Hospital-acquired infections in Belgian acute-care hospitals: an estimation of their global impact on mortality, length of stay and healthcare costs

2011 ◽  
Vol 140 (1) ◽  
pp. 126-136 ◽  
Author(s):  
F. VRIJENS ◽  
F. HULSTAERT ◽  
S. DEVRIESE ◽  
S. VAN DE SANDE
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Excess Mortality ◽  
National Level ◽  
Acute Care Hospitals ◽  
Public Healthcare ◽  
Hospital Acquired Infections ◽  
Number Of Patients ◽  
Hospital Acquired ◽  
The Impact

SUMMARYAssessing the overall burden of disease which can be attributed to hospital-acquired infections (HAIs) remains a challenge. A matched cohort study was performed to estimate excess mortality, length of stay and costs attributable to HAIs in Belgian acute-care hospitals, using six matching factors (hospital, diagnosis-related group, age, ward, Charlson score, estimated length of stay prior to infection). Information was combined from different sources on the epidemiology and burden of HAIs to estimate the impact at national level. The total number of patients affected by a HAI each year was 125 000 (per 10·9 million inhabitants). The excess mortality was 2·8% and excess length of stay was 7·3 days, corresponding to a public healthcare cost of €290 million. A large burden was observed outside the intensive-care unit setting (87% of patients infected and extra costs, 73% of excess deaths).

scholarly journals The Impact of a Massachusetts State-Sponsored Educational Program on Antimicrobial Stewardship in Acute Care Hospitals

2013 ◽  
Vol 34 (4) ◽  
pp. 437-439 ◽  
Author(s):  
Adam Weston ◽  
Lauren Epstein ◽  
Lisa E. Davidson ◽  
Alfred DeMaria ◽  
Shira Doron
Keyword(s):  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Educational Program ◽  
Business Models ◽  
National Level ◽  
State Level ◽  
Acute Care Hospitals ◽  
The State ◽  
Team Approach ◽  
The Impact

Antimicrobial stewardship programs (ASPs) are critically important for combating the emergence of antimicrobial resistance. Despite this, there are no regulatory requirements at a national level, which makes initiatives at the state level critical. The objectives of this study were to identify existing antimicrobial stewardship practices, characterize barriers to antimicrobial stewardship implementation in acute care hospitals throughout Massachusetts, and evaluate the impact on these hospitals of a state-sponsored educational conference on antimicrobial stewardship.In September 2011, a state-sponsored educational program entitled “Building Stewardship: A Team Approach Enhancing Antibiotic Stewardship in Acute Care Hospitals” was offered to interested practitioners from throughout the state. The program consisted of 2 audio conferences, reading materials, and a 1-day conference consisting of lectures focusing on the importance of ASPs, strategies for implementation, improvement strategies for existing programs, and panel discussions highlighting successful practices. Smaller breakout sessions focused on operational issues, including understanding of pharmacodynamics, business models, and electronic surveillance.

Has Improved Hand Hygiene Compliance Reduced the Risk of Hospital-Acquired Infections among Hospitalized Patients in Ontario? Analysis of Publicly Reported Patient Safety Data from 2008 to 2011

2013 ◽  
Vol 34 (6) ◽  
pp. 605-610 ◽  
Author(s):  
Giulio DiDiodato
Keyword(s):  
Patient Safety ◽  
Hand Hygiene ◽  
Acute Care ◽  
Poisson Regression ◽  
Hand Hygiene Compliance ◽  
Acute Care Hospitals ◽  
Ordinary Least Squares ◽  
Hospital Acquired Infections ◽  
Hygiene Compliance ◽  
Hospital Acquired

Design.Prospective, observational, ecological, time series, cross-sectional study examining the association between hand hygiene compliance (HHC) rates and the incidence of hospital-acquired infections.Setting.Acute care hospitals (N = 166) located in the province of Ontario, Canada.Methods.All data were extracted from the Ontario patient safety indicator database (http://www.hqontario.ca/public-reporting/patient-safety). Complete data were available for 166 acute care hospitals from October 1, 2008, to December 31, 2011. The rates of Clostridium difficile infection (CDI) are reported monthly, methicillin-resistant Staphylococcus aureus (MRSA) bacteremia quarterly, and HHC rates yearly. Trends and associations for each indicator were evaluated by ordinary least squares regression (HHC), zero-inflated Poisson regression (MRSA bacteremia), or Poisson regression (CDI). Dependent variables included in the regression analyses were extracted from the same database and included year, healthcare region, and type of hospital (teaching or small or large community).Results.Compared to those in 2008, reported HHC rates improved every year both before and after environment/patient contact (range, 10.6%–25.3%). Compared to those in 2008, there was no corresponding change in the rates of MRSA bacteremia; however, the rates of CDI decreased in 2009 but were not statistically significantly decreased from baseline in either 2010 or 2011. No consistent association was demonstrated between changes in the rates of HHC and these two healthcare-associated infections (HAIs).Conclusions.Despite significant improvements in reported rates of HHC among healthcare personnel in Ontario's hospitals, we could not demonstrate a positive ecological impact on rates of these two HAIs.

scholarly journals Physical restraint of dementia patients in acute care hospitals during the COVID-19 pandemic: A cohort analysis in Japan

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260446
Author(s):  
Takuya Okuno ◽  
Hisashi Itoshima ◽  
Jung-ho Shin ◽  
Tetsuji Morishita ◽  
Susumu Kunisawa ◽  
...  
Keyword(s):  
Acute Care ◽  
Hospital Admissions ◽  
Cohort Analysis ◽  
Physical Restraint ◽  
Acute Care Hospitals ◽  
Physical Restraints ◽  
Restraint Use ◽  
Dementia Patients ◽  
Number Of Patients ◽  
The Impact

Introduction The coronavirus disease (COVID-19) pandemic has caused unprecedented challenges for the medical staff worldwide, especially for those in hospitals where COVID-19-positive patients are hospitalized. The announcement of COVID-19 hospital restrictions by the Japanese government has led to several limitations in hospital care, including an increased use of physical restraints, which could affect the care of elderly dementia patients. However, few studies have empirically validated the impact of physical restraint use during the COVID-19 pandemic. We aimed to evaluate the impact of regulatory changes, consequent to the pandemic, on physical restraint use among elderly dementia patients in acute care hospitals. Methods In this retrospective study, we extracted the data of elderly patients (aged > 64 years) who received dementia care in acute care hospitals between January 6, 2019, and July 4, 2020. We divided patients into two groups depending on whether they were admitted to hospitals that received COVID-19-positive patients. We calculated descriptive statistics to compare the trend in 2-week intervals and conducted an interrupted time-series analysis to validate the changes in the use of physical restraint. Results In hospitals that received COVID-19-positive patients, the number of patients who were physically restrained per 1,000 hospital admissions increased after the government’s announcement, with a maximum incidence of 501.4 per 1,000 hospital admissions between the 73rd and 74th week after the announcement. Additionally, a significant increase in the use of physical restraints for elderly dementia patients was noted (p = 0.004) in hospitals that received COVID-19-positive patients. Elderly dementia patients who required personal care experienced a significant increase in the use of physical restraints during the COVID-19 pandemic. Conclusion Understanding the causes and mechanisms underlying an increased use of physical restraints for dementia patients can help design more effective care protocols for similar future situations.

scholarly journals 399. Epidemiology of Laboratory-identified Late-onset SARS-CoV-2 Positivity in Two Large, Urban, Acute-Care Hospitals: Implications for Surveillance of Hospital-Acquired COVID-19

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S301-S302
Author(s):  
William Trick ◽  
Michael Y Lin ◽  
Sharon F Welbel ◽  
Onfofre T Donceras ◽  
Huiyuan Zhang ◽  
...  
Keyword(s):  
Acute Care ◽  
Chart Review ◽  
Late Onset ◽  
Delayed Diagnosis ◽  
Acute Care Hospitals ◽  
Healthcare Facility ◽  
Clinical Criteria ◽  
Number Of Patients ◽  
Time Of Presentation ◽  
Hospital Acquired

Abstract Background Laboratory identification (Lab-ID) of late-onset SARS-CoV-2 positive tests during a hospital stay is a potential public health surveillance approach for hospital-acquired COVID-19. However, prolonged RNA fragment shedding and intermittent detection of SARS-CoV-2 virus via PCR testing among infected patients may hamper interpretation of laboratory-identified events. We aimed to describe the epidemiology of late-onset SARS-CoV-2 laboratory events using clinical criteria, to evaluate the feasibility of a Lab-ID approach to detection of nosocomial SARS-COV-2 infection. Methods We evaluated all SARS-CoV-2 RT-PCR positive results recovered from patients at two acute-care hospitals in Chicago, IL, during March 1 — November 30, 2020. Each hospital maintained stringent infection control policies through-out the study period. Through chart review (WT & CS), we categorized all initial SARS-CoV-2 positive tests collected > Hospital Day 5 (defined as ‘late-onset’ based on the 5-day mean incubation period for COVID-19) into the following clinical categories: Community Acquired; Unlikely Hospital Acquired; Possible Hospital Acquired; and Probable Hospital Acquired. Categorizations were made using hospital day, symptoms, alternative diagnoses, and clinical notes (Figure 1). Results Of 2,671 SARS-CoV-2-positive patients, most positive tests (n=2,551; 96%) were recovered pre-admit or by Hospital Day 2; first positive tests were uncommon during Hospital Days 6 to 14 (n=40; 1.5%); and rare after Hospital Day 14 (n=15; 0.6%). By chart review, of the 55 late-onset records reviewed, categorizations in descending order were: Prior positive at outside facility (n=23); Possible Hospital Acquired (n=16); Community Acquired (n=12); Probable Hospital Acquired (n=4). Less than half of the late-onset cases were categorized as a possible or probable hospital acquisition (Figure 2). Conclusion Hospital-acquired SARS-CoV-2 infection was uncommon. Most late-onset episodes of SARS-CoV-2 were explained by detection at an outside healthcare facility or by delayed diagnosis of patients with symptoms at time of presentation. A Lab-ID approach to nosocomial COVID-19 surveillance would potentially misclassify a substantial number of patients. Disclosures All Authors: No reported disclosures

scholarly journals Physical Restraint of Dementia Patients in Acute-Care Hospitals During the COVID-19 Pandemic: A Cohort Analysis in Japan

2020 ◽  
Author(s):  
Takuya Okuno ◽  
Jung-ho Shin ◽  
Daisuke Takada ◽  
Tetsuji Morishita ◽  
Susumu Kunisawa ◽  
...  
Keyword(s):  
Acute Care ◽  
Hospital Admissions ◽  
Cohort Analysis ◽  
Physical Restraint ◽  
Acute Care Hospitals ◽  
Physical Restraints ◽  
Restraint Use ◽  
Dementia Patients ◽  
Number Of Patients ◽  
The Impact

Abstract Background: The coronavirus disease (COVID-19) pandemic has caused unprecedented challenges for medical staff worldwide, especially for those working in hospitals in which COVID-19-positive or -suspected patients are being treated. The announcement of COVID-19 hospital restrictions by the Japanese government has led to several limitations in hospital care, including an increased use of physical restraints, that could affect the care of elderly dementia patients. However, few studies have empirically validated the impact of physical restraint use during the COVID-19 pandemic. We aimed to evaluate the impact of regulatory changes, consequent to the pandemic, on physical restraint use among elderly dementia patients in acute care hospitals.Methods: In this retrospective cohort study, we extracted the data of elderly patients (age >65 years) who received dementia care in acute care hospitals to which COVID-19-positive or -suspected patients were admitted between July 1, 2018 and June 30, 2020. We calculated descriptive statistics to compare the year-on-year trend in 2-week intervals and conducted an interrupted time-series analysis to validate the changes in the use of physical restraint.Results: The year-on-year trend in the number of patients who were physically restrained per 1,000 hospital admissions increased after the government’s announcement of COVID-19 restrictions, with a maximum incidence of 111.4% between the 47th and 48th week after the announcement. Additionally, a significant increase in the use of physical restraints in elderly dementia patients was noted (p=.002).Conclusions: Elderly dementia patients who required personal care experienced an obvious and significant increase in the use of physical restraints during the COVID-19 pandemic. Understanding the causes and mechanisms underlying an increased use of physical restraints in dementia patients can help design more effective care protocols for similar future situations.

Physical restraint to patients with dementia in acute physical care settings: effect of the financial incentive to acute care hospitals

2017 ◽  
Vol 30 (7) ◽  
pp. 991-1000 ◽  
Author(s):  
Miharu Nakanishi ◽  
Yasuyuki Okumura ◽  
Asao Ogawa
Keyword(s):  
Acute Care ◽  
Financial Incentive ◽  
Physical Restraint ◽  
Acute Care Hospitals ◽  
Dementia Care ◽  
Lower Percentage ◽  
Public Healthcare ◽  
Cross Sectional ◽  
Insurance Program ◽  
Healthcare Insurance

ABSTRACTBackground:In April 2016, the Japanese government introduced an additional benefit for dementia care in acute care hospitals (dementia care benefit) into the universal benefit schedule of public healthcare insurance program. The benefit includes a financial disincentive to use physical restraint. The present study investigated the association between the dementia care benefit and the use of physical restraint among inpatients with dementia in general acute care settings.Methods:A national cross-sectional study design was used. Eight types of care units from acute care hospitals under the public healthcare insurance program were invited to participate in this study. A total of 23,539 inpatients with dementia from 2,355 care units in 937 hospitals were included for the analysis. Dementia diagnosis or symptoms included any signs of cognitive impairment. The primary outcome measure was “use of physical restraint.”Results:Among patients, the point prevalence of physical restraint was 44.5% (n= 10,480). Controlling for patient, unit, and hospital characteristics, patients in units with dementia care benefit had significantly lower percentage of physical restraint than those in any other units (42.0% vs. 47.1%; adjusted odds ratio, 0.76; 95% confident interval [0.63, 0.92]).Conclusions:The financial incentive may have reduced the risk of physical restraint among patients with dementia in acute care hospitals. However, use of physical restraint was still common among patients with dementia in units with the dementia care benefit. An educational package to guide dementia care approach including the avoidance of physical restraint by healthcare professionals in acute care hospitals is recommended.

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