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.
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:
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
Public Health Alert: Candida Auris
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.
NSW Health: Public Health Amendment (Legionella Control) Regulation 2018.
The Australian Government Department of Health and Aging provides updated Australian Immunisation Guidelines to reflect latest national & international evidence for vaccination. If you missed any of your childhood immunisations or require assessment of your immunisation status your GP can assist/ advise/prioritise an action plan.
Refer to your HCF Staff Health Program coordinator if you require further information on specific requirements.
1. Australian Government Department of Health. Immunisations for healthcare workers. https://beta.health.gov.au/health-topics/immunisation/health-professionals/immunisations-for-health-care-workers
2. The Australian Immunisation Handbook. www.immunise.health.gov.au/.../publishing.nsf/Content/Handbook10 -home
Accessing the Guidelines
For more information & to provide feedback, please visit the consultation page & make a submission by 5pm (AEST) 15/05/18. https://consultations.nhmrc.gov.au/public_consultations/infection-healthcare