53 / 150
Results:
Four quarterly audits have been completed during the course
of the academic year 2015
–
2016. Average compliance across the five
standards for these quarters was 76%, 74%, 81% and 78%, respectively.
Overall annual compliance with the above standards was 77.25%.
Following the delivery of teaching sessions, the above standards will
be re-audited. Targets set for 2016/2017 and 2017/2018 are 85% and
95% compliance, respectively.
Discussion and/or Conclusion(s):
Despite previous interventions,
compliance with prescribing standards has remained relatively static.
Following formal education through peer-to-peer teaching, an
improvement is expected, sufficient to meet the desired targets.
ID: 5147
Multidisciplinary development of initial treatment guidance of
adult patients with suspected sepsis in the community health
setting
Rhian Manley, Steve DuBois, Mike Paynter, Karen Anderson, Liz Berry,
Paul Aldwinkle, Claire Nettleton.
Somerset Partnership NHS Foundation
Trust
Background:
Acuity and complexity of patients treated in community
health services have increased dramatically as pressures on all NHS
services escalate. In rural Somerset high risk patients presenting with
suspected sepsis may require initial treatment in geographically
dispersed and potentially isolated Minor Injuries Units or community
hospitals where:
•
transfer to acute trusts could result in unacceptable delays in
treatment initiation
•
principles of patient-centred care support appropriate avoidance
of unnecessary hospital transfers.
Aim(s)/Objective(s):
Development of a sepsis treatment pathway in
rural community health service settings which:
•
provide prompt and safe care to septic patients and optimise
outcomes within confines of the commissioned service model
•
implement and maintain good medicines governance for, initially
unfamiliar, high risk medicines
•
promote appropriate antibiotic stewardship in line with local
strategies and local resistance
Method(s):
A prospective review of the process undertaken and
lessons learnt when developing antibiotic guidance for sepsis by a
multidisciplinary clinical team.
Results:
Development of a robust uniform pathway across geograph-
ically dispersed and sometimes disparate service settings, proved
challenging. Safe and timely treatment of sepsis using high risk
drugs, not traditionally administered in community health service
(e.g. gentamicin, teicoplanin and vancomycin), required novel
approaches and considerations.
Discussion and/or Conclusion(s):
The legacy of the historical NHS
community health service operating model includes limited access to
medical prescribers, clinical pharmacy services, consultant micro-
biology support, rapid diagnostic testing and other infrastructure
routinely available in acute hospital settings. Resources for developing
local and national antibiotic guidelines require review to ensure that
the current gaps identified through this process are acknowledged and
mitigated.
ID: 5158
Barrier and facilitators of antimicrobial guidelines adherence in
dentistry: knowledge and attitude assessment tool
Noha Seoudi, Zhang Xu.
QMUL
Background:
Antimicrobial stewardship is one of the most important
strategies to tackle the increasingly serious threat of antimicrobial
resistance globally. The Faculty of General Dental Practitioners (FGDP)
and the Public Health England (PHE) issued guidelines to regulate the
use of antimicrobials in primary dental care. However, poor adherence
was reported in the literature. Barriers to guidelines adherence are
expected to be different according to the local setting. Therefore,
analysing these barriers is a very important step before developing the
antimicrobial stewardship intervention.
Aim:
To develop a validated knowledge and attitude assessment tool
assessing barriers and facilitators to guidelines adherence.
Method:
A questionnaire was developed based on Mitchi
’
s behaviour
change wheel to assess capability, motivation and opportunity in
relation to the dental antimicrobial prescribing habits. The knowledge
part of the questionnaire was modified from a previously published
tool (Palmer et al., 2001). After a peer review and consultation stage, a
pilot audit was conducted. To validate the tool the results of the pilot
was compared to the results of a prospective antimicrobial prescribing
patterns audit in the same setting.
Result:
30 participants took part in the questionnaire and 200
antimicrobial prescription episodes were also audited. There were no
statistical significant difference in the concordance rate with the
national and local guidelines when comparing the questionnaire and
the prospective audit.
Conclusion:
We aim to present the newly developed knowledge and
attitude assessment tool, which can be used to audit antimicrobial
prescribing patterns and identify the best local antimicrobial stew-
ardship interventions in dentistry.
Topic: Clinical cases
ID: 4452
Mitral valve endocarditis secondary to
Paenibacillus provencensis
Ana-Catarina Pinho-Gomes, Abdul Nasir, Sajjad Mirza, Isaac Kadir.
University Hospital of South Manchester
Background:
Despite the recent advances in diagnostic and thera-
peutic strategies, infective endocarditis remains challenging to
treat and thus associated with bad prognosis in terms of morbidity
and mortality, particularly when uncommon microorganisms are
involved.
Method(s):
We report the first case of infective endocarditis caused by
Paenibacillus provencensis
, a very rare Gram-negative spore-forming
rod.
Results:
Amitral valve vegetationwas incidentally discovered by intra-
operative transoesophageal echocardiography in a 70-year old lady
undergoing aortic valve replacement. Empirical antibiotic treatment
for infective endocarditis with gentamicin and teicoplanin was
started. The precise identification of the causative agent relied on
genotypic characterisation with 16S rDNA gene sequencing.
Microbiologic culture was subsequently performed to obtain the
antimicrobial susceptibility profile and adjust the antibiotic regimen
accordingly. The patient was treated with a 4-week course of
vancomycin and meropenem, followed by a further 2 weeks of
daptomycin due to the identification of vancomycin-resistant entero-
cocci in a rectal swab. After a long in-hospital stay, the patient
eventually recovered clinically and biochemically and transthoracic
echocardiogram demonstrated awell functioning mitral valve without
residual lesions from the endocarditis.
Discussion and/or Conclusion(s):
This is, to the best of our knowl-
edge, the first report showing that
Paenibacillus provencensis
can be a
pathogen in humans and that a member of the genus Paenibacillus
may be involved in native valve endocarditis. This case also emphasis
the importance of 16S rDNA gene sequencing by real-time polymerase
chain reaction, as a rapid and accurate method to identify micro-
organisms, like Paenibacillus, which can be missed by conventional
microbiology investigations.
ID: 4539
A case of brucellosis in a patient heading for liver transplantation
Shradha Bhagani, Adrian Kennedy, Phil Stanley, Paul McWhinney,
Sulman Hasnie, Riccardo Guintini, Ben Jeffs.
Bradford Royal Infirmary
Background:
A 48 year old woman was admitted to hospital in
October 2015 with symptoms of fever, intermittent diarrhoea and
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S48