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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    Development and Trial of An Environmental Cleaning Assessment Program
    (2013-10-01) Wells, Anne; Wilson, Fiona; Mitchell, Brett G.

    Background: The Tasmanian Infection Prevention and Control Unit (TIPCU) reviewed methods of evaluating environmental cleanliness in healthcare in July 2012. At a subsequent State wide multidisciplinary forum, there was consensus for the TIPCU to develop a standardised method of assessing environmental cleanliness within Tasmanian healthcare using a combination of both visual and ultraviolet (UV) gel applicator assessments.

    Methods: The TIPCU developed a protocol outlining methodology for performing both visual and UV gel cleanliness assessments. An on-line tool was used to develop secure web based data collection and reporting. We developed a training program which could be used for face to face or web based education and provided training of key personnel across the Tasmanian Health Organisations (THOs) in the use of the environmental cleaning assessment tools and accompanying data collection and reporting tools. The sites were provided with IPads for data entry, UV sensitive gel and UV lights for a 6 week trial and consultation period. We sought feedback from participants via an on-line survey.

    Results: A trial period to test the programs functionality was held in the four Tasmanian larger acute public hospitals during April and May 2013. Over 80% of respondents were positive about the protocol, on-line tools and training. On qualitative feedback, the major themes that emerged were around the number of UV gel sites and the limitations in using the UV gel in some specialist areas. We have addressed each of these in the revised protocol.

    Conclusion: The consultation phase of this project highlighted a number of modifications that were required in the protocol and on-line tools and was an important phase that allowed us to evaluate aspects of the program prior to finalisation of the protocol and tools.

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    TIPCU Engagement Program in Rural Hospitals and Non-Acute Settings
    (2013-01-01) Mitchell, Brett G.; Wilson, Fiona; Wells, Anne

    Introduction: In 2012 the Tasmanian Infection Prevention and Control Unit (TIPCU) implemented an Infection Control Assessment (ICA) program in rural hospitals and non-acute settings (RHANAS). The three main aims of the ICA program are:

    1. Build clinician capacity in RHANAS
    2. Have the ability to assess and manage infection control risks
    3. Foster local ownership of infection prevention and control by individual service providers and clinicians.

    The project implementation and evaluation is ongoing.

    Methods: The ICA consists of a range of location and process specific audits, designed specifically for RHANS. Each rural hospital in Tasmania participated in the ICA program during 2012. The program was undertaken collaboratively by a TIPCU CNC, regional infection prevention and control clinical nurse educator and either the DON of the hospital or a designated representative. The majority of the assessments were done on site at each rural hospital in conjunction with a short education program which was tailored on requests from each facility.

    Results: Consistent themes emerged from the results of each rural hospital ICA. These included the following set of challenges relating to infection prevention and control:

    • No management plan including no regular or structured auditing program
    • No consistent orientation messages
    • Limited direction for site portfolio holders
    • Limited or no healthcare associated infection surveillance programs
    • No ongoing education for staff
    • Outdated policies and procedures

    Conclusion: The TIPCU in conjunction with the regional Tasmanian Health Organisations (THO) are working collaboratively to address the challenges identified by the ICA program. The TIPCU have produced a template for an infection prevention and control management plan, a portfolio position description and tools for undertaking surveillance in RHANS. The additional challenges identified by the ICA are being addressed at the local THO level.

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    The Hospital Environment as a Source of Resistant Gram Negatives
    (2013-01-01) Mitchell, Brett G.

    Presented at the ASID Gram Negative 'Superbugs' Meeting, 2-3 Aug. 2013.

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    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.

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    The Role of Chlorhexidine in Reducing Catheter Associated Urinary Tract Infection: A Randomised Controlled Study
    (2018-11-20) Gregory, Victoria; Graves, Nicholas; Collignon, Peter; Koerner, Jane; Gardner, Anne; Fasugba, Oyebola; Cheng, Allen; Mitchell, Brett G.

    Introduction: The evidence on which solution to use for meatal cleaning, prior to urinary catheter insertion is mixed. There are conflicting recommendations in international guidelines and in clinical practice, which reflect this uncertainty. The aim of this study was to evaluate the effectiveness of using chlorhexidine in meatal cleaning prior to catheter insertion, in reducing catheter-associated asymptomatic bacteriuria (CA-ASB) and CAUTI.

    Methods: A stepped wedge randomised controlled clinical trial was undertaken in three Australian hospitals. The intervention was the use of chlorhexidine (0.1%) solution, compared to normal saline (0.9%) for meatal cleaning prior to catheter insertion. The number of CA-ASB and CAUTI were analysed using Poisson regression, with no intervention delay on the outcome. The stepped wedge design allows hospitals to act as their own control.

    Results: 1642 catheters were inserted over the study period (697 control, 945 intervention). The mean age of participants was 62 years, 57% were female. Following the introduction of the intervention, the incidence of CAUTI reduced by 94%, IRR 0.06 (95%CI 0.01-0.32). Similarly, there was a 72% reduction in CA-ASB (IRR 0.28, 95%CI 0.08-0.93).

    Conclusion: The use of chlorhexidine was associated with a decrease in both bacteriuria and CAUTI. This decrease was identified at all sites, with no CAUTI observed in the post-intervention period in two of the three study sites. The study findings will have implications for recommendation in national guidelines, hospital policy and clinical practice.

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    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, Oyebola

    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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    The Impact of Urinary Tract Infections in an Australian Setting: A Multi-State Model
    (2016-04-01) Barnett, Adrian G.; Sear, Jacqueline; Anderson, Malcolm; Ferguson, John K.; Mitchell, Brett G.

    The emergence of antimicrobial resistance is of particular concern with respect to urinary tract infections, since the majority of causative agents are Gram negative bacteria. Healthcare-associated urinary tract infections (HAUTIs) are frequently associated with instrumentation of the urinary tract, specifically within dwelling catheters.