Survey of infection control and antimicrobial stewardship practices in Australian residential aged-care facilities

This study assessed infection prevention and antimicrobial stewardship (AMS) practices in Australian residential aged-care facilities (RACF). Two hundred and sixty-five surveys (15.6%) were completed with all states represented and the majority (177 (67.3%)) privately run. Only 30.6% RACF had infection control trained staff on site. Few facilities had AMS policies, only 14% had antimicrobial prescribing restrictions. Most facilities offered vaccination to residents (influenza vaccination rates >75% in 73% of facilities), but pneumococcal vaccination was poor.

Consensus guidelines for implementation of quality processes to prevent invasive fungal disease and enhanced surveillance measures during hospital building works, 2014

Healthcare-associated fungal outbreaks impose a substantial economic burden on the health system and typically result in high patient morbidity and mortality, particularly in the immunocompromised host. As the population at risk of invasive fungal infection continues to grow due to the increased burden of cancer and related factors, the need for hospitals to employ preventative measures has become increasingly important. These guidelines outline the standard quality processes hospitals need to accommodate into everyday practice and at times of healthcare-associated outbreak, including the role of antifungal stewardship programmes and best practice environmental sampling. Specific recommendations are also provided to help guide the planning and implementation of quality processes and enhanced surveillance before, during and after high-risk activities, such as hospital building works. Areas in which information is still lacking and further research is required are also highlighted.

Visualization of HIV-1 interactions with penile and foreskin epithelia: clues for female-to-male HIV transmission

To gain insight into female-to-male HIV sexual transmission and how male circumcision protects against this mode of transmission, we visualized HIV-1 interactions with foreskin and penile tissues in ex vivo tissue culture and in vivo rhesus macaque models utilizing epifluorescent microscopy. 12 foreskin and 14 cadaveric penile specimens were cultured with R5-tropic photoactivatable (PA)-GFP HIV-1 for 4 or 24 hours. Tissue cryosections were immunofluorescently imaged for epithelial and immune cell markers. Images were analyzed for total virions, proportion of penetrators, depth of virion penetration, as well as immune cell counts and depths in the tissue. We visualized individual PA virions breaching penile epithelial surfaces in the explant and macaque model. Using kernel density estimated probabilities of localizing a virion or immune cell at certain tissue depths revealed that interactions between virions and cells were more likely to occur in the inner foreskin or glans penis (from local or cadaveric donors, respectively). Using statistical models to account for repeated measures and zero-inflated datasets, we found no difference in total virions visualized at 4 hours between inner and outer foreskins from local donors. At 24 hours, there were more virions in inner as compared to outer foreskin (0.0495 +/- 0.0154 and 0.0171 +/- 0.0038 virions/image, p = 0.001). In the cadaveric specimens, we observed more virions in inner foreskin (0.0507 +/- 0.0079 virions/image) than glans tissue (0.0167 +/- 0.0033 virions/image, p<0.001), but a greater proportion was seen penetrating uncircumcised glans tissue (0.0458 +/- 0.0188 vs. 0.0151 +/- 0.0100 virions/image, p = 0.099) and to significantly greater mean depths (29.162 +/- 3.908 vs. 12.466 +/- 2.985 μm). Our in vivo macaque model confirmed that virions can breach penile squamous epithelia in a living model. In summary, these results suggest that the inner foreskin and glans epithelia may be important sites for HIV transmission in uncircumcised men.

Barrier textiles for protection against microbes

The presence or growth of microbes on textiles may result in a series of problems such as unpleasant odors, cross infection, disease transmission, or discoloration and deterioration of textiles. Imparting textiles with antimicrobial property can effectively eliminate these adversities and thus has been attracting great attention. This chapter summarizes the commonly used antimicrobial agents such as silver, metal oxides, photoactive dyes, quaternary ammonium compounds, N-halamines, triclosan, polybiguanides, chitosan, and plant-derived bioactive agents, their characteristics, toxicity, antimicrobial ability, ecological acceptability, and related textile finishing techniques and evaluation methods. Since durability to repeated washing is the major challenge for the practical use of antimicrobial textiles, the chapter provides details on the technique to immobilize antimicrobial agents onto fibers. In addition, impacts of using antimicrobial textiles on the environment and health are discussed in the last section.

Identifying and integrating patient and caregiver perspectives for clinical practice guidelines on the screening and management of infectious microorganisms in hemodialysis units

<b>Introduction</b>: The integration of patient and caregiver input into guideline development can help to ensure that clinical care addresses patient expectations, priorities, and needs. We aimed to identify topics and outcomes salient to patients and caregivers for inclusion in the Kidney Health Australia Caring for Australasians with Renal Impairment (KHA-CARI) clinical practice guideline on the screening and management of infectious microorganisms in hemodialysis units. <br /><br /><b>Methods</b>: A facilitated workshop was conducted with 11 participants (patients [n&thinsp;=&thinsp;8], caregivers [n&thinsp;=&thinsp;3]). Participants identified and discussed potential topics for inclusion in the guidelines, which were compared to those developed by the guideline working group. The workshop transcript was thematically analyzed to identify and describe the reasons underpinning their priorities. <br /><b><br />Findings</b>: Patients and caregivers identified a range of topics already covered by the scope of the proposed guidelines and also suggested additional topics: privacy and confidentiality, psychosocial care during/after disease notification, quality of transportation, psychosocial treatment of patients in isolation, patient/caregiver education and engagement, and patient advocacy. Five themes characterized discussion and underpinned their choices: shock and vulnerability, burden of isolation, fear of infection, respect for privacy and confidentiality, and confusion over procedural inconsistencies. <br /><br /><b>Discussion</b>: Patients and caregivers emphasized the need for guidelines to address patient education and engagement, and the psychosocial implications of communication and provision of care in the context of infectious microorganisms in hemodialysis units. Integrating patient and caregiver perspectives can help to improve the relevance of guidelines to enhance quality of care, patient experiences, and health and psychosocial outcomes.

Systemic activation of dendritic cells by toll-like receptor ligands or malaria infection impairs cross-presentation and antiviral immunity

The mechanisms responsible for the immunosuppression associated with sepsis or some chronic blood infections remain poorly understood. Here we show that infection with a malaria parasite (Plasmodium berghei) or simple systemic exposure to bacterial or viral Toll-like receptor ligands inhibited cross-priming. Reduced cross-priming was a consequence of downregulation of cross-presentation by activated dendritic cells due to systemic activation that did not otherwise globally inhibit T cell proliferation. Although activated dendritic cells retained their capacity to present viral antigens via the endogenous major histocompatibility complex class I processing pathway, antiviral responses were greatly impaired in mice exposed to Toll-like receptor ligands. This is consistent with a key function for cross-presentation in antiviral immunity and helps explain the immunosuppressive effects of systemic infection. Moreover, inhibition of cross-presentation was overcome by injection of dendritic cells bearing antigen, which provides a new strategy for generating immunity during immunosuppressive blood infections.<br />

Treatment and prevention of Mycobacterium ulcerans infection (Buruli ulcer) in Australia: guideline update

&bull; Guidelines reflecting contemporary clinical practice in the management of Buruli ulcer (<i>Mycobacterium ulceran</i>s infection) in Australia were published in 2007. <br /><br />&bull; Management has continued to evolve, as new evidence has become available from randomised trials, case series and increasing clinical experience with oral antibiotic therapy. <br /><br />&bull; Therefore, guidelines on the diagnosis, treatment and prevention of Buruli ulcer in Australia have been updated. They include guidance on the new role of antibiotics as first-line therapy; the shortened duration of antibiotic treatment and the use of all-oral antibiotic regimens; the continued importance, timing and role of surgery; the recognition and management of paradoxical reactions during antibiotic treatment; and updates on the prevention of disease.

Public perceptions of the causes and prevention of obesity among primary school children

<b>OBJECTIVE: </b>To investigate lay perceptions of the causes and prevention of obesity among primary school children. <br /><br /><b>DESIGN:</b> A cross-sectional survey of randomly selected sample of adults in a shopping centre. <br /><br /><b>SUBJECTS:</b> 315 adults in Melbourne, Australia. <br /><br /><b>MEASUREMENTS:</b> Subjects completed a self-completion questionnaire, in which they rated the importance of 25 possible causes of obesity and the importance of 13 preventive measures on four-point scales: not important; quite important; very important; extremely important. Demographic information about the respondents' age, sex, marital status, education level and parental status was also collected. <br /><br /><b>RESULTS:</b> The most important reported causes of childhood obesity were related to overconsumption of unhealthy food, parental responsibility, modern technology and the mass media. The most popular prevention activities were associated with specific actions aimed at children. Principal components analysis of the causes data revealed eight factors, provisionally named: parental responsibility, modern technology and media, overconsumption of unhealthy food, children's lack of knowledge and motivation, physical activity environment, lack of healthy food, lack of physical activity and genes. Two prevention factors were also derived, named government action and children's health promotion. Parents saw modern technology and media, and government activities as more important causes, and government policy as a more important means of prevention than nonparents and men. Women's responses tended to be similar to those of parents. There were few educational differences, although nontertiary educated respondents reported that modern technology and media were more important causes of obesity than did the tertiary educated.<br /><br /> <b>CONCLUSION:</b> The findings suggest that the public appears to hold quite sophisticated views of the causes and prevention of children's obesity. They suggest that a number of prevention strategies would be widely supported by the public, especially by parents.<br /><br />

Australian women`s experiences of living with hepatitis C virus: results from a cross-sectional survey

Background: Of the estimated 160 000 Australians currently infected with the hepatitis C virus (HCV), over one-third are women and very few have received clinical treatment, with most managing their illness in non-specialist settings. Little is known about the experiences of women living with HCV in the general community. The present study provides the results from the first comprehensive social survey of Australian women's experiences of living with HCV.<br /><br />Methods: In 2000, a questionnaire was administered to a largely non-clinical sample of women with HCV (<i>n </i>= 462) living in the state of Victoria and the Australian Capital Territory, Australia. The questionnaire was self-administered with a return rate of 75%. The mean age was 35 years and 83% were 'current' or 'past' injecting drug users. The mean time since diagnosis was 4.6 years (SD = 4.0) and the mean time since infection was 10.5 years (SD = 8.2).<br /><br />Results: Fifty-eight percent of women reported experiencing symptoms related to their HCV, the most common being tiredness (78%) and nausea (44%). Of the sample, 56% currently saw a doctor for their HCV, and while 52% had ever been referred to a specialist, only 17% of the total sample had ever begun interferon-based combination or monotherapy. Forty-eight percent of women reported experiencing less favorable treatment by a health professional because of their HCV. Age-related self-assessed health status was significantly lower than Australian norms, as were SF-12 physical and mental health scores. The SF-12 physical and mental health scores were highly correlated, indicating a significant physical and mental health burden associated with HCV.<br /><br />Conclusion: The social, physical and mental health needs of women living with HCV are considerable. Most women had not accessed specialist treatment and the response of the primary health care system to HCV-related women's health issues requires improvement.<br />

Effect of three wound dressings on infection, healing comfort, and cost in patients with sternotomy wounds - a randomized trial

<b>Study objective: </b>To compare three dressing types in terms of their ability to protect against infection and promote healing, patient comfort, and cost-effectiveness.<br /><br /><b>Design: </b>Prospective, randomized controlled trial.<br /><br /><b>Setting: </b>Major metropolitan, academically affiliated, tertiary referral center.<br /><br /><b>Patients: </b>Seven hundred thirty-seven patients were randomized to receive a dry absorbent dressing (n = 243) [Primapore; Smith &amp; Nephew; Sydney, NSW, Australia], a hydrocolloid dressing (n = 267) [Duoderm Thin ConvaTec; Mulgrave, VIC, Australia], or a hydroactive dressing (n = 227) [Opsite; Smith &amp; Nephew] in the operating theater on skin closure.<br /><br /><b>Results: </b>There was no difference in the rate of wound infection or wound healing between treatment groups. The Primapore dressing was the most comfortable and cost-effective dressing option for the sternotomy wound. Duoderm Thin dressings were associated with increased wound exudate (p &lt; 0.001), poor dressing integrity (p &lt; 0.001), more frequent dressing changes (p &lt; 0.001), more discomfort with removal (p &lt; 0.05), and increased cost (p &lt; 0.001).<br /><br /><b>Conclusions:</b> In the context of no additional benefit for the prevention of wound infection or the rate of wound healing for any of the three dressing products examined, dry absorbent dressings are the most comfortable and cost-effective products for sternotomy wounds following cardiac surgery.<br />

Early childhood caries: current evidence for aetiology and prevention

<b>Background</b>: Despite the fact that it is largely preventable, dental caries (decay) remains one of the most common chronic diseases of early childhood. Dental decay in young children frequently leads to pain and infection necessitating hospitalization for dental extractions under general anaesthesia. Dental problems in early childhood have been shown to be predictive of not only future dental problems but also on growth and cognitive development by interfering with comfort nutrition, concentration and school participation. <b>Objective</b>: To review the current evidence base in relation to the aetiology and prevention of dental caries in preschool-aged children. <b>Methods</b>: A search of MEDLINE, CINALH and Cochrane electronic databases was conducted using a search strategy which restricted the search to randomized controlled trials, meta-analyses, clinical trials, systematic reviews and other quasi-experimental designs. The retrieved studies were then limited to articles including children aged 5 years and under and published in English. The evidence of effectiveness was then summarized by the authors. <b>Conclusions</b>: The review highlighted the complex aetiology of early childhood caries (ECC). Contemporary evidence suggests that potentially effective interventions should occur in the first 2 years of a child's life. Dental attendance before the age of 2 years is uncommon; however, contact with other health professionals is high. Primary care providers who have contact with children well before the age of the first dental visit may be well placed to offer anticipatory advice to reduce the incidence of ECC.<br />