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Economic Impacts of Nosocomial Clostridium Difficile Infection in a Health Care Facility
Váchová, Eva ; Lešetický, Ondřej (advisor) ; Bednářová, Martina (referee)
Nosocomial infections represent for the health care providers serious economical and also health complications. The aim of this thesis is a comprehensive presentation of nosocomial infections. Second part focuses on a bacteria Clostridium difficile. This thesis analyzes epidemiological situation in a particular medical care facility together with the cost of therapy. The incidence of Clostridium difficile is, despite of the worldwide increasing trend, decreasing in the selected facility. Significant differences exist among individual departments in the amount of samples collected as well as in their rate of positivity for the bacteria presence. Data collected are applied to a German pharmacoeconomic model which compares vancomycin therapy with fidaxomicin therapy. On a group of 100 patients it was proved that more efficient is, despite of its higher price, treatment by fidaxomicin because it leads to a lower percentage of recurrences and morbidity and mortality decrease.
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The issue of nursing care in patients with Clostridium difficile
ŠEDIVÁ, Ilona
Nosocomial infections, which do not often relate to the diseases are increasing nowadays. Clostridium difficile belongs to the frequent nosocomial infections and it is known as post-antibiotic colitis. The main reason of colitis is the usage of antibiotics, especially broad-spectrum antibiotics. The thesis is divided into the theoretical part and practical, as well. Theoretical part describes the division of the nosocomial infections, infection of the intestinal tract, anatomy, physiology of the intestines and infectious diarrhoeal diseases. The thesis is subsequently aimed to the clostridial infections and precautions against the spread of the disease. Practical part is aimed to the knowledge of the nurses, skills and attitude towards this issue.The thesis uses quantitative investigation and technique of the questionnaires, hidden observation of the nurses working on the selected wards and additional interviews with head nurses. The research was conducted in hospital in Tábor, a.s. The questionnaires were distributed on the surgery, orthopaedics, surgical JIP, ARO, ONP, infective ward, rehabilitative ward, TRN, cardio JIP, internal ward-cardio, internal ward-gastro. The thesis was formed from 143 questionnaires and 171 questionnaires were distributed. Hidden observation was made by head nurses from individual wards and it was logged to the relevant observation sheets.From existing findings we can say that there exist specifics of nursing care at the patient with the clostridium difficile. Among to these specifics we can cite the barrier nursing care where we can include the isolation of the patient, disinfection and hygiene of hands,using protectors, appropriate usage of laundries and infectious waste, location of the patient according to the epidemiological perpective and individualization of the tools for the patients. From another investigation ensue that the nurses keep barrier nursing care, superficial disinfecion, decontamination of the tools. From the results is evident that the nurses do not know the methods of the transmission of the clostridial infection. On the base of another investigations we have found out that the nurses do not know principles of the barrier nursing care. In conclusion is it possible to say that the nurses do not have so extensive information, that are essential for care for the patiens with clotridium difficile. In order to care for these patients in right way is neccessary to know principles of the barrier nursing care and keep them all. Keeping the principles of the barrier nursing care is crucial step in preventing the transmission nosocomial infections. The results will be provided to the officials of the individual hospital´s wards as an option of improvement in caring for the patiens with clostridial infection. The results were partially presented at a conference in Tabor´s hospital in May 2014. We recommend to re-train the staff of the hospital, which would be specifically aimed towards the principles of the barrier nursing care and towards the disinfection and decontamination in related to the nosocomial infections. On the base of these findings was made a proposal of the nursing care standard, which would specify and unite the care for the patiens with clostride infection. Subsequently, it would be apropriate to repeat the research in 1 2 years and than both researches compare together.
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Comparison of sensitivity of Bacillus subtilis and Clostridium difficile against selected chemical ingredients.
Šlitrová, Barbora ; Ing.Veronika Holá, Ph.D. (referee) ; Omelková, Jiřina (advisor)
Sporicidal activity of disinfectants is tested on Bacillus subtilis spores according to ČSN EN 13704 standard. Until December 2007, 10 countries encountered outbreaks and 7 additional countries had endemic cases of Clostridium difficile-associated disease due to hypervirulent strain C. difficile PCR ribotype 027. This outbreak of CDAD with increased severity and mortality is spread as typical nosocomial infection. Clostridium difficile spores can persist on dry surfaces for 5 months. Therefore it is important to compare the effectiveness of disinfectants on both strains and find out whether Bacillus subtilis is the only proper microorganism for testing the sporicidal activity.
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Possible Diagnosis for Clostridium Difficile and Its Toxins in Písek Hospital, a.s.
HRDLIČKOVÁ, Jana
At present, nosocomial infections, i.e. infections connected with the health care, are a serious issue in all hospitals. These infections also include intestinal infections caused by Clostridium difficile. Clostridium difficile is a movable, anaerobic gram-positive rod, which is able to form spores. It may be found in the intestines of about 5 % of healthy adults. Toxigenic strains of Clostridium difficile generate two thermolabile protein toxins, enterotoxin (toxin A) and cytotoxin (toxin B). With these toxins, it may cause intestinal infectious disease of various severity, which may occur as trivial diarrhoea or as a life-threatening condition. In literature, the disease is referred to as Clostridium difficile infection (CDI) (Beneš et al., 2014a). The disease belongs to infections connected with health care and it often occurs as a result of previous treatment with antibiotics. In recent years, the number of CDI cases reported in the Czech Republic has apparently increased. 303 cases were reported in 2008 compared to 4 097 cases in 2014 (Pokorná, 2015). The aim of the thesis is to consider whether the method(s) applied for CDI diagnostics in laboratory in Nemocnice Písek, a.s. are sufficient or whether another method should be implemented. Laboratory procedure was compared with recommended procedures. Using qualitative, immunochromatographic method, the presence of clostridium glutamate dehydrogenase as well as the presence of toxins A and B were demonstrated. The results were utilized for statistical purposes and determination of hypotheses. Obtained data were calculated by means of Chi quadrate test in order to define the achieved level of severity. My assumption is that the recovery of Clostridium difficile and its toxins increased in Nemocnice Písek, a.s. in 2014 compared to 2013. I presume that patients over 65 years of age are more sensitive to CDI than patients up to 65 years of age (Beneš et al., 2014b, p. 58). Representation of genders in my setting in 2013 and in 2014 was also focused on as well as positive results of men and women. Method applied to diagnose CDI in Písek hospital is sufficient. In total, 240 samples were examined in 2013, out of which 209 were negative, i.e. 87.1 %, and 31 samples were positive (12.9 %). Total number of men was 132 (55.0 %), number of women was 108 (45 %). In 2014, 195 samples were examined in total, out of which 169 samples were negative, i.e. 86.7 %, 26 samples were positive, i.e. 13.3 %. In 2014, 195 samples were examined in total, out of which 122 samples were taken from patients over 65 years old (62.6 %) and 73 samples from patients under 65 years old (37.4 %). In 2013, 132 samples were taken from men and examined, out of which 19 were positive, i.e. 14.4 %. 108 samples were taken from women, out of which 12 were positive, i.e. 11.1 %. In 2014, 75 samples taken from men were examined (38.5 %), out of which 12 samples were positive, i.e. 16 %. In total, 120 samples were taken from women (61.5 %), out of which 14 samples were positive, which represents 11.7 %. Recovery of Clostridium difficile fecal samples in 2014 is similar to 2013. In my setting, patients over 65 were not more sensitive to the infection compared to younger patients. These results differ from literature stating that the incidence and severity of the disease is increasing significantly after 65 years of age. With regard to the results, I also assume that gender influences the sensitivity to CDI only slightly. For further study, larger sample of patients or longer time span for monitoring would be needed.
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Nosocomial infections and their causes.
KROUPOVÁ, Lucie
The present thesis focuses on nosocomial infections and their causes. The theoretical part summarizes information on especially the sources of these infections, the way of their transfer and the most frequent infection agents. Clostridium difficile is studied in more detail. The illness caused by this pathogen leads to the complications especially with in-patients with a previous antibiotic therapy and immuno-compromised individuals. And this is the problem the present thesis is also concerned with. The thesis also divides nosocomial infections by their clinical manifestations and contains basic anti-epidemic measures and surveillance methods. Its empirical part focuses on the description of an occurrence of select nosocomial infections in Strakonice Hospital, a.s., especially an occurrence of the Clostridium difficile pathogen and methicillin-resistant Staphylococcus aureus (MRSA).
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Laboratory diagnosis of Clostridium difficile
JANDOVÁ, Romana
Clostridium difficile toxin with production is the most common cause of nosocomial enteric infections. It causes inflammatory bowel disease called Clostridium difficile infection (CDI) of varying severity - from trivial diarrhea to life-threatening conditions such as paralytic ileus and toxic megacolon. C.difficile still escapes the attention of the general public and is in the background of other bacteria, such as MRSA. Clostridium difficile is a strictly anaerobic bacterium. It is a gram-positive rod forming an oval subterminal spores. C. difficile can produce two types of toxins - and toxin A (enterotoxin) and toxin B (a cytotoxin). Due to the toxin causes damage of the intestinal epithelium and deeper layers of the bowel wall. Into inflammatory ulceration that cover of the pseudomembrane. Some strains produce more binary toxin, whose exact function is not underwood yet. It is assumed that potentiates the effect of toxins A and B to increase their concentration. To demonstrate the CDI must remove the stool sample into a sterile tube. In the bacteriology workplace in Czech Budweis Hospital is being made direct conclusiveness of antigen and toxin by immuncgromatography method. It is a membrane-enzyme immunoanalysis for the detection of antigen - glutamate dehydrogenase (GDH) and toxin A / B. Negative result excludes GDH with high reliability clostridial infection. For confirmed CDI is considered proof toxigenic strain of C. difficile. This is evident from the result of either immunochromatography which is demonstrated both the antigen and the toxin, or identity of the gene for toxin B by PCR. If you find out in direct detection only positive antigen, the sample is sent for PCR testing to the Laboratory of Molecular Biology and Genetics. Regardless of the outcome of the immunochromatography, the microscopic specimen stained by Gram are being produce from reces. In the case of proven C. difficile toxin is carried anaerobic culture test that takes two days. For identification of accrued bacteria is used latex agglutination. This is a method in which IgG antibodies bound to latex particles specifically bind to the antigens of the cell wall. To identify the bacteria can be also used the VITEK - MS machine that uses a laser ionization method in the presence of the matrix, followed by mass spectrometry. In case of a positive culture findings Clostridium difficile is being from grown culture set sensitivity to antibiotics by E-test and disk diffusion methods For the year 2011 the Department of Bacteriology examined 291 samples of feces. 13,4 % of these samples had positive antigen and toxin in an imunochromatographyc examination; 15,1 % had a positive antigen and negative toxin and 71,5 % were negative. 74 samples was positive in C. difficile toxin. These samples were subsequently conducted to culture examination - 62,2 % were positive. Most positive samples were sent from the infectious department. It has been examined 53,6 % of women and 46.4 % of mens. Percentage of toxigenic strains of both sexes were virtually identical - 25 %. All strains were susceptible to vancomycin and only one strain was resistant to metronidazole.
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Diagnostics of Clostridium difficile as nosocomial infections in Nemocnice ČB a.s. using methods of molecular biology.
ŠTĚRBOVÁ, Denisa
Nosocomial infections caused by Clostridium difficile represent a substantial part of hospital-acquired infections in Czech hospitals. Intoxication by toxins produced by Clostridium difficile leads to serious damage to gastrointestinal tract and life of the patient may be in danger. The progress of intoxication could be quick, this is why reliable and time-efficient diagnostic methods are of great importance for efficient treatment of the patients. Bacterial toxins are not produced during the whole life cycle of Clostridium difficile. This is why it is better to detect bacterial DNA which is always present in the bacterial cells, not the toxins. In Nemocnice ČB a.s. (České Budějovice municipal hospital) I compared methods based on toxins detection (?hyplex? ClosTox? and ?hyplex? ClosTox 027? by BAG Health Care) with a method based on DNA detection (real-time PCR ?Xpert C. Difficile? by Cepheid). I found out the real-time PCR method is much quicker. It takes one hour to prepare the samples and to obtain analytical result for this method. Both tests based on toxin detection are much more time consuming. It takes up to 5 hours to complete them. I conclude the real-time PCR is much quicker analytical method and it allows Clostridium difficile detection during all life phases of the bacteria.
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