The Journal of Hospital Infection - Supplement 1

available is one of the Quality standards (QS) recommended in NICE

antimicrobial stewardship guidelines.

Aim(s)/Objective(s):

The aim of this study is to audit compliance with

NICE QS statement 4 in relation to presumptive diagnosis of UTI and to

find out whether microbiological samples were taken before starting

antimicrobial therapy.

Method(s):

This study was carried out in care of elderly wards in a

large district hospital over a two week period. All patients prescribed

antimicrobials for urinary tract infection were identified daily by the

ward based pharmacist over the study period. Microbiological results

were collected and interpreted by microbiologist. Clinical notes were

reviewed and data was analysed.

Results:

We identified 28 patients on antimicrobials for UTI. The

median patient age was 85 years old (71

–

97). Our study showed that

57% had urine dip while 86% of the patients had a urine culture done.

Seventy nine (79%) were on the appropriate antimicrobial treatment

based on the current culture results. C-Reactive protein (CRP) was

raised (>20 mg/L) in 82% of the patients.

Discussion and/or Conclusion(s):

Our results showed that compli-

ance with the trust antimicrobial guidelines and NQ standards was

achieved in the majority of cases. Raising awareness of the staff to the

importance of microbiological investigations is key to ensure appro-

priate antibiotic use.

ID: 4988

Monitoring antimicrobial prescribing, review of monthly point

prevalence audits

Iain Hayden, Mehmet Pilot, Sultana Begum, Kirsten Khonyongwa,

Surabhi Taori, Nergish Desai.

King

’

s College Hospital NHS Foundation

Trust

Background:

Monthly point-prevalence audits have been conducted

at King College Hospital (KCH) since 2010 and at Princess Royal

University Hospital (PRUH) from 2014. Trust-wide reports are

produced and discussed at Infection Control Clinical Leads meetings.

Results are fed back to individual teams at Divisional governance

meetings and included on performance scorecards.

Aim(s)/Objective(s):

To drive improvements in antimicrobial

stewardship.

Method(s):

Junior doctors at KCH and pharmacists at PRUH record

compliance with KPIs once a month (targets in brackets):

Indication(s) recorded (90%)

Stop/Review date recorded (90%)

IV to oral switch not overdue (95%)

Prescribed according to guidelines (90%)

Spreadsheets are submitted to the Surveillance Team for collation.

Results:

Numbers of patients audited at KCH varied between 2,050

and 2,879 per quarter with an average of 38% on antimicrobials. At

PRUH between 478 and 1472 patients were audited per quarter with

an average of 27% on antimicrobials.

Indications were recorded for over 95% (KCH) and 67% (PRUH). At KCH,

Stop or Review compliance decreased by 5% between the first quarter

and third quarter of 2014 but, was consistently above 90% in 2015. At

the PRUH this ranged between 54.5% and 79.1%.

Discussion and/or Conclusion(s):

This method of auditing at a 1500

bedded NHS Trust has been sustained for 5 years and rolled out to the

second site on acquisition. Divisional Clinical Leads take ownership

and champion the program locally. The performance management

program ensures these KPIs are high on the Trust agenda. Scores are

higher when junior doctors perform audits and electronic prescribing

is used (KCH).

ID: 4991

Serumprocalcitonin testing can help in achieving antibiotic CQUIN

in UK hospitals

Yann Gelister

, Kordo Saeed

, Matthew Dryden

, Alan Abid

University of Southampton,

Hampshire Hospitals NHS Foundation Trust,

Royal Hampshire County Hospital,

University of Portsmouth

Background:

Serum procalcitonin (PCT) is a more specific and

sensitive biomarker for detecting bacterial infection compared to

CRP and white cell count. We report on the use of PCT measurement as

a diagnostic tool to support clinical decision making around antibiotic

use in patients suspected of infection.

Aim(s)/Objective(s):

The aim of this study was to audit the use of

serum PCT measurement in relation to antibiotic prescribing in a

hospital setting.

Method(s):

Patients on medical and surgical wards (excluding ICU/

HDU) who had undergone PCT testing were audited during a 3 week

clinical attachment in microbiology. Antibiotic prescribing decisions

were reviewed from the notes within 24 hours of PCT results in

accordance with Hampshire Hospitals

’

Guidelines.

Results:

Using the threshold of 0.25 mcg/L, 34 of 69 PCT results were

elevated and 35 were negative. In 21 out of 34 (61.7%) elevated results,

a clinical diagnosis of bacterial infection was supported and patients

started, continued, or escalated antibiotics. In 26 of 35 (74.3%) negative

PCT results, antibiotics were appropriately either withheld (68.6%) or

stopped (5.7%).

Discussion and/or Conclusion(s):

We believe these findings to be

clinically important as PCT results can aid clinicians in decisionmaking

regarding the withholding or cessation of antibiotics. This in turn

reduces unnecessary prescriptions of

“

just in case

”

antibiotics. Serum

PCT measurement can help achieve hospital antibiotic CQUIN targets

and, importantly, reduce selective pressure and antimicrobial misuse

in the rising era of antibiotic resistance.

ID: 4993

United Kingdom antibiotics: CQUIN a challenge to clinicians?

Alan Abid

, Yann Gelister

, Natalie Parker

, Taryn Keyser

Kordo Saeed

, Matthew Dryden

, Sophie Lewis

University of

Portsmouth,

University of Southampton,

Hampshire Hospital

Foundation Trust

Background:

Many patients admitted to hospital develop life

threatening infections which require antibiotics. In the acute setting,

clinicians may not always consider the consequence of prescribing

broad spectrum antibiotics leading to potential antibiotic resistance.

There is an increasing pressure on hospitals to reduce the use of

broad spectrum antibiotics as well as antibiotics as a whole, especially

following the new financial implications created by the CQUIN

framework.

Aim(s)/Objective(s):

The aims were to assess the use of Piperacillin-

Tazobactam (Tazocin) within the Royal Hampshire County Hospital

and the compliance of clinicians with expert advice and/or prescribing

guidelines.

Method(s):

A real life audit was carried out by identifying patients

prescribed Tazocin through the use of the electronic prescribing

software, JAC. Over an 8 day period 36 patients were found and a case

note review performed to assess the reasoning and circumstance of

antibiotic prescription.

Results:

27 patients (75%) were prescribed Tazocin according

to trust guidelines or following advice from microbiology, 9 (25%)

were not deemed compliant. Within the sample the majority of

diagnoses were of an intra-abdominal or respiratory nature, in 39% and

36% of cases respectively. 26 prescriptions (72%) did not have a stop

date.

Discussion and/or Conclusion(s):

Clinicians did not follow local

protocol in 25% of cases irrespective of clinical appropriateness.

Stop dates were included in a small proportion of prescriptions.

Although the CQUIN can be a challenge, the findings here suggests it is

potentially achievable by improving compliance with local guidelines

and expert microbiology advice.

ID: 4995

E-prescribing efficiencies in PPS

Orla Geoghegan, Tracy Lyons, Mark Gilchrist, Bo Ye.

Imperial College

NHS Healthcare Trust

Abstracts of FIS/HIS 2016

–

Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24

–

S134

S44