|
|
Problem of sepsis in the intensive care unit
Škrabánková, Hana ; Marková, Eva (advisor) ; Jankovcová, Kateřina (referee)
The aim of the thesis was to determine the microbial colonization at the injection site of central venous catheter and its possible influence to maintain the lowest incidence of catheter sepsis. The culture results of skin swabs and taken blood cultures from two groups of patients were compared with each other using qualitative analysis methods. Those were Intensive Care Unit patients with established central venous catheter. The result was the discovery of microbial colonization of the skin and the representation of different pathogenic strains at the site of a central venous catheter for both established groups. Further showed that the higher the risk of microbial colonization with symptoms of catheter sepsis was seen where patients have central venous catheter established for longer period of time and have been treated under home parental nutrition program with stoma. The recommendation is the continuous education of health professionals to act in accordance with the latest preventive treatment recommendations, and the emphasis is mainly placed on hands cleaning and disinfecting as the hands of health professionals are one of the most common and risky way of transmission of pathogenic strains with potential nosocomial infection formation. Aseptic principles must be repeatedly communicated to all...
|
|
|
Hemo elimination method in the treatment of sepsis and early multi-organ dysfunction
Sýkora, Roman ; Matějovič, Martin (advisor) ; Chytra, Ivan (referee) ; Maňák, Jan (referee) ; Šrámek, Vladimír (referee)
The most common cause of death in patients with sepsis/septic shock is deterioration of the function of multiple organs, termed multiple organ dysfunction syndrome. Although our understanding of mechanisms involved in the pathophysiology of sepsis-induced tissue damage has improved substantially, therapy of these syndromes still remains largely supportive. The hallmark of sepsis is an overwhelming systemic production of both pro- and anti-inflammatory mediators leading to generalized endothelial and epithelial damage, microcirculatory-mitochondrial distress, altered endocrine and coagulation homeostasis and cellular immune hyporesponsiveness. Therefore, the hypothesis that modulation of this excessive immunological and biological response to infection might improve patient outcome appears reasonable. Hemoelimination techniques represent biologically plausible way to provide non-specific removal of soluble pro- and anti-inflammatory mediators, although the concept of blood purification in sepsis remains a matter of considerable debate. The aim of this thesis was to elucidate effects of 1) high volume hemofiltration (HVHF) and 2) coupled plasma filtration adsorption (CPFA) in a long-term, hyperdynamic porcine septic shock model, which fulfils the criteria for human sepsis. We hypothesized that both HVHF and...
|
|
|
Bacteriological examination of blood cultures
MAJEROVÁ, Natálie
The aim of this bachelor thesis is the introduction of possibilities of hemoculture examination, assuming the methodology of evolving the manual and automated hemocultures in tha Stafila laboratories and at the Department of Bacteriology in the Hospital of České Budějovice. Then it deals with the comparison of those two systems and learning the basic interpretation of results. In the theoretical part I focus on blood circulation infections, sepsis and its diagnostics and nozocomial infections.The last part delas with the most frequent bacterial causers of blood circulation infections. The practical part focuses on the approach of hemoculture process, firstly on the preanalytic part which includes the sample collection and its transport. Secondly there is the analytic part where cultivation bottles are described as well as the basic methods for bacteria certification such as making the microscopic sample and bacteria cultivation. The next part delas with the determination of a bacteria kind and its antibiotics sensitivity.In the last part there are results of cultivation of the followed up file from the both methods. Positive findig occuresd in 15% of taken hemocultures.
|
|
|
Microbiological examination of blood cultures by automated system BACTEC
VANIŠOVÁ, Petra
Objective: The aim of this work is to describe a presence of pathogenic microorganisms in bloodstream that could possibly threaten the health and life of a patient. Using an automated microbial detection system Bactec we have detected bacteria or yeast that partake on an extension of a sepsis in given area, we have also compared results with special literature. We have evaluated the percentage of contaminated samples trying to point out the importance of a correct material sampling and also the importance of the level of education of the medical staff. After comparing samples in the cell culture medium we have used control skin smears. We have also marked the period of time for which the cultivation occurred since it is an important factor in the restoration of a patient and lowers the cost of a prospective treatnent. The method: In contrast with the theoretical section of this this work, the practical part is focused on laboratory samples preparation and actual analysis, including identification of the microorganisms, using microscopic, cultivation and biochemical techniques. For the detection of infective agents in blood culture we have used automated microbial detection system BACTEC 9050 which uses fluorescent sensor for the registration of CO2 creation. Carbon dioxide reacts with water and creates acid. This chemical process is followed with the descrease of pH. The content of a positive aerobic vial is vactinated for the right cultivation broth. Microbial groth is then evaluated after 17 to 24 hours in thermostat, followed be antibiotics sensitivity tests and then the optimal treatment is determined. The result: We have colected 1643 samples, 1359 of which did not show any pathogenic species. The work deals with findings inside of 284 samples which the machine marked as positive. The most common was Escherichia coli. The second place in quatity was represented by Klebsiella pneumoniae. The majority of bacteria were gram-negative (72 %). Sample contamination occured in 4.7 % of all samples and was connected with sampling errors. The conclusion: There is an annual growth in bloodstream infections that are also connected with a high percentage of death possibility. Blood cultivation examination with a use of automated systems is crucial for quick and precise detection of microorganisms.
|
|
|
The problem of blood collecting for testing blood culture.
NOVÁKOVÁ, Olga
Current situation: Blood culture is intended to detect infection in the bloodstream. Increasingly today, complications of diseases like toxicemia, bacteremia and sepsis occur.Diagnosis of sepsis is not easy and blood culture plays an irreplaceable role. Blood sampling for blood culture is one of the technically challenging and time-consuming procedures, and these samples must be perfectly controlled by the nurses.Point of interest: Risk factors identification that may affect the results of blood culture relating to the collection of blood cultures was the main aim of the research. Determination of nurses' knowledge and compliance with the recommended procedures for collecting blood cultures, and identifi cation of the most frequently committed sisters' errors was the main objective.Participants: The research sample was chosen on purpose, with respect to the research problem. Group consisted of nurses working in the Department of Infectious Diseases in Hospital České Budějovice.Results: The recommended procedures of blood culture collection and risk factors that affect the result of blood culture are reviewed.The results of observations showed the errors of nurses taking blood culture are most often perpetrated.Nurses' knowledge is sufficient regarding the recommended sampling procedure and rules characterizing this collection, as detected by conducting interviews. Nurses are apprised with the procedure, and are able to justify different methods.Conclusion: Patients' lives could be saved by the correct diagnosis of bloodstream infections. The nurses have a high responsibility to perform their procedures in accordance with the sandards possible to eliminate risk factors that may affect the outcome of blood culture examination. The outcome of this work is to identify the most common errors made by the nurses and to propose preventive measures that would eliminate exposed areas of risk. The errors may be caused by ignorance, the automated process and also different time and mental pressure in patient care.
|
|
|
Specifics of feed nutrition to patients in acute and septic state
HOLOUBKOVÁ, Martina
This bachelor thesis describes specifics of nutrition for patients in acute and septic state. It is aimed at improvement of awareness and information of nurses that care about these patients, on the problems of malnutrition and possibilities of specific nutrition. The theoretical part describes malnutrition - imbalanced diet, as a risk factor that complicates the course of disease, extends the hospitalization time and increases mortality. There is also an outline of cooperation with nutrition specialists, diet recommendations and methods of feeding patients in acute disease stage. Enteral end parenteral feeding is analyzed here. The conclusion of the theoretical part deals with the organism inflammatory response syndrome, sepsis, multiorganic dysfunction, like complications threatening a patient in acute state. There are also diet recommendations for patients in septic state. The practical part of this thesis contains results of quantitative research based on data collection by means of an anonymous questionnaire designed for nurses or healthcare rescuers of anaesthetic-resuscitation departments and intensive care units. A nursing care standard focused on assistance in introduction of central venous catheter and consequent patient care was elaborated as the output of the work upon study of the issues of nutrition for patients in acute and septic state, specific possibilities of its administration and evaluation of the research results. The bachelor thesis may also be used as study material for education of healthcare staff caring about patients in acute or septic state.
|
|
|
Investigation of blood cultures
ŠINDELÁŘOVÁ, Radka
Bloodstream infections are among the most serious pathologies with often severe or even fatal course, and therefore the microbiological testing blood cultures is very important. Bloodstream infections caused by various microorganisms - bacteria, viruses, parasites and fungal agents. Each of them in the organism induces a different response and clinical course. The aim of this work was to ascertain the possibility of investigating bloodstream infections, appropriate the technique of treatment of blood cultures in the laboratory of bacteriology in České Budějovice Hospital, Inc. and based on the results determine the percentage of positivity for the months of September and October 2012 and which agents and with what frequency was from the positive blood cultures catched. The theoretical part deals with the explanation of basic concepts that are associated with bloodstream infections and their complications. I also explore the possibilities of investigation in other laboratory branches - biochemistry and hematology which are also very important for the diagnostics of this infections and their importance is especially in speed of obtaining results. The main examination is the clinical microbiology one where culturing agents that cause these diseases, the rapid identification and determination of susceptibility to antimicrobial agents leads to accelerated and targeted therapy. The last section of the theoretical part I dedicated to individual agents that can cause bloodstream infections. The practical part describes the procedure by which blood cultures were processed. At first, I describe the pre-analytical sample testing, which is very important. Here is included the sampling and sample transport to the laboratory. Medical personnel, which take the sampling, should be duly lessoned how to act during the sampling to avoid contamination of the sample, so the patient was not been needlessly prescribed antibiotics. The actual analysis of the examination were performed in blood cultures system the Bact/ALERT 3D bioMerieux, whose principle is based on the colorimetric detection of CO2, arising from the growth of bacteria. If the unit is assessed positively, blood cultures bottle was further processed - inoculated on solid media and microscopic specimen was taken. The research results are displayed using simple statistics in graphs and a chart. From the assignment of the percentage of positivity, that are depicted in the graphs, the result for the months of September and October of 2012 is 17%. Another objective was to determine the isolated agent. These results are in a chart where I put the number of their representation and their relative frequency. The most common were isolated: Escherichia coli, Staphylococcus epidermidis, Staphylococcus hominis, and Staphylococcus aureus. The results, which I reached in this work, are similar to the results in the international literature. The occurrence of Escherichia coli and coagulase-negative staphylococci is presented in the frequency of incidence of agents isolated from the blood cultures in the first place. During the isolation of coagulase-negative staphylococci should be considered their incidence as a possible contamination of the skin flora in case of the taking of blood cultures. During the practical part of the thesis I was closer acquaint with the operation of bacteriological laboratories and methods of its work including techniques of blood cultures processing. These activities are the necessary part of diagnostics of infectious diseases and treatment of the patient.
|
|
|
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.
|
|
|
Laboratory markers of sepsis
OCHOZKOVÁ, Šárka
Sepsis and its complications are currently the most frequent cause of death owing to multi organ failure at intensive care units. The aim of this thesis was to evaluate the most suitable usable marker with sufficient diagnostic sensitivity and specificity for early catch of sepsis development. For my thesis a chosen data collection patients of intensive care units and patients of neonatology department in Nemocnice a.s. (Hospital Inc.) in České Budějovice was used. In patients, determinations of following concentration parameters were carried out: PCT, CRP, IL-6. For diagnosis and evaluation of clinical state change in relation to sepsis PCT is convenient. For monitoring of steady course and clinical state it is useful and sufficient to watch dynamics of CRP. In newborns the sensitivity PCT decreases in sepsis probably due to immaturity of liver and immunity system. That is why according to experience gained in Nemocnice a.s. (Hospital Inc.) České Budějovice it is more convenient to determine IL-6 instead of PCT.
|
|
|
Use of Procalcitonin Levels Measurement in Diagnosis and Prognosis of Septic States.
PAVLÍKOVÁ, Lenka
The Master thesis gives an overview of sepsis, its causes, manifestation and diagnostics. The role of procalcitonin as a sepsis marker is dicussed. In the experimental part, case records of 106 were examined and the determination of procalcitonin as a sepsis marker was evaluated. Based on the evaluation, a recommendation about timing of the procalcitonin level analyses with septic patients were made.
|
guest ::
