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. 

VACCINE PREVENTABLE DISEASES IMMUNISATION FOR HEALTH CARE WORKERS (HCWs) AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH

Published 2nd July 2018

FACTS: 

• Infectious Diseases (ID) have no boarders. 
• Widespread International travel enables ID spread between countries/across borders to people in cities or communities. 
• Patient diagnosis of a disease is not always clear or identified immediately on admission. 
• HCWs have increased risk of acquiring vaccine preventable diseases (VPD). 
• If immunity status unknown HCWs/employees may be at risk of infection from patients and/or the environment. 
• All HCWS must provide documented evidence of childhood vaccination records of immunisation/serology prior to employment. 
• The National Australian Immunisation Register records vaccinations given to all Australians and ensures patient immunisation records are complete and available online for medical professionals. 

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 

NHMRC Draft Revised Australian Guidelines for the Prevention & Control Of Infection in Healthcare

Published 1st May 2018

• The National health & Medical Research Council (NHMRC) draft Guidelines have been updated to reflect the latest national & international evidence on Infection Prevention & Control (IPC). They are evidence based & focus on the critical aspects of IPC, including core principles, risk assessment & priority areas for action. 
• The update has been led by the Infection Control Guidelines Advisory Committee. The evidence reviews commissioned by NHMRC are publicly available for background information. Nb. These reports are not subject to consultation. 

Accessing the Guidelines 

• NHMRC is piloting an interactive ‘living guidelines’ model. Two IT platforms are available to access the draft Guidelines:

1. MAGICapp - an online interactive platform for developing & publishing guidelines (third party website) or 
2. NHMRC Interactive Guideline Platform (Aust Govt website). 

• Once the final updated Guideline is released, users will have the choice of accessing the contents interactively through NHMRC’s website, MAGICapp’s website or as a mobile application with online / offline capability.

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 

IT'S INFLUENZA VACCINATION TIME AGAIN!

Published 6th April 2018

• The Northern Hemisphere has experienced a significant  increase in Influenza this season – so be prepared / protected. 
• The recommended composition of Quadrivalent Influenza Vaccine for Australia in 2018 introduces a new A (H3N2) like virus strain when compared to the composition of the Trivalent and Quadrivalent Vaccines for Australia in 2017. 
• For adults over 65 years, in addition to the Quadrivalent Influenza Vaccines (QIVs), two higher-immunogenicity Trivalent Influenza Vaccines (TIVs) are available (one is a high dose vaccine, and the other contains an adjuvant). 
• The Influenza Vaccine components for the Australian 2018 Influenza season will contain the following: 
  • An A/Michigan/45/2015 (H1N1) pdm09 - like virus 
  • An A/Singapore/INFIMH-16-0019/2016 (H3N2) - like virus; 
  • A B/Brisbane/60/2008-like virus (belonging to the Vic lineage) 
  • A B/Phuket/3073/2013-like virus 
• Vaccination is your best defence as recommended by the World Health Organisation / CDC / NHMRC – Australian Immunisation Guidelines. 
• The HICMR Influenza HCW Toolkit has been updated with new information and is available on the Client Portal. 
• Refer to Infection Prevention and Control (IPC) for details of the HCF Vaccination Program.

REVISED NATIONAL SAFETY & QUALITY HEALTH SERVICE STANDARDS (NQSHSS)

Published 17th December 2017

• The second edition of the NSQHS. Standards is now available for use. 
• Assessment to the 2nd edition will commence from 1st January 2019. The 2nd edition streamlines actions & addresses gaps identified in the 1st edition. It also updates the evidence for actions, & consolidates & streamlines the Standards to make them clearer & easier to implement. 
• The Preventing & Controlling Healthcare-Associated Infection Standard in the 2nd edition continues its focus on systems & processes that prevent & control healthcare-associated infection (HAI), which promote effective prescribing & use of antimicrobials as part of antimicrobial stewardship. Actions related to standard and transmission-based precautions have been brought together, & the wording across the standard has been revised to make the requirements clear.
• The Revised NSQHSS & Summary Fact Sheets are available at:  https://www.safetyandquality.gov.au/our-work/assessment-to-the-nsqhs-standards/nsqhs-standards-second-edition/