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Marie-hélène Metzger - One of the best experts on this subject based on the ideXlab platform.
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Can epidemic detection systems at the hospital level complement regional surveillance networks: Case study with the influenza epidemic?
BMC Infectious Diseases, 2014Co-Authors: Solweig Gerbier-colomban, Véronique Potinet-pagliaroli, Marie-hélène MetzgerAbstract:Background Early knowledge of influenza outbreaks in the community allows local hospital healthcare workers to recognise the clinical signs of influenza in hospitalised patients and to apply effective Precautions. The objective was to assess intra-hospital surveillance systems to detect earlier than regional surveillance systems influenza outbreaks in the community. Methods Time series obtained from computerized medical data from patients who visited a French hospital emergency department (ED) between June 1st, 2007 and March 31st, 2011 for influenza, or were hospitalised for influenza or a respiratory syndrome after an ED visit, were compared to different regional series. Algorithms using CUSUM method were constructed to determine the epidemic detection threshold with the local data series. Sensitivity, specificity and mean timeliness were calculated to assess their performance to detect community outbreaks of influenza. A sensitivity analysis was conducted, excluding the year 2009, due to the particular epidemiological situation related to pandemic influenza this year. Results The local series closely followed the seasonal trends reported by regional surveillance. The algorithms achieved a sensitivity of detection equal to 100% with series of patients hospitalised with respiratory syndrome (specificity ranging from 31.9 and 92.9% and mean timeliness from −58.3 to 20.3 days) and series of patients who consulted the ED for flu (specificity ranging from 84.3 to 93.2% and mean timeliness from −32.3 to 9.8 days). The algorithm with the best balance between specificity (87.7%) and mean timeliness (0.5 day) was obtained with series built by analysis of the ICD-10 codes assigned by physicians after ED consultation. Excluding the year 2009, the same series keeps the best performance with specificity equal to 95.7% and mean timeliness equal to −1.7 day. Conclusions The implementation of an automatic surveillance system to detect patients with influenza or respiratory syndrome from computerized ED records could allow outbreak alerts at the intra-hospital level before the publication of regional data and could accelerate the implementation of preventive Transmission-Based Precautions in hospital settings.
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Can epidemic detection systems at the hospital level complement regional surveillance networks: Case study with the influenza epidemic?
BMC Infectious Diseases, 2014Co-Authors: Solweig Gerbier-colomban, Véronique Potinet-pagliaroli, Marie-hélène MetzgerAbstract:Early knowledge of influenza outbreaks in the community allows local hospital healthcare workers to recognise the clinical signs of influenza in hospitalised patients and to apply effective Precautions. The objective was to assess intra-hospital surveillance systems to detect earlier than regional surveillance systems influenza outbreaks in the community. Time series obtained from computerized medical data from patients who visited a French hospital emergency department (ED) between June 1st, 2007 and March 31st, 2011 for influenza, or were hospitalised for influenza or a respiratory syndrome after an ED visit, were compared to different regional series. Algorithms using CUSUM method were constructed to determine the epidemic detection threshold with the local data series. Sensitivity, specificity and mean timeliness were calculated to assess their performance to detect community outbreaks of influenza. A sensitivity analysis was conducted, excluding the year 2009, due to the particular epidemiological situation related to pandemic influenza this year. The local series closely followed the seasonal trends reported by regional surveillance. The algorithms achieved a sensitivity of detection equal to 100% with series of patients hospitalised with respiratory syndrome (specificity ranging from 31.9 and 92.9% and mean timeliness from −58.3 to 20.3 days) and series of patients who consulted the ED for flu (specificity ranging from 84.3 to 93.2% and mean timeliness from −32.3 to 9.8 days). The algorithm with the best balance between specificity (87.7%) and mean timeliness (0.5 day) was obtained with series built by analysis of the ICD-10 codes assigned by physicians after ED consultation. Excluding the year 2009, the same series keeps the best performance with specificity equal to 95.7% and mean timeliness equal to −1.7 day. The implementation of an automatic surveillance system to detect patients with influenza or respiratory syndrome from computerized ED records could allow outbreak alerts at the intra-hospital level before the publication of regional data and could accelerate the implementation of preventive Transmission-Based Precautions in hospital settings.
Andrew Whitelaw - One of the best experts on this subject based on the ideXlab platform.
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Utilization of paediatric isolation facilities in a TB-endemic setting
Antimicrobial Resistance and Infection Control, 2015Co-Authors: Angela Dramowski, Mark F. Cotton, Andrew WhitelawAbstract:Introduction In hospital settings, patient isolation is used to limit transmission of certain pathogens (e.g. M. tuberculosis [TB], antibiotic-resistant bacteria and viruses causing respiratory and enteric infection). Data is lacking on utilization of paediatric isolation facilities in low-resource, TB-endemic settings. Methods Prospective weekday observation of 18 paediatric isolation rooms at Tygerberg Children’s Hospital, Cape Town, South Africa, was conducted between 1 May 2014 and 31 October 2014 documenting: occupancy rate; indication for isolation; duration of isolation; application of Transmission-Based Precautions and infection prevention (IPC) behaviour of personnel. Potential under-utilization of isolation rooms was determined by cross-referencing isolation room occupancy with laboratory isolates of antibiotic-resistant bacteria, M. tuberculosis and selected viral pathogens. Results Six percent (335/5906) of hospitalized children were isolated: 78 % (260/335) for IPC purposes. Most IPC-isolated patients had community-acquired infections (213/260; 82 %), including tuberculosis (130/260; 50 %) and suspected viral infections (75/260; 29 %). Children (median age 17 months [IQR 6–50]) spent 4 days (IQR 2–8) in isolation. Isolation occupancy was 66 % (2172/3294 occupied bed days), but varied significantly by month. Laboratory data identified an additional 135 patients warranting isolation with 2054 extra bed-days required. Forty patients with 171 patient days of inappropriate isolation were identified. During 1223 weekday visits to IPC-isolated patient rooms: alcohol-based handrub was available (89 %); Transmission-Based Precautions were appropriately implemented (71 %); and personal protective equipment was provided (74 %). Of 358 observed interactions between paediatric staff and isolated patients, hand hygiene compliance was 65 % and adherence to Transmission-Based Precautions was 58 %. Conclusion Patients isolated for TB (under airborne Precautions) accounted for more than half of all isolation episodes. Missed opportunities for patient isolation were common but could be reduced by implementation of syndromic isolation. Demand for isolation facilities was seasonal, with projected demand exceeding available isolation beds over winter months.
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Utilization of paediatric isolation facilities in a TB-endemic setting
Antimicrobial Resistance and Infection Control, 2015Co-Authors: Angela Dramowski, Mark F. Cotton, Andrew WhitelawAbstract:In hospital settings, patient isolation is used to limit transmission of certain pathogens (e.g. M. tuberculosis [TB], antibiotic-resistant bacteria and viruses causing respiratory and enteric infection). Data is lacking on utilization of paediatric isolation facilities in low-resource, TB-endemic settings. Prospective weekday observation of 18 paediatric isolation rooms at Tygerberg Children’s Hospital, Cape Town, South Africa, was conducted between 1 May 2014 and 31 October 2014 documenting: occupancy rate; indication for isolation; duration of isolation; application of Transmission-Based Precautions and infection prevention (IPC) behaviour of personnel. Potential under-utilization of isolation rooms was determined by cross-referencing isolation room occupancy with laboratory isolates of antibiotic-resistant bacteria, M. tuberculosis and selected viral pathogens. Six percent (335/5906) of hospitalized children were isolated: 78 % (260/335) for IPC purposes. Most IPC-isolated patients had community-acquired infections (213/260; 82 %), including tuberculosis (130/260; 50 %) and suspected viral infections (75/260; 29 %). Children (median age 17 months [IQR 6–50]) spent 4 days (IQR 2–8) in isolation. Isolation occupancy was 66 % (2172/3294 occupied bed days), but varied significantly by month. Laboratory data identified an additional 135 patients warranting isolation with 2054 extra bed-days required. Forty patients with 171 patient days of inappropriate isolation were identified. During 1223 weekday visits to IPC-isolated patient rooms: alcohol-based handrub was available (89 %); Transmission-Based Precautions were appropriately implemented (71 %); and personal protective equipment was provided (74 %). Of 358 observed interactions between paediatric staff and isolated patients, hand hygiene compliance was 65 % and adherence to Transmission-Based Precautions was 58 %. Patients isolated for TB (under airborne Precautions) accounted for more than half of all isolation episodes. Missed opportunities for patient isolation were common but could be reduced by implementation of syndromic isolation. Demand for isolation facilities was seasonal, with projected demand exceeding available isolation beds over winter months.
Solweig Gerbier-colomban - One of the best experts on this subject based on the ideXlab platform.
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Can epidemic detection systems at the hospital level complement regional surveillance networks: Case study with the influenza epidemic?
BMC Infectious Diseases, 2014Co-Authors: Solweig Gerbier-colomban, Véronique Potinet-pagliaroli, Marie-hélène MetzgerAbstract:Background Early knowledge of influenza outbreaks in the community allows local hospital healthcare workers to recognise the clinical signs of influenza in hospitalised patients and to apply effective Precautions. The objective was to assess intra-hospital surveillance systems to detect earlier than regional surveillance systems influenza outbreaks in the community. Methods Time series obtained from computerized medical data from patients who visited a French hospital emergency department (ED) between June 1st, 2007 and March 31st, 2011 for influenza, or were hospitalised for influenza or a respiratory syndrome after an ED visit, were compared to different regional series. Algorithms using CUSUM method were constructed to determine the epidemic detection threshold with the local data series. Sensitivity, specificity and mean timeliness were calculated to assess their performance to detect community outbreaks of influenza. A sensitivity analysis was conducted, excluding the year 2009, due to the particular epidemiological situation related to pandemic influenza this year. Results The local series closely followed the seasonal trends reported by regional surveillance. The algorithms achieved a sensitivity of detection equal to 100% with series of patients hospitalised with respiratory syndrome (specificity ranging from 31.9 and 92.9% and mean timeliness from −58.3 to 20.3 days) and series of patients who consulted the ED for flu (specificity ranging from 84.3 to 93.2% and mean timeliness from −32.3 to 9.8 days). The algorithm with the best balance between specificity (87.7%) and mean timeliness (0.5 day) was obtained with series built by analysis of the ICD-10 codes assigned by physicians after ED consultation. Excluding the year 2009, the same series keeps the best performance with specificity equal to 95.7% and mean timeliness equal to −1.7 day. Conclusions The implementation of an automatic surveillance system to detect patients with influenza or respiratory syndrome from computerized ED records could allow outbreak alerts at the intra-hospital level before the publication of regional data and could accelerate the implementation of preventive Transmission-Based Precautions in hospital settings.
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Can epidemic detection systems at the hospital level complement regional surveillance networks: Case study with the influenza epidemic?
BMC Infectious Diseases, 2014Co-Authors: Solweig Gerbier-colomban, Véronique Potinet-pagliaroli, Marie-hélène MetzgerAbstract:Early knowledge of influenza outbreaks in the community allows local hospital healthcare workers to recognise the clinical signs of influenza in hospitalised patients and to apply effective Precautions. The objective was to assess intra-hospital surveillance systems to detect earlier than regional surveillance systems influenza outbreaks in the community. Time series obtained from computerized medical data from patients who visited a French hospital emergency department (ED) between June 1st, 2007 and March 31st, 2011 for influenza, or were hospitalised for influenza or a respiratory syndrome after an ED visit, were compared to different regional series. Algorithms using CUSUM method were constructed to determine the epidemic detection threshold with the local data series. Sensitivity, specificity and mean timeliness were calculated to assess their performance to detect community outbreaks of influenza. A sensitivity analysis was conducted, excluding the year 2009, due to the particular epidemiological situation related to pandemic influenza this year. The local series closely followed the seasonal trends reported by regional surveillance. The algorithms achieved a sensitivity of detection equal to 100% with series of patients hospitalised with respiratory syndrome (specificity ranging from 31.9 and 92.9% and mean timeliness from −58.3 to 20.3 days) and series of patients who consulted the ED for flu (specificity ranging from 84.3 to 93.2% and mean timeliness from −32.3 to 9.8 days). The algorithm with the best balance between specificity (87.7%) and mean timeliness (0.5 day) was obtained with series built by analysis of the ICD-10 codes assigned by physicians after ED consultation. Excluding the year 2009, the same series keeps the best performance with specificity equal to 95.7% and mean timeliness equal to −1.7 day. The implementation of an automatic surveillance system to detect patients with influenza or respiratory syndrome from computerized ED records could allow outbreak alerts at the intra-hospital level before the publication of regional data and could accelerate the implementation of preventive Transmission-Based Precautions in hospital settings.
Angela Dramowski - One of the best experts on this subject based on the ideXlab platform.
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Infectious disease exposures and outbreaks at a South African neonatal unit with review of neonatal outbreak epidemiology in Africa.
International Journal of Infectious Diseases, 2017Co-Authors: Angela Dramowski, Aucamp M, A. Bekker, Shaheen MehtarAbstract:Summary Background Hospitalized neonates are vulnerable to infection, with pathogen exposures occurring in utero, intrapartum, and postnatally. African neonatal units are at high risk of outbreaks owing to overcrowding, understaffing, and shared equipment. Methods Neonatal outbreaks attended by the paediatric infectious diseases and infection prevention (IP) teams at Tygerberg Children's Hospital, Cape Town (May 1, 2008 to April 30, 2016) are described, pathogens, outbreak size, mortality, source, and outbreak control measures. Neonatal outbreaks reported from Africa (January 1, 1996 to January 1, 2016) were reviewed to contextualize the authors' experience within the published literature from the region. Results Thirteen outbreaks affecting 148 babies (11 deaths; 7% mortality) over an 8-year period were documented, with pathogens including rotavirus, influenza virus, measles virus, and multidrug-resistant bacteria ( Serratia marcescens , Acinetobacter baumannii , methicillin-resistant Staphylococcus aureus , and vancomycin-resistant enterococci). Although the infection source was seldom identified, most outbreaks were associated with breaches in IP practices. Stringent Transmission-Based Precautions, staff/parent education, and changes to clinical practices contained the outbreaks. From the African neonatal literature, 20 outbreaks affecting 524 babies (177 deaths; 34% mortality) were identified; 50% of outbreaks were caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae . Conclusions Outbreaks in hospitalized African neonates are frequent but under-reported, with high mortality and a predominance of Gram-negative bacteria. Breaches in IP practice are commonly implicated, with the outbreak source confirmed in less than 50% of cases. Programmes to improve IP practice and address antimicrobial resistance in African neonatal units are urgently required.
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Utilization of paediatric isolation facilities in a TB-endemic setting
Antimicrobial Resistance and Infection Control, 2015Co-Authors: Angela Dramowski, Mark F. Cotton, Andrew WhitelawAbstract:Introduction In hospital settings, patient isolation is used to limit transmission of certain pathogens (e.g. M. tuberculosis [TB], antibiotic-resistant bacteria and viruses causing respiratory and enteric infection). Data is lacking on utilization of paediatric isolation facilities in low-resource, TB-endemic settings. Methods Prospective weekday observation of 18 paediatric isolation rooms at Tygerberg Children’s Hospital, Cape Town, South Africa, was conducted between 1 May 2014 and 31 October 2014 documenting: occupancy rate; indication for isolation; duration of isolation; application of Transmission-Based Precautions and infection prevention (IPC) behaviour of personnel. Potential under-utilization of isolation rooms was determined by cross-referencing isolation room occupancy with laboratory isolates of antibiotic-resistant bacteria, M. tuberculosis and selected viral pathogens. Results Six percent (335/5906) of hospitalized children were isolated: 78 % (260/335) for IPC purposes. Most IPC-isolated patients had community-acquired infections (213/260; 82 %), including tuberculosis (130/260; 50 %) and suspected viral infections (75/260; 29 %). Children (median age 17 months [IQR 6–50]) spent 4 days (IQR 2–8) in isolation. Isolation occupancy was 66 % (2172/3294 occupied bed days), but varied significantly by month. Laboratory data identified an additional 135 patients warranting isolation with 2054 extra bed-days required. Forty patients with 171 patient days of inappropriate isolation were identified. During 1223 weekday visits to IPC-isolated patient rooms: alcohol-based handrub was available (89 %); Transmission-Based Precautions were appropriately implemented (71 %); and personal protective equipment was provided (74 %). Of 358 observed interactions between paediatric staff and isolated patients, hand hygiene compliance was 65 % and adherence to Transmission-Based Precautions was 58 %. Conclusion Patients isolated for TB (under airborne Precautions) accounted for more than half of all isolation episodes. Missed opportunities for patient isolation were common but could be reduced by implementation of syndromic isolation. Demand for isolation facilities was seasonal, with projected demand exceeding available isolation beds over winter months.
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Utilization of paediatric isolation facilities in a TB-endemic setting
Antimicrobial Resistance and Infection Control, 2015Co-Authors: Angela Dramowski, Mark F. Cotton, Andrew WhitelawAbstract:In hospital settings, patient isolation is used to limit transmission of certain pathogens (e.g. M. tuberculosis [TB], antibiotic-resistant bacteria and viruses causing respiratory and enteric infection). Data is lacking on utilization of paediatric isolation facilities in low-resource, TB-endemic settings. Prospective weekday observation of 18 paediatric isolation rooms at Tygerberg Children’s Hospital, Cape Town, South Africa, was conducted between 1 May 2014 and 31 October 2014 documenting: occupancy rate; indication for isolation; duration of isolation; application of Transmission-Based Precautions and infection prevention (IPC) behaviour of personnel. Potential under-utilization of isolation rooms was determined by cross-referencing isolation room occupancy with laboratory isolates of antibiotic-resistant bacteria, M. tuberculosis and selected viral pathogens. Six percent (335/5906) of hospitalized children were isolated: 78 % (260/335) for IPC purposes. Most IPC-isolated patients had community-acquired infections (213/260; 82 %), including tuberculosis (130/260; 50 %) and suspected viral infections (75/260; 29 %). Children (median age 17 months [IQR 6–50]) spent 4 days (IQR 2–8) in isolation. Isolation occupancy was 66 % (2172/3294 occupied bed days), but varied significantly by month. Laboratory data identified an additional 135 patients warranting isolation with 2054 extra bed-days required. Forty patients with 171 patient days of inappropriate isolation were identified. During 1223 weekday visits to IPC-isolated patient rooms: alcohol-based handrub was available (89 %); Transmission-Based Precautions were appropriately implemented (71 %); and personal protective equipment was provided (74 %). Of 358 observed interactions between paediatric staff and isolated patients, hand hygiene compliance was 65 % and adherence to Transmission-Based Precautions was 58 %. Patients isolated for TB (under airborne Precautions) accounted for more than half of all isolation episodes. Missed opportunities for patient isolation were common but could be reduced by implementation of syndromic isolation. Demand for isolation facilities was seasonal, with projected demand exceeding available isolation beds over winter months.
Brett G Mitchell - One of the best experts on this subject based on the ideXlab platform.
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Where is the strength of evidence? A review of infection prevention and control guidelines.
Journal of Hospital Infection, 2020Co-Authors: Brett G Mitchell, Oyebola Fasugba, Philip L. RussoAbstract:Abstract Background An important aspect of safety and quality in healthcare is the implementation of infection prevention and control guidelines. However, little is known regarding the strength of evidence on which recommendations for such guidelines are based. Aim This study aimed to describe the strength of recommendations of infection prevention and control guidelines published in the last ten years. Methods For this review, we purposely searched the websites of government and professional organisations for national and international infection prevention and control clinical guidelines. The search was limited to publications between January 2009 and April 2019, and those with a formal grading system used to determine the strength of the evidence underpinning the recommendations. Recommendations from guidelines were categorised into 21 infection control categories. A descriptive synthesis of the data was undertaken. Results A total of 31 guidelines comprising 1855 recommendations were included. Guidelines were mainly developed in the United States (n=11, 35.5%) and Canada (n=9, 29.0%). Most guidelines used the GRADE approach (n=6, 19.4%. The majority of the guidelines contained recommendations categorised under the themes of devices (n=316, 16.9%) and Transmission-Based Precautions (n=315, 16.8%). Most recommendations (n=769, 41.5%) were graded as using evidence from descriptive studies, expert opinion and low quality evidence. Conclusion There is a vast number of infection prevention and control guidelines developed by national and international government or professional organisations, many without a strong evidence base. This presents multiple research opportunities that should prioritise common prevention activities that currently have a low evidence base.
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Establishing the prevalence of healthcare-associated infections in Australian hospitals: protocol for the Comprehensive Healthcare Associated Infection National Surveillance (CHAINS) study
BMJ Open, 2018Co-Authors: Philip L. Russo, Andrew J. Stewardson, Allen C. Cheng, Tracey Bucknall, Kalisavar Marimuthu, Brett G MitchellAbstract:INTRODUCTION: A healthcare-associated infection (HAI) data point prevalence study (PPS) conducted in 1984 in Australian hospitals estimated the prevalence of HAI to be 6.3%. Since this time, there have been no further national estimates undertaken. In the absence of a coordinated national surveillance programme or regular PPS, there is a dearth of national HAI data to inform policy and practice priorities. METHODS AND ANALYSIS: A national HAI PPS study will be undertaken based on the European Centres for Disease Control method. Nineteen public acute hospitals will participate. A standardised algorithm will be used to detect HAIs in a two-stage cluster design, random sample of adult inpatients in acute wards and all intensive care unit patients. Data from each hospital will be collected by two trained members of the research team. We will estimate the prevalence of HAIs, invasive device use, single room placement and deployment of Transmission-Based Precautions. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Alfred Health Human Research Ethics Committee (HREC/17/Alfred/203) via the National Mutual Assessment. A separate approval was obtained from the Tasmanian Health and Medical Human Research Committee (H0016978) for participating Tasmanian hospitals. Findings will be disseminated in individualised participating hospital reports, peer-reviewed publications and conference presentations.
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Australian graduating nurses’ knowledge, intentions and beliefs on infection prevention and control: a cross-sectional study
BMC Nursing, 2014Co-Authors: Brett G Mitchell, Anne Wells, Fiona Wilson, Linda Cloete, Lucinda MathesonAbstract:Background In recent year, national bodies have been actively addressing the increasing concern on the spread of healthcare-associated infections (HAIs). The current study measures the knowledge, intentions and beliefs of third-year Australian nursing students on key infection prevention and control (IPC) concepts. Methods A cross-sectional study of final-year undergraduate nursing students from Schools of Nursing at six Australian universities was undertaken. Students were asked to participate in an anonymous survey. The survey explored knowledge of standard Precautions and transmission based Precautions. In addition intentions and beliefs towards IPC were explored. Results 349 students from six universities completed the study. 59.8% (95% CI 58.8–60.8%) of questions were answered correctly. Significantly more standard precaution questions were correctly answered than Transmission-Based precaution questions (p
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Australian Graduating Nurses’ Knowledge, Intentions and Beliefs on Infection Prevention and Control: A Cross-Sectional Study
BMC Nursing, 2014Co-Authors: Brett G Mitchell, Anne Wells, Fiona Wilson, Linda Cloete, Lucinda MathesonAbstract:In recent year, national bodies have been actively addressing the increasing concern on the spread of healthcare-associated infections (HAIs). The current study measures the knowledge, intentions and beliefs of third-year Australian nursing students on key infection prevention and control (IPC) concepts. A cross-sectional study of final-year undergraduate nursing students from Schools of Nursing at six Australian universities was undertaken. Students were asked to participate in an anonymous survey. The survey explored knowledge of standard Precautions and transmission based Precautions. In addition intentions and beliefs towards IPC were explored. 349 students from six universities completed the study. 59.8% (95% CI 58.8–60.8%) of questions were answered correctly. Significantly more standard precaution questions were correctly answered than Transmission-Based precaution questions (p
