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Tinelli M, Athanasiou A, Veroniki AA, Efthimiou O, Kalliala I, Bowden S, Paraskevaidi M, Lyons D, Martin-Hirsch P, Bennett P, Paraskevaidis E, Salanti G, Kyrgiou M, Naci H. Treatment methods for cervical intraepithelial neoplasia in England: A cost-effectiveness analysis. BJOG 2024; 131:1411-1419. [PMID: 38659133 DOI: 10.1111/1471-0528.17829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To compare the cost-effectiveness of different treatments for cervical intraepithelial neoplasia (CIN). DESIGN A cost-effectiveness analysis based on data available in the literature and expert opinion. SETTING England. POPULATION Women treated for CIN. METHODS We developed a decision-analytic model to simulate the clinical course of 1000 women who received local treatment for CIN and were followed up for 10 years after treatment. In the model we considered surgical complications as well as oncological and reproductive outcomes over the 10-year period. The costs calculated were those incurred by the National Health Service (NHS) of England. MAIN OUTCOME MEASURES Cost per one CIN2+ recurrence averted (oncological outcome); cost per one preterm birth averted (reproductive outcome); overall cost per one adverse oncological or reproductive outcome averted. RESULTS For young women of reproductive age, large loop excision of the transformation zone (LLETZ) was the most cost-effective treatment overall at all willingness-to-pay thresholds. For postmenopausal women, LLETZ remained the most cost-effective treatment up to a threshold of £31,500, but laser conisation became the most cost-effective treatment above that threshold. CONCLUSIONS LLETZ is the most cost-effective treatment for both younger and older women. However, for older women, more radical excision with laser conisation could also be considered if the NHS is willing to spend more than £31,500 to avert one CIN2+ recurrence.
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Affiliation(s)
- Michela Tinelli
- Department of Health Policy, The London School of Economics and Political Science, London, UK
- Care Policy Evaluation Centre, The London School of Economics and Political Science, London, UK
| | - Antonios Athanasiou
- Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Institute of Reproductive and Developmental Biology (IRDB), Imperial College London, London, UK
| | - Areti Angeliki Veroniki
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Ilkka Kalliala
- Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Institute of Reproductive and Developmental Biology (IRDB), Imperial College London, London, UK
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sarah Bowden
- Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Institute of Reproductive and Developmental Biology (IRDB), Imperial College London, London, UK
- Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London, UK
| | - Maria Paraskevaidi
- Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Institute of Reproductive and Developmental Biology (IRDB), Imperial College London, London, UK
| | - Deirdre Lyons
- Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Phillip Bennett
- Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Institute of Reproductive and Developmental Biology (IRDB), Imperial College London, London, UK
- Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London, UK
| | - Evangelos Paraskevaidis
- Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London, UK
- Department of Obstetrics and Gynaecology, University of Ioannina and University Hospital of Ioannina, Ioannina, Greece
| | - Georgia Salanti
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Maria Kyrgiou
- Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Institute of Reproductive and Developmental Biology (IRDB), Imperial College London, London, UK
- Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London, UK
| | - Huseyin Naci
- Department of Health Policy, The London School of Economics and Political Science, London, UK
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Boyce JM. Current issues in hand hygiene. Am J Infect Control 2023; 51:A35-A43. [PMID: 37890952 DOI: 10.1016/j.ajic.2023.02.003] [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: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Multiple aspects of hand hygiene have changed in recent years. METHODS A PubMed search was conducted to identify recent articles about hand hygiene. RESULTS The COVID-19 pandemic caused temporary changes in hand hygiene compliance rates and shortages of alcohol-based hand sanitizers (ABHSs), and in marketing of some products that were ineffective or unsafe. Fortunately, ABHSs are effective against SARS-CoV-2 and other emerging pathogens including Candida auris and mpox. Proper placement, maintenance, and design of ABHS dispensers have gained additional attention. Current evidence suggests that if an adequate volume of ABHS has been applied to hands, personnel must rub their hands together for at least 15 seconds before hands feel dry (dry time), which is the primary driver of antimicrobial efficacy. Accordingly, practical methods of monitoring hand hygiene technique are needed. Direct observation of hand hygiene compliance remains a challenge in many healthcare facilities, generating increased interest in automated hand hygiene monitoring systems (AHHMSs). However, several barriers have hindered widespread adoption of AHHMSs. AHHMSs must be implemented as part of a multimodal improvement program to successfully improve hand hygiene performance rates. CONCLUSIONS Remaining gaps in our understanding of hand hygiene warrant continued research into factors impacting hand hygiene practices.
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Affiliation(s)
- John M Boyce
- J.M. Boyce Consulting, LLC, Middletown, CT, USA.
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Salinas-Escudero G, la Rosa-Zamboni DD, Carrillo-Vega MF, Gamiño-Arroyo AE, Toledano-Toledano F, Ortega-Riosvelasco F, Granados-García V, Villa-Guillén M, Garduño-Espinosa J. Cost-effectiveness analysis of a hand hygiene monitoring system in a tertiary pediatric hospital in Mexico. Front Public Health 2023; 11:1117680. [PMID: 36969625 PMCID: PMC10034395 DOI: 10.3389/fpubh.2023.1117680] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/17/2023] [Indexed: 03/11/2023] Open
Abstract
BackgroundAn automated hand-hygiene monitoring system (AHHMS) was implemented in October 2019 at the Hospital Infantil de México Federico Gómez (HIMFG), a tertiary pediatric referral hospital, in four of the hospital wards with the highest rates of Healthcare Associated Infections (HAIs). The clinical and economic impact of this system had not yet been assessed prior to this study. This study aimed to evaluate if the AHHMS is a cost-effective alternative in reducing HAIs in the HIMFG.MethodologyA full cost-effectiveness economic assessment was carried out for the hospital. The alternatives assessed were AHHMS implementation vis-a-vis AHHMS non-implementation (historical tendency). The outcomes of interest were infection rate per 1,000 patient-days and cost savings as a result of prevented infections. Infection rate data per 1,000 patient-days (PD) were obtained from the hospital's Department of Epidemiology with respect to the AHHMS. As regards historical tendency, an infection-rate model was designed for the most recent 6-year period. Infection costs were obtained from a review of available literature on the subject, and the cost of the implemented AHHMS was provided by the hospital. The assessment period was 6 months. The incremental cost-effectiveness ratio was estimated. Costs are reported in US Dollars (2021). Univariate sensitivity and threshold analysis for different parameters was conducted.ResultsThe total estimated cost of the AHHMS alternative represented potential savings of $308,927–$546,795 US Dollars compared to non-implementation of the system (US$464,102 v. US$773,029–$1,010,898) for the period. AHHMS effectiveness was reflected in a diminished number of infections, 46–79 (−43.4–56.7%) compared to non-implementation (60 v. 106-139 infections).ConclusionThe AHHMS was found to be a cost-saving alternative for the HIMFG given its cost-effectiveness and lower cost vis-a-vis the alternate option. Accordingly, the recommendation was made of extending its use to other areas in the hospital.
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Affiliation(s)
- Guillermo Salinas-Escudero
- Center for Economic and Social Studies in Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Daniela De la Rosa-Zamboni
- Subdirector Comprehensive Patient Attention, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
- *Correspondence: Daniela De la Rosa-Zamboni
| | | | - Ana Estela Gamiño-Arroyo
- Hospital Epidemiology Department, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Filiberto Toledano-Toledano
- Unidad de Investigación en Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez, National Institute of Health, Mexico City, Mexico
- Unidad de Investigación Sociomédica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
- Dirección de Investigación y Diseminación del Conocimiento, Instituto Nacional de Ciencias e Innovación para la Formación de Comunidad Científica, INDEHUS, Mexico City, Mexico
| | | | - Víctor Granados-García
- Epidemiological and Health Services Research Unit Aging Area, Centro Médico Nacional, Mexico City, Mexico
| | - Mónica Villa-Guillén
- Medical Director, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
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Moore L, Guertin JR, Tardif PA, Ivers NM, Hoch J, Conombo B, Antony J, Stelfox HT, Berthelot S, Archambault P, Turgeon A, Gandhi R, Grimshaw JM. Economic evaluations of audit and feedback interventions: a systematic review. BMJ Qual Saf 2022; 31:754-767. [PMID: 35750494 DOI: 10.1136/bmjqs-2022-014727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/15/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The effectiveness of audit and feedback (A&F) interventions to improve compliance to healthcare guidelines is supported by randomised controlled trials (RCTs) and meta-analyses of RCTs. However, there is currently a knowledge gap on their cost-effectiveness. OBJECTIVE We aimed to assess whether A&F interventions targeting improvements in compliance to recommended care are economically favourable. METHODS We conducted a systematic review including experimental, observational and simulation-based economic evaluation studies of A&F interventions targeting healthcare providers. Comparators were a 'do nothing' strategy, or any other intervention not involving A&F or involving a subset of A&F intervention components. We searched MEDLINE, CINAHL, CENTRAL, Econlit, EMBASE, Health Technology Assessment Database, MEDLINE, NHS Economic Evaluation Database, ABI/INFORM, Web of Science, ProQuest and websites of healthcare quality associations to December 2021. Outcomes were incremental cost-effectiveness ratios, incremental cost-utility ratios, incremental net benefit and incremental cost-benefit ratios. Pairs of reviewers independently selected eligible studies and extracted relevant data. Reporting quality was evaluated using CHEERS (Consolidated Health Economic Evaluation Reporting Standards). Results were synthesised using permutation matrices for all studies and predefined subgroups. RESULTS Of 13 221 unique citations, 35 studies met our inclusion criteria. The A&F intervention was dominant (ie, at least as effective with lower cost) in 7 studies, potentially cost-effective in 26 and was dominated (ie, the same or less effectiveness and higher costs) in 2 studies. A&F interventions were more likely to be economically favourable in studies based on health outcomes rather than compliance to recommended practice, considering medical costs in addition to intervention costs, published since 2010, and with high reporting quality. DISCUSSION Results suggest that A&F interventions may have a high potential to be cost-effective. However, as is common in systematic reviews of economic evaluations, publication bias could have led to an overestimation of their economic value.
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Affiliation(s)
- Lynne Moore
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Jason Robert Guertin
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Pier-Alexandre Tardif
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Noah Michael Ivers
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Hoch
- Department of Public Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Blanchard Conombo
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Jesmin Antony
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | | | - Simon Berthelot
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Patrick Archambault
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Alexis Turgeon
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Rohit Gandhi
- Department of Pediatric Neurology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - J M Grimshaw
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Schmidtke KA, Aujla N, Marshall T, Hussain A, Hodgkinson GP, Arheart KL, Birnbach DJ, Kudrna L, Vlaev I. A Crossover Randomized Controlled Trial of Priming Interventions to Increase Hand Hygiene at Ward Entrances. Front Public Health 2022; 9:781359. [PMID: 35111716 PMCID: PMC8801705 DOI: 10.3389/fpubh.2021.781359] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundResearch conducted in the United States suggests that two primes (citrus smells and pictures of a person's eyes) can increase hand gel dispenser use on the day they are introduced in hospital. The current study, conducted at a hospital in the United Kingdom, evaluated the effectiveness of these primes, both in isolation and in combination, at the entry way to four separate wards, over a longer duration than the previous work.MethodsA crossover randomized controlled trial was conducted. Four wards were allocated for 6 weeks of observation to each of four conditions, including “control,” “olfactory,” “visual,” or “both” (i.e., “olfactory” and “visual” combined). It was hypothesized that hand hygiene compliance would be greater in all priming conditions relative to the control condition. The primary outcome was whether people used the gel dispenser when they entered the wards. After the trial, a follow up survey of staff at the same hospital assessed the barriers to, and facilitators of, hand hygiene compliance. The trial data were analyzed using regression techniques and the survey data were analyzed using descriptive statistics.ResultsThe total number of individuals observed in the trial was 9,811 (female = 61%), with similar numbers across conditions, including “control” N = 2,582, “olfactory” N = 2,700, “visual” N = 2,488, and “both” N = 2,141. None of the priming conditions consistently increased hand hygiene. The lowest percentage compliance was observed in the “both” condition (7.8%), and the highest was observed in the “visual” condition (12.7%). The survey was completed by 97 staff (female = 81%). “Environmental resources” and “social influences” were the greatest barriers to staff cleaning their hands.ConclusionsTaken together, the current findings suggest that the olfactory and visual priming interventions investigated do not influence hand hygiene consistently. To increase the likelihood of such interventions succeeding, future research should focus on prospectively determined mechanisms of action.
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Affiliation(s)
| | - Navneet Aujla
- Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Tom Marshall
- Primary Care Clinical Sciences Institute of Applied Health Research College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Abid Hussain
- Public Health England, Public Health Laboratory, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Gerard P. Hodgkinson
- Manchester Institute of Innovation Research, Alliance Manchester Business School, The University of Manchester, Manchester, United Kingdom
| | - Kristopher L. Arheart
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | - David J. Birnbach
- Department of Anesthesiology, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Laura Kudrna
- Institute of Applied Health, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Laura Kudrna
| | - Ivo Vlaev
- Behavioral Science Group, Warwick Business School, The University of Warwick, Coventry, United Kingdom
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Azor-Martinez E, Garcia-Mochon L, Lopez-Lacort M, Strizzi JM, Muñoz-Vico FJ, Jimenez-Lorente CP, Fernandez-Campos MA, Bueno-Rebollo C, Del Castillo-Aguas G, Balaguer-Martinez JV, Gimenez-Sanchez F. Child Care Center Hand Hygiene Programs' Cost-Effectiveness in Preventing Respiratory Infections. Pediatrics 2021; 148:183449. [PMID: 34814193 DOI: 10.1542/peds.2021-052496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We previously demonstrated that a hand hygiene program, including hand sanitizer and educational measures, for day care center (DCC) staff, children, and parents was more effective than a soap-and-water program, with initial observation, in preventing respiratory infections (RIs) in children attending DCCs. We analyzed the cost-effectiveness of these programs in preventing RIs. METHODS A cluster, randomized, controlled and open study of 911 children aged 0 to 3 years, attending 24 DCCs in Almeria. Two intervention groups of DCC-families performed educational measures and hand hygiene, one with soap-and-water (SWG) and another with hand sanitizer (HSG). The control group (CG) followed usual hand-washing procedures. RI episodes, including symptoms, treatments, medical contacts, complementary analyses, and DCC absenteeism days, were reported by parents. A Bayesian cost-effectiveness model was developed. RESULTS There were 5201 RI episodes registered. The adjusted mean societal costs of RIs per child per study period were CG: €522.25 (95% confidence interval [CI]: 437.10 to 622.46); HSG: €374.53 (95% CI: 314.90 to 443.07); SWG: €494.51 (95% CI: 419.21 to 585.27). The indirect costs constituted between 35.7% to 43.6% of the total costs. Children belonging to the HSG had an average of 1.39 fewer RI episodes than the CG and 0.93 less than the SWG. It represents a saving of societal cost mean per child per study period of €147.72 and €119.15, respectively. The HSG intervention was dominant versus SWG and CG. CONCLUSIONS Hand hygiene programs that include hand sanitizer and educational measures for DCC staff, children, and parents are more effective and cost less than a program with soap and water and initial observation in children attending DCCs.
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Affiliation(s)
| | - Leticia Garcia-Mochon
- Escuela Andaluza de Salud Pública, University of Granada, Granada, Spain.,Center for Biomedical Research Network in Epidemiology and Public Health, Madrid, Spain.,Institute of Biomedical Research Granada, University Hospitals of Granada, University of Granada, Granada, Spain
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KHosravi N, Alami A, Aelami MH, KHosrovan S. Improving Hand Hygiene Compliance of Intensive Care Unit by Using Pender's Model. Ethiop J Health Sci 2021; 31:553-560. [PMID: 34483612 PMCID: PMC8365475 DOI: 10.4314/ejhs.v31i3.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022] Open
Abstract
Background Hand hygiene (HH) compliance is an effective behavior in controlling hospital-acquired infection because the hand is the main means of transmitting infections in patient-medical staff communication as well as the inanimate environment. This study aimed to explore the effect of applying Pender's Health Promotion Model on the HH compliance of intensive care unit staff. Methods This quasi-experimental study with a single research group was conducted from January to July in 2019. The required data were collected from 90 staff of the intensive care units of Imam Reza Hospital in Mashhad, Iran through 1796 and 2343 opportunity of monitoring before and after the intervention. The data collection instruments were a standard HH observation form and a researcher-made HH questionnaire in the light of Pender's health promotion model. The data were statistically analyzed in SPSS using Paired-samples T-test and Chi-squared test. Results The mean age of the 90 included participants was 35.92 (± 6.5) years and the mean length of their work experience was 10 (±1.5). The hand hygiene index rose from 23% before the intervention to 41.4% after the intervention (p=0.001). Moreover, statistically significant differences were found in moments after touching surroundings (p=0.001), before and after touching a patient (p=0.001), and also in perceived barriers (p=0.015), interpersonal influences (p=0.008) and situational influences (p<0.001). Conclusion Pender's model showed to have improved the staff's HH compliance as a professional behavior.
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Affiliation(s)
- Nasrin KHosravi
- Department of Community Health Nursing & Management Nursing, School of Nursing, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Ali Alami
- Department of Social Medicine, Social Determinants of Health Research Center, School of Public Health Faculty, Gonabad University of Medical Sciences, Gonabad, Iran. Orcid ID: https://orcid.org/0000-0002-8882-3110
| | - Mohammad Hasan Aelami
- Department of Pediatrics, School of Medicine, Antimicrobial Resistance Research Center, Basic Sciences Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shahla KHosrovan
- Department of Community Health Nursing & Management Nursing, School of Nursing, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad
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Stewart S, Robertson C, Pan J, Kennedy S, Dancer S, Haahr L, Manoukian S, Mason H, Kavanagh K, Cook B, Reilly J. Epidemiology of healthcare-associated infection reported from a hospital-wide incidence study: considerations for infection prevention and control planning. J Hosp Infect 2021; 114:10-22. [PMID: 34301392 DOI: 10.1016/j.jhin.2021.03.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The measure of disease frequency most widely used to report healthcare-associated infection (HAI) is the point-prevalence survey. Incidence studies are rarely performed due to time and cost constraints; they show which patients are affected by HAI, when and where, and inform planning and design of infection prevention and control (IPC) measures. AIM To determine the epidemiology of HAI within a general and a teaching hospital in Scotland. METHODS A prospective observational incidence study was undertaken for one year from April 2018 using data collected as part of the Evaluation of Cost of Nosocomial Infection (ECONI) study. A novel, robust approach was undertaken, using record linkage to national administrative data to provide full admission and discharge information. Cases were recorded if they met international HAI definitions. FINDINGS Incidence of HAI for the combined hospitals was 250 HAI cases per 100,000 acute occupied bed-days (AOBD). Highest frequency was in urinary tract (51.2 per 100,000 AOBD), bloodstream (44.7), and lower respiratory tract infection (42.2). The most frequently reported organisms were Escherichia coli, Staphylococcus aureus, and norovirus. Incidence of HAI was higher in older people and emergency cases. There was an increase in the rate of HAI in summer months (pneumonia, respiratory, surgical, and gastrointestinal infection) and in winter months norovirus gastrointestinal infection (P < 0.0001). The highest incidence specialties were intensive care, renal medicine, and cardiothoracic surgery. HAI occurred at a median of 9 days (interquartile range: 4-19) after admission. Incidence data were extrapolated to provide an annual national estimate of HAI in NHS Scotland of 7437 (95% confidence interval: 7021-7849) cases. CONCLUSION This study provides a unique overview of incidence of HAI and identifies the burden of HAI at the national level for the first time. Understanding the incidence in different clinical settings, at different times, will allow targeting of IPC measures to those patients who would benefit the most.
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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 Dancer
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, UK; School of Applied Sciences, Edinburgh Napier University, Edinburgh, 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
| | - 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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Hachenberg J, Acis E, Auer-Schmidt MM, Warm M, Malter W, Thangarajah F, Eichler C. Preoperative Octenidine Application in Breast Reconstruction Surgery. In Vivo 2021; 35:549-554. [PMID: 33402508 DOI: 10.21873/invivo.12290] [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: 10/19/2020] [Revised: 11/21/2020] [Accepted: 11/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Postoperative infection in implant-based reconstructive breast surgery is a common problem. The preoperative application of a disinfecting washing agent may reduce postoperative infection rates. This retrospective analysis aimed to evaluate whether preoperative Octenisan® application yields a reduction in postoperative complications or infection rates in breast reconstructive surgery. PATIENTS AND METHODS Between 2016 and 2019, 127 women received implant-based breast reconstruction at the municipal hospital of Cologne, Holweide, Germany. A total of 197 treatments were performed. After giving consent, patients were asked to use Octenisan® wash lotion for five days before breast reconstructive surgery. All patients were asked by a simple questionnaire whether they performed showering and washing according to the proposed protocol. In 96 cases patients did adhere to the protocol. In 101 cases they did not. Patient cohorts were then divided into patients who had applied Octenisan® wash lotion and patients who had not. Endpoints were defined as minor complications with no implant loss and major complications with consecutive implant loss. RESULTS Patient adherence to the application regimen was 48.7%. Overall minor complications occurred in 34.4% with preoperative Octenidine usage and 36.6% without preoperative Octenidine usage. Major complications happened in 7% with preoperative Octenidine and 5% without Octenidine. Overall, there was no significant difference concerning minor or major complication rates. CONCLUSION Preoperative washing protocols involving the Octenisan® wash lotion is relatively cheap and easy to follow. There is evidence that washing protocols result in a reduction of S. aureus infections leading to a better perioperative outcome. Octenisan® is safe to use in implant-based breast reconstructive surgery and is not associated with higher risks for patients. Our study did not yield any significant reduction in perioperative and postoperative complication and infection rates. This is attributed to a relatively low study population. Wash lotion compliance was only 48.7%. Proper patient education is crucial. With those preliminary data, it is now possible to design a larger analysis since patient adherence to washing protocol with Octenisan® wash lotion has been established.
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Affiliation(s)
- Jens Hachenberg
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany;
| | - Ellen Acis
- Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany
| | | | - Mathias Warm
- Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.,Department of Gynecology and Obstetrics, Frauenklinik Holweide, Kliniken der Stadt Köln, Cologne, Germany
| | - Wolfram Malter
- Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, The University of Cologne, Cologne, Germany
| | - Fabinshy Thangarajah
- Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany
| | - Christian Eichler
- Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.,Department of Gynecology and Obstetrics, Frauenklinik Holweide, Kliniken der Stadt Köln, Cologne, Germany.,German Center for Material Science in Gynecology and Senology (DZMGS), Cologne, Germany
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10
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Effectiveness of an electronic hand hygiene monitoring system in increasing compliance and reducing healthcare-associated infections. J Hosp Infect 2021; 115:71-74. [PMID: 34058262 DOI: 10.1016/j.jhin.2021.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/18/2021] [Accepted: 05/18/2021] [Indexed: 12/29/2022]
Abstract
During an interventional study in a nephrology department, we investigated the effect of an electronic hand hygiene monitoring system on the hand hygiene compliance of healthcare workers (N = 99) and hospital-acquired bloodstream infections. The hand hygiene compliance of the doctors and nurses improved significantly during the intervention phase when they received group and individual feedback based on actionable insights from the electronic hand hygiene monitoring system. The improvements in hand hygiene compliance were associated with a significant reduction in the number of hospital-acquired bloodstream infections.
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11
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Cawthorne KR, Cooke R. A survey of commercially available electronic hand hygiene monitoring systems and their impact on reducing healthcare-associated infections. J Hosp Infect 2021; 111:40-46. [DOI: 10.1016/j.jhin.2021.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 01/18/2023]
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12
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Kısacık ÖG, Ciğerci Y, Güneş Ü. Impact of the fluorescent concretization intervention on effectiveness of hand hygiene in nursing students: A randomized controlled study. NURSE EDUCATION TODAY 2021; 97:104719. [PMID: 33341066 DOI: 10.1016/j.nedt.2020.104719] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/20/2020] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Hand hygiene is the most effective and simplest infection control method but there is a considerable amount of evidence that shows hand hygiene skills of nursing students should be improved. Nursing education plays an important role in giving nursing students the necessary knowledge, beliefs and teaching and improving basic hand hygiene skills. An effective learning method that enables students to understand both the practical skills and the underlying theoretical principles should be used in teaching hand hygiene. OBJECTIVES The aim of this study was to compare the effects of a fluorescent concretization intervention and conventional education on improving the hand hygiene beliefs and skills of nursing students. DESIGN AND SETTING This double blinded pretest-posttest randomized controlled trial was carried out from January 1 to June 1, 2019 with the participation of 126 nursing students in a faculty of health science in a state university in Turkey. METHODS The participants were randomly assigned to an intervention group (n = 63), receiving education with a fluorescent concretization intervention, and a control group (n = 63) receiving conventional education. RESULTS There was a significant difference between the intervention and control groups in terms of the total post-test hand hygiene belief score (p = .016 effect size(r) = 0.214). The final handwashing skill score of the students in the intervention group increased significantly for the seven regions of hands (p < .001 effect size(r) = 0.863). In addition, final handwashing skill score in the intervention group (20.62 ± 4.07) was found to be significantly higher than that of the students in the control group (12.57 ± 2.85) (p < .001 effect size(r) = 0.805). CONCLUSION Hand hygiene training which includes visual concretization intervention with glo germ can be used as a useful strategy to improve nursing students' negative beliefs about hand hygiene and to gain students to effective handwashing behaviors.
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Affiliation(s)
- Öznur Gürlek Kısacık
- Faculty of Health Science, Fundamentals of Nursing Department, Afyonkarahisar Health Science University, 03200 Afyonkarahisar, Turkey.
| | - Yeliz Ciğerci
- Faculty of Health Science, Surgical Nursing Department, Afyonkarahisar Health Science University, 03200 Afyonkarahisar, Turkey
| | - Ülkü Güneş
- Faculty of Nursing, Ege University, 35030 Bornova, İzmir, Turkey
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13
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McGinn C, Scott R, Donnelly N, Roberts KL, Bogue M, Kiernan C, Beckett M. Exploring the Applicability of Robot-Assisted UV Disinfection in Radiology. Front Robot AI 2021; 7:590306. [PMID: 33501347 PMCID: PMC7815819 DOI: 10.3389/frobt.2020.590306] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/12/2020] [Indexed: 01/21/2023] Open
Abstract
The importance of infection control procedures in hospital radiology departments has become increasingly apparent in recent months as the impact of COVID-19 has spread across the world. Existing disinfectant procedures that rely on the manual application of chemical-based disinfectants are time consuming, resource intensive and prone to high degrees of human error. Alternative non-touch disinfection methods, such as Ultraviolet Germicidal Irradiation (UVGI), have the potential to overcome many of the limitations of existing approaches while significantly improving workflow and equipment utilization. The aim of this research was to investigate the germicidal effectiveness and the practical feasibility of using a robotic UVGI device for disinfecting surfaces in a radiology setting. We present the design of a robotic UVGI platform that can be deployed alongside human workers and can operate autonomously within cramped rooms, thereby addressing two important requirements necessary for integrating the technology within radiology settings. In one hospital, we conducted experiments in a CT and X-ray room. In a second hospital, we investigated the germicidal performance of the robot when deployed to disinfect a CT room in <15 minutes, a period which is estimated to be 2-4 times faster than current practice for disinfecting rooms after infectious (or potentially infectious) patients. Findings from both test sites show that UVGI successfully inactivated all of measurable microbial load on 22 out of 24 surfaces. On the remaining two surfaces, UVGI reduced the microbial load by 84 and 95%, respectively. The study also exposes some of the challenges of manually disinfecting radiology suites, revealing high concentrations of microbial load in hard-to-reach places. Our findings provide compelling evidence that UVGI can effectively inactivate microbes on commonly touched surfaces in radiology suites, even if they were only exposed to relatively short bursts of irradiation. Despite the short irradiation period, we demonstrated the ability to inactivate microbes with more complex cell structures and requiring higher UV inactivation energies than SARS-CoV-2, thus indicating high likelihood of effectiveness against coronavirus.
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Affiliation(s)
- Conor McGinn
- School of Engineering, Trinity College Dublin, Dublin, Ireland
- Akara Robotics, Dublin, Ireland
| | - Robert Scott
- School of Engineering, Trinity College Dublin, Dublin, Ireland
| | | | - Kim L. Roberts
- Department of Microbiology, Trinity College Dublin, Dublin, Ireland
| | - Marina Bogue
- Department of Microbiology, Trinity College Dublin, Dublin, Ireland
| | | | - Michael Beckett
- Department of Microbiology, Trinity College Dublin, Dublin, Ireland
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14
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Xu N, Liu C, Feng Y, Li F, Meng X, Lv Q, Lan C. Influence of the Internet of Things management system on hand hygiene compliance in an emergency intensive care unit. J Hosp Infect 2020; 109:101-106. [PMID: 33346043 DOI: 10.1016/j.jhin.2020.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/01/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hand hygiene is a critical strategy for infection prevention in all healthcare settings. Automated electronic monitoring systems are expected to improve hand hygiene performance. AIM To investigate the impact of the Internet of Things (IoT) management system on hand hygiene compliance among medical staff in an emergency intensive care unit (EICU). METHODS This retrospective observational study was conducted between July 1st, 2017 and February 28th, 2018 in a 19-bed EICU. The changes in hand hygiene compliance among 54 members of medical staff and the incidence of hospital infections were compared, counted, and analysed before and after implementing the IoT management system in the EICU that was initiated on November 1st, 2017. FINDINGS After the application of the IoT management system, the hand hygiene compliance rates among the members of the medical staff before (29.5% (3347/11,338) vs 57.9% (4690/8094), P < 0.001) and after (59.9% (9915/16,556) vs 73.8% (17,194/23 286), P < 0.001) the contact with patients and surrounding environment significantly improved. However, hand hygiene compliance among three cleaning staff did not significantly improve after the application. Moreover, there was no significant difference in healthcare-acquired infection rates (2.535% (9/355) vs 2.047% (7/342), P = 0.667) nor in the detection rates of the four major multidrug-resistant bacteria in the EICU before and after the application of the IoT management system (P > 0.05). CONCLUSION The IoT management system significantly improved hand hygiene compliance among medical staff, except cleaners, in the EICU of one provincial hospital; however, the rates of nosocomial infection did not significantly decrease. The quality of hand hygiene implementation needs to be improved.
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Affiliation(s)
- N Xu
- Emergency Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - C Liu
- Department of Infection Management, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - Y Feng
- Department of Infection Management, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - F Li
- Department of Infection Management, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - X Meng
- Emergency Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - Q Lv
- Emergency Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - C Lan
- Emergency Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China.
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15
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Ge XY, Pu Y, Liao CH, Huang WF, Zeng Q, Zhou H, Yi B, Wang AM, Dou QY, Zhou PC, Chen HL, Liu HX, Xu DM, Chen X, Huang X. Evaluation of the exposure risk of SARS-CoV-2 in different hospital environment. SUSTAINABLE CITIES AND SOCIETY 2020; 61:102413. [PMID: 32834932 PMCID: PMC7375302 DOI: 10.1016/j.scs.2020.102413] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 05/03/2023]
Abstract
The ongoing coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has imposed a significant impact on social and economic activities. As a high infectious pathogen, the existence of SARS-CoV-2 in public space is very important for its transmission. During the COVID-19 pandemic, hospitals are the main places to deal with the diseases. In this work, we evaluated the exposure risk of SARS-CoV-2 in hospital environment in order to protect healthcare workers (HCWs). Briefly, air and surface samples from 6 different sites of 3 hospitals with different protection levels were collected and tested for the SARS-CoV-2 nucleic acid by reverse transcription real-time fluorescence PCR method during the COVID-19 epidemic. We found that the positive rate of SARS-CoV-2 nucleic acid was 7.7 % in a COVID-19 respiratory investigation wards and 82.6 % in a ICUs with confirmed COVID-19 patients. These results indicated that in some wards of the hospital, such as ICUs occupied by COVID-19 patients, the nucleic acid of SARS-CoV-2 existed in the air and surface, which indicates the potential occupational exposure risk of HCWs. This study has clarified retention of SARS-CoV-2 in different sites of hospital, suggesting that it is necessary to monitor and disinfect the SARS-CoV-2 in hospital environment during COVID-19 pandemic, and will help to prevent the iatrogenic infection and nosocomial transmission of SARS-CoV-2 and to better protect the HCWs.
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Affiliation(s)
- Xing-Yi Ge
- Institute of Pathogen Biology and Immunology, College of Biology, Hunan Provincial Key Laboratory of Medical Virology, Hunan University, Changsha, China
| | - Ying Pu
- Department of Hospital Infection Control Center, Xiangya Hospital of Central South University, Changsha, China
- Department of Endocrine Subspecialty of Gerontology, Xiangya Hospital of Central South University, Changsha, China
| | - Ce-Heng Liao
- Institute of Pathogen Biology and Immunology, College of Biology, Hunan Provincial Key Laboratory of Medical Virology, Hunan University, Changsha, China
| | - Wen-Fen Huang
- Department of Infectious Diseases, Chenzhou Second People's Hospital, Chenzhou, China
| | - Qi Zeng
- Department of Infectious Diseases, Shaoyang Central Hospital, Shaoyang, China
| | - Hui Zhou
- Clinical Laboratory, Xiangya Hospital of Central South University, Changsha, China
| | - Bin Yi
- Clinical Laboratory, Xiangya Hospital of Central South University, Changsha, China
| | - Ai-Min Wang
- Department of Emergency Medicine, Xiangya Hospital of Central South University, Changsha, China
| | - Qing-Ya Dou
- Department of Hospital Infection Control Center, Xiangya Hospital of Central South University, Changsha, China
| | - Peng-Cheng Zhou
- Department of Hospital Infection Control Center, Xiangya Hospital of Central South University, Changsha, China
| | - Hui-Ling Chen
- Department of Endocrine Subspecialty of Gerontology, Xiangya Hospital of Central South University, Changsha, China
| | - Hui-Xia Liu
- Department of Endocrine Subspecialty of Gerontology, Xiangya Hospital of Central South University, Changsha, China
| | - Dao-Miao Xu
- Department of Critical Care Medicine, Xiangya Hospital of Central South University, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital of Central South University, Changsha, China
| | - Xun Huang
- Department of Hospital Infection Control Center, Xiangya Hospital of Central South University, Changsha, China
- National Center for Clinical Medicine of Geriatric Diseases, Changsha, China
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16
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Guest JF, Keating T, Gould D, Wigglesworth N. Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England. BMJ Open 2020; 10:e033367. [PMID: 31974088 PMCID: PMC7045184 DOI: 10.1136/bmjopen-2019-033367] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To estimate the annual health economic impact of healthcare-associated infections (HCAIs) to the National Health Service (NHS) in England. DESIGN A modelling study based on a combination of published data and clinical practice. SETTING NHS hospitals in England. PRIMARY AND SECONDARY OUTCOME MEASURES Annual number of HCAIs, additional NHS cost, number of occupied hospital bed days and number of days front-line healthcare professionals (HCPs) are absent from work. RESULTS In 2016/2017, there were an estimated 653 000 HCAIs among the 13.8 million adult inpatients in NHS general and teaching hospitals in England, of which 22 800 patients died as a result of their infection. Additionally, there were an estimated 13 900 HCAIs among 810 000 front-line HCPs in the year. These infections were estimated to account for a total of 5.6 million occupied hospital bed days and 62 500 days of absenteeism among front-line HCPs. In 2016/2017, HCAIs were estimated to have cost the NHS an estimated £2.1 billion, of which 99.8% was attributable to patient management and 0.2% was the additional cost of replacing absent front-line HCPs with bank or agency staff for a period of time. When the framework of the model was expanded to include all NHS hospitals in England (by adding specialist hospitals), there were an estimated 834 000 HCAIs in 2016/2017 costing the NHS £2.7 billion, and accounting for 28 500 patient deaths, 7.1 million occupied hospital bed days (equivalent to 21% of the annual number of all bed days across all NHS hospitals in England) and 79 700 days of absenteeism among front-line HCPs. CONCLUSION This study should provide updated estimates with which to inform policy and budgetary decisions pertaining to preventing and managing these infections. Clinical and economic benefits could accrue from an increased awareness of the impact that HCAIs impose on patients, the NHS and society as a whole.
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Affiliation(s)
- Julian F Guest
- Catalyst Consultants, Rickmansworth, UK
- King's College London, London, UK
| | | | - Dinah Gould
- Cardiff University School of Healthcare Studies, Cardiff, UK
- Healthcare Sciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Neil Wigglesworth
- Directorate of Infection, Guy's & St Thomas' NHS Foundation Trust, London, UK
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