Health Protection Scotland Research Articles

Knowledge, attitudes and practices regarding COVID-19 among healthcare professionals in anaesthesiology and intensive care

Background/Aims This quality improvement study investigated the knowledge, attitudes and practices regarding COVID-19 among healthcare professionals working in the department of anaesthesiology and intensive care at University Hospital Ayr. Methods A questionnaire was adapted from the April 2020 guidelines for healthcare workers issued by the Department of Health and Social Care, Health Protection Scotland and Public Health Scotland. A total of 70 healthcare workers completed the questionnaire, including doctors, intensive care nurses and operation theatre staff. Continuous variables were analysed using the student's independent t-test and analysis of variance, while categorical variables were compared using either the Chi-square or Fisher's exact test. A P value of less than 0.05 was considered statistically significant. Results The mean knowledge, positive attitude and good practice scores were 14.86, 12.25 and 12.96 out of 19 (respectively) among all staff. Analysis showed statistically significant differences between scores dependent on job category, particularly in their knowledge of key terms, personal protective equipment use and the latest COVID-19 guidelines. Consultants scored significantly higher than other staff members, while operating theatre staff and redeployed intensive care unit nurses tended to score lower on average. Conclusions Healthcare staff require more professional support, with more emphasis placed on their physical and psychological wellbeing. This can be achieved through periodic training to increase knowledge and confidence. Clearer communication and a more positive working environment is also needed.

Vaccine effectiveness of live attenuated and trivalent inactivated influenza vaccination in 2010/11 to 2015/16: the SIVE II record linkage study.

There is good evidence of vaccine effectiveness in healthy individuals but less robust evidence for vaccine effectiveness in the populations targeted for influenza vaccination. The live attenuated influenza vaccine (LAIV) has recently been recommended for children in the UK. The trivalent influenza vaccine (TIV) is recommended for all people aged ≥ 65 years and for those aged < 65 years who are at an increased risk of complications from influenza infection (e.g. people with asthma). To examine the vaccine effectiveness of LAIV and TIV. Cohort study and test-negative designs to estimate vaccine effectiveness. A self-case series study to ascertain adverse events associated with vaccination. A national linkage of patient-level general practice (GP) data from 230 Scottish GPs to the Scottish Immunisation & Recall Service, Health Protection Scotland virology database, admissions to Scottish hospitals and the Scottish death register. A total of 1,250,000 people. LAIV for 2- to 11-year-olds and TIV for older people (aged ≥ 65 years) and those aged < 65 years who are at risk of diseases, from 2010/11 to 2015/16. The main outcome measures include vaccine effectiveness against laboratory-confirmed influenza using real-time reverse-transcription polymerase chain reaction (RT-PCR), influenza-related morbidity and mortality, and adverse events associated with vaccination. Two-fifths (40%) of preschool-aged children and three-fifths (60%) of primary school-aged children registered in study practices were vaccinated. Uptake varied among groups [e.g. most affluent vs. most deprived in 2- to 4-year-olds, odds ratio 1.76, 95% confidence interval (CI) 1.70 to 1.82]. LAIV-adjusted vaccine effectiveness among children (aged 2-11 years) for preventing RT-PCR laboratory-confirmed influenza was 21% (95% CI -19% to 47%) in 2014/15 and 58% (95% CI 39% to 71%) in 2015/16. No significant adverse events were associated with LAIV. Among at-risk 18- to 64-year-olds, significant trivalent influenza vaccine effectiveness was found for four of the six seasons, with the highest vaccine effectiveness in 2010/11 (53%, 95% CI 21% to 72%). The seasons with non-significant vaccine effectiveness had low levels of circulating influenza virus (2011/12, 5%; 2013/14, 9%). Among those people aged ≥ 65 years, TIV effectiveness was positive in all six seasons, but in only one of the six seasons (2013/14) was significance achieved (57%, 95% CI 20% to 76%). The study found that LAIV was safe and effective in decreasing RT-PCR-confirmed influenza in children. TIV was safe and significantly effective in most seasons for 18- to 64-year-olds, with positive vaccine effectiveness in most seasons for those people aged ≥ 65 years (although this was significant in only one season). The UK Joint Committee on Vaccination and Immunisation has recommended the use of adjuvanted injectable vaccine for those people aged ≥ 65 years from season 2018/19 onwards. A future study will be required to evaluate this vaccine. Current Controlled Trials ISRCTN88072400. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 67. See the NIHR Journals Library website for further project information.

COVID-19 in patients undergoing chronic kidney replacement therapy and kidney transplant recipients in Scotland: findings and experience from the Scottish renal registry

BackgroundInfection with the severe acute respiratory coronavirus 2 (SARS-CoV-2) has led to a worldwide pandemic with coronavirus disease 2019 (COVID-19), the disease caused by SARS-CoV-2, overwhelming healthcare systems globally. Preliminary reports suggest a high incidence of infection and mortality with SARS-CoV-2 in patients receiving kidney replacement therapy (KRT). The aims of this study are to report characteristics, rates and outcomes of all patients affected by infection with SARS-CoV-2 undergoing KRT in Scotland.MethodsStudy design was an observational cohort study. Data were linked between the Scottish Renal Registry, Health Protection Scotland and the Scottish Intensive Care Society Audit Group national data sets using a unique patient identifier (Community Health Index (CHI)) for each individual by the Public Health and Intelligence unit of Public Health, Scotland. Descriptive statistics and survival analyses were performed.ResultsDuring the period 1st March 2020 to 31st May 2020, 110 patients receiving KRT tested positive for SARS-CoV-2 amounting to 2% of the prevalent KRT population. Of those affected, 86 were receiving haemodialysis or peritoneal dialysis and 24 had a renal transplant. Patients who tested positive were older and more likely to reside in more deprived postcodes. Mortality was high at 26.7% in the dialysis patients and 29.2% in the transplant patients.ConclusionThe rate of detected SARS-CoV-2 in people receiving KRT in Scotland was relatively low but with a high mortality for those demonstrating infection. Although impossible to confirm, it appears that the measures taken within dialysis units coupled with the national shielding policy, have been effective in protecting this population from infection.

An update on the incidence of human giardiasis in Scotland, 2011\u20132018

BackgroundGiardia duodenalis is one of the most common parasites in the UK to cause diarrhoeal illness. Giardiasis is likely to be significantly under-reported in the UK as laboratory testing is largely based on examining stool samples from individuals with a recent travel history. This results in the majority of locally-acquired cases going undetected. To increase awareness of giardiasis, we describe data gathered from cases reported within Scotland during 2011–2018.MethodsAll of the 21 Scottish National Health Service (NHS) diagnostic microbiology laboratories performed microscopy examination to detect Giardia cysts in stools, from mostly travel-related cases. The exception was one laboratory that implemented an antigen-based enzyme immunoassay in 2015. This resulted in every submitted stool being tested for Giardia. Laboratory-confirmed cases of giardiasis were reported to Health Protection Scotland (HPS) via the Electronic Communication of Surveillance in Scotland (ECOSS) during the eight-year period. Data for calculating the incidence per 100,000 of the population were obtained from the National Records of Scotland mid-2018 population estimates in Scotland.ResultsA total of 1631 Scottish cases were reported during 2011–2018 (8-year mean: 204; range: 166–269). National Health Service Grampian, Borders and Lothian reported the highest incidence of Giardia (9.8, 7.5 and 6.7 per 100,000, respectively), all of which were above the Scottish mean incidence (3.8 per 100,000). Following the implementation of antigen testing in NHS Grampian during 2015, reports significantly increased 3.6-fold (P = 0.005). The highest incidence of giardiasis occurred in the 20–49 years age group (mean 5.4 per 100,000). Of interest, the mean incidence of giardiasis was significantly higher in males than in females (4.8 versus 3.1 per 100,000, respectively; P < 0.0001).ConclusionsThis report highlights the need to capture enhanced information on every laboratory-confirmed case of giardiasis to gain a better understanding of the local sources and transmission pathways occurring in Scotland. In addition, implementing sensitive, automated technologies across UK NHS diagnostic microbiology laboratories to permit the efficient, routine testing of every submitted stool for Giardia, should be encouraged to ensure all cases are identified and treated appropriately.

Aerosol generating procedures, dysphagia assessment and COVID-19: A rapid review.

Aerosol generating procedures, dysphagia assessment and COVID-19: A rapid review.

Urinary tract infection prevention: evaluating Scotland's national hydration campaign.

Urinary tract infection (UTI) is a prevalent healthcare-associated infection in adult acute and long-term care facilities in Scotland. To convey the public health benefits of optimal hydration to support UTI prevention, the Scottish UTI Network, coordinated by Health Protection Scotland, launched a national hydration campaign in 2018. The benefits of hydration were promoted using a range of materials displayed in a variety of settings, including community pharmacies, inpatient hospital wards, care homes and community settings such as GP surgeries and district nursing hubs. The campaign consisted of three stages, of which the first two stages were aimed at adults. The first two stages were evaluated using online surveys, which were completed by a total of 153 respondents. This article puts the hydration campaign in the context of UTI prevention in Scotland, describes the first two stages of the campaign and provides an overview of the evaluation findings, which suggest that the campaign was received positively.

Infections without borders: a new coronavirus in Wuhan, China.

Infections without borders: a new coronavirus in Wuhan, China.

Outcomes of Staphylococcus aureus bacteraemia attributed to blood culture contamination

Staphylococcus aureus is a common skin commensal and leading cause of bloodstream infection. Given the formidable mortality and morbidity associated with S. aureus bacteraemia (SAB), it is uncertain whether S. aureus can be viewed safely as a blood culture contaminant. 19 episodes of SAB over two years were identified that were prospectively attributed as contaminants using Health Protection Scotland criteria and compared these with 168 cases of genuine SAB. All cases were assessed by an infection specialist and underwent multidisciplinary review to agree the source. Follow-up was a minimum of six months. Female sex, cognitive impairment and chronic skin conditions were more common in the contaminant group. No single clinical or laboratory feature reliably predicted contamination. No patients in the contaminant group subsequently developed a SAB or metastatic complications associated with SAB. Eighteen patients (95%) survived to hospital discharge. Compared to patients with genuine SAB surviving to discharge, the contaminant group had a shorter duration of hospital stay (median 14 days versus 19.5 days), a briefer exposure to intravenous antibiotics (median 1 day versus 14 days) and received less total antibiotic (median 7 days versus 19 days). Twelve patients received at least five days of antibiotics active against their SAB, though none would have been deemed appropriate SAB treatment under current guidelines. The careful attribution of SAB as a contaminant by an infection specialist, combined with appropriate follow-up, is associated with favourable clinical outcomes, shorter hospital stay and reduced antibiotic use. A more robust definition of genuine SAB is needed.

Re-emergence of HIV related to injecting drug use despite a comprehensive harm reduction environment: a cross-sectional analysis

In 2015, an outbreak of HIV was identified among people who inject drugs (PWID) in the Greater Glasgow and Clyde (GGC) area of Scotland, an area which distributes more than 1 million needles and syringes per year. This is the largest such incident in the UK for 30 years. Here, we provide an epidemiological analysis of the impact of the outbreak on HIV prevalence trends in the population and the individual and environmental risk factors associated with infection. Four cross-sectional, anonymous, bio-behavioural surveys of almost 4000 PWID attending services providing injecting equipment across GGC between 2011 and 2018 were analysed. Participants were recruited by trained independent interviewers and eligible if they had a history of injecting drug use, either current (within the past 6 months) or historical. Interviewers asked participants questions about demographics, behaviours, and service use and to give a dried blood spot sample that was tested anonymously for the presence of blood-borne viruses. Our primary outcome measure was HIV infection status, as determined by the dried blood spot sample. We removed duplicates and participants with missing data and used all remaining participants to examine trends in prevalence of HIV infection, risk behaviours, and intervention coverage. We then did multivariate analysis with adjusted and unadjusted logistic regression to determine individual and environmental factors associated with HIV infection. The overall GGC sample comprised 3641 PWID; data from 2712 PWID were available for multivariate analysis after further removal of duplicate participants and missing data. Between 2011 and 2018, HIV prevalence in GGC rose from 0·1% (95% CI 0·0-0·6) to 4·8% (3·4-6·2) overall, and from 1·1% (0·2-6·2) to 10·8% (7·4-15·5) in Glasgow city centre. Over the same period, the prevalence of cocaine injecting in all individuals in GGC in our sample rose from 16% (129/805) to 50% (291/583) overall, and from 37% (26/70) to 77% (117/153) in Glasgow city centre. HIV infection was more likely among PWID who had participated in surveys after the start of the outbreak in 2014 (adjusted odds ratio 3·4, 95% CI 1·7-6·7; p=0·00052), been homeless in the past 6 months (3·0, 1·7-5·0; p<0·0001), had had more than five incarcerations since they first began injecting (2·1, 1·2-3·7; p=0·0098); and had injected cocaine within the past 6 months (6·7, 3·8-12·1; p<0·0001). Age (per 1-year increase) was also a significant factor (1·1, 1·0-1·1; p=0·0016) but sex was not (1·7, 0·9-3·2; p=0·083). Despite high coverage of harm reduction interventions, Glasgow has experienced a rapid rise in prevalence of HIV among its PWID population, associated with homelessness, incarceration, and a major shift to injection of cocaine. Robust surveillance through regular HIV testing of high-risk populations is crucial to ensure outbreaks are detected and rapid responses are informed by the best available evidence. Health Protection Scotland.

Hepatitis A—2017 an unusual year in Scotland

BackgroundThe number of cases of acute hepatitis A reported in Scotland each year is small, and the majority of cases have been associated with travel to endemic regions. However, in early 2017, in the midst of ongoing outbreaks of hepatitis A among MSM in Europe, there was a sharp rise in the number of cases reported to Health Protection Scotland. ObjectivesThe initial aim of this study was to investigate the reason for the observed increase in cases of hepatitis A at the start of 2017. As cases continued for the remainder of the year, these cases were typed to determine whether these cases were linked to each other, or other outbreaks. Study designThe study population consisted of 42 hepatitis A infected patients with no obvious source of infection. The patient samples were collected between January and December 2017. The VP1/2 A region was amplified and sequenced. ResultsThe majority of samples typed as genotype 1 A (n = 17) or genotype 1B (n = 15). Within genotype 1 A, fifteen samples had strains (VRD_521_2016 or RIVM_HAV16_090) associated with ongoing outbreaks of hepatitis A in MSM in Europe. Within genotype 1B, there were four clusters of infections, with identical cases in geographically distinct regions with no identified epidemiological link. ConclusionsMolecular typing proved useful, as it allowed public health to identify clusters, establish links with other outbreaks and compare Scottish strains with those reported elsewhere.

Outbreak Column 22: How to manage an outbreak

This outbreak column uses the Health Protection Scotland (HPS) Outbreak Process and Algorithm to examine and reflect on a published outbreak report. The report involved an extensively drug-resistant Acinetobacter baumannii in an oncology unit. High-reliability theory is then used to reflect on how the outbreak was managed and consider how best to improve local outbreak prevention, preparedness, detection and management. The conclusion of this exercise is that if the possibility of an era of untreatable infections caused by antibiotic-resistant organisms is to be significantly postponed, Infection Prevention and Control Teams must improve their ability to get others to prevent cross-transmission in the absence of recognised risks.

Evaluating the effectiveness, impact and safety of live attenuated and seasonal inactivated influenza vaccination: protocol for the Seasonal Influenza Vaccination Effectiveness II (SIVE II) study

IntroductionSeasonal (inactivated) influenza vaccination is recommended for all individuals aged 65+ and in individuals under 65 who are at an increased risk of complications of influenza infection, for example, people...

Roundtable discussion: how the World Hepatitis Summit 2015 strengthened stakeholders' efforts to combat viral hepatitis.

The inaugural World Hepatitis Summit was jointly convened by the World Health Organization (WHO) and the World Hepatitis Alliance and hosted by the Scottish Government and supported by Glasgow Caledonian University and Health Protection Scotland in September 2015. The three day event convened a broad range of stakeholders to meet and share ideas, experience and best practice in addressing the many facets of viral hepatitis prevention, diagnosis and treatment.With the next World Hepatitis Summit scheduled to take place from 1 to 3 November 2017, the World Hepatitis Alliance asked Hepatology, Medicine and Policy to commission a roundtable discussion article in order to encourage reflection on how the 2015 Summit was significant for stakeholders’ efforts and why it is important to keep the momentum going ahead of the World Hepatitis Summit 2017 and in the light of the newly adopted first-ever Global Health Sector Strategy on Viral Hepatitis.

Safety of live attenuated influenza vaccine in young people with egg allergy: multicentre prospective cohort study

Study question How safe is live attenuated influenza vaccine (LAIV), which contains egg protein, in young people with egg allergy?Methods In this open label, phase IV intervention study, 779 young...

The Cost-Effectiveness of Glove Reprocessing.

We have read, with interest, the original article entitled “Gloves Reprocessing: Does It Really Save Money?” by Arora et al. [1] in the Indian Journal of Surgery. The authors presented the advantage of using disposable gloves in terms of cost-effectiveness. When we read the article, we have wondered about a few conditions. We feel that clarification regarding the following details would be beneficial. According to Health Protection Scotland, sterile gloves should be worn for surgical procedures, for invasive procedures, as part of aseptic technique, for the insertion of invasive devices, and for the immediate management of acute wounds, e.g., suturing. And non-sterile gloves should be worn for non-sterile procedures and chronic wound care [2]. If the authors made a classification due to above information, would there be any difference? Another question related to the users of the both gloves. Were there any difference for tactile sensation and dexterity? We have also wondered about the infection rate of the non-sterile gloves for the transmitted diseases and sterilization unit’s staff costs at the same time period with the study. If there was, the increase for the cost of medical bill in the patient population would be interesting to the readers.

PTH-228 Genotyping of rotavirus isolates prior to the introduction of the rotavirus vaccine in scotland and early indications of the impact of the vaccine

<h3>Introduction</h3> Rotaviruses (RV) are the leading cause of severe gastroenteritis in children less than five years of age worldwide. Rotarix®, a live attenuated monovalent vaccine containing a RV strain of G1P[8] specificity has been included in the routine childhood immunisation schedule from June 2013 in Scotland and is offered to infants under the age of four months in two doses. This study aimed to characterise the prevalent rotavirus strains in Scotland prior to the introduction of the vaccine. <h3>Method</h3> Rotavirus positive faecal samples from various Scottish regional virology laboratories covering the years 2012–2013, before the introduction of the vaccine, were genotyped. Viral RNA was extracted from faecal suspensions using guanidine isothiocyanate – silica gel extraction method. VP7 and VP4 gene specific multiplex hemi-nested PCRs were used for genotyping. Surveillance systems were established by Health Protection Scotland to monitor the impact of the vaccine. <h3>Results</h3> A total of 387 samples were genotyped from the regional virology laboratories in Aberdeen, Dundee, Inverness, Glasgow and Edinburgh. The commonest strain in Scotland was G1P[8] accounting for 72.1% of cases. The other strains that were identified were G2P[4] in 7.2%, G4P[8] in 6.9%, G9P[8] in 3.4% and G3P[8] in a further 2.3% of cases. Single cases of G12P[8] and G9P[4] were also found (0.26% respectively). Mixed infections were seen in 5.4% of cases. The provisional uptake for the first dose of Rotarix® vaccine in Scotland for children born between 1^stof July to 30^thSept 2013 was 92.7%% for the completed course by 12 months. The laboratory confirmed cases of RV reported to HPS via ECOSS (The Electronic Communication of Surveillance in Scotland) showed a marked reduction in confirmed reports of RV compared to a three year average of the years 2011–13. Surrogate markers, e.g. calls to NHS24 and GP consultations with childhood diarrhoea and vomiting, have also shown a downward trend. <h3>Conclusion</h3> The pre-vaccine surveillance of RV strains confirms that G1P[8] is the predominant strain in Scotland. There has been a promising reduction in laboratory confirmed cases of RV in Scotland following the introduction of the vaccine. The baseline genotyping data will be used to ascertain cross protection against strains and also identify vaccine induced RV strain shifts and an overall evaluation of the programme. <h3>Disclosure of interest</h3> None Declared.

Results from a national treatment database – does it matter which ART combination is prescribed in the real world?

IntroductionClinical trials frequently show differences in viral load (VL) response between antiretroviral therapy (ART) regimes. Patterns of prescribing vary from country to country (Mocroft et al. Infection 2014 Jun 6 [epub ahead of print]), and are likely to vary between individual clinics. Scotland has a national database that records VL results and specific ART regimes for every patient under care, thus allowing different prescribing patterns between clinical centres to be monitored. Does this reveal any difference in achievement of undetectable VL?Materials and MethodsWe interrogated the database held by Health Protection Scotland (HPS) that contains a record of every VL result matched against prescribed ART. Results were censored at the end of December 2013 and are based on the latest attendance of patients who have been under monitoring for at least six months. For simplicity, we have broken the results into class of drug rather than individual drugs for example, nucleoside reverse transcriptase inhibitor (NRTI) rather than lamivudine, abacavir etc. The data were analyzed using univariate Poisson regression.ResultsThe anonymized records of 3302 individual patients who attended in 11 separate regions were scrutinized. Sixty-eight different combinations of antiretroviral regimes were identified. The prescribing patterns for the five most frequently prescribed regimes in the four largest clinics are shown in Table 1, along with the overall percentage of patients with undetectable VL. A higher proportion of patients in Scotland who are prescribed regimes of NRTI×2 or NRTI/NtRTI plus PI have detectable VL but this is not statistically significant. Although the percentage of patients with VL<50 varies between regions 1 and 4 versus regions 2 and 3, this is also not statistically significant.ConclusionsOverall, a high proportion of Scottish patients on ART have undetectable VL. Patterns of ART prescribing in Scotland do vary by region but there are no significant differences in outcome with regard to undetectable VL. There is a non-significant trend which may be accounted for by differing levels of PI prescribing.

New healthcare checks for medical and dental students

Medical students will require additional health clearance before being permitted to carry out medical procedures with a high risk of transmission of infection, after the publishing of new guidance by the Medical Schools Council, the Dental Schools Council, Public Health England and Health Protection Scotland.1 All students and healthcare employees already undergo standard health clearance, which assesses exposure to tuberculosis and offers immunisation …

The successful implementation of Scotland's Hepatitis C Action Plan: what can other European stakeholders learn from the experience? A Scottish voluntary sector perspective.

The successful implementation of Scotland's Hepatitis C Action Plan: what can other European stakeholders learn from the experience? A Scottish voluntary sector perspective.

The importance of aseptic technique

Nursing and Residential CareVol. 16, No. 8 EditorialThe importance of aseptic techniqueLinda NazarkoLinda NazarkoSearch for more papers by this authorLinda NazarkoPublished Online:24 Jul 2014https://doi.org/10.12968/nrec.2014.16.8.426AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bhatia N, Daga MK, Garg S, Prakash SK (2010) Urinary catheterization in medical wards. J Global Infect Dis 2(2): 83–90 Crossref, Google ScholarClinimed (2010) Summary of product characteristics. http://bit.ly/O2xOIR (accessed 28 June 2014) Google ScholarFakih MG, Pena ME, Shemes S et al. (2010) Effect of establishing guidelines on appropriate urinary catheter placement. Acad Emerg Med 17(3): 337–40 Crossref, Google ScholarGokula RR, Hickner JA, Smith MA (2004) Inappropriate use of urinary catheters in elderly patients at a midwestern community teaching hospital. Am J Infect Control 32(4): 196–9 Crossref, Google ScholarNational Audit Office (2009) Reducing Healthcare Associated Infections in Hospitals in England. The Stationery Office, London Google ScholarNational Institute for Health and Clinical Excellence (2012) Infection Control. NICE Clinical guideline 139. http://bit.ly/UDPw3S (accessed 28 June 2014) Google ScholarNazarko L (2010) Effective evidence based catheter care: an update. Br J Nurs 19(15): 948–53 Link, Google ScholarNazarko L (2012) Clinical review: Urinary incontinence. Nursing & Residential Care 14(11): 578–83 Link, Google ScholarNHS Services Scotland and Health Protection Scotland (2012) Targeted literature review: What are the key infection prevention and control recommendations to inform a urinary catheter maintenance care quality improvement tool? http://bit.ly/QAWcyf (accessed 28 June 2014) Google ScholarPellowe C, Pratt R (2004) Catheter-associated urinary tract infections: primary care guidelines. Nurs Times 100(2): 53–5 Google ScholarRothfeld AF, Stickley A (2010) A program to limit urinary catheter use at an acute care hospital. Am J Infect Control 38(7): 568–71. doi: https://doi.org/10.1016/j.ajic.2009.12.017 Crossref, Google ScholarStamm WE (1998) UTI. In: Bennett JVBrachman PS, eds. Hospital Infection. 4th edn. Lippincott-Raven, Philadelphia Google ScholarWoodward S (2012) Catheter-associated urinary tract infections in women. Br J Nurs 21(11): 655–56 Link, Google Scholar FiguresReferencesRelatedDetailsCited byOptimising nutrition for older people with constipationOmorogieva Ojo17 July 2017 | Nursing and Residential Care, Vol. 19, No. 8Managing malnutrition for older people in residential careOmorogieva Ojo17 August 2016 | Nursing and Residential Care, Vol. 18, No. 9 2 August 2014Volume 16Issue 8ISSN (print): 1465-9301ISSN (online): 2052-2932 Metrics History Published online 24 July 2014 Published in print 2 August 2014 Information© MA Healthcare LimitedPDF download