Kirurgisten potilasohjeiden laatu ja valmius tukea voimavaraistavaa potilasohjausta sekä infektioiden torjuntaan liittyvä sisältö

Hoitotyössä infektioiden torjunnan painopistealueena on ollut lisätä potilaiden osallistuvuutta voimavaraistavalla potilasohjauksella. Potilasohjauksen apuna käytetään usein kirjallisia potilasohjeita, joiden rakenne ja laatu tulee olla hyvä. Lisäksi potilasohjeiden tulee omata valmiuksia tukea voimavaraistavaa potilasohjausta. Kirjalliset potilasohjeet ovat hyvä potilasohjauksen keino, mutta systemaattinen tieto potilasohjeiden laadusta, valmiuksista tukea voimavaraistavaa potilasohjausta sekä infektioiden torjunnan sisällöstä puuttuu. Tutkimuksen tarkoituksena oli analysoida Suomen yliopistosairaaloiden kirurgisten potilasohjeiden infektioiden torjuntaan liittyvää sisältöä. Lisäksi oltiin kiinnostuneita potilasohjeiden laadusta hyvien kirjallisten potilasohjeiden ominaispiirteiden toteutumisessa sekä potilasohjeiden valmiuksista tukea voimavaraistavaa potilasohjausta. Tutkimuksen aineistona oli viiden yliopistosairaalan kirurgisille aikuispotilaille tarkoitetut potilasohjeet (N = 237). Organisaatioittain joka viides potilasohje (n = 50) analysoitiin potilasohjeiden laadun osalta sisällönerittelyllä ja aikaisemmin kehitetyn mittarin avulla (Salanterä ym. 2004). Deduktiivisella sisällönanalyysillä analysoitiin potilasohjeiden valmiuksia tukea voimavaraistavaa potilasohjausta, jonka ulottuvuuksien esiintyvyyden arviointiasteikko oli kehitetty tätä tutkimusta varten. Induktiivisella sisällönerittelyllä analysoitiin infektioiden torjuntaan liittyvä sisältö. Potilasohjeiden laadussa oli paljon vaihtelua, ja vain 36 % (n = 18) potilasohjeista oli julkaistu viimeisen kolmen vuoden (2010–2012) aikana. Potilasohjeet olivat ulkoasultaan selkeitä ja johdonmukaisia, jolloin kirjallisten potilasohjeiden ominaisuuksista parhaiten toteutuivat ulkoasun sekä kielen ja rakenteen ominaisuudet. Potilasohjeet kuvasivat toimenpidettä ja siitä selviytymistä, antaen parhaiten valmiuksia tukea toiminnallista ja bio-fysiologista selviytymistä potilasohjauksella. Infektioiden torjuntaan liittyvä sisältö oli pääasiassa esitetty epäsuorasti toisen asian kautta. Infektioiden syntyyn tai torjuntaan ei viitattu, vaan asiaa tarkasteltiin muusta näkökulmasta esimerkiksi ylipainon ja ihon kunnon osalta. Yleisin infektioiden torjuntaan liittyvä sisältö koski käsihygieniaa, vaikka sen toteuttamista ei opastettu tai ohjeistettu. Tutkimus tarjoaa lähtökohdan kehittää potilasohjeiden infektioiden torjuntaan liittyvää sisältöä sekä potilaan osallistuvuuden lisäämistä. Erityisesti tulisi kehittää potilaan osallistuvuuden tukemista voimavaraistavalla potilasohjauksella. Jatkotutkimuksena tulisi kartoittaa potilaiden tarpeet infektioiden torjunnan sisällöstä sekä kehittää kansallinen ohjeistus potilasohjeiden infektioon torjuntaan liittyvästä sisällöstä ja rakenteesta.Surgical patient education material and the infection related- content in the university hospitals Infection control priorities in nursing care have been to increase patients' participatory by empowering patient education. In patient education, it is common to use written patient education material, which needs to be understandable and good in quality. Furthermore, patient education material needs to have capacity to support empowering patient education. Written materials are a good method of patient education. However, the systematic information of patient education materials quality, capacity to support empowering patient education and infection control content is missing. The purpose of this study was to analyze the surgical patient education materials infection control-related content in Finnish university hospitals. In addition, there was interest in the quality of written patient education materials, through the implementation of good characteristics, and patient education materials capacity to support empowering patient education. The study material consisted of surgical patient education materials for adults in five university hospitals (N = 237). By organization every fifth patient education material (n = 50) were also analyzed for the quality of the content with the previously developed instrument (Salanterä et al. 2004). Deductive content analysis was done to analyze the patient education materials capacities to support empowering patient education with the dimensions of the empowerment assessment scale which was developed for this study. Inductive content analysis was used to analyze the infection control-related content. In the quality of patient education materials were a lot of variation, and only 36 % (n = 18) patient education materials were published in the past three years (2010–2012) period. Patient education materials were visually clear and consistent, as the best feature of the quality were the appearance and the structure of language. Patient education materials described surgical procedure and the coping with it, providing the best capabilities to support the functional and the bio-physiological dimensions of the empowerment. Infection control-related content was mainly presented indirectly through another case. In that case, there were no refer to infection control, rather referred to other health related point of view e.g. obesity, and the condition of the skin. The most common infection control content was hand hygiene, although its implementation was not guided or instructed. The study provides a starting point to develop patient education materials guidelines with infection control-related content, as well as to increase the patient's involvement. In particular, the develop patients involvement with empowering patient education. In the further research, should the patients infection control information needs to be identified as well as to develop national guidelines for the patient education materials infection control-related content and structure.Siirretty Doriast

Molecular epidemiology of carbapenemase-producing Enterobacterales in Finland, 2012-2018

Carbapenemase-producing Enterobacterales (CPE) pose an increasing threat to patient safety and healthcare systems globally. We present molecular epidemiology of CPE in Finland during 2012-2018 with detailed characteristics of CPE strains causing clusters during the same time period. All Finnish clinical microbiology laboratories send Enterobacterales isolates with reduced susceptibility to carbapenems or isolates producing carbapenemase to the reference laboratory for further characterization by whole genome sequencing (WGS). In total, 231 CPE strains from 202 patients were identified during 2012-2018. Of the strains, 59% were found by screening and 32% from clinical specimens, the latter were most commonly urine. Travel and/or hospitalization history abroad was reported for 108/171 strains (63%). The most common species were Klebsiella pneumoniae (45%), Escherichia coli (40%), and Citrobacter freundii (6%), and the most common carbapenemase genes bla(NDM-like) (35%), bla(OXA-48-like) (33%), and bla(KPC-like) (31%). During 2012-2018, the annual number of CPE strains increased from 9 to 70 and different sequence types from 7 to 33, and bla(OXA-48-like) genes became the most prevalent. Of the clusters, 3/8 were linked to traveling or hospitalization abroad and 5/8 were caused by K. pneumoniae clone clonal complex 258. Most of the clusters were caused by K. pneumoniae producing KPC. High variety among different sequence types indicates that majority of CPE cases detected in Finland are likely imported from foreign countries. Nearly one-third of the cases are not found by screening suggesting that there is hidden transmission occurring in the healthcare settings.Peer reviewe

Molecular epidemiology of carbapenemase-producing Enterobacterales in Finland, 2012-2018

Carbapenemase-producing Enterobacterales (CPE) pose an increasing threat to patient safety and healthcare systems globally. We present molecular epidemiology of CPE in Finland during 2012-2018 with detailed characteristics of CPE strains causing clusters during the same time period. All Finnish clinical microbiology laboratories send Enterobacterales isolates with reduced susceptibility to carbapenems or isolates producing carbapenemase to the reference laboratory for further characterization by whole genome sequencing (WGS). In total, 231 CPE strains from 202 patients were identified during 2012-2018. Of the strains, 59% were found by screening and 32% from clinical specimens, the latter were most commonly urine. Travel and/or hospitalization history abroad was reported for 108/171 strains (63%). The most common species were Klebsiella pneumoniae (45%), Escherichia coli (40%), and Citrobacter freundii (6%), and the most common carbapenemase genes bla(NDM-like) (35%), bla(OXA-48-like) (33%), and bla(KPC-like) (31%). During 2012-2018, the annual number of CPE strains increased from 9 to 70 and different sequence types from 7 to 33, and bla(OXA-48-like) genes became the most prevalent. Of the clusters, 3/8 were linked to traveling or hospitalization abroad and 5/8 were caused by K. pneumoniae clone clonal complex 258. Most of the clusters were caused by K. pneumoniae producing KPC. High variety among different sequence types indicates that majority of CPE cases detected in Finland are likely imported from foreign countries. Nearly one-third of the cases are not found by screening suggesting that there is hidden transmission occurring in the healthcare settings