Avondale Research

The practice of lifestyle medicine and its emphasis on behavioral change continues to grow around the world. Yet much of the burden of disease weighing on healthcare systems from chronic, modifiable conditions remains stubbornly present. From a behavior change perspective, efforts to date have primarily focused on public health messaging and public health campaigns (global approaches) to interventions such as health coaching (individual approaches). There exists an opportunity to consider contextual elements which support behavioral change. The practice of “nudging” behavior in primary care and allied health settings is proposed as a means of responding to these contextual opportunities. Nudging does not assure change; however, it can invite curiosity about change and small behavioral efforts in the direction of a desired change. Furthermore, its nature conserves autonomy and patient choice while inviting a health-creating behavior. As such, when considered and applied in the context of public health and individual treatment options, it creates a consistent milieu in which behavior change is facilitated.

The reduction of saltmarsh habitat at a global scale has seen a concomitant loss of associated ecosystem services. As such, there is a need and a push for habitat rehabilitation. This study examined an innovative saltmarsh restoration project in Australia which sought to address the threats of mangrove encroachment and sea level rise. The project was implemented in 2017, using automated hydraulic control gates, termed“SmartGates,”to lower the tidal regime over one site, effectively reversing sea level rise at a local level. Measured indicators of saltmarsh cover, number of species, seedling counts, and saltmarsh assemblages all showed significant positive development over time, with trends varying based on saltmarsh zone. The saltmarsh, predominantly Sarcocornia quinque flora, developed from remnant supralittoral (previously high) marsh which remained at 45% cover to achieve over 15% coverage across the cleared habitat after 3 years. Slower development in the low marsh (

Background

Evidence from a previous systematic review indicates that patients admitted to a room where the previous occupant had a multidrug-resistant bacterial infection resulted in an increased risk of subsequent colonisation and infection with the same organism for the next room occupant. In this paper, we have sought to expand and update this review.

Methods

A systematic review and meta-analysis was undertaken. A search using Medline/PubMed, Cochrane and CINHAL databases was conducted. Risk of bias was assessed by the ROB-2 tool for randomised control studies and ROBIN-I for non-randomised studies.

Results

From 5175 identified, 12 papers from 11 studies were included in the review for analysis. From 28,299 patients who were admitted into a room where the prior room occupant had any of the organisms of interest, 651 (2.3%) were shown to acquire the same species of organism. In contrast, 981,865 patients were admitted to a room where the prior occupant did not have an organism of interest, 3818 (0.39%) acquired an organism(s). The pooled acquisition odds ratio (OR) for all the organisms across all studies was 2.45 (95% CI: 1.53–3.93]. There was heterogeneity between the studies (I2 89%, P < 0.001).

Conclusion

The pooled OR for all the pathogens in this latest review has increased since the original review. Findings from our review provide some evidence to help inform a risk management approach when determining patient room allocation. The risk of pathogen acquisition appears to remain high, supporting the need for continued investment in this area.

Introduction

Adults living in Residential Aged Care Facilities (RACFs) are highly susceptible to seasonal respiratory infections. Evidence indicates that the aerosols contaminated with virus particles in closed indoor spaces may play a significant role in the transmission of respiratory infections. In this protocol paper, we outline details of a planned RCT which aims to evaluate the effectiveness of portable in room air purifiers in reducing the risk of ARIs among residents in Australian RACFs.

This study uses a multi-centre double-blind randomised crossover design. Three RACFs in a regional area of New South Wales will be invited to participate in the study. Air purifiers with or without high-efficiency particulate absorbing (HEPA) filters will be placed in the rooms of residents who are enrolled in the trial. The primary outcome will be a reduction in the incidence of ARI and the secondary outcomes will be the time to first infection, number of emergency department admissions, hospital admissions, and medical consultations due to an ARI.

Conclusion

To our knowledge, this will be the first RCT using air purifiers in resident rooms to identify their effect in reducing ARIs in RACFs. If our findings indicate some potential benefit for in-room air purification, it will help provide support and justification for larger trials, which may include a facility wide approach to air purification.

Background

‘Contact precautions,’ are recommended for hospitalised patients with known methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) colonisation. Despite increasing observational evidence suggesting that gowns and gloves are of no added benefit over hand hygiene and environmental cleaning, guidelines continue to recommend them.

Methods

A cross-sectional online survey of infection prevention professionals, infectious diseases physicians and microbiologists in Australian and New Zealand hospitals was conducted. The purpose was to explore variations in current approaches to known MRSA and VRE colonisation, and determine clinical equipoise for a proposed randomised control trial (RCT) to withdraw the use of gowns and gloves in this setting.

Results

226 responses from 122 hospitals across all Australian jurisdiction and multiple regions of New Zealand were received. While most hospitals implement contact precautions for MRSA (86%) and VRE (92%), variations based on MRSA and VRE subtypes are common. There was strong interest in removing glove and gown use for MRSA (72% and 73%, respectively) and VRE (70% and 68%, respectively). 62% of surveyed hospitals expressed interest in participating in a proposed cluster RCT comparing discontinuation of gown and glove use as part of contact precautions for MRSA and VRE, with their ongoing use.

Conclusion

The mandated use of PPE in the context of MRSA and VRE colonisation warrants further examination. An RCT is needed to definitively address this issue and to promote a widespread change in practice, if warranted.