The Journal of Hospital Infection - Supplement 1 - November 2016

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SSI surveillance was previously undertaken for neurosurgical proce-
dures in our hospital from 2003–2006. This involved a manual paper
based system for data collection.
Aim(s)/Objective(s): We discuss the use of an integrated electronic
approach to initial data capture, post surgery patient surveillance,
readmission and microbiology alerts.
Method(s): The IPC team use ICNet and the addition of a SSI
surveillance package has enabled robust light surveillance.
The system provides real time data import, alerts and customisable
reports via intranet PCs and tablets allows increased accessibility
throughout multiple hospital sites. This also reduces the burden of
requiring staff to complete paper forms.
Once the patient surgery case is identified for surveillance inclusion
this is automatically displayed on the surveillance nurses ICNet
‘ dashboard’ allowing monitoring of each case for 30 days post surgery.
Results: This method relies on accurate surgical procedure coding
data as the unique identifier for surveillance inclusion. It was noted
that some procedures were not captured due to coding anomalies;
however this was identified and remedied locally.
Discussion and/or Conclusion(s): Using a real-time web application
to undertake SSI Surveillance within cranial surgery has reduced
the burden of a paper based process. SSI monitoring provides a single
data repository for surveillance data and provides a straightforward
approach to monitoring SSI outcome following surgery.
ID: 4940
A review of the analytical methodology used to estimate excess
length of stay due to health care associated infections
Sarkis Manoukian1, Sally Stewart1, Agi McFarland1, Jacqui Reilly2,
Nick Graves3. 1Glasgow Caledonian University, 2GCU/NHS, 3Queensland
University of Technology
Background: Accurately quantifying the additional costs of healthcare
associated infections (HAIs) is essential for developing cost-effective
infection prevention and control measures. A major component of the
economic cost due to health care associated infections can be captured
my measuring the additional length of stay (LOS) due to these
infections.
Aim(s)/Objective(s): The preference for modelling LOS instead of
monetary valuation of hospital cost stems from a belief that many
decisions about healthcare investments are made in the short term
where most financial expenditures are made for costs which are fixed.
However, estimating excess LOS due to HAI is complicated due to the
fact an infection increases duration of hospital stay but at the same
time risk of infection increases with duration of stay. This problem of
endogenous variables can potentially be addressed by using appro-
priate statistical methods.
Method(s): This systematic review examined papers in PubMed
published between 1997 and 2016 and identified English language
studies that estimated increased LOS due to HAIs.
Results: The methodological approaches used in the literature to
estimate excess LOS due to HAIs include case reviews, matched
comparisons and regression analyses. The choice of estimation
methodologies can affect the accuracy of the resulting estimates and
due to that estimates of LOS varied widely between studies reviewed.
Studies examining LOS attributed to HAI varied considerably in design
and data collected.
Discussion and/or Conclusion(s): This review summarises the most
recent statistical methodologies and the message is that a robust
application of these can address key gaps in our understanding of HAIs
and their effects on healthcare.
ID: 4943
Infection after trans rectal ultrasound (TRUS) prostate biopsy –
findings of a two year surveillance programme
Mairead Skally 1, Sara White2, Sheila Donlon3, Caoimhe Finn 3,
Richard Power4, Gordon Smyth5, Ijaz Cheema6, Frank Keeling 7,
Martina Morrin7, Yvonne Williams8, Caitriona Higgins8,
Edmond Smyth9, Hilary Humphreys10, Eimear Dunne2, Karen Burns11,
Fidelma Fitzpatrick10. 1Department of Microbiology, Beaumont hospital,
2Clinical Nurse Specialist - Prostate Cancer, Beaumont Hospital, 3Infection
Control Department, Beaumont Hospital, 4Consultant Urologist & Renal
Transplant Surgeon, 5Consultant Urologist, 6Consultant Urologist
Surgeon, 7Consultant Radiologist, Beaumont Hospital, 8Cancer Data
Manager, Beaumont Hospital, 9Consultant Microbiologist, Beaumont
Hospital, 10Consultant Microbiologist, Beaumont Hospital and Royal
College of Surgeons Ireland, 11Consultant Microbiologist, Beaumont
Hospital and Health Protection Surveillance Centre
Background: Antimicrobial resistant (AMR) infectious complications
following transrectal ultrasound (TRUS)-guided prostate biopsy are
increasing, and include urinary tract infection (UTI) and bloodstream
infection (BSI).
Aim(s)/Objective(s): A prospective multi-disciplinary local infection
surveillance programme was established for men undergoing prostate
biopsy and results of the first two years (2014–2015) are described.
Method(s): Ciprofloxacin is standard prophylaxis. Intravenous
gentamicin is added if risk factors are identified from pre-procedure
AMR assessment. A man representing with suspected infection is
investigated and managed according to the local guideline. UTI and BSI
surveillance within 15 days of biopsy, using European (ECDC)
definitions is performed. Rates are expressed per 100 biopsies. Root
cause analysis (RCA) is completed for confirmed UTI or BSI. Results and
interventions are discussed at biannual team meetings.
Results: The rate of microbiologically-confirmed infections per 100
biopsies decreased by 26% from 1.534 (2014) to 1.133 (2015), with
E. coli the causative pathogen in 100% and 78% non-susceptible to
ciprofloxacin. Therewas a contemporaneous 62% increase in the rate of
microbiologically-unconfirmed infections from 1.227 to 1.983, despite
100% compliance with sending blood cultures and urine. No man
who represented with suspected infection had gentamicin added to
ciprofloxacin prophylaxis, as AMR risks were not evident pre-
procedure.
Discussion and/or Conclusion(s): Implementation of an AMR risk
assessment, robust infection surveillance and management processes
and RCA led to a 26% reduction in infection. The contemporaneous
increase in non-microbiologically confirmed infections, despite full
compliance with testing, warrants further investigation.
ID: 4945
Invasive Candida infections in an Irish tertiary referral hospital: a
descriptive review
Mairead Skally1, Leah Gaughan2, Elaine McFadden3,
Sinead O’Donnell3, Zainab Barker3, Denise McGowan3, Karen Burns 4,
Fidelma Fitzpatrick5, Lillian Rajan3, Binu Dinesh3, Edmon Smyth3,
Hilary Humphreys6, Anna Rose Prior6. 1Department of Microbiology,
Beaumont hospital, 2Pharmacy Department, Beaumont Hospital,
3Department of Microbiology, Beaumont Hospital, 4Department of
Microbiology, Beaumont Hospital and Health Protection Surveillance
Centre, 5Department of Microbiology, Beaumont Hospital and Royal
College of Surgeons Irealn, 6Department of Microbiology, Beaumont
Hospital and Royal College of Surgeons Ireland
Background: Invasive Candida infection is associated with increased
morbidity and mortality. Standardised surveillance programmes for
such infections are limited.
Aim(s)/Objective(s): To investigate incidence of Candida species
isolated from blood and cerebral spinal fluid (CSF) over a five year
period.
Method(s): A retrospective review was conducted between January
2011– December 2015 of blood and CSF resullts where Candida species
was isolated, antifungal susceptibility and patient outcomes.
Results: Candida was cultured from blood (n = 75) and CSF (n = 4) of 79
patients. Nine patients had documented recurrent infections. The
average time of positive culture was day 28 of admission. Male and
females were equally affected. The average age was 55 years (range 16
to 91 years). Ten patients (13%) were in critical care at time of culture.
Abstracts of FIS/HIS 2016 – Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24–S134 S124