The Journal of Hospital Infection - Supplement 1 - November 2016

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cause analysis (RCA) and ribotyping of isolates did not uncover specific
areas of weakness. A trend of non-compliance with preventative
methods was felt to be the overarching theme.
Aim(s)/Objective(s): Primary aim was to raise awareness on prevent-
ive interventions to reduce HCAI. Infection Prevention & Control Team
(IPCT) developed a new strategy which promoted staff engagement,
ownership and healthy competition to improve quality of care to
patients.
Method(s): IPCT had a ‘ light bulb moment’ and the “diarrhoea road
show” was born. Key elements were:
• Best practice express train with SIGHT pneumonic became screen
savers
• A Carriage with key message added every fortnight
• Focus changed to ‘CDI free days’ and wards awarded for
achievements
• Use SIGHT pneumonic to engage, refresh practice
• ‘Colin’ Oscopy was born, a mascot which captured everyone’ s
imagination & won hearts & minds
• Discussions from ward to board
Results: Enthusiasm and ownership around being rewarded for
achieving their trajectory for ‘ CDI free’ days was infectious amongst
all staff members. Launch of the quality improvement (QI) programme
turned practice and focus to getting on board ‘best practice express’
and and achieve trajectory of 26 CDI cases, originally thought to be an
impossible task.
Discussion and/or Conclusion(s): Visible Clinical leadership,
innovation by IPC Team and Board engagement made this a
sustainable and successful QI project. Next steps is to continue in
2016/17 and create more innovations and sustain improvements
throughout the year.
ID: 4968
An observational study of the effect of chlorhexidine bathing on
MDR organisms and bloodstream infections in the ICU
Hilde Jansens, Frank Van Laer, Emiel Goovaerts, Herman Goossens,
Philippe Jorens. University Hospital Antwerp
Background: Colonization is a risk factor for infections with multi-
drug-resistant organisms (MDRO).
Aim(s)/Objective(s): To investigate the effect of daily bathing of
patients with chlorhexidine washcloths on the acquisition of MDRO
and on the incidence of central line-associated bloodstream infections
(CLABSI).
Method(s): We conducted a singlecenter observational study on the
effect of daily bathing with no-rinse 2% chlorhexidine-impregnated
washcloths in an intensive care unit (ICU) of a university hospital.
The incidence rates of the acquisition of MDRO and the rates of CLABSI
were compared.
Results: The overall rate of MDRO acquisition was 4.38 cases per 1000
patient-days before chlorhexidine bathing versus 2.03 cases per 1000
patient-days after the introduction of the wash cloths, a 53.6%
reduction. The overall rate of CLABSI was 1.95 per 1000 catheter days
at the start of the washing period versus 1.40 per 1000 catheter days at
the end, a reduction of 28.2%.
Discussion and/or Conclusion(s): Introduction of daily chlorhexidine
washing appeared to be an effective intervention to reduce the rates
of MDRO acquisition and decrease the infection rates in the ICU.
ID: 4979
Characterising dynamics of Staphylococcus aureus carriage in
healthcare workers in critical care
James Price1, Kevin Cole2, Andrew Bexley2, Martin Llewelyn3,
John Paul2. 1Brighton and Sussex University Hospital NHS Trust,
2Public Health England, 3Brighton and Sussex Medical School
Background: Colonised healthcare workers (HCWs) have been impli-
cated as sources in nosocomial Staphylococcus aureus outbreaks.
Despite this little is known about dynamics of S. aureus carriage in
HCWs.
Aim(s)/Objective(s): We performed a detailed evaluation of S. aureus
carriage in critical care HCWs.
Method(s): Consenting critical care HCWs in a teaching hospital in
Southern England were serially screened for S. aureus carriage over 14
months. Data on demographics, co-morbidities, and medical carewere
collected. Longitudinal nasal carriage was defined using carriage
profile indices (CPI) (total culture-positive swabs over total swabs).
Measures of association were calculated using multivariate logistic
regression.
Results: Of 198 HCWs 147 (74.2%) were female, 146 (73.4%) were <40
years and prevalence of co-morbidities was low. Nasal carriage at
study entry was identified in 54/149 (36.2%) nurses, 16/40 (40.0%)
doctors and 3/9 (33.3%) physiotherapists (8MRSA (all nurses)) andwas
associated with concurrent nursing home employment (OR 11, 95%CI
1.2–106.1, p = 0.038) and living with a partner (OR 2.2, 95%CI 1.1–4.3,
p = 0.02).
Serial screening revealed 73 HCWs (38.2%) intermittently carried
S. aureus (CPI = 0.07– 0.93), 36 (18.9%) were always culture-positive
(CPI = 1) and 82 (42.9%) always culture-negative (CPI = 0). Of
these serially screened HCWs, 54 (28.3%) (52 nurses, p < 0.001)
received ≥ 1 course of antibiotics during the study. HCWs receiving
antibiotics were twice as likely to carry S. aureus intermittently
(OR 2.5, 95%CI 1.3–4.7, p = 0.006).
Discussion and/or Conclusion(s): Longitudinal nasal carriage of
S. aureus in critical care HCWs reveal diverse intermittent carriage
profiles associated with receipt of antibiotics. Further work is required
to determine the implications of carriage profiles and transmission.
ID: 5001
Clinical factors associated with E-coli bacteraemia and risk factors
associated with 30-day all-cause mortality in East Kent Hospitals
Nuzhath Khan1, Srinivasulu Reddy2, Nash James 2. 1Microbiology
Department, William Harvey Hospital, 2East Kent Hospitals, Microbiology
Background: Escherichia Coli (E. coli) bacteraemia is rising in
incidence. It has a comparative mortality rate double that of other
bacteraemia, including methicillin resistance S. aureus (MRSA).
Aim(s)/Objective(s):
1. Analyse clinical factors associated with E-coli bacteraemia;
2. Identify risk factors associated with 30-day all-cause mortality in
cohort
Method(s): Retrospective analysis of 68 E. coli bacteraemia cases
in East Kent Hospitals over three months was applied. Risk fac-
tors analysed included age, gender, antibiotic non-susceptibility,
extended-spectrum β-lactamase (ESBL) production, number of
hospitalisations in the previous year, co-morbidities and source of
bacteraemia. Binary logistic regression model was applied to identify
risk factors for mortality.
Results:
• Thirty-day all cause mortality rate was 20.6%
• Higher mortality rate associated with male gender (p = 0.02);
underlying hepatobiliary focus (p = 0.04); and resistance to
amoxicillin/clavulanate (p = 0.06)
• 25.0% resistance to amoxicillin/clavulanate and ciprofloxacin
• 10.3% of cases were ESBL E. coli
• 61.8% of patients had one or more previous hospital admissions in
the previous year; 20.6% had an intervention in the previous year,
including biliary intervention (11.8%); and 88.2% had one or more
comorbidities
Discussion and/or Conclusion(s): Results suggest that elderly male
patients may have a higher risk of mortality from E. coli bacteraemia.
There is need to further investigate the possible link between
higher mortality and hepatobiliary source. High rate of resistance to
commonly used antibiotics such as amoxicillin/clavulanate highlights
the need to maintain use of appropriate antibiotics.
Abstracts of FIS/HIS 2016 – Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24–S134 S98