Browsing by Author "Cheng, Allen"
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Item A Mixed Methods Evaluation of an Electronic Reminder System for Reducing Urinary Catheter Use in Australian Hospital(2018-11-01) Northcote, Maria T.; Rosebrock, Hannah; Russo, Philip L.; Fasugba, Oyebola; Cheng, Allen; Mitchell, Brett G.Introduction: An important risk-factor for catheter-associated urinary tract infections (CAUTIs) is prolonged catheterisation. This study examined the efficacy of an electronic reminder system to reduce catheterisation duration and its effect on nurses’ ability to deliver patient care.
Methods: A stepped-wedge randomised controlled design, in addition to a survey and focus groups were undertaken. The intervention was the use of the CATH TAG, an electronic tag placed on the catheter bag, which prompted a review of ongoing catheterisation. The study was conducted in an Australian hospital, over 24 weeks. Primary outcomes were mean catheter duration and perceptions of nurses about ease of use. A Cox proportional hazards regression model was used, duration was the outcome variable. Patients who were transferred between wards with catheters were censored. The intervention was treated as a time varying covariate.
Results: 1167 patients participated in the study. The duration of catheterisation was slightly lower in patients where the CATH TAG was used (mean 5.1 vs 5.5 days, HR 1.02 95% CI: 0.91, 1.14, p=0.75). Excluding the patients transferred between wards, mean catheterisation duration was 5.5 vs 4.2 days, IRR 0.78 (22% reduction), p=0.15. Data gathered from the focus group and the online survey for nurses, indicated positive response.
Conclusion: A clinically important reduction in catheter duration for a sub-group of patients was identified. The short duration of this study may have impeded the ability to change catheter practice and hence duration in the short term.
Item A Randomised Controlled Trial Investigating the Effect of Improving the Cleaning and Disinfection of Shared Medical Equipment on Healthcare-associated Infections: The CLEaning and Enhanced disiNfection (CLEEN) Study(2023-02-22) Mitchell, Brett; Brain, David; Kiernan, Martin; King, Jennie; O'Kane, Gabrielle; Graham, Kirsty; Cheng, Allen; Stewardson, Andrew; Amin, Maham; Russo, Philip; Tehan, Peta; White, Nicole; Browne, KatrinaBackground
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.
Methods
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.
Discussion
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.
Trial registration
Australia New Zealand Clinical Trial Registry ACTRN12622001143718.
Item Chlorhexidine for Meatal Cleaning in Reducing Catheter-Associated Urinary Tract Infections: A Multicentre Stepped-Wedge Randomised Controlled Trial(2019-06-01) Mitchell, Brett G.; Gardner, Anne; Collignon, Peter; Koerner, Jane; Graves, Nicholas; Gregory, Victoria; Cheng, Allen; Fasugba, OyebolaBackground
Evidence for the benefits of antiseptic meatal cleaning in reducing catheter-associated urinary tract infection (UTI) is inconclusive. We assessed the efficacy of 0·1% chlorhexidine solution compared with normal saline for meatal cleaning before urinary catheter insertion in reducing the incidence of catheter-associated asymptomatic bacteriuria and UTI.
Methods
A cross-sectional, stepped-wedge, open-label, randomised controlled trial was undertaken in Australian hospitals. Eligible hospitals were Australian public and private hospitals, with an intensive care unit and more than 30 000 hospital admissions per year. Hospitals were randomly assigned to an intervention crossover date using a computer-generated randomisation system. Crossover dates occurred every 8 weeks; during the first 8 weeks of the study, no hospitals were exposed to the intervention (control phase), after which each hospital sequentially crossed over from the control to the intervention every 8 weeks. Patients requiring a urinary cathetwer were potentially eligible for inclusion in this hospital-wide study. Participants were excluded if they were younger than 2 years, had a medical reason preventing the use of the chlorhexidine, had the catheter inserted in theatre, did not have the catheter insertion date documented, required in-and-out or suprapubic catheterisation, had symptoms and signs suggestive of UTI at the time of catheter insertion, or were currently undergoing treatment for UTI. The intervention was the use of 0·1% chlorhexidine solution for meatal cleaning before urinary catheterisation with 0·9% normal saline used in the control phase. Masking of hospitals was not possible because it was not feasible to mask staff administering the intervention. The co-primary outcomes were the number of cases of catheter-associated asymptomatic bacteriuria and UTI per 100 catheter-days and were assessed within 7 days of catheter insertion in the intention-to-treat population. This trial is registered with Australian New Zealand Clinical Trials Registry, number ACTRN12617000373370.
Findings
21 hospitals were assessed for eligibility between Jan 5, 2017, and May 1, 2017; of these, three were successfully enrolled and randomised to one of three intervention crossover dates. 1642 participants in these hospitals were included in the study between Aug 1, 2017, and March 12, 2018, 697 (42%) in the control phase and 945 (58%) in the intervention period. In the control period, 13 catheter-associated UTI and 29 catheter-associated asymptomatic bacteriuria events in 2889 catheter-days (0·45 catheter-associated UTI cases and 1·00 catheter-associated asymptomatic bacteriuria cases per 100 catheter-days) were recorded compared with four catheter-associated UTI and 16 catheter-associated asymptomatic bacteriuria events in 2338 catheter-days (0·17 catheter-associated UTI cases and 0·68 catheter-associated asymptomatic bacteriuria cases per 100 catheter-days) during the intervention period. The intervention was associated with a 74% reduction in the incidence of catheter-associated asymptomatic bacteriuria (incident rate ratio 0·26, 95% CI 0·08–0·86, p=0·026), and a 94% decrease in the incidence of catheter-associated UTI (0·06, 95% CI 0·01–0·32, p=0·00080). There were no reported adverse events.
Interpretation
The use of chlorhexidine solution for meatal cleaning before catheter insertion decreased the incidence of catheter-associated asymptomatic bacteriuria and UTI and has the potential to improve patient safety.
Item Chlorhexidine for Prevention of Catheter-Associated Urinary Tract Infections: The Totality of Evidence - Author's Reply(2019-08-01) Collignon, Peter; Koerner, Jane; Graves, Nicholas; Gardner, Anne; Fasugba, Oyebola; Cheng, Allen; Mitchell, Brett G.Item Chlorhexidine Versus Saline in Reducing the Risk of Catheter Associated Urinary Tract Infection: A Cost-Effectiveness Analysis(2019-09-01) Graves, Nicholas; Gardner, Anne; Collignon, Peter; Koerner, Jane; Gregory, Victoria; Cheng, Allen; Fasugba, Oyebola; Mitchell, Brett G.Background: 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.
Results: 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.
Conclusion: 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.
Item Healthcare Associated Infection Point Prevalence Study(2017-01-01) Stewardson, Andrew J.; Bucknall, Tracey; Cheng, Allen; Mitchell, BrettItem Healthcare-Associated Infections in Australia: Tackling the 'Known Unknowns'(2018-04-01) Hall, Lisa; Mitchell, Brett G.; Cheng, Allen; Russo, PhilipAustralia 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.
Item Increased Fluid Intake for the Prevention of Urinary Tract Infection in Adults and Children in all Settings: A Systematic Review(2020-01-01) Middleton, Sandy; Cheng, Heilok; Cheng, Allen; Koerner, Jane; McInnes, Elizabeth; Mitchell, Brett G.; Fasugba, OyebolaBackground
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.
Aim
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.
Methods
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 ((
Findings
Of the 2822 potentially relevant papers, two were eligible for inclusion: an RCT (individual randomization) and a cluster-RCT. Both studies differed regarding participants, setting, sample 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.
Conclusion
The lack of enough adequately powered and robust RCTs highlights the need for further research on the effectiveness of this intervention for UTI prevention.
Item Infection, Disease and Health: A Journal for the Future(2016-05-06) Gilbert, Lyn; Cheng, Allen; Dancer, Stephanie; Shaban, Ramon Z.; Mitchell, Brett G.Item Meatal Cleaning: Discrepancies in Need of Explanation - Author's Reply(2019-11-01) Collignon, Peter; Koerner, Jane; Graves, Nicholas; Fasugba, Oyebola; Mitchell, Brett G.; Cheng, AllenItem Mycobacterial Infections Due to Contaminated Heater Cooler Units used in Cardiac Bypass: An Approach for Infection Control Practitioners(2016-12-01) Stuart, Rhonda; Johnson, Paul; Collignon, Peter; Mitchell, Brett G.; Stewardson, Andrew J.; Cheng, AllenMycobacterium chimaera infection in patients who have had cardiac bypass surgery has recently been associated with contamination of water in heater cooler units. Those responsible for infection prevention and control programs face the challenge of responding to this rare but potentially life-threatening and avoidable healthcare-associated infection. Infection control professionals need to be aware of this issue and take an active role in formulating hospital responses. Policies should be rational and appropriate to the level of risk, should minimise service disruption and costs, and recognise that evidence about risk mitigation measures is still emerging. This paper provides background information to the topic and proposes a risk management based approach to heater cooler units in hospitals that perform cardiac bypass surgery, so that infection control professionals can develop a local, tailored response.
Item Reducing Catheter-Associated Urinary Tract Infections in Hospitals: Study Protocol for a Multi-Site Randomised Controlled Study(2017-11-28) Gregory, Victoria; Morey, Peter; Graves, Nicholas; Cheng, Allen; Collignon, Peter; Koerner, Jane; Gardner, Anne; Fasugba, Oyebola; Mitchell, Brett G.Introduction
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.
Methods and analysis
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.
Dissemination
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.
Item Reducing Urinary Catheter Use: A Randomised Controlled Study on the Efficiacy of an Electronic Reminder System(2017-01-01) Milgate, Gabrielle; Gregory, Victoria; Cheng, Allen; Russo, Philip L.; Rosebrock, Hannah; Fasugba, Oyebola; Northcote, Maria; Mitchell, BrettItem The Role of Chlorhexidine in Reducing Catheter Associated Urinary Tract Infection: A Randomised Controlled Study(2018-11-20) Gregory, Victoria; Graves, Nicholas; Collignon, Peter; Koerner, Jane; Gardner, Anne; Fasugba, Oyebola; Cheng, Allen; Mitchell, Brett G.Introduction: The evidence on which solution to use for meatal cleaning, prior to urinary catheter insertion is mixed. There are conflicting recommendations in international guidelines and in clinical practice, which reflect this uncertainty. The aim of this study was to evaluate the effectiveness of using chlorhexidine in meatal cleaning prior to catheter insertion, in reducing catheter-associated asymptomatic bacteriuria (CA-ASB) and CAUTI.
Methods: A stepped wedge randomised controlled clinical trial was undertaken in three Australian hospitals. The intervention was the use of chlorhexidine (0.1%) solution, compared to normal saline (0.9%) for meatal cleaning prior to catheter insertion. The number of CA-ASB and CAUTI were analysed using Poisson regression, with no intervention delay on the outcome. The stepped wedge design allows hospitals to act as their own control.
Results: 1642 catheters were inserted over the study period (697 control, 945 intervention). The mean age of participants was 62 years, 57% were female. Following the introduction of the intervention, the incidence of CAUTI reduced by 94%, IRR 0.06 (95%CI 0.01-0.32). Similarly, there was a 72% reduction in CA-ASB (IRR 0.28, 95%CI 0.08-0.93).
Conclusion: The use of chlorhexidine was associated with a decrease in both bacteriuria and CAUTI. This decrease was identified at all sites, with no CAUTI observed in the post-intervention period in two of the three study sites. The study findings will have implications for recommendation in national guidelines, hospital policy and clinical practice.