Nursing & Health

Permanent URI for this collectionhttps://research.avondale.edu.au/handle/123456789/457

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    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

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    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, Oyebola
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    Surveillance To Reduce Urinary Tract Infections: The STRUTI Project
    (2014-09-01) Bennett, Noleen; Beckingham, Wendy; Mitchell, Brett G.; Gardner, Anne; Fasugba, Oyebola

    Researchers and infection control experts at Australian Catholic University’s School of Nursing, Midwifery and Paramedicine; Avondale College for Higher Education; Canberra Hospital; and Victorian Healthcare Associated Infection Surveillance Coordinating Centre are working in partnership to develop a national surveillance system for HAUTIs using point prevalence survey.

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    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, Anne

    Objectives: 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.

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    Healthcare Associated Urinary Tract Infections: A Protocol for a National Point Prevalence Study
    (2014-03-01) Fasugba, Oyebola; Beckingham, Wendy; Gardner, Anne; Mitchell, Brett G.

    Background: Urinary tract infections account for ~30% of healthcare-associated infections reported by hospitals. Virtually all healthcare-associated urinary tract infections (HAUTIs) are caused by instrumentation of the urinary tract, creating an opportunity to prevent a large proportion of HAUTIs, including catheter-associated urinary tract infections (CAUTIs). In Australia, there is no specific national strategy and surveillance system in place to address HAUTIs or CAUTIs. To determine the need for prospective surveillance of HAUTIs, we propose undertaking a national point prevalence study. This paper describes the methods that could be used to undertake such a study.

    Methods: A cross-sectional point prevalence design is proposed. The population is all patients hospitalised overnight in Australian hospitals, with the sample to exclude outpatients and those in emergency departments. The proposed operational definition is that used by the Health Protection Agency. A standardised training package for data collectors is recommended with standardised data collection and analysis processes described. Individual patient consent should be waived.

    Discussion: Explanation of aspects of the proposed methods are provided, primarily based on findings from a pilot study that informed the development of the proposed protocol. This included development and delivery of training for data collectors and use of the Health Protection Agency HAUTI surveillance definition, rather than the Centers for Disease Control definition.

    Conclusion: Conducting a national point prevalence study on HAUTIs including CAUTIs will provide evidence that can be subsequently used to debate the cost effectiveness and value of prospective surveillance. By conducting a pilot study and critically evaluating that process, we have been able to propose a method that could be used for a single hospital or national study.

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    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, Allen
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    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.
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    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, Oyebola

    Background

    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.

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    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, Oyebola

    Background

    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.

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    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