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of the AMR Strategy: Optimising Prescribing Practice and Objective 5:

better access to and use of surveillance data.

Thinking outside the box? Healthcare acquired waterborne

infections from equipment

Jimmy Walker.

Public Health England

Thinking outside the box? Healthcare acquired waterborne infections

from equipment The recent publication of the

Health Technical

Memorandum 04-01: Safe water in healthcare Premises


recommendations for the safe management of water systems, via the

integration of water safety groups (WSG) to recognise and manage

microbial risks to health. This presentationwill assist those involved in

WSG to assess the risks from a range of microorganisms including

Legionella spp., Pseudomonas aeruginosa and Mycobacteria spp.

Water is used in a wide range of equipment across hospitals and the

risks are not always obvious. As well as considering water systems and

outlets including showers and taps the presentationwill also highlight

the microbial risk from a range of stand-alone equipment including

ice-machines, endoscopy washer disinfectors as well as heater-cooler

units used during cardiac by-pass surgery. Control strategies will be

discussed from a holistic perspective that will include competencies

and training of staff.

Changes to ACDP guidance

Jimmy Walker.

Public Health England

Recent guidance publications have maintained the precautionary

approach in terms of the risk from prion related diseases and the

potential for iatrogenic transmission and indicates that decontamin-

ation of re-usable surgical instruments is the cornerstone of safe

surgery. Such approaches are underpinned by recent research that

indicated that up to 1:2,000 of the population may have identifiable

levels of abnormal prion protein in their peripheral lymphoid tissues

and may be incubating the disease. As a consequence of this evidence,

DH research and risk assessments the current suite of protein

detection technologies were brought into question and alternative

protein detection strategies related to the entire surface of instruments

investigated. After reviewing the data, the Advisory Committee on

Dangerous Pathogens (ACDP) published recommendations that were

subsequently written into recent guidance updates in HTM 01-01

Decontamination of surgical instruments

and HTM 01-06

Decontamination of Endoscopes

, to improve the decontamination

of both reusable instruments and endoscopes. This presentation will

discuss the back ground and the stages involved in formulating the

recent DH guidance.

Clean water: complacency is not an option

Jimmy Walker.

Public Health England

From a global perspective, climate change is predicted to have a major

impact on people

s lives. However, the recent regional extremes of

temperature, from <10°C to >30°C, across the UK in September 2016

raised concerns that there may also be an impact in the burden and

type of disease at a local level, and that this may occur sooner than has

previously been considered. Changes to marine and fresh water

supplies already affect significant parts of the world

s population and

it is likely to get worse and affect more countries. Infectious agents

vary greatly in size, type and mode of transmission and can include

viruses, bacteria, protozoa and multicellular parasites. This presenta-

tion will consider the changes in infectious disease transmission

patterns of water-borne diseases and the likely consequences of

climate change due to warmer water, drought, higher rainfall, rising

sea levels and flooding, all of which will have an impact on the risk of

water-borne disease in the UK.

Emerging waterborne infections and new sources

Michael Weinbren.

Chesterfield Royal Hospital Foundation Trust

Water systems from a hospital infection perspective, apart from

legionella, were largely ignored within the UK despite a significant

body of evidence until the Belfast neonatal outbreak. As we learn more

about water systems there is increasing evidence emerging that drains

are an important key to the jigsaw. It is still likely to be the case that a

high percentage of water transmission events go unrecognised.

Laboratory diagnosis of

Pneumocystis jirovecii

an update

P. Lewis White.

Public Health Wales, Microbiology Cardiff

Pneumocystis jirovecii

is a ubiquitous fungus that causes Pneumocystis

pneumonia (PCP) specifically in humans. Diagnosis of PCP was

hampered by the inability to culture Pneumocystis. Historically,

diagnosis was based on microscopic examination and straining of

respiratory samples for the presence of trophic and cysts forms. The

performance of the different stains was generally comparable, but

superseded by immunofluorescent testing using monocloncal anti-

bodies to target the cyst, or both cyst and trophic forms. While the

sensitivity of IF testing is superior to conventional staining it is not

infallible, although specificity is good.

Newdiagnostic assays can assist in the diagnosis of PCP although result

interpretation can be far from straightforward. PCP PCR has permitted

testing of respiratory samples other than BAL, easing sampling

pressures. PCR has greater sensitivity over IF but questions remain as

to the significance of low level positivity, particularly in cohorts

capable of raising an immune response. Conversely, PCR negativity in

BAL samples can exclude disease, provided BAL sampling is adequate.

The presence of 1-3-


-D-Glucan in serum is also a useful biomarker of

PCP, providing high sensitivity and good specificity. However, 1-3-



Glucan is not specific to PCP, and definitive thresholds for PCP are yet to

be determined.

New guidelines for the diagnosis of PCP will also be discussed.

Stewardship issues related to rising resistance and new agents

Hayley Wickens.

University Hospital Southampton NHS Foundation Trust

Good Antimicrobial stewardship requires a careful balance between

choosing the correct antimicrobial to ensure optimal patient outcome,

and being mindful of the effects on microbial ecology, particularly

when making broad policy choices that will impact overall usage. At a

timewhen antimicrobial resistance is inexorably rising, how dowe use

new agents appropriately?

Markedly variable risks of bacterial dissemination according to

choice of hand drying method

Mark Wilcox.

Medical Microbiology, University of Leeds, Leeds Teaching

Hospitals NHS Trust

New data confirm the low proportion of CDIs that can be matched to

prior cases. Independent significant risk factors for acquisition of CDI

from another case include older age, longer inpatient duration and

ribotype; these factors, male, higher severity and multiple positive

samples increase the risk of onward transmission. Notably, there is a

significantly greater risk of recurrence and 30-daymortality in patients

with a matched donor. Changes to definitions used in England to

apportion CDIs to healthcare/community will result in an increased

proportion of cases designated as healthcare onset, and a marked

decrease in those currently designated as community associated. The

great majority of community onset cases with prior healthcare

interactions occurred in the same Trust that reported the CDI.

Treatment options for CDI will increase with the likely approval of

bezlotoxumab, a human antitoxin B antibody. Bezlotoxumab reduces

recurrence risk by

40%, including in those at increased risk (severe

cases, elderly, immunocompromised, hypervirulent strain). There is

increasing evidence that metronidazole is an inferior treatment option

for CDI, and so its place in guidelines requires review. FMT efficacy is

Abstracts of FIS/HIS 2016

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