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Shafiqa N, Aston S, Howard A, Turtle L, Abrams S, Young B, Sherratt F, Alvarez Nishio A, Wilshaw S, Jones AP, Wootton DG. HAP-FAST: a feasibility study incorporating qualitative, mechanistic and costing sub-studies alongside a randomised pilot trial comparing chest x-ray to low-dose CT scan and empirical antibiotics to antibiotics guided by the BIOFIRE® FILM ARRAY® pneumonia plus panel in adults with suspected non-ventilator-associated hospital-cquired pneumonia. BMJ Open 2024; 14:e088490. [PMID: 38964799 PMCID: PMC11227820 DOI: 10.1136/bmjopen-2024-088490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/11/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Non-ventilator-associated hospital-acquired pneumonia (nv-HAP) is the most common healthcare-associated infection (HCAI), is associated with high mortality and morbidity and places a major burden on healthcare systems. Diagnosis currently relies on chest x-rays to confirm pneumonia and sputum cultures to determine the microbiological cause. This approach leads to over-diagnosis of pneumonia, rarely identifies a causative pathogen and perpetuates unnecessary and imprecise antibiotic use. The HAP-FAST study aims to evaluate the feasibility of a randomised trial to evaluate the clinical impact of low-dose, non-contrast-enhanced thoracic CT scans and rapid molecular sputum analysis using the BIOFIRE® FILMARRAY® pneumonia plus panel (FAPP) for patients suspected with nv-HAP. METHODS AND ANALYSIS The HAP-FAST feasibility study consists of a pilot randomised trial, a qualitative study, a costing analysis and exploratory analyses of clinical samples to investigate the immune-pathophysiology of HAP. Participants are identified and recruited from four acute hospitals in the Northwest of the UK. Using a Research Without Prior Consent model, the pilot trial will recruit 220 adult participants, with or without mental capacity, and with suspected HAP. HAP-FAST is a non-blinded, sequential, multiple assignment, randomised trial with two possible stages of randomisation: first, chest x-ray (CXR) or CT; second, if treated as nv-HAP, FAPP or standard microbiological processing alone (no FAPP). Pathogen-specific antibiotic guidance will be provided for FAPP results. Randomisation uses a web-based platform and followed up for 90 days. The feasibility of a future trial will be determined by assessing trial processes, outcome measures and patient and staff experiences. ETHICS AND DISSEMINATION This study has undergone combined review by the UK NHS Research Ethics Committee and Health Research Authority. Results will be disseminated via peer-reviewed journals, via the funders' website and through a range of media to engage the public. TRIAL REGISTRATION NUMBER NCT05483309.
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Affiliation(s)
- Natalia Shafiqa
- Department of Clinical Infection, Microbiology and Immunology (CIMI), University of Liverpool, Liverpool, UK
- Department of Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Stephen Aston
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Department of Antimicrobial Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Alex Howard
- Department of Antimicrobial Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Lance Turtle
- Department of Clinical Infection, Microbiology and Immunology (CIMI), University of Liverpool, Liverpool, UK
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - Simon Abrams
- Department of Clinical Infection, Microbiology and Immunology (CIMI), University of Liverpool, Liverpool, UK
| | - Bridget Young
- Institute of Population Health, Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Frances Sherratt
- Institute of Population Health, Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | | | - Stephanie Wilshaw
- Liverpool Clinical Trials Centre (LCTC), University of Liverpool, Liverpool, UK
| | - Ashley P Jones
- Liverpool Clinical Trials Centre (LCTC), University of Liverpool, Liverpool, UK
| | - Dan G Wootton
- Department of Clinical Infection, Microbiology and Immunology (CIMI), University of Liverpool, Liverpool, UK
- Department of Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
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Mahieu R, Yannart M, Dauby N, Catry B, Newton S. Prevalence of hospital-associated infections and its association with discharge destinations and hospital readmissions in Brussels, Belgium, from 2008 to 2020: A hospital-based, cross-sectional study. Infect Control Hosp Epidemiol 2024; 45:434-442. [PMID: 37946381 DOI: 10.1017/ice.2023.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVES To examine time trends of hospital-associated infections (HAIs) in people living in the Brussels-Capital Region, and to evaluate the consequences for hospitals and long-term care facilities (LTCFs). DESIGN Cross-sectional analyses of yearly hospital administrative data. SETTING All Belgian hospitals and discharge destinations, focusing on LTCFs. PARTICIPANTS All individuals from the Brussels-Capital Region hospitalized for >1 day throughout Belgium between 2008 and 2020 (N = 1,915,572). METHODS We calculated HAI prevalences and then, adjusting for confounders, the odds of being discharged to a LTCF or being readmitted within 30 days postdischarge after an HAI. HAIs included hospital-associated bloodstream infections, hospital-associated urinary tract infections, hospital-associated pneumonia, ventilator-associated pneumonia, and surgical-site infections. RESULTS Between 2008 and 2020, we identified 77,004 HAIs. Changes in time trends occurred. We observed a decrease of all HAIs from 2012 to 2014 from 5.17% to 2.19% (P < .001) and an increase from 2019 to 2020 from 3.38% to 4.06% (P < .001). Among patients with HAIs, 24.36% were discharged to LTCFs and 13.51% underwent early readmission. For stays ≥4 days, HAIs were associated with higher odds of LTCF discharge (adjusted odds ratio [aOR], 1.25; 95% confidence interval [CI], 1.22-1.28), but with lesser odds of early readmission (aOR, 0.88; 95% CI, 0.85-0.90). CONCLUSIONS Administrative data can be useful to detect HAIs trends, but they seem to underestimate the burden compared to surveillance systems. Risk factors of readmission should be identified during hospital stays to ensure continuity of care. Considering the results from 2020 coinciding with the COVID-19 pandemic, monitoring the impact of HAIs should continue.
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Affiliation(s)
- Romain Mahieu
- London School of Hygiene & Tropical Medicine, University of London, London, United Kingdom
- Department of Infectious Disease Prevention and Control, Common Community Commission, Brussels-Capital Region, Brussels, Belgium
| | - Melody Yannart
- Brussels-Capital Health and Social Observatory, Common Community Commission, Brussels-Capital Region, Brussels, Belgium
| | - Nicolas Dauby
- School of Public Health, Université Libre de Bruxelles (ULB), Brussels-Capital Region, Brussels, Belgium
- Department of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels-Capital Region, Brussels, Belgium
| | - Boudewijn Catry
- School of Public Health, Université Libre de Bruxelles (ULB), Brussels-Capital Region, Brussels, Belgium
- Epidemiology and Public Health, Sciensano, Brussels-Capital Region, Brussels, Belgium
| | - Sam Newton
- London School of Hygiene & Tropical Medicine, University of London, London, United Kingdom
- Department of Global and International Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Torrini I, Lucifora C, Russo AG. The Long-Term Effects of Hospitalization on Health Care Expenditures: An Empirical Analysis for the Young-Old Population in Lombardy. Health Policy 2023; 132:104803. [PMID: 37030272 DOI: 10.1016/j.healthpol.2023.104803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023]
Abstract
As the burden of acute care on government budgets is mounting in many countries, documenting the evolution of health costs following patients' hospital admission is essential for assessing overall hospital-related costs. In this paper, we investigate the short- and long-term effects of hospitalization on different types of health care expenditures. We specify and estimate a dynamic DID model using register data of the entire population of individuals aged 50-70 residing in Milan, Italy, over the period 2008-2017. We find evidence of a large and persistent effect of hospitalization on total health care expenditures, with future medical expenses mostly accounted for by inpatient care. Considering all health treatments, the overall effect is sizable and is about twice the cost of a single hospital admission. We show that chronically ill and disabled individuals require greater post-discharge medical assistance, especially for inpatient care, and that cardiovascular and oncological diseases together account for more than half of expenditures on future hospitalizations. Alternative out-of-hospital management practices are discussed as a post-admission cost-containment measure.
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Affiliation(s)
- Irene Torrini
- Department of Economics, Quantitative Methods and Business Strategies, University of Milan - Bicocca, Piazza dell'Ateneo Nuovo 1, Milan 20126, Italy.
| | - Claudio Lucifora
- Department of Economics and Finance, Catholic University of Milan, Italy
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Dadon M, Chedid K, Martin ET, Shaul I, Greiver O, Katz I, Saadon H, Alfaro M, Hod L, Shorbaje A, Braslavsky-Siag A, Moscovici S, Kaye KS, Marchaim D. The impact of bedside wipes in multi-patient rooms: a prospective, crossover trial evaluating infections and survival. J Hosp Infect 2023; 134:50-56. [PMID: 36754289 DOI: 10.1016/j.jhin.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Multidrug-resistant organisms (MDROs) are prevalent on high-touch surfaces in multi-patient rooms. AIM To quantify the impact of hanging single-use cleaning/disinfecting wipes next to each bed. Pre-specified outcomes were: (1) hospital-acquired infections (HAIs), (2) cleaning frequency, (3) MDRO room contamination, (4) new MDRO acquisitions, and (5) mortality. METHODS Clustered randomized crossover trial at Shamir Medical Center, Israel (October 2016 to January 2018). Clusters were randomly assigned to use for cleaning either single-use quaternary ammonium wipes (Clinell) or standard practices (reusable cloths and buckets with bleach). Six-month intervention periods were implemented in alternating sequence, separated by a washout period. Five high-touch surfaces were monitored by fluorescent markers. Study outcomes were compared between periods using generalized estimating equations, Poisson regression, and Cox proportional hazards models. FINDINGS Overall, 7725 patients were included (47,670 person-days), 3793 patients in rooms with intervention cleaning and 3932 patients in rooms with standard practices. During the intervention, there was no significant difference in HAI rates (incidence rate ratio: 1.6; 95% confidence interval (CI): 0.7-3.5; P = 0.3). However, in intervention rooms, the frequency of environmental cleaning was higher (odds ratio: 3.73; 95% CI: 2.0-7.1; P < 0.0001), MDRO environmental contamination rate was insignificantly lower (odds ratio: 0.7; 95% CI: 0.5-1.0; P = 0.06), new MDRO acquisition rate was lower (hazard ratio: 0.4; 95% CI: 0.2-1.0; P = 0.04), and in-hospital mortality rate was lower (incidence rate ratio: 0.8; 95% CI: 0.7-1.0; P = 0.03). CONCLUSION Hanging single-use cleaning/disinfecting wipes next to each bed did not affect the HAI rates but did improve the frequency of cleaning, reduce MDRO environmental contamination, and was associated with reduced incidence of new MDRO acquisitions and reduced mortality. This is a feasible, recommended practice to improve patient outcomes in multi-patient rooms.
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Affiliation(s)
- M Dadon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - K Chedid
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - E T Martin
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - I Shaul
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Greiver
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - I Katz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Saadon
- Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - M Alfaro
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Hod
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Shorbaje
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - S Moscovici
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K S Kaye
- Division of Allergy, Immunology and Infectious Diseases, Robert Wood Johnson Medical School, NJ, USA
| | - D Marchaim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.
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Stewart S, Robertson C, Pan J, Kennedy S, Haahr L, Manoukian S, Mason H, Kavanagh K, Graves N, Dancer SJ, Cook B, Reilly J. Impact of healthcare-associated infection on length of stay. J Hosp Infect 2021; 114:23-31. [PMID: 34301393 DOI: 10.1016/j.jhin.2021.02.026] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Increased length of stay (LOS) for patients is an important measure of the burden of healthcare-associated infection (HAI). AIM To estimate the excess LOS attributable to HAI. METHODS This was a one-year prospective incidence study of HAI observed in one teaching hospital and one general hospital in NHS Scotland as part of the Evaluation of Cost of Nosocomial Infection (ECONI) study. All adult inpatients with an overnight stay were included. HAI was diagnosed using European Centres for Disease Prevention and Control definitions. A multi-state model was used to account for the time-varying nature of HAI and the competing risks of death and discharge. FINDINGS The excess LOS attributable to HAI was 7.8 days (95% confidence interval (CI): 5.7-9.9). Median LOS for HAI patients was 30 days and for non-HAI patients was 3 days. Using a simple comparison of duration of hospital stay for HAI cases and non-cases would overestimate the excess LOS by 3.5 times (27 days compared with 7.8 days). The greatest impact on LOS was due to pneumonia (16.3 days; 95% CI: 7.5-25.2), bloodstream infections (11.4 days; 5.8-17.0) and surgical site infection (SSI) (9.8 days; 4.5-15.0). It is estimated that 58,000 bed-days are occupied due to HAI annually. CONCLUSION A reduction of 10% in HAI incidence could make 5800 bed-days available. These could be used to treat 1706 elective patients in Scotland annually and help reduce the number of patients awaiting planned treatment. This study has important implications for investment decisions in infection prevention and control interventions locally, nationally, and internationally.
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Affiliation(s)
- S Stewart
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK.
| | - C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - J Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - S Kennedy
- HPS Stats Support, Public Health Scotland, Glasgow, UK
| | - L Haahr
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK
| | - S Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - H Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - K Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - N Graves
- Duke-NUS Medical School, Singapore
| | - S J Dancer
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, UK; School of Applied Science, Edinburgh Napier University, Edinburgh, UK
| | - B Cook
- Departments of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - J Reilly
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK; National Services Scotland (NSS), UK
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Graves N, Mitchell BG, Otter JA, Kiernan M. The cost-effectiveness of temporary single-patient rooms to reduce risks of healthcare-associated infection. J Hosp Infect 2021; 116:21-28. [PMID: 34246721 DOI: 10.1016/j.jhin.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The use of single rooms for patient isolation often forms part of a wider bundle to prevent certain healthcare-associated infections (HAIs) in hospitals. Demand for single rooms often exceeds what is available and the use of temporary isolation rooms may help resolve this. Changes to infection prevention practice should be supported by evidence showing that cost-effectiveness is plausible and likely. AIM To perform a cost-effectiveness evaluation of adopting temporary single rooms into UK National Health Service (NHS) hospitals. METHODS The cost-effectiveness of a decision to adopt a temporary, single-patient, isolation room to the current infection prevention efforts of an NHS hospital was modelled. Primary outcomes are the expected change to total costs and life-years from an NHS perspective. FINDINGS The mean expected incremental cost per life-year gained (LYG) is £5,829. The probability that adoption is cost-effective against a £20,000 threshold per additional LYG is 93%, and for a £13,000 threshold the probability is 87%. The conclusions are robust to scenarios for key model parameters. If a temporary single-patient isolation room reduces risks of HAI by 16.5% then an adoption decision is more likely to be cost-effective than not. Our estimate of the effectiveness reflects guidelines and reasonable assumptions and the theoretical rationale is strong. CONCLUSION Despite uncertainties about the effectiveness of temporary isolation rooms for reducing risks of HAI, there is some evidence that an adoption decision is likely to be cost-effective for the NHS setting. Prospective studies will be useful to reduce this source of uncertainty.
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Affiliation(s)
- N Graves
- Health Services & Systems Research, Duke-NUS Medical School, Singapore.
| | - B G Mitchell
- School of Nursing and Midwifery, University of Newcastle, Ourimbah, NSW, Australia
| | - J A Otter
- National Institute for Healthcare Research Health Protection Research Unit (NIHR HPRU) in HCAI and AMR, Imperial College London & Public Health England, Hammersmith Hospital, London, UK
| | - M Kiernan
- Gama Healthcare Ltd, Hemel Hempstead, UK
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