Predictors of surgical wound infection in Australia: a national study

In July 1984, the first national Australian Nosocomial Prevalence Survey collected data on 12,742 surgical patients from 265 hospitals. This sample represented 59% of public and private hospitals with 50 or more acute-care beds in Australia. The infection control officers at each hospital provided data on patients in a random sample of beds. The over-all surgical wound infection rate was 4.6%. The surgical wound infection rate was twice (5.4%) as high in public than in private (2.8%) hospitals. The infection rates were greater in larger hospitals in both the public and private sector. However, after adjusting for the other predictor factors that are noted below the infection rate did not show any particular pattern for the size of hospital. Clean surgery had a higher (4.8%) infection rate than did clean-contaminated surgery (2.9%). The infection rate for contaminated surgery was 15.0%. Men were found to have nearly twice (6.5%) the infection rate of women (3.4%). Infection rates were lowest in the 15-to-34 years' age-group and highest in those of over 55 years of age. These trends remained even after adjusting for the other risk factors for infection. The cost of surgical wound infections for all hospitals during the year of 1984 was estimated at approximately $60 million. We suggest that a concerted effort should be made to attempt to reduce the infection rate for clean surgery to 1% or less.     

The spot indole test for identification of swarming Proteus

The authors evaluated the use of the spot indole test for rapid speciation of swarming Proteus from the primary isolation plate. One hundred seventy-two consecutive isolates of swarming Proteus were studied, 163 Proteus mirabilis and nine Proteus vulgaris. One hundred fifty-six isolates (95.7%) of Proteus mirabilis gave a negative spot indole. Seven (4.3%) gave a positive spot indole test, but all seven isolates were from cultures in which other indole-producing organisms also were present. If only isolates representing single gram-negative strains in the specimens were tested, the predictive value was greater than 99%. Eight of the nine (88.9%) Proteus vulgaris isolates gave a positive spot indole test; one (11.1%) gave a negative result. This isolate also failed to produce indole by conventional methods but was ornithine decarboxylase negative, and additional biochemical testing was consistent with the Proteus vulgaris identification. All Proteus vulgaris isolates were resistant to ampicillin, and 94.2% of the Proteus mirabilis tested were ampicillin susceptible. The spot indole test is a rapid, accurate, simple, and cost-effective means of speciating swarming Proteus strains isolated as the only gram-negative bacilli in a specimen. The spot indole test should be used in conjunction with an ampicillin susceptibility test result or other confirmatory test information if other gram-negative bacilli are present in the culture.     

Cognitive and behavioural correlates of non‐adherence to HIV anti‐retroviral therapy: Theoretical and practical insight for clinical psychology and health psychology

This cross‐sectional study identified variables associated with protease inhibitor (PI) non‐adherence in 179 patients taking anti‐retroviral therapy. Univariate analyses identified 11 variables associated with PI non‐adherence. Multiple logistic regression modelling identified three predictors of PI non‐adherence: low adherence self‐efficacy and seriousness of non‐adherence and HIV (p < .001), perceived absence of HIV associated illness (p < .01), and use of more than one type of recreational drug (p = .001). The model correctly classified 83.9% of the sample, offers psychologists insight into psychological barriers to treatment adherence to guide interventions for improving adherence, and supports a modified version of the reformulated health belief model.     

Glomerulocystic disease with hepatoblastoma in a neonate: a case report

Glomerulocystic disease (GCD) is a very rare condition. Only two previous reports have linked this condition with hepatoblastoma. We report a neonate with US evidence of grossly enlarged echogenic kidneys and features typical of hepatic fibrosis, complicated by the presence of a hepatoblastoma. The report discusses the differential diagnosis and highlights GCD as one cause of large, bright kidneys on US. It also adds further evidence to the suggested association between GCD and hepatoblastoma. Received: 15 May 1997 Accepted: 24 February 1998     

When continuous surgical site infection surveillance is interrupted: the Royal Hobart Hospital experience

BACKGROUND: The prevalence of surgical site infections (SSI) is second only to urinary tract infections in hospitalized patients. They continue to threaten the health of hospitalized patients and impact negatively on the financial solvency of hospitals through prolonged hospitalization, increased rates of rehospitalization, and significantly increased health care costs. METHODS: We describe the effect of a 12-year surveillance program that included postdischarge follow-up and feedback to clinicians on the rate of SSI and the effect when surveillance is interrupted. Surgical procedures performed at the Royal Hobart Hospital (RHH), a university teaching hospital in Australia, between 1988 and 2001 were monitored for evidence of SSI in hospitals and for up to 30 days postoperatively. The surveillance program was inadvertently disrupted for 15 months from October 1990 to January 1992 and then recommenced. It has been ongoing since that time, apart from a 3-month interruption in 1998. Infection rates were determined on a regular basis, and these results were provided to surgeons, theatre staff, and surgical ward staff every 6 months. Patients included all adult surgical patients with an incisional wound, excluding burn patients and day-only surgical patients. RESULTS: Over the 12-year active surveillance period, 47,581 surgical procedures were followed for SSI. In-hospital SSI rates declined significantly over the study period from 4.7% (95% CI: 3.9%-5.6%) in 1988-1989 to 1.2% (95% CI: 0.8%-1.7%) in 2001 (P < .0001). Infection rates fell rapidly following the commencement of the program. This decline was halted during the period from October 1990 to January 1992 when the program was suspended. In-hospital SSI rates declined once again following the recommencement of the surveillance program, and these lower rates have been maintained. In contrast, postdischarge infection rates rose significantly from 1.2% (95% CI: 0.8%-1.7%) in 1988-1989 to 2.1% (95% CI: 1.6%-2.7%) in 2001 (P < .0001). CONCLUSION: The introduction of a program of continuous SSI surveillance at the RHH was associated with a reduction in the in-hospital and total SSI rate. This phenomenon was repeated following the recommencement of the program after a temporary interruption. Increasing numbers of SSIs are arising after hospital discharge. Many of these patients are readmitted to the hospital for further management of the SSI. Surveillance programs that do not perform postdischarge surveillance will have difficulty in capturing this data. Our experience supports the Study on the Efficacy of Nosocomial Infection Control (SENIC) findings, showing that health care facilities can achieve improved levels of infection management with active surveillance programs.     

The Effectiveness of Preventative Mass Vaccination Regimes Against the Incidence of Highly Pathogenic Avian Influenza on Java Island,Indonesia

We conducted an operational research study involving backyard and semicommercial farms on Java Island, Indonesia, between April 2008 and September 2009 to evaluate the effectiveness of two preventive mass vaccination strategies against highly pathogenic avian influenza (HPAI). One regimen used Legok 2003 H5N1 vaccine, while the other used both Legok 2003 H5N1 and HB1 Newcastle disease (ND) vaccine. A total of 16 districts were involved in the study. The sample size was estimated using a formal power calculation technique that assumed a detectable effect of treatment as a 50% reduction in the baseline number of HPAI‐compatible outbreaks. Within each district, candidate treatment blocks with village poultry populations ranging from 80 000 to 120 000 were created along subdistrict boundary lines. Subsequently, four of these blocks were randomly selected and assigned one treatment from a list that comprised control, vaccination against HPAI, vaccination against HPAI + ND. Four rounds of vaccination were administered at quarterly intervals beginning in July 2008. A vaccination campaign involved vaccinating 100 000 birds in a treatment block, followed by another 100 000 vaccinations 3 weeks later as a booster dose. Data on disease incidence and vaccination coverage were also collected at quarterly intervals using participatory epidemiological techniques. Compared with the unvaccinated (control) group, the incidence of HPAI‐compatible events declined by 32% (P = 0.24) in the HPAI‐vaccinated group and by 73% (P = 0.00) in the HPAI‐ and ND‐vaccinated group. The effect of treatment did not vary with time or district. Similarly, an analysis of secondary data from the participatory disease and response (PDSR) database revealed that the incidence of HPAI declined by 12% in the HPAI‐vaccinated group and by 24% in the HPAI + ND‐vaccinated group. The results suggest that the HPAI + ND vaccination significantly reduced the incidence of HPAI‐compatible events in mixed populations of semicommercial and backyard poultry.     

Australian Infection Control Association members' use of skills and resources that promote evidence-based infection control

BACKGROUND: To adopt an evidence-based approach, professionals must be able to access, identify, interpret, and critically appraise best evidence. Critical appraisal requires essential skills, such as computer literacy and an understanding of research principles. These skills also are required for professionals to contribute to evidence. METHODS: In 1996, members of the Australian Infection Control Association were surveyed to establish a profile including the extent to which they were reading infection control publications, using specific documents for policy and guideline development, developing and undertaking research, publishing research, and using computers. The relationships between demographics, computer use, and research activity were examined. RESULTS: The response rate was 63. 4% (630/993). The study group comprised mostly women (96.1%), and most (66.4%) were older than 40 years of age. Median infection control experience was 4 years (mean, 5.4 years; range, <12 months to 35 years). When developing guidelines and policies (92.7%; 584/630), infection control professionals reviewed State Health Department Infection Control Guidelines and Regulations. Research relating to infection control was undertaken by 21.5% (135/628) of the sample, and 27.6% (37/134) of this group published their research findings. Of the respondents (51.1%; 318/622) who used a computer to undertake infection control tasks, the majority (89.0%) used a personal computer for word processing. CONCLUSION: Regardless of infection control experience, Australian infection control professionals must be adequately prepared to contribute to, access, appraise, and where appropriate, apply best evidence to their practice. We suggest that computer literacy, an understanding of research principles, and familiarity with infection control literature are three essential skills that infection control professionals must possess and regularly exercise.