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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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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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Cheng, Chi-chung Vincent, i 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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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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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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Hlady, Christopher Scott. "Nosocomial infection modeling and simulation using fine-grained healthcare data". Diss., University of Iowa, 2011. https://ir.uiowa.edu/etd/4856.
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Simulation has long been used in healthcare settings to study a range of problems, such as determining ideal staffing levels, allocating patient beds, and assisting with medical decision making. Some of this work naturally focuses on the spread of infection within hospitals, where the importance of hospitals as loci and amplifiers of infection was demonstrated during the 2002-2003 SARS outbreak. Increasingly, fine-grained healthcare data is being collected (e.g., patient care data stored in electronic medical record systems, and healthcare worker data from sources including nurse locator badges), presenting an opportunity to develop models that can drive more realistic simulations. We seek to build a realistic hospital simulator that can be used to answer a wide variety of questions about infection prevention, the allocation and placement of expensive resources, and issues surrounding patient care.
Our simulation framework requires three primary inputs: architectural, healthcare worker, and patient data. We used data from the University of Iowa Hospitals and Clinics to build our virtual hospital. We manually constructed a weighted, directed, 19,000 node graph-theoretic representation of the facility based on printed architectural drawings. Using timestamped location information from electronic medical record system logins and algorithms inspired by prior work on location-aware search, each healthcare worker is modeled by one or more “centers” of activity. Centers are determined using a maximum likelihood approach to fit a location and appropriate decay parameters that best describe the observed data. Finally, we developed compartmental patient models of varying granularity, with each compartment representing some subset of patient care areas within the hospital. Transition probabilities and patient length of stay were fit using three years of patient data.
In designing our simulator, we were able to minimize assumptions about how healthcare workers and patients move, avoiding the “random mixing” assumption common to many infectious disease simulators. We translated techniques from location-aware search into the hospital environment, developed data structures for use in efficiently processing millions of location data points in tens of thousands of rooms for thousands of healthcare workers, improved the performance of the algorithm for identifying optimal single-center healthcare worker models, and introduced heuristics for training multi-center models. We validated our models by comparing the properties of simulated data to known quantities, and testing against expert expectations. To the best of our knowledge, this is the first agent-level hospital-wide simulator based on fine-grained location and interaction data for healthcare workers and patients.
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Asante, Michael. "Numerical modeling of nosocomial infection in a multi-bed ward environment". Thesis, University of Warwick, 2012. http://wrap.warwick.ac.uk/50260/.
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A review on nosocomial infection has shown that there are various compelling evidence to suggest that the role of the airborne route to infection in a multi-bed environment cannot be ignored. Expiratory activities such as coughing, sneezes, talking and patient-centric activities such as bed-making has been shown in literature to generate significant quantity of infectious quanta that may become airborne and pose an infection threat to vulnerable patients. In this study, an airborne infection route of MRSA in the health care environment has been investigated using both the large-eddy simulation (LES) technique and an infection modeling. From analyzing flow field regimes in both a single room (typically found in isolation wards) and multi-bed ward environments, it was observed that the supply air delivered into the ventilated space produces pockets of recirculation areas near the walls and midway of the room in the wake of the advancing ventilation outlet bound flows, after impinging on internal surfaces such as beds. These recirculation areas have been identified as hot spots for possible airborne infection. Furthermore, the results suggests that the further the outlet vent is away from the inlet vent, the more likely will be the generation of recirculation regions, which directly translate to poor ventilation spots and that the use of curtains within the vicinity of the aerosol generating activities increases the number of recirculation areas. The overall airflow analysis suggest that any engineering solution designed to limit or remove the recirculation regions from the flow regime will be an effective way of fighting cross infections within the hospital ward environment, and as such ventilation schemes that are optimally designed to achieve this should be encouraged and investigated. This study has also predicted the possibility of a secondary infection in a multiward environment using various modeling approaches. The results obtained indicated that the posture of an infected person involved in the release of pathogens in relation to cohorts can have a profound effect on infection rates within the ward environment. The study of the coughing episode with the patient lying on the side generated a unit secondary infection, whilst the same simulated episode with an adjacent curtain in position failed to generate a secondary infection within the exposure period. The activity of bed making was also found to generate a secondary infection over the duration of the simulation, suggesting that bed-making can be a potential source of infection. The particle concentration decay curves examined in this work equally suggest that patients are at their most vulnerable state at the initial stages of coughing/sneezes, and talking episodes where the infecting patient assumes a directly facing posture to the susceptible.
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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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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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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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FlorÃncio, Caroline Mary Gurgel Dias. "Nosocomial infection Childhood:he importance of respiratory viruses as agents of these diseases". Universidade Federal do CearÃ, 2014. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=12835.
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CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel SuperiorNosocomial infections (NI) are a serious public health problem. Knowledge about the etiology of NI is important for the development of control measures, prevention and treatment. Viruses are important etiologic agent of NI has been studied in populations considered at risk as premature, heart disease, lung disease, and immunosuppressed. Respiratory hospital infection (RHI) generate discomfort to patients, postponing medical interventions, postoperative complications, use more drugs and, in some cases, intensive care, may progress to cure or to death. Viruses are responsible for outbreaks of RHI in wards and intensive care units, with the virus as detected respiratory syncytial virus. In our country there are few data on the impact of RHI caused by respiratory viruses in children. Aims of the study were: identify and describe RHI cases in children and submit nasopharyngeal aspirates collected from January to December 2013 to search for molecular diagnosis 13 respiratory viruses [respiratory syncytial virus (RSV), adenovirus, influenza A and B, parainfluenza virus -1 ,-2 , -3 and -4 , metapneumovirus and human coronavirus OC43 , NL63 , 229E and HKU - 1]. During the study period, 120 samples were included in the study and 65 % were positive for at least one virus. A total of 114 viruses were detected (33 RSV, 32 adenovirus, 14 Parainfluenza -3, 14 influenza A , 12 Parainfluenza -4 , 5 parainfluenza -1 , 3 metapneumovirus and 1 coronavirus OC43). Co-detections occurred in 26 cases: 16 with two viruses and 10 with three viruses. No clinical differences between positive and negative RHI for viruses investigated were observed. Respiratory virus were detected in four of five deaths (5/120 4.16%) associated RHI. The knowledge about the occurrence of viral RHI in association with the period of viruses circulation in the community, as described in the study, allows to develop specific actions steps to prevent and control hospital outbreaks caused by viruses.
As infecÃÃes relacionadas à assistÃncia à saÃde (IRAS) sÃo um sÃrio problema de saÃde pÃblica. O conhecimento sobre a etiologia das IRAS à importante para o desenvolvimento de medidas de controle, prevenÃÃo e tratamento. A importÃncia dos vÃrus na etiologia das IRAS tem sido estudada em populaÃÃes consideradas de risco, como prematuros, cardiopatas, pneumopatas e imunodeprimidos. As infecÃÃes respiratÃrias hospitalares (IRH) geram aos pacientes desconforto, adiamento de intervenÃÃes mÃdicas, complicaÃÃes pÃs-cirÃrgicas, uso adicional de medicamentos e, em alguns casos, cuidados intensivos, podendo cursar para a cura ou para o Ãbito. Os vÃrus sÃo responsÃveis por surtos de IRH em enfermarias e unidades de terapia intensiva, sendo o vÃrus sincicial respiratÃrio o mais detectado. Em nosso paÃs sÃo escassos os dados sobre o impacto das IRH causadas por vÃrus respiratÃrios em pediatria. Os objetivos deste estudo foram: identificar e descrever os casos de IRH em crianÃas e submeter aspirados de nasofaringe coletados no perÃodo de janeiro a dezembro de 2013 ao diagnÃstico molecular para pesquisa de 13 vÃrus respiratÃrios [vÃrus sincicial respiratÃrio (VSR), adenovÃrus, influenza A e B, parainfluenza 1, 2, 3 e 4, metapneumovÃrus e coronavÃrus humanos OC43, NL63, 229E e HKU-1]. Para tanto, as amostras foram extraÃdas para obtenÃÃo do material genÃtico viral e, posteriormente, para os vÃrus de RNA, parte deste produto foi transformada em DNA complementar e depois a amplificado. Para detecÃÃo do adenovÃrus, foram realizados PCR e Nested PCR. No perÃodo de estudo, 120 amostras foram incluÃdas e 65% delas foram positivas para pelo menos um vÃrus. Um total de 114 vÃrus foram detectados (33 VSR; 32 adenovÃrus; 14 parainfluenza-3; 14 influenza A; 12 parainfluenza-4; 5 parainfluenza-1; 3 metapneumovÃrus e 1 coronavÃrus OC43). Co-detecÃÃes ocorreram em 26 casos: 16 com dois vÃrus e 10 com trÃs vÃrus. NÃo foram observadas diferenÃas clÃnicas entre as IRH positivas e negativas para os vÃrus pesquisados. VÃrus respiratÃrios foram identificados em quatro dos cinco casos de Ãbito (4,16%; 5/120) associados à IRH. O conhecimento sobre a ocorrÃncia da IRH virais em associaÃÃo com o perÃodo de circulaÃÃo dos vÃrus na comunidade, como descrito no estudo, permite desenvolver aÃÃes especÃficas de medidas para prevenir e controlar surtos hospitalares causados pelos vÃrus.
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Pollock, Evelyn M. M. "Nosocomial infection in a paediatric intensive care unit : incidence, surveillance and sequelae". Thesis, University of Edinburgh, 1990. http://hdl.handle.net/1842/20114.
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The study reports nosocomial infection rate of 7 infected patients per 100 patients admitted. As a percentage of the total, the most prevalent organisms are: coagulase negative staphylocci (32%), Pseudomonas aeruginosa (23%), Candida species (20%) and Staphylococcus aureus (9&37); the commonest sites of infection are: blood stream (36%), skin/eye drain site (22&37); respiratory tract (16&37); wound (15%) and urinary tract (9%). Severity of the underlying illness of admission, as measured by the PRISM scoring system, predicts a population at risk of developing nosocomial infection. Patients with admission PRISM scores of ≥10 are significantly more likely to acquire infection than those with scores < 10 (10.8% vs 3.6%, p < 0.001) andthis association holds through age, clinical speciality and length of stay. The sensitivity, specificity, positive and negative predictive values of a PRISM score ≥10 are 75%, 53%, 11% and 97% respectively. In post operative cardiac surgery patients non-wound infections account for 72&37 of the total nosocomial infections. With regard to wound infection; the most prevalent pathogenic organisms vary depending on whether surgery is closed ie. non bypass (Staph. aureus and coagulase negative staphylocci) or open ie. bypass (coagulase negative staphylococci, P. aeruginosa, Candida species and Staph. aureus). Risk factors for the acquisition of infection relate to specific operative procedures and to surgical technique particularly the presence of an open sternotomy wound in the post operative period. The system of infection surveillance recently introduced in the PICU (the Infection Control Sentinel Sheet; ICSS) compares favourably with daily bedside examination of patients plus daily review of in-patient charts. The ICSS, which requires only 20 minutes of surveillance time per day, detects 87&37 of nosocomially infected patients; 85&37 of infections at the three standard sites (blood, wound and urine); and 72% of infections at all of the 11 sites surveyed. Certain adverse effects of nosocomial infection are reported to occur in up to 40% of infected patients. A crude costing study of intravenous antibiotic required for treatment of nosocomial infection suggests that the minimum cost was Can 15,000 (approx 7,500). In conclusion, following a resume of the results of the individual studies, areas, where future research efforts might be focussed, are identified.
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Oskarsson, Sofia, i Camilla Johansson. "Effekter på antalet vårdrelaterade urinvägsinfektioner av nya rutiner för kateteranvändning". Thesis, Uppsala University, Department of Public Health and Caring Sciences, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-112551.
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Introduction Every tenth patient in Sweden is affected by nosocomial infections. Among these, urinary tract infection (UTI) is the most frequently occurring within the hospital environment. Nosocomial infections lead to increasing costs for care, more suffering among the patients, increasing use of antibiotics, and longer treatment spells. The Academic hospital have engaged all wards in the so called VRISS-project (“nosocomial infections must be stopped”) in order to reduce the number of nosocomial infections.
Aim In connection to the VRISS-project new routines for removal of uretrahl catheters are introduced at ward 70E2 at the Academic hospital. The new routines imply that the catheter should be removed during the first post-op day. According to the old routines the catheter was to be removed no later than on the third post-op day. The authors of this study choose to investigate whether the new routines for uretrahl catheter removal have any effect on the occurrence of nosocomial UTI’s.
Methods The study is a restrospective record study with quantitative, descriptive design. 411 journals from 2007 (188) and 2009 (223) have been reviewed. All patients that underwent knee or hip operations during January, February, March, and April 2007 and 2009 are included in the sample.
Results The study shows that the new routines at ward 70E2 had some, but not full, influence on the share of patients with nosocomial UTI. Among women under 71 years of age and men older than 70 years, the number of days with uretrahl catheter and the share of patients with nosocomial UTI have decreased. However, among the younger men (<71 years) and the older women (>70 years) no effects of the new routines are detected.
Conclusion To summarize it can be concluded that the routines for how to use uretrahl catheters at ward 70E2 work fairly well. However, the results also show that the number of days with uretrahl catheter and the share of patients with nosocomial UTI among risk patients, above all among the older women, are the same in spite of the new routines for removal of uretrahl catheters. Thus, strategies for detecting risk patients in an early stage can be improved upon. Such measures can reduce the risk for nosocomial UTI among these patients.
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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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Mesquita, Ana Maria Ribeiro Cardoso. "Diarreia nosocomial e doenÃa associada ao clostridium difficile em pacientes imunossuprimidos de hospital universitÃrio em Fortaleza - CE". Universidade Federal do CearÃ, 2014. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=12377.
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nÃo hÃDiarreia nosocomial (DN) à uma infecÃÃo relacionada à assistÃncia à saÃde (IRAS) com incidÃncia e severidade crescentes. PropÃe-se determinar a incidÃncia da DN, os fatores de risco e a incidÃncia da doenÃa associada a Clostridium difficile (C. difficile). Para isso, um estudo caso â controle, pareando pacientes por idade, sexo, perÃodo de admissÃo, clÃnica e diagnÃstico, foi conduzido, de 06/ fev/12 a 05/fev/13, no Hospital UniversitÃrio da UFC. Casos ̶ pacientes com DN e Controles ̶ pacientes sem DN. Definiu-se DN como fezes lÃquidas, trÃs ou mais vezes em 24 horas, com duraÃÃo superior a 12 horas, sem outras causas inflamatÃrias ou procedimentos diagnÃsticos. DN foi detectada mediante busca ativa, visitando-se os pacientes das Unidades de Hematologia, Transplante HepÃtico e Renal. O teste ELISA TOX A/B II foi utilizado para detectar as toxinas A e/ou B e diagnosticar doenÃa associada ao C. difficile. Demais IRAS foram investigadas por intermÃdio de fichas de notificaÃÃo de infecÃÃo hospitalar (IH). O Ãndice geral de IH foi de 7,17%. A incidÃncia da DN nas enfermarias de Hematologia, Transplante HepÃtico e Renal foi 4,80% (44/925) e da DN associada ao C. difficile 0,12% (01/925). Detectaram-se toxinas A/B de C. difficile em caso [1/43 (2,32%)] e controles [3/72 (4,17%)]. DN foi significantemente associada ao uso prÃvio > 6 antimicrobianos por paciente, alÃm do uso prÃvio de ciprofloxacina, metronidazol, polimixina B e dieta enteral (p≤ 0,05). Pacientes com DN permaneceram mais tempo internados, tiveram mais vÃmitos, cÃlicas e febre, verificando-se alta significÃncia estatÃstica (p≤ 0,05). Outras IRAS identificadas, nos casos e controles, foi infeÃÃo do trato urinÃrio 54% (15/28), seguida da corrente sanguÃnea 32% (8/28), do sÃtio cirÃrgico 11% (3/28) e de infecÃÃo de partes moles 4% (1/28). DN impÃe riscos aos pacientes jà debilitados. Os dados demonstram a presenÃa endÃmica do C. difficile. A atualizaÃÃo da epidemiologia local orienta medidas de controle da IH, como uso judicioso de antibiÃticos, cautelas com a dieta enteral e precauÃÃes de contato, para os pacientes com diarreia nosocomial.
Nosocomial diarrhea (ND) is a healthcare - associated infections (HAI) with increasing incidence and severity. It is proposed to determine the incidence of ND, the associated risk factors and the incidence of disease associated to Clostridium difficile (C. difficile). For this, a case - control study, pairing patients by age, sex, length of admission, and clinical diagnosis was conducted 06 / Feb/12 to 05/Fev/13 in the University Hospital of the UFC. Cases: patients with DN and controls: patients without ND. Nosocomial diarrhea is defined as watery stools, three or more times within 24 hours, over 12 hours without further diagnostic procedures or inflammatory causes. ND was detected by active surveillance, visiting the patients of Hematology, Liver and Renal Transplant. DN was defined as loose stools, 3 or more times in 24 hours, with duration longer than 12 hours, without other inflammatory causes or diagnostic procedures. The ELISA TOX A / B II test was used to detect toxin A and/or B and to diagnose C. difficile associated disease. Others HAI were investigated by the notification records of nosocomial infection (NI). The overall rate of Nosocomial infection was 7.17 %. The incidence of DN in the wards of Hematology, Liver and Renal Transplant was 4.80% (44/925) and C. difficile associated with DN was 0.12 % (01/925). Toxins A/B were detected in the case of C. difficile [1/43 (2.32%)] and controls [3/72 (4.17%)]. DN was significantly associated with previous use > 6 antimicrobials per patient, beyond the prior use of ciprofloxacin, metronidazole, polymyxin B and enteral feeding (p ≤ 0.05). Patients with ND remained in hospital longer, had more vomiting, cramps and fever, verifying high statistical significance (p ≤ 0.05). Other identified HAI were mainly urinary infection 54% (15/28), followed by bacterial bloodstream infection 32% (8/28), surgical site infection 11% (3/28) and soft tissue infection 4% (1/28). ND entails risks to the already debilitated patients. The data demonstrate the presence of endemic C. difficile. The updated of the local epidemiology guide control measures NI, such as judicious use of antibiotics, enteral feeding precautions and contact precautions for patients with nosocomial diarrhea.
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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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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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Thomas, Lee. "Genetic methods for Rapid Detection of Medically Important Nosocomial Bactera". Thesis, The University of Sydney, 2007. http://hdl.handle.net/2123/3575.
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The role of the microbiology laboratory is (1) to provide infection control information, so that highly transmissible isolates may be identified and appropriate control measures instigated as rapidly as possible and (2) to provide adequate information to the clinician enabling correct antibiotic choices to be made, particularly in the critically ill. Microbiological data is by definition slow as it is culture dependent: this study focused on the development of genetic, culture-independent methods for detection of resistance in nosocomial pathogens that could be introduced into the routine microbiology department and would fit into the routine workflow with a consequent reduction in time to result. Initially a duplex real-time polymerase chain reaction was developed for the rapid identification and detection of S. aureus and methicillin-resistance. This was optimised for immediate as-needs testing of positive blood cultures signalling with “Gram positive cocci, possibly staphylococcus” evident on Gram stain, on a random access real-time PCR platform. This technology, allowing early identification of S. aureus and its susceptibility to methicillin, by simple automated methodology, may soon become the standard for all microbiology laboratories servicing the critically ill. The second part of the study involved the development of a selective broth and multiplex PCR for detection of three important nosocomial isolates at this institution, methicillin-resistant S. aureus (MRSA), carbapenem-resistant Enterobacteriaceae, and multi-resistant Acinetobacter baumannii (MRAB). A multiplex PCR using four primer sets was designed to detect low colonisation levels of these isolates after overnight incubation in selective broth, significantly reducing the time to result and associated costs. This potentially useful epidemiological screening tool is practical, reproducible and sensitive with the potential of moving to an automated test (using real-time PCR, for example) in the future. The availability of early negative results judged by simple visual scanning (or by densitometry), means that the result is less operator-dependent, potentially reducing error rate. The last part of the study dealt with an important resistance phenotype, aminoglycoside resistance. There had been no recent comprehensive local surveys performed to determine the frequency of aminoglycoside resistance amongst the Enterobacteriaceae, or to identify the genetic determinants and their transmissibility. The isolates collected for the study were all resistant to at least one of gentamicin, tobramycin or amikacin. Identification of integron cassette arrays and use of specific internal primers identified at least one genetic determinant for gentamicin and tobramycin resistance in 22 of 23 isolates. Three isolates had two aminoglycoside resistance genes, and three isolates had three aminoglycoside resistance genes identified (Table 6.1). Transferable gentamicin-resistant plasmids were predominant amongst Klebsiella spp., but less so amongst Enterobacter spp. and E. coli. Gentamicin-resistant Klebsiella spp. were often ESBL positive, the genetic determinants of which were typically co-transferred on a conjugative plasmid. The importance of screening at a local level was demonstrated by the unexpected predominance of aac(6')-IIc amongst Enterobacter spp. and the detection of a new gene (aac(6')-LT). This part of the study has provided an understanding of the primary aminoglycoside resistance genes present in the local setting and their association with other resistances. This knowledge will allow development of assays for patient screening (clinical isolates and colonising flora), to better understand the epidemiology of aminoglycoside resistance and to allow better choice of antibiotic therapy related to presence or absence of these genes.
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Thomas, Lee. "Genetic methods for Rapid Detection of Medically Important Nosocomial Bactera". University of Sydney, 2007. http://hdl.handle.net/2123/3575.
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Master of ScienceThe role of the microbiology laboratory is (1) to provide infection control information, so that highly transmissible isolates may be identified and appropriate control measures instigated as rapidly as possible and (2) to provide adequate information to the clinician enabling correct antibiotic choices to be made, particularly in the critically ill. Microbiological data is by definition slow as it is culture dependent: this study focused on the development of genetic, culture-independent methods for detection of resistance in nosocomial pathogens that could be introduced into the routine microbiology department and would fit into the routine workflow with a consequent reduction in time to result. Initially a duplex real-time polymerase chain reaction was developed for the rapid identification and detection of S. aureus and methicillin-resistance. This was optimised for immediate as-needs testing of positive blood cultures signalling with “Gram positive cocci, possibly staphylococcus” evident on Gram stain, on a random access real-time PCR platform. This technology, allowing early identification of S. aureus and its susceptibility to methicillin, by simple automated methodology, may soon become the standard for all microbiology laboratories servicing the critically ill. The second part of the study involved the development of a selective broth and multiplex PCR for detection of three important nosocomial isolates at this institution, methicillin-resistant S. aureus (MRSA), carbapenem-resistant Enterobacteriaceae, and multi-resistant Acinetobacter baumannii (MRAB). A multiplex PCR using four primer sets was designed to detect low colonisation levels of these isolates after overnight incubation in selective broth, significantly reducing the time to result and associated costs. This potentially useful epidemiological screening tool is practical, reproducible and sensitive with the potential of moving to an automated test (using real-time PCR, for example) in the future. The availability of early negative results judged by simple visual scanning (or by densitometry), means that the result is less operator-dependent, potentially reducing error rate. The last part of the study dealt with an important resistance phenotype, aminoglycoside resistance. There had been no recent comprehensive local surveys performed to determine the frequency of aminoglycoside resistance amongst the Enterobacteriaceae, or to identify the genetic determinants and their transmissibility. The isolates collected for the study were all resistant to at least one of gentamicin, tobramycin or amikacin. Identification of integron cassette arrays and use of specific internal primers identified at least one genetic determinant for gentamicin and tobramycin resistance in 22 of 23 isolates. Three isolates had two aminoglycoside resistance genes, and three isolates had three aminoglycoside resistance genes identified (Table 6.1). Transferable gentamicin-resistant plasmids were predominant amongst Klebsiella spp., but less so amongst Enterobacter spp. and E. coli. Gentamicin-resistant Klebsiella spp. were often ESBL positive, the genetic determinants of which were typically co-transferred on a conjugative plasmid. The importance of screening at a local level was demonstrated by the unexpected predominance of aac(6')-IIc amongst Enterobacter spp. and the detection of a new gene (aac(6')-LT). This part of the study has provided an understanding of the primary aminoglycoside resistance genes present in the local setting and their association with other resistances. This knowledge will allow development of assays for patient screening (clinical isolates and colonising flora), to better understand the epidemiology of aminoglycoside resistance and to allow better choice of antibiotic therapy related to presence or absence of these genes.
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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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McGovern, James Gerard. "Pathogenesis and control of infection associated with the oropharynx and the polyvinyl chloride endotracheal tube". Thesis, Queen's University Belfast, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.388226.
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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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Kempe-Kropf, maria, i Satu Peltonen. "Följsamhet gällande handhygien bland vårdpersonal : - en litteraturstudie". Thesis, University of Gävle, Ämnesavdelningen för vårdvetenskap, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-6245.
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Syftet med denna litteraturstudie var att beskriva varför följsamheten gällande handhygien ofta är låg bland vårdpersonal, samt hur man kan öka följsamheten för handhygien bland vårdpersonal. Metoden som använts var en litteraturstudie. Datainsamling skedde via databaserna Medline (PubMed), Cinahl (EBSCO host) och Academic Search Elite. Sökorden som använts: prevention, hand disinfection, hand washing, infection control, nosocomial infection och education. Totalt användes 15 vetenskapliga artiklar. Resultatet delades in i två huvudrubriker: Orsaker till att följsamheten ofta är låg bland vårdpersonal och faktorer som kan öka följsamheten gällande handhygien bland vårdpersonal. De två huvudrubrikerna delades in i sex underrubriker: tidsbrist, hudbekymmer, kunskapsbrist, utbildning, affisch/posters och tillgänglighet. Resultatet visade att det finns många anledningar till att följsamheten för handhygien är låg. Studien visar att tidsbrist, hudbekymmer samt kunskapsbrist gällande hand hygien är de vanligaste orsakerna. Utbildning tillsammans med affischer/posters samt ökad tillgänglighet vad gäller material har visat sig vara det mest effektiva sättet att öka följsamheten av handhygien.
Nyckelord .
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Багуля, К. В., i Т. О. Зайцева. "Вивчення мікробного пейзажу біотопів жінок та немовлят в акушерських стаціонарах". Thesis, Сумський державний університет, 2016. http://essuir.sumdu.edu.ua/handle/123456789/47826.
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Проблема внутрішньолікарняних інфекцій в акушерських та неонатологічних стаціонарах залишається актуальною для охорони здоров'я України у зв'язку з високим рівнем захворюваності, відсутністю тенденції до зниження. Розвитку ВЛІ передує колонізація різних біотопів вагітних та новонароджених госпітальними штамами, як правило, умовно патогенних мікроорганізмів (УПМ). Мета роботи - встановити домінуючі колонізуючі агенти біотопів жінок і дітей в акушерських стаціонарах.
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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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Parker, Nicola Sarah. "The psychological impact of nosocomial infection : a phenomenological investigation of patients’ experiences of Clostridium difficile". Thesis, University of Leicester, 2011. http://hdl.handle.net/2381/9893.
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Whilst the genesis and management of healthcare-associated infections (HAIs) is well represented in health literature, less attention has been given to patient experiences. The review of literature is a narrative synthesis of eight qualitative research studies focusing on patients’ experiences of healthcare associated infections. Results indicated that psychological needs of patients with iatrogenic infections are often inadequately addressed, and that patients’ experiences of iatrogenic infection were characterised by fears, worries, stress and guilt. Furthermore it highlighted inadequate information-giving practices, in some cases due to staff concerns about frightening patients, or because they assumed patients already knew they were infected. This impeded patient adjustment to infection, and may have consequently developed a double iatrogenic effect on those patients. The research report investigates patients’ experiences of hospital acquired Clostridium difficile using interpretative phenomenological analysis to interrogate interview data collected from six inpatient participants. Emergent themes were lack of information, psychological distress and concerns over possible future hospitalisation. Patients also reported observing poor adherence to hygiene protocol by hospital staff and anxiety about making complaints due to fear of possible reprisals. Results indicated that poor information sharing practices can inadvertently place an additional burden of anxiety and confusion on iatrogenically infected patients. Systems of staff training need more emphasis on explaining diagnoses and its implications for patients to mitigate some of these avoidable problems. Attention also needs to be paid to HAIs as deterrents of future engagement with health services, potentially putting patients’ health at risk. In reflecting on the process of conducting this research, the critical appraisal addresses several key areas of learning and development that have been pertinent for the author; these being reflections of epistemological and methodological issues throughout, consideration of aspects of researcher safety, a critique of the limitations of the study and proposals for future research.
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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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Gasser, Raphael Götz-Ulrich. "Quantitative Erfassung nosokomialer Infektionen auf der interdisziplinären operativen Intensivstation des Universitätsklinikums Leipzig". Doctoral thesis, Universitätsbibliothek Leipzig, 2017. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-219965.
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Nosokomiale Infektionen (NKI) gehören zu den häufigsten Komplikationen eines
Krankenhausaufenthaltes, insbesondere auf Intensivstationen mit einer Prävalenz von rund
18,65%. Die Folgen sind eine längere Verweildauer, erhöhte Morbidität und Letalität sowie
höhere Kosten für das Gesundheitssystem. Die Erfassung NKI stellt einen wichtigen
Qualitäts- Parameter für Intensivstationen dar.
Ziel dieser Arbeit war es, die Übereinstimmung von nur nach KISS (Krankenhaus-InfektionsSurveillance
System)- Definitionen erfassten Infektionen mit der klinisch diagnostizierten
nosokomialen Infektion zu prüfen und den Zusammenhang zwischen ärztlicher Diagnose und
den laborchemischen und klinisch erhobenen Kriterien darzustellen.
Hierfür wurden auf einer interdisziplinären operativen Intensivstation nosokomiale
Infektionen sowohl nach ITS- KISS (VAP, ZVK- assoziierte Infektionen und HWI), als auch
nach ärztlicher Diagnose plus Beginn oder Eskalation einer Antibiotikatherapie erfasst.
Zusätzlich zu den KISS-Parametern wurden laborchemische Entzündungsparameter (CRP
und PCT) registriert.
Es traten 32 Infektionen nach ITS- KISS und 69 Infektionen nach ärztlicher Diagnose auf.
Acht Infektionen wurden ausschließlich nach KISS und 45 ausschließlich nach der ärztlichen
Diagnose erfasst.
Die Infektionsrate nach KISS für VAP lag bei 20,6, für ZVK bei 5,9 und für HWI bei 2
Infektionen, jeweils pro 1000 Devicetage.
Spezifität und positiv prädiktiver Wert hinsichtlich der Vorhersage einer ärztlich
diagnostizierten Infektion waren gering. Auch durch Kombination verschiedener Parameter
wurden keine höheren prädiktiven Werte erreicht.
Die geringe Übereinstimmung der beiden Methoden legt nahe, dass KISS die klinisch
relevanten Infektionen nicht wesentlich erfasst und relevante Infektfoci nicht berücksichtigt
werden, beispielsweise abdominelle Infektionen.
Zudem erlauben die erfassten Laborparameter keine zuverlässige Diagnose bzw. Prädiktion
einer nosokomialen Infektion. Die ärztliche Diagnose in Verbindung mit dem Beginn oder der
Eskalation einer Antibiotikatherapie könnte eine vereinfachte Methode zur Surveillance
nosokomialer Infektionen darstellen.
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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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Verdial, Cláudia Sofia Serafim. "Prevenção de infeções nosocomiais : controlo bacteriológico de superfícies hospitalares da Unidade de Isolamento e Contenção Biológica do Hospital Escolar da FMV-ULisboa". Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2020. http://hdl.handle.net/10400.5/21064.
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Dissertação de Mestrado Integrado em Medicina VeterináriaA Unidade de Isolamento e Contenção Biológica (UICB) é uma subunidade hospitalar do Hospital Escolar da FMV-ULisboa, destinada à admissão de animais com diagnóstico ou suspeita clínica de doenças infeciosas. A UICB constitui um ambiente de alto risco de transmissão de agentes infeciosos, pelo que a implementação de programas de vigilância de infeções nosocomiais nestas instalações apresenta extrema relevância. Neste trabalho propôs-se identificar as superfícies hospitalares mais contaminadas da UICB, que poderiam beneficiar de ações corretivas a nível dos seus protocolos de limpeza e desinfeção. Para tal, foram realizadas colheitas de amostras de superfícies hospitalares de 3 áreas distintas da UICB, de modo a efetuar a contagem de aeróbios totais e investigar a presença de 4 microrganismos nosocomiais: Enterococcus spp. resistente à vancomicina, Staphylococcus aureus resistente à meticilina, Escherichia coli resistente a cefalosporinas de 3ª geração e Pseudomonas aeruginosa resistente a carbapenemos. Posteriormente, foram implementados novos protocolos de desinfeção, tendo sido avaliada a sua eficácia. A quantificação bacteriana foi realizada com auxílio de um meio de cultura inespecífico, enquanto que para o isolamento das espécies bacterianas de interesse foram utilizados meios de cultura seletivos e diferenciais. Os isolados bacterianos foram identificados com base nas suas características macro e microscópicas, bem como no seu perfil bioquímico. A avaliação quantitativa revelou que as jaulas, a esponja e o telefone foram as superfícies com maior carga bacteriana das salas de isolamento, preparatório e de trabalho, respetivamente. Das 4 bactérias sinalizadas neste estudo, Enterococcus spp. (11,3%) foram os mais frequentemente isolados, seguindo-se Escherichia coli (1,5%) e Pseudomonas aeruginosa (1,5%). Não foi possível isolar nenhuma das bactérias sinalizadas, no entanto um dos isolados de P. aeruginosa apresentou resistência ao imipenem. Após avaliação destes resultados, foram implementados novos protocolos de limpeza e desinfeção que revelaram uma eficácia na redução contagens bacterianas de 99,99% nas jaulas e na esponja e de 90 a 95% no telefone. Este estudo conclui que as jaulas e as superfícies de contato humano foram as mais contaminadas nas salas de isolamento. Ainda assim, as novas estratégias de desinfeção implementadas demonstraram-se eficazes na redução da contaminação ambiental. Estes resultados podem contribuir para realçar a importância das medidas de prevenção e controlo de infeções na redução da disseminação de agentes infeciosos em ambiente hospitalar e, consequentemente, no aumento da qualidade e segurança do serviço prestado.
ABSTRACT - PREVENTING NOSOCOMIAL INFECTIONS: BACTERIOLOGICAL CONTROL OF HOSPITAL SURFACES OF THE BIOLOGICAL ISOLATION AND CONTAINMENT UNIT OF THE TEACHING HOSPITAL OF FMV-ULISBOA - The Biological Isolation and Containment Unit (BICU) is a subunit of the Teaching Hospital of FMV-ULisboa, for the admission of animals with confirmed infectious diseases or under clinical suspicion and waiting for a diagnosis. As a high-risk environment for the transmission of infectious agents, it is extremely important to implement programs for the surveillance of nosocomial infections in these facilities. The purpose of this study was to identify the BICU environmental surfaces with a higher bacterial contamination level and to implement corrective actions on their cleaning and disinfection protocols. For that, swab samples were collected from selected environmental surfaces in 3 different areas of the isolation unit, to evaluate the total aerobic bacteria load and investigate the presence of 4 nosocomial microorganisms: vancomycin-resistant Enterococcus spp., methicillin-resistant Staphylococcus aureus, 3rd generation cephalosporin-resistant Escherichia coli and carbapenem-resistant Pseudomonas aeruginosa. Subsequently, new disinfection protocols were implemented, and their effectiveness evaluated. Bacterial quantification was performed by using a non-selective media, while specific selective media were used for the isolation of the target bacteria. Isolates were identified based on their macro and microscopic characteristics and their biochemical profile. The quantitative evaluation revealed that the cages, sponge, and telephone were the surfaces with the highest bacterial load in the isolation, preparatory and worker’s rooms, respectively. Regarding the 4 pathogens investigated, Enterococcus spp. were the most frequently isolated (11.3%), followed by E. coli (1.5%) and P. aeruginosa (1.5%). It was not possible to isolate any of the target bacteria, although one of the P. aeruginosa isolates was resistant to imipenem. In the end, new cleaning and disinfection protocols were implemented, which proved to be effective in reducing bacterial counts by 99.99% in cages and the sponge, and by 90 to 99% on the telephone. This study concludes that the cages and the human contact surfaces were the most contaminated surfaces in the isolation rooms. Nevertheless, the new disinfection strategies were effective in reducing environmental contamination, including by some potentially nosocomial agents. These results may contribute to highlight the importance of infection prevention and control measures, as fundamental tools to reduce the spread of infectious agents in the hospital environment and, consequently, to increase the quality and safety of the service provided.
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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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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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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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Russo, Philip L. "Evidence based recommendations for national healthcare-associated infection surveillance". Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/100034/1/Philip_Russo_Thesis.pdf.
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This thesis has provided new knowledge about the surveillance of healthcare associated infections both in Australia and internationally. Using a mixed methods approach, a series of evidence based and pragmatic recommendations for a national surveillance program in Australia have been generated. Gaps in current surveillance activities across Australia were identified, and findings from the novel application of a discrete choice experiment, have identified strong key stakeholder support for a preferred national program to reduce the burden of infections in Australian hospitals.
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Orellana, Robert Charles. "Recurrent Clostridioides difficile infection: epidemiology and bedside scoring system analysis, 2014-2016". The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1543505897011863.
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Garcia, Priscila do Nascimento [UNESP]. "Adesão dos profissionais de saúde às precauções de contato em unidade de terapia intensiva". Universidade Estadual Paulista (UNESP), 2011. http://hdl.handle.net/11449/96447.
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garcia_pn_me_botfm.pdf: 574437 bytes, checksum: 631b71eaec9a9eb25af2a850c50c5a29 (MD5)As Infecções Relacionadas à Assistência à Saúde (IRAS) representam um dos principais entraves na qualidade da assistência médica, sendo considerada um grave problema de saúde pública. Dentre as complicações associadas às IRAS estão a morbi-mortalidade, o aumento do tempo de internação e da quantidade dos procedimentos invasivos, elevação do consumo de antimicrobianos e a disseminação de bactérias multirresistentes. As ações de controle das infecções voltadas às precauções e isolamentos possuem dois níveis, um composto pelas precauções padrão e o outro baseado nas vias de transmissão dos agentes, podendo ser classificados em três tipos: precauções respiratórias para transmissão aérea e para gotículas e em precauções para transmissão por contato. O objetivo deste estudo foi avaliar o uso das precauções de contato pelos profissionais de saúde de uma unidade de terapia intensiva. Trata-se de um estudo descritivoexploratório, composto por duas etapas, sendo a primeira correspondente à entrevista individual, na qual foram levantados o perfil demográfico, as doenças que necessitam das precauções de contato, as medidas que devem ser utilizadas e as dificuldades na assistência aos pacientes sob esta precaução. Na segunda etapa, os participantes foram observados durante três procedimentos assistenciais a pacientes em precaução de contato. As respostas da entrevista foram transcritas para a planilha do software Microsoft Office Excel, recebendo caracterização em adequada, parcialmente adequada e inadequada, segundo a categoria de acertos e erros. A etapa observacional foi conceituada como adequada e inadequada, considerando-se adequada a realização de 75% ou mais dos itens avaliados. Participaram desta casuística 31 profissionais de saúde da UTI, representando 88,6% do número...
Infections Related to Healthcare (IRH) represent a major constraint on medical care quality, being considered a severe public health problem. Among the complications associated with IRH, are morbidity and mortality, increased hospital staying length and the number of invasive procedures, increased consumption of antimicrobials and the dissemination of multiresistant bacteria. The actions aimed at infection control precautions and isolation have two levels, one composed of standard precautions and the other based on the agents transmission routes, which can be classified into three types: respiratory precautions for airborne transmission and droplets precautions and in precautions for transmission by contact. The objective of this study was to evaluate the use of contact precautions for healthcare professionals from an intensive care unit. It is a descriptive exploratory study, consisting of two phases, the first corresponding to individual interviews, which demographic profile was raised, the illnesses that require contact precautions, what measures should be used and the difficulties in patient care in this case. In the second stage, participants were observed for three health care procedures to patients in contact precautions. The interview responses were transcribed to the spreadsheet software Microsoft Office Excel, getting characterization in adequate, in partially adequate or in inadequate, according to the hits and misses category. The observational phase was defined as adequate and inadequate, considering adequate the performance of 75% or more, of the items evaluated. Thirty one health professionals from the ICU participated in our study, representing 88.6% of the total number of the unit staff. There was female... (Complete abstract click electronic access below)
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Almeida, Marcela Cristina Candido de [UNESP]. "Descrição bacteriológica de brinquedo utilizado em unidade de internação pediátrica". Universidade Estadual Paulista (UNESP), 2010. http://hdl.handle.net/11449/96462.
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A hospitalização infantil acarreta fatores estressantes para a criança e sua família. É uma situação que pode trazer traumas emocionais à criança, exigindo dos profissionais da área da saúde além de tratamento terapêutico, o carinho e a atenção. Esses cuidados podem ser alcançados através do brinquedo, que proporciona à criança restabelecimento físico e emocional, contribuindo para sua recuperação. Todavia, há fatores que contribuem para que o uso do brinquedo se torne objeto de atenção especial quando se pensa em compartilhá-los e na falta de práticas de higiene para os mesmos em unidade de internação pediátrica, considerando que o brinquedo pode ser um veículo na transmissão de microrganismos. O objetivo deste estudo foi: descrever as condições bacteriológicas do brinquedo de plástico utilizados na unidade de internação pediátrica do Hospital Estadual Bauru (HEB). Utilizou-se swabs estéreis para a coleta das amostras das mãos e do brinquedo. A amostragem foi realizada utilizando swab estéril em três momentos: no primeiro momento realizou-se a coleta de swab das mãos das crianças e do brinquedo antes de iniciar a brincadeira, no segundo momento coletou-se a amostra imediatamente após a brincadeira e no terceiro momento houve a coleta de swab no brinquedo após o processo de higienização com álcool 70%. Após as coletas, as amostras foram encaminhadas para o laboratório de Análises Clínicas do HEB onde foi realizada a semeadura das amostras em meios de cultura Ágar MacConkey e Manitol. Após 24 horas, observava-se a presença ou não de crescimento bacteriano. Quando havia crescimento bacteriano, seguia-se para a identificação do achado e, quando não havia crescimento bacteriano, mantinha-se a amostra na estufa por mais 24 horas para determiná-la como presente ou ausente de crescimento bacteriano. Seguidamente realizou-se o...
Children’s hospitalization leads to stressful factors for patients and their relatives. It is a situation that can cause emotional trauma in children, thus requiring kindness and attention from health care professionals, in addition to therapeutic care. Such care can be achieved by means of toys, which help children recover physical and emotional wellness, thus contributing to their health recovery. Nevertheless, there are factors that contribute for toy use to become an object of attention when considering the fact that toys will be shared and the lack of toy hygiene practices at pediatric hospitalization units, since they may be a vehicle for microorganism transmission. The objective of this study was: to describe the bacteriological conditions of plastic toys used at the hospitalization unit of Bauru State Hospital (BSH). Sterile swabs were used to collect samples from hands and toys. Sampling was performed by using sterile swabs at three different moments: at the first moment, swab collection was performed from children’s hand and from toys before playing began; at the second moment, a sample was collected immediately after playing; and, at the third moment, swab collection from the toy took place after hygienization using 79% alcohol. Following collection, the samples were sent to the Laboratory of Clinical Analysis of BSH, where they were seeded in Agar MacConkey and Manitol culture media. The presence or not of bacterial growth was observed after 24 hours. Whenever bacterial growth occurred, the findings were identified, and when no growth was observed, the sample was kept in a stove for another 24 hours in order to determine it as present or absent of bacterial growth. Next, an antibiogram and in-vivo sensitivity tests for hospital cleaning products were performed by the Agar-Gel diffusion method. Results showed that, in most findings, bacterial growth occurred on the ... (Complete abstract click electronic access below)
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Thomas, Claudia. "The epidemiology and control of Clostridium difficile infection in a Western Australian hospital". University of Western Australia. School of Population Health, 2003. http://theses.library.uwa.edu.au/adt-WU2004.0011.
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[Truncated abstract] The prinicipal aim of this thesis was to explore the relationship between 3rd generation cephalosporin antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea (CDAD). This antibiotic class has been implicated in the aetiology of CDAD; therefore restriction of these antibiotics via antibiotic policies represents a potential strategy for prevention and control of CDAD. Successful control of CDAD in hospitals translates to improved quality of care for patients, and a reduction of pressure on hospital resources. Therefore, the objectives of this study were to determine whether 3rd generation cephalosporins were related to CDAD, to evaluate the effect of changes to antibiotic policy on the incidence of CDAD, and to determine the impact of CDAD on patient length of stay and hospital costs. The study was conducted in Sir Charles Gairdner Hospital (SCGH), a public teaching hospital located in Perth, the capital city of the state of Western Australia. Evidence for an association between 3rd generation cephalosporins and CDAD was obtained from studies of ecologic- and individual-level data. A time series analysis of the relationship between monthly consumption of 3rd generation cephalosporins and the incidence of CDAD in SCGH was undertaken covering the period 1994 to 2000. The results demonstrated a positive relationship between the use of 3rd generation cephalosporins and CDAD. A matched case-control study that involved 193 adult inpatients diagnosed with CDAD and 386 adult inpatients without CDAD, selected from the period 1996 to 2000, was conducted. Information was collected on exposure to 3rd generation cephalosporin antibiotics during hospitalisation, as well as exposure to other antibiotics and medications, procedures, and comorbidities. Results from conditional logistic regression analyses found CDAD cases were six times more likely to be exposed to 3rd generation cephalosporins during their admission, prior to the onset of diarrhoea, than controls (adjusted odds ratio [OR] = 6.17, 95% confidence interval [CI] = 1.56-24.37). Approximately one third of CDAD in the study population could be attributed to 3rd generation cephalosporins. CDAD cases were also four times more likely to have been exposed to either amoxicillin-clavulanate or ticarcillin-clavulanate (adjusted OR=4.23, 95% CI=1.81-9.93). In October 1998, an antibiotic policy was introduced at SCGH that restricted the use of ceftriaxone, the 3rd generation cephalosporin most commonly used by the hospital. During 1999 and 2000, the incidence of CDAD halved as ceftriaxone consumption fell in response to this policy. The effect of this policy was demonstrated in the time series model; during the post-policy period the relationship between ceftriaxone and CDAD that was evident prior to the policy was cancelled out. From the individual-level data, obtained from the case-control study, a reduction in the prevalence of exposure to 3rd generation cephalosporins from 11% to 1% accounted for a 30% reduction in the incidence of CDAD. Data from the case-control study was also used to analyse the independent contribution of CDAD to length of stay and admission costs using multiple linear regression
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Kraus, Frank. "Infections nosocomiales et facteurs de risque en court séjour gériatrique : étude à l'occasion de 2 audits prospectifs sur le soutien nutritionnel". Bordeaux 2, 1998. http://www.theses.fr/1998BOR2M096.
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Gil, Rueda Bernardo. "Vigilancia de la infección nosocomial en un Servicio de Medicina Intensiva mediante la aplicación de un Ciclo de Garantia de Calidad. Nosocomial infection surveillance in the intensive care unit through measures designed for quality assurance". Doctoral thesis, Universidad de Murcia, 2003. http://hdl.handle.net/10803/95942.
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FUNDAMENTO: análisis de la aplicación de un ciclo de garantía de calidad sobre las tasas de infección nosocomial (IN) en una UCI polivalente de nivel II.
MÉTODO: Estudio prospectivo de cohortes, de dos años de duración, sobre 568 pacientes; Grupo A (n=281), observacional y Grupo B (n=287), en el que se aplicaron medidas de mejora (administración de sucralfato, correcta profilaxis antibiótica quirúrgica y medidas estrictas de asepsia)
Se comparan las tasas de IN asociada a ventilación mecánica (NAVM), sonda uretral, catéter venoso central e infección de herida quirúrgica en ambos grupos, así como la estancia y mortalidad intra-UCI.
RESULTADOS Tras la aplicación del ciclo de mejora de calidad mediante el cumplimiento de criterios de calidad, obtuvimos una reducción significativa de las tasas de incidencia de todas las infecciones controladas. No apreciamos diferencias en la mortalidad global intra-UCI entre ambos grupos, aunque sí en los que desarrollaron una IN.
Los pacientes con NAVM, mostraron una reducción no significativa de la mortalidad. El subgrupo de pacientes que recibió sucralfato presentó una disminución de la frecuencia de IN y mortalidad relacionada. Sin embargo, el grado de incumplimientos del protocolo de mejora se mostró elevado (diagrama de Pareto).
CONCLUSIONES: La instauración de un sistema de vigilancia y la aplicación de medidas de mejora han logrado reducir tanto la incidencia como la mortalidad de la IN, no así la mortalidad global intra-UCI.BACKGROUND: To analyze the effects of implementation of a quality assurance cycle on rates of nosocomial infection (NI) in a level II intensive care unit (ICU.) METHOD: Prospective cohort study of two years on 568 patients divided in Group A (n = 281, cohort observational control group) and Group B (n = 287; experimental cohort group), which were implemented improvement measures (administration of oral sucralfate, surgical prophylaxis and aseptic measures). We compare the rates of follow aspects: ventilator-associated pneumonia (VAP), urethral catheter, central venous catheter and surgical wound infections, length and ICU mortality in both groups. RESULTS: After the implementation of quality improvement cycle by meeting quality criteria, we obtained a significant reduction in incidence rates of all infections under control. We found no differences in overall mortality ICU between the two groups, except in those who developed one NI. Patients with VAP showed a non significant reduction in mortality. The subgroup of patients receiving sucralfate showed a decrease in the frequency of NI and related mortality. However, the degree of improvement protocol violations was high (analyzed by Diagram’ s Pareto). CONCLUSIONS: The establishment of a surveillance system and implementation of improvement measures have reduced both the incidence and mortality of NI, but not the overall ICU mortality.
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Tembo, Chazanga. "An exploration of the factors which can contribute to nosocomial TB infection among healthcare workers in a public hospital in Free State province, South Africa". University of the Western Cape, 2019. http://hdl.handle.net/11394/6860.
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Magister Public Health - MPHIntroduction: Despite ongoing training provided to healthcare workers (HCWs) on tuberculosis infection prevention and control (TB IPC), at the health institution and implementation of TB IPC precautions, nosocomial TB infection within the hospital persist. The facility’s 2017 Occupational Infection & Needle Prick Report showed the proportions of new nosocomial TB infection cases among HCWs rose steadily from (5.6%) n=2 in 2013/14, (7.8%) n= 4 2015/16 and (9%) n=7, to (11%) n=11 cases in 2017/18. Study findings confirmed high new nosocomial TB infections among HCWs and a likelihood that these cases were usually under- reported meaning the problem of nosocomial TB infection among HCWs was actually bigger than understood at the hospital. In fact during the period of the mini-thesis study (July 2018) alone, three (3) cases of nosocomial TB infections were reported among HCWs (a porter and 2 nurses). Aim: The aim of this study was to explore the factors which are perceived to be contributing to nosocomial TB infection amongst doctors and nurses in a Level 2 referral hospital in the Free State Province of South Africa.
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Viani, Paula Regina Cazares. "Candida provenientes de infecção hospitalar isoladas de pacientes internados em hospital infantil do estado de São Paulo e avaliadas por marcadores fenotípicos". Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/42/42132/tde-31012008-113443/.
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Este estudo avaliou a incidência e distribuição de Candida spp. isoladas de casos de infecção hospitalar no período entre 2005 to 2007, em um hospital público infantil, em São Paulo. Brasil. As amostras foram isoladas de sangue, urina e outros materiais biológicos (36,6%, 37,12% e 26,52%, respectivamente). As análises micromorfológicas e bioquímicas revelaram que a distribuição por espécie foi 62,12% Candida albicans, 37,88% não-albicans. Uma maior incidência de amostras de C. albicans foi observada em casos de candidúria (53,62%) enquanto espécies não-albicans foram mais prevalentes em candidemia (71,43%) (p < 0.05). A respeito da produção enzimática, 68,94%, 47,73%, 65,91% e 66,67% foram positivas para proteínase, fosfolipase, lipase e hemolisina. Em relação aos antifúngicos, para Anfotericina B, 96,97% dos isolados mostraram e para 5- fluorcitosina foi observado o maior índice de resistência. Os fatores de risco identificados para candidemia hospitalar foram as doenças pré-existentes, terapia antibiótica de largo espectro e a presença de cateter venoso central.This study evaluated the incidence and distribution of Candida spp. identified from cases of nosocomial infection in the period from 2005 to 2007, in a public children\'s hospital in São Paulo, Brazil. The strains were isolated from the blood, urine and other biological specimens (36,6%, 37,12% and 26,52%, respectively). Micromorphological and biochemical analyses revealed that the overall distribution by species was 62,12% Candida albicans, 37,88% non-albicans. A higher incidence of C. albicans strains was observed in cases of candiduria (53,62%) while non-albicans species were more prevalent in cases of candidemia (71,43%) (p < 0.05). Concernig the production of enzymes, 68,94%, 47,73%, 65,91% and 66,67% presented positive proteinase, phospholipase, lipase and hemolin activity. In relation to antifungal for the Amphotericin B, 96,97% of isolates showed sensitivity and for 5- fluorocytosine was observed the biggest index of resistence. The Risk factors identified for nosocomial candidemia was underlying disease, therapy with broad-spectrum antibiotics and the presence of a central venous catheter.
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Almeida, Marcela Cristina Candido de. "Descrição bacteriológica de brinquedo utilizado em unidade de internação pediátrica /". Botucatu : [s.n.], 2010. http://hdl.handle.net/11449/96462.
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Orientador: Ione CorreaBanca: Ilda Godoy
Banca: Silvana Denofre Carvalho
Resumo: A hospitalização infantil acarreta fatores estressantes para a criança e sua família. É uma situação que pode trazer traumas emocionais à criança, exigindo dos profissionais da área da saúde além de tratamento terapêutico, o carinho e a atenção. Esses cuidados podem ser alcançados através do brinquedo, que proporciona à criança restabelecimento físico e emocional, contribuindo para sua recuperação. Todavia, há fatores que contribuem para que o uso do brinquedo se torne objeto de atenção especial quando se pensa em compartilhá-los e na falta de práticas de higiene para os mesmos em unidade de internação pediátrica, considerando que o brinquedo pode ser um veículo na transmissão de microrganismos. O objetivo deste estudo foi: descrever as condições bacteriológicas do brinquedo de plástico utilizados na unidade de internação pediátrica do Hospital Estadual Bauru (HEB). Utilizou-se swabs estéreis para a coleta das amostras das mãos e do brinquedo. A amostragem foi realizada utilizando swab estéril em três momentos: no primeiro momento realizou-se a coleta de swab das mãos das crianças e do brinquedo antes de iniciar a brincadeira, no segundo momento coletou-se a amostra imediatamente após a brincadeira e no terceiro momento houve a coleta de swab no brinquedo após o processo de higienização com álcool 70%. Após as coletas, as amostras foram encaminhadas para o laboratório de Análises Clínicas do HEB onde foi realizada a semeadura das amostras em meios de cultura Ágar MacConkey e Manitol. Após 24 horas, observava-se a presença ou não de crescimento bacteriano. Quando havia crescimento bacteriano, seguia-se para a identificação do achado e, quando não havia crescimento bacteriano, mantinha-se a amostra na estufa por mais 24 horas para determiná-la como presente ou ausente de crescimento bacteriano. Seguidamente realizou-se o ... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Children's hospitalization leads to stressful factors for patients and their relatives. It is a situation that can cause emotional trauma in children, thus requiring kindness and attention from health care professionals, in addition to therapeutic care. Such care can be achieved by means of toys, which help children recover physical and emotional wellness, thus contributing to their health recovery. Nevertheless, there are factors that contribute for toy use to become an object of attention when considering the fact that toys will be shared and the lack of toy hygiene practices at pediatric hospitalization units, since they may be a vehicle for microorganism transmission. The objective of this study was: to describe the bacteriological conditions of plastic toys used at the hospitalization unit of Bauru State Hospital (BSH). Sterile swabs were used to collect samples from hands and toys. Sampling was performed by using sterile swabs at three different moments: at the first moment, swab collection was performed from children's hand and from toys before playing began; at the second moment, a sample was collected immediately after playing; and, at the third moment, swab collection from the toy took place after hygienization using 79% alcohol. Following collection, the samples were sent to the Laboratory of Clinical Analysis of BSH, where they were seeded in Agar MacConkey and Manitol culture media. The presence or not of bacterial growth was observed after 24 hours. Whenever bacterial growth occurred, the findings were identified, and when no growth was observed, the sample was kept in a stove for another 24 hours in order to determine it as present or absent of bacterial growth. Next, an antibiogram and in-vivo sensitivity tests for hospital cleaning products were performed by the Agar-Gel diffusion method. Results showed that, in most findings, bacterial growth occurred on the ... (Complete abstract click electronic access below)
Mestre
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Garcia, Priscila do Nascimento. "Adesão dos profissionais de saúde às precauções de contato em unidade de terapia intensiva /". Botucatu : [s.n.], 2011. http://hdl.handle.net/11449/96447.
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Orientador: Ione CorrêaBanca: Maria Virgínia M. F. F. Alves
Banca: Silvana Denofre Carvalho
Resumo: As Infecções Relacionadas à Assistência à Saúde (IRAS) representam um dos principais entraves na qualidade da assistência médica, sendo considerada um grave problema de saúde pública. Dentre as complicações associadas às IRAS estão a morbi-mortalidade, o aumento do tempo de internação e da quantidade dos procedimentos invasivos, elevação do consumo de antimicrobianos e a disseminação de bactérias multirresistentes. As ações de controle das infecções voltadas às precauções e isolamentos possuem dois níveis, um composto pelas precauções padrão e o outro baseado nas vias de transmissão dos agentes, podendo ser classificados em três tipos: precauções respiratórias para transmissão aérea e para gotículas e em precauções para transmissão por contato. O objetivo deste estudo foi avaliar o uso das precauções de contato pelos profissionais de saúde de uma unidade de terapia intensiva. Trata-se de um estudo descritivoexploratório, composto por duas etapas, sendo a primeira correspondente à entrevista individual, na qual foram levantados o perfil demográfico, as doenças que necessitam das precauções de contato, as medidas que devem ser utilizadas e as dificuldades na assistência aos pacientes sob esta precaução. Na segunda etapa, os participantes foram observados durante três procedimentos assistenciais a pacientes em precaução de contato. As respostas da entrevista foram transcritas para a planilha do software Microsoft Office Excel, recebendo caracterização em adequada, parcialmente adequada e inadequada, segundo a categoria de acertos e erros. A etapa observacional foi conceituada como adequada e inadequada, considerando-se adequada a realização de 75% ou mais dos itens avaliados. Participaram desta casuística 31 profissionais de saúde da UTI, representando 88,6% do número... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Infections Related to Healthcare (IRH) represent a major constraint on medical care quality, being considered a severe public health problem. Among the complications associated with IRH, are morbidity and mortality, increased hospital staying length and the number of invasive procedures, increased consumption of antimicrobials and the dissemination of multiresistant bacteria. The actions aimed at infection control precautions and isolation have two levels, one composed of standard precautions and the other based on the agents transmission routes, which can be classified into three types: respiratory precautions for airborne transmission and droplets precautions and in precautions for transmission by contact. The objective of this study was to evaluate the use of contact precautions for healthcare professionals from an intensive care unit. It is a descriptive exploratory study, consisting of two phases, the first corresponding to individual interviews, which demographic profile was raised, the illnesses that require contact precautions, what measures should be used and the difficulties in patient care in this case. In the second stage, participants were observed for three health care procedures to patients in contact precautions. The interview responses were transcribed to the spreadsheet software Microsoft Office Excel, getting characterization in adequate, in partially adequate or in inadequate, according to the hits and misses category. The observational phase was defined as adequate and inadequate, considering adequate the performance of 75% or more, of the items evaluated. Thirty one health professionals from the ICU participated in our study, representing 88.6% of the total number of the unit staff. There was female... (Complete abstract click electronic access below)
Mestre
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Bredenkamp, Sonia Theresa. "A quantitative and qualitative assessment of dental aerosols within a dental clinical unit: An avenue for the transmission of resistant nosocomial infection". University of Western Cape, 2020. http://hdl.handle.net/11394/8164.
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Magister Scientiae (Medical Bioscience) - MSc(MBS)Introduction: Nosocomial infections are infections that occur 48 hours after receiving care for an unrelated condition in a clinic or a hospital environment, many of which are resistant to at least one of the drugs most commonly used to treat them. The dental clinical settings are reservoirs for the transmission of microbes through aerosols produced by routine dental procedures.
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Rueda, Jacqueline Oliveira. "Descrição dos episódios de candidemia de origem nosocomial no Hospital Universitário Cassiano Antônio de Moraes". Universidade Federal do Espírito Santo, 2006. http://repositorio.ufes.br/handle/10/5881.
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Previous issue date: 2006-09-04Este trabalho foi um estudo descritivo, que descreveu os episódios de candidemia nosocomial ocorridos no Hospital Universitário Cassiano Antônio de Moraes (HUCAM), entre 1.º de março de 2003 e 28 de fevereiro de 2006. Seu objetivo foi definir as taxas de prevalência e mortalidade desses espisódios, identificar as espécies envolvidas e relacionar a freqüência dos fatores de risco entre adultos e recém-nascidos (RNs), bem como entre os episódios de candidemia por Candida albicans (CA) e por Candida não-albicans (CNA). A metodologia Incluiu os casos de forma consecutiva, à medida que foi detectada hemocultura positiva para esses fungos. A coleta de dados dos pacientes foi realizada com base no prontuário médico, por meio de formulário padronizado e analisados utilizando o programa Social Package Statistical Science e englobando 45 casos de candidemia, sendo dezenove casos (42%) em neonatos. Foi observado que a incidência de candidemia nosocomial no HUCAM foi de 2,0/10.000 pacientes-dia, 1,9/1.000 altas e 16/10.000 admissões, sendo maior nos pacientes internados em unidades de terapia intensiva. As espécies não-albicans predominaram e Candida parapsilosis foi mais incidente entre os RNs; os grupos de pacientes susceptíveis mais envolvidos foram aqueles com internação em torno de três semanas, com síndrome séptica aguda e em uso de antibióticos; a freqüência dos fatores de risco foi similar entre os adultos e os RNs, assim como entre os episódios devidos a CA e os devidos a CNA; maior utilização de nutrição parenteral total foi encontrada entre os RNs e de diálise, entre os adultos (p < 0,05); a taxa de mortalidade global foi de 44% entre os adultos e de 58% entre os RNs; e a taxa de mortalidade atribuída foi de 16% entre os adultos e 26% entre os RNs. Foi concluído que a incidência de candidemia no HUCAM foi alta e associada com substancial mortalidade.
This work was a descriptive study, which described the episodes of nosocomial candidemias occurring at Hospital Universitário Cassiano Antônio de Moraes (HUCAM), between March 1st, 2003 and February 28th, 2006. Its aim was to define the rates of prevalence and mortality of these epidsodes, to identify the species involved and to relate the frequency of the risk factors among adults and newborn (NBs), as well as the epidsodes among candidemias caused by Candida albicans (CA) and Candida non-albicans (CNA). The methodology included the cases in a consecutive way, as positive hemoculture was detected for these fungi. The date collection of patients was based on the medical records, through a standard form and it was analyzed using the Social Package Statistical Science program, including 45 cases of candidemias, being nineteen cases (42%) in NBs. It was observed that the incidence of nosocomial candidemia at HUCAM was 2.0/10.000 patient-day, 1.9/1.000 discharges and 16/10.000 admissions, being greater in patients interned in intensive therapy unity. the CNA predominated and C. parapsilosis was more incidente among the NBs; the group of susceptible more involved were those interned for 3 weeks with acute septical syndrome and in use of antibiotics; the frequency of risk factor was similar among the episodes due to CA and the ones due to CAN; greater utilization of total parenteral nutrition was found in the NBs and the dialysis, among the adults (p< 0,005); the total mortality rate was 44% among adults and 58% among the NBs. And the attributed mortality rate was 16 in adults and 26% in NBs. It was concluded that incidence of candidemias at HUCAM was high and associated with substantial mortality.
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Lißner, Mareike. "Epidemiologie nosokomialer Infektionen und die Abhängigkeit krankenhausassoziierter Komplikationen von der Personalbesetzung in der Neonatologie". Doctoral thesis, Universitätsbibliothek Leipzig, 2011. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-69074.
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Nosokomiale Infektionen bei Früh- und Neugeborenen stellen aufgrund ihrer hohen Inzidenz und Mortalität eine große Herausforderung für die moderne Versorgung dar. Außerdem sind sie Indikatoren für die Pflegequalität, wie auch Verletzungen und Gefäßschädigungen. In dieser retrospektiven Querschnittsstudie wurden die epidemiologische Situation nosokomialer Infektionen auf den neonatologischen Stationen der Universitätskinderklinik Leipzig für das Jahr 2006 beleuchtet, die Abhängigkeit der genannten Komplikationen von Plegepersonalqualifikation und –quantität untersucht, sowie die Stationsauslastung und Personalbesetzung mit deutschen Empfehlungen verglichen. Die Inzidenz systemischer Infektionen lag sowohl auf der neonatologischen Intensiv- als auch auf der Nachsorgestation unter dem deutschlandweiten Durchschnitt. Dagegen traten Lokalinfekte wie Windel-/ Mundsoor und Konjunktivitiden häufig auf. Das beobachtete Keimspektrum zeigte das aus der Literatur bekannte Bild, multiresistente Keime traten nicht auf. Bei der Untersuchung der Abhängigkeiten zeigte sich für die Intensivstation eine signifikante Häufung von Candidainfektionen bei geringerer Stationsauslastung und höherer Personalbesetzung, unabhängig von der Qualifikation des Personals. Auf der Nachsorgestation wurde eine vermehrte Zahl systemischer Infektionen bei höherem Anteil von Schwestern am Gesamtpersonal festgestellt. Beide Stationen waren gegenüber den Empfehlungen fast das ganze Jahr überbelegt und unterbesetzt.
Gründe für die gefundenen Abhängigkeiten wurden vermutet in Informationsverlust und Trittbrettfahrerproblemen in größeren Kollektiven und verstärkter minimal-handling-Pflege und verstärkter Hygiene-Compliance in Stresssituationen. Die geringe Inzidenz systemischer Infektionen spricht für eine sichere Pflege und ist demnach sehr positiv zu bewerten, trotzdem sollten die Hintergründe für das Auftreten der Lokalinfekte, auch wenn sie meist einen milden Verlauf zeigten, überprüft werden.
Eine Gesamtbeurteilung der Pflege ist anhand der gemachten Untersuchungen nicht möglich, da aufgrund der Retrospektive keinerlei Faktoren wie Belastungseinschätzung der Schwestern, Lerneinschätzung der Schüler oder Betreuungseinschätzung der Eltern einfließen konnten.
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Silva, Luciene Ribeiro da Costa. "Identificação, perfil fenotípico e disseminação clonal de cepas de Acinetobacter spp. em hospitais do estado do Rio de Janeiro". Universidade do Estado do Rio de Janeiro, 2010. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=4555.
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Espécies do gênero Acinetobacter são patógenos oportunistas que têm sido associados a várias infecções relacionadas à assistência em saúde acometendo principalmente, pacientes hospitalizados em centros de tratamento intensivo. A. baumannii , Acinetobacter genoespécie 3 e Acinetobacter genoespécie 13TU constituem o complexo A. baumannii e são consideradas as espécies de maior importância clínica. O objetivo deste trabalho foi identificar em nível de espécie, avaliar o perfil de resistência e analisar a diversidade genética de 102 amostras de Acinetobacter spp. isoladas de hemoculturas de pacientes internados em quatro hospitais do estado do Rio de Janeiro. Após a utilização de duas técnicas moleculares, 87 (85,3%) amostras foram identificadas como A. baumannii, sete (6,9%) como A. genoespécie 3, duas (1,9%) A. genoespécie 13TU e seis (5,9%) não foram identificadas em nível de espécie. A maioria das amostras de A. baumannii apresentou caráter multirresistente mostrando percentuais de resistência acima de 70% para ceftazidima, cefotaxima e ciprofloxacina. A resistência aos carbapenêmicos variou de 59% a 91%. Foi encontrada uma grande variedade de antibiotipos entre as amostras de A. baumannii, sendo prevalente dois multirresistentes. Um deles, caracterizado pela sensibilidade apenas aos aminoglicosídeos, ocorreu em 20,7% das amostras e o outro observado em 14,9% das amostras , foi caracterizado pela resistência a todos os antimicrobianos testados. Através da PCR, foi observado que 77% das amostras de A. baumannii apresentaram produto de amplificação compatível com gene blaOXA-23-like e destas, 64 mostraram-se resistentes tanto a imipenem quanto a meropenem. Em contrapartida, todas as amostras de A. baumannii OXA-23 negativas mostraram-se sensíveis aos carbapenens. Em relação às amostras de A. genoespécie 3 e 13TU, foram observados baixos percentuais de resistência frente aos antimicrobianos testados e apenas uma amostra de Acinetobacter genoespécie 3 apresentou produto de amplificação compatível com gene blaOXA-23-like, sendo esta sensível aos carbapenens. Não foram detectados os genes blaOXA-40-like e blaOXA-58-like nas 102 amostras de Acinetobacter spp.. A análise do polimorfismo genético das amostras de A. baumannii por PFGE mostrou a presença de 35 clones distribuídos entre os hospitais. Um clone (designado A), presente em 32 amostras (36,9%), foi encontrado nos quatro hospitais, sendo prevalente em três. Em 93,8% das amostras do clone A foi detectado o gene blaOXA-23-like. A disseminação de um clone de A. baumannii multirresistente produtor de OXA-23 entre os hospitais estudados evidencia a importância de medidas de controle de infecções mais eficazes, visando minimizar a morbidade e a mortalidade causadas por este importante patógeno. Além disso, como outras espécies também podem estar associadas a infecções, destacamos a importância da identificação correta das amostras em nível de espécie, visando o conhecimento da patogenicidade, do perfil de resistência e dados epidemiológicos des outras espécies, principalmente as pertencentes ao complexo A. baumanniiAcinetobacter species are opportunistic pathogens that have been associated with wide variety infections related to health care affects mainly patients hospitalized in intensive care units. A. baumannii and its phenotypically related species (Acinetobacter genoespécie 3 and genoespécie 13TU), together forming the A.baumannii complex and are considered species of greatestclinical importance. The objective of this study was to identify at the species level, to know the resistance profile and analyze the genetic diversity of 102 samples of Acinetobacter spp. isolated from blood cultures of patients admitted to four hospitals in the state of Rio de Janeiro. After using two molecular techniques, 87 (85.3%) were identified as A. baumannii, seven (6.9%) as A. genoespécie 3, two (1.9%) A. genoespécie 13TU and six (5.9%) were not identified at the species level. The most specimens of A. baumannii presented multidrug resistance, showing resistance rates above 70% for ceftazidime, cefotaxime and ciprofloxacin. The carbapenem resistance ranged from 59% to 91%. There was a wide variety of antibiotype between samples of A. baumannii, with two prevalent multiresistant antibiotypes. One, characterized by sensitivity only to aminoglycosides occurred in 20.7% of the samples and the other (14.9% of the samples) characterized by resistance to all antimicrobials tested. By PCR, we observed that 77% of the samples of A. baumannii showed amplification product consistent with gene blaOXA-23-like and of these, 64 were resistant to both imipenem and meropenem. In contrast, all samples of A. baumannii OXA-23 negative were sensitive to carbapenems. In samples of A. genoespécie 3 and 13TU were observed low percentages of resistance against the tested antimicrobials and only a sample of Acinetobacter genoespécie 3 showed amplification product consistent with blaOXA-23-like, which was sensitive to carbapenens. The genes blaOXA-40-like and blaOXA-58-like were not detected in 102 samples of Acinetobacter spp.. Analysis of genetic polymorphism of the samples of A. baumannii by PFGE showed the presence of 35 clones distributed among the hospitals. A clone (designated A), present in 32 samples (36.9%) was found in four hospitals. In 93.8% of the samples inclued clone A were detected the gene blaOXA-23-like. The spread of a clone multidrug-resistant A. baumannii producing the OXA-23 enzyme in the four hospitals showed the importance of infections control measures more effective, in order to minimize morbidity and mortality caused by this important pathogen. Moreover, as other species may also can be associated with infections, we showed the importance of correct identification of the samples at the species level, for the knowledge of the pathogenicity.The resistance profile and epidemiological study of species of Acinetobacter other than A. baumannii, especially those belonging to the Complex A. baumannii
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Larentis, Daniela Zilio. "Fatores de risco e prognóstico associados à diarreia por clostridium difficile em pacientes adultos hospitalizados". reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2014. http://hdl.handle.net/10183/117068.
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Introdução: Devido ao uso indiscriminado de antibióticos, infecção por Clostridium difficile (ICD) tem aumentado significativamente em frequência e severidade ao longo dos anos, acarretando em maior morbidade e mortalidade além de maiores custos hospitalares. Objetivo: O objetivo deste estudo é avaliar os fatores de risco e fatores associados à pior prognóstico por colite Clostridium difficile em pacientes adultos internados. Desenho do estudo: Estudo de caso-controle retrospectivo Métodos: Em um Hospital terciário, durante o período de 1° de janeiro de 2010 a 31 de julho de 2012, foram comparados 75 pacientes com colite por Clostridium difficile documentada com 75 controles correspondentes com diarreia de origem nosocomial devido a outras etiologias. Foram identificados pacientes com ICD aqueles cuja pesquisa de toxinas A ou B, exame imunoenzimático VIDAS®, foi positiva ou aqueles com exames negativos ou indeterminados para estas toxinas com colonoscopia compatível com colite por Clostridium difficile. Todas variáveis clínicas e microbiológicas com P <0,10 na análise univariada, foram incluídos na análise de regressão logística múltipla afim de avaliar potenciais fatores de risco e fatores de pior prognóstico associados a colite por C. difficile entre pacientes com diarréia internados. Na análise multivariada, variáveis independentes permaneceram se P < 0,05. Resultados: Uso prévio de antibióticos (OR, 13.3; 95% CI, 1.40-126.90), presença de distensão abdominal (OR, 3.85; 95% CI, 1.35-10.98) e leucócitos fecais (OR, 8.79; 95% CI, 1.41-54.61) diante a apresentação de diarreia foram de preditores de infecção por Clostridium difficile. Por outro lado, presença de anorexia esteve negativamente associado com ICD (OR, 0.15; 95% CI, 0.03-0.66). Em relação a análise multivariada, alimentação por sonda naso-entérica (SNE) mostrou-se o único fator independente associado a pior prognóstico, este avaliado como: pacientes admitos em unidade de terapia intensiva (UTI), mortalidade hospitalar e falência de tratamento (OR, 3.75; 95% CI, 1.24-11.29). Conclusão: Uso de antibiótico foi fator de risco para colite por Clostridium difficile observado neste estudo. O uso de suporte nutricional por SNE foi o único fator associado a pior prognóstico.Background: Due to the indiscriminate use of antibiotics, Clostridium difficile infections (CDI) is increasing in frequency and severity over the years, resulting in increased morbidity and mortality as well as higher hospital costs. Objective: The aim of this study was to evaluate factors associated with Clostridium difficile infection among adult patients with hospital-acquired diarrhea and factors associated with poor prognosis. Study design: Retrospective case-control study. Methods: In a terciary hospital, during the period of january 1° 2010 to 31 july 2012, were compared 75 patients with documented Clostridum difficile colitis with 75 matched controls with hospital-acquired diarrhea secondary to an etiology other than Clostridium difficile. Patients with colits were identified by a positive toxins A or B, an immunoenzymatic test VIDAS®, or by a negative or indeterminate test for these toxins with colonoscopy compatible with Clostridium difficile colitis. All clinical and microbiological variables with a P value <0.10 in the univariate analysis were included in the stepwise multiple logistic regression to identify potential factors associated with C. difficile etiology among patients with hospital-acquired diarrhea and factors associated with poor prognosis among those patients with documented C.difficile colitis. In the multivariate model, independent variables remained in the model if the P value was < 0.05. Results: Previous antibiotic treatment (OR, 13.3; 95% CI, 1.40-126.90), presence of abdominal distension (OR, 3.85; 95% CI, 1.35-10.98) and fecal leukocytes (OR, 8.79; 95% CI, 1.41-54.61) at the onset of diarrhea were predictors of CDI. On the other hand, presence of anorexia was negatively associated with C.difficile etiology (OR, 0.15; 95% CI, 0.03-0.66). Upon multivariate analysis, enteral tube feeding was the only factor independently associated with a composite endpoint which included in-hospital mortality, ICU admission and treatment failure (OR, 3.75; 95% CI, 1.24-11.29). Conclusion:.Previous antibiotic use was risk factor for clostridium difficile colits. In this study tube feeding was the only factor associated with poor prognosis.