Publications
60 results found
Vaillant L, Birgand G, Esposito-Farese M, et al., 2019, Awareness among French healthcare workers of the transmission of multidrug resistant organisms: a large cross-sectional survey, Antimicrobial Resistance and Infection Control, Vol: 8, ISSN: 2047-2994
BackgroundMuch effort has been made over the last two decades to educate and train healthcare professionals working on antimicrobial resistance in French hospitals. However, little has been done in France to assess perceptions, attitudes and knowledge regarding multidrug resistant organisms (MDROs) and, more globally, these have never been evaluated in a large-scale population of medical and non-medical healthcare workers (HCWs). Our aim was to explore awareness among HCWs by evaluating their knowledge of MDROs and the associated control measures, by comparing perceptions between professional categories and by studying the impact of training and health beliefs.MethodsA multicentre cross-sectional study was conducted in 58 randomly selected French healthcare facilities with questionnaires including professional and demographic characteristics, and knowledge and perception of MDRO transmission and control. A knowledge score was calculated and used in a logistic regression analysis to identify factors associated with higher knowledge of MDROs, and the association between knowledge and perception.ResultsBetween June 2014 and March 2016, 8716/11,753 (participation rate, 74%) questionnaires were completed. The mean knowledge score was 4.7/8 (SD: 1.3) and 3.6/8 (SD: 1.4) in medical and non-medical HCWs, respectively. Five variables were positively associated with higher knowledge: working in a university hospital (adjusted odds ratio, 1.41, 95% CI 1.16–1.70); age classes 26–35 years (1.43, 1.23–1.6) and 36–45 years (1.19, 1.01–1.40); medical professional status (3.7, 3.09–4.44), working in an intensive care unit (1.28, 1.06–1.55), and having been trained on control of antimicrobial resistance (1.31, 1.16–1.48). After adjustment for these variables, greater knowledge was significantly associated with four cognitive factors: perceived susceptibility, attitude toward hand hygiene, self-efficacy, and motivation.Conc
Ahmad R, Zhu NJ, Leather AJM, et al., 2019, Strengthening strategic management approaches to address antimicrobial resistance in global human health: a scoping review, BMJ Global Health, Vol: 4, ISSN: 2059-7908
Introduction: The development and implementation of national strategic plans is a critical component towards successfully addressing antimicrobial resistance (AMR). This study aimed to review the scope and analytical depth of situation analyses conducted to address AMR in human health to inform the development and implementation of national strategic plans. Methods: A systematic search of the literature was conducted to identify all studies since 2000, that have employed a situation analysis to address AMR. The included studies are analysed against frameworks for strategic analysis, primarily the PESTELI (Political, Economic, Sociological, Technological, Ecological, Legislative, Industry) framework, to understand the depth, scope and utility of current published approaches. Results: 10 studies were included in the final review ranging from single country (6) to regional-level multicountry studies (4). 8 studies carried out documentary review, and 3 of these also included stakeholder interviews. 2 studies were based on expert opinion with no data collection. No study employed the PESTELI framework. Most studies (9) included analysis of the political domain and 1 study included 6 domains of the framework. Technological and industry analyses is a notable gap. Facilitators and inhibitors within the political and legislative domains were the most frequently reported. No facilitators were reported in the economic or industry domains but featured inhibiting factors including: lack of ring-fenced funding for surveillance, perverse financial incentives, cost-shifting to patients; joint-stock drug company ownership complicating regulations. Conclusion: The PESTELI framework provides further opportunities to combat AMR using a systematic, strategic management approach, rather than a retrospective view. Future analysis of existing quantitative data with interviews of key strategic and operational stakeholders is needed to provide critical insights about where implementation eff
Troughton R, Mariano V, Campbell A, et al., 2019, Understanding determinants of infection control practices in surgery: the role of shared ownership and team hierarchy, Antimicrobial Resistance and Infection Control, Vol: 8, ISSN: 2047-2994
Background. Despite a large literature on surgical site infection (SSI), the determinants ofprevention behaviours in surgery remain poorly studied. Understanding key social andcontextual components of surgical staff behaviour may help to design and implementinfection control (IC) improvement interventions in surgery.Methods. Qualitative semi-structured interviews were conducted with surgeons (n = 8),nurses (n = 5) theatre personnel (n = 3), and other healthcare professionals involved in surgery(n=4) in a 1500-bed acute care London hospital group. Participants were approached throughestablished mailing lists and snowball sampling. Interviews were recorded and transcribedverbatim. Transcripts were coded and analysed thematically using a constant comparativeapproach.Results. IC behaviour of surgical staff was governed by factors at individual, team, and widerhospital level. IC practices were linked to the perceived risk of harm caused by an SSI morethan the development of an SSI alone. Many operating room participants saw SSI preventionas a team responsibility. The sense of ownership over SSI occurence was closely tied to howpreventable staff perceived infections to be, with differences observed between clean andcontaminated surgery. However, senior surgeons claimed personal accountability for ratesdespite feeling SSIs are often not preventable. Hierarchy impacted on behaviour in differentways depending on whether it was within or between professional categories. One particularknowledge gap highlighted was the lack of awareness regarding criteria for SSI diagnosis.Conclusions. To influence IC behaviours in surgery, interventions need to consider the socialteam structure and shared ownership of the clinical outcome in order to increase theawareness in specialties where SSIs are not seen as serious complications.
Azevedo-Coste C, Pissard-Gibollet R, Toupet G, et al., 2019, Tracking clinical staff behaviors in an operating room, Sensors, Vol: 19, ISSN: 1424-2818
Inadequate staff behaviors in an operating room (OR) may lead to environmental contamination and increase the risk of surgical site infection. In order to assess this statement objectively, we have developed an approach to analyze OR staff behaviors using a motion tracking system. The present article introduces a solution for the assessment of individual displacements in the OR by: (1) detecting human presence and quantifying movements using a motion capture (MOCAP) system and (2) observing doors’ movements by means of a wireless network of inertial sensors fixed on the doors and synchronized with the MOCAP system. The system was used in eight health care facilities sites during 30 cardiac and orthopedic surgery interventions. A total of 119 h of data were recorded and analyzed. Three hundred thirty four individual displacements were reconstructed. On average, only 10.6% individual positions could not be reconstructed and were considered undetermined, i.e., the presence in the room of the corresponding staff member could not be determined. The article presents the hardware and software developed together with the obtained reconstruction performances.
Birgand G, Azevedo C, Rukly S, et al., 2019, Motion-capture system to assess intraoperative staff movements and door openings: Impact on surrogates of the infectious risk in surgery, Infection Control & Hospital Epidemiology, Vol: 40, Pages: 566-573, ISSN: 0899-823X
Objectives:We longitudinally observed and assessed the impact of the operating room (OR) staff movements and door openings on surrogates of the exogenous infectious risk using a new technology system.Design and setting:This multicenter observational study included 13 ORs from 10 hospitals, performing planned cardiac and orthopedic surgery (total hip or knee replacement). Door openings during the surgical procedure were obtained from data collected by inertial sensors fixed on the doors. Intraoperative staff movements were captured by a network of 8 infrared cameras. For each surgical procedure, 3 microbiological air counts, longitudinal particles counts, and 1 bacteriological sample of the wound before skin closure were performed. Statistics were performed using a linear mixed model for longitudinal data.Results:We included 34 orthopedic and 25 cardiac procedures. The median frequency of door openings from incision to closure was independently associated with an increased log10 0.3 µm particle (ß, 0.03; standard deviation [SD], 0.01; P = .01) and air microbial count (ß, 0.07; SD, 0.03; P = .03) but was not significantly correlated with the wound contamination before closure (r = 0.13; P = .32). The number of persons (ß, −0.08; SD, 0.03; P < .01), and the cumulated movements by the surgical team (ß, 0.0004; SD, 0.0005; P < .01) were associated with log10 0.3 µm particle counts.Conclusions:This study has demonstrated a previously missing association between intraoperative staff movements and surrogates of the exogenous risk of surgical site infection. Restriction of staff movements and door openings should be considered for the control of the intraoperative exogenous infectious risk.
Hue R, Coroller-Bec C, Guilloteau V, et al., 2019, Highly drug-resistant bacteria: Is intra- and inter-hospital communication optimal?, Médecine et Maladies Infectieuses, ISSN: 0399-077X
Legeay C, Hue R, Berton C, et al., 2019, Control strategy for carbapenemase-producing Enterobacteriaceae in nursing homes: perspectives inspired from three outbreaks, Journal of Hospital Infection, Vol: 10, Pages: 183-187, ISSN: 0195-6701
Three outbreaks of carbapenemase-producing Enterobacteriaceae (CPE) in three nursing homes in western France were retrospectively assessed. In all, ten cases of colonization or infection with CPE were detected upon admission in neighbouring hospitals. Antibiotic consumption or high frailty was infrequent among them. Nursing homes should be included in a regional strategy to limit CPE spread.
Charani E, Smith I, Skodvin B, et al., 2019, Investigating the cultural and contextual determinants of antimicrobial stewardship programmes across low-, middle- and high-income countries – a qualitative study, PLoS ONE, Vol: 14, ISSN: 1932-6203
BackgroundMost of the evidence on antimicrobial stewardship programmes (ASP) to help sustain the effectiveness of antimicrobials is generated in high income countries. We report a study investigating implementation of ASP in secondary care across low-, middle- and high-income countries. The objective of this study was to map the key contextual, including cultural, drivers of the development and implementation of ASP across different resource settings.Materials and methodsHealthcare professionals responsible for implementing ASP in hospitals in England, France, Norway, India, and Burkina Faso were invited to participate in face-to face interviews. Field notes from observations, documentary evidence, and interview transcripts were analysed using grounded theory approach. The key emerging categories were analysed iteratively using constant comparison, initial coding, going back the field for further data collection, and focused coding. Theoretical sampling was applied until the categories were saturated. Cross-validation and triangulation of the findings were achieved through the multiple data sources.Results54 participants from 24 hospitals (England 9 participants/4 hospitals; Norway 13 participants/4 hospitals; France 9 participants/7 hospitals; India 13 participants/ 7 hospitals; Burkina Faso 8 participants/2 hospitals) were interviewed. Across Norway, France and England there was consistency in ASP structures. In India and Burkina Faso there were country level heterogeneity in ASP. State support for ASP was perceived as essential in countries where it is lacking (India, Burkina Faso), and where it was present, it was perceived as a barrier (England, France). Professional boundaries are one of the key cultural determinants dictating involvement in initiatives with doctors recognised as leaders in ASP. Nurse and pharmacist involvement was limited to England. The surgical specialty was identified as most difficult to engage with in each country. Despite challenges, on
Troughton R, Birgand G, Johnson AP, et al., 2018, Mapping national surveillance of surgical site infections (SSIs) to national needs and priorities: an assessment of England’s surveillance landscape, Journal of Hospital Infection, Vol: 100, Pages: 378-385, ISSN: 0195-6701
BackgroundThe rise in antimicrobial resistance has highlighted the importance of surgical site infection (SSI) prevention with effective surveillance strategies playing a key role in improving patient safety. This study maps national needs and priorities for SSI surveillance against current national surveillance activity.MethodsThis study analysed SSI surveillance in NHS hospitals in England covering 23 surgical procedures. Data collected were: (i) annual number of procedures, (ii) SSI rates from national reports, (iii) national reporting requirement (mandatory, voluntary, not offered), (iv) priority ranking from a survey of 84 English NHS hospitals, (v) excess length of stay and costs from the literature. The relationships between estimated SSI burden, national surveillance activity, and hospital-reported priorities were explored with descriptive and univariate analyses.FindingsAmong the 23 surgical categories analysed, top priority ranking by hospitals was associated only with current surveillance (r=0.76, p<0.01) and mandatory reporting (33% vs 8 and 4%, p=0.04). Percentage of hospitals undertaking surveillance, mandatory reporting, and the selection of priorities did not match SSI burden. Large bowel surgery (LBS, voluntary) and caesarean section (not offered) were the two highest contributors of total SSIs per annum, with 39,000 (38%) and 17,000 (16%) respectively, while the four orthopaedic categories (all mandatory) contributed 5,000 (5%). LBS also had the highest associated costs (£119m per annum).ConclusionCurrent surveillance and future priorities were not associated with SSI rate, volume, or cost to hospitals. The two highest contributors of SSIs and related costs have no (caesarean section) or limited (LBS) coverage by national surveillance.
Perozziello A, Routelous C, Charani E, et al., 2018, Experiences and perspectives of implementing antimicrobial stewardship in five French hospitals: a qualitative study, International Journal of Antimicrobial Agents, Vol: 51, Pages: 829-835, ISSN: 0924-8579
ObjectiveTo describe current antimicrobial stewardship program (ASP) in France, both at policy level and at local implementation level, and to assess how ASP leaders (ASPL) worked and prioritised their activities.MethodsWe conducted a qualitative study based on face-to-face semi-structured interviews with healthcare professionals responsible for ASP across five French hospitals. Five infectious disease specialists and one microbiologist were interviewed between April and June 2016.ResultsStewards had dedicated time to perform ASP activities in two university-affiliated hospitals while in the other hospitals (one university, one general and one semi-private), ASPLs had to balance these activities with clinical practice. Consequently, they had to adapt interventions according to their resources (IT or human). Responding to colleagues' consultation requests formed baseline work. Systematic and pro-active measures allowed for provision of unsolicited counselling, while direct counselling on wards required appropriate staffing. ASPL aimed at increasing clinicians' ability to prescribe adequately and awareness of the unintended consequences of inappropriate use of antibiotics. Thus, persuasive e.g. education measures were preferred to coercive ones. ASPL faced several challenges in implementing ASP: overcoming physicians' or units' reluctance, and balancing the influence of medical hierarchy and professional boundaries.ConclusionBeyond resources constraints, ASPLs' conceptions of their work, as well as contextual and cultural aspects, led them to adopt a persuasive and collaborative approach of counselling. This is the first qualitative study about ASP in France exploring stewards' experiences and points of view.
Birgand GJC, Mutters N, Ahmad R, et al., 2018, Infection control specialists' perception of antimicrobial resistance in European hospitals. The Percept-R study., ECCMID
Troughton R, Mariano V, Holmes A, et al., 2018, Understanding the determinants of infection control practices insurgery: The surgeon sets the tone, European Congress of Clinical Microbiology and Infectious Diseases
Birgand G, Castro-Sánchez E, Hansen S, et al., 2018, Comparison of governance approaches for the control of antimicrobial resistance: Analysis of three European countries, Antimicrobial Resistance and Infection Control, Vol: 7, ISSN: 2047-2994
Policy makers and governments are calling for coordination to address the crisis emerging from the ineffectiveness of current antibiotics and stagnated pipe-line of new ones - antimicrobial resistance (AMR). Wider contextual drivers and mechanisms are contributing to shifts in governance strategies in health care, but are national health system approaches aligned with strategies required to tackle antimicrobial resistance? This article provides an analysis of governance approaches within healthcare systems including: priority setting, performance monitoring and accountability for AMR prevention in three European countries: England, France and Germany. Advantages and unresolved issues from these different experiences are reported, concluding that mechanisms are needed to support partnerships between healthcare professionals and patients with democratized decision-making and accountability via collaboration. But along with this multi-stakeholder approach to governance, a balance between regulation and persuasion is needed.
Birgand GJC, Zahar JR, Lucet JC, 2018, Insight into the complex epidemiology of multidrug-resistant Enterobacteriacae, Clinical Infectious Diseases, Vol: 66, Pages: 494-496, ISSN: 1058-4838
Kardaś-Słoma L, Lucet J-C, Perozziello A, et al., 2017, Universal or targeted approach to prevent the transmission of extended-spectrum beta-lactamase-producing Enterobacteriaceae in intensive care units: a cost-effectiveness analysis, BMJ Open, Vol: 7, ISSN: 2044-6055
Objective Several control strategies have been used tolimit the transmission of multidrug-resistant organisms inhospitals. However, their implementation is expensive andeffectiveness of interventions for the control of extendedspectrumbeta-lactamase-producing Enterobacteriaceae(ESBL-PE) spread is controversial. Here, we aim to assessthe cost-effectiveness of hospital-based strategies to preventESBL-PE transmission and infections.Design Cost-effectiveness analysis based on dynamic,stochastic transmission model over a 1-year time horizon.Patients and setting Patients hospitalised in a hypothetical10-bed intensive care unit (ICU) in a high-income country.Interventions Base case scenario compared with (1)universal strategies (eg, improvement of hand hygiene (HH)among healthcare workers, antibiotic stewardship), (2)targeted strategies (eg, screening of patient for ESBL-PEat ICU admission and contact precautions or cohorting ofcarriers) and (3) mixed strategies (eg, targeted approachescombined with antibiotic stewardship).Main outcomes and measures Cases of ESBL-PEtransmission, infections, cost of intervention, cost ofinfections, incremental cost per infection avoided.Results In the base case scenario, 15 transmissions and fiveinfections due to ESBL-PE occurred per 100 ICU admissions,representing a mean cost of €94 792. All control strategiesimproved health outcomes and reduced costs associated withESBL-PE infections. The overall costs (cost of intervention andinfections) were the lowest for HH compliance improvementfrom 55%/60% before/after contact with a patient to80%/80%.Conclusions Improved compliance with HH was the mostcost-saving strategy to prevent the transmission of ESBLPE.Antibiotic stewardship was not cost-effective. However,adding antibiotic restriction strategy to HH or screening andcohorting strategies slightly improved their effectiveness andmay be worthy of consideration by decision-makers
Birgand GJC, Troughton R, Moore L, et al., 2017, Blogging in infectious diseases and clinical microbiology: Assessment of the 'blogosphere' content, Infection Control and Hospital Epidemiology, Vol: 38, Pages: 832-839, ISSN: 1559-6834
Objective.To analyzeinfluential infectious diseases, antimicrobial stewardship, infection control, or medical microbiology blogs and bloggers.Setting. World Wide WebDesign. We conducted a systematic search for blogs in accordance with the PRISMA guidelines in September 2015.Methods.A snowball sampling approach was applied to identify blogs using various search engines. Blogs were eligible if they: 1) focused on infectious diseases (ID), antimicrobial stewardship (AMS), infection control (IC), or medical microbiology (MM); 2) were intended for health professionals, 3) were written in English and updated regularly. We mapped blogs/bloggers characteristics and used an innovative tool to assess their architecture and content. Motivations and perceptions of bloggers and readers were assessed. Results.A total of 88 blogs were identified. 28 (32%) focused on ID, 46 (52%) on MM and 14 (16%) in IC or AMS. Bloggers were mainly male, MD and/or PhD, 32 (36%) posted at least weekly, and 51 (58%) for a research purpose. The aims were considered clear for 23 (26%) blogs, the field covered was broad for 25 (28%), presentation was good for 22 (25%), 51 were easy to read (58%) and 46 included expert interpretation (52%). Among the top 10 blogs (2 equally-ranked), 3 focused on ID, 6 on MM and 2 on IC. Bloggers questioned were motivated by sharing independent expertise/opinion. Readers appreciated the concise messages given on scientific and practical updates.Conclusions.This study describes high level blogs in ID/IC/MM suggesting how bloggers should build/orientate blogs for readers, and highlighting current gaps in topics such as AMS.
Birgand GJC, 2017, Les indicateurs à diffusion publique au Royaume-Uni, Congrès de la société francaise d'hygiène hospitalière SF2H
Birgand GJC, 2017, The year in Infection Control, ASM Microbe
Birgand GJC, 2017, Impact du comportement sur le risque infectieux au bloc opératoire, Journée nationale du réseau ISO RAISIN
Charani E, Ahmad R, Tarrant C, et al., 2017, Opportunities for system level improvement in antibiotic use across the surgical pathway, International Journal of Infectious Diseases, Vol: 60, Pages: 29-34, ISSN: 1201-9712
Optimizing antibiotic prescribing across the surgical pathway (before, during, and after surgery) is a key aspect of tackling important drivers of antimicrobial resistance and simultaneously decreasing the burden of infection at the global level. In the UK alone, 10 million patients undergo surgery every year, which is equivalent to 60% of the annual hospital admissions having a surgical intervention. The overwhelming majority of surgical procedures require effectively limited delivery of antibiotic prophylaxis to prevent infections. Evidence from around the world indicates that antibiotics for surgical prophylaxis are administered ineffectively, or are extended for an inappropriate duration of time postoperatively. Ineffective antibiotic prophylaxis can contribute to the development of surgical site infections (SSIs), which represent a significant global burden of disease. The World Health Organization estimates SSI rates of up to 50% in postoperative surgical patients (depending on the type of surgery), with a particular problem in low- and middle-income countries, where SSIs are the most frequently reported healthcare-associated infections. Across European hospitals, SSIs alone comprise 19.6% of all healthcare-acquired infections. Much of the scientific research in infection management in surgery is related to infection prevention and control in the operating room, surgical prophylaxis, and the management of SSIs, with many studies focusing on infection within the 30-day postoperative period. However it is important to note that SSIs represent only one of the many types of infection that can occur postoperatively. This article provides an overview of the surgical pathway and considers infection management and antibiotic prescribing at each step of the pathway. The aim was to identify the implications for research and opportunities for system improvement.
Birgand GJC, 2017, How to improve reliability in HAI surveillance? Local opportunities, European congress of microbiology and infectious diseases
Troughton R, Castro Sanchez EM, Birgand GJC, et al., 2017, Post-discharge surveillance of surgical site infections: is anyone getting it right?
Loison G, Troughton R, Raymond F, et al., 2017, Dress code and traffic flow in the operating room: A multicentre study of staff discipline during surgical procedures., Journal of Hospital Infection, Vol: 96, Pages: 281-285, ISSN: 0195-6701
This multi-centre study assessed operating room (OR) staff compliance with clothing regulations and traffic flow during surgical procedures. Of 1615 surgical attires audited, 56% respected the eight clothing measures. Lack of compliance was mainly due to inappropriate wearing of jewellery (26%) and head coverage (25%). In 212 procedures observed, a median of five people [interquartile range (IQR) 4–6] were present at the time of incision. The median frequency of entries to/exits from the OR was 10.6/h (IQR 6–29) (range 0–93). Reasons for entries to/exits from the OR were mainly to obtain materials required in the OR (N=364, 44.5%). ORs with low compliance with clothing regulations tended to have higher traffic flows, although the difference was not significant (P=0.12).
Iwami M, Ahmad R, Castro Sanchez E, et al., 2017, Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: a multi-level qualitative analysis., BMJ Open, Vol: 7, ISSN: 2044-6055
Objective: (1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice. Design: A national and local-level analysis of the 27 indicators was conducted. At the national level, documentary review of regulations/policies/guidelines was conducted. At the local level: a) documentary review of 14 hospitals to determine the capacity to report on performance; b) qualitative interviews with three senior managers from five hospitals and direct observation of hospital wards to identify gaps in use of these indicators to improve IPC management and practice.Setting: Two acute English National Health Service (NHS) trusts and one NHS foundation trust (14 hospitals).Participants: Three senior managers from five hospitals for qualitative interviews.Primary and secondary outcome measures: As primary outcome measures, a ‘Red-Amber-Green’ (RAG) rating was developed reflecting how well the indicators were included in national documents or their availability at local organisational level. The current use of the indicators to inform IPC management and practice was also assessed. Secondary outcome measure includes the assessment of gaps across national and local levels by comparing the RAG rating results.ResultsNational regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management.ConclusionsFor effective patient safety and infection prevention in English hospitals, ro
Troughton R, birgand G, holmes A, et al., 2016, Mapping Priority Areas for Surveillance of Surgical Site Infections in England, FIS/HIS 2016
Vella V, Aylin PP, Moore L, et al., 2016, Bed utilisation and increased risk of Clostridium difficile infections in acute hospitals in England in 2013/2014., BMJ Quality & Safety, ISSN: 2044-5423
BACKGROUND: The study aimed to identify thresholds for hospital bed utilisation which are independently associated with significantly higher risks for Clostridium difficile infections (CDI) in acute hospitals in England. METHOD: A retrospective analysis was carried out on reported data from the English National Health Service (NHS) for the financial year 2013/2014. Reported rates of CDI were used as a proxy for hospital infection rates in acute NHS hospital trusts. Multivariate linear regression was used to assess the relationship between bed utilisation values and CDI controlling for confounding factors. Hospitals were finally plotted in a Pabon Lasso graph according to their average bed occupancy rate (BOR) and bed turnover rate (BTR) per year to visualise the relationship between bed utilisation and CDI. RESULTS: Among English hospital NHS trusts, increasing BTR and decreasing BOR were associated with a decrease in CDI. However, this effect was not large, and patient mix had a larger impact on CDI rates than bed utilisation. CONCLUSIONS: While policymakers and managers wishing to target healthcare providers with high CDI rates should look at bed utilisation measures, focusing on these alone is unlikely to have the desired impact. Instead, strategies to combat CDI must take a wider perspective on contributory factors at the institutional level.
Troughton R, Birgand G, Moore L, et al., 2016, Blogging in infectious diseases and clinical microbiology: assessment of the ‘blogosphere' content, SHEA Spring Conference 2016
Blogs are becoming increasingly widespread, and can be useful for quickly and interactively communicating new information. To explore this resource we analysed the content and characteristics of influential infectious disease (ID) and infection control (IC) blogs and bloggers to describe the ID blogosphere.
Vella V, Moore LS, Robotham JV, et al., 2016, Isolation demand from carbapenemase-producing Enterobacteriaceae screening strategies based on a West London hospital network, Journal of Hospital Infection, Vol: 94, Pages: 118-124, ISSN: 1532-2939
OBJECTIVE: To estimate the isolation demands arising from high-risk specialty-based screening for carbapenemase-producing Enterobacteriaceae (CPE), and the potential fraction of CPE burden detected. METHODS: Clinical specialty groups from three London hospitals were ranked by incidence of carbapenem resistance among Escherichia coli and Klebsiella spp. Contact precaution bed-days were estimated for three screening strategies: Strategy 1, 'circulation science and renal medicine'; Strategy 2, Strategy 1 plus 'specialist services'; and Strategy 3, Strategy 2 plus 'private patients'. Isolation bed occupancy rates and potential CPE detection rates were estimated. RESULTS: Of 99,105 admissions to the three hospitals in Financial Year 2014/15, Strategies 1, 2 and 3 would have screened 4371 (4.4%), 7482 (7.6%), and 13,542 (13.7%) patients, respectively. The specialties' isolation bed occupancy rates varied between 3% and 696% depending on strategy, number of consecutive tests, and whether or not pre-emptive isolation had been applied. Expected detection rates of the potential CPE burden in the hospital network would have varied between 17.1% and 47.5%. CONCLUSIONS: High-risk specialty-based screening has the potential to detect nearly half of the potential CPE burden, and would be more pragmatic than patient-level risk-factor-based screening. Pre-emptive isolation increases isolation requirements substantially. CPE screening strategies need to balance risk and resources.
Birgand GJC, Bourigault C, Moore L, et al., 2015, Measures to eradicate multidrug-resistant organism outbreaks: How much does it cost?, Clinical Microbiology and Infection, Vol: 22, Pages: 162.e1-162.e9, ISSN: 1469-0691
This study aimed to assess the economic burden of infection control measures that succeeded in eradicating multidrug resistant organisms (MDROs) in emerging epidemic contexts in hospital settings. Medline, Embase and Ovid databases were systematically interrogated for original English language articles detailing costs associated with strict measures to eradicate MDROs published between 1st January 1974 and 2nd November 2014. This study was conducted in accordance with the PRISMA guidelines. Overall, 13 original articles were retrieved reporting data on several MDROs including; glycopeptide resistant enterococci (n=5), carbapenemase producing Enterobacteriacae (n=1), meticillin resistant Staphylococcus aureus (n=5) and carbapenem-resistant Acinetobacter baumannii (n=2). Overall, the cost of strict measures to eradicate MDROs ranged from €285 to €57,532 per positive patient. The major component of these overall costs was related to interruption of new admissions, representing from €2,466 to €47,093 per positive patient (69% of the overall cost in mean, range: 13 - 100), followed by mean laboratory costs of €628 to €5,849 (24%, range: 3.3 - 56.7), staff reinforcement €6,204 to €148,381 (22%, range: 3.3 – 52) and contact precautions €166 to €10,438 per positive patient (18%, range: 0.7 - 43.3). Published data on the economic burden of strict measures to eradicate MDRO are limited, heterogeneous, and weakened by several methodological flaws. Novel economic studies should be performed to assess the financial impact of current policies and identify the most cost-effective strategies to eradicate emerging MDROs in healthcare facilities.
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