The peripherally inserted central catheter (PICC): a prospective study of its natural history after cubital fossa insertion.

A prospective cohort study was undertaken to describe the natural history of the cubital fossa peripherally inserted central catheter (PICC), determine which factors influenced the hazard of complication and develop a standard methodology for evaluation of a PICC service. A total of 4349 patient days of PICC observation were analysed using survival analysis techniques. The median time to PICC removal for a complication was 60 days. The most common complications were phlebitis, malposition and tip migration. Complications usually occurred during the first week. There was only one episode of line-related sepsis. Size 3 French gauge catheters had a complication rate of 7.3 per 1,000 line days compared to 14.2 for 4 French catheters (hazard rate 1.26 90% CI 1.02 to 1.55). PICCs requiring two or more attempts at insertion were more likely to develop complications than those inserted at the first attempt: 20 per 1,000 line days vs 10.5 but the confidence intervals were wide (hazard rate 1.91, 90% CI 0.90 to 4.05). Operator (amongst the four experienced operators who inserted all PICCs), arm of placement, or medial or lateral placement in the cubitalfossa did not influence PICC survivaL

Malaria and its implications for public health in Far North Queensland: a prospective study.

This prospective study's objectives were to describe the features of all episodes of malaria diagnosed in Far North Queensland (excluding the Torres Strait) and to assess how much of a threat they posed to the area's public health. Over a three-year period, 216 episodes of malaria were diagnosed (158 Plasmodium vivax and 68 P. falciparum infections). Most (82%) of the infections were acquired in Papua New Guinea (PNG). Approximately 70% of the episodes occurred in Australian citizens, about half of whom were in malaria-endemic countries for work; the remainder travelled abroad for recreation. Three-quarters of the Australian citizens with malaria had taken either no or inadequate prophylaxis. Australian citizens who had taken adequate prophylaxis were much less likely to develop P. falciparum than other types of malaria compared to those who took either no or inadequate prophylaxis (p = 0.01). Gametocytes were present in 121 (56%) of the episodes of malaria. Mosquito surveillance was carried out in response to 38 (31%) of these gametocytaemic episodes. Significant numbers of Anopheles farauti sensu lato mosquitoes were found close to the residence of a patient in 4 (11%) of these episodes. Only two occasions when local transmission could have possibly occurred were recognised. We do not believe malaria poses an important threat to the health of the public in Far North Queensland. Nevertheless, it remains an important problem for those who travel abroad to malarious areas.

Plasmodium vivax malaria acquired in far north Queensland.

In February 1996, vivax malaria was diagnosed in a man from a remote community in far north Queensland who had not visited a malarious area for the past 19 years. Microscopy and DNA studies of blood from other residents of the community did not identify a source of infection. It was suspected the infection was transmitted by mosquitoes from a neighbour who had been infected in Papua New Guinea, but whose blood was not available for DNA tests.

An outbreak of hepatitis A in an intensive care unit.

We describe an outbreak of hepatitis A that occurred in an Intensive Care Unit (ICU) in a regional hospital in North Queensland. Seven people were infected including two patients, two close contacts of the index patient and three ICU nursing staff. The index case was admitted with an overdose and multiple trauma; he was not suspected to be incubating hepatitis A. The outbreak was initiated as a result of inadequate precautions taken whilst handling the index patient's bile. Problems identified upon reviewing the outbreak were inadequate terminal cleaning of equipment, food consumption in the ICU and inadequate handwashing practices. Implementation and maintenance of standard infection control practices is vital if further outbreaks of hospital-acquired hepatitis A and other enteric infections are to be avoided. We also suggest that the inactivated hepatitis A vaccine be considered for ICU staff.