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Ben-Sassi K, Sarwar S. Impact of first-line dalbavancin for cellulitis on hospital admissions and costs: A case series. J Glob Antimicrob Resist 2024; 38:306-308. [PMID: 38821442 DOI: 10.1016/j.jgar.2024.05.020] [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: 12/19/2023] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Many patients with cellulitis are treated with oral antibiotics as outpatients, but some require hospital admission for intravenous antibiotics. During the coronavirus disease 2019 pandemic, Betsi Cadwaladr University Health Board in Wales approved use of dalbavancin as first-line intravenous antibiotic from April to December 2020 to facilitate early discharge and prevent hospital admission. OBJECTIVES To report cost savings and admission avoidance through first-line intravenous use of dalbavancin for cellulitis in one health board in Wales. PATIENTS AND METHODS Patients with cellulitis who presented to the emergency department or medical assessment unit at Betsi Cadwaladr University Health Board's two hospitals between April and December 2020 were identified for treatment with dalbavancin, because they had not responded to oral antibiotics or their initial presentation warranted intravenous antibiotics. Patients received 1500 mg dalbavancin by intravenous infusion according to prescribing information and were sent home without being admitted. Outcomes were admission within 30 d of dalbavancin and cost savings from avoiding admission. RESULTS 31 patients were treated with dalbavancin for cellulitis in the emergency department or medical assessment unit. No patient was admitted within 30 d of receiving dalbavancin. Use of dalbavancin is estimated to have saved 248 bed-days over the study period, with an estimated saving of $120,444.23 based on avoidance of admission. The cost of dalbavancin for these 31 patients was $69,959.08, giving an overall cost saving of $50,485.15 ($1529.95 per patient). CONCLUSIONS Prescribing dalbavancin as first-line intravenous antibiotic for cellulitis prevents admission, saving bed-days and admission-related costs.
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Affiliation(s)
- Kailey Ben-Sassi
- Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Wrexham, Wales, UK.
| | - Suhail Sarwar
- Maelor Wrexham Hospital, Betsi Cadwaladr University Health Board, Wrexham, Wales, UK
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Huang L, Ning H, Liu XC, Wang Y, Deng C, Li H. Economic burden attributable to hospital-acquired infections among tumor patients from a large regional cancer center in Southern China. Am J Infect Control 2024; 52:934-940. [PMID: 38460730 DOI: 10.1016/j.ajic.2024.03.002] [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: 01/19/2024] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND To evaluate the economic loss of hospital-acquired infections (HAIs) among tumor patients so as to help policymakers to allocate health care resources and address the issue. METHODS We conducted a retrospective, 1:1 matched case-control study in a large region cancer hospital between January 1 and December 31, 2022. The economic burden was estimated as the median of the 1:1 pair differences of various hospitalization fees and hospital length of stay (LOS). RESULTS In this study of 329 matched pairs, the patients with HAIs incurred higher hospitalization cost (ie, $16,927) and experienced longer hospital LOS (ie, 22 days), compared to the non-HAI groups. The extra hospitalization cost and the prolonged hospital LOS caused by HAIs were $4,919 and 9 days, respectively. Accordingly, the direct nonmedical economic loss attributable to HAI was approximately $478 to 835 per case. Furthermore, the increment of hospitalization costs varied by sites of infection, types of tumors, and stratum of age. CONCLUSIONS HAIs lead to the increment of direct economic burden and hospital LOS in tumor patients. Our findings highlight the importance of implementing effective infection control measures in hospitals to reduce the financial burden on tumor patients.
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Affiliation(s)
- Lihua Huang
- Administration Department of Nosocomial Infection, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Huacheng Ning
- Department of Medical Records and Statistics, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Xin-Chen Liu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yongjie Wang
- Department of Medical Records and Statistics, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Chuangzhong Deng
- Deparment of Musculoskeletal Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.
| | - Huan Li
- Administration Department of Nosocomial Infection, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
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Tang M, Zhao Y, Xiao J, Jiang S, Tan J, Xu Q, Pan C, Wang J. Development and validation of a predictive model for prolonged length of stay in elderly type 2 diabetes mellitus patients combined with cerebral infarction. Front Neurol 2024; 15:1405096. [PMID: 39148703 PMCID: PMC11325865 DOI: 10.3389/fneur.2024.1405096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/12/2024] [Indexed: 08/17/2024] Open
Abstract
Background This study aimed to identify the predictive factors for prolonged length of stay (LOS) in elderly type 2 diabetes mellitus (T2DM) patients suffering from cerebral infarction (CI) and construct a predictive model to effectively utilize hospital resources. Methods Clinical data were retrospectively collected from T2DM patients suffering from CI aged ≥65 years who were admitted to five tertiary hospitals in Southwest China. The least absolute shrinkage and selection operator (LASSO) regression model and multivariable logistic regression analysis were conducted to identify the independent predictors of prolonged LOS. A nomogram was constructed to visualize the model. The discrimination, calibration, and clinical practicality of the model were evaluated according to the area under the receiver operating characteristic curve (AUROC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC). Results A total of 13,361 patients were included, comprising 6,023, 2,582, and 4,756 patients in the training, internal validation, and external validation sets, respectively. The results revealed that the ACCI score, OP, PI, analgesics use, antibiotics use, psychotropic drug use, insurance type, and ALB were independent predictors for prolonged LOS. The eight-predictor LASSO logistic regression displayed high prediction ability, with an AUROC of 0.725 (95% confidence interval [CI]: 0.710-0.739), a sensitivity of 0.662 (95% CI: 0.639-0.686), and a specificity of 0.675 (95% CI: 0.661-0.689). The calibration curve (bootstraps = 1,000) showed good calibration. In addition, the DCA and CIC also indicated good clinical practicality. An operation interface on a web page (https://xxmyyz.shinyapps.io/prolonged_los1/) was also established to facilitate clinical use. Conclusion The developed model can predict the risk of prolonged LOS in elderly T2DM patients diagnosed with CI, enabling clinicians to optimize bed management.
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Affiliation(s)
- Mingshan Tang
- Department of Neurology, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Zhao
- Department of Neurology, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Xiao
- Department of Neurology, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Side Jiang
- Department of Neurology, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Juntao Tan
- Operation Management Office, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Xu
- Library, Chongqing Medical University, Chongqing, China
| | - Chengde Pan
- Department of Neurology, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Wang
- Department of Neurology, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
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Zhang M, Wu S, Ibrahim MI, Noor SSM, Mohammad WMZW. Significance of Ongoing Training and Professional Development in Optimizing Healthcare-associated Infection Prevention and Control. JOURNAL OF MEDICAL SIGNALS & SENSORS 2024; 14:13. [PMID: 39100741 PMCID: PMC11296567 DOI: 10.4103/jmss.jmss_37_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 08/06/2024]
Abstract
The employees who work in infection prevention and control (IPC) are very important in the field of health-care because they are committed to protecting patients, staff, and visitors from the risk of acquiring infections while in the hospital. The complexity of infection control in hospitals is alwaysgrowing in tandem with the rapid developments that are being made in medical technology andpractices. IPC personnel are required to maintain vigilance and continually improve their monitoringof the entire health-care process due to the ongoing development of IPC guidelines and regulations, the fluctuating infection risks, and the emergence of new infectious diseases. As a result, individuals involved in the prevention and control of infections in health-care settings absolutely need to participate in continual training and professional development. This reviewemphasizes the need of relevant professionals to engage in ongoing training and professional development to maintain their skills in the area of healthcare-associated infection control and prevention. Personnel working in IPC may more effectively react to newly discovered health risks andmake certain that hospital infection (HI) management gets the appropriate attention if they have atimely and in-depth awareness of best practices. They are better able to maintain their composure, react correctly, and deliver the most effective infection control and prevention techniques for the health-care system, all while increasing awareness about the significance of effective HI management.
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Affiliation(s)
- Maojie Zhang
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Department of Infection Management, The First Affiliated Hospital of Guizhou Traditional Chinese Medicine University, Guiyang, China
| | - Shengwei Wu
- Department of Infection Management, The First Affiliated Hospital of Guizhou Traditional Chinese Medicine University, Guiyang, China
| | - Mohd Ismail Ibrahim
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Siti Suraiya Md Noor
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Wan Mohd Zahiruddin Wan Mohammad
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Whapham CA, Walker JT. Too much ado about data: continuous remote monitoring of water temperatures, circulation and throughput can assist in the reduction of hospital-associated waterborne infections. J Hosp Infect 2024; 152:47-55. [PMID: 38960042 DOI: 10.1016/j.jhin.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND National and international guidance provides advice on maintenance and management of water systems in healthcare buildings; however, healthcare-associated waterborne infections (HAWIs) are increasing. AIM To identify parameters critical to water quality in healthcare buildings and to assess whether remote sensor monitoring can deliver safe water systems, thus reducing HAWIs. METHODS A narrative review was performed using the following search terms: (1) consistent water temperature AND waterborne pathogen control OR nosocomial infection; (2) water throughput AND waterborne pathogen control OR nosocomial infection; (3) remote monitoring of in-premises water systems AND continuous surveillance for temperature OR throughput OR flow OR use. Databases employed were PubMed, CDSR (Clinical Study Data Request) and DARE (Database of Abstracts of Reviews of Effects) from January 2013 to March 2024. FINDINGS Single ensuite-patient rooms, expansion of handwash basins, widespread glove use, alcohol gel and wipes have increased water system stagnancy resulting in amplification of waterborne pathogens and transmission risk of legionella, pseudomonas, and non-tuberculous mycobacteria. Manual monitoring does not represent temperatures across large complex water systems. This review deems that multiple-point continuous remote sensor monitoring is effective at identifying redundant and low use outlets, hydraulic imbalance and inconsistent temperature delivery across in-premises water systems. CONCLUSION As remote monitoring becomes more common there will be greater recognition of failures in temperature control, hydraulics, and balancing in water systems, and there remains much to learn as we adopt this developing technology within our hospitals.
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Affiliation(s)
- C A Whapham
- Independent Water Hygiene Consultant, Ludlow, UK.
| | - J T Walker
- Independent Microbiology Consultant, Walker on Water, Salisbury, UK
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Phillips I, Walton A, Barrie C, Mackean M. Prehabilitation Reduces Hospital Admissions for Patients With Advanced Lung Cancer. Clin Oncol (R Coll Radiol) 2024; 36:e242-e243. [PMID: 38749806 DOI: 10.1016/j.clon.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/09/2024] [Accepted: 03/12/2024] [Indexed: 06/03/2024]
Affiliation(s)
- I Phillips
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland.
| | - A Walton
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland; St Johns Hospital, Livingston, West Lothian, Scotland
| | - C Barrie
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland; St Johns Hospital, Livingston, West Lothian, Scotland
| | - M Mackean
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland
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Antonelli A, Ales ME, Chiecca G, Dalla Valle Z, De Ponti E, Cereda D, Crottogini L, Renzi C, Signorelli C, Moro M. Healthcare-associated infections and antimicrobial use in acute care hospitals: a point prevalence survey in Lombardy, Italy, in 2022. BMC Infect Dis 2024; 24:632. [PMID: 38918691 PMCID: PMC11197227 DOI: 10.1186/s12879-024-09487-7] [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: 03/05/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Healthcare-Associated Infections (HAIs) are a global public health issue, representing a significant burden of disease that leads to prolonged hospital stays, inappropriate use of antimicrobial drugs, intricately linked to the development of resistant microorganisms, and higher costs for healthcare systems. The study aimed to measure the prevalence of HAIs, the use of antimicrobials, and assess healthcare- and patient-related risk factors, to help identify key intervention points for effectively reducing the burden of HAIs. METHODS A total of 28 acute care hospitals in the Lombardy region, Northern Italy, participated in the third European Point Prevalence Survey (PPS-3) coordinated by ECDC for the surveillance of HAIs in acute care hospitals (Protocol 6.0). RESULTS HAIs were detected in 1,259 (10.1%, 95% CI 9.6-10.7%) out of 12,412 enrolled patients. 1,385 HAIs were reported (1.1 HAIs per patient on average). The most common types of HAIs were bloodstream infections (262 cases, 18.9%), urinary tract infections (237, 17.1%), SARS-CoV-2 infections (236, 17.0%), pneumonia and lower respiratory tract infections (231, 16.7%), and surgical site infections (152, 11.0%). Excluding SARS-CoV-2 infections, the overall prevalence of HAIs was 8.4% (95% CI 7.9-8.9%). HAIs were significantly more frequent in patients hospitalized in smaller hospitals and in intensive care units (ICUs), among males, advanced age, severe clinical condition and in patients using invasive medical devices. Overall, 5,225 patients (42.1%, 95% CI 41.3-43.0%) received systemic antimicrobial therapy. According to the WHO's AWaRe classification, the Access group accounted for 32.7% of total antibiotic consumption, while Watch and Reserve classes accounted for 57.0% and 5.9% respectively. From a microbiological perspective, investigations were conducted on only 64% of the HAIs, showing, however, a significant pattern of antibiotic resistance. CONCLUSIONS The PPS-3 in Lombardy, involving data collection on HAIs and antimicrobial use in acute care hospitals, highlights the crucial need for a structured framework serving both as a valuable benchmark for individual hospitals and as a foundation to effectively channel interventions to the most critical areas, prioritizing future regional health policies to reduce the burden of HAIs.
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Affiliation(s)
- Antonio Antonelli
- Università Vita Salute San Raffaele, Via Olgettina 58, Milan, 20132, Italy.
| | - Maria Elena Ales
- Università Vita Salute San Raffaele, Via Olgettina 58, Milan, 20132, Italy
| | - Greta Chiecca
- Università Vita Salute San Raffaele, Via Olgettina 58, Milan, 20132, Italy
| | - Zeno Dalla Valle
- Università Vita Salute San Raffaele, Via Olgettina 58, Milan, 20132, Italy
| | - Emanuele De Ponti
- Università Vita Salute San Raffaele, Via Olgettina 58, Milan, 20132, Italy
| | - Danilo Cereda
- Regione Lombardia Direzione Generale Welfare, Milan, Italy
| | | | - Cristina Renzi
- Università Vita Salute San Raffaele, Via Olgettina 58, Milan, 20132, Italy
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, WC1E 7HB, London, UK
| | - Carlo Signorelli
- Università Vita Salute San Raffaele, Via Olgettina 58, Milan, 20132, Italy
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Fluck D, Fry CH, Robin J, Affley B, Kakar P, Sharma P, Han TS. Impact of healthcare-associated infections within 7-days of acute stroke on health outcomes and risk of care-dependency: a multi-centre registry-based cohort study. Intern Emerg Med 2024; 19:919-929. [PMID: 38517643 PMCID: PMC11186937 DOI: 10.1007/s11739-024-03543-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/16/2024] [Indexed: 03/24/2024]
Abstract
Healthcare-associated infections (HCAIs) in patients admitted with acute conditions remain a major challenge to healthcare services. Here, we assessed the impact of HCAIs acquired within 7-days of acute stroke on indicators of care-quality outcomes and dependency. Data were prospectively collected (2014-2016) from the Sentinel Stroke National Audit Programme for 3309 patients (mean age = 76.2 yr, SD = 13.5) admitted to four UK hyperacute stroke units (HASU). Associations between variables were assessed by multivariable logistic regression (odds ratios, 95% confidence intervals), adjusted for age, sex, co-morbidities, pre-stroke disability, swallow screening, stroke type and severity. Within 7-days of admission, urinary tract infection (UTI) and pneumonia occurred in 7.6% and 11.3% of patients. Female (UTI only), older age, underlying hypertension, atrial fibrillation, previous stroke, pre-stroke disability, intracranial haemorrhage, severe stroke, and delay in swallow screening (pneumonia only) were independent risk factors of UTI and pneumonia. Compared to patients without UTI or pneumonia, those with either or both of these HCAIs were more likely to have prolonged stay (> 14-days) on HASU: 5.1 (3.8-6.8); high risk of malnutrition: 3.6 (2.9-4.5); palliative care: 4.5 (3.4-6.1); in-hospital mortality: 4.8 (3.8-6.2); disability at discharge: 7.5 (5.9-9.7); activity of daily living support: 1.6 (1.2-2.2); and discharge to care-home: 2.3 (1.6-3.3). In conclusion, HCAIs acquired within 7-days of an acute stroke led to prolonged hospitalisation, adverse health consequences and risk of care-dependency. These findings provide valuable information for timely intervention to reduce HCAIs, and minimising subsequent adverse outcomes.
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Affiliation(s)
- David Fluck
- Department of Cardiology, Ashford & St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD, UK
| | - Jonathan Robin
- Department of Acute Medicine, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Brendan Affley
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Puneet Kakar
- Department of Stroke, Epsom and St Helier University Hospitals, Epsom, KT18 7EG, UK
| | - Pankaj Sharma
- Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, W6 8RF, UK
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX, UK
| | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX, UK.
- Department of Endocrinology, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
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Phillips I, Deans M, Walton A, Vallet M, Mencnarowksi J, McMillan D, Peacock C, Hall P, O'Brien F, Stares M, Mackean M, Plant T, Grecian R, Allan L, Petrie R, Blues D, Haddad S, Barrie C. Early prehabilitation reduces admissions and time in hospital in patients with newly diagnosed lung cancer. BMJ Support Palliat Care 2024:spcare-2024-004869. [PMID: 38631891 DOI: 10.1136/spcare-2024-004869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES Lung cancer is the leading cause of cancer death in the UK. Prehabilitation aims to maximise patient fitness and minimise the negative impact of anticancer treatment. What constitutes prehabilitation before non-surgical anticancer treatment is not well established. We present data from a pilot project of Early prehabilitation In lung Cancer. METHODS All new patients with likely advanced lung cancer were offered prehabilitation at respiratory clinic, if fit for further investigation. Prehabilitation included assessment and appropriate intervention from a consultant in palliative medicine, registered dietitian and rehabilitation physiotherapist. Four objective endpoints were identified, namely admissions to hospital, time spent in the hospital, treatment rates and overall survival. Outcomes were to be compared with 178 prehab eligible historical controls diagnosed from 2019 to 2021. RESULTS From July 2021 to June 2023, 65 patients underwent prehabilitation and 72% of patients underwent all 3 interventions. 54 patients had a stage 3 or 4 lung cancer. In the prehab group, fewer patients attended Accident and Emergency (31.5 vs 37.4 attendances per 100 patients) and fewer were admitted (51.9 vs 67.9) when compared with historical controls. Those receiving prehab spent a lot less time in the hospital (129.7 vs 543.5 days per 100 patients) with shorter admissions (2.5 vs 8 days). Systemic anticancer treatment rates increased in the short term but were broadly similar overall. Median survival was higher in the prehabilitation group (0.73 vs 0.41 years, p=0.046). CONCLUSIONS Early prehabilitation appears to reduce time spent in the hospital. It may improve survival. Further work is required to understand its full effect on treatment rates.
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Affiliation(s)
- Iain Phillips
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
- Edinburgh University, Edinburgh, UK
| | - Maria Deans
- Cancer Information Team, Western General Hospital, Edinburgh, UK
| | - Abi Walton
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
- St Johns Hospital, Livingston, UK
| | | | | | | | | | | | | | | | - Melanie Mackean
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
| | | | | | - Lindsey Allan
- Department of Nutrition and Dietetics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Rebecca Petrie
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
| | - Duncan Blues
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
| | - Suraiya Haddad
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
| | - Colin Barrie
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
- St Johns Hospital, Livingston, UK
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Bear NL, Wilson A, Blackmore AM, Geelhoed E, Simpson S, Langdon K. The cost of respiratory hospitalizations in children with cerebral palsy. Dev Med Child Neurol 2024; 66:344-352. [PMID: 37491764 DOI: 10.1111/dmcn.15714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/18/2023] [Accepted: 06/14/2023] [Indexed: 07/27/2023]
Abstract
AIM To establish the burden of respiratory illness in cerebral palsy (CP) on the Western Australian health care system by quantifying the costs of respiratory hospitalizations in children with CP, compared with non-respiratory hospitalizations. METHOD A 2-year (2014-2015) retrospective study using linked hospital data (excluding emergency department visits), in a population of children with CP in Western Australia aged 18 years and under (median age at hospitalization 7 years; interquartile range 5-12 years). RESULTS In 671 individuals (57% male) there were 726 emergency hospitalizations, and 1631 elective hospitalizations. Although there were more elective hospitalizations, emergency hospitalizations were associated with longer stays in hospital, and more days in an intensive care unit, resulting in a higher total cost of emergency hospitalizations than elective hospitalizations (total costs: emergency AU$7 748 718 vs elective AU$6 738 187). 'Respiratory' was the leading cause of emergency hospitalizations, contributing to 36% of all emergency admission costs. For a group of high-cost inpatient users (top 5% of individuals with the highest total inpatient costs) the most common reason for hospitalization was 'respiratory'. Where non-respiratory admissions were complicated by an additional respiratory diagnosis, length of stay was greater. INTERPRETATION Respiratory hospitalizations in CP are a significant driver of health care costs. In the paediatric group, they are a burden for a subgroup of children with CP. WHAT THIS PAPER ADDS Respiratory illness is the most costly area for unplanned, emergency hospitalizations for children and young people with cerebral palsy. The top 5% of individuals with the highest total inpatient costs account for a disproportionate amount of health care costs.
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Affiliation(s)
- Natasha L Bear
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Andrew Wilson
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Crawley, WA, Australia
| | | | - Elizabeth Geelhoed
- School of Allied Health, The University of Western Australia, Crawley, WA, Australia
| | - Shannon Simpson
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Katherine Langdon
- Telethon Kids Institute, Nedlands, WA, Australia
- Kids' Rehab WA, Perth Children's Hospital, Nedlands, WA, Australia
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Oliveira RMC, de Sousa AHF, de Salvo MA, Petenate AJ, Gushken AKF, Ribas E, Torelly EMS, Silva KCCD, Bass LM, Tuma P, Borem P, Ue LY, de Barros CG, Vernal S. Estimating the savings of a national project to prevent healthcare-associated infections in intensive care units. J Hosp Infect 2024; 143:8-17. [PMID: 37806451 DOI: 10.1016/j.jhin.2023.10.001] [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: 06/23/2023] [Revised: 09/14/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) have a significant impact on patients' morbidity and mortality, and have a detrimental financial impact on the healthcare system. Various strategies exist to prevent HAIs, but economic evaluations are needed to determine which are most appropriate. AIM To present the financial impact of a nationwide project on HAI prevention in intensive care units (ICUs) using a quality improvement (QI) approach. METHODS A health economic evaluation assessed the financial results of the QI initiative 'Saúde em Nossas Mãos' (SNM), implemented in Brazil between January 2018 and December 2020. Among 116 participating institutions, 13 (11.2%) fully reported the aggregate cost and stratified patients (with vs without HAIs) in the pre-intervention and post-intervention periods. Average cost (AC) was calculated for each analysed HAI: central-line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTIs). The absorption model and time-driven activity-based costing were used for cost estimations. The numbers of infections that the project could have prevented during its implementation were estimated to demonstrate the financial impact of the SNM initiative. RESULTS The aggregated ACs calculated for each HAI from these 13 ICUs - US$8480 for CLABSIs, US$10,039 for VAP, and US$7464 for CAUTIs - were extrapolated to the total number of HAIs prevented by the project (1727 CLABSIs, 3797 VAP and 2150 CAUTIs). The overall savings of the SNM as of December 2020 were estimated at US$68.8 million, with an estimated return on investment (ROI) of 765%. CONCLUSION Reporting accurate financial data on HAI prevention strategies is still challenging in Brazil. These results suggest that a national QI initiative to prevent HAIs in critical care settings is a feasible and value-based approach, reducing financial waste and yielding a significant ROI for the healthcare system.
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Affiliation(s)
| | | | - M A de Salvo
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - A J Petenate
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | | | - E Ribas
- Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | | | - L M Bass
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - P Tuma
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Institute for Healthcare Improvement, Cambridge, MA, USA
| | - P Borem
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - L Y Ue
- Ministério da Saúde, Brasilia, Brazil
| | - C G de Barros
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - S Vernal
- Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil; Hcor, Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Hospital Moinhos de Vento, Porto Alegre, Brazil; Hospital Sírio-Libanês, Sao Paulo, Brazil.
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12
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Panca M, Blackstone J, Stirrup O, Cutino-Moguel MT, Thomson E, Peters C, Snell LB, Nebbia G, Holmes A, Chawla A, Machin N, Taha Y, Mahungu T, Saluja T, de Silva TI, Saeed K, Pope C, Shin GY, Williams R, Darby A, Smith DL, Loose M, Robson SC, Laing K, Partridge DG, Price JR, Breuer J. Evaluating the cost implications of integrating SARS-CoV-2 genome sequencing for infection prevention and control investigation of nosocomial transmission within hospitals. J Hosp Infect 2023; 139:23-32. [PMID: 37308063 PMCID: PMC10257337 DOI: 10.1016/j.jhin.2023.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND The COG-UK hospital-onset COVID-19 infection (HOCI) trial evaluated the impact of SARS-CoV-2 whole-genome sequencing (WGS) on acute infection, prevention, and control (IPC) investigation of nosocomial transmission within hospitals. AIM To estimate the cost implications of using the information from the sequencing reporting tool (SRT), used to determine likelihood of nosocomial infection in IPC practice. METHODS A micro-costing approach for SARS-CoV-2 WGS was conducted. Data on IPC management resource use and costs were collected from interviews with IPC teams from 14 participating sites and used to assign cost estimates for IPC activities as collected in the trial. Activities included IPC-specific actions following a suspicion of healthcare-associated infection (HAI) or outbreak, as well as changes to practice following the return of data via SRT. FINDINGS The mean per-sample costs of SARS-CoV-2 sequencing were estimated at £77.10 for rapid and £66.94 for longer turnaround phases. Over the three-month interventional phases, the total management costs of IPC-defined HAIs and outbreak events across the sites were estimated at £225,070 and £416,447, respectively. The main cost drivers were bed-days lost due to ward closures because of outbreaks, followed by outbreak meetings and bed-days lost due to cohorting contacts. Actioning SRTs, the cost of HAIs increased by £5,178 due to unidentified cases and the cost of outbreaks decreased by £11,246 as SRTs excluded hospital outbreaks. CONCLUSION Although SARS-CoV-2 WGS adds to the total IPC management cost, additional information provided could balance out the additional cost, depending on identified design improvements and effective deployment.
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Affiliation(s)
- M Panca
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.
| | - J Blackstone
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - O Stirrup
- Institute for Global Health, UCL, London, UK
| | | | - E Thomson
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - C Peters
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - L B Snell
- Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - G Nebbia
- Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - A Holmes
- Imperial College Healthcare NHS Trust, London, UK
| | - A Chawla
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - N Machin
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Y Taha
- Departments of Virology and Infectious Diseases, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - T Mahungu
- Royal Free NHS Foundation Trust, London, UK
| | - T Saluja
- Sandwell and West Birmingham NHS Trust, UK
| | - T I de Silva
- Department of Infection, Immunity and Cardiovascular Disease, Medical School, The University of Sheffield, Sheffield, UK
| | - K Saeed
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Pope
- St George's University Hospitals NHS Foundation Trust, London, UK; Institute for Infection and Immunity, St George's University of London, London, UK
| | - G Y Shin
- University College London Hospitals NHS Foundation Trust, London, UK
| | - R Williams
- Department of Genetics & Genomic Medicine, UCL Great Ormond Street Institute of Child Health, UCL, London, UK
| | - A Darby
- Centre for Genomic Research, University of Liverpool, Liverpool, UK
| | - D L Smith
- Department of Applied Sciences, Northumbria University, Newcastle, UK
| | - M Loose
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - S C Robson
- Centre for Enzyme Innovation & School of Pharmacy and Biomedical Science, University of Portsmouth, Portsmouth, UK
| | - K Laing
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - D G Partridge
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J R Price
- Imperial College Healthcare NHS Trust, London, UK
| | - J Breuer
- Department of Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, UCL, London, UK
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13
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Fox JM, Saunders NJ, Jerwood SH. Economic and health impact modelling of a whole genome sequencing-led intervention strategy for bacterial healthcare-associated infections for England and for the USA. Microb Genom 2023; 9:mgen001087. [PMID: 37555752 PMCID: PMC10483413 DOI: 10.1099/mgen.0.001087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023] Open
Abstract
Bacterial healthcare-associated infections (HAIs) are a substantial source of global morbidity and mortality. The estimated cost associated with HAIs ranges from $35 to $45 billion in the USA alone. The costs and accessibility of whole genome sequencing (WGS) of bacteria and the lack of sufficiently accurate, high-resolution, scalable and accessible analysis for strain identification are being addressed. Thus, it is timely to determine the economic viability and impact of routine diagnostic bacterial genomics. The aim of this study was to model the economic impact of a WGS surveillance system that proactively detects and directs interventions for nosocomial infections and outbreaks compared to the current standard of care, without WGS. Using a synthesis of published models, inputs from national statistics, and peer-reviewed articles, the economic impacts of conducting a WGS-led surveillance system addressing the 11 most common nosocomial pathogen groups in England and the USA were modelled. This was followed by a series of sensitivity analyses. England was used to establish the baseline model because of the greater availability of underpinning data, and this was then modified using USA-specific parameters where available. The model for the NHS in England shows bacterial HAIs currently cost the NHS around £3 billion. WGS-based surveillance delivery is predicted to cost £61.1 million associated with the prevention of 74 408 HAIs and 1257 deaths. The net cost saving was £478.3 million, of which £65.8 million were from directly incurred savings (antibiotics, consumables, etc.) and £412.5 million from opportunity cost savings due to re-allocation of hospital beds and healthcare professionals. The USA model indicates that the bacterial HAI care baseline costs are around $18.3 billion. WGS surveillance costs $169.2 million, and resulted in a net saving of ca.$3.2 billion, while preventing 169 260 HAIs and 4862 deaths. From a 'return on investment' perspective, the model predicts a return to the hospitals of £7.83 per £1 invested in diagnostic WGS in the UK, and US$18.74 per $1 in the USA. Sensitivity analyses show that substantial savings are retained when inputs to the model are varied within a wide range of upper and lower limits. Modelling a proactive WGS system addressing HAI pathogens shows significant improvement in morbidity and mortality while simultaneously achieving substantial savings to healthcare facilities that more than offset the cost of implementing diagnostic genomics surveillance.
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Blatnik P, Bojnec Š. Analysis of impact of nosocomial infections on cost of patient hospitalisation. Cent Eur J Public Health 2023; 31:90-96. [PMID: 37451240 DOI: 10.21101/cejph.a7631] [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: 10/10/2022] [Accepted: 04/22/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES The scale of the economic problem of the occurrence of nosocomial infections and the resulting high additional costs of treatment can only be assessed using economic analyses. The aim of the study was to analyse the impact of a nosocomial infection in a patient in the treatment process and the direct costs of patient hospitalisation. The article contributes to a cost analysis, which is a relevant basis for adopting effective solutions and decisions on the introduction of new programmes and measures to reduce nosocomial infections and associated costs. METHODS In the first phase of the micro-economic analysis, we analysed the course of hospitalisation of a non-colonised patient treated in an ordinary hospital room. In the second phase, we analysed the process of hospitalisation of a patient who developed a nosocomial infection and was transferred to an isolation room. The difference in cost of both types of treatment allowed us to carry out an economic analysis to estimate the direct costs of nosocomial infection, which are not related to the initial diagnosis of the patient but only to the patient hospitalisation. To calculate the individual types of direct costs of both alternative treatments, we first used the process flow diagram method, which then enabled us to analyse the impact of the occurrence of nosocomial infection on the efficiency and costs of the hospital. RESULTS The results showed that the total direct cost of hospitalisation of a non-colonised patient was 1,317.58 euro per day, and the direct cost of hospitalisation of a patient with a nosocomial infection was 2,268.14 euro per day of hospitalisation. CONCLUSIONS We found that reducing nosocomial infections would have a significant impact on the savings or reduction in healthcare costs associated with a different work process for patients in isolation. It would save 950.56 euro per patient for each day of hospitalisation for individual treatment of a patient hospitalised in an isolation room as consequence of a nosocomial infection.
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Affiliation(s)
- Patricia Blatnik
- Department of Economics, Faculty of Management, University of Primorska, Koper, Slovenia
| | - Štefan Bojnec
- Department of Economics, Faculty of Management, University of Primorska, Koper, Slovenia
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15
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Despotović A, Milić N, Cirković A, Milošević B, Jovanović S, Mioljević V, Obradović V, Kovačević G, Stevanović G. Incremental costs of hospital-acquired infections in COVID-19 patients in an adult intensive care unit of a tertiary hospital from a low-resource setting. Antimicrob Resist Infect Control 2023; 12:39. [PMID: 37085906 PMCID: PMC10120483 DOI: 10.1186/s13756-023-01240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 04/07/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Hospital-acquired infections (HAIs) are a global public health problem and put patients at risk of complications, including death. HAIs increase treatment costs, but their financial impact on Serbia's healthcare system is unknown. Our goal was to assess incremental costs of HAIs in a tertiary care adult intensive care unit (ICU) that managed COVID-19 patients. METHODS A retrospective study from March 6th to December 31st, 2020 included patients with microbiologically confirmed COVID-19 (positive rapid antigen test or real-time polymerase chain reaction) treated in the ICU of the Teaching Hospital for Infectious and Tropical Diseases, University Clinical Centre of Serbia. Demographic and HAI-specific data acquired in our ICU were collected, including total and stratified medical costs (services, materials, laboratory testing, medicines, occupancy costs). Median total and stratified costs were compared in relation to HAI acquisition. Linear regression modelling was used to assess incremental costs of HAIs, adjusted for age, biological sex, prior hospitalisation, Charlson Comorbidity Index (CCI), and Glasgow Coma Scale (GCS) on admission. Outcome variables were length of stay (LOS) in days and mortality. RESULTS During the study period, 299 patients were treated for COVID-19, of which 214 were included. HAIs were diagnosed in 56 (26.2%) patients. Acinetobacter spp. was the main pathogen in respiratory (38, 45.8%) and bloodstream infections (35, 42.2%), the two main HAI types. Median total costs were significantly greater in patients with HAIs (€1650.4 vs. €4203.2, p < 0.001). Longer LOS (10.0 vs. 18.5 days, p < 0.001) and higher ICU mortality (51.3% vs. 89.3%, p < 0.001) were seen if HAIs were acquired. Patients with ≥ 2 HAIs had the highest median total costs compared to those without HAIs or with a single HAI (€1650.4 vs. €3343.4 vs. €7336.9, p < 0.001). Incremental costs in patients with 1 and ≥ 2 HAIs were €1837.8 (95% CI 1257.8-2417.7, p < 0.001) and €5142.5 (95% CI 4262.3-6022.7, p < 0.001), respectively. CONCLUSIONS This is the first economic evaluation of HAIs in Serbia, showing significant additional costs to our healthcare system. HAIs prolong LOS and influence ICU mortality rates. Larger economic assessments are needed to enhance infection control practices.
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Affiliation(s)
- Aleksa Despotović
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Nataša Milić
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Anđa Cirković
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branko Milošević
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Teaching Hospital for Infectious and Tropical Diseases, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Snežana Jovanović
- Department of Microbiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Vesna Mioljević
- Department of Hospital Epidemiology and Nutrition Hygiene, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Vesna Obradović
- Teaching Hospital for Infectious and Tropical Diseases, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Gordana Kovačević
- Teaching Hospital for Infectious and Tropical Diseases, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Goran Stevanović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Teaching Hospital for Infectious and Tropical Diseases, University Clinical Centre of Serbia, Belgrade, Serbia
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16
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Wang L, Zhang D, Liu J, Tang Y, Zhou Q, Lai X, Zheng F, Wang Q, Zhang X, Cheng J. The mediating role of incentives in association between leadership attention and self-perceived continuous improvement in infection prevention and control among medical staff: A cross-sectional survey. Front Public Health 2023; 11:984847. [PMID: 36844830 PMCID: PMC9947710 DOI: 10.3389/fpubh.2023.984847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
Objectives Promoting improvement in Infection Prevention and Control (IPC) is an important part of improving the quality of care. The influence of leadership attention and incentives on the self-perceived continuous improvement in IPC has drawn a lot of attention, but relevant academic research is still lacking. The objective of this study is to explore the effect of leadership attention on self-perceived continuous improvement in IPC among medical staff and its underlying mechanisms. Method The 3,512 medical staff from 239 health facilities in Hubei, China, were surveyed online during September 2020. Data on leadership attention, incentives, and improvement in Infection Prevention and Control were collected using self-administered questionnaires. Correlation analysis was used to analyze the relationship between leadership attention, incentives, and improvement in Infection Prevention and Control. Amos 24.0 was used to analyze the mediating role. Results The scores of leadership attention, incentives and self-perceived continuous improvement in Infection Prevention and Control were all high. The score of leadership attention was the highest (4.67 ± 0.59), followed by self-perceived continuous improvement (4.62 ± 0.59) and incentives in Infection Prevention and Control (4.12 ± 0.83). Leadership attention positively affected self-perceived continuous improvement in Infection Prevention and Control (β = 0.85, 95% CI = [0.83, 0.87]). Moreover, incentives partially mediated the effect of leadership attention on self-perceived continuous improvement in Infection Prevention and Control among medical staff (β = 0.13, 95% CI = [0.12, 0.15]). Conclusion Leadership attention positively affects self-perceived continuous improvement in Infection Prevention and Control among medical staff, and incentives mediates this relationship. The present study has valuable implications for self-perceived continuous improvement in Infection Prevention and Control from the perspective of leadership attention and incentives.
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Affiliation(s)
- Lu Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dandan Zhang
- The First Affiliated Hospital, Nanjing Medical University, Human Resource Office, Nanjing, China
| | - Junjie Liu
- School of Statistics and Mathematics, Central University of Finance and Economics, Beijing, China
| | - Yuqing Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Zhou
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoquan Lai
- Department of Nosocomial Infection, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feiyang Zheng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qianning Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Xinping Zhang ✉
| | - Jing Cheng
- Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Jing Cheng ✉
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Tackling the issue of healthcare associated infections through point-of-care devices. Trends Analyt Chem 2023. [DOI: 10.1016/j.trac.2023.116983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Mendez-Sotelo BJ, López-Jácome LE, Colín-Castro CA, Hernández-Durán M, Martínez-Zavaleta MG, Rivera-Buendía F, Velázquez-Acosta C, Rodríguez-Zulueta AP, Morfín-Otero MDR, Franco-Cendejas R. Comparison of Lateral Flow Immunochromatography and Phenotypic Assays to PCR for the Detection of Carbapenemase-Producing Gram-Negative Bacteria, a Multicenter Experience in Mexico. Antibiotics (Basel) 2023; 12:antibiotics12010096. [PMID: 36671297 PMCID: PMC9855030 DOI: 10.3390/antibiotics12010096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/07/2023] Open
Abstract
The identification of carbapenemase-producing Enterobacterales and Pseudomonas aeruginosa is important for treating and controlling hospital infections. The recommended methods for their identification require a long waiting time, technical training, and expertise. Lateral flow immunoassays such as NG-Test CARBA 5® overcome these needs. We analyzed 84 clinical isolates of carbapenem-resistant Enterobacterales and P. aeruginosa from four different hospitals in a two-year period. Antimicrobial resistance patterns were confirmed with the broth dilution method. Evaluation of KPC, VIM, NDM, IMP, and OXA-48-like enzymes was performed and compared to NG-Test CARBA 5 and phenotypic assays. Enterobacterales represented 69% of isolates and P. aeruginosa represented 31%. Carbapenemase-producing strains were 51 (88%) of Enterobacterales and 23 (88.4%) of P. aeruginosa; 20 (34%) and 23 (88%) were Class B ß-lactamases, respectively. The NG-Test CARBA 5® assay for Enterobacterales showed high sensitivity (98%), specificity (100%), and PPV (100%); however, it did not for P. aeruginosa. The Kappa concordance coefficient was 0.92 for Enterobacterales and 0.52 for P. aeruginosa. NG-Test CARBA 5® is a fast and easy-to-use assay. In Enterobacterales, we found excellent agreement in our comparison with molecular tests. Despite the low agreement in P. aeruginosa, we suggest that this test could be used as a complementary tool.
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Affiliation(s)
- Braulio Josue Mendez-Sotelo
- División de Infectología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City 14389, Mexico
| | - Luis Esaú López-Jácome
- División de Infectología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City 14389, Mexico
- Correspondence: (L.E.L.-J.); (R.F.-C.)
| | - Claudia A. Colín-Castro
- División de Infectología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City 14389, Mexico
| | - Melissa Hernández-Durán
- División de Infectología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City 14389, Mexico
| | | | - Frida Rivera-Buendía
- Oficina de Apoyo Sistemático para la Investigación Superior, Subdirección de Investigación Clínica, Instituto Nacional de Cardiología, Mexico City 14080, Mexico
| | | | | | - Maria del Rayo Morfín-Otero
- Infectología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Universidad de Guadalajara, Guadalajara 44280, Mexico
| | - Rafael Franco-Cendejas
- Biomedical Research Subdirection, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México 14389, Mexico
- Correspondence: (L.E.L.-J.); (R.F.-C.)
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Prevalence of healthcare-associated infections in public hospitals in New Zealand, 2021. J Hosp Infect 2023; 131:164-172. [PMID: 36270518 DOI: 10.1016/j.jhin.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are no contemporary data on healthcare-associated infections (HAIs) in New Zealand. AIMS To determine the epidemiology of HAIs, prevalence of medical devices, and microbiology of HAIs in adults in public hospitals in New Zealand. METHODS Point prevalence survey. Surveyors reviewed patients aged ≥18 years using the HAI definitions of the European Centres for Disease Prevention and Control. Device use and microbiology of HAIs were recorded. FINDINGS In total, 5468 patients were surveyed; 361 patients (6.6%) had 423 HAIs (7.7 HAIs per 100 patients). The most common HAIs were: surgical site infections (N=104, 25%), urinary tract infections (N=80, 19%), pneumonia (N=75, 18%) and bloodstream infections (N=55, 13%). Overall, 3585 patients (66%) had at least one device, with 2922 (53%) patients having a peripheral intravenous catheter. Sixty-nine (16%) HAIs were device-associated. On multi-variable analysis, independent risk factors for HAIs included the presence of a peripheral [odds ratio (OR) 2.0] or central (OR 5.7) intravenous catheter and clinical service. HAI rates were higher in surgical patients (OR 1.8), intensive care unit patients (OR 2.6) and rehabilitation/older persons' health patients (OR 2.4) compared with general medicine patients (P≤0.01 for all groups). In total, 301 organisms were identified. Clostridioides difficile infection was uncommon, accounting for 1.7% of all HAIs. Forty-two isolates (14%) were drug-resistant, and most (N=33, 79%) were Enterobacterales. CONCLUSION This study established the most common HAIs and their risk factors in New Zealand. The high prevalence of device use underscores the need to ensure that proven multi-modal prevention interventions are in place. However, as less than half of HAIs are device- or surgery-associated, other intervention strategies will be required to reduce their burden.
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Wang S, Yao R, Li Z, Gong X, Xu J, Yang F, Yang K. Vancomycin Use in Posterior Lumbar Interbody Fusion of Deep Surgical Site Infection. Infect Drug Resist 2022; 15:3103-3109. [PMID: 35747329 PMCID: PMC9212791 DOI: 10.2147/idr.s364432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/27/2022] [Indexed: 12/12/2022] Open
Abstract
Objective To retrospectively analyze if the use of topical intraoperative vancomycin powder reduces deep surgical site infection (DSSI) after posterior lumbar interbody fusion. Methods All spinal surgeries for lumbar degenerative disease and underwent posterior fixation interbody fusion between January 2013 and December 2018 were reviewed. A total of 891 patients were included, of which 527 patients (treatment group) received intraoperatively topical vancomycin powder; the others were served as control group. The primary outcomes were the overall incidence of DSSI and the effect of vancomycin on its development. The secondary outcome was risk factors for DSSI. Data on the baseline characteristics, postoperative complications, perioperative risk factors, and one-year postoperative prognoses were extracted from the medical records. Results A total of 20 patients met the diagnostic criteria for DSSI (2.24%), of which 7 patients (1.33%) in the treatment group and 13 patients (3.57%) in the control group. There was a significant difference in the incidence of DSSI between the groups (P = 0.026). Multivariate logistic regression analysis with stepwise backward elimination showed that the local use of vancomycin powder was an independent protective factor for DSSI (odds ratio (OR): 0.25, P = 0.01), whereas high body mass index (BMI) (OR: 1.21, P = 0.005), drinking (OR: 5.19, P = 0.005), urinary tract infections (OR: 4.49, P = 0.021), diabetes mellitus (OR: 4.32, P = 0.03), and blood transfusions (OR: 3.67, P = 0.03) were independent risk factors for DSSI. Conclusion The intraoperative usage of vancomycin powder could reduce effectively decreases the incidence of DSSI after posterior lumbar interbody fusion for degenerative lumbar diseases. High BMI, diabetes mellitus, drinking, and urinary tract infections were independent risk factors for DSSI, whereas the local use of vancomycin protected against these factors.
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Affiliation(s)
- Shiyong Wang
- Department of Spinal Surgery, First Affiliated Hospital of Dali University, Dali, Yunnan, People's Republic of China
| | - Rubin Yao
- Department of Spinal Surgery, First Affiliated Hospital of Dali University, Dali, Yunnan, People's Republic of China
| | - Zhongjie Li
- Department of Spinal Surgery, First Affiliated Hospital of Dali University, Dali, Yunnan, People's Republic of China
| | - Xiangdong Gong
- Department of Spinal Surgery, First Affiliated Hospital of Dali University, Dali, Yunnan, People's Republic of China
| | - Jitao Xu
- Department of Spinal Surgery, First Affiliated Hospital of Dali University, Dali, Yunnan, People's Republic of China
| | - Fajun Yang
- Department of Spinal Surgery, First Affiliated Hospital of Dali University, Dali, Yunnan, People's Republic of China
| | - Kaishun Yang
- Department of Spinal Surgery, First Affiliated Hospital of Dali University, Dali, Yunnan, People's Republic of China
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21
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An Overview of Healthcare Associated Infections and Their Detection Methods Caused by Pathogen Bacteria in Romania and Europe. J Clin Med 2022; 11:jcm11113204. [PMID: 35683591 PMCID: PMC9181229 DOI: 10.3390/jcm11113204] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/25/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
Healthcare-associated infections can occur in different care units and can affect both patients and healthcare professionals. Bacteria represent the most common cause of nosocomial infections and, due to the excessive and irrational use of antibiotics, resistant organisms have appeared. The most important healthcare-associated infections are central line-associated bloodstream infections, catheter-associated urinary tract infections, surgical site, soft tissue infections, ventilator-associated pneumonia, hospital acquired pneumonia, and Clostridioides difficile colitis. In Europe, some hospitalized patients develop nosocomial infections that lead to increased costs and prolonged hospitalizations. Healthcare-associated infection prevalence in developed countries is lower than in low-income and middle-income countries such as Romania, an Eastern European country, where several factors contribute to the occurrence of many nosocomial infections, but official data show a low reporting rate. For the rapid identification of bacteria that can cause these infections, fast, sensitive, and specific methods are needed, and they should be cost-effective. Therefore, this review focuses on the current situation regarding healthcare-associated infections in Europe and Romania, with discussions regarding the causes and possible solutions. As a possible weapon in the fight against the healthcare-associated infections, the diagnosis methods and tests used to determine the bacteria involved in healthcare-associated infections are evaluated.
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22
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Estimating excess length of stay due to healthcare-associated infections by applying and comparing three time-varying approaches: multistate model, survival regression and matched case control methods. J Hosp Infect 2022; 126:44-51. [DOI: 10.1016/j.jhin.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/24/2022] [Accepted: 04/03/2022] [Indexed: 11/21/2022]
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23
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Barbon HCV, Fermin JL, Kee SL, Tan MJT, AlDahoul N, Karim HA. Going Electronic: Venturing Into Electronic Monitoring Systems to Increase Hand Hygiene Compliance in Philippine Healthcare. Front Pharmacol 2022; 13:843683. [PMID: 35250592 PMCID: PMC8892004 DOI: 10.3389/fphar.2022.843683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/01/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Jamie Ledesma Fermin
- Department of Electronics Engineering, University of St. La Salle, Bacolod, Philippines
| | - Shaira Limson Kee
- Department of Natural Sciences, University of St. La Salle, Bacolod, Philippines
| | - Myles Joshua Toledo Tan
- Department of Natural Sciences, University of St. La Salle, Bacolod, Philippines
- Department of Chemical Engineering, University of St. La Salle, Bacolod, Philippines
- *Correspondence: Myles Joshua Toledo Tan, ; Hezerul Abdul Karim,
| | - Nouar AlDahoul
- Faculty of Engineering, Multimedia University, Cyberjaya, Malaysia
| | - Hezerul Abdul Karim
- Faculty of Engineering, Multimedia University, Cyberjaya, Malaysia
- *Correspondence: Myles Joshua Toledo Tan, ; Hezerul Abdul Karim,
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24
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Verberk JDM, Aghdassi SJS, Abbas M, Nauclér P, Gubbels S, Maldonado N, Palacios-Baena ZR, Johansson AF, Gastmeier P, Behnke M, van Rooden SM, van Mourik MSM. Automated surveillance systems for healthcare-associated infections: results from a European survey and experiences from real-life utilization. J Hosp Infect 2022; 122:35-43. [PMID: 35031393 DOI: 10.1016/j.jhin.2021.12.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/04/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND As most automated surveillance (AS) methods to detect healthcare-associated infections (HAIs) have been developed and implemented in research settings, information about the feasibility of large-scale implementation is scarce. AIM We aimed to describe key aspects of the design of AS systems and implementation in European institutions and hospitals. METHODS An online survey was distributed via email in February/March 2019 among 1) PRAISE (Providing a Roadmap for Automated Infection Surveillance in Europe) network members; 2) corresponding authors of peer-reviewed European publications on existing AS systems; and 3) the mailing list of national infection prevention and control focal points of the European Centre for Disease Prevention and Control. Three AS systems from the survey were selected, based on quintessential features, for in-depth review focusing on implementation in practice. FINDINGS Through the survey and the review of three selected AS systems, notable differences regarding the methods, algorithms, data sources and targeted HAIs were identified. The majority of AS systems used a classification algorithm for semi-automated surveillance and targeted HAIs were mostly surgical site infections, urinary tract infections, sepsis or other bloodstream infections. AS systems yielded a reduction of workload for hospital staff. Principal barriers of implementation were strict data security regulations as well as creating and maintaining an information technology infrastructure. CONCLUSION AS in Europe is characterized by heterogeneity in methods and surveillance targets. To allow for comparisons and encourage homogenization, future publications on AS systems should provide detailed information on source data, methods and the state of implementation.
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Affiliation(s)
- Janneke D M Verberk
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Utrecht, Utrecht, the Netherlands; Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Epidemiology and Surveillance, Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
| | - Seven J S Aghdassi
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Digital Clinician Scientist Program, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
| | - Mohamed Abbas
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Pontus Nauclér
- Department of Medicine Solna, Division of Infectious Disease, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Sophie Gubbels
- Department of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Natalia Maldonado
- Unit of Infectious Diseases, Clinical Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena, Institute of Biomedicine of Seville (IBIS), Sevilla, Spain
| | - Zaira R Palacios-Baena
- Unit of Infectious Diseases, Clinical Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena, Institute of Biomedicine of Seville (IBIS), Sevilla, Spain
| | - Anders F Johansson
- Department of Clinical microbiology and the Laboratory for Molecular Infection Medicine (MIMS), Umeå University, Umeå, Sweden
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Behnke
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephanie M van Rooden
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Epidemiology and Surveillance, Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Maaike S M van Mourik
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Utrecht, Utrecht, the Netherlands
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25
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Cai Y, Hoo GSR, Lee W, Tan BH, Yoong J, Teo YY, Graves N, Lye D, Kwa AL. Estimating the economic cost of carbapenem resistant Enterobacterales healthcare associated infections in Singapore acute-care hospitals. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001311. [PMID: 36962882 PMCID: PMC10021918 DOI: 10.1371/journal.pgph.0001311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/30/2022] [Indexed: 12/12/2022]
Abstract
Quantifying the costs of hospital associated infections (HAIs) caused by carbapenem-resistant Enterobacterales (CRE) can aid hospital decision makers in infection prevention and control decisions. We estimate the costs of a CRE HAI by infection type and the annual costs of CRE HAIs to acute-care hospitals in Singapore. We used tree diagrams to estimate the costs (in Singapore dollar) of different CRE HAI types from the health service perspective and compared them to the costs of carbapenem-susceptible HAIs. We used two approaches to estimate costs-direct costs of consumables for infection prevention and treatment; and costs associated with lost bed days. Cost of a HAI were extrapolated to annual CRE HAI incidence in Singapore acute-care hospitals to estimate the annual cost to the hospitals. We found that the cost of a CRE HAI based on direct cost and lost bed days are SGD$9,913 (95% CI, SGD$9,431-10,395) and SGD$10,044 (95% CI, SGD$9,789-10,300) respectively. CRE HAIs are markedly higher than the carbapenem-susceptible HAIs for all infection types. In both approaches, CRE pneumonia was the costliest infection. Based on a CRE HAI incidence of 233 per 100,000 inpatient admissions, CRE HAIs costed SGD$12.16M (95% CI, SGD$11.84-12.48M) annually based on direct costs, and SGD$12.33M (95% CI, SGD$12.01-12.64M) annually based on lost bed days. In conclusion, we described the cost of CRE HAIs in Singapore hospitals and identified infections with the highest costs. The findings may be useful in informing future economic evaluations of competing CRE HAI prevention and treatment programmes.
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Affiliation(s)
- Yiying Cai
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Grace S R Hoo
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Winnie Lee
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Joanne Yoong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Research for Impact, Singapore, Singapore
| | - Yik-Ying Teo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Nicholas Graves
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - David Lye
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Infectious Diseases, National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Andrea L Kwa
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
- Singhealth Duke-NUS Medicine Academic Clinical Programme, Singapore, Singapore
- Emerging Infectious Diseases, Duke-National University of Singapore, Singapore, Singapore
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26
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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: 48] [Impact Index Per Article: 16.0] [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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27
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Evaluating the post-discharge cost of healthcare-associated infection in NHS Scotland. J Hosp Infect 2021; 114:51-58. [PMID: 34301396 DOI: 10.1016/j.jhin.2020.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Whereas the cost burden of healthcare-associated infection (HAI) extends beyond the inpatient stay into the post-discharge period, few studies have focused on post-discharge costs. AIM To investigate the impact of all types of HAI on the magnitude and distribution of post-discharge costs observed in acute and community services for patients who developed HAI during their inpatient stay. METHODS Using data from the Evaluation of Cost of Nosocomial Infection (ECONI) study and regression methods, this study identifies the marginal effect of HAI on the 90-daypost-discharge resource use and costs. To calculate monetary values, unit costs were applied to estimates of excess resource use per case of HAI. FINDINGS Post-discharge costs increase inpatient HAI costs by 36%, with an annual national cost of £10,832,437. The total extra cost per patient with HAI was £1,457 (95% confidence interval: 1,004-4,244) in the 90 days post discharge. Patients with HAI had longer LOS if they were readmitted and were prescribed more antibiotics in the community. The results suggest that HAI did not have an impact on the number of readmissions or repeat surgeries within 90 days of discharge. The majority (95%) of the excess costs was on acute care services after readmission. Bloodstream infection, gastrointestinal infection, and pneumonia had the biggest impact on post-discharge cost. CONCLUSION HAI increases costs and antibiotic consumption in the post-discharge period. Economic evaluations of IPC studies should incorporate post-discharge costs. These findings can be used nationally and internationally to support decision-making on the impact of IPC interventions.
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28
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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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