Five-year surveillance of patients with communicable diseases nursed in isolation

Consequences of Migrating U.S. Contagious Facilities Into General Hospitals, 1900-1950

Until the 1880s, hospitals excluded contagious disease patients from admission because of the danger they posed to other patients; by the 1950s, contagious disease care had literally moved into the general hospital. This article correlates the changing isolation facility designs with changing disease incidence and prevention strategies. It argues that isolation moved into the hospital in stages that have consequence for isolation facility design today. Between the 1890s and 1940s, contagious disease care shifted from remote isolation hospitals (commonly known as pest houses) to separate contagious disease hospitals, to contagious disease "units" adjacent to or within a general hospital facility, and to isolation rooms included in nursing units. The architectural history of isolation facility designs shows that the integration of isolation facilities into general hospitals relied on the success of new aseptic nursing procedures that prevented contact transmission but which downgraded the need for spatial separation to prevent airborne transmission. In the second half of the 20th century, federal funding and standards made isolation rooms in the hospital the norm. This migration coincided with a historically unprecedented reduction in contagious disease incidence produced by successful vaccines and antibiotics. By the 1980s, the rise of new and antibiotic resistant diseases led to extensive redesigns of the in-house isolation rooms to make them more effective. This article suggests that it is time to rethink isolation not just at the detail level but in terms of its location in relation to the general hospital.

Increased hospital length of stay attributable to Clostridium difficile infection in patients with four co-morbidities: an analysis of hospital episode statistics in four European countries

Hospital-onset Clostridium difficile infection (CDI) places a significant burden on health care systems throughout Europe, estimated at around €3 billion per annum. This burden is shared between national payers and hospitals that support additional bed days for patients diagnosed with CDI while in hospital or patients re-admitted from a previous hospitalisation. This study was performed to quantify additional hospital stay attributable to CDI in four countries, England, Germany, Spain, and The Netherlands, by analysing nationwide hospital-episode data. We focused upon patients at increased risk of CDI: with chronic obstructive pulmonary disease, heart failure, diabetes, or chronic kidney disease, and aged 50 years or over. Multivariate regression and propensity score matching models were developed to investigate the impact of CDI on additional length of hospital stay, controlling for confounding factors such as underlying disease severity. Patients in England had the longest additional hospital stay attributable to CDI at 16.09 days, followed by Germany at 15.47 days, Spain at 13.56 days, and The Netherlands at 12.58 days, derived using regression analysis. Propensity score matching indicated a higher attributable length of stay of 32.42 days in England, 15.31 days in Spain, and 18.64 days in The Netherlands. Outputs from this study consistently demonstrate that in European countries, for patients whose hospitalisation is complicated by CDI, the infection causes a statistically significant increase in hospital length of stay. This has implications for optimising resource allocation and budget setting at both the national and hospital level to ensure that levels of CDI-complicated hospitalisations are minimised.

Effects of the contact isolation application on anxiety and depression levels of the patients

This study was aimed to assess the effects of contact isolation application on anxiety and depression levels of the patients, the effects of certain sociodemographics and patient characteristics on anxiety and depression levels, and the thoughts of the isolated patients about contact isolation. This non-randomized quasi-experimental study was carried out with 60 isolated and 57 non-isolated patients with hospital infection. The data were acquired from Hospital Anxiety and Depression Scale (HADS-A (anxiety) and HADS-D (depression)) and patient information form. There was no statistically significant difference between the anxiety and depression levels of the isolated and non-isolated patients. In the isolated patients, the depression points were higher in patients who were, women, received primary education and had lower income levels. Of the patients, 86.4% of them told that they were happy to be in the isolation room. Contact isolation application did not affect anxiety and depression levels of the patients. However, personal attributes increased the development of depression. In contact isolated patients, personal attributes should be taken into consideration in nursing care planning to prevent development of depression.

Clinical and economic burden of Clostridium difficile infection in Europe: a systematic review of healthcare-facility-acquired infection

PubMed, EMBASE and conference abstracts were reviewed systematically to determine the clinical and economic burden associated with Clostridium difficile infection (CDI) acquired and treated in European healthcare facilities. Inclusion criteria were: published in the English language between 2000 and 2010, and study population of at least 20 patients with documented CDI acquired/treated in European healthcare facilities. Data collection was completed by three unblinded reviewers using the Cochrane Handbook and PRISMA statement. The primary outcomes were mortality, recurrence, length of hospital stay (LOS) and cost related to CDI. In total, 1138 primary articles and conference abstracts were identified, and this was narrowed to 39 and 30 studies, respectively. Data were available from 14 countries, with 47% of studies from UK institutions. CDI mortality at 30 days ranged from 2% (France) to 42% (UK). Mortality rates more than doubled from 1999 to 2004, and continued to rise until 2007 when reductions were noted in the UK. Recurrent CDI varied from 1% (France) to 36% (Ireland); however, recurrence definitions varied between studies. Median LOS ranged from eight days (Belgium) to 27 days (UK). The incremental cost of CDI was £4577 in Ireland and £8843 in Germany, after standardization to 2010 prices. Country-specific estimates, weighted by sample size, ranged from 2.8% to 29.8% for 30-day mortality and from 16 to 37 days for LOS. CDI burden in Europe was most commonly described using 30-day mortality, recurrence, LOS and cost data. The continued spread of CDI and resultant healthcare burden underscores the need for judicious use of antibiotics.

Implementing the MRSA recommendations made by the Commission for Hospital Hygiene and Infection Prevention (KRINKO) of 1999 - current considerations by the DGKH Management Board

In Germany, recommendations on dealing with patients who are colonised with methicillin-resistant S. aureus (MRSA) for the inpatient sector have been published in 1999 by the Commission for Hospital Hygiene and Infection Prevention (KRINKO). Some challenges arise with regard to the practical implementation of the KRINKO recommendations. These challenges do not principally question the benefit of the recommendations but have come into criticism from users. In this commentary the German Society for Hospital Hygiene (DGKH) discusses some controversial issues and adds suggestions for unresolved problems regarding the infection control management of MRSA in healthcare settings.

Overcrowding and understaffing in modern health-care systems: key determinants in meticillin-resistant Staphylococcus aureus transmission

Recent decades have seen the global emergence of meticillin-resistant Staphylococcus aureus (MRSA), causing substantial health and economic burdens on patients and health-care systems. This epidemic has occurred at the same time that policies promoting higher patient throughput in hospitals have led to many services operating at, or near, full capacity. A result has been limited ability to scale services according to fluctuations in patient admissions and available staff, and hospital overcrowding and understaffing. Overcrowding and understaffing lead to failure of MRSA control programmes via decreased health-care worker hand-hygiene compliance, increased movement of patients and staff between hospital wards, decreased levels of cohorting, and overburdening of screening and isolation facilities. In turn, a high MRSA incidence leads to increased inpatient length of stay and bed blocking, exacerbating overcrowding and leading to a vicious cycle characterised by further infection control failure. Future decision making should use epidemiological and economic evidence to evaluate the effect of systems changes on the incidence of MRSA infection and other adverse events.

[Utilization of patient isolation in non critical units from a university hospital]

BACKGROUND AND OBJECTIVE

Correct utilization of source isolation (SI) in hospitals is important to take advantage of hospital resources. The objective of this work was to evaluate the utilization of SI considering the appropriateness of isolation length-stay.

PATIENTS AND METHOD

During a period of 19 months a prospective observational study was carried out among non-critical inpatients who underwent SI in a university hospital. The information was obtained from Admission Unit data, daily ward rounds and review of case history records.

RESULTS

A total of 239 SIs were identified, summarizing 2,589 days in isolation (median: 8 days, range: 1-56 days). These data supposed a cumulative incidence of 6.74 isolations by 1,000 admissions, and an incidence density of 1.08 isolations by 1,000 inpatient-day. 36.8% of SIs were considered incorrectly used, meaning a total of 703 inappropriate stays in isolation (27.1% of all stays carried out in SI). Surgical wound infections prompted inappropriate isolations with a greater frequency (45.2%), mainly after hip and knee prosthesis implantation interventions (42.9% and 17.9%, respectively).

CONCLUSIONS

It is necessary to develop quality criteria and indicators in order to implement quality improvement actions to optimize SI length-stay management.