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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


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.


To review the effect of universal decolonisation

on the incidence of MRSA acquisition and MRSA bacteraemia in a

clinical care unit.


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


Blood culture contamination reduces the usefulness of

blood cultures as a diagnostic test and can contribute to over use of



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.


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.


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


, Victoria Hine


, Helen Bucior


, Wendy Foster



Nyarayi Mukumbe


, Jane Ryan Ryan


, Sandra Smirthwaite



Jodie Winfield




NHS Improvement,


University Hospitals North

Midlands NHS Trust,


Northampton General Hospital NHS Trust,


West Hertfordshire NHS Trust,


Bedford NHS Trust,


United Lincolnshire

Hospitals NHS Trust,


The Royal Wolverhampton NHS Trust


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


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


, James McDonald


, Ashutosh Deshpande








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.


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.


Retrospective review of urine cultures from pregnant

women within GGC over a 6 month period.


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