Impact of surgical-site infection on health utility values: a meta-analysis

Background: SSI are recognised as negatively affecting patient quality of life. Currently, no meta-analysis of SSI utility values is available in the literature to inform estimates of this burden and investment decisions in prevention. Method: A systematic search of PubMed, Medline, CINAHL and the NHS Economic Evaluation Database was performed in April 2022 as per PROSPERO registration CRD 42021262633. Studies were included where quality of life data was gathered from adults undergoing surgery whereby quality of life data was presented as those with infection and those without at similar time points. Two researchers performed data extraction and quality appraisal independently, with a third as arbiter. Utility values were converted to EQ-5D. Meta-analyses were conducted using a random effects model across all relevant studies with subgroup analyses on SSI type and timing since surgery. Results: 15 studies met the inclusion criteria with 2817 patients; six studies across seven time points were used for meta-analysis. The pooled mean difference in EQ-5D utility in all studies combined was – 0.08 (95% CI -0.11 - -0.05, I2 = 40%, prediction interval -0.16 to -0.01.). The mean difference in EQ-5D utility associated with Deep SSI was -0.10 (95%CI -0.14 - -0.06, I2 = 0.00%) and the mean difference in EQ-5D persisted over time. Conclusion: The first synthesised estimate of SSI burden over the short and long term is provided. EQ-5D utility estimates for a range of SSI are essential for infection prevention planning and future economic modelling.I am uploading the PDF of the accepted manuscript and will update it with the PDF proof once availabl

How do we evaluate the cost of nosocomial infection? The ECONI protocol: an incidence study with nested case-control evaluating cost and quality of life

Introduction Healthcare-associated or nosocomial infection (HAI) is distressing to patients and costly for the National Health Service (NHS). With increasing pressure to demonstrate cost-effectiveness of interventions to control HAI and notwithstanding the risk from antimicrobial-resistant infections, there is a need to understand the incidence rates of HAI and costs incurred by the health system and for patients themselves. Methods and analysis The Evaluation of Cost of Nosocomial Infection study (ECONI) is an observational incidence survey with record linkage and a nested case-control study that will include postdischarge longitudinal follow-up and qualitative interviews. ECONI will be conducted in one large teaching hospital and one district general hospital in NHS Scotland. The case mix of these hospitals reflects the majority of overnight admissions within Scotland. An incidence survey will record all HAI cases using standard case definitions. Subsequent linkage to routine data sets will provide information on an admission cohort which will be grouped into HAI and non-HAI cases. The case-control study will recruit eligible patients who develop HAI and twice that number without HAI as controls. Patients will be asked to complete five questionnaires: the first during their stay, and four others during the year following discharge from their recruitment admission (1, 3, 6 and 12 months). Multiple data collection methods will include clinical case note review; patient-reported outcome; linkage to electronic health records and qualitative interviews. Outcomes collected encompass infection types; morbidity and mortality; length of stay; quality of life; healthcare utilisation; repeat admissions and postdischarge prescribing. Ethics and dissemination The study has received a favourable ethical opinion from the Scotland A Research Ethics Committee (reference 16/SS/0199). All publications arising from this study will be published in open-access peer-reviewed journal. Lay-person summaries will be published on the ECONI website. Trial registration number NCT03253640; Pre-results

Estimating excess length of stay due to healthcare-associated infections: A systematic review and meta-analysis of statistical methodology

BackgroundHealthcare-associated infection (HAI) affects millions of patients worldwide. HAI is associated with increased healthcare costs, owing primarily to increased hospital length of stay (LOS) but calculating these costs is complicated due to time-dependent bias. Accurate estimation of excess LOS due to HAI is essential to ensure we invest in cost-effective infection prevention and control (IPC) measures.AimTo identify and review the main statistical methods that have been employed to estimate differential LOS between patients with, and without, HAI; to highlight and discuss potential biases of all statistical approaches.MethodsA systematic review from 1997 to April 2017 was conducted in PUBMED, CINAHL, PROQUEST and ECONLIT databases. Studies were quality assessed using an adapted Newcastle-Ottawa Scale (NOS). Methods were categorised into time-fixed or time-varying with the former exhibiting time-dependent bias. We use two examples of meta-analysis to illustrate how estimates of excess LOS differ between different studies.FindingsNinety-two studies with estimates on excess LOS were identified. The majority of articles employed time-fixed methods (75%). Studies using time-varying methods are of higher quality according to NOS. Studies using time-fixed methods overestimate additional LOS attributable to HAI. Undertaking meta-analysis is challenging due to a variety of study designs and reporting styles. Study differences are further magnified by heterogeneous populations, case definitions, causative organisms and susceptibilities.ConclusionsMethodologies have evolved over the last 20 years but there is still a significant body of evidence reliant upon time-fixed methods. Robust estimates are required to inform investment in cost-effective IPC interventions

Effectiveness of national and subnational infection prevention and control interventions in high-income and upper-middle-income countries: a systematic review

Evidence-based guidance for national infection prevention and control (IPC) programmes is needed to support national and global capacity building to reduce health-care-associated infection and antimicrobial resistance. In this systematic review we investigate evidence on the effectiveness of IPC interventions implemented at national or subnational levels to inform the development of WHO guidelines on the core components of national IPC programmes. We searched CENTRAL, CINAHL, Embase, MEDLINE, and WHO IRIS databases for publications between Jan 1, 2000, and April 19, 2017. 29 studies that met the eligibility criteria (ie, economic evaluations, cluster-randomised trials, non-randomised trials, controlled before-and-after studies, and interrupted time-series studies exploring the effective of these interventions) were categorised according to intervention type: multimodal, care bundles, policies, and surveillance, monitoring, and feedback. Evidence of effectiveness was found in all categories but the best quality evidence was on multimodal interventions and surveillance, monitoring, and feedback. We call for improvements in study design, reporting of research, and quality of evidence particularly from low-income countries, to strengthen the uptake and international relevance of IPC interventions

Wound debridement: a clinical update.

This article aims to improve nurses’ knowledge of wound debridement through a review of different techniques and the related physiology of wound healing. Debridement has long been an established component of effective wound management. However, recent clinical developments have widened the choice of methods available. This article provides an overview of the physiology of wounds, wound bed preparation, methods of debridement and the important considerations for the practitioner in implementing effective, informed and patient-centred wound car

Evaluating a brief intervention for mealtime difficulty on older adults with dementia

Aims and objective: To test a spaced retrieval intervention using spaced retrieval to alleviate mealtime difficulties in older people with dementia. Design: A single-case study design. Setting: Nursing Homes in North Central England, United Kingdom. Participants: Older people with Alzheimer’s disease. Methods: A single-case study using an ABA design was used. Data were collected using the Edinburgh Feeding Evaluation in Dementia scale, Mini Nutritional Assessment, and Body Mass Index before intervention, postintervention and following 3 months of postintervention. Realist evaluation was used to identify for which participants the intervention was effective, and an economic evaluation was also carried out. Finding: Of 15 participants who entered the study, eight completed all phases of the study. A mean 104.4 h were needed to deliver the intervention. The number of sessions required ranged from 90–222. The length of time each participant retained information (for all sessions) ranged from 13–28 min. Participants had most difficulty with: “putting food into mouth and chewing it”; “realizing it was mealtime”; and “eating a whole meal continuously.” A reduction in the difficulty with mealtimes occurred between phase A1–A2 for most participants. Six participants maintained this in phase A3. Similar patterns were evident for nutritional scores. For most participants, the effect size of the intervention was moderate or large. Conclusions: Spaced retrieval is useful in reducing mealtime difficulties in older participants with dementia. While the results of this study are promising, further large and multicentre trials are needed to explore the effectiveness of the intervention in diverse populations