Summary
The rapid spread of severe acute respiratory syndrome coronavirus 2 led to the declaration of a global pandemic within 3 months of its emergence.
The majority of patients presenting with ...coronavirus disease 2019 (COVID‐19) experience a mild illness that can usually be managed in the community. Patients require careful monitoring and early referral to hospital if any signs of clinical deterioration occur.
Increased age and the presence of comorbidities are associated with more severe disease and poorer outcomes.
Treatment for COVID‐19 is currently predominantly supportive care, focused on appropriate management of respiratory dysfunction.
Clinical evidence is emerging for some specific therapies (including antiviral and immune‐modulating agents). Investigational therapies for COVID‐19 should be used in the context of approved randomised controlled trials.
Australian clinicians need to be able to recognise, diagnose, manage and appropriately refer patients affected by COVID‐19, with thousands of cases likely to present over the coming years.
In this double-blind, randomized trial, vancomycin was added to cefazolin as surgical prophylaxis for arthroplasty. Surgical-site infections occurred in 4.5% of vancomycin recipients and 3.5% of ...placebo recipients.
Objectives
To design and evaluate 3D‐printed nasal swabs for collection of samples for SARS‐CoV‐2 testing.
Design
An iterative design process was employed. Laboratory evaluation included in vitro ...assessment of mock nasopharyngeal samples spiked with two different concentrations of gamma‐irradiated SARS‐CoV‐2. A prospective clinical study compared SARS‐CoV‐2 and human cellular material recovery by 3D‐printed swabs and standard nasopharyngeal swabs.
Setting, participants
Royal Melbourne Hospital, May 2020. Participants in the clinical evaluation were 50 hospital staff members attending a COVID‐19 screening clinic and two inpatients with laboratory‐confirmed COVID‐19.
Intervention
In the clinical evaluation, a flocked nasopharyngeal swab sample was collected with the Copan ESwab and a mid‐nasal sample from the other nostril was collected with the 3D‐printed swab.
Results
In the laboratory evaluation, qualitative agreement with regard to SARS‐CoV‐2 detection in mock samples collected with 3D‐printed swabs and two standard swabs was complete. In the clinical evaluation, qualitative agreement with regard to RNase P detection (a surrogate measure of adequate collection of human cellular material) in samples collected from 50 hospital staff members with standard and 3D‐printed swabs was complete. Qualitative agreement with regard to SARS‐CoV‐2 detection in three pairs of 3D‐printed mid‐nasal and standard swab samples from two inpatients with laboratory‐confirmed SARS‐CoV‐2 was also complete.
Conclusions
Using 3D‐printed swabs to collect nasal samples for SARS‐CoV‐2 testing is feasible, acceptable to patients and health carers, and convenient.
Introduction: Antimicrobial resistance (amr) has been recognised as an urgent health priority, both nationally and internationally. Australian hospitals are required to have an antimicrobial ...stewardship (ams) program, yet the necessary resources May not be available in regional, rural or remote hospitals. This review will describe models for ams programs that have been introduced in regional, rural or remote hospitals internationally and showcase achievements and key considerations that May guide Australian hospitals in establishing or sustaining ams programs in the regional, rural or remote hospital setting. Methods: A narrative review was undertaken based on literature retrieved from searches in ovid medline, scopus, web of science and the grey literature. 'cited' and 'cited by' searches were undertaken to identify additional articles. Articles were included if they described an ams program in the regional, rural or remote hospital setting (defined as a bed size less than 300 and located in a non-metropolitan setting). Results: Eighteen articles were selected for inclusion. The ams initiatives described were categorised into models designed to address two different challenges relating to ams program delivery in regional, rural and remote hospitals. This included models to enable regional, rural and remote hospital staff to manage ams programs in the absence of on-site infectious diseases (id) trained experts. Non-id doctor-led, pharmacist-led and externally led initiatives were identified. Lack of pharmacist resources was recognised as a core barrier to the further development of a pharmacist-led model. The second challenge was access to timely off-site expert id clinical advice when required. Examples where this had been overcome included models utilising visiting id specialists, telehealth and hospital network structures. Formalisation of such arrangements is important to clarify the accountabilities of all parties and enhance the quality of the service. Information technology was identified as a facilitator to a number of these models. The variance in availability of information technology between hospitals and cost limits the adoption of uniform programs to support ams. Conclusion: Despite known barriers, regional, rural and remote hospitals have implemented ams programs. The examples highlighted show that difficulty recruiting id specialists should not inhibit ams programs in regional, rural and remote hospitals, as much of the day-to-day work of ams can be done by non-experts. Capacity building and the strengthening of networks are core features of these programs. Descriptions of how Australian regional, rural and remote hospitals have structured and supported their ams programs would add to the existing body of knowledge sourced from international examples. Research into ams programs predominantly led by gps and nursing staff will provide further possible models for regional, rural and remote hospitals.
There is no published health-system-wide framework to guide antimicrobial stewardship (AMS) in general practice. The aim of this scoping review was to identify the component parts necessary to inform ...a framework to guide AMS in general practice. Six databases and nine websites were searched. The sixteen papers included were those that reported on AMS in general practice in a country where antibiotics were available by prescription from a registered provider. Six multidimensional components were identified: 1. Governance, including a national action plan with accountability, prescriber accreditation, and practice level policies. 2. Education of general practitioners (GPs) and the public about AMS and antimicrobial resistance (AMR). 3. Consultation support, including decision support with patient information resources and prescribing guidelines. 4. Pharmacist and nurse involvement. 5. Monitoring of antibiotic prescribing and AMR with feedback to GPs. 6. Research into gaps in AMS and AMR evidence with translation into practice. This framework for AMS in general practice identifies health-system-wide components to support GPs to improve the quality of antibiotic prescribing. It may assist in the development and evaluation of AMS interventions in general practice. It also provides a guide to components for inclusion in reports on AMS interventions.
Many regional and remote hospitals (RRHs) do not have the specialist services that usually support antimicrobial stewardship (AMS) programmes in major city hospitals. It is not known if this is ...associated with higher rates of inappropriate antimicrobial prescribing. The aim of this study was to identify similarities and differences in antimicrobial prescribing patterns between major city hospitals and RRHs in Australia. The Australian Hospital National Antimicrobial Prescribing Survey (H-NAPS) datasets from 2014, 2015 and 2016 (totalling 47,876 antimicrobial prescriptions) were analysed. The antimicrobial prescribed, indications for use, documentation of indication, recording of a review date and assessment of the appropriateness of prescribing were evaluated. Overall, inappropriate prescribing of antimicrobials was higher in RRHs than in major city hospitals (24.0% vs. 22.1%; P<0.001). Compared with major city hospitals, inappropriate prescribing of ceftriaxone was higher in RRHs (33.9% vs. 27.6%; P<0.001), as was inappropriate prescribing for cellulitis (25.7% vs. 19.0%; P≤0.001). A higher rate of inappropriate prescribing was noted for some high-risk infections in RRHs compared with major city hospitals, including Gram-positive bacteraemia with sepsis (12.6% vs. 6.5%; P=0.004), empiric therapy for sepsis (26.0% vs. 12.0%; P<0.001) and endocarditis (8.2% vs. 2.7%; P=0.02). To the authors’ knowledge, this is the largest study to date comparing antimicrobial prescribing of RRHs with major city hospitals. A key finding was that antimicrobial prescribing was more frequently inappropriate for some high-risk infections treated in RRHs. Targeted strategies that support appropriate antimicrobial prescribing in RRHs are required.
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