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  • 1.
    Alsterlund, Rolf
    et al.
    Department of Infectious Diseases, Central Hospital, Kristianstad.
    Axelsson, Carolina
    Kristianstad University, School of Education and Environment, Avdelningen för Naturvetenskap. Kristianstad University, Forskningsmiljön PRO-CARE.
    Olsson-Liliequist, Barbro
    Unit of Antibiotics and Infection Control, Swedish Institute for Communicable Disease Control, Solna.
    Long-term carriage of extended-spectrum beta-lactamase-producing Escherichia Coli2012In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 44, no 1, p. 51-54Article in journal (Refereed)
    Abstract [en]

    In 2009 we described an outbreak caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli in southern Sweden that occurred during 2005–2006. An important finding from the investigation was the long carriage times of the ESBL-producing E. coli in several of the patients, which in some cases exceeded 30 months. Here we report findings from the continued follow-up of bacterial carriage. In September 2010, 5 of the 42 patients still carried the bacteria after a median of 58 months (range 41–59 months), 18 had had repeatedly negative cultures after shedding bacteria for a median of 7.5 months (range 0–39 months), 16 had died while still shedding the bacteria for a median of 9 months (range 0–38 months), and 3 had been lost to follow-up.

  • 2.
    Axelsson, Carolina
    Kristianstad University, School of Health and Society.
    A cross-sectional pre- and postintervention study of hygiene routines amongst health care workers combined with a screening of microbes in wounds2014Independent 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.

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