The Prevalence and Estimates of the Cumulative Incidence of Hospital-Acquired Infections Among Patients Admitted to Auckland District Health Board Hospitals in New Zealand

AbstractObjectives:To report the pooled results of seven prevalence surveys of hospital-acquired infections conducted between November 1996 and November 1999, and to use the data to predict the cumulative incidence of hospital-acquired infections in the same patient group.Design:The summary and modeling of data gathered from the routine surveillance of the point prevalence of hospital-acquired infections.Setting:Auckland District Health Board Hospitals (Auckland DHBH), the largest publicly funded hospital group in New Zealand supplying secondary and tertiary services.Patients:All inpatients.Method:Point-prevalence surveys were conducted including all patients in Auckland DHBH. Standard definitions of hospital-acquired infection were used. The data from the seven surveys were pooled and used in a modeling exercise to predict the cumulative incidence of hospital-acquired infection. An existing method for the conversion of prevalence to cumulative incidence was applied. Results are presented for all patients and stratified by clinical service and site of hospital-acquired infection.Results:The underlying patterns of hospital-acquired infection by site and service were stable during the seven time periods. The prevalence rate for all patients was 9.5%, with 553 patients identified with one or more hospital-acquired infections from a population of 5,819. The predicted cumulative incidence for all patients was 6.33% (95% confidence interval, 6.20% to 6.46%).Conclusions:The prevalence and the predicted cumulative incidence are similar to rates reported in the international literature. The validity of the predicted cumulative incidence derived here is not known. If it were accurate, then the application of this method would represent a cost-effective alternative to incidence studies.

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Modeling the Costs of Hospital-Acquired Infections in New Zealand

Infection Control and Hospital Epidemiology ◽

10.1086/502192 ◽

2003 ◽

Vol 24 (3) ◽

pp. 214-223 ◽

Cited By ~ 19

Author(s):

Nicholas Graves ◽

Tanya M. Nicholls ◽

Arthur J. Morris

Keyword(s):

New Zealand ◽

Economic Cost ◽

Cost Effective ◽

Sensitivity Analyses ◽

Primary Data ◽

Health Board ◽

District Health ◽

Hospital Acquired Infections ◽

Input Variables ◽

Hospital Acquired

AbstractObjective:To model the economic costs of hospital-acquired infections (HAIs) in New Zealand, by type of HAI.Design:Monte Carlo simulation model.Setting:Auckland District Health Board Hospitals (DHBH), the largest publicly funded hospital group in New Zealand supplying secondary and tertiary services. Costs are also estimated for predicted HAIs in admissions to all hospitals in New Zealand.Patients:All adults admitted to general medical and general surgical services.Method:Data on the number of cases of HAI were combined with data on the estimated prolongation of hospital stay due to HAI to produce an estimate of the number of bed days attributable to HAI. A cost per bed day value was applied to provide an estimate of the economic cost. Costs were estimated for predicted infections of the urinary tract, surgical wounds, the lower and upper respiratory tracts, the bloodstream, and other sites, and for cases of multiple sites of infection. Sensitivity analyses were undertaken for input variables.Results:The estimated costs of predicted HAIs in medical and surgical admissions to Auckland DHBH were $10.12 (US $4.56) million and $8.64 (US $3.90) million, respectively. They were $51.35 (US $23.16) million and $85.26 (US $38.47) million, respectively, for medical and surgical admissions to all hospitals in New Zealand.Conclusions:The method used produces results that are less precise than those of a specifically designed study using primary data collection, but has been applied at a lower cost. The estimated cost of HAIs is substantial, but only a proportion of infections can be avoided. Further work is required to identify the most cost-effective strategies for the prevention of HAI.

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Evaluation of an Algorithm for Electronic Surveillance of Hospital-Acquired Infections Yielding Serial Weekly Point Prevalence Scores

Infection Control and Hospital Epidemiology ◽

10.1086/676869 ◽

2014 ◽

Vol 35 (7) ◽

pp. 888-890 ◽

Cited By ~ 6

Author(s):

Roel H. R. A. Streefkerk ◽

Gerard J. J. M. Borsboom ◽

Conrad P. van der Hoeven ◽

Margreet C. Vos ◽

Roel P. Verkooijen ◽

...

Keyword(s):

Medical Center ◽

Cost Effective ◽

Point Prevalence ◽

Software System ◽

Hospital Acquired Infections ◽

Effective Manner ◽

Highly Sensitive ◽

Integrated Software ◽

Hospital Acquired ◽

Electronic Hospital

Surveillance of hospital-acquired infections can be approximated by repeated surveys that are performed in a standardized, cost-effective manner. We developed an integrated software system for serial electronic hospital-wide point prevalence surveys using algorithms that proved highly sensitive and specific over a 5-year period in a large university medical center.Infect Control Hosp Epidemiol 2014;35(7):888–890

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Isolation of post operative hospital acquired infections in a private hospital of Bangladesh and identification of clonal relatedness of E. coli by using Pulse filed gel electrophoresis

Bangladesh Journal of Medical Microbiology ◽

10.3329/bjmm.v6i2.19369 ◽

2012 ◽

Vol 6 (2) ◽

pp. 7-10

Author(s):

Mohammad Murshed ◽

Sabeena Shahnaz ◽

Md. Abdul Malek

Keyword(s):

Private Hospital ◽

Isolation And Identification ◽

College Hospital ◽

Hospital Acquired Infection ◽

E Coli ◽

Hospital Acquired Infections ◽

Medical College ◽

Clonal Relatedness ◽

Hospital Acquired ◽

Dressing Materials

Isolation and identification of post operative hospital acquired infection was carried out from July 2008 to December 2008 in Holy Family Red Crescent Medical College Hospital (private hospital). The major pathogen of wound infection was E. coli. A total; of 120 samples were collected from the surrounding environment of post operative room like floor, bed sheets, instruments, dressing materials, catheter, nasogastric and endotracheal tube. E. coli (40%) was the predominant organism followed by S. aureus (24%). DNA fingerprinting analysis using pulsed field gel electreopheresis of XbaI restriction digested genomic DNA showed that clonal relatedness between the two clinical nd environmental isolates were 100%.DOI: http://dx.doi.org/10.3329/bjmm.v6i2.19369 Bangladesh J Med Microbiol 2012; 06(02): 7-10

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Registered nurse prescribing: A descriptive survey of prescribing practices in a single district health board in Aotearoa New Zealand

Nursing Praxis Aotearoa New Zealand ◽

10.36951/27034542.2020.014 ◽

2020 ◽

Vol 36 (3) ◽

pp. 61-72

Author(s):

Melinda McGinty ◽

◽

Betty Poot ◽

Jane Clarke ◽

◽

...

Keyword(s):

Primary Care ◽

New Zealand ◽

Registered Nurse ◽

Health Conditions ◽

Health Board ◽

Prescribing Practices ◽

District Health ◽

Survey Tool ◽

Aotearoa New Zealand ◽

Descriptive Survey

The expansion of prescribing rights in Aotearoa New Zealand has enabled registered nurse prescribers (RN prescribers) working in primary care and specialty teams, to enhance nursing care, by prescribing medicines to their patient population. This widening of prescribing rights was to improve the population’s access to medicines and health care; however, little is known about the medications prescribed by RN prescribers. This paper reports on a descriptive survey of self-reported RN prescribers prescribing in a single district health board. The survey tool used was a Microsoft Excel spreadsheet to record nurse’s area of practice, patient demographic details, health conditions seen, and medicines prescribed and deprescribed. Simple data descriptions and tabulations were used to report the data. Eleven RN prescribers consented to take part in the survey and these nurses worked in speciality areas of cardiology, respiratory, diabetes, and primary care. Findings from the survey demonstrated that RN prescribers prescribe medicines within their area of practice and within the limits of the list of medicines for RN prescribers. Those working in primary care saw a wider range of health conditions and therefore prescribed a broader range of medications. This survey revealed that the list of medications available for RN prescribers needs to be updated regularly to align with the release of evidence-based medications on the New Zealand Pharmaceutical Schedule. It is also a useful record for both educational and clinical settings of the types of medications prescribed by RN prescribers.

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Infectious events in patients with severe COVID-19: results of a cohort of patients with high prevalence of underlying immune defect

Annals of Intensive Care ◽

10.1186/s13613-021-00873-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Anastasia Saade ◽

Giulia Moratelli ◽

Guillaume Dumas ◽

Asma Mabrouki ◽

Jean-Jacques Tudesq ◽

...

Keyword(s):

Risk Factors ◽

Cumulative Incidence ◽

Cumulative Risk ◽

Incidence Density ◽

Hospital Acquired Infections ◽

Underlying Malignancy ◽

Single Center Study ◽

High Prevalence ◽

Immune Defect ◽

Hospital Acquired

Abstract Background Empirical antibiotic has been considered in severe COVID-19 although little data are available regarding concomitant infections. This study aims to assess the frequency of infections, community and hospital-acquired infections, and risk factors for infections and mortality during severe COVID-19. Methods Retrospective single-center study including consecutive patients admitted to the intensive care unit (ICU) for severe COVID-19. Competing-risk analyses were used to assess cumulative risk of infections. Time-dependent Cox and fine and gray models were used to assess risk factors for infections and mortality. Propensity score matching was performed to estimate the effect of dexamethasone. Results We included 100 patients including 34 patients with underlying malignancies or organ transplantation. First infectious event was bacterial for 35 patients, and fungal for one. Cumulative incidence of infectious events was 27% [18–35] at 10 ICU-days. Prevalence of community-acquired infections was 7% [2.8–13.9]. Incidence density of hospital-acquired infections was 125 [91–200] events per 1000 ICU-days. Risk factors independently associated with hospital-acquired infections included MV. Patient’s severity and underlying malignancy were associated with mortality. Dexamethasone was associated with increased infections (36% [20–53] vs. 12% [4–20] cumulative incidence at day-10; p = 0.01). After matching, dexamethasone was associated with hospital-acquired infections (35% [18–52] vs. 13% [1–25] at 10 days, respectively, p = 0.03), except in the subset of patients requiring MV, and had no influence on mortality. Conclusions In this population of COVID-19 patients with high prevalence of underlying immune defect, a high risk of infections was noted. MV and use of steroids were independently associated with infection rate.

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Association between ward-transfers and hospital-acquired infection: a study using routine data

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.602 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

E Boncea ◽

P Expert ◽

C Costelloe

Keyword(s):

Elderly Patients ◽

Routine Data ◽

Pathogen Transmission ◽

High Risk Population ◽

Retrospective Case ◽

Hospital Acquired Infection ◽

Hospital Acquired Infections ◽

Hospital Trust ◽

London Hospital ◽

Hospital Acquired

Abstract Ward-transfers have become more common as hospital staff balance patient needs with bed availability on specific wards. However, increased movement through the hospital may leave patients more vulnerable to potential infectious pathogen transmission routes via increased exposure to contaminated surfaces and more contacts with individuals. This may increase their risk of hospital-acquired infections (HAIs), an adverse event associated with greater antibiotic resistance, patient costs, morbidity, and mortality. This study aimed to quantify the association between the number of ward-transfers undergone during a hospital spell and the outcome of HAI. As elderly patients comprise a large proportion of hospital users and are a high-risk population for HAIs, analysis was focused on people over 65-years old. A retrospective case-control study was undertaken using data extracted from electronic health records and microbiology cultures of non-elective medical admissions to a London hospital trust between January 2016 and December 2018 (n = 24,439). Logistic regression was used to obtain the odds ratio for developing a HAI as a function of the number of ward-transfers until onset of HAI for cases, or hospital discharge for controls, while controlling for covariates including length of stay, procedures and comorbidities. Each additional ward-transfer increased the odds of developing a HAI by 8% (OR 1.08; 95%CI:1.04-1.12). The hospital is a complex environment, and interventions should be viewed in light of their impact on the system as a whole. These findings indicate that non-essential ward-transfers of elderly patients should be minimised. This may lower the incidence of infections in this population, potentially reduce the number of pathogen transmission routes in hospitals and alleviate staff burden incurred by ward-transfer associated procedures. Key messages We analysed 3 years of patient movement and microbiology data of elderly patients in a London hospital trust. Each ward-transfer increased the risk of developing a hospital-acquired infection by 8%. Reducing the number of non-essential ward-transfers patients undergo may lower the incidence of hospital-acquired infections; the decision to move a patient should therefore be carefully considered.

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Hospital-acquired infection awareness and control practices among healthcare staff: an evaluation

British Journal of Healthcare Management ◽

10.12968/bjhc.2020.0037 ◽

2021 ◽

Vol 27 (11) ◽

pp. 296-302

Author(s):

Pallavi Saraswat ◽

Rajnarayan R Tiwari ◽

Muralidhar Varma ◽

Sameer Phadnis ◽

Monica Sindhu

Keyword(s):

Infection Control ◽

Healthcare Facility ◽

Hospital Staff ◽

Control Measures ◽

Prevention Measures ◽

Cross Sectional ◽

Control Policies ◽

Hospital Acquired Infection ◽

Hospital Acquired Infections ◽

Hospital Acquired

Background/Aims Hospital-acquired infections pose a risk to the wellbeing of both patients and staff. They are largely preventable, particularly if hospital staff have adequate knowledge of and adherence to infection control policies. This study aimed to assess the knowledge, awareness and practice of hospital-acquired infection control measures among hospital staff. Methods A cross-sectional study was conducted among 71 staff members in a tertiary healthcare facility in Karnataka, India. The researchers distributed a questionnaire containing 33 questions regarding knowledge of hospital-acquired infections, awareness of infection control policies and adherence to control practices. The results were analysed using the Statistical Package for the Social Sciences, version 16.0 and a Kruskal–Wallis test. Results Respondents' mean percentage score on the knowledge of hospital-acquired infections section was 72%. Their mean percentage scores on the awareness and practice of infection prevention measures sections were 82% and 77% respectively. Doctors and those with more years of experience typically scored higher. Conclusion The respondents had an acceptable level of knowledge, awareness and adherence to infection control practices. However, continued training is essential in the prevention of hospital-acquired infections. The majority of the respondents stated that they were willing to undertake training in this area, and this opportunity should be provided in order to improve infection control quality.

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Repeated nationwide point-prevalence surveys of antimicrobial use in Swedish hospitals: data for actions 2003–2010

Eurosurveillance ◽

10.2807/1560-7917.es.2016.21.25.30264 ◽

2016 ◽

Vol 21 (25) ◽

Cited By ~ 16

Author(s):

Gunilla Skoog ◽

Johan Struwe ◽

Otto Cars ◽

Håkan Hanberger ◽

Inga Odenholt ◽

...

Keyword(s):

Community Acquired Pneumonia ◽

Point Prevalence ◽

Antimicrobial Use ◽

Surgical Prophylaxis ◽

Hospital Acquired Infection ◽

Local Implementation ◽

Inappropriate Use ◽

Local Feedback ◽

Uncomplicated Cystitis ◽

Hospital Acquired

This study sought to analyse antimicrobial pressure, indications for treatment, and compliance with treatment recommendations and to identify possible problem areas where inappropriate use could be improved through interventions by the network of the local Swedish Strategic Programme Against Antibiotic Resistance (Strama) groups. Five point-prevalence surveys were performed in between 49 and 72 participating hospitals from 2003 to 2010. Treatments were recorded for 19 predefined diagnosis groups and whether they were for community-acquired infection, hospital-acquired infection, or prophylaxis. Approximately one-third of inpatients were treated with antimicrobials. Compliance with guidelines for treatment of community-acquired pneumonia with narrow-spectrum penicillin was 17.0% during baseline 2003–2004, and significantly improved to 24.2% in 2010. Corresponding figures for quinolone use in uncomplicated cystitis in women were 28.5% in 2003–2004, and significantly improved, decreasing to 15.3% in 2010. The length of surgical prophylaxis improved significantly when data for a single dose and 1 day were combined, from 56.3% in 2003–2004 to 66.6% in 2010. Improved compliance was possibly the effect of active local feedback, repeated surveys, and increasing awareness of antimicrobial resistance. Strama groups are important for successful local implementation of antimicrobial stewardship programs in Sweden.

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Community Governance and Civil Society: An Examination of the Purpose, Intent and Structure of Residents' Groups in New Zealand

10.26686/wgtn.17000653 ◽

2021 ◽

Author(s):

◽

Jarrod Coburn

Keyword(s):

New Zealand ◽

News Media ◽

Local Community ◽

Political Activity ◽

Health Board ◽

District Health ◽

Community Governance ◽

Set Up ◽

Civil Defence ◽

Charitable Activities

<p>Residents’ groups have been in existence in New Zealand for almost 150 years yet very little is known about them. The collection of residents’, ratepayers’ and progressive associations, community councils, neighbourhood committees and the like make up a part of the community governance sector that numbers over a thousand-strong. These groups are featured prominently in our news media, are active in local government affairs and expend many thousands of volunteer hours every year in their work in communities… but what exactly is that work? From the literature we see these groups can be a source of local community knowledge (Kass et al., 2009), a platform for political activity (Deegan, 2002), critical of government (Fullerton, 2005) or help maintain government transparency and accountability (Mcclymont and O'Hare, 2008). They are sometimes part of the establishment too (Wai, 2008) and are often heard promoting the interests of local people (Slater, 2004). Residents’ groups can be set up to represent the interests of a specific demographic group (Seng, 2007) or focus on protecting or promoting a sense of place (Kushner and Siegel, 2003) or physical environment (Savova, 2009). Some groups undertake charitable activities (Turkstra, 2008) or even act in a negative manner that can impact on the community (Horton, 1996). This research examines 582 New Zealand organisations to derive a set of purposes that residents’ groups perform and ascertains how their purposes differ between geo-social and political locality and over three distinct eras of community development. The thesis also examines the relationship between residents’ groups and councillors, council officers, district health board members and civil defence and seeks to uncover if the level of engagement (if any) has an affect on their overall raison d’etre. The research concludes with a typology of New Zealand residents’ groups along with the key purposes of each type.</p>

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Promoting positive interactions between midwives and obstetricians at the primary/secondary interface

New Zealand College of Midwives ◽

10.12784/nzcomjnl57.2021.6.41-48 ◽

2021 ◽

Vol 57 ◽

pp. 41-48

Author(s):

Rachel Cassie ◽

Christine Griffiths ◽

George Parker

Keyword(s):

New Zealand ◽

Thematic Analysis ◽

Maternity Care ◽

Interprofessional Collaboration ◽

Theoretical Perspective ◽

Positive Interactions ◽

Health Board ◽

District Health ◽

Interprofessional Communication ◽

Aotearoa New Zealand

Background: Interprofessional communication is a critical component of safe maternity care. The literature reports circumstances in Aotearoa New Zealand and overseas when interprofessional collaboration works well between midwives and obstetricians, as well as descriptions of unsatisfactory communication between the two professions. Aim: To explore and define effective collaboration between midwives and obstetricians at the primary/secondary interface in maternity care, in order to generate suggestions to foster positive collaboration. Method: Eight primary care midwives, three obstetricians and two obstetric registrars from a single District Health Board in Aotearoa New Zealand were interviewed about their interactions at the primary/secondary interface and their understanding, and use, of the Referral Guidelines. The theoretical perspective was Appreciative Inquiry. Data were analysed using thematic analysis. Findings: Results indicate usually positive interprofessional interactions. Dominant emergent themes are the need to negotiate differing philosophies, to clarify blurred boundaries that sometimes lead to lack of clear lines of responsibility, and the importance of three-way conversations. Of the three themes, this article focuses on three-way communication between midwife, obstetrician/registrar and woman. Participants reported that, when effective three-way communication between woman, midwife and obstetrician occurred, philosophical difference could be negotiated, blurred boundaries clarified and understanding of the respective roles of the LMC midwife and the obstetric team promoted. Participants value the Referral Guidelines but report some limitations to their applicability. Conclusion: Effective three-way communication promotes good maternity care. This study has identified ways to support optimal communication.

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