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In 2015, a marked increase in vancomycin-resistant Enterococcus faecium (VREfm) isolation was detected at the Royal Hobart Hospital, Australia. The primary objective of this work was to examine the dynamics of VREfm transmission using whole genome data mapped to public health surveillance information. Screening and clinical isolates of VREfm from patients were typed for the specific vancomycin-resistance locus present. Of total isolates collected from 2014–2016 (n = 222), 15.3% and 84.7% harboured either the vanA or the vanB vancomycin-resistance locus, respectively. Whole-genome sequencing of 80 isolates was performed in conjunction with single-nucleotide polymorphic (SNP) analysis and in silico multi-locus sequence typing (MLST). Among the isolates sequenced, 5 phylogenetic clades were identified. The largest vanB clade belonged to MLST sequence type ST796 and contained clinical isolates from VREfm infections that clustered closely with isolates from colonised patients. Correlation of VREfm genotypes with spatio-temporal patient movements detected potential points of transmission within the hospital. ST80 emerged as the major vanA sequence type for which the most likely index case of a patient cluster was ascertained from SNP analyses. This work has identified the dominant clones associated with increased VREfm prevalence in a healthcare setting, and their likely direction of transmission.

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.

The government's response to an online petition calling for fair pay for nurses is disgusting (news, 16 November). Ministers should come to a trust unexpectedly - without the trust suddenly having enough staff just for the visit. Only then will they appreciate how nurses try to manage a ward with patients all with differing diagnoses, helped only by agency and bank staff who may not know the hospital, let alone the ward.

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

Drawing on the interconnection of workforce diversity and oral health access, the American Dental Education Association (ADEA) is leading a novel approach to improve student body diversity in U.S. dental schools through an admissions committee development program. With funding provided by the Pipeline, Profession, and Practice: Community-Based Dental Education program and the Robert Wood Johnson Foundation, ten dental directors/deans of admissions from a cross-section of U.S. dental schools were selected through a competitive application process to participate in a Train-the-Trainers Admissions Committee Workshop. After completing intensive training that was built on legally sound admissions practices, these new trainers copresented ADEA Admissions Committee Workshops in two-member teams at six U.S. dental schools. This report summarizes the evaluation of both the train-the-trainers workshop and six workshops held in summer 2009. Also summarized are post-workshop outcomes relative to structural diversity at the participating schools.

The American Dental Education Association's Admissions Committee Workshop (ADEA ACW) was designed to challenge dental school administrators and admissions committee members to review their current admissions practices and to explore ways to attract a more diverse student body. Presented at the invitation of dental schools, this half-day interactive workshop provides opportunities for a dental school's administrators, staff, and admissions committee members to learn about the value of diversity in the educational environment and how to implement holistic admissions practices that take into consideration the experiences, attributes, and metrics of candidates for admission. This report explores the rationale for the development of the ADEA ACW, discusses lessons learned from presentation of the workshop at more than twenty-seven U.S. dental schools, and tracks enrollment trends of underrepresented minority students in dental schools where the workshop has been presented.

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].