Professor Brett Mitchell

Professor Brett Mitchell

Professor in Nursing

School of Nursing and Midwifery

Infection control and the future of healthcare

Professor Brett Mitchell’s research is tackling the looming global threat of microbial resistance by researching hygiene-based methods of increasing patient safety and controlling infections within hospital settings.

Image of Professor Brett Mitchell

What happens when antibiotics don’t work like they should? In recent years, the rise of ‘superbug’ infections has attracted international attention and alarm. While the world looks for ways to stop microorganisms adapting and becoming resistant to antibiotics, internationally esteemed infection prevention and control researchers like Professor Brett Mitchell are finding novel ways to prevent infections from happening at all.

A Fellow of the Australasian College for Infection Prevention and Control and the Australian College of Nursing, Brett is determined to protect Australians from infections by advancing best practice hygiene and sanitation standards in hospitals and using evidence-based infection management strategies to halt the spread of deadly bacteria.

“Infections caused by drug-resistant bacteria are becoming more common, and this is not good news for patients or the general community,” says Brett.

“Infections are now more difficult to treat, because drugs used to treat infections are becoming less effective. This increasing resistance to antimicrobials means that preventing infections from occurring is now more important than ever.

“My research focuses on preventing the most common infections acquired in healthcare: urinary tract infections, pneumonia and drug-resistant bacteria. It aims to enhance the care patients receive in hospital, reduce the risk of infection and help clinicians undertake best practice. Reducing infections also means less antimicrobials are used to treat infection—which reduces the risk of antimicrobial resistance.”

It starts in our hospitals

Did you know that around one in ten people in an Australian hospital today have an infection acquired during their stay? Without stringent healthcare policies and practices in place, hospitals can quickly become breeding grounds for dangerous bacteria. Patients are highly vulnerable to a range of infections while receiving treatment, and especially following surgery, including wound and bloodstream infections.

“There are around 165,000 infections acquired in Australian hospitals each year, so there is a really big opportunity to improve patient care and outcomes.”

While improving infection control is critical to the future of healthcare, researchers are faced with significant barriers to success. These multi-faceted challenges motivate Brett and his team to design rigorous research methods that deliver practical solutions and can be implemented at scale.

“There are many things that can influence whether a person acquires an infection. Ensuring you account for these factors means complex study designs and generally a large number of participants. To complicate things further, the way infections are defined in Australian hospitals varies.”

Brett has recently been involved in a major study aimed at cleaning up hospitals’ hygiene practices to minimise patients’ risk of infections. The study looked at current practices across 11 Australian hospitals to demonstrate and test a fresh approach to sanitation.

“We found that improving hospital cleaning is a highly effective way to reduce the risk of infection for patients. While it might seem straightforward, this was the first time such a study has been undertaken and the study results will have an immense impact on the provision of cleaning in hospitals internationally.”

The price of patient safety

This first-of-its-kind study into the benefits of hospital cleaning also highlights an important cost-saving advantage for health services and communities. Put simply, the better protected patients are from infections, the fewer costly treatments they require and the shorter their hospital stays.

“As well as benefitting patient health, the study found that investing in hospital cleaning is a cost-effective intervention. Reducing infections also reduces healthcare costs from diagnostics, hospitals stays and treatments.”

While proper sanitation and cleaning practices can help save lives, Brett’s emerging research shows that some approaches are more effective—and more cost-effective—than others. Brett and his team have just completed  a another  study to find out which antiseptics are gold standard for preventing urinary tract infections, which is one of the most common hospital-obtained infections in Australia, particularly among women.

“We have undertaken a trial of an antiseptic called chlorhexidine and sought to determine whether using this prior to insertion of a urinary catheter could reduce the risk of a urinary tract infection. We found this method was associated with a 94 per cent reduction in infection and that the product is a cost saving for health services.

“Findings from this study are leading to new product development and implementation of chlorhexidine in urinary catheter insertion practices in hospitals across the world. Because of this research, there will be far fewer patients who acquire this infection while in hospital.”

Both of Brett’s studies serve as a reminder that, sometimes, it’s the simple strategies that can have the greatest impact. The studies are contributing to a growing database of knowledge that can inform the future of infection control and hospital care in Australia and worldwide.

“As a nurse, my motivation is about providing the best care possible. My research focuses on making a difference to patient care and providing evidence for the best possible care.”

Image of Professor Brett Mitchell

Infection control and the future of healthcare

Professor Brett Mitchell’s research is tackling the looming global threat of microbial resistance by researching hygiene-based methods of increasing patient safety and controlling infections within hospital settings.What happens when antibiotics don’t work like they should? In recent years, the rise…

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Career Summary

Biography

Professor Brett Mitchell is an internationally recognised researcher in the area of infection prevention and control.

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He has extensive clinical experience as well as strong academic and research skills. As an academic and researcher, Prof Mitchell has over 150 peer reviewed journal and oral conference presentations, authored several books, and has been an invited speaker at numerous infection prevention and control conferences in Australia and internationally.

Professor Brett Mitchell sees the prevention of healthcare associated infections, infections acquired as consequence of people receiving healthcare as growing patient safety issue. "Today, in hospital, one in ten patients in an Australian hospital will have an infection acquired during their hospital stay. Infections not only impact patients, but also health services through longer hospitals stays and treatments costs". Antimicrobial resistance is also making infections more difficult to treat. The World Health Organisation acknowledges this by suggesting that antimicrobial resistance threatens the very core of modern medicine and the sustainability of an effective, global public health response to the enduring threat from infectious diseases.

"We need to find solutions to preventing infections from occurring in the first instance and this is my area of particular interest" says Professor Mitchell. In recent years, key publications from Professor Mitchell include publications

He is a Fellow of the Australasian College for Infection Prevention and Control and the Australian College of Nursing. Professor Mitchell is also Editor-in-Chief of Infection, Disease and Health, an Australian-based, international, peer-reviewed journal on infection and disease-causing infection in human beings that provides a platform for the publication and dissemination of original knowledge at the nexus of infection research through a One Health context.

Professor Mitchell has experience leading nursing teams, research teams and infection prevention and control teams in both Australia and the United Kingdom. Professor Mitchell has had a major influence on the infection prevention and control agenda in Australia through his committee roles at such as the Australian Commission on Safety and Quality in Health Care (ACSQHC),  and was the chair of a NHMRC Committee responsible for revision pf the 2019 National Infection Control Guidelines in addition to being a member of this same committee during the creation of the 2010 guidelines.

Clinically, Professor Mitchell has worked in the areas of acute medicine, infectious disease, cardiology and medical admissions within hospitals, as well as public health and nurse immunisation in non hospital settings.


Qualifications

  • Doctor of Philosophy, Australian Catholic University
  • Master of Advanced Practice, Griffith University

Keywords

  • Antimicrobial
  • Health services
  • Infection
  • Infection control
  • Nursing
  • Patient safety

Fields of Research

Code Description Percentage
111799 Public Health and Health Services not elsewhere classified 15
111003 Clinical Nursing: Secondary (Acute Care) 65
110309 Infectious Diseases 25

Professional Experience

UON Appointment

Title Organisation / Department

Academic appointment

Dates Title Organisation / Department
1/1/2015 - 1/1/2017 Associate Professor of Nursing Avondale College NSW
Australia
1/1/2017 - 20/7/2019 Professor of Nursing Avondale College NSW
Australia

Professional appointment

Dates Title Organisation / Department
27/10/2008 - 31/10/2012 President Tasmanian Infection Control Association
Australia
1/7/2013 -  Editor in Chief Australasian College for Infection Prevention and Control
Infection, Disease and Health
Australia
2/7/2008 - 28/6/2013 Assistant Director of Nursing Department of Health and Human Services Tasmania
Public and Environmental Health
Australia
4/6/2012 - 1/4/2013 Senior Clinical Lecturer University of Tasmania
Australia
3/7/2006 - 7/12/2007 Senior Nurse Manager North Glamorgan NHS Trust
United Kingdom

Awards

Prize

Year Award
2018 Elaine Graham Robertson Award
Australasian College for Infection Prevention and Control
2018 Best Poster Award, Infection Prevention Society Conference, United Kingdom
Infection Prevention Society
2017 Best Poster Award, ACIPC conference, Australia
Australasian College for Infection Prevention and Control

Recognition

Year Award
2007 National (Welsh) Service Quality Improvement Award
Welsh Assembly Government

Scholarship

Year Award
2017 Excellence in Scholarship Award.
Avondale College of Higher Education

Invitations

Committee Member

Year Title / Rationale
2020 (Chair) Scientific Organising Committee. 6th International Australasian College for Infection Prevention and Control
2020 Infection Control Expert Group (Australian Government, Department of Health)
2020 National COVID-19 Clinical Evidence Taskforce - Guideline Leadership Group
2019 Scientific Organising Committee. 5th International Australasian College for Infection Prevention and Control
2018 (Chair) Human Research Ethics Committee
2018 (Chair) NHMRC Infection Control Guidelines Committee, National Health and Medical Research Council
2017 (Chair) Scientific Organising Committee. 4th International Australasian College for Infection Prevention and Control
2016 Research Advisory Committee, Charles Sturt University
2014 National Antimicrobial Usage and Resistance Project Reference Group, Australian Commission on Safety and Quality in Health Care
2011 External Affairs Committee, Society of Healthcare Epidemiology of America
2010 Chair, Nurse Immunisation Authorisation Advisory Panel, Department of Health and Human Services (Tasmania)
2010 Nursing and Midwifery Executive, Department of Health and Human Services (Tasmania)
2010 Healthcare Association Infection Technical Advisory Group, Australian Commission on Safety and Quality in Health Care
2009 Tasmanian Healthcare Associated Infection Steering Committee, Department of Health and Human Services (Tasmania)
2008 National Hand Hygiene Advisory Committee, Australian Commission on Safety and Quality in Health Care
2008 Australian Infection Control Guidelines, National Health and Medical Research Council

Speaker

Year Title / Rationale
2018 Reducing the risk of catheter related complications: results from two randomised controlled studies. Infection Prevention Society.
2018 Implementation lessons from the Researching Effective Approaches to Cleaning in Hospitals (REACH) trial
2018 Antibiotic Resistance
2018 The three top papers that have in influenced infection prevention practice: USA vs. Europe vs. The Rest of the World. Hospital Infection Society.
2018 Meet the expert: The use of social media and relevance to Infection Prevention and Control. Infection Prevention Society.

Grant Reviews

Year Grant Amount
2020 MRFF Global Health Tackling Antimicrobial Resistance and Drug ResistantTuberculosis
C1300 - Aust Competitive - Medical Research Future Fund - 1300, C1300 - Aust Competitive - Medical Research Future Fund - 1300
$0
2020 Cardinal Health
C1700 - Aust Competitive - Other - 1700, C1700 - Aust Competitive - Other - 1700
$0
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Publications

For publications that are currently unpublished or in-press, details are shown in italics.


Chapter (3 outputs)

Year Citation Altmetrics Link
2019 Hall L, Mitchell B, 'Cleaning and decontamination of the healthcare environment', Decontamination in Hospitals and Healthcare, Woodhead Publishing Limited, Duxford, UK 227-239 (2019) [B1]
2019 Mitchell B, Shaban R, Russo P, Potter J, 'Healthcare-associated infections and infectious diseases', Emergency and Trauma Care for Nurses and Paramedics, Elsevier, Elsevier Australia 717-728 (2019)
2019 Mitchell B, Shaban R, Russo P, Potter J, 'Healthcare-associated infections and infectious diseases', Emergency and Trauma Care for Nurses and Paramedics, Elsevier, Elsevier Australia 717-728 (2019)

Journal article (103 outputs)

Year Citation Altmetrics Link
2020 White NM, Barnett AG, Hall L, Mitchell BG, Farrington A, Halton K, et al., 'Cost-effectiveness of an Environmental Cleaning Bundle for Reducing Healthcare-associated Infections', Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 70 2461-2468 (2020) [C1]

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. BACKGROUND: Healthcare-associated infections (HAIs) remain a significant... [more]

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. BACKGROUND: Healthcare-associated infections (HAIs) remain a significant patient safety issue, with point prevalence estimates being ~5% in high-income countries. In 2016-2017, the Researching Effective Approaches to Cleaning in Hospitals (REACH) study implemented an environmental cleaning bundle targeting communication, staff training, improved cleaning technique, product use, and audit of frequent touch-point cleaning. This study evaluates the cost-effectiveness of the environmental cleaning bundle for reducing the incidence of HAIs. METHODS: A stepped-wedge, cluster-randomized trial was conducted in 11 hospitals recruited from 6 Australian states and territories. Bundle effectiveness was measured by the numbers of Staphylococcus aureus bacteremia, Clostridium difficile infection, and vancomycin-resistant enterococci infections prevented in the intervention phase based on estimated reductions in the relative risk of infection. Changes to costs were defined as the cost of implementing the bundle minus cost savings from fewer infections. Health benefits gained from fewer infections were measured in quality-adjusted life-years (QALYs). Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio and net monetary benefit of adopting the cleaning bundle over existing hospital cleaning practices. RESULTS: Implementing the cleaning bundle cost $349 000 Australian dollars (AUD) and generated AUD$147 500 in cost savings. Infections prevented under the cleaning bundle returned a net monetary benefit of AUD$1.02 million and an incremental cost-effectiveness ratio of $4684 per QALY gained. There was an 86% chance that the bundle was cost-effective compared with existing hospital cleaning practices. CONCLUSIONS: A bundled, evidence-based approach to improving hospital cleaning is a cost-effective intervention for reducing the incidence of HAIs.

DOI 10.1093/cid/ciz717
Citations Scopus - 2
2020 Russo PL, Stewardson AJ, Cheng AC, Bucknall T, Mitchell BG, 'Prevalence of device use and transmission based precautions in nineteen large Australian acute care public hospitals: Secondary outcomes from a national healthcare associated infection point prevalence survey', Infection, Disease and Health, (2020)

© 2020 The Authors Background: The use of invasive devices increases the risk of healthcare associated infections (HAI). The recent national HAI point prevalence survey secondary ... [more]

© 2020 The Authors Background: The use of invasive devices increases the risk of healthcare associated infections (HAI). The recent national HAI point prevalence survey secondary outcomes aimed to estimate the prevalence of patients with an indwelling urinary catheter device and vascular access devices; and also identify prevalence of those managed under transmission based precautions (TBP); and those colonised or infected with a multi drug resistant organism (MDRO). Methods: A point prevalence study was conducted in large acute care Australian public hospitals. All data were collected by two trained Research Assistants. Surveillance methodology was based on the European Centre for Disease Prevention and Control PPS Protocol. Data was also collected on prevalence of TBPs and MDROs. Results: A total of 2767 acute adult inpatients were sampled across 19 hospitals. The prevalence of peripheral vascular, central vascular and urinary catheters devices was 55.2% (95%CI: 53.3%¿57.1%), 14.8% (95%CI: 13.5%¿16.1%) and 20.7% (95%CI: 19.2%¿22.3%) respectively. Of the 2767 patients sampled 285 (10.3%, 95%CI: 9.2%¿11.5%) were documented as either being infected or colonised with a MDRO, and 781 (11.8%) patients were being managed under the hospital TBP policy. Conclusion: This is the first national study to describe the prevalence of devices, TBPs and MDROs in Australian healthcare settings. In an era where device use should be constantly reviewed to minimise risk of HAI, and the increasing challenges of managing patients with MDROs, this data can serve as a benchmark for future studies.

DOI 10.1016/j.idh.2020.05.006
2020 Shaban RZ, Sotomayor-Castillo C, Nahidi S, Li C, MacBeth D, Mitchell BG, Russo PL, 'Global burden, point sources, and outbreak management of healthcare-associated Burkholderia cepacia infections: An integrative review', Infection Control and Hospital Epidemiology, 41 777-783 (2020) [C1]

© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.. Objective: To examine the global burden, associated point sources, and successful prevention an... [more]

© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.. Objective: To examine the global burden, associated point sources, and successful prevention and control measures for documented outbreaks of Burkholderia cepacia healthcare-associated infections (HAIs).Design: Integrative review.Methods: A review of all outbreaks of Burkholderia cepacia HAIs published in the peer-reviewed literature between January 1970 and October 2019 was conducted to identify the global burden, associated point sources, and successful prevention and control measures using the Guidelines for Outbreak Reports and Intervention Studies of Nosocomial Infections (ORION).Results: In total, we reviewed 125 documented outbreaks of Burkholderia cepacia-related HAIs worldwide. The reported B. cepacia HAIs for this period involved 3,287 patients. The point sources were identified in most outbreaks of B. cepacia HAIs (n = 93; 74.4%); they included medication vials, disinfectants, and antiseptics. Moreover, 95 of the outbreak reports (76%) described effective prevention and control measures, but only 33 reports indicated the use of a combination of environment-, patient- and staff-related measures. None of the outbreak reports used the ORION guidelines.Conclusions: Outbreaks of Burkholderia cepacia HAIs are an ongoing challenge. They are often associated with immunocompromised patients who acquire the infection from exposure to contaminated medications, products, and equipment. These outbreaks are not infrequent, and a range of infection prevention and control measures have been effective in arresting spread. The use of ORION guidelines for outbreak reporting would improve the quality of information and data to generate evidence for translation into practice.

DOI 10.1017/ice.2020.184
2020 Oon A, Reading E, Ferguson JK, Dancer SJ, Mitchell BG, 'Measuring environmental contamination in critical care using dilute hydrogen peroxide (DHP) technology: An observational cross-over study', Infection, Disease and Health, 25 107-112 (2020) [C1]

© 2019 Australasian College for Infection Prevention and Control Background: The environment has an important role in the transmission of healthcare associated infections. This ha... [more]

© 2019 Australasian College for Infection Prevention and Control Background: The environment has an important role in the transmission of healthcare associated infections. This has encouraged interest in novel methods to improve hygiene in hospitals. One such technology is the use of hydrogen peroxide to decontaminate rooms and equipment; there are, however, few studies that have investigated the effect of continuous dilute hydrogen peroxide (DHP) in the clinical environment. The aim of this study was to examine the use of dilute hydrogen peroxide (DHP) in a critical care unit and measure the microbiological impact on surface contamination. Methods: We conducted a prospective observational cross-over study in a ten-bed critical care unit in one rural Australian hospital. Selected high-touch sites were screened using dipslides across three study phases: baseline; continuous DHP; and no DHP (control). Quantitative aerobic colony counts (ACC) were assessed against a benchmark standard of ACC >2.5 cfu/cm2 to indicate hygiene failure. Results: There were low levels of microbial contamination in the unit for baseline; DHP; and no DHP phases: 2.2% (95% CI 0.7¿5.4%) vs 7.7% (95% CI 4.3¿13.0%) vs 6% (95% CI 3.2¿10.4%) hygiene failures, respectively. Significant reduction in ACCs did not occur when the DHP was operating compared with baseline and control phases. Conclusion: Further work is needed to determine whether continuous DHP technology has a role in decontamination for healthcare settings.

DOI 10.1016/j.idh.2019.12.005
Co-authors John Ferguson
2020 Loftus MJ, Curtis SJ, Naidu R, Cheng AC, Jenney AWJ, Mitchell BG, et al., 'Prevalence of healthcare-associated infections and antimicrobial use among inpatients in a tertiary hospital in Fiji: A point prevalence survey', Antimicrobial Resistance and Infection Control, 9 (2020)

© 2020 The Author(s). Background: Healthcare-associated infections (HAIs) and antimicrobial use (AMU) are important drivers of antimicrobial resistance, yet there is minimal data ... [more]

© 2020 The Author(s). Background: Healthcare-associated infections (HAIs) and antimicrobial use (AMU) are important drivers of antimicrobial resistance, yet there is minimal data from the Pacific region. We sought to determine the point prevalence of HAIs and AMU at Fiji's largest hospital, the Colonial War Memorial Hospital (CWMH) in Suva. A secondary aim was to evaluate the performance of European Centre for Diseases Prevention and Control (ECDC) HAI criteria in a resource-limited setting. Methods: We conducted a point prevalence survey of HAIs and AMU at CWMH in October 2019. Survey methodology was adapted from the ECDC protocol. To evaluate the suitability of ECDC HAI criteria in our setting, we augmented the survey to identify patients with a clinician diagnosis of a HAI where diagnostic testing criteria were not met. We also assessed infection prevention and control (IPC) infrastructure on each ward. Results: We surveyed 343 patients, with median (interquartile range) age 30 years (16-53), predominantly admitted under obstetrics/gynaecology (94, 27.4%) or paediatrics (83, 24.2%). Thirty patients had one or more HAIs, a point prevalence of 8.7% (95% CI 6.0% to 12.3%). The most common HAIs were surgical site infections (n = 13), skin and soft tissue infections (7) and neonatal clinical sepsis (6). Two additional patients were identified with physician-diagnosed HAIs that failed to meet ECDC criteria due to insufficient investigations. 206 (60.1%) patients were receiving at least one antimicrobial. Of the 325 antimicrobial prescriptions, the most common agents were ampicillin (58/325, 17.8%), cloxacillin (55/325, 16.9%) and metronidazole (53/325, 16.3%). Use of broad-spectrum agents such as piperacillin/tazobactam (n = 6) and meropenem (1) was low. The majority of prescriptions for surgical prophylaxis were for more than 1 day (45/76, 59.2%). Although the number of handwashing basins throughout the hospital exceeded World Health Organization recommendations, availability of alcohol-based handrub was limited and most concentrated within high-risk wards. Conclusions: The prevalence of HAIs in Fiji was similar to neighbouring high-income countries, but may have been reduced by the high proportion of paediatric and obstetrics patients, or by lower rates of inpatient investigations. AMU was very high, with duration of surgical prophylaxis an important target for future antimicrobial stewardship initiatives.

DOI 10.1186/s13756-020-00807-5
2020 Mitchell BG, McGhie A, Whiteley G, Farrington A, Hall L, Halton K, White NM, 'Evaluating bio-burden of frequently touched surfaces using Adenosine Triphosphate bioluminescence (ATP): Results from the Researching Effective Approaches to Cleaning in Hospitals (REACH) trial', Infection, Disease and Health, 25 168-174 (2020)

© 2020 The Author(s) Background: Environmental cleaning is an important approach to reducing healthcare-associated infection. The aim of this short research paper is to describe c... [more]

© 2020 The Author(s) Background: Environmental cleaning is an important approach to reducing healthcare-associated infection. The aim of this short research paper is to describe changes in the efficacy of post-discharge cleaning by examining the amount of bio-burden on frequent touch points (FTPs) in patient areas, using a validated Adenosine Triphosphate (ATP) bioluminescence sampling method. In so doing, we present findings from a secondary outcome of a recent trial, the Researching Effective Approaches to Cleaning in Hospitals (REACH) study. Methods: The REACH study used a prospective, stepped-wedge randomised cluster design. Cross sectional ATP sampling was conducted at three of the 11 participating hospitals. At each hospital, during the control and intervention phase of the study, six Frequent Touch Points (FTPs) were sampled: toilet flush, bathroom tap, inside bathroom door handle, patient call button, over bed tray table, and bed rails. Results: Across the three hospitals, 519 surfaces in 49 rooms (control phase) and 2856 surfaces in 251 rooms (intervention phase) were sampled. Bedroom FTP cleaning improved across all three hospitals. The cleaning of bathroom FTPs was generally high from the outset and remained consistent throughout the whole study period. Average cleaning outcomes for bathroom FTPs were consistently high during the control period however outcomes varied between individual FTP. Changes in cleaning performance over time reflected variation in intervention effectiveness at the hospital level. Conclusion: Findings confirm improvement in cleaning in the FTPs in bedrooms, demonstrating improvements in discharge cleaning aligned with the improvements seen when using fluorescent marking technology as a marker of performance.

DOI 10.1016/j.idh.2020.02.001
2020 Mitchell BG, Fasugba O, Russo PL, 'Where is the strength of evidence? A review of infection prevention and control guidelines', Journal of Hospital Infection, 105 242-251 (2020) [C1]

© 2020 The Healthcare Infection Society An important aspect of safety and quality in healthcare is the implementation of infection prevention and control guidelines. However, litt... [more]

© 2020 The Healthcare Infection Society An important aspect of safety and quality in healthcare is the implementation of infection prevention and control guidelines. However, little is known regarding the strength of evidence on which recommendations for such guidelines are based. This study aimed to describe the strength of recommendations of infection prevention and control guidelines published in the last 10 years. For this review, the websites of government and professional organizations for national and international infection prevention and control clinical guidelines were purposively searched. The search was limited to publications between January 2009 and April 2019, and those with a formal grading system were used to determine the strength of the evidence underpinning the recommendations. Recommendations from guidelines were categorized into 21 infection control categories. A descriptive synthesis of the data was undertaken. A total of 31 guidelines comprising 1855 recommendations were included. Guidelines were mainly developed in the USA (N = 11, 35.5%) and Canada (N = 9, 29.0%). Most guidelines used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach (N = 6, 19.4%. The majority of the guidelines contained recommendations categorized under the themes of devices (N = 316, 16.9%) and transmission-based precautions (N = 315, 16.8%). Most recommendations (N = 769, 41.5%) were graded as using evidence from descriptive studies, expert opinion and low-quality evidence. There are a vast number of infection prevention and control guidelines developed by national and international government or professional organizations, many without a strong evidence base. This presents multiple research opportunities that should prioritize common prevention activities that currently have a low evidence base.

DOI 10.1016/j.jhin.2020.01.008
Citations Scopus - 2
2020 Ray-Barruel G, Wu ML, Marsh N, Mitchell B, 'Strategies for CAUTI prevention: Are we on the same page?', Infection, Disease and Health, 25 194-196 (2020)
DOI 10.1016/j.idh.2020.01.005
2020 Mitchell B, 'A reflection of 2019: Reviewers, metrics and Editor's pick', Infection, Disease and Health, 25 1-2 (2020)
DOI 10.1016/j.idh.2019.12.004
2020 Shaban RZ, Sotomayor-Castillo C, Macbeth D, Russo PL, Mitchell BG, 'Scope of practice and educational needs of infection prevention and control professionals in Australian residential aged care facilities', Infection, Disease and Health, (2020)

© 2020 Australasian College for Infection Prevention and Control Background: Healthcare-associated infections are serious and significant complications present across healthcare s... [more]

© 2020 Australasian College for Infection Prevention and Control Background: Healthcare-associated infections are serious and significant complications present across healthcare services, including residential aged care facilities. Although ensuring high quality personal and clinical care delivered to older people residing in these facilities is a high national priority, there is a paucity of evidence published about outbreaks, governance and education programs held for healthcare workers within Australian residential aged care facilities. The aim of this study is to examine the scope of practice of Infection Prevention and Control professionals within Australian residential aged care facilities and the types of infection prevention and control education and training delivered. Methods: A cross-sectional study was conducted inviting all Australian residential aged care facilities to participate in an online survey. Results: A total of 134 residential aged care facilities completed the survey. The majority (88.1%) reported having a designated Infection Prevention and Control professional responsible for surveillance and educational activities. Hand hygiene (94%), personal protective equipment (PPE) (79.9%) and environmental cleaning (70.1%) were some of the available Infection Prevention and Control programs. The lack of access to Infection Prevention and Control education (69.5%) and lack of Infection Prevention and Control expert advice (67.2%) were also reported by some Residential aged care facilities. Conclusion: Australian residential aged care facilities recognise the importance of Infection Prevention and Control training programs to manage infection surveillance and outbreaks. Considerable activities are carried out to increase knowledge on breaking the chain of infection. Yet, more support and resources are needed to assist these efforts.

DOI 10.1016/j.idh.2020.06.001
2020 Fasugba O, Mitchell BG, McInnes E, Koerner J, Cheng AC, Cheng H, Middleton S, 'Increased fluid intake for the prevention of urinary tract infection in adults and children in all settings: a systematic review', Journal of Hospital Infection, 104 68-77 (2020) [C1]

© 2019 The Healthcare Infection Society Background: Non-antibiotic interventions for urinary tract infection (UTI) prevention have been investigated as a strategy to reduce antibi... [more]

© 2019 The Healthcare Infection Society Background: Non-antibiotic interventions for urinary tract infection (UTI) prevention have been investigated as a strategy to reduce antibiotic prescribing for UTI and subsequent antibiotic resistance. Increased hydration is widely advocated for preventing UTI; however, evidence for its effectiveness is unknown. Aim: To systematically review the published literature on the effectiveness of increased fluid intake as a preventive intervention for UTI in adults and children in any setting. Methods: Five electronic databases were searched from inception to February 2019 to identify published randomized controlled trials (RCTs) and quasi-experimental studies evaluating the effectiveness of high (=1.5 L/24 h) versus normal/low (<1.5 L/24 h) fluid intake for UTI prevention. The outcome was UTI incidence. Risk of bias was assessed using the Cochrane Collaboration's tool. Due to the small number of studies identified, meta-analysis was not possible. Hence a narrative synthesis was undertaken. Findings: Of the 2822 potentially relevant papers, two were eligible for inclusion: an RCT (individual randomization) and a cluster-RCT. Both studies differed regarding participants, setting, sample size, UTI definition, and intervention. The RCT was assessed as having a low risk of bias whereas the cluster-RCT had a high risk of bias. Only the RCT, which included healthy premenopausal women visiting primary care clinics, demonstrated statistical significance for the effect of high fluid intake for UTI prevention. Conclusion: The lack of enough adequately powered and robust RCTs highlights the need for further research on the effectiveness of this intervention for UTI prevention.

DOI 10.1016/j.jhin.2019.08.016
Citations Scopus - 1Web of Science - 1
2020 Hall L, White NM, Allen M, Farrington A, Mitchell BG, Page K, et al., 'Effectiveness of a structured, framework-based approach to implementation: The Researching Effective Approaches to Cleaning in Hospitals (REACH) Trial', Antimicrobial Resistance and Infection Control, 9 (2020) [C1]
DOI 10.1186/s13756-020-0694-0
2020 Geia L, Baird K, Bail K, Barclay L, Bennett J, Best O, et al., 'A unified call to action from Australian nursing and midwifery leaders: ensuring that Black lives matter.', Contemp Nurse, 1-12 (2020)
DOI 10.1080/10376178.2020.1809107
Co-authors Rhonda Wilson, Alison Hutton, Maralyn Foureur, Tracy Levett-Jones, Michael Hazelton
2019 Mitchell B, 'Editorial', INFECTION DISEASE & HEALTH, 24 57-57 (2019)
DOI 10.1016/j.idh.2019.04.001
2019 Cloete L, Mitchell BG, Morton D, 'Protocol: Investigating the effectiveness and cost benefit of a lifestyle intervention targeting type 2 diabetes in Australia', BMC Endocrine Disorders, 19 (2019)

© 2019 The Author(s). Background: Type 2 Diabetes Mellitus (T2DM) has become an endemic disease. A number of interrelated factors increase the risk of the onset of T2DM, however m... [more]

© 2019 The Author(s). Background: Type 2 Diabetes Mellitus (T2DM) has become an endemic disease. A number of interrelated factors increase the risk of the onset of T2DM, however much of the pathogenesis of the disease is associated with lifestyle. A number of studies have indicated that adopting positive lifestyle changes can successfully prevent or delay the onset of T2DM in a number of different population groups. The CHIP intervention is a lifestyle program that has been shown in over more than 30 published papers have indicated that the CHIP intervention leads to dramatic improvement in the indicators of T2DM these diseases of lifestyle. Methods: A randomized control trial will be conducted involving 150 individuals with an established diagnosis of T2DM. All participants will continue to receive usual ongoing diabetes care, however, the intervention group (75 individuals) will in addition participate in a 12-week CHIP lifestyle intervention programme followed by a further 9 months of monthly follow-up appointments. Approval for funding was obtained on 30 June 2017. Discussion: The outcomes of this study have the potential to inform decisions about patient treatment and potentially provide incentive for the provision of funded lifestyle-based preventive and restorative programs for patients diagnosed with T2DM. Trial registration: This trial is registered as an initial version with the Australia New Zealand Clinical Trials Registry (http://www.anzctr.org.au/), registration number ACTRN12617001233314. Registered on 23/08/2017. No enrollments in the study to date.

DOI 10.1186/s12902-019-0396-x
2019 Mitchell BG, Shaban RZ, MacBeth D, Russo P, 'Organisation and governance of infection prevention and control in Australian residential aged care facilities: A national survey', Infection, Disease and Health, 24 187-193 (2019) [C1]

© 2019 Australasian College for Infection Prevention and Control Background: Individuals in residential and aged care facilities (RACFs) are at risk of developing health care-asso... [more]

© 2019 Australasian College for Infection Prevention and Control Background: Individuals in residential and aged care facilities (RACFs) are at risk of developing health care-associated infections (HAIs) due to factors such as age-related changes in physiology, immunity, comorbid illness and functional disability. The recent establishment of an Australian Royal Commission into the Quality of Residential and Aged Care Services highlights the challenges of providing care in this sector. This national study identified infection prevention and control (IPC) services, practice and priorities in Australian RACFs. Methods: A cross-sectional study of 158 Australian RACFs comprising a 42-question survey incorporating five key domains relating to IPC namely governance, education, practice, surveillance, competency and capability was undertaken in 2018. Results: Of the 131 respondents, the majority 92.4% of respondents reported having a documented IPC program, 22.9% (n = 30) operated with a dedicated infection control committee The majority of RACFs reported lacking specialist and qualified experienced IPC professionals (n = 67). The majority of RACFs (90.1%, n = 118) reported the existence of a designated employee with IPC responsibilities. Of these 118 staff members with IPC responsibilities, 42.5% had a qualification in IPC. The reported average funded hours per month for IPC professional or an external provider of IPC activities was 14 (95% CI 9.6¿18.9 h). Conclusion: The overwhelming majority of RACFs deliver IPC services and report doing so in ways that meet the needs of their own specific contexts in the absence of the lack of formal guidelines when compared to the hospital sector. Quality residential and aged care free from HAIs requires formal structure and organization strategies.

DOI 10.1016/j.idh.2019.06.004
Citations Scopus - 1
2019 Mitchell BG, Russo PL, Cheng AC, Stewardson AJ, Rosebrock H, Curtis SJ, et al., 'Strategies to reduce non-ventilator-associated hospital-acquired pneumonia: A systematic review', Infection, Disease and Health, 24 229-239 (2019) [C1]

© 2019 The Authors Background: Point prevalence studies identify that pneumonia is the most common healthcare associated infection. However, non-ventilator associated healthcare a... [more]

© 2019 The Authors Background: Point prevalence studies identify that pneumonia is the most common healthcare associated infection. However, non-ventilator associated healthcare associated pneumonia (NV-HAP) is both underreported and understudied. Most research conducted to date, focuses on ventilator associated pneumonia. We conducted a systematic review, to provide the latest evidence for strategies to reduce NV-HAP and describe the methodological approaches used. Methods: We performed a systematic search to identify research exploring and evaluating NV-HAP preventive measures in hospitals and aged-care facilities. The electronic database Medline was searched, for peer-reviewed articles published between 1st January 1998 and 31st August 2018. An assessment of the study quality and risk of bias of included articles was conducted using the Newcastle¿Ottawa Scale. Results: The literature search yielded 1551 articles, with 15 articles meeting the inclusion criteria. The majority of strategies for NV-HAP prevention focussed on oral care (n = 9). Three studies evaluated a form of physical activity, such as passive movements, two studies used dysphagia screening and management; and another study evaluated prophylactic antibiotics. Most studies (n = 12) were conducted in a hospital setting. Six of the fifteen studies were randomised controlled trials. Conclusion: There was considerable heterogeneity in the included studies, including the type of intervention, study design, methods and definitions used to diagnose the NV-HAP. To date, interventions to reduce NV-HAP appear to be based broadly on the themes of improving oral care, increased mobility or movement and dysphagia management.

DOI 10.1016/j.idh.2019.06.002
Citations Scopus - 5Web of Science - 2
2019 Mitchell BG, Northcote M, Cheng AC, Fasugba O, Russo PL, Rosebrock H, 'Reducing urinary catheter use using an electronic reminder system in hospitalized patients: A randomized stepped-wedge trial', Infection Control and Hospital Epidemiology, 40 427-431 (2019) [C1]

© 2019 by The Society for Healthcare Epidemiology of America. Objective: To determine the effectiveness and ease of use of an electronic reminder device in reducing urinary cathet... [more]

© 2019 by The Society for Healthcare Epidemiology of America. Objective: To determine the effectiveness and ease of use of an electronic reminder device in reducing urinary catheterization duration.Design: A randomized controlled trial with a cross-sectional anonymous online survey and focus group.Setting: Ten wards in an Australian hospital.Participants: All hospitalized patients with a urinary catheter.Intervention: An electronic reminder system, the CATH TAG, applied to urinary catheter bags to prompt removal of urinary catheters.Outcomes: Catheterization duration and perceptions of nurses about the ease of use.Methods: A Cox proportional hazards model was used to assess the rate of removal of catheters. A phenomenological approach underpinned data collection and analysis methods associated with the focus group.Results: In total, 1,167 patients with a urinary catheter were included. The mean durations in control and intervention phases were 5.51 days (95% confidence interval [CI], 4.9-6.2) and 5.08 days (95% CI, 4.6-5.6), respectively. For patients who had a CATH TAG applied, the hazard ratio (HR) was 1.02 (95% CI, 0.91-1.14; P =.75). A subgroup analysis excluded patients in an intensive care unit (ICU), and the use of the CATH TAG was associated with a 23% decrease in the mean, from 5.00 days (95% CI, 4.44-5.56) to 3.84 days (95% CI, 3.47-4.21). Overall, 82 nurses completed a survey and 5 nurses participated in a focus group. Responses regarding the device were largely positive, and benefits for patient care were identified.Conclusion: The CATH TAG did not reduce the duration of catheterization, but potential benefits in patients outside the ICU were identified. Electronic reminders may be useful to aid prompt removal of urinary catheters in the non-ICU hospital setting.

DOI 10.1017/ice.2019.31
Citations Scopus - 4Web of Science - 4
2019 Mitchell BG, 'Achievements and highlights for Infection, Disease and Health', INFECTION DISEASE & HEALTH, 24 1-2 (2019)
DOI 10.1016/j.idh.2018.12.004
2019 Cheng AC, Mitchell BG, Fasugba O, Graves N, Koerner J, Collignon P, 'Meatal cleaning: discrepancies in need of explanation Authors' reply', The Lancet Infectious Diseases, 19 1165 (2019)
DOI 10.1016/S1473-3099(19)30531-6
2019 Mitchell BG, Hall L, White N, Barnett AG, Halton K, Paterson DL, et al., 'An environmental cleaning bundle and health-care-associated infections in hospitals (REACH): a multicentre, randomised trial', The Lancet Infectious Diseases, 19 410-418 (2019) [C1]

© 2019 Elsevier Ltd Background: The hospital environment is a reservoir for the transmission of microorganisms. The effect of improved cleaning on patient-centred outcomes remains... [more]

© 2019 Elsevier Ltd Background: The hospital environment is a reservoir for the transmission of microorganisms. The effect of improved cleaning on patient-centred outcomes remains unclear. We aimed to evaluate the effectiveness of an environmental cleaning bundle to reduce health care-associated infections in hospitals. Methods: The REACH study was a pragmatic, multicentre, randomised trial done in 11 acute care hospitals in Australia. Eligible hospitals had an intensive care unit, were classified by the National Health Performance Authority as a major hospital (public hospitals) or having more than 200 inpatient beds (private hospitals), and had a health-care-associated infection surveillance programme. The stepped-wedge design meant intervention periods varied from 20 weeks to 50 weeks. We introduced the REACH cleaning bundle, a multimodal intervention, focusing on optimising product use, technique, staff training, auditing with feedback, and communication, for routine cleaning. The primary outcomes were incidences of health-care-associated Staphylococcus aureus bacteraemia, Clostridium difficile infection, and vancomycin-resistant enterococci infection. The secondary outcome was the thoroughness of cleaning of frequent touch points, assessed by a fluorescent marking gel. This study is registered with the Australian and New Zealand Clinical Trial Registry, number ACTRN12615000325505. Findings: Between May 9, 2016, and July 30, 2017, we implemented the cleaning bundle in 11 hospitals. In the pre-intervention phase, there were 230 cases of vancomycin-resistant enterococci infection, 362 of S aureus bacteraemia, and 968 C difficile infections, for 3 534 439 occupied bed-days. During intervention, there were 50 cases of vancomycin-resistant enterococci infection, 109 of S aureus bacteraemia, and 278 C difficile infections, for 1 267 134 occupied bed-days. After the intervention, vancomycin-resistant enterococci infections reduced from 0·35 to 0·22 per 10 000 occupied bed-days (relative risk 0·63, 95% CI 0·41¿0·97, p=0·0340). The incidences of S aureus bacteraemia (0·97 to 0·80 per 10 000 occupied bed-days; 0·82, 0·60¿1·12, p=0·2180) and C difficile infections (2·34 to 2·52 per 10 000 occupied bed-days; 1·07, 0·88¿1·30, p=0·4655) did not change significantly. The intervention increased the percentage of frequent touch points cleaned in bathrooms from 55% to 76% (odds ratio 2·07, 1·83¿2·34, p<0·0001) and bedrooms from 64% to 86% (1·87, 1·68¿2·09, p<0·0001). Interpretation: The REACH cleaning bundle was successful at improving cleaning thoroughness and showed great promise in reducing vancomycin-resistant enterococci infections. Our work will inform hospital cleaning policy and practice, highlighting the value of investment in both routine and discharge cleaning practice. Funding: National Health and Medical Research Council (Australia).

DOI 10.1016/S1473-3099(18)30714-X
Citations Scopus - 23Web of Science - 24
2019 Fasugba O, Das A, Mnatzaganian G, Mitchell BG, Collignon P, Gardner A, 'Incidence of single-drug resistant, multidrug-resistant and extensively drug-resistant Escherichia coli urinary tract infections: An Australian laboratory-based retrospective study', JOURNAL OF GLOBAL ANTIMICROBIAL RESISTANCE, 16 254-259 (2019)
DOI 10.1016/j.jgar.2018.10.026
Citations Scopus - 1Web of Science - 1
2019 Mitchell BG, Cheng AC, Fasugba O, Gardner A, Graves N, Koerner J, Collignon P, 'Chlorhexidine for prevention of catheter-associated urinary tract infections: the totality of evidence Authors' reply', The Lancet Infectious Diseases, 19 808-809 (2019)
DOI 10.1016/S1473-3099(19)30349-4
2019 Russo PL, Stewardson AJ, Cheng AC, Bucknall T, Mitchell BG, 'The prevalence of healthcare associated infections among adult inpatients at nineteen large Australian acute-care public hospitals: a point prevalence survey', Antimicrobial Resistance & Infection Control, 8 1-8 (2019) [C1]
DOI 10.1186/s13756-019-0570-y
Citations Scopus - 9
2019 Mitchell BG, Fasugba O, Cheng AC, Gregory V, Koerner J, Collignon P, et al., 'Chlorhexidine versus saline in reducing the risk of catheter associated urinary tract infection: A cost-effectiveness analysis', International Journal of Nursing Studies, 97 1-6 (2019) [C1]

© 2019 The Author(s) Background: Catheter associated urinary tract infections are one of the most common infections acquired in hospital. A recent randomised control study demonst... [more]

© 2019 The Author(s) Background: Catheter associated urinary tract infections are one of the most common infections acquired in hospital. A recent randomised control study demonstrated the benefit of using chlorhexidine (0.1%) for meatal cleaning prior to urinary catheter insertion, by reducing both catheter associated asymptomatic bacteriuria and infection. These findings raise the important question of whether a decision to switch from saline to chlorhexidine was likely to be cost-effective. The aim of this paper was to evaluate the cost-effectiveness of adopting routine use of chlorhexidine for meatal cleaning prior to urinary catheter insertion Methods: The outcomes of this cost-effectiveness study are changes to health service costs in $AUD and changes to quality adjusted life years from a decision to adopt 0.1% chlorhexidine for meatal cleaning prior to urinary catheter insertion as compared to saline. Effectiveness outcomes for this study were taken from a 32 week stepped wedge randomised controlled study conducted in three Australian hospitals. Results: The changes in health costs from switching from saline to 0.1% chlorhexidine per 100,000 catheterisations would save hospitals AUD$387,909 per 100,000 catherisations, prevent 70 cases of catheter associated urinary tract infections, release 282 bed days and provide a small improvement in health benefits of 1.43 quality adjusted life years. Using a maximum willingness to pay for a marginal quality adjusted life year threshold of AUD$28,000 per 100,000 catherisations, suggests that adopting chlorhexidine would be cost effective and potentially cost-saving. Conclusion: The findings from our work provide evidence to health system administrators and those responsible for drafting catheter associated urinary tract infections prevention guidelines that investing in switching from saline to chlorhexidine is not only clinically effective but also a sensible decision in the context of allocating finite healthcare resources.

DOI 10.1016/j.ijnurstu.2019.04.003
Citations Scopus - 5Web of Science - 4
2019 Fasugba O, Cheng AC, Gregory V, Graves N, Koerner J, Collignon P, et al., 'Chlorhexidine for meatal cleaning in reducing catheter-associated urinary tract infections: a multicentre stepped-wedge randomised controlled trial', The Lancet Infectious Diseases, 19 611-619 (2019) [C1]

© 2019 Elsevier Ltd Background: Evidence for the benefits of antiseptic meatal cleaning in reducing catheter-associated urinary tract infection (UTI) is inconclusive. We assessed ... [more]

© 2019 Elsevier Ltd Background: Evidence for the benefits of antiseptic meatal cleaning in reducing catheter-associated urinary tract infection (UTI) is inconclusive. We assessed the efficacy of 0·1% chlorhexidine solution compared with normal saline for meatal cleaning before urinary catheter insertion in reducing the incidence of catheter-associated asymptomatic bacteriuria and UTI. Methods: A cross-sectional, stepped-wedge, open-label, randomised controlled trial was undertaken in Australian hospitals. Eligible hospitals were Australian public and private hospitals, with an intensive care unit and more than 30 000 hospital admissions per year. Hospitals were randomly assigned to an intervention crossover date using a computer-generated randomisation system. Crossover dates occurred every 8 weeks; during the first 8 weeks of the study, no hospitals were exposed to the intervention (control phase), after which each hospital sequentially crossed over from the control to the intervention every 8 weeks. Patients requiring a urinary cathetwer were potentially eligible for inclusion in this hospital-wide study. Participants were excluded if they were younger than 2 years, had a medical reason preventing the use of the chlorhexidine, had the catheter inserted in theatre, did not have the catheter insertion date documented, required in-and-out or suprapubic catheterisation, had symptoms and signs suggestive of UTI at the time of catheter insertion, or were currently undergoing treatment for UTI. The intervention was the use of 0·1% chlorhexidine solution for meatal cleaning before urinary catheterisation with 0·9% normal saline used in the control phase. Masking of hospitals was not possible because it was not feasible to mask staff administering the intervention. The co-primary outcomes were the number of cases of catheter-associated asymptomatic bacteriuria and UTI per 100 catheter-days and were assessed within 7 days of catheter insertion in the intention-to-treat population. This trial is registered with Australian New Zealand Clinical Trials Registry, number ACTRN12617000373370. Findings: 21 hospitals were assessed for eligibility between Jan 5, 2017, and May 1, 2017; of these, three were successfully enrolled and randomised to one of three intervention crossover dates. 1642 participants in these hospitals were included in the study between Aug 1, 2017, and March 12, 2018, 697 (42%) in the control phase and 945 (58%) in the intervention period. In the control period, 13 catheter-associated UTI and 29 catheter-associated asymptomatic bacteriuria events in 2889 catheter-days (0·45 catheter-associated UTI cases and 1·00 catheter-associated asymptomatic bacteriuria cases per 100 catheter-days) were recorded compared with four catheter-associated UTI and 16 catheter-associated asymptomatic bacteriuria events in 2338 catheter-days (0·17 catheter-associated UTI cases and 0·68 catheter-associated asymptomatic bacteriuria cases per 100 catheter-days) during the intervention period. The intervention was associated with a 74% reduction in the incidence of catheter-associated asymptomatic bacteriuria (incident rate ratio 0·26, 95% CI 0·08¿0·86, p=0·026), and a 94% decrease in the incidence of catheter-associated UTI (0·06, 95% CI 0·01¿0·32, p=0·00080). There were no reported adverse events. Interpretation: The use of chlorhexidine solution for meatal cleaning before catheter insertion decreased the incidence of catheter-associated asymptomatic bacteriuria and UTI and has the potential to improve patient safety. Funding: HCF Research Foundation.

DOI 10.1016/S1473-3099(18)30736-9
Citations Scopus - 9
2018 Mitchell BG, White N, Farrington A, Allen M, Page K, Gardner A, et al., 'Changes in knowledge and attitudes of hospital environmental services staff: The Researching Effective Approaches to Cleaning in Hospitals (REACH) study', AMERICAN JOURNAL OF INFECTION CONTROL, 46 980-985 (2018)
DOI 10.1016/j.ajic.2018.02.003
Citations Scopus - 9Web of Science - 10
2018 Russo PL, Shaban RZ, Macbeth D, Carter A, Mitchell BG, 'Impact of electronic healthcare-associated infection surveillance software on infection prevention resources: a systematic review of the literature', JOURNAL OF HOSPITAL INFECTION, 99 1-7 (2018)
DOI 10.1016/j.jhin.2017.09.002
Citations Scopus - 11Web of Science - 9
2018 Fasugba O, Koerner J, Bennett N, Burrell S, Laguitan R, Hoskins A, et al., 'Development and evaluation of a website for surveillance of healthcare-associated urinary tract infections in Australia', JOURNAL OF HOSPITAL INFECTION, 99 98-102 (2018)
DOI 10.1016/j.jhin.2018.01.006
Citations Scopus - 1Web of Science - 1
2018 Anderson M, Mitchell B, Northcote M, Williams A, Petrie K, de Waal K, Carton J, 'The construction of a postgraduate student and supervisor support framework: Using stakeholder voices to promote effective postgraduate teaching and learning practice', JOURNAL OF UNIVERSITY TEACHING AND LEARNING PRACTICE, 15 (2018)
Citations Scopus - 2Web of Science - 1
2018 Mitchell BG, Gardner A, Stone PW, Hall L, Pogorzelska-Maziarz M, 'Hospital Staffing and Health Care-Associated Infections: A Systematic Review of the Literature', JOINT COMMISSION JOURNAL ON QUALITY AND PATIENT SAFETY, 44 613-622 (2018)
DOI 10.1016/j.jcjq.2018.02.002
Citations Scopus - 18Web of Science - 21
2018 Fasugba O, Cheng AC, Russo PL, Northcote M, Rosebrock H, Mitchell BG, 'Reducing urinary catheter use: a protocol for a mixed methods evaluation of an electronic reminder system in hospitalised patients in Australia', BMJ OPEN, 8 (2018)
DOI 10.1136/bmjopen-2017-020469
Citations Scopus - 4Web of Science - 4
2018 Russo PL, Stewardson A, Cheng AC, Bucknall T, Marimuthu K, Mitchell BG, 'Establishing the prevalence of healthcare-associated infections in Australian hospitals: protocol for the Comprehensive Healthcare Associated Infection National Surveillance (CHAINS) study', BMJ OPEN, 8 (2018)
DOI 10.1136/bmjopen-2018-024924
Citations Scopus - 4Web of Science - 3
2018 Mitchell BG, Shaban RZ, 'Infection, Disease & Health for today, tomorrow, and the future', INFECTION DISEASE & HEALTH, 23 1-2 (2018)
DOI 10.1016/j.idh.2018.02.001
2017 Cloete L, Mitchell B, Morton D, 'The role of obesity in the onset of type 2 diabetes mellitus', Nursing standard (Royal College of Nursing (Great Britain) : 1987), 31 59-71 (2017)

The onset of type 2 diabetes mellitus is associated with various modifiable and non-modifiable risk factors, including lifestyle factors. Obesity is the principal lifestyle factor... [more]

The onset of type 2 diabetes mellitus is associated with various modifiable and non-modifiable risk factors, including lifestyle factors. Obesity is the principal lifestyle factor associated with an increased risk of developing type 2 diabetes. It is essential for nurses to have an understanding of the pathophysiology associated with factors that contribute to an increased risk of type 2 diabetes, particularly those associated with obesity. Nurses who have an understanding of the interaction between obesity and the onset of type 2 diabetes are better equipped to discuss the importance of weight loss and other necessary lifestyle adjustments in the prevention and management of obesity and diabetes associated with obesity, to implement evidence-based practice and to support patients to manage their health effectively.

DOI 10.7748/ns.2017.e10672
Citations Scopus - 4
2017 Mitchell BG, Anderson M, Ferguson JK, 'A predictive model of days from infection to discharge in patients with healthcare-associated urinary tract infections: a structural equation modelling approach.', The Journal of hospital infection, 97 282-287 (2017) [C1]
DOI 10.1016/j.jhin.2017.08.006
Citations Scopus - 6Web of Science - 6
Co-authors John Ferguson
2017 Russo PL, Cheng AC, Mitchell BG, Hall L, 'Healthcare-associated infections in Australia: Tackling the 'known unknowns'', Australian Health Review, 42 178-180 (2017)

© AHHA. Australia does not have a national healthcare-associated infection (HAI) surveillance program. Without national surveillance, we do not understand the burden of HAIs, nor ... [more]

© AHHA. Australia does not have a national healthcare-associated infection (HAI) surveillance program. Without national surveillance, we do not understand the burden of HAIs, nor can we accurately assess the effects of national infection prevention initiatives. Recent research has demonstrated disparity between existing jurisdictional-based HAI surveillance activity while also identifying broad key stakeholder support for the establishment of a national program. A uniform surveillance program will also address growing concerns about hospital performance measurements and enable public reporting of hospital data.

DOI 10.1071/AH16223
Citations Scopus - 5Web of Science - 5
2017 Fasugba O, Koerner J, Mitchell BG, Gardner A, 'Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections', Journal of Hospital Infection, 95 233-242 (2017)

© 2016 The Healthcare Infection Society Background Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Antiseptic cle... [more]

© 2016 The Healthcare Infection Society Background Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Antiseptic cleaning of the meatal area before and during catheter use may reduce the risk of CAUTIs. Aim To undertake a systematic review of the literature and meta-analysis of studies investigating the effectiveness of antiseptic cleaning before urinary catheter insertion and during catheter use for prevention of CAUTIs. Methods Electronic databases were searched to identify randomized controlled trials. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and compared across intervention and control groups using DerSimonian¿Laird random-effects model. Subgroup analyses were performed. Heterogeneity was estimated using the I2 statistic. Findings In total, 2665 potential papers were identified; of these, 14 studies were eligible for inclusion. There was no difference in the incidence of CAUTIs when comparing antiseptic and non-antiseptic agents (pooled OR 0.90, 95% CI 0.73¿1.10; P=0.31), or when comparing different agents: povidone-iodine vs routine care; povidone-iodine vs soap and water; chlorhexidine vs water; povidone-iodine vs saline; povidone-iodine vs water; and green soap and water vs routine care (P>0.05 for all). Comparison of an antibacterial agent with routine care indicated near significance (P=0.06). There was no evidence of heterogeneity (I2=0%; P>0.05). Subgroup analyses showed no difference in the incidence of CAUTIs in terms of country, setting, risk of bias, sex and frequency of administration. Conclusions There were no differences in CAUTI rates, although methodological issues hamper generalizability of this finding. Antibacterial agents may prove to be significant in a well-conducted study. The present results provide good evidence to inform infection control guidelines in catheter management.

DOI 10.1016/j.jhin.2016.10.025
Citations Scopus - 16Web of Science - 14
2017 Halton K, Hall L, Gardner A, MacBeth D, Mitchell BG, 'Exploring the context for effective clinical governance in infection control', American Journal of Infection Control, 45 278-283 (2017)

© 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Background Effective clinical governance is necessary to support improvements in infection control... [more]

© 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Background Effective clinical governance is necessary to support improvements in infection control. Historically, the focus has been on ensuring that infection control practice and policy is based on evidence, and that there is use of surveillance and auditing for self-regulation and performance feedback. There has been less exploration of how contextual and organizational factors mediate an infection preventionists (IP's) ability to engage with evidence-based practice and enact good clinical governance. Methods A cross sectional Web-based survey of IPs in Australia and New Zealand was undertaken. Questions focused on engagement in evidence-based practice and perceptions about the context, culture, and leadership within the infection control team and organization. Responses were mapped against dimensions of Scally and Donaldson's clinical governance framework. Results Three hundred surveys were returned. IPs appear well equipped at an individual level to undertake evidence-based practice. The most serious set of perceived challenges to good clinical governance related to a lack of leadership or active resistance to infection control within the organization. Additional challenges included lack of information technology solutions and poor access to specialist expertise and financial resources. Conclusions Focusing on strengthening contextual factors at the organizational level that otherwise undermine capacity to implement evidence-based practice is key to sustaining current infection control successes and promoting further practice improvements.

DOI 10.1016/j.ajic.2016.10.022
Citations Scopus - 5Web of Science - 4
2017 Mitchell BG, Williams A, Wong Z, 'Assessing the functionality of temporary isolation rooms', American Journal of Infection Control, 45 1231-1237 (2017)

© 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Background Challenges with limited single rooms and isolation facilities in hospitals have created... [more]

© 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Background Challenges with limited single rooms and isolation facilities in hospitals have created an opportunity for temporary, portable isolation technology. This article describes the process used to evaluate the prototype of a new isolation room (RediRoom; CareStrategic Ltd, Brisbane, Queensland, Australia) that can be installed in existing hospital ward areas. Our aim is to assess the functionality of this new room, and in so doing, to evaluate the methods used. Methods We employed a mixed-methods approach involving video recording, interviews, and objective temperature and humidity measurements within a crossover interventional study. Participants completed a range of clinical activities in the RediRoom and a control. The setting for the study was a clinical ward environment at an Australian higher education institution. Results There were similarities between the RediRoom and the control using a range of measures. The time taken to complete a range of clinical activities in both rooms was broadly consistent. Network analysis also suggested broad similarities in the movement of nurses undertaking activities in both rooms. Conclusion Our study attempted to simulate a clinical environment and clinical activities and provide the best possible comparison by completing activities sequentially, with immediate feedback to researchers. Video recording added significant value to the process because it provided some objectivity. A form of reflexive ethnography with participants could be of value in similar studies in the future.

DOI 10.1016/j.ajic.2017.05.019
2017 Mitchell BG, Petrie D, Morton L, Dancer SJ, 'What's Trending in Infection Control? Scoping and Narrative Reviews', Infection Control and Hospital Epidemiology, 38 1098-1102 (2017)

© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. OBJECTIVE To explore the trends in infection control peer-reviewed journals, mainstream media, a... [more]

© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. OBJECTIVE To explore the trends in infection control peer-reviewed journals, mainstream media, and blogs written by infection control professionals DESIGN Narrative and scoping reviews METHODS Narrative and scoping reviews were performed to identify trending infection prevention and control topics from international journals, national news websites, newspapers, and so-called grey literature throughout 2015. Data were analyzed using word frequencies, and results are displayed in word clouds. RESULTS For 2015, our search identified 6 news websites with a total of published 116 articles, 71 articles from selected newspapers, and 214 publications from infection control websites. In total, 1,059 journal articles were initially identified; 98 articles were anonymous and thus were excluded, leaving 961 articles in the reviews. The terms 'superbug' and 'antibiotics' were most commonly used in titles of news websites and newspapers, whereas the terms 'infection' and 'prevention' were most commonly used in infection control websites or blogs. The word frequency differences among the 4 selected journals reflected their respective specialties. CONCLUSION In infection prevention and control, the integration of a range of mediums is necessary to best serve public interests. Whether the aim is advocacy, general health information dissemination, or warnings of imminent risk, health researchers have access to multiple forums with different strengths through which to influence public risk perceptions and responses. Infect Control Hosp Epidemiol 2017;38:1098-1102.

DOI 10.1017/ice.2017.130
Citations Scopus - 2Web of Science - 2
2017 Mitchell BG, Russo PL, Otter JA, Kiernan MA, Aveling L, 'What Makes a Tweet Fly? Analysis of Twitter Messaging at Four Infection Control Conferences', Infection Control and Hospital Epidemiology, 38 1271-1276 (2017)

© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. OBJECTIVE To examine tweeting activity, networks, and common topics mentioned on Twitter at 4 in... [more]

© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. OBJECTIVE To examine tweeting activity, networks, and common topics mentioned on Twitter at 4 international infection control and infectious disease conferences. DESIGN A cross-sectional study. METHODS An independent company was commissioned to undertake a Twitter 'trawl' each month between July 1, 2016, and November 31, 2016. The trawl identified any tweets that contained the official hashtags of the conferences for (1) the UK Infection Prevention Society, (2) IDWeek 2016, (3) the Federation of Infectious Society/Hospital Infection Society, and (4) the Australasian College for Infection Prevention and Control. Topics from each tweet were identified, and an examination of the frequency and timing of tweets was performed. A social network analysis was performed to illustrate connections between users. A multivariate binary logistic regression model was developed to explore the predictors of 'retweets.' RESULTS In total, 23,718 tweets were identified as using 1 of the 2 hashtags of interest. The results demonstrated that the most tweets were posted during the conferences. Network analysis demonstrated a diversity of twitter networks. A link to a web address was a significant predictor of whether a tweet would be retweeted (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.9-2.1). Other significant factors predicting a retweet included tweeting on topics such as Clostridium difficile (OR, 2.0; 95% CI, 1.7-2.4) and the media (OR, 1.8; 95% CI, 1.6-2.0). Tweets that contained a picture were significantly less likely to be retweeted (OR, 0.06; 95% CI, 0.05-0.08). CONCLUSION Twitter is a useful tool for information sharing and networking at infection control conferences.

DOI 10.1017/ice.2017.170
Citations Scopus - 11Web of Science - 11
2017 Morton DP, Kent L, Rankin P, Mitchell B, Parker K, Gobble J, Diehl H, 'Optimizing the Intensity of Lifestyle Medicine Interventions: Similar Outcomes for Half the Sessions', American Journal of Lifestyle Medicine, 11 274-279 (2017)

© 2015, © 2015 The Author(s). Lifestyle medicine interventions are typically intensive by design. This study explored the optimal ¿dosage¿ of a well-known lifestyle medicine inter... [more]

© 2015, © 2015 The Author(s). Lifestyle medicine interventions are typically intensive by design. This study explored the optimal ¿dosage¿ of a well-known lifestyle medicine intervention¿the Complete Health Improvement Program (CHIP). A total of 2383 individuals (mean age = 61.0 ± 9.2 years; 34% males) participated in either an 8-session (N = 448) or 16-session (N = 1935) version of the CHIP intervention conducted over 4 weeks in community settings throughout North America. Both the 8- and 16-session groups experienced significant improvements in all the chronic disease risk factors measured. There was no difference between the changes experienced by the 8- and 16-session groups in lipid profile, fasting plasma glucose, or systolic blood pressure. The 8-session group experienced a significantly greater reduction in body mass (0.3 percentage points or 0.8 lbs, P <.01), but the 16-session group recorded a significantly greater reduction in diastolic blood pressure (2.8 percentage points or 2.2 mm Hg, P <.01). There was no clear difference between the outcomes achieved in 4 weeks by the 8- and 16-session versions of the CHIP lifestyle medicine intervention. This study suggests that the short-term outcomes achieved by a 16-session CHIP intervention can be achieved in half the number of sessions, which has implications from a resourcing and cost-effectiveness perspective.

DOI 10.1177/1559827615612420
Citations Scopus - 1Web of Science - 1
2017 Mitchell BG, MacBeth D, Halton K, Gardner A, Hall L, 'Resourcing hospital infection prevention and control units in Australia: A discussion paper', Infection, Disease and Health, 22 83-88 (2017)

© 2017 Australasian College for Infection Prevention and Control Background Infection control professionals (ICPs) are critical in maintaining high standards of quality patient ca... [more]

© 2017 Australasian College for Infection Prevention and Control Background Infection control professionals (ICPs) are critical in maintaining high standards of quality patient care. Until recently, little was known about the scope of practice, structures, resources and priorities for ICPs and infection control units more generally. Over the past three years we have undertaken a program of work to explore these issues. The purpose of this discussion paper is to synthesise these results and outline implications for the Australian infection control community. Methods We undertook a survey of individual ICPs in Australian and New Zealand and a survey of hospital infection control units within Australia. To understand how our research program could be used to inform and be of value, we also convened a stakeholder workshop to discuss how data from our studies could be translated into meaningfully constructed findings. A synthesis of the findings from the two surveys and the workshop was undertaken and this formed the basis of this discussion paper. Results We were able for the first time, to comprehensively report on infection control staffing levels, priorities and barriers within Australia. We identified considerable variability in the scope, experience and expertise of ICPs and the potential value that credentialing has with respect to effective infection control programs. We were however, unable to develop recommendations with respect to staffing. Conclusion The findings of our work may be used in designing and justifying business cases for infection prevention and control resources. There is also a need to undertake a similar study in settings other than hospitals.

DOI 10.1016/j.idh.2017.02.001
Citations Scopus - 2Web of Science - 1
2017 Fasugba O, Koerner J, Mitchell BG, Gardner A, 'Meatal cleaning with antiseptics for the prevention of catheter-associated urinary tract infections: A discussion paper', Infection, Disease and Health, 22 136-143 (2017)

© 2017 Australasian College for Infection Prevention and Control Urinary tract infections related to indwelling urinary catheters, known as catheter-associated urinary tract infec... [more]

© 2017 Australasian College for Infection Prevention and Control Urinary tract infections related to indwelling urinary catheters, known as catheter-associated urinary tract infections (CAUTI), are largely preventable healthcare-associated infections (HAI). Healthcare-associated infections including CAUTI are associated with prolonged hospital stay, increased resistance of microorganisms to antimicrobials, increased morbidity and mortality as well as additional financial burden on health care systems, patients and their families. While the optimal aim for patients and the health care system is to prevent CAUTI using measures such as reducing unnecessary placement and early removal of urinary catheters, there is evidence that cleaning of the meatal or peri-urethral area with antiseptic prior to catheter insertion and care of this area while the catheter is insitu has the potential to reduce CAUTI. Evidence suggests that meatal cleaning with antiseptics while the catheter is insitu is non-beneficial in reducing CAUTI but current international and Australian guidelines for infection control professionals identifies that the benefit of antiseptic solution versus non-antiseptic solution for meatal or peri-urethral cleaning before urinary catheter insertion remains unresolved. This discussion paper therefore focuses primarily on antiseptic meatal cleaning prior to urinary catheter insertion in preventing CAUTI. Using evidence from a recently published systematic review and meta-analysis of the literature, this paper discusses the scope of the problem and limitations in the evidence regarding the effectiveness of antiseptics for preventing CAUTI and finally, proposes a way forward through the undertaking of a rigorously conducted randomised controlled trial aimed at evaluating the effectiveness and cost-effectiveness of antiseptic meatal cleaning for prevention of CAUTI.

DOI 10.1016/j.idh.2017.06.004
Citations Scopus - 3Web of Science - 2
2017 Mitchell BG, Williams A, Wong Z, O'Connor J, 'Assessing a temporary isolation room from an infection control perspective: A discussion paper', Infection, Disease and Health, 22 129-135 (2017)

© 2017 The Authors Introduction Assessing the functionality and infection control implications of new technologies presents significant challenges. In this discussion paper, we pr... [more]

© 2017 The Authors Introduction Assessing the functionality and infection control implications of new technologies presents significant challenges. In this discussion paper, we present our approach to assessing infection control aspects of a new isolation room, the RediRoom¿ (prototype). We report how we evaluated this room, lessons learnt and suggestions for future evaluations in this area. Methods There is no documented method for evaluating a novel temporary isolation room. We combined a range of existing tools to undertake a technical assessment. Three approaches were used, an assessment against standards or guidelines; professional assessment; and a cleaning assessment. Results To assess compliance against existing recommendations related to the built environment and isolation rooms, elements contained within Australasian and United Kingdom guidelines were used. We were able to identify which elements in these guidelines were of the most value and relevance. An ultraviolet (UV) solution with fluorescent light assessment was used to assess the ability to clean surfaces. This approach was a useful objective measure. A professional assessment is potentially subjective, but provides an opportunity to identify other potential issues and benefits. In this study, the RediRoom¿ performed well against all three approaches. We identified limitations in using existing guidelines for a temporary isolation room. Conclusion In our study, the use of video and video reflexive ethnography for the professional assessment would have been useful. We propose a revised list of assessment against which new isolation solutions or technologies could be assessed, with the view of others continuing to build on this.

DOI 10.1016/j.idh.2017.06.003
Citations Scopus - 1Web of Science - 1
2017 Mitchell BG, Shaban RZ, MacBeth D, Wood CJ, Russo PL, 'The burden of healthcare-associated infection in Australian hospitals: A systematic review of the literature', Infection, Disease and Health, 22 117-128 (2017)

© 2017 The Authors Introduction Central to all efforts to control and prevent healthcare associated infections (HAIs) is the inherent need to measure the burden of infection and d... [more]

© 2017 The Authors Introduction Central to all efforts to control and prevent healthcare associated infections (HAIs) is the inherent need to measure the burden of infection and disease, classically referred to as surveillance. Australia does not have a national HAI surveillance system making it very difficult to systematically assess and report on the burden of hospital-acquired HAIs. This systematic review reports the incidence burden of HAIs in Australian hospitals as reported in the peer-reviewed literature from 2010 to 2016. Methods Systematic review of the peer-reviewed literature reporting the incidence of HAIs in Australian hospitals between from 2010 to 2016 was identified using MEDLINE and CINAHL databases. The study protocol is registered with PROSPERO (registration number: CRD42016052997). Results Of the 844 articles identified in the search, 24 articles were included in this review. Overall, these data suggest 83,096 HAIs per year in Australia, comprising 71,186 urinary tract infections, 4902 Clostridium difficile infections, 3946 surgical site infections, 1962 respiratory infections in acute stroke patients and 1100 hospital-onset Staphylococcus aureus bacteraemia. This is very large underestimate given the lack of or incomplete data on common infections such as pneumonia, gastroenterological and bloodstream infection, thus potentially missing up to 50%¿60% of infections. If that is the case, the incidence of HAIs in Australia may be closer to 165,000 per year. Conclusion There is a dearth of peer-reviewed literature reporting the incidence of HAIs in Australian hospitals, making it very difficult to an accurate burden of infection. On the eve of a global ¿post antibiotic era¿, the need for national consensus on definitions, surveillance methodology and reporting is paramount.

DOI 10.1016/j.idh.2017.07.001
Citations Scopus - 25Web of Science - 23
2017 Fasugba O, Mitchell BG, Beckingham W, Bennett N, Gardner A, 'Point prevalence surveys of healthcare-associated urinary tract infections: Development, pilot testing and evaluation of face-to-face and online educational packages', Infection, Disease and Health, 22 187-194 (2017)

© 2017 The Authors Objective To describe the development, pilot testing and evaluation of face-to-face and online educational training packages for healthcare staff undertaking po... [more]

© 2017 The Authors Objective To describe the development, pilot testing and evaluation of face-to-face and online educational training packages for healthcare staff undertaking point prevalence surveys (PPS) of healthcare-associated urinary tract infections (HAUTIs) in Australian hospitals and aged care facilities. Methods The study involved two phases. A face-to-face educational training package was developed and used in Phase I of the HAUTI PPS data collection conducted in six hospitals. In Phase II, the training package was expanded and modified for online use by healthcare staff in 82 hospitals and 17 aged care facilities. Ten staff evaluated the face-to-face training package in Phase I. For Phase II, 38 staff evaluated the online training package. After each phase, staff completed an online evaluation survey about the usefulness of the training package and ease of data collection. Results For Phase I, usefulness of the training package was rated highly (100%, n = 10) with all respondents rating the training useful in preparing for data collection. Staff in Phase II also reported the online training useful in preparing for data collection and was rated very useful by 21% (n = 8) of respondents and useful by 66% (n = 25). Some respondents (Phase I, n = 4 and Phase II, n = 25) provided small amount of text data that was triangulated with quantitative data. Qualitative feedback reinforced quantitative ranking of usefulness of the training package. Conclusion The training packages were sufficient to train healthcare staff with varying levels of knowledge and skills in undertaking HAUTI PPS in hospitals and/or aged care facilities.

DOI 10.1016/j.idh.2017.07.002
Citations Scopus - 1Web of Science - 1
2017 Mitchell BG, Farrington A, Allen M, Gardner A, Hall L, Barnett AG, et al., 'Variation in hospital cleaning practice and process in Australian hospitals: A structured mapping exercise', Infection, Disease and Health, 22 195-202 (2017)

© 2017 The Authors Background The purpose of this paper is to highlight the range of cleaning practices and processes in 11 Australian hospitals and to discuss the challenges this... [more]

© 2017 The Authors Background The purpose of this paper is to highlight the range of cleaning practices and processes in 11 Australian hospitals and to discuss the challenges this variation poses to the implementation of clinical trials or changes to hospital cleaning practices. Methods A cross-sectional study design was used to determine cleaning practices and processes in hospitals participating in the ¿Researching Effective Approaches to Cleaning in Hospitals¿ (REACH) study. A standardised template and approach was used to collect information. Data collection activities included structured on-site discussions, a review of hospital practices and a document review of policy and procedural documents related to cleaning. Results Variations in the auditing process used to evaluate environmental cleanliness, cleaning practices, product use, training and communication pathways available to cleaning staff were identified. There was also variation in workforce structure and responsibilities for cleaning. Conclusion This paper is the first to describe the differences in cleaning practices between Australian hospitals. The variations identified present a number of challenges for the conduct of research and have important implications for both monitoring of and standards for cleanliness. These challenges include implementing a practice change or cleaning study where hospitals have different processes, practices and structures.

DOI 10.1016/j.idh.2017.08.001
Citations Scopus - 6Web of Science - 8
2017 Mitchell BG, Fasugba O, Gardner A, Koerner J, Collignon P, Cheng AC, et al., 'Reducing catheter-associated urinary tract infections in hospitals: Study protocol for a multi-site randomised controlled study', BMJ Open, 7 (2017)

© 2017 Article author(s) (or their employer(s) unless otherwise stated in the text of the article). All rights reserved. No commercial use is permitted unless otherwise expressly ... [more]

© 2017 Article author(s) (or their employer(s) unless otherwise stated in the text of the article). All rights reserved. No commercial use is permitted unless otherwise expressly granted. Introduction Despite advances in infection prevention and control, catheter-associated urinary tract infections (CAUTIs) are common and remain problematic. A number of measures can be taken to reduce the risk of CAUTI in hospitals. Appropriate urinary catheter insertion procedures are one such method. Reducing bacterial colonisation around the meatal or urethral area has the potential to reduce CAUTI risk. However, evidence about the best antiseptic solutions for meatal cleaning is mixed, resulting in conflicting recommendations in guidelines internationally. This paper presents the protocol for a study to evaluate the effectiveness (objective 1) and cost-effectiveness (objective 2) of using chlorhexidine in meatal cleaning prior to catheter insertion, in reducing catheter-associated asymptomatic bacteriuria and CAUTI. Methods and analysis A stepped wedge randomised controlled trial will be undertaken in three large Australian hospitals over a 32-week period. The intervention in this study is the use of chlorhexidine (0.1%) solution for meatal cleaning prior to catheter insertion. During the first 8 weeks of the study, no hospital will receive the intervention. After 8 weeks, one hospital will cross over to the intervention with the other two participating hospitals crossing over to the intervention at 8-week intervals respectively based on randomisation. All sites complete the trial at the same time in 2018. The primary outcomes for objective 1 (effectiveness) are the number of cases of CAUTI and catheter-associated asymptomatic bacteriuria per 100 catheter days will be analysed separately using Poisson regression. The primary outcome for objective 2 (cost-effectiveness) is the changes in costs relative to health benefits (incremental cost-effectiveness ratio) from adoption of the intervention. Dissemination Results will be disseminated via peer-reviewed journals and presentations at relevant conferences.A dissemination plan it being developed. Results will be published in the peer review literature, presented at relevant conferences and communicated via professional networks. Ethics Ethics approval has been obtained. Trial registration number 12617000373370, approved 13/03/2017. Protocol version 1.1.

DOI 10.1136/bmjopen-2017-018871
Citations Scopus - 4Web of Science - 6
2016 Mitchell BG, Ferguson JK, Anderson M, Sear J, Barnett A, 'Length of stay and mortality associated with healthcare-associated urinary tract infections: A multi-state model', Journal of Hospital Infection, 93 92-99 (2016) [C1]

© 2016 The Authors. Background: The emergence of antimicrobial resistance is of particular concern with respect to urinary tract infections, since the majority of causative agents... [more]

© 2016 The Authors. 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.

DOI 10.1016/j.jhin.2016.01.012
Citations Scopus - 48Web of Science - 46
Co-authors John Ferguson
2016 Mitchell BG, Ferguson JK, 'The use of clinical coding data for the surveillance of healthcare-associated urinary tract infections in Australia', Infection, Disease and Health, 21 32-35 (2016) [C1]

© 2016 Australasian College for Infection Prevention and Control Introduction Given the trends in antimicrobial resistance, particularly for Gram-negative organisms, the surveilla... [more]

© 2016 Australasian College for Infection Prevention and Control Introduction Given the trends in antimicrobial resistance, particularly for Gram-negative organisms, the surveillance of urinary tract infections (UTIs) has the potential to become increasingly important in the future. Whilst considering accuracy and efficiency, we undertook a cohort study in a large Australian health district to inform future discussions around surveillance approaches to healthcare-associated UTIs (HAUTI). Methods A retrospective cohort study in eight hospitals was conducted to examine the clinical coding data of all patients hospitalised for more than two days over a four-and-half-year period. These data were compared to a conservative laboratory-based HAUTI definition. Results The data from 162,503 patient admissions were examined. During the study period, 2821 of the admitted patients acquired a HAUTI. Of those patients identified as having a laboratory-diagnosed HAUTI, 29.3% had a clinical code relating to a UTI. Conclusion The clinical coding data used to identify cases of HAUTI is very unreliable as a significant proportion of cases were not identified. To ensure the efficient and effective use of resources, a range of approaches should be considered in the event of HAUTI surveillance being required.

DOI 10.1016/j.idh.2016.03.002
Citations Scopus - 3Web of Science - 3
Co-authors John Ferguson
2016 MacBeth D, Hall L, Halton K, Gardner A, Mitchell BG, 'Credentialing of Australian and New Zealand infection control professionals: An exploratory study', American Journal of Infection Control, 44 886-891 (2016)

© 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Background Despite evidence from overseas that certification and credentialing of infection contro... [more]

© 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Background Despite evidence from overseas that certification and credentialing of infection control professionals (ICPs) is important to patient outcomes, there are no standardized requirements for the education and preparation of ICPs in Australia. A credentialing process (now managed by the Australasian College of Infection Prevention and Control) has been in existence since 2000; however, no evaluation has occurred. Methods A cross-sectional study design was used to identify the perceived barriers to credentialing and the characteristics of credentialed ICPs. Results There were 300 responses received; 45 (15%) of participants were credentialed. Noncredentialed ICPs identified barriers to credentialing as no employer requirement and no associated remuneration. Generally credentialed ICPs were more likely to hold higher degrees and have more infection control experience than their noncredentialed colleagues. Conclusions The credentialing process itself may assist in supporting ICP development by providing an opportunity for reflection and feedback from peer review. Further, the process may assist ICPs in being flexible and adaptable to the challenging and ever-changing environment that is infection control.

DOI 10.1016/j.ajic.2016.01.026
Citations Scopus - 1Web of Science - 1
2016 Morton D, Mitchell B, Kent L, Egger G, Hurlow T, 'Lifestyle as medicine - Past precepts for present problems', Australian Family Physician, 45 248-249 (2016)
2016 Mitchell BG, Hall L, Halton K, MacBeth D, Gardner A, 'Time spent by infection control professionals undertaking healthcare associated infection surveillance: A multi-centred cross sectional study', Infection, Disease and Health, 21 36-40 (2016)

© 2016 Australasian College for Infection Prevention and Control Background There is limited contemporary information on how infection control professionals (ICPs) in hospitals ut... [more]

© 2016 Australasian College for Infection Prevention and Control Background There is limited contemporary information on how infection control professionals (ICPs) in hospitals utilise their time, with even less providing any specific data on time taken to undertake HAI surveillance. HAI surveillance is a critical component of any infection control program. Methods An anonymous online web-based survey was used to conduct a cross-sectional study of infection control units in public and private Australian hospitals. Participants were asked demographic information and time spent undertaking infection control activities, including surveillance. Results Forty infection control units, responsible for providing services to 138 hospitals completed the survey. The percentage of time spent undertaking HAI surveillance activities by members of the infection control units was 1675¿h or 36.0% (95% CI 34.3%¿37.8%; range 17%¿61%) of all contracted infection control professionals time (4653¿h). Of the time spent undertaking HAI surveillance, 56% was spent collecting data, 27% collecting data on compliance with infection control activities and 17% feeding HAI data back to clinicians and management. There was no difference in the proportion of time spent undertaking HAI surveillance between public and privately funded hospitals or infection control units led by a credentialed ICP. Infection control units with a form of electronic surveillance dedicated more time to surveillance, compared to units that did not use such a system. Demands for surveillance increased with larger number of hospitals beds. Conclusion The costs of undertaking HAI surveillance and collecting data can be considerable. The efficiency of undertaking surveillance should be considered, weighing investment against the likely improvement in infection rates and patient quality of life.

DOI 10.1016/j.idh.2016.03.003
Citations Scopus - 12Web of Science - 12
2016 Mitchell BG, Shaban RZ, Dancer SJ, Cheng A, Gilbert L, 'Infection, Disease and Health: A journal for the future', Infection, Disease and Health, 21 1-2 (2016)
DOI 10.1016/j.idh.2016.04.001
2016 Mitchell BG, Fasugba O, Beckingham W, Bennett N, Gardner A, 'A point prevalence study of healthcare associated urinary tract infections in Australian acute and aged care facilities', Infection, Disease and Health, 21 26-31 (2016)

© 2016 Objectives Surveillance of healthcare associated urinary tract infections (HAUTIs) in Australian acute and aged care facilities is lacking. Therefore, to provide the founda... [more]

© 2016 Objectives Surveillance of healthcare associated urinary tract infections (HAUTIs) in Australian acute and aged care facilities is lacking. Therefore, to provide the foundation for a national point prevalence study of HAUTIs and catheter associated urinary tract infection (CAUTIs), a three phase project was developed with recent completion of the second phase. The objectives of Phase II were to (1) develop a website incorporating tools for conducting point prevalence of HAUTIs and CAUTIs, (2) pilot an online process and database for conducting point prevalence of HAUTIs and CAUTIs and (3) determine the point prevalence of HAUTIs and CAUTIs in acute and aged care facilities. This paper reports on the third objective. Methods Point prevalence of HAUTIs and CAUTIs were assessed in 82 acute care and 17 aged care facilities within four Australian jurisdictions using an online survey. Results The study included 1320 patients and 663 residents from acute and aged care facilities respectively. HAUTI prevalence was 1.4% (95% CI 0.8¿2.2%) in acute care and 1.5% (95% CI 0.8¿2.6%) in aged care. Catheter use in acute care (9.3%) was three times greater than aged care (3.3%). Conclusion Given the relative frequency with which HAUTI occurs, associations with addition length of stay in hospital and risk of systemic sepsis from these infections, efforts should be made to further minimise HAUTI prevalence. There is also a need to develop targeted interventions for catheter use especially in acute care because inappropriate and/or excessive catheter use has implications for the risk of CAUTIs and adds consumable costs.

DOI 10.1016/j.idh.2016.03.001
Citations Scopus - 11Web of Science - 9
2016 Cheng AC, Stewardson AJ, Mitchell BG, Collignon P, Johnson PD, Stuart RL, 'Mycobacterial infections due to contaminated heater cooler units used in cardiac bypass: An approach for infection control practitioners', Infection, Disease and Health, 21 154-161 (2016)

© 2016 Australasian College for Infection Prevention and Control Mycobacterium chimaera infection in patients who have had cardiac bypass surgery has recently been associated with... [more]

© 2016 Australasian College for Infection Prevention and Control Mycobacterium chimaera infection in patients who have had cardiac bypass surgery has recently been associated with contamination of water in heater cooler units. Those responsible for infection prevention and control programs face the challenge of responding to this rare but potentially life-threatening and avoidable healthcare-associated infection. Infection control professionals need to be aware of this issue and take an active role in formulating hospital responses. Policies should be rational and appropriate to the level of risk, should minimise service disruption and costs, and recognise that evidence about risk mitigation measures is still emerging. This paper provides background information to the topic and proposes a risk management based approach to heater cooler units in hospitals that perform cardiac bypass surgery, so that infection control professionals can develop a local, tailored response.

DOI 10.1016/j.idh.2016.10.002
Citations Scopus - 2Web of Science - 2
2016 Hall L, Farrington A, Mitchell BG, Barnett AG, Halton K, Allen M, et al., 'Researching effective approaches to cleaning in hospitals: Protocol of the REACH study, a multi-site stepped-wedge randomised trial', Implementation Science, 11 (2016)

© 2016 Hall et al. Background: The Researching Effective Approaches to Cleaning in Hospitals (REACH) study will generate evidence about the effectiveness and cost-effectiveness of... [more]

© 2016 Hall et al. Background: The Researching Effective Approaches to Cleaning in Hospitals (REACH) study will generate evidence about the effectiveness and cost-effectiveness of a novel cleaning initiative that aims to improve the environmental cleanliness of hospitals. The initiative is an environmental cleaning bundle, with five interdependent, evidence-based components (training, technique, product, audit and communication) implemented with environmental services staff to enhance hospital cleaning practices. Methods/design: The REACH study will use a stepped-wedge randomised controlled design to test the study intervention, an environmental cleaning bundle, in 11 Australian hospitals. All trial hospitals will receive the intervention and act as their own control, with analysis undertaken of the change within each hospital based on data collected in the control and intervention periods. Each site will be randomised to one of the 11 intervention timings with staggered commencement dates in 2016 and an intervention period between 20 and 50 weeks. All sites complete the trial at the same time in 2017. The inclusion criteria allow for a purposive sample of both public and private hospitals that have higher-risk patient populations for healthcare-associated infections (HAIs). The primary outcome (objective one) is the monthly number of Staphylococcus aureus bacteraemias (SABs), Clostridium difficile infections (CDIs) and vancomycin resistant enterococci (VRE) infections, per 10,000 bed days. Secondary outcomes for objective one include the thoroughness of hospital cleaning assessed using fluorescent marker technology, the bio-burden of frequent touch surfaces post cleaning and changes in staff knowledge and attitudes about environmental cleaning. A cost-effectiveness analysis will determine the second key outcome (objective two): the incremental cost-effectiveness ratio from implementation of the cleaning bundle. The study uses the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to support the tailored implementation of the environmental cleaning bundle in each hospital. Discussion: Evidence from the REACH trial will contribute to future policy and practice guidelines about hospital environmental cleaning. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in hospitals. Trial registration: Australia New Zealand Clinical Trial Registry ACTRN12615000325505

DOI 10.1186/s13012-016-0406-6
Citations Scopus - 18Web of Science - 16
2016 Fasugba O, Mitchell BG, Mnatzaganian G, Das A, Collignon P, Gardner A, 'Five-year antimicrobial resistance patterns of urinary Escherichia coli at an Australian tertiary hospital: Time series analyses of prevalence data', PLoS ONE, 11 (2016)

© 2016 Fasugba et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and rep... [more]

© 2016 Fasugba et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This study describes the antimicrobial resistance temporal trends and seasonal variation of Escherichia coli (E. coli) urinary tract infections (UTIs) over five years, from 2009 to 2013, and compares prevalence of resistance in hospital- and community-acquired E. coli UTI. A cross sectional study of E. coli UTIs from patients attending a tertiary referral hospital in Canberra, Australia was undertaken. Time series analysis was performed to illustrate resistance trends. Only the first positive E. coli UTI per patient per year was included in the analysis. A total of 15,022 positive cultures from 8724 patients were identified. Results are based on 5333 first E. coli UTIs, from 4732 patients, of which 84.2% were communityacquired. Five-year hospital and community resistance rates were highest for ampicillin (41.9%) and trimethoprim (20.7%). Resistance was lowest for meropenem (0.0%), nitrofurantoin (2.7%), piperacillin-tazobactam (2.9%) and ciprofloxacin (6.5%). Resistance to amoxycillin-clavulanate, cefazolin, gentamicin and piperacillin-tazobactam were significantly higher in hospital- compared to community-acquired UTIs (9.3% versus 6.2%; 15.4% versus 9.7%; 5.2% versus 3.7% and 5.2% versus 2.5%, respectively). Trend analysis showed significant increases in resistance over five years for amoxycillin-clavulanate, trimethoprim, ciprofloxacin, nitrofurantoin, trimethoprim-sulphamethoxazole, cefazolin, ceftriaxone and gentamicin (P<0.05, for all) with seasonal pattern observed for trimethoprim resistance (augmented Dickey-Fuller statistic = 4.136; P = 0.006). An association between ciprofloxacin resistance, cefazolin resistance and ceftriaxone resistance with older age was noted. Given the relatively high resistance rates for ampicillin and trimethoprim, these antimicrobials should be reconsidered for empirical treatment of UTIs in this patient population. Our findings have important implications for UTI treatment based on setting of acquisition.

DOI 10.1371/journal.pone.0164306
Citations Scopus - 16Web of Science - 17
2015 Mitchell BG, Dancer SJ, Anderson M, Dehn E, 'Risk of organism acquisition from prior room occupants: A systematic review and meta-analysis', Journal of Hospital Infection, 91 211-217 (2015)

© 2015 The Healthcare Infection Society. A systematic review and meta-analysis was conducted to determine the risk of pathogen acquisition for patients associated with prior room ... [more]

© 2015 The Healthcare Infection Society. 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 ß-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.

DOI 10.1016/j.jhin.2015.08.005
Citations Scopus - 87Web of Science - 79
2015 Mitchell BG, Hall L, Macbeth D, Gardner A, Halton K, 'Hospital infection control units: Staffing, costs, and priorities', American Journal of Infection Control, 43 612-616 (2015)

© 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Background This article describes infection prevention and control professionals&apos; (ICPs&apos;... [more]

© 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Background This article describes infection prevention and control professionals' (ICPs') staffing levels, patient outcomes, and costs associated with the provision of infection prevention and control services in Australian hospitals. A secondary objective was to determine the priorities for infection control units. Methods A cross-sectional study design was used. Infection control units in Australian public and private hospitals completed a Web-based anonymous survey. Data collected included details about the respondent; hospital demographics; details and services of the infection control unit; and a description of infection prevention and control-related outputs, patient outcomes, and infection control priorities. Results Forty-nine surveys were undertaken, accounting for 152 Australian hospitals. The mean number of ICPs was 0.66 per 100 overnight beds (95% confidence interval, 0.55-0.77). Privately funded hospitals have significantly fewer ICPs per 100 overnight beds compared with publicly funded hospitals (P <.01). Staffing costs for nursing staff in infection control units in this study totaled $16,364,392 (mean, $380,566). Infection control units managing smaller hospitals (<270 beds) identified the need for increased access to infectious diseases or microbiology support. Conclusion This study provides valuable information to support future decisions by funders, hospital administrators, and ICPs on service delivery models for infection prevention and control. Further, it is the first to provide estimates of the resourcing and cost of staffing infection control in hospitals at a national level.

DOI 10.1016/j.ajic.2015.02.016
Citations Scopus - 19Web of Science - 14
2015 Mitchell BG, Hall L, Halton K, MacBeth D, Gardner A, 'Infection control standards and credentialing', American Journal of Infection Control, 43 1380-1381 (2015)
DOI 10.1016/j.ajic.2015.06.034
Citations Scopus - 3Web of Science - 3
2015 Meumann EM, Mitchell BG, McGregor A, McBryde E, Cooley L, 'Urinary Escherichia coli antimicrobial susceptibility profiles and their relationship with community antibiotic use in Tasmania, Australia', International Journal of Antimicrobial Agents, 46 389-393 (2015)

© 2015 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved. This study assessed urinary Escherichia coli antibiotic susceptibility patterns in Tasmani... [more]

© 2015 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved. This study assessed urinary Escherichia coli antibiotic susceptibility patterns in Tasmania, Australia, andexamined their association with community antibiotic use. The susceptibility profiles of all urinary E. coliisolates collected in Tasmania between January 2010 and December 2012 were included. The amount ofPharmaceutical Benefits Scheme (PBS)-subsidised use of amoxicillin, amoxicillin/clavulanic acid (AMC),cefalexin, norfloxacin, ciprofloxacin and trimethoprim was retrieved (at the Tasmanian population level)and the number of defined daily doses per 1000 population per day in Tasmania for these antibiotics wascalculated for each month during the study period. Antimicrobial susceptibility data were assessed forchanges over time in the 3-year study period. Antimicrobial use and susceptibility data were assessedfor seasonal differences and lag in resistance following antibiotic use. Excluding duplicates, 28 145 E. coliisolates were included. Resistance levels were low; 35% of isolates were non-susceptible to amoxicillin,14% were non-susceptible to trimethoprim and <5% were non-susceptible to AMC, cefalexin, gentamicinand norfloxacin. Amoxicillin use increased by 35% during winter/spring compared with summer/autumn,and AMC use increased by 21%. No seasonal variation in quinolone use or resistance was detected. Thelow levels of antimicrobial resistance identified may relate to Tasmania's isolated geographical location.Significant seasonal variation in amoxicillin and AMC use is likely to be due to increased use of theseantibiotics for treatment of respiratory tract infections in winter. Quinolone use is restricted by the PBSin Australia, which is the likely explanation for the low levels of quinolone use and resistance identified.

DOI 10.1016/j.ijantimicag.2015.05.015
Citations Scopus - 7Web of Science - 7
2015 Havers SM, Russo PL, Mitchell B, Hall L, 'Health-care-associated infections', The Lancet Infectious Diseases, 15 763-764 (2015)
DOI 10.1016/S1473-3099(15)00069-9
Citations Scopus - 1Web of Science - 1
2015 Hall L, Halton K, Macbeth D, Gardner A, Mitchell B, 'Roles, responsibilities and scope of practice: Describing the 'state of play' for infection control professionals in Australia and New Zealand', Healthcare Infection, 20 29-35 (2015)

Journal compilation © Australasian College for Infection Prevention and Control 2015. Background In the past decade the policy and practice context for infection control in Austra... [more]

Journal compilation © Australasian College for Infection Prevention and Control 2015. Background In the past decade the policy and practice context for infection control in Australia and New Zealand has changed, with infection control professionals (ICPs) now involved in the implementation of a large number of national strategies. Little is known about the current ICP workforce and what they do in their day-to-day positions. The aim of this study was to describe the ICP workforce in Australia and New Zealand with a focus on roles, responsibilities, and scope of practice. Methods A cross-sectional design using snowball recruitment was employed. ICPs completed an anonymous web-based survey with questions on demographics; qualifications held; level of experience; workplace characteristics; and roles and responsibilities. Chi-squared tests were used to determine if any factors were associated with how often activities were undertaken. Results A total of 300 ICPs from all Australian states and territories and New Zealand participated. Most ICPs were female (94%); 53% were aged over 50, and 93% were employed in registered nursing roles. Scope of practice was diverse: all ICPs indicated they undertook a large number and variety of activities as part of their roles. Some activities were undertaken on a less frequent basis by sole practitioners and ICPs in small teams. Conclusion This survey provides useful information on the current education, experience levels and scope of practice of ICPs in Australia and New Zealand. Work is now required to establish the best mechanisms to support and potentially streamline scope of practice, so that infection-control practice is optimised.

DOI 10.1071/HI14037
Citations Scopus - 16Web of Science - 15
2015 Shaban RZ, Mitchell BG, 'Trends in publication scholarship in Healthcare Infection: A 12-year analysis', Healthcare Infection, 20 85-88 (2015)

© Australasian College for Infection Prevention and Control 2015. Background Healthcare Infection, the official publication of the Australasian College for Infection Prevention Co... [more]

© Australasian College for Infection Prevention and Control 2015. Background Healthcare Infection, the official publication of the Australasian College for Infection Prevention Control, is an international, peer-reviewed journal. This paper presents an analysis of the publication scholarship trends of articles published within Healthcare Infection, providing insight into future publication trends. Methods A cross-sectional study design was used to explore published articles over a 12-year period, between 2002 and 2015. A content analysis was performed to examine the key thematic characteristics of all published articles. Citation data from articles published between 2011 and 2015 were extracted from Scopus. Results A total of 345 articles were published in Healthcare Infection during this time. The topics and content of the publications varied considerably. Approximately half the published articles were original research of which the majority were low level evidence. Other articles comprised discussion papers, review articles and editorials. Conclusion In recent years, there has been an increase in international collaborations and diversification of topics published, including urinary tract infection, sharps injuries, health economics, and antibiotic resistance and stewardship.

DOI 10.1071/HI15008
Citations Scopus - 1Web of Science - 1
2015 Mitchell BG, Wilson F, Wells A, 'Evaluating environment cleanliness using two approaches: A multi-centred Australian study', Healthcare Infection, 20 95-100 (2015)

© Australasian College for Infection Prevention and Control 2015. Introduction A standardised approach to evaluating environmental cleanliness is important to ensure consistency o... [more]

© Australasian College for Infection Prevention and Control 2015. Introduction A standardised approach to evaluating environmental cleanliness is important to ensure consistency of assessor training, allow benchmarking of results between facilities, ensure consistency of the assessment of the environment and assist in meeting national accreditation standards. This paper describes the development process and the findings of the first 12 months of data following the introduction of a standardised program for evaluating environmental cleanliness within Tasmanian healthcare facilities using two different evaluation methods. Methods Evaluation of environmental cleanliness was undertaken as part of a structured program and involved the use of an ultraviolet solution and fluorescent light in addition to a visual assessment. Twelve Tasmanian hospitals participated in this study. Results A total of 290 fluorescent light assessments and 232 visual inspections were conducted. Using the fluorescent light assessment, the percentage of correctly cleaned items increased from a baseline of 82.3% to 85.4% over the 12-month study period. Using the visual assessment, 92.5% of items were deemed acceptable during the study period. Conclusions Our multi-centred study identified a high baseline level of cleanliness using a fluorescent light. We identified that objects were frequently deemed to be visually acceptable, yet may not have been cleaned. The project was supported by a range of online tools for data submission, training tools and a formal assessment of auditors.

DOI 10.1071/HI15009
Citations Scopus - 7Web of Science - 6
2015 Mitchell BG, 'Healthcare Infection: A time for change', Healthcare Infection, 20 81-83 (2015)
DOI 10.1071/HI15019
2015 Fasugba O, Gardner A, Mitchell BG, Mnatzaganian G, 'Ciprofloxacin resistance in community- and hospital-acquired Escherichia coli urinary tract infections: A systematic review and meta-analysis of observational studies', BMC Infectious Diseases, 15 (2015)

© 2015 Fasugba et al. Background: During the last decade the resistance rate of urinary Escherichia coli (E. coli) to fluoroquinolones such as ciprofloxacin has increased. Systema... [more]

© 2015 Fasugba et al. Background: During the last decade the resistance rate of urinary Escherichia coli (E. coli) to fluoroquinolones such as ciprofloxacin has increased. Systematic reviews of studies investigating ciprofloxacin resistance in community- and hospital-acquired E. coli urinary tract infections (UTI) are absent. This study systematically reviewed the literature and where appropriate, meta-analysed studies investigating ciprofloxacin resistance in community- and hospital-acquired E. coli UTIs. Methods: Observational studies published between 2004 and 2014 were identified through Medline, PubMed, Embase, Cochrane, Scopus and Cinahl searches. Overall and sub-group pooled estimates of ciprofloxacin resistance were evaluated using DerSimonian-Laird random-effects models. The I2 statistic was calculated to demonstrate the degree of heterogeneity. Risk of bias among included studies was also investigated. Results: Of the identified 1134 papers, 53 were eligible for inclusion, providing 54 studies for analysis with one paper presenting both community and hospital studies. Compared to the community setting, resistance to ciprofloxacin was significantly higher in the hospital setting (pooled resistance 0.38, 95 % CI 0.36-0.41 versus 0.27, 95 % CI 0.24-0.31 in community-acquired UTIs, P < 0.001). Resistance significantly varied by region and country with the highest resistance observed in developing countries. Similarly, a significant rise in resistance over time was seen in studies reporting on community-acquired E. coli UTI. Conclusions: Ciprofloxacin resistance in E. coli UTI is increasing and the use of this antimicrobial agent as empirical therapy for UTI should be reconsidered. Policy restrictions on ciprofloxacin use should be enhanced especially in developing countries without current regulations.

DOI 10.1186/s12879-015-1282-4
Citations Scopus - 69Web of Science - 61
2015 Mitchell BG, Russo PL, 'Preventing healthcare-associated infections: the role of surveillance', Nursing standard (Royal College of Nursing (Great Britain) : 1987), 29 52-58 (2015)

Surveillance of healthcare-associated infections is central to healthcare epidemiology and infection control programmes and a critical factor in the prevention of these infections... [more]

Surveillance of healthcare-associated infections is central to healthcare epidemiology and infection control programmes and a critical factor in the prevention of these infections. By definition, the term 'infection prevention' implies that healthcare-associated infections may be preventable. The purpose of surveillance is to provide quality data that can be used in an effective monitoring and alert system and to reduce the incidence of preventable healthcare-associated infections. This article examines the purpose of surveillance, explains key epidemiological terms, provides an overview of approaches to surveillance and discusses the importance of validation.

DOI 10.7748/ns.29.23.52.e9609
Citations Scopus - 8
2014 Slimings C, Armstrong P, Beckingham WD, Bull AL, Hall L, Kennedy KJ, et al., 'Increasing incidence of Clostridium difficile infection, Australia, 2011-2012', Medical Journal of Australia, 200 272-276 (2014)

Objectives: To report the quarterly incidence of hospital-identified Clostridium difficile infection (HI-CDI) in Australia, and to estimate the burden ascribed to hospital-associa... [more]

Objectives: To report the quarterly incidence of hospital-identified Clostridium difficile infection (HI-CDI) in Australia, and to estimate the burden ascribed to hospital-associated (HA) and community-associated (CA) infections. Design, setting and patients: Prospective surveillance of all cases of CDI diagnosed in hospital patients from 1 January 2011 to 31 December 2012 in 450 public hospitals in all Australian states and the Australian Capital Territory. All patients admitted to inpatient wards or units in acute public hospitals, including psychiatry, rehabilitation and aged care, were included, as well as those attending emergency departments and outpatient clinics. Main outcome measures: Incidence of HI-CDI (primary outcome); proportion and incidence of HA-CDI and CA-CDI (secondary outcomes). Results: The annual incidence of HI-CDI increased from 3.25/10 000 patient-days (PD) in 2011 to 4.03/10 000 PD in 2012. Poisson regression modelling demonstrated a 29% increase (95% CI, 25% to 34%) per quarter between April and December 2011, with a peak of 4.49/10 000 PD in the October-December quarter. The incidence plateaued in January-March 2012 and then declined by 8% (95% CI, - 11% to - 5%) per quarter to 3.76/10 000 PD in July-September 2012, after which the rate rose again by 11% (95% CI, 4% to 19%) per quarter to 4.09/10 000 PD in October-December 2012. Trends were similar for HA-CDI and CA-CDI. A subgroup analysis determined that 26% of cases were CA-CDI. Conclusions: A significant increase in both HA-CDI and CA-CDI identified through hospital surveillance occurred in Australia during 2011-2012. Studies are required to further characterise the epidemiology of CDI in Australia.

DOI 10.5694/mja13.11153
Citations Scopus - 65Web of Science - 67
2014 Mitchell BG, Gardner A, 'A model for influences on reliable and valid health care-associated infection data', American Journal of Infection Control, 42 190-192 (2014)

Reliable surveillance data and continuous monitoring can provide useful information for clinicians and patients alike, by identifying areas needing improvement and demonstrating t... [more]

Reliable surveillance data and continuous monitoring can provide useful information for clinicians and patients alike, by identifying areas needing improvement and demonstrating the effectiveness of interventions. Improving the rigor of health care-associated infection surveillance makes it possible to provide more valid and reliable information. We propose a model that can be used by infection control preventionists, researchers, and health planners and can serve as a trigger for understanding the influences on reliable and valid health care-associated infection data.

DOI 10.1016/j.ajic.2013.08.002
Citations Scopus - 4Web of Science - 4
2014 Mitchell BG, Gardner A, Barnett AG, Hiller JE, Graves N, 'The prolongation of length of stay because of Clostridium difficile infection', American Journal of Infection Control, 42 164-167 (2014)

Background Clostridium difficile infection (CDI) possibly extends hospital length of stay (LOS); however, the current evidence does not account for the time-dependent bias, ie, wh... [more]

Background Clostridium difficile infection (CDI) possibly extends hospital length of stay (LOS); however, the current evidence does not account for the time-dependent bias, ie, when infection is incorrectly analyzed as a baseline covariate. The aim of this study was to determine whether CDI increases LOS after managing this bias. Methods We examined the estimated extra LOS because of CDI using a multistate model. Data from all persons hospitalized >48 hours over 4 years in a tertiary hospital in Australia were analyzed. Persons with health care-associated CDIs were identified. Cox proportional hazards models were applied together with multistate modeling. Results One hundred fifty-eight of 58,942 admissions examined had CDI. The mean extra LOS because of infection was 0.9 days (95% confidence interval: -1.8 to 3.6 days, P =.51) when a multistate model was applied. The hazard of discharge was lower in persons who had CDI (adjusted hazard ratio, 0.42; P <.001) when a Cox proportional hazard model was applied. Conclusion This study is the first to use multistate models to determine the extra LOS because of CDI. Results suggest CDI does not significantly contribute to hospital LOS, contradicting findings published elsewhere. Conversely, when methods prone to result in time-dependent bias were applied to the data, the hazard of discharge significantly increased. These findings contribute to discussion on methods used to evaluate LOS and health care-associated infections.

DOI 10.1016/j.ajic.2013.07.006
Citations Scopus - 16Web of Science - 13
2014 Mitchell BG, Gardner A, 'Addressing the need for an infection prevention and control framework that incorporates the role of surveillance: A discussion paper', Journal of Advanced Nursing, 70 533-542 (2014)

Aim: To present a discussion on theoretical frameworks in infection prevention and control. Background: Infection prevention and control programmes have been in place for several ... [more]

Aim: To present a discussion on theoretical frameworks in infection prevention and control. Background: Infection prevention and control programmes have been in place for several years in response to the incidence of healthcare-associated infections and their associated morbidity and mortality. Theoretical frameworks play an important role in formalizing the understanding of infection prevention activities. Design: Discussion paper. Data sources: A literature search using electronic databases was conducted for published articles in English addressing theoretical frameworks in infection prevention and control between 1980-2012. Results: Nineteen papers that included a reference to frameworks were identified in the review. A narrative analysis of these papers was completed. Two models were identified and neither included the role of surveillance. Discussion: To reduce the risk of acquiring a healthcare-associated infection, a multifaceted approach to infection prevention is required. One key component in this approach is surveillance. The review identified two infection prevention and control frameworks, yet these are rarely applied in infection prevention and control programmes. Only one framework considered the multifaceted approach required for infection prevention. It did not, however, incorporate the role of surveillance. We present a framework that incorporates the role of surveillance into a biopsychosocial approach to infection prevention and control. Conclusion: Infection prevention and control programmes and associated research are led primarily by nurses. There is a need for an explicit infection prevention and control framework incorporating the important role that surveillance has in infection prevention activities. This study presents one framework for further critique and discussion. © 2013 John Wiley & Sons Ltd.

DOI 10.1111/jan.12193
Citations Scopus - 14Web of Science - 12
2014 Kent LM, Morton DP, Rankin PM, Mitchell BG, Chang E, Diehl H, 'Gender differences in effectiveness of the Complete Health Improvement Program (CHIP) lifestyle intervention: An Australasian study', Health Promotion Journal of Australia, 25 222-229 (2014)

Issue addressed Complete Health Improvement Program (CHIP) is a lifestyle modification program that promotes healthy diet, physical activity and stress management techniques. Amon... [more]

Issue addressed Complete Health Improvement Program (CHIP) is a lifestyle modification program that promotes healthy diet, physical activity and stress management techniques. Among US CHIP participants, differences in gender responsiveness to improvements in chronic disease risk factors were demonstrated. This study examined gender differences in outcomes to the CHIP intervention in Australasia. Methods Changes in body weight, blood pressure (BP), blood lipid profile and fasting plasma glucose (FPG) were assessed in 925 participants (34.3% men, mean age=56.0±12.5 years; 65.7% women, mean age=54.4±13.5 years) 30 days after program commencement. Results Significant reductions (P<0.001) in all biometrics measured were found for men and women but were greater among men for total (TC) and low-density lipoprotein cholesterol (LDL), triglycerides (TG), FPG, body mass index (BMI) and TC/high-density lipoprotein cholesterol (HDL) ratio. Participants with highest baseline classifications of BMI, systolic BP, blood lipids and FPG showed greatest reductions in 30 days. Conclusions CHIP more effectively reduced chronic disease risk factors among men than women. All participants, but particularly men, entering the program with the greatest risk achieved the largest reductions. Possible physiological or behavioural factors include food preferences, making commitments and differential support modes. So what? Developers of lifestyle intervention programs should consider gender differences in physiological and behavioural factors when planning interventions. In particular, developers should manage expectations of people entering lifestyle interventions to increase awareness that men tend to respond better than women. In addition, this is a call for further research to identify the underlying mechanisms responsible for the disproportionate responsiveness of males.

DOI 10.1071/HE14041
Citations Scopus - 7Web of Science - 7
2014 Mitchell BG, Collignon PJ, McCann R, Wilkinson IJ, Wells A, 'Major reduction in hospital-onset Staphylococcus aureus bacteremia in Australia - 12 years of progress: An observational study', Clinical Infectious Diseases, 59 969-975 (2014)

© The Author 2014. Background. Staphylococcus aureus bacteremia (SAB) is a serious cause of morbidity and mortality. This longitudinal study describes significant reductions in ho... [more]

© The Author 2014. Background. Staphylococcus aureus bacteremia (SAB) is a serious cause of morbidity and mortality. This longitudinal study describes significant reductions in hospital-onset SAB (HO-SAB) in Australian hospitals over the past 12 years. Methods. An observational cohort study design was used. Prospective surveillance of HO-SAB in 132 hospitals in Australia was undertaken. Aggregated data from all patients who acquired HO-SAB was collected (defined as 1 or more blood cultures positive for S. aureus taken from a patient who had been admitted to hospital for <48 hours). The primary outcome was the incidence of HO-SAB, including both methicillin-resistant (MRSA) and methicillinsusceptible (MSSA) S. aureus strains. Results. A total of 2733 HO-SAB cases were identified over the study period, giving an aggregate incidence of 0.90 per 10 000 patient-days (PDs) (95% confidence interval [CI], .86-.93). There was a 63% decrease in the annual incidence, from 1.72 per 10 000 PDs in 2002 (95% CI, 1.50-1.97) to 0.64 per 10 000 PDs (95% CI, .53-.76) in 2013. The mean reduction per year was 9.4% (95% CI, -8.1% to -10.7%). Significant reductions in both HO-MRSA (from 0.77 to 0.18 per 10 000 PDs) and HO-MSSA (from 1.71 to 0.64 per 10 000 PDs) bacteremia were observed. Conclusions. There was a major and significant reduction in incidence of HO-SAB caused by both MRSA and MSSA in Australian hospitals since 2002. This reduction coincided with a range of infection prevention and control activities implemented during this time. It suggests that national and local efforts to reduce the burden of healthcareassociated infections have been very successful.

DOI 10.1093/cid/ciu508
Citations Scopus - 35Web of Science - 37
2014 Mitchell BG, Collignon PJ, McCann R, Wilkinson IJ, Wells A, 'Reply to worth et al', Clinical Infectious Diseases, 59 1809-1810 (2014)
DOI 10.1093/cid/ciu692
2014 Mitchell B, Gardner A, Beckingham W, Fasugba O, 'Healthcare associated urinary tract infections: A protocol for a national point prevalence study', Healthcare Infection, 19 26-31 (2014)

Background Urinary tract infections account for ~30% of healthcare-associated infections reported by hospitals. Virtually all healthcare-associated urinary tract infections (HAUTI... [more]

Background Urinary tract infections account for ~30% of healthcare-associated infections reported by hospitals. Virtually all healthcare-associated urinary tract infections (HAUTIs) are caused by instrumentation of the urinary tract, creating an opportunity to prevent a large proportion of HAUTIs, including catheter-associated urinary tract infections (CAUTIs). In Australia, there is no specific national strategy and surveillance system in place to address HAUTIs or CAUTIs. To determine the need for prospective surveillance of HAUTIs, we propose undertaking a national point prevalence study. This paper describes the methods that could be used to undertake such a study. Methods A cross-sectional point prevalence design is proposed. The population is all patients hospitalised overnight in Australian hospitals, with the sample to exclude outpatients and those in emergency departments. The proposed operational definition is that used by the Health Protection Agency. A standardised training package for data collectors is recommended with standardised data collection and analysis processes described. Individual patient consent should be waived. Discussion Explanation of aspects of the proposed methods are provided, primarily based on findings from a pilot study that informed the development of the proposed protocol. This included development and delivery of training for data collectors and use of the Health Protection Agency HAUTI surveillance definition, rather than the Centers for Disease Control definition. Conclusion Conducting a national point prevalence study on HAUTIs including CAUTIs will provide evidence that can be subsequently used to debate the cost effectiveness and value of prospective surveillance. By conducting a pilot study and critically evaluating that process, we have been able to propose a method that could be used for a single hospital or national study. © 2014 Australasian College for Infection Prevention and Control.

DOI 10.1071/HI13037
Citations Scopus - 8
2014 Mitchell BG, 'Clostridium difficile infection: Incidence in an Australian setting', Asian Nursing Research, 8 213-218 (2014)

© 2014, Korean Society of Nursing Science. Published by Elsevier. All rights reserved. Purpose The aim of this study is to determine the incidence of Clostridium difficile infecti... [more]

© 2014, Korean Society of Nursing Science. Published by Elsevier. All rights reserved. Purpose The aim of this study is to determine the incidence of Clostridium difficile infection (CDI) in an Australian hospital and highlight considerations for other Asian countries that are considering establishing or modifying existing CDI surveillance programs.Methods An observational study design with dynamic population was used. Data from all persons hospitalized for more than 48 hours over 4 years in a tertiary hospital in Australia were analyzed. Persons with healthcare associated, healthcare facility onset CDIs were identified. The calculation of the relative risk was performed to compare the occurrence of CDI in different groups.Results Of the total 58,942 admissions examined, 158 admissions had CDI. The incidence of CDI per 1,000 admissions for the entire study period was 2.68 (95% confidence interval [2.28, 3.13]). There was a statistically significant increase in the incidence of CDI in 2010 compared to that of 2007 (p <.001). The incidence of CDI increased from the 30-39-year age group onwards.Conclusion Comparisons between this study and others are challenging due to the lack of standardized definitions for CDI internationally. Noting the increases of CDI internationally and the associated mortality, there is increasing importance to monitor and report the incidence of this infection worldwide.

DOI 10.1016/j.anr.2014.07.003
Citations Scopus - 1Web of Science - 1
2014 Fasugba O, Gardner A, Mitchell B, Beckingham W, Bennett N, 'Surveillance to reduce urinary tract infections: the STRUTI project', Australian nursing &amp; midwifery journal, 22 34 (2014)
2014 Mitchell BG, Say R, Wells A, Wilson F, Cloete L, Matheson L, 'Australian graduating nurses' knowledge, intentions and beliefs on infection prevention and control: A cross-sectional study', BMC Nursing, 13 1-7 (2014)

© 2014 Mitchell et al.; licensee BioMed Central Ltd. Background: In recent year, national bodies have been actively addressing the increasing concern on the spread of healthcare-a... [more]

© 2014 Mitchell et al.; licensee BioMed Central Ltd. Background: In recent year, national bodies have been actively addressing the increasing concern on the spread of healthcare-associated infections (HAIs). The current study measures the knowledge, intentions and beliefs of third-year Australian nursing students on key infection prevention and control (IPC) concepts. Methods: A cross-sectional study of final-year undergraduate nursing students from Schools of Nursing at six Australian universities was undertaken. Students were asked to participate in an anonymous survey. The survey explored knowledge of standard precautions and transmission based precautions. In addition intentions and beliefs towards IPC were explored. Results: 349 students from six universities completed the study. 59.8% (95% CI 58.8-60.8%) of questions were answered correctly. Significantly more standard precaution questions were correctly answered than transmission-based precaution questions (p < 0.001). No association was found between self-reported compliance with IPC activities and gender or age. Certain infection control issues were correlated with the percentage of correctly answered transmission-based precaution questions. The participants were most likely to seek infection control information from an infection control professional. Conclusion: Knowledge on transmission-based precautions was substandard. As transmission-based precautions are the foundation of IPC for serious organisms and infections, education institutions should reflect on the content and style of educational delivery on this topic.

DOI 10.1186/s12912-014-0043-9
Citations Scopus - 17
2014 Mitchell BG, Digney W, Locket P, Dancer SJ, 'Controlling methicillin-resistant Staphylococcus aureus (MRSA) in a hospital and the role of hydrogen peroxide decontamination: An interrupted time series analysis', BMJ Open, 4 (2014)

Objectives: The impact of surface disinfection versus detergent cleaning on healthcare associated infection rates remains unresolved. We aimed to evaluate the efficacy of hydrogen... [more]

Objectives: The impact of surface disinfection versus detergent cleaning on healthcare associated infection rates remains unresolved. We aimed to evaluate the efficacy of hydrogen peroxide (HP) decontamination against methicillin-resistant Staphylococcus aureus (MRSA). Design: Single centred retrospective before and after study design. Setting: Launceston General Hospital, Tasmania, Australia. Participants: Patients with MRSA infection or colonisation. Interventions: Rooms occupied by patients with MRSA infection or colonisation were cleaned following discharge with either detergent or HP. Main outcome measures: MRSA room contamination following cleaning; new MRSA acquisition in patients. Results: Over 3600 discharge cleans were completed, with more than 32 600 environmental swabs processed. MRSA was isolated from 24.7% rooms following detergent cleaning and from 18.8% of rooms after HP (p<0.001). The incidence of MRSA acquisition reduced from 9.0 to 5.3 per 10 000 patient days in detergent and disinfectant arms, respectively (p<0.001). Conclusions: Use of HP disinfection led to a decrease in residual MRSA contamination in patient rooms compared with detergent. It may also have encouraged the reduction in patient MRSA acquisition despite several confounders including staff feedback on terminal cleaning, additional MRSA screening and quicker laboratory methods. Infection control is best served by concurrent interventions targeting both the patient and healthcare environment.

DOI 10.1136/bmjopen-2013-004522
Citations Scopus - 16Web of Science - 14
2014 Gardner A, Mitchell B, Beckingham W, Fasugba O, 'A point prevalence cross-sectional study of healthcare-associated urinary tract infections in six Australian hospitals', BMJ Open, 4 (2014)

Objectives: Urinary tract infections (UTIs) account for over 30% of healthcare-associated infections. The aim of this study was to determine healthcare-associated UTI (HAUTI) and ... [more]

Objectives: Urinary tract infections (UTIs) account for over 30% of healthcare-associated infections. The aim of this study was to determine healthcare-associated UTI (HAUTI) and catheter-associated UTI (CAUTI) point prevalence in six Australian hospitals to inform a national point prevalence process and compare two internationally accepted HAUTI definitions. We also described the level and comprehensiveness of clinical record documentation, microbiology laboratory and coding data at identifying HAUTIs and CAUTIs. Setting: Data were collected from three public and three private Australian hospitals over the first 6 months of 2013. Participants: A total of 1109 patients were surveyed. Records of patients of all ages, hospitalised on the day of the point prevalence at the study sites, were eligible for inclusion. Outpatients, patients in adult mental health units, patients categorised as maintenance care type (ie, patients waiting to be transferred to a long-term care facility) and those in the emergency department during the duration of the survey were excluded. Outcome measures: The primary outcome measures were the HAUTI and CAUTI point prevalence. Results: Overall HAUTI and CAUTI prevalence was 1.4% (15/1109) and 0.9% (10/1109), respectively. Staphylococcus aureus and Candida species were the most common pathogens. One-quarter (26.3%) of patients had a urinary catheter and fewer than half had appropriate documentation. Eight of the 15 patients ascertained to have a HAUTI based on clinical records (6 being CAUTI) were coded by the medical records department with an International Classification of Diseases (ICD)-10 code for UTI diagnosis. The Health Protection Agency Surveillance definition had a positive predictive value of 91.67% (CI 64.61 to 98.51) compared against the Centers for Disease Control and Prevention definition. Conclusions: These study results provide a foundation for a national Australian point prevalence study and inform the development and implementation of targeted healthcare-associated infection surveillance more broadly.

DOI 10.1136/bmjopen-2014-005099
Citations Scopus - 37Web of Science - 34
2014 Mitchell BG, Russo PL, Race P, 'Clostridium difficile infection: nursing considerations', Nursing standard (Royal College of Nursing (Great Britain) : 1987), 28 43-48 (2014)

Clostridium difficile is a bacterium which commonly causes diarrhoea in inpatients. C. difficile affects hospitalised patients worldwide and can pose a significant risk to patient... [more]

Clostridium difficile is a bacterium which commonly causes diarrhoea in inpatients. C. difficile affects hospitalised patients worldwide and can pose a significant risk to patients. This article explores the transmission and risk factors for C. difficile infection (CDI). There are many aspects to the prevention and control of CDI: appropriate antibiotic use, early instigation and maintenance of prevention and control strategies, and high standards of environmental cleanliness, education, and surveillance. This article discusses the role of the nurse in each of these prevention and control activities.

DOI 10.7748/ns.28.47.43.e8857
Citations Scopus - 1
2014 Mitchell BG, Digney W, Ferguson JK, 'Prior room occupancy increases risk of methicillin-resistant Staphylococcus aureus acquisition', Healthcare Infection, 19 135-140 (2014) [C1]

© 2014 Australasian College for Infection Prevention and Control. Background In Australia, little is known about the risk of acquiring methicillin-resistant Staphylococcus aureus ... [more]

© 2014 Australasian College for Infection Prevention and Control. Background In Australia, little is known about the risk of acquiring methicillin-resistant Staphylococcus aureus (MRSA) from prior room occupants. The aims of the study are to understand the risk of MRSA acquisition from prior room occupants and to further extend the existing knowledge-base on the role of discharge cleaning in hospitals. Methods A non-concurrent cohort study was undertaken in five wards at a 250-bed general hospital in Tasmania, Australia. All admitted patients were screened for MRSA. Weekly screenings for all patients who remained in hospital were undertaken. New MRSA acquisitions were identified. The exposed group were patients whose immediate prior room occupant had MRSA, while the unexposed prior room occupant did not have MRSA. Results 6228 patients were at risk of acquiring MRSA, with 237 new MRSA acquisitions equating to an acquisition rate of 3.8% for each at-risk patient admission. The unadjusted odds ratio for acquiring MRSA when the prior room occupant had MRSA was 2.9 (95% CI 2.2-3.9). Using logistic regression, exposure to a prior occupant harbouring MRSA remained a significant predictor of subsequent acquisition, after controlling for variables, OR 2.7 (95% CI 2.0-3.6). Conclusion Admission to a room previously occupied by a person with MRSA increased the odds of acquisition for the subsequent patient, independent of other risk factors. It demonstrates the necessity of having effective discharge cleaning practices in place. We believe increased attention to discharge room cleaning in hospitals is required and the reconsideration of additional recommendations for discharge cleaning.

DOI 10.1071/HI14023
Citations Scopus - 5
Co-authors John Ferguson
2013 Mitchell BG, Dancer SJ, Shaban RZ, Graves N, 'Moving forward with hospital cleaning', American Journal of Infection Control, 41 1138-1139 (2013)
DOI 10.1016/j.ajic.2013.03.307
Citations Scopus - 7Web of Science - 6
2013 Mitchell BG, Gardner A, Hiller JE, 'Mortality and clostridium difficile infection in an Australian setting', Journal of Advanced Nursing, 69 2162-2171 (2013)

Aim: To quantify the risk of death associated with Clostridium difficile infection, in an Australian tertiary hospital. Background: Two reviews examining Clostridium difficile inf... [more]

Aim: To quantify the risk of death associated with Clostridium difficile infection, in an Australian tertiary hospital. Background: Two reviews examining Clostridium difficile infection and mortality indicate that Clostridium difficile infection is associated with increased mortality in hospitalized patients. Studies investigating the mortality of Clostridium difficile infection in settings outside of Europe and North America are required, so that the epidemiology of Clostridium difficile infection in these regions can be understood and appropriate prevention strategies made. Design: An observational non-concurrent cohort study design was used. Methods: Data from all persons who had (exposed) and a matched sample of persons who did not have Clostridium difficile infection, for the calendar years 2007-2010, were analysed. The risk of dying within 30, 60, 90 and 180 days was compared using the two groups. Kaplan-Meier survival analysis and conditional logistic regression models were applied to the data to examine time to death and mortality risk adjusted for comorbidities using the Charlson Comorbidity Index. Results: One hundred and fifty-eight cases of infection were identified. A statistically significant difference in all-cause mortality was identified between exposed and non-exposed groups at 60 and 180 days. In a conditional regression model, mortality in the exposed group was significantly higher at 180 days. Conclusion: In this Australian study, Clostridium difficile infection was associated with increased mortality. In doing so, it highlights the need for nurses to immediately instigate contact precautions for persons suspected of having Clostridium difficile infection and to facilitate a timely faecal collection for testing. Our findings support ongoing surveillance of Clostridium difficile infection and associated prevention and control activities. © 2013 Blackwell Publishing Ltd.

DOI 10.1111/jan.12078
Citations Scopus - 5Web of Science - 5
2013 Mitchell BG, Wilson F, Dancer SJ, McGregor A, 'Methods to evaluate environmental cleanliness in healthcare facilities', Healthcare Infection, 18 23-30 (2013)

Background The role of environment in infection prevention and control is being increasingly acknowledged. However, gaps remain between what is promoted as best practice in the li... [more]

Background The role of environment in infection prevention and control is being increasingly acknowledged. However, gaps remain between what is promoted as best practice in the literature and what is occurring in healthcare settings. In part, this is due to a lack of generally accepted scientific standards, further confounding the ability to demonstrate an undisputed role for the healthcare environment in healthcare-acquired infections (HAIs). Evaluating environmental cleanliness in a standardised format is required, in order to enable a framework for performance management and provide a method by which interventions can be evaluated. Standardised assessment would provide reliable data to support quality-improvement activities and to ensure that healthcare staff have relevant and useful information to inform and adapt practice. Methods This integrative literature review describes approaches to assessing environmental cleanliness. A search of the published literature was undertaken, in combination with a targeted review of the grey literature. Results Four methods for assessing environmental cleanliness were identified: visual inspection, fluorescent gel marker, adenosine triphosphate (ATP) and microbial cultures. Advantages and disadvantages for each are explored. Conclusion Methods that evaluate cleaning performance are useful in assessing adherence to cleaning protocols, whereas methods that sample bio-burden provide a more relevant indication of infection risk. Fast, reproducible, cost-effective and reliable methods are needed for routine environmental cleaning evaluation in order to predict timely clinical risk. © Australasian College for Infection Prevention and Control 2013.

DOI 10.1071/HI12047
Citations Scopus - 28
2013 Mitchell BG, Dancer SJ, Shaban RZ, Graves N, 'Scholarly writing, peer-review and quality papers for Healthcare Infection', Healthcare Infection, 18 131-132 (2013)
DOI 10.1071/HI13026
2012 Mitchell BG, Gardner A, McGregor A, 'Healthcare-associated infections: getting the balance right in safety and quality v. public reporting', AUSTRALIAN HEALTH REVIEW, 36 365-+ (2012)
DOI 10.1071/AH11200
Citations Scopus - 2Web of Science - 2
2012 Mitchell BG, Gardner A, 'Prolongation of length of stay and Clostridium difficile infection: a review of the methods used to examine length of stay due to healthcare associated infections', ANTIMICROBIAL RESISTANCE AND INFECTION CONTROL, 1 (2012)
DOI 10.1186/2047-2994-1-14
Citations Scopus - 22Web of Science - 25
2012 Mitchell BG, Gardner A, 'Mortality and Clostridium difficile infection: a review', Antimicrobial Resistance and Infection Control, 1 20-20 (2012)
DOI 10.1186/2047-2994-1-20
2012 Mitchell BG, Gardner A, Stewart L, 'The epidemiology of Staphylococcus aureus bacteraemia in Tasmania', Healthcare Infection, 17 98-103 (2012)

Background The seriousness of Staphylococcus aureus bacteraemia (SAB), coupled with the potential to reduce its occurrence, suggests that each case of SAB demands rigorous investi... [more]

Background The seriousness of Staphylococcus aureus bacteraemia (SAB), coupled with the potential to reduce its occurrence, suggests that each case of SAB demands rigorous investigation and epidemiological understanding. To accurately determine the incidence and better understand the epidemiology of SAB at a population level, detailed data about SAB need to be collected from all settings, not just publicly funded hospitals. The aim of this study was to understand the epidemiology of SAB in Tasmania and to quantify the extent to which SAB incidence is under reported if only public hospital data are reported. Methods A population-based observational study for all people who had laboratory-identified SAB during 2009 and 2010 in Tasmania was conducted. The incidence of SAB was calculated using population data. Results Incidence of SAB was calculated as 21.3 per 100000 population per year (95% CI 18.5124.31). The majority of SAB cases were community associated (58.4%) and were caused by methicillin-sensitive Staphylococcus aureus (90.7%). Fifty-five percent of healthcare-associated SAB cases were associated with an intravascular device. Eleven percent of all SAB cases were identified in a private hospital. Conclusion This study represents the first known Australian study to capture and analyse data from all cases of SAB in a well-defined population, enabling calculation of incidence. The incidence of SAB in Tasmania is lower than in other Australian studies. Community-associated SAB is more common than healthcare-associated SAB yet little attention is paid to this community burden nationally. Current national surveillance programs for SAB focus only on public hospitals and, in doing so, a significant number of cases of SAB are missed. © Australasian College for Infection Prevention and Control 2012.

DOI 10.1071/HI12020
Citations Scopus - 5
2012 Mitchell B, 'Moving forward with Healthcare Infection', Healthcare Infection, 17 75 (2012)
DOI 10.1071/HI12032
2012 Mitchell BG, Wells A, McGregor A, McKenzie D, 'Can homemade fit testing solutions be as effective as commercial products?', Healthcare Infection, 17 111-114 (2012)

Background Fit testing is used to determine whether a N95 mask will provide respiratory protection for the wearer by preventing inhalation of airborne transmitted microorganisms. ... [more]

Background Fit testing is used to determine whether a N95 mask will provide respiratory protection for the wearer by preventing inhalation of airborne transmitted microorganisms. National guidelines recommend that healthcare workers (HCW) who use N95 masks require fit testing. Quantitative fit testing requires the purchasing and use of fit testing solutions and associated equipment. In high volume, these solutions are expensive and may not be readily available, as was seen in the 2009 H1N1 influenza pandemic. The aim of this study was to determine how a homemade solution compared against a commercially available product and a placebo. Methods A fit test was performed on the same person, on three separate occasions, using three different solutions commercial (45% sodium saccharin), homemade (to be disclosed) and placebo (water). The solution was double blinded and solutions were chosen and administered in a random order. Results A total of 48 people participated in this study. At the threshold testing stage, 8.3% did not taste any solution, 16.7% of people could taste the placebo, 89.6% could taste the commercial solution and 91.7% could taste the homemade solution. All persons who could taste the commercial solution could taste homemade solution. Conclusion The findings of our study suggest that fit testing solutions could be made locally with a similar effect to that of commercial products, that quantitative fit testing is unreliable and that serious consideration should be given to the role of quantitative fit testing in future guidelines and standards. We recommend that this study be conducted on a larger scale to support our findings. © 2012 Australasian College for Infection Prevention and Control.

DOI 10.1071/HI12019
Citations Scopus - 3
2012 Mitchell BG, Wilson F, McGregor A, 'An increase in community onset Clostridium difficile infection: A population-based study, Tasmania, Australia', Healthcare Infection, 17 127-132 (2012)

Background In early 2012, the Tasmanian Infection Prevention and Control Unit identified a 53% increase in the number of cases of Clostridium difficile infection (CDI) identified ... [more]

Background In early 2012, the Tasmanian Infection Prevention and Control Unit identified a 53% increase in the number of cases of Clostridium difficile infection (CDI) identified in Tasmanian public hospitals. To understand this issue further, we undertook a population-based study. The aim of this research was to examine the epidemiology of CDI in Tasmania, with an overarching objective of understanding whether the increase seen in late 2011 was isolated to hospitals or represented a wider phenomenon. Methods A population-based study design was used. All cases of laboratory diagnosed CDI that occurred during 2010 and 2011 in Tasmania were identified. Association of the cases with healthcare were determined using national and international CDI surveillance definitions. Results A total of 459 cases of CDI from 438 individuals were identified. The incidence of CDI for the study period was 45 per 100000 persons per year, 95% CI [41-49]. The relative risk (RR) of CDI was significantly higher in females, compared with males, RR 1.27, P=0.01, 95% CI [1.06-1.54]. We estimate that the incidence of community associated CDI increased from 10 per 100 000 population in 2010, 95% CI [7.5-13.2] to 17 per 100000 population in 2011 95% CI [14-21.5]. Conclusion Tasmania experienced a sudden and substantial increase in the number of CDI cases in late 2011. This was most likely linked to transmission and infection pathways in the community, not inside hospitals. This hypothesis requires further testing on a larger scale. © 2012 Australasian College for Infection Prevention and Control.

DOI 10.1071/HI12029
Citations Scopus - 7
2011 Grayson ML, Russo PL, Crulckshank M, Bear JL, Gee CA, Hughes CF, et al., 'Outcomes from the first 2 years of the Australian National Hand Hygiene Initiative', MEDICAL JOURNAL OF AUSTRALIA, 195 615-619 (2011)
DOI 10.5694/mja11.10747
Citations Scopus - 100Web of Science - 83
2011 Mitchell B, Ware C, McGregor A, Brown S, Wells A, Stuart RL, et al., 'ASID (HICSIG)/AICA Position Statement: Preventing catheter-associated urinary tract infections in patients', Healthcare Infection, 16 45-52 (2011)

Catheter-associated urinary tract infections (CAUTIs) occur frequently in healthcare settings. The insertion and maintenance of indwelling urinary catheters is a routine element o... [more]

Catheter-associated urinary tract infections (CAUTIs) occur frequently in healthcare settings. The insertion and maintenance of indwelling urinary catheters is a routine element of healthcare. In order to prevent CAUTI, it is important that healthcare professionals providing catheter care understand the indications for catheter use and the correct procedure for insertion and maintenance of catheters. This paper reviews and summarises three recent key publications on the prevention of CAUTIs and proposes the use of a care bundle and checklist for catheter indications, insertion and maintenance, and quality improvement. © 2011 Australian Infection Control Association.

DOI 10.1071/HI11007
Citations Scopus - 12
2011 Mitchell B, Ware C, McGregor A, Brown S, Wells A, 'Clostridium difficile infection in Tasmanian public hospitals 2006 - 2010', Healthcare Infection, 16 101-106 (2011)

Objective To describe the current epidemiology of Clostridium difficile infection (CDI) in Tasmania. Design, setting and participants Tasmania undertakes continuous surveillance f... [more]

Objective To describe the current epidemiology of Clostridium difficile infection (CDI) in Tasmania. Design, setting and participants Tasmania undertakes continuous surveillance for CDI at all public hospitals. Data on cases of CDI between 2006 and 2010 were examined. All positive tests occurring within 8 weeks of a previous case, and cases occurring in children less than 2 years old were excluded, consistent with national definitions. Only cases identified at public hospitals were included in the analysis. Main outcome measures The rate of CDI in Tasmanian hospitals over the study period and the ability to demonstrate the effect of variances in surveillance definitions. Results A total of 357 cases of CDI were reported over the study period a rate of 3.08 per 10000 patient care days (95%CI 2.903.27) or 0.94 per 1000 patient separations (95%CI 0.910.98) for hospital-identified cases of CDI. Yearly rates for the period 2006 to 2010 were 2.3, 3.2, 2.8 and 3.9 per 10000 patient care days, respectively. The overall trend was an increase in cases over the study period. The CDI rate from 200910 was significantly higher than that from 200809. Of the total cases reported, 64% were healthcare-associated, healthcare-facility onset (HCA HFO), equating to a rate of 2.1 per 10000 patient care days over the 4-year period. Conclusion The Tasmanian rate of HCA HFO is increasing, and appears to be greater than that reported by other Australian states, but is less than many northern hemisphere regions, where hypervirulent strains of C. difficile are causing increasing morbidity and mortality. It is difficult to compare reported rates of CDI nationally and internationally owing to inconsistencies in study duration, denominator selection, testing effort and testing methodology. This study demonstrates the need for national standards for CDI testing and reporting. © Australian Infection Control Association 2011.

DOI 10.1071/HI11009
Citations Scopus - 8
2010 Mitchell B, Gardner A, Collignon P, Stewart L, Cruickshank M, 'A literature review supporting the proposed national Australian definition for Staphylococcus aureus bacteraemia', Healthcare Infection, 15 105-113 (2010)

Staphylococcus aureus bacteraemia (SAB) is a major cause of morbidity and mortality. During 2009, a national surveillance definition for SAB was developed through the Australian C... [more]

Staphylococcus aureus bacteraemia (SAB) is a major cause of morbidity and mortality. During 2009, a national surveillance definition for SAB was developed through the Australian Commission on Safety and Quality in Healthcare (ACSQHC). The aim of this paper is to review the literature surrounding SAB surveillance and in doing so, evaluate the recently developed Australian national definition for SAB. The issues examined in this paper that relate to SAB surveillance include detection, the management of duplicates, classification and acquisition of SAB. Upon reviewing the literature, it was clear that the national Australian SAB surveillance definitions developed by the ACSQHC Healthcare Associated Infection Surveillance Committee are consistent with the majority of literature. Where inconsistencies exist, for example the lack of acquisition information in SAB surveillance programs in the United Kingdom, it is clear that the Australian surveillance definitions are more robust and provide more useful information. The national surveillance definitions for SAB developed by the ACSQHC surveillance committee sets an improved standard for other countries. © Australian Infection Control Association 2010.

DOI 10.1071/HI10030
Citations Scopus - 5
2009 Mitchell B, McGregor A, Coombs G, 'Prevalence of methicillin-resistant Staphylococcus aureus colonisation in Tasmanian rural hospitals', Healthcare Infection, 14 159-163 (2009)

A point prevalence study was performed to determine the methicillin-resistant Staphylococcus aureus (MRSA) nasal colonisation rates in Tasmanian rural hospital inpatients. Nasal s... [more]

A point prevalence study was performed to determine the methicillin-resistant Staphylococcus aureus (MRSA) nasal colonisation rates in Tasmanian rural hospital inpatients. Nasal swabs were performed on all Tasmanian rural hospital inpatients hospitalised for more than 48h before collection. A single swab was collected from both anterior nares and cultured for MRSA. Molecular typing was performed on all MRSA isolated. Demographic and clinical data was collected for each study participant. Data was analysed using the statistical software program SPSS. A total of 185 patients from 14 rural hospitals were included in the study. MRSA was isolated from 13 (7%) patients. Significant differences in MRSA prevalence were found between regions (P0.05) and between hospitals (P0.05). In the northern region of Tasmania, 11% of rural inpatients were colonised with MRSA, compared with 3 and 0% of rural inpatients in the State's north-west and southern regions, respectively. The presence of an indwelling urinary catheter was associated with a higher risk of MRSA nasal colonisation (P=0.066). Patient age, gender and duration of hospital admission before the swab was collected were not identified as significant risk factors for MRSA nasal colonisation. Twelve of the 13 MRSA (92%) isolated were characterised as ST22-MRSA-IV (EMRSA-15). There is a higher prevalence of MRSA nasal colonisation in rural hospital inpatients in the northern region of Tasmania compared with other Tasmanian regions. ST22-MRSA-IV may be endemic in at least one northern Tasmanian rural hospital. This information may have implications for future strategies designed to minimise the prevalence and transmission of MRSA in Tasmania. © 2009 Australian Infection Control Association.

DOI 10.1071/HI09023
Citations Scopus - 2
2007 Mitchell B, 'A background and critical analysis of the treatment of pneumocystis carinii pneumonia (PCP) in HIV/AIDS.', Australian nursing journal (July 1993), 14 20-23 (2007)
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Other (1 outputs)

Year Citation Altmetrics Link
2019 Mitchell B, 'The Research Behind Infection Prevention with Prof. Brett Mitchell and Dr. Mohamed Yassin', (2019) [O1]
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Grants and Funding

Summary

Number of grants 23
Total funding $2,951,424

Click on a grant title below to expand the full details for that specific grant.


20204 grants / $178,455

The benefits of barrier products for skin protection $104,500

Funding body: GAMA Healthcare Ltd.

Funding body GAMA Healthcare Ltd.
Project Team Professor Brett Mitchell, Student Un-named
Scheme PhD Industry Scholarship
Role Lead
Funding Start 2020
Funding Finish 2023
GNo G2000143
Type Of Funding C3111 - Aust For profit
Category 3111
UON Y

The effect of COVID-19 on healthcare associated infections in a multi-campus private health care facility$50,000

Funding body: Cabrini Institute

Funding body Cabrini Institute
Project Team

A/Professor Philip Russo, Wei Wang, Robyne Renton

Scheme Alan Jackson Research Grant
Role Investigator
Funding Start 2020
Funding Finish 2021
GNo
Type Of Funding C3112 - Aust Not for profit
Category 3112
UON N

Real-time collection of hand hygiene product use: An observational, pilot study$15,000

Funding body: Mezrit Pty Ltd

Funding body Mezrit Pty Ltd
Project Team Professor Brett Mitchell, Associate Professor Philip Russo
Scheme Research Grant
Role Lead
Funding Start 2020
Funding Finish 2021
GNo G2000755
Type Of Funding C3111 - Aust For profit
Category 3111
UON Y

Patient perspectives of healthcare associated infection$8,955

Funding body: Cardinal Health

Funding body Cardinal Health
Project Team Professor Brett Mitchell, Professor Maria Northcote, Dr Carolyn Rickett, A/Professor Phillip Russo
Scheme Research Grant
Role Lead
Funding Start 2020
Funding Finish 2021
GNo G1901316
Type Of Funding C3111 - Aust For profit
Category 3111
UON Y

20195 grants / $948,052

Infection prevention and control$792,660

Funding body: Private Industry

Funding body Private Industry
Scheme Research Grant
Role Investigator
Funding Start 2019
Funding Finish 2023
GNo
Type Of Funding C3211 - International For profit
Category 3211
UON N

Investigating the patient experience of the RediRoom$49,980

Funding body: GAMA Healthcare Ltd.

Funding body GAMA Healthcare Ltd.
Project Team Professor Brett Mitchell
Scheme Entrepreneurs' Programme: Innovation Connections
Role Lead
Funding Start 2019
Funding Finish 2019
GNo G1901244
Type Of Funding C3111 - Aust For profit
Category 3111
UON Y

Investigating the patient experience of the RediRoom$49,980

Funding body: Department of Industry, Innovation and Science

Funding body Department of Industry, Innovation and Science
Project Team Professor Brett Mitchell
Scheme Entrepreneurs' Programme: Innovation Connections
Role Lead
Funding Start 2019
Funding Finish 2019
GNo G2000013
Type Of Funding C2120 - Aust Commonwealth - Other
Category 2120
UON Y

Brett Mitchell Research Funds$40,432

Funding body: Avondale College of Higher Education

Funding body Avondale College of Higher Education
Project Team Professor Brett Mitchell
Scheme Research Grant
Role Lead
Funding Start 2019
Funding Finish 2022
GNo G1901075
Type Of Funding Scheme excluded from IGS
Category EXCL
UON Y

Establishing the prevalence of healthcare associated infections in two Australian private hospitals$15,000

Funding body: Cardinal Health Australia

Funding body Cardinal Health Australia
Project Team

Associate Professor Philip Russo, Professor Brett Mitchell, Dr Andrew Stewardson, Professor Allen Cheng, Robyne Rentor, Jayne O'Connor

Scheme Research Grant
Role Investigator
Funding Start 2019
Funding Finish 2020
GNo
Type Of Funding C1700 - Aust Competitive - Other
Category 1700
UON N

20174 grants / $493,100

National Healthcare Associated Infection Point Prevalence Study$180,000

Funding body: Rosemary Norman Foundation

Funding body Rosemary Norman Foundation
Project Team

A/Professor Phiip Russo, Professor Brett Mitchell, Professor Allen Cheng, Dr Andrew Stewardson, Professor Tracey Bucknall

Scheme Rosemary Norman Foundation
Role Investigator
Funding Start 2017
Funding Finish 2019
GNo
Type Of Funding C3120 - Aust Philanthropy
Category 3120
UON N

Reducing catheter associated urinary tract infections in hospitals: randomised control study$170,600

Funding body: HCF Health and Medical Research Foundation

Funding body HCF Health and Medical Research Foundation
Scheme Health Services Research Grants
Role Lead
Funding Start 2017
Funding Finish 2018
GNo
Type Of Funding C1700 - Aust Competitive - Other
Category 1700
UON N

An electronic reminder to reduce catheter use$132,000

Funding body: Senver

Funding body Senver
Scheme Industry Grant (Commercialisation Grant).
Role Lead
Funding Start 2017
Funding Finish 2019
GNo
Type Of Funding C1500 - Aust Competitive - Commonwealth Other
Category 1500
UON N

Infection Control and Aged Care$10,500

Funding body: Covidien

Funding body Covidien
Scheme Major Research Grant
Role Lead
Funding Start 2017
Funding Finish 2019
GNo
Type Of Funding C1700 - Aust Competitive - Other
Category 1700
UON N

20151 grants / $30,000

Develop and implement an institutional framework to support and improve supervision of honours and higher degree research students$30,000

Funding body: Office of Teaching and Learning (Commonwealth)

Funding body Office of Teaching and Learning (Commonwealth)
Scheme Extension Grant
Role Investigator
Funding Start 2015
Funding Finish 2015
GNo
Type Of Funding C1500 - Aust Competitive - Commonwealth Other
Category 1500
UON N

20144 grants / $691,817

Researching Effective Approaches to Cleaning in Hospitals$646,817

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Scheme Partnership Projects
Role Investigator
Funding Start 2014
Funding Finish 2018
GNo
Type Of Funding C1100 - Aust Competitive - NHMRC
Category 1100
UON N

Surveillance to Prevent Urinary Tract Infections$20,000

Funding body: Ian Potter Foundation

Funding body Ian Potter Foundation
Scheme Health & Disability
Role Investigator
Funding Start 2014
Funding Finish 2015
GNo
Type Of Funding C1700 - Aust Competitive - Other
Category 1700
UON N

The burden of urinary tract infections in an Australian setting$15,000

Funding body: Australasian College of Infection Prevention and Control

Funding body Australasian College of Infection Prevention and Control
Scheme Research Grant
Role Lead
Funding Start 2014
Funding Finish 2016
GNo
Type Of Funding C1700 - Aust Competitive - Other
Category 1700
UON N

Point prevalence study on urinary tract infections$10,000

Funding body: Australian Catholic University

Funding body Australian Catholic University
Scheme Australian Catholic University Faculty Grant
Role Investigator
Funding Start 2014
Funding Finish 2014
GNo
Type Of Funding Internal
Category INTE
UON N

20131 grants / $10,000

Understanding nursing graduates’ knowledge of infection prevention and control$10,000

Funding body: Covidien

Funding body Covidien
Scheme Major Research Grant
Role Lead
Funding Start 2013
Funding Finish 2014
GNo
Type Of Funding C1700 - Aust Competitive - Other
Category 1700
UON N

20111 grants / $15,000

The M.A.W.A Trust$15,000

Funding body: The Medical Advances Without Animals Trust (MAWA)

Funding body The Medical Advances Without Animals Trust (MAWA)
Scheme Scholarship
Role Lead
Funding Start 2011
Funding Finish 2012
GNo
Type Of Funding C1700 - Aust Competitive - Other
Category 1700
UON N

20103 grants / $585,000

Evaluating hand hygiene interventions and their ability to reduce health care associated infection$500,000

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Scheme Partnership Projects
Role Investigator
Funding Start 2010
Funding Finish 2015
GNo
Type Of Funding C1100 - Aust Competitive - NHMRC
Category 1100
UON N

The role of surveillance$75,000

Funding body: Nurse Memorial Centre

Funding body Nurse Memorial Centre
Scheme “Babe” Normal Scholarship
Role Investigator
Funding Start 2010
Funding Finish 2013
GNo
Type Of Funding C1700 - Aust Competitive - Other
Category 1700
UON N

Florence Nightingale Scholarship$10,000

Funding body: Royal College of Nursing Australia

Funding body Royal College of Nursing Australia
Scheme Florence Nightingale Scholarship
Role Lead
Funding Start 2010
Funding Finish 2013
GNo
Type Of Funding C1700 - Aust Competitive - Other
Category 1700
UON N
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Research Supervision

Number of supervisions

Completed2
Current3

Current Supervision

Commenced Level of Study Research Title Program Supervisor Type
2020 PhD Preventing Pressure Injury Through Skin Protection Strategies PhD (Nursing), Faculty of Health and Medicine, The University of Newcastle Principal Supervisor
2018 PhD To investigate the effectiveness of implementing a resident-directed-care intervention and daily evening activity program for reducing symptoms of depression in older persons in residential aged care Nursing, Avondale College NSW Principal Supervisor
2017 PhD An investigation into the effects and cost benefits of a lifestyle programme in the reversal of symptoms of Type 2 Diabetes Mellitus Nursing, Avondale College NSW Principal Supervisor

Past Supervision

Year Level of Study Research Title Program Supervisor Type
2019 Masters The perceived value and use of public open space in high- and low-density communities Health Not Elswhere Classified, Avondale College NSW Principal Supervisor
2017 PhD Antimicrobial resistance in urinary tract infections caused by Escherichia coli Nursing, Australian Catholic University Co-Supervisor
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Research Projects

The Australian National Healthcare Associated Infection Point Prevalence Survey 2018 -


Patient experience of healthcare associated infections 2019 -


The DOIPS study 2018 -


Strategies to prevention healthcare associated pneumonia 2018 -


Evaluation of the TimerTag 2019 -


Patient experience of the RediRoom 2019 -

Grants

Investigating the patient experience of the RediRoom

Funding body: GAMA Healthcare Ltd.

Funding body GAMA Healthcare Ltd.
Project Team Professor Brett Mitchell
Scheme Entrepreneurs' Programme: Innovation Connections

Researching Effective Approaches to Cleaning in Hospitals (REACH) Study 2014 - 2020


Reducing CAUTIs in Hospitals: a randomized controlled study in three Australian hospitals 2017 - 2019


Nurse, cleaning and the environment 2019 -


Volunteer taster program 2019 -


Epidemiology of Healthcare-Associated Infections in Australia 1e 2019 -


Healthcare-Associated Infections in Australia: Principles and Practice of Infection Prevention and Control 1e 2019 -


Preventing Pressure Injury Through Skin Protection Strategies 2020 -


Burden of ventilated healthcare-associated pneumonia: A linkage study 2020 -


Urinary tract infection in patients who undertake intermittent catheterisation: A systematic review 2020 -


Hand Hygiene Sensors 2020 -


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Research Collaborations

The map is a representation of a researchers co-authorship with collaborators across the globe. The map displays the number of publications against a country, where there is at least one co-author based in that country. Data is sourced from the University of Newcastle research publication management system (NURO) and may not fully represent the authors complete body of work.

Country Count of Publications
Australia 102
United Kingdom 15
United States 4
Fiji 1
Singapore 1
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Professor Brett Mitchell

Position

Professor in Nursing
School of Nursing and Midwifery
Faculty of Health and Medicine

Contact Details

Email brett.mitchell@newcastle.edu.au
Phone (02) 4349 4536
Links Twitter
Personal webpage
YouTube
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