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ID: 4908
A retrospective analysis of seven years of measles cases, their
recognition and management in a London hospital
Beatrice Cockbain
1
, Tehmina Bharucha
2
, Jennifer Hart
2
,
Ons El Hayet Ben Ismail
2
, Tabitha Mahungu
2
, Dianne Irish
2
,
Tanzina Haque
2
.
1
Royal Free Hospital,
2
Royal Free Hospitals NHS Trust
Background:
London is experiencing a measles outbreak: with the
first half of 2016 seeing 138 cases, compared to only 91 across the UK in
2015.
Aim(s)/Objective(s):
To better characterise this outbreak, a retro-
spective analysis of measles cases between 2010 and 2016 was
performed at a large central London teaching hospital, which has had
12.3% of all measles cases in London in 2016.
Method(s):
Electronic patient notes and laboratory reporting systems
were used to retrospectively analyse the clinical course and demo-
graphic information of 60 patients with laboratory-confirmed measles
diagnoses (RT-PCR positive and/or IgM positive/equivocal with IgG
either positive/negative) between 2010 and 2016.
Results:
Of the 60 patients with confirmed measles, 44 (73%) were
aged 15 and older. Delayed diagnosis due to misattribution of the
measles rash to a drug reactionwas seen in 3 (5%) of patients. Of the 30
patients with full clinical information available, 23 (77%) were not
placed in respiratory isolation within 15 minutes of arrival to A&E,
thereby requiring contact tracing of large numbers of exposed
patients. 3 (10%) presented to hospital up to more 3 times after their
first visit. The median number of hospital doctors reviewing a patient
pre-diagnosis was 2 (IQR 1
–
2; range 1
–
6).
Discussion and/or Conclusion(s):
The reasons for delayed diagnosis
include lack of recognition of measles by clinicians despite seem-
ingly classical presentations, highlighting a clear need for improved
awareness and education. Our measles control strategy therefore
should focus on both clinician education as well as awareness
regarding infection control measures.
ID: 4919
High mortality of the infections caused by hyper toxin producer
Clostridium difficile
078
Milind Khare, Deborah Gnanarajah, Helen Forrest.
Royal Derby Hospital
Background:
PHE reported that there is a national rise in infections
caused by hyper toxin producer
Clostridium difficile
078. Its origin is
thought to be from pigs and calves. There is increased incidence
reported from other European countries as well.
Aim(s)/Objective(s):
To evaluate
Clostridium difficile
078 infections.
Method(s):
In the teaching hospital, patients with C diff ribotype 078
were evaluated
Results:
16 patients have been identified with C diff ribotype 078 since
January 2015. Therewere 6 females and 10 males. Mean agewas 80 yrs
(range 70
–
98 except one of 49 years). With the available data 4 had
resolved within 30 days. 11/16 (69%) patients died following
this infection. Six died within 30 days whilst 5 died after 30 days. All
16 of these cases have been linked to the same cluster using VNTR
profile/DNA finger printing.
Discussion and/or Conclusion(s):
Extensive mapping was done to
see movements of these patients in the hospital. No single ward had
been identified where all 16 patients have been through. They
’
ve been
cared for in 18 different wards. Majority of the patients have been
admitted through MAU. Public Health England also undertook
patient mapping, no links (Trust or community) were identified. We
believe that equipment and the environment is a key causative link,
therefore cleanliness was the focus for the management of the
outbreak. Hydrogen peroxide decontamination of enteric isolation
rooms were done routinely as standard.
Hyper toxin producer
Clostridiumdifficile
078was associatedwith high
mortality rate.
ID: 4925
An outbreak of
Malassezia pachydermitis
in a Neonatal ICU
Laura Cottom
1
, Huma Changez
2
, Gillian Mills
3
, Kate Hamilton
3
,
Teresa Inkster
4
.
1
Department of Medical Microbiology, Queen Elizabeth
University Hospital,
2
Department of Microbiology, Glasgow Royal
Infirmary,
3
Infection Control, Glasgow Royal Infirmary,
4
Department of
Microbiology, Queen Elizabeth University Hospital, Glasgow
Background:
Malassezia is a
basidiomycetous fungus that is a com-
mensal of human and animal skin. Although rare,
Malassezia
species
are an important cause of nosocomial infection and fungemia in
preterm neonates and immunocompromised patients.
M.pachydermatis
colonizes the stratum corneum of dogs, with reports
of zoonotic transmission by healthcare workers being well documen-
ted. Risk factors for colonisation in neonates include the degree of
prematurity, corresponding skin condition, endotracheal intubation
and indwelling vascular catheters.
Aim(s)/Objective(s):
In January 2016, 3 babies in a 13-cot neonatal
unit isolated
M.pachydermatis
from ear swabs taken as part of routine
microbiological screening. Following identification an outbreak
investigation was initiated.
Before 2016
M.pachydermatis
had never been isolated in the unit,
furthermore no change had been made to the laboratory procedure for
processing neonatal screens.
Method(s):
As part of the outbreak investigation, all babies on the unit
were screened weekly. Infection control measures included education
on standard infection control precautions, hand hygiene and compli-
ance with uniform policy. Equipment disinfection was also reviewed.
Results:
A total of 9 babies isolated
M.pachydermatis
from ear swabs.
To date this has represented colonisation only, with no evidence
of infection being identified. Environmental screening cultured
M.pachydermatis
from the unit equipment. Staff screening was not
undertaken.
Discussion and/or Conclusion(s):
Following implementation of the
infection control measures, no new cases of
M.pachydermatis
have
been identified on neonatal screening or cultured from equipment in
the unit. Human carriage of this ubiquitous opportunistic pathogen
reinforces the importance of good hand hygiene.
ID: 4942
Influenza outbreak in an elderly rehabilitation ward
Virginia Ledda, Christopher Lawrence, Orla Whitehead.
County
Durham and Darlington Foundation Trust
Background:
Influenza can cause significant morbidity and mortality
in the elderly. Influenza vaccination is recommended in high-risk
groups (elderly, significant co-morbidities) to prevent infection.
Aim(s)/Objective(s):
To describe an influenza outbreak in an elderly
rehabilitation ward and to audit diagnosis and management against
Infection Control and Prevention Trust guidelines.
Method(s):
Following identification of the Influenza A H1N1 virus,
all patients were risk assessed and treated as per Trust protocol.
Symptomatic patients had oropharyngeal swabs taken to confirm the
diagnosis. They were treated with Oseltamivir. Influenza vaccination
status was checked with patients or confirmed with patients
’
GPs.
Anonymised data was collected.
Staff members were risk assessed and their vaccination status was
checked. Staff was consented for use of anonymised data in research:
data was recorded by staff type.
Results:
18 patients were present on the ward: 4 patients
’
vaccina-
tion status was unknown. 7 patients were vaccinated, 7 were not
vaccinated.
Of the 7 vaccinated patients, 1 patient was symptomatic and influenza
positive. Of the 7 non-vaccinated, 4 were symptomatic and found to be
influenza positive. Zero patients with influenza died or required
higher care.
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S108