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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


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


, Charlotte Bell


, Amie Wilson


, David Lissauer



Aurelio Tobias


, Arri Coomarasamy




University of BirminghamMedical

School, Institute of Metabolism & Systems Research,


University Hospitals

Coventry & Warwickshire NHS Trust,




Sepsis is a global problemwith increasing incidence and



A number of sepsis care bundles have been produced and in

high-income countries, the introduction of these bundles has shown

to double survival.


However, the majority of these are seen to be

unsuitable for use in lowand low-middle income countries (LMIC) due

to resource limitations.


To review the effectiveness of the use of various

care bundles in comparison to usual care in LMIC.


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.


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.


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


Little is known about health careworkers


) hand

hygiene (HH) compliance evaluated by HCWs themselves, by patients

and the real life observations in the same institution.


Aim of this study was to compare possible dif-

ferences in three HH evaluationmethods and escpecially the relevance

of HCWs



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.


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


(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


Gabriel Wallis


, Ali M. Shendi Mohamed


, Mark Harber



Sophie Collier




Royal Free Hospital,


Zagazig University


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.


To better understand the epidemiology of

bacteraemias among renal transplant recipients at Royal Free



A retrospective analysis of all positive blood cultures in

renal transplant patients between 2009 and 2016 was carried out.


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


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


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


, Tarek El Gamel


, Gillian Jackson


, Simon Platt




Wirral University Teaching Hospital,


Wirral University Teaching

Hospital Trust


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.


To establish the outcomes of patients with dia-

betic foot ulcers and osteomyelitis treated with calcium sulphate

(Stimulan) and antibiotics.


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