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Nursing care of vascular access focused to prevention of catheter sepsis
Prošková, Michaela ; Heczková, Jana (advisor) ; Chvojková, Kateřina (referee)
Ensuring the bloodstream is one of the most frequently indicated invasive procedures, especially in the pre-hospital emergency and intensive care. All invasive inputs are nowadays an integral part of intensive care. Despite careful daily care, vascular accesses are at risk of complications, which annually effects many patients institutionalized at intensive care units. Catheter sepsis is undoubtedly one of the most serious. Although a significant proportion of these infections are considered highly preventable, they still contribute to high morbidity and mortality among these patients. The aim of this diploma thesis is to analyse nursing care for vascular inputs. One of the partial goals is to evaluate and compare the relevance of the nursing standard of a medical facility with scientific knowledge and current recommendations of professional societies. The research method is a quantitative questionnaire survey focused on nursing staff working in the Department of Anesthesiology and Reanimation. The analysis of the vascular inputs re-dressings was performed in patients hospitalized in the same ward, where the research itself took place. The results of the research survey show a discrepancy between the given procedure in the nursing standard and common practice in the ward. In view of the...
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Antibiotic prophylaxis of extensive obstetric perineal injuries repair
Menzlová, Erika ; Záhumenský, Jozef (advisor) ; Procházka, Martin (referee) ; Roztočil, Aleš (referee)
Objective Our aim was to compare two regimens of antibiotic prophylaxis at the time of repair of obstetric anal sphincter injury. Benefit of long regimen of antibiotic prophylaxis in comparison with short regimen of antibiotic administration haven't been till now proven. Material and Methods Women who gave vaginal birth in department of gynaecology and obstetrics of the First Faculty of Medicine of Charles University and Hospital Bulovka from 1.1.2008 to 30.6.2013 and who sustained third - or fourth - degree perineal tears have been enrolled in our trial. All women who fulfilled trial criteria received at the time of repair antibiotic prophylaxis which was cefuroxim (second - generation cephalosporin). This antibiotic has good sensitivity to vaginal gram-positive flora and to rectal gram-negative microorganisms too. Suture technique and following postpartum care have been standardized. All enrolled women were checked 2 weeks and 3 months after delivery. We evaluated subjective and objective parameters of healing of the obstetric perineal injury and 3 months postpartum we looked for symptomps regarding anal incontinence. The Manchester questionnaire was used for evaluation of anal incontince occurance. Results Incidence of third - and fourth - degree perineal tears was 1,4 % during period of our...
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Urinary tract infections by community and nosocomial strains
RAFAJOVÁ, Michaela
This thesis deals with Urinary tract infections. It includes information about pathogenes, methods of their identification and treatment. The goal of this thesis is observing of pathogen species representation that cause infecion in community and in hospital (includes hospital infections) and observing resistence to five most common antibiotics for Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis.
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Nursing care measures in the prevention of ventilator-associated pneumonia
Kukol, Václav ; Heczková, Jana (advisor) ; Feixová, Dagmar (referee)
The thesis is focused on ventilator-associated pneumonia and its possible preventive measures during nursing care. In the theoretical part of the work we have included chapters on nosocomial infections emphasizing on the etiology and epidemiology of ventilator-associated pneumonia and its clinical manifestations. We have analyzed the issues of artificial airway management with a detailed focus on the peculiarities of nursing care of the ventilated patients. There, we focus primarily on the care of the patients oral cavity, respiratory tract and the ventilation circuit. A big chapter is dedicated to preventive measures and to the possibilities of prevention in the nursing practice. The empirical part includes research on preventive measures that are implemented in practice and comparative analysis of the measures between different facilities as well as their compliance to the guidelines. We have also determined the level of VAP awareness and its prevention among the nurses. KEYWORDS nosocomials infections, nursing care, prevention, ventilator-associated pneumonia
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The possibilities of prevention nosocomial infections of urinary tract at long-term intensive care department
Jánská, Pavla ; Heczková, Jana (advisor) ; Zatočilová, Jana (referee)
The graduation theses is about urinary tract infections and the preventive care that we are able to provide within nursing care of patients with urinary catheter. The theoretical part of graduation theses includes the chapters about general introduction to nosocomial infections, as well as epidemiology, pathogenesis, diagnosis and treatment of urinary tract infections. Furthermore, it relates to their antibiotic therapy and resistence to antibiotics. The main task is the prevention of urinary tract infections. Generally I have focused on the methods of urinary catheterization and their correct indications, the materials and design of urinary catheters, as well as on nursing care of urinary catheters. The thesis includes research aimed at providing preventive measures that are implemented in practice, comparing them to each other and comparison with the current studies and recommendations.. This research provides both positive and negative results. Some of the recommendations for preventive care of urinary tract infections are being followed, other are being omitted. There are also differences between respondents from different departments as well as among the departments. Nursing care procedures are not unified despite of presence of guidelines and standard procedures. keywords: nosocomial...
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Antibiotic prophylaxis of extensive obstetric perineal injuries repair
Menzlová, Erika ; Záhumenský, Jozef (advisor) ; Procházka, Martin (referee) ; Roztočil, Aleš (referee)
Objective Our aim was to compare two regimens of antibiotic prophylaxis at the time of repair of obstetric anal sphincter injury. Benefit of long regimen of antibiotic prophylaxis in comparison with short regimen of antibiotic administration haven't been till now proven. Material and Methods Women who gave vaginal birth in department of gynaecology and obstetrics of the First Faculty of Medicine of Charles University and Hospital Bulovka from 1.1.2008 to 30.6.2013 and who sustained third - or fourth - degree perineal tears have been enrolled in our trial. All women who fulfilled trial criteria received at the time of repair antibiotic prophylaxis which was cefuroxim (second - generation cephalosporin). This antibiotic has good sensitivity to vaginal gram-positive flora and to rectal gram-negative microorganisms too. Suture technique and following postpartum care have been standardized. All enrolled women were checked 2 weeks and 3 months after delivery. We evaluated subjective and objective parameters of healing of the obstetric perineal injury and 3 months postpartum we looked for symptomps regarding anal incontinence. The Manchester questionnaire was used for evaluation of anal incontince occurance. Results Incidence of third - and fourth - degree perineal tears was 1,4 % during period of our...
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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 incidence of MRSA in Nemocncie Havlíčkův Brod during the years 2009 - 2013
KOUDELOVÁ, Šárka
Staphylococcus aureus is a gram-positive bacteria living in one third of human population as a natural skin microflora, nasal flora in particular, where in majority of cases this bacteria does not evoke any reaction. In some cases, however, S. aureus may cause severe health issues, ranging from minor festering disease to severe sepsis, which can even lead to death (Votava, 2010). Major problem occurs while the individual is infected with Methicilin-resistant Staphylococcus aureus (MRSA), as this type is resistant to majority of antibiotics, making its treatment more difficult and financially demanding. The biggest danger associated with MRSA lies within its high presence in medical centres and hospitals, which is one of the reasons responsible for its rapid spread in whole population. In other words, there is a high volume of individuals, who are infected from those regularly present in affected areas, but without symptoms of infection, such as hospital staff, other patients etc. In the theoretical background section of this thesis, author discusses the following topics related to the area of research: general information about S. aureus - taxonomy, cell structure, details of diseases caused by this bacteria, factors of virulence, resistance to antibiotics and detection of type. In addition, author focuses on MRSA, in particular in its role as a source of nosocomial infections. Moreover, the work takes interest in anti-epidemic solutions that should be put into practise in order to decrease and eliminate the spread of MRSA. To link this theory with the practise, author explores the internal anti-epidemic policies of Havlickuv Brod hospital in the final part of this study. The actual research part of this study took place within Havlickuv Brod hospital in 2013.Hypotheses made by the researcher suggest presence of S. aureus between 2009 and 2013. Research points out to the existence of MRSA in clinical material as well the detection of MRSA in routine laboratory. The results of the study indicate that both S. aureus and MRSA are evident in the studied hospital. Data collected during the research are consistent with the hypotheses, as the data, assorted into tables in results section of the study demonstrate existence of S. aureus and MRSA in the Havlickuv Brod hospital within the five period of research. Furthemore, an antibiogram of MRSA-positive patients divided into types of hospital-asociated and community-asociated has been designed on the basis of laboratory data. The final part of the results section considers the detection of S. aureus and MRSA results from routine laboratory. As the presence of MRSA in the studied hospital is insignificant, its detection has been conducted on the basis of sample groups, from upper respiratory tract samples, thanks to which the research has been able to identify S. aureus as a part of microflora, and MRSA as an example of presence of asymptomic infection. In regards to the methods carried out by researcher, as the laboratory used was not equipped with PCR, the types of MRSA have been identified using disc diffuse test. Such method is more timely consuming, nevertheless as there was a low presence of MRSA in the research area, this method served its aim with reliability comparative to PCR. The Discussion section of the thesis consists of the summary of results, where the author comments on the results and data collected in this research, and analyzes their significance in comparison with the data collected in the past. Results are also discussed in relation to the hypotheses made by the research prior to the study.
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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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Attitude of nurses to barrier nursing care on department of Infectious Diseases and on other departments of Internal Medicine
MOTLOVÁ, Anna
This bachelor's thesis deals with the nurses' approach to the barrier nursing care in the isolation ward and in other wards of internal type. The barrier nursing care is a system of work and organization measures which prevents the creation of nosocomial infections and the transmission of pathogenic germs in hospitals or social facilities. The nosocomial infection is an infection occurred in the direct connection with the patient's stay in the relevant facility. The barrier nursing method is a preventive measure which protects the sensitive individuals from the formation of the nosocomial infection. This method has to be respected by every medical worker without regard to the ward type. The most frequently occurring disease caused in connection with the stay in a hospital facility is the MRS A infection or the Methicillin-resistant Staphylococcus aureus. The barrier care is a complex of many methods including the sterilization, isolation of infectious patients, personal treatment of the staff, treating of the diseases of the medical staff, hygienic hand wash and the following hand disinfection. In the internal type ward, patients with diseases of internal organs are hospitalized. This ward type counts among the most basic wards of a hospital facility. The isolation ward is very specific because here, the patients with an infection disease or with a justified suspicion of such a disease are hospitalized. This implies that in the isolation ward the barrier care has to be respected more strictly. In the research part of the thesis, two objectives were determined: Detection of the nurses' approach to the barrier nursing care in the isolation ward and other internal type wards. Monitoring of nurses' knowledge and skills in the field of the barrier nursing care in the isolation ward and other internal type wards. On the basis of the mentioned objectives of the thesis, following research questions were set: How is the nurses' approach to the barrier nursing care in the isolation ward and the internal type ward? Are there any differences between the knowledge of the nurses in the isolation ward and in other internal type wards? Are there any differences between the skills of the nurses in the isolation ward and in other internal type wards? From the research survey follows that the knowledge and skills of nurses in the isolation ward and nurses in other internal type wards are not absolutely identical. From the research followed that the nurses' approach to barrier nursing is more effective in the isolation ward. Further, it was found out that the answers from a part of the respondents don't completely correspond with the data found out during the participating hidden observation. While the answers of the nurses from the internal ward nearly complied to the desirable providing of barrier nursing, during the observation was found out that the theoretical knowledge is not corresponding with the real practice in the form of practical skills. The results of the thesis can serve as a basis for teaching of nursing subjects or as a contribution to expert courses, tutorials or conferences dealing with this topic. Further, the results will be offered to expert periodicals where we would like to give to the expert and also general public a notice about the importance of providing of an effective barrier nursing care and contribute to paying more attention to this topic in all wards of health facilities.
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