BACKGROUND:Catheter-associated urinary tract infections (CAUTIs) are a significant cause of morbidity and healthcare costs in acute care settings. CAUTI surveillance is essential for identifying infection trends and implementing targeted prevention strategies. We performed hospital wide CAUTI surveillance to establish baseline CAUTI rates. METHODS:Data for all patients at the City Campus of Royal Melbourne Hospital with a positive urine culture between July 2024 and June 2025 were reviewed prospectively. CAUTI cases were identified according to standardised surveillance definitions, with remaining records classified as either healthcare associated UTI, community associated, indwelling catheter in situ and asymptomatic, or no indwelling catheter and asymptomatic. RESULTS:During the 12-month period, a total of 1334 urine culture positive results were reviewed for 1042 patients. Community associated urinary tract infections were most common, followed by healthcare associated urinary tract infections, comprising 51% and 10% of positive urine cultures reviewed, respectively. Only 8% were identified as CAUTI. The overall CAUTI rate was 3.1 (95% CI: 2.6-3.8) per 1000 catheter-days and the Intensive Care Unit specific rate was 5.4 (95% CI: 3.3-8.2) per 1000 catheter-days. CONCLUSIONS:The baseline surveillance data revealed that CAUTIs accounted for a small proportion of all positive urine cultures within our hospital. Hospital wide CAUTI surveillance presents significant logistical and resource challenges. Continued surveillance and more in-depth analysis are required to determine the most efficient and impactful allocation of surveillance resources.

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:As one of the many measures to limit the potentially infectious persons entering healthcare settings, the Victorian Department of Health (DH) introduced a daily attestation between 2020 and 2022. Upon entry to a health service, employees were required to confirm they were free from symptoms related to COVID-19 and did not have contact with a confirmed COVID-19 case in the previous 7-14 days. METHODS:We performed a retrospective analysis of employee attestations and SARS-CoV-2 tests performed between 1/6/2021 and 14/2/2022 at the main campus of the Royal Melbourne Hospital. RESULTS:We found the proportion of SARS-CoV-2 positive employees identified through workplace attestation was low (1.3%). Most SARS-CoV-2 positive employees analysed in this study (94%) were asymptomatic. DISCUSSION:Although the proportion of SARS-CoV-2 positive employees identified was low, attestations may have deterred unwell employees from presenting to work. Proactively monitoring employee attestations, such as measuring and reporting the number of symptomatic attestations, may make this a more useful tool.

Introduction: Burkholderia species are known environmental pathogens which can cause significant illness, particularly in hospitalized immunocompromised populations and intensive care settings. We describe a combined epidemiologic, genomic and engineering investigation of intermittent clusters of Burkholderia from clinical and environmental samples in the intensive care unit (ICU) of Royal Melbourne Hospital. Methods: All ICU patients with Burkholderia identified in clinical samples from microbiology records between April 2017 and December 2022 were investigated. Environmental samples were collected from faucets in ICU after Burkholderia was detected in a patient. Burkholderia isolates underwent molecular and whole genome sequencing. Taps where Burkholderia was isolated underwent thermal disinfection. The existing chlorination program was reviewed. Results: Twenty-nine patients were Burkholderia positive, with isolates from respiratory samples (n=19, 65%) most common. A total of 275 environmental samples were collected across all ICU pods, of which 37 (13%) grew Burkholderia. Molecular sequencing identified diverse sequence types across clinical and environmental samples. One probable episode of environment to patient transmission was identified. Variable water chlorine levels within ICU were detected, ranging from acceptable to non-detectable. Conclusion: Isolation of Burkholderia from tap water in all ICU pods suggests presence of biofilm that intermittently releases organisms into the water. Dispersal of organisms from taps to patient can occur through a variety of mechanisms. It is unknown if low chlorine levels are associated with presence of organisms in the tap water. Combining epidemiology and genomic data to identify the source of potential contamination is important for risk mitigation and prevent further Burkholderia cases.

AbstractObjectiveTo describe COVID-19 infections amongst healthcare workers at the Royal Melbourne Hospital from 1st July to 31st August 2020DesignProspective observational studySettingA 550 bed tertiary referral hospital in metropolitan MelbourneParticipantsAll healthcare workers identified with COVID-19 infection in the period of interestResults262 healthcare worker infections were identified over 9 weeks. 68.3% of infected healthcare workers were nurses and the most affected locations were the geriatric and rehabilitation wards. Clusters of infection occurred in staff working in wards with patients known to have COVID-19 infection. Staff infections peaked when COVID-19 infected inpatient numbers were highest, and density of patients and certain patient behaviours were noted by staff to be linked to possible transmission events. Three small outbreaks on other wards occurred but all were recognised and brought under control. Availability of rapid turn-around staff testing, and regular review of local data and obtaining feedback from staff helped identify useful interventions which were iteratively implemented. Attention to staff wellbeing was critical to the response and a comprehensive support service was implemented.Conclusion(s)A comprehensive multimodal approach to containment was instituted with iterative refinement based on frontline workers observations and ongoing analysis of local data in real time.The known: Healthcare workers are a group recognized to be at risk of acquisition of infection in the workplace during the current COVID-19 pandemicThe new: This describes the experience of the largest Australian outbreak to date of COVID- 19 infection amongst healthcare workers in a hospital environmentThe implications: This paper should assist healthcare services to prepare for surges in COVID-19 infection to help limit future transmissions to healthcare workers

BACKGROUND:Hospital-based contact tracing aims to limit spread of COVID-19 within healthcare facilities. In large outbreaks, this can stretch resources and workforce due to quarantine of uninfected staff. We analysed the performance of a manual contact tracing system for healthcare workers (HCW) at a multi-site healthcare facility in Melbourne, Australia, from June-September 2020, during an epidemic of COVID-19. METHODS:All HCW close contacts were quarantined for 14 days, and tested around day 11, if not already diagnosed with COVID-19. We examined the prevalence and timing of symptoms in cases detected during quarantine, described this group as proportions of all close contacts and of all cases, and used logistic regression to assess factors associated with infection. RESULTS:COVID-19 was diagnosed during quarantine in 52 furloughed HCWs, from 483 quarantine episodes (11%), accounting for 19% (52/270) of total HCW cases. In 361 exposures to a clear index case, odds of infection were higher after contact with an infectious patient compared to an infectious HCW (aOR: 4.69, 95% CI: 1.98-12.14). Contact with cases outside the workplace increased odds of infection compared to workplace contact only (aOR: 7.70, 95% CI: 2.63-23.05). We estimated 30%, 78% and 95% of symptomatic cases would develop symptoms by days 3, 7, and 11 of quarantine, respectively. CONCLUSION:In our setting, hospital-based contact tracing detected and contained a significant proportion of HCW cases, without excessive quarantine of uninfected staff. Effectiveness of contact tracing is determined by a range of dynamic factors, so system performance should be monitored in real-time.

Introduction: Hand hygiene compliance (HHC) in the Emergency Department (ED) was significantly lower than the rest of Austin Health at 58.9% (95%CI 54.0-63.7%) compared to 79.3% (95%CI 78.1-80.5%). Reasons were unknown, but potentially related to workflow and limited alcohol-based handrub (ABHR) access. There was a lack of engagement from ED staff who suggested the 5 moments didn’t apply to them and were also ‘too difficult’.

Introduction: The National Hand Hygiene Initiative (NHHI) program is well embedded in acute wards. Implementation of this methodology is challenging in the operating room (OR) environment. Difficulty defining the patient zone, large number of moments performed by Anaesthetists and workflow bring challenges not considered in the current program.

Background: In acute healthcare facilities, auditing of hand hygiene (HH) compliance informs quality improvement programs and is a requirement for accreditation standards. However, there is currently no program tailored for use in Australian residential aged care facilities (RACFs). The objective of this study was to review existing methods for assessing HH compliance within RACFs. Methods: Recommendations for monitoring HH in RACFs from World Health Organisation (WHO), the Centers for Disease Control and Prevention (CDC), National Health and Medical Research Council (NHMRC) and Hand Hygiene Australia (HHA) were reviewed. Results: The WHO recommends modification of the ‘5 moments for hand hygiene’ in outpatient settings, with omission of moment 5 in RACFs for auditing of HH in RACFs. CDC recommend process indicators for monitoring compliance in RACFs: auditing one moment, ‘after contact with a resident or the objects/surfaces in the immediate vicinity of the resident’, without differentiating between staff types. NHMRC recommends use of the WHO 5 moments within RACFs without recommendations on assessing compliance. HHA does not currently recommend auditing in facilities with low staff/patient activity, and suggests alternative measures of assessing compliance such as staff knowledge surveys, HH technique audits and product placement/availability audits. Conclusions: Recommendations and models for assessing HH compliance within RACFs are not uniform. Observational auditing in these settings may be unjustified given the opportunity cost of resourcing. Although CDC process monitoring may be less resource-intensive, limited data are provided for quality improvement. Looking ahead, a range of methods should be piloted for acceptability/sustainability within Australian RACFs.