An observational cohort study to determine the impact of research capacity building strategies implemented in an Australian metropolitan hospital occupational therapy department.

INTRODUCTION: Research capacity building enhances the abilities of individuals and is critical within health systems for quality patient care and promotes a culture of excellence within the occupational therapy profession. A research capacity building toolkit was proposed identifying strategies to support allied health professionals to undertake research. This study evaluated participant-reported outcomes of research capacity building toolkit implementation in an occupational therapy department. METHODS: An observational pre-post-cohort study at a tertiary hospital with volunteer occupational therapists using the standardised Research Capacity in Context Tool (RCCT) and an author-designed quality improvement (QI) survey was employed. The RCCT measures research capacity and culture at organisation, team and individual levels. Semi-structured interviews were used to elicit reflections regarding participant experience. RESULTS: All levels of the toolkit were implemented successfully. The response rate was 59% (n = 36) at baseline and 49.1% (n = 26) at follow-up. Eighty-five percent of participants held direct clinical roles. Nine clinicians participated in the interviews. There were significant improvements in the estimate mean for the organisation (6.51 [2019] compared with 8.13 [2020], p = <0.001) and the team (5.52 [2019] compared with 7.15 [2020], p = 0.001). The individual level did not significantly change with an estimate mean of 4.20 in 2019 increasing slightly to 4.84 in 2020 (p = 0.128). This was supported by the QI survey where improvements were noted in the department but not at an individual level. The qualitative findings verified the components of the toolkit including 'supporting clinicians in research', 'working together', 'valuing research for excellence' and reflected the importance of 'individual attributes'. CONCLUSION: The toolkit supported the implementation of specific strategies to enhance research capacity and culture. Improvements within the organisation and team were evident; however, these were not seen at an individual level. Further research about the contribution of individual-related factors and processes to the building of research capacity is required.

Integrative Review of Service-Learning Assessment in Nursing Education.

AIM: The aim of the research is to review all qualitative research studies related to service-learning assessment in nursing education. BACKGROUND: Recent literature reviews have examined quantitative but not qualitative research studies on service-learning assessment in nursing education. METHOD: An integrative review analyzed the results of published qualitative research of service-learning assessment. Articles included in this review were published in English in peer-reviewed journals from 1997 to 2014 and encompassed information on outcomes, assessment or evaluation, nursing education, and service-learning. RESULTS: Nine articles containing thematic analysis were included in the final review. Findings were synthesized into a higher order of analysis. Eight categories from that analysis were created: professional competency development, integration of knowledge for the professional nursing role, greater understanding of community strengths and needs, collaboration and teamwork, transformation and personal growth, civic engagement, emotions and adjustment, and culture awareness and competency. CONCLUSION: The integrative review will aid in the development of measurement categories for further nursing service-learning assessment work.

Barriers and facilitators influencing adherence to occupational therapy home assessment recommendations: a mixed methods systematic review protocol.

OBJECTIVE: To identify and describe the barriers and facilitators that influence adherence to recommendations provided as part of an occupational therapy home assessment. INTRODUCTION: Home assessments, including environmental interventions, are commonly used by occupational therapists. Home assessment recommendations aim to support a patient's independence in their occupational roles and improve safety in the home. Research evaluating home assessments and adherence to recommended strategies is limited. However, low adherence has been associated with poorer outcomes including falls, deconditioning, and decreased function. This research aims to synthesize factors that influence adherence to home assessment recommendations. INCLUSION CRITERIA: This review will consider all qualitative and quantitative studies that report on adherence to recommendations provided during occupational therapy home assessments. Studies will include adults (>18) and/or their caregivers, who live in the community and receive an occupational therapy home assessment. METHODS: A mixed methods systematic review will be undertaken. Eight databases will be searched for studies published in English reporting on adherence following home assessments completed by occupational therapists published after January 2000. Study quality will be assessed using standardized JBI critical appraisal tools dependent on study design. Data extraction will be performed using a standardized tool, followed by data transformation. Data synthesis will follow the convergent integrated approach. All findings will be tabulated to explore factors that influence adherence. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020159233.

Isolate independent molecular typing improves the yield of O typing of infections due to Shiga toxin producing Escherichia coli.

Molecular screening has increased detection of Shiga-toxin producing Escherichia coli (STEC). However, it is difficult to isolate the organism for epidemiological typing. We applied a molecular method for direct detection of nine O types from 110 stx positive faeces samples and compared the results with conventional isolate based methods. Using conventional methods 55/110 (50%) samples were O typed. Using the molecular method, 72/110 (65%) were O typed, including 23/38 (61%) culture negative samples. Combining both techniques typed 88/110 (80%) of samples. Molecular typing increased detection of O128 (2-25%, p<0.001), O26 (11-16%) O45 (0-6%) and O103 (1-6%) infections. Molecular typing of STEC direct from faecal samples improved O type yield; risk of bias in epidemiological and surveillance activities may be reduced by inclusion of culture independent typing methods.

Collaborative networks enable the rapid establishment of serological assays for SARS-CoV-2 during nationwide lockdown in New Zealand.

BACKGROUND: Serological assays that detect antibodies to SARS-CoV-2 are critical for determining past infection and investigating immune responses in the COVID-19 pandemic. We established ELISA-based immunoassays using locally produced antigens when New Zealand went into a nationwide lockdown and the supply chain of diagnostic reagents was a widely held domestic concern. The relationship between serum antibody binding measured by ELISA and neutralising capacity was investigated using a surrogate viral neutralisation test (sVNT). METHODS: A pre-pandemic sera panel (n = 113), including respiratory infections with symptom overlap with COVID-19, was used to establish assay specificity. Sera from PCR­confirmed SARS-CoV-2 patients (n = 21), and PCR-negative patients with respiratory symptoms suggestive of COVID-19 (n = 82) that presented to the two largest hospitals in Auckland during the lockdown period were included. A two-step IgG ELISA based on the receptor binding domain (RBD) and spike protein was adapted to determine seropositivity, and neutralising antibodies that block the RBD/hACE­2 interaction were quantified by sVNT. RESULTS: The calculated cut-off (>0.2) in the two-step ELISA maximised specificity by classifying all pre-pandemic samples as negative. Sera from all PCR-confirmed COVID-19 patients were classified as seropositive by ELISA ≥7 days after symptom onset. There was 100% concordance between the two-step ELISA and the sVNT with all 7+ day sera from PCR­confirmed COVID-19 patients also classified as positive with respect to neutralising antibodies. Of the symptomatic PCR-negative cohort, one individual with notable travel history was classified as positive by two-step ELISA and sVNT, demonstrating the value of serology in detecting prior infection. CONCLUSIONS: These serological assays were established and assessed at a time when human activity was severely restricted in New Zealand. This was achieved by generous sharing of reagents and technical expertise by the international scientific community, and highly collaborative efforts of scientists and clinicians across the country. The assays have immediate utility in supporting clinical diagnostics, understanding transmission in high-risk cohorts and underpinning longer­term 'exit' strategies based on effective vaccines and therapeutics.

First case of Mycobacterium heckeshornense lymphadenitis.

Mycobacterium heckeshornense is a slow-growing nontuberculous mycobacterium first characterized in 2000. It is reported to cause lung disease and tenosynovitis. We report a case of isolated massive axillary lymphadenopathy in an elderly woman, where histology showed necrotizing granulomata and M. heckeshornense was isolated as the causative organism.

Effect of antimicrobial locks for tunneled hemodialysis catheters on bloodstream infection and bacterial resistance: a quality improvement report.

BACKGROUND: Catheter-restricted antimicrobial lock (AML) use reduces catheter-associated bloodstream infection (CA-BSI) in clinical trial settings, but may not be as effective in clinical settings and may increase bacterial resistance. DESIGN: Quality improvement report analyzed using a cross-sectional time series (unbalanced panel) design. SETTING & PARTICIPANTS: The study cohort comprised all prevalent adults treated with hemodialysis through a tunneled catheter for any, but not necessarily all, of the time from January 1, 2003, to June 30, 2006, in Manukau City, New Zealand (135,346 catheter-days, 404 tunneled catheters, 320 patients). QUALITY IMPROVEMENT PLAN: Catheter-restricted AMLs (heparin plus gentamicin) for all tunneled catheters from July 1, 2004. MEASURES: Repeated observations of CA-BSI, hospitalization, tunneled catheter removal, and death from CA-BSI analyzed by using generalized estimating equations with a single level of clustering for each tunneled catheter and patterns of bacterial resistance analyzed by using simple descriptive statistics. RESULTS: AML use was associated with reductions in rates of CA-BSI and hospitalization for CA-BSI by 52% and 69% for patients with tunneled catheters locked continuously with AMLs since their insertion compared with those with tunneled catheters that were not, respectively. AML exposure also was associated with a trend to increased gentamicin resistance amongst coagulase-negative staphylococci isolates, a pattern similar to that observed for BSIs in our general hemodialysis population in which tunneled catheters were not the source of BSI, but different from that in the general non-end-stage renal disease population in the region. LIMITATIONS: This is an uncontrolled observational study and cannot prove causality. The follow-up period of 18 months is longer than for other studies, but still too short to definitely answer whether AML use drives bacterial resistance. CONCLUSIONS: A change to use of AMLs may improve clinical outcomes; however, additional study of associated bacterial resistance is needed before AML use becomes standard care.

Burkholderia cepacia: An Outbreak in the Peritoneal Dialysis Unit.

Burkholderia cepacia is a ubiquitous, opportunistic, environmental gram-negative bacillus which most commonly affects cystic fibrosis and immunocompromised patients. Rarely, it can cause peritoneal dialysis (PD) exit-site infection (ESI). Information relating to predisposing factors, clinical course, and treatment options for B. cepacia ESIs is limited. Although reports of B. cepacia healthcare-associated infections exist, outbreaks in PD units have not previously been reported. A recent outbreak of B. cepacia ESI in our PD unit provided a unique opportunity to study B. cepacia ESIs and to outline an approach to investigating such an outbreak.After unexpectedly identifying B. cepacia as the cause of PD catheter ESIs in 3 patients over an 11-week period, we began systematically screening our PD population for B. cepacia exit-site colonization. A further 6 patients were found to be affected, 3 with asymptomatic colonization and 3 with symptomatic B. cepacia ESI. Four of the 6 developed tunnel infections requiring multiple courses of antibiotic treatment, and 3 patients required catheter removal; 2 patients with symptomatic ESIs without tunnel involvement responded to oral and topical antibiotics. Further investigation implicated 4% chlorhexidine aqueous bodywash used by all patients as the probable source of the outbreak.This is the first reported outbreak of B. cepacia ESIs. We noted an association between diabetes mellitus and refractory/more extensive infection. Our experience suggests that isolated ESIs can be treated successfully with oral antibiotics whereas tunnel infections generally require catheter removal.

Suboptimal performance of rotavirus testing in a vaccinated community population should prompt laboratories to review their rotavirus testing algorithms in response to changes in disease prevalence.

Rotavirus vaccine has reduced disease prevalence in many countries. Consequently, we aimed to assess the reliability of a rotavirus immunoassay in the community population of Auckland and Northland, New Zealand. Between 22 October 2015 and 31 December 2016, 2873 fecal samples were tested by enzyme immunoassay (EIA, Rotascreen II, Microgen, UK) from 2748 patients (median age 8 years, range 0-101 years). Eighty-nine (3.1%) samples were reactive; 86 samples were tested by a second method. Rotavirus was confirmed in 49/86 (57%). Positive rotavirus EIAs were more likely to be confirmed in samples from cases ≥1 year of age (positive predictive value [PPV] 61%, 95% confidence interval [CI] 50-72%, P = 0.049) and in spring/summer (PPV 67%, 95% CI 55-78%, P = 0.003). Reactive rotavirus tests required confirmatory testing regardless of demographic, vaccine, or seasonal factors; a review of rotavirus testing algorithms may be necessary in other vaccinated community populations.

The burden of Legionnaires' disease in New Zealand (LegiNZ): a national surveillance study.

BACKGROUND: Legionnaires' disease is under-diagnosed because of inconsistent use of diagnostic tests and uncertainty about whom to test. We assessed the increase in case detection following large-scale introduction of routine PCR testing of respiratory specimens in New Zealand. METHODS: LegiNZ was a national surveillance study done over 1-year in which active case-finding was used to maximise the identification of cases of Legionnaires' disease in hospitals. Respiratory specimens from patients of any age with pneumonia, who could provide an eligible lower respiratory specimen, admitted to one of 20 participating hospitals, covering a catchment area of 96% of New Zealand's population, were routinely tested for legionella by PCR. Additional cases of Legionnaires' disease in hospital were identified through mandatory notification. FINDINGS: Between May 21, 2015, and May 20, 2016, 5622 eligible specimens from 4862 patients were tested by PCR. From these, 197 cases of Legionnaires' disease were detected. An additional 41 cases were identified from notification data, giving 238 cases requiring hospitalisation. The overall incidence of Legionnaires' disease cases in hospital in the study area was 5·4 per 100 000 people per year, and Legionella longbeachae was the predominant cause, found in 150 (63%) of 238 cases. INTERPRETATION: The rate of notified disease during the study period was three-times the average over the preceding 3 years. Active case-finding through systematic PCR testing better clarified the regional epidemiology of Legionnaires' disease and uncovered an otherwise hidden burden of disease. These data inform local Legionnaires' disease testing strategies, allow targeted antibiotic therapy, and help identify outbreaks and effective prevention strategies. The same approach might have similar benefits if applied elsewhere in the world. FUNDING: Health Research Council of New Zealand.

Rotavirus Infection in the Auckland Region After the Implementation of Universal Infant Rotavirus Vaccination: Impact on Hospitalizations and Laboratory Implications.

BACKGROUND: In July 2014, New Zealand introduced universal infant vaccination with RotaTeq (Merk & Co.) administered as 3 doses at 6 weeks, 3 and 5 months of age. We sought to assess the impact of rotavirus vaccination on gastroenteritis (GE) hospitalizations in the greater Auckland region and analyze changes in rotavirus testing in the period around vaccine introduction. METHODS: Hospitalizations, laboratory testing rates and methods were compared between the pre-vaccine period (2009-2013), post-vaccine period (January 2015 to December 2015) and year of vaccine introduction (2014). RESULTS: There was a 68% decline in rotavirus hospitalizations of children <5 years of age after vaccine introduction (from 258/100,000 to 83/100,000) and a 17% decline in all-cause gastroenteritis admissions (from 1815/100,000 to 1293/100,000). Reductions were also seen in pediatric groups too old to have received vaccine. Despite these changes, rotavirus testing rates in our region remained static in the year after vaccine introduction compared with the 2 prior years, and after vaccine introduction, we observed a high rate of false positives 19/58 (33%) in patients with reactive rotavirus tests. CONCLUSIONS: Rotavirus vaccine has had a significant early impact on gastroenteritis hospitalizations for children in the Auckland region. However, continued rotavirus testing at pre-vaccine rates risks generating false positive results. Laboratories and clinicians should consider reviewing their testing algorithms before vaccine introduction.

Haemophilus ducreyi causing chronic skin ulceration in children visiting Samoa.

Chancroid is a sexually transmitted infection associated with genital ulceration and lymphadenopathy caused by Haemophilus ducreyi. Localized skin infections, in the absence of genital lesions, have not been previously reported. We report 3 cases of lower limb ulceration in children caused by H. ducreyi and postulate that H. ducreyi may be a previously unrecognized cause of chronic skin ulceration.

Staphylococcus epidermidis in urine is not always benign: a case report of pyelonephritis in a child.

PURPOSE: Staphylococcus epidermidis in urine cultures from previously healthy children is usually considered to be a contaminant. The goal of this study was to identify cases in which S. epidermidis was an infectious cause of urinary tract infection (UTI) in children. METHODS: A literature search identified 7 cases, 6 of which were previously published and 1 which was unpublished, described herein. RESULTS: S. epidermidis was identified as the causative organism of UTIs in children with underlying urinary tract abnormalities. CONCLUSION: UTIs caused by S. epidermidis in a previously healthy child should not be disregarded as a contaminant and further workup for urinary tract abnormality is indicated.

Severe Clostridium difficile infection in New Zealand associated with an emerging strain, PCR-ribotype 244.

AIM: To compare disease severity and clinical outcome of Clostridium difficile infection (CDI) due to PCR-ribotype (RT) 244 with CDI due to other strains present in Auckland. METHOD: A retrospective, case-control study was conducted. Ten cases with CDI due to RT 244 were compared with 20 controls infected with other C. difficile strains. RT 244 isolates were further analysed for antimicrobial susceptibility, binary toxin genes and mutations in the tcdC gene. RESULTS: Cases were significantly more likely to have severe disease than controls (OR 9.33; p=0.015). 50% of cases had community-associated CDI compared with 15% of controls (p=0.078). All RT 244 isolates produced binary toxin and had a single-base pair deletion in tcdC at position 117. CONCLUSION: C. difficile RT 244 is a newly recognised strain in New Zealand. It shares several features that characterise RT 027. Given its propensity to cause severe community-associated disease, a heightened awareness of this strain is needed to ensure early testing in patients admitted from the community with identified risk factors for CDI.

Association between antimicrobial locks for hemodialysis central venous catheters and antibiotic resistance.

Antimicrobial locks (AMLs) are effective in preventing catheter-associated bloodstream infections (CABSI) in hemodialysis (HD) patients, but may increase antibiotic resistance. In our center, gentamicin-heparin locks have been used for all HD central venous catheters since July 1, 2004. We previously reported a significant reduction in CABSI rates, but a short-term trend to increased gentamicin resistance among coagulase-negative staphylococci (CNS). We present a further 3-year follow-up study of bacterial resistance in our dialysis center. We examined the susceptibility of bacterial isolates from CABSI from July 1, 2006 to July 31, 2009, restricting analyses to CNS, gram-negative bacilli, and Staphylococcus aureus. We compared the frequency of gentamicin resistance in these isolates between four groups: CABSI in HD patients, non-CABSI in HD patients, peritonitis in peritoneal dialysis (PD) patients, and bloodstream infection in the non-end-stage kidney failure general population. For CNS isolates, the frequency of gentamicin resistance was similar between the CABSI and PD peritonitis groups, but higher in both groups than the general population. The pattern was similar for S. aureus although the differences were of borderline statistical significance. The frequency of gentamicin resistance among gram-negative bacilli isolates did not differ between groups. Gentamicin resistance was more common than expected in CNS and possibly S. aureus isolates from CABSI, although this resistance may be part of a generally higher frequency of antibiotic resistance in the dialysis population, rather than a direct result of AML use. AMLs remain a valuable clinical tool although surveillance is needed to ensure that benefits continue to outweigh risks.

Bloodstream infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae at a tertiary care hospital in New Zealand: risk factors and outcomes.

OBJECTIVES: To define local risk factors and outcomes for bacteremia with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) at a tertiary hospital in New Zealand. METHODS: Patients with ESBL-E bacteremia were compared to matched control patients with non-ESBL-producing Enterobacteriaceae bacteremia. Patients were matched by onset of bacteremia (community vs. hospital), site of blood culture collection (peripheral vs. via central line), and infecting organism species. RESULTS: Forty-four cases with matched controls were included. Eight- and 30-day mortality was higher in cases than controls (27% vs. 7%; p=0.011 and 34% vs. 11%, p=0.011). Twenty-one cases (48%) were community-onset. Community-onset cases were associated with urinary tract infection, whereas hospital-onset cases were associated with central line infection, intensive care admission, and Enterobacter cloacae. Independent risk factors for ESBL-E bacteremia were fluoroquinolone exposure (odds ratio (OR) 6.56, 95% confidence interval (CI) 1.79-24), first-generation cephalosporin exposure (OR 12.3, 95% CI 1.01-148), and previously-known colonization with ESBL-E (OR 46.2, 95% CI 3.45-619). CONCLUSIONS: The association with fluoroquinolone exposure suggests that measures to reduce unnecessary use may be an effective preventative strategy. Known colonization with ESBL-E is a strong risk factor for ESBL-E bacteremia, and colonization status should be taken into consideration when choosing empirical therapy.