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Afilalo M, Xue X, Soucy N, Colacone A, Jourdenais E, Boivin JF. Patient Needs, Required Level of Care, and Reasons Delaying Hospital Discharge for Nonacute Patients Occupying Acute Hospital Beds. J Healthc Qual 2018; 39:200-210. [PMID: 28658090 DOI: 10.1111/jhq.12076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study aims to determine the proportion of nonacute patients occupying acute care beds and to describe their needs, the appropriate level of alternative care, and reasons preventing discharge. Data from 952 patients hospitalized in an acute care unit for 30 days were obtained from their medical charts and by consulting with the medical team at two tertiary teaching hospitals. Among them, 333 (35%) were determined nonacute on day 30 of hospitalization. According to the Appropriateness Evaluation Protocol (AEP), 55% had no medical, nursing, or patient needs. Among nonacute patients with AEP needs, 88% were related to nursing/life-support services and 12% related to patient condition factors. Regarding alternative level of care, 186 (56%) were waiting for out-of-hospital resources, of which 36% were waiting for palliative care, 33% for long-term care, 18% for rehabilitation, and 12% for home care. For the remaining 147 (44%) nonacute patients, the alternative resources remained undetermined although acute care was no longer required. Main reasons preventing discharge included unavailability of alternative resources, ongoing assessment to determine appropriate resources, ongoing process with community care, and family/patient education/counseling. Available subacute facilities and community-based care would liberate acute care beds and facilitate their appropriate use.
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Harnoss JC, Assadian O, Kramer A, Probst P, Müller-Lantzsch C, Scheerer L, Bruckner T, Diener MK, Büchler MW, Ulrich AB. Comparison of chlorhexidine–isopropanol with isopropanol skin antisepsis for prevention of surgical-site infection after abdominal surgery. Br J Surg 2018; 105:893-899. [DOI: 10.1002/bjs.10793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/11/2017] [Accepted: 11/17/2017] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Prevention of surgical-site infection (SSI) has received increasing attention. Clinical trials have focused on the role of skin antisepsis in preventing SSI. The benefit of combining antiseptic chlorhexidine with alcohol has not been compared with alcohol-based skin preparation alone in a prospective controlled clinical trial.
Methods
Between August and October 2014, patients undergoing abdominal surgery received preoperative skin antisepsis with 70 per cent isopropanol (PA). Those treated between November 2014 and January 2015 received 2 per cent chlorhexidine with 70 per cent isopropanol (CA). The primary endpoint was SSI on postoperative day (POD) 10, which was evaluated using univariable analysis, and a multivariable logistic regression model correcting for known independent risk factors for SSI. The study protocol was published in the German Registry of Clinical Studies (DRKS00011174).
Results
In total, 500 patients undergoing elective midline laparotomy were included (CA 221, PA 279). The incidence of superficial and deep SSIs was significantly different on POD 10: 14 of 212 (6·6 per cent) among those treated with CA and 32 of 260 (12·3 per cent) in those who received PA (P = 0·038). In the multivariable analysis, skin antisepsis with CA was an independent factor for reduced incidence of SSI on POD 10 (P = 0·034).
Conclusion
This study showed a benefit of adding chlorhexidine to alcohol for skin antisepsis in reducing early SSI compared with alcohol alone.
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Affiliation(s)
- J C Harnoss
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - O Assadian
- Department for Hospital Epidemiology and Infection Control, Medical University of Vienna, Vienna, Austria
| | - A Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | - P Probst
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - C Müller-Lantzsch
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - L Scheerer
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - T Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - M K Diener
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - M W Büchler
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - A B Ulrich
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
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The Effect of Chlorhexidine Bathing on Rates of Nosocomial Infections Among the Critically Ill Population: An Analysis of Current Clinical Research and Recommendations for Practice. Dimens Crit Care Nurs 2018; 35:84-91. [PMID: 26836601 DOI: 10.1097/dcc.0000000000000165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This literature review examined the current research of evidence-based standards to evaluate the effectiveness of daily bathing with 2% chlorhexidine gluconate (CHG; manufactured by Sage Products Inc) compared with traditional non-antimicrobial bathing on reducing the incidence of nosocomial infections in the critically ill population. OBJECTIVE/AIM The objective of this article is 3-fold: first, to provide a background on the increased susceptibility to pathogens that have become endemic in many intensive care units; second, to challenge health care providers to question current practice and consider additional ways to ensure safety and better outcomes in the critically ill population; and third, to provide health care providers with clinical evidence to avoid infection control failures. METHOD To determine whether published standards for daily patient bathing exist, a search was conducted of bibliographic databases for articles published within the last 5 years (2010-2015). Ultimately, 3 large multicenter cluster randomized controlled studies were chosen to compare the outcomes of daily bathing with 2% CHG cloths with those of daily bathing with non-antimicrobial cloths. RESULTS The side-by-side comparison of the studies revealed similar outcomes, but with variations in study design. Climo et al (2013) and Milestone et al (2013) recommended the implementation of daily bathing with 2% CHG washcloths as a strategy to decrease nosocomial infections in the critically ill population. Huang et al (2013) recommended universal decolonization as the most effective method to decrease nosocomial infections. DISCUSSION The analysis of the 3 primary studies revealed similar findings that support the recommendation for the implementation of daily bathing with 2% CHG in the critically ill population. Further research will inform clinicians on the susceptibility of bacteria to CHG and the probability of creating microbial resistance.
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Lloyd-Smith P. Controlling for endogeneity in attributable costs of vancomycin-resistant enterococci from a Canadian hospital. Am J Infect Control 2017; 45:e161-e164. [PMID: 29056328 DOI: 10.1016/j.ajic.2017.08.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Decisions regarding the optimal provision of infection prevention and control resources depend on accurate estimates of the attributable costs of health care-associated infections. This is challenging given the skewed nature of health care cost data and the endogeneity of health care-associated infections. The objective of this study is to determine the hospital costs attributable to vancomycin-resistant enterococci (VRE) while accounting for endogeneity. METHODS This study builds on an attributable cost model conducted by a retrospective cohort study including 1,292 patients admitted to an urban hospital in Vancouver, Canada. Attributable hospital costs were estimated with multivariate generalized linear models (GLMs). To account for endogeneity, a control function approach was used. RESULTS The analysis sample included 217 patients with health care-associated VRE. In the standard GLM, the costs attributable to VRE are $17,949 (SEM, $2,993). However, accounting for endogeneity, the attributable costs were estimated to range from $14,706 (SEM, $7,612) to $42,101 (SEM, $15,533). Across all model specifications, attributable costs are 76% higher on average when controlling for endogeneity. CONCLUSIONS VRE was independently associated with increased hospital costs, and controlling for endogeneity lead to higher attributable cost estimates.
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Implementation of daily chlorhexidine bathing to reduce colonization by multidrug-resistant organisms in a critical care unit. Am J Infect Control 2017; 45:1014-1017. [PMID: 28431846 DOI: 10.1016/j.ajic.2017.02.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Colonized patients are a reservoir for transmission of multidrug-resistant organisms (MDROs). Not many studies have examined the effectiveness of daily chlorhexidine gluconate (CHG) bathing under routine care conditions. We present a descriptive analysis of the trends of MDRO colonization following implementation of daily CHG bathing under routine clinical conditions in an intensive care unit (ICU). METHODS From May 2010-January 2011, we screened patients admitted to a 24-bed ICU for and methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and fluoroquinolone-resistant gram-negative bacilli (FQRGNB). We calculated and plotted monthly incidence and prevalence of colonization of these MDROs. RESULTS Prevalence decreased in the immediate aftermath of daily CHG bathing implementation and generally remained at that level throughout the observation period. We observed low rates of incidence of MDRO colonization with VRE>FQRGNB>MRSA. Monthly prevalence of colonization and incidence for the composite of MRSA, VRE, and/or FQRGNB was 1.9%-27.9% and 0-1.1/100 patient-days, respectively. CONCLUSIONS Following the implementation of daily CHG bathing, the incidence of MDROs remained low and constant over time, whereas the prevalence decreased immediately after the implementation.
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Dhar S, Cook E, Oden M, Kaye KS. Building a Successful Infection Prevention Program: Key Components, Processes, and Economics. Infect Dis Clin North Am 2017; 30:567-89. [PMID: 27515138 DOI: 10.1016/j.idc.2016.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Infection control is the discipline responsible for preventing health care-associated infections (HAIs) and has grown from an anonymous field, to a highly visible, multidisciplinary field of incredible importance. There has been increasing focus on prevention rather than control of HAIs. Infection prevention programs (IPPs) have enormous scope that spans multiple disciplines. Infection control and the prevention and elimination of HAIs can no longer be compartmentalized. This article discusses the structure and responsibilities of an IPP, the regulatory pressures and opportunities that these programs face, and how to build and manage a successful program.
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Affiliation(s)
- Sorabh Dhar
- Department of Hospital Epidemiology and Infection Prevention, Detroit Medical Center, Detroit, MI, USA; Department of Medicine, Wayne State University, Detroit, MI, USA; Department of Hospital Epidemiology and Infection Prevention, John D Dingell VA Medical Center, Detroit, MI, USA; Harper University Hospital, 5 Hudson, 3990 John R, Detroit, MI 48201, USA.
| | - Evelyn Cook
- Duke Infection Control Outreach Network, Duke University Medical Center, 1610 Sycamore Street, Durham, NC 27707, USA
| | - Mary Oden
- Infection Prevention, Clinical Operations, Tenet Health, 1443 Ross Avenue Suite 1400, Dallas, TX 75202, USA
| | - Keith S Kaye
- Department of Hospital Epidemiology and Infection Prevention, Detroit Medical Center, Detroit, MI, USA; Department of Medicine, Wayne State University, Detroit, MI, USA; University Health Center, 4201 Saint Antoine, Suite 2B, Box 331, Detroit, MI 48201, USA
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Leal JR, Conly J, Henderson EA, Manns BJ. How externalities impact an evaluation of strategies to prevent antimicrobial resistance in health care organizations. Antimicrob Resist Infect Control 2017; 6:53. [PMID: 28588766 PMCID: PMC5457558 DOI: 10.1186/s13756-017-0211-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/25/2017] [Indexed: 01/21/2023] Open
Abstract
Background The rates of antimicrobial-resistant organisms (ARO) continue to increase for both hospitalized and community patients. Few resources have been allocated to reduce the spread of resistance on global, national and local levels, in part because the broader economic impact of antimicrobial resistance (i.e. the externality) is not fully considered when determining how much to invest to prevent AROs, including strategies to contain antimicrobial resistance, such as antimicrobial stewardship programs. To determine how best to measure and incorporate the impact of externalities associated with the antimicrobial resistance when making resource allocation decisions aimed to reduce antimicrobial resistance within healthcare facilities, we reviewed the literature to identify publications which 1) described the externalities of antimicrobial resistance, 2) described approaches to quantifying the externalities associated with antimicrobial resistance or 3) described macro-level policy options to consider the impact of externalities. Medline was reviewed to identify published studies up to September 2016. Main body An externality is a cost or a benefit associated with one person’s activity that impacts others who did not choose to incur that cost or benefit. We did not identify a well-accepted method of accurately quantifying the externality associated with antimicrobial resistance. We did identify three main methods that have gained popularity to try to take into account the externalities of antimicrobial resistance, including regulation, charges or taxes on the use of antimicrobials, and the right to trade permits or licenses for antimicrobial use. To our knowledge, regulating use of antimicrobials is the only strategy currently being used by health care systems to reduce antimicrobial use, and thereby reduce AROs. To justify expenditures on programs that reduce AROs (i.e. to formally incorporate the impact of the negative externality of antimicrobial resistance associated with antimicrobial use), we propose an alternative approach that quantifies the externalities of antimicrobial use, combining the attributable cost of AROs with time-series analyses showing the relationship between antimicrobial utilization and incidence of AROs. Conclusion Based on the findings of this review, we propose a methodology that healthcare organizations can use to incorporate the impact of negative externalities when making resource allocation decisions on strategies to reduce AROs. Electronic supplementary material The online version of this article (doi:10.1186/s13756-017-0211-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jenine R Leal
- Infection Prevention and Control, Alberta Health Services, Calgary, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Canada.,Health Sciences Centre, Room G236, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - John Conly
- Departments of Medicine, University of Calgary, Calgary, Canada.,Departments of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Canada.,Departments of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada.,Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.,Infection Prevention and Control, Alberta Health Services, Calgary, Canada.,Foothills Medical Centre, AGW5, 1403 29th Street NW, Calgary, AB T2N 2T9 Canada
| | - Elizabeth Ann Henderson
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.,Infection Prevention and Control, Alberta Health Services, Calgary, Canada.,Foothills Medical Centre, AGW5, 1403 29th Street NW, Calgary, AB T2N 2T9 Canada
| | - Braden J Manns
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Departments of Medicine, University of Calgary, Calgary, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.,Foothills Medical Centre, AGW5, 1403 29th Street NW, Calgary, AB T2N 2T9 Canada
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Barrasa-Villar JI, Aibar-Remón C, Prieto-Andrés P, Mareca-Doñate R, Moliner-Lahoz J. Impact on Morbidity, Mortality, and Length of Stay of Hospital-Acquired Infections by Resistant Microorganisms. Clin Infect Dis 2017; 65:644-652. [DOI: 10.1093/cid/cix411] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 04/27/2017] [Indexed: 02/07/2023] Open
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Dickinson CM, Karlin DR, Nunez HR, Cao SA, Heffernan DS, Monaghan SF, Kheirbek T, Adams CA, Stephen AH. Do Patients with Pre-Existing Psychiatric Illness Have an Increased Risk of Infection after Injury? Surg Infect (Larchmt) 2017; 18:545-549. [PMID: 28353417 DOI: 10.1089/sur.2016.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Trauma remains a leading cause of death and long term-morbidity. We have shown that patients who sustain traumatic injuries are at increased risk for the development of infectious complications. Psychiatric illnesses (PIs) are also noted to occur frequently among the general population. The presence of a PI has been shown to be a risk factor for the development of infections. Despite the prevalence of both traumatic injuries and psychiatric diseases, there are little data relating the impact of PI on the outcome of patients with trauma. We hypothesize that the presence of a PI will be associated with an increased risk of an infection developing after injury. PATIENTS AND METHODS This is a five year retrospective chart review of all admitted patients with trauma age 18 years and older. Patients with and without a major psychiatric illness were compared. Demographic data, mechanism of injury and Injury Severity Score (ISS) were reviewed. Co-morbidities included diabetes mellitus, obesity, pre-injury steroid use, and International Classification of Diseases, 9th edition, based psychiatric illness. All infections were diagnosed by microbiologic criteria (urinary tract infection [UTI], ventilator-associated pneumonia) or Centers for Disease Control and Prevention criteria for clinically evident infections (surgical site infection). RESULTS Of the 11,147 admitted trauma patients, 14.5% had a pre-injury PI diagnosis. The PI patients were older (61.5 ± 0.5 vs. 54.3; p < 0.001), more often female (56% vs. 39.1%; p < 0.001), and had no difference in blunt mechanism rates (88.4% vs. 89.9%; p = 0.06) or median ISS (9 vs. 9; p = 0.06). There was no difference between PI and non-PI patients in pre-injury diabetes mellitus (13.4% vs. 12.7%; p = 0.4), steroid use (2.5% vs. 1.9%; p = 0.1), but patients with PI were more likely to be obese (15.7% vs. 13.6%; p = 0.03). Patients with PI were more likely to have an infection develop (10.4% vs. 7.5%; p < 0.001). The most common infection in both groups was UTI (6.9% vs. 4.2%; p < 0.001). Compared with non-PI patients, adjusting for age, gender, ISS, diabetes mellitus, and obesity, patients with PI were more likely to have an infection develop (odds ratio 1.3, 95% confidence interval = 1.1-1.5) Conclusions: Patients with an underlying PI are at increased risk of having a UTI after traumatic injury. This study identifies a previously unknown independent risk factor for UTIs in patients with trauma. This stresses the need for increased awareness and attention to this vulnerable population.
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Affiliation(s)
- Catherine M Dickinson
- 1 Department of Surgery, Alpert Medical School at Brown University , Providence, Rhode Island
| | - Daniel R Karlin
- 2 Department of Psychiatry, Tufts University School of Medicine , Boston, Massachusetts
| | - Hector R Nunez
- 1 Department of Surgery, Alpert Medical School at Brown University , Providence, Rhode Island
| | - Shiliang A Cao
- 1 Department of Surgery, Alpert Medical School at Brown University , Providence, Rhode Island
| | - Daithi S Heffernan
- 1 Department of Surgery, Alpert Medical School at Brown University , Providence, Rhode Island
| | - Sean F Monaghan
- 1 Department of Surgery, Alpert Medical School at Brown University , Providence, Rhode Island
| | - Tareq Kheirbek
- 1 Department of Surgery, Alpert Medical School at Brown University , Providence, Rhode Island
| | - Charles A Adams
- 1 Department of Surgery, Alpert Medical School at Brown University , Providence, Rhode Island
| | - Andrew H Stephen
- 1 Department of Surgery, Alpert Medical School at Brown University , Providence, Rhode Island
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Popovich KJ, Snitkin ES. Whole Genome Sequencing-Implications for Infection Prevention and Outbreak Investigations. Curr Infect Dis Rep 2017; 19:15. [PMID: 28281083 DOI: 10.1007/s11908-017-0570-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Whole genome sequencing (WGS) is a laboratory method that has emerged as a promising tool for epidemiologic investigations. RECENT FINDINGS Genomic epidemiology approaches have been utilized in outbreak settings, community settings, within acute care hospitals, and across healthcare facilities to better understand transmission and spread of potential pathogens. These studies have highlighted how essential robust epidemiologic data is in these analyses as well as how results can be translated into clinical practice and infection control and prevention. Existing studies have highlighted both the promise and challenges of using WGS as an epidemiologic tool in a community and healthcare setting and across a region. Costs for performing and interpreting WGS analyses are decreasing, and availability of and experience with WGS analyses in healthcare epidemiology are increasing. With these favorable trends, this laboratory method soon could emerge as the gold standard for epidemiologic evaluations.
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Affiliation(s)
- Kyle J Popovich
- Department of Internal Medicine, University Infectious Diseases, Rush University Medical Center, Stroger Hospital of Cook County, 600 South Paulina, Suite 143, Chicago, IL, 60612, USA.
| | - Evan S Snitkin
- Department of Microbiology and Immunology, Department of Medicine, Division of Infectious Diseases, Center for Microbial Systems, University of Michigan, 1520D MSRB I, 1150 W. Medical Center Dr., Ann Arbor, MI, 48109-5680, USA
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Musuuza JS, Roberts TJ, Carayon P, Safdar N. Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veteran's Hospital by examining nurses' perspectives and experiences. BMC Infect Dis 2017; 17:75. [PMID: 28088171 PMCID: PMC5237510 DOI: 10.1186/s12879-017-2180-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/02/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Daily bathing with chlorhexidine gluconate (CHG) of intensive care unit (ICU) patients has been shown to reduce healthcare-associated infections and colonization by multidrug resistant organisms. The objective of this project was to describe the process of daily CHG bathing and identify the barriers and facilitators that can influence its successful adoption and sustainability in an ICU of a Veterans Administration Hospital. METHODS We conducted 26 semi-structured interviews with a convenience sample of 4 nurse managers (NMs), 13 registered nurses (RNs) and 9 health care technicians (HCTs) working in the ICU. We used qualitative content analysis to code and analyze the data. Dedoose software was used to facilitate data management and coding. Trustworthiness and scientific integrity of the data were ensured by having two authors corroborate the coding process, conducting member checks and keeping an audit trail of all the decisions made. RESULTS Duration of the interviews was 15 to 39 min (average = 26 min). Five steps of bathing were identified: 1) decision to give a bath; 2) ability to give a bath; 3) decision about which soap to use; 4) delegation of a bath; and 5) getting assistance to do a bath. The bathing process resulted in one of the following three outcomes: 1) complete bath; 2) interrupted bath; and 3) bath not done. The outcome was influenced by a combination of barriers and facilitators at each step. Most barriers were related to perceived workload, patient factors, and scheduling. Facilitators were mainly organizational factors such as the policy of daily CHG bathing, the consistent supply of CHG soap, and support such as reminders to conduct CHG baths by nurse managers. CONCLUSIONS Patient bathing in ICUs is a complex process that can be hindered and interrupted by numerous factors. The decision to use CHG soap for bathing was only one of 5 steps of bathing and was largely influenced by scheduling/workload and patient factors such as clinical stability, hypersensitivity to CHG, patient refusal, presence of IV lines and general hygiene. Interventions that address the organizational, provider, and patient barriers to bathing could improve adherence to a daily CHG bathing protocol.
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Affiliation(s)
- Jackson S Musuuza
- William S. Middleton Memorial Veterans Affairs Hospital, Madison, WI, USA.,Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tonya J Roberts
- William S. Middleton Memorial Veterans Affairs Hospital, Madison, WI, USA.,School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.,Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, WI, USA
| | - Nasia Safdar
- William S. Middleton Memorial Veterans Affairs Hospital, Madison, WI, USA. .,Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA. .,Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Lapointe-Shaw L, Voruganti T, Kohler P, Thein HH, Sander B, McGeer A. Cost-effectiveness analysis of universal screening for carbapenemase-producing Enterobacteriaceae in hospital inpatients. Eur J Clin Microbiol Infect Dis 2017; 36:1047-1055. [PMID: 28078557 DOI: 10.1007/s10096-016-2890-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 12/22/2016] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to assess the cost-effectiveness of screening all hospital inpatients for carbapenemase-producing Enterobacteriaceae (CPE) at the time of hospital admission, compared to not screening, from a US hospital perspective. We used a linked transmission/Markov model to compare outcomes for a typical hospitalized medical patient, from a community with a colonization prevalence of 0.05%. Outcomes were number of colonized patients, CPE-related clinical infections and deaths, expected quality-adjusted life years (QALYs), cost, and the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed to assess the effect of parameter uncertainty, using a willingness-to-pay threshold of $100,000 per QALY gained. Screening prevented six CPE colonization cases per 1000 patients (1/1000 colonized with screening, 7/1000 without screening), over half of all symptomatic CPE infections (2/10,000 symptomatic with screening, 5/10,000 symptomatic without screening), and nearly half of all CPE-related deaths (8/100,000 deaths with screening, 15/100,000 deaths without screening). Screening accrued 0.0009 additional QALYs and cost an additional $24.68, compared to not screening, and was cost-effective (ICER $26,283 per QALY gained). Our results were sensitive to uncertainty in prevalence and the number of secondary colonizations per colonized patient. Screening was not cost-effective at a prevalence below 0.015% or if transmission to fewer than 0.9 new patients occurred for each colonized patient. At prevalence levels above 0.3%, screening was cost-saving compared to not screening. Screening inpatients for CPE carriage is likely cost-effective, and may be cost-saving, depending on the local prevalence of carriage.
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Affiliation(s)
- L Lapointe-Shaw
- Department of Medicine, University of Toronto, Toronto, Canada.
- Toronto General Hospital, 14 EN room 213, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada.
| | - T Voruganti
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - P Kohler
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - H-H Thein
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - B Sander
- Public Health Ontario, Toronto, Canada
| | - A McGeer
- Sinai Health System, Toronto, Canada
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Popovich KJ. Another look at CHG bathing in a surgical intensive care unit. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:13. [PMID: 28164098 DOI: 10.21037/atm.2016.12.76] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kyle J Popovich
- Rush University Medical Center, Stroger Hospital of Cook County, Chicago, Illinois, USA
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Haac B, Rock C, Harris AD, Pineles L, Stein D, Scalea T, Hu P, Hagegeorge G, Liang SY, Thom KA. Hand Hygiene Compliance in the Setting of Trauma Resuscitation. Injury 2017; 48:165-170. [PMID: 27568844 PMCID: PMC5711429 DOI: 10.1016/j.injury.2016.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/06/2016] [Accepted: 08/11/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Healthcare-associated infections are a significant health burden, and hand hygiene (HH) is an essential prevention strategy. World Health Organization (WHO) 2009 guidelines recommend washing hands during five moments of patient care; 1)before touching a patient; 2)before a clean procedure; 3)after body fluid exposure; and 4)after touching a patient or 5)patient surroundings. HH opportunities at these 5 moments are frequent and compliance is low (22-60%). Infection risk is particularly high in trauma patients, and HH compliance during active trauma resuscitation has yet to be evaluated. MATERIALS AND METHODS Using video surveillance, all healthcare worker (HCW)-patient interactions for 30 patients were retrospectively reviewed for HH compliance according to WHO guidelines and glove use during initial resuscitation at a level-1 trauma center. RESULTS 342 HCW-patient interactions and 1034 HH opportunities were observed. HH compliance with the WHO moments was 7% (71/1034) overall; 3% (10/375) before patient contact, 0% (0/178) before a clean procedure, 11% (2/19) after body fluid contact, 15% (57/376) after patient contact and 2% (2/86) after contact with the environment. Glove use was more common, particularly before (69%) and after (47%) patient contact and after body fluid contact (58%). No HH was observed before clean procedures, but HCW donned new gloves 75% of the time before bedside procedures. If donning/removing gloves was included with HH as compliant, compliance was 57% overall. CONCLUSION HH opportunities are frequent and compliance with WHO HH guidelines may be infeasible, requiring significant amounts of time that may be better spent with the patient during the golden hour of trauma resuscitation. In an era where more scrutiny is being applied to patient safety, particularly the prevention of inpatient infections, more research is needed to identify alternative strategies (e.g. glove use, prioritizing moments) that may more effectively promote compliance in this setting.
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Affiliation(s)
- Bryce Haac
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene St., Baltimore, MD 21201, United States
| | - Clare Rock
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Halsted 831, 600 N. Wolfe Street, Baltimore, MD 21287, United States
| | - Anthony D Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 W Baltimore MSTF, Baltimore, MD 21201, United States
| | - Lisa Pineles
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 W Baltimore MSTF, Baltimore, MD 21201, United States
| | - Deborah Stein
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene St., Baltimore, MD 21201, United States
| | - Thomas Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene St., Baltimore, MD 21201, United States
| | - Peter Hu
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene St., Baltimore, MD 21201, United States
| | - George Hagegeorge
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene St., Baltimore, MD 21201, United States
| | - Stephen Y Liang
- Divisions of Infectious Diseases and Emergency Medicine, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8051, St. Louis, MO 63110, United States
| | - Kerri A Thom
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 W Baltimore MSTF, Baltimore, MD 21201, United States.
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Wu D, Lu R, Chen Y, Qiu J, Deng C, Tan Q. Study of cross-resistance mediated by antibiotics, chlorhexidine and Rhizoma coptidis in Staphylococcus aureus. J Glob Antimicrob Resist 2016; 7:61-66. [DOI: 10.1016/j.jgar.2016.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 07/19/2016] [Accepted: 07/25/2016] [Indexed: 10/21/2022] Open
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Musuuza JS, Safdar N. Every other day bathing with chlorhexidine gluconate: what is the evidence? ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:506. [PMID: 28149868 DOI: 10.21037/atm.2016.11.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jackson S Musuuza
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; ; Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Nasia Safdar
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; ; Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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Frost SA, Alogso MC, Metcalfe L, Lynch JM, Hunt L, Sanghavi R, Alexandrou E, Hillman KM. Chlorhexidine bathing and health care-associated infections among adult intensive care patients: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:379. [PMID: 27876075 PMCID: PMC5120440 DOI: 10.1186/s13054-016-1553-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/31/2016] [Indexed: 12/13/2022]
Abstract
Background Health care-associated infections (HAI) have been shown to increase length of stay, the cost of care, and rates of hospital deaths (Kaye and Marchaim, J Am Geriatr Soc 62(2):306–11, 2014; Roberts and Scott, Med Care 48(11):1026–35, 2010; Warren and Quadir, Crit Care Med 34(8):2084–9, 2006; Zimlichman and Henderson, JAMA Intern Med 173(22):2039–46, 2013). Importantly, infections acquired during a hospital stay have been shown to be preventable (Loveday and Wilson, J Hosp Infect 86:S1–70, 2014). In particular, due to more invasive procedures, mechanical ventilation, and critical illness, patients cared for in the intensive care unit (ICU) are at greater risk of HAI and associated poor outcomes. This meta-analysis aims to summarise the effectiveness of chlorhexidine (CHG) bathing, in adult intensive care patients, to reduce infection. Methods A systematic literature search was undertaken to identify trials assessing the effectiveness of CHG bathing to reduce risk of infection, among adult intensive care patients. Infections included were: bloodstream infections; central line-associated bloodstream infections (CLABSI); catheter-associated urinary tract infections; ventilator-associated pneumonia; methicillin-resistant Staphylococcus aureus (MRSA); vancomycin-resistant Enterococcus; and Clostridium difficile. Summary estimates were calculated as incidence rate ratios (IRRs) and 95% confidence/credible intervals. Variation in study designs was addressed using hierarchical Bayesian random-effects models. Results Seventeen trials were included in our final analysis: seven of the studies were cluster-randomised crossover trials, and the remaining studies were before-and-after trials. CHG bathing was estimated to reduce the risk of CLABSI by 56% (Bayesian random effects IRR = 0.44 (95% credible interval (CrI), 0.26, 0.75)), and MRSA colonisation and bacteraemia in the ICU by 41% and 36%, respectively (IRR = 0.59 (95% CrI, 0.36, 0.94); and IRR = 0.64 (95% CrI, 0.43, 0.91)). The numbers needed to treat for these specific ICU infections ranged from 360 (CLABSI) to 2780 (MRSA bacteraemia). Conclusion This meta-analysis of the effectiveness of CHG bathing to reduce infections among adults in the ICU has found evidence for the benefit of daily bathing with CHG to reduce CLABSI and MRSA infections. However, the effectiveness may be dependent on the underlying baseline risk of these events among the given ICU population. Therefore, CHG bathing appears to be of the most clinical benefit when infection rates are high for a given ICU population. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1553-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steven A Frost
- Critical Care Research for Innovation & Evidence Translation (CCRICET) Research Group, School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia. .,Simpson Centre for Health Services Research, South Western Sydney Clinical School & Ingham Institute of Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia. .,Department of Intensive Care, Liverpool Hospital, Sydney, New South Wales, Australia. .,Western Sydney University, Campbelltown Campus, Building 7, Locked Bag 1797, Penrith South, New South Wales, DC 1797, Australia.
| | - Mari-Cris Alogso
- Critical Care Research for Innovation & Evidence Translation (CCRICET) Research Group, School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia.,Department of Intensive Care, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Lauren Metcalfe
- Critical Care Research for Innovation & Evidence Translation (CCRICET) Research Group, School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
| | - Joan M Lynch
- Critical Care Research for Innovation & Evidence Translation (CCRICET) Research Group, School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia.,Department of Intensive Care, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Leanne Hunt
- Critical Care Research for Innovation & Evidence Translation (CCRICET) Research Group, School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia.,Department of Intensive Care, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Ritesh Sanghavi
- Department of Intensive Care, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Evan Alexandrou
- Critical Care Research for Innovation & Evidence Translation (CCRICET) Research Group, School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia.,Department of Intensive Care, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Kenneth M Hillman
- Simpson Centre for Health Services Research, South Western Sydney Clinical School & Ingham Institute of Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia.,Department of Intensive Care, Liverpool Hospital, Sydney, New South Wales, Australia
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Gyllensten H, Wiberg M, Alexanderson K, Hillert J, Tinghög P. How does work disability of patients with MS develop before and after diagnosis? A nationwide cohort study with a reference group. BMJ Open 2016; 6:e012731. [PMID: 27856477 PMCID: PMC5128990 DOI: 10.1136/bmjopen-2016-012731] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We compared work disability of patients with multiple sclerosis (MS) from 5 years before with 5 years after diagnosis, with that of matched controls, and analysed whether progression in work disability among patients with MS was associated with sociodemography. DESIGN Population-based cohort study. SETTING The adult Swedish general population. PARTICIPANTS Residents aged 24-57 diagnosed with MS (n=3685) in 2003-2006 and 18 425 matched controls without MS. PRIMARY AND SECONDARY OUTCOME MEASURES Annual net days of sickness absence (SA) and disability pension (DP), used as a proxy for work disability, followed from 5 years before to 5 years after diagnosis (ie, T-5-T+5). For patients with MS, regression was used to identify sociodemographic factors related to progression in work disability. RESULTS Work disability of patients with MS increased gradually between T-5 and T-1 (mean: 46-82 days) followed by a sharp increase (T+1, 142 days), after which only a marginal increase was observed (T+5, 149 days). The matched controls had less work disability, slightly increasing during the period to a maximum of ∼40 days. Men with MS had a sharper increase in work disability before diagnosis. High educational level was associated with less progression in work disability before and around diagnosis. CONCLUSIONS Patients with MS had more work disability days also 5 years before diagnosis. Several sociodemographic variables were associated with the absolute level and the progression in SA and DP.
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Affiliation(s)
- Hanna Gyllensten
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Centre for Person-centred Care (GPCC), and Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Wiberg
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Analysis and Prognosis, Swedish Social Insurance Agency, Stockholm, Sweden
| | - Kristina Alexanderson
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Petter Tinghög
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Public Health and Medicine, Red Cross University College, Stockholm, Sweden
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Halpern JA, Sedrakyan A, Dinerman B, Hsu WC, Mao J, Hu JC. Indications, Utilization and Complications Following Prostate Biopsy: New York State Analysis. J Urol 2016; 197:1020-1025. [PMID: 27856226 DOI: 10.1016/j.juro.2016.11.081] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE Uptake of active surveillance and changes in prostate cancer care may affect the utilization of and complications following prostate needle biopsy. We characterized recent trends and risk factors for prostate needle biopsy complications using a statewide, all-payer cohort. MATERIALS AND METHODS We used SPARCS (New York Statewide Planning and Research Cooperative System) to identify prostate needle biopsies performed between 2011 and 2014 via the transrectal and the transperineal approach (9,472 and 421 patients, respectively). We characterized trends in utilization and complications using Poisson regression and the Cochrane-Armitage test. We applied logistic regression to examine predictors of complications within 30 days of prostate needle biopsy. RESULTS Ambulatory use of prostate needle biopsy decreased with time (p <0.01). The most common indication for prostate needle biopsy was elevated prostate specific antigen in 53.2% of patients, followed by active surveillance for cancer in 26.7%, abnormal digital rectal examination in 2.6% and atypia in 1.6%. The prostate needle biopsy associated infection rate increased from 2.6% to 3.5% during the study period (p = 0.02). Among the 777 repeat prostate needle biopsies, the complication rate was comparable to that of initial prostate needle biopsy. Preprocedural rectal swab was done in less than 1% of prostate needle biopsies. On multivariable analysis, patient race, procedure year, diabetes (OR 1.92, 95% CI 1.29-2.86, p <0.01), transrectal approach (OR 3.48, 95% CI 1.27-9.54, p = 0.02) and recent hospitalization (OR 2.03, 95% CI 1.43-2.89, p <0.01) were significantly associated with infection. The median total charge for infectious complications was $4,129 (IQR 711-19,185). CONCLUSIONS Across New York State, infectious complications after prostate needle biopsy have increased over time. With higher complications using the transrectal approach and minimal utilization of targeted antibiotic prophylaxis, further efforts should focus on the evaluation and implementation of these strategies to reduce post-prostate needle biopsy complications nationally.
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Affiliation(s)
- Joshua A Halpern
- Department of Urology, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy and Research (AS, WCH), Weill Cornell Medical College, New York, New York
| | - Art Sedrakyan
- Department of Urology, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy and Research (AS, WCH), Weill Cornell Medical College, New York, New York
| | - Brian Dinerman
- Department of Urology, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy and Research (AS, WCH), Weill Cornell Medical College, New York, New York
| | - Wei-Chun Hsu
- Department of Urology, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy and Research (AS, WCH), Weill Cornell Medical College, New York, New York
| | - Jialin Mao
- Department of Urology, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy and Research (AS, WCH), Weill Cornell Medical College, New York, New York
| | - Jim C Hu
- Department of Urology, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy and Research (AS, WCH), Weill Cornell Medical College, New York, New York.
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Huang HP, Chen B, Wang HY, He M. The efficacy of daily chlorhexidine bathing for preventing healthcare-associated infections in adult intensive care units. Korean J Intern Med 2016; 31:1159-1170. [PMID: 27048258 PMCID: PMC5094930 DOI: 10.3904/kjim.2015.240] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 08/23/2015] [Accepted: 09/06/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Healthcare-associated infections (HAIs) in critically ill patients with prolonged length of hospital stay and increased medical costs. The aim of this study is to assess whether daily chlorhexidine gluconate (CHG) bathing will significantly reduce the rates of HAIs in adult intensive care units (ICUs). METHODS PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were systematically searched until December 31, 2014 to identify relevant studies. Two authors independently reviewed and extracted data from included studies. All data was analyzed by Review Manager version 5.3. RESULTS Fifteen studies including three randomized controlled trials and 12 quasi-experimental studies were available in this study. The outcomes showed that daily CHG bathing were associated with significant reduction in the rates of primary outcomes: catheter-related bloodstream infection (risk ratio [RR], 0.44; 95% confidence interval [CI], 0.32 to 0.63; p < 0.00001), catheter-associated urinary tract infection (RR, 0.68; 95% CI, 0.52 to 0.88; p = 0.004), ventilator-associated pneumonia (RR, 0.73; 95% CI, 0.57 to 0.93; p = 0.01), acquisition of methicillin-resistant Staphylococcus aureus (RR, 0.78; 95% CI, 0.68 to 0.91; p = 0.001) and vancomycin-resistant Enterococcus (RR, 0.56; 95% CI, 0.31 to 0.99; p = 0.05). CONCLUSIONS Our study suggests that the use of daily CHG bathing can significantly prevent HAIs in ICUs. However, more well-designed studies are needed to confirm these findings.
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Affiliation(s)
- Hua-ping Huang
- Nursing Administration, Mianyang Central Hospital, Mianyang, China
- Correspondence to Hua-ping Huang, R.N. Nursing Administration, Mianyang Central Hospital, No. 12, Changjia Alley, Jingzhong Street, Fucheng District, Mianyang 621000, China Tel: +86-816-223-9671 Fax: +86-816-222-2566 E-mail:
| | - Bin Chen
- Intensive Care Unit, Mianyang Central Hospital, Mianyang, China
| | - Hai-Yan Wang
- Nursing Administration, Mianyang Central Hospital, Mianyang, China
| | - Me He
- Nursing Administration, Mianyang Central Hospital, Mianyang, China
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Muscedere J, Maslove D, Boyd JG, O'Callaghan N, Lamontagne F, Reynolds S, Albert M, Hall R, McGolrick D, Jiang X, Day AG. Prevention of nosocomial infections in critically ill patients with lactoferrin (PREVAIL study): study protocol for a randomized controlled trial. Trials 2016; 17:474. [PMID: 27681799 PMCID: PMC5041570 DOI: 10.1186/s13063-016-1590-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/02/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Nosocomial infections remain an important source of morbidity, mortality, and increased health care costs in hospitalized patients. This is particularly problematic in intensive care units (ICUs) because of increased patient vulnerability due to the underlying severity of illness and increased susceptibility from utilization of invasive therapeutic and monitoring devices. Lactoferrin (LF) and the products of its breakdown have multiple biological effects, which make its utilization of interest for the prevention of nosocomial infections in the critically ill. METHODS/DESIGN This is a phase II randomized, multicenter, double-blinded trial to determine the effect of LF on antibiotic-free days in mechanically ventilated, critically ill, adult patients in the ICU. Eligible, consenting patients will be randomized to receive either LF or placebo. The treating clinician will remain blinded to allocation during the study; blinding will be maintained by using opaque syringes and containers. The primary outcome will be antibiotic-free days, defined as the number of days alive and free of antibiotics 28 days after randomization. Secondary outcomes will include: antibiotic utilization, adjudicated diagnosis of nosocomial infection (longer than 72 h of admission to ICU), hospital and ICU length of stay, change in organ function after randomization, hospital and 90-day mortality, incidence of tracheal colonization, changes in gastrointestinal permeability, and immune function. Outcomes to inform the conduct of a larger definitive trial will also be evaluated, including feasibility as determined by recruitment rates and protocol adherence. DISCUSSION The results from this study are expected to provide insight into a potential novel therapeutic use for LF in critically ill adult patients. Further, analysis of study outcomes will inform a future, large-scale phase III randomized controlled trial powered on clinically important outcomes related to the use of LF. TRIAL REGISTRATION The trial was registered at www.ClinicalTrials.gov on 18 November 2013. TRIAL REGISTRATION NUMBER NCT01996579 .
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Affiliation(s)
- John Muscedere
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada. .,Kingston General Hospital, Room 5-411, Angada 4, 76 Stuart Street, Kingston, ON, K7L 2 V3, Canada.
| | - David Maslove
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - John Gordon Boyd
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Nicole O'Callaghan
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Francois Lamontagne
- Centre de recherché du CHU de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Steven Reynolds
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Martin Albert
- Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal, Division of Critical Care Medicine, Critical Care and Medicine Departments, Université de Montréal, Montréal, QC, Canada
| | - Rick Hall
- Department of Critical Care Medicine, Dalhousie University and the Nova Scotia Health Authority, Halifax, NS, Canada
| | - Danielle McGolrick
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Xuran Jiang
- Kingston General Hospital, Room 5-411, Angada 4, 76 Stuart Street, Kingston, ON, K7L 2 V3, Canada
| | - Andrew G Day
- Kingston General Hospital, Room 5-411, Angada 4, 76 Stuart Street, Kingston, ON, K7L 2 V3, Canada
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MacVane SH. Antimicrobial Resistance in the Intensive Care Unit. J Intensive Care Med 2016; 32:25-37. [DOI: 10.1177/0885066615619895] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/30/2015] [Accepted: 11/09/2015] [Indexed: 11/16/2022]
Abstract
Bacterial infections are a frequent cause of hospitalization, and nosocomial infections are an increasingly common condition, particularly within the acute/critical care setting. Infection control practices and new antimicrobial development have primarily focused on gram-positive bacteria; however, in recent years, the incidence of infections caused by gram-negative bacteria has risen considerably in intensive care units. Infections caused by multidrug-resistant (MDR) gram-negative organisms are associated with high morbidity and mortality, with significant direct and indirect costs resulting from prolonged hospitalizations due to antibiotic treatment failures. Of particular concern is the increasing prevalence of antimicrobial resistance to β-lactam antibiotics (including carbapenems) among Pseudomonas aeruginosa and Acinetobacter baumannii and, recently, among pathogens of the Enterobacteriaceae family. Treatment options for infections caused by these pathogens are limited. Antimicrobial stewardship programs focus on optimizing the appropriate use of currently available antimicrobial agents with the goals of improving outcomes for patients with infections caused by MDR gram-negative organisms, slowing the progression of antimicrobial resistance, and reducing hospital costs. Newly approved treatment options are available, such as β-lactam/β-lactamase inhibitor combinations, which significantly extend the armamentarium against MDR gram-negative bacteria.
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Affiliation(s)
- Shawn H. MacVane
- Department of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
- Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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The Value of E-Learning for the Prevention of Healthcare-Associated Infections. Infect Control Hosp Epidemiol 2016; 37:1052-9. [PMID: 27174463 DOI: 10.1017/ice.2016.107] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Healthcare workers (HCWs) lack familiarity with evidence-based guidelines for the prevention of healthcare-associated infections (HAIs). There is good evidence that effective educational interventions help to facilitate guideline implementation, so we investigated whether e-learning could enhance HCW knowledge of HAI prevention guidelines. METHODS We developed an electronic course (e-course) and tested its usability and content validity. An international sample of voluntary learners submitted to a pretest (T0) that determined their baseline knowledge of guidelines, and they subsequently studied the e-course. Immediately after studying the course, posttest 1 (T1) assessed the immediate learning effect. After 3 months, during which participants had no access to the course, a second posttest (T2) evaluated the residual learning effect. RESULTS A total of 3,587 HCWs representing 79 nationalities enrolled: 2,590 HCWs (72%) completed T0; 1,410 HCWs (39%) completed T1; and 1,011 HCWs (28%) completed T2. The median study time was 193 minutes (interquartile range [IQR], 96-306 minutes) The median scores were 52% (IQR, 44%-62%) for T0, 80% (IQR, 68%-88%) for T1, and 74% (IQR, 64%-84%) for T2. The immediate learning effect (T0 vs T1) was +24% (IQR, 12%-34%; P300 minutes yielded the greatest residual effect (24%). CONCLUSIONS Moderate time invested in e-learning yielded significant immediate and residual learning effects. Decision makers could consider promoting e-learning as a supporting tool in HAI prevention. Infect Control Hosp Epidemiol 2016;37:1052-1059.
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Riu M, Chiarello P, Terradas R, Sala M, Garcia-Alzorriz E, Castells X, Grau S, Cots F. Cost Attributable to Nosocomial Bacteremia. Analysis According to Microorganism and Antimicrobial Sensitivity in a University Hospital in Barcelona. PLoS One 2016; 11:e0153076. [PMID: 27055117 PMCID: PMC4824502 DOI: 10.1371/journal.pone.0153076] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 03/23/2016] [Indexed: 11/25/2022] Open
Abstract
AIM To calculate the incremental cost of nosocomial bacteremia caused by the most common organisms, classified by their antimicrobial susceptibility. METHODS We selected patients who developed nosocomial bacteremia caused by Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, or Pseudomonas aeruginosa. These microorganisms were analyzed because of their high prevalence and they frequently present multidrug resistance. A control group consisted of patients classified within the same all-patient refined-diagnosis related group without bacteremia. Our hospital has an established cost accounting system (full-costing) that uses activity-based criteria to analyze cost distribution. A logistic regression model was fitted to estimate the probability of developing bacteremia for each admission (propensity score) and was used for propensity score matching adjustment. Subsequently, the propensity score was included in an econometric model to adjust the incremental cost of patients who developed bacteremia, as well as differences in this cost, depending on whether the microorganism was multidrug-resistant or multidrug-sensitive. RESULTS A total of 571 admissions with bacteremia matched the inclusion criteria and 82,022 were included in the control group. The mean cost was € 25,891 for admissions with bacteremia and € 6,750 for those without bacteremia. The mean incremental cost was estimated at € 15,151 (CI, € 11,570 to € 18,733). Multidrug-resistant P. aeruginosa bacteremia had the highest mean incremental cost, € 44,709 (CI, € 34,559 to € 54,859). Antimicrobial-susceptible E. coli nosocomial bacteremia had the lowest mean incremental cost, € 10,481 (CI, € 8,752 to € 12,210). Despite their lower cost, episodes of antimicrobial-susceptible E. coli nosocomial bacteremia had a major impact due to their high frequency. CONCLUSIONS Adjustment of hospital cost according to the organism causing bacteremia and antibiotic sensitivity could improve prevention strategies and allow their prioritization according to their overall impact and costs. Infection reduction is a strategy to reduce resistance.
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Affiliation(s)
- Marta Riu
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Pietro Chiarello
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Roser Terradas
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- School of Nursing, Hospital del Mar, Barcelona, Spain
| | - Maria Sala
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Department of Epidemiology and Evaluation, Hospital del Mar, Barcelona, Spain
- Redissec (Red de Investigación en Servicios Sanitarios en enfermedades crónicas), Madrid, Spain
| | | | - Xavier Castells
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Department of Epidemiology and Evaluation, Hospital del Mar, Barcelona, Spain
- Redissec (Red de Investigación en Servicios Sanitarios en enfermedades crónicas), Madrid, Spain
| | - Santiago Grau
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Department of Pharmacy, Hospital del Mar, Barcelona, Spain
| | - Francesc Cots
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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Assessment of Fidelity in Interventions to Improve Hand Hygiene of Healthcare Workers: A Systematic Review. Infect Control Hosp Epidemiol 2016; 37:567-75. [PMID: 26861117 DOI: 10.1017/ice.2015.341] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Compliance with hand hygiene in healthcare workers is fundamental to infection prevention yet remains a challenge to sustain. We examined fidelity reporting in interventions to improve hand hygiene compliance, and we assessed 5 measures of intervention fidelity: (1) adherence, (2) exposure or dose, (3) quality of intervention delivery, (4) participant responsiveness, and (5) program differentiation. DESIGN Systematic review METHODS A librarian performed searches of the literature in PubMed, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Library, and Web of Science of material published prior to June 19, 2015. The review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews, and assessment of study quality was conducted for each study reviewed. RESULTS A total of 100 studies met the inclusion criteria. Only 8 of these 100 studies reported all 5 measures of intervention fidelity. In addition, 39 of 100 (39%) failed to include at least 3 fidelity measures; 20 of 100 (20%) failed to include 4 measures; 17 of 100 (17%) failed to include 2 measures, while 16 of 100 (16%) of the studies failed to include at least 1 measure of fidelity. Participant responsiveness and adherence to the intervention were the most frequently unreported fidelity measures, while quality of the delivery was the most frequently reported measure. CONCLUSIONS Almost all hand hygiene intervention studies failed to report at least 1 fidelity measurement. To facilitate replication and effective implementation, reporting fidelity should be standard practice when describing results of complex behavioral interventions such as hand hygiene.
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Alotaibi AM, Sathasivam S, Nair SP, Parkin IP. Antibacterial properties of Cu–ZrO2thin films prepared via aerosol assisted chemical vapour deposition. J Mater Chem B 2016; 4:666-671. [DOI: 10.1039/c5tb02312b] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The antibacterial properties of a Cu–ZrO2film grownviaaerosol assisted chemical vapour deposition are presented.
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Affiliation(s)
- Abdullah M. Alotaibi
- Materials Chemistry Centre
- Department of Chemistry
- University College London
- London WC1H 0AJ
- UK
| | - Sanjayan Sathasivam
- Materials Chemistry Centre
- Department of Chemistry
- University College London
- London WC1H 0AJ
- UK
| | - Sean P. Nair
- Department of Microbial Diseases
- University College London Eastman Dental Institute
- London
- UK
| | - Ivan P. Parkin
- Materials Chemistry Centre
- Department of Chemistry
- University College London
- London WC1H 0AJ
- UK
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77
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Ponja SD, Sehmi SK, Allan E, MacRobert AJ, Parkin IP, Carmalt CJ. Enhanced Bactericidal Activity of Silver Thin Films Deposited via Aerosol-Assisted Chemical Vapor Deposition. ACS APPLIED MATERIALS & INTERFACES 2015; 7:28616-28623. [PMID: 26632854 DOI: 10.1021/acsami.5b10171] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Silver thin films were deposited on SiO2-barrier-coated float glass, fluorine-doped tin oxide (FTO) glass, Activ glass, and TiO2-coated float glass via AACVD using silver nitrate at 350 °C. The films were annealed at 600 °C and analyzed by X-ray powder diffraction, X-ray photoelectron spectroscopy, UV/vis/near-IR spectroscopy, and scanning electron microscopy. All the films were crystalline, and the silver was present in its elemental form and of nanometer dimension. The antibacterial activity of these samples was tested against Escherichia coli and Staphylococcus aureus in the dark and under UV light (365 nm). All Ag-deposited films reduced the numbers of E. coli by 99.9% within 6 h and the numbers of S. aureus by 99.9% within only 2 h. FTO/Ag reduced bacterial numbers of E. coli to below the detection limit after 60 min and caused a 99.9% reduction of S. aureus within only 15 min of UV irradiation. Activ/Ag reduced the numbers of S. aureus by 66.6% after 60 min and TiO2/Ag killed 99.9% of S. aureus within 60 min of UV exposure. More remarkably, we observed a 99.9% reduction in the numbers of E. coli within 6 h and the numbers of S. aureus within 4 h in the dark using our novel TiO2/Ag system.
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Affiliation(s)
- Sapna D Ponja
- Materials Chemistry Research Centre, Department of Chemistry, University College London , 20 Gordon Street, London WC1H 0AJ, United Kingdom
| | - Sandeep K Sehmi
- Materials Chemistry Research Centre, Department of Chemistry, University College London , 20 Gordon Street, London WC1H 0AJ, United Kingdom
- UCL Division of Surgery and Interventional Science, University College London , 67-73 Riding House Street, London W1 W7EJ, United Kingdom
- Division of Microbial Disease, UCL Eastman Dental Institute, University College London , 256 Gray's Inn Road, London WC1X 8LD, United Kingdom
| | - Elaine Allan
- Division of Microbial Disease, UCL Eastman Dental Institute, University College London , 256 Gray's Inn Road, London WC1X 8LD, United Kingdom
| | - Alexander J MacRobert
- UCL Division of Surgery and Interventional Science, University College London , 67-73 Riding House Street, London W1 W7EJ, United Kingdom
| | - Ivan P Parkin
- Materials Chemistry Research Centre, Department of Chemistry, University College London , 20 Gordon Street, London WC1H 0AJ, United Kingdom
| | - Claire J Carmalt
- Materials Chemistry Research Centre, Department of Chemistry, University College London , 20 Gordon Street, London WC1H 0AJ, United Kingdom
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Reducing Time-dependent Bias in Estimates of the Attributable Cost of Health Care-associated Methicillin-resistant Staphylococcus aureus Infections: A Comparison of Three Estimation Strategies. Med Care 2015. [PMID: 26225444 DOI: 10.1097/mlr.0000000000000403] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous estimates of the excess costs due to health care-associated infection (HAI) have scarcely addressed the issue of time-dependent bias. OBJECTIVE We examined time-dependent bias by estimating the health care costs attributable to an HAI due to methicillin-resistant Staphylococcus aureus (MRSA) using a unique dataset in the Department of Veterans Affairs (VA) that makes it possible to distinguish between costs that occurred before and after an HAI. In addition, we compare our results to those from 2 other estimation strategies. METHODS Using a historical cohort study design to estimate the excess predischarge costs attributable to MRSA HAIs, we conducted 3 analyses: (1) conventional, in which costs for the entire inpatient stay were compared between patients with and without MRSA HAIs; (2) post-HAI, which included only costs that occurred after an infection; and (3) matched, in which costs for the entire inpatient stay were compared between patients with an MRSA HAI and subset of patients without an MRSA HAI who were matched based on the time to infection. RESULTS In our post-HAI analysis, estimates of the increase in inpatient costs due to MRSA HAI were $12,559 (P<0.0001) and $24,015 (P<0.0001) for variable and total costs, respectively. The excess variable and total cost estimates were 33.7% and 31.5% higher, respectively, when using the conventional methods and 14.6% and 11.8% higher, respectively, when using matched methods. CONCLUSIONS This is the first study to account for time-dependent bias in the estimation of incremental per-patient health care costs attributable to HAI using a unique dataset in the VA. We found that failure to account for this bias can lead to overestimation of these costs. Matching on the timing of infection can reduce this bias substantially.
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Scott RD, Sinkowitz-Cochran R, Wise ME, Baggs J, Goates S, Solomon SL, McDonald LC, Jernigan JA. CDC central-line bloodstream infection prevention efforts produced net benefits of at least $640 Million during 1990-2008. Health Aff (Millwood) 2015; 33:1040-7. [PMID: 24889954 DOI: 10.1377/hlthaff.2013.0865] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The prevention of central line-associated bloodstream infections in patients in hospital critical care units has been a target of efforts by the Centers for Disease Control and Prevention (CDC) since the 1960s. We developed a historical economic model to measure the net economic benefits of preventing these infections in Medicare and Medicaid patients in critical care units for the period 1990-2008-a time when reductions attributable to federal investment resulted primarily from CDC efforts-using the cost perspective of the federal government as a third-party payer. The estimated net economic benefits ranged from $640 million to $1.8 billion, with the corresponding net benefits per case averted ranging from $15,780 to $24,391. The per dollar rate of return on the CDC's investments ranged from $3.88 to $23.85. These findings suggest that investments in CDC programs targeting other health care-associated infections also have the potential to produce savings by lowering Medicare and Medicaid reimbursements.
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Affiliation(s)
- R Douglas Scott
- R. Douglas Scott II is an economist in the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia
| | - Ronda Sinkowitz-Cochran
- Ronda Sinkowitz-Cochran is a behavioral scientist in the Division of Healthcare Quality Promotion, CDC
| | - Matthew E Wise
- Matthew E. Wise is an epidemiologist in the Division of Foodborne, Waterborne, and Environmental Diseases, CDC
| | - James Baggs
- James Baggs is an epidemiologist in the Division of Healthcare Quality Promotion, CDC
| | - Scott Goates
- Scott Goates was an economist in the Office of the Assistant Director for Policy, CDC, at the time of this research. He is now health economics and outcomes research manager, Abbott Nutrition, in Columbus, Ohio
| | - Steven L Solomon
- Steven L. Solomon is director of the Office of Antimicrobial Resistance, Division of Healthcare Quality Promotion, CDC
| | - L Clifford McDonald
- L. Clifford McDonald is senior adviser for science and integrity, Division of Healthcare Quality Promotion, CDC
| | - John A Jernigan
- John A. Jernigan is director of the Office of Prevention Research and Evaluation, Division of Healthcare Quality Promotion, CDC
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Ma H, Irudayanathan FJ, Jiang W, Nangia S. Simulating Gram-Negative Bacterial Outer Membrane: A Coarse Grain Model. J Phys Chem B 2015; 119:14668-82. [DOI: 10.1021/acs.jpcb.5b07122] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Huilin Ma
- Department of Biomedical
and Chemical Engineering, Syracuse University, Syracuse, New York 13244, United States
| | | | - Wenjuan Jiang
- Department of Biomedical
and Chemical Engineering, Syracuse University, Syracuse, New York 13244, United States
| | - Shikha Nangia
- Department of Biomedical
and Chemical Engineering, Syracuse University, Syracuse, New York 13244, United States
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Noto MJ, Wheeler AP. Understanding chlorhexidine decolonization strategies. Intensive Care Med 2015; 41:1351-4. [PMID: 26088910 DOI: 10.1007/s00134-015-3846-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/24/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Michael J Noto
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, 1161 21st Ave South, T-1223, MCN, Nashville, TN, 37232-2650, USA,
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The Magnitude of Time-Dependent Bias in the Estimation of Excess Length of Stay Attributable to Healthcare-Associated Infections. Infect Control Hosp Epidemiol 2015; 36:1089-94. [DOI: 10.1017/ice.2015.129] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUNDEstimates of the excess length of stay (LOS) attributable to healthcare-associated infections (HAIs) in which total LOS of patients with and without HAIs are biased because of failure to account for the timing of infection. Alternate methods that appropriately treat HAI as a time-varying exposure are multistate models and cohort studies, which match regarding the time of infection. We examined the magnitude of this time-dependent bias in published studies that compared different methodological approaches.METHODSWe conducted a systematic review of the published literature to identify studies that report attributable LOS estimates using both total LOS (time-fixed) methods and either multistate models or matching patients with and without HAIs using the timing of infection.RESULTSOf the 7 studies that compared time-fixed methods to multistate models, conventional methods resulted in estimates of the LOS to HAIs that were, on average, 9.4 days longer or 238% greater than those generated using multistate models. Of the 5 studies that compared time-fixed methods to matching on timing of infection, conventional methods resulted in estimates of the LOS to HAIs that were, on average, 12.6 days longer or 139% greater than those generated by matching on timing of infection.CONCLUSIONOur results suggest that estimates of the attributable LOS due to HAIs depend heavily on the methods used to generate those estimates. Overestimation of this effect can lead to incorrect assumptions of the likely cost savings from HAI prevention measures.Infect. Control Hosp. Epidemiol. 2015;36(9):1089–1094
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Patients' perceptions of hospital-acquired infections in northern Queensland, Australia: a pilot study. Am J Infect Control 2015; 43:418-9. [PMID: 25721059 DOI: 10.1016/j.ajic.2015.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/07/2015] [Accepted: 01/07/2015] [Indexed: 11/24/2022]
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Greco G, Shi W, Michler RE, Meltzer DO, Ailawadi G, Hohmann SF, Thourani VH, Argenziano M, Alexander JH, Sankovic K, Gupta L, Blackstone EH, Acker MA, Russo MJ, Lee A, Burks SG, Gelijns AC, Bagiella E, Moskowitz AJ, Gardner TJ. Costs associated with health care-associated infections in cardiac surgery. J Am Coll Cardiol 2015. [PMID: 25572505 DOI: 10.1016/j.jacc.201.09.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Health care-associated infections (HAIs) are the most common noncardiac complications after cardiac surgery and are associated with increased morbidity and mortality. Current information about their economic burden is limited. OBJECTIVES This research was designed to determine the cost associated with major types of HAIs during the first 2 months after cardiac surgery. METHODS Prospectively collected data from a multicenter, observational study of the Cardiothoracic Surgery Clinical Trials Network, in which patients were monitored for infections for 65 days after surgery, were merged with related financial data routinely collected by the University HealthSystem Consortium. Incremental length of stay (LOS) and cost associated with HAIs were estimated using generalized linear models, with adjustments for patient demographics, clinical history, baseline laboratory values, and surgery type. RESULTS Among 4,320 cardiac surgery patients (mean age: 64 ± 13 years), 119 (2.8%) experienced a major HAI during the index hospitalization. The most common HAIs were pneumonia (48%), sepsis (20%), and Clostridium difficile colitis (18%). On average, the estimated incremental cost associated with a major HAI was nearly $38,000, of which 47% was related to intensive care unit services. The incremental LOS was 14 days. Overall, there were 849 readmissions; among these, 8.7% were attributed to major HAIs. The cost of readmissions due to major HAIs was, on average, nearly threefold that of readmissions not related to HAIs. CONCLUSIONS Hospital cost, LOS, and readmissions are strongly associated with HAIs. These associations suggest the potential for large reductions in costs if HAIs following cardiac surgery can be reduced. (Management Practices and the Risk of Infections Following Cardiac Surgery; NCT01089712).
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Affiliation(s)
- Giampaolo Greco
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York.
| | - Wei Shi
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York
| | - Robert E Michler
- Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - David O Meltzer
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | | | - Vinod H Thourani
- Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Michael Argenziano
- Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York
| | - John H Alexander
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kathy Sankovic
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lopa Gupta
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael A Acker
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | | | - Albert Lee
- Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Sandra G Burks
- Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Annetine C Gelijns
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York
| | - Emilia Bagiella
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York
| | - Alan J Moskowitz
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York
| | - Timothy J Gardner
- Center for Heart and Vascular Health, Christiana Care Health System, Newark, Delaware
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Greco G, Shi W, Michler RE, Meltzer DO, Ailawadi G, Hohmann SF, Thourani VH, Argenziano M, Alexander JH, Sankovic K, Gupta L, Blackstone EH, Acker MA, Russo MJ, Lee A, Burks SG, Gelijns AC, Bagiella E, Moskowitz AJ, Gardner TJ. Costs associated with health care-associated infections in cardiac surgery. J Am Coll Cardiol 2015; 65:15-23. [PMID: 25572505 DOI: 10.1016/j.jacc.2014.09.079] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 09/18/2014] [Accepted: 09/19/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Health care-associated infections (HAIs) are the most common noncardiac complications after cardiac surgery and are associated with increased morbidity and mortality. Current information about their economic burden is limited. OBJECTIVES This research was designed to determine the cost associated with major types of HAIs during the first 2 months after cardiac surgery. METHODS Prospectively collected data from a multicenter, observational study of the Cardiothoracic Surgery Clinical Trials Network, in which patients were monitored for infections for 65 days after surgery, were merged with related financial data routinely collected by the University HealthSystem Consortium. Incremental length of stay (LOS) and cost associated with HAIs were estimated using generalized linear models, with adjustments for patient demographics, clinical history, baseline laboratory values, and surgery type. RESULTS Among 4,320 cardiac surgery patients (mean age: 64 ± 13 years), 119 (2.8%) experienced a major HAI during the index hospitalization. The most common HAIs were pneumonia (48%), sepsis (20%), and Clostridium difficile colitis (18%). On average, the estimated incremental cost associated with a major HAI was nearly $38,000, of which 47% was related to intensive care unit services. The incremental LOS was 14 days. Overall, there were 849 readmissions; among these, 8.7% were attributed to major HAIs. The cost of readmissions due to major HAIs was, on average, nearly threefold that of readmissions not related to HAIs. CONCLUSIONS Hospital cost, LOS, and readmissions are strongly associated with HAIs. These associations suggest the potential for large reductions in costs if HAIs following cardiac surgery can be reduced. (Management Practices and the Risk of Infections Following Cardiac Surgery; NCT01089712).
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Affiliation(s)
- Giampaolo Greco
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York.
| | - Wei Shi
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York
| | - Robert E Michler
- Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - David O Meltzer
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | | | - Vinod H Thourani
- Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Michael Argenziano
- Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York
| | - John H Alexander
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kathy Sankovic
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lopa Gupta
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael A Acker
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | | | - Albert Lee
- Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Sandra G Burks
- Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Annetine C Gelijns
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York
| | - Emilia Bagiella
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York
| | - Alan J Moskowitz
- International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York
| | - Timothy J Gardner
- Center for Heart and Vascular Health, Christiana Care Health System, Newark, Delaware
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Noto MJ, Domenico HJ, Byrne DW, Talbot T, Rice TW, Bernard GR, Wheeler AP. Chlorhexidine bathing and health care-associated infections: a randomized clinical trial. JAMA 2015; 313:369-78. [PMID: 25602496 PMCID: PMC4383133 DOI: 10.1001/jama.2014.18400] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Daily bathing of critically ill patients with the broad-spectrum, topical antimicrobial agent chlorhexidine is widely performed and may reduce health care-associated infections. OBJECTIVE To determine if daily bathing of critically ill patients with chlorhexidine decreases the incidence of health care-associated infections. DESIGN, SETTING, AND PARTICIPANTS A pragmatic cluster randomized, crossover study of 9340 patients admitted to 5 adult intensive care units of a tertiary medical center in Nashville, Tennessee, from July 2012 through July 2013. INTERVENTIONS Units performed once-daily bathing of all patients with disposable cloths impregnated with 2% chlorhexidine or nonantimicrobial cloths as a control. Bathing treatments were performed for a 10-week period followed by a 2-week washout period during which patients were bathed with nonantimicrobial disposable cloths, before crossover to the alternate bathing treatment for 10 weeks. Each unit crossed over between bathing assignments 3 times during the study. MAIN OUTCOMES AND MEASURES The primary prespecified outcome was a composite of central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated pneumonia (VAP), and Clostridium difficile infections. Secondary outcomes included rates of clinical cultures that tested positive for multidrug-resistant organisms, blood culture contamination, health care-associated bloodstream infections, and rates of the primary outcome by ICU. RESULTS During the chlorhexidine bathing period, 55 infections occurred: 4 CLABSI, 21 CAUTI, 17 VAP, and 13 C difficile. During the control bathing period, 60 infections occurred: 4 CLABSI, 32 CAUTI, 8 VAP, and 16 C difficile. The primary outcome rate was 2.86 per 1000 patient-days during the chlorhexidine and 2.90 per 1000 patient-days during the control bathing periods (rate difference, -0.04; 95% CI, -1.10 to 1.01; P = .95). After adjusting for baseline variables, no difference between groups in the rate of the primary outcome was detected. Chlorhexidine bathing did not change rates of infection-related secondary outcomes including hospital-acquired bloodstream infections, blood culture contamination, or clinical cultures yielding multidrug-resistant organisms. In a prespecified subgroup analysis, no difference in the primary outcome was detected in any individual intensive care unit. CONCLUSION AND RELEVANCE In this pragmatic trial, daily bathing with chlorhexidine did not reduce the incidence of health care-associated infections including CLABSIs, CAUTIs, VAP, or C difficile. These findings do not support daily bathing of critically ill patients with chlorhexidine. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02033187.
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Affiliation(s)
- Michael J. Noto
- Departments of Medicine, Vanderbilt University, Nashville TN
| | | | | | - Tom Talbot
- Departments of Medicine, Vanderbilt University, Nashville TN
| | - Todd W. Rice
- Departments of Medicine, Vanderbilt University, Nashville TN
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Ferreira ML, Dantas RC, Faria ALS, Gonçalves IR, Silveira de Brito C, Queiroz LL, Gontijo-Filho PP, Ribas RM. Molecular epidemiological survey of the quinolone- and carbapenem-resistant genotype and its association with the type III secretion system in Pseudomonas aeruginosa. J Med Microbiol 2015; 64:262-271. [PMID: 25596115 DOI: 10.1099/jmm.0.000023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This study evaluated the predictors of mortality and the impact of inappropriate therapy on the outcomes of patients with bacteraemia and ventilator-associated pneumonia (VAP). Additionally, we evaluated the correlation of the type III secretion system (TTSS) effector genotype with resistance to carbapenems and fluoroquinolones, mutations in the quinolone resistance-determining regions (QRDRs), metallo-β-lactamase and virulence factors. A retrospective cohort was conducted at a tertiary hospital in patients with multidrug-resistant (MDR) P. aeruginosa bacteraemia (157 patients) and VAP (60 patients). The genes for blaIMP, blaVIM, blaSIM, blaGIM and blaSPM and virulence genes (exoT, exoS, exoY, exoU, lasB, algD and toxA) were detected; sequencing was conducted for QRDR genes on fluoroquinolone-resistant strains. The multivariate analyses showed that the predictors independently associated with death in patients with bacteraemia were cancer and inappropriate therapy. Carbapenem resistance was more frequent among strains causing VAP (53.3 %), and in blood we observed the blaSPM genotype (66.6 %) and blaVIM genotype (33.3 %). The exoS gene was found in all isolates, whilst the frequency was low for exoU (9.4 %). Substitution of threonine to isoleucine at position 83 in gyrA was the most frequent mutation among fluoroquinolone-resistant strains. Our study showed a mutation at position 91 in the parC gene (Glu91Lys) associated with a mutation in gyrA (Thre83Ile) in a strain of extensively drug-resistant P. aeruginosa, with the exoT(+)exoS(+)exoU(+) genotype, that has not yet been described in Brazil to the best of our knowledge. This comprehensive analysis of resistance mechanisms to carbapenem and fluoroquinolones and their association with TTSS virulence genes, covering MDR P. aeruginosa in Brazil, is the largest reported to date.
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Affiliation(s)
| | | | - Ana Luiza Souza Faria
- Laboratory of Microbiology, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Iara Rossi Gonçalves
- Laboratory of Microbiology, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | | | | | - Paulo P Gontijo-Filho
- Laboratory of Microbiology, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Rosineide Marques Ribas
- Laboratory of Microbiology, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
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88
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Thabit AK, Crandon JL, Nicolau DP. Antimicrobial resistance: impact on clinical and economic outcomes and the need for new antimicrobials. Expert Opin Pharmacother 2014; 16:159-77. [PMID: 25496207 DOI: 10.1517/14656566.2015.993381] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Antimicrobial resistance is a well-recognized global threat; thus, the development of strong infection control policies coupled with antimicrobial stewardship strategies and new therapies is required to reverse this process. In its 2013 report on antimicrobial resistance, the Centers for Disease Control and Prevention focused on this problem while presenting estimated annual rates of infections with antimicrobial-resistant organisms and their related mortality rates. Whereas some resistant pathogens were considered less threatening, others such as carbapenem-resistant Enterobacteriaceae were associated with higher mortality rates owing to limited treatment options. AREAS COVERED An overview of the most common antimicrobial-resistant pathogens, focusing on risk factors for acquisition, clinical and economic outcomes, as well as current treatment options. Strategies to optimize antimicrobial therapy with currently available agents, in addition to newly developed antimicrobials are also discussed. EXPERT OPINION The emergence of pathogens with a variety of resistance mechanisms has intensified the challenges associated with infection control and treatment strategies. Therefore, prudent use of currently available antimicrobial agents, as well as implementing measures to limit spread of resistance is paramount. Although several new antimicrobials have been recently approved or are in the pipeline showing promise in the battle against resistance, the appropriate use of these agents is required as the true benefits of these treatments are to be recognized in the clinical care setting.
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Affiliation(s)
- Abrar K Thabit
- Hartford Hospital, Center for Anti-infective Research and Development , 80 Seymour Street, Hartford, CT 06102 , USA +1 860 972 3941 ; +1 860 545 3992 ;
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89
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Liu H, Zhao J, Xing Y, Li M, Du M, Suo J, Liu Y. Nosocomial infection in adult admissions with hematological malignancies originating from different lineages: a prospective observational study. PLoS One 2014; 9:e113506. [PMID: 25415334 PMCID: PMC4240653 DOI: 10.1371/journal.pone.0113506] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 10/24/2014] [Indexed: 11/23/2022] Open
Abstract
Background Nosocomial infection (NI) causes prolonged hospital stays, increased healthcare costs, and higher mortality among patients with hematological malignancies (HM). However, few studies have compared the incidence of NI according to the HM lineage. Objective To compare the incidence of NI according to the type of HM lineage, and identify the risk factors for NI. Methods This prospective observational study monitored adult patients with HM admitted for >48 hours to the General Hospital of the People's Liberation Army during 2010–2013. Attack rates and incidences of NI were compared, and multivariable logistic regression was used to control for confounding effects. Results This study included 6,613 admissions from 1,922 patients. During these admissions, 1,023 acquired 1,136 NI episodes, with an attack rate of 15.47% and incidence of 9.6‰ (95% CI: 9.1–10.2). Higher rates and densities of NIs were observed among myeloid neoplasm (MN) admissions, compared to lymphoid neoplasm (LN) admissions (28.42% vs. 11.00%, P<0.001 and 11.4% vs. 8.4‰, P<0.001). NI attack rates in acute myeloid leukemia (AML) and myelodysplastic/myeloproliferative neoplasm (MDS/MPN) were higher than those in MDS (30.69% vs. 20.19%, P<0.001; 38.89% vs. 20.19%, P = 0.003). Attack rates in T/NK-cell neoplasm and B-cell neoplasm were higher than those in Hodgkin lymphoma (15.04% vs. 3.65%; 10.94% vs. 3.65%, P<0.001). Multivariable regression analysis indicated prolonged hospitalization, presence of central venous catheterization, neutropenia, current stem cell transplant, infection on admission, and old age were independently associated with higher NI incidence. After adjusting for these factors, MN admissions still had a higher risk of infection (odds ratio 1.34, 95% CI: 1.13–1.59, P<0.001). Conclusion Different NI attack rates were observed for HM from different lineages, with MN lineages having a higher attack rate and incidence than LN lineages. Special attention should be paid to MN admissions, especially AML and MDS/MPN admissions, to control NI incidence.
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Affiliation(s)
- Hui Liu
- Department of Digestive Medicine, the Second Affiliated Hospital of Dalian Medical University, Dalian, China
- Department of Infection Management and Disease Control, Chinese PLA General Hospital, Beijing, China
| | - Jin Zhao
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Yubin Xing
- Department of Digestive Medicine, the Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Meng Li
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Mingmei Du
- Department of Digestive Medicine, the Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jijiang Suo
- Department of Infection Management and Disease Control, Chinese PLA General Hospital, Beijing, China
| | - Yunxi Liu
- Department of Infection Management and Disease Control, Chinese PLA General Hospital, Beijing, China
- * E-mail:
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90
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Revankar N, Ward AJ, Pelligra CG, Kongnakorn T, Fan W, LaPensee KT. Modeling economic implications of alternative treatment strategies for acute bacterial skin and skin structure infections. J Med Econ 2014; 17:730-40. [PMID: 25019580 DOI: 10.3111/13696998.2014.941065] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The economic implications from the US Medicare perspective of adopting alternative treatment strategies for acute bacterial skin and skin structure infections (ABSSSIs) are substantial. The objective of this study is to describe a modeling framework that explores the impact of decisions related to both the location of care and switching to different antibiotics at discharge. METHODS A discrete event simulation (DES) was developed to model the treatment pathway of each patient through various locations (emergency department [ED], inpatient, and outpatient) and the treatments prescribed (empiric antibiotic, switching to a different antibiotic at discharge, or a second antibiotic). Costs are reported in 2012 USD. RESULTS The mean number of days on antibiotic in a cohort assigned to a full course of vancomycin was 11.2 days, with 64% of the treatment course being administered in the outpatient setting. Mean total costs per patient were $8671, with inpatient care accounting for 58% of the costs accrued. The majority of outpatient costs were associated with parenteral administration rather than drug acquisition or monitoring. Scenarios modifying the treatment pathway to increase the proportion of patients receiving the first dose in the ED, and then managing them in the outpatient setting or prescribing an oral antibiotic at discharge to avoid the cost associated with administering parenteral therapy, therefore have a major impact and lower the typical cost per patient by 11-20%. Since vancomycin is commonly used as empiric therapy in clinical practice, based on these analyses, a shift in treatment practice could result in substantial savings from the Medicare perspective. CONCLUSIONS The choice of antibiotic and location of care influence the costs and resource use associated with the management of ABSSSIs. The DES framework presented here can provide insight into the potential economic implications of decisions that modify the treatment pathway.
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91
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Kariuki S, Dougan G. Antibacterial resistance in sub-Saharan Africa: an underestimated emergency. Ann N Y Acad Sci 2014; 1323:43-55. [PMID: 24628272 PMCID: PMC4159419 DOI: 10.1111/nyas.12380] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Antibacterial resistance-associated infections are known to increase morbidity, mortality, and cost of treatment, and to potentially put others in the community at higher risk of infections. In high-income countries, where the burden of infectious diseases is relatively modest, resistance to first-line antibacterial agents is usually overcome by use of second- and third-line agents. However, in developing countries where the burden of infectious diseases is high, patients with antibacterial-resistant infections may be unable to obtain or afford effective second-line treatments. In sub-Saharan Africa (SSA), the situation is aggravated by poor hygiene, unreliable water supplies, civil conflicts, and increasing numbers of immunocompromised people, such as those with HIV, which facilitate both the evolution of resistant pathogens and their rapid spread in the community. Because of limited capacity for disease detection and surveillance, the burden of illnesses due to treatable bacterial infections, their specific etiologies, and the awareness of antibacterial resistance are less well established in most of SSA, and therefore the ability to mitigate their consequences is significantly limited.
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Affiliation(s)
- Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - Gordon Dougan
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
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92
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The Ecology of Dying. ACTA ACUST UNITED AC 2014. [DOI: 10.1108/s1057-6290(2013)0000015013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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93
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Goudie A, Dynan L, Brady PW, Rettiganti M. Attributable cost and length of stay for central line-associated bloodstream infections. Pediatrics 2014; 133:e1525-32. [PMID: 24799537 PMCID: PMC4258643 DOI: 10.1542/peds.2013-3795] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Central line-associated bloodstream infections (CLABSI) are common types of hospital-acquired infections associated with high morbidity. Little is known about the attributable cost and length of stay (LOS) of CLABSI in pediatric inpatient settings. We determined the cost and LOS attributable to pediatric CLABSI from 2008 through 2011. METHODS A propensity score-matched case-control study was performed. Children <18 years with inpatient discharges in the Nationwide Inpatient Sample databases from the Healthcare Cost and Utilization Project from 2008 to 2011 were included. Discharges with CLABSI were matched to those without CLABSI by age, year, and high dimensional propensity score (obtained from a logistic regression of CLABSI status on patient characteristics and the presence or absence of 262 individual clinical classification software diagnoses). Our main outcome measures were estimated costs obtained from cost-to-charge ratios and LOS for pediatric discharges. RESULTS The mean attributable cost and LOS between matched CLABSI cases (1339) and non-CLABSI controls (2678) was $55 646 (2011 dollars) and 19 days, respectively. Between 2008 and 2011, the rate of pediatric CLABSI declined from 1.08 to 0.60 per 1000 (P < .001). Estimates of mean costs of treating patients with CLABSI declined from $111 852 to $98 621 (11.8%; P < .001) over this period, but cost of treating matched non-CLABSI patients remained constant at ∼$48 000. CONCLUSIONS Despite significant improvement in rates, CLABSI remains a burden on patients, families, and payers. Continued attention to CLABSI-prevention initiatives and lower-cost CLABSI care management strategies to support high-value pediatric care delivery is warranted.
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Affiliation(s)
| | - Linda Dynan
- James M. Anderson Center for Health Systems Excellence, and,Haile US Bank College of Business, Northern Kentucky University, Highland Heights, Kentucky
| | - Patrick W. Brady
- James M. Anderson Center for Health Systems Excellence, and,Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and
| | - Mallikarjuna Rettiganti
- Division of Biostatistics, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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94
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Banerjee A, Kelly KB, Zhou HY, Dixon SD, Papana Dagiasis A, Quinn LM, Claridge JA. Diagnosis of Infection after Splenectomy for Trauma Should Be Based on Lack of Platelets Rather Than White Blood Cell Count. Surg Infect (Larchmt) 2014; 15:221-6. [DOI: 10.1089/sur.2012.176] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Aman Banerjee
- Department of Surgery, MetroHealth Medical Center Campus, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Katherine B. Kelly
- Department of Surgery, MetroHealth Medical Center Campus, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Hannah Y. Zhou
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | | | - Linda M. Quinn
- Department of Mathematics, Cleveland State University, Cleveland, Ohio
| | - Jeffrey A. Claridge
- Department of Surgery, MetroHealth Medical Center Campus, University Hospitals Case Medical Center, Cleveland, Ohio
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95
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Stevens V, Geiger K, Concannon C, Nelson R, Brown J, Dumyati G. Inpatient costs, mortality and 30-day re-admission in patients with central-line-associated bloodstream infections. Clin Microbiol Infect 2014; 20:O318-24. [DOI: 10.1111/1469-0691.12407] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 09/04/2013] [Accepted: 09/19/2013] [Indexed: 11/27/2022]
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96
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Quraishi SA, Bittner EA, Blum L, Hutter MM, Camargo CA. Association between preoperative 25-hydroxyvitamin D level and hospital-acquired infections following Roux-en-Y gastric bypass surgery. JAMA Surg 2014; 149:112-8. [PMID: 24284777 DOI: 10.1001/jamasurg.2013.3176] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Postoperative hospital-acquired infections (HAIs) may result from disruption of natural barrier sites. Recent studies have linked vitamin D status and barrier site integrity. OBJECTIVE To investigate the association between preoperative vitamin D status and the risk for HAIs. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis was performed using propensity score methods to construct a matched-pairs cohort to reduce baseline differences between patients with 25-hydroxyvitamin D (25[OH]D) levels less than 30 ng/mL vs 30 ng/mL or greater. Multivariable logistic regression analysis was then performed to examine the association between 25(OH)D levels and HAIs while adjusting for additional perioperative factors. Locally weighted scatterplot smoothing was used to depict the relationship between increasing 25(OH)D levels and the risk for HAIs. This study was conducted in a single, teaching hospital in Boston, Massachusetts, and involved 770 gastric bypass surgery patients between January 1, 2007, and December 31, 2011. EXPOSURES Preoperative 25(OH)D levels. MAIN OUTCOMES AND MEASURES Association between preoperative 25(OH)D levels and the risk for postoperative HAIs. RESULTS The risk for HAIs was 3-fold greater (adjusted odds ratio, 3.05; 95% CI, 1.34-6.94) in patients with 25(OH)D levels less than 30 ng/mL vs 30 ng/mL or greater. Further adjustment for additional perioperative factors did not materially change this association. Locally weighted scatterplot smoothing analysis depicted a near inverse linear relationship between vitamin D status and the risk for HAIs for 25(OH)D levels around 30 ng/mL. CONCLUSIONS AND RELEVANCE In our patient cohort, a significant inverse association was observed between preoperative 25(OH)D levels and the risk for HAIs. These results suggest that preoperative 25(OH)D levels may be a modifiable risk factor for postoperative nosocomial infections. Prospective studies must determine whether there is a potential benefit to preoperative optimization of vitamin D status.
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Affiliation(s)
- Sadeq A Quraishi
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edward A Bittner
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Livnat Blum
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mathew M Hutter
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carlos A Camargo
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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97
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Economic Burden of Diabetes Mellitus on Patients with Respiratory Failure Requiring Mechanical Ventilation during Hospitalizations. Value Health Reg Issues 2014; 3:33-38. [PMID: 29702934 DOI: 10.1016/j.vhri.2014.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To examine the economic burden of diabetes mellitus (DM) on medical expenditure among patients with respiratory failure (RF) requiring mechanical ventilation during hospitalization. METHODS We extracted the data from Taiwan National Health Research Insurance Database for those adult patients on their first hospitalization for RF requiring mechanical ventilation between 2004 and 2010. We examined associations between medical expenditure and the presence of comorbid DM. We performed independent t tests, chi-square tests, and multivariate linear regression analysis to identify factors associated with excess medical expenditure. RESULTS Of 347,961 patients hospitalized with first occurrence of RF requiring mechanical ventilation, 123,023 (35.36%) patients were documented to have a previous diagnosis of DM. Patients with RF and DM were sicker and consumed more health care resources than did patients with RF without DM. After adjusting for the specified covariates, mechanically ventilated patients with RF and DM consumed at least US $618 more of total inpatient medical expenditure than did patients with RF without DM. There were statistically significant interactions between age and DM on their total inpatient medical expenditure regardless of discharge status. CONCLUSIONS DM was associated with more severe disease status and higher consumption of medical expenditure during hospitalizations among mechanically ventilated patients due to first occurrence of RF in Taiwan. These findings provide scientific evidence to facilitate appropriate resource allocation and formulate programs for higher quality of care in the future in Taiwan and other countries.
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98
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Babiarz LS, Savoie B, McGuire M, McConnell L, Nagy P. Hand sanitizer-dispensing door handles increase hand hygiene compliance: a pilot study. Am J Infect Control 2014; 42:443-5. [PMID: 24679575 DOI: 10.1016/j.ajic.2013.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 11/08/2013] [Accepted: 11/11/2013] [Indexed: 11/29/2022]
Abstract
Improving rates of hand hygiene compliance (HHC) has been shown to reduce nosocomial disease. We compared the HHC for a traditional wall-mounted unit and a novel sanitizer-dispensing door handle device in a hospital inpatient ultrasound area. HHC increased 24.5%-77.1% (P < .001) for the exam room with the sanitizer-dispensing door handle, whereas it remained unchanged for the other rooms. Technical improvements like a sanitizer-dispensing door handle can improve hospital HHC.
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Affiliation(s)
- Lukasz S Babiarz
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Medical Institutions, Baltimore, MD.
| | - Brent Savoie
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Mark McGuire
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Lauren McConnell
- The Johns Hopkins Hospital, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Paul Nagy
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Medical Institutions, Baltimore, MD
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99
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Monk AB, Kanmukhla V, Trinder K, Borkow G. Potent bactericidal efficacy of copper oxide impregnated non-porous solid surfaces. BMC Microbiol 2014; 14:57. [PMID: 24606672 PMCID: PMC3973859 DOI: 10.1186/1471-2180-14-57] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 02/28/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The role of fomites and the environment in nosocomial infections is becoming widely recognized. In this paper we discuss the use of Cupron copper oxide impregnated non-porous solid surface in the hospital setting and present in vitro testing data via USA Environmental Protection Agency (EPA) approved testing protocols that demonstrate the efficacy of these products to assist in reduction in environmental contamination and potentially nosocomial infections. RESULTS The two countertops tested passed all the acceptance criteria by the EPA (>99.9% kill within 2 hours of exposure) killing a range of bacterial pathogens on the surface of the countertops even after repeated exposure of the countertops to the pathogen, and multiple wet and dry abrasion cycles. CONCLUSIONS Cupron enhanced EOS countertops thus may be an important adjunct to be used in hospital settings to reduce environmental bioburden and potentially nosocomial infections.
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Affiliation(s)
- Alastair B Monk
- Cupron Inc, 800 East Leigh Street, Suite 123, Richmond, VA 23219, USA
| | - Vikram Kanmukhla
- Cupron Inc, 800 East Leigh Street, Suite 123, Richmond, VA 23219, USA
| | | | - Gadi Borkow
- Cupron Inc, 800 East Leigh Street, Suite 123, Richmond, VA 23219, USA
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100
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Impacto económico de los eventos adversos en los hospitales españoles a partir del Conjunto Mínimo Básico de Datos. GACETA SANITARIA 2014; 28:48-54. [DOI: 10.1016/j.gaceta.2013.06.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/30/2013] [Accepted: 06/03/2013] [Indexed: 11/23/2022]
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