ORCID Profile
0000-0003-4220-8291
Current Organisations
Avondale University
,
Griffith University
,
London School of Hygiene and Tropical Medicine
,
Australasian College for Infection Prevention and Control
,
Australian Catholic University Canberra Campus
,
Queensland University of Technology
,
Monash University
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Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1071/HI11009
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.JHIN.2017.09.002
Abstract: Surveillance of healthcare-associated infections is fundamental for infection prevention. The methods and practices for surveillance have evolved as technology becomes more advanced. The availability of electronic surveillance software (ESS) has increased, and yet adoption of ESS is slow. It is argued that ESS delivers savings through automation, particularly in terms of human resourcing and infection prevention (IP) staff time. To describe the findings of a systematic review on the impact of ESS on IP resources. A systematic search was conducted of electronic databases Medline and the Cumulative Index to Nursing and Allied Health Literature published between January 1 In all, 2832 articles were reviewed, of which 16 studies met the inclusion criteria. IP resources were identified as time undertaken on surveillance. A reduction in IP staff time to undertake surveillance was demonstrated in 13 studies. The reduction proportion ranged from 12.5% to 98.4% (mean: 73.9%). The remaining three did not allow for any estimation of the effect in terms of IP staff time. None of the studies demonstrated an increase in IP staff time. The results of this review demonstrate that adopting ESS yields considerable idends in IP staff time relating to data collection and case ascertainment while maintaining high levels of sensitivity and specificity. This has the potential to enable reinvestment into other components of IP to maximize efficient use of scarce IP resources.
Publisher: Springer Science and Business Media LLC
Date: 12-2014
Publisher: BMJ
Date: 29-07-2014
Publisher: Elsevier BV
Date: 12-2016
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1071/HI10030
Publisher: Elsevier BV
Date: 11-2021
Publisher: Elsevier BV
Date: 08-2023
Publisher: Elsevier BV
Date: 11-2020
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1071/HI11007
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1071/HI13026
Publisher: Elsevier
Date: 2020
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.AJIC.2016.01.026
Abstract: Despite evidence from overseas that certification and credentialing of infection control professionals (ICPs) is important to patient outcomes, there are no standardized requirements for the education and preparation of ICPs in Australia. A credentialing process (now managed by the Australasian College of Infection Prevention and Control) has been in existence since 2000 however, no evaluation has occurred. A cross-sectional study design was used to identify the perceived barriers to credentialing and the characteristics of credentialed ICPs. There were 300 responses received 45 (15%) of participants were credentialed. Noncredentialed ICPs identified barriers to credentialing as no employer requirement and no associated remuneration. Generally credentialed ICPs were more likely to hold higher degrees and have more infection control experience than their noncredentialed colleagues. The credentialing process itself may assist in supporting ICP development by providing an opportunity for reflection and feedback from peer review. Further, the process may assist ICPs in being flexible and adaptable to the challenging and ever-changing environment that is infection control.
Publisher: Informa UK Limited
Date: 03-07-2020
Publisher: Elsevier BV
Date: 03-2018
Publisher: Elsevier BV
Date: 05-2016
Publisher: Cambridge University Press (CUP)
Date: 22-08-2017
DOI: 10.1017/ICE.2017.170
Abstract: To examine tweeting activity, networks, and common topics mentioned on Twitter at 4 international infection control and infectious disease conferences. A cross-sectional study. An independent company was commissioned to undertake a Twitter ‘trawl’ each month between July 1, 2016, and November 31, 2016. The trawl identified any tweets that contained the official hashtags of the conferences for (1) the UK Infection Prevention Society, (2) IDWeek 2016, (3) the Federation of Infectious Society/Hospital Infection Society, and (4) the Australasian College for Infection Prevention and Control. Topics from each tweet were identified, and an examination of the frequency and timing of tweets was performed. A social network analysis was performed to illustrate connections between users. A multivariate binary logistic regression model was developed to explore the predictors of ‘retweets.’ In total, 23,718 tweets were identified as using 1 of the 2 hashtags of interest. The results demonstrated that the most tweets were posted during the conferences. Network analysis demonstrated a ersity of twitter networks. A link to a web address was a significant predictor of whether a tweet would be retweeted (odds ratio [OR], 2.0 95% confidence interval [CI], 1.9–2.1). Other significant factors predicting a retweet included tweeting on topics such as Clostridium difficile (OR, 2.0 95% CI, 1.7–2.4) and the media (OR, 1.8 95% CI, 1.6–2.0). Tweets that contained a picture were significantly less likely to be retweeted (OR, 0.06 95% CI, 0.05–0.08). Twitter is a useful tool for information sharing and networking at infection control conferences. Infect Control Hosp Epidemiol 2017 :1271–1276
Publisher: CSIRO Publishing
Date: 2012
DOI: 10.1071/AH11200
Abstract: Healthcare settings are dangerous places. For those receiving care, the risk of unintended harm from healthcare failures continues to be significant. Given this, there is a need to monitor standards in healthcare, not only to identify potential issues, but also to plan and evaluate interventions aimed at improving healthcare standards. Public reporting of performance standards is one aspect to monitoring standards, but not the only one. Public reporting also brings with it challenges. This perspective explores the recent move to publicly report one healthcare-associated infection (HAI) on the MyHospitals website and comments on the broader issue of using existing HAI data for the purposes of public reporting.
Publisher: Elsevier BV
Date: 02-2020
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.IDH.2019.12.005
Abstract: The environment has an important role in the transmission of healthcare associated infections. This has encouraged interest in novel methods to improve hygiene in hospitals. One such technology is the use of hydrogen peroxide to decontaminate rooms and equipment there are, however, few studies that have investigated the effect of continuous dilute hydrogen peroxide (DHP) in the clinical environment. The aim of this study was to examine the use of dilute hydrogen peroxide (DHP) in a critical care unit and measure the microbiological impact on surface contamination. We conducted a prospective observational cross-over study in a ten-bed critical care unit in one rural Australian hospital. Selected high-touch sites were screened using dipslides across three study phases: baseline continuous DHP and no DHP (control). Quantitative aerobic colony counts (ACC) were assessed against a benchmark standard of ACC >2.5 cfu/cm There were low levels of microbial contamination in the unit for baseline DHP and no DHP phases: 2.2% (95% CI 0.7-5.4%) vs 7.7% (95% CI 4.3-13.0%) vs 6% (95% CI 3.2-10.4%) hygiene failures, respectively. Significant reduction in ACCs did not occur when the DHP was operating compared with baseline and control phases. Further work is needed to determine whether continuous DHP technology has a role in decontamination for healthcare settings.
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.IJANTIMICAG.2015.05.015
Abstract: This study assessed urinary Escherichia coli antibiotic susceptibility patterns in Tasmania, Australia, and examined their association with community antibiotic use. The susceptibility profiles of all urinary E. coli isolates collected in Tasmania between January 2010 and December 2012 were included. The amount of Pharmaceutical Benefits Scheme (PBS)-subsidised use of amoxicillin, amoxicillin/clavulanic acid (AMC), cefalexin, norfloxacin, ciprofloxacin and trimethoprim was retrieved (at the Tasmanian population level) and the number of defined daily doses per 1000 population per day in Tasmania for these antibiotics was calculated for each month during the study period. Antimicrobial susceptibility data were assessed for changes over time in the 3-year study period. Antimicrobial use and susceptibility data were assessed for seasonal differences and lag in resistance following antibiotic use. Excluding duplicates, 28145 E. coli isolates were included. Resistance levels were low 35% of isolates were non-susceptible to amoxicillin, 14% were non-susceptible to trimethoprim and <5% were non-susceptible to AMC, cefalexin, gentamicin and norfloxacin. Amoxicillin use increased by 35% during winter/spring compared with summer/autumn, and AMC use increased by 21%. No seasonal variation in quinolone use or resistance was detected. The low levels of antimicrobial resistance identified may relate to Tasmania's isolated geographical location. Significant seasonal variation in amoxicillin and AMC use is likely to be due to increased use of these antibiotics for treatment of respiratory tract infections in winter. Quinolone use is restricted by the PBS in Australia, which is the likely explanation for the low levels of quinolone use and resistance identified.
Publisher: Elsevier BV
Date: 10-2021
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.IDH.2017.07.001
Abstract: Central to all efforts to control and prevent healthcare associated infections (HAIs) is the inherent need to measure the burden of infection and disease, classically referred to as surveillance. Australia does not have a national HAI surveillance system making it very difficult to systematically assess and report on the burden of hospital-acquired HAIs. This systematic review reports the incidence burden of HAIs in Australian hospitals as reported in the peer-reviewed literature from 2010 to 2016. Systematic review of the peer-reviewed literature reporting the incidence of HAIs in Australian hospitals between from 2010 to 2016 was identified using MEDLINE and CINAHL databases. The study protocol is registered with PROSPERO (registration number: CRD42016052997). Of the 844 articles identified in the search, 24 articles were included in this review. Overall, these data suggest 83,096 HAIs per year in Australia, comprising 71,186 urinary tract infections, 4902 Clostridium difficile infections, 3946 surgical site infections, 1962 respiratory infections in acute stroke patients and 1100 hospital-onset Staphylococcus aureus bacteraemia. This is very large underestimate given the lack of or incomplete data on common infections such as pneumonia, gastroenterological and bloodstream infection, thus potentially missing up to 50%-60% of infections. If that is the case, the incidence of HAIs in Australia may be closer to 165,000 per year. There is a dearth of peer-reviewed literature reporting the incidence of HAIs in Australian hospitals, making it very difficult to an accurate burden of infection. On the eve of a global 'post antibiotic era', the need for national consensus on definitions, surveillance methodology and reporting is paramount.
Publisher: Elsevier BV
Date: 11-2019
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1071/HI13037
Publisher: BMJ
Date: 06-2021
DOI: 10.1136/BMJOPEN-2020-046817
Abstract: A systematic review on meatal cleaning prior to urinary catheterisation and post catheterisation and reduces the risk catheter-associated urinary tract infections (CAUTIs) and bacteriuria was published in 2017, with further studies undertaken since this time. The objective of this paper is to present an updated systematic review on the effectiveness of antiseptic cleaning of the meatal area for the prevention of CAUTIs and bacteriuria in patients who receive a urinary catheter. Systematic review. Electronic databases Cochrane Library, PubMed, Embase, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Academic Search Complete were searched from 1 January 2016 and 29 February 2020. Randomised controlled trials (RCTs) and quasi-experimental studies evaluating the use of antiseptic, antibacterial or non-medicated agents for cleaning the meatal, periurethral or perineal areas before indwelling catheter insertion or intermittent catheterisation or during routine meatal care. Data were extracted using the Cochrane Collaboration’s data collection form for RCTs and non-RCTs. Data were extracted by one researcher and then checked for accuracy by a second researcher. A total of 18 studies were included. Some potential benefit of using antiseptics, compared with non-antiseptics for meatal cleaning to prevent bacteriuria and or CAUTI was identified (OR 0.84, 95% CI 0.69 to 1.02 p=0.071). Antiseptics (chlorhexidine or povidine-iodine) may be of value for meatal cleaning on the incidence of CAUTI, compared with comparator agents (saline, soap or antimicrobial cloths) (OR=0.65, 95% CI 0.42 to 0.99 p=0.047). There is emerging evidence of the role of some specific antiseptics (chlorhexidine) prior to urinary catheterisation, in reducing CAUTIs, and some potential benefit to the role of antiseptics more generally in reducing bacteriuria. CRD42015023741.
Publisher: Elsevier BV
Date: 12-2017
Publisher: Wiley
Date: 07-01-2013
DOI: 10.1111/JAN.12078
Abstract: To quantify the risk of death associated with Clostridium difficile infection, in an Australian tertiary hospital. Two reviews examining Clostridium difficile infection and mortality indicate that Clostridium difficile infection is associated with increased mortality in hospitalized patients. Studies investigating the mortality of Clostridium difficile infection in settings outside of Europe and North America are required, so that the epidemiology of Clostridium difficile infection in these regions can be understood and appropriate prevention strategies made. An observational non-concurrent cohort study design was used. Data from all persons who had (exposed) and a matched s le of persons who did not have Clostridium difficile infection, for the calendar years 2007-2010, were analysed. The risk of dying within 30, 60, 90 and 180 days was compared using the two groups. Kaplan-Meier survival analysis and conditional logistic regression models were applied to the data to examine time to death and mortality risk adjusted for comorbidities using the Charlson Comorbidity Index. One hundred and fifty-eight cases of infection were identified. A statistically significant difference in all-cause mortality was identified between exposed and non-exposed groups at 60 and 180 days. In a conditional regression model, mortality in the exposed group was significantly higher at 180 days. In this Australian study, Clostridium difficile infection was associated with increased mortality. In doing so, it highlights the need for nurses to immediately instigate contact precautions for persons suspected of having Clostridium difficile infection and to facilitate a timely faecal collection for testing. Our findings support ongoing surveillance of Clostridium difficile infection and associated prevention and control activities.
Publisher: RCN Publishing Ltd.
Date: 23-07-2014
DOI: 10.7748/NS.28.47.43.E8857
Abstract: Clostridium difficile is a bacterium which commonly causes diarrhoea in inpatients. C. difficile affects hospitalised patients worldwide and can pose a significant risk to patients. This article explores the transmission and risk factors for C. difficile infection (CDI). There are many aspects to the prevention and control of CDI: appropriate antibiotic use, early instigation and maintenance of prevention and control strategies, and high standards of environmental cleanliness, education, and surveillance. This article discusses the role of the nurse in each of these prevention and control activities.
Publisher: Elsevier BV
Date: 08-2020
Publisher: Elsevier BV
Date: 12-2009
DOI: 10.1071/HI09023
Publisher: Elsevier BV
Date: 09-2021
Publisher: Wiley
Date: 23-06-2014
DOI: 10.1111/JAN.12193
Abstract: To present a discussion on theoretical frameworks in infection prevention and control. Infection prevention and control programmes have been in place for several years in response to the incidence of healthcare-associated infections and their associated morbidity and mortality. Theoretical frameworks play an important role in formalizing the understanding of infection prevention activities. Discussion paper. A literature search using electronic databases was conducted for published articles in English addressing theoretical frameworks in infection prevention and control between 1980-2012. Nineteen papers that included a reference to frameworks were identified in the review. A narrative analysis of these papers was completed. Two models were identified and neither included the role of surveillance. To reduce the risk of acquiring a healthcare-associated infection, a multifaceted approach to infection prevention is required. One key component in this approach is surveillance. The review identified two infection prevention and control frameworks, yet these are rarely applied in infection prevention and control programmes. Only one framework considered the multifaceted approach required for infection prevention. It did not, however, incorporate the role of surveillance. We present a framework that incorporates the role of surveillance into a biopsychosocial approach to infection prevention and control. Infection prevention and control programmes and associated research are led primarily by nurses. There is a need for an explicit infection prevention and control framework incorporating the important role that surveillance has in infection prevention activities. This study presents one framework for further critique and discussion.
Publisher: Elsevier BV
Date: 07-2015
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.IDH.2019.06.004
Abstract: In iduals in residential and aged care facilities (RACFs) are at risk of developing health care-associated infections (HAIs) due to factors such as age-related changes in physiology, immunity, comorbid illness and functional disability. The recent establishment of an Australian Royal Commission into the Quality of Residential and Aged Care Services highlights the challenges of providing care in this sector. This national study identified infection prevention and control (IPC) services, practice and priorities in Australian RACFs. A cross-sectional study of 158 Australian RACFs comprising a 42-question survey incorporating five key domains relating to IPC namely governance, education, practice, surveillance, competency and capability was undertaken in 2018. Of the 131 respondents, the majority 92.4% of respondents reported having a documented IPC program, 22.9% (n = 30) operated with a dedicated infection control committee The majority of RACFs reported lacking specialist and qualified experienced IPC professionals (n = 67). The majority of RACFs (90.1%, n = 118) reported the existence of a designated employee with IPC responsibilities. Of these 118 staff members with IPC responsibilities, 42.5% had a qualification in IPC. The reported average funded hours per month for IPC professional or an external provider of IPC activities was 14 (95% CI 9.6-18.9 h). The overwhelming majority of RACFs deliver IPC services and report doing so in ways that meet the needs of their own specific contexts in the absence of the lack of formal guidelines when compared to the hospital sector. Quality residential and aged care free from HAIs requires formal structure and organization strategies.
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.IDH.2019.06.002
Abstract: Point prevalence studies identify that pneumonia is the most common healthcare associated infection. However, non-ventilator associated healthcare associated pneumonia (NV-HAP) is both underreported and understudied. Most research conducted to date, focuses on ventilator associated pneumonia. We conducted a systematic review, to provide the latest evidence for strategies to reduce NV-HAP and describe the methodological approaches used. We performed a systematic search to identify research exploring and evaluating NV-HAP preventive measures in hospitals and aged-care facilities. The electronic database Medline was searched, for peer-reviewed articles published between 1st January 1998 and 31st August 2018. An assessment of the study quality and risk of bias of included articles was conducted using the Newcastle-Ottawa Scale. The literature search yielded 1551 articles, with 15 articles meeting the inclusion criteria. The majority of strategies for NV-HAP prevention focussed on oral care (n = 9). Three studies evaluated a form of physical activity, such as passive movements, two studies used dysphagia screening and management and another study evaluated prophylactic antibiotics. Most studies (n = 12) were conducted in a hospital setting. Six of the fifteen studies were randomised controlled trials. There was considerable heterogeneity in the included studies, including the type of intervention, study design, methods and definitions used to diagnose the NV-HAP. To date, interventions to reduce NV-HAP appear to be based broadly on the themes of improving oral care, increased mobility or movement and dysphagia management.
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1071/HI12032
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.JHIN.2019.08.016
Abstract: Non-antibiotic interventions for urinary tract infection (UTI) prevention have been investigated as a strategy to reduce antibiotic prescribing for UTI and subsequent antibiotic resistance. Increased hydration is widely advocated for preventing UTI however, evidence for its effectiveness is unknown. To systematically review the published literature on the effectiveness of increased fluid intake as a preventive intervention for UTI in adults and children in any setting. Five electronic databases were searched from inception to February 2019 to identify published randomized controlled trials (RCTs) and quasi-experimental studies evaluating the effectiveness of high (≥1.5 L/24 h) versus normal/low (<1.5 L/24 h) fluid intake for UTI prevention. The outcome was UTI incidence. Risk of bias was assessed using the Cochrane Collaboration's tool. Due to the small number of studies identified, meta-analysis was not possible. Hence a narrative synthesis was undertaken. Of the 2822 potentially relevant papers, two were eligible for inclusion: an RCT (in idual randomization) and a cluster-RCT. Both studies differed regarding participants, setting, s le size, UTI definition, and intervention. The RCT was assessed as having a low risk of bias whereas the cluster-RCT had a high risk of bias. Only the RCT, which included healthy premenopausal women visiting primary care clinics, demonstrated statistical significance for the effect of high fluid intake for UTI prevention. The lack of enough adequately powered and robust RCTs highlights the need for further research on the effectiveness of this intervention for UTI prevention.
Publisher: Elsevier BV
Date: 06-2019
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.AJIC.2015.02.016
Abstract: This article describes infection prevention and control professionals' (ICPs') staffing levels, patient outcomes, and costs associated with the provision of infection prevention and control services in Australian hospitals. A secondary objective was to determine the priorities for infection control units. A cross-sectional study design was used. Infection control units in Australian public and private hospitals completed a Web-based anonymous survey. Data collected included details about the respondent hospital demographics details and services of the infection control unit and a description of infection prevention and control-related outputs, patient outcomes, and infection control priorities. Forty-nine surveys were undertaken, accounting for 152 Australian hospitals. The mean number of ICPs was 0.66 per 100 overnight beds (95% confidence interval, 0.55-0.77). Privately funded hospitals have significantly fewer ICPs per 100 overnight beds compared with publicly funded hospitals (P < .01). Staffing costs for nursing staff in infection control units in this study totaled $16,364,392 (mean, $380,566). Infection control units managing smaller hospitals (<270 beds) identified the need for increased access to infectious diseases or microbiology support. This study provides valuable information to support future decisions by funders, hospital administrators, and ICPs on service delivery models for infection prevention and control. Further, it is the first to provide estimates of the resourcing and cost of staffing infection control in hospitals at a national level.
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.JHIN.2016.10.025
Abstract: Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Antiseptic cleaning of the meatal area before and during catheter use may reduce the risk of CAUTIs. To undertake a systematic review of the literature and meta-analysis of studies investigating the effectiveness of antiseptic cleaning before urinary catheter insertion and during catheter use for prevention of CAUTIs. Electronic databases were searched to identify randomized controlled trials. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and compared across intervention and control groups using DerSimonian-Laird random-effects model. Subgroup analyses were performed. Heterogeneity was estimated using the I In total, 2665 potential papers were identified of these, 14 studies were eligible for inclusion. There was no difference in the incidence of CAUTIs when comparing antiseptic and non-antiseptic agents (pooled OR 0.90, 95% CI 0.73-1.10 P=0.31), or when comparing different agents: povidone-iodine vs routine care povidone-iodine vs soap and water chlorhexidine vs water povidone-iodine vs saline povidone-iodine vs water and green soap and water vs routine care (P>0.05 for all). Comparison of an antibacterial agent with routine care indicated near significance (P=0.06). There was no evidence of heterogeneity (I There were no differences in CAUTI rates, although methodological issues h er generalizability of this finding. Antibacterial agents may prove to be significant in a well-conducted study. The present results provide good evidence to inform infection control guidelines in catheter management.
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.JCJQ.2018.02.002
Abstract: Previous literature has linked the level and types of staffing of health facilities to the risk of acquiring a health care-associated infection (HAI). Investigating this relationship is challenging because of the lack of rigorous study designs and the use of varying definitions and measures of both staffing and HAIs. The objective of this study was to understand and synthesize the most recent research on the relationship of hospital staffing and HAI risk. A systematic review was undertaken. Electronic databases MEDLINE, PubMed, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for studies published between January 1, 2000, and November 30, 2015. Fifty-four articles were included in the review. The majority of studies examined the relationship between nurse staffing and HAIs (n = 50, 92.6%) and found nurse staffing variables to be associated with an increase in HAI rates (n = 40, 74.1%). Only 5 studies addressed non-nurse staffing, and those had mixed results. Physician staffing was associated with an increased HAI risk in 1 of 3 studies. Studies varied in design and methodology, as well as in their use of operational definitions and measures of staffing and HAIs. Despite the lack of consistency of the included studies, overall, the results of this systematic review demonstrate that increased staffing is related to decreased risk of acquiring HAIs. More rigorous and consistent research designs, definitions, and risk-adjusted HAI data are needed in future studies exploring this area.
Publisher: Springer Science and Business Media LLC
Date: 18-02-2020
DOI: 10.1186/S13756-020-0694-0
Abstract: Implementing sustainable practice change in hospital cleaning has proven to be an ongoing challenge in reducing healthcare associated infections. The purpose of this study was to develop a reliable framework-based approach to implement and quantitatively evaluate the implementation of evidence-based practice change in hospital cleaning. The Researching Effective Approaches to Cleaning in Hospitals (REACH) trial was a pragmatic, stepped-wedge randomised trial of an environmental cleaning bundle implemented in 11 Australian hospitals from 2016 to 2017. Using a structured multi-step approach, we adapted the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to support rigorous and tailored implementation of the cleaning bundle intervention in eleven erse and complex settings. To evaluate the effectiveness of this strategy we examined post-intervention cleaning bundle alignment calculated as a score (an implementation measure) and cleaning performance audit data collected using ultraviolet (UV) gel markers (an outcome measure). We successfully implemented the bundle and observed improvements in cleaning practice and performance, regardless of hospital size, intervention duration and contextual issues such as staff and organisational readiness at baseline. There was a positive association between bundle alignment scores and cleaning performance at baseline. This diminished over the duration of the intervention, as hospitals with lower baseline scores were able to implement practice change successfully. Using a structured framework-based approach allows for pragmatic and successful implementation of clinical trials across erse settings, and assists with quantitative evaluation of practice change. Australia New Zealand Clinical Trial Registry ACTRN12615000325505 , registered on 4 September 2015.
Publisher: RCN Publishing Ltd.
Date: 04-02-2015
DOI: 10.7748/NS.29.23.52.E9609
Abstract: Surveillance of healthcare-associated infections is central to healthcare epidemiology and infection control programmes and a critical factor in the prevention of these infections. By definition, the term 'infection prevention' implies that healthcare-associated infections may be preventable. The purpose of surveillance is to provide quality data that can be used in an effective monitoring and alert system and to reduce the incidence of preventable healthcare-associated infections. This article examines the purpose of surveillance, explains key epidemiological terms, provides an overview of approaches to surveillance and discusses the importance of validation.
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.JHIN.2015.08.005
Abstract: A systematic review and meta-analysis was conducted to determine the risk of pathogen acquisition for patients associated with prior room occupancy. The analysis was also broadened to examine any differences in acquisition risk between Gram-positive and Gram-negative organisms. A search using Medline/PubMed, Cochrane and CINHAL yielded 2577 citations between 1984 and 2014. Reviews were assessed in accordance with the international prospective register of systematic reviews (PROSPERO). Just seven articles met the inclusion criteria, namely: (a) papers were peer reviewed, (b) pathogen acquisition prevalence rates were reported, (c) articles were written in English and (d) had minimal or no risk of bias based on the Newcastle-Ottawa Scale (NOS). One study was an extension of a previous study and was discarded. Employing NOS provided little difference between the studies, with five studies receiving eight-star and two studies receiving seven-star ratings, respectively. Overall, pooled acquisition odds ratio for study pathogens (meticillin-resistant Staphylococcus aureus vancomycin-resistant enterococcus Clostridium difficile acinetobacter extended-spectrum β-lactamase-producing coliforms pseudomonas) was 2.14 [95% confidence interval (CI): 1.65-2.77]. When comparing data between Gram-positive and Gram-negative organisms, the pooled acquisition odds ratio for Gram-negatives was 2.65 (95% CI: 2.02-3.47) and 1.89 (95% CI: 1.62-2.21) for Gram positives. The findings have important implications for infection control professionals, environmental cleaning services and patients, since current practices fail to adequately reduce acquisition risk. Although there may be non-preventable sources of acquisition, revised practices require collaborative work between all responsible staff in order to reduce this risk to a minimum.
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.AJIC.2013.07.006
Abstract: Clostridium difficile infection (CDI) possibly extends hospital length of stay (LOS) however, the current evidence does not account for the time-dependent bias, ie, when infection is incorrectly analyzed as a baseline covariate. The aim of this study was to determine whether CDI increases LOS after managing this bias. We examined the estimated extra LOS because of CDI using a multistate model. Data from all persons hospitalized >48 hours over 4 years in a tertiary hospital in Australia were analyzed. Persons with health care-associated CDIs were identified. Cox proportional hazards models were applied together with multistate modeling. One hundred fifty-eight of 58,942 admissions examined had CDI. The mean extra LOS because of infection was 0.9 days (95% confidence interval: -1.8 to 3.6 days, P = .51) when a multistate model was applied. The hazard of discharge was lower in persons who had CDI (adjusted hazard ratio, 0.42 P < .001) when a Cox proportional hazard model was applied. This study is the first to use multistate models to determine the extra LOS because of CDI. Results suggest CDI does not significantly contribute to hospital LOS, contradicting findings published elsewhere. Conversely, when methods prone to result in time-dependent bias were applied to the data, the hazard of discharge significantly increased. These findings contribute to discussion on methods used to evaluate LOS and health care-associated infections.
Publisher: IOP Publishing
Date: 16-05-2017
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.AJIC.2016.10.022
Abstract: Effective clinical governance is necessary to support improvements in infection control. Historically, the focus has been on ensuring that infection control practice and policy is based on evidence, and that there is use of surveillance and auditing for self-regulation and performance feedback. There has been less exploration of how contextual and organizational factors mediate an infection preventionists (IP's) ability to engage with evidence-based practice and enact good clinical governance. A cross sectional Web-based survey of IPs in Australia and New Zealand was undertaken. Questions focused on engagement in evidence-based practice and perceptions about the context, culture, and leadership within the infection control team and organization. Responses were mapped against dimensions of Scally and Donaldson's clinical governance framework. Three hundred surveys were returned. IPs appear well equipped at an in idual level to undertake evidence-based practice. The most serious set of perceived challenges to good clinical governance related to a lack of leadership or active resistance to infection control within the organization. Additional challenges included lack of information technology solutions and poor access to specialist expertise and financial resources. Focusing on strengthening contextual factors at the organizational level that otherwise undermine capacity to implement evidence-based practice is key to sustaining current infection control successes and promoting further practice improvements.
Publisher: Elsevier BV
Date: 11-2013
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.AJIC.2018.02.003
Abstract: The Researching Effective Approaches to Cleaning in Hospitals (REACH) study tested a multimodal cleaning intervention in Australian hospitals. This article reports findings from a pre ost questionnaire, embedded into the REACH study, that was administered prior to the implementation of the intervention and at the conclusion of the study. A cross-sectional questionnaire, nested within a stepped-wedge trial, was administered. The REACH intervention was a cleaning bundle comprising 5 interdependent components. The questionnaire explored the knowledge, reported practice, attitudes, roles, and perceived organizational support of environmental services staff members in the hospitals participating in the REACH study. Environmental services staff members in 11 participating hospitals completed 616 pre- and 307 post-test questionnaires (n = 923). Increases in knowledge and practice were seen between the pre-and post-test questionnaires. Minimal changes were observed in attitudes regarding the role of cleaning and in perceived organizational support. To our knowledge, this is the first study to report changes in knowledge, attitudes, and perceived organizational support in environmental services staff members, in the context of a large multicenter clinical trial. In this underexplored group of hospital workers, findings suggest that environmental services staff members have a high level of knowledge related to cleaning practices and understand the importance of their role.
Publisher: Springer Science and Business Media LLC
Date: 15-07-2019
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.JHIN.2016.01.012
Abstract: The emergence of antimicrobial resistance is of particular concern with respect to urinary tract infections, since the majority of causative agents are Gram-negative bacteria. Healthcare-associated urinary tract infections (HAUTIs) are frequently associated with instrumentation of the urinary tract, specifically with indwelling catheters. To evaluate the current incidence, mortality, and length of hospital stay associated with HAUTIs. A non-concurrent cohort study design was used, conducted between January 1st, 2010 and June 30th, 2014. All patients admitted to one of the eight participating Australian hospitals and who were hospitalized for more than two days were included. The primary outcome measures were the incidence, mortality, and excess length of stay associated with HAUTIs. From 162,503 patient admissions, 1.73% [95% confidence interval (CI): 1.67-1.80] of admitted patients acquired a HAUTI. Using a multi-state model, the expected extra length of stay due to HAUTI was four days (95% CI: 3.1-5.0 days). Using a Cox regression model, infection significantly reduced the rate of discharge (hazard ratio: 0.78 95% CI: 0.73-0.83). Women were less likely to die (0.71 0.66-0.75), whereas older patients were more likely to die (1.40 1.38-1.43). Death was rarer in a tertiary referral hospital compared to other hospitals, after adjusting for age and sex (0.74 0.69-0.78). This study is the first to explore the burden of HAUTIs in hospitals using appropriate statistical methods in a developed country. Our study indicates that the incidence of HAUTI, in addition to its associated extra length of stay in hospital, presents a burden to the hospital system. With increasing incidence of UTI due to antimicrobial-resistant organisms, surveillance and interventions to reduce the incidence of HAUTI are required.
Publisher: Oxford University Press (OUP)
Date: 27-06-2014
DOI: 10.1093/CID/CIU508
Abstract: Staphylococcus aureus bacteremia (SAB) is a serious cause of morbidity and mortality. This longitudinal study describes significant reductions in hospital-onset SAB (HO-SAB) in Australian hospitals over the past 12 years. An observational cohort study design was used. Prospective surveillance of HO-SAB in 132 hospitals in Australia was undertaken. Aggregated data from all patients who acquired HO-SAB was collected (defined as 1 or more blood cultures positive for S. aureus taken from a patient who had been admitted to hospital for >48 hours). The primary outcome was the incidence of HO-SAB, including both methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) S. aureus strains. A total of 2733 HO-SAB cases were identified over the study period, giving an aggregate incidence of 0.90 per 10 000 patient-days (PDs) (95% confidence interval [CI], .86-.93). There was a 63% decrease in the annual incidence, from 1.72 per 10 000 PDs in 2002 (95% CI, 1.50-1.97) to 0.64 per 10 000 PDs (95% CI, .53-.76) in 2013. The mean reduction per year was 9.4% (95% CI, -8.1% to -10.7%). Significant reductions in both HO-MRSA (from 0.77 to 0.18 per 10 000 PDs) and HO-MSSA (from 1.71 to 0.64 per 10 000 PDs) bacteremia were observed. There was a major and significant reduction in incidence of HO-SAB caused by both MRSA and MSSA in Australian hospitals since 2002. This reduction coincided with a range of infection prevention and control activities implemented during this time. It suggests that national and local efforts to reduce the burden of healthcare-associated infections have been very successful.
Publisher: BMJ
Date: 05-2018
Publisher: Springer Singapore
Date: 2017
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1071/HI12047
Publisher: Cambridge University Press (CUP)
Date: 04-03-2019
DOI: 10.1017/ICE.2019.31
Abstract: To determine the effectiveness and ease of use of an electronic reminder device in reducing urinary catheterization duration. A randomized controlled trial with a cross-sectional anonymous online survey and focus group. Ten wards in an Australian hospital. All hospitalized patients with a urinary catheter. An electronic reminder system, the CATH TAG, applied to urinary catheter bags to prompt removal of urinary catheters. Catheterization duration and perceptions of nurses about the ease of use. A Cox proportional hazards model was used to assess the rate of removal of catheters. A phenomenological approach underpinned data collection and analysis methods associated with the focus group. In total, 1,167 patients with a urinary catheter were included. The mean durations in control and intervention phases were 5.51 days (95% confidence interval [CI], 4.9–6.2) and 5.08 days (95% CI, 4.6–5.6), respectively. For patients who had a CATH TAG applied, the hazard ratio (HR) was 1.02 (95% CI, 0.91–1.14 P = .75). A subgroup analysis excluded patients in an intensive care unit (ICU), and the use of the CATH TAG was associated with a 23% decrease in the mean, from 5.00 days (95% CI, 4.44–5.56) to 3.84 days (95% CI, 3.47–4.21). Overall, 82 nurses completed a survey and 5 nurses participated in a focus group. Responses regarding the device were largely positive, and benefits for patient care were identified. The CATH TAG did not reduce the duration of catheterization, but potential benefits in patients outside the ICU were identified. Electronic reminders may be useful to aid prompt removal of urinary catheters in the non-ICU hospital setting.
Publisher: RCN Publishing Ltd.
Date: 25-01-2017
Abstract: The onset of type 2 diabetes mellitus is associated with various modifiable and non-modifiable risk factors, including lifestyle factors. Obesity is the principal lifestyle factor associated with an increased risk of developing type 2 diabetes. It is essential for nurses to have an understanding of the pathophysiology associated with factors that contribute to an increased risk of type 2 diabetes, particularly those associated with obesity. Nurses who have an understanding of the interaction between obesity and the onset of type 2 diabetes are better equipped to discuss the importance of weight loss and other necessary lifestyle adjustments in the prevention and management of obesity and diabetes associated with obesity, to implement evidence-based practice and to support patients to manage their health effectively.
Publisher: Elsevier BV
Date: 11-2020
Publisher: Elsevier BV
Date: 09-2014
Publisher: BMJ
Date: 04-2014
Publisher: Springer Science and Business Media LLC
Date: 25-11-2015
Publisher: Elsevier BV
Date: 06-2023
Publisher: Cambridge University Press (CUP)
Date: 11-07-2017
DOI: 10.1017/ICE.2017.130
Abstract: To explore the trends in infection control peer-reviewed journals, mainstream media, and blogs written by infection control professionals Narrative and scoping reviews Narrative and scoping reviews were performed to identify trending infection prevention and control topics from international journals, national news websites, newspapers, and so-called grey literature throughout 2015. Data were analyzed using word frequencies, and results are displayed in word clouds. For 2015, our search identified 6 news websites with a total of published 116 articles, 71 articles from selected newspapers, and 214 publications from infection control websites. In total, 1,059 journal articles were initially identified 98 articles were anonymous and thus were excluded, leaving 961 articles in the reviews. The terms ‘superbug’ and ‘antibiotics’ were most commonly used in titles of news websites and newspapers, whereas the terms ‘infection’ and ‘prevention’ were most commonly used in infection control websites or blogs. The word frequency differences among the 4 selected journals reflected their respective specialties. In infection prevention and control, the integration of a range of mediums is necessary to best serve public interests. Whether the aim is advocacy, general health information dissemination, or warnings of imminent risk, health researchers have access to multiple forums with different strengths through which to influence public risk perceptions and responses. Infect Control Hosp Epidemiol 2017 :1098–1102
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.AJIC.2017.05.019
Abstract: Challenges with limited single rooms and isolation facilities in hospitals have created an opportunity for temporary, portable isolation technology. This article describes the process used to evaluate the prototype of a new isolation room (RediRoom CareStrategic Ltd, Brisbane, Queensland, Australia) that can be installed in existing hospital ward areas. Our aim is to assess the functionality of this new room, and in so doing, to evaluate the methods used. We employed a mixed-methods approach involving video recording, interviews, and objective temperature and humidity measurements within a crossover interventional study. Participants completed a range of clinical activities in the RediRoom and a control. The setting for the study was a clinical ward environment at an Australian higher education institution. There were similarities between the RediRoom and the control using a range of measures. The time taken to complete a range of clinical activities in both rooms was broadly consistent. Network analysis also suggested broad similarities in the movement of nurses undertaking activities in both rooms. Our study attempted to simulate a clinical environment and clinical activities and provide the best possible comparison by completing activities sequentially, with immediate feedback to researchers. Video recording added significant value to the process because it provided some objectivity. A form of reflexive ethnography with participants could be of value in similar studies in the future.
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.JHIN.2018.01.006
Abstract: Phase II of the Surveillance to Reduce Urinary Tract Infections project piloted a website for point prevalence surveys of healthcare-associated (HAUTI) and catheter-associated urinary tract infection in Australian hospitals and aged care homes. This report describes development and evaluation of the website for online data collection. Evaluation findings from 38 data collectors indicated that most respondents found website registration and web form use easy (N = 22 58% and N = 16 43%, respectively). The need for improved computer literacy skills and automated data systems were highlighted. This study demonstrated a novel approach for Australian HAUTI data collection however, refinements are needed before national roll-out.
Publisher: Springer Science and Business Media LLC
Date: 28-08-2020
DOI: 10.1186/S13756-020-00807-5
Abstract: Healthcare-associated infections (HAIs) and antimicrobial use (AMU) are important drivers of antimicrobial resistance, yet there is minimal data from the Pacific region. We sought to determine the point prevalence of HAIs and AMU at Fiji’s largest hospital, the Colonial War Memorial Hospital (CWMH) in Suva. A secondary aim was to evaluate the performance of European Centre for Diseases Prevention and Control (ECDC) HAI criteria in a resource-limited setting. We conducted a point prevalence survey of HAIs and AMU at CWMH in October 2019. Survey methodology was adapted from the ECDC protocol. To evaluate the suitability of ECDC HAI criteria in our setting, we augmented the survey to identify patients with a clinician diagnosis of a HAI where diagnostic testing criteria were not met. We also assessed infection prevention and control (IPC) infrastructure on each ward. We surveyed 343 patients, with median (interquartile range) age 30 years (16–53), predominantly admitted under obstetrics/gynaecology (94, 27.4%) or paediatrics (83, 24.2%). Thirty patients had one or more HAIs, a point prevalence of 8.7% (95% CI 6.0% to 12.3%). The most common HAIs were surgical site infections ( n = 13), skin and soft tissue infections (7) and neonatal clinical sepsis (6). Two additional patients were identified with physician-diagnosed HAIs that failed to meet ECDC criteria due to insufficient investigations. 206 (60.1%) patients were receiving at least one antimicrobial. Of the 325 antimicrobial prescriptions, the most common agents were icillin (58/325, 17.8%), cloxacillin (55/325, 16.9%) and metronidazole (53/325, 16.3%). Use of broad-spectrum agents such as piperacillin/tazobactam ( n = 6) and meropenem (1) was low. The majority of prescriptions for surgical prophylaxis were for more than 1 day (45/76, 59.2%). Although the number of handwashing basins throughout the hospital exceeded World Health Organization recommendations, availability of alcohol-based handrub was limited and most concentrated within high-risk wards. The prevalence of HAIs in Fiji was similar to neighbouring high-income countries, but may have been reduced by the high proportion of paediatric and obstetrics patients, or by lower rates of inpatient investigations. AMU was very high, with duration of surgical prophylaxis an important target for future antimicrobial stewardship initiatives.
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1071/HI15008
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1071/HI15009
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1071/HI12019
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1071/HI14037
Publisher: Elsevier BV
Date: 05-2016
Publisher: Elsevier BV
Date: 02-2021
Publisher: Elsevier BV
Date: 05-2016
Publisher: Public Library of Science (PLoS)
Date: 06-10-2016
Publisher: Elsevier BV
Date: 05-2016
Publisher: Elsevier BV
Date: 04-2021
Publisher: Oxford University Press (OUP)
Date: 09-09-2014
DOI: 10.1093/CID/CIU692
Publisher: Elsevier BV
Date: 12-2017
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.IJNURSTU.2019.04.003
Abstract: Catheter associated urinary tract infections are one of the most common infections acquired in hospital. A recent randomised control study demonstrated the benefit of using chlorhexidine (0.1%) for meatal cleaning prior to urinary catheter insertion, by reducing both catheter associated asymptomatic bacteriuria and infection. These findings raise the important question of whether a decision to switch from saline to chlorhexidine was likely to be cost-effective. The aim of this paper was to evaluate the cost-effectiveness of adopting routine use of chlorhexidine for meatal cleaning prior to urinary catheter insertion METHODS: The outcomes of this cost-effectiveness study are changes to health service costs in $AUD and changes to quality adjusted life years from a decision to adopt 0.1% chlorhexidine for meatal cleaning prior to urinary catheter insertion as compared to saline. Effectiveness outcomes for this study were taken from a 32 week stepped wedge randomised controlled study conducted in three Australian hospitals. The changes in health costs from switching from saline to 0.1% chlorhexidine per 100,000 catheterisations would save hospitals AUD$387,909 per 100,000 catherisations, prevent 70 cases of catheter associated urinary tract infections, release 282 bed days and provide a small improvement in health benefits of 1.43 quality adjusted life years. Using a maximum willingness to pay for a marginal quality adjusted life year threshold of AUD$28,000 per 100,000 catherisations, suggests that adopting chlorhexidine would be cost effective and potentially cost-saving. The findings from our work provide evidence to health system administrators and those responsible for drafting catheter associated urinary tract infections prevention guidelines that investing in switching from saline to chlorhexidine is not only clinically effective but also a sensible decision in the context of allocating finite healthcare resources.
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1071/HI12020
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1071/HI15019
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1071/HI12029
Publisher: Elsevier BV
Date: 04-2019
Publisher: BMJ
Date: 02-2021
DOI: 10.1136/BMJOPEN-2020-041968
Abstract: To predict the cost and health effects of routine use of whole-genome sequencing (WGS) of bacterial pathogens compared with those of standard of care. Budget impact analysis was performed over the following 5 years. Data were primarily from sequencing results on clusters of multidrug-resistant organisms across 27 hospitals. Model inputs were derived from hospitalisation and sequencing data, and epidemiological and costing reports, and included multidrug resistance rates and their trends. Queensland, Australia. Hospitalised patients. WGS surveillance of six common multidrug-resistant organisms ( Staphylococcus aureus , Escherichia coli , Enterococcus faecium , Klebsiella pneumoniae , Enterobacter sp and Acinetobacter baumannii ) compared with standard of care or routine microbiology testing. Expected hospital costs, counts of patient infections and colonisations, and deaths from bloodstream infections. In 2021, 97 539 patients in Queensland are expected to be infected or colonised with one of six multidrug-resistant organisms with standard of care testing. WGS surveillance strategy and earlier infection control measures could avoid 36 726 infected or colonised patients and avoid 650 deaths. The total cost under standard of care was $A170.8 million in 2021. WGS surveillance costs an additional $A26.8 million but was offset by fewer costs for cleaning, nursing, personal protective equipment, shorter hospital stays and antimicrobials to produce an overall cost savings of $30.9 million in 2021. Sensitivity analyses showed cost savings remained when input values were varied at 95% confidence limits. Compared with standard of care, WGS surveillance at a state-wide level could prevent a substantial number of hospital patients infected with multidrug-resistant organisms and related deaths and save healthcare costs. Primary prevention through routine use of WGS is an investment priority for the control of serious hospital-associated infections.
Publisher: Informa UK Limited
Date: 03-2016
DOI: 10.2147/IJN.S102096
Publisher: SAGE Publications
Date: 23-10-2017
Abstract: Lifestyle medicine interventions are typically intensive by design. This study explored the optimal “dosage” of a well-known lifestyle medicine intervention—the Complete Health Improvement Program (CHIP). A total of 2383 in iduals (mean age = 61.0 ± 9.2 years 34% males) participated in either an 8-session (N = 448) or 16-session (N = 1935) version of the CHIP intervention conducted over 4 weeks in community settings throughout North America. Both the 8- and 16-session groups experienced significant improvements in all the chronic disease risk factors measured. There was no difference between the changes experienced by the 8- and 16-session groups in lipid profile, fasting plasma glucose, or systolic blood pressure. The 8-session group experienced a significantly greater reduction in body mass (0.3 percentage points or 0.8 lbs, P .01), but the 16-session group recorded a significantly greater reduction in diastolic blood pressure (2.8 percentage points or 2.2 mm Hg, P .01). There was no clear difference between the outcomes achieved in 4 weeks by the 8- and 16-session versions of the CHIP lifestyle medicine intervention. This study suggests that the short-term outcomes achieved by a 16-session CHIP intervention can be achieved in half the number of sessions, which has implications from a resourcing and cost-effectiveness perspective.
Publisher: Elsevier BV
Date: 12-2015
Publisher: Springer Science and Business Media LLC
Date: 15-07-2019
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.IDH.2017.06.004
Abstract: Urinary tract infections related to indwelling urinary catheters, known as catheter-associated urinary tract infections (CAUTI), are largely preventable healthcare-associated infections (HAI). Healthcare-associated infections including CAUTI are associated with prolonged hospital stay, increased resistance of microorganisms to antimicrobials, increased morbidity and mortality as well as additional financial burden on health care systems, patients and their families. While the optimal aim for patients and the health care system is to prevent CAUTI using measures such as reducing unnecessary placement and early removal of urinary catheters, there is evidence that cleaning of the meatal or peri-urethral area with antiseptic prior to catheter insertion and care of this area while the catheter is insitu has the potential to reduce CAUTI. Evidence suggests that meatal cleaning with antiseptics while the catheter is insitu is non-beneficial in reducing CAUTI but current international and Australian guidelines for infection control professionals identifies that the benefit of antiseptic solution versus non-antiseptic solution for meatal or peri-urethral cleaning before urinary catheter insertion remains unresolved. This discussion paper therefore focuses primarily on antiseptic meatal cleaning prior to urinary catheter insertion in preventing CAUTI. Using evidence from a recently published systematic review and meta-analysis of the literature, this paper discusses the scope of the problem and limitations in the evidence regarding the effectiveness of antiseptics for preventing CAUTI and finally, proposes a way forward through the undertaking of a rigorously conducted randomised controlled trial aimed at evaluating the effectiveness and cost-effectiveness of antiseptic meatal cleaning for prevention of CAUTI.
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.IDH.2017.06.003
Abstract: Assessing the functionality and infection control implications of new technologies presents significant challenges. In this discussion paper, we present our approach to assessing infection control aspects of a new isolation room, the RediRoom™ (prototype). We report how we evaluated this room, lessons learnt and suggestions for future evaluations in this area. There is no documented method for evaluating a novel temporary isolation room. We combined a range of existing tools to undertake a technical assessment. Three approaches were used, an assessment against standards or guidelines professional assessment and a cleaning assessment. To assess compliance against existing recommendations related to the built environment and isolation rooms, elements contained within Australasian and United Kingdom guidelines were used. We were able to identify which elements in these guidelines were of the most value and relevance. An ultraviolet (UV) solution with fluorescent light assessment was used to assess the ability to clean surfaces. This approach was a useful objective measure. A professional assessment is potentially subjective, but provides an opportunity to identify other potential issues and benefits. In this study, the RediRoom™ performed well against all three approaches. We identified limitations in using existing guidelines for a temporary isolation room. In our study, the use of video and video reflexive ethnography for the professional assessment would have been useful. We propose a revised list of assessment against which new isolation solutions or technologies could be assessed, with the view of others continuing to build on this.
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.AJIC.2013.08.002
Abstract: Reliable surveillance data and continuous monitoring can provide useful information for clinicians and patients alike, by identifying areas needing improvement and demonstrating the effectiveness of interventions. Improving the rigor of health care-associated infection surveillance makes it possible to provide more valid and reliable information. We propose a model that can be used by infection control preventionists, researchers, and health planners and can serve as a trigger for understanding the influences on reliable and valid health care-associated infection data.
Publisher: Elsevier BV
Date: 08-2020
Publisher: Springer Science and Business Media LLC
Date: 22-02-2023
DOI: 10.1186/S13063-023-07144-Z
Abstract: Healthcare-associated infections (HAIs) are a common, costly, yet largely preventable complication impacting patients in healthcare settings globally. Improving routine cleaning and disinfection of the hospital environment has been shown to reduce the risk of HAI. Contaminated shared medical equipment presents a primary transmission route for infectious pathogens, yet is rarely studied. The CLEEN study will assess how enhanced cleaning and disinfection of shared medical equipment affects the rate of HAIs in a tertiary hospital setting. The initiative is an evidence-based approach combining staff training, auditing and feedback to environmental services staff to enhance cleaning and disinfection practices. The CLEEN study will use a stepped wedge randomised controlled design in 10 wards of one large Australian hospital over 36 weeks. The intervention will consist of 3 additional hours per weekday for the dedicated cleaning and disinfection of shared medical equipment on each ward. The primary outcome is to demonstrate the effectiveness of improving the quality and frequency of cleaning shared medical equipment in reducing HAIs, as measured by a HAI point prevalence study (PPS). The secondary outcomes include the thoroughness of equipment cleaning assessed using fluorescent marker technology and the cost-effectiveness of the intervention. Evidence from the CLEEN study will contribute to future policy and practice guidelines about the cleaning and disinfection of shared medical equipment. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in healthcare facilities. Australia New Zealand Clinical Trial Registry ACTRN12622001143718.
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.JGAR.2018.10.026
Abstract: The aim of this study was to evaluate the incidence of single-drug resistant, multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR) Escherichia coli urinary tract infections (UTIs) in a s le of Australian Capital Territory (ACT) residents. Laboratory-based retrospective data from all ACT residents whose urine s les were processed from January 2009 to December 2013 at ACT Pathology were utilised. Multivariate logistic regression models were constructed to determine the associations of age, sex, urine s le source and socioeconomic status with risk of resistant infections. A total of 146 915 urine s les from 57 837 ACT residents were identified over 5 years. The mean±standard deviation age of residents at first s le submitted was 48±26years, and 64.4% were female. The 5-year incidence of single-drug resistant E. coli UTI was high for icillin, trimethoprim and cefazolin (6.8%, 3.5% and 1.9%, respectively). No PDR E. coli UTI was detected. Five-year incidences of MDR and XDR E. coli UTIs were 1.9% and 0.2%, respectively, which is low in comparison with international rates. Female sex and age ≥38 years were significantly associated with single-drug and multidrug resistance. The risk of single-drug resistance was significantly higher in s les from after-hours general practice (GP) clinics compared with hospitals, office-hours GP clinics, and community and specialist health services (adjusted odds ratio=2.6, 95% confidence interval 2.2-3.1). These findings have significant implications for antimicrobial prescribing given the identified risk factors for the detection of resistance, especially in patients attending after-hours GP clinics.
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/AH16223
Abstract: Australia does not have a national healthcare-associated infection (HAI) surveillance program. Without national surveillance, we do not understand the burden of HAIs, nor can we accurately assess the effects of national infection prevention initiatives. Recent research has demonstrated disparity between existing jurisdictional-based HAI surveillance activity while also identifying broad key stakeholder support for the establishment of a national program. A uniform surveillance program will also address growing concerns about hospital performance measurements and enable public reporting of hospital data.
Publisher: Cambridge University Press (CUP)
Date: 22-05-2020
DOI: 10.1017/ICE.2020.184
Abstract: To examine the global burden, associated point sources, and successful prevention and control measures for documented outbreaks of Burkholderia cepacia healthcare-associated infections (HAIs). Integrative review. A review of all outbreaks of Burkholderia cepacia HAIs published in the peer-reviewed literature between January 1970 and October 2019 was conducted to identify the global burden, associated point sources, and successful prevention and control measures using the Guidelines for Outbreak Reports and Intervention Studies of Nosocomial Infections (ORION). In total, we reviewed 125 documented outbreaks of Burkholderia cepacia –related HAIs worldwide. The reported B. cepacia HAIs for this period involved 3,287 patients. The point sources were identified in most outbreaks of B. cepacia HAIs (n = 93 74.4%) they included medication vials, disinfectants, and antiseptics. Moreover, 95 of the outbreak reports (76%) described effective prevention and control measures, but only 33 reports indicated the use of a combination of environment-, patient- and staff-related measures. None of the outbreak reports used the ORION guidelines. Outbreaks of Burkholderia cepacia HAIs are an ongoing challenge. They are often associated with immunocompromised patients who acquire the infection from exposure to contaminated medications, products, and equipment. These outbreaks are not infrequent, and a range of infection prevention and control measures have been effective in arresting spread. The use of ORION guidelines for outbreak reporting would improve the quality of information and data to generate evidence for translation into practice.
Publisher: Elsevier BV
Date: 06-2020
DOI: 10.1016/J.JHIN.2020.01.008
Abstract: An important aspect of safety and quality in healthcare is the implementation of infection prevention and control guidelines. However, little is known regarding the strength of evidence on which recommendations for such guidelines are based. This study aimed to describe the strength of recommendations of infection prevention and control guidelines published in the last 10 years. For this review, the websites of government and professional organizations for national and international infection prevention and control clinical guidelines were purposively searched. The search was limited to publications between January 2009 and April 2019, and those with a formal grading system were used to determine the strength of the evidence underpinning the recommendations. Recommendations from guidelines were categorized into 21 infection control categories. A descriptive synthesis of the data was undertaken. A total of 31 guidelines comprising 1855 recommendations were included. Guidelines were mainly developed in the USA (N = 11, 35.5%) and Canada (N = 9, 29.0%). Most guidelines used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach (N = 6, 19.4%. The majority of the guidelines contained recommendations categorized under the themes of devices (N = 316, 16.9%) and transmission-based precautions (N = 315, 16.8%). Most recommendations (N = 769, 41.5%) were graded as using evidence from descriptive studies, expert opinion and low-quality evidence. There are a vast number of infection prevention and control guidelines developed by national and international government or professional organizations, many without a strong evidence base. This presents multiple research opportunities that should prioritize common prevention activities that currently have a low evidence base.
Publisher: Elsevier BV
Date: 02-2021
Publisher: Wiley
Date: 12-2014
DOI: 10.1071/HE14041
Publisher: Elsevier BV
Date: 08-2019
Publisher: Elsevier BV
Date: 06-2017
Publisher: Elsevier BV
Date: 07-2016
DOI: 10.1016/J.FREERADBIOMED.2016.04.020
Abstract: Despite its extraordinary antioxidant capacity, the clinical usage of silymarin has remained restricted to amelioration of hepatic pathology. Perhaps its low bioavailability and uneven bio-distribution, owing to its poor aqueous solubility, are two main causes that have d ened the clinical applicability and scope of this preparation. We took these two challenges and suggested an unexplored application of silymarin. Apart from liver, two of the most susceptible vital organs at the highest risk of oxidative stress are brain and lung, especially during reduced oxygen saturation (hypoxia) at anatomical level. Hypoxia causes excess generation of radicals primarily in the lungs as it is the first organ at the interphase of atmosphere and organism making it the most prone and vulnerable to oxidative stress and the first responder against hypobaric hypoxia. As our first objective, we improved the silymarin formulation by restricting its size to the lower threshold and then successfully tested the prophylactic and therapeutic action in rat lung challenged with simulated hypobaric hypoxia. After dose optimization, we observed that 50mg/kg BW silymarin as size restricted and homogenous aqueous suspension successfully minimized the reactive oxygen species and augmented the antioxidant defense by significant upregulation of catalase and superoxide dismutase and reduced glutathione. Moreover, the well-established hypoxia markers and proteins related to hypoxia adaptability, hif1a and VEGF were differentially regulated conferring significant reduction in the inflammation caused by hypobaric hypoxia. We therefore report,the unexplored potential benefits of silymarin for preventing high altitude associated pathophysiology further paving its road to clinical trials.
Publisher: Springer Science and Business Media LLC
Date: 2012
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1071/HI14023
Publisher: Oxford University Press (OUP)
Date: 30-07-2020
DOI: 10.1093/CID/CIZ717
Abstract: Healthcare-associated infections (HAIs) remain a significant patient safety issue, with point prevalence estimates being ~5% in high-income countries. In 2016–2017, the Researching Effective Approaches to Cleaning in Hospitals (REACH) study implemented an environmental cleaning bundle targeting communication, staff training, improved cleaning technique, product use, and audit of frequent touch-point cleaning. This study evaluates the cost-effectiveness of the environmental cleaning bundle for reducing the incidence of HAIs. A stepped-wedge, cluster-randomized trial was conducted in 11 hospitals recruited from 6 Australian states and territories. Bundle effectiveness was measured by the numbers of Staphylococcus aureus bacteremia, Clostridium difficile infection, and vancomycin-resistant enterococci infections prevented in the intervention phase based on estimated reductions in the relative risk of infection. Changes to costs were defined as the cost of implementing the bundle minus cost savings from fewer infections. Health benefits gained from fewer infections were measured in quality-adjusted life-years (QALYs). Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio and net monetary benefit of adopting the cleaning bundle over existing hospital cleaning practices. Implementing the cleaning bundle cost $349 000 Australian dollars (AUD) and generated AUD$147 500 in cost savings. Infections prevented under the cleaning bundle returned a net monetary benefit of AUD$1.02 million and an incremental cost-effectiveness ratio of $4684 per QALY gained. There was an 86% chance that the bundle was cost-effective compared with existing hospital cleaning practices. A bundled, evidence-based approach to improving hospital cleaning is a cost-effective intervention for reducing the incidence of HAIs.
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Elsevier BV
Date: 02-2019
Publisher: Elsevier BV
Date: 08-2020
Publisher: Elsevier BV
Date: 08-2021
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.JHIN.2017.08.006
Abstract: Length of stay (LOS) in hospital is an important component of describing how costs change in relation to healthcare-associated infection and this variable underpins models used to evaluate cost. It this therefore imperative that estimations of LOS associated with infections are performed accurately. To test the relationships between the size of hospital, age, and patient comorbidity on days from admission to infection and days from infection to discharge in patients with a healthcare-associated urinary tract infection (HAUTI), using structural equation modelling (SEM). A non-current cohort study in eight hospitals in New South Wales, Australia. All patients admitted to the hospital for >48 h and who acquired a HAUTI were included. From the 162,503 eligible patient admissions, 2821 (1.73%) acquired a HAUTI. SEM showed that the proposed model had acceptable fit indices for the combined s le (GFI = 1.00 AGFI = 1.00 NFI = 1.00 CFI = 1.00 RMSEA = 0.000). The main findings showed that age of patient had a direct association with days from admission to infection and with days from infection to discharge. Patient comorbidity had direct links to the variables days from admission to infection and days from infection to discharge. Multi-group analysis indicated that the age of male patients was more influential on the factor days from admission to infection when compared to female patients. Furthermore, the number of comorbidities was significantly more influential on days from admission to infection in male patients than in female patients. As the first published study to use SEM to explore a healthcare-associated infection and the predictors of days from infection to discharge in hospital, we can confirm that accounting for the timing of infection during hospitalization is important and that patient comorbidity influences the timing of infection.
Publisher: BMJ
Date: 11-2018
DOI: 10.1136/BMJOPEN-2018-024924
Abstract: A healthcare-associated infection (HAI) data point prevalence study (PPS) conducted in 1984 in Australian hospitals estimated the prevalence of HAI to be 6.3%. Since this time, there have been no further national estimates undertaken. In the absence of a coordinated national surveillance programme or regular PPS, there is a dearth of national HAI data to inform policy and practice priorities. A national HAI PPS study will be undertaken based on the European Centres for Disease Control method. Nineteen public acute hospitals will participate. A standardised algorithm will be used to detect HAIs in a two-stage cluster design, random s le of adult inpatients in acute wards and all intensive care unit patients. Data from each hospital will be collected by two trained members of the research team. We will estimate the prevalence of HAIs, invasive device use, single room placement and deployment of transmission-based precautions. Ethics approval was obtained from the Alfred Health Human Research Ethics Committee (HREC/17/Alfred/203) via the National Mutual Assessment. A separate approval was obtained from the Tasmanian Health and Medical Human Research Committee (H0016978) for participating Tasmanian hospitals. Findings will be disseminated in in idualised participating hospital reports, peer-reviewed publications and conference presentations.
Publisher: BMJ
Date: 11-2017
DOI: 10.1136/BMJOPEN-2017-018871
Abstract: Despite advances in infection prevention and control, catheter-associated urinary tract infections (CAUTIs) are common and remain problematic. A number of measures can be taken to reduce the risk of CAUTI in hospitals. Appropriate urinary catheter insertion procedures are one such method. Reducing bacterial colonisation around the meatal or urethral area has the potential to reduce CAUTI risk. However, evidence about the best antiseptic solutions for meatal cleaning is mixed, resulting in conflicting recommendations in guidelines internationally. This paper presents the protocol for a study to evaluate the effectiveness (objective 1) and cost-effectiveness (objective 2) of using chlorhexidine in meatal cleaning prior to catheter insertion, in reducing catheter-associated asymptomatic bacteriuria and CAUTI. A stepped wedge randomised controlled trial will be undertaken in three large Australian hospitals over a 32-week period. The intervention in this study is the use of chlorhexidine (0.1%) solution for meatal cleaning prior to catheter insertion. During the first 8 weeks of the study, no hospital will receive the intervention. After 8 weeks, one hospital will cross over to the intervention with the other two participating hospitals crossing over to the intervention at 8-week intervals respectively based on randomisation. All sites complete the trial at the same time in 2018. The primary outcomes for objective 1 (effectiveness) are the number of cases of CAUTI and catheter-associated asymptomatic bacteriuria per 100 catheter days will be analysed separately using Poisson regression. The primary outcome for objective 2 (cost-effectiveness) is the changes in costs relative to health benefits (incremental cost-effectiveness ratio) from adoption of the intervention. Results will be disseminated via peer-reviewed journals and presentations at relevant conferences.A dissemination plan it being developed. Results will be published in the peer review literature, presented at relevant conferences and communicated via professional networks. Ethics approval has been obtained. 12617000373370, approved 13/03/2017. Protocol version 1.1.
Location: Australia
Location: United Kingdom of Great Britain and Northern Ireland
Location: Australia
No related grants have been discovered for Brett Mitchell.