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Vårdplatsbyten och Clostridium difficile-infektion: En fall-kontroll-studie
University of Skövde, School of Health and Education.
2019 (Swedish)Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesisAlternative title
Patient transfers and Clostridium difficile infection : A case-control study (English)
Abstract [sv]

Introduktion: Clostridium difficile är en bakterie som bildar tåliga sporer som kan överleva länge i sjukhusmiljön trots goda rutiner. De flesta Clostridium difficile-infektioner (CDI) är sjukhusförvärvade. Att tarmen koloniseras av sporer eller bakterier är en förutsättning för infektion, risken att sedan insjukna beror på tarmflorans och immunförsvarets tillstånd. I modern sjukvård sker regelmässigt patientomflyttningar inom och mellan avdelningar, vilket gör att patienten exponeras mot en större del av sjukhusmiljön där C. difficile-sporer kan finnas. Syfte: Att undersöka om byte av vårdplats inom och/eller mellan avdelningar är en riskfaktor för att insjukna i CDI när hänsyn tas till andra kända riskfaktorer. Metod: En fall-kontroll-studie på alla sjukhusförvärvade fall hos vuxna på Södra Älvsborgs Sjukhus i Borås under två år, 2012 och 2015. Beräkning av odds ratio med univariat logistisk regression följt av multivariat logistisk regression för statistiskt signifikanta variabler. Resultat: Vårdplatsbyten var inte vanligare i fallgruppen när hänsyn togs till övriga riskfaktorer. I den multivariata modellen var vårdtid innan provtagning den enda variabel som utföll statistiskt signifikant (OR per vårddygn: 1,07, konfidensintervall: 1,02–1,12).

Slutsats: Studien kunde inte påvisa att vårdplatsbyten är en oberoende riskfaktor för CDI, men att genomföra undersökningen på ett större studiematerial kan vara av värde.

Abstract [en]

Introduction: Clostridium difficile is a spore-forming bacterium; the spores are highly resilient and can survive for long periods of time in the hospital environment. Most Clostridium difficile infections (CDI) are hospital-acquired. Colonization of spores or vegetative bacteria in the large intestine is necessary for infection to occur; the risk of infection is modulated by the state of the intestinal microbiome and the host´s immune status. Patient-to-patient transmission within and between wards are commonplace in modern healthcare, exposing patients to more of the hospital environment where spores may exist. Aim: To determine whether changing room and/or ward is a risk factor for developing CDI when adjusted for other known risk factors. Method: A case-control study of all hospital-acquired CDI cases at Södra Älvsborg Hospital, Borås, Sweden, during two years: 2012 and 2015. Odds ratios were calculated using univariate logistic regression analysis followed by multivariate logistic regression analysis to evaluate statistically significant (p<0,05) variables identified by the univariate analysis. Results: Patient transfers were not more common in the case group when data was adjusted for other known risk factors. In the multivariate model, length of stay [A1] alone was the only statistically significant variable (OR per additional day of care: 1.07, 95 % confidence interval: 1.02-1.12). Conclusion: The study could not demonstrate patient transfers as an independent risk factor for CDI, though replicating the study on a larger patient sample might be valuable.

Place, publisher, year, edition, pages
2019. , p. 23
Keywords [en]
clostridium difficile, patient transfers, risk factor, healthcare-associated infections
Keywords [sv]
clostridium difficile, vårdplatsbyten, riskfaktor, vårdrelaterade infektioner
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:his:diva-16635OAI: oai:DiVA.org:his-16635DiVA, id: diva2:1289265
External cooperation
Vårdhygien, Södra Älvsborgs Sjukhus, Borås
Subject / course
Public Health Science
Educational program
Public Health Science: Infection Prevention and Control - Master’s Programme 60 ECTS
Supervisors
Examiners
Available from: 2019-02-22 Created: 2019-02-15 Last updated: 2019-02-22Bibliographically approved

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