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Smitteverntiltak ved Clostridium difficileinfeksjon.: En kvantitativ tverrsnittsstudie blant helsepersonell i et norsk sykehus
Nordic Council of Ministers, Nordic School of Public Health NHV.
2014 (Norwegian)Independent thesis Advanced level (degree of Master (Two Years))Student thesisAlternative title
Infection control measures for Clostridium difficile : a retrospective cross-sectional survey among healthcare professionals in a Norwegian hospit (English)
Abstract [no]

Bakgrunn: Clostridium difficile(CD)er antatt å være den utløsende årsak for 20-30 % av tilfeller med antibiotikaassosiert diaré. CD er den vanligste formen for helsetjenesteervervet diaré, og forår-saker økt sykelighet og dødelighet, samt økte kostnader for helsetjenesten. Desiste tiår er det rappor-tert om endringeri epidemiologien, forårsaket av en ny CD stamme, ribotype 027. Den spres lettere, lager mer alvorlig sykdom og tilbakefall. I Norge har denne stammen til nå ikke vært noe problem. Forekomsten kan reduseres ved en tydelig antibiotikapolitikk, og etterlevelse av anbefalte smitte-verntiltakfor å forebygge CD.

Hensikt: Finne ut hvilke smitteverntiltak helsepersonell i sykehuset velger ved håndtering av pasien-ter med CD, og hvor de henter kunnskap om slike smitteverntiltak fra.

Metode: En retrospektiv tverrsnittsstudie med spørreskjema til helsepersonell ble gjennomførtvåren og høsten 2011 i Sørlandet sykehus HF (SSHF), sør i Norge.

Resultat: 168 helsepersonell deltok i undersøkelsen, fordelt på 59 leger og 109 pleiere. Svarprosen-ten var 94. Antibiotikarestriksjoner sier 94 % av medisinerne og 38 % av kirurgene atde har i sine avdelinger(x²=10.756, p<0.001). Stetoskop brukt i isolat med CD pasienter sier 25 % legerat de spritdesinfiserer og tar med, mens 6 % pleiere sier det samme (x²=22.273, p<0.001). 73 % av leger og 64 % pleiere sier at de både desinfiserer og vasker hendene etter kontakt med CD pasient (x²=6.451, p=0.011). Pasientinformasjon om viktigheten av håndhygiene sier 8 % leger og 36 % pleiere at de alltid gir (p<0.001). Desinfeksjonsmiddel til bruk etter en CD pasient, sier 48 % medi-sinske pleiere og 43 % kirurgiske pleiere at de velgerVirkon (feil). Infeksjonskontroll-programmet (IKP) som kunnskapskilde brukes av 14 % leger og 46 % pleiere, (p<0.001). Kunnskap om smitte-verntiltak ved CD sier 63 % legerog 72 % pleiere at de får fra kolleger.

Konklusjon: Helsepersonell har generell kunnskap om smitteverntiltak, men mangler spesifikk kunnskap om smitteverntiltak ved CD. For å møte utfordringen med nye mer spredningspotente CD stammer, må etterlevelsen av smitteverntiltak øke. IKPalene, synes ikke å være tilstrekkelig for å holde helsepersonelloppdatert. Den manglende spesifikke kunnskapen om smitteverntiltak ved CD kan utsette pasienter i sykehuset for smitterisiko

Abstract [en]

Background: Clostridium difficile(CD) causes 20 %–30 % of all nosocomial infectious diarrhea, resulting in significant morbidity and increasing healthcare costs. Good antibiotic stewardship reduc-es the incidence of CD, andcompliance with infection control measures limits its spread. In recent years, ribotype 027, a new strain of CD, caused several disease outbreaks. Ribotype 027 spreads more easily and increases disease severity and relapse. Thus far, ribotype 027 has caused few prob-lems in Norway.

Objective: This thesis aimed to determine whether hospital-based healthcare professionals comply with recommended infection control measures for CD prevention and identify how they learn about such measures.

Method: A retrospective cross-sectional survey and questionnaire was performed among healthcare professionals at Sørlandet Hospital, Norway,during the spring and fall of 2011.

Results: Survey participants included 168 health professionals (59 physicians and 109 nurses). The response rate was 94 %. Medical doctors (94 %) and surgeons (38 %) said that their clinics impose antibiotic restrictions (x ² = 10.756, p< 0.001). After contact with a CD patient, physicians and nurs-es (73 % and 64 %, respectively) said they disinfect and wash their hands (x ²= 6.451, p< 0.011). Notably, only 8% of physicians and 36 % of nurses always give patients information about the im-portance of hand hygiene (p< 0.001). Even 25 % of physicians and 6 % of nurses reported using ethanol (does not eliminated CD spores) to disinfect stethoscopes before leaving a CD isolation room (x ² = 22.273, p< 0.001). Medical and surgical nurses (48 % and 43 %, respectively) incorrectly used Virkon as a disinfectant in the CD patient’s room. Physicians and nurses (63 % and 72 %, respective-ly) mainly obtain knowledge about infection control measures from colleagues, compared to physi-cians and nurses (14 % and 46 % , respectively) who gain such knowledge from the hospital’s infec-tion control program (p< 0.001).

Conclusion: Healthcare professionals have some knowledge about infection control measures, but lack knowledge specific to limiting the spread of CD. Increased compliance with infection control measures is crucial to meeting the challenge of new and more potent strainsof CD. Guidelines alone are likely insufficient to keep healthcare professionals up to date. The lack of specific knowledge about infection control measures for CD may expose hospitalized patients to CD infection

Place, publisher, year, edition, pages
2014. , 43 p.
Series
Master of Public Health, MPH, ISSN 1104-5701 ; MPH 2014:4
Keyword [en]
Clostridium Difficile, Infection Control Measures, Compliance, Healthcare Professiona
Keyword [no]
clostridium difficile, smitteverntiltak, implementering, etterlevelse, helsepersonel
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3330OAI: oai:DiVA.org:norden-3330DiVA: diva2:733998
Presentation
2014-05-09, Nordic School of Public Health NHV, Box 12133, 402 42 Göteborg, Sweden, 13:00 (Norwegian)
Supervisors
Note

ISBN 978-91-86739-69-0

Available from: 2014-07-15 Created: 2014-07-14 Last updated: 2015-01-30Bibliographically approved

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