Abstracts published at Infection Prevention 2015, Liverpool

doi:10.1177/1757177415599501

. 2015 Sep;16(1 Suppl):S3–S52. doi: 10.1177/1757177415599501

Abstracts published at Infection Prevention 2015, Liverpool

PMCID: PMC5074091

Oral Presentations

Abstract ID: 3730

The HANDS study: A pragmatic cross-over cluster randomised study of electronic compliance monitoring of staff hand sanitisation in critical care

Pat Cattini¹ and Simon Finney², Sundeep Kaul²

¹Royal Marsden National Health Service (NHS) Foundation Trust

²Royal Brompton and Harefield NHS Trust London, UK

Background

This study tested the hypothesis that feedback to healthcare workers (HCWs) has a positive effect on hand hygiene compliance. The MedSense™ system uses a personalised electronic badge worn by each HCW, a set of beacons placed above each bed space, and detectors placed beneath each alcohol and soap dispenser. The system can correlate actions at dispensers with entry and exit to these patient areas (Moments 1, 4 and 5 of the World Health Organization (WHO) “Five Moments”). The system can also cause the badge to vibrate, if it detects that an opportunity is about to be missed.

Methods

The Medsense system was installed in three intensive care units (ICUs) within the Trust. The trial consisted of three 8-week phases. In Phase 1, compliance was monitored, but no feedback was given. In Phase 2, staff on each unit was sent a daily email, detailing their individual compliance along with online access to Medsense HQ, where they could compare their performance with their peers. Staff in the paediatric ICU (PICU) was given additional real-time feedback in the form of a vibration from their badge. In Phase 3, the staff in the Adult Intensive Care Unit and Intensive Treatment Unit received an additional vibration and the staff in PICU reverted to delayed feedback only.

Results

Compared to baseline, delayed electronic feedback to HCWs increased compliance by 1%, 2% and 6% in each of the three units examined. These figures increased to 8%, 11% and 24% when real-time feedback (vibration) was added to the delayed feedback.

Conclusions

The real-time feedback from the MedSense™ system had a positive impact on compliance in the three ICUs, and might represents a cost-effective means of monitoring hand hygiene compliance, as well as giving encouragement to the staff through feedback.

Declaration of conflicting interest

Pat Cattini is a member of the IPS SPC.

Abstract ID: 3732

Carbapenemase-producing organisms: Learning from five outbreaks in a year

Ruth Finn, Caroline Smyth, Roisin Gillan and Irene Thompson

Belfast Health and Social Care Trust, Ireland UK

Background

¹University of Bristol, Bristol, UK

²Queen Elizabeth Hospital, University of Birmingham, Birmingham, UK

³University of Birmingham, Birmingham, UK

⁴University of Bristol, University Hospitals Bristol National Health Service (NHS) Foundation Trust, Bristol, UK

⁵Severn and Peninsula Audit

⁶Bluebelle Study Group, Research Collaborative for Surgeons

Background

Accurate assessment of surgical site infections (SSIs) is difficult, particularly after hospital discharge, when most SSIs are present. Commonly-used criteria, checklists and grading scales to aid surveillance and diagnosis exist, but have not been validated. There is a lack of patient input into their design and they do not identify SSIs consistently. This study aimed to develop a single measure for SSI assessment for patient self-reporting or observer completion.

Methods

Content analyses of existing tools (CDC and ASEPSIS) and semi-structured interviews with patients and professionals (n = 19) identified domains potentially indicative of SSI. These domains were operationalised and drafted as questions (items) in lay language, using standard methods for designing patient questionnaires. Medical terms were included at the end of the items in parentheses. Further interviews with patients (n = 28) and professionals (on-going) used a ‘think aloud’ technique, to test for understanding, accuracy and acceptability of a single measure for SSI assessment.

Results

Content analyses of existing tools identified 18 domains, supplemented by one additional domain identified from interviews (smell). These were developed into a provisional questionnaire, comprising 13 items. Further interviews and discussions within the research team led to six iterations of the questionnaire, resulting in a final version with 16 items. Patients and healthcare professionals found the questionnaire to be comprehensive, acceptable and easy to complete.

Conclusions

A single SSI measure was developed that is suitable for patient and observer completion. On-going work will assess the validity and reliability of the tool in a sample of patients undergoing elective and unplanned abdominal surgery, and caesarean section.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3849

A controlled laboratory study to investigate microbial aerosols generated by a heater-cooler unit used for cardiopulmonary bypass

Samuel Collins, Ginny Moore, Simon Parks, Jimmy Walker and Allan Bennett

Public Health England, UK

Background

A small number of Mycobacterium chimaera (M. chimaera) infections were identified following surgery in Europe. Infections were attributed to the use of heater-cooler units (HCUs) used during cardiopulmonary bypass surgery. It is believed that mycobacteria were transmitted to the surgical site by aerosolisation of contaminated water from inside the HCU. In the UK, retrospective case findings identified 13 M. chimaera and M. intracellulare infections potentially associated with cardiopulmonary bypass. Public Health England Porton conducted a controlled laboratory study to investigate microbial aerosol generation from one such HCU.

Methods

Investigations were conducted in a controlled environmental test chamber. A HCU was set up to mimic a standard theatre system. Multiple air samplers were used to sample the aerosols generated by the HCU.

Results

A high level of localised aerosol at the rear of the HCU was detected, consisting of several waterborne opportunistic micro-organisms similar to those recovered from the water inside the HCU. The mean number of bacteria recovered from the air using a cyclone impinger sampler was significantly higher when the machine was circulating water (519 colony-forming units (cfu) per m³) than when the pumps were not operating (6 cfu per m³). Two possible areas of aerosol generation inside the HCU were identified, using an Aerodynamic Particle Sizer. Microbial aerosol generation from these sites was confirmed using all glass impinger samplers. Smoke tracing experiments demonstrated the air in the vicinity of one of these sites was rapidly ejected from the device by the rear cooling fan.

Conclusions

These data suggest a possible means of microbial aerosol generation from the HCU and a mechanism whereby the aerosol may enter the theatre environment. It can be inferred that microbial aerosols from the HCU may contaminate theatre equipment and/or personnel and possibly reach the patient table. How the conditions within an operating theatre influence the aerosol produced is not known.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3851

A feasibility study to establish if a main trial of different dressing types or no dressing is possible, to reduce the risk of surgical site infection (SSI): The Bluebelle Study

Rhiannon Macefield^1,2

¹University of Bristol, UK

²Bluebelle Study Group UK

Background

The role of dressings to reduce surgical site infection (SSI) on closed primary wounds is controversial and in some types of surgery, it is unusual to apply a dressing. The Bluebelle feasibility study had two phases: Phase A was preliminary work to establish how and Phase B was a pilot randomised controlled trial (RCT) to determine whether it is possible to compare the effectiveness and cost-effectiveness of different types of dressings or no dressing, in a definitive trial.

Methods

Phase A included multi-disciplinary team work to complete:

Interview case studies with patients (n = 32) and healthcare professionals (n = 60) in general, obstetric and paediatric surgery from two universities and five district hospitals, to explore views of dressing practice and a proposed RCT;
A survey of wound dressing use in general surgery (n = 702 patients; 1738 wounds);
Literature work and discussion to define and categorise different dressing types; and
Development of outcome measures to use in a main trial.

Results

Interviews and survey data showed that simple adhesive dressings were widely used (69.2% of wounds), tissue adhesive “as-a-dressing” is relatively common (27.2% of wounds) and a few wounds in adult surgery were left without a dressing. Despite this, enthusiasm and willingness to participate in a RCT with a no dressing group was found. Pragmatic definitions of ‘simple’, ‘advanced’ and ‘no dressings’ were agreed upon, consistent with clinical practice. A patient-centred measure of SSI has been developed and the need for a validated practical measure of wound management to use as a key outcome for a wound dressings/no dressing trial has become apparent.

Conclusions

The feasibility work has informed the design of a three-group pilot RCT (tissue adhesive versus a simple adhesive dressing, versus no dressing). This will assess whether it is possible to recruit and for patients to maintain their treatment allocation.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3860

Risk factors for patients with carbapenemase-producing Enterobacteriaceae (CPE) in a Northwest London hospital trust, 2014 – 2015

Siddharth Mookerjee, Jonathan Sullivan, Frances Davies, Hugo Donaldson, Eimear Brannigan, Alison Holmes and Jonathan Otter

We found that a change in the message to the patient when seeking permission for a rectal swab for CRE carriage reduced the decline rate considerably. Younger patients tended to choose to self-collect their rectal swabs more frequently than older patients, but whether a swab was self-collected or nurse-collected did not affect the CRE detection rate. We plan to continue rectal screening for CRE, for high-risk patients.

Declaration of conflicting interest

One of the authors is a member of the IPS SPC and is a consultant to Gama.

Poster presentations

Antimicrobial prescribing and stewardship

Abstract ID: 3694

Laboratory investigation of four Providencia stuartii isolates with intermediate resistance to imipenem

Chin-Lu Chang

Department of Infectious Diseases, Tainan Municipal Hospital, Tainan, Taiwan

Background

At a regional hospital in southern Taiwan, four Providencia stuartii (P. stuartii) isolates with intermediate resistance to imipenem were isolated between March 2013 and June 2014. Because of the rarity, the present study was performed to investigate the associated antibiotic resistance mechanisms.

Methods

A Phoenix automation system (Becton Dickinson Diagnostic Systems, Sparks, MD, USA) was used for antibiotic susceptibility testing, and the interpretation criteria followed those recommended by the Clinical Laboratory Standards Institute (CLSI) in 2014. The antibiotics tested included cefazolin, cefuroxime, ceftriaxone, ceftazidime, gentamicin, amikacin, levofloxacin, imipenem and meropenem. Polymerase chain reaction (PCR) and sequencing were used to detect the presence of beta-lactamase genes (CTX-M, SHV, TEM, AmpC, and carbapenemases) and mutations in two major outer membrane proteins (Omp), OmpPst1 and OmpPst2.

Results

The isolates were resistant to all tested antibiotics except meropenem and amikacin. The minimum inhibitory concentrations (MICs) of imipenem were all 2 mg/L. An IncA/C plasmid, carrying blaCMY-2, qnrD1, and aac(6’)-Ib-cr genes simultaneously, were identified among the isolates. None of the known imipenem resistance genes was identified. Several genetic mutations, insertions and deletions were found in the ompPst1 gene, while the ompPst2 gene remained unchanged.

Conclusions

Previous reports indicate that the OmpPst1 of P. stuartii demonstrates a decreased level of permeation for imipenem, compared to meropenem. Our study further demonstrated many mutational changes in the OmpPst1 genes of the P. stuartii isolates showing intermediate resistance to imipenem. Together with the presence of the CMY-2 genes, the isolates may then develop full resistance to all carbapenems, similar to those having been observed in other family members of the Enterobacteriaceae. P. stuartii is known to express natural resistance to tigecycline and colistin, the two last-resort antibiotics. The development of full resistance to all carbapenems in P. stuartii may then lead to an awkward situation for clinicians, in selecting appropriate antibiotics for treatment.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3698

Short-term efficacy and resistance after repeated courses of nasal mupirocin

Toney Thomas^1,3, Georgina Gethin², Deirdre Hughes-Fitzgerald³, Hilary Humphreys^3,1

¹Beaumont Hospital Dublin, Ireland

²National University of Ireland Galway, Dublin Ireland

³Royal College of Surgeons, Ireland

Background

Mupirocin is an important component in meticillin-resistant Staphylococcus aureus (MRSA) control and specifically for the clearance of nasal Staphylococcus aureus (S. aureus). Increased mupirocin use predisposes to mupirocin resistance (MR). There is a strong association between previous mupirocin exposure and both low- and high-level MR (HLMR) and the latter is linked to multi-drug resistance.

Aims

To determine the efficacy of repeated courses of mupirocin on nasal MRSA colonisation, to determine and evaluate the mupirocin susceptibility of sequential MRSA isolates and to evaluate the incidence of MR after repeated courses of mupirocin.

Methods

MRSA-colonised patients were recruited, following consent, to a randomised controlled trial (RCT) comparing topically-applied honey to mupirocin for eradication of MRSA. Up to two courses of either treatment was administered, i.e. three times a day for 5 days. Phenotypic and genotypic investigations were performed on sequential MRSA isolates. Historic or previous and pre-treatment or baseline isolates were genetically characterised using spa typing, from which the sequence type was inferred.

Results

The interim results report on the efficacy of mupirocin, while other results are awaiting analysis. Of the 30 patients treated with mupirocin, 26 completed the study. Of the 30 patients, 26 (87%) had two or more courses before study enrolment. Following enrolment in this study, 14 (47%) patients were decolonised after one or two courses, and 12 (40%) remained persistently colonised. Two patients acquired HLMR. One patient with intermediate MR was successfully decolonised. The mupirocin susceptibility of most sequential isolates was unchanged. The spa type of historic and baseline isolates were indistinguishable, in 45% of patients.

Conclusions

Additional courses of mupirocin may clear MRSA from some patients. Among persistent carriers, decolonisation attempts must be risk-assessed. Patients with persistent carriage tend to have indistinguishable isolates, but further work is required to identify the factors that may contribute to persistence.

Declaration of conflicting interest

No conflict of interests to declare.

Abstract ID: 3716

Does carbon dioxide concentration influence antimicrobial susceptibility testing in an isolate of carbon dioxide-dependent Proteus mirabilis?

Chin-Lu Chang

Department of Infectious Diseases, Tainan Municipal Hospital, Tainan, Taiwan

Background

At a regional hospital in southern Taiwan, an isolate of multidrug-resistant carbon dioxide-dependent Proteus mirabilis (P. mirabilis) was isolated on 20 June 2014. This study was conducted to assess whether carbon dioxide concentration could influence antimicrobial susceptibility testing in this isolate.

Methods

The standard disk diffusion method was used for antimicrobial susceptibility testing. The antibiotics tested included amikacin, levofloxacin, piperacillin-tazobactam, ceftriaxone, ceftazidime, imipenem and meropenem. Results were interpreted according to the criteria recommended by the Clinical Laboratory Standards Institute in 2014. We regarded intermediate results as resistant, in this study. The carbon dioxide concentrations tested included 2.5%, 5%, 7.5% and 10% carbon dioxide.

Results

For amikacin, the zone sizes were 15, 15, 14 and 15 mm, in 2.5%, 5%, 7.5% and 10% carbon dioxide, respectively. All results were resistant.

For levofloxacin, all the zone sizes were 6 mm, despite the tested carbon dioxide concentration, and all results were resistant.

For piperacillin-tazobactam, the zone sizes were 23, 25, 23 and 25 mm in 2.5%, 5%, 7.5% and 10% carbon dioxide, respectively. All results were susceptible.

For ceftriaxone, the zone sizes were 19, 19, 20 and 21 mm in 2.5%, 5%, 7.5% and 10% carbon dioxide, respectively; all results were resistant.

For ceftazidime, the zone sizes were 16, 17, 18 and 18 mm; in 2.5%, 5%, 7.5% and 10% carbon dioxide, respectively. All results were resistant.

For imipenem, the zone sizes were 17, 17, 18 and 17 mm, in 2.5%, 5%, 7.5% and 10% carbon dioxide, respectively; all results were resistant.

For meropenem, the zone sizes were 31, 30, 31 and 30 mm in 2.5%, 5%, 7.5% and 10% carbon dioxide, respectively; all results were susceptible.

Conclusions

As a result of this study, we saw that the carbon dioxide concentration could not influence antimicrobial susceptibility testing in this isolate of carbon dioxide-dependent P. mirabilis.

Declaration of conflicting interest

No conflict of interests to declare.

Abstract ID: 3745

Monitoring and supporting antimicrobial prescribing and stewardship in a community setting, for extended-spectrum beta-lactamase (ESBL) urinary tract infections (UTIs)

Amanda Miskell and Lynn Barton

Cheshire and Wirral Partnership, NHS Foundation Trust, UK

Background

Extended-spectrum beta lactamase (ESBL) urinary tract infections (UTIs) have increased significantly within the community population over the previous 4 years. Contradictory to popular belief, most of these isolates are from patients living in their own homes, not from hospitals and care home environments where monitoring and microbiology advice regarding prudent prescribing is much more accessible.

Methods

An agreement was made with our local microbiology department to distribute hard copies of all ESBL UTIs to the community Infection Prevention and Control team, for two of our Clinical Commissioning Group (CCG) populations. The IPC team reviewed every ESBL UTI, considering gender, age, accommodation, history and resistance/intermediate/sensitivities. Communication was then faxed to the general practitioner (GP) and relevant others, such as the community nursing team, to request a response describing treatment and risk factors.

Results

The GPs responded within 2 working days and the IPC team reviewed the information, supporting GPs in the change of treatment, advice or filing of correct actions. Any discrepancies in prescribing and end dates, including delays, were reported to the prescribing leads for the CCG and learning was shared across the CCGs.

Each month the numbers of ESBLs were considered and the percentage of total/multi-resistance to oral antibiotics was calculated. Trends were monitored and reported to the CCG and healthcare associated infection network meetings, and shared with colleagues. This work has supported the review of our antibiotic formulary, and compliance in prescribing, or appropriate non-prescribing for all ESBLs. Prescribing is now correct or changed where required, in 99% of cases.

Conclusions

The team have become familiar with repetitive sampling situations, and support this with education sessions and newsletters to all community nurses and care homes. This process has promoted networking and a collaborative approach to addressing antimicrobial stewardship across the community setting, and has now been incorporated into all of our mental health settings.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3755

Development and clinical application of a novel wound surveillance system for the targeted antimicrobial treatment of sternal wound infections following cardiac surgery

Ida Atti, Melissa Rochon, Latha Gurusamy, Zainab Khanbhai, Sukeshi Makhecha, Carly Reeves, Qamar Hussain, Stephen Squire, Antonios Kourliouros, Shahzad Raja and Anne Hall

Royal Brompton and Harefield NHS Foundation Trust, UK

Background

Cardiac surgical patients are usually discharged from the hospital between post-operative days 5–10. This timing coincides with the pathogenic process to elicit the effector phase of host response (early signs of new inflammation or exudate). Root cause analysis indicates that patients readmitted with a surgical site infection (SSI) often have early evidence of infection at primary discharge, but their care was not effectively followed up. Furthermore, review of culture-positive sternal wound swabs reveal that 80% of sternal swabs of recently discharged patients were lost to follow-up. This is often due to the misconception that the infection control team routinely reviews all microbiology results.

Methods

Our Trust created a Surveillance via Queries (SvQ) system, to improve antibiotic stewardship by reconciling wound swab results with antibiotics dispensed at discharge, along with details on procedure, allergies, blood trends and contact numbers. SvQ results were reviewed by the multidisciplinary team (MDT), including surgeons, advanced nurse practitioners, pharmacists and a consultant microbiologist, to identify cardiac surgical patients at risk of infection, optimise their antimicrobial care and occasionally, the need for intervention. Communication with general practitioners (GPs) was streamlined and patient satisfaction feedback sought.

Results

Evidence of improvement: This novel electronic surveillance system allowed for a 100% capture of patients with positive sternal swabs, where preliminary results indicated approximately 40% of them benefit from new targeted antibiotic therapy or a change from broad-spectrum regimens. In addition, the patient questionnaire revealed their preference towards efficient community care, as guided by the newly-adopted system.

Conclusions

Future steps: This system supports the benefit of the MDT approach to improve antibiotic stewardship and patient care, without the high cost usually associated with other commercially available electronic solutions. Early identification and management of SSIs may influence the morbidity and resource utilisation associated with advanced cases in the community.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3762

Doripenem may be an optimal therapeutic option for treating biliary tract infections caused by extended-spectrum beta-lactamase-producing organisms

Chin-Lu Chang

Department of Infectious Diseases, Tainan Municipal Hospital, Tainan, Taiwan

Background

Carbapenems have been recommended as the treatment of choice for treating infections caused by extended-spectrum beta-lactamase (ESBL)-producing organisms, especially severe infections. For treating biliary tract infections (BTI), some guides suggest that high biliary penetration of antibiotics should be preferred. According to some studies, the ratios of bile-to-serum concentrations of imipenem, meropenem and doripenem are 0.01, 0.75 and 1.17, respectively. Consequently, doripenem may be an optimal therapeutic option for treating BTI caused by ESBL-producing organisms. This study was conducted to assess the treatment response to doripenem for these infections.

Methods

At a regional hospital in southern Taiwan, from June 2013 to May 2015, all clinical cases of BTI caused by ESBL-producing organisms being treated with doripenem were enrolled. In these cases, chart reviews were done to assess the treatment response to doripenem. If infection signs or symptoms resolved gradually, they were regarded as treatment success. If infection signs or symptoms worsened persistently, even resulting in mortality, they were regarded as treatment failure.

Results

A total of 16 cases were enrolled. ESBL-producing Escherichia coli and Klebsiella pneumoniae accounted for 94% (n = 15) and 6% (n = 1), respectively, of the offending pathogens. Among these cases, 86% (n = 14) of cases were treatment successes, and 14% (n = 2) were treatment failures. The two cases of treatment failure were diagnosed as BTI accompanied by septic shock, where one case had had an old stroke and one case had hepatic carcinoma.

Discussion

As a result of this study, we found that doripenem had a high treatment success rate (86%) for treating BTI caused by ESBL-producing organisms. Moreover, those cases of treatment failure had serious infection and underlying disease. Accordingly, we suggest that doripenem should be regarded as an optimal therapeutic option for treating these infections, especially severe infections.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3828

A retrospective diary study to establish the real-world dosing and subsequent cost-effectiveness of echinocandins for Candida infection, through market research

Ruth Rostron¹, Ruth Rostron¹, Rasti Lacko¹ and Joanna Thompson²

¹Astellas Pharma Ltd. UK

²Adelphi Research UK, Bollington, UK

Background

Anecdotal feedback from UK healthcare professionals (HCP) has raised a question that the average daily dose of micafungin required in clinical practice is higher than the 100 mg used in cost models. The objective of this market research was to establish the average dose of micafungin used in a typical population, and to compare this with the other two echinocandins: anidulafungin and caspofungin.

Methods

132 HCPs, contacted via telephone, reviewed clinical notes from their eight most recent patients weighing over 40 kgs and treated with an echinocandin for prevention or treatment of a suspected or confirmed Candida infection. A total of 868 patient records were matched for age, weight, gender and neutropenic status across the three treatment groups. For each patient record, the HCP was asked to report: echinocandin maintenance dose (excluding any initial loading dose), duration of treatment (days) and dose adjustment (time to adjustment and new dose). From this, we calculated the average dose per treatment day, and cost per treatment day (based on the UK National Health Service (NHS) list price).

Results

Echinocandin	Initiation dose n (%)	Patients with a dose adjustment n (%)	Average daily dose	Average daily cost
Micafungin (n = 333)	50 mg: 49 (15%)	24 (7%)	104 mg	£380
	100 mg: 228 (68%)
	150 mg: 45(14 %)
Caspofungin (n = 268)	50 mg: 180 (67%)	23 (9%)	65 mg	£402
	70 mg: 21(8%)
	100 mg: 46 (17%)
	150 mg: 14 (5%)
Anidulafungin (n = 267)	100 mg: 187 (70%)	23 (9%)	140 mg	£432
	200 mg: 51 (19%)
	300 mg: 17(6%)
	400 mg: 12 (4%)

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Conclusions

Patients treated with an echinocandin for prevention or treatment of a suspected or confirmed Candida infection are often critically ill, meaning their care can be costly. In comparable patient populations (based on the patient metrics collected), real-world dosing of micafungin in the UK incurred a lower average daily cost, relative to the other echinocandins; this could represent greater value for the NHS.

Declaration of conflicting interest

Adelphi was commissioned by Astellas.

Behaviour Change

Abstract ID: 3608

Colour-coded cards for infection control

Lorraine Durham^1,2 and Daniel Leach¹

¹Pennine Acute NHS Trust UK

²The Royal Oldham Hospital UK

Background

An on-going issue within the Trust is staff compliance with wearing of personal protective equipment, compliance with the bare below the elbows and hand hygiene policy, particularly among medical staff. A conversation between an Infection Prevention Nurse at The Royal Oldham Hospital (Pennine Acute) and a medical consultant led to the formation of a Listening into Action group; staff conversations and development of an action plan to address the issues identified.

Among other ideas being implemented, one concept that the Infection Control Nurse has had for a few years has now been embraced by the group and developed; the colour-coded card system (red/yellow/green), which is currently on trial in one of the hospital sites within the Trust for 6 months, with a view to a Trust-wide roll-out.

Methods

The use of red and yellow cards is a similar concept to those used in a football match. Infection control practitioners would be able to issue a yellow card for staff members not complying with infection control policy; for instance, wearing a watch in a clinical setting, not washing hands between patients, etc. The yellow card would serve to identify poor practice to the individual and would not be construed as a disciplinary or punitive measure. A record would be kept of the staff member’s name, and the reason for the yellow card. The staff member could receive multiple yellow cards on separate occasions for different issues. If a staff member was seen breaching infection control policy on a second occasion for an action they had previously been yellow-carded for, they could be given a red card. A red card could also be given after a specified number of unrelated yellow cards are received. The red card, in contrast to the yellow card, would result in remedial action (for instance, notifying the ward manager). It is anticipated that yellow cards would represent the bulk of the scheme, with red cards useful mostly as a last resort and as a way of increasing the significance with which staff view receiving a yellow card. A green card would be given for exceptional good practice noted.

Results

Evidence of improvement: A simple data base will be used in order to collate information on the staff members’ name; line manager and ward in which it occurred. The database will allow the infection prevention team to identify trends of poor-performing staff groups and wards, as well as individuals.

Conclusions

Anticipated benefits:

Quality of care given improved by reduction of cross-infection risk;
Increased awareness of infection control issues;
Personalised feedback on issues
Framework for quantifying and addressing persistent problematic behaviour;
Increased personal responsibility;
Creation of a culture of accountability;
Improved compliance with infection control measures; and
Reduction in the incidence of hospital-acquired infections.

Future Steps: The vision for this scheme is to review at the end of the 6-month trial and see if they have made the expected impact. It is envisioned that the process of handing a card to a staff member will have a powerful impact, much more than just verbally challenging or discussing a lapse in care. A Trust-wide roll-out is expected, with an article being jointly written by the ICN and a medic within the LIA group.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3682

It’s hand hygiene, but not as we know it

Joanne Martin¹, Andrew Dodgson¹, Julie Cawthorne¹ and Paul Cryer²

¹Central Manchester University Hospitals NHS Foundation Trust, UK

²Veraz Ltd. UK

Background

A unique opportunity has brought the Central Manchester University Foundation Trust (CMFT) to work in partnership with Veraz Ltd, the 2014 Build Better Health Care winners, to trial a ground-breaking hand hygiene monitoring system. It objectively measured hand hygiene compliance over a 3-month period, on four surgical wards. The system gives real-time feedback of hand hygiene compliance to patients and staff via light emitting diods and wireless networks. It can identify when an individual cleans their hands with soap and water or alcohol gel, and when they have come in to contact with a patient. Feedback reports are provided to all ward staff and senior management teams regularly. Ward staff are able to access anonymised feedback of their personal hand hygiene compliance.

Methods

The methodology used to audit compliance normally relies on observation of practice by individuals. The results of these audits are regularly in the 85–100% range. It is well documented that adherence to hand hygiene practice is actually 40–60%.

To test this methodology, observe behaviour, understand reasons for poor compliance and to provide a baseline prior to the trial commencing, over 2500 observational hand hygiene audits were completed over a 2-month period.

Results

In a previous trial at University College London Hospitals adopting this monitoring system, hand hygiene compliance increased from 22% to 66%. The aim of this trial at CMFT is to determine if the monitoring system improved the rate of hand hygiene compliance, to validate the results of the previous trial, and to determine the acceptability of the system to staff.

Conclusions

This innovative system would support staff and patients as a visual reminder to clean their hands, in turn improving hand hygiene compliance. The technology used may also be used for other technology in the future, to support other nursing duties.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3697

Structure + process + cultural change = Optimum outcome

Toney Thomas, Fionnuala Duffy, Caoimhe Finn, John Walsh, Fiona McCormack, Valerie Caffrey

¹Beaumont Hospital Dublin, Ireland

Background

Hand hygiene (HH) reduces the transmission of pathogens and healthcare-associated infections. Structures and processes are essential to facilitate cultural change, thus achieving optimum outcome; however, managing cultural change in organisations can be critical. We discuss an organisation’s journey over a decade, changing the culture of HH.

Methods

Audits of HH facilities and practice at predetermined intervals commenced in 2005, forming the basis for a continued model of improvement. Mandatory staff induction and HH training necessitated innovative training approaches and quality measurement. Online training and self-certification was introduced, which complemented didactic training. Major investments were made on HH facilities and point-of-care HH access. Key performance indicators (KPIs) and league tables were agreed upon, monitored and published at regular intervals. A recognised audit tool was consistently used and auditor inter-rater reliability supported. HH audits in clinical directorates were managed by multidisciplinary teams, ensuring ownership at the personal and team level. Positive reinforcement was encouraged, with awards to recognise good performance. Concurrently, service users were empowered and user satisfaction assessed.

Results

Evidence of improvement: HH practice improved from 46% to 90.7%. Online training access doubled the training uptake. Alcohol hand gel (AHG) use increased from 23.6 L/1000 bed days, to 38.1/L; and AHG was used for 70% of HH opportunities, an improvement of 46% during this time. Higher training uptake, facility improvements, KPIs and ownership correlated with practice improvement. Dual role of qualified internal auditors as auditors and change agents ‘seeing through an auditor’s eye’ entrenched positive cultural change and local ownership. The embedded ownership culture is replicated in other quality improvements in the organisation.

Conclusions

Embedding safety culture in organisations necessitates innovation, as well as sustained corporate learning. Systems intelligence, interaction and feedback should be encouraged to empower human behavioural change, and subsequently to lead to quality improvement.

Declaration of interest

No conflict of interests to declare.

Abstract ID: 3722

Improving infection control using the Infection Risk Scan (IRIS) in five medical wards in a Dutch hospital

Ina Willemsen¹, Esther Weterings¹, Gonny Moen¹, Marie-Louise Van Leest¹, Veronica Weterings¹ and Jan Kluytmans^1,2

¹Amphia Hospital, Breda, The Netherlands

²Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands

Background

Sustained improvement of infection control in health care is difficult to achieve. We describe the first results of an innovative multifactorial method, the Infection Risk Scan (IRIS). This scan measures several outcome and process parameters and gives visual feedback to healthcare workers (HCW), using an easy-to-read plot.

Methods

IRIS was performed in five wards. Investigated parameters were hand hygiene compliance (HHC), environmental contamination (using adenosine-triphosphate (ATP) detection), personal hygiene of HCW, appropriateness of catheter and antimicrobial use, and transmission of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E). Results were compared with reference data and classified into risk categories. The results were visualised in a risk profile showing patient-related risks and an improvement-plot showing that risks that can be influenced by HCW. We performed IRIS three times in a 2-year period, according to the ‘Plan-Do-Check-Act’ methodology.

Results

The IRIS improvement-plots provided ward-specific results and were the basis for targeted improvement programs. After the third IRIS, improvement was observed in all five wards, regarding the HHC. Overall HHC increased from 43% to 66% (more than 1000 observations per IRIS, p < 0.000). Also, a significant ATP level reduction was measured (p < 0.000). Furthermore, the appropriateness of the use of urethral catheters in geriatrics was improved. The personal hygiene of employees was good at the start of the project and sustained over the 2 years. The appropriate use of antibiotics did not improve; however, clear targets for interventions were obtained. Finally, transmission of ESBL-E was observed only once during all measurements, involving two patients.

Conclusions

Using the IRIS method, we achieved several important improvements in infection control procedures. Especially, HHC and environmental contamination levels improved. Aspects that were already good at the start were maintained at this level. Testing of this method in a multicentre study is warranted, to determine the generalizability of our findings.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3724

The evolution of a checklist into an infection prevention and control process in the care and management of patients with Clostridium difficile infection (CDI)

Andrea Denton¹, Annie Topping² and Paul Humphreys¹

¹University of Huddersfield UK

²Hamad Medical Corporation Doha, Qatar

Background

Clostridium difficile (C. difficile) infection (CDI) has the potential to be a severe or fatal infection (National Health Service (NHS) England, 2014). In 2010, the Infection Prevention and Control Team, in association with staff across an acute Trust began to undertake a collaborative daily checklist review for all patients with CDI. This later became known as the daily review checklist process (DRCP). These reviews included feedback at the ward and organisational levels, and incorporated completion of a checklist through contemporaneous clinical patient assessment and ward-level examination of infection prevention and control practices. The reviews were undertaken by an Infection Prevention and Control Practitioner (IPCP) and a matron, in conjunction with ward-based staff.

Methods

A constructivist grounded theory approach was used, which enabled participants’ views of the daily checklist review to be explored. Semi-structured interviews with different staff groups (IPCPs, matrons, ward-based staff and senior managers) were used to collect the data.

Results

Staff perceived that the DRCP had been influential in the care and management of patients with CDI. This focused around three main areas: Education and learning, developing and sustaining relationships, and leadership and change management. These were seen to be influential by all staff groups and offered an explanatory framework for understanding the interactive processes that may have contributed to the care and management of patients with CDI and behavioural change in staff.

Conclusions

The DRCP evolved from a checklist serving as an instrument of surveillance and monitoring, to an interactive educative facilitative process, assisting staff in the care and management of patients with CDI and in compliance with general infection prevention and control practice. What emerged during the evolution of the DRCP was the influence of a human factors approach and the impact that communication, teamwork, situated learning and leadership had on behavioural change and improved patient outcomes.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3729

Improving environmental cleanliness through staff engagement and frontline ownership

Della Powell

Powys Teaching Health Board Wales

Background

On commencing as a new Infection Prevention and Control Nurse (IPCN), links were made to attend quarterly environmental cleanliness (EC) audits. On completion of the first audit, the cleanliness of the wards were suboptimal and in some instances, concerning. From attending all nine sites, common themes emerged, these being; blurred lines of cleaning responsibility, no engagement/attendance of staff within the walking round, minimal ownership of the EC agenda and no standardisation of cleaning products used within the organisation.

Methods

The following strategies were implemented: Introduction of cleaning schedules and standardisation of cleaning products throughout the Health Board; re-design of the audit process; senior nurses, domestics, representation from estates and IPC link workers began attending and contributing; the IPCN started working alongside and training front-line staff personally, to gain an understanding of the organisation’s diverse culture and to be visible in the IPCN role. Environmental cleanliness compliance was generated using the Credits 4 Cleaning (C4C) Monitoring Tool.

Results

Evidence of improvement.

Month	EC Compliance Range, %	EC Compliance Mean, %	Hospitals achieving > 90%	EC Compliance Mean, % of the hospitals with < 90%
September 14	78.42–93.37	86.21	2/9 = 22.2
December 14	65.85–93.85	83.35	2/9 = 22.2
March 15	97.22–87.12	92.40	6/9 = 66.66	3/9 = 33.33% achieving < 90%
				n = 3
				Mean 87.74%

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Conclusions

Despite that frontline staff are more engaged in EC practices and now have increased ownership, more work is needed on encouragement of collaborative work between staff groups. At times there continues to be a defensive culture that prohibits improvement. Staff are often uncomfortable with change and there is a strong need to continue working alongside frontline staff, to engage and encourage ownership and compliance. A future piece of work needs to be commenced looking for trends in relation to cleaning scores and infection rates.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3736

100 Days ‘C Diff’ Free! Using meaningful data to engage staff with infection prevention

Allison Bradley, Kate Prevc, Carolyn Dawson, Carly Baker, Melanie Gallo, Joan Goodbody, Fiona Reakes-Wells, Merja Thomas, Darren Wheldon, Emily Connor and James Parr

University Hospitals Coventry and Warwickshire NHS Trust, UK

Background

Front-line staff were aware of Trust targets and incidences of Clostridium difficile (C. difficile); however, they showed less awareness of C. difficile incidence attributable to their own areas Previous research suggests that positive changes in behaviour are more likely when the presented data is seen as ‘meaningful’ to the recipient.

Our aim was to ensure that staff knew how many cases of C. difficile had occurred in their area, to make data applicable or meaningful to them. To achieve this, we aimed to motivate staff to focus on reaching 100 consecutive days free of C. difficile.

Methods

We delivered ‘Power Training’ to all areas. The short, direct message, “WIPE” (Wash hands with soap and water, Isolate promptly, Prudent antibiotic prescribing and Environmental cleanliness); formed the core of our interactive education.

A database was developed to track how many days each area achieved. Wards were given ‘Stool Smart’ charts, providing personalised targets based on their previous 5-year average. This allowed further meaning to be attributed to the data, recognising specific challenges experienced by individual areas and setting realistic, achievable targets accordingly.

Celebrations occurred once wards reached their goal, including presentation of certificates signed by the executive team and chocolate or tea incentives. Celebratory pictures were shared on Twitter.

Results

Evidence of improvement: Meaningful data improved staff ownership. Staff showed awareness of their own C. difficile rates, and demonstrated interest in investigating cases in their area. Quotes demonstrating engagement include: “When will we get our certificate?!” and “We know our data now”. We saw additional benefits through all hospital areas achieving 100 consecutive days free of C. difficile.

Conclusions

Our initiative continues, with > 50% of wards achieving over 1 year of being clear of C. difficile, and some approaching 1000 days free. Focus remains on engaging staff with issues surrounding C. difficile causation and transmission, and responding to national and international invitations to share our approach.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3738

“Delivering Behaviour Change”: A midwife as a member of an infection prevention and control team

Merja Thomas, Carolyn Dawson, Kate Prevc, Carly Baker, Allison Bradley, Melanie Gallo, Joan Goodbody, Fiona Reakes-Wells, Darren Wheldon, Emily Connor and James Parr

University Hospitals Coventry and Warwickshire NHS Trust, UK

Background

Historically, Maternity Services at the study site worked in a silo, with limited connections with the Infection Prevention and Control Team (IPCT). They perceived the IPCT as a punitive, negative entity, citing a lack of specialist knowledge as a barrier to effective infection prevention and control (IPC) service provision.

In February 2014, a midwife with interest in IPC was seconded to the IPCT for 2 days a week, with the intention of establishing rapport between the Women’s and Children’s Services (W&CS) and the IPCT. Initial impressions suggested the IPCT did not fully understand specifically maternity, paediatric and neonatal issues; sometimes resulting in negative interactions. This hindered communication and implementation of the IPC guidelines and processes.

Methods

Methods

We conducted a mixed-methods study in a 1500-bed tertiary-care hospital in Singapore, in July 2013. Focus group discussions were conducted among purposefully-sampled physicians, nurses and allied health professionals (AHPs), and the data were analysed using the framework approach. Emerging themes were included in the subsequent hospital-wide cross-sectional survey. Principal components analysis was performed to derive the latent factor structure, which was later applied in multivariable logistic regression analyses.

Results

Staff acknowledged that hand hygiene was a critical component of patient care, but shared that heavy workloads and forgetfulness posed barriers to hand hygiene. Many perceived senior colleagues as role models for hand hygiene. Staff felt that gentle reminders and nudges from team members and “hand hygiene-buddies” could enhance their hand hygiene compliance.

Of 1066 staff, the proportion who reported good hand hygiene compliance (> 90% of the time): nurses, 40.1%; AHPs, 31.0%; and physicians, 22.8% (p < 0.01). After adjusting for gender; staff category; years in their profession; seniority; history of dermatitis; we found that having positive knowledge, attitudes, and behaviours toward hand hygiene (OR 1.44; 95%CI 1.22–1.68; p < 0.0001), having personal motivators and enablers (OR 1.61; 95%CI 1.39–1.86; p < 0.0001) and emotional motivators (OR 1.62; 95%CI 1.40–1.88; P < 0.0001) were positively associated with good hand hygiene compliance. Perceived barriers to hand hygiene (OR 0.83; 95%CI 0.72–0.95; p = 0.0063) and the need for external reminders (OR 0.76; 95%CI 0.66–0.87; p < 0.0001) were negatively associated with good hand hygiene compliance.

Conclusions

Healthcare staff recognised the importance of hand hygiene, but faced practical barriers that reduced compliance. Role modelling by senior staff, and external reminders and nudges by team members could enhance hand hygiene compliance: These should be actively promoted.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3799

To PPE or not to PPE

Angus Turnbull, Luke Moore and Berge Azadian

Imperial College London, London, UK

Background

Isolating patients based on their infective status is essential to patient safety, yet implementation of isolation procedures in some clinical settings may not be optimal. To explore this, we undertook a cross-sectional observational study at a central London hospital, to investigate concordance with isolation policy, identify potential at-risk incidents, and explore the underlying barriers and facilitators for optimal use of isolation rooms.

Methods

We conducted 2-point prevalence studies 9 months apart that involved inspection of available side-rooms (n = 82 and n = 52) and comparison of signage with patient infective status.

Results

Inaccurate signage was found in 25% of cases in the first study and 46% in the second, and side-room doors were open in 32% and 34% of the rooms containing an infectious patient, respectively. Observed incidents where there was a potential infectious risk included clinical examinations, phlebotomy, patient transport and family visits. Of the incorrect signage, approximately one-half detailed an over-requirement for personal protective equipment (PPE), leading to wasted resources by staff who obeyed the signs. This inaccuracy contributed to an atmosphere of disregard for infection control signs.

Conclusions

The potential infection risks and patient safety issues from these observations are clear; yet simple interventions, derived from these observations, could be implemented to make improvements. Improvement strategies include: A re-designed set of visually improved uniform posters that clearly identify infectious risks and required infection control measures, a classification system for side-room posters that depends on patient infection risk, a standard operating protocol to ensure side-room posters are kept up to date daily, staff education regarding side-room infection control; as well as a computer desktop-based electronic poster side-room infection control day, to increase awareness (analysis of the impact of these multi-modal interventions is currently on-going). If signage is to be effective, it must be accurate, consistent and observed by all.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3800

Jordanian paediatric nurses’ perspectives and experiences about compliance with standard infection precautions guidelines: A qualitative study

Murad Sawalha

University of Hull UK

Background

Compliance with evidenced-based standard precautions guidelines (SPGs) among healthcare practitioners is an important practice recommended to combat healthcare-associated infections (HCAIs); however, evidence of non-compliance with these precautions remains and negatively impacts on paediatric patients. Most existing studies regarding this problem have used quantitative methods, yet these studies have failed to explain non-compliance behaviour in actual practice or to address the issues that are specific to paediatric clinical areas.

This study was designed to investigate paediatric nurses’ perceptions and experiences in relation to infection control measures and to achieve a better understanding of the factors that influence nurses’ compliance with SPGs.

Methods

This qualitative study was conducted in four Jordanian hospitals. The study recruited 25 qualified paediatric nurses from different paediatric areas. Data were gathered using face-to-face semi-structured audio-taped interviews, which were transcribed and coded through constant comparative analysis.

Results

The study highlighted barriers and facilitators to SPG compliance. The results suggested that paediatric nurses are willing to comply with SPGs, but they fail sometimes to achieve their goal. They comply properly if the risk of exposure to micro-organisms is high and to protect themselves, but they justify their non-compliant behaviour in other circumstances. Nursing of children impacted both positively and negatively on infection control practices.

Conclusions

Nurses were reluctant to see themselves as agents of change to improve practice. Rather, compliance was viewed as behavioural and influenced by various determinants that affect nursing roles in relation to infection control. In general, nurses viewed compliance with SPGs as suboptimal in paediatric departments, but better than in other departments.

Infection control is not going to get any better until nurses feel empowered to initiate change and deal with the practical difficulties that impact on good infection control. In other words, to work in a professional manner, accepting responsibility as characterises the profession.

Declaration of conflicting interest

No conflicts of interest to declare.

Cleaning / disinfection / sterilisation

Abstract ID: 3725

A study of environmental cleaning of surfaces contaminated with MRSA in Japanese hospitals

Michiko Morimoto¹, Fuminori Tanabe², Tsuneki Kusaba³, Atsushi Tago³, Takashi Yamamoto³, Satoshi Sekiya³ and Junya Kawaguchi³

¹University of Hyogo, Japan

²Graduate Faculty of Interdisciplinary Research, University of Yamanashi, Japan

³MORAINE Corporation, Japan

Background

In Japanese hospitals, there are no criteria for environmental cleaning of the surfaces in wards contaminated with meticillin-resistant Staphylococcus aureus (MRSA). In this study, we attempted to clarify the effects of different wipes on sanitisation of high-frequency contact surfaces, such as overtables contaminated with MRSA.

Methods

These experiments were performed at 24.5 °C, 41% humidity in a microbiological laboratory in a university. We performed the experiments using overtables, one of the high-frequency contact surfaces at the wards in Japanese hospitals. The MRSA used was clinical isolates from Yamanishi University Hospital. We used three different wipes for the environmental cleaning: Wipe A was a non-woven fabric (the main components were benzalkonium chloride and didecyl methyl ammonium chloride). Wipe B was a sanitisation cross (with the main component, ethanol 80%). Wipe C was a water-included hand towel cloth (soft type). 10 cm × 10 cm tokens of over-bed table were cut out, and MRSA was adjusted to 10⁶ colony-forming units (CFU), of which 10μL was dropped on the left edge of the corner of the tokens. We then wiped the tokens using three kinds of wipes for 10 seconds, in a standardised way. After 1 minute, the bacteria remaining were harvested with a cotton swab in a standardised way. Data analyses were performed by using one-way analysis of variance (ANOVA) in a multiple comparison test. The significance level was < 5%.

Results

The remaining bacteria after wiping with Wipe A were not detected. In contrast, the number of remaining bacteria after wiping with Wipe B and Wipe C were 150.4 ± 69.2 CFU and 134.4 ± 117.6 CFU, respectively. By the statistical analysis, the remaining bacteria in the non-woven fabric containing the disinfection with benzalconium chloride and dodecyl methyl ammonium chloride (Wipe A) was significantly less than the other tools (p < 0.01).

Conclusions

In environmental cleaning of a high-frequency contact surface contaminated with MRSA, staff should select the appropriate cleaning tools, in order to prevent the spread of MRSA.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3764

Clostridium difficile in the hospital environment: A risk for disease acquisition

Monika Muzslay¹, Shanom Ali¹, Annette Jeanes¹, Vanya Gant¹, Charles Chiu², Alex Greninger² and Peter Wilson¹

¹University College London Hospitals, London, UK

²University of California, San Francisco, CA, USA

Background

An intensive screening program was performed to identify reservoirs of Clostridium difficile contamination in the hospital environment, to determine possible failure points in cleaning.

Methods

A recently published in-house technique was applied to maximize recovery of C. difficile. Sampling using sponge swabs was focused on bed spaces occupied or previously occupied by patients who were positive for C. difficile infection (CDI). Environmental and clinical isolates were analysed by polymerase chain reaction (PCR) ribotyping and selected isolates were subjected to whole-genome sequencing (WGS).

Results

A total of 301 sites were sampled and 35% of the surfaces in the near-patient-area were contaminated with C. difficile, after terminal cleaning with sporicidal agents. PCR ribotyping revealed a diverse population of C. difficile strains, but in three cases ribotyping suggested more than contemporaneous shedding from the patient and WGS indicated cross-transmission.

Ribotype CD050 was recovered on sites beyond the patient’s reach (being bed-bound), suggesting transfer of C. difficile by staff, and it persisted on surfaces despite terminal disinfection. The toilet floor remained contaminated after enhanced decontamination with hydrogen peroxide vapour of the room, but the strain was genetically distinct from CD050.
We found that 11 consecutive days after a patient with CDI was discharged, CD039 persisted on a nurse-call button and on the floor, despite daily cleaning episodes.
A patient had not developed diarrhoea at the time of sampling, but the bed space was widely contaminated (CD002; CD010; NT). Symptomatic infection was reported 3 days later, and sequencing confirmed that the environmental and clinical isolates (CD002) were indistinguishable.

Conclusions

Patients may acquire C. difficile from surfaces in their environment. Using a sensitive sampling method, surfaces posing a risk for cross-transmission may be identified. The presence of C. difficile contamination despite terminal cleaning suggested there was ineffective disinfection or failure to clean/access all surfaces (e.g. the nurse call button). In addition to use of sporicidal agents, training and immediate feedback of cleaning quality are essential to preventing horizontal transmission in the patients’ environment.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3772

Evaluating decontamination methods for mobile devices

Stephen White¹, Paul Humphreys¹, Annie Topping² and Lauren Oakes¹

¹University of Huddersfield UK

²Hamad Medical Corporation, Doha, Qatar

Background

The use of mobile devices within healthcare settings by staff, patients and visitors is widespread, and growing. DoH guidance states that patients should be allowed the widest possible use of mobile phones. For staff, mobile devices have become an essential aspect of their day-to-day professional and personal lives; however, there is clear evidence that phones/tablets can become contaminated with pathogens, which may survive for prolonged periods before being transferred onto hands or other surfaces. This quantitative study evaluates the ability of a range of technologies to decontaminate iPads.

Methods

The front, back and sides of iPads were contaminated with a standard suspension of Staphylococcus aureus. One-half of these surfaces were sampled to provide the pre-values, whilst the other one-half was decontaminated with either alcohol wipes, detergent wipes, quaternary ammonium-impregnated wipes, or exposure to ultraviolet light (UV) for either 30 or 60 seconds. As a control, a microfibre cloth impregnated with sterile water was also tested.

Results

The alcohol-based wipes were most effective, generating on average a 2 log reduction on the back of the iPad and a 3 log reduction on the front. The cleaning of the front surface of the iPad was consistently easier to clean that the back. However, all of the wipes were less effective than UV exposure, where a 60-second exposure generated a 4 log reduction on the front and a 3.5 log reduction on the back.

Conclusions

These results indicated that commercial wipes are unable to effectively decontaminate the high-touch surfaces of an iPad; however, the application of a UV-decontamination technology was a much more effective method for the removal of bacteria from these surfaces. This suggested that UV-based decontamination technology would provide a quick, efficient and economical method for the disinfection of mobile devices such as iPads in healthcare settings.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3776

Can room decontamination with ultraviolet light be a useful addition to healthcare cleaning processes? A small study of its use in a UK hospital setting

Matthew Reid¹, Mike Cooper¹, Karen Fenna Jones¹, James Parr¹ and Corrado Gilbert²

¹Royal Wolverhampton NHS Trust, UK

²Hygiene Solutions UK

Background

Environmental cleanliness is a vital element in reducing healthcare-associated infections (HCAIs). Manual cleaning remains a prerequisite to any additional environmental cleaning processes; however, new decontamination technologies have become available in recent years, including improved and automated hydrogen peroxide vapour (HPV) and more recently, ultraviolet light-based decontamination systems (UVCs). This is an evaluation study to explore the integration of UVC as an adjunctive cleaning practice. As hospital capacity pressures multiply, it is imperative that the time taken to decontaminate the environment is minimised, yet still ensure it is clean enough for safe patient care.

Methods

Over an 8-week period (mid-October to mid-December 2014), the UVC system was used following routine manual cleaning in 18 vacated single rooms. All 18 rooms required either a ‘red’ or ‘amber’ clean (terminal cleans utilising HPV or a chlorine-releasing agent, respectively). Environmental microbiological sampling was undertaken at 24 sites in each room and the results expressed as colony-forming units (CFUs).

Results

The average trend indicated a very clear correlation between the different levels of intervention, with 25% (n = 6) of room sampling sites having a CFU reduction post-UVC processing that was statistically significant.

	Total n of sites sampled	Mean CFU
Before Manual Cleaning	383	77.48
Post Manual Cleaning	383	15.71
Post UVC	383	2.92

Evidence of improvement: All alternative methods were compared to chlorine-releasing agents. There was no evidence that steam cleaning is more effective, with some evidence of it being less effective. There was no evidence that microfibre products were more effective, and many reusable microfibre products are not compatible with chlorine-releasing agents. Some evidence suggested that ultraviolet light (UV-C) disinfection was as effective and that pulsed-xenon UV disinfection was more effective than cleaning with biocides; however, these studies were either undertaken as part of an infection control bundle or didn’t provide enough detail on their comparator for results to be conclusive. Whilst some evidence demonstrates the effectiveness of hydrogen peroxide, there are insufficient studies to assess practical considerations.

Of the five alternative methods of decontamination reviewed, electrolysed water showed the most promise as an alternative. Details are included in the abstract on the use of electrolysed water for environmental decontamination in a healthcare setting.

Conclusions

The results from this literature review were used to inform recommendations on the use of steam, microfibre, UV light, hydrogen peroxide and electrolysed water as alternative methods of decontamination by NHS Scotland.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3824

Assessing the efficacy of disinfectants and antiseptics against multidrug-resistant Gram-negative pathogens: Evidence of adaptation to sub-lethal exposure and survival at working concentrations

Mark J Sutton, Lucy Bock, Laura Bonney, Rebecca Touzel and Matthew Wand

Public Health England (PHE), UK

Introduction

The emergence of multidrug-resistant (MDR) pathogens means that there is an increasing dependency on disinfection and antisepsis to control infections. MDR pathogens such as Klebsiella pneumoniae (K. pneumoniae), Acinetobacter baumannii and Pseudomonas aeruginosa have become entrenched in a number of healthcare settings and have a number of features, such as the ability to form biofilms, which make them difficult to control.

Methods

The minimum inhibitory, bactericidal and biofilm eradication concentrations (MIC, MBC and MBEC) were determined for different disinfectants and antiseptics used in healthcare, using clinical isolates of the three Gram-negative pathogens. For example, chlorhexidine-containing formulations were tested for efficacy against planktonic cultures and biofilms. The clinical strains were also exposed to sub-lethal levels of biocide and their ability to adapt to exposure was assessed, using phenotypic and genotypic methods.

Results

Our data demonstrated that there were a number of commercial disinfectants and antiseptics which were ineffective at or close to their working concentration, against several different MDR pathogens including carbapenemase-producing K. pneumoniae. When grown in simple biofilms, the number of strains which are resistant to the biocide (those capable of growing at > 50% of its working concentration) increases. When bacteria are exposed to sub-lethal doses of biocide, there is a significant decrease in their susceptibility, for many of the biocide-pathogen combinations. Again using K. pneumoniae adaptation to chlorhexidine as an example, this results not only in increased levels of resistance to commercial formulations of chlorhexidine, but also in cross-resistance to the antibiotic colistin. The mechanism of adaptation and the potential for this to be observed in other pathogens is being examined.

Conclusions

Data showed that there may be differences in the efficacy of biocide formulations against MDR pathogens and that these cannot be relied on to provide adequate infection control. The ability of the pathogens to adapt to become more resistant is also evident, and this requires increased vigilance to prevent breakdown of antisepsis and disinfection in critical healthcare settings.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3842

False assurance from audit highlighted, following a carbapenemase-producing Enterobacteriaceae outbreak

Rosemarie Dobson¹, Alison Hunt¹, Debbie Sykes¹, Robina Fayyaz¹, Haley Brown¹, Philip Stanley¹, Sulman Hasnie¹ and Miles Denton²

¹Bradford Teaching Hospital National Health Service (NHS) Trust, UK

The monitoring tool is now available on the HPS website. This tool is aimed at increasing compliance with equipment decontamination. A review of the uptake and impact of the tool will take place in the near future.

Declaration of conflicting interest

No conflicts of interest to declare.

Communicable disease prevention

Abstract ID: 3792

Ebola: “We’re ready!” The journey of a surge centre

Allison Sykes

Newcastle upon Tyne Hospitals, National Health Service (NHS) Foundation Trust, UK

Background

Improvement issue: The unprecedented epidemic of Ebola ‘Zaire’ in West Africa, affecting over 27,000 people to date and with over 11,000 deaths, put the UK on high alert to ensure readiness for safe management of cases entering the country. This included the preparation of four surge centres in England to care for confirmed cases. This poster describes how one of these surge centres reached its readiness.

Methods

Although the Trust had previously been one of two centres in the UK to manage patients with Viral Haemorrhagic Fever (VHF), the old unit had closed 6 years previously; therefore, there was very little in place before preparations began in July 2014, when the Trust was asked to be one of the surge centres. The enormity of the task grew as all the possible scenarios were considered; each involving greater numbers of staff, specialities, planning and resources.

An abundance of resources, training materials and policy documents were required, through liaison with a plethora of internal and external departments and training of many multidisciplinary staff from a variety of specialities. Infectious disease (ID) staff also gained experience working with a confirmed case at The Royal Free Hospital.

Results

To date, 230 staff have undergone training appropriate to their role, including 64 staff to manage confirmed Ebola/VHF cases in either a Trexler Isolator or in personal protective equipment (PPE)-based High Level Isolation.

Conclusions

The Trust is ready to manage Ebola/VHF cases; however, maintaining readiness and sustaining the workforce will require continued training and preparation. A substantial legacy has been left from this work which will be built upon, to ensure readiness to manage any organisms requiring high-level isolation whether adult or paediatric, eventually within a new state-of-the-art facility.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3826

Implication on the socioeconomic burden of leptospirosis: A beginning

Mm Ramzan, Za Hamid, Knm Isa, Mr Jais and Rm Noah

University of Kuala Lumpur (UNIKL), Malaysia

Background

Information on prevalence and worldwide incidence of human leptospirosis is scattered across scientific publications. Most of the reported cases emerged following a natural disaster in any of the reporting countries. Similarly, reportable cases of human leptospirosis in Malaysia increased unexpectedly, following massive floods early in 2015. Previously-published investigations report high seroprevalence of leptospiral antibodies among Malaysians, especially in citizens employed within the Municipal Services. This is true because those workers are exposed to waste materials generally in contact with rodents.

Methods

This preliminary study was done to evaluate whether food handlers, classified as a low-risk group of being infected by the spirochaetes, do contribute to the under-reporting of the public health threat. The sociodemographic factors were assessed to implicate the economic burden that will eventually increase the social cost of combating leptospirosis in the local community.

Results

We conducted food outlet-based cross-sectional research on 49 food handlers in the district of Kajang, within the most developed state in the country. All samples tested positive for leptospiral antibodies by microscopic agglutination test (MAT) with different serological variations of the organisms.

Demographic data showed that 55% of the food handlers had only a primary education, 91.8% were not exposed to the outdoor environment prior to obtaining the blood samples and 53% informed of being knowledgeable of the disease; but only 10.2% received health facts via the internet.

Conclusions

These findings highlighted the importance of sociodemographic factors in determining the total social cost in confirming the disease, as well as introduction of preventive measures. The municipality budget allocated to deal with communicable diseases has risen more than double, following the emergence of leptospirosis. Low-risk groups have to be inclusive of total assessment of the disease, as reflected by these food handlers. Precautionary guidelines are definitely needed, as preventive measures need to be imposed on food handlers, as their close contact with the consumers is obvious.

Declaration of conflicting interest

No conflicts of interest to declare.

Education of healthcare staff and the public

Abstract ID: 3693

The effect of patient intervention by nurses systematically trained in infectious disease care

Kiyomi Hosoda¹ and Aiko Koh²

¹Fukuiken Saiseikai Hospital, Japan

²Japanese Nursing Association, Japan

Background

With systematic educational training in infection control and prevention (ICP) for 630 hours and certification by the Japanese Nursing Association for experience specializing in ICP, nurse specialists were given the opportunity to learn the medical knowledge about infectious disease (ID) practice, as an experimental model project in Japan. Moreover, the “selecting and administering of antibiotics,” which was not allowed for nurses until now, was also undertaken as a national project. As a result, a foundation of a system where trained nurses intervene with patients suspected of an infectious disease, without waiting for a physician’s instructions, is under preparation. We introduce its process and effects.

Methods

Nurses who had completed training in ICP and ID practice intervened in the practice of subject patients for surgical site infection (SSI) surveillance who had shown any form of infection (54 cases), or blood culture-positive patients (298 cases), during the period from June 2011 to March 2013 (132 cases in 2011, 108 in 2012 and 136 in 2013).

Results

Intervention details were: Observing clinical findings at the bedside, proposing and deciding with the attending physician for any additional imaging and culture studies necessary for ID diagnosis (24 cases); appropriately selecting and changing the antibiotic (153 cases), its dose and administration frequency (91 cases); and removing of devices (30 cases).

Conclusions

With a certified nurse with experience, who has gone through systematic education and intervened immediately after signs of an infection began to appear in the patient, it is possible to improve infection-related outcomes by inhibiting the occurrence of resistant strains. In addition, the proportion of meticillin-resistant Staphylococcus aureus (MRSA) was reduced by 10%, and the mortality rate from MRSA sepsis decreased by 3% after this action. Indices demonstrating the effects of intervention by nurses need to be discussed further after more experiences are collected.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3734

Not just “heart balloons and sweets”: The importance of active engagement of healthcare professionals with infection prevention education

Carolyn Dawson¹, Kate Prevc², Carly Baker², Allison Bradley², Melanie Gallo², Joan Goodbody², Fiona Reakes-Wells², Merja Thomas², Darren Wheldon², Emily Connor and James Parr²

¹University Hospitals Coventry and Warwickshire National Health Service (NHS) Trust, & University of Warwick

²University Hospitals Coventry and Warwickshire National Health Service (NHS) Trust

Background

Our Trust’s Infection Prevention and Control Team (IPCT) has become widely recognised for being an innovator within the infection prevention community, known for social media use and high-profile campaigns, including: “Get Stool Smart”, “WIPE Wednesdays” and “Ban the Bacteraemia”. Such campaigns stem from our strategy to deliver evidence-based education in an engaging manner and to address acknowledged challenges of apathy and hostility towards infection prevention activities.

Whilst anecdotal evidence of improvement has been encouraging, including positive feedback from front-line staff and the Trust board members, evidence of improved staff knowledge and infection prevention behaviour, the scope for a formal measurement of campaign impact existed.

Methods

Pilot work on two recent campaigns investigated the feasibility of capturing analysable data whilst maintaining an innovative, engaging approach:

“Sepsis September” Quiz: An email and paper-based quiz available to all Trust staff testing their sepsis knowledge, refreshed daily for 5 days around World Sepsis Day 2014.
“Mr. Grey has MRSA”: A mobile interactive game taken to wards, to educate front-line staff on meticillin-resistant Staphylococcus aureus (MRSA) protocols throughout February 2015.

Results

Formal data collection during the campaigns improved IPCT awareness of staff knowledge and practice around two key areas: sepsis and MRSA. For example, 50% of respondents were unclear about sepsis survival rates and 40% lacked knowledge of sepsis prevalence. The IPCT have now analysed campaign responses to identify educational targets for both Sepsis September 2015 and their on-going MRSA awareness work.

Conclusions

Effectiveness of resultant focused education for Sepsis September 2015 will be measured using a similar quiz format, whilst staff awareness of MRSA will be evaluated during International Infection Prevention Week 2015. The IPCT have translated this approach to a large-scale hand hygiene campaign for summer 2015, involving data collection of hand hygiene knowledge of the staff and staff perceptions, using World Health Organization (WHO)-validated tools.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3735

What lies beneath: How Trust-wide mattress quality auditing revealed inter-site differences in clinical engagement with Standard Operating Procedures (SOPs)

Joan Goodbody, Carolyn Dawson, Kate Prevc, Carly Baker, Allison Prevc, Melanie Gallo, Fiona Reakes-Wells, Merja Thomas, Darren Wheldon, Emily Connor and James Parr

University Hospitals Coventry and Warwickshire National Health Service (NHS) Trust, UK

Background

Our busy teaching Trust cares for 1,000,000+ people across a large University hospital (Site A) and a smaller hospital, 14 miles away (Site B). Our focus is on quality patient care, including stringent infection prevention and control (IPC).

Checking soft foam mattresses involves un-zipping the mattress cover, to check for integrity of the cover and seeing whether any ingress on the foam interior has occurred. During routine mattress checks by the IPC Team (IPCT) it became evident that soft foam mattresses were not being checked between patient use: Many holes in the covers and instances of ingress were identified.

Methods

Link staff were educated to cascade the process of mattress checks between patient uses. A standard operating procedure (SOP) was implemented for staff to follow if ingress or holes were found. This SOP formed part of a new Trust-wide guideline: “The Bed Cleaning Process.” The IPCT designed cleaning tape for staff to attach to a clean, ingress-free mattress, so they knew it was safe for the next patient. Defective mattresses were taken to the equipment library for further inspection and cleaning. The IPCT introduced Trust-wide yearly audits, conducted by an independent auditor to aid with reliability.

Results

Site B saw improvement, compliance rose annually from 72% in 2011/2012 to 96% in 2014/2015. The reverse occurred at Site A: Compliance fell annually from 77% in 2011/2012 to 64.57% by 2014/2015. Differences in implementing the SOP have been suggested as explanatory factors, with ownership and engagement more evident at Site B, while resistance and apathy were noted at Site A.

Conclusions

The IPCT focus is on maintaining Site B performance, whilst developing methods to engage clinical enthusiasm for ensuring mattresses are checked and cleaned, at Site A. We aim for 100% compliance Trust-wide, ensuring that every patient is cared for on a clean mattress.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3739

A multimodal approach to improving catheter care

Melanie Gallo, Kate Prevc, Carolyn Dawson, Carly Baker, Allison Bradley, Joan Goodbody, Fiona Reakes-Wells, Merja Thomas, Darren Wheldon, Emily Connor and James Parr

We devised a C. difficile-focused educational programme. Education was delivered at the ward level, to ensure staff attendance. The topics covered included a definition of C. difficile and associated risks, management of a patient with diarrhoea in a ward setting, hand hygiene and environmental decontamination. Training sessions were mandatory for all nursing staff in the areas involved. Records of attendance were compiled to monitor compliance.

Results

The teaching sessions were conducted over an 8-week period. No further cases have been identified in these areas and the sessions were completed. There was an increased awareness in both areas in ensuring that patients experiencing diarrhoea are isolated, assessed and treated promptly. Staff will frequently contact the Infection Prevention and Control team, using a dedicated hotline for advice and support.

Conclusions

Whilst the initial focus of the education was C. difficile, and was centred within two specific areas, the emerging incidence of multi-drug resistant organisms cannot be ignored. The educational programme has now been developed further, with an emphasis on ‘back to basics’. This has now been introduced as essential training for clinical staff across the wider organisation. Additional ward-based training is under development, which when completed by all staff on the ward, will result in ward accreditation.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3785

Knowledge, perceptions and decision making: What matters to patients?

Raheelah Ahmad¹, Enrique Castro-Sanchez¹, Michiyo Iwami¹, Fran Husson² and Alison Holmes¹

¹Imperial College, London, UK

Although a small sample, a skill-set may be missing in the training of nurses to effectively use evidence-based critical thinking. Moreover, the level of routine data collection and management may undermine the ethos of evidence-based medicine and seems to be present at all levels within the healthcare organisation. Further focus groups are being undertaken, with an aim to develop an online training tool that can be accessed by nurses at any stage of training, in order to engage better with the literature.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3833

Simulation and visualisation: Developing new tools for IPC education

Fionnuala Browne, Andrea Heaton, Wendy Moens, Eimear Donnelly and Anne Jones

Aintree University Hospital National Health Service (NHS) Foundation Trust, UK

Background

Compliance with basic Infection Prevention and Control (IPC) precautions remains challenging; and evidence suggests that the use of simulation is an effective tool to improve healthcare practices (Pope et al, 2014). An immersive simulation exercise was undertaken as part of the IPC Link Practitioner Programme. The IPC nurses developed and participated in the exercise that simulated routine nursing care of a bed-bound patient on a medical ward. The aim of the exercise was to make link practitioners more aware of the critical importance of IPC precautions in preventing avoidable infections and to ultimately change practice.

Methods

The objective of the 20-minute simulation was to create a realistic clinical setting that focused on the role of the environment, inanimate objects, hands of healthcare workers and personal protective equipment (PPE) in the potential transmission of infection. Unbeknown to participants, a transparent ultraviolet light (UV) reacting gel was applied to the hands of nurses, prior to the simulation.

Following the simulation, the lights were switched off to darken the room; demonstrating the widespread contamination of the environment, the patient and nurses. An informal debrief was undertaken and a questionnaire was sent via email, to seek feedback.

Results

Of the seven questionnaire responses, every participant “strongly agreed” that the simulation was beneficial, was relevant to their clinical practice, increased their awareness of infection risks to patients and crucially, everyone agreed that it would influence their practice. Descriptions included that it was “excellent” and “highly effective” in increasing their awareness of basic IPC precautions. Three participants reported that they are sharing their learning with colleagues and suggested that IPC simulation be rolled-out widely, to multi-disciplinary colleagues.

Conclusions

Two nurse specialists are currently undergoing formal training in simulation and human factors science, and are engaged with The Centre for Simulation and Patient Safety (UK National Health Service (NHS) Health Education North West), to further develop and deliver scenarios as a core feature of IPC education at Aintree, UK.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3837

Transforming IPC education in an acute hospital: Taking bespoke workshops to the frontline, using PDSA cycles to drive improvement

Eimear Donnelly, Wendy Moens, Damian Burns, Andrea Heaton and Anne Jones

Aintree University Hospital National Health Service (NHS) Foundation Trust, UK

Background

Traditionally, mandatory infection prevention and control (IPC) training in the National Health Service (NHS) Trust has been designed to give key messages to a large number of people in a short time, via didactic presentations. Informal reports from staff and discussions within the IPC team suggested that key messages around IPC were not always well understood nor translated into clinical practice. Frontline pressures also resulted in difficulties releasing staff for training. This has driven us to explore innovative approaches, including the development of ward-based interactive mandatory training.

Methods

A variety of practical and interactive workshops were set out, covering a range of IPC subjects. Supporting printed information was also provided. Workshops included meticillin-resistant Staphylococcus aureus (MRSA) Clostridium difficile infection (CDI) and multidrug-resistant organism (MDRO) management, hand hygiene and personal protective equipment (PPE) stations.

Although formal staff opinions were not sought pre-intervention, informal discussions with staff revealed that insufficient practical detail was provided during traditional sessions. The IPC Team also observed a lack of confidence around knowledge and IPC practices, such as appropriate use of PPE. The objective was to provide the same standard messages as presentations in the lecture theatre setting, but to also provide the opportunity for staff to ask questions, to seek clarification and increase levels of understanding. Evaluation forms were given to staff attending the workshops (22 evaluations) and some peer reviews were also carried out. Plan, Do, Study, Act (PDSA) cycles allowed feedback and identification of improvement for future sessions.

Results

All participants rated every work station as either “very good” or ”good,” and all comments were positive. The next cycle of workshops will incorporate their comments, including revised staff information leaflets with a lighter word count, advertisements to go to all staff groups, both permanent and temporary, and sessions planned for when sufficient staff are available.

Conclusions

Further sessions are planned, with on-going evaluations and PDSA cycles. Further information gathered will drive improvement in session content, interaction and provision of relevant information.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3845

Improving aseptic technique practice in Renal Services

Sarah Freeman¹ and Pamela Sinclair²

¹NHS Education for Scotland (NES)

²NHS Greater Glasgow and Clyde, Scotland, UK

Background

People with chronic kidney disease, who are haemodialysis dependent, rely on functioning vascular access to enable effective regular treatment. The native arteriovenous fistula (AVF) has a reduced risk of complication and an increased long-term viability; therefore, it is considered the optimal vascular access. Appropriate cannulation technique is vital to maintain the fistular viability and reduce the risk of access-related complications. Within the National Health Service (NHS) of Greater Glasgow and Clyde’s renal services, we conduct approximately 54,600 cannulations a year. Aseptic technique prior to cannulation and upon connecting to the dialysis machine is vital in preventing infection.

Methods

Observation of aseptic technique practice during the cannulation procedure and connection to the dialysis machine was carried out against a defined and agreed standard. The standards were a list of steps that had been agreed upon by experts. Consent was given for direct observation. Following the observation of practice, an education plan was put into place, and post-observation of aseptic technique practice was carried out.

Results

Consistent themes appeared throughout the observation period (63 observations were carried out). Key areas where compliance was poorer were included:

The six steps of hand hygiene technique was not followed;
The patients were not performing hand hygiene prior to holding the site, after the needle was removed;
Hand hygiene was not carried out immediately after glove removal;
The cannulation site was being disinfected prior to needle insertion, but then the site was re-palpated;
The skin disinfectant was not left on the skin for the desired time; and
The nurses were documenting the dialysis book after cannulation, whilst still wearing gloves.

Following observation (68 observations), compliance rates increased from 75–80% to 90–100%.

Conclusions

There are high levels of experience within renal services and a repetitive task, such as the aseptic technique, may mean that through time staff may have developed behaviours that can be difficult to change. This project highlighted the need for continual audit and education, and should be undertaken on a regular basis.

Declaration of conflicting interest

No conflicts of interest to declare.

Epidemiology and surveillance of HCAI

Abstract ID: 3699

Recognising the ever-increasing healthcare-associated infection (HCAI) and healthcare-associated outbreak (HCAO) challenge

Evonne Curran

Health Protection Scotland, Scotland, UK

Introduction

The latest point prevalence survey results show that healthcare-associated infections (HCAIs) have a lower prevalence; however, novel emerging and re-emerging pathogens, combined with perennial or novel modes of transmission, have increased the HCAI challenge.

Methods

The potential consequences of a perceived HCAI reduction with the reality of increasing HCAI risks were examined by a review of the literature to identify current and emerging HCAI threats and healthcare-associated outbreaks (HCAOs), to create a catalogue of national mandatory requirements to prevent or minimise HCAI/HCAO threats.

Results

None of the traditional pathogens with outbreak potential (e.g. Streptococcus pyogenes or Staphylococcus aureus), nor the recognised infection categories (e.g. surgical site infection or gastrointestinal outbreaks) have been eradicated.
Excluding resistant organisms, at least 22 novel pathogens/pathogen groups with HCAI/HCAO potential have emerged over the past 40 years. Novel transmission pathways continue to arise or be recognised.
- Some of these emerging pathogens have resulted in significant challenges (e.g. Clostridium difficile and MRSA).
- Other pathogens, although causing fewer HCAIs/HCAOs, have generated disproportionate amounts of work for Infection Prevention and Control Teams (IPCTs), e.g. blood-borne viruses, variant Creutzfeldt-Jakob disease (CJD) and Ebola.
Each novel threat results in new national guidance and new pathogen-specific must dos.

Conclusions

Even if HCAI prevalence is lower, IPCTs are burdened with an ever-increasing range of activity needed to keep people in care settings safe. No recognised HCAI challenge has thus far been negated. Each new threat is responded to with pathogen-specific actions, to minimise each individual challenge. It could be tempting for managers to respond to a lower HCAI prevalence by reducing the IPCT resource. This work demonstrates the importance of maintaining the IPCT resource, and in responding to new challenges in ways that synergise IPCT efforts to control multiple pathogen challenges, rather than producing pathogen-specific must dos.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3706

Do current estimates of healthcare-associated infection burden include outbreaks?

Evonne Curran and Catherine Dalziel

Health Protection Scotland, Scotland, UK

Background

We wanted to identify the significance of healthcare-associated outbreak (HCAO) burden as a proportion of all healthcare-associated infections (HCAIs). The sources of information available were the oft-quoted studies that advise that between 1–10% of HCAIs present as HCAOs; and European Centre for Disease Prevention and Control (ECDC’s) Point Prevalence Survey (PPS), the primary objective of which is “To estimate the total burden (prevalence) of HCAI.”

Methods

A literature search for, and examination of, papers that estimated HCAO as part of HCAI. A review of the capability of ECDC’s PPS and to detect HCAO.

Results

Examination of studies that estimated HCAOs showed that they lacked validity, due to a low sensitivity to detect HCAOs (< 70%), and because they pre-date both advanced healthcare systems and the emergence of the nosocomial pathogen challenge, e.g. meticillin-resistant Staphylococcus aureus (MRSA) Clostridium difficile infection (CDI) and norovirus.

ECDC’s PPS is neither designed to, nor is capable of detecting HCAOs, e.g. ECDC’s latest report contains no cases of HCAI influenza and only three cases of norovirus.

Conclusions

Estimates of HCAOs used today are from old studies, which lack validity. ECDC’s estimate of HCAI burden uses PPS data, which underestimates HCAI burden, as the data contain only the HCAI which are prevalent. PPSs largely exclude the commonest HCAO pathogens (influenza and norovirus). HCAI burden, as measured by PPS, omits not just outbreaks but also an estimate of outbreak potential, e.g. patients admitted from the community with alert organisms and/or communicable diseases. More importantly, there appears to be no estimate of the resources needed to prevent outbreaks. Estimates of HCAI burden should include both outbreaks and the resources needed to prevent them. The accepted inference that as there are so few HCAOs, the focus of surveillance programmes should be on endemic and not epidemic infections (outbreaks), is therefore called into question.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3718

Utilising local electronic systems to collect national surveillance

Jane McNeish, Christopher Sullivan and Laura Imrie

Health Protection Scotland (HPS), Scotland, UK

Introduction

The Scottish Surveillance of Healthcare Associated Infection Programme (SSHAIP) within Health Protection Scotland (HPS) coordinates the surgical site infection (SSI) surveillance programme within National Health System (NHS) Scotland. Currently, web-based data collection is via the Surgical Site Infection Reporting System (SSIRS); however, the majority of data recorded on SSIRS is also collected by NHS boards, using a variety of local software systems. In addition, a number of boards use a version of ICNet, enabling these data to be collated locally.

At the request of the NHS boards, HPS and ICNet have collaborated to develop a method for the automated export of data from ICNet to SSIRS, which would prevent the need for manually entering the same data twice.

Methods

ICNet developed a surgical site infection (SSI) module, based on the data collection forms within SSIRS. These forms were then populated with data already collected within the ICNet. This includes the automatic importing of data from other software systems, such as local theatre systems. All validation rules within SSIRS were included within the ICNet SSI module, and an export file was developed. SSIRS was then configured to accept ICNet-imported files, with additional validation rules to prevent the duplication of records.

Results

Three NHS boards (NHS Borders, NHS Dumfries and Galloway, and NHS Greater Glasgow and Clyde) were involved in a pilot study to test the validation rules, import and export features. Surveillance data continued to be collected through SSIRS, to allow comparison of both datasets. Analysis of ICNet collated data found the transfer process to be accurate, reproducible and reliable.

The results from this pilot study showed that SSI surveillance data can be collected using ICNet, with data then transferred to SSIRS. This prevents the need for manually entering data onto two systems, thus freeing up valuable resources which can be utilised in other areas.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3756

Hand hygiene monitoring: Is it the real deal?

Lincoln Fowler

Bairnsdale Regional Health Service, Australia

Background

Since the introduction of the “5 moments of hand hygiene” framework for monitoring by the World Health Organization (WHO) in 2008, there has been a movement across the globe to accomplish change in healthcare worker compliance to this important aspect of care. In Australia, the improvements in hand hygiene data and associated infection rates have been gradual and in-line with national requirements. This has also been observed locally, at a small rural hospital (69 beds and 800 staff).

Methods

Australia-wide, the overall hand hygiene compliance target using “5 moments” auditing is 70%, with calls to raise it to 75%. In the state of Victoria, the health service compliance target was raised to 80% in 2015. While the “5 moments” are an indirect measure for the potential for infection across five domains, some of the domains predominate in data recording, e.g. Moment 1 and Moment 4. As a result, there are a lot fewer observations of the moments that potentially have the biggest potential for transmission, with resultant healthcare associated infections (HCAIs).

Results

A recent audit showed overall compliance was at 85.9% and involved only 205 moment observations. Moment 2 had a compliance of 52.9%, but involved only 17 observations. Moment 3 was observed to have compliance at 95%, involving 21 observations. This is not necessarily indicative of the absolute infection risk in this hospital environment.

Conclusions

Moment 2 is the most commonly observed, before intravenous cannulation, giving of intravenous medication, phlebotomy and wound care. In order to observe more of these, greater observer time would be required, as well as greater intrusion into the patient zone. Procedures are often undertaken behind closed curtains.

Satisfactory overall results are not something for hospital executives to cheer about. Instead, they need to understand the deleterious effects on the bottom line when more significant infection risks are hidden.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3763

Investigation of suspected cross-infection of Providencia stuartii among different nursing homes

Chin-Lu Chang

Department of Infectious Diseases, Tainan Municipal Hospital, Tainan, Taiwan

Introduction

At a regional hospital in southern Taiwan, from 9 January 2014 to 12 May 2014, four strains of third-generation cephalosporin-resistant Providencia stuartii (P. stuartii) were isolated from three different nursing homes. Because these strains were rare at this hospital before, a study was conducted to investigate suspected cross-infection of the third-generation cephalosporin-resistant P. stuartii among the different nursing homes.

Methods

The standard disk diffusion method was used for antimicrobial susceptibility testing, and the interpretation criteria were according to the Clinical Laboratory Standards Institute, 2014. The antibiotics tested included cefazolin, cefuroxime, ceftriaxone, ceftazidime, gentamicin, amikacin, levofloxacin, imipenem and meropenem. Pulsed-field gel electrophoresis (PFGE) was used for bacterial genotyping. PFGE patterns were interpreted as the same (no band difference), similar (≦ 3-band differences), or different (≧ 4-band differences) strains.

Results

All four isolates of P. stuartii were resistant to cefazolin, cefuroxime, ceftriaxone, ceftazidime, gentamicin and levofloxacin; as well as were susceptible to meropenem. Three isolates were intermediately susceptible to imipenem. PFGE patterns revealed that these four isolates were similar strains.

Discussion

As a result of this study, PFGE results confirmed that this was a cross-infection of third-generation cephalosporin-resistant P. stuartii among different nursing homes, which might be caused by clonal spread. Although implementation of infection control measures is one of the important measures to reduce the spread of antibiotic-resistant organisms in hospitals, we suggest that they should also be performed in long-term care facilities, to yield better effect.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3767

Laboratory investigation of a cluster of ceftazidime-resistant Haemophilus parainfluenzae infections

Chin-Lu Chang

Department of Infectious Diseases, Tainan Municipal Hospital, Tainan, Taiwan

Introduction

At a regional hospital in southern Taiwan, from 9 May 2014 to 6 June 2014, three strains of ceftazidime-resistant Haemophilus parainfluenzae (H. parainfluenzae) were isolated from different hospital patients (HP1, HP2 and HP3). Because these isolates were rare, a study was conducted to detect an outbreak. In addition, the mechanisms of ceftazidime resistance were also investigated.

Methods

E-test strip was used for antimicrobial susceptibility testing. The antibiotics tested included: ampicillin, amoxicillin-clavulanate, ceftriaxone, ceftazidime, ertapenem, doripenem and ciprofloxacin. The interpretation was according to the criteria recommended by the Clinical Laboratory Standards Institute (CLSI) in 2014. Pulsed-field gel electrophoresis (PFGE) was used for genotyping, and the results were interpreted as the same (no band difference), similar (≦ 3-band differences), or different (≧ 4-band differences) strains. Polymerase chain reaction (PCR) and sequencing was used for detecting β-lactamase genes and the mutations of penicillin-binding protein 3 (PBP3).

Results

All three isolates were resistant to ampicillin, ceftazidime and ciprofloxacin; as well as susceptible to ceftriaxone, ertapenem and dorienem. Hospital patient strains HP1 and HP3 were resistant to amoxicillin-clavulanate, but HP2 remained susceptible. PFGE revealed the three isolates were different strains. No β-lactamase genes were detected, other than blaTEM-1 being detected in HP1. The three isolates presented PBP3 mutations: HP1 had amino acid changes at the Thr574Ala position, and HP2 and HP3 had amino acid changes at the Val511Ala and Asn526Lys position.

Conclusions

As a result of this study, we found this event was only a cluster of ceftazidime-resistant H. parainfluenzae infections, rather than an outbreak; however, we still suggest that laboratory investigation should be done to detect an outbreak, once some unusual antibiotic-resistant organisms increase suddenly. HP2 and HP3 were beta-lactamase-negative ampicillin-resistant (BLNAR) strains, and HP1 was a beta-lactamase-positive amoxicillin-clavulanate-resistant (BLPACR) strain. The mechanism of ceftazidime resistance of H. parainfluenzae might be due to PBP3 mutations.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3769

Of six MRSA BSI, three were related to central venous access devices, one to a peripheral venous access device, one to a contaminant and one was a possible contaminant. Of the 83 E. coli BSI, 30 had a urinary source, 13 of which were considered catheter-associated urinary tract infections (UTIs). The other E. coli BSI were from diverse sources. Of 29 MSSA BSI, eight were from central venous access devices, nine were of unknown source, and the rest from diverse sources.

Of the six MRSA BSI cases, documentation of intravenous access devices was incomplete or missing in four cases. In three cases, the documentation of blood cultures was incomplete or missing. In one case, admission screening for MRSA was not in line with local policy and in a further case, the MRSA suppression therapy was not administered correctly.

Conclusions

Our detailed review of BSI cases has provided valuable data on the likely source of a BSI. Whilst there will always be some uncertainty around the actual source of the BSI, the likely source data is useful in identifying problems, particularly around documentation of vascular access devices and blood culture collection.

Declaration of conflicting interest

Jonathan Otter is a consultant to Gama.

Abstract ID: 3863

Pilot evaluation of environmental hygiene using fluorescent markers and microbiological cultures

Amish Acharya, Dunisha Samarasinghe, Julie Singleton, Eimear Brannigan, Tracey Galletly, Hugo Donaldson, Alison Holmes and Jonathan Otter

Although perineal swabs would be preferable to rectal swabs in terms of patient acceptability, our data suggested that they are significantly less sensitive for detecting ESBL-E, detecting only around one-half of carriers. This has clear implications for the detection of other resistant Enterobacteriaceae, most notably CRE. We did not evaluate the performance of an anal or perianal swab (without sampling the rectum), which could be the subject of further studies; but in the meantime, we recommend rectal swabs for detecting carriage of resistant Enterobacteriaceae.

Declaration of conflicting interest

One of the authors is a member of the IPS SPC and Jonathan Otter is a consultant to Gama.

Infection prevention in acute and specialist settings

Abstract ID: 3538

Magnusiomyces capitatus in a haematology unit

John Swanson and Annette Jeanes

University College London Hospital National Health Service (NHS) Foundation Trust, London, UK

Background

A cluster of Magnusiomyces capitatus cases on a haematology inpatient unit led to an investigation to identify the source and prevent further cases.

Methods

Extensive environmental and food sampling was combined with the limited published evidence of the role of this organism in outbreaks, to establish the root cause.

Results

Despite considerable infection prevention and control investigative prowess, we were unable to identify a source or a cause for this cluster of cases; however, the investigation did lead to improvements in many practices. This included the cleanliness of the environment, condition of the built environment and storage of equipment and food.

A total of 104 sites were sampled, using established methods to retrieve fungi. This included foodstuff, equipment and sundries for mealtime support. Gram-negative bacteria, Candida and other organisms were found, but unfortunately not Magnusiomyces capitatus.

Many practices were identified that had to be changed, including milkshake rounds undertaken by volunteers, which had suboptimal food hygiene practices. A well-used beverage bay was in a poor state of repair and contained a hot drink machine, which generated heat that made the room temperature high. The fridge in this room was used to store patient foodstuff, but was poorly managed and contained date-expired items with little evidence of labelling to identify the owners.

Conclusions

It was concluded that the patient environment must be managed to optimise patient safety. It was important that there is a clear understanding of what and how the environment may lead to illness in patients.

Subsequently, the ward received increased cleaning, training and support from the infection control team for 12 weeks, and although the source was not identified; the ward, staff and multidisciplinary team became acutely aware of the importance the cleanliness of the ward and the management of patient foodstuffs. The improvements made have been sustained, and no further cases have been identified.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3567

Gender differences in hand hygiene among Saudi nursing students

Jonas Cruz, Charlie Cruz and Abdullah Suleiman Al-otaibi

Shaqra University Shagra, Saudi Arabia

Background

Hand hygiene is the most common infection control measure in a health care setting and forms the core of patient safety. Student nurses have direct contact with patients and other members of the healthcare team during their tour of duty. Thus, it is essential to evaluate their knowledge, attitude, practice and performance of hand hygiene and understand the differences between genders.

Methods

This cross-sectional study was conducted to determine the gender differences on knowledge, attitude and practices of hand hygiene and the performance of the “5 moments of hand hygiene” among Saudi nursing students. A total of 209 students participated in the study. A questionnaire with four parts was used to gather data on knowledge, attitude and practices on hand hygiene; and the students’ self-reported performance of the “5 moments” of hand hygiene. Data were analysed using SPSS version 21.

Results

Both male and female nursing students have moderate knowledge of hand hygiene. Females have a better attitude towards hand hygiene and higher self-reported performance of the “5 moments of hand hygiene”. On the other hand, male students had better practice of hand hygiene. Attitude and practice were statistically different at a p < 0.05 level of significance.

Conclusions

Gender differences in attitude, practice and performance of hand hygiene were observed. Knowledge of both genders needs to be improved. Gender-specific hand hygiene educational and behavioural interventions are essential, in order to meet the gender-specific needs of the students.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3630

Using an electronic hand hygiene monitoring badge: What does it achieve?

Maurice Madeo¹, Judith Dyson² and Louise Lowry³

¹Doncaster and Bassetlaw Hospitals UK

²University of Hull UK

³Leeds Teaching Hospitals UK

Background

The gold standard for measuring hand hygiene (HH) compliance is direct observation; however, this is resource-intensive and leads to artificially inflated results, due to the Hawthorne effect. Recently, electronically-assisted HH monitoring systems have been developed to support hand hygiene monitoring and feedback, to help improve compliance. The aims of this study were to investigate whether such a device impacts on HH and to establish the views, opinions and experiences of health care practitioners about if and how such systems support HH.

Methods

An electronic hand hygiene monitoring and prompt system was implemented in two inpatient hospital units. Sensors on badges and in the environment record entry to and exit from a patient zone, along with HH events. The badge produces a visual and audible alarm to remind practitioners when a hand hygiene opportunity is required. The impact of the device on HH was measured by consideration of routine peer observed compliance data supplemented (in one of the two units) by: independent observations conducted by the Infection Prevention Control Team (IPC) using the World Health Organisation’s (WHO) “WHO 5 moments” format and by alcohol rub usage Semi-structured interviews with practitioners (n = 12) who had worn badges established views, opinions and experiences.

Results

Routine and IPC observations identified the HH compliance at 73% before implementation, 83% during the use of the electronic system and then back to baseline, when the system was removed. Use of the alcohol rub quadrupled during the badge use, but also returned to baseline after use.

Conclusions

Interviews identified factors associated with the system that both supported greater awareness and undermined, such as the system being more sensitive to gel than soap HH. Data gathered will inform future adoption of the product and may support product development.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3652

The most effective methods of preventing and controlling Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection in hospitals: A literature review

Alia Albaharnah¹ and Dona Foster²

¹Ministry of Health, Saudi Arabia

²Department of Biological and Life Sciences, Oxford Brookes University, Oxford, UK

Background

The aim of this review was to investigate the methods currently available to prevent the spread of infection by Middle East Respiratory Syndrome coronavirus (MERS-CoV) in hospitals and to evaluate current recommendations used as preventative measures with a focus on transmission. In addition, this project will present the most effective strategies to monitor and manage the disease in both the short and long term. The work will detail effective measures to protect individuals and communities against MERS-CoV.

Methods

Primary research articles relating to MERS-CoV and preventative control measures for respiratory viral outbreaks were examined in a critical literature review.

Results

We chose 15 studies, following a thorough critical analysis of a wide range of literature. Four main themes emerged: Clinical manifestation, prevention and treatment, breaking the chain of infection, and the risk factors of MERS-CoV. There was an increased number of cases of MERS-CoV, over the time of the study. Transmission was shown to include animal-to-human and human-to-human routes, as well as through environmental factors. The risk to healthcare workers has been demonstrated.

Conclusions

Many factors contributing to an increased risk of an individual contracting the MERS-CoV virus were identified. The main reservoir for the virus was identified and the transmission route was determined. The risk of infection among healthcare workers was examined, including the impact of their behaviour on the efficacy of early diagnosis in reducing and controlling the spread of MERS-CoV. Continuous education, surveillance systems and enforcement of infection control measures comprise the main recommendations for the effective control of the MERS-CoV in hospital environments.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3667

Patient Group Direction (PGD) decolonisation prior to surgery, to reduce surgical site infection rate in spinal patients

Annesha Archyangelio, Amritpal Shakhon

Royal National Orthopaedic Hospital Middlesex, UK

Background

A Patient Group Direction (PGD) is instructions for the administration of medicine by trained professionals to a specific patient with an identified condition, without them seeing a prescriber, by assessing that they meet the criteria. For example, the patient group of spinal patients are identified as having higher infection rates.

Methods

We captured spinal patients through the pre-operative assessment (POA) clinic, in order to provide Staphylococcus aureus (S. aureus) decolonisation, including: Chlorhexidine 4% body/hair wash, Mupriocin 2% nasal ointment and Chlorhexidine 0.2% mouthwash, to be used prior to surgery, to reduce bacterial load.

Implementation started for the POA in June 2014. The staff marked records for patients to whom they provided the PGD, to monitor compliance and distribution. The categories of patients who did not receive the PGD/decolonisation included hips, knees, shoulders, foot and ankle, and a spinal patient who did not attend the POA clinic. Patients in this group were screened for methicillin-resistant S. aureus (MRSA), in line with current practice, and the MRSA-positive patients received standard MRSA decolonisation.

There was a post-implementation audit of the S. aureus PGD, from June to December 2014, reviewing: Patients captured on the electronic records, reasons some patients were not given the PGD, infection rates since system introduction, staff interviews to check for process compliance and a patient survey to check for the application of decolonisation.

Results

The PGD implementation occurred smoothly. Staff/patients indicated overall compliance with the process. Patients given the PGD did not have POA or were missed. Data showed a reduction in surgical site infection (SSI) rates in spinal patients, post-PGD: There were 19 infections in that period the previous year, but only three infections in patients given the PGD.

Conclusions

Embed capture of spinal patients. Continue PGD-infection rate analysis, to assess the impact of blanket decolonisation in spinal patients. Consider standard pre-operative decolonisation for all orthopaedic patients.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3679

Comparision of compliance versus incidence of line-related bacteremias

Corinne Cameron-Watson

Barking Havering and Redbridge UK

Background

Currently in the UK, all intravenous (IV) needle-free access devices are required to be disinfected before every access. Current UK guidelines (EPIC3) recommend “Scrubbing the Hub” (active disinfection) for a minimum of 15 seconds and then leaving the disinfectant to dry (30 seconds is recommended). This practice relies on the caregiver to use a consistent technique, while ensuring the correct time is given to both the scrubbing of the device and the drying time (kill time) of the disinfectant. The introduction of passive disinfection devices have shown significantly improved clinical outcomes, by eliminating the multiple steps involved and subsequent human variation in the current active disinfection method. The purpose of this study was to compare compliance versus incidence of line-related bacteremias.

Methods

This study was conducted on four wards (Oncology, Acute Care of the Elderly, Critical Care and a surgical ward), following intensive staff training. A total of 1074 patients from 7 April 2014 to 6 October 2014 had their needle-free devices cleaned with a ‘Curos’ passive device. We took the incidence of catheter-related blood stream infections (CRBSIs) for the 6 months prior to the start of study from the laboratory blood culture data, to enable benchmarking for each ward. All devices were audited on a daily basis and monthly compliance audits were carried out.

Results

In the 6 months on the four wards prior to the use of a passive disinfection device, the incidence of CRBSIs was 26. In the 6 months whilst ‘Curos’ was being used, the incidence was eight CRBSIs, which created a 69% reduction in infection. Where compliance was 80% or over, the infection rates remained low; however, when compliance dropped below 80%, CRABSIs occurred.

Conclusions

The business case was submitted to the Trust for the introduction of passive disinfection devices for all lines.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3685

Multi-pathogen gastroenteritis outbreak among employees at a maternity ward after travelling to Morocco

Marita Skogstad, Nina Handal and Silje Bakken Jørgensen

Akershus University Hospital, Norway

Background

We describe an outbreak of gastroenteritis with multiple pathogenic agents among employees at a maternity ward. We had 13 out of 16 employees develop gastroenteritis after travelling to Morocco for touristic purposes in October 2014.

Methods

Faecal sampling and work restrictions were recommended for all symptomatic employees. All staff was reminded of hand hygiene procedures and the importance of reporting any new cases of gastroenteritis among patients or personnel. Samples were initially tested by a multiplex polymerase chain reaction (PCR) for common bacteria, viruses and parasites. We did follow-up faecal cultures from the employees having pathogenic bacteria.

Results

Enteropathogenic Escherichia coli was found in three employees, Campylobacter jejuni (C. jejuni) in two employees, EPEC and C. jejuni in three employees, EPEC and norovirus in one employee and EPEC and Salmonella bredeney in one employee. After 4 weeks, seven employees still had not cleared their pathogens. One employee was still positive for EPEC after 3 months.

All employees with pathogenic faecal findings were initially issued work restrictions, despite the rapid cessation of symptoms. After 4 weeks, the work restrictions made running the maternity ward challenging. Individuals with infectious gastroenteritis are most likely to infect other people during and immediately after symptoms occur, and infectivity usually decreases during a carrier state.

Person-to-person transmission of Campylobacter is rare, and there were no microbiological nor clinical indications of an Enterohaemorrhagic E. coli Consequently, we perceived the risk of further spread of pathogens as low. The employees returned to work with the following restrictions:

Weekly testing;
Focus on hand hygiene; and
No handling/preparation of food.

Conclusions

The presumed source of this multi-pathogen outbreak of gastroenteritis was in Morocco. No secondary cases were reported in Norway. We concluded that our infection control measures were successful.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3692

Clostridium difficile isolation: When do we stop?

Louise Hall¹, John Perry¹, Linda Prescott-Clements² and Allison Sykes¹

¹Newcastle upon Tyne Hospitals National Health Services (NHS) Foundation Trust, Newcastle upon Tyne, UK

Invasive devices are integral, life-sustaining devices used in modern day medicine. They are also a significant risk. A number of hospital acquired bacteraemias were associated with invasive devices in one organisation. The Post-Infection Review (PIR) process highlights poor documentation on invasive device insertion and care. There is evidence that evidence-based care bundles were not being adhered to. It is known that a lack of documentation is associated with fragmented care. We undertook a Quality Improvement Plan to Do, Study and Act (QI PDSA) project to improve documentation compliance by introducing a standardised invasive device documentation record to improve patient safety.

Methods

Our aim was to use a standardised invasive device record to improve compliance. We used a quantitative, quasi experimental approach, with a pre- and post-intervention study design. The study took place at an 843-bed multi-site acute London NHS Trust. We conducted 2-point prevalence audits both pre- and post-implementation of the new documentation record.

Contingency tables were used for each variable (insertion, daily review and on-going care) and Pearson’s Chi square tests were applied to assess their significance (we used 0.05 as the p-value cut-off to define significance). The odds ratio (OR) was also calculated for each of the variables, as a measure of change between the baseline and the post-implementation phase of the study.

Results

Following the implementation of the invasive device record, documentation compliance improved for all of the three measured variables of insertion, daily review and on-going care, from 49.4% to 68.8%, from 33.8% to 62.5%, and from 36.9% to 61.3%, respectively. The p value was < 0.05 in all of the three measured variables.

Conclusions

The importance of accurate documentation must not be underestimated, as failure to document can contribute to the cascade of events that can compromise patient safety and increase the risk of adverse events, such as that of invasive device-associated bacteraemia. A standardised documentation record that uses checklists and incorporates evidence-based practice has improved documentation compliance and assisted with information flow amongst clinicians. The expectation is that this QI PDSA cycle will continue, as this will ensure that the new record is used optimally and that it becomes fully embedded. Despite improvement, further progress is still required and future studies are planned.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3709

Ban the bacteraemia: Improvements to reduce MRSA and MSSA bacteraemia

James Bitmead and Lynne Sweeney

Infection Prevention and Control Teams (IPCT) strive to improve patient safety; ensuring that, “no patient is harmed by a preventable infection” (IPS 2011). Process and outcome performance data was used to support improvement strategies, but it had not been used specifically to congratulate staff on their commitment to the infection prevention and control (IPC) improvement. The IPCT were keen to honour excellence, and with this in mind, we formulated the New Year’s Honours Awards, representing a number of key aspects of infection prevention practice/standards.

Methods

We developed criteria for each award, e.g. for the Excellence in Hand Hygiene award, the wards that win have to achieve 85% compliance throughout the year; for the Progress in C. difficile Prevention award, the winning ward/s have to reduce the number of ward-acquired C. difficile infections to zero in 2014. Using surveillance and audit data, the IPCT matched ward or individual performances to the criteria for each award and then selected the winning wards/departments. The award winners were published and certificates presented publically. A selection of the wards/departments were then visited and asked for feedback on three questions, anonymously:

What the awards meant to them?
Have they caused them to do anything differently?
Have the awards made them think differently about IPC?

Conclusions

The concept of the awards was well received within the Trust. Staff felt positive about them, pleased their hard work was recognised; they encouraged staff to think about infection prevention practices, encouraged discussion and raised morale. Importantly, they supported staff to strive for improvement with IPC principles, helping to keep our patients safe from harm.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3727

Outbreak of linezolid-resistant enterococci on an Intensive Care Unit (ICU)

Anne Ninham, Fiona Downie, Helen Wickenden, Margaret Gillham and Doreen Pullen

Papworth Hospital National Health Service (NHS) Foundation Trust

Background

Since 2006, Intensive Care Unit (ICU) patients have been screened weekly for vancomycin-resistant enterococci (VRE). 2012 saw an increase in positive screens; typing revealed varying strains, including one (CAMBPEC-11) that was linezolid-sensitive. In 2013, six patients were identified with vancomycin and linezolid-resistant enterococci (LRE), which was typed as CAMPBEC-11. Immediate actions included isolation of positive patients, closure of contact bays, twice weekly screening on the ICU; screening/isolating of all contact patients until either discharged or three negative screens were received on the Wards. Environmental cleaning and effective hand hygiene practices were heightened and no further cases occurred.

Methods

An outbreak meeting identified actions: The erection of physical barriers to segregate ICU areas; designated cleaning staff for the clean and dirty areas; and daily review of the provision of cardio-thoracic services. A Public Health England (PHE) expert visit highlighted the ineffective cleaning of communal items. Thorough checking of dynamic mattresses resulted in some being condemned and a review of off-site decontamination standards, leading to cleaning being brought in-house.

Results

The off-site mattress decontamination area visit revealed concerns around clean and dirty facilities not being available and inadequate methods being used when cleaning mattresses, including: Clean mattresses folded wet and stored alongside the dirty, and cells not removed prior to cleaning. A comprehensive procedure for in-house mattress decontamination was formulated, with identifiable numbers given to mattresses for tracking and an inspection programme established. No further cases have occurred since the implementation of the enhanced mattress-cleaning programme.

Conclusions

This was the first recorded outbreak of its kind in the UK. An increase in VRE was noted prior to the outbreak; typing results suggested this strain had remained in the environment since 2012, and subsequently become resistant to linezolid. Ineffective cleaning and tracking of dynamic mattresses was a challenge, as it was impossible to determine any mattress-sharing between the colonised patients. Routine screening allowed for prompt identification of cases and effective outbreak management.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3743

Management of side room availability through a RAG rating system

Damian Burns, Eimear Donnelly, Andrea Heaton, Wendy Moens, Ruth May, Anne Jones and Jean Graham

Aintree University Hospital Foundation Trust

Background

Isolation capacity is a valuable resource in all acute organisations. In the absence of an electronic management system, the aim of this project was to release inappropriately-used side rooms by assisting the bed management team to identify appropriate available side rooms within the Trust.

Methods

The ward staff would submit side room plans to the Infection Prevention and Control (IPC) team by 08:00 in the morning. The IPC team would Red, Amber and Green (RAG) rate the side rooms. Another field was added for patients requiring isolation for other non-IPC reasons.

Red: Patient cannot move out of side room;
Amber: Requiring further assessment by another team, e.g. medical team;
Green: Patient can safely move out of the side room; and
Purple: Patient isolated for non-IPC reasons.

The RAG rating would entail an IPC nurse checking side room plans against patient results and also an assessment of patients with known infectious organisms. This would then determine the RAG rating and identify if a patient can be moved out of the side room safely. The IPC nurse would contact the wards for more information if required, highlighting why the information is important to the rating process. This process would be completed from Monday to Friday only, excluding bank holidays.

Results

An audit was undertaken during May 2015 over a period of 18 days, to evaluate whether the RAG rating by the IPC nurses identified more side rooms than the ward staff. The audit showed an average of 16 side rooms per day were identified by the IPC nurses, as opposed to the side room information submitted by the wards.

Conclusions

To re-audit every 6 months and compare the previous audits’ results, to evaluate whether the education has assisted the ward staff in assessing the availability of the side-rooms.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3757

Uvo™ decontamination following new ward-building project

Jo Ellison

Walsall Healthcare National Health Services (NHS) Trust West Midlands, UK

Background

Walsall Healthcare NHS Trust has used hydrogen peroxide vapour (HPV) decontamination since 2011; however, this process takes approximately 2 .5 hours. This has led to an evaluation of the Uvo™ system as a faster environmental decontamination technology. This evaluation assessed the efficacy of ultraviolet light (UV-C) decontamination using a Total Viability Count (TVC).The Trust had recently carried out a new building project, which gave the opportunity to evaluate contamination of the environment during the building and maintenance works.

Methods

Resources: A Uvo™ decontamination System (2); and Rodac Agar Plates (170) Pro-Tect TWI (Contact Plate) - Product Code PO0678D.

Testing was carried out by the following steps:

Room cleaned;
Samples taken from bed foot board, mattress, bed rails, oxygen trunking, patient chair arm, bed foot board, above sink (in bay area), above sink (in en-suite), handrail, toilet roll holder and toilet seat;
Uvo™ system deployed;
Samples taken from slightly offset locations as before; and
Samples cultured at 37° for 24 hours, and then the colonies were counted.

Ward: The ward had previously been cleaned and samples were taken from five bays and six side rooms, from 13 locations. Touch plate samples and swabs were taken on the following locations: the bed foot board, mattress, bed rails, oxygen trunking (behind bed), patient chair arm, bed foot board, above sink (in bay area), above sink (in en-suite), handrail, toilet roll holder, toilet seat. They were then taken from slightly offset locations, following the Uvo.

Previously-occupied side room: Samples were taken from 13 locations around the room, before cleaning. Touch plate samples and swabs were taken on the following locations: the bed mattress, bed base, bed rails, patient call bell, bedside locker, bedside table, patient chair, windowsill, light switch, door handle, toilet handrail, taps on sink and toilet seat. They were then taken from slightly offset locations, following cleaning, and then again after Uvo.

Results

The after-cleaning results from the refurbished environment cultured up to 43.5 colonies on average (handrail). After the Uvo decontamination, these were consistently reduced (0–2.1 range). A previously patient-occupied side room showed TVCs of 34.2, 31.8 and 0 for before cleaning, after cleaning and after Uvo treatment, respectively.

Conclusions

Increasingly in clinical settings, decontamination using HPV is time-prohibitive. This Uvo technology, taking an average of 18 minutes, could help improve that situation, owing to the increased level of efficacy, compared with manual cleaning alone.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3766

New comparison of traditional audits with electronic measurements: Further perspectives in the measurement of compliance with hand hygiene protocols

Julie Hayhurst, Caterina Galani, Jane Kirk, James Arbogast and Andrew Eaton

GOJO Industries Europe Ltd

Background

Auditing of hand hygiene compliance produces biased results, due to variances in the methodology used, and the Hawthorne Effect. The only thing an audit result can claim is that at the time of the measurement, the compliance rate was “X”.¹ In the UK, compliance rates > 90% are widely reported, leading the government and hospital management to believe that hand hygiene is under control; therefore, that no additional time nor money need be spent improving clinical practice. Electronic monitoring systems are now available which provide complementary results. Although such systems cannot report the “5 moments,” several workers have reported that the “Wash-in Wash-out” approach provides a good analogue for the “5 moments.”²

Methods

Two wards in four UK National Health Service (NHS) hospitals were fitted with the GOJO SMARTLINK™, an automatic electronic hand hygiene compliance monitoring system. Results were compared to self-audit and the “Secret Shopper” audits, which were carried out at different times of the day.

Results

The highest reported figures were those provided to the Trust Management, whilst the electronic compliance monitoring (ECM) results were significantly lower, typically at 5–25%.

Conclusions

By using a different methodology, ECM offers a different perspective on the issue of hand hygiene compliance that can be used in training or education, evaluation and feedback; and as reminders in the workplace; and as part of the World Health Organization’s (WHO) Multimodal Hand Hygiene Improvement Strategy.

References:

1. Haas JP and Larson EL (2007) Measurement of compliance with hand hygiene. J Hosp Infect 66; 6–14.

2. Sunkesula V, Meranda D, Kundrapu S, Zabarsky T, McKee M, Macinga D and Donskey C (2015) Comparison of hand hygiene monitoring using the “5 moments for hand hygiene” method, versus a “wash in, wash out” method. Am J Infect Control 43; 16–19.

Declaration of conflicting interest

The authors are employed by GOJO Industries Europe Ltd.

Abstract ID: 3771

Evaluating mobile device cleaning policies in the National Health Service (NHS)

Stephen White¹, Dr Paul Humphreys¹, Visiting Professor of Nursing, Annie Topping²

¹University of Huddersfield, UK

²Hamad Medical Corporation, Doha, Qatar

Background

The use of mobile devices within healthcare settings by staff, patients and visitors is widespread and growing. Department of Health guidance states that patients should be allowed the widest possible use of mobile phones. For staff, mobile devices have become an essential aspect of their day-to-day professional and personal lives; however, there is clear evidence that phones/tablets can become contaminated with pathogens, which may survive for prolonged periods before being transferred onto hands or other surfaces.

Methods

A Freedom of Information request for, “all current policies or guidelines that make reference to the use and management of mobile phones and tablet devices in the healthcare environment, by staff, service users and visitors – this applies to both personal and institutionally-owned devices”, was sent to National Health Service (NHS) institutions across England, Scotland and Wales; with a response rate of 96% (n = 252).

Results

We found that 22% of organisations had no policy in place, with approximately 11% stating that this would be considered policy reviews. Organisations that acknowledged the issue responded that staff was informed of disinfection procedures: e.g. “the normal cleaning schedule” or the use of universal sanitising or detergent wipes. Many organisations referred to their “Cleaning and Decontamination” policy; however, none of these explicitly mentioned mobile devices. Instead, the general advice for electrical devices was to follow the manufacturer’s instructions, as using any other process might invalidate warranties. Where specific cleaning policies were in place, they advocated the use of “general purpose/universal detergent wipes,” without any technical justification. Multiple organisations suggest that existing hand decontamination procedures are sufficient to address this issue.

Conclusions

There is no consistency in infection control advice, regarding the potential risks posed by the use of mobile devices. Regular cleaning may be a solution, but there is little evidence evaluating the available methods. The literature in this field calls for clear, evidence-based guidelines for cleaning and disinfecting of mobile devices.

Declaration of interest

No conflicts of interest to declare.

Abstract ID: 3777

Secret Shopper for hand hygiene audits

Christine O’Connor, Catherine Williams, Marie Dewhurst, Andrea Williams and Lauren Gould

Royal Liverpool University Hospital National Health Services (NHS) Trust, Liverpool, England, UK

Background

Compliance with the Trust weekly hand hygiene audits appears to show between 80–100%; however, there is some question about the validity of these audit results. In an attempt to gain a more accurate picture of hand hygiene compliance across the Trust, it was decided to carry out quarterly covert hand hygiene prevalence audits.

Methods

The Infection and Prevention Control Team (IPCT) recruited student nurses via the university to undertake the prevalence audits, using the standard Trust hand hygiene audit tool. Students were invited to attend a presentation to understand the benefits of audit, and were trained on using the hand hygiene audit tool. They were randomly allocated clinical areas. Following completion of the audits, the students returned the audits and evaluation forms. The hand hygiene audits results were analysed by the IPCT.

Results:

Number of hand hygiene audits completed each quarter.
Feb 2014	Apr 2014	Aug 2014	Dec 2014	May 2015
23	34	36	32	46

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Overall, there were 52 ward areas audited; however, not all areas have been consecutively audited as this was dependent on student numbers. The average hand hygiene compliance following the audits was 60%. Improved scores have been demonstrated in one-half of the audited areas. Some areas where only audited once; therefore, we were unable to state whether there had been any improvement.

Conclusions

The audit results have been disseminated throughout the Trust, with Ward and Department Managers required to complete action plans and provide assurance that compliance will improve. Domestic and catering staff training has been reviewed and the staff is now required to complete a training workbook. The same auditors had not been used on each occasion; therefore, there has been no consistency. In the future, a recommendation would be to have a core group of staff undertake the covert audits.

Declaration of competing interest

No conflicts of interest to declare.

Abstract ID: 3783

Design, implementation and evaluation of a Trust-wide infection prevention electronic patient alert system: “If you care, Bee Aware!”

Craig Bradley¹, Mark Garvey¹, Jane Parkes¹, Shirley Bird¹, Tracey Martin¹, Kerry Holden¹, Johan Dews² and Nicola Mousley²

¹University Hospitals Birmingham National Health Service (NHS) Foundation Trust, Birmingham, UK

In addition to patients with pneumonia and non-airway respiratory diseases, patients presenting with general symptoms and unspecified infectious diseases should be actively tested for influenza and pre-emptive isolation considered, particularly when approaching influenza season.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3809

Bugs that glow in the dark: Using Encompass to assess hospital cleanliness

Rachel Hobson¹ and Victoria Cosgrove²

¹St John’s Hospital, West Lothian, UK

²Royal Infirmary Edinburgh, Edinburgh, Scotland, UK

Background

Patients often perceive visual dirt as a marker for determining whether a hospital ward is clean. Poor environmental cleaning can result in surfaces harbouring reservoirs of bacteria invisible to the naked eye; thus patients admitted to rooms previously colonised with pathogens have a substantially greater risk of cross-transmission if the environment has not been cleaned appropriately. To evaluate whether direct feedback of environmental cleanliness would influence cleaning practices, an audit was carried out in two wards within two hospitals.

Methods

The audit involved a liquid ultraviolet light (UV)-reactive gel applied to high-touch surfaces. After cleaning, the areas were assessed by an optical fluorescent marker, to analyse whether the gel had been removed; and thus, evaluate cleanliness of the surface. The baseline data was obtained using a blinded method; immediate feedback to staff was given after Phase 1 and Phase 2, to recognise good cleaning practices and highlight aspects requiring further input.

Results

The data from both wards revealed significant improvement, from 47% (n = 63) overall cleanliness in the baseline data to 67% (n = 64) after Phase 1; and then 73% (n = 78) in Phase 2. Two surfaces out of the eight deteriorated between baseline and Phase 1, but improved in Phase 2 after feedback, whereas surprisingly a separate two areas decreased in cleanliness between Phase 1 and Phase 2, despite discussion with the staff.

Conclusions

The overall findings demonstrated that communication with staff can enhance cleaning techniques. Immediate feedback can also have a positive impact on quality improvement and improve patient safety. The audit also supported the hypothesis that, as most microorganisms are invisible to the naked eye, visual cleanliness cannot be a reliable indicator of infection risk, and cannot be relied upon to provide a neither quantitative nor qualitative assessment of patients’ risk for acquiring an infection.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3814

New Year’s Honours Awards as a motivational tool

Janet De’Witt, Bridget Spooner and Judy Potter

Royal Devon and Exeter National Health Service (NHS) Trust, UK

Background

Infection Prevention and Control Teams (IPCTs) strive to improve patient safety, ensuring that “no patient is harmed by a preventable infection” (IPS, 2011). Process and outcome performance data is used to support improvement strategies, but it had not been used specifically to congratulate staff on their commitment to infection prevention and control (IPC) improvement. The IPCT was keen to honour excellence and, with this in mind, formulated the New Year’s Honours Awards, representing a number of key aspects of infection prevention practices and standards.

Methods

We developed criteria for each award, e.g. for the “Excellence in Hand Hygiene award,” the winning ward(s) had to achieve 85% compliance throughout the year; for the “Progress in C. difficile Prevention award,” the winning ward/s had to reduce the number of ward-acquired Clostridium difficile (C. difficile) infection to zero in 2014. Using surveillance and audit data, the IPCT matched ward or individual performances to the criteria for each award, and selected the winning wards or departments.

Results

The award winners were published and certificates presented publically. A selection of the wards or departments were then visited and asked for feedback on three questions, anonymously:

What the awards meant to them?
Have they caused them to do anything differently?
Have the awards made them think differently about IPC?

Conclusions

The concept of the awards was well received within the Trust. Staff felt positive about them, pleased their hard work was recognised; they encouraged staff to think about infection prevention practices, encouraged discussion and raised morale. Importantly, they supported staff to strive for improvement with IPC principles, helping to keep our patients safe from harm.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3829

Creutzfeldt-Jakob disease (CJD) and Variant Creutzfeldt-Jakob disease (vCJD) pre-surgical risk assessment audit with neurosurgical procedures

Gill Lishman, Ann Turner and Hayley McIntyre

Newcastle upon Tyne Hospitals National Health Service (NHS) Trust, Newcastle upon Tyne, UK

Background

An audit was undertaken in a neurosurgical department, in order to establish the level of compliance to national guidance in relation to the Creutzfeldt-Jakob disease/Variant Creutzfeldt-Jakob disease (CJD/vCJD) pre-surgical risk assessment. In the hospital, the CJD/vCJD risk assessment is undertaken to reduce the risk of iatrogenic spread of the disease. Current methods available for decontamination of instruments are not reliable in the removal of prion proteins (the causative agents of CJD/vCJD). Assessment is undertaken in those undergoing medium-to-high-risk surgery, so that any instruments used in these risk procedures can be quarantined or destroyed. The need for this precaution is identified in the guidance from the Advisory Committee on Dangerous Pathogens and the Spongiform Encephalopathy Working Group (Great Britain Advisory Committee on Dangerous Pathogens (ACDP), 2014), as well as being listed as a requirement in the Health and Social Care Act (Great Britain Department of Health, Health and Social Care Act, 2008).

The objective was to identify compliance to national guidance in the Control of Transmissible Spongiform Encephalopathies (TSEs), including CJD in intra-dural procedures in hospital patients within Neurosurgery.

Methods

An audit was undertaken by theatre staff within the neurosurgical department. This was a retrospective study in a cohort of patients attending for intra-dural procedures between 24 November 2014 and 17 January 2015. In this time, the medical notes of 62 patients were reviewed in relation to CJD risk assessment.

Results

We had 79% of patients who met the intra-dural procedure criteria who had a completed assessment. The client demographics included both adults and children: Of those, 83% and 56% had an assessment completed, respectively. A significant number of the 21% of patients who attended the theatre without assessment were emergency cases.

Conclusions

The audit demonstrated a reasonable compliance to the standard; however, complete compliance to risk assessment remains elusive, in part due to the client group. Further work in relation to post-surgical assessment is required.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3834

Vancomycin-resistant enterococci (VRE) outbreak in a Norwegian university hospital: Infection control to the point

Jenny K Aasland^1,2, Kirsti Hermstad², Andreas Radtke², Mari Sagli Holte², Anita Wang Børseth³, Marthe Lind Kroknes², Kaja L Fleldsæter³

¹Saint Olavs Hospital, Trondheim, Norway

²Trondheim University Hospital, Trondheim, Norway

³Regional Center for Disease Control in Central Norway, Norway

Background

Vancomycin-resistant enterococci (VRE) were discovered in two patients in a university hospital in Norway, at the beginning of 2014. Screening around these cases revealed an outbreak of VRE, mainly in a satellite hospital of the university hospital. Departments located in the main hospital were also involved (orthopaedic surgery, gastroenterology and gastrointestinal surgery). In late August 2014, the outbreak included 47 patients. By mid-June 2015, another three patients were added.

Methods

An outbreak committee was quickly established. All wards in the satellite hospital were declared as “outbreak wards,” as well as the departments of gastroenterology and orthopaedic surgery. Outbreak wards had to implement several measures in a short time. Different screening strategies were applied to detect patients colonized with VRE.

We performed screenings in the outbreak wards and other wards that either had VRE patients or were considered at high risk. We initiated screening of all patients who were re-admitted after 1 January 2014. Patients transferred to other healthcare institutions were screened prior to departure.

Results

Most cases were found in the period from February to April of 2014. Since then, the number of VRE detections has been declining. As of mid-June 2015, the hospital has no outbreak wards and is now planning an exit strategy, as the outbreak apparently draws towards its end.

Conclusions

The hospital management was dedicated to solving the VRE problem from the start. This support made it easier to implement infection control measures. Greater availability and presence of infection control personnel in the wards was needed to assure that measures were implemented.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3836

Role of a clinical scientist in an Infection Prevention and Control Team

Mark Garvey

University Hospitals Birmingham National Health Service (NHS) Foundation Trust, Birmingham, UK

Background

Employment of a clinical scientist within the Infection Prevention and Control Team (IPCT) at a large teaching Trust hospital, due to re-structuring, had the aims of: development of a multi-disciplinary team, introduction of a scientific accruement, provision of a link between the laboratory, nurses and medical staff in addition to developing epidemiology/surveillance processes of healthcare-associated infection (HCAI) pathogens.

Methods

The clinical scientist was primarily employed to aid the Director of Infection Prevention and Control, and provide enhanced surveillance and innovative research for the IPCT.

Results

The clinical scientist has proved a useful member of the IPCT, providing the scientific and evidence basis needed to reduce healthcare infections in this ever-changing healthcare environment. The clinical scientist has provided comprehensive surveillance for HCAIs, enabling a more robust way of identifying clusters and outbreaks; streamlined and provided more enhanced reporting, freeing up time for the infection control doctor to concentrate on microbiology and/or infection control-related clinical issues; creating scientific evidence-based interventions to prevent infections, such as re-invigorating how Safety Thermometer data for CAUTIs is utilised by staff to reduce these infections, by changing practice; taken on and developed the environmental aspect of infection control within the Trust, especially in relation to water microbiology, including Legionella, Pseudomonas and renal water management; has developed clinical surveillance pertaining to Pseudomonas in the water supply of augmented care, identifying water and/or patient transmission and implementing practice changes to reduce this transmission risk; working with Public Health England experts on important water pathogens, for example, helping develop national water guidelines for Pseudomonas in augmented care settings; provided a link between the medical staff and IPCT by participating in ward rounds and providing Infection Control with advice; providing a link between the laboratory and IPCT, through enhanced surveillance of nosocomial pathogens; and developing links with other Trusts, Clinical Commissioning Groups and PHE, to develop a national profile for the IPCT, enabling cutting-edge IPC practice.

Conclusions

To develop science and evidence-based practice to drive IPC improvement at a hospital through research. By creating a multidisciplinary team approach to IPC with alternative ways of working, utilising a clinical scientist skill set in the mix of an IPCT can provide novel approaches to reduce infections in the current era of antimicrobial resistance.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3838

Implementation of an electronic documentation system to improve patient care

Gill Lishman

Newcastle upon Tyne Hospitals National Health Service (NHS) Trust, Newcastle upon Tyne, UK

Background

Infection Prevention and Control Teams (IPCTs) in large organisations are continuously seeking to develop robust documentation pertaining to individual patient care needs. The explosion in technology offers solutions to this dilemma; however, not all health professionals are ready to embrace this change. The plan was to centralise the Infection Prevention and Control Nurse (IPCN) patient documentation onto the Trust’s electronic record system, to enable all relevant clinical personnel access to written individual patient advice in real time.

Methods

A comparison of the existing system and the proposed new electronic documentation systems was undertaken by representatives of the infection prevention and control nursing team. Consultation with the Trust legal department resulted in assurances that the electronic record system would fulfil the Trust’s legal requirements.

This comparative data was verified by electronic record experts and shared with the IPCT, as well as microbiology representatives. A consultation meeting with representation from key stakeholders resulted in this recommendation of prospective transfer of documentation from the IPCN data base to the e-record system, once assurances were given in relation to audit systems available. The IPCN team require assurances that real-time audit data on meticillin-resistant Staphylococcus aureus (MRSA) screening results and eradication therapy for MRSA is available. If these assurances are given, then it is the recommendation of the IPCN Team that we transfer our data entry prospectively to the electronic record system.

Results

Evidence of Improvement:

Robust Trust-wide system;
Information accessible to clinical staff 24 hours a day;
Reduced data entry requirement for IPCN team;
IPC patient data held in central record;
Realistic audit options; and
Real-time alert available for patient status.

Conclusions

The electronic alert is a robust system to ensure that an up-to-date, real-time notification is attached to the patient’s record. This system replaced the paper system. Future directions include expanding the system to merge IPC data with that of ward based clinical data.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3839

Norovirus: Another bank holiday surprise

Karen Hawker, Rachel Ben Salem, Catherine Ganda and Iain Hayden

King’s College Hospital National Health Service (NHS) Foundation Trust, London, UK

Background

This report describes the incidence of Norovirus at the Princess Royal University Hospital (PRUH) and the declaration of an outbreak in April 2015, and the subsequent actions and learning points. The outbreak was compared to a previous incident in the same hospital, in 2010.

Methods

PRUH is a District General Hospital in greater London. It was merged with King’s College Hospital NHS Foundation Trust in 2014. The hospital has particular problems inherent in its layout, which means that outbreaks of Norovirus need concerted action. Between 24 February and 26 April 2015, a total of 78 hospital and 19 community-acquired cases of Norovirus were reported across the hospital, with an outbreak declared following a spike in cases on 2 April 2015. A previous outbreak from 2010 had resulted in complete closure of the hospital, and the lessons learned from that incident were used to inform action, to reduce any impact.

Results

Actions taken included: Staff in closed wards wearing scrubs, visiting restrictions, route changes in the hospital to avoid affected wards, changes to virology testing regimes, staff keeping symptom logs, infection control rounds, collaboration between site management, infection control and enhanced cleaning.

Table 1.

Outbreak comparison.

	2010	2015
Duration (approximate)	5 weeks	5 weeks
Peak n wards closed	14	5
Symptomatic patients, n (approximate)	288	381
Positive tests	32	40
Beds blocked	No data	26
Staff affected	No data	18
Accident and emergency closure	Yes	No

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Conclusions

Being informed by actions from the previous outbreak helped to inform us for effective action to prevent the spread of the infection between wards, although the affected wards suffered more cases than in the earlier incident. The limitation of the spread of Norovirus helped us to prevent closure of the Accident and Emergency Department, and avoided any impact on Outpatient services. Challenges continue with regard to the hospital layout. Further actions with regard to long-term action to reduce the effects of any further outbreaks are in progress.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3852

Pseudomonas aeruginosa in the Critical Care Unit tap water: A systematic approach to eradication

Andrew Chalmers, Rashmi Gupta, Andrew Green, Ian Perry, Steve Scott and Nicola Gilbert

Southport and Ormskirk Hospital NHS Trust Merseyside, UK

Background

Pseudomonas aeruginosa (P. aeruginosa) is an opportunistic organism that has been associated with outbreaks in critical care areas, due to contamination of the water supply. In following the Department of Health Guidelines (2013), Health Technical Memorandum 04-01 Addendum, trusts are required to test water samples from taps in augmented care areas and to take remedial action if samples are positive, so that vulnerable patients are protected.

Methods

Following routine testing of the tap water in the critical care unit, P. aeruginosa was found to be present in 50% of the outlets. Initial remedial actions proved ineffective; hence, a systematic approach was adopted to identify the source of the contamination, which involved a review of: Cleaning practices of sinks and taps, tap design, tap decontamination processes, staff hand hygiene, patient personal hygiene, disposal of patient wash water, the main water supply, water flow and temperatures, immediate pipework leading from the supply to the outlet, P. aeruginosa colonised/infected patients and the efficacy of outlet water filters.

Results

By undertaking a systematic approach of identifying issues and resolving these issues typically one at a time, and then verifying efficacy through repeated water testing, over 9 months the contamination was resolved. The problem was found to be multifaceted; however, the primary source of the problem lied in the length of pipework that connected the tap to the main supply.

Conclusions

When P. aeruginosa was found in the tap water in Critical Care, a possible reaction could have been to make many rapid interventions, which may have proved expensive and which may also have proved futile. By taking a systematic approach, it allowed for more measured actions, which led to identifying the root cause of the problem and to its resolution. It also became evident that through the process of incremental changes, we unwittingly may enhance the opportunity for P. aeruginosa to grow, e.g. increased use of the filters leads to decreased water flow, decreased tap usage leads to increased water stagnation; hence, any change to the water systems or the quantity of water used may need additional actions to prevent further contamination. To safeguard against further contamination, we chose to increase the flushing of outlets to 5 minutes, for both hot and cold water, and to do this twice daily.

Declaration of conflicting interest

No conflicts of interest to declare.

Infection prevention in community settings

Abstract ID: 3638

Who knows what’s lurking in the back of your throat? The management of an outbreak of an infectious Group A Streptococcus (IGAS)

June Ayre, Helen McCoy and Linda Raybould

Birmingham Cross City Clinical Commissioning Group (CCG), Birmingham, UK

Background

In January 2015, an infectious Group A Streptococcus (IGAS) outbreak was declared in a care home in Birmingham, UK, following two cases in May 2014, a further case in November 2014 and a fourth case in January 2015. The care home was closed.

Methods

In February, environmental swabbing identified the same IGAS strain in a chair. Environmental cleaning was enhanced and the care home agreed to replace all carpets with washable flooring.

There were 16 positive throat swabs, nine from staff and seven from residents, from over 250 swabs obtained from staff and residents by the Clinical Commissioning Group (CCG) Infection Prevention (IP) team. A member of the care home staff was admitted to intensive care following a reaction to Chicken Pox that was IGAS positive in a wound. The IP team believed that the severity of her condition had a huge impact on the rest of the care home staff’s willingness and compliance with throat swabbing. It was established that staff in the care home were very young and needed on-going support throughout the outbreak.

Results

An action plan looking at issues around infection prevention and control was agreed upon and education provided. The IP team had a visible high-profile presence within the home throughout the outbreak, offering support and advice. Prophylactic antibiotics were given to over 140 staff and over 40 residents. All staff was re-swabbed, and upon all negative results, the home re-opened in April 2015.

Conclusions

This was a complex and lengthy outbreak, the cost to the home has been immense, both emotionally and financially. There was a huge impact on the overall local health economy, due to the closure of interim beds. A table-top discussion will take place to review the positive and negative aspects encountered, which will include clarification of the CCG IP nurses’ roles.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3687

Pilot project: An approach to Clostridium difficile as a disease in its own right in Primary Care

Lynn Rodrigues and Belinda Sadler

Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) UK

Background

Root cause analysis (RCA) is used to examine the patient pathway for Clostridium difficile (C. difficile) cases, with the intent of identifying lapses in care in the prevention, treatment and management of the disease. National guidance has focussed on performing RCAs in acute Trusts, but the patient journey does not start nor stop in the hospital and needs involvement by the whole health economy.

Methods

Nurses working in commissioning are in a position to lead and support this work, and to help develop relationships with primary care colleagues.

A pilot project has been developed to review all cases of C. difficile identified in primary care practices in a large Clinical Commissioning Group (CCG) in England. A modified version of an existing RCA form was developed for primary care. Data was collected directly from the practices through the completion of the RCA form, with any learning communicated directly back. This feedback encourages general practitioners (GPs) to:

Understand their role to prevent, treat and manage this disease;
Consider C. difficile when prescribing antibiotics; and
Treat C. difficile as a disease in its own right.

Results

The project aimed to reduce the number of C. difficile cases that have associated lapses in care; while also recognising good practice, raising awareness of C. difficile in primary care and keeping the patient experience as a focus. Evidence of improvement is still being collected, but results to date will be presented.

Conclusions

It is envisioned that this pilot will enable a joined-up, whole-health economic approach for dealing with C. difficile. A key future development of this project will be patient involvement by being informed of the investigation and inviting participation. Patient involvement will also encourage clinicians’ commitment to the process.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3721

A “one-stop-shop” for community-based providers, including health and social care and general practitioner practices

Sonya Ashworth

Harrogate and District Foundation Trust Harrogate, UK

Background

As a dynamic National Health Service (NHS) community Infection Prevention and Control (IPC) Team, we aim to improve IPC standards and reduce the incidence of healthcare-associated infections (HCAIs). It is estimated there are over 300,000 HCAIs in England every year. To help reduce this, it is essential that health and social care providers access quality, evidence-based IPC resources, to improve their practice and patient safety.

Methods

IPC information and guidance for community-based providers of health and social care is available on the internet; however, the quality and standard can be poor, incorrect or misleading, compromising patient safety. To address this and help organisations achieve compliance with the Health and Social Care Act of 2008 and Care Quality Commission (CQC), we consulted with care home and general practitioner (GP) staff to develop an innovative IPC website specifically for these target groups.

This easy-to-use website, one of the first independent National Health Service (NHS) IPC websites, provides evidence-based resources developed by a highly experienced NHS IPC team, and includes:

IPC policies and guidance;
Comprehensive resources including the highly acclaimed “Preventing Infection Workbooks” and “CQC Inspection Preparation Pack”;
Posters, leaflets and audit tools; and
Testimonials and case studies.

Results

The website was launched in April 2015, and has received extremely positive feedback, with numerous and repeated orders for resources. We are currently continuing our plan of raising awareness with Clinical Commissioning Groups (CCGs), Local Authorities and Care Organisations nationally.

Conclusions

Some of the comments received:

“Easy to use and navigate”;
“I was impressed by the number of resources available”;
“Helped me to get everything I needed for CQC, including the CQC inspection pack” and
“The Preventing Infection Workbooks are a great resource, without them the staff wouldn’t have completed their training.”

To access the website visit: www.infectionpreventioncontrol.co.uk

Declaration of conflicting interest

Some of the resources on the website that we produced are available to purchase; the cost has been kept to a minimum, to cover the cost of printing.

Abstract ID: 3742

Reduction of chronic wounds: An Infection Prevention Team led city-wide project

Matthew Reid¹, Vanessa Whatley¹ and Jodie Jordan²

¹Royal Wolverhampton National Health Service (NHS) Trust, UK

²Birmingham and Solihull Mental Health Trust, UK

Background

Previous local root cause analyses identified chronic wounds as a significant reservoir of meticillin-resistant Staphylococcus aureus (MRSA) contributing to MRSA bacteraemia. Chronic wounds are also a significant burden on our population and the provision of community health. The local objective set in autumn 2012 was that by the end of March 2014, we would get a 30% reduction in the number of chronic wounds (of > 1 year duration) identified in a baseline audit across the city.

Methods

The local burden of chronic wounds was established, which enabled initial cohorts of patients to be assessed and their management supported by the Chronic Wounds Team (CWT); subsequently, further patients with chronic wounds were referred to the CWT from areas such as: Adult Community Nursing, general practitioner (GP) practice nurses, foot health and nursing homes. We developed and disseminated pathways: Chronic Wound Pathway and Leg Ulcer Care Pathway/care package and Clinical Practices (application of compression bandages).

Results

It is evident from data generated that the work of the Chronic Wounds Project has had a positive impact upon the management of chronic wounds across the city. In total, 44% (102) of the wounds healed (95% CI: 37.4% to 50.0%) and 82% (192) of the wounds were either healed or improving (95% CI: 76.6% to 86.4%). See data table.

There was no formal cost-benefit analysis nor evaluation of the patient experience undertaken, but anecdotal feedback indicated that it was likely that cost savings were made through optimal chronic wound management; and that there are a number of patients who have struggled, sometimes for many years, with chronic wounds causing pain and suffering who were reported healed.

Intrinsic factor		Unique wounds	Healed	Improving	Same	Worsening
Patient cohort	Initial audit patients	83	32 (39%)	35 (42%)	5 (6%)	11 (13%)
	GP practice patients	95	45 (47%)	35 (37%)	8 (8%)	7 (7%)
	Nursing home patients	22	12 (55%)	6 (27%)	3 (14%)	1 (5%)
	Extras	34	13 (38%)	14 (41%)	2 (6%)	5 (15%)
Total		234	102 (44%)	90 (38%)	18 (8%)	24 (10%)

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Conclusions

The use of the pathways and practices developed continues; there is further joint work between the Infection Prevention and Tissue Viability teams to assist in transforming wound care provision across the city.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3747

MRSA infections in the community: A literature review study

Agatha Katsande¹ and Dona Foster²

¹Barnet Enfield and Haringey National Health Service (NHS) Trust, Enfield, UK

²Oxford Brookes University Oxford, UK

Background

A literature review study was carried out, to seek to understand meticillin-resistant Staphylococcus aureus (MRSA) infections in the community.

Methods

A search of online databases (e.g. Medline, Cochrane, HMIC-PubMed, CINAHL and Embase), conference abstracts and references from selected study articles was carried out, to identify the essential studies that need to be included in our literature review study. A total of 15 studies that met the inclusion criteria were included in the literature review study.

Results

Our literature review study revealed that community-acquired MRSA is affecting different age groups (young adults and children) other than the known vulnerable group (i.e. 60+ years). The results revealed that community-acquired MRSA is affecting household members of index patients and colonisation of the environment; and that MRSA-affected healthy people in the community is on the increase. The results highlighted the need to have policies, guidelines and constant structured infection control training in the community.

Conclusions

MRSA infections in the community are of great concern across the world and in the UK. Prevention and control of MRSA infections in the community will require: joint work between healthcare organisations and healthcare stakeholders; financial backup; and a community MRSA strategy that includes policies, screening guidelines, treatment pathways and trained professionals. Community-acquired MRSA is on the increase and its prevalence remains unknown.

Declaration of conflicting interest

Dona is an incoming member of the IPS SPC.

Abstract ID: 3779

Infections, disinfections and misconceptions: Engaging with community staff

Ann McQueen, Carol Balfour, Gill Bowler, Caroline Bowman, Lindy Manson and Fiona Muldoon

National Health Service (NHS) Lothian UK

Background

Infection Prevention and Control (IPC) education is key to minimising and preventing avoidable illness to our vulnerable patients. Healthcare-associated infections (HAIs) are problematic in both acute and community settings; therefore, it is essential that education reaches the appropriate community staff in appropriate settings.

Methods

The IPC Team (IPCT) collaborated with the HAI education lead to develop and deliver HAI education drop-in sessions for community staff. Focus groups were established to identify specific learning requirements for community staff, the most convenient settings and times at which community staff could access. The drop-in sessions were communicated through a variety of networks; for example: district nurse managers, health visitors, Community Health Partnerships, and including general practitioners (GPs) and dentists.

The drop-in sessions were held over 4 days in May 2015, in a variety of community settings. Present at each stand was representation from the IPCT, Education (including NHS Education for Scotland, Wound Management, catheter associated urinary tract infection, and Sharp Safety and Procurement. Community staff were welcomed and signed in to evidence their attendance. They were encouraged to spend as little time or as long as they could afford, depending on workload, and were encouraged to visit all the stands. On leaving, they were encouraged to complete a short evaluation. Throughout the 4 days, over 250 community staff attended the drop-in sessions. Staff groups ranged from district nurses, community paediatric nurses, community psychiatric teams, GP practice teams, and others.

Results

The sessions evaluated extremely well, with staff feeling that they gained a great deal of knowledge and understanding relating to aspects of IPC specific to their settings. Furthermore, they very much enjoyed meeting and engaging with all individuals, teams and departments.

Conclusions

Due to the success of the HAI education drop-in sessions for community staff, further sessions are currently being planned and will be delivered later in the year.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3797

Non-adherence to treatment for patients with MRSA in primary care

Jude Robinson

De Montfort University Leicester, UK

Background

More patients are receiving treatment for meticillin-resistant Staphylococcus aureus (MRSA) in primary care, which requires patient engagement and adherence with treatment. Decolonisation treatment that is used correctly eradicates MRSA, improves health outcomes for patients and reduces the number of patients with MRSA. Nationally, 21% of patients do not complete decolonisation programmes and remain colonised with MRSA. These patients are susceptible to acquiring a MRSA bacteraemia. There is limited research focusing on why patients do not complete treatment, remain colonised or refuse treatment.

Methods

A literature review was conducted to explore non-adherence to treatment for patients with MRSA in the community setting: We searched the Cochrane Library, Medline, CINAHL, EMBASE and British Nursing Index databases. Keyword descriptors included: methicillin-resistant Staphylococcus aureus, methicillin, MRSA, patient compliance, primary medical care, community, patient treatment, decolonisation, treatment refusal, non-adherence, infection control, strategies and prevention.

Results

Failing treatment is a major problem in primary care. Non-adherence with the correct application of decolonisation treatment is a main concern in clinical practice. The proposed interventions that improve adherence with treatment are algorithms for health professionals and patient education. Providing patients with 15 minutes of education on MRSA, along with reminder phone calls, increased the reported adherence by one-third.

Patient toolkits, including education materials, screening, prevention, nurse-led interventions and home aids have been successful at improving communication and health outcomes for patients in a variety of other healthcare disciplines, such as: palliative care, asthma, diabetes and cardiovascular disease.

Conclusions

There is limited research as to why patients are refusing treatment, not completing treatment or remaining colonised with MRSA. There is a need to understand the factors that are preventing these vulnerable patients from becoming free from MRSA. Research into the barriers and facilitators to MRSA treatment will allow appropriate resource and education provision for these patients with MRSA in primary care, thus transforming their health outcomes.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3813

Outbreak investigation: Group A β-haemolytic Streptococcus (GAS) in a Walk-in Centre (WIC)

Janet De’Witt, Melissa Baxter and Marina Morgan

Royal Devon and Exeter National Health Service (NHS) Trust, UK

Background

Four patients reported to have Group A beta-haemolytic Streptococcus (GAS) wound infections following dressing changes in a Walk-in Centre (WIC) during January 2015. We describe our investigation and a pragmatic approach to environmental sampling without “ideal” equipment (contact plates and honey jars).

Methods

Investigation: The general environment was assessed for cleanliness and condition of the décor. Hand hygiene audits, equipment, environmental cleaning records and schedules were reviewed. Aseptic technique was assessed.

Environmental sampling: charcoal swabs, saline-soaked gauze directly into Robertson’s cooked meat (RCM) broth and “staph strep” selective agar impression plates for the curtains. Data was collected from the site of sampling, as well as for the presence of visible contamination.

Laboratory processing:

Charcoal swabs inoculated directly onto selective agar, swab tips enriched in RCM;
Gauze swabs directly into RCM, sub-cultured at 24 hours, 5 and 7 days; and
Impression plates read at 24 hours and 48 hours.

Results

Review of patient documentation: three of four patients had been seen in this clinic, but none on the same day. The clinic environment was found to be clean and in clean, very good decorative order; all equipment and furniture was intact and easily cleanable. A hand hygiene audit in January had a result of 86%. Nursing equipment cleaning schedules for items, the frequency and what with, was all detailed and signed/dated.

Environmental cleaning schedules for areas to be cleaned were listed, but it was not signed/dated when done and there were no details of the products used. Environmental sampling was with GAS in 1 of 53 specimens from a gauze pillow swab.

Conclusions

Infection control advice: There is a need for clear, comprehensive, signed/dated environmental cleaning schedules; the importance of equipment cleaning between patients to be stressed and for terminal cleaning following a known infection. Since this investigation, there have been no further cases. We were able to demonstrate environmental GAS using gauze swabs directly inoculated into RCM, an easy and inexpensive method of environmental sampling.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3816

Focused reduction effort within a CCG with a high rate of Clostridium difficile infections

Alison Young

The IPCT is working to implement surveillance systems in all areas, in order to provide equity in surveillance in the community and for inpatients receiving care from Trust services, and to ensure timely shared learning.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3850

Identifying and improving infection control practices and standards within care homes

Natalie Foley¹, Mandy Catchpole¹ and Rachel Loveday²

¹Infection Control Consultancy UK,

²West Sussex County Council UK

Background

Since the Care Quality Commission (CQC) inspections were introduced within care homes, reports have identified differing levels of standards with infection control (IC). The County Council wanted to review the IC practices, to enable a targeted approach in trying to standardise and support care homes in achieving best practice levels of IC.

Methods

A programme was developed to audit 36 care homes across the county. The homes identified were based on poor compliance with recent CQC reports, recent outbreaks or by self-nomination. An electronic audit tool was designed to cover over 23 elements, such as the resident’s room and dirty utility. Each standard that was audited was weighted, to provide a percentage score for the 23 elements. This audit was undertaken by a trained IC nurse (ICN), in conjunction with a representative from the home, which allowed for the staff to be trained on the audit process and the areas that required improvement were witnessed at the time of the audit, which allowed for ownership of the problem.

Common low-scoring areas (below 80%) were identified from the audits.

Area audited	General keep table management	Staff health	Lounge	Dining room	Bed-room	Dirty utility	Sharp
Average score %	66%	25%	69%	75%	75%	78%	78%

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Results

Following the audit, immediate feedback was given. An audit report and action plan with recommendations on all areas that did not meet the expected standard was distributed to the Council and the care home. Additional IC training is being provided to all contract managers within the Council. In addition, they are able to use action plans to assist in the monitoring of the care homes that have had audits undertaken.

Conclusions

The development of a local IC champions’ programme followed an initial training day. These programmes will provide a supportive and educational network for all IC champions: the IC Consultancy and Public Health of West Sussex County Council.

Declaration of conflicting interest

No conflicts of interest to declare.

Infection Prevention in Dentistry

Abstract ID: 3639

Improvements in infection control practices in Japanese dental facilities after infection control seminar participation

Chie Shibuya¹, Masako Uchiyama², Hiroko Inda³, Mayumi Aminaka⁴, Hitomi Kurosu⁵, Kazuyo Ono⁶ and Keiko Okamori⁷

¹Japanese Nursing Association, Japan

²Niigata University Medical and Dental Hospital, Japan

³Doctoral Program in Nursing, Chiba University, Japan

⁴National College of Nursing, Japan

⁵Tokyo Metropolitan Health and Medical Treatment Corporation, Ebara Hospital, Tokyo, Japan

⁶Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan

⁷Holonics Group Headquarters

Background

In June 2014, the Japanese Ministry of Health, Labour and Welfare (MHLW) issued a notice emphasizing the need to raise awareness of infection control (IC) in dentistry, citing inadequate sterilisation of dental handpieces in dental facilities. Improvements in dental infection control are needed in Japan. In 2012, we published a guidebook titled, “Preventing health-care-associated infection in dental health-care settings”; and based on this, we conducted IC seminars for dental health care personnel at various locations. We report the results of our questionnaire on IC practices that the seminar participants implemented after returning to their facilities and evaluate the effectiveness of the seminar.

Methods

Between 20 October and 30 November 2014, we mailed self-report questionnaires to 181 dental facilities to which the dental health care personnel who participated in our 2012–2014 infection control seminar were affiliated.

Results

The response rate from dental facilities was 40.9.1% (74/181). The types of facilities included: 69 (93.2%) dental clinics, three (4.1%) hospitals and two (2.7%) other institutions. Occupational categories were: 39 (52.7%) dentists, 24 (32.4%) dental hygienists, 10 (13.5%) dental assistants and one (1.4%) other. A total of 65 (87.8%) facilities felt the need for some kind of IC improvements after participating in the seminar: 46 (62.2%) actually improved their equipment reprocessing procedures. Of the facilities, 19 (25.7%) began changing the handpieces between patients, and nine (12.2%) now use sterilization bags, instead of leaving them unpackaged.

Conclusions

In Japan, where medical care is largely financed by public health insurance, the current challenge is the cost of IC. In addition to our IC seminars, the notice issued by the MHLW helped improve handpiece reprocessing; however, the future challenge is to reinforce supervision in private dental clinics, where opportunities for qualified third-party inspection are limited, to maintain these improvements.

Declaration of conflicting interest

No conflicts of interest to declare.

Abstract ID: 3857

An adaptation of ISO16594 was used to quantitatively and qualitatively evaluate biofilm removal and biofilm prevention capabilities of a dental water line cleanser

Samantha Westgate

Perfectus Biomed Cheshire, UK

Background

Dental waterlines have been linked to potentially fatal Pseudomonas aeruginosa (P. aeruginosa) infections. Until recently, there were no recognised methods for determining the efficacy of antimicrobial treatments that accurately reflected the way these water lines are used.

EN16594 (draft standard at the time of commencement) was followed to assess the efficacy of an anti-biofilm treatment for cleansing dental water lines. The standard applies semi-quantitative (scanning electron microscopy (SEM)) and quantitative (total viable counts (TVCs)) methods to determine biofilm removal and prevention against single-species P. aeruginosa (ATCC 700888) in vitro biofilms. Additionally, this study included biofilm recovery and quantification steps.

Methods

The system represented a typical dental chair using appropriate tubing material, diameter, lengths and inoculum flow rates. P. aeruginosa biofilms were grown at room temperature for 4 weeks, establishing confluent growth. Concurrently, the lines were treated to investigate biofilm prevention. The TVCs and SEM were carried out weekly. SEM images were further used to assess bacterial coverage. In addition, planktonic isolates were removed by rinsing the water lines prior to quantifying biofilm recovery. Data was analysed using a two-tailed t-test.

Results

Over the 12-week test period, untreated lines showed confluent growth via SEM and a stable TVC of approximately 105 colony-forming units (cfu) per ml. In 10 tests, no viable organisms were recovered from the treated or prevention lines. No biofilm material was recovered from the prevention lines, SEM showed no organisms until after Week 3, when isolated micro-organisms and semi-confluent coverage was observed. SEM data showed semi-confluence in the treated lines, with biofilm material not recovered in 10 tests.

Conclusions

This study demonstrated that treatment with the test agent significantly reduced the P. aeruginosa bacterial load within the water line. The additional steps aided the interpretation of the data, as although SEM images demonstrated some evidence of bacteria within the lines post-treatment, these bacteria were either below the recoverable level or were non-viable.

Declaration of conflicting interest

This study was performed with an educational grant from Schulke and Mayr, UK Ltd; Aura Infection Control (Dental) T/A Quality Water Specialists; and Alpron Medical GmbH.

Infection Prevention in Perioperative Practice

Abstract ID: 3748

High surgical site infections in patients with fracture of the neck of the femur and hypothermia

Sajjad Mushtaq, Zahir Mughal, Rajesh Sofat, Tamer Sherief, Jonathan Kitson, Nicholas DeRoeck and Adam Rumian

Optimal peri-operative practice is key to achieving reductions in SSI rates. In spite of the marked reduction in overall rates, the knee replacement SSI rate is still higher than EU average; thus, future interventions will focus on this surgery.

Declaration of conflicting interest

No conflicts of interest to declare.

PERMALINK

Abstracts published at Infection Prevention 2015, Liverpool

Oral Presentations

Abstract ID: 3730

Background

Methods

Results

Conclusions

Declaration of conflicting interest

Abstract ID: 3732

Background

Methods

Results

Conclusions

Declaration of conflicting interest

Abstract ID: 3773

Background

Methods

Results

Conclusions

Declaration of conflicting interest

Abstract ID: 3782

Background

Methods

Results

Conclusions

Declaration of conflicting interest

Abstract ID: 3787

Background

Methods

Results

Conclusions

Declaration of conflicting interest

Abstract ID: 3832

Background

Methods

Results

Conclusions

Declaration of conflicting interest

Abstract ID: 3840

Background

Methods

Results

Conclusions

Declaration of conflicting interest

Abstract ID: 3849

Background

Methods

Results

Conclusions

Declaration of conflicting interest

Abstract ID: 3851

Background

Methods

Results

Conclusions

Declaration of conflicting interest

Abstract ID: 3860

Background

Methods

Results

Conclusions

Declaration of conflicting interest

Abstract ID: 3865

Background

Methods

Results

Conclusion

Declaration of conflicting interest

Abstract ID: 3866

Background

Methods

Results

Conclusions

Declaration of conflicting interest

Poster presentations

Antimicrobial prescribing and stewardship

Abstract ID: 3694

Background

Methods