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Youngs J, Marshall B, Farragher M, Whitney L, Glass S, Pope C, Planche T, Riley P, Carrington D. Implementation of influenza point-of-care testing and patient cohorting during a high-incidence season: a retrospective analysis of impact on infection prevention and control and clinical outcomes. J Hosp Infect 2018; 101:276-284. [PMID: 30471317 DOI: 10.1016/j.jhin.2018.11.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/12/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND During high-incidence influenza seasons, a robust infection prevention and control policy is imperative to reduce nosocomial transmission of influenza. AIM To assess the impact of influenza point-of-care testing (POCT) in an emergency department (ED) and patient cohorting on an influenza ward on infection prevention and control and clinical outcomes. METHODS Influenza POCT was operational in the study ED from 21st January 2018 and patient cohorting was operational on an influenza ward from 25th January 2018. A retrospective 'before-after' analysis was performed with pre-intervention defined as 1st November 2017 to 20th January 2018 and post-intervention defined as 21st January 2018 to 30th April 2018. The primary outcome was the rate of hospital-acquired influenza. Secondary outcomes included antiviral prescription and length of stay. The length of time that inpatients remained influenza-positive was estimated by polymerase chain reaction (PCR). FINDINGS There were 654 inpatients with confirmed influenza during the 2017/18 influenza season: 223 pre- and 431 post-intervention. Post-intervention, there were fewer cases of hospital-acquired influenza per day (0.66 vs 0.95, P < 0.0001), median length of stay was shorter (5.5 vs 7.5 days, P = 0.005) and antiviral prescription was more frequent (80% vs 64.1%, P < 0.0001). Cohorting released 779 single rooms for use elsewhere in the trust. The fixed probability of being PCR-negative by the next day (P) was 0.14 [95% confidence interval (CI) 0.12-0.16] for immunocompetent patients. This implies that half of immunocompetent patients are PCR-negative by five days post-diagnosis (95% CI 5-6). CONCLUSION Influenza POCT in an ED and patient cohorting on an influenza ward were associated with reduced nosocomial transmission of influenza and improved patient flow. A policy of retesting immunocompetent patients five days post-diagnosis could allow half of these patients to come out of respiratory isolation earlier.
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Affiliation(s)
- J Youngs
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK.
| | - B Marshall
- Analytical Services, Ministry of Justice, London, UK
| | - M Farragher
- Infection Prevention and Control Team, St George's University Hospitals NHS Foundation Trust, London, UK
| | - L Whitney
- Pharmacy Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - S Glass
- Department of Microbiology, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - C Pope
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK; Institute of Infection and Immunity, St George's University of London, London, UK
| | - T Planche
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK; Institute of Infection and Immunity, St George's University of London, London, UK
| | - P Riley
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK; Institute of Infection and Immunity, St George's University of London, London, UK
| | - D Carrington
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK; Institute of Infection and Immunity, St George's University of London, London, UK
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Goldenberg SD, Brown S, Edwards L, Gnanarajah D, Howard P, Jenkins D, Nayar D, Pasztor M, Oliver S, Planche T, Sandoe JAT, Wade P, Whitney L. The impact of the introduction of fidaxomicin on the management of Clostridium difficile infection in seven NHS secondary care hospitals in England: a series of local service evaluations. Eur J Clin Microbiol Infect Dis 2015; 35:251-9. [PMID: 26661400 PMCID: PMC4724367 DOI: 10.1007/s10096-015-2538-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/09/2015] [Indexed: 11/24/2022]
Abstract
Clostridium difficile infection (CDI) is associated with high mortality. Reducing incidence is a priority for patients, clinicians, the National Health Service (NHS) and Public Health England alike. In June 2012, fidaxomicin (FDX) was launched for the treatment of adults with CDI. The objective of this evaluation was to collect robust real-world data to understand the effectiveness of FDX in routine practice. In seven hospitals introducing FDX between July 2012 and July 2013, data were collected retrospectively from medical records on CDI episodes occurring 12 months before/after the introduction of FDX. All hospitalised patients aged ≥18 years with primary CDI (diarrhoea with presence of toxin A/B without a previous CDI in the previous 3 months) were included. Recurrence was defined as in-patient diarrhoea re-emergence requiring treatment any time within 3 months after the first episode. Each hospital had a different protocol for the use of FDX. In hospitals A and B, where FDX was used first line for all primary and recurrent episodes, the recurrence rate reduced from 10.6 % to 3.1 % and from 16.3 % to 3.1 %, with a significant difference in 28-day mortality from 18.2 % to 3.1 % (p < 0.05) and 17.3 % to 6.3 % (p < 0.05) for hospitals A and B, respectively. In hospitals using FDX in selected patients only, the changes in recurrence rates and mortality were less marked. The pattern of adoption of FDX appears to affect its impact on CDI outcome, with maximum reduction in recurrence and all-cause mortality where it is used as first-line treatment.
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Affiliation(s)
- S D Goldenberg
- Centre for Clinical Infection and Diagnostics Research, King's College, London and Guy's and St Thomas' NHS Foundation Trust, 5th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - S Brown
- Department of Microbiology, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - L Edwards
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - P Howard
- Department of Microbiology, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D Jenkins
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - D Nayar
- Department of Microbiology, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - M Pasztor
- University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | | | - T Planche
- St George's Healthcare NHS Trust, London, UK
| | - J A T Sandoe
- Department of Microbiology, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Wade
- Centre for Clinical Infection and Diagnostics Research, King's College, London and Guy's and St Thomas' NHS Foundation Trust, 5th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - L Whitney
- St George's Healthcare NHS Trust, London, UK
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Ashiru-Oredope D, Kessel A, Hopkins S, Ashiru-Oredope D, Brown B, Brown N, Carter S, Charlett A, Cichowka A, Faulding S, Gallagher R, Johnson A, McNulty C, Moore M, Patel B, Puleston R, Richman C, Ridge K, Robotham J, Sharland M, Stephens P, Stokle L, Towers K, Underhill J, West T, Whitney L, Wight A, Woodford N, Young T. Antimicrobial stewardship: English Surveillance Programme for Antimicrobial Utilization and Resistance (ESPAUR). J Antimicrob Chemother 2013; 68:2421-3. [DOI: 10.1093/jac/dkt363] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Bicanic T, Ogden D, Whitney L, Loyse A, Jarvis J. British HIV Association opportunistic infection guidelines: in defence of amphotericin B deoxycholate. HIV Med 2013; 13:636-7. [PMID: 23051823 DOI: 10.1111/j.1468-1293.2012.01022.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Knight GM, Budd EL, Whitney L, Thornley A, Al-Ghusein H, Planche T, Lindsay JA. Shift in dominant hospital-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) clones over time. J Antimicrob Chemother 2012; 67:2514-22. [DOI: 10.1093/jac/dks245] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Abstract
The ability to drink clear liquids without vomiting after anesthesia and surgery is a commonly used criteria for discharge of pediatric day surgery patients. We hypothesized that the ability to drink as a prerequisite for discharge would not affect the frequency of vomiting, delay discharge, or increase the frequency of readmission of children for dehydration after day surgical procedures. We randomized 989 patients between the ages of 1 month and 18.0 yr to one of two groups. The 464 "mandatory drinkers" were required to demonstrate the ability to drink clear liquids without vomiting prior to discharge from the hospital, whereas 525 "elective drinkers" were allowed but not required to drink. Other than the discharge criteria, the patients were managed in an identical fashion; the minimum volume of intravenous fluids received by all patients was adequate to supply a calculated 8-h fluid deficit prior to discharge from the hospital. There were no differences between the two groups in the incidence of vomiting in the operating room, the postanesthesia care unit, or after discharge from the hospital. However, in the day surgery unit, only 14% of the elective drinkers vomited compared to 23% of the mandatory drinker group (P less than 0.001). The mandatory drinkers had a more prolonged stay in the day surgical unit, averaging 101 +/- 58 min (mean +/- SD) compared to 84 +/- 40 min for elective drinkers (P less than 0.001). No patient in either group required admission to the hospital for persistent vomiting on the day of surgery, and no patient required readmission for vomiting or dehydration after discharge from the day surgery unit.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M S Schreiner
- Children's Hospital of Philadelphia, Pennsylvania 19104-4399
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Whitney L. Chronic bronchitis and emphysema. Airing the differences. Nursing 1992; 22:34-41. [PMID: 1553088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Sisodia N, Sullivan C, Whitney L. Spousal allegations of incest during transient psychotic episodes. Br J Psychiatry 1991; 159:886. [PMID: 1817490 DOI: 10.1192/s0007125000032293] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Whitney L, Holm K. Nursing care delivery: into the 1990s. Dimens Crit Care Nurs 1987; 6:259-60. [PMID: 3650148 DOI: 10.1097/00003465-198709000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Whitney L. Fluoridation: what's California waiting for? CDA J 1982; 10:33-6. [PMID: 6955029] [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: 01/22/2023]
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Whitney L. Will President Reagan be good for dentistry? CDA J 1981; 9:29-33. [PMID: 6949652] [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: 01/22/2023]
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Whitney L. The National Health Professions Placement Network: a way out of the manpower predicament? J Calif Dent Assoc (1961) 1980; 8:47-52. [PMID: 6935202] [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: 01/22/2023]
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Lange S, Whitney L. Teaching mental retardation nursing. The faculty learn. Nurs Outlook 1966; 14:58-61. [PMID: 5176006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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