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Activation of an acute ‘Code Stroke’ pathway on hospital arrival improves thrombolysis rates. Whilst post-stroke protocols to manage fever, hyperglycaemia, and dysphagia (Fever, Sugar and Swallow (FeSS) Protocols) have been shown to reduce death and dependency, facilitated implementation in Emergency Department (ED) has been difficult.

AbstractObjective:To determine the effectiveness and ease of use of an electronic reminder device in reducing urinary catheterization duration.Design:A randomized controlled trial with a cross-sectional anonymous online survey and focus group.Setting:Ten wards in an Australian hospital.Participants:All hospitalized patients with a urinary catheter.Intervention:An electronic reminder system, the CATH TAG, applied to urinary catheter bags to prompt removal of urinary catheters.Outcomes:Catheterization duration and perceptions of nurses about the ease of use.Methods:A Cox proportional hazards model was used to assess the rate of removal of catheters. A phenomenological approach underpinned data collection and analysis methods associated with the focus group.Results:In total, 1,167 patients with a urinary catheter were included. The mean durations in control and intervention phases were 5.51 days (95% confidence interval [CI], 4.9–6.2) and 5.08 days (95% CI, 4.6–5.6), respectively. For patients who had a CATH TAG applied, the hazard ratio (HR) was 1.02 (95% CI, 0.91–1.14; P= .75). A subgroup analysis excluded patients in an intensive care unit (ICU), and the use of the CATH TAG was associated with a 23% decrease in the mean, from 5.00 days (95% CI, 4.44–5.56) to 3.84 days (95% CI, 3.47–4.21). Overall, 82 nurses completed a survey and 5 nurses participated in a focus group. Responses regarding the device were largely positive, and benefits for patient care were identified.Conclusion:The CATH TAG did not reduce the duration of catheterization, but potential benefits in patients outside the ICU were identified. Electronic reminders may be useful to aid prompt removal of urinary catheters in the non-ICU hospital setting.

•Escherichia coliresistance incidence was highest for ampicillin, trimethoprim and cefazolin.•Multidrug- and extensively drug-resistant E. coliUTIs were detected.•No pandrug-resistant E. coliUTI was detected.•Risk of single-drug resistance was high in samples from after-hours general practices.

To describe the development, pilot testing and evaluation of face-to-face and online educational training packages for healthcare staff undertaking point prevalence surveys (PPS) of healthcare-associated urinary tract infections (HAUTIs) in Australian hospitals and aged care facilities.

Urinary tract infections related to indwelling urinary catheters, known as catheter-associated urinary tract infections (CAUTI), are largely preventable healthcare-associated infections (HAI). Healthcare-associated infections including CAUTI are associated with prolonged hospital stay, increased resistance of microorganisms to antimicrobials, increased morbidity and mortality as well as additional financial burden on health care systems, patients and their families. While the optimal aim for patients and the health care system is to prevent CAUTI using measures such as reducing unnecessary placement and early removal of urinary catheters, there is evidence that cleaning of the meatal or peri-urethral area with antiseptic prior to catheter insertion and care of this area while the catheter is insitu has the potential to reduce CAUTI. Evidence suggests that meatal cleaning with antiseptics while the catheter is insitu is non-beneficial in reducing CAUTI but current international and Australian guidelines for infection control professionals identifies that the benefit of antiseptic solution versus non-antiseptic solution for meatal or peri-urethral cleaning before urinary catheter insertion remains unresolved. This discussion paper therefore focuses primarily on antiseptic meatal cleaning prior to urinary catheter insertion in preventing CAUTI. Using evidence from a recently published systematic review and meta-analysis of the literature, this paper discusses the scope of the problem and limitations in the evidence regarding the effectiveness of antiseptics for preventing CAUTI and finally, proposes a way forward through the undertaking of a rigorously conducted randomised controlled trial aimed at evaluating the effectiveness and cost-effectiveness of antiseptic meatal cleaning for prevention of CAUTI.

Surveillance of healthcare associated urinary tract infections (HAUTIs) in Australian acute and aged care facilities is lacking. Therefore, to provide the foundation for a national point prevalence study of HAUTIs and catheter associated urinary tract infection (CAUTIs), a three phase project was developed with recent completion of the second phase. The objectives of Phase II were to (1) develop a website incorporating tools for conducting point prevalence of HAUTIs and CAUTIs, (2) pilot an online process and database for conducting point prevalence of HAUTIs and CAUTIs and (3) determine the point prevalence of HAUTIs and CAUTIs in acute and aged care facilities. This paper reports on the third objective.

Inconsistent evidence about product effectiveness to prevent moist desquamation during radiation treatment and minimal research about the acceptability to patients of recommended products prompted this study.

Objective:This study aimed to evaluate the internal consistency reliability and construct validity of the Fitzpatrick Skin Type Scale during radiation therapy in a cohort of women receiving treatment for breast cancer.Method:The assessment of the scale was performed as a nested study within a randomised controlled trial of two creams used for radiation therapy skin care for breast cancer patients. The sample consisted of 244 female patients undergoing radiation therapy for breast cancer. Participants completed a modified version of the Fitzpatrick Skin Type Scale.Results:Internal consistency as measured by Cronbach's alpha was 0.505, 0.829 and 0.339 for the Genetic Disposition, Sun Exposure and Tanning Habits subscales respectively. Only the Sun Exposure subscale surpassed the 0.70 cut-off, indicating good internal consistency. Maximum likelihood factor analysis with promax rotation method confirmed the a priori factor structure for the Sun Exposure subscale as well as providing evidence of construct validity for this subscale. Analysis for the other two subscales highlighted issues with internal reliability and construct validity suggesting that not all items on each subscale truly measure the intended trait.Conclusion:The study findings support reliability and validity of the Sun Exposure subscale of the Fitzpatrick Skin Type Scale in a convenience sample of women receiving radiation therapy for cancer. Despite limitations with two of the three subscales, this tool continues to be used in clinical practice.

Background Urinary tract infections account for ~30% of healthcare-associated infections reported by hospitals. Virtually all healthcare-associated urinary tract infections (HAUTIs) are caused by instrumentation of the urinary tract, creating an opportunity to prevent a large proportion of HAUTIs, including catheter-associated urinary tract infections (CAUTIs). In Australia, there is no specific national strategy and surveillance system in place to address HAUTIs or CAUTIs. To determine the need for prospective surveillance of HAUTIs, we propose undertaking a national point prevalence study. This paper describes the methods that could be used to undertake such a study. Methods A cross-sectional point prevalence design is proposed. The population is all patients hospitalised overnight in Australian hospitals, with the sample to exclude outpatients and those in emergency departments. The proposed operational definition is that used by the Health Protection Agency. A standardised training package for data collectors is recommended with standardised data collection and analysis processes described. Individual patient consent should be waived. Discussion Explanation of aspects of the proposed methods are provided, primarily based on findings from a pilot study that informed the development of the proposed protocol. This included development and delivery of training for data collectors and use of the Health Protection Agency HAUTI surveillance definition, rather than the Centers for Disease Control definition. Conclusion Conducting a national point prevalence study on HAUTIs including CAUTIs will provide evidence that can be subsequently used to debate the cost effectiveness and value of prospective surveillance. By conducting a pilot study and critically evaluating that process, we have been able to propose a method that could be used for a single hospital or national study.

Neonatal malaria has been considered to be rare even in malaria-endemic areas and this assumption has led to a significant proportion of neonates with malaria being missed or wrongly diagnosed. A case is reported of a 15-day-old female with Plasmodium falciparum malaria in Lagos, Nigeria. An initial diagnosis of septicaemia was made and peripheral blood film for malaria parasite was not included among the laboratory investigations due to a low index of suspicion for malaria in this age group. The diagnosis of neonatal malaria was eventually made after poor improvement in the clinical state of the baby prompting microscopic examination for malaria parasite in the patient’s blood. The patient was successfully treated and recovered without any complications. Knowledge of the prevalence of malaria in neonates will ensure screening for malaria parasite is included as part of the routine investigations or sepsis work-up for all neonates with fever. As non-endemic countries such as Australia continue to receive a high number of immigrants from neighbouring and distant malaria endemic regions, it is imperative to consider this condition in babies of mothers who have recently travelled to or emigrated from a malaria-endemic region. This has implications for infection control professionals and travel medicine clinics as they need to have a good understanding of malaria to provide expert advice and manage patients appropriately.