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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
Background:
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.
Aim(s)/Objective(s):
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.
Method(s):
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.
Results:
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
analysed.
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
months.
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
1
, Clare Treharne
2
, Rohan Aggarwal
2
,
Martin Dedicoat
3
.
1
Heart of England Trust,
2
University of Birmingham,
3
Heart of England trust
Background:
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.
Aim(s)/Objective(s):
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.
Method(s):
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.
Results:
Analysis of pulmonary contacts found 14% had
≥
3 CXRs
whilst 32% had 1
≤
x
≤
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/
Mantoux.
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
1
, Kavita Sethi
2
, Miles Denton
1
.
1
Public Health England,
2
Leeds Teaching Hospitals NHS TRust
Background:
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.
Aim(s)/Objective(s):
We investigated the prevalence of a multi-
resistant strain of
Staphylococcus capitis
in this centre over 11 months.
Method(s):
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.
Results:
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-
resistant
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
1
, François Severac
2
, Pierre Tran Ba Loc
2
,
Stéphanie Deboscker
1
, Gilles Prevost
3
, François Lefebvre
2
,
Mickael Schaeffer
2
, Francis Schneider
4
, Thierry Lavigne
1
.
1
Strasbourg
University Hospital; Infection control and prevention unit,
2
Strasbourg
University Hospital; Public health service,
3
University of Strasbourg,
Faculty of Medicine, EA7290,
4
Strasbourg University Hospital; Medical
intensive care unit
Background:
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.
Aim(s)/Objective(s):
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.
Method(s):
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
–
S134
S118