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ID: 4693

Point prevelance survey of asymptomatic carriers in a Community

Foundation Trust

Kath Hughes.

Birmingham Community Healthcare NHS Foundation Trust


Morbitity and mortality of patients with Clostridium

difficile Infection (CDI) increases. Infection and Prevention Nurses

(IPCN) we investigated how to prevent transmission of asympto-

matic CDI in patient areas to prevent further harm to others from

asymptomatic carriers, cross infection, contamination from fomites,

staff hands and equipment they use.


Following a serious CDI outbreak, a research

question hypothesised to identify asymptomatic carriage. C.diff has

been the source of serious life-threatening outbreaks and had

difficulty determining association in the same environment within

the same period. Others proposed screening asymptomatic patients on

admission may prevent Healthcare Associated CDI.


IPCNR proposed that a total of 413 patients be interviewed,

notes reviewed, samples of skin and faeces were sent to the laboratory.

30 item questionnaire designed.


11 adult hospital inpatient wards (7) and inpatient units (4)

were included in the study.

A total of 407 patient samples collected. 154 faeces samples were


253 skin swabs were collected and analysed.

A total of 22 faecal samples were positive

0 skin swabs were shown not to have any carriage.

Positive asymptomatic carriers had received antimicrobials, received

proton pump inhibitors, received care in an Acute Hospital in the last 3


Discussion and/or Conclusion(s):

Predicted rate of colonisation was

20%. Actual results were 14.3%

This study adds to the growing knowledge base of C.diff research

would benefit from larger scale studies to draw relevant conclusions.

Isolating identified asymptomatic carriers of C.diff potentially confines

and prevents further contamination of the environment, staff employ-

ing extra precautions concerned with source isolation together

protects patients in the vicinity.

ID: 4697

A service evaluation assessing the follow-up of contacts of

multidrug-resistant tuberculosis cases at the Birmingham and

Solihull TB service

Thomas Harrison


, Clare Treharne


, Rohan Aggarwal



Martin Dedicoat




Heart of England Trust,


University of Birmingham,


Heart of England trust


Between 2004 and 2011, the proportion of UK

tuberculosis diagnoses proven to be multi-drug resistant tuberculosis

(MDR-TB), increased from 1.1% to 1.6%, equating to 50

80 cases per

year. Outcomes for MDR-TB are poor with cure rates under 50% in

Europe compared to 98% for drug sensitive TB.

The World Health Organisation, European Centre for Disease Control

and National Institute for Clinical Excellence recommend monitoring

MDR-TB contacts for two years through chest radiography (CXR) and

clinical examination.


This service evaluation retrospectively analysed

surveillance of 103 contacts of MDR-TB cases managed by Birmingham

and Solihull TB service between 2010 and 2015. Of these, four were

extra-pulmonary MDR-TB contacts.


Service standards were set as: all contacts

18 years old

require three CXRs, four clinician contacts, and if

35 years old, a

mantoux/IGRA test within a three year window. A proforma was

created and data were obtained from electronic medical records.


Analysis of pulmonary contacts found 14% had

3 CXRs

whilst 32% had 1


3 CXRs. 53% had no CXR. 11% completed

24 months of follow-up. 63% had partial follow-up, 24% had none and

2% had ongoing follow-up. Of the eligible cohort, 65% had IGRA/


Discussion and/or Conclusion(s):

Results were presented at a local

TB meeting. Given that standards were not met, an action plan for

enhanced follow-up was agreed. In addition to a quarterly cohort

review of all TB cases, an annual cohort meeting for MDR-TB will be

implemented, supplemented by weekly discussion at the TB multi-

disciplinary team meeting. Re-audit will be undertaken in two years.

ID: 4708

Surveillance of multi-resistant

Staphylococcus capitis

in a large

tertiary centre for newborn care

Carolyne Horner


, Kavita Sethi


, Miles Denton




Public Health England,


Leeds Teaching Hospitals NHS TRust


Leeds Centre for Newborn Care is one of the largest

neonatal services in the UK, providing specialist care for approximately

1800 babies/year from the Yorkshire region and beyond.


We investigated the prevalence of a multi-

resistant strain of

Staphylococcus capitis

in this centre over 11 months.


Cefoxitin-resistant coagulase-negative staphylococci

(FOX-R-CNS) from blood cultures of neonates >72 hours old were

speciated using matrix-assisted laser desorption/ionisation time of

flight (MALDI-ToF) spectrophotometry. Cefoxitin-resistant isolates of

S. capitis

were sent to the Staphylococcus Reference Unit, London for

further work.


Between 1st July 2015 and 31st May 2016, 102 CNS were

isolated. There were 38 FOX-R-CNS grown from 26 neonates. A male

baby born in Leeds at 31 weeks gestation grew

S. capitis

from blood

cultures in the third week of neonatal unit stay. The isolate was

confirmed to belong to the same multi-resistant clone seen in other

neonatal units worldwide. The source of the late-onset CNS bacter-

aemia was thought to be a central venous catheter used for

administration of total parenteral nutrition in this very low birth

weight baby (1.22kg). The intravenous catheter was removed and the

baby was successfully treated with daptomycin.

Discussion and/or Conclusion(s):

Within the Leeds Centre for

Newborn Care, there is currently a low prevalence of the multi-


S. capitis

strain that has caused clonal outbreaks in neonatal

units worldwide, including UK. There is a need for on-going

surveillance given vancomycin selective pressure in neonatal units

and we will continue to monitor for the emergence of this multi-

resistant strain.

ID: 4727

Comparison of the impact of different kinds of nosocomial

infections acquired in intensive care units until hospital discharge:

a retrospective nine years study

Joris Muller


, François Severac


, Pierre Tran Ba Loc



Stéphanie Deboscker


, Gilles Prevost


, François Lefebvre



Mickael Schaeffer


, Francis Schneider


, Thierry Lavigne





University Hospital; Infection control and prevention unit,



University Hospital; Public health service,


University of Strasbourg,

Faculty of Medicine, EA7290,


Strasbourg University Hospital; Medical

intensive care unit


The impact of different kinds of nosocomial infections

(NI) acquired in intensive care unit (ICU) on the whole hospital stay is

still a subject of controversy especially due to statistical challenges.


Our objective was to provide comprehensive and

accurate metrics concerning the risk of death and the excess in length

of stay due to NI acquired in ICU.


NI (nosocomial pneumonia, central venous catheter

related infection, bacteraemia and urinary tract infections) were

continuously recorded from 2004 to 2012 for every patient hospita-

lised more than two days in one 30 beds medical ICU according to the

protocol of the French

s Survey Network for ICU-Acquired Infection

(REA-RAISIN). We merged data from the local diagnosis-related group

system (PMSI) to add information about the whole hospital stay,

including primary diagnosis. For each type of NI, we assessed the

impact of NI with the state-of-the-art statistical models: extended

Abstracts of FIS/HIS 2016

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