Clare Prohaska
Placed at Royal Prince Alfred Hospital in Sydney, Australia 14 hour flight from LAX to SYD Australia
What are antibiotic resistance rates in Australia? How do physicians determine which antibiotic to use? Do pharmacists round with teams similar to American rounds? What are the contact precaution regulations? How was the hospital handling the Ebola epidemic? Questions before Arrival
Australia itself has a low rate of multidrug resistant (MDR) organisms Many Australians traveling overseas actually acquire MDR organisms there, and are transferred back to Australia for treatment 1,2 Physicians and nurses change their contact precautions based on how virulent they perceive the organism to be 3 Research Prior to Travel
The physicians at RPA had Australian antibiotic guidelines that they referenced whenever they had a question Incredible stewardship Flucloxacillin—anti-Strep antibiotic, not used in US Physicians spent time in the microbiology lab; knew what organism was growing in every patient in hospital No pharmacists rounded with team Antibiotic Selection
NO WHITE COATS Only the examiner must use contact gown; if just observing in the room, plastic apron and gloves sufficient Ebola screening performed in ED Contact Precautions and Ebola
Australia has very specific antibiotic choices for clinical scenarios, and the physicians adhere to the guidelines No pharmacists round with team—at this time, do not seem necessary Contact precautions vary greatly between Australian and American health systems—room for improvement in the US Ebola screening similar to American screening Conclusions
Cohesive department Weekly meetings with other department members discussing Consults Organisms grown Inpatients on service Interdisciplinary teaching Weekly meetings with radiology, ICU attendings Monthly pathology meetings Most Profound Clinical Experience
Very laid back, both in and out of hospital Great diversity Food, cultures, peoples Chinese New Year celebrations in Sydney last two weeks! Everyone very polite and friendly Most Profound Cultural Experiences
Royal Prince Alfred Hospital and Team Front of RPA My resident Steph, attending Dr. Rebecca Davis, advanced trainee Sarah, and me
Chua et al. The growing burden of multidrug- resistant infections among returned Australian travellers. Medical Journal of Australia (2): Cossart, Yvonne. The rise and fall of infectious diseases: Australian perspectives, Medical Journal of Australia. 2014; 201(1): S Gralton, et al. Health care workers' perceptions predicts uptake of personal protective equipment. American Journal of Infection Control. 2013; 41(1):2 -7. References