Malcolm Anderson

Risk of Organism Acquisition from Prior Room Occupants: A Systematic Review and Meta-Analysis

A systematic review and meta-analysis was conducted to determine the risk of pathogen acquisition for patients associated with prior room occupancy. The analysis was also broadened to examine any differences in acquisition risk between Gram-positive and Gram-negative organisms. A search using Medline/PubMed, Cochrane and CINHAL yielded 2577 citations between 1984 and 2014. Reviews were assessed in accordance with the international prospective register of systematic reviews (PROSPERO). Just seven articles met the inclusion criteria, namely: (a) papers were peer reviewed, (b) pathogen acquisition prevalence rates were reported, (c) articles were written in English; and (d) had minimal or no risk of bias based on the Newcastle-Ottawa Scale (NOS). One study was an extension of a previous study and was discarded. Employing NOS provided little difference between the studies, with five studies receiving eight-star and two studies receiving seven-star ratings, respectively. Overall, pooled acquisition odds ratio for study pathogens (meticillin-resistant Staphylococcus aureus; vancomycin-resistant enterococcus; Clostridium difficile; acinetobacter; extended-spectrum β-lactamase-producing coliforms; pseudomonas) was 2.14 [95% confidence interval (CI): 1.65-2.77]. When comparing data between Gram-positive and Gram-negative organisms, the pooled acquisition odds ratio for Gram-negatives was 2.65 (95% CI: 2.02-3.47) and 1.89 (95% CI: 1.62-2.21) for Gram positives. The findings have important implications for infection control professionals, environmental cleaning services and patients, since current practices fail to adequately reduce acquisition risk. Although there may be non-preventable sources of acquisition, revised practices require collaborative work between all responsible staff in order to reduce this risk to a minimum.

Differential pathways of psychological distress in spouses vs. parents of people with severe traumatic brain injury (TBI): multi-group analysis.

Primary objective: A contemporary model of psychological stress based on an amalgamation of Conservation of Resources theory and the McMaster Model of Family Functioning was devised to compare the effects of neurobehavioural impairments on family functioning and psychological distress in spouses and parents caring for relatives with TBI. Method: Participants were 64 spouses and 58 parents. They completed the Neurobehavioral Problem Checklist, Family Assessment Device and the Brief Symptom Inventory. Structural equation modelling (SEM) was used to test the model for the combined (spouses and parents) sample. Multi-group analysis was then employed for examining differences in structural weights for spouses and parents. Main results: SEM supported the model for the combined sample. Multi-group analysis showed for spouses cognitive and behavioural impairments significantly disrupted family functioning, which in turn increased psychological distress. In contrast, cognitive and behavioural impairments did not significantly disrupt family functioning in parents. For parents, however, cognitive impairments increased psychological distress. Furthermore, parents who reported disrupted family functioning also experienced higher levels of psychological distress. The effect of cognitive impairments was statistically more influential on the level of distress in parents when compared to spouses. Conclusions: Understanding these differences can assist in better targeting family support interventions.

Length of Stay and Mortality Associated with Healthcare-Associated Urinary Tract Infections: A Multi-State Model

BACKGROUND The emergence of antimicrobial resistance is of particular concern with respect to urinary tract infections, since the majority of causative agents are Gram-negative bacteria. Healthcare-associated urinary tract infections (HAUTIs) are frequently associated with instrumentation of the urinary tract, specifically with indwelling catheters. AIM To evaluate the current incidence, mortality, and length of hospital stay associated with HAUTIs. METHODS A non-concurrent cohort study design was used, conducted between January 1st, 2010 and June 30th, 2014. All patients admitted to one of the eight participating Australian hospitals and who were hospitalized for more than two days were included. The primary outcome measures were the incidence, mortality, and excess length of stay associated with HAUTIs. FINDINGS From 162,503 patient admissions, 1.73% [95% confidence interval (CI): 1.67-1.80] of admitted patients acquired a HAUTI. Using a multi-state model, the expected extra length of stay due to HAUTI was four days (95% CI: 3.1-5.0 days). Using a Cox regression model, infection significantly reduced the rate of discharge (hazard ratio: 0.78; 95% CI: 0.73-0.83). Women were less likely to die (0.71; 0.66-0.75), whereas older patients were more likely to die (1.40; 1.38-1.43). Death was rarer in a tertiary referral hospital compared to other hospitals, after adjusting for age and sex (0.74; 0.69-0.78). CONCLUSION This study is the first to explore the burden of HAUTIs in hospitals using appropriate statistical methods in a developed country. Our study indicates that the incidence of HAUTI, in addition to its associated extra length of stay in hospital, presents a burden to the hospital system. With increasing incidence of UTI due to antimicrobial-resistant organisms, surveillance and interventions to reduce the incidence of HAUTI are required.

The impact of neurobehavioral impairment on family functioning and the psychological well-being of male versus female caregivers of relatives with severe traumatic brain injury: multigroup analysis.

Objective:To examine the differential effect of neurobehavioral impairments (cognitive, behavioral, and social) on family functioning, family roles, and psychological distress in male versus female caregivers of relatives with severe traumatic brain injury (TBI). Design:Structural equation modeling with multigroup analysis conducted in a cross-sectional sample to test an established theoretical model. Participants:An aggregated sample of 122 caregivers (46 male, 76 female) of people with severe TBI. The sample comprised 64 spouses and 58 parents (29 parental couples) of 93 persons with TBI. Measures:Neurobehavioral Problem Checklist; Family Assessment Device; and Brief Symptom Inventory. Results:Structural equation modeling showed that the proposed model had acceptable fit indices for the combined sample. Multigroup analysis indicated that both male and female caregivers (i) responded similarly to the neurobehavioral impairments experienced by the injured relative and (ii) reported behavior having a direct effect on family functioning, which, in turn, increased psychological distress. However, the effect of disrupted family functioning was more influential on the level of distress in male caregivers than in female caregivers. Conclusion:Evidence was found for gender-specific pathways underlying the psychological distress of male versus female caregivers. Such findings can assist in tailoring family support strategies so that they cater for caregivers of both genders.

Chapter 7 the relationship between coping and psychological adjustment in family caregivers of individuals with traumatic brain injury: a systematic review.

A systematic review was conducted to evaluate the association between coping (as measured by the Ways of Coping Questionnaire [WOCQ]) and psychological adjustment in caregivers of individuals with traumatic brain injury (TBI). A search conducted using the CINAHL, Medline, and PsycINFO databases yielded 201 citations between 1974 and 2014. A total of seven articles met the inclusion criteria; namely, the respondents who completed the WOCQ were family caregivers of individuals with TBI (including 66-item, 42-item, or 21-item versions). Reviews were conducted in accordance with the American Academy of Neurology guidelines (2011) for classifying evidence. The results found no Class 1 or Class II studies but only four Class III and three Class IV studies. The major finding across the better-rated Class III studies was that the use of emotion-focused coping and problem-focused coping was possibly associated with psychological adjustment in caregivers. The Class IV studies were determined to be inadequate or conflicting in determining the association between coping and psychological adjustment. Future studies need to employ carefully crafted designs, adhere to statistical procedure, apply advanced analytic techniques, and employ explicit models of coping, which will increase the accuracy and generalizability of the findings.