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.

Sustained low-efficiency dialysis with filtration (SLEDD-f) in the management of acute sodium valproate intoxication

Hemodialysis is only infrequently used in drug overdosage situations. The efficacy of hemodialysis to remove the drug depends upon the pharmacokinetics and pharmacodynamics of the drug. At normal therapeutic concentrations, valproic acid is predominantly protein bound and therefore removal by hemodialysis is limited. In an overdose situation, protein binding is rapidly saturated and therefore the substantially larger quantities of the free drug can rapidly cause toxicity. Slow low-efficient daily diafiltration (SLEDD) has not previously been utilized in a drug overdose situation. We report the effective use of SLEDD to remove high toxic concentrations of valproic acid in an overdose situation. Slow low-efficient daily diafiltration also prevented the rebound phenomenon that can occur as the excess drug is released from its protein-bound stores. Hybrid dialysis therapies deserve further evaluation in the management of other poisonings where extra-corporeal therapy is indicated.

Reductions in nutrient discharge from aquaculture through recycling of water utilising floating media and activated carbon filtration

Nutrient discharge into coastal areas, such as the Great Barrier Reef can result in the degradation of coastal ecosystems. For example, excess nitrogen and phosphorus can damage corals through inducing algal bloom and subsequent shading. Excessive phosphorus can further weaken coral skeletons making them susceptible to damage. Land based industries such as aquaculture can contribute to such problems. This study set out to develop a system whereby water from aquaculture can be constantly reused resulting in minimized waste discharge. A three-stage filtration system utilizing floating media and activated carbon was designed to harness bacterial processes that could reduce both particulate and dissolved compounds to the extent whereby approximately 100% reuse of the wastewater became possible. This involved efficient and effective particulate and biological removal mechanisms in both aerobic and anaerobic zones of the filtration system. This design reduced dissolved nitrogen levels by up to 70% and maintained low phosphorus levels, which allowed the reuse of water for the successful culture of barramundi with a survival rate of 97% over 25 days. This pilot scale study demonstrated the potential of reusing aquaculture wastewater from the viewpoint of reducing nutrient input into coastal environments. Future research will refine these processes and assess the performance of the system at several commercial scale applications.

Mathematical modelling of deep bed filtration

Numerous mathematical models have been developed to evaluate both initial and transient stage removal efficiency of deep bed filters. Microscopic models either using trajectory analysis or convective-diffusion equations were used to compute the initial removal efficiency. These models predicted the removal efficiency under favorable filtration conditions quantitatively, but failed to predict the removal efficiency under unfavorable conditions. They underestimated the removal efficiency under unfavorable conditions. Thus, semi-empirical formulations were developed to compute initial removal efficiencies under unfavorable conditions. Also, correction for the adhesion of particles onto filter grains improved the results obtained for removal efficiency from the trajectory analysis. Macroscopic models were used to predict the transient stage removal efficiency of deep bed filters. O’Melia and Ali’s model assumed that the particle removal is due to filter grains as well as the particles that are already deposited onto the filter grain. Thus, semi-empirical models were used to predict the ripening of filtration. Several modifications were made to the model developed by O’Melia and Ali to predict the deterioration of particle removal during the transient stages of filtration. Models considering the removal of particles under favorable conditions and the accumulation of charges on the filter grains during the transient stages were also developed. This paper evaluates those models and their applicability under different operating conditions of filtration.