RESUMO
Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of preventable nosocomial infections and is endemic in hospitals worldwide. The effectiveness of infection control policies varies significantly across hospital settings. The impact of the hospital context towards the rate of nosocomial MRSA infections and the success of infection control is understudied. We conducted a modelling study to evaluate several infection control policies in surgical, intensive care, and medical ward specialties, each with distinct ward conditions and policies, of a tertiary public hospital in Sydney, Australia. We reconfirm hand hygiene as the most successful policy and find it to be necessary for the success of other policies. Active screening for MRSA, patient isolation in single-bed rooms, and additional staffing were found to be less effective. Across these ward specialties, MRSA transmission risk varied by 13% and reductions in the prevalence and nosocomial incidence rate of MRSA due to infection control policies varied by up to 45%. Different levels of infection control were required to reduce and control nosocomial MRSA infections for each ward specialty. Infection control policies and policy targets should be specific for the ward and context of the hospital. The model we developed is generic and can be calibrated to represent different ward settings and pathogens transmitted between patients indirectly through health care workers. This can aid the timely and cost effective design of synergistic and context specific infection control policies.
Assuntos
Infecção Hospitalar/prevenção & controle , Controle de Infecções/métodos , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/prevenção & controle , Infecções Estafilocócicas/transmissão , Algoritmos , Austrália , Simulação por Computador , Análise Custo-Benefício , Infecção Hospitalar/economia , Infecção Hospitalar/epidemiologia , Administração Hospitalar , Hospitais , Humanos , Controle de Infecções/normas , Modelos Teóricos , Isolamento de Pacientes , Admissão e Escalonamento de Pessoal , Estudos Retrospectivos , Infecções Estafilocócicas/epidemiologiaRESUMO
OBJECTIVE: To understand the dynamics underlying 'bed-blocking' in Australian public hospitals that is frequently blamed on older patients. METHODS: Analysis of primary and secondary data of utilisation patterns of hospital and aged care services by older Australians. RESULTS: A model of the dynamics at the acute-aged care interface was developed, in which the pathway into permanent high-care Residential Aged Care (RAC) is conceptualised as competing queues for available places by applicants from the hospital, the community and from within RAC facilities. The hospital effectively becomes a safety net to accommodate people with high-care needs who cannot be admitted into RAC in a timely manner. CONCLUSION: The model provides a useful tool to explore some of the issues that give rise to access-block within the public hospital system. Access-block cannot be understood by viewing the hospital system in isolation from other sectors that support the health and well-being of older Australians.
