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| 2. |
- Lymer, Ulla-Britt, 1943-, et al.
(författare)
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Blood exposure : factors promoting health care workers' compliance with guidelines in connection with risk
- 2004
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 13:5, s. 547-554
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Health care workers compliance with guidelines, universal precautions, in connection with tasks that could involve contact with patient's blood is unsatisfactory. In a previous paper, we identified different forces that undermine compliance. Socialization into infection control, routinization, stereotyping, perceptions of patients' wishes and the presence of competing values and norms are examples of such forces. AIMS AND OBJECTIVES: The aim of this article is to describe and analyse different forces that promote adherence to universal precautions. Behavioural variations are seen as a consequence of differences between wards with regard to the safety culture. Safety culture is conceptualized as the outcome of a constant interplay between deactivating and reactivating forces. In this article the focus is on the latter. METHOD: The grounded theory approach. Data were collected through interviews with nurses and assistant nurses. RESULTS: The charge nurse, informal leaders, students, infection control nurses, type of work, availability of equipment, blood-exposure incidents and media-coverage of infectious diseases are described as potentially important for compliance. The properties these agents must possess in order to be influential are also described. RELEVANCE TO CLINICAL PRACTICE: The outcome of an occupationally acquired infection can be fatal. Hence it is important that health care workers take protective measures. The results imply that mere information about safe practices alone is insufficient to achieve that goal. All factors of importance for compliance must be taken in to consideration in clinical work and in education.
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| 3. |
- Lymer, Ulla-Britt, 1943-
(författare)
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Blood exposure in health care : health care workers' and patients' experiences
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of this thesis was to describe and analyse health care workers' blood-exposure incidents, protective measures, and the motives behind decision making about risks and protective measures. The aim was also to procure knowledge about patients' conceptions about their care, and if precautions taken by the health care workers were included in quaiity care. The methods used were: in study I quantitative method, in studies II and III grounded theory method, and in study IV phenomenographic method.The aims of study I were to describe and analyse blood-exposure incidents and compliance in relation to recommended serological investigations, universal precautions and incident reporting routines and also to follow up a campaign against blood-exposure. Instruments used were incident report forms (n=473) and questionnaires (n=132), (n=108), (n=517). The majority of the 473 reported blood-exposure incidents came from nurses and the minority from physicians. Incidents occurred most often on hospital wards, the most commonly reported incident being needle-stick injuries, 35% ofwhich occurred during recapping the needle. Medicallaboratory technicians reported significantIy more mucocutaneous incidents than other professionaIs (P<0,01). Serological investigations post-exposure varied and 35% of individuaIs were not tested. In an anonymous questionnaire, the respondents recalled 1180 incidents, although onIy 9% of these were reported. Physicians reported onIy 3% of these, medical laboratory technicians reporting 36%. The under reporting was most common in operation theatres and in anaesthesia. Eighty-one percent believed that the accident could have been avoided if they had followed the recommended clinical practice. Despite knowledge of universal precautions, professionaIs continue to behave in a risky manner, which can result in blood exposure incidents and possibly a blood-borne viral infection.The aim of study II was to identify factors that influenced health care workers' actions in situations involving a risk of blood-exposure. Nurses and assistant nurses were interviewed (n=15). The analysis showed that there was a conflict between different demands involving protecting the patient's privacy, protecting themselves from being infected and respecting the norms of the department. The process of managing this conflict was labelled 'balancing', which most often resulted in the choice of a diagnosis-related strategy, i.e. a non-compliant behaviour. The underlying causes of how patterns of action are formed by individual and socio-cultural forces resulted in five categories, which were seen as forces that could underrnine compliance.The aim of study III was to describe and analyse different forces that promote adherence to universal precautions. Nurses and assistant nurses were interviewed (n=15, the same as in study II). The charge nurse, informal leaders, students, infection controi nurses, type of work., availability of equipment, blood-exposure incidents and media-coverage of viral blood-borne infections were described as potentially irnportant for compliance. The properties these agents must possess in order to be influential were also described. The results irnply that information about safe practices alone is insufficient to achieve that goal. All factors of importance for compliance must be taken into consideration in clinical work and in education.The aim in study IV was to identify and describe patients' conceptions of quality care and of barrier care. The patients (n=14) were adult and treated for orthopaedic reasons. Included in their conceptions of quality care were: Nice manners, mutual achievement, being involved, being cured, being cared for, and having safe care. When comparing these conceptions with previous research about patients' views of quaIity care, the findings confirmed, to a large extent, the findings from other studies. Included in patients' conceptions of barrier care were: Regular use of gloves, regular use of masks and eye-shields, use of gloves in special situations, use of masks and eye-shields in special situations, and keeping clean. The conceptions were of an interpersonal, as well as of a medical-technical nature. Patients' conceptions of barrier care could be included in the category: Having safe care. The frequentIy expressed opinion, among nurses and assistant nurses, that patients may be offended by the use of protective equipment could be refuted.This thesis has contributed to an improved understanding of the occurrence and handling of blood-exposure incidents. The dynamics of compliance and non-compliance with universal precautions have also been described by means of an attempt to uncover the interplay between deactivators and re-activators in the safety culture on wards. Patients' conceptions about barrier care were shown to be an integrated part of quality care.
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| 4. |
- Saeedi, Baharak, 1972-, et al.
(författare)
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Genetic relatedness of Enterococcus faecalis isolates with high-level gentamicin resistance from patients with bacteraemia in the south east of Sweden 1994-2001
- 2004
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 36:6-7, s. 405-409
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Tidskriftsartikel (refereegranskat)abstract
- High-level gentamicin resistant (HLGR) enterococci (Enterococcus faecalis and Enterococcus faecium) have become a substantial nosocomial problem in many countries. In this study, we investigated the prevalence of HLGR enterococci and their genetic relatedness in blood culture isolates from patients with bacteraemia admitted to the 3 hospitals in Östergötland, a county in the south east of Sweden, during 1994–2001. 36 of 250 E. faecalis (14%) and 4 of 106 E. faecium isolates (4%) were shown by PCR to carry the aac(6′)-Ie-aph(2″)-Ia aminoglycoside modifying gene and these isolates were also classified as HLGR enterococci by the gentamicin antibiotic disk diffusion method. A majority of HLGR E. faecalis isolates (83%) belonged to the same cluster of genetically related isolates, according to the pulsed-field gel electrophoresis (PFGE) patterns, whereas all 4 HLGR E. faecium isolates had unique PFGE patterns. In conclusion, our study showed that in contrast to studies from many other countries, the presence of HLGR enterococci was more common in E. faecalis than in E. faecium and appeared the first time in 1996 and 1999, respectively. Bacteraemia with HLGR enterococci in Östergötland was mainly due to the spread of a cluster related of E. faecalis strains.
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| 5. |
- Almroth, Gabriel, 1953-, et al.
(författare)
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Perspectives on hepatitis B infections and the efficacy of vaccination (hepatitis B and pneumococci) in dialysis patients.
- 2003
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Ingår i: Upsala journal of medical sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 108:1, s. 61-74
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Tidskriftsartikel (refereegranskat)abstract
- Hepatitis B is a well known problem in dialysis units. We therefore examined the historical frequency of hepatitis B carriers in our unit, our vaccination program to hepatitis B virus (HBV), the response to hepatitis B vaccine, the IgG subclass response of anti-HBs and the response and IgG subclass response to pneumococcal vaccination (another vaccine) in dialysis patients. From 1970 and onwards 23 HBV carriers were found, but no new cases of hepatitis B occurred during the study period, i.e. from 1980 and onwards. Only one of the carriers was alive by the end of 2001. In four patients liver disease (in one of them liver cirrhosis) may have been a concomitant cause of death. The antibody response to hepatitis B vaccine was significantly lower in patients than in staff. In four patients a fourth injection was cancelled due to transplantation and bad health, while such data were lacking in 8 cases. In anti-HBs positive patients and controls a significant difference in the response of healthy adults was observed in anti-HBs IgG1 (p < 0.001) vs all other IgG subclasses. Dialysis patients had low levels, or negative findings, in all cases, with IgG1 as the highest proportion found (3/11 patients). An antibody response to pneumococcal vaccination was registered in 25 out of 29 dialysis patients (in all 86%). The IgG-subclass vaccination response to pneumococci in 28 dialysis patients was mainly IgG2 and IgG1 but also occurred in IgG3 and IgG4. Prevaccination antibody levels of the controls were higher in IgG1 and IgG2 (p < 0.01) (n = 21) than in dialysis patients (n = 28). Hepatitis B is nowadays a rare, but still dangerous disease in nephrology units. Dialysis patients have a reduced response to hepatitis B vaccine and vaccination schedules should be started early as some patients otherwise may not receive a fourth injection. The adequate antibody response to pneumococcal vaccination mainly due to IgG2 and IgG1 antibodies indicates that the antigen involved is important in vaccination responses in dialysis patients.
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| 6. |
- Hällgren, Anita, 1963-, et al.
(författare)
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Genetic relatedness among Enterococcus faecalis with transposon-mediated high-level gentamicin resistance in Swedish intensive care units
- 2003
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Ingår i: Journal of Antimicrobial Chemotherapy. - : Oxford University Press (OUP). - 0305-7453 .- 1460-2091. ; 52:2, s. 162-167
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Tidskriftsartikel (refereegranskat)abstract
- We studied 45 isolates of Enterococcus faecalis with high-level gentamicin resistance (HLGR), all but one concomitantly resistant to ciprofloxacin, and 25 ciprofloxacin-resistant isolates without HLGR for genetic relatedness using pulsed-field gel electrophoresis (PFGE). E. faecalis were isolated from patients admitted to intensive care units at eight hospitals in southern Sweden from December 1996 through December 1998. Genomic analysis by PFGE resulted in three clusters of genetically related isolates (designated clusters I, II and III) and 23 unique clones. Cluster I was found predominantly in the eastern and central parts of southern Sweden and clusters II and III in south-western Sweden. Among the 45 isolates with HLGR, 69% belonged to cluster I, 20% to cluster II, and 11% had unique PFGE patterns, which suggests that the majority of isolates with HLGR are closely related. Among the 25 ciprofloxacin-resistant isolates without HLGR, 68% had unique PFGE patterns, 12% belonged to cluster I and 20% to cluster III, which suggests the ciprofloxacin-resistant isolates are not related. All isolates with HLGR contained the aac(6′)Ie-aph(2″)Ia gene, which was carried on a Tn5281-like transposon in all isolates except one. We conclude that HLGR in E. faecalis was mainly due to dissemination of genetically related clones during the time studied, and that HLGR in these isolates was due to the presence of the aac(6′)Ie-aph(2″)Ia gene.
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| 7. |
- Isaksson, Barbro, 1947-
(författare)
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MRSA och andra multiresistenta bakterier.
- 2003
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Ingår i: Smittnytt : information från smittskyddet och mikrobiologen. - Linköping : Smittskyddsenheten. ; 36, s. 24-25
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Tidskriftsartikel (populärvet., debatt m.m.)
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| 8. |
- Lymer, Ulla-Britt, et al.
(författare)
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Health care workers' action strategies in situations that involve a risk of blood exposure
- 2003
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Ingår i: Journal of Clinical Nursing. - 0962-1067 .- 1365-2702. ; 12:5, s. 660-667
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Tidskriftsartikel (refereegranskat)abstract
- A mapping of fatigue crack growth rates in thick plates of a high strength aluminium alloy has been done. The plate thicknesses investigated was 100, 150 and 200 mm. In this work, material from near edge at near surface and mid-thickness has been investigated. Measurements of crack length has been performed using DC potential drop. Cyclic condensation is used in order to reveal crack growth behaviour for stage I and the earlier part of stage II crack growth. Influence of crack closure, crack branching and slow growing side cracks on fatigue crack growth rate of S-L and L-T oriented specimens are discussed. Variation of difference in growth rate in the upper part of the stage II growth between near surface and mid thickness positioned L-T specimens are found to vary with plate thickness.
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| 9. |
- Lymer, Ulla-Britt, 1943-, et al.
(författare)
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Health care workers' action strategies in situations that involve a risk of blood exposure
- 2003
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 12:5, s. 660-667
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Tidskriftsartikel (refereegranskat)abstract
- • Previous research shows that health care workers (HCWs) often act in a risky way in blood-exposure situations, and thereby run the risk of becoming infected by blood-borne pathogens.• A qualitative study was conducted in order to describe factors that influence HCWs' actions in such situations. Nurses and nursing assistants were interviewed.• The analysis shows that HCWs perceive that there is a conflict among different demands. These demands are protecting the patient's privacy, protecting themselves from being infected and respecting the norms of the department.• The process of managing this conflict is labelled `balancing', which most often results in the choice of a diagnosis-related strategy.
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| 10. |
- Samuelsson, A, et al.
(författare)
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Clustering of enterococcal infections in a general intensive care unit
- 2003
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Ingår i: Journal of Hospital Infection. - 0195-6701 .- 1532-2939. ; 54:3, s. 188-195
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Tidskriftsartikel (refereegranskat)abstract
- This is a retrospective study comparing patients' characteristics, antibiotic consumption and environmental contamination before the impact of a new regimen of intensified infection control measures in a general intensive care unit (ICU) at a university-affiliated tertiary-care teaching hospital. The new regimen consisted of (1) reorganization of patient rooms (2) improved hygienic measures including strict hygiene barrier nursing (3) more isolated patient care and (4) more restrictive use of antibiotics. The regimen was introduced after a cluster of enterococcal infections. All patients admitted to the ICU from 1 March 1995 to 28 february 1997 were included. A study period of 12 months after reorganization of the ward was compared with the 12 months immediately before it. The antibiotic consumption, the individual patient's severity of disease (APACHE score), and the extent of therapeutic interventions (TISS score) were recorded. Enterococci were typed biochemically, antibiograms were established and the relation between the isolates was investigated with pulsed-field gel electrophoresis. The bacteriological results and the patient data suggested a hospital-acquired spread as the cause of the ICU enterococcal outbreak. After implementation of the new regimen, we observed a reduction in the rate of enterococcal bloodstream infections from 3.1 to 1.8%. The consumption of antibiotics fell from 6.11 to 4.24 defined daily doses per patient.The introduction of strict hygiene and barrier nursing, more restrictive use of antibiotics, isolation of infected patients, thorough cleaning and disinfection of the unit was followed by an absence of enterococcal infection clustering and reduction in incidence of enterococcal bacteraemia. We were not able to determine whether the reduction in antibiotic consumption was due to the intervention programme. ⌐ 2003 The Hospital Infection Society. Published by Elsevier Science Ltd. All rights reserved.
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