June 15, 2012
Background:
Screening at hospital admission for carriage of methicillin-resistant Staphylococcus aureus (MRSA) has been proposed as a strategy to reduce nosocomial infections. The objective of this study was to determine the long-term costs and health benefits of selective and universal screening for MRSA at hospital admission, using both PCR-based and chromogenic media-based tests in various settings.
Posted in Journal Articles, READ Portal | Tagged with Cost effectiveness, Hospitals, Infection control | No Comments
May 10, 2012
“Objective. Hospital readmissions are a current target of initiatives to reduce healthcare costs. This study quantified the association between having a clinical culture positive for 1 of 3 prevalent hospital-associated organisms and time to hospital readmission.
Design. Retrospective cohort study.
Patients and setting. Adults admitted to an academic, tertiary care referral center from January 1, 2001, through December 31, 2008.
Methods. The primary exposure of interest was a clinical culture positive for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), or Clostridium difficile obtained more than 48 hours after hospital admission during the index hospital stay. The primary outcome of interest was time to readmission to the index facility. Multivariable Cox proportional hazards models were used to model the adjusted association between positive clinical culture result and time to readmission and to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).
Results. Among 136,513 index admissions, the prevalence of hospital-associated positive clinical culture result for 1 of the 3 organisms of interest was 3%, and 35% of patients were readmitted to the index facility within 1 year after discharge. Patients with a positive clinical culture obtained more than 48 hours after hospital admission had an increased hazard of readmission (HR, 1.40; 95% CI, 1.33–1.46) after adjusting for age, sex, index admission length of stay, intensive care unit stay, Charlson comorbidity index, and year of hospital admission.
Conclusions. Patients with healthcare-associated infections may be at increased risk of hospital readmission. These findings may be used to impact health outcomes after discharge from the hospital and to encourage better infection prevention efforts.”
Posted in Journal Articles, READ Portal | Tagged with Health care costs, Hospitals, Infection control | No Comments
March 30, 2012
“Overview: Antibiotic resistance development is a natural process of adaption leading to a limited lifespan of antibiotics. Unnecessary and inappropriate use of antibiotics favours the emergence and spread of resistant bacteria. A crisis has been building up over decades, so that today common and life-threatening infections are becoming difficult or even impossible to treat. It is time to take much stronger action worldwide to avert an ever increasing health and economic burden. A new WHO publication “The evolving threat of antimicrobial resistance – Options for action” describes examples of policy activities that have addressed AMR in different parts of the world. The aim is to raise awareness and to stimulate further coordinated efforts.”
Posted in READ Portal, Reports & Papers | Tagged with Infection control, Prevention and control | No Comments
January 27, 2012
“This study was based on publicly available information and self-reported data provided by the case study institution(s). The aim of Commonwealth Fund–sponsored case studies of this type is to identify institutions that have achieved results indicating high performance in a particular area of interest, have undertaken innovations designed to reach higher performance, or exemplify attributes that can foster high performance. The studies are intended to enable other institutions to draw lessons from the studied institutions’ experience that will be helpful in their own efforts to become high performers. Even the best-performing organizations may fall short in some areas or make mistakes—emphasizing the need for systematic approaches to improve quality and prevent harm to patients and staff.
“Between 4 percent and 5 percent of hospitalizations result in a health care–associated infection (HAI), at tremendous cost to individuals who become infected and those who fund health care. One of the most common and preventable HAIs is the central line–associated bloodstream infection (CLABSI), which can result when a central venous catheter is not inserted cleanly or maintained properly. An estimated 43,000 CLABSIs occurred in hospitals in 2009 and nearly one of five infected patients died as a result. This case study is part of a series that describes practices used by four leading hospitals that eliminated CLABSIs in their ICUs.”
Posted in READ Portal, Reports & Papers | Tagged with Benchmarking, Infection control, Prevention and control | No Comments
January 24, 2012
“Background: The risk of infection following a visit to the emergency department is unknown. We explored this risk among elderly residents of long-term care facilities.
Methods: We compared the rates of new respiratory and gastrointestinal infections among elderly residents aged 65 years and older of 22 long-term care facilities. We used standardized surveillance definitions. For each resident who visited the emergency department during the study period, we randomly selected two residents who did not visit the emergency department and matched them by facility unit, age and sex. We calculated the rates and proportions of new infections, and we used conditional logistic regression to adjust for potential confounding variables.
Results: In total, we included 1269 residents of long-term care facilities, including 424 who visited the emergency department during the study. The baseline characteristics of residents who did or did not visit the emergency department were similar, except for underlying health status (visited the emergency department: mean Charlson Comorbidity Index 6.1, standard deviation [SD] 2.5; did not visit the emergency department: mean Charlson Comorbidity index 5.5, SD 2.7; p < 0.001) and the proportion who had visitors (visited the emergency department: 46.9%; did not visit the emergency department: 39.2%; p = 0.01). Overall, 21 (5.0%) residents who visited the emergency department and 17 (2.0%) who did not visit the emergency department acquired new infections. The incidence of new infections was 8.3/1000 patient-days among those who visited the emergency department and 3.4/1000 patient-days among those who did not visit the emergency department. The adjusted odds ratio for the risk of infection following a visit to the emergency department was 3.9 (95% confidence interval 1.4–10.8).
Interpretation: A visit to the emergency department was associated with more than a threefold increased risk of acute infection among elderly people. Additional precautions should be considered for residents following a visit to the emergency department.”
Posted in Journal Articles, READ Portal | Tagged with Health services for the aged, Infection control, Prevention and control, Safety | No Comments
October 3, 2011
“These guidelines have been developed for health care personnel who insert intravascular catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home healthcare settings.”
“These guidelines are (also) intended to provide evidence-based recommendations for preventing intravascular catheter-related infections. Major areas of emphasis include 1) educating and training healthcare personnel who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a > 0.5% chlorhexidine skin preparation with alcohol for antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters and chlorhexidine impregnated sponge dressings if the rate of infection is not decreasing despite adherence to other strategies (i.e., education and training, maximal sterile barrier precautions, and >0.5% chlorhexidine preparations with alcohol for skin antisepsis). These guidelines also emphasize performance improvement by implementing bundled strategies, and documenting and reporting rates of compliance with all components of the bundle as benchmarks for quality assurance and performance improvement.”
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Posted in READ Portal, Reports & Papers | Tagged with Evidence-based, Infection control, Safety | No Comments
September 7, 2011
A new study has a message for doctors and nurses who fail to wash their hands: Don’t think about yourself. Think about your patients.
Getting health care professionals to comply with notices to wash their hands before and after dealing with patients has been something of a thorn in the side of many hospitals. Although this simple measure limits the spread of sickness — and could potentially reduce the nation’s hospital health care bill by billions of dollars — many doctors and nurses simply ignore it. Compliance rates for hand washing in American hospitals are only around 40 percent, and years of awareness programs urging doctors to wash up or use disinfectant gels have had little effect.
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Posted in Mass Media Articles, READ Portal | Tagged with Infection control, Safety | No Comments
July 20, 2011
“The following document is a summary guide of infection prevention recommendations for outpatient (ambulatory care) settings. The recommendations included in this document are not new but rather reflect existing evidence-based guidelines produced by the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee. This summary guide is based primarily upon elements of Standard Precautions and represents the minimum infection prevention expectations for safe care in ambulatory care settings. Readers are urged to consult the full guidelines for additional background, rationale, and evidence behind each recommendation.”
Posted in READ Portal, Reports & Papers | Tagged with Evidence-based, Infection control, Outpatient care, Safety | No Comments
June 6, 2011
“Partnering to Heal is a computer-based, video-simulation training program on infection control practices for clinicians, health professional students, and patient advocates.
The training highlights effective communication about infection control practices and ideas for creating a “culture of safety” in healthcare institutions to keep patients from getting sicker. Users assume the identity of the following five main characters and make decisions about preventing healthcare-associated infections (HAIs):
- A Physician, Nathan Green, Director of a Hospital Post-op Unit, ready to start new prevention efforts in the unit;
- A Registered Nurse, Dena Gray, working to learn effective communications skills that could make the difference for her patients;
- An Infection Preventionist, Janice Upshaw, a new employee charged with using a team-based approach to reducing infections;
- A Patient Family Member, Kelly McTavish, whose father was just admitted to the hospital;
- A third-year Medical Student, Manuel Hernandez, who wants to gain confidence to make a difference for his patients.”
Posted in Multimedia, READ Portal | Tagged with Health technology, Infection control, Information technology, Patient-centered care, Prevention and control, Safety | No Comments
May 4, 2011
Health-care facilities can track their progress in hand hygiene promotion, plan their actions and aim for hand hygiene improvement and sustainability through the use of the WHO Hand Hygiene Self-Assessment Framework.
The Framework is a tool with which to obtain a situation analysis of hand hygiene promotion and practices within an individual health-care facility, according to a set of indicators. It also acts as a diagnostic tool, identifying key issues requiring attention and improvement. Repeated use of the Framework will allow documentation of progress with time.
By completing the Framework, you can:
- calculate the score of each section and the overall score to identify at what level of progress your facility stands;
- evaluate with your infection control committee and hospital administrators which areas need improvement and whether any of these can be targeted with specific approaches (e.g. staff education, preparation of new posters/reminders, etc);
- disseminate the results, in particular to share strengths and gaps of your facility in promoting hand hygiene.
Posted in Multimedia, READ Portal | Tagged with Indicators, Infection control, Safety | No Comments
