Environmental contamination and hospital-acquired infection: factors that are easily overlooked

There is an ongoing debate about the reasons for and factors contributing to healthcare-associated infection (HAI). Different solutions have been proposed over time to control the spread of HAI, with more focus on hand hygiene than on other aspects such as preventing the aerial dissemination of bacteria. Yet, it emerges that there is a need for a more pluralistic approach to infection control; one that reflects the complexity of the systems associated with HAI and involves multidisciplinary teams including hospital doctors, infection control nurses, microbiologists, architects, and engineers with expertise in building design and facilities management. This study reviews the knowledge base on the role that environmental contamination plays in the transmission of HAI, with the aim of raising awareness regarding infection control issues that are frequently overlooked. From the discussion presented in the study, it is clear that many unknowns persist regarding aerial dissemination of bacteria, and its control via cleaning and disinfection of the clinical environment. There is a paucity of good-quality epidemiological data, making it difficult for healthcare authorities to develop evidence-based policies. Consequently, there is a strong need for carefully designed studies to determine the impact of environmental contamination on the spread of HAI.

Effective emergency messaging during natural disasters: An application of message compliance theories

Study/Objective This research examines the types of emergency messages used in Australia during the response and early recovery phases of a natural disaster. The aim of the research is to develop theory-driven emergency messages that increase individual behavioural compliance during a disaster. Background There is growing evidence of non-compliant behaviour in Australia, such as refusing to evacuate and travelling through hazardous areas. This can result in personal injury, loss of life, and damage to (or loss of) property. Moreover, non-compliance can place emergency services personnel in life-threatening situations when trying to save non-compliant individuals. Drawing on message compliance research in psychology and sociology, a taxonomy of message types was developed to ascertain how emergency messaging can be improved to produce compliant behaviour. Method A review of message compliance literature was conducted to develop the taxonomy of message types previously found to achieve compliance. Seven categories were identified: direct-rational, manipulation, negative phrasing, positive phrasing, exchange appeals, normative appeals, and appeals to self. A content analysis was then conducted to assess the emergency messages evident in the Australian emergency management context. The existing messages were aligned with the literature to identify opportunities to improve emergency messaging. Results & Conclusion The results suggest there is an opportunity to improve the effectiveness of emergency messaging to increase compliance during the response and early recovery phases of a natural disaster. While some message types cannot legally or ethically be used in emergency communication (e.g. manipulative messaging), there is an opportunity to create more persuasive messages (e.g. appeals to self) that personalise the individual’s perception of risk, triggering them to comply with the message.

Hospital infection control units: Staffing, costs, and priorities

Background: This article describes infection prevention and control professionals’ (ICPs’) staffing levels, patient outcomes, and costs associated with the provision of infection prevention and control services in Australian hospitals. A secondary objective was to determine the priorities for infection control units. Methods: A cross-sectional study design was used. Infection control units in Australian public and private hospitals completed a Web-based anonymous survey. Data collected included details about the respondent; hospital demographics; details and services of the infection control unit; and a description of infection prevention and control-related outputs, patient outcomes, and infection control priorities. Results: Forty-nine surveys were undertaken, accounting for 152 Australian hospitals. The mean number of ICPs was 0.66 per 100 overnight beds (95% confidence interval, 0.55-0.77). Privately funded hospitals have significantly fewer ICPs per 100 overnight beds compared with publicly funded hospitals (P < .01). Staffing costs for nursing staff in infection control units in this study totaled $16,364,392 (mean, $380,566). Infection control units managing smaller hospitals (<270 beds) identified the need for increased access to infectious diseases or microbiology support. Conclusion: This study provides valuable information to support future decisions by funders, hospital administrators, and ICPs on service delivery models for infection prevention and control. Further, it is the first to provide estimates of the resourcing and cost of staffing infection control in hospitals at a national level. Copyright

Public and private mitigation for natural disasters in Japan

An increasing number of studies analyze the relationship between natural disaster damage and income levels, but they do not consider the distinction between public and private disaster mitigation. This paper empirically distinguishes these two types of mitigation using Japanese prefectural panel data from 1975 to 2007. Our results show that public mitigation rather than private mitigation has contributed to mitigating the total damage resulting from natural disasters. Our estimation of cost-benefit ratios for each prefecture confirms that the mitigation efforts of urban prefectures are less effective than those of rural prefectures in focusing on both large and frequent/small disasters. Hence, urban prefectures need to reassess their public mitigation measures. Furthermore, to lessen the damage resulting from extreme catastrophes, policy makers are required to invest in improved mitigation infrastructures when faced with a high probability of disasters.

Not learning from the past: Adaptive governance challenges for Australian natural resource management

Australia’s governance arrangements for NRM have evolved considerably over the last thirty years. The impact of changes in governance on NRM planning and delivery requires assessment. We undertake a multi-method program evaluation using adaptive governance principles as an analytical frame and apply this to Queensland to assess the impacts of governance change on NRM planning and governance outcomes. Data to inform our analysis includes: 1) a systematic review of sixteen audits/evaluations of Australian NRM over a fifteen-year period; 2) a review of Queensland’s first generation NRM Plans; and 3) outputs from a Queensland workshop on NRM planning. NRM has progressed from a bottom-up grassroots movement into a collaborative regional NRM model that has been centralised by the Australian Government. We found that while some adaptive governance challenges have been addressed, others remained unresolved. Results show that collaboration and elements of multi-level governance under the regional model were positive moves, but also that NRM arrangements contained structural deficiencies across multiple governance levels in relation to public involvement in decision-making and knowledge production for problem responsiveness. These problems for adaptive governance have been exacerbated since 2008. We conclude that the adaptive governance framework for NRM needs urgent attention so that important environmental management problems can be addressed.

Prevalence of Chlamydia trachomatis infection in Samoan women aged 18 to 29 and assessment of possible risk factors: a community-based study

Background Knowledge about genital Chlamydia trachomatis (CT) infections in the Pacific is limited. In this study we investigated CT infection in Samoan women. Methods We recruited women having unprotected sex aged 18 to 29 years from 41 Samoan villages. They completed a questionnaire and provided a urine sample for CT testing by PCR. Associations between CT infection and possible risk factors were explored using logistic regression. Results Altogether, 239 women were recruited; 86 (36.0%; weighted estimate of prevalence: 41.9%; 95% CI: 33.4–50.5%) were positive for CT infection. A higher proportion of women aged 18 to 24 were positive (54/145; 37.2%) than those aged 25 to 29 (32/94; 34.0%; p=0.20). Being single (OR 1.92; 95% CI: 1.02–3.63) and having two or more lifetime sexual partners (OR 3.02; 95% CI: 1.19–7.67) were associated with CT infection; 27.6% of those with one lifetime partner were positive. Participants who had a previous pregnancy were less likely to be positive (OR 0.49; 95% CI: 0.27–0.87). Primiparous and multiparous women were less likely to be positive than nulliparous women (OR 0.54; 95% CI: 0.30–0.99 and OR 0.46; 95% CI: 0.24–0.89, respectively). Conclusions The prevalence of CT infection in these Samoan women is very high. Further studies, including investigating the prevalence of CT infection in men, and strategies for sustainable control are needed.

Preoperative bathing or showering with skin antiseptics to prevent surgical site infection

Background Surgical site infections (SSIs) are wound infections that occur after invasive (surgical) procedures. Preoperative bathing or showering with an antiseptic skin wash product is a well-accepted procedure for reducing skin bacteria (microflora). It is less clear whether reducing skin microflora leads to a lower incidence of surgical site infection. Objectives To review the evidence for preoperative bathing or showering with antiseptics for preventing hospital-acquired (nosocomial) surgical site infections. Search methods For this fifth update we searched the Cochrane Wounds Group Specialised Register (searched 18 December 2014); the Cochrane Central Register of Controlled Trials (The Cochrane Library 2014 Issue 11); Ovid MEDLINE (2012 to December Week 4 2014), Ovid MEDLINE (In-Process & Other Non-Indexed Citations December 18, 2014); Ovid EMBASE (2012 to 2014 Week 51), EBSCO CINAHL (2012 to December 18 2014) and reference lists of articles. Selection criteria Randomised controlled trials comparing any antiseptic preparation used for preoperative full-body bathing or showering with non-antiseptic preparations in people undergoing surgery. Data collection and analysis Two review authors independently assessed studies for selection, risk of bias and extracted data. Study authors were contacted for additional information. Main results We did not identify any new trials for inclusion in this fifth update. Seven trials involving a total of 10,157 participants were included. Four of the included trials had three comparison groups. The antiseptic used in all trials was 4% chlorhexidine gluconate (Hibiscrub/Riohex). Three trials involving 7791 participants compared chlorhexidine with a placebo. Bathing with chlorhexidine compared with placebo did not result in a statistically significant reduction in SSIs; the relative risk of SSI (RR) was 0.91 (95% confidence interval (CI) 0.80 to 1.04). When only trials of high quality were included in this comparison, the RR of SSI was 0.95 (95%CI 0.82 to 1.10). Three trials of 1443 participants compared bar soap with chlorhexidine; when combined there was no difference in the risk of SSIs (RR 1.02, 95% CI 0.57 to 1.84). Three trials of 1192 patients compared bathing with chlorhexidine with no washing, one large study found a statistically significant difference in favour of bathing with chlorhexidine (RR 0.36, 95%CI 0.17 to 0.79). The smaller studies found no difference between patients who washed with chlorhexidine and those who did not wash preoperatively. Authors' conclusions This review provides no clear evidence of benefit for preoperative showering or bathing with chlorhexidine over other wash products, to reduce surgical site infection. Efforts to reduce the incidence of nosocomial surgical site infection should focus on interventions where effect has been demonstrated.

Near infrared spectroscopy of marble from Chillagoe, Australia and in comparison with other selected natural carbonates

Marble from the Chillagoe deposits was extensively used in the construction of Australia’s parliament house. Near infrared (NIR) spectroscopy has been applied to study the quality of marble from the Chillagoe marble deposits and to distinguish between different types of marble in the Chillagoe deposits. A comparison of the NIR spectra of marble with dolomite and monohydrocalcite is made. The spectrum of the marble closely resembles that of monohydrocalcite and is different from that of dolomite. The infrared spectra of the minerals are characterised by OH and water stretching vibrations. Both the first and second fundamental overtones of these bands are observed in the NIR spectra. Marble is characterised by NIR bands at 4005, 4268 and 4340 cm–1, attributed to carbonate combination bands and overtones. Marble also shows NIR bands at 5005, 5106, 5234 and 5334 cm–1 assigned to water combination bands. Finally the NIR spectrum of the marble displays broad low-intensity features centred upon 6905 cm–1 attributed to the water first overtones. It appears feasible to identify marble through the use of NIR spectroscopy.

Near infrared spectroscopy of selected natural magnesium carbonates: implications for geosequestration

The approach to remove greenhouse gases by pumping liquid CO2 several kilometres below the ground implies that many carbonate containing minerals will be formed. Among these minerals, the formation of hydromagnesite, dypingite and nesquehonite are possible, thus necessitating a study of such minerals. These minerals with a hydrotalcite-related formulae have been characterised by a combination of infrared and near infrared spectroscopy. Layered double hydroxides (also known as anionic clays or hydrotalcites) are a group of layered clay minerals described by the general formula: [M1–x2+Mx3+(OH)2]x+[An–]x/n∙mH2O. The infrared spectra of the minerals are characterised by OH and water stretching vibrations. Both the first and second fundamental overtones of these bands are observed in the NIR spectra in the 7030–7235 cm–1 and 10,490–10,570 cm–1 spectral ranges. Intense (CO3)2– symmetrical and anti-symmetrical stretching vibrations confirm the distortion of the carbonate anion. The position of the water bending vibration indicates water is strongly hydrogen-bonded to the carbonate anion in the mineral structure. NIR spectroscopy offers a method for quickly analysing such materials.

Broadening the perspective on the airborne transmission of respiratory infection

Airborne bioaerosols are becoming increasingly recognized as a potential route of transmission for the spread of bacterial and viral respiratory tract infections.

Phenomenology and Extreme Sports in Natural Landscapes

Husserl reminded us of the imperative to return to the Lebensweldt, or life-world. He was preoccupied with the crisis of Western science which alienated the experiencing self from the world of immediate experience. Immediate experience provides a foundation for what it means to be human. Heidegger, building upon these ideas, foresaw a threat to human nature in the face of ‘technicity’. He argued for a return to a relationship between ‘authentic self’ and nature predicated upon the notion of ‘letting be’ in which humans are open to the mystery of being. Self and nature are not conceived as alienated entities but as aspects of a single entity. In modern times, separation between self and the world is further evidenced by scientific rational modes of being exemplified through consumerism and the incessant use of screen-based technology which dominate human experience. In contrast, extreme sports provide an opportunity for people to return to the life-world by living in relation to the natural world. Engagement in extreme sports enables a return to authenticity as we rediscover self as part of nature.

Natural hazards and land use planning: How resilient must a landowner be?

The past decade has seen an increase in the occurrence of natural hazards and the experience in Australia has led to a reconsideration of the planning for natural hazards by government and to the adoption of a whole-of-nation resilience-based approach to disaster management. A key component of creating community resilience is the integration of disaster management with government and community strategic planning in relation to the social, built, economic and natural environments. Joint responsibility of government and the community for ‘land use planning systems and building control arrangements [which] reduce, as far as is practicable, community exposure to unreasonable risks from known hazards’, is a critical element of a resilient community. As the responsibility for the implementation of land use planning policies in Australia is generally with local governments, this paper will examine whether, in light of improved predictive technology, the failure of a local government to adequately foresee and make provision for a known hazard will give rise to liability for damage or loss of property caused by that hazard.

Can biophilic urbanism deliver strong economic and social benefits in cities? An economic and policy invetigations into the increased use of natural elements in urban design

Biophilic urbanism, or urban design that reflects humanity’s innate need for nature, stands to make significant contributions to a range of national, state and local government policies related to climate change mitigation and adaptation, by investigating ways in which nature can be integrated into, around and on top of buildings. Potential benefits of such design include reducing the heat island effect, reducing energy consumption for thermal control, enhancing urban biodiversity, improving well being and productivity, improving water cycle management, and assisting in the response to growing needs for densification and revitalisation of cities. This report will give an overview of the concept of biophilia and consider enablers and disablers to its application to urban planning and design. The paper will present findings from stakeholder engagement and a series of detailed case studies, related to a consideration of the economics of the use of biophilic elements (direct and indirect).

Cost-effectiveness of hospital infection control interventions in resource-limited settings

The aim of this project was to evaluate the cost-effectiveness of hand hygiene interventions in resource-limited hospital settings. Using data from north-east Thailand, the research found that such interventions are likely to be very cost-effective in intensive care unit settings as a result of reduced incidence of methicillin-resistant Staphylococcus aureus bloodstream infection alone. This study also found evidence showing that the World Health Organization's (WHO) multimodal intervention is effective and when adding either goal-setting, reward incentives, or accountability strategies to the WHO intervention, compliance could be further improved.