1
|
Senges C, Herzer C, Norkus E, Krewing M, Mattner C, Rose L, Gebhardt T, Mattner F, Niesalla H. Workflows and locations matter - insights from electronic hand hygiene monitoring into the use of hand rub dispensers across diverse hospital wards. Infect Prev Pract 2024; 6:100364. [PMID: 38601127 PMCID: PMC11004075 DOI: 10.1016/j.infpip.2024.100364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/28/2024] [Indexed: 04/12/2024] Open
Abstract
Background While healthcare-associated infections (HAIs) affect approximately 3.2-6.5% of hospitalised patients in the US and Europe, improving hand hygiene (HH) could reduce HAI rates. Investigating HH is time-consuming and not always objective, and comprehensive, unbiased data is needed to develop effective strategies. Using electronic tools can provide new and detailed insights on the determinants of HH. Aim To evaluate location-dependent usage of wall-mounted dispensers (WMDs) and point-of-care dispensers (POCs) using an electronic HH recording system. Methods In this retrospective study, hand rub volumes were anonymously recorded for 931,446 disinfections from 17 wards in nine German hospitals using the electronic monitoring system NosoEx®. Number of disinfections and rub volumes of WMDs/POCs by ward and room type were analysed. Findings Generally, WMDs were most prevalent. With >3 dispensers per bed and >20 disinfections per patient day, availability and use were highest in intensive care (ICU) and intermediate care (IMC), but here rub volumes from WMDs were lowest (∼2.0 mL). Although most dispensers are located in patient rooms (∼42%), they are more frequently used in hallways. In surgical ICUs, dispensers are often used in patient rooms, where contact with open wounds is common. About 3.6 mL of hand rub is used per disinfection in treatment rooms, the highest volume of all room types. Conclusion Dispenser use was dependent on location, room type, ward specialisation and workflow. Optimising the location of hand rub dispensers (HRDs)s is not the only solution to improve HH, but can help reduce inconvenience, achieve more ergonomic workflows and better meet user needs.
Collapse
Affiliation(s)
- Christoph Senges
- HARTMANN SCIENCE CENTER, BODE Chemie GmbH a company of the HARTMANN GROUP, Hamburg, Germany
| | | | | | - Marco Krewing
- HARTMANN SCIENCE CENTER, BODE Chemie GmbH a company of the HARTMANN GROUP, Hamburg, Germany
| | - Clara Mattner
- Chair for Hygiene and Environmental Medicine, University Witten-Herdecke, Cologne Clinics, Cologne, Germany
- Institute of Rural Studies, Johann Heinrich von Thünen Institute, Braunschweig, Germany
| | - Leonard Rose
- Chair for Hygiene and Environmental Medicine, University Witten-Herdecke, Cologne Clinics, Cologne, Germany
| | | | - Frauke Mattner
- Chair for Hygiene and Environmental Medicine, University Witten-Herdecke, Cologne Clinics, Cologne, Germany
| | - Heide Niesalla
- HARTMANN SCIENCE CENTER, BODE Chemie GmbH a company of the HARTMANN GROUP, Hamburg, Germany
| |
Collapse
|
2
|
Mant SJ, Amadi-Livingstone C, Ahmed MH, Panourgia M, Owles H, Pearce O. Orthogeriatric Care Following Hip Fracture: Improving Post-Operative Outcomes in an Aged Population. Life (Basel) 2024; 14:503. [PMID: 38672773 PMCID: PMC11050858 DOI: 10.3390/life14040503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/30/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Hip fractures globally are associated with high levels of morbidity, mortality, and significant financial burden. This audit aimed to assess the impact of orthogeriatric liaison care on post-operative outcomes following surgical management of neck or femur fractures. METHODS Here, 258 patients who underwent hip fracture surgery over 1-year were included. Data were collected as an audit following the transition to an orthogeriatric liaison care model, involving regular orthogeriatric review (thrice weekly ward rounds, daily board rounds), superseding orthogeriatric review as requested. The audit is meant to assess the development of post-operative non-surgical site infection (NSSI) and mortality and duration of inpatient stay. Outcomes were compared to previous data from our hospital site in 2015/2016. RESULTS Patients with severe cognitive impairment and systemic disease (Abbreviated Mental Test Score (AMTS) < 7 and American Society of Anesthesiologists (ASA) grade ≥ 3) showed significantly elevated NSSI risk, consistent across the study periods. Both periods demonstrated an increased risk of NSSI associated with admission from nursing homes. Despite the 2021/2022 cohort being notably older, NSSI risk decreased from 40.6% to 37.2% after implementing the orthogeriatric care model. NSSI risk was notably reduced for severe cognitive impairment (51.6% vs. 71%), and the p-value was 0.025. Average hospital stay decreased post-intervention (2.4 days shorter), with a notable reduction for NSSI patients (3.4 days shorter). Overall mortality rates were similar, although mortality due to infection was significantly reduced in 2021/2022 (44.4% vs. 93.3%), and the p-value was 0.003. CONCLUSION The orthogeriatric liaison care model significantly decreased NSSI only in individuals with severe cognitive impairment and infection-associated mortality. This highlights the integral role of orthogeriatricians in the care of elderly hip fracture patients.
Collapse
Affiliation(s)
- Sarah J. Mant
- The Medical School, University of Buckingham, Buckingham MK18 1EG, UK; (S.J.M.); (C.A.-L.)
| | | | - Mohamed H. Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
- Department of Geriatric Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK; (M.P.); (H.O.)
- Honorary senior lecturer. Faculty of Medicine and Health Sciences, University of Buckingham, Buckingham MK18 1EG, UK
| | - Maria Panourgia
- Department of Geriatric Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK; (M.P.); (H.O.)
- Honorary senior lecturer. Faculty of Medicine and Health Sciences, University of Buckingham, Buckingham MK18 1EG, UK
| | - Henry Owles
- Department of Geriatric Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK; (M.P.); (H.O.)
| | - Oliver Pearce
- Department of Trauma and Orthopedics, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK;
| |
Collapse
|
3
|
Fluck D, Fry CH, Robin J, Affley B, Kakar P, Sharma P, Han TS. Impact of healthcare-associated infections within 7-days of acute stroke on health outcomes and risk of care-dependency: a multi-centre registry-based cohort study. Intern Emerg Med 2024:10.1007/s11739-024-03543-5. [PMID: 38517643 DOI: 10.1007/s11739-024-03543-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/16/2024] [Indexed: 03/24/2024]
Abstract
Healthcare-associated infections (HCAIs) in patients admitted with acute conditions remain a major challenge to healthcare services. Here, we assessed the impact of HCAIs acquired within 7-days of acute stroke on indicators of care-quality outcomes and dependency. Data were prospectively collected (2014-2016) from the Sentinel Stroke National Audit Programme for 3309 patients (mean age = 76.2 yr, SD = 13.5) admitted to four UK hyperacute stroke units (HASU). Associations between variables were assessed by multivariable logistic regression (odds ratios, 95% confidence intervals), adjusted for age, sex, co-morbidities, pre-stroke disability, swallow screening, stroke type and severity. Within 7-days of admission, urinary tract infection (UTI) and pneumonia occurred in 7.6% and 11.3% of patients. Female (UTI only), older age, underlying hypertension, atrial fibrillation, previous stroke, pre-stroke disability, intracranial haemorrhage, severe stroke, and delay in swallow screening (pneumonia only) were independent risk factors of UTI and pneumonia. Compared to patients without UTI or pneumonia, those with either or both of these HCAIs were more likely to have prolonged stay (> 14-days) on HASU: 5.1 (3.8-6.8); high risk of malnutrition: 3.6 (2.9-4.5); palliative care: 4.5 (3.4-6.1); in-hospital mortality: 4.8 (3.8-6.2); disability at discharge: 7.5 (5.9-9.7); activity of daily living support: 1.6 (1.2-2.2); and discharge to care-home: 2.3 (1.6-3.3). In conclusion, HCAIs acquired within 7-days of an acute stroke led to prolonged hospitalisation, adverse health consequences and risk of care-dependency. These findings provide valuable information for timely intervention to reduce HCAIs, and minimising subsequent adverse outcomes.
Collapse
Affiliation(s)
- David Fluck
- Department of Cardiology, Ashford & St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD, UK
| | - Jonathan Robin
- Department of Acute Medicine, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Brendan Affley
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Puneet Kakar
- Department of Stroke, Epsom and St Helier University Hospitals, Epsom, KT18 7EG, UK
| | - Pankaj Sharma
- Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, W6 8RF, UK
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX, UK
| | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX, UK.
- Department of Endocrinology, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
| |
Collapse
|
4
|
Huang L, Ning H, Liu XC, Wang Y, Deng C, Li H. Economic burden attributable to hospital-acquired infections among tumor patients from a large regional cancer center in Southern China. Am J Infect Control 2024:S0196-6553(24)00107-X. [PMID: 38460730 DOI: 10.1016/j.ajic.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND To evaluate the economic loss of hospital-acquired infections (HAIs) among tumor patients so as to help policymakers to allocate health care resources and address the issue. METHODS We conducted a retrospective, 1:1 matched case-control study in a large region cancer hospital between January 1 and December 31, 2022. The economic burden was estimated as the median of the 1:1 pair differences of various hospitalization fees and hospital length of stay (LOS). RESULTS In this study of 329 matched pairs, the patients with HAIs incurred higher hospitalization cost (ie, $16,927) and experienced longer hospital LOS (ie, 22 days), compared to the non-HAI groups. The extra hospitalization cost and the prolonged hospital LOS caused by HAIs were $4,919 and 9 days, respectively. Accordingly, the direct nonmedical economic loss attributable to HAI was approximately $478 to 835 per case. Furthermore, the increment of hospitalization costs varied by sites of infection, types of tumors, and stratum of age. CONCLUSIONS HAIs lead to the increment of direct economic burden and hospital LOS in tumor patients. Our findings highlight the importance of implementing effective infection control measures in hospitals to reduce the financial burden on tumor patients.
Collapse
Affiliation(s)
- Lihua Huang
- Administration Department of Nosocomial Infection, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Huacheng Ning
- Department of Medical Records and Statistics, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Xin-Chen Liu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yongjie Wang
- Department of Medical Records and Statistics, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Chuangzhong Deng
- Deparment of Musculoskeletal Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.
| | - Huan Li
- Administration Department of Nosocomial Infection, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| |
Collapse
|
5
|
Satheesan MK, Tsang TW, Wong LT, Mui KW. The air we breathe: Numerical investigation of ventilation strategies to mitigate airborne dispersion of MERS-CoV in inpatient wards. Heliyon 2024; 10:e26159. [PMID: 38404798 PMCID: PMC10884507 DOI: 10.1016/j.heliyon.2024.e26159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 01/03/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024] Open
Abstract
Ventilation strategies for infection control in hospitals has been predominantly directed towards isolation rooms and operating theatres, with relatively less emphasis on perceived low risk spaces, such as general wards. Typically, the ventilation systems in general wards are intended to optimize patient thermal comfort and energy conservation. The emission of pathogens from exhalation activity, such as sneezing, by an undiagnosed infectious patient admitted to general wards, is a significant concern for infection outbreaks. However, the ventilation guidelines for general wards with respect to infection control are vague. This research article presents a numerical study on the effect of varying air change rates (3 h-1, 6 h-1, 9 h-1, 13 h-1) and exhaust flow rates (10%, 50% of supply air quantity) on the concentration of airborne pathogens in a mechanically ventilated general inpatient ward. The findings imply that the breathing zone directly above the source patient has the highest level of pathogen exposure, followed by the breathing zones at the bedside and adjacent patients close to the source patient. The dispersion of pathogens throughout the ward over time is also apparent. However, a key difference while adopting a lower ACH (3 h-1) and a higher ACH (13 h-1) in this study was that the latter had a significantly lower number of suspended pathogens in the breathing zone than the former. Thus, this research suggests high ventilation rates for general wards, contrary to current ventilation standards. In addition, combining a higher air change rate (13 h-1) with a high exhaust flow rate (50% of supply air) through a local exhaust grille dramatically reduced suspended pathogens within the breathing zone, further mitigating the risk of pathogen exposure for ward users. Therefore, this study presents an effective ventilation technique to dilute and eliminate airborne infectious pathogens, minimizing their concentration and the risk of infection.
Collapse
Affiliation(s)
- Manoj Kumar Satheesan
- Department of Building Environment and Energy Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Tsz Wun Tsang
- Department of Building Environment and Energy Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Ling Tim Wong
- Department of Building Environment and Energy Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Kwok Wai Mui
- Department of Building Environment and Energy Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| |
Collapse
|
6
|
Al Harbi S, Aljohani B, Elmasry L, Baldovino FL, Raviz KB, Altowairqi L, Alshlowi S. Streamlining patient flow and enhancing operational efficiency through case management implementation. BMJ Open Qual 2024; 13:e002484. [PMID: 38423585 PMCID: PMC10910643 DOI: 10.1136/bmjoq-2023-002484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/11/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Improving patient flow in hospitals represents a worldwide healthcare challenge. The objective of this project was to depict the effectiveness of case management in improving patient flow in a tertiary hospital setting. METHODS Quality improvement methods, including quantitative pre-Lean and post-Lean design, the Plan-Do-Check-Act concept, the Single Minute Exchange of Dies and the 'demand and supply approach' of the Institute of Healthcare Improvement, were adapted to examine and modify factors influencing hospital patient flow. RESULTS This study (conducted from the last quarter of 2019 through September 2022) resulted in a remarkable improvement in patient flow, as evident from the reduction in average hospital length of stay (from 11.5 to 4.4 days) and average emergency department boarding time (from 11.9 to 1.2 hours) and the improvement of bed turnover rate (from 0.57 to 0.93), (p<0.001, p=0.017, p=0.038, respectively), with net cost savings of 123 130 192 million Saudi Riyals (US$32 821 239). CONCLUSION Implementing a well-structured case management programme can enhance care coordination, streamlilne transitions, boost patient outcomes, and increase revenues within hospital settings.
Collapse
Affiliation(s)
- Sultanah Al Harbi
- Case Management Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Baker Aljohani
- Medical Administration, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Lamiaa Elmasry
- Quality Improvement and Patient Safety Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Frenk Lee Baldovino
- Case Management Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Kamille Bianca Raviz
- Case Management Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Lama Altowairqi
- Admission Office Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Seetah Alshlowi
- Case Management Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| |
Collapse
|
7
|
Bunduki GK, Masoamphambe E, Fox T, Musaya J, Musicha P, Feasey N. Prevalence, risk factors, and antimicrobial resistance of endemic healthcare-associated infections in Africa: a systematic review and meta-analysis. BMC Infect Dis 2024; 24:158. [PMID: 38302895 PMCID: PMC10836007 DOI: 10.1186/s12879-024-09038-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/20/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Healthcare-associated infections (HCAI) place a significant burden on healthcare systems globally. This systematic review and meta-analysis aimed to investigate the prevalence, risk factors, and aetiologic agents of endemic HCAI in Africa. METHODS MEDLINE/PubMed, CINAHL, and Global Health databases (EBSCOhost interface) were searched for studies published in English and French describing HCAI in Africa from 2010 to 2022. We extracted data on prevalence of HCAI, risk factors, aetiologic agents, and associated antimicrobial resistance patterns. We used random-effects models to estimate parameter values with 95% confidence intervals for risk factors associated with HCAI. This study was registered in PROSPERO (CRD42022374559) and followed PRISMA 2020 guidelines. RESULTS Of 2541 records screened, 92 were included, comprising data from 81,968 patients. Prevalence of HCAI varied between 1.6 and 90.2% with a median of 15% across studies. Heterogeneity (I2) varied from 93 to 99%. Contaminated wound (OR: 1.75, 95% CI: 1.31-2.19), long hospital stay (OR: 1.39, 95% CI: 0.92-1.80), urinary catheter (OR: 1.57, 95% CI: 0.35-2.78), intubation and ventilation (OR: 1.53, 95% CI: 0.85-2.22), vascular catheters (OR: 1.49, 95% CI: 0.52-2.45) were among risk factors associated with HCAI. Bacteria reported from included studies comprised 6463 isolates, with E. coli (18.3%, n = 1182), S. aureus (17.3%, n = 1118), Klebsiella spp. (17.2%, n = 1115), Pseudomonas spp. (10.3%, n = 671), and Acinetobacter spp. (6.8%, n = 438) being most common. Resistance to multiple antibiotics was common; 70.3% (IQR: 50-100) of Enterobacterales were 3rd -generation cephalosporin resistant, 70.5% (IQR: 58.8-80.3) of S. aureus were methicillin resistant and 55% (IQR: 27.3-81.3) Pseudomonas spp. were resistant to all agents tested. CONCLUSIONS HCAI is a greater problem in Africa than other regions, however, there remains a paucity of data to guide local action. There is a clear need to develop and validate sustainable HCAI definitions in Africa to support the implementation of routine HCAI surveillance and inform implementation of context appropriate infection prevention and control strategies.
Collapse
Affiliation(s)
- Gabriel Kambale Bunduki
- Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi.
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
- Centre d'Excellence en Maladies Infectieuses et Soins Critiques du Graben (CEMISoCG), Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo.
| | - Effita Masoamphambe
- Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tilly Fox
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Janelisa Musaya
- Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Patrick Musicha
- Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nicholas Feasey
- Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- School of Medicine, University of St Andrews, St Andrews, UK
| |
Collapse
|
8
|
Obaitan I, Wehbe H, Easler JJ, Stethen JT, Mahendraker N, Tong Y, Vargas A, Dewitt JM, Bick BL, Fogel E, Gutta A, Sherman S, Watkins J, Gromski M, Saleem N, Zyromski N, Al-Haddad MA. Factors predictive of hospital length of stay in patients with an index episode of acute necrotizing pancreatitis. Pancreatology 2024; 24:32-40. [PMID: 37996268 DOI: 10.1016/j.pan.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/28/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Acute necrotizing pancreatitis (ANP) complicates 15 % of acute pancreatitis cases and is associated with prolonged length of stay (LOS). There are limited studies exploring potential predictors. METHODS We carried out a retrospective study of all consecutive patients presenting to a large referral healthcare system with ANP. Patients younger than 18 years of age, without confirmed glandular necrosis and with in-hospital mortality were excluded. Poisson regression was carried out to identify potential predictors of prolonged hospital stay. RESULTS One hundred and sixty-two patients hospitalized between December 2016 and June 2020 were included. The median LOS was 12 days (range: 1-155 days). On multivariate analysis, organ dysfunction at presentation (Incidence rate ratio (IRR) 1.21, p = 0.01) or during admission (IRR 1.32, p = 0.001), Charlson Comorbidity Index scores (IRR 1.1 per CCI point, p < 0.001), known chronic pancreatitis (IRR 1.19, p = 0.03), concurrent (non-pancreas related) infections (IRR 1.13, p = 0.04), need for enteral tube placement (IRR 3.42, p < 0.001) and in-hospital interventions (IRR 1.48-2.85 depending on intervention, p < 0.001) were associated with increased LOS. For patients in the cohort to whom this applied, delayed hospital transfers (IRR 1.02, p < 0.001) and delayed start of enteral feeds (IRR 1.01, p = 0.017) contributed to increased overall LOS. CONCLUSION We demonstrate that multiple factors including delayed transfers to hospitals with pancreaticobiliary expertise lead to increased length of hospitalization. We suggest various strategies that can be considered to target those gaps and may have a favorable effect on LOS.
Collapse
Affiliation(s)
- Itegbemie Obaitan
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hisham Wehbe
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jeffrey J Easler
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joseph T Stethen
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Neetu Mahendraker
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Yan Tong
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alejandra Vargas
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - John M Dewitt
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Benjamin L Bick
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Evan Fogel
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Aditya Gutta
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stuart Sherman
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - James Watkins
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark Gromski
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nasir Saleem
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicholas Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mohammad A Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
| |
Collapse
|
9
|
Ramirez GA, Damanti S, Caruso PF, Mette F, Pagliula G, Cariddi A, Sartorelli S, Falbo E, Scotti R, Di Terlizzi G, Dagna L, Praderio L, Sabbadini MG, Bozzolo EP, Tresoldi M. Sustainability in Internal Medicine: A Year-Long Ward-Wide Observational Study. J Pers Med 2024; 14:115. [PMID: 38276237 PMCID: PMC10820757 DOI: 10.3390/jpm14010115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Population aging and multimorbidity challenge health system sustainability, but the role of assistance-related variables rather than individual pathophysiological factors in determining patient outcomes is unclear. To identify assistance-related determinants of sustainable hospital healthcare, all patients hospitalised in an Internal Medicine Unit (n = 1073) were enrolled in a prospective year-long observational study and split 2:1 into a training (n = 726) and a validation subset (n = 347). Demographics, comorbidities, provenance setting, estimates of complexity (cumulative illness rating scale, CIRS: total, comorbidity, CIRS-CI, and severity, CIRS-SI subscores) and intensity of care (nine equivalents of manpower score, NEMS) were analysed at individual and Unit levels along with variations in healthcare personnel as determinants of in-hospital mortality, length of stay and nosocomial infections. Advanced age, higher CIRS-SI, end-stage cancer, and the absence of immune-mediated diseases were correlated with higher mortality. Admission from nursing homes or intensive care units, dependency on activity of daily living, community- or hospital-acquired infections, oxygen support and the number of exits from the Unit along with patient/physician ratios were associated with prolonged hospitalisations. Upper gastrointestinal tract disorders, advanced age and higher CIRS-SI were associated with nosocomial infections. In addition to demographic variables and multimorbidity, physician number and assistance context affect hospitalisation outcomes and healthcare sustainability.
Collapse
Affiliation(s)
- Giuseppe A. Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Sarah Damanti
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Pier Francesco Caruso
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Francesca Mette
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Gaia Pagliula
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Adriana Cariddi
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Silvia Sartorelli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Elisabetta Falbo
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Raffaella Scotti
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Gaetano Di Terlizzi
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
| | - Luisa Praderio
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Maria Grazia Sabbadini
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Enrica P. Bozzolo
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| |
Collapse
|
10
|
Ouwerkerk JJJ, van Ee EPX, Brown TA, Dorken-Gallastegi A, Gebran A, Argandykov D, Proaño-Zamudio JA, Hwabejire JO, Kaafarani HMA, Velmahos GC, Parks J. Video-Assisted Thoracic Surgery Evacuation of Retained Hemothorax; Timing May Not Increase Thoracoscopic Failure. J Surg Res 2024; 293:168-174. [PMID: 37774594 DOI: 10.1016/j.jss.2023.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 06/30/2023] [Accepted: 07/23/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Current guidelines for retained hemothorax (rHTX) in trauma patients recommend video-assisted thoracic surgery (VATS) within 4 days. However, this recommendation is currently based upon evidence from small observational studies. The aim of this study is to further evaluate the association between timing of VATS and clinical outcomes in rHTX following trauma. METHODS Using the 2017-2019 Trauma Quality Improvement Program database, adult (≥15 years-old) trauma patients with rHTX who underwent evacuation of rHTX through VATS were included. Multivariable linear and logistic regression were used to evaluate the association between the timing of VATS and clinical outcomes. Postponing/delaying evacuation through VATS was defined in our analysis as performing the surgery 1 day later in time. RESULTS 793 patients were included. VATS was performed at a median 4.5 days (Interquartile range = 2.4, 8.4). A 1.17 day increase in hospital length of stay (P = <0.001), a 0.17 day increase in postoperative hospital length of stay (P = 0.007), a 0.48 day increase in ventilation days (P = <0.001), and a 0.66 day increase in intensive care unit length of stay (P = <0.001) was found for each day that VATS was delayed. Additionally, a 1.10 odds ratio for infectious complications (P = <0.001) and a 0.96 odds ratio for discharge to home (P = 0.006) was seen for each day VATS was delayed. There was no significant association between the timing of VATS failure of VATS (defined as requiring additional procedures such as a secondary VATS or progressed to thoracotomy after initial VATS) and mortality (P > 0.05). CONCLUSIONS While delaying VATS was statistically associated with increased hospital length of stay, and other secondary outcomes, the clinical significance of the increase in these variables were less dramatic compared to the results of other studies, thus tempering the urgency of evacuation. Additionally, there was no association found between the timing of VATS and mortality, discharge disposition, or the need for additional VATS and/or thoracotomy. Therefore, in the appropriate clinical context, the evacuation of rHTX through VATS can be delayed if clinically necessary, without an associated increase in mortality or the requirement for additional procedures.
Collapse
Affiliation(s)
- Joep J J Ouwerkerk
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Trauma Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Elaine P X van Ee
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Trauma Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Tommy A Brown
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ander Dorken-Gallastegi
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anthony Gebran
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dias Argandykov
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jefferson A Proaño-Zamudio
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John O Hwabejire
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - George C Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jonathan Parks
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
11
|
Kassam MI, Silago V, Damiano P, Wajanga B, Seni J, Mshana SE, Kalluvya S. Patterns and outcomes of health-care associated infections in the medical wards at Bugando medical centre: a longitudinal cohort study. Antimicrob Resist Infect Control 2023; 12:139. [PMID: 38049911 PMCID: PMC10696763 DOI: 10.1186/s13756-023-01345-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/25/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND The burden of healthcare associated infections (HCAIs) in low- and middle-income countries (LMICs) remains underestimated due to diagnostic complexity and lack of quality surveillance systems. We designed this study to determine clinical diagnosis, laboratory-confirmed, associated factors and risks of HCAIs. METHODS This hospital-based longitudinal cohort study was conducted between March and June 2022 among adults (≥ 18 years) admitted in medical wards at BMC in Mwanza, Tanzania. Patients who were negative for HCAIs by clinical evaluations and laboratory investigations during admission were enrolled and followed-up until discharge or death. Clinical samples were collected from patients with clinical diagnosis of HCAIs for conventional culture and antimicrobial sensitivity testing. RESULTS A total of 350 adult patients with a median [IQR] age of 54 [38-68] years were enrolled in the study. Males accounted for 54.6% (n = 191). The prevalence of clinically diagnosed HCAIs was 8.6% (30/350) of which 26.7% (8/30) had laboratory-confirmed HCAIs by a positive culture. Central-line-associated bloodstream infection (43.3%; 13/30) and catheter-associated urinary tract infection (36.7%; 11/30) were the most common HCAIs. Older age was the only factor associated with development of HCAIs [mean (± SD); [95%CI]: 58.9(± 12.5); [54.2-63.5] vs. 51.5(± 19.1); [49.4-53.6] years; p = 0.0391) and HCAIs increased the length of hospital stay [mean (± SD); [95%CI]: 13.8 (± 3.4); [12.5-15.1] vs. 4.5 (± 1.7); [4.3-4.7] days; p < 0.0001]. CONCLUSION We observed a low prevalence of HCAIs among adult patients admitted to medical wards in our setting. Central-line-associated bloodstream infections and catheter-associated urinary tract infections are common HCAIs. Significantly, older patients are at higher risk of acquiring HCAIs as well as patients with HCAIs had long duration of hospital stays.
Collapse
Affiliation(s)
- Maliha I Kassam
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Center, P. O. Box 1370, Mwanza, Tanzania
| | - Vitus Silago
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania.
| | - Prisca Damiano
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
| | - Bahati Wajanga
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Center, P. O. Box 1370, Mwanza, Tanzania
| | - Jeremiah Seni
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
| | - Samuel Kalluvya
- Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Center, P. O. Box 1370, Mwanza, Tanzania
| |
Collapse
|
12
|
Fluck D, Fry CH, Robin J, Affley B, Kakar P, Sharma P, Han TS. Determination of independent risk factors for early healthcare-associated infections acquired after acute stroke admission: A multi-centre registry-based cohort study. J Stroke Cerebrovasc Dis 2023; 32:107402. [PMID: 37804783 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/20/2023] [Accepted: 09/30/2023] [Indexed: 10/09/2023] Open
Abstract
OBJECTIVE Healthcare-associated infections (HCAIs) in patients admitted with acute conditions pose a serious risk to patients and a major challenge to healthcare services. However, there is a lack of consistency in reporting aetiological risk factors, particularly in acute stroke patients. Here, we determined independent risk factors of two common HCAIs (urinary tract infection and pneumonia) acquired within 7-days of admission after an acute stroke. METHODS Data were prospectively collected (2014-2016) from the Sentinel Stroke National Audit Programme for 3,309 patients (mean age=76.2yr, SD=13.5) admitted to four UK hyperacute stroke units. Associations between variables were assessed by forward stepwise multivariable logistic regression (odds ratios, 95 % confidence intervals). RESULTS The rate of urinary tract infection and/or pneumonia occurring within 7-days of admission was 15.0 %. The risk of urinary tract infection and/or pneumonia was increased amongst women: OR = 1.35 (1.08-1.68); patients from ethnic minority backgrounds: OR = 1.77 (1.01-3.10); patients aged 70-79 years: OR = 2.08 (1.42-3.06), and ≥80 years: OR = 3.20 (2.26-4.55); history of hypertension: OR = 1.59 (1.27-1.98); history of atrial fibrillation: OR = 1.67 (1.32-2.12); pre-stroke disability: OR = 2.08 (1.44-3.00); intracranial haemorrhage: OR = 1.41 (1.07-1.86); severe stroke: OR = 3.21 (2.32-4.45); swallow screening within 4-72 h: OR = 1.42 (1.08-1.86); swallow screening beyond 72 h: OR = 1.70 (1.08-2.70). History of congestive heart failure, diabetes and previous stroke did not significantly associate with HCAIs. CONCLUSIONS A profile of independent risk factors for two common HCAIs in acute stroke was identified. These findings provide valuable information for timely intervention to reduce HCAIs, and the ability to minimise subsequent adverse outcomes.
Collapse
Affiliation(s)
- David Fluck
- Department of Cardiology, Ashford & St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD UK3
| | - Jonathan Robin
- Department of Acute Medicine, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Brendan Affley
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Puneet Kakar
- Department of Stroke, Epsom and St Helier University Hospitals, Epsom KT18 7EG, UK
| | - Pankaj Sharma
- Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London W6 8RF, UK; Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX, UK
| | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX, UK; Department of Endocrinology, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
| |
Collapse
|
13
|
Roberts G, Chang L, Park JM, Thynne T. The occurrence of Hospital-Acquired Pneumonia is independently associated with elevated Stress Hyperglycaemia Ratio at admission but not elevated blood glucose. Diabetes Res Clin Pract 2023; 205:110955. [PMID: 37839754 DOI: 10.1016/j.diabres.2023.110955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/02/2023] [Accepted: 10/13/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND The association between stress-induced hyperglycaemia (SIH) and increased infection rates in hospitalised subjects is well-known. It is less clear if SIH at admission independently drives new-onset infections. We assessed the relationship between early exposure at admission to both the Stress Hyperglycaemia Ratio (SHR) and Blood Glucose (BG) with Hospital-Acquired Pneumonia (HAP). METHODS This observational retrospective study included those with length-of-stay > 1 day, BG within 24 h of admission and recent haemoglobin A1c. SIH was defined as BG ≥ 10 mmol/L, or SHR ≥ 1.1, measured at both admission and as a 24-hour maximum. Multivariable analyses were adjusted for length-of-stay, age, mechanical ventilation, and chronic respiratory disease. RESULTS Of 5,339 eligible subjects, 110 (2.1%) experienced HAP. Admission SHR ≥ 1.1 was independently associated with HAP (OR 3.04, 95% CI 1.98-4.68, p < 0.0001) but not BG ≥ 10 mmol/L (OR 0.65, 95% CI 0.41-1.03, p = 0.0675). The association with SHR strengthened using maximum 24-hour values (OR 3.37, 95% CI 2.05-5.52, p < 0.0001) while BG ≥ 10 mmol/L remained insignificant (OR 0.96, 95% CI 0.63-1.46, p = 0.86). Of those experiencing HAP 40 (36.4%) occurred in subjects with no recorded BG ≥ 10 mmol/L but SHR ≥ 1.1. CONCLUSION SIH at admission defined as SHR ≥ 1.1, but not the conventional marker of BG ≥ 10 mmol/L, was independently associated with the subsequent onset of HAP, commonly at BG < 10 mmol/L.
Collapse
Affiliation(s)
- Gregory Roberts
- SA Pharmacy, Flinders Medical Centre, Bedford Park SA 5042, Australia; College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia.
| | - Leonard Chang
- College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia.
| | - Joong-Min Park
- College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia.
| | - Tilenka Thynne
- College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia; Department of Clinical Pharmacology, Flinders Medical Centre, Bedford Park SA 5042, Australia.
| |
Collapse
|
14
|
Uhland FC, Li XZ, Mulvey MR, Reid-Smith R, Sherk LM, Ziraldo H, Jin G, Young KM, Reist M, Carson CA. Extended Spectrum β-Lactamase-Producing Enterobacterales of Shrimp and Salmon Available for Purchase by Consumers in Canada-A Risk Profile Using the Codex Framework. Antibiotics (Basel) 2023; 12:1412. [PMID: 37760708 PMCID: PMC10525137 DOI: 10.3390/antibiotics12091412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/24/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
The extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-EB) encompass several important human pathogens and are found on the World Health Organization (WHO) priority pathogens list of antibiotic-resistant bacteria. They are a group of organisms which demonstrate resistance to third-generation cephalosporins (3GC) and their presence has been documented worldwide, including in aquaculture and the aquatic environment. This risk profile was developed following the Codex Guidelines for Risk Analysis of Foodborne Antimicrobial Resistance with the objectives of describing the current state of knowledge of ESBL-EB in relation to retail shrimp and salmon available to consumers in Canada, the primary aquacultured species consumed in Canada. The risk profile found that Enterobacterales and ESBL-EB have been found in multiple aquatic environments, as well as multiple host species and production levels. Although the information available did not permit the conclusion as to whether there is a human health risk related to ESBLs in Enterobacterales in salmon and shrimp available for consumption by Canadians, ESBL-EB in imported seafood available at the retail level in Canada have been found. Surveillance activities to detect ESBL-EB in seafood are needed; salmon and shrimp could be used in initial surveillance activities, representing domestic and imported products.
Collapse
Affiliation(s)
- F. Carl Uhland
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| | - Xian-Zhi Li
- Veterinary Drugs Directorate, Health Products and Food Branch, Health Canada, Ottawa, ON K1A 0K9, Canada
| | - Michael R. Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB R3E 3R2, Canada
| | - Richard Reid-Smith
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| | - Lauren M. Sherk
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| | - Hilary Ziraldo
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| | - Grace Jin
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| | - Kaitlin M. Young
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB R3E 3R2, Canada
| | - Mark Reist
- Veterinary Drugs Directorate, Health Products and Food Branch, Health Canada, Ottawa, ON K1A 0K9, Canada
| | - Carolee A. Carson
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| |
Collapse
|
15
|
Gao S, Albu E, Tuand K, Cossey V, Rademakers F, Van Calster B, Wynants L. Systematic review finds risk of bias and applicability concerns for models predicting central line-associated bloodstream infection. J Clin Epidemiol 2023; 161:127-139. [PMID: 37536503 DOI: 10.1016/j.jclinepi.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES To systematically review the risk of bias and applicability of published prediction models for risk of central line-associated bloodstream infection (CLA-BSI) in hospitalized patients. STUDY DESIGN AND SETTING Systematic review of literature in PubMed, Embase, Web of Science Core Collection, and Scopus up to July 10, 2023. Two authors independently appraised risk models using CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) and assessed their risk of bias and applicability using Prediction model Risk Of Bias ASsessment Tool (PROBAST). RESULTS Sixteen studies were included, describing 37 models. When studies presented multiple algorithms, we focused on the model that was selected as the best by the study authors. Eventually we appraised 19 models, among which 15 were regression models and four machine learning models. All models were at a high risk of bias, primarily due to inappropriate proxy outcomes, predictors that are unavailable at prediction time in clinical practice, inadequate sample size, negligence of missing data, lack of model validation, and absence of calibration assessment. 18 out of 19 models had a high concern for applicability, one model had unclear concern for applicability due to incomplete reporting. CONCLUSION We did not identify a prediction model of potential clinical use. There is a pressing need to develop an applicable model for CLA-BSI.
Collapse
Affiliation(s)
- Shan Gao
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Elena Albu
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Krizia Tuand
- 2Bergen - Learning Centre Désiré Collen, KU Leuven Libraries, KU Leuven, Leuven, Belgium
| | - Veerle Cossey
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Infection Control and Prevention, University Hospitals Leuven, Leuven, Belgium
| | | | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands; EPI-Center, KU Leuven, Leuven, Belgium.
| | - Laure Wynants
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; EPI-Center, KU Leuven, Leuven, Belgium; Care & Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
16
|
Browne K, Mitchell BG. Multimodal environmental cleaning strategies to prevent healthcare-associated infections. Antimicrob Resist Infect Control 2023; 12:83. [PMID: 37612780 PMCID: PMC10463433 DOI: 10.1186/s13756-023-01274-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/10/2023] [Indexed: 08/25/2023] Open
Abstract
Infection transmission in healthcare is multifaceted and by in large involves the complex interplay between a pathogen, a host and their environment. To prevent transmission, infection prevention strategies must also consider these complexities and incorporate targeted interventions aimed at all possible transmission pathways. One strategy to prevent and control infection is environmental cleaning. There are many aspects to an environmental cleaning strategy. We believe the key to successfully reducing the risk of healthcare-associated infections through the environment, is to design and implement a multimodal intervention. This paper aims to provide an overview of important considerations for designing a meaningful and sustainable environmental program for healthcare facilities.
Collapse
Affiliation(s)
- Katrina Browne
- School of Nursing and Health, Avondale University, Cooranbong, NSW, Australia
- Central Coast Local Health District, Gosford Hospital, Gosford, NSW, Australia
| | - Brett G Mitchell
- School of Nursing and Health, Avondale University, Cooranbong, NSW, Australia.
- Central Coast Local Health District, Gosford Hospital, Gosford, NSW, Australia.
- School of Nursing and Midwifery, Monash University, Melbourne, VIC, Australia.
- Hunter Medical Research Institute, Newcastle, NSW, Australia.
| |
Collapse
|
17
|
Nam J, Sljivic S, Matthews R, Pak J, Agala C, Salamah H, Hatch E, Nizamani R, King B, Laughon SL, Williams FN. The Cost of Mental Health Comorbid Conditions in Burn Patients: A Single-site Experience. J Burn Care Res 2023; 44:751-757. [PMID: 36512488 DOI: 10.1093/jbcr/irac181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Many burn survivors suffer from psychiatric sequelae long after their physical injuries have healed. This may even be more pronounced in individuals who have a history of mental health disorders prior to admission. The aim of this study was to explore the clinical outcomes of patients with previously diagnosed mental health disorders who were admitted to our Burn Center. This was a single-site, retrospective review using our institutional Burn Center registry. All adult patients (18 years or older) admitted to our Burn Center between January 1, 2014 and June 30, 2021 with burn injury or inhalation injury were included in this study. Variables of interest included demographics and burn mechanism. Outcomes of interests were length of stay, cost of hospitalization, and mortality. A P-value of < .05 was considered statistically significant for all analyses. There were 4958 patients included in this study, with 35% of these patients having a previous diagnosis of mental health disorders. Patients with mental health disorders were younger, with larger burns, P < .05. They had significantly longer lengths of stay and significantly higher costs (P < .00001). Mortality for those with a mental health disorder history was 2% and 3% for those without (P = .04). Patients with pre-existing mental health disorders had decreased odds of mortality. However, they do have extended lengths of stay, which may exhaust current sparse staff and burn bed resources.
Collapse
Affiliation(s)
- Jason Nam
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Hospital, 2301 Erwin Road, Durham, North Carolina 27710, USA
| | - Sanja Sljivic
- Department of Surgery, University of North Carolina School of Medicine, 101 Manning Drive, Chapel Hill, North Carolina 27599, USA
- North Carolina Jaycee Burn Center, 101 Manning Drive, Chapel Hill, North Carolina 27599, USA
| | - Robert Matthews
- Department of Anesthesiology, University of North Carolina School of Medicine, 101 Manning Drive, Chapel Hill, North Carolina 27599, USA
| | - Joyce Pak
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina 27599, USA
| | - Chris Agala
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Hospital, 2301 Erwin Road, Durham, North Carolina 27710, USA
| | - Hanaan Salamah
- Department of Surgery, University of North Carolina School of Medicine, 101 Manning Drive, Chapel Hill, North Carolina 27599, USA
| | - Erica Hatch
- Department of Psychiatry, University of North Carolina School of Medicine, 101 Manning Drive, Chapel Hill, North Carolina 27599, USA
| | - Rabia Nizamani
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Hospital, 2301 Erwin Road, Durham, North Carolina 27710, USA
- Department of Surgery, University of North Carolina School of Medicine, 101 Manning Drive, Chapel Hill, North Carolina 27599, USA
| | - Booker King
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Hospital, 2301 Erwin Road, Durham, North Carolina 27710, USA
- Department of Surgery, University of North Carolina School of Medicine, 101 Manning Drive, Chapel Hill, North Carolina 27599, USA
| | - Sarah L Laughon
- Department of Psychiatry, University of North Carolina School of Medicine, 101 Manning Drive, Chapel Hill, North Carolina 27599, USA
| | - Felicia N Williams
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Hospital, 2301 Erwin Road, Durham, North Carolina 27710, USA
- Department of Surgery, University of North Carolina School of Medicine, 101 Manning Drive, Chapel Hill, North Carolina 27599, USA
| |
Collapse
|
18
|
Liapi F, Chater AM, Kenny T, Anderson J, Randhawa G, Pappas Y. Evaluating step-down, intermediate care programme in Buckinghamshire, UK: a mixed methods study. BMC Public Health 2023; 23:1087. [PMID: 37280556 DOI: 10.1186/s12889-023-15868-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/10/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Intermediate care (IC) services are models of care that aim to bridge the gap between hospital and home, enabling continuity of care and the transition to the community. The purpose of this study was to explore patient experience with a step-down, intermediate care unit in Buckinghamshire, UK. METHODS A mixed-methods study design was used. Twenty-eight responses to a patient feedback questionnaire were analysed and seven qualitative semi-structured interviews were conducted. The eligible participants were patients who had been admitted to the step-down IC unit. Interview transcripts were analysed using thematic analysis. FINDINGS Our interview data generated five core themes: (1) "Being uninformed", (2) "Caring relationships with health practitioners", (3) "Experiencing good intermediate care", (4) "Rehabilitation" and (5) "Discussing the care plan". When comparing the quantitative to the qualitative data, these themes are consistent. CONCLUSIONS Overall, the patients reported that the admission to the step-down care facility was positive. Patients highlighted the supportive relationship they formed with healthcare professionals in the IC and that the rehabilitation that was offered in the IC service was important in increasing mobility and regaining their independence. In addition, patients reported that they were largely unaware about their transfer to the IC unit before this occurred and they were also unaware of their discharge package of care. These findings will inform the evolving patient-centred journey for service development within intermediate care.
Collapse
Affiliation(s)
- Fani Liapi
- Institute for Health Research, University of Bedfordshire, Luton, LU2 8LE, UK.
| | - Angel Marie Chater
- Institute for Sport and Physical Activity Research, University of Bedfordshire, MK41 9EA, Bedford, UK
- University College London, Centre for Behaviour Change, WC1E 7HB, London, UK
| | - Tina Kenny
- Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | - Juliet Anderson
- Buckinghamshire Health and Social Care Academy, Aylesbury, HP21 7Q, UK
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, LU2 8LE, UK
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Luton, LU2 8LE, UK
| |
Collapse
|
19
|
Zhang Y, Wang Y, Sheng Z, Wang Q, Shi D, Xu S, Ai Y, Chen E, Xu Y. Incidence Rate, Pathogens and Economic Burden of Catheter-Related Bloodstream Infection: A Single-Center, Retrospective Case-Control Study. Infect Drug Resist 2023; 16:3551-3560. [PMID: 37305736 PMCID: PMC10256568 DOI: 10.2147/idr.s406681] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/25/2023] [Indexed: 06/13/2023] Open
Abstract
Purpose Indwelling central venous catheters (CVCs) can cause catheter related bloodstream infection (CRBSI). CRBSI occurring in intensive care unit (ICU) patients may lead to the worse outcomes and extra medical costs. The present study aimed to assess the incidence and incidence density, pathogens and economic burden of CRBSI in ICU patients. Patients and Methods A case-control study was retrospectively carried out in six ICUs of one hospital between July 2013 and June 2018. The Department of Infection Control performed routinely surveillance for CRBSI on these different ICUs. Data of the clinical and microbiological characteristics of patients with CRBSI, the incidence and incidence density of CRBSI in ICUs, the attributable length of stay (LOS), and the costs among patients with CRBSI in ICU were collected and assessed. Results A total of 82 ICU patients with CRBSI were included into the study. The CRBSI incidence density was 1.27 per 1000 CVC-days in all ICUs, in which the highest was 3.52 per 1000 CVC-days in hematology ICU and the lowest was 0.14 per 1000 CVC-days in Special Procurement ICU. The most common pathogen causing CRBSI was Klebsiella pneumoniae (15/82, 16.67%), in which 12 (80%) were carbapenem resistant. Fifty-one patients were successfully matched with control patients. The average costs in the CRBSI group were $ 67,923, which were significantly higher (P < 0.001) than the average costs in the control group. The total average costs attributable to CRBSI were $33, 696. Conclusion The medical costs of ICU patients were closely related to the incidence of CRBSI. Imperative measures are needed to reduce CRBSI in ICU patients.
Collapse
Affiliation(s)
- Yibo Zhang
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yichen Wang
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Zike Sheng
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Qun Wang
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Dake Shi
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Shirui Xu
- Department of Clinical Laboratory Medicine, Shanghai Fenglin Clinical Laboratory Co. Ltd, Shanghai, People’s Republic of China
| | - Yaping Ai
- Health Economics and Outcome Research, Becton & Dickinson Medical Device (Shanghai) Ltd, Shanghai, People’s Republic of China
| | - Erzhen Chen
- Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yumin Xu
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| |
Collapse
|
20
|
Neidhöfer C, Rathore K, Parčina M, Sieber MA. ESKAPEE Pathogen Biofilm Control on Surfaces with Probiotic Lactobacillaceae and Bacillus species. Antibiotics (Basel) 2023; 12:antibiotics12050871. [PMID: 37237774 DOI: 10.3390/antibiotics12050871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/21/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Combatting the rapidly growing threat of antimicrobial resistance and reducing prevalence and transmission of ESKAPEE pathogens in healthcare settings requires innovative strategies, one of which is displacing these pathogens using beneficial microorganisms. Our review comprehensively examines the evidence of probiotic bacteria displacing ESKAPEE pathogens, with a focus on inanimate surfaces. A systematic search was conducted using the PubMed and Web of Science databases on 21 December 2021, and 143 studies were identified examining the effects of Lactobacillaceae and Bacillus spp. cells and products on the growth, colonization, and survival of ESKAPEE pathogens. While the diversity of study methods limits evidence analysis, results presented by narrative synthesis demonstrate that several species have the potential as cells or their products or supernatants to displace nosocomial infection-causing organisms in a variety of in vitro and in vivo settings. Our review aims to aid the development of new promising approaches to control pathogen biofilms in medical settings by informing researchers and policymakers about the potential of probiotics to combat nosocomial infections. More targeted studies are needed to assess safety and efficacy of different probiotic formulations, followed by large-scale studies to assess utility in infection control and medical practice.
Collapse
Affiliation(s)
- Claudio Neidhöfer
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Kamni Rathore
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Institute for Functional Gene Analytics, Bonn-Rhein-Sieg University of Applied Sciences, 53757 Sankt Augustin, Germany
| | - Marijo Parčina
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Martin A Sieber
- Institute for Functional Gene Analytics, Bonn-Rhein-Sieg University of Applied Sciences, 53757 Sankt Augustin, Germany
| |
Collapse
|
21
|
Polancich S, Miltner R, Montgomery A, Dick T, Poe T, Brown D, Patrician PA. Quality Matters: Examining the Impact of Nurse Staffing Challenges on Clinical Outcomes. J Healthc Manag 2023; 68:174-186. [PMID: 37159016 DOI: 10.1097/jhm-d-22-00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
GOAL The purpose of this study was to examine nurse staffing while describing the relationships that exist in staffing and quality associated with nursing care during the COVID-19 pandemic, a significantly challenging time for nurse staffing. We examined the relationship between permanent registered nurse (RN) and travel RN staffing during the pandemic and the nursing-sensitive outcomes of catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), falls, and hospital-acquired pressure injuries (HAPIs) and length of stay and compared the cost of CAUTIs, CLABSIs, falls, and HAPIs in fiscal years 2021 and 2022. METHODS We used a descriptive, observational design to retrospectively examine permanent nurse staffing volume and CAUTI, CLABSI, HAPI, and fall counts from October 1, 2019, to February 28, 2022, and travel nurse volume for the most current 12 months, April 1, 2021, to March 31, 2022. Descriptive statistics, Pearson correlation, and statistical process control analyses were completed. PRINCIPAL FINDINGS Pearson correlation showed a statistically significant, moderately strong negative correlation (r = -0.568, p = .001) between the active registered nurse full-time equivalents (RN FTEs) and average length of stay (ALOS), and a moderately strong positive correlation (r = 0.688, p = .013) between the travel RN FTEs and ALOS. Pearson correlations were not statistically significant, with low to moderate negative correlations for CAUTIs (r = -0.052, p = .786), CLABSIs (r = -0.207, p = .273), and falls (r = -0.056, p = .769). Pearson correlation for active RN and HAPI showed a moderately strong, statistically significant positive correlation (r = 0.499, p = .003). We observed common cause variation in CAUTIs and CLABSIs, with HAPIs and falls showing special cause variation via statistical process control. PRACTICAL APPLICATIONS Despite the challenges associated with the lack of available nurse staffing accompanied by increasing responsibilities including unlicensed tasks, positive clinical outcomes can be maintained by staff adherence to evidence-based quality improvement.
Collapse
Affiliation(s)
- Shea Polancich
- University of Alabama at Birmingham School of Nursing and University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | | | | | - Tracey Dick
- University of Alabama at Birmingham School of Nursing
| | - Terri Poe
- University of Alabama at Birmingham Hospital
| | - Daran Brown
- University of Alabama at Birmingham Hospital
| | | |
Collapse
|
22
|
Sharma M, Bachani R. Knowledge, Attitude, Practice, and Perceived Barriers for the Compliance of Standard Precautions among Medical and Nursing Students in Central India. Int J Environ Res Public Health 2023; 20:5487. [PMID: 37107771 PMCID: PMC10139079 DOI: 10.3390/ijerph20085487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES The aim of this study was to assess and compare (a) the knowledge, attitude, and practice of standard precautions (SPs), (b) the knowledge of post-exposure management, and (c) the perceived barriers underlying the noncompliance with SPs among future healthcare professionals (HCPs), i.e., students of medical and nursing courses in Central India. SETTING AND PARTICIPANTS A cross-sectional study was conducted in 2017-2018 among students of a medical and a nursing college using a pretested and modified questionnaire. Data were collected during 23 face-to-face sessions. Responses were scored according to standard guidelines of the Centers for Disease Control and Prevention and WHO, where each correct response was given a score of 1. RESULTS Among 600 participants, 51% of medical students and 75% of nursing students could not select the correct definition of SPs from the given options. Sixty-five percent of medical students (275/423) and 82% of nursing students (145/177) were unaware of the term post-exposure prophylaxis. Overall, knowledge about personal protective equipment and hazard symbols was poor (<25%). Furthermore, although theoretical knowledge about hand hygiene was good (510/600; 85%), its implementation was poor (<30%). Sixty-four percent of participants believed that the use of hand rub replaced the need for handwashing, even for visibly soiled hands. Some of the participants believed that the use of PPE might offend patients (16%). High workload and poor knowledge were other significant barriers underlying the noncompliance with SPs. CONCLUSIONS A suboptimal translation of participants' knowledge into practice is evident and signifies the presence of the know-do gap. Poor knowledge and inappropriate presumptions about the use of SPs discourage the practice of SPs. This results in increased healthcare-associated infections, increased treatment costs, and a suppressed social economy. The inclusion of a dedicated curriculum with repeated hands-on and practice-based training on SPs is suggested to minimize this know-do gap among future healthcare workers.
Collapse
Affiliation(s)
- Megha Sharma
- Department of Pharmacology, R. D. Gardi Medical College, Ujjain 456006, MP, India
- Department of Global Public Health-Health Systems and Policy: Medicines, Karolinska Institutet, 171 77 Stockholm, Sweden
| | | |
Collapse
|
23
|
Zwicker P, Meng M, Friesecke S, Stein T, Herzog A, Herzer C, Kammerlander M, Gebhardt T, Kugler C, Kramer A. An interactive feedback system for increasing hand antisepsis adherence in stationary intensive care. J Hosp Infect 2023; 133:73-80. [PMID: 36646137 DOI: 10.1016/j.jhin.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Pathogens causing infections are in many cases transmitted via the hands of personnel. Thus, hand antisepsis has strong epidemiological evidence of infection prevention. Depending on various factors, hand antisepsis adherence ranges between 9.1% and 85.2%. AIM To evaluate a new transponder system that reminded medical staff to use an alcohol-based hand rub based on indication by giving real-time feedback, to detect hand antisepsis adherence. METHODS The monitoring system consisted of three components: a portable transponder detecting alcohol-based hand rub and able to give feedback; a beacon recognizing entries to and exits from the patient's surroundings; and a sensor placed at the hand-rub dispensers to count the number of hand rubs. With these components, the system provided feedback when hand antisepsis was not conducted although it was necessary according to moments 1, 4, and 5 of hand antisepsis. Adherence was measured in two use-cases with five phases, starting with the baseline measurement followed by intervention periods and phases without intervention to test the sustainability of the feedback. FINDINGS Using the monitoring system, hand antisepsis adherence was increased by up to 104.5% in comparison to the baseline measurement. When the intervention ceased, however, hand antisepsis adherence decreased to less than or equal to the baseline measurement. CONCLUSION A short-term intervention alone is not sufficient to lead to a long-term change in hand antisepsis adherence. Rather, permanent feedback and/or the integration in a multi-modal intervention strategy are necessary.
Collapse
Affiliation(s)
- P Zwicker
- Institute of Hygiene and Environmental Medicine, University Medicine, Greifswald, Germany; Section Antiseptic Stewardship of the German Society of Hospital Hygiene, Berlin, Germany.
| | - M Meng
- Institute of Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Federal Institute for Vocational Education and Training (VET), Bonn, Germany
| | - S Friesecke
- Department of Internal Medicine B, Medical Intensive Care Unit, University Medicine, Greifswald, Germany
| | - T Stein
- Neurological Rehabilitation Center gGmbH, Greifswald, Germany
| | - A Herzog
- HyHelp AG, Frankfurt am Main, Germany; United-Ventures GmbH, Frankfurt am Main, Germany
| | - C Herzer
- GWA Hygiene GmbH, Stralsund, Germany
| | - M Kammerlander
- Institute of Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Institute of Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | | | - C Kugler
- Institute of Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine, Greifswald, Germany; Section Antiseptic Stewardship of the German Society of Hospital Hygiene, Berlin, Germany
| |
Collapse
|
24
|
Gidey K, Gidey MT, Hailu BY, Gebreamlak ZB, Niriayo YL. Clinical and economic burden of healthcare-associated infections: A prospective cohort study. PLoS One 2023; 18:e0282141. [PMID: 36821590 PMCID: PMC9949640 DOI: 10.1371/journal.pone.0282141] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 02/09/2023] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Healthcare-associated infections (HAIs) have become a serious public health problem. Despite the fact that implementing evidence-based infection control strategies could prevent HAIs and save billions of dollars, Ethiopia lacks national surveillance studies on the rate, economic, and clinical burden of HAIs. OBJECTIVE To assess the clinical and economic burden of HAIs in hospitalized patients at Ayder comprehensive specialized hospital. MATERIALS AND METHODS A prospective cohort study design was conducted in patients with and without HAIs. A review of medical records, interviews, and patient bills was used to extract necessary information. The patients in the two arms were matched based on age, sex, Charlson comorbidity index, and ward type. Measurable factors were compared between infected and uninfected patients using the paired ttest or McNemar's test, as appropriate. Logistic regression was used to identify predictors of in-hospital mortality. Stata 14.1 was used to conduct all analyses. RESULTS A total of 408 patients, 204 with HAIs and 204 without HAIs were included in the study. In-hospital mortality was higher in patients with HAI (14.7% vs 7.8%, P = 0.028). Patients with HAI stayed an average of 8.3 days longer than controls (18.85 vs 10.59, P<0.001). The average direct medical costs for patients with HAI were 3033 Ethiopian birrs (ETB) higher than controls (4826 vs 1793, P<0.001). The presence of HAIs (AOR: 2.22, 95% CI: 1.13-4.39) and admission to intensive care units (AOR: 3.39, 95% CI: 1.55-7.40) were significant predictors of in-hospital mortality. CONCLUSION HAIs have a significant impact on in-hospital mortality, the length of extra hospital stays, and extra costs for medical care. Patients admitted to intensive care units and those with HAIs were found to be significant predictors of in-hospital mortality. Interventions must be implemented to prevent HAIs, especially in patients admitted to intensive care units.
Collapse
Affiliation(s)
- Kidu Gidey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- * E-mail:
| | - Meles Tekie Gidey
- Pharmacoepidemiology and Social Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Berhane Yohannes Hailu
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | | | - Yirga Legesse Niriayo
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| |
Collapse
|
25
|
Biscione A, Corrado G, Quagliozzi L, Federico A, Franco R, Franza L, Tamburrini E, Spanu T, Scambia G, Fagotti A. Healthcare associated infections in gynecologic oncology: clinical and economic impact. Int J Gynecol Cancer 2023; 33:278-284. [PMID: 36581487 DOI: 10.1136/ijgc-2022-003847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess the rate and type of infections in gynecological cancer patients. We also performed an economic analysis to provide an overview of costs related to healthcare associated infections. METHODS We retrospectively collected data from culture samples at the site of infection from patients undergoing surgery or chemotherapy, admitted to the Gynecologic Oncology Unit, Fondazione Policlinico Agostino Gemelli IRCCS, from January 2017 to December 2018. We performed univariate and multivariate analyses to calculate potential risk factors for prolonged length of hospitalization. The average cost per patient was calculated, including the cost of hospital stay, operating room, medications, and diagnostic and invasive procedures. RESULTS Among 5682 patients, 322 (5.6%) gynecological cancer patients with healthcare associated infections were identified. A total of 249 patients (77.3%) had undergone surgery in the previous 30 days and 73 (22.7%) patients were receiving chemotherapy. In the whole population, the most common healthcare associated infections were urinary infections (58%) and surgical wound infections (42.1%). In addition, 14.5% of patients had central venous catheter infections and 21.7% had blood stream infections. Median length of stay was 20 days (range 1-100). Among surgical patients, advanced age (odds ratio (OR) 1.233, 95% confidence interval (CI) 1.001 to 1.519, p=0.049), bowel resection (OR 2.659, 95% CI 1.493 to 4.735, p=0.001), surgical site infection (OR 10.447, 95% CI 1.143 to 95.5, p=0.038), and central venous catheter infection (OR 9.856, 95% CI 1.139 to 85.319, p=0.038) were independently associated with an increased risk of prolonged hospital stay (>20 days). The overall direct cost of healthcare associated infections was $6 273 852 per year. CONCLUSIONS The infection rate in our population was 5.6%. The most common healthcare associated infections were urinary and surgical wound infections. Among surgical patients, advanced age, bowel resection, surgical site, and central venous catheter infection were associated with an increased length of hospitalization. Healthcare associated infections cause an increase in the length of stay after surgery and hospital costs.
Collapse
Affiliation(s)
- Antonella Biscione
- Department for Women's and Children's Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Giacomo Corrado
- Department for Women's and Children's Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Lorena Quagliozzi
- Department for Women's and Children's Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Alex Federico
- Department for Women's and Children's Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Rita Franco
- Department for Women's and Children's Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Laura Franza
- Department of Infectious Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Enrica Tamburrini
- Department of Infectious Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Teresa Spanu
- Department of Laboratory and Infectious Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Giovanni Scambia
- Department for Women's and Children's Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Roma, Italy
| | - Anna Fagotti
- Department for Women's and Children's Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Roma, Italy
| |
Collapse
|
26
|
Sheikh Omar NM, Erismis B, Muse Osman M, Garba B, Hassan MA, Akuku IG. Retrospective Evaluation of Nosocomial Bacterial Infections and Their Antimicrobial Resistance Patterns Among Hospitalized Patients in Mogadishu, Somalia. Infect Drug Resist 2023; 16:705-720. [PMID: 36756609 PMCID: PMC9900145 DOI: 10.2147/idr.s398387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/22/2023] [Indexed: 02/01/2023] Open
Abstract
Background Nosocomial infection constitutes a significant public health challenge globally, with resource-limited countries bearing the greatest burden. Sadly, the emergence of drug-resistant strains of these pathogens have worsened the already precarious situation. Methods This study aimed to determine the incidence of nosocomial infections, the causative agents, and their antimicrobial susceptibilities among patients admitted to a tertiary hospital in Mogadishu, Somalia. The study included patients who had positive cultures 48 hours after admission. Abstracted data include the patient's demographic, infection outcome, the agents involved, and the site of infection. Results A total of 330 patients were found to have acquired nosocomial infection, comprising 100 (30%) patients from the ICU department. The median age for the patients in this study was 36 years. Patients who died of all-cause mortality were older than those discharged. Most of the bacteria were collected from sepsis/bloodstream infections (34%) dominated by Staphylococcus aureus (42.1%), Acinetobacter baumannii (14.0%), Escherichia coli (14.0%), and Klebsiella spp. (7.0%). Urinary tract infections were mainly associated with Escherichia coli (37.5%), Staphylococcus aureus (18.8%), and Klebsiella spp. 50% of all microorganisms were multidrug-resistant. Conclusion The findings of this study suggested that hospital infection control and prevention strategies need to be strengthened to improve the quality of care among hospitalized patients.
Collapse
Affiliation(s)
- Nasteho Mohamed Sheikh Omar
- University of Health Sciences Turkey, Mogadishu Somalia-Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | - Betul Erismis
- University of Health Sciences, Bakirkoy Dr Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Marian Muse Osman
- University of Health Sciences Turkey, Mogadishu Somalia-Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | - Bashiru Garba
- Dr Sumait Hospital, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, 2526, Somalia,Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, Usmanu Danfodiyo University, Sokoto, Sokoto State, Nigeria
| | - Mohamed Abdulahi Hassan
- Dr Sumait Hospital, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, 2526, Somalia,Correspondence: Mohamed Abdulahi Hassan, Tel + 252 61 5987780, Email
| | - Isaiah G Akuku
- Institutes of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| |
Collapse
|
27
|
Rudiman R, Hanafi RV, Almawijaya, Halim F. Complications of biliary stenting versus T-tube insertion after common bile duct exploration: A systematic review and meta-analysis. PLoS One 2023; 18:e0280755. [PMID: 36662877 PMCID: PMC9858848 DOI: 10.1371/journal.pone.0280755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/06/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Complications following the insertion T-tube or stent after common bile duct exploration (CBDE) remain problematic in nowadays surgical era. Based on our knowledge, we did not find any meta-analysis intentionally evaluating the complications between both groups. At this moment, we aimed to analyze and compare both procedures' complications, efficacy, efficiency, and feasibility. METHODS We searched literature from four databases (EuroPMC, PubMed, Scopus, and ClinicalTrials.gov) up to June 2022 to compile the randomized controlled trials and pro-/retrospective cohort studies. Review Manager 5.4 was used to statistically analyze each outcome measured between biliary stenting and T-tube insertion. RESULTS Sixteen studies with 1,080 patients (534 biliary stents and 546 T-tube) were included for qualitative and quantitative analysis. The pooled risk ratio (RR) of the overall postoperative complications rate was significantly lower in the biliary stent group compared to the T-tube group 0.43 [95% confidence interval (CI) 0.23-0.80, p = 0.007]. In terms of the operation time, length of hospital stay, and readmission rate was also decreased in stenting as biliary drainage over T-tube placement 1.02 minutes [95% CI -1.53, -0.52, p < 0.0001], 1.96 days [95% CI -2.63, -1.29, p < 0.00001], and RR 0.39 [95% CI 0.15-0.97, p = 0.04], respectively. CONCLUSIONS Stenting as biliary drainage after CBDE was superior to T-tube insertion. A shorter operation time and hospital stay in biliary drainage resulted in a lower overall postoperative complication rate. Other influences, including the complexity and shorter learning curve, might also affect the superiority of biliary stenting.
Collapse
Affiliation(s)
- Reno Rudiman
- Division of Digestive Surgery, Department of General Surgery, School of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | | | - Almawijaya
- Division of Digestive Surgery, Department of General Surgery, School of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Freda Halim
- Department of General Surgery, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| |
Collapse
|
28
|
Raoofi S, Pashazadeh Kan F, Rafiei S, Hosseinipalangi Z, Noorani Mejareh Z, Khani S, Abdollahi B, Seyghalani Talab F, Sanaei M, Zarabi F, Dolati Y, Ahmadi N, Raoofi N, Sarhadi Y, Masoumi M, Sadat Hosseini B, Vali N, Gholamali N, Asadi S, Ahmadi S, Ahmadi B, Beiramy Chomalu Z, Asadollahi E, Rajabi M, Gharagozloo D, Nejatifar Z, Soheylirad R, Jalali S, Aghajani F, Navidriahy M, Deylami S, Nasiri M, Zareei M, Golmohammadi Z, Shabani H, Torabi F, Shabaninejad H, Nemati A, Amerzadeh M, Aryankhesal A, Ghashghaee A. Global prevalence of nosocomial infection: A systematic review and meta-analysis. PLoS One 2023; 18:e0274248. [PMID: 36706112 DOI: 10.1371/journal.pone.0274248] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/24/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Hospital-acquired infections (HAIs) are significant problems as public health issues which need attention. Such infections are significant problems for society and healthcare organizations. This study aimed to carry out a systematic review and a meta-analysis to analyze the prevalence of HAIs globally. METHODS We conducted a comprehensive search of electronic databases including EMBASE, Scopus, PubMed and Web of Science between 2000 and June 2021. We found 7031 articles. After removing the duplicates, 5430 studies were screened based on the titles/ abstracts. Then, we systematically evaluated the full texts of the 1909 remaining studies and selected 400 records with 29,159,630 participants for meta-analysis. Random-effects model was used for the analysis, and heterogeneity analysis and publication bias test were conducted. RESULTS The rate of universal HAIs was 0.14 percent. The rate of HAIs is increasing by 0.06 percent annually. The highest rate of HAIs was in the AFR, while the lowest prevalence were in AMR and WPR. Besides, AFR prevalence in central Africa is higher than in other parts of the world by 0.27 (95% CI, 0.22-0.34). Besides, E. coli infected patients more than other micro-organisms such as Coagulase-negative staphylococci, Staphylococcus spp. and Pseudomonas aeruginosa. In hospital wards, Transplant, and Neonatal wards and ICU had the highest rates. The prevalence of HAIs was higher in men than in women. CONCLUSION We identified several essential details about the rate of HAIs in various parts of the world. The HAIs rate and the most common micro-organism were different in various contexts. However, several essential gaps were also identified. The study findings can help hospital managers and health policy makers identify the reason for HAIs and apply effective control programs to implement different plans to reduce the HAIs rate and the financial costs of such infections and save resources.
Collapse
|
29
|
Hardingham N, Ward E, Clayton N, Gallagher R. Acute Swallowing Outcomes After Surgical Resection of Oral Cavity and Oropharyngeal Cancers With the Mandibular Lingual Release Approach. Otolaryngol Head Neck Surg 2022:1945998221123925. [PMID: 36066970 DOI: 10.1177/01945998221123925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the incidence, nature, severity, and recovery of early dysphagia in patients following surgical resection of oral and/or oropharyngeal squamous cell carcinoma with a mandibular lingual release approach (MLRA). STUDY DESIGN Retrospective cohort study. SETTING Tertiary head and neck cancer center. METHODS Inclusion of patients' after surgical resection of oral cavity and/or oropharyngeal squamous cell carcinoma via an MLRA between 2012 and 2017. Data collection included acute medical care, enteral feeding, and swallowing outcomes derived from clinical swallow examination and videofluoroscopic swallowing study assessments at baseline, after surgery, and prior to discharge. RESULTS Twenty-eight patients were eligible for participation (23 males; mean age, 63 years). Baseline clinical swallow examination findings revealed that 32% (n = 9) were tolerating normal diet and fluids preoperatively (Functional Oral Intake Scale [FOIS] = 7). Following surgery, the majority (n = 21, 75%) experienced severe dysphagia (FOIS ≤4), of which 15 were nil by mouth. Twelve patients received a postoperative videofluoroscopic swallowing study, with silent aspiration observed in 9 cases. At discharge, 12 (43%) patients had persistent severe functional dysphagia (FOIS ≤4) with ongoing enteral feeding requirements, of which 7 were nil by mouth. Eleven (39%) were managing diets of modified fluid/diet consistencies (FOIS = 5), and 5 (18%) had mild dysphagia (FOIS ≥6) at discharge. None were able to manage a normal diet. The average length of hospital stay was 27.9 days. CONCLUSIONS Early dysphagia post-MLRA is a common and often severe complication of surgery. Patients require extended hospital admission with prolonged enteral feeding, which may persist postdischarge. This cohort requires early intervention by speech-language pathology services to aid swallow rehabilitation.
Collapse
Affiliation(s)
- Nicola Hardingham
- Speech Pathology Department, St Vincent's Hospital, Sydney, Australia.,School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Elizabeth Ward
- School of Health and Rehabilitation Sciences, University of Queensland, Australia.,Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia
| | - Nicola Clayton
- School of Health and Rehabilitation Sciences, University of Queensland, Australia.,Speech Pathology Department, Concord Repatriation Hospital, Sydney, Sydney, Australia.,Faculty of Health Sciences, University of Sydney, Australia
| | - Richard Gallagher
- ENT Department, St Vincent's Hospital, Sydney, Australia.,Department of Medicine, University of Notre Dame, Sydney, Australia
| |
Collapse
|
30
|
Golling E, van de Mortel T, Barr N, Zimmerman P. Pre-hospital peripheral intravenous catheter insertion practice: An integrative review. Australas Emerg Care 2022. [DOI: 10.1016/j.auec.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/21/2022] [Indexed: 11/15/2022]
|
31
|
Aldarragi A, Lythgoe C, Katsanouli T, Thangaraj R, Scott S, Scott S, Melling D. Retrospective study of consecutive rib fracture patients treated by open reduction internal fixation in a single major trauma centre, UK. Injury 2022; 53:2768-73. [PMID: 35680436 DOI: 10.1016/j.injury.2022.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/28/2022] [Accepted: 05/29/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Rib fractures are a common presentation in both patients presenting with high impact poly-trauma and as a result of low energy falls in the elderly. This injury can lead to various complications including prolonged hospital admission, pneumonia, need for ventilation and in admission to intensive care unit. There is much controversy around the management of this injury in the literature, with favourable outcomes for patients treated non-operatively as well as surgically. METHODS We collated a database for all rib fracture fixations between 2014 and 2019 that took place at the major trauma centre in Liverpool. The decision to undergo surgical fixation was after discussion with multidisciplinary team at trauma meeting. Following British Orthopaedic Association Standards for Trauma and Orthopaedics (BOASTs), these injuries should ideally be operated on within 48 h. RESULTS Overall, a total of 220 patients were included in the study (143 male and 77 female). 142 (64%) patients were operated on within 48 h of admission. A total of 101 (45%) patients required admission to ITU. Those in the early surgical fixation group had a statistically significant decrease in their hospital length of stay (12.8 days compared to 15.5 days, p=<0.001). Mean length of ITU stay was shorter in the early surgical group with no statistical significance (p = 0.1). Those patients that required mechanical ventilation in turn stayed in hospital for a longer period compared to those who did not (p=<0.001). There is no statistical difference in survival between the 2 patient groups (p = 0.3). DISCUSSION To our knowledge, this is the largest data set published in the rib fracture fixation cohort. Our results agree with previous studies which have demonstrated that those who undergo ORIF tend require fewer days of hospital stay, less ventilatory support and overall have better outcomes in terms of pain when compared to those treated non-operatively. Our study adds that patients who receive treatment within 48-hours as per BOAST guidelines have better outcomes, specifically reducing hospital length of stay by nearly 4 days (p = 0.014). CONCLUSION Early surgical fixation of rib fractures leads to significantly favoured outcomes.
Collapse
|
32
|
Hiremath SB, Massicotte-Tisluck K, Chakraborty S. Factors affecting hospitalization, imaging severity, and complications in posterior reversible encephalopathy syndrome. Neurol Sci 2022; 43:6461-6470. [DOI: 10.1007/s10072-022-06271-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/03/2022] [Indexed: 10/17/2022]
|
33
|
Bucuresteanu R, Ionita M, Chihaia V, Ficai A, Trusca RD, Ilie CI, Kuncser A, Holban AM, Mihaescu G, Petcu G, Nicolaev A, Costescu RM, Husch M, Parvulescu V, Ditu LM. Antimicrobial Properties of TiO2 Microparticles Coated with Ca- and Cu-Based Composite Layers. Int J Mol Sci 2022; 23:ijms23136888. [PMID: 35805899 PMCID: PMC9266884 DOI: 10.3390/ijms23136888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 11/16/2022] Open
Abstract
The ability of TiO2 to generate reactive oxygen species under UV radiation makes it an efficient candidate in antimicrobial studies. In this context, the preparation of TiO2 microparticles coated with Ca- and Cu-based composite layers over which Cu(II), Cu(I), and Cu(0) species were identified is presented here. The obtained materials were characterized by a wide range of analytical methods, such as X-ray diffraction, electron microscopy (TEM, SEM), X-ray photoelectron (XPS), and UV-VIS spectroscopy. The antimicrobial efficiency was evaluated using qualitative and quantitative standard methods and standard clinical microbial strains. A significant aspect of this composite is that the antimicrobial properties were evidenced both in the presence and absence of the light, as result of competition between photo and electrical effects. However, the antibacterial effect was similar in darkness and light for all samples. Because no photocatalytic properties were found in the absence of copper, the results sustain the antibacterial effect of the electric field (generated by the electrostatic potential of the composite layer) both under the dark and in light conditions. In this way, the composite layers supported on the TiO2 microparticles’ surface can offer continuous antibacterial protection and do not require the presence of a permanent light source for activation. However, the antimicrobial effect in the dark is more significant and is considered to be the result of the electric field effect generated on the composite layer.
Collapse
Affiliation(s)
- Razvan Bucuresteanu
- Microbiology Department, Faculty of Biology, University of Bucharest, Intr. Portocalelor 1-3, 060101 Bucharest, Romania; (R.B.); (A.-M.H.); (G.M.)
- Research Institute of the University of Bucharest, Sos. Panduri 90, 050663 Bucharest, Romania
| | - Monica Ionita
- Faculty of Chemical Engineering and Biotechnologies, University Politehnica of Bucharest, 1-7 Gh Polizu Street, 011061 Bucharest, Romania;
| | - Viorel Chihaia
- Institute of Physical Chemistry “Ilie Murgulescu”, Romanian Academy, Splaiul Independentei 202, 060021 Bucharest, Romania; (V.C.); (G.P.)
| | - Anton Ficai
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Chemical Engineering and Biotechnologies, University Politehnica of Bucharest, 1-7 Gh Polizu Street, 011061 Bucharest, Romania; (A.F.); (C.-I.I.)
- National Centre for Micro and Nanomaterials and National Centre for Food Safety, Faculty of Chemical Engineering and Biotechnologies, University Politehnica of Bucharest, Spl. Indendentei 313, 060042 Bucharest, Romania;
- Academy of Romanian Scientists, 3 Ilfov Street, 050045 Bucharest, Romania
| | - Roxana-Doina Trusca
- National Centre for Micro and Nanomaterials and National Centre for Food Safety, Faculty of Chemical Engineering and Biotechnologies, University Politehnica of Bucharest, Spl. Indendentei 313, 060042 Bucharest, Romania;
| | - Cornelia-Ioana Ilie
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Chemical Engineering and Biotechnologies, University Politehnica of Bucharest, 1-7 Gh Polizu Street, 011061 Bucharest, Romania; (A.F.); (C.-I.I.)
- National Centre for Micro and Nanomaterials and National Centre for Food Safety, Faculty of Chemical Engineering and Biotechnologies, University Politehnica of Bucharest, Spl. Indendentei 313, 060042 Bucharest, Romania;
| | - Andrei Kuncser
- National Institute of Materials Physics, 405A Atomistilor Street, 077125 Magurele, Romania; (A.K.); (A.N.); (R.M.C.)
| | - Alina-Maria Holban
- Microbiology Department, Faculty of Biology, University of Bucharest, Intr. Portocalelor 1-3, 060101 Bucharest, Romania; (R.B.); (A.-M.H.); (G.M.)
- Research Institute of the University of Bucharest, Sos. Panduri 90, 050663 Bucharest, Romania
| | - Grigore Mihaescu
- Microbiology Department, Faculty of Biology, University of Bucharest, Intr. Portocalelor 1-3, 060101 Bucharest, Romania; (R.B.); (A.-M.H.); (G.M.)
- Research Institute of the University of Bucharest, Sos. Panduri 90, 050663 Bucharest, Romania
| | - Gabriela Petcu
- Institute of Physical Chemistry “Ilie Murgulescu”, Romanian Academy, Splaiul Independentei 202, 060021 Bucharest, Romania; (V.C.); (G.P.)
| | - Adela Nicolaev
- National Institute of Materials Physics, 405A Atomistilor Street, 077125 Magurele, Romania; (A.K.); (A.N.); (R.M.C.)
| | - Ruxandra M. Costescu
- National Institute of Materials Physics, 405A Atomistilor Street, 077125 Magurele, Romania; (A.K.); (A.N.); (R.M.C.)
| | - Mihai Husch
- Faculty of Building Services Engineering, Technical University of Civil Engineering Bucharest, 020396 Bucharest, Romania;
| | - Viorica Parvulescu
- Institute of Physical Chemistry “Ilie Murgulescu”, Romanian Academy, Splaiul Independentei 202, 060021 Bucharest, Romania; (V.C.); (G.P.)
- Correspondence: (V.P.); (L.-M.D.); Tel.: +40-744-42-15-51 (V.P.); +40-745-67-38-22 (L.M.-D.)
| | - Lia-Mara Ditu
- Microbiology Department, Faculty of Biology, University of Bucharest, Intr. Portocalelor 1-3, 060101 Bucharest, Romania; (R.B.); (A.-M.H.); (G.M.)
- Research Institute of the University of Bucharest, Sos. Panduri 90, 050663 Bucharest, Romania
- Correspondence: (V.P.); (L.-M.D.); Tel.: +40-744-42-15-51 (V.P.); +40-745-67-38-22 (L.M.-D.)
| |
Collapse
|
34
|
YAZICI G, BULUT H, BAYRAK KAHRAMAN B, PALTEKİ T. Bir yoğun bakım ünitesinde sık görülen enfeksiyonların önlenmesi için bir bakım paketinin etkinlik ve maliyetinin analizi: Yarı deneysel bir öntest-sontest tasarım çalışması. Konuralp Tıp Dergisi 2022. [DOI: 10.18521/ktd.1109974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Amaç
Sağlık hizmeti ilişkili enfeksiyonlar hasta güvenliğini tehdit etmekte, hastanede yatış süresinin uzamasına, morbidite, mortalite ve maliyetlerin artmasına neden olmaktadır. Bu çalışma, sağlık hizmeti ilişkili enfeksiyonları önlemeye yönelik müdahalelerin etkinliğini ve bu müdahalelerin maliyete etkisini değerlendirmek amacıyla yapılmıştır.
Metod
Bu araştırma bir yoğun bakım ünitesinde 1 Ocak – 30 Haziran 2018 ile 1 Ekim 2018 – 31 Mart 2019 tarihleri arasında 27 eğitim öncesi ve 27 eğitim sonrası olmak üzere toplam 54 hasta ile yarı deneysel ön test-son test tasarım çalışması olarak yapılmıştır.
Bulgular
Çalışmada enfeksiyon oranları Ocak-Mart 2018'de 20.34, Nisan-Haziran 2018'de 25.7, Ekim-Aralık 2018'de 20.97 ve Ocak-Mart 2019'da 17.77 olarak bulunmuştur. Dört farklı dönemin enfeksiyon oranları karşılaştırıldığında, eğitim öncesine göre eğitim sonrasında enfeksiyon oranlarında azalma olduğu ancak bu düşüşün istatistiksel olarak anlamlı olmadığı saptanmıştır (p>0.05). Eğitim öncesi ortalama maliyet 11361.35₺, eğitim sonrası ortalama maliyet 9149.87₺ olarak belirlenmiştir. Tüm maliyetlerin en önemlisi olan ortalama yatak maliyeti eğitim öncesine göre %95 güven aralığında %25,7 oranında azalmıştır. (5241.86₺-13251.50₺, sırasıyla 3489.03₺-10257.41₺).
Sonuç
Sonuç olarak, çalışmada eğitimin yoğun bakım hemşirelerinin sağlık hizmeti ilişkili enfeksiyonlara ilişkin puanlarında anlamlı bir artış sağladığı, sağlık hizmeti ilişkili enfeksiyon oranlarında, hastanede kalış sürelerinde ve eğitim sonrası maliyette istatistiksel olarak anlamlı olmasa da azalma sağladığı belirlenmiştir.
Collapse
Affiliation(s)
- Gülay YAZICI
- ANKARA YILDIRIM BEYAZIT UNIVERSITY, FACULTY OF HEALTH SCIENCES
| | - Hülya BULUT
- Gazi University Health Sciences Faculty Nursing Department
| | | | | |
Collapse
|
35
|
McMillan S. Preventing healthcare-associated infections by decontaminating the clinical environment. Nurs Stand 2022; 37:e11935. [PMID: 35477994 DOI: 10.7748/ns.2022.e11935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/09/2022]
Abstract
Healthcare-associated infections (HAIs) continue to cause patient harm and at increasing rates. Factors contributing to this increase include suboptimal hand hygiene, antimicrobial resistance, and inadequate decontamination of the patient environment and shared patient equipment. To reduce the risk of HAIs and enhance patient safety, it is important that nurses and other healthcare professionals adhere to infection prevention and control guidance, including decontamination procedures. It is also important to identify and address the barriers that can affect adherence to this guidance. This article discusses effective decontamination of the patient environment and non-critical shared patient equipment, the barriers to adhering to guidance and strategies for improving decontamination procedures.
Collapse
Affiliation(s)
- Sacha McMillan
- Christchurch Hospital Campus, Canterbury District Health Board, Christchurch, Canterbury, New Zealand
| |
Collapse
|
36
|
Issa M, Dunne SS, Dunne CP. Hand hygiene practices for prevention of health care-associated infections associated with admitted infectious patients in the emergency department: a systematic review. Ir J Med Sci 2022; 192:871-899. [PMID: 35435564 PMCID: PMC10066077 DOI: 10.1007/s11845-022-03004-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/01/2022] [Indexed: 11/24/2022]
Abstract
Abstract
Background
In most high-income countries, emergency departments (ED) represent the principal point of access forcer by critically ill or injured patients. Unlike inpatient units, ED healthcare workers (ED HCWs) have demonstrated relative lack of adherence to hand hygiene (HH) guidelines, commonly citing frequency of intervention and high rates of admission, which reflect severity of cases encountered.
Aim
Assessment of studies on hand hygiene compliance (HHC) by ED HCWs conducted between 2010 and 2020, seeking to estimate HHC rates and intervention strategies utilised to improve HHC in EDs.
Methods
Searches conducted in Web of Science, EBSCO HOST (CINHAL & Medline), PubMed, Embase, and Cochrane for full studies published between 2010 and 2020 on the topic of HHC in the ED.
Results
One hundred twenty-nine eligible articles were identified of which 79 were excluded. Fifty-one underwent full-text screening before 20 studies were deemed relevant. Of the eligible studies, fifteen (75%) had, as the primary outcome, HHC according to the WHO-recommended 5-moments. Twelve studies (60%) implemented multimodal or single intervention strategies. Eight studies were ambiguous regarding the nature of the approach adopted. In the nine observational studies where HHC was documented, an overall post-intervention median HHC rate of 45% (range 8–89.7%).
Conclusion
Multimodal approaches appear to have enhanced HHC moderately among ED HCWs. Elevated complexity associated with critically ill patients, and ED overcrowding, are contributing factors to relatively low compliance rates observed. Strategies to improve HHC rates may need to acknowledge, and cater for, the context of an unpredictable environment.
Collapse
Affiliation(s)
- M Issa
- School of Medicine, University of Limerick, Master's in Public Health Programme, Limerick, Ireland
| | - S S Dunne
- Centre for Interventions in Infection, Inflammation & Immunity (4I) and School of Medicine, University of Limerick, Limerick, Ireland
| | - C P Dunne
- Centre for Interventions in Infection, Inflammation & Immunity (4I) and School of Medicine, University of Limerick, Limerick, Ireland.
| |
Collapse
|
37
|
Pan J, Kavanagh K, Stewart S, Robertson C, Kennedy S, Manoukian S, Haahr L, Graves N, Reilly J. Estimating excess length of stay due to healthcare-associated infections by applying and comparing three time-varying approaches: multistate model, survival regression and matched case control methods. J Hosp Infect 2022. [DOI: 10.1016/j.jhin.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/24/2022] [Accepted: 04/03/2022] [Indexed: 11/21/2022]
|
38
|
Graves N, Kiernan M, Mitchell BG. A cost-effectiveness model for a decision to adopt temporary single-patient rooms to reduce risks of healthcare-associated infection in the Australian public healthcare system. Infect Dis Health 2022; 27:129-135. [DOI: 10.1016/j.idh.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/23/2021] [Accepted: 01/20/2022] [Indexed: 11/27/2022]
|
39
|
Manoukian S, Stewart S, Graves N, Mason H, Robertson C, Kennedy S, Pan J, Kavanagh K, Haahr L, Adil M, Dancer SJ, Cook B, Reilly J. Bed-days and costs associated with the inpatient burden of healthcare-associated infection in the UK. J Hosp Infect 2021; 114:43-50. [PMID: 34301395 DOI: 10.1016/j.jhin.2020.12.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Healthcare-associated infection (HAI) is associated with increased morbidity and mortality resulting in excess costs. AIM To investigate the impact of all types of HAI on the inpatient cost of HAI using different approaches. METHODS The incidence, types of HAI, and excess length of stay were estimated using data collected as part of the Evaluation of Cost of Nosocomial Infection (ECONI) study. Scottish NHS reference costs were used to estimate unit costs for bed-days. Variable (cash) costs associated with infection prevention and control (IPC) measures and treatment were calculated for each HAI type and overall. The inpatient cost of HAI is presented in terms of bed-days lost, bed-day costs, and cash costs. FINDINGS In Scotland 58,010 (95% confidence interval: 41,730-74,840) bed-days were estimated to be lost to HAI during 2018/19, costing £46.4 million (19m-129m). The total annual cost in the UK is estimated to be £774 million (328m-2,192m). Bloodstream infection and pneumonia were the most costly HAI types per case. Cash costs are a small proportion of the total cost of HAI, contributing 2.4% of total costs. CONCLUSION Reliable estimates of the cost burden of HAI management are important for assessing the cost-effectiveness of IPC programmes. This unique study presents robust economic data, demonstrating that HAI remains a burden to the UK NHS and bed-days capture the majority of inpatient costs. These findings can be used to inform the economic evaluation and decision analytic modelling of competing IPC programmes at local and national level.
Collapse
Affiliation(s)
- S Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - S Stewart
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK.
| | - N Graves
- Duke-NUS Medical School, Singapore
| | - H Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - S Kennedy
- HPS Stats Support, Public Health Scotland, Glasgow, UK
| | - J Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - K Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - L Haahr
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK
| | - M Adil
- Public Health Scotland, Edinburgh, UK
| | - S J Dancer
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, UK; School of Applied Science, Edinburgh Napier University, Edinburgh, UK
| | - B Cook
- Departments of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - J Reilly
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK; National Services Scotland (NSS), UK
| |
Collapse
|
40
|
Manoukian S, Stewart S, Graves N, Mason H, Robertson C, Kennedy S, Pan J, Haahr L, Dancer SJ, Cook B, Reilly J. Evaluating the post-discharge cost of healthcare-associated infection in NHS Scotland. J Hosp Infect 2021; 114:51-8. [PMID: 34301396 DOI: 10.1016/j.jhin.2020.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Whereas the cost burden of healthcare-associated infection (HAI) extends beyond the inpatient stay into the post-discharge period, few studies have focused on post-discharge costs. AIM To investigate the impact of all types of HAI on the magnitude and distribution of post-discharge costs observed in acute and community services for patients who developed HAI during their inpatient stay. METHODS Using data from the Evaluation of Cost of Nosocomial Infection (ECONI) study and regression methods, this study identifies the marginal effect of HAI on the 90-daypost-discharge resource use and costs. To calculate monetary values, unit costs were applied to estimates of excess resource use per case of HAI. FINDINGS Post-discharge costs increase inpatient HAI costs by 36%, with an annual national cost of £10,832,437. The total extra cost per patient with HAI was £1,457 (95% confidence interval: 1,004-4,244) in the 90 days post discharge. Patients with HAI had longer LOS if they were readmitted and were prescribed more antibiotics in the community. The results suggest that HAI did not have an impact on the number of readmissions or repeat surgeries within 90 days of discharge. The majority (95%) of the excess costs was on acute care services after readmission. Bloodstream infection, gastrointestinal infection, and pneumonia had the biggest impact on post-discharge cost. CONCLUSION HAI increases costs and antibiotic consumption in the post-discharge period. Economic evaluations of IPC studies should incorporate post-discharge costs. These findings can be used nationally and internationally to support decision-making on the impact of IPC interventions.
Collapse
|
41
|
Graves N, Mitchell BG, Otter JA, Kiernan M. The cost-effectiveness of temporary single-patient rooms to reduce risks of healthcare-associated infection. J Hosp Infect 2021; 116:21-28. [PMID: 34246721 DOI: 10.1016/j.jhin.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The use of single rooms for patient isolation often forms part of a wider bundle to prevent certain healthcare-associated infections (HAIs) in hospitals. Demand for single rooms often exceeds what is available and the use of temporary isolation rooms may help resolve this. Changes to infection prevention practice should be supported by evidence showing that cost-effectiveness is plausible and likely. AIM To perform a cost-effectiveness evaluation of adopting temporary single rooms into UK National Health Service (NHS) hospitals. METHODS The cost-effectiveness of a decision to adopt a temporary, single-patient, isolation room to the current infection prevention efforts of an NHS hospital was modelled. Primary outcomes are the expected change to total costs and life-years from an NHS perspective. FINDINGS The mean expected incremental cost per life-year gained (LYG) is £5,829. The probability that adoption is cost-effective against a £20,000 threshold per additional LYG is 93%, and for a £13,000 threshold the probability is 87%. The conclusions are robust to scenarios for key model parameters. If a temporary single-patient isolation room reduces risks of HAI by 16.5% then an adoption decision is more likely to be cost-effective than not. Our estimate of the effectiveness reflects guidelines and reasonable assumptions and the theoretical rationale is strong. CONCLUSION Despite uncertainties about the effectiveness of temporary isolation rooms for reducing risks of HAI, there is some evidence that an adoption decision is likely to be cost-effective for the NHS setting. Prospective studies will be useful to reduce this source of uncertainty.
Collapse
Affiliation(s)
- N Graves
- Health Services & Systems Research, Duke-NUS Medical School, Singapore.
| | - B G Mitchell
- School of Nursing and Midwifery, University of Newcastle, Ourimbah, NSW, Australia
| | - J A Otter
- National Institute for Healthcare Research Health Protection Research Unit (NIHR HPRU) in HCAI and AMR, Imperial College London & Public Health England, Hammersmith Hospital, London, UK
| | - M Kiernan
- Gama Healthcare Ltd, Hemel Hempstead, UK
| |
Collapse
|