Health care workers' experiences of video-based monitoring of hand hygiene behaviors: a qualitative study.

BACKGROUND: Hand hygiene is key to preventing health care-associated infections. Human observation is the gold standard for measuring compliance, but its utility is increasingly being questioned with calls for the use of video monitoring approaches. The utility of video-based systems to measure compliance according to the WHO 5 moments is largely unexamined, as is its acceptability amongst health care workers (HCW) and patients. This study examined HCW acceptability of video monitoring for hand hygiene auditing. METHODS: Following trial of a video monitoring system (reported elsewhere), 5 participating HCW attended 2 in-depth group interviews where they reviewed the footage and explored responses to the approach. Transcripts were analyzed using thematic analysis. RESULTS: Four themes were identified: 1) Fears; 2) Concerns for patients; 3) Changes to feedback; and 4) Behavioral responses to the cameras. HCWs expressed fears of punitive consequences, data security, and confidentiality. For patients, HCWs raised issues regarding invasion of privacy, ethics, and consent. HCWs suggested that video systems may result in less immediate feedback but also identified potential to use the footage for feedback. They also suggested that the Hawthorne Effect was less potent with video systems than human observation. CONCLUSIONS: The acceptability of video monitoring systems for hand hygiene compliance is complex and has the potential to complicate practical implementation. Additionally, exploration of the acceptability to patients is warranted. CHECKLIST: COREQ.

Australian critical care nurses' knowledge, preparedness, and experiences of managing SARS-COV-2 and COVID-19 pandemic.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has again highlighted the crucial role of healthcare workers in case management, disease surveillance, policy development, and healthcare education and training. The ongoing pandemic demonstrates the importance of having an emergency response plan that accounts for the safety of frontline healthcare workers, including those working in critical care settings. OBJECTIVES: The aim of the study was to explore Australian critical care nurses' knowledge, preparedness, and experiences of managing patients diagnosed with severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2) and COVID-19. METHODS: An exploratory cross-sectional study of Australian critical care nurses was conducted between June and September 2020. An anonymised online survey was sent to Australian College of Critical Care Nurses' members to collect information about their knowledge, preparedness, and experiences during the COVID-19 pandemic. Descriptive statistics were used to summarise and report data. RESULTS: A total of 157 critical care nurses participated, with 138 fully complete surveys analysed. Most respondents reported 'good' to 'very good' level of knowledge about COVID-19 and obtained up-to-date COVID-19 information from international and local sources. Regarding managing patients with COVID-19, 82.3% felt sufficiently prepared at the time of data collection, and 93.4% had received specific education, training, or instruction. Most participants were involved in assessing (89.3%) and treating (92.4%) patients with COVID-19. Varying levels of concerns about SARS-CoV-2 infection were expressed by respondents, and 55.7% thought the pandemic had increased their workload. The most frequent concerns expressed by participants were a lack of appropriate personal protective equipment (PPE) and fear of PPE shortage. CONCLUSIONS: While most nurses expressed sufficient preparedness for managing COVID-19 patients, specific education had been undertaken and experiential learning was evident. Fears of insufficient or lack of appropriate PPE made the response more difficult for nurses and the community. Preparedness and responsiveness are critical to successful management of the COVID-19 pandemic and future outbreaks of emerging infectious diseases.

Australian dentists' knowledge, preparedness, and experiences during the COVID-19 pandemic.

BACKGROUND: COVID-19 is a global health crisis. Close contact with the mucous membranes and respiratory secretions of patients and aerosol-generating procedures renders dentists and other oral health professionals at high risk of exposure to SARS-CoV-2. We examined dentists' knowledge, preparedness, and experiences of managing COVID-19 in Australia. METHODS: A cross-sectional online survey of dentists with a current membership with The Australian Dental Association (ADA) was conducted between March and April 2021. RESULTS: Of the 368 survey responses, most dentists (72.3%) reported having a good level of knowledge about COVID-19, with most visiting the ADA Federal COVID-19 (74.7%) and state/territory department of health websites (62.8%), respectively to source up-to-date information. Most dentists (87.6%) felt prepared to manage COVID-19 into the future, although 66% reported not receiving training or certification in the use of PPE. Over half (58.7%) reported not being concerned about contracting SARS-CoV-2 at work, with some (28.9%, n = 98/339) feeling more stressed than usual and having heavier workloads. CONCLUSION: COVID-19 had significant impact in oral healthcare in Australia. Dentistry has adapted to the varied challenges raised by the pandemic. Comprehensive training and detailed guidelines were fundamental for successful patient management during the COVID-19 outbreak.

"We will have to learn to live with it": Australian dentists' experiences during the COVID-19 pandemic.

BACKGROUND: Australian dentists are among the frontline healthcare workers providing dental and oral health care during the COVID-19 pandemic, and therefore have been affected in multiple ways. In this study, we explore their experiences of practising and living in this pandemic. METHODS: A qualitative study analysed responses of 333 Australian dentists' who participated in a survey with open-ended questions about the challenges and positive outcomes of practising during the COVID-19 pandemic. The questions were embedded in a national online survey of Australian dentists' knowledge, preparedness and experiences conducted between March and April 2021. Data were analysed using content analysis. RESULTS: Australian dentists reported their challenging experiences to be four-fold, including 'public health orders and restrictions', 'Infection prevention and control measures (IPC), 'Personal concerns about COVID-19' and 'Detracting opinions about COVID-19'. Conversely, they reported positive outcomes in relation to their practice during COVID-19, including 'Awareness of and adherence to IPC practices', 'Teamwork and interpersonal dynamics', 'Decompressed workload', 'Perceived support' and 'unintended positive outcomes'. CONCLUSION: The COVID-19 pandemic generated several challenges for Australian dentists, but it also engendered some positive outcomes. Understanding of these can help tailor the professional support plans to address the needs and priorities of Australian dentists during the current and future pandemics.

Infection control professionals' and infectious diseases physicians' knowledge, preparedness, and experiences of managing COVID-19 in Australian healthcare settings.

BACKGROUND: COVID-19 has placed unprecedented demands on infection control professionals (ICPs) and infectious disease (ID) physicians. This study examined their knowledge, preparedness, and experiences managing COVID-19 in the Australian healthcare settings. METHODS: A cross-sectional study of ICPs and ID physician members of the Australasian College for Infection Prevention and Control (ACIPC) and the Australasian Society for Infectious Diseases (ASID) was conducted using an online survey. Descriptive statistics were used to summarise and report data. RESULTS: A total of 103 survey responses were included in the analysis for ICPs and 45 for ID physicians. A majority of ICPs (78.7%) and ID physicians (77.8%) indicated having 'very good' or 'good' level of knowledge of COVID-19. Almost all ICPs (94.2%) relied on state or territory's department of health websites to source up-to-date information While most ID physicians (84.4%) used scientific literature and journals. A majority of ICPs (96%) and ID physicians (73.3%) reported feeling 'moderately prepared' or 'extremely prepared' for managing COVID-19. Most respondents had received specific training about COVID-19 within their workplace (ICPs: 75%; ID physicians: 66.7%), particularly training/certification in PPE use, which made them feel 'mostly or entirely confident' in using it. Most ICPs (84.5%) and ID physicians (76.2%) reported having 'considerably' or 'moderately more' work added to their daily duties. Their biggest concerns included the uncertainties under a rapidly changing landscape, PPE availability, and the community's compliance. CONCLUSION: Harmonised information, specific COVID-19 training and education, and adequate support for front-line workers are key to successfully managing COVID-19 and other future outbreaks.

Emergency clinicians' knowledge, preparedness and experiences of managing COVID-19 during the 2020 global pandemic in Australian healthcare settings.

BACKGROUND: Emergency clinicians have a crucial role during public health emergencies and have been at the frontline during the COVID-19 pandemic. This study examined the knowledge, preparedness and experiences of Australian emergency nurses, emergency physicians and paramedics in managing COVID-19. METHODS: A voluntary cross-sectional study of members of the College of Emergency Nursing Australasia, the Australasian College for Emergency Medicine, and the Australasian College of Paramedicine was conducted using an online survey (June-September 2020). RESULTS: Of the 159 emergency nurses, 110 emergency physicians and 161 paramedics, 67.3-78% from each group indicated that their current knowledge of COVID-19 was 'good to very good'. The most frequently accessed source of COVID-19 information was from state department of health websites. Most of the respondents in each group (77.6-86.4%) received COVID-19 specific training and education, including personal protective equipment (PPE) usage. One-third of paramedics reported that their workload 'had lessened' while 36.4-40% of emergency nurses and physicians stated that their workload had 'considerably increased'. Common concerns raised included disease transmission to family, public complacency, and PPE availability. CONCLUSIONS: Extensive training and education and adequate support helped prepare emergency clinicians to manage COVID-19 patients. Challenges included inconsistent and rapidly changing communications and availability of PPE.

General practitioners' knowledge, preparedness, and experiences of managing COVID-19 in Australia.

BACKGROUND: COVID-19 has brought unprecedented demands to general practitioners (GPs) worldwide. We examined their knowledge, preparedness, and experiences managing COVID-19 in Australia. METHODS: A cross-sectional online survey of GPs members of the Royal Australian College of General Practitioners (RACGP) was conducted between June and September 2020. RESULTS: Out of 244 survey responses, a majority of GPs (76.6%) indicated having good knowledge of COVID-19, relying mostly on state/territory department of health (84.4%) and the RACGP (76.2%) websites to source up-to-date information. Most felt prepared to manage patients with COVID-19 (75.7%), yet over half reported not receiving training in the use of PPE. The majority were concerned about contracting SARS-CoV-2, more stressed than usual, and have heavier workloads. Their greatest challenges included scarcity of PPE, personal distress, and information overload. CONCLUSION: Access to PPE, training, accurate information, and preparedness are fundamental for the successful role of general practices during outbreaks.

Enhancing genomics-based outbreak detection of endemic Salmonella enterica serovar Typhimurium using dynamic thresholds.

Salmonella enterica serovar Typhimurium is the leading cause of salmonellosis in Australia, and the ability to identify outbreaks and their sources is vital to public health. Here, we examined the utility of whole-genome sequencing (WGS), including complete genome sequencing with Oxford Nanopore technologies, in examining 105 isolates from an endemic multi-locus variable number tandem repeat analysis (MLVA) type over 5 years. The MLVA type was very homogeneous, with 90 % of the isolates falling into groups with a five SNP cut-off. We developed a new two-step approach for outbreak detection using WGS. The first clustering at a zero single nucleotide polymorphism (SNP) cut-off was used to detect outbreak clusters that each occurred within a 4 week window and then a second clustering with dynamically increased SNP cut-offs were used to generate outbreak investigation clusters capable of identifying all outbreak cases. This approach offered optimal specificity and sensitivity for outbreak detection and investigation, in particular of those caused by endemic MLVA types or clones with low genetic diversity. We further showed that inclusion of complete genome sequences detected no additional mutational events for genomic outbreak surveillance. Phylogenetic analysis found that the MLVA type was likely to have been derived recently from a single source that persisted over 5 years, and seeded numerous sporadic infections and outbreaks. Our findings suggest that SNP cut-offs for outbreak cluster detection and public-health surveillance should be based on the local diversity of the relevant strains over time. These findings have general applicability to outbreak detection of bacterial pathogens.

Outbreak of community-acquired Staphylococcus aureus skin infections in an Australian professional football team.

OBJECTIVES: Skin and soft tissue infections commonly affect athletes and can lead to cluster outbreaks if not managed appropriately. We report the findings of an investigation into an outbreak of community-acquired Staphylococcus aureus infection in an Australian professional football team. DESIGN: Retrospective cross-sectional study. METHODS: Nose, axilla, groin and throat swab were collected from 47 participants. MRSA and MSSA isolates underwent antibiotic susceptibility testing, binary typing and whole genome sequencing. Infection control practitioners (ICPs) investigated the training grounds for risk factors in the transmission of S. aureus. RESULTS: Almost half of the participants (n=23, 48.9%) were found to be colonised with MSSA. An outbreak cluster of MRSA ST5 closely related to the fusidic acid-resistant New Zealand NZAK3 clone was identified in a group of four players. MSSA ST15 and MSSA ST291 strains were found to have colonised and spread between two and five players, respectively. All participants were advised to undergo decolonisation treatment consisting of 4% chlorhexidine body wash and mupirocin nasal ointment for ten days. The ICP team identified several unhygienic practices within the club's shared facilities that may have played a role in the transmission of S. aureus. CONCLUSIONS: We report for the first time a community-associated S. aureus outbreak involving the highly successful fusidic acid-resistant MRSA ST5 clone in a professional football club associated with inadequate hygiene procedures. Management and prevention of S. aureus relies heavily on hygiene education and adherence to personal and environmental hygiene practices and policies.

Air travel in a COVID-19 world: Commercial airline passengers' health concerns and attitudes towards infection prevention and disease control measures.

BACKGROUND: COVID-19 and its associated travel bans have reduced international passenger traffic by over 80% below 2019 levels. If airlines are to resume flying at commercially sustainable levels, they must work to restore passengers confidence and sense of security. This study examined commercial airline passengers' health concerns and attitudes towards infection prevention and control measures for travel health and safety in the current COVID-19 global pandemic. METHODS: A cross-sectional study was conducted inviting adult members of 39 frequent flyer groups across three social media platforms to participate in an online survey. RESULTS: A total of 205 respondents completed the survey. The majority (75.6%) reported feeling 'somewhat' to 'extremely concerned' about contracting an infectious disease while flying, particularly respiratory-related. Few (9.8%) reported perceiving their health as an 'essential priority' for their preferred airline. Most respondents agreed airlines should provide complimentary hand sanitisers (86.8%), sanitary wipes (82.9%) and masks (64.4%) for passengers to use while flying as well as more information about preventing the spread of infections (90.7%), which would make the majority feel safer to fly. CONCLUSION: COVID-19 has extensively challenged the air travel industry. Passengers have signalled that they expect more from airlines, and that they would actively engage in additional infection prevention and disease control measures while flying. Airlines must ensure passengers about the steps taken to minimize travel-associated risks, and their commitment towards passengers' health and wellbeing, in order to rebuild consumers' confidence in the recovery of the air travel industry.

COVID-19 in Australia: our national response to the first cases of SARS-CoV-2 infection during the early biocontainment phase.

BACKGROUND: On 31 December 2019, the World Health Organization recognised clusters of pneumonia-like cases due to a novel coronavirus disease (COVID-19). COVID-19 became a pandemic 71 days later. AIM: To report the clinical and epidemiological features, laboratory data and outcomes of the first group of 11 returned travellers with COVID-19 in Australia. METHODS: This is a retrospective, multi-centre case series. All patients with confirmed COVID-19 infection were admitted to tertiary referral hospitals in New South Wales, Queensland, Victoria and South Australia. RESULTS: The median age of the patient cohort was 42 years (interquartile range (IQR), 24-53 years) with six men and five women. Eight (72.7%) patients had returned from Wuhan, one from Shenzhen, one from Japan and one from Europe. Possible human-to-human transmission from close family contacts in gatherings overseas occurred in two cases. Symptoms on admission were fever, cough and sore throat (n = 9, 81.8%). Co-morbidities included hypertension (n = 3, 27.3%) and hypercholesterolaemia (n = 2, 18.2%). No patients developed severe acute respiratory distress nor required intensive care unit admission or mechanical ventilation. After a median hospital stay of 14.5 days (IQR, 6.75-21), all patients were discharged. CONCLUSIONS: This is a historical record of the first COVID-19 cases in Australia during the early biocontainment phase of the national response. These findings were invaluable for establishing early inpatient and outpatient COVID-19 models of care and informing the management of COVID-19 over time as the outbreak evolved. Future research should extend this Australian case series to examine global epidemiological variation of this novel infection.

SARS-CoV-2 infection and COVID-19: The lived experience and perceptions of patients in isolation and care in an Australian healthcare setting.

BACKGROUND: Isolation and quarantine are key measures in outbreak management and disease control. They are, however, associated with negative patient experiences and outcomes, including an adverse impact on mental health and lower quality of care due to limited interaction with healthcare workers. In this study, we explore the lived experience and perceptions of patients in isolation with COVID-19 in an Australian healthcare setting. METHODS: Using a phenomenological approach from a Heideggerian hermeneutical perspective, we conducted individual semistructured interviews with the first 11 COVID-19 patients admitted to a designated COVID-19 facility in Australia. Interviews were audiorecorded, transcribed verbatim, and imported into NVivo 12 for coding and analysis. RESULTS: Participants' lived experience and perceptions of COVID-19 were represented by 5 themes: "Knowing about COVID-19," "Planning for, and responding to, COVID-19," "Being infected," "Life in isolation and the room," and "Post-discharge life." Within these, participants conveyed both positive and negative lived experiences of infection, isolation, and illness. The contextual aspects of their social and physical environment together with their individual resources contributed to the framing of their planning for, and response to, the outbreak, and were important mediators in their experience. CONCLUSIONS: Findings from this study provide a valuable insight into the lived experiences of patients with COVID-19, which reflect those of patients with other infectious diseases who require isolation.

Scope of practice and educational needs of infection prevention and control professionals in Australian residential aged care facilities.

BACKGROUND: Healthcare-associated infections are serious and significant complications present across healthcare services, including residential aged care facilities. Although ensuring high quality personal and clinical care delivered to older people residing in these facilities is a high national priority, there is a paucity of evidence published about outbreaks, governance and education programs held for healthcare workers within Australian residential aged care facilities. The aim of this study is to examine the scope of practice of Infection Prevention and Control professionals within Australian residential aged care facilities and the types of infection prevention and control education and training delivered. METHODS: A cross-sectional study was conducted inviting all Australian residential aged care facilities to participate in an online survey. RESULTS: A total of 134 residential aged care facilities completed the survey. The majority (88.1%) reported having a designated Infection Prevention and Control professional responsible for surveillance and educational activities. Hand hygiene (94%), personal protective equipment (PPE) (79.9%) and environmental cleaning (70.1%) were some of the available Infection Prevention and Control programs. The lack of access to Infection Prevention and Control education (69.5%) and lack of Infection Prevention and Control expert advice (67.2%) were also reported by some Residential aged care facilities. CONCLUSION: Australian residential aged care facilities recognise the importance of Infection Prevention and Control training programs to manage infection surveillance and outbreaks. Considerable activities are carried out to increase knowledge on breaking the chain of infection. Yet, more support and resources are needed to assist these efforts.

Global burden, point sources, and outbreak management of healthcare-associated Burkholderia cepacia infections: An integrative review.

OBJECTIVE: To examine the global burden, associated point sources, and successful prevention and control measures for documented outbreaks of Burkholderia cepacia healthcare-associated infections (HAIs). DESIGN: Integrative review. METHODS: A review of all outbreaks of Burkholderia cepacia HAIs published in the peer-reviewed literature between January 1970 and October 2019 was conducted to identify the global burden, associated point sources, and successful prevention and control measures using the Guidelines for Outbreak Reports and Intervention Studies of Nosocomial Infections (ORION). RESULTS: In total, we reviewed 125 documented outbreaks of Burkholderia cepacia-related HAIs worldwide. The reported B. cepacia HAIs for this period involved 3,287 patients. The point sources were identified in most outbreaks of B. cepacia HAIs (n = 93; 74.4%); they included medication vials, disinfectants, and antiseptics. Moreover, 95 of the outbreak reports (76%) described effective prevention and control measures, but only 33 reports indicated the use of a combination of environment-, patient- and staff-related measures. None of the outbreak reports used the ORION guidelines. CONCLUSIONS: Outbreaks of Burkholderia cepacia HAIs are an ongoing challenge. They are often associated with immunocompromised patients who acquire the infection from exposure to contaminated medications, products, and equipment. These outbreaks are not infrequent, and a range of infection prevention and control measures have been effective in arresting spread. The use of ORION guidelines for outbreak reporting would improve the quality of information and data to generate evidence for translation into practice.

Global commercial passenger airlines and travel health information regarding infection control and the prevention of infectious disease: What's in a website?

BACKGROUND: Air travel has never been easier, cheaper or faster, with large volumes of people travelling around the world. These factors increase the risk of the spread of infectious diseases by air travel. Little is known, however, about the extent to which airlines provide information to passengers on infection control and measures to prevent the spread of infectious diseases. This study examined the websites of the global commercial passenger airlines to see if they contained information about infection control and prevention of infectious diseases and appraised the clinical usefulness of that information. METHOD: A cross-sectional text-based analysis of the 73 airline websites from the six global commercial passenger airline conglomerates was performed to identify information about infection control and prevention of infectious between July and August 2019. RESULTS: Of the 73 airline websites, less than half (n = 35, 28.6%) contained information deemed useful for passengers. While there was a range of general health advice within the websites, there was limited information about infection control and preventing infectious diseases. A minority of websites contained information about vaccination status prior to travel, and to a lesser extent handwashing and hand hygiene, with very few including disease-specific advice or preventive measures. CONCLUSIONS: Airline websites are an underutilised source of information for infection control and the prevention of infectious diseases. Providing passengers with information on basic infection control and prevention measures may support the global efforts against the spread of infectious diseases.

Prevalencia de síntomas asociados a trastornos musculoesqueléticos en estudiantes de odontología / Prevalence of symptoms associated to musculoskeletal disorders in dental students

Existe una alta prevalencia de dolor musculoesqueletal en odontólogos y estudiantes de odontología alrededor del mundo. El objetivo de esta investigación será determinar la prevalencia de síntomas asociados a trastornos musculoesqueléticos en estudiantes de odontología de la Universidad Austral de Chile. Un cuestionario de auto respuesta fue aplicado a 206 estudiantes entre segundo y quinto año al finalizar el semestre académico. El cuestionario incluyó preguntas de antecedentes generales y de presencia de síntomas según tipo, localización, intensidad, frecuencia y momento del día en que aparecen. El 83 por ciento de los estudiantes reportaron molestias musculoesqueléticas encontrando en general una mayor prevalencia en mujeres. En hombres la zona más reportada fue la espalda media, y en mujeres la zona del cuello y hombro. La mayor intensidad se concentró en mujeres con nivel de dolor 4 y en hombres con nivel 3 (según escala EVA). El momento del día con más molestias fue al terminar el trabajo clínico. Según el año de la carrera que cursan, la mayor prevalencia se observó en cuarto año y el síntoma más frecuente fue el cansancio y la fatiga. El incremento en la carga académica y clínica estaría relacionada con una alta prevalencia de trastornos musculoesqueléticos en estudiantes de odontología.

There is a high prevalence of musculoskeletal pain in dentists and dental students around the world. The aim of the study is to determine the prevalence of musculoskeletal disorder symptoms in dental students of the Universidad Austral de Chile. A self responded questionnaire was applied to 206 students between second and fifth year, at the end of the academic semester. The questionnaire included questions of general background and symptoms presence depending on type, location, intensity, frequency and time of the day in which they appear. An 83 percent of the students reported musculoskeletal discomfort, finding a higher prevalence among women. According to the school year, the highest prevalence was observed in fourth year and the most frequent symptom was tiredness and fatigue. In men, the most reported area was mid back, and in women neck and shoulder. The highest intensity was focused on women with pain level 4 and in men with level 3 (depending on the scale (VAS). The moment of the day with higher discomfort was at the end of the clinical work. A high prevalence of musculoskeletal disorders was found, probably related to the progressive increase of clinical work.