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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
’
included
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-
β
-D-Glucan in serum is also a useful biomarker of
PCP, providing high sensitivity and good specificity. However, 1-3-
β
-D-
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
–
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