Browsing by Author "Henderson, Elizabeth"
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- ItemOpen AccessA cost-effectiveness analysis of mupirocin and chlorhexidine gluconate for Staphylococcus aureus decolonization prior to hip and knee arthroplasty in Alberta, Canada compared to standard of care(2019-07-11) Rennert-May, Elissa; Conly, John; Smith, Stephanie; Puloski, Shannon; Henderson, Elizabeth; Au, Flora; Manns, BradenAbstract Background While decolonization of Staphylococcus aureus reduces surgical site infection (SSI) rates following hip and knee arthroplasty, its cost-effectiveness is uncertain. We sought to examine the cost-effectiveness of a decolonization protocol for Staphylococcus aureus prior to hip and knee replacement in Alberta compared to standard care – no decolonization. Methods Decision analytic models and a probabilistic sensitivity analysis were used for a cost-effectiveness analysis, with the effectiveness of decolonization based on a large published pre- and post- intervention trial. The primary outcomes of the models were infections prevented and health care costs. We modelled the cost-effectiveness of decolonization in a hypothetical cohort of adult patients undergoing hip and knee replacement in Alberta, Canada. Information on the incidence of complex surgical site infections (SSIs), as well as the cost of care for patients with and without SSIs was taken from a provincial infection control database, and health administrative data. Results Use of the decolonization bundle was cost saving compared to usual care ($153/person), and resulted in 16 complex Staphylococcus aureus SSIs annually as opposed to 32 (with approximately 8000 hip or knee arthroplasties performed). The probabilistic sensitivity analysis demonstrated that the majority (84%) of the time the decolonization bundle was cost saving. The model was robust to one-way sensitivity analyses conducted within plausible ranges. There were small upfront costs associated with using a decolonization protocol, however, this model demonstrated cost savings over one year. In a Markov model that considered the impact of a decolonization bundle over a lifetime as it pertained to the need for subsequent joint replacements and patient quality of life, the bundle still resulted in cost savings ($161/person). Conclusions Decolonization for Staphylococcus aureus prior to hip and knee replacements resulted in cost savings and fewer SSIs, and should be considered prior to these procedures.
- ItemOpen AccessA Mathematical Model For Optimal Admission Screening For Methicillin Resistant Staphylococcus aureus In Acute Care Facilities(2016-01-26) Simmonds, Kimberley Anne; Henderson, Elizabeth; Laupland, Kevin; Joffe, Mark; Svenson, Larry; Dean, Stafford; Li, MichaelMethicillin-resistant Staphylococcus aureus (MRSA) is one of the most common healthcare associated infections (HAIs) worldwide. It has both an economic and personal cost to the healthcare system and infected individuals. Admission screening for MRSA is one method to detect MRSA entering the acute care system. Screening combined with isolation is currently a common method for preventing MRSA transmission in Alberta acute care facilities. There remains uncertainty about the best methods to screening patients for MRSA. Universal screening is the testing of all patients admitted to the hospital, regardless of their risk of MRSA colonization; conversely targeted screening only tests a selected patient population considered at greatest risk for MRSA colonization. Mathematical models for infectious diseases, such as MRSA, are very useful for predicting outcomes with varying scenarios. The purpose of this project was to develop and validate a deterministic differential equations model for MRSA transmission to determine the optimal screening method for the detection of MRSA infected individuals entering acute care facilities. Based on the local epidemiology used to develop this model, the conclusions drawn from the model are that targeted screening of 70-90% of high-risk patients will reduce unidentified-infected MRSA positive individuals. However, this Alberta model that shows a targeted screening program for high-risk individuals with horizontal measures to reduce the hospital transmission rate is the most effective way to reduce MRSA in Alberta acute care facilities.
- ItemOpen AccessAn exploration of IPAC educational intervention research: What do we mean by education?(Infection Prevention and Control Canada, 2018) Meyers, Gwyneth; Jacobsen, Michele; Henderson, ElizabethBackground: Education is considered an important component of Infection Prevention and Control (IPAC) practice. A shift has occurred from exploring how education plays a role in changing healthcare provider infection control practices to increased interest in the use of multimodal interventions. However, several comprehensive systematic literature reviews have identified theoretical, conceptual and methodological challenges in IPAC educational intervention research. Methods: To gain deeper insight into the challenges, a qualitative review was conducted using a content analysis of 122 papers published between 1989 and 2017. Results: IPAC educational practice and research is predominantly informed by the traditional educational paradigm of knowledge acquisition, with a commitment to quantitative research methodologies that treat education as a static tool. Limited attention is given to educational theories, teaching and learning concepts and instructional design processes. Conclusions: IPAC educational practice is constrained by implicit philosophical assumptions about education as information delivery. This paper proposes a paradigm shift from transmission educational practices to those more attuned to the concepts of teaching and learning. By making this shift, IPAC can begin to address the challenges identified in the literature and explore educational theories, contemporary active and engaged teaching and learning processes, instructional design frameworks, and using innovative educational research methodologies.
- ItemOpen AccessClostridium difficile infection incidence and mortality in Alberta(2017) Crocker, Alysha; Henderson, Elizabeth; Henderson, Elizabeth; Smith, Stephanie; Barkema, Herman; Chandran, Uma; Kim, Joseph; Vicker, DavidClostridium difficile infection (CDI) is the leading cause of hospital-acquired diarrhea. It causes significant morbidity and mortality, manifesting in life threatening conditions such as pseudomembranous colitis. This study determined the incidence of CDI in Alberta, investigated risk factors associated with mortality amongst Alberta CDI patients, and investigated the inter-rater reliability between the Death Attribution Rules for Patients Infected by C. difficile (DARPIC) algorithm and IPC physicians. Incidence of CDI in Alberta hospitals, continuing care facilities, and the community provided a comprehensive understanding of CDI in Alberta. Although CDI is predominantly a nosocomial infection, 47% of the CDI cases identified in this study occurred in the community. Risk factors for mortality amongst hospitalized CDI patients were increasing age and comorbidity count, liver disease, and metastatic solid tumour. Attributing death to CDI is difficult and opinions vary by clinicians, to accurately and consistently report attributable CDI mortality a standardized approach is necessary.
- ItemOpen AccessComprehensive Strategy to Decolonize Methicillin-Resistant Staphylococcus aureus in the Outpatient Setting: a Randomized Controlled Study(2013-10-03) Kim, Joseph; Henderson, Elizabeth; Conly, John; Louie, Thomas; Sauve, Reg; Zhang, KunyanThe objective of this study was to examine the efficacy of a comprehensive decolonization treatment in reducing methicillin-resistant Staphylococcus aureus (MRSA) carriage among an outpatient population. Patients colonized with MRSA were randomized to receive pharmacological decolonization treatment or no treatment. The primary outcome was detection of MRSA at 3 months. Occurrence of MRSA infection was assessed at 6 months. Molecular analyses were performed on all MRSA isolates. Of 205 patients, 15 (7%) were enrolled into the study (9 treatment; 6 control). At 3 months, 4/8 (50%) in the treatment group had eradication and none in the control group (0/4, 0%). Infection occurred in 5 patients (3 treatment; 2 control). All of the MRSA isolates were community-associated MRSA strain types with USA300 accounting for 87%. Among persistent CA-MRSA carriers, our decolonization treatment was well tolerated. However, enrollment was limited. Future studies with different enrollment strategies are required.
- ItemOpen AccessHospital ward design and prevention of hospital-acquired infections: A prospective clinical trial(2014-01-01) Ellison, Jennifer; Southern, Danielle; Holton, Donna; Henderson, Elizabeth; Wallace, Jean; Faris, Peter; Ghali, William A; Conly, JohnBACKGROUND: Renovation of a general medical ward provided an opportunity to study health care facility design as a factor for preventing hospital-acquired infections.OBJECTIVE: To determine whether a hospital ward designed with predominantly single rooms was associated with lower event rates of hospital-acquired infection and colonization.METHODS: A prospective controlled trial with patient allocation incorporating randomness was designed with outcomes on multiple ‘historic design’ wards (mainly four-bed rooms with shared bathrooms) compared with outcomes on a newly renovated ‘new design’ ward (predominantly single rooms with private bathrooms).RESULTS: Using Poisson regression analysis and adjusting for time at risk, there were no differences (P=0.18) in the primary outcome (2.96 versus 1.85 events/1000 patient-days, respectively). After adjustment for age, sex, Charlson score, admitted from care facility, previous hospitalization within six months, isolation requirement and the duration on antibiotics, the incidence rate ratio was 1.44 (95% CI 0.71 to 2.94) for the new design versus the historic design wards. A restricted analysis on the numbers of events occurring in single-bed versus multibed wings within the new design ward revealed an event incidence density of 1.89 versus 3.47 events/1000 patient-days, respectively (P=0.18), and an incidence rate ratio of 0.54 (95% CI 0.15 to 1.30).CONCLUSIONS: No difference in the incidence density of hospital-acquired infections or colonizations was observed for medical patients admitted to a new design ward versus historic design wards. A restricted analysis of events occurring in single-bed versus multibed wings suggests that ward design warrants further study.
- ItemOpen AccessImplementation strategies for hospital-based probiotic administration in a stepped-wedge cluster randomized trial design for preventing hospital-acquired Clostridioides difficile infection(2023-12-11) Bresee, Lauren C.; Lamont, Nicole; Ocampo, Wrechelle; Holroyd-Leduc, Jayna; Sabuda, Deana; Leal, Jenine; Dalton, Bruce; Kaufman, Jaime; Missaghi, Bayan; Kim, Joseph; Larios, Oscar E.; Henderson, Elizabeth; Raman, Maitreyi; Fletcher, Jared R.; Faris, Peter; Kraft, Scott; Shen, Ye; Louie, Thomas; Conly, John M.Abstract Background Clostridioides difficile infection (CDI) is associated with considerable morbidity and mortality in hospitalized patients, especially among older adults. Probiotics have been evaluated to prevent hospital-acquired (HA) CDI in patients who are receiving systemic antibiotics, but the implementation of timely probiotic administration remains a challenge. We evaluated methods for effective probiotic implementation across a large health region as part of a study to assess the real-world effectiveness of a probiotic to prevent HA-CDI (Prevent CDI-55 +). Methods We used a stepped-wedge cluster-randomized controlled trial across four acute-care adult hospitals (n = 2,490 beds) to implement the use of the probiotic Bio-K + ® (Lactobacillus acidophilus CL1285®, L. casei LBC80R® and L. rhamnosus CLR2®; Laval, Quebec, Canada) in patients 55 years and older receiving systemic antimicrobials. The multifaceted probiotic implementation strategy included electronic clinical decision support, local site champions, and both health care provider and patient educational interventions. Focus groups were conducted during study implementation to identify ongoing barriers and facilitators to probiotic implementation, guiding needed adaptations of the implementation strategy. Focus groups were thematically analyzed using the Theoretical Domains Framework and the Consolidated Framework of Implementation Research. Results A total of 340 education sessions with over 1,800 key partners and participants occurred before and during implementation in each of the four hospitals. Site champions were identified for each included hospital, and both electronic clinical decision support and printed educational resources were available to health care providers and patients. A total of 15 individuals participated in 2 focus group and 7 interviews. Key barriers identified from the focus groups resulted in adaptation of the electronic clinical decision support and the addition of nursing education related to probiotic administration. As a result of modifying implementation strategies for identified behaviour change barriers, probiotic adherence rates were from 66.7 to 75.8% at 72 h of starting antibiotic therapy across the four participating acute care hospitals. Conclusions Use of a barrier-targeted multifaceted approach, including electronic clinical decision support, education, focus groups to guide the adaptation of the implementation plan, and local site champions, resulted in a high probiotic adherence rate in the Prevent CDI-55 + study.
- ItemOpen AccessMeasuring the effectiveness of terminal cleaning by housekeepers at the Foothills Medical Center(2012-10-03) Pearce, Craig; Henderson, ElizabethThe primary objective of this study was to quantify and map the biological contamination within private hospital rooms at Foothills Medical Center in Calgary Alberta. Secondary objectives were to assess the ability of two common cleaning products to remove biological contamination from surfaces as well as compare two methods of measuring housekeeping efficacy (UV gel and microbiological sampling techniques). Researchers covertly observed 9 housekeepers terminally clean 31 private rooms. Assessment took place using microbial swabbing and UV gel technology to evaluate cleanliness. Results suggest that the type of cleaning product does not make an impact, and that cleaning technique may be of higher importance. Lastly, the use of UV gel is may not be a suitable substitute for measuring a reduction of microbial contamination.
- ItemOpen AccessReasons for Testing Women for Genital Chlamydia trachomatis Infection in the Calgary Region(2003-01-01) Church, Deirdre L; Zentner, Ali; Semeniuk, Heather; Henderson, Elizabeth; Read, RonOBJECTIVE: To determine the clinical reason(s) for screening women with varying degrees of risk for genital Chlamydia trachomatis (CT) in the Calgary region.DESIGN: Women aged 15 to 75 years were enrolled at various patient care locations. Pertinent risk factors for genital CT infection were recorded and a gynecological examination was performed. Two endocervical swabs and a first-void urine sample were collected for CT detection using two different nucleic acid amplification test methods.SETTING: Calgary is an urban region that provides healthcare services to a population of almost one million people. Microbiology services are provided by Calgary Laboratory Services through a centralized regional laboratory service.MAIN RESULTS: 504 women with a mean age of 28.1 ± SD 8.22 years were enrolled. Two hundred ninety-one women (57.8%) were at high risk for acquiring genital CT infection. Twenty-eight (5.6%) tested positive for CT infection and almost all of these women (26 of 28, 93%) had risk factors for acquiring infection. Of the high-risk women, 9.8% were CT positive versus only 1.3% of women at low risk (P=0.0001). Only two of 152 (1.3%) women older than 30 years had genital CT infections. Although most women were asymptomatic, those with laboratory-confirmed CT infection were more likely to have genitourinary symptoms. Three hundred forty-three of 476 (72%) women who did not have genital CT infection had no risk factors, and screening was done as part of a routine gynecological examination for other purposes (prenatal visit, Pap smear).CONCLUSION: Women without risk factors are being screened routinely for genital CT infection as part of a routine gynecological examination done for other reasons. Elimination of the routine screening of low-risk women older than 30 years of age would decrease the current regional utilization of CT tests by as much as one-third.
- ItemOpen AccessSocial Return On Investment (SROI): valuing what matters in a complete community - the Twinhills LEED-ND project(2012) Tahir, Mahrukh; Henderson, Elizabeth; Herremans, Irene
- ItemOpen AccessThe impact of ventilator-associated pneumonia among prehospital intubated patients.(2012-08-16) Linton, Kathryn; Henderson, ElizabethThe objective of this study was to determine if all-cause mortality and hospital length of stay among patients who develop ventilator-associated pneumonia (VAP) differs for patients intubated in the Prehospital setting compared to those intubated in the Emergency Department. A retrospective cohort design was employed and secondary data was retrieved from the local VAP Surveillance database and manual chart reviews. Intubated patients entered the cohort upon VAP diagnosis and exited upon death or hospital discharge. This study used data from three large inner-city adult hospitals within Calgary, Alberta Canada. The sample (n=193) consisted of all adult (>18 years old) patients that developed VAP in an Intensive Care Unit who were intubated either in the Prehospital or Emergency Department setting during the study period (January 01, 2005 and December 31, 2009). Patients in this study intubated in the Prehospital setting were very similar to patients intubated in the Emergency Department with regards to basic demographic and admission characteristics. This study provides several novel results about the association between endotracheal intubation (ETI) location and morbidity and mortality among patients who acquire VAP in the ICU. Patients who suffer severe illness or injury (APACHE II score >25) are more likely to die if they are intubated in the Prehospital setting compared to the Emergency Department (p=<0.001). Furthermore, Prehospital ETI patients who die, do so sooner than Emergency Department ETI patients; whereas Prehospital ETI patients who survive, have longer hospitalizations than their Emergency Department counterparts (p=<0.001). Perhaps preventing ETI in the Prehospital setting or postponing ETI until Emergency Department would result in decreased hospital mortality. Further research is required before this information should be used in a clinical setting.