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. 2018 Sep 25;19(1 Suppl):S4–S63. doi: 10.1177/1757177418794054

IPS supplement abstracts

PMCID: PMC6399768
J Infect Prev. 19(1 Suppl):S4–S63.

52

Development of resources for the management of urinary tract infections (UTIs) in older adults – qualitative findings specific to decision making and current practice in primary care

Leah Jones 1, Emily Cooper 1, Amelia Joseph 2, Rosie Allison 1, Natalie Gold 1, Cliodna McNulty 1

Abstract

Introduction

To help decrease E. coli bacteraemia and improve antimicrobial use in older adults, we undertook a needs assessment specific to resources around the diagnosis and prevention of urinary tract infections (UTI) using qualitative methods.

Methods

Focus groups and interviews were held with over 118 general practitioner (GP), nursing and residential home staff, and members of the public. Questions explored diagnosis, management, prevention of UTIs and antibiotic use in older adults, focusing on those in care. A UTI leaflet and diagnostic guide were modified iteratively. Discussions were transcribed and analysed using NVivo.

Results

Many GP staff relied on urine dip sticks to diagnose a UTI in older adults, though some knew this was unhelpful. The high prevalence of asymptomatic bacteriuria was understood by GP staff, but not untrained care home staffs who were fearful of having no diagnostic test. GP staff were also greatly influenced by the consistent use of dipsticks in care homes. Carers of older adults reported they had an important role in identifying UTIs in older adults by flagging symptoms such as confusion or changes in behaviour to nurses or GP staff. Many would conduct a urine dipstick before contacting the GP. All staff welcomed the development of diagnostic guidance for UTIs and complementary information in parallel to information leaflets that could be shared with patients and carers, promoting consistent messages across the care pathway. Hydration and prevention were highlighted as key areas within the resources, and participants thought a colourful leaflet with large print could improve patient care.

Discussion

Resources should highlight the appropriateness of using urine dipsticks in the diagnosis of UTI in older adults with non-specific symptoms, including clear explanations of asymptomatic bacteriuria and possible alternative causes of confusion. Resources on UTI prevention, pyelonephritis and sepsis would be valued by care staff in particular.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

97

Effectiveness of a nurse and pharmacist-led antimicrobial stewardship ward round

Della Barker 1, Kathryn M Ashton 1, Stuart E Bond 1

Abstract

Introduction

Department of Health Start Smart then Focus recommends that successful antimicrobial stewardship (AMS) programmes include a ward-focused antimicrobial team. Nurses are underutilised in AMS, and nurse/pharmacist-led initiatives have not been well described in the literature. A shortage of consultant microbiologists has required the AMS team to consider a creative multi-disciplinary approach to post-prescription review and individual feedback at ward level.

Methods

An antimicrobial pharmacist and a senior infection control nurse, both non-medical prescribers, attended the acute admissions unit (AAU) for 2 hours each week from July to September 2017. Patients with infections were identified using the paper medical handover; those on antibiotics were deemed eligible for review. Interventions were documented in the medical notes and fed back to the prescriber or lead consultant. Interventions were defined as dose optimisation, escalation, intravenous to oral switch (IVOS), de-escalation, cessation, therapeutic drug monitoring and referral to microbiology.

Results

On AAU 69 patients prescriptions were reviewed during eight ward rounds; 61/67 known prescriptions accorded with local guidelines, where prescribing was outside of guidance interventions were initiated. The intervention rate was 30% (21/69). The most common interventions were antibiotic dose optimisation (6/21) and escalation of treatment (6/21). Of note there were only 2/21 interventions of IVOS, 3/21 de-escalations and 3/21 cessations. Microbiologist referral occurred on one occasion.

Discussion

This project has demonstrated the value of a nurse/pharmacist collaboration for improving antimicrobial prescribing. The low intervention rate for IVOS was deemed to be due to the timing of intervention in relation to patient admission and has led to a change of focus to areas where duration of stay is typically longer. Future vision is to ensure sustainability in the context of long-term doctor shortages and continue to evidence the value of non-medical prescribers in AMS.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

91

IPS EPDC Guidance at a Glance & IPS competences roadshows

Lilian Chiwera 1, Andrea Denton 2, Carole Fry 3, Kerry Holden 4, Vickie Longstaff 5, Jude Robinson 6, Julie Spendlove

Abstract

Introduction

The Infection Prevention Society (IPS) encourages members to be active to fully enjoy member benefits. The IPS Yorkshire branch members developed an idea of “Guidance at a Glance” to help often busy and stressed clinical health and social care staff who may not always be able to access full infection prevention and control policies, especially areas such as care homes and community settings. The Education & Professional Development Committee (EPDC) (one of the standing committees of the IPS) are promoting this idea along with the recently revamped IPS competences through a series of roadshows.

Methods

From early 2018, the EPDC and IPS branch education officers (EOs) have collaborated in a series of roadshows to promote Guidance at a Glance and IPS competences. Roadshows have involved oral and poster presentations on respective educational materials at various IPS branch meetings and regional branch conferences. The EOs will aim to produce up to six Guidance at a Glance per year on different aspects of infection prevention and control, which will be endorsed by the EPDC before wider dissemination. IPS members are encouraged to suggest topics of interest.

Discussion

A Guidance at a Glance on standard infection control precautions is currently on the IPS website and has been translated into different languages for our international IPS colleagues. Presentations have taken place to promote Guidance at a Glance at three branch conferences and are set to continue across the rest of the UK and Ireland. Current feedback has been very positive, with staff keen to adopt Guidance at a Glance and Competences, generating a lot of interest on social media.

Future steps

The EPDC and EOs continue to promote the Guidance at a Glance and Competences and other IPS resources widely and collaborate with IPS branches to further this IPS vision.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

42

Ensuring robust local surveillance in the absence of an automated system

Linda Thomas 1, Nicola Miller 1; IPCT Lanarkshire1

Abstract

Introduction

NHS Lanarkshire does not have access to an automated local surveillance system. As local surveillance in infection prevention and control is single most important means of detecting outbreaks (when they are present), we sought to devise a system to both optimise patient care and detect statistical control in the numbers of key alert organisms (MRSA, CDI, SAB and total alert organisms).

Methods

The iterative development of a safe system resulted from the IPCT:

  • - Identifying a list of alert organisms which would be referred from the microbiology laboratory

  • - Being informed of all new patients with alert organisms

  • - Visiting and checking the care of all new patients with an alert organisms

  • - Identifying and recording where acquisition of the alert organism most likely took place

  • - Producing statistical process control charts (SPCs) monthly to look for both positive and negative out-of-control episodes

  • - Undertaking education sessions on producing and reading SPCs.

Results

  • - A total of 18 SPCs for alert organisms are read each month

  • - Since introduction the IPCT is able to detect promptly outbreaks when present, and identify situations where they need to act to help prevent them

  • - The IPCT is now better able to detect and discuss the burden of alert organisms on the organisation and identify.

Discussion

The inability to access an electronic surveillance system has resulted in the development of a specific robust bespoke system which uses SPC charts to detect both negative out-of-control episodes (outbreaks) and positive ones indicating system improvements. NHSL is able to detect outbreaks when they are present and early warnings thereof. Although there were initial costs in seeking the expertise in the use of SPCs, the recurring annual cost in the region of £250k was avoided.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

143

Evaluating the impact of an extensive CPE screening programme in reducing CPE clinical infections

Jonathan Otter 1, Siddharth Mookerjee 2, Frances Davies 2, Tracey Galletly 2, Eimear Brannigan 2, Alison Holmes 2

Abstract

Introduction

Carbapenemase-producing Enterobacteriaceae (CPE) are an emerging cause of challenging clinical infection. CPE screening is recommended by international guidelines. We evaluate the impact of an extensive screening programme in reducing CPE clinical infections in London.

Methods

All 979 CPE isolates identified between April 2014 and March 2018 were included; this excluded repeated isolates with the same organism/carbapenemase from the same patient. In June 2015, a new CPE policy was launched, which included widespread admission screening combined with extensive contact tracing. We report the rate of CPE detected in clinical cultures prior to (April 2014–June 2015) and after the launch of the new policy (July 2015–March 2018), and changes in the rate of CPE detected by screening cultures.

Results

The rate of CPE in clinical cultures reduced from 0.25 to 0.11 per 1000 admissions (odds ratio 0.45, 95% confidence interval 0.32–0.64, p<0.0001). The number of CPE screens increased progressively as the screening programme rolled out, from 4530 in July 2015 to 10,589 in March 2018. Whilst the number and rate of CPE detected by the screening programme increased (from 18 in July 2015 (1.0 per 1000 admissions) to 50 in March 2018 (2.7 per 1000 admissions)), the proportion of screening cultures growing CPE remained <0.5% throughout; this suggests that the rate of CPE in the patient population did not change but that ascertainment of CPE carriage improved.

Discussion

Our findings suggest a previously undetected reservoir of CPE colonisation in our patient population. There was a significant reduction in CPE clinical infection associated with the new CPE policy, which included extensive screening for CPE. The new policy also included enhanced disinfection, therapeutic changes, laboratory methodology changes, and staff and patient education, which may also have contributed to the reduction in CPE clinical infection.

Footnotes

Declaration of interest: JAO is a consultant to GAMA Healthcare and Pfizer.

J Infect Prev. 19(1 Suppl):S4–S63.

64

Infection prevention control and organisational patient safety culture within the context of isolation

Julian Hunt 1, Sue Rees 2

Abstract

Introduction

Healthcare-associated infection (HCAI) is a major cause of morbidity and mortality. HCAI remains a costly burden to health services, a source of concern to patients and the public, and at present is receiving priority from policy makers as it contributes to the global threat of antimicrobial resistance. This presentation introduces a new study that explores the ways in which adherence to IPC strategies and principles informs and shapes organisational patient safety culture and vice versa.

Methods

The study involves qualitative case studies within isolation settings at two district general hospitals within one health board in Wales, UK. The study incorporates Manchester Patient Safety Framework (MaPSaF) workshops, interviews with health workers, other hospital staff, patients and their relative/carer, and periods of hospital ward observation.

Results

This presentation offers analysis drawn from the MaPSaF workshops. MaPSaF is designed specifically for use in the NHS and provides a view of safety culture on 10 dimensions at five progressive levels of safety maturity. The utilisation of MaPSaF in this study has enabled the generation of a profile of maturity of patient safety culture within each hospital setting in terms of areas of relative strength and challenge.

Discussion

Understanding the ways in which IPC is presented, implemented and engaged with by health workers, and what that means for organisational patient safety culture, is essential to driving improvements in healthcare and clinical practice. This study offers an understanding of the meaning of IPC “ownership” for health workers; of the ways in which IPC is promoted, of how IPC teams operate as new challenges arise, how their effectiveness is assessed and of the positioning of IPC within the broader context of organisational patient safety culture, within hospital isolation settings.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

155

Respiratory virus PCR testing in febrile neutropaenia – addressing an underappreciated cause of fever in neutropenic patients

Jordan Ashwood 1, Akash Maniam 1, Rishi Banerjee 1

Abstract

Introduction

Our study sought to address two important aspects of care in patients admitted with febrile neutropaenia: first, whether routine testing via PCR for respiratory viruses on admission would enhance patient care and promote antibiotic stewardship; second, if this process could be facilitated via the implementation of an easy-to-use careset for admitting teams to use.

Methods

We standardised the assessment of febrile neutropaenia on admission at a district general hospital in North London. To provide this, we created a one-stop careset on Powerchart for investigation of febrile neutropaenia that included respiratory virus PCR, in addition to other standard investigations. This ensured its use by doctors on the acute medical take on admission. Data were collected for 6 months (September 2017–February 2018) that examined the admissions of all patients admitted with fever >38 degrees and confirmed neutrophils of <1.0. All patients who subsequently did not undergo viral PCR testing were excluded, leaving 18 patients. We then analysed the impact of positive virology on clinical management.

Results

Ten patients (55.6% of total) tested positively for the viruses shown in Table 1, with two of those positive for multiple viruses. These results influenced six of these cases, with all four influenza patients immediately being given oseltamivir and two others being discharged early.

Table 1.

Viruses identified by respiratory virus PCR in our patient cohort

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Discussion

This study demonstrates the heavy burden of viral illness in febrile neutropaenia, hitherto underestimated. Identifying such patients on admission empowers clinical decision-making in three key ways. First, it reduces the use of broad-spectrum intravenous antibiotics (such as Tazocin). Second, it facilitates appropriate use of anti-viral therapy. Finally, it reduces admission length and the burden on our healthcare services. This study demonstrates how the innovative use of focused microbiology investigations can promote effective antibiotic stewardship and provide clear and measurable improvements for our management of febrile neutropaenia.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

173

Using patient stories from carbapenemase-producing Enterobacteriaceae (CPE) patients in a quality improvement project to understand and improve the patient experience

Barbara Slevin 1, Patricia Treacy 1, Nuala O’Connell 1, Colum Dunne 2

Abstract

Background

Our hospital has detected the highest rates of carbapenemase-producing Enterobacteriaceae (CPE) in Ireland since 2009. There has been an ongoing outbreak at University Hospital Limerick (UHL) since 2011. These resistant microbes are associated with significant morbidity and mortality. Patient stories are well described in the literature and are being used to organise services around the needs and preferences of patients rather than just service needs.

Aim

A quality improvement (QI) project was undertaken to improve the experience of the patient at UHL by using CPE patient stories.

Methods

Surveys were conducted on CPE patients and their families to help understand what works and what needs to improve from the CPE patient perspective. Patients or their families were met individually to gather patient stories through a series of open-ended questions including ascertainment of the CPE patient’s experience on a newly opened infection control cohort ward.

Results

Patients and their families talked about what they felt, saw, heard, the emotions that were evoked and how this affected their hospital experience. Eight stories provided varying insights from patients (including healthcare workers who were CPE patients) and family members. Terms such as “Leper, Pariah, and Plague” were strong commonalities identified. Family members expressed their fear of the seriousness of the CPE diagnosis, fear of touching the patient at home and lack of understanding of information provided. Experiences for patients improved following the implementation of the cohort ward which enhanced CPE management standards.

Conclusion

Good communication with CPE patients is paramount. Following completion of the QI project, CPE patients are being met on an ongoing basis to ascertain their hospital experience. The value of their stories cannot be underestimated as they assist staff in improving the experience for all patients through education and reflection

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

113

Are we there yet? Setting out on a nationwide journey of improvement

The 1000 Lives Improvement (NHS Wales) Healthcare Associated Infection (HCAI) and Antimicrobial Resistance (AMR) Collaborative1, Helen Ronchetti 1

Abstract

Introduction

The prevention of infection is a well-recognised patient safety issue; however, it is also a key factor in the increasingly urgent drive to reduce antimicrobial resistance (AMR). Significant improvements have been achieved in reducing the incidence of healthcare-associated infection (HCAI) in Wales; however, reductions have reached a plateau in recent years. Additionally, there is a need to extend efforts to prevent HCAI in the community, as well as continuing the work within hospitals.

Methods

October 2017 saw the launch of a National (All Wales) Collaborative ambitiously aiming to reduce HCAI and AMR throughout Wales. The broad aims of the Collaborative are to support healthcare providers to:

  • Reduce HCAI including Clostridium difficile, Escherichia coli and Staphylococcus aureus bloodstream infections and surgical site infections (Colorectal, Orthopaedic and C-Section)

  • Improve antimicrobial stewardship

The methodology is based on the Institute of Healthcare Improvement’s “Breakthrough Series Collaborative” (2003), whereby over the course of the Collaborative (2 years) 1000 Lives Improvement is facilitating a number of learning sessions and supporting quality improvement work in the intervening “action periods”.

Results

Two “learning sessions” have been held so far and 167 NHS staff have attended one or more of the events – a broad mix of multi-disciplinary clinical teams along with quality improvement and executive leadership support from their organisations, and leaders from National Bodies such as Public Health Wales and Welsh Government. A total of 76 quality improvement initiatives were outlined by health boards and Trusts as part of their Collaborative work (see Table).

Discussion

It is clear is that collectively there is an enormous amount of experience and expertise around HCAI/AMR Quality Improvement in Wales; the Collaborative is focussing on connecting people so that knowledge and experiences can be shared, in doing so facilitating the dissemination of evidence-based practice more consistently throughout Wales.

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Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

125

Implementing a system-wide improvement programme to support the ambition to reduce healthcare-associated Gram-negative bloodstream infections in England

David Charlesworth 1, Linda Dempster 1, Gaynor Evans 1, Gavin Eyres 1, Helen Wilkinson 1, Ranvir Virk 1

Abstract

Introduction

Gram-negative bloodstream infections (GNBSI) contribute significantly to mortality in the United Kingdom NHS. In response to the O’Neill independent review of antimicrobial resistance (AMR) in May 2016, the Secretary of State for Health launched an ambition to reduce healthcare-associated GNBSIs and inappropriate antimicrobial prescribing by 50%. Previous successful strategies to address national infection concerns such as Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA) focussed primarily on the management of hospitalised patients. A significant majority of GNBSIs occur before people are admitted to hospital, thus reduction requires a whole health economy approach.

Methods

A national 12-point multi-modal programme was co-designed with other NHS arms-length bodies and after consultation with over 1000 healthcare professionals nationally. This included developing a single point of online access for GNBSI resources to support education and training, enrolling cohorts of Trust-led health systems on improvement collaboratives, and a development programme for new or aspiring directors of infection prevention and control (DIPC). The programme also focused on developing commissioning and provider organisational incentives, undertaking clinical and board assurance, and work to understand how infection prevention and AMR would contribute to developing Sustainability and Transformation Partnerships and Integrated Care Systems.

Discussion

This presentation will describe the progress of the programme to date, including the initial experiences of those individuals and Trusts involved in the programme. The programme is developing closer alignment with existing sepsis and antimicrobial prescribing and stewardship work, addressing infection prevention and control across the health and social care economy, with a specific focus on reducing the impact of GNBSI. At the time of presentation, a review of board understanding and assurance has been undertaken and the findings shared. Sixty local health systems will be part of a UTI collaborative and another 60 current or aspiring DIPC will be undertaking leadership development.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

126

Use of a model hospital sink system to investigate proliferation, aerosolisation and dispersal of carbapenemase-producing Enterobacteriaceae from hospital waste traps

Paz Aranega Bou 1, Susan Paton 1, Ginny Moore 1, Allan Bennett 1

Abstract

Introduction

Carbapenemase-producing Enterobacteriaceae (CPE) are increasingly important causes of healthcare-associated infection. Reservoirs include hospital sinks, waste traps and drains. A unique laboratory model incorporating stainless steel utility sinks (SSUS) and clinical hand-wash basins (CHWB) has been built to simulate a clinical setting.

Methods

Eight hospital waste traps contaminated with CPE-containing biofilms and four uncontaminated (non-hospital) traps were installed. Taps were automatically operated for 30 seconds four times a day and dosed with nutrients daily. No cleaning or disinfection was applied. Changes in microbial communities were determined using selective media and MALDI-TOF MS. The potential for aerosols and droplets to be released was assessed using cyclone air samplers and settle plates.

Results

Upon installation of the waste traps, regular addition of nutrients was required to maintain Enterobacteriaceae levels in the waste trap water. Population changes over time were observed including bacterial exchange between sinks connected via a common waste pipe. Aerobiological sampling highlighted dispersal risks for both SSUS and CHWB. Dispersal was greater from sinks fitted with hospital traps contaminated with CPE-containing biofilms than from sinks fitted with traps that had been artificially seeded. The accumulation of water in the sink basin due to bad drainage led to a significant increase in CPE recovery from cyclone samples and settle plates. Under these conditions, Enterobacteriaceae-containing splashes were detected up to 64 cm from the CHWB and 72 cm from the SSUS. Contamination of either sink basin also resulted in CPE release up to 54 cm from CHWB and 1m from SSUS.

Discussion

Our results suggest that CPE present in hospital sinks and waste traps can re-enter the clinical environment. The presence of biofilm, resulting from inappropriate waste disposal and/or ineffective disinfection, can increase the risk of dispersal. Likewise, bad drainage leading to accumulation of water in the basin is a major risk factor.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

167

Designing an optimal infection prevention service

Emma Burnett 2, Jude Robinson 1, Evonne Curran, Heather Loveday 3, Brett Mitchell, Catherine Daiziel, Helen Ugbome, Karen Wares, Neil Wigglesworth 4, Paul Cryer, Chris Settle, Fiona Smith, Tracey Cooper, Lilian Chiwera 4, Lesley Price

Abstract

Introduction

Infection prevention and control (IPC) in the UK has substantial variability in team structures and IPC service delivery models. Eight core components for IPC highlight the need for a national IPC programme. Research into service delivery models in the UK is limited.

Methods

The aim is to define an optimal infection prevention service in different contexts and settings within the UK and Ireland to inform a national infection prevention service. This four-phase, mixed-methods study has completed phase 1; a survey questionnaire for lead IPC professionals to explore current components of IPC services and how they are organised.

Results and discussion

In total, 70 surveys were completed from 400 clinicians invited (response rate 17.5%). Respondents were employed by a wide range of organisations. IPC service covered a median 580 acute beds and 162 community beds. IPC service staff were predominantly nurses (n=375; 69.8%), although 15 different roles were identified. Respondents (n=68) reported a median 18 components of their IPC service (min–max=6–21). Report writing was the most frequently endorsed component (100%), followed by education and teaching (95.7%) and IPC advice provided directly to health professionals (94.3%). Research and public engagement were endorsed by only 40% and 54.3%, respectively. Perceived enablers to IPC service success include teamwork, leadership, resource availability, engagement from relevant parties, effective communication/relationships, team knowledge and skill mix, commitment, shared vision, time availability, team visibility, and effective use of data. Key barriers identified include poor staffing, staff shortages, time pressures, lack of time/capacity, financial pressures and lack of resources, lack of engagement, competing/conflicting interests, lack of leadership, lack of support and staff not being valued, poor communication, lack of education, lack of investment in service, lack of IT support. This has provided key insights into IPC service components and how they are organised, which was previously unknown.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

15

Phenotypic and genotypic profile of carbapenem-resistant Pseudomonas species and their correlation with clinical outcomes in hospitalised patients at a level 1 trauma centre in India

Niladri Banerjee 1, Vijeta Bajpai 1, Purva Mathur 1, Sushma Sagar 1, Amit Gupta 1, Subodh Kumar 1, Biplab Mishra 1, Kapil Dev Soni 1

Abstract

Introduction

Nosocomial infections caused by carbapenem-resistant (CR) Pseudomonas species are becoming major clinical and public health concern. The aim of our study was to characterise the phenotypic and molecular pattern of carbapenemase production in Pseudomonas spp. in hospitalised patients and their correlation with clinical outcomes.

Methods

A total of 115 consecutive, non-duplicate strains of Pseudomonas spp. isolated from various clinical samples over a period of 2 years were included. All strains were identified by using automated culture system VITEK 2 (Biomerieux, France) and subjected to Clinical and Laboratory Standards Institute (CLSI) recommended screening tests for detection of carbapenemase production, followed by polymerase chain reaction (PCR)-based detection of carbapenemase-encoding genes. The patients were followed up on a day-to-day basis until their final discharge.

Results

Among 115 clinical isolates, 109 (94.7%) isolates were identified as Pseudomonas aeruginosa and another six (5.3%) strains. Most of the strains were recovered from pus (27.0%), followed by broncho-alveolar-lavage (20.9%), tracheal-secretion (19.1%), urine (19%) and blood (12.2%). Overall resistance to carbapenems was detected in 78 (65–72%) isolates. Strains were also resistant to multiple antibiotics such as ticarcillin-clavulanic acid (89.0%), piperacillin-tazobactam (28%), ceftazidime (CAZ) (63%), cefepime (66%) and aztreonam (69%). Prevalence of carbapenemase-encoding gene were found in 70 (60.9%) isolates; the most common gene detected was blaNDM-1 39 (55.7%), followed by bla OXA-1 23 (32.8%), bla VIM 19 (29%), bla KPC 14 (20%) and bla IMP 3 (4%). The majority of patients with carbapenem-resistant organisms had a prolonged stay in the hospital.

Discussion

Our findings suggest that a high rate of CR is seen in Pseudomonas species. Prompt detection of carbapenemases by molecular methods is important for infection control, tracing of resistance determinants and better clinical outcomes.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

45

Choosing the path of least resistance? Exploring nurse prescribers’ antibiotic prescribing behaviour

Valerie Ness 1, Lesley Price 1, Kay Currie 1, Jacqui Reilly 1,2

Abstract

Introduction

Inappropriate prescribing is a contributing factor to antimicrobial resistance. Nurses across the world, through additional training or through specific guidance/governance, can independently prescribe and yet little is known about their antibiotic prescribing behaviour. This study aimed to explore the appropriateness of nurses’ antimicrobial prescribing behaviour and the influences on this behaviour.

Methods

This was a three-stage, mixed-methods study, using a behavioural model – the Reasoned Action Approach (RAA). Stage one was an analysis of prescribing data which was carried out to describe current nurse antimicrobial prescribing practice. Stage two involved telephone interviews with 27 nurse prescribers, and stage three was the development of an online questionnaire using the findings from stage two. This national survey was completed by 184 nurse prescribers. Descriptive and inferential statistical analysis, including correlation and regression analysis, was carried out to establish the key determinants of respondents’ behaviour.

Results

Results from both the prescribing data and the survey found that nurse prescribers adhere to antimicrobial prescribing guidelines. Key significant influences facilitating this behaviour were: social influence from other non-medical prescribers (NMP) (β=0.042; p=0.007) and other nurse prescribers (β=0.036; p=0.045); and experience and confidence (facilitator) (β=0.044; p=0.001), whilst pressure from patients/carers to prescribe an antibiotic was a barrier (β=0.026; p=0.031).

Discussion

Nurse prescribing of antibiotics is increasing, and these results suggest this cohort prescribe appropriately. To promote this behaviour in other nurse prescribers, interventions should focus on reducing the influence of patient pressure, using the positive influence of other NMPs, or by changing nurse prescribers’ beliefs about their capability to manage these patients.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

46

Antimicrobial resistance pattern of Escherichia coli isolated from samples at Holy Family Hospital, Rawalpindi, Pakistan

Muhammad Sheharyar Khan 1, Abdullah Nasir 1, Daniyal Munawar 1, Sophia Khan 1

Abstract

Introduction

Escherichia coli is the most common cause of urinary tract infections. It also causes diarrhoea, pneumonia, meningitis and sepsis. There is increasing antibiotic resistance in E. coli worldwide. Antibiotic resistance has become a major health problem in recent years, and has increased morbidity and mortality as well as the cost of health care. In Pakistan, the situation is particularly dire because of the indiscriminate prescription of antibiotics by general practitioners. The antimicrobial resistance pattern is constantly changing, and so it is important to conduct studies to determine it.

Methods

A descriptive cross-sectional study was carried out at the Pathology department, Holy Family Hospital, Rawalpindi. Various samples were collected and analysed in the laboratory to determine the presence of E. coli by use of microbiological and biochemical tests. Antibiotic resistance was determined using the disc diffusion method. Previous records were also included in the study. The data were entered and analysed using SPSS version 23. The resistance patterns in male and female patients were compared using Pearson’s chi-square test.

Results

Using the results of 363 samples, high resistance was found to cefepime (81.2%), ceftriaxone (86.6%), cefixime (90.1%), ciprofloxacin (75.6%) and Augmentin (90.2%). On the other hand, there was less resistance to amikacin (23.1%), imipenem (16.6%), meropenem (32.1%) and nitrofurantoin (32.4%). The antibiotic resistance was generally greater in men, and statistically significant differences were obtained in the case of cefepime (p=0.003) and ceftriaxone (p=0.006). The antibiotic resistance pattern also showed some variation with sample type.

Discussion

E. coli has become resistant to many commonly prescribed antibiotics such as the cephalosporins and fluoroquinolones. The resistance has been increasing over the years, and clinicians must take steps to discourage inappropriate use of antibiotics. Imipenem and nitrofurantoin may be used as first-line drugs against E. coli infections.

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Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

51

Is C-reactive protein point-of-care testing feasible in routine general practice, improving diagnostic certainty and antibiotic use? A mixed-methods study

Anita Sharma 2, Charlotte Eley 1, Hazel Lee 2, Rebecca Owens 1, Donna Lecky 1, Andre Charlett 1, Cliodna McNulty 1

Abstract

Objectives

  • Determine feasibility of introducing C-reactive protein point-of-care tests (CRP POCTs) in a high antibiotic prescribing clinical care group (CCG)

  • To evaluate staff and patients views on CRP POCTs and effect on antibiotic prescribing in acute cough

Methods

A McNulty-Zelen Randomised Controlled Trial design was used in this study; eight intervention practices that accepted CRP, two intervention practices that declined CRP and eight control practices were included. Data collection included process evaluation, patient questionnaires, staff interviews, and audits.

Results

Feasibility: Eight practices undertook 359 CRP tests over 6 months (1–100 tests per practice); practices used 45% of tests. Some 78% of patients had a CRP <20 mg/l (88% were managed in line with NICE guidance); 20% of patients had a CRP 20–100 mg/l (21% followed NICE guidance); 2% of patients had a CRP >100 mg/l (100% followed NICE guidance). Patients were positive about CRP; 88% reported that the test was comfortable, 84% convenient, 92% useful, and 85% explained very well. Patients believed CRP aids clinical diagnosis, provides quick results and reduces unnecessary antibiotic use. Staff viewed CRP as a “tool in your armoury” to support clinical decision and educate patients. Reported barriers included cost, time, easy access to the machine, and the effects on clinical workflow. Audits: Antibiotic prescribing and acute cough audits were collected in 16 practices: intervention practices during the CRP trial were compared with (1) their previous year and (2) control practices.

Implications

CRP POCTs in primary care needs funding, smaller, cheaper and accessible testing devices and practice action plans for exact processes to be successful.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

88

Impact of antimicrobial stewardship on the antimicrobial susceptibility pattern of Pseudomonas aeruginosa isolates at a tertiary-care teaching hospital

Mazen A Sid Ahmed 1, Sulieman Abu Jarir 1, Alaaeldin Abdelmajid 1, Jana Jass 2, Emad B Ibrahim 1, Mahmood Mohamed 1, Muna El-Maslamani 1, Hisham Ziglam 1

Abstract

Introduction

Unnecessary use of antibiotics is a common occurrence in hospitals. The implementation of a monitoring and intervention system is vital to optimise the effectiveness of currently available antimicrobial agents and preserve our ability to use them in the future. The purpose of this investigation was to describe the effect of antimicrobial stewardship (AMS) and evaluate the trends and correlation of antibacterial resistance of Pseudomonas aeruginosa and usage from 2014 to 2017 at Hamad teaching hospital in Doha, Qatar.

Methods

In a 600-bed teaching hospital located in Doha, Qatar, a significantly increasing prescription of broad-spectrum antibiotics include carbapenems was observed. A multidisciplinary AMS was implemented, starting in August 2015. A two-phase retrospective study in adult patients admitted to the hospital was conducted. The first phase was from October 2014 until September 2015 (before AMS implementation), whereas the second phase was from September 2015 until September 2017 (while implementing AMS) on yearly basis. The antimicrobial susceptibility pattern of P. aeruginosa was reviewed in September 2016 and September 2017. The measure of resistance pattern of P. aeruginosa was the proportion of resistant isolates (percentage resistant). The measure of antibacterial consumption in the study phases was DDDs/1000 patient day.

Results

Compared with the pre-AMS period, there was a significant reduction in antibiotics consumption of 30.4% total inpatient antibiotics (p=0.008). The overall meropenem consumption decreased significantly in the second phase, from 47.32 to 31.90 (p=0.012), piperacillin/tazobactam from 45.35 to 32.67 (p<0.001) and ciprofloxacin from 9.71 to 5.63 (p=0.015) DDDs/1000 patient-days. The prevalence of multidrug resistance (MDR) P. aeruginosa decreased significantly from 9% to 5.4% (p=0.019) (Table 1).

Conclusions

We have demonstrated sustained reductions in both antimicrobial use and drug-resistant P. aeruginosa following implementation of an AMS.

graphic file with name 10.1177_1757177418794054-img5.jpg

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

90

Prevention of surgical site infection in patients with asymptomatic bacteriuria prior to joint arthroplasty: Is there a real benefit on treating?

Sergio Alejandro Gómez Ochoa 1, Blanca Beatriz Espín Chico 2, Agustín Vega Vera 1, Jose Luis Osma Rueda 1

Abstract

Introduction

Routine treatment for pre-operative asymptomatic bacteriuria (ASB) in patients taken to joint arthroplasty (JA) is a controversial topic. Taking into account the potential harm of unnecessary antibiotic use and the clinical and economic impact of this conduct, we performed a systematic literature review in order to evaluate the potential benefit of antibiotic use in these patients regarding the risk of surgical site infections (SSIs).

Methods

Studies published during 2000–2017 that reported data of SSIs in patients taken to JA with pre-operative ASB or bacterial colonisation markers (BCM), such as pyuria or leukocyturia, were included. A meta-analysis with a random effect model was performed for those studies reporting also the number of patients without treatment. Heterogeneity was assessed with the I2 measure.

Results

Eleven studies were included, involving a total of 29,371 patients (35,323 joints). The main procedures were total hip replacements (18,818 cases; 53, 3%). 2400 cases (9.5%) reported pre-operative BCM (15%) or ASB (85%). From these, 51 cases (2.1%) had a SSI; however, from the ASB cases, in only six cases (12.7%) was the micro-organism correlated with the pre-operative UC. Four studies were included in the meta-analysis. The proportion of SSIs was not significantly different in treated versus untreated patients (1.7% vs. 1.1%; p=0.345), the risk not being significantly higher in any of the groups regardless of the antibiotic treatment (OR 0.82; 95% CI, 0.33–20.4). No heterogeneity (I2=0%) was evident.

Discussion

ASB represents a common finding among these patients; however, there may not be a real benefit in treating regarding the SSI risk. ASB may represent a surrogate marker for other conditions correlated with bacterial infection, as most of the isolated pathogens in the SSI were not the same causing the ASB. Therefore, a complete risk assessment must be performed in patients with ASB before considering treating it or postponing surgery.

graphic file with name 10.1177_1757177418794054-img6.jpg

graphic file with name 10.1177_1757177418794054-img7.jpg

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

93

Implementing a nurse-led antimicrobial stewardship programme

Victoria Clewer 1

Abstract

Background

Antimicrobial resistance (AMR) is a global public health issue that is driven predominantly by the overuse and inappropriate prescribing of antibiotics. Antimicrobial stewardship (AMS) aims to preserve existing antibiotics to ensure treatments such as cancer therapy can continue. Educating clinicians in the prudent use of antibiotics is of paramount importance. Here we discuss the implementation of a nurse-led AMS programme highlighting the valuable input ward nurses have in addressing AMR at a large acute NHS teaching hospital.

Methods

The role of nurses in AMS has been widely researched, yet little has been done to empower nurses to use their expertise and ensure effective stewardship at the ward level. Ward nurses were surveyed to get an understanding of their existing stewardship knowledge. From this we were able to identify key issues, such as a general perceived lack of influence over antibiotic prescriptions; lack of understanding of nursing interventions and medicine management; little to no understanding of AMR or AMS. To address this, a programme of education was developed for all healthcare workers, highlighting their key roles in preventing and addressing AMR. In addition to this, nurses with an interest in stewardship were appointed as “antibiotic stewards” for their wards, to act as role models, peer support and AMS programme link practitioners.

Results

Since the introduction of the nurse-led AMS programme, nurses have improved antibiotic knowledge and increased confidence in questioning antibiotic prescriptions. Multi-disciplinary working has improved, with nurses, doctors and pharmacists working together to better identify possible infections, prescribing, administration and review of antibiotics.

Discussion

In this poster we demonstrate the benefit of implementing a nurse-led AMS programme to engage and empower ward nurses and the wider healthcare team to have a greater role in AMR prevention and stewardship.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

102

Managing self-limiting infections in community pharmacies: A cross-sectional COM-B survey administered as a part of a cluster randomised controlled trial

Natalie Gold 1, Diane Ashiru-Oredope 1, Chaamala Klinger 1, Anne Doble 1, Tracey Thornley 3, Ayoub Saei 1, Anna Sallis 1, Cliodna McNulty 1, Eno Umoh 1, Michelle Youd 1, Donna Lecky 1

Abstract

Introduction

Community pharmacy teams are key in contributing to tackling antimicrobial resistance (AMR). The study aimed to explore determinants of pharmacy team members’ behaviour in managing self-limiting infections using the COM-B (capability, opportunity, motivation and behaviour) model.

Methods

The study was conducted as part of a trial implementing an infection management leaflet (TARGET). A questionnaire measuring COM-B in relation to management of self-limiting infections was distributed to 133 pharmacies.

Results

158 questionnaires were completed by 84 pharmacies (63%). Primary descriptive COM-B analysis:

C: >90% agreed/strongly agreed that they knew how long common infections last, what self-care advice to provide and what antibiotic resistance is. 26% found it difficult to explain to patients why antibiotics were not needed.

O: 41% respondents agreed that they did not get the opportunity to provide all the self-care advice they wanted due to time pressures.

M: 73% believed they have a key role in helping control antibiotic use and 94% believe it is important they give self-care advice.

B: 56% reported that on a typical day they would often or very often have self-care conversations. 35% would often or very often give out self-care resources, information and advice; 25% reported that they would have liked to give self-care resources, information.

Conclusion

Community pharmacy teams seem to be capable of giving self-care advice and are motivated to give it, but they lack opportunity to provide self-care advice and find it difficult to explain why antibiotics are not needed.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

103

Development of a Candida albicans biofilm model using the CDC Bioreactor

Anne-Marie Salisbury 1, Steven Percival 1, Marc Mullin 1

Abstract

Introduction

Candida albicans is an opportunistic fungal pathogen that is commonly found in biofilms. Patients that have undergone surgery, have implanted medical devices such as catheters or who are immunocompromised in some way are at high risk of acquiring infection through biofilm formation, therefore there is a great medical need to treat common biofilm species such as C. albicans. The aim of this study was to develop a C. albicans biofilm model to assess antibiofilm activity of a surfactant-based wound dressing containing 1% silver sulfadiazine (SSD) against this problematic pathogen.

Methods

C. albicans biofilms were grown over 24 hours using the CDC Bioreactor model. Test gels were used to coat coupons and the coupons were incubated for 24 hours. Coupons were sonicated to remove attached biofilm and samples were serial diluted, plated onto agar and incubated overnight at 37°C. The following day colonies were enumerated and CFU/ml determined.

Results

A robust and reproducible 24 hour C. albicans biofilm model was developed using the CDC Bioreactor. Following treatment of the C. albicans biofilm, a reduction in fungal cell density was found following 24-hour treatment with the SSD surfactant-based wound dressing.

Discussion

The SSD surfactant-based wound dressing tested here demonstrated antibiofilm activity against C. albicans, a common problematic fungal species in hospitals.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

104

Development of a biofilm extracellular polymeric substances (EPS) model and assessment of the ability of a silver sulfadiazine-based wound gel to cause EPS breakdown

Anne-Marie Salisbury 1, Marc Mullin 1, Steven Percival 1

Abstract

Introduction

A biofilm is a community of micro-organisms that adhere to each other and to surfaces and secrete extracellular polymeric substances (EPS) encasing themselves in a matrix. Biofilms can form in wounds and on indwelling medical devices, and as a result can delay wound healing and cause infection. Micro-organisms within a biofilm have increased tolerance to antimicrobials and antibiotics and are therefore difficult to treat. The extracellular polymeric matrix (EPM) is thought to be a factor that increases tolerance, and therefore breakdown of it would increase sensitivity to treatment of the micro-organisms. The aim of this study was to develop a model to measure EPS breakdown and to assess the ability of an antimicrobial surfactant-based wound dressing containing 1% silver sulfadiazine (SSD) to break down EPS.

Methods

Pseudomonas aeruginosa ATCC 15442 biofilm was grown for 24 hours at 37°C and 125 rpm. Biofilms were treated with an SSD-based surfactant-based wound dressing for 24 hours. Following treatment, total biomass was determined by staining the biofilm with 0.5% crystal violet and measuring the OD at 590 nm. The total amount of bacterial cells and total amount of live bacterial cells was determined using the LIVE/DEAD BacLight bacterial viability kit with SYTO 9 (480/500 nm excitation/emission) and propidium iodide (490/635 nm excitation/emission) stains. Reduction of EPS following treatment was determined by comparing the total biomass with the total number of bacterial cells in the treated and untreated groups.

Results

The SSD surfactant-based wound dressing reduced EPS over 24 hours and also showed bactericidal activity against P. aeruginosa.

Discussion

A model to quantify EPS was developed here and effectively demonstrated the ability of an SSD surfactant-based wound dressing to reduce bacterial biofilm over 24 hours.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

105

Assessment of antibiofilm activity of a silver sulfadiazine-based wound gel against a multispecies biofilm model

Anne-Marie Salisbury 1, Rui Chen 1, Marc Mullin 1, Steven Percival 1

Abstract

Introduction

Biofilms are a community of micro-organisms that adhere to each other and surfaces and are encased in an extracellular polymeric matrix (EPM). Although micro-organisms can form single species biofilms, they often form multispecies biofilms in the natural environment. Biofilms can form in wounds and on indwelling medical devices, causing complications such as delayed wound healing, inflammation and infection. Additionally, treatment of biofilms is difficult due to increased tolerance to antimicrobials and antibiotics. This study aimed to assess the antibiofilm activity of a surfactant-based wound dressing containing 1% silver sulfadiazine (SSD) against an in vitro multispecies biofilm model.

Methods

Overnight cultures were set up by inoculating 10 ml of broth with a single colony and incubating at 37°C and 125 rpm. Cultures were adjusted to 0.5 McFarland (1 × 108 CFU/ml) and diluted 1:100 to 1 × 106 CFU/ml. Adjusted cultures were added to 24 well plates and incubated at 37°C and 125 rpm for 24 hours. Biofilms were washed with 0.8% sodium chloride solution to remove non-adherent cells and treated with the SSD-containing surfactant-based wound dressing for 24 hours. Following treatment, biofilms were sonicated, serial diluted and plated onto agar to determine total viable counts.

Results

Following treatment of a multispecies biofilm model with an SSD-containing surfactant-based wound dressing, a reduction in bacterial cell density was found in comparison with the untreated control.

Discussion

The SSD-containing surfactant-based wound dressing tested here demonstrated antibiofilm activity against a multispecies biofilm model.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

106

Set up of an in vitro biofilm wound model and assessment of antibiofilm activity of a silver sulfadiazine-based wound gel

Anne-Marie Salisbury 1, Rui Chen 1, Marc Mullin 1, Steven Percival 1

Abstract

Introduction

Complicated and chronic wounds often result in delayed healing and inflammation, causing a large burden on health care. Research has shown that delayed wound healing is often associated with the presence of a biofilm. Biofilms show increased tolerance or resistance to antimicrobials and are therefore difficult to treat. Antimicrobials that are efficacious against biofilms are needed to address this unmet medical need. The aim of this study was to develop an in vitro biofilm wound model and to test an antimicrobial surfactant-based wound dressing containing 1% silver sulfadiazine (SSD) for antibiofilm activity using this model.

Methods

Pseudomonas aeruginosa ATCC 700888 was set up by inoculating 10 ml of broth with a single colony and incubating at 37°C and 125 rpm. Cultures were adjusted to 0.5 McFarland (1 × 108 CFU/ml). A glass microscope slide with an absorbent pad or pigskin adhered to it was placed in each reactor channel of the drip flow model. A membrane filter was placed on the top and inoculated. Cultures were grown in continuous phase for 24 and 72 hours to allow the formation of immature and mature biofilms. Established biofilms were treated with wound dressings for 24 hours. Following treatment, membrane filters were placed in Dey-Engley broth and vortexed, before serial diluting of samples and plating onto agar. Agar plates were incubated at 37°C overnight. The following day bacterial colonies were enumerated.

Results

A robust and reproducible wound biofilm model was set up with absorbent pads or pig skin using the drip flow reactor. A reduction in P. aeruginosa cell density was found following treatment with the SSD-containing dressing.

Discussion

A relevant biofilm wound model using absorbent pads or pig skin was established. An SSD-containing surfactant-based wound dressing demonstrated antibiofilm activity in this model.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

108

Ability of a surfactant-based wound dressing to prevent the co-aggregation of bacterial species often found in wound biofilms

Anne-Marie Salisbury 1, Marc Mullin 1, Steven Percival 1

Abstract

Introduction

Co-aggregation occurs when different species of bacteria adhere to each other, and there is growing evidence to suggest this can increase the development of complex multispecies biofilms. While this is more recognised in oral cavity bacterial biofilms, co-aggregation is being identified elsewhere, for example the biofilms in the mammalian gut. Biofilms have an increased tolerance to antimicrobials and are difficult to treat, therefore preventative measures to inhibit co-aggregation would be highly beneficial in susceptible patients, such as those with chronic wounds. The aim of this study was to investigate the ability of a surfactant-based wound dressing to prevent co-aggregation bacterial species.

Methods

Bacterial cultures were set up by inoculating 10 ml of broth with a single colony and incubating at 37°C and 125 rpm overnight. Cultures were adjusted to an OD630nm of 1.5 and mixed in equal volumes. Mixed cultures were incubated at 37°C with shaking for 24 hours with and without the test dressing. At various time points, samples were taken and co-aggregation was visually determined using a scoring system. Co-aggregated species were also visualised using confocal microscopy.

Results

Reduced co-aggregation was observed following incubation with the surfactant-based wound dressing over 24 hours.

Discussion

The surfactant-based wound dressing tested here demonstrated the ability to reduce co-aggregation of bacterial species, which may be important for preventing biofilm formation.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

111

Antibiofilm activity of a silver sulfadiazine surfactant-based wound dressing against clinical isolates of Acinetobacter baumannii

Anne-Marie Salisbury 1, Marc Mullin 1, Steven Percival 1

Abstract

Introduction

Acinetobacter baumannii is a Gram-negative pathogen, increasingly associated with multidrug-resistant infections. The World Health Organization has recently prioritised development of new antibiotics for carbapenem-resistant A. baumannii as critical. Infection if untreated can develop into sepsis, which is a life-threatening condition. The aim of this study was to evaluate the antimicrobial and antibiofilm activity of a silver sulfadiazine (SSD) surfactant-based wound dressing against clinical A. baumannii strains isolated from patients with sepsis and A. baumannii ATCC 19606.

Methods

Antimicrobial activity was determined using the zone of inhibition (ZOI) assay. Overnight cultures were adjusted to 1 × 106 CFU/ml and swabbed over TSA. Filter paper discs (10 mm) were coated with test gels and placed in the centre of the inoculated agar. Plates were incubated overnight at 37°C. The following day ZOI was measured, discs were removed and plates were re-incubated. Biofilm forming potential of the isolates was determined. Adjusted overnight cultures were added to a 96-well plate and incubated for 24 hours. Wells were washed before addition of 0.5% crystal violet and subsequently 30% acetic acid. Biofilms were grown over 24 hours using the CDC Bioreactor. Coupons were removed, coated with test gels and incubated for 24 hours. Biofilms from coupons were homogenised, serial diluted, plated onto agar and incubated overnight at 37°C to determine total viable counts.

Results

A ZOI of 9–14 mm was observed with all A. baumannii strains treated with the SSD-containing surfactant-based wound dressing. A significant log reduction in A. baumannii was demonstrated following a treatment period of only 24 hours with the SSD surfactant-based wound dressing.

Discussion

The SSD surfactant-based wound dressing tested here demonstrated both antimicrobial and antibiofilm activity against all clinical A. baumannii strains isolated from the blood of patients who had been diagnosed with sepsis.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

120

Public knowledge, attitudes, and behaviours related to antibiotic use and resistance in self-limiting infections: A scoping review

Elaine Cutajar 1, Kay Currie 1, Paul Flowers 1, Adele Dickson 1

Abstract

Background

Inappropriate antibiotic use has been identified as one of the chief causes of antibiotic resistance (AR), especially within a subset of highly common self-limiting infections (SLI) whose disease process normally resolves spontaneously, without the need of antibiotic intervention. This study aimed to explore existing literature pertaining to public awareness and knowledge of, attitudes towards, and behaviours around antibiotic use and resistance in SLI.

Methods

A scoping review was conducted on seven electronic databases from inception until May 2017. For included studies, quantitative and qualitative data was extracted, charted and synthesised.

Results

In total 143 studies were included. Symptoms and infections of the respiratory tract were most frequently studied. A number of key common factors that may lead to unnecessary antibiotic use in SLI were uncovered, including a number of misunderstandings and inappropriate attitudes towards antibiotic use in SLI. The most common factors reported to influence public knowledge, attitude, and behaviours towards antibiotics in SLI include factors such as age, gender, ethnicity, area of residence, previous antibiotic use, and perceived symptom severity. However, the direction and strength of these influences was not consistent between studies. The use of theoretical frameworks to satisfy study aims was observed in a small minority of included studies, and interventions to improve outcomes showed little reduction in inappropriate knowledge, attitudes, or behaviour.

Discussion

Narrowing our research focus into areas that are relatively under-explored can help us uncover some important infection-, population-, and context- specific factors that influence inappropriate antibiotic use. The use and application of theory must be further explored if we are to give predictive and robust value to behaviour change interventions.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

124

Broad-spectrum antibiotic prescribing in elderly patients is it to guidelines?

Naomi Fleming 1, Demisha Vaghela 1

Abstract

Introduction

C. difficile infection (CDI) occurs when the balance of the gut flora is disrupted, often by broad-spectrum antibiotics. C. difficile produces toxins damaging the lining of the colon, leading to diarrhoea, colitis and sometimes, colon rupture and death. Antimicrobial stewardship measures restricting broad-spectrum antibiotic use are essential to protect vulnerable patient groups from CDI.

Method

The aim of this audit was to identify whether prescribing of broad-spectrum antibiotics in high-risk patients (age >65, immunocompromised, previous CDI) was appropriate. The audit was carried out over 14 days in care of the elderly wards in patients prescribed Co-Amoxiclav, Ciprofloxacin, Clindamycin, Cephalosporins or Piperacillin/tazobactam (PT). Prescriptions were classed as appropriate if to guidelines or recommended by microbiology.

Results

Some 25 patients out of 50 were prescribed one of the antibiotics being audited. The highest prescribed was IV Co-Amoxiclav, oral Ciprofloxacin the least prescribed; 25% prescribed to guidelines, most commonly for Pseudomonas or sepsis; 75% prescribed inappropriately, for urinary tract infections (UTI) or respiratory tract infections (RTI). Co-Amoxiclav was most commonly inappropriately prescribed followed by PT. Recommendations to change antibiotics to guideline choices were made in 17 patients by the auditor and accepted in 15.

Discussion

Some 75% of these antibiotics were not to guidelines. Patients were prescribed Co-Amoxiclav inappropriately for uncomplicated UTI, guideline choice for urosepsis, suggesting lack of awareness in the differences between diagnosis and treatment of UTI versus urosepsis. Antibiotics prescribed inappropriately for RTIs, often due to lack of CURB score calculation, and empiric prescribing for a high score unnecessarily as auditor calculated score was low. Reassuringly, where the auditor intervened, the majority of antibiotics were changed to guideline choices.

Recommendations

  • Produce document highlighting diagnosis differentiation for UTIs and urosepsis

  • Promote treating UTI flowchart and Trust antibiotic guidelines

  • Training for staff on CDI and appropriate prescribing.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

127

An investigation of the enablers and barriers associated with rapid diagnostic test (RDT) acceptability in a healthcare setting from the perspective of healthcare professionals and patients: A systematic review

Lauren Blane 1, Paul Flowers 1, Kay Currie 1

Abstract

Introduction

Global interest and investment in rapid diagnostic tests (RDTs) is facilitated by increased pressure to reduce the burden of antibiotic resistance (AR). Inappropriate prescribing of antibiotics has been identified as a cause of AR. This includes giving incorrect or unnecessary antibiotic prescriptions. Introducing RDTs could help healthcare professionals prescribe the correct antibiotic at the right time. Little is understood about the impact of such tests on antibiotic providers and patients. This systematic review with thematic analysis is the first to explore the factors that affect acceptability of RDTs from a patient and healthcare professional perspective.

Methods

The PICO framework and seven databases were utilised: CINAHL, AMED, PsychINFO, PsychARTICLE, Medline, Cochrane and Web of Science. There were no language or date limiters. In total, 28 articles met the inclusion criteria. The JBI extraction tool structured data extraction. Extracted items were investigated using inductive thematic analysis (Braun and Clarke, 2006).

Results

Thematic analysis indicated that some patients may feel that an RDT helps to reassure them about non-antibiotic prescribing choices. Yet, some articles outlined sample collection, waiting time and cost as possible barriers to RDT acceptability for patients. Most included articles investigated healthcare professionals’ (HCP) perspectives, identifying such barriers as practicalities, test performance, and belief that clinical assessment was sufficient for diagnosis. This review suggested that RDTs may be more acceptable where HCP were uncertain of diagnoses.

Discussion

This study recommends that RDTs are acceptable to some extent, to both healthcare professionals and patients, but further research is required, and barriers should be addressed before they are introduced. Given national endorsements to introduce RDTs, it is essential that behavioural factors affecting implementation are better understood. Future research may develop a theory-based understanding of these factors.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

128

Can local release of gentamicin be effective against microbes isolated from diabetic foot infection in a wound model?

Bianca Price 1, Robert Morley 2

Abstract

Aim

We aimed to characterise the microbiome of a grade 1B diabetic foot infection (DFI) and to determine the susceptibility of the bacteria present in the ulcer to gentamicin released from calcium sulphate beads.

Methods

Debrided tissue from three subjects’ DFI was homogenised. Bacteria were plated onto chocolate agar and incubated for 3 days at 37°C under anaerobic, microaerophilic and aerobic conditions. Bacteria were then enumerated and identified using 16S rRNA sequencing. Bacteria for each subject were harvested from chocolate agar plates, inoculated into a collagen wound model, and a biofilm was allowed to develop over 3 days. Gentamicin-loaded calcium sulphate beads were added to the biofilms and incubated for a further 3 days. Bacteria were enumerated and log reductions calculated using unloaded beads as a control. Gentamicin concentration in the models after incubation with beads was also assayed.

Results

From each DFI, 3 to 5 strains of bacteria were isolated. Staphylococcus spp. and Corynebacterium spp. were the most common isolates. The biofilm developed from subjects 1 and 2 was eradicated by antibiotic-loaded beads, corresponding to a 9-log reduction in bacterial counts. A 5-log reduction in counts was recorded for bacteria isolated from subject 3, whose microbiome included gentamicin-resistant group B streptococcus. The gentamicin concentration in the models was 300 µg/ml.

Discussion

This is the first report to the authors’ knowledge of the bacterial species present in an early stage DFI, before treatment. These biofilms could be inhibited or eradicated with sustained release of gentamicin from calcium sulphate beads in an in vitro model.

Footnotes

Declaration of interest: This work was funded by Biocomposites Ltd.

J Infect Prev. 19(1 Suppl):S4–S63.

133

Targeted teaching improves confidence in antibiotic prescribing in advanced nurse prescribers (ANP)

David Watson 1, Fran Kerr 1; MDGH Hospital Emergency Care Team1

Abstract

Introduction

Non-medical prescribing is recognised as a component of advanced practice and the role of the advanced nurse practitioner (ANP). However, ANPs may still have concerns about prescribing. Questionnaires identified antimicrobial stewardship and antibiotic prescribing locally as an area requiring focus. Collaboration with antimicrobial pharmacists and ANPs was undertaken to address this.

Methods

Questionnaires were used to measure effectiveness of interventions. Audit was conducted to measure compliance with National Quality Indicators for antibiotic prescribing. Prescribing error reporting and medical prescriber feedback was sought. Interventions included group education sessions, peer support and directed reading using national resources from National Education for Scotland (NES), Scottish Antimicrobial Prescribing Group (SAPG) and Association of Scottish Antimicrobial Pharmacists (ASAP).

Results

  • 100% compliance with National Quality Indicator antibiotic prescribing standards

  • Variety of antibiotic prescribed as per local policy or patient escalation plan

  • Zero ANP prescribing errors reported during the study period

  • Structured questionnaire responses from baseline demonstrated increased confidence levels throughout the team

  • Improved ANP confidence translated into safer outcomes with a shift from prescribing single antibiotic doses to full treatment courses

  • Increased ANP ownership of prescribing role reduced staff duplication of activity, i.e. re-assessment referral to medical teams

  • Positive feedback from medical colleagues at subsequent clinical review demonstrated safe, effective antibiotic care successfully delivered by local ANP team

Discussion

Targeted education and peer support was embraced by all members of the team as an effective intervention to increase confidence levels and ensure appropriate prescribing of antimicrobials by ANPs. The intervention was identified as worthwhile and ANPs recommend this approach to colleagues. Nurses felt more confident to take ownership of antibiotic prescribing within the sphere of advanced practice. Prescribing full courses of antibiotics reduced the risk of patients missing subsequent antibiotic doses. Further education needs have been identified and peer support is ongoing.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

169

Correlating antimicrobial consumption to resistance in Gram-negative bacteria and stewardship in a Greek hospital over a 4-year period

Charalabos Tamvakos 1, Evdoxia Bletsa 1, Christina Alexanian 1, Alexia Bakossi 1, Maria Koutraki 1, Alexios Sotiropoulos 1, Despoina Papadaki 1, Maria Demetriou 1, Athannasia Kontomichou 1, Paraskevi Karle 1, Theodoros Peppas 1

Abstract

Introduction

Local antimicrobial usage and resistance parameters must direct antimicrobial stewardship (AMS) to priority goals attempting to limit selection of resistant strains. The strategy and efforts of a Greek 576 bed tertiary hospital’s AMS team are described.

Methods

Defined daily doses (DDDs) for third-generation cephalosporins, ciprofloxacin, carbapenems and aminoglycosides were recorded and compared with resistance of GNB from 580 blood and 1572 urine cultures from 2014 to 2017.

Results

Annual resistance rate was demonstrating a tendency to rise in linear fashion for most antibiotics, but the most striking correlation was the soaring of carbapenem resistance, where a 17.1% rise to its DDDs from 2014 to late 2016 was followed by a 71.1% increase of GNB resistance (from 15% in 2014 to 52% in 2017) with its major impact in Klebsiella pneumonia, which reached an all-time high 64% in 2017, double that of 32% in 2014. This climax prompted the Infection Control Team (ICT) to target carbapenem usage as primary intervention target, and in 2017 a decrease in its use was achieved. The AMS team led by pharmacist and ID physician had regular face-to-face meetings with doctors, targeting wards with excessive carbapenem usage. The intervention period was 1/1/2017–31/10/17. A decrease of carbapenem to 4.48 DDDs/100 pt.d (compared with 5.53, 5.58 and 5.62 in the three previous years) also resulted in a cost saving of 30,915€ versus the respective months of 2016, and reached 42,317€ for 2017 versus 2016 expenditure.

Discussion

Surveillance of antimicrobial usage and resistance, setting priorities, and intensive teamwork and effort in stewardship can produce encouraging results in rational antibiotic usage, economic benefit and, if maintained, in reducing antimicrobial resistance. It is also well known that initial success encourages, but continuous effort must be made to preserve performance.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

4

Biocide options to control the transmission of pathogens

Shilpa Saseendran Nair 1, Simon Swift 1, Siouxsie Wiles 1

Abstract

Introduction

Fomites are a risk factor for nosocomial infections. Antimicrobial surfaces may be a solution to reduce transmission of pathogens, and thereby reduce the incidence of infections.

Objectives

1. To develop wet and dry fomite assays to determine the activity of antimicrobial surfaces against model bacteria Staphylococcus aureus, MRSA, Escherichia coli and ESBL E. coli on plastic (LDPE), glass and stainless steel carriers. 2. To test the effectiveness of a commercially available siloxane-anchored quaternary ammonium compound (SAQAC) in these assays. 3. To develop a “fit for purpose” assay testing the microbial burden surfaces following application of the biocide.

Methods

Wet fomite assays followed the JISZ2801:2000 method; dry fomite assays aseptically dried the inoculum onto the surface. Viable cells remaining on the surfaces were assayed at five time-points during incubation at room temperature. Active surfaces reduce the number of viable cells by at least 1000-fold. “Fit for purpose” testing regularly swabbed nine frequently touched areas of a laboratory over a 30-day period before and after application of the biocide, and viable counting determined the microbial burden.

Results

SAQAC-treated antimicrobial surfaces are effective in wet fomite assays against S. aureus and MRSA in 10 minutes, E. coli in 30 minutes, and ESBL in 2 hours. The surfaces were effective in dry fomite assays against S. aureus and E. coli within 10 minutes, and MRSA and ESBL within 1 hour. “Fit for purpose” testing showed the effectiveness of SAQAC-treated benches and door handles for up to 11 days, but not treated floor surfaces.

Discussion

The potential of SAQAC treatment to protect surfaces from hospital pathogens is demonstrated. The methodology can now be applied to other surface-anchored antimicrobials. The activity of SAQAC treatment in reducing environmental burden in hospitals and the consequent effect on infection rates should now be determined.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

47

Taking the safer disinfectant road

Lorna Barbour 1, Elinor Sommervile 1, Lynne Linden 1, Emer Shepherd 1

Abstract

Introduction

It is imperative that all endoscopes are effectively cleaned and disinfected. Failure to do so can lead to outbreaks of life-threatening infections. The disinfectant process must be effective in preventing prions adhering to the equipment. Consequently, aldehyde disinfectants are no longer approved in the UK. We identified the use of aldehyde disinfectants in one outpatient department and sought to remove the chemical whilst providing a safe system for both patients and healthcare workers (HCWs). The process was iterative and failed twice before a safe system was found.

Methods

  1. Discussions with staff identified that a previous change from an aldehyde disinfectant resulted in side effects (including respiratory symptoms).

  2. A room with increased ventilation was secured but the change back to the non-aldehyde disinfectant once again resulted in HCWs experiencing symptoms.

  3. The resources needed to use chemicals in automated washer disinfectors were identified and secured. This involved production of an SBAR (Situation • Background • Assessment • Recommendation) and presenting findings to the Decontamination Environmental Monitoring Group.

Results

Increasing the ventilation in the decontamination room did not prevent staff experiencing side effects. By changing to an automated system, side effects were negated and effective disinfection achieved as evidenced by validation of the process.

Discussion

Effective system change is difficult. To have safe systems, a continuous awareness of individual processes, by experts, external to the departments, is needed, i.e. a decontamination clinical nurse specialist. Chemical disinfectants used must meet the expected microbial challenge posed and harm neither patients nor HCWs both during and after the procedure. Removing aldehydes to negate the risk of prion adherence by an automated, validated system also decreases the risk of outbreaks from other more common organisms, e.g. Enterobacteriaceae. This process is now considered “gold standard” and negates risks to staff and patients.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

53

StethHygiene: A preliminary report

Billexter Bonifacio 1

Abstract

Introduction

Studies show that many stethoscopes when tested were found to harbour disease-causing bacteria (Breen, 2017), hence disinfection of stethoscopes is one factor healthcare facilities must consider in order to prevent spread of infections. This study showed the effectiveness of the StethHygiene project in reducing the number of micro-organisms in the intensive care unit (ICU).

Method

St. Luke’s Medical Center, Quezon City, made a pilot study to observe the effectiveness of the StethHygiene project in reducing the number of micro-organisms isolated from patients. The project was implemented to ICU by installing a desktop poster on the nurses’ station bundled with alcohol swabs with a message: “Are your stethoscopes clean? Get your swabs here”. Doctors were encouraged to get an alcohol swab to clean the hubs of their stethoscopes. The Infection Control Service together with the management of ICU observed the microbial growths in the laboratory and the financial impact of the use of alcohol swabs for 3 months.

Results

There was a generalised decrease in the microbial count in the laboratory especially with P. aeruginosa, S. marcescens, S. maltophilia and K. pneumoniae. The management spent around Php 500 or USD 9.62 for the 3-month period. Reduction of micro-organism was observed with the StethHygiene project. With the observed cost of expenses for the alcohol swab compared with the reduction of micro-organisms which are identified to cause healthcare-acquired infections, the management approved that this project is acceptable and can provide safety to patients and healthcare workers.

Discussion

Disinfection of fomites such as the stethoscope must also become one important focus of healthcare facilities for prevention of healthcare-associated infections. Further observation of this study is recommended to gather a stronger data to prove the effectiveness of the StethHygiene Project in St. Luke’s Medical Center, Quezon City.

graphic file with name 10.1177_1757177418794054-img8.jpg

graphic file with name 10.1177_1757177418794054-img9.jpg

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

57

How effective are wipes at pathogen removal?

Michael Luetzeler 1, Amy Huang 1, James Clarke 1, Matthew Bromfield 1, Anna Guest 1

Abstract

Introduction

Understanding the effectiveness of wipes is important in order to deliver a high level of cleaning within hygiene-critical environments. In 2015, Prof. Jean-Yves Maillard¹ examined the transfer and removal of pathogens by wipes. The study found that detergent wipe products “have 2 major drawbacks: their variability in removing microbial bioburden from inanimate surfaces and a propensity to transfer pathogens between surfaces”. One strategy proposed for further investigation was the use of combined detergent–disinfectant wipes as well as provision of appropriate use instructions for infection control and prevention.

Methods

This study assessed how disinfectant wipes can address the issues of pathogen transference and ensure microbes are actually removed from surfaces. The role of the wipe material was (i) assessed on its own opposite pathogen removal and (ii) in combination with a liquid disinfectant in order to provide antimicrobial efficacy, as measured by the EN 16615:2015 Protocol.²

Results

It was found that by selecting wipe substrates with particular attributes, disinfectant wipes can be developed that are able to both physically pick up organisms and simultaneously deploy sufficient liquid on the surface to stay wet for the required contact time as per recommended use instructions. With further optimisation it was also shown that it is possible for wipes to remove and kill pathogens over an extended surface area, and hence offer superior disinfection options in daily cleaning regimes.

Discussion

The EN 16615:2015 Protocol allows Infection Prevention Professionals to check their suppliers have assessed their products using a test that simulates actual product use, to meet required efficacy criteria. This will ensure healthcare institutions select wipes which both kill pathogens whilst also avoiding microbial transfer in their hygiene regimes for the benefit of patients and staff.

  • 1Ramm L, Siana H, Wesgate R, Maillard J-Y. AJIC 2015; 43: 724–728.

  • 2EN 16615:2015 Test Protocol

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

68

Infection prevention in a model hospital: It’s your data – use it!

Debra Adams 1, Siobhan Heafield 1, James Cook 1, Emma Hardwick 2, Glynis Bennett 2, Victoria Bagshaw 3, Rachael Corser 4

Abstract

Background

The Model Hospital (https://model.nhs.uk/) is a digital information service provided by NHS Improvement to support, identify and realise productivity opportunities. NHS Trusts are able to explore their comparative productivity, quality and responsiveness, to provide a clearer view of improvement opportunities. Anecdotal evidence obtained from discussing the Model Hospital cleaning data with infection prevention (IP) teams in the Midlands and East region is that they were not aware of the system and had not reviewed their data to potentially improve IP resources.

Methods

A Plan, Do, Study, Act (PDSA) cycle was developed to raise awareness of Model Hospital data, specifically in relation to environmental cleaning. PDSA Cycle 1: Three Trusts in Midlands and East who experienced IP challenges associated with C. difficile infection and/or environmental cleaning were chosen for the pilot study. Data slides were produced which included: Cleaning costs/m2, cleaning productivity (m2/WTE), trend in C. difficile assigned cases and rolling trend of C. difficile assigned cases/100,000 bed-days.

Results

Trusts reviewed their Model Hospital cleaning and C. difficile data in comparison with their peers. This identified potential outliers, and assisted the development of business cases to review and improve environmental cleaning resources. This data supported standard IP information and helped facilitate improved interventions which controlled increasing infection rates/outbreaks.

Discussion

Anecdotally, IP teams were not aware of the data they had access to from the Model Hospital. Model Hospital data is often seen as data for efficiency savings and cost cutting. IP teams should be made aware of the data available and utilise it to potentially benefit the quality of care. The next PDSA cycle is to scale up the project and raise awareness of how to access this data across the region.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

73

Predictors of Legionella contamination in dental care settings: A systematic review and meta-analysis

David Scott 1

Abstract

Introduction

Exposure to dental equipment is a well-established risk factor for Legionnaires’ disease. Reports of fatal legionellosis in dental patients, transmitted via contaminated aerosols, led Health Protection Scotland to develop guidance on the management of dental unit waterlines (DUWLs). To facilitate guideline implementation and focus quality improvement, this study aimed to ascertain which characteristics of dental care settings are predictive of DUWL contamination with legionellae.

Methods

MEDLINE, EMBASE and CINAHL were searched up to June 2017 to identify studies reporting the prevalence of legionellae in DUWLs. Pooled prevalence (PP) was calculated using a random effects model, while subgroup analysis and meta-regression by continent, setting type (i.e. dental hospital or practice), total number of dental chair units (DCUs) and publication date, were used to identify predictive characteristics. Sensitivity analysis excluded low-quality studies, and publication bias was assessed using funnel plots and Egger’s test.

Results

Thirty-six studies measured the prevalence of legionellae in 3669 water samples collected from 2448 DCUs across 19 countries. Studies were performed in Europe (n=26), North America (n=3), Africa (n=1), and Asia (n=6). Legionellae were more common in dental hospitals (PP=29.3%; 95% CI: 22.8–36.8%; I²=87%) compared with dental practices (PP=5.9%; 95% CI: 3.5–9.7%, I²=83%). The prevalence of legionellae did not vary by continent, total number of DCUs or publication date (p>0.05). Exclusion of eight low-quality studies had minimal impact on results. Visual inspection of funnel plots, and Egger’s test (p<0.01), suggested that publication bias was evident only amongst dental practice-based studies.

Discussion

Since the risk of healthcare-associated legionellosis correlates with the presence of Legionella in distal outlets, these results indicate that dental hospitals pose a greater risk and require concentrated effort to prevent future infections.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

77

Introduction of ultraviolet (UV) decontamination technology at a busy emergency department admissions unit

Csaba Beviz 1, Neil Wigglesworth 1, Chaminda Kapurusinghe 1, Lorraine Mooney 1, Yusupha Ceesay 1

Abstract

Introduction

Environmental decontamination is vital in preventing healthcare-associated infections (HCAI). Technologies, e.g. Vaporised Hydrogen Peroxide (VHP), provide assurance of cleanliness, and in emergency settings can delay patient flow and affect accident and emergency (A&E) waiting times. Ultraviolet (UV) offers reduced turnaround times and improvements in flow. We describe the introduction of UV to the Acute Admissions Ward (AAW) of a teaching hospital.

Methods

The AAW, a 62-bedded ward, accepts patients from A&E. UV-C (Clinell, Watford, UK) was trialled between April and October 2016. It was operated by the existing “Rapid Response Team” and accessed using existing systems. Utilisation, including reason for use, location, and time/duration, was recorded compared and with pre-existing VHP. The Infection Prevention Team (IPT) and facilities developed a prioritisation process, including types of known/suspected infection and choice of decontamination, i.e. UV, VHP (where feasible) or manual deep clean.

Results

In a period of 12 months, UV technology was deployed 3980 times at one hospital site, and the most common reasons for deployment were methicillin-resistant Staphylococcus aureus (MRSA) and influenza. The average turnaround time for UV was 1 hour, compared with 3 hours for VHP. In addition, due to the smaller size of the unit, it was possible to deploy the UV in spaces that were too small for VHP units, such as bathrooms and toilets.

Discussion

The use of UV contributed to improved patient flow in the AAW by freeing up beds/isolation capacity more quickly than VHP, whilst providing assurance of a safe patient environment compared with manual deep cleaning only. Limitations of this approach include requirement for use in an empty space (as with VHP) and limited efficacy against some organisms, e.g. Clostridium difficile, for which VHP was still specified. As part of a menu of options, UV offered effective decontamination and was positively evaluated by all parties involved.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

119

Engaging environmental services staff in hospital cleaning research

Brett Mitchell 1; REACH study team1

Abstract

Introduction

The Researching Effective Approaches to Cleaning in Hospitals (REACH) study evaluated the effectiveness of a novel cleaning bundle intervention in 11 major Australian hospitals in 2016–2017. It was essential for effective bundle implementation that there was close collaboration with staff at each hospital who perform hospital cleaning, and the trial activities reflected the local staff context and characteristics. Multiple approaches were used to engage with environmental services staff and to promote ownership of the cleaning bundle at each hospital.

Methods

Pre-trial questionnaires, that aimed to identify environmental services staffs’ baseline knowledge about cleaning and their attitudes and perceptions of their role and organisational support, were completed by 616 people across the 11 hospitals (35.63% of total staff). The REACH study team facilitated 25 discussion groups (n=223) to identify local issues and contextual factors around hospital cleaning work. Data from these activities were used to tailor the cleaning bundle and plan the hospital-specific staff engagement. Post-trial, the questionnaires were repeated at each hospital (n=307) and questions included about staff experience of participating in the REACH trial.

Results

Analysis of pre- and post-trial questionnaire results indicated minimal increase in attitudes related to perceptions of organisational support. However, post-trial (n=307), 64% of staff agreed they felt recognised for their participation in the trial (range 33–90%) and 68% agreed they felt supported throughout the trial (range 44–100%). Thematic analysis of post-trial feedback will be presented.

Discussion

Providing tailored and context-responsive activities in each hospital supported the research trial implementation. In terms of increasing staff engagement with the research, the bundle included activities to support and recognise the importance of environmental services staff within a hospital’s “culture of safety”.

Funding: The REACH study is a National Health and Medical Research Council Partnership Project (GN1076006).

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

137

Estimate the risk of infection following endoscopy procedures within NHSScotland and production of a minimal standard for the management of endoscopy rinse water results

Hayley Kane 1, Annette Rankin 1

Abstract

Introduction

Flexible endoscopes have been associated with outbreaks of infection. Despite guidance there is variation nationally between health boards regarding management of endoscopy rinse water test results. Removing an endoscopy washer disinfector (EWD) from use can have a negative impact on patient services (cancellation or delayed treatment). However, the continued use of a EWD where the decontamination process may not have achieved the desired decontamination level may pose an infection risk to patients. This study aimed to estimate the risk of infection following endoscopy procedures in NHSScotland and use data to produce a minimal standard response to endoscopy rinse water results.

Methods

A systematic review of the published literature on harms associated with endoscopy procedures was undertaken. Data linkage was performed using patient admission data and positive isolates post endoscopic procedure. Health boards were surveyed to ascertain local practices for the clinical management of endoscopy rinse water results.

Results

The literature review found common decontamination breaches; however, no reported cases or outbreaks linked to the contaminated rinse water were identified from the published literature. The data linkage study found the risk of infection following an endoscopic procedure in Scotland was 1.5–3.3% over the 5-year study period, lower than reported rates found within the literature. The results of the health board survey found variation in organisms tested and responses to positive samples.

Discussion

The data linkage study and subsequent cluster analysis found the estimated risk of infection following endoscopic procedures in NHSScotland was low despite variation in the management of positive final rinse water results locally, and recommended the development of a national minimum standard for the interpretation and management of EWD final rinse water results. The minimal standard has been produced in a user-friendly algorithm which can be adopted by health boards.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

140

UV light decontamination – comparison with HPV of usage and staff satisfaction

Allison Sykes 1

Abstract

Introduction

Room decontamination following source isolation is essential to prevent the transmission of potentially pathogenic organisms between patients. In addition to cleaning with a combined detergent and chlorine disinfectant, the Trust has HPV devices for enhanced decontamination. However, due to the complexities and time it takes to complete the process, this resource is often not deployed. To increase the use of enhanced decontamination the Trust has recently acquired an ultraviolet (UV) light device. This poster is an initial evaluation of the usage and staff satisfaction of the UV light device.

Methods

The usage of the UV light device has been collated and compared with the usage of the HPV device over a similar time period. In addition to this, staff who deploy the devices and ward staff who often experience delays in bed availability have completed evaluations on the two types of device.

Results

Initial findings have demonstrated a dramatic increased use of enhanced decontamination with the UV light device compared with the HPV device, as well as very positive staff evaluations.

Discussion

This limited study has demonstrated that the use of a device which is quicker and easier to use has increased the use of enhanced environmental decontamination, which should reduce the bioburden of patient areas. Although HPV is arguably the most effective form of surface and facility decontamination with a much broader spectrum of targets, there are some disadvantages to its use, which can have a significant impact on patient flow and staff time. UV light disinfection, however, although often less effective due to the line-of-sight limiting factor, is a more ubiquitous method for environmental disinfection. Going forward to facilitate at least some form of enhanced environmental room disinfection following source isolation, additional UV light devices are being recommended in addition to HPV disinfection for C. difficile cases.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

144

Housekeepers: A valuable addition to the healthcare team? An evaluation of the impact housekeepers have on the cleanliness of the healthcare environment and the time nurses spend cleaning

Hayley Kane 1, Heather Wallace 1, Annette Rankin 1

Abstract

Introduction

Health Protection Scotland (HPS)’s UK and International review of alternative approaches identified housekeepers as a positive initiative for decontamination of reusable patient care equipment and the healthcare environment. This study aims to evaluate the impact a housekeeper has on the cleanliness of, and the time spent by, nursing staff cleaning reusable patient equipment.

Methods

A health board was identified with housekeepers in post. Participation was requested from all senior charge nurses (SCN). Follow-up visits to all clinical areas were undertaken. Formal interviews were conducted with areas with and without housekeepers. Participants were requested to provide 5 years of environmental audit scores and undertake a time to clean data collection. Audit data and time to clean data-collection forms were returned electronically to HPS for data analysis.

Results

Data collection is ongoing at this time; however, the limited data available shows the average overall audit score for areas with a housekeeper was 90.1% and 87.8% without a housekeeper, a Gold and Green RAG status respectively. The time to clean data is still being received and therefore has not been analysed at this time. The hypothesis is that wards with a housekeeper nursing staff will spend less time cleaning reusable patient care equipment. Interviews found housekeepers were introduced in response to either HEI report findings or local infection prevention and control audit scores. Senior management highlighted, “they felt they were taking a risk” by removing funds for direct patient care to indirect patient care.

Discussion

Valuable information was gained from the interviews held with staff. The general consensus was overwhelmingly that the housekeepers “were worth their weight in gold”, and that despite some initial uncertainty about the role it was more beneficial to the ward/department/team than expected. It is expected this study will be complete and published by the conference date.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

153

Management of dental unit water lines: Recommendations for practice

Hayley Kane 1, Heather Wallace 1, Annette Rankin 1

Abstract

Introduction

In 2012, a case report published in The Lancet confirmed that an 82-year-old woman in Italy had died from Legionnaires’ disease associated with a strain of Legionella pneumophila genetically identical to one isolated from the dental unit waterlines (DUWLs) of a dental practice she had attended in the past 10 days. Following heightened awareness of the infectious risk from contaminated DUWLs, Health Protection Scotland (HPS) was asked by Scottish NHS Boards to provide guidance for healthcare workers on the appropriate disinfection of DUWLs within the dental chair unit (DCU) – a reusable medical device.

Methods

A scientific literature search was undertaken to review the extant literature regarding the appropriate management (including decontamination) of DUWLs for the prevention of healthcare-associated infections. Critical appraisal of the studies included in the review and considered judgement of the evidence was carried out by the lead reviewer using the Scottish Intercollegiate Guidelines Network (SIGN) methodology.

Results

The literature search identified 295 articles. After the first and second-stage screening, 46 articles were included for critical appraisal. As a reusable medical device under the European Union Medical Devices Directive, DCUs must be maintained according to the manufacturer’s instructions. Accordingly, DCU manufacturers may endorse a specific commercial product to disinfect DUWLs; however, unless a DUWL biocide is considered incompatible with the unit, a variety of products are likely to be available for this purpose. The limited evidence available from published research supports the recommendation that continuous agents should preferably be used, based on peroxide compounds.

Discussion

A number of recommendations have been made for practice within Scottish Dental Practices. The recommendations cover risk assessments, technical requirements water supply management, infection control management, flushing management, decontamination, microbiological requirements and monitoring test kits.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

168

Evaluation of a disinfectant in hospital curtains using three different sample-collecting methods: A laboratory study

Camila de Quartim de Moraes Bruna 2, Caroline Lopes Ciofi-Silva 1, Kazuko Uchikawa Graziano 2, Edna Maria da Silva Beck 4, Lycia Mara Jenné Mimica 3, Cely Barreto da Silva 3

Abstract

Introduction

Hospital privacy curtains are a challenge for infection prevention and control practices because they are high-touched surfaces; difficult to clean and disinfect; and also infrequently changed. This study aimed to appraise the efficacy of a disinfectant with potential residual effect in different types of curtains and to compare three surface-sampling methods.

Material/Methods

Sterilised pieces of curtains (10×10cm) made of cotton, polyester, vinyl and zinc-impregnated tissue were treated with a solution compound of 3-(trimethoxysilyl)-propyldimethyloctadecyl ammonium chloride, and then positive control and experimental groups were contaminated with a solution containing 106 carbapenemase-producing Klebsiella pneumoniae (KPC), vancomycin-resistant enterococci (VRE) and antibiotic-sensitive Escherichia coli. A negative control group (sterilised and disinfectant-treated only) was also made. Three methods for surface sampling were used: contact plates; sterilised cotton swabs; and membrane filtering. Isolates were cultured on relevant chromogenic media for microbiological identification and incubated.

Results

KPC was the main bacteria recovered from the curtains in positive control group (mean of 5.31×105 CFU) and experimental group (mean of 2.35×105 CFU). The membrane filtering method resulted in a higher mean of bacterial recovery for the positive control group (4.54×105 CFU) and in the experimental group, the contact plates (2.32×105 CFU). Cotton curtain showed the lowest mean of bacterial recovery (1.77×105 and 8.6×102 CFU for positive control and experimental groups). Only one log10 reduction was observed when analysing the antimicrobial effect of the solution.

Discussion

Different strategies to improve cleaning and disinfection practices must be implemented to control the spread of antibiotic-resistant pathogens; nevertheless, the disinfectant tested did not show relevant control of the micro-organisms that could justify the investment in this product. Contact plates seem a sensitive method to detect microbial contamination on hospital surfaces.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

96

“Biofilm, biofilm everywhere”: Bacterial pathogens in dry biofilms are widespread on frequently touched healthcare surfaces

Katarzyna Ledwoch 1,2, Jean-Yves Maillard 1

Abstract

Introduction

Biofilms are highly resistant microbial communities. “Wet” biofilms formed in the presence of moisture, on medical devices such as endoscopes, have received the most recognition for their role in healthcare-associated infections (HCAI). Limited attention has been paid to biofilms colonising various dry surfaces within healthcare settings. Overall, “dry” biofilms have been shown to be less susceptible to disinfection than wet biofilms. This study aimed to raise awareness of the presence of dry biofilm in healthcare settings by providing information on their occurrence, prevalence, and diversity on frequently touched hospital surfaces.

Methods

Over 60 previously “decontaminated” items were obtained from three different hospitals across the UK, including patient folders and nursing station keyboards. All surfaces were declared free of bacteria following routine surface swabbing, agar inoculation and incubation. The presence of dry biofilm on frequently touched surfaces was confirmed by inoculation and incubation of test surfaces in enrichment broth and scanning electron microscope (SEM). Ribosomal intergenic spacer analysis (RISA) and next-generation sequencing (NGS) was performed to investigate community composition of the recovered dry biofilms. Selective chromogenic agars enabled identification of pathogenic bacterial phenotypes.

Results

Multispecies biofilms were recovered from 95% samples. SEM confirmed their complexity and abundance as biofilm rafts randomly spread on surfaces. All biofilms harboured Gram-positive bacteria, mainly Bacillus spp., Staphylococci (including MRSA) and VRE. Bacterial genera abundance was similar in two hospitals but differed in the third.

Discussion

The presence of dry biofilms harbouring bacterial pathogens is widespread on frequently touched items. Standard decontamination protocols fail to remove or eliminate dry biofilms. Surface swabbing followed by agar inoculation failed to detect biofilms, contributing to a false sense of security that these surfaces are free of pathogens. The impact of bacterial pathogens in dry biofilms on HCAIs remains to be determined.

Footnotes

Declaration of interest: K Ledwoch is partly funded by GAMA Healthcare Ltd.

J Infect Prev. 19(1 Suppl):S4–S63.

164

Wet cupping: Developing a toolkit to address a potential infection control issue

Karen Hawker 1, Ann Lusmore 1, Rebecca Stretch 2

Abstract

Introduction

Cupping is an alternative therapy with roots in different cultures. Dry cupping involves applying suction to an area of skin. In wet cupping, application of the vacuum is accompanied by small skin incisions, inducing bleeding. Also termed Hijama (Arabic for “sucking”) wet cupping is increasing in popularity in some groups.

Method

Due to the invasive nature and blood exposure during wet cupping, poor infection control practice could lead to infection or injury. Frameworks for environmental health departments to regulate this “special treatment” are dependent on local licensing arrangements where they exist, although health and safety and public health legislation can be used where an immediate danger to the public can be demonstrated. There are currently no national guidelines, although local policies exist, such as Leicester City Council’s. To address this, Public Health England (PHE) has formed a multidisciplinary working group to develop a national toolkit for Environmental Health Officers and practitioners. The group has representation from PHE, the Chartered Institute of Environmental Health (CIEH), the Health and Safety Laboratory (HSL) and local authorities, plus a practitioner. The format will be based on the Tattooing and Body Piercing Guidance Toolkit (2013), with each section allocated to a sub group (see Table). Section 2 is being prepared by representatives from PHE and HSL. The section will consist of main guidance and more in-depth appendices.

Results

The Infection Control subgroup has agreed the contents of the section, which are ready to take forward for incorporation into the main document.

Discussion

Whilst evidence of outbreaks associated with wet cupping are lacking, in countries where the practice is more prevalent, surveillance for blood-borne viruses identifies the practice as a risk factor. When completed this toolkit will assist environmental health departments ensure safety for clients and practitioners.

graphic file with name 10.1177_1757177418794054-img10.jpg

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

16

The impact of biosafety trainings on knowledge and attitudes of life sciences students towards biosafety in Hazara, Khyber Pakhtunkhwa, Pakistan

Faizan Rashid 1, Sumbal Fatima 1, Sana Jalal 1

Abstract

Introduction

The current study aimed to assess the impact of biosafety training on knowledge and attitude of life sciences students towards biosafety in Hazara, Khyber Pakhtunkhwa, Pakistan.

Methods

This study was conducted from January 2018 to April 2018 at five different universities. Data was collected from a total of 256 students in various life sciences departments using a pre-designed questionnaire. The information about attitude and use of standard laboratory practices in laboratory and biosafety awareness was obtained using 40 different survey questions.

Results

In total 210 (82%) of study participants had received one or more biosafety training sessions in the past from four major organisations currently working on biosafety awareness in Pakistan. The knowledge gaps were observed with respect to biosafety in both untrained and trained students for each of the survey questions. A significantly lower percentage of untrained students reported knowledge about proper use of personal protective equipment (PPE), primary safety devices, waste disposal methods and emergency responses as compared with trained students. Despite the fact that the trained students had a better knowledge, the compliance rate to various standard laboratory practices ranged from 46.1–85.2% among trained students.

Discussion

The survey results showed a better attitude and level of awareness among trained students as compared with untrained students. However, the lower compliance rate among trained students for some of the standard laboratory practices could be due to non-availability of most of the standard operating procedures revealed from survey results. Therefore, strong leadership is required to ensure compliance with SOPs. In addition, adequate supply of lab equipment and PPE should be maintained, with refresher biosafety training for all life sciences students.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

20

Low-fidelity simulation-based training: Mandatory infection prevention and control training for combat medical technicians

Major Johan Dews 1

Abstract

Introduction

This teaching innovation in practice aimed to establish if delivering mandatory Infection Prevention and Control (IPC) training as a practical, low-fidelity simulation-based session would increase interest and knowledge in IPC and demonstrate the impact of poor compliance for Combat Medical Technicians.

Methods

Following a theoretical teaching session, a clinical simulation suite was used to emulate two bed spaces within a Field Hospital Unit. Students were asked to observe and document poor IPC practices within the care environment during role-play, then reflect on their findings and feedback to the group. UV gel and powder was used to illustrate how easily micro-organisms can be spread about the care environment, highlighting the impact of non-compliance.

Results

The students completed a pre-and post-learning questionnaire to demonstrate understanding, along with an evaluation to establish their perceptions of the simulation session. The post-training questionnaire demonstrated a 30% increase in learning after the simulation session when compared with the pre-training questionnaire results. 54% of the respondents scored the session 10/10 for all evaluation questions, stating that the session was “fun and informative” it “improved my knowledge of IPC” and “will make me more aware of my actions”. One respondent gave a score of 8/10 for “relevance of the topics” and suggested that donning and doffing techniques were taught.

Discussion

The simulation-based session directly transferred the theory learnt in the classroom into simulated clinical practice. Visual cues are a powerful tool to demonstrate poor compliance, as the students were visibly shocked when they observed how easily the UV was spread around. Simulation-based training is resource heavy, requiring a clinical simulation suite, consumables and Subject Matter Expert guidance. This simulation-based training proved to be beneficial for students, increasing their interest, interaction and confidence in IPC practices, and will influence my future practice as an IPC nurse and nurse educator.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

29

Using ANTT® CATS (Competency Assessment Tools), a guide for nurse assessors and nursing students

Lisa Duffy 1

Abstract

Aim

This poster provides information on various ways that both nurse assessors and nursing students can effectively support the learning and assessment strategy using ANTT® CATS in order to promote evidence-based practice and reinforce safe clinical practice.

Method

Critically reviewing literature relating to the ANTT® CATS competency evaluation tool was utilised to identify ways assessors can effectively support the assessment process for students, by highlighting students’ responsibilities relating to assessment, and the skills, knowledge and expertise individual assessors require to assess effectively.

Results

The use of ANTT® CATS:

  • Enables students to practise new skills in a safe environment and learn from mistakes.

  • Improves students’ wound-dressing skills and build individual students’ confidence.

  • Allows assessment of theoretical knowledge in relation to ANTT.

  • Promotes evidence-based practice and reinforces safe practice.

  • Provides a way of assessors synthesising observations and questioning into an overall score which can reduce assessor subjectivity.

  • Ensures accurate description of the required skill to assess a student as being competent.

Discussion

This poster highlights various factors that can influence the delivery of effective formative assessment using ANTT® CATS. In addition, the poster identifies and reinforces the need to ensure that effective feedback methods are used and students’ perception and participation is considered.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

38

Keeping staff and patients safe: Healthcare workers and respiratory protection equipment review using the Leeds Improvement Method

Charlotte Lobley 1, Halina Davidson 1

Abstract

Introduction

The Health and Safety Executive (HSE) review of Respiratory Protective Equipment (RPE) (2013) mandates that healthcare workers (HCWs) using RPE must be trained in its use and be tested for achieving correct mask fit by an accredited person. Leeds Teaching Hospitals NHS Trust had a two pronged approach to achieve this:

  • “Train the Tester” sessions facilitated by an accredited provider (external company) offered on a “first come first serve” basis.

  • The infection prevention nurses (IPNs) ran a fortnightly session for staff to be tested which was booked through organisational learning, which were often under filled.

The process was reviewed using the Leeds Improvement Method (LIM) adapted from the prestigious Virginia Mason Institute to examine the values and wastes within this process and to ensure compliance with the legislation.

Method

Benchmarking against peer Trusts:

  • Questionnaires to existing testers.

  • 5s applied to a fit test from collection of equipment to completion of the test.

  • Audit of IPN sessions utilised.

The findings:

  • Variation in the number of trained testers within clinical service units (CSUs).

  • Gaps in the number of staff tested in line with the HSE legislation.

  • Inadequate record keeping.

  • Underutilisation of training sessions with a 38% fill rate recorded.

Results

  • Targeted training sessions for CSUs with no or low numbers of testers.

  • Standardisation of the number of testers required for each area.

  • Step-by-step instructions produced for each fit testing bag.

  • Refresher sessions provided by IPNs to existing trained testers focusing on the testing and documentation process.

Discussion

A standardised approach to Fit testing is now in place throughout the Trust, ensuring staff and patients are protected from respiratory viruses when FFP3 masks are worn. Elimination of waste can be achieved by utilising the LIM.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

61

Scottish Infection Prevention and Control Education Pathway (SIPCEP)

Sabine Nolte 1, Sarah Freeman 1

Abstract

Introduction

NHS Education for Scotland has developed the Scottish Infection Prevention and Control Education Pathway (SIPCEP) to enable Scottish health and social care students and staff from all care settings to continually develop their IPC knowledge and skills by selecting learning resources appropriate to their role. Comprising three layers (Foundation, Intermediate and Improvement), this is the first education pathway of its kind. The Foundation Layer includes 15 e-learning modules and other resources. All content is closely aligned with the National Infection Prevention and Control Manual (NIPCM).

Methods

The SIPCEP was developed in close collaboration with stakeholders from all care settings, including strategy workshops, focus groups, content development and piloting. The project is governed by the SIPCEP Advisory Group. Content plans were created using an Action Mapping approach, focussing on job tasks. HAI Education Leads identified critical elements and common areas staff find most challenging in practice for each Standard Infection Control Precaution, to be addressed in the content using scenario-based learning.

Results

The SIPCEP Foundation Layer was launched at the NHS Scotland event in June 2017 and is now embedded in the IPC education strategies in most NHS Scotland boards. It is being used in more than 30 university and college locations. There have been over 160,000 module completions in the first year, with uptake across a wide range of staff and student groups (>47,000 users enrolled in the first year).

Discussion

Further promotion and implementation activities need to be carried out, with an emphasis on line managers, who are crucial in ensuring that personalised learning pathways are created. It is hoped that flexible learning for students and staff as appropriate to their role will also have an impact on succession planning for IPC teams. A first-year evaluation of the Foundation Layer is currently under way.

graphic file with name 10.1177_1757177418794054-img11.jpg

graphic file with name 10.1177_1757177418794054-img12.jpg

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

65

Education through gaming: e-Bug educational online games for school aged children to learn about microbes, the spread of infection and antibiotics

Charlotte Eley 1, Vicki Young 1, Catherine Hayes 1, Neville Verlander 2, Cliodna McNulty 1

Abstract

Introduction

Education of children and young people can raise awareness, increase knowledge and modify behavioural intentions around hygiene and antibiotic use, so helping to control antibiotic resistance. e-Bug, led by Public Health England, educates children and young people on hygiene, the spread of infections and antibiotics. Body Busters and Stop the Spread are two new educational games on the e-Bug website aiming to increase student knowledge on microbes, appropriate antibiotic use, and value of vaccination and preventing the spread of infection. This study aimed to measure knowledge change and student views on these games.

Methods

Researchers attended five educational sites across the UK and observed students playing on “Body Busters” and “Stop the Spread”. Students completed before and after knowledge questionnaires, evaluation forms and participated in focus groups at all sites to provide feedback on games.

Results

In total, 123 junior and 350 senior students completed both knowledge questionnaires. Junior students showed significant (p<0.05) improvements in knowledge in four out of 12 questions asked, while senior students saw significant improvement in six. Both age groups had knowledge improvement around correct antibiotic use, preventing the spread of infection when we sneeze, and the value of vaccinations. Ten junior and 16 senior student focus groups (149 students) were conducted. Qualitative results for Body Busters found that it was engaging, with correct level of difficulty and students liked the different levels and good bacteria. Stop the Spread was described as stressful, fast paced and challenging but reported an increase in knowledge particularly around vaccinations and health behaviour intentions.

Discussion

The e-Bug online games are a useful tool to increase awareness and knowledge around microbes, the spread of infection and antibiotics. Suggestions for game improvements include; more levels and creating options for the user to choose the difficulty.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

71

Education on the frontline: IPC Focus Week

Claudia Salvagno 1

Abstract

Introduction

Education of healthcare workers is of high priority for Infection Prevention and Control, but often high workload is keeping staff far from the classroom. A new approach to it has been developed: the IPC Focus week. The aim of the project is to offer accessible, constructive and tailored education to staff in the clinical area.

Methods

During the IPC Focus Week, two IPC Band 5 work in one unit for a week. They shadow registered nurses and clinical support workers to deliver hands-on teaching and provide live evaluations. Drop-in teaching sessions and ad-hoc short talks are also held daily in order to involve the multidisciplinary team. Observing while helping allows personalised feedback with minimal disruption on the workload. This is also a precious opportunity to understand and address challenges toward IPC compliance the workers may encounter in their daily practice. At the end of the week, the wards’ managers have been asked to circulate an online evaluation survey.

Key results

The IPC team has held the project in six units between February and May 2018; 17 people have completed the survey in this period.

  • Improvement on units’ approach to IPC issues has been reported in 92% of the cases.

  • 11 staff indicated a better understanding on isolation of infectious patients and management as the single most valuable thing learned during the Focus Week.

  • No negative comment was recorded to the question “What did you dislike about the event?”

  • 100% of the respondents would advise the IPC Focus Week to other units.

Conclusion

The project has proved to provide valuable IPC updates to clinical staff with a personalised approach and minimal disruption on workload. The programme has just only begun, but more units in the whole Trust will have an IPC Focus Week in the foreseeable future.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

83

Application of MRSA suppression therapy

Dawn Hoole 1, Robert Chambers 1, Claire Haill 1

Abstract

Introduction

DoH Saving Lives (2006) outlines the requirement that hospitals implement MRSA decolonisation programmes. Often these utilise a topical agent such as Chlorhexidine applied as a wash and a nasal ointment such as Mupirocin applied to the nostrils. In order for these regimes to be effective these agents must be correctly applied.

Methods

Registered nurses (RN) and health care assistants (HCAs) were questioned to establish knowledge of the correct application of suppression therapy. Five wards were included, representing a range of specialties. The project audited the application of suppression therapy against standards set out in the Management and Control of MRSA policy and the instructions set out in the Chlorhexidine and Mupirocin patient information leaflets. One ward was audited each day over the 5-day period. The interviewer arrived on the ward unannounced, interviewed as many RNs and HCAs on shift as possible; feedback was given if any answers were incorrect at the conclusion of the interview on a one-to-one basis.

Results

Our results demonstrated poor knowledge of applying Chlorhexidine to patients who need assistance with hygiene (specifically that the product should be applied neat to the skin) and about the frequency that it should be applied to the hair.

Discussion

This project prompted changes to training delivered to staff, both on induction and at ward level. Posters, aide memoires and teaching aides were produced and disseminated.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

141

Creating and delivering a sepsis care improvement programme in a multidisciplinary, non-acute NHS Trust

Jennifer Adams 1

Abstract

Introduction/background

Sepsis claims approximately 44, 000 lives annually in the UK, but until recently few had heard of it. Early intervention saves lives. In hospitals and long-term care facilities, sepsis is one of the most common causes of patient deterioration. In the community it accounts for 10–20% of adult medical emergencies. Urgent basic care can make a real difference between survival and death.

Methods

Delay in accessing antibiotic treatment has a major impact upon the likelihood of recovery for the patient, so it is imperative that patients receiving services from our Trust do not experience delay in accessing treatment where sepsis is suspected. Awareness is key. As a Trust our aim was to raise awareness by educating our entire patient-facing staff. We have developed a Sepsis Care Improvement Programme, which includes an e-learning programme specific to our responsibilities.

Results

Following a pilot programme, we rolled out our work Trust wide. Early feedback already highlights successful application of the pathways and sepsis screening tools. We anticipate further staff confidence to suspect sepsis appropriately. Ultimately this is resulting in improved patient care by facilitating timely access to intravenous antibiotics as per NICE guidelines.

Discussion/conclusion

As a non-acute Trust we are not responsible for the diagnosis and management of sepsis. NICE guidelines state, “Give intravenous antibiotics without delay and at least within one hour of identification of high risk criteria” (NG51, July 2016). The challenges facing our multidisciplinary services are very specific regarding identification of suspected sepsis, and these will be covered by the proposed poster and oral presentation. Our Trust provides mental health, physical health and young person’s services, both as inpatients and in the community. Our staff need to be aware of when and what actions to take where sepsis is suspected.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

161

Initial evaluation of an executive leadership development programme for aspirant or new directors of infection prevention and control (DIPC) in England

David Charlesworth 1, Gaynor Evans 1, Linda Dempster 1, Gavin Eyres 1, Helen Wilkinson 1, Ranvir Virk 1

Abstract

Introduction

The Director of Infection Prevention and Control (DIPC) role was first introduced in England in 2003 (DH 2003). Changes in health and social care provision and accountability have made the DIPC role increasingly challenging and complex. In some organisations this has made the role harder to appoint into, and to identify effective leaders committed to reducing infection rates and impacting on patient outcomes and experience across the wider health economy. This poster will describe the delivery of a national scheme to develop the next generation of individuals aspiring to progress into a DIPC role, as well as support people newly in post in the role.

Methods

The Executive Development Programme (EDP) consists of three modules, each delivered over two residential contact days, with additional supported action learning sets and a final celebratory event. Thirty delegates were selected for the first cohort from applicants from across the wider health economy via initial self- or organisation nomination then successful completion of an assessment centre.

Results

This poster will provide delegate and programme evaluation on the first cohort. A second cohort is being recruited to start in autumn 2018.

Discussion

Through co-design of the national programme to deliver the UK Government Gram-negative bloodstream infection ambition, a gap in executive leadership development was identified. Given the renewed national profile for infection prevention and control, the aim of this bespoke leadership course is to provide a platform for the sustainability of the next generation of DIPCs. The EDP is a mix of taught and self-directed leadership activities and aims to facilitate Board engagement and assurance for IPC through influencing, coaching and facilitation skills. The EDP is contributing to an enhanced system-wide profile for IPC, supporting safe delivery of care and improving patient outcomes and a sustainable future leadership workforce.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

162

Appropriate glove use survey during Glove Awareness Campaign as a guide for IPCT to plan focused education sessions in acute Trust

Eimear Donnelly 1

Abstract

Introduction

The Royal College of Nursing (RCN) launched a Glove Awareness Campaign during 30th April–4th May 2018. Previous discussions within the IPC team revealed concerns about glove misuse; therefore, we used the RCN campaign to survey staff to determine training requirements.

Methods

The survey created asked participants to provide examples of their use of sterile, non-sterile and glove use not indicated. All staff groups were invited to complete the survey, given to participants from a stand promoting best practice. The RCN leaflet promoting glove awareness was provided, and multiple incentives encouraged engagement with the IPC team.

Results

In total 100 surveys were completed; 92% of staff indicated the correct choice of glove for the task. 8% of staff didn’t provide examples of tasks were gloves were not indicated, whilst 6% chose to wear gloves that may not be required. 5% inappropriately chose sterile/non-sterile gloves for aseptic non-touch technique (ANTT) procedures. 3% of staff on the day had had dermatitis, and were referred into Occupational Health.

Discussion

The results show high levels of knowledge regarding glove use. Clarity is needed when choosing the correct glove for the task, including ANTT, and whether gloves are needed at all. Developing staff knowledge and confidence to undertake those risk assessments is key to appropriate glove use and reducing occupational dermatitis.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

174

Skyping solutions to improve remote training

Joanne Reynard 1

Abstract

Introduction

Infection prevention mandatory training is a requirement for all healthcare professionals (HCP); updates have previously been provided face to face at planned sessions or meetings. In order to get greater staff attendance, innovative ways were needed to train HCP working in police custody. Due to the role and geography (area of 15,420 km2), there are usually one or two HCPs working per shift, and three to five per region (16 suites). Time away from direct patient care is increased when staff members have to travel to complete training meetings, etc. Further sessions are planned and detailed analysis will be provided after these sessions.

Methods

The Trust is working to develop innovative ways to use technology; Skype for business was seen as a potential solution for meetings and direct communication. To take this forward the Custody and IPC leads opted to trial Skype training. PowerPoint and videos were developed to share online, and teams were trained show to use Skype.

Results

Though in its infancy (one session), this has reduced travelling by over 18 hours (six staff attending), reduced costs associated with time, and increased time able to be spent with direct patient care. Initial feedback is positive and further in-depth evaluation is taking place; it increased morale. Though there were some teething problems with this session it was not deemed as an issue by these staff. Staff members were able to have discussions these within the session.

Discussion

This still has areas for development and the training session is still not finished, but within the next few weeks this approach will revolutionise IPC training within hard-to-reach areas. There are plans to make this technology available within the IPC office and not solely on laptops, so that staff are able to direct reactive day-to-day questions as well as training.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

19

Celebrating 70 Years of the National Health Service: An infection prevention and control perspective

Tracey Jones 1, Jen Adams 1, Louise Phimester 1, Ben Lynch 1, Natalie Brett 1

Abstract

Introduction

In 1948 Aneurin Bevan had a vision to bring good health care to all (NHS Choices, 2018) and the service that this vision birthed has both endured and overcome numerous and varied challenges throughout its first 70 years. Likewise, the Infection Prevention Society (IPS) was no less ambitious when it described its vision, “That no person is harmed by a preventable infection (IPS)” (Infection Prevention Society, 2018). The work of the IPS during its first decade has provided all infection prevention and control practitioners locally, nationally and internationally with a robust evidence base on which to develop their practice. It seems fitting, at this juncture, to highlight the reciprocity of this relationship and as a consequence the milestones achieved in enhancing patients’ experiences of their care and ensuring their safety.

Aim

The aim of this poster is to celebrate the symbiotic relationship between the National Health Service (NHS) and Infection Prevention and Control (IPC) and all that this has achieved. The poster will take the form of a timeline that showcases significant NHS and IPC milestones, including those achieved by the IPS, that have enhancing patients’ experiences of their care and ensured their safety.

Footnotes

Declaration of interest: No conflicts of interest to declare.

References

  1. Infection Prevention Society (2018) About IPS. Available from: https://www.ips.uk.net/about/ [Accessed 16th May 2018].
  2. NHS Choices (2018). The history of the NHS in England. Available from: https://www.nhs.uk/NHSEngland/thenhs/nhshistory/Pages/NHShistory1948.aspx (Accessed 16th May 2018).
J Infect Prev. 19(1 Suppl):S4–S63.

112

Equipping a new Mother and Baby Mental Health Unit to be “infection prevention ready”

Penny Criddle 1, Bridget Spooner 1, Hannah Fieldhouse 1

Abstract

Introduction

NHS England announced funding of new Mother and Baby units in England in 2017 to increase capacity of mental health inpatient beds in this specialty and improve access for women who previously had to travel considerable distances for this care.

Methods

Examples of how the IPC team aided equipping of the unit to meet IPC standards will be given under the following headings:

Building scheme: The IPC team used the principles of the Department of Health’s HTM 00-09 Infection Control in the Built Environment and knowledge of mental health inpatient services to advise the project group on both an interim and a new unit.

Policy Development: Many existing IPC policies required amendment to ensure risks associated with pregnant or new mothers and babies were considered. New policies to ensure safe working practices in aspects such as storage and handling of expressed breast milk were required.

Education: A bespoke programme of education was implemented to equip the multidisciplinary team. This included use of practical scenarios and simulation-based methods to demonstrate and practice key IPC activity.

Results

Photographs from the interim unit will be used together with an evaluation of some of the lessons learnt from the project. The challenges of meeting IPC standards in an existing old building, as well as meeting the aesthetic and therapeutic needs for this speciality are described.

Discussion

The early involvement of IPC teams in new services is of vital importance. Being involved with the project group, newly formed multidisciplinary team and having time to provide education at an early stage allowed IPC principles to be incorporated into practice from the outset. Meeting clinical and aesthetic needs whilst reducing infection risk is a challenge, but can be achieved.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

10

Are acute NHS Trusts in England doing enough to prevent the cross-border spread of carbapenem-resistant Enterobacteriaceae?

Sharon Mawdsley 1

Abstract

Introduction

Public Health England (PHE) (2013) advocates screening patients who have recently been in hospitals (in the UK or abroad) known to have problems with carbapenem-resistant Enterobacteriaceae (CRE). However, the European Centre for Disease Prevention and Control (ECDC) (2016) also advises screening patients who have recently travelled to countries known for their high rates of CRE, even if they were not in contact with a healthcare institution.

Methods

152 acute NHS Trusts in England were invited to participate in a multicentre quantitative study via an online survey. The survey consisted of a number of questions relating to local CRE screening policy and how that policy aligns with PHE and ECDC guidance. The questionnaire also included questions relating to local CRE surveillance and screening results.

Results

In total 91 Trusts (60%) completed the survey; 83 Trusts (91.2%) adhere to the PHE (2013) guidance. However, only 22 Trusts (24.2%) have adopted the ECDC (2016) recommendations. This is a concern given that 31 of the Trusts (34.1%) have reported incidences of person-to-person transmission, of which 45.2% was related to foreign travel. Furthermore, 31 of the participating Trusts (34.1%) reported that patients who have had an admission to a hospital in the UK not known to have a high prevalence of healthcare-associated CRE had screened positive. This is also a concern as 54 participating Trusts (59.3%) do not routinely screen all patients that have been hospitalised in the UK.

Discussion

Some Trusts are not doing enough to prevent the cross-border or indeed inter-hospital spread of CRE. Mandatory participation and completion of all fields within the existing PHE Electronic Reporting System for carbapenemase-producing Gram-negative bacteria could provide PHE with the epidemiological evidence required to support widening the screening criteria for CRE.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

26

Laboratory-confirmed primary bloodstream infections in patients with cancer

Jinhong Lee 1, Kowoon Choi 1, Byeongyeo Lee 1, Heejeong Kang 1

Abstract

Introduction

We investigated the characteristics and epidemiology of bloodstream infections (BSIs) in haematological malignancies (HM) and solid tumour (ST) patients.

Method

We reviewed the medical data of patients who developed BSIs from January 2017 to October 2017 at a 571-bed cancer centre. Characteristics of patients with HM and ST were compared. Total BSIs, catheter-related bloodstream infection (CLABSI), mucosal barrier injury–laboratory-confirmed bloodstream infection (MBI-LCBI) and non-MBI-LCBI rates were compared between HM and ST patients.

Results

In total 133 BSI episodes were developed from patients with HM and ST; 44 occurred in patients with HM and 89 in patients with ST. A total of 83 CLABSIs were identified during the study period; 41 cases in HM patients and 42 cases in STs were CLABSIs. There was a significant difference in the incidence of MBI-LCBI between HM and ST (52.3% vs. 3.4%, p<0.05). Gender, age, ICU admission, and hospital days were not different between HM and ST. However, neutropenia (72% vs. 11.2%), use of central catheter (93.2% vs. 50.6%), type of central catheter (Hickman cath vs. implanted port), blood transfusion (95.5% vs. 32.6%), total parenteral nutrition (TPN) infusion (27.3% vs. 47.2%), MBI-LCBI (52.3% vs. 3.4%) were different between the two groups (p<0.05). Escherichia coli was the most common organism in both HM and ST, followed by K. pneumoniae. Fungaemia was identified in 13 cases (9.8%), 12 in ST and one in HM. Fungaemia was significantly higher in TPN-infused patients during the 7 days prior to collection of the positive blood culture in ST (p<0.05).

Discussion

We identified significant differences in the characteristics of BSI in patients with HM and in those with ST. CLABSIs were more frequently developed in neutropenic patients with HM. Fungi were more often isolated in patients with ST in the case of TPN-infused patients.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

36

Engaging multidisciplinary teams in infection prevention & control quality improvement programmes

Lilian Chiwera 1, Neil Wigglesworth 1

Abstract

Introduction

Multidisciplinary (MDT) working is increasingly being recognised and acknowledged as a cornerstone for effective quality improvement initiatives. However, changing organisational culture and engaging MDT teams fully can be a huge, yet necessary, undertaking in health care where there is a need to continually update practice in line with emerging evidence. Poor uptake of robust surgical site infection surveillance (SSIS) may be attributed to a lack of resources. In 2009, Guy’s & St Thomas’ NHS Foundation Trust embarked on a daunting task of expanding SSIS beyond mandatory requirements, despite having limited resources.

Methods

We identified factors that were and remain critical to successful engagement, and explored ways an effectively collaborating MDT could help in overcoming barriers that threaten our success. To overcome any challenges, face-to-face meetings with key opinion leaders and / senior leadership (who became respective SSIS Leads) in various departments were proposed. This was followed by several 1:1 meetings and presentations for staff at various fora.

Results

Despite initial challenges, focusing on patient benefit improved engagement and uptake of continuous surveillance of up to 12 surgical categories, championed by front-line staff and a surveillance team of three. The Trust is now supporting the introduction of electronic SSIS wound documentation to promote better compliance and more joined-up care. Our SSIS Leads engage fully with SSI detailed investigations and shared learning. MDT working, and efficient use of available IT systems, has significantly reduced data-collection burden, enabling us to sustain an important quality improvement initiative.

Discussion

Engaging MDT in quality improvement work is not an easy task and requires a lot of patience, passion and perseverance. The sustained growth and success of our SSIS has been achieved in part through the use of effective collaborating MDTs and should be promoted.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

40

Evaluation of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia: Clinical characteristics, epidemiology and outcomes in the elderly (EMBRACE ME)

Kejal Hasmukharay 1, Sasheela Sri La Sri Ponnampalavanar 1, Tan Kit Mun 1

Abstract

Introduction

MRSA bacteraemia is a major concern globally; however, local data in Asia is scarce, especially in the elderly.

Methods

This is a 5-year retrospective study conducted in University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia, including adult patients (>18 years old) with MRSA bacteraemia from 1 January 2012 to 31 December 2016.

Results

The incidence of MRSA bacteraemia increased from 0.12/100 admission (2012) to 0.17/100 admission (2016). Out of 275 patients, 139 (50.5%) cases occurred in patients ⩾65 years old. Comorbidities and severity were significantly more in the older adults (Charlson score >4: 79.9 vs. 43.4%, p<0.001, Pitt score ⩾3: 23.7 vs.12.5%, p=0.016). Primary bacteraemia was more frequent among those ⩾65 (36.7% vs 28.7%, p=0.157), while younger patients had more central-line-associated bloodstream infections (CLABSI) (37.5% vs. 17.3%, p<0.001). Only 18.3% of the older adults and 14.2% of the younger adults received effective empirical MRSA treatment. All-cause mortality and in-hospital mortality were significantly more frequent in the older persons (82.7 vs. 63.2%, p<0.001; 66.1 vs. 28.7%, p=0.02). In multivariate analysis, age ⩾65 (aOR: 3.36, CI: 1.24–9.13), Pitts score ⩾3 (aOR: 2.15, CI:1.54–3.01), hospital (aOR: 6.12,CI: 1.81–20.72) and healthcare acquisition (aOR: 3.19, CI: 1.30–7.8), indwelling urinary catheters (aOR: 5.43, CI: 1.39–21.23), no infectious disease team consult (aOR: 2.90, CI: 1.44–8.11) and hypoalbuminaemia (aOR: 3.31, CI: 1.25–8.79) were independent risk factors for 30-days mortality.

Discussion

Older persons had three times higher risk of mortality, were more likely to acquire HA/HCA-MRSA and they were less likely to get appropriate antibiotics therapy (empirical and targeted). The possible reasons are immunosenescence, fraility and poor infection control measures. As the world’s older population is growing, specific guidelines for the prevention and management of MRSA bacteraemia should be developed. This EMBRACE ME study has laid a platform for more robust studies realising the paucity of such data in Asia, and is a call for developing and validating a scoring system that will assist in risk-stratifying patients.

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Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

48

Timely feedback to multidisciplinary clinical teams (MDT) using statistical process chart (SPC) methodology to minimise patient harm from surgical site infection (SSI) in three District General Hospitals

Clare Penrice 1, Elizabeth Young 1, Alison Gold 1

Abstract

Introduction

Local surveillance of surgical site infection (SSI) combined with effective feedback is essential to maintain safe systems. Statistical Process Control (SPC) charts enable the understanding of system performance, reduce variation, drive quality improvement and detect out-of-control episodes. NHS Lanarkshire (NHSL) has used SPCs since 2013; we sought to improve our current chart production to increase capability to detect out-of-control episodes and improve feedback communications.

Methods

  • All local SPCs were reviewed to ensure their capability to detect out-of-control episodes and improve feedback and feeding forward.

  • Training on SPCs was provided by an external consultant to all IPCNs and surveillance nurses.

  • The procedure following the identification of an SSI was modified to more promptly involve the surgeon.

Results

  • Nine SPCs of SSIs are produced monthly and fed back to clinicians, microbiologists, anaesthetists, senior management, senior charge nurses, theatre managers, Infection Prevention and Control Team (IPCT), enhanced recovery after surgery (ERAS) nurses, antimicrobial pharmacists.

  • Since the changes no positive out-of-statistical-control episodes have been identified.

  • Early detections of possible out-of-control episodes have been identified, enabling prompt feedback and alert warning.

  • SPCs are also fed forward to management via the IPCT regardless of there being out-of-control episodes.

Discussion

The most effective type of surveillance is local surveillance involving feedback to those whose work generates the data (in this case the surgeons). Sometimes when rates are low (or even zero), teams in NHSL have requested to continue to have a chart as this enables positive feedback to staff. All systems require updating and modifying to ensure they remain relevant and capable of detecting issues. We will continue to engage with all those who receive our feedback to ensure its relevance.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

70

Preliminary analysis of mandatory Klebsiella sp. bacteraemia surveillance risk factor data, West Midlands, England

Shakeel Suleman 1, Obaghe Edeghere 1, Catherine Alves 1

Abstract

Introduction

Surveillance of Klebsiella sp bacteraemia became mandatory in England in April 2017. We describe the epidemiology and antibiotic non-susceptibility patterns of Klebsiella bacteraemia in the West Midlands.

Methods

This is a descriptive analysis of individual-level data on all Klebsiella bacteraemia episodes in the West Midlands reported to the English mandatory surveillance system for the period 2017/18. Episodes of Klebsiella infection were categorised as “hospital-onset” or “community-onset” based on the difference between the admission and specimen dates. This dataset was matched with antibiotic susceptibility data from the Second Generation Surveillance System (SGSS) – PHE laboratory surveillance system – for the same time period. Additional trend data for the period 2013/14 to 2017/18 was extracted from SGSS. We focussed on the surveillance of drug–bug combinations recommended by the UK 5-Year AMR Strategy.

Results

Between 2013/14 and 2017/18, laboratory reports of Klebsiella bacteraemia incidence increased by 27.5%. The majority of episodes (69%) occurred in persons aged 65 years and over and males (60 %). Over the 5-year period, Klebsiella sp. isolates were non-susceptible to third-generation cephalosporins (8.2%) and carbapenems (0.6%). Non-susceptibility to cephalosporins remained broadly unchanged. In the mandatory system, data completion was 100% for age and sex and more than 99% for specialty. However, completion for key risk factor variables was low. Univariate analysis showed that non-susceptibility to cephalosporins was higher among hospital-onset cases (p=0.014), haematology speciality (p=0.026) and cases with increasing antibiotic courses prescribed 28 days prior (p=0.0079).

Discussion

Klebsiella bacteraemia disproportionately affects the elderly. Antibiotic non-susceptibility was highest among hospital-onset cases, and the overall regional estimates are broadly consistent with the picture in England. This preliminary analysis is based on an evolving surveillance system and is limited by the low completion of key risk-exposure data fields. It is important that detailed and quality data are captured to support interventions.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

75

Increased incidence of Pseudomonas aeruginosa on a Neonatal Unit

Nicola Colborne 1, Tina Oldfield 1, Judy Potter 1

Abstract

Introduction

The Neonatal Unit (NNU) has 23 incubator/cot spaces. Neonates admitted to NNU are screened weekly for MRSA and Pseudomonas aeruginosa. Sites screened are nose, umbilicus and perineum. Screening has been undertaken since 2016. Water testing for P. aeruginosa has been undertaken since 2012 as per Department of Health (DH) guidance on sampling in augmented care areas. A total of five neonates screened positive on routine screening for P. aeruginosa between July 2017 and October 2017. One of these neonates was also positive in a clinical isolate. Routine water sampling had not identified any issues.

Methods

An incident meeting was held and cases were discussed. Screening samples and the clinical isolate were sent for typing to determine common strains. Estates carried out further water sampling of outlets. Environmental sampling was also undertaken. Neonates were barrier nursed in cubicles with infection control precautions implemented. All neonates were washed with sterile water instead of tap water (a change in practice).

Results

No P. aeruginosa was identified in the water outlets or on environmental sampling. Typing indicated that all screening isolates of P. aeruginosa were different, so cross-infection was not identified, neither was environmental contamination. Three of the types are very common types. Of note, one of the positive neonates had the same P. aeruginosa type as their sibling, who was positive in September 2016. Hand hygiene compliance remained about Trust target during this period.

Discussion

Weekly screening for early identification of potential outbreaks in augmented care areas proved valuable in this instance. NNU staff were fully engaged in the process of investigation. This very prompt identification and action plan ensured protection of extremely vulnerable neonates from risk of infection. In turn, parents of neonates had continued confidence in the safe care of their babies.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

89

Antibiotics used in the intensive care unit: Focus on resistant pathogens

Abu Hena Mostafa Kamal 1, Wahida Khatun 1, Pranab Karmaker 1

Abstract

Introduction

Klebsiella pneumoniae and Escherichia coli are among the most rampant organisms causing infections in the intensive care unit (ICU), Rajshahi Medical College Hospital (RMCH), Bangladesh. Their common relationship with multidrug resistance has challenged traditional treatment options which include the use of β-lactam antibiotics. Although quiet rare, carbapenem resistance in Enterobacteriaceae (defined as meropenem MIC ⩾ 4ug/ml) has emerged in ICU, RMCH, Bangladesh. Although these are not “carbapenem-resistant” strains, they are not wild-type carbapenem-susceptible strains and are labelled as “carbapenem reduced susceptible-CRS” E. coli and K. pneumoniae throughout this research.

Methods

Resistant strains including one reference strains (DH5α) and several clinical strains were recovered from patients. Susceptibility test was performed using Mueller Hinton Agar media (disc diffusion method). Pulsed-field gel electrophoresis (PFGE) was performed for all clinical strains.

Results

Total admission in the RMCH was 1367 patients and suspected sepsis patients were 305 (22%) which were referred to the ICU. This study found that 129 (42.3%) out of 305 suspected sepsis cases were positive; the majority of the isolated micro-organisms were Gram-negative bacteria 58% (75), followed by Gram-positive bacteria 38% (49), and 3.8% (5) were the fungus Candida albicans. The resistance rates for different types of antibiotics were used in this study (common antibiotics). The resistance rates of K. pneumoniae to the third-generation cephalosporins, ceftazidime, ceftriaxone and meropenem were lower than those in the study carried out in 2014, but were higher than those in the study carried out for the year 2015.

Discussion

Antibiotic-resistant organisms are a growing concern all over the world and also in our country. These resistant organisms create lots of problems in ICU, RMCH. At present, mortality and morbidity of sepsis patient is high due to delayed recognition and inappropriate and insufficient management of sepsis in the ICU in Bangladesh.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

94

What have we learnt from a year of reviewing E. coli bacteraemias?

Katie Hardy 1, Jane Codd 1, Karen Porter 1

Abstract

Introduction

Escherichia coli blood stream infections cause a significant amount of morbidity and mortality, and have been increasing in the United Kingdom. This rise in incidence has led to a national target to reduce the incidence of E. coli bacteraemias by 50% by 2021. The most common focus for E. coli bacteraemia is urinary, with a high prevalence of these being community onset.

Methods

From April 2017 to March 2018 all E. coli bacteraemia cases were identified by the laboratory and designated as healthcare onset, community onset healthcare associated or community onset. Basic demographic data was collected on all community-onset cases and a comprehensive data set of risk factors collated for healthcare-onset cases, involving note reviews and root cause analysis.

Results

There were a total of 642 E. coli bacteraemias during the 12-month period, of which 105 were healthcare onset, 112 community onset healthcare associated and 425 were community onset. Review of the healthcare-onset cases revealed the most prevalent focus of infection to be urinary (43), followed by biliary (15) and intravascular (15). Eighteen of the patients with a urinary focus had E. coli isolated from the urine within the previous 7 days; for 11 patients no urine was received. 55% of the patients with urinary focus had a urinary catheter at the time of bacteraemia. Eight of the 105 (7.6%) patients had had a previous E. coli bacteraemia, with no predominant focus of infection. Review of risk factors revealed 29% had a diagnosis of cancer, 24% were diabetic and 20% had dementia. No common themes have been identified through root cause analysis.

Discussion

Review of E. coli bacteraemias has shown urinary as the most common focus for healthcare-onset cases. Root cause analysis and review of case notes has not revealed any common failings.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

95

Spinal surgical site infection – have we hit a nerve?

Louise Hall 1, Iain Thompson 1, Lesley Wilson 1, Anita Gair 1, Ruth Saunders 1, Cheryl Teasdale 1

Abstract

Introduction

Infections acquired by patients in healthcare facilities are associated with significant morbidity. Incidence of surgical site infection (SSI) is one of the most common types of healthcare-associated infection (HCAI). There are many risk factors in the patient’s surgical pathway, and therefore prevention of these infections requires coordinated implementation of a whole range of interventions.

Methods

The IPC team collects data on spinal surgical site infections which are submitted to the national PHE Surgical Site Infection Surveillance System (SSIS). Using the data to benchmark our own baseline performance and against other Trusts also participating in this surveillance category, the results demonstrated increasing rates of spinal SSI. With this in mind, and as part of the Sign up to Safety programme, a multidisciplinary group was established to review and understand the current position and agree strategies to reduce infection rates. The group undertook a comprehensive review of all elements of the patient pathway including pre-assessment, pre-, intra-, and post-operative care, and also post discharge. A spinal SSI care bundle was developed following this review which also incorporates WHO guidance for the prevention of SSI.

Results

The surveillance data in the last year has demonstrated a reduction in spinal SSI rates. There is evidence of good engagement form the multi-disciplinary team, the clinicians have taken ownership of root cause analysis process, a new wound care plan has been developed, the type of skin prep used peri-operatively has changed and we have promoted patient education prior to coming in to hospital and on discharge.

Discussion

We will continue to monitor the rates of infection and the next steps will be to audit the interventions introduced in the care bundle to gain assurance that the changes are embedded in to practice. The care bundle will be shared with other specialties as an exemplar of good practice.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

107

Statistical review of Clostridium difficile infections: Using intelligence to develop effective reduction strategies

Martin Jones 1, Ann Irvine 1

Abstract

Introduction

  • Statistically analyse key themes and contributing factors of community-associated (CA) C. difficile from data collected in root cause analysis (RCA).

  • To identify root causes, themes or patterns in order to develop local intelligence and evidenced-based, bespoke reduction strategies.

Method

Data were collected from each RCA between April 2016 and Jan 2017, and analysed using IBM SPSS Version 24, Statistical Package for Social Sciences.

Results – See Table 1

89.5% had antibiotics within 3 months leading up to the C. difficile. Pie Chart 2 demonstrates the indications for the antibiotics. The most common indication was urinary tract infection (UTI). In all cases; samples obtained in 23.7% occurrences, almost half 42.1%, no sample was taken.

  • Majority, 68.4% had been a hospital inpatient within 6 months prior to CDI

  • 42% cases not taken PPI

  • Majority of cases had long-standing conditions or underlying disease, 65.8%. Cancer was the most common condition, 23.7% cases.

Discussion

Root Cause: UTI is the most common condition requiring antibiotic therapy leading up to the infection.

Reduction strategy: the most effective prevention strategy to reduce CA C. difficile and Gram-negative BSIs would be focusing on reduction and prevention of UTIs. Collecting samples would provide clinicians with critical culture and sensitivity information, particularly for UTIs in the 65+ years age group. Avoidance of inappropriate and broad-spectrum antibiotic regimes to reduce CDI risk and antimicrobial resistance.

  • Support sample collection.

  • PPI reduction and patient control (i.e. move to PRN).

  • Reviewing rescue packs – improve education and potential addition of sputum pots.

  • Review prophylactic antibiotics in primary care.

  • Robust procedures for management of wounds.

Reducing CA C. difficile and E. coli BSIs by focusing on reduction strategies based on a single primary infection such as UTIs would contribute to a major reduction in healthcare-associated infections.

graphic file with name 10.1177_1757177418794054-img14.jpg

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

109

Deciphering epidemiological link between healthcare-associated infections involving multidrug-resistant Enterococcus faecium vanA in Algeria underlines the need to reinforce infection control programme in developing countries

Sonia Benammar 4, Alix Pantel 2, Aujoulat Fabien 3, M Benmehidi 4, René Courcol 5, Jean-Philippe Lavigne 2, Sara Romano-Bertrand 1,3, Hélène Marchandin 1,3

Abstract

Introduction

Compared with the threat and burden of Vancomycin-resistant Enterococcus (VRE) faecium (VREfm) in Europe and USA, a delayed emergence is observed in some developing countries, including Algeria, in part related to the non-use of avoparcin and to an increased vancomycin prescription since very few years. We investigated the first healthcare-associated infections (HAIs) involving VRE in a University Hospital in Algeria, performed the first molecular epidemiology study of related VRE, and reviewed infection control (IC) strategies.

Methods

Medical charts and IC measures were reviewed for patients with VREfm. Van genes were detected by multiplex polymerase chain reaction (PCR) and strains characterised by repetitive sequence-based-PCR, pulsed-field gel electrophoresis and multi-locus sequence typing.

Results

During a 6-month period, VREfm infections occurred in four patients hospitalised in three wards. Molecular analyses identified E. faecium vanA belonging to the hospital-adapted clonal complex 17 and delineated a subgroup of three genetically related VREfm in patients who underwent surgery in the same department, suggesting an outbreak. Review of IC measures showed: (i) no care sectoring for one patient, (ii) no systematic rectal screening of contact patients, (iii) a delayed cleaning of ward / disinfection of equipment after the index-case death, (iv) no monitoring of surface contamination in the units.

Discussion

VREfm persistence in our institution is highly probable, as three clonally related strains were identified during a 6-month period. However, the source and route of VREfm transmission remained unidentified. In the worldwide and worrying context of increasing antimicrobial resistance and easier population movement, outbreaks of HAIs involving multidrug VREfm in developing countries are worrisome. Our study, revealing some problems in the current management of such infections in Algeria, urges the need for improved and early adequate IC measures to avoid VRE spread not only in North African hospitals but also as a global healthcare measure.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

116

Identifying risk factors and interventions for an unwelcome visitor; the quest for Clostridium difficile control over 4 years

Andriani Christodoulopoulou 1, Despoina Papadaki 1, Nikolaos Zachos 1, Maria Pappas 1, George Kokotos 1, Vassilios Kordinas 1, Anastasios Koutsovassilis 1, Paraskevi Karle 1, Theodoros Peppas 1

Abstract

Introduction

Facing outbreaks of Clostridium difficile infection (CDI) the Infection Control Team (ICT) registered all action taken, risk factors and initiated a continuous audit to enhance health workers’ (HW) vigilance and compliance with instructions.

Methods

Seeing cases of CDI, in late 2013, the ICT proceeded to prospectively record all patients who had CD isolated, with ICT nurse checking daily relevant microbiology data. All risk factors were noted, as well as defined daily doses (DDDs) prescribed in hospital in the respective months. Precaution measures were provided and explained to HWs of the respective department. Nine emergency gatherings were performed and face-to-face HW education was performed continuously in higher incidence wards. Time: 1/1/2014 to 31/12/2017. Data entry in simple Excel book form.

Results

A total of 377 CDIs was recorded, thus yielding an incidence of 0.51/1000 pt. days. Patients, m. age 73.4 yrs had prior antibiotic and hospitalisation history, nursing home origin, PPI use and comorbidity in 82.4, 64.4, 76.4 and 94.9%, respectively. Up to 3 months prior to admission, 67.25% had received antibiotics. No correlation was noted with hospital antibiotic 6-monthly DDDs and CDIs at the same time. Efforts had some effect, with CDI/annum reducing from 126 (2015) to 93 and 98 in the following 2 years.

Discussion

The increasing rate of CDI, despite ICT efforts, constitutes an alarm. Continuous monitoring, and strenuous medical as well as administrative interventions seem mandatory. Some improvement is seen after educational efforts, albeit short-lived. There is also considerable room for improvement in HW compliance with precautions, plus prudent antimicrobial and PPI usage.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

132

Borderline oxacillin-resistant Staphylococcus aureus in a dermatology unit

Linda Dalrymple 1, Jennifer Lee 1, Benjamin Parcell 1, Claire Buick-Clark 1, Ross Hearn 1, Matthew Holden 2, Catriona Harkins 1, Elizabeth Dickson 3, Anne Marie Karcher 1

Abstract

Introduction

An outbreak of borderline oxacillin-resistant Staphylococcus aureus (BORSA) belonging to spa type t10939 and linked to a dermatology unit was first identified by the National MRSA Reference Laboratory. Collaboration between the Laboratory, the NHS Board and the University of St Andrews has enhanced the local surveillance and epidemiological work to understand the nature of the outbreak and reduce the potential for transmission in healthcare settings.

Method

BORSA isolates identified as t10939 underwent whole-genome sequencing at the University of St Andrews to establish the relatedness of the organisms and their phylogeny. Whole-genome sequencing of new isolates has continued throughout the outbreak, adding to the knowledge of the organism and its evolution over time. Environmental samples have been taken on three occasions to determine the risk of spread from environmental contamination. Ongoing data collection to describe the patient population and risk factors has continued alongside these technical investigations.

Results

Standard epidemiological details relating to the patient population have been enhanced by knowledge obtained from laboratory testing. Whole-genome sequencing identified that early in the outbreak isolates were closely related with some clear links to a common ancestry. Environmental samples taken using swabs for culture and PCR in December 2017, and swabs and sponges in April 2018 grew BORSA.

Discussion

A combined technological and epidemiological approach to developing a greater understanding of the outbreak organism and the individuals at greatest risk of infection has enabled the targeting of interventions to reduce and prevent transmission in a healthcare setting. Close collaboration between clinical teams, infection prevention and control and the university has been central to this.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

135

Optimal antibiotic prophylaxis timing in knee replacement surgery: A re-audit

Karen Denman 1, Sue Fox 1, Rohinton Mulla 1

Abstract

Introduction

Surgical site infection (SSI) after knee replacement can cause debilitating outcomes, including loss of the prosthesis. Adequate perfusion of prophylactic antibiotics into the tissues is essential to reduce the risk of SSI. Thus, the time interval between administration of the antibiotic and tourniquet application must be sufficient, according to antibiotic type; generally regarded as being at least 30 minutes before the tourniquet is applied. The surveillance nurse conducted corresponding 6-month audits, in 2016 and 2017, to determine whether or not our patients were receiving optimal antibiotic prophylaxis. These aimed to reduce the rate of SSI in our hospital.

Methods

The times between administration of antibiotic prophylaxis and tourniquet application were recorded for every knee replacement patient, 150 and 153 respectively, using data from their anaesthetic and theatre records.

Results

Data was missing on average for 8% of patients over both audits. Some patients (2.8%) were administered antibiotics after tourniquet application, whilst all others received prophylaxis within a range of 1 minute to almost 1 hour before tourniquet application. Only 17.6% achieved optimal timing of prophylaxis prior to tourniquet application. 100% of all SSIs occurred following a suboptimal administration interval, whilst 60% of SSIs in 2016 happened when the interval was less than 20 minutes.

Discussion

The wide-ranging results suggested possible confusion regarding the best time to administer prophylactic antibiotics, especially when a tourniquet is integral to surgery. Limited theatre time may impact on the interval between prophylaxis and tourniquet application, whilst insufficient perfusion time reduces the efficacy of the antibiotic and potentially increases the risk of SSI. Patient safety should be of primary concern. Therefore, it might require change in theatre practice, such as requesting the attendance of the next patient earlier than previously, or commencing pre-operative antibiotic prophylaxis on the wards. Each requires improved inter-departmental communication and documentation.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

148

Say “No” to norovirus

Catherine Ganda 1, Rachael Ben Salem 1, Najad Ali Khan 1, Iain Hayden 1, Roxanne Mohammed-Klein 1, Kamal Sehmbey 1, Madeleine Farren 1, Andrew Letters 1, Andrew Mackay 1, Mustafa Atta 1, Sumati Srivastava 1, Isla Mcdonald 1, Genelyn Ildefonzo 1

Abstract

Introduction

After successful management and containment of norovirus for over 3 years, a large cross-site outbreak occurred in 2018, throwing back confidence and opening up new areas of learning.

Methods

Data collected since 2014 following the restructuring of the Trust shows that major outbreaks have been reported, often attributed to interconnection of wards which are used as thoroughfares as well as the usual challenges with adherence to infection prevention and control practices. Following comprehensive norovirus review we have identified additional factors which may have contributed to the outbreak this year.

Results

A four-fold increase in the number of hospital-acquired cases (HAI) was recorded in this outbreak compared with the previous year; 9.4 (95% CI 3.4–15.4) additional staff reported a short episode of gastrointestinal illness per week, during this outbreak compared with the last. The issue of variation in bed capacity was also investigated to identify any effect on the outbreak, and how this could impact future outbreak management.

Discussion

Increase in staff sickness preceded the outbreak and occurred throughout the outbreak period; community-acquired norovirus infection and norovirus infection rates reported by Public Health England were similar to previous outbreaks. Hence, staff sickness contributed to the duration and size of the outbreak in terms of staff/patients and wards affected. Staff sickness, bed pressure, infection prevention leadership on wards and on-site norovirus testing are key factors that will affect norovirus management in busy teaching hospitals.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

170

Incidence and fatality of nosocomial bacteraemia in a Greek tertiary hospital over two calendar years

Despoina Papadaki, Maria Bourikou, Spyridon Katechis, Alexia Bakossi, Jannis Kounelakis, Jonathan Klogeri, Charalabos Tamvakos, Vassilis Kordinas 1, Dimitrios Ntionias, Paraskevi Karle, Theodoros Peppas

Abstract

Introduction

This is a study of the incidence, epidemiology and outcome of patients with nosocomial bacteraemia (B) in a 576-bed tertiary hospital over two calendar years.

Methods

All patients with B prospectively registered and analysed regarding death at 7, 14 and 28 days after B onset. Time 1 June 2016 to 31 May 2018. Susceptibilities as by Kirby-Bauer and Vitek standard methods.

Results

A total of 493 episodes of B was recorded in the study period in a total of 386 patients, mean age 75.6 years. Incidence of B was 3.03 per 1000 patient-days; of those Bs 74.8% were due to Gram-negative bacteria and 301/493 (61%) were nosocomial Bs. Klebsiella pneumoniae rose to first place of B pathogens, followed by E. coli, Enterococcal and Acinetobacter B.

Death rate at 7, 14 and 28 days for nosocomial B was 16.6, 12.9 and 10.9% per each episode, thus yielding a 29.6% fatality rate during the first month post B, as opposed to a rate of 28.1% for non-nosocomial B. Among individuals with one or more B episodes, fatality during hospital stay occurred in 216/386 (55.9%) with comorbidities also contributing. The most “fatal” pathogen was, expectedly, Klebsiella pneumonia, with a 52% fatality rate per B at 4 weeks.

Discussion

An updated surveillance of B fluctuations is fundamental for optimal empirical therapy choice and local guidelines to improve outcome, namely survival, of critically ill patients. High resistance rates need targeted intervention through hospital hygiene and antibiotic stewardship.

K. pneumoniae E. coli Enterococcal Acinetobacter
Hospital acquired 71 8 38 42
Community acquired 20 61 16 7
Total 91 69 54 49
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Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

1

Fluorescent isothiocyanate dextran evaluates the permeability of blood–brain barrier in rabies infected brain of mice

Waqas Ahmad 1,2, Muhammad Awais 1, Iahtasham Khan 1, Zhang Maolin 2, Zhenhong Guan 2, Ming Duan 2

Abstract

Background

Acute encephalitis develops as the rabies virus (RABV) enters to the central nervous system by crossing the blood–brain barrier (BBB), which is a tight junction of endothelial cells. In this study, three different molecular weight (70 kDa, 150 kDa and 200 kDa) of fluorescent isothiocyanate dextrans (FITC-Dextrans) were used to measure the extent of BBB damage and subsequent leakage patterns in brain tissues of rabies infected mice which were post-immunised with neutralising antibodies to observe whether it has positive effect on infected mice by decreasing the death ratio.

Methods

The brains were processed for immunofluorescence to observe the neutralising antibodies and the relevant compatibility with the leakage of FITC-Dextrans.

Results

Results showed that 70 kDa and 150 kDa FITC-Dextrans efficiently crossed BBB, and produced fluorescent illumination mainly in the cerebral cortex of brain. The enhancement of BBB permeability was significant at 5th day of post-immunisation, while the neutralising antibody neutralised some particles of RABV by crossing BBB, but it did not present enough treatment effect to the dying mice.

Conclusions

Taken together, these findings suggest that FITC-Dextran is an important fluorescent marker to investigate the integrity of BBB permeability in severe neurodegenerative diseases like rabies.

graphic file with name 10.1177_1757177418794054-img15.jpg

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

44

Clostridium difficile infection; the road to recovery

Clare Mitchell 1, Lee Macready 1, Lyndsay Quarrell 1; IPCT Lanarkshire1

Abstract

Introduction

The inquiry into the outbreak of Clostridium difficile infection (CDI) at the Vale of Leven Hospital recommended that all NHS Boards in Scotland review their policies and procedures for managing CDI cases. NHS Lanarkshire (NHSL) did so and identified the need to strengthen their policy and ensure robustness in the management of CDI patients. The findings and actions to improve patient management are detailed.

Methods

An IPCT review of CDI case management identified:

  • The IPCT discharged patients from follow-up after 48 hours of being asymptomatic of loose stools.

  • Inconsistencies in the assessment and recording of the severity of CDI.

  • Learning opportunities to improve the management of CDI cases.

We initiated the following:

  • A review and strengthening of the NHSL CDI Policy.

  • The introduction of CDI severity stickers.

  • The introduction of CDI severe case reviews.

  • Engaging the multi-disciplinary team (MDT) in sharing and learning from the management of all CDI cases.

  • IPCT follow-up of all patients with CDI for a minimum of 30 days.

  • Laboratory reminders to prompt staff to the correct treatment algorithms.

Results

  • Since the changes, NHSL has met the national target for CDI reduction.

  • Severity sticker usage is now standard practice.

  • The cohesive MDT approach ensures consistent and safe management of CDI cases.

Discussion

It took time for the improvements to become embedded in practice, but consequently the culture around the management of patients with CDI has changed; patients are managed more effectively and infection prevention risks have been reduced. The continued input from the IPCT has been beneficial for both the clinical teams and patients. We will continue to review and add to this process ensuring the ongoing safe care of patients with CDI in our hospitals.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

92

A multifaceted intervention to reduce multidrug-resistant colonisation and infection in an intensive care unit in a tertiary teaching hospital in Malaysia: A 3-year study

Sasheela Ponnampalavanar 1, Haryani Che Hamzah 1, Siti Norintan Zainon 1, Suzana Saaibon 1, Mohd Shahnaz Hasan 1, Mohamad Fadhil Hadi Jamaluddin 1, Hasimah Zainol 1, Premelar Naidu 1

Abstract

Background

Multidrug-resistant organisms (MDROs) are challenging to manage in the intensive care unit (ICU). In 2015 an increase of MDRO cases (colonisation and infection) was observed in the ICU of a tertiary teaching hospital in Malaysia. We sought to determine the impact of a multifaceted infection control intervention to reduce the incidence of hospital-onset (HO) MDRO including carbapenem-resistant A. baumannii (CRAB), methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobactereciae (CRE).

Methods

A 3-year, prospective quasi-experimental study of implementation was conducted in a 20-bed general adult ICU in University Malaya Medical Centre from 2015–2017. HO MDRO incidence rates per 1000 patient-days in ICU were compared between the baseline, intervention and follow-up periods, which were from 1 January to 31 December of 2015, 2016 and 2017 respectively. The interventions included re-educating and retraining of ICU staff; implementing active surveillance, cohorting patients with MDRO to a dedicated wing in the ICU; reinforcing contact precautions, hand hygiene compliance and environmental cleaning; with weekly feedback to the ICU staff. All interventions were continued in the post-intervention period.

Results

At baseline the MDRO rate was 25.66 cases/1000 patient-days. In 2016, the rate decreased by 47% to 14.33 cases/1000 patient-days (p<0.001) and in 2017 to 13.60 cases/1000 patient-days (p<0.001). CRAB decreased from 14.55 cases/1000 patient-days in 2015 to 11.24 cases/1000 patient-days in 2016 (p=0.02); CRE per 1000 patient-days decreased from 7.54 cases in 2015 to 1.41 cases in 2016 (p=0.02); and MRSA reduced from 3.57 cases in 2015 to 1.69 cases/1000 patient-days in 2016(p=0.05). In the 2017 incidence of CRAB, CRE and MRSA decreased to 11.12, 1.39 and 1.08 cases/1000 patient-days respectively.

Conclusions

A multifaceted infection prevention intervention resulted in sustained reductions of MDRO rates among ICU patients in a developing country.

graphic file with name 10.1177_1757177418794054-img16.jpg

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

160

Sherwood Forest Hospitals utilise audit and quality assurance software to reduce HCAI and bring significant cost savings

Sally Palmer 1, Rosie Dixon 1

Abstract

Introduction

In 2015, our Trust was struggling with poor compliance with infection prevention guidelines, inadequate staff involvement in infection prevention, high Clostridium difficile acquisition rates and a diminished Infection Prevention Team. The board supported a business plan to implement audit and quality assurance software, citing how the initial investment would be quickly offset by reduced healthcare-associated infections (HCAI) and increased capacity for audit, training and surveillance within the IPC team. The system was live on all three sites in the Trust by end May 2015. This poster details the impact on the Trust.

Method

Using the software’s comprehensive training and education system, the team were able to utilise their support staff to carry out non-clinical auditing, such as sharps and equipment audits. This smarter usage of resources freed the IPCNs up to increase their clinical hours, focusing on management of invasive devices, completing extra audits and more frequent and detailed prevalence studies.

Results

Within 12 months, the team reported a tripling of their audit capacity and immediate feedback of data to wards and departments. During the same time period, rates of catheter-associated urinary tract infection (CAUTI) reduced by 63% between 2016 and 2017 and there was a sustained decrease of 50% in hospital-attributable C. difficile. Using National Institute for Care Excellence attributable costs of healthcare-associated infections (NICE, 2015) the cost savings to the Trust over the same time period was over £900,000.

Discussion

Utilising the auditing and quality assurance software released IPCN time to increase clinical audit, training and feedback. Empowering staff with individual access to issues raised against their departments increased accountability. Together, these interventions reduced rates of HCAI and saved the Trust substantial funds. In an era of funding deficits, this is an example of how spending cleverly can generate real savings, improve patient outcomes and importantly, increase staff morale.

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Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

163

Collaborative approach to tackling Gram-negative bloodstream infections (GNBSI)

Tricia Gordon 1, Jo Malkin 1, Claire Skull 1, Jane Lawson 2

Abstract

Introduction

Approximately 59% of all Gram-negative blood stream infections (GNBSI) are healthcare associated and therefore could potentially be avoided. Escherichia coli (E. coli) make up 55% of the GNBSIs. 75% of these cases are community onset, and therefore a whole health economy approach is required to bring about a reduction in line with national ambition.

Method

The Infection Prevention and Control teams across both CCG and Foundation Trust have a history of working together to address many issues. A steering group was developed to include representation from local primary care, CCG and Acute Trust which audited the data, identified the key issues, and produced a clear action plan, including:

  • “Don’t Dipstick to Diagnose” walk rounds and primary care protocol for diagnosis/management /treatment of urinary tract infection (UTI)

  • Care home UTI resource pack, dehydration guide, fluid matrix and top tips

  • Quality improvement visits to wards and care homes

  • Joint education programmes for all staff in all settings

  • Joint catheter group: standardisation of equipment, policies and procedures, introduction of patient-held catheter passports

  • Catheter champions

  • Audit and surveillance and case note review

Results

The group has delivered key improvements in care homes, primary and secondary care across the health economy, resulting in raised awareness among healthcare workers, promotion of optimum patient safety and positively contributing to the issue of antibiotic resistance associated with inappropriate treatment. This collaboration has resulted in reduction in antibiotic use, 5% reduction of total number E. coli BSI cases and 34% reduction of Trust-apportioned cases.

Discussion

Achievement has been attained by the CCG and Trust IPC teams’ collaborative approach, supported by Trust and CCG boards, demonstrating strong leadership and vision to drive this agenda forward, achieving improved health outcomes and experience for all our patients.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

150

The challenges in healthcare-associated infection surveillance in 2018: Experience from prevalence and incidence studies

Sally Stewart 1, Lynne Haahr 1, Rosalind Boyle 2, Audrey McAlpine 2, Norma Williamson 3, Helen Thain 3, Claire Beith 2, Anna Munro 3, Clare Mitchell 2, Liz Young 2

Abstract

Introduction

The need for surveillance of healthcare-associated infection (HAI) has grown over recent years. There have been major developments in electronic systems used for patient care, often with multiple systems containing different information. Infection prevention and control practitioners and researchers still rely on clinical case note review (regardless of the way the information is captured and accessed) in order to identify HAI cases. The questions we wish to address are: have these new developments made the challenges of collecting reliable, valid surveillance data any easier, or are they just different? What are the greatest barriers and enablers in surveillance data collection and are these dependent on the systems in place for patient management?

Methods

The population we will approach will be those involved in surveillance data collection with two Scottish health boards (a combination of research nurses and infection control practitioners). We will use a modified Delphi approach to seek insight on the barriers and enablers to undertaking HAI surveillance within a modern healthcare setting. Barriers we have already identified include: delays in scanning full medical notes, filing paper notes, gaining access to paper notes in wards, down time of electronic systems, lack of information within notes about reasons for samples being sent for examination; despite all information with electronic notes being available, they often require extraction of information from multiple databases. Enablers include electronic notes, which are less time-consuming as they are available from any PC, and information is available as soon as laboratory results are available.

Results

We will report barriers and enablers identified and similarities and difference between hospitals with electronic clinical notes and those using paper notes.

Discussion

We will rank areas where improvements could be made in areas using electronic or paper notes in future to assist surveillance.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

152

An outbreak becomes a puzzle

Sophie Baranovsky 1,2, Sara Romano-Bertrand 1,2, Patricia Licznar-Fajardo 1,2, Luc Téot 3, Delphine Grau 1,2, Sylvie Parer 1,2, Estelle Jumas-Bilak 1,2

Abstract

Introduction

A patient infected by several carbapenemase-producing bacteria (CPB): NDM Acinetobacter baumannii (NDM-Ab), NDM/OXA48 Klebsiella pneumoniae (NDM/OXA48-Kp) and NDM Enterobacter cloacae (NDM-Ec) was the index case of an outbreak of six patients. This patient transmitted NDM-Ab to patient B and NDM-Kp to patient C during his hospitalisation. In September then February 2017, two other patients hospitalised in the same ward and bedroom of index patient A were contaminated by NDM-Ab and NDM-Ec. This study analyses spreading and persistence of these CPB in the hospital environment.

Methods

All available clinical strains (colonisation and infection) were collected. Swabs from ward surfaces were inoculated to selective medium. Bacteria were identified by MALDI-TOF-MS. Genotypes were compared by multiplex rep-PCR. The genes blaOXA48 and blaNDM were studied by PCR and sequencing, and plasmids by conjugation assay, extraction and RFLP.

Results

268 samples were collected in patients’ bedrooms. 90% of environmental strains shared their genotypes with clinical strains. The respective role of plasmids and strains in this complex outbreak of resistant population was evaluated. Main insights gained from the outbreak tracking were: (1) several species and genotypes of CPB were isolated from the same patient, (2) typing of several colonies of same species and resistotype is needed to fully track cross-transmissions among patients, (3) some Ec and Kp environmental strains displayed the same genotype as patient resistant strains but lacked the genes blaOXA48 or blaNDM, (4) some Ec and Kp strains collected in patient B’s bedroom were not detected in the patient, (5) inter-species and inter-genotype diffusion of plasmids appeared as a minor phenomenon.

Discussion

These results highlighted the persistence of environmental CPB and a possible instability of the resistance gene in the environment. Intensive sampling of environmental and clinical strains revealed the unsuspected diversity of the bacteria circulating in hospital during outbreaks.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

9

Increasing engagement of the wider local health economy in methicillin-resistant Staphylococcus aureus bacteraemia post-infection reviews

Louise Popple 1

Abstract

Introduction

Within the community health economy, methicillin-resistant Staphylococcus aureus (MRSA) blood stream infections (BSI) investigation is led by the community NHS Trust. Investigations include a wider collaborative post-infection review (PIR) meeting of all involved care providers. Historically it was difficult to engage general practitioners (GPs) with the PIR process; attendance at meetings was noted to be poor. This led to incomplete investigations relating to GP activity. Steps were taken to increase GP attendance and interest in the PIR process.

Methodology

Contact was made with the CCGs and a select number of GP surgeries to understand their lack of PIR attendance. Template emails were created to provide a standardised response to MRSA BSI notifications and a formal invitation to each PIR meeting. GP surgeries were encouraged to host the meetings, aiming to increase the likelihood of GP attendance due to reduced travel time and less need to re-organise busy, daily workloads. For surgeries which were unwilling to or unable to host meetings, the closest health centre was used or teleconference facilities were made available. Verbal and written emphasis was given on the importance of attending the PIR meeting. PIR was continually discussed at wider multi-organisation healthcare-associated infection (HCAI) improvement groups.

Results

GP attendance at PIR meetings increased considerably following the inclusion of template emails and encouragement for GP surgeries to act as host. Increased attendance was also noted from community pharmacists and practice nurses.

Discussion

Altering the meeting process and location increased attendance from all disciplines, not just GPs, ensuring well-rounded knowledge-based learning. Standardised email templates ensured a standardised response to notifications. Increased awareness at HCAI improvement and other high-level groups ensured members disseminated the importance of such work to front-line staff. Continuous discussion kept interest in the PIR process high and has formed a good process moving forward.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

43

Persistence to improve patient safety

Sandra Burke 1, Julie Burns 1, Carol Whitefield 1; IPCT Lanarkshire1

Abstract

Introduction

The prompt identification of people who present an infection risk to others is critical to reducing the risk of outbreaks. The electronic patient management system at our hospitals had an alert indicator available; however, this was not unique to the Infection Prevention and Control Team (IPCT). Routine clinical visits by the IPCT identified that despite IPCT use of the electronic indicator (yellow triangle), staff were unaware of the patients’ infection risk – and thus patients were not isolated and screens were omitted. To increase awareness and make it easier for staff to do the right thing and know what the right thing to do is, we sought to have an IPC unique electronic indicator for all clinical areas.

Methods

  • Repeated arguments and appeals (over several years) were made for a unique infection risk identifier.

  • Eventually, the significant infection risks were recognised and permission agreed.

  • The IPCT:
    • Met to agree which infection risks would merit use of the unique alert identifier (pink star).
    • Were trained in the use application of the alerts.
    • Launched the IPCT alert system across the entire organisation (all clinical areas were visited), included on all screen savers and in organisational magazine, etc.

Results

  • The IPCT:
    • Noted that when phoning wards about patients, isolation and appropriate care is much more likely to have been instigated.
    • Have an accurate daily prevalence of all inpatients who present an infection risk.
    • Are able to identify outbreak risks, i.e. a high prevalence, and then increase IPCT visits.

Discussion

The IPCT were eventually successful in negotiating the unique infection alert after multiple submission rejections. Persistence was rewarded with a system which is widely and successfully used. The IPCT can demonstrate increased safety for the patients and increased efficiency in their working.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

49

Use of digital tools to improve IV audit process and patient outcomes

Jane Hodson 1, Anthony Robertson 1, Wenona Giles 1

Abstract

Introduction

Audit and surveillance of intravenous (IV) devices is a mainstay of our IV team. With the expansion of clinical activities, audit placed a significant burden on the team. In times of increased clinical activity, audit was the first task to fall.

Method

Prior to January 2017 a paper-based audit tool was used. Point prevalence audits were conducted monthly, feedback was provided to the staff and reports produced. Audits were time-consuming to undertake and required significant additional time to input data on completion. Results confused ward staff due to lack of understanding. Reports were burdensome in terms of time, but also unreliable as they were dependent on human factors. In January 2018 the team were introduced to a digital audit tool in the form of a mobile app and web-based reporting system. The team decide to undertake a trial of this app to determine if it would provide benefits in terms of time management and data capture.

Results

The app is extremely easy to use. Data input is instantaneous, feedback reports and quality improvement plans are generated automatically and sent on completion of the audit. The report produced is clear, understandable and the visual approach improves staff engagement and awareness.

Discussion

Since implementation of the app, the time required to undertake an audit has been reduced by more than 50%. There is a reduction in the cost using this more streamlined system and team members are freed to spend more time on patient-focused tasks. Monthly reports that took upwards of 8 hours can now be created in less than 30 minutes. The very visual nature of the reports has engendered interest across the Trust and improved outcomes through responsiveness to the issues highlighted. Using mobile apps and web-based reporting has revolutionised our approach to audit.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

62

Reducing surgical site infections at Cardiff and Vale Health Board’s maternity unit

Kim Stokes 1, Lorraine Hopkins 1

Abstract

Introduction

Public Health Wales conducted a national caesarean section surgical sites surveillance audit; this showed that our infection rates had increased to 10.8% from 9.1%, that the all-Wales average was 5.1% and that we were not meeting our quarterly reduction plan of 25%.

Methods

A senior nurse undertook a service improvements course and was coached by the senior midwife in service improvement methodology. PDSA cycles were used to analyse systems and processes. The reliability of the data used was improved, with continuous small-step improvements in the systems and processes conducted. Awareness was raised within the department, and midwives received education on the criteria for reporting of infections. Women with suspected infections were encouraged to attend the maternity assessment unit to ensure robust assessment, reducing the prescribing of antibiotics. Ensuring best practice was being followed. Patient education was improved. The theatre environment was de-cluttered and a cleaning schedule implemented. Monthly hand hygiene audit was conducted, scoring 96%. We have seen staff engagement and raised awareness of issues around infection. Practices not in line with best practice have been challenged. We have liaised closely with Public Health Wales’ improving communication, disseminating good practice.

Results

We have reduced our infection rate from 10.8% to 3.9% in less than 18 months.

Conclusion

Collectively as a team, we have been able to do this through creating a dynamic environment for change and valuing the small part that a lot of people have had in the process. We have pushed the boundaries involving all staff in celebrating our success. We hope to continue making improvements, computerising the system for collecting data for Public Health Wales in the near future. This will enable us to concentrate on how we improve the outcome for the small number of women who do get infections after they have caesarean section.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

63

InFLUencing low vaccine uptake using a quality improvement approach

Frances Notman 1, Syed Ahmed 1, Jim McMenamin 2, David Crombie 3, Karen Pawelczyk 1, Elizabeth McGovern 1

Abstract

Introduction

Immunisation is the most effective preventative measure for flu, but uptake in at-risk patients under age 65 persistently remains well below Scottish Government target levels. The aim was to test a novel quality improvement initiative to improve flu vaccine uptake in these patients in the local NHS Health Board (HB) during the 17/18 flu season. The regional ethics service confirmed ethics approval was not required.

Method

Local HB practices, in the lowest 25th percentile (n=57) for flu vaccine uptake, completed and returned a self-audit of their flu vaccine procedures, against criteria associated with improved uptake. Participating practices received an illustrated feedback report with recommendations for improving uptake which they were asked to share widely. 2016/17 and 2017/18 seasons’ data for participating practices were compared with non-participating practices in the lowest 25th percentile in a neighbouring HB. Opinions of participants were sought by questionnaire and interview.

Results

Practice response rate was 75.4% (n=43), and 44% (n=19) met 75% of the criteria. Areas for improvement included collaboration with stakeholders, call and recall arrangements, links with hospital specialities and potential for involvement of community pharmacy. Sharing of the report was poor, and only 10 practices shared their report externally. Only five practices implemented even some of the recommendations. Vaccine uptake demonstrated a significant increase for 2017/18 compared with 2016/17 (p<0.001); however, this was also observed for the control group (p=0.03). Participants supported this approach, highly rated the visual impact of the feedback report and agreed recommendations were appropriate.

Discussion

The self-audit approach was acceptable to practices and the format of the report was valued. However, although immunisation uptake improved for the 2017/2018 season, the effectiveness of the intervention was not proven. As with all quality improvement approaches, further cycles of the self-audit approach would be required to conclusively demonstrate efficacy.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

76

Impact of infection prevention and control team-led peer vaccinator influenza campaign

Nicola Colborne 1, Tina Oldfield 1, Judy Potter 1

Abstract

Introduction

The frontline healthcare worker (HCW) influenza vaccination campaign has been run by Occupational Health in the Trust for a number of years. Percentage uptake has been variable, but had never exceeded 40% prior to 2014/15. In 2015/16, the Infection Prevention and Control Team (IPCT) became increasingly involved in the vaccination campaign and recruited peer vaccinators to assist with delivery of the campaign enabling HCWs to receive their vaccine at any time, in any department.

Methods

Lead nurse requested names of registered nurses who could undertake vaccination. Training was required to fulfil this role and was provided by the IPCT, including understanding the impact of vaccination and the importance of maintaining the cold chain. Vaccinator packs were given to all trained vaccinators, containing everything required to undertake vaccination, record sheets and health promotion material to empower them to promote vaccination. The IPCT were the point of access for peer vaccinators and supported them during the vaccination period with telephone advice and department visits. The IPCT were also trained as peer vaccinators. The IPCT formulated a protocol with Pharmacy to ensure vaccines could be obtained in a timely way. Occupational Health also continued to offer vaccination.

Results

In 2014/15, when the campaign was purely delivered by Occupation Health, the staff uptake was 36.6%. After introduction of peer vaccinators, overseen by the IPCT, staff uptake was 50.5% in 2015/16, 77.6% in 2016/17 and 76.9% in 2017/18. The peer vaccinators delivered over 55% of the total vaccinations each year.

Discussion

The IPCT-led peer vaccination programme has proved to be invaluable in this Trust, in ensuring that staff are protected from influenza, and therefore secondary protection is provided to patients. The enthusiasm shown by the peer vaccinators has increased year on year, as has the amenability of HCWs to be vaccinated.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

84

Isolation care plans

Tamasin Davis 1, Catherine Ford 1

Abstract

Introduction

The Infection Prevention and Control Team (IPCT) used numerous care plans dedicated to various suspected/confirmed micro-organisms. These were issued only by the IPCT. The clinical areas were not able to raise them when an infection was suspected. This led to a reduction in self-sufficiency for the wards/departments and sometimes a failure to instigate correct infection control practices in a timely manner. An isolation care plan was required, that was informative, included advice on personal protective equipment (PPE), environmental/equipment cleaning, available to all Trust staff and could be utilised for any condition/infection where there is a transmission risk.

Method

The Trust already utilised a colour-coded system for the three types of isolation, standard, respiratory and droplet. The new care plan would utilise the familiar colour-coding system to ensure a smooth transition and to assist staff to recognise the different types of transmission of pathogens.

Results

A “one for all” isolation care plan was developed to include all transmission precautions, where staff select the correct type of isolation required and a section for free notes to allow for additional IPC instructions. On the reverse of the care plan healthcare signatures can be applied to document that all care specific to the patient’s infection risk has been completed.

Discussion

Clinical areas now able to raise appropriate isolation care plans on suspicion of infection, (from own stock) in a timely manner. One isolation care plan may be used for several suspected/confirmed infections where there is a cross-infection risk, thus reducing the number of documents. There is an increase in healthcare staff knowledge of transmission risks of organisms. The type of isolation selected on the care plan is colour coded and has a matching colour-coded isolation display sign to be adhered to the single-room door in which the patient is being cared for.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

85

How my journey as infection prevention and control link practitioner led to the opportunity of achieving a specialist role within a University Trust

Tracey Hambridge 1, Tamasin Davis 1

Abstract

Introduction

As a ward sister my role included being the ward infection prevention and control link practitioner (IPCLP) with a transferable skill set applicable to this new specialist post. Over 14 years I developed an extensive knowledge base around infection control applicable to the clinical speciality of gastroenterology. The IPCLP role helped facilitate my development as a transformational empathetic leader, whilst developing specialist subject interest. My curiosity allowed thorough investigation of infection-related incidents, assimilation of key learning and implementation of changes to practice on the ward. Central to the IPCLP role is the ability to influence cultural change by accepting change as necessary, giving feedback and being a role model across disciplines.

Method

The IPCLP role receives structured support from the Infection Prevention and Control Team (IPCT). Each IPCLP is issued with a contract, portfolio and nominated lead from the IPCT, access to an electronic resource, informal and formal education. I optimised these opportunities for personal learning while also sharing and leading others to improve patient care. Following my appointment into the IPCT a structured induction period has allowed a smooth transition to being part of a larger, Trust-wide service.

Results

By cultivating my learning opportunities I was successful in my application for specialist practitioner in the IPCT. I am now able to apply skills developed on my ward to all wards and departments across the whole acute Trust.

Discussion

I have moved from being a valued member of a ward team to a team providing expert advice and support across the acute Trust. I have bought my key skills to a team who are visionary in optimising clinical development opportunities. My leadership skills and enthusiasm will inspire others to take ownership and become clinical champions and change agents for their own clinical areas.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

99

“Jab it up!” Increasing influenza vaccine uptake in staff at a Mental Health Trust

Katie Grayson 1

Abstract

Introduction

As the National Health Service (NHS) approaches its busiest time of the year, NHS England are encouraging staff to take steps to protect individuals in their care as well as protecting themselves, their colleagues and family by getting an influenza (flu) jab. Frontline healthcare workers (FLHCWs) are more likely to be exposed to the influenza virus particularly during the winter months when some of the people in their care will be infected; so it is vital to reduce the impact of flu to protect patient care (NHS Improvement, 2013).

Methods

Historically the Trust has had a poor uptake rate, with many staff being vaccine hesitant. For the 2017/18 staff vaccination programme; the EAST framework developed by the Behavioural Insight Team (2014) was implemented to steer how the staff campaign was facilitated Trust wide by the Infection Prevention & Control Team. The EAST framework claims that behaviour is more likely to occur if it is made Easy, Attractive, Social and Timely (EAST). Each of the categories is underpinned by a body of evidence from behavioural science.

Results

2015/16 – uptake in FLHCW = 22%

2016/17 – uptake in FLHCW = 25%

2017/18 – uptake in FLHCW = 57.6%

A remarkable achievement to increase vaccination uptake by a staggering 129% in one season by implementing EAST.

Discussion

Last year in England saw the highest ever vaccination rate for FLHCWs since the start of the staff programme in 2002, with almost two-thirds of staff vaccinated (NHS Improvement, 2017). Following the EAST framework appears to have had a positive effect and boosted uptake figures locally. The poster will provide readers with an explanation of how we implemented EAST.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

110

Escherichia coli reduction in the oncology setting: A collaborative approach

Pat Cattini 1, Paul Chadwick 2, Wayne Gilbart 2, Gary Thirkell 2, Marcial Magdalena 1

Abstract

Introduction

NHS Improvement has been tasked by the Minister of State for Health to reduce E. coli bacteraemia by 50% by 2021. E. coli bacteraemias appear to be worse in specialist cancer centres than in many other hospitals, and are associated with infection in oncology patients through: mucositis, allowing gut bacteria to translocate into the blood stream; hepato-biliary sepsis, associated with gall stones, and surgical interventions; survival of E. coli on skin, particularly when there is skin damage, giving a route of infection via wounds or invasive devices; urinary tract infection due to catheterisation, invasive stenting or as a result of dehydration.

Methods

A collaboration has been established between two leading cancer centres to establish how E. coli affects oncology patients and to devise collaborative ways of capturing and controlling risk factors.

Results

  • Increased knowledge and awareness across the Trusts about E. coli.

  • Enhanced patient education via a new HEALTHY care leaflet.

  • Development and trial of a new ward “E. coli unfriendliness” bundle.

  • Development and trial of a patient E. coli care bundle.

  • Improved data collection, allowing us to establish the true impact of key risk factors on developing E. coli bacteraemia.

  • Recruitment of a Darzi Fellow to focus on E. coli reduction in cancer patients.

  • Peer review of cases to ensure consistency of data.

Discussion

There is a belief that cancer patients are disproportionately affected by E. coli bacteraemia, which may be linked to chemotherapy. Chemotherapy is not a risk factor accounted for in the DH data capture system (which considers only neutropaenia). This collaboration represents an approach to establishing whether perceived risks are important and whether cases are preventable. This may allow cancer centres to be benchmarked equitably with other organisations. The work has allowed the teams to look at establishing best practice actions to prevent avoidable cases.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

114

Get up and brush your teeth: A HAP prevention strategy

Kerry Holden 1, Craig Bradley 1, Helen Woodall 1, Allison Page 1, Joanne Basketfield 1

Abstract

Introduction

During the 2011 European point prevalence survey of healthcare-associated infections (HCAI) pneumonia represented the most frequent HCAI. Hospital-acquired pneumonia (HAP) continues to be a significant burden, contributing to increased length of stay, patient morbidity and mortality. Whilst international guidance was recommended for ventilator-associated pneumonia, no specific recommendations for HAP prevention in non-ventilated patients was made available.

Method

Literature searches yielded reasonable evidence that oral care is associated with a reduction in NV-HAP, with early mobilisation interventions also having a positive impact. In January 2018, a multidisciplinary HAP prevention group was formed. The principal aims were to improve the delivery of basic mouth care utilising the national “Mouth care matters” initiative and to increase physical activity amongst inpatients to prevent HAP. Two pilot ward areas (elderly care and respiratory) were identified in which interventions would be focused.

Results

We found a substantial amount of unreported NV-HAP, with only 107 coded cases from January 2016–2017. In pilot areas (utilising the ECDC HCAI definitions for pneumonia) prior to interventions NV-HAP prevalence was 11.4% and 13% in elderly care and respiratory, respectively. After intervention the number of patients sat out of bed and engaging in physical activities increased by 67%. There was also a 30% increase in the number of patients receiving twice-daily mouth care. A repeat point prevalence survey following interventions has seen the prevalence of NV-HAP reduce to 3.6% and 5.5% in pilot areas.

Discussion

NV-HAP needs to be elevated to the same level of concern and attention as is seen in the prevention of ventilator-associated pneumonia in hospitals. The development of a HAP prevention group has enabled the design and implementation of resources, education and tools to improve the delivery of basic mouth care and increase patient activity, which has contributed to reduced prevalence of NV-HAP.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

121

An evaluation of two novel means of recording ‘flu vaccine uptake in a Mental Health Trust

Bridget Spooner 1, Penny Criddle 1, Rony Arafin 2

Abstract

Introduction

Two innovative means of data collection were used in the flu campaign of 2017/18 within a Mental Health Trust. Declination forms confirming a clear decision to refuse vaccine were provided to front-line staff demonstrating the reach of the campaign and promoting informed choices. An electronic app was devised allowing real-time data entry for individuals receiving vaccination generating the Trust’s ImmForm submission each month. Previous years had required time-consuming manual entry of consent forms.

Method

Both methods of data collection were developed and approved at a senior level within the Trust. Peer vaccinators and team managers were invited to complete evaluation surveys of the campaign features through SurveyMonkey®.

Results

Peer vaccinators evaluated the electronic app positively, although there were challenges in internet access on some sites. Some had used paper records then entered data subsequently through the app. This reduced time saving within clinic time, but overall savings were still substantial. Declination forms were evaluated by peer vaccinators as having mainly negative or no impact. A minority reported a positive impact through challenging decision making and promoting discussion. Managers who responded recorded negative impacts. Both groups reported staff feeling “pressured” by the process and some were suspicious of the motive.

Discussion

A letter from NHS Improvement in October 2017 implied that Trusts must collect data about staff refusing vaccine as part of CQUIN criteria, which will pose logistical challenges for Trusts and may risk unintended consequences. Electronic data entry is time saving for Trusts compiling submissions for PHE ImmForm with potential to include data of refusals. This may be seen as “softer” than written declinations for a vaccine that is not mandatory for staff in the NHS. Declination forms have not been extensively evaluated across services but received profoundly negative feedback on this occasion.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

122

A year of journey with the Meridian Hand Hygiene tool

Marietta Niala 1, Sue Fox 1, Rohinton Mulla 1

Abstract

Improvement issue and context

Hand hygiene (HH) paper-based audits have been in place for decades and have been found to be laborious and inaccurate. Observational HH audit requires manual data input and computation. It is seen to be inaccurate because it depends on the understanding and knowledge of the designated observer.

Methods and measurement

The Meridian HH tool was developed by the Infection Control Team in a University Teaching Hospital to help monitor HH compliance in a more efficient way. The tool was first introduced in June 2017 and became live the following month. The tool can be accessed by a tablet or computer. Staff fill in the data using the five moments of HH and it is computed automatically. The scores are extracted on to the Harm Free Care database and reported at Quality Performance meetings.

Evidence and improvement

In the last 12 months, an average of 6088 questionnaires have been filled in. The highest compliance was 94.96% and the lowest compliance was 83.05%. After body fluid exposure risk has the highest compliance of 96.03%, while after contact with patient surroundings has the lowest compliance of 85.36%. In those 12 months, improvement in the understanding and quality of HH was evidenced in the 6 months’ data. Results are reviewed and monitored closely by the infection control nurses (ICN) to determine the validity of results. The ICN continued to support staff on their understanding by ward visits and refresher study sessions.

Future steps

The Meridian HH tool saves staff time from using paper-based audits and manual computation, but more so it gives better qualitative data that can identify areas of non-compliance. However, more coaching maybe needed for staff to understand that a score of 100% based on one or less than five observations is not good qualitative data.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

130

Patient hand hygiene: How often does it happen?

Heather Loveday 1, Jennie Wilson 1

Abstract

Introduction

Current evidence suggests that patients are rarely offered the opportunity to decontaminate their hands while in hospital. In addition to the aesthetics, lack of patient hand hygiene (HH) may contribute to healthcare-associated infections (HCAI) via a number of routes: ingestion, contamination of invasive device or transfer to the healthcare environment. A variety of pathogens are associated with healthcare infections on the hands of patients, including C. difficile, MRSA, VRE, and Gram-negative organisms, acquired either from their immediate environment, equipment or the hands of staff. There are few studies that have investigated strategies to improve patient HH. This paper reports the first stage of an improvement study.

Methods

Patient HH was observed by researchers in 3h period between 8am and 7pm on six wards in an acute district general hospital. Data was captured on opportunities for patient HH, reason HH required, availability of HH agents, method used, and prompting by staff. Qualitative data on factors that prevented/facilitated were documented.

Results

303 HH opportunities were analysed. In 95 opportunities (31.4%) patients had access to at least one option to perform HH. In only 40 opportunities (13.2%) HH occurred. There were significant differences between different wards. There was no difference in performance relating to patient dependency and also no difference those cognitively impaired and those not. The most prevalent opportunity was before food and drink (63%) followed by before touching nose/mouth (11.9%), after using the toilet or a commode/urinal/bedpan (21.8%). Of the methods available to all patients, soap and water was available (12.9%), a hospital-supplied hand wipe (15.5%) and patient’s own wipe (3.3%). Qualitative analysis was undertaken to look for barriers to patient HH.

Conclusion

There are significant opportunities for enhancing patient HH. Further work is currently being undertaken to implement a co-designed patient HH bundle.

Footnotes

Declaration of interest: This study was funded by an unencumbered research grant from GAMA Healthcare. The funders had no input to the design, management or reporting of the study.

J Infect Prev. 19(1 Suppl):S4–S63.

138

Impact of influenza POCT by nursing staff on isolation decisions and infection control management in an Acute Medical Unit

Janet De Witt 1, Nicola Colborne 1, Joanna Randall 1, Aiden J Plant 1, Stella Roberts 1, Cressida Auckland 1

Abstract

Introduction

Management of patients with influenza provides diagnostic, management and infection prevention and control challenges. Influenza point-of-care testing (POCT) has the potential to transform the assessment of the patient with acute respiratory illnesses, resulting in correct placement of the patient, freeing up valuable single-room accommodation and faster treatment decisions, reducing the risk of secondary spread/hospital outbreaks. This study aimed to assess the impact of POCT on the management of patients with respiratory signs and symptoms over a 2-year period.

Method

The 2-year study compared diagnosis and management of influenza patients before and after POCT. Adults with acute respiratory illness and fever presenting to the Acute Medical Unit were swabbed and tested for Influenza A & Influenza B by either laboratory-based testing (phase 1: 01-01-17 until 18-01-17)) or POCT (phases II and III: 29-01-17 until 13-02-17, and 29-02-18 until 13-02-18). Trained nursing staff undertook the POCT using the GeneXpert system tandem Xpert for influenza/RSV assay, and made management decisions on the basis of the results. The Infection Control Team oversaw the infection control management, which included isolation, risk assessment and contact tracing.

Results

The results show a dramatic reduction in time from sample collection to test result between phases, which resulted in:

  • Quicker results: sample to diagnosis

  • Fewer contacts from positive cases

  • Proportion of patients isolated within 4 hours of admission increased

  • Reduced hospital-acquired infection

Discussion

POCT for influenza is a positive tool that has significantly reduced the time to diagnosis of influenza, that results in faster isolation and discharge of patients, reduces the number of contacts and the risk of secondary spread and hospital influenza outbreaks.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

145

Bioquell POD: A solution to reduce lost bed-days?

Julie Singleton 1, Tracey Galletly 1, Siddharth Mookerjee 1, Alison Holmes 2, Jemmy Mumbwatasai 1, Nerissa Cummings 1, Karen Hathway 1, Jonathan Otter 2

Abstract

Introduction

Vascular services and IPC installed and evaluated an intervention that promised to increase the ability to isolate, reducing transfers of infectious patients, alleviating bed closures, whilst improving patient safety in the wake of a CPE outbreak in 2015. The outbreak cost €1.1m over 10 months with the greatest cost (€349,000) attributed to bed closures and the inability to provide a flexible elective vascular service due to reduced capacity.

Methods

The intervention was the installation of a Pod system by Bioquell; a single-occupancy room solution which allows for potentially infectious patients to be safely and effectively isolated with transmission-based precautions in an open ward environment.

Results

A user satisfaction survey provided by Bioquell was completed by 32 members of staff and 19 patients between Apr-17 and Jun-17. Between the months of Apr-17 and Jun-17 the Pod was occupied on 12 occasions for IPC reasons (based on continuous Pod occupancy during this period). The Pod allowed patients with infections that required transmission-based precautions to receive level 2 care in an open planned HDU environment safely. As a result, HDU were able to retain the use of all its beds by preventing the blocking of 22 HDU bed-days during this period.

Discussion

Using the POD system reduced transfers and mitigated loss of HDU beds. This is a key intervention to enable patients to stay in their area of required specialist care, improving patient safety and patient experience. Patient feedback was encouraging on issues of comfort, quality of care. Staff acknowledged the benefits in carrying out their role by the bed side and financial implications for the Trust. Future scope for a Pod will be supported by the Trust.

Footnotes

Declaration of interest: JAO is a consultant to GAMA Healthcare and Pfizer.

J Infect Prev. 19(1 Suppl):S4–S63.

172

Improving the patient’s experience through the reduction in newly identified CPE cases in University Hospital Limerick, Ireland

Barbara Slevin 1, Patricia Treacy 1, Nuala O’Connell 1, Colum Dunne 2

Abstract

Introduction

The emergence and spread of carbapenemase-producing Enterobacteriaceae (CPE) is a clinical and public health concern nationally and internationally. These resistant microbes are associated with significant morbidity and mortality. In this hospital, the first documented case of CPE was described in 2009, and since then new CPE cases have risen since 2013 accounting for 53% of the total national burden in 2015. The aim of our quality improvement (QI) project was to improve the patient’s experience through the reduction of newly identified CPE cases from 27 (total for the first 6 months, 2015) to 13 for the first 6 months, 2016. It was opportune to review all aspects of the management of CPE, including financial costs and the impact of the new cohort ward.

Methods

Patient surveys were conducted to ascertain the effect of CPE on patients and their families to help better understand the impact of CPE from the patient perspective. Stakeholder mapping and analysis was conducted to achieve the project’s aim. A series of PDSA cycles were undertaken, as a consequence of baseline audits, to enhance compliance with CPE, infection prevention and control processes for screening and diagnostics, hand hygiene, care bundles for devices and contact precautions. The daily cost of each of the CPE patients and an average cost per night identified for the patient stay was calculated.

Results

Sixteen new CPE cases were identified for the first 6 months of 2016. The impact of the QI measures utilised have evidenced a safer, more efficient and higher quality of care provided to the patient population with an identifiable cost saving of €682,086 for the first 6 months of 2016.

Discussion

These interventions will be useful at regional and national level, as a coordinated approach has the potential to yield significant reductions in overall CPE transmission compared with traditional single institutional approaches.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

146

Scottish National Hydration Campaign to support UTI reduction within a whole health population

Jane Mcneish 1, Lesley Shepherd 1

Abstract

Introduction

Within Scotland, urinary tract infections (UTIs) are the most common type of healthcare-associated infection seen in hospitals (24.6%) and care homes (31%) Around one-third of E. coli bacteraemias are caused by a UTI, which is similar to the findings in England. In addition, during 2017 more than half of E. coli bacteraemias originated within the community. Evidence suggests that adequate hydration can reduce one’s risk of UTI. The Scottish UTI Network (SUTIN) developed a national hydration campaign to raise awareness of the benefits of good hydration within a whole health population. This was then linked to work of other national health programmes where good hydration can be beneficial, e.g. falls, pressure ulcers, delirium and acute kidney injury.

Method

A SUTIN Short Life Working Group developed a suite of resources to highlight the benefits of good hydration. These support the people of Scotland to make the right choices in terms of hydration and spotting the signs of dehydration by looking at the colour of their urine. All community pharmacies across Scotland displayed poster and leaflets communicating this message. Specific resources were then developed for the acute and care sectors, e.g. infographic depiction of the signs of dehydration on the body’s systems, and a reusable aide-memoir to remind folks to drink.

Result

Initial feedback has been very positive, in particular around the urine colour chart, signs of dehydration and the drinking aide-memoir.

Discussion

Evaluation exercises have commenced to assess the impact of the campaign. Engagement will be with pharmacists regarding the hydration poster, requesting feedback on the public’s comments and also the use of the leaflet when providing advice on uncomplicated UTI (supporting Pharmacy First). Additional evaluation will be sought from other staff groups (nursing/care home) using the specific resources for their setting.

Footnotes

Declaration of interest: No conflicts of interest to declare

J Infect Prev. 19(1 Suppl):S4–S63.

159

Impact of a PCR point-of-care test for Influenza A/B on an emergency department in an acute hospital

Kerry Holden 1, Craig Bradley 2, Martin Biggs 1, Tracey Martin 1, Jane Parkes 1, Sophia Byfield 1, Sarah-Louise Round 1, Victoria Clewer 1, Caroline Smith 1, Elisabeth Holden 1, Mark Garvey 1

Abstract

Introduction

Influenza is a leading cause of acute respiratory infection and places a significant burden on health care. To reduce hospital transmission, patients clinically suspected of having influenza are isolated and offered empirical antiviral treatment. Here we report the use of a point-of-care test (POCT) for influenza in an emergency department (ED) and its effects.

Method

The evaluation was conducted in the ED at Queen Elizabeth Hospital Birmingham in patients presenting with influenza-like illness (ILI) during two time periods ((Period 1 (P1) Dec 16–Mar 17 vs. Period 2 (P2) Dec 17–Mar 18)). A PCR POCT (Cepheid) was installed in the ED in P2 and used to test any patients with ILI. Four outcomes were used to assess the impact of the POCT: length of stay (LoS), drug utilisation (oseltamivir), time to isolation (TTI) and in-hospital transmission of influenza.

Results

There were 666 confirmed influenza cases in P2 vs. 51 in P1. During P2, the LoS of patients presenting with ILI was significantly lower (median = 17 days P1 vs. 3.8 days P2) and TTI timelier (median 2.5 days P1 vs. 1 day P2). The time to initial receipt of antivirals for patients with influenza was quicker in P2 (median 3 days P1 vs. 1.5 days P2). In P2 significantly fewer of the total number of influenza cases were identified after 48 hours of admission (8%) compared with P1 (20%), suggesting less in-hospital influenza transmission.

Discussion

Following introduction of the POCT, there was an increase in appropriately targeted oseltamivir prescribing, shorter TTI, proportionally fewer post-48 hour influenza cases and a reduction in LoS of patients presenting with ILI. This study demonstrates that POCTs have the potential to improve the quality and efficiency of management of ILI. Although difficult to quantify, there is likely an additional benefit of admission avoidance.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

2

Contact tracing of dog-bites, disability-adjusted life year score and associated risk of rabies in four Government hospitals of Pakistan

Waqas Ahmad 1, Muhammad Awais 1, Iahtasham Khan 1, Muhammad Amjad Ali 2

Abstract

Background

Rabies is an underestimated, lingering and neglected tropical disease in Pakistan. The present study was designed to investigate the burden of bite cases in humans, associated disability-adjusted life year score (DALYs) and risk of rabies. The risk of rabies can be correlated with the number of bites caused by different species. The data were obtained from four district headquarter hospitals (DHQs).

Method

The data were manually procured from the outdoor patient department from two hospitals during 2006 to 2012, while a similar method was carried out to obtain the data from remaining two hospitals during 2012 to 2017. It was manually categorised into number of total bites to male, female and children with species causing the bite. Analysis of variance was carried out to statistically analyse the data.

Results

Results showed that the dog is the principal reservoir, causing almost all the bites in humans. The highest number of cases (n=310) was recorded in 2017, carrying the maximum number of male patients in one DHQ. The monthly distribution of bites was higher in summer, with the highest figure (>80%) of DALYs caused by category II bites, while a limited number (>10%) of DALYs was reported due to category III bites. The case of dog bite with essential requisites from a single patient was neither uniformly composed in hard form nor it was stored in soft form for future surveillance or national control plan.

Conclusions

Rabies is still endemic in Pakistan due to various epidemiological constraints including inadequate and insufficient prophylactic measures in basic health units of Pakistan, lack of proper awareness among people, increasing population of unvaccinated stray dogs, and lack of responsible pet ownership. Most importantly, lack of proper diagnostics and higher economic cost towards the prevention and elimination of rabies are the barriers behind legislative negligence.

Table 1.

Total number of dog-bites in humans from 2 DHQs of Punjab, Pakistan.

graphic file with name 10.1177_1757177418794054-img19.jpg
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Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

30

Clostridium difficile infection: A multi-disciplinary approach to prevention – “Sustained”

Thressia Puthussery Devassy 1, Sheila Donlon 1, Caoimhe Finn 1, Fionnuala Duffy 1, Helen Good 1, Helen Cox 1, Pauline Flood 1, Dorothy Costello 1, Eric Watson 1, Margaret Fitzpatrick 1, Mairead Skally 1, Karen Burns 1, Edmond Smyth 1, Hilary Humphreys 1, Binu Dinesh 1, Fidelma Fizpatrick 1

Abstract

Introduction

Clostridium difficile infection (CDI) is the leading cause of infectious nosocomial diarrhoea in Europe. In recent years, Beaumont hospital has managed a number of outbreaks of CDI, including the hyper-virulent strains 027 and 078, with a combination of infection prevention and antimicrobial stewardship improvements.

Aims and objectives

To reduce the rate of hospital-acquired CDI.

Methodology

Multi-disciplinary interventions utilised:

Clinical

  • Since 2015, fidaxomicin in use as first-line therapy for toxin-producing hospital-acquired CDI

  • Targeted antimicrobial stewardship rounds on wards with increased incidence of CDI

  • Decontamination of single rooms with hydrogen peroxide vapour (HPV) following discharge or transfer of a patient with CDI

  • Monthly mattress audits, with replacement of soiled/contaminated mattresses

  • Introduction of “mattress check” tracking labels

  • Introduced new compatible bedpans, urinals, jugs and new commodes, also pulp disposal units in some areas

Education sessions conducted on CDI and infection prevention and control management of inpatients

Results

  • In 2015, there were 77 hospital-acquired CDI cases, 73 in 2016 and 56 in 2017, representing a decreasing rate per 10,000 bed-days used from 3.4 in 2015 to 2.4 in 2017

  • The annual total hospital CDI outbreaks declined from six in 2015, to three in 2016 and one in 2017

  • HPV was utilised for 92 rooms in 2017, a reduction from 140 rooms in 2016

  • Mattress audits and “mattress check” tracking labels have facilitated timely identification and replacement of soiled mattresses

  • Annual antimicrobial consumption rates remained stable over 3 years

Discussion

A multi-disciplinary approach has reduced the rate of hospital- acquired CDI in a tertiary hospital since 2015. This in turn has resulted in fewer outbreaks of CDI. The reduced incidence has been sustained, and fewer patients with CDI has led to a reduced demand for HPV of patient rooms following discharge or transfer of a patient with CDI.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

72

Environmental reservoirs of methicillin-resistant Staphylococcus aureus (MRSA) in clinical areas and the efficacy of Ultra-V decontamination in an outbreak situation

Niamh Whittome 1, Laura Jadkauskaite 2

Abstract

Introduction

Hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) infection is one of the biggest concerns in the healthcare industry. As such, effective cleaning and early screening are essential to control and prevent MRSA infection. However, due to high patient numbers and ineffective domestic cleaning, outbreaks of MRSA can still occur. Therefore, during an MRSA outbreak on a gastroenterology ward, deep clean UV-C system was implemented to decontaminate the environment.

Method

Patient (n=10) and environmental (n=17) isolates were collected from patient spaces and air vents in the gastroenterology ward using mannitol salt agar contact plates. Testing of MRSA isolates was done by Gram stain, subculture and coagulase test followed by PFGE genotyping.

Result

Due to the MRSA outbreak and ineffective manual cleaning the ward was closed. Collection of patient and environmental isolates was identical, identifying MRSA type T032. During the ward closure period, deep clean using the Ultra-VTM UV-C system was used. Subsequently, post-clean swabs were taken, tested and results were negative for MRSA. Following the successful deep clean using the Ultra-V system, additional infection prevention requirements were raised. Wearing appropriate personal protective equipment and usage was monitored, followed by the implementation of an educational programme on manual cleaning to domestic and clinical staff. Furthermore, additional hand hygiene trainings were provided, together with ongoing weekly MRSA patient screening. Finally, improved integrity equipment checks were performed.

Discussion

During the MRSA outbreak it was identified that manual cleaning alone is not sufficient to protect against MRSA. Therefore, we suggest that regular usage of a deep clean UV-C system together with essential infection prevention steps can protect against bacterial spread and reduce the possibilities of outbreaks within hospital wards.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

78

Collaborative working during a time of infection incidents

Federico Tabios 1, Shona Perkins 1, Neil Wigglesworth 1, Timothy Watts 1, John Klein 1, William Newsholme 1, Alex Phillips Jr 1

Abstract

Introduction

During October–December 2017, there were two clusters of infection and colonisation identified in a large tertiary neonatal unit in Southeast London. Two micro-organisms were identified: Pseudomonas aeruginosa and Serratia marcescens. In response to these cases, the Paediatric IPC team with the Neonatal IPC Group conducted a detailed investigation and this led to increased collaborative working.

Methods

The cases were reviewed and samples were sent for typing. Actions taken including liaison with the Water Safety Team to increase water testing across the Neonatal Unit. Some other actions have been carried out, such as reviewing clinical practice, e.g. hand hygiene, aseptic non-touch technique, IV care, shared equipment and equipment cleaning practices. The staffing of the Neonatal Unit including acuity and cot spacing was also reviewed.

Results

From January 2018 to May 2018 no more cases linked to the infection incidents of either micro-organism have been detected. Collaborative working with the neonatal team (which has included training doctors to do hand hygiene audits) continues on the unit. The team approach to making improvements has been reflected in improved audit results, specifically hand hygiene compliance. There has also been a cultural shift across the Neonatal Team with the Neonatal Infection Group expanding to include the MDT but also the enthusiasm and bright ideas from differing staff members.

Conclusion

A collaborative working relationship in the implementation of IPC procedures and strategies has resulted the decline of Pseudomonas and Serratia cases on the neonatal unit. Good engagement and ownership by the neonatal team has been the driving force in the process of solving this issue.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

80

An outbreak of norovirus linked to a residential patient facility in a Children’s Hospital

Federico Tabios Jr 1, Shona Perkins 1, Neil Wigglesworth 1, William Newsholme 1, Gaia Nebbia 1, Victoria Felton 1

Abstract

Introduction

During November 2017 there was an outbreak of norovirus on a general paediatric ward. In the course of the investigation, the outbreak was linked to a family member being unwell at the residential facility.

Methods

The Paediatric IPC team were informed of a confirmed case of norovirus of a child in a bay. This child’s symptoms were not escalated to the IPC team. Over the course of 2 days new cases of children with symptoms of diarrhoea and/or vomiting were declared across the ward. Seven children had laboratory-confirmed norovirus. The ward was closed to admissions and transfers. The ward team were advised to follow IPC instructions detailed in the viral gastro-enteritis resource pack available.

Results

The Outbreak Incident Team was convened and the whole ward was to be closed for admissions and transfers. The family support worker highlighted that the parents of the confirmed norovirus cases were staying in the hospital’s family residential facility. It was also discovered that some of the families of affected children were also identified to be symptomatic. In response to the information, the residential facility was closed to any new parents and symptomatic families were advised to go home and stay away until 72 hours until clear of symptoms. All communal areas were closed and the accommodation was deep cleaned. Families were provided with advice leaflets about norovirus and preventing the spread.

Discussion

The residential patient/family facility was identified as a possible source of the outbreak. It is important for IPC teams who oversee paediatric clinical areas that they consider the family and facilities they may resident in as a possible source or place for ongoing transmission of infection.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

98

Management of an outbreak of MRSA blood stream infection at an Acute Trust in England

Glynis Bennett 1, Emma Hardwick 1, Debra Adams 3, Elizabeth Beech 3, Mark Reacher 4, Sarah Jane Ward 5

Abstract

Background

In April 2018 three potentially linked cases of MRSA bloodstream infection were identified on a medical ward at an Acute Hospital Trust in England. This abstract provides an overview of the outbreak, outbreak management and the challenges faced.

Methods

The outbreak management followed standard principles. In addition, a multi-agency Appreciative Enquiry approach was utilised; this included support from NHS Improvement, Public Health England and the local Clinical Commissioning Group.

Results

The outbreak identified several challenges. These included; staff engagement, staff awareness of roles and responsibilities, environmental/equipment decontamination, terminology associated with decontamination, the identification for facilities/funding for a decant ward and patient/staff screening.

Discussion

The outbreak identified lapses in standard precautions and awareness of roles and responsibilities. This highlighted the need to improve awareness of infection prevention in the clinical area and not rely solely on observational audits. Following this outbreak the Trust has developed a protocol for decanting patients, undertaken a roles and responsibilities awareness campaign for staff and reviewed the decontamination processes used. An education programme for ANTT is in place and all clinical staff on the medical ward concerned are attending to update competencies as required. In addition, an Appreciative Enquiry peer review visit was commissioned from NHS Improvement. This not only identified the areas of outbreak management which could be improved, but also areas where we excelled. This focussed on embedding Infection Prevention and governance in the organisation and not just improving it in response to the outbreak. The Trust has also adopted a board to ward approach to IP&C with the CEO leading an awareness session using patient experiences as an awareness tool. Sessions have been for all staff and catered for shift patterns including evening sessions.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

101

Outbreak of Clostridium difficile in an intensive care unit

Hannah Bysouth 1, Berina Kaur 1

Abstract

Introduction

Over a 6-week period, there was an outbreak of Clostridium difficile (CD) in a 9-bedded intensive care unit. There were five cases in total which were associated with the unit. This is unusual for this care setting and organisation. This prompted the Infection Control Team to initiate a cascade of infection prevention intervention in collaboration with the intensive care and infection prevention multidisciplinary teams.

Method

It was agreed that the unit will have to do the following:

  • Use sporicidal wipes for damp dusting patient bed space and patient equipment

  • Amber clean of each bed space after each discharged

  • Minimise equipment in the unit and bed space area

  • Hydrogen Peroxide Vapour (HPV) the single rooms on discharge.

  • Hand hygiene with soap and water is adhered to

  • Enhance cleaning

Results

Despite the interventions there were new cases of CD. This is when the Infection Prevention Team suggested cleaning of the whole unit with HPV. This was agreed with the critical care team who engaged the rest of the hospital to facilitate patients and postpone operations. After the HPV clean, there were no further acquisitions of CD in the intensive care unit. A few weeks after the event, we found that the ribotypes were different in all the patients. The acquisitions were linked with patient location and timeline.

Discussion

Infection prevention in an outbreak is a multimodular approach, which is what we have done in this case. Good evidence is difficult to source for some of these interventions. Therefore we implemented a number of interventions based on best practice. There were also only two single rooms. Both the enhanced cleaning and the cleaning done by the staff in unit was of good quality, as evidenced in the result from the environmental swab.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

131

An outbreak of borderline oxacillin-resistant Staphylococcus aureus in a dermatology unit

Linda Dalrymple 1, Jennifer Lee 1, Benjamin Parcell 1, Claire Buick-Clark 1, Ross Hearn 1, Matthew Holden 2, Catriona Harkins 1, Elizabeth Dickson 3, Anne Marie Karcher 1

Abstract

Introduction

Typing of borderline oxacillin-resistant Staphylococcus aureus (BORSA) carried out by the National MRSA Reference Laboratory identified a single strain common to an NHS Board. Investigation identified links to patients admitted to the dermatology ward in one hospital. Inpatient and outpatient services, including phototherapy, are delivered here.

Method

Multi-disciplinary Incident Management Team meetings occurred to discuss new isolates. These aimed to establish potential routes of transmission and prevent further spread. Interventions were agreed and monitored by the group to determine if the improvements had impacted on the outcome. The Infection Prevention and Control Team (IPCT) undertook observations of practice and spot checks in the clinical areas with immediate feedback to staff.

Results

Interventions focused on improved standards of cleanliness, clinical practice, environmental improvements, and cleaning and decontamination of equipment were put in place. Contact precautions, including isolation, started as soon as a possible BORSA was identified in the laboratory; samples were then sent to the National Reference Laboratory for confirmation. Screening and decolonisation protocols have been developed and implemented. A reduction in the number of new isolates associated with or linked to Dermatology has been observed. Whilst this is positive, the outbreak cannot yet be considered to be at an end until a sustained time period without a new isolate being observed.

Discussion

Close collaboration between the clinical team, IPCT and Support Services has enabled a coordinated and sustained approach to bringing the outbreak to an end. Eliminating BORSA from the Dermatology unit has been challenging despite improvements in practices, antimicrobial prescribing and the environment. Reducing the burden of organisms in an environment where heavy skin shedding is common has proven to be difficult, but has highlighted the need for, and benefits of, joint working between all staff groups to address a complex and challenging problem.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

134

Measles: The forgotten virus?

Carolyn Lewis 1, Karen Porter 1

Abstract

Introduction

Measles is a highly contagious disease thought to be eradicated in the UK. However, a lack of compliance with vaccination has resulted in an increased incidence of the disease. The virus Morbillivirus paramyxoviridae is transmitted via the respiratory route and it is most contagious 4 days prior to and 4 days after the onset of a rash.

Method

A community outbreak of measles resulted in an influx of measles cases at an acute care hospital, challenging the infection prevention and control services and posing a cross-infection risk to staff and patients. Precautions needed to be implemented including isolation of patients and use of personal protective equipment. Systems were developed to identify non-immune paediatric patients and to inform adult patients of their potential exposure to measles. Infection control practices were reinforced with staff education. The measles policy was updated and flow charts were devised for staff working in emergency areas. Patients who were exposed to the virus were informed via letter and staff were advised to confirm their immunity status. Patients who were non-immunised, pregnant or immune suppressed were reviewed for further intervention.

Results

During this outbreak more than 100 patients presented to the hospital and over half were diagnosed with measles. The outbreak revealed three key areas of management – prompt identification of patients, implementing infection control practices and informing and treating patients and staff exposed to measles.

Discussion

Identifying adult patients was difficult, resulting in a delay in isolation and some patients being misdiagnosed due to a lack of staff awareness. Patients also failed to identify themselves as potentially having measles. It was challenging to access accurate patient and staff records, and staff were unaware of their measles immunity. Consequently, the Occupational Health Department was overwhelmed with checking staff vaccination and immune status.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

142

Are our attempts to control CPE going down the drain?

Tracey Galletly 1, Julie Singleton 1, Moya Alexander 1, Dunisha Samarasinghe 1, Anan Ghazy 1, Alison Holmes 1, Eimear Brannigan 1, Jonathan Otter 1

Abstract

Introduction

Carbapenemase-producing Enterobacteriaceae (CPE) are of urgent public health concern. There is emerging evidence that contaminated drains may contribute to protracted outbreaks of CPE. We evaluated whether the drains of sinks and showers on a ward affected by an ongoing outbreak of CPE (Klebsiella pneumoniae OXA-48) could be a possible point source for transmission.

Methods

Drains from 28 clinical wash hand basins, patient sinks and showers on a 19-bedded vascular ward were sampled. These were cultured overnight in enrichment broth and then plated onto selective agar for CPE. The drains were then treated with a 10,000ppm chlorine solution. The same drains were resampled 1 week later.

Results

25 of the 28 drains sampled cultured positive for Gram-negative bacteria. Five of these were CPE, with the remainder comprising a mix of mostly pseudomonads and enterobacters. There were no Klebsiellae among the CPEs found, but OXA-48s were identified in the Citrobacters and one Enterobacter species. Of the second samples, 25 of 30 were culture positive for Gram-negative bacteria and five of these were a CPE. Three of the five positives were the same organism as identified in the first samples. The outbreak organism was not cultured on either round of sampling.

Conclusion

We did not identify the outbreak strain in the drains of sinks and showers on a ward with a protracted outbreak of CPE, suggesting that sink and shower drains were not a point source for transmission. However, the carbapenemase involved in the outbreak (OXA-48) was detected, suggesting that sink and shower drains could be a reservoir for clinically relevant carbapenemases. Further studies are required to ascertain the effectiveness of treating the drains and to develop protocols in order to achieve this.

Footnotes

Declaration of interest: JAO is a consultant to GAMA Healthcare and Pfizer.

J Infect Prev. 19(1 Suppl):S4–S63.

154

Spreading and persistence of carbapenemase-producing bacteria in patients’ bedrooms

Sophie Baranovsky 1,2, Sara Romano-Bertrand 1,2, Patricia Licznar-Fajardo 1,2, Hélène Marchandin 1,3, Sylvie Parer 1,2, Estelle Jumas-Bilak 1,2

Abstract

Introduction

Carbapenemase-producing bacteria (CPB) are more and more involved in healthcare-associated infections. The hospital environment is often supposed to be the source and/or an amplifier of CPB outbreak. This study described the spreading and the persistence of CPB in the bedrooms of patients infected or colonised by CPB.

Methods

Hygiene practices were upgraded in every ward where a CPB colonisation/infection case was detected. Environment room samples (n=30; classified in six categories) were taken in the presence of the patient, 24h after the daily room cleaning. Bacteria were grown onto Gram-negative selective medium and identified by MALDI-TOF-MS. Genotypes were compared by multiplex rep-PCR. The genes blaOXA48 and blaNDM were studied by PCR and sequencing.

Results

In total, 2257 surfaces in the bedrooms of 28 CPB-carrying patients provided 188 environmental strains: 96 Klebsiella pneumoniae, 34 Enterobacter cloacae, 13 Escherichia coli, and 45 Acinetobacter baumannii. Contamination rate ranged from 0% to 30% and was not linked to CPB species, to colonised/infected patient’s status or to ward type. The more contaminated surfaces were dry furniture (31.5%) and water points-of-use (24.9%). Some patients’ genotypes were not found in bedrooms and in contrast, environmental genotypes were not all detected in patients. Some environmental strains displayed the same genotype as clinical CPB but lacked resistance genes. For instances, this was the case for all OXA-48 E. coli strains but for none of NDM A. baumannii.

Discussion

A wide diversity in genotypes and resistotypes was observed in CPB populations isolated in patients and in their rooms. This diversified population should be considered as a whole epidemiologic unit for a better understanding of CPB transmission dynamics. Strains of the same species displaying clear-cut behaviour in patients’ rooms could be experimentally studied to find spreading and/or persistence traits. In further studies, the concepts of high-spreader patients and high-spreading bacteria could be considered together and addressed.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

166

What is the risk of Ebola virus transmission to patients in isolation facilities? A review of the literature

Emilio Hornsey 1

Abstract

Introduction

Although the potential risk to patients of acquiring Ebola while admitted to isolation facilities is widely acknowledged, it is hard to quantify. The fear of acquiring Ebola was a considerable barrier to people’s willingness to be admitted during the epidemic in West Africa 2013–2016. Transmission within an isolation centre is counter-productive to resolving an outbreak, and efforts should be made to understand this risk in order to eliminate it. We undertook a systematic review of the literature in an attempt to (i) quantify the infection risk in Ebola isolation units, (ii) identify knowledge gaps and (iii) orient future operational research on infection prevention and control in these facilities.

Methods

This reviewed literature on readmission to an isolation facility within 21 days, as a proxy measure of within-facility transmission in an attempt to quantify the risk posed by admission to an Ebola isolation centre. Healthcare worker infections and infections in general hospitals were not included. The search was not limited to a particular date, location or patient subset.

Results

Readmission rates varied from 0% to 6.5%. All studies were retrospective studies of existing data and had significant limitations. Very little information was presented about the nature of the facilities and individual patient exposures. From the published evidence it is impossible to accurately say what the risk of Ebola transmission is in isolation units.

Discussion

Further research is urgently needed to investigate cases of virus transmission to patients admitted to isolation units. This should include a full investigation of the circumstances surrounding each case. Any identified risk factors should be mitigated in order to improve confidence of patients and enhance the prompt resolution of an Ebola outbreak.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

171

Improving compliance when undertaking carbapenemase-producing Enterobacteriaceae (CPE) screening as part of an outbreak management plan

Mandy Brailey 1, Joanna Peasland 1

Abstract

Introduction

An outbreak in a community neurological rehabilitation unit was identified as carbapenemase-producing Enterobacteriaceae (CPE). Microbiology testing later confirmed the samples to be of the same strain NDM and OXA 48. Following recommendations within the DH Community CPE toolkit, a CPE screen was commenced for all patients on the unit.

Methods

The screening programme consisted of faecal samples, urine samples and wound swabs; it was agreed a rectal swab was an acceptable alternative in the absence of a faecal specimen. Screening was undertaken at 48 hour intervals until three negative screens had been achieved. Following this, weekly screening was to continue for a period of 3 weeks.

Results

There were a number of issues that meant that we were unable to achieve a streamlined and structured screening programme. Although no further cases were identified; the length of time to complete the screening programme and the lack of sequencing is an important area to ensure that lessons are learned.

Discussion

Carbapenems are a powerful group of broad-spectrum beta-lactam antibiotics, and in many cases our last effective defence against infections caused by multi-resistant bacteria. It is paramount that on notification of a CPE outbreak, a robust screening programme is essential. This should consist of the development of a standard operating procedure for staff, to ensure specimens are obtained and labelled in a timely manner to avoid rejection of specimens in the laboratory. In addition, robust communication regarding the sending of specimens is required to ensure that a coordinated screening programme is delivered with a clear and detailed system of recording samples obtained. Patient education is also critical to ensure compliance with specimen collection in line with the screening process.

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Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

158

C. diff – What matters to me: A patient and relatives perspective of Clostridium difficile infection

Elaine Ross 1, Kay Currie 2, Caroline King 2, Justine McCuaig 1

Abstract

Introduction

Patients and relatives interviewed as part of the Vale of Leven inquiry into an outbreak of Clostridium difficile infection (CDI) in 2007 expressed concern regarding the information they received. This study was designed to evaluate the impact of contact with an infection prevention and control nurse (IPCN) on patients and relatives experience of CDI.

Method

All patients meeting the Health Protection Scotland criteria for CDI in one NHS Scotland health board were assessed for inclusion in the study. Exclusions were deceased patients and their relatives, inpatients, or those with a known mental or physical condition that would prevent them from participating in a telephone interview. Letters were sent to 35 patients. In addition to those interviewed several patients responded but gave reasons for declining. Qualitative semi-structured telephone interviews were conducted with four patients and two partners. This yielded rich narrative data. Thematic analysis of transcripts was conducted and peer reviewed.

Results

Demographics

  • Sex: 1 female, 4 males

  • Age range: 33–94

  • Sample taken: 1 GP, 4 Hospital,

  • Origin of infection: 2 HAI, 1 CAI, 2 Unknown

  • Number of cases: 1 patient – 3 cases, 4 patients – first case

Key findings

  • Patients and relatives value direct contact with those providing information on Clostridium difficile infection

  • They don’t remember who gave them information but do remember how it was given

  • Leaflets and links to information do help

  • Contact with IPCNs when out of hospital is valued

  • The impact of CDI is much wider than the physical effects

  • Patients describe feelings of stigma by being provided with a card to give to other healthcare providers

Discussion

This study aids understanding of the impact of specialist IPCN advice and support. This can be used to design optimal services to improve patients’ and relatives’ knowledge and experience of CDI.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

12

Efficacy of MSSA operative site surveillance

Edward Jeans 1, Matthew Corlett 1, Andrew Jennings 1

Abstract

Introduction

Surgical site infection (SSI) is a devastating complication of arthroplasty surgery. Treatment often involves further surgery and prolonged courses of antibiotics. This is associated with costs to the patient in reduced quality of life but also to the healthcare system. Methicillin-sensitive staphylococcus aureus (MSSA) is a common cause of SSI; screening and eradication is now recommended by the World Health Organization. Currently pre-operative swabs are taken from the nose and surgical site. In a time of NHS rationing, the aim of this study is to assess any additional benefit from swabbing the surgical site.

Methods

This was a retrospective review of prospectively gathered infection control data. All patients presenting for hip and knee arthroplasty between 1st September and 31st October 2017 were included. Data on demographics, surgery performed, positive swabs and SSIs were collected from the case notes and infection surveillance team.

Results

There were 171 patients included (84 hip arthroplasties and 87 knee arthroplasties); 42 positive nasal swabs; six positive surgical site swabs; one case of positive surgical site swab with negative nasal swabs. Three early SSIs were identified (1.75%), of these one had positive pre-operative nasal swab, none having positive surgical site swab. The odds ratio of developing SSI in a MSSA-positive patient pre-operatively is 1.5 (CI 0.14–17.5) versus MSSA negative.

Conclusion

It would appear there is a weak correlation between pre-operative colonisation and SSI; this, of course, could indicate that pre-operative screening and decolonisation is effective in our centre. There is little or no added value of swabbing the surgical site, yielding an extra 0.6% MSSA positives. In our Trust where approximately 1500 arthroplasty surgeries are performed per annum, simplifying the pre-operative screening to just nasal swab would save £9000.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

25

Improving clinical management of peripheral venous access devices

Sarah Flinders 1

Abstract

Introduction

Poor compliance of peripheral venous catheter (PVC) management within the Trust has been acknowledged through audits and surveillance of the device. Also, the Trust has had two confirmed cases of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in 2017/2018, in which poor PVC care and documentation had been implicated.

Method

A revised audit tool was created to review clinical practices of staff caring for patients with PVCs, which covered four categories: documentation of insertion, was it used in the last 24 hours, was there a visual infusion phlebitis score recorded daily, and were dressings clean and intact. The audit was piloted on three busy acute wards which were randomly selected over seven weeks (December 2017–January 2018). The expectation was for the pilot wards to undertake the audit weekly. A questionnaire was also formulated to establish ward staff knowledge regarding management of PVC. Forty participants were asked from the pilot wards to complete the questionnaire.

Results

Audit data shows there has been an improvement over time with PVC care standards which have been sustained. Compliance improved from an average of 83.8% to 93.7% during the pilot study. Ward staff acted upon their results and implemented strategies to improve PVC care standards. Responses to the questionnaire revealed staff knowledge around PVC care was excellent at 100% and fell in line with local policy and best practice.

Discussion

The collaborative working between the ward staff and IPCT has made the revised PVC audit tool a success. It has demonstrated ward staff actively undertaking their own PVC audit as well as the IPCT, and taking ownership of their results has improved PVC care standards compliance. However, to continue this success ward staff need to ensure strategies are implemented to remind staff of best practice.

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Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

41

A “quick win” to improve vascular access device care

Anne Leitch 1, Julie Burns 1, Nicola Miller 1; IPCT Lanarkshire1

Abstract

Introduction

During a whole system assessment of vascular access device (VAD) care in NHS Lanarkshire (NHSL) weaknesses were identified in structures, processes and outcomes. A short-life working group (SLWG) including clinicians was set up to produce “quick wins” in VAD safety. The SLWG undertook a questionnaire in three wards asking staff about challenging VAD procedures. The survey identified that the current unsafe disconnection and reconnection procedure required greater clarity. We sought to promptly provide information for staff on this issue prior to producing written procedures.

Methods

  • The IPCT was aware that VAD disconnection / reconnection should be avoided.

  • An iterative process was undertaken to produce a positive education campaign to emphasise the need to avoid disconnection. This was finalised as: “stay safe: stay connected”.

  • Three different “Stay safe: stay connected” posters were produced targeting nurses, allied health professions and clinical support workers.

  • Practice-based education sessions by the IPCT (in all clinical areas) were undertaken over a 3-month period.

Results

Ongoing engagement identified that staff were complying with the key message (e.g. one hospital walk around identified only three inappropriate disconnections). However, further engagement identified instances where disconnections had to happen. Consequently, a “5 moments for safe disconnection” poster was produced. One unintended consequence was a complaint regarding the increasing costs in the number of administration sets being used (staff were no longer leaving disconnected sets hanging).

Discussion

To promptly improve VAD patient safety, NHSL has both long and short-term goals. This process provided a quick win in that it responded to a “challenging” procedure for staff that had led to the unsafe custom and practice of disconnection / reconnection of VADs. Working with clinicians in their settings enabled a realistic pragmatic short-term solution whilst our policy manual is awaited.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

55

K.I.S. (knowledge integrated skill) CLABSI goodbye

Billexter Bonifacio 1

Abstract

Introduction

Central line-associated bloodstream infections (CLABSIs) result in thousands of deaths each year and costs billions of dollars. Most of these central line infections can be prevented with proper insertion technique, cleaning, and maintenance care. In St. Luke’s Medical Center, Quezon City (SLMC-QC), for the last quarter of 2017 CLABSI rate was recorded to be 17.19 CLABSI per 1000 central line days. The Infection Control Service (ICS) was able to identify units having increased rates of CLABSI.

Method

The ICS worked hand in hand in collaboration with the Nursing Care Group (NCG), Biomedical Engineering and Ancillary Services. The ICS team provided a training module programme focused on the prevention of CLABSIs for one of the progressive care unit and renal unit, and provided all the staff nurses with a certification courses entitled “Prevention of Central Line Associated Bloodstream Infection among patients with Central Line Catheters”. Creative reminders in the workplace were institutionalised. Signage “scrub the hub for 15 seconds” for all infusion pumps and dialysis machines was created. This signage served as a reminder to all healthcare workers every time they used the machines.

Results

With the educational intervention and reminders in the work place, the ICS noted a significant decreased CLABSI rate in the unit from 17.19 per 1000 device days (last quarter of 2017) to 0.0 per 1000 device days (first quarter of 2018). Completion of all staff in the programme and applying what they learned from the training resulted in 100% reduction from the intervention, and patient safety was strengthened.

Discussion

There was a strong impact on CLABSIs rates from implementing the training programme and placing reminders in the workplace. We can also attribute strong leadership involvement in promoting the application and education of staff for the prevention of CLABSIs.

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Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

66

Reducing risks of infection and improving urinary catheter care: A health economy approach

Helen Bosley 1

Abstract

Introduction

Urinary tract infection (UTI) accounts for 19% of healthcare-associated infections (HCAI) with nearly half (43–56%) associated with a urethral catheter.¹ Catheterisation is a frequent intervention in both acute and community care settings, with 15–25% of patients receiving a catheter at some point during their stay.¹ The infection risk is associated with the catheterisation method, duration of catheterisation, quality of catheter care and patient susceptibility. It represents a significant source of avoidable harm for patients. A joint approach to standardising urinary catheter care management was undertaken across three local Trusts, with the aim to reduce risks associated with developing catheter-associated urinary tract infections (CaUTI).

Methods

Trusts formed working groups which reviewed, streamlined and standardised catheterisation procedures and continence products across the health economy, reflecting the patient pathway. A new patient-held catheter passport was created for use across the county and a business case for additional bladder scanners developed. Staff training was assessed via a knowledge survey at the beginning and end of the project. Additional training sessions were provided and an E-learning package developed and funded by Health Education England for national access.

Results

There was improvement in staff knowledge after interventions, although general continence care was variable. Bladder scanning was often not given sufficient priority due to the availability of too few scanners. Communication when transferring between care settings was a key issue, as was the documentation of catheter insertion and catheter care. The catheter passport was received well by staff, patients and carers.

Discussion

Improving urinary catheter care is complex and multi-faceted, and monitoring CaUTI rates is very challenging in the community. A joined-up health economy approach is vital in ensuring standardised practices to reduce CaUTI risks.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

129

CCaMa: Community catheter management study

Heather Loveday 1, Jennie Wilson 1, Jacqui Prieto 2, Andrea Denton 3, Ashley Flores 4, Gail Lusardi 5, Matt Reid 6, Naimh Whittome 8, Lesley Shepherd 7

Abstract

Background

Urinary tract infection (UTI) is one of the most common healthcare-associated infections (HAIs). Indwelling urethral catheters (IUC) predispose patients to UTI, and the duration of catheterisation is associated with UTI. Evidence-based guidelines recommend the use of IUC only when clinically indicated. On discharge the plan for the review and timely removal of the IUC is essential. This study aimed to determine the:

  • Prevalence of patients with an IUC managed by district nurses (DN)

  • Proportion of IUC placed within last month with an indication and plan for review/removal

Methods

Community NHS providers were recruited through the IPS. Data collection was coordinated by the local IPCN and captured from district nursing via an electronic survey.

Results

149 DN teams from 21 NHS organisations, with 49,056 patients on their case-load, participated in the study Nov/Dec 2017.

Prevalence of IUC managed by DN:

  • Mean prevalence of catheters was 11%

  • Prevalence of IUC varied between organisations with a range 2.4% to 22%

  • 5% (269) of the catheters had been newly placed within the last month

Indications for IUC

  • Data was available for 99% (267) patients with new catheters; 259 (97%) were urethral

  • 76% were male and 75% were 70 years or older

  • 45% were referred by general ward at hospital

  • 84% had a clinical indication for the IUC recorded

Management plan

  • 50% (134/267) had a plan for active removal or review of the IUC

  • 13% of patients had a Catheter Passport but these patients were significantly more likely to also have an active management plan (p<0.0001)

Discussion

1 in 10 patients on the DN case-load has an IUC and half have no active plan for assessment for continuing need or removal. This burden of IUC use may contribute to the prescribing of antimicrobials, emergence of resistant uropathogens and secondary E. coli BSI.

Footnotes

Declaration of interest: This study was partially funded by the Infection Prevention Society

J Infect Prev. 19(1 Suppl):S4–S63.

147

Improving outcomes for people with long-term catheters – a national approach

Jane Mcneish 1, Lesley Shepherd 1

Abstract

Introduction

Within Scotland, urinary tract infections (UTIs) are the most common type of healthcare-associated infection seen in hospitals (24.6%) and care homes (33%). Many infections occur in those patients with an indwelling urinary catheter. Best evidence-based practice relating to the use and management of urinary catheters is well defined, both in hospitals and the community; that being the use of catheters only when clinically indicated and when alternative methods are deemed unsuitable. The Scottish UTI Network (SUTIN) has developed a Scottish National Catheter Passport (NCP) in response to an identified fragmentation of care and subsequent increased risk to people’s lives and independence arising from CAUTI. The NCP was launched in Scotland in January 2018. The NCP provides the patient and their carers with information regarding, for example, the expected removal date and troubleshooting.

Methods

A SUTIN short-life working group was established with representation from across Health and Social Care to produce the NCP content. Testing occurred within 15 locations across Scotland. Collaboration with National Procurement and suppliers followed to include the NCP as part of the national catheter contract, therefore free at point of use.

Results

Feedback has been favourable; particularly regarding the “ease of communication” across primary and secondary care. The document is now available for NHS Boards to order via the national Professional Electronic Commerce Online System (PECOS). Care homes with no access to PECOS are able to obtain the NCP through bladder and bowel nurses or care home liaison nurses.

Discussion

Next steps are to evaluate patients’ and nurses’ perceptions of the impact of the NCP, using a qualitative approach by undertaking telephone interviews. The NCP evaluation will provide vital feedback for future iterations of the document. This supports guidance around catheter care and prompts timely removal, potentially reducing that person’s risk of healthcare-associated infection.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

149

Peripheral vascular catheter-related Staphylococcus aureus bacteraemia: Prevention and management: An improvement journey

Rebecca Fyfe 1, James Gorman 1, Marie Paterson 1, Norma Beveridge 1, Christina Coulombe 1, Kathryn Brechin 1

Abstract

Introduction

An increasing trend in the number of peripheral venous catheter (PVC)-related Staphylococcus aureus bacteraemia (SAB) since October 2014 to April 2016 was identified in a medium-sized mainland board. Six of these infections were concentrated in one acute ward; almost one-third of the total cases (16). The aim of this work was to achieve sustained compliance with the PVC care bundle in the acute ward with the highest prevalence of SAB.

Methods

  • Process measure: % of PVC care bundle compliance (target 95%)

  • Low-level aim: to achieve and sustain 95% compliance with the PVC care bundle

  • Outcome measure: Number of days between PVC-related SAB

  • High-level aim: to achieve 300 days without a PVC-related SAB

A quality improvement project group was established with a co-produced project charter. A multi-modal strategy for prevention was employed using the model for improvement. An understanding of the system and areas of non-compliance were identified.

Results

Daily PVC care bundle validation audits highlighted key areas of non-compliance. The majority of patients transferred to the department had a PVC already in place prior to transfer, and often the PVC care bundle non-compliances occurred prior to patient’s arrival on this ward.

  • 0 SAB since April 2016

  • Over 300 days since the last PVC-related SAB by February 2017

  • Marked improvement with PVC care bundle compliance

  • Point prevalence study results: 98% of PVC clinically appropriate

Unintended outcomes

  • Staff associated SAB occurrences with the grief cycle (Kubler-Ross)

Discussion

A sustained improvement in PVC care bundle compliance and a reduction in avoidable harm can be achieved using a co-production approach with clinical teams taking ownership for the change ideas and improvement strategies. This work has now progressed to using electronic solutions for process measure data capture.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

37

Hands count: Starting a multimodal hand hygiene programme in a developing country hospital

Wendy Artiga 1

Abstract

Introduction

In developing countries, with limited economic resources, the challenge of controlling healthcare-associated infections requires getting all the available tools with the minimum costs. Therefore, hand hygiene offers great potential: excellent prevention and it is relatively cheap. Since 2005, WHO has developed several strategies to prevent healthcare-associated diseases; one of them, the multimodal hand hygiene programme, can be reproduced without a big investment but engaging with an educational effort that include continuous surveillance.

Methods

We made a total of 2607 observations over 1 year on all staff members involved in patient care at an Internal Medicine guard: physicians, nurses, physiotherapists, phlebotomists, X-ray technicians and respiratory therapists. The observations were random and were made across all working hours. The data collected has been expressed in percentages. After its analysis, the results were released to the observed staff, monthly.

Results

The average hand hygiene compliance rate at the start point of intervention was 48%. From this, there was improvement in the monthly percentages, achieving a 55% compliance on average. The nursing staff obtained the highest compliance percentages, with 68% on average, followed by physicians with 62%. Respiratory therapy staff scored 48% on average. Physical therapy obtained an average of 58%. The adherence to the practice was lower among the X-ray technicians (15%) and phlebotomists (28%). Throughout the monitoring, a clear preference was made for cleaning hands with the hydroalcoholic solution than washing with soap and water (60% and 40%, respectively).

Discussion

Starting a multimodal programme on hand hygiene requires great commitment to maintain the surveillance–feedback cycle. Although the results are evident at the beginning, practice strategies should be individualised in order to maintain the results over time.

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Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

54

Back to basics: Standard precautions audit in community and mental health inpatient units

Gaelle Diallo 1

Abstract

Introduction

Standard precautions are designed to minimise the risk of transmission of micro-organisms from sources of infection, thereby protecting patients, staff and visitors from cross-infection. These precautions must be applied by all members of staff working in health care settings. The standard precautions audit encompassed:

  • The principles of hand hygiene

  • The use and disposal of personal protective equipment

  • The use and disposal of sharps

Methods

The audit was undertaken by the infection prevention and control nurse as part of the annual programme. The tool comprised 15 criteria. The data was collected over the course of 3 months:

  • Physical health wards

  • Mental health wards

  • Children’s respite units

The data was collected through observation, and where an observation of practice was not possible the staff (nurses, healthcare assistants and support workers) were asked to describe the procedures. Following data collection, the data was logged into an Excel spreadsheet for analysis. Comparison was made with data collected the previous year for assessment purposes.

Results

Data was obtained from 18 wards; 5/15 criteria audited were 100% compliant, and 4/15 criteria audited scored below 50%. Non-compliance was observed across all inpatient units. The challenges identified included:

  • Awareness of the 5 moments of hand hygiene

  • Correct management of sharps bins

  • Provision or full complement of personal protective equipment (PPE)

  • Cleanliness of patients’ environment and equipment

Discussion and action plan

Inpatient units developed their action plan to address these issues. The IPCT supported them through:

  • Inclusion of the 5 moments of hand hygiene within the hand hygiene audit tool

  • Checking on PPE stock and sharps bins compliance during their monthly ward visits

  • Arranging training on the correct use of sharps bins

  • Re-enforcing responsibilities for cleaning during training and ward visits

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

100

The role of the hand hygiene champion

Liz Dobson-Bell 1, Wendy Watts 1, Lesley Wharton 1

Abstract

Introduction

During national infection prevention and control week 2014 a campaign was launched by the infection prevention and control nurses (IPCNs) at North Tees and Hartlepool NHS Foundation Trust to create a sustainable educational network of hand hygiene champions (HHCs) to actively promote and instil good hand hygiene messages and best practice among colleagues, patients, staff and visitors.

Method

Initially visits to wards, departments and directorate meetings were carried out to canvass for HHCs. A hand hygiene embroidered logo for uniforms and pledge cards were developed and offered to over 120 HHCs to promote visibility and purpose of the role. Various methods of engagement were employed such as coffee mornings, walk-about sessions, and finally monthly challenges.

Results

The attendance to coffee mornings was poor due to operational pressures, and although walk-about sessions by the IPCNs were well received they were not very effective at disseminating our hand hygiene messages to a large audience. The IPCNs went on to develop monthly challenges which have generated lots of interest, participation and fun. In turn this has had a positive effect on hand hygiene in practice.

Discussion

This initiative has presented a sustainable network of HHCs who enjoy promoting positive, non-criticising, educational messages on a monthly basis, in order to keep up the momentum of best practice on the shop floor. Further work is now planned to provide each ward / department with a photograph of their HHC, and the IPCT would like to audit engagement by checking the knowledge of the HHCs colleagues around the monthly challenge.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

115

An exploration of cultural issues affecting staff compliance with recommended infection prevention and control practices in a “ring-fenced” acute hospital elective surgical ward

Tanakasei Axilia Makoni 1

Abstract

Introduction

Healthcare-associated infection (HCAI) poses a serious threat to patients admitted into hospital as well as healthcare staff. Whilst recommendations for preventing HCAI exist, many studies, primarily quantitative in nature, have reported serious concerns about the suboptimal infection prevention and control (IPC) practices adopted by healthcare workers (HCWs) within acute clinical settings. However, there remains a lack of understanding about why suboptimal practices persist. Although quantitative studies have identified poor staff compliance with the IPC recommended practices, attempts to tackle the problem have yielded limited success. It is suggested that a key reason for this is the failure to take into account the cultural context in which the non-compliant behaviours take place.

Method

This qualitative study, guided by ethnographic principles, uses a combination of focus groups and individual interviews with frontline staff and organisational leaders to explore cultural issues affecting staff compliance with recommended IPC practices in a ring-fenced acute hospital elective surgical ward (ESW).

Findings

The study reveals that non-compliance with IPC policies and procedures in the ESW was legitimised and subsequently tolerated by both frontline and managerial staff, especially when the acute hospital was under stress. In particular, the ESW operational ring-fencing policy for protecting elective surgical patients from HCAI acquisition was repeatedly breached due to the conflicting pressures and competing demands of a busy hospital environment.

Conclusion

The findings challenge the sustainability of the policy of ring-fencing the ESW as a discrete component of a busy acute hospital in order to protect elective surgical patients from HCAI in the context of the current healthcare system. It is highly likely that, as people live longer due to advances in medicine and technology, the demand for trauma and medical emergency beds will increase in the future, rendering the ring-fencing of any bed unsustainable in an acute hospital setting.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

123

Antimicrobial hand wipes are as effective at hand decontamination as soap and water

Maryn Wilkinson 1, Martin Kiernan 2, Jennie Wilson 2, Heather Loveday 2, Christina Bradley 1

Abstract

Background

Patients with mobility issues are often unable to access hand-washing facilities, especially in bays in which there are only hand hygiene sinks. It is possible to use alcohol hand rub; however, this are not advised for soiled hands or social hand hygiene. One possible alternative is to use a disposable hand wipe. Little is known about the efficacy of hand wipes in removal and destruction of transient micro-organisms carried on the surface of hands.

Aim

To determine whether the antimicrobial efficacy of hand wipes was comparable with washing with soap and water and to consider whether a hand wipe could be an acceptable method of promoting patient hand hygiene.

Methods

As there is no standard for hand wipes, a methodology was developed based on European standards EN 1499 (2013) and EN 1500 (2013). Hands of 20 healthy volunteers were artificially contaminated by immersion in a non-pathogenic strain of Escherichia coli and then sampled before and after using a reference soft soap or hand wipes for 60 seconds. Two type of hand wipe were tested, one impregnated with a formulated disinfectant and a control wipe that was identical apart from the antimicrobial formulation. Counts obtained were expressed as log10, and the log10 reductions calculated.

Results

The hand wipe without active agents achieved a 2.46 log10 reduction. After applying Wilcoxon–Wilcox and Hodges–Lehmann tests it was classed as inferior to soft soap. The antimicrobial wipe was statistically non-inferior to soap as log10 reductions of 3.54 were obtained for the reference and 3.67 for the antimicrobial wipe.

Conclusion

The statistical analysis suggests that when used for 60 seconds, the antimicrobial-impregnated hand wipe is at least as good as soap and water, representing an acceptable method of hand hygiene that can be made available at the point of use.

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Footnotes

Declaration of interest: Martin Kiernan is an employee of GAMA Healthcare.

J Infect Prev. 19(1 Suppl):S4–S63.

139

Nurses’ hand hygiene trends over 8 years

Liz Kingston 1, Barbara Slevin 2, Nuala O’Connell 2, Colum Dunne 1

Abstract

Introduction

There is an abundance of research exploring hand hygiene practices among nurses. However, few studies compare practices over time. The aim of this study was to compare and contrast hand hygiene practices and alcohol-based handrub (ABHR) use among nurses between 2007 and 2015.

Methods

In 2007, a random sample of nurses in a large teaching hospital was invited to complete a postal survey using a validated questionnaire. In 2015, the study was replicated among all nurses employed in a university hospital group, including the setting of the original study. Data were analysed quantitatively and qualitatively using appropriate software.

Results

In 2015, 13% fewer nurses (42%) reported using ABHR for hand hygiene (>90% of the time (or almost always), compared with in 2007 (55%). In addition, 10% more nurses in 2015 (21%) compared with 2007 (11%) reported using ABHR sometimes, rarely, or never. In 2015, 90% of nurses with <2 years’ experience reported using ABHR >50% of the time compared with 73% of nurses with 2–5 years’ experience and 74% of those working 10–20 years in practice. Comparative data reveal a downward trend in perceptions of barriers to ABHR use (skin sensitivity: 2007: 23%, 2015: 17%; skin damage: 2007: 18%, 2015: 13%; unpleasant to use; 2007; 26%, 2015; 20%).

Discussion

Despite experiencing a high burden of hand hygiene, nurses have a moral, ethical and professional responsibility to engage in optimal practice in the interest of patient safety. The reported decline in ABHR use is of concern, as is the trend towards lesser compliance among more experienced nurses, despite a downward trend in perceptions of barriers. Continuing professional development, use of role models and hand hygiene champions and addressing social and cultural norms are strategies that may help to harness best practice throughout nurses’ professional lives.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

156

Standard infection control precautions (SICPs): Making the SICPs audit tool user friendly and effective using quality improvement methodology

Jacqueline Donachie 1, Hayley Wilson 1, Doreen Millar 1

Abstract

Introduction

Following findings from a Healthcare Environment Inspectorate visit it was recognised that there was not a consistent approach to the monitoring of standard infection control precautions (SICPs) in wards and departments. Most wards/departments were scoring 100% compliance, and it was evident from observations of practice that this level of compliance was not a reliable indicator. The aim of this project was to standardise the SICPs audit tool and methodology using a quality improvement approach.

Methods

Questionnaires were given to all staff on one ward to identify what the current level of understanding of SICPs was, who undertakes the audits and how this information is shared with the team. A staff information leaflet was created by the staff on the project team to provide all staff with an understanding of the 10 elements of SICPs and how these elements are audited. Awareness sessions were delivered at safety briefs for a period of 1 week. Observations of care were undertaken and SICPs relevant to that care practice were audited. A number of Plan, Do, Study, Act (PDSA) cycles were generated. Previous data was compared with recent observations of clinical practice which highlighted inconsistencies.

Results

Following a number of PDSA cycles the SICPs audit tool was adapted to include guidance (methodology) on how to complete the audit. The guidance was developed to ensure that there was a consistent and standardised approach to audit and that data reported was a true reflection of care delivered and infection prevention and control knowledge and practice.

Discussion

A new audit tool and monitoring framework has been developed to support a consistent standardised approach to SICPs compliance monitoring. This has been an iterative approach using improvement methodology and co-production across disciplines. This work was owned and progressed by the teams delivering the patient care. Testing is complete and implementation now planned.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

157

Using an automated electronic hand hygiene device with performance feedback to increase hand hygiene adherence: An interrupted time series study

Neil Wigglesworth 1, Dinah Gould 2, Hakan Lindstrom 3, Ed Purcell 4

Abstract

Introduction

Hand hygiene breaks the chain of infection and is an essential part of any infection prevention programme. A recent systematic Cochrane review demonstrated that performance feedback is the most effective way of securing hand hygiene adherence. We undertook a feasibility study on an acute cardiology ward, to evaluate the ability of an automated electronic hand hygiene monitoring system with performance feedback to increase hand hygiene adherence.

Method

This was an interrupted time series study. Electronically monitored healthcare worker location tracking and hand hygiene product dispenser activation were used to identify surrogate hand hygiene compliance for World Health Organization hand hygiene moments one, four and five (before and after patient contact). Feedback is in three phases: 1. No feedback (baseline); 2. Group feedback using real-time data displayed on a tablet and discussions in the clinical area; 3. Individual feedback via email (weekly) and mobile devices (every 2 days) – in progress.

Results

The system demonstrated high sensitivity and real-time responsiveness to changes in hand hygiene adherence. Preliminary analysis suggests moderate increases in hand hygiene adherence in Phase 2 compared with baseline. Full analysis including results from Phase 3 will be presented.

Discussion

Preliminary results suggest that use of an electronic hand hygiene system with performance feedback to staff, both group and individual, is feasible in an acute hospital setting and could be applied in routine clinical practice. Increases in hand hygiene compliance were seen, although it remains to be seen if these increases will be sustained with continued use. Further work will include observational validation of sensitivity and specificity of the system in identifying hand hygiene opportunities and compliance.

Footnotes

Declaration of interest: NW – IPS President

The project is supported by Essity, HL is an employee of Essity.

J Infect Prev. 19(1 Suppl):S4–S63.

165

Measuring incomplete hand hygiene technique in NHS hospitals

Szava Bansaghi 1, Akos Lehotsky 2, Istvan Barcs 1, Tamas Haidegger 3

Abstract

Introduction

Hand hygiene (HH) is one of the most efficient tools to prevent the transmission of healthcare-associated infections. When applying alcohol-based handrub, it must cover the entire hand surface to take effect. Inaccurate HH technique can result in missed areas on the hand surface, where germs can survive. The aim of this study was to estimate how inaccurate hand hygiene technique is in selected NHS hospitals.

Methods

HH assessment was conducted in 11 NHS hospitals from October 2017 to March 2018. Participation was voluntary. HH technique was evaluated by the Semmelweis Scanner (HandInScan Zrt.), a digital HH technique monitoring device. After performing HH with a fluorescent-labelled handrub, the Semmelweis Scanner can visualise the handrub-covered areas on hands, and also highlights the missed areas. It gives immediate visual feedback about the HH performance.

Results

In 11 different NHS hospitals, 986 HH events were recorded and analysed. In general, hand coverage was 94.76±10.39% (average ± standard deviation). Coverage was better on the palmar side of the hands than on the back, 97.13±8.41% and 92.39±13.60%, respectively. HH was considered acceptable if at least 95% of the hand’s surface was covered by the alcohol-based rub. 26.98% of healthcare workers failed to perform acceptable HH. In the best performing hospital, only 4.76% of staff failed, while at the worst performing, this ratio was 76.92%.

Discussion

Critical issues regarding HH in practice have been revealed. Our study had several limitations. As participation was voluntary, selection bias was probable. Participants were aware of being monitored, which may have altered their behaviour. Nonetheless, it was shown that there is room for improvement in all of the investigated NHS hospitals. HH performance varied widely among hospitals. Objective HH technique monitoring can be used to identify which hospital or ward needs additional training, and to confirm excellent performance.

Footnotes

Declaration of interest: Lehotsky A. and Haidegger T. are co-founders of HandInScan Zrt, the manufacturer of the Semmelweis Scanner. Bansaghi S. is an employee of HandInScan Zrt.

J Infect Prev. 19(1 Suppl):S4–S63.

118

Investigating the effect of preparation for and participation in a hand-sanitising relay on nursing students’ ability to recall the WHO six-step hand hygiene technique

Lesley Price 1, Lynn Melone 1, Elaine Cutajar 1, Lauren Blane 1, Lucyna Gozdzielewska 1, Mairi Young 1, Kareena McAloney-Kocaman 1, Jacqui Reilly 1

Abstract

Introduction

The six-step hand hygiene (HH) technique endorsed by the World Health Organization (WHO) appears to be effective in reducing hand bacterial load in comparison to its three-step counterpart (WHO, 2009). However, a suboptimal quality of compliance rates and technique recall of the recommended six steps has been recorded in healthcare professionals (O’Boyle, et al, 2001; Reilly, et al, 2016). In November 2015, 417 out of 419 students in a Scottish university performed the six-step technique correctly, breaking the Guinness World Record (GWR) for the largest number of participants in a hand-sanitising relay. The aim of the current study was to explore whether preparation for and participation in this hand-sanitising relay had any effect on nursing students’ ability to recall the WHO six-step HH technique 12 months later.

Methods

Twelve months following the initial GWR attempt, the same cohort of students was invited to demonstrate the six-step HH technique as if using alcohol-based handrub. Their attempts were observed and recorded using a standardised tool, and between-group analyses were performed using Chi-Squared (χ2) tests with the use of SPSS statistics software (version 22).

Results

170 nursing students were recruited. Ability to recall the six-step technique correctly did not significantly differ between the groups (χ2=0.114, df=1, p=0.736). Additionally, the most frequently missed step was Step 3 (palm to palm with finger interlaced).

Discussion

Whilst the educational preparation and participation in the event itself may have contributed to its success, recall of the HH technique was not sustained over a 12-month period, possibly due to the deterioration of skill-based memories over time (Grayson, et al, 2015). Our results suggest that regular feedback may be an important additional component in future interventions (e.g. Fuller, et al, 2012).

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Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

136

New methodology for the National Infection Prevention and Control Manual

Catherine Dalziel 1, Jackie McIntyre 1, Lisa Ritchie 1

Abstract

Introduction

The National Infection Prevention and Control Manual (NIPCM) was first published in Scotland in 2012; it aims to:

  • Make it easy for care staff to apply effective infection prevention and control precautions.

  • Reduce variation and optimise infection prevention and control practices throughout Scotland.

  • Help reduce the risk of healthcare-associated infection (HAI).

  • Help align practice, monitoring, quality improvement and scrutiny.

Methods

The NIPCM literature reviewing methodology uses a “semi-systematic” approach where the majority of steps are carried out by a single reviewer. A consultation process involving NHS stakeholders is used to agree final recommendations which are then translated into practice recommendations within the NIPCM. This step reduces the risk of bias and ensures recommendations are fit for purpose. The evidence bases for each of the literature reviews underpinning the NIPCM are monitored continually, ensuring our recommendations are informed by the most current evidence.

Results

The NIPCM is well embedded in NHS Scotland and has been adopted for use in NHS Wales; Health Protection Scotland (HPS) hopes to encourage its adoption by other (particularly UK) organisations. A potential criticism of the NIPCM methodology is its single-reviewer approach, as it may increase the risk of bias; however, this is largely addressed by a thorough consultation process. The NIPCM methodology also allows a faster response to changing evidence bases, whereas the process for typical systematic reviews may mean these guidelines are outdated by the time they are published.

Future work

HPS intends to enhance the NIPCM methodology by moving to a minimum two-person review while maintaining the agility of the current process. All existing reviews will be backdated using this more rigorous methodology to ensure the recommendations of the NIPCM remain robust and evidence based, and to make adoption of the NIPCM more attractive to other organisations.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

151

Reducing the incidence of sharps injury in Siloam Hospitals Lippo Cikarang, Indonesia

AMK Sisilia Revita 1

Abstract

Introduction

Occupational health and staff safety is one of the most important issues in the work place. Health care is full of occupational risks; one example is the sharp injury caused by needle or infectious scalpel. Although the puncture wound is small, it can lead to the transmission of blood-borne viruses. In the Siloam Hospital Lippo Cikarang Indonesia, it has became our focus to reduce the incidence of sharps injury. There were 15 incidences in 2015, eight in 2016 and nine in 2017. 62% of incidence caused by human error is re-capping, and 70% occurs in nurses.

Methods

What we did in 2015:

  1. Communicate with an internist to provide single-use insulin needle instruction.

  2. Education on the handling of sharp objects for clinical staff and new employees.

In 2017 there was no sustained reduction, possibly due to the replacement of the cheaper sharp container type for efficiency.

What we did in mid-2017:

  1. Holding a clamping facility or a clamp tool to release the needle.

  2. New educational methods, demonstration and simulation about handling sharp objects for all clinical staff and new employees.

  3. Direct observations of healthcare workers performing actions related to injection.

  4. Providing education on every shift change about the consequences of when a patient needle is stabbed, which can be infected with blood-borne viruses.

  5. Creating posters on needle stick injury.

Results

There was a decrease in the incidence of needle puncture in 2018 at Siloam Hospitals Lippo Cikarang. One incident with a new employee was due to re-capping and not bringing a sharp container at the time of administering the injection.

Conclusion

Staff more easily understand the educational system with simulation and demonstration methods in handling sharp objects used on patients.

Footnotes

Declaration of interest: No conflicts of interest to declare

J Infect Prev. 19(1 Suppl):S4–S63.

56

Disrupting the flow – theatre traffic during orthopaedic surgery

Karen Denman 1, Sue Fox 1, Rohinton Mulla 1

Abstract

Introduction

The devastating impact of surgical site infection (SSI) on patient morbidity and health costs after total hip (THR) and total knee (TKR) joint replacement surgery has been well documented. Infection prevention in theatres, including traffic reduction and positive pressure ventilation, aim to diminish airborne micro-organisms entering the wound, thereby lessening the risk of SSI and enhancing patient safety. Hence, the surveillance nurse conducted a covert, observational audit to measure the frequency of theatre door use, with subsequent airflow disruption during surgery. Ten joint replacement operations were audited over a 5-month period in 2013.

Methods

Five THR and five TKR operations were randomly selected from the theatre lists. Theatre personnel were notified that the audit was to observe theatre “culture”. Theatre door activity was recorded discreetly, from skin preparation to wound closure.

Results

Theatre door usage in both surgical categories averaged more than once for every minute of operating time from skin preparation to wound closure, mainly occurring in the interval between incision and dressing application; 83% for TKR and 79.4% for THR. Excluding a revision procedure, doors were used more frequently during protracted TKR and during expedited THR.

Discussion

The audit demonstrated excessive activity and indicated areas for improvement, both environmentally and in staff behaviours. It was noted, but unrecorded, that doors were occasionally left open for extended periods, and multiple operating room entrances were opened at the same time. Operating room “lockdown” during surgery should be the “gold standard”. However, lack of a theatre intercom system presented communication challenges, and there were planning issues regarding staff changeover and insufficient or incorrect equipment availability. Hence, improvements need to be made to theatre functionality and resource management to minimise airflow disruption and optimise the theatre environment for patients. Otherwise, unnecessary theatre traffic may increase SSI probability.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

117

Assessing factors influencing intra-operative body temperature during prosthetic joint surgery within laminar flow theatres

Gary Bonnici 1, Michael Borg 1, Deborah Maria Xuereb 1

Abstract

Introduction

Perioperative hypothermia is recognised as a major factor in development of surgical site infections (SSI). Ambient temperature, anaesthetic drugs, intravenous and irrigation fluids influence the development of hypothermia intra-operatively.

Methods

We audited a sample of 53 patients requiring elective total knee/hip replacement and measured factors influencing perioperative body temperature. Warming devices, type of anaesthesia and duration of surgery were recorded for each operation. Patients’ perception of body temperature was also recorded in the pre-operative phase. Data loggers were used to measure each operating room (OR) temperature every 15 minutes of each operation. Body temperature was recorded using oral digital thermometer on arrival to the operating theatre department, after induction of anaesthesia and in recovery. Ethics approval was obtained from the hospital’s ethics committee.

Results

The median patients’ body temperature in the pre-operative phase was 36.5°C. This temperature dropped to a median of 35.5°C in the intra-operative phase and to 35.4°C in the post-operative phase. The lowest body temperature was recorded in the post-operative phase at 33.8°C. The median ambient OR temperature was 20°C with the lowest temperature recorded at 16.5°C. Patients with the shortest duration of surgery (<90 minutes) had the highest median temperature loss, and those with surgery time longer than 150 minutes had least temperature loss. Further analysis of the relation between warming device, ambient temperature, duration of operation and type of anaesthesia will be presented.

Discussion

Although the majority of patients entered the operating theatre department with a body temperature higher than 36°C, this fell significantly after induction of anaesthesia and continued to drop in spite of use of fluid warmers and active warming devices. Duration of operation seemed to be inversely related to the body temperature loss. Our study shows that more active management is required in our orthopaedic ORs to ensure peri-operative hypothermia is prevented.

Footnotes

Declaration of interest: No conflicts of interest to declare.

J Infect Prev. 19(1 Suppl):S4–S63.

8

Surgical site infections: A local audit

Catriona Daly 1, Rebecca Grossman 1, Jinesh Patel 1

Abstract

Introduction

Getting It Right First Time (GIRFT) is a national programme with the aim of improving medical care within the NHS by reducing unwarranted variations.1 Hospital Trusts nationally vary in their surgical site infection (SSI) rates, and in many cases, the infection rates for each specialty are not known to Trusts and surgeons. The SSI audit was carried out in order to establish the incidence rates and nature of SSIs across different surgical specialities.

Methods

Prospective data collection was carried out between May and October 2017 in the departments of general surgery and breast surgery. The audit analysed the prevalence of both deep and organ/space infections occurring within 30 days of a defined list of surgical procedures. The data collected included surgical factors, perioperative factors, details of SSI management and patient outcome.

Results

In total, 670 general surgery procedures and 66 breast surgery procedures were included in this audit. General surgery had an overall SSI rate of 5.97% (40 SSIs), with the highest rates following emergency laparotomy (23.2%) and elective gastrointestinal resection (14.9%). In breast surgery, the overall SSI rate was 6.06%, with the highest rates following breast implant procedures (8.1%) and pedicled flap procedures (10%).

Discussion

Overall, the SSI rates in RBH correlated with those predicted from national benchmarking standards from 2016.2 Two important outcomes were highlighted in the execution of this audit; the first, that RBH does not have a protocol for the surveillance of SSIs in general surgery or breast surgery. The second important finding was that RBH does not currently have a documented protocol for surgical antimicrobial prophylaxis. An action plan is being implemented in order to initiate a surgical antimicrobial prophylaxis guideline, starting with colorectal surgery, with a view to progressing to all surgical specialties in the Trust.

Footnotes

Declaration of interest: No conflicts of interest to declare.

References

Articles from Journal of Infection Prevention are provided here courtesy of SAGE Publications

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