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Quan K, Mao Z, Lu Y, Qin Y, Wang S, Yu C, Bi X, Tang H, Ren X, Chen D, Cheng Y, Wang Y, Zheng Y, Xia D. Composited silk fibroins ensured adhesion stability and magnetic controllability of Fe 3O 4-nanoparticle coating on implant for biofilm treatment. MATERIALS HORIZONS 2024; 11:3157-3165. [PMID: 38629215 DOI: 10.1039/d4mh00097h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Magnetic propulsion of nano-/micro-robots is an effective way to treat implant-associated infections by physically destroying biofilm structures to enhance antibiotic killing. However, it is hard to precisely control the propulsion in vivo. Magnetic-nanoparticle coating that can be magnetically pulled off does not need precise control, but the requirement of adhesion stability on an implant surface restricts its magnetic responsiveness. Moreover, whether the coating has been fully pulled-off or not is hard to ensure in real-time in vivo. Herein, composited silk fibroins (SFMA) are optimized to stabilize Fe3O4 nanoparticles on a titanium surface in a dry environment; while in an aqueous environment, the binding force of SFMA on titanium is significantly reduced due to hydrophilic interaction, making the coating magnetically controllable by an externally-used magnet but still stable in the absence of a magnet. The maximum working distance of the magnet can be calculated using magnetomechanical simulation in which the yielding magnetic traction force is strong enough to pull Fe3O4 nanoparticles off the surface. The pulling-off removes the biofilms that formed on the coating and enhances antibiotic killing both in vitro and in a rat sub-cutaneous implant model by up to 100 fold. This work contributes to the practical knowledge of magnetic propulsion for biofilm treatment.
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Affiliation(s)
- Kecheng Quan
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China.
| | - Zhinan Mao
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China.
| | - Yupu Lu
- Department of Dental Materials, Peking University School and Hospital of Stomatology, & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing 100081, China.
| | - Yu Qin
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China.
| | - Shuren Wang
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China.
| | - Chunhao Yu
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China.
| | - Xuewei Bi
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China.
| | - Hao Tang
- Department of Dental Materials, Peking University School and Hospital of Stomatology, & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing 100081, China.
| | - Xiaoxiang Ren
- Institute of Translational Medicine, Shanghai University, Shanghai, 200444, China
| | - Dafu Chen
- Laboratory of Bone Tissue Engineering, Beijing Laboratory of Biomedical Materials, National Center for Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
| | - Yan Cheng
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China.
| | - Yong Wang
- Center of Digital Dentistry, Peking University School and Hospital of Stomatology, Beijing, 100081, China.
| | - Yufeng Zheng
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China.
| | - Dandan Xia
- Department of Dental Materials, Peking University School and Hospital of Stomatology, & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing 100081, China.
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Quan K, Zhang Z, Ren Y, Busscher HJ, van der Mei HC, Peterson BW. On-demand pulling-off of magnetic nanoparticles from biomaterial surfaces through implant-associated infectious biofilms for enhanced antibiotic efficacy. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 131:112526. [PMID: 34857305 DOI: 10.1016/j.msec.2021.112526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
Biomaterial-associated infections can occur any time after surgical implantation of biomaterial implants and limit their success rates. On-demand, antimicrobial release coatings have been designed, but in vivo release triggers uniquely relating with infection do not exist, while inadvertent leakage of antimicrobials can cause exhaustion of a coating prior to need. Here, we attach magnetic-nanoparticles to a biomaterial surface, that can be pulled-off in a magnetic field through an adhering, infectious biofilm. Magnetic-nanoparticles remained stably attached to a surface upon exposure to PBS for at least 50 days, did not promote bacterial adhesion or negatively affect interaction with adhering tissue cells. Nanoparticles could be magnetically pulled-off from a surface through an adhering biofilm, creating artificial water channels in the biofilm. At a magnetic-nanoparticle coating concentration of 0.64 mg cm-2, these by-pass channels increased the penetrability of Staphylococcus aureus and Pseudomonas aeruginosa biofilms towards different antibiotics, yielding 10-fold more antibiotic killing of biofilm inhabitants than in absence of artificial channels. This innovative use of magnetic-nanoparticles for the eradication of biomaterial-associated infections requires no precise targeting of magnetic-nanoparticles and allows more effective use of existing antibiotics by breaking the penetration barrier of an infectious biofilm adhering to a biomaterial implant surface on-demand.
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Affiliation(s)
- Kecheng Quan
- College of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou 215123, PR China; University of Groningen and University Medical Center Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713 AV Groningen, the Netherlands
| | - Zexin Zhang
- College of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou 215123, PR China.
| | - Yijin Ren
- University of Groningen and University Medical Center Groningen, Department of Orthodontics, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Henk J Busscher
- University of Groningen and University Medical Center Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713 AV Groningen, the Netherlands.
| | - Henny C van der Mei
- University of Groningen and University Medical Center Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713 AV Groningen, the Netherlands.
| | - Brandon W Peterson
- University of Groningen and University Medical Center Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713 AV Groningen, the Netherlands
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Senanayake S, Graves N, Healy H, Baboolal K, Kularatna S. Cost-utility analysis in chronic kidney disease patients undergoing kidney transplant; what pays? A systematic review. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:18. [PMID: 32477010 PMCID: PMC7236510 DOI: 10.1186/s12962-020-00213-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/13/2020] [Indexed: 12/14/2022] Open
Abstract
Background Health systems are under pressure to deliver more effective care without expansion of resources. This is particularly pertinent to diseases like chronic kidney disease (CKD) that are exacting substantial financial burden to many health systems. The aim of this study is to systematically review the Cost Utility Analysis (CUA) evidence generated across interventions for CKD patients undergoing kidney transplant (KT). Methods A systemic review of CUA on the interventions for CKD patients undergoing KT was carried out using a search of the MEDLINE, CINAHL, EMBASE, PsycINFO and NHS-EED. The CHEERS checklist was used as a set of good practice criteria in determining the reporting quality of the economic evaluation. Quality of the data used to inform model parameters was determined using the modified hierarchies of data sources. Results A total of 330 articles identified, 16 met the inclusion criteria. Almost all (n = 15) the studies were from high income countries. Out of the 24 characteristics assessed in the CHEERS checklist, more than 80% of the selected studies reported 14 of the characteristics. Reporting of the CUA were characterized by lack of transparency of model assumptions, narrow economic perspective and incomplete assessment of the effect of uncertainty in the model parameters on the results. The data used for the economic model were satisfactory quality. The authors of 13 studies reported the intervention as cost saving and improving quality of life, whereas three studies were cost increasing and improving quality of life. In addition to the baseline analysis, sensitivity analysis was performed in all the evaluations except one. Transplanting certain high-risk donor kidneys (high risk of HIV and Hepatitis-C infected kidneys, HLA mismatched kidneys, high Kidney Donor Profile Index) and a payment to living donors, were found to be cost-effective. Conclusions The quality of economic evaluations reviewed in this paper were assessed to be satisfactory. Implementation of these strategies will significantly impact current systems of KT and require a systematic implementation plan and coordinated efforts from relevant stakeholders.
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Affiliation(s)
- Sameera Senanayake
- 1Australian Centre for Health Services Innovation, School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD 4059 Australia
| | - Nicholas Graves
- 1Australian Centre for Health Services Innovation, School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD 4059 Australia
| | - Helen Healy
- 2Royal Brisbane Hospital for Women, Brisbane, Australia.,3School of Medicine, University of Queensland, Brisbane, Australia
| | - Keshwar Baboolal
- 2Royal Brisbane Hospital for Women, Brisbane, Australia.,3School of Medicine, University of Queensland, Brisbane, Australia
| | - Sanjeewa Kularatna
- 1Australian Centre for Health Services Innovation, School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD 4059 Australia
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Gamalathge PU, Kularatna S, Carter HE, Senanayake S, Graves N. Cost-effectiveness of interventions to reduce the risk of healthcare-acquired infections in middle-income countries: A systematic review. J Infect Prev 2019; 20:266-273. [PMID: 31762788 DOI: 10.1177/1757177419852662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 04/03/2019] [Indexed: 11/16/2022] Open
Abstract
Background Hospital-acquired infections (HAI) contribute to prolonged hospital stays and account for a substantial economic burden to healthcare systems. Middle-income countries (MICs) experience a greater burden of HAI than developed countries. Evidence on the cost-effectiveness of interventions to reduce HAI is required to inform decision-making in these settings. Aim To synthesise the evidence on cost-effectiveness as related to HAI interventions in MICs and to assess the quality of this evidence. Methods A systematic review of published literature on the cost-effectiveness of interventions to reduce the incidence of HAI in MICs between 2000 and 2018 was conducted. Results Six studies met the pre-determined inclusion criteria. The studies were from three countries: Thailand; India; and Vietnam. The evidence suggests that interventions to reduce HAI are cost-effective and, in most cases, cost-saving to healthcare systems. The quality of the reporting varied across studies. Conclusions The implementation of HAI prevention interventions appears to be a high value use of resources in MICs. There is a need for further cost-effectiveness analyses in a wider range of MICs in order to confirm these findings. Improved standardisation and quality of reporting is required.
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Affiliation(s)
- Pushpa Udayangani Gamalathge
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia.,Ministry of Health, Sri Lanka
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Hannah E Carter
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Nicholous Graves
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
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Sodhi J, Satpathy S, Sharma DK, Lodha R, Kapil A, Wadhwa N, Gupta SK. Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs. Indian J Med Res 2017; 143:502-6. [PMID: 27377508 PMCID: PMC4928558 DOI: 10.4103/0971-5916.184306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND & OBJECTIVES Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India. METHODS This prospective study was done in the seven bedded PICU of a large multi-specialty tertiary care hospital in New Delhi, India. A total of 20 children with HAI (cases) and 35 children without HAI (controls), admitted to the PICU during the study period (January 2012 to June 2012), were matched for gender, age, and average severity of illness score. Each patient's length of stay was obtained prospectively. Costs of healthcare were estimated according to traditional and time driven activity based costing methods approach. RESULTS The median extra length of PICU stay for children with HAI (cases), compared with children with no HAI (controls), was seven days (IQR 3-16). The mean total costs of patients with and without HAI were ' 2,04,787 (US$ 3,413) and ' 56,587 (US$ 943), respectively and the mean difference in the total cost between cases and controls was ' 1,48,200 (95% CI 55,716 to 2,40,685, p<0.01). INTERPRETATION & CONCLUSIONS This study highlights the effect of HAI on costs for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care.
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Affiliation(s)
- Jitender Sodhi
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Sidhartha Satpathy
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - D K Sharma
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nitya Wadhwa
- Paediatric Biology Centre, Translational Health Science & Technology Institute, Gurgaon, India
| | - Shakti Kumar Gupta
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
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Harron K, Mok Q, Dwan K, Ridyard CH, Moitt T, Millar M, Ramnarayan P, Tibby SM, Muller-Pebody B, Hughes DA, Gamble C, Gilbert RE. CATheter Infections in CHildren (CATCH): a randomised controlled trial and economic evaluation comparing impregnated and standard central venous catheters in children. Health Technol Assess 2016; 20:vii-xxviii, 1-219. [PMID: 26935961 DOI: 10.3310/hta20180] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Impregnated central venous catheters (CVCs) are recommended for adults to reduce bloodstream infection (BSI) but not for children. OBJECTIVE To determine the effectiveness of impregnated compared with standard CVCs for reducing BSI in children admitted for intensive care. DESIGN Multicentre randomised controlled trial, cost-effectiveness analysis from a NHS perspective and a generalisability analysis and cost impact analysis. SETTING 14 English paediatric intensive care units (PICUs) in England. PARTICIPANTS Children aged < 16 years admitted to a PICU and expected to require a CVC for ≥ 3 days. INTERVENTIONS Heparin-bonded, antibiotic-impregnated (rifampicin and minocycline) or standard polyurethane CVCs, allocated randomly (1 : 1 : 1). The intervention was blinded to all but inserting clinicians. MAIN OUTCOME MEASURE Time to first BSI sampled between 48 hours after randomisation and 48 hours after CVC removal. The following data were used in the trial: trial case report forms; hospital administrative data for 6 months pre and post randomisation; and national-linked PICU audit and laboratory data. RESULTS In total, 1859 children were randomised, of whom 501 were randomised prospectively and 1358 were randomised as an emergency; of these, 984 subsequently provided deferred consent for follow-up. Clinical effectiveness - BSIs occurred in 3.59% (18/502) of children randomised to standard CVCs, 1.44% (7/486) of children randomised to antibiotic CVCs and 3.42% (17/497) of children randomised to heparin CVCs. Primary analyses comparing impregnated (antibiotic and heparin CVCs) with standard CVCs showed no effect of impregnated CVCs [hazard ratio (HR) 0.71, 95% confidence interval (CI) 0.37 to 1.34]. Secondary analyses showed that antibiotic CVCs were superior to standard CVCs (HR 0.43, 95% CI 0.20 to 0.96) but heparin CVCs were not (HR 1.04, 95% CI 0.53 to 2.03). Time to thrombosis, mortality by 30 days and minocycline/rifampicin resistance did not differ by CVC. Cost-effectiveness - heparin CVCs were not clinically effective and therefore were not cost-effective. The incremental cost of antibiotic CVCs compared with standard CVCs over a 6-month time horizon was £1160 (95% CI -£4743 to £6962), with an incremental cost-effectiveness ratio of £54,057 per BSI avoided. There was considerable uncertainty in costs: antibiotic CVCs had a probability of 0.35 of being dominant. Based on index hospital stay costs only, antibiotic CVCs were associated with a saving of £97,543 per BSI averted. The estimated value of health-care resources associated with each BSI was £10,975 (95% CI -£2801 to £24,751). Generalisability and cost-impact - the baseline risk of BSI in 2012 for PICUs in England was 4.58 (95% CI 4.42 to 4.74) per 1000 bed-days. An estimated 232 BSIs could have been averted in 2012 using antibiotic CVCs. The additional cost of purchasing antibiotic CVCs for all children who require them (£36 per CVC) would be less than the value of resources associated with managing BSIs in PICUs with standard BSI rates of > 1.2 per 1000 CVC-days. CONCLUSIONS The primary outcome did not differ between impregnated and standard CVCs. However, antibiotic-impregnated CVCs significantly reduced the risk of BSI compared with standard and heparin CVCs. Adoption of antibiotic-impregnated CVCs could be beneficial even for PICUs with low BSI rates, although uncertainty remains whether or not they represent value for money to the NHS. Limitations - inserting clinicians were not blinded to allocation and a lower than expected event rate meant that there was limited power for head-to-head comparisons of each type of impregnation. Future work - adoption of impregnated CVCs in PICUs should be considered and could be monitored through linkage of electronic health-care data and clinical data on CVC use with laboratory surveillance data on BSI. TRIAL REGISTRATION ClinicalTrials.gov NCT01029717. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 18. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Katie Harron
- Institute of Child Health, University College London, London, UK
| | - Quen Mok
- Great Ormond Street Hospital, London, UK
| | - Kerry Dwan
- Medicines for Children Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - Colin H Ridyard
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Tracy Moitt
- Medicines for Children Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | | | | | | | - Berit Muller-Pebody
- Healthcare Associated Infection and Antimicrobial Resistance (HCAI & AMR) Department, National Infection Service, Public Health England, London, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Carrol Gamble
- Medicines for Children Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - Ruth E Gilbert
- Institute of Child Health, University College London, London, UK
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Tang M, Feng M, Chen L, Zhang J, Ji P, Luo S. Closed blood conservation device for reducing catheter-related infections in children after cardiac surgery. Crit Care Nurse 2016; 34:53-60; quiz 61. [PMID: 25274764 DOI: 10.4037/ccn2014416] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Arterial catheters are potential sources of nosocomial infection. OBJECTIVE To investigate use of a closed blood conservation device in preventing catheter-related bloodstream infections in children after cardiac surgery. METHODS Children with an indwelling arterial catheter after cardiac surgery were randomly assigned to 2 groups: a control group with a conventional 3-way stopcock in the catheter system and an interventional group with the conservation device in the catheter system. Catheter tips, catheter intraluminal fluid, and blood samples obtained from the catheter and peripherally were cultured for microbiological analysis. RESULTS Intraluminal fluid contamination was significantly lower (P = .03) in the interventional group (3 of 147 catheters) than in the control group (10 of 137 catheters). The 2 groups did not differ significantly in the rate of tip colonization (9 of 147 vs 12 of 137; P = .40) or in the number of catheter-related bloodstream infections (0 of 147 vs 2 of 137; P = .21). CONCLUSION Use of a closed blood conservation device could decrease the incidence of catheter-related contamination of intraluminal fluid.
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Affiliation(s)
- Menglin Tang
- Menglin Tang is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University, Chengdu, Sichuan, China.Mei Feng is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University.Lijun Chen is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University.Jinmei Zhang is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University.Peng Ji is a resident physician, Department of Anesthesiology, West China Hospital of Sichuan University.Shuhua Luo is an attending physician, Department of Cardiac Surgery, West China Hospital of Sichuan University.
| | - Mei Feng
- Menglin Tang is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University, Chengdu, Sichuan, China.Mei Feng is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University.Lijun Chen is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University.Jinmei Zhang is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University.Peng Ji is a resident physician, Department of Anesthesiology, West China Hospital of Sichuan University.Shuhua Luo is an attending physician, Department of Cardiac Surgery, West China Hospital of Sichuan University
| | - Lijun Chen
- Menglin Tang is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University, Chengdu, Sichuan, China.Mei Feng is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University.Lijun Chen is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University.Jinmei Zhang is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University.Peng Ji is a resident physician, Department of Anesthesiology, West China Hospital of Sichuan University.Shuhua Luo is an attending physician, Department of Cardiac Surgery, West China Hospital of Sichuan University
| | - Jinmei Zhang
- Menglin Tang is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University, Chengdu, Sichuan, China.Mei Feng is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University.Lijun Chen is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University.Jinmei Zhang is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University.Peng Ji is a resident physician, Department of Anesthesiology, West China Hospital of Sichuan University.Shuhua Luo is an attending physician, Department of Cardiac Surgery, West China Hospital of Sichuan University
| | - Peng Ji
- Menglin Tang is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University, Chengdu, Sichuan, China.Mei Feng is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University.Lijun Chen is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University.Jinmei Zhang is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University.Peng Ji is a resident physician, Department of Anesthesiology, West China Hospital of Sichuan University.Shuhua Luo is an attending physician, Department of Cardiac Surgery, West China Hospital of Sichuan University
| | - Shuhua Luo
- Menglin Tang is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University, Chengdu, Sichuan, China.Mei Feng is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University.Lijun Chen is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University.Jinmei Zhang is a nurse in the pediatric intensive care unit at West China Hospital of Sichuan University.Peng Ji is a resident physician, Department of Anesthesiology, West China Hospital of Sichuan University.Shuhua Luo is an attending physician, Department of Cardiac Surgery, West China Hospital of Sichuan University
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Walz JM, Ellison RT, Mack DA, Flaherty HM, McIlwaine JK, Whyte KG, Landry KE, Baker SP, Heard SO. The bundle "plus": the effect of a multidisciplinary team approach to eradicate central line-associated bloodstream infections. Anesth Analg 2015; 120:868-76. [PMID: 24149581 DOI: 10.1213/ane.0b013e3182a8b01b] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSIs) have decreased significantly over the last decade. Further reductions in CLABSI rates should be possible. We describe a multidisciplinary approach to the reduction of CLABSIs. METHODS This was an observational study of critically ill patients requiring central venous catheters in 8 intensive care units in a tertiary medical center. We implemented a catheter bundle that included hand hygiene, education of providers, chlorhexidine skin preparation, use of maximum barrier precautions, a dedicated line cart, checklist, avoidance of the femoral vein for catheter insertion, chlorhexidine-impregnated dressings, use of anti-infective catheters, and daily consideration of the need for the catheter. Additional measures included root cause analyses of all CLABSIs, creation of a best practice atlas for internal jugular catheters, and enhanced education on blood culture collection. Data were analyzed using the Poisson test and regression. RESULTS CLABSI, catheter use, and microbiology were tracked from 2004 to 2012. There was a 92% reduction in CLABSIs (95% lower confidence limit: 67.4% reduction, P < 0.0001). Central venous catheter use decreased significantly from 2008 to 2012 (P = 0.032, -151 catheters per year, 95% confidence limits: -277 to -25), whereas peripherally inserted central catheter use increased (P = 0.005, 89 catheters per year, 95% confidence limits: 50 to 127). There was no apparent association between unit-specific Acute Physiology And Chronic Health Evaluation III/IV scores and CLABSI. Three units have not had a CLABSI in more than a year. The most common organism isolated was coagulase-negative staphylococcus. Since the implementation of minocycline/rifampin catheters, no cases of methicillin-resistant Staphylococcus aureus CLABSI have occurred. CONCLUSIONS The implementation of a standard catheter bundle combined with chlorhexidine dressings, minocycline/rifampin catheters, and other behavioral changes was associated with a sustained reduction in CLABSIs.
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Affiliation(s)
- J Matthias Walz
- From the *Departments of Anesthesiology and Surgery, University of Massachusetts Medical School and UMass Memorial Medical Center; †Department of Medicine, Division of Infectious Diseases, ‡Infection Control Department, §Critical Care Operations Committee, and ∥Department of Surgery, UMass Memorial Medical Center; and ¶Departments of Quantitative Health Sciences and Cell Biology, University of Massachusetts Medical School, Worcester, Massachusetts
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Herzer KR, Niessen L, Constenla DO, Ward WJ, Pronovost PJ. Cost-effectiveness of a quality improvement programme to reduce central line-associated bloodstream infections in intensive care units in the USA. BMJ Open 2014; 4:e006065. [PMID: 25256190 PMCID: PMC4179409 DOI: 10.1136/bmjopen-2014-006065] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To assess the cost-effectiveness of a multifaceted quality improvement programme focused on reducing central line-associated bloodstream infections in intensive care units. DESIGN Cost-effectiveness analysis using a decision tree model to compare programme to non-programme intensive care units. SETTING USA. POPULATION Adult patients in the intensive care unit. COSTS Economic costs of the programme and of central line-associated bloodstream infections were estimated from the perspective of the hospital and presented in 2013 US dollars. MAIN OUTCOME MEASURES Central line-associated bloodstream infections prevented, deaths averted due to central line-associated bloodstream infections prevented, and incremental cost-effectiveness ratios. Probabilistic sensitivity analysis was performed. RESULTS Compared with current practice, the programme is strongly dominant and reduces bloodstream infections and deaths at no additional cost. The probabilistic sensitivity analysis showed that there was an almost 80% probability that the programme reduces bloodstream infections and the infections' economic costs to hospitals. The opportunity cost of a bloodstream infection to a hospital was the most important model parameter in these analyses. CONCLUSIONS This multifaceted quality improvement programme, as it is currently implemented by hospitals on an increasingly large scale in the USA, likely reduces the economic costs of central line-associated bloodstream infections for US hospitals. Awareness among hospitals about the programme's benefits should enhance implementation. The programme's implementation has the potential to substantially reduce morbidity, mortality and economic costs associated with central line-associated bloodstream infections.
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Affiliation(s)
- Kurt R Herzer
- Medical Scientist Training Program, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Louis Niessen
- Centre for Applied Health Research and Delivery (CAHRD), Liverpool School of Tropical Medicine, University of Warwick, Coventry, UK
| | - Dagna O Constenla
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - William J Ward
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter J Pronovost
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA
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On-demand antimicrobial release from a temperature-sensitive polymer — Comparison with ad libitum release from central venous catheters. J Control Release 2014; 188:61-6. [DOI: 10.1016/j.jconrel.2014.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/05/2014] [Accepted: 06/10/2014] [Indexed: 11/18/2022]
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11
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The interaction of bacteria with engineered nanostructured polymeric materials: a review. ScientificWorldJournal 2014; 2014:410423. [PMID: 25025086 PMCID: PMC4084677 DOI: 10.1155/2014/410423] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/08/2014] [Accepted: 05/10/2014] [Indexed: 12/17/2022] Open
Abstract
Bacterial infections are a leading cause of morbidity and mortality worldwide. In spite of great advances in biomaterials research and development, a significant proportion of medical devices undergo bacterial colonization and become the target of an implant-related infection. We present a review of the two major classes of antibacterial nanostructured materials: polymeric nanocomposites and surface-engineered materials. The paper describes antibacterial effects due to the induced material properties, along with the principles of bacterial adhesion and the biofilm formation process. Methods for antimicrobial modifications of polymers using a nanocomposite approach as well as surface modification procedures are surveyed and discussed, followed by a concise examination of techniques used in estimating bacteria/material interactions. Finally, we present an outline of future sceneries and perspectives on antibacterial applications of nanostructured materials to resist or counteract implant infections.
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12
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Responsive and “smart” antibacterial surfaces: Common approaches and new developments (Review). Biointerphases 2014; 9:029005. [DOI: 10.1116/1.4866697] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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13
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Taheri S, Cavallaro A, Christo SN, Smith LE, Majewski P, Barton M, Hayball JD, Vasilev K. Substrate independent silver nanoparticle based antibacterial coatings. Biomaterials 2014; 35:4601-9. [DOI: 10.1016/j.biomaterials.2014.02.033] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 02/20/2014] [Indexed: 12/25/2022]
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14
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Central venous catheter-related biofilm infections: An up-to-date focus on meticillin-resistant Staphylococcus aureus. J Glob Antimicrob Resist 2013; 1:71-78. [DOI: 10.1016/j.jgar.2013.03.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 02/25/2013] [Accepted: 03/05/2013] [Indexed: 11/17/2022] Open
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Sagana R, Hyzy RC. Achieving Zero Central Line–associated Bloodstream Infection Rates in Your Intensive Care Unit. Crit Care Clin 2013. [DOI: 10.1016/j.ccc.2012.10.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
Improving the quality and safety of intensive care unit (ICU) care in the United States is a significant challenge for the future. Obtaining improvement in systems of care is difficult given the reactionary mode physicians tend to enter when dealing with moment-to-moment crises. It will be important to implement quality and safety measures that are already supported by evidence. Improvement of device safety will be critical to reducing the large number of device-related complications that occur in US ICUs. Prospective collection of adverse events with rigorous analysis will be important to allow systematic errors to be exposed and corrected.
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Affiliation(s)
- Peter J Rossi
- Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Graves N, Barnett AG, Halton K, Crnich C, Cooper B, Beyersmann J, Wolkewitz M, Samore M, Harbarth S. The importance of good data, analysis, and interpretation for showing the economics of reducing healthcare-associated infection. Infect Control Hosp Epidemiol 2012; 32:927-8; author reply 928-30. [PMID: 21828978 DOI: 10.1086/661600] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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18
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Waters HR, Korn R, Colantuoni E, Berenholtz SM, Goeschel CA, Needham DM, Pham JC, Lipitz-Snyderman A, Watson SR, Posa P, Pronovost PJ. The business case for quality: economic analysis of the Michigan Keystone Patient Safety Program in ICUs. Am J Med Qual 2011; 26:333-9. [PMID: 21856956 DOI: 10.1177/1062860611410685] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health care-associated infections affect an estimated 5% of hospitalized patients and represent one of the leading causes of illness and death in the United States. This study calculates the costs and benefits of a patient safety program in intensive care units in 6 hospitals that were part of the Michigan Keystone ICU Patient Safety Program. On average, 29.9 catheter-related bloodstream infections and 18.0 cases of ventilator-associated pneumonia were averted per hospital on an annual basis. The average cost of the intervention is $3375 per infection averted, measured in 2007 dollars. The cost of the intervention is substantially less than estimates of the additional health care costs associated with these infections, which range from $12 208 to $56 167 per infection episode. These results do not take into account the additional effect of the Michigan Keystone program in terms of reducing cases of sepsis or its effects in terms of preventing mortality, improving teamwork, and reducing nurse turnover.
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Affiliation(s)
- Hugh R Waters
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Ramirez C, Malloch K, Agee C. Evaluation of Respiratory Care Practitioner Central Venous Catheter Insertion Program. ACTA ACUST UNITED AC 2011. [DOI: 10.2309/java.15-4-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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20
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Reunes S, Rombaut V, Vogelaers D, Brusselaers N, Lizy C, Cankurtaran M, Labeau S, Petrovic M, Blot S. Risk factors and mortality for nosocomial bloodstream infections in elderly patients. Eur J Intern Med 2011; 22:e39-44. [PMID: 21925041 DOI: 10.1016/j.ejim.2011.02.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 02/07/2011] [Accepted: 02/08/2011] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine risk factors for nosocomial bloodstream infection (BSI) and associated mortality in geriatric patients in geriatric and internal medicine wards at a university hospital. METHODS Single-center retrospective (1992-2007), pairwise-matched (1:1-ratio) cohort study. Geriatric patients with nosocomial BSI were matched with controls without BSI on year of admission and length of hospitalization before onset of BSI. Demographic, microbiological, and clinical data are collected. RESULTS One-hundred forty-two BSI occurred in 129 patients. Predominant microorganisms were Escherichia coli (23.2%), coagulase-negative Staphylococci (19.4%), Pseudomonas aeruginosa (8.4%), Staphylococcus aureus (7.1%), Klebsiella pneumoniae (5.8%) and Candida spp. (5.8%). Matching was successful for 109 cases. Compared to matched control subjects, cases were more frequently female, suffered more frequently from arthrosis, angina pectoris and pressure ulcers, had worse Activities of Daily Living-scores, had more often an intravenous or bladder catheter, and were more often bedridden. Logistic regression demonstrated presence of an intravenous catheter (odds ratio [OR] 7.5, 95% confidence interval [CI] 2.5-22.9) and being bedridden (OR 2.9, 95% CI 1.6-5.3) as independent risk factors for BSI. In univariate analysis nosocomial BSI was associated with increased mortality (22.0% vs. 11.0%; P=0.029). After adjustment for confounding co-variates, however, nosocomial BSI was not associated with mortality (hazard ratio 1.3, 95% CI 0.6-2.6). Being bedridden and increasing age were independent risk factors for death. CONCLUSION Intravenous catheters and being bedridden are the main risk factors for nosocomial BSI. Although associated with higher mortality, this infectious complication seems not to be an independent risk factor for death in geriatric patients.
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Affiliation(s)
- S Reunes
- Faculty of Medicine and Health Sciences, Ghent University, Belgium
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Furtado LCDR. Incidence and predisposing factors of phlebitis in a surgery department. ACTA ACUST UNITED AC 2011; 20:S16-8, S20, S22 passim. [DOI: 10.12968/bjon.2011.20.sup7.s16] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Luís Carlos do Rego Furtado
- Central Operating Theatre, Hospital do Divino Espírito Santo de Ponta Delgada EPE, São Miguel Island, Portugal
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New Strategies in the Development of Antimicrobial Coatings: The Example of Increasing Usage of Silver and Silver Nanoparticles. Polymers (Basel) 2011. [DOI: 10.3390/polym3010340] [Citation(s) in RCA: 343] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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Vilela R, Dantas SRPE, Trabasso P. Equipe interdisciplinar reduz infecção sanguínea relacionada ao cateter venoso central em Unidade de Terapia Intensiva Pediátrica. REVISTA PAULISTA DE PEDIATRIA 2010. [DOI: 10.1590/s0103-05822010000400002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Avaliar o impacto de intervenções interdisciplinares nos indicadores de infecção de corrente sanguínea relacionada ao cateter venoso central e microrganismos isolados, em uma Unidade de Terapia Intensiva Pediátrica. MÉTODOS: Estudo de intervenção do tipo antes e depois. Foi criado um programa educativo e constituída uma equipe interdisciplinar de intervenção composta por médicos e enfermeiros da unidade e do Serviço de Controle de Infecção Hospitalar. As intervenções foram compostas por medidas diretas e indiretas educativas e processuais. O período pré-intervenção (Fase 1), de junho de 2003 a maio de 2004, foi comparado ao período pós-intervenção nas Fases 2 (junho de 2004 a maio de 2005) e 3 (junho de 2005 a maio de 2006). As taxas de infecção foram comparadas por ANOVA, sendo significante p<0,05. RESULTADOS: Foram avaliados 1.234 pacientes entre 1º de junho de 2003 e 31 de maio de 2006. A densidade de incidência de infecção de corrente sanguínea relacionada ao cateter venoso central foi de 22,72 por 1.000 dias de cateter na Fase 1; diminuiu para 6,81 e 5,87 nas Fases 2 e 3, respectivamente (p<0,01) e não houve diferença entre as Fases 2 e 3. Os Gram-positivos representaram 57% dos microrganismos isolados no período pré-intervenção e 45 e 58%, respectivamente, nos períodos pós-intervenção. CONCLUSÕES: A abordagem educacional interdisciplinar e o estabelecimento de normas para inserção e intervenção no processo de manutenção de cateteres reduziram as taxas de infecção da corrente sanguínea relacionada ao cateter venoso central em uma Unidade de Terapia Intensiva Pediátrica.
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Anti-infective external coating of central venous catheters: a randomized, noninferiority trial comparing 5-fluorouracil with chlorhexidine/silver sulfadiazine in preventing catheter colonization. Crit Care Med 2010; 38:2095-102. [PMID: 20711070 DOI: 10.1097/ccm.0b013e3181f265ba] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The antimetabolite drug, 5-fluorouracil, inhibits microbial growth. Coating of central venous catheters with 5-fluorouracil may reduce the risk of catheter infection. Our objective was to compare the safety and efficacy of central venous catheters externally coated with 5-fluorouracil with those coated with chlorhexidine and silver sulfadiazine. DESIGN Prospective, single-blind, randomized, active-controlled, multicentered, noninferiority trial. SETTING Twenty-five US medical center intensive care units. PATIENTS A total of 960 adult patients requiring central venous catheterization for up to 28 days. INTERVENTIONS Patients were randomized to receive a central venous catheter externally coated with either 5-fluorouracil (n = 480) or chlorhexidine and silver sulfadiazine (n = 480). MEASUREMENTS AND MAIN RESULTS The primary antimicrobial outcome was a dichotomous measure (<15 colony-forming units or ≥ 15 colony-forming units) for catheter colonization determined by the roll plate method. Secondary antimicrobial outcomes included local site infection and catheter-related bloodstream infection. Central venous catheters coated with 5-fluorouracil were noninferior to chlorhexidine and silver sulfadiazine coated central venous catheters with respect to the incidence of catheter colonization (2.9% vs. 5.3%, respectively). Local site infection occurred in 1.4% of the 5-fluorouracil group and 0.9% of the chlorhexidine and silver sulfadiazine group. No episode of catheter-related bloodstream infection occurred in the 5-fluorouracil group, whereas two episodes were noted in the chlorhexidine and silver sulfadiazine group. Only Gram-positive organisms were cultured from 5-fluorouracil catheters, whereas Gram-positive bacteria, Gram-negative bacteria, and Candida were cultured from the chlorhexidine and silver sulfadiazine central venous catheters. Adverse events were comparable between the two central venous catheter coatings. CONCLUSIONS Our results suggest that central venous catheters externally coated with 5-fluorouracil are a safe and effective alternative to catheters externally coated with chlorhexidine and silver sulfadiazine when used in critically ill patients.
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Halton KA, Cook D, Paterson DL, Safdar N, Graves N. Cost-effectiveness of a central venous catheter care bundle. PLoS One 2010; 5. [PMID: 20862246 PMCID: PMC2941454 DOI: 10.1371/journal.pone.0012815] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 08/23/2010] [Indexed: 11/18/2022] Open
Abstract
Background A bundled approach to central venous catheter care is currently being promoted as an effective way of preventing catheter-related bloodstream infection (CR-BSI). Consumables used in the bundled approach are relatively inexpensive which may lead to the conclusion that the bundle is cost-effective. However, this fails to consider the nontrivial costs of the monitoring and education activities required to implement the bundle, or that alternative strategies are available to prevent CR-BSI. We evaluated the cost-effectiveness of a bundle to prevent CR-BSI in Australian intensive care patients. Methods and Findings A Markov decision model was used to evaluate the cost-effectiveness of the bundle relative to remaining with current practice (a non-bundled approach to catheter care and uncoated catheters), or use of antimicrobial catheters. We assumed the bundle reduced relative risk of CR-BSI to 0.34. Given uncertainty about the cost of the bundle, threshold analyses were used to determine the maximum cost at which the bundle remained cost-effective relative to the other approaches to infection control. Sensitivity analyses explored how this threshold alters under different assumptions about the economic value placed on bed-days and health benefits gained by preventing infection. If clinicians are prepared to use antimicrobial catheters, the bundle is cost-effective if national 18-month implementation costs are below $1.1 million. If antimicrobial catheters are not an option the bundle must cost less than $4.3 million. If decision makers are only interested in obtaining cash-savings for the unit, and place no economic value on either the bed-days or the health benefits gained through preventing infection, these cost thresholds are reduced by two-thirds. Conclusions A catheter care bundle has the potential to be cost-effective in the Australian intensive care setting. Rather than anticipating cash-savings from this intervention, decision makers must be prepared to invest resources in infection control to see efficiency improvements.
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Affiliation(s)
- Kate A Halton
- The Centre for Healthcare Related Infection Surveillance and Prevention, Brisbane, Queensland, Australia.
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Rowlands I, Graves N, de Jersey S, McIntyre HD, Callaway L. Obesity in pregnancy: outcomes and economics. Semin Fetal Neonatal Med 2010; 15:94-9. [PMID: 19819773 DOI: 10.1016/j.siny.2009.09.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Maternal obesity is an important aspect of reproductive care. It is the commonest risk factor for maternal mortality in developed countries and is also associated with a wide spectrum of adverse pregnancy outcomes. Maternal obesity may have longer-term implications for the health of the mother and infant, which in turn will have economic implications. Efforts to prevent, manage and treat obesity in pregnancy will be costly, but may pay dividends from reduced future economic costs, and subsequent improvements to maternal and infant health. Decision-makers working in this area of health services should understand whether the problem can be reduced, at what cost; and then, what cost savings and health benefits will accrue in the future from a reduction of the problem.
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Affiliation(s)
- Ingrid Rowlands
- School of Medicine, University of Queensland, Brisbane, Australia
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[Management of peripheral intravascular devices]. ENFERMERIA CLINICA 2010; 20:68-70. [PMID: 20176328 DOI: 10.1016/j.enfcli.2009.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 12/03/2009] [Indexed: 11/23/2022]
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Zingg W, Sax H, Inan C, Cartier V, Diby M, Clergue F, Pittet D, Walder B. Hospital-wide surveillance of catheter-related bloodstream infection: from the expected to the unexpected. J Hosp Infect 2009; 73:41-6. [DOI: 10.1016/j.jhin.2009.05.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 05/22/2009] [Indexed: 12/13/2022]
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Abstract
Catheter-related bloodstream infection is one of the most serious complications of central venous access devices. Antimicrobial-coated catheters represent one novel strategy to prevent catheter-related bloodstream infection. A comprehensive economic evaluation is essential to guide informed decision-making regarding the adoption of this technology and its expected benefits in healthcare institutions.
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Affiliation(s)
- Nasia Safdar
- Section of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, H4/572, Madison, WI 53792, USA.
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Tacconelli E, Smith G, Hieke K, Lafuma A, Bastide P. Epidemiology, medical outcomes and costs of catheter-related bloodstream infections in intensive care units of four European countries: literature- and registry-based estimates. J Hosp Infect 2009; 72:97-103. [DOI: 10.1016/j.jhin.2008.12.012] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 12/18/2008] [Indexed: 11/30/2022]
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Halton KA, Cook DA, Whitby M, Paterson DL, Graves N. Cost effectiveness of antimicrobial catheters in the intensive care unit: addressing uncertainty in the decision. Crit Care 2009; 13:R35. [PMID: 19284570 PMCID: PMC2689469 DOI: 10.1186/cc7744] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 02/27/2009] [Accepted: 03/11/2009] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Some types of antimicrobial-coated central venous catheters (A-CVC) have been shown to be cost effective in preventing catheter-related bloodstream infection (CR-BSI). However, not all types have been evaluated, and there are concerns over the quality and usefulness of these earlier studies. There is uncertainty amongst clinicians over which, if any, A-CVCs to use. We re-evaluated the cost effectiveness of all commercially available A-CVCs for prevention of CR-BSI in adult intensive care unit (ICU) patients. METHODS We used a Markov decision model to compare the cost effectiveness of A-CVCs relative to uncoated catheters. Four catheter types were evaluated: minocycline and rifampicin (MR)-coated catheters, silver, platinum and carbon (SPC)-impregnated catheters, and two chlorhexidine and silver sulfadiazine-coated catheters; one coated on the external surface (CH/SSD (ext)) and the other coated on both surfaces (CH/SSD (int/ext)). The incremental cost per quality-adjusted life year gained and the expected net monetary benefits were estimated for each. Uncertainty arising from data estimates, data quality and heterogeneity was explored in sensitivity analyses. RESULTS The baseline analysis, with no consideration of uncertainty, indicated all four types of A-CVC were cost-saving relative to uncoated catheters. MR-coated catheters prevented 15 infections per 1,000 catheters and generated the greatest health benefits, 1.6 quality-adjusted life years, and cost savings (AUD $130,289). After considering uncertainty in the current evidence, the MR-coated catheters returned the highest incremental monetary net benefits of AUD $948 per catheter; however there was a 62% probability of error in this conclusion. Although the MR-coated catheters had the highest monetary net benefits across multiple scenarios, the decision was always associated with high uncertainty. CONCLUSIONS Current evidence suggests that the cost effectiveness of using A-CVCs within the ICU is highly uncertain. Policies to prevent CR-BSI amongst ICU patients should consider the cost effectiveness of competing interventions in the light of this uncertainty. Decision makers would do well to consider the current gaps in knowledge and the complexity of producing good quality evidence in this area.
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Affiliation(s)
- Kate A Halton
- The Centre for Healthcare Related Infection Surveillance & Prevention, GPO Box 48, Brisbane, Queensland, 4001 Australia
- Institute of Health & Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland, 4059 Australia
| | - David A Cook
- Intensive Care Unit, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, 4102 Australia
| | - Michael Whitby
- Infection Management Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, 4102 Australia
| | - David L Paterson
- The Centre for Healthcare Related Infection Surveillance & Prevention, GPO Box 48, Brisbane, Queensland, 4001 Australia
- University of Queensland, Royal Brisbane & Women's Hospital, Butterfield Street, Herston, Queensland, 4029 Australia
| | - Nicholas Graves
- The Centre for Healthcare Related Infection Surveillance & Prevention, GPO Box 48, Brisbane, Queensland, 4001 Australia
- Institute of Health & Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland, 4059 Australia
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Rogers KL, Fey PD, Rupp ME. Coagulase-Negative Staphylococcal Infections. Infect Dis Clin North Am 2009; 23:73-98. [DOI: 10.1016/j.idc.2008.10.001] [Citation(s) in RCA: 238] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
CRBSIs are expensive, prevalent, and often fatal complications. In the past few years, several preventive interventions have been applied with excellent results toward decreasing CRBSIs. Studies show that most CRBSIs are preventable; therefore, health care organizations should strive to substantially reduce if not eliminate them. In addition to being a measure of quality of care, reducing infections will soon be a bottom-line issue, given that the Centers for Medicare and Medicaid Services announced its decision to cease paying hospitals from October 2008 for some care necessitated by "preventable complications", including CRBSIs. Therefore, health care facilities that do not make the necessary adjustments to improve the quality of their patient care and avoid harm may be economically penalized. This article reviews the available evidence on and possible barriers to the widespread use of preventive strategies. The health care community has struggled to build a culture that can eliminate the barriers obstructing high-quality care. These new approaches must facilitate collaboration among caregivers. During the past few years, much effort has been dedicated to researching causes for inadequate patient care and executing interventions to improve processes of care; only now are projects beginning to focus on evaluating whether patients are safer. This article discusses the prevention of CRBSIs and shows that substantial reductions in the rate of these infections are possible. It is no longer acceptable for health care organizations to have the goal of being at the CDC mean for rate of infections; they should strive to substantially reduce or even eliminate them. Patients deserve no less.
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Affiliation(s)
- Jose M Rodriguez-Paz
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, 297 Meyer, Baltimore, MD 21287, USA.
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The International Nosocomial Infection Control Consortium (INICC): goals and objectives, description of surveillance methods, and operational activities. Am J Infect Control 2008; 36:e1-12. [PMID: 18992646 DOI: 10.1016/j.ajic.2008.06.003] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Revised: 06/09/2008] [Accepted: 06/09/2008] [Indexed: 02/07/2023]
Abstract
We have shown that intensive care units (ICUs) in countries with limited resources have rates of device-associated health care-associated infection (HAI), including central line-related bloodstream infection (CLAB), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI), 3 to 5 times higher than rates reported from North American, Western European, and Australian ICUs. The International Nosocomial Infection Control Consortium (INICC) is an international ongoing collaborative HAI control program with a surveillance system based on that of the US National Healthcare Safety Network. The INICC was founded 10 years ago to promote evidence-based infection control in hospitals in limited-resource countries and in hospitals of developed countries without sufficient experience in HAI surveillance and control, through the analysis and feedback of surveillance data collected voluntarily by the member hospitals. It developed from a handful of South American hospitals in 1998 to a dynamic network of 98 ICUs in 18 countries, and is the only source of aggregate standardized international data on HAI epidemiology. Herein we report the criteria and mechanisms for gaining membership in INICC; the training of personnel in INICC hospitals; the INICC protocol for outcome surveillance of CLABs, VAPs, and CAUTIs in ICUs, microorganism profiles, bacterial resistance, antibiotic use, extra length of stay, extra costs, extra mortality, and risk factor analysis, and for process surveillance, including compliance rates for hand hygiene, vascular catheter care, urinary catheter care, and measures for prevention of VAP; and the use of surveillance data feedback as a powerful weapon for control of HAIs. The INICC will continue to evolve in its quest to find more effective and efficient ways to assess patient risk and improve patient safety in hospitals.
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Abstract
Almost 30% of prevalent hemodialysis patients use catheters for vascular access although outcomes are superior with the use of either an arteriovenous fistula or a synthetic graft. Catheter complications are a major cause of morbidity and mortality for hemodialysis patients and increase the burden on the health care system. Surface-treated catheters have been developed to combat the three most common causes of catheter failure: infection, fibrin sheath formation, and thrombus formation. Two types of catheter surface treatments are available: antimicrobial coatings and antithrombotic coatings. Surface treatment of central venous catheters with antimicrobial materials reduces both bacterial colonization and the incidence of catheter-related bacteremia in critical care patients by 30-50%. Antithrombotic coatings reduce platelet adhesion, inhibit the inflammatory response, and reduce thrombus formation on coronary stents, ventricular assist devices, central venous catheters, and vascular grafts. However, few reports on the use of surface-treated catheters in the chronic hemodialysis patient population exist. At the present time, it is difficult to justify the increased cost of surface-treated catheters for chronic hemodialysis in the absence of clinical data demonstrating that they reduce catheter-related complications in this patient population.
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Affiliation(s)
- Amy Dwyer
- Kidney Disease Program, Department of Medicine, University of Louisville, Louisville, Kentucky 40202, USA.
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Zingg W, Cartier-Fässler V, Walder B. Central venous catheter-associated infections. Best Pract Res Clin Anaesthesiol 2008; 22:407-21. [DOI: 10.1016/j.bpa.2008.05.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ramritu P, Halton K, Cook D, Whitby M, Graves N. Catheter-related bloodstream infections in intensive care units: a systematic review with meta-analysis. J Adv Nurs 2008; 62:3-21. [PMID: 18352960 DOI: 10.1111/j.1365-2648.2007.04564.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIM This paper is a report of a systematic review and meta-analysis of strategies, other than antimicrobial coated catheters, hypothesized to reduce risk of catheter-related bloodstream infections and catheter colonization in the intensive care unit setting. BACKGROUND Catheter-related bloodstream infections occur at a rate of 5 per 1000 catheter days in the intensive care unit setting and cause substantial mortality and excess cost. Reducing risk of catheter-related bloodstream infections among intensive care unit patients will save costs, reduce length of stay, and improve outcomes. METHODS A systematic review of studies published between January 1985 and February 2007 was carried out using the keywords 'catheterization - central venous' with combinations of infection*, prevention* and bloodstream*. All included studies were screened by two reviewers, a validated data extraction instrument was used and data collection was completed by two blinded independent reviewers. Risk ratios for catheter-related bloodstream infections and catheter colonization were estimated with 95% confidence intervals for each study. Results from studies of similar interventions were pooled using meta-analyses. RESULTS Twenty-three studies were included in the review. The strategies that reduced catheter colonization included insertion of central venous catheters in the subclavian vein rather than other sites, use of alternate skin disinfection solutions before catheter insertion and use of Vitacuff in combination with polymyxin, neomycin and bacitracin ointment. Strategies to reduce catheter-related bloodstream infection included staff education multifaceted infection control programmes and performance feedback. CONCLUSION A range of interventions may reduce risks of catheter-related bloodstream infection, in addition to antimicrobial catheters.
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Affiliation(s)
- Prabha Ramritu
- The Centre for Healthcare Related Infection Surveillance & Prevention, Princess Alexandra Hospital, Brisbane, Qld, Australia
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Bolz K, Ramritu P, Halton K, Cook D, Graves N. Management of central venous catheters in adult intensive care units in Australia: policies and practices. ACTA ACUST UNITED AC 2008. [DOI: 10.1071/hi08016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Cunha BA. Oral versus IV treatment for catheter-related bloodstream infections. Emerg Infect Dis 2008; 13:1800-1; author reply 1801. [PMID: 18217579 PMCID: PMC2876959 DOI: 10.3201/eid1311.070729] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Halton K, Graves N. Oral Versus IV Treatment for Catheter-related Bloodstream Infections. Emerg Infect Dis 2007. [DOI: 10.3201/eid1311.071046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Kate Halton
- Princess Alexandra Hospital, Brisbane, Queensland, AustraliaQueensland University of Technology, Brisbane, Queensland, Australia
| | - Nicholas Graves
- Princess Alexandra Hospital, Brisbane, Queensland, AustraliaQueensland University of Technology, Brisbane, Queensland, Australia
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