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- Blomgren, Per-Ola
(författare)
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Clean work, the pursuit of increased adherence to hand hygiene routines : a descriptive study
- 2022
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Healthcare-associated infections (HAI) are a problem in health care worldwide. In Sweden 7-8% of all patients treated in hospital suffer from an adverse event of varying severity, of which approximately 60,000 from a HAI. Proper hand hygiene is considered the single most important measure to reduce HAI. Despite the importance, adherence to correct hand hygiene routines are lacking among healthcare workers (HCWs). The World Health Organizations (WHO) multimodal promotion strategy promotes areas that need to be addressed in order to change the behaviour of individual HCWs to optimise adherence to hand hygiene and to improve patient safety. These areas include feedback, education, reminders at the workplace and institutional safety climate. The overall aim of this study was to examine the possibility of adherence to hand hygiene routines and to explore factors that might influence the HCWs adherence. The study used a descriptive research design made through qualitative method, with focus group interviews, and quantitative method, using a questionnaire survey. Eight focus group interviews were conducted with assistant nurses (n=18), nurses (n=15) and physicians (n=5) and analysed with abductive qualitative content analysis. The questionnaire survey was answered by nurses (n=84) and nursing students in their first semester (n=71) and last semester (n=46) and the data was statistically analysed.The main findings show that there are barriers to hand hygiene adherence and measures to improve these. HCWs highlighted discrepancies regarding how the organisation was supposed to give feedback and how it actually was at the workplace and expressed needs for more direct feedback to improve adherence. The study also found that hygienic knowledge gaps exists among nurses and nursing students regarding causes of HAI and how the risk of contamination of patients and HCWs can be minimized among others. Students at the beginning of the education had a lower level of knowledge than last semester students and registered nurses. The last semester students tended to have the highest level of hand hygiene knowledge. In conclusion, the key areas presented by WHO’s multimodal promotion strategy to improve adherence all lack the appropriate measures, in some extent. The use of an electronic reminder system could give the means to improve a behaviour as long as the individual integrity is protected and development of curriculums for nursing students and continuing education of nurses is needed to further develop and maintaining knowledge.
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| 2. |
- Elvén, Malin
(författare)
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Novel host defence mechanisms during bacterial infections
- 2020
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The immune system has evolved through thousands of years and its architecture has challenged the medical field since the first hieroglyphs and will likely continue do so. With our co-evolution with millions of other species, the complexity to treat infectious diseases has been a race in increasing speed ever since. The establishment of penicillin shortened the length of that battle against a broad spectrum of bacteria. Till this day, penicillin and other types of antibiotics have saved an enormous number of lives. Unfortunately, pathogenic bacteria don’t cease to develop. Many share similarities, which may be an advantage in attempts to cure infection. In other aspects- some bacteria, partly due to their very sophisticated biology develop resistance. This is one of several reasons that antibiotic resistance is one of the largest threats to survival of mankind today. Chronic wounds and pulmonary diseases are examples among many other conditions that have become difficult to treat by standard anti-biotic schemes. The need for novel, more specific, treatments for bacterial infections is urgent. Fortunately, the immune system carries a range of endogenous anti-bacterial proteins and peptides with many immunological features left to unravel. With a deeper understanding of their structure and function, these studies can hopefully aid in the search for alternatives to anti-biotics as well as bridge understanding between infection and other disease mechanisms. This thesis provides novel mechanistic insights to a group of endogenous proteins and their role during bacterial infections. Tissue Factor Pathway Inhibitor- 2, primarily known as a serine protease, highly expressed in placenta and additionally proposed to own function as a tumor- suppressor among others, was found to be important for survival during pulmonary P.aeruginosa infection in mice. Novel roles of complement components during persistent, intra-cellularly, infected skin by S.aureus was uncovered, a sophisticated mechanism facilitated by these bacteria to hide from the immune system. Lastly, plasma apoE was found anti-bacterial against E.coli and P.aeruginosa. Additionally, a mechanism on how apoE neutralize their endotoxins is suggested. Our findings suggest the role(s) for these host defence molecules to be re-considered, depending on site of expression as well as the bacteria they face.
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| 3. |
- Stepulane, Annija, 1994
(författare)
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Antibacterial elastomeric materials for biomedical applications
- 2022
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- An ageing population in combination with scientific and clinical advancements have led to a steady increase in the use of medical devices. Elastomeric biomaterials – materials displaying rubber-like mechanics – have found widespread applicability in the production of both short- and long-term medical devices. Despite the prevalence of such devices, issues with medical device-associated infections remain. By surface colonization of bacteria, systemic infection can arise resulting in patient suffering and increased burden on the healthcare system. Consequentially, development of antibacterial elastomers capable of withstanding bacterial surface colonization has been proposed as an effective strategy for prevention and mitigation of medical device-associated infections. In this thesis, two alternative strategies to develop antibacterial polydimethylsiloxane (PDMS) elastomers have been proposed and evaluated. In the first strategy, PDMS surface modification with multifunctional hydrogel microparticle coating has been developed. Using a coating of antimicrobial peptide (AMP) RRPRPRPRPWWWW-NH2 functionalized hydrogel particles, high antibacterial activity was reported against Staphylococcus epidermidis and Staphylococcus aureus. As an additional functionality, the ability of the coating to encapsulate and release therapeutic substances was investigated, resulting in a sustained delivery of polar, amphiphilic, and nonpolar drugs. In the second strategy, modification of bulk PDMS by synthesis of drug-eluting PDMShydrogel blends was proposed. PDMS and triblock copolymer (diacrylated Pluronic F127, DA-F127) hydrogel blends were prepared with varying ternary PDMS–DA-F127–H2O compositions. The test compositions chosen resulted in stable elastomers with tailorable mechanics and ordered self-assembled nanostructure. The variation in composition offered potential for sustained delivery of polar and nonpolar drugs, demonstrating potential for production of drug-eluting and antibacterial elastomeric devices with tailorable mechanics.
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