Jul 062014
 
Related Articles

Hospitalization stay and costs attributable to Clostridium difficile infection: a critical review.

J Hosp Infect. 2014 May 17;

Authors: Gabriel L, Beriot-Mathiot A

Abstract
In most healthcare systems, third-party payers fund the costs for patients admitted to hospital for Clostridium difficile infection (CDI) whereas, for CDI cases arising as complications of hospitalization, not all related costs are refundable to the hospital. We therefore aimed to critically review and categorize hospital costs and length of hospital stay (LOS) attributable to Clostridium difficile infection and to investigate the economic burden associated with it. A comprehensive literature review selected papers describing the costs and LOS for hospitalized patients as outcomes of CDI, following the use of statistics to identify costs and LOS solely attributable to CDI. Twenty-four studies were selected. Estimated attributable costs, all ranges expressed in US dollars, were $6,774-$10,212 for CDI requiring admission, $2,992-$29,000 for hospital-acquired CDI, and $2,454-$12,850 where no categorization was made. The ranges for LOS values were 5-13.6, 2.7-21.3, and 2.8-17.9 days, respectively. The categorization of CDI attributable costs allows budget holders to anticipate the cost per CDI case, a perspective that should enrich the design of appropriate incentives for the various budget holders to invest in prevention so that CDI prevention is optimized globally.

PMID: 24996516 [PubMed - as supplied by publisher]

Link to Article at PubMed

Share


Jun 252014
 

National European guidelines for the prevention of Clostridium difficile infection: a systematic qualitative review.

J Hosp Infect. 2014 May 28;

Authors: Martin M, Zingg W, Knoll E, Wilson C, Dettenkofer M, the PROHIBIT study group

Abstract
BACKGROUND: Clostridium difficile is the most frequent infectious cause of nosocomial diarrhoea and a major topic in infection prevention.
AIM: To overview current national European guidelines for C. difficile infection (CDI) prevention and review the recommendations in respect of their evidence base and conformity to each other and the European Centre for Disease Control and Prevention (ECDC) guidance.
METHODS: In 34 European countries, the ECDC healthcare-associated infection (HCAI) surveillance National Contact Points and other HCAI experts (NCPs) were invited to complete an online questionnaire and to supply their guidelines. Guidelines not available in English, French or German were translated into English. For the qualitative analysis, a matrix with key measures based on the 2008 ECDC guidance was established. The review process was conducted independently by two reviewers.
RESULTS: All 34 NCPs responded to the questionnaire and supplied 15 guidelines in total. Six of 34 (18%) countries reported having used the ECDC guidance as a basis for the development or revision of their national guideline. There was wide variation in the scope and detailing. Only six of the documents and the ECDC guidance supplied a rating for the strength of recommendations. The rating systems varied in how the categories were defined. Furthermore, the stated strength for similar measures varied across different guidelines.
CONCLUSION: The ECDC guidance has not yet had a strong influence on the development or revision of national CDI prevention guidelines. One possible explanation for the variations is the necessity to adapt recommendations to national conditions. The use of internationally recognized instruments for the development of guidelines could help to improve their quality. Recommendations about monitoring or auditing the implementation would make them more useful.

PMID: 24957805 [PubMed - as supplied by publisher]

Link to Article at PubMed

Share


Jun 152014
 
Related Articles

Catheter-related bloodstream infection: burden of disease in a tertiary hospital.

J Hosp Infect. 2014 May 15;

Authors: Martínez-Morel HR, Sánchez-Payá J, Molina-Gómez MJ, García-Shimizu P, García Román V, Villanueva-Ruiz C, González-Hernández M, Nolasco-Bonmatí A

Abstract
BACKGROUND: Surveillance programmes have become the most effective tool for controlling catheter-related bloodstream infections (CRBSI). However, few studies have investigated programmes covering all hospital settings.
AIM: To describe the results of a control and prevention programme for CRBSI based on compliance with recommendations for insertion and maintenance, using annual burden of disease in a tertiary level hospital.
METHODS: A CRBSI control and prevention programme involving all hospital settings was implemented. The programme consisted of CRBSI surveillance, direct observation of insertion and maintenance of catheters to determine performance, and education for healthcare workers.
FINDINGS: In total, 2043 short-term catheters were inserted in 1546 patients for 18,570 catheter-days, and 279 long-term catheters were inserted in 243 patients for 40,440 catheter-days. The annual incidence density was 5.98 (first semester 6.40, second semester 5.64) CRBSI per 1000 catheter-days for short-term catheters, and 0.57 (first semester 0.66, second semester 0.43) CRBSI per 1000 catheter-days for long-term catheters. One hundred and forty insertion procedures were observed, with an average insertion time of 13 (standard deviation 7) min. Compliance with recommendations was as follows: hand hygiene, 86.8%; use of alcoholic chlorhexidine solution for skin disinfection, 35.5%; use of mask, 93.4%; use of gloves, 98.7%; use of gown, 75.0%; use of sterile cloth, 93.8%; use of cap, 92.2%; bandage application, 62.7%; and use of aseptic technique, 89.5%. Forty-five maintenance procedures were observed, and compliance rates were as follows: hand hygiene, 42.1%; use of gloves, 78.1%; and port disinfection with alcoholic chlorhexidine solution, 32.5%.
CONCLUSION: The CRBSI control and prevention programme implemented at the study hospital has decreased the rate of CRBSI, provided important information about the total burden of disease, and revealed possible ways to improve interventions in the future.

PMID: 24928788 [PubMed - as supplied by publisher]

Link to Article at PubMed

Share


Jun 152014
 
Related Articles

Implications of targeted versus universal admission screening for meticillin-resistant Staphylococcus aureus carriage in a London hospital.

J Hosp Infect. 2014 May 10;

Authors: Otter JA, Tosas-Auguet O, Herdman MT, Williams B, Tucker D, Edgeworth JD, French GL

Abstract
Universal admission screening for meticillin-resistant Staphylococcus aureus (MRSA) has been performed in England since 2010. We evaluated the predictive performance of a regression model derived from the first year of universal screening for detecting MRSA at hospital admission. If we had used our previous targeted screening policy, 75% fewer patients (21,699 per year) would have been screened. However, this would have identified only ∼55% of all MRSA carriers, 65% of healthcare-associated MRSA strains, and 40% of community-associated strains. Failing to identify ∼45% of patients (262 per year) carrying MRSA at hospital admission may have implications for MRSA control.

PMID: 24928784 [PubMed - as supplied by publisher]

Link to Article at PubMed

Share


Jun 152014
 
Related Articles

Outbreak of invasive group A streptococcus infection: contaminated patient curtains and cross-infection on an ear, nose and throat ward.

J Hosp Infect. 2014 May 10;

Authors: Mahida N, Beal A, Trigg D, Vaughan N, Boswell T

Abstract
BACKGROUND: Outbreaks of group A streptococcus (GAS) infections may occur in healthcare settings and have been documented in surgical, obstetrics and gynaecology, and burns units. The environment may serve as a reservoir and facilitate transmission via contaminated equipment.
AIM: To describe the investigation and control of an outbreak of healthcare-associated GAS infection on an ear, nose and throat (ENT) ward in a tertiary referral centre.
METHODS: Two patients with laryngeal cancer developed invasive GAS infection (bacteraemia) with associated tracheostomy wound cellulitis within a 48h period. The outbreak team undertook an investigation involving a retrospective review of GAS cases, prospective case finding, healthcare worker screening and sampling of patient curtains. Immediate control measures included source isolation, a thorough rolling clean with a chlorine-based disinfectant and hydrogen peroxide decontamination of patient equipment.
FINDINGS: Prospective patient screening identified one additional patient with carriage of GAS from a tracheostomy wound swab. Staff screening identified one healthcare worker who acquired GAS during the outbreak and who subsequently developed pharyngitis. Environmental sampling demonstrated that 10 out of 34 patient curtains on the ward were contaminated with GAS and all isolates were typed as emm-1.
CONCLUSION: This is the first outbreak report to demonstrate patient curtains as potential source for GAS cross-transmission, with implications in relation to hand hygiene and frequency of laundering. Based on this report we recommend that during an outbreak of GAS infection all patient curtains should be changed as part of the enhanced decontamination procedures.

PMID: 24928787 [PubMed - as supplied by publisher]

Link to Article at PubMed

Share


May 092014
 

No association between ultrasound-guided insertion of central venous catheters and bloodstream infection: a prospective observational study.

J Hosp Infect. 2014 Apr 13;

Authors: Cartier V, Haenny A, Inan C, Walder B, Zingg W

Abstract
BACKGROUND: Ultrasound guidance for the insertion of central venous catheters (CVCs) reduces mechanical complications and shortens insertion time, but its effect on CVC-associated bloodstream infection (CABSI) remains controversial.
AIM: To test the effect of ultrasound-guided CVC insertion on CABSI in a hospital-wide setting.
METHODS: A four-year prospective cohort study was conducted at a university-affiliated, tertiary care centre. All patients receiving a non-tunnelled CVC, inserted by an anaesthetist, were enrolled. Catheter surveillance was performed by trained infection control nurses and checked by an infection control doctor. The primary outcome was CABSI as defined by the US Centers for Disease Control and Prevention. The secondary outcome was all-cause mortality up to 28 days after CVC removal.
FINDINGS: In total, 2312 patients with 2483 CVCs were included and analysed. Ultrasound guidance was used for 844 CVC insertions (34.0%), with a significant increasing trend over the study period [incidence rate ratio 1.13, 95% confidence interval (CI) 01.11-1.15; P < 0.001]. Forty-seven CABSIs were identified, representing an overall incidence of 2.1 episodes per 1000 catheter-days. No association was detected between ultrasound guidance and CABSI (hazard ratio 0.69, 95% CI 0.36-1.30; P = 0.252). All-cause mortality was 11.0% (253/2312), with no significant trend and no association with ultrasound guidance.
CONCLUSION: Ultrasound guidance had no effect on CABSI or mortality. In a hospital-wide setting with baseline CABSI rates at the standard level currently found in high-income countries, the use of ultrasound has no additional benefit for the prevention of CABSI.

PMID: 24811115 [PubMed - as supplied by publisher]

Link to Article at PubMed

Share