Publications (2)9.72 Total impact
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Article: Cough-generated aerosols of Pseudomonas aeruginosa and other Gram-negative bacteria from patients with cystic fibrosis.
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ABSTRACT: Pseudomonas aeruginosa is the most common bacterial pathogen in patients with cystic fibrosis (CF). Current infection control guidelines aim to prevent transmission via contact and respiratory droplet routes and do not consider the possibility of airborne transmission. It was hypothesised that subjects with CF produce viable respirable bacterial aerosols with coughing. A cross-sectional study was undertaken of 15 children and 13 adults with CF, 26 chronically infected with P aeruginosa. A cough aerosol sampling system enabled fractioning of respiratory particles of different sizes and culture of viable Gram-negative non-fermentative bacteria. Cough aerosols were collected during 5 min of voluntary coughing and during a sputum induction procedure when tolerated. Standardised quantitative culture and genotyping techniques were used. P aeruginosa was isolated in cough aerosols of 25 subjects (89%), 22 of whom produced sputum samples. P aeruginosa from sputum and paired cough aerosols were indistinguishable by molecular typing. In four cases the same genotype was isolated from ambient room air. Approximately 70% of viable aerosols collected during voluntary coughing were of particles <or=3.3 microm aerodynamic diameter. P aeruginosa, Burkholderia cenocepacia, Stenotrophomonas maltophilia and Achromobacter xylosoxidans were cultivated from respiratory particles in this size range. Positive room air samples were associated with high total counts in cough aerosols (p = 0.003). The magnitude of cough aerosols was associated with higher forced expiratory volume in 1 s (r = 0.45, p = 0.02) and higher quantitative sputum culture results (r = 0.58, p = 0.008). During coughing, patients with CF produce viable aerosols of P aeruginosa and other Gram-negative bacteria of respirable size range, suggesting the potential for airborne transmission.Thorax 08/2009; 64(11):926-31. · 6.84 Impact Factor -
Article: Making choices: why parents present to the emergency department for non-urgent care.
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ABSTRACT: This study aims to provide a better understanding of the motivations and actions of parents of children with non-urgent injury or illness who attend the emergency department at a tertiary paediatric hospital seeking care. A prospective questionnaire-based survey of 355 parents aimed to ascertain information about parent care-giving and care-seeking behaviours prior to presentation at the emergency department with their child. A total of 355 parents were surveyed, representing 8% of the parents/carers presenting to the emergency department in a 3-month period for non-urgent (Australasian Triage System 4 and 5) care of their child. The factors identified were: parents rated their child's condition as moderate to very serious (242 (68%)); two-thirds of parents (234 (66%)) had sought advice prior to attending the emergency department; 54% (77) of the 137 children who attended with an injury presented promptly to emergency (ie, within 4 h of injury) whereas of the 216 presenting with an illness, 41% (88) presented within 2-7 days of the onset of the illness. This study displayed the accuracy of "parental triage," that is, parents assess their child's health and generally engage in appropriate care-giving and care-seeking behaviours before presenting to a paediatric emergency department. Highlighted are the deficiencies in current primary care services available to families and the perception that not all cases deemed as non-urgent by the emergency department are able to be dealt with in a primary care setting.Archives of Disease in Childhood 04/2009; 94(10):817-20. · 2.88 Impact Factor
