Financial and temporal costs of patient isolation in Norwegian hospitals

Clinical and imaging factors that can predict contagiousness of pulmonary tuberculosis

BACKGROUND

Knowledge on predicting pulmonary tuberculosis (PTB) contagiosity in the hospital admission setting is limited. The objective was to assess clinical and radiological criteria to predict PTB contagiosity.

METHODS

Retrospective analysis of 7 clinical, 4 chest X-ray (CXR) and 5 computed tomography (CT) signs in 299 PTB patients admitted to an urban tertiary hospital from 2008 to 2016. If the acid fact bacilli stain was positive (AFB+) on admission, the case was considered high contagiosity.

RESULTS

Best predictors for high PTB contagiosity (AFB+) were haemoptysis (OR 4.33), cough (3.00), weight loss (2.96), cavitation in CT (2.75), cavitation in CXR (2.55), tree-in-bud-sign in CT (2.12), German residency of the patient (1.89), and abnormal auscultation findings (1.83). A previous TB infection reduced the risk of contagiosity statistically (0.40). Radiographic infiltrates, miliary picture, and pleural effusion were not helpful in predicting high or low contagiosity. 34% of all patients were clinically asymptomatic (20% of the highly contagious group, 50% of the low contagious group).

CONCLUSION

Haemoptysis, cough and weight loss as well as cavitation and tree-in-bud sign in CXR/CT can be helpful to predict PTB contagiosity and to improve PTB management.

Evaluation of the relationship between individual workload perception and compliance with isolation measures of emergency and critical care nurses

BACKGROUND

As a result of the coronavirus 2019 (COVID-19) pandemic, compliance with isolation measures has become challenging.

OBJECTIVE

To evaluate the individual workload perception and compliance with isolation measures of nurses working in the emergency service and critical care unit during the COVID-19 outbreak.

METHODS

This descriptive correlational study was carried out in the emergency service and critical care unit of a public hospital between April 20 and May 20, 2021. A total of 153 nurses working in the emergency service and critical care unit who agreed to participate in the study were included in the study.

RESULTS

Nurses from a state hospital's emergency department and critical care unit (n = 153) were included in the study sample. The impression of overall individual workload by nurses and compliance with isolation (r = 0.153; p <  0.05) had a positive, weak, and significant relationship. The Isolation Measures Compliance Scale resulted in a mean score of 70.70±5.35. The mean score on the Individual Workload Scale for nurses was moderate (3.22±0.54).

CONCLUSION

The low perception of individual workload of nurses working in the emergency service and critical care unit during the COVID-19 pandemic increased the compliance with isolation measures.

Review of decontamination protocols for shared non-critical objects in 35 policies of UK NHS Acute Care Organisations

BACKGROUND

Decontamination of non-critical objects shared by patients is key in reducing HAIs, but it is a complex process that needs precise guidance from UK NHS Acute Care Organisations (ACOs).

AIM

To review the indications given by NHS ACOs' policies regarding the decontamination of shared non-critical devices.

METHODS

Detailed lists of decontamination protocols for shared non-critical objects were retrieved from cleaning, disinfection, and decontamination policies of 35 NHS ACOs. Three parameters were considered for each object: decontamination method, decontamination frequency and person responsible for decontamination.

FINDINGS

1279 decontamination protocols regarding 283 different shared non-critical objects were retrieved. 689 (54%) did not indicate the person responsible for decontamination, while only 425 (33%), were complete, giving indications for all three parameters analysed. Only 2.5% (32/1279) decontamination protocols were complete and identical in two policies. In policies where cleaning represented the major decontamination method, chemical disinfection was rarely mentioned and vice versa. A general agreement among policies can be found for four main decontamination methods (detergent and water, detergent wipes, disinfectant wipes, use of disposable items), two decontamination frequencies (between events, daily) and two responsible person designations (nurses, domestic staff).

CONCLUSIONS

Decontamination protocol policies for shared non-critical objects had some similarities but did not concur on how each individual object should be decontaminated. The lack of clear indications regarding the person responsible for the decontamination process put at risk the ability of policies to serve as guidance.

Healthcare resource use in hospitalized patients with carbapenem-resistant Gram-negative infections

OBJECTIVES

Antimicrobial resistance (AMR) is a threat to global public health. Infections with resistant organisms are more challenging to treat, often delay patient recovery and can increase morbidity and mortality. Healthcare costs associated with treating patients with AMR organisms are poorly described. In particular, data for specific organisms, such as those harbouring carbapenem resistance, are lacking.

METHODS

This was a retrospective, matched (1:1), single-centre, cohort study at a Central London hospital, comparing costs and resource use of 442 adult inpatients infected with either carbapenem-sensitive (CSO) or carbapenem-resistant organisms (CRO) over a two-year period. Resource use and micro-costing data were obtained from the hospital Patient, Education and Research Costing System (PERCS), and included both direct and indirect costs.

RESULTS

Overall, the median healthcare-related cost of treating a patient with a CRO was more than double (£49,537 vs £19,299) that of treating a patient with a CSO. There were statistically significant increases in expenditure across 21 of 44 measured parameters including critical care costs, which accounted for the greatest proportion of overall costs in both groups. Infections were predominantly of the respiratory tract (41%) and caused by Pseudomonas aeruginosa (76%).

CONCLUSIONS

Infection with CROs increases healthcare expenditure significantly. Many of the costs, including patient support, portering and catering, have been underappreciated in previous work. We additionally note that patients infected with CROs have longer hospital stays, and increased theatre operating times compared with patients infected with CSOs.