124 / 150
Cox models for mortality risk and multistate models for extra length of
stay.
Results:
Among the 6069 inpatient stays, 771 (12.7%) presented at
least one NI. The proportion of in-hospital death was 1.6 times higher
among patients with NI. However, the adjusted hazard ratio was not
significant (HR = 1.13, CI95% 0.99
–
1.29). The crude excess length of stay
was 39 days and, albeit lower, it remained significant with multistate
analysis (13 days, CI95% 9
–
17). These analyses were performed for each
kind of NI.
Discussion and/or Conclusion(s):
Our results are in favour of a
significant effect of the ICU-acquired NI on length of stay without any
significant effect on mortality.
ID: 4741
Epidemiology of healthcare associated infections (HAIs) in the
neonatal intensive care unit (NICU)
Miguel Rosales.
Complejo Hospitalario Universitario de Granada
Background:
Newborns to preterm, have the highest infection rates
of all pediatric patients, it was found that the introduction of a
monitoring system of the lead HAIs to a decrease in these rates.
Aim(s)/Objective(s):
To know the incidence of HAIs appeared in our
unit during 2015.
Method(s):
We performed a prospective observational epidemio-
logical study. All patients who remained in the NICU more than 24
hours were included.
The classification criteria of HAI were the NEO- KISS.
Incidence rates and cumulative incidence of various infections, as well
as their confidence intervals were calculated.
Results:
118 patients, 65 men and 53 women were studied, and 38% of
patients had a weight less than 1500 grams.
The incidence density overall was 11.7 per thousand stays, and
accumulated incidence in 17.8% patients, bacteremia associated
central venous catheter 9.3 per thousand catheter days, I am not
going no pneumonias associated with mechanical ventilation. Preterm
infants less than 1000 grams had the highest infection rate 24.5%.
The most frequent germ were Escherichia coli.
Discussion and/or Conclusion(s):
The most frequent bacteremia
infection has been associated with central venous catheter 8.2 per
thousand catheters day.
The OR of having a HAIs according to weight at birth is 13 for those
under 1000 grams compared to children of 2,500 grams or more.
In relation to infection and sex, we found that men have a slightly
higher risk of infection women, 27.1% versus 17%.
ID: 4751
An economic evaluation of additional costs due to
Clostridium
difficile
infection in an Irish Hospital
Fidelma Fitzpatrick
1
, Padhraig Ryan
2
, Mairead Skally
3
,
Fionnuala Duffy
3
, Mary Farrelly
3
, Leah Gaughan
3
, Pauline Flood
3
,
Elaine Mc Fadden
3
.
1
Beaumont Hospital and Royal College of Surgeons in
Ireland,
2
Centre for Health Policy and Management, Trinity College
Dublin, Ireland;
3
Beaumont Hospital, Dublin, Ireland
Background:
Irish Public hospitals receive annual block funding based
on historical spending and activity patterns, without explicit adjust-
ment for the rate of hospital acquired infection.
Aim(s)/Objective(s):
We aimed to ascertain additional financial cost
per routine case of
Clostridium difficile
infection (CDI) and the cost of a
CDI outbreak in our hospital.
Method(s):
A micro-costing approach was used to estimate the addi-
tional cost of CDI per patient identified during August 2015 and for a
CDI outbreak managed that month. Resource use was quantified based
on review of patient charts, pharmacy prescribing data, prospective
collection of administrative resource input, and records of cleaning
expenditure.
Results:
The additional cost of routine (non-outbreak) CDI in 13
inpatients in August was
€
75,680 (mean
€
5,820/patient) with clean-
ing, pharmaceuticals, and additional length of stay (LOS) being key
cost drivers. Additional LOS ranged from 1.75 days to 22.55 days.
Seven patients were involved in a CDI outbreak. Bed closures (58 lost
bed days, estimated value
€
34,585), five outbreak control meetings
(mean staff cost/meeting
€
546, aggregate cost
€
2,728), and additional
outbreak-related cleaning (costing
€
9,654) represented the additional
CDI outbreak-associated costs. Excluding the value of lost bed days,
outbreak costs were
€
12,382. Therefore total spending on CDI during
August was
€
88,062 (a mean of
€
6,773 across all patients).
Discussion and/or Conclusion(s):
Investment in disease prevention
may be offset by cost savings. This analysis suggests that investment
in
C. difficile
prevention could offer a net financial benefit in some
circumstances, as well as improving value for money and clinical
outcomes.
ID: 4752
Utilising VNTR typing to identify a dominant EMRSA-15 clone in
Birmingham (UK)
Calum Thomson
1
, Katie Hardy
2
, Peter Hawkey
1
.
1
University of
Birmingham,
2
Public Health Laboratory Birmingham (Public Health
England)
Background:
EMRSA-15 (ST 22) is the dominant MRSA clone in the
United Kingdom (UK), and understanding the epidemiology is key to
control.
Aim(s)/Objective(s):
We have utilized whole genome sequencing
(WGS) and variable number tandem repeat typing (VNTR) to esta-
blish the epidemiology and evolution of EMRSA-15 in a large UK
conurbation over time.
Method(s):
171 EMRSA-15 isolates sampled between 1985 and
2015 across Birmingham were whole genome sequenced and VNTR
typed. WGS data was mapped to the reference strain HO50960412
and single nucleotide polymorphisms (SNP) from the core
genome were used to generate a phylogenetic tree using Bayesian
phylogenetics.
VNTR datawas generated by PCR amplification of 7 tandem repeat loci.
Results:
5082 SNP-sites were used to construct a phylogenetic tree
revealing a distinct clade of 91 (52%) isolates (BHM clade) that
diverged from the rest of the Birmingham population in 1995. The
remaining 80 isolates were more diverse with a wider range of
divergence dates (1986 to 2015). Variation in repeat number was only
observed at loci L13, L16 and L21, with L21 and L16 showing the
highest variability. Mapping of VNTR data onto the tips of the tree
revealed that all isolates with two tandem repeats at L13 (n = 91)
mapped to the BHM clade while isolates with 3, 4 or 5 tandem repeats
were dispersed throughout the rest of the tree.
Discussion and/or Conclusion(s):
WGS provides a high degree of
discrimination amongst the Birmingham isolates, highlighting the
presence of a highly related clade, which is identifyable by a specific
repeat number at one loci with VNTR.
ID: 4762
Community management of
Escherichia coli
bacteraemia cases
diagnosed in Wye Valley NHS Trust September 2013
–
September
2014
Alison Johnson
1
, Emma Sneed
2
.
1
Wye Valley NHS Trust,
2
Worcestershire CCG
Background:
A review of
Escherichia coli
bacteraemia cases diagnosed
in Wye Valley NHS Trust between September 2013 and September
2014 was undertaken to determine whether there may be any
opportunities in the community to prevent admission.
Method(s):
A questionnaire was submitted to GPs of all cases.
Results:
90 cases were reviewed; 59 (65%) were female; average age 72
with range 0
–
97 and mode 88; 39 (43%) were
≥
80 years old; 13 (14%)
were care home residents; the commonest source of the bacteraemia
was urinary
–
54 (60%); 77 had dehydration status recorded on
admission; 13 (20%) of the patients admitted from home were
recorded as dehydrated compared with 5 (38%) of the patients
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S119