Modelling the transmission of healthcare associated infections: a systematic review

Kleef, Esther van; Robotham, Julie V.; Jit, Mark; Deeny, Sarah R; Edmunds, W. John

doi:10.1186/1471-2334-13-294

Cited by 152 publications

(150 citation statements)

References 118 publications

(218 reference statements)

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“…Healthcare-associated infections (HCAIs) can occur in care homes, hospitals or in a patient's own home (van Kleef et al, 2013), with a prevalence level of 6.4 % and 1 000 000 cases reported each year in England (HPA, 2012a). Medical device-related infections pose a huge financial burden on healthcare services and are associated with increased patient morbidity and mortality (Donlan, 2008); not surprisingly, HCAIs are of significant economic concern (NAO, 2000).…”

Section: Introductionmentioning

confidence: 99%

Healthcare-associated infections, medical devices and biofilms: risk, tolerance and control

Percival

Suleman

Vuotto

et al. 2015

Journal of Medical Microbiology

614

482

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Section: Introductionmentioning

confidence: 99%

Healthcare-associated infections, medical devices and biofilms: risk, tolerance and control

Percival

Suleman

Vuotto

et al. 2015

Journal of Medical Microbiology

614

482

View full text Add to dashboard Cite

“…Relevant research is dispersed across clinical, service management and design literatures 8,11,44 and extends to include themes of infection control effectiveness, transmission routes, the impact of movement patterns between health-care institutes, the development of antimicrobial resistance and strain competitiveness or cocolonisation. 45 Specific studies relate to different types of impact or measures of infection, clinical settings, population groups, different types of infection site (e.g. respiratory, urine, wound, blood) and organisms, including Escherichia coli (Migula 1895) Castellani and Chalmers 1919, methicillin-resistant Staphylococcus aureus Rosenbach 1884 (MRSA), Clostridium difficile (Hall and O'Toole 1935) Prévot 1938 (C.…”

Section: Box 1 Advantages and Disadvantages Of Single Rooms For Patiementioning

confidence: 99%

Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

Maben

Griffiths

Penfold

et al. 2015

Health Services and Delivery Research

177

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BackgroundNew hospital design includes more single room accommodation but there is scant and ambiguous evidence relating to the impact on patient safety and staff and patient experiences.ObjectivesTo explore the impact of the move to a newly built acute hospital with all single rooms on care delivery, working practices, staff and patient experience, safety outcomes and costs.Design(1) Mixed-methods study to inform a pre-/post-‘move’ comparison within a single hospital, (2) quasi-experimental study in two control hospitals and (3) analysis of capital and operational costs associated with single rooms.SettingFour nested case study wards [postnatal, acute admissions unit (AAU), general surgery and older people’s] within a new hospital with all single rooms. Matched wards in two control hospitals formed the comparator group.Data sourcesTwenty-one stakeholder interviews; 250 hours of observation, 24 staff interviews, 32 patient interviews, staff survey (n = 55) and staff pedometer data (n = 56) in the four case study wards; routinely collected data at ward level in the control hospitals (e.g. infection rates) and costs associated with hospital design (e.g. cleaning and staffing) in the new hospital.Results(1) There was no significant change to the proportion of time spent by nursing staff on different activities. Staff perceived improvements (patient comfort and confidentiality), but thought the new accommodation worse for visibility and surveillance, teamwork, monitoring, safeguarding and remaining close to patients. Giving sufficient time and attention to each patient, locating other staff and discussing care with colleagues proved difficult. Two-thirds of patients expressed a clear preference for single rooms, with the benefits of comfort and control outweighing any disadvantages. Some patients experienced care as task-driven and functional, and interaction with other patients was absent, leading to a sense of isolation. Staff walking distances increased significantly after the move. (2) A temporary increase in falls and medication errors within the AAU was likely to be associated with the need to adjust work patterns rather than associated with single rooms, although staff perceived the loss of panoptic surveillance as the key to increases in falls. Because of the fall in infection rates nationally and the low incidence at our study site and comparator hospitals, it is difficult to conclude from our data that it is the ‘single room’ factor that prevents infection. (3) Building an all single room hospital can cost 5% more but the difference is marginal over time. Housekeeping and cleaning costs are higher.ConclusionsThe nature of tasks undertaken by nurses did not change, but staff needed to adapt their working practices significantly and felt ill prepared for the new ways of working, with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. There was no strong evidence that single rooms had any impact on patient safety but housekeeping and cleaning costs are higher. In terms of future work, patient experience and preferences in hospitals with different proportions of single rooms/designs need to be explored with a larger patient sample. The long-term impact of single room working on the nature of teamwork and informal learning and on clinical/care outcomes should also be explored.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…20 For healthcare-associated infections, computational models of pathogen transmission have become valuable tools to evaluate healthcare interventions, especially in the absence of controlled intervention studies. 21 In this study, we evaluated the effect of screening patients for C. difficile colonization at admission-followed by contact precautions for patients who tested positive-on preventing colonization and disease in an endemic setting. We used an agent-based model of C. difficile transmission to specifically address how diagnostic test characteristics (ie, sensitivity and turnaround time) used for screening, colonization prevalence, and type of strain carried by colonized patients at admission affected the effectiveness of screening for asymptomatic carriers in reducing transmission and hospital-onset CDIs (HO-CDIs) in a hospital ward.…”

mentioning

confidence: 99%

Effectiveness of Screening Hospital Admissions to Detect Asymptomatic Carriers of Clostridium difficile: A Modeling Evaluation

Lanzas

Dubberke

2014

Infect. Control Hosp. Epidemiol.

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ObjectiveBoth asymptomatic and symptomatic Clostridium difficile carriers contribute to new colonizations and infections within a hospital, but current control strategies focus only on preventing transmission from symptomatic carriers. Our objective was to evaluate the potential effectiveness of methods targeting asymptomatic carriers to control C. difficile colonization and infection (CDI) rates in a hospital ward: screening patients at admission to detect asymptomatic C. difficile carriers and placing positive patients into contact precautions.MethodsWe developed an agent-based transmission model for C. difficile that incorporates screening and contact precautions for asymptomatic carriers in a hospital ward. We simulated scenarios that vary according to screening test characteristics, colonization prevalence, and type of strain present at admission.ResultsIn our baseline scenario, on average, 42% of CDI cases were community-onset cases. Within the hospital-onset (HO) cases, approximately half were patients admitted as asymptomatic carriers who became symptomatic in the ward. On average, testing for asymptomatic carriers reduced the number of new colonizations and HO-CDI cases by 40%–50% and 10%–25%, respectively, compared with the baseline scenario. Test sensitivity, turnaround time, colonization prevalence at admission, and strain type had significant effects on testing efficacy.ConclusionsTesting for asymptomatic carriers at admission may reduce both the number of new colonizations and HO-CDI cases. Additional reductions could be achieved by preventing disease in patients who are admitted as asymptomatic carriers and developed CDI during the hospital stay.

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Modelling the transmission of healthcare associated infections: a systematic review

Cited by 152 publications

References 118 publications

Healthcare-associated infections, medical devices and biofilms: risk, tolerance and control

Healthcare-associated infections, medical devices and biofilms: risk, tolerance and control

Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

Effectiveness of Screening Hospital Admissions to Detect Asymptomatic Carriers of Clostridium difficile: A Modeling Evaluation

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