NSW Department Research Articles

More than hand hygiene is needed to affect methicillin‐resistant Staphylococcus aureus clinical indicator rates: Clean hands save lives, Part IV

To examine whether improved hand hygiene compliance in health care workers after a statewide hand hygiene campaign in New South Wales hospitals was associated with a fall in rates of infection with multiresistant organisms. Data on rates of new methicillin-resistant Staphylococcus aureus (MRSA) infections (expressed as four clinical indicators) are reported by some Australian hospitals to the Australian Council on Healthcare Standards (ACHS) for accreditation purposes and are mandatorily reported by all NSW hospitals to the NSW Department of Health. Infections are classified according to whether they are acquired in the intensive care unit (ICU) or other wards and whether they are from sterile sites (blood cultures) or non-sterile sites. The clinical indicators reflect four different site categories (ICU sterile site, ICU non-sterile site, non-ICU sterile site and non-ICU non-sterile site) and are expressed as the number of new health care-associated infections per 10,000 acute care bed-days. Clinical indicator rates were examined for any decline between the pre-campaign period (July-December 2005) and post-campaign period (January-July 2007), and were compared with trends over a similar period in states without a hand hygiene campaign. Pre-campaign and post-campaign rates for four MRSA clinical indicators. Between the pre- and post-campaign periods, there was a 25% fall in MRSA non-ICU sterile site infections, from 0.60/10,000 bed-days to 0.45/10,000 bed-days (P = 0.027), and a 16% fall in ICU non-sterile site infections, from 36.36/10,000 bed-days to 30.43/10,000 bed-days (P = 0.037). The pre- and post-campaign rates of MRSA infection from ICU sterile sites (5.28/10,000 bed-days v 4.80/10,000 bed-days; P = 0.664) and non-ICU non-sterile sites (5.92/10,000 bed-days v 5.66/10,000 bed-days; P = 0.207) remained stable. Australia-wide MRSA data reported to the ACHS showed a 45% decline in infections from ICU non-sterile sites, from 25.89/10,000 bed-days to 14.30/10,000 bed-days (P < 0.001), and a 46% decline in infections from non-ICU non-sterile sites, from 3.70/10,000 bed-days to 1.99/10,000 bed-days (P < 0.001) over the period 2005-2006. Two out of four clinical indicators of MRSA infection remained unchanged despite significant improvements in hand hygiene compliance in NSW hospitals. The reduction in MRSA infections from ICU non-sterile sites in NSW hospitals was mirrored in ACHS data for other Australian states and cannot be assumed to be the result of improved hand hygiene compliance. Concurrent clinical and infection control practices possibly influence MRSA infection rates and may modify the effects of hand hygiene compliance. More sensitive measurements of hand hygiene compliance are needed.

Toward the sustainable adaptation of existing facilities

PurposeMuch of the existing commercial building stock in Western Australia has the ability to adapt to varying conditions such as climate change, which provides some potential for reusability and sustainability. Current sustainability assessment systems tend to be relevant only for new construction. The purpose of this paper is to examine the use of the National Australian Built Environment Rating System (NABERS) to address this gap by considering the influence of occupant behaviour on performance.Design/methodology/approachFeedback provided from 39 stakeholders during a public review of NABERS and a subsequent trial of NABERS on nine office buildings in Sydney and Victoria are examined. The data are obtained from the Department of Environment and Heritage and NSW Department of Energy, Utilities and Sustainability (now the Department of Environment and Climate Change).FindingsAssessment of the environment performance of existing facilities is needed to improve their energy efficiency. These findings need to be given serious thought when considering an adaptation strategy or the construction of a new facility. From a sustainability perspective, it will almost always be a more viable option to use an adaptive re‐use strategy. The use of adaptation will require clients and designers to re‐examine how their facilities are to be used and require them to embrace whole‐life costing and the use of innovative materials and technologies.Originality/valueAdaptive re‐use has received limited attention in Australia, as there has been a tendency to demolish or construct new buildings in response to client demands. However, adaptation is proving to be an effective strategy in ensuring a sustainable built environment. This research provides the impetus and foundations for exploring the invaluable role of adaptation and energy efficiency of existing facilities.

Residential Centre or Day Prison? The Case of COSP

In 2008 the NSW Department of Corrective Services (DCS) announced the establishment of the Community Offender Support Program (COSP). COSPs are classified as residential centres for offenders on community based orders. However most of those to be built in 2009 are to be located in the grounds or adjacent to correctional centres. The Program is said to be able to offer short term and crisis accommodation for offenders, enhanced supervision for those experiencing difficulty on community orders, rehabilitative experiences, and assistance to make connections with community services needed for reintegration. This Comment raises questions about these claims. The rationale for this program is problematic. It co-opts the accommodation and broader integration needs of offenders and subverts these entitlement claims for other purposes which include the management of offenders on punitive community orders and the placement of sex offenders. Questions are raised about the effects of this location on the management of a large concentration of offenders and its rehabilitative program and about the claim to be non-custodial and community-based in the face of the introduction of more punitive community penalties.

Toxicology and Circumstances of Completed Suicide by Means Other than Overdose*

To determine the prevalence and circumstances of psychoactive substances amongst nonoverdose completed suicide, 1436 consecutive cases autopsied at the NSW Department of Forensic Medicine over the period 1/1/1997-12/31/2006 were analyzed. Substances were detected in 67.2% of cases, and illicit drugs in 20.1%. Alcohol was present in 40.6% of cases. Males were more likely to be positive for alcohol, cannabis, and psychostimulants, and females for pharmaceuticals. Illicits were associated with younger age. Alcohol was most prominent amongst toxicity cases, as were opioids, psychostimulants amongst gunshot cases, and pharmaceuticals amongst drownings. Cases in which drug and alcohol histories were noted were more likely to have a substance detected. Alcohol was more common where a suicide note was left and where relationship problems were involved. Pharmaceuticals were more common where a previous attempt was noted. Licit and illicit substances are strongly associated with suicide, even when the method does not involve drug overdose.

Paediatricots: Utilisation of an Australian list serve to support occupational therapists working with children

The development of list serves has enabled occupational therapists working in a range of practice settings and geographical locations to share information and provide each other with professional support. The aim of this study was to gain insight into the nature of communications occurring on the Paediatricots list serve, and determine whether topics and issues raised were congruent with current practice trends for therapists working with children. A content analysis was undertaken of all archived Paediatricots emails sent between 1 June 2003 and 31 May 2004, using the previous Yahoo paediatricots group. The group is now maintained by the NSW Department of Health. A total of 2104 postings were made to Paediatricots during the 12-month period. These postings addressed a wide range of issues; however, the majority were of a clinical nature related to day-to-day practice. The focus of these communications was mainly on the performance components of children's skills, with less emphasis on task demands, environmental factors and practice approaches. The variety of issues raised, coupled with high membership levels and reciprocity rates, suggests that Paediatricots is providing a valuable professional resource for occupational therapists. Members appear to predominantly utilise the list serve to address day-to-day practice issues, particularly concerning performance components impacting on children's occupations. The facility also served to support organisational and professional development needs.

EpiReview: Tuberculosis in NSW, 2003–2007

must report all cases to their local public health unit. Public health unit or chest clinic staff enter case details into the Notifiable Diseases Database (NDD), which is maintained by the Communicable Diseases Branch of the NSW Department of Health. Cases were assigned to their corresponding year of notification using a specific tuberculosis field in NDD called year of diagnosis. This field was added to NDD in 2004 to assist the assignment of cases where dates of onset, specimen collected, notification and treatment overlap years. Cases in 2003 and earlier were assigned to their corresponding year if their date of onset, date of report or date of notification fell between 1 January and 31 December of the relevant year. We analysed the characteristics of cases for the period 2003–2007 and examined trends in incidence since 1991. Incidence rates were calculated using the Australian Bureau of Statistics (ABS) estimated mid-year population for the relevant year. Estimates for different resident populations by country of birth were provided by the Health Outcomes Information Statistical Toolkit (HOIST) and were calculated from a number of ABS datasets. 7

Bug Breakfast in theBulletin:Salmonella: pits and pets

ANSW Public Health Officer Training Program, NSW Department of Health BPublic Health Unit, Northern Sydney Central Coast Area Health Service CDepartment of Health and Ageing Risk factors The main risk factor for developing salmonellosis is eating raw or undercooked food such as poultry, beef, lamb, pork and eggs. It can also be spread from person-to-person or through contact with a contaminated animal or environment. Anyone is at risk of being infected with Salmonella; however, elderly people, children and immunocompromised individuals are at greater risk of developing more serious illness.5

Who's left holding the woman?: Practice issues facing hospital social workers working with women who have infants removed at birth by NSW Department of Community Services

Over the past three years, there has been a significant change in the focus of hospital social work intervention with pregnant women–from supportive counselling relating to motherhood, to systems advocacy within the child protection context.Hospital social workers in this field have frequently been faced with the inevitable conflicting interests of supporting parents and protecting infants. However, the recent changes have thrown up various ethical questions, and issues of integrity and advocacy, in what is a complex area of practice.This paper seeks to examine some of the current practice issues for social workers in this area. By examining the current context and literature, several practice themes will be considered and explored. In examining this issue at both the micro level of current hospital social work practice and the macro level of legislative and systemic issues, several best practice suggestions are considered within the context of the author's current workplace.

The first century of Phalaris aquatica L. cultivation and genetic improvement: a review

2006 marked the centenary of the commercial propagation of phalaris (Phalaris aquatica L.) as a cultivated pasture plant, firstly in Australia, and soon after in New Zealand, South Africa, and North and South America. Small-scale evaluation of cv. Australian began in the Toowoomba Botanic Gardens, Queensland, in 1884. The first recorded large-scale production of seed was at the Glen Innes Research Farm of the NSW Department of Agriculture in February 1906. By 1908–15, several graziers in Australia and New Zealand sold seed widely within Australia, New Zealand, USA, Argentina, and South Africa. Factors affecting the utilisation of the original cultivar in Australia over the first half-century are reviewed. Thereafter, the need to extend the area of perennial pastures into regions unsuitable for cv. Australian led CSIRO and the US Department of Agriculture to collect germplasm widely in the Mediterranean region. Selection between and within Moroccan populations produced cvv. Sirocco and El Golea in Australia, and cv. Perla koleagrass in the USA. In Argentina, selection within cv. Australian produced the very successful, seed-retaining cv. Pergamino El Gaucho INTA, which was re-selected in Australia to produce cv. Seedmaster. The discovery of a single seed-retaining plant within a certified line of cv. Australian gave cv. Uneta, which had excellent seed retention because the rachillae of most seeds remained intact at maturity. In Australia, selection in populations derived from crosses between cv. Australian and Mediterranean ecotypes gave a succession of winter-active cultivars: Sirosa, Sirolan, Holdfast, Landmaster, Atlas PG, Advanced AT, and Holdfast GT. The latter 5 have Uneta-type seed retention, reduced tryptamine and tyramine alkaloids, and adaptation to different soil and climatic niches. Populations for the hotter, drier inland slopes of NSW are being field-tested. Also, a promising but unstable semi-dwarf line has been found: dwarfism appears to be caused by a transposable element. Breeding and selection programs in Argentina, several states of the USA, New Zealand, Israel, Tunisia, and Greece also produced cultivars with specific adaptations. Active breeding programs are continuing at Ardmore, OK, USA, and Pergamino, Argentina. A major remaining obstacle to the further improvement and utilisation of phalaris is the unknown chemical nature of the toxin(s) causing ‘sudden death’, which temporarily interfere with nitrogen metabolism in the brains of herbivores, especially ruminants.

Meeting the recycled water challenge for Sydney

Sydney Water is seeking to maximise the delivery of recycled water meeting suitable standards for the intended use. The approach of health risk management through the 12 components of the national guidelines for water recycling is used in close consultation with the NSW Department of Health. Considerable effort is being put into demonstrating compliance with the guidelines when they are applied to specific recycling projects.

The re-evaluation of the use of videoconferencing to deliver the Bug Breakfast, December 2004

Executive summary Bug Breakfast is a continuing professional development activity for the multidisciplinary public health workforce in NSW. It is a series of seminars of one-hour duration about communicable diseases that are delivered by the NSW Department of Health approximately 11 times a year. Since 1999, the Bug Breakfast has been videoconferenced through the resources of the NSW Telehealth Initiative to up to 19 remote sites across NSW to enable the participation of rural public health practitioners. This report presents the results of a 2004 evaluation of the videoconferencing of the Bug Breakfast to assess the effect of implementing a range of recommendations intended to improve the quality of the learning experience of participants at both the live and remote sites.

Coherence between teleseismic tomography and long-wavelength features of the gravity and magnetic fields of southeastern Australia

During 2007 the NSW Department of Primary Industries contracted the Australian National Research Facility for Earth Sounding (ANSIR) to conduct the SEAL2 (South East Australia Linkage experiment, part 2) teleseismic program in southwestern New South Wales, to supplement earlier teleseismic acquisition in Victoria and southeastern South Australia (Figure 1). Interpretation of the results of the earlier SEAL1 program (Rawlinson et al., 2006), acquired with a seismic array in the southern Murray basin, appeared to conflict with recent interpretations of upper-crustal tectonic trends inferred primarily from aeromagnetic surveys in southwestern NSW (Hallett et al., 2005), which suggested that the Stawell Zone of western Victoria continued northwards into NSW. Instead, the SEAL1 tomographic model suggested a break in upper mantle velocities near the state border; the model implied that the Stawell Zone in Victoria is underlain by high vp upper mantle, consistent with lithospheric basement of Proterozoic age, while the putative extension of the Stawell Zone into NSW is underlain by low vp mantle, corresponding to Palaeozoic basement. Analysis of the SEAL2 dataset included a synthesis of all the southeast Australian teleseismic data into a single tomographic model of the upper mantle (Rawlinson, 2008). This model complicated the interpretation of the Stawell Zone further, by indicating a boundary between high vp ?Proterozoic? and low vp ?Phanerozoic? upper mantle cutting obliquely across the boundary between the Stawell and Bendigo zones in Victoria. In addition, two lobes of high vp upper mantle east of 145°E lie below Phanerozoic upper crust of the Lachlan Orogen, and lack any apparent relationship to internal tectonic divisions within the Lachlan Orogen. This paper investigates, and seeks to resolve, the apparent discrepancy between the tomographic upper mantle models on the one hand, and the combination of mappable surface geology and interpreted upper-crustal geophysics on the other, by comparing both with geophysical and geological evidence which arises from sources located in the middle to lower crust. Potential field anomalies with wavelengths greater than about 20 km should reveal middle crustal features, although the ability to discriminate them is compromised by the presence of broad anomalous sources (granitoids) in the upper crust, and, for the magnetic field, by suppression of long wavelengths during grid merging.

An extreme bushfire smoke pollution event: health impacts and public health challenges

To determine the health impacts of smoke and the effectiveness of public health advisories during a severe bushfire smoke event in Albury, NSW. The NSW Department of Environment and Climate Change provided PM(10) data. A computer-assisted telephone survey using random digit dialling was conducted following the smoke event to assess health impacts and the effectiveness of advisories. The smoke event lasted 38 days. The maximum daily PM(10) level was 415 microg/m(3). Public health advisories were based on alerts for air pollution issued by NSW Department of Health. From the survey, a total of 389 interviews were available for analysis. At least one health effect of the smoke was reported by 70% of respondents and 5% reported seeking medical treatment. Over 74% reported seeing, hearing or reading the health advisories. Behaviour change was significantly greater in this group (odds ratio = 2.74; 95% confidence interval 1.50-5.02). High rates of health effects may be experienced by populations exposed to bushfire smoke pollution. Public health advisories can support behaviour change to reduce exposure to bushfire smoke.

The role of in-field seismic processing in early evaluation in under-explored areas of the Darling Basin

The 2008 Rankins Springs Seismic Survey was a joint initiative by Geoscience Australia and NSW Department of Primary Industries under the Onshore Energy Security Program (OESP) in the under-explored southeastern Darling Basin. Regional seismic acquisition parameters of 300 channels, 40 m group interval and 80 m vibration point interval nevertheless allowed detailed imaging of a 3 second (TWT) thick sedimentary sequence in the Yathong Trough. Use of three 12 second vari-sweeps from truck mounted Hemi 50 (50,000 lb) vibrators provided sufficient energy to image from immediately below regolith to the Moho. The sweep frequency ranges 6 - 64, 10 - 96 and 8 - 80 Hz were chosen both for deep penetration and high resolution in the sedimentary section. In-field processing produced a high quality preliminary section on a daily basis using an iterative process of automatic residual statics calculation on a deep gate and interactive stacking velocity analysis. Both automatic statics and stacking velocity were essential for successful imaging, but velocity was more important, as initial estimates based on first arrival velocities produced a degraded section. The field seismic section clearly shows a fault bounded trough, with evidence of compressional structures in the upper part and hints of underlying older sedimentary basins. The in-field stacking velocity analysis also provided immediate evaluation of the maximum depth of the trough, approximately 6 km, deeper than expected. Efficient in-field processing allowed early notification to project partners of a successful survey, facilitating future planning, and provided a sound basis for streamlined subsequent processing.

When unequals are treated equally: The 2002 commission of inquiry into Orica's geomelt proposal

This paper deals with the Commission of Inquiry (COI) established by the NSW Department of Planning to examine Orica's proposal to build a Geomelt plant at its Botany site to destroy its stockpile of Hexachlorobenzene. The Inquiry is analysed in light of the literature on democracy/democratisation. The paper argues that the standard operating procedures of the Inquiry ensured that all stakeholders were treated equally. However, this equality was found to be purely formal, and drawing on the critique of formal equality dating back to Aristotle, it is argued that treating unequals equally results in the circumvention of deliberative democratic ideals by perpetuating entrenched structural inequalities while nonetheless giving the superficial appearance of fair play.

Serum dioxin levels in Sydney Harbour commercial fishers and family members

Background Commercial fishing in Sydney Harbour (SH) was banned in February 2006 as a result of high dioxin levels in some SH seafood. Because of concerns by some fishers about their own dioxin levels, testing of serum dioxin levels was offered to SH commercial fishers and their families. Objectives Aims of this study were to describe blood dioxin levels of SH fishers and family members; compare these levels to background Australian levels and international data; analyze association between intake of SH seafood and dioxin levels; and assess whether blood dioxin levels were useful to inform ongoing care of SH fishers. Methods NSW Department of Health conducted clinics at which 112 fishers and family members gave blood for analysis of dioxin levels. Dioxin exposure was assessed through a questionnaire. Seafood dioxin levels were provided by the NSW Department of Environment and Climate Change. Results For the fishers ( n = 26), median TCDD and total TEQ levels were 27.3 and 62.4 pg g −1 lipid, respectively. For the whole group ( n = 112), median TCDD and total TEQ levels were 9.3 and 26.1 pg g −1 lipid, respectively. Age was the strongest predictor of increased dioxin levels ( p < 0.01), and consumption of SH seafood was also strongly associated ( p = 0.01). Conclusions Serum dioxin levels in the SH fisher cohort were higher than Australian background levels, but comparable with other international high fish-eating communities, and lower than occupationally and accidentally exposed cohorts. High TCDD levels in commonly eaten seafood by the SH fishers confirms this as the likely exposure source.

Disability, Heroism and Australian National Identity

Disability, Heroism and Australian National Identity

Classification and description of stillbirths in New South Wales, 2002–2004

To describe the pattern of stillbirths by cause and gestation period in New South Wales since the introduction of the Perinatal Society of Australia and New Zealand perinatal death classification (PSANZ-PDC); and to assess the agreement between classifications on cause of death between local hospital committees and the Perinatal Outcomes Working Party (POWP - a subgroup of the NSW Department of Health Ministerial Maternal and Perinatal Committee). Population-based retrospective cohort study of all 258 045 births in NSW and all 1264 stillbirths classified by the POWP in 2002-2004, based on linked data on perinatal deaths from the NSW Midwives Data Collection and the NSW Ministerial Maternal and Perinatal Committee. Pattern of stillbirths by cause and gestation period; and interobserver agreement on classification of cause of death (according to the PSANZ-PDC) between local hospital review committees and the POWP. The most common classification was unexplained antepartum death, comprising 41.5% of the cohort and 60% of stillbirths of > or = 37 weeks' gestation. These unexplained stillbirths were more likely to have had an autopsy performed than the explained stillbirths (45% v 36%; x2 = 10.1; df = 1; P = 0.001). Agreement on cause of death differed by cause of death classification, with an overall kappa statistic of 0.638. Unexplained antepartum death is the most common classification of stillbirths near term, and these stillbirths are more likely to have had an autopsy. Although reported interobserver agreement is high for PSANZ-PDC, in practice it is relatively low between hospital mortality review committees and the POWP.

Infants in Australian Out-of-Home Care

This paper presents findings from a study examining the out-of-home care (OOHC) experiences of children aged less than one year (infants), based on data collected by the NSW Department of Community Services (DoCS), Australia. The purpose of the study is to develop a profile of infant children in OOHC and to better understand why so many young children require OOHC services and their experiences with the child welfare system. Using administrative data, we employ both descriptive and multivariate analysis to explore how child, child maltreatment history and system factors are related to the placement of infants in care. Our results are in line with research conducted in the USA and UK. The most notable finding is the high child protection reporting rate and high entry rate by infants and by Indigenous infants in particular. The tendency for infants to stay in care longer than other children, coupled with a high entry rate to care, has and will continue to have a significant impact on the child welfare system and its consequences. The implications for development of policy and early intervention programmes are discussed.

What Role Place and Localness in the Design of Sustainable Buildings?

Is “the new modernism” in domestic architecture—sometimes called “internationalism”—a useful step on the road toward sustainable buildings? Mindless recreations of traditional forms from other times and places are no better, as many writers have noted, but any building's natural and cultural context must play a fundamental role in the design, materials selection, and even the detailing, if sustainability is to be more readily achieved. The role of place-based planning has been well researched and reported (Clarke 2006; Mant 1998, 2000; NSW Department of Urban Affairs and Planning 2001). Less well understood is the role of “localness” in building design. This informs the overall form of buildings, and their detailing, as well as their technical functionality. A local understanding stems from a sense of materials, climate, and indigenous or local culture, and informs the design process at every level. In this article, the position of internationalist domestic architecture (espoused in glossy architecture publications) is criticised, drawing also on previous research (a case study of the outcomes of a place-based planning instrument, by the author, and a joint paper on locality-based design written jointly with Trevor King). The internationalist design approach is shown not to provide culturally appropriate or technically sustainable buildings.