Magisteruppsatser - M2CMA

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Enteropatogena Escherichia coli (EPEC) – ett vanligt fynd i halländska fecesprover
(2025-07-16) Hiljemark, Åsa; University of Gothenburg/Institute of Biomedicin; Göteborgs universitet/Institutioen för biomedicin
Background: Enteropathogenic Escherichia coli (EPEC) is known for causing gastroenteritis, especially in children in developing countries, but in a Swedish context the bacteria are less studied and described. In Halland, a new method for analyzing stool samples for suspected infectious diarrhoea was introduced in April 2024. The analysis is a multiplex PCR that includes EPEC. Positive test results regarding EPEC have created uncertainty among the clinics. Research questions: What does the patient population with EPEC look like in Halland in terms of age, gender and seasonality? How does it differ from the patient population with Campylobacter in Halland? Materials and methods: A retrospective cohort study was conducted by collecting data from positive stool samples for EPEC and Campylobacter. The study subjects are people who from April 24, 2024, to January 31, 2025, were positive for EPEC and/or Campylobacter jejuni/coli/upsaliensis in stool samples analyzed at Clinical Microbiology in Halland. Results: About 10% of all samples analyzed were positive for EPEC. 29,8% of the EPEC cohort tested positive for other intestinal pathogens at the time of sampling, which was significantly different from the Campylobacter cohort (12.6% p <0.001). The mean age for EPEC and Campylobacter, respectively, was 41.4 years and 49.3 years (p <0.02). More than 50% of the samples in both cohorts were taken at a health care center, but the proportion of samples taken in a hospital ward were larger for EPEC than for Campylobacter (13.4% vs 2.7%). Conclusion: EPEC was common in stool samples from Halland. In the EPEC cohort, patients tested positive for additional pathogens more often, but otherwise the cohorts did not differ much. Implications: Further investigation of EPEC is needed to understand the virulence and clinical relevance in a Swedish context.
Kunskapsnivån avseende hantering av perifer venkateter (PVK) bland sjuksköterskor inom kirurgisk vård vid ett universitetssjukhus
(2025-07-16) Szkinc-Olsson, Grazyna; University of Gothenburg/Institute of Biomedicin; Göteborgs universitet/Institutioen för biomedicin
Introduction: Peripheral intravenous catheters (PIVCs) are the most used invasive medical device. Management of peripheral intravenous catheters is a key responsibility of nurses and requires both theoretical knowledge and clinical skills. Research questions: What is the current level of knowledge regarding the management of PIVCs among nurses in surgical care at a university hospital? Is there any relationship between the nurses´ knowledge related to: level of education; professional experience; or type of surgical department (workplace)? Material and method: A quantitative descriptive study was performed. Data were collected using a structured questionnarie adressing PIVCs management, level of education, and professional experience. Participants were nurses from three surgical departments and one surgical clinic. Data were analyzed using IBM SPSS program with nonparametric tests to map knowledge levels and compare them across the specified variables. Results:The collected data was limited, only 59 nurses of 146 (40%) answered the survey.The analyses showed that neither level of education nor professional experience was associated with higher number of scores on the knowlegde test. Nurses from the clinic performed worse and this was statistically significant (p=0,011). Identified knowledge gaps included frequency of inspection of PIVCs, understanding of infection risk (e.g.,sepsis) and proper disinfection of the injection membrane (” scrub the hub”). Conclusion and implications: Nurses knowledge regarding handling of PIVCs was assessed as good, some knowledge gaps were identified. The results showed that there were no significant differences related to level of education or professional experience, unlike other than workplace, which may reflect differences in routines and follow-up of complications in different units. Despite of the limited generality due to the small sample, the results offer useful insight for local improvement work. There is a need for targeted training initiatives with a focus on the identified shortcomings and continuous skills development regardless of previous experience or level of education
Vaccinationsvilja hos gravida: en undersökning av vaccination mot kikhosta under graviditeten i Stockholms län.
(2025-07-16) Stolt, Teresia; University of Gothenburg/Institute of Biomedicin; Göteborgs universitet/Institutioen för biomedicin
Introduction Pertussis is an acute respiratory infection caused by the bacteria Bordetella pertussis. The infection is highly contagious and can be severe for infants. Vaccination during pregnancy provides the infant with protection during the first months of life, before the infant receives vaccination. In Sweden, vaccination is recommended after week 16 of the pregnancy. Although the vaccine is safe, effective, and free of charge, vaccination coverage varies within Stockholm County. Research question Which factors are associated with the choice to receive or decline pertussis vaccination during pregnancy in Stockholm County? Study participants and methods A quantitative cross-sectional study using surveys was conducted from March 3 to April 10, 2025. Study participants were pregnant from gestational week 25 onwards and registered at midwifery clinics in Stockholm County. Data were analysed using descriptive statistics and logistic regression to identify factors associated with the intention to get vaccinated. Results Eighty-seven people participated in the study. 75% reported that they either planned to get vaccinated against pertussis during pregnancy or had already been vaccinated, while 25% were unsure or did not intend to get vaccinated. Multivariable logistic regression analysis identified significant associations between lower vaccination willingness and: having a native language other than Swedish; responses indicating lack of knowledge or awareness about the disease; uncertainty about or lack of information regarding pertussis vaccination from a midwife/other healthcare personnel and being unsure/not knowing anyone who had been vaccinated against pertussis during pregnancy. Conclusions and Implications This study highlights several factors associated with the participants declining pertussis vaccination during pregnancy in Stockholm County, worth further investigation. A better understanding of these factors may support development of targeted interventions, such as midwife-led vaccination models, information campaigns, education about pertussis risks, and initiatives highlighting positive vaccination experiences. Due to study limitations, general conclusions should be made carefully.
Sundhedserhvervet kateterrelateret urinvejsinfektioner på hospitalet En databaseret undersøgelse
(2025-07-16) Ladefoged, Marie Louise; University of Gothenburg/Institute of Biomedicin; Göteborgs universitet/Institutioen för biomedicin
Background: Indwelling urinary catheters (IUCs) increase the risk of healthcare-associated urinary tract infections. Healthcare-associated catheter-related urinary tract infections usually cause additional complications and discomfort for patients, highlighting the need for careful and appropriate use of IUCs and monitoring of the use and related urinary tract infections. Research question: What was the prevalence of healthcare-associated urinary tract infections among patients > 50 years of age and with IUCs at Aarhus University Hospital in 2024? Which factors increase the risk of developing catheter-related urinary tract infections and which risk factors can be targeted for interventions? Methods: A data-driven cohort study was conducted comprising patients aged over 50 years with an IUC at Aarhus University Hospital in 2024. Patient data were extracted from the electronic patient record system and data on health care-associated urinary tract infections were obtained from the Danish national HAIBA database. The variables analyzed in relation to catheter-related urinary tract infections included sex, age, BMI, and catheter dwell time. Results: The cohort comprised 8305 patients over 50 years of age, all with an IUC. In total, 243 patients (2.9%) developed a catheter-related healthcare-associated urinary tract infection. A significantly higher incidence was detected among females compared to males and among patients over 70 years of age. Catheter dwell time was significantly longer in the group that developed catheter-related urinary tract infections compared to those who did not. BMI >30 did not increase the risk of these infections. Conclusion: In the present study significant risk factors for healthcare-associated urinary tract infections in patients with IUCs were female sex, age over 70 years and long catheter dwell time. Perspective: The results highlight that non-modifiable risk factors such as gender and age should be taken into account when deciding on the use of IUCs and IUCs should be used for the shortest possible time.
Sikring af præoperativ tandbørstning hos den ortopædkirurgiske patient
(2025-07-16) Lyhne, Maria Elisabeth Heerdegen; University of Gothenburg/Institute of Biomedicin; Göteborgs universitet/Institutioen för biomedicin
Introduction Hospital-acquired infections are a significant challenge that, in many cases, can be prevented through targeted initiatives. Studies suggest that preoperative toothbrushing reduces the risk of postoperative infections. Research question How does the proportion of preoperative patients performing toothbrushing change in an orthopedic surgical ward after implementing a recommendation for preoperative toothbrushing in staff guide-lines and supplementary patient instructions? Patients and Methods This interventional study examined the effect of an initiative aimed at increasing preoperative tooth-brushing among orthopedic surgical patients. The intervention included emphasizing preoperative toothbrushing in staff guidelines and patient instructions, the staff should assist patients when neces-sary and distribute toothbrushes to patients who had not brought their own. The control ward re-ceived no intervention. Data on toothbrushing were collected from patients using structured ques-tionnaires in both the intervention and the control wards before and after the intervention. Baseline measurements were compared with post-intervention measurements and analyzed statistically. Results The study included 77 patients: 42 during the baseline period and 35 during the post-intervention period. Post-intervention results showed a tendency for an increased proportion of patients who: (1) performed preoperative toothbrushing and (2) received a toothbrush in the intervention ward when lacking one. However, the differences between the pre- and post-intervention measurements were not statistically significant. Conclusion and implications. The implementation of staff guidelines and patient instructions regarding preoperative toothbrushing among orthopedic surgical patients did not result in a significant change in the proportion of preoper-ative toothbrushing but indicated an improving trend in: (1) adherence to preoperative oral hygiene practices and (2) the distribution of toothbrushes when needed. The results highlight the importance of larger studies when evaluating targeted interventions to im-prove the likelihood of achieving statistically reliable results.
Kommer antal anmälda TBE-fall att öka om årstiderna blir varmare?
(2025-07-16) Lilja, David; University of Gothenburg/Institute of Biomedicin; Göteborgs universitet/Institutioen för biomedicin
Background Studies have shown that the global temperature is increasing due to emission of greenhouse gases. Europe is the continent where the temperature is increasing the most. The ticks’ survival and reproduction benefits from a warmer climate. Due to increased global temperature, there is a risk that tick-borne diseases like TBE will continue to increase. Research question Is there any relation between reported TBE-cases and warmer temperatures during winter, spring, summer and autumn in Västra Götaland? Materials and methods Temperatures during each season that are fundamental for Ixodes ricinus and the TBE-virus were used to construct temperature intervals for the different seasons. Nine municipalities in region Västra Götaland were included in the study, based on having a weather station in the municipality or nearby where temperature data could be obtained, and having at least 20 cases of TBE between 2005 and 2024 assumed to result from tick exposure in the municipality. The average number of days that the temperature lay within each interval was calculated for the nine municipalities. Number of TBE cases were then compared with the number of days for each temperature intervals for the year the case was reported and the year before with Spearman’s rank correlation. Results A significant increase in reported TBE-cases was seen when there was a previous winter with days with temperatures between 0 °C and below 5 °C (Spearman’s rho: 0,55; p=0,013). Many days during a previous autumn with temperatures at least +10°C was related to increased reported TBE-cases the year after (Spearmans rho: 0,526; p=0,017). Fewer reported TBE-cases were seen when many days during the previous summer had a temperature below +10 °C (Spearman’s rho: -0,72; p=<0,001). Conclusion There is a correlation between temperatures during several seasons preceding reported TBE-cases. Since the global temperature is increasing there is a risk that the numbers of reported TBE-cases will continue to increase.
Fästingburen encefalit i Göteborgsregionen: En retrospektiv jämförelse av patientdemografi och kliniska mönster mellan 2014–2015 och 2023–2024
(2025-07-16) Jansson, Sofia; University of Gothenburg/Institute of Biomedicin; Göteborgs universitet/Institutioen för biomedicin
Background: Tick-borne encephalitis (TBE) is an increasing public health challenge in Sweden as well as the rest of Europe. The number of reported cases continues to rise, including in regions where TBE has not previously been observed. Transmission occurs through bites from infected ticks and can lead to serious neurological symptoms with a risk of long-term sequelae. Research questions: Have there been any changes in the patient population hospitalized for TBE at the Department of Infectious Diseases in Gothenburg between the periods 2014–2015 and 2023–2024? Are there any differences in gender and age distribution? Are there any differences in underlying immunosuppression, disease severity, length of hospital stay, and mortality? Has the proportion of vaccinated patients changed? Materials and methods: This retrospective cohort study compares two groups of TBE patients treated at the Department of Infectious Diseases in Sahlgrenska University Hospital, Gothenburg, during 2014–2015 and 2023–2024. Patients were identified using ICD-10 code A84.1. Variables such as age, sex, length of stay, disease severity, vaccination status, course of illness, immunosuppression, and mortality were analyzed. Results: A total of 21 patients were included in the study: seven during 2014–2015 and fourteen during 2023–2024. The results showed greater variation in disease severity in the latter period, as well as an increased proportion of vaccinated patients. There was also a trend toward shorter hospital stays and greater age variation during 2023–2024. Conclusion and implications: The findings suggest changes in disease presentation and vaccination status over time. Vaccinated patients tended to experience monophasic courses of illness, indicating that vaccination may influence disease progression but does not always prevent infection. The study highlights the importance of continued vaccination efforts and standardized diagnostics. Further research is needed to confirm these trends and inform public health measures.
Vårdpersonalens kunskaper och attityder till städrutiner vid vård av patient med Vankomycinresistenta Enterokocker
(2025-07-16) Veljanovska Gräsman, Aleksandra; University of Gothenburg/Institute of Biomedicin; Göteborgs universitet/Institutioen för biomedicin
Background Vancomycin-resistant enterococci (VRE) have been implicated in various outbreaks in hospitals since the 1980s. Outbreaks among patients with kidney diseases are common and recently an outbreak has occurred in the department of Renal medicine at Sahlgrenska University Hospital. The purpose of this study was to investigate the healthcare staff’s attitudes and knowledge of cleaning procedures. Research questions  What level of knowledge regarding VRE does the healthcare staff have? Does it differentiate between the units and those that have had an outbreak compared with those who had not?  Which background factors could affect the level of knowledge?  What is the attitude of healthcare staff towards cleaning procedures compared to Infection prevention and control care unit and what are the differences between the units and those that have had an outbreak?  Which background factors could influence the attitude towards cleaning procedure? Materials and methods A quantitative survey was sent out and completed by healthcare staff working in the fields of renal medicine and by Infection prevention and control care at Sahlgrenska University Hospital. The responsible director of renal care gave approval after ethical review. Results 48 out of 134 recipients took part in the survey. The average number of correct answers was 76%. There was a statistically significant difference in knowledge level between the different units (p-value: 0.049) but not depending on whether the department had been involved in the VRE outbreak or not. No significant differences between the departments were seen regarding the attitude questions. Units that had not been involved in outbreaks were closer to Infection prevention and control care in the attitude questions, but the difference was not statistically significant. Conclusion and implication Continuous education is required for healthcare staff in renal units to reduce the risk of an outbreak of VRE, and to prevent human suffering and increased costs of care.
Retningslinjer for antibiotikaprofylakse og råd for temperaturkontroll, blir de etterlevd ved hofteprotesekirurgi?
(2025-07-16) Reset Simonsen, Gøril; University of Gothenburg/Institute of Biomedicin; Göteborgs universitet/Institutioen för biomedicin
Background This quality improvement project examined adherence to national guidelines for antibiotic prophylaxis and recommendations for temperature control in hip replacement surgery. It also explored whether adherence was associated with postoperative surgical site infections at two hospitals during 2022–2024. Research question To what extent are national guidelines for antibiotic prophylaxis and temperature control followed in hip arthroplasty? Is there an association between adherence to these guidelines and the incidence of postoperative surgical site infections? And are there differences in adherence between the two hospitals? Materials and methods Data were collected from the MRS-POSI quality registry and through manual chart review. A total of 79 patients were included, of whom 27 developed POSI. Most underwent elective surgery (78%) and received a total hip replacement (81%). The majority were women (59%) and aged 60–79 years (64%). Statistical analysis was conducted using Stata/MP 18. Results All patients received the correct antibiotic and dose, but deviations were found in the number of doses and combinations of prophylactic regimens. In total, 71 % of patients received antibiotic prophylaxis at the correct time. Adherence to temperature control before and after surgery was 74 %. No statistically significant association was found between adherence and the occurrence of POSI. Kristiansund Hospital had significantly higher adherence to timely administration of the first antibiotic dose (p=0.002) and preoperative temperature control (p=0.001) compared to Volda Hospital. Conclusion and implications The results show high adherence to the choice and dosage of antibiotics, while adherence to timely administration of antibiotic prophylaxis (71%) and temperature control (74%) could be improved. There were differences in adherence between the two hospitals, indicating a need for better implementation, training, and follow-up of recommendations to ensure consistent practice and patient safety across institutions.
Iordningställande av steril kirurgisk utrustning inför ortopedisk implantatkirurgi – Följs hygienrutiner?
(2025-07-16) Berggren, Elisabeth; University of Gothenburg/Institute of Biomedicin; Göteborgs universitet/Institutioen för biomedicin
Background: Post-sterilization contamination of surgical instruments in orthopedic surgery increases the risk of postoperative infections. Adherence to hygiene routines is crucial to minimize this risk. Research question: How well are hygiene protocols followed during the preparation and protection of sterile surgical equipment prior to orthopedic implant surgery? Does adherence to protocols regarding equipment protection and the number of door openings differ between prosthetic surgery and other types of orthopedic implant surgery (e.g., plates, screws, and intramedullary nails)? Materials and Methods: This observational, quantitative study involved systematic data collection using an observation protocol. Surgical teams were observed during the preoperative preparation of sterile equipment. Two categories were studied: prosthetic surgery (n = 22) and other implant surgery (n = 25). Data were analyzed descriptively. Results: High adherence was observed for surgical attire, masks, and head coverings. However, significant variation occurred in the protection of sterile equipment. Compliance with sterile draping was lower in other implant surgery 20% (n = 5) compared to prosthetic surgery 59% (n = 13) (p < 0.05). Preparing equipment with closed doors was followed in 50% (n = 11) of prosthetic and 48% (n = 12) of other implant surgeries. The median number of door openings was 0.5 for prosthetic surgery and 1.0 for other implant surgery, with no significant difference (p = 0.53). Conclusions and Implications: The study identified variations in hygiene routine adherence, particularly in protecting sterile equipment, depending on surgery type. These findings suggest a need for targeted interventions to standardize practices and maintain equipment sterility. Non-compliance with minimizing door openings during preparation remains a concern for patient safety. Further research is necessary to explore contributing factors and improve compliance.
Risikofaktorer for postoperative sårinfeksjoner etter keisersnitt i Helse Møre og Romsdal 2020-2024
(2025-07-16) Berg, Thea Martine Foss; University of Gothenburg/Institute of Biomedicin; Göteborgs universitet/Institutioen för biomedicin
Background The proportion of cesarean sections in Norway has increased significantly over the past 50 years. Given complications such as postoperative wound infections (POSI), identifying risk factors to prevent POSI is of interest. A quality assurance project was therefore conducted to examine potential risk factors for developing POSI after cesarean section. Research Question Which risk factors are associated with the development of postoperative wound infections (POSI) after cesarean section in Helse Møre og Romsdal in the period 2020–2024, and how can the timing of antibiotic prophylaxis affect the infection rate? Sub-questions include risks related to emergency cesarean sections, contamination class, antibiotic prophylaxis, blood loss, and challenges with medical record data. Patients and Methods Data from cesarean sections at hospitals in Helse Møre og Romsdal (Kristiansund, Molde, Ålesund, Volda) were retrieved from the POSI registry (2020–2024). Multivariate analysis assessed factors such as urgency, contamination class, antibiotic prophylaxis, age, operation time, and ASA score. For one hospital, medical record data were additionally analyzed for blood loss (n=39) and timing of antibiotic prophylaxis (n=29). Results The use of antibiotic prophylaxis for cesarean sections varied considerably (Ålesund: 97.3%, Kristiansund: 35.7%). Emergency cesarean sections had twice the risk of POSI compared to non-emergency ones. The use of antibiotic prophylaxis (yes/no) showed no effect. For those receiving early antibiotic prophylaxis (n=29, up to 53 minutes before incision), the risk of POSI increased with each delayed minute (OR per delayed minute = 1.056, 95% CI: 1.002–1.110, p=0.040). All patients without infection received antibiotic prophylaxis before incision. Incomplete medical record documentation limited the analysis. Conclusions and Implications Emergency cesarean sections increase the risk of POSI. Early antibiotic prophylaxis shows a significant reduction in infection risk. Incomplete documentation in medical records complicates the analysis of data. Despite the small dataset, the findings support the need for further research on optimal administration of antibiotic prophylaxis to prevent POSI.
Utvärdering av tularemispecifik diagnostik
(2025-07-15) Fohlin, Lisa; University of Gothenburg/Institute of Biomedicin; Göteborgs universitet/Institutioen för biomedicin
Background. Tularemia is a zoonotic infection caused by the bacterium Francisella tularensis. Laboratory diagnosis consists primarily of serological methods. Enzyme- linked immunosorbent assay (ELISA) is performed at the Laboratory Medicine, Norrland’s University Hospital in Umeå. A rapid serological test, Virapid tularemia, is also used there and at the Laboratory Medicine, Östersund ́s Hospital. It is considered important to compare Virapid with ELISA as this has not been done previously on this material. Research question. How well does Virapid agree with ELISA? To what extent are there clinical indications for current tularemia when the result of Virapid and/or ELISA is positive? Is the result for either test (Virapid and ELISA) better than the other in detecting a current infection with tularemia? Materials and methods. In total, 2443 serum samples analyzed between 2011 and 2025 at Norrland’s University Hospital and 304 serum samples analyzed at Östersund ́s hospital between 2022 and 2025 were included. For all samples, simultaneous analysis had been performed with Virapid and ELISA. Sixty-two patient records were reviewed to determine correlation to current tularemia. Results. In the Umeå material, the sensitivity for Virapid in comparison with ELISA was 55.8% and the specificity was 93.9%. The corresponding values in the Östersund material were 67.9% and 92.8%. A comparison was made between ELISA and Virapid in relation to current tularemia with similar outcomes; the former assay showed a sensitivity of 88.9% and a specificity of 87.1% and the latter 83,3% and 86,4%, respectively. Conclusion. A relatively large discrepancy was seen between Virapid and ELISA. For both ELISA and Virapid, there were positive samples that did not correlate to a current infection. The result indicates that borderline responses for ELISA have low predictive value. Larger studies are required to further investigate how Virapid and ELISA relate to each other and to current tularemia.
Kontroll av dialysevann til hemodialyse, Seksjon for dekontaminering, Oslo Universitetssykehus, 2013-2023
(2024-08-19) Holm, Monica; University of Gothenburg/Institute of Biomedicin; Göteborgs universitet/Institutioen för biomedicin
Background: The laboratory at the Decontamination Unit, Oslo University Hospital, has analyzed water used for dialysis treatment from dialysis units across Norway during the period 2013-2023. The sample materials include dialysis water, dialysis fluid, and substitution fluid. The details and results have not been previously reviewed. Aim: To review the data collected and analyze the results with the aim of: 1) Establishing an overview of the material, 2) Examining changes over time, 3) Identifying variables associated with positive test results, 4) Formulating recommendations and suggestions for quality improvement in monitoring and control. Materials and Methods: Data collected by the laboratory 2013-2023, based on information provided by requesters and analysis results. The laboratory tests the samples for viable microbes and endotoxins. Results: The total number of water samples received by the laboratory has steadily declined over the years, while the number of samples from dialysis water has remained stable. The proportion of positive samples increased significantly from 2020-2023, primarily testing positive for endotoxins. Dialysis performed outside hospitals or outside the hospital's central water purification systems accounts for most of the positive dialysis water samples. Both dialysis outside hospitals and the number of positive samples are increasing. There is no clear correlation between positive test results and different seasons. Conclusion: Lack of procedures guiding how the laboratory's collected data is analyzed, interpreted, and distributed makes it difficult to ensure the quality of dialysis water on a national basis. Therefore, we cannot conclude that there are more positive samples from dialysis satellites and mobile water purification units than from central water purification systems in hospitals. Implications: With a better data management system, there is significant potential for improved monitoring of dialysis water quality for individual hospitals/requesters and in general. This could contribute to better quality dialysis treatment for chronically ill kidney patients.
KONTAMINERET KEYBOARD I ULTRALYD - ET KVANTITATIVT STUDIE OM BAKTERIEL FOREKOMST PÅ ULTRALYDSAPPARATER
(2023-12-22) Seneca Schmidt, Brian; University of Gothenburg/Institute of Biomedicin; Göteborgs universitet/Institutioen för biomedicin
Baggrund: Med et stort flow af ambulante og indlagte patienter til ultralydsundersøgelse på røntgenafdelingen på Hvidovre Hospital, København, er der dagligt mange berøringsflader med patienter og patientkategorier. Kritisk syge der ikke kan transporteres til røntgenafdelingen fx intensivpatienter, undersøges på stuen med mobile ultralydsapparater. Ultralydsapparaterne har mange flader som er svære at rengøre, og ofte ses rester af gel efter rengøring. Formål: At undersøge om der findes patogene bakterier i overfladeprøver indsamlet på 6 ultralydsapparater i røntgenafdelingen, og om myndighedsbestemte retningslinjer og grænseværdier for bakterier efter rengøring efterleves. Metode: Et kvantitativt observationsstudie, hvor prævalensen af bakterier på 5 udvalgte fokuspunkter på de 6 ultralydsapparater blev målt via trypsan soya agar aftryksplader (TSA). Pladerne blev inkuberet og aflæst efter 24 og 48 timer. Total antal colony forming units (CFU) pr plade blev talt, og morfologisk forskellige bakteriekolonier på species niveau identificeret via Maldi-TOF. Resultater: 60 prøver blev taget, og 2 måtte ekskluderes grundet fejl. Af de 58 inkluderede prøver havde 90% af prøverne bakteriel påvisning. Der blev fundet 19 forskellige mikroorganismer; koagulase-netative staphylokokker (KNS), Staphylocccus aureus, andre gram-posite bakterier samt en gram-negativ. 54% af prøverne bestod af KNS som alle kan være opportunistisk patogene. 3 ud af 5 fokuspunkter havde acceptable CFU/cm2 (p<0.003). 24% af prøverne levede ikke op til fastsatte grænseværdier for total antal CFU/cm2 på under 2.5, dog var dette ikke statistisk signifikant (p<0.37). Der blev påvist S. aureus som ikke må forefindes på rengjorte flader. Konklusion: Der blev identificeret forskellige miljøbakterier, bakterier fra hudens normalflora samt patogene bakterier på rengjorte områder. En stor del påviste bakterier er opportunistisk patogene, og sammen med Enterococcus faecalis og S. aureus kan de potentielt udgøre en smitterisiko for patienterne. Betydning: Studiet giver anledning til overvejelser, om nuværende introduktionsprogrammer til infektionshygiejne samt oplæring i korrekt rengøring, er tilstrækkelige eller om nye tiltag skal iværksættes.
Sjuksköterskors upplevelser av etiska konflikter under covid-19-pandemin på en infektionsklinik
(2023-12-22) Edsberger, Gabriella; University of Gothenburg/Institute of Biomedicin; Göteborgs universitet/Institutioen för biomedicin
Introduktion: Etiska konflikter är något sjuksköterskor världen över ofta ställs inför i sitt dagliga arbete. Covid-19-pandemin som drabbade världen våren 2020 ledde till stora samhällsförändringar. Inom sjukvården förändrades snabbt rutiner och arbetssätt. Arbetsbelastningen var hög och osäkerheterna gällande såväl diagnostik, behandling, omvårdnad och smittrisker var stora. I samband med pandemin uppstod nya situationer där etiska konflikter inte kunde undvikas. Syfte: Syftet med detta arbete är att öka kunskapen om sjuksköterskors upplevelser av etiska konflikter, som arbetande på en infektionsklinik, under covid-19-pandemin med primärt fokus på hygienrutiner och smittrisker. Metod: Enskilda semi-strukturerade intervjuer följt av transkribering och kvalitativ innehållsanalys. Resultat: Åtta intervjuer genomfördes på en Infektionsklinik i västra Sverige. Analysen av materialet delades in i fyra huvudkategorier och sju subkategorier. De fyra huvudkategorierna var Anhöriga, Skyddsutrustning, Patienten samt Rollen som sjuksköterska. Studiens resultat visar att etiska konflikter har varit vanligt förekommande i sjukvården under covid-19-pandemin, i synnerhet relaterat till besöksrestriktioner och skyddsutrustningens negativa påverkan i omvårdnadsarbetet. Konklusion och betydelse: Studien ger ökad kunskap och förståelse av de etiska konflikter som kan uppstå̊ i samband med en pandemi, relativ betydelse av målkonflikter och ökad förståelse av den stress som det kan medföra. Studien kan även ge en inblick i den extremt föränderliga arbetsmiljön och höga arbetsbelastningen som uppstår i samband med stora utbrott av smittsamma sjukdomar. Trots detta beskrivs även en positiv utveckling i arbetet med nya lärdomar. För att kunna omvandla erfarenheter till kunskap behöver etiska konflikter belysas och etisk reflektion för att kunna utveckla och förbättra omvårdnaden. Fortsatt forskning om etiska konflikter ur såväl patientens som vårdpersonalens perspektiv behövs för att öka kunskapen.
Hvilken evidens er der for, at ventilation og udluftning kan forebygge smitte med luftvejsvirus? Særligt fokus på børn og ansatte i dagtilbud.
(2023-12-22) Stephansen, Lene; University of Gothenburg/Institute of Biomedicin; Göteborgs universitet/Institutioen för biomedicin
Baggrund: Coronapandemien har givet os megen ny viden om forebyggelse af luftvejsinfektioner. Særligt betydningen af smitte via luften er kommet i fokus. Luftvejsinfektioner er meget hyppige i daginstitutioner både blandt børn og ansatte og medfører betragtelige udgifter for samfundet i form af vikarbudgetter, manglende produktivitet, dårligere service og personlige omkostninger. Det vir-ker åbenlyst, at en reduktion af koncentrationen af smitsomme virus i indeluften vil medføre færre sygdomstilfælde, men er der solid evidens i litteraturen for forebyggelse via forbedret ventilation og udluftning? Forskningsspørgsmål: Er der evidens for, at ventilation og udluftning kan reducere smitte med luftvejsvirus i daginstitutioner og sammenlignelige indeklimaer som skoler og kontormiljøer? Metode: Der er gennemført et struktureret litteraturstudie i PubMed og Google Scholar med inklu-sionskriterierne: originale studier, som har fokus på om ventilations-effektivitet/kvalitet kan doku-mentere en ændring i incidensen af luftvejsinfektioner i ikke health-care indeklimaer. Eksklusions-kriterier er oversigtsstudier, modellerings-studier og studier, som kun kikker på overlevelse, identi-fikation og spredning af virus. Resultater: Der blev fundet i alt 7 studier som levede op til inklusionskriterierne. Heraf 2 som havde fokus på daginstitutioner, 3 med fokus på skoler og 2 i kontormiljøer. Smitte blev målt som sygdom/sygefravær og ventilationskvalitet oftest via CO2-koncentrationen som en proxy for smitte-risiko i personers udånding. Konklusion: Seks af de 7 studier viste en reduktion i sygefravær eller sygdom som følge af forbed-ret ventilation og udluftning. Alle studier var behæftet med en vis usikkerhed (bias) og der blev ikke fundet solid evidens for at forbedret luftkvalitet medfører begrænset smitte med luftvejsvirus. Der er dog omfattende indikationer på at det er tilfældet.
Mundhygiejne til beboere på plejehjem i et infektionshygiejnisk perspektiv – en kvalitativ undersøgelse blandt SOSU-medarbejdere i Københavns Kommune
(2023-12-22) Gosmann, Fanny; University of Gothenburg/Institute of Biomedicin; Göteborgs universitet/Institutioen för biomedicin
Baggrund Manglende mundhygiejne kombineret med forskellige risikofaktorer kan associeres med pneumoni og risiko for indlæggelse. Danmark har en relativ høj incidens for pneumoni som forebyggelig indlæggelse blandt ældre. På trods af systematisk forebyggende tandpleje til københavnske plejehjemsbeboere, ses problemer med plak og tandkødsblødninger hos 18-23 %. Mundhygiejne vurderes samtidig til at være et dagligt plejebehov hos 75 %. Social- og sundhedsmedarbejdere (SOSU-medarbejdere) har det daglige plejeansvar for beboerne inklusiv mundhygiejne. Det undersøges derfor, hvordan disse forholder sig til mundhygiejne som infektionshygiejnisk indsats. Forskningsspørgsmål Hvilken viden og opfattelse har SOSU-medarbejdere om mundhygiejne som infektionshygiejnisk indsats blandt beboere på plejehjem? Hvilke forhold eller faktorer ser SOSU-medarbejderne som fremmende eller begrænsende i forhold til at understøtte eller udføre mundhygiejne? Metode Kvalitativ undersøgelse med semi-strukturerede individuelle interviews af seks erfarne SOSU-medarbejdere med plejeansvar for plejehjemsbeboere i København. Resultater Daglig mundhygiejne ses som en vigtig infektionsforebyggende indsats og som en hverdagspraksis, der giver velvære. Personligt kendskab, relation og samarbejde med beboeren er væsentlige forudsætninger, der fremmer mulighed for mundhygiejne, hvorimod vægring og manglende samarbejde hæmmer. Uhensigtsmæssige arbejdsstillinger og dårlig belysning angives som barrierer, ligesom del-proteser opleves som svære at gennemskue og håndtere. Tandplejen er den vigtigste samarbejdspartner i forhold til viden, sparring og feedback. Mundhygiejne ses desuden i et etisk perspektiv, hvor SOSU-medarbejderen er forpligtet til at varetage den plejeafhængige beboers helbred og samtidig forpligtet til at værne om beboerens autonomi ved ikke at overskride dennes grænser. Konklusion SOSU-medarbejderne forstår mundhygiejne som en vigtig infektionshygiejnisk opgave. Tryg relation, accept og samarbejde er de vigtigste forudsætninger for opgaven, mens hensynet til beboerens autonomi kan betyde nødtørftig og lejlighedsvis udførelse af mundhygiejne, særligt hos kognitivt svækkede beboere. Hyppigste barrierer for mundhygiejne er manglende samarbejde eller vægring fra beboeren samt fysiske forhold som dårlig belysning og ubekvemme arbejdsstillinger, hvilket bør medtænkes ved indsatser, der skal forbedre beboernes mundhygiejne.
Samband mellan sociodemografiska faktorer i befolkningen och covid-19-relaterad mortalitet på särskilda boenden för äldre – en jämförelse på kommunnivå
(2023-12-22) Petersson, Lina; University of Gothenburg/Institute of Biomedicin; Göteborgs universitet/Institutioen för biomedicin
Introduktion: Studier visar att faktorer som hög ålder och födelseland påverkar hur allvarligt personer drabbas av covid-19. Personer boendes på särskilda boenden för äldre utgjorde närmare hälften av de avlidna med covid-19 under 2020. Låg personalomsättning och tillgång till en anställd sjuksköterska är associerat till lägre risk för död i covid-19 på ett sådant boende. Syfte: Att undersöka om det finns ett samband mellan covid-19-relaterad mortalitet bland boende på särskilda boenden för äldre under 2020 och sociodemografiska faktorer i befolkningen på kommunnivå. Metod och material: Detta är en kvantitativ ekologisk studie. Kommunernas covid-19-relaterade mortalitet under 2020 beräknades som antalet avlidna boende på särskilt boende för äldre delat med populationen på särskilda boenden för äldre. Kommunernas covid-19-relaterade mortalitet klassificerades som hög eller låg baserat på om mortaliteten låg över eller under den 60:e respektive 40:e percentilen bland alla kommuner inom en region. Sambandet mellan sociodemografiska faktorer och mortalitet på särskilda boenden för äldre analyserades med logistisk regression. Resultat: Medianvärdet på kommunernas covid-19-relaterade mortalitet var 4,5 avlidna per 100 boende på särskilt boende för äldre. Bland de analyserade sociodemografiska faktorerna på kommunnivå framkom ett samband mellan hög mortalitet på särskilt boende för äldre och högre andel av kommunens befolkning födda utanför Norden (justerat Odds ratio: 2,9 95 % konfidensintervall 1,2 – 6,9). Konklusion: Resultatet tyder på att hög covid-19-relaterad mortalitet på särskilt boende för äldre samvarierade med andelen utlandsfödda i befolkningen även efter justering för incidensen av covid-19. Liknande samband har visats i internationella studier. Betydelse: Resultatet kan ses som ett första steg i att identifiera ojämlika förutsättningar för god hälsa hos grupper på kommunnivå. Resultatet kan vägleda i fortsatta analyser för att identifiera möjliga insatser som kan ge kommuner rätt förutsättningar att skydda de mest sårbara i befolkningen i framtida utbrott av smittsamma sjukdomar.
Helsepersonell sin erfaring med smittesporing av apekopper – en kvalitativ studie
(2023-12-22) Simensen, Ina; University of Gothenburg/Institute of Biomedicin; Göteborgs universitet/Institutioen för biomedicin
Bakgrunn I mai 2022 ble det påvist flere tilfeller av virussykdommen apekopper utenfor endemiske områder i verden. Apekopper er endemisk i sentral- og vestafrikanske land. Det ble meldt om smittekjeder hovedsakelig blant menn som har sex med menn uten forutgående reise i endemiske områder. Helsepersonell i Oslo kommune fikk i oppgave å smittespore. For intervjuobjektene var dette en ukjent sykdom og det fantes ingen prosedyrer for hvordan dette skulle håndteres. Formål Formålet med studien var å undersøke helsepersonell sine opplevelser og erfaringer med å smittespore apekopper i utbruddet 2022. Forskningsspørsmål Hvilke erfaringer gjorde helsepersonell seg ved smittesporing av apekopper i utbruddet i 2022? Hva erfarte helsepersonell ved smittesporing av apekopper som en ny sykdom? Materiale og Metode Det ble gjort enkeltvis semistrukturerte intervjuer med seks helsepersonell ansatt i ulike bydeler i Oslo kommune. Materialet ble analysert med Malterud sin kvalitative metode; Systematisk tekstkondensering. Resultat Intervjuobjektene syntes at smittesporing av apekopper gikk relativt greit da de hadde nylig erfaring med smittesporing fra Covid-19 pandemien. De påpekte at det var avgjørende å ha tilpassede verktøy og faglig bistand. Smittesporing knyttet til seksuell aktivitet opplevdes mer utfordrende. Å ha lite kunnskap om sykdommen apekopper skapte utrygghet i rollen, spesielt hos sykepleierne. Flere mente at det hadde lettet og styrket arbeidet hvis de hadde samarbeidet med andre bydeler. Informasjonen fra index kunne ofte være mangelfull og begrense videre smittesporing. Tross dette mente alle det var viktig å smittespore for både utbruddet og index sin del da det var viktig informasjon som skulle deles begge veier. Konklusjon Når helsepersonell skal smittespore nye sykdommer er det viktig med erfaring, tilpassende verktøy, kunnskap, faghjelp og samarbeid for å gjøre dette komplekse arbeidet.
Kartläggning av vårdrelaterade infektioner och antibiotikaanvändning i hemsjukvården
(2023-12-22) Dahlberg, Kasper; University of Gothenburg/Institute of Biomedicin; Göteborgs universitet/Institutioen för biomedicin
Bakgrund: Vårdrelaterade infektioner (VRI) är en infektion relaterad till en vårdåtgärd som om den är undvikbar är en vårdskada. VRI orsakar onödigt patient lidande, längre vårdtider och ökade ekonomiska kostnader för vården. Hemsjukvård är idag en vanlig vårdform och antas växa de kommande åren. Det finns årliga mätningar på VRI och antibiotika inom både sjukhus och vård- och omsorgsboende, hur det ser ut inom hemsjukvård är okänt. Syftet med studien är att få kunskap om VRI och antibiotikaanvändning inom hemsjukvården. Vetenskapliga frågeställningar: 1. Vilken är förekomsten av VRI hos patienter inom hemsjukvården? 2. Hur vanligt är det att patienter inom hemsjukvården står på antibiotikabehandling? 3. Kan kända riskfaktorer för VRI kopplas till förekomst av infektioner hos patienter i hemsjukvården? Metod: En deskriptiv studie med fokus på VRI och antibiotika samt en sambandsanalys av riskfaktorer för VRI. Datainsamlingen är utförd av sjuksköterskor som arbetar inom hemsjukvården i stadsdelsområdet Centrum i Göteborg. De patienter som blev inkluderade hade besök av en sjuksköterska under vecka 10, 2023. Kartläggningen har fokuserat på följande typer av VRI: Läkemedelsrelaterad infektion, postoperativa infektioner och övriga ingreppsrelaterade infektioner. Även sårinfektioner och infektioner som tillkommit på mätdagen utan tydlig koppling till omvårdnadsåtgärd registrerades. Data för antibiotika som studeras är typ av antibiotikapreparat samt den givna indikationen för ordination enligt förskrivande läkare. Resultat: Studien lyckades kartlägga 302 patienter under vecka 10, 2023, vilket var 72% av de totala besöken som gjordes under vecka 10. Totalt hade 10 patienter en VRI och totalt hade 29 patienter någon form av infektion. 18 patienter behandlades med antibiotika, där flukloxacillin behandling för sårinfektion var den vanligaste ordinationen. Sambandsanalysen visade att urinkateter (p=0,002), kirurgiskt ingrepp de senaste 30 dagarna (p=0,004) och en barriärbrytandeinfart var riskfaktorer (p=0,002) som var associerade med VRI. Slutsats: Resultatet visar att VRI och antibiotikaanvändning är något mer förekommande inom hemsjukvården än inom vård- och omsorgsboenden i Sverige. Riskfaktorer som urinkateter och kirurgiskt ingrepp de senaste 30 dagarna är associerade med VRI. Studien mäter VRI och antibiotikaanvändning inom hemsjukvården och kan ses som en grund för fortsatt arbete inom ämnesområdet.

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