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Background: Physical removal of soil rather than biocidal activity is the focus for this safer cleaning method. Methods: We compared 11 years of Victorian healthcare norovirus and suspected viral gastroenteritis outbreak data. Results: Improvements in infection control practice, including the Victorian hand hygiene program corresponds with reduced illness across Victoria during that time. Monash Health reductions are statistically significant and coincide with the implementation of a novel cleaning methodology. Conclusion: Cleaning without chemicals has not increased the risk of norovirus or suspected viral gastroenteritis illness at Monash Health. [ABSTRACT FROM AUTHOR]

Periodic microbiological monitoring of endoscopes is a recommendation of the Gastroenterological Society of Australia (GENSA). The aim of monitoring has been to provide quality assurance of the cleaning and disinfection of endoscopes; however, there is controversy regarding its frequency. This lack of consensus stimulated a review of the experience within our health service. At Southern Health, routine microbiological sampling has involved 4-weekly monitoring of bronchoscopes, duodenoscopes and automated flexible endoscope reprocessors (AFER), and 3-monthly monitoring of all other gastrointestinal endoscopes. Records of testing were reviewed from 1 January 2002 until 31 December 2006. A literature review was conducted, cost analysis performed and positive cultures investigated. There were 2374 screening tests performed during the 5-year period, including 287 AFER, 631 bronchoscopes for mycobacteria and 1456 endoscope bacterial screens. There were no positive results of the AFER or bronchoscopes for mycobacteria. Of the 1456 endoscopic bacterial samples, six were positive; however, retesting resulted in no growth. The overall cost of tests performed and cost in time for nursing staff to collect the samples was estimated at $AUD 100 400. Periodic monitoring of endoscopes is both time-consuming and costly. Our review demonstrates that AFER (Soluscope) perform well in cleaning endoscopes. Based on our 5-year experience, assurance of quality for endoscopic use could be achieved through process control as opposed to product control. Maintenance of endoscopes and AFER should be in accordance with the manufacturer's instructions and microbiological testing performed on commissioning, annually and following repair. Initial prompt manual leak testing and manual cleaning followed by mechanical leak testing, cleaning and disinfection should be the minimum standard in reprocessing of endoscopes. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses a pilot study of influenza vaccination among health care workers (HCWs) of a tertiary hospital in Australia.

Objectives: Clinical utility of carbapenem antibiotics is under threat because of the emergence of acquired metallo-β-lactamase (MBL) genes. We describe an outbreak in an intensive care unit (ICU) possibly associated with contaminated sinks., Design, Setting and Participants: Four clusters of gram-negative bacteria harbouring the MBL gene blaIMP-4 were detected in the ICU at Dandenong Hospital between November 2009 and July 2012. Epidemiological investigations were undertaken in order to identify a common point source. During September 2012, screening using rectal swabs for all ICU patients, and environmental swabs targeting all ICU handwashing sinks and taps were collected. Samples were cultured onto selective carbapenem-resistant Enterobacteriaceae (CRE) agar. Suspected CRE isolates were further characterised using the modified Hodge test and VITEK 2 and confirmed by polymerase chain reaction and sequencing of MBL genes. Clinical and environmental CRE isolates were typed by pulsed-field gel electrophoresis., Results: Ten clinical isolates and one screening isolate of CRE (consisting of Klebsiella pneumoniae [5], Serratia marcescens [4], Enterobacter cloacae [1] and Escherichia coli [1]) were detected with the blaIMP-4 gene over the 30-03 period. S. marcescens was isolated persistently from the grating and drain of eight central sinks. Molecular typing confirmed that clinical and environmental isolates were related. Tap water cultures were negative. Several attempts to clean and decontaminate the sinks using detergents and steam cleaning proved unsuccessful., Conclusion: This report highlights the importance of identification of potential environmental reservoirs, such as sinks, for control of outbreaks of environmentally hardy multiresistant organisms.

Introduction: In 2001, screening for methicillin-resistant Staphylococcus aureus (MRSA) was initiated in the intensive care unit at Dandenong Hospital, Melbourne, Australia. This followed the identification of a clinical isolate of vancomycin intermediate-resistant S. aureus (VISA). Contact precautions for patients colonised or infected with MRSA or VISA were utilised, together with the promotion of hand hygiene and additional environmental cleaning. In 2004, poor compliance with hand-hygiene requirements was recognised as potentially contributing to the inability to control MRSA transmission., Methods: A renewed campaign was introduced in 2004, aimed at improving hand hygiene in the ICU. This involved the introduction of an alcoholic chlorhexidine handrub station on a trolley at the door of the ICU. Use of alcoholic chlorhexidine handrub was mandated for existing and visiting staff to the ICU, and its use was actively promoted by all ICU staff., Results: From 2001 to 2004, the average monthly acquisition of MRSA in the unit was 15.2 patients per 1000 occupied bed days (OBD). Following the implementation of the campaign aimed at visiting staff, the average acquisition of MRSA dropped to 3.2 patients per 1000 OBD., Conclusions: Ownership of hand-hygiene responsibility for patients' protection appeared to contribute to the success of this initiative. The ability to sustain the excellent result was enhanced by the unit leadership and the empowerment of the nurse at the bedside to be the patient's advocate. Nurses, who are at the patient bedside 24 hours per day, 7 days per week, are well positioned to reinforce appropriate hand hygiene.