The Journal of Hospital Infection - Supplement 1

Fundamentals of behaviour change

Carmen Lefevre.

University College London

The importance of behaviour in preventing the spread of infection is

increasingly recognised. For example, appropriate hand hygiene,

correct use of protective gloves and clothing, and cleaning procedures,

some of the key measures in preventing infection spread according the

WHO, are all behaviours. For such measures to be effectively

implemented we require a good understanding of what is required

for a person to perform each behaviour. The most effective interven-

tions to change behaviour target multiple parts of the health care

system, including health care professionals, patients, and the public.

Behavioural science provides methods for understanding behaviours

and their influences, and for developing interventions that are most

likely to be effective in their contexts. This talk will outline evidence-

based principles of behaviour change and a systematic method for

designing interventions to change behaviour. This involves defining a

clear target behaviour, conducting a behavioural analysis to identify

the facilitators and barriers of the target behaviour, and identifying the

most suitable behaviour change techniques for the context. The talk

will illustrate how these principles and methods can be applied to

infection prevention, using examples of improving hand-hygiene and

adherence to the

‘

Sepsis 6

’

guidelines in hospitals.

Resistance epidemiology update: new and old friends

David Livermore.

Medical Microbiology, University of East Anglia

Old friends might be the wrong term in context, but the UK

′

s ESBL and

carbapenemase problems show no sign of diminishing. Rather, the

proportion of carbapenemase producers with OXA-48-like carbape-

nemases is expanding and local transmission of these, and of isolates

with NDM carbapenemases, is increasingly important. Multidrug-

resistant serotype 15A pneumococci, which are not covered by any

conjugate vaccine, continue to represent an expanding problem.

New resistance concerns include Enterobacteriaceae and

P. aeruginosa

with GES carbapenemases, which are difficult to recognise from

phenotypes, also a few

Salmonella

and

E. coli

with the plasmid-

mediated MCR-1 colistin resistance, though these are greatly out-

numbered by isolates with mutational resistance.

P. aeruginosa

with

VEB ESBLs are regular imports, best recognised by strong ceftazidime-

clavulanate synergy. They are highly clonal. Regularly seen too are

pneumoniae

that have resistance to ceftazidime and cefepime, variable

resistance or susceptibility to cefotaxime, together with reduced

carbapenem susceptibility; ceftazidime-avibactam synergy is appar-

ent but no relevant

-lactamase activity has been found, leaving their

mechanism(s) an ongoing mystery. Lastly, a clonal outbreak of

gonococci with high-level azithromycin resistance continues to

cause concern: isolates were initially localised around Leeds, but

have now spread into the Midlands and Southern England.

Investigator-led clinical infection research in the NHS: ARREST and

ARK-Hospital

Martin Llewelyn.

Infectious Diseases, Brighton and Sussex Medical

School

The evidence we rely on to guide antibiotic treatment recommenda-

tions is remarkably weak. Better evidence is needed if we are to safely

reduce unnecessary antibiotic use, particularly of broad-spectrum

agents. With CRN support NHS clinicians can make a substantial

contribution to research in this area. This is well illustrated by recent

experience of the ARREST trial. ARK-Hospital is a new NIHR-funded

research programme with the potential to dramatically reduce

antibiotic overuse in NHS hospitals. By incorporating studies like

ARREST and ARK-Hospital into our clinical practice we can ensure

research is not merely completed but also impacts on our practice for

the benefit of our patients.

HIV and ARVs: their impact on exposed uninfected children

Hermione Lyall.

Infectious Diseases, Imperial College Healthcare NHS

Trust

The number of HIV exposed uninfected (HEU) children born to HIV

infected women now greatly outnumbers those few who are infected,

an excellent consequence of worldwide PMTCT programmes. For more

than 20 years, foetal exposure to antiretrovirals (ARVs) in utero has

continued to increase, with over time, longer exposure and many

different drug combinations. The possible effects of ARV in-utero

exposure have to be considered on a complex background of the

maternal, foetal and infant environment with consideration for:

maternal immune function/activation; genetics; other infections;

other drugs; smoking; prematurity; breast feeding and nutrition;

and whether it is a resource rich or poor setting. Ideal studies should

include all three groups: HIV unexposed uninfected (HUU); HEUs and

HIV exposed infected (HEI) infants, unfortunately there are very few

such large well controlled studies. Evidence for effects on mortality,

congenital anomalies, cancers, infections, immune function, mito-

chondrial function, organ function and growth & development will be

discussed. Specific drug associated toxicities will also be cited. The

need for new epidemiological ways to follow up of HEU children,

especially in resource poor settings, where the majority live, will be

highlighted.

Is the Swedish and Finnish surveillance system a good indicator for

quality?

Birgitta Lytsy.

Department of Clinical Microbiology and Infection Control,

Uppsala University Hospital

The Swedish Association of Local Authorities and Regions (SALAR) is

an politically and economically independent employers

’

organisation

that represents and advocates for local government in Sweden. All of

Sweden

’

s municipalities, county councils and regions are members of

SALAR. SALAR represents and acts on their initiative. In 2008 SALAR

initiated the national point-prevalence survey of health-care asso-

ciated infections (HAI) that is still running twice a year and is

mandatory for all regions. In 2013 SALAR implemented a national

system for continous incidence surveillance of HAI. The Swedish

surveillance system is semi-automated and similar to the Finnish

system SAI. The presentation will describe how the Swedich

surveillance system is built up, how it works, describe the data

compiled with its advantages and limitations.

Surveillance of antimicrobial use and resistance in Scotland

William Malcolm.

NHS National Services Scotland

The UK Five Year Antimicrobial Resistance Strategy (2013

–

2018),

co-ordinated in Scotland through the Controlling Antimicrobial

Resistance in Scotland (CARS) group calls for better access to and use

of surveillance data and improved data linkage. Moreover, the UK

strategy highlights that linked data on bacterial resistance, epidemi-

ology of infection, antibiotic use and clinical outcome are required to

assess the intended and unintended impact of antimicrobial steward-

ship interventions. This short presentationwill give an overview of the

arrangements for surveillance of antimicrobial use and resistance in

Scotland. The presentation will consider where the data comes from

and how it is managed but the key focus will be on how the

information is used to drive improvements in the antimicrobial

stewardship programme co-ordinated by the Scottish Antimicrobial

Prescribing Group. The presentation will also cover details of how the

NHS Scotland Infection Intelligence Platform aims to support

clinicians to improve outcomes and reduce harm for patients with or

at risk from infection through enhancing and linking infection

information held within NHSScotland in a single secure platform.

Abstracts of FIS/HIS 2016

–

Invited Speaker Abstracts / Journal of Hospital Infection 94S1 (2016) S1

–

S10