In reply: One moment doctor! Have you forgotten hand hygiene?

Auditing the five moments of hand hygiene is potentially subjective, but auditor training is designed to ensure consistency between auditors within and between health care settings. Interpretative differences cannot explain consistent differences in compliance between professions. Moments sometimes, legitimately, coincide. The example given by Barnes is a double moment that would be audited as two correct moments if nothing were touched in between, as described in the Hand Hygiene Australia manual: “Typically, this occurs when moving directly from one patient to another without touching anything in between . . . a single hand hygiene action will cover two moments for HH [hand hygiene], as Moments 4 and 1 coincide”. Nevertheless, it is common, when moving between patients — even those immediately adjacent to each other — for us to touch objects, unconsciously; for example, the bed curtain, door handle, patient record, stethoscope, mobile phone, our nose, etc. Any of these objects can be contaminated with potential pathogens; failure to perform hand hygiene immediately before touching the next patient (Moment 1, the least often performed) can transmit pathogens more readily than most people realise

A persistent spot of bother – why vaccinations haven’t stopped measles

Despite high vaccination rates, Australia and other developed countries periodically have small outbreaks of measles, as seen in the recent scares in Victoria and New South Wales. Until about 40 years ago, serious measles epidemics occurred every two or three years. Virtually every child was infected within the first few years of life and one or two in every thousand died from complications. Many were admitted to hospital and some suffered permanent brain damage from encephalitis. When the measles vaccine was introduced in 1968, the incidence of the disease fell rapidly, but small outbreaks continued.A national survey in 1989 showed that 85% of Australian children were immunised. But then a large and prolonged measles outbreak in 1993-4 prompted an Australian Measles Control Campaign (MCC) in 1997

No, you don’t have to finish all your antibiotics

Most people believe – and have been told by health professionals – that it’s essential to finish a course of antibiotics to prevent antibiotic resistance. But this advice is not only wrong, it could actually be harmful. The idea that you have to take all the antibiotics you’re prescribed is based on the assumption that all the bacteria causing the infection have to be killed, so the surviving minority don’t become resistant. In fact, for most otherwise healthy people, significantly reducing, but not necessarily totally eliminating, the bacteria causing the infection allows the body’s natural defences to take over and mop up the remaining few. Some important caveats There are some special circumstances when it’s important to kill all the bacteria – when the patient’s normal defences are damaged for any reason, for instance, or when the infection is in a site that’s relatively inaccessible to antibiotics and the white blood cells that kill bacteria. This can be in the middle of an abscess or cavity filled with pus (as in tuberculosis infection), on a foreign body, such as a prosthetic heart valve, or in dead tissue that can’t be removed (as in osteomyelitis or infection of the bone). Obviously, stopping antibiotics before a serious infection is cured will risk a relapse. That’s what happened to Albert Alexander, the London policeman who was one of the first people to be treated with penicillin by Howard Florey in 1941

Epidemic ethics: four lessons from the current Ebola outbreak

The extent of the current Ebolavirus outbreak in West Africa has belatedly focused the attention of non-governmental organisations, local and Western governments, and international media. What we haven’t caught up with though, is the extent to which these outbreaks and their devastating effects are predictable and preventable. The spread of Ebola virus occurs because health infrastructure in the region is fragmented, under-resourced, or non-existent. And the therapeutic response to the illness is constrained by failure of markets to drive drug and vaccine development that would help the world’s poorest people. Resource constraints This is the largest known Ebola virus outbreak, with more than 1,800 cases and 1,000 deaths so far. But the actual number of people affected and mortality rates are uncertain because laboratory diagnosis is limited and only severe cases are admitted to hospitals. Apart from its longevity and extent, what distinguishes this outbreak is that, for the first time, there’s a prospect of drugs and vaccines to treat and prevent the disease. But these important therapeutic milestones don’t alter the fact that the outbreak will not be controlled by drugs. Rather, what’s required is strict infection control and quarantine. Person-to-person spread of Ebola virus, by contact with blood, body fluids or tissues of an infected person (mainly in the late stages of disease or after death) is not particularly difficult to prevent by well-established infection prevention measures that should be routine practice in any modern hospital. Unlike influenza, for instance, Ebola virus doesn’t spread by coughing or during the incubation period. So the current hospital outbreaks are related to inadequate health-care resources rather than a particularly high level of infectiousness

Epidemic ethics: four lessons from the current Ebola outbreak

The extent of the current Ebolavirus outbreak in West Africa has belatedly focused the attention of non-governmental organisations, local and Western governments, and international media. What we haven’t caught up with though, is the extent to which these outbreaks and their devastating effects are predictable and preventable. The spread of Ebola virus occurs because health infrastructure in the region is fragmented, under-resourced, or non-existent. And the therapeutic response to the illness is constrained by failure of markets to drive drug and vaccine development that would help the world’s poorest people. Resource constraints This is the largest known Ebola virus outbreak, with more than 1,800 cases and 1,000 deaths so far. But the actual number of people affected and mortality rates are uncertain because laboratory diagnosis is limited and only severe cases are admitted to hospitals. Apart from its longevity and extent, what distinguishes this outbreak is that, for the first time, there’s a prospect of drugs and vaccines to treat and prevent the disease. But these important therapeutic milestones don’t alter the fact that the outbreak will not be controlled by drugs. Rather, what’s required is strict infection control and quarantine. Person-to-person spread of Ebola virus, by contact with blood, body fluids or tissues of an infected person (mainly in the late stages of disease or after death) is not particularly difficult to prevent by well-established infection prevention measures that should be routine practice in any modern hospital. Unlike influenza, for instance, Ebola virus doesn’t spread by coughing or during the incubation period. So the current hospital outbreaks are related to inadequate health-care resources rather than a particularly high level of infectiousness

Don’t panic about Ebola’s spread, here’s what we can do instead

News that a 25-year-old Gold Coast man is being quarantined in hospital after returning from the Democratic Republic of Congo two days ago is no reason to panic. If anything, the incident highlights the problematic nature of the international response to the current Ebola epidemic. Segments of the media have quickly highlighted the possibility the Australian man contracted Ebola virus disease during his time in Congo. The country is experiencing an outbreak of the haemorrhagic fever virus, but it’s separate to the one reported in West African nations of Guinea, Liberia, Sierra Leone, Senegal, and Nigeria. The danger of such reports is that risks can get blown out of proportion and cause the spread of misinformation

Mandatory influenza immunisation of health-care workers

Seasonal influenza imposes an enormous but poorly defined burden of excess deaths, hospital admissions, and health-care costs, and often spreads within health-care facilities. Hospital patients with influenza are a potential source of infection for health-care workers that are not immunised, with attack rates among health-care workers of 18–24%.1 Unfortunately, health-care workers infected with influenza often continue to work, despite symptoms, with potentially devastating consequences for high-risk patients, including those who are very young, elderly, or immunocompromised—for example, patients receiving bone-marrow transplants have a high risk of pneumonia and death from influenza.2 Trivalent subunit influenza vaccines are 70–90% effective3 and safe, with mild side-effects in less than 10% of recipients.4 Immunisation of health-care workers can reduce exposure to, and illness and death from, influenza among patients in long-term care facilities5 even with modest uptake rates6 (at an estimated cost of £51–405 per life-year saved), as well as reducing infection and absenteeism among health-care workers that have been immunised (with estimated savings of £12 per vaccinee).5 In a bone-marrow-transplant unit in the USA, increasing immunisation uptake from 12% to 58% among health-care workers, was associated with a reduction in nosocomial influenza infections from 14 to 4 cases per 10 000 patients days.7 Despite this evidence and recommendations by major health authorities for yearly immunisation of health-care workers,8 uptake is often poor (less than 30%). Immunisation uptake rarely exceeds 60%, even when vaccine is free and easily accessible,5 and 9 which is inadequate to protect the most vulnerable patients, many of whom are unimmunised because of immunosuppression or comorbidities. Uptake can be increased by various interventions, including staff education, active promotion, incentives, declination forms, clinical leadership, and provision of free vaccine at convenient locations, such as mobile carts,8 and 10 but increases are often modest and difficult to sustain over successive season

Medical interns' reflections on their training in use of personal protective equipment.

BACKGROUND:The current COVID-19 pandemic has demonstrated that personal protective equipment (PPE) is essential, to prevent the acquisition and transmission of infectious diseases, yet its use is often sub-optimal in the clinical setting. Training and education are important to ensure and sustain the safe and effective use of PPE by medical interns, but current methods are often inadequate in providing the relevant knowledge and skills. The purpose of this study was to explore medical graduates' experiences of the use of PPE and identify opportunities for improvement in education and training programmes, to improve occupational and patient safety. METHODS:This study was undertaken in 2018 in a large tertiary-care teaching hospital in Sydney, Australia, to explore medical interns' self-reported experiences of PPE use, at the beginning of their internship. Reflexive groups were conducted immediately after theoretical and practical PPE training, during hospital orientation. Transcripts of recorded discussions were analysed, using a thematic approach that drew on the COM-B (capability, opportunity, motivation - behaviour) framework for behaviour. RESULTS:80% of 90 eligible graduates participated. Many interns had not previously received formal training in the specific skills required for optimal PPE use and had developed potentially unsafe habits. Their experiences as medical students in clinical areas contrasted sharply with recommended practice taught at hospital orientation and impacted on their ability to cultivate correct PPE use. CONCLUSIONS:Undergraduate teaching should be consistent with best practice PPE use, and include practical training that embeds correct and safe practices

Diversity of group B streptococcus serotypes causing urinary tract infection in adults

Serotypes of group B streptococcus (GBS) that cause urinary tract infection (UTI) are poorly characterized. We conducted a prospective study of GBS UTI in adults to define the clinical and microbiological characteristics of these infections, including which serotypes cause disease. Patients who had GBS cultured from urine over a 1-year period were grouped according to symptoms, bacteriuria, and urinalysis. Demographic data were obtained by reviewing medical records. Isolates were serotyped by latex agglutination and multiplex PCRreverse line blotting (mPCR/RLB). Antibiotic susceptibilities were determined by disc diffusion. GBS was cultured from 387/34,367 consecutive urine samples (1.1%): 62 patients had bacteriuria of >10 7 CFU/liter and at least one UTI symptom; of these patients, 31 had urinary leukocyte esterase and pyuria (others not tested), 50 (81%) had symptoms consistent with cystitis, and 12 (19%) had symptoms of pyelonephritis. Compared with controls (who had GBS isolated without symptoms), a prior history of UTI was an independent risk factor for disease. Increased age was also significantly associated with acute infection. Serotyping results were consistent between latex agglutination and mPCR/RLB for 331/387 (85.5%) isolates; 22 (5.7%) and 7 (1.8%) isolates were nontypeable with antisera and by mPCR/RLB, respectively; and 45/56 (80.4%) isolates with discrepant results were typed by mPCR/RLB as belonging to serotype V. Serotypes V, Ia, and III caused the most UTIs; serotypes II, Ib, and IV were less common. Nontypeable GBS was not associated with UTI. Erythromycin (39.5%) and clindamycin (26.4%) resistance was common. We conclude that a more diverse spectrum of GBS serotypes causes UTI than previously recognized, with the exception of nontypeable GBS

Patient involvement can affect clinicians’ perspectives and practices of infection prevention and control: A “post-qualitative” study using video-reflexive ethnography

© The Author(s) 2017. This study, set in a mixed, adult surgical ward of a metropolitan teaching hospital in Sydney, Australia, used a novel application of video-reflexive ethnography (VRE) to engage patients and clinicians in an exploration of the practical and relational complexities of patient involvement in infection prevention and control (IPC). This study included individual reflexive sessions with eight patients and six group reflexive sessions with 35 nurses. VRE usually involves participants reflecting on video footage of their own (and colleagues’) practices in group reflexive sessions. We extended the method here by presenting, to nurses, video clips of their clinical interactions with patients, in conjunction with footage of the patients themselves analyzing the videos of their own care, for infection risks.We found that this novel approach affected the nurses’ capacities to recognize, support, and enable patient involvement in IPC and to reflect on their own, sometimes inconsistent, IPC practices from patients’ perspectives. As a “post-qualitative” approach, VRE prioritizes participants’ roles, contributions, and learning. Invoking affect as an explanatory lens, we theorize that a “safe space” was created for participants in our study to reflect on and reshape their assumptions, positionings, and practices