Category Archives: infection control

Australian HAI Point Prevalence Study is Coming

Followers of this blog will know how passionate Phil Russo and Brett Mitchell are about the need for national surveillance and a point prevalence study (PPS). Map Aus2We are very pleased to let you know that a HAI PPS is coming, by way of a research project.

For more information, please see www.ipcca.com.au/pps

 

 

What can $6m buy you?

The ability to run a children’s hospital for a year of course.Image result for angkor childrens hospital

I am in Siem Reap (Cambodia) at present and spending some time at Angkor Children’s Hospital. The hospital run entirely on donations and is the only children’s hospital in Cambodia. All services provided free. I won’t bore you with some stats, but here are some impressive figures considering the budget:

  • 27,000 ED patients a year
  • 132,000 outpatient visits
  • 880 intensive care admissions a year
  • Average cost of an ER visit $7, ICU $820 a stay.

Cambodia is a very poor country with a neonatal mortality of 18 per 1000 live births. 32% of children under 5 are stunted, 24% are underweight. Just $500 will is enough to provide weekly lectures to nurses for year; $5000 enough to buy medication for all ICU patients for 6 weeks.Image result for angkor childrens hospital

The most common hospital diagnosis are respiratory infections, asthma, gastro and sepsis. Over the next few days, I am meeting the Cambodia Oxford Medical Research Unit team, spending some time looking at infection control issues and challenges and similarly with nursing education and development. On infection control, the issues are significant, Gram negative resistance is a real problem (more on that to come in another blog).

If you want to know more about Angkor Children’s hospital, try this Angkor Hospital Video

More to come on infection control successes and challenges.

Brett

(Note: Pictures were not taken by me, rather publicly available)

 

Making antimicrobial resistance and the control of communicable disease, like infection control, is really everyone’s business.

As I reflect on another year, there have been many headline issues in infection control and communicable diseases. One headline was arguably the brightest, loudest and most prominent—antimicrobial resistance. In many respects 2016 was the year for antimicrobial resistance (AMR). The march of resistance and the grave concerns therein, particularly with the spread of carbapenem-resistant Enterobacteriaceae or CRE, have focused the attention of many. Global recognition and focus came via the United Nations as well as multi-national whole of government emphasis of AMR as a priority in the United Kingdom, the United States and other countries around the world. The year also saw a much-needed corrective global focus and attention on access and excess rather than overuse and misuse. All made for interesting times for clinicians, patients and consumers, and society in general. It also makes for interesting times for what comes next. In considering the priorities for research and innovation, the following seem to me to be some of the important focal areas for the future:

One priority focal point should be the formal designation of the control of communicable diseases, the spread of infection and antimicrobial resistance as societal, political, health and research priorities within a One Health approach. As we have seen, the United Nations declared AMR as a global health priority, only forth health priority to be so declared. The WHO and its many divisions applied renewed focus of AMR around the world. The United States and United Kingdom has posited AMR squarely as a whole-of-government and whole of society issue. Others have followed suit in various forms. Doing so matters. Such declarations matter. They transact change. Such designations focus the efforts and attention turn of governments, NGO, researchers, funding bodies, industry, clinicians, educators and society more broadly. Some doubt the significant and weight of such declarations as declared health and/or research priorities. To those I say try de-designate an existing health or research priority that has unfinished business and see what happens. For example removing cancer from Australia’s list of national health and research priorities would never be entertained, and any attempt would attract unanimous condemnation. The new and impressive Australian Medical Research Future Fund and Australian Medical Research and Innovation Priorities 2016-2018 have AMR and the control of communicable diseases as core priorities. Such designation is commended, but more is needed. AMR should be a national designated national health priority, as it is one issue that underpins so many health areas. It also underpins the fabric of society.

Another focus should be the acceleration and expansion of infection-excluding diagnostics and technology. While technology and resources for rapid and definitive diagnosis is the ultimate goal, excluding infection attributable injury and disease that has a reliance on antibiotics would go a long way to reducing our use of antibiotics. 

Closely related to this is the need for intense and considered focus on new and renewed countermeasures. This should include, but is not limited to, One Health vaccine development for conditions that have reliance on antimicrobials, drug discovery, rapid definitive diagnostics at both bench and bedside, utility of non-classic pharmacological interventions such as bacteriophages, and the standardisation of laboratory testing.

Moreover, we should focus on extending the evidence and practice base that is we know works (or not as the case may be) in human health and non-health related context into animal, agricultural and environment sectors for a truly One Health approach. Is it not time equivalent of the Five Moments for Hand Hygiene for veterinarians?

Finally, and not before time, it’s time cast of the armoury of own specialist professions and embrace the many in non-clinical professions, and call upon them to join be part of the solution to AMR. It is high time we harnessed existing and new knowledge into human factors and behaviour modification to bring about whole of societal change within a One Health approach. This should focus on existing evidence base for non-infection control and non-health to effect changes in human factors for reliance on antibiotics for all populations across the lifespan and across One Health. So much is known about behaviour change in the non-health areas, as marketing and behavioural sciences. It is difficult to see how these cannot be applicable (or relevant in some form) to AMR. What we can learn from our non-clinical peers about changing people behaviours from the commercial work is enormous. Moreover, such focus must be across the spectrum of disease and illness including prevention, treatment, rehabilitation and coalescence.

AMR is not, and can no longer be considered, a problem for just for clinicians both human and veterinary, and industry to solve. It is a whole of society challenge, and many of the solutions are non-clinical. It, like infection control, is everyone’s business.

 

Daddy, you swallowed a bug

“Daddy, maybe you swallowed the bugs”

I was tucking my four year old son into bed. He asked how I was feeling and I said that I was feeling a little sick. He said ‘maybe you ate chicken that wasn’t cooked’. I explained that I had not eaten any chicken. He then said ‘maybe you touched some bugs and swallowed them’. Now, that was a plausible explanation.

This simple conversation made me think of two things:

  1. Am I talking about infection control too much with my son (or maybe we should all talk more about infection prevention with our kids)
  2. Although simple, he is onto something, that as a civilised intelligent species, we seem still not to appreciate. What I hear you ask…..

Antimicrobial resistance.

On the news today, I heard about Antarctic Sewage Contamination. Some of the most pristine oceans in the world are contaminated with raw sewage (ironically from research bases that are working in the interests of the environment).  The most stand out point is was that researchers found some mammals (e.g. seals) showing signs of antibiotics resistance.

How? Humans consume antibiotics – directly (e.g. treatment) or indirectly by consuming meat or similar products that provided antibiotics.

With the winter cold and flu season kicking off in the Southern Hemisphere, it is time we all took some personal and community responsibility by prudent antibiotic use – or even better, antibiotic avoidance. We can all talk to friends and our children about the importance of preserving this miracle drug and infection prevention.

So, my son, for a four year, has cracked something we still continue to have trouble accepting and or changing – the vicious cycle of the overuse and or misuse of antibiotics.

Just for the record, I didn’t have an antibiotics resistance diarrheal disease, nor did I end up with D+V. I must have only consumed a small dose of the bugs….