Results
- Showing results for:
- Reset all filters
Search results
-
Journal articleOtter JA, Mutters NT, Tacconelli E, et al., 2015,
Controversies in guidelines for the control of multidrug-resistant Gram-negative bacteria in EU countries
, CLINICAL MICROBIOLOGY AND INFECTION, Vol: 21, Pages: 1057-1066, ISSN: 1198-743X- Cite
- Citations: 68
-
Journal articlePalmer WL, Bottle A, Aylin PP, 2015,
The association between day of delivery and obstetric outcomes: an observational study
, The BMJ, Vol: 351, ISSN: 0959-8138Objective To examine the association between day of delivery and measures of quality and safety of maternity services and, in particular, compare weekend with weekday performance.Design We examined outcomes for maternal and neonatal records within the nationwide administrative dataset for English hospitals by day of the week. Groups were defined by day of admission (for maternal indicators) or delivery (for neonatal indicators) rather than by day of complication. We used logistic regression to adjust for case-mix factors including gestational age, birth-weight, and maternal age. We also investigated staffing factors using multi-level models to evaluate the association between outcomes and level of consultant presence. Setting English National Health Service public hospitals.Participants 1,332,835 deliveries and 1,349,599 births between 1 April 2010 and 31 March 2012. Main outcome measures The primary outcomes were perinatal mortality and – for both neonate and mother – infections, emergency readmissions and injuries.Results Performance across four of the seven measures was significantly worse for women admitted, and babies born, at weekends. In particular, the perinatal mortality rate was 7.3 per 1,000 babies delivered at weekends, 0.9 per 1,000 higher than at weekdays (adjusted odds ratio [AOR] 1.07; 95% confidence interval 1.02 to 1.13). We did not identify a consistent association between outcomes and staffing, although trusts who complied with recommended levels of consultant presence had a perineal tear rate of 3.0% compared with 3.3% for non-compliant services (AOR 1.21; 1.00 to 1.45).Conclusion The study suggests an association between day of delivery and aspects of performance, and some outcomes appear worse for both women admitted, and babies born, at the weekend. The results would suggest approximately 770 perinatal deaths and 470 maternal infections per year above what might be expected if performance was consistent across women admitted, and
-
Journal articleHolmes AH, Moore LSP, Sundsfjord A, et al., 2015,
Understanding the mechanisms and drivers of antimicrobial resistance
, Lancet, Vol: 387, Pages: 176-187, ISSN: 1474-547XTo combat the threat to human health and biosecurity from antimicrobial resistance, an understanding of its mechanisms and drivers is needed. Emergence of antimicrobial resistance in microorganisms is a natural phenomenon, yet antimicrobial resistance selection has been driven by antimicrobial exposure in health care, agriculture, and the environment. Onward transmission is affected by standards of infection control, sanitation, access to clean water, access to assured quality antimicrobials and diagnostics, travel, and migration. Strategies to reduce antimicrobial resistance by removing antimicrobial selective pressure alone rely upon resistance imparting a fitness cost, an effect not always apparent. Minimising resistance should therefore be considered comprehensively, by resistance mechanism, microorganism, antimicrobial drug, host, and context; parallel to new drug discovery, broad ranging, multidisciplinary research is needed across these five levels, interlinked across the health-care, agriculture, and environment sectors. Intelligent, integrated approaches, mindful of potential unintended results, are needed to ensure sustained, worldwide access to effective antimicrobials.
-
Journal articleAhmad R, Iwami M, Castro-Sanchez E, et al., 2015,
Defining the user role in infection control
, Journal of Hospital Infection, Vol: 92, Pages: 321-327, ISSN: 1532-2939BackgroundHealth policy initiatives continue to recognize the valuable role of patients and the public in improving safety, advocating the availability of information as well as involvement at the point of care. In infection control, there is a limited understanding of how users interpret the plethora of publicly available information about hospital performance, and little evidence to support strategies that include reminding healthcare staff to adhere to hand hygiene practices.AimTo understand how users define their own role in patient safety, specifically in infection control.MethodsThrough group interviews, self-completed questionnaires and scenario evaluation, user views of 41 participants (15 carers and 26 patients with recent experience of inpatient hospital care in London, UK) were collected and analysed. In addition, the project's patient representative performed direct observation of the research event to offer inter-rater reliability of the qualitative analysis.FindingsUsers considered evidence of systemic safety-related failings when presented with hospital choices, and did not discount hospitals with high (‘red’ flagged) rates of meticillin-resistant Staphylococcus aureus. Further, users considered staff satisfaction within the workplace over and above user satisfaction. Those most dissatisfied with the care they received were unlikely to ask staff, ‘Have you washed your hands?’ConclusionThis in-depth qualitative analysis of views from a relatively informed user sample shows ‘what matters’, and provides new avenues for improvement initiatives. It is encouraging that users appear to take a holistic view of indicators. There is a need for strategies to improve dimensions of staff satisfaction, along with understanding the implications of patient satisfaction.
-
Journal articleLaunders H, Jacklin A, Franklin BD, 2015,
Allergy transcription before and after the implementation of an inpatient electronic prescribing system in a tertiary referral hospital: a case study in two oncology wards
, Safety in Health, Vol: 1, ISSN: 2056-5917Background Patients with allergies can be protected from potentially life threatening harm by recording their allergen and reaction correctly. Electronic prescribing is being widely implemented with a view to improving patient safety; decision support functions can alert prescribers to the risk of prescribing an allergen. However the allergen must be correctly recorded to utilize this functionality. This study aimed to explore whether the introduction of an inpatient electronic prescribing system, in place of paper-based prescribing, has affected the accuracy of transfer of allergen data between hospital documentation systems.Methods Retrospective case note review of a random sample of 100 patients admitted to two oncology wards in a UK hospital before implementation of electronic prescribing, and 100 admitted afterwards. We compared accuracy of allergy information transcribed from admission documentation to the inpatient prescribing system and then to the separate electronic discharge summary for paper-based versus electronic inpatient prescribing. We analyzed data separately for patients with no known drug allergy and those with a recorded allergen.Results There was no difference between prescribing systems in the transfer of ‘no known drug allergy’ status from the admission documentation to the inpatient prescribing record. However transfer of ‘no known drug allergy’ status was better on electronic discharge summaries prepared from the separate electronic inpatient system (transferred correctly for 58 of 72 discharges, 81%) when compared with paper inpatient prescriptions (26 of 68 patient discharges, 38%) p<0.001.For patients with an allergy the correct transfer of allergens from admission documentation to the inpatient prescribing record was lower for the electronic prescribing system (10 of 28 patient admissions, 36%) when compared with paper prescribing (21 of 32 patient admissions, 66%) p=0.02. However correct transfer of aller
-
Journal articleRawson TM, Moore LSP, Gilchrist MJ, et al., 2015,
Antimicrobial stewardship: are we failing in cross-specialty clinical engagement?
, Journal of Antimicrobial Chemotherapy, Vol: 71, Pages: 554-559, ISSN: 1460-2091Background Antimicrobial resistance (AMR) is a public health priority and leading patient safety issue. Globally, antimicrobial stewardship (AMS) has been integral in promoting therapeutic optimization whilst minimizing harmful antimicrobial use. A cross-sectional, observational study was undertaken to investigate the coverage of AMS and antibacterial resistance across clinical scientific conferences in 2014, as a surrogate marker for current awareness and attributed importance.Methods Clinical specialties were identified, and the largest corresponding clinical scientific/research conferences in 2014 determined (i) within the UK and (ii) internationally. Conference characteristics and abstracts were interrogated and analysed to determine those related to AMS and AMR. Inter-specialty variation was assessed using χ2 or Fisher's exact statistical analysis.Results In total, 45 conferences from 23 specialties were analysed representing 59 682 accepted abstracts. The UK had a significantly greater proportion of AMS-AMR-related abstracts compared with international conferences [2.8% (n = 221/7843) compared with 1.8% (n = 942/51 839); P < 0.001]. Infection conferences contained the greatest proportion of AMS-AMR abstracts, representing 20% (732/3669) of all abstracts [UK 66% (80/121) and international 18% (652/3548); P < 0.0001]. AMS-AMR coverage across all general specialties was poor [intensive care 9% (116/1287), surgical 1% (8/757) and medical specialties 0.64% (332/51 497)] despite high usage of antimicrobials across all.Conclusions Despite current AMS-AMR strategies being advocated by infection specialists and discussed by national and international policy makers, AMS-AMR coverage remained limited across clinical specialty scientific conferences in 2014. We call for further intervention to ensure specialty engagement with AMS programmes and promote the AMR agenda across clinical practice.
-
Journal articleBirgand 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: 1469-0691This 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.
-
Journal articleVenanzio V, Gharbi M, Moore LSP, et al., 2015,
Screening suspected cases for carbapenemase-producing Enterobacteriaceae, inclusion criteria and demand
, JOURNAL OF INFECTION, Vol: 71, Pages: 493-495, ISSN: 0163-4453- Author Web Link
- Cite
- Citations: 7
-
Journal articlePowell N, Franklin BD, Jacklin A, et al., 2015,
Omitted doses as an unintended consequence of a hospital restricted antibacterial system: a retrospective observational study
, Journal of Antimicrobial Chemotherapy, Vol: 70, Pages: 3379-3383, ISSN: 1460-2091Objective: To determine the frequency of omitted doses of antibacterial agents and explore a number of risk factors, including the effect of a restricted antibacterial system. Methods: Antibacterial data were extracted from a hospital electronic prescribing and medication administration system for the period 1 January to 30 April 2014. Percentage dose omission rates were calculated. Omission rates for the first dose of antibacterial courses were analysed using logistic regression to identify any correlation between first dose omission rates and potential risk factors including the antibacterials’ restriction status and whether or not they were ward stock. Results: 90,761 antibacterial doses were included. Of these, 6,535 (7.2%) were documented as having been omitted; 847 (0.9% of 90,761) due to medication being unavailable. Non-restricted, ward stock antibacterials had the lowest frequency of omission with 6.2% (271 of 4,391) first doses omitted. The prevalence was 10.4% (27 of 260) for restricted, ward stock antibacterials (OR = 1.6, 95% CI: 1.0 – 2.4, p = 0.027), and 15.5% (53 of 341) for non-restricted, non-ward stock antibacterials (OR = 2.7, 95% CI: 2.0 – 3.7, p = <0.001). Restricted, non-ward stock antibacterials had the highest frequency of 30.7% (71 of 231; OR = 6.2, 95% CI: 4.5 to 8.4, p = <0.001). Conclusions: Antibacterials not stocked in clinical areas were significantly more likely to be omitted. The prevalence of omitted doses increased further if the antibiotic was also restricted. To achieve safe effective antimicrobial use, a balance is needed between promoting antimicrobial stewardship and preventing unintended omitted doses.
-
Journal articleCharani E, Gharbi M, Frost G, et al., 2015,
Antimicrobial therapy in obesity: a multicentre cross-sectional study.
, Journal of Antimicrobial Chemotherapy, Vol: 70, Pages: 2906-2912, ISSN: 1460-2091Objectives Evidence indicates a relationship between obesity and infection. We assessed the prevalence of obesity in hospitalized patients and evaluated its impact on antimicrobial management.Methods Three National Health Service hospitals in London in 2011–12 were included in a cross-sectional study. Data from all adult admissions units and medical and surgical wards were collected. Patient data were collected from the medication charts and nursing and medical notes. Antimicrobial therapy was defined as ‘complicated’ if the patient's therapy met two or more of the following criteria: (i) second- or third-line therapy according to local policy; (ii) intravenous therapy where an alternative oral therapy was appropriate; (iii) longer than the recommended duration of therapy as per local policy recommendations; (iv) repeated courses of therapy to treat the same infection; and (v) specialist advice on antimicrobial therapy provided by the medical microbiology or infectious diseases teams.Results Of the 1014 patients included in this study, 22% (225) were obese, 69% (696) were normal/overweight and 9% (93) were underweight. Obese patients were significantly more likely to have more complicated antimicrobial therapy than normal/overweight and underweight patients (36% versus 19% and 23%, respectively, P = 0.002). After adjustment for hospital, age group, comorbidities and the type of infection, obese patients remained at significantly increased odds of receiving complicated antimicrobial therapy compared with normal/overweight patients (OR = 2.01, 95% CI 1.75–3.45).Conclusions One in five hospitalized patients is obese. Compared with the underweight and normal/overweight, the antimicrobial management in the obese is significantly more complicated.
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.
