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Public Health and Communicable Diseases - SA Health - SA.Gov.au

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Early treatment of infections is essential in reducingtransmission of infection. This may be achieved throughhealth promotion <strong>and</strong> promotion of good health seekingbehaviour. Most individuals with infections are identifiedthrough screening <strong>and</strong> not as a result of havingsymptoms, hence screening of susceptible personsneeds to be continued <strong>and</strong> opportunistic screeningshould be encouraged.In order to make a difference a coordinated multisectoralapproach addressing many different factorsis necessary. There is an urgent need to coordinateeducational activities with the Department of Education<strong>and</strong> to liaise with those working in the field of alcohol<strong>and</strong> other drugs to address the issue of substancemisuse <strong>and</strong> STI transmission.There is a great void in our knowledge concerningsexual behaviour <strong>and</strong> sexual networking in CentralAustralian indigenous communities. In order to develop<strong>and</strong> disseminate appropriate safer sexual behaviourmessages there is a need to underst<strong>and</strong> current normsin the area. Social <strong>and</strong> behavioural research needs to beconducted in this area.Finally, condoms should be accessible <strong>and</strong> freelyavailable in communities <strong>and</strong> there is a need to explorethe acceptability of female condoms to give women anopportunity to exercise greater control of their sexualhealth.References1. National Centre in HIV Epidemiology <strong>and</strong> ClinicalResearch. HIV/AIDS, viral hepatitis <strong>and</strong> sexuallytransmissible infections in Australia AnnualSurveillance Report 2005. National Centre in HIVEpidemiology <strong>and</strong> Clinical Research, The Universityof New South Wales, Sydney, NSW. Canberra, ACT:Australian Institute of <strong>Health</strong> <strong>and</strong> Welfare; 2005.2. World <strong>Health</strong> Organization Global Programme on AIDSmanagement of Sexually Transmitted <strong>Diseases</strong>.WHO/GPA/TEM/94.1. Geneva; 1994.3. Latif AS, Smith KS. STI screening conducted in NTDepartment of <strong>Health</strong> <strong>and</strong> Community Services <strong>and</strong>Community Controlled <strong>Health</strong> Services in CentralAustralia in 2004. NT Disease Control Bulletin. Centrefor Disease Control, NT Department of <strong>Health</strong> <strong>and</strong>Community Services. 2004;11:18-20.4. Miller PJ, Law M, Torzillo PJ, Kaldor J. Incident sexuallytransmitted infections <strong>and</strong> their risk factors in anAboriginal community in Australia: a population basedcohort study. Sex Transm Inf. 2001;77:21–25.5. Warchivker I, Japangati T, Wakerman J. The turmoilof Aboriginal enumeration: mobility <strong>and</strong> servicepopulation analysis in a central Australian community.Aust NZ J <strong>Public</strong> <strong>Health</strong>. 2000;4:444-449.6. Tangey A. Report on STI Screen. Sexual <strong>and</strong>reproductive health program. Ngaanyatjarra <strong>Health</strong>Service; 2004.7. Nganampa <strong>Health</strong> Council. Annual Report 2005.Alice Springs; 2005. Available from: http://www.nganampahealth.com.<strong>au</strong>34The Impact of <strong>Health</strong>Care AssociatedInfectionIrene WilkinsonManager, Infection Control Service,<strong>Communicable</strong> Disease Control Branch.<strong>Health</strong>care associated infections (HAI) have long beenrecognised as a critical problem affecting the quality ofhealth care <strong>and</strong> are a principal source of adverse healthcare outcomes in Australian hospitals. 1 In overseasstudies, they have been shown to lead to increasedpatient morbidity <strong>and</strong> mortality, resulting in increasedlength of hospital stay, <strong>and</strong> additional diagnostictesting <strong>and</strong> treatment, with consequent increasedcosts to the health system. 2 In 1992 it was estimatedthat in the United States HAI affected over 2 millionpatients annually, at a cost in excess of $4.5 billion <strong>and</strong>have been reported to account for 50% of all majorcomplications of hospitalisation. 3In 1999 the U<strong>SA</strong> National Institutes of <strong>Health</strong> publisheda report entitled “To Err is Human” which addressed theincidence <strong>and</strong> impact of adverse events in healthcare, ofwhich HAI were a major contributor. 4 During the sameyear, the Department of <strong>Health</strong> in Britain published areport entitled “The Socio-Economic Burden of HospitalAcquired Infection”. 5 The aim of this study was to assessthe burden of HAI in terms of the costs to the publicsector, patients, informal carers <strong>and</strong> society as a whole.The researchers found that 7.8% of patients experienceda healthcare associated infection whilst still an in-patient,<strong>and</strong> a further 19.1% of surveyed patients experienceda possible HAI after discharge from hospital. Byextrapolation, HAI were estimated to cost the NHS £986million annually, of which £930 million was incurredduring the patients’ hospital stay <strong>and</strong> £56 million (or 6%of the total cost) was incurred post-discharge.There are little data on the cost of HAI in Australia,but recent estimates are provided in a report fromthe Expert Working Group of the Australian InfectionControl Association to the Commonwealth Departmentof <strong>Health</strong> <strong>and</strong> Ageing. 6 It is estimated that surgical siteinfections could be costing as much as $268 million peryear <strong>and</strong> that the total costs to the health care systemfor bloodstream infection may be as high as $686million. However, these figures should be viewed withc<strong>au</strong>tion, since the lack of comprehensive surveillancedata in Australia make the estimation of the total burdenproblematic. There is little known about the relativecontribution of out-of-hospital expenses <strong>and</strong> societalcosts to the overall costs of nosocomial infection in

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