Nursing & Health
Permanent URI for this collectionhttps://research.avondale.edu.au/handle/123456789/457
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Item Increasing Incidence of Clostridium difficile Infection, Australia, 2011-2012(2014-03-17) Riley, Thomas V.; Worth, Leon; Wilson, Fiona; Wilkinson, Irene; Tracey, Lauren; Smollen, Paul; Richards, Michael; Mitchell, Brett G.; Menzies, Andrea; McCann, Rebecca; Marquess, John; Kennedy, Karina; Hall, Lisa; Bull, Ann; Beckingham, Wendy; Armstrong, Paul; Slimings, ClaudiaObjectives: To report the quarterly incidence of hospital-identified Clostridium difficile infection (HI-CDI) in Australia, and to estimate the burden ascribed to hospital-associated (HA) and community-associated (CA) infections.
Design, setting and patients: Prospective surveillance of all cases of CDI diagnosed in hospital patients from 1 January 2011 to 31 December 2012 in 450 public hospitals in all Australian states and the Australian Capital Territory. All patients admitted to inpatient wards or units in acute public hospitals, including psychiatry, rehabilitation and aged care, were included, as well as those attending emergency departments and outpatient clinics.
Main outcome measures: Incidence of HI-CDI (primary outcome); proportion and incidence of HA-CDI and CA-CDI (secondary outcomes).
Results: The annual incidence of HI-CDI increased from 3.25/10 000 patient days (PD) in 2011 to 4.03/10 000 PD in 2012. Poisson regression modelling demonstrated a 29% increase (95% CI, 25% to 34%) per quarter between April and December 2011, with a peak of 4.49/10 000 PD in the October–December quarter. The incidence plateaued in January–March 2012 and then declined by 8% (95% CI, 11% to 5%) per quarter to 3.76/10 000 PD in July–September 2012, after which the rate rose again by 11% (95% CI, 4% to 19%) per quarter to 4.09/10 000 PD in October–December 2012. Trends were similar for HA-CDI and CA-CDI. A subgroup analysis determined that 26% of cases were CA-CDI.
Conclusions: A significant increase in both HA-CDI and CA-CDI identified through hospital surveillance occurred in Australia during 2011–2012. Studies are required to further characterise the epidemiology of CDI in Australia.
Item Mortality and Clostridium Difficile Infection in an Australian Setting(2013-10-01) Hiller, Janet; Gardner, Anne; Mitchell, Brett G.Aim: To quantify the risk of death associated with Clostridium difficile infection, in an Australian tertiary hospital. Background Two reviews examining Clostridium difficile infection and mortality indicate that Clostridium difficile infection is associated with increased mortality in hospitalized patients. Studies investigating the mortality of Clostridium difficile infection in settings outside of Europe and North America are required, so that the epidemiology of Clostridium difficile infection in these regions can be understood and appropriate prevention strategies made.
Design: An observational non-concurrent cohort study design was used.
Methods: Data from all persons who had (exposed) and a matched sample of persons who did not have Clostridium difficile infection, for the calendar years 2007-2010, were analysed. The risk of dying within 30, 60, 90 and 180 days was compared using the two groups. Kaplan-Meier survival analysis and conditional logistic regression models were applied to the data to examine time to death and mortality risk adjusted for comorbidities using the Charlson Comorbidity Index.
Results: One hundred and fifty-eight cases of infection were identified. A statistically significant difference in all-cause mortality was identified between exposed and non-exposed groups at 60 and 180 days. In a conditional regression model, mortality in the exposed group was significantly higher at 180 days.
Conclusion: In this Australian study, Clostridium difficile infection was associated with increased mortality. In doing so, it highlights the need for nurses to immediately instigate contact precautions for persons suspected of having Clostridium difficile infection and to facilitate a timely faecal collection for testing. Our findings support ongoing surveillance of Clostridium difficile infection and associated prevention and control activities.
Item Mortality and Clostridium Difficile Infection: A Review(2012-05-30) Gardner, Anne; Mitchell, Brett G.Abstract
Background: Clostridium difficile infection (CDI) is a common cause of diarrhoea in hospitalised patients. Around the world, the incidence and severity of CDI appears to be increasing, particularly in the northern hemisphere. The purpose of this integrative review was to investigate and describe mortality in hospitalised patients with CDI.
Methods: A search of the literature between 1 January 2005 and 30 April 2011 focusing on mortality and CDI in hospitalised patients was conducted using electronic databases. Papers were reviewed and analysed individually and themes were combined using integrative methods.
Results: All cause mortality at 30 days varied from 9% to 38%. Three studies report attributable mortality at 30 days, varying from 5.7% to 6.9%. In hospital mortality ranged from 8% to 37.2%
Conclusion: All cause 30 day mortality appeared to be high, with 15 studies indicating a mortality of 15% or greater. Findings support the notion that CDI is a serious infection and measures to prevent and control CDI are needed. Future studies investigating the mortality of CDI in settings outside of Europe and North America are needed. Similarly, future studies should include data on patient co-morbidities.
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 Complicating the Complicated(2018-06-07) Potter, Julie E.; Mitchell, Brett G.; Russo, Philip L.; Shaban, Ramon Z.Hospital-acquired complications data on urinary tract infections is unreliable, and could result in hospitals being incorrectly financially penalised.
Item Final Year Nursing Students: Infection Prevention and Control Knowledge Translation(2015-11-01) Mitchell, Brett G.Item Risk of Organism Acquisition From Prior Room Occupants: A Systematic Review and Meta-Analysis(2015-11-01) Dehn, Emily; Anderson, Malcolm; Dancer, Stephanie; Mitchell, Brett G.A systematic review and meta-analysis was conducted to determine the risk of pathogen acquisition for patients associated with prior room occupancy. The analysis was also broadened to examine any differences in acquisition risk between Gram-positive and Gram–negative organisms.
Item Paper Trails: Brett Mitchell on Infectious Diseases(2016-09-22) Mitchell, Brett G.Hospitals help sick people and there is evidence of infection control issues in hospitals which the discussion in this podcast examines.
Item Mycobacterial Infections Due to Contaminated Heater Cooler Units used in Cardiac Bypass: An Approach for Infection Control Practitioners(2016-12-01) Stuart, Rhonda; Johnson, Paul; Collignon, Peter; Mitchell, Brett G.; Stewardson, Andrew J.; Cheng, AllenMycobacterium chimaera infection in patients who have had cardiac bypass surgery has recently been associated with contamination of water in heater cooler units. Those responsible for infection prevention and control programs face the challenge of responding to this rare but potentially life-threatening and avoidable healthcare-associated infection. Infection control professionals need to be aware of this issue and take an active role in formulating hospital responses. Policies should be rational and appropriate to the level of risk, should minimise service disruption and costs, and recognise that evidence about risk mitigation measures is still emerging. This paper provides background information to the topic and proposes a risk management based approach to heater cooler units in hospitals that perform cardiac bypass surgery, so that infection control professionals can develop a local, tailored response.
Item Five-Year Antimicrobial Resistance Patterns of Urinary Escherichia Coli at an Australian Tertiary Hospital: Time Series Analyses of Prevalence Data(2016-10-06) Gardner, Anne; Collignon, Peter; Das, Anindita; Mnatzaganian, George; Mitchell, Brett G.; Fasugba, OyebolaThis study describes the antimicrobial resistance temporal trends and seasonal variation of Escherichia coli (E. coli) urinary tract infections (UTIs) over five years, from 2009 to 2013, and compares prevalence of resistance in hospital- and community-acquired E. coli UTI. A cross sectional study of E. coli UTIs from patients attending a tertiary referral hospital in Canberra, Australia was undertaken. Time series analysis was performed to illustrate resistance trends. Only the first positive E. coli UTI per patient per year was included in the analysis.
A total of 15,022 positive cultures from 8724 patients were identified. Results are based on 5333 first E. coli UTIs, from 4732 patients, of which 84.2% were community acquired. Five-year hospital and community resistance rates were highest for ampicillin (41.9%) and trimethoprim (20.7%). Resistance was lowest for meropenem (0.0%), nitrofurantoin (2.7%), piperacillin-tazobactam (2.9%) and ciprofloxacin (6.5%). Resistance to amoxycillin-clavulanate, cefazolin, gentamicin and piperacillin-tazobactam were significantly higher in hospital- compared to community-acquired UTIs (9.3% versus 6.2%; 15.4% versus 9.7%; 5.2% versus 3.7% and 5.2% versus 2.5%, respectively). Trend analysis showed significant increases in resistance over five years for amoxycillin-clavulanate, trimethoprim, ciprofloxacin, nitrofurantoin, trimethoprim-sulphamethoxazole, cefazolin, ceftriaxone and gentamicin (P