Å kle seg etter arbeidstøysretningslinje.Er det så viktig?

Forskrift om smittevern i helse- og omsorgstjenesten pålegger sykehus å ha infeksjonskontrollprogram. Infeksjonskontrollprogram skal blant annet inneholde retningslinjer for bruk av arbeidstøy. I arbeidstøysretningslinjen i Helse Nord står det blant annet at klokke og ring ikke er tillatt å bruke, samtidig som man er ikledd arbeidstøy, og i pasientrettet arbeid. Klokke og ring forhindrer god håndhygiene. Etter mange år som hygienesykepleier har jeg erfart at helsepersonell ikke bruker arbeidstøy etter gjeldende retningslinje, til tross for mange undervisninger og kampanjer. Hensikten med denne studien er å få frem hvilke tanker og refleksjoner helsepersonell har rundt etterlevelse av arbeidstøysretningslinje i sykehus. Videre om de har kjennskap til retningslinjen, og hvilken betydning de mener arbeidstøy og håndhygiene har. I studien kom det frem at informantene har inngående kunnskap om smittevern. De kjenner til sykehusets arbeidstøysretningslinje, og hvorfor ansatte skal bruke arbeidstøy. De vet også at klokke og ring ikke er tillatt å bære når man er ikledd arbeidstøy og i pasientnært arbeid, og at klokke og ring forhindrer god håndhygiene. Informantene opplever at kampanjer og undervisning om temaet er viktig for å øke ansattes kunnskapsnivå og etterlevelse av arbeidstøysretningslinjen. Informantene trekker frem at ledere må være mer tydelig, og at de bør framstå som gode rollemodeller for å få ansatte til å følge arbeidstøysretningslinjen. På bakgrunn av anvendt teori i studien, viser det blant annet at det ikke alltid er samsvar mellom kunnskap en person besitter og det som vises gjennom handling

Contact allergy in patients with chronic venous leg ulcers

Contact allergy (CA) is prevalent in patients with chronic leg ulcers (CLUs) due to venous stasis1 and may delay wound healing. Exposure to different ointments and wound dressings over time, combined with occlusive bandaging, may predispose to contact sensitization.2 The spectrum of allergens depends on wound care practices.3, 4 Studies on CA in patients with CLUs from Norway are lacking. To determine the occurrence of CA in patients with CLUs, patch testing was performed with the Leg Ulcer Series (LUS) containing 27 chemicals and five additional substances relevant to wound treatment: Caine mix III and V, hydrocortisone, IntraSite gel (propylene glycol 20%, Smith & Nephew), and Brulidine (dibrompropamidine 0.15%, Sanofi‐Aventis) (Table S1). Fifty‐two of the 97 patients were also tested with the European Baseline Series (EBS) (Table S2)

Long‐term efficacy and safety of biosimilar infliximab (CT‐P13) after switching from originator infliximab: Open‐label extension of the NOR‐SWITCH trial

Background and objectives The 52‐week, randomized, double‐blind, noninferiority, government‐funded NOR‐SWITCH trial demonstrated that switching from infliximab originator to less expensive biosimilar CT‐P13 was not inferior to continued treatment with infliximab originator. The NOR‐SWITCH extension trial aimed to assess efficacy, safety and immunogenicity in patients on CT‐P13 throughout the 78‐week study period (maintenance group) versus patients switched to CT‐P13 at week 52 (switch group). The primary outcome was disease worsening during follow‐up based on disease‐specific composite measures. Methods Patients were recruited from 24 Norwegian hospitals, 380 of 438 patients who completed the main study: 197 in the maintenance group and 183 in the switch group. In the full analysis set, 127 (33%) had Crohn's disease, 80 (21%) ulcerative colitis, 67 (18%) spondyloarthritis, 55 (15%) rheumatoid arthritis, 20 (5%) psoriatic arthritis and 31 (8%) chronic plaque psoriasis. Results Baseline characteristics were similar in the two groups at the time of switching (week 52). Disease worsening occurred in 32 (16.8%) patients in the maintenance group vs. 20 (11.6%) in the switch group (per‐protocol set). Adjusted risk difference was 5.9% (95% CI −1.1 to 12.9). Frequency of adverse events, anti‐drug antibodies, changes in generic disease variables and disease‐specific composite measures were comparable between arms. The study was inadequately powered to detect noninferiority within individual diseases. Conclusion The NOR‐SWITCH extension showed no difference in safety and efficacy between patients who maintained CT‐P13 and patients who switched from originator infliximab to CT‐P13, supporting that switching from originator infliximab to CT‐P13 is safe and efficacious

Efficacy and safety of baricitinib in hospitalized adults with severe or critical COVID-19 (Bari-SolidAct): a randomised, double-blind, placebo-controlled phase 3 trial

International audienceAbstract Background Baricitinib has shown efficacy in hospitalized patients with COVID-19, but no placebo-controlled trials have focused specifically on severe/critical COVID, including vaccinated participants. Methods Bari-SolidAct is a phase-3, multicentre, randomised, double-blind, placebo-controlled trial, enrolling participants from June 3, 2021 to March 7, 2022, stopped prematurely for external evidence. Patients with severe/critical COVID-19 were randomised to Baricitinib 4 mg once daily or placebo, added to standard of care. The primary endpoint was all-cause mortality within 60 days. Participants were remotely followed to day 90 for safety and patient related outcome measures. Results Two hundred ninety-nine patients were screened, 284 randomised, and 275 received study drug or placebo and were included in the modified intent-to-treat analyses (139 receiving baricitinib and 136 placebo). Median age was 60 (IQR 49–69) years, 77% were male and 35% had received at least one dose of SARS-CoV2 vaccine. There were 21 deaths at day 60 in each group, 15.1% in the baricitinib group and 15.4% in the placebo group (adjusted absolute difference and 95% CI − 0.1% [− 8·3 to 8·0]). In sensitivity analysis censoring observations after drug discontinuation or rescue therapy (tocilizumab/increased steroid dose), proportions of death were 5.8% versus 8.8% (− 3.2% [− 9.0 to 2.7]), respectively. There were 148 serious adverse events in 46 participants (33.1%) receiving baricitinib and 155 in 51 participants (37.5%) receiving placebo. In subgroup analyses, there was a potential interaction between vaccination status and treatment allocation on 60-day mortality. In a subsequent post hoc analysis there was a significant interaction between vaccination status and treatment allocation on the occurrence of serious adverse events, with more respiratory complications and severe infections in vaccinated participants treated with baricitinib. Vaccinated participants were on average 11 years older, with more comorbidities. Conclusion This clinical trial was prematurely stopped for external evidence and therefore underpowered to conclude on a potential survival benefit of baricitinib in severe/critical COVID-19. We observed a possible safety signal in vaccinated participants, who were older with more comorbidities. Although based on a post-hoc analysis, these findings warrant further investigation in other trials and real-world studies. Trial registration Bari-SolidAct is registered at NCT04891133 (registered May 18, 2021) and EUClinicalTrials.eu ( 2022-500385-99-00 )