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Are Routine Healthcare Worker Hand Hygiene Protocols (soap/water, Alcohol-based Handrub) Effective Against Influenza?
Funder
National Health and Medical Research Council
Funding Amount
$99,950.00
Summary
Although influenza is mainly spread from person-to-person by aerosol transmission (coughing, sneezing etc), there is growing evidence that spread also occurs on the hands of infected patients and their carers (non-aerosol transmission). Because of this, health authorities now recommend the use of careful hand hygiene (HH: hand washing with soap-water or use of alcohol-based hand rub solutions [ABHRS]) by healthcare workers (HCWs) and patients. However, despite these recommendations, there are no ....Although influenza is mainly spread from person-to-person by aerosol transmission (coughing, sneezing etc), there is growing evidence that spread also occurs on the hands of infected patients and their carers (non-aerosol transmission). Because of this, health authorities now recommend the use of careful hand hygiene (HH: hand washing with soap-water or use of alcohol-based hand rub solutions [ABHRS]) by healthcare workers (HCWs) and patients. However, despite these recommendations, there are no data that demonstrate the effectiveness of such HH protocols. This project aims to assess the clinical effectiveness of four HH protocols (handwashing with soap-water, alcohol-only ABHRS, two alcohol-chlorhexidine ABHRS) in common use in Australian hospitals to see which protocol is best for killing influenza virus. We also plan to assess how long influenza virus remains infectious on HCWs hands if they fail to use appropriate HH. Since it could be dangerous to use live avian influenza virus in this study, we plan to use the H1N1 influenza A strain that was a component of the influenza vaccine administered to most HCWs in 2005. Thus, only HCWs with protective immunity to H1N1 will participate in a series of tests in which they will have their hands artificially contaminated with a known concentration of live H1N1 before using either no HH, or one of the four HH protocols, followed by an assessment (virus culture and molecular tests) or the amount of H1N1 surviving on their hands after each protocol. Some selected HCWs will also have the amount of surviving virus assessed 30 and 60 minutes after contamination to identify how long H1N1 survives on HCWs hands should they not use appropriate HH. Following all protocols, all HCWs will perform a detailed surgical scrub (similar to surgeons before an operation) to make certain that all H1N1 is killed to avoid any infection of themselves or their contacts. The study will be undertaken in special, secure, negative-pressure rooms at Austin Hospital away from patient care areas to provide maximum safety conditions. All virus culture and molecular tests will be performed in the virus Identification Laboratory at the Victorian Infectious Disease Reference Laboratory (VIDRL), Melbourne. Results of the study should help identify which HH protocol provides the most protection against influenza.Read moreRead less
Highly Pathogenic Avian Influenza (HPAI) - Improved Diagnosis With Quality Assurance Of Serological & Molecular Diagnost
Funder
National Health and Medical Research Council
Funding Amount
$249,019.00
Summary
This project aims to produce Quality Assurance (QA) algorithms to ensure accurate diagnosis of highly pathogenic avian influenza (HPAI) using serological and molecular techniques. The project will assess HPAI diagnosis accurately within the setting of other circulating respiratory illnesses, utilising a new HPAI module, ,in combination with existing modules within the Royal College of Pathologists of Australia (RCPA) Serology Quality Assurance Program (SQAP). This will ensure rapid, cost-efficie ....This project aims to produce Quality Assurance (QA) algorithms to ensure accurate diagnosis of highly pathogenic avian influenza (HPAI) using serological and molecular techniques. The project will assess HPAI diagnosis accurately within the setting of other circulating respiratory illnesses, utilising a new HPAI module, ,in combination with existing modules within the Royal College of Pathologists of Australia (RCPA) Serology Quality Assurance Program (SQAP). This will ensure rapid, cost-efficient improvements in diagnostics by utilizing existing infrastructure. The key elements of the project are: Introduction of quality assurance processes to ensure accurate diagnosis and to evaluate existing and developing laboratory testing procedures, test accuracy, and result interpretation; Involvement of human and veterinary laboratories in the QA and development processes; Production of suitable antigenic material through molecular virology as targets for HPAI antibody and molecular diagnostics in QA programs. This will thereby allow large quantities of non-infectious material for HPAI QA assessment of serological and molecular assays around Australia, using baculovirus expressed antigens and cloned gene targets respectively. These projects are designed within a short (<12 month) time frame in order to fulfil the needs of the Australian community in controlling the developing HPAI avian pandemic, and the possible human pandemic. Significant positive outcomes in the next six months are assured by the existence of current QA processes, experience in influenza research already available in the human and animal health laboratories involved, the research records of the groups, and the close existing linkages between the research, QA, diagnostic and avian virology groups.Read moreRead less
Development Of National Protocols For The Detection Of Influenza A H5N1
Funder
National Health and Medical Research Council
Funding Amount
$248,229.00
Summary
This project will develop a best practice approach to the diagnosis of influenza A H5N1 (Bird Flu) in Australian public health laboratories. Tests such as reverse transcription polymerase chain reaction (RT-PCR) are in use globally for influenza A H5N1 detection. Some proprietary rapid influenza A tests also claim to detect influenza A H5N1. However there is little information on systematic evaluation of these, largely because there have been relatively few human influenza A H5N1 cases and patie ....This project will develop a best practice approach to the diagnosis of influenza A H5N1 (Bird Flu) in Australian public health laboratories. Tests such as reverse transcription polymerase chain reaction (RT-PCR) are in use globally for influenza A H5N1 detection. Some proprietary rapid influenza A tests also claim to detect influenza A H5N1. However there is little information on systematic evaluation of these, largely because there have been relatively few human influenza A H5N1 cases and patient specimens. Australian laboratories need authoritative guidelines as to optimal influenza tests, target genes and reagents. Development of a simple, potentially automated type specific test for influenza A H5N1 antibody such as enzyme immunoassay (EIA) is also desirable, as widely used tests cannot distinguish between infection with H5 or other influenza types. Reference methods such as haemagglutination inhibition (HAI) are cumbersome. In this project mock specimens for virus and antibody detection will be created using viral cell culture and infected chicken derived influenza A H5N1. This will be undertaken in physical containment level 4 (PC4) facilities in Australia's designated human and animal PC4 laboratories. This material will be used for (i) specimen panels to compare the performance of candidate laboratory tests (ii) positive control material in all tests undertaken and (iii) quality assurance exercises to ensure high standards of testing. Using these panels the group will assess influenza H5N1 RT-PCR, tests for detection of influenza proteins including immunofluorescence, and rapid point of care influenza A detection tests available in Australia. An EIA method currently used to detect influenza antibodies from different animal species will be refined to develop a simple test for type specific detection influenza A H5N1 antibodies, and subsequently evaluated using animal sera. A standard method for HAI reference serology for use in public health laboratories will also be recommended, and the best approaches to high throughput automated RT-PCR, and performing RT-PCR in the field on portable instrumentation will be explored. Recommendations for standard protocols for influenza A H5N1 will be developed and will submitted for review and endorsement by Commonwealth ministerial advisory committees.Read moreRead less