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From 2015 onwards, the number of vancomycin-resistant Enterococcus faecium (VREfm) isolates increased in Tasmania. Previously, we examined the transmission of VREfm at the Royal Hobart Hospital (RHH). In this study, we performed a state-wide analysis of VREfm from Tasmania’s four public acute hospitals. Whole-genome analysis was performed on 331 isolates collected from screening and clinical specimens of VREfm. In silico multi-locus sequence typing (MLST) was used to determine the relative abundance of broad sequence types (ST) across the state. Core genome MLST (cgMLST) was then applied to identify potential clades within the ST groupings followed by single-nucleotide polymorphic (SNP) analysis. This work revealed that differences in VREfm profiles are evident between the state’s two largest hospitals with the dominant vanA types being ST80 at the RHH and ST1421 at Launceston General Hospital (LGH). A higher number of VREfm cases were recorded at LGH (n = 54 clinical, n = 122 colonization) compared to the RHH (n = 14 clinical, n = 67 colonization) during the same time period, 2014–2016. Eleven of the clinical isolates from LGH were vanA and belonged to ST1421 (n = 8), ST1489 (n = 1), ST233 (n = 1), and ST80 (n = 1) whereas none of the clinical isolates from the RHH were vanA. For the recently described ST1421, cgMLST established the presence of individual clusters within this sequence type that were common to more than one hospital and that included isolates with a low amount of SNP variance (≤16 SNPs). A spatio-temporal analysis revealed that VREfm vanA ST1421 was first detected at the RHH in 2014 and an isolate belonging to the same cgMLST cluster was later collected at LGH in 2016. Inclusion of isolates from two smaller hospitals, the North West Regional Hospital (NRH) and the Mersey Community Hospital (MCH) found that ST1421 was present in both of these institutions in 2017. These findings illustrate the spread of a recently described sequence type of VREfm, ST1421, to multiple hospitals in an Australian state within a relatively short time span.

There have been efforts worldwide to reduce the incidence of hospital-onset Staphylococcus aureus bacteremia (SAB). This longitudinal study demonstrates a nationwide reduction in both methicillin-resistant and methicillin-susceptible SAB in Australia. Background. Staphylococcus aureus bacteremia (SAB) is a serious cause of morbidity and mortality. This longitudinal study describes significant reductions in hospital-onset SAB (HO-SAB) in Australian hospitals over the past 12 years. Methods. An observational cohort study design was used. Prospective surveillance of HO-SAB in 132 hospitals in Australia was undertaken. Aggregated data from all patients who acquired HO-SAB was collected (defined as 1 or more blood cultures positive for S. aureus taken from a patient who had been admitted to hospital for >48 hours). The primary outcome was the incidence of HO-SAB, including both methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) S. aureus strains. Results. A total of 2733 HO-SAB cases were identified over the study period, giving an aggregate incidence of 0.90 per 10 000 patient-days (PDs) (95% confidence interval [CI], .86–.93). There was a 63% decrease in the annual incidence, from 1.72 per 10 000 PDs in 2002 (95% CI, 1.50–1.97) to 0.64 per 10 000 PDs (95% CI, .53–.76) in 2013. The mean reduction per year was 9.4% (95% CI, −8.1% to −10.7%). Significant reductions in both HO-MRSA (from 0.77 to 0.18 per 10 000 PDs) and HO-MSSA (from 1.71 to 0.64 per 10 000 PDs) bacteremia were observed. Conclusions. There was a major and significant reduction in incidence of HO-SAB caused by both MRSA and MSSA in Australian hospitals since 2002. This reduction coincided with a range of infection prevention and control activities implemented during this time. It suggests that national and local efforts to reduce the burden of healthcare-associated infections have been very successful.

BACKGROUND: Childhood abuse is a major global and public health problem associated with a myriad of adverse outcomes across the life course. Suicide is one of the leading causes of mortality during the perinatal period. However, few studies have assessed the relationship between experiences of childhood abuse and suicidal ideation in pregnancy. OBJECTIVE: We sought to examine the association between exposure to childhood abuse and suicidal ideation among pregnant women. STUDY DESIGN: A cross-sectional study was conducted among 2964 pregnant women attending prenatal clinics in Lima, Peru. Childhood abuse was assessed using the Childhood Physical and Sexual Abuse Questionnaire. Depression and suicidal ideation were assessed using the Patient Health Questionnaire-9 scale. Logistic regression procedures were performed to estimate adjusted odds ratios and 95% confidence intervals adjusted for potential confounders. RESULTS: Overall, the prevalence of childhood abuse in this cohort was 71.8% and antepartum suicidal ideation was 15.8%. The prevalence of antepartum suicidal ideation was higher among women who reported experiencing any childhood abuse compared to those reporting none (89.3% vs 10.7%, P

Background In recent year, national bodies have been actively addressing the increasing concern on the spread of healthcare-associated infections (HAIs). The current study measures the knowledge, intentions and beliefs of third-year Australian nursing students on key infection prevention and control (IPC) concepts. Methods A cross-sectional study of final-year undergraduate nursing students from Schools of Nursing at six Australian universities was undertaken. Students were asked to participate in an anonymous survey. The survey explored knowledge of standard precautions and transmission based precautions. In addition intentions and beliefs towards IPC were explored. Results 349 students from six universities completed the study. 59.8% (95% CI 58.8–60.8%) of questions were answered correctly. Significantly more standard precaution questions were correctly answered than transmission-based precaution questions (p

Background Fit testing is used to determine whether a N95 mask will provide respiratory protection for the wearer by preventing inhalation of airborne transmitted microorganisms. National guidelines recommend that healthcare workers (HCW) who use N95 masks require fit testing. Quantitative fit testing requires the purchasing and use of fit testing solutions and associated equipment. In high volume, these solutions are expensive and may not be readily available, as was seen in the 2009 H1N1 influenza pandemic. The aim of this study was to determine how a homemade solution compared against a commercially available product and a placebo. Methods Afit test was performed on the same person, on three separate occasions, using three different solutions – commercial (45% sodium saccharin), homemade (to be disclosed) and placebo (water). The solution was double blinded and solutions were chosen and administered in a random order. Results Atotal of 48 people participated in this study.At the threshold testing stage, 8.3% did not taste any solution, 16.7% of people could taste the placebo, 89.6% could taste the commercial solution and 91.7% could taste the homemade solution. All persons who could taste the commercial solution could taste homemade solution. Conclusion The findings of our study suggest that fit testing solutions could be made locally with a similar effect to that of commercial products, that quantitative fit testing is unreliable and that serious consideration should be given to the role of quantitative fit testing in future guidelines and standards. We recommend that this study be conducted on a larger scale to support our findings.

To the Editor—We thank Worth and colleagues [1] for reflecting on some important points related to our recent study where we reported a 63% reduction in hospital-onset (HO) Staphylococcus aureus bacteremia (SAB) in Australia [2]. We agree that the HO-SAB definition used in our study is not the national definition currently used for healthcare-associated (HCA) SAB surveillance in Australian hospitals. We commented on this in the discussion. Authors of our study have previously made similar comments to those made by Worth and colleagues [3–8]. For the purposes of benchmarking Australia internationally, we believe a HO-SAB definition is a robust and accurate approach to identify any real reduction in SAB—the aim of the paper. Capturing all HCA-SAB cases requires much more additional work by infection control professionals and infectious diseases physicians at a local level. In addition, collecting such additional surveillance requires validation [9, 10], potentially lacking in parts of Australia. However, there are 2 important reasons why we used only a HO-SAB definition in our study. First, we wanted to report data over a long time frame, 12 years of data. The HCA-SAB definition was not agreed upon by Health Ministers until 2008 in Australia, meaning previous longitudinal prospective data were not collected consistently. Retrospective analysis would have been very difficult and likely subject to bias. Second, the HO-SAB definition allows for international comparisons, whereas the HCA-SAB definition does not. Without using a HO-SAB definition, we would not have been able to undertake the comparisons outlined in our discussion. We fully support the use of HCA-SAB surveillance definition and hope that many other countries move to such a definition for the reasons described by Worth and colleagues. We believe that when data are presented, HO-SAB should be presented as a subset of the total HCA-SAB numbers where possible. Comparisons can then be made with studies that have not used the more inclusive definition. The conclusions in our study are consistent with the definitional approach we used. We never stated or implied that we tried to measure and report all cases of HCA-SAB. We acknowledge the point made by Worth and colleagues regarding data analysis and model adjustment for heterogeneity and multistate frailty. We are not convinced that this extra complexity in analysis is needed to demonstrate the points made. Regardless, under the agreements with those providing data for our study, only aggregated hospital data were to be analyzed and published, so the proposed analysis was not possible. What our data showed was a major and significant reduction in incidence of HO-SAB over a 12-year period caused by both methicillin-resistant and methicillin-sensitive S. aureus in Australian hospitals since 2002. This reduction coincided with a range of infection prevention and control activities implemented during this time [2]. It suggests that national and local efforts to reduce the burden have been very successful. As we commented, there are many potential reasons for the reductions in HO-SAB observed in our study, and Worth and colleagues are correct in acknowledging the important role that surveillance and multiple interventions play [11, 12].

The paper attempts to reconcile the conflicting concerns about information as a public resource and information as an economic commodity within an information society. The free and uncompensated distribution of information can be rationalized within the context of an agricultural or manufacturing society as a means for furthering the economic interests of the group; however, an information society requires a global economy which is interdependent, for information societies cannot survive without outside support for basic goods and needs. Such a society requires a legal system which recognizes the value of the contribution of those who engage in the creative process. The paper discusses various property rights in information, including rights of access, rights of confidentiality, and rights of reply. The paper also discusses jurisdictional questions concerning the structure of information transport systems, as well as the applicability of the GATT to telecommunications services and information pro...