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The aim of this study was to solicit opinions from healthcare workers (HCWs) as to their attitude to working during a pandemic. A cross-sectional survey of HCWs using a self-administered, anonymous survey was conducted between February 2007 and April 2007. The setting was a large Victorian metropolitan health service, employing over 10 000 staff. Sixty-seven percent of HCWs stated they would be available to work during a pandemic, 26% stated they would stay at home to care for their children, whereas 10% admitted they would stay away because of fear of catching influenza. The majority of employees expected to be provided with personal protective equipment, antivirals and vaccine (92%, 90% and 89%, respectively). HCWs also believed that family members should be supplied with antivirals and vaccine (64% and 63%, respectively), 20% believed they needed a place of residence while working, 45% were prepared to be relocated to another site, and 36% were prepared to change to another duty. The survey highlights several areas that need attention in preparing for a pandemic. Targeted education is required now for all those HCWs who will be expected to work during a pandemic. How we cope with the next inevitable pandemic depends on the depth of our preparation.

The prevention and control of multi-resistant organisms (MRO) in residential aged care facilities (RACF) has significant implications for health services. The use of broad-spectrum antibiotics is associated with the development of MRO and therefore antimicrobial stewardship is a key initiative in decreasing development and spread of these organisms. This pilot study aims to assess the role of the infection control clinical nurse consultant in the antimicrobial stewardship team in two RACFs.

Background The ability of doctors to ‘speak up' when a medical error occurs is a cornerstone of patient safety. Hand hygiene (HH) is one of the simplest methods of reducing patient harm and represents a behavioural model in which to observe medical staff interaction. Our hypothesis is that the hierarchical structure amongst doctors prevents them from speaking up, which in turn contributes to poor HH compliance. Methods Ananonymous survey was administered to doctors employed in a health service in Melbourne, Australia. Questions included: willingness to prompt doctors to perform HH, reasons for not speaking up, perceived reactions of a doctor being prompted to perform HH and perceived reaction if they were asked to perform HH. Results One hundred and sixty-three doctors completed the questionnaire. Willingness to prompt a doctor to perform HH decreased as the questioned doctor's seniority increased, with 88.5% willing to ask an intern but only 40.4% willing to ask a consultant. The main reason for not asking a senior doctor was not wanting to speak up to a superior. Conclusions Our study highlights a steep medical hierarchy, with less than half of the doctors willing to question seniors, even when they noticed an error occurring.Wesuggest that if acquired, the skills needed to respectfully prompt HH are transferrable to many other patient safety initiatives.

Catheter-associated urinary tract infections (CAUTIs) occur frequently in healthcare settings. The insertion and maintenance of indwelling urinary catheters is a routine element of healthcare. In order to prevent CAUTI, it is important that healthcare professionals providing catheter care understand the indications for catheter use and the correct procedure for insertion and maintenance of catheters. This paper reviews and summarises three recent key publications on the prevention of CAUTIs and proposes the use of a care bundle and checklist for catheter indications, insertion and maintenance, and quality improvement.

Since 2000 there has been an increase in the rates of Clostridium difficile infection (CDI) in many healthcare facilities in the United States, Canada and Europe. This increase is associated with an epidemic strain of C. difficile and this strain (PCR ribotype 027) has recently been identified in Australia. All healthcare services should have in place an optimal evidence-based program for CDI prevention and control. Management principles include the following. • All healthcare organisations, including residential aged care facilities, must give CDI prevention and control the highest priority, even if the prevailing incidence of CDI is low. • Surveillance should be integrated into quality improvement programs to optimise prevention, control and clinical care of CDI. • Antimicrobial stewardship programs aimed at minimising the frequency and duration of antibiotic use and promoting a narrow spectrum antibiotic policy should be implemented. • Emphasis should be placed on compliance with hand disinfection using alcohol-based hand rub and glove use for CDI patient care to minimise spore contamination. • Contact precautions should be in place for symptomatic CDI patients, including the donning of gowns/aprons and gloves on entry to patient rooms. • The use of sporocidal environmental cleaning and disinfection in high-risk areas such as toilets, bathrooms, and CDI patient rooms should be implemented. There should be the limination of other potential fomites by either using disposable equipment or ensuring that equipment is adequately cleaned and disinfected before re-use. • Education of all healthcare staff, patients and visitors about C. difficile disease, its prevention and management should be implemented.

Vaccine-preventable diseases cause significant mortality and morbidity. Immunisation of healthcare workers (HCW) plays a significant role in preventing nosocomial transmission in healthcare settings. Non-immune HCW put themselves, their contacts and patients at risk of preventable diseases. Achieving 100% protection for HCW and patients should be an achievable target; however, voluntary vaccination programs fail to achieve this rate of protection. This is true in the case of influenza, which contributes to the highest mortality and morbidity of any vaccine-preventable disease. Despite available safe, effective vaccines for seasonal influenza and recommendations by local and international authoritative bodies, the annual influenza vaccination rates amongst HCW remain disappointingly low despite recommendations by local and international authoritative bodies. Voluntary strategies of increasing access, offers of free vaccines, education, and highly visible publicity campaigns have had limited success. In the US, more innovative ideas have been proposed to complement these steps.We discuss such strategies including mandatory influenza vaccination and its possible implementation.

Objective During a recent Melbourne-wide measles outbreak, we reviewed cases admitted to a single health service, to identify infection control measures implemented and to measure resources required to implement the recommendations to control measles in healthcare facilities. Here we analyse the economic impact of measles containment efforts in a single health service. Design, participants and setting All cases of measles identified in the service from 1 January–31 March 2009 were included. Contacts were individuals (staff, patients and relatives) who were present within the emergency departments at the same time as the case and for 2 h after the visit. Results Twelve episodes (17 confirmed individual cases) of measles were identified. The mean time before patients were placed into appropriate precautions was 19 h (range 0–72 h). The total number of people requiring follow-up was 871 (365 staff and 506 patients and relatives). More than 82 individuals required vaccination and immunoglobulin was administered to 11 patients. More than 150 h of personnel time were expended in containing this outbreak. Estimated costs, over and above the costs of hospitalisation of the cases, was $10 339. One case of nosocomial transmission of measles occurred. Conclusions Measles containment efforts in our health service are expensive. The key to decreasing cost is through early case recognition, prompt instigation of airborne precautions, maintaining near-total immunity among healthcare workers with an active staff vaccination program and increasing community awareness over the importance of vaccination.

Background: In January 2008, a positive Ziehl-Neelsen stained smear of an endotracheal aspirate was collected from an infant in the neonatal nursery. Mycobacterium tuberculosis was identified, yet neither parent had active pulmonary tuberculosis. Further investigation revealed the neonate had congenital TB most likely acquired in utero. Methods: A definition of ‘potentially at risk’ persons included all staff who worked in the bay with the infant during his two periods of ventilation, all staff in the bay with the infant for a cumulative total of greater than 8 hours and other infants and families who shared a bay with the infant during his two periods of ventilation. Screening for ‘potentially at risk’ persons was performed at baseline and at 10 weeks post-exposure for neonates, families and staff. Individuals who had a positive test were sent for a chest X-ray and referred for appropriate management by an infectious diseases physician. Results: Overall, 163 staff and 20 neonates and families were considered ‘potentially at risk’. Fourteen staff were positive, none had evidence of active disease and all were born in countries of high-risk for TB exposure and reported previous exposure. No positive results were deemed to be related to the index case. Over 40 h of infection control clinical nurse consultant and clerical time were spent coordinating baseline and follow-up tests and X-rays, notifying staff of results, organising repeat tests and attempting to contact staff who did not present. Pathology staff time was spent collecting specimens from staff and patients and direct costs of over $10 000. Conclusion: This case highlights that neonatal and paediatric staff can be exposed to TB. The workload and costs would have been significantly decreased if staff had recorded a baseline and interferon-gamma release assay (QuantiFeron®-TB Gold, Cellesitis, Victoria, Australia) (QFN) or Mantoux result on employment. This is especially important in healthcare facilities employing large numbers of staff originating from countries of high TB prevalence.

Hand hygiene is the most important measure to prevent hospital-acquired infection, yet hand hygiene compliance rates are poor in intensive care units (ICUs). Handprofiling using fingertip imprints was used to demonstrate the effectiveness of alcohol hand rub (AHR) on reducing bacterial carriage and to assess AHR application as an additional educational tool in the ICU setting. At each hand hygiene opportunity, fingertip imprints, from both hands of the Director of the ICU, were plated and organisms cultured during a patient examination. Micro-organisms were counted and speciated. Hands were examined for general condition and details documented. After presenting the evidence of the value of appropriate hand hygiene to the unit head, the plating activity (hand profiling) was made available to any ICU staff. Nearly twice the number of micro-organisms were plated from the dominant hand fingertips of the Director of the ICU compared with his non-dominant hand. Following the application of AHR, the number of organisms reduced but the right thumb consistently grew micro-organisms. An examination of his hand hygiene technique demonstrated the need to focus on his right thumb when applying AHR. Sixty-five ICU and visiting clinical staff participated in assessing hand hygiene technique after AHR application. Twenty-four staff were recommended for follow-up review of their hand hygiene technique. Through hand profiling, an improvement in application of AHR was demonstrated after the technique was corrected. Hand profiling is a useful educational tool and could be made available to clinical staff to maximise the efficacy of AHR application.

Influenza vaccination of healthcare workers (HCWs) is an important consideration for all health services. In 2007, Southern Health set a target vaccination rate of 75% for all staff within the health service. To achieve this, an extended vaccination service was implemented that included the use of additional mobile rounds and extra staffing for night and weekend duty. The target of 75% was not achieved, however the overall uptake increased by 14%. To prepare for the 2008 program, a quality activity was undertaken to gain an understanding of why more than 40% of HCWs were still not vaccinated. Anin-depth interview was conducted of 20 HCWs to identify common themes of vaccine refusal. Twenty HCWs who were known to have openly refused influenza vaccination, were approached by an experienced infection control nurse consultant and an interview time was arranged. An in-depth interview comprising of six open-ended questions was used in a standardised interview model. Common themes emerged from the in-depth interview, including limited understanding of the importance of influenza vaccination, disbelief of herd immunity, doubt about the protection of influenza vaccine, fear of needles and concern about becoming unwell from the vaccine. The results of the interviews were used to develop strategies for the 2008 program. Education about the importance of influenza vaccination for HCWs was commenced well in advance of the arrival of vaccines for the 2008 program. Information disseminated to HCWs focussed on vaccine effectiveness, risk of illness in HCWs and patients, and the duty of care HCWs provide to patients through vaccination. A declination form was introduced to improve vaccine knowledge and reinforce the importance of duty of care.

Multidrug-resistant organisms (MROs) are a significant and growing concern in many healthcare facilities. Resistant organisms can be rapidly transmitted, have limited antimicrobial treatment options, are capable of significant morbidity and mortality, and are associated with longer hospital stays and greater overall costs. Clinical indicators can be used to identify environments that may benefit from closer monitoring. Specific indicators for Southern Health, the largest metropolitan health service in Victoria, were constructed using the methodology developed by the Australian Infection Control Association. Organisms monitored were methicillin-resistant Staphylococcus aureus , vancomycin-resistant enterococci, Gram-negative bacilli ( Pseudomonas spp., Acinetobacter spp., Serratia marcescens ) and Clostridium difficile . Rate-based graphs were constructed to provide a display of changes to the prevalence of MROs. Denominator data (occupied bed days) were easily obtained from the health services clinical information system. Continuous monitoring using clinical indicators allows the infection control team to identify areas that may benefit from enhanced unit activity and allows a framework to be constructed for the ongoing development of quality indicators in infection control. Suitable statistical charts that provide 95% confidence intervals and flag MRO levels requiring action are currently under investigation.