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A cross-sectional pre- and postintervention study of hygiene routines amongst health care workers combined with a screening of microbes in wounds
Kristianstad University, School of Health and Society.
2014 (English)Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
Abstract [en]

During the fall of 2005 and the spring of 2006, there was a nosocomial infection outbreak caused by a multiresistant Escherichia coli producing Extended-Spectrum Beta-Lactamase (ESBL) in a unit at the Central Hospital in Kristianstad. The bacteria were believed to be transmitted through patient contact with the hands of staff members. Since five of the cases of ESBL-producing E. coli were found in wounds of patients from the unit, wounds in other units needed to analyzed. In Sweden, patients with wounds are treated in hospitals as well as in municipal health care settings. The aim of this study was to investigate, improve and evaluate hygiene routines among the hospitals’ and municipal health care facilities’ staff members. In addition, a screening for the microbial flora, including multi antibiotic resistance, in patients’ wounds in these facilities was carried out.

The study used a cross-sectional pre- and postintervention design. The data collection was designed as naturalistic observational study with participant observations and interviews. The study was performed at two central general hospitals, three general hospitals and six counties municipal health care settings in Sweden. The coverage area were 370 000 inhabitants. The data from the investigation in 2006 were analyzed and presented in individually written reports for each unit. The national regulations on basic hygiene were implemented in 2007. A poster was distributed to all participating units and displayed for patients and visitors. The message of the poster stated: “[We respect patient hygiene safety by: wearing short sleeves; long hair wearing up; have short unpainted nails; not wearing jewellery on our hands or arms; disinfect our hands before and after every patient and care procedure. Please remind us if we forget!]“. In 2006, 214 units, 2541 staff members in a patient care situation and 218 staff members were observed when treating wounds. In 2008, 221 units, 2339 staff members in a patient care situation and 142 staff members were observed when treating wounds.

The working clothes provided by the employer significantly increased for municipal staff members (from 39% to 62%) as did the use of plastic aprons also (from 53% to 75%). Staff members with either short hair or long hair wearing it up was significantly decreased for municipality staff members (from 94% to 88%). The correct absence of jewellery increased significantly (from 53% to 69%), as did the correct absence of nail polish, build up nails, and infected cuticles (from 74% to 77%)). The use of gloves increased significantly for all staff members (from 83% to 89%). The staff members were observed during a wound treatment situation, and the correct absence of jewellery increased for hospital staff members (from 75% to 89%). The use of gloves decreased (from 91% to 80%). The use of plastic apron significantly increased (from 27% to 52%). In the microbiology screening study, a total of 394 patients with 438 wounds were included. The most frequent microbe was Gram-positive cocci, which was found in 458 (60%) of the 760 isolates and in 353 (81%) of the wounds. Two ESBL-producing isolates were found, one Escherichia coli and one Enterobacter aerogenes.

The findings suggest that the combined interventions and the method used with multidisciplinary teams as well as multiple strategies for interventions might have a positive effect on focusing on hygiene routines. Knowledge of the local bacteria flora and their antibiotic resistance as well as the type of wounds, is of importance when deci ing what antimicrobial treatment to suggest, and the monitoring needs to be continuing.

Abstract [sv]

Under hösten 2005 och våren 2006, utbröt en nosokomial infektion orsakad av en Extended Spectrum Beta-Lactamase (ESBL) producerande Escherichia coli på en avdelning på Centralsjukhuset i Kristianstad. Spridningen av bakterien troddes ske via patienters kontakt med personalens händer. Eftersom fem fall av de ESBL-producerande E. coli fanns i patienters sår, behövde sår från andra avdelningar undersökas. I Sverige behandlas patienter med sår på sjukhus samt i den kommunala hälso-och sjukvården. Syftet med denna studie var att undersöka, förbättra och utvärdera personalens hygienrutiner på sjukhusen och kommunernas vårdinrättningar. Dessutom gjordes en mikrobiologisk screening, inklusive undersökning av antibiotikaresistens, i patienternas sår vid dessa vårdinstanser.

Studiens design var tvärsnitts pre- och postintervention. Datainsamlingen var utformat som naturalistisk observationsstudie med deltagande observatörer (sjuksköterskestudenter, kliniska handledare och två sjuksköterskor på varje avdelning). Studien utfördes vid två länssjukhus, tre regionalsjukhus och sex kommunala hälsoinrättningar i Sverige. Täckningsområdet var 370 000 invånare. Data från undersökningen år 2006 analyserades och presenterades i individuellt skriftliga rapporter till varje avdelning. De nationella bestämmelserna om grundläggande hygienförskrifter genomfördes 2007. En poster distribuerades till alla avdelningar och exponerades för patienter och besökare. På postern stod: ”Vi respekterar hygiensäkerheten genom att använda kortärmade arbetskläder; ha långt hår uppsatt; ha kortklippta, omålade naglar; inte använda klockor, armband eller ringar i vårdarbetet; desinficera händerna mellan varje patient och innan olika vårdprocedurer; Påminn oss gärna om vi glömmer oss!". År 2006 deltog 214 avdelningar, 2541 personal i en omvårdnadssituation och 218 personal vid sårbehandlingar. År 2008 deltog 221 avdelningar, 2339 personal i en omvårdnadssituation och 142 personal vid sårbehandlingar.

Tillgången till arbetskläder och användning av plastförkläden ökade signifikant (från 39% till 62% respektive 53% till 75%). Personal med kort eller uppsatt hår minskade signifikant för kommunernas personal (från 94% till 88%). Personal som inte bar smycken ökade signifikant (från 53% till 69%), liksom den korrekta frånvaron av nagellack, påbyggnadsnaglar och infekterade nagelband (från 74% till 77%)). Användning av handskar ökade signifikant för all personal (från 83% till 89%). Frånvaro av smycken för personal som observerades under en sårbehandling ökade signifikant (från 75% till 89%). Användningen av handskar vid sårbehandling minskade signifikant (från 91% till 80%). Användningen av plastförkläde ökade signifikant (från 27% till 52%). I mikrobiologi studien deltog 394 patienter med 438 sår. Mest frekvent var gram-positiva kocker, som fanns i 458 (60%) av de 760 isolaten och 353 (81%) av såren. Två ESBL-producerande isolat upptäcktes, en Escherichia coli och en Enterobacter aerogenes.

Resultaten tyder på att de kombinerade interventioner och den metod som användes med multidisciplinära team samt flera strategier, inklusive patientinvolvering, kan ha en positiv effekt på att fokusera hygienrutiner. Kunskap om bakteriefloran och dess antibiotikaresistens lokalgeografiskt och i olika sårtyper, är av betydelse när beslut om eventuell antibiotikabehandling ska fattas, därför bör monitoreringen kontinuerligt uppdateras.

Place, publisher, year, edition, pages
2014. , 41 p.
Keyword [en]
Bacteria, Community, ESBL, Health care, Hospital, Hygiene, Resistance
Keyword [sv]
Bakterier, ESBL, Hygien, Hälso- sjukvård, Kommuner, Resistens, Sjukhus
National Category
Nursing Infectious Medicine
Identifiers
URN: urn:nbn:se:hkr:diva-16601OAI: oai:DiVA.org:hkr-16601DiVA: diva2:1083441
Educational program
Masterprogram Integrerad hälsovetenskap
Uppsok
Medicine
Supervisors
Examiners
Available from: 2017-03-21 Created: 2017-03-21 Last updated: 2017-03-21Bibliographically approved

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