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ABSTRACT: Litigation costs resulting from clinical negligence claims involving healthcare-associated infections are a significant but underappreciated cost to healthcare organizations. In England these claims are handled on behalf of the National Health Service (NHS) organizations by the NHS Litigation Authority (NHSLA). The total number of claims and the amounts awarded have increased significantly in recent years.
To determine whether the recent significant reductions in meticillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) and Clostridium difficile infections in England have had an effect on the number and value of NHSLA claims relating to these infections.
Data obtained from the NHSLA relating to claims mentioning C. difficile or MRSA from 2003 to 2010 were correlated with mandatory surveillance data from the Health Protection Agency for these infections.
The rate of NHSLA claims for MRSA has decreased in line with reductions in BSI for this infection (0.007 per BSI between 2003/4-2006/7 to 0.0017 per BSI between 2007/8 and 2010/11), but there was no significant change in claims relating to C. difficile infection. Overall the amounts awarded for successful claims have decreased significantly from a total of £76,846 for the period 1997/8-2006/7 to £24,821 for the period 2007/8-2010/11.
The number of litigation claims involving MRSA has recently decreased significantly in line with surveillance data. There was no observed effect on claims involving C. difficile. The amounts awarded for successful claims for both infections have also fallen, although the reasons for this are not clear.
The Journal of hospital infection 05/2012; 81(3):156-62. · 3.01 Impact Factor
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ABSTRACT: Recent studies have shown poor performance of commonly used toxin enzyme immunoassays (EIAs) for laboratory testing for Clostridium difficile infection (CDI). In 2009-2010, the UK Health Protection Agency and the European Society of Clinical Microbiology and Infectious Diseases stated that toxin EIA testing alone is suboptimal, and recommended a two-step testing protocol (i.e. screening with one method and confirming the results with another method). All acute English National Health Service trusts were surveyed to determine their testing methods and positivity rates using freedom of information requests. Replies were received from 168 of 170 trusts (99% response rate). Seventy percent of trusts were using a toxin EIA as a standalone testing method, with positive predictive values (PPVs) as low as 20% in some cases. The mean positivity rate decreased from 6.45% in 2008 to 4.47% in 2009, which will have a negative effect on the PPVs of these tests. The UK Department of Health publishes CDI rates as a measure of quality of care and good infection control practice. However, this may not provide valid comparisons because of the wide disparity between testing methods. The present study demonstrates wide variation in testing practices for CDI in England, and laboratories should reconsider their current testing strategies.
The Journal of hospital infection 07/2011; 79(1):4-7. · 3.01 Impact Factor
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The Journal of hospital infection 02/2011; 77(2):169-70. · 3.01 Impact Factor
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Journal of clinical microbiology 08/2010; 48(8):3048-9. · 4.16 Impact Factor
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The Journal of hospital infection 05/2010; · 3.01 Impact Factor
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ABSTRACT: Current diagnosis of Clostridium difficile infection (CDI) relies upon detection of toxins A/B in stool by enzyme immunoassay [EIA(A/B)]. This strategy is unsatisfactory because it has a low sensitivity resulting in significant false negatives. We investigated the performance of a two-step algorithm for diagnosis of CDI using detection of glutamate dehydrogenase (GDH). GDH-positive samples were tested for C. difficile toxin B gene (tcdB) by polymerase chain reaction (PCR). The performance of the two-step protocol was compared with toxin detection by the Meridian Premier EIA kit in 500 consecutive stool samples from patients with suspected CDI. The reference standard among samples that were positive by either EIA(A/B) or GDH testing was culture cytotoxin neutralisation (culture/CTN). Thirty-six (7%) of 500 samples were identified as true positives by culture/CTN. EIA(A/B) identified 14 of the positive specimens with 22 false negatives and two false positives. The two-step protocol identified 34 of the positive samples with two false positives and two false negatives. EIA(A/B) had a sensitivity of 39%, specificity of 99%, positive predictive value of 88% and negative predictive value of 95%. The two-step algorithm performed better, with corresponding values of 94%, 99%, 94% and 99% respectively. Screening for GDH before confirmation of positives by PCR is cheaper than screening all specimens by PCR and is an effective method for routine use. Current EIA(A/B) tests for CDI are of inadequate sensitivity and should be replaced; however, this may result in apparent changes in CDI rates that would need to be explained in national surveillance statistics.
The Journal of hospital infection 11/2009; 74(1):48-54. · 3.01 Impact Factor
