101 / 150
A graph will display the Operating Room hand hygiene audits results
dated 2009
–
current (average 95% and above).
Discussion and/or Conclusion(s):
Sustained compliance with the
World Health Organisation
’
s
‘
My five moments of hand hygiene
’
in the
Operating Theatre has been achieved through multimodal strategies.
Continuous improvement through education, audit and rapid feedback
has helped to maintain focus on the importance of hand hygiene.
ID: 4724
The use of care bundles in lowand low-middle income countries: a
systematic review and meta-analysis
Fatima Taki
1
, Charlotte Bell
2
, Amie Wilson
1
, David Lissauer
1
,
Aurelio Tobias
3
, Arri Coomarasamy
1
.
1
University of BirminghamMedical
School, Institute of Metabolism & Systems Research,
2
University Hospitals
Coventry & Warwickshire NHS Trust,
3
IDAEA-CSIC, Spain
Background:
Sepsis is a global problemwith increasing incidence and
mortality.
1
A number of sepsis care bundles have been produced and in
high-income countries, the introduction of these bundles has shown
to double survival.
1
However, the majority of these are seen to be
unsuitable for use in lowand low-middle income countries (LMIC) due
to resource limitations.
Aim(s)/Objective(s):
To review the effectiveness of the use of various
care bundles in comparison to usual care in LMIC.
Method(s):
We performed a systematic review of studies that included
adult patients in LMIC and compared the use of bundled care to usual
care. Bundles included those for sepsis, ventilator-associated pneu-
monia and catheter-associated UTIs. Outcomes included improved
care with the use of a bundle, reduced incidence of infection and
mortality and process outcomes.
Results:
We identified one randomised controlled trial (n = 109) and
nine non-randomised before-and-after studies (n = 87, 055). Meta-
analysis of five studies showed an overall significant reduction in
the incidence of infection with bundled care (rate ratio 0.58, 95%
CI 0.48
–
0.70, p < 0.001). Three studies were included in further
meta-analyses, showing no decrease in mortality rate and no signi-
ficant reduction in severity score (APACHE II).
Discussion and/or Conclusion(s):
The use of a care bundle in LMIC can
significantly reduce the incidence of infections. There is no significant
effect on mortality. These results may be used to consider developing
care bundles for specific use in LMIC.
Reference
1. Damiani
et al.
Effect of performance improvement programs on
compliance with sepsis bundles and mortality: a systematic review
and meta-analysis of observational studies.
PLoS One
. 2015.
ID: 4739
Health care workers overestimate their hand hygiene compliance
Hannu Syrjälä, Raija Järvinen, Helena Ojanperä.
Department of
Infection Control, Oulu University Hospital, Finland
Background:
Little is known about health careworkers
’
(HCWs
’
) hand
hygiene (HH) compliance evaluated by HCWs themselves, by patients
and the real life observations in the same institution.
Aim(s)/Objective(s):
Aim of this study was to compare possible dif-
ferences in three HH evaluationmethods and escpecially the relevance
of HCWs
’
self-evaluation.
Method(s):
The study was conducted in Oulu University Hospital in
Finland. Since 2013 infection control link nurses have observed HCWs
’
adherence to HH practices according to WHO guideline on the five
moments (FM). A good HH adherence was regarded if a hand
disinfection (HD) time was at least 20 seconds. Patients were asked
by questionnaire about HCWs
’
HH practices in 2011 and 2016. HCWs
’
views to proper hand hygiene (HH) concerning FMwere asked by web-
based questionnaire in 2016.
Results:
According to the self-evaluation, 81% of 74 doctors and 94% of
876 nurses disinfected their hands before patient contact. The 741
patients who answered the questionnaire considered that 51% of
doctors and 65% of the nurses always disinfected their hands before
treating them. Basing on real life observations proper HD before
patient contact was performed by doctors in 28% and by nurses in 61%
of the occasions. The range of successfully performed HD in five
moments was 28
–
42% (n = 2632 observations) for doctors and 61
–
66%
(n = 14953 observations) for nurses, respectively.
Discussion and/or Conclusion(s):
Both doctors and nurses overesti-
mate their HH practices. Patients consider HCWs
’
HH practices better
than the real life observations. HCWs
’
especially doctors
’
hand hygiene
practices needs improvement in our hospital.
ID: 4747
Bacteraemias in renal transplant patients: a single centre
experience
Gabriel Wallis
1
, Ali M. Shendi Mohamed
2
, Mark Harber
1
,
Sophie Collier
1
.
1
Royal Free Hospital,
2
Zagazig University
Background:
Bacteraemia remains a significant cause of morbidity
andmortallity among recipients of renal transplants with an incidence
40 times higher than that of the general population.
Aim(s)/Objective(s):
To better understand the epidemiology of
bacteraemias among renal transplant recipients at Royal Free
Hospital.
Method(s):
A retrospective analysis of all positive blood cultures in
renal transplant patients between 2009 and 2016 was carried out.
Results:
Enterobacteriacease were responsible for 74% of positive
blood cultures. Eschericia coli was the commonest individual
organism (45%) followed by Klebsiella pneumoniae (18%) and
Pseudomonas aeruginosa (7.5%)
Urinary tract was implicated as the source of bacteraemia in over half
of our patients with gastrointestinal tractbeing the second commonest
source.
Among the Enterobacteriaceae over 90% of isolates were found to
be sensitive to carbapenems, amikacin, colistin and fosfomycin.
Over 70% of isolates were found to be sensitive to piperacillin/
tazobactam and gentamicin. Over 65% of isolates were sensitive to
temocillin.
Greater than 40% of isolates were resistant to ciprofloxacin and
ceftriaxone. Resistance rates to amoxicillin/clavulanic acid, trime-
thoprim, trimethoprim/sulfamethoxazole and amoxicillin were over
50%, 60%, 65% and 80% respectively.
Discussion and/or Conclusion(s):
This study confirms findings pre-
viously described elsewhere regarding the common causative organ-
isms and sources of bacteraemia among renal transplant recipients.
This study demonstrates the growing problem of antibiotic resistance
with almost fifty percent of isolates resistant to previously commonly
used antibiotics (amoxicillin/clavulanic acid and ciprofloxacin) and
gives us important information to informempirical treatment for renal
transplant patients presenting with sepsis.
ID: 4748
A new method of treating patients with diabetic foot ulcers and
osteomyelitis using antibiotic impregnated calcium sulphate
Benjamin Kapur
1
, Tarek El Gamel
2
, Gillian Jackson
2
, Simon Platt
2
.
1
Wirral University Teaching Hospital,
2
Wirral University Teaching
Hospital Trust
Background:
Osteomyelitis can be limb and life threatening and have
devastating consequences. It can be managed medically or surgically.
Antibiotics can be locally delivered using methyl methacrylate or
impregnated absorbable gauze. Calcium sulphate-based antibiotic
therapy allows high concentration local delivery of a combination of
antibiotics. Diabetic patients are predisposed to infectionwith a varied
and complex microbial load.
Aim(s)/Objective(s):
To establish the outcomes of patients with dia-
betic foot ulcers and osteomyelitis treated with calcium sulphate
(Stimulan) and antibiotics.
Method(s):
Retrospective data collection of patients treated with
stimulan for osteomyelitis of the foot treated by 2 consultants at
Wirral University Teaching Hospital Trust between March 2014 and
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S96