Influenza experts have consistently warned of the possibility of a pandemic in the near future. Historically, pandemics have occurred at intervals of 11 ? 42 years and it has now been 38 years since the last Hong Kong flu (H3N2) in 1968 - 1969. Whether the current strain (H5N1) undergoes mutation to enable it to transmit efficiently from human to human, or whether another, as yet unidentified virus, becomes the pandemic strain remains to be seen. Regardless, one thing is certain - We need to prepare.
Traditionally, influenza is monitored via passive surveillance, which is often neither timely nor likely to identify an outbreak early in its course. Early detection of influenza epidemics could prevent significant morbidity and mortality and as a result the emphasis of research has changed to investigate early indicators for detection. This review identifies the strengths and weaknesses of data sources available for influenza surveillance and their potential impact on infection control resources.
The aim of this study was to compare pulsed-field gel electrophoresis (PFGE), random amplified polymorphic DNA (RAPD) - polymerase chain reaction (PCR) and automated ribotyping for the typing of Serratia marcescens across four geographically separate neonatal intensive care units. A selection of clinical and screening isolates of S. marcescens were obtained from patients during an outbreak period and tested along with archived specimens from the previous ten years. Sixty three selected isolates of S. marcescens were tested, 34 by PFGE, RAPD-PCR and automated ribotyping (RiboPrinter®) and 29 by PFGE and RAPD only. Of the 34 isolates tested by all three methods, 29 had concordant results. Four of the remaining five isolates had concordant results by RAPD and PFGE, but not by automated ribotyping. Of the 29 isolates tested by RAPD and PFGE only, 27/29 test results were concordant. Typing and discrimination of isolates was achieved with all three molecular methods. The decision as to which method to use will be guided by the level of requirement for timely epidemiological and standardized results balanced against the laboratory costs and availability of labor resources.
Technological advances have increased our capacity to access information and advance knowledge. In healthcare this has created the imperative to base practice on scientific evidence rather than opinion. Evidence-based guidelines can provide a link between evidence and practice by translating research findings into actionable recommendations. Therefore, the quality of guidelines is important, as they are used to inform practices that have an impact on health outcomes.
A forum on healthcare-associated (HCA) methicillin-resistant Staphylococcus aureus (MRSA) control took place at the 2007 Australasian Society for Infectious Diseases (ASID) Conference in Hobart. The aim was to highlight differing rates of MRSA morbidity across Australia and New Zealand and explore the emerging consensus about patient screening and isolation processes.
Recently published international consensus documents have attempted to provide guidance for infection control professionals in the often contentious area of active surveillance for methicillin-resistant Staphylococcus aureus (MRSA). As well as hospital-based policies in this area, there are also national and state-based guidelines in both Australia and New Zealand.
Infection Control (IC) nurses in 85 smaller (<100 acute care beds) public hospitals reported hospital acquired primary laboratory confirmed (LC) bloodstream infections (BSIs) over 26 months. The ‘true’ infection rate (as confirmed by two infectious diseases physicians) was 0.2 BSIs per 10,000 acute occupied bed days. Only 25% of the BSIs reported by the IC nurses were confirmed as ‘true’ infections. Staphylococcus aureus was the most commonly cultured causative micro-organism. The cause of the 12 confirmed BSIs may have been associated with the use of intravascular devices. The usefulness for smaller hospitals continuing this type of surveillance (particularly because hospital acquired primary LC BSIs are an infrequent, albeit serious event) is questionable.
The ‘Pull Thru’ [Novapharm Research Aust. Pty Ltd], a new device designed for cleaning the biopsy/suction channel of flexible gastrointestinal endoscopes, was compared to reusable brushes in a clinical setting. A total of 53 endoscopes were tested with a microbiological assay. Directly after removing the endoscope from the patient, a sterile saline solution was flushed down the biopsy channel to provide a ‘before clean’ estimate of bioburden. Following a cleaning protocol with either of two manual cleaning devices – i.e. one pass with a Pull Thru or six passes with a reusable brush – a second volume of saline solution was used to provide an ‘after clean’ estimate. The protocols were compared for Log10Reduction in colony-forming units (cfu)/mL between the ‘before clean’ and ‘after clean’ samples. No significant difference was found between the two cleaning protocols (P=0.058) using a combined factorial analysis. The adjusted means for Log10Reduction (cfu/mL) were 3.003 (brush) and 3.302 (Pull Thru) with a standard error of difference of 0.154. It is concluded that the cleaning efficacy of one pass with the Pull Thru was as effective as six passes with a reusable brush.
Routine surveillance of colonisations with multiple antibiotic resistant organisms (MROs) is now widespread and these data are increasingly summarised in control charts. The purpose of their analysis in this manner is to provide early warning of outbreaks or to judge the response to system changes designed to reduce colonisation rates. Conventional statistical process control (SPC) charts assume independence of observations. In addition, there needs to be a run of stable, non-trended (stationary) data values to obtain accurate control limits.
The evidence to support the vaccination of health care workers is robust. In a recent systematic review Burls and colleagues 5 concluded that influenza vaccination is highly effective in health care workers with minimal adverse effects, and that it protects them and provides indirect protection to people at high risk of developing complications from influenza. Another recent study by Hayward and colleagues 6 used a pair matched cluster randomised control trial design and found that vaccinating aged care facility staff can prevent deaths, health service use, influenza like illness and hospital admissions in residents during periods of moderate influenza activity.
Like a window to the future, we can observe the proceedings in the US regarding the issues of mandatory public reporting (MPR) of hospital acquired infections (HAIs). At the recent Society for Healthcare Epidemiology of America (SHEA) meeting in Baltimore, Carlene Muto from the University of Pittsburgh Medical Center presented a paper outlining the differences in HAI rates using traditional Centers for Disease Control and Prevention (CDC) methods compared to HAI data identified only during hospital admission as requested by state agencies.
There are few reports of infection surveillance in residential aged care facilities (RACFs) within Australia. Prior to 2006, limited infection surveillance was undertaken within the units/wards of the RACF at Kingston Centre, Melbourne, Australia. This paper discusses the changes that have been introduced to the surveillance program at Kingston Centre and the literature review undertaken.
It is recognised that a successful infection control program requires a qualified infection control professional to oversee its implementation. To date, the knowledge, skills and scope of practice for the Australian infection control professional (ICP) have not been well defined. To advance this process, the scope of practice for the Victorian ICP was investigated. A developing a curriculum (DACUM) technique was employed to determine the role of the ICP within the workplace. A two-day workshop was conducted with twelve identified experts led by a facilitator, to define the speciality role through a series of brainstorming activities. At the end of the workshop, ten main duty areas performed by an ICP were listed with their associated tasks. The knowledge and skills required by the ICP to facilitate an infection control program were also identified. The DACUM process substantiated that infection control is underpinned by core nursing competencies and could be considered a nursing speciality. A follow-up survey will need to be undertaken to validate the workshop outcomes and ensure they reflect the activities within the broader Victorian infection control community.
Despite widespread acceptance of the need for better compliance with infection control practices in the acute care setting, methods for instilling sustainable changes in the habits of healthcare workers have been elusive, especially hand hygiene practice. In view of this limited success, a fresh approach is timely. It is contended that such an approach should include consideration of infection control practice improvement as an organisational cultural change issue. Within this framework, an exploration of the conceptual ecologies of healthcare workers using an appropriate qualitative methodology can provide the rich data required to increase the deep-seated understanding that is needed for the construction of improved promotion and education of good infection control practices.
Within a hospital, antibiotic usage can be affected by clustering of infections. In addition, pharmacy imprest systems may deliver stock in one time period that are used in a subsequent time period. As a result, hospital antibiotic usage data can be unpredictable and highly variable.
All I maintain is that on this earth there are pestilences and there are victims, and it is up to us, as far as possible, not to join forces with the pestilences. Albert Camus, The Plague (Vintage Books; New York, 1972)
