Browsing by Author "Cheng, Allen C."
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Item Burden of Five Healthcare Associated Infections in Australia(2022-05-13) Stewardson, Andrew J.; Russo, Philip L.; Cheng, Allen C.; Bucknall, Tracey; Mitchell, Brett G.; Lydeamore, Michael J.Healthcare associated infections (HAIs) are associated with increased morbidity and mortality, but there are few data that quantify the burden of infection nationally in Australia. We used data from an Australian national point prevalence survey to estimate the burden of HAIs amongst adults in Australian public hospitals. The incidence based approach, introduced by the ECDC Burden of Communicable Diseases in Europe was used. We estimate that 155,013 HAIs occur in adults admitted to public hospitals in Australia annually, resulting in 6906 deaths. Hospital acquired pneumonia is the most frequent HAI, followed by surgical site infections, and urinary tract infections. We find that blood stream infections contribute a small percentage of HAIs, but contribute the highest number of deaths (3207), more than twice that of the second largest, while pneumonia has the highest impact on years lived with disability. This study is the first time the national burden of HAIs has been estimated for Australia from point prevalence data. The estimated burden is high, and highlights the need for continued investment in HAI prevention.
Item Establishing the Prevalence of Healthcare-associated Infections in Australian Hospitals: Protocol for the Comprehensive Healthcare Associated Infection National Surveillance (CHAINS) Study(2018-11-08) Mitchell, Brett G.; Marimuthu, Kalisavar; Bucknall, Tracey; Cheng, Allen C.; Stewardson, Andrew J.; Russo, Philip L.Introduction 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.
Methods and analysis 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 sample 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.
Item Reducing Urinary Catheter Use Using an Electronic Reminder System in Hospitalized Patients: A Randomized Stepped-Wedge Trial(2019-04-01) Rosebrock, Hannah; Russo, Philip; Fasugba, Oyebola; Cheng, Allen C.; Northcote, Maria T.; Mitchell, Brett G.Objective: To determine the effectiveness and ease of use of an electronic reminder device in reducing urinary catheterization duration.
Design: A randomized controlled trial with a cross-sectional anonymous online survey and focus group.
Setting: Ten wards in an Australian hospital.
Participants: All hospitalized patients with a urinary catheter.
Intervention: An electronic reminder system, the CATH TAG, applied to urinary catheter bags to prompt removal of urinary catheters.
Outcomes: Catheterization duration and perceptions of nurses about the ease of use.
Methods: 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.
Results: 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.
Conclusion: 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. (Received
Item Reducing Urinary Catheter Use: A Protocol for a Mixed Methods Evaluation of an Electronic Reminder System in Hospitalised Patients in Australia(2018-05-09) Mitchell, Brett G.; Rosebrock, Hannah; Northcote, Maria T.; Russo, Philip; Cheng, Allen C.; Fasugba, OyebolaIntroduction: Despite advances in infection prevention and control, catheter-associated urinary tract infections (CAUTIs) are common and remain problematic. Prolonged urinary catheterisation is the main risk factor for development of CAUTIs; hence, interventions that target early catheter removal warrant investigation. The study’s objectives are to examine the efficacy of an electronic reminder system, the CATH TAG, in reducing urinary catheter use (device utilisation ratio) and to determine the effect of the CATH TAG on nurses’ ability to deliver patient care.
Methods and analysis: This study uses a mixed methods approach in which both quantitative and qualitative data will be collected. A stepped wedge randomised controlled design in which wards provide before and after observations will be undertaken in one large Australian hospital over 24 weeks. The intervention is the use of the CATH TAG. Eligible hospital wards will receive the intervention and act as their own control, with analysis undertaken of the change within each ward using data collected in control and intervention periods. An online survey will be administered to nurses on study completion, and a focus group for nurses will be conducted 2 months after study completion. The primary outcomes are the urinary catheter device utilisation ratio and perceptions of nurses about ease of use of the CATH TAG. Secondary outcomes include a reduced number of cases of catheter-associated asymptomatic bacteriuria, a reduced number of urinary catheters inserted per 100 patient admissions, perceptions of nurses regarding effectiveness of the CATH TAG, changes in ownership/interest by patients in catheter management, as well as possible barriers to successful implementation of the CATH TAG.
Item Strategies to Reduce Non-Ventilator-Associated Hospital-Acquired Pneumonia: A Systematic Review(2019-11-01) Kiernan, Martin; Robinson, Sophia; Curtis, Stephanie J.; Rosebrock, Hannah; Stewardson, Andrew J.; Cheng, Allen C.; Russo, Philip L.; Mitchell, Brett G.Background
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.
Methods
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.
Results
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.
Conclusion
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.
Item The Prevalence of Healthcare Associated Infections Among Adult Inpatients at Nineteen Large Australian Acute-care Public Hospitals: A Point Prevalence Survey(2019-07-15) Mitchell, Brett G.; Bucknall, Tracey; Cheng, Allen C.; Stewardson, Andrew J.; Russo, Philip L.Background
Australia does not have a national healthcare associated infection (HAI) surveillance program. Only one HAI point prevalence study has been undertaken in 1984. The objective of this study was to estimate the burden of healthcare associated infection (HAI) in acute adult inpatients in Australia.
Methods
A cross sectional point prevalence study (PPS) was conducted in a sample of large acute care hospitals. All data were collected by two trained Research Assistants. Surveillance methodology was based on the European Centre for Disease Prevention and Control (ECDC) PPS Protocol with variation in the sampling method in that only acute inpatients ≥ 18 years old were included. ECDC HAI definitions were applied.
Results
Data was collected between August and November 2018. A total of 2767 patients from 19 hospitals were included in the study. The median age of patients was 67, and 52.9% of the sample were male. Presence of a multi-drug resistant organism was documented for 10.3% of the patients. There were 363 HAIs present in 273 patients. The prevalence of patients with a HAI was 9.9% (95%CI: 8.8–11.0). Hospital prevalence rates ranged from 5.7% (95%CI:2.9–11.0) to 17.0% (95%CI:10.7–26.1). The most common HAIs were surgical site infection, pneumonia and urinary tract infection, comprising 64% of all HAIs identified.
Conclusion
This is the first HAI PPS to be conducted in Australia in 34 years. The prevalence rate is higher than the previous Australian study and that reported by the ECDC, however differences in methodology limit comparison. Regular, large scale HAI PPS should be undertaken to generate national HAI data to inform and drive national interventions.