BACKGROUND:Australia is recognised as a leading contributor to infection prevention and control (IPC) randomised controlled trials. However, the broader landscape of Australian IPC research has not been comprehensively mapped. This bibliometric review examined research trends, thematic focus areas, and methodological approaches in Australian IPC research over the past two decades. METHODS:A systematic search of Scopus identified IPC-related documents from January 2003 to September 2025. Eligible documents reported original IPC research involving an Australian population and included at least one author with an Australian institutional affiliation. Reviews required an Australian author. Following screening in Covidence, metadata from included documents were analysed using the web application Biblioshiny® to assess publication trends, citation patterns, authorship networks, and international collaboration. Manual thematic coding was undertaken, and reporting followed the BIBLIO checklist. RESULTS:A total of 841 documents from 241 sources were included in the analysis. Publication output increased notably from 2013 onward, with further growth during 2020-2021 and again in 2025. Surveillance was the most common research theme (18.2% [153/841]). Observational designs dominated the literature (44.9% [378/841]), while randomised controlled trials accounted for just 1.2% (10/841) of documents. There was extensive international collaboration, involving authors from 81 countries. CONCLUSION:Australian IPC research output has expanded considerably but remains concentrated within a limited number of themes and is dominated by single-centre observational studies. These findings highlight opportunities to diversify methodologies, strengthen evidence quality, and better align future research with IPC practice and policy priorities.

The emergence and spread of antimicrobial-resistant organisms is a major global health challenge. We report on the approach and outcomes of a programme which aimed to take a One Health approach, incorporating an understanding that the health of humans, animals and the environment are linked. Combating the Threat of Antimicrobial Resistance in Pacific Island Countries (COMBAT-AMR) was funded by the Australian Department of Foreign Trade and designed to build capacity across human and animal health to address the threat of antimicrobial resistance (AMR) in Fiji, Samoa, Papua New Guinea and the Solomon Islands between 2020 and 2023.Semi-structured interviews were undertaken with implementers, key stakeholders and participants across the programme themes (n=53). Evaluation of specific activities included participant surveys, competency assessments and document reviews.Both the human health and animal health sectors made significant progress in capacity-building and mentoring of local staff and collection and analysis of surveillance data. However, the sectors largely operated in parallel, with limited planning or resources allocated for explicit intersectoral activities. Resources allocated to animal health were also insufficient to compensate for under-resourced animal health sectors in comparison to human health sectors in the target countries.The increasing use of One Health approaches to address AMR necessitates careful consideration of strategies to support intersectoral collaboration at the design and implementation stages. The comprehensive evaluation of the COMBAT-AMR programme contributes to the current evidence base regarding operationalising One Health principles in building capacity in AMR in low- and middle-income countries.

BACKGROUND:Suspected healthcare-associated tuberculosis (TB) transmission requires careful investigation due to its implications for infection prevention and public health. CASE REPORT:We describe a suspected nosocomial TB transmission event that was investigated using whole genome sequencing (WGS). An 83-year-old man with an unexpected diagnosis of pleural TB and suspected pulmonary TB had shared a hospital room with a 52-year-old man undergoing investigation for metastatic lung cancer. The contact later developed pulmonary TB after commencing immunotherapy for pulmonary adenocarcinoma, raising concern for hospital transmission. CONCLUSIONS:WGS demonstrated that the isolates belonged to different genomic lineages, excluding transmission. This case highlights the value of genomic surveillance in clarifying TB transmission events and guiding infection prevention responses.

Introduction Administration of antibiotics before incising the skin ('surgical antimicrobial prophylaxis') is a critical infection prevention strategy in surgery. Extending doses of prophylaxis into the postoperative period is a common practice in cardiac surgery; however, the benefit has not been clearly established and may lead to emergence of antimicrobial resistance and patient harm. We present the protocol for a large international multicentre, adaptive, pragmatic, double-blind, three-arm, placebo-controlled, randomised, non-inferiority clinical trial to compare the incidence of surgical site infection after three different durations of postoperative surgical antimicrobial prophylaxis in patients undergoing cardiac surgery.Methods and analysis This adaptive, multi-arm multistage non-inferiority trial will compare intraoperative only (Arm A), to intraoperative and 24 hours (Arm B) and, to intraoperative and 48 hours (Arm C) of intravenous cefazolin and placebo as surgical antimicrobial prophylaxis in 9180 patients undergoing cardiac surgery. The adaptive design allows for potential dropping of any of the three arms if clear inferiority is indicated at any of the scheduled interim analyses. The trial will evaluate the clinical and cost-effectiveness of the three different antibiotic prophylaxis durations.Ethics and dissemination Ethics approval will be obtained at all participating sites. Results of the study will be submitted for publication in peer-reviewed journals and the key findings presented at national and international conferences. Patients and members of the public will also be involved in the dissemination and translation of the trial results.Trial registration number NCT05447559.

BACKGROUND:Hospital-acquired complications (HACs) have recently been introduced in Australia as a quality-of-care metric. These use International Classification of Diseases (ICD) codes to identify potentially avoidable complications, including healthcare-associated infections. We sought to determine the positive predictive value (PPV) of the HAC algorithms in detecting hospital-acquired pneumonia (HAP) and healthcare-associated urinary tract infections (HA-UTI) using traditional surveillance as the standardised comparator. METHODS:We conducted a retrospective analysis at Alfred Health. For both HAP and UTI, we selected 50 admitted episodes with ICD codes that satisfied the HAC definition. We applied standardised surveillance definitions to these episodes, based on European Centre for Disease Prevention and Control (ECDC) guidance. This involved a manual review of documentation and results by an Infection Prevention and Control Nurse Consultant. PPVs were calculated by comparing ICD-code diagnoses with surveillance-confirmed infections. RESULTS:The PPV for the HAP algorithm was 20% (95% CI: 11.0-33.2%). Among non-confirmed cases, 23% (9/40) had no radiological evidence of pneumonia, and 23% (9/40) had symptoms or consolidation on admission. Of the ten true HAP cases, 50% (5/10) were ventilator-associated. The PPV for the HA-UTI algorithm was 58% (95% CI: 44.2-70.6%), with 71% (15/21) of false positives due to asymptomatic bacteriuria. CONCLUSIONS:We found that current HAC algorithms based on ICD coding data did not reliably predict HAP and HA-UTI as defined by standardised surveillance. Given their use in healthcare funding, further validation and improvement of current algorithms should be explored.

Background:People who inject drugs are at increased risk of invasive bacterial infections. We aimed to determine the prevalence and molecular epidemiology of Staphylococcus aureus and Streptococcus pyogenes carriage in this population. Methods:We performed a cross-sectional survey of carriage among people who inject drugs in Melbourne, Australia. Participants provided a combined throat-anterior nares and an axillae swab for S. aureus and S. pyogenes culture. Univariable analysis identified factors associated with S. aureus and methicillin-resistant S. aureus (MRSA) carriage. Isolates underwent whole-genome sequencing (WGS) and were integrated in comparative genomic analysis with carriage and invasive disease isolates identified in 3 geotemporally linked studies of persons who both do and do not inject drugs. Results:We enrolled 305 participants between June 2022 and March 2023. We identified carriage with S. aureus in 40% (122/305), MRSA in 3% (9/305), and S. pyogenes in 1% (3/305) of participants. Recent incarceration was associated with MRSA carriage (OR 6.05, 95% CI 1.55-25.20). Whole WGS analysis identified multiple unrelated sequence types (STs), but S. aureus ST12 and ST398 were overrepresented in carriage and invasive disease isolates from people who inject drugs. We identified multiple clonal groupings (ie, isolates whose core genomes differed by ≤25 single-nucleotide polymorphisms) among carriage and invasive isolates. Conclusions:S. aureus, but not S. pyogenes, carriage is common among people who inject drugs in Melbourne, with MRSA carriage associated with incarceration. While isolates from people who inject drugs in Melbourne were genetically diverse, the presence of clonal groupings and overrepresentation of specific lineages among people who inject drugs suggests that epidemiological dynamics may differ from those in the broader population.

BACKGROUND:Non-ventilator hospital-acquired pneumonia (NV-HAP) is among the most prevalent health-care-associated infections, yet remains under-reported, understudied, and infrequently targeted by infection prevention strategies. Oral care is considered a key preventive measure; however, there are few high-quality randomised controlled trials conducted in hospital settings. The aim of this study is to evaluate whether an enhanced oral care intervention reduces the incidence of NV-HAP. METHODS:The Hospital Acquired Pneumonia Prevention (HAPPEN) trial was an open-cohort, stepped-wedge, cluster-randomised trial conducted across three Australian hospitals. Large public or private hospitals were eligible. Simple randomisation was used to allocate nine wards (clusters) across three treatment sequences. All patients aged 18 years or older admitted to a trial cluster were eligible, with outcomes assessed for patients admitted for at least 48 h. The intervention comprised three components: enhanced delivery of oral care and provision of products, patient and staff education, and audit and feedback, delivered by dedicated research nurses. The control was usual practice-ie, oral care performed by health-care workers as per hospital policy. Primary and secondary outcomes were analysed in the intention-to-treat population. The primary outcome was NV-HAP incidence, defined according to European Centre for Disease Prevention and Control criteria. Secondary outcomes included hospital-acquired lower and upper respiratory tract infections and oral cavity infections. Outcomes were defined using established definitions and determined following a review of medical records. This study was single blinded, with data collectors masked to allocated treatment sequences. The completed trial is registered with the Australia New Zealand Clinical Trials Registry (ACTRN12624000187549). FINDINGS:The trial was conducted from June 3, 2024, to Aug 22, 2025. A total of 12 446 admitted patients were eligible to receive the intervention, 3336 of whom were excluded because they were admitted to a trial cluster for less than 48 h. A total of 8870 patients were analysed, with 4523 exposed to the control condition and 4347 exposed to the intervention condition. NV-HAP was confirmed in 78 (0·9%) of 8870 patients: 46 (1·0%) of 4523 under the control condition and 32 (0·7%) of 4347 under the intervention condition. Intervention exposure was associated with a cumulative hazard ratio of 0·40 (95% CI 0·19-0·82), representing a decrease from 1·00 to 0·41 infections per 100 admission-days at risk. Intervention exposure resulted in a cumulative hazard ratio of 1·64 (95% CI 0·61-4·39) for lower or upper respiratory tract infection, and 1·08 (0·66-1·77) for oral cavity infection. The proportion of participants who completed the oral care protocol increased from 474 (15·9%) of 2988 to 1727 (61·9%) of 2791 following intervention exposure. INTERPRETATION:This multicentre randomised controlled trial demonstrates that improving oral care reduces NV-HAP incidence among hospitalised patients, compared with usual care. Our findings provide novel and clinically important evidence to inform future prevention guidelines and hospital infection control policy. FUNDING:Medical Research Future Fund.

BACKGROUND:Oral care has a critical role in hospital-acquired infection prevention, is part of fundamental nursing care, yet is poorly undertaken in hospital. The study's aim was to understand Australian nurses' perceptions of their role in oral care and their experience providing oral care in hospital, with the focus on enablers and barriers. METHODS:A qualitative exploratory descriptive design. Seven registered nurses working in acute adult in-patient hospitals in Australia participated in three semi-structured focus groups in October and November 2023. Data analysis followed thematic analysis procedures. The study is reported using Standards for Reporting Qualitative Research. RESULTS:Three themes were identified: nurses' perceptions of their role in oral care; barriers to providing oral care for hospitalised patients; and enablers to providing oral care for hospitalised patients. Nurses' experiences revealed expectations for different clinical settings. In the intensive care unit where patients required mechanical ventilation, oral care was inextricably linked to that care. In palliative care or oncology units, oral care was intrinsically linked to holistic care. Reported challenges include time and staffing constraints; limited resources; nurses' limited knowledge about the importance of oral care, and patient-related factors. Opportunities to promote oral care include empowering patients and educating nurses about the importance of oral care to health. CONCLUSIONS:Nurses have a pivotal role in oral care and it is important that this is part of patient care in hospital. The findings will inform a comprehensive co-design process to develop an intervention to be examined in a multi-centre randomised control trial.

INTRODUCTION:There are limited existing data regarding the financial costs associated with hospitalisation for injection-related infection (IRI) in Australia. We aimed to estimate the cost, from the healthcare funder perspective, of admissions to treat IRI. METHODS:We performed a retrospective audit of 226 admissions with an IRI at the Alfred Hospital (Melbourne, Australia), from January 2017 to April 2019. Eligibility criteria included admission for management of an IRI and current injecting drug use, defined as self-reported injecting drug use within the preceding 6 months, documented in the medical record. We estimated the cost of each hospital admission, using national hospital price weights that accounted for the Australian Refined Diagnosis Related Groups and length of stay. RESULTS:Among admissions with IRI, the median (interquartile range; IQR) cost of admissions with uncomplicated skin and soft tissue infection and complicated infection were AU$8416 (IQR $4132-$8611) and AU$31,938 (IQR $14,301-$54,397), respectively. Admissions requiring intensive care or surgery were associated with higher costs. The most expensive infection based on hospital cost was spinal infections (median AU$58,366 [IQR 31,938-$69,001]), despite endocarditis having higher median length of stay (38 days [IQR 18-46] vs. 24 [15-32]). DISCUSSION AND CONCLUSIONS:We demonstrate the costs associated with hospital admissions for IRI, including the substantial increased costs associated with complicated IRI. This highlights the opportunity for cost savings associated with harm minimisation interventions to avoid infections and their sequelae.

Objectives:Antimicrobial resistance (AMR) is a global health threat, with third-generation cephalosporin-resistant (3GCR) and carbapenem-resistant infections of particular concern. There is currently a lack of genomic data on AMR organisms in the Pacific region. Methods:We aimed to address this gap by examining the genetic diversity of a collection of 788 Gram-negative and Gram-positive clinical isolates collected between July 2020 and October 2022 from a single hospital in Suva, Fiji. We sampled sensitive and resistant isolates, focusing on 3GCR and carbapenem-resistant Gram-negatives, and methicillin-resistant Staphylococcus and vancomycin-resistant Enterococcus. Results:We detected 29 distinct species across 12 different genera. Amongst Gram-negative genomes, Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii and Pseudomonas aeruginosa were the most common. Carbapenem resistance was mostly detected in A. baumannii ST2 and P. aeruginosa ST773, with both STs carrying NDM-1 and showing evidence of transmission within Fiji. Carbapenem resistance was relatively rare amongst the Enterobacterales; however, we observed evidence of transmission of OXA-232-carrying K. pneumoniae ST395 and NDM-7 E. coli ST410. For Gram-positive bacteria, Staphylococcus aureus ST1 was the dominant clone, and phylogenetic analysis revealed a single clade harbouring the majority of Fijian genomes, with close relationships to genomes from neighbouring Samoa. Enterococcus was relatively rare, with only 22 genomes detected. Conclusions:This study provides crucial genomic data on AMR organisms in Fiji, highlighting the diversity of resistant species in the region. Local transmission of four carbapenem-resistant clones within Fiji was observed, underscoring the importance of local spread of these resistant strains.

Background and objectives:There are few Australian data regarding the burden of hospital-onset bloodstream infections (HO-BSIs). To quantify the impact of antimicrobial-susceptible and -resistant HO-BSIs on patient outcomes by augmenting laboratory-based surveillance data. Methods:We performed a retrospective cohort study at a tertiary referral hospital in Melbourne, Australia, from 2015 to 2020. We linked administrative data with bloodstream infection surveillance data from the Australian Group on Antimicrobial Resistance. We performed cause-specific Cox proportional hazards regression to quantify the impact of HO-BSI on inpatient mortality and discharge alive, with separate models for Enterobacterales, Staphylococcus aureus, Enterococcus species and the non-fermenting Gram-negative bacilli (NFGNB), Pseudomonas aeruginosa and Acinetobacter species, compared to admissions without HO-BSI. Excess length of stay (LOS) was estimated using multistate models. Results:The cohort of 278 984 admissions included 814 (0.3%) HO-BSIs. Enterobacterales were the most frequent pathogens, followed by enterococci, S. aureus and NFGNB (incidence 3.62, 2.34, 1.11 and 0.80 events per 10 000 patient-days, respectively). Both antimicrobial-resistant and -susceptible HO-BSI increased risk of death and LOS compared with admissions without HO-BSI. Antimicrobial-resistant and -susceptible HO-BSIs, respectively, increased LOS by 5.7 days (95% CI: 4.9-6.5) and 4.1 days (95% CI: 3.8-4.5) for Enterobacterales, 4.9 days (95% CI: 4.5-5.4) and 3.1 days (95% CI: 2.6-3.6) for enterococci, and 6.3 days (95% CI: 5.3-7.3) and 9.8 days (95% CI: 9.1-10.5) for S. aureus. Conclusions:Antimicrobial-susceptible and -resistant HO-BSIs have a substantial impact on patient outcomes. We demonstrated the feasibility of leveraging a national laboratory-based surveillance system to quantify the impact of HO-BSI.

Contact tracing is an effective method for mitigating the infectious diseases spread and it played a crucial role in reducing COVID-19 outbreak. Since the pandemic, there has been an increased concern regarding people's health in hospital and office settings, as these limited air exchange spaces provide a conductive medium for virus spread. Various technologies were used to recognize close contacts autonomously, in addition, multiple machine learning attempts were carried out to determine proximity in contact tracing. This study, however, proposes a unique concept in contact tracing: forecasting future close contact prior to occurrence in order to regulate and control it rather than tracking past occurrences. For our research, we constructed a completely new real-life dataset that was collected during the pandemic in a hospital infectious ward (Alfred Hospital, Melbourne, Australia) utilizing a Bluetooth Low Energy (BLE) Internet of Things (IoT) system. Our prediction technique considers two types of environments: single transceiver environments and multiple transceivers settings, these transceivers record the nearby tags' BLE received signal strength indicator (RSSI) values. The system employs mathematical models and supervised machine learning (ML) algorithms to solve regression and classification problems for workers' pattern recognition within the environment. The output is compared using different metrics, such as efficiency, which reached more than 80%, root mean square errors and mean absolute errors which were as low as 2.4 and 1.2 respectively in some models.

We assessed the hospital environment as a reservoir of vancomycin-resistant E. faecium (VRE) and compared environmental VRE isolates to bloodstream infection E. faecium isolates. We identified distinct environmental and patient reservoirs, with the environment dominated by vanB VRE. Environment-clinical reservoir spillover accounted for 292/895 (33%) of putative transmission links.

BACKGROUND:Antimicrobial resistance increases the risk of misaligned initial antibiotic treatment (IAT), as susceptibility data are typically delayed. The causal effect on patient outcomes, however, is unclear due to reliance on observational studies with methodological heterogeneity. OBJECTIVES:To describe the terminology and definitions for IAT misalignment and evaluate methods used to analyse its association with mortality and hospital length of stay (LOS) for patients with drug-resistant bloodstream infections (BSIs). METHODS:A systematic review. DATA SOURCES:PubMed and EMBASE: January 1990 to August 2024. STUDY ELIGIBILITY CRITERIA:We included studies on drug-resistant BSIs caused by ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species, and other Enterobacterales). Eligible studies defined IAT misalignment and assessed its effect on mortality/LOS. PARTICIPANTS:Patients with drug-resistant BSIs. EXPOSURE:(mis)aligned IAT. ASSESSMENT OF RISK OF BIAS:Revised versions of the Joanna Briggs Institute tools. METHODS OF DATA SYNTHESIS:Qualitative synthesis. RESULTS:From 3627 screened publications, 187 studies were included, predominantly cohort studies (n = 183). The most common terminology for IAT misalignment was "(in)appropriate" (n = 139, 74.3%), followed by "(in)adequate" (n = 34, 18.2%). Definitions primarily considered in vitro susceptibility to prescribed antibiotic(s) (n = 184, 98.4%), with up to nine additional criteria. Impact of (in)appropriate IAT on mortality (n = 186) was mostly evaluated using logistic or Cox regression, including various confounder selection methods, showing an association in 122 of 186 studies (65.6%). Admission-to-infection time and infection-to-treatment time were rarely considered. Impact of (in)appropriate IAT on LOS was shown in two of nine studies. Only four studies explicitly analysed postinfection LOS. No study scored a low risk of bias, due to residual confounding and time-dependent bias. DISCUSSION:Wide variability of IAT definitions and impact analysis was observed, with a high risk of bias, hindering data aggregation and limiting understanding of the causal effect of inappropriate IAT on clinical outcomes. Guidelines are required to improve study quality and harmonize future research.

BACKGROUND:The Australian Commission on Safety and Quality in Healthcare developed a list of sixteen potentially preventable Hospital-Acquired Complications (HACs) and an algorithm using International Classification of Disease (ICD) codes to detect them. We evaluated this algorithm's performance for diagnosing hospital-onset bloodstream infections (HO-BSI). METHODS:Administrative records were extracted for episodes of admitted patient care from July 2016 to June 2017 at five Australian principal referral hospitals. We applied the BSI HAC algorithm to each episode, then randomly selected 50 patients deemed positive and negative for HO-BSI at each site. Reviewers blinded to HAC status applied the reference surveillance definition for HO-BSI. The positive predictive value (PPV) and negative predictive value (NPV) for the BSI HAC were calculated. We explored changes to the HAC algorithm to improve these metrics. RESULTS:Overall, 352 917 episodes were included; median (IQR) age was 54 (33-71) years, 49.6 % were female, and 43.8 % were elective admissions. Of these, 2229 (0.6 %) had a HO-BSI according to the HAC algorithm. Among manually reviewed episodes, the PPV for the HAC algorithm was 0.28 (95 % CI, 0.23-0.34) and the NPV was 1.00 (95 % CI, 0.98-1.00). The codes 'Sepsis, unspecified' and 'bacterial sepsis of newborn, unspecified' were both common triggers for HO-BSI HACs (accounting for 35.8 % and 18.4 % of HO-BSIs, respectively) and had poor PPV (0.06 and 0.03, respectively). Removal of these codes from the algorithm increased PPV to 0.53 (0.45-0.62). CONCLUSION:The HAC algorithm had sub-optimal PPV for HO-BSI. This performance was improved by removing the 'unspecified sepsis' ICD codes.

BACKGROUND AND AIMS:Injecting-related bacterial infections are increasing in many countries. Systemic infections often require prolonged treatment. Evidence suggests that people who inject drugs who have invasive infections are less likely to complete antimicrobial treatment and have poorer outcomes than patients without a history of injecting drug use. We used a social ecological model to identify critical barriers and facilitators that impact healthcare service access for people who inject drugs with an invasive infection. DESIGN:A qualitative study using semi-structured interviews. SETTING:Melbourne, Victoria, Australia in 2023. PARTICIPANTS:Twenty participants were recruited from SuperMIX, a longitudinal cohort of people who inject drugs. MEASUREMENTS:Thematic analysis used inductive coding to chart themes onto the core domains of the social ecological model. FINDINGS:Participant experiences informed five key themes. (1) Health literacy influenced how participants responded to the physical and experiential embodiment of symptoms. (2) The intersection between drug use and marginalisation created compounding barriers to care. (3) Familial and social embeddedness of participants could both enable or restrict their healthcare access. (4) The use of patient-centred care to respond to intersecting needs directly contributed to healthcare engagement outcomes. Finally, (5) trust was a critical dimension that influenced participants' experiences of healthcare access. While its presence or absence was felt at intrapersonal and interpersonal levels, cultivating or discouraging trust had its roots at the societal and institutional level. CONCLUSIONS:Among people who inject drugs, facilitators and barriers to seeking healthcare for invasive infections appear to be influenced by factors at all levels of the social ecological model (intrapersonal, interpersonal, institutional and societal).

Importance:The economic value of cleaning and disinfection of shared medical equipment is currently unknown. Objective:To evaluate whether or not better environmental cleaning and disinfection of shared medical equipment would be cost-effective compared with usual care. Design, Setting, and Participants:This economic evaluation study was a within-trial cost-effectiveness analysis of a stepped-wedge cluster randomized clinical trial: the Cleaning and Enhanced Disinfection (CLEEN) study. The trial included 5002 inpatients and was conducted in 10 adult acute-care wards at a tertiary hospital in Australia between March 20, 2023, and November 24, 2023. The evaluation takes a hospital costing perspective. A decision-tree model was developed to evaluate the intervention; costs are presented in Australian dollars. Statistical analysis was performed from May to October 2024. Interventions:A multimodal cleaning intervention was introduced during the intervention, focusing on additional cleaning hours, education, audit, and feedback. The control group received usual care, including routine cleaning by clinical staff. Main Outcomes and Measures:Incremental cost-effectiveness ratio, where the mean change to costs associated with the intervention is divided by the mean change in outcomes. Results:This study assessed 5002 patients (2478 [49.5%] male, 2524 [50.5%] female [50.5%]; mean [SD] age, 71.6 [16.1] years). For a cohort of 1000 patients at risk of health care-associated infection (HAI), the estimated total costs associated with the intervention were $1 513 300, compared with $2 155 310 for usual care. The estimated number of HAIs was 100 in the intervention group, compared with 130 for the usual care group. Compared with usual care, the intervention was associated with reduced HAIs and costs, with a 90.5% chance that intervention adoption was cost-saving. This probability increased to 99.9% if a decision-maker was willing to pay $20 000 to avoid an infection. Conclusions and Relevance:In this economic evaluation study of enhanced cleaning and disinfection of shared medical equipment, the intervention resulted in reduced HAIs and a $642 010 reduction in costs per 1000 patients, compared with the control group. These results suggest that the CLEEN intervention is a cost-saving initiative.

BACKGROUND:Peripheral intravenous catheter (PIVC) care in Australia remains suboptimal and continues to cause harm. Gaps in local policy, variation in clinician training and competing clinical priorities all continue to lead to poor PIVC practices and associated complications. METHODS:A priority setting study was undertaken with the aim of identifying infection prevention and control priorities for PIVC care and key actionable strategies that would facilitate effective improvements in PIVC practices. RESULTS:Sixty-five multidisciplinary clinicians participated in the study. Nine priority themes were identified with key actionable strategies including greater consumer engagement, development of standardised and evidence-informed resources, and strong national leadership for PIVC care improvement. CONCLUSION:This study provides valuable knowledge from clinicians with an in-depth understanding of the clinical factors contributing to poor PIVC practices. Efforts to improve these practices and address the key themes identified will depend on strong leadership and a coordinated approach across the system.

BACKGROUND:Healthcare infection prevention and control (IPC) programs are recognised globally as a system-wide strategy to support patient and staff safety. Research evidence is essential to underpin these programs, however it is unclear the level of national research funding invested into healthcare IPC in the past decade. METHODS:Scoping review using Arksey and O'Malley's framework. A systematic search of national category 1 grants awarded between 2014 and 2023 on healthcare IPC was undertaken. Grants were eligible if they were focused on healthcare IPC, we excluded preclinical studies and vaccine development studies. Two independent reviewers screened and extracted data, result were summarised narratively. RESULTS:We identified 10,394 grants, amounting to $19.7B, awarded between 2014 and 2023. A total of $37.11M was provided for 23 IPC research projects/programs (median per grant $1.10M, interquartile range 335k to 2.44M). Accounted for approximately 0.19 % of the total government health research funding in Australia from 2014 to 2023. No healthcare IPC related grants were awarded in 2020, the peak of the pandemic. CONCLUSION:IPC research funding in Australia remains disproportionately low relative to infection health and economic burden.

Mitigation measures against infectious aerosols are desperately needed. We aimed to: 1) compare germicidal ultraviolet radiation (GUV) at 254nm (254-GUVUpper-Room) and 222nm (222-GUVWhole-Room) with portable high efficiency particulate air (HEPA) filters to inactivate/remove airborne bacteriophage ϕX174, 2) measure the effect of air mixing on the effectiveness of 254-GUVUpper-Room, and 3) determine the relative susceptibility of ϕX174, SARS-CoV-2, and Influenza A(H3N2) to GUV (254nm, 222nm). A nebulizer generated ϕX174 laden aerosols in an occupied clinical room (sealed-low flow). Mitigation devices (3 commercial GUV devices, HEPA-470m3/hr-class H13 filter) were compared by counterbalanced experimental design with negative (no mitigation) control. Viral inactivation was determined by air sampling (SartoriusMD8 and Gilair5). Environmental physical properties (airflow, particle matter, GUV irradiance, temperature and humidity) were also characterized. The effect of improving air mixing on the efficacy of 254-GUVUpper-Room devices was systematically explored by adding fans. The relative susceptibility of SARS-CoV-2, Influenza A(H3N2) and ϕX174 were assessed by exposure to 254nm and 222nm wavelength radiation in a 82L chamber. 254-GUVUpper-Room with highest irradiance (Philips UV-C WL345W) resulted in highest calculated equivalent air changes per hour (eACH) of 8.18±0.74 (hr-1). This increased to 19.20±2.45 (hr-1) with the addition of 2 fans. HEPA filtration achieved 11.10±1.25 (hr-1). For 254nm GUV rank order (most-to-least) of susceptibility was SARS-CoV-2, ϕX174, Influenza A(H3N2), and for 222nm GUV SARS-CoV-2, Influenza A(H3N2), ϕX174. GUV effectively inactivates virus laden aerosol in poorly ventilated clinical environments. Efficacy is improved by increasing airflow. HEPA performance is superior to GUV under low flow conditions.