Megan Campbell

The increased risks of death and extra lengths of hospital and ICU stay from hospital-acquired bloodstream infections: a case-control study

Objectives Hospital-acquired bloodstream infections are known to increase the risk of death and prolong hospital stay, but precise estimates of these two important outcomes from well-designed studies are rare, particularly for non-intensive care unit (ICU) patients. We aimed to calculate accurate estimates, which are vital for estimating the economic costs of hospital-acquired bloodstream infections. Design Case–control study. Setting 9 Australian public hospitals. Participants All the patients were admitted between 2005 and 2010. Primary and secondary outcome measures Risk of death and extra length of hospital stay associated with nosocomial infection. Results The greatest increase in the risk of death was for a bloodstream infection with methicillin-resistant Staphylococcus aureus (HR=4.6, 95% CI 2.7 to 7.6). This infection also had the longest extra length of stay to discharge in a standard bed (12.8 days, 95% CI 6.2 to 26.1 days). All the eight bloodstream infections increased the length of stay in the ICU, with longer stays for the patients who eventually died (mean increase 0.7–6.0 days) compared with those who were discharged (mean increase: 0.4–3.1 days). The three most common organisms associated with Gram-negative infection were Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumonia. Conclusions Bloodstream infections are associated with an increased risk of death and longer hospital stay. Avoiding infections could save lives and free up valuable bed days.

Cost-effectiveness of a national initiative to improve hand hygiene compliance using the outcome of healthcare associated staphylococcus aureus bacteraemia

Background The objective is to estimate the incremental cost-effectiveness of the Australian National Hand Hygiene Inititiave implemented between 2009 and 2012 using healthcare associated Staphylococcus aureus bacteraemia as the outcome. Baseline comparators are the eight existing state and territory hand hygiene programmes. The setting is the Australian public healthcare system and 1,294,656 admissions from the 50 largest Australian hospitals are included. Methods The design is a cost-effectiveness modelling study using a before and after quasi-experimental design. The primary outcome is cost per life year saved from reduced cases of healthcare associated Staphylococcus aureus bacteraemia, with cost estimated by the annual on-going maintenance costs less the costs saved from fewer infections. Data were harvested from existing sources or were collected prospectively and the time horizon for the model was 12 months, 2011–2012. Findings No useable pre-implementation Staphylococcus aureus bacteraemia data were made available from the 11 study hospitals in Victoria or the single hospital in Northern Territory leaving 38 hospitals among six states and territories available for cost-effectiveness analyses. Total annual costs increased by

Costing the Australian National Hand Hygiene Initiative.

2,851,475 for a return of 96 years of life giving an incremental cost-effectiveness ratio (ICER) of

Changes in healthcare-associated staphylococcus aureus bloodstream infections after the introduction of a national hand hygiene initiative

29,700 per life year gained. Probabilistic sensitivity analysis revealed a 100% chance the initiative was cost effective in the Australian Capital Territory and Queensland, with ICERs of

Streamlined research funding using short proposals and accelerated peer review: an observational study

1,030 and

The high costs of getting ethical and site-specific approvals for multi-centre research

8,988 respectively. There was an 81% chance it was cost effective in New South Wales with an ICER of

Research funding for telemedicine: an Australian perspective.

33,353, a 26% chance for South Australia with an ICER of

Response to Grayson's letter to the editor: 'Response to K. Page et al., 'Costing the Australian National Hand Hygiene Initiative''.

64,729 and a 1% chance for Tasmania and Western Australia. The 12 hospitals in Victoria and the Northern Territory incur annual on-going maintenance costs of

The role of time pressure and different psychological safety climate referents in the prediction of nurses’ hand hygiene compliance☆

1.51M; no information was available to describe cost savings or health benefits. Conclusions The Australian National Hand Hygiene Initiative was cost-effective against an Australian threshold of

The role of time pressure and different psychological safety climate referents in the prediction of nurses’ hand hygiene compliance

42,000 per life year gained. The return on investment varied among the states and territories of Australia.