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Roopashree MR. To Analyze and Evaluate the Rate of Compliance of Hand Hygiene Practices in a Tertiary Care Hospital: Initiation of Quality Improvement Program and Clinical Audit. Hosp Top 2024; 102:52-60. [PMID: 38264864 DOI: 10.1080/00185868.2024.2302599] [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] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Health care as a service organization is associated with hospital-acquired infection which is drawing attention. There are concerns raised by patients, attenders, stake holders, insurers, government agencies, and regulatory bodies. The study aims to evaluate the awareness and the rate of compliance with hand hygiene. METHODS The audit methodology implemented is a concurrent medical record audit. The period of the audit was conducted for 6 months. A random sampling method was incorporated. The sample size was determined as 20% of the staff had been involved. RESULTS The Total average level of awareness of hand hygiene and adherence to policy is 93.6%. The average of all the 3 categories of compliance at 5 levels of hand hygiene in percentage is 82.3%. DISCUSSION Hand hygiene practices if stringently implemented will minimize the cross-transmission of infection in health care facilities. By knowing the awareness level and compliance level are measured with standardized training modules. APPLICATIONS Create awareness on hand hygiene and provide training with respect to the effectiveness of implementation. Incorporate hand hygiene steps as well as in the audit process. CONCLUSIONS There is a requirement for training with respect to the effectiveness of the implementation of the techniques. The level of care and quality of services can be made better by incorporating quality improvement programs (QIPs). By regular audits, we can raise the service quality and benchmark it.
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Eriksson E, Griffith GL, Nuutila K. Topical Drug Delivery in the Treatment of Skin Wounds and Ocular Trauma Using the Platform Wound Device. Pharmaceutics 2023; 15:pharmaceutics15041060. [PMID: 37111546 PMCID: PMC10145636 DOI: 10.3390/pharmaceutics15041060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/18/2023] [Accepted: 03/23/2023] [Indexed: 03/28/2023] Open
Abstract
Topical treatment of injuries such as skin wounds and ocular trauma is the favored route of administration. Local drug delivery systems can be applied directly to the injured area, and their properties for releasing therapeutics can be tailored. Topical treatment also reduces the risk of adverse systemic effects while providing very high therapeutic concentrations at the target site. This review article highlights the Platform Wound Device (PWD) (Applied Tissue Technologies LLC, Hingham, MA, USA) for topical drug delivery in the treatment of skin wounds and eye injuries. The PWD is a unique, single-component, impermeable, polyurethane dressing that can be applied immediately after injury to provide a protective dressing and a tool for precise topical delivery of drugs such as analgesics and antibiotics. The use of the PWD as a topical drug delivery platform has been extensively validated in the treatment of skin and eye injuries. The purpose of this article is to summarize the findings from these preclinical and clinical studies.
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Watson F, Wilks SA, Keevil CW, Chewins J. Evaluating the environmental microbiota across four National Health Service hospitals within England. J Hosp Infect 2023; 131:203-212. [PMID: 36343745 DOI: 10.1016/j.jhin.2022.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
Hospital surfaces contaminated with microbial soiling, such as dry surface biofilms (DSBs), can act as a reservoir for pathogenic micro-organisms, and inhibit their detection and removal during routine cleaning. Studies have recognized that such increases in bioburden can hinder the impact of disinfectants and mask the detection of potential pathogens. Cleanliness within healthcare settings is often determined through routine culture-based analysis, whereby surfaces that exhibit >2.5 colony-forming units (CFU) per cm2 pose a risk to patient health; therefore, any underestimation could have detrimental effects. This study quantified microbial growth on high-touch surfaces in four hospitals in England over 19 months. This was achieved using environmental swabs to sample a variety of surfaces within close proximity of the patient, and plating these on to non-specific low nutrient detection agar. The presence of DSBs on surfaces physically removed from the environment was confirmed using real-time imaging through episcopic differential interference contrast microscopy combined with epifluorescence. Approximately two-thirds of surfaces tested exceeded the limit for cleanliness (median 2230 CFU/cm2), whilst 83% of surfaces imaged with BacLight LIVE/DEAD staining confirmed traces of biofilm. Differences in infection control methods, such as choice of surface disinfectants and cleaning personnel, were not reflected in the microbial variation observed and resulting risk to patients. This highlights a potential limitation in the effectiveness of the current standards for all hospital cleaning, and further development using representative clinical data is required to overcome this limitation.
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Affiliation(s)
- F Watson
- School of Biological Sciences, University of Southampton, Southampton, UK; Bioquell UK Ltd, Andover, UK
| | - S A Wilks
- School of Health Sciences, University of Southampton, Southampton, UK
| | - C W Keevil
- School of Biological Sciences, University of Southampton, Southampton, UK
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Graves N, Cai Y, Mitchell B, Fisher D, Kiernan M. Cost effectiveness of temporary isolation rooms in acute care settings in Singapore. PLoS One 2022; 17:e0271739. [PMID: 35867648 PMCID: PMC9307192 DOI: 10.1371/journal.pone.0271739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/06/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives To estimate the change to health service costs and health benefits from a decision to adopt temporary isolation rooms that are effective at isolating the patient within a general ward environment. We assess the cost-effectiveness of a decision to adopt an existing temporary isolation room in a Singapore setting. Method We performed a model-based cost-effectiveness analysis to evaluate the impact of a decision to adopt temporary isolation rooms for infection prevention. We estimated changes to the costs from implementation, the number of cases of healthcare associated infection, acute care bed days used, they money value of bed days, the number of deaths, and the expected change to life years. We report the probability that adoption was cost-effective by the cost by life year gained, against a relevant threshold. Uncertainty is addressed with probabilistic sensitivity analysis and the findings are tested with plausible scenarios for the effectiveness of the intervention. Results We predict 478 fewer cases of HAI per 100,000 occupied bed days from a decision to adopt temporary isolation rooms. This will result in cost savings of $SGD329,432 and there are 1,754 life years gained. When the effectiveness of the intervention is set at 1% of cases of HAI prevented the incremental cost per life year saved is $16,519; below the threshold chosen for cost-effectiveness in Singapore. Conclusions We provide some evidence that adoption of a temporary isolation room is cost-effective for Singapore acute care hospitals. It is plausible that adoption is a positive decision for other countries in the region who may demonstrate fewer resources for infection prevention and control.
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Affiliation(s)
- Nicholas Graves
- Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
- * E-mail:
| | - Yiying Cai
- Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Brett Mitchell
- School of Nursing and Midwifery, University of Newcastle, Ourimbah, NSW, Australia
| | - Dale Fisher
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Martin Kiernan
- School of Nursing and Midwifery, University of Newcastle, Ourimbah, NSW, Australia
- Gama Healthcare Ltd, Hemel Hempstead, United Kingdom
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Hirani S, Trivedi NA, Chauhan J, Chauhan Y. A study of clinical and economic burden of surgical site infection in patients undergoing caesarian section at a tertiary care teaching hospital in India. PLoS One 2022; 17:e0269530. [PMID: 35658054 PMCID: PMC9165765 DOI: 10.1371/journal.pone.0269530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background Caesarian section is one of the most commonly performed surgeries in India. Determination of the incidence as well as the clinical and financial burden of post caesarian surgical site infection (SSI), is of critical importance for all the stakeholders for rational and fair allocation of resources. Methods This study was a prospective observational case-control study. The mean direct and indirect cost of treatment for the cases were compared with the control patients. An unpaired t-test was used to compare the mean between the two groups. Results Out of 2024 patients, who underwent caesarian section during the study period, 114 had acquired incisional surgical site infection (ISSI), with the infection incidence being 5.63%. The total cost of illness due to post caesarian ISSI was almost three times higher compared to the non-infected matched control group. (P<0.0001). An average length of hospital stay in the ISSI patient group was 10 days longer than that in the control group (P<0.0001) and importantly total length of antimicrobial therapy(LOT) in patients with ISSI was also almost three times higher than the control group (P<0.0001). Conclusion The development of post caesarian SSI imposes a significant clinical as well as a financial burden. The study highlights the necessity of taking effective preventive measures to decrease the incidence of SSI.
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Affiliation(s)
- Shilpa Hirani
- Department of Pharmacology, Medical College & SSG Hospital, Vadodara, Gujarat, India
| | - Niyati A. Trivedi
- Department of Pharmacology, Medical College & SSG Hospital, Vadodara, Gujarat, India
- * E-mail:
| | - Janki Chauhan
- Department of Pharmacology, Medical College & SSG Hospital, Vadodara, Gujarat, India
| | - Yash Chauhan
- Department of Pharmacology, Medical College & SSG Hospital, Vadodara, Gujarat, India
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Kang J, Ji E, Kim J, Bae H, Cho E, Kim ES, Shin MJ, Kim HB. Evaluation of Patients' Adverse Events During Contact Isolation for Vancomycin-Resistant Enterococci Using a Matched Cohort Study With Propensity Score. JAMA Netw Open 2022; 5:e221865. [PMID: 35267031 PMCID: PMC8914578 DOI: 10.1001/jamanetworkopen.2022.1865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Although contact isolation has been widely recommended for multidrug-resistant organisms, contact isolation has raised some concerns that it may bring unintended patient harms. OBJECTIVE To compare adverse events between a contact isolation group with vancomycin-resistant Enterococcus (VRE) and a matched comparison group using a relatively large data set from full electronic medical records (EMR) and propensity score-matching methods. DESIGN, SETTING, AND PARTICIPANTS This retrospective, matched cohort study was conducted at Seoul National University Bundang Hospital (SNUBH) in Korea, a tertiary, university-affiliated hospital that has 1337 inpatient beds. Participants included a total of 98 529 hospitalized adult patients (aged ≥18 years) during 2015 to 2017. EXPOSURES Contact isolation in a single or shared double room. MAIN OUTCOMES AND MEASURES As adverse contact isolation-related outcomes, falls and pressure ulcers were included. All relevant EMR data were extracted from the SNUBH clinical data warehouse. Risk factors for adverse events were included in the propensity score model based on literature reviews, such as Braden scale score and Hendrich II fall risk score. A fine stratification and weighting (FSW) and a 1:10 nearest neighbor (NN) propensity score matching as a sensitivity analysis were adopted to compare adverse events between the 2 groups for the observation period from the study entry date and the exit date. Time-to-event analyses with a Cox proportional hazard model were conducted in December 2021. RESULTS For comparison of outcomes in wards, 177 patients (mean [SD] age, 67.38 [14.12] years; 98 [55.4%] female) with VRE and 93 022 patients (mean [SD] age, 56.44 [16.88] years; 49 462 [53.2%] female) without VRE were included and no difference was found in basic characteristics from the FSW (VRE contact isolation [n = 172] vs comparison [n = 69 434]) as well as from the 1:10 NN (VRE contact isolation [n = 168] vs comparison [n = 1650]). Among 177 patients with VRE contact isolation, 8 pressure ulcers and 3 falls occurred during their hospital stays; incidence rates of adverse events were 2.5 and 0.9 per 1000 patient-days, respectively (pressure ulcer incidence rate from the FSW: 2.53 per 1000 patient-days [95% CI, 1.09-4.99 per 1000 patient-days]; pressure ulcer incidence rate from the 1:10 NN: 2.54 per 1000 patient-days [95% CI, 1.10-5.01 per 1000 patient-days]; fall incidence rate from the FSW: 0.87 per 1000 patient-days [95% CI, 0.18-2.54 per 1000 patient-days]; fall incidence rate from the 1:10 NN: 0.87 per 1000 patient-days [95% CI, 0.18-2.55 per 1000 patient-days]). The hazard ratios for adverse events showed no statistically significant differences for both groups: 1.42 (95% CI, 0.67-2.99) for pressure ulcer and 0.66 (95% CI, 0.20-2.13) for fall from the FSW. CONCLUSIONS AND RELEVANCE In this cohort study, no association was found between the likelihood of adverse events and contact isolation using propensity score-matching methods and closely related covariates for adverse events.
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Affiliation(s)
- JaHyun Kang
- College of Nursing, Seoul National University, Seoul, Korea
- Research Institute of Nursing Science, Seoul National University, Seoul, Korea
| | - Eunjeong Ji
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Junghee Kim
- Division of Infectious Diseases, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Hyunok Bae
- Office of Digital Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Eunyoung Cho
- Office of Digital Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Eu Suk Kim
- Division of Infectious Diseases, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
- Center for Infection Control, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Myoung Jin Shin
- Center for Infection Control, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Hong Bin Kim
- Division of Infectious Diseases, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea
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Graves N, Mitchell BG, Otter JA, Kiernan M. The cost-effectiveness of temporary single-patient rooms to reduce risks of healthcare-associated infection. J Hosp Infect 2021; 116:21-28. [PMID: 34246721 DOI: 10.1016/j.jhin.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The use of single rooms for patient isolation often forms part of a wider bundle to prevent certain healthcare-associated infections (HAIs) in hospitals. Demand for single rooms often exceeds what is available and the use of temporary isolation rooms may help resolve this. Changes to infection prevention practice should be supported by evidence showing that cost-effectiveness is plausible and likely. AIM To perform a cost-effectiveness evaluation of adopting temporary single rooms into UK National Health Service (NHS) hospitals. METHODS The cost-effectiveness of a decision to adopt a temporary, single-patient, isolation room to the current infection prevention efforts of an NHS hospital was modelled. Primary outcomes are the expected change to total costs and life-years from an NHS perspective. FINDINGS The mean expected incremental cost per life-year gained (LYG) is £5,829. The probability that adoption is cost-effective against a £20,000 threshold per additional LYG is 93%, and for a £13,000 threshold the probability is 87%. The conclusions are robust to scenarios for key model parameters. If a temporary single-patient isolation room reduces risks of HAI by 16.5% then an adoption decision is more likely to be cost-effective than not. Our estimate of the effectiveness reflects guidelines and reasonable assumptions and the theoretical rationale is strong. CONCLUSION Despite uncertainties about the effectiveness of temporary isolation rooms for reducing risks of HAI, there is some evidence that an adoption decision is likely to be cost-effective for the NHS setting. Prospective studies will be useful to reduce this source of uncertainty.
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Affiliation(s)
- N Graves
- Health Services & Systems Research, Duke-NUS Medical School, Singapore.
| | - B G Mitchell
- School of Nursing and Midwifery, University of Newcastle, Ourimbah, NSW, Australia
| | - J A Otter
- National Institute for Healthcare Research Health Protection Research Unit (NIHR HPRU) in HCAI and AMR, Imperial College London & Public Health England, Hammersmith Hospital, London, UK
| | - M Kiernan
- Gama Healthcare Ltd, Hemel Hempstead, UK
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Estimating the excess bed days and economic burden of healthcare-associated infections in Singapore public acute-care hospitals. Infect Control Hosp Epidemiol 2021; 43:1245-1248. [PMID: 34016198 DOI: 10.1017/ice.2021.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We estimated the annual bed days lost and economic burden of healthcare-associated infections to Singapore hospitals using Monte Carlo simulation. The mean (standard deviation) cost of a single healthcare-associated infection was S$1,809 (S$440) [or US$1,362 (US$331)]. This translated to annual lost bed days and economic burden of 55,978 (20,506) days and S$152.0 million (S$37.1 million) [or US$114.4 million (US$27.9 million)], respectively.
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Bartsch SM, O'Shea KJ, Lee BY. The Clinical and Economic Burden of Norovirus Gastroenteritis in the United States. J Infect Dis 2021; 222:1910-1919. [PMID: 32671397 DOI: 10.1093/infdis/jiaa292] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/28/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Although norovirus outbreaks periodically make headlines, it is unclear how much attention norovirus may receive otherwise. A better understanding of the burden could help determine how to prioritize norovirus prevention and control. METHODS We developed a computational simulation model to quantify the clinical and economic burden of norovirus in the United States. RESULTS A symptomatic case generated $48 in direct medical costs, $416 in productivity losses ($464 total). The median yearly cost of outbreaks was $7.6 million (range across years, $7.5-$8.2 million) in direct medical costs, and $165.3 million ($161.1-$176.4 million) in productivity losses ($173.5 million total). Sporadic illnesses in the community (incidence, 10-150/1000 population) resulted in 14 118-211 705 hospitalizations, 8.2-122.9 million missed school/work days, $0.2-$2.3 billion in direct medical costs, and $1.4-$20.7 billion in productivity losses ($1.5-$23.1 billion total). The total cost was $10.6 billion based on the current incidence estimate (68.9/1000). CONCLUSION Our study quantified norovirus' burden. Of the total burden, sporadic cases constituted >90% (thus, annual burden may vary depending on incidence) and productivity losses represented 89%. More than half the economic burden is in adults ≥45, more than half occurs in winter months, and >90% of outbreak costs are due to person-to-person transmission, offering insights into where and when prevention/control efforts may yield returns.
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Affiliation(s)
- Sarah M Bartsch
- Public Health Informatics, Computational, and Operations Research, City University of New York, New York City, New York, USA
| | - Kelly J O'Shea
- Public Health Informatics, Computational, and Operations Research, City University of New York, New York City, New York, USA
| | - Bruce Y Lee
- Public Health Informatics, Computational, and Operations Research, City University of New York, New York City, New York, USA
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Rønfeldt I, Larsen LK, Pedersen PU. Urinary tract infection in patients with hip fracture. Int J Orthop Trauma Nurs 2021; 41:100851. [PMID: 33798910 DOI: 10.1016/j.ijotn.2021.100851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/11/2021] [Accepted: 02/10/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Urinary tract infection (UTI) is a frequent complication of hip fractures. The Danish national clinical guideline for hip fracture recommends early and systematic mobilisation after surgery and that indwelling catheters are not used perioperatively. AIMS The aim of this study was to describe the number of patients who received nursing care to prevent UTIs in accordance with the recommendations from the national Danish clinical guidelines. Specifically, the aim was to report the number of patients developing UTIs during admission, have indwelling catheters removed and being mobilised with 24 hours after surgery. METHODS This prospective study included 65 patients. Data were collected on mobilisation and catheter use with a chart designed for this study. Sterile intermittent catheterisation was used to collect urine samples on admission and at discharge. Urine samples were sent for analysis at the microbiology laboratory. The urine sample was positive for UTI if the test showed 104 CFU/ml bacteria. RESULTS A total of five patients contracted nosocomial UTI during their hospital stay (7.7%), while 29.2% of patients had a positive urine culture on admission and were treated for UTI. At discharge, 20% of the patients had a positive urine sample but no symptoms. Postoperatively, 52.3% of the patients were mobilised within 24 hours. CONCLUSION The incidence of nosocomial UTI was similar to what has been found in other studies (95% [CI], 0.03-0.17]). The percentage of patients with nosocomial UTI was 7.7%. Nursing care related to hygienic performance of catheterisation or intermittent catheterisation adhered to the Danish national clinical guidelines, and 52.3% of the patients were mobilised within 24 h after surgery, which showed low adherence to the guidelines.
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Affiliation(s)
- Ingerlise Rønfeldt
- Master of Science in Clinical Science and Technology, Aalborg University Hospital, Orthopedic Division, Clinic Farsoe, Denmark.
| | - Lis Kjær Larsen
- Master of Clinical Nursing, Aalborg University Hospital, Orthopedic Division, Clinic Hjoerring, Denmark
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Lee BY, Bartsch SM, Lin MY, Asti L, Welling J, Mueller LE, Leonard J, Brown ST, Doshi K, Kemble SK, Mitgang EA, Weinstein RA, Trick WE, Hayden MK. How Long-Term Acute Care Hospitals Can Play an Important Role in Controlling Carbapenem-Resistant Enterobacteriaceae in a Region: A Simulation Modeling Study. Am J Epidemiol 2021; 190:448-458. [PMID: 33145594 DOI: 10.1093/aje/kwaa247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 11/14/2022] Open
Abstract
Typically, long-term acute care hospitals (LTACHs) have less experience in and incentives to implementing aggressive infection control for drug-resistant organisms such as carbapenem-resistant Enterobacteriaceae (CRE) than acute care hospitals. Decision makers need to understand how implementing control measures in LTACHs can impact CRE spread regionwide. Using our Chicago metropolitan region agent-based model to simulate CRE spread and control, we estimated that a prevention bundle in only LTACHs decreased prevalence by a relative 4.6%-17.1%, averted 1,090-2,795 new carriers, 273-722 infections and 37-87 deaths over 3 years and saved $30.5-$69.1 million, compared with no CRE control measures. When LTACHs and intensive care units intervened, prevalence decreased by a relative 21.2%. Adding LTACHs averted an additional 1,995 carriers, 513 infections, and 62 deaths, and saved $47.6 million beyond implementation in intensive care units alone. Thus, LTACHs may be more important than other acute care settings for controlling CRE, and regional efforts to control drug-resistant organisms should start with LTACHs as a centerpiece.
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12
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The impact of healthcare associated infections on mortality and length of stay in Singapore-A time-varying analysis. Infect Control Hosp Epidemiol 2020; 41:1315-1320. [PMID: 32665057 DOI: 10.1017/ice.2020.304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Methods that include the time-varying nature of healthcare-associated infections (HAIs) avoid biases when estimating increased risk of death and excess length of stay. We determined the excess mortality risk and length of stay associated with HAIs among inpatients in Singapore using a multistate model that accommodates the timing of key events. DESIGN Analysis of existing prospective cohort study data. SETTING Seven public acute-care hospitals in Singapore. PATIENTS Inpatients reviewed in a HAI point-prevalence survey (PPS) conducted between June 2015 and February 2016. METHODS We modeled each patient's admission over time using 4 states: susceptible with no HAI, infected, died, and discharged alive. We estimated the excess mortality risk and length of stay associated with HAIs, with adjustment for the baseline characteristics between the groups for mortality risk. RESULTS We included 4,428 patients, of whom 469 had ≥1 HAI. Using a multistate model, the expected excess length of stay due to any HAI was 1.68 days (95% confidence interval [CI], 1.15-2.21 days). Surgical site infections were associated with the longest excess length of stay of 4.68 days (95% CI, 2.60-6.76 days). After adjusting for baseline differences, HAIs were associated with increased hazards of in-hospital mortality (adjusted hazard ratio [aHR], 1.32; 95% CI, 1.09-1.65) and decreased hazards in being discharged (aHR, 0.75; 95% CI, 0.67-0.84). CONCLUSIONS HAIs are associated with increased length of hospital stay and mortality in hospitalized patients. Avoiding nosocomial infections can improve patient outcomes and free valuable bed days.
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White NM, Barnett AG, Hall L, Mitchell BG, Farrington A, Halton K, Paterson DL, Riley TV, Gardner A, Page K, Gericke CA, Graves N. Cost-effectiveness of an Environmental Cleaning Bundle for Reducing Healthcare-associated Infections. Clin Infect Dis 2020; 70:2461-2468. [PMID: 31359053 PMCID: PMC7286366 DOI: 10.1093/cid/ciz717] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/29/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Healthcare-associated infections (HAIs) remain a significant patient safety issue, with point prevalence estimates being ~5% in high-income countries. In 2016-2017, the Researching Effective Approaches to Cleaning in Hospitals (REACH) study implemented an environmental cleaning bundle targeting communication, staff training, improved cleaning technique, product use, and audit of frequent touch-point cleaning. This study evaluates the cost-effectiveness of the environmental cleaning bundle for reducing the incidence of HAIs. METHODS A stepped-wedge, cluster-randomized trial was conducted in 11 hospitals recruited from 6 Australian states and territories. Bundle effectiveness was measured by the numbers of Staphylococcus aureus bacteremia, Clostridium difficile infection, and vancomycin-resistant enterococci infections prevented in the intervention phase based on estimated reductions in the relative risk of infection. Changes to costs were defined as the cost of implementing the bundle minus cost savings from fewer infections. Health benefits gained from fewer infections were measured in quality-adjusted life-years (QALYs). Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio and net monetary benefit of adopting the cleaning bundle over existing hospital cleaning practices. RESULTS Implementing the cleaning bundle cost $349 000 Australian dollars (AUD) and generated AUD$147 500 in cost savings. Infections prevented under the cleaning bundle returned a net monetary benefit of AUD$1.02 million and an incremental cost-effectiveness ratio of $4684 per QALY gained. There was an 86% chance that the bundle was cost-effective compared with existing hospital cleaning practices. CONCLUSIONS A bundled, evidence-based approach to improving hospital cleaning is a cost-effective intervention for reducing the incidence of HAIs.
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Affiliation(s)
- Nicole M White
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Western Australia
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - Adrian G Barnett
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Western Australia
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - Lisa Hall
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
- School of Public Health, University of Queensland, Brisbane, Western Australia
| | - Brett G Mitchell
- Discipline of Nursing, Avondale College of Higher Education, Wahroonga, New South Wales, Western Australia
- School of Nursing and Midwifery, University of Newcastle, New South Wales, Western Australia
| | - Alison Farrington
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Western Australia
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - Kate Halton
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - David L Paterson
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital, Crawley, Western Australia
| | - Thomas V Riley
- School of Biomedical Sciences, The University of Western Australia, Crawley, Western Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia
- School of Veterinary and Life Sciences, Murdoch University, Western Australia,, Cairns, Queensland, Australia
| | - Anne Gardner
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - Katie Page
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - Christian A Gericke
- School of Clinical Medicine, University of Queensland, Cairns, Queensland, Brisbane, Australia
- College of Public Health, Medical and Veterinary Sciences, and College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Nicholas Graves
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Western Australia
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
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Shepard J, Frederick J, Wong F, Madison S, Tompkins L, Hadhazy E. Could the prevention of health care-associated infections increase hospital cost? The financial impact of health care-associated infections from a hospital management perspective. Am J Infect Control 2020; 48:255-260. [PMID: 32089192 DOI: 10.1016/j.ajic.2019.08.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/30/2019] [Accepted: 08/31/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The financial burden health care-associated infections (HAIs) have on patients, payers, and hospitals is not clear. Although patient safety is the highest priority, administrators require data to justify the expense of HAI reduction programs. METHODS Chart review was performed to identify HAIs for patients discharged from Stanford Hospital. Using a t test, we tested whether patients with an HAI will have a different daily total hospital cost and length of stay than patients without an HAI. We calculated the change in hospital profit related to HAIs by comparing patients with and without an HAI in the same admit All-Patient Refined Diagnosis Related Group and complexity score. RESULTS Between October 1, 2015 and September 30, 2018, there were 78,551 inpatient discharges and 1,541 HAIs identified. Daily total hospital cost and length of stay for patients with an HAI versus patients without an HAI was $6,433 ($6,251, $6,615) versus $6,604 ($6,557, $6,651) (P = .073), and 26.30 days (24.89, 27.71) versus 5.69 (5.64, 5.74) (P < .001). DISCUSSION For each HAI eliminated, data suggests that hospital's cost and revenue would increase $25,008 and $1,518,682, respectively, by backfilling beds with new patients at a 4.62:1 ratio. The reduction of HAIs is profitable for hospitals. CONCLUSIONS Data from this study suggest that the more HAIs you eliminate and the more capacity you build for the hospital, the higher the total hospital costs will go. This is an essential shift to the current paradigm that will allow for the accurate and continued funding of HAI reduction programs. Although hospital cost appears to increase as HAIs are reduced, hospital profits rise even more.
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Castellanos JG, Preminger J, Steinkamp ML, Longman RS, Pryor KO. Evaluation of a novel ultraviolet C irradiation locker for microbial sterilization of hospital laboratory coats. J Hosp Infect 2020; 105:334-336. [PMID: 32027947 DOI: 10.1016/j.jhin.2020.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/27/2020] [Indexed: 11/16/2022]
Affiliation(s)
- J G Castellanos
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA; Jill Roberts Institute for Research in Inflammatory Bowel Disease, Weill Cornell Medicine, New York, NY, USA.
| | - J Preminger
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - M L Steinkamp
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - R S Longman
- Jill Roberts Institute for Research in Inflammatory Bowel Disease, Weill Cornell Medicine, New York, NY, USA; Jill Roberts Center for Inflammatory Bowel Disease, Weill Cornell Medicine, New York, NY, USA
| | - K O Pryor
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
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16
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Rojas D, Wendell D, Ferguson PhD TF, Robinson WT, Trepka MJ, Straif-Bourgeois SC. HIV-associated comorbidities as mediators of the association between people living with HIV and hospital-acquired infections. Am J Infect Control 2019; 47:1500-1504. [PMID: 31324490 DOI: 10.1016/j.ajic.2019.05.028] [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: 02/13/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hospital-acquired infections (HAIs) lead to poor health outcomes in hospitalized patients and may be disproportionately affecting the aging population of people living with HIV (PLWH). This study determined the association between HIV and HAIs, and analyzed the potential mediating effects of comorbidities. METHODS The Louisiana Hospital Inpatient Discharge Database for the years 2011-2015 was used. All patients with at least 1 HAI diagnosis within this source population were included as cases in the case-control study, and a 1:1 ratio of controls was randomly selected from the same hospitals. RESULTS Of the 1,852,769 eligible hospital discharges that occurred from 2011 through 2015, there were 7,422 patients with at least 1 HAI. Marginal logistic regressions of the case-control sample showed a strong association between HIV and central line-associated bloodstream infections (CLABSIs), but an inverse association between HIV and any HAI. However, the mediation analyses revealed that having at least 1 comorbidity mediates the association between HIV and CLABSIs. DISCUSSION The unexpected inverse association between HIV and HAI could be attributed to the sample size of the exposed group of patients, or it could be explained by the mechanisms of treatment for HIV patients. CONCLUSIONS This study found that people living with HIV are at an increased risk of developing a CLABSI, which is consistent with the published literature. The mediation analyses indicated that having at least 1 comorbidity mediated the association between HIV and CLABSI diagnosis.
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The potential economic value of sputum culture use in patients with community-acquired pneumonia and healthcare-associated pneumonia. Clin Microbiol Infect 2019; 25:1038.e1-1038.e9. [DOI: 10.1016/j.cmi.2018.11.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/07/2018] [Accepted: 11/17/2018] [Indexed: 11/24/2022]
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18
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Saleem Z, Godman B, Hassali MA, Hashmi FK, Azhar F, Rehman IU. Point prevalence surveys of health-care-associated infections: a systematic review. Pathog Glob Health 2019; 113:191-205. [PMID: 31215326 PMCID: PMC6758614 DOI: 10.1080/20477724.2019.1632070] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Health-care-associated infections (HAIs) are considered a serious public health issues that contribute substantially to the global burden of mortality and morbidity with respect to infectious diseases. The aim is to assess the burden of health-care-associated infections by collation of available data from published point prevalence surveys (PPS) on HAIs to give future guidance. Study protocol and methodology were designed according to preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Published research papers that conducted a point prevalence survey of HAIs in hospital settings by following the structured survey methodology employed by European Centre of Disease Prevention and Control (ECDC) were included. Of 1212 articles, 67 studies were included in the final analysis conducted across different countries. Overall, 35 studies were conducted in Europe, 21 in Asia, 9 in America, and 2 in Africa. The highest prevalence of HAIs was recorded in a study conducted in adult ICU settings of 75 regions of Europe (51.3%). The majority of the studies included HAI data on urinary tract infections, respiratory tract infections, and bloodstream infections. Klebsiella pneumonia, Pseudomonas aeruginosa and E. coli were the most frequent pathogens responsible for HAIs. PPS is an useful tool to quantify HAIs and provides a robust baseline data for policymakers. However, a standardize surveillance method is required. In order to minimize the burden of HAIs, infection prevention and control programs and antibiotic stewardship may be effective strategies to minimize the risk of HAIs.
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Affiliation(s)
- Zikria Saleem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia
- Rashid Latif College of Pharmacy, Lahore, Pakistan
| | - Brian Godman
- Department of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
| | - Mohamed Azmi Hassali
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia
| | | | - Faiza Azhar
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Inayat Ur Rehman
- School of Pharmacy, Monash University Malaysia, Kuala Selangor, Malaysia
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, Pakistan
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Ripabelli G, Tamburro M, Guerrizio G, Fanelli I, Agnusdei CP, Sammarco ML. A single-arm study to evaluate skin tolerance, effectiveness and adherence to use of an alcohol-based hand rub solution among hospital nurses. J Infect Prev 2019. [DOI: 10.1177/1757177419846295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Hand hygiene is considered as the most important strategy for preventing healthcare infections. Objective: In this single-arm study, skin tolerance, effectiveness and prolonged efficacy, and adherence to use an alcohol-based hand rub (ABHR) solution among hospital nurses was evaluated. Methods: Nurses were recruited in the main hospital of Molise Region, Central Italy. Skin reactions during 12-week follow-up were self-reported by nurses and, when occurring examined by hospital dermatologist. Samples were collected from palms and fingertips before and after ABHR, also at random times during work. Results: Dermatological reactions were not reported by 20 nurses (15 female and 5 male, aged 30–59 years) after product use. Microbial counts decreased by 99% (2Log10) in 75%, with higher reduction in palm than fingertips (99% vs 70% respectively). Analysis of six randomly collected samples after 10–20 and 30–40 min from the last use showed a satisfactory prolonged efficacy. Discussion: Beyond high effectiveness to reduce transient microbiota, no skin reactions were observed, likely due to the camomile, thyme and eucalyptus extracts contained within the gel. This study, addressing technical questions of a commercialised product, provides useful information for public health authorities faced with a choice of hand disinfectants, evaluating cost-effectiveness and cost-benefit in the light of the huge amount of these products needed at hospital level.
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Affiliation(s)
- Giancarlo Ripabelli
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - Manuela Tamburro
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - Giuliana Guerrizio
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - Incoronata Fanelli
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - Concetto Paolo Agnusdei
- Unit of Dermatology, Azienda Sanitaria Regionale del Molise, “A. Cardarelli” Hospital, Campobasso, Italy
| | - Michela Lucia Sammarco
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
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Blythe R, Naidoo S, Abbott C, Bryant G, Dines A, Graves N. Development and pilot of a multicriteria decision analysis (MCDA) tool for health services administrators. BMJ Open 2019; 9:e025752. [PMID: 31023757 PMCID: PMC6502058 DOI: 10.1136/bmjopen-2018-025752] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Health administration is complex and serves many masters. Value, quality, infrastructure and reimbursement are just a sample of the competing interests influencing executive decision-making. This creates a need for decision processes that are rational and holistic. METHODS We created a multicriteria decision analysis tool to evaluate six fields of healthcare provision: return on investment, capacity, outcomes, safety, training and risk. The tool was designed for prospective use, at the beginning of each funding round for competing projects. Administrators were asked to rank their criteria in order of preference. Each field was assigned a representative weight determined from the rankings. Project data were then entered into the tool for each of the six fields. The score for each field was scaled as a proportion of the highest scoring project, then weighted by preference. We then plotted findings on a cost-effectiveness plane. The project was piloted and developed over successive uses by the hospital's executive board. RESULTS Twelve projects competing for funding at the Royal Brisbane and Women's Hospital were scored by the tool. It created a priority ranking for each initiative based on the weights assigned to each field by the executive board. Projects were plotted on a cost-effectiveness plane with score as the x-axis and cost of implementation as the y-axis. Projects to the bottom right were considered dominant over projects above and to the left, indicating that they provided greater benefit at a lower cost. Projects below the x-axis were cost-saving and recommended provided they did not harm patients. All remaining projects above the x-axis were then recommended in order of lowest to highest cost-per-point scored. CONCLUSION This tool provides a transparent, objective method of decision analysis using accessible software. It would serve health services delivery organisations that seek to achieve value in healthcare.
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Affiliation(s)
- Robin Blythe
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Shamesh Naidoo
- Administration, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Cameron Abbott
- Administration, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Geoffrey Bryant
- Administration, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Amanda Dines
- Administration, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Nicholas Graves
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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21
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Mitchell BG, Fasugba O, Cheng AC, Gregory V, Koerner J, Collignon P, Gardner A, Graves N. Chlorhexidine versus saline in reducing the risk of catheter associated urinary tract infection: A cost-effectiveness analysis. Int J Nurs Stud 2019; 97:1-6. [PMID: 31129443 DOI: 10.1016/j.ijnurstu.2019.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Catheter associated urinary tract infections are one of the most common infections acquired in hospital. A recent randomised control study demonstrated the benefit of using chlorhexidine (0.1%) for meatal cleaning prior to urinary catheter insertion, by reducing both catheter associated asymptomatic bacteriuria and infection. These findings raise the important question of whether a decision to switch from saline to chlorhexidine was likely to be cost-effective. The aim of this paper was to evaluate the cost-effectiveness of adopting routine use of chlorhexidine for meatal cleaning prior to urinary catheter insertion METHODS: The outcomes of this cost-effectiveness study are changes to health service costs in $AUD and changes to quality adjusted life years from a decision to adopt 0.1% chlorhexidine for meatal cleaning prior to urinary catheter insertion as compared to saline. Effectiveness outcomes for this study were taken from a 32 week stepped wedge randomised controlled study conducted in three Australian hospitals. RESULTS The changes in health costs from switching from saline to 0.1% chlorhexidine per 100,000 catheterisations would save hospitals AUD$387,909 per 100,000 catherisations, prevent 70 cases of catheter associated urinary tract infections, release 282 bed days and provide a small improvement in health benefits of 1.43 quality adjusted life years. Using a maximum willingness to pay for a marginal quality adjusted life year threshold of AUD$28,000 per 100,000 catherisations, suggests that adopting chlorhexidine would be cost effective and potentially cost-saving. CONCLUSION The findings from our work provide evidence to health system administrators and those responsible for drafting catheter associated urinary tract infections prevention guidelines that investing in switching from saline to chlorhexidine is not only clinically effective but also a sensible decision in the context of allocating finite healthcare resources.
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Affiliation(s)
- Brett G Mitchell
- Faculty of Arts, Nursing and Theology, Avondale College of Higher Education, 185 Fox Valley Road, Wahroonga, New South Wales 2076, Australia; School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia.
| | - Oyebola Fasugba
- Nursing Research Institute, Australian Catholic University & St Vincent's Health Australia Sydney, New South Wales, Australia; Lifestyle Research Centre, Avondale College of Higher Education, Cooranbong, New South Wales, Australia
| | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Infectious Prevention and Healthcare Epidemiology Unit, Alfred Hospital, Melbourne, Australia
| | - Victoria Gregory
- Faculty of Arts, Nursing and Theology, Avondale College of Higher Education, 185 Fox Valley Road, Wahroonga, New South Wales 2076, Australia
| | - Jane Koerner
- School of Nursing, Midwifery and Paramedicine Australian Catholic University, Watson Australia
| | - Peter Collignon
- Australian Capital Territory Pathology, Canberra Hospital and Health Services, Yamba Drive, Garran, Australian Capital Territory 2605, Australia; Medical School, Australian National University, Acton, Australian Capital Territory 2601, Australia
| | - Anne Gardner
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nicholas Graves
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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22
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Contardi M, Heredia-Guerrero JA, Guzman-Puyol S, Summa M, Benítez JJ, Goldoni L, Caputo G, Cusimano G, Picone P, Di Carlo M, Bertorelli R, Athanassiou A, Bayer IS. Combining dietary phenolic antioxidants with polyvinylpyrrolidone: transparent biopolymer films based on p-coumaric acid for controlled release. J Mater Chem B 2019; 7:1384-1396. [PMID: 32255009 DOI: 10.1039/c8tb03017k] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Polyvinylpyrrolidone (PVP) has probably been one of the most utilized pharmaceutical polymers with applications ranging from a blood plasma substitute to nanoparticle drug delivery, since its synthesis in 1939. It is a highly biocompatible, non-toxic and transparent film forming polymer. Although high solubility of PVP in aqueous environment is advantageous, it still poses several problems for some applications in which sustained targeting and release are needed or hydrophobic drug inclusion and delivery systems are to be designed. In this study, we demonstrate that a common dietary phenolic antioxidant, p-coumaric acid (PCA), can be combined with PVP covering a wide range of molar ratios by solution blending in ethanol, forming new transparent biomaterial films with antiseptic and antioxidant properties. PCA not only acts as an effective natural plasticizer but also establishes H-bonds with PVP increasing its resistance to water dissolution. PCA could be released in a sustained manner up to a period of 3 days depending on the PVP/PCA molar ratio. Sustained drug delivery potential of the films was studied using methylene blue and carminic acid as model drugs, indicating that the release can be controlled. Antioxidant and remodeling properties of the films were evaluated in vitro by free radical cation scavenging assay and in vivo on a murine model, respectively. Furthermore, the material resorption of films was slower as PCA concentration increased, as observed from the in vivo full-thickness excision model. Finally, the antibacterial activity of the films against common pathogens such as Escherichia coli and Staphylococcus aureus and the effective reduction of inflammatory agents such as matrix metallopeptidases were demonstrated. All these properties suggest that these new transparent PVP/PCA films can find a plethora of applications in pharmaceutical sciences including skin and wound care.
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Affiliation(s)
- Marco Contardi
- Smart Materials, Istituto Italiano di Tecnologia, Via Morego, 30, Genova 16163, Italy.
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Khan S, P MR, Rizvi A, Alam MM, Rizvi M, Naseem I. ROS mediated antibacterial activity of photoilluminated riboflavin: A photodynamic mechanism against nosocomial infections. Toxicol Rep 2019; 6:136-142. [PMID: 30671349 PMCID: PMC6330557 DOI: 10.1016/j.toxrep.2019.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/04/2019] [Accepted: 01/08/2019] [Indexed: 11/16/2022] Open
Abstract
Riboflavin undergoes intersystem conversion under photoillumination. Interacts with molecular oxygen and generates ROS. Generated ROS disrupts E. coli cell membranes. Ultimately killing E. coli. Mechanism can be used to kill E. coli on hospital ware causing nosocomial infections.
Nosocomial infections are a major threat to modern therapeutics. The major causative agent of these infections is multidrug-resistant gram-negative bacteria, which impart high morbidity and mortality rate. This has led to an urge for the development of new antibiotics. Antimicrobial photodynamic therapy is a promising strategy to which till date no resistant strain has been reported. Since the efficacy of photodynamic therapy largely depends on the selection and administration of an appropriate photosensitizer, therefore, the realization of clinically active photosensitizers is an immediate need. Here, by using E. coli as a study model we have demonstrated the antimicrobial photodynamic potential of riboflavin. Intracellular ROS formation by DCFH-DA assay, lipid peroxidation, protein carbonylation, LDH activity was measured in treated bacterial samples. Enzymatic (SOD, CAT, GSH) antioxidants and non-enzymatic (GSH) was further evaluated. Bacterial death was confirmed by colony forming assay, optical microscopy and scanning electron microscopy. The treated bacterial cells exhibited abundant ROS generation and marked increment in the level of oxidative stress markers as well as significant reduction in LDH activity. Marked reduction in colony forming units was also observed. Optical microscopic and SEM images further confirmed the bacterial death. Thus, we can say that photoilluminated riboflavin renders the redox status of bacterial cells into a compromised state leading to significant membrane damage ultimately causing bacterial death. This study aims to add one more therapeutic dimension to photoilluminated riboflavin as it can be effectively employed in targeting bacterial biofilms occurring on hospital wares causing several serious medical conditions.
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Affiliation(s)
- Saniyya Khan
- Department of Biochemistry, Faculty of Life Sciences, The Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mohammed Rayis P
- Department of Biochemistry, Faculty of Life Sciences, The Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Asim Rizvi
- Department of Biochemistry, Faculty of Life Sciences, The Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Md Maroof Alam
- Department of Biochemistry, Faculty of Life Sciences, The Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Meher Rizvi
- Department of Microbiology, Jawaharlal Nehru Medical College, The Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Imrana Naseem
- Department of Biochemistry, Faculty of Life Sciences, The Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Bluhmki T, Allignol A, Ruckly S, Timsit JF, Wolkewitz M, Beyersmann J. Estimation of adjusted expected excess length-of-stay associated with ventilation-acquired pneumonia in intensive care: A multistate approach accounting for time-dependent mechanical ventilation. Biom J 2018; 60:1135-1150. [DOI: 10.1002/bimj.201700242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 06/28/2018] [Accepted: 08/06/2018] [Indexed: 12/29/2022]
Affiliation(s)
| | | | | | - Jean-Francois Timsit
- UMR 1137 IAME Inserm/University Paris Diderot; Paris France
- APHP; Bichat Hospital; Intensive Care Unit; Paris France
| | - Martin Wolkewitz
- Institute for Medical Biometry and Statistics; Faculty of Medicine and Medical Center-University of Freiburg; Freiburg Germany
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Hübner C, Ried W, Flessa S. Assessing the opportunity costs of patients with multidrug-resistant organisms in hospitals. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:1009-1017. [PMID: 29247340 DOI: 10.1007/s10198-017-0949-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The concept of opportunity cost can be applied to the utilization of hospital beds with special focus on patients colonized or infected with multidrug-resistant organisms. Blocked beds due to isolation measures or increased length of stay may result in opportunity costs if newly arriving patients have to be rejected and the hospital is confronted with revenue foregone. However, the amount of these costs is unclear, since different approaches are used in the literature to determine the respective costs. Our paper develops a concept to assess opportunity costs from the perspective of a hospital. METHODS The analysis is two-stage. In a first step, the probability of rejecting a patient due to over-occupancy in a hospital is calculated with a queuing model and a Monte Carlo simulation taking various assumptions into account. In a second step, the amount of the opportunity costs is calculated as an expected value applying a stochastic approach based on a potential patient pool. RESULTS Opportunity costs will occur only with a probability that is influenced, among others, by current bed occupancy rates. They have to be measured by average net revenue foregone, i.e., by the difference between average revenue foregone and average costs avoided. CONCLUSIONS Previous studies have a tendency of overestimating the occurrence or the size of opportunity costs with regard to the use of hospital beds. Nonetheless, its influence on the hospital budget is crucial and should be determined exactly.
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Affiliation(s)
- Claudia Hübner
- Chair of Health Care Management, Faculty of Law and Economics, University of Greifswald, F.-Loeffler-Str. 70, Greifswald, Germany.
| | - Walter Ried
- Chair of Public Finance, Faculty of Law and Economics, University of Greifswald, Greifswald, Germany
| | - Steffen Flessa
- Chair of Health Care Management, Faculty of Law and Economics, University of Greifswald, F.-Loeffler-Str. 70, Greifswald, Germany
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Brain D, Yakob L, Barnett A, Riley T, Clements A, Halton K, Graves N. Economic evaluation of interventions designed to reduce Clostridium difficile infection. PLoS One 2018; 13:e0190093. [PMID: 29298322 PMCID: PMC5752026 DOI: 10.1371/journal.pone.0190093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 12/07/2017] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Healthcare decision-makers are increasingly expected to balance increasing demand for health services with a finite budget. The role of economic evaluation in healthcare is increasing and this research provides decision-makers with new information about the management of Clostridium difficile infection, from an economic perspective. METHODS A model-based economic evaluation was undertaken to identify the most cost-effective healthcare intervention relating to the reduction of Clostridium difficile transmission. Efficacy evidence was synthesised from the literature and was used to inform the effectiveness of both bundled approaches and stand-alone interventions, where appropriate intervention combinations were coupled together. Changes in health outcomes were estimated by combining information about intervention effectiveness and its subsequent impact on quality of life. RESULTS A bundled approach of improving hand hygiene and environmental cleaning produces the best combination of increased health benefits and cost-savings. It has the highest mean net monetary benefit when compared to all other interventions. This intervention remains the optimal decision under different clinical circumstances, such as when mortality rate and patient length of stay are increased. Bundled interventions offered the best opportunity for health improvements. CONCLUSION These findings provide healthcare decision-makers with novel information about the allocation of scarce resources relating to Clostridium difficile. If investments are not made in interventions that clearly yield gains in health outcomes, the allocation and use of scarce healthcare resources is inappropriate and improvements in health outcomes will be forgone.
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Affiliation(s)
- David Brain
- Queensland University of Technology, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Australia
- * E-mail:
| | - Laith Yakob
- London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London, United Kingdom
| | - Adrian Barnett
- Queensland University of Technology, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Australia
| | - Thomas Riley
- University of Western Australia, Pathology and Laboratory Medicine, Perth, Western Australia, Australia
| | - Archie Clements
- Australian National University, Research School of Population Health, Canberra, Australian Capital Territory, Australia
| | - Kate Halton
- Queensland University of Technology, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Australia
| | - Nicholas Graves
- Queensland University of Technology, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Australia
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An Effective Surrogate Tracer Technique for S. aureus Bioaerosols in a Mechanically Ventilated Hospital Room Replica Using Dilute Aqueous Lithium Chloride. ATMOSPHERE 2017. [DOI: 10.3390/atmos8120238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Finding a non-pathogenic surrogate aerosol that represents the deposition of typical bioaerosols in healthcare settings is beneficial from the perspective of hospital facility testing, general infection control and outbreak analysis. This study considers aerosolization of dilute aqueous lithium chloride (LiCl) and sodium chloride (NaCl) solutions as surrogate tracers capable of representing Staphylococcus aureus bioaerosol deposition on surfaces in mechanically ventilated rooms. Tests were conducted in a biological test chamber set up as a replica hospital single patient room. Petri dishes on surfaces were used to collect the Li, Na and S. aureus aerosols separately after release. Biological samples were analyzed using cultivation techniques on solid media, and flame atomic absorption spectroscopy was used to measure Li and Na atom concentrations. Spatial deposition distribution of Li tracer correlated well with S. aureus aerosols (96% of pairs within a 95% confidence interval). In the patient hospital room replica, results show that the most contaminated areas were on surfaces 2 m away from the source. This indicates that the room’s airflow patterns play a significant role in bioaerosol transport. NaCl proved not to be sensitive to spatial deposition patterns. LiCl as a surrogate tracer for bioaerosol deposition was most reliable as it was robust to outliers, sensitive to spatial heterogeneity and found to require less replicates than the S. aureus counterpart to be in good spatial agreement with biological results.
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Fasugba O, Koerner J, Mitchell BG, Gardner A. Meatal cleaning with antiseptics for the prevention of catheter-associated urinary tract infections: A discussion paper. Infect Dis Health 2017; 22:136-143. [DOI: 10.1016/j.idh.2017.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/21/2017] [Accepted: 06/21/2017] [Indexed: 11/15/2022]
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Moura J, Baylina P, Moreira P. Exploring the real costs of healthcare-associated infections: an international review. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2017. [DOI: 10.1080/20479700.2017.1330729] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- João Moura
- Associação de Politécnicos do Norte, Instituto Politécnico do Porto, Portugal
| | - Pilar Baylina
- Escola Superior de Saúde do Porto, Instituto Politécnico do Porto, Portugal
| | - Paulo Moreira
- Instituto para as Políticas Públicas e Sociais, ISCTE – Instituto Universitário de Lisboa, Lisboa, Portugal
- Universidade Atlântica, Lisboa, Portugal
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Shin N, Kwag T, Park S, Kim YH. Effects of operational decisions on the diffusion of epidemic disease: A system dynamics modeling of the MERS-CoV outbreak in South Korea. J Theor Biol 2017; 421:39-50. [PMID: 28351702 PMCID: PMC7094130 DOI: 10.1016/j.jtbi.2017.03.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/08/2017] [Accepted: 03/20/2017] [Indexed: 12/16/2022]
Abstract
Development of a macro-level health system dynamics model. Performance measurements of epidemic disease diffusion and patient-care performance from an operational perspective. Comparison of economic and optimal patient room design performance under different infectivity scenarios. Comparison of secondary infection outcomes under different ER occupancy circumstances.
We evaluated the nosocomial outbreak of Middle East Respiratory Syndrome (MERS) Coronavirus (CoV) in the Republic of Korea, 2015, from a healthcare operations management perspective. Establishment of healthcare policy in South Korea provides patients’ freedom to select and visit multiple hospitals. Current policy enforces hospitals preference for multi-patient rooms to single-patient rooms, to lower financial burden. Existing healthcare systems tragically contributed to 186 MERS outbreak cases, starting from single “index patient” into three generations of secondary infections. By developing a macro-level health system dynamics model, we provide empirical knowledge to examining the case from both operational and financial perspectives. In our simulation, under base infectivity scenario, high emergency room occupancy circumstance contributed to an estimated average of 101 (917%) more infected patients, compared to when in low occupancy circumstance. Economic patient room design showed an estimated 702% increase in the number of infected patients, despite the overall 98% savings in total expected costs compared to optimal room design. This study provides first time, system dynamics model, performance measurements from an operational perspective. Importantly, the intent of this study was to provide evidence to motivate public, private, and government healthcare administrators’ recognition of current shortcomings, to optimize performance as a whole system, rather than mere individual aspects.
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Affiliation(s)
- Nina Shin
- Graduate School of Business, Seoul National University 1 Gwankak-ro, Gwanak-gu, 08826, Seoul, Republic of Korea.
| | - Taewoo Kwag
- Executive Director, Healthcare R&D, G-Doc Partners 78, Donggwang-ro 27-gil, Seocho-gu, 06582, Seoul, Republic of Korea.
| | - Sangwook Park
- Graduate School of Business, Seoul National University 1 Gwankak-ro, Gwanak-gu, 08826, Seoul, Republic of Korea.
| | - Yon Hui Kim
- Executive Director, Business Development, Corestem Inc., 24 Pangyo-ro 255beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13486 Republic of Korea.
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Stewardson AJ, Allignol A, Beyersmann J, Graves N, Schumacher M, Meyer R, Tacconelli E, De Angelis G, Farina C, Pezzoli F, Bertrand X, Gbaguidi-Haore H, Edgeworth J, Tosas O, Martinez JA, Ayala-Blanco MP, Pan A, Zoncada A, Marwick CA, Nathwani D, Seifert H, Hos N, Hagel S, Pletz M, Harbarth S. The health and economic burden of bloodstream infections caused by antimicrobial-susceptible and non-susceptible Enterobacteriaceae and Staphylococcus aureus in European hospitals, 2010 and 2011: a multicentre retrospective cohort study. ACTA ACUST UNITED AC 2017; 21:30319. [PMID: 27562950 PMCID: PMC4998424 DOI: 10.2807/1560-7917.es.2016.21.33.30319] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 04/20/2016] [Indexed: 01/21/2023]
Abstract
We performed a multicentre retrospective cohort study including 606,649 acute inpatient episodes at 10 European hospitals in 2010 and 2011 to estimate the impact of antimicrobial resistance on hospital mortality, excess length of stay (LOS) and cost. Bloodstream infections (BSI) caused by third-generation cephalosporin-resistant Enterobacteriaceae (3GCRE), meticillin-susceptible (MSSA) and -resistant Staphylococcus aureus (MRSA) increased the daily risk of hospital death (adjusted hazard ratio (HR) = 1.80; 95% confidence interval (CI): 1.34–2.42, HR = 1.81; 95% CI: 1.49–2.20 and HR = 2.42; 95% CI: 1.66–3.51, respectively) and prolonged LOS (9.3 days; 95% CI: 9.2–9.4, 11.5 days; 95% CI: 11.5–11.6 and 13.3 days; 95% CI: 13.2–13.4, respectively). BSI with third-generation cephalosporin-susceptible Enterobacteriaceae (3GCSE) significantly increased LOS (5.9 days; 95% CI: 5.8–5.9) but not hazard of death (1.16; 95% CI: 0.98–1.36). 3GCRE significantly increased the hazard of death (1.63; 95% CI: 1.13–2.35), excess LOS (4.9 days; 95% CI: 1.1–8.7) and cost compared with susceptible strains, whereas meticillin resistance did not. The annual cost of 3GCRE BSI was higher than of MRSA BSI. While BSI with S. aureus had greater impact on mortality, excess LOS and cost than Enterobacteriaceae per infection, the impact of antimicrobial resistance was greater for Enterobacteriaceae.
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Affiliation(s)
- Andrew J Stewardson
- Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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Making change easy: A peer-to-peer guide on transitioning to new hand hygiene products. Am J Infect Control 2017; 45:46-50. [PMID: 27544793 DOI: 10.1016/j.ajic.2016.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 11/24/2022]
Abstract
This report summarizes our experiences planning and implementing the transition to a new commercial line of hand hygiene products and their dispensing systems in a large academic health care facility in Toronto, Canada. Our lessons learned are organized into a practical guide made available in 2 different formats: this article and an illustrated peer-to-peer guide (http://www.baycrest.org/wp-content/uploads/HCE-PROG-HH_HighQuality.pdf).
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Bartsch SM, McKinnell JA, Mueller LE, Miller LG, Gohil SK, Huang SS, Lee BY. Potential economic burden of carbapenem-resistant Enterobacteriaceae (CRE) in the United States. Clin Microbiol Infect 2017; 23:48.e9-48.e16. [PMID: 27642178 PMCID: PMC5547745 DOI: 10.1016/j.cmi.2016.09.003] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/09/2016] [Accepted: 09/10/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The Centers for Disease Control and Prevention considers carbapenem-resistant Enterobacteriaceae (CRE) an urgent public health threat; however, its economic burden is unknown. METHODS We developed a CRE clinical and economics outcomes model to determine the cost of CRE infection from the hospital, third-party payer, and societal, perspectives and to evaluate the health and economic burden of CRE to the USA. RESULTS Depending on the infection type, the median cost of a single CRE infection can range from $22 484 to $66 031 for hospitals, $10 440 to $31 621 for third-party payers, and $37 778 to $83 512 for society. An infection incidence of 2.93 per 100 000 population in the USA (9418 infections) would cost hospitals $275 million (95% CR $217-334 million), third-party payers $147 million (95% CR $129-172 million), and society $553 million (95% CR $303-1593 million) with a 25% attributable mortality, and would result in the loss of 8841 (95% CR 5805-12 420) quality-adjusted life years. An incidence of 15 per 100 000 (48 213 infections) would cost hospitals $1.4 billion (95% CR $1.1-1.7 billion), third-party payers $0.8 billion (95% CR $0.6-0.8 billion), and society $2.8 billion (95% CR $1.6-8.2 billion), and result in the loss of 45 261 quality-adjusted life years. CONCLUSIONS The cost of CRE is higher than the annual cost of many chronic diseases and of many acute diseases. Costs rise proportionally with the incidence of CRE, increasing by 2.0 times, 3.4 times, and 5.1 times for incidence rates of 6, 10, and 15 per 100 000 persons.
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Affiliation(s)
- S M Bartsch
- Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J A McKinnell
- Infectious Disease Clinical Outcomes Research Unit (ID-CORE), Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA; Torrance Memorial Medical Center, Torrance, CA, USA
| | - L E Mueller
- Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - L G Miller
- Infectious Disease Clinical Outcomes Research Unit (ID-CORE), Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - S K Gohil
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine Health School of Medicine, Irvine, CA, USA
| | - S S Huang
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine Health School of Medicine, Irvine, CA, USA
| | - B Y Lee
- Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Dik JWH, Sinha B, Lokate M, Lo-Ten-Foe JR, Dinkelacker AG, Postma MJ, Friedrich AW. Positive impact of infection prevention on the management of nosocomial outbreaks at an academic hospital. Future Microbiol 2016; 11:1249-1259. [DOI: 10.2217/fmb-2016-0030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Infection prevention (IP) measures are vital to prevent (nosocomial) outbreaks. Financial evaluations of these are scarce. An incremental cost analysis for an academic IP unit was performed. Material & methods: On a yearly basis, we evaluated: IP measures; costs thereof; numbers of patients at risk for causing nosocomial outbreaks; predicted outbreak patients; and actual outbreak patients. Results: IP costs rose on average yearly with €150,000; however, more IP actions were undertaken. Numbers of patients colonized with high-risk microorganisms increased. The trend of actual outbreak patients remained stable. Predicted prevented outbreak patients saved costs, leading to a positive return on investment of 1.94. Conclusion: This study shows that investments in IP can prevent outbreak cases, thereby saving enough money to earn back these investments.
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Affiliation(s)
- Jan-Willem H Dik
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - Bhanu Sinha
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - Mariëtte Lokate
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - Jerome R Lo-Ten-Foe
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - Ariane G Dinkelacker
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
- Department of Medical Microbiology, University Hospital Tübingen, Elfriede-Aulhorn-Straße 6, 72076, Tübingen, Germany
| | - Maarten J Postma
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, University of Groningen, Antonius Deusinglaan 1, 9713AV, Groningen, The Netherlands
- Institute of Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - Alexander W Friedrich
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
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Ziebarth D. Altruistic and economic measurements used for prevention health services: Faith community nursing program. EVALUATION AND PROGRAM PLANNING 2016; 57:72-79. [PMID: 27232193 DOI: 10.1016/j.evalprogplan.2016.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 02/10/2016] [Accepted: 02/21/2016] [Indexed: 06/05/2023]
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Misal DD, Maulingkar SV, Bhonsle S. Economic burden of antibiotic treatment of healthcare-associated infections at a tertiary care hospital ICU in Goa, India. Trop Doct 2016; 47:197-201. [PMID: 27307475 DOI: 10.1177/0049475516653068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Antibiotics to treat healthcare-associated infections (HCAIs) contribute to a substantial proportion of drug expenditure in intensive care units (ICUs). Our study aimed to determine the common HCAIs in our hospital ICU, to assess the antibiotics prescribed and the mean antibiotic cost per HCAI. All adult patients, admitted to the ICU over a 1-year period, were included in the study. HCAIs were determined according to CDC definition. The incidence of HCAIs in the ICU was 16%. Ventilator associated pneumonia (50%) was the most common HCAI, followed by urinary tract infection (35.6%). The total cost of antibiotic treatment for HCAIs in ICU over a 1-year period was approximately Rs. 2 million (US$32,000); the mean antibiotic cost per HCAI was calculated as Rs. 17,000 (US$255). HCAIs in the ICU thus put a significant economic burden on the patient and the healthcare network and should be prevented by implementing recommended infection control guidelines.
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Affiliation(s)
- Devika D Misal
- 1 Assistant Professor, Department of Pharmacology, DMWIMS Medical College, Wayanad, Kerala, India
| | - Saleel V Maulingkar
- 2 Associate Professor, Department of Microbiology, DMWIMS Medical College, Wayanad, Kerala, India
| | - Sushma Bhonsle
- 3 Professor, Department of Pharmacology, Goa Medical College, Goa, India
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Singh A, Bartsch SM, Muder RR, Lee BY. An Economic Model: Value of Antimicrobial-Coated Sutures to Society, Hospitals, and Third-Party Payers in Preventing Abdominal Surgical Site Infections. Infect Control Hosp Epidemiol 2016; 35:1013-20. [DOI: 10.1086/677163] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundWhile the persistence of high surgical site infection (SSI) rates has prompted the advent of more expensive sutures that are coated with antimicrobial agents to prevent SSIs, the economic value of such sutures has yet to be determined.MethodsUsing TreeAge Pro, we developed a decision analytic model to determine the cost-effectiveness of using antimicrobial sutures in abdominal incisions from the hospital, third-party payer, and societal perspectives. Sensitivity analyses systematically varied the risk of developing an SSI (range, 5%–20%), the cost of triclosan-coated sutures (range, $5–$25/inch), and triclosan-coated suture efficacy in preventing infection (range, 5%–50%) to highlight the range of costs associated with using such sutures.ResultsTriclosan-coated sutures saved $4,109–$13,975 (hospital perspective), $4,133–$14,297 (third-party payer perspective), and $40,127–$53,244 (societal perspective) per SSI prevented, when a surgery had a 15% SSI risk, depending on their efficacy. If the SSI risk was no more than 5% and the efficacy in preventing SSIs was no more than 10%, triclosan-coated sutures resulted in extra expenditure for hospitals and third-party payers (resulting in extra costs of $1,626 and $1,071 per SSI prevented for hospitals and third-party payers, respectively; SSI risk, 5%; efficacy, 10%).ConclusionsOur results suggest that switching to triclosan-coated sutures from the uncoated sutures can both prevent SSIs and save substantial costs for hospitals, third-party payers, and society, as long as efficacy in preventing SSIs is at least 10% and SSI risk is at least 10%.
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Hall L, Farrington A, Mitchell BG, Barnett AG, Halton K, Allen M, Page K, Gardner A, Havers S, Bailey E, Dancer SJ, Riley TV, Gericke CA, Paterson DL, Graves N. Researching effective approaches to cleaning in hospitals: protocol of the REACH study, a multi-site stepped-wedge randomised trial. Implement Sci 2016; 11:44. [PMID: 27009342 PMCID: PMC4806497 DOI: 10.1186/s13012-016-0406-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 03/12/2016] [Indexed: 12/02/2022] Open
Abstract
Background The Researching Effective Approaches to Cleaning in Hospitals (REACH) study will generate evidence about the effectiveness and cost-effectiveness of a novel cleaning initiative that aims to improve the environmental cleanliness of hospitals. The initiative is an environmental cleaning bundle, with five interdependent, evidence-based components (training, technique, product, audit and communication) implemented with environmental services staff to enhance hospital cleaning practices. Methods/design The REACH study will use a stepped-wedge randomised controlled design to test the study intervention, an environmental cleaning bundle, in 11 Australian hospitals. All trial hospitals will receive the intervention and act as their own control, with analysis undertaken of the change within each hospital based on data collected in the control and intervention periods. Each site will be randomised to one of the 11 intervention timings with staggered commencement dates in 2016 and an intervention period between 20 and 50 weeks. All sites complete the trial at the same time in 2017. The inclusion criteria allow for a purposive sample of both public and private hospitals that have higher-risk patient populations for healthcare-associated infections (HAIs). The primary outcome (objective one) is the monthly number of Staphylococcus aureus bacteraemias (SABs), Clostridium difficile infections (CDIs) and vancomycin resistant enterococci (VRE) infections, per 10,000 bed days. Secondary outcomes for objective one include the thoroughness of hospital cleaning assessed using fluorescent marker technology, the bio-burden of frequent touch surfaces post cleaning and changes in staff knowledge and attitudes about environmental cleaning. A cost-effectiveness analysis will determine the second key outcome (objective two): the incremental cost-effectiveness ratio from implementation of the cleaning bundle. The study uses the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to support the tailored implementation of the environmental cleaning bundle in each hospital. Discussion Evidence from the REACH trial will contribute to future policy and practice guidelines about hospital environmental cleaning. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in hospitals. Trial registration Australia New Zealand Clinical Trial Registry ACTRN12615000325505
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Affiliation(s)
- Lisa Hall
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Alison Farrington
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia.
| | - Brett G Mitchell
- Faculty of Nursing and Health, Avondale College, 185 Fox Valley Road, Wahroonga, NSW, 2076, Australia
| | - Adrian G Barnett
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Kate Halton
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Michelle Allen
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Katie Page
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Anne Gardner
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, PO Box 256, Dickson, ACT, 2062, Australia
| | - Sally Havers
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Emily Bailey
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Stephanie J Dancer
- Department of Microbiology, Hairmyres Hospital, Eaglesham Rd, East Kilbride, G75 8RG, UK
| | - Thomas V Riley
- School of Pathology and Laboratory Medicine, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia
| | - Christian A Gericke
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia.,School of Public Health, University of Queensland, Herston, QLD, 4006, Australia
| | - David L Paterson
- Wesley Medical Research, Wesley Hospital, PO Box 499, Toowong, QLD, 4066, Australia.,University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Nicholas Graves
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
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Nandy P, Lucas AD, Gonzalez EA, Hitchins VM. Efficacy of commercially available wipes for disinfection of pulse oximeter sensors. Am J Infect Control 2016; 44:304-10. [PMID: 26589998 DOI: 10.1016/j.ajic.2015.09.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study examined the effectiveness of commercially available disinfecting wipes and cosmetic wipes in disinfecting pulse oximeter sensors contaminated with pathogenic bacterial surrogates. METHODS Surrogates of potential biological warfare agents and bacterial pathogens associated with hospital-acquired infections (HAIs) were spotted on test surfaces, with and without an artificial test soil (sebum), allowed to dry, and then cleaned with different commercially available cleaning and disinfecting wipes or sterile gauze soaked in water, bleach (diluted 1:10), or 70% isopropanol. The percentage of microbial survival and an analytical estimation of remaining test soil on devices were determined. RESULTS Wipes containing sodium hypochlorite as the active ingredient and gauze soaked in bleach (1:10) were the most effective in removing both vegetative bacteria and spores. In the presence of selective disinfectants, sebum had a protective effect on vegetative bacteria, but not on spores. CONCLUSIONS The presence of sebum reduces the cleaning efficiency of some commercially available wipes for some select microbes. Various commercial wipes performed significantly better than the designated cleaning agent (70% isopropanol) in disinfecting the oximetry sensor. Cosmetic wipes were not more effective than the disinfecting wipes in removing sebum.
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Graves N, Page K, Martin E, Brain D, Hall L, Campbell M, Fulop N, Jimmeison N, White K, Paterson D, Barnett AG. Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia. PLoS One 2016; 11:e0148190. [PMID: 26859688 PMCID: PMC4747462 DOI: 10.1371/journal.pone.0148190] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/14/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The objective is to estimate the incremental cost-effectiveness of the Australian National Hand Hygiene Inititiave implemented between 2009 and 2012 using healthcare associated Staphylococcus aureus bacteraemia as the outcome. Baseline comparators are the eight existing state and territory hand hygiene programmes. The setting is the Australian public healthcare system and 1,294,656 admissions from the 50 largest Australian hospitals are included. METHODS The design is a cost-effectiveness modelling study using a before and after quasi-experimental design. The primary outcome is cost per life year saved from reduced cases of healthcare associated Staphylococcus aureus bacteraemia, with cost estimated by the annual on-going maintenance costs less the costs saved from fewer infections. Data were harvested from existing sources or were collected prospectively and the time horizon for the model was 12 months, 2011-2012. FINDINGS No useable pre-implementation Staphylococcus aureus bacteraemia data were made available from the 11 study hospitals in Victoria or the single hospital in Northern Territory leaving 38 hospitals among six states and territories available for cost-effectiveness analyses. Total annual costs increased by $2,851,475 for a return of 96 years of life giving an incremental cost-effectiveness ratio (ICER) of $29,700 per life year gained. Probabilistic sensitivity analysis revealed a 100% chance the initiative was cost effective in the Australian Capital Territory and Queensland, with ICERs of $1,030 and $8,988 respectively. There was an 81% chance it was cost effective in New South Wales with an ICER of $33,353, a 26% chance for South Australia with an ICER of $64,729 and a 1% chance for Tasmania and Western Australia. The 12 hospitals in Victoria and the Northern Territory incur annual on-going maintenance costs of $1.51M; no information was available to describe cost savings or health benefits. CONCLUSIONS The Australian National Hand Hygiene Initiative was cost-effective against an Australian threshold of $42,000 per life year gained. The return on investment varied among the states and territories of Australia.
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Affiliation(s)
- Nicholas Graves
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Katie Page
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Elizabeth Martin
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Brain
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lisa Hall
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Megan Campbell
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Naomi Fulop
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Nerina Jimmeison
- School of Management, Queensland University of Technology, Brisbane, Australia
| | - Katherine White
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Paterson
- Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Adrian G. Barnett
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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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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43
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Karkhane M, Pourhosiengholi MA, Akbariyan Torkabad MR, Kimiia Z, Mortazavi SM, Hossieni Aghdam SK, Marzban A, Zali MR. Annual Antibiotic Related Economic Burden of Healthcare Associated Infections; a Cross-Sectional Population Based Study. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2016; 15:605-10. [PMID: 27642332 PMCID: PMC5018289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
So far, too little attention has been paid to total burden of healthcare associated infections (HAIs) in Iran. In the present study, we aimed to assess the rate of HAIs, as well as economic burden of hospitalization and antibiotic related cost associated with HAIs in ICU at training Taleghani hospital in Iran and to compare our results with national nosocomial infections surveillance (NNIS) system. This research to date for the first time has tended to focus on the economic burden of HAIs rather than epidemiology of HAIs evaluation. The total of 474 patients was followed up in this study. Overall, the rate of HAIs was 19.2 % in which ventilator associated pneumonia (VAP) was dominant HAIs and followed by urinary tract infection (UTI). Importantly, mortality rate increased significantly in infected patients. The highest total hospitalization economic burden and antibiotic related cost were observed for patients having blood stream infection (BSI). The results demonstrated significant differences between antibiotic related cost in patients and uninfected patients. Antibiotic related absolute extra cost for HAIs was 2.09 PPP$ per day. Estimation of direct annually HAIs associated economic burden of antibiotic and Total hospitalization was 433,382.4 PPP$ and 705,024 PPP$ respectively in Iran at intensive care unit (ICU). The most obvious findings were a strong relationship between relatively heavy antibiotic related financial burden, higher mortality rate, longer hospitalization time, and HAIs emergence on the Iranian national health system. It also reflects, more fundamentally a shift toward the need for comprehensive thinking about HAIs at ICU ward from Iran's hospitals. On the question of the research found that: With the implementation of policies and strategies to reduce hospital infections, which will benefit; Patient, Society, and/or national health system?!
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Affiliation(s)
- Maryam Karkhane
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. ,Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohamad Amin Pourhosiengholi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. ,Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. ,
| | | | - Zahra Kimiia
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | | | - Abdolrazagh Marzban
- Biotechnology Research Center, Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Murugan K, Selvanayaki K, Al-Sohaibani S. Urinary catheter indwelling clinical pathogen biofilm formation, exopolysaccharide characterization and their growth influencing parameters. Saudi J Biol Sci 2016; 23:150-9. [PMID: 26858552 PMCID: PMC4705282 DOI: 10.1016/j.sjbs.2015.04.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/15/2015] [Accepted: 04/27/2015] [Indexed: 12/23/2022] Open
Abstract
Self-reproducing microbial biofilm community mainly involved in the contamination of indwelling medical devices including catheters play a vital role in nosocomial infections. The catheter-associated urinary tract infection (CA-UTI) causative Staphylococcus aureus, Enterobacter faecalis, and Pseudomonas aeruginosa were selectively isolated, their phenotypic as well as genotypic biofilm formation, production and monomeric sugar composition of EPS as well as sugar, salt, pH and temperature influence on their in vitro biofilm formation were determined. From 50 culture positive urinary catheters S. aureus (24%), P. aeruginosa (18%), E. faecalis (14%) and others (44%) were isolated. The performed assays revealed their varying biofilm forming ability. The isolated S. aureus ica, E. faecalis esp, and P. aeruginosa cup A gene sequencing and phylogenetic analysis showed their close branching and genetic relationship. The analyzed sugar, salt, pH, and temperature showed that the degree of CA-UTI isolates biofilm formation is an environmentally sensitive process. EPS monosaccharide HPLC analysis showed the presence of neutral sugars (ng/μl) as follows: glucose (P. aeruginosa: 44.275; E. faecalis: 4.23), lactose (P. aeruginosa: 7.29), mannitol (P. aeruginosa: 2.53; S. aureus: 2.62; E. faecalis: 2.054) and maltose (E. faecalis: 7.0042) revealing species-specific presence and variation. This study may have potential clinical relevance for the easy diagnosis and management of CA-UTI.
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Affiliation(s)
- Kasi Murugan
- Department of Botany and Microbiology, College of Science, P.O. Box 2455, King Saud University, Riyadh 11451, Saudi Arabia
| | - Krishnasamy Selvanayaki
- P.G. and Research Department of Microbiology, K. S. Rangasamy College of Arts and Science, Tiruchengode, Namakkal 637 215, Tamilnadu, India
| | - Saleh Al-Sohaibani
- Department of Botany and Microbiology, College of Science, P.O. Box 2455, King Saud University, Riyadh 11451, Saudi Arabia
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Robotham JV, Deeny SR, Fuller C, Hopkins S, Cookson B, Stone S. Cost-effectiveness of national mandatory screening of all admissions to English National Health Service hospitals for meticillin-resistant Staphylococcus aureus: a mathematical modelling study. THE LANCET. INFECTIOUS DISEASES 2015; 16:348-56. [PMID: 26616206 DOI: 10.1016/s1473-3099(15)00417-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/21/2015] [Accepted: 10/22/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND In December, 2010, National Health Service (NHS) England introduced national mandatory screening of all admissions for meticillin-resistant Staphylococcus aureus (MRSA). We aimed to assess the effectiveness and cost-effectiveness of this policy, from a regional or national health-care decision makers' perspective, compared with alternative screening strategies. METHODS We used an individual-based dynamic transmission model parameterised with national MRSA audit data to assess the effectiveness and cost-effectiveness of admission screening of patients in English NHS hospitals compared with five alternative strategies (including no screening, checklist-activated screening, and high-risk specialty-based screening), accompanied by patient isolation and decolonisation, over a 5 year time horizon. We evaluated strategies for different NHS hospital types (acute, teaching, and specialist), MRSA prevalence, and transmission potentials using probabilistic sensitivity analyses. FINDINGS Compared with no screening, mean cost per quality-adjusted life-year (QALY) of screening all admissions was £89,000-148,000 (range £68,000-222,000), and this strategy was consistently more costly and less effective than alternatives for all hospital types. At a £30,000/QALY willingness-to-pay threshold and current prevalence, only the no-screening strategy was cost effective. The next best strategies were, in acute and teaching hospitals, targeting of high-risk specialty admissions (30-40% chance of cost-effectiveness; mean incremental cost-effectiveness ratios [ICERs] £45,200 [range £35,300-61,400] and £48,000/QALY [£34,600-74,800], respectively) and, in specialist hospitals, screening these patients plus risk-factor-based screening of low-risk specialties (a roughly 20% chance of cost-effectiveness; mean ICER £62,600/QALY [£48,000-89,400]). As prevalence and transmission increased, targeting of high-risk specialties became the optimum strategy at the NHS willingness-to-pay threshold (£30,000/QALY). Switching from screening all admissions to only high-risk specialty admissions resulted in a mean reduction in total costs per year (not considering uncertainty) of £2·7 million per acute hospital, £2·9 million per teaching, and £474,000 per specialist hospital for a minimum rise in infections (about one infection per year per hospital). INTERPRETATION Our results show that screening all admissions for MRSA is unlikely to be cost effective in England at the current NHS willingness-to-pay threshold, and our findings informed modified guidance to NHS England in 2014. Screening admissions to high-risk specialties is likely to represent better resource use in terms of cost per QALY gained. FUNDING UK Department of Health.
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Affiliation(s)
- Julie V Robotham
- Modelling and Economics Unit, Public Health England, London, UK.
| | - Sarah R Deeny
- Modelling and Economics Unit, Public Health England, London, UK
| | - Chris Fuller
- Department of Infection and Population Health, Farr Institute, University College London, UK
| | | | - Barry Cookson
- Division of lnfection and lmmunity, University College London, UK
| | - Sheldon Stone
- Department of Medicine, Royal Free Campus, University College London Medical School, London, UK
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Hübner C, Hübner NO, Muhr M, Claus F, Leesch H, Kramer A, Flessa S. Cost analysis of hospitalized Clostridium difficile-associated diarrhea (CDAD). GMS HYGIENE AND INFECTION CONTROL 2015; 10:Doc13. [PMID: 26550553 PMCID: PMC4635781 DOI: 10.3205/dgkh000256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Aim:Clostridium difficile-associated diarrhea (CDAD) causes heavy financial burden on healthcare systems worldwide. As with all hospital-acquired infections, prolonged hospital stays are the main cost driver. Previous cost studies only include hospital billing data and compare the length of stay in contrast to non-infected patients. To date, a survey of actual cost has not yet been conducted. Method: A retrospective analysis of data for patients with nosocomial CDAD was carried out over a 1-year period at the University Hospital of Greifswald. Based on identification of CDAD related treatment processes, cost of hygienic measures, antibiotics and laboratory as well as revenue losses due to bed blockage and increased length of stay were calculated. Results: 19 patients were included in the analysis. On average, a CDAD patient causes additional costs of € 5,262.96. Revenue losses due to extended length of stay take the highest proportion with € 2,555.59 per case, followed by loss in revenue due to bed blockage during isolation with € 2,413.08 per case. Overall, these opportunity costs accounted for 94.41% of total costs. In contrast, costs for hygienic measures (€ 253.98), pharmaceuticals (€ 22.88) and laboratory (€ 17.44) are quite low. Conclusion: CDAD results in significant additional costs for the hospital. This survey of actual costs confirms previous study results.
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Affiliation(s)
- Claudia Hübner
- Department of Health Care Management, University of Greifswald, Greifswald, Germany
| | - Nils-Olaf Hübner
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Michaela Muhr
- Department of Health Care Management, University of Greifswald, Greifswald, Germany
| | - Franziska Claus
- Department of Economics and Financial Management, University of Greifswald, Greifswald, Germany
| | - Henning Leesch
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Steffen Flessa
- Department of Health Care Management, University of Greifswald, Greifswald, Germany
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47
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Cost-benefit analysis from the hospital perspective of universal active screening followed by contact precautions for methicillin-resistant Staphylococcus aureus carriers. Infect Control Hosp Epidemiol 2015; 36:2-13. [PMID: 25627755 DOI: 10.1017/ice.2014.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To explore the economic impact to a hospital of universal methicillin-resistant Staphylococcus aureus (MRSA) screening. METHODS We used a decision tree model to estimate the direct economic impact to an individual hospital of starting universal MRSA screening and contact precautions. Projected costs and benefits were based on literature-derived data. Our model examined outcomes of several strategies including non-nares MRSA screening and comparison of culture versus polymerase chain reaction-based screening. RESULTS Under baseline conditions, the costs of universal MRSA screening and contact precautions outweighed the projected benefits generated by preventing MRSA-related infections, resulting in economic costs of $104,000 per 10,000 admissions (95% CI, $83,000-$126,000). Cost-savings occurred only when the model used estimates at the extremes of our key parameters. Non-nares screening and polymerase chain reaction-based testing, both of which identified more MRSA-colonized persons, resulted in more MRSA infections averted but increased economic costs of the screening program. CONCLUSIONS We found that universal MRSA screening, although providing potential benefit in preventing MRSA infection, is relatively costly and may be economically burdensome for a hospital. Policy makers should consider the economic burden of MRSA screening and contact precautions in relation to other interventions when choosing programs to improve patient safety and outcomes.
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Atif M, Azouaou A, Bouadda N, Bezzaoucha A, Si-Ahmed M, Bellouni R. Incidence and predictors of surgical site infection in a general surgery department in Algeria. Rev Epidemiol Sante Publique 2015; 63:275-9. [DOI: 10.1016/j.respe.2015.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 09/07/2012] [Accepted: 05/11/2015] [Indexed: 12/01/2022] Open
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49
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Levy AR, Szabo SM, Lozano-Ortega G, Lloyd-Smith E, Leung V, Lawrence R, Romney MG. Incidence and Costs of Clostridium difficile Infections in Canada. Open Forum Infect Dis 2015; 2:ofv076. [PMID: 26191534 PMCID: PMC4503917 DOI: 10.1093/ofid/ofv076] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 06/01/2015] [Indexed: 12/18/2022] Open
Abstract
Background. Limited data are available on direct medical costs and lost productivity due to Clostridium difficile infection (CDI) in Canada. Methods. We developed an economic model to estimate the costs of managing hospitalized and community-dwelling patients with CDI in Canada. The number of episodes was projected based on publicly available national rates of hospital-associated CDI and the estimate that 64% of all CDI is hospital-associated. Clostridium difficile infection recurrences were classified as relapses or reinfections. Resource utilization data came from published literature, clinician interviews, and Canadian CDI surveillance programs, and this included the following: hospital length of stay, contact with healthcare providers, pharmacotherapy, laboratory testing, and in-hospital procedures. Lost productivity was considered for those under 65 years of age, and the economic impact was quantified using publicly available labor statistics. Unit costs were obtained from published sources and presented in 2012 Canadian dollars. Results. There were an estimated 37 900 CDI episodes in Canada in 2012; 7980 (21%) of these were relapses, out of a total of 10 900 (27%) episodes of recurrence. The total cost to society of CDI was estimated at $281 million; 92% ($260 million) was in-hospital costs, 4% ($12 million) was direct medical costs in the community, and 4% ($10 million) was due to lost productivity. Management of CDI relapses alone accounted for $65.1 million (23%). Conclusions. The largest proportion of costs due to CDI in Canada arise from extra days of hospitalization. Interventions reducing the severity of infection and/or relapses leading to rehospitalizations are likely to have the largest absolute effect on direct medical costs.
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Affiliation(s)
- Adrian R Levy
- Department of Community Health and Epidemiology , Dalhousie University , Halifax, Nova Scotia , Canada ; Oxford Outcomes Ltd , Vancouver , Canada
| | - Shelagh M Szabo
- Department of Community Health and Epidemiology , Dalhousie University , Halifax, Nova Scotia , Canada
| | - Greta Lozano-Ortega
- Department of Community Health and Epidemiology , Dalhousie University , Halifax, Nova Scotia , Canada
| | - Elisa Lloyd-Smith
- St Paul's Hospital, Providence Health Care , Vancouver, British Columbia , Canada
| | - Victor Leung
- St Paul's Hospital, Providence Health Care , Vancouver, British Columbia , Canada ; University of British Columbia , Vancouver , Canada
| | | | - Marc G Romney
- St Paul's Hospital, Providence Health Care , Vancouver, British Columbia , Canada ; University of British Columbia , Vancouver , Canada
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50
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Percival SL, Suleman L, Vuotto C, Donelli G. Healthcare-associated infections, medical devices and biofilms: risk, tolerance and control. J Med Microbiol 2015; 64:323-334. [PMID: 25670813 DOI: 10.1099/jmm.0.000032] [Citation(s) in RCA: 427] [Impact Index Per Article: 47.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/23/2015] [Indexed: 01/30/2023] Open
Abstract
Biofilms are of great importance in infection control and healthcare-associated infections owing to their inherent tolerance and 'resistance' to antimicrobial therapies. Biofilms have been shown to develop on medical device surfaces, and dispersal of single and clustered cells implies a significant risk of microbial dissemination within the host and increased risk of infection. Although routine microbiological testing assists with the diagnosis of a clinical infection, there is no 'gold standard' available to reveal the presence of microbial biofilm from samples collected within clinical settings. Furthermore, such limiting factors as viable but non-culturable micro-organisms and small-colony variants often prevent successful detection. In order to increase the chances of detection and provide a more accurate diagnosis, a combination of microbiological culture techniques and molecular methods should be employed. Measures such as antimicrobial coating and surface alterations of medical devices provide promising opportunities in the prevention of biofilm formation on medical devices.
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Affiliation(s)
- Steven L Percival
- Scapa Healthcare, Manchester, UK.,Surface Science Research Centre, University of Liverpool, Liverpool, UK.,Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Louise Suleman
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Claudia Vuotto
- Microbial Biofilm Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy
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