Browsing by Author "Kiernan, Martin"
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Item A Cost-effectiveness Model for a Decision to Adopt Temporary Single-patient Rooms to Reduce Risks of Healthcare-associated Infection in the Australian Public Healthcare System(2022-08-01) Mitchell, Brett G.; Kiernan, Martin; Graves, NicholasBackground
The cost-effectiveness of patient isolation as part of an infection prevention effort is poorly understood. The potential to reduce risks of transmission saving costs and improving health outcomes is strong, yet up front investments in patient isolation are required. We report a cost-effectiveness model to inform adoption of a portable single isolation rooms into Australian publicly funded acute hospitals.
Methods
Information is harvested from a range of contemporary sources to reveal the expected changes to total costs and total health benefits measured by life years gain. An Incremental cost-effectiveness ratio is estimated with uncertainty in all model parameters included by probabilistic sensitivity analysis.
Results
The adoption decision was found to change total costs per 100,000 occupied bed-days by $1,429,011 and generate health benefits of 436 life years. The mean cost per life year gained is $3278. The probability an adoption decision is cost saving is 2.1%.
Conclusion
There is some evidence that adoption of rediroom is likely to be a cost-effective solution for Australian hospitals. Important caveats and assumptions need to be considered when interpreting this conclusion.
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 Environmental Hygiene, Knowledge and Cleaning Practice: A Phenomenological Study of Nurses and Midwives During COVID-19(2021-09-01) Mitchell, Brett G.; Smith, Kate; Wares, Karen D.; Kiernan, Martin; Russo, Philip; Curryer, CassieBackground: Environmental cleanliness is a fundamental tenet in nursing and midwifery but often over-shadowed in practice. This study explored nurses’and midwives’knowledge and experiences of infection prevention and control (IPC) processes and cleaning, and perceptions about workplace risk-management
during COVID-19.
Methods: Six registered and enrolled nurses (one with dual midwife qualifications) were recruited. In-depth telephone interviews were analyzed using Colaizzi's phenomenological method.
Results: Four major themes were identified: Striving towards environmental cleanliness; Knowledge and learning feeds good practice; There's always doubt in the back of your mind; and COVID has cracked it wide open. These articulate the nurses’and midwives’experiences and knowledge of IPC, particularly during
COVID-19.
Discussion: The findings emphasize the dynamic, interdependent nature of clinical (time, staff knowledge and compliance, work processes, hospital design) and organizational contexts and environmental cleanliness, which must be constantly maintained. COVID-19 opened up critical insights regarding poor past practices and lack of IPC compliance.
Conclusions: COVID-19 has highlighted the criticality of environmental cleanliness within clinical and community settings. Evidence-based, experiential learning is important for nurses and midwives at all career stages, but provides only one solution. Clinician-led hospital design may also reduce the spread of infection; thus, promoting better patient careItem Nurses' and Midwives' Cleaning Knowledge, Attitudes and Practices: An Australian Study(2021-02-01) Curryer, Cassie; Kiernan, Martin; Russo, Philip L.; Mitchell, Brett G.Background
As frontline providers of care, nurses and midwives play a critical role in controlling infections such as COVID-19, influenza, multi-drug resistant organisms and health care associated infections. Improved cleaning can reduce the incidence of infection and is cost effective but relies on healthcare personnel to correctly apply cleaning measures. As nurses and midwives have the most contact with patients and as an important first step in improving compliance, this study sought to explore nurses' and midwives’ knowledge on the role of the environment in infection prevention and control and identify challenges in maintaining clean patient environments.
Methods
Cross-sectional online survey of 96 nurses (RN/EN) and midwives (RW) employed in clinical settings (e.g. hospital, aged care, medical centre, clinic) in Australia.
Results
Nurses and midwives broadly stated that they understood the importance of cleaning. However, cleaning responsibilities varied and there was confusion regarding the application of different disinfectants when cleaning after patients with a suspected or diagnosed infection post-discharge. Most would not be confident being placed in a room where a previous patient had a diagnosed infection such as multi-drug resistant organism.
Conclusion
Greater organisational support and improving applied knowledge about infection control procedures is needed. This includes correct use of disinfectants, which disinfectant to use for various situations, and cleaning effectively following discharge of a patient with known infection. The cleanliness of shared medical equipment may also pose current risk due to lack of cleaning.
Item Risk of Organism Acquisition from Prior Room Occupants: An Updated Systematic Review(2023-09-01) Kiernan, Martin; Browne, Katrina; Rawson, Helen; Maillard, Jean-Yves; Russo, Philip; Thottiyil Sultanmuhammed Abdul Khadar, Bismi; Sims, Jenny; Ford, Sindi; Dancer, Stephanie; McDonagh, Julee; Mitchell, Brett G.Background
Evidence from a previous systematic review indicates that patients admitted to a room where the previous occupant had a multidrug-resistant bacterial infection resulted in an increased risk of subsequent colonisation and infection with the same organism for the next room occupant. In this paper, we have sought to expand and update this review.
Methods
A systematic review and meta-analysis was undertaken. A search using Medline/PubMed, Cochrane and CINHAL databases was conducted. Risk of bias was assessed by the ROB-2 tool for randomised control studies and ROBIN-I for non-randomised studies.
Results
From 5175 identified, 12 papers from 11 studies were included in the review for analysis. From 28,299 patients who were admitted into a room where the prior room occupant had any of the organisms of interest, 651 (2.3%) were shown to acquire the same species of organism. In contrast, 981,865 patients were admitted to a room where the prior occupant did not have an organism of interest, 3818 (0.39%) acquired an organism(s). The pooled acquisition odds ratio (OR) for all the organisms across all studies was 2.45 (95% CI: 1.53–3.93]. There was heterogeneity between the studies (I2 89%, P < 0.001).
Conclusion
The pooled OR for all the pathogens in this latest review has increased since the original review. Findings from our review provide some evidence to help inform a risk management approach when determining patient room allocation. The risk of pathogen acquisition appears to remain high, supporting the need for continued investment in this area.
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 What Makes a Tweet Fly? Analysis of Twitter Messaging at Four Infection Control Conferences(2017-11-01) Aveling, Landon; Kiernan, Martin; Otter, Jonathan A.; Russo, Philip; Mitchell, Brett G.Objective: To examine tweeting activity, networks, and common topics mentioned on Twitter at four international infection control and infectious disease conferences.
Design: A cross-sectional study.
Methods: An independent company was commissioned to undertake a Twitter ‘trawl’ each month between July 1, 2016, and November 31, 2016. The trawl identified any tweets that contained the official hashtags of the conferences for (1) the UK Infection Prevention Society, (2) IDWeek 2016, (3) the Federation of Infectious Society/Hospital Infection Society, and (4) the Australasian College for Infection Prevention and Control. Topics from each tweet were identified, and an examination of the frequency and timing of tweets was performed. A social network analysis was performed to illustrate connections between users. A multivariate binary logistic regression model was developed to explore the predictors of ‘retweets.’
Results: In total, 23,718 tweets were identified as using 1 of the 2 hashtags of interest. The results demonstrated that the most tweets were posted during the conferences. Network analysis demonstrated a diversity of twitter networks. A link to a web address was a significant predictor of whether a tweet would be retweeted (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.9–2.1). Other significant factors predicting a retweet included tweeting on topics such as Clostridium difficile (OR, 2.0; 95% CI, 1.7–2.4) and the media (OR, 1.8; 95% CI, 1.6–2.0). Tweets that contained a picture were significantly less likely to be retweeted (OR, 0.06; 95% CI, 0.05–0.08).
Conclusion: Twitter is a useful tool for information sharing and networking at infection control conferences.