The Prolongation of Length of Stay Because of Clostridium Difficile Infection

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avondale-bepress-to-dspace.facultyNursing
avondale-bepress-to-dspace.peer_review_statusPeer reviewed before publication
avondale-bepress.abstract<p><h4 id="x-x-x-x-x-x-x-x-x-x-absSec_1">Background</h4> <p id="x-x-x-x-x-x-x-x-x-x-abspara0010"><em>Clostridium difficile</em> infection (CDI) possibly extends hospital length of stay (LOS); however, the current evidence does not account for the time-dependent bias, ie, when infection is incorrectly analyzed as a baseline covariate. The aim of this study was to determine whether CDI increases LOS after managing this bias. <h4 id="x-x-x-x-x-x-x-x-x-x-absSec_2">Methods</h4> <p id="x-x-x-x-x-x-x-x-x-x-abspara0015">We examined the estimated extra LOS because of CDI using a multistate model. Data from all persons hospitalized >48 hours over 4 years in a tertiary hospital in Australia were analyzed. Persons with health care-associated CDIs were identified. Cox proportional hazards models were applied together with multistate modeling. <h4 id="x-x-x-x-x-x-x-x-x-x-absSec_3">Results</h4> <p id="x-x-x-x-x-x-x-x-x-x-abspara0020">One hundred fifty-eight of 58,942 admissions examined had CDI. The mean extra LOS because of infection was 0.9 days (95% confidence interval: −1.8 to 3.6 days, <em>P</em> = .51) when a multistate model was applied. The hazard of discharge was lower in persons who had CDI (adjusted hazard ratio, 0.42; <em>P</em> < .001) when a Cox proportional hazard model was applied. <h4 id="x-x-x-x-x-x-x-x-x-x-absSec_4">Conclusion</h4> <p id="x-x-x-x-x-x-x-x-x-x-abspara0025">This study is the first to use multistate models to determine the extra LOS because of CDI. Results suggest CDI does not significantly contribute to hospital LOS, contradicting findings published elsewhere. Conversely, when methods prone to result in time-dependent bias were applied to the data, the hazard of discharge significantly increased. These findings contribute to discussion on methods used to evaluate LOS and health care-associated infections.</p>
avondale-bepress.articleid1034
avondale-bepress.authorsBrett G Mitchell
avondale-bepress.authorsAnne Gardner
avondale-bepress.authorsAdrian G Barnett
avondale-bepress.authorsJanet Hiller
avondale-bepress.authorsNicholas Graves
avondale-bepress.context-key4898129
avondale-bepress.coverpage-urlhttps://research.avondale.edu.au/nh_papers/33
avondale-bepress.document-typearticle
avondale-bepress.field.author_faculty_disciplineNursing
avondale-bepress.field.comments<p>Due to copyright restrictions this article is unavailable for download.</p> <p>Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier, Inc. All rights reserved.</p> <p>Staff and Students of Avondale College may access this article from library PRIMO search <a href="http://www.avondale.edu.au/library">here.</a></p>
avondale-bepress.field.custom_citation<p>Mitchell, B., Gardner, A., Barnett, A., Hiller, J., & Graves, N. (2014). The prolongation of length of stay because of <em>Clostridium difficile</em> infection.<em> American Journal of Infection Control, 42</em>(2), 164-167. doi:10.1016/j.ajic.2013.07.006</p>
avondale-bepress.field.doihttps://doi.org/10.1016/j.ajic.2013.07.006
avondale-bepress.field.email_boxtrue
avondale-bepress.field.embargo_date2013-12-08T00:00:00Z
avondale-bepress.field.field_of_education06 Health
avondale-bepress.field.for110309 Infectious Diseases
avondale-bepress.field.issn0196-6553
avondale-bepress.field.issue_number2
avondale-bepress.field.journalAmerican Journal of Infection Control
avondale-bepress.field.page_numbers164-167
avondale-bepress.field.peer_reviewBefore publication
avondale-bepress.field.publication_date2014-02-01T00:00:00Z
avondale-bepress.field.reportable_itemsC1
avondale-bepress.field.research_centreLifestyle Research Centre
avondale-bepress.field.source_fulltext_urlhttps://doi.org/10.1016/j.ajic.2013.07.006
avondale-bepress.field.source_publication<p>This article was originally published as:</p> <p>Mitchell, B., Gardner, A., Barnett, A., Hiller, J., & Graves, N. (2014). The prolongation of length of stay because of <em>Clostridium difficile</em> infection.<em> American Journal of Infection Control, 42</em>(2), 164-167. doi: 10.1016/j.ajic.2013.07.006</p> <p>ISSN: 0196-6553</p>
avondale-bepress.field.staff_classificationPermanent
avondale-bepress.field.volume_number42
avondale-bepress.keywordsclostridium difficile
avondale-bepress.keywordslength of stay
avondale-bepress.keywordsmultistate model
avondale-bepress.keywordsinfection control
avondale-bepress.label33
avondale-bepress.publication-date2014-02-01T00:00:00Z
avondale-bepress.publication-titleNursing and Health Papers and Journal Articles
avondale-bepress.statepublished
avondale-bepress.submission-date2013-12-08T17:00:48Z
avondale-bepress.submission-pathnh_papers/33
avondale-bepress.titleThe Prolongation of Length of Stay Because of Clostridium Difficile Infection
avondale-bepress.typearticle
dc.contributor.authorGraves, Nicholas
dc.contributor.authorHiller, Janet
dc.contributor.authorBarnett, Adrian G.
dc.contributor.authorGardner, Anne
dc.contributor.authorMitchell, Brett G.
dc.date.accessioned2023-11-01T00:37:41Z
dc.date.available2023-11-01T00:37:41Z
dc.date.issued2014-02-01
dc.date.submitted2013-12-08T17:00:48Z
dc.description.abstract<p><h4 id="x-x-x-x-x-x-x-x-x-x-absSec_1">Background</h4> <p id="x-x-x-x-x-x-x-x-x-x-abspara0010"><em>Clostridium difficile</em> infection (CDI) possibly extends hospital length of stay (LOS); however, the current evidence does not account for the time-dependent bias, ie, when infection is incorrectly analyzed as a baseline covariate. The aim of this study was to determine whether CDI increases LOS after managing this bias. <h4 id="x-x-x-x-x-x-x-x-x-x-absSec_2">Methods</h4> <p id="x-x-x-x-x-x-x-x-x-x-abspara0015">We examined the estimated extra LOS because of CDI using a multistate model. Data from all persons hospitalized >48 hours over 4 years in a tertiary hospital in Australia were analyzed. Persons with health care-associated CDIs were identified. Cox proportional hazards models were applied together with multistate modeling. <h4 id="x-x-x-x-x-x-x-x-x-x-absSec_3">Results</h4> <p id="x-x-x-x-x-x-x-x-x-x-abspara0020">One hundred fifty-eight of 58,942 admissions examined had CDI. The mean extra LOS because of infection was 0.9 days (95% confidence interval: −1.8 to 3.6 days, <em>P</em> = .51) when a multistate model was applied. The hazard of discharge was lower in persons who had CDI (adjusted hazard ratio, 0.42; <em>P</em> < .001) when a Cox proportional hazard model was applied. <h4 id="x-x-x-x-x-x-x-x-x-x-absSec_4">Conclusion</h4> <p id="x-x-x-x-x-x-x-x-x-x-abspara0025">This study is the first to use multistate models to determine the extra LOS because of CDI. Results suggest CDI does not significantly contribute to hospital LOS, contradicting findings published elsewhere. Conversely, when methods prone to result in time-dependent bias were applied to the data, the hazard of discharge significantly increased. These findings contribute to discussion on methods used to evaluate LOS and health care-associated infections.</p>
dc.description.versionBefore publication
dc.identifier.citation<p>Mitchell, B., Gardner, A., Barnett, A., Hiller, J., & Graves, N. (2014). The prolongation of length of stay because of <em>Clostridium difficile</em> infection.<em> American Journal of Infection Control, 42</em>(2), 164-167. doi:10.1016/j.ajic.2013.07.006</p>
dc.identifier.doihttps://doi.org/10.1016/j.ajic.2013.07.006
dc.identifier.issn0196-6553
dc.identifier.urihttps://research.avondale.edu.au/handle/123456789/04898129
dc.language.isoen_us
dc.provenance<p>This article was originally published as:</p> <p>Mitchell, B., Gardner, A., Barnett, A., Hiller, J., & Graves, N. (2014). The prolongation of length of stay because of <em>Clostridium difficile</em> infection.<em> American Journal of Infection Control, 42</em>(2), 164-167. doi: 10.1016/j.ajic.2013.07.006</p> <p>ISSN: 0196-6553</p>
dc.rights<p>Due to copyright restrictions this article is unavailable for download.</p> <p>Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier, Inc. All rights reserved.</p> <p>Staff and Students of Avondale College may access this article from library PRIMO search <a href="http://www.avondale.edu.au/library">here.</a></p>
dc.subjectclostridium difficile
dc.subjectlength of stay
dc.subjectmultistate model
dc.subjectinfection control
dc.titleThe Prolongation of Length of Stay Because of Clostridium Difficile Infection
dc.typeJournal Article
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