104 / 150
ID: 5005
The effect of universal decolonisation to reduce MRSA bacteraemia
in a critical care unit
Mark Garvey, Craig Bradley, Pauline Jumaa.
Univeristy Hospitals
Birmingham NHS Foundation Trust
Background:
Isolation and decolonisation are the two main targeted
control measures for reducing the transmission of MRSA in hospitals.
Universal MRSA decolonisation in critical care units is thought to
reduce MRSA incidence and be a cost-effective method of control-
ling MRSA in this setting. Before 2014 all critical care patients at
UHB received MRSA decolonisation therapy. In June 2014 UHB
implemented a revised strategy for the control of MRSA and
discontinued the use of universal decolonisation in critical care.
Aim(s)/Objective(s):
To review the effect of universal decolonisation
on the incidence of MRSA acquisition and MRSA bacteraemia in a
clinical care unit.
Results:
There was an increase of 31 acquisitions (55%; P < 0.005) and
increase in bacteraemias from 5 to 11 (P < 0.005) in the 1-year period
following the changes compared to the previous 12 months. Given
these significant increases in the incidence of MRSA bacteraemias
universal decolonisation was reintroduced into critical care. There
has been a reduction of 37 acquisitions (46%; P < 0.005) and decrease
in bacteraemias from 7 to 2 in the 6 month period following
the reintroduction of routine decolonisation in critical care. Audits
revealed no significant changes in hand hygiene compliance; appro-
priate use of personal protective equipment or environmental
cleanliness during these periods. The clinical activity in critical care
did not change during this time.
Discussion and/or Conclusion(s):
We suggest that routine decolon-
isation for MRSA in critical care is an effective strategy to reduce the
spread of MRSA and the incidence of MRSA bacteraemia.
ID: 5018
Intra-hospital variation in blood culture contamination rates
Susan Williams, Christine Peters.
NHS Greater Glasgow and Clyde
Background:
Blood culture contamination reduces the usefulness of
blood cultures as a diagnostic test and can contribute to over use of
antibiotics.
Aim(s)/Objective(s):
To examine the rates of blood culture
contamination within a large city hospital. To identify areas within
the hospital with high contamination rates and areas with low
contamination rates
–
measured against the recommended bench-
mark of <3%. To identify factors which could account for the difference
in rates.
Method(s):
The Laboratory data system was interigated to identify
all Blood culture results for a 6 month period Rates of positivity and
Contamination rates were calculated for each clinical area within the
hospital. Electronic clinical notes were utilised to ensure accurate
allocation of contaminant status.
Areas of high and low rates were visited and a questionnaire com-
pleted to identify variations in practice which could account for the
contamination rates.
Results:
Contaminations rates varied from 0.0% to 17.7%, with highest
rates in A + E and one Acute admission Unit.
Questioning of clinical areas with highest and lowest rates revealed a
number of factors which could account for the difference in rates
icluding ease of access to equipment and lack of standardised method
of obtaining blood cultures.
Discussion and/or Conclusion(s):
Key variance in practice between
clinical areas with high rates of blood culture contamination and
those with low rates include standardised method of collection and
ease of access to equipment.
Strategies to reduce contamination rates within QEUH should focus
on producing readily available standard methods and equipment kits.
ID: 5078
Using a Quality Improvement approach to improve infection
prevention and control: Experiences of Trusts in the Midlands and
East region
Debra Adams
1
, Victoria Hine
1
, Helen Bucior
2
, Wendy Foster
3
,
Nyarayi Mukumbe
4
, Jane Ryan Ryan
5
, Sandra Smirthwaite
6
,
Jodie Winfield
7
.
1
NHS Improvement,
2
University Hospitals North
Midlands NHS Trust,
3
Northampton General Hospital NHS Trust,
4
West Hertfordshire NHS Trust,
5
Bedford NHS Trust,
6
United Lincolnshire
Hospitals NHS Trust,
7
The Royal Wolverhampton NHS Trust
Background:
In 2016, NHS Improvement was formed. NHS Improve-
ment is responsible for overseeing foundation trusts, NHS trusts and
independent providers. It offers support providers need to enable
them to deliver consistently safe, high quality, compassionate care to
patients.
Infection prevention and control (IPC) remains high on the patient
safety agenda in England. It is estimated that only around two-thirds
of healthcare improvements go on to result in a sustainable change,
which achieves the planned objective (Health Foundation, 2013).
Sustainable change is more likely to result from a model that involves
patients and staff in developing, designing and implementing changes,
rather than from a
‘
command and control
’
/top down model (Health
Foundation, 2013).
In response, to this the four Heads of IPC in NHS Improvement and
the quality improvement support specialists developed a 90 day
IPC quality improvement (QI) collaborative programme for 24 Trusts/
Foundation Trusts in England. The aim was to promote shared;
learning, best practices and innovations with colleagues from other
provider organisations and to cultivate new approaches to developing
and sustaining effective IPC.
This poster discusses the collaborative approach used, and the
experiences of the six Trusts within Midlands and East which
participated; Bedford Hospital, Northampton General Hospital, The
Royal Wolverhampton Trust, University Hospitals North Midlands,
United Lincolnshire Hospitals and West Hertfordshire Hospitals.
ID: 5083
An audit of UTIs in pregnancy
Sarah Macalister Hall
1
, James McDonald
1
, Ashutosh Deshpande
2
.
1
NHS GG&C,
2
NHS GGC
Background:
Urinary tract infection during pregnancy is associated
with an increased risk of pyelonephritis, which may cause significant
maternal and foetal morbidity. Pregnant women with asymptomatic
bacteruria are also more likely to develop pyelonephritis compared to
their non-pregnant counterparts.
The recommendations within national and local guidelines state that
to ensure successful treatment of symptomatic and asymptomatic
bacteruria, pregnant women should have a repeat urine culture 7 days
after completion of antibiotic treatment.
Aim(s)/Objective(s):
To audit compliancewithin NHS Greater Glasgow
and Clyde (GGC) with the recommendations to repeat urine cultures in
pregnant women with a previous positive urine culture.
Method(s):
Retrospective review of urine cultures from pregnant
women within GGC over a 6 month period.
Results:
Between April and October 2015, GGC processed 240 positive
urine cultures from 202 pregnant women.
Of the samples, 58% came from secondary care settings, 40% from
primary care settings, with the remaining 2% from unknown locations.
38.6% and 49.6% of all samples were repeated within a 1-month and
2-month period respectively. At the time of analysis, 28% of samples
had not been repeated. There was no significant difference between
primary and secondary care.
Discussion and/or Conclusion(s):
This audit shows that of the 236
positive urine cultures, less than half were repeated within a timely
period, and a significant number were not repeated at all. This
demonstrates a need for increased awareness of this recommendation.
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S99