The Journal of Hospital Infection - Supplement 1 - November 2016

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Southampton General Hospital. In doing so, we hope to reduce
inappropriate use of broad-spectrum antibiotics.
Method(s): Over one week, all twenty oncology inpatients who had
received at least 72 hours of antibiotics were identified (excluding
haematological cancer patients and those receiving stem cell trans-
plant). We audited antibiotic choice and duration, investigations to
identify infection source and severity, compliance with local guide-
lines, and outcomes of antibiotic reviews. The results were dissemi-
nated, and good practice guidelines were produced and incorporated
into the Trust ’s application-based antibiotic policy.
Results: Tazocin was used in 55% of patients, with no clear
justification in 46% of these. Nearly 70% of patients received long
antibiotic courses (>7 days), and no changes were made in 70% of
antibiotic reviews. There was inadequate use of documentation,
cultures to guide antibiotic prescribing, and of tools to assess
infection risk (e.g. MASCC score not used in any patient with febrile
neutropenia) or severity (e.g. blood lactate measured in only 36% of
patients).
Discussion and/or Conclusion(s): Inappropriate broad-spectrum
antibiotic use was associated with inadequate assessment of infection
risk, source and severity. By educating and empowering clinicians to
improve these domains, we hope to reduce inappropriate antibiotic
use (re-audit pending at the time of writing).
ID: 5122
Evaluating behaviour change as part of Antimicrobial Stewardship
interventions; a review of UK state-of-the-art conferences
Adam Tsao 1, Ann Tivey1, Timothy M. Rawson2, Esmita Charani 2,
Mark Gilchrist3, Luke Moore2, Alison Holmes2. 1Imperial College School
of Medicine, 2Imperial College London, 3Imperial College Healthcare NHS
Trust
Background: To improve the quality of antimicrobial stewardship
(AMS) interventions the application of behavioural sciences suppor-
ted by multidisciplinary collaboration has been recommended. We
analysed major UK scientific research conferences to investigate the
level of AMS behaviour change intervention reporting.
Method(s): Leading UK 2015 scientific conference abstracts for 30
clinical specialties were identified and interrogated by four research-
ers. All AMS and/or antimicrobial resistance (AMR) abstracts were
identified using validated search criteria. Abstracts were then
independently reviewed by three researchers with reported behav-
ioural interventions categorised using the behaviour change wheel
framework described by Michie and colleagues.
Results: Overall, conferences ran for 110 days with >57,000 delegates.
311/12,313 (2.5%) AMS-AMR abstracts (oral and poster) were identi-
fied. 118/311 (40%) were presented at the UK’ s infectious diseases/
microbiology conference. 56/311 (18%) AMS-AMR abstracts described
behaviour change interventions. The commonest abstract reporting
behaviour change interventions were quality improvement projects
[44/56 (79%)]. In total 71 unique behaviour change functions were
identified. Policy categories; “guidelines” (16/71) and “service provi-
sion” (11/71) were the most frequently reported. Intervention
functions; “education” (6/71), “persuasion” (7/71), and “enablement”
(9/71) were also common. Intervention categories “incentivisation ”
and “coercion” and policy categories “fiscal” and “legislation” were not
reported in any identified abstracts.
Discussion and/or Conclusion(s): Despite the benefits of behaviour
change interventions on antimicrobial prescribing, very few AMS-
AMR studies at UK state-of-the-art conferences report implementing
them in 2015. AMS interventions must focus on promoting behaviour
change towards antimicrobial prescribing. Greater emphasis must be
placed on non-infection specialties to engage them with the issue of
behaviour change towards antimicrobial use.
ID: 5132
An audit of appropriate sampling for culture prior to starting
intravenous antibiotics in acute admissions at St. James’ University
Hospital, Leeds
Amy Baggott, Miles Denton. Leeds Teaching Hospitals Trust
Background: Frequently the opportunity for obtaining critical micro-
biological specimens appears to be missed prior to starting intraven-
ous antibiotics in acute admissions to hospital.
Aim(s)/Objective(s): By gaining an accurate picture of current practice,
a strategy to improve practice might then be developed.
Method(s): 100 patients on intravenous antibiotics were reviewed
on the medical and surgical admissions wards at St. James University
Hospital in a series of “spot checks” over a period of three weeks.
Data was then analysed to primarily see how many patients had blood
cultures obtained prior to intravenous antibiotics being commenced.
Secondary analyses were carried out to identify if any demographic or
diagnostic features or adverse treatment outcomes were associated
with samples not being taken.
Results: Only 52 patients had blood cultures taken prior to the first
dose of antibiotics.
25 patients had no cultures taken at all.
Being apyrexial on admission was associated with a failure to take
cultures, as was presenting with biliary sepsis and also being admitted
to the surgical ward.
25% of blood cultures taken before antibiotics were positive compared
to 13% of blood cultures taken after antibiotics.
Length of stay was increased for those who had cultures taken after
antibiotics had been given, relative to those who had cultures taken
first.
Four patients died, none of whom had cultures taken before
antibiotics.
Discussion and/or Conclusion(s): Current practice falls far short of
the standard. This audit helps identify areas to focus interventions and
education on. It also demonstrates the negative impact on patient
outcome that failure to sample appropriately causes.
ID: 5134
Foundation doctor-led audit and education as an effective
intervention to promote antimicrobial stewardship at Royal Bolton
Hospital
C. Subudhi, Aideen Carroll, Jonathan Evans, Emma Clare Hughes,
Rhian Proffitt, Alex Smith, Andrew Steele, Samim Patel. Royal Bolton
Hospital, Bolton NHS Foundation Trust
Background: In view of rapidly emerging antibiotic-resistant bacteria,
there is a growing need for antibiotic stewardship programmes.
It is important that interventions to improve stewardship target
foundation doctors, as they comprise a significant proportion of
antibiotic prescribers.
Aim(s)/Objective(s): This study aims to evaluate improvements in the
quality of antibiotic prescribing following foundation doctor-led
educational interventions at Royal Bolton Hospital.
Method(s): At Royal Bolton Hospital, quarterly audits are carried out in
conjunction with the microbiology department. The audit standards,
based on Public Health England’s guidance, are as follows:
• Standard 1: Compliance with trust guidelines.
• Standard 2: Indication for treatment written in patient case notes.
• Standard 3: Indication for treatment written in antibiotic section
of prescription charts.
• Standard 4: Stop/review date documented in patient case notes by
48–72 hours.
• Standard 5: Stop/review date documented on prescription charts
by 48–72 hours.
Using data collected from this audit, foundation doctor-led teaching
sessions will be designed and delivered to improve safe prescribing of
antibiotics by fellow foundation trainees.
Abstracts of FIS/HIS 2016 – Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24–S134 S47