Mel P-Santini - Academia.edu (original) (raw)
Papers by Mel P-Santini
INQUIRY: The Journal of Health Care Organization, Provision, and Financing, Dec 31, 2022
Value in Health, Nov 30, 2023
ClinicoEconomics and Outcomes Research
Intravenous (IV) access point protectors, serving as passive disinfection devices and a cover bet... more Intravenous (IV) access point protectors, serving as passive disinfection devices and a cover between line accesses, are available to help reduce the risk of central line-associated bloodstream infections (CLABSIs). This low-maintenance disinfection solution is particularly valuable in situations with excessive workloads. This study examined the effect of a disinfecting cap for an IV access point on CLABSI rates, hospital length of stay, and cost of care in an inpatient setting during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The study utilized data from the Premier Healthcare Database, focusing on 200,411 hospitalizations involving central venous catheters between January 2020 and September 2020. Among these cases, 7423 patients received a disinfecting cap, while 192,988 patients did not use any disinfecting caps and followed the standard practice of hub scrubbing. The two cohorts, Disinfecting Cap and No-Disinfecting Cap groups, were compared in terms of CLABSI rates, hospital length of stay (LOS), and hospitalization costs. The analysis accounted for baseline group differences and random clustering effects by employing a 34-variable propensity score and mixed-effect multiple regression, respectively. Results: The findings demonstrated a significant 73% decrease in CLABSI rates (p= 0.0013) in the Disinfecting Cap group, with an adjusted CLABSI rate of 0.3% compared to 1.1% in the No-Disinfecting Cap group. Additionally, the Disinfecting Cap group exhibited a 0.5-day reduction in hospital stay (9.2 days versus 9.7 days; p = 0.0169
<p>The costs per patient for each health state were calculated in both CHG and No-CHG dress... more <p>The costs per patient for each health state were calculated in both CHG and No-CHG dressing as respectively: State 1: €1,270 and €1,266; State 2: €1,364 and €1,361; State 3: €13,661 and €13,658; State 4: €13,756 and €13,752; State 5: €1,388 and €1,385; State 6: €1,266 and €1,266; State 7: €0 for both groups; State 8: €0 for both groups; CHG: chlorhexidine gluconate; CRBSI: catheter-related bloodstream infection; CT: catheter.</p
<p>* New CT needed can mean either the replacement of the existing catheter, or the need fo... more <p>* New CT needed can mean either the replacement of the existing catheter, or the need for an additional catheter at a new site.</p><p>CRBSI, Catheter-related Bloodstream Infections; CT, Catheter (Central venous or radial / femoral arterial).</p><p>Health states defined from a multicentre randomized controlled trial [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0130439#pone.0130439.ref013" target="_blank">13</a>].</p
<p>The analysis uses 1,000 non-homogeneous Markov-Chain Monte Carlo simulations of 1,000 pa... more <p>The analysis uses 1,000 non-homogeneous Markov-Chain Monte Carlo simulations of 1,000 patients for each dressing strategy. The x axis represents the difference in effectiveness (number of CRBSI events in CHG versus non CHG dressing) and the y axis represents the difference in cost (mean cost per patient with CHG versus non CHG dressing) in €2013. The (0,0)-point indicates the reference dressing strategy (Non-CHG group). Each point in the graph represents the Incremental Cost-Effectiveness Ratio (ICER) of CHG-dressing strategy versus reference dressing. All but three points are at the left side of the graph, showing that CHG dressing strategy was 99.7% more effective than the comparator at the same costs per patient. The squared point in the center of the cloud represents the average CE ratio of all 1,000 simulations. CHG: chlorhexidine gluconate; CRBSI: catheter-related bloodstream infection.</p
<p>Time Horizon: 30-days ICU—1,000 NH-MCMC simulations of 1,000 patients (€2013).</p>... more <p>Time Horizon: 30-days ICU—1,000 NH-MCMC simulations of 1,000 patients (€2013).</p><p>CHG: Chlorhexidine Gluconate; CI: Confidence Interval; ICU: Intensive Care Unit; NH-MCMC: Non-Homogeneous Markov-Chain Monte Carlo simulation</p><p>Mean Cost for one patient in each dressing group.</p
<p>This diagram illustrates the impact of the variation in some parameters of the model on ... more <p>This diagram illustrates the impact of the variation in some parameters of the model on the cost difference between the strategies. The base case is average cost difference (€+141) between the two dressing strategies for the parameter’s values indicated on the “y” axis. The tested range for each parameter is indicated by the arrows. The main driver parameter for cost difference is the Extra LOS associated to CRBSI. ICU: Intensive Care Unit; CRBSI: Catheter-related bloodstream infection; CHG: Chlorhexidine Gluconate; LOS: Length of Stay.</p
<p>CHG, Chlorhexidine Gluconate; CI, Confidence Interval; CRBSI, Catheter-related bloodstre... more <p>CHG, Chlorhexidine Gluconate; CI, Confidence Interval; CRBSI, Catheter-related bloodstream infection; CT, Catheter; ICU, Intensive Care Unit; NH-MCMC, Non-Homogeneous Markov Chain Monte Carlo.</p><p>Occurrences per 1,000 patients as generated through 1,000 NH-MCMC of 1,000 patients in each dressing group, according to the base case scenario.</p
This article cites 40 articles, 33 of which can be accessed free
This is an Open Access article distributed under the terms of the Creative Commons Attribution Li... more This is an Open Access article distributed under the terms of the Creative Commons Attribution License
Journal of Clinical Microbiology, 2006
Bloodstream infections are potentially life-threatening and require rapid identification and anti... more Bloodstream infections are potentially life-threatening and require rapid identification and antibiotic susceptibility testing of the causative pathogen in order to facilitate specific antimicrobial therapy. We developed a prototype DNA microarray for the identification and characterization of three important bacteremia-causing species: Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. The array consisted of 120 species-specific gene probes 200 to 800 bp in length that were amplified from recombinant plasmids. These probes represented genes encoding housekeeping proteins, virulence factors, and antibiotic resistance determinants. Evaluation with 42 clinical isolates, 3 reference strains, and 13 positive blood cultures revealed that the DNA microarray was highly specific in identifying S. aureus, E. coli, and P. aeruginosa strains and in discriminating them from closely related gram-positive and gram-negative bacterial strains also known to be etiological agents of...
Cette invention concerne un pansement de fixation de catheter (1) plat, auto-adhesif, prefabrique... more Cette invention concerne un pansement de fixation de catheter (1) plat, auto-adhesif, prefabrique, qui s'applique sur une zone laterale du cou d'un sujet humain. Le pansement presente une forme externe allongee, generalement triangulaire definie par un premier cote long (10), un second cote long (20) a l'oppose du premier, et au moins un cote court (30) reliant une partie d'extremite du premier cote long et une partie d'extremite du second cote long.
BMC Microbiology, 2009
Background Medium density DNA microchips that carry a collection of probes for a broad spectrum o... more Background Medium density DNA microchips that carry a collection of probes for a broad spectrum of pathogens, have the potential to be powerful tools for simultaneous species identification, detection of virulence factors and antimicrobial resistance determinants. However, their widespread use in microbiological diagnostics is limited by the problem of low pathogen numbers in clinical specimens revealing relatively low amounts of pathogen DNA. Results To increase the detection power of a fluorescence-based prototype-microarray designed to identify pathogenic microorganisms involved in sepsis, we propose a large scale multiplex PCR (LSplex PCR) for amplification of several dozens of gene-segments of 9 pathogenic species. This protocol employs a large set of primer pairs, potentially able to amplify 800 different gene segments that correspond to the capture probes spotted on the microarray. The LSplex protocol is shown to selectively amplify only the gene segments corresponding to the...
Journal of Clinical Microbiology, Jul 1, 2006
PLOS ONE, 2015
Objective To model the cost-effectiveness impact of routine use of an antimicrobial chlorhexidine... more Objective To model the cost-effectiveness impact of routine use of an antimicrobial chlorhexidine gluconate-containing securement dressing compared to non-antimicrobial transparent dressings for the protection of central vascular lines in intensive care unit patients. Design This study uses a novel health economic model to estimate the cost-effectiveness of using the chlorhexidine gluconate dressing versus transparent dressings in a French intensive care unit scenario. The 30-day time non-homogeneous markovian model comprises eight health states. The probabilities of events derive from a multicentre (12 French intensive care units) randomized controlled trial. 1,000 Monte Carlo simulations of 1,000 patients per dressing strategy are used for probabilistic sensitivity analysis and 95% confidence intervals calculations. The outcome is the number of catheter-related bloodstream infections avoided. Costs of intensive care unit stay are based on a recent French multicentre study and the cost-effectiveness criterion is the cost per catheter-related bloodstream infections avoided. The incremental net monetary benefit per patient is also estimated. Patients 1000 patients per group simulated based on the source randomized controlled trial involving 1,879 adults expected to require intravascular catheterization for 48 hours.
Gene Function & Disease, 2001
INQUIRY: The Journal of Health Care Organization, Provision, and Financing, Dec 31, 2022
Value in Health, Nov 30, 2023
ClinicoEconomics and Outcomes Research
Intravenous (IV) access point protectors, serving as passive disinfection devices and a cover bet... more Intravenous (IV) access point protectors, serving as passive disinfection devices and a cover between line accesses, are available to help reduce the risk of central line-associated bloodstream infections (CLABSIs). This low-maintenance disinfection solution is particularly valuable in situations with excessive workloads. This study examined the effect of a disinfecting cap for an IV access point on CLABSI rates, hospital length of stay, and cost of care in an inpatient setting during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The study utilized data from the Premier Healthcare Database, focusing on 200,411 hospitalizations involving central venous catheters between January 2020 and September 2020. Among these cases, 7423 patients received a disinfecting cap, while 192,988 patients did not use any disinfecting caps and followed the standard practice of hub scrubbing. The two cohorts, Disinfecting Cap and No-Disinfecting Cap groups, were compared in terms of CLABSI rates, hospital length of stay (LOS), and hospitalization costs. The analysis accounted for baseline group differences and random clustering effects by employing a 34-variable propensity score and mixed-effect multiple regression, respectively. Results: The findings demonstrated a significant 73% decrease in CLABSI rates (p= 0.0013) in the Disinfecting Cap group, with an adjusted CLABSI rate of 0.3% compared to 1.1% in the No-Disinfecting Cap group. Additionally, the Disinfecting Cap group exhibited a 0.5-day reduction in hospital stay (9.2 days versus 9.7 days; p = 0.0169
<p>The costs per patient for each health state were calculated in both CHG and No-CHG dress... more <p>The costs per patient for each health state were calculated in both CHG and No-CHG dressing as respectively: State 1: €1,270 and €1,266; State 2: €1,364 and €1,361; State 3: €13,661 and €13,658; State 4: €13,756 and €13,752; State 5: €1,388 and €1,385; State 6: €1,266 and €1,266; State 7: €0 for both groups; State 8: €0 for both groups; CHG: chlorhexidine gluconate; CRBSI: catheter-related bloodstream infection; CT: catheter.</p
<p>* New CT needed can mean either the replacement of the existing catheter, or the need fo... more <p>* New CT needed can mean either the replacement of the existing catheter, or the need for an additional catheter at a new site.</p><p>CRBSI, Catheter-related Bloodstream Infections; CT, Catheter (Central venous or radial / femoral arterial).</p><p>Health states defined from a multicentre randomized controlled trial [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0130439#pone.0130439.ref013" target="_blank">13</a>].</p
<p>The analysis uses 1,000 non-homogeneous Markov-Chain Monte Carlo simulations of 1,000 pa... more <p>The analysis uses 1,000 non-homogeneous Markov-Chain Monte Carlo simulations of 1,000 patients for each dressing strategy. The x axis represents the difference in effectiveness (number of CRBSI events in CHG versus non CHG dressing) and the y axis represents the difference in cost (mean cost per patient with CHG versus non CHG dressing) in €2013. The (0,0)-point indicates the reference dressing strategy (Non-CHG group). Each point in the graph represents the Incremental Cost-Effectiveness Ratio (ICER) of CHG-dressing strategy versus reference dressing. All but three points are at the left side of the graph, showing that CHG dressing strategy was 99.7% more effective than the comparator at the same costs per patient. The squared point in the center of the cloud represents the average CE ratio of all 1,000 simulations. CHG: chlorhexidine gluconate; CRBSI: catheter-related bloodstream infection.</p
<p>Time Horizon: 30-days ICU—1,000 NH-MCMC simulations of 1,000 patients (€2013).</p>... more <p>Time Horizon: 30-days ICU—1,000 NH-MCMC simulations of 1,000 patients (€2013).</p><p>CHG: Chlorhexidine Gluconate; CI: Confidence Interval; ICU: Intensive Care Unit; NH-MCMC: Non-Homogeneous Markov-Chain Monte Carlo simulation</p><p>Mean Cost for one patient in each dressing group.</p
<p>This diagram illustrates the impact of the variation in some parameters of the model on ... more <p>This diagram illustrates the impact of the variation in some parameters of the model on the cost difference between the strategies. The base case is average cost difference (€+141) between the two dressing strategies for the parameter’s values indicated on the “y” axis. The tested range for each parameter is indicated by the arrows. The main driver parameter for cost difference is the Extra LOS associated to CRBSI. ICU: Intensive Care Unit; CRBSI: Catheter-related bloodstream infection; CHG: Chlorhexidine Gluconate; LOS: Length of Stay.</p
<p>CHG, Chlorhexidine Gluconate; CI, Confidence Interval; CRBSI, Catheter-related bloodstre... more <p>CHG, Chlorhexidine Gluconate; CI, Confidence Interval; CRBSI, Catheter-related bloodstream infection; CT, Catheter; ICU, Intensive Care Unit; NH-MCMC, Non-Homogeneous Markov Chain Monte Carlo.</p><p>Occurrences per 1,000 patients as generated through 1,000 NH-MCMC of 1,000 patients in each dressing group, according to the base case scenario.</p
This article cites 40 articles, 33 of which can be accessed free
This is an Open Access article distributed under the terms of the Creative Commons Attribution Li... more This is an Open Access article distributed under the terms of the Creative Commons Attribution License
Journal of Clinical Microbiology, 2006
Bloodstream infections are potentially life-threatening and require rapid identification and anti... more Bloodstream infections are potentially life-threatening and require rapid identification and antibiotic susceptibility testing of the causative pathogen in order to facilitate specific antimicrobial therapy. We developed a prototype DNA microarray for the identification and characterization of three important bacteremia-causing species: Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. The array consisted of 120 species-specific gene probes 200 to 800 bp in length that were amplified from recombinant plasmids. These probes represented genes encoding housekeeping proteins, virulence factors, and antibiotic resistance determinants. Evaluation with 42 clinical isolates, 3 reference strains, and 13 positive blood cultures revealed that the DNA microarray was highly specific in identifying S. aureus, E. coli, and P. aeruginosa strains and in discriminating them from closely related gram-positive and gram-negative bacterial strains also known to be etiological agents of...
Cette invention concerne un pansement de fixation de catheter (1) plat, auto-adhesif, prefabrique... more Cette invention concerne un pansement de fixation de catheter (1) plat, auto-adhesif, prefabrique, qui s'applique sur une zone laterale du cou d'un sujet humain. Le pansement presente une forme externe allongee, generalement triangulaire definie par un premier cote long (10), un second cote long (20) a l'oppose du premier, et au moins un cote court (30) reliant une partie d'extremite du premier cote long et une partie d'extremite du second cote long.
BMC Microbiology, 2009
Background Medium density DNA microchips that carry a collection of probes for a broad spectrum o... more Background Medium density DNA microchips that carry a collection of probes for a broad spectrum of pathogens, have the potential to be powerful tools for simultaneous species identification, detection of virulence factors and antimicrobial resistance determinants. However, their widespread use in microbiological diagnostics is limited by the problem of low pathogen numbers in clinical specimens revealing relatively low amounts of pathogen DNA. Results To increase the detection power of a fluorescence-based prototype-microarray designed to identify pathogenic microorganisms involved in sepsis, we propose a large scale multiplex PCR (LSplex PCR) for amplification of several dozens of gene-segments of 9 pathogenic species. This protocol employs a large set of primer pairs, potentially able to amplify 800 different gene segments that correspond to the capture probes spotted on the microarray. The LSplex protocol is shown to selectively amplify only the gene segments corresponding to the...
Journal of Clinical Microbiology, Jul 1, 2006
PLOS ONE, 2015
Objective To model the cost-effectiveness impact of routine use of an antimicrobial chlorhexidine... more Objective To model the cost-effectiveness impact of routine use of an antimicrobial chlorhexidine gluconate-containing securement dressing compared to non-antimicrobial transparent dressings for the protection of central vascular lines in intensive care unit patients. Design This study uses a novel health economic model to estimate the cost-effectiveness of using the chlorhexidine gluconate dressing versus transparent dressings in a French intensive care unit scenario. The 30-day time non-homogeneous markovian model comprises eight health states. The probabilities of events derive from a multicentre (12 French intensive care units) randomized controlled trial. 1,000 Monte Carlo simulations of 1,000 patients per dressing strategy are used for probabilistic sensitivity analysis and 95% confidence intervals calculations. The outcome is the number of catheter-related bloodstream infections avoided. Costs of intensive care unit stay are based on a recent French multicentre study and the cost-effectiveness criterion is the cost per catheter-related bloodstream infections avoided. The incremental net monetary benefit per patient is also estimated. Patients 1000 patients per group simulated based on the source randomized controlled trial involving 1,879 adults expected to require intravascular catheterization for 48 hours.
Gene Function & Disease, 2001