الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Liver transplantation (LT) represents the only curative therapy for patients
with end stage liver disease, giving excellent long-term survival. Infection is a
major problem for patients who get liver transplanted. Infections like
(cytomegalovirus disease, hepatitis recurrence, fungal and bacterial infection) also
contribute to significant morbidity, fulminant fungemia and tuberculosis, although
unusual, develop in severe immunocompromised recipient. The infection control
nurse (ICN) as an expert healthcare professional will endeavor to set up and
monitor quality programs, facilitate the safe delivery of patient care and
performed quality control and surveillance by continually monitoring and
verifying the status of process.
The present study was designed to examining the effect of implementation
of nosocomial prevention strategies in liver transplant recipients through
assessment of nosocomial infection among liver transplanted patients before,
during and after liver transplantation surgery. And examine nursing knowledge,
attitude, and behaviors before and after implementation of infection control
preventive strategies for patients underwent living related liver transplantation in
National Liver Institute, Menoufiya University.
The obtained data not only described the post-liver transplantation
Infections that occurred in the patients studied and the nosocomial infection
control program in National liver Institute, Menoufiya University, but it also
offered an information base when attempting to investigate more in the future to
obtain the special characteristics -if any- of the Egyptian liver transplantation
patients, and factors to be considered to lower the rates of post-liver
transplantation infections.
- The Study was done on living related liver transplantation patients. The results of the study revealed the following Infection complicated 10 patients of the 60 patients (16.7 %) The average number of infections was 2.7 episodes per patient The majority of infections due to bacteria and fungi occurred in the first
month after transplant and these accounted for virtually all of infections
during that early period.
There was a statistical significant difference (P<0.01) between the
infection rate before and after implementation of the nosocomial infection
control program (16.7% after implementation of the nosocomial infection
control program in the current study compared to 70 % infection rate
before applying infection control program
There was a statistical significant difference (P<0.01) between preoperative
ascitis and incidence of infection post liver transplantation.
There was a statistical significant difference (P<0.01) between preoperative
GIT bleeding and incidence of infection post liver
transplantation.
There was a statistical significant difference (P<0.01) between preoperative
attacks of encephalopathy and incidence of infection post liver
transplantation
There was a statistical significant difference (P<0.01) between preoperative
Diabetes and incidence of infection post liver transplantation.
There was a statistical significant difference (P<0.01) between preoperative
abnormal CT chest, abnormal chest X ray and abnormal upper
GIT endoscopy and incidence of infection post liver transplantation.
There was a statistical significant difference (P<0.01) between prolonged
operative time more than 12 hours and prolonged ICU stays more than 7
days (the maximum ICU stay days in non infected patients) and incidence
of infection
There was a statistical significant difference (P<0.01) between
postoperative prolonged ICU stays more than 7 days (the maximum ICU
stay days in non infected patients) and incidence of infection
There was a statistical significant difference (P<0.01) between the
improvement of nurse’s knowledge and the implementation of the
infection control program
Summary
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There was a statistical significant difference (P<0.01) between the
improvement of nurse’s attitude and the implementation of the infection
control program
There was a statistical significant difference (P<0.01) between the
improvement of nurse’s practice and the implementation of the infection
control program
In conclusion, the current study focuses on prevention of infection in
transplanted recipients and improve the nurse’s knowledge, attitude and practice.
It was found that patients with elevated preoperative CRP and TLC level were
risky to acquire infection. In addition prolonged operative time and preoperative
abnormal radiology tests considered significant risk factors of infection. And it
also found after implementation of the nosocomial infection control program the
nurse’s levels of knowledge, attitude and practice was improved which also
reflected on the rate of transmission of infection in patients with liver transplants
where the infection rate decreased to 16.7% after implementation of the
nosocomial infection control program in the current study compared to 70%
infection rate before implementation of the program
The current study recommended that, Maintain continued assessment and
evaluation of the nurse’s knowledge, attitude and practice regarding to the all
instructions in the nosocomial infection control program. Maintain continued
Patient and family/visitor education regarding infection prevention and control
programs. Inclusion of infection prevention and control duties into the job
description of every hospital employee and contract staff. All staff (employed and
credentialed) will be expected to know and be held accountable for following
facility infection prevention and control policies. And maintain adequately fund
infection prevention and control programs, including staffing and software needs.
Acute care facilities without appropriate resources should identify outside staff
and resources to assist as needed in order to reduce the infection rate after the
transplantation surgery.