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Mitchell BG, McDonagh J, Dancer SJ, Ford S, Sim J, Thottiyil Sultanmuhammed Abdul Khadar B, Russo PL, Maillard JY, Rawson H, Browne K, Kiernan M. Risk of organism acquisition from prior room occupants: An updated systematic review. Infect Dis Health 2023; 28:290-297. [PMID: 37385863 DOI: 10.1016/j.idh.2023.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Evidence from a previous systematic review indicates that patients admitted to a room where the previous occupant had a multidrug-resistant bacterial infection resulted in an increased risk of subsequent colonisation and infection with the same organism for the next room occupant. In this paper, we have sought to expand and update this review. METHODS A systematic review and meta-analysis was undertaken. A search using Medline/PubMed, Cochrane and CINHAL databases was conducted. Risk of bias was assessed by the ROB-2 tool for randomised control studies and ROBIN-I for non-randomised studies. RESULTS From 5175 identified, 12 papers from 11 studies were included in the review for analysis. From 28,299 patients who were admitted into a room where the prior room occupant had any of the organisms of interest, 651 (2.3%) were shown to acquire the same species of organism. In contrast, 981,865 patients were admitted to a room where the prior occupant did not have an organism of interest, 3818 (0.39%) acquired an organism(s). The pooled acquisition odds ratio (OR) for all the organisms across all studies was 2.45 (95% CI: 1.53-3.93]. There was heterogeneity between the studies (I2 89%, P < 0.001). CONCLUSION The pooled OR for all the pathogens in this latest review has increased since the original review. Findings from our review provide some evidence to help inform a risk management approach when determining patient room allocation. The risk of pathogen acquisition appears to remain high, supporting the need for continued investment in this area.
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Affiliation(s)
- Brett G Mitchell
- Central Coast Local Health District, Gosford Hospital, NSW, Australia; School of Nursing, Avondale University, Lake Macquarie, NSW, Australia; Nursing and Midwifery, Monash University, Victoria, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia. https://twitter.com/1healthau
| | - Julee McDonagh
- Centre for Chronic and Complex Care, Blacktown Hospital, Western Sydney Local Health District, NSW, Australia; School of Nursing, Faculty of Science, Medicine and Health, The University of Wollongong, NSW, Australia. https://twitter.com/JuleeMcDonagh
| | - Stephanie J Dancer
- Department of Microbiology, Hairmyres Hospital, Glasgow, and Edinburgh Napier University, Glasgow, UK
| | - Sindi Ford
- Central Coast Local Health District, Gosford, NSW, Australia; School of Health Science, University of Newcastle, Ourimbah, NSW, Australia
| | - Jenny Sim
- WHO Collaborating Centre for Nursing, Midwifery & Health Development, University of Technology Sydney, NSW Australia; School of Nursing & Midwifery, University of Newcastle, NSW Australia; School of Nursing, University of Wollongong, NSW Australia; Australian Health Services Research Institute, University of Wollongong, NSW Australia. https://twitter.com/jennysim_1
| | | | - Philip L Russo
- School of Nursing, Avondale University, Lake Macquarie, NSW, Australia; Nursing and Midwifery, Monash University, Victoria, Australia; Cabrini Research, Cabrini Health, Victoria, Australia. https://twitter.com/PLR_aus
| | - Jean-Yves Maillard
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Helen Rawson
- Nursing and Midwifery, Monash University, Victoria, Australia. https://twitter.com/DrHelenRawson
| | - Katrina Browne
- Central Coast Local Health District, Gosford Hospital, NSW, Australia; School of Nursing, Avondale University, Lake Macquarie, NSW, Australia. https://twitter.com/savvy_science
| | - Martin Kiernan
- School of Nursing, Avondale University, Lake Macquarie, NSW, Australia; Richard Wells Research Centre, University of West London, UK. https://twitter.com/emrsa15
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Gu GY, Chen M, Pan JC, Xiong XL. Risk of multi-drug-resistant organism acquisition from prior bed occupants in the intensive care unit: a meta-analysis. J Hosp Infect 2023; 139:44-55. [PMID: 37406860 DOI: 10.1016/j.jhin.2023.06.020] [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: 02/25/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
Multi-drug-resistant organisms (MDROs) have become a global threat to human health. Prior bed occupancy with MDRO infection/colonization is an exposure factor that is closely associated with the MDRO acquisition rates in subsequent bed patients in intensive care units (ICUs). A meta-analysis was conducted to investigate the risk of MDRO acquisition from prior bed occupants in the ICU. PubMed, Cochrane Library, Web of Science, and Embase databases and reference lists were searched for articles published up to December 2021. The Newcastle-Ottawa scale was used for quality assessment. The risk measure was calculated as the odds ratio (OR) and corresponding 95% confidence interval (CI), and the heterogeneity was tested using I2 method and Q test. Eight articles were analysed using a random-effects model. Of the 8147 patients exposed to prior bed occupants infected or colonized with MDROs, 421 had acquired MDROs. The control group consisted of 55,933 patients without exposure factors, of which 1768 had been infected/colonized with MDROs. The pooled acquisition OR for MDROs was 1.80 (95% CI: 1.42, 2.29), P<0.00001. Subgroup analysis based on multi-drug-resistant Gram-positive and Gram-negative organisms was conducted using a fixed-effects model. The results significantly varied between the groups. Heterogeneity was partially explained by the MDRO type. In conclusion, exposure of bed occupants to infected/colonized MDROs significantly increased the risk of MDRO acquisition in subsequent bed occupants.
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Affiliation(s)
- G Y Gu
- Neurosurgical Intensive Care Unit, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - M Chen
- Rehabilitation Medicine Department, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - J C Pan
- Neurosurgical Intensive Care Unit, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - X L Xiong
- The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
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Mitchell BG, Russo PL, Kiernan M, Curryer C. Nurses' and midwives' cleaning knowledge, attitudes and practices: An Australian study. Infect Dis Health 2020; 26:55-62. [PMID: 33011114 PMCID: PMC7526607 DOI: 10.1016/j.idh.2020.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/07/2020] [Indexed: 12/03/2022]
Abstract
Background As frontline providers of care, nurses and midwives play a critical role in controlling infections such as COVID-19, influenza, multi-drug resistant organisms and health care associated infections. Improved cleaning can reduce the incidence of infection and is cost effective but relies on healthcare personnel to correctly apply cleaning measures. As nurses and midwives have the most contact with patients and as an important first step in improving compliance, this study sought to explore nurses' and midwives’ knowledge on the role of the environment in infection prevention and control and identify challenges in maintaining clean patient environments. Methods Cross-sectional online survey of 96 nurses (RN/EN) and midwives (RW) employed in clinical settings (e.g. hospital, aged care, medical centre, clinic) in Australia. Results Nurses and midwives broadly stated that they understood the importance of cleaning. However, cleaning responsibilities varied and there was confusion regarding the application of different disinfectants when cleaning after patients with a suspected or diagnosed infection post-discharge. Most would not be confident being placed in a room where a previous patient had a diagnosed infection such as multi-drug resistant organism. Conclusion Greater organisational support and improving applied knowledge about infection control procedures is needed. This includes correct use of disinfectants, which disinfectant to use for various situations, and cleaning effectively following discharge of a patient with known infection. The cleanliness of shared medical equipment may also pose current risk due to lack of cleaning. Improved cleaning reduces incidence of healthcare associated infection but relies on correct application. Nurses and midwives expressed confusion regarding disinfectant use and cleaning responsibility. Most would not be confident being placed in a room where a previous patient had a diagnosed infection.
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Affiliation(s)
- Brett G Mitchell
- School of Nursing and Midwifery, University of Newcastle, Ourimbah, New South Wales, Australia; School of Nursing, Avondale College of Higher Education, Wahroonga, New South Wales, Australia.
| | - Philip L Russo
- Department of Nursing Research, Cabrini Institute, Malvern, VIC, Australia; Nursing and Midwifery, Monash University, Frankston, VIC, Australia
| | - Martin Kiernan
- School of Nursing and Midwifery, University of Newcastle, Ourimbah, New South Wales, Australia; Richard Wells Research Centre, University of West London, Brentford, UK
| | - Cassie Curryer
- School of Nursing and Midwifery, University of Newcastle, Ourimbah, New South Wales, Australia
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Mitchell BG, McGhie A, Whiteley G, Farrington A, Hall L, Halton K, White NM. Evaluating bio-burden of frequently touched surfaces using Adenosine Triphosphate bioluminescence (ATP): Results from the Researching Effective Approaches to Cleaning in Hospitals (REACH) trial. Infect Dis Health 2020; 25:168-174. [PMID: 32234296 DOI: 10.1016/j.idh.2020.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Environmental cleaning is an important approach to reducing healthcare-associated infection. The aim of this short research paper is to describe changes in the efficacy of post-discharge cleaning by examining the amount of bio-burden on frequent touch points (FTPs) in patient areas, using a validated Adenosine Triphosphate (ATP) bioluminescence sampling method. In so doing, we present findings from a secondary outcome of a recent trial, the Researching Effective Approaches to Cleaning in Hospitals (REACH) study. METHODS The REACH study used a prospective, stepped-wedge randomised cluster design. Cross sectional ATP sampling was conducted at three of the 11 participating hospitals. At each hospital, during the control and intervention phase of the study, six Frequent Touch Points (FTPs) were sampled: toilet flush, bathroom tap, inside bathroom door handle, patient call button, over bed tray table, and bed rails. RESULTS Across the three hospitals, 519 surfaces in 49 rooms (control phase) and 2856 surfaces in 251 rooms (intervention phase) were sampled. Bedroom FTP cleaning improved across all three hospitals. The cleaning of bathroom FTPs was generally high from the outset and remained consistent throughout the whole study period. Average cleaning outcomes for bathroom FTPs were consistently high during the control period however outcomes varied between individual FTP. Changes in cleaning performance over time reflected variation in intervention effectiveness at the hospital level. CONCLUSION Findings confirm improvement in cleaning in the FTPs in bedrooms, demonstrating improvements in discharge cleaning aligned with the improvements seen when using fluorescent marking technology as a marker of performance.
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Affiliation(s)
- Brett G Mitchell
- School of Nursing and Midwifery, University of Newcastle, Ourimbah, NSW, 2258, Australia.
| | - Alexandra McGhie
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Greg Whiteley
- Whiteley Corporation, North Sydney, NSW, 2060, Australia; Western Sydney University, School of Medicine, Liverpool, NSW, 2010, Australia
| | - Alison Farrington
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia; School of Public Health and Social Work, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Lisa Hall
- School of Public Health, University of Queensland, Herston, Qld, 4006, Australia
| | - Kate Halton
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Nicole M White
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia; School of Public Health and Social Work, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
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Transmission pathways of multidrug-resistant organisms in the hospital setting: a scoping review. Infect Control Hosp Epidemiol 2019; 40:447-456. [PMID: 30837029 DOI: 10.1017/ice.2018.359] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Prevalence of multidrug-resistant microorganisms (MDROs) continues to increase, while infection control gaps in healthcare settings facilitate their transmission between patients. In this setting, 5 distinct yet interlinked pathways are responsible for transmission. The complete transmission process is still not well understood. Designing and conducting a single research study capable of investigating all 5 complex and multifaceted pathways of hospital transmission would be costly and logistically burdensome. Therefore, this scoping review aims to synthesize the highest-quality published literature describing each of the 5 individual potential transmission pathways of MDROs in the healthcare setting and their overall contribution to patient-to-patient transmission. METHODS In 3 databases, we performed 2 separate systematic searches for original research published during the last decade. The first search focused on MDRO transmission via the HCW or the environment to identify publications studying 5 specific transmission pathways: (1) patient to HCW, (2) patient to environment, (3) HCW to patient, (4) environment to patient, and (5) environment to HCW. The second search focused on overall patient-to-patient transmission regardless of the transmission pathway. Both searches were limited to transmission of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus, multidrug-resistant A. baumannii, and carbapenem-resistant Enterobacteriaceae. After abstract screening of 5,026 manuscripts, researchers independently reviewed and rated the remaining papers using objective predefined criteria to identify the highest quality and most influential manuscripts. RESULTS High-quality manuscripts were identified for all 5 routes of transmission. Findings from these studies were consistent for all pathways; however, results describing the routes from the environment/HCW to a noncolonized patient were more limited and variable. Additionally, most research focused on MRSA, instead of other MDROs. The second search yielded 10 manuscripts (8 cohort studies) that demonstrated the overall contribution of patient-to-patient transmission in hospitals regardless of the transmission route. For MRSA, the reported cross-transmission was as high as 40%. CONCLUSIONS This scoping review brings together evidence supporting all 5 possible transmission pathways and illustrates the complex nature of patient-to-patient transmission of MDROs in hospitals. Our findings also confirm that transmission of MDROs in hospitals occurs frequently, suggesting that ongoing efforts are necessary to strengthen infection prevention and control to prevent the spread of MDROs.
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Mitchell B, Dancer S, Anderson M, Dehn E. Risk of organism acquisition from prior room occupants: a systematic review and meta-analysis. J Hosp Infect 2015; 91:211-7. [DOI: 10.1016/j.jhin.2015.08.005] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/04/2015] [Indexed: 11/25/2022]
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Mitchell BG, Wilson F, Wells A. Evaluating environment cleanliness using two approaches: a multi-centred Australian study. ACTA ACUST UNITED AC 2015. [DOI: 10.1071/hi15009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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