110 / 150
Method(s):
Analysis of the national MRSA surveillance database at the
RIVM.
Results:
From virtually absent in 2008 and 2009, the number of
MT1352 isolates increased to 191 of 2254 referred non-LA-MRSA
isolates in 2015 (8.5%). From 2011 onward, MT1352 spread to the East
and North-West of the country, but no new provinces were affected
since 2012. The large province of Gelderland in the East saw rising
numbers up to 2014, followed by a slight decline. North Holland faced
the highest figures in 2015; 2016 numbers remained low up to May.
MT1352 affected LTCFs more frequently than hospitals.
Discussion and/or Conclusion(s):
MRSA MT1352 is part of Clonal
Complex 45, and is PVL-negative. Colonization is common, and serious
infections are rare. The strain is easily transmissible in healthcare
settings. Reconstruction of transmission routes within and to LTCFs
proved difficult. Little genetic variability of MT1352 limits the use of
current typing methods to elucidate the micro-epidemiology. NGS
might be helpful although sufficient numbers of strains and
epidemiological data will be needed.
The next few years will learn whether MT1352 disappears or will
remain at an endemic level.
ID: 4712
Outbreak Support Team; the Belgian answer to the emerging treat
of multidrug resistant organisms (MDRO) and MDRO-outbreaks in
care facilities
Barbara Legiest, Annie Uwineza, Beatrice Jans, Boudewijn Catry.
Scientific Institute of Public Health
Background:
Healthcare associated infections, caused by multidrug
resistant organisms (MDRO), signifie a therapeutic impasse as
infections are more difficult to treat and the hospitalisations last
longer. Consequently morbidity, mortality, and hospital costs increase.
Moreover, MDROs are easily transmitted and cause outbreaks often
difficult to contain in care facilities.
Aim(s)/Objective(s):
In Belgium, the Outbreak Support Team (OST) is
created to give the opportunity to the care facilities, struggling with
outbreaks involving MDROs, to call for help from an external partner
without being blamed or stigmatized.
Method(s):
This OST is a collaboration between the regional health
authorities in charge of infectious diseases, the Scientific Institute of
Public Health, and the National Reference Laboratories.
The help, offered by OST, includes scientific support, site visits, advice
on prioritizing actions, and (rarely) enforcement.
Results:
The contribution of the OST to outbreak management will be
described. Several tools have been developed: a checklist to inventory
the measures, transfer- and transport documents to standardize the
communication about MDRO contaminated patients, initiatives to
increase the knowledge of MDRO at other care sectors like nursing
homes, revalidation centers, and homecare.
Based on our experience and on the hand of examples, some recurrent
triggers for the development of and fitfalls in the control of an
outbreak can be listed.
Discussion and/or Conclusion(s):
Despite the expertise present and
the measures taken in the hospitals, the OST can help to control the
outbreak. At the national level, the OST contribute to a more
coordinated approach to the MDRO battle.
ID: 4717
Management of a parainfluenza 3 outbreak on a Special Care Baby
Unit including Neonatal ICU
Gavin Boyd, Jean Robinson, Christine Bishop, Sahar Musaad.
Calderdale
and Huddersfield NHS Foundation Trust
Background:
In April 2016 four infants on the special care baby unit
baby required ventilation over a 24 hour period, and two infants
developed signs of a respiratory tract infection. A viral pathogen
was suspected. We describe the control measures that we but in
place before and after confirmation of the aetiological pathogen as
parainflunza 3 virus.
Aim(s)/Objective(s):
To share the timeline of the outbreak, describing
how it evolved, the control measures that were put in place and our
communication strategy.
Method(s):
The outbreak was managed through a series of outbreak
control meetings. Decisions around closure of the unit, cohorting,
personal protective equipment for both staff and visitors, restrictions
to the visitor policy, enviornmental cleaning and communication with
parents and staff were all agreed and reveiwed at each meeting.
Results:
Twenty infants were on the special care baby unit at the
time the outbreak started. Four required intubation and mechanical
ventilation. Two other infants were confirmed postive cases but
did not require ventilatory support. The unit was closed to admissions
for a period of four days. Visiting was restricted to parents only. PPE
initally included full use of gloves, aprons and surgical masks. Cotside
cleaning was increased to three times per day. Parents received daily
written updates on the situation. We do not believe there was any
further cross tranmission following identification that we had a
potential outbreak.
Discussion and/or Conclusion(s):
This was a rapidly evolving
outbreak successfully controlled by the control measures described.
Changes made in light of our experiences will hopefully prevent a
similar outbreak in the future.
ID: 4719
The sink as a potential source of transmission of carbapenemase-
producing Enterobacteriaceae in intensive care unit
Deborah De Geyter
1
, Lieve Blommaert
2
, Nicole Verbraeken
2
,
Denis Piérard
2
, Ingrid Wybo
2
.
1
University Hospital Brussels,
2
University
Hospital Brussels/Microbiology and Infection Prevention
Background:
Carbapenemase-producing
Enterobacteriaceae
(CPE) are
emerging pathogens that represent a major public health threat. In the
University Hospital of Brussels, the incidence of new patients with CPE
rose from 1 case in 2010 to 35 cases in 2015. Between January and
August 2015, 6 patients became infected/colonized with CPE during
their stay in the same room in intensive care unit (ICU).
Results:
The time period between those patients was relatively small
and although the strains belonged to different species with different
antibiograms and mechanisms of resistance, the hypothesis was
that the environment could be a possible source of transmission.
Investigation suggested that the evil doer was a contaminated sink.
Besides other strains,
C. freundii
type OXA-48 was frequently isolated
from patients and sinks. To investigate the phylogenetic relationschip
between those strains, PGFE was performed. The strains isolated from
patients and the sink in the implicated room were highly related and
pointed to sink to patient transmission. Samples in the other ICU
rooms were also taken, revealing that 9 out of the 32 sinks were
contaminated with CPE. To control the outbreak, the sinks and their
plumbings were replaced by new ones with another structure, they
were flushed every morning with a glucoprotamin solution and
routines regarding sink practices were improved. In the eight months
period after replacements of the sinks, only one new patient with CPE
was detected in ICU.
Discussion and/or Conclusion(s):
In conclusion, this outbreak high-
lights that sink drains can accumulate strains with resistance genes
and become a potential source of CPE.
ID: 4820
Outbreak of respiratory syncytial virus in an adult haemato-
oncology unit
Kirsty Ferguson, Alison Edwardson, Teresa Inkster.
NHSGGC
Infection Control
Background:
Respiratory Syncytial virus (RSV) can cause upper
respiratory tract infection and/or pneumonia in immunocompromised
adults such as bone marrow transplant patients and those with
lymphomas/leukaemia.
Aim(s)/Objective(s):
We describe a recent outbreak of RSV on a 19
bedded adult haemato-oncology ward.
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S105