Brukarstyrd inläggning : MANUAL FÖR UTBILDNING OCH IMPLEMENTERING

Personer med självskadebeteende och komplex psykisk ohälsa kan förväntas vara suicidnära. De kommer att vara suicidnära under hela den Brukarstyrda inläggningen (BI). På tre dagar kan vi inte ändra på det. Det kan ta år tills stress inte längre triggar suicidalitet. Det vi kan hjälpa till med under BI är stressen.Denna manual (med tillhörande utbildning som tillhandahålls som uppdragsutbildning för hälso- och sjukvårdspersonal via Lunds universitet) är vårt bidrag till att sprida kunskap och stötta psykiatriska verksamheter som är intresserade av att erbjuda Brukarstyrd inläggning

Composition of Challenge Substance in Standardized Antimicrobial Efficacy Testing of Wound Antimicrobials Is Essential to Correctly Simulate Efficacy in the Human Wound Micro-Environment

Current standards insufficiently acknowledge the influence of the wound micro-environment on the efficacy of antimicrobial agents. To address this, octenidine/phenoxyethanol, polyhexanide, povidone-iodine, and sodium-hypochloride/hypochlorous acid solutions were submitted to standard-based (DIN-EN-13727) or modified peptide-based challenges and compared to a simulated clinical reference using human acute or chronic wound exudate (AWF/CWF). Antimicrobial efficacy against S. aureus and P. aeruginosa was compared using a quantitative suspension method. Agreement between methods were investigated using Bland-Altman (B&A) analysis. Different substances and challenges demonstrated diverging results, depending on class and concentration of agent and challenge. Highly concentrated antiseptics maintained a high efficacy under complex challenges, while especially chlorine-based irrigation solutions showed a remarkably reduced antimicrobial effect. Composition of challenge substance proved more relevant than pure concentration. Therefore, the current standard challenge conditions did not adequately reflect the wound micro-environment with over- or under-estimating antimicrobial efficacy, whilst the modified peptide-challenge showed a higher level of agreement with simulated realistic conditions (AWF/CWF). The results emphasize that a “one-fits-all” approach is not feasible to generalize antimicrobial efficacy, as certain aspects of the complex micro-environment pose a differing influence on varying agents. Based on these results, revision and target focused adaptation of the current standards should be considered