The Journal of Hospital Infection - Supplement 1

Genetic susceptibility to severe viral infections in children

Vanessa Sancho Shimizu.

Imperial College London

Severe, unusual or recurrent viral infections of childhood are

increasingly recognized as being due to an underlying genetic

primary immunodeficiency. With recent advances in genomics and

sequencing technology, there has been a surge in the discovery of

single gene disorders identified as underlying childhood infectious

diseases. Among these are a number of genes predominantly

associated with viral infections of childhood, which will be discussed

in this talk with a specific focus on the human herpesviruses. Some of

these immunodeficiencies are specific to a particular viral infection

whereas others predispose to multiple viral, bacterial or fungal

infections. The discovery of these genes has greatly enhanced our

understanding of protective immunity to pathogens, allowing us to

gain new insights into the specific and non-specific immune

mechanisms controlling viral infection.

Tuberculosis

–

whole genome sequencing and other laboratory

developments

Grace Smith.

PHE NIS National Reference Mycobacteriology Service,

PHE- Birmingham Public Health Laboratory

Advocates of Whole Genome Sequencing technology suggest that

whole genome determination should form a key part of future

diagnostic pathways for M. tuberculosis. However, the NGS-based

process requires careful evaluation before it can be introduced

into routine practice as an accredited TB diagnosis solution. The

Birmingham Public Health Laboratory (PHL) has lead on a pilot

project for TB-WGS with which began in July 2014.A successful

collaboration between Oxford University, PHE, NHS and international

collaborating partners in France, Germany and Canada has enabled us

to design a world-first pilot for creating a WGS-centred TB identifi-

cation, resistance prediction and determining transmission events

within local communities. The main aim of the Birmingham pilot was

to the wider implementation of WGS as part of the routine

management of NHS patients with TB and the more specific objectives

included:

•

To accelerate the introduction of WGS into the NHS TB care

pathway

•

To deliver improved patient care through a personalised thera-

peutic approach, especially for drug resistance prediction

•

To deliver improved public health control of TB through better

understanding and management of local transmission networks

and to support national surveillance I will give an update on

progress towards full accreditation of WGS for mycobacteria and

additional developments in the Reference Service.

Issues affecting women with HIV

Shema Tariq.

University College London

Of the 37 million people currently living with HIV globally, half

are women. Looking at the United Kingdom (UK) in particular,

women are the second largest group (after men who have sex with

men) affected by HIV. Furthermore, advancements in antiretroviral

therapy (ART) have resulted in significant improvements in survival

leading to increasing HIV prevalence rates amongst women in

their midlife and beyond. There are important biological and

psychosocial differences between men and women that may lead to

disparities in both HIV-related clinical outcomes and experiences

of living with HIV. For women, this includes reproductive transition

from puberty through to pregnancy and menopause. In this presen-

tation I aim to provide a broad overview of HIV in women through

the life course. As context I will summarise current epidemio-

logical data on HIV in women in the UK. I will then focus on three

key themes: virological response to ART, pregnancy and infant feeding,

and finally the emergent area of menopause transition in women

living with HIV.

HIV in pregnancy

–

current trends and challenges in the UK

Pat Tookey.

UCL GOS Institute of Child Health

About 1200 women living with HIV currently become pregnant each

year in the UK, down from the peak of nearly 1500 in 2010. Most of

these women know about their HIV before they get pregnant, and

around two-thirds are already taking anti-HIV drugs when they

conceive. Transmission of infection from a diagnosed mother to her

baby is at an all-time low, with fewer than 1 in 200 infants becoming

infected themselves. Preventing new infections in women and

children, maintaining high (and early) uptake of antenatal screening,

providing appropriate care in pregnancy and ensuring that women

can have as normal a pregnancy and delivery as possible while

maintaining and even improving on this very low transmission rate are

all vital but challenging goals. Why do paediatric infections still

happen? What should be done if a woman declines the antenatal

screening test? What are the safest HIV drugs to use before and during

pregnancy? Do some women with HIV still need to deliver by

caesarean section? Can a mother who has HIV breastfeed her baby?

Before, during and beyond pregnancy we need to ensure and enhance

the long term health and well-being of women living with HIV, and all

their children.

Can new diagnostic technologies help infection prevention and

management?

Estee Torok.

University of Cambridge

This talk will outline recent advances in diagnostic technologies,

including microbial whole genome sequencing, and discuss their

potential applications in the diagnosis and prevention of infectious

diseases.

Practical aspects of the changes

Karen Tweed.

Sheffield Teaching Hospital Trust

Practical aspects of the changes for surgical equipment and endoscopy.

The updated HTM 01-01 guidance has been developed to support

health organisation in delivering the required standard of decontam-

ination for surgical instruments, building on good practice to ensure

the correct standards of infection prevention and control are met. The

major change to the guidance is the recent changes in Advisory

Committee on Dangerous Pathogens Transmissible Spongiform

Encephalopathy (ACDP

–

TSE) which is suggesting a move towards in

situ testing for residual proteins on instruments because of the

continuing risk of transmission of prions. The guidance provides

information on how sterile services departments (SSDs) can mitigate

the patient safety risk from residual protein with a move towards first

achieving this

≤

g level and subsequently producing further

reductions in protein contamination levels through the optimisation

of decontamination processes. It is hoped that all acute trusts engage

in this and have implemented this guidance by 1 July 2018 but for

healthcare providers whose instruments are likely to come into

contact with higher risk tissues, ie neurological tissue, are expected to

give this guidance higher priority and move to in situ protein detection

methodologies by 1 July 2017. The impact of this guidance and the

feasibility of implementation will be discussed.

Examples of using surveillance data for quality improvement

Tejal Vaghela.

West Hertfordshire Hospitals NHS Trust

Surveillance data of antimicrobial usage is critical to understanding

changes in antimicrobial resistance and for measuring the effects of

stewardship interventions. In addition quality improvement interven-

tions utilising an audit and feedback approach can provide process and

outcome measures as an integral part of an antimicrobial stewardship

plan. This session will share examples from hospital practice from

across the UK to show how surveillance and audit data have been used

to improve clinical practice and patient outcomes. The work

demonstrates how UKCPA colleagues are contributing to Objective 2

Abstracts of FIS/HIS 2016

–

Invited Speaker Abstracts / Journal of Hospital Infection 94S1 (2016) S1

–

S10