Does Prior Respiratory Viral Infection Provide Cross-Protection Against Subsequent Respiratory Viral Infections? A Systematic Review and Meta-Analysis.

The epidemiology of different respiratory viral infections is believed to be affected by prior viral infections in addition to seasonal effects. This PROSPERO-registered systematic review identified 7388 studies, of which six met our criteria to answer the question specifically. The purpose of this review was to compare the prevalence of sequential viral infections in those with previously documented positive versus negative swabs. The pooled prevalence of sequential viral infections over varying periods from 30-1000 days of follow-up was higher following a negative respiratory viral swab at 0.15 than following a positive swab at 0.08, indicating the potential protective effects of prior respiratory viral infections. However, significant heterogeneity and publication biases were noted. There is some evidence, albeit of low quality, of a possible protective effect of an initial viral infection against subsequent infections by a different virus, which is possibly due to broad, nonspecific innate immunity. Future prospective studies are needed to validate our findings.

Arcobacter Butzleri in an AIDS Patient.

Background: Arcobacter butzleri (A. butzleri) is an emerging enteric pathogen increasingly identified in Europe and is likely under-reported in other global regions. We describe to our knowledge the first case report of A. butzleri in an AIDS patient, along with the first documented local (Singapore) case of A. butzleri infection. Case Presentation. A 38-year-old AIDS patient presented with diarrhoea of 2 weeks' duration. Stool cultures yielded A. butzleri. The patient was treated with 3 days of ciprofloxacin with clinical resolution of diarrhoea. Conclusion: A. butzleri is likely to be present, although under-reported in AIDS patients, and it should be noted as a pathogen of increasing significance.

Effectiveness of a Ward level target accountability strategy for hand hygiene.

Background: Hand hygiene is a simple and effective solution in prevention of Multi Drug Resistant Organisms. Hand Hygiene campaigns have mostly taken the form of a generalised hospital approach with visual reminders and rewards for improvement in compliance. We describe a hand hygiene programme that sets an individualised ward target to increase accountability and drive improvement. Methods: We undertook to develop a "Hand Hygiene Accountability" model, where the mean compliance rate, using the WHO hand hygiene assessment tool, for each ward over the past 6 months plus 10% was used as a target for that particular ward.Rewards were given to wards with the most percentage improvement over the year. A graded escalation was used for wards that did not meet targets based on 1,2 or 3 months of non-compliance. The most extreme action, setting up a task force directed by the Chairman of our Medical Board, would be required if 3 continuous months of non-compliance was observed. Hand Hygiene audits were performed by staff trained using the WHO audit tools. The same strategy was repeated at our community hospital.Active surveillance testing for Methicillin Resistant Staphylococcus aureus (MRSA) using nasal, groin and axilla swabs established before the project continued to be in operation, as did surveillance for hospital acquired MRSA bacteraemia (using NHSN criteria), hospital-onset Clostridioides difficile (HO-CD), and multi-resistant gram-negative bacilli. Results: Data from July 2015 to December 2017 was analysed. In the acute and community hospitals, 21,582 and 5770 hand hygiene (HH) observations were undertaken respectively.In the acute care hospital, HH compliance rates went from 65 to 78% (p-value < 0.00001). There was a reduction in MRSA bacteraemia from 5 episodes at the start of the study to 0 in 2017.In the community hospital, HH compliance improved from a mean of 64 to 75% (p-value 0.00005). MRSA transmission rate decreased from 5.72 per 1000 patient days, to 2.79 per 1000 patient days (p-value 0.00035) with an admission prevalence of 13.1% for 2016 and 20.6% in 2017. Conclusions: Using a ward level accountability for hand hygiene is possible and can be successful in improving hand hygiene rates, possibly reducing transmission of MDROs. Realistic targets need to be set and adequate rewards and incentives provided to ensure continuous improvement.