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Wilson J, Griffin H, Görzig A, Prieto J, Saeed K, Garvey MI, Holden E, Tingle A, Loveday H. Identifying patients at increased risk of non-ventilator-associated pneumonia on admission to hospital: a pragmatic prognostic screening tool to trigger preventative action. J Hosp Infect 2023; 142:49-57. [PMID: 37820778 DOI: 10.1016/j.jhin.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/13/2023] [Accepted: 09/17/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Non-ventilator healthcare-associated pneumonia (NV-HAP) is an important healthcare-associated infection. This study tested the feasibility of using routine admission data to identify those patients at high risk of NV-HAP who could benefit from targeted, preventive interventions. METHODS Patients aged ≥64 years who developed NV-HAP five days or more after admission to elderly-care wards, were identified by retrospective case note review together with matched controls. Data on potential predictors of NV-HAP were captured from admission records. Multi-variate analysis was used to build a prognostic screening tool (PRHAPs); acceptability and feasibility of the tool was evaluated. RESULTS A total of 382 cases/381 control patients were included in the analysis. Ten predictors were included in the final model; nine increased the risk of NV-HAP (OR between 1.68 and 2.42) and one (independent mobility) was protective (OR 0.48; 95% CI 0.30-0.75). The model correctly predicted 68% of the patients with and without NV-HAP; sensitivity 77%; specificity 61%. The PRHAPs tool risk score was 60% or more if two predictors were present and over 70% if three were present. An expert consensus group supported incorporating the PRHAPs tool into electronic logic systems as an efficient mechanism to identify patients at risk of NV-HAP and target preventative strategies. CONCLUSIONS This prognostic screening (PRHAPs) tool, applied to data routinely collected when a patient is admitted to hospital, could enable staff to identify patients at greatest risk of NV-HAP, target scarce resources in implementing a prevention care bundle, and reduce the use of antimicrobial agents.
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Affiliation(s)
- J Wilson
- Richard Wells Research Centre, University of West London, Brentford, UK.
| | - H Griffin
- Richard Wells Research Centre, University of West London, Brentford, UK
| | - A Görzig
- School of Human Sciences, University of Greenwich, London, UK
| | - J Prieto
- Department of Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - K Saeed
- Department of Clinical and Experimental Sciences, University of Southampton, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M I Garvey
- Department of Clinical Microbiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - E Holden
- Department of Clinical Microbiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Tingle
- Richard Wells Research Centre, University of West London, Brentford, UK
| | - H Loveday
- Richard Wells Research Centre, University of West London, Brentford, UK
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Garvey MI, Williams N, Gardiner A, Ruston C, Wilkinson M, Kiernan M, Walker J, Holden E. The sink splash zone. J Hosp Infect 2023; 135:154-156. [PMID: 36870392 DOI: 10.1016/j.jhin.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 03/06/2023]
Affiliation(s)
- Mark I Garvey
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2WB; Hospital Infection Research Laboratory, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB; Institute of Microbiology and Infection, The University of Birmingham, Edgbaston, Birmingham, United Kingdom.
| | - Nathan Williams
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2WB
| | - Alyson Gardiner
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2WB
| | - Charlotte Ruston
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2WB
| | - Martyn Wilkinson
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2WB; Hospital Infection Research Laboratory, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB
| | - Martin Kiernan
- University of West London, Richard Wells Research Centre, London, United Kingdom
| | | | - Elisabeth Holden
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2WB
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Garvey MI, Wilkinson MAC, Woodall H, Smith C, Holden K, Cartin J, Dosanjh D, Holden E, Kiernan M. Mouth care matters - A HAP prevention strategy. J Infect 2021; 83:381-412. [PMID: 34062180 DOI: 10.1016/j.jinf.2021.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Mark I Garvey
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2WB Birmingham, United Kingdom; Institute of Microbiology and Infection, The University of Birmingham, Edgbaston, Birmingham, United Kingdom.
| | - Martyn A C Wilkinson
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2WB Birmingham, United Kingdom
| | - Helen Woodall
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2WB Birmingham, United Kingdom
| | - Caroline Smith
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2WB Birmingham, United Kingdom
| | - Kerry Holden
- Gloucestershire NHS Foundation Trust, Gloucester, United Kingdom
| | - Jenna Cartin
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2WB Birmingham, United Kingdom
| | - Davinder Dosanjh
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2WB Birmingham, United Kingdom; Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Elisabeth Holden
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2WB Birmingham, United Kingdom
| | - Martin Kiernan
- University of West London, Richard Wells Research Centre, London, United Kingdom
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Garvey MI, McMurray C, Casey AL, Ratcliffe L, Stockton J, Wilkinson MAC, Holden E, Osman H, Loman NJ. Observations of SARS-CoV-2 variant of concern B.1.1.7 at the UK's largest hospital trust. J Infect 2021; 83:e21-e23. [PMID: 33932449 PMCID: PMC8080512 DOI: 10.1016/j.jinf.2021.04.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/22/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Mark I Garvey
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB, England; Institute of Microbiology and Infection, The University of Birmingham, Edgbaston, Birmingham, England.
| | - Claire McMurray
- Institute of Microbiology and Infection, The University of Birmingham, Edgbaston, Birmingham, England.
| | - Anna L Casey
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB, England.
| | - Liz Ratcliffe
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB, England.
| | - Joanne Stockton
- Institute of Microbiology and Infection, The University of Birmingham, Edgbaston, Birmingham, England.
| | - Martyn A C Wilkinson
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB, England.
| | - Elisabeth Holden
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB, England.
| | - Husam Osman
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB, England.
| | - Nick J Loman
- Institute of Microbiology and Infection, The University of Birmingham, Edgbaston, Birmingham, England.
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5
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Garvey MI, Biggs M, Reddy-Kolanu V, Flavell H, Wallett A, Holden E. Lessons learnt from influenza POCT implementation in an acute medical unit. J Hosp Infect 2019; 103:358-360. [PMID: 31398383 DOI: 10.1016/j.jhin.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/01/2019] [Indexed: 11/17/2022]
Affiliation(s)
- M I Garvey
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK; Institute of Microbiology and Infection, The University of Birmingham, Edgbaston, Birmingham, UK.
| | - M Biggs
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - V Reddy-Kolanu
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - H Flavell
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - A Wallett
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - E Holden
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
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6
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Garvey MI, Wilkinson MAC, Bradley CW, Biggs M, Reddy-Kolanu V, Osman H, Carmalt S, Holden E. Impact of a PCR point of care test for influenza A/B on an acute medical unit in a large UK teaching hospital: results of an observational, pre and post intervention study. Antimicrob Resist Infect Control 2019; 8:120. [PMID: 31346461 PMCID: PMC6636012 DOI: 10.1186/s13756-019-0575-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/09/2019] [Indexed: 01/13/2023] Open
Abstract
Background Influenza viruses is a leading cause of acute respiratory infection, placing a significant burden on healthcare. To reduce hospital transmission, patients clinically suspected of having influenza are isolated and offered empirical antiviral treatment. Here we report the use of a point of care test (POCT) for influenza viruses in an acute medical unit (AMU) at Queen Elizabeth Hospital Birmingham for patients presenting with influenza-like illness. Methods A PCR POCT was installed on AMU in Dec 17 – Mar 18 (period 2) and used to test any patient with influenza-like illness. We conducted an evaluation against influenza virus’s data collected between Dec 16–Mar 17 (period 1) where no POCT was used. Four outcomes were measured: length of stay, oseltamivir utilisation, time to isolation and in-hospital cases of influenza viruses. Results There were 51 confirmed influenza virus cases in period 1 vs 666 in period 2. During period 2, the length of stay of patients presenting with influenza-like illness (2.4 vs 7.9 days) and time to isolation from receipt of a positive result (0.09 vs 1.26 days) was significantly shorter. The time to initial receipt of antivirals for patients with influenza virus was significantly quicker in period 2 (0.59 vs 1.1 days) and the total number of influenza virus cases identified after 72 h of admission was significantly lower (9% vs 51%). Discussion Following introduction of the POCT, there was an increase in appropriately targeted oseltamivir prescribing, shorter time to isolation, proportionally less post-72-h influenza virus cases and a reduction in length of stay of patients presenting with influenza-like illness. Conclusions Routine use of POCTs for viruses should be introduced into diagnostic pathways for acute respiratory illness, especially at the front door of hospitals.
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Affiliation(s)
- Mark I Garvey
- 1University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB UK.,2Institute of Microbiology and Infection, The University of Birmingham, Edgbaston, Birmingham, UK
| | - Martyn A C Wilkinson
- 1University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB UK
| | - Craig W Bradley
- 3Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire Royal Hospital, Gloucester, GL1 3NN UK
| | - Martin Biggs
- 1University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB UK
| | - Vinay Reddy-Kolanu
- 1University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB UK
| | - Husam Osman
- 1University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB UK
| | - Sarah Carmalt
- 1University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB UK
| | - Elisabeth Holden
- 1University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB UK
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7
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Biggs M, Iqbal T, Holden E, Clewer V, Garvey M. Effect of using fidaxomicin on recurrent Clostridium difficile infection. J Hosp Infect 2019; 102:165-167. [DOI: 10.1016/j.jhin.2018.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/26/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
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8
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Garvey MI, Bradley CW, Wilkinson MAC, Holden KL, Clewer V, Holden E. The value of the infection prevention and control nurse led MRSA ward round. Antimicrob Resist Infect Control 2019; 8:53. [PMID: 30911379 PMCID: PMC6417022 DOI: 10.1186/s13756-019-0506-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 03/04/2019] [Indexed: 11/12/2022] Open
Abstract
Meticillin-resistant S. aureus (MRSA) is prevalent in most parts of the world. The study took place at Queen Elizabeth Hospital Birmingham (QEHB) a UK tertiary referral hospital. At QEHB innovative nurse led daily ward rounds for patients that acquire hospital acquired MRSA during their hospital stay are undertaken. The aim is to optimise care delivered for these patients whilst at QEHB, thereby reducing the risk of infection in patients with healthcare-acquired MRSA. A segmented Poisson regression model suggests that the MRSA bacteraemia rate was affected where an 88.94% reduction (p = 0.0561) in bacteraemias was seen by the introduction of these ward rounds. We describe a nurse led MRSA ward round which was associated with a lower rate of MRSA bacteraemias.
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Affiliation(s)
- Mark I Garvey
- 1University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB UK.,2Institute of Microbiology and Infection, The University of Birmingham, Edgbaston, Birmingham, UK
| | - Craig W Bradley
- 3Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire Royal Hospital, Gloucester, GL1 3NN UK
| | - Martyn A C Wilkinson
- 1University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB UK
| | - Kerry L Holden
- 3Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire Royal Hospital, Gloucester, GL1 3NN UK
| | - Victoria Clewer
- 1University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB UK
| | - Elisabeth Holden
- 1University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB UK
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9
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Smith C, Casey A, Round SL, Malladi R, Holden E, Garvey MI. Prolonged norovirus shedding and the use of a rapid norovirus polymerase chain reaction to assess terminal room cleaning in immunocompromised patients. J Hosp Infect 2019; 102:354-355. [PMID: 30790606 DOI: 10.1016/j.jhin.2019.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 02/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- C Smith
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - A Casey
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - S L Round
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - R Malladi
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - E Holden
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - M I Garvey
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK; Institute of Microbiology and Infection, The University of Birmingham, Edgbaston, Birmingham, UK.
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10
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Garvey MI, Wilkinson MAC, Bradley CW, Holden KL, Holden E. Wiping out MRSA: effect of introducing a universal disinfection wipe in a large UK teaching hospital. Antimicrob Resist Infect Control 2018; 7:155. [PMID: 30574298 PMCID: PMC6299988 DOI: 10.1186/s13756-018-0445-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/03/2018] [Indexed: 11/23/2022] Open
Abstract
Background Contamination of the inanimate environment around patients constitutes an important reservoir of MRSA. Here we describe the effect of introducing a universal disinfection wipe in all wards on the rates of MRSA acquisitions and bacteraemias across a large UK teaching hospital. Methods A segmented Poisson regression model was used to detect any significant changes in the monthly numbers per 100,000 bed days of MRSA acquisitions and bacteraemias from April 2013 - December 2017 across QEHB. Results From April 2013 to April 2016, cleaning of ward areas and multi-use patient equipment by nursing staff consisted of a two-wipe system. Firstly, a detergent wipe was used, which was followed by a disinfection step using an alcohol wipe. In May 2016, QEHB discontinued the use of a two-wipe system for cleaning and changed to a one wipe system utilising a combined cleaning and disinfection wipe containing a quaternary ammonium compound. The segmented Poisson regression model demonstrated that the rate of MRSA acquisition/100,000 patient bed days was affected by the introduction of the new wiping regime (20.7 to 9.4 per 100,000 patient bed days; p <0.005). Discussion Using a Poisson model we demonstrated that the average hospital acquisition rate of MRSA/100,000 patient bed days reduced by 6.3% per month after the introduction of the new universal wipe. Conclusion We suggest that using a simple one wipe system for nurse cleaning is an effective strategy to reduce the spread and incidence of healthcare associated MRSA.
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Affiliation(s)
- Mark I. Garvey
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB England
- Institute of Microbiology and Infection, The University of Birmingham, Edgbaston, Birmingham, England
| | - Martyn A. C. Wilkinson
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB England
| | - Craig W. Bradley
- Gloucestershire Hospital’s NHS Foundation Trust, Gloucester Royal Hospital, Great Western Road, Gloucester, GL1 3NN England
| | - Kerry L. Holden
- Gloucestershire Hospital’s NHS Foundation Trust, Gloucester Royal Hospital, Great Western Road, Gloucester, GL1 3NN England
| | - Elisabeth Holden
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB England
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Aalami-Harandi P, Amirlatifi N, Akinola D, Holden E, McGovern P, Fechner A. Assessment of knowledge regarding elective oocyte cryopreservation amongst healthcare professionals in training. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Garvey MI, Bradley CW, Holden E. Waterborne Pseudomonas aeruginosa transmission in a hematology unit? Am J Infect Control 2018; 46:383-386. [PMID: 29195780 DOI: 10.1016/j.ajic.2017.10.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa is an important nosocomial pathogen that commonly colonizes hospital water supplies, including in taps and sinks. We report the transmission of P. aeruginosa from water to patients in a clinical hematology setting. METHODS P. aeruginosa from water samples were compared to clinical isolates from hematology ward patients, via molecular typing (pulsed field gel electrophoresis). RESULTS P. aeruginosa cultured from blood cultures from 3 patients was indistinguishable from water strains, by molecular typing. Based on infection control inspections, the transmission event was surmised to be due to cleaning of equipment, specifically an infusion therapy procedure tray used to transport intravenous drugs to patients, with water from an outlet colonized by P. aeruginosa. CONCLUSION We show the importance of holistic factors, such as disposal of patient waste water, cleaning of tap outlets, and cleaning of medical equipment, in the transmission of P. aeruginosa, and demonstrate that the role of waterborne transmission of this organism in a hematology setting cannot be overlooked. We suggest that appropriate management of water, including both holistic and engineering interventions, is needed to stop transmission of P. aeruginosa from water to patients.
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Affiliation(s)
- Mark I Garvey
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2WB, UK.
| | - Craig W Bradley
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2WB, UK
| | - Elisabeth Holden
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2WB, UK
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14
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Garvey MI, Bradley CW, Wilkinson MAC, Holden E. Can a toxin gene NAAT be used to predict toxin EIA and the severity of Clostridium difficile infection? Antimicrob Resist Infect Control 2017; 6:127. [PMID: 29270290 PMCID: PMC5735516 DOI: 10.1186/s13756-017-0283-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 11/23/2017] [Indexed: 12/17/2022] Open
Abstract
Background Diagnosis of C. difficile infection (CDI) is controversial because of the many laboratory methods available and their lack of ability to distinguish between carriage, mild or severe disease. Here we describe whether a low C. difficile toxin B nucleic acid amplification test (NAAT) cycle threshold (CT) can predict toxin EIA, CDI severity and mortality. Methods A three-stage algorithm was employed for CDI testing, comprising a screening test for glutamate dehydrogenase (GDH), followed by a NAAT, then a toxin enzyme immunoassay (EIA). All diarrhoeal samples positive for GDH and NAAT between 2012 and 2016 were analysed. The performance of the NAAT CT value as a classifier of toxin EIA outcome was analysed using a ROC curve; patient mortality was compared to CTs and toxin EIA via linear regression models. Results A CT value ≤26 was associated with ≥72% toxin EIA positivity; applying a logistic regression model we demonstrated an association between low CT values and toxin EIA positivity. A CT value of ≤26 was significantly associated (p = 0.0262) with increased one month mortality, severe cases of CDI or failure of first line treatment. The ROC curve probabilities demonstrated a CT cut off value of 26.6. Discussions Here we demonstrate that a CT ≤26 indicates more severe CDI and is associated with higher mortality. Samples with a low CT value are often toxin EIA positive, questioning the need for this additional EIA test. Conclusions A CT ≤26 could be used to assess the potential for severity of CDI and guide patient treatment.
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Affiliation(s)
- Mark I Garvey
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, B15 2WB, Edgbaston, Birmingham, UK.,Institute of Microbiology and Infection, The University of Birmingham, Edgbaston, Birmingham, UK
| | - Craig W Bradley
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, B15 2WB, Edgbaston, Birmingham, UK
| | - Martyn A C Wilkinson
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, B15 2WB, Edgbaston, Birmingham, UK
| | - Elisabeth Holden
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, B15 2WB, Edgbaston, Birmingham, UK
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15
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Bradley CW, Flavell H, Raybould L, McCoy H, Dempster L, Holden E, Garvey MI. Reducing Escherichia coli bacteraemia associated with catheter-associated urinary tract infections in the secondary care setting. J Hosp Infect 2017; 98:236-237. [PMID: 29203447 DOI: 10.1016/j.jhin.2017.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Affiliation(s)
- C W Bradley
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - H Flavell
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - L Raybould
- NHS Birmingham Cross City Clinical Commissioning Group, Birmingham, UK
| | - H McCoy
- NHS Birmingham Cross City Clinical Commissioning Group, Birmingham, UK
| | | | - E Holden
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - M I Garvey
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
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16
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Garvey M, Bradley C, Holden E. Blossoming vancomycin-resistant enterococci infections. J Hosp Infect 2017; 97:421-423. [DOI: 10.1016/j.jhin.2017.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 10/19/2022]
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17
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Garvey M, Bradley C, Casey A, Clewer V, Holden E. Using a vanA polymerase chain reaction to detect environmental contamination during a vancomycin-resistant enterococci outbreak. J Hosp Infect 2017; 97:419-421. [DOI: 10.1016/j.jhin.2017.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 10/19/2022]
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18
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Garvey MI, Bradley CW, Biggs MJ, Holden E, Gill MJ. Selection of carbapenem-resistant Pseudomonas aeruginosa in a haematology unit? J Hosp Infect 2017; 98:238-240. [PMID: 29126992 DOI: 10.1016/j.jhin.2017.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/27/2017] [Indexed: 11/25/2022]
Affiliation(s)
- M I Garvey
- Infection Prevention and Control Team, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
| | - C W Bradley
- Infection Prevention and Control Team, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - M J Biggs
- Infection Prevention and Control Team, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - E Holden
- Infection Prevention and Control Team, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - M J Gill
- Infection Prevention and Control Team, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
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Bradley C, Holden E, Garvey M. Hand hygiene compliance targets: what are we actually targeting? J Hosp Infect 2017; 95:359-360. [DOI: 10.1016/j.jhin.2017.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 02/02/2017] [Indexed: 11/26/2022]
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Calvo G, Holden E, Reid J, Scott EM, Firth A, Bell A, Robertson S, Nolan AM. Development of a behaviour-based measurement tool with defined intervention level for assessing acute pain in cats. J Small Anim Pract 2014; 55:622-9. [DOI: 10.1111/jsap.12280] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 08/21/2014] [Accepted: 08/28/2014] [Indexed: 11/28/2022]
Affiliation(s)
- G. Calvo
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences; University of Glasgow; Glasgow G61 1QH
| | - E. Holden
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences; University of Glasgow; Glasgow G61 1QH
| | - J. Reid
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences; University of Glasgow; Glasgow G61 1QH
| | - E. M. Scott
- School of Mathematics and Statistics, College of Science and Engineering; University of Glasgow; Glasgow G12 8QQ
| | - A. Firth
- Vets Now Emergency; Dunfermline FIFE KY11 8SG
| | - A. Bell
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences; University of Glasgow; Glasgow G61 1QH
| | - S. Robertson
- College of Veterinary Medicine; Michigan State University; East Lansing MI 48824 USA
| | - A. M. Nolan
- School of Life, Sport and Social Sciences; Edinburgh Napier University; Edinburgh EH11 4BN
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Holden E, Calvo G, Collins M, Bell A, Reid J, Scott EM, Nolan AM. Evaluation of facial expression in acute pain in cats. J Small Anim Pract 2014; 55:615-21. [DOI: 10.1111/jsap.12283] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/01/2014] [Accepted: 09/15/2014] [Indexed: 11/30/2022]
Affiliation(s)
- E. Holden
- School of Veterinary Medicine; University of Glasgow; Glasgow G61 1QH
| | - G. Calvo
- School of Veterinary Medicine; University of Glasgow; Glasgow G61 1QH
| | - M. Collins
- School of Veterinary Medicine; University of Glasgow; Glasgow G61 1QH
| | - A. Bell
- School of Veterinary Medicine; University of Glasgow; Glasgow G61 1QH
| | - J. Reid
- School of Veterinary Medicine; University of Glasgow; Glasgow G61 1QH
| | - E. M. Scott
- School of Mathematics and Statistics; University of Glasgow; Glasgow G12 8QW
| | - A. M. Nolan
- School of Life, Sports and Social Sciences; Edinburgh Napier University; Edinburgh EH11 4BN
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Holden E, Bashir A, Das I, Morton H, Steadman CD, Nightingale P, Steeds RP, David MD. Staphylococcus aureus bacteraemia in a UK tertiary referral centre: a 'transoesophageal echocardiogram for all' policy. J Antimicrob Chemother 2014; 69:1960-5. [PMID: 24677159 DOI: 10.1093/jac/dku082] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Infective endocarditis (IE) is a feared complication in up to 38% of cases of Staphylococcus aureus bacteraemia (SAB). BSAC guidelines recommend echocardiography in all cases of SAB. The aim of this study was to determine the incidence of IE in SAB using transoesophageal echocardiography (TOE) as the first step in diagnostic imaging. This study also sought to identify clinical predictors that could improve stratification of those with and without IE. METHODS A guideline was implemented that any SAB resulted in the microbiology department (i) recommending that the patient be referred for TOE and (ii) notifying the echocardiography department, resulting in streamlined listing of the patient for TOE. All cases of SAB were then assessed prospectively at University Hospitals Birmingham NHS Foundation Trust between September 2011 and October 2012. Previously identified risk factors for complicated S. aureus bacteraemia were recorded. RESULTS There were 98 SAB episodes in total. TOE was performed in 58 (59%) with a further 22 episodes imaged by transthoracic echocardiography alone. IE was diagnosed overall in 13 (16%) cases investigated with echocardiography. No risk factor for IE other than presence of a cardiac device was detected in this group (P = 0.013). CONCLUSIONS The rate of IE found in SAB is high when TOE is performed first line. There are no clear risk factors to improve yield or the type of echocardiography to be performed. Echocardiography should be performed in all cases and TOE should be considered where it is expected to influence management, as long as local resources allow.
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Affiliation(s)
- Elisabeth Holden
- Microbiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ahmed Bashir
- Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ira Das
- Microbiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hugh Morton
- Microbiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christopher D Steadman
- Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter Nightingale
- Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard P Steeds
- Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Miruna D David
- Microbiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Holden E, Jackson M. A pilot trial in healthy volunteers to determine the reliability and accuracy of the oxygen compliance monitor, oxymon®. J Med Eng Technol 2009; 33:604-9. [DOI: 10.3109/03091900903067432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Newton A, Watling R, Davy L, Holden E, Ward S. Progress towards implementing the Biodiversity Action Plan for stipitate hydnoid fungi in Scotland. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/03746600208685031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Elsdon-Dew RW, Holden E. A comparison of slow Trasicor (oxprenolol 160 mg) and Trasidrex (oxprenolol 160 mg and cyclopenthiazide 0.25 mg) in the treatment of hypertension in general practice. J Int Med Res 1981; 9:315-8. [PMID: 7028531 DOI: 10.1177/030006058100900503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
A crossover study was carried out in general practice to compare Slow Trasicor and Trasidrex (a fixed combination of Slow Trasicor 160 mg and Navidrex 0.25 mg) in the treatment of newly diagnosed hypertensive patients. Trasidrex produced a significantly lower systolic and diastolic pressure, but there were no obvious differences in the incidence of side-effects between the two treatments.
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Browning RC, Holden E, Gostick N, Shepherd F, Watson J. Antihypertensive medication regimens and their revision. A General Practitioner Clinical Research Group study. Practitioner 1981; 225:587-9. [PMID: 7024973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Hashimoto H, Tillmanns H, Sarma JS, Mao J, Holden E, Bing RJ. Lipid metabolism in perfused human nonatherosclerotic coronary arteries and saphenous veins. Atherosclerosis 1974; 19:35-45. [PMID: 4810469 DOI: 10.1016/0021-9150(74)90042-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Holden E. General anaesthesia for dentistry. Br Dent Surg Assist 1968; 27:25-7 passimc. [PMID: 5246090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Holden E. A Practical Sphygmograph. Buffalo Med Surg J 1874; 13:219-221. [PMID: 36668045 PMCID: PMC9467265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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