Preventing catheter-associated urinary tract infection (CAUTI) is an important patient safety issue worldwide. In addition to understanding the required technical elements, addressing the socio-adaptive or behavioural elements of CAUTI prevention is also critical to ensure effective implementation and reduce the risk of patient harm.
Asymptomatic bacteriuria and pyuria are pervasive in the long-term care population. Optimal management of urinary infection for residents of long-term care facilities requires knowledge of the unique features of the infection in this setting, together with critical evaluation of each episode of potential urinary infection in the individual resident.
A non-structured review of current knowledge and recommendations relevant to urinary infection in long-term care facilities.
Urinary infection is the second most common infection occurring in long-term care facility residents. For residents without chronic indwelling catheters, acute, localising, genitourinary symptoms should be present to support a clinical diagnosis of symptomatic infection. Inappropriate antimicrobial use for urinary tract infection, particularly treatment of asymptomatic bacteriuria and prophylaxis of urinary infection, is a consistent observation in reviews of antimicrobial use in these facilities. Management approaches to improve treatment include observation and reassessment when symptoms are questionable or the diagnosis is unclear, limiting the use of chronic indwelling catheters, and early identification of complications, such as obstruction, of indwelling catheters.
Clinical diagnostic imprecision and a high prevalence of asymptomatic bacteriuria means these infections are overdiagnosed and overtreated, leading to adverse events from excess antimicrobial use. Antimicrobial stewardship programs to improve antimicrobial use for this indication need to be developed in long-term care facilities.
This paper describes an outbreak of Pseudomonas aeruginosa (PAE) that occurred in a haematology ward between 8 January and 24 March 2009. Four patients had healthcare-associated infections due to PAE which was recovered in the groin, blood and perianal tissue.
This report highlights the risks associated with the use of sinks and outlines the approach used to manage the outbreak.
Subsequent investigations showed that a contaminated sink drainage system represented the possible source of spread. Of a total of 21 environmental samples taken, two samples from the sink drainage system showed a similar susceptibility pattern as the patients involved in the outbreak. Four cycles of disinfection of the sink drainage systems were attempted with various modalities.
PAE contamination of the sink drains at the multiple grooves in the drains proved difficult to disinfect adequately, despite using several cleaning protocols. The outbreak was finally terminated following a change in the sink drainage system to one without grooves, hence preventing any further PAE colonisation.
Our experience demonstrated that the design of the sink drainage system may be a potential source of PAE contamination for an immunocompromised patient.
Noroviruses account for over 90% of all viral gastroenteritis cases and ~50% of all outbreaks worldwide. Each year in Australia, there are an estimated 1.8 million cases. Casesmaybe sporadic or part of outbreaks, occurring in either the community or healthcare setting. Outbreaks are associated with significant morbidity and some mortality. They incur substantial costs and can be difficult to control in healthcare institutions or other closed settings.
Multiple factors (related to virus biological properties, human immune responses or inadequate management modalities) make it a challenging pathogen to control. They include: multiple transmission routes, low infectious dose, environmental survival, spread and persistence, diagnostic difficulty, hand hygiene controversies, imperfect immunity and immune evasion, asymptomatic and prolonged shedding, lack of vaccine and lack of antiviral treatment. The purpose of this article is to promote a better understanding of these factors in order that health professionals may be better equipped to manage the problems posed by noroviruses.
Until large-scale effective vaccination and specific treatments become available, the safeguarding of food and water supplies and the rigorous and timely application of outbreak management and infection control measures will remain the key to norovirus disease prevention and control.
Healthcare-associated infections contribute greatly to the global burden of morbidity and mortality in relation to infectious disease. Consequences impact on individuals, populations and health services. Surveillance of infection provides the information to lead infection prevention activities. However, surveillance can require a significant resource investment by healthcare organisations. Point prevalence surveys of healthcareassociated infections are a useful surveillance methodology where resources are limited. Findings provide information in relation to infection and also in relation to patient risk factors.
Repeated point prevalence surveys were implemented over 4 years in 2006–09 in a 345-bed acute private hospital in the Republic of Ireland. Each annual survey followed an unchanged methodology and the data were collected and analysed by the infection prevention and control team.
The prevalence of hospital-acquired infection ranged from 1.1% to 4.4% with a mean value of 3.2% (CI: 2.09–4.62). Mean prevalence of invasive devices was as follows: peripheral venous catheters: 61.3%; urinary catheters: 19.4%; and central venous catheters: 3.9%. The findings of the studies indicated the high prevalence of risk factors associated with invasive devices, particularly peripheral venous catheters. The results supported the introduction of a bundled approach to patient care in relation to invasive devices. This integrated the use of ‘care bundles’ or checklists into daily patient care and management.
A multidisciplinary approach incorporating ward staff in relation to documentation and auditing of compliance with the bundle has increased awareness regarding the risks of invasive devices and the importance of infection prevention strategies.
Patients colonised with extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E) pose a risk to other hospitalised patients and additional measures such as contact precautions are often used. For patients clearing colonisation, however, such measures are unjustified. We reviewed data from a large-scale active surveillance program for ESBL-E to describe the natural history of colonisation. Of 124 colonised patients with sequential rectal swabs, 32 (25.8%) cleared colonisation. Kaplan–Meier analysis suggested that 75% of patients remained colonised at 1 year and that the median duration of colonisation was ~3 years. Improved understanding of the natural history of ESBL-E colonisation will allow more rational approaches to managing previously colonised patients. Additional keywords: duration of colonisation, extended-spectrumbeta-lactamase, natural history of colonisation.
Healthcare-acquired infections are a major source of morbidity and mortality in people living in residential aged care facilities. Compliance with hand hygiene by healthcare workers can reduce the risk of infection to residents, yet compliance rates are generally low. Infection-control advocates within the aged care sector are looking to conduct programs to improve rates among their staff. This review was conducted to identify a reproducible intervention to improve staff hand hygiene compliance within an Australian residential aged care facility.
Medline, Embase, and CINAHL databases were searched for combinations of ‘hand hygiene’, ‘hand washing’, ‘residential aged care facility’, ‘aged care’, ‘nursing home’ and ‘long-term care facility’ from 2000 to current. Articles were excluded if the information was not clearly stated as pertaining to a residential aged care facility or if the data investigated staff knowledge or perceptions of hand hygiene.
Most of the five articles included in the review reported an improvement in compliance rates. Studies were multimodal, had an education or training component, and included the promotion of alcohol-based hand rubs. Several used aspects of the World Health Organization's hand hygiene initiatives. Compliance audit tools across the studies were not consistent; thus, results may not be comparable.
There are few published studies which report interventions that improve hand hygiene compliance among healthcare workers within residential aged care facilities. Successful studies included the promotion of alcoholbased hand rubs. More research is needed to improve hand hygiene compliance in the aged care sector.
Antimicrobial resistance is a growing public health issue influenced by inappropriate prescribing and use. In Australia the prevalence of antibiotic-resistant bacteria in hospital, nursing home and community settings is on the rise. To address this issue, a 5-year program focuses on reducing the prescribing and inappropriate use of antibiotics. In order to inform development of the program, a cross-sectional survey was conducted.
The survey was sent to a random sample of 1570 Australian general practitioners (GPs), and data was collected on GP knowledge, attitudes, awareness and self-reported behaviour in relation to antibiotic resistance, medical imaging referrals and antibiotic prescribing.
730 GPs participated in the survey (46.5% response rate). While GPs perform very well in many areas, especially in recommending symptomatic management rather than prescribing an antibiotic, there is some possible confusion amongstGPs about the factors that increase antibiotic resistance. The results showed that patient expectation also plays a role in the decision to prescribe antibiotics, with almost 40% of respondents admitting that they would prescribe antibiotics to meet a patient's expectations. Antibiotic resistance is generally not discussed with patients (only half [50%] of respondents would always or often discuss the issue of antibiotic resistance).
Programs to address the prescribing of antibiotics must be informed by existing knowledge, attitudes, awareness and practice of GPs. There is room for improvement in GPs’ knowledge of prescribing behaviours that decrease antibiotic resistance. GPs should be encouraged to discuss the issue of antibiotic resistance with patients and to not provide an antibiotic prescription to be dispensed at a later date or to meet patient expectation.
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