Statistical Process Control Charts for Monitoring Staphylococcus aureus Bloodstream Infections in Australian Health Care Facilities

WITHDRAWN: Medical assurance system under reliability theory and countermeasures to public health risks

Ahead of Print article withdrawn by publisher.

Use of a Victorian statewide surveillance program to evaluate the burden of healthcare-associated Staphylococcus aureus bacteraemia and Clostridioides difficile infection in patients with cancer

BACKGROUND

Patients with cancer are at high risk for infection, but the epidemiology of healthcare-associated Staphylococcus aureus bacteraemia (HA-SAB) and Clostridioides difficile infection (HA-CDI) in Australian cancer patients has not previously been reported.

AIMS

To compare the cumulative aggregate incidence and time trends of HA-SAB and HA-CDI in a predefined cancer cohort with a mixed statewide patient population in Victoria, Australia.

METHODS

All SAB and CDI events in patients admitted to Victorian healthcare facilities between 1^st July 2010 and 31^st December 2018 were submitted to the Victorian Healthcare Associated Infection Surveillance System Coordinating Centre. Descriptive analyses and multilevel mixed-effects Poisson regression modelling were applied to a standardised data extract.

RESULTS

In total, 10,608 and 13,118 SAB and CDI events were reported across 139 Victorian healthcare facilities, respectively. Of these, 89 (85%) and 279 (88%) were healthcare-associated in the cancer cohort compared to 34% (3,561/10,503) and 66% (8,403/12,802) in the statewide cohort. The aggregate incidence was more than two-fold higher in the cancer compared to the statewide cohort for HA-SAB (2.25 [95% CI: 1.74-2.77] vs. 1.11 [95% CI: 1.07-1.15] HA-SABs/10,000 OBDs) and three-fold higher for HA-CDI (6.26 [95% CI: 5.12-7.41] vs. 2.31 [95% CI: 2.21-2.42] HA-CDIs/10,000 OBDs). Higher quarterly diminishing rates were observed in the cancer cohort than the statewide data for both infections.

CONCLUSIONS

Our findings demonstrate a higher burden of HA-SAB and HA-CDI in a cancer cohort when compared with state data and highlight the need for cancer-specific targets and benchmarks to meaningfully support quality improvement. This article is protected by copyright. All rights reserved.

Rapid Decline in Online Search Queries for Hip and Knee Arthroplasties Concurrent With the COVID-19 Pandemic

BACKGROUND

In response to the coronavirus disease 2019 (COVID-19) pandemic, US hospitals have canceled elective surgeries. This decline in total joint arthroplasty (TJA) revenue may place financial strain on hospitals. Our goal was to quantify the impact of COVID-19 on the public interest in elective TJA.

METHODS

The Google Search Volume Index (GSVI) identified the terms "knee replacement," "hip replacement," and "orthopedic surgeon" as the most common to describe TJA. The term "elective surgery cancellation" was also analyzed. Weekly GSVI data were extracted between 04-01-2015 and 04-04-2020. Time series analysis was conducted and state GSVI values were compared with COVID-19 prevalence and unemployment claims.

RESULTS

The relative public interest in elective TJA has sharply declined since the WHO declaration of COVID-19 as a global pandemic. Between 03-01-2020 and 03-29-2020, the popularity of searches for "knee replacement", "hip replacement," and "orthopedic surgeon" dropped by 62.1%, 52.1%, and 44.3%, respectively. A concurrent spike was observed for the term "elective surgery cancellation." California, New Hampshire, Maine, and Nevada showed a low relative rate for TJA searches, and the highest increase in unemployment claims.

CONCLUSION

The onset of COVID-19 correlates with declining relative popularity of searches related to elective TJA. Higher volume of COVID-19 cases in certain states may correspond with lower relative search popularity, although this correlation remains unclear. These results portend the possibility of a decline in elective TJA case volume, further straining hospitals. Further research is required to inform stakeholders how best to proceed and determine any sustained effects from the current diminished relative interest in TJA.

LEVEL OF EVIDENCE

Level III.