Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England

Objectives To estimate the annual health economic impact of healthcare-associated infections (HCAIs) to the National Health Service (NHS) in England. Design A modelling study based on a combination of published data and clinical practice. Setting NHS hospitals in England. Primary and secondary outcome measures Annual number of HCAIs, additional NHS cost, number of occupied hospital bed days and number of days front-line healthcare professionals (HCPs) are absent from work. Results In 2016/2017, there were an estimated 653 000 HCAIs among the 13.8 million adult inpatients in NHS general and teaching hospitals in England, of which 22 800 patients died as a result of their infection. Additionally, there were an estimated 13 900 HCAIs among 810 000 front-line HCPs in the year. These infections were estimated to account for a total of 5.6 million occupied hospital bed days and 62 500 days of absenteeism among front-line HCPs. In 2016/2017, HCAIs were estimated to have cost the NHS an estimated £2.1 billion, of which 99.8% was attributable to patient management and 0.2% was the additional cost of replacing absent front-line HCPs with bank or agency staff for a period of time. When the framework of the model was expanded to include all NHS hospitals in England (by adding specialist hospitals), there were an estimated 834 000 HCAIs in 2016/2017 costing the NHS £2.7 billion, and accounting for 28 500 patient deaths, 7.1 million occupied hospital bed days (equivalent to 21% of the annual number of all bed days across all NHS hospitals in England) and 79 700 days of absenteeism among front-line HCPs. Conclusion This study should provide updated estimates with which to inform policy and budgetary decisions pertaining to preventing and managing these infections. Clinical and economic benefits could accrue from an increased awareness of the impact that HCAIs impose on patients, the NHS and society as a whole

National cross-sectional survey to explore preparation to undertake aseptic technique in pre-registration nursing curricula in the United Kingdom

Background Aseptic technique is a core nursing skill. Sound preparation is required during pre-registration nursing education to enable student nurses to acquire the knowledge and skills necessary to prevent and control healthcare-associated infection and promote patient safety. Few studies have explored nursing students' education and training in aseptic technique. Objectives To investigate what, when and how pre-registration nursing students are taught aseptic technique and how they are assessed in undergraduate, pre-registration nursing programmes in the United Kingdom. Design National cross-sectional survey exploring preparation to undertake aseptic technique in pre-registration nursing curricula in the United Kingdom. Setting Universities providing undergraduate, pre-registration adult nursing programmes in the United Kingdom. Participants Nurse educators. Methods Structured telephone interviews were conducted with nurse educators. Descriptive and inferential statistical data analyses were undertaken. Results Response rate was 70% (n = 49/70). A variety of different learning and teaching methods were reported to be in use. Teaching in relation to aseptic technique took place in conjunction with teaching in relation to different clinical procedures rather than placing emphasis on the principles of asepsis per se and how to transfer them to different procedures and situations. Wide variation in teaching time; use of multiple guidelines; inaccuracy in the principles identified by educators as taught to students; and limited opportunity for regular, criteria based competency assessment were apparent across programmes. Conclusions Pre-registration preparation in relation to aseptic technique requires improvement. There is a need to develop a working definition of aseptic technique. The generalisability of these findings in other healthcare students needs to be explored

The Orphan G Protein-coupled Receptors GPR41 and GPR43 Are Activated by Propionate and Other Short Chain Carboxylic Acids

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The Emergence and Development of Association Football: Influential Sociocultural Factors in Victorian Birmingham

This article explores the interdependent, complex sociocultural factors that facilitated the emergence and diffusion of football in Birmingham. The focus is the development of football in the city, against the backdrop of the numerous social changes in Victorian Birmingham. The aim is to fill a gap in the existing literature which seemingly overlooked Birmingham as a significant footballing centre, and the ‘ordinary and everyday’ aspects of the game’s early progression. Among other aspects, particular heed is paid to the working classes’ involvement in football, as previous literature has often focused on the middle classes and their influence on and participation in organized sport. As the agency of the working classes along with their mass participation and central role in the game’s development is unfolded, it is argued that far from being passive cultural beings, the working classes, from the beginnings, actively negotiated the development of their own emergent football culture

Industrial scale high-throughput screening delivers multiple fast acting macrofilaricides.

Nematodes causing lymphatic filariasis and onchocerciasis rely on their bacterial endosymbiont, Wolbachia, for survival and fecundity, making Wolbachia a promising therapeutic target. Here we perform a high-throughput screen of AstraZeneca's 1.3 million in-house compound library and identify 5 novel chemotypes with faster in vitro kill rates (<2 days) than existing anti-Wolbachia drugs that cure onchocerciasis and lymphatic filariasis. This industrial scale anthelmintic neglected tropical disease (NTD) screening campaign is the result of a partnership between the Anti-Wolbachia consortium (A∙WOL) and AstraZeneca. The campaign was informed throughout by rational prioritisation and triage of compounds using cheminformatics to balance chemical diversity and drug like properties reducing the chance of attrition from the outset. Ongoing development of these multiple chemotypes, all with superior time-kill kinetics than registered antibiotics with anti-Wolbachia activity, has the potential to improve upon the current therapeutic options and deliver improved, safer and more selective macrofilaricidal drugs

Influenza vaccination for immunocompromised patients: systematic review and meta-analysis from a public health policy perspective.

Immunocompromised patients are vulnerable to severe or complicated influenza infection. Vaccination is widely recommended for this group. This systematic review and meta-analysis assesses influenza vaccination for immunocompromised patients in terms of preventing influenza-like illness and laboratory confirmed influenza, serological response and adverse events

What is the size and nature of the current need for single room isolation in hospital, and how does success or 'failure to isolate' patients affect the control of meticillin-resistant Staphylococcus aureus (MRSA)?

Healthcare-associated infections, in particular those caused by antibiotic-resistant organisms, are a major cause of morbidity, mortality and increased cost to healthcare providers and MRSA are, in terms of prevalence, by far the most significant resistant organisms in the United Kingdom as well as many other countries worldwide. Isolation of hospital patients, usually in single rooms, is intended to interrupt the transmission of potential pathogens between patients and/or staff. Risk assessment is used to determine whether individual patients with potentially transmissible pathogens, including MRSA, should be isolated in single rooms. However, limited isolation room availability and/or operational needs may compromise this process and this has contributed to a general perception that although isolation may be recommended, in many cases it is not achieved due to a lack of facilities and conflicting priorities for the use of those facilities. Despite it being considered as standard practice the evidence for the efficacy of isolation in a single room in preventing the transmission of MRSA is limited. An initial study examined, prospectively, the incidence of isolation failure in a large UK National Health Service hospital and the relationship between the rate of 'failure to isolate' of patients from whose clinical samples MRSA had been identified and the rate of MRSA identified from samples sent for clinical purposes, per ward. A subsequent study compared the transmission of MRSA from index cases who were isolated and those who were not isolated with a cohort of contacts who were immediately adjacent to them. The results of these studies demonstrate that 'failure to isolate' is a frequent occurrence; isolation requirements were not met in 22% of cases and that there was a significant correlation between failing to isolate patients with MRSA, and rates of MRSA identified from samples sent for clinical purposes (Spearman's p=0.596, p<0.001). Conversely there was no significant difference in the MRSA acquisition rates in the contacts of people with MRSA who were not isolated vs. index cases who were isolated. Risk factors for MRSA acquisition in multivariate analysis were: exposure to antibiotics(quinolones and macrolides),presence of a nasogastric tube, dermatological conditions and the index case being risk-assessed as requiring isolation. Further research is needed into the efficacy of isolation in preventing the hospital transmission of MRSA