Richard Everts

Nelson Bays Primary Health


Faecal microbiota transplantation – an infection control catastrophe or the ultimate probiotic?

Concurrent session:  Faecal microbiota transplantation (FMT) involves transplantation of about a trillion bacteria and viruses from the bowel of a healthy ‘donor’ into the bowel of a sick patient.  The resultant increased diversity of bowel flora in the patient cures almost all cases of Clostridium difficile colitis, gives symptomatic benefit for most patients with irritable bowel syndrome, puts some patients with inflammatory bowel disease into remission, and may help patients with a wide range of other disorders.  Complications of FMT are rare as long as strict donor screening criteria are maintained.
Many DHBs provide FMT for patients with recurrent Clostridium difficile colitis. I run NZ’s only ‘stool bank’ of frozen FMT samples, and provide a DHB and small private clinic service for patients from around NZ with various bowel conditions.  I am a member of the national advisory group for FMT.
In this presentation I will discuss the rationale behind FMT, evidence for benefit (or lack of benefit) in various conditions, risks involved to the recipient, and donor screening requirements.  In a world where an extra-ordinary degree of hygiene and infection prevention is required in our health and residential care facilities, how can this practice be safe?

Richard is a hospital and community Infectious Disease Specialist Physician and Medical Microbiologist, based in Nelson and Marlborough in New Zealand.  He provides several Pacific Islands with antibiotic stewardship, infection control and microbiology laboratory support.  He does a little acute hospital General Medicine, consult to ACC, run a private internal medicine clinic, and carry out a variety of research and writing activities.

 

Masks – how they work, which are best and what to do if you run out. 

Concurrent session:

In this presentation I will discuss the evidence for how respiratory infections spread, how facemasks prevent this, which are the best masks, and how masks should be correctly worn.

In the event of a shortage of ‘single-use’ masks, reprocessing these masks may be an option.  This is especially relevant for personal mask use at home or non-healthcare settings, and in low-resource countries.  I will present the results of a study of eight reprocessing methods that each involved washing or soaking masks in water and is likely to eliminate respiratory viruses from the mask material.  These methods all reduced the filtration efficiency of the masks, largely by removing their electrostatic charge.  The reduction was mild-moderate (6.5-25.8%) after warm water wash, hot water soak or boiling water soak; and moderate-large (24.1-51.5%) after detergent, soap or laundry machine wash, or bleach soak.  There were mixed and minor changes in pressure differential.  Most reprocessed masks had better filtration efficiency than new non-standard commercial masks and than cotton and cotton-polyester mix fabric samples, even triple-layered fabrics.

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