42 / 150
Discussion and/or Conclusion(s):
Following the health board
’
s
reorganisation, the infection consults remain an important service in
the new hospital and continue to support NHSGGC
’
s antimicrobial
stewardship agenda.
ID: 4700
Does 16S PCR really contribute to antimicrobial stewardship?
Sinead O
’
Donnell, Karen Burns, Fidelma Fitzpatrick, Lillian Rajan,
Mairead Skally, Edmond Smyth, Hilary Humphreys.
Beaumont Hospital,
Dublin 9, Ireland
Background:
16S rRNA PCR (16S PCR) is utilised in clinical micro-
biology to identify organisms from culture negative clinical specimens,
with the potential to optimise empiric antimicrobial management.
Selected critical specimens were referred to a UK laboratory for 16S
PCR on a case-by-case basis and after review of local culture results.
Method(s):
We investigated if 16s PCR influenced antimicrobial
management over a one year period (2015), by conducting a retro-
spective review of specimens sent for 16S PCR. Specimen type, result
turnaround time (TAT) and the clinical impact of a positive result were
evaluated.
Results:
Seventy-eight specimens were sent from 60 patients, with an
average TATof five days (range 1
–
11). A large proportion (35, 45%) were
from neurosurgical patients and included; CSF (17), bone flap (5) and
intracranial material (13).
Overall, positive results were received on 33 specimens (42%) from 28
patients (46%). Of those, treatment information was available for 24
(86%), with de-escalation to a narrower spectrum agent upon receipt
of positive 16S PCR possible for five (20%).
Of 32 patients, from whom 45 specimens were sent, with DNA not
detected, treatment information was available in 21 (66%), with two
patients having antimicrobials discontinued upon receipt of the
negative result.
Discussion and/or Conclusion(s):
16S rRNA PCR has a role in anti-
microbial stewardship for complex infection requiring lengthy treat-
ment courses, whereby providing evidence of presence of microbial
DNA may support de-escalation decisions or absence of microbial DNA
may support decisions to discontinue empiric treatment in selected
patients.
ID: 4701
Younger generation views
–
community pharmacists delivering the
5-year antimicrobial resistance strategy
Gill Hawksworth
1
, Phil Howard
2
, Jake Mills
1
, Bahareh Yazdani
1
,
Sophie Devine
1
, Emily Clifford
1
.
1
University of Huddersfield,
2
Leeds
Teaching Hospitals NHS Trust, Leeds
Background:
This study determined University students
’
current
understanding of antimicrobial resistance and issues related to the
work of community pharmacists implementing the NHS England
5-year antimicrobial resistance strategy.
Aim(s)/Objective(s):
To determine students views on having the
reason for their infection on a prescription, the importance of hand-
washing, their knowledge on antimicrobial resistance, importance of
adherence, use of left over medicines and to what extent they trust
health care professionals when advising on antibiotic use.
Method(s):
This study received ethical approval. Questionnaires were
handed out to University of Huddersfield students at a stand pro-
moting awareness of antimicrobial resistance on Antibiotic awareness
day November 2015.
Results:
From 90 questionnaires, 54.4% (n = 49) students missed
and/or stopped before the antibiotic course ended, 72.2% (n = 65)
correctly identified antibiotics solely effective against bacterial
infections and a chi-squared test determined healthcare/applied
science students were more likely to correctly identify this showing
a statistically significant result (p = 0.038) with a small effect
(Phi = 0.219). For cold/flu symptoms only 66.7% (n = 67) students saw
a pharmacist before GP however 61.1% (n = 55) support the cause
of infection on their prescription with 21 of these feeling
uncomfortable for personal conditions such as chlamydia, HIV and
thrush. Handwashing was important for 70.9% (n = 61) who used good
hand washing technique.
Discussion and/or Conclusion(s):
Students
’
knowledge on anti-
microbial resistance needs improving, many students were not
taking their antibiotics correctly. Community pharmacists could
increasing compliance of antibiotic use with further counselling,
signposting to informative websites, and provision of leaflets on hand
washing technique. However many students are unwilling to see a
pharmacist before a GP.
ID: 4707
Impact of pharmacy-led stewardship rounds at a London Teaching
Hospital
Laura Whitney, Ghadeer Muqbill, Matthew Laundy.
St George
’
s
University Hospitals NHS Foundation Trust
Background:
In 2013
–
14 we were required to reduce hospital-
acquired Clostridium difficile infection (CDI) by 27%. The year began
with 12 cases in 6 weeks; significantly above trajectory. Root cause
analyses (RCAs) were completed alongside review of ward-based
antibiotic prescribing. These identified scope to optimise prescribing,
particularly treatment review.
Aim(s)/Objective(s):
Intervention was required to reduce HA-CDI
through improved stewardship by:
•
Raising stewardship on the pharmacy agenda
•
Providing additional junior pharmacist supervision and external
scrutiny of prescribing
•
Increasing documented antimicrobial reviews
•
Improving documentation relating to stewardship by pharmacists
Method(s):
In May 2013 education on stewardship and the recent
RCAs was provided to pharmacists. Senior pharmacists were tasked to
perform monthly ward stewardship visits, supported by further
education and referral of complex cases to the stewardship MDT.
Activity is reviewed, collated and discussed at pharmacy directorate
meetings.
This approach is supported by a comprehensive stewardship strategy
within the Trust.
Results:
This intervention significantly increased the number of
stewardship encounters (149 patients reviewed monthly by pharmacy
and 123 by the MDT). Pharmacist-led rounds had a lower intervention
rate (31%vs46%) and made different intervention types, most com-
monly improving prescription documentation, and dose adjustment,
with similar rates of IV to PO switch (6%vs8%).
CDI rates were significantly reduced (by 53% in 2013/14) and have
remained under trajectory.
Documented clinical review has increased from 77% to 90%.
Discussion and/or Conclusion(s):
The rounds have positively
contributed to stewardship within the Trust. Work in 2016/17
will focus on understanding clinical variation in these stewardship
rounds both in the number of patients reviewed and the intervention
rates.
ID: 4725
Does electronic prescribing facilitate antimicrobial stewardship
Laura Whitney, Matthew Laundy.
St George
’
s University Hospitals NHS
Foundation Trust
Background:
The slow implementation of electronic prescribing and
medicines administration (EPMA) has been identified as a barrier to
stewardship in the UK.
Aim(s)/Objective(s):
To identify how electronic prescribing has
facilitated stewardship at a large London teaching hospital.
Method(s):
EPMA was introduced sequentially in our Trust; first in
paediatrics, then cardiology and neurosciences using the Cerner
system (Kansas, US). A delay in further role out has lead to EPMA
being used alongside paper medical records for 2 years, which offers
us a unique opportunity to analyse the effects of implementation on
stewardship metrics and activities.
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S37