The Journal of Hospital Infection - Supplement 1

Of the 41 staff members, 24 (58%) had been vaccinated before

the outbreak. 10 staff members were found to be high risk: of these,

2 were not vaccinated while 9 were.

Discussion and/or Conclusion(s):

As anticipated, vaccinated patients

had a lower rate of Influenza infection.

The low rate of vaccinated staff members suggests that staff working

with the elderly should be encouraged to undergo vaccination to

reduce risk of outbreak transmission.

ID: 4950

Norway losing its antimicrobial innocence?

Kristin Stenhaug Kilhus

, Dorthea Oma

Department of Research and

Development, Division of Patient safety and Infection Control, Haukeland

University Hospital,

Department of Research and Development, Division

of Patient Safety and Infection Control, Haukeland University Hospital

Background:

Norway is considered a country of prudent use of

antibiotics and few problems with multidrug resistant bacteria. We

describe the first hospital outbreak of vancomycin-resistant entero-

cocci (VRE) in Norway and the control measures implemented to

contain it.

Method(s):

Main interventions were:

•

Establishing a local VRE control committee

•

Multidisciplinary communication and leadership

•

Systematic surveillance screening and contact tracing

•

Cohorting and contact isolation

•

VRE labelling of patient journals

•

Optimizing laboratory diagnostics

•

Reinforcing environmental cleaning and disinfection

•

Adherence to standard precautions

•

Antibiotic stewardship

Results:

From June 2010 to June 2016 499 cases with vancomycin-

resistant

Enterococcus faecium

of the

vanB

genotype were identified.

More than 90% (461/499) were asymptomatic carriers identified

through screening or contact tracing. 11 blood culture isolates were

identified. 21 different wards had at least one patient with VRE.

Pulsed-field gel electrophoresis (PFGE) and Multi-locus sequence

typing (MLST) indicated a single-strain outbreak.

Discussion:

Containing the outbreak was costly and tedious. We

believe this was mainly due to the lack of guidelines, standardized

laboratory methodology and organizational culture. Despite increas-

ing rates of colonization in our hospital, there have been few adverse

outcomes related to VRE. What actually defines a cost-effective

infection control intervention? Antibiotic resistance knows no

geographic borders and VRE is said to be

“

a canary in the mine

”

Should VRE actually be one of our main concerns in the future?

Conclusion:

VRE has not been eradicated form our hospital. We must

remain vigilant to prevent another large outbreak but getting back to

baseline may be illusive.

ID: 4970

Community-associated methicillin-resistant

Staphylococcus

aureus

outbreaks in Belgian maternity wards

Annie Uwineza

, Béatrice Jans

, Barbara Legiest

, Caroline Broucke

Hanna Masson

, Wouter Dhaeze

, Sofie Theunis

, Isabelle Bendels

Olivier Denis

, Sylvanus Fonguh

, Boudewijn Catry

The Scientific

Institute of Public Health (WIV-ISP),

The Scientific Institute of Public

Health (WIV-ISP), Outbreak Support Team,

Agency for Care and Health,

Prevention Division, Infectious Disease Control and Vaccination, Outbreak

Support Team,

Belgian National Reference Centre for Staphylococcus

Aureus

Background:

In recent years, Community-Associated Methicillin-

Resistant

Staphylococcus aureus

(CA-MRSA) prevalence increased in

Belgium. Since 2014, at least 3 Belgian hospitals reported outbreaks

involving PVL + CA-MRSA in maternity wards.

Aim(s)/Objective(s):

Our aim is to describe the three CA-MRSA

outbreaks.

Method(s):

Healthcare facilities with outbreaks involving multi-drug

resistant organisms (MDRO) can ask for support from the national

Outbreak Support Team (OST).

Results:

Outbreak1: September 2014-April 2015 (strain USA300,

t008): 14 infected and 5 colonized persons among 10 families,

several relapses observed. The index case had a history of non-

investigated relapsing skin infections. The outbreak was reported 5

months after onset.

Outbreak2: September-December 2015 (strain USA300, t008): 3

families involved with 4 infected and 4 colonized cases. A HCW with

a known CA-MRSA history started working in theward few days before

the index case was identified.

Outbreak3: January-April 2016 (strain USA400, t1931): 6 families

involved with 6 infections (mostly breast abscesses) and 6 coloniza-

tions (4 patients, 2 HCW). The index case was a patient with non

investigated relapsing skin infections who probably contaminated

HCW1, who further contaminated HCW2. The outbreak spread among

mothers and babies.

All outbreaks were successfully managed through close collaboration

between OST, Medical direction, infection control teams, maternity

HCWand laboratories.

Discussion and/or Conclusion(s):

Controlling the spread of CA-MRSA

requires carefully elaborated strategies. Although mothers are mostly

in good health, compliance to hand hygiene recommendations

remains essential in maternity wards. Early declaration of outbreaks

is important. Screening mothers with skin disease history before

delivery could be a protective measure.

ID: 4977

Healthcare associated infection incident epidemiology in

NHSScotland (2015/16)

Catherine Dalziel, Lisa Ritchie.

Health Protection Scotland

Background:

In NHSScotland infection incidents (outbreaks) are

reported to Health Protection Scotland (HPS) using the Healthcare

Associated Infection Incident Assessment Tool (HIIAT) which assesses

infection incidents as red, amber or green based on risk. Recently, HPS

performed a descriptive epidemiological analysis of reported infection

incidents between 01/04/2015 and 31/03/2016.

Results:

As well as describing the organisms, infection categories

and care settings involved in infection incidents during this time

period the report also highlighted potential reporting biases. The

report found lower levels of reporting of CDI and S

taphylococcus

aureus

than expected given that there has been no significant change

in infection incidence for these pathogens according to national

surveillance; there was also considerable variation in reporting (no.

of reports) between boards. Previously, NHS Boards were required to

report all incidents assessed as amber or red to HPS, reporting of

HIIAT green incidents to HPS was voluntary; if a bias exists it is

possibly due to variation in application of the HIIAT resulting in

under reporting.

Discussion and/or Conclusion(s):

In April 2016 reporting of all non-

norovirus HIIAT green incidents was made mandatory in NHSScotland.

It is anticipated that this mandatory reporting will reduce potential

reporting biases and enable HPS to provide a more accurate picture of

infection incident epidemiology in NHSScotland. This study provides a

baseline against which to measure the impact of non-norovirus HIIAT

green reporting and may also provide an opportunity to improve

consistency of healthcare associated infection incident assessment in

NHSScotland.

ID: 5085

An outbreak of

Staphylococcus capitis

bacteraemia in a Scottish

neonatal unit

Teresa Inkster

, Huma Changez

, Kate Hamilton

, Elizabeth Dickson

Gillian Bowskill

, Gillian Mills

, Jennifer Slorach

Queen Elizabeth

University Hospital, Glasgow,

NHSGGC

Abstracts of FIS/HIS 2016

–

Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24

–

S134

S109