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Epidemiological situation of scabies incidence in the Czech Republic within period 2003 - 2012
KUCHAŘOVÁ, Eliška
Theoretical part of dissertation was written on the basis of studying professional literature. It provides overview of Scabies disease, its epidemiological incidence, transmission, clinical course, diagnostics and also of its treatment. Practical part was formed retrospectively by qualitative research and secondary data analysis. These data were collected from different publications from the State Health Institute in Prague and the Health Information and Statistics Institute in the Czech Republic. The main aim of this dissertation was analyzing the trend of scabies incidence in the Czech Republic within ten years period (2003 2012). Moreover the practical part of this dissertation contains information related to trends of scabies incidence in individual districts of the Czech Republic depending on age, sex, team, seasonal index, or epidemiological scabies incidence as occupational disease. Linear regression was used to assess the incidence trend. Subsequently correlations were ascertained by using method of correlation coefficient calculation. In the research it was found that registered scabies incidence seems to more likely be decreasing from the beginning of followed period (i.e. from the beginning of 2003). According to the seasonal index the most common incidence of this disease within followed period was in October. On the other hand the lowest scabies incidence was in June. The highest sickness rate was recorded in the district Ústí nad Labem with almost 50 cases per 100 000 inhabitants. Scabies as occupational disease belongs to the most common recorded transmissible and parasitic disease in the Czech Republic, mainly at nurses in the hospitals, attendants in retirement homes, in internal wards and in social care institutes. The highest incidence rate was notified in age categories from 5 to 9 years. There exists strong positive linear correlation between scabies incidence and age. Epidemiological scabies incidence in the Czech Republic had two main peaks during period 1965 2012, in 1970 and 1993.
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The comparison of nursing care for clients with MRSA at the ICU and standard unit
AMBROŽOVÁ, Martina
This thesis deals with one of the most important multidrug-resistant infection ?MRSA. Methicillin-resistant Staphylococcus aureus (MRSA) is a nosocomial pathogen that has the ability to spread very fast. Infections caused by MRSA are always associated with high mortality. An antibiotic resistance is a reason for twice increased morbidity, it prolongs hospitalization of patients, thus significantly increases the costs of health care (European Antibiotic Awareness Day, 2012). The costs spent for the prevention of multidrug-resistant infections represents less than 20% of the cost needed to treat patients suffering this infection. Among the risk factors associated with the emergence of MRSA infection or its carriage include a long stay in the hospital, especially the ICN, invasive procedures, antibiotic treatment, diabetes mellitus, chronic renal failure associated with dialysis, and skin disease. There is a usual transfer by hands of nursing staff, but the transfer via the air can not be excluded (Maďar et al., 2006).There were set four objectives for the study. The first goal was to determine whether there are differences in the principles of barrier nursing care for patients with MRSA in hygiene, eating, emptying and the re-bandaging at intensive care units (?ARO? and ?JIP? departments) and standard units. The second objective was to map the availability of protective equipment for staff in particular departments. The third goal was to find out differences in knowledge of the nursing staff on the issue of MRSA at various departments. The fourth objective was to determine how the various departments involve families of the patients with MRSA in the treatment process.Study conclusions show differences between particular intensive care departments. There is the best provision of barrier nursing care at the ICN ? ARO in all explored parts. The research found there is the possibility of isolating patients with MRSA on a separate stall or room in all departments. There were deficiencies in barrier nursing care related to ICN ? JIP and standard units. Than survey found out there are some standard units and ICN ? JIP, where there are used decolonization neither in health care and nor in re-bandaging of patients with MRSA. In the case of specific nutrition of a patient with MRSA there are not properly distinguished and disinfected used tools in these departments. Regarding the specifics of emptying of patient with MRSA there are usual mistakes made by respondents from ICN ? JIP and standard units in the procedure of handling infectious biological waste. A positive result is unlimited availability of protective equipment for particular departments. However, there are the standard units where the use of protective equipment involves gloves only. Startling finding is the washing of hands before entering the room and after leaving disinfectant respondents from ICN ? ARO only. The knowledge of respondents on the issue of MRSA were at a very good level except one respondent from the standard department. There is an effort to involve the family in the treatment process in all departments. According to all respondents there is a great irreplaceable importance of the family during hospitalization of the patient.
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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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Monitoring Nosocomial Infections in the District Hospital
VOJÍKOVÁ, Lucie
The Diploma thesis provides basic information about the incidence of nosocomial infections, especially about the process of spreading infections, their subdivision according various aspects, major means of nosocomial infections, and about methods of surveillance. Investigative part of the thesis is aimed to describe the incidence of nosocomial infection, which can be used as quality indicator of hospital care, including the spectrum of the most frequent etiological microbial agents and their resistance against antibiotic treatment. There were used mixed research methods to process the investigative part of the thesis because the methods were quantitative and qualitative. The analysis of the data represents main part of the thesis. The research was carried out in the district hospital, namely in The Hospital Strakonice, a.s.. There were monitored infections at operation sites, between Jan 1, 2011 and Dec 31, 2011 at the surgical and gynaecology units. There were also monitored infections of the blood stream between Jan 1, 2009 and Dec 31, 2011 at all departments. The research group was formed by inpatients staying in The Hospital Strakonice, a.s., who were after surgical procedure or those, who were catheterized central blood stream in defined time period.
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Nosocomial infection occurrence in patients receiving mechanical ventilation
HOMOLKOVÁ, Lenka
The thesis deals with the most frequent nosocomial infection in the intensive care, the ventilator-associated pneumonia. The main purpose of the thesis was to raise nurses? awareness of this hospital-associated infection. It concentrates particularly on possibilities of prevention from this infection. The thesis consists of a theoretical part and a research part. As the ventilator-associated pneumonia occurs in connection with the mechanical ventilation the introduction to the theoretical chapter deals with the basic terms related to mechanical ventilation. It concentrates on the description of reasons for mechanical ventilation and the ways of its application by nurses during the care of patients receiving mechanical ventilation. The subsequent part deals with nosocomial infections, the factors conditioning the occurrence of nosocomial infections, nosocomial infections in the intensive care and the ways of prevention from these infections. The part following the introduction to mechanical ventilation and nosocomial infections deals with the nosocomial infection associated with continuous mechanical ventilation, the ventilator-associated pneumonia. It describes the disease pathogenesis, factors conditioning its occurrence, diagnostics, treatment and particularly the ways of prevention from this disease. The research part of this thesis contains the results of the quantitative research based on the data gathered by means of an anonymous questionnaire targeted at the nurses at the anesthesiology and resuscitation department and by subsequent monitoring of the nurses. The research also included monitoring the nurses at work. In order to complete the thesis five objectives were outlined and six hypotheses were constructed. The aim of the objectives was to investigate how the nurses care of a tracheostomy and the pulmonary toilet of respiratory tract in patients receiving mechanical ventilation, how they maintain the ventilator and its components. The investigation also concerned the nurses? awareness of the aseptic techniques during the treatment of the respiratory tract and the ventilator. The aim of the last objective was to investigate the ways of prevention from the occurrence of nosocomial infections in patients receiving mechanical ventilation at individual workplaces. Concurrently the following hypotheses were constructed: H1 ? nurses perform the tracheostomy under aseptic conditions; H2 ? nurses perform the pulmonary toilet under aseptic conditions; H3 ? nurses observe the aseptic techniques when maintaining the ventilator; H4 ? nurses are informed about the aseptic techniques during the care of tracheostomy; H5 ? nurses are informed about the aseptic techniques during pulmonary toilet; H6 ? nurses are informed about the ventilator maintenance. On the basis of the knowledge of the issue and the results of the research the output of the thesis was realized in the form of a nursing care standard aimed at the suction of the lower respiratory tract. The second output of this thesis is a poster with ways of prevention from the ventilator-associated pneumonia designed simply to motivate nurses to observe the preventive measures.
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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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Adherence to Health and Safety Regulations on the Part of the Students of General Nursing during Nursing Procedures.
KUŘÍMSKÁ, Yvette
Occupational safety and health is a broad area which makes part of a state policy. The aim of OSH is to make a system of rules protecting students gaining working experience, employees and employers. It endeavours to limit all negative aspects related to work performance or occupation. Observance of OSH rules is an indispensable part of work performance of all medical workers. That also applies to students of the study field General Nurse while performing their practical training, thus practice. Students get acquainted with the OSH issues in the first grade of studying in a subject called treating / caring procedures. Before taking up practical training they should be able to follow the OSH rules and understand consequences linked to their non-observance. The aim of this diploma thesis is to chart how the students of the field General Nurse keep the OSH rules and find out students´ knowledge in this area. The empirical part was carried out in a form of quantitative investigation. A questionnaire was used as a method to collect data and was meant for students of the second and third grades of the General Nurse study field. Results were compiled into graphs. Results of survey confirmed that the students keep the OSH rules. However, in the area of personal hygiene they are considerably irresponsible. Their knowledge concerning OSH is very good and the students are informed well. Based on the results a leaflet has been created and may be used as study or information resource for students of medical fields of study.
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The effekt of accreditation on the quality of health care providet in selected medical facilites.
SOMROVÁ, Jana
The quality of nursing care is becoming an increasingly important concept in contemporary nursing. The most effective means of achieving quality of nursing care and the means of proof is the accreditation of medical facilities. It is a significant appreciation of professionalism, the work of health professionals and an important signal for the patients. Quality of care, security of supply and preventing potential risks for health care priority. The main aim of the thesis "The influence of accreditation on quality of care in selected health facilities" was to map the set of quality management and impact monitoring and evaluation of quality indicators in hospitals accredited by the Czech Republic. To determine whether accreditation has become an instrument to ensure comparable quality, and time has changed from an unpopular instrument into an instrument for continuous quality improvement. The survey took place from November 2010 to March 2011 in the form of quantitative data collection using an anonymous questionnaire survey in selected hospitals accredited by the Czech Republic. In the research study were asked managers of nursing care, main, upper station and sisters. The thesis has been established 6 goals. The first objective was to determine what indicators of quality nursing care in accredited hospitals pursue. Interested in us as quality indicators that were studied before accreditation, and quality indicators to setting up medical facilities in preparation for accreditation. The second objective was determine how frequently watched indicator of quality is monitored in hospital. The third objective was to determine whether there was in accredited hospitals to reduce adverse events - falls. The fourth objective was to determine whether there was in accredited hospitals to reduce the incidence of nosocomial infections in complying with barrier nursing regime. The fifth objective was to identify the biggest problems arose during the implementation of audits, completeness and comprehensiveness of nursing documentation management into practice. " The sixth objective was to determine whether there was during the preparation of an increase in hospital nursing staff. The thesis then was examined six hypotheses. First hypothesis Accredited hospitals monitor the quality of care provided by at least ten quality indicators - were confirmed. Hypothesis 2 The most frequently monitored indicator of the quality of nursing care, the prevalence of pressure ulcers - was confirmed. All respondents said they monitor the prevalence of pressure ulcers as an indicator of quality nursing care. Hypothesis 3 gaining accreditation to reduce the incidence of falls - was confirmed. Hypothesis 4 obtaining accreditation decreased nosocomial infections - was confirmed. Hypothesis 5 The biggest problem in implementing the audit, management complexity and completeness of nursing documentation in practice "has been an increase in paperwork for nursing staff - were confirmed. Hypothesis 6 During the preparation for accreditation has been an increase in nursing staff - has not been confirmed. Accreditation is perceived by respondents as beneficial for the hospital. Due to accreditation standards and developing quality indicators were identified risk areas in the provision of hospital care and detail can be paid to the prevention of adverse events, nosocomial infections and other risks. The results of work will be to provide medical facilities where the research was conducted investigation, the presentation of the research will be presented at a conference, the South Bohemian nursing days "and also gives the United Accreditation Commission of the Czech Republic as a presentation at the conference to be held early next year (spring ) 2012th Nursing standards were created.
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Barrier recovery system at the occurrence of nosocomial infections in the department
JAREŠOVÁ, Marie
Infections acquired during a treatment in a hospital or healthcare service unit are called nosocomial infections. Their history goes back to the first institutions where patients were gathered. To prevent nosocomial infections, so called barrier nursing is used. It is a set of procedures aimed at preventive measures to avoid the appearance or transmission of the infection. The awareness of observing all rules connected belong to the essentials. The aim of the Bachelor work was to find out if general nurses who work in in-patient hospital wards are aware of nosocomial infections. They were interviewed about barrier nursing rules and their observing. The survey was carried out in the hospitals in Písek and Strakonice. There were 110 anonymous questionnaires distributed and 90 of them were given back. All data were compiled and the findings were depicted in a graphic form. Two hypotheses were set at the beginning: Hypothesis 1: Nurses are familiar with barrier nursing regime rules and their use while nosocomial infection appears at the wards. Hypothesis 2: Nurses respect the rules when nosocomial infection appears at the wards. Both hypotheses were confirmed. The analysis of the data acquired from the questionnaires resulted into the finding that the nurses were keeping abreast of nosocomial infection prevention. The nurses are likely to attend seminars as a part of preventive measures of nosocomial infections. All findings will be offered to the management of the hospitals where the survey was carried out.
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Sepsis in intensive care, precautionary measures on the part of nursing personnel and department management
JANOUŠKOVÁ, Ludmila
Sepsis represents a serious medical, but also social problem. Hundreds of thousands of patients die from serious sepsis and septic shock every year. Patients with serious sepsis are treated at intensive care units and their treatment is long, costly and low efficient. These are the reasons why prevention of sepsis focused on prevention and effective treatment of nosocomial infections or timely solution of another problem, e.g. a shock is so much stressed. Nosocomial infections affect about 30 per cent of patients at intensive care units and may cause serious diseases, sepsis or even death. This thesis deals with the possibilities nurses have to influence sepsis, particularly by adherence to aseptic procedures and prevention of nosocomial infection, which might consequently develop in nosocomial sepsis. Combination of quantitative and qualitative methods was used for the research. There were two goals set for the quantitative research. 1. To find whether obstacles occur in adherence to proper aseptic procedures in nursing work as prevention of nosocomial infection occurrence and subsequent septic conditions in patients hospitalized at intensive medicine workplaces. 2. To map the weak points in adherence to proper aseptic procedures in nursing work in intensive care. The goals led to hypotheses H1 Obstacles obstructing thorough adherence to proper aseptic procedures in nursing work exist in intensive care. H2 Non-adherence to aseptic procedures occurs in nursing work at intensive medicine workplaces as a consequence of lack of time for particular interventions. The research sample consisted of nurses from the intensive care workplaces ARD and ICU from 8 hospitals. Questioning method through the questionnaire technique was used for data collection. 342 questionnaires were distributed in total. Hypothesis 1 was refuted, hypothesis 2 was refuted. We found that no obstacles obstructing adherence to proper aseptic methods occur, we mapped the weak points in adherence to proper aseptic procedures in nursing work in intensive care. There were two goals set for the qualitative research. GOAL 3 To find what measures preventing occurrence of nosocomial infection and subsequent septic conditions in patients hospitalized at intensive medicine workplaces are taken by department managements. GOAL 4 To find out how department management deals with possible occurrence of nosocomial infection and subsequent septic conditions in patients hospitalized at intensive medicine workplaces. The following research questions were set. 1. What are the measures preventing occurrence of nosocomial infection and subsequent septic conditions in patients hospitalized at intensive medicine workplaces taken by department managements? 2. How does department management solve possible occurrence of nosocomial infection and subsequent septic conditions in patients hospitalized at intensive medicine workplaces? The research sample consisted of 5 departmental nurses and 5 head nurses from intensive care workplaces from the same hospitals where the quantitative research took place. The research was performed by semi-standardized interview. The research questions were answered. A manual for nurses called ?Recommendation for nurses in prevention of nosocomial infection and nosocomial sepsis not only at intensive care units? was elaborated upon study of these issues and the performed research. A thought map for department management illustrating prevention and solution of nosocomial infection and nosocomial sepsis was also elaborated. Both the document and the research results will be provided particularly to the managements of the hospitals that took part in our research. The thesis may also be helpful to nurses, students and other interested people to gain overall insight into the issue.
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