1. Clare Prohaska

2.   Placed at Royal Prince Alfred Hospital in Sydney, Australia  14 hour flight from LAX to SYD Australia

3.   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

4.   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

5.   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

6.   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

7.   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

8.   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

9.   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

10.  Royal Prince Alfred Hospital and Team Front of RPA My resident Steph, attending Dr. Rebecca Davis, advanced trainee Sarah, and me

11. 

12.   Chua et al. The growing burden of multidrug- resistant infections among returned Australian travellers. Medical Journal of Australia. 2014 200(2): 116-18.  Cossart, Yvonne. The rise and fall of infectious diseases: Australian perspectives, 1914-2014. Medical Journal of Australia. 2014; 201(1): S11-14.  Gralton, et al. Health care workers' perceptions predicts uptake of personal protective equipment. American Journal of Infection Control. 2013; 41(1):2 -7. References