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Along with emerging technologies electrolysed water (EW) systems have been proposed for cleaning and/or disinfection in clinical areas. There is evidence for the use of EW in food-handling and the dairy industry however there is lack of evidence for EW as an effective cleaning and disinfecting agent in a clinical setting. Existing publications mostly are either laboratory based or from non-clinical settings. This is in direct contrast to other approaches used in healthcare cleaning. The aim of this paper is to provide infection prevention and control professionals with a risk assessment checklist using an evaluation of electrolysed water as an example of the analysis and consideration required prior to the introduction of any new technology and, in particular, the inclusion of sustainability.
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BACKGROUND: Tight-fitting respirators are a critical component of respiratory protection against airborne diseases for health workers. However, they are not recommended for health workers with facial hair. Some health workers are unable to shave for religious or medical reasons. Under-mask beard covers have been proposed as a solution to allow health workers with facial hair to wear tight-fitting respirators. However, studies to date have been limited by their predominant reliance on qualitative rather than quantitative fit testing techniques. AIM: To assess the efficacy of under-mask beard covers in achieving an adequate seal with tight-fitting disposable P2/N95 respirators using quantitative fit testing. METHODS: Bearded adult males underwent quantitative fit testing with an under-mask beard cover using either a TSI PortaCount Respirator Fit Tester 8038 or an AccuFit 9000 PRO fit testing device on up to five disposable P2/N95 respirators (3M 1860, 3M 1870+, BYD N95 Healthcare Particulate Respirator, BSN Medical ProShield N-95 Medium and Trident RTCFFP2). The primary outcome was the proportion of subjects that passed or failed quantitative fit testing with an under-mask beard cover. FINDINGS: Thirty subjects were assessed; of these, 24 (80%) passed quantitative fit testing with at least one tight-fitting P2/N95 disposable respirator. Among these subjects, the median best-achieved fit factor was 200 (interquartile range 178-200). None of the subjects had an adverse reaction to the under-mask beard cover. CONCLUSION: The under-mask beard cover technique may be used to achieve a satisfactory seal with tight-fitting P2/N95 respirators in health workers with facial hair who cannot shave.
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Exposição Ocupacional , Dispositivos de Proteção Respiratória , Adulto , Desenho de Equipamento , Pessoal de Saúde , Humanos , Masculino , Respiradores N95 , Exposição Ocupacional/prevenção & controle , Ventiladores MecânicosRESUMO
BACKGROUND: Inappropriate antimicrobial prescribing may harm patients and drive antimicrobial resistance. Junior doctors' knowledge of infectious diseases and antimicrobial prescribing is inadequate. Online spaced case-based learning can improve knowledge. OBJECTIVE: To develop infectious diseases and antimicrobial prescribing course content for online spaced education and assess its effectiveness and feasibility for junior doctors. METHODS: Infectious diseases and antimicrobial course content was developed for an online spaced education platform (Qstream Inc., Burlington, MA). Junior doctors (postgraduate years 1-3) at two tertiary teaching hospitals in Sydney participated in the study. Course content was provided with Qstream at one hospital and at the other hospital via two face-to-face (FTF) tutorials from August to October 2017. Knowledge and self-confidence were compared before and after training within and between both cohorts. RESULTS: Participation in the course was higher in the Qstream cohort with 48/127 (37.8%) completing the course compared with 44/110 (40%) attending one or both FTF sessions, of whom 22/110 (20%) attended both. Improvement in mean knowledge score from 69.7% to 81.5% in the Qstream cohort was significantly greater than the FTF cohort's minimal improvement from 67.6% to 67.9% (95% CI 2.79-20.33; P=0.01). In the Qstream cohort mean confidence rating (0-10) improvement from 5.14 to 6.55 was greater than the FTF group improvement from 5.37 to 5.85 (95% CI 0.132-1.171; P=0.02). Qstream feedback was very positive. CONCLUSIONS: Online spaced education in infectious diseases and antimicrobial prescribing was feasible, acceptable and effective for junior doctors. It has potential to reduce inappropriate antimicrobial prescribing and warrants further investigation.
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Antibacterianos , Doenças Transmissíveis , Antibacterianos/uso terapêutico , Doenças Transmissíveis/tratamento farmacológico , Hospitais de Ensino , Humanos , Prescrição InadequadaAssuntos
Diagnóstico Tardio , Infecções por HIV/diagnóstico , Hepatite B Crônica/diagnóstico , Hepatite C Crônica/diagnóstico , Adulto , Idoso , Diagnóstico Tardio/efeitos adversos , Feminino , Infecções por HIV/complicações , Infecções por HIV/virologia , Hepatite B Crônica/complicações , Hepatite B Crônica/virologia , Hepatite C Crônica/complicações , Hepatite C Crônica/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Long-term outcomes of HIV-infected patients admitted to the intensive care unit (ICU) since the advent of combination antiretroviral therapy (cART) have not been well described. We reviewed the long-term outcomes and clinical follow-up of HIV-infected patients admitted to the Prince of Wales Hospital ICU between 1999 and 2005 by a retrospective medical record review. Mortality was assessed in the ICU, in hospital and in the long-term. Twenty-four HIV-infected male patients underwent 26 ICU admissions. Their ICU and in-hospital mortalities were 33% and 46%, respectively. Higher APACHE (acute physiology and chronic health evaluation) II scores (median 27 versus 12, P < 0.001), lower CD4 cell counts (median 45 versus 335 cells/µL, P = 0.041) and longer hospitalization times prior to ICU admission (median 4 versus 1 day, P = 0.02) were significantly associated with in-hospital mortality. We found 85% of the subjects who survived hospital admission were still alive at a median of 41 months (4 months to 5 years) of follow-up, all of who were functionally independent. HIV-infected patients who survived ICU admission at our institution had good long-term outcomes in the cART era.
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Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , APACHE , Adulto , Idoso , Antirretrovirais/uso terapêutico , Austrália/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Resultado do TratamentoAssuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Antifúngicos/uso terapêutico , Aspergilose/diagnóstico , Pirimidinas/uso terapêutico , Triazóis/uso terapêutico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Adulto , Terapia Antirretroviral de Alta Atividade , Aspergilose/tratamento farmacológico , Aspergilose/imunologia , Evolução Fatal , Humanos , Masculino , VoriconazolRESUMO
OBJECTIVES: To describe, retrospectively, the Australian experience of multi-centric Castleman's disease (MCD) in the setting of HIV infection, specifically with the advent of HAART, and newer chemotherapeutic agents. PATIENTS AND METHODS: HIV-infected patients diagnosed with MCD since 1994, were identified from three major HIV treatment centres in Australia. Demographic and disease characteristic variables were collated by the National Centre in HIV Epidemiology and Clinical Research. RESULTS: Eleven patients were identified with MCD. Medial follow up was 46 (18-57) months. All had CD4 cell counts less than 500 cells/microL. All but one patient was receiving HAART at the time of diagnosis. Nine of the 11 patients had Kaposi's sarcoma (KS) and two patients also developed non-Hodgkin's Lymphoma (NHL). All patients received chemotherapy for MCD. The response rate from Chemotherapy was 64%. Only two patients achieved sustained remissions. The median survival was 21.9 (1-52) months. The mortality was 45% from MCD and its related complications. CONCLUSION: MCD in HIV infected patients is a rare and life-threatening disorder. There is limited recent information on optimal treatment for MCD. MCD in our series appeared to be a chemo-responsive disease. In our experience, treatment with liposomal anthracycline was associated with good response rates and acceptable toxicity in several patients, and therefore merits further exploration to establish its role. Treatment in the future may concentrate on novel agents such as anti-interleukin 6, anti-CD20 antibodies, thalidomide and viral ablation.
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Hiperplasia do Linfonodo Gigante/virologia , Infecções por HIV/complicações , Adulto , Alquilantes/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Hiperplasia do Linfonodo Gigante/tratamento farmacológico , Hiperplasia do Linfonodo Gigante/mortalidade , Seguimentos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Vitória/epidemiologiaRESUMO
OBJECTIVE: Amphotericin B deoxycholate initial therapy and fluconazole maintenance therapy is the treatment of choice for AIDS-associated cryptococcal meningitis. However, the administration of amphotericin B is associated with considerable toxicity. A potential strategy for reducing the toxicity and increasing the therapeutic index of amphotericin B is the use of lipid formulations of this drug. DESIGN AND METHODS: HIV-infected patients with cryptococcal meningitis were randomized to treatment with either liposomal amphotericin B (AmBisome) 4 mg/kg daily or standard amphotericin B 0.7 mg/kg daily for 3 weeks, each followed by fluconazole 400 mg daily for 7 weeks. During the first 3 weeks, clinical efficacy was assessed daily. Mycological response was primarily evaluated by cerebrospinal fluid (CSF) cultures at days 7, 14, 21 and 70. RESULTS: Of the 28 evaluable patients, 15 were assigned to receive AmBisome and 13 to receive amphotericin B. Baseline characteristics were comparable. The time to and the rate of clinical response were the same in both arms. AmBisome therapy resulted in a CSF culture conversion within 7 days in six out of 15 patients versus one out of 12 amphotericin B-treated patients (P = 0.09), within 14 days in 10 out of 15 AmBisome patients versus one out of nine amphotericin B patients (P = 0.01), and within 21 days in 11 out of 15 AmBisome patients versus three out of eight amphotericin B patients (P = 0.19). When Kaplan-Meier estimates were used to compare time to CSF culture conversion, AmBisome was more effective (P < 0.05; median time between 7 and 14 days for AmBisome versus > 21 days for amphotericin B). AmBisome was significantly less nephrotoxic. CONCLUSIONS: A 3-week course of 4 mg/kg AmBisome resulted in a significantly earlier CSF culture conversion than 0.7 mg/kg amphotericin B, had equal clinical efficacy and was significantly less nephrotoxic when used for the treatment of primary episodes of AIDS-associated cryptococcal meningitis.
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Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Fluconazol/uso terapêutico , Meningite Criptocócica/tratamento farmacológico , Administração Oral , Adolescente , Adulto , Anfotericina B/administração & dosagem , Anfotericina B/efeitos adversos , Anfotericina B/farmacocinética , Antifúngicos/administração & dosagem , Antifúngicos/efeitos adversos , Sistemas de Liberação de Medicamentos , Quimioterapia Combinada , Fluconazol/administração & dosagem , Fluconazol/efeitos adversos , Humanos , Lipossomos , Meningite Criptocócica/complicações , Avaliação de Resultados em Cuidados de SaúdeRESUMO
OBJECTIVE: To measure fertility and birth rates and to describe the reproductive histories of women diagnosed with HIV-1 infection in Australia. METHODS: The medical records of 294 women with HIV-1 infection in four states of Australia were reviewed. Expected fertility and birth rates were calculated using national statistics. RESULTS: In the study population, 152 (52%) women had at least one pregnancy prior or subsequent to HIV-1 diagnosis. At maternal HIV-1 diagnosis, 71 (24%) women had a total of 106 children aged under 15 years. During the study period, 246 women were aged 15, 44 years and 58 (23%) of these became pregnant after HIV-1 diagnosis. Women whose exposure to HIV-1 was injecting drug use were twice as likely to become pregnant and more likely to have multiple pregnancies than women who did not report injecting drug use. The annual general fertility rate was 30 per 10,000 compared with 63 per 10,000 for the Australian female population aged 15-44 years, and the birth rate in women with HIV-1 infection was one-half that of the general female population. Of pregnancies confirmed after HIV-1 diagnosis, 47% were voluntarily terminated, a rate more than double that of the general population. All multiple terminations were among women whose exposure to HIV-1 was injecting drug use. CONCLUSIONS: Fertility and birth rates among women with HIV-1 infection are lower than the general population and the rate of termination higher. The results of this study provide a basis for the management of women with HIV-1 infection who are considering pregnancy.
PIP: Review of the medical records of 294 HIV-1-infected women in four states of Australia found the fertility and birth rates among those women to be lower and the rate of pregnancy termination higher than those of the general female Australian population. Expected fertility and birth rates were calculated using national statistics. 152 women had at least one pregnancy before or subsequent to HIV-1 diagnosis. At maternal HIV-1 diagnosis, 71 women had a total of 106 children under age 15 years. During the study period of 1987-92, 58 of the 246 women aged 15-44 years became pregnant after HIV-1 diagnosis. Women whose exposure to HIV-1 was IV drug use were twice as likely to become pregnant and more likely to have multiple pregnancies than women who did not report such drug use. The annual general fertility rate was 30/10,000 compared to 63/10,000 for the general Australian female population, while the birth rate among HIV-1-infected women was also half that of the general female population. Of pregnancies confirmed after HIV-1 diagnosis, 47% were voluntarily terminated, a rate more than double that of the general population. All multiple terminations were among women whose exposure to HIV-1 was through IV drug use.
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Fertilidade , Infecções por HIV , Adolescente , Adulto , Austrália/epidemiologia , Coeficiente de Natalidade , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Infecções por HIV/transmissão , Humanos , Transmissão Vertical de Doenças Infecciosas , Gravidez , Resultado da GravidezRESUMO
Gay men with HIV often belong to strong mutually supportive groups, but many women with HIV experience the disease in relative isolation. Informed primary care doctors can make a valuable difference to their management.
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Infecções por HIV/diagnóstico , HIV-1 , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/transmissão , Humanos , Transmissão Vertical de Doenças Infecciosas , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológicoRESUMO
Initiating or changing antiretroviral therapy requires specialist knowledge of indications, side effects and drug interactions. This brief guide highlights the key points for monitoring antiretroviral therapy.
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Antivirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Inibidores Enzimáticos/uso terapêutico , Humanos , Inibidores da Transcriptase Reversa/uso terapêuticoRESUMO
Treating systemic malignancies requires specialist skill and experience, with active treatment often providing the best initial palliation of symptoms. A full management plan involving general practitioner, patient and others is essential at this stage of HIV disease.
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Neoplasias Encefálicas/etiologia , Infecções por HIV/complicações , Linfoma Relacionado a AIDS , Linfoma não Hodgkin/etiologia , Displasia do Colo do Útero/etiologia , Neoplasias do Colo do Útero/etiologia , Neoplasias Encefálicas/terapia , Feminino , Infecções por HIV/terapia , Doença de Hodgkin/etiologia , Doença de Hodgkin/terapia , Humanos , Linfoma Relacionado a AIDS/terapia , Linfoma não Hodgkin/terapia , Masculino , Cuidados Paliativos , Prognóstico , Fatores de Risco , Neoplasias do Colo do Útero/terapia , Displasia do Colo do Útero/terapiaRESUMO
PIP: Late-stage HIV infection is characterized by profound immunodeficiency with a progressive and irreversible decline in the CD4 count, functional impairment of cellular and humoral immunity, and evidence of increased viral replication, with the appearance of p24 antigenemia and increasing levels of beta(2)-microglobulin and neopterin. These changes are associated with increased susceptibility to many infections, the emergence of malignancies, and neurological complications due to the direct infection of neural tissue with HIV. In Australia, opportunistic infections and malignancies account for 75% and 18% of AIDS diagnoses, respectively. Opportunistic infections and neurological involvement usually occur late in the illness and may be associated with disturbances of function of each part of the neuraxis. The detailed clinical nature of the involvement has been described in several recent reviews and is probably not different in the Asia-Pacific region. The most common opportunistic infections in Australia are Pneumocystis carinii pneumonia (PCP), esophageal candidiasis, toxoplasmosis, CMV infection, atypical mycobacteriosis, and cryptococcal meningitis. There are few data from Asian countries, but it seems that the most common opportunistic infections are tuberculosis, PCP, systemic Penicillium marneffei infection, and cryptococcal meningitis. There is little information from Asia on neurological conditions. Tuberculosis is probably the most significant threat to public health in Asia and the Pacific. Its management and prevention require ongoing planning and resources. To that end, a collaborative effort is called for to help resource-poor countries. Mycobacterial, fungal, viral, and protozoal infections are discussed, along with consideration of neurological complications, malignant disease, and late manifestations of HIV infection in children.^ieng
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Complexo Relacionado com a AIDS , Infecções Oportunistas Relacionadas com a AIDS , Complexo Relacionado com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Ásia/epidemiologia , Criança , Feminino , Humanos , Ilhas do Pacífico/epidemiologiaRESUMO
The initial impact of HIV infection on the practising obstetrician and gynaecologist was specifically related to the treatment of HIV positive women who were pregnant. The current North American experience suggests that HIV will be an important consideration in gynaecology from now on.