Objective.To estimate the independent effect of a single lower respiratory tract infection, urinary tract infection, or other healthcare-acquired infection on length-of-stay and variable costs and to demonstrate the bias from omitted variables that is present in previous estimates.Design.Prospective cohort study.Setting.A tertiary care referral hospital and regional district hospital in southeast Queensland, Australia.Patients.Adults aged 18 years or older with a minimum inpatient stay of 1 night who were admitted to selected clinical specialities.Results.Urinary tract infection was not associated with an increase in length of hospital stay or variable costs. Lower respiratory tract infection was associated with an increase of 2.58 days in the hospital and variable costs of AU$24, whereas other types of infection were associated with an increased length of stay of 2.61 days but not with variable costs. Many other factors were found to be associated with increased length of stay and variable costs alongside healthcare-acquired infection. The exclusion of these variables caused a positive bias in the estimates of the costs of healthcare-acquired infection.Conclusions.The existing literature may overstate the costs of healthcare-acquired infection because of bias, and the existing estimates of excess costs may not make intuitive sense to clinicians and policy makers. Accurate estimates of the costs of healthcare-acquired infection should be made and used in appropriately designed decision-analytic economic models (ie, cost-effectiveness models) that will make valid and believable predictions of the economic value of increased infection control.

This article describes the findings of a phenomenographic research approach used to understand the experiences of competence of new nurse graduates. The aim of phenomenography is to describe the qualitatively different ways in which people understand a phenomenon. Six new graduates, who had been employed in two paediatric metropolitan hospitals in Australia, participated in the research. The graduates were interviewed and asked to describe and draw their understanding of competence. The interviews were audio-taped and transcribed verbatim. Interview transcripts were analysed according to accepted phenomenographic methods of analysis. The graduates described eight conceptions of competence: competence as safe practice; competence as limited independence; competence as utilization of resources; competence as management of time and workload; competence as ethical practice; competence as performance of clinical skills; competence as knowledge; and competence as evolving. The final outcome of identification of conceptions led to the development of an outcome space (a diagrammatic representation of the logical relations between conceptions). The outcome space depicted a three-level hierarchical relationship between the eight conceptions of competence experienced within a global framework of safety. The findings contribute to nursing knowledge by describing the meaning of competence from the perspective of the new nurse graduate. The need for support and assistance by employers of new graduates is confirmed from the findings. New nurse graduate experiences of competence provide suggestions for improving undergraduate education programmes as well as clarification of entry-level competency standards.

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Title. Catheter-related bloodstream infections in intensive care units: a systematic review with meta-analysis. Aim. This paper is a report of a systematic review and meta-analysis of strategies, other than antimicrobial coated catheters, hypothesized to reduce risk of catheterrelated bloodstream infections and catheter colonization in the intensive care unit setting. Background. Catheter-related bloodstream infections occur at a rate of 5 per 1000 catheter days in the intensive care unit setting and cause substantial mortality and excess cost. Reducing risk of catheter-related bloodstream infections among intensive care unit patients will save costs, reduce length of stay, and improve outcomes. Methods. A systematic review of studies published between January 1985 and February 2007 was carried out using the keywords 'catheterization -central venous' with combinations of infection*, prevention* and bloodstream*. All included studies were screened by two reviewers, a validated data extraction instrument was used and data collection was completed by two blinded independent reviewers. Risk ratios for catheter-related bloodstream infections and catheter colonization were estimated with 95% confidence intervals for each study. Results from studies of similar interventions were pooled using meta-analyses. Results. Twenty-three studies were included in the review. The strategies that reduced catheter colonization included insertion of central venous catheters in the subclavian vein rather than other sites, use of alternate skin disinfection solutions before catheter insertion and use of Vitacuff in combination with polymyxin, neomycin and bacitracin ointment. Strategies to reduce catheter-related bloodstream infection included staff education multifaceted infection control programmes and performance feedback. Conclusion. A range of interventions may reduce risks of catheter-related bloodstream infection, in addition to antimicrobial catheters.