We report an increase in incidence of Enter-
in a tertiary care hospital in London,
detected in a low risk population by enhanced screening and
concurrent outbreak investigations.
Patients are regularly screened for CPE carriage in high risk
specialities (liver transplant, haematology, haemodialysis and inten-
sive care). Contacts of positive cases are traced and screened and
investigations widened if an outbreak is detected. Screening was done
on Brilliance CRE agar. Molecular confirmation was by PCR and typing
by VNTR analysis at the PHE reference laboratory.
Detection of two
colonisations in high risk areas prompted contact tracing which
led to screening in low risk wards (cardiology and general
medicine). Unexpectedly, fourteen patients with bla
Enterobacteriaceae were detected. These comprised three different
and one E.cloacae of which two also colonised
clinical sinks. One strain predominated causing 8 colonisations and
two bacteraemias (one death). Active screening, deep cleaning and
enhanced environmental and hand hygiene has resulted in no further
cases of two of the three strains.
Discussion and/or Conclusion(s):
Current guidelines recommend
risk based screening; however detection of carriers in erstwhile low
prevalence populations is changing the definition of risk factors. A
relatively rare but diverse carbapenemase gene
emerging in the UK with clinical implications to protocols for
An outbreak of Group A Streptococcus: The challenges of outbreak
management in the residential care setting
, Tracey Lamming
, Sally Bird
, Wendy Walker
, Vivienne Weston
, Vanessa MacGregor
University Hospitals/Health Education East Midlands,
England East Midlands,
NHS Mansfield and Ashfield Clinical
Public Health England Colindale,
There are currently no national guidelines on the control
of Group A Streptococci (GAS) in care homes.
We describe the management of an outbreak of
GAS in an 82-bedded facility providing residential and nursing care
separated over four floors.
Two residents from the residential care floor of the home
presented with invasive GAS (IGAS)
type st1.0 infection within a
two week period prompting an outbreak investigation. Retrospective
case-finding, resident and staff screening, and environmental sam-
pling were undertaken.
Retrospective case-finding identified another two recent
cases of GAS in the home and one possible linked case of IGAS at a
mental health facility. Screening identified three residents and six
staff with throat carriage; five were confirmed as
two further results awaited. The residential level communal areas
had soft furnishings that were difficult or impossible to clean.
Environmental sampling yielded GAS
type st1.0 from residents
carpets and curtains, as well as curtains and furniture in the
communal lounge despite a deep clean. A terminal clean with
hypochlorite and steam-cleaning of furniture and carpets was
synchronised with antibiotic prophylaxis offered to all residents and
staff at the home.
Discussion and/or Conclusion(s):
Four confirmed symptomatic
cases and at least five asymptomatic cases were identified, plus one
possible case. Contamination of carpets and soft furnishings may have
contributed to transmission. Decontamination of the environment
was complicated by the choice of furnishings, exemplifying the
importance of good infection control
even in residential
level care settings.
Outbreak with a PVL + CA-MRSA strain in a maternity ward linked
to an asymptomatic healthcare worker in Belgium
, An Willemse
, Tina De Beer
, Katia Verhamme
Kristien Van Vaerenbergh
OLV ziekenhuis campus Asse,
Panton-Valentine Leucocidin (PVL) positive community-
acquired methicillin resistant Staphylococcus aureus (CA-MRSA) can
cause necrotic skin lesions and severe necrotizing pneumonia.
Outbreaks with PVL + CA-MRSA in maternity wards have been
described in literature.
To investigate an outbreak with a PVL + CA-MRSA
in a maternity ward from September 2015 until December 2015.
The outbreak investigation consisted of a literature study, a
retrospective analysis of the medical records and the reinforcement of
infection control procedures. Additionally a nasal screening of all
healthcare workers was performed, as well as genotyping of the
PVL + CA-MRSA isolates using the spa typing method.
Eight cases of PVL + CA-MRSA patients were observed in the
hospital. The cluster consisted of 3 families and affected both mother
and newborn. In 1 family the father and an older child were also
involved. All 3 mothers and 1 father suffered from invasive skin
infections and 1 newborn showed 2 skin blisters. Three family
members were colonized. Genotyping showed that all 8 isolates
belonged to the same spa type t008 clone
. Screening of all
healthcareworkers of the maternity ward resulted in the identification
of 1 person colonized in the nose with the same clone
several unsuccessful decolonization procedures the carrier was treated
with peroral antibiotic therapy and now remains negative for MRSA.
No new cases were further detected.
Discussion and/or Conclusion(s):
Reinforcement of infection control
procedures, screening of healthcare workers for PVL + CA-MRSA and
decolonization of the health professional who carried the genetically
identical strain resulted in an outbreak control.
Breaking the chain of transmission
2 clusters of
, Essam Rizkalla
, Dina Elzimaity
, Jennie Lovell
, Sonia Mellor
, Martha Bird
Kettering General Hospital Foundation Trust,
Kettering General Hospital
In 2014, the newand expanded purpose built ICU had 16
beds of which 50% were side rooms. With the new build came state of
the art equipment, new fabric and interiors, The new unit could nurse
3 patients, and treated >600 patients a year with average
length of stay of 5.9 days.
In July & August 2014, there were 2 cases (both sputums) of
, with similar PFGE typing, and sensitive to Meropenem. One
patient was difficult to intubate, agitated, and staff had persistent
difficulty in retaining invasive devices.
Between November 2014 and February 2015, 4 cases of
were identified (3 sputums and tip), resistant to Meropenem, similar
PFGE typing but different VNTR typing to previous cluster.
On-going transmission of 2 strains of
in ICU was evidenced over a period of 8 months. An outbreak team
consisting of PHE and Trust key representatives investigated potential
source of transmision and implemented interventions to reduce
further transmission on the unit.
Following PHE advice, ICU changed cleaning regimes,
frequency and practice. All new patients were screened on admis-
sion. Respiratory equipment cleaning practice was reviewed and
changed. Case presentation to trust-wide forum raised awareness
on hand-hygiene and antibiotic stewardship. Visiting teams were
Abstracts of FIS/HIS 2016
Oral Presentations / Journal of Hospital Infection 94S1 (2016) S11