FP1.02 Costs of the MRSA ‘Search and Destroy’ Policy in a Dutch Hospital

Objective.The low prevalence of infection and colonization with methicillin-resistantStaphylococcus aureus(MRSA) in The Netherlands is ascribed to a national “search-and-destroy” policy. We describe the measures that were implemented to control widespread MRSA colonization and infection in a Dutch hospital.Design.Descriptive intervention study.Setting.Teaching medical center with a capacity of 679 beds, including 16 intensive care beds.Interventions.MRSA colonization and infection were identified using conventional culture with a selective broth. Isolates were typed using pulsed-field gel electrophoresis. Measures to control the epidemic included screening of contacts (patients and hospital staff), screening of patients at readmission or discharge, strict isolation of MRSA-positive patients, decolonization of colonized staff and patients, the development of an electronic signal identifying MRSA-positive patients, and the development of a culture information-system for hospital personnel.Results.Awareness of uncontrolled dissemination of MRSA began in November 2001. Because the clone involved had a low minimum inhibitory concentration for oxacillin, at first it was not recognized as MRSA. In February 2002, when major screening efforts started, it appeared that MRSA had spread all over the hospital and that many staff members were colonized. By the end of December 2005, a total of 600 patients and 135 staff members were found to be newly colonized. The yearly incidence of cases of MRSA colonization and infection decreased from 351 in 2002 to 56 in 2005. Typing of the isolates showed that 3 MRSA clones were predominant. Outbreaks of colonization involving these clones did not occur after 2003.Conclusion.Our observations show that strict application of “search-and-destroy” measures can effectively control a huge epidemic of MRSA colonization and infection.

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Costs and benefits of the MRSA Search and Destroy policy in a Dutch hospital

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-009-0775-8 ◽

2009 ◽

Vol 28 (10) ◽

pp. 1245-1252 ◽

Cited By ~ 41

Author(s):

M. M. L. Rijen ◽

J. A. J. W. Kluytmans

Keyword(s):

Costs And Benefits ◽

Dutch Hospital ◽

Search And Destroy

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Identifying and characterizing high-risk clusters in a heterogeneous ICU population with deep embedded clustering

Scientific Reports ◽

10.1038/s41598-021-91297-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

José Castela Forte ◽

Galiya Yeshmagambetova ◽

Maureen L. van der Grinten ◽

Bart Hiemstra ◽

Thomas Kaufmann ◽

...

Keyword(s):

Machine Learning ◽

High Risk ◽

Mortality Risk ◽

Clustering Algorithms ◽

Kidney Injury ◽

Risk Groups ◽

Admission Diagnosis ◽

Dutch Hospital ◽

Cluster Membership

AbstractCritically ill patients constitute a highly heterogeneous population, with seemingly distinct patients having similar outcomes, and patients with the same admission diagnosis having opposite clinical trajectories. We aimed to develop a machine learning methodology that identifies and provides better characterization of patient clusters at high risk of mortality and kidney injury. We analysed prospectively collected data including co-morbidities, clinical examination, and laboratory parameters from a minimally-selected population of 743 patients admitted to the ICU of a Dutch hospital between 2015 and 2017. We compared four clustering methodologies and trained a classifier to predict and validate cluster membership. The contribution of different variables to the predicted cluster membership was assessed using SHapley Additive exPlanations values. We found that deep embedded clustering yielded better results compared to the traditional clustering algorithms. The best cluster configuration was achieved for 6 clusters. All clusters were clinically recognizable, and differed in in-ICU, 30-day, and 90-day mortality, as well as incidence of acute kidney injury. We identified two high mortality risk clusters with at least 60%, 40%, and 30% increased. ICU, 30-day and 90-day mortality, and a low risk cluster with 25–56% lower mortality risk. This machine learning methodology combining deep embedded clustering and variable importance analysis, which we made publicly available, is a possible solution to challenges previously encountered by clustering analyses in heterogeneous patient populations and may help improve the characterization of risk groups in critical care.

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Can Fall Risk Screening and Fall Prevention Advice in Hospital Settings Motivate Older Adult Patients to Take Action to Reduce Fall Risk?

Journal of Applied Gerontology ◽

10.1177/07334648211004037 ◽

2021 ◽

pp. 073346482110040

Author(s):

Lotte M. Barmentloo ◽

Vicki Erasmus ◽

Branko F. Olij ◽

Juanita A. Haagsma ◽

Johan P. Mackenbach ◽

...

Keyword(s):

Fall Risk ◽

Individual Risk ◽

Preventive Action ◽

Dutch Hospital ◽

Risk Screening ◽

Patients At Risk ◽

Individual Risk Factors ◽

Fall Risk Screening ◽

Tailored Advice

Objective: We investigated whether an in-hospital intervention consisting of fall risk screening and tailored advice could prompt patients to take preventive action. Method: Patients (≥70) attending the emergency department and nephrology outpatient clinic in a Dutch hospital were screened. Patients at high risk received tailored advice based on their individual risk factors. Three months after screening, preventive steps taken by patients were surveyed. Results: Two hundred sixteen patients were screened. Of the 83 patients completing a 3-month follow-up, 51.8% took action; among patients who received tailored advice ( n = 20), 70% took action. Patients most often adhered to advice on improving muscle strength and undergoing vision checkups (20%). Tailored advice and a reported low quality of life were associated with consulting a health care provider. Discussion: Patients at risk in these settings are inclined to take action after screening. However, they do not always adhere to the tailored prevention advice.

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Perspectives and experiences of patients and healthcare professionals with geriatric assessment in chronic kidney disease: a qualitative study

BMC Nephrology ◽

10.1186/s12882-020-02206-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Carlijn G. N. Voorend ◽

Noeleen C. Berkhout-Byrne ◽

Yvette Meuleman ◽

Simon P. Mooijaart ◽

Willem Jan W. Bos ◽

...

Keyword(s):

Kidney Disease ◽

Qualitative Study ◽

Clinical Outcomes ◽

Geriatric Assessment ◽

Clinical Care ◽

Treatment Options ◽

Routine Care ◽

Treatment Team ◽

Dutch Hospital ◽

Additional Support

Abstract Background Older patients with end-stage kidney disease (ESKD) often live with unidentified frailty and multimorbidity. Despite guideline recommendations, geriatric assessment is not part of standard clinical care, resulting in a missed opportunity to enhance (clinical) outcomes including quality of life in these patients. To develop routine geriatric assessment programs for patients approaching ESKD, it is crucial to understand patients’ and professionals’ experiences with and perspectives about the benefits, facilitators and barriers for geriatric assessment. Methods In this qualitative study, semi-structured focus group discussions were conducted with ESKD patients, caregivers and professionals. Participants were purposively sampled from three Dutch hospital-based study- and routine care initiatives involving geriatric assessment for (pre-)ESKD care. Transcripts were analysed inductively using thematic analysis. Results In six focus-groups, participants (n = 47) demonstrated four major themes: (1) Perceived characteristics of the older (pre)ESKD patient group. Patients and professionals recognized increased vulnerability and (cognitive) comorbidity, which is often unrelated to calendar age. Both believed that often patients are in need of additional support in various geriatric domains. (2) Experiences with geriatric assessment. Patients regarded the content and the time spent on the geriatric assessment predominantly positive. Professionals emphasized that assessment creates awareness among the whole treatment team for cognitive and social problems, shifting the focus from mainly somatic to multidimensional problems. Outcomes of geriatric assessment were observed to enhance a dialogue on suitability of treatment options, (re)adjust treatment and provide/seek additional (social) support. (3) Barriers and facilitators for implementation of geriatric assessment in routine care. Discussed barriers included lack of communication about goals and interpretation of geriatric assessment, burden for patients, illiteracy, and organizational aspects. Major facilitators are good multidisciplinary cooperation, involvement of geriatrics and multidisciplinary team meetings. (4) Desired characteristics of a suitable geriatric assessment concerned the scope and use of tests and timing of assessment. Conclusions Patients and professionals were positive about using geriatric assessment in routine nephrology care. Implementation seems achievable, once barriers are overcome and facilitators are endorsed. Geriatric assessment in routine care appears promising to improve (clinical) outcomes in patients approaching ESKD.

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Cardiovascular risk in 159 934 frequent blood donors while addressing the healthy donor effect

Heart ◽

10.1136/heartjnl-2018-314138 ◽

2019 ◽

Vol 105 (16) ◽

pp. 1260-1265 ◽

Cited By ~ 1

Author(s):

Karlijn Peffer ◽

Martin den Heijer ◽

Wim L A M de Kort ◽

André L M Verbeek ◽

Femke Atsma

Keyword(s):

Cardiovascular Risk ◽

High Frequency ◽

Healthy Donor ◽

Blood Donors ◽

Cox Regression ◽

Blood Donation ◽

Low Frequency ◽

Sensitivity Analyses ◽

Hospital Data ◽

Dutch Hospital

ObjectiveTo investigate whether regular blood donation decreases cardiovascular risk.MethodsAll 159 934 Dutch whole-blood donors with an active donation career of at least 10 years were categorised into sex-specific donation tertiles based on the number of donations during this 10-year qualification period. Cardiovascular endpoints were based on hospital discharge diagnoses and death certificates from Dutch Hospital Data and Statistics Netherlands and occurring after the 10-year qualification period. Cox regression was used to estimate the age-adjusted and starting year-adjusted hazard rate ratio (HRR).ResultsFemale high-frequency blood donors had a reduced cardiovascular morbidity (HRR=0.91, 95% CI 0.85 to 0.98) compared with low-frequency blood donors. No effect was observed in men (HRR=1.00, 95% CI 0.95 to 1.05). To rule out a residual healthy donor effect (HDE), additional sensitivity analyses using a 5-year qualification period were conducted. The results supported the absence of a residual HDE.ConclusionsThis study showed a protective effect of long-term, high-frequency blood donation against cardiovascular disease. This effect was only observed in women and not in men.

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