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Pearse I, Corley A, Rickard CM, Marsh N. Unnecessary removal of vascular access devices due to suspected infection in Australian intensive care units. Aust Crit Care 2021; 35:644-650. [PMID: 34711493 DOI: 10.1016/j.aucc.2021.09.005] [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: 04/25/2021] [Revised: 07/31/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Vascular access devices suspected of infection are often removed unnecessarily and frequently require replacement. The aim of this study was to identify the prevalence and economic impact of premature, unnecessary device removal due to suspected infection in adult patients admitted to the intensive care unit. METHODS Secondary data analysis of a prospectively collected data set detailing central venous catheters and peripheral arterial catheters in 1458 adult patients was conducted in nine Australian intensive care units. Data extracted from the parent database included patient demographics, device, and infection-specific data including the reason for device removal. Cost estimates were based on a recently published review of device utilisation and associated costs in Queensland public hospitals. RESULTS A total of 6144 central venous catheter days and 4696 arterial catheter days were studied. Median device dwell time was 7.2 (interquartile range: 5.6-9.0) days for central venous catheters and 6.5 (interquartile range: 4.8-8.5) days for arterial catheters. Device removal due to suspected infection occurred at a rate of 25.7 and 15.3 episodes/1000 catheter days in central venous and arterial catheters, respectively. Central venous and arterial catheter-related bloodstream infections occurred at a rate of 1.8 and 0.2 episodes/1000 catheter days, respectively. Central line-associated bloodstream infection occurred at a rate of 3.3 episodes/1000 catheter days. Local central venous and arterial catheter infection occurred at 0.16 and 0.02 episodes/1000 catheter days, respectively. The difference in incidence between devices suspected of infection and those responsible for infection resulted in AUD$67,087 unnecessarily spent on device replacement. CONCLUSIONS Unnecessary device removal due to suspected infection presents a substantial clinical problem which is costly for the healthcare organisation and time-consuming for clinicians and places the patient at an increased risk of iatrogenic complications. There is a need for robust evidence and clinical practice guidelines to inform clinical decision-making to reduce unnecessary device removal.
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Affiliation(s)
- India Pearse
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute, Griffith University, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Queensland, Australia.
| | - Amanda Corley
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute, Griffith University, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Queensland, Australia.
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute, Griffith University, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Queensland, Australia.
| | - Nicole Marsh
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute, Griffith University, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Queensland, Australia.
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Polyhexamethylene biguanide discs versus unmedicated dressings for prevention of central venous catheter-associated infection in the intensive care unit: A pilot randomised controlled trial to assess protocol safety and feasibility. Aust Crit Care 2021; 35:512-519. [PMID: 34321181 DOI: 10.1016/j.aucc.2021.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/16/2021] [Accepted: 05/25/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Central venous catheters are prone to infectious complications, affecting morbidity, mortality and healthcare costs. Polyhexamethylene biguanide-impregnated discs at the catheter insertion site may prevent local and bloodstream infection; however, efficacy has not been established in a critical care setting. OBJECTIVE The objective of this study was to pilot test polyhexamethylene biguanide-impregnated discs compared to standard unmedicated dressings for central venous catheter infection prevention in critically ill patients. METHODS This was a single-centre pilot randomised controlled trial. Adults admitted to intensive care requiring a central venous catheter for >72 h were eligible. Patients with a current bloodstream infection, concurrent central venous catheter, chlorhexidine or polyhexamethylene biguanide allergy, or sensitive skin were excluded. Patients were randomised to receive standard central venous catheter dressings with/without polyhexamethylene biguanide discs. OUTCOME MEASURES The primary outcome was feasibility, defined by patient eligibility, recruitment, retention, protocol adherence, missing data, and staff satisfaction. Secondary outcomes included: central line-associated infection; primary bloodstream infection; local infection; skin complications; device/dressing dwell time; serious adverse events, and cost-effectiveness. RESULTS Of 309 patients screened, 80 participants were recruited with 98% (n = 78) receiving an internal jugular catheter which dwelled for a median of 5 days (interquartile range = 4.0, 6.0). Feasibility criteria were predominantly met (recruitment 88%; retention 100%; protocol fidelity 91%); however, eligibility criteria were not met (32%; most commonly owing to short predicted catheter dwell). Staff acceptability criteria were met, with 83% of staff scoring dressing application and removal ≥7 on a numerical rating scale. There were no central line-associated bloodstream infections and no local infections. Insertion site itch occurred in 4% (control [n = 0], intervention [n = 3]) of participants, while 32% (24/76) reported pain, and 46% (35/76) tenderness. CONCLUSIONS Polyhexamethylene biguanide discs appear safe for central venous catheter infection prevention. Feasibility of a large efficacy trial was established with some modifications to screening processes. Large, adequately powered randomised controlled trials are needed to test the infection prevention hypotheses.
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Longembe EB, Kitronza PL. [Compliance with hand-hygiene practice in the General Reference Hospitals of the city of Kisangani, Democratic Republic of the Congo]. Pan Afr Med J 2020; 35:57. [PMID: 32537061 PMCID: PMC7266366 DOI: 10.11604/pamj.2020.35.57.18500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 11/25/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION the purpose of this study was to assess the compliance with hand-hygiene practice of health-care workers in the General Reference Hospitals (GRH) of the city of Kisangani and to identify factors contributing to it. METHODS we conducted a cross-sectional study in the Maternity, Surgery, Pediatric and Emergency Departments at four GRH of the city of Kisangani over the period 13th-20th June 2018. One hundred and twenty professionals recruited from among doctors, nurses, laboratory technicians and attendants were asked to complete a self-administered questionnaire to assess their level of knowledge and a grid indicating the compliance with hand-hygiene practice in 44 health professionals (1920 opportunities). RESULTS the rate of overall compliance with hand-hygiene practice was 39% [CI95 0.37; 0.41]; friction with hydroalcoholic solution was much less frequent (5%); cleaners and physicians had higher compliance rates (49% and 44% respectively) than nurses (33%). Approximately one third of professionals were aware of the indications for hand-hygiene according to the WHO; 37% of health professionals declared that they had followed a on-the-job training on hand-hygiene and 36% knew the importance of hand-hygiene in the healthcare environment. The gap in knowledge was not significant between the occupational categories studied (p >0.05). CONCLUSION this study and the results obtained from it allowed us to conclude that the level of compliance to precautions standards including hand hygiene by healthcare professionals is insufficient. It is therefore necessary to strengthen the compliance with hand-hygiene practices through training and awareness programs for healthcare professionals, the supply of hygiene products and the awareness of healthcare providers.
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Affiliation(s)
- Eugène Basandja Longembe
- Faculté de Médecine et de Pharmacie, Université de Kisangani, Kisangani, République Démocratique du Congo
| | - Panda Lukongo Kitronza
- Faculté de Médecine et de Pharmacie, Université de Kisangani, Kisangani, République Démocratique du Congo
- Ecole de Santé Publique, Faculté de Médecine, Université de Liège, Liège, Belgique
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Alkhawaja S, Saeed NK, Rosenthal VD, Abdul-Aziz S, Alsayegh A, Humood ZM, Ali KM, Swar S, Magray TAS. Impact of International Nosocomial Infection Control Consortium's multidimensional approach on central line-associated bloodstream infection rates in Bahrain. J Vasc Access 2019; 21:481-489. [PMID: 31820669 DOI: 10.1177/1129729819888426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Central line-associated bloodstream infections are serious life-threatening infections in the intensive care unit setting. METHODS To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and INICC Surveillance Online System (ISOS) on central line-associated bloodstream infection rates in Bahrain from January 2013 to December 2016, we conducted a prospective, before-after surveillance, cohort, observational study in one intensive care unit in Bahrain. During baseline, we performed outcome and process surveillance of central line-associated bloodstream infection on 2320 intensive care unit patients, applying Centers for Disease Control and Prevention's National Healthcare Safety Network definitions. During intervention, we implemented IMA through ISOS, including (1) a bundle of infection prevention interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on central line-associated bloodstream infection rates and consequences, and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention on the central line-associated bloodstream infection rate. RESULTS During baseline, 672 central line days and 7 central line-associated bloodstream infections were recorded, accounting for 10.4 central line-associated bloodstream infections per 1000 central line days. During intervention, 13,020 central line days and 48 central line-associated bloodstream infections were recorded. After the second year, there was a sustained 89% cumulative central line-associated bloodstream infection rate reduction to 1.2 central line-associated bloodstream infections per 1000 central line days (incidence density rate, 0.11; 95% confidence interval 0.1-0.3; p, 0.001). The average extra length of stay of patients with central line-associated bloodstream infection was 23.3 days, and due to the reduction of central line-associated bloodstream infections, 367 days of hospitalization were saved, amounting to a reduction in hospitalization costs of US$1,100,553. CONCLUSION Implementing IMA was associated with a significant reduction in the central line-associated bloodstream infection rate in Bahrain.
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Affiliation(s)
- Safaa Alkhawaja
- Salmaniya Medical Center, Ministry of Health, Manama, Bahrain
| | | | | | - Sana Abdul-Aziz
- Salmaniya Medical Center, Ministry of Health, Manama, Bahrain
| | - Ameena Alsayegh
- Salmaniya Medical Center, Ministry of Health, Manama, Bahrain
| | | | | | - Saleh Swar
- Salmaniya Medical Center, Ministry of Health, Manama, Bahrain
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Bardossy AC, Zervos J, Zervos M. Preventing Hospital-acquired Infections in Low-income and Middle-income Countries. Infect Dis Clin North Am 2016; 30:805-18. [DOI: 10.1016/j.idc.2016.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rosenthal VD. International Nosocomial Infection Control Consortium (INICC) resources: INICC multidimensional approach and INICC surveillance online system. Am J Infect Control 2016; 44:e81-90. [PMID: 26975716 DOI: 10.1016/j.ajic.2016.01.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/21/2015] [Accepted: 01/04/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND The International Nosocomial Infection Control Consortium (INICC) is an international, nonprofit, multicentric health care-associated infection (HAI) cohort surveillance network with a methodology based on the U.S. Centers for Disease Control and Prevention's National Healthcare Safety Network (CDC-NHSN). The INICC was founded in 1998 to promote evidence-based infection control in limited-resource countries through the analysis of surveillance data collected by their affiliated hospitals. The INICC is comprised of >3,000-affiliated infection control professionals from 1,000 hospitals in 67 countries and is the only source of aggregate standardized international data on HAI epidemiology. Having published reports on device-associated (DA) HAI (HAI) and surgical site infections (SSIs) from 43 countries and several reports per individual country, the INICC showed DA HAI and SSI rates in limited-resources countries are 3-5 times higher than in high-income countries. METHODS The INICC developed the INICC Multidimensional Approach (IMA) for HAI prevention with 6 components, bundles with 7-13 elements, and the INICC Surveillance Online System (ISOS) with 15 modules. RESOURCES In this article the IMA, the ISOS for outcome surveillance of HAIs and process surveillance of bundles to prevent HAIs, and the use of surveillance data feedback are described. COMMENTS Remarkable features of the IMA and ISOS are INICC's applying of the latest published CDC-NHSN HAI definitions, including their updates and revisions in 2008, 2013, 2015 and 2016; INICC's informatics system to check accuracy of fulfillment of CDC-NHSN HAI criteria; and INICC's system to check compliance with each bundle element.
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Length of stay and mortality associated with healthcare-associated urinary tract infections: a multi-state model. J Hosp Infect 2016; 93:92-9. [DOI: 10.1016/j.jhin.2016.01.012] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/19/2016] [Indexed: 11/19/2022]
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Ng YY, Abdel-Latif MEA, Gan CS, Siham A, Zainol H, Lum LCS. Impact of infection control training for interns on PICU-acquired bloodstream infections in a middle-income country. Singapore Med J 2016; 56:506-12. [PMID: 26451053 DOI: 10.11622/smedj.2015135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The present study aimed to determine the impact of an extended infection control training programme, which was conducted for all interns posted to the Department of Paediatrics, on the incidence of paediatric intensive care unit (PICU)-acquired bloodstream infections (BSIs) in University Malaya Medical Centre, Malaysia. METHODS The development of nosocomial BSIs during the baseline period (1 January-31 October 2008) and intervention period (1 November-31 December 2009) was monitored. During the intervention period, all paediatric interns underwent training in hand hygiene and aseptic techniques for accessing vascular catheters. RESULTS A total of 25 patients had PICU-acquired BSIs during the baseline period, while 18 patients had PICU-acquired BSIs during the intervention period (i.e. infection rate of 88 per 1,000 and 41 per 1,000 admissions, respectively). The infections were related to central venous catheters (CVCs) in 22 of the 25 patients who had PICU-acquired BSIs during the baseline period and 11 of the 18 patients who had PICU-acquired BSIs during the intervention period. Thus, the incidence rates of catheter-related BSIs were 25.2 per 1,000 CVC-days and 9.3 per 1,000 CVC-days, respectively (p < 0.05). The Paediatric Risk of Standardised Mortality III score was an independent risk factor for PICU-acquired BSIs and the intervention significantly reduced this risk. CONCLUSION The education of medical interns on infection control, a relatively low-cost intervention, resulted in a substantial reduction in the incidence of PICU-acquired BSIs.
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Affiliation(s)
- Yun Yun Ng
- Department of Paediatrics, Faculty of Medicine, University Malaya, Malaysia ; Institute Paediatrics, Hospital Kuala Lumpur, Malaysia
| | - Mohamed El-Amin Abdel-Latif
- School of Clinical Medicine, Australian National University, Canberra Hospital, Australia ; Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Australia
| | - Chin Seng Gan
- Department of Paediatrics, Faculty of Medicine, University Malaya, Malaysia ; Paediatric Intensive Care Unit, University Malaya Medical Center, Malaysia
| | - Anis Siham
- Paediatric Intensive Care Unit, University Malaya Medical Center, Malaysia ; Department of Paediatrics, Faculty of Medicine, Universiti Teknologi MARA, Malaysia
| | - Hasimah Zainol
- Paediatric Intensive Care Unit, University Malaya Medical Center, Malaysia
| | - Lucy Chai See Lum
- Department of Paediatrics, Faculty of Medicine, University Malaya, Malaysia ; Paediatric Intensive Care Unit, University Malaya Medical Center, Malaysia
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Arefian H, Hagel S, Heublein S, Rissner F, Scherag A, Brunkhorst FM, Baldessarini RJ, Hartmann M. Extra length of stay and costs because of health care-associated infections at a German university hospital. Am J Infect Control 2016; 44:160-6. [PMID: 26521700 DOI: 10.1016/j.ajic.2015.09.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 09/02/2015] [Accepted: 09/03/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Health care-associated infections (HAIs) can be associated with increased health care costs. We examined extra length of hospital stay (LOS) and associated per diem costs attributable to HAIs in a large academic medical center. METHODS Data for analysis were acquired in a preinterventional phase of a prospective cohort study (ALERTS) conducted over 12 months in 27 general and 4 intensive care units at Jena University Hospital. HAIs were identified among patients hospitalized for ≥48 hours with at least 1 risk factor for HAI and new antimicrobial therapy; the diagnosis was confirmed by U.S. Centers for Disease Control and Prevention criteria. Extra LOS was estimated by multistate modeling, and associated extra costs were based on average per diem costs for clinical units sampled. RESULTS Of a total of 22,613 patients hospitalized for ≥48 hours, 893 (3.95%) experienced 1,212 episodes of HAI during 12 months. The associated mean extra LOS ± SEM in general units was 8.45 ± 0.80 days per case and 8.09 ± 0.91 days for patients treated in both general and intensive care units. Additional costs attributable to HAIs were €5,823-€11,840 ($7,453-$15,155) per infected patient. CONCLUSION HAIs generated substantial extra costs by prolonging hospitalization. Potential clinical and financial savings may be realized by implementing effective infection prevention programs.
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Reducing Time-dependent Bias in Estimates of the Attributable Cost of Health Care-associated Methicillin-resistant Staphylococcus aureus Infections: A Comparison of Three Estimation Strategies. Med Care 2015. [PMID: 26225444 DOI: 10.1097/mlr.0000000000000403] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous estimates of the excess costs due to health care-associated infection (HAI) have scarcely addressed the issue of time-dependent bias. OBJECTIVE We examined time-dependent bias by estimating the health care costs attributable to an HAI due to methicillin-resistant Staphylococcus aureus (MRSA) using a unique dataset in the Department of Veterans Affairs (VA) that makes it possible to distinguish between costs that occurred before and after an HAI. In addition, we compare our results to those from 2 other estimation strategies. METHODS Using a historical cohort study design to estimate the excess predischarge costs attributable to MRSA HAIs, we conducted 3 analyses: (1) conventional, in which costs for the entire inpatient stay were compared between patients with and without MRSA HAIs; (2) post-HAI, which included only costs that occurred after an infection; and (3) matched, in which costs for the entire inpatient stay were compared between patients with an MRSA HAI and subset of patients without an MRSA HAI who were matched based on the time to infection. RESULTS In our post-HAI analysis, estimates of the increase in inpatient costs due to MRSA HAI were $12,559 (P<0.0001) and $24,015 (P<0.0001) for variable and total costs, respectively. The excess variable and total cost estimates were 33.7% and 31.5% higher, respectively, when using the conventional methods and 14.6% and 11.8% higher, respectively, when using matched methods. CONCLUSIONS This is the first study to account for time-dependent bias in the estimation of incremental per-patient health care costs attributable to HAI using a unique dataset in the VA. We found that failure to account for this bias can lead to overestimation of these costs. Matching on the timing of infection can reduce this bias substantially.
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Mitchell BG, Gardner A, Barnett AG, Hiller JE, Graves N. The prolongation of length of stay because of Clostridium difficile infection. Am J Infect Control 2014; 42:164-7. [PMID: 24290226 DOI: 10.1016/j.ajic.2013.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/04/2013] [Accepted: 07/05/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Clostridium difficile infection (CDI) possibly extends hospital length of stay (LOS); however, the current evidence does not account for the time-dependent bias, ie, when infection is incorrectly analyzed as a baseline covariate. The aim of this study was to determine whether CDI increases LOS after managing this bias. METHODS We examined the estimated extra LOS because of CDI using a multistate model. Data from all persons hospitalized >48 hours over 4 years in a tertiary hospital in Australia were analyzed. Persons with health care-associated CDIs were identified. Cox proportional hazards models were applied together with multistate modeling. RESULTS One hundred fifty-eight of 58,942 admissions examined had CDI. The mean extra LOS because of infection was 0.9 days (95% confidence interval: -1.8 to 3.6 days, P = .51) when a multistate model was applied. The hazard of discharge was lower in persons who had CDI (adjusted hazard ratio, 0.42; P < .001) when a Cox proportional hazard model was applied. CONCLUSION This study is the first to use multistate models to determine the extra LOS because of CDI. Results suggest CDI does not significantly contribute to hospital LOS, contradicting findings published elsewhere. Conversely, when methods prone to result in time-dependent bias were applied to the data, the hazard of discharge significantly increased. These findings contribute to discussion on methods used to evaluate LOS and health care-associated infections.
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Affiliation(s)
- Brett G Mitchell
- School of Nursing, Midwifery, and Paramedicine, Australian Catholic University, Canberra, ACT, Australia; Faculty of Nursing and Health, Avondale College for Higher Education, Wahroonga, NSW, Australia.
| | - Anne Gardner
- School of Nursing, Midwifery, and Paramedicine, Australian Catholic University, Canberra, ACT, Australia; National Centre for Clinical Outcomes Research (NaCCOR), Australian Catholic University, Sydney, NSW, Australia
| | - Adrian G Barnett
- Institute of Health Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Janet E Hiller
- Faculty of Health Science, Australian Catholic University, Melbourne, VIC, Australia
| | - Nicholas Graves
- Institute of Health Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
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Leblebicioglu H, Öztürk R, Rosenthal VD, Akan ÖA, Sirmatel F, Ozdemir D, Uzun C, Turgut H, Ersoz G, Koksal I, Özgültekin A, Esen S, Ulger F, Dilek A, Yilmaz H, Dikmen Y, Aygún G, Tulunay M, Oral M, Ünal N, Cengiz M, Yilmaz L, Geyik MF, Şahin A, Erdogan S, Sacar S, Sungurtekin H, Uğurcan D, Kaya A, Kuyucu N, Yýlmaz G, Kaya S, Ulusoy H, İnan A. Impact of a multidimensional infection control approach on central line-associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC). Ann Clin Microbiol Antimicrob 2013; 12:10. [PMID: 23641950 PMCID: PMC3674978 DOI: 10.1186/1476-0711-12-10] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 02/23/2013] [Indexed: 02/07/2023] Open
Abstract
Background Central line-associated bloodstream infections (CLABs) have long been associated with excess lengths of stay, increased hospital costs and mortality attributable to them. Different studies from developed countries have shown that practice bundles reduce the incidence of CLAB in intensive care units. However, the impact of the bundle strategy has not been systematically analyzed in the adult intensive care unit (ICU) setting in developing countries, such as Turkey. The aim of this study is to analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce the rates of CLAB in 13 ICUs of 13 INICC member hospitals from 8 cities of Turkey. Methods We conducted active, prospective surveillance before-after study to determine CLAB rates in a cohort of 4,017 adults hospitalized in ICUs. We applied the definitions of the CDC/NHSN and INICC surveillance methods. The study was divided into baseline and intervention periods. During baseline, active outcome surveillance of CLAB rates was performed. During intervention, the INICC multidimensional approach for CLAB reduction was implemented and included the following measures: 1- bundle of infection control interventions, 2- education, 3- outcome surveillance, 4- process surveillance, 5- feedback of CLAB rates, and 6- performance feedback on infection control practices. CLAB rates obtained in baseline were compared with CLAB rates obtained during intervention. Results During baseline, 3,129 central line (CL) days were recorded, and during intervention, we recorded 23,463 CL-days. We used random effects Poisson regression to account for clustering of CLAB rates within hospital across time periods. The baseline CLAB rate was 22.7 per 1000 CL days, which was decreased during the intervention period to 12.0 CLABs per 1000 CL days (IRR 0.613; 95% CI 0.43 – 0.87; P 0.007). This amounted to a 39% reduction in the incidence rate of CLAB. Conclusions The implementation of multidimensional infection control approach was associated with a significant reduction in the CLAB rates in adult ICUs of Turkey, and thus should be widely implemented.
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Gandra S, Ellison RT. Modern trends in infection control practices in intensive care units. J Intensive Care Med 2013; 29:311-26. [PMID: 23753240 DOI: 10.1177/0885066613485215] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hospital-acquired infections (HAIs) are common in intensive care unit (ICU) patients and are associated with increased morbidity and mortality. There has been an increasing effort to prevent HAIs, and infection control practices are paramount in avoiding these complications. In the last several years, numerous developments have been seen in the infection prevention strategies in various health care settings. This article reviews the modern trends in infection control practices to prevent HAIs in ICUs with a focus on methods for monitoring hand hygiene, updates in isolation precautions, new methods for environmental cleaning, antimicrobial bathing, prevention of ventilator-associated pneumonia, central line-associated bloodstream infections, catheter-associated urinary tract infections, and Clostridium difficile infection.
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Affiliation(s)
- Sumanth Gandra
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Richard T Ellison
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
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