Browsing by Author "Halton, Kate"
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Item An Environmental Cleaning Bundle and Health-Care-Associated Infections in Hospitals (REACH): A Multicentre, Randomised Trial(2019-04-01) Graves, Nicholas; Gericke, Christian A.; Farrington, Alison; Page, Katie; Gardner, Anne; Riley, Thomas V.; Paterson, David L.; Halton, Kate; Barnett, Adrian G.; White, Nicole; Hall, Lisa; Mitchell, Brett G.Background The hospital environment is a reservoir for the transmission of microorganisms. The effect of improved cleaning on patient-centred outcomes remains unclear. We aimed to evaluate the effectiveness of an environmental cleaning bundle to reduce health care-associated infections in hospitals.
Methods The REACH study was a pragmatic, multicentre, randomised trial done in 11 acute care hospitals in Australia. Eligible hospitals had an intensive care unit, were classified by the National Health Performance Authority as a major hospital (public hospitals) or having more than 200 inpatient beds (private hospitals), and had a health-care-associated infection surveillance programme. The stepped-wedge design meant intervention periods varied from 20 weeks to 50 weeks. We introduced the REACH cleaning bundle, a multimodal intervention, focusing on optimising product use, technique, staff training, auditing with feedback, and communication, for routine cleaning. The primary outcomes were incidences of health-care-associated Staphylococcus aureus bacteraemia, Clostridium difficile infection, and vancomycin-resistant enterococci infection. The secondary outcome was the thoroughness of cleaning of frequent touch points, assessed by a fluorescent marking gel. This study is registered with the Australian and New Zealand Clinical Trial Registry, number ACTRN12615000325505.
Findings Between May 9, 2016, and July 30, 2017, we implemented the cleaning bundle in 11 hospitals. In the pre-intervention phase, there were 230 cases of vancomycin-resistant enterococci infection, 362 of S aureus bacteraemia, and 968 C difficile infections, for 3 534 439 occupied bed-days. During intervention, there were 50 cases of vancomycin-resistant enterococci infection, 109 of S aureus bacteraemia, and 278 C difficile infections, for 1 267 134 occupied bed-days. After the intervention, vancomycin-resistant enterococci infections reduced from 0·35 to 0·22 per 10 000 occupied bed-days (relative risk 0·63, 95% CI 0·41–0·97, p=0·0340). The incidences of S aureus bacteraemia (0·97 to 0·80 per 10 000 occupied bed-days; 0·82, 0·60–1·12, p=0·2180) and C difficile infections (2·34 to 2·52 per 10 000 occupied bed-days; 1·07, 0·88–1·30, p=0·4655) did not change significantly. The intervention increased the percentage of frequent touch points cleaned in bathrooms from 55% to 76% (odds ratio 2·07, 1·83–2·34, p
Interpretation The REACH cleaning bundle was successful at improving cleaning thoroughness and showed great promise in reducing vancomycin-resistant enterococci infections. Our work will inform hospital cleaning policy and practice, highlighting the value of investment in both routine and discharge cleaning practice.
Funding National Health and Medical Research Council (Australia).
Item Changes in Knowledge and Attitudes of Hospital Environmental Services Staff: The Researching Effective Approaches to Cleaning in Hospitals (REACH) Study(2018-09-01) Hall, Lisa; Graves, Nicholas; Paterson, David L.; Gericke, Christian A.; Riley, Thomas V.; Halton, Kate; Gardner, Anne; Page, Katie; Allen, Michelle; Farrington, Alison; White, Nicole; Mitchell, Brett G.Background
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/post questionnaire, embedded into the REACH study, that was administered prior to the implementation of the intervention and at the conclusion of the study.
Methods
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.
Results
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.
Conclusion
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.
Item Cost-Effectiveness of an Environmental Cleaning Bundle for Reducing Healthcare Associated Infections(2020-06-15) Graves, Nicholas; Gericke, Christian A.; Page, Katie; Gardner, Anne; Riley, Thomas V.; Paterson, David L.; Halton, Kate; Farrington, Alison; Mitchell, Brett G.; Hall, Lisa; Barnett, Adrian G.; White, NicoleBackground
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.
Methods
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.
Results
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.
Conclusions
A bundled, evidence-based approach to improving hospital cleaning is a cost-effective intervention for reducing the incidence of HAIs.
Item Credentialing of Australian and New Zealand Infection Control Professionals: An Exploratory Study(2016-08-01) Mitchell, Brett G.; Gardner, Anne; Halton, Kate; Hall, Lisa; MacBeth, DeboroughBackground
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.
Methods
A cross-sectional study design was used to identify the perceived barriers to credentialing and the characteristics of credentialed ICPs.
Results
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.
Conclusions
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.
Item Effectiveness of a Structured, Framework-Based Approach to Implementation: The Researching Effective Approaches to Cleaning in Hospitals (REACH) Trial(2020-02-18) Gardner, Anne; Graves, Nicholas; Gericke, Christian A.; Riley, Thomas V.; Halton, Kate; Page, Katie; Mitchell, Brett G.; Farrington, Alison; Allen, Michelle; White, Nicole; Hall, LisaBackground
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.
Design/methods
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 diverse 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).
Results
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.
Conclusion
Using a structured framework-based approach allows for pragmatic and successful implementation of clinical trials across diverse settings, and assists with quantitative evaluation of practice change.
Item Exploring the Context for Effective Clinical Governance in Infection Control(2017-03-01) Mitchell, Brett G.; MacBeth, Deborough; Gardner, Anne; Hall, Lisa; Halton, KateBackground: 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.
Methods: 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.
Results: Three hundred surveys were returned. IPs appear well equipped at an individual 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.
Conclusions: 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.
Item Hospital Infection Control Units: Staffing, Costs, and Priorities(2015-06-01) Halton, Kate; Gardner, Anne; MacBeth, Deborough; Hall, Lisa; Mitchell, Brett G.Background: 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.
Methods: 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.
Results: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 totalled $16,364,392 (mean, $380,566). Infection control units managing smaller hospitals (
Conclusion: 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.
Item Infection Control Standards and Credentialing(2015-12-01) Gardner, Anne; MacBeth, Deborough; Halton, Kate; Hall, Lisa; Mitchell, Brett G.Infection control professionals (ICPs) play an integral part of developing, implementing, and evaluating infection control programs. In Australia, there is no minimum or standardized education to practice as an ICP. The Australasian College of Infection Prevention and Control, the professional body for ICPs in Australasia, sought to address the issue by developing a credentialing process.1-3 This decision was made in recognition that self-regulation is one of the hallmarks of professionalism.4 The process of becoming credentialed as an ICP in Australia involves the submission of evidence against a range of criteria with a subsequent peer-review process.
Item Researching Effective Approaches to Cleaning in Hospitals (REACH)(2014-01-01) Page, Katie; Hall, Lisa; Riley, Tom; Gericke, Christian; Paterson, David; Mitchell, Brett; Gardner, Anne; Barnett, Adrian; Halton, Kate; Graves, NicholasItem Researching Effective Approaches to Cleaning in Hospitals: Protocol of the REACH Study, A Multi-Site Stepped-Wedge Randomised Trial(2016-03-24) Graves, Nicholas; Paterson, David L.; Gericke, Christian A.; Riley, Thomas V.; Dancer, Stephanie; Bailey, Emily; Havers, Sally; Gardner, Anne; Page, Katie; Allen, Michelle; Halton, Kate; Barnett, Adrian G.; Mitchell, Brett G.; Farrington, Alison; Hall, LisaBackground: The Researching Effective Approaches to Cleaning in Hospitals (REACH) study will generate evidence about the effectiveness and cost-effectiveness of a novel cleaning initiative that aims to improve the environmental cleanliness of hospitals. The initiative is an environmental cleaning bundle, with five interdependent, evidence-based components (training, technique, product, audit and communication) implemented with environmental services staff to enhance hospital cleaning practices.
Methods/design: The REACH study will use a stepped-wedge randomised controlled design to test the study intervention, an environmental cleaning bundle, in 11 Australian hospitals. All trial hospitals will receive the intervention and act as their own control, with analysis undertaken of the change within each hospital based on data collected in the control and intervention periods. Each site will be randomised to one of the 11 intervention timings with staggered commencement dates in 2016 and an intervention period between 20 and 50 weeks. All sites complete the trial at the same time in 2017. The inclusion criteria allow for a purposive sample of both public and private hospitals that have higher-risk patient populations for healthcare-associated infections (HAIs). The primary outcome (objective one) is the monthly number of Staphylococcus aureus bacteraemias (SABs), Clostridium difficile infections (CDIs) and vancomycin resistant enterococci (VRE) infections, per 10,000 bed days. Secondary outcomes for objective one include the thoroughness of hospital cleaning assessed using fluorescent marker technology, the bio-burden of frequent touch surfaces post cleaning and changes in staff knowledge and attitudes about environmental cleaning. A cost-effectiveness analysis will determine the second key outcome (objective two): the incremental cost-effectiveness ratio from implementation of the cleaning bundle. The study uses the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to support the tailored implementation of the environmental cleaning bundle in each hospital
Discussion: Evidence from the REACH trial will contribute to future policy and practice guidelines about hospital environmental cleaning. 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 hospitals.
Item Resourcing Hospital Infection Prevention and Control Units in Australia: A Discussion Paper(2017-06-01) Hall, Lisa; Gardner, Anne; Halton, Kate; MacBeth, Deborough; Mitchell, Brett G.Background
Infection control professionals (ICPs) are critical in maintaining high standards of quality patient care. Until recently, little was known about the scope of practice, structures, resources and priorities for ICPs and infection control units more generally. Over the past three years we have undertaken a program of work to explore these issues. The purpose of this discussion paper is to synthesise these results and outline implications for the Australian infection control community.
Methods
We undertook a survey of individual ICPs in Australian and New Zealand and a survey of hospital infection control units within Australia. To understand how our research program could be used to inform and be of value, we also convened a stakeholder workshop to discuss how data from our studies could be translated into meaningfully constructed findings. A synthesis of the findings from the two surveys and the workshop was undertaken and this formed the basis of this discussion paper.
Results
We were able for the first time, to comprehensively report on infection control staffing levels, priorities and barriers within Australia. We identified considerable variability in the scope, experience and expertise of ICPs and the potential value that credentialing has with respect to effective infection control programs. We were however, unable to develop recommendations with respect to staffing.
Conclusion
The findings of our work may be used in designing and justifying business cases for infection prevention and control resources. There is also a need to undertake a similar study in settings other than hospitals
Item Roles, Responsibilities and Scope of Practice: Describing the ‘State of Play’ for Infection Control Professionals in Australia and New Zealand(2015-03-01) Mitchell, Brett G.; Gardner, Anne; MacBeth, Deborough; Halton, Kate; Hall, LisaBackground: In the past decade the policy and practice context for infection control in Australia and New Zealand has changed, with infection control professionals (ICPs) now involved in the implementation of a large number of national strategies. Little is known about the current ICP workforce and what they do in their day-to-day positions. The aim of this study was to describe the ICP workforce in Australia and New Zealand with a focus on roles, responsibilities, and scope of practice.
Methods: A cross-sectional design using snowball recruitment was employed. ICPs completed an anonymous web-based survey with questions on demographics; qualifications held; level of experience; workplace characteristics; and roles and responsibilities. Chi-squared tests were used to determine if any factors were associated with how often activities were undertaken.
Results: A total of 300 ICPs from all Australian states and territories and New Zealand participated. Most ICPs were female (94%); 53% were aged over 50, and 93% were employed in registered nursing roles. Scope of practice was diverse: all ICPs indicated they undertook a large number and variety of activities as part of their roles. Some activities were undertaken on a less frequent basis by sole practitioners and ICPs in small teams.
Conclusion: This survey provides useful information on the current education, experience levels and scope of practice of ICPs in Australia and New Zealand. Work is now required to establish the best mechanisms to support and potentially streamline scope of practice, so that infection-control practice is optimised.
Item Time Spent by Infection Control Professionals Undertaking Healthcare Associated Infection Surveillance: A Multi-centred Cross Sectional Study(2016-05-05) Gardner, Anne; MacBeth, Deborough; Halton, Kate; Hall, Lisa; Mitchell, Brett G.Background: There is limited contemporary information on how infection control professionals (ICPs) in hospitals utilise their time, with even less providing any specific data on time taken to undertake HAI surveillance. HAI surveillance is a critical component of any infection control program.
Methods: An anonymous online web-based survey was used to conduct a cross-sectional study of infection control units in public and private Australian hospitals. Participants were asked demographic information and time spent undertaking infection control activities, including surveillance.
Results: Forty infection control units, responsible for providing services to 138 hospitals completed the survey. The percentage of time spent undertaking HAI surveillance activities by members of the infection control units was 1675 h or 36.0% (95% CI 34.3%e37.8%; range 17%e61%) of all contracted infection control professionals time (4653 h). Of the time spent undertaking HAI surveillance, 56% was spent collecting data, 27% collecting data on compliance with infection control activities and 17% feeding HAI data back to clinician and management. There was no difference in the proportion of time spent undertaking HAI surveillance between public and privately funded hospitals or infection control units led by a credentialed ICP. Infection control units with a form of electronic surveillance dedicated more time to surveillance, compared to units that did not use such a system. Demands for surveillance increased with larger number of hospitals beds.
Conclusion: The costs of undertakingHAI surveillance and collectingdata can be considerable.The efficiency ofundertaking surveillance should be considered, weighing investment against the likely improvement in infection rates and patient quality of life.
Item Variation in Hospital Cleaning Practice and Process in Australian Hospitals: A Structured Mapping Exercise(2017-12-01) Graves, Nicholas; Paterson, David L.; Gericke, Christian A.; Riley, Thomas V.; Dancer, Stephanie; Page, Katie; Halton, Kate; Barnett, Adrian G.; Hall, Lisa; Gardner, Anne; Allen, Michelle; Farrington, Alison; Mitchell, Brett G.Background: The purpose of this paper is to highlight the range of cleaning practices and processes in 11 Australian hospitals and to discuss the challenges this variation poses to the implementation of clinical trials or changes to hospital cleaning practices.
Methods: A cross-sectional study design was used to determine cleaning practices and processes in hospitals participating in the ‘Researching Effective Approaches to Cleaning in Hospitals’ (REACH) study. A standardised template and approach was used to collect information. Data collection activities included structured on-site discussions, a review of hospital practices and a document review of policy and procedural documents related to cleaning.
Results: Variations in the auditing process used to evaluate environmental cleanliness, cleaning practices, product use, training and communication pathways available to cleaning staff were identified. There was also variation in workforce structure and responsibilities for cleaning.
Conclusion: This paper is the first to describe the differences in cleaning practices between Australian hospitals. The variations identified present a number of challenges for the conduct of research and have important implications for both monitoring of and standards for cleanliness. These challenges include implementing a practice change or cleaning study where hospitals have different processes, practices and structures.