ORCID Profile
0000-0002-9141-6970
Current Organisation
Illawarra Shoalhaven Local Health District
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Publisher: Cambridge University Press (CUP)
Date: 05-09-2005
DOI: 10.1017/S0950268805005091
Abstract: The study was undertaken in response to local concerns of a rising number of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections. All patients resident in the community in Essex at the time of diagnosis with a first isolate of MRSA between 1994 and 2001 identified by the diagnostic microbiology laboratory were included. Although the annual incidence rose throughout the study period the majority of those with MRSA (82%) had had hospital contact within the last 5 years. The subset of patients without hospital contact had a median age of 79·5 years, 63% were female and 32% were residents of care homes. Carriage in this population was detected for up to 41 months post-diagnosis. Neither antibiogram nor clinical presentation distinguished these isolates from local hospital-acquired strains.
Publisher: Elsevier BV
Date: 05-2023
Publisher: Oxford University Press (OUP)
Date: 13-07-2020
Abstract: Carbapenemase-producing Enterobacterales (CPE) are increasingly seen in Australian hospitals. Antimicrobial stewardship (AMS) interventions have been shown to reduce rates of carbapenem-resistant organisms data on their effect on CPE rates are limited. To explore the effect of a multi-site computer-supported AMS programme on the rates of CPE in an Australian local health district. All laboratory CPE isolates between 2008 and 2018 were identified. Microbiological and demographic data, CPE risk factors and outcomes were collected. Monthly carbapenem use was expressed as DDD per 1000 occupied bed days (OBD). Hand hygiene compliance rates among healthcare workers were analysed. A computer-supported AMS programme was implemented district-wide in 2012. Bivariate relationships were examined using Pearson’s r and predictors of CPE isolates using time series linear regression. We identified 120 isolates from 110 patients. Numbers of CPE isolates and carbapenem use both showed a strong downward trend during the study period the decreases were strongly correlated (r = 0.80, P = 0.006). The positive relationship between carbapenem use and CPE isolation was maintained while adjusting for time (b = 0.05, P & 0.001). Average yearly consumption of carbapenems fell by 20%, from 18.4 to 14.7 DDD/1000 OBD following implementation of the AMS programme. Hand hygiene compliance rates remained high throughout. We demonstrated a reduction of CPE isolates in conjunction with reduced carbapenem use, longitudinally consolidated by a formal AMS programme. Prospective studies are needed to validate the effect of AMS on carbapenem resistance, especially in high-prevalence settings.
Publisher: SAGE Publications
Date: 15-06-2017
Abstract: Hospital infection control practices known as Contact Precautions are recommended for the management of people with pathogens such as methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococci. Background: The patient is isolated, and staff are required to wear gloves, and a gown or apron when providing care. A notice is displayed to remind staff of these requirements and an ‘alert’ message is placed in the patient’s medical record. Objective: The aim of this article is to discuss and explore whether practices used in hospitals to reduce the transmission of endemic antibiotic-resistant organisms are ethically justified in today’s healthcare environment in the developed world. In order to do this, the history of the development of these practices is summarised, and the evidence base for their effectiveness is reviewed. Key bioethics principles are then discussed and contextualised from the perspective of hospital infection prevention and control, and an ethically superior model for the prevention and control of healthcare associated infection is proposed.
Publisher: Elsevier BV
Date: 06-2023
DOI: 10.1016/J.AJIC.2022.08.010
Abstract: Contact Precautions (CP) were developed to control multi-resistant organisms (MROs) in hospitals. However, MROs persist and harms are associated with CP. Research objectives were to understand the bioethical impact of CP on patients and health-professionals, and make recommendations for ethically-improved management of MRO-colonized patients. Interpretive description methodology scaffolded upon bioethical principles framed this qualitative study. Findings were explored alongside contemporary published reports to make recommendations for practice and research. Nine patients and 24 health professionals participated. Four themes were found: Powerlessness moving to acceptance You feel a bit of a pariah Others need protection, but I need looking after too Doing Contact Precautions is not easy. CP conflict with the principle of respect for autonomy due to non-adherence to informed consent, and sub-optimal communication. Patients experience health care inequality, and discriminatory practices breaching the principle of justice. CP elicit stigma for patients, and moral distress and inter-personal conflict for staff, breaching the principle of non-maleficence. Under the principle of beneficence, pluralistic cost-benefit assessment situates CP as low-value practice. CP challenge organizational culture, professional well-being, and person-centered ethical care. Ethical costs of CP outweigh benefits, obliging policy-makers to reconsider CP in managing MRO-colonized patients.
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.AJIC.2015.07.009
Abstract: Within the Australian public health care system, an observation model is used to assess hand hygiene practice in health care workers, culminating in a publicly available healthcare service performance indicator. The intent of this study was for the results to inform the development of a strategy to support in idual auditors and local sustainability of the hand hygiene auditing program. This qualitative study used a values clarification tool to gain an understanding of the experiences of hand hygiene auditors. The methodology involved qualitative interpretation of focus group discussions to identify the enablers and barriers to successful performance of the auditors' role. Twenty-five participants identified congruous themes of the need for peer and managerial support, improved communication and feedback, and consideration for succession planning. There was consistency in the participants' most frequently identified significant barriers in undertaking the role. Hand hygiene auditors take pride in their role and work toward the goal of reducing health care-associated infections by having a part to play in improving hand hygiene practices of all staff members. Important themes, barriers, and enablers were identified in this study. This research will be of interest nationally and globally, considering the dearth of published information on the experience of hand hygiene auditors. This study provides evidence of the need to support in idual hand hygiene auditors.
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.IDH.2019.12.006
Abstract: Nurses face challenges when providing information about multi-resistant organisms (MROs), and related hospital policies, to patients found to be colonised, and may be concerned for their own safety when caring for MRO-colonised people. Resultant emotional responses may influence behaviours of staff caring for these patients. This study aimed to identify the feelings experienced by nurses when talking about MROs with patients. Secondary objectives were to learn about staff behaviours towards MRO-colonised patients, and to explore the utility of Emotional Touchpoints methodology in this context. A qualitative study using an adapted Emotional Touchpoints method delivered as a paper survey tool for data collection. Content analysis and inductive coding of responses was used to identify key themes. 53 nurses participated. 'Nervous', 'Concerned' and 'Knowledgeable' were the most commonly selected adjectives chosen to describe their feelings. Reasons for these choices were themed as 'Empowerment through knowledge', 'Performance anxiety', 'Concern for the patient' and 'Concern for professional reputation'. Social or temporal distancing, and the need for staff and other patients to be protected from contagion were key themes for the behaviours these nurses had witnessed towards patients. Talking about MROs with patients can elicit strong emotional responses in nurses, and MRO-colonised patients may be treated and spoken about in a discriminatory fashion. Infection prevention and control teams should recognise this and focus on the person rather than the pathogen when educating and supporting nurses. Recommendations for practice are made to support improved wellbeing of nurses as well as MRO colonised patients.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Joanna Harris.