Accepted Manuscript Processes of care in surgical patients who died with hospital-acquired infections in Australian hospitals Jennifer Allen, Therese Rey-Conde, John B. North, Peter Kruger, Wendy J. Babidge, Arkadiusz P. Wysocki, Robert S. Ware, J. Lennert Veerman, Guy J. Maddern PII:

S0195-6701(17)30490-5

DOI:

10.1016/j.jhin.2017.09.001

Reference:

YJHIN 5215

To appear in:

Journal of Hospital Infection

Received Date: 31 July 2017 Accepted Date: 1 September 2017

Please cite this article as: Allen J, Rey-Conde T, North JB, Kruger P, Babidge WJ, Wysocki AP, Ware RS, Veerman JL, Maddern GJ, Processes of care in surgical patients who died with hospital-acquired infections in Australian hospitals, Journal of Hospital Infection (2017), doi: 10.1016/j.jhin.2017.09.001. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT Title: Processes of care in surgical patients who died with hospital-acquired infections in Australian hospitals. Running title: Processes of care in patients who die with HAI. a‡,f¶

Jennifer Allen

a

a

, Therese Rey-Conde , John B North , Peter Kruger

d

e

f,h‡

c

, Wendy J Babidge , Arkadiusz

c‡,g

, Guy J Maddern

RI PT

P. Wysocki , Robert S Ware , J Lennert Veerman

b‡,i

Queensland Audit of Surgical Mortality, Royal Australasian College of Surgeons, PO Box 7476, East Brisbane, Queensland, Australia 4169. Emails: [email protected]; [email protected] and [email protected]

b

Intensive Care Unit, Princess Alexandra Hospital, Brisbane, 199 Ipswich Road, Woolloongabba, Queensland, Australia 4102. Email: [email protected]

c

The Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, Australia, 5006. Emails: [email protected] and [email protected]

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SC

a

Department of Surgery, Logan Hospital, PO Box 6031 Yatala, Queensland, Australia, 4207. Email: [email protected]

e

Menzies Health Institute Queensland, Griffith University, 170 Kessels Road, Nathan, Queensland, Australia 4111. Email: [email protected]

f

The University of Queensland, School of Public Health, Level 2, Public Health Building (887), Cnr Herston Road & Wyndham Street, Herston, Brisbane, Queensland, Australia 4006. Emails: [email protected] and [email protected]

g

Discipline of Surgery, University of Adelaide and The Queen Elizabeth Hospital; 28 Woodville Rd, Woodville, Adelaide, South Australia, Australia 5011. Email: [email protected]

h

Cancer Council NSW, PO Box 572, Kings Cross Sydney, New South Wales, Australia 1340. Email:

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d

[email protected]

The University of Queensland, School of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia 4006. Email: [email protected]

EP

i

AC C

Permanent Address: ‡

Corresponding author: Jennifer Allen. Address: Queensland Audit of Surgical Mortality, Royal Australasian College of Surgeons, PO Box 7476, East Brisbane, Queensland. Australia 4169.

Telephone: +61 7 3249 2971 E-mail: [email protected] Category: Original article Word count: 3135 + 3 tables + 2 figures Key words: surgery, quality assurance, survey, survey, surgical infection, costs

1

ACCEPTED MANUSCRIPT Summary (Word Count: 227) Background: Infection may complicate surgical patients’ hospital admission. The effect of hospitalacquired infections (HAIs) on processes of care among surgical patients who died is unknown. Aim: We investigated the effect of HAIs on processes of care in surgical patients who died in-hospital.

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Methods: Surgeon-recorded infection data extracted from a national Australian surgical mortality audit (2012-2016) were grouped into HAIs and no infection. The audit included all-age surgical patients, who died in-hospital. Not all patients had surgery. Excluded from analysis were patients with communityacquired infection and those with missing timing of infection. Multivariable logistic regression was used

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to determine the adjusted effects of HAIs on the processes of care in these patients. Costs associated

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with HAIs were estimated.

Findings: One-fifth of surgical patients who died did so with an HAI (2242/11 681; 19.2%). HAI patients had increased processes of care compared to those who died without infection: post-operative 1

complications (51.0% vs 30.3% [aOR 2.20; 95%CI 1.98 to 2.45]; p