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Publications (10)11.05 Total impact

  • Journal of Hospital Infection - J HOSP INFECT. 01/2010; 76.
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    ABSTRACT: Following recommendations from a Health Technology Assessment (HTA), a prospective cohort study of meticillin-resistant Staphylococcus aureus (MRSA) screening of all admissions (N=29 690) to six acute hospitals in three regions in Scotland indicated that 7.5% of patients were colonised on admission to hospital. Factors associated with colonisation included re-admission, specialty of admission (highest in nephrology, care of the elderly, dermatology and vascular surgery), increasing age, and the source of admission (care home or other hospital). Three percent of all those who were identified as colonised developed hospital-associated MRSA infection, compared with only 0.1% of those not colonised. Specialties with a high rate of colonisation on admission also had higher rates of MRSA infection. Very few patients refused screening (11 patients, 0.03%) or had treatment deferred (14 patients, 0.05%). Several organisational issues were identified, including difficulties in achieving complete uptake of screening (88%) or decolonisation (41%); the latter was largely due to short duration of stay and turnaround time for test results. Patient movement resulted in a decision to decolonise all positive patients rather than just those in high risk specialties as proposed by the HTA. Issues also included a lack of isolation facilities to manage patients with MRSA. The study raises significant concerns about the contribution of decolonisation to reducing risks in hospital due to short duration of stay, and reinforces the central role of infection control precautions. Further study is required before the HTA model can be re-run and conclusions redrawn on the cost and clinical effectiveness of universal MRSA screening.
    The Journal of hospital infection 12/2009; 74(1):35-41. · 3.01 Impact Factor
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    ABSTRACT: This study identifies factors associated with a high prevalence of healthcare-associated infection (HAI) in the Scottish inpatient population, on the basis of the Scotland National HAI Prevalence Survey data set. The multivariate models developed can be used to predict HAI prevalence in specific patient groups to help with planning and policy in infection control.
    Infection Control and Hospital Epidemiology 02/2009; 30(2):187-9. · 4.02 Impact Factor
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    ABSTRACT: We report the development of a local healthcare associated infection prevalence survey methodology that uses multivariate adjustment and funnel plots to facilitate benchmarking of local survey results against Scottish National HAI Prevalence Survey data. The tool provides robust and consistent results that can be used to inform infection control strategy.
    Journal of Infection Prevention 01/2009; 10:194-196.
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    ABSTRACT: To investigate the impact of postdischarge surveillance (PDS) on surgical-site infection (SSI) rates for selected surgical procedures in acute care hospitals in Scotland. Prospective surveillance of SSI after selected surgical procedures. The Scottish Surveillance of Healthcare Associated Infection Programme (SSHAIP), which is based on the methodology of the Centers for Disease Control and Prevention (CDC) National Nosocomial Infections Surveillance system (NNIS). Thirty-two of 46 acute care hospitals throughout Scotland contributed data to SSHAIP for this study. Data were from 21,710 operations that took place between April 1, 2002, and June 30, 2004; nine categories of surgical procedures were analyzed. CDC NNIS system definitions and methods were used for SSI PDS. PDS is a voluntary component of the mandatory SSI surveillance program in Scotland. PDS was categorized as none, passive, active without direct observation, and active with direct observation. From our study information, PDS data were available for 12,885 operations (59%). A total of 2,793 procedures (13%) were associated with passive PDS and 10,092 (46%) with active PDS. The SSI rate among the 8,825 operations with no PDS was 2.61% (95% confidence interval [CI], 2.3%-3.0%), which was significantly lower than the SSI rate found among the 12,885 operations for which PDS was performed (6.34% [95% CI, 5.9%-6.8%]). For breast surgery, cesarean section, hip replacement, and abdominal hysterectomy, the rate of SSI when PDS was performed was significantly higher than that when PDS was not performed (P<.01 for each procedure). No differences in SSI rates were found for surgery to repair fractured neck of the femur or for knee replacement. SSI rates were examined according to procedure type, performance of PDS, and NNIS risk index; rates of SSI increased with NNIS risk index within procedure group and PDS group. Logistic regression analyses confirmed that procedure type, performance of PDS, and NNIS risk index were all statistically independent predictors of report of an SSI (P<.05). This Scottish national data set incorporates a substantial amount of PDS data. We recommend a procedure-specific approach to PDS, with direct observation of patients after breast surgery, cesarean section, and hysterectomy, for which the length of stay is typically short. Readmission surveillance may be adequate to detect most SSIs after orthopedic surgery or vascular surgery, for which the length of stay is typically longer.
    Infection Control and Hospital Epidemiology 12/2006; 27(12):1318-23. · 4.02 Impact Factor
  • Journal of Hospital Infection - J HOSP INFECT. 01/2006; 64.
  • R. Hill, G. Allardice, J. Reilly, M. Coyne
    Journal of Hospital Infection - J HOSP INFECT. 01/2006; 64.
  • Journal of Hospital Infection - J HOSP INFECT. 01/2006; 64.
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    ABSTRACT: Chronic disease status of a patient may contribute to their risk of acquiring HAI. Three common chronic conditions that have previously been associated with an increased risk of infection are malignancies, chronic renal failure and diabetes mellitus. These conditions are known to have an effect on neutrophil counts and neutropenic patients are at a higher risk of infection due to impaired immune responses (2,3). The aim of this study was to determine the effect of three common chronic diseases, namely cancer, chronic renal failure and diabetes mellitus, on the prevalence of healthcare associated infection in Scottish hospitals.
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