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Problem of hospital infections such as scabies
Kováříková, Pavla ; Hošťálková, Monika (advisor) ; Eislerová, Iva (referee)
v AJ The main goal of this thesis is to define the aspects of the disease scabies as a nosocomial infection. This disease belongs to the most common skin infestations ever and that is why its introduction into the medical facilities often threatens. Nosocomial infections are one of the most important indicator of the quality of provided medical care and for this reason medics pay great attention to prevent any kinds of contagion. My thesis is divided into two parts. The theoretical part is devoted to the disease scabies itself, epidemiological situation, occupational diseases and legislation. In the research part of this thesis i deal with the availability of personal protective equipment, which is important for the prevention of nosocomial infections. Further i follow the health prefesionals knowledge and thein obtaining of necedssary information. The occurrence of nosocomial infection among questioned persons and the percentage of disease scabies are being evaluated as well. From the obtained results i tis obvils that scabies is a common parasitic disease and even that the sings and symptoms are well known, not always this disease is properly diagnosed. Due to the high hygiene standard sof the clients scabies is often confused with other itchy noninfectious disease and that is the reason why...
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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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Incidence and molecular typing of Clostridium difficile strains in the Czech republic
Malinová, Anna ; Jirásková, Alena (advisor) ; Čáp, Michal (referee)
Clostridium difficile is a major cause of infectious diarrhea in hospitalized patients. Clostridium difficile-associated disease (CDAD) is of gaining importance now due to its increasing incidence and severity. However, little is known about the C. difficile infections in the Czech Republic. The aim of the study was to characterize C. difficile strains recently isolated (2008 to 2011) from patients hospitalized with gastrointestinal disease in four Prague health care institutions using molecular typing methods; PCR toxinotyping, PCR ribotyping and MLVA (multilocus variable number tandem repeat analysis). Among 273 C. difficile strains, we identified 8 toxinotypes (0, III, IV, V, VI, VIII, IX a XXIII) and 63 ribotypes, of which ribotypes 596 (23,4 % patient), 017 (13,9 %) and 176 (7 %) were the most frequent. According to PCR ribotyping, the situation in the Czech Republic is the most similar to the situation in Poland. Within ribotypes 017, 017/1 and 017/2 and ribotypes 596 and 596/1, 5 and 4 distinct clusters were identified by MLVA, none of which was institution-specific. Additionally, pathogenic C.difficile were isolated from piglet faeces (63,3 %) in a single piglet farm, evaluating the role of C. difficile as an emerging animal pathogen. All piglet isolates belonged to the toxinotype 0 and the ribotype...
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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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Identification of nosocomial infection by electrophoretic techniques
Kubesová, Anna ; Moravcová, Dana ; Tesařová, Marie ; Horká, Marie
The detection and identification of pathogens currently relies upon a very diverse range of techniques and skills, from traditional culturing and taxonomic procedures to modern molecular biology based methods. However, conventional laboratory methods are time consuming, laborious, and they may provide both false positive or negative results, especially for closely related microorganisms. In this study, we suggest capillary electrophoresis techniques for differentiation and characterization of Methicillin-resistant and Methicillin-susceptible Staphylococcus aureus.
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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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