MRSA and other resistant bacteria : prevalence, patient and staff experiences, wounds and infection control

Antibiotic resistance has become a major and serious global problem in healthcare. Limited treatment options for infections caused by these organisms can lead to increased morbidity and mortality. Sweden has a low prevalence of antibiotic resistance compared to most other countries but this presents an increasing problem for society and healthcare even in Sweden. The overall aim of this thesis was to illuminate potential problems related to antibiotic resistance from different perspectives: assessing the prevalence of resistant bacteria methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) or other resistant bacteria, and associated wound types, patient and health staff experiences when confronted with resistant bacteria infection, and the occurrence of such infections in the nursing home environment. In the first study a total of 2172 patients admitted to hospital or as out-patient visit at a University hospital during one day were examined with the purpose to identify all wounds, wound types and wound characteristics, and to identify bacteria in all wounds, particularly MRSA, VRE and multi-resistant Gramnegative rods. Four hundred and eight (19%) patients had a total of 668 wounds. Of these, 248 wounds, from 216 patients were cultured. Two unknown MRSA-patients were identified. No patient with VRE was found and there was a low prevalence of other multi-resistant bacteria. In the second study fifteen patients with MRSA infected wounds were interviewed. The aim was to ascertain and describe patients’ knowledge, perceptions and experiences of being MRSA-positive. The interviews were analyzed according to qualitative content analysis. From the analysis three categories and one overall theme were identified. Results showed that information about the MRSA diagnosis often caused a shock-like reaction. The patients’ perception of being MRSA-positive was that it was stigmatizing like the plague or leprosy; they felt dirty and a severe threat to their environment. Fears of infecting someone else and being rejected were commonly expressed. Knowledge and empathy from staff involved in their care was crucial to optimise patients’ experiences. Staff’s needs of education to meet patients’ demands for information, and to prevent spread of antibiotic contamination was essential. In the third study eight nurses and seven assistant nurses from different hospital wards and nursing homes were interviewed regarding their experiences of caring for MRSA-positive patients. Qualitative content analysis was carried out when analysing the data and three themes were identified during the process. Stress and too high workload were factors which were described to cause concerns in the caring situation. A major concern was that nurses felt at risk of becoming infected themselves and then transmitting the infection to other patients and to family members. Knowledge and ignorance about MRSA affected the nurses’ caring; ignorance made them afraid and insecure while knowledge and understanding shaped confidence in their role as caregivers. In the fourth study 560 residents in a total of 67 wards, in nine nursing homes were investigated for prevalence of MRSA, VRE and extended-spectrum β-lactamase (ESBL) - producing Enterobacteriaceae and if carriage of resistant bacteria was related to antibiotic treatment, other risk factors and/or staff´s adherence to guidelines for infection control. In all 296 staff members were interviewed and observed. No resident was positive for MRSA or VRE. Fifteen residents were found to be ESBL-positive. Usage of antibiotics was higher in wards where ESBL-positive residents were detected and there was an indication that there was transmission of ESBL between residents. Staff´s adherence to infection control guidelines sometimes revealed shortcomings but no significant difference regarding adherence to the guidelines could be found. In conclusion: Prevalence of MRSA appears low in both hospitalized patients, out-patients and nursing home residents. Adherence to infection control guidelines among healthcare staff, however, needs further improvement. MRSA colonized patients experienced psychological pressure and stigmatization. Knowledge and empathy from staff involved in their care is crucial to optimise patients’ experiences. Staff education to meet patients' demands for information and the prevention of contamination is essential

Hjelper det å snakke om det? En kvalitativ studie om betydningen prosessveiledning har for barnevernkonsulenter sin motivasjon til å bli barneverntjenesten

Denne masteroppgaven handler om barnevernkonsulenters opplevelse av prosessveiledning, og dens betydning for deres motivasjon til å bli i jobben. Kommunal barneverntjeneste har høy turnover. Det er kjent at barnevernkonsulenter blir utsatt for emosjonelle belastninger og er i risiko for utbrenthet. I dag er det opp til de enkelte tjenestene hvordan de ivaretar sine ansatte og bidrar til deres faglige utvikling. Gjennom fem kvalitative dybdeintervjuer søker denne oppgaven kunnskap om barnevernkonsulenters opplevelse av sammenhengen mellom prosessveiledning, egen motivasjon og emosjonelle belastninger i arbeidet. Funnene viser store variasjoner i veiledningstilbudet i de ulike tjenestene. Deltakerne opplever alle at prosessveiledning er av betydning for deres arbeidshverdag, faglig trygghet og motivasjon til å bli i jobben. Samtidig er det både ulike og samsvarende faktorer som vektlegges som vesentlige for at veiledningen skal oppleves nyttig, og faktisk ha en direkte påvirkning på barnevernkonsulentenes motivasjon

How to reach the national environmental objective ”sustainable forests” in the County of Jämtland

Det finns i dagsläget 16 miljömål i Sverige. Ett miljömål beskriver den kvalitet och det tillstånd för Sveriges miljö-, natur- och kulturresurser som är miljömässigt hållbara på lång sikt. Dessa mål anpassas för olika geografiska området: nationellt, regional samt lokalt där varje geografisk nivå också har understående delmål. Som en del i sektorsansvaret för miljömålet ”levande skogar” har Skogsstyrelsen, genomfört ett projekt i Jämtlands län: ”Seminarium för skogsbruket i Jämtlands län – nu ska vi nå de regionala miljömålen”. Syftet var att få en ökad intensitet i arbetet att nå miljömålen och ökad förståelse för miljömålsarbetet inom skogssektorn inom länet. Under seminariet redovisades nio föreläsares erfarenheter kring området, trots åtgärder är det endast ”förstärkt biologisk mångfald i all skog” som tros blir uppnått till målåret 2010. Samtliga föreläsare var överens om att mer areal skog måste skyddas, samt att den generella hänsynen vid avverkning måste vidtas i större utsträckning än vad som görs i dagsläget. Seminariet har sammanfattats i kombination med en litteraturstudie kring ämnet, där det samlande syftet med rapporten varit att studera hur olika aktörer inom skogsbruket arbetar med miljömålsfrågor samt utvärdera hur långt Jämtlands län har kvar tills miljömålet ”levande skogar” är uppnått. Det samlade resultatet tyder tyvärr på att miljömålet ”levande skogar” i Jämtlands län är mycket svårt att nå inom den utsatta tidsramen även om ytterligare åtgärder sätts in/genomförs (Länsstyrelsen Jämtlands län, Miljömålsbedömningar, 2009).Today we have 16 environmental goals in Sweden. The Environmental objectives describe the quality and the state that Sweden’s environmental-, nature- and culture resource that’s environmental sustainable in long-term should have. Environmental goals are bookmarked for different geographical areas: National, regional and local, every area has their own milestones. Swedish Forest Agency has a sector responsibility for the environmental objective “living forests”, as a part of their sector they have been implemented a project in the country of Jämtland: "Seminar on forestry in the country of Jämtland - now we will reach the regional environmental objectives". The aim was to obtain an increased intensity of work to achieve environmental objectives and increased understanding of environmental work in the forestry sector in the County. In the seminar there were nine speakers that were sharing their experiences around this subject. The conclusion was that even of measures were taken to achieve each of the four strands, "enhanced biodiversity of all forests" is the only one of the four milestones that are believed to reach the target until year 2010th. All speakers agreed that larger forest areas need to be protected, and in general, considerations must be taken when logging to a greater extent than is done in the present situation. The seminar was summarized in combination with a literature review on the subject environmental goal. Overall purpose of the project was to study how various forestry stakeholders involved in environmental issues and to evaluate how far the progress has come before the environmental goal of "living forest" is reached in the country of Jämtland. The result show, unfortunately, that the environmental goal of "living forest" in the country of Jämtland is very difficult to achieve within the required time frame, even with action taken for implementation (Länsstyrelsen Jämtlands län, Miljömålsbedömningar, 2009)