonly used agents for the treatment of antimicrobial textiles and their possible use in the prevention of healthcare associated infections. The theoretical part concludes with methods of testing antimicrobial textiles. The experimental part is focused on testing the antimicrobial effect of textile materials and agents that could be used for textile treatment., Fakulta chemicko-technologická, 1. Prezentace výsledků diplomové práce. 2. Diskuze k posudkům vedoucího a oponenta diplomové práce. 3. Studentka zodpověděla všechny dotazy a připomínky k diplomové práci., Dokončená práce s úspěšnou obhajobou

Tato práce se zabývá problematikou dodržování bariérových ošetřovatelských technik na standardních lůžkových odděleních. V teoretické části jsou zmíněna základní fakta, která blíže souvisí s hlavním tématem práce. Tato část práce zahrnuje infekce spojené se zdravotní péčí, hygienu a dezinfekci rukou, dezinfekci a sterilizaci, osobní ochranné pracovní pomůcky a zásady bariérových ošetřovatelských technik. Průzkumná část se věnuje analýze výsledků dotazníkového šetření a nepřímého pozorování., This work deals with the issue of compliance with barrier nursing techniques in standard wards. The theoretical part mentions the basic facts that are closely related to the main topic of the work. This part of the work includes infections associated with health care, hand hygiene and disinfection, disinfection and sterilization, personal protective equipment and principles of barrier nursing techniques. The exploratory part is devoted to the analysis of the results of the questionnaire survey and non-participatory observation., Fakulta zdravotnických studií, Student/ka úspěšně obhájil/a bakalářskou práci, odpověděl/a na doplňující otázky oponenta., Dokončená práce s úspěšnou obhajobou

Introduction: The administration of improperly prepared intravenous fluids might determine healthcare-associated infections. Quality and sterility assurance in radiopharmaceutical manufacturing products must be evaluated by media fill tests that simulate the performance of the aseptic manufacturing procedure. The aim of this study is to show a methodological modification of a specific step of media fill tests, giving an overview of economic and organizational advantages that it might bring. Materials And Methods: Media fill tests were conducted to ensure that they reproduce as strictly as possible the routine aseptic production process with all the critical steps described in the internal Standard Operating Procedures. We introduced an innovative modification in step 1: instead of using a completely decayed99Mo/99mTc generator, we used a99Mo/99mTc generator just before its dis-posal, eluting it with saline solution aspirated in an empty vacuum vial. Results: A total of 47 production runs were performed, and a total of 799 vials were tested for sterility. Thirteen nuclear medicine technicians were assessed. We found contamination in 1% of the total number of vials analyzed. Conclusions: The modification proposed shows several advantages: reduction of the costs of the media fill tests, the possibility to manage these without referring to external services, and decreased injuries for technicians who perform the tests.

Introduktion: En god handhygien utgör grunden för att minska smittspridning av smittsamma sjukdomar. Vårdrelaterade infektioner kostar samhället mycket rent ekonomiskt och i lidande för den enskilde. Individer med funktionsnedsättning som bor på gruppbostad riskerar att drabbas om inte vårdpersonalen tillämpar de basala hygienrutinerna och är relevant ur ett folkhälsovetenskapligt perspektiv. Syfte: Att analysera en befintlig självskattningsenkät avseende efterlevnad av basala hygienrutiner gällande handhygien som genomförts under våren samt hösten 2020 bland kommunanställd omvårdnadspersonal på gruppboenden inom en kommun i Stockholm. Metod: En upprepad tvärsnittsstudie med kvantitativ och kvalitativ analys av en befintlig självskattningsenkät. Analysen baseras på enkätsvar med en svarsfrekvens på 78 % från personal inom kommunens 15 gruppboenden och bestod av 80 deltagare på våren respektive 81 deltagare på hösten2020. Resultat: Mellan 69 - 97,5 % av deltagarna ansåg att de följde hygienrutinerna avseende basal handhygien under år 2020. I jämförelse mellan vår och höst sågs en signifikant förbättring av användning av handsprit före omvårdnadsmoment. I studiens kvalitativa del framkom deltagarnasupplevelse av hinder i tillämpningen och dessa utgjordes bland annat av; varierad användning av handskar, ovetskap, glömska, tidsbrist, tillgänglighet samt praktiska hinder i verksamheten. Slutsats: En stor del av omvårdnadspersonalen ansåg att de följde de basala hygienrutinerna avseende handhygien men kravet på att all personal skall arbeta efter hygienrutinerna avseende handhygienuppfylls inte. Hygienutbildningen som omvårdnadspersonalen erbjuds behöver utvecklas för att främja utveckling av health literacy vilket kan bidra till en ökad förståelse för varför tillämpningen är viktig. Detta kan förbättra följsamheten till de basala hygienrutinerna., Introduction: Good hand hygiene is the basis for reducing the spread of infections. Healthcare-related infections cost society a great deal financially and in suffering for the individual. Individuals with disabilities who live in group housing are at risk if the care staff does not apply the basic hygiene routines. Aim: Analyze an existing self-assessment survey regarding compliance with basic hygiene routines regarding hand hygiene that was carried out during the spring and autumn of 2020 among municipally employed nursing staff in group housing. Method: A repeated cross-sectional study with quantitative and qualitative analysis of an existing self-assessment survey. The analysis is based on questionnaire responses from staff with a response rate of 78%, within the municipality's 15 group homes and consisted of 80 participants in the spring and 81 participants in the autumn of 2020. Results: Between 69-97.5% of the participants considered that they followed the hygiene routines regarding basic hand hygiene during the year 2020. In a comparison between spring and autumn, a significant improvement was seen in the use of hand alcohol before nursing. The qualitative part of the study also revealed the participants' experience of obstacles, and included use of gloves, ignorance, forgetfulness, lack of time, accessibility and practical obstacles. Conclusion: A large part of the nursing staff believed that they followed the basic hygiene routines regarding hand hygiene. The hygiene training offered by the nursing staff needs to be developed to promote the development of health literacy. This can improve compliance with the basic hygiene routines.

Antimicrobial-resistant organisms (AMROs) can colonize people without symptoms for long periods of time, during which these agents can spread unnoticed to other patients in healthcare systems. The accurate identification of asymptomatic spreaders of AMRO in hospital settings is essential for supporting the design of interventions against healthcare-associated infections (HAIs). However, this task remains challenging because of limited observations of colonization and the complicated transmission dynamics occurring within hospitals and the broader community. Here, we study the transmission of methicillin-resistant Staphylococcus aureus (MRSA), a prevalent AMRO, in 66 Swedish hospitals and healthcare facilities with inpatients using a data-driven, agent-based model informed by deidentified real-world hospitalization records. Combining the transmission model, patient-to-patient contact networks, and sparse observations of colonization, we develop and validate an individual-level inference approach that estimates the colonization probability of individual hospitalized patients. For both model-simulated and historical outbreaks, the proposed method supports the more accurate identification of asymptomatic MRSA carriers than other traditional approaches. In addition, in silica control experiments indicate that interventions targeted to inpatients with a high-colonization probability outperform heuristic strategies informed by hospitalization history and contact tracing.

Introduktion: En god handhygien utgör grunden för att minska smittspridning av smittsamma sjukdomar. Vårdrelaterade infektioner kostar samhället mycket rent ekonomiskt och i lidande för den enskilde. Individer med funktionsnedsättning som bor på gruppbostad riskerar att drabbas om inte vårdpersonalen tillämpar de basala hygienrutinerna och är relevant ur ett folkhälsovetenskapligt perspektiv. Syfte: Att analysera en befintlig självskattningsenkät avseende efterlevnad av basala hygienrutiner gällande handhygien som genomförts under våren samt hösten 2020 bland kommunanställd omvårdnadspersonal på gruppboenden inom en kommun i Stockholm. Metod: En upprepad tvärsnittsstudie med kvantitativ och kvalitativ analys av en befintlig självskattningsenkät. Analysen baseras på enkätsvar med en svarsfrekvens på 78 % från personal inom kommunens 15 gruppboenden och bestod av 80 deltagare på våren respektive 81 deltagare på hösten2020. Resultat: Mellan 69 - 97,5 % av deltagarna ansåg att de följde hygienrutinerna avseende basal handhygien under år 2020. I jämförelse mellan vår och höst sågs en signifikant förbättring av användning av handsprit före omvårdnadsmoment. I studiens kvalitativa del framkom deltagarnasupplevelse av hinder i tillämpningen och dessa utgjordes bland annat av; varierad användning av handskar, ovetskap, glömska, tidsbrist, tillgänglighet samt praktiska hinder i verksamheten. Slutsats: En stor del av omvårdnadspersonalen ansåg att de följde de basala hygienrutinerna avseende handhygien men kravet på att all personal skall arbeta efter hygienrutinerna avseende handhygienuppfylls inte. Hygienutbildningen som omvårdnadspersonalen erbjuds behöver utvecklas för att främja utveckling av health literacy vilket kan bidra till en ökad förståelse för varför tillämpningen är viktig. Detta kan förbättra följsamheten till de basala hygienrutinerna., Introduction: Good hand hygiene is the basis for reducing the spread of infections. Healthcare-related infections cost society a great deal financially and in suffering for the individual. Individuals with disabilities who live in group housing are at risk if the care staff does not apply the basic hygiene routines. Aim: Analyze an existing self-assessment survey regarding compliance with basic hygiene routines regarding hand hygiene that was carried out during the spring and autumn of 2020 among municipally employed nursing staff in group housing. Method: A repeated cross-sectional study with quantitative and qualitative analysis of an existing self-assessment survey. The analysis is based on questionnaire responses from staff with a response rate of 78%, within the municipality's 15 group homes and consisted of 80 participants in the spring and 81 participants in the autumn of 2020. Results: Between 69-97.5% of the participants considered that they followed the hygiene routines regarding basic hand hygiene during the year 2020. In a comparison between spring and autumn, a significant improvement was seen in the use of hand alcohol before nursing. The qualitative part of the study also revealed the participants' experience of obstacles, and included use of gloves, ignorance, forgetfulness, lack of time, accessibility and practical obstacles. Conclusion: A large part of the nursing staff believed that they followed the basic hygiene routines regarding hand hygiene. The hygiene training offered by the nursing staff needs to be developed to promote the development of health literacy. This can improve compliance with the basic hygiene routines.

Objectives: To evaluate the outbreak size and hospital cost effects of bacterial whole-genome sequencing availability in managing a large-scale hospital outbreak. Methods: We built a hybrid discrete event/agent-based simulation model to replicate a serious bacterial outbreak of resistant Escherichia coli in a large metropolitan public hospital during 2017. We tested the 3 strategies of using whole-genome sequencing early, late (actual outbreak), or not using it and assessed their associated outbreak size and hospital cost. The model included ward dynamics, pathogen transmission, and associated hospital costs during a 5-month outbreak. Model parameters were determined using data from the Queensland Hospital Admitted Patient Data Collection (N = 4809 patient admissions) and local clinical knowledge. Sensitivity analyses were performed to address model and parameter uncertainty. Results: An estimated 197 patients were colonized during the outbreak, with 75 patients detected. The total outbreak cost was A$460 137 (US$317 117), with 6.1% spent on sequencing. Without sequencing, the outbreak was estimated to result in 352 colonized patients, costing A$766 921 (US$528 547). With earlier detection from use of routine sequencing, the estimated outbreak size was 3 patients and cost A$65 374 (US$45 054). Conclusions: Using whole-genome sequencing in hospital outbreak management was associated with smaller outbreaks and cost savings, with sequencing costs as a small fraction of total hospital costs, supporting the further investigation of the use of routine whole-genome sequencing in hospitals.

Background: Healthcare workers’ hand hygiene remains a key pillar because it prevents and controls healthcare associated infections. Healthcare Workers’ hand hygiene compliance is suboptimal. Aim: The study developed contextualised guidelines for Healthcare Workers’ hand hygiene and infection control in patient care. Methods: The Precede-Proceed model with Theory of Planned Behaviour guided the study. The study was conducted following the mixed methodology approach, observational survey, exploratory, descriptive and contextual in nature study with mixed thematic analyses in a research wheel process. Data were collected through direct participant observation of hand hygiene opportunities through observing (n=95 Healthcare Workers; n=570 practices). Self-administered questionnaires were used to collect data from Healthcare workers (n=189) regarding challenges they faced in achieving hand hygiene. Structured interviews were conducted with patients (n=574). Retrospective reviews of healthcare associated infections and their associated mortalities were carried out from mortality records. Data were analysed retrospectively. Partly the data were statistically and mixed thematically analysed. Guidelines were developed using intervention alignment throughout, mapping, matching, pooling, patching and validation corroborated with Precede-Proceed models’ best practices. The study was ethically reviewed and approved by University of South Africa and the Medical Research Council of Zimbabwe project numbers, 6067662 and MRCZ/B/208. Results: Hand hygiene non-compliances were mostly found in the following contexts, after touching patients’ surroundings, and before doing an aseptic procedure. A non-hand hygiene compliance of Healthcare workers 167(29.3%) and compliance 403(70.7%) in context was suboptimal with sad patients and challenges faced by Healthcare workers. Conclusion: Healthcare Workers had gaps in hand hygiene compliance and availability of required resources. Gaps were al

Bakgrund: Handhygienrutiner är en grundläggande åtgärd i sjuksköterskans dagliga arbete för att förebygga vårdrelaterade infektioner. Över 1500 patienter dör varje år på grund av bristfällig standard på hygienrutiner. Vårdrelaterade infektioner orsakar stort vårdlidande hos patienten som kan förebyggas med god följsamhet till handhygienrutiner. Syfte: Syftet med denna studie var att beskriva orsaker som påverkar sjuksköterskors följsamhet till riktlinjer vid handhygien på sjukhus. Metod: Metoden som användes var en litteraturöversikt av artiklar med både kvalitativ och kvantitativ ansats. Resultat: Ur analysen av datamaterialet framkom tre huvudkategorier; Risk för smittspridning, omgivningens villighet att ge återkoppling, samt brister i organisationen, med åtta underkategorier. Konklusion: Brister på följsamhet till handhygienrutiner ökar risken för vårdrelaterade infektioner. Det finns ett behov av större insikt inom sjuksköterskors följsamhet till handhygienrutiner för att minska vårdlidandet hos patienten., Background: Following guidelines for hand hygiene is a basic part of the daily routine of nurses to help prevent healthcare associated infections. Over 1500 patients die every year as the result of poor adherence to hand hygiene guidelines. Health care associated infections result in care suffering for the patient which could have been prevented with higher adherence to hand hygiene guidelines. Aim: The aim of the literature review was to identify what causes nurses adherence to hand hygiene guidelines in a hospital setting. Method: The method used was a literature review where both qualitative and quantitative articles were analyzed. Results: Three main categories emerged from the analysis; risk for infectivity, peers willingness to give feedback and organizational shortcomings, with eight subcategories. Conclusion: Poor adherence to hand hygiene guidelines increases the risk of health care associated infections. To prevent care suffering for the patient there is a need for a deeper understanding for nurses’ adherence to hand hygiene guidelines.

Introduction: Healthcare associated infections (HAIs) are a global problem and lead to a large burden for the patients, healthcare systems and society. In low and middle-income countries the burden and prevalence is higher than in high-income countries. It is possible with good prevention to reduce the prevalence and burden of healthcare associated infections. Aim: Investigate Vietnamese Nurses’ and Nursing students’ conceptions about healthcare associated infections and their role in prevention of healthcare associated infections. Method: Qualitative research with a cross-sectional design and the data was collected through eight semi-structured interviews and unstructured observations. The data was analyzed by content analysis. Results: Four categories were identified in the data analysis: Understanding and conceptions about HAI, Hinders for the prevention of HAI, How to work in a preventive way for HAI, Responsibility for patient safety. Conclusion: The study showed hinders for the nurses to perform their work correctly, limitations in the environment, lack of time, and equipment and supplies. The need for improvements are more nurses, make equipment and supplies more available and more rooms for patients. The participants acknowledge about responsibility and the importance of following guidelines at the hospitals are identified in the result.

Low hand hygiene compliance among health staff is a problem globally in health care settings. Improving hand hygiene could prevent many of the health care associated infections that affects hundreds of millions of patients every year around the globe. The aim of this literature study was to describe obstacles to maintain proper hand hygiene in hospitals, seen from a global perspective. Eight articles from seven countries, all based on qualitative research have been analysed according to Friberg's five-step method that contributes to evidence-based nursing. The challenges to sustain hand hygiene found in the results were split into two main categories: Organizational factors and Individual factors. Organizational factors included five subcategories: Work environment, Inadequate education, Infrastructure, Insufficient management and Power structures. The results showed that when these factors were negatively affected so was compliance regarding proper hand hygiene. These were often issuesthat the health staff felt powerless to change and affect. Individual factors included two subcategories: Attitudes and social factors. Example of this could be healthcare workers neglected hygiene guidelines out of personal reasons or healthcare workers giving care to patients that didn’t accept how it was carried out because of social and cultural differences. The complex issues revolving these matters need to be addressed on an overall perspective. Cooperation between management and health staff is fundamental to obtain changes within healthcare organizations. Both parties need to work together to be able to improve hand hygiene compliance and to reduce healthcare associated infections.

Several studies have investigated antimicrobial resistance in low- and middle-income countries, but to date little attention has been paid to the Pacific Islands Countries and Territories (PICTs). This study aims to review the literature on antibiotic resistance (ABR) in healthcare settings in PICTs to inform further research and future policy development for the region. Following the PRISMA-ScR checklist health databases and grey literature sources were searched. Three reviewers independently screened the literature for inclusion, data was extracted using a charting tool and the results were described and synthesised. Sixty-five studies about ABR in PICTs were identified and these are primarily about New Caledonia, Fiji and Papua New Guinea. Ten PICTs contributed the remaining 21 studies and nine PICTs were not represented. The predominant gram-positive pathogen reported was community-acquired methicillin resistant S. aureus and the rates of resistance ranged widely (>50% to <20%). Resistance reported in gram-negative pathogens was mainly associated with healthcare-associated infections (HCAIs). Extended spectrum beta-lactamase (ESBL) producing K. pneumoniae isolates were reported in New Caledonia (3.4%) and Fiji (22%) and carbapenem resistant A. baumannii (CR-ab) isolates in the French Territories (24.8%). ABR is a problem in the PICTs, but the epidemiology requires further characterisation. Action on strengthening surveillance in PICTs needs to be prioritised so strategies to contain ABR can be fully realised.

Low hand hygiene compliance among health staff is a problem globally in health care settings. Improving hand hygiene could prevent many of the health care associated infections that affects hundreds of millions of patients every year around the globe. The aim of this literature study was to describe obstacles to maintain proper hand hygiene in hospitals, seen from a global perspective. Eight articles from seven countries, all based on qualitative research have been analysed according to Friberg's five-step method that contributes to evidence-based nursing. The challenges to sustain hand hygiene found in the results were split into two main categories: Organizational factors and Individual factors. Organizational factors included five subcategories: Work environment, Inadequate education, Infrastructure, Insufficient management and Power structures. The results showed that when these factors were negatively affected so was compliance regarding proper hand hygiene. These were often issuesthat the health staff felt powerless to change and affect. Individual factors included two subcategories: Attitudes and social factors. Example of this could be healthcare workers neglected hygiene guidelines out of personal reasons or healthcare workers giving care to patients that didn’t accept how it was carried out because of social and cultural differences. The complex issues revolving these matters need to be addressed on an overall perspective. Cooperation between management and health staff is fundamental to obtain changes within healthcare organizations. Both parties need to work together to be able to improve hand hygiene compliance and to reduce healthcare associated infections.

Bakgrund: Handhygienrutiner är en grundläggande åtgärd i sjuksköterskans dagliga arbete för att förebygga vårdrelaterade infektioner. Över 1500 patienter dör varje år på grund av bristfällig standard på hygienrutiner. Vårdrelaterade infektioner orsakar stort vårdlidande hos patienten som kan förebyggas med god följsamhet till handhygienrutiner. Syfte: Syftet med denna studie var att beskriva orsaker som påverkar sjuksköterskors följsamhet till riktlinjer vid handhygien på sjukhus. Metod: Metoden som användes var en litteraturöversikt av artiklar med både kvalitativ och kvantitativ ansats. Resultat: Ur analysen av datamaterialet framkom tre huvudkategorier; Risk för smittspridning, omgivningens villighet att ge återkoppling, samt brister i organisationen, med åtta underkategorier. Konklusion: Brister på följsamhet till handhygienrutiner ökar risken för vårdrelaterade infektioner. Det finns ett behov av större insikt inom sjuksköterskors följsamhet till handhygienrutiner för att minska vårdlidandet hos patienten., Background: Following guidelines for hand hygiene is a basic part of the daily routine of nurses to help prevent healthcare associated infections. Over 1500 patients die every year as the result of poor adherence to hand hygiene guidelines. Health care associated infections result in care suffering for the patient which could have been prevented with higher adherence to hand hygiene guidelines. Aim: The aim of the literature review was to identify what causes nurses adherence to hand hygiene guidelines in a hospital setting. Method: The method used was a literature review where both qualitative and quantitative articles were analyzed. Results: Three main categories emerged from the analysis; risk for infectivity, peers willingness to give feedback and organizational shortcomings, with eight subcategories. Conclusion: Poor adherence to hand hygiene guidelines increases the risk of health care associated infections. To prevent care suffering for the patient there is a need for a deeper understanding for nurses’ adherence to hand hygiene guidelines.

Introduction: Healthcare associated infections (HAIs) are a global problem and lead to a large burden for the patients, healthcare systems and society. In low and middle-income countries the burden and prevalence is higher than in high-income countries. It is possible with good prevention to reduce the prevalence and burden of healthcare associated infections. Aim: Investigate Vietnamese Nurses’ and Nursing students’ conceptions about healthcare associated infections and their role in prevention of healthcare associated infections. Method: Qualitative research with a cross-sectional design and the data was collected through eight semi-structured interviews and unstructured observations. The data was analyzed by content analysis. Results: Four categories were identified in the data analysis: Understanding and conceptions about HAI, Hinders for the prevention of HAI, How to work in a preventive way for HAI, Responsibility for patient safety. Conclusion: The study showed hinders for the nurses to perform their work correctly, limitations in the environment, lack of time, and equipment and supplies. The need for improvements are more nurses, make equipment and supplies more available and more rooms for patients. The participants acknowledge about responsibility and the importance of following guidelines at the hospitals are identified in the result.

Bakalářská práce je zaměřena na problematiku výskytu infekcí spojených se zdravotní péčí na porodních sálech v důsledku nedodržení zásad bariérové péče. Teoretická část se zabývá infekcemi spojenými se zdravotní péčí, bariérovou péčí a jejím dodržováním. Cílem práce je zjistit, jak dodržuje vyškolený zdravotnický personál zásady bariérové péče v souvislosti s prevencí infekcí spojených se zdravotní péčí na vybraném porodním sále., Bachelor thesis is dealing with issues of the occurrence of the healthcare associated infections in the delivery rooms due violation principles of the barrier care. The theoretical part is engaged in the healthcare-associated infections, barrier care and compliances in the barrier care. The purpose of this thesis is to find out how the thorough-paces medical staff follows the rules of the barrier care associated prevention healthcare associated infections in the selected delivery room., Fakulta zdravotnických studií, Hodnocení vedoucího: velmi dobře Hodnocení oponenta: velmi dobře minus Doplňující otázky k obhajobě: 1. Jakým způsobem jste např. u oblasti E hodnotila u jednotlivých PA dodržování pravidel úklidu a dezinfekce povrchů a prostředí? 2. Jak si vysvětlujete, že jednou z nejlépe hodnocených oblastí bylo např. zacházení s odpadem? 3. Jak se nazývá škrtidlo využívané k odběru venózní krve, o kterém se zmiňujete opakovaně v textu? Obhajoba bakalářské práce s prezentací dobrá., Dokončená práce s úspěšnou obhajobou

Tématem této diplomové práce je mikrobiální osídlení dolních cest dýchacích u pacientů s umělou plicní ventilací tracheostomickou kanylou. Teoretická část zahrnuje anatomii a fyziologii dýchacích cest, umělou plicní ventilaci, infekce spojená se zdravotní péčí a ventilační pneumonii. Ve výzkumné části jsou vyhodnoceny výsledky retrospektivní studie, kde byly hodnoceny faktory (BMI, K+C sputa, věk, diagnóza) ovlivňující mikrobiální osídlení u tracheostomovaných pacientů a výsledky byly zaznamenány v grafech a tabulkách., The topic of this Diploma thesis is the Microbial colonization of the Lower respiratory tract of patients with an Artificial pulmonary ventilation by a Tracheostomy cannula. The theoretical part includes Anatomy and Physiology of Respiratory system, Theory of Artificial ventilation, Healthcare associated infections and Ventilation pneumonia. In the research part The results of a Retrospective study were evaluated assessing the factors (BMI, K + C sputum, age, diagnosis) affecting the Microbial colonization of tracheostomized patients. The results were summarized in graphs and tables., Fakulta zdravotnických studií, Hodnocení vedoucího: C Hodnocení oponenta: D Doplňující otázky k obhajobě: 1. Jak vlídná komunikace ovlivňuje vnímavost pacienta k infekci spojenou se zdravotní péčí (s. 20)? 2. Jaké další ošetřovatelské intervence snižují uroinfekci u pacientů s permanentním močovým katétrem kromě údajů uvedených na s. 21? 3. Proč u ventilátorových pneumonií je řazeno pohlaví mužské jako neovlivnitelný rizikový faktor? 4. Jak využijete výsledky výzkumného šetření diplomové práce pro svou praxi?, Dokončená práce s úspěšnou obhajobou

Background: Surgical site infections (SSI) are one of the most common healthcare associated infections in the low-middle income countries. Data on incidence and risk factors for SSI following surgeries in general and Obstetric and Gynecological surgeries in particular are scare. This study set out to identify risk factors for SSI in patients undergoing Obstetric and Gynecological surgeries in an Indian rural hospital. Methods: Patients who underwent a surgical procedure between September 2010 to February 2013 in the 60-bedded ward of Obstetric and Gynecology department were included. Surveillance for SSI was based on the Centre for Disease Control (CDC) definition and methodology. Incidence and risk factors for SSI, including those for specific procedure, were calculated from data collected on daily ward rounds. Results: A total of 1173 patients underwent a surgical procedure during the study period. The incidence of SSI in the cohort was 7.84% (95% CI 6.30-9.38). Majority of SSI were superficial. Obstetric surgeries had a lower SSI incidence compared to gynecological surgeries (1.2% versus 10.3% respectively). The risk factors for SSI identified in the multivariate logistic regression model were age (OR 1.03), vaginal examination (OR 1.31); presence of vaginal discharge (OR 4.04); medical disease (OR 5.76); American Society of Anesthesia score greater than 3 (OR 12.8); concurrent surgical procedure (OR 3.26); each increase in hour of surgery, after the first hour, doubled the risk of SSI; inappropriate antibiotic prophylaxis increased the risk of SSI by nearly 5 times. Each day increase in stay in the hospital after the surgery increased the risk of contacting an SSI by 5%. Conclusions: Incidence and risk factors from prospective SSI surveillance can be reported simultaneously for the Obstetric and Gynecological surgeries and can be part of routine practice in resource-constrained settings. The incidence of SSI was lower for Obstetric surgeries compared to Gynecolo

Background: Surgical site infections (SSI) are one of the most common healthcare associated infections in the low-middle income countries. Data on incidence and risk factors for SSI following surgeries in general and Obstetric and Gynecological surgeries in particular are scare. This study set out to identify risk factors for SSI in patients undergoing Obstetric and Gynecological surgeries in an Indian rural hospital. Methods: Patients who underwent a surgical procedure between September 2010 to February 2013 in the 60-bedded ward of Obstetric and Gynecology department were included. Surveillance for SSI was based on the Centre for Disease Control (CDC) definition and methodology. Incidence and risk factors for SSI, including those for specific procedure, were calculated from data collected on daily ward rounds. Results: A total of 1173 patients underwent a surgical procedure during the study period. The incidence of SSI in the cohort was 7.84% (95% CI 6.30-9.38). Majority of SSI were superficial. Obstetric surgeries had a lower SSI incidence compared to gynecological surgeries (1.2% versus 10.3% respectively). The risk factors for SSI identified in the multivariate logistic regression model were age (OR 1.03), vaginal examination (OR 1.31); presence of vaginal discharge (OR 4.04); medical disease (OR 5.76); American Society of Anesthesia score greater than 3 (OR 12.8); concurrent surgical procedure (OR 3.26); each increase in hour of surgery, after the first hour, doubled the risk of SSI; inappropriate antibiotic prophylaxis increased the risk of SSI by nearly 5 times. Each day increase in stay in the hospital after the surgery increased the risk of contacting an SSI by 5%. Conclusions: Incidence and risk factors from prospective SSI surveillance can be reported simultaneously for the Obstetric and Gynecological surgeries and can be part of routine practice in resource-constrained settings. The incidence of SSI was lower for Obstetric surgeries compared to Gynecolo

Background: Surgical site infections (SSI) are one of the most common healthcare associated infections in the low-middle income countries. Data on incidence and risk factors for SSI following surgeries in general and Obstetric and Gynecological surgeries in particular are scare. This study set out to identify risk factors for SSI in patients undergoing Obstetric and Gynecological surgeries in an Indian rural hospital. Methods: Patients who underwent a surgical procedure between September 2010 to February 2013 in the 60-bedded ward of Obstetric and Gynecology department were included. Surveillance for SSI was based on the Centre for Disease Control (CDC) definition and methodology. Incidence and risk factors for SSI, including those for specific procedure, were calculated from data collected on daily ward rounds. Results: A total of 1173 patients underwent a surgical procedure during the study period. The incidence of SSI in the cohort was 7.84% (95% CI 6.30-9.38). Majority of SSI were superficial. Obstetric surgeries had a lower SSI incidence compared to gynecological surgeries (1.2% versus 10.3% respectively). The risk factors for SSI identified in the multivariate logistic regression model were age (OR 1.03), vaginal examination (OR 1.31); presence of vaginal discharge (OR 4.04); medical disease (OR 5.76); American Society of Anesthesia score greater than 3 (OR 12.8); concurrent surgical procedure (OR 3.26); each increase in hour of surgery, after the first hour, doubled the risk of SSI; inappropriate antibiotic prophylaxis increased the risk of SSI by nearly 5 times. Each day increase in stay in the hospital after the surgery increased the risk of contacting an SSI by 5%. Conclusions: Incidence and risk factors from prospective SSI surveillance can be reported simultaneously for the Obstetric and Gynecological surgeries and can be part of routine practice in resource-constrained settings. The incidence of SSI was lower for Obstetric surgeries compared to Gynecolo

Background: Surgical site infections (SSI) are one of the most common healthcare associated infections in the low-middle income countries. Data on incidence and risk factors for SSI following surgeries in general and Obstetric and Gynecological surgeries in particular are scare. This study set out to identify risk factors for SSI in patients undergoing Obstetric and Gynecological surgeries in an Indian rural hospital. Methods: Patients who underwent a surgical procedure between September 2010 to February 2013 in the 60-bedded ward of Obstetric and Gynecology department were included. Surveillance for SSI was based on the Centre for Disease Control (CDC) definition and methodology. Incidence and risk factors for SSI, including those for specific procedure, were calculated from data collected on daily ward rounds. Results: A total of 1173 patients underwent a surgical procedure during the study period. The incidence of SSI in the cohort was 7.84% (95% CI 6.30-9.38). Majority of SSI were superficial. Obstetric surgeries had a lower SSI incidence compared to gynecological surgeries (1.2% versus 10.3% respectively). The risk factors for SSI identified in the multivariate logistic regression model were age (OR 1.03), vaginal examination (OR 1.31); presence of vaginal discharge (OR 4.04); medical disease (OR 5.76); American Society of Anesthesia score greater than 3 (OR 12.8); concurrent surgical procedure (OR 3.26); each increase in hour of surgery, after the first hour, doubled the risk of SSI; inappropriate antibiotic prophylaxis increased the risk of SSI by nearly 5 times. Each day increase in stay in the hospital after the surgery increased the risk of contacting an SSI by 5%. Conclusions: Incidence and risk factors from prospective SSI surveillance can be reported simultaneously for the Obstetric and Gynecological surgeries and can be part of routine practice in resource-constrained settings. The incidence of SSI was lower for Obstetric surgeries compared to Gynecolo

Background: Surgical site infections (SSI) are one of the most common healthcare associated infections in the low-middle income countries. Data on incidence and risk factors for SSI following surgeries in general and Obstetric and Gynecological surgeries in particular are scare. This study set out to identify risk factors for SSI in patients undergoing Obstetric and Gynecological surgeries in an Indian rural hospital. Methods: Patients who underwent a surgical procedure between September 2010 to February 2013 in the 60-bedded ward of Obstetric and Gynecology department were included. Surveillance for SSI was based on the Centre for Disease Control (CDC) definition and methodology. Incidence and risk factors for SSI, including those for specific procedure, were calculated from data collected on daily ward rounds. Results: A total of 1173 patients underwent a surgical procedure during the study period. The incidence of SSI in the cohort was 7.84% (95% CI 6.30-9.38). Majority of SSI were superficial. Obstetric surgeries had a lower SSI incidence compared to gynecological surgeries (1.2% versus 10.3% respectively). The risk factors for SSI identified in the multivariate logistic regression model were age (OR 1.03), vaginal examination (OR 1.31); presence of vaginal discharge (OR 4.04); medical disease (OR 5.76); American Society of Anesthesia score greater than 3 (OR 12.8); concurrent surgical procedure (OR 3.26); each increase in hour of surgery, after the first hour, doubled the risk of SSI; inappropriate antibiotic prophylaxis increased the risk of SSI by nearly 5 times. Each day increase in stay in the hospital after the surgery increased the risk of contacting an SSI by 5%. Conclusions: Incidence and risk factors from prospective SSI surveillance can be reported simultaneously for the Obstetric and Gynecological surgeries and can be part of routine practice in resource-constrained settings. The incidence of SSI was lower for Obstetric surgeries compared to Gynecolo

Introduction: Hospital infections, or “healthcare associated infections” (HAI) represent the most frequent and serious complications of health care. Hence, there is a necessity to adopt safe care practices which are able to prevent or control the transmission of infections both in hospitals and in all non hospital healthcare facilities. The aim of this investigation is to assess the knowledge of the risk and the most effective means of prevention of HAI in the University of Ferrara nursing school students, giving particular attention to hand hygiene practices and the use of standard prophylactic precautions. Methods: The study enlisted a sample consisting of 339 students by first, second and third year nursing school students of the same academic year. An anonymous questionnaire was administered in order to investigate the knowledge of the students about three specific areas: infections associated with care practices (HAI), standard precautions (SP) and hand hygiene (HH). Results: The results showed a sufficient level of knowledge by all three groups of students, only in the section regarding SP. A barely sufficient score was reached only by the third year students with regard to the correct HH. For all the other answers, the level of knowledge shown by the students was inadequate. This is affirmed particularly for the section regarding the HAI. Conclusions: Literature data confirm that the knowledge of nursing students is often inadequate. It would be advisable to periodically check the knowledge of the students to improve training, to reduce HAI and increase their compliance with prevention.

Introduction: Hospital infections, or “healthcare associated infections” (HAI) represent the most frequent and serious complications of health care. Hence, there is a necessity to adopt safe care practices which are able to prevent or control the transmission of infections both in hospitals and in all non hospital healthcare facilities. The aim of this investigation is to assess the knowledge of the risk and the most effective means of prevention of HAI in the University of Ferrara nursing school students, giving particular attention to hand hygiene practices and the use of standard prophylactic precautions. Methods: The study enlisted a sample consisting of 339 students by first, second and third year nursing school students of the same academic year. An anonymous questionnaire was administered in order to investigate the knowledge of the students about three specific areas: infections associated with care practices (HAI), standard precautions (SP) and hand hygiene (HH). Results: The results showed a sufficient level of knowledge by all three groups of students, only in the section regarding SP. A barely sufficient score was reached only by the third year students with regard to the correct HH. For all the other answers, the level of knowledge shown by the students was inadequate. This is affirmed particularly for the section regarding the HAI. Conclusions: Literature data confirm that the knowledge of nursing students is often inadequate. It would be advisable to periodically check the knowledge of the students to improve training, to reduce HAI and increase their compliance with prevention.

Diplomová práce je zaměřena na problematiku pozdních sepsí a infekcí spojených se zdravotní péčí se zaměřením na novorozence. Zkoumána je incidence, zdroj a původci těchto infekcí. Teoretická část se zabývá infekcemi u novorozenců, infekcemi spojenými se zdravotní péčí a bariérovou péčí v porodní asistenci. Cílem práce je analýza retrospektivního sběru dat týkajících se pozdních novorozeneckých sepsí v daném zdravotnickém zařízení a dále zhodnocení bariérové péče na novorozeneckém oddělení pomocí zúčastněného přímého pozorování., The Diploma thesis is dealing with issues of late onset sepsis and healthcare-associated infections focused of newborns. The incidence, source and originator of these infections are examined. The theoretical part is engaged in infections by newborns, healthcare-associated infections and barrier technics in midwifery. The purpose of this thesis is an analysis of retrospective data collection, regarding late neonatal sepsis, in given medical facilities. Finally a barrier technics nursing on a newborn department through an involved direct observation is evaluated., Fakulta zdravotnických studií, Hodnocení vedoucího: výborně Hodnocení oponenta: výborně minus Doplňující otázky k obhajobě: 1. Jaké nejčastější chyby jste v průběhu pozorování nelékařského zdravotnického personálu zjistila? 2. Mělo zájem sledované pracoviště o zjištěné výsledky pozorování? Obhajoba diplomové práce s prezentací výborná., Dokončená práce s úspěšnou obhajobou

Antimicrobial resistance (AMR), i.e., the ability of microbes such as bacteria, viruses, fungi and parasites to resist the actions of one or more antimicrobial drugs or agents, is a serious global threat. Bacterial antibiotic resistance poses the largest threat to public health. The prevention of antimicrobial infections and their spread relies heavily on infection control management, and requires urgent, coordinated action by many stakeholders. This is especially true for nosocomial infections, also known as healthcare-associated infections (HAIs), i.e., infections that are acquired in healthcare settings. It is known that continuous, systematic collection, analysis and interpretation of data relevant to nosocomial infections and feedback for the use by doctors and nurses can reduce the frequency of these infections. Data from one hospital are more valid and more effective when they are compared with those from other hospitals. In order to avoid false conclusions, comparisons are only possible when identical methods of data collection with fixed diagnostic definitions are used. The automatic aggregation of standardized data using data from electronic medical records (EMRs), lab data, surveillance data and data on antibiotic use would greatly enhance comparison and computerized decision support systems (CDSSs). Once standardized, data can be aggregated from unit to institutional, regional, national and EU level, analysed and fed back to enhance local decision support on antibiotic use and detection of nosocomial infections.

Introduction. Hand decontamination with alcohol-based antiseptic agents is considered the best practise to reduce healthcare associated infections.Methods. We present a new method to monitor hand hygiene, introduced in a tertiary care pediatric hospital inNorthern Italy, which estimates the mean number of daily hand decontamination procedures performed per patient. The total amount of isopropyl alcohol and chlorhexydine solution supplied in a trimester to each hospital ward was put in relation with the number of hospitalization days, and expressed as liters/1000 hospitalization-days (World Health Organization standard), and the mean number of patients hospitalized and expressed as mean estimated number of hand hygiene procedures per patient per day (new method).Results. The two methods had similar performance for estimating the adherence to correct hand disinfection procedures. The new method identified wards and/or periods with high or low adherence to the procedure and indicated where to perform interventions and their effectiveness. The new methods could result easy-to understand also for non-infection control experts.Conclusion. This method can help non-infection control experts to understand adherence to correct hand- hygiene procedures and improve quality standards.

Introduction. Hand decontamination with alcohol-based antiseptic agents is considered the best practise to reduce healthcare associated infections.Methods. We present a new method to monitor hand hygiene, introduced in a tertiary care pediatric hospital inNorthern Italy, which estimates the mean number of daily hand decontamination procedures performed per patient. The total amount of isopropyl alcohol and chlorhexydine solution supplied in a trimester to each hospital ward was put in relation with the number of hospitalization days, and expressed as liters/1000 hospitalization-days (World Health Organization standard), and the mean number of patients hospitalized and expressed as mean estimated number of hand hygiene procedures per patient per day (new method).Results. The two methods had similar performance for estimating the adherence to correct hand disinfection procedures. The new method identified wards and/or periods with high or low adherence to the procedure and indicated where to perform interventions and their effectiveness. The new methods could result easy-to understand also for non-infection control experts.Conclusion. This method can help non-infection control experts to understand adherence to correct hand- hygiene procedures and improve quality standards.

BACKGROUND: Australia has commenced public reporting and benchmarking of healthcare associated infections (HAIs), despite not having a standardised national HAI surveillance program. Annual hospital Staphylococcus aureus bloodstream (SAB) infection rates are released online, with other HAIs likely to be reported in the future. Although there are known differences between hospitals in Australian HAI surveillance programs, the effect of these differences on reported HAI rates is not known. OBJECTIVE: To measure the agreement in HAI identification, classification, and calculation of HAI rates, and investigate the influence of differences amongst those undertaking surveillance on these outcomes. METHODS: A cross-sectional online survey exploring HAI surveillance practices was administered to infection prevention nurses who undertake HAI surveillance. Seven clinical vignettes describing HAI scenarios were included to measure agreement in HAI identification, classification, and calculation of HAI rates. Data on characteristics of respondents was also collected. Three of the vignettes were related to surgical site infection and four to bloodstream infection. Agreement levels for each of the vignettes were calculated. Using the Australian SAB definition, and the National Health and Safety Network definitions for other HAIs, we looked for an association between the proportion of correct answers and the respondents' characteristics. RESULTS: Ninety-two infection prevention nurses responded to the vignettes. One vignette demonstrated 100 % agreement from responders, whilst agreement for the other vignettes varied from 53 to 75 %. Working in a hospital with more than 400 beds, working in a team, and State or Territory was associated with a correct response for two of the vignettes. Those trained in surveillance were more commonly associated with a correct response, whilst those working part-time were less likely to respond correctly

Objective. Healthcare-associated infection (HAI) surveillance programs are critical for infection prevention. Australia does not have a comprehensive national HAI surveillance program. The purpose of this paper is to provide an overview of established international and Australian statewide HAI surveillance programs and recommend a pathway for the development of a national HAI surveillance program in Australia. Methods. This study examined existing HAI surveillance programs through a literature review, a review of HAI surveillance program documentation, such as websites, surveillance manuals and data reports and direct contact with program representatives. Results. Evidence from international programs demonstrates national HAI surveillance reduces the incidence of HAIs. However, the current status of HAI surveillance activity in Australian states is disparate, variation between programs is not well understood, and the quality of data currently used to compose national HAI rates is uncertain. Conclusions. There is a need to develop a well-structured, evidence-based national HAI program in Australia to meet the increasing demand for validated reliable national HAI data. Such a program could be leveraged off the work of existing Australian and international programs.

Background Australia has commenced public reporting and benchmarking of healthcare associated infections (HAIs), despite not having a standardised national HAI surveillance program. Annual hospital Staphylococcus aureus bloodstream (SAB) infection rates are released online, with other HAIs likely to be reported in the future. Although there are known differences between hospitals in Australian HAI surveillance programs, the effect of these differences on reported HAI rates is not known. Objective To measure the agreement in HAI identification, classification, and calculation of HAI rates, and investigate the influence of differences amongst those undertaking surveillance on these outcomes. Methods A cross-sectional online survey exploring HAI surveillance practices was administered to infection prevention nurses who undertake HAI surveillance. Seven clinical vignettes describing HAI scenarios were included to measure agreement in HAI identification, classification, and calculation of HAI rates. Data on characteristics of respondents was also collected. Three of the vignettes were related to surgical site infection and four to bloodstream infection. Agreement levels for each of the vignettes were calculated. Using the Australian SAB definition, and the National Health and Safety Network definitions for other HAIs, we looked for an association between the proportion of correct answers and the respondents’ characteristics. Results Ninety-two infection prevention nurses responded to the vignettes. One vignette demonstrated 100 % agreement from responders, whilst agreement for the other vignettes varied from 53 to 75 %. Working in a hospital with more than 400 beds, working in a team, and State or Territory was associated with a correct response for two of the vignettes. Those trained in surveillance were more commonly associated with a correct response, whilst those working part-time were less likely to respond correctly. Conclusion These findings reveal the need for fu

The aim of this study is to increase hand sanitizer usage among healthcare workers by developing and implementing a low-cost intervention using RFID and wireless mesh networks to provide real-time alarms for increasing hand hygiene compliance during opportune moments in an open layout Intensive Care Unit (ICU). A wireless, RFID based system was developed and implemented in the ICU. The ICU beds were divded into an intervention arm (n = 10) and a control arm (n = 14). Passive RFID tags were issued to the doctors, nurses and support staff of the ICU. Long range RFID readers were positioned strategically. Sensors were placed beneath the hand sanitizers to record sanitizer usage. The system would alert the HCWs by flashing a light if an opportune moment for hand sanitization was detected. A significant increase in hand sanitizer use was noted in the intervention arm. Usage was highest during the early part of the workday and decreased as the day progressed. Hand wash events per person hour was highest among the ancilliary staff followed by the doctors and nurses. Real-time feedback has potential to increase hand hygiene compliance among HCWs. The system demonstrates the possibility of automating compliance monitoring in an ICU with an open layout.

We studied a dataset of care episodes in a regional Swedish hospital system. We followed how 2,314,477 patients moved between 8,507 units (hospital wards and outpatient clinics) over seven years. The data also included information on the date when patients tested positive with methicillin resistant Staphylococcus aureus. To simplify the complex flow of patients, we represented it as a network of units, where two units were connected if a patient moved from one unit to another, without visiting a third unit in between. From this network, we characterized the typical network position of units with a high prevalence of methicillin resistant Staphylococcus aureus, and how the patient’s location in the network changed upon testing positive. On average, units with medium values of the analyzed centrality measures had the highest average prevalence. We saw a weak effect of the hospital system’s response to the patient testing positive - after a positive test, the patient moved to units with a lower centrality measured as degree (i.e. number of links to other units) and in addition, the average duration of the care episodes became longer. The network of units was too random to be a strong predictor of the presence of methicillin resistantStaphylococcus aureus - would it be more regular, one could probably both identify and control outbreaks better. The migration of the positive patients with within the healthcare system, however, helps decreasing the outbreak sizes.

We studied a dataset of care episodes in a regional Swedish hospital system. We followed how 2,314,477 patients moved between 8,507 units (hospital wards and outpatient clinics) over seven years. The data also included information on the date when patients tested positive with methicillin resistant Staphylococcus aureus. To simplify the complex flow of patients, we represented it as a network of units, where two units were connected if a patient moved from one unit to another, without visiting a third unit in between. From this network, we characterized the typical network position of units with a high prevalence of methicillin resistant Staphylococcus aureus, and how the patient’s location in the network changed upon testing positive. On average, units with medium values of the analyzed centrality measures had the highest average prevalence. We saw a weak effect of the hospital system’s response to the patient testing positive - after a positive test, the patient moved to units with a lower centrality measured as degree (i.e. number of links to other units) and in addition, the average duration of the care episodes became longer. The network of units was too random to be a strong predictor of the presence of methicillin resistantStaphylococcus aureus - would it be more regular, one could probably both identify and control outbreaks better. The migration of the positive patients with within the healthcare system, however, helps decreasing the outbreak sizes.

We studied a dataset of care episodes in a regional Swedish hospital system. We followed how 2,314,477 patients moved between 8,507 units (hospital wards and outpatient clinics) over seven years. The data also included information on the date when patients tested positive with methicillin resistant Staphylococcus aureus. To simplify the complex flow of patients, we represented it as a network of units, where two units were connected if a patient moved from one unit to another, without visiting a third unit in between. From this network, we characterized the typical network position of units with a high prevalence of methicillin resistant Staphylococcus aureus, and how the patient’s location in the network changed upon testing positive. On average, units with medium values of the analyzed centrality measures had the highest average prevalence. We saw a weak effect of the hospital system’s response to the patient testing positive - after a positive test, the patient moved to units with a lower centrality measured as degree (i.e. number of links to other units) and in addition, the average duration of the care episodes became longer. The network of units was too random to be a strong predictor of the presence of methicillin resistantStaphylococcus aureus - would it be more regular, one could probably both identify and control outbreaks better. The migration of the positive patients with within the healthcare system, however, helps decreasing the outbreak sizes.

__Abstract__ S. aureus colonizes the skin and mucosae of a proportion of the human population. Carriers of S. aureus are at increased risk of developing infections with this pathogen. The aim of this thesis was to add to the prevention of healthcare associated S. aureus infections. We conducted a RCT which aimed to identify S. aureus carriers upon admission to hospital, and treated carriers with either mupirocin ointment and chlorhexidin soap, or with placebo ointment and placebo soap. The mup/chx treated group developed significantly less S. aureus infections than the placebo treated group. In this study, many types of patients, both surgical and nonsurgical, were included. Chapter 3 describes, based on mortality rates, which groups of patients benefit most from this strategy. In

Introduction: Interventions that prevent healthcare-associated infections should lead to fewer deaths and shorter hospital stays. Cleaning hands with soap and water or alcohol rub is an effectiveway to prevent the transmission of organisms, but compliance is sometimes low. The National Hand Hygiene Initiative in Australia aimed to improve hand hygiene compliance among healthcare workers, with the goal of reducing rates of healthcare-associated infections. Methods: We examined if the introduction of the National Hand Hygiene Initiative was associated with a change in infection rates. Monthly infection rates for six types of healthcare-associated infections were examined in 38 Australian hospitals across six states. Infection categories were: bloodstream infections, centralline associated bloodstream infections, methicillin-resistant and methicillin-sensitive Staphylococcus aureus, Staphylococcus aureus bacteraemia and surgical site infections. Results: The National Hand Hygiene Initiative was associated with a statistically significant reduction in infection rates in 11 out of 23 state and infection combinations studied. There was no change in infection rates for nine combinations, and there was an increase in three infection rates in South Australia. Conclusions: The intervention was associated with reduced infection rates in many cases. The lack of improvement in nine cases may have been because they already had effective initiatives before the national initiative’s introduction.

We studied a dataset of care episodes in a regional Swedish hospital system. We followed how 2,314,477 patients moved between 8,507 units (hospital wards and outpatient clinics) over seven years. The data also included information on the date when patients tested positive with methicillin resistant Staphylococcus aureus. To simplify the complex flow of patients, we represented it as a network of units, where two units were connected if a patient moved from one unit to another, without visiting a third unit in between. From this network, we characterized the typical network position of units with a high prevalence of methicillin resistant Staphylococcus aureus, and how the patient's location in the network changed upon testing positive. On average, units with medium values of the analyzed centrality measures had the highest average prevalence. We saw a weak effect of the hospital system's response to the patient testing positive - after a positive test, the patient moved to units with a lower centrality measured as degree (i.e. number of links to other units) and in addition, the average duration of the care episodes became longer. The network of units was too random to be a strong predictor of the presence of methicillin resistant Staphylococcus aureus - would it be more regular, one could probably both identify and control outbreaks better. The migration of the positive patients with within the healthcare system, however, helps decreasing the outbreak sizes.

We studied a dataset of care episodes in a regional Swedish hospital system. We followed how 2,314,477 patients moved between 8,507 units (hospital wards and outpatient clinics) over seven years. The data also included information on the date when patients tested positive with methicillin resistant Staphylococcus aureus. To simplify the complex flow of patients, we represented it as a network of units, where two units were connected if a patient moved from one unit to another, without visiting a third unit in between. From this network, we characterized the typical network position of units with a high prevalence of methicillin resistant Staphylococcus aureus, and how the patient’s location in the network changed upon testing positive. On average, units with medium values of the analyzed centrality measures had the highest average prevalence. We saw a weak effect of the hospital system’s response to the patient testing positive - after a positive test, the patient moved to units with a lower centrality measured as degree (i.e. number of links to other units) and in addition, the average duration of the care episodes became longer. The network of units was too random to be a strong predictor of the presence of methicillin resistantStaphylococcus aureus - would it be more regular, one could probably both identify and control outbreaks better. The migration of the positive patients with within the healthcare system, however, helps decreasing the outbreak sizes.

We studied a dataset of care episodes in a regional Swedish hospital system. We followed how 2,314,477 patients moved between 8,507 units (hospital wards and outpatient clinics) over seven years. The data also included information on the date when patients tested positive with methicillin resistant Staphylococcus aureus. To simplify the complex flow of patients, we represented it as a network of units, where two units were connected if a patient moved from one unit to another, without visiting a third unit in between. From this network, we characterized the typical network position of units with a high prevalence of methicillin resistant Staphylococcus aureus, and how the patient’s location in the network changed upon testing positive. On average, units with medium values of the analyzed centrality measures had the highest average prevalence. We saw a weak effect of the hospital system’s response to the patient testing positive - after a positive test, the patient moved to units with a lower centrality measured as degree (i.e. number of links to other units) and in addition, the average duration of the care episodes became longer. The network of units was too random to be a strong predictor of the presence of methicillin resistantStaphylococcus aureus - would it be more regular, one could probably both identify and control outbreaks better. The migration of the positive patients with within the healthcare system, however, helps decreasing the outbreak sizes.

ABSTRACT Background: Healthcare-associated infections (HAIs) and HAI disease outbreaks present challenges for healthcare facilities. In 2008, a Clostridium difficile outbreak in Ontario resulted in the deaths of 91 patients and raised awareness of HAIs. Over the last 5 years, the outbreak rate has risen dramatically. Traditionally, HAI research has focused on epidemiology, healthcare systems, and the economic burden. Little is known about the impact HAI disease outbreaks have on the work of healthcare professionals. Purpose: The purpose of this study was to examine the effects of HAI outbreaks on healthcare professionals in a large acute care hospital in Ontario. Methods: A retrospective exploratory case study approach was used, including individual interviews, document analysis, and incidence analysis of HAIs hospital data. The sample was frontline nurses, clinical managers, infection control professionals, and environmental service staff. Document analysis included hospital policies and protocols related to infectious diseases and HAI disease outbreaks. Findings: The incidence rates of Methicillin-resistant staphylococcus aureus, Clostridium difficile, and Vancomycin-resistant enterococci have decreased but remained above the provincial benchmarks. The daily work of healthcare professionals was impacted by HAI outbreaks. Nurses experienced workload challenges, time pressures, and increased documentation. Infection control professionals' responsibilities have expanded. The environmental services staffs' cleaning processes have become more intensive. In response, several unique innovations were developed by hospital staff. Conclusion: The daily work of healthcare professionals at the study site has been affected by HAI outbreaks. Implications for futu, Master of Science in Nursing (MSN)

Syfte: Att genom vetenskaplig litteratur beskriva vilka metoder och instrument somanvänds inom hälso- och sjukvård för att mäta följsamheten tillhygienföreskrifter.Metod: Föreliggande studie har genomförts som en litteraturöversikt. Artiklar söktes viaCinahl, PubMed och Web Of Science.Resultat: Resultatet grundar sig på 14 artiklar. Fem kategorier av metoder beskrevs, medtio tillhörande instrument. I tio av studierna användes manuell observation sommätmetod. Två studier tog upp provtagning på ytor (ATP-mätning) för attutvärdera städrutiner. Även elektronisk observation, självskattning samt intervjubeskrevs. Instrumenten som beskrevs var fyra typer av observationsformulär, tvåtyper av ATP-mätare, två typer av enheter som registrerar elektroniska signaler,ett intervjuformulär samt ett självskattningsformulär.Slutsats: Att mäta följsamheten till hygienregler behöver inte vara svårt eller kostsamt,men kan hjälpa oss i arbetet mot en högre patientsäkerhet. Mätningar kan ge ossen bild av våra svaga punkter i följsamhet till hygienregler. I och med attsynliggöra svagheterna kan vi också arbeta med att förbättra dem.

Syfte: Att genom vetenskaplig litteratur beskriva vilka metoder och instrument somanvänds inom hälso- och sjukvård för att mäta följsamheten tillhygienföreskrifter.Metod: Föreliggande studie har genomförts som en litteraturöversikt. Artiklar söktes viaCinahl, PubMed och Web Of Science.Resultat: Resultatet grundar sig på 14 artiklar. Fem kategorier av metoder beskrevs, medtio tillhörande instrument. I tio av studierna användes manuell observation sommätmetod. Två studier tog upp provtagning på ytor (ATP-mätning) för attutvärdera städrutiner. Även elektronisk observation, självskattning samt intervjubeskrevs. Instrumenten som beskrevs var fyra typer av observationsformulär, tvåtyper av ATP-mätare, två typer av enheter som registrerar elektroniska signaler,ett intervjuformulär samt ett självskattningsformulär.Slutsats: Att mäta följsamheten till hygienregler behöver inte vara svårt eller kostsamt,men kan hjälpa oss i arbetet mot en högre patientsäkerhet. Mätningar kan ge ossen bild av våra svaga punkter i följsamhet till hygienregler. I och med attsynliggöra svagheterna kan vi också arbeta med att förbättra dem.

The complex and multilevel nature of health has made it challenging to evaluate public health actions. Performing comparative analyses in different contexts is particularly challenging. Health care associated infections are a public health threat in need of more effective hospital infection control. They are associated with significant morbidity and mortality worldwide and place a large burden on health care resources. Hospital infection control has had mixed success, with many aspects of context playing a large role. As such, systems approaches are called for that improve the capability to capture multilevel determinants, context and complex and causal interrelationships (such as feedback and nonlinearity) that may change over time.In this thesis a novel ‘multilevel systems approach’ is proposed that appears capable of complex, multilevel and causal analysis. The approach draws together qualitative and quantitative concepts and methods from four multilevel systems theories and methodologies: the Realist approach, Systems Thinking, Health System Frameworks and System Modelling and Simulation. The power and feasibility of the approach to analyse and evaluate complex public health actions in different contexts is examined by its specific application to hospital infection control. In particular, to the control of Methicillin-resistant Staphylococcus aureus (MRSA), a health care associated multidrug-resistant infection.In doing so, the context-specific (and nonlinear) effects of competing hospital infection control policies on changing trends in the incidence rate and prevalence of MRSA were measured and compared. The capability to evaluate multiple infection control policies implemented in different and interacting ward settings simultaneously, had not previously been demonstrated. This subsequently provided valuable insights. Given the contribution and generalisability of the multilevel systems approach, its application toward a range of public health action

Enligt Socialstyrelsen (2011) avlider cirka 1 500 människor årligen i Sverige på grund av vårdrelaterade infektioner. Den viktigaste åtgärden för att förebygga vårdrelaterade infektioner är att arbeta utifrån basala hygienrutiner (Socialstyrelsen, 2006). Det är idag oklart hur följsamheten till basala hygienrutiner ser ut inom primärvården i Sverige och bland distriktssköterskor. Syftet med studien var att undersöka distriktssköterskors följsamhet till basala hygienrutiner inom primärvården. Studien var baserad på strukturerade observationer och en enkät. Observationerna utfördes av distriktssköterskestudenter och genomfördes vid nio vårdcentraler i Uppsala. Observationsstudien visade att distriktssköterskorna hade god följsamhet till rådande hygienrutiner gällande klädregler, att hålla långt hår uppfäst och fingernaglar kortklippta samt till att inte använda färgat nagellack, lösnaglar och att inte bära ring. Det finns behov av förbättring av distriktssköterskornas följsamhet till handdesinfektion, att inte bära armbandsur samt korrekt användning av handskar och skyddskläder. Enkätstudien visade att distriktssköterskor inte har tillräckliga kunskaper om basala hygienrutiner. Det finns behov av förbättring inom den enskilda distriktssköterskans hygienarbete och inom arbetsgivarnas ansvarsområden gällande hygien. För att distriktssköterskan skall kunna arbeta med att förebygga smittspridning, behövs uppdaterade kunskaper och mer utbildning inom området. Arbetet med hygien bör lyftas fram och uppmuntras inom primärvården, i större utsträckning än vad som görs idag., Approximately 1500 people dies, every year in Sweden, as a result of healthcare associated infections (Socialstyrelsen, 2011). The most important action for preventing healthcare associated infections is compliance to hygiene routines (Socialstyrelsen, 2006). Today there is scarce knowledge about the compliance to hygiene routines within the area of primary healthcare and among district nurses in Sweden. This study aimed to examine the compliance to hygiene routines among district nurses in primary healthcare. Data was collected through observations and a questionnaire. The observations were carried out by nurses currently studying to become district nurses and were implemented on nine primary healthcare centers in Uppsala. The study showed that the district nurses had good compliance to the prevailing hygiene regulations concerning, clothing, hair, finger nails and to not carrying fingerings. There are however needs of improvement in the district nurses compliance to handdesinfection, not carrying wristwatches and correct use of gloves and protective aprons. Data from the questionnaire shows that district nurses don’t have sufficient knowledge about basic hygiene routines. There are needs of improvement within the individual district nurse's hygiene work and within the employers' area of responsibility concerning hygiene. In order to making it possible for the district nurse to work with preventing transmission of infectious diseases, more education within the area is needed. The work with hygiene routines should be encouraged within primary healthcare, in a bigger extent than its done today.

Enligt Socialstyrelsen (2011) avlider cirka 1 500 människor årligen i Sverige på grund av vårdrelaterade infektioner. Den viktigaste åtgärden för att förebygga vårdrelaterade infektioner är att arbeta utifrån basala hygienrutiner (Socialstyrelsen, 2006). Det är idag oklart hur följsamheten till basala hygienrutiner ser ut inom primärvården i Sverige och bland distriktssköterskor. Syftet med studien var att undersöka distriktssköterskors följsamhet till basala hygienrutiner inom primärvården. Studien var baserad på strukturerade observationer och en enkät. Observationerna utfördes av distriktssköterskestudenter och genomfördes vid nio vårdcentraler i Uppsala. Observationsstudien visade att distriktssköterskorna hade god följsamhet till rådande hygienrutiner gällande klädregler, att hålla långt hår uppfäst och fingernaglar kortklippta samt till att inte använda färgat nagellack, lösnaglar och att inte bära ring. Det finns behov av förbättring av distriktssköterskornas följsamhet till handdesinfektion, att inte bära armbandsur samt korrekt användning av handskar och skyddskläder. Enkätstudien visade att distriktssköterskor inte har tillräckliga kunskaper om basala hygienrutiner. Det finns behov av förbättring inom den enskilda distriktssköterskans hygienarbete och inom arbetsgivarnas ansvarsområden gällande hygien. För att distriktssköterskan skall kunna arbeta med att förebygga smittspridning, behövs uppdaterade kunskaper och mer utbildning inom området. Arbetet med hygien bör lyftas fram och uppmuntras inom primärvården, i större utsträckning än vad som görs idag., Approximately 1500 people dies, every year in Sweden, as a result of healthcare associated infections (Socialstyrelsen, 2011). The most important action for preventing healthcare associated infections is compliance to hygiene routines (Socialstyrelsen, 2006). Today there is scarce knowledge about the compliance to hygiene routines within the area of primary healthcare and among district nurses in Sweden. This study aimed to examine the compliance to hygiene routines among district nurses in primary healthcare. Data was collected through observations and a questionnaire. The observations were carried out by nurses currently studying to become district nurses and were implemented on nine primary healthcare centers in Uppsala. The study showed that the district nurses had good compliance to the prevailing hygiene regulations concerning, clothing, hair, finger nails and to not carrying fingerings. There are however needs of improvement in the district nurses compliance to handdesinfection, not carrying wristwatches and correct use of gloves and protective aprons. Data from the questionnaire shows that district nurses don’t have sufficient knowledge about basic hygiene routines. There are needs of improvement within the individual district nurse's hygiene work and within the employers' area of responsibility concerning hygiene. In order to making it possible for the district nurse to work with preventing transmission of infectious diseases, more education within the area is needed. The work with hygiene routines should be encouraged within primary healthcare, in a bigger extent than its done today.

Healthcare associated infections (HAI) are considered an avoidable patient safety risk, and warnings have been issued from professional and national agencies to focus on their prevention. In the United States, an estimated 5 to 10% of patients develop HAI, at an annual cost of $4.5 billion. There are many risk factors associated with HAI, among them poor staff adherence to hand hygiene. The topic for this video is hand hygiene. The target audience is first grade students.