The NHHI was associated with widespread sustained improvements in HH compliance among Australian health care workers. Although specific linking of SAB rate changes to the NHHI was not possible, further declines in national SAB rates are expected.

Objectives: To report the quarterly incidence of hospital‐identified Clostridium difficile infection (HI‐CDI) in Australia, and to estimate the burden ascribed to hospital‐associated (HA) and community‐associated (CA) infections. Design, setting and patients: Prospective surveillance of all cases of CDI diagnosed in hospital patients from 1 January 2011 to 31 December 2012 in 450 public hospitals in all Australian states and the Australian Capital Territory. All patients admitted to inpatient wards or units in acute public hospitals, including psychiatry, rehabilitation and aged care, were included, as well as those attending emergency departments and outpatient clinics. Main outcome measures: Incidence of HI‐CDI (primary outcome); proportion and incidence of HA‐CDI and CA‐CDI (secondary outcomes). Results: The annual incidence of HI‐CDI increased from 3.25/10 000 patient‐days (PD) in 2011 to 4.03/10 000 PD in 2012. Poisson regression modelling demonstrated a 29% increase (95% CI, 25% to 34%) per quarter between April and December 2011, with a peak of 4.49/10 000 PD in the October–December quarter. The incidence plateaued in January–March 2012 and then declined by 8% (95% CI, − 11% to − 5%) per quarter to 3.76/10 000 PD in July–September 2012, after which the rate rose again by 11% (95% CI, 4% to 19%) per quarter to 4.09/10 000 PD in October–December 2012. Trends were similar for HA‐CDI and CA‐CDI. A subgroup analysis determined that 26% of cases were CA‐CDI. Conclusions: A significant increase in both HA‐CDI and CA‐CDI identified through hospital surveillance occurred in Australia during 2011–2012. Studies are required to further characterise the epidemiology of CDI in Australia.

Certain facial characteristics were associated with higher or lower pass rates with regard to fit testing, and fit testers were able to select a suitable respirator on the basis of a visual assessment in the majority of cases. For the fit tester, training and experience were important factors; however, for the HCW being fitted, prior experience in respirator use was not an important factor.

There was a major and significant reduction in incidence of HO-SAB caused by both MRSA and MSSA in Australian hospitals since 2002. This reduction coincided with a range of infection prevention and control activities implemented during this time. It suggests that national and local efforts to reduce the burden of healthcare-associated infections have been very successful.

Staphylococcus aureus bloodstream (SAB) infections are common and serious causes of morbidity and mortality that incur considerable health care costs and are potentially preventable. It should be relatively easy for hospitals to collect data on the incidence of SAB episodes, to determine whether infections were acquired in hospital or in the community, and to establish whether they were health care associated. The proportion of SAB infections caused by methicillin‐resistant S. aureus strains should be a useful indicator of the level of control of antibiotic resistance in the community and in the health care setting. Continuous monitoring of infection incidence would enable health care facilities to determine the effectiveness of interventions designed to minimise SAB infections.

Following investigation of an outbreak of legionellosis in South Australia, numerous Legionella-like organisms were isolated from water samples. Because of the limited number of commercially available direct fluorescent-antibody reagents and the cross-reactions found with some reagents, non-pneumophila legionellae proved to be difficult to identify and these isolates were stored at-70°C for later study. Latex agglutination reagents for Legionella pneumophila and Legionella anisa developed by the Institute of Medical and Veterinary Science, Adelaide, Australia, were found to be useful as rapid screening aids. Autofluorescence was useful for placing isolates into broad groups. Cellular fatty acid analysis, ubiquinone analysis, and DNA hybridization techniques were necessary to provide definitive identification. The species which were isolated most frequently were L. pneumophila, followed by L. anisa, Legionella jamestowniensis, Legionella quinlivanii, Legionella rubrilucens, Legionella spiritensis, and a single isolate each of Legionella erythra, Legionellajordanis, Legionella birminghamensis, and Legionella cincinnatiensis. In addition, 10 isolates were found by DNA hybridization studies to be unrelated to any of the 26 currently known species, representing what we believe to be 6 possible new species.

Summary Antimicrobial agents play a central role in modern health care, especially in the hospital setting. This article describes the currently available information on the volumes of antimicrobial use in Australian hospitals, the appropriateness of that use, and the levels of compliance with nationally or locally endorsed prescribing guidelines. The data presented here come from the 2014 National Antimicrobial Utilisation Surveillance Program report and the 2013 and 2014 National Antimicrobial Prescribing Survey reports and are based on voluntary participation in the two programs. While the results can be considered indicative only, they show that Australia has high volumes of prescribing in hospitals, and that in certain circumstances and conditions these are inappropriate and/or not compliant with national or local prescribing guidelines. In 2014, the national aggregate use rate for antimicrobials was 936 defined daily doses per 1000 occupied bed days. In the same year, the overall rate of appropriate prescribing was 72%, and compliance with guidelines was 74% where this was assessable. The rate of surgical antimicrobial prophylaxis exceeding the benchmark of 24 hours was high (36%), as was the inappropriate prescribing for infective exacerbations of chronic obstructive pulmonary disease (38%). The findings indicate that there is room for improvement in antimicrobial prescribing in Australian hospitals, and provides insights into where the efforts for improvement might be directed.

Summary. The effect of dietary xyiitol on the ability ofthe rat caeca! flora lo metabolise xylitol was investigated. Xylitol metabolism in micro-organisms has generally been assessed in terms ofpH change and acid production wbich are often insensitive in demonstrating low rates ofsubstrate utilisation. Using a rapid and sensitive radioisotopic assay. in which '*COj production from lU-'^Cl xylitol was measured, it was possible to show that the caecal microflora obtained from rats can metabolise xylitol. This activity was increased 10, 15, 30 and 40-fold in the caecal flora taken from rats fed diets containing 2'5. 5. 10 and 20% xylitol, respectively.Using the caecal microflora of normally fed rats, the order of'•'COj production from '*C-iabelled sugars and sugar alcohols was glucose > fructose > xylose > sorbitol ? xylitol. The feeding of glucose and fructose did not alter tbe '^COj producing activities, whereas xylose feeding increased xylose metabolism, sorbitol feeding increased sorbitol and xylitol metabolism, xylitol feeding increased sorbitol, xylose and its own metabolism and arabitol feeding increased xylose and sorbitol metabolism. Marked changes were also observed in the population of the caecal flora of xylitol-fed rats, with increases in the number of gram-positive bacteria, compared to rats on a normal diet. Possible mechanisms for these effects involve mutation, selection of micro-organisms capable of metabolising sugar alcohols, and the induction of enzymes involved in sugar alcohol metabolism. INTRODUCTIONThere now exists considerable scientiftc and commercial pressure to introduce xylitoi into our diets in greater than normal quantities in order to reduce the incidence of dental caries, a major health problem in our society (Scheinin and Makinen, 1975;Makinen, 1978; Counsell, 1978). This is because the total or partial substitution of dietary sucrose by xylito] considerably reduced the incidence of dental caries in volunteers who participated in a two-year trial in Turku, Finland (Scheinin and Makinen, 1975).