Dissertations / Theses on the topic 'Nosocomial infections'
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Voirin, Nicolas. "Analyse et modélisation de la transmission de la grippe nosocomiale." Thesis, Lyon 1, 2009. http://www.theses.fr/2009LYO10151.
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Les conséquences des épidémies de grippe nosocomiale (GN) pour les patients en termes de morbidité et mortalité sont importantes. Cependant, la présentation clinique des cas, la fréquence de l’infection, le risque d’infection parmi les patients, la transmission et les mesures de contrôle les plus adaptées restent mal connues. Une analyse originale de la littérature nous a permis de synthétiser les connaissances sur la GN. Puis sur la base d’une étude prospective menée pendant 3 saisons de grippe de 2004 à 2007, nous avons présenté une description clinique des cas de grippe observés à l’hôpital Edouard Herriot de Lyon. Nous avons ensuite développé un modèle statistique d’analyse du risque de GN chez les patients et nous avons appliqué ce modèle sur des données concernant plus de 21500 patients. Les facteurs influençant la transmission ont été étudiés par simulation de la diffusion du virus grippal dans une unité de soin à l’aide d’un modèle biomathématique. Nous montrons qu’il était difficile d’identifier les cas de grippe dans l’hôpital sans réalisation systématique d’un test de dépistage. Le risque pour le patient de présenter un syndrome grippal était 2 fois plus important à l’hôpital que dans la communauté. De plus ce risque était 5 à 35 fois plus élevé lorsqu’un patient était exposé à un autre patient ou à un soignant contagieux au cours de son séjour. La transmission de patient à patient semblait une voie de transmission importante. La démarche de ce travail pourrait être adaptée et l’outil statistique étendu à l’étude de la dynamique et du contrôle des infections nosocomialesThe consequences of outbreaks of nosocomial influenza (NI) for patients in terms of morbidity and mortality are an issue of concerned. However, clinical presentation of cases, frequency of infection, risk of infection among patients, transmission and the most adapted control measures remain poorly understood. An original analysis of the literature allowed synthesizing the knowledge on NI. Then on the basis of a prospective study conducted during 3 influenza seasons from 2004 to 2007, we report a description of clinical cases of NI observed at the Edouard Herriot hospital in Lyon. Then, we developed a statistical model to analyze the risk of NI among patients and we apply this model on data from over 21,500 patients. Factors influencing the transmission were studied by simulating the spread of influenza virus in a hospital unit using a mathematical model. We show that identifying cases of influenza in the hospital without a systematic virological screening is difficult. The risk for the patient to present influenza like illness was 2 times higher in hospital than in the community. Furthermore, the risk was 5 to 35 times higher when a patient was exposed to other contagious patients or health care workers during his hospitalization. Transmission from patient to patient seemed to be a major route of transmission. The approach used in this work could be adapted and the statistical tools could be extended to study of the dynamics and control of nosocomial infections
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Hammond, Janet Margaret Justine. "Nosocomial infections in intensive care." Master's thesis, University of Cape Town, 1993. http://hdl.handle.net/11427/26477.
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The objectives of this thesis are : 1) To provide a review of the literature on the significance, pathogenesis, diagnosis and management of secondary infections in the Intensive Care Unit. 2) To present the findings of a study of the technique of selective parenteral and enteral antisepsis regimen (SPEAR) in the patient population of the Respiratory ICU at Groote Schuur Hospital, aimed at reducing the incidence of secondary infection and, further to evaluate the study in terms of the effect of SPEAR on the incidence of secondary infection and its influence on the mortality due to secondary infection. 3) To present the findings of the effect of SPEAR on patient bacterial colonisation in the ICU, and to evaluate its longterm influence on the microbial flora of the ICU.
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Gagné, Stéphanie. "Étude des mécanismes de virulence du pathogène nosocomial Acinetobacter baumannii." Thesis, Lyon, 2018. http://www.theses.fr/2018LYSE1045/document.
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Acinetobacter baumannii est un pathogène nosocomial qui induit principalement des infections du système respiratoire ou urinaire, et des septicémies chez les patients immunodéprimés. L'émergence de souches multi résistantes aux antibiotiques et l'augmentation de nombreuses d'infections par A. baumannii fait de ce pathogène un enjeu majeur de santé publique. De plus aujourd'hui émerge des souches hypervirulentes. Nous nous sommes intéressés à différentes souches afin de caractériser le phénotype hypervirulent de ces souches. L'étude du système de sécrétion de type VI montre la complexité des mécanismes de virulence d'A. baumannii et sa régulation dépendante des souches. Dans un second temps l'étude des souches cliniques hypervirulentes et nous avons mis en évidence deux nouveaux potentiels mécanismes de virulence : une phase de réplication intracellulaire et une limitation de la réponse immunitaire. Ces mécanismes peuvent expliquer la virulence accrue de ces souches chez l'homme. L'étude nous montre également qu'A. baumannii est un pathogène complexe et qu'on son étude à l'heure actuelle nécessité l'emploi de souche représentative des souches infectant les patientsA. baumannii is an hospital acquired pathogen which causes mainly ventilator associated infection, urinary tract infection and bacteraemia. Last years Multi Drug Resistant strains increase and nosocomial infection cause by A. baumannii also which led him as a serious health care problem. We compare different strains in propose to find phenotype that can explain hypervirulent strain emergence. We studied type six secretion and showed that the complexity of A. baumannii virulence mechanism. Indeed type six secretion system regulation is strain dependant. Secondary we study hypervirulent strain and showed that intracellular stage exists and there is intracellular replication. Also hypervirulent strain induces less immune response. Those two mechanisms can explain A. baumannii hypervirulent phenotype
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Dray, Sandrine. "Prévention des infections acquises en réanimation." Thesis, Aix-Marseille, 2019. http://theses.univ-amu.fr.lama.univ-amu.fr/191220_DRAY_424hxvw233y909lp868mkhqej_TH.pdf.
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En réanimation,le taux de patients présentant une infection nosocomiale atteint les 15%.Parmi les méthodes de prévention, la lutte contre le portage de germes au niveau cutané et la prévention de la transmission croisée par le lavage des mains du personnel sont des méthodes efficaces.La désinfection de la peau à la Chlorhexidine est une stratégie d’intérêt croissant pour les patients en réanimation.Cette stratégie nécessite encore des essais explorant la sécurité,le rapport coût-efficacité et l'impact de l'utilisation systématique de lingettes.La compliance à l’hygiène des mains (HH) reste une limite à la prévention des infections.Nous avons réalisé une étude pédagogique par simulation et l'utilisation des cabinets UV améliore la technique et la conformité aux opportunités en HH.Concernant la prévention des infections pulmonaires, la colonisation bactérienne trachéobronchique précède souvent l’apparition de la pneumopathie acquises sous ventilation mécanique (PAV),et il a été postulé que les microbes présents dans les sécrétions trachéales quelques jours avant la PAV pourraient être identiques à ceux retrouvés dans les voies respiratoires inférieures.La réalisation d’aspirations trachéales (ETA) régulières serait une méthode préventive.Nous avons réalisé une mise au point des études publiées pour déterminer les forces et les faiblesses de la gestion des antibiotiques sur la base des cultures de surveillance ETA dans la PAV.Ainsi,l’ETA pourrait être systématiquement réalisée pour prédire de manière fiable les micro-organismes de la PVA.Cependant, nous ne pouvons recommander le recours généralisé à la surveillance de routine de la flore trachéobronchiqueIn intensive care, the rate of patients with a nosocomial infection reaches 15%.Prevention is a central element in reducing their incidence. Among the methods of prevention, the fight against the carriage of germs at the cutaneous level and the prevention of cross-transmission by the washing of the hands of the personnel are effective methods.Disinfection of the skin with Chlorhexidine is one of the strategie of increasing interest for patients in intensive care.This strategy still requires trials exploring safety, cost-effectiveness and the impact of routine use of wipes.Compliance with hand hygien(HH)remains a limit to infection prevention.We carried out an educational study by simulation in HH and the use of UV cabinets improves technique and compliance with HH opportunities.Concerning the prevention of pulmonary infections, the tracheobronchial bacterial colonization often precedes the occurrence of VAP,and it has been postulated that the microbes present in the tracheal secretions a few days before VAP might be the same as those retrieved in the lower respiratory tract.The realization of regular tracheal aspirations(ETA)would be a preventive method.We have realized this review in the aim to provide an updated overview of the literature available in the field and to attempt to determine the strengths and weaknesses of antibiotic stewardship based on ETA surveillance cultures in VAP.ETA could be routinely performed to reliably predict the microorganisms of VAP.However we can't recommandthe widespread use of routine surveillance of tracheobronchial flora
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Maldonado, Vázquez Jesús Manuel. "Interferometric biosensors for rapid identification of nosocomial infections." Doctoral thesis, Universitat Autònoma de Barcelona, 2017. http://hdl.handle.net/10803/403761.
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Esta tesis doctoral se centra en el desarrollo de un nuevo biosensor óptico como una técnica alternativa para la identificación de infecciones nosocomiales con el fin de determinar el tratamiento más eficaz y reducir el uso inespecífico de fármacos antimicrobianos de amplio espectro. Proponemos el uso de un nuevo sensor nanofótonico basado en un dispositivo interferométrico, el biosensor de guías de onda bimodales (BiMW) para un análisis rápido, específico, directo y altamente sensible de los diferentes patógenos asociados a infecciones nosocomiales y su resistencia a múltiples fármacos. En primer lugar, se evaluaron y optimizaron diferentes estrategias de biofuncionalización para conseguir una inmovilización eficiente de los elementos de bioreconocimiento que aseguran una detección bacteriana altamente sensible con suficiente selectividad y reproducibilidad, particularmente para la detección directa en matrices complejas tales como orina y líquido ascítico. Posteriormente, las estrategias optimizadas se utilizaron para la identificación de diversos patógenos nosocomiales como Bacillus cereus, Escherichia coli y Pseudomonas aeruginosa utilizando anticuerpos como elementos de bioreconocimiento. La detección de Escherichia coli se realizó en una matriz compleja como es el líquido ascítico humano. Finalmente, el biosensor BiMW se empleó para identificar bacterias resistentes a múltiples fármacos como: i) la identificación de Staphylococcus aureus resistente a meticilina (MRSA) usando un aptámero, que es capaz de discriminar entre un Staphylococcus susceptible a antibióticos y un Staphylococcus multirresistente y (ii) la detección ultra sensible de genes de E. coli resistentes a múltiples fármacos, sin la necesidad de una previa amplificación por PCR.
En general, esta tesis aprovecha los conocimientos en biosensores fotónicos y en métodos bioanalíticos de nuestro Grupo de investigación para desarrollar una poderosa herramienta que permita la identificación directa y efectiva de patógenos nosocomiales y su resistencia a antibióticos.This doctoral Thesis is focusing on the development of a novel optical biosensor as an alternative technique for the identification of nosocomial infections in a faster way. This new tool will also facilitate the finding of the most effective treatment for each patient, reduce the nonspecific use of broad-spectrum antimicrobial drugs, and facilitate new antibiotic treatments. We propose the use of a novel nanophotonic sensor based on an interferometric transducer device, the Bimodal Waveguide device (BiMW) for the rapid, specific, highly sensitive and direct analysis of different pathogens associated to nosocomial infections and their multidrug resistant. First, we assessed and optimized different biofunctionalization strategies for an efficient immobilization of the required biorecognition receptors, which ensure a highly sensitive bacterial detection with enough selectivity and reproducibility, particularly suitable for the direct detection in complex matrices, such as urine and ascitic fluid. The optimized strategies were employed for the identification of various nosocomial pathogens such as Bacillus cereus, Escherichia coli, and Pseudomonas aeruginosa using antibodies as biorecognition elements. The detection of Escherichia coli was done in human ascitic fluid. Finally, the BiMW biosensor was employed to identify the multidrug-resistant bacteria such as: i) the identification of methicillin-resistant Staphylococcus aureus (MRSA) using a specific aptamer, which is able to discriminate among a susceptible one to antibiotic and a multidrug-resistant Staphylococcus, and (ii) the ultra-sensitive detection of multidrug-resistant E. coli genes without PCR amplification. This Thesis takes advantage of the knowledge in photonics biosensors and bioanalytical methods in our Group in order to develop a powerful tool for the direct and effective identification of nosocomial pathogens and their antibiotic-resistance in a rapid and label-free scheme.
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Ibbeson, Brett Martin. "Chemical strategies to target commonly acquired nosocomial infections." Thesis, University of Cambridge, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.610828.
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Thomas, Lee Carolyn. "Genetic methods for rapid detection of medically important nosocomial bacteria." Connect to full text, 2007. http://hdl.handle.net/2123/3575.
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Thesis (M. Sc. Med.)--University of Sydney, 2007.Title from title screen (viewed 15 October 2008). Submitted in fulfilment of the requirements for the degree of Master of Science in Medicine to the Discipline of Medicine, Faculty of Medicine. Includes bibliographical references. Also available in print form.
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Marshall, Caroline. "Endemic methicillin-resistant staphylococcus aureus in the intensive care unit." Monash University, Dept. of Medicine, 2004. http://arrow.monash.edu.au/hdl/1959.1/9505.
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Khanafer, Nagham. "Épidémiologie des infections à Clostridium difficile chez les patients hospitalisés dans un centre hospitalo-universitaire." Thesis, Lyon 1, 2013. http://www.theses.fr/2013LYO10136/document.
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Clostridium difficile est responsable de 15 à 25% des cas de diarrhées post-antibiotiques (ATB) et de plus de 95% des cas de colite pseudomembraneuse. Depuis 2003 et suite à l'émergence du clone 027, les ICD sont devenues plus fréquentes et plus sévères. Compte tenu des conséquences, il a été décidé d'explorer en détail et prospectivement cette maladie au Groupement Hospitalier Edouard Herriot L'inclusion des patients a débuté fin février 2011 et devrait s'arrêter fin février 2014. Dans une méta-analyse, nous avons montré que l'ICD communautaire est associée à l'exposition aux mêmes ATB qu'une ICD nosocomiale. Une analyse de la littérature, en utilisant la grille ORION comme outil, nous a permis de synthétiser les connaissances sur la prévention et le contrôle d'ICD en milieu hospitalier. Par la suite sur la base d'une étude rétrospective, le sexe, la CRP et l'exposition aux fluoroquinolones ont été identifiés comme associés à une ICD sévère chez les patients hospitalisés en réanimation. Entre 2011 et 2013, 430 patients ont été inclus dans notre cohorte. L'analyse des données de la prise en charge thérapeutique de 118 cas d'ICD a montré un niveau insuffisant de la connaissance des recommandations actuelles concernant le traitement de cette infection. L'analyse pronostique a montré un taux de mortalité de 19,5% dans les 30 jours qui suivent le diagnostic. L'ICD était indiquée comme une cause principale ou contributive de décès dans quinze cas (65,7% des décédés). Les analyses multivariées ont montré que les facteurs associés au décès sont différents entre les patients avec une ICD et les patients présentant une diarrhée non liée au Clostridium difficileClostridium difficile is responsible for almost all cases of pseudomembranous colitis and for 15%-25% of cases of post-antibiotic (ATB) diarrhea. Since 2003 and the emergence of 027 strain, CDI epidemiology is changing, with evidence of rising incidence and severity. In response to the alarming situation we decided to conduct a prospective study at Eduard Herriot Hospital to explore in details this infection. Patient’s inclusion has started in February 2011 and will end in February 2014. In a meta-analysis we found that the risk profiles for antimicrobial classes as risk factors for community-acquired CDI are similar to those described for nosocomial CDI. We used the ORION statement (Outbreak Reports and Intervention Studies Of Nosocomial infection) to synthesize knowledge of interventions to reduce and to control CDI in hospitals. Then in a retrospective study, we found that male gender, rising serum C-reactive protein level, and previous exposure to fluoroquinolones were independently associated with severe CDI in ICU. Between 2011 and 2013, 430 patients were included in our prospective cohort study. Data analysis of 118 cases of CDI showed an inefficient knowledge of current recommendations of CDI treatment. The crude mortality rate within 30 days after CDI diagnosis was 19.5%, with 15 deaths (65.7% of deceased patients) related to CDI. In a multivariate cox regression model, gender, serum albumin, antidiarrheal medications, cephalosporins, peritonitis and septic shock were independently associated with mortality in CDI patients. When diarrhea was not related to C. difficile, mortality was rather associated with cancer and high WBC level
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Arocha, Doramarie. "Characteristics of Adult ICU Patients with Device Associated Nosocomial Infections." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3135.
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Nosocomial infections are a cause of concern for hospital patients and the incidence rates of these infections are greater in intensive care units (ICUs) due to the invasive nature of treatments, additional risk factors and comorbidities, and therapies used. Invasive devices, such as vascular central lines, Foley catheters, and mechanical ventilators pose a risk for critically ill patients in the ICUs to develop device-related, healthcare-associated infections (HAI). The purpose of this study was to describe the epidemiological characteristics of patients who developed device-related HAIs within 3 ICU units (medical-surgical, cardiovascular, and neurosurgical) of an academic medical facility. The ecosocial theory of disease distribution provided the theoretical framework for the study to describe how ecological and social determinants interact and affect health variances. Secondary data were analyzed using analysis of variance (ANOVA), Pearson correlations, and chi-square statistical tests. A total of 4,213 patients admitted to the 3 ICUs from 2010-2014 were identified. According to the chi-square analysis, there was significant association between race/ethnicity and type of device-associated infection; between gender and types of infection; and between risk factors (diabetes, obesity, smoking habits) and kinds of infection, all of which the statistical significance had varied for each individual ICU. Bacterial differences were noted between device-associated infections. The potential positive social change from this study could be insight on possible new processes and interventions to reduce nosocomial infections and improve adult ICU patient outcomes such as decreased HAIs, decreased length of stay, comorbidities, and cost for both the patient and the hospital.
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Cheng, Chi-chung Vincent, and 鄭智聰. "Proactive infection control measures." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48540596.
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Infection control is an often neglected clinical subject in Hong Kong until the outbreak of severe acute respiratory syndrome (SARS) in 2003. A total of eight healthcare workers, including four medical doctors, succumbed as a result of nosocomial acquisition of SARS-coronavirus (SARS-CoV) at the time. Since then, the importance of infection control practice was much better appreciated by the frontline healthcare workers, as it can be a matter of life-or-death. My thesis summarized our research on the proactive infection control measures to prevent nosocomial transmission of respiratory and gastrointestinal viruses, to control emerging and endemic antibiotic-resistant bacteria, and on the management of unprecedented infection outbreaks in the hospital.
Promotion of hand hygiene is the cornerstone of proactive infection control measures. By adopting the concept and practice of directly-observed hand hygiene, we demonstrated successful control of outbreaks and prevention for both respiratory and gastroenteritis viruses. Introduction of electronic devices for continuous monitoring of hand hygiene compliance in high risk clinical areas provides an opportunity for immediate feedback and timely education to frontline staffs.
The global dissemination of multiple drug resistant organisms (MDROs) such as methicillin-resistant Staphylococcus aureus (MRSA), community-associated MRSA (CA-MRSA), vancomycin-resistant enterococcus (VRE), hypervirulent clone of Clostridium difficile, extended-spectrum beta-lactamase (ESBL) producing organisms, and the recently described carbapenem-resistant enterobacteriaceae (CRE), pose a great challenge to the infection control professionals. In Hong Kong, MRSA has been endemic for more than two decades. Although we proved that the appropriate use of single room isolation and hand hygiene can significantly reduce the incidence of nosocomial MRSA in the adult intensive care unit, the isolation facilities remain limited in the general medical and surgical units. Innovations are much in need to manage this old and persistent problem. Therefore, we demonstrated that use of antibiotics, in particular beta-lactams and fluoroquinolones, could increase the risk of environmental contamination by increasing microbial density of MRSA in the anterior nares by 2-3 log10 in as little as 1 week. We also found that some MRSA strains such as spa types t1081 and t037 were more transmissible. Based on these findings, we prioritized our isolation facilities for those patients who are heavily colonized or infected with highly transmissible spa-type t1081, especially when they are receiving antibiotic therapy. Along with our enhancement of hand hygiene practices and antibiotic stewardship program, the incidence of MRSA bacteremia per 1000-patient-days was the lowest among the seven hospital clusters in Hong Kong. We believe that our experience in the control of the MRSA can be extended to contain the spread of CA-MRSA and other MDROs.
Besides the prevailing infectious diseases with high endemicity, we have to be vigilant against other potential outbreaks due to uncommon micro-organisms such as the polymicrobial outbreak in patients undergoing intermittent peritoneal dialysis caused by hospital renovation, the unprecedented outbreak of intestinal mucormycosis caused by Rhizopus microsporous among the patients with hematological malignancy, and the nosocomial outbreak of legionellosis in our locality. Extensive outbreak investigations were performed, which demonstrated that environmental factors were also important in causing nosocomial outbreaks.published_or_final_version
Microbiology
Master
Doctor of Medicine
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Byrd, Charmaine Amoy. "Nurse Education and the Reduction of Nosocomial Infections in Acute Care Settings." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3022.
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Nosocomial infections are acquired in health care settings and they can lead to catastrophic health care consequences for patients. These infections can also pose significant financial burdens on society and health care systems. Educating nurses on hand hygiene is essential to reducing infection rates. The research question for the study examined the effectiveness of hand hygiene among nurses in reduction of nosocomial infections and how can health care organizations develop educational strategies to reduce nosocomial infections to improve public confidence in health care systems. The purpose of this study was to educate nurses on how to reduce the incidence of nosocomial infections. The evidence-based practice model for this project was Florence Nightingale's environmental theory. The health belief model was used to identify the reasons for health care culture and how they inspire change. In this study, 2 licensed practical nurses and 2 registered nurses were educated on how to reduce nosocomial infections in acute care settings. Participants then completed a questionnaire to assess their knowledge of hand hygiene as a means of reducing nosocomial infections when caring for patients. All participants agreed that hand hygiene; reduces the risk of contracting a nosocomial infection, suggesting that the incidence of nosocomial infections within acute care settings maybe reduced through this education. This project has potential positive social change by educating first and second year nursing students on the importance of hand hygiene in reduction of nosocomial infections and preventing patients from sustaining further injuries while admitted in acute care settings.
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Ancheril, Alphonsa. "Evaluation of a program implemented to reduce surgical wound infection in an acute care hospital in India : a clinical practice improvement project /." Electronic version, 2004. http://adt.lib.uts.edu.au/public/adt-NTSM20040913.150110/index.html.
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Zahar, Jean-Ralph. "Epidémiologie et conséquences des infections nosocomiales en réanimation : Impact et conséquences de la résistance bactérienne en réanimation." Thesis, Grenoble, 2012. http://www.theses.fr/2012GRENS004/document.
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Les infections nosocomiales à bactéries multi-résistantes sont en constante augmentation en réanimation. Elles ont des conséquences individuelles et collectives majeures. La mortalité en réanimation et les prolongations des durées de séjour sont les deux principales conséquences individuelles connues à ce jour. Plusieurs facteurs confondants rendent l'interprétation des études difficiles, dont l'état sous jacent du patient, la virulence de la bactérie et l'adéquation thérapeutique. Mesurer la part de chacun de ces facteurs et préciser leur responsabilité respective est indispensable pour mobiliser les différents acteurs et améliorer le pronostic des patients en réanimation. Dans cette thèse nous avons souhaité approcher la réponse quant aux conséquences individuelles. A partir d'une base de données incluant des patients de réanimation, nous avons utilisé les méthodes statistiques les plus récentes et avons tenté de prendre en compte les différents facteurs confondants , pour répondre à trois questions précises que sont : la mortalité liée à une espèce bactérienne donnée, les facteurs associés à la mortalité des patients présentant un sepsis sévère ou choc septique en réanimation et les conséquences liées à l'isolement des patients infectés ou colonisés avec une bactérie multi-résistante. Nous montrons que (1) par l'intermédiaire d'une prolongation de la durée de séjour en réanimation, l'infection à Clostridium difficile augmente la pression de colonisation, sans pour autant avoir d'impact direct sur le décès. (2) que le pronostic des sepsis sévères et des chocs septiques dépend de l'adéquation de l'antibiothérapie et que les bactéries résistantes sont plus souvent traitées de manière inadéquate. (3) que l'isolement contact est associé non seulement à une augmentation attendue du risque de pneumonie nosocomiale a germe multi-résistants mais aussi à une augmentation du risque d'erreurs thérapeutiques et d'événements indésirables non infectieux. Cet impact délétère suggéré par des études en dehors de la réanimation doit être pris en compte lors de la mise en place des précautions contact en réanimationNosocomial infections with multidrug-resistant bacteria are increasing in ICU. They have major individual and collective consequences. Mortality in the ICU and prolongation of length of stay are the two main individual consequences known to date. Several confounding factors make it difficult to interpret studies, including the patient's underlying condition, the virulence of bacteria and the adequacy of therapy. It is essential to measure the share of each of these factors and to clarify their respective responsibilities to mobilize the different actors and improve the prognosis of patients in intensive care. In this thesis, and drawing upon a database including ICU patients, we used the latest statistical methods and tried to take into account the various confounding factors to evaluate the individual consequences of multidrug-resistant bacteria in ICU. We sought to address three specific questions: mortality linked to specific bacterial species, factors associated with mortality in patients with severe sepsis or septic shock in intensive care unit, and the consequences of the isolation of patients infected or colonized with multidrug-resistant bacteria. We demonstrated that (1) because they are associated with a longer stay in intensive care unit, Clostridium difficile infections increase the pressure of colonization although they have no direct consequence on mortality; (2) the prognosis of sever sepsis or septic shock depends on the adequacy of the antibiotic therapy and that resistant bacteria are often inadequately treated; and (3) that isolation is not only associated with an expected increase in the risk of nosocomial pneumonia with multi-drug resistant pathogens strains but also with an increase in non-infectious adverse events
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Spenillo, Jocelyn K. "Nurse’s Perceptions of Visitor’s Adherence to Transmission-Based Precautions." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/honors/316.
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Transmissions based precautions are measures implemented in various clinical health care settings as a means to prevent the transmission of infectious diseases and decrease instances of healthcare acquired infections (HAI). HAI’s result in increased cost to hospitals, longer hospitalization for patients, increased patient suffering, and fatal patient outcomes. While staff member adherence to transmissions based precautions are mandated through various organizations and hospital policies, a review of literature indicates little research has been conducted regarding visitor compliance with transmission-based precautions. The potential implications in healthcare from visitor non-adherence acquired infections are unknown; revealing a gap in literature and supporting the need for further research to describe the phenomenon. Through utilization of a descriptive online survey instrument, the purpose of this descriptive study is to gain insight into why nurses believe visitors may or may not be compliant with transmission-based precautions. To collect the data, an online descriptive survey instrument was developed and distributed via email to all graduate students’ enrolled East Tennessee State University’s College of Nursing. Only ten participants met the eligibility requirements to participate in this study. Data was analyzed though a predictive analytics software and grouping responses into themes. Responses suggest that nurses feel visitors are not complying with transmission-based precautions because of a lack in education, not perceiving the infection as a threat, prior exposure to loved one at home, and inconvenience.
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Rashleigh-Rolls, Rebecca M. "Hospital acquired infections : outbreaks and infection control interventions, a national descriptive survey." Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/101494/1/Rebecca_Rashleigh-Rolls_Thesis.pdf.
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This study investigated hospital-acquired infection (HAI) across Australian public hospitals from January 2005 - December 2011. Specifically, outbreaks of HAI and infection control interventions (aimed at reducing HAI rates) were investigated. Outbreaks of HAI, with the most frequent pathogens being Norovirus and Vancomycin-resistant Enterococcus, occurred in the majority of hospitals. Further, a wide variety of infection control interventions were applied during the time-frame yet there was no standardised implementation approach. Rates of HAI appeared to be affected by the implementation of particular infection control interventions, either by reducing or increasing mean infection rates.
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Yeung, Suk-ching Stephenie. "The effectiveness of educational programs to improve the knowledge and compliance of healthcare workers towards standard precautions /." View the Table of Contents & Abstract, 2007. http://sunzi.lib.hku.hk/hkuto/record/B38297279.
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Tassev, Dimiter V. "Antimicrobial susceptibility testing of novel anticancer derivatives against infectious bacteria for the potential minimization of nosocomial infections." Connect to resource, 2006. http://hdl.handle.net/1811/6457.
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Thesis (Honors)--Ohio State University, 2006.Title from first page of PDF file. Document formatted into pages: contains 27 p.; also includes graphics. Includes bibliographical references (p. 24-27). Available online via Ohio State University's Knowledge Bank.
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Struelens, Marc. "Bacterial genome fingerprinting: a molecular approach to the epidemiology of nosocomial infections." Doctoral thesis, Universite Libre de Bruxelles, 1993. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/212868.
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Letrilliart, Laurent. "Le risque nosocomial détecté en médecine générale." Bordeaux 2, 2000. http://www.theses.fr/2000BOR28800.
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En France comme aux Etats-Unis, la lutte contre la iatrogénie est aujourd'hui une priorité de santé publique. Les risques de iatrogénie nosocomiale ont surtout été étudiés en milieu hospitalier, bien que la diminution actuelle des durées d'hospitalisation puisse favoriser la survenue de complications d'origine hospitalière se manifestant en ville. Afin d'évaluer ce risque en médecine générale, nous avons mis en place un système de surveillance épidémiologique et de suivi prospectif des recours à l'hospitalisation par les médecins généralistes du réseau Sentinelles de l'INSERM. Les données ont été recueillies par voie télématique (Internet et/ou Minitel), et les motifs d'hospitalisation codés selon la Classification Internationale des Soins Primaires (CISP), grâce à des outils informatiques développés à cet effet. Entre août 1997 et juillet 1999, 7540 recours à l'hospitalisation ont été individuellement décrits par 305 médecins Sentinelles. Les 5 principaux motifs d'hospitalisation, représentant 17,1 % des motifs, étaient les suivants : douleur abdominale généralisée, traumatisme, insuffisance cardiaque, appendicite aiguê et altération de l'état général. Quatre-vingt-onze cas de complications iatrogènes détectées dans les suites de l'hospitalisation ont été rapportés et validés, incluant 21 infections nosocomiales, 30 réactions indésirables médicamenteuses, et 40 complications d'autre nature. L'incidence globale des complications iatrogènes nosocomiales détectées en médecine générale après la sortie de l'hôpital a été estimée à 1,2 pour cent admissions (IC95 % : 1,0 à 1,5 pour cent. Les infections nosocomiales diagnostiquées en ville étaient survenues en dehors de toute intervention chirurgicale dans 62 % des cas. Les réactions indésirables médicamenteuses impliquaient principalement les médicaments cardio-vasculaires et ceux du système nerveux central, et 59 % d'entre elles étaient potentiellement évitables. Un suivi rapproché des patients à leur sortie de l'hôpital, et une communication adéquate entre les différents acteurs permettraient de mieux détecter et maîtriser ces risquesIn France as in the United States, the control of preventable adverse events has become a public health priority. Risks of nosocomial adverse events have been mainly studied in the inpatient setting, although the current decrease in hospitalisation lengths may favour the occurence of complications of hospital origin arising outside hospital. In order to assess this risk in general practice, we have implemented an epidemiological system for surveillance and prospective follow-up of referrals to hospital by general practitioners of the French Sentinel network. Data have been collected via teleinformatics (Internet or Minitel), and reasons for referral to hospital have been coded according to the International Classification of Primary Care (ICPC), through automated tools developed therefore. Between August 1997 and July 1999, 7540 referrals to hospital have been individually described by 305 Sentinel physicians. Top 5 reasons for hospital referral, accounting for 17. 1 % of reasons, were the following : generalised abdoiminal pain, trauma, heart failure, acute appendicitis, and weakness. Ninety-one cases of iatrogenic comlications detected after discharge have been reported and validated, including 21 nosocomial infections, 30 adverse drug reactions, and 40 complications of other origin. The overall incidence of iatrogenic complications detected in general practice after hospital discharge has been estimated at 1. 2 per hundred admissions (95 % CI, 1. 0 to 1. 5 per hundred. Nosocomial infections diagnosed outside hospital had occured in the absence of any surgical operation in 62 % of cases. Adverse drug reactions mainly involved drugs used in cardiovascular disease and central nervous system, and 59 % of them were potentially preventable. A close patient follow-up after hospital discharge, and an appropriate communication between the different actors should improve the detection and control of those risks
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Ohlen, Ingrid. "Analyse du caractère nosocomial de deux cas d'aspergillose invasive à A. Flavus par typage moléculaire R. A. P. D. (Random Amplification Polymorphic DNA)." Paris 5, 1999. http://www.theses.fr/1999PA05P006.
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Ching, Wing-han Michael. "Modeling of contaminant dispersion by statistical mechanics." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B42664500.
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Coady, Charles F. "Nosocomial infections and antibiotic utilization in long-term care facilities : traditional versus protective care settings /." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0012/MQ36105.pdf.
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Leung, Tsz-kwan, and 梁子鈞. "An evidence-based guideline to prevent nosocomial infections in infants with enteral feeding." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B4833571X.
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Enteral feeding is commonly used in paedaitric patients. It helps to improve the digestive, absorptive, immunologic and nutrition status. However, poor handling in enteral feeding can lead to bacterial contaminations and severe consequences resulting in significant morbidity and mortality. At present, there are no definite guidelines on the handling of enteral feeding in local setting, therefore developing evidence based guideline on enteral feeding is critically important to eliminate inconsistent practices and prevent nosocomial infections related to enteral feeding.
This dissertation is a translational nursing research that aims at developing evidence based guideline on enteral feeding in infants. The objectives of this thesis are to search for existing literatures on enteral feeding; perform a critical appraisal on the literatures; develop guideline on enteral feeding in infants; assess the implementation potential of the proposed guidelines, and develop the implementation and evaluation plans. The ultimate goal is to reduce the nosocomial infections in infants with enteral feeding in an acute hospital.
A systemic search for relevant and valid evidence was performed using three electronic databases and nine relevant studies were retrieved. Critical appraisals on the nine studies were performed and the level of evidence for each study was graded according to the Scottish Intercollegiate Guidelines Network (SIGN). By synthesizing the data from nine studies, it is concluded that optimal hang time and proper hand hygiene appeared to have significant effect in reducing nosocomial infections related to enteral feeding.
The implementation potential of the innovation was assessed in terms of the transferability, feasibility and cost benefit ratio. After assessing the implementation potential, it is found that the evidence is transferable and feasible to implement the proposed guideline in the target paeditaric setting. An evidence based guideline on enteral feeding in infants was developed.
An implementation plan of the new guideline included a comprehensive communication plan with both administration and nurses and a pilot test were developed to ensure a smooth implementation and optimize the transferability and effectiveness of the evidence based guideline in the target population.
A systematic evaluation plan on patient outcomes, health care provider outcomes and systemic outcomes was developed. The evidence based guideline on enteral feeding was expected to be implemented in the long run to reduce the risk of nosocomial infections in infants with enteral feeding.published_or_final_version
Nursing Studies
Master
Master of Nursing
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Stuart, Rhonda Lee 1963. "Nosocomial tuberculous infection : assessing the risk among health care workers." Monash University, Dept. of Epidemiology and Preventive Medicine, 2000. http://arrow.monash.edu.au/hdl/1959.1/9004.
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Haddadi, Ahmed Zine El Abidine. "Construction d’un score prédictif du risque nosocomial pour des patients de réanimation." Thesis, Lille 2, 2013. http://www.theses.fr/2013LIL2S039/document.
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Les infections nosocomiales demeurent un véritable défi de santé publique en dépit des progrès techniques considérables enregistrés. Inhérentes à la prise en charge de soins, se sont les services de réanimation qui comptabilisent les plus fort taux de prévalence. En effet, quelle que soit leur orientation (chirurgicale, médicale ou mixte), ces services, ont pour mission la prise en charge des patients dont le processus vital est menacé par la survenue brutale d’une ou de plusieurs défaillances organiques nécessitant un arsenal diagnostic et/ou thérapeutique souvent invasif.Parmi les conséquences induites par ces infections ; i) l’allongement de la durée de séjour, ii) le surcoût, iii) une augmentation de la mortalité, et iv) la résistance bactérienne.Pouvoir anticiper en amont et en aval cette problématique aux motifs complexes et aux conséquences parfois fatales serait un atout majeur au profit des patients et un outil stratégique pour les équipes soignantes.Organisée autour de trois étapes charnières, la présente étude s’est d’abord attelée à la phasede l’identification des facteurs de risque de l’évènement nosocomial et de mortalité au service de réanimation ou s’est passé l’étude –prise en compte du case-mix du service de réanimation CHU la TIMONE-. Réalisée grâce à deux méthodes statistiques différentes à savoir la régression logistique et la méthode des risques compétitifs. L’étape suivante a consisté dans un premier temps à comparer les capacités prédictives des scores APACHE II, LOD, SOFA et SAPS II chez ces patients -hospitalisés en réanimation-ayant développé un épisode nosocomial. Dans un second temps de déterminer si la variation des scores LOD, SOFA, APACHEII et SAPS II est un facteur pronostique du risque nosocomial. Les résultats obtenus révèlent que la meilleure performance prédictive est objectivée au profit du SOFA et que seule la variation de ce même score entre le premier jour d’hospitalisation et celui du diagnostic de l’infection nosocomiale mesurée grâce à l’AUC est prédictive du risque nosocomial.À l’issue de ces étapes et au moyen des résultats obtenus une construction d’un score prédictif est réalisée grâce à la méthode de régression logistique. L’objectif de ce score est d’éclairer voire d’influencer le prescripteur lors de ses prises de décisions ou d’éventuelle démarche d’ajustement de ses conduites thérapeutiquesLimiting nosocomial infections is still a health challenge although the technical development has improved. They are inherent in medical care and the health care services have the highest prevalence. Indeed, whatever the service (surgical, medical or both), the patients life-giving process is under attack because of the emergence of one or several organ faillures;This generates a diagnostic and therapeutic arsenal which is often invasive.Among the consequences resulting from these infections we will take into account :i) a longer stay in hospitalii) an extra costiii) a higher mortality rateiv) bacterial resistance .If we could anticipate upstream and downstream this issue with complex origins and sometimes fatal consequences, it would be a major asset for patients and a strategic tool for medical teams.The present study is organized in three parts, and first focusses onto the identification of the nosocomial event and death risk factors in intensive care where the study took place. We took into account the the case-mix of the intensive care unit in the TIMONE University Hospital. The study was made with two different statistic methods that is logistic regression and the competitive risks method.The next step first consisted in comparing the predictive capacities of the APACHE II, LOD, SOFA and SAPS II scores in nosocomial patients hospitalized in intensive care . Then it tried to determine if the variation of the LOD, SOFA, APACHEII and SAPS II scores was a prognostic risk factor.Results showed that the best predictive performance was objectively measured by the SOFA and that only the variation of this score between the first day in hospital and the day of the diagnosis of a nosocomial infection, calculated thanks to the AUC, could be predictive of a nosocomal risk. After these steps, and with the results calculated , the construction of a predictive score could be established thanks to the logistic regression method. The objective of this score is to help, or even influence the prescribing doctors when they take decisions or when they try to adjust their therapeutic practices
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Van, Ginkel Marney. "Molecular characterisation of the multi-antibiotic resistant bacteria, Klebsiella Pneumoniae isolated from nosocomial infections." Thesis, Cape Peninsula University of Technology, 2017. http://hdl.handle.net/20.500.11838/2735.
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Thesis (MSc (Biomedical Technology))--Cape Peninsula University of Technology, 2017.Background: It is well established that Klebsiella pneumoniae (K. pneumoniae) is an opportunistic pathogenic organism that has been frequently identified as the cause of nosocomial and community acquired infections. Furthermore, studies have shown that over the last few decades strains of the genus Klebsiella have systematically developed resistance to numerous antibiotics. Aims and Methods: The primary aim of this study was to investigate the prevalence of K. pneumoniae in nosocomial and community isolates in the Western Cape province of South Africa. Various identification techniques such as the polymerase chain reaction (PCR) using the API 20 E, the VITEK®2 system, primers specific for the 16S-23S rDNA ITS region and the Matrix-assisted laser desorption/ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) were compared for the identification of this pathogen. The VITEK 2 system was used to detect antibiotic resistant profiles of the K. pneumoniae isolates and to identify the extended spectrum beta-lactamase (ESBL) phenotypic among these isolates. The PCR was used to detect Beta-lactam genes viz. CTX-M (blaCTX-M), TEM (blaTEM) and SHV (blaSHV) respectively in both the genome and plasmid DNA of K. pneumoniae using gene specific primers. Results: In total 57 agar plate bacterial cultures or glycerol stock bacterial cultures were obtained during 2011. Of the 57 isolates, the API 20 E test identified 47 (82.5%) of the isolates (n = 57) as K. pneumoniae while 10 isolates (17.5%) were identified as Raoultella species. The VITEK 2 method and PCR identified all 57 isolates as K. pneumoniae (100%). Of the isolates, 82.5% (47/57) were positively identified as Klebsiella species, 14% (8/57) were identified as Klebsiella variicola and 3.5% (2/57) were shown as no reliable identification (NRI) when using the MALDI-TOF MS. Examination of the 57 isolates using primers specific for the CTX-M (blaCTX-M), TEM (blaTEM) and SHV (blaSHV) respectively showed the following: PCR amplicons for the TEM gene were produced successfully for 46 (81%) of the 57 isolates included in this project, while 11 (19%) of the samples did not yield any TEM amplicons; PCR amplicons for the blaSHV gene were obtained successfully for 56 (98%) of the 57 DNA samples, while 1 sample (2%) did not yield any SHV amplicons; and PCR amplicons for the blaCTX-M gene were produced successfully by 89% (n = 51) of the DNA samples included in this project, while 11% (n = 6) did not yield any CTX-M amplicon. Extended-spectrum beta-lactamase phenotypes had been confirmed in 84% (n = 48) K. pneumoniae isolates while nine isolates were found to be non-ESBL. Resistance rates for these 48 isolates were high and showed resistance patterns of: Amoxicillin/Ampicillin, Amoxycillin/Clavulanate, Ceftriaxone/Cefotaxime, Cefuroxime/Cefprozil and Ceftazidime (100%, n = 48); Piperacillin/Tazobactam and Cefoxitin (98%, 47/48); Cefepime (96%, 46/48); Aztreonam (94%; 45/48); Tobramycin (81%, 39/48); Gentamycin and Ciprofloxacin (77%, 37/48); Trimethoprim/Sulfamethoxazole (67%, 32/48); and Tigecycline (25% 12/48). Conclusion: For the analysis by all four methods employed, a total agreement of 68.4% was obtained, indicating the positive identification of K. pneumoniae in 39 of the 57 samples analysed. An average agreement of 28.1% was then obtained for the comparison of results generated for three of the methods utilised, while a 3.5% average agreement was obtained for at least two methods. Furthermore, all four methods agreed that 82.5% of the isolates were Klebsiella species while three methods agreed that 17.5% of the isolates were Klebsiella species. Based on the results obtained in the current study, PCR and VITEK 2 were the methods of choice for the identification of K. pneumoniae. The current study also showed, that ESBL-K. pneumoniae strains are present in the Western Cape province, South Africa; with high resistance profiles to numerous antibiotics including the Cephalosporins.
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SCANO, ALESSANDRA. "Pseudomonas aeruginosa related to Nosocomial and Animal infections. New approaches in diagnosis and therapy." Doctoral thesis, Università degli Studi di Cagliari, 2019. http://hdl.handle.net/11584/260761.
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Pseudomonas aeruginosa is a small bacillus gram negative, aerobic, asporogenous, monoflagellate, non-fermenting. P. aeruginosa infections often have a very severe course and are difficult to treat because of its ability to form biofilms characterized by a thick capsule coated with alginate (an exopolysaccharide consisting of D-mannuronic acid and glucuronic acid monomers). Alginate represent the main component of the extracellular matrix of P. aeruginosa biofilm; as a consequence, the alginate lysis facilitates the spread of antimicrobial substances. In fact, this extracellular matrix makes these micro-organisms resistant to antimicrobial agents and leads to the emergence of multidrug resistant clinical isolates (MDR) during therapy. Mutations in the mucA gene encode a protein involved in the production of this exopolysaccharide. In fact, in vitro inactivation of mucA in Pseudomonas aeruginosa PAO1 (non-mucoid) produces Alg+ strains; this seems to indicate, therefore, that mucA acts as a negative regulator of the production of alginate because it can bind and sequester the factor σ22, through the N-terminal cytoplasmic domain. The risk of P. aeruginosa infection may be related to several factors such as: (i) inappropriate therapies or prophylaxis measures, (ii) failure in the environmental monitoring systems (iii) inadequate laboratory protocols for detecting MDR strains. For example, the inappropriate use of peroxides as disinfectants could be increase the mutation rate in mucA gene. In this context, the P. aeruginosa biofilm studies allow to characterize new antimicrobials and to ascertain what are the useful ranges of the disinfectant that do not induce the mucoid phenotype more virulent and more resistant respectively to the not mucoid phenotype. Mutations present in the promoter of the gene or along the amino terminal part of the protein modulate an alginate hyper-expression giving the biofilm a barrier almost impermeable to the antimicrobials, this aspect must be considered during the use of oxidizing microbicides such as hydrogen peroxides, in able to determine mutations in the mucA gene.
This work aims to study P. aeruginosa infections and its environmental contaminations as a global health problem. In fact, this multi-task pathogen can contaminate different areas in human, veterinary and agricultural fields. For this reason, a comprehensive work must be performed by different strategies in these points:
1 Pathogen detection: in this work, we describe a fast-molecular approach to detect the initial pathogen biofilm samples contaminated with Pseudomonas spp. (P. aeruginosa, P. fluorescens and P. putida). This procedure is based on the particular bi-functional FRET oligonucleotide probes named DUAL-FRET.
2 mucA / alginate profile: in P. aeruginosa, mucA genotype resulted essential to reveal high drug-resistant strains due to alginate hyperproduction in the biofilm.
3 Evaluation of potential new antimicrobials: a critical point in anti - P. aeruginosa prophylaxis is represented by the absence of highly performant disinfectant.
4 New cultural systems: design/use of bioreactors able to reproduce, in standard controlled conditions, the initial parameters in the primary contamination area, for example the cold storage implants in the food production
5 Future strategies: following the recent new molecular procedures obtained in biological field could be possible to design new clinical/laboratory strategies against P. aeruginosa, for example the study of miRNAs.
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Mengal, Muhammad Hashim. "Infectious disease control knowledge and practice among health care workers in Bolan Medical College Hospital Quetta Pakistan." Thesis, Södertörns högskola, Institutionen för naturvetenskap, miljö och teknik, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-27097.
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Background Hospital-acquired infections are significant cause of morbidity and mortality among hospitalized patients worldwide. Healthcare workers during job are exposed to blood borne pathogens through contact with infected body parts, blood and body fluids. World health organization (WHO) estimated that globally about 2.5% of HIV and 40% of hepatitis viral infected cases are among health workers due to exposures. The most important mechanism of spread of these pathogens is through contaminated hands of the healthcare workers. Standard precautions measures are essential to prevent and control healthcare associated infection among healthcare workers and patients. In developing countries despite the development of detailed guideline for infection control the knowledge of standard precautions is low and not properly applied. The aim of this study is to assess the knowledge and practice of health care workers regarding standard precautions and hand hygiene to infectious disease control. Aim The aim of this study was to assess the knowledge and practice of health care workers regarding hand wash and standard precautions to control infectious diseases in BMCH. In addition create awareness among participants and encourage them to practice regularly hand hygiene and standard precautions to control or reduce nosocomial infections in health care facilities Methods The study design is cross-sectional evaluation of healthcare worker knowledge and practices about standard precautions and hand hygiene for infectious disease control. A questionnaire administered to health care workers (doctors and nurses). The questionnaire was divided in two parts and the first part concerns demographic information, asking knowledge and practice. The second part asked opinions about risk and prevention of HAIs. The questionnaire was developed with consultation of other studies of the same kind. It has been pre tested and is finalized for survey. The ethical approval was given by hospital superintendent and informs consent from all study participants. Statistic analysis was done on Excel and statistical software SPSS version 20. Data was described in numbers, percentages and Chi Square test done for association among categorical variables, significant level was considered P= <0.05. Results Two hundred questionnaires were distributed to HCWs in BMCH and 169 completely fill questionnaire were returned. The male gender respondents were 42% and female respondents were 58%. The basic questions about knowledge of hand hygiene and standard precautions were answered well in both categories; about 73% were with sufficient knowledge. The practice of hand hygiene and standard precautions was not satisfactory among both categories; about 47% found with good practice. Differences found in sub groups, young age none trained doctors and nurses answered wrong and shown lack of knowledge. This study found an association of age, profession and job experience with knowledge and practice regarding hand hygiene and standard precautions. Open handed questions described well the major issue regarding HAIs and participants emphasized on risk and prevention methods. Conclusions The respondents were HCWs (doctors and nurses) of both sex and this study found that majority of HCWs have good knowledge and practice about control of HAIs but difference were found in age groups, sex and profession. Above half of the HCWs were not trained for infection control in health facilities, thus getting training of infection control is important but more important is implementation of it during practice.
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Worby, Colin J. "Statistical inference and modelling for nosocomial infections and the incorporation of whole genome sequence data." Thesis, University of Nottingham, 2013. http://eprints.nottingham.ac.uk/13154/.
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Healthcare-associated infections (HCAIs) remain a problem worldwide, and can cause severe illness and death. The increasing level of antibiotic resistance among bacteria that cause HCAIs limits infection treatment options, and is a major concern. Statistical modelling is a vital tool in developing an understanding of HCAI transmission dynamics. In this thesis, stochastic epidemic models are developed and used with the aim of investigating methicillin-resistant Staphylococcus aureus (MRSA) transmission and intervention measures in hospital wards. A detailed analysis of MRSA transmission and the effectiveness of patient isolation was performed, using data collected from several general medical wards in London. A Markov chain Monte Carlo (MCMC) algorithm was used to derive parameter estimates, accounting for unobserved transmission dynamics. A clear reduction in transmission associated with the use of patient isolation was estimated. A Bayesian framework offers considerable benefits and flexibility when dealing with missing data; however, model comparison is difficult, and existing methods are far from universally accepted. Two commonly used Bayesian model selection tools, reversible jump MCMC and the deviance information criterion (DIC), were thoroughly investigated in a transmission model setting, using both simulated and real data. The collection of whole genome sequence (WGS) data is becoming easier, faster and cheaper than ever before. With WGS data likely to become abundant in the near future, the development of sophisticated analytical tools and models to exploit such genetic information is of great importance. New methods were developed to model MRSA transmission, using both genetic and epidemiological data, allowing for the reconstruction of transmission networks and simultaneous estimation of key transmission parameters. This approach was tested with simulated data and employed on WGS data collected from two Thai intensive care units. This work offers much scope for future investigations into genetic diversity and more complex transmission models, once suitable data become available.
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MOSCATO, GIUSELLA. "Epidemiology of nosocomial infections in intensive care units in Rome (Italy): a multicentric prospective study." Doctoral thesis, Università degli Studi di Roma "Tor Vergata", 2013. http://hdl.handle.net/2108/209994.
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Objective: This study investigated BSI incidence in the Intensive Care Unit and their impact
on the mortality rate compared with others causes. As primary point it has been
evaluated the rate of bacteremia per year, the causative organisms, the outcome of
infection, the antimicrobial susceptibility patterns, the risk factors and the prevalence of
multi-drug resistant Gram-positive and Gram-negative bacilli. As secondary end point, the
study evaluated the most significant predictors of mortality among the usual risk factors for
acquiring BSI at the admission in the ICU.
Methods and materials: The study included 1,318 patients admitted to ICUs.
Demographics characteristics, SAPS II score, comorbidities and BSI isolates data were
collected. Crude mortality rate compared with the overall mortality rate for all causes
were evaluated.
Results: 324 BSIs from 1,318 patients were evaluated with a total of 407 isolates: 48.6% were
Gram + , 43.7% Gram – (GNB) and 7.6% Candida spp. Among Gram+, 69.1% were
Coagulase negative Staphylococci (CoNS), 21.7% Enterococci, 6% S. aureus. Among GNB,
30.8% were K. pneumoniae, 28.8% A. baumannii, 17.4% P. aeruginosa, and 6.7% E. coli. At
least one episode of BSI was developed in 175 patients (132/1000 pts/year): 139/175 pts
had a monomicrobial BSI and 36/175 had polymicrobial BSI. The overall mortality rate was
25.4%: 82/175 pts with BSI died, (44.4% of pts with monomicrobial BSI vs. 61.1 % of pts with
polymicrobial BSI). At univariate analysis, SAPS II score (p = 0.039, OR 1.03, 1.001-1.06 CI),
cardiac illness (p = 0.015, OR 2.5, 1.20-5.42 CI), and K.pneumoniae BSI (p= 0.005, OR 2.96,
1.37-6.37 CI) were significantly associated to higher risk of death. A slightly significant
association between a polymicrobial bacteremia and a higher risk of death was also
found (p= 0.057, OR 2.07, 0.98-4.38 CI). At multivariate analysis, having a K. pneumoniae
BSI and cardiac illness at the admission in ICU were confirmed to be significantly
associated with higher mortality rate (p= 0.0162 and p= 0.0158 respectively). After
stratification for outcome (survivors vs. nonsurvivors), univariate and multivariate analysis
were performed.
Conclusions: These data suggest that K. pneumoniae BSI , cardiovascular comorbidity and
polymicrobial BSI in ICU pts are associated to a higher risk of death.
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Boudjema, Sophia. "Infections nosocomiales, comportement soignants et technologies innovantes." Thesis, Aix-Marseille, 2016. http://www.theses.fr/2016AIXM5055.
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Les infections nosocomiales sont responsables de milliers de décès chaque année. Les soignants, les patients et l'environnement à l'hôpital peuvent être source de contamination. Les objets tels que les téléphones cellulaires, les stéthoscopes, les tensiomètres, les cravates, les blouses et les bagues sont utilisés par les soignants et peuvent être contaminés. Ils deviennent alors des vecteurs potentiels pouvant être responsables d'infections nosocomiales. Les mains des soignants peuvent aussi être un vecteur de la transmission d'agents pathogènes. Respecter l'ensemble des règles d'hygiènes au quotidien est indispensable mais peut être contraignant pour les soignants. Afin d'avoir une mesure plus précise de la désinfection des mains, un outil automatique de mesure appelé MédiHandTrace® (MHT) a été développé, et breveté. Il permet de tracer les soignants grâce à leurs sabots pucés. MHT montre des taux d'observance inférieurs à 50% et aussi que l'hygiène des mains est individuelle. Aussi, Nous avons voulu comprendre le raisonnement des soignants au regard de leurs pratiques d'hygiène. Grâce à la vidéo, nous avons mis en lumière des comportements singuliers. L'amélioration de l'hygiène des mains reste une priorité. En conséquence, nous avons introduit des outils couplés à MHT, envoyé des sms sur les téléphones des soignants donnant leurs performances individuelles. L'hygiène des mains est un geste simple, mais sa réalisation se fait dans des situations de soins souvent complexes. L'adhérence à l'hygiène reste multifactorielle nécessitant l'apport de nouveaux outils d'apprentissage et de communication afin de délivrer des messages simples et efficaces auprès des soignantsNosocomial infections are responsible for thousands of deaths each year. Healthcare workers (HCW), patients and the hospital environment can be a source of contamination. Fomites such as cell phones, stethoscopes, tensiometers, ties, gowns and rings are used by HCW and may be contaminated. They become potential vectors that can be responsible for nosocomial infections. The HCWs hands' can also be a vector for the transmission of pathogens. Respecting all the rules of hand hygiene in everyday life is essential but can be binding for the HCW. In order to have a more accurate measurement of hand disinfection, an automatic measuring tool called MédiHandTrace® (MHT) was developed and patented. It makes it possible to trace the HCWs with tags into their shoe hoofs. MHT shows compliance rates below 50% and also that hand hygiene is individual. Also, we wanted to understand the reasoning of HCW with regard to their hygiene practices. Through the video, we have highlighted some singular behaviors of HCWs. Improving hand hygiene remains a priority. As a result, we introduced tools coupled with MHT, sent sms to the phones of HCWs showing their individual performance. Hand hygiene is a simple gesture, but its realization takes place in often complex care situations. Adherence to hand hygiene remains multifactorial, requiring new learning and communication tools to deliver simple and effective messages to HCWs
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Liesse, Iyamba Jean-Marie. "Etude de l'interaction des souches cliniques de Staphylococcus aureus avec une surface abiotique." Doctoral thesis, Universite Libre de Bruxelles, 2012. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209630.
Full textAbstract:
Staphylococcus aureus est l’une des causes majeures des infections communautaires et nosocomiales. Ce germe est responsable des infections aiguës et chroniques dont la plupart sont dues à sa capacité à adhérer sur les implants médicaux et à former un biofilm. D’après le Center for Disease Control and Prevention (CDC), 65% des infections bactériennes sont dues à la présence des biofilms. En outre, les infections associées aux biofilms constituent un problème majeur en clinique et sont la cause de l’augmentation de la mortalité et du coût de traitement. Chez S. aureus, la formation du biofilm se déroule en deux phases principales: la première phase est l’attachement initial des cellules sur une surface, et la seconde est la multiplication et la formation d’une communauté structurée, mature et multicouche des cellules bactériennes. A l’intérieur du biofilm, les bactéries développent plusieurs types d’interactions et accroissent leur résistance aux agents antimicrobiens et aux défenses immunitaires de l’hôte, ce qui constitue un véritable problème de santé publique.
Les objectifs de ce travail étaient: (1) de caractériser des souches cliniques de S. aureus sensibles et résistantes à la méticilline (SASM et SARM) par une analyse phénotypique et génotypique; (2) d’étudier la répercussion des propriétés de membranes sur l’adhésion et la formation du biofilm; (3) de rechercher un moyen pour la prévention de l’adhésion et de la formation d’un biofilm sur une surface abiotique.
Deux souches de référence et 12 souches cliniques de S. aureus (4 SARM et 8 SASM) collectées à Kinshasa ont été caractérisées par la résistance aux antibiotiques, par le typage d’une région X du gène spa codant pour la protéine A de S. aureus et par la détermination des propriétés de la surface cellulaire. L’adhésion à une surface et la formation du biofilm ont été respectivement étudiées par la méthode de Biofilm Ring Test® (BFRT®) et par celle de coloration au cristal violet. Ces deux méthodes ont été utilisées pour l’évaluation de l’activité de l’acide éthylèneglycol tétraacétique (EGTA) sur l’adhésion et la formation du biofilm.
L’amplification par PCR (Polymerase Chain Reaction) d’un fragment du gène mecA a confirmé l’appartenance des souches étudiées au phénotype SARM ou SASM. L’analyse par PCR des répétitions présentes dans la séquence codante de la protéine A de S. aureus (spa typing) a permis d’identifier 7 types spa pour toutes les souches SARM et SASM2 dont un nouveau type spa t10715.
Les résultats du test MATS (Microbial Adhesion to Solvents) ont montré que les souches de S. aureus sensibles et résistantes à la méticilline possédaient des propriétés membranaires différentes susceptibles de modifier l’adhésion ou la formation d’un biofilm. Les souches sensibles à la méticilline avaient une paroi plus hydrophobe que celle de souches résistantes dont la paroi était acide, acceptrice d’électrons.
Les études sur l’interaction entre des souches cliniques de S. aureus et des surfaces abiotiques ont montré que les souches SARM adhéraient moins vite à une surface et formaient moins de biofilms que les souches SASM.
Les études de l’activité de l’EGTA, un chélateur des cations divalents, ont montré que ce dernier inhibait l’adhésion de souches SARM à une surface abiotique comme un tube de cathéter et empêchait la formation d’un biofilm par toutes les souches sensibles et résistantes à la méticilline. Cette action inhibitrice sur la formation du biofilm était réversible en présence d’un cation divalent (magnésium, calcium ou manganèse).
L’ensemble des données obtenues sur l’adhésion et la formation du biofilm par la méthode de BFRT® et par celle de coloration au cristal violet ont montré que le BFRT® était la méthode de choix dans les études de l’adhésion initiale des souches de S. aureus sur une surface abiotique. Le BFRT® pourrait être utilisée dans le screening rapide de produits contre l’adhésion bactérienne à la surface des implants médicaux à base de polystyrène ou de silicone.
Doctorat en Sciences biomédicales et pharmaceutiques
info:eu-repo/semantics/nonPublished
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Ching, Wing-han Michael, and 程永鏗. "Modeling of contaminant dispersion by statistical mechanics." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B42664500.
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Yuan, Yuan, and 袁媛. "Incidence and factors associated with nosocomial infections in a neonatal intensive care unit (NICU) of an urban children hospital inChina." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48427287.
Full textAbstract:
Background:
With the increasing survival rate of early preterm infants and the extensive use of invasive health care procedures, the nosocomial infection rate is on the rise in the past decade in the neonatal intensive care unit (NICU). The patients in NICU are a unique and highly vulnerable population, including preterm infants and infants requiring surgery. Nosocomial infection (NI) is associated with the majority of infectious complications of infants, resulting in morbidity and mortality. Close surveillance, accurate measurement, and promotion of full awareness of the risk factors of infection are essential to nosocomial infection control. Previous research had pointed out some factors related to the NI in other countries, and further research is still much needed to reveal the incidence of NI and further analyze the risk factors in China.
Objectives:
The objectives of this study were to assess incidence and epidemiologic profile of nosocomial infection in NICU of China, and to identify the main risk factors of nosocomial infections.
Methods:
This was a retrospective cohort with a nested case control study. All data were collected from the database of the medical records of all the patients who were admitted to the Guangzhou Women and Children’s Medical Center (N=1653) during December 2009 to May 2012.Infection rate, infection density and central line-associated bloodstream infection rate were estimated. Stepwise regression model yielded adjusted odds ratio (OR) of potential risk factors for NI.
Results:
The infection rate in NICU during the study period was 6.2 episodes per 100 patients (6.0-6.4 episodes per 100 patients). Infection density was 4.2 episodes per 1000 patient-days each year (95%CI=3.4-5.0 episodes per 1000 patient-days). The infection rate of ventilation-related pneumonia was 3.4 episodes per 1000 Mechanical Ventilation (MV) days. (95%CI= 3.2-3.5 episodes per MV patient-days).Central line-associated bloodstream infection rate was 5.4 episodes per 1000 central line days (95%CI= 5.1-5.6episodes per central line days). Overall, infants with gestational age >32weeks, longer duration of receipt of parenteral nutrition and longer duration of receipt of probiotics were significantly less likely to have NI (adjusted ORs= 0.35, 0.94 and 0.88, respectively). Congenital malformation, multiple birth, receipt of vein or arterial catheter, receipt of surgical operation and gastric tube feeding were significantly more likely to have NI(adjusted ORs=4.43,3.24 and 3.88, respectively). And longer duration of using prophylactic antibiotic was significantly more likely to have NI (adjusted OR=1.13).
Conclusion:
Our study provided information to the prevention strategies of nosocomial infections and improvement of health care service.We described the nosocomial infection rate, infection density and device-related infection rate, seasonal distribution, the type of infection and the pathogens identified to reveal the profile of nosocomial infection of NICU in Guangzhou, China.Andwe identified the association between intrinsic factors of infants and health care procedures with NI. Multicenter prospective study can be conducted in the future to investigate the specific risk factors on different birth weight or gestational age in China.published_or_final_version
Public Health
Master
Master of Public Health
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Mascrier, Isabelle. "L'indemnisation des dommages causés par les infections nosocomiales." Thesis, Toulon, 2014. http://www.theses.fr/2014TOUL0089.
Full textAbstract:
Les infections nosocomiales sont définies comme des infections contractées lors d’un séjour dans un établissement de soins. En matière de sécurité sanitaire, celles-ci sont déterminées par le principe de prévention et de précaution. En droit français, les infections nosocomiales ont longtemps été indemnisées en conséquences de solutions prétoriennes. Ce régime indemnitaire repose aujourd'hui sur le principe de la responsabilité sans faute qui a été consacré par la loi du 4 mars 2002. Toutefois la difficile prise en charge de cette indemnisation par les assureurs conduisit à l’adoption d’un nouveau régime découlant de la loi du 30 décembre 2002. Ces lois successives ont rendu complexe et ambigu le mécanisme de la réparation des dommages causés par les infections nosocomiales. Le constat résulte du fait qu’il manque une définition juridique de l’infection nosocomiale, outil essentiel à la pérennité du système indemnitaire mis en place pour la réparation des dommages causés par ces infectionsNosocomial infections are infections acquired during a stay in a health care institution. From the sanitary safety point of view, they are defined by the prevention principle and the precautionary principle. According to the French law, the nosocomial infections have long been compensated by a case law. Nowadays, this compensation system is based on the principle of liability without fault laid down by the law of the 4th of March 2002. However, the reluctance of the insurers to assume this compensation led to the adoption of a new system resulting from the law of the 30th of December 2002. Because of these successive laws, the compensation mechanism for the damages due to nosocomial infections has been made more complex and ambiguous. This observation stems from the lack of a legal definition of the nosocomial infection, an essential tool for ensuring the sustainability of the compensation system for the damages caused by these infections
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Esteban, Torné Elisabeth. "Impacte d’una campanya de prevenció d’Infecció Nosocomial a una Unitat de Cures Intensives Pediàtriques. Utilitat d’un registre multicèntric d’infecció nosocomial." Doctoral thesis, Universitat de Barcelona, 2015. http://hdl.handle.net/10803/385909.
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INTRODUCCIÓ: La infecció nosocomial (IN) a les Unitats de Cures Intensives Pediàtriques (UCIP) incrementa la morbimortalitat dels nens. En aquesta memòria de tesi doctoral es presenten dos estudis relacionats. El primer valora l’impacte d’ una campanya de prevenció d’IN a la UCIP, i el segon presenta un registre multicèntric d’IN a UCIP a Espanya.
HIPÒTESIS: La campanya de prevenció d’IN a la UCIP podria disminuir les taxes d’IN i comportaria un descens de la morbimortalitat dels pacients. La creació d’un registre nacional multicèntric d’IN a les UCIPs permetria tenir informació sobre l’epidemiología de la infecció i el perfil de resistències.
METODOLOGIA: El primer treball és un estudi prospectiu amb intervenció múltiple per reduir IN a la UCIP de l’hospital Sant Joan de Déu. Es dividí en tres períodes: Pre-intervenció (2006), intervenció (2007) en el que simplementaren els mesures i el període de seguiment a llarg plaç (2008). La intervenció radicava en tres accions principals: Crear un grup de Control d’ infecció, un programa educatiu d’higiene de mans i aplicar un paquet de mesures per reduir la IN. S’inclogueren nens ingressats a la UCIP t més de 24 hores. Es calcularen taxes de Bacterièmia relacionada con catèter (BRC), pneumònia associada a ventilació mecànica (NAVM) i infecció urinària associada a sondatge uretral (ITU-SU).
El segon estudi és un estudi multicèntric prospectiu, observacional i descriptiu. El 2007 es creà el registre VINCIP (Vigilancia de Infección Nosocomial en Cuidados Intensivos Pediátricos). Es recolliren dades durant un mes (1-31 de març) per cada any d’estudi (2008-2012). No es van fer intervencions específiques durant aquest període com grup, però la majoria de les UCIPs implementen mesures per reduir la IN. Es recolliren taxes de BRC, NAVM i ITU-SU, microorganismes causants i patrons de resistències.
RESULTATS: Primer estudi: S’inclogueren 851, 822 y 940 pacients, respectivament. Milloraren la taxa de BRC (8.1 a 6/1000-dies de catèter venós central CVC, p = 0.640), la de NAVM (28.3 a 10.6/1000 dies de ventilació mecànica, p = 0.005) i ITU-SU (23.3 a 5.8/1000 dies de sonda urinària, p < 0.001). Es va reduir l’estada hospitalària (18.56 vs 14,57 dies, p = 0,035) i la mortalitat (5,1% a 3,3%, p = 0.056). El model de regressió logística multivariable mostrà que la presència d’IN era factor independent de risc de mortalitat (OR 2.35 [95% IC, 1.02-5.55]; p = 0.046). Durant el seguiment a llarg plaç (en comparació amb el període pre-intervenció), les taxes van seguir millorant, BRC 4,6/1000 dies de CVC; NAVM, 9,1/1000 dies de ventilació mecànica i ITU-SU 5,2/1000 dies de sonda urinària (p = 0,205, p = 0.001 i p < 0.001 respectivament).
Segon estudi. Ingressaren 3667 pacients. El nombre de pacients amb infecció nosocomial fou 90 (2.45%). La mitja de taxes dels 5 anys foren: BRC 3.8/1000 dies de CVC, NAVM 7.5/1000 dies de ventilació mecànica i ITU-SU 4.1/1000 dies de sonda urinària. Les taxes es reduiren homogèniament des de 2009 a 2012: BRC de 5.83 (95% CI 2.67- 11.07) a 0.49 (95% CI 0.0125- 2.76), p =0.0029; NAVM de 10.44 (95% CI 5.21-18.67) a 4.04 (95% CI 1.48-8.80), p= 0.0525; ITU-SU 7.10 (95% CI 3.067-13.999) a2.56 (95% CI 0.697-6.553), p= 0.0817; respectivament. Microorganismes: 63 de 99 (83.6%) bacteris gram-negatius (36.5% resistents), 19 (19.2%) bacteris gram-positius i 17 (17.2%) infeccions per Candida spp.
CONCLUSIONS: Respecte al primer estudi, la campanya de prevenció d’IN va baixar globalment les taxes d’IN, l’estada hospitalària i la mortalitat. Els resultats es mantingueren en el període de seguimient a llarg plaç. Respecte al segon estudi presentat, els sistemes de vigilància local aporten informació per millorar les taxes d’infecció nosocomial, així com el patró de resistències.INTRODUCTION: Nosomial infections (NI) in the Pediatric Intensive care Unit (PICU) increases morbidity and mortality of patients. In this thesis we include two related articles. OBJECTIVES: - First study: To evaluate whether a quality improvement intervention could reduce NI in a PICU. - Second study: To report 5-years of NI surveillance data, as well as trends in infections by multidrug resistant organisms in Spanish PICU. METODOLOGY: - First article: Prospective interventional cohort study conducted during three periods: preintervention period, intervention period, and long-term follow-up. The quality improvement intervention consisted of the creation of an infection control team, a program targeting hand hygiene, and quality practices focused on preventing NI. - Second article: multicentre, prospective, descriptive and observational study was conducted using the data from surveillance system for NI created in 2007 for Spanish PICU. Data were collected for one month, between 01 and 31 March, for every study year (2008–2012). RESULTS: - First study: We included 851, 822 and 940 patients. Compared with the preintervention period, in the intervention period, the rates of central line–associated bloodstream infection (CLABSI) decreased from 8.1to 6/1,000 central venous catheter-days (p = 0.640), ventilator associated pneumonia (VAP) decreased from 28.3 to 10.6/1,000 days of ventilation (p = 0.005), and catheter-associated urinary tract infection (CAUTI) decreased from 23.3 to 5.8/1,000 urinary catheter-days (p < 0.001). Furthermore, hospital length of stay decreased from 18.56 to 14.57 days (p = 0.035) and mortality decreased from 5.1% to 3.3% (p = 0.056). - Second study: A total of 3667 patients were admitted to the units during the study period. There were 90 (2.45%) patients with NI. The mean rates during the 5 years study were:CLABSI, 3.8/1000 central venous catheter-days, VAP 7.5/1000 endotracheal tube-days, and cathet CAUTI 4.1/1000 urinary catheter-days. All rates homogeneously decreased from 2009 to 2012. The microorganism analysis: 63 of the 99 isolated bacteria (63.6%) were Gramnegative bacteria (36.5% were resistant), 19 (19.2%) Gram-positive bacteria, and 17 (17.2%) were Candida spp. CONCLUSIONS: A multifaceted quality improvement intervention reduced nosocomial infections rates, hospital length of stay, and mortality in our PICU. The local surveillance systems provide information for dealing with nosocomial infections
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Jooste, Marius Johannes. "The in vitro antimicrobial activity of amikacin and ceftazidime against multiple resistant gram-negative bacilli in nosocomial infections." Thesis, Cape Town : Cape Technikon, 1988. http://dk.cput.ac.za/cgi/viewcontent.cgi?article=1018&context=td_ctech.
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Duval, Audrey. "Comprendre et contrôler la transmission des bactéries multirésistantes par l'analyse et la modélisation des réseaux d’interactions interindividuelles en milieu hospitalier." Thesis, Université Paris-Saclay (ComUE), 2019. http://www.theses.fr/2019SACLV075/document.
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Les infections associées aux soins représentent un enjeu majeur de santé publique dans le monde. Les bactéries multirésistantes (BMR) sont responsables d’une grande partie de ces infections. Mieux comprendre leur dissémination dans les établissements de soins est indispensable pour élaborer des mesures de contrôle et de prévention.L’objectif de cette thèse est d’utiliser des données détaillées sur les réseaux de contacts interindividuels, couplées à des méthodes de modélisation mathématique, pour étudier la dissémination des BMR à l’hôpital afin d’améliorer leur contrôle. Pour répondre à cette problématique, les données de l’étude i-Bird ont été analysées. Cette étude prospective longitudinale a eu lieu dans l’hôpital maritime de Berck-sur-Mer durant 4 mois en 2009. Pendant cette période, les interactions de proximités entre tous les individus de l’hôpital ont été enregistrées chaque jour grâce à des capteurs RFID (Radio Frequency Identification Devices) et des prélèvements microbiologiques ont été récoltés chaque semaineDans un premier temps, la structure des contacts interindividuels au sein de et entre les différentes catégories d’individus (patient, aide-soignant, infirmier, …) a été analysée. Cette première étude a souligné l’importance des contacts patient-patient en établissement de longue durée. De plus, certaines catégories de personnel hospitalier ont été identifiées comme de potentiels super-propagateurs, tel que les brancardiers et les médecins.Dans un deuxième temps, le rôle du réseau de contacts dans la dissémination de deux espèces (E. coli et K. pneumoniae) d’entérobactéries résistantes aux béta-lactamines à spectre étendue (BLSE) a été étudié. Cette étude a montré que le réseau d’interactions de proximités était suffisant pour expliquer la propagation des KP-BLSE. En revanche, il n’était pas suffisant pour retracer la dissémination des EC-BLSE.La dernière partie de la thèse a été consacrée au développement d’un modèle individu-centré de transmission de BMR à l’hôpital modélisant explicitement les contacts interindividuels. Ce modèle permet d’évaluer l’effet de mesures de contrôle ciblant la structure du réseau de contacts. A titre d’application, les données de l’étude i-Bird ont été utilisées pour simuler la transmission de Staphylococcus aureus résistant à la méticilline (SARM) durant les 4 mois de l’étude. La simulation de procédures de cohorting du personnel dans l’hôpital de Berck-sur-Mer suggère que la mise en place de telles mesures permet de réduire l’acquisition de SARM chez les patients.Cette thèse combine analyse de réseaux, épidémiologie des maladies infectieuses et modélisation dynamique. Elle apporte une meilleure compréhension de la diffusion et du contrôle des BMR dans les hôpitaux de longue durée. De plus, elle apporte un outil innovant, visant à être développé, pour la compréhension et le contrôle de la dissémination des BMR à travers les contacts en milieu hospitalierHealthcare-associated infections represent a huge public health issue worldwide. Multidrug resistant bacteria (MDR) are a major cause of these infections. Hence, better understanding their transmission routes in hospital settings is crucial to design efficient control measures.The purpose of this thesis is to use detailed data on interindividual contact networks, associated with mathematical modelling methods, to study MDR spread in hospitals and improve their control. To this end, data collected during the i-Bird study was used. This longitudinal prospective study took place at the Berck-sur-Mer hospital during 4 months in 2009. Close proximity interactions were recorded by the use of RFID (Radio Frequency Identification Devices) sensors everyday. Meanwhile, microbiological swabs were collected weekly.In a first part, interindividual contact patterns within and between each individual categories (patients, nurses, hospital porters, etc.) were analyzed. This first study notably underlined the importance of patient-to-patient contacts in long-term care facilities (LTCF). Moreover, some hospital staff categories, such as hospital porters and physicians, were identified as potential superspreaders based on their contact patterns.In a second part, we investigated the impact of the contact network on the spread of two species of Extended-spectrum beta-lactamases (ESBL) Enterobacteriaceae (E. coli and K. pneumoniae). This work showed that the contact network was an important driver of ESBL-K. pneumoniae dynamics, but not of ESBL-E. coli dynamics over the i-Bird study.The last part of the thesis was dedicated to the development of an agent-based model of MDR spread in hospital settings that explicitly formalizes detailed interindividual contacts. This model allows to assess control measures focused on contact patterns. The model was applied to the i-Bird data; we simulated methicillin-resistant Staphylococcus aureus (MRSA) transmission during the 4-month study over the reported contact network. Using our simations, we evaluated measures associated with hospital staff cohorting and showed it can lead to reduce the MRSA acquisition=.This thesis combines network analysis, epidemiology of infectious diseases and dynamic modeling. It allows a better understanding of MDR spread and control in LTCF. Moreover, it brings an innovative tool, intended to be developed, to understand and control BMR spread through contact networks in hospital settings
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Yeung, Mei-yan, and 楊美恩. "Evidence-based guidelines on ventilator-associated pneumonia prevention for mechanically ventilated patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44626885.
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Váchová, Eva. "Ekonomické dopady nozokomiální nákazy Clostridium difficile ve zdravotnickém zařízení." Master's thesis, Vysoká škola ekonomická v Praze, 2014. http://www.nusl.cz/ntk/nusl-264487.
Full textAbstract:
Nosocomial infections represent for the health care providers serious economical and also health complications. The aim of this thesis is a comprehensive presentation of nosocomial infections. Second part focuses on a bacteria Clostridium difficile. This thesis analyzes epidemiological situation in a particular medical care facility together with the cost of therapy. The incidence of Clostridium difficile is, despite of the worldwide increasing trend, decreasing in the selected facility. Significant differences exist among individual departments in the amount of samples collected as well as in their rate of positivity for the bacteria presence. Data collected are applied to a German pharmacoeconomic model which compares vancomycin therapy with fidaxomicin therapy. On a group of 100 patients it was proved that more efficient is, despite of its higher price, treatment by fidaxomicin because it leads to a lower percentage of recurrences and morbidity and mortality decrease.
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Rubenovitch, Josh. "Les infections nosocomiales : à propos des infections liées aux catheters." Montpellier 1, 1995. http://www.theses.fr/1995MON11168.
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Lavigne, Thierry. "Surveillance des infections nosocomiales en réanimation : intérêt d'une approche multimodale clinico-biologique et étude d'impact." Thesis, Strasbourg, 2016. http://www.theses.fr/2016STRAJ123/document.
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La surveillance des infections acquises en réanimation (IAR) représente un outil majeur dans la stratégie de lutte contre les infections nosocomiales. Nous avons enrichi la base de données de surveillance REA-RAISIN avec des données médico-administratives du PMSI afin de disposer d’informations sur l’hospitalisation complète et d’analyser des facteurs de risques supplémentaires. L’étude descriptive détaillée des 11 années de notre cohorte a permis de montrer des variations temporelles et les groupes les plus à risque. L’estimation de l’impact de ces IAR sur la mortalité et la durée de séjour nécessite des techniques statistiques multiples afin de prendre en compte les biais dont la durée d’apparition de l’IAR et le risque compétitif. Cet impact dépend du type d’IAR. La mortalité est très impactée par les bactériémies, peu par les pneumopathies et pas par les infections urinaires. L’augmentation de la durée de séjour est la plus importante pour les pneumopathies, suivie des infections urinaires et est modérée pour les bactériémies. L’étude du portage de S. aureus méticillino-résistant est parue insuffisante pour détecter des épidémiesMonitoring the infection acquired in intensive care units (ICU-AI) is a strategic tool for the control of hospital-associated infections. We enhanced the national surveillance database REA-RAISIN with the local diagnosis-related group database. This allows us to have data on the whole hospitalization and assess additional risk factors. The assessment of the impact of these ICU-AI on mortality and length of stay needs appropriate and multiple statistical analysis to take in account various potential bias, including time-dependent bias and competitive risk. This impact is a function of the kind of IAR. Mortality is most affected by bacteremia, more lightly by pneumonia and stay equivalent for patients with or without urinary tract infections. On the other hand, excess of length of stay was the most important for patients with pneumonia and urinary tract infections but moderate for those with bacteremia.Finally, studying the carriage of methicillin-resistant S. aureus appeared insufficient to detect outbreaks and does not measure the risk associated with SASM carriage
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Tudó, i. Vilanova Griselda. "Estudi de la transmissió de la tuberculosi en el context nosocomial i poblacional: caracterització fenotípica i genotípica de soques de Mycobacterium tuberculosis." Doctoral thesis, Universitat de Barcelona, 2004. http://hdl.handle.net/10803/673164.
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Anualmente se producen 9 millones de casos de tuberculosis. La fuente de transmisión principal de la enfermedad son los bacilos que expulsan los enfermos al expectorar, inhalados por otras personas.
El objetivo general de la tesis es el estudio de la transmisión de la tuberculosis en el contexto nosocomial y poblacional. En cuanto a los objetivos concretos, son los siguientes:
1,- Análisis de la transmisión nosocomial de la tuberculosis en pacientes ingresados en un hospital de tercer nivel durante un periodo de 4 años, utilizando la técnica de tipado molecular RFLP.
2,- Descripción de resistencias y factores de riesgo en pacientes tuberculosos de los distritos de Bata y Malabo (Guinea Ecuatorial).
3,- Caracterización y tipado molecular de las cepas de Mycobacterium tuberculosis aisladas en pacientes de los distritos de Bata y Malabo (Guinea Ecuatorial).
RESULTADOS:
1,- Se estudiaron cepas de 151 pacientes. Se hallaron 11 agrupaciones entre 37 pacientes. En el 5,4% de los pacientes se estableció un nexo epidemiológico en prisión, previo al ingreso en el hospital. No se halló relación entre los restantes pacientes que compartieron agrupación. Las variables historias previas de tuberculosis y estancia en prisión se asociaron a agrupación. Se realizó un seguimiento entre 18 y 60 meses a 109 pacientes que compartieron habitación con enfermos tuberculosos, no demostrándose ningún caso secundario de tuberculosis, aunque el 68,3% de los pacientes VIH+ y 26,4% de los VIH- murieron durante el seguimiento.
2,- Se estudiaron 240 pacientes. Las resistencias en casos nuevos fueron del 16,9% y del 41,6% en casos previamente tratados. La mono-resistencia más importante fue a la isoniacida (12,5% en casos nuevos). La multi-resistencia en casos nuevos fue del 1,7%. El sexo femenino se asoció a resistencia.
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Venier, Anne-Gaëlle. "Pseudomonas aeruginosa en réanimation : épidémiologie et facteurs de risque d’acquisition." Thesis, Bordeaux 2, 2011. http://www.theses.fr/2011BOR21851/document.
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Malgré les avancées en matière de prévention, Pseudomonas aeruginosa reste un pathogène fréquent et délétère en réanimation. Des facteurs de risque d’acquisition de ce micro-organisme ont déjà pu être identifiés, mais jamais dans un contexte multicentrique et rarement en ajustant sur des caractéristiques du service. Si l’analyse de la littérature était jusqu’alors en faveur d’une forte origine individuelle, la part du contexte d’hospitalisation et des caractéristiques de la réanimation paraît de moins en moins négligeable. Notre travail a permis non seulement de faire un état des lieux concernant les connaissances actuelles sur Pseudomonas aeruginosa en réanimation mais également d’identifier des profils type de patients et services de réanimation plus à risque vis à vis de ce micro-organisme. L’intérêt majeur est non seulement de pouvoir ainsi orienter les cliniciens face à une conjonction d’éléments mais surtout, là où les facteurs patients restent souvent peu modifiables, d’identifier des éléments contextuels d’acquisition sur lesquels il serait possible d’agir afin de réduire le risque infectieuxDespite major advance in techniques and reinforcement of infection control measures, Pseudomonas aeruginosa remains frequent in intensive care unit (ICU) and is responsible for severe hospital-acquired infections. Several patient and pathogen-specific risk factors have been associated with acquisition of P. aeruginosa in ICUs Nevertheless those risk factors were identified in monocentric studies which rarely took in account the context of cares. If individual risk factors for P. aeruginosa acquisition have appeared to be predominant since then, the role of contextual variables seems to have been underestimated. This thesis provides insight into the epidemiology of P. aeruginosa in ICU, identifies individual and contextual risk factors for P. aeruginosa infection and P. aeruginosa acquisition and emphasizes the interest of contextual variables which gives new perspectives to P. aeruginosa prevention
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Aujoulat, Fabien. "Adaptation et spécialisation des bactéries environnementales à l'infection humaine : étude des genres Ochrobactrum et Agrobacterium." Thesis, Montpellier 1, 2012. http://www.theses.fr/2012MON13501/document.
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Les bactéries pathogènes opportunistes (BPO) sont responsables d'une grande part de la pathologie infectieuse bactérienne. Les BPO d'origine environnementale doivent subir des changements profonds de mode de vie pour s'adapter et coloniser l'homme. Comprendre les conditions de cette adaptation permettra de préciser la notion d'opportunisme infectieux et le rôle des BPO environnementales dans l'émergence des pathogènes.Les genres Ochrobactrum et Agrobacterium regroupent des bactéries présentant une grande variété de modes de vie et établissant différentes relations avec la cellule eucaryote. Ces bactéries connues pour vivre dans l'environnement sont par ailleurs des pathogènes opportunistes de l'homme principalement responsables d'infections chez les individus immunodéprimés. Dans le cadre de ce travail nous avons entrepris une étude populationnelle par une approche de génétique multilocus sur des collections de souches cliniques et environnementales de différentes origines géographiques. Les structures de population obtenues ont été confrontées à divers caractères phénotypiques reliés à la virulence et/ou l'adaptation chez l'homme, la température de croissance, la formation de biofilm et la virulence vis-à-vis des modèles Caenorhabditis elegans et macrophages humains.Ochrobactrum anthropi et Ochrobactrum intermedium sont les deux principales espèces d'intérêt médical du genre Ochrobactrum. La population d'O. anthropi est de type épidémique qui s'organise en deux complexes clonaux (CCs). Si le CC1 regroupe à la fois des souches de diverses origines, le CC4 ne contient que des souches cliniques. Cette sous-population apparait associée à l'homme même si les caractères phénotypiques étudiés ne révèlent pas de différences entre ces deux sous populations. De la même façon, ces deux CCs ne se distinguent pas par leur comportement en modèle macrophage ou par leur diversité génomique. O. intermedium, tout comme O. anthropi, présente une forte diversité génétique toutefois, aucun regroupement des souches en fonction de leur origine n'est mis en évidence pour cette espèce. La diversité des souches cliniques apparait aussi importante que celle de l'ensemble de la population. Plusieurs arguments suggèrent une niche étroite pour cette espèce, notamment une faible diversité génomique. Par ailleurs, le faible nombre de souches environnementales associé à une meilleure croissance planctonique à 37°C qu'à 25°C et 30°C suggèrent que l'homme pourrait constituer cette niche. L'étude de la virulence d'O. intermedium en modèle macrophage ou C. elegans met en évidence différents comportements, pour autant ceux-ci ne semblent pas liés à la structure de population. Certaines souches sont capables de se multiplier dans le modèle macrophage.L'étude du genre Agrobacterium par une approche multilocus sur une collection représentative des différents modes de vie de ces bactéries met en évidence, tout comme pour O. anthropi, une sous population clinique qui regroupe près de 80% des souches de cette origine. D'autres arguments tels que la croissance à 42°C confirment que le génovar A7 peut correspondre à une sous-population associée à l'homme. Les données obtenues seront confrontées aux connaissances sur d'autres bactéries pathogènes opportunistes d'origine environnementale comme Pseudomonas aeruginosa, Stenotrophomonas maltophilia et les bactéries du complexe Burkholderia cepacia qui présentent également des sous populations associées à l'homme et/ou à certaines pathologies humaines. L'existence de ces sous populations suggère une spécialisation qui sera discutée dans le contexte de la spéciation des bactéries pathogènes afin de revisiter le concept d'opportunisme infectieuxThe opportunistic bacterial pathogens (OBP) cause the main part of bacterial infectious diseases. Environmental-borne OBP should encounter dramatic changes in lifestyle in order to colonize human beings. The conditions of this adaptation should precise concepts about OBP and emerging pathogens.The genera Ochrobactrum and Agrobacterium groups bacteria with versatile lifestyles that establish diverse relationships with the eukaryotic cells. These environmental-borne OBP caused diverse infectious diseases in immune-compromised patients. In this study, we undertook an approach of multilocus genetic on large population of environmental and clinical strains of Ochrobactrum and Agrobacterium. The population structures were compared to phenotypic traits related to adaptation and virulence in man, such as growth temperature, biofilm formation and virulence tested in Caenorhabditis elegans and human macrophages models.Ochrobactrum anthropi and Ochrobactrum intermedium are the two main Ochrobactrum species to be involved in human diseases. O. anthropi displays an epidemic population structure organized in two large clonal complexes (CCs). CC4 groups only human associated strains whereas CC1 contain environmental and clinical strains. Population genetics suggested that CC4 is a human-associated clone although phenotypic, genomic and virulence traits do not differ between CC1 and CC4 strains.As O. anthropi, O. intermedium displays a high genetic diversity without correlation between the genetic structure and the origin of strains. The level of genetic diversity among clinical strains appears as high as observed in the whole population. Several data such as a low level of genomic diversity suggested that O. intermedium is associated to a narrow ecological niche. The low number of environmental strains described for this species as well as an optimal growth at 37°C suggested that human beings could be the main niche for O. intermedium. Virulence in macrophage and C. elegans models showed diverse behaviour whereas some strains are able to survive and multiply in macrophages model.Multilocus genetics in a population of Agrobacterium spp. that displays diverse lifestyles, revealed a human associated population as observed for O. anthropi. The clinical genovar A7 groups 80% of the clinical strains included in the study, this strains growing at 42°C. Data obtained in this study will be confronted to the knowledge about other environmental-borne OBP such as Pseudomonas aeruginosa, Stenotrophomonas maltophilia and bacteria belonging to the species complex Burkholderia cepacia. All these bacteria displayed sub-populations associated to man or to a particular human disease. These sub-populations suggest a specialization process that will be described in the context of the speciation of bacterial pathogen in order to revisite the concept of « opportunisme infectieux »
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Zhao, Qian Sissi, and 赵茜. "The impact of human behaviors on healthcare-associated infections in neonatal intensive care unit: systematicreview." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46944175.
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Oliveira, Ana Rita Castelo Branco. "Pneumonias adquiridas durante o internamento hospitalar : impacte na saúde e implicação nos custos." Master's thesis, Universidade Nova de Lisboa. Escola Nacional de Saúde Pública, 2012. http://hdl.handle.net/10362/9702.
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RESUMO - Introdução: O presente estudo pretende analisar o impacte na saúde e a implicação nos custos da Pneumonia adquirida durante o internamento hospitalar. Está comprovado que as infeções hospitalares constituem um problema de Saúde pública dos hospitais em todo o mundo.
Metodologia: A população em estudo abrange 97 033 episódios de internamento, ocorridos em 10 hospitais, no ano de 2010. O trabalho compreende três fases: i) caracterização da população em estudo; ii) identificação das variáveis que influenciam os resultados em saúde; iii) estimação dos custos do internamento com Pneumonia.
Resultados: Os episódios de internamento com Pneumonia ocorreram maioritariamente no sexo masculino (58.1%). A faixa etária com mais episódios foi a dos 80 aos 89 anos. A taxa de Prevalência foi de 4.16% e a taxa de Mortalidade foi de 34.56%. Os doentes com Pneumonia tiveram uma demora média superior em 13 dias em relação aos doentes sem Pneumonia para o mesmo conjunto de GDH. Pertencer ao sexo masculino e os episódios de internamento ocorridos em hospitais não universitários levam a um aumento da probabilidade de morrer. Por sua vez apresentar uma maior duração de internamento e um número superior de comorbilidades levam a uma diminuição deste risco. Os custos em excesso dos episódios de internamento devido à aquisição de Pneumonia como doença secundária foram de aproximadamente 18 milhões de euros.
Conclusão: O trabalho foi elaborado tendo em vista a quantificação do fenómeno em Portugal, tanto em termos da carga da doença, como das implicações financeiras. Os valores encontrados são preocupantes, pelo que se torna necessário tomar medidas e introduzir práticas na atividade hospitalar que minimizem as infeções hospitalares em geral e da Pneumonia em particular. Por sua vez é expectável, face ao descrito na literatura internacional, que a introdução destas práticas melhor os resultados em saúde e o desempenho financeiro dos hospitais.ABSTRACT - Introduction: The main goal of this study is to analyze the health and the costs due to acquired Pneumonia during hospital stay. There is evidence that hospital infections are a public health problem in hospitals worldwide. Methods: The population analyzed is 97,033 hospital admissions, occurred in 10 hospitals in the year 2010. The work comprises three phases: i) characterization of the population, ii) identification of variables that influence health outcomes, iii) estimating the costs of acquired Pneumonia. Results: Admissions with acquired Pneumonia are more frequent on males (58.1%). The most relevant age group was from 80 to 89 years. The prevalence rate was 4.16% and the in-hospital mortality rate was 34.56%. The patients with acquired Pneumonia had an increase of the length of stay circa 13 days compared with patients without acquired Pneumonia for the same set of GDH. The males and admissions on non-teaching hospitals lead to an increased risk of hospital death. Moreover larger length of stay and higher number of comorbidities had decreased the risk of hospital death. The increase on admissions costs due to acquired Pneumonia were circa 18 million euros. Conclusions: The study presents some poor health outcomes, as well as costs increase due to acquired Pneumonia in Portuguese public hospitals. These results should be considered as a real problem in Portugal, and therefore it is necessary to be more evidenced based on hospital guidelines definition and in clinical management practice in order to increase hospital’s effectiveness and efficiency.
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Coelho, Sara Fernandes. "Estudo preliminar sobre a contaminação microbiológica e a aplicação de boas práticas no manuseamento e preparação de medicamentos anestésicos em 19 centros de atendimento médico-veternário." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2017. http://hdl.handle.net/10400.5/14792.
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Dissertação de Mestrado Integrado em Medicina VeterináriaAs infeções nosocomiais são uma realidade tanto em medicina humana como em medicina veterinária. Dada a crescente multi-resistência de microrganismos patogénicos às terapêuticas convencionais, a identificação de falhas humanas nos cuidados de saúde que favoreçam a sua transmissão é crucial. O acto anestésico é um procedimento que representa uma oportunidade privilegiada para o estabelecimento destas infeções, tendo em conta a enorme variedade e quantidade de medicamentos utilizados num só paciente. Inserido neste contexto, este estudo piloto procurou identificar uma fonte de contaminação e transmissão de agentes patogénicos em medicamentos anestésicos de apresentação multi-dose, através da sua análise microbiológica em ambiente clínico e hospitalar. O estudo contou com a participação de 19 CAMV, nos quais foram recolhidas amostras. As amostras recolhidas foram separadas em dois grupos: o grupo A (n=19) - medicamentos cujo excipiente possui alguma ação conservante, biocida ou bacteriostática e o grupo B (n=11) - medicamentos cujo excipiente não possui nenhuma das ações anteriores. No grupo A verificou-se 100% medicamentos negativos à contaminação e no grupo B observou-se 18,2% de positividade à contaminação bacteriana. Foram identificadas, nas duas amostras positivas, 3 isolados com potencial patogenicidade (Citrobacter braakii, Pseudomonas aeruginosa e Serratia marcescens) resistentes a várias classes de antibióticos (β-lactâmicos, tetraciclinas, cefalosporinas, quinolonas, trimetropim e sulfamidas). E foi, ainda, realizado um questionário relativamente às boas práticas de higiene e assepsia no maneio e preparação de medicamentos, revelando no geral uma fraca aplicação das mesmas, sendo coerente com os resultados microbiológicos: apenas 26,3% lava as mãos/usa luvas, 10,5% não utiliza material estéril, 15,78% re-utiliza a agulha no mesmo medicamento e 47,37% em medicamentos diferentes, 84,21% não desinfeta a tampa antes de preparar. Os resultados obtidos, apesar da amostra reduzida são indicativos da necessidade da melhoria das práticas utilizadas na manipulação de medicamentos anestésicos em apresentação multidose nos CAMV.
ABSTRACT - PRELIMINARY STUDY ON MICROBIOLOGICAL CONTAMINATION AND THE APPLICATION OF GOOD PRACTICES ON THE HANDLING AND PREPARATION OF ANESTHETIC DRUGS IN 19 CENTERS FOR MEDICAL-VETERINARY CARE - Nosocomial infections are a reality in both human and veterinary medicine. Given the increasing multi-resistance of pathogenic microorganisms to conventional therapies, the identification of human flaws in health care that favor their transmission is crucial. Anesthetic procedures represent a privileged opportunity for the establishment of these infections, taking into account the enormous variety and quantity of drugs used in a single patient. In this context, this pilot study sought to identify a source of contamination and transmission of pathogens in multidose presentation anesthetic drugs through microbiological analysis in clinical and hospital settings. The study counted on the participation of 19 CAMVs, in which samples were collected. The collected samples were separated into two groups: group A (n = 19) - drugs whose excipient has some conservative, biocidal or bacteriostatic action and group B (n = 11) - drugs whose excipient does not have any of the previous actions. In group A, 100% negative drugs were present, and in group B, 18.2% positivity to bacterial contamination was observed. Three bacteria with potential pathogenicity (Citrobacter braakii, Pseudomonas aeruginosa and Serratia marcescens) resistant to several classes of antibiotics (β-lactams, tetracyclines, cephalosporins, quinolones, trimethoprim and sulfamides) were identified in the two positive samples. A questionnaire was carried out regarding the good practices of hygiene and asepsis in the management and preparation of drugs, generally revealing poor application of them, consistent with microbiological results: only 26.3% wash their hands / wear gloves, 10.5% do not use sterile material, 15.78% reuse the needle in the same drug and 47.37% on different drugs, 84.21% did not disinfect the cap prior to preparation. The results obtained, despite the reduced sample, are indicative of the need to improve the practices used in the manipulation of anesthetic drugs in multidose presentation in CAMV.
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Kalfopoulou, Ermioni [Verfasser], and Johannes [Akademischer Betreuer] Hübner. "Novel active and passive immunotherapy regimens against nosocomial infections caused by multidrug resistant enterococci / Ermioni Kalfopoulou ; Betreuer: Johannes Hübner." München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2019. http://d-nb.info/1200852192/34.
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