Rozprawy doktorskie: „Healthcare resistance”

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Tumin, Rachel Ann. "Social and healthcare factors of methicillin-resistant Staphylococcus aureus resistance to targeted antibiotics". The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1311691184.

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Daiski, Isolde. "Bedside nurses and the restructuring of healthcare, identity, power and resistance". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/NQ63784.pdf.

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Garcia, Tanisha. "Associations Between Leadership Style and Employee Resistance to Change in a Healthcare Setting". ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2536.

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. Abstract Health reform is forcing healthcare administrators to make rapid changes. A tendency to resist change can present problems for these organizations, including the large, not-for-profit Catholic healthcare systems. In order to make positive contributions towards healthcare, it's important to recognize the nature of the organization's involvement to change. The transformational leadership style has been shown to be positively correlated with change however, the relationship among leadership styles, employees' behaviors, and motivation to change are still not well understood and require further study. Further, although Oreg's Resistance to Change (RTC) approach has been researched in direct patient care areas, RTC research in non-patient settings is lacking and necessary in delivering the full spectrum of patient care. This study focused on the relationship of transformational leadership to RTC and if the relationships leaders' have with subordinates' influence change. A customized survey that included the Multifactor Leadership Questionnaire, RTC, and Leader Member Exchange (LMX 7) was emailed to 500 random individuals of various ages and races from 3 non-patient areas. Thirty leaders and 133 raters responded. The regression analysis showed a strong correlation between transformational leadership and RTC. Additionally, each of the variables from the LMX 7 section of the survey showed associations indicating the relationship leaders develop with their subordinates and leader transformational scores were positive. This study may contribute to the awareness of RTC and utilizing transformational leadership style to move change in a positive direction for a healthcare setting.

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Samuelsson, Annika. "The faecal flora : a source of healthcare-associated infections and antibiotic resistance". Doctoral thesis, Linköpings universitet, Avdelningen för mikrobiologi och molekylär medicin, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-97709.

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Healthcare-associated infections (HAI) are important causes of mortality and morbidity, and antibiotic treatment is often necessary. Development and availability of new antibiotics are closely followed by development of resistance among microorganisms. During antibiotic therapy, a fraction of the antibiotic given is found in the gut. The human gut is an important reservoir of bacteria. Microorganisms residing or passing the gut is referred to as the gut flora or microbiota. The results of this thesis showed spread of Enterococcus spp between patients on a general intensive care unit, causing septicaemia. After improved hygiene, reorganisation of rooms and thorough cleaning of the unit, together with revision of antibiotic strategy, the incidence of septicaemia with Enterococcus spp fell. Investigation of patients treated for acute intra-abdominal infections showed a shift in the aerobic faecal flora from antibiotic-susceptible Enterobacteriaceae spp towards Enterococcus faecium, yeasts and species of Enterobacteriaceae more resistant to antibiotics, after antibiotic treatment and hospital care. Investigation of recurrent outbreaks of Serratia marcescens sepsis in patients admitted to a neonatal intensive care unit showed different clones with each outbreak. Multiple hygiene interventions and revision of antibiotic strategy subsequently obviated recurrent outbreaks of sepsis, but spread of S. marcescens was not reduced until compliance with basic hygiene guidelines remained stable above 80%. We also found that low gestational age at birth, ventilator treatment and central venous or umbilical catheters are independent risk factors for late onset sepsis. Investigation of the faecal microbiota in patients with acute appendicitis or diverticulitis revealed that disturbance of the faecal microbiota already existed on admission, with higher numbers of Enterobacteriaceae and less Bacteroides, Faecalibacterium, Ruminococcus and Prevotella prior to antibiotic treatment and hospitalisation, than the control population. After treatment and hospitalisation diversity increased significantly in the diverticulitis group, approaching the healthy controls in composition.

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CHEN, JOHAN. "Rationalisation within a healthcare context: Application of the concept Theory of Constraints within a minor healthcare department". Thesis, KTH, Industriell Management, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-199205.

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The demand for healthcare services is currently growing worldwide with an ever increasing pace.Healthcare institutions need to adapt to the changing demographics in order to satisfy the demand. Meanwhile, many hospitals and care units have limited economic means to find appropriate solutions. A concept from the manufacturing industry that is considered to fulfill these criteria’s is called Theory of Constraints (ToC). This concept is focusing on streamlining processes by coordinating the activities and ensuring an efficient stream the production flow. This study has investigated the ability of the concept to support medical and administration staff in the department’s overall objective to decrease overall lead time.The investigation has been realized by conducting a case study at one of the largest emergency hospitals in Stockholm, Sweden. The hospital is one of the leading hospitals within Swedish medicine and receives and treats over 300000 patients annually. The case design consisted of three methods all linked to qualitative data collection, the three methods consisted of interviews, observations and shadowing.The results suggest that the application of ToC revealed little resistance to change among the participants. The concept was able to identify and resolve minor constraints in the case setting; the department of obstetrics and gynecology and also display promising characteristics in terms of solving more complex and intricate constraints. ToC as a concept were able to identify constraints in a healthcare department with a simple yet apparent cause and effect linkage. Finally, the findings indicate that ToC complements the concept of working with Continuous Improvements (CI) within the healthcare.The conclusions from this study have implications both in a theoretical perspective and a practical perspective. The findings provide additional empirical data to a field that is currently dominated by theories. In a practical aspect, the results of this study provides hospitals insights of ToC, a potentially valuable tool to improve efficiency and decrease lead times while working long-term towards an approach with CI.
Det nuvarande behovet för sjukvård ökar med en allt snabbare takt världen över. Sjukhus och andravårdinstitutioner behöver anpassa sig och göra förändringar för att hantera de demografiska förändringar som sker. Samtidigt så har många sjukhus och vårdcentraler mycket begränsade resurser för att hitta lämpliga lösningar. Ett koncept från tillverkningsindustrin som betraktas som en lämplig lösning för denna situation är ett koncept som heter Theory of Constraints (ToC). Detta koncept fokuserar på att effektivisera processer genom att koordinera de aktiviteter som ingår i en process för att i sin tur säkerställa ett effektivt produktionsflöde. Denna studie har undersökt detta koncepts möjligheter att stödja medicinsk och administrativ personal i arbetet med att försöka minska ledtider i en vårdmiljö.Utredningen har genomförts praktiskt genom en fältstudie på ett av Stockholms största sjukhus. Sjukhuset är ett av de ledande inom svensk medicin och tar emot och behandlar uppemot 300 000 patienter årligen. Fältstudiens utformning bygger på tre metoder, intervjuer, skuggningar och observationer vilket alla är sammankopplade med kvalitativ datainsamling.Resultaten indikerar att tillämpandet av konceptet ToC har påvisat litet förändringsmotstånd av de som har deltagit i förändringsarbetet samt att konceptet har haft förmågan att identifiera och lösa mindre restriktioner inom sjukhusavdelningen för Obstetrik och Gynekologi. Detta har i huvudsak gjorts genom att kartlägga olika aktiviteter med en tydlig orsak och verkan samband. Utöver detta så har konceptet initialt påvisat intressanta framsteg för att eventuellt lösa mer komplexa restriktioner som begränsar produktionsflödet i en sjukhusmiljö. Vidare så framgår det att konceptet ToC i viss utsträckning kompletterar filosofin att arbeta med kontinuerliga förbättringar (Continuous Improvements/CI).Slutsatserna för denna studie har implikationer för både ett teoretiskt och praktiskt perspektiv. Utifrån ett teoretiskt perspektiv, så förser resultaten från studien med ytterligare empiriska data i ett område som för närvarande är uppbyggt av teori och litteratur. Utifrån en praktisk synvinkel ger resultaten för denna studie sjukhus och vårdinstitutioner värdefulla insikter om konceptet ToC, ett potentiellt värdefullt verktyg för att förbättra effektiviteten och minska ledtider samtidigt som det stödjer ett långsiktigt arbete med kontinuerliga förbättringar.

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New, Elizabeth. "RACISM, RESISTANCE, RESILIENCE: CHRONICALLY ILL AFRICAN AMERICAN WOMEN’S EXPERIENCES NAVIGATING A CHANGING HEALTHCARE SYSTEM". UKnowledge, 2018. https://uknowledge.uky.edu/anthro_etds/28.

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This medical anthropology dissertation is an intersectional study of the illness experiences of African-American women living with the chronic autoimmune syndrome systemic lupus erythematosus (SLE), commonly known as lupus. Research was conducted in Memphis, Tennessee from 2013 to 2015, with the aim of examining the healthcare resources available to working poor and working class women using public sector healthcare programs to meet their primary care needs. This project focuses on resources available through Tennessee’s privatized public sector healthcare system, TennCare, during the first phases of the Patient Protection and Affordable Care Act (ACA). A critical medical anthropological analysis is used to examine chronically ill women’s survival strategies regarding their daily health and well-being. The objectives of this research were to: 1) understand what factors contribute to poor women’s ability to access healthcare resources, 2) explore how shared illness experiences act as a form of community building, and 3) document how communities of color use illness narratives as a way to address institutionalized racism in the United States. The research areas included: the limits of biomedical objectivity; diagnostic timeline in relation to self-reported medical history; effects of the relationship between socio-economic circumstance and access to consistent healthcare resources, including primary and acute care, as well as access to pharmaceutical interventions; and the role of non-medical support networks, including personal support networks, illness specific support groups, and faith based organizations. Qualitative methods were used to collect data. Methods included: participant observation in support groups, personal homes, and faith based organizations, semi-structured group interviews, and open-ended individual interviews. Fifty-one women living with clinically diagnosed lupus or undiagnosed lupus-like symptoms participated in individual interviews. Additionally twenty-one healthcare workers, including social workers, Medicaid caseworkers, and clinic support staff were interviewed in order to contextualize current state and local health programs and proposed changes to federal and state healthcare policy.

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Foli, Matilda. "nalysing Change Resistance to an Information Systems-Supported Process in a South African Public Hospital". Master's thesis, Faculty of Commerce, 2019. http://hdl.handle.net/11427/31219.

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Introducing technological change to an organization’s normal processes can potentially bring about positive or negative results, depending mostly on the manner in which the change was facilitated and integrated into the organization. However, very little research has been done on information technology (IT) investment among hospitals, its effect on the personnel, as well as how it influences patient care and financial performance. Consequently, little is known about users’ resistance to new technologies and the precedents of technology rejection in healthcare. Therefore, this study seeks to fill the gap of understanding South African hospital staffs’ perceptions towards change, caused by introducing an information system into one of the hospital’s daily processes. Where resistance towards change is identified, the study aims to understand the reasons behind such resistance. Finally, it aims to find appropriate intervention strategies to deal with and minimize resistance. In doing so, the study seeks to contribute to the body of research regarding change resistance to information systems in public South African hospitals. By adopting a descriptive and exploratory interpretivist paradigm, in conjunction with an inductive approach, the study aims to get a better understanding of hospital staffs’ perceptions through shared meaning. The study adopted a case study research strategy, as it affords the researcher the opportunity to participate in the study, and as such contributes to the subjective interpretation of the findings. Data was collected using a mixed method approach, and was used to describe the difference between the current and proposed process. In addition, it was used to explore the reasons for change resistance to information system-supported change, and to explore methods of successfully introducing change to tertiary public hospitals in South Africa. Fourteen participants (7 medical interns and 7 ward clerks) who were directly involved in the process being studied, were interviewed. Two other participants (the head of the pharmacy and the patient flow manager), who were indirectly involved in the process, were interviewed, to verify the observed and mapped process. Interview data was analyzed qualitatively, firstly through coding techniques before using sentiment and thematic analysis. While the mapped process followed Business Process Modelling Notation conventions. In addition to a mapped proposed process, a change resistance conceptual model was developed from a conjunction of the findings and extensive review of literature. The conceptual model asserts that five main factors contribute to change resistance: unclearly defined duties; fear of job security and technology usage; years of service; resource availability and resource mismatch; as well as insufficient training resulting from the lack of a learning culture. These factors can be moderated by: the existing state of affairs referred to as status quo; management involvement; and communication. The conceptual model can be used to better understand the causes of change resistance, as well as how to minimize change resistance and successfully introduce change into a health organization. Change agents should aim to understand the status quo that exists in the organization and find ways of incorporating that into the change process. Furthermore, management should aim to involve and communicate with all affected stakeholders during a change process. This research has provided a better understanding of hospital staffs’ reactions to change, their reasons for resistance, and ways to minimize change resistance while successfully introducing change into a health organization.

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Lum, Elaine P. M. "Making decisions about antibiotic use in the Australian primary healthcare sector". Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/107540/1/Elaine_Lum_Thesis.pdf.

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Antibiotic use drives antibiotic resistance, a global issue with significant human health and economic burden. Australia’s antibiotic consumption is above the OECD average. However, it is unclear which factors are most important for driving antibiotic use in Australian primary healthcare. This research established the most important factors influencing general practitioners to prescribe antibiotics and consumers to use antibiotics. In addition, a model was developed — the Enabling Antibiotic Eupraxis (EABE) model — to explain the drivers of antibiotic use from three perspectives: general practitioners, community pharmacists and consumers. This evidence informs the implementation of Australia’s national antimicrobial resistance strategy.

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Bazile, Emmanuel Patrick. "Electronic Medical Records (EMR): An Empirical Testing of Factors Contributing to Healthcare Professionals’ Resistance to Use EMR Systems". NSUWorks, 2016. http://nsuworks.nova.edu/gscis_etd/964.

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The benefits of using electronic medical records (EMRs) have been well documented; however, despite numerous financial benefits and cost reductions being offered by the federal government, some healthcare professionals have been reluctant to implement EMR systems. In fact, prior research provides evidence of failed EMR implementations due to resistance on the part of physicians, nurses, and clinical administrators. In 2010, only 25% of office-based physicians have basic EMR systems and only 10% have fully functional systems. One of the hindrances believed to be responsible for the slow implementation rates of EMR systems is resistance from healthcare professionals not truly convinced that the system could be of substantive use to them. This study used quantitative methods to measure the relationships between six constructs, namely computer self-efficacy (CSE), perceived complexity (PC), attitude toward EMR (ATE), peer pressure (PP), anxiety (AXY), and resistance to use of technology (RES), are predominantly found in the literature with mixed results. Moreover, they may play a significant role in exposing the source of resistance that exists amongst American healthcare professionals when using Electronic Medical Records (EMR) Systems. This study also measured four covariates: age, role in healthcare, years in healthcare, gender, and years of computer use. This study used Structural Equation Modeling (SEM) and an analysis of covariance (ANCOVA) to address the research hypotheses proposed. The survey instrument was based on existing construct measures that have been previously validated in literature, however, not in a single model. Thus, construct validity and reliability was done with the help of subject matter experts (SMEs) using the Delphi method. Moreover, a pilot study of 20 participants was conducted before the full data collection was done, where some minor adjustments to the instrument were made. The analysis consisted of SEM using the R software and programming language. A Web-based survey instrument consisting of 45 items was used to assess the six constructs and demographics data. The data was collected from healthcare professionals across the United States. After data cleaning, 258 responses were found to be viable for further analysis. Resistance to EMR Systems amongst healthcare professionals was examined through the utilization of a quantitative methodology and a cross-sectional research measuring the self-report survey responses of medical professionals. The analysis found that the overall R2 after the SEM was performed, the model had an overall R2 of 0.78, which indicated that 78% variability in RES could be accounted by CSE, PC, ATE, PP, and AXY. The SEM analysis of AXY and RES illustrated a path that was highly significant (β= 0.87, p < .001), while the other constructs impact on RES were not significant. No covariates, besides years of computer use, were found to show any significance differences. This research study has numerous implications for practice and research. The identification of significant predictors of resistance can assist healthcare administrators and EMR system vendors to develop ways to improve the design of the system. This study results also help identify other aspects of EMR system implementation and use that will reduce resistance by healthcare professionals. From a research perspective, the identification of specific attitudinal, demographic, professional, or knowledge-related predictors of reference through the SEM and ANCOVA could provide future researchers with an indication of where to focus additional research attention in order to obtain more precise knowledge about the roots of physician resistance to using EMR systems.

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Costa, Diana Sofia Pereira Espadinha de Oliveira. "Update on the population structure of MRSA causing infection in a central hospital and in healthcare centers in Portugal". Master's thesis, Faculdade de Ciências Médicas. Universidade Nova de Lisboa, 2012. http://hdl.handle.net/10362/7101.

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RESUMO:Staphylococcus aureus é um dos principais agentes patogénicos humanos, sendo frequentemente associado a infecções nosocomiais e infecções na comunidade. A prevalência de S. aureus resistentes à meticilina (MRSA) em hospitais portugueses é uma das mais elevadas da Europa e tem sido caracterizada extensivamente; contrariamente, a prevalência e epidemiologia de MRSA na comunidade em Portugal não tem sido devidamente seguida. Com o objectivo de compreender as causas possíveis do aumento na frequência de MRSA num dos maiores hospitais centrais portugueses (HSM) ao longo de 17 anos, isolados de MRSA recolhidos em 1993 (n=54) e 2010 (n=180) de pus, sangue e urina foram analisados por PFGE, MLST, tipagem do spa e tipagem de SCCmec. Os resultados mostraram que ocorreu uma mudança global nos tipos clonais predominantes, onde o clone ST22-IVh substituiu os clones, ST239-IIIvar e ST247-I, representando mais de 70% da população actual. Além disso, entre 1993 e 2010 verificou-se um aumento na diversidade genética dos tipos clonais de MRSA. Para determinar a frequência e a natureza clonal de MRSA e S. aureus sensíveis à meticilina (MSSA) isolados de infecções de pele e tecidos moles (SSTI) em pessoas que frequentam centros de saúde em Portugal, 73 amostras foram recolhidas em nove centros de saúde (Rede Médicos Sentinela). Isolou-se um total de 40 S. aureus (55%), dos quais 17,5% eram MRSA. Os isolados de MRSA pertenciam aos clones ST22-IVh (n=4), ST5-IVc (n=2) e ST105-II (n=1), que foram descritos neste estudo como sendo clones de origem hospitalar. Os nossos resultados sugerem que o aumento da frequência de MRSA no HSM pode estar associado à emergência de um clone de MRSA com maior capacidade epidémica. Além disso, verificámos que a principal causa de SSTI em pessoas que frequentam centros de saúde em Portugal são MRSA de origem hospitalar e não MRSA associados à comunidade.------ABSTRACT: Staphylococcus aureus is one of the most important human pathogens, being a major cause of infections worldwide both in the hospital and in the community. In Portugal, the prevalence of methicillin resistant S. aureus (MRSA) in hospitals is one of the highest in Europe and has been characterized extensively; contrarily the prevalence and epidemiology of MRSA in the community has not been followed in a meaningful way. To understand the epidemiological events that could explain a steep increase in MRSA frequency in a major Portuguese central hospital (HSM) within a 17 year period, two MRSA collections recovered in 1993 (n=54) and 2010 (n=180) from pus, blood and urine were analyzed by PFGE, MLST, spa and SCCmec typing. The results showed that a major clonal shift occurred, wherein ST22-IVh clone has replaced the previous ST239-IIIvar and ST247-I clones and accounts for more than 70% of the present population. Moreover, an increase in genetic diversity of MRSA clonal types was observed between the two study periods. With the aim of determining the frequency and clonal nature of MRSA and methicillin-susceptible S. aureus (MSSA) causing skin and soft tissue infections (SSTI) in patients attending healthcare centers in Portugal, 73 samples were collected from nine healthcare centers (Medicos Sentinela Network). A total of 40 S. aureus were isolated, accounting for 55% of the SSTI, of which 17.5% were MRSA. MRSA isolates belonged to ST22-IVh (n=4), ST5-IVc (n=2) and ST105-II (n=1) that have also been described in the hospital in an equivalent period. Our results suggest that the increase in MRSA frequency in HSM may be associated to the emergence of a MRSA clone with higher epidemic potential. Moreover, we propose that the spillover of MRSA from the hospital rather than community-associated-MRSA was the main cause of SSTI in persons attending healthcare centers in Portugal.

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Mahal, Dawn. "Resistance to change in primary care : an exploration of the role of professional identity". Thesis, University of Stirling, 2017. http://hdl.handle.net/1893/27608.

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This thesis contributes to the academic knowledge in the field of professional identity and organisational change. This thesis also has a practical implication as the findings helped to shape an organisational change within the co-funders organisation. The research was guided by the wish to explore the extent to which professional identity affects the willingness of those within Primary healthcare Units to accept fundamental changes in their working practices. Specifically, the aim was to establish the relationship of professional identity to processes of change. As the owners of small businesses who contract their services to the Health Board, the opinions of General Practitioners (GPs) were deemed to be of particular interest. The study was undertaken using a mixed method design, based upon a Constructivist grounded theory methodology. This was chosen as the ideal vehicle to examine the complex nature of identity within healthcare professionals and how they viewed organisational changes. Research started with unstructured interviews (n-14) and the analysis of the data obtained was fed into a questionnaire (n-97). The questionnaire offered validation of the initial findings. The findings of the research showed that professional identity has a bearing on the willingness of professionals to accept changes to their working environment. The resistance demonstrated by Healthcare staff, and specifically, GPs, to organisational change could be linked to feeling a perceived threat to their professional identity. Therefore, to undertake a successful organisational change, change managers must recognise that identity is vitally important and can affect the success or failure of an organisational change. Consideration of how any change may be perceived by professionals, within an identity context, must be built into the organisational change programme and revisited regularly during the change programme.

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Harnesk, Gustav, i Zara Galzie. "Mobile Devices in the Public Healthcare Sector : Perceptions, Experiences and Expectations of Nursing Care Providers". Thesis, Linköpings universitet, Informatik, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-152242.

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There are high expectations regarding mobile technology and how it can be used to promote improvements in the quality and efficiency in healthcare. There appears to be a gap between the goals and strategy on the macro level and the micro level experiences of the usage of mobile devices among healthcare professionals. The purpose of this study is to examine the perceptions, experiences and expectations of nursing care providers at two wards with regards to the recently implemented mobile platform COSMIC Nova Ward and other related IT artefacts. Special emphasis has been on COSMIC Nova Ward Tablet, a part of COSMIC Nova Ward, facilitated in iPad MINIs. It is designed to act as a tool to facilitate the provision of care and has been introduced at both the wards during a pilot project. Even though the two wards are similar in both practice and structure, the pilot project resulted in failure at one of the wards and a relative success at the other. A comparative case study of the perceptions, experiences and expectations of the nursing personnel at the two wards was conducted in order to highlight the differences in the outcomes of the pilot project. By reflexively comparing these with theory, it was concluded that there are several factors other than adequacy of the IT system that determine the outcome of the implementation of a mobile platform in a clinical setting. These findings were then compared with existing legislation and policies, in order to identify potential discrepancies between the nursing personnel’s usage of IT with the regional and national goals and strategy. It was then determined that there needs to be a clear connection between the usage of IT and the goals and strategy within healthcare.

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Kristiansson, Charlotte. "Access to health care for children in Amazonian Peru focus on antibiotic use and resistance /". Stockholm : Karolinska institutet, 2009. http://diss.kib.ki.se/2009/978-91-7409-616-3/.

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Mohajeri, Kaveh. "THEORIZING WHEN USER REACTION TO IT IMPLEMENTATION IS NEITHER RESISTANCE NOR ACCEPTANCE, BUT CONSTRUCTIVE BEHAVIOR: A CASE STUDY OF HEALTHCARE IT IMPLEMENTATION". VCU Scholars Compass, 2014. http://scholarscompass.vcu.edu/etd/3830.

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The prevailing discourse of “resistance vs. acceptance” in IT implementation research mostly personalizes the issue as “users” versus IT implementers (e.g., managers, CIOs, CMIOs, etc.). This kind of discourse has created an IT-implementer-centric attitude among IS scholars and practitioners. The IT-implementer-centric attitude, while embraces “acceptance” as a desirable reaction almost unconditionally, frequently holds for minimizing or more conservatively suppressing “resistance” to IT implementation. In other words, the mainstream IT implementation research, almost completely, treats “users” as passive recipients whose choices, as they face pre-developed/pre-designed/pre-rolled-out technology being implemented, can only be defined on a spectrum from “acceptance” to “resistance.” The current research study, however, offers an alternative perspective that views the “resistance vs. acceptance” duality “from the other side,” i.e., from the perspective of the supposed “resistors” or “acceptors” themselves. Through a review of the literature, this study first identifies major drawbacks of the extant theories and models of IT implementation research. Next, drawing on an interpretive paradigm of research (more specifically, phenomenological sociology), this study investigates a real world case of healthcare IT implementation. The results of the aforementioned literature review and case investigation subsequently form the basis for the study’s proposed theoretical account, which provides an unprecedented understanding and explanation of how actors representing different stakeholder groups, among which people who are routinely called “users” are but one group, experience IT implementation as they live their everyday lives. The proposed theoretical account is lastly used as a guide for crafting both practical and research prescriptions with respect to managing IT-involved change occasions.

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Hamel, Michael Graham. "RESISTANCE TO MANDATED HEALTHCARE CHANGE: USING PSYCHOLOGICAL REACTANCE TO PREDICT RESPONSES TO THE PATIENT PROTECTION AND AFFORDABLE CARE ACT INSURANCE COVERAGE REQUIREMENT". OpenSIUC, 2015. https://opensiuc.lib.siu.edu/dissertations/1139.

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The Affordable Care Act (ACA), passed on March 23rd, 2010, contains widesweeping legislation aimed at reforming the current U.S. healthcare system. The ACA has been lauded by its proponents and deeply criticized by its opponents. The current paper included two experimental studies designed to test if the individual insurance mandate requirement is a specific source of the psychological and behavioral resistance displayed toward the ACA. In study 1 the individual insurance mandate requirement did not produce greater negative attitudes towards the ACA or the current Presidential administration and it did not predict attitudes towards the longevity of the ACA. Democrats were found to have significantly less negative attitudes towards the ACA and towards the longevity of the ACA and Democrats also reported a lower likelihood of the ACA being repealed in comparison to Independents, Republicans or Libertarians. In study 2, the non-significant individual insurance mandate findings from study 1, were replicated in study 2. However, Democrats again were found to have significantly less negative attitudes towards the ACA and towards the longevity of the ACA in comparison to Independents, Republicans and those with no political affiliation. Democrats also indicated that they were less likely to vote for a political candidate who supports the repeal of the ACA in comparison to Independents, Republicans and those with no political affiliation. Implications and future research directions are discussed.

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Conislla, Limaylla Dayanne. "Temperatura, umidade e infecções relacionadas à assistência à saúde um estudo ecológico prospectivo. /". Botucatu, 2019. http://hdl.handle.net/11449/180982.

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Orientador: Carlos Magno Castelo Branco Fortaleza
Resumo: Estudos anteriores do nosso grupo reforçaram a evidência recente e inesperada de sazonalidade e determinação meteorológica na incidência das Infecções Relacionadas à Assistência à Saúde (IRAS, anteriormente chamadas “Infecções Hospitalares”. No entanto, nenhuma pesquisa até o momento associou esses agravos à temperatura e umidade nos diversos setores de um hospital. Com o objetivo de preencher esse hiato no conhecimento sobre epidemiologia das IRAS, realizamos um estudo ecológico baseado na avaliação de temperatura e umidade em áreas assistenciais. Resumidamente, oito termo-higrômetros foram afixados em diferentes unidades do Hospital das Clínicas da Faculdade de Medicina de Botucatu, e dois outros foram utilizados de forma móvel para os demais setores de internação desse mesmo hospital. Os resultados obtidos serão comparados com: (a) dados informados por estação meteorológica no município de Botucatu; (b) indicadores de incidência de IRAS; (c) Indicadores de incidência de microrganismos multidroga-resistentes. O estudo teve duração de 12 meses. A análise estatística envolveu modelos multivariados de regressão de Poisson e Regressão Logística. Os resultados demonstraram que, apesar de haver diferença significativa, temperatura e umidade no interior do hospital (mesmo em áreas climatizadas) variam em associação estatisticamente significante com os parâmetros medidos em estação meteorológica. Apesar do pouco tempo de observação, foi possível constatar associação entre temperatu... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Previous studies by our group have reinforced recent and unexpected evidence of seasonality and meteorological determination in the incidence of Healthcare-Associated Infections (HAI’s, formerly called “Nosocomial infections.") However, no research to date has associated these conditions with temperature and humidity. In order to fill this gap in the knowledge on HAI epidemiology, we carried out an ecological study based on the evaluation of temperature and humidity in care areas. In summary, eight thermohygrometers were posted in different units of the teaching hospital of Botucatu Medical School (“Hospital das Clínicas da Faculdade de Medicina de Botucatu”). The results obtained would be compared with: (a) data reported by meteorological station in the city of Botucatu, (b) incidence of HAI; (c) incidence of multidrug-resistant microorganisms. The study lasted 12 months. Statistical analysis involved multivariate Poisson regression and logistic regression models. The results showed that, although there is a significant difference, temperature and humidity inside the hospital (even in climatized areas) vary in a statistically significant association with the parameters measured in meteorological station. Despite the short observation period, it was possible to verify the association between temperature and HAI (including multidrug-resistant microorganisms) in the Intensive Care Unit (ICU), wards for non-critically ill patients and Surgical Theater. Taken together, our findin... (Complete abstract click electronic access below)
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Jensen, Anette. "Sundhedspersonales opfattelser og håndtering af smitterisiko : et kvalitativt studie". Thesis, Nordic School of Public Health NHV, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-3070.

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Formål: Formålet med dette studie var at udforske og beskrive hvordan sundhedspersonale opfatter og håndterer risiko for smittespredning, både hos isolationspatienter og patienter, som ikke er isoleret. Desuden var formålet at afdække, om en eventuel særlig opfattelseaf smitterisiko hos isolationspatienter påvirker sundhedspersonalets opfattelse af betydningen af de generelle infektionshygiejniske forholdsregler. Metode:Studiet er et kvalitativt studie, hvor det empiriske materiale blev indsamlet i otte fokusgruppeinterviews, hvor deltagerne var sundhedspersonale.Som analysemetode blev anvendtsystematisk tekstkondensering. Den konceptuelle ramme omfatter antibiotikaresistens i et folkesundhedsperspektiv, en beskrivelseaf rammerne for infektionsforebyggelse i Danmark samt en teoretisk ramme bestående af risikobegrebet, sundhedspædagogik og et perspektiv på samarbejde. Resultater:Studiet viste, at sundhedspersonalet vurderede smitterisikoforskelligt, både ved isolationspatienterog ved ikke-isolerede patienter. De opfattede, at deres hygiejne ved isolations-patienter var bedre, fordi de tænkte sig bedre om og arbejdede mere struktureret. Samarbejde var en vigtig motivationsfaktor for arbejdet på isolationsstuer. Hos ikke-isolerede patienter opfattede sundhedspersonalet det som risikosituationer, når patienter delte stue og toilet. De oplevede selv brist i egen smitteafbrydelse og at patienters og pårørendes adfærd udgjorde en smitterisiko. Sundheds-personalet læste og forholdt sig forskelligt til infektionshygiejniske forholdsregler, hvilket kunne give anledning til forvirring og misforståelser. Det blev betragtet som en udfordring at skulle forholde sig til,at viden og praksis ændrede sig over tid og at ny udvikling skabte nye infektionshygiejniske udfordringer. Konklusion:Sundhedspersonale opfatter smitterisiko forskelligt, både i forhold til smitterisiko ved isolerede og ikke-isolerede patienter og arbejdet med at pleje og behandle isolationspatienter kunne være forbundet med stor angst for at sprede smitte. Forskelle i videns-og erfaringsgrundlag samt individuelle risikovurderinger ses som medvirkende årsager til,at sundhedspersonale opfatter og håndterer smitterisiko forskelligt
Aim:This study aimed to explore and describe how healthcare workers (HCWs) perceive and handle the risk of infection in isolated and non-isolated patients.The study also sought to determinewhetherany specialperceived risk of infection in isolated patients affects how HCWsperceive the importance of general infection control measures. Method:This was a qualitative study. Data was collected from eight HCW focus groups and analyzed using a systematic textcondensation method. The conceptual framework includes antibiotic resistance in a public health perspective, adescription of the context of infection controland prevention in Denmark, a theoretical framework consisting of the concept of risk, health education and a perspective on cooperation. Results: The study showed that HCWsassessed risk differently inisolated and in non-isolated patients. HCWs perceivedthat they prevented infection more effectively in isolated patients, due to greater attentiveness and a more structured approach.Cooperation was an important motivation in isolation rooms. HCWsperceived special risk situations among non-isolated patients who shared rooms and toilets. The HCWs experienced flaws in their own infection control measures andin the behaviour of patients and their relatives. HCWs read and interpreted infection control protocols differently leading to confusion and misunderstandings. It was a challenge keeping up the changing of knowledge and practice over time as well as new development caused new infection control challenges. Conclusion:HCWsperceive the risk of infection differently in isolated and non-isolated patients. Further, HCWs often associatethe work of caring for and treating isolated patients with fear of spreading infection. Differences in knowledge base, experience level and individualrisk assessments contribute to the explanation of differing perceptions and approaches to handle infection control

ISBN 978-91-86739-49-2

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Fix, Olsson Josefin, i Hanna Ågren. "Hälso- och sjukvårdspersonalens upplevelser av attvårda patienter med multiresistenta bakterier : En litteraturöversikt". Thesis, Högskolan Dalarna, Omvårdnad, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:du-27673.

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Bakgrund: Multiresistenta bakterier är ett globalt problem och ett hot mot folkhälsan. Smittförebyggande åtgärder som basala hygienrutiner är en central del i det preventiva arbetet mot multiresistenta bakterier. Patienter som är bärare av en multiresistent bakterie kan uppleva känslor av otrygghet och skam, därför är det av stor vikt att all hälso- och sjukvårdspersonal tillämpar en personcentrerad vård. Syfte: Att undersöka hälso- och sjukvårdspersonalens upplevelser av att vårda patienter med multiresistenta bakterier. Metod: Studien har genomförts som en litteraturöversikt baserad på 15 stycken artiklar. Artiklarna var av både kvalitativ, kvantitativ samt kombinerad kvalitativ och kvantitativ metod. Databaser som använts i sökningen är PubMed och CINAHL. Analysen resulterade i tre teman. Resultat: Resultatet presenteras under tre olika teman: Upplevelser av rädsla och osäkerhet, upplevd okunskap och behov av utbildning samt upplevelser av hinder för utförandet av infektions-preventiva åtgärder. Slutsats: Rädsla och osäkerhet hos vårdpersonalen framkom tydligt och ledde till brister i utförandet av omvårdnaden. Resultatet visade även en upplevd okunskap om multiresistenta bakterier och ett behov av utbildning efterfrågades. Kunskap genom utbildning skulle resultera i en större förståelse om multiresistenta bakterier och minska rädslan hos vårdpersonalen.
Background: Multiresistant bacteria is a global problem and a threat to public health. Infection prevention such as basic hygiene routines are a key part of preventive work against multiresistant bacteria. Patients who is a carrier of a multiresistant bacteria can experience feelings of insecurity and shame, therefore it is important that all healthcare professionals apply a person-centered care. Aim: To study the healthcare professionals' experience of caring for patients with multiresistant bacteria. Method: The study has been conducted as a literature review based on 15 articles. The articles were of both qualitative and quantitative method as well as mixed method with combined qualitative and quantitative method. Databases used in the search are PubMed and CINAHL. The analysis resulted in three themes. Result: The results are presented in three different themes: Experiences of fear and insecurity, experienced lack of knowledge and need for education and experiences of obstacles to the performance of infection prevention measures. Conclusion: Fear and insecurity in healthcare staff clearly emerged and led to shortcomings in the performance of nursing care. The result also showed an experienced ignorance of multiresistant bacteria and a need for education was requested. Knowledge through education would result in a greater understanding of multiresistant bacteria and reduce the fear among healthcare professionals ’.

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Nhambe, Lúcia Florêncio. "Caracterização de carbapenemases do tipo KPC em enterobactérias de origem clínica". Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/9/9136/tde-27052015-150406/.

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Atualmente, no Brasil, a produção de enzimas do tipo KPC constitui o principal mecanismo de resistência aos carbapenêmicos em Klebsiella pneumoniae, contribuindo para a endemicidade hospitalar da espécie. No presente estudo, foi caracterizada a produção de KPC em 38 enterobactérias que foram diferençadas entre os grupos CESP (enterobactérias com produção induzida da βlactamase AmpC, ex., Enterobacter spp., Serratia marcescens e Morganella morganii) e não CESP (ex., Klebsiella pneumoniae, Escherichia coli e Proteus mirabilis). pertencendo a isolados recuperados de pacientes colonizados e/ou apresentando infecção urinária, pneumonia ou bacteremia, em três centros médicos de três diferentes regiões do Brasil (Amazonas, Mato grosso, Minas Gerais), durante 2008-2013. Os isolados apresentaram resistência para cefalosporinas de amplo espectro (86,8 - 94,7%), cefoxitina (86,8%), ertapenem (89,4%), imipenem (89,4%), meropenem (84,2%), amicacina (86,8%), ciprof1oxacina (84,2%), tigeciclina (42,1 %, CIM50= 2 µg/ml), sulfametoxazol/trimetoprim (SXT, 60,5%) e gentamicina (57,8%). Entre bactérias do grupo CESP, os isolados de S. marcescens apresentaram sensibilidade para fosfomicina (CIM50= 8 µg/mL) e sulfametoxazol-trimetoprim (CIM50= 1/19 µg/mL). A produção de carbapenemase foi confirmada pelo teste de Hodge modificado e por inibição por acido fenil borônico em 76,31 e 73,68% dos isolados do grupo CESP e não CESP, respectivamente. A presença do gene blaKPC-2 foi confirmada em 78,9% dos isolados clinicos e variantes do gene blaCTX-M foram identificados em 57,89% das cepas. Cepas de S. marcescens e E. aerogenes clonalmente relacionadas por ERIC-PCR foram associadas a surtos de infecção nosocomial. Resultados do presente estudo confirmam que a produção de KPC no Brasil, ocorre em uma grande variedade de espécies de enterobactérias sendo frequentemente associada com a co-produção de ESBLs do tipo CTX-M, o que poderia favorecer a endemicidade com o subseqüente estabelecimento de surtos de infecção. Um dado relevante, foi à alta resistência a fosfomicina (66,66%) associada à presença do gene fosA2 em cepas de E. aerogenes e K. pneumoniae produtores de KPC-2.
Currently, in Brazil, the production of KPC-type enzymes is considered the main mechanism of carbapenem resistance in Klebsiella pneumoniae, which has contributed for the nosocomial endemicity of this specie. In this study, the KPC production was characterized in 38 Enterobacteriaceae isolates differenced among CESP (Enterobacteriaceae with inducible production of AmpC-type β-lactamase, i.e., Enterobacter spp., Serratia marcescens and Morganella morganii) and not CESP (Klebsiella pneumoniae, Escherichia coli e Proteus mirabilis) groups recovered from colonized patients and/or with urinary tract infection, pneumonia or bacteremia, in three medicai centers from different regions of Brazil (Amazonas, Mato Grosso, Minas Gerais) during 2011-2013. The isolates were resistant to broad-spectrum cephalosporins (86.8 - 94.7%), cefoxitin (86.8%), ertapenem (89.4%), imipenem (89.4%), meropenem (84.2%), amikacin (86.8%), ciprofloxacin (84.2%), tigecycline (42.1 %, MIC50 = 2 µg/mL), trimethoprim-sulfamethoxazole (SXT, 60.5%) and gentamicin (57.8%). S. Marcescens isolates exhibited additional susceptibility to fosfomycin (MIC50 = 8 µg/mL) and sulfamethoxazole-trimethoprim (MIC50 = 1/19 µg/mL). Carbapenemase production was confirmed by Hodge modified test and inhibition by phenyl boronic acid in 76.31 and 73.68% of CESP and no CESP isolates, respectively. In fact, the presence of the blaKPC-2 gene was confirmed in 78.9% of enterobacterial isolates, whereas blaCTX-M ESBL gene variants were identified in 57.89% of the strains. S. Marcescens and E. aerogenes isolates were clonally related by ERIC-PCR being associated with outbreaks of nosocomial infection. Results of this study confirm that the production of KPC in Brazil occurs in a variety of species of Enterobacteriacea producing CTX-M-rype ESBLs, favoring the endemicity and the establisbment of outbreaks. A relevant finding was the high resistance to fosfomycin (66.66%) associated with the presence of the fosA2 gene in KPC-2-producing E. aerogenes and K. pneumoniae strains.

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Nekkab, Narimane. "Spread of hospital-acquired infections and emerging multidrug resistant enterobacteriaceae in healthcare networks : assessment of the role of interfacility patient transfers on infection risks and control measures". Thesis, Paris, CNAM, 2018. http://www.theses.fr/2018CNAM1180/document.

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The spread of healthcare-associated infections (HAIs) and multi-drug resistance in healthcare networks is a major public health issue. Evaluating the role of inter-facility patient transfers that form the structure of these networks may provide insights on novel infection control measures. Identifying novel infection control strategies is especially important for multi-drug resistant pathogens such as Carbapenemase-producing Enterobacteriaceae (CPE) due to limited treatment options. The increasing use of inter-individual contact and inter-facility transfer network data in mathematical modelling of HAI spread has helped these models become more realistic; however, they remain limited to a few settings and pathogens. The main objectives of this thesis were two-fold: 1) to better understand the structure of the healthcare networks of France and their impact on HAI spread dynamics; and 2) to assess the role of transfers on the spread of CPE in France during the 2012 to 2015 period. The French healthcare networks are characterized by centralized patient flows towards hubs hospitals and a two-tier community clustering structure. We also found that networks of patients with HAIs form the same underlying structure as that of the general patient population. The number of CPE episodes have increased over time in France and projections estimate that the number of monthly episodes could continue to increase with seasonal peaks in October. The general patient network was used to show that, since 2012, patient transfers have played an increasingly important role over time in the spread of CPE in France. Multiple spreading events of CPE linked to patient transfers were also observed. Despite subtle differences in the flows of patients with an HAI and the general patient population, the general patient network may best inform novel infection control measures for pathogen spread. The structure of healthcare networks may help serve as a basis for novel infection control strategies to tackle HAIs in general but also CPE in particular. Key healthcare hubs in large metropoles and key patient flows connecting hospital communities at the local and regional level should be considered in the development of coordinated regional strategies to control pathogen spread in healthcare systems
La propagation des infections nosocomiales (IN), notamment liées aux bactéries multi-résistantes, au sein du réseau des hôpitaux, est un grand enjeu de santé publique. L’évaluation du rôle joué par les transferts inter-établissements des patients sur cette propagation pourrait permettre l’élaboration de nouvelles mesures de contrôle. L’identification de nouvelles mesures de contrôle est particulièrement importante pour les bactéries résistantes aux antibiotiques comme les entérobactéries productrices de carbapenemase (EPC) pour lesquelles les possibilités de traitement sont très limitées. L’utilisation des données de réseaux de contact inter-individus et de transferts inter-établissement dans la modélisation mathématique ont rendu ces modèles plus proches de la réalité. Toutefois, ces derniers restent limités à quelques milieux hospitaliers et quelques pathogènes. La thèse a eu pour objectifs de 1) mieux comprendre la structure des réseaux hospitaliers français et leur impact sur la propagation des IN ; et 2) évaluer le rôle des transferts sur la propagation des EPC.Les réseaux hospitaliers français sont caractérisés par des flux de patients vers des hubs et par deux niveaux de communautés des hôpitaux. La structure du réseau de transfert des patients présentant une IN n’est pas différente de celle du réseau général de transfert des patients. Au cours des dernières années, le nombre d’épisode d’EPC a augmenté en France et les prédictions prévoient une poursuite de cette augmentation, avec des pics de saisonnalité en octobre. Ce travail a également montré que, depuis 2012, les transferts de patients jouent avec les années un rôle de plus en plus important sur la diffusion des EPC en France. Des évènements de propagation multiple liée aux transferts sont également de plus en plus souvent observés.En conséquence, la structure du réseau des hôpitaux pourrait servir de base pour la proposition des nouvelles stratégies de contrôles des IN en général, et des EPC en particulier. Les hôpitaux très connectés des grandes métropoles et les flux des patients entre les communautés locale et régionale doivent être considérés pour le développement de mesures de contrôle coordonnées entre établissements de santé

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Medeiros, Micheli. "Avaliação in vitro e in vivo de efeitos sinérgicos de antibacterianos para o tratamento de infecções por Acinetobacter baumannii multirresistentes produtoras de carbapenemases tipo OXA endêmicas no Brasil". Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/9/9136/tde-09042013-142547/.

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As infecções relacionadas à assistência à saúde (IRAS) são um grave problema de saúde pública cujo prognóstico tem sido desfavorecido pela emergência e endemicidade de bactérias multirresistentes (MRs). Neste cenário, seguindo uma tendência mundial, no Brasil, infecções por cepas de Acinetobacter baumannii MRs produtoras de carbapenemases do tipo OXA são atualmente consideradas uma emergência clínica e epidemiológica. Na falta de alternativas terapêuticas efetivas para infecções relacionadas, este trabalho objetivou avaliar efeitos sinérgicos (utilizando checkerboard e time-kill) decorrentes da combinação de 10 antimicrobianos de diferentes classes, contra 8 cepas MRs de A. baumannii, clonalmente não relacionadas, produtoras de carbapenemases do tipo OXA-23, OXA-72, OXA-58 e OXA-143, representativas de diferentes centros hospitalares do Brasil. Como resultado, a combinação amicacina/tigeciclina apresentou atividade sinérgica (S= ΣCIF ≤ 0,5) e parcialmente sinérgica (PS= ΣCIF ;0,5-0,75) contra 4 (50%) cepas produtoras de OXA-143 ou OXA-72, e 2 cepas (25%) produtoras de OXA-23, respectivamente. Por outro lado, a combinação polimixina B/imipenem apresentou atividade S e PS contra 3 (37,5%) isolados OXA-143, OXA-23 ou OXA-72 positivos, e 1 (12,5%) isolado produtor de OXA-58, respectivamente. Já, a combinação amicacina/ampicilina-sulbactam foi S contra 2 (25%) A. baumannii OXA-143 ou OXA-23 positivos, sendo PS contra dois (25%) A. baumannii OXA-58 ou OXA-143/23 positivos. De interesse, foi o efeito S da combinação polimixina B/vancomicina, contra 2 cepas (25%) produtoras de OXA-72 ou OXA-23. Por outro lado, a combinação ampicilina-sulbactam/rifampicina apresentou atividade PS contra 6 (75%) cepas produtoras das variantes OXA-23, OXA-143, OXA-72 ou OXA-58. Da mesma forma, rifampicina combinada com polimixina B foi sinérgica para uma cepa OXA-23 (12,5%) e PS para 5/8 (62,5%) cepas produtoras de OXA-72, OXA-58, OXA-23/-OXA143 ou OXA-143. O efeito sinérgico da combinação polimixina B/imipenem foi confirmado, in vivo, no modelo murino de infecção, tanto por avaliação histopatológica como por redução das UFC/g pulmão ou baço (p ≤ 0,05). Finalmente, foi avaliada a atividade, in vitro, do lípide catiônico brometo de dioctadecildimetilamônio (DDA), individualmente e em combinação com tigeciclina. DDA possui efeito bactericida, e potencializou sinergicamente a tigeciclina contra 2 (25%) cepas OXA-143 ou OXA-23 positivas. A atividade do DDA, assim como a atividade da sua combinação com tigeciclina foram efetivas já na segunda hora de interação, como avaliado pelas curvas de morte. Em resumo, o efeito sinérgico decorrente do uso combinado de amicacina, tigeciclina, polimixina B, imipenem, rifampicina ou ampicilina/sulbactam, pode constituir uma alternativa terapêutica para o tratamento de infecções produzidas por cepas de A. baumannii MRs produtoras de oxacilinases, sendo que nanofragmentos catiônicos de bicamada do lipídeo sintético de DDA tem potencial para consolidar um produto de aplicação clínica.
Healthcare-associated infections (HAIs) are a serious public health issue, which have been related with an unfavorable prognosis due to the emergence and endemicity of multidrug-resistant (MDR) bacteria. In this scenario, following a worldwide trend, in Brazil, infections produced by MDR OXA-type carbapenemase-producing Acinetobacter baumannii are currently considered a clinical and epidemiological urgency. In the absence of effective therapeutic alternatives for related infections, this study aimed to evaluate synergistic effects (by using time-kill and checkerboard assays) achieved by the combination of 10 different classes of antimicrobial against 8 strains of MDR, clonally unrelated, A. baumannii strains producing OXA-23, OXA-72, OXA-58 and OXA-143 carbapenemases, being representatives of different medical centers in Brazil. As a result, the combination of amikacin / tigecycline showed synergistic (S = ΣFIC ≤ 0.5) and partially synergistic (PS = 0.5 to 0.75 ΣFIC) activity against 4 (50%) OXA-72 or OXA-143 producing A. baumannii strains, and two strains (25%) producing OXA-23, respectively. Moreover, the combination of polymyxin B / imipenem showed S and PS activity against 3 (37.5%) OXA-143, OXA-23 and OXA-72 positive isolates, and 1 (12.5%) OXA-58 producer, respectively. On the other hand, the combination amikacin / ampicillin-sulbactam was S against 2 (25%) OXA-143 and OXA-23 positive strains, being PS against two (25%) OXA-58- and OXA-143/23-producing A. baumannii. Of interest was the synergistic effect achieved by polymyxin B plus vancomycin against two strains (25%) producing OXA-72 and OXA-23, respectively. Furthermore, the ampicilina-sulbactam / rifampicin combination displayed a PS activity against six (75%) strains producing OXA-23, OXA-143, OXA-72 or OXA-58-type enzymes. Likewise, rifampicin combined with polymyxin B was S against 1 (25%) OXA-23-positive A. baumannii being PS to 5/8 (62.5%) strains producing OXA-72, OXA-58, OXA-23/-OXA143 or OXA-143. The synergistic effect of the combination polymyxin B / imipenem was confirmed, in vivo, in the murine model of infection, by using both histopathological studies and bacterial clearance from the lungs and spleen (CFU/g, p≤ 0.05). Finally, we evaluated the in vitro activity of the cationic lipid dioctadecyldimethylammonium bromide (DDA), alone and in combination with tigecycline. DDA display a bactericidal effect, enhancing synergistically the activity of tigecycline against 2 (25%) OXA-143 and OXA-23 positive strains, respectively. DDA activity alone and in combination with tigecycline was effective on the second hour of interaction, as evaluated by time-kill assays. In summary, the synergistic effect resulting from the combined use of amikacin, tigecycline, polymyxin B, imipenem, rifampicin or ampicillin / sulbactam, could be an alternative therapy for the treatment of infections caused by MDR A. baumannii strains producing oxacilinases. On the other hand, cationic bilayer nanofragments of DDA has potential for consolidating a product for medical application.

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Vedrana, Petrić. "Ispitivanje primenjivosti međunarodnih smernica za lečenje infektivnih bolesti bakterijske etiologije". Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2016. http://www.cris.uns.ac.rs/record.jsf?recordId=100308&source=NDLTD&language=en.

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Uvod: U našoj zemlji nema smernica za lečenje bakterijskih infekcija u tercijarnim zdravstvenim ustanovama. Odabir antibakterijskih lekova je empirijski, što nije uvek u skladu sa preporučenom terapijom prema međunarodnim smernicama. Zbog toga su na Klinici za infektivne bolesti Kliničkog centra Vojvodine u januaru 2013. godine usvojeni međunarodni protokoli i primenjivani za lečenje infektivnih bolesti bakterijske etiologije. Cilj istraživanja bio je da se ispita i uporedi efikasnost lečenja pojedinih antibiotskih tretmana za lečenja infektivnih bolesti bakterijske etiologije prema kliničkom iskustvu ordinirajućeg lekara, prema međunarodno prihvaćenim protokolima i prema modifikovanim međunarodnim protokolima na osnovu stanja lokalne rezistencije. Materijal i metode: Ispitivanje je bilo retrospektivno-prospektivno u trajanju od tri godine od 01.01.2012-31.12.2014.godine, sprovedeno je na Klinici za infektivne bolesti Kliničkog centra Vojvodine. U studiju je uključeno 1147 pacijenata sa dijagnozom infektivne bolesti bakterijske etiologije (sepsa, infekcija urinarnog trakta, bakterijski meningitis, infekcije kože i mekih tkiva, bakterijski tonzilofaringitisi, pneumonija, febrilni gastroenteritis i spondilodiscitis). U retrospektivnom delu, tokom 2012. godine ustanovljena je efikasnost lečenja prema kliničkom iskustvu ordinirajućeg lekara, kod 459 pacijenata. U drugom delu ispitivanja koje je bilo prospektivno, tokom 2013. godine, kod 487 pacijenata, ustanovljena je efikasnost lečenja prema međunarodnim protokolima i upoređena sa lečenjem prema kliničkom iskustvu ordinirajućeg lekara. Tokom 2012. i 2013. godine, ustanovljena je struktura uzročnika i rezistencija na antimikrobne lekove, i prema stanju lokalne rezistencija modifikovani su međunarodni protkoli i primenjivani su tokom 2014. godine. U trećem delu ispitivanja koje je bilo prospektivno, tokom 2014. godine, kod 201 pacijenta ustanovljena je efikasnost lečenja prema modifikovanim međunarodnim protokolima i upoređena sa lečenjem prema usvojenim međunarodnim protokolima. Efikasnost lečenja praćena je na osnovu vrednosti telesne temperature i na osnovu laboratorijskih parametara (leukocita, C reaktivnog proteina, fibrinogena, sedimentacije eritrocita i prokalcitonina), prvog i sedmog dana hospitalizacije. Za upoređivanje efikasnosti terapijskih režima napravljen je sistem skorovanja telesne temperature i laboratorijskih parametara. Za statističku obradu podataka korišćen je programski paket Statistical Package for Social Sciences - SPSS 21. Statistički značajnim se smatraju vrednosti nivoa značajnosti p<0.05. Rezultati: Praćenjem rezistencija bakterija u našoj sredini modifikovani su međunarodni protokoli za lečenje infekcija izazvanih E.coli i S aureus-om. Rezistencija E. coli iz urinokultura tokom 2012. i 2013. godine na ciprofloksacin (koji je preporučen prema međunarodnim protokolima za lečenje infekcija urinarnog trakta) je bila u 2012. godini 38,8% i u 2013. godini 57,1%, a na levofloksacin 27,7% u 2012. godini i u 2013. godini 28,6%. Rezistencija S. aureus-a izolovanog iz brisa rana na cefazolin (koji je preporučen prema međunarodnim protokolima za lečenje infekcija kože i mekih tkiva) u prve dve godine ispitivanja bila je 25% a na klindamicin nije zabeležena rezistencija. Rezistencija S. aureus-a na cefazolin (koji je preporučen prema međunarodnim protokolima za lečenje bakterijskih tonzilofaringitisa) iz brisa grla bila je u 2012. godini 18,1%, u 2013. godini 14,2% a na klindamicin u ovom periodu nije zabeležena rezistencija. Tako da je preporuka u modifikovanom kliničkom protokolu za lečenje infekcija urinarnog trakta levofloksacin, za lečenje bakterijskih tonzilofaringitisa i lečenje infekcija kože i mekih tkiva izazvanih S aureus-om klindamicin.Poredeći ukupan skor kliničkih i laboratorijskih parametara, lečenje pacijenata prema usvojenim međunarodnim protokolima, statistički značajno je efikasnije u odnosu na lečenje prema kliničkom iskustvu lekara kod lečenja pacijenata sa infekcijom urinarnog trakta (p=0,034) i infekcijom kože i mekih tkiva (p=0,032). U lečenju ostalih ispitivanih bakterijskih infekcija prema kliničkom iskustvu lekara i usvojenim međunarodnim protokolima nema statički značajne razlike (p>0,05). Lečenje pacijenata sa infekcijom urinarnog trakta, prema modifikovanim međunarodnim protokolima je statistički značajno efikasnije u odnosu na efikasnost lečenja prema usvojenim međunarodnim protokolima (p=0,025) poredeći ukupan skor kliničkih i laboratorijskih parametara. Lečenje pacijenata sa tonzilofaringitisima i infekcijama kože i mekih tkiva prema modifikovanim međunarodnim protokolima podjednako je efikasno u odnosu na lečenje prema usvojenim međunarodnim protokolima (p=0,100) poredeći ukupan skor kliničkih i laboratorijskih parametara. Zaključak: Upoređivanjem dobijenih rezultata, omogućeno je određivanje najoptimalnijeg načina lečenja bolesti bakterijske etiologije, uvažavajući preporuke prema međunarodnim smernicama. Dobijeni rezultati ukazuju na to da je praćenjem lokalne strukture uzročnika i stanja lokalne rezistencije omogućeno određivanje optimalnijeg načina lečenja infekcija urinarnog trakta i infekcije kože i mekih tkiva, uvažavajući međunarodne preporuke i modifikaciju međunarodnih smernica prema stanju rezistencija bakterija na antimikrobne lekove u našoj sredini
Introduction:In our country,there are noguidelines for the treatment of bacterial infections in tertiary health institutions. The choice of antibiotic is empirical and it does not always comply with the recommended treatment according to international guidelines. For this reason, international protocols were adopted at the Clinic for infectious diseases of the Clinical Center of Vojvodinain January 2013. and implemented in therapy of infectious diseases caused by bacteria. The aim of the study was to compare different regimens and to evaluate their effectiveness in therapy of the bacterial infections: one based on the clinical experience of the prescribing physician, another based on international guidelines and the third, modified international protocoladapted to comply with the local antibacterial resistance. Material and methods: Thisretrospective-prospective study was conducted at the Clinic for Infectious Diseases of the Clinical Center of Vojvodina and it covered the period of three years, from 01.01.2012.-31.12.2014. 1,147 patients diagnosed with infectious diseases of bacterial etiology (sepsis, urinary tract infections, bacterial meningitis, skin and soft tissue infections, bacterial tonsillopharyngitis, pneumonia, febrile gastroenteritis and spondylodiscitis) were included in the study. In the first, retrospective part of the study, the efficacy of therapy based on the clinical experience of the prescribing physician was analyzed from medical records of 459 patients treated in 2012. In 2013, during the second, prospective part of the study, the efficacy of treatment according to the international guidelines was evaluated in 487 patients and the results were compared to the data obtained from the patients treated according to the clinical experience of the prescribing physician. The types of organism isolated in 2012/2013 were analyzed as well as their resistance to antimicrobials, the international protocols were subsequently modified according to the state of local resistance and implemented during 2014. In 2014, during the third, prospective part of the study, the efficacy of therapy according to modified international protocols was established in 201 patients, and the results were compared to the ones obtained by therapy according to original international protocols. The efficacy of the treatment was estimated by body temperature measurements and laboratory parameters (leukocytes, C-reactive protein, fibrinogen, erythrocyte sedimentation rate and procalcitonin) on day 1 and day 7 of hospitalization. The scoring system for body temperature and laboratory parameters was designed to compare therapeutic regimes efficiency. For statistical analysis, we used a software package Statistical Package for Social Sciences- SPSS 21. The values of p<0.05were considered statistically significant. Results.Monitoring of antibiotic resistance patterns in our community led to modification international protocols for treating infections caused by E. coli and S aureus. Resistance of E.coli to ciprofloxacin (recommended for the treatment of urinary tract infectionsby international protocols) from urine culture in 2012 and 2013 was 38.8% and 57.1% respectively, while resistance to levofloxacin in 2012 and 2013 was 27.7% and 28.6%, respectively. Resistance of S. aureus to cefazolin (recommended by international protocols for the treatment of the skin and soft tissue infections) from wound cultures in 2012 and 2013 was 25% while the resistance to clindamycin was not present. Resistance to cefazolin (recommended for the treatment of bacterial tonsillopharyngitisby international protocols) from throat culture in 2012 and 2013 was 18,1% and 14,2%, respectively,and the resistance to clindamycin was not present in the same period. Accordingly, clinical therapeutic protocols were modified, levofloxacin was recommended for urinary tract infections and clindamycin was recommended for treatment of tonsillopharyngitis and skin and soft tissues infections caused by S. aureus. Comparing the total score of clinical and laboratory parameters, the treatment of patients according to the adopted international protocols was statistically significantly more effective compared to the one based on clinical experience of physicianin urinary tract infections (p = 0.034) and skin and soft tissue infections(p = 0.032). No statically significant difference (p>0.05) was observed in efficiency of treatment options for other studied bacterial infections. In therapy of urinary tract infections, modified international protocols proved to be significantly more efficient than the adopted international protocols (p = 0.025) when the total score of clinical and laboratory parameters was compared. Comparing the total score of clinical and laboratory parameters, both adopted international protocols and modified international protocols proved to be equally efficient (p=0,100) in therapy of bacterial tonsillopharyngitis and skin and soft tissue infections. Conclusion:Comparison of the obtained results made possible to develop the optimal way of treating diseases of bacterial etiology, taking into account recommendations by international guidelines.The results suggest that the monitoring of the local structure of pathogens and their resistance pattern enabled the determination of optimal treatment options for urinary tract infections and skin and soft tissue infections, respecting international recommendations and modifying the international guidelines to match bacterial resistance pattern in our community.

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Muller, Allison. "Bon usage des antibiotiques : résultats d'actions dans différents types d'établissements de santé". Thesis, Bourgogne Franche-Comté, 2017. http://www.theses.fr/2017UBFCE021/document.

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La résistance bactérienne aux antibiotiques est un problème de santé publique mondial principalement lié à un mésusage des antibiotiques (surconsommation et prescription inadéquate).Pour lutter contre cette menace, des recommandations diffusées par les sociétés savantes et des plans d’action ont été mis en place. Même si ils sont nécessaires, ils ne sont pas suffisants pour assurer une amélioration significative de l’usage des antibiotiques. Un fort taux de non-conformité de la prescription antibiotique au regard des recommandations est observé dans les établissements de santé (ES). La mise en place de programmes volontaristes de bon usage antibiotique au sein de chaque ES s’avère essentiel pour améliorer l’usage des antibiotiques : une action sur les comportements des prescripteurs est indispensable, par le biais de différentes stratégies. Qu’elles soient persuasives ou restrictives, celles-ci ont toutes montré leur efficacité, sans entraîner d’effets cliniques néfastes pour les patients (pas d’augmentation de la mortalité ni de la durée de séjour), tout en permettant une réduction des coûts liés aux anti-infectieux.Par le biais de nos travaux, nous avons cherché à étudier le bon usage antibiotique en milieu hospitalier, à l’échelle de différents types d’ES (hôpital local, centre hospitalier régional universitaire, cohorte de 259 ES), et en évaluant l’impact de recommandations nationales ou de programmes et de guides locaux. Ces travaux nous ont permis de constater que la diffusion de recommandations nationales pouvait permettre de réduire les consommations de carbapénèmes, et qu’un programme mené dans un hôpital local pouvait être très efficace pour réduire les consommations de fluoroquinolones, mais également la résistance bactérienne à plus long terme. Des audits ciblés sur la prescription des aminosides et l’antibioprophylaxie chirurgicale ont permis de mettre en évidence des non-conformités récurrentes orientant sur des actions d’amélioration ciblées à mener.En conclusion, ce travail souligne l’importance des programmes de bon usage antibiotique au sein de chaque ES, quel que soit le type et le nombre de lits. En effet, ces programmes venant en appui aux recommandations ont démontré leur efficacité pour réduire les consommations et améliorer la qualité des prescriptions antibiotiques, grâce à leur impact positif sur les comportements des prescripteurs
Bacterial resistance to antibiotics is a worldwide public health issue which is mainly linked to antibiotic misuse (overconsumption and inappropriate prescription).To fight this threat, recommendations from learned societies and national action plans have been set up. Even if they are necessary, they are not sufficient to provide a significant improvement in the antibiotic use. A high rate of non-compliance with the recommendations is observed among healthcare facilities (HCFs). The setting up of proactive antimicrobial stewardship programs (ASP) among every HCF is essential to improve antibiotic use: an action on prescribers’ behavior is necessary, by using various strategies. These strategies, however persuasive or restrictive, have been shown to be effective, with no clinical negative effects for the patients (no increase in mortality and in length of stay), while reducing anti-infective costs.With this work, we aimed to study the appropriateness of antibiotic use in hospitals, at different HCFs levels (local hospital, university hospital, 259 French HCFs cohort), by assessing the impact of national recommendations or local ASP and guidelines. These studies showed that national recommendations could lead to a reduction in carbapenem consumptions, and that an ASP conducted in a local hospital could be very effective to reduce fluoroquinolones consumptions, and bacterial resistance at a longer term. Targeted audits on aminoglycosides prescription and on surgical antibioprophylaxis have permitted to highlight recurrent non-compliances, guiding improvement measures to set up.In conclusion, this work supports the weight of ASPs among each HCF, whatever type and size. Indeed, these ASPs, set up in support of the national recommendations, have demonstrated their effectiveness in reducing antibiotic consumptions and improving prescription appropriateness, by their positive impact on prescribers’ behaviors

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Vandendriessche, Stien. "Molecular epidemiology of livestock-associated staphylococcus aureus in animal and human populations in Belgium". Doctoral thesis, Universite Libre de Bruxelles, 2012. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209576.

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Staphylococcus aureus is a major opportunistic pathogen causing a wide range of infections in humans and animals. Methicillin-resistant S. aureus (MRSA) has traditionally been regarded as a strictly human problem, initially confined to the healthcare settings and later a matter of concern in the general community too. All this changed in 2005 with the isolation of a specific MRSA clone, assigned to Clonal Complex (CC)398, from pigs and pig farmers in the Netherlands. These findings triggered worldwide investigation, showing the presence of this livestock-associated (LA)-MRSA clone in a variety of farm animals and in persons in contact with affected animals. Furthermore, the capacity of LA-MRSA CC398 to cause infections in humans and animals has been well documented. Recently, MRSA with a divergent mecA-homologue gene variant has been discovered in bovines and humans. Together, these emerging MRSA strains from animal sources have raised new questions as to their origin and inter-host transmission, as well as raised global concern in both veterinary and human medicine about health risks posed by MRSA prevailing in livestock.

In the present work, we aimed to investigate the extent and molecular epidemiology of the LA-MRSA reservoir in animal and human populations, including on livestock farms and in acute-care hospitals in Belgium. As a secondary objective, the presence of methicillin susceptible S. aureus (MSSA) CC398, from which MRSA CC398 could locally emerge by acquisition of the Staphylococal Cassette Chromosome mec (SCCmec) element, was assessed. To this end, we undertook an extensive and systematic cross-sectional survey of S.aureus and MRSA carriage among humans and animals on pig, veal calf, dairy cattle, beef cattle, broiler and horticulture farms. A questionnaire, completed by all farm residents, was used to assess occupational risk factors for human MRSA CC398 carriage. Bacterial genetic characterisation was done by spa typing, SCCmec typing and multi-locus sequence typing (MLST). Antimicrobial susceptibility profiles were determined; the presence of resistance genes and toxin genes were determined by PCR. A second set of S. aureus clinical isolates from two national surveys organised in 2005 and 2008 were characterised using the same methods.

Carriage of MRSA CC398 was highly prevalent in animals and humans on pig and veal calf farms and to a significantly lesser extent on beef, dairy, broiler and horticulture farms (Chapter 5.1). Persons who work with pigs or veal calves on a daily basis are at significantly higher risk for MRSA CC398 carriage compared to farm-exposed persons who work with them less regularly or never. In accordance with the results from the present work as well as those from others, it appears important to assess the impact of interventions at farm-level that aim to reduce the MRSA carriage rate in animals, as this would also reduce the risk for MRSA carriage in farmers and relatives.

MRSA CC398 isolates, especially those from veal calf farms, were frequently multi-resistant and thereby represent a reservoir of antimicrobial resistance determinants that could be transferred to other, more human-adapted staphylococci or other micro-organisms (Chapter 5.1). Additionally, this multi-resistance phenotype should be considered when applying empiric treatment of human staphylococcal infections in livestock-exposed persons. Only very few major “human-associated” virulence factors were detected, indicating a limited virulence capacity of LA-MRSA CC398 isolates. MRSA strains with the mecA homologue mecC, which is difficult to detect using conventional diagnostic methods, were found in beef and dairy cattle, but not in humans.

MSSA CC398 strains from which MRSA CC398 might locally emerge were frequently detected in humans and animals on pig, veal and broiler farms, all of which are commonly known to be affected by MRSA CC398 (Chapter 5.2). Three porcine MSSA CC398-t011 isolates harbored remnant DNA of a composite SCCmec V(5C2&5)c element, from which the mec gene complex was lacking. These findings indicate that the strains were previously involved in SCCmec recombination events. Processes similar to the one described here likely contribute to the enormous diversity of SCCmec elements observed in staphylococci.

Although LA-MRSA CC398 strains were frequently detected in livestock and livestock-exposed persons, they only represented a minority (~1%) of the MRSA strains from hospitalised patients. This suggests that this specific MRSA clone has not yet spread among Belgian patients without livestock contact (Chapter 5.3). However, similar to what has been seen in other countries, we observed a recent emergence of severe infections, caused by a human-adapted subclone of MSSA CC398, in hospitalised patients without livestock contact (Chapter 5.4).

Once more has S. aureus proven its versatility: it has optimally adapted to the selective pressure exerted by intensive animal farming by acquisition of mobile genetic elements, such as resistance determinants. Clearly MRSA is no longer a strictly human problem. Working across the human and veterinary health sectors will be essential to tackle the dissemination and pathogenic evolution of MRSA in livestock.

Doctorat en Sciences biomédicales et pharmaceutiques
info:eu-repo/semantics/nonPublished

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Winbush, Deborah. "Correctional Nurses' Knowledge and Perceptions of Methicillin-Resistant Staphylococcus aureus". ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/366.

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Since 1999, Methicillin-resistant Staphylococcus aureus (MRSA) outbreaks have occurred in many correctional facilities. Even after the Federal Bureau of Prisons developed clinical practice guidelines on the management of MRSA within correctional facilities, the prevalence of MRSA decreased only insignificantly. Other researchers suggested infection control compliance was equally as important as developing clinical practice guidelines in reducing the incidence of MRSA. Several studies identified the healthcare professionals' nonadherence and inconsistencies to clinical practice guidelines as contributors to MRSA transmission. Accordingly, this project was designed to develop evidence-based recommendations for improving nurse professionals' adherence to MRSA practice guidelines in correctional settings. Using the health belief model as the theoretical framework, this project examined the nurse professionals' perceptions as well as their level of knowledge regarding MRSA by using an original instrument, Knowledge and Health Beliefs Regarding MRSA Questionnaire. The study employed a quantitative design with a purposeful sample of 36 participants using social media. Through descriptive statistical analysis, it was determined that MRSA training and education were the greatest barriers among the nurse professionals in taking MRSA preventive action (64%, n = 23). Based on the findings, assessing the educational needs of the nurse professionals must become the priority when designing infection control programs. This study contributes to social change by recognizing the potential health impact of MRSA and cautions that if public health officials do not control MRSA within correctional settings, such behavior can affect the transmission of MRSA both nationally and globally.

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Locke, Tiffany. "Methicillin-resistant Staphylococcus Aureus in Canadian Hospitals from 1995 to 2007: A Comparison of Adult and Pediatric Inpatients". Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/26110.

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The literature directly comparing the epidemiology of MRSA among adult and pediatric hospitalized patients is strikingly minimal. The objective of this thesis was to identify any differences between these two patient groups. The Canadian Nosocomial Infections Surveillance Program MRSA data (1995 to 2007: n=1,262 pediatric and 35,907 adult cases) were used to compare MRSA clinical and molecular characteristics and rates. Hospital characteristics were modeled using repeated measures Poisson regressions. The molecular and epidemiological characteristics of MRSA differed significantly between adults and children. Compared to children, MRSA in adults was more likely to be healthcare-associated, colonization, SCCmec type II, PVL negative, and resistant to most antibiotics. Rates of MRSA in Canada increased in both populations over time but were significantly higher in adults. The hospital characteristics associated with increased MRSA rates differed in adult and pediatric facilities. Implications for infection prevention and control strategies are discussed.

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Adebanjo, Omotayo David. "Knowledge, attittudes and practices of healthcare workers about prevention and control of multidrug-resistant tuberculosis at Botsabelo Hospital Maseru, Lesotho". Thesis, University of Limpopo ( Medunsa Campus), 2011. http://hdl.handle.net/10386/423.

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Thesis (MPH)--University of Limpopo, 2011.
Background: Tuberculosis is one of the major public health problems in Lesotho. With the occurrence of multi-drug resistant tuberculosis, little is known about the views of health care workers on this disease. The aim of this study was to investigate the knowledge, attitudes, and practices of healthcare professionals about prevention and control of MDR-TB at Botsabelo hospital, situated in Maseru, Lesotho. Methods: This study was conducted by means of a semi-structured, anonymous, and self-administered questionnaire that was sent to health care workers. Returned questionnaires were collected through designated boxes stationed at selected places at the study site from 23rd September to 13th October 2010. The investigator and his assistants collected the returned questionnaires on the 15th October 2010. Results: The results of this study indicate that, overall, less than half (47.3%) of respondents had good level of knowledge about MDR-TB; but the overwhelming majority of them held negative attitude towards patients with MDR-TB. Further analysis showed that the level of knowledge did not affect the attitude towards patients suffering from MDR-TB but it influenced their practices. Having good level of knowledge about MDR-TB was associated with good practices such as the use of protective masks and MDR-TB guidelines and involvement in educating patients about MDR-TB. Moreover, the findings of this study showed also that the attitude of respondents towards patients suffering from MDR-TB did not influence their practices. Conclusion: In conclusion, less than half of respondents had good level of knowledge about MDR-TB, but over 85.5% of them held negative attitude towards patients suffering from MDR-TB. Although the level of knowledge about MDR-TB was found not to have influenced the attitude of respondents towards patients suffering from MDR-TB; and that xi their attitude did not influence practices, good level of knowledge was positively associated with safer practices such as using protective masks, educating patients on MDR-TB, and referring to the MDR-TB guidelines manual. An educational remedial intervention is recommended.

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Kenny, Jacqueline M. "The characterisation of the antimicrobial activity of honey on clinical isolates of multi-drug resistant bacteria implicated in healthcare associated infections". Thesis, Kingston University, 2013. http://eprints.kingston.ac.uk/28188/.

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Bacterial resistance to antibiotics has presented increasing challenges in healthcare and the management of infection. This has resulted in alternative and traditional products that are used in other cultures being considered as an alternative to topical antibiotics. Honey, particularly Manuka honey is a product which has gained credibility as an antibacterial agent in a healthcare environment. The aim of this study was to investigate the antimicrobial capacity of syrups and honeys from different floral sources on antibiotic sensitive and resistant bacteria isolated from a clinical environment. The antimicrobial activity of seven Manuka honeys, seven honeys from other floral sources and two syrups were assayed against antibiotic sensitive and resistant isolates of 'Staphylococcus aureus', 'Enterococcus species', 'Escherichia coli' and 'Pseudomonas aeruginosa' using agar diffusion and microbroth methods to determine minimum inhibitory concentrations. These assays demonstrated both the superior antimicrobial activity of the Manuka products and highlighted differences in susceptibility between sensitive and resistant strains within organism groups. Clinical grade Manuka honeys were used to study the effect of bioload on antimicrobial efficacy on isolates from clinical polymicrobial wound populations. This demonstrated that it was the direct physical contact with the organism and not the microbial bioload which influences antimicrobial efficacy. Bacteria may form biofilms when they come into contact with an adherent surface. Organisms in biofilms have greater resistance to antimicrobials and are recognised clinically as a feature of chronically infected wounds. The ability of medical grade Manuka honey to remove established biofilms from a variety of surfaces was investigated. The results indicated potential activity but were inconsistent due to the fragility of biofilm adherence to artificial surfaces. To better emulate a clinical environment a wound model was designed using cooked meat and the polymicrobial bacterial populations from clinical wounds. The results of these experiments showed the Manuka honeys to have a bacteriostatic effect on the biofilms with no contamination of the surrounding honey medium. Chemical analysis of the honey products was performed using thin layer chromatography (TLC) and diffusion ordered spectroscopy nuclear magnetic resonance (DOSY NMR). TLC demonstrated the presence of antimicrobial fractions but insufficient material was yielded for further analysis and identification using NMR. Using DOSY NMR directly on the untreated honey products enabled characterisation of the products, identifying aromatic compounds in the Manuka products which are reputed to have antimicrobial activity. There did not appear to be any single constituent proportional to the antimicrobial UMF rating (Unique Manuka Factor) of the Manuka products where a high rating indicates a high level of antibacterial activity. The results suggest that it is a combination of compounds which confer the antimicrobial properties of the Manuka products. In conclusion this study demonstrated the superior antimicrobial activity of Manuka honey compared to syrups and honey from other floral sources and that this activity is likely due to a number of aromatic compounds present only in the Manuka products. Clinical grade Manuka honey appears to have bactericidal activity upon planktonic organisms with mainly bacteriostatic activity on biofilms grown on a wound model.

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Albertson, Justin Paul. "Development and validation of a prediction rule for methicillin-resistant Staphylococcus aureus recurrent infection among a veterans affairs healthcare system population". Thesis, University of Iowa, 2014. https://ir.uiowa.edu/etd/4561.

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Objective: Recurrent methicillin-resistant Staphylococcus aureus (MRSA) infections are a significant problem in the healthcare system. Our objective was to create a clinical prediction rule to identify Veterans at high-risk of recurrent MRSA infections. Methods: A retrospective cohort study of Veterans with MRSA bacteremia was performed using patient data from 2003 to 2011. Recurrent MRSA infection was defined as a positive blood culture between two days and 180 days after discharge from the index hospitalization. Severity of illness was measured at the time of admission using a modified APACHE score. Patients were randomly split into a development or validation cohort. Using the development cohort, variables significant in predicting recurrence on univariate analysis were input into a logistic regression model. The final model, c-statistics, and receiver operating characteristic curves were compared in each cohort. Results: Of 9,279 patients in the combined cohort, 1,127 (12.1%) had a recurrent MRSA infection within 180 days of the index infection. Using the development cohort, the risk factors identified and included in the logistic regression model were severity of illness, duration of bacteremia, distance to care, lack of MRSA-directed antibiotic therapy, renal failure, coagulopathy, cancer, and cardiac arrhythmia. The model had average discrimination (c-statistic, 0.657), with 68.9% sensitivity and 54.0% specificity. The validation cohort also had average discrimination (c-statistic, 0.625), with 66.8% sensitivity and 52.6% specificity. Conclusions: Our results identify important risk factors for MRSA recurrence and may help to guide clinicians in targeting high-risk patients for treatment and aggressive follow-up.

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Van, Balen Rubio Joany Christina. "Methicillin-resistant Staphylococcus aureus: ecology and molecular epidemiology of environmental contamination in veterinary and human healthcare settings during non-outbreak periods". The Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1429796647.

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Hudson, Lyndsey Olivia. "Methicillin-resistant Staphylococcus aureus : a novel approach to molecular detection and a US countywide study of strain diversity and distribution among healthcare facilities". Thesis, Imperial College London, 2012. http://hdl.handle.net/10044/1/11646.

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Methicillin-resistant Staphylococcus aureus (MRSA) is a global public health problem and is a major cause of morbidity and mortality worldwide, imposing serious economic costs on patients and hospitals. Prior to the mid-1990s, MRSA was largely a healthcare-associated pathogen, causing infection predominantly in people with frequent or recent contact with healthcare facilities (HA-MRSA). Since then, community-associated MRSA (CA-MRSA), which often causes infection among healthy children and young adults with no exposure to the healthcare setting, has become increasingly prevalent. Worryingly, there is evidence that CA-MRSA is penetrating the healthcare MRSA reservoir, and even replacing traditional HA-MRSA strains. This highlights the need to keep abreast of the changing epidemiology of MRSA in order to implement effective infection control strategies. To investigate the composition of the healthcare MRSA reservoir and ascertain the extent to which CAMRSA has penetrated this reservoir, a countywide, population-based cohort study of MRSA in hospital inpatients and nursing home residents was conducted in Orange County (OC), California, covering a total of 46 facilities. CA-MRSA was found to be fully mixed with HA-MRSA in the hospital setting. The predominant CA-MRSA clone in the US, USA300, was the most commonly isolated MRSA clone in OC hospitals. In OC nursing homes, HA-MRSA (specifically a variant of USA100 that is also very common in OC hospitals but has not been reported elsewhere) predominates, but USA300 made up just over a quarter of the isolates and was the second most frequently isolated clone. Both OC hospitals and nursing homes were dominated by the same three strains: USA300, USA100 and a variant of USA100. Not only are community-based infection control strategies needed to stem the influx of community associated strains, in particular USA300, into the hospital setting, but also strategies tailored to the complex problem of MRSA transmission and infection in nursing homes, to minimise the impact of the unique nursing home MRSA reservoir on overall regional MRSA burden. A key component of effective infection control strategies is prompt isolation of MRSA carriers, facilitated by rapid diagnostics. PCR-based methods of MRSA detection offer a much faster alternative to traditional culture techniques, but are expensive and often complex to operate. A novel nucleic acid amplification technique developed by my industrial sponsor, TwistDx Ltd, called recombinase polymerase amplification (RPA), has been incorporated into a probe based detection system called TwistAmp MRSA, and offers a simple and cheap alternative to current commercial PCR-based assays, amplifying MRSA to detectable levels within 20 minutes. I tested the assay with diverse collections of MRSA and discovered that 4% of isolates from a UK MRSA collection could not be detected by the assay. I subsequently developed RPA primers for their detection. Nonetheless, TwistAmp MRSA was able to detect most MRSA strains, and was comparable to current commercial assays in this respect. Despite a very high analytical sensitivity of approximately 20 CFU/swab, the clinical sensitivity of TwistAmp MRSA was lower than expected with respect to the current market leader, Xpert MRSA. I investigated lysis and filtration methods to improve the assay's clinical sensitivity, but found that such methods did not currently warrant inclusion in the TwistAmp MRSA protocol. While TwistAmp MRSA performance is in line with current assays, and is a faster, cheaper and simpler assay, a problem faced by all molecular methods of MRSA detection is the constant emergence of undetectable MRSA strains, necessitating continual assay evaluation and improvement where possible.

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Moldovan, Ioana Doina. "Network Analysis of Methicillin-Resistant Staphylococcus aureus Spread in a Large Tertiary Care Facility". Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/35700.

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Methicillin-resistant Staphylococcus aureus (MRSA) is an antibiotic-resistant bacterium of epidemiologic importance in Canadian healthcare facilities. The contact between MRSA colonized or infected patients with other patients, healthcare workers (HCWs) and/or the healthcare environment can result in MRSA transmission and healthcare-associated MRSA (HA-MRSA) infections in hospitals. These HA-MRSA infections are linked with increased length of hospital stay, economic burden, morbidity and mortality. Although infection prevention and control programs initiated in 2009 in Canada and other developed countries (e.g., UK, France, Belgium, Denmark, etc.) have been relatively successful in reducing the rate of HA-MRSA infections, they continue to pose a threat to patients, especially to the more vulnerable in long term care and geriatric institutions. Historically, MRSA was a problem mainly in hospital settings but after mid-1990s new strains of MRSA have been identified among people without healthcare-related risks and have been classified as community-associated MRSA (CA-MRSA). Furthermore, the distinction between HA-MRSA and CA-MRSA strains is gradually waning due to both the introduction of HA-MRSA in communities, and the emergence of CA-MRSA strains in hospitals. The purpose of this thesis was to explore the feasibility of constructing healthcare networks to evaluate the role of healthcare providers (e.g., physicians) and places (e.g., patient rooms) in the transmission of MRSA in a large tertiary care facility. Method of investigation: a secondary data case-control study, using individual characteristics and network structure measures, conducted at The Ottawa Hospital (TOH) between April 1st, 2013 and March 31th, 2014. Results: It was feasible to build social networks in a large tertiary care facility based on electronic medical records data. The networks' size (represented by the number of vertices and lines) increased during the outbreak period (period 1) compared to the pre-outbreak period (period 0) for both groups and at all three TOH campuses. The calculated median degree centrality showed significant increase in value for both study groups during period 1 compared to period 0 for two of the TOH campuses (Civic and General). There was no significant difference between the median degree centrality calculated for each study group at the Heart Institute when compared for the two reference periods. The median degree centrality of the MRSA case group for period 0 showed no significant difference when compared to the same measure determined for the control group for all three TOH campuses. However, the median degree centrality calculated for period 1 was significantly increased for the control group compared to the MRSA case group for two TOH campuses (Civic and General) but showed no significant difference between the two groups from the Heart Institute. In addition, there was a correlation between the two network measures (degree centrality and eigenvector centrality) calculated to determine the most influential person or place in the MRSA case group networks. However, there was no correlation between the two network’s measures calculated for physicians included in MRSA case group networks. Conclusions: It is feasible to use social network analysis as an epidemiologic analysis tool to characterize the MRSA transmission in a hospital setting. The network's visible changes between the groups and reference periods were reflected by the network measures and supported also by known hospital patient movements after the outbreak onset. Furthermore, we were able to identify potential source cases and places just prior of the outbreak start. Unfortunately, we were not able to show the role of healthcare workers in MRSA transmission in a hospital setting due to limitations in data collection and network measure chosen (eigenvector centrality). Further research is required to confirm these study findings.

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Coleman, Joshua B., Wesley Drew Gill, Allee C. Maxwell i Russell W. Brown. "Analysis of a Poly(ADP-ribose) Polymerase (PARP) Inhibitor in a Treatment-resistant Depression Model in the Rat". Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/asrf/2020/presentations/53.

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Over 16 million people in the US suffer from major depressive disorder (MDD) each year. Approximately 1/3rd of MDD patients (~5 million) obtain only partial remission or no benefit after trials with multiple drugs or drug combinations. Recently, Ordway and colleagues have reportedelevated levels of DNA oxidation and upregulated gene expression of the base excision repair enzyme poly(ADP-ribose) polymerase-1 (PARP1) in postmortem brain from donors who had MDD at the time of death, as compared to age-matched psychiatrically normal control donors. This study was designed to test whether an inhibitor of PARP, 3-aminobenzamide (3-AB), may be effective to alleviate depressive-like behaviors in a rodent model of treatment-resistant depression. Male rats were ip administered lipopolysaccharide (LPS;100ug/kg) daily for 28 days, and administered a chronic unpredictable stressor on each day. All rats were also administered saline, 3-AB (40 mg/kg), or the serotonin-reuptake inhibitor (SSRI) fluoxetine (trade name: Prozac; 10 mg/kg) on each day, approximately 30 min after LPS treatment. During the 28 day period of LPS treatment, animals were behaviorally tested 5 times on sucrose preference (a test of anhedonia). At the end of the 28 day period, rats were behaviorally tested on a test of acute stress, the Porsolt swim test. Results revealed that 3-AB alleviated anhedonia and the response to acute stress in the Porsolt swim test superior to the fluoxetine group, demonstrating the utility of a PARP inhibitor to alleviate depressive-like behavior in this model. In addition, fluoxetine produced a loss of weight which recovered over days, but not to control levels, and 3-AB did not produce this effect. This study shows that PARP inhibitors may be effective in treatment-resistant depression.

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Silva, Alexsandra Gomes Resende de Souza da. "Análise das notificações das infecções primárias de corrente sanguínea em unidades de terapia intensiva adulto de Goiânia-GO". Universidade Federal de Goiás, 2018. http://repositorio.bc.ufg.br/tede/handle/tede/8971.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
Introduction: Central-line associated bloodstream infections (CLABSIs) are common in Intensive care units (ICUs), leading to longer hospital stays, high hospital costs and death. As such, surveillance, prevention and control are indispensable.Objective: Analyze the epidemiological and microbiological profile of central-line associated bloodstream infections in adult ICUs in the municipality of Goiânia, Brazil. Method: Analytical ecological study conducted using secondary data from reports of all clinical and laboratory central-line associated bloodstream infections in adult ICUs in Goiânia, between 2012 and 2016. SPSS-17.0 and Stata software (version 14.0) were used. Data were expressed as temporal trend, descriptive statistics and percentiles. Data analysis considered a 95% confidence interval and significance level of p<0.05. Results: We analyzed 1988 healthcare-associated infection (HAI) notifications from 42 adult ICUs. The temporal trend of central-line associated bloodstream infections incidence density was stationary. The incidence density of laboratory central-line associated bloodstream infections varied from 3.32 to 4.34 infections per 1000 catheters/day. The rate of central venous catheter use in the period was 55.36%. In relation to percentile, increase was observed in the study period, particularly in 2016 in the 90th percentile. There was no statistical association between the variables analyzed. With respect to the microbiological and antimicrobial susceptibility profile, SCon and S. aureus showed 91.8% and 71.4% resistance to oxacillin, respectively, in 2016. K. pneumoniae and Acinectobacter spp. Were resistant to 3rd and 4th generation cephalosporins and carbapenems. Conclusion: It was concluded that the temporal trend of central-line associated bloodstream infections was stationary, and incidence density and percentiles increased over the years. The primary causative agents were SCon and K. pneumoniae, with broad spectrum antimicrobial resistance. Measures should be implemented to monitor health services and provide continuing education for health workers regarding the prevention and control of these infections.
Introdução: As infecções primárias de corrente sanguínea são frequentes, em Unidade de Terapia Intensiva (UTI) ocasionando prolongamento no tempo de internação, elevados custos hospitalares e óbitos. Mediante essa situação a vigilância, prevenção e controle são imprescindíveis. Objetivo: Analisar o perfil epidemiológico e microbiológico das infecções primárias de corrente sanguínea de UTI adulto do Município de Goiânia. Método: Estudo analítico ecológico, realizado a partir de dados secundários de notificações de infecções primárias de corrente sanguínea clínicas e laboratoriais das UTI adulto no Município de Goiânia-GO, no período de 2012-2016. Utilizou-se os Softwares SPSS-17.0 e Stata, versão 14.0. Os dados foram apresentados por meio da tendência temporal, estatística descritiva e percentis. Considerou-se IC: 95% e p<0,05.de significância de p<0,05. Resultados: Analisou-se 1988 fichas de notificações de IRAS dos referentes a 42 UTI adulto. A tendência temporal da densidade de incidência das infecções primárias de corrente sanguínea foi estacionária. A densidade de incidência das infecções primárias de corrente sanguínea laboratoriais variou de 3,32 a 4,34 infecções por 1000 cateteres-dia. A taxa de utilização de cateter venoso central no período foi de 55,36%. Em relação aos percentis houve elevação no período de estudo com destaque no ano de 2016 no percentil 90. Não houve associação estatística entre as variáveis analisadas. Quanto ao perfil microbiológico e de sensibilidade antimicrobiana identificou-se: SCon e S. aureus resistentes à oxacilina em 91,8% e 71,4% respectivamente em 2016. K. pneumoniae e Acinectobacter spp. resistentes às cefalosporinas de 3ª e 4ª gerações e aos carbapenêmicos. Conclusão: Conclui-se que a tendência temporal das infecções primárias de corrente sanguínea se manteve estacionária; a densidade de incidência e os percentis apresentaram elevação no decorrer dos anos. Os principais patógenos foram os SCon e K. pneumoniae com resistência a antimicrobianos de amplo espectro. Medidas de monitoramento dos serviços de saúde e de educação permanente dos trabalhadores da área da saúde, quanto a prevenção e controle dessas infecções, devem ser instituídas.

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Serko, Sawin, i Sofia Johansson. "Patienters upplevelser av vård och bemötande i samband med MRSA-smitta : en litteraturöversikt". Thesis, Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-6857.

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Meticillinresistent staphylococcus aureus (MRSA) är en bakterie som är resistent mot ett flertal antibiotika. Det är en bakterie som har ökat både i Sverige och i resten av världen. Tidigare var smittspridningen av MRSA vanligt förekommande på sjukhusen men har på senare tid även blivit allt mer förekommande utanför sjukvården. Att smittas av MRSA kan innebära svåra infektionssjukdomar som pneumoni, urinvägsinfektion och sepsis. För att minimera smittspridningen av MRSA flyttas patienter till isoleringssalar, vilket kan resulterat i lidande för patienten. Syfte är att belysa MRSA smittade patienters upplevelse av möten med hälso- och sjukvårdspersonal. Denna litteraturöversikt är baserad på tio vetenskapligt granskade artiklar, nio av artiklarna är kvalitativa och en är kvantitativ. De vetenskapliga artiklarna har noggrant granskats och därifrån har en sammanställning med teman till resultatet bildats. Databaserna CINAHL Complete, PubMed och Academic Search Complete har använts. Utifrån de tio artiklarna sammanställdes fyra teman som belyser patienters upplevelser. Dessa redovisas under i följande rubriker: Hälso- och sjukvård samt närståendes bemötande av patienter med MRSA, Psykologiskt trauma, Negativa och positiva upplevelser av isolering samt Kunskap om MRSA. Katie Erikssons teori med fokus på lidande diskuteras tillsammans med resultatet, utifrån patientens perspektiv. En av sjuksköterskornas centrala roll inom omvårdnadsarbetet är förebyggandet av smittspridning av MRSA, främst genom basala handhygienrutiner. Resultatet påvisade faktorer som kan påverka patienters syn på vården gällande MRSA. Där många patienter upplever att hälso- och sjukvårdspersonalen saknar kunskap angående smittspridning, infektioner och isoleringsrestriktioner.
Meticillin-resistant staphylococcus aureus (MRSA) is a bacteria that is resistant to a variety of antibiotics. This bacteria has increased both in Sweden and worldwide. Previously, the spread of MRSA was common in hospitals, but has recently become more common outside the healthcare sector. To be infected with MRSA often involves severe infectious such as pneumonia, urinary tract infection and sepsis. To minimize the spread of MRSA, patients are moved to isolation, which can result in suffering. To shed light on the experiences of MRSA-infected patients’ interactions with healthcare professionals. This literature review is based on ten scientifically reviewed articles, nine are qualitative and one is quantitative. The scientific articles have been carefully reviewed and from there have a summary with the themes to the result, been formed. Databases CINAHL Complete, PubMed and Academic Search Complete have been used. Based on the ten articles, four themes summarized the patient's experiences. These are listed under the following headings: Healthcare, and relatives response to patients with MRSA, Psychological trauma, Negative and positive experiences of insulation, and Knowledge of patients and healthcare professionals. Katie Eriksson's theory on suffering is discussed with the result, based on patient's perspective. One of the nurses' central role in nursing work is preventing contagious spread of MRSA, primarily through basic hand hygiene routines. Our results indicate that there are factors that may affect patients' views on the care of MRSA. Where many patients experience that healthcare professionals lack knowledge about spread of infection, infections and isolation restrictions.

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Lindberg, Maria. "Methicillin-resistant Staphylococcus aureus (MRSA) an Unclear and Untoward Issue : Patient-Professional Interactions, Experiences, Attitudes and Responsibility". Doctoral thesis, Uppsala universitet, Vårdvetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-168319.

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The overall aim of the present thesis was to investigate experiences of living with multidrug-resistant bacteria (MDRB), using methicillin-resistant Staphylococcus aureus (MRSA) colonization as an illustration, and to develop and validate a tool to describe healthcare personnel’s attitudes towards patients with MDRB. A further objective was to study MRSA-colonized persons’ and healthcare personnel’s experiences of patient-professional interactions and responsibilities for infection prevention. Four empirical studies were conducted. A total of 18 MRSA-colonized persons and 20 healthcare personnel were interviewed regarding their experiences, and a total of 726 RNs responded the MDRB Attitude Questionnaire. The findings revealed the difficulties associated with living with MRSA colonization, which was described as something uncertain, and as an indefinable threat that has to be managed in both everyday life and in contacts with healthcare. Interactions with healthcare personnel were described as unprofessional owing to personnel’s inappropriate behaviour and insufficient information provision. According to the personnel, achieving adequate patient-professional interactions required having knowledge and experiences of MRSA. They also experienced difficulties in providing tailored information to patients. The MRSA-colonized persons described their unwanted responsibility to inform healthcare personnel about the colonization, but also felt responsible for limiting the spread of infection to others. Furthermore, responsibility for infection control was regarded as shared between healthcare personnel and patients. The personnel described such responsibility as a natural part of their daily work, although it was not always easy to adhere to hygiene precautions. The MRSA-colonized persons felt that healthcare personnel have insufficient knowledge of the bacteria and of hygiene precautions. The MDRB Attitude Questionnaire showed that registered nurses do have knowledge deficiencies. The MDRB Attitude Questionnaire has adequate psychometric properties. In conclusion, MRSA colonization constitutes a psychological strain for carriers, and interactions with healthcare personnel resulted in feelings of stigmatization. The present thesis indicates that there is a need to improve healthcare personnel’s knowledge, behaviour and emotional response in relation to patients with MDRB, in order to ensure patient safety and address patients’ needs. The heads of department is responsible for such improvements, and the MDRB Attitude Questionnaire is useful in identifying areas in need for improvement.

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Abdusemed, Sabrin, i Jessika Karlsson-Rohmée. "Att vårda patienter med Meticillinresistens Staphylococcus Areus : En litteraturöversikt". Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-23591.

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Meticillinresistent Staphylococcus Aureus (MRSA) är en bakterie som är resistent mot olika typer av antibiotika. Spridningen av MRSA utgör ett hot mot modern medicin och möjligheten till en effektiv behandling och vård. Hälso- och sjukvårdspersonal bör arbeta förebyggande för att på så vis minska spridningen av MRSA, vilket är en viktig del av arbetet mot antibiotikaresistens. Hälso- och sjukvårdspersonalen är de som är i frontlinjen för att vårda patienter med MRSA, därmed fokuserar denna studie på deras upplevelser av att vårda dessa patienter. En litteraturöversikt genomfördes och resultatet visar att det finns kunskapsskillnader mellan hälso- och sjukvårdspersonal. Mängden kunskap påverkar även hälso- och sjukvårdspersonalens attityd av att vårda MRSA - smittade patienter. Det framkommer att hälso- och sjukvårdspersonalen är rädda för att bli smittade av MRSA, vilketupplevs skapa en barriär mellan hälso- och sjukvårdspersonal och patient. Denna rädsla kan prägla vården som ges vilket kan riskera att drabba patienterna negativt med en känsla av att vården distanseras som följd. Dessutom anses tidsbrist vara en faktor som gör det svårare att förebygga infektioner och kan leda till en bristande handhygien. Sammanfattningsvis medför en ökad kunskap om MRSA att hälso- och sjukvårdspersonalen känner sig säkrare och tryggare i sitt vårdande jämfört med de med lite kunskap, som ofta är rädda och kan överdriva användandet av handskar och desinfektionsmedel.
Methicillin Resistant Staphylococcus Aureus (MRSA) is a bacteria that is resistant to several forms of antibiotics. The spread of MRSA thus possess a threat to modern medicine and the possibility of effective treatment and care. To reduce the risk of MRSA spreading, healthcare professionals should work preventively, which is an important part of the work regarding antibiotic resistance. Due to the fact that healthcare professionals are those in the frontlines in the care of patients with MRSA, this study focuses on their experiences caring for said patients. Furthermore, a literature overview was used to perform this study. The result shows that there are differences in knowledge between the healthcare professionals. The amount of knowledge is also found to influence the attitude of healthcare professionals in caring for MRSA-infected patients. The results also showed that healthcare professionals were afraid of being infected by MRSA themselves. This fear could be reflected in their care which risked affecting the patients negatively with a feeling of isolation as a result. Furthermore, increased workload and lack of time was seen as a factor that made it more difficult to prevent infections and could lead to a poor execution of hand hygiene. In conclusion, Increased knowledge regarding MRSA made the healthcare workers more secure and comfortable in their care in comparison to those with little knowledge who were often scared and exaggerated their use of gloves and disinfection.

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Breton, Cecilia, i Nathalie Stark. "Speglas den egna attityden i bemötandet? : Multiresistenta bakterier (MRB); inställning, kunskap och attityd". Thesis, Ersta Sköndal högskola, Institutionen för vårdvetenskap, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-4910.

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Bakgrund: Kolonisering och spridning av multiresistenta bakterier (MRB) är ett ökande problem både i samhället och i sjukvården idag. MRB smittar genom kontaktsmitta, genom direkt personkontakt eller kontakt av kontaminerade ytor. Frågor rörande patientsäkerhet påverkar alla inom hälso- och sjukvårdens organisationer, men huvudansvaret att utveckla ledningssystem för att ett systematiskt kvalitetsarbete ska kunna bedrivas, ligger på vårdorganisationen- och vårdgivaren. Kunskapsbrist om MRB hos vårdpersonal samt brist på tydliga riktlinjer i vården i det kliniska arbetet kan påverka attityder till och bemötande av patienter med MRB. Syfte: Att belysa vårdorganisationers ansvar, sjuksköterskans kunskaper om MRB samt hens attityder till och bemötande av patienter med MRB- smitta. Metod: Studien gjordes som en litteraturöversikt där tio vetenskapliga artiklar analyserades för att framställa resultatet. Resultat: I resultatet framkom att vårdorganisationen och ledarskapet var av stor vikt för sjuksköterskans förutsättningar att ge god och säker vård till patienter med MRB. Kunskaperna om MRB var oftast låga. Attityder och bemötande visade sig i de flesta fall också påverkas av kunskapsnivån. Dålig kunskap och brist på erfarenhet av patienter med MRB kunde även relateras till ökade rädslor hos sjuksköterskor att smittas av MRB. Diskussion: Resultatet diskuterades mot Travelbee´s teori om mellanmänskliga relationer och konsensusbegreppet vårdande. Vårdorganisationens ansvar och kunskaper hos sjuksköterskor om MRB tycks vara de faktorer som mest påverkade bemötandet gentemot och attityderna till patienter med MRB.
Background: Colonization and transmission of MDRB is an increasing problem today, both in society and in health care settings. MDRB is most commonly transmitted through cross-contamination through personal contact and contact with contaminated surfaces. Patient safety affects everybody within health care settings. Main responsibility lies with healthcare organizations and caregivers, to develop management systems for systematic quality improvement. Knowledge deficiency of MDRB among health care personnel and lack of clear guidelines in health care settings may influence the attitudes and behaviour towards patients with MDRB. Aim: To illustrate healthcare organizations responsibilities, nurses’ knowledge of MDRB and nurses’ attitudes and behaviour towards patients with MDRB. Method: The study was conducted as a literature review and ten scientific papers were analysed to generate the results. Results: The results showed that healthcare organizations and leadership were of great importance for the nurses’ ability to provide good and safe care for patients with MDRB. Knowledge about MDRB was also proved to be low. Deficient knowledge and lack of experience of caring for patients with MDRB among nurses might also influence their own fears of contracting MDRB. Discussions: The results were discussed against Travelbee’s Intrapersonal relationship- theory and the concept of caring. Healthcare organizations responsibility and nurses’ knowledge of MDRB seemed to be the eminent factors that influenced both behaviour and attitudes towards patients with MDRB.

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Siripol, Samantha. "Health service delivery and health outcomes of at-risk populations". Master's thesis, Canberra, ACT : The Australian National University, 2018. http://hdl.handle.net/1885/154723.

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As required by the Master of Philosophy (Applied Epidemiology) program I completed a field placement in the Strategic Investment, Data and Evaluation Section in the Indigenous Health Division, Australian Government Department of Health. Following the introduction chapter (chapter 1), this thesis contains three projects, which aimed to: 1) explore the performance of health organisations providing social and emotional wellbeing (SEWB) services for Aboriginal and Torres Strait Islander peoples (chapter 2); 2) analyse the relationships between health organisations’ cultural safety policies and the uptake of Medicare Benefits Scheme (MBS) health assessments among Aboriginal and Torres Strait Islander clients (chapter 3); and 3) describe and the characteristics of inpatients who acquired vanA vancomycin-resistant enterococci and compare the characteristics of inpatients with vanA versus vanB sterile site infections at the John Hunter and Calvary Mater Newcastle hospitals in Newcastle, New South Wales (chapter 4). My first project was a national survey of SEWB service delivery in 2014-15 using a quantitative questionnaire, administrative data and qualitative case studies. Service delivery strengths included accessibility, capability, continuity, appropriateness, responsiveness and sustainability. Fifteen opportunities to strengthen SEWB service delivery were identified, including in the areas of: client access, perceptions and experiences of service delivery; strengthening the SEWB workforce; and facilities required to support service delivery. These opportunities represent potential approaches that could improve the SEWB of Aboriginal and Torres Strait Islander peoples. For my second project, I used logistic regression to model univariate relationships between seven cultural safety policies and low or high uptake of MBS health assessments in 2014-16 using existing administrative and service performance data. Data from 174 health organisations showed no associations between cultural safety policies and health assessment uptake, however this is likely due to study and data limitations. In my third project, I conducted two case series analyses. The first described numbers and proportions of 168 vanA and vanAB acquisitions in 2013-2015. It also examined potential contributing environmental exposures and other risk factors that might lead to infection or colonisation. The second case series used Wilcoxon rank-sum, Chi-squared or Fisher’s exact tests to compare morbidity and mortality outcomes between vanA and vanB for 42 inpatients with laboratory-confirmed sterile site infections in 2015. No specific environmental exposures or risk factors that likely contributed to acquisition, and no difference in morbidity and mortality outcomes between genotypes, were identified. This may suggest that vanA is endemic to the hospital environment, highlighting the importance of standard, enhanced and tailored infection prevention and control precautions. To meet the teaching requirements, I presented to my peers on logic models and confounding. Additional to the program requirements, I completed an internship in the Ebola Community Engagement Team at the World Health Organization, Geneva, Switzerland. Chapters 5 and 6, respectively, reflect on these experiences. I highly value the opportunities and the skills, experience and knowledge in epidemiology, public health research and practice I developed in the program. I applied my knowledge of logic models, skills in data analysis and interpretation, and knowledge of the importance of understanding and accommodating culture and belief systems when addressing public health issues in my paid employment in my field placement.

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Eendebak, Robert. "The potential relationships between hormone biomarkers and functional and health outcomes of ageing". Thesis, University of Manchester, 2017. https://www.research.manchester.ac.uk/portal/en/theses/the-potential-relationships-between-hormone-biomarkers-and-functional-and-health-outcomes-of-ageing(e28321cc-703c-44df-99b4-fb0d76f7f429).html.

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Although the female menopause has been extensively characterized as a well-defined symptomatic state of oestrogen deficiency, which responds relatively well to oestrogen replacement therapy, the symptomatic state of androgen deficiency in men is poorly defined and uncertainty exists whether it responds to testosterone replacement. It has been proposed that hypothalamic-pituitary-testicular (HPT)-axis function (responsible for the production of androgens) and regulation could be viewed as a âbarometerâ of health status in older men and that potential alterations in HPT-axis function and regulation reflect subclinical and clinical deficits in function and health, which may result in an aged phenotype of human health and disease in older men. The HPT-axis constitutes a well-defined, tractable, clinically-relevant, biological system, which may permit insight into the mechanisms underlying the expression of ageing-related phenotypes of human health and disease. By using a different lens â such as the genetic background; the compensatory responses within the HPT-axis; the syndromes of androgen deficiency; the ethnic background of an individual or the life course trajectory of function and health from conception into older age â to magnify potential dysregulation in the HPT-axis will it be possible to visualize and understand the phenotypic expression of human male ageing as a gradient of functional and health outcomes. This will allow for a better understanding of the physiological mechanics underlying symptomatic expression of dysregulation in the HPT-axis.

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41

Assab, Rania. "Modéliser la diffusion des infections nosocomiales : l'importance des données de réseaux au sein des établissements de soins". Thesis, Paris, CNAM, 2018. http://www.theses.fr/2018CNAM1199/document.

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Chaque année les infections nosocomiales touchent plus de 4 millions de patients en Europe, avec un impact important en termes de mortalité, de morbidité et de coût. Parmi ces infections, celles causées par des bactéries multi-résistantes aux antibiotiques (BMR) jouent un rôle majeur. La modélisation mathématique des épidémies est un outil essentiel qui permet de mieux comprendre la dynamique de diffusion des BMR et d’évaluer l’efficacité des mesures de prévention.L'objectif principal de ce projet est d'étudier la dynamique de propagation de BMR au sein d'un réseau d'hôpitaux, en prenant en compte différentes échelles : intra-service, inter-services et inter-hôpitaux. Il s'agit de mettre en place une recherche méthodologique basée sur la modélisation mathématique et informatique et validée par des données recueillies au sein du réseau de soins Paris Île de France Ouest (PIFO), afin de mieux comprendre le rôle joué par chaque hôpital dans l'émergence et la sélection de BMR, de quantifier le risque de leur dissémination (y compris dans la population générale), et d'identifier des mesures de contrôle efficaces. Ce travail s'appuiera sur des méthodes d'inférence statistiques, d'analyse de sensibilité et d'analyses d'incertitude
Each year nosocomial infections affect more than 4 million patients in Europe, with a significant impact in terms of mortality, morbidity and cost. Of these infections, those caused by multi-resistant bacteria (BMR) play a major role. Mathematical modeling of epidemics is an important tool to better understand the dynamics of dissemination of BMR and evaluate the effectiveness of prevention measures.The main objective of this project is to study the BMR propagation dynamics within a network of hospitals, taking into account different levels: intra-ward and inter-wards and inter-hospitals. This is to establish a research methodology based on mathematical and computer modeling and supported by data collected in the Paris Île de France Ouest (PIFO), to better understand the role played by each hospital in the emergence and selection of BMR, to quantify the risk of their dissemination (including in the general population), and to identify effective control measures. This work will be based on statistical inference methods, analytical sensitivity and uncertainty analysis

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42

Chan, Ming-Chin, i 詹明錦. "Drug Resistance Mechanism of Extensively Drug-resistant Acinetobacter baumannii (XDRAB) and Risk Factors of Healthcare-associated XDRAB Infections". Thesis, 2011. http://ndltd.ncl.edu.tw/handle/19671294885149958749.

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碩士
國立臺灣大學
公共衛生碩士學位學程
99
The emergence of drug-resistant Acinetobacter baumannii (A. baumannii) is now a serious problem in healthcare-associated infections (HAIs) control. Data from Taiwan TINS showed that, while the percentage of carbapenem-resistant A. baumannii (CRAB) in ICU of medical centers/regional hospitals was less than 20% in 2003, it rose to 70% in Q3 2010. The objective of this study is to investage the distribution of integron drug-resistant gene and OXA typing of carbapenemase in extensively drug-resisitant A. baumannii (XDRAB) isolates from XDRAB-HAIs cases (2008~2010, 25 months). We also used pulsed-field gel electrophoresis (PFGE) to investigate the linkage between XDRAB strains. The risk factors of XDRAB-HAIs were investigated using case-control study (case: control=1:4). The result shows that 23 of 25 XDRAB isolates habored class I integron with a 2300-kb gene cassette. None carries class II integron. Most isolates had carry OXA 23 (n=21, 84%) and OXA51 (n=25, 100%). PFGE showed a genetic diversity among the 25 XDRAB isolates. Univariate analysis showed that long-term bed rest, hemodialysis, tracheostomy, use of glycopeptide, use of imipenem or meropenem, use of anti-pseudomonal penicillins, and use of the fourth generation cephalosporins, are statistically significant risk factors. Multiple conditional logistic regression analysis showed that, after adjusting for the effect of other variables, long-term bed rest (adjusted odds ratio 5.2, 95%CI: 1.1–24.4) and use of imipenem, meropenem, anti-pseudomonal penicillins, or the fourth-generation cephalosporins (adjusted odds ratio 4.3, 95%CI: 1.4–12.7) remain independent risk factors. We concluded that, for XDRAB HAIs control, it is essential to emphasize the prudent use of board-spectrum antibiotics active against gram-negative bacteria.

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43

Liu, Jung-An, i 劉榕安. "Applying Innovation Resistance Theory to Examine Factors Affecting Consumers to Use Mobile Healthcare Payments". Thesis, 2017. http://ndltd.ncl.edu.tw/handle/h95593.

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碩士
國立臺灣大學
健康政策與管理研究所
105
In 2017, the Ministry of Health and Welfare and Visa announced the launch of its newest mobile healthcare payments for consumers to pay the bills online after visiting.Mobile healthcare payments offer consumers a new type of payment options, which has been widely used in many countries. However, according to the Market Intelligence & Consulting Institute, Taiwan is still in the initial stage. This study was aimed to explore the factors that influence consumer’s behavioral intentions of using mobile healthcare payments. The model of this study is based on the Innovation Resistance Theory and also combined customer segmentation which included Rejecters, Postponers and Opponents into this research framework. In order to understand these barriers on behavioral intention of using mobile healthcare payments,the study collected data through online survey. The total of 341 valid questionnaires were collected and using SPSS software to examine hypotheses. Research results are summarized as followings: (1) Value Barrier and Risk Barrier have significant positive effects on behavioral intention of using mobile healthcare payments. (2) The barriers among those who haven’t use mobile healthcare payments (Rejecters, Postponers and Opponents) are different. After segmenting consumers’ barriers toward resisting new technology application, the differentiated marketing and products improving strategies could be developed to promoting the new healthcare mobile payments.

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44

Lin, Jhe-Yu, i 林哲宇. "From the Organizational Innovation Resistance Point of View to Explore Strategic Partners of Hospital''s Healthcare Cloud". Thesis, 2014. http://ndltd.ncl.edu.tw/handle/64750875157369056031.

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碩士
義守大學
企業管理學系
102
Because of the trend of medical informatization, hospitals face the challenge of managing large amounts of data and electronizing information. Hospitals can reduce cost and improve the quality of care through the characteristics of cloud computing. With the rise of aging population and chronic disease, Healthcare cloud is become the countries of world’s important developing direction. Hospitals can reduce direct operation cost and risk, and improve the range and scope of service by strategic alliances. From the point of view of organization innovation resistance, this study reviews the foreign and domestic references and practical cases to organize the hospitals’ dilemmas of developing healthcare cloud. Using the content analysis method to extract the evaluated principle of practical cases interviews the industrial practical experts. Then this study designs the principle of organizing references and practical cases interviews to questionnaire, using the fuzzy Delphi method to select principle. Finding the causal relation between the principles uses the interpretive structural modeling. At last this study uses the analytic network process to establish the model of evaluating strategic alliance partners that hospitals develop healthcare cloud. This study’s result finds out that the fittest alliance partner is non-competition intra-industry strategic alliance. And the order of selecting strategic alliance type is non-competition intra-industry strategic alliance, competition intra-industry strategic alliance, non-competition inter-industry strategic alliance, and competition inter-industry strategic alliance. This study’s result can provide for hospitals and other cloud computing providers.

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45

HongWong, Kit, i 黃傑康. "Healthcare Professionals’ Resistance Behaviors to Electronic Medical Record System (EMRs) Implementation: Equity Theory and Psychological Reactance Theory Perspectives". Thesis, 2015. http://ndltd.ncl.edu.tw/handle/tb8uck.

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博士
國立成功大學
企業管理學系
103
Electronic medical record (EMR) system which records patients’ entire consulting and diagnostic information on electronic basis can not only provide hospital sufficient information but also enable physicians to make accurate disease diagnoses effectively. Chang et al. (2012) and Lehmann et al. (2015) indicated that most of the hospital’s medical record system is in the early to medium phase and healthcare professional resistance behavior to adopt the system is a crucial element to hinder success. Therefore, this study attempts to discuss whether the healthcare professional evaluation on the hospital performance of the expected reciprocal obligation will lead to healthcare professionals’ perceived unmet promises and perceived organizational justice, and results in psychological contract breach (PCB) and generated resistance behavior to EMR implementation from the perspective of equity and psychological reactance theory; furthermore, to study whether the effects of healthcare professionals’ personal trait (e.g., personal innovativeness in IT ＆ healthcare technology management (HTM) competency) and the hospital management practice (e.g., responses to resistance behavior) can potentially mitigate the healthcare professional resistance behavior. By applying both qualitative and quantitative research approach, 12 cases of in-depth interview was conducted with senior healthcare professionals and IT staffs to ensure the reliability of research framework and hypotheses; and develop survey questionnaire based on these outcomes. Four hundred and eighty-nine valid questionnaires have been collected from healthcare professionals and IT staffs for quantitative analysis and hypotheses testing. The results demonstrated that perceived unmet promises and perceived organizational justice had effect on healthcare professional PCB and generated resistance behavior to EMR implementation. In term of the moderating effects, acknowledgement and rectification responses approach was the most suitable method in response to the healthcare professional resistance behavior; healthcare professionals with high- or low-PIIT and high- or low-HTM competency had significantly different between groups in the effect of perceived organizational justice on PCB or the effect of perceived unmet promises and perceived organizational justice on resistance behavior to EMR implementation. The study suggested that the hospital should be more concentrated on the healthcare professional negative using experience and improves it; besides, the hospital should perform more transparent and respected in job and responsibility distribution, and avoid giving heavy workload and responsibility to the healthcare professionals who are more capable and talented to mitigate their emotional exhaustion. Finally, the study suggested that the hospitals should develop a complete two-way communication mechanism to increase the understanding between the hospitals and healthcare professionals to obtain a win-win situation.

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46

Yuan-Ti i 李原地. "A Study of Healthcare-associated Methicillin-resistant Staphylococcus aureus Forecasting Models at a Tertiary Care Hospital in Central Taiwan- the Trends, Correlation of Antimicrobial Consumption and Resistance, Time Series Analysis, and Molecular Typing". Thesis, 2011. http://ndltd.ncl.edu.tw/handle/70642800716720579773.

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博士
中山醫學大學
醫學研究所
99
Background: The importance of methicillin-resistant Staphylococcus aureus (MRSA) infection antimicrobial resistance has increased rapidly during the last 15 years and has become a global health issue. MRSA infections have an enormous impact on the mortality and morbidity in the hospital settings. Objectives: (1) Study 1: The objective of study 1 is to use the correlation between antimicrobial consumption and antimicrobial resistance and apply the forecasting models performed time series analysis to explain the relationship antimicrobial consumption, infection control measures and antibiotic resistance. (2) Study 2: The objective of study 2 is to use molecular typing techniques and to identify the most feasible methods for routine clinical setting to investigate MRSA isolates in a standard clinical laboratory. We also aimed to use the results of these molecular methods to characterize the MRSA strains isolated from health care workers (HCWs) and patients during an outbreak in a respiratory care ward in central Taiwan. Methods: (1) Study 1: We investigated the long-term impact of antibiotic use policy on the rates of consumption (expressed as daily-defined doses (DDD) per 1000 patient days (PD)) of various parenteral antibiotics, the prevalence of MRSA, and incidence of healthcare-associated MRSA (HA-MRSA, persons/1000 PD) infection at Chung Shan Medical University Hospital (CSMUH) from 2001 to 2009. Using time-series analysis based on monthly data during 6 year period (January 2004 to December 2009). The different antimicrobials consumption and alcohol-based hand rub were separately regressed to explore the relationship of incidence of healthcare-associated infection (HAI) and HA-MRSA (persons/1000 PD). Monthly alcohol-based hand rub consumption was expressed in liters/1000 PD. (2) Study 2: We used the methods include Pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), antibiograms derived from susceptibility testing of MRSA isolates, and multiplex PCR for detection of staphylococcal cassette chromosome (SCC)mec typing and Panton-Valentine leukocidin (pvl) gene typing to discriminate MRSA isolates. Results: (1) Study 1: During this time, the consumption of all antimicrobials for systemic use decreased by 33%. This change was driven by a 44% decrease in the consumption of the unrestricted antibacterials, which was offset by a 42% increase in the consumption of the restricted agents. The trends in MRSA prevalence (number of isolates per 1000 PD) and HA-MRSA incidence (number of HA-MRSA-infected persons per 1000 PD) correlated with the trend in overall consumption of the antimicrobials. Significant positive correlations were observed between MRSA prevalence and the consumption of extended-spectrum and β-lactamase-resistant penicillins, first-generation cephalosporins, macrolides, lincosamides, aminoglycosides, and glycopeptides. Significant positive correlations were found between the incidence of HA-MRSA infection and the consumption of tetracyclines, extended-spectrum and β-lactamase-resistant penicillins, sulfonamides and trimethoprim, macrolides, lincosamides, and aminoglycosides. The multivariate analysis showed that using alcohol-based hand rub for hand hygiene practice had a statistical significant effectiveness on the HAI (P = 0.0002) and HA-MRSA incidence (P = 0.0066). An increasing alcohol-based hand rub consumption was subsequently associated with reduce incidence of HAI and HA-MRSA incidence. In HA-MRSA incidence model showed that temporal increase in the use of third-generation cephalosporins (P = 0.0015) is, after a time lag of up to 4 months, followed by temporal increase in the incidence of HA-MRSA significantly. This model explained 39% of the monthly variations in the incidence of HA-MRSA. An increasing alcohol-based hand rub consumption of one liters/1000 PD are associated with decreasing 0.375 persons/1000 PD HA-MRSA Infection, after one month later. This model explained 27 % of the monthly variations in the incidence of HA-MRSA. (2) Study2: From March to June 2006, the incidence of MRSA infection increased 3.75-fold. The overall carrier rates among the HCWs were 31.3% (21/67, total S. aureus) and 16.4% (MRSA), and 14.9% (methicillin-sensitive SA, MSSA). PFGE, MLST, antibiograms derived from susceptibility testing of MRSA isolates, multiplex PCR typing and pvl gene typing provided strong epidemiologic and microbiologic evidence that an outbreak of MRSA infections at our hospital was linked to the same PFGE pulsotype A SCCmec type II, pvl negative, MLST ST5 strain of MRSA isolated from seven HCWs and five patients. The outbreak was controlled by application of topical fucidin ointment to the anterior nares by all HCWs colonized with MRSA. After one week’s treatment with fucidin ointment, follow-up cultures revealed no colonization by MRSA, and no new infections arose among the patients. Conclusions: (1) Study1: We have documented the ongoing successful reduction in total consumption of antimicrobials associated with a decrease in the incidence of HA-MRSA and prevalence of MRSA over a 9-year period. We successfully applied forecasting model to demonstrate the increase alcohol-based hand rub consumption was correlated with reduction the incidence of HAI and HA-MRSA, and reductions in individual restricted antimicrobials were significantly positively correlated with decreases in the incidence of HA-MRSA infections. (2) Study 2: We used molecular typing methods to investigate of an outbreak of MRSA infection in a respiratory care ward in Taiwan. We conclude that multiplex PCR is a feasible and useful method combination with PFGE for outbreak investigations in routine clinical laboratories.

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47

Woods, Martin. "Parental resistance : mobile and transitory discourses : a discursive analysis of parental resistance towards medical treatment for a seriously ill child : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing, Massey University, Palmerston North, New Zealand". 2007. http://hdl.handle.net/10179/1585.

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This qualitative thesis uses discourse analysis to examine parental resistance towards medical treatment of critically ill children. It is an investigation of the 'mobile and transitory' discourses at play in instances of resistance between parents, physicians and nurses within health care institutions, and an examination of the consequences of resistance through providing alternative ways of perceiving and therefore understanding these disagreements. The philosophical perspectives, methodology and methods used in this thesis are underpinned by selected ideas taken from the works of Michel Foucault and Pierre Bourdieu and supported by relevant literature in the fields of media, law, children, parenting, caring, serious childhood illness, medicine and nursing. The thesis obtains information from a variety of texts that includes established literature (such as medical, sociological, legal, academic and philosophical), newspaper articles, radio or television interviews, internet sources, court reports and proceedings, legal experts and other commentators - and 15 interview based texts, where the focus is on analyses of narratives of parents, doctors and nurses. In the texts gathered for this thesis, there are noticeable differences between the personal experience discourses of parents, the 'in-between' discourses of nurses, and the disciplined discourses of physicians. This thesis brings these discourses into conversation with each other suggesting that parental resistance does not occur because of an infrequent and unusual set of circumstances where a few socially isolated and/or 'difficult' parents disagree with the treatment desires of paediatric physicians. Instead, it is argued that from an examination of interview based texts, parental resistance is an omnipresent but transitory occurrence that affects many of the interactions between the parents of seriously ill children and clinical staff. It is maintained that within these interactions, the seeds of this resistance are sown in both critical decision making situations and in everyday occurrences between doctors, nurses and parents within healthcare institutions. Contributing factors to parental resistance include the use of power games by staff, the language of medicine, forms of symbolic violence, the presence or absence of trust between parents and medical staff, the effects of medical habitus, and challenges to the parental role and identity. Overall, it is proposed in this thesis that parents who resist treatment for their seriously ill child are not exceptions to the normative patient-physician relationship. Instead an analysis of their discourses and practices is able to illuminate the complex interactions between patients and medical conventions. It is therefore possible to see parents who resist medical advice not as peripheral to the medical encounter but as examples of how patient-physician relationships come to be codified, constructed and crafted through everyday discourses and practices within health care settings.

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48

Lima, Cláudia Sofia Afonso de. "Activity of carvacrol against Coagulase-negative Staphylococci biofilm related infections". Master's thesis, 2015. http://hdl.handle.net/1822/41452.

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Dissertação de mestrado em Bioengenharia
Coagulase-negative staphylococci (CoNS) are frequently found in healthy human skin and mucosae, and hence, have long been considered non-pathogenic bacteria. However, in recent years, they have been recognized as important etiological agents of healthcareassociated infections, being particularly associated with patients with indwelling medical devices. Despite their importance as nosocomial pathogens, very little is known regarding their virulence determinants. Nevertheless, it is recognized that the ability of CoNS to form biofilms play the most important role in their pathogenesis. Biofilms are communities of microorganisms attached to a surface and encased in an extracellular polymeric matrix, which among other functions, protect bacteria from antimicrobial agents allowing, consequently, the progression of infection. In addition, the overuse of antibiotics led to a dramatic rise of resistant bacteria, resulting in an increase in patients’ morbidity and in the costs associated with the treatment of these infections. Hence, major efforts need to be made toward the development of new prophylactic and therapeutic strategies for the management of CoNS biofilm-associated infections. The objective of this work is, therefore, to study the susceptibility of CoNS biofilms to carvacrol, a monoterpenic phenol, which presents a wide antimicrobial activity spectrum and is considered as one of the latest novelties in biofilm disruption studies. Carvacrol displayed a significant effect in the viability of planktonic and biofilm cells after a short period of time. Small concentrations (2 μM) were sufficient to exhibit antibacterial effect on these cells. Interestingly, the effect of carvacrol at 2 μM was greater to the effect of vancomycin at peak serum concentration in planktonic cells. Overall, the results indicate a potential antibacterial effect of carvacrol against CoNS, and therefore the possible action of this molecule on the prevention and treatment of S. epidermidis and other CoNS related infections.
Os stafilococus coagulase-negativos (CoNS) são frequentemente encontrados na pele e mucosas de pessoas saudáveis e portanto, são normalmente considerados bactérias não patogénicas. No entanto, nos últimos anos foram reconhecidos como agentes etiológicos importantes de infecções nosocomiais, estando particularmente associados a pacientes com dispositivos médicos invasivos. Apesar da sua importancia como patógenos nosocomiais, muito pouco se sabe acerca da sua virulência. Contudo, reconhece-se que a capacidade dos CoNS de formar biofilmes, desempenha o papel mais importante na sua patogénese. Biofilmes são comunidades de microrganismos aderidos a uma superfície e cobertos por uma matriz extracelular polimérica, que, entre outras funções, protege as bactérias de agentes antimicrobianos permitindo, consequentemente, a progressão da infecção. Além disso, a utilização excessiva de antibióticos conduziu a um aumento dramático de bactérias resistentes, resultando num aumento da morbidade e dos custos associados com o tratamento destas infecções. Assim, esforços devem ser feitos para o desenvolvimento de novas estratégias profiláticas e terapêuticas para o controlo de infecções causadas por biofilmes de CoNS. O objetivo deste trabalho foi, portanto, estudar a suscetibilidade dos biofilmes dos CoNS ao carvacrol, um fenol monoterpénico, que apresenta um largo espectro de atividade antimicrobiana e é considerado como uma das mais recentes novidades em estudos de rutura de biofilmes. O carvacrol exibiu um efeito significativo na viabilidade das células planctónicas e de biofilme após um curto período de exposição. Pequenas concentrações (2 μM) foram suficientes para exibir efeito antibacteriano sobre as células. Curiosamente, o efeito de carvacrol a 2 μM em células planctónicas foi superior ao efeito da vancomicina na concentração máxima no soro humano. No geral, os resultados indicam um potencial efeito antibacteriano do carvacrol contra os CoNS, e, portanto, o possível uso desta molécula na prevenção e tratamento de infecções relacionadas com S. epidermidis e outros CoNS.
This thesis was partially supported by the Project “BioHealth - Biotechnology and Bioengineering approaches to improve health quality" Ref. NORTE-07-0124-FEDER-000027, co-funded by the Programa Operacional Regional do Norte (ON.2 – O Novo Norte), QREN, FEDER and the Project RECI/BBB-EBI/0179/2012 (FCOMP-01-0124-FEDER-027462)

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49

Pogorzelska, Monika. "Institutional and Patient Level Predictors of Multi-Drug Resistant Healthcare-Associated Infections". Thesis, 2011. https://doi.org/10.7916/D84T6RBD.

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Healthcare-associated infections (HAI) caused by multi-drug resistant organisms (MDRO) are an important patient safety concern resulting in a substantial financial and clinical burden. This dissertation aims to contribute to the evidence base on institutional and patient level factors that predict multi-drug resistant infections in the hospital setting. In the first chapter, I review the evidence base on patient-level risk factors for methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI), system-level factors associated with implementation of infection control policies and MDRO rates, and the current knowledge on the use of infection control policies on the national level. In the second chapter, I use data from a national cross-sectional study to describe the range of MDRO screening and infection control policies in U.S. hospitals and identify predictors of their presence and implementation. In the third chapter, using data from a cross-sectional study of California hospitals, I assess the association between the presence and implementation of infection control policies for MDRO infections and rates of BSI caused by MRSA or vancomycin-resistant Enterococcus and infections caused by Clostridium difficile. Next, I identify risk factors for healthcare-associated MRSA BSI in a nested case control study using two sets of controls. In the last chapter, I conclude by summarizing the findings of these three studies.

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50

Chen, Chiao-Erh, i 陳巧兒. "Risk factors of healthcare-associated infections with multidrug-resistant Acinetobactor baumannii (MDRAB)". Thesis, 2013. http://ndltd.ncl.edu.tw/handle/60437255211683178874.

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碩士
國立臺灣大學
公共衛生碩士學位學程
101
Healthcare-associated infections (HAIs) of Acinetobactor baumannii is emeging as a serious issue in Taiwan. Multidrug-resistant A. baumannii (MDRAB) are often occurred due to its long surviving on environmental desiccation and antimicrobial resistance mechanisms. According to the data of Taiwan Nosocomial Infections Surveillance System (TNIS) in 2011, while the percentage of carbapenem-resistant A. baumannii (CRAB) in ICU of medical centers/ metropolitan hospitals was less than 20% in 2003, it rose to 70% in Q3 in 2010. It is essential to find relevant risk factors and make policies to prevent healthcare-associated infections because that will increase morbidity, mortality and medical costs. The purpose of this study is to investigate risk factors of MDRAB in a metropolitan hospital from 2008 to 2011 (48 months), using case-control study (case:control=1:4). Univariate analysis showed that days of hospitalization, uremia, bronchoscopy, double lumen, use of glycopeptides, use of Anti-Pseudomonal cephalosporins and use of the fourth generation cephalosporins, are statistically significant risk factors. Multiple conditional logistic regression analysis showed that, after adjusting for the effect of other variables, days of hospitalization, bronchoscopy, use of Anti-pseudomonal cephalosporins and use of the fourth generation cephalosporins remain independent risk factors. We concluded that, for MDRAB HAIs control, it is necessary to emphasize on proper antibiotics prescription, monitor antibiotics usages and environmental clean after invasive procedures.

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