Polish infection control nurses : self-assessment of their duties and professional autonomy in different types of hospitals

Background The objective of the study is self-assessment of Polish infection control nurses (ICNs) in terms of the structure of professional tasks and autonomy of decision-making. Material and Methods A questionnaire survey was filled out by 208 ICNs (around 21% of all Polish ICNs) in 15 provinces located in Poland. The research encompassed ICNs surveillance healthcare-associated infections (HAIs) in 2014. Results The work time that ICNs devote to professional tasks and decision autonomy on the scale of 1–100% was as follows: 34% (67% of decision autonomy) was dedicated to detecting and registering HAIs, 12% (71%) – internal control, 10% (58%) – devising and implementing infection prevention practices, 10% (68%) – staff trainings, 8% (65%) – identification and study of outbreaks, 7% (58%) – promoting hand hygiene, 6% (51%) – consults with infected patients, 4% (57%) – consults on decontamination, 4% (54%) – consults on maintaining cleanliness, 3% (51%) – isolation and application of personal protective measures, 2% – other tasks. Infection prevention and control nurses estimated, on average, that their autonomy of decisions concerning the professional tasks performed amounted to 60%. Conclusions Infection control nurses in Poland have difficulty in achieving balance between tasks they perform and the authority they exercise. The ICN professional task structure is dominated by duties associated with monitoring hospital infections, however, the greatest decision autonomy is visible regarding internal control. Decision-making concentrated on internal control may hinder building a positive image of an ICN. We should strive to firmly establish professional tasks and rights of ICNs in legislation concerning performing the duties of a nurse and midwife. Med Pr 2018;69(6):605–61

Analysis of occupational exposure of healthcare workers in the years 1998-2013 for bloodborne pathogens on the example of the hospital of the surgical profile

Background: To analyze occupational exposures to blood-borne pathogens among workers of a 130-bed hospital of surgical profile in the Małopolska province. Material and Methods: All cases of occupational exposure recorded in the hospital in the years 1998–2013 were analyzed, taking into account exposure rates (no. of incidents / no. of exposed workers ×100%) and the frequency, circumstances, professional groups, hospital staff, the place of rendered services and type of exposure. Results: Average rates of exposure for all workers, regardless of the wards, ranged in different years from 4.3% (2006) to 12.6% (2013), and the average value in the whole period was 7.3% (±2.39). The majority of exposure cases were reported among nurses – 67.8%, followed by physicians – 29.7%, the lowest number of cases was found among other employees – 1.5%. The proportion of injuries in the years 1998–2013 did not show a significant decreasing trend (p = 0.356). Among physicians there was a significant trend of an exponential character (p = 0.002). Among other workers no significant change was observed in the period under consideration. Over the analyzed period the distribution of exposure showed a downward trend for nurses (p = 0.001) and upward trend for physicians (p < 0.001). There was a significant downward trend in the percentage of needle-sticks, and an upward trend in exposures during surgery. Conclusions: The reported trends were linked with the recent introduction of safe equipment and the increased number of surgeons’ reports on exposure incidents. Due to differences between health care units there is a necessity to keep reliable records of exposure by individual units. Med Pr 2014;65(6):723–73

Healthcare workers' occupational exposure to bloodborne pathogens : a 5-year observation in selected hospitals of the Małopolska province

Objectives: The study presents data concerning occupational exposures among the staff of 5 hospitals in the Małopolska province in 2008–2012, taking into account the frequency and circumstances of exposure formation, occupational groups of hospital workers, as well as diversification of the reported rates in subsequent years between the hospitals and in each of them. An additional objective of the analysis was to assess the practical usefulness of the reported data for planning and evaluation of the effectiveness of procedures serving to minimize the risk of healthcare workers’ exposure to pathogens transmitted through blood. Material and Methods: Data were derived from occupational exposure registries kept by 5 hospitals of varying sizes and operational profiles from the Małopolska province from the years 2008–2012. Results: Seven hundred and seventy-five cases of exposure were found in a group of 3165 potentially exposed workers in the analyzed period. Most cases were observed in nurses (68%) and these were mainly various types of needlestick injuries (78%). Exposure rates with respect to all workers ranged from 2.6% to 8.3% in individual hospitals, but the differences in their values registered in the hospitals in subsequent years did not bear any statistical significance, in a way similar to the rates calculated separately for each occupational group. Conclusions: There was no upward or downward trend in the number of reported cases of exposure to bloodborne pathogens in the studied period in any of the hospitals. Statistically significant differences in the percentages of exposures were reported between individual hospitals in some years of the analyzed period, which confirms the need for registries in individual units in order to plan and evaluate the effectiveness of preventative measures

Carbon fibers as a new type of scaffold for midbrain organoid development

The combination of induced pluripotent stem cell (iPSC) technology and 3D cell culture creates a unique possibility for the generation of organoids that mimic human organs in in vitro cultures. The use of iPS cells in organoid cultures enables the differentiation of cells into dopaminergic neurons, also found in the human midbrain. However, long-lasting organoid cultures often cause necrosis within organoids. In this work, we present carbon fibers (CFs) for medical use as a new type of scaffold for organoid culture, comparing them to a previously tested copolymer poly-(lactic-co-glycolic acid) (PLGA) scaffold. We verified the physicochemical properties of CF scaffolds compared to PLGA in improving the efficiency of iPSC differentiation within organoids. The physicochemical properties of carbon scaffolds such as porosity, microstructure, or stability in the cellular environment make them a convenient material for creating in vitro organoid models. Through screening several genes expressed during the differentiation of organoids at crucial brain stages of development, we found that there is a correlation between PITX3, one of the key regulators of terminal differentiation, and the survival of midbrain dopaminergic (mDA) neurons and tyrosine hydroxylase (TH) gene expression. This makes organoids formed on carbon scaffolds an improved model containing mDA neurons convenient for studying midbrain-associated neurodegenerative diseases such as Parkinson’s disease

Evaluation of nursing students' preparation for their first contact with the patient in terms of hand hygiene

Proper hand hygiene is an essential skill which allows nursing staff to provide health services of good quality. The subject of the study was the knowledge of hand hygiene procedures among Polish students of nursing who were starting their internship in health care centers. The study was carried out in June 2017 with the application of a self-designed questionnaire. A group of 322 nursing students who completed their first year of Bachelor of Arts (BA) studies participated in the research which was carried out in four medical schools providing education to nurses and situated in the south of Poland. As many as 22 of nursing students after their first year of vocational education could not correctly identify any moment of '5 moments for hand hygiene', 29 of students managed to name only one moment, 23 - three moments, 11 - four moments and only 3 succeeded in identifying all five moments. Only 32 of the respondents knew that HH should be performed before clean/aseptic procedures, 23 were aware that it should be performed before touching a patient and the same percentage saw such a need after touching a patient, 14 knew that HH was necessary after body fluid exposure and only 7 claimed hand hygiene should be performed after touching patient surroundings. The level of nursing students' knowledge varied between particular medical schools taking part in the study (p < 0.001). Only in 13 of cases students’ knowledge of '5 moments for hand hygiene' was checked by an academic teacher before they started their first internship. As far as '5 moments for hand hygiene' are concerned, deficient knowledge and skills were observed among nursing students during their first internship. The curriculum for the first year of nursing studies seems to be lacking in proper education towards prevention of healthcare-associated infections (HAIs) by means of hand hygiene procedures. What was also detected was a low level of academic nursing teachers' control concerning '5 moments for hand hygiene'

Investigation of "Acinetobacter baumannii" activity in vascular surgery units through epidemiological management based on the analysis of antimicrobial resistance, biofilm formation and genotyping

Background/Objectives: The genus Acinetobacter demonstrates resistance to antibiotics and has been shown to spread in the hospital environment causing epidemic outbreaks among hospitalized patients. The objectives of the present study was to investigate the antibiotic resistance, biofilm formation, and clonality among Acinetobacter baumannii strains. Materials and Methods: The study involved 6 (I Outbreak) and 3 (II Outbreak) A. baumannii strains isolated from patients hospitalized in vascular surgery unit. Results: All tested A. baumannii strains were extensively drug resistant (XDR) and all the isolates were carbapenem-resistant and among them, all carried the blaOXA-51 gene, the blaOXA-24 gene, as well as the blaOXA-23 gene. All of the investigated strains had the ability to form a biofilm, but all of them produced less biofilm than the reference strain. Multi-locus sequence typing (MLST) showed that all strains belonged to the ST2 clone. Pulsed-field gel electrophoresis (PFGE) divided the tested outbreak strains into two clones (A and B). Conclusion: This study shows a nosocomial spread of XDR A. baumannii ST2 having the blaOXA-51 gene, the blaOXA-24 gene, as well as the blaOXA-23 gene, low biofilm formers, that was prevalent in the vascular surgery unit. To identify the current situation of vascular surgery departments targeted epidemiological investigation was needed. Effective implementation of infection control prevented the spread of the epidemic outbreaks

Longevity and gender as the risk factors of methicillin-resistant Staphylococcus aureus infections in southern Poland

BACKGROUND: The proportion of older people among the general population has risen. Staphylococcus aureus (SA) constitutes a significant problem. Underlying disease and functional debility, predispose the older adult to staphylococcal carriage and infection, specially bloodstream infection and pneumonia. METHODS: This is a retrospective cohort study of older patients with SA infections. We analyzed a database containing the results of laboratory cultures from patients treated in 2013 for SA infections and selected 613 hospitalized and non-hospitalized people aged ≥60 years. RESULTS: The prevalence of Methicillin-resistant SA (MRSA) were significantly different in categories of patients: from 14.1% in young old, 19.5% in old old and 26.7 in longevity. MRSA was significantly more frequently reported in cases of pneumonia, 40.4% of SA strains (p < 0.0001, OR 0.3, 95%CI 0.14–0.49). The nosocomial MRSA infections were more common in ICU departments: prevalence 36.8%, than in non-ICU departments: prevalence 17.3% (OR 2.8, 95%CI 1.06–7.34, p = 0.014). Bloodstream infections, which accounted for 6% of all infections, were more frequent in males (p = 0.0231, OR 2.25, 95%CI 1.098–4.604). The greatest increase in antibiotic resistance was related to trimethoprim/sulfamethoxazole (TMP/SXT), which increased to over 80% in the older study groups. All age groups demonstrated increased MIC90 values for glycopeptide and tigecycline. Although strains isolated from patients in all age groups remained sensitive to vancomycin, strains isolated from patients in the old-old and longevity groups demonstrated resistance to teicoplanin. The MIC90 for tigecycline was the highest in the group aged >90 years. CONCLUSIONS: MRSA constitutes a significant epidemiological problem in cases of hospital-treated pneumonia. The findings were similar for long-term-care facilities, where MRSA appears to affect male residents in particular, although there were fewer male residents than female residents. The low sensitivity to TMP/SXT of SA strains isolated from the oldest patients indicates potentially serious challenges pertaining to efficacious treatment of SA infections

Zakażenia szpitalne oraz nadzór po zakończeniu hospitalizacji w wybranych procedurach chirurgii naczyń

Background. Nosocomial infections are an unwanted complication present in almost every hospital. Among patients of highly specialized departments, including vascular surgery wards, the most prevalent form of clinical infection are Surgical Site Infections (SSIs). SSIs significantly extend the patient's stay in the hospital, increase costs and above all can be the direct cause of death after vascular procedures. Material and methods. This paper presents the results of studies on infection epidemiology in vascular surgery in the years 2002-2006 (9,573 surgical procedures) as well as a targeted study which included 413 patients of two highly specialized wards in the year 2005. The registration of infections was based on definitions formulated on the basis of CDC guidelines, and included postdischarge cases. Results. Within the Active Surveillance System, 207 cases of SSI have been identified (incidence 2.2%) and 99 cases of hospital acquired pneumonia (incidence 1.0%); other forms of infection accounted for 21 cases. The overall incidence among patients undergoing surgical procedures (vascular surgery) was 3.4%. The targeted study allowed for a detailed analysis of SSI incidence with consideration of the SSI standardized infection ratio. The cumulated incidence rate of SSIs was 2.6% in site I and 5.6% in site II. Among the etiological factors isolated from materials taken from patients with symptoms of SSI, staphylococci were in the majority, among them Stapylococcus aureus. In the targeted study, almost half of the isolated S. aureus strains (40%) manifested a resistance to methicillin (MRSA) as well as macrolides, lincosamides and streptogramin B (MLS&#946;). Conclusions. The Active Infection Surveillance System confirmed that in the patients of the studied population the most prevalent form of infection was SSI; however, a high incidence of hospital acquired pneumonia was also noticed. In the targeted study, the SSI incidence in site no. I was within the expected values. The possibility of performing postdischarge registration of infections was confirmed as well as the purposefulness of systematic infection control conducted by experienced personnel. The study showed the need for an improvement in microbiological surveillance in infection control, as well as the necessity of performing further detailed studies regarding the relationship of the operating team experience to the incidence of SSIs within Polish vascular surgery wards. We claim that in certain cases the division, together with the later reconstruction, of the left renal vein may facilitate the course of reconstructive operation of the abdominal aorta and decreases the risk of haemo-rrhage complications. Moreover, this manoeuvre does not influence postoperative renal function.Wstęp. Zakażenia szpitalne są niepożądanym powikłaniem występującym praktycznie w każdym szpitalu. Wśród pacjentów oddziałów wysokospecjalistycznych, w tym w chirurgii naczyń, dominującą formę kliniczną tych zakażeń stanowią zakażenia miejsca operowanego. W istotny sposób przedłużają one pobyt pacjenta w szpitalu, zwiększają koszty, a przede wszystkim mogą być bezpośrednią przyczyną śmierci chorych po zabiegu w zakresie naczyń. Materiał i metody. Zaprezentowano wyniki badań dotyczących epidemiologii zakażeń w chirurgii naczyniowej w latach 2002-2006 (9573 zabiegi operacyjne) oraz badania celowanego, którym objęto łącznie 413 pacjentów dwóch oddziałów wysokospecjalistycznych w 2005 roku. Rejestracja zakażeń opierała się na definicjach opracowanych na podstawie zaleceń Centers for Disease Control and Prevention (CDC) i uwzględniała przypadki wykryte po zakończeniu hospitalizacji. Wyniki. Wśród dominujących zakażeń szpitalnych w ramach Systemu Czynnego Nadzoru rozpoznano 207 przypadków zakażenia miejsca operowanego (zachorowalność 2,2%) i 99 szpitalnych zapaleń płuc (zachorowalność 1,0%), inne formy zakażeń stanowiły 21 przypadków. Zachorowalność w grupie pacjentów operowanych - chirurgia naczyniowa - wyniosła ogółem: 3,4%. Badanie celowane umożliwiło szczegółową analizę zachorowalności zakażeń miejsc operowanych z uwzględnieniem standaryzowanego indeksu ryzyka. Współczynniki zachorowalności skumulowanej zakażeń miejsc operowanych wyznaczono na poziomie 2,6% w ośrodku I oraz 5,6% w ośrodku II. Wśród czynników etiologicznych izolowanych z materiałów pochodzących od pacjentów z objawami zakażenia miejsca operowanego dominowały gronkowce, a wśród nich gatunek Stapylococcus aureus. W badaniu celowanym prawie połowa z izolowanych szczepów S. aureus (40%) to szczepy oporne na metycylinę (MRSA) oraz makrolidy, linkozamidy i streptograminy B (MLSb). Wnioski. System Czynnego Nadzoru potwierdził, że w badanej populacji pacjentów dominującą formą zakażenia jest zakażenie miejsca operowanego, jednak zaobserwowano również wysoką zachorowalność dotyczącą szpitalnych zapaleń płuc. W badaniu celowanym stwierdzona zachorowalność zakażenia miejsca operowanego w przypadku I pierwszego badanego ośrodka odpowiadała oczekiwanym wartościom. Potwierdzono możliwość prowadzenia rejestracji zakażeń manifestujących się po zakończeniu hospitalizacji chorego oraz celowość systematycznej kontroli zakażeń prowadzonej przez doświadczony personel. Wykazano konieczność poprawy wykorzystania nadzoru mikrobiologicznego w kontroli zakażeń oraz dalszych szczegółowych badań w zakresie związku pomiędzy doświadczeniem zespołu operującego a zachorowalnością na oddziałach chirurgii naczyniowej w Polsce