Academic literature on the topic 'Nosocomial infections – Western Australia – Prevention'

SummaryThrombosis is a common pathology underlying ischaemic heart disease, ischaemic stroke, and venous thromboembolism (VTE). The Global Burden of Disease Study 2010 (GBD 2010) documented that ischaemic heart disease and stroke collectively caused one in four deaths worldwide. GBD 2010 did not report data for VTE as a cause of death and disability. We performed a systematic review of the literature on the global disease burden due to VTE in low, middle and high income countries. Studies from Western Europe, North America, Australia, and Southern Latin America (Argentina) yielded consistent results with annual incidences ranging from 0.75 to 2.69 per 1,000 individuals in the population. The incidence increased to between 2 and 7 per 1,000 among those 70 years of age or more. Although the incidence is lower in individuals of Chinese and Korean ethnicity, their disease burden is not low because of population aging. VTE associated with hospitalisation was the leading cause of disability-adjusted-lifeyears (DALYs) lost in low and middle income countries, and second in high income countries, responsible for more DALYs lost than nosocomial pneumonia, catheter-related blood stream infections, and adverse drug events. VTE causes a major burden of disease across low, middle, and high income countries. More detailed data on the global burden of VTE should be obtained to inform policy and resource allocation in health systems, and to evaluate if improved utilisation of preventive measures will reduce the burden.Note: The copyright for the article is being held by the International Society on Thrombosis and Haemostasis under a CC-BY-NC-ND license.

In 1972 the Council of Europe, in which most of the Western European countries are represented, adopted a resolution aimed at the improvement of hospital hygiene and the promotion of the prevention of nosocomial infections. The member states were invited to take the required measures, but each country was free to implement the resolution according to its own needs and particularities. In Belgium, the first legal regulations were issued in 1974—every hospital was obliged to set up a committee for hospital hygiene.Although similar regulations were issued in most other member states. the actual infection control policies adopted can vary. This article highlights some of the particularities for Belgium.

ObjectivesAcute respiratory infections (ARIs) are a global cause of childhood morbidity. We compared temporal trends and socioeconomic disparities for ARI hospitalisations in young children across Western Australia, England and Scotland.DesignRetrospective population-based cohort studies using linked birth, death and hospitalisation data.Setting and participantsPopulation birth cohorts spanning 2000–2012 (Western Australia and Scotland) and 2003–2012 (England).Outcome measuresARI hospitalisations in infants (<12 months) and children (1–4 years) were identified through International Classification of Diseases, 10th edition diagnosis codes. We calculated admission rates per 1000 child-years by diagnosis and jurisdiction-specific socioeconomic deprivation and used negative binomial regression to assess temporal trends.ResultsThe overall infant ARI admission rate was 44.3/1000 child-years in Western Australia, 40.7/1000 in Scotland and 40.1/1000 in England. Equivalent rates in children aged 1–4 years were 9.0, 7.6 and 7.6. Bronchiolitis was the most common diagnosis. Compared with the least socioeconomically deprived, those most deprived had higher ARI hospitalisation risk (incidence rate ratio 3.9 (95% CI 3.5 to 4.2) for Western Australia; 1.9 (1.7 to 2.1) for England; 1.3 (1.1 to 1.4) for Scotland. ARI admissions in infants were stable in Western Australia but increased annually in England (5%) and Scotland (3%) after adjusting for non-ARI admissions, sex and deprivation.ConclusionsAdmissions for ARI were higher in Western Australia and displayed greater socioeconomic disparities than England and Scotland, where ARI rates are increasing. Prevention programmes focusing on disadvantaged populations in all three countries are likely to translate into real improvements in the burden of ARI in children.

HIV (Human Immunodeficiency Virus) and other sexually transmitted infections (STIs) in Western Australia are at their highest in 20 years. In response to this worrying escalation and the public need for accurate and balanced information about these diseases, the journalism department at Edith Cowan University, in partnership with the WA AIDS Council (WAAC), developed a pilot project that consisted of a series of media training and education programmes to enable WAAC staff to share information and stories with the media on HIV and STIs in a more confident and proactive way. The project offers a model framework for media and community engagement that can be applied to a broader range of health promotion and disease prevention issues.

The incidence of methicillin-resistantStaphylococcus aureus(MRSA) and vancomycin-resistantEnterococcus(VRE) infections continues to rise in National Nosocomial Infections Surveillance system hospitals, and these pathogens are reportedly causing more than 100,000 infections and many deaths each year in US healthcare facilities. This has led some to insist that control measures are now urgently needed, but several recent articles have suggested that isolation of patients does not work, is not needed, or is unsafe, or that a single cluster-randomized trial could be used to decide such matters. At least 101 studies have reported controlling MRSA infection and 38 have reported controlling VRE infection by means of active detection by surveillance culture and use of isolation for all colonized patients in healthcare settings where the pathogens are epidemic or endemic, in academic and nonacademic hospitals, and in acute care, intensive care, and long-term care settings. MRSA colonization and infection have been controlled to exceedingly low levels in multiple nations and in the state of Western Australia for decades by use of active detection and isolation. Studies suggesting problems with using such data to control MRSA colonization and infection have their own problems, which are discussed. Randomized trials are epidemiologic tools that can sometimes provide erroneous results, and they have not been considered necessary for studying isolation before it is used to control other important infections, such as tuberculosis, smallpox, and severe acute respiratory syndrome. No single epidemiologic study should be considered definitive. One should always weigh all available evidence. Infection with antibiotic-resistant pathogens such as MRSA and VRE is controllable to a low level by active detection and isolation of colonized and infected patients. Effective measures should be used to minimize the morbidity and mortality attributable to these largely preventable infections.

Objective: To describe recent trends in the diagnosis of HIV infection in Australia. Methods: National HIV surveillance data from 1993 to 2006 were analysed with a focus on geographic differences by HIV exposure route and late presentation (HIV within 3 months of a first AIDS-defining illness or a CD4 count of less than 200 cells μL–1). Results: In 1993–99, the number of HIV diagnoses declined by 32%, and then increased by 39% from 1999 to 2006. From 2000 onwards, rates increased significantly in Victoria, Queensland, South Australia and Western Australia. The most frequently reported routes of HIV exposure were male to male sex (71%) and heterosexual contact (18%), and the population rate of diagnoses have increased in both categories. Among the cases reported as heterosexually acquired (n = 2199), 33% were in people born in a high-prevalence country and 19% in those with partners from a high-prevalence country. Late presentation was most frequent in heterosexually acquired infections in persons who had a partner from a high-prevalence country: 32% compared with 20% overall. Conclusions: Recent increases in annual numbers of HIV diagnoses in Australia underline the continuing need for HIV-prevention programs, particularly among men having male to male sex. Early diagnosis and access to care and treatment should also be emphasised, as a substantial proportion of people with HIV infection are unaware of their status until late in the course of disease.

Introduction. Among the most important causes of diarrhea in modern hospitals is Clostridium difficile (C. difficile). A wide spectrum of diseases caused by this bacterium is now known as C. difficile associated disease (CDAD). The development of CDAD is usually preceded by the administration of antimicrobial therapy and fecal-oral infections with C. difficile. Over the last years epidemiology of CDAD has significantly changed. Recently, a hypervirulent BI/NAP1/027 strain, the cause of severe epidemics in North America and Western Europe, has been identified. Objective. The aim of this study was to identify risk factors for CDAD in patients operated on at the Military Medical Academy (MMA). Methods. The study included all patients who underwent surgery at the MMA during 2010. Nested case-control study design was used. The subjects were divided into groups of operated patients with and without CDAD. The patients were under prospective follow-up, while their data were collected using a questionnaire during a routine epidemiological control. Results. During 2010 the incidence rate of CDAD was 3.3 per 10,000 hospital days. Univariate regression analysis showed that the length of administration of one or two antibiotics, as well as concurrent administration of two antibiotics, were far more frequently observed in the patients with than in the patients without CDAD. Independent risk factor for the development of CDAD was the length of the administration of one antibiotic. Conclusion Reduction in the incidence rate of CDAD can be achieved by using reliable measures of prevention and control; the rational use of antibiotics, early diagnosis and therapy of infected patients, contact isolation of infected persons, proper disinfection, and continued education of medical and non-medical personnel.

In this issue, Witte and colleagues report on the emergence, since 2002, of cases in Germany of infection with community-acquired methicillin-resistant Staphylococcus aureus (c-MRSA) producing the Panton-Valentine leukocidin. This report adds evidence to the rapid geographical dissemination of this emerging, hyper-virulent variant of an 'old pathogen' across Europe. First reported in the early 1990s among aboriginal populations in Western Australia, outbreaks of c-MRSA infections have more recently been described in population groups such as prison inmates, injecting drug users, sports teams and schoolchildren, in the United States and Europe. Current evidence from molecular studies points to the spread in each continent of a limited number of PVL-producing MRSA clones that are genetically distinct from epidemic nosocomial strains. This represents a public health threat, because these strains are associated with severe soft tissue and pulmonary infection and the outcome of MRSA infection is worse than with infection caused by beta-lactam susceptible S. aureus, especially if inappropriately treated with beta-lactams that are usually prescribed for these infections. We must, therefore, upgrade the diagnostic work-up for this kind of infection in the outpatient setting and adapt empirical therapy accordingly. Moreover, surveillance should be intensified to monitor the incidence of MRSA and detect and control outbreaks in the community. In this respect, the report by Witte et al underscores the important early warning role that reference laboratories can play by using high resolution molecular markers based on routine typing and susceptibility data.

Foodborne diseases (FBD) present high prevalence worldwide and more than 250 types have been reported. The main agents are Staphylococcus aureus, Escherichia coli, Salmonella and certain parasites. The habit of consuming foods sold in street markets in the city of São Paulo exposes consumers to the risk of acquiring FBD. 25 samples of vinaigrette salad were collected in the central, northern, southern, eastern and western regions of the city of São Paulo, Brazil. The samples were inoculated in selective, enriched culture media and biochemical analyses were performed. Bacterial and fungal growth occurred in all samples. The microorganisms detected were E. coli (64%), Enterobacter (60%), S. aureus (52%), Klebsiella (40%), Proteus sp. (32%), Shigella sp. (28%), Citrobacter sp. (16%), Edwardsiella sp. (12%), Alcaligenes sp. (8%), Serratia sp. (8%), Salmonella sp. (4%), Pseudomonas sp. (4%) and; 72% were positive for aflatoxins. Twelve species were identified, 50% of which can cause FBD. S. aureus and fecal coliforms can cause FBD, while Alcaligenes sp. can cause nosocomial infections and Edwardsiella sp. can cause hepatic abscess, meningitis and septicemia. Aflatoxins may cause mycotoxicoses and liver cancer. Therefore, inspections, and prevention and awareness measures should be reinforced to minimize the risks of contracting FBD from foods sold in street markets in the city of São Paulo.

AimTo characterise the epidemiology, clinical features and treatment of paediatric cellulitis.MethodsA retrospective study of children presenting to a paediatric tertiary hospital in Western Australia, Australia in 2018. All inpatient records from 1 January to 31 December 2018 and emergency department presentations from 1 July to 31 December 2018 were screened for inclusion.Results302 episodes of cellulitis were included comprising 206 (68.2%) admitted children and 96 (31.8%) non-admitted children. The median age was 5 years (IQR 2–9), 40 (13.2%) were Aboriginal and 180 (59.6%) boys. The extremities were the most commonly affected body site among admitted and non-admitted patients. There was a greater proportion of facial cellulitis in admitted patients (27.2%) compared with non-admitted patients (5.2%, p<0.01). Wound swab was the most frequent microbiological investigation (133/302, 44.0%), yielding positive cultures in the majority of those tested (109/133, 82.0%). The most frequent organisms identified were Staphylococcus aureus (94/109, 86.2%) (methicillin-susceptible S. aureus (60/94, 63.8%), methicillin-resistant S. aureus) and Streptococcus pyogenes (22/109, 20.2%) with 14 identifying both S. aureus and S. pyogenes. Intravenous flucloxacillin was the preferred antibiotic (154/199, 77.4%), with median intravenous duration 2 days (IQR 2–3), oral 6 days (IQR 5–7) and total 8 days (IQR 7–10).ConclusionsCellulitis is a common reason for presentation to a tertiary paediatric hospital. We confirm a high prevalence of extremity cellulitis and demonstrate that children with facial cellulitis often require admission. Cellulitis disproportionately affected Aboriginal children and children below 5 years. Prevention of cellulitis involves early recognition and treatment of skin infections such as impetigo and scabies.

[Truncated abstract] The prinicipal aim of this thesis was to explore the relationship between 3rd generation cephalosporin antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea (CDAD). This antibiotic class has been implicated in the aetiology of CDAD; therefore restriction of these antibiotics via antibiotic policies represents a potential strategy for prevention and control of CDAD. Successful control of CDAD in hospitals translates to improved quality of care for patients, and a reduction of pressure on hospital resources. Therefore, the objectives of this study were to determine whether 3rd generation cephalosporins were related to CDAD, to evaluate the effect of changes to antibiotic policy on the incidence of CDAD, and to determine the impact of CDAD on patient length of stay and hospital costs. The study was conducted in Sir Charles Gairdner Hospital (SCGH), a public teaching hospital located in Perth, the capital city of the state of Western Australia. Evidence for an association between 3rd generation cephalosporins and CDAD was obtained from studies of ecologic- and individual-level data. A time series analysis of the relationship between monthly consumption of 3rd generation cephalosporins and the incidence of CDAD in SCGH was undertaken covering the period 1994 to 2000. The results demonstrated a positive relationship between the use of 3rd generation cephalosporins and CDAD. A matched case-control study that involved 193 adult inpatients diagnosed with CDAD and 386 adult inpatients without CDAD, selected from the period 1996 to 2000, was conducted. Information was collected on exposure to 3rd generation cephalosporin antibiotics during hospitalisation, as well as exposure to other antibiotics and medications, procedures, and comorbidities. Results from conditional logistic regression analyses found CDAD cases were six times more likely to be exposed to 3rd generation cephalosporins during their admission, prior to the onset of diarrhoea, than controls (adjusted odds ratio [OR] = 6.17, 95% confidence interval [CI] = 1.56-24.37). Approximately one third of CDAD in the study population could be attributed to 3rd generation cephalosporins. CDAD cases were also four times more likely to have been exposed to either amoxicillin-clavulanate or ticarcillin-clavulanate (adjusted OR=4.23, 95% CI=1.81-9.93). In October 1998, an antibiotic policy was introduced at SCGH that restricted the use of ceftriaxone, the 3rd generation cephalosporin most commonly used by the hospital. During 1999 and 2000, the incidence of CDAD halved as ceftriaxone consumption fell in response to this policy. The effect of this policy was demonstrated in the time series model; during the post-policy period the relationship between ceftriaxone and CDAD that was evident prior to the policy was cancelled out. From the individual-level data, obtained from the case-control study, a reduction in the prevalence of exposure to 3rd generation cephalosporins from 11% to 1% accounted for a 30% reduction in the incidence of CDAD. Data from the case-control study was also used to analyse the independent contribution of CDAD to length of stay and admission costs using multiple linear regression