Browsing by Author "Mitchell, Brett G."
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Item A Community-Based Lifestyle Intervention Targeting Type II Diabetes Risk Factors in an Australian Aboriginal Population: A Feasibility Study(2016-08-08) Mitchell, Brett G.; Kent, Lillian; Morton, Darren; Rankin, PaulObjectives: To examine the responsiveness of an Aboriginal cohort to a community-based lifestyle intervention targeting risk factors for type II diabetes.
Methods: A Pre-test/post-test cohort study conducted in two rural Australian locations: Port Augusta, South Australia and Drouin, Victoria. The cohort consisted of 25 individuals of Aboriginal descent (mean age = 44.4 ± 12.3 yrs, age range = 25-70 yrs, 7 males/18 females). The intervention used was the Complete Health Improvement Program, involving 11 group sessions conducted over a one-month period, which promoted a low-fat plant-based diet and physical activity. The main outcomes measured were changes in body weight, fasting plasma glucose (FPG), lipid profile and blood pressure (BP).
Results: Over the 4 week intervention mean body weight decreased by 3.1 kg (95% CI 2.26 to 4.06), a 3.5% reduction from baseline (p 5.5 mmol/L at baseline showed a 23.6% reduction in mean FPG (7.82 mmol/L to 5.97 mmol/L, p=0.005) and a 4.12% reduction in body weight (98.85 kg to 94.78 kg, p
Conclusion: This feasibility study showed that a lifestyle intervention promoting a low-fat eating pattern combined with physical activity reduced risk factors associated with type II diabetes in a rural Aboriginal cohort when conducted in their usual living environment.
Implications: There is potential for committee-based lifestyle interventions to improve the health risk profile of Aboriginal participants.
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 Critical Review to Plan the Future: An Infection Prevention and Control Conference with a Difference(2015-09-15) Mitchell, Brett G.; Hodgson, PaulThis article discusses the program for the 4th International Australasian College for Infection Prevention and Control (ACIPC) Conference, which focuses on the future of infection prevention and control.
Item A Literature Review Supporting the Proposed National Australian Definition for Staphylococcus Aureus Bacteraemia(2010-12-01) Cruickshank, Marilyn; Stewart, Lee; Collignon, Peter; Gardner, Anne; Mitchell, Brett G.Staphylococcus aureus bacteraemia (SAB) is a major cause of morbidity and mortality. During 2009, a national surveillance definition for SAB was developed through the Australian Commission on Safety and Quality in Healthcare (ACSQHC). The aim of this paper is to review the literature surrounding SAB surveillance and in doing so, evaluate the recently developed Australian national definition for SAB. The issues examined in this paper that relate to SAB surveillance include detection, the management of duplicates, classification and acquisition of SAB. Upon reviewing the literature, it was clear that the national Australian SAB surveillance definitions developed by the ACSQHC Healthcare Associated Infection Surveillance Committee are consistent with the majority of literature. Where inconsistencies exist, for example the lack of acquisition information in SAB surveillance programs in the United Kingdom, it is clear that the Australian surveillance definitions are more robust and provide more useful information. The national surveillance definitions for SAB developed by the ACSQHC surveillance committee sets an improved standard for other countries.
Item A Major Reduction in Hospital-Onset Staphylococcus Aureus Bacteremia in Australia - 12 Years of Progress: An Observational Study(2014-10-01) Wells, Anne; Wilkinson, Irene; McCann, Rebecca; Collignon, Peter; Mitchell, Brett G.Background. Staphylococcus aureus bacteremia (SAB) is a serious cause of morbidity and mortality. This longitudinal study describes significant reductions in hospital-onset SAB (HO-SAB) in Australian hospitals over the past 12 years.
Methods. An observational cohort study design was used. Prospective surveillance of HO-SAB in 132 hospitals in Australia was undertaken. Aggregated data from all patients who acquired HO-SAB was collected (defined as 1 or more blood cultures positive for S. aureus taken from a patient who had been admitted to hospital for >48 hours). The primary outcome was the incidence of HO-SAB, including both methicillin-resistant (MRSA) and methicillin susceptible (MSSA) S. aureus strains.
Results. A total of 2733 HO-SAB cases were identified over the study period, giving an aggregate incidence of 0.90 per 10 000 patient-days (PDs) (95% confidence interval [CI], .86–.93). There was a 63% decrease in the annual incidence, from 1.72 per 10 000 PDs in 2002 (95% CI, 1.50–1.97) to 0.64 per 10 000 PDs (95% CI, .53–.76) in 2013. The mean reduction per year was 9.4% (95% CI, −8.1% to −10.7%). Significant reductions in both HO-MRSA (from 0.77 to 0.18 per 10 000 PDs) and HO-MSSA (from 1.71 to 0.64 per 10 000 PDs) bacteremia were observed.
Conclusions. There was a major and significant reduction in incidence of HO-SAB caused by both MRSA and MSSA in Australian hospitals since 2002. This reduction coincided with a range of infection prevention and control activities implemented during this time. It suggests that national and local efforts to reduce the burden of healthcare associated infections have been very successful.
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 Model for Influences on Reliable and Valid Health Care-Associated Infection Data(2014-02-01) Gardner, Anne; Mitchell, Brett G.Reliable surveillance data and continuous monitoring can provide useful information for clinicians and patients alike, by identifying areas needing improvement and demonstrating the effectiveness of interventions. Improving the rigor of health care-associated infection surveillance makes it possible to provide more valid and reliable information. We propose a model that can be used by infection control preventionists, researchers, and health planners and can serve as a trigger for understanding the influences on reliable and valid care-associated infection data.
preventionists, researchers, and health planners and can serve as a trigger for u
Item A Point Prevalence Cross-Sectional Study of Healthcare-Associated Urinary Tract Infections in Six Australian Hospitals(2014-07-29) Fasugba, Oyebola; Beckingham, Wendy; Mitchell, Brett G.; Gardner, AnneObjectives: Urinary tract infections (UTIs) account for over 30% of healthcare-associated infections. The aim of this study was to determine healthcare-associated UTI (HAUTI) and catheter-associated UTI (CAUTI) point prevalence in six Australian hospitals to inform a national point prevalence process and compare two internationally accepted HAUTI definitions. We also described the level and comprehensiveness of clinical record documentation, microbiology laboratory and coding data at identifying HAUTIs and CAUTIs.
Setting: Data were collected from three public and three private Australian hospitals over the first 6 months of 2013.
Participants A total of 1109 patients were surveyed. Records of patients of all ages, hospitalised on the day of the point prevalence at the study sites, were eligible for inclusion. Outpatients, patients in adult mental health units, patients categorised as maintenance care type (ie, patients waiting to be transferred to a long-term care facility) and those in the emergency department during the duration of the survey were excluded.
Outcome measures: The primary outcome measures were the HAUTI and CAUTI point prevalence.
Results: Overall HAUTI and CAUTI prevalence was 1.4% (15/1109) and 0.9% (10/1109), respectively. Staphylococcus aureus and Candida species were the most common pathogens. One-quarter (26.3%) of patients had a urinary catheter and fewer than half had appropriate documentation. Eight of the 15 patients ascertained to have a HAUTI based on clinical records (6 being CAUTI) were coded by the medical records department with an International Classification of Diseases (ICD)-10 code for UTI diagnosis. The Health Protection Agency Surveillance definition had a positive predictive value of 91.67% (CI 64.61 to 98.51) compared against the Centers for Disease Control and Prevention definition.
Conclusions: These study results provide a foundation for a national Australian point prevalence study and inform the development and implementation of targeted healthcare-associated infection surveillance more broadly.
Item A Point Prevalence Study of Healthcare Associated Urinary Tract Infections in Australian Acute and Aged Care Faciltiies(2016-11-01) Gardner, Anne; Bennett, Noleen; Beckingham, Wendy; Fasugba, Oyebola; Mitchell, Brett G.Most healthcare-associated urinary tract infections (HAUTIs) including catheter associated urinary tract infections (CAUTIs) are potentially preventable through implementation of effective strategies. To provide the foundation for a national point prevalence study of HAUTIs including CAUTIs, a three phase project was developed. This study reports the findings of Phase II which aimed to (1) pilot an online process including online database for conducting point prevalence survey of HAUTIs and CAUTIs and (2) determine the point prevalence of HAUTIs and CAUTIs in acute and aged care facilities
Item A Point Prevalence Study of Healthcare Associated Urinary Tract Infections in Australian Acute and Aged Care Facilities(2016-05-01) Gardner, Anne; Bennett, Noleen; Beckingham, Wendy; Fasugba, Oyebola; Mitchell, Brett G.Objectives: Surveillance of healthcare associated urinary tract infections (HAUTIs) in Australian acute and aged care facilities is lacking. Therefore, to provide the foundation for a national point prevalence study of HAUTIs and catheter associated urinary tract infection (CAUTIs), a three phase project was developed with recent completion of the second phase. The objectives of Phase II were to (1) develop a website incorporating tools for conducting point prevalence of HAUTIs and CAUTIs, (2) pilot an online process and database for conducting point prevalence of HAUTIs and CAUTIs and (3) determine the point prevalence of HAUTIs and CAUTIs in acute and aged care facilities. This paper reports on the third objective.
Methods: Point prevalence of HAUTIs and CAUTIs were assessed in 82 acute care and 17 aged care facilities within four Australian jurisdictions using an online survey.
Results: The study included 1320 patients and 663 residents from acute and aged care facilities respectively. HAUTI prevalence was 1.4% (95% CI 0.8e2.2%) in acute care and 1.5% (95% CI 0.8 e2.6%) in aged care. Catheter use in acute care (9.3%) was three times greater than aged care (3.3%).
Conclusion: Given the relative frequency with which HAUTI occurs, associations with addition length of stay in hospital and risk of systemic sepsis from these infections, efforts should be made to further minimise HAUTI prevalence. There is also a need to develop targeted interventions for catheter use especially in acute care because inappropriate and/or excessive catheter use has implications for the risk of CAUTIs and adds consumable costs.
Item A Point Prevalence Study of Healthcare Associated Urinary Tract Infections in Australian Acute and Aged Care Facilities: Results of the STRUTI Project(2016-03-01) Gardner, Anne; Bennett, Noleen; Mitchell, Brett G.; Koerner, Jane; Beckingham, Wendy; Fasugba, OyebolaMost healthcare-associated urinary tract infections (HAUTIs) including catheter associated urinary tract infections (CAUTIs) are potentially preventable through implementation of effective strategies. To provide the foundation for a national point prevalence study of HAUTIs including CAUTIs, a three phase project was developed. This study reports the findings of Phase II which aimed to (1) pilot an online process including online database for conducting point prevalence survey of HAUTIs and CAUTIs and (2) determine the point prevalence of HAUTIs and CAUTIs in acute and aged care facilities.
Item A Predictive Model of Days from Infection to Discharge in Patients with Healthcare Associated Urinary Tract Infections (HAUTI): A Structural Equation Modelling Approach(2017-11-01) Ferguson, John K.; Anderson, Malcolm; Mitchell, Brett G.Background
Length of stay (LOS) in hospital is an important component of describing how costs change in relation to healthcare-associated infection and this variable underpins models used to evaluate cost. It this therefore imperative that estimations of LOS associated with infections are performed accurately.
Aim
To test the relationships between the size of hospital, age, and patient comorbidity on days from admission to infection and days from infection to discharge in patients with a healthcare-associated urinary tract infection (HAUTI), using structural equation modelling (SEM).
Methods
A non-current cohort study in eight hospitals in New South Wales, Australia. All patients admitted to the hospital for >48 h and who acquired a HAUTI were included.
Findings
From the 162,503 eligible patient admissions, 2821 (1.73%) acquired a HAUTI. SEM showed that the proposed model had acceptable fit indices for the combined sample (GFI = 1.00; AGFI = 1.00; NFI = 1.00; CFI = 1.00; RMSEA = 0.000). The main findings showed that age of patient had a direct association with days from admission to infection and with days from infection to discharge. Patient comorbidity had direct links to the variables days from admission to infection and days from infection to discharge. Multi-group analysis indicated that the age of male patients was more influential on the factor days from admission to infection when compared to female patients. Furthermore, the number of comorbidities was significantly more influential on days from admission to infection in male patients than in female patients.
Conclusion
As the first published study to use SEM to explore a healthcare-associated infection and the predictors of days from infection to discharge in hospital, we can confirm that accounting for the timing of infection during hospitalization is important and that patient comorbidity influences the timing of infection.
Item A Strategy for the Prevention and Control of Healthcare Associated Infection in Tasmania 2013-2015(2013-12-01) McGregor, Alistair; Wilson, Fiona; Wells, Anne; Mitchell, Brett G.Healthcare associated infections continue to cause substantial patient morbidity and costs to health services. This document to reduce the incidence of these infections in Tasmania by developing a high quality, consistent infection prevention and control strategy across the state. In the past few years, Tasmania has been actively engaged in prevention through the work of the Australian Commission on Safety and Quality in Healthcare (ACSQHC). This strategy complements and supports the work of the ACSQHC, as well as National Safety and Quality Standards for Healthcare Services. The strategy outlines the overarching objectives for HAI prevention in the coming years. Specific aims for the TIPCU and the THOs are subsequently detailed.
Item Achievements and Highlights for Infection, Disease and Health(2019-02-01) Mitchell, Brett G.Item Air Purifiers for Reducing the Incidence of Acute Respiratory Infections in Australian Residential Aged Care Facilities: A Study Protocol for a Randomised Control Trial(2023-08-01) Mitchell, Brett G.; McDonald, Vanessa; McDonagh, Julee; Sim, Jenny; Adbul Khadar, BismiIntroduction
Adults living in Residential Aged Care Facilities (RACFs) are highly susceptible to seasonal respiratory infections. Evidence indicates that the aerosols contaminated with virus particles in closed indoor spaces may play a significant role in the transmission of respiratory infections. In this protocol paper, we outline details of a planned RCT which aims to evaluate the effectiveness of portable in room air purifiers in reducing the risk of ARIs among residents in Australian RACFs.
This study uses a multi-centre double-blind randomised crossover design. Three RACFs in a regional area of New South Wales will be invited to participate in the study. Air purifiers with or without high-efficiency particulate absorbing (HEPA) filters will be placed in the rooms of residents who are enrolled in the trial. The primary outcome will be a reduction in the incidence of ARI and the secondary outcomes will be the time to first infection, number of emergency department admissions, hospital admissions, and medical consultations due to an ARI.
Conclusion
To our knowledge, this will be the first RCT using air purifiers in resident rooms to identify their effect in reducing ARIs in RACFs. If our findings indicate some potential benefit for in-room air purification, it will help provide support and justification for larger trials, which may include a facility wide approach to air purification.
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 An Increase in Community Onset Clostridium difficile Infection: A Population Based Study, Tasmania, Australia(2012-12-01) McGregor, Alistair; Wilson, Fiona; Mitchell, Brett G.Background: In early 2012, the Tasmanian Infection Prevention and Control Unit identified a 53% increase in the number of cases of Clostridium difficile infection (CDI) identified in Tasmanian public hospitals. To understand this issue further, we undertook a population-based study. The aim of this research was to examine the epidemiology of CDI in Tasmania, with an overarching objective of understanding whether the increase seen in late 2011 was isolated to hospitals or represented a wider phenomenon.
Methods: A population-based study design was used. All cases of laboratory diagnosed CDI that occurred during 2010 and 2011 in Tasmania were identified. Association of the cases with healthcare were determined using national and international CDI surveillance definitions.
Results: A total of 459 cases of CDI from 438 individuals were identified. The incidence of CDI for the study period was 45 per 100 000 persons per year, 95% CI [41–49]. The relative risk (RR) of CDI was significantly higher in females, compared with males, RR 1.27, P = 0.01, 95% CI [1.06–1.54]. We estimate that the incidence of community associated CDI increased from 10 per 100 000 population in 2010, 95% CI [7.5–13.2] to 17 per 100 000 population in 2011 95% CI [14–21.5].
Conclusion: Tasmania experienced a sudden and substantial increase in the number of CDI cases in late 2011. This was most likely linked to transmission and infection pathways in the community, not inside hospitals. This hypothesis requires further testing on a larger scale.
Item Answers Linked to Mitchell BG, Dancer SJ, Anderson A, Dehn E. Risk of Organism Acquisition from Prior Room Occupants: A Systematic Review and Meta-analysis(2016-04-01) Dehn, Emily; Anderson, Malcolm; Dancer, Stephanie; Mitchell, Brett G.Item Antimicrobial Resistance Among Urinary Tract Infection Isolates of Escheria Coli in an Australian Population-Based Sample(2014-08-01) Mitchell, Brett G.; Mnatzaganian, George; Gardner, Anne; Fasugba, OyebolaItem Antimicrobial Resistance Patterns of Urinary Escheria Coli at an Australian Tertiary Hospital(2015-11-01) Gardner, Anne; Mnatzaganian, George; Mitchell, Brett G.; Fasugba, Oyebola