Little is known about how different government communication strategies may systematically affect people's attitudes to staying home or going out during the COVID-19 pandemic, nor how people perceive and process the risk of viral transmission in different scenarios. In this study, we report results from two experiments that examine the degree to which people's attitudes regarding the permissibility of leaving one's home are (1) sensitive to different levels of risk of viral transmission in specific scenarios, (2) sensitive to communication framings that are either imperative or that emphasize personal responsibility, or (3) creating 'loopholes' for themselves, enabling a more permissive approach to their own compliance. We find that the level of risk influences attitudes to going out, and that participants report less permissive attitudes to going out when prompted with messages framed in imperative terms, rather than messages emphasizing personal responsibility; for self-loopholes, we find no evidence that participants' attitudes towards going out in specific scenarios are more permissive for themselves than for others. However, participants report they are more rigorous in staying home than others, which may cause moral licensing. Additionally, we find that age is negatively associated with permissive attitudes, and that male participants are more permissive to going out. Thus, during phases where it is important to promote staying home for all scenarios, including those perceived to be low-risk, imperative communication may be best suited to increase compliance.

Introduction: Current surveillance definitions fail to account for modifiable and non-modifiable factors that contribute to healthcare-associated Staphylococcus aureus bloodstream infection (HA-SAB). We developed a tool to classify these infections by their degree of 'preventability' to assist organisations with targeting their responses at the most preventable HA-SABs.Methods: The literature was reviewed for definitions of preventable harm and causative factors for HA-SAB, and a tool was drafted. A Delphi Technique was used to survey experts (n=11) in infection prevention (IP) to refine the tool. The completed tool was retrospectively piloted on HA-SAB events at Alfred Health (n=43).Results: Expert feedback was incorporated into the tool, with consensus achieved after four survey rounds. Three categories of HA-SAB, with tailored organisational responses for each classification, were established in the tool. 'Highly preventable' infections involved a clear breach in IP practices, and 'possibly preventable' infections were associated with healthcare interventions where a specific IP breach was not evident. 'Not actionable' events were those where the source of infection does not appear amenable to local change. Pilot application of the completed tool found that 56% of HA-SAB events were highly or possibly preventable, with modifiable factors not identified in the remainder of reviewed cases.Conclusion: A Prevention Assessment and Response Tool was successfully developed using a Delphi Technique to assist organisations with investigating and responding to HA-SAB events, and to identify future priority areas for HA-SAB reductions. Wider use of the tool is required to evaluate utility and impact on patient outcomes. Introduction: Current surveillance definitions fail to account for modifiable and non-modifiable factors that contribute to healthcare-associated Staphylococcus aureus bloodstream infection (HA-SAB). We developed a tool to classify these infections by their degree of 'preventability' to assist organisations with targeting their responses at the most preventable HA-SABs. Methods: The literature was reviewed for definitions of preventable harm and causative factors for HA-SAB, and a tool was drafted. A Delphi Technique was used to survey experts (n=11) in infection prevention (IP) to refine the tool. The completed tool was retrospectively piloted on HA-SAB events at Alfred Health (n=43). Results: Expert feedback was incorporated into the tool, with consensus achieved after four survey rounds. Three categories of HA-SAB, with tailored organisational responses for each classification, were established in the tool. 'Highly preventable' infections involved a clear breach in IP practices, and 'possibly preventable' infections were associated with healthcare interventions where a specific IP breach was not evident. 'Not actionable' events were those where the source of infection does not appear amenable to local change. Pilot application of the completed tool found that 56% of HA-SAB events were highly or possibly preventable, with modifiable factors not identified in the remainder of reviewed cases. Conclusion: A Prevention Assessment and Response Tool was successfully developed using a Delphi Technique to assist organisations with investigating and responding to HA-SAB events, and to identify future priority areas for HA-SAB reductions. Wider use of the tool is required to evaluate utility and impact on patient outcomes.

Background: Healthcare-associated Staphylococcus aureus bloodstream infection (HASAB) causes preventable harm in hospitalized patients. Currently, there is no standardized method available to review HA-SAB events in order to identify and target preventable risks requiring action at an organizational level. Aim: To develop a tool to classify SAB events, and the necessary response actions, according to the degree of preventability. Methods: Following a literature review, a tool was developed. Consensus feedback and development of the tool was sought from experts (N = 11) in healthcare-associated infection surveillance using a Delphi technique. The completed tool was retrospectively applied to HA-SAB events (N = 43) that occurred at a large healthcare organization. Findings: Survey completion rates were high (91-100%). Clinicians' poor adherence to infection prevention practices and lack of engagement with feedback processes was established as the key modifiable element. A second key theme was the need for structured and detailed response actions. This feedback was incorporated into the tool and refined until consensus on all elements was achieved. Pilot application of the tool found that 56% of HA-SAB events were highly or possibly preventable; modifiable factors for HASAB prevention were not present in the remainder of cases. Conclusion: A prevention assessment and response tool was successfully developed via a consensus method to assist organizations in investigating and responding to individual cases of HA-SAB and identify future priority areas for SAB reduction strategies. Wider use of the tool with routine surveillance activities is required to evaluate impact upon infection prevention programmes and patient outcomes. (c) 2021 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Positron emission tomography (PET) imaging necessitates the use of multidose vials for radiopharmaceutical delivery to patients. Conventional practices involve manual extraction of radiopharmaceuticals from a multidose vial prior to each PET procedure, which exposes the technologist to increasing levels of radiation and poses a potential infection risk to patients with frequent handling and access of the vial. New technologies for automated dosing and infusion delivery are available, however these incorporate both a multidose vial and a multi-patient infusion set. There is an absence of guidance for infection prevention (IP) units regarding the safety and acceptability of these devices. This paper describes the process of risk assessment and the mitigation measures for training, workflows, and documentation which led to the safe introduction of an automated PET infusion device in a large tertiary public healthcare facility.

BACKGROUND:Healthcare-associated Staphylococcus aureus bacteraemia (HA-SAB) results in morbidity, mortality, and increased healthcare costs, and these infections are frequently regarded as preventable.AIM:To implement a multi-modal prevention programme for improved processes regarding peripheral intravenous cannula (PIVC) insertion and maintenance, in order to reduce PIVC-associated HA-SAB events in a large Australian health service.METHODS:Baseline clinical practice was evaluated for a 12-month pre-intervention period. Measures to reduce HA-SAB risk were introduced between January and September 2013: staff education, improved documentation (including phlebitis scoring), and availability of standardized equipment. Post-intervention auditing was performed during the 27 months following intervention. Baseline and post-intervention HA-SAB and PIVC-associated infection rates were compared. Interrupted time-series and Bayesian change-point analyses were applied to determine the impact of interventions and timing of change.FINDINGS:Significantly improved documentation regarding PIVC insertion and management was observed in the post-intervention period, with fewer PIVCs left in situ for ≥4 days (2.6 vs 6.9%, P<0.05). During the baseline period a total of 68 HA-SAB events occurred [1.01/10,000 occupied bed-days (OBDs)] and 24 were PIVC-associated (35% of total, rate 0.39 per 10,000 OBDs). In the post-intervention period, a total of 83 HA-SAB events occurred (0.99 per 10,000 OBDs) and 12 were PIVC-associated (14.4% of total, rate 0.14 per 10,000 OBDs). PIVC-associated SAB rates were 63% lower in the post-intervention period compared to baseline (P=0.018) with a change point observed following full bundle implementation in October 2013.CONCLUSION:A successful multi-modal hospital-wide campaign was introduced to reduce PIVC-associated SAB rates. Evaluation of cost-effectiveness and sustainability is required.