Search

Background: The 2022 WHO global survey on infection prevention and control (IPC) exposes significant gaps in IPC in the WHO Southeast Asia region. A better understanding of IPC vulnerabilities will inform improvement initiatives. We describe an evaluation of IPC practices known to prevent and contain carbapenem-resistant organisms (CROs) at hospitals participating in the United States Centers for Disease Control Global Action in Healthcare Network –Antimicrobial Resistance in India. Prior hospital evaluations suggest resistance to carbapenems among gram-negative isolates is up to 45%. Methods: We conducted a mixed methods evaluation including cross-sectional surveys, semi-structured interviews, and site observations at five hospitals (one government, two private tertiary care, and two private teaching) located in three cities. The number of hospital beds ranged from 362 to 2,011. Hospital and IPC program characteristics, and CRO prevention and containment activities were examined virtually. Site observations focused on hand hygiene, environmental cleaning, personal protective equipment (PPE), CRO containment practices and use of water for patient care. Results: All sites had IPC programs with established policies and qualified IPC staff. The IPC nurse-to-bed ratio ranged from 1:73 to 1:432 (mean, 1:209). Due to the integral role of microbiology staff in IPC at these hospitals, the two departments had strong communication channels associated with CRO identification. Screening for CRO colonization, if done, targeted patients from outside hospitals. Three of the five hospitals routinely implemented contact precautions for patients with identified CROs, displayed isolation signage at the bedside, and provided adequate PPE at point-of-use; however, all sites reported barriers to effective isolation and/or cohorting patients with CROs. Timely communication of CROs to clinical staff varied and no sites effectively relayed CRO status upon patient discharge to another facility. IPC teams identified gaps in environmental cleaning procedures and practices related to medical devices and equipment. All sites used alternatives to tap water for clinical care and sink etiquette was evident. Each IPC team performed audits of patient isolation and hand hygiene practices. Despite the considerable proportion of IPC resources dedicated to daily education and feedback in clinical areas, the IPC teams reported that improvement was often difficult to achieve. Conclusion: Given the high burden of CROs and limited IPC resources, detailed knowledge of IPC opportunities for improvement will help hospitals target novel interventions for CRO prevention and containment. Further investigation of colonization rates and effective performance improvement methods in these settings is needed.

Marsha A Ivey,1,2 Sheree M Smith,3,4 Geza Benke,1 Brett G Toelle,5,6 Michael L Hunter,7 Alan L James,8 Graeme P Maguire,9 Richard Wood-Baker,10 David P Johns,11 Guy B Marks,5,12 Michael J Abramson1 1School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia; 2School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago; 3School of Nursing and Midwifery, Campbelltown Campus, Western Sydney University, Penrith, NSW, 2751, Australia; 4Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; 5Respiratory and Environmental Epidemiology Group, Woolcock Institute of Medical Research, Sydney, NSW, 2037, Australia; 6Sydney Local Health District, Sydney, NSW, 2050, Australia; 7School of Population and Global Health, University of Western Australia, Perth, WA, 6009, Australia; 8Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital and Medical School, University of Western Australia, Perth, WA, 6009, Australia; 9Curtin Medical School, Curtin University, Perth, WA, 6102, Australia; 10School of Medicine, University of Tasmania, Hobart, TAS, 7000, Australia; 11Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; 12School of Clinical Medicine, University of New South Wales, Sydney, NSW, 2052, AustraliaCorrespondence: Michael J Abramson, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia, Tel +61 3 9903 0573, Fax +61 3 9903 0556, Email michael.abramson@monash.eduPurpose: Tobacco smoking is the major risk factor for COPD, and it is common for other risk factors in never-smokers to be overlooked. We examined the prevalence of COPD among never-smokers in Australia and identified associated risk factors.Methods: We used data from the Australia Burden of Obstructive Lung Disease (BOLD) study, a cross-section of people aged ≥ 40 years from six sites. Participants completed interviews and post-bronchodilator spirometry. COPD was primarily defined as an FEV1/FVC ratio < 0.70 and secondarily as the ratio less than the lower limit of normal (LLN).Results: The prevalence of COPD in the 1656 never-smokers who completed the study was 10.5% (95% CI: 9.1– 12.1%) [ratio

Yijun Zhou,1 Maria R Ampon,2 Michael J Abramson,3 Alan L James,4 Graeme P Maguire,5 Richard Wood-Baker,6 David P Johns,6 Guy B Marks,1,7 Helen K Reddel,2,8,9 Brett G Toelle1,8,9 1The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; 2Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; 3School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia; 4Sir Charles Gairdner Hospital, Perth, WA, Australia; 5Curtin Medical School, Curtin University, Perth, WA, Australia; 6Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; 7South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; 8Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, NSW, Australia; 9Sydney Local Health District, Sydney, NSW, AustraliaCorrespondence: Brett G Toelle, Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW, 2037, Australia, Email brett.toelle@woolcock.org.auPurpose: Population data on the burden of chronic obstructive pulmonary disease (COPD) are often based on patient-reported diagnoses of COPD, emphysema or chronic bronchitis, without spirometry. We aimed to investigate the relationship between health burden, quality of life and severity of airway obstruction in Australian adults aged ≥ 40 years.Methods: We used data from the BOLD Australia study, which included randomly selected adults aged ≥ 40 years from six study sites to reflect the sociodemographic and geographic diversity of the Australian population (n = 3522). Participants with post-bronchodilator airflow limitation (ratio of forced expiratory volume in 1 second FEV1 to forced vital capacity < 0.7) were grouped by GOLD spirometry grades 1– 4. Quality of life was assessed with Short Form 12 (SF-12) Health Survey Questionnaire. Health burden was assessed as lost time off work or social activities, and healthcare utilization.Results: Of the study sample, 2969 participants did not have airflow limitation, 294 (8.4%) were classified as GOLD Grade 1, 212 (6.0%) as GOLD 2 and 43 (1.2%) as GOLD 3– 4. Participants with higher GOLD grades had more respiratory symptoms, more comorbidities and greater burden than those with lower GOLD grades. The scores of mental and physical subscales of SF-12 were lower, indicating worse quality of life, from the no airflow limitation group to the GOLD 3– 4 group (P = 0.03 and P < 0.001, respectively).Conclusion: Greater airflow limitation is associated with greater burden and poor quality of life. Interventions to prevent, or reduce the level of, airflow limitation will reduce the symptom burden and improve quality of life for patients.Keywords: chronic obstructive pulmonary disease, airflow limitation, comorbidities, The Burden of Obstructive Lung Disease, quality of life

Epsilon-near-zero (ENZ) materials have recently emerged as a promising platform for infrared nanophotonics. A significant challenge in the design of ENZ-based optics is to control the dispersion of ENZ modes that otherwise have a flat profile near the ENZ frequency. Strong coupling with an optical cavity is a promising approach to ENZ dispersion engineering, which however has limitations due to the lack of tunability or nanofabrication demands of the cavity employed. Here, we theoretically and numerically show that much of the limitations of previous approaches can be overcome by strongly coupling the ENZ mode to an unpatterned Fabry–Perot cavity. We demonstrate this unprecedented ENZ dispersion control in coupled cavities by designing tunable infrared polarizers that can absorb s and reflect p-polarized components, or vice versa, for almost any oblique angle of incidence, i.e. omnidirectional polarizers. The feasibility of active control is also demonstrated using a phase change material within the cavity, which predicts dynamic switchability of polariton dispersions across multiple resonant levels at mid-infrared wavelengths. These results are expected to advance the current understanding of strongly coupled ENZ interactions and demonstrate their potential in tailoring dispersions for active and passive control of light.

Poultry enteric bacterial diseases are of significant economic importance because they are responsible for production losses due to weight loss, increased morbidity and mortality, and increased cost of production arising from poor feed conversion and treatment. This cross-sectional purposive study characterized enteric bacterial pathogens in poultry from selected agroclimatic regions in Kenya and investigated their antimicrobial resistance gene profiles. Cloacal (n = 563) and oropharyngeal (n = 394) swabs were collected and pooled into 16 and 14 samples, respectively, to characterize bacterial pathogens and their antimicrobial resistance gene profiles. We report that Proteobacteria, Chlamydiae, and Firmicutes are the most dominant phyla present in both cloacal and oropharyngeal swabs of the six poultry species studied, indicating the colonization of the poultry gut by many pathogenic bacteria. Using KEGG and COG databases, some pathways related to metabolism, genetic information, and cellular processing were detected. We also report the abundance of antimicrobial resistance genes that confer resistance to β-lactamases, aminoglycosides, and tetracycline in most of the poultry analyzed, raising concern about the dangers associated with continuous and inappropriate use of these antibiotics in poultry production. The antimicrobial resistance gene data generated in this study provides a valuable indicator of the use of antimicrobials in poultry in Kenya. The information generated is essential for managing bacterial diseases, especially in backyard poultry raised under scavenging conditions.