CORD-19_Custom_license_subset  

CORD-19:03d3df2f6a5754f5325e881ff83c35d4d4100fc3 JSONTXT 9 Projects

Annnotations TAB TSV DIC JSON TextAE-old TextAE

Id Subject Object Predicate Lexical cue
T1 0-125 Sentence denotes Impact of admission screening for meticillin-resistant Staphylococcus aureus on the length of stay in an emergency department
T2 127-135 Sentence denotes Abstract
T3 136-252 Sentence denotes Preventing and controlling meticillin-resistant Staphylococcus aureus (MRSA) includes early detection and isolation.
T4 253-415 Sentence denotes In the emergency department (ED), such measures have to be balanced with the requirement to treat patients urgently and transfer quickly to an acute hospital bed.
T5 416-670 Sentence denotes We assessed, in a busy and overcrowded ED, the contribution made to a patient's stay by previous MRSA risk group identification and by selective rescreening of those patients who were previously documented in the research hospital as being MRSA positive.
T6 671-945 Sentence denotes Patients with a previous diagnosis of MRSA colonisation were flagged automatically as 'risk group' (RG) on their arrival in the ED and were compared with 'non-risk group' (NRG), i.e. not previously demonstrated in the research hospital to be infected or colonised with MRSA.
T7 946-1047 Sentence denotes Over an 18 month period, there were 16 456 admissions via the ED, of which 985 (6%) were RG patients.
T8 1048-1183 Sentence denotes The expected median times to be admitted following a request for a ward bed for NRG and RG patients were 10.4 and 12.9 h, respectively.
T9 1184-1344 Sentence denotes Female sex, age >65 years, and RG status all independently predicted a statistically significantly longer stay in the ED following a request for a hospital bed.
T10 1345-1557 Sentence denotes We consider that national and local policies for MRSA need to balance the welfare of patients in the ED with the need to comply with best practice, when there are inadequate ED and inpatient isolation facilities.
T11 1558-1642 Sentence denotes Patients with MRSA requiring emergency admission must have a bed available for them.
T12 1644-1864 Sentence denotes Healthcare-associated infection affects 5-10% of patients in an acute hospital; many of these infections are device-related, and meticillin-resistant Staphylococcus aureus (MRSA) accounts for about 16% of all infections.
T13 1865-2100 Sentence denotes 1, 2 General infection prevention and control measures, such as the use of standard precautions, as well as specific measures for MRSA are justified as the outcome from MRSA infections is less favourable compared with other infections.
T14 2101-2284 Sentence denotes A meta-analysis comparing bloodstream infection due to MRSA and meticillin-susceptible S. aureus showed a significant increase in mortality associated with MRSA bloodstream infection.
T15 2285-2442 Sentence denotes 3 Preventing and controlling MRSA requires a multifaceted approach that includes early detection and isolation, a common feature of many national guidelines.
T16 2443-2652 Sentence denotes 4 In the UK and elsewhere, there is a move towards the introduction of universal screening, i.e. the taking of swabs from all patients irrespective of risk, and this has provoked some discussion on its merits.
T17 2653-2890 Sentence denotes 5 In the emergency department (ED), infection prevention and control measures have to be balanced with the requirement to treat patients urgently and to transfer patients requiring admission as quickly as possible to acute hospital beds.
T18 2891-3084 Sentence denotes Furthermore, in North America and elsewhere, the phenomenon of community-acquired MRSA is being seen, particularly in EDs, in patients without known risk factors for healthcare-associated MRSA.
T19 3085-3215 Sentence denotes 6 We have documented that anything that prolongs patients' ED stay may adversely affect patient welfare and compound overcrowding.
T20 3216-3372 Sentence denotes 7 Most national and local guidelines on the prevention and control of MRSA largely focus on inpatients but their implementation has implications for the ED.
T21 3373-3520 Sentence denotes Prolonging patients' stay in the ED will further compound overcrowding, which is a recognised contributor to spread of hospital-acquired infection.
T22 3521-3686 Sentence denotes 8 We assessed the contribution that previous MRSA risk group identification and selective rescreening of these patients made to their stay in a busy, overcrowded ED.
T23 3687-3922 Sentence denotes The study was conducted in the ED of an urban academic teaching hospital with an annual census of about 46 000 patient visits, an admission rate of about 23% and an average occupancy with patients awaiting admission (boarders) of 105%.
T24 3923-4011 Sentence denotes The observational study was approved by the chair of the institution's ethics committee.
T25 4012-4152 Sentence denotes From 1 November 2006 to 30 April 2008, data were gathered in the ED's Oracle database on all patient attendances that resulted in admission.
T26 4153-4328 Sentence denotes This Oracle database was interrogated using the Diver Solution programme, which is a data warehousing solution that facilitates the gathering of data from different databases.
T27 4329-4552 Sentence denotes Selective screening involved the taking of swabs from nose, groin and wounds (if present) from patients at the time of their reattendance to the ED where there was a previous positive swab for MRSA in the research hospital.
T28 4553-4747 Sentence denotes The prior diagnosis of MRSA colonisation or infection in the research hospital automatically gave rise to the patients being flagged as 'risk group' (RG) on the ED information technology system.
T29 4748-4897 Sentence denotes For the purposes of this study the term 'risk group' is applied only to those diagnosed with MRSA in the hospital laboratory on a previous admission.
T30 4898-4983 Sentence denotes All such risk group patients were screened for evidence of ongoing MRSA colonisation.
T31 4984-5149 Sentence denotes Previous MRSA carriers were declared clear on the basis of three negative swab results, but even those cleared of infection remained as RG on return to the hospital.
T32 5150-5390 Sentence denotes Patients with a previous diagnosis of MRSA colonisation and/or infection, whether or not they had negative screens subsequently, were flagged automatically as a 'risk group' (RG) patient on their arrival in the ED using the Oracle database.
T33 5391-5628 Sentence denotes Those patients with a prior diagnosis of MRSA colonisation were compared to those without it in respect of age, sex, triage category, total ED processing time, and time from a bed on a ward being requested until the patient was admitted.
T34 5629-5681 Sentence denotes Triage is the systematic prioritisation of patients.
T35 5682-5826 Sentence denotes The Manchester Triage System uses a series of criteria to decide what level of priority patients should have on the basis of their presentation.
T36 5827-6010 Sentence denotes The National Triage scale from the UK is used in many EDs and is a five-point scale from immediate (red), very urgent (orange), urgent (yellow), standard (green) to non-urgent (blue).
T37 6011-6264 Sentence denotes 9 The results from all patients screened for MRSA by the hospital's diagnostic laboratory were entered on the laboratory information system, and this informs the hospital's inpatient system at 06:00 on the morning following MRSA results being available.
T38 6265-6499 Sentence denotes The hospital's inpatient system informed in turn the Oracle database, and if the patient subsequently re-attended the ED, that patient was automatically flagged as RG and selectively screened for evidence of ongoing MRSA colonisation.
T39 6500-6725 Sentence denotes Patients previously MRSA positive or RG were screened with swabs from the nose, groin and broken areas of skin, and swabs were cultured on MRSA Select Chromogenic Agar (Bio-Rad Life Science group, Marnes La Coquette, France).
T40 6726-6876 Sentence denotes Patients positive for MRSA were decolonised according to guidelines, and this was commenced in the ED and continued on hospital wards after admission.
T41 6877-6936 Sentence denotes 10 The ED is open plan with 14 cubicles and two side rooms.
T42 6937-7110 Sentence denotes Clinically stable patients with a prior history of MRSA were isolated, where possible in these rooms, pending the availability of other isolation facilities in the hospital.
T43 7111-7324 Sentence denotes However, these side rooms do not have separate toilet facilities or an ante room, and frequently the number of patients requiring isolation for MRSA and for other indications exceeds the capacity of the two rooms.
T44 7325-7453 Sentence denotes Other patients in the department wait on trolleys or chairs, usually in close proximity to other patients in the open plan area.
T45 7454-7617 Sentence denotes Cox proportional hazards methods were used to evaluate relative probabilities of being admitted for RG patients versus non-RG patients (NRG) who acted as controls.
T46 7618-7815 Sentence denotes The interval time to event analysis determines whether a patient category has an increased or decreased chance of admittance at a particular time point, and the result is defined by a hazard ratio.
T47 7816-7984 Sentence denotes A multifactorial model was used to examine whether risk group identification was independently significant in the presence of confounding variables such as age and sex.
T48 7985-8045 Sentence denotes In addition the model was stratified into triage categories.
T49 8046-8162 Sentence denotes Stata (version 10, College Station, TX, USA) was used to analyse the data and P < 0.05 was deemed to be significant.
T50 8163-8294 Sentence denotes The expected median time to be admitted following a request for a ward bed was 10.5 h; NRG patients waited a median of 10.4 h (IQR:
T51 8295-8331 Sentence denotes 3.1-20.6) compared with 12.9 h (IQR:
T52 8332-8358 Sentence denotes 4.3-26.6) for RG patients.
T53 8359-8591 Sentence denotes The results of the Cox model revealed that older age (>65 years old) and female sex were statistically significant factors influencing the time spent in the ED from arrival to a bed request but MRSA colonisation was not (Table II) .
T54 8592-8889 Sentence denotes However, female sex, age >65 years and RG status all independently predicted a longer stay in the ED following a request for a hospital bed, i.e. RG status did not impact on the ED's and the on-call team's processing of patients but did influence the time taken to allocate a ward bed (Table II) .
T55 8890-9241 Sentence denotes Risk factors for healthcare-associated MRSA infection include advanced age, male gender, previous hospitalisation, nursing home care, length of hospitalisation, a stay in intensive care, chronic medical illness, prior antibiotic use, presence of indwelling devices, asymptomatic colonisation with MRSA and exposure to an infected or colonised patient.
T56 9242-9380 Sentence denotes 11 In this study we applied the term RG only to those with a prior diagnosis of MRSA colonisation or infection in our hospital laboratory.
T57 9381-9459 Sentence denotes All such patients were electronically flagged as RG on their return to the ED.
T58 9460-9610 Sentence denotes The flagging of patients with a prior diagnosis of MRSA and selective rescreening of this group in this study was associated with a prolonged ED stay.
T59 9611-9720 Sentence denotes In the USA it is estimated that the rate of MRSA colonisation in the community is about 2% of the population.
T60 9721-9843 Sentence denotes 12 Gopal et al. found that 6.7% of screened adult emergency admissions to their UKbased hospital were colonised with MRSA.
T61 9844-9962 Sentence denotes 8 It is estimated that a non-isolated MRSA carrier will infect 0.14 patients per day in the absence of decolonisation.
T62 9963-10148 Sentence denotes 13 Consequently, the early identification of colonised/infected patients and the prompt implementation of contact precautions are important in preventing MRSA transmission in hospitals.
T63 10149-10374 Sentence denotes 8, [14] [15] [16] [17] With regards to the limitations of our research, the RG status of a patient is not validated but is assumed to reflect all patients with a previous positive result for MRSA colonisation in our hospital.
T64 10375-10537 Sentence denotes The study required the analysis of a real-time computer database which is dependent upon the medical and nursing staff putting in data in a time-sensitive manner.
T65 10538-10661 Sentence denotes We have no reason to believe that any failure to do so would have been more prevalent in either those with or without MRSA.
T66 10662-10759 Sentence denotes Overcrowding in EDs is a distressing and potentially dangerous phenomenon in many health systems.
T67 10760-10917 Sentence denotes In our hospital, the elderly, those with prior colonisation with MRSA and women wait longest for an acute hospital bed when they require emergency admission.
T68 10918-11193 Sentence denotes The research hospital has insufficient acute beds to provide for emergency admissions and this is further compounded by the fact that many patients in the hospital experience delayed discharges owing to lack of nursing home beds or step-down facilities in the catchment area.
T69 11194-11430 Sentence denotes The reason for the delay for females may be due to the fact that our hospital does not usually house males and females in the same bay of a ward, and, as more males are admitted as emergencies, finding a 'female bed' can be problematic.
T70 11431-11571 Sentence denotes The expected time for admission from time of arrival in the ED was a median of 22.6 h for RG patients compared with 19.9 h for NRG patients.
T71 11572-11820 Sentence denotes The additional 2.7 h for those requiring selective screening and in an individual patient sick enough to require hospital admission on an already unacceptably long wait for a hospital bed is of concern, and further compounds overcrowding in our ED.
T72 11821-11996 Sentence denotes Paradoxically, the implementation of screening to identify patients early who require isolation or cohorting in hospital impacts negatively on the provision of emergency care.
T73 11997-12242 Sentence denotes Overcrowding in EDs has already been shown to increase ambulance diversions to other units, delay treatments, increase waiting times and walkouts and lead to greater lengths of hospital stay as well as increasing patient morbidity and mortality.
T74 12243-12486 Sentence denotes 7 The early identification and recognition of patients with potentially transmissible diseases and their early isolation is desirable and appropriate, as illustrated by the severe acute respiratory syndrome (SARS) epidemic earlier this decade.
T75 12487-12644 Sentence denotes However, it is neither desirable nor appropriate that such patients have more prolonged stays in the most overcrowded part of an acute hospital, i.e. the ED.
T76 12645-12776 Sentence denotes Vichard et al. argue that 'sepsis containment units', where patients with MRSA can be isolated, help to prevent crosscontamination.
T77 12777-12919 Sentence denotes 18 However, the ED cannot be expected to house patients for prolonged periods in the absence of isolation rooms or cohort facilities on wards.
T78 12920-13146 Sentence denotes Dantas et al. noted that prolonged stay in the ED posed a risk for colonisation and the transmission of multidrug-resistant bacteria and for contracting healthcare-associated infection, all associated with increased mortality.
T79 13147-13371 Sentence denotes 19 Cunningham et al. documented that overcrowding and the rapid turnover of patients in acute hospital settings contribute to cross-infection with MRSA, and they argue that adequate acute capacity would help to address this.
T80 13372-13454 Sentence denotes 20 Borg has described the correlation between workload indices and increased HCAI.
T81 13455-13712 Sentence denotes 21 The results of the study reported here show that the selective screening of patients with a prior diagnosis of MRSA colonisation prolongs their ED stay and increases the workload of already busy ED nursing staff, potentially increasing MRSA transmission.
T82 13713-13922 Sentence denotes Reducing overcrowding in neonatal intensive care units has been shown to be effective in controlling endemic MRSA spread, and it is plausible that reducing ED overcrowding would have a similar positive effect.
T83 13923-14062 Sentence denotes 22 The delay in being admitted to a ward bed from the ED in this study has been shown to be partly related to selective screening for MRSA.
T84 14063-14214 Sentence denotes Being aged >65 years, being female or having MRSA should not mean that the patient will have a longer wait in the ED when they require acute admission.
T85 14215-14330 Sentence denotes Being able to clarify the patient's MRSA status sooner would probably help to facilitate earlier transfer to a bed.
T86 14331-14407 Sentence denotes Polymerase chain reaction testing for MRSA may be of benefit in this regard.
T87 14408-14570 Sentence denotes Hospital ward staff are reluctant to accept patients from our ED with MRSA without there being an isolation room available because of the risk of cross-infection.
T88 14571-14707 Sentence denotes Clearly, leaving patients for prolonged periods in the ED, which is the most overcrowded part of any acute hospital, is not appropriate.
T89 14708-14836 Sentence denotes Acute hospitals must accept that factors contributing to the spread of infection are important on inpatient wards and in the ED.
T90 14837-15028 Sentence denotes Having identified the problem, the research hospital has now allocated areas within each ward that allow for the setting up of cohorts of patients with MRSA, if no single rooms are available.
T91 15029-15250 Sentence denotes Another alternative suggestion is not to selectively screen patients during the ED component of their hospital stay, if doing so would make ward placement more difficult, and to allow patients to be screened on the wards.
T92 15251-15906 Sentence denotes Harbarth et al. investigated the use of a universal rapid MRSA admission screening in a surgical department, and although they did not demonstrate a reduction in nosocomial MRSA, they acknowledge that others have recommended universal admission screening as a means to control MRSA. [23] [24] [25] Robiecsek et al., in their study of universal admission MRSA surveillance with isolation and decolonisation of patients who tested positive for MRSA, found that this was associated with a >50% reduction in healthcare-associated MRSA bloodstream, respiratory, urinary tract and surgical site infections during admission and for up to 30 days after discharge.
T93 15907-16060 Sentence denotes 26 The early isolation of patients with MRSA is the standard in most centres but adequate facilities must be available both on hospital wards and in EDs.
T94 16061-16246 Sentence denotes We have shown that selective screening of patients with a prior diagnosis of MRSA colonisation in our hospital prolongs the wait for an acute hospital bed and compounds ED overcrowding.
T95 16247-16467 Sentence denotes National and local policies for MRSA control need to address this by balancing the welfare of patients in the ED with the need to comply with best practice when there are inadequate ED and inpatient isolation facilities.
T96 16468-16554 Sentence denotes Patients with MRSA requiring emergency admission to hospital must have a bed to go to.