127 / 150
Discussion and/or Conclusion(s):
Intensified infection control mea-
sures combined with routine rectal surveillance cultures resulted
effective in reducing the circulation of CR-Kp in the ICUs.
ID: 4844
Prevalence of healthcare-associated infections and antimicrobial
use in a tertiary acute-care university hospital of north-west Italy:
a three-years
’
experience
Andrea Orsi
1
, Cristiano Alicino
1
, Daniele Roberto Giacobbe
1
,
Laura Sticchi
1
, Valerio Daturi
2
, Antonella Talamini
2
, Chiara Paganino
1
,
Ilaria Barberis
1
, Valeria Faccio
1
, Cecilia Trucchi
1
, Valerio Del Bono
3
,
Giancarlo Icardi
1
.
1
Department of Health Sciences, University of Genoa,
2
Hygiene Unit, I.R.C.C.S. University Hospital San Martino
–
IST National
Institute for Cancer Research, Genoa, Italy;
3
Infectious Diseases Unit, I.R.C.
C.S. University Hospital San Martino - IST National Institute for Cancer
Research, Genoa, Italy
Background:
Healthcare-associated infections (HAI) point prevalence
surveys, repeated periodically, provide an effective epidemiological
tool for monitoring the extent of the phenomenon.
Aim(s)/Objective(s):
i) To estimate HAI prevalence and antimicrobial
use, (ii) to study microbial ecology and (iii) to identify risk factors for
HAI at the tertiary 1,300 acute-care beds regional referral center
university hospital, I.R.C.C.S. AOU San Martino-IST of Genoa, Liguria
region, north-west Italy.
Method(s):
During January-February of three consecutive years
(2014
–
2016), we conducted three point prevalence surveys of HAI
and antimicrobial use by adopting the protocol of the European Center
for Disease Prevention and Control (ECDC), Version 4.3.
Results:
Overall, we enrolled 2820 patients, with a median age of 73
years (IQR: 57
–
82), a male:female ratio = 0.96:1 and a median hospital
stay of 8 days (IQR: 3
–
17). Nearly half of the patients had a ultimately
or rapidly fatal McCabe score. HAI prevalence decreased from 15.5% in
2014 to 13.2 in 2016. Bloodstream and low-respiratory tract infections
represented the most frequent site of HAI. Antibiotic treatment
prevalence remained nearly 47% in the period. We observed an
increase in the isolation of Klebsiella pneumoniae and Escherichia coli.
At multivariate analysis, statistically significant risk factors for HAI
resulted length of hospital stay, worst McCabe score, presence of
central and peripheral line, and presence of urinary catheter.
Discussion and/or Conclusion(s):
The study allowed us to increase
knowledge for the prompt implementation of appropriate preventive
interventions, aimed at controlling one of the most important public
health problems in our country.
ID: 4855
Similar outcomes for individuals colonised with Pneumocystis
jirovecii and those with Pneumocystis pneumonia (PCP) in
Northern Ireland; should we decolonise?
Lynsey Patterson
1
, Peter Coyle
2
, Tanya Curran
2
, Shane McAnearney
2
,
Jillian Johnston
1
.
1
Public Health Agency,
2
Belfast Health and Social
Care Trust
Background:
Pneumocystis jirovecii colonisation is a risk factor for the
development of PCP disease. Few studies have compared individuals
with P. jirovecii colonisation to those with PCP disease.
Aim(s)/Objective(s):
To describe the epidemiology of
P. jirovecii
colonisation and PCP disease in order to inform preventive measures.
Method(s):
From July 2011-July 2012 information on demographics,
clinical severity and clinical features for all hospital inpatients in NI
aged
≥
18 years with
P. jirovecii
confirmed in any respiratory tract
sample. We defined PCP or
P. jirovecii
colonisation using clinical and
radiological findings. We compared demographics and clinical vari-
ables for PCP compared to
P. jirovecii
colonisation calculating adjusted
median unbiased estimate (AMUE) of the odds ratio (OR) using
multivariable exact logistic regression, adjusting
a priori
for age and
sex.
Results:
There were 13
P. jirovecii
colonisations and 36 PCP cases, with
no difference in age (P = 0.1) or sex (P = 0.4). There was no difference in
the proportion admitted to ICU (P = 0.9), the length of stay following
P. jirovecii
detection (P = 0.9) or 30-day all-causemortality (P = 0.8). The
odds of PCP increasedwith exposure to chemotherapy (AMUE OR 8.73;
95% confidence interval (CI) 0.84,
∞
), immunosuppressive drugs
(AMUE OR 12.1; 95% CI 1.94,
∞
) and an HIV diagnosis (AMUE OR 16.2;
95% CI 1.71,
∞
).
Discussion and/or Conclusion(s):
Our study showed no difference in
clinical severity between individuals colonised with
P. jirovecii
and
those with PCP. Given the higher odds of PCP in those exposed to
chemotherapy, immunosuppressive drugs and those with HIV we
propose decolonisation should be considered in these groups.
ID: 4864
An influenza care bundle approach to patient management,
surveillance and documentation
Stella Barnass
1
, Josephine Elfick
2
, Colin Barnes
2
, Farhana Butt
2
,
Nupur Goel
2
, Yolanda Hedges
2
, Linda Woodward-Stammers
2
.
1
West
Middlesex University Hospital, Chelsea and Westminster NHS Foundation
Trust,
2
West Middlesex University Hospital, Chelsea and Westminster NHS
Foundation Trust
Aim(s)/Objective(s):
An influenza care bundle was developed to faci-
litate consistent management and documentation of influenza cases.
The care bundle covers:
•
patient demographic information
•
laboratory results
•
informing ward staff
•
patient treatment
•
isolation with respiratory precautions
•
contact tracing for adult patients on general wards, pregnant
patients and children
•
contact tracing for staff contacts
•
antiviral prophylaxis for contacts
•
incident reporting
•
consideration of whether an incident meeting is required
•
patient outcome
There is guidance onwhich sections should be completed by one of the
medical microbiologists and/or one of the infection prevention and
control nurses. The name of the person(s) completing the form and the
date are included.
Method(s):
On completion the form is scanned into the department
shared drive and the data is readily to hand for analysis and to compile
reports.
Discussion and/or Conclusion(s):
Copies of the care bundle will be
available at the conference, and an electronic version can be e-mailed
on request for local adaptation.
ID: 4879
How much do we Trust epidemiological definitions of healthcare-
associated
C. difficile
infection?
Jon Otter, Jonathan Sullivan, Eleonora Dyakova, Siddharth Mookerjee,
Tracey Galletly, Eimear Brannigan, Mark Gilchrist, Frances Davies,
Alison Holmes.
Imperial College NHS Healthcare Trust
Background:
Epidemiological definitions from PHE do not include
previous hospitalisation in defining healthcare-associated (Trust-
apportioned)
C. difficile
, in contrast to other definitions such as from
the CDC and ECDC.
Aim(s)/Objective(s):
To investigate previous hospitalization in
patients presenting with
C. difficile
infection within the first 72
hours of hospital admission.
Method(s):
We evaluated all cases of
C. difficile
PCR and toxin EIA
positive cases identified in the 14/15 Financial Year to determine
attribution of cases, comparing surveillance definitions from PHE
(which do not include previous hospitalization) and CDC (which
include previous hospitalization). For each case of
C. difficile
identified
in the first 72 hours of admission, previous hospitalization in our
hospitals was determined through medical note review.
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S122