A multi-state outbreak of Salmonella enterica serovar Saintpaul infection occurred in Australia during October 2006. A case-control study conducted in three affected jurisdictions, New South Wales, Victoria and Australian Capital Territory, included 36 cases with the outbreak-specific strain of S. Saintpaul identified by multiple locus variable-number tandem repeat analysis (MLVA) in a faecal specimen and 106 controls. Consumption of cantaloupe (rockmelon) was strongly associated with illness (adjusted OR 23.9 95%, 95% CI 5.1-112.4). S. Saintpaul, with the outbreak MLVA profile, was detected on the skin of two cantaloupes obtained from an implicated retailer. Trace-back investigations did not identify the specific source of the outbreak strain of S. Saintpaul, but multiple Salmonella spp. were detected in environmental samples from farms and packing plants investigated during the trace-back operation. Cantaloupe production and processing practices pose a potential public health threat requiring regulatory and community educational interventions.

Aim This study aims to evaluate the effectiveness of HealthTracker, a surgical site infection surveillance system that aims to improve the notification of surgical site infection for women after giving birth by caesarean section. Design This protocol is an intervention study to evaluate the effectiveness of the surveillance system called “HealthTracker” in monitoring surgical site infections post caesarean section. Methods This study will use a mobile web application to automatically send a text message inviting all women who give birth to a live baby by caesarean section over six months during 2020–2021, at an Australian tertiary referral hospital. The text message invites women to complete a web‐based validated Wound Healing Questionnaire. The estimated number of eligible women in six months is 700 (caesarean section rate: 34% of 4,000 births annually). Intervention: the proposed “HealthTracker” surveillance system facilitates active patient‐reported surgical site infection identification through an automated mobile text message linking women to an individualized online Wound Healing Questionnaire. Discussion This project aims to provide a consistent, reliable and cost effective surgical site infection surveillance tool to improve post caesarean section surgical site infection reporting, can be scaled for broader utilization and will provide valuable information to decision makers regarding surgical site infection prevention. Impact Study findings will provide insights into whether HealthTracker is an efficient and cost effective platform for a systematic and consistent approach to surgical site infection surveillance that can be adopted more broadly, across the local health organization, the State and across other surgical specialty areas. This information will equip hospitals and clinicians with knowledge to better identify patient outcomes related to SSI post discharge from hospital and inform decision making related to preventative strategies, providing the necessary momentum to introduce practice change initiatives aimed at reducing surgical site infection rates. Trial Registration: ACTRN12620001233910.

BackgroundOutbreak investigation is a core function of public health agencies. Suboptimal outbreak investigation endangers both public health and agency reputations. While audits of clinical medical and nursing practice are conducted as part of continuous quality improvement, public health agencies rarely make systematic use of structured audits to ensure best practice for outbreak responses, and there is limited guidance or policy to guide outbreak audit.MethodsA framework for prioritising which outbreak investigations to audit, an approach for conducting a successful audit, and a template for audit trigger questions was developed and trialled in four foodborne outbreaks and a respiratory disease outbreak in Australia.ResultsThe following issues were identified across several structured audits: the need for clear definitions of roles and responsibilities both within and between agencies, improved communication between agencies and with external stakeholders involved in outbreaks, and the need for development of performance standards in outbreak investigations - particularly in relation to timeliness of response. Participants considered the audit process and methodology to be clear, useful, and non-threatening. Most audits can be conducted within two to three hours, however, some participants felt this limited the scope of the audit.ConclusionThe framework was acceptable to participants, provided an opportunity for clarifying perceptions and enhancing partnership approaches, and provided useful recommendations for approaching future outbreaks. Future challenges include incorporating feedback from broader stakeholder groups, for example those of affected cases, institutions and businesses; assessing the quality of a specific audit; developing training for both participants and facilitators; and building a central capacity to support jurisdictions embarking on an audit. The incorporation of measurable performance criteria or sharing of benchmark performance criteria will assist in the standardisation of outbreak investigation audit and further quality improvement.

T he international shortage of piperacillin/tazobactam (PT) in 2017 prompted its replacement by intravenous amoxicillin/clavulanate (IVAC). 1 Two studies have examined the effect of broad spectrum antibiotic usage on the epidemiology of vancomycin-resistant Enterococcus (VRE) in hospitals. An interrupted time series study found that VRE prevalence declined after partial replacement of cephalosporins, vancomycin and clindamycin by ampicillin/sulbactam and, to a lesser extent, PT. 2 In another study, a switch from ceftazidime to PT for febrile neutropenia was associated with reduced VRE acquisition in a haematology unit. 3 We examined the impact of the PT shortage on VRE and methicillin-resistant Staphylococcus aureus (MRSA) acquisitions at the John Hunter Hospital (Newcastle), where there has been a sustained outbreak of VRE since 2014. 4 We compared the incidence of hospital-onset acquisitions (hospital-wide) during the 12 months before (Oct 2016 -Sept 2017) and 12 months after (Nov 2017 -Oct 2018) the start of the PT shortage. We analysed routine surveillance data; the first unique patient VRE and MRSA isolates from blood, tissue or fluid specimens were deemed indicators of morbidity. The interrupted time series was analysed in a regression framework with a generalised linear model; changes in usage trends and levels, adjusted for seasonality, were assessed. Structural breaks in the series were explored with a blinded generalised fluctuation test.Ethics approval was not required; we observed the guidance of the Outbreak Reports and Intervention studies of Nosocomial infection (ORION) statement. 5Twelve-month mean PT use declined from 44 defined daily doses (DDD)/1000 occupied bed-days (OBD) before the shortage to 5 DDD/1000 OBD; IVAC usage increased from 4 to 33 DDD/1000 OBD. As IVAC is a narrower spectrum antibiotic, total broad spectrum parenteral antimicrobial use fell from 129 DDD/1000 OBD before the shortage to 91 DDD/1000 OBD.A model with cyclical terms and a monthly lag effect best fitted the VRE acquisition time series, with a statistically significant change in level (P = 0.004) and trend (P = 0.002) at October 2017. A model with cyclical terms best fitted the MRSA time series, with a non-significant reduction in MRSA events (10% per month) during the shortage (Box). There were no meaningful structural breaks in either time series.There were 191 acquisitions of VRE and 53 of MRSA before the shortage; during the shortage, there were 101 (fall of 47%) and 31 (42% fewer) respectively. There were 24 sterile site detections of VRE and 49 of MRSA before the shortage, and eight (67% fewer) and 37 (24% fewer) during the shortage. Fifty-three health careassociated Clostridium difficile infections were detected before the shortage, 52 in the subsequent 12 months.

No abstract