Bird Flu

Published 1st July 2024

In May, the Interim Australian Centre for Disease Control issued a Media release advising that a human case of avian influenza (H5N1) has been detected in Australia (Victoria), this is the first human case ever recorded in Australia. A child acquired the infection while overseas and became unwell on returning to Australia earlier this year. Importantly, the case in Victoria is not the same as the strains that have recently been found in dairy cattle in the USA. It is also not the same strain that has been detected at a poultry farm in Victoria. Australia’s interim Centre for Disease Control (CDC) is monitoring the risks to the Australian public

About Bird Flu

• The highly pathogenic avian (bird) influenza (flu) is caused by a virus that mainly affects birds. It can also be found in other animals.
• Most avian influenza viruses don’t spread easily from animals to humans. But it can happen with certain strains.
• There is no evidence that bird flu strains found around the world can spread easily from human to human. If humans do get bird flu, symptoms range from mild to severe.
• While seasonal influenza immunisation will not protect against avian influenza, getting the seasonal flu vaccine each year can help prevent bird flu from mixing with other flu viruses which may lead to new mutated viruses and become a bigger threat to people. This is particularly important for people who work on a poultry farm or are travelling to countries with bird flu.
• Source: Interim Australian Centre for Disease Control: Bird Flu, updated 17 June 2024.

Influenza (Flu)

Published 1st May 2024

• Flu is caused by the type A, type B or rarely the type C influenza virus. Only types A and B cause major outbreaks and severe disease, while type C can cause an illness in children similar to the common cold.
• Colds and flu are very contagious viral infections, and you can catch a cold or flu at any time of the year, not just in winter — however they are more common during the winter months. This may be because people are more likely to stay indoors and be in close contact with each other.
• If you have a cold or flu and you sneeze or cough, tiny droplets of fluid containing the virus are launched into the air. These droplets spread about 1 metre and are suspended in the air for a while so they can be breathed in by someone else who may then become infected.
• These tiny droplets of fluid can also land on surfaces. Anyone who touches these surfaces can catch a cold or flu if they pick up the virus on their hands and then touch their nose or mouth.
• If you have a cold or flu and you touch your mouth or nose and then touch a person or object without first washing your hands, then you can transfer the virus to that person or object.
• Flu Prevention: Get a flu shot; Wash your hands; Cover coughs and sneezes; Bin your tissues; avoid sharing – clean surfaces eg. keyboard, phone, and door handles; Self-care at home.
• NOTE: Antibiotics won’t help!!

Source: Australian Govt Department of Health & Aged Care: Influenza and Immunisation Guidelines.

Legionnaires' Disease

Published 1st February 2024

In early January 2024, a media release was issued for people who had been in the Sydney CBD to be on alert for symptoms of Legionnaires disease as a number of people had developed the disease after spending time in the area.

• What is Legionnaires’ disease? Legionnaires' disease is an infection of the lungs (pneumonia) caused by Legionella bacteria. Infection occurs when a person breathes in bacteria that are commonly found in the environment.
• What are the symptoms? Legionnaires' disease usually causes fever, chills, cough, and shortness of breath. Some people also have muscle aches, headache, tiredness, loss of appetite and diarrhoea. People can become very sick with pneumonia; most people recover but the disease is occasionally fatal.
• How is it spread? Legionnaires' disease can occur after a person breathes in contaminated water droplets or dust. The time between the person’s exposure to the bacteria and becoming sick is between 2 to 10 days. Legionnaires' disease is not spread from person to person.
• Who is at risk? Legionnaires' disease most often affects middle-aged and older people, particularly those who smoke or who have chronic lung disease. Also at increased risk are people whose immune systems are suppressed.
• How is it diagnosed? It is often difficult to distinguish Legionnaires' disease from other types of pneumonia by symptoms alone. Chest X-rays help diagnose pneumonia, but the diagnosis of Legionnaires' disease requires special tests. Urine, sputum, and blood samples can help confirm the diagnosis. Blood samples need to be taken three to six weeks apart to check on antibodies in the blood.
• How is it treated? Legionnaires' disease can usually be cured by treatment with antibiotics, for serious infections, admission to hospital may be required. Source: NSW Health, 2022. Legionnaires’ disease. Fact sheet

Buruli Ulcer

Published 1st November 2023

• Buruli ulcer is a bacterial skin infection caused by the bacterium Mycobacterium ulcerans (M. ulcerans). Patients usually develop a painless lump or wound (known as a nodule or papule) which can initially be mistaken for an insect bite. Over time the lesion can slowly progress to develop into a destructive skin ulcer which is known as Buruli or Bairnsdale ulcer.
• Everyone is susceptible to infection. Disease can occur at any age, but Buruli ulcer notifications are highest in people aged 60 years and the risk of contracting Buruli ulcer, however, is still considered low.
• The disease is spreading geographically across Victoria and is no longer restricted to specific coastal locations. Most recently, there has been an increase in cases linked to several suburbs in Greater Geelong and the inner north and west of Melbourne.
• The highest risk for infection occurs during the warmer months, but it usually takes between 4-5 months for an ulcer to develop following infection.
• Early recognition and diagnosis are critical to prevent skin and tissue loss – consider the diagnosis in patients with a persistent ulcer, nodule, papule, or oedema and cellulitis not responding to usual treatments, especially on exposed parts of the body.
• Buruli ulcer must be notified to the Department within five days of diagnosis. There is increasing evidence that mosquito bites and possums play a role in disease transmission in Victoria.
• Prevention measures include avoiding mosquito bites, reducing mosquito breeding sites, covering cuts and abrasions when outdoors and washing any soil or water off your skin following outdoor activities. tps://www.health.vic.gov.au/health-advisories/buruli-ulcer-is-spreading

Responsible and Safe Use of Antimicrobials for Respiratory Infections

Published 12th September 2023

• Inappropriate antimicrobial prescribing contributes not only to the growing antimicrobial resistance crisis, but also to potential adverse outcomes such as allergic reactions and drug–drug interactions. Despite a downtrend in Healthcare antimicrobial prescribing in Australia, rates of prescribing per capita remain high when compared with other Organisation for Economic Cooperation and Development (OECD) nations. This is particularly an issue for upper respiratory tract infections (URTIs), which have higher rates of prescribing.
• Prescription review and feedback in Private hospitals:
• Review of antimicrobial prescriptions and provision of feedback to prescribers regarding the quality of antimicrobial prescribing is an effective strategy for improving appropriate use of antimicrobials. Review and feedback can be provided by a clinician with ID expertise, including medical, pharmacy and / or IPC nursing professionals.
• Audits such as the National Antimicrobial Prescribing Survey (NAPS) can help in identifying the units, services, groups of providers and even individual providers for whom prescription review and feedback interventions may be prioritised.
• Use of an antimicrobial management team (AMT) to provide post-prescription advice to prescribers for patients on certain antimicrobials or with certain indications is a useful method for delivering Antimicrobial Stewardship, which has been implemented in Australian private hospitals. Ward pharmacists, nursing staff, or a combination of both, can identify patients suitable for review by the AMT.

COVID-19, Influenzas and Respiratory Syncytial Virus (RSV)

Published 17th July 2023

• COVID-19, the flu and respiratory syncytial virus (RSV) are together driving a wave of respiratory illnesses this year.
• RSV: RSV is one of about 200 viruses that can cause a cold — which is very common. Most cases of illness caused by RSV are mild, but it can lead to serious illness for young children, the elderly, and people with immunosuppressive conditions. Contracting the virus can lead to chest infections like bronchiolitis and pneumonia.
• It can also cause ear infections and the coughing associated with the illness can worsen asthma symptoms.
• Usually, the first symptoms are: Fever; Runny nose; Coughing; Wheezing or difficulty breathing; Decreased appetite.
• Typically, most cases go away after about two weeks but can have symptoms up to 4 weeks.
• COVID, Influenza and RSV have very similar symptoms. COVID poses the biggest risk to those who are older. RSV poses the biggest threat to young children and Influenzas pose the biggest threat to young children, older adults, and pregnant women. All these diseases pose an increased risk in individuals who have underlying health conditions or are immunocompromised regardless of age".

Its that time of the year!! When to get the flu jab and don't forget that Covid booster

Published 29th May 2023

• Annual influenza vaccination should occur anytime from April onwards to be protected for the peak flu season, which is generally June to September. The highest level of protection occurs in the first 3 to 4 months following vaccination.
• Pregnant women should receive the vaccine at any stage during pregnancy. Influenza vaccines can be given on the same day with a COVID-19 vaccine. There is no set timeframe to wait between having a COVID-19 infection and then having the influenza vaccine. Once you are feeling well and have no fever, you may receive an influenza vaccine.
• ATAGI recommends a 2023 COVID-19 vaccine booster dose for adults in the following groups, if their last COVID-19 vaccine dose or confirmed infection (whichever is the most recent) was 6 months ago or longer, and regardless of the number of prior doses received:
  • All adults aged 65 years and over
  • Adults aged 18-64 years who have medical comorbidities that increase their risk of severe COVID-19, or disability with significant or complex health needs.
  • Refer to ATAGI state for further recommendations: https://www.health.gov.au/news/atagi-2023-booster-advice
• A new Immunisation History Statement (IHS) is now available which only shows COVID-19 and influenza vaccination information that has been recorded on the Australian Immunisation Register (AIR). This provides individuals with more privacy as they can use it as evidence for employment purposes.

Flu Season 2023

Published 10th March 2023

• After a record low Australian influenza season in 2021 and then significantly higher numbers in 2022, experts are preparing for what may come in 2023.
• Given Australian influenza epidemics are typically sparked by returned overseas travellers, reviewing the Northern Hemisphere flu season often provides a glimpse into what Australia can expect later in the year.
• The World Health Organization (WHO) Collaborating Centre for Reference and Research on Influenza at the Doherty Institute stated the Northern Hemisphere has experienced an early flu season and similar to the flu season in 2022.
• ‘Normally our peak is August, but last year it was in late May and early June then tailed off quickly.
• Centers for Disease Control and Prevention (CDC), the US hospitalisation rate for influenza at this point in their season is four times higher than any season in the past decade.
• Germany has experienced a similar spike, with confirmed influenza cases increasing from 3000 to 56,000 per week over the past month, while in England there was an average of 344 patients per day in hospital with influenza last month – more than 10 times higher than last year’s numbers.
• US media had initially labelled their impending winter flu season a ‘tripledemic’ as it began with high rates of COVID, influenza and respiratory syncytial virus (RSV).
• ‘There is also currently an outbreak of influenza in Fiji.
• ‘Peaks of other viruses have also occurred in Australia recently including metapneumovirus.
• Meanwhile, trials by Novavax continue in Australia and New Zealand for a combined COVID and influenza vaccine. Moderna are also making a combination vaccine. While neither will be available in 2023. COVID and flu vaccination will once again form a major part of Australia’s defences against the viruses.
• All HCFs should stay informed about recommendations on influenza vaccination and continue to test for respiratory viruses via multiplex PCR, where possible.
• State and territory surveillance reports for influenza are available online, as are the Australian Influenza Vaccine Committee recommendations for the 2023 quadrivalent and trivalent influenza vaccines.

Monkey Pox Vaccine

Published 7th December 2022

• In Victoria, MPX vaccine (JYNNEOS® vaccine) is available free-of-charge for specific priority groups. Eligibility criteria will be expanded when additional supply of vaccines become available. Refer to State guidelines for Current eligibility criteria. 
• A person will start to build protection in the days after their first dose with antibodies providing protection within 2 weeks.The monkeypox vaccine requires two doses for optimal protection. While supply is limited, second dose administration is currently reserved for individuals who meet criteria for ‘immunocompromise’ as per the State monkeypox vaccination program guidelines. For all other cohorts, the administration of the second vaccine dose should be postponed until further advice is issued by the Department of Health.
• There is significant global demand for the vaccine. Australia is expected to receive additional doses at the beginning of 2023. A limited supply has been allocated to select public hospitals and sexual health clinics to vaccinate high risk individuals. More clinics and access points will be able to provide the vaccine as additional stock becomes available.

The Future is Infection Prevention: 50 Years of Infection Prevention

Published 16th October 2022

• Infection Prevention and Control (IPC) week is celebrated during the third week of October each year to coincide with international Infection Prevention week.
• IPC week 2022 takes place October 16 – 22, 2022!
• COVID-19 has continued to show the world what we’ve always known, infection control professionals (ICPs) play a crucial role in keeping us safe and healthy. In addition to fighting a global pandemic, the infection prevention and control community is protecting us from surges in healthcare-associated infections, monkeypox, measles outbreaks, flu season, and so many other day-to-day infectious battles.
• IPC week aims to shine a light on infection prevention each and every year. Last year’s focus was on making infection prevention our intention in 2021. This year’s theme highlights the decades of infection prevention and inspires the next generation of ICPs to join the fight.
• Please join the celebration and inspire others.
• Some useful websites and tools:
  • https://www.acipc.org.au/ipc-week/
  • https://infectionpreventionandyou.org/iipw/
  • https://gamahealthcare.com.au/IPCweek2022?utm_source=sendgrid.com&utm_medium=email&utm_campaign=website

ACIPC CONFERENCE

• 2022 ACIPC International Conference will be held on the 13-16th November in Sydney.
• ACIPC is delivering the 2022 conference in a hybrid format, and the in-person component of the event is to be held at the International Convention Centre, Sydney.
• The conference will provide an opportunity to reflect on the lessons learnt during the pandemic, our remote leadership, pivoting and adapting the past to deal with the present and future and the innovations that have occurred in IPC along with other developments in industry and research.
• The ACIPC 2022 Conference is focusing on capturing new approaches and thinking, as well as the cornerstones of IPC with healthcare epidemiology; antimicrobial resistance and stewardship; IPC in long-term care and non-clinical settings; education, training, and staff development; community engagement and patient care.
• The conference has national and international experts, network with likeminded professionals and meet with Australasia’s largest collection of IPC industry suppliers.
• For more information visit: https://acipcconference.com.au/

Respiratory Viruses

Published 1st September 2022

Respiratory viruses cause illnesses that affect the nose, throat and breathing passages including the lungs. These viruses commonly result in mild cold or flu like symptoms in most people, except in those with risk factors, the elderly and the very young.

• Common respiratory viruses include:
  • Respiratory syncytial virus (RSV)
  • Human parainfluenza virus (HPIV)
  • Adenovirus
  • Rhinovirus
  • Human metapneumovirus (HMPV)
• Respiratory viruses are spread from person to person by breathing in droplets when someone with the virus breathes, coughs or sneezes OR touching a contaminated surface or object that a person with the virus has coughed or sneezed on, then touching their own eyes, nose or mouth.

Infectiousness. Most patients are usually most infectious in the first few days that they have symptoms. However, sometimes people are infectious a few days before their symptoms start. While they continue to have a fever or generally feel unwell, you are still infectious. Some people, particularly those who are immunosuppressed, can remain infectious after they have recovered from their illness.

Who is at risk?

• While anyone can get respiratory viruses, those who are at higher risk of severe illness include:
  • People aged 60 years and older
  • Pregnant women
  • Aboriginal, Torres Strait Islander and Pacific Islander
  • People with obesity, diabetes, serious cardiovascular disease, chronic lung disease (including severe asthma),  severe chronic liver or kidney disease, active cancer or who are immunocompromised
  • Some people with a disability including those with a disability that affects their lungs, heart or immune system
  • Residents of aged care and disability care facilities
  • People aged 18 years and older who are unvaccinated

Symptoms and transmission

• Most people develop symptoms between 1 to 10 days after  getting infected, depending on which virus they have.
  • ​​​​​​​​​​​​​​Symptoms may be different depending on which virus is causing the illness and severity.
  • However, there are symptoms that are common to many respiratory viruses. These include fever, cough, runny nose, sneezing, sore throat, headache, muscle aches, fatigue and feeling generally unwell.
  • Symptoms will often be mild or moderate, but some people may get very unwell and this is usually due to complications from worsening infection eg. Bronchiolitis; Bronchitis; Croup; Pneumonia; Acute Sinusitis; Acute ear infection and /or Laryngitis.

​​​​​​​For more information refer to HICMR Information Sheets: RSV and Bronchiolitis; Human Metapneumovirus; and Common Respiratory Infections. State Health Departments also have information sheets for Consumers.

Monkeypox

Published 1st July 2022

• Monkeypox is a rare disease that is caused by infection with the monkeypox virus.
• Recently there have been unrelated cases in Australia.

What is the issue?

• Monkeypox is endemic in Central and West Africa. When cases are detected outside Africa; they are usually identified in returned travellers who visited endemic areas.
• A recent (since mid-May) increase in monkeypox cases have been reported in multiple overseas countries which are not endemic with local person-to-person transmission.
• This disease is usually self-limiting with symptoms resolving within a few weeks. However, severe illness can develop in a small percentage of people. Children unvaccinated against smallpox are at higher risk of severe disease and death.

Who is at risk?

• In endemic countries monkeypox is spread via interaction with animals (typically rodents) or consumption of wild game.
• In non-endemic countries, those who are at increased risk have had direct and often intimate contact with someone with monkeypox.

Symptoms and transmission

• The first symptoms are usually fever, chills, muscle aches,backache, swollen lymph nodes, and exhaustion.
• After a few days, the characteristic blistering rash usually appears in the mouth, and on the face and then spreads to other parts of the body. It may also appear on the palms of hands and soles of the feet, or on the genitalia. The number of lesions varies from a few to several thousand. The rash changes and goes through different stages, like chickenpox, before finally becoming a scab that falls off.
• The symptoms usually resolve within a few weeks.
• Person-to-person transmission of monkeypox occurs with very close contact with infected people (such as skin-to skin contact during intimate or sexual contact) and can also spread through respiratory droplets and contact with ‘fomites’ or infected surfaces (such as contaminated clothing, towels or furniture).
• The incubation period typically varies from 6-13 days from exposure but may be up to 21 days. 
• People are contagious from the time that they develop their first symptoms (which is usually fever, but occasionally starts with a rash) and until rash lesions crust, dry or fall off.

Recommendations

Clinicians should be aware of compatible clinical presentations in travellers returning from an endemic area or affected countries. Information on recent travel history, contacts and immunisation should be elicited.

Clinicians should consider the possibility of monkeypox as well as alternative diagnoses such as measles, varicella zoster, Herpes Simplex and Varicella Zoster Virus infections, and syphilis. Notify any suspect cases to the Department of Health / Public Health Unit.

Timely contact tracing and surveillance measures are essential to prevent secondary cases. Vaccination may be offered to close contacts within 4 days of exposure.

HCWs caring for suspected or confirmed patients should implement both standard contact and airborne precautions.

Patient Placement

Published 1st May 2022

As we are entering a post lockdown COVID era, with surgery and admissions returning to normal – it is a good reminder to refocus on re-emergence of healthcare acquired infections and prevention of same especially Influenza and other Respiratory infections.

All Patients are potentially at risk of acquiring, and transmitting, infectious conditions to other patients and healthcare workers. Patients should be assessed on, and during admission, to ensure that their bed allocation is both appropriate and timely. Patient placement is an important element of transmission-based precautions, along with the use of dedicated equipment, the use of appropriate PPE, and effective environmental cleaning.

Patient placement is a two-step process that is informed by a risk assessment (Step 1) followed by prioritisation of the seriousness of the infection and any competing patient needs (Step 2). Collaboration with the IPC service should be sought as soon as possible.

Step 1: Risk Assessment

The placement of patients in any clinical area should be considered, and risk assessed according to a number of factors, including, but not limited to:

• Whether the patient is suspected or known to be colonised or infected with a highly transmissible or epidemiologically significant pathogen (such as a  multidrug-resistant organism)
• Whether the patient has signs and symptoms that raise suspicion of the presence of an infectious condition
• How the known or suspected infectious organism is transmitted, and
• The period of time transmission-based precautions should be used.

Step 2: Prioritisation

The prioritisation of single room isolation, or other arrangements when a single room is not available, is not just dependent on the mode of transmission and infectivity of the pathogen, but also on the seriousness of the infection to other individuals.

Single rooms are preferred for all patients requiring isolation due to infectious conditions, and are always indicated for patients requiring airborne precautions (ideally with negative pressure ventilation). Designated bathroom facilities should be available, the door must be kept closed and appropriate signage displayed outside the room. Consideration of competing needs must also be taken into account, such as patients requiring end-of-life care; those who are immunosuppressed; patients with a higher need for privacy and dignity; or those requiring reduction of harm afforded by a single room.

The Commission has developed a Guide to support nurses, doctors, bed managers, patient flow managers and after-hours managers in the appropriate bed allocation.

Standardised infection control signage complements good patient placement by increasing the awareness of healthcare workers, patients and visitors to the necessary precautions required.

https://www.safetyandquality.gov.au/our-work/infection-prevention-and-control/ensuring-appropriate-patient-placement

Japenese Encephalitis

Published 1st March 2022

What is Japanese Encephalitis: Japanese encephalitis (JE) is a rare but serious disease caused by the Japanese encephalitis virus (JEV). It is spread to humans by infected mosquitoes.

Symptoms: Less than 1% of people infected with JEV will experience symptoms. Some infected people experience an illness with fever and headache. People with a severe infection may experience neck stiffness, disorientation, tremors, coma, and seizures. If you have any of these symptoms, seek medical treatment. Among those who develop severe infection, some will go on to experience permanent neurological complications or possibly death. Symptoms, if they are to occur, usually develop 5 to 15 days after being bitten by infected mosquitoes.

Transmission: JE is spread by the bite of infected Culex species mosquitoes which are commonly found in NSW. Culex mosquitoes can become infected with JEV from biting infected animals. The virus is spread when mosquitoes bite an infected animal, and the mosquito then bites a human. Infected pigs and some waterbirds are the animals more likely to infect mosquitoes. Humans are not able to pass JEV to other humans. Humans cannot get infected with JEV by touching an infected animal or eating animal products including pork or poultry products.

Who is at Risk? JEV has recently been identified in commercial piggeries in locations in NSW, Queensland, Victoria and South Australia.  Local infection risks are likely highest among:

• People working at and/or living close to piggeries which have tested positive for JEV.
• People who engage in outdoor activities (eg., camping, fishing, hiking) near significant mosquito populations, particularly near waterways.

JEV is endemic in much of Asia and parts of the Pacific. For most travellers in these regions, the risk of being infected with JEV is very low. People at the greatest risk of becoming infected are those who are staying more than a month in rural areas in countries where the disease is endemic or in some of the Torres Strait Islands.

Prevention:  AVOID MOSQUITO BITES

The mosquitoes that transmit JEV are most active at dawn and dusk and into the evening. Take extra care during peak mosquito biting hours, avoid the outdoors if possible or take preventive actions.

Personal protection measures

•  Wear light-coloured, loose-fitting long-sleeved shirts, long pants and covered footwear and socks (to reduce skin exposure).
• Apply repellent, especially those that contain DEET, picaridin, or oil of lemon eucalyptus which are the most effective against mosquitoes, to all areas of exposed skin.

Treatment: There is no specific treatment available for JEV. The best way to avoid infection is to avoid being bitten by mosquitoes.

Vaccination: A safe and effective vaccine for JEV is available for people aged 2 months and older. Vaccination against JEV is currently only recommended for those at highest risk of infection.

Refer to State Health Alerts for further information.

Vaccine Updates

Published 1st February 2022

Latest ATAGI / Govt. recommendations 24/1/22

Past Infection:

People with a past SARS-CoV-2 infection. Past infection is not a contraindication to vaccination. People with SARS-CoV-2 infection can be vaccinated as soon as they have recovered from their acute illness or can temporarily defer vaccination for up to 4 months after onset of the SARS-CoV-2 infection. ATAGI has decreased the time allowable for deferral of vaccination after prior SARS-CoV-2 infection from 6 months to 4 months, due to the increased risk of re-infection with the Omicron variant, particularly for those who had a Delta variant infection in 2021.

https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/advice-for-providers/clinical-guidance/latest-updates

Timing of administration of other vaccines

COVID-19 vaccines can be co-administered (that is, given on the same day) with an influenza vaccine. Studies demonstrate the safety and immunogenicity of co-administration of COVID-19 and influenza vaccines.

COVID-19 vaccines can also be co-administered with other vaccines if required.

This includes routine childhood and adolescent vaccines. The benefits of ensuring timely vaccination and maintaining high vaccine uptake outweigh any potential risks associated with immunogenicity, local adverse reactions or fever. There is limited evidence on the safety and effectiveness of co-administering COVID-19 vaccines at the same time as other vaccines. Providers need to balance the opportunistic need for co-administration with giving the vaccines on separate visits. There is the potential for an increase in mild to moderate adverse events when more than one vaccine is given at the same time.

Booster dose recommendations

A single COVID-19 vaccine booster dose is recommended for people aged ≥16 years who completed their primary course 3 or more months ago.

Pfizer or Moderna COVID-19 vaccines are the preferred vaccines for this booster dose, regardless of which vaccine was used for the primary course. Although not preferred, AstraZeneca can also be used as a booster dose for:

• people who have received AstraZeneca for their first two doses if there are no contraindications or precautions for use.
• If a significant adverse reaction has occurred after a previous mRNA vaccine dose which contraindicates further doses of mRNA vaccine (eg., anaphylaxis, myocarditis).

There is a growing body of evidence supporting the safety and effectiveness of Pfizer and Moderna as booster vaccines. Data on the use of AstraZeneca as a booster dose are more limited. (See Vaccine information – clinical guidance)

The recommended interval between completing the primary COVID-19 vaccine course (the second dose for most vaccine brands) and the booster dose is 3 months.

COVID-19 Boosters

Published 25th November 2021

Recommendations regarding COVID -19 Boosters have been released 28/10/21 by the Australian Technical Advisory group on Immunisation (ATAGI). ATAGI advises that, the highest priority groups to receive booster doses are those with risk factors for severe COVID-19 and/or those at increased occupational risk, notably: 

• People at greater risk of severe COVID-19: individuals aged 50 years and older, those with underlying medical conditions, residents of aged care and disability facilities, and Aboriginal and Torres Strait Islander adults. 
• People at increased occupational risk of COVID-19: a booster dose for individuals in this group is expected to reduce their likelihood of SARS-CoV-2 infection and associated occupation-related impacts, acknowledging that infection will be mostly mild in these individuals due to prior vaccination and younger age. 

To facilitate implementation of the COVID-19 vaccine booster program, ATAGI supports the use of a single booster dose for those who completed their primary COVID-19 vaccine course ≥6 months ago; initially to include, the groups above who were prioritised in the rollout of the vaccine program from early 2021. Refer to https://www.health.gov.au/sites/default/files/documents/2021/10/atagi-recommendations-on-the-use-of-a-booster-dose-of-covid-19-vaccine.pdf

World Sepsis Day 2021 and the National Sepsis Awareness Campaign

Published 21st September 2021

• https://www.safetyandquality.gov.au/sepsis-campaign 
• Monday 13 September 2021 was World Sepsis Day – an initiative of the Global Sepsis Alliance established in 2012 to draw attention to the impact sepsis has on the lives of everyday people and their families. 
• World Sepsis Day provides an opportunity for clinicians and the community alike to be aware of the signs and symptoms of sepsis, encourage prompt recognition and treatment, and ensure adequate support for survivors. 
• The Australian Commission on Safety and Quality in Health Care, in partnership with The George Institute for Global Health are undertaking a National Sepsis Awareness Campaign targeted towards clinicians, health service organisations and the general community, focussed on reducing preventable harm caused by sepsis. 
• The Campaign commenced on World Sepsis Day 2021 – 13 September 2021 – and will run for ten weeks through to 26 November 2021. 
• Campaign theme The consistent theme to raise awareness nationally is: “Could it be sepsis?” 
• By simply asking whether it could be sepsis, life-saving treatment can be provided to stop severe health complications and death. “Could it be sepsis” is an enabling phrase that the public can use to engage with clinicians when concerned and it empowers clinicians to suspect sepsis where patients present with no clear provisional diagnosis and there is the possibility of infection. 
• A sepsis awareness toolkit and resources can be found at https://www.safetyandquality.gov.au/sepsis-campaign. The Commission is also developing a Sepsis Clinical Care Standard 
• HICMR provide a PA tool to assist in auditing responses to sepsis in the Healthcare facility environment.

NSQHS Advisory- Implementing the Preventing and Controlling Infections Standards

Published 10th July 2021

• In May 2021, ACSQHC advisory AS21/01 version 1 was released.
• The requirements in this Advisory relate to all actions in the 2021 Preventing and Controlling Infections Standard and the interrelationships between these actions and all of the NSQHS Standards, in particular the Clinical Governance and Partnering with Consumers Standards. 
• The following requirements are noted in this version: 
• Health service organisations are required to commence implementation of the 2021 Preventing and Controlling Infections Standard immediately following its release in May 2021. 
• Transition between the current and revised Prevention and Controlling Infections Standards to be fully implemented by 21 December 2021. 
• From January 2022, compliance with the 2021 Preventing and Controlling Infections Standard will be assessed at the next accreditation assessment.
• See these websites for more information: Australian Commission on Safety and Quality in Health Care

AS 4187 / ACSQHC

Published 4th May 2021

In March 2021, ACSQHC advisory AS18/0 version 7 was released.

The following requirements are noted in this version:

“To comply with the requirements of Action 3.14 health service organisations should:

• a) By June 2021, complete a gap analysis to determine its current level of compliance.
• b) By December 2021, develop and document a plan to address identified gaps in compliance, specifying timeframes, milestones, and deliverables to support implementation.
• Compliance gaps may be addressed in a standalone plan or may be addressed as part of the organisation’s capital works and/or asset management and procurement planning cycles and may form part of a jurisdictional or private sector health services group capital works or asset management plan.
• c) Demonstrate progress toward implementing the plan”
• Full compliance is required by 31st December 2022. For HCFs that will not comply by this date, an action plan detailing strategy to achieve same with Executive endorsement should be completed prior to 31st December 2022.
• See Below website for more information.

https://www.safetyandquality.gov.au/publications-and-resources/resource-library/as1807-reprocessing-reusable-medical-devices-health-service-organisations

Australian Immunisation Register (AIR)

Published 25th March 2021

• The Australian Immunisation Register (AIR) is a national register that records all vaccines given to all people in Australia. 
• All Immunisation providers (Healthcare Facilities and/or Corporates) should apply to have access to the Australian Immunisation Register (AIR). Reporting to the AIR of COVID-19 and Influenza vaccinations commences 1st March 2021. Mandatory reporting of all vaccines to the AIR will be effective from 1 July 2021. 
• AIR site: Recognised vaccination providers and administrators can use the AIR site through HPOS to record immunisation details for individuals, view and print immunisation history statements, request reports (for example due/overdue vaccinations report) and update their contact details. 
• PRODA: PRODA is an online identity verification and authentication system. It lets you securely access online government services. PRODA is digital and portable across web enabled devices. You can use it from anywhere if you have internet access. Vaccination providers must first register for Provider Digital Access (PRODA) as an individual to access the AIR through Health Professional Online Services (HPOS). All vaccination providers and administrators who need access to the AIR site will need to have an individual PRODA account. This includes if you are a: 
  • medical practitioner, midwife, or nurse practitioner 
  • delegate of a medical practitioner, midwife, or nurse practitioner 
  • member of an organisation registered with the AIR as an ‘other’ vaccination provider such as a council, pharmacy, or commercial organisation. 

See below website for more information. 

https://www.servicesaustralia.gov.au/organisations/health-professionals/services/medicare/australian-immunisation-register-health-professionals

COVID-19 UPDATES – VACCINE PREPAREDNESS

Published 25th January 2021

• The vaccine will be tested to ensure it is safe before it is made available to people. To make a vaccine available in Australia it needs to pass Australian safety standards set by the Therapeutic Goods Administration (TGA). 
• The vaccine will be free. 
• Australia plans to be ready to administer the first doses of the vaccine in February / March 2021, (To be confirmed) if the vaccine is safe and approved by the TGA. It is expected that there will be limited doses of the coronavirus (COVID-19) vaccine initially with certain groups to be prioritised for the first doses. Check the Australian Government website for latest updates. 
• It is highly likely people will need two doses of the vaccine. 
• Health care workers (HCWs) will play a key role in ensuring people in each state can get safely vaccinated. HCWs have been identified as a priority group to receive the vaccine. 
• Each State Government is currently working with the Australian Government on the following elements to ensure they are prepared to roll out the vaccine: 
  • Strategy for roll out 
  • Safety - including monitoring, reporting and follow up 
  • Logistics including distribution and storage 
  • Workforce capacity and training to administer the vaccine 
  • Identifying priority groups that will be able to access the vaccine first 
  • Systems to support the vaccine roll out 
  • Evaluation 
  • Communication and engagement including engagement with the health care sector and priority populations. 

Refer to your State COVID website for latest information. 

COVID-19 UPDATES – Fit testing

Published 29th November 2020

The COVID-19 situation is changing rapidly and each state has a different epidemiological situation that is depicting guidelines. It is prudent to check the National and State COVID-19 sites daily. The below have been recently updated: 

COVID-19 – CDNA National Guidelines for Public Health Units – SoNG, v3.9, 09 October 2020

https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-coronavirus.htm

There are currently programs in each state that are advocating / reviewing the requirement for fit testing: 

Fit-testing measures the effectiveness of the seal between the respirator and the wearer’s face. It is required for all tight-fitting respirators, including: 

• half-face disposable 

• half-face reusable 

• full-face reusable 

• tight-fitting powered air purifying respirators (PAPR). 

There are two methods of fit-testing that meet AS/ NZS 1715:2009 Selection, use and maintenance of respiratory protective equipment: 

• Qualitative – a pass/fail test that relies on the wearer’s ability to taste or smell a test agent. This type of test can only be used on half-face respirators. 

• Quantitative – uses specialised equipment to measure how much air leaks into the respirator. This type of test can be used on half-face respirators, full-face respirators and PAPR. Quantitative fit-testing results are more objective than qualitative testing because some workers have difficulty with their ability to taste or smell. This can result in a potential for a false pass to the qualitative fit-test and worker health not being adequately protected. For further information refer to www.standards.org.au and search AS/NZS 1715 and / or state direction / recommendations.

COVID UPDATES

Published 2nd September 2020

The COVID situation is changing rapidly and each state has a different epidemiological situation that is depicting guidelines. It is prudent to check the National and State COVID-19 sites daily. The below have been recently updated: 

COVID-19 – CDNA National Guidelines for Public Health Units – SoNG, v3.8, 23rd August 2020 - https://www1.health.gov.au/internet/main/publishing.nsf/Content /cdna-song-novel-coronavirus.htm 

For specific State and Territory information, including testing information, refer to: 

ACT - https://health.act.gov.au/health-professionals/chief-health-officer-alerts

NSW - https://www.health.nsw.gov.au/Infectious/covid- 19/Pages/default.aspx

NT - https://coronavirus.nt.gov.au/stay-safe/if-you-are-unwell

QLD - https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/take-action/testing-and-fever-clinics

SA - www.sahealth.sa.gov.au/healthalerts

TAS - https://www.coronavirus.tas.gov.au/keeping-yourself-safe/testing-for-covid19

VIC - https://www.dhhs.vic.gov.au/health-services-and-general-practitioners-coronavirus-disease-covid-19

WA - https://www.healthywa.wa.gov.au/sitecore/content/Corporate/Articles/A-E/Coronavirus/COVID19-information-for-health-professionals

RETURNING TO WORK POST POSITIVE COVID RESULT

Published 20th July 2020

*Diagnosis and management of COVID-19 must be undertaken by medical practitioners in accordance with the current guidelines from the State Health Depts/Public Health Units.

*Healthcare workers (HCWs) should NOT be their own testing or treating doctor. 

*Clearance testing should be arranged by the HCWs worker’s employer, the HCWs treating doctor, or at a coronavirus assessment centre if testing by the treating doctor is not feasible. 

*HCWs and workers in aged care facilities who meet the below criteria can be released from isolation and do not require further testing to return to work or an at-risk setting. 

*However, these individuals must meet additional criteria before they can return to work. 

1. Confirmed cases who are asymptomatic

The HCW can be released from isolation if at least 10 days have passed since the first respiratory specimen positive for SARS-CoV-2 by PCR was taken and no symptoms have developed during this period. 

2. Confirmed or probable cases with mild illness who did not require hospitalisation

The case can be released from isolation if they meet all of the following criteria: 

• at least 10 days have passed since the onset of symptoms; and 
• there has been resolution of all symptoms of the acute illness for the previous 72 hours.

3. Confirmed or probable cases with more severe illness who have been in hospital

a. Confirmed and probable cases clinically ready for hospital Discharge - then they can be discharged to isolation at home or another facility. The case can be released from home isolation if they meet all of the following criteria: 

• at least 10 days have passed since hospital discharge; and 
• there has been resolution of all symptoms of the acute illness for the previous 72 hours. 

b. Confirmed and probable cases who will be remaining in Hospital: A case that remains in hospital can be released from isolation if they meet all the following criteria: 

• at least 10 days have passed since the onset of symptoms; and 
• there has been resolution of all symptoms of the acute illness for the previous 72 hours and 
• the case has had two consecutive respiratory specimens negative for SARS-CoV-2 by PCR taken at least 24 hours apart at least 7 days from symptom onset. 

4. Significantly immunocompromised persons

In addition to meeting the appropriate criteria described in points 1, 2, or 3 above, persons who are significantly immunocompromised and are identified as confirmed or probable cases must meet a higher standard requiring additional assessment. They can be released from isolation when they meet the following additional criterion: 

• PCR negative on at least two consecutive respiratory specimens collected at least 24 hours apart at least 7 days after symptom onset. 

Nb: Refer to Current State Guidelines for Health Care workers guidelines as advice is updated regularly. 

CLEANING REQUIREMENTS FOR CONFIRMED / SUSPECTED COVID-19 PATIENT ENVIRONMENT

Published 7th May 2020

The virus that causes COVID-19 infection is transmitted via droplets when an infected person coughs, sneezes or exhales. As these droplets are heavy and fall onto horizonal surfaces or the floor. 

Therefore the importance of social distancing (1.5m), & the requirement to not touch eyes nose or mouth and routinely clean frequently touched surfaces is emphasized. 

• The period of time the virus (SARS-COV-2) survives on inanimate surfaces varies dependent on the amount of soil and material present. Environmental temperature and humidity are also compounding factors. 
• Cleaning is an essential component of the disinfection process, as organic material inactivates many disinfectants. 
• Cleaning programs should include frequently touched surfaces (e.g.door handles, bed rails, call bells, lift buttons, stair rails, hand rails) and minimally touched surfaces (e.g. floors, blinds, walls). 
• The cleaning of frequently touched surfaces should be undertaken more frequently within COVID-19 isolation rooms and / or intensive care units. 
• Disinfection should be undertaken following cleaning, the choice of product is based on the manufacturers’ antiviral claims / ability of the product to kill the virus. Most chlorine based products are effective and are commonly used. 
• Some disinfectants have 2 in 1 properties, i.e they have the ability to clean and disinfect using the one product. This is also the case for some disposable detergent / disinfectant wipes. 
• Cleaning staff should receive explicit training regarding use of cleaning / disinfectant agents and donning / doffing of PPE. 

Coronavirus (COVID-19)

Published 25th March 2020

The information on this page relates to the health and safety precautions and the business continuity plan that HICMR has put in place in response to the COVID-19 pandemic.

HICMR are closely monitoring and proactively responding to the developments associated with the coronavirus (COVID-19).

Current Status:

We understand that the rapidly evolving and unprecedented and widespread effects of COVID-19 may result in high levels of concern, however we want to reassure you that we are well-prepared and well-resourced to manage the impacts and will provide ongoing support.

Health and Safety

Our priority as always remains the health and safety of all customers, their patients, staff and families. Further, as an integral part of Australia's healthcare system, our priority is to ensure the service we provide to the Healthcare sector is not interrupted.

HICMR Response Team

A Pandemic Response Team has been established and is meeting regularly to monitor and respond to the situation. HICMR has established a Business Continuity Plan to ensure continuity of service to our customers and the Healthcare sector.

Continuity of Service

Our priority is to ensure our services remain uninterrupted. Accordingly a number of directives have been implemented to reduce any risk to our business operations.

• Our Support desk and IPC consultancy will  continue to operate as per normal with enhanced response.

We appreciate this situation is unprecedented and changing by the day. We will provide updates in the event of changes to our response. In the meantime please do not hesitate to contact your IPC Consultant or Support desk for any further details.

JUST for your information: -

Social distancing

It is important to practise social distancing to stop or slow the spread of infectious diseases, such as COVID-19. The more space between you and others, the harder it is for the virus to spread.

Important tips include:

• You should aim to remain 1.5 metres apart from other people at all times. If you are required to move closer than 1.5 metres, ensure that the time spent within this proximity does not exceed 15 minutes
• Do not shake hands
• Do not share food

Where can I get more information?

Visit the Australian Government Department of Health homepage at www.health.gov.au

Call the Public Health Information Line on 1800 004 599.

Discuss any questions you have with the Public Health Agency monitoring you.

Contact your state or territory public health agency:

ACT call 02 5124 9213

NSW call 1300 066 055

NT call 08 8922 8044

QLD call 13HEALTH (13 43 25 84)

SA call 1300 232 272

TAS call 1800 671 738

VIC call 1300 651 160

WA visit www.healthywa.wa.gov.au or call your local public health unit.

Coronavirus (COVID-19) – Background information only – This is a rapidly changing situation

Published 9th March 2020

Background 

• December 2019, cluster of pneumonia cases occurred in Hubei Province in central China linked to a previously unknown virus.
• Identified as a Coronavirus which are known to cause differing illnesses including respiratory and gastrointestinal disease which can range from mild to very severe. Now named COVID-19 originally occurred in a group of people associated with a seafood and live animal market in Wuhan, the disease then spread to their families and HCWs. 
• The disease spread outside China in January and has now been confirmed in 58 countries including Australia. 
• As of 3/3/20 WHO reports 93,006 cases have been confirmed worldwide with 80,152 of those cases being in China; 3162 deaths have been reported with 2873 of those occurring within China. Refer to Coronavirus COVID-19 Global Cases for updated Global numbers.
• Coronaviruses circulate in a range of animals and sometimes ‘spill over’ from animals to humans occurs possibly due to a change in the virus or the increased contact between humans and animals, the animal reservoir for COVID-19 is not known yet.

Transmission 

• While the exact transmission route is yet to be determined, COVID-19 is transmitted from person to person and likely to be through contact with droplets from an infected person’s cough or sneeze or touching objects or surfaces (like doorknobs or tables) that have cough or sneeze droplets from an infected person, and then touching your mouth or face including eyes. 

Presenting symptoms 

• These can be mild to severe eg. fever, cough and shortness of breath to pneumonia, kidney failure and death.

Diagnosis 

• COVID-19 PCR testing of nasopharyngeal or oropharyngeal swab or sputum.

Treatment 

• No specific treatment, supportive care only and currently no vaccine available to prevent the infection. 

Preventing Transmission 

• Travel restrictions are in place for visitors from mainland China and Iran (NSW) These restrictions will be continually reviewed. 
• Quarantine of known possible contacts such as those returning from mainland China and Iran is currently being used to prevent transmission within Australia both in the form of self/home isolation and the use of formal quarantine stations. 

Case Definition 

Confirmed A person who tests positive to a validated COVID-19 test. 

Suspect Person with history of travel to (including transit through) a country considered to pose a risk of transmission in the 14 days before the onset of illness. OR Close or casual contact in 14 days before illness onset with a confirmed case of COVID-19. AND Fever OR Acute respiratory infection (e.g. shortness of breath or cough) with or without fever. 

Person under investigation It is recommended that clinicians should consider testing people with a clinically compatible illness who travelled to any of the following countries in the 14 days before onset of symptoms: 

Higher risk: Mainland China (excludes Hong Kong, Macau and Taiwan), Iran, Italy, South Korea.

Moderate risk: Japan, Singapore, Cambodia, Hong Kong; Indonesia and Thailand.

(This list is based on the risk of the person having been exposed to COVID-19 due to travel to a country with sustained community transmission and other epidemiological evidence. Clinical and public health judgement should be applied). 

For Hospital Presentations 

• Standard plus Contact and Droplet Precautions, including eyewear to be used for routine care of suspected or confirmed cases of COVID-19 and patients that fit the criteria of Persons under Investigation.
• Standard plus Contact and Airborne Precautions, including eyewear to be used where aerosol generating procedures are undertaken eg. intubation, bronchoscopy or suctioning and for care of critically ill cases in ICU which should occur in a NP Room. 

Refer to COVID-19 CDNA National Guidelines for Public Health Units for latest updates. 

State Guidelines are being frequently revised 

Refer daily to your state health website for up to date information and below guidelines/information.

https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-coronavirus.htm 

https://www.health.gov.au/health-topics/novel-coronavirus-2019-ncov 

https://openwho.org/courses/introduction-to-ncov 

ACSQHC Education Modules updates

Published 9th March 2020

The Commission has a number of education resources to support healthcare workers (HCWs) and health service organisation’s (HSOs) in implementing effective infection prevention and control (IPC) practices. 

The resources include: 

• The Basics of Infection Prevention and Control: This module is suitable as an orientation for HCWs working in clinical and non-clinical settings, whether having direct, indirect or minimal contact with patients. The module includes a short quiz between sections to assess knowledge.
• Hand Hygiene Modules, which are designed for HSOs to use as part of their orientation program for HCWs. There are nine modules available which provide education on hand hygiene practices in a range of clinical areas. There are modules for Nursing and Midwifery, Medical and Surgical staff, Renal/Dialysis, Allied health, Dental, Student Health Practitioners, Non-Clinical staff and a Standard Theory Module for those who require hand hygiene knowledge but do not fit into the categories above.
• The Commission’s Infection Prevention and Control learning modules (modules 1 -10) which are designed to develop HCWs knowledge, understanding and implementation of the principles of IPC in the Australian healthcare setting. The modules include; Principles of IPC, risk management systems for infectious agents and infectious diseases, basic microbiology and multi-resistant organisms, cleaning, disinfection and sterilisation, infectious agent health screening and immunisation of HCWs, outbreak investigation and management, management of occupation exposure, renovation, repairs and redevelopment, basic epidemiology/statistics and surveillance and quality improvement. These modules are based on the content of the Australian Guidelines for the Prevention and Control of Infection in Healthcare. There is an associated workbook for this course.

The resources are available through the National Hand Hygiene Initiative Learning Management System (NHHI LMS). To access the modules, you will need to log into the NHHI LMS using your current login details, or register as a new user via: -

https://www.safetyandquality.gov.au/our-work/infection-prevention-and-control/national-hand-hygiene-initiative-nhhi/online-learning#online-learner-registration

Measles Outbreaks 2019

Published 18th January 2020

• Measles remains a common disease in many parts of the world, including areas of Europe, Asia, the Pacific, and Africa, with outbreaks often occurring. 
• However, the number of measles cases worldwide has increased substantially in recent years, with a number of countries currently experiencing severe and prolonged measles outbreaks eg. Tonga, Samoa, New Zealand 
• Anyone who is not fully vaccinated against measles is at risk of becoming infected when traveling overseas. They may also risk exposing others to this highly infectious, serious illness either while travelling, or when they return to Australia. 
• In Australia, the majority of measles cases are due to unvaccinated individuals becoming infected while travelling to countries in which measles is either common or there are outbreaks occurring. As measles is highly contagious, these people can then spread the disease to others, causing outbreaks, often before they are aware that they have the virus. 
• People who are experiencing signs and symptoms of measles should seek medical attention. It is recommended that you call ahead to the medical practice or hospital emergency department to alert of them of your symptoms so that measures can be taken to limit your exposure to others upon your arrival. 
• The Australian Government continues to closely monitor measles outbreaks overseas and in Australia. 
• In Australia, many people have had two doses of measles vaccine, and most people born in 1965 or earlier have immunity from having had the disease. 
• The Australian Immunisation Handbook provides relevant information about measles vaccination for healthcare workers. 

World Antibiotic Week: 18th – 24th November, 2019

Published 7th November 2019

Antibiotic Awareness Week is here soon – see below resources available to assist your campaign. 

1. The Australian Commission on Safety and Quality in Health Care https://www.safetyandquality.gov.au/our-work/healthcare-associated-infection/antimicrobial-stewardship/antibiotic-awareness-week/, Selected materials from previous campaigns are also still available.

2. NPS MedicineWise campaign information available from: https://www.nps.org.au/antibiotic-awareness Further digital resources to be made available by the end of the month.

3. World Health Organisation WAAW information and updates to be made available from: http://www.who.int/campaigns/world-antibiotic-awareness-week/en/

4. The Commonwealth Department of Health information, including infographic for consumers 'Do I need antibiotics?' is available: https://www.amr.gov.au/ 

Buruli ulcer (Mycobacterium ulcerans infection)

Published 12th September 2019

• Buruli Ulcer is a chronic debilitating disease caused by environmental Mycobacterium ulcerans. 
• M. ulcerans is a member of the Mycobacteriaceae family of acid-fast bacilli. The same family to which the causative organisms for tuberculosis and leprosy belong. 
• It presents as a non-tender lump often mistaken to be an insect bite. The lump which can be itchy, occurs anywhere on the body but is commonly at the joints of an exposed limb. 
• 4 – 8 weeks after appearing, the lump generally breaks down and forms an ulcer with an undermined edge. This is due to the organism producing a unique toxin mycolactone – which causes tissue damage 
• If left untreated, the ulceration can become wide-spread with significant loss of tissue. This can lead to permanent disfigurement and long-term disability. 
• Occasionally the disease may present as a firm, painless elevated plaque or a large area including a whole limb may be indurated by oedema without an ulcer. 
• WHO data indicates that Buruli Ulcer occurs in at least 33 countries with most cases arising in tropical and subtropical regions except where those occur in Australia, China and Japan. 
• Australia has seen an increase in notifications of the disease since 2013 when 74 cases were reported, compared to the 358 cases reported in 2018. 
• Within Australia, the disease exists in Far North Queensland and in parts of coastal Victoria where it is firmly entrenched. 
• The exact method of transmission is unclear. The one widely accepted risk factor for contracting the disease is to live in a Buruli-endemic area. Following that, exposure to contaminated environments eg. water or soil and associated skin or tissue trauma including insect bites are thought to play their part. 
• Early diagnosis and treatment are important to minimise tissue damage. Swabs of the ulcer should be taken for PCR and culture, and a tissue biopsy for (AFBs). Pathology request should note suspicion of M. ulcerans. 
• Treatment can be a combination of antimicrobials and wide surgical excision of affected tissue. 
• In-patients are managed with Standard Precautions and ulcers should be covered. 
• Disease prevention may be assisted in endemic areas with the use of protective clothing when undertaking activities in the garden or in water. 

References and for further information; 

https://www.who.int/en/news-room/fact-sheets/detail/buruli-ulcer-(mycobacterium-ulcerans-infection) 

Infections of the Respiratory System.

Published 20th August 2019

Upper Respiratory Infections: Common cold, Sinusitis Pharyngitis, Epiglottitis and laryngotracheitis:  Most are of viral etiology. Epiglottitis and laryngotracheitis are exceptions with severe cases likely caused by Haemophilus influenzae type b. Bacterial pharyngitis is often caused by Streptococcus pyogenes. 

Pathogenesis: Organisms gain entry to the respiratory tract by inhalation of droplets and invade the mucosa. Epithelial destruction may ensue, along with redness, edema, hemorrhage and sometimes an exudate. 

Clinical Manifestations: Initial symptoms of a cold are runny, stuffy nose and sneezing, usually without fever. Other upper respiratory infections may have fever. Children with epiglottitis may have difficulty in breathing, muffled speech, drooling and stridor. Children with serious laryngotracheitis (croup) may also have tachypnea, stridor and cyanosis. 

Microbiologic Diagnosis: Common colds can usually be recognised clinically. Bacterial and viral cultures of throat swab specimens are used for pharyngitis, epiglottitis and laryngotracheitis. Blood cultures are also obtained in cases of epiglottitis. 

Prevention and Treatment: Viral infections are treated symptomatically. Streptococcal pharyngitis and epiglottitis caused by H influenzae are treated with antibacterials. 

Lower Respiratory Infections: Bronchitis, Bronchiolitis and Pneumonia: Causative agents are viral or bacterial. Viruses cause most cases of bronchitis and bronchiolitis. In community-acquired pneumonias, the most common bacterial agent is Streptococcus pneumoniae. Atypical pneumonias can be caused by Mycoplasma pneumoniae, Chlamydia spp, Legionella, Coxiella burnetti and viruses. Nosocomial pneumonias and pneumonias in immunosuppressed patients have etiology with gram-negative organisms and staphylococci as predominant organisms. 

Pathogenesis: Organisms enter the distal airway by inhalation, aspiration or by hematogenous seeding. The pathogen multiplies in or on the epithelium, causing inflammation, increased mucus secretion, and impaired mucociliary function; other lung functions may also be affected. In severe bronchiolitis, inflammation and necrosis of the epithelium may block small airways leading to airway obstruction. 

Clinical Manifestations: Symptoms include cough, fever, chest pain, tachypnea and sputum production. Patients with pneumonia may also exhibit non-respiratory symptoms such as confusion, headache, myalgia, abdominal pain, nausea, vomiting and diarrhea. 

Microbiologic Diagnosis: Sputum specimens are cultured for bacteria, fungi and viruses. Culture of nasal washings is usually sufficient in infants with bronchiolitis. Fluorescent staining technic can be used for legionellosis. Blood cultures and/or serologic methods are used for viruses, rickettsiae, fungi and many bacteria. Detection of nucleotide fragments specific for the microbial antigen in question by DNA probe or polymerase chain reaction can offer a rapid diagnosis. 

Prevention and Treatment: Symptomatic treatment is used for most viral infections. Bacterial pneumonias are treated with antibacterials. A vaccine against 23 serotypes of Streptococcus pneumoniae is recommended for individuals at high risk 

Reference: Dasaraju PV, Liu C. Infections of the Respiratory System. Medical Microbiology. 4th edition. https://www.ncbi.nlm.nih.gov/books/NBK8142/ 

Refer to HICMR Information Sheets - Common Causes of Respiratory Infections (New); Influenza; Human Metapneumovirus; RSV & Bronchiolitis and Legionella.

Therapeutic Goods Administration (TGA) - Listed hard surface disinfectants.

Published 9th July 2019

The new NHMRC Australian IPC Guidelines recommend the use of TGA-listed hospital-grade disinfectants with specific claims for the disinfection of hard surfaces in healthcare facilities. 

This changes reflects regulation for hard surface disinfectants which have been implemented by the TGA. The streamlining of the regulatory pathway has resulted in changes to terminology and requirements of entry: 

• Hard surface disinfectants which were previously “listed” (hospital grade without specific claims) are now exempt from the requirements of entry in the ARTG. 
• Hard surface disinfectants which were previously ‘registered’ (hospital grade with specific claims) are now “listed” other therapeutics goods (OTG)

In addition, TGO 54 (Standard for Disinfectants and Sterilants) was superseded by TGO 104 (Standard for Disinfectants and Sanitary Products) on 1st April 2019. 

Refer to TGA website for more information. - https://www.tga.gov.au/therapeutic-goods-order-54-standard-disinfectants-and-sterilants-tgo-54

6 WAYS TO FIGHT THE FLU

Published 1st May 2019

• Get a flu shot - It is important to get the influenza vaccination each year to continue to be protected, since it wears off after 3 to 4 months. Flu strains (types) also change over time. 
• Wash your hands - In addition to vaccination, good hygiene is one of the best ways to help prevent colds and flu from spreading. Wash your hands regularly. 
• Cover coughs and sneezes - Cover your mouth and nose when coughing or sneezing. 
• Bin your tissues - Throw disposable tissues in the bin immediately after using them. 
• Avoid sharing  - Don't share cups, plates, cutlery and towels with other people, if you can. 
• Keep surfaces clean - Clean surfaces such as your keyboard, telephone and door handles regularly to get rid of germs. 
• Self-care at home - In most cases you can treat mild cold or flu symptoms at home. 
• NOTE: Antibiotics won't help - Antibiotics do not reduce symptoms of colds and flu as these illnesses are caused by viruses. Antibiotics only work for bacterial infections. 

WHO: 2019 WHO Global Survey on IPC and Hand Hygiene

Published 6th March 2019

• WHO has launched the 2019 WHO Global Survey on IPC and Hand Hygiene. 
• It will be open for four months from 16 January to 16 May 2019. 
• The survey has two levels, involving the completion of two tools at the health care facility: 
  • the WHO Infection Prevention and Control Assessment Framework (IPCAF), and 
  • the WHO Hand Hygiene Self-Assessment Framework (HHSAF). 
• This is a great opportunity to perform a gap analysis of your programs and also be involved in this year’s Global campaign. For all Australian organisations wanting to participate please do not use the link previously provided – please use this link instead https://www.who-ipc-survey.org/?language=en&from=YAEKV58EZ8 
• All data submitted via the WHO online system will be confidential. All resources for the campaign can be found here – https://www.who.int/infection-prevention/campaigns/clean-hands/5may2019/en/ 
• For information about the two surveys please see here – https://www.who.int/infection-prevention/campaigns/ipc-global-survey-2019/en/ 
• Prior to consideration please refer to your Corporate and HCF Executive for direction. 

Management of Health Care Workers known to be Infected with Blood Borne Viruses

Published 29th January 2019

• The Australian National Guidelines for the Management of Health Care Workers known to be infected with Blood-Borne Viruses from the Communicable Diseases Network of Australia (CDNA) was published in April 2012. Since then there have been several advances in treatment and testing of blood borne viruses that has led to a revision of these guidelines. 
• The New and updated guidelines are aimed at the prevention of transmission from, and the management and treatment of, healthcare workers (HCWs) with hepatitis B virus (HBV), hepatitis C virus (HCV) and/or human immunodeficiency virus (HIV). 
• The Guidelines outline the professional standard expected of HCWs who perform exposure prone procedures (EPPs), HCWs living with a blood borne virus (BBV) who perform exposure prone procedures, and doctors treating HCWs with a BBV who perform EPPs. The Guidelines will allow HCWs living with HIV who comply with these guidelines to return to performing EPPs (excluded in the current guidelines). A table outlining exposure prone procedures has been developed to assist HCWs in assessing whether they perform EPPs and if they require testing and a number of fact sheets have also been provided. 
• The Guidelines support healthcare workers to get timely testing and treatment. All healthcare workers who are performing EPPs are required to take reasonable steps to know their BBV status and to have appropriate and timely testing after potential exposures. Refer to Department of Health Website to access the updated guidelines: http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-cdna-bloodborne.htm 

CANDIDA AURIS (C. auris)

Published 5th November 2018

 Public Health Alert: Candida Auris 

• C. auris is a fungus which can cause colonisation on the skin, or invasive infections ( eg. Bloodstream or urine infections) and has caused outbreaks in other countries. 
• People at highest risk of infection or colonisation include those with: 
  • Recent overseas healthcare admission ( particularly the UK, USA, South Korea, India, Pakistan, South Africa, Kuwait, Columbia and Venezuela) 
  • Diabetes Mellitus 
  • Recent Antibiotic Use 
  • Recent Surgery 
  • Central venous catheters. 
• Colonisation is asymptomatic and generally on the skin, in the urine, or around an indwelling device. Invasive infection presents as sepsis, urinary tract infections, ear infections or line infections. 
• C. Auris is of a major health concern as it: 
  • Causes serious infections - Case fatality rate 30-60% 
  • It is often resistant to anti-fungal medicines and may be untreatable. 
  • It is becoming more common internationally. Discovered in 2009, spread quickly and caused outbreaks. Case in Victoria. 
  • It is difficult to identify as it can be misidentified as other Candida species. 
  • It can spread readily in Nursing Homes / Aged Care. 

Has caused outbreaks in HCF’s and can spread through contact with affected patients and contaminated surfaces or equipment. C. auris can live on surfaces for several weeks. 

• It is important for laboratories and clinicians to be aware of the possibility of C. Auris in high-risk patients. 
• Any confirmed cases of C. Auris in patients should be notified to State Health department immediately. 
• Confirmed isolates C. Auris should be forwarded to State Reference laboratory as required. 
• Patient Management: Isolation of all colonised or infected patients during all admissions. Contact precautions, decolonisation of colonised patient and disinfection of patient rooms and equipment should be considered.

NSW: New Regulations for Managing Cooling Systems

Published 3rd September 2018

NSW Health: Public Health Amendment (Legionella Control) Regulation 2018. 

• Cooling water systems must be managed safely in order to prevent the growth and transmission of Legionella bacteria. Infection may cause Legionnaires’ disease, a serious and potentially life-threatening condition. 
• NSW Health has strengthened the Public Health Regulation 2012 to require a performance based (or risk management) approach to managing cooling water systems. This approach allows each system to be managed according to its risk of Legionella contamination. 
• From 10 August 2018, building occupiers are required to ensure that there are six key safeguards in place for their cooling water systems: 
  • Risk assessment of Legionella contamination documented in a Risk Management Plan (RMP) – every five years (or more frequently if required) 
  • Independent auditing of compliance with the RMP and Regulation – every year 
  • Providing certificates of RMP completion and audit completion to the local government authority 
  • Sampling and testing for Legionella and heterotrophic colony count – every month 
  • Notifying reportable laboratory test results (Legionella count ≥1000 cfu/mL or heterotrophic colony count ≥5,000,000 cfu/mL) to the local government authority 
  • Displaying unique identification numbers on all cooling towers. 
• The requirements for building occupiers to test for Legionella bacteria on a monthly basis and notify high ‘reportable test results’ to the local government authority commenced on 1st January 2018. 
• The above information will be included in the next HICMR Maintenance Policies updates – which are currently in progress.