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human airways are colonized with niche-specific bacterial communi-
ties: it is increasingly recognized that one of their main functions
might be to prevent respiratory pathogens from gaining a foothold on
the mucosal surface and spreading to the lower respiratory tract.
Current research addresses how the healthy URT microbiome is
established, and what ecological and environmental factors direct
early and subsequent development of respiratory microbial commu-
nities. Moreover, we focus on the relationship between respiratory
microbiota development and maintenance of respiratory health.
Impact of the changes
–
endoscope decontamination
Christina Bradley.
Hospital Infection Research Laboratory, Queen
Elizabeth Hospital Birmingham
The Advisory Committee on Dangerous Pathogens (ACDP) published
revised guidance for the management of medical devices in relation to
reducing the risk of transmission of TSE related diseases in February
2015. This included revision to Annex F for endoscopy. More recently
the Department of Health England have revised CFPP 01-06 (nowHTM
01-06) to take account of these revisions and have included more
information on the use of endoscope storage cabinets along with
advice on residual protein testing, advice on decontamination of ERCP
endoscopes and choledochoscopes etc. It is accepted that the
assessment of cleaning is vital so the weekly testing schedule now
includes the use of a process challenge device. The ACDP guidance
recommends that endoscopes are reprocessed as soon as possible after
use and HTM 01-06 puts a timeframe of 3 hours from use to the
completion of the decontamination process. This and other changes to
the advice on endoscope decontamination and the possible impact
will be discussed.
Quality indicators and HAI prevention and control: experiences
and perspectives
Silvio Brusaferro.
Hygiene and Public Health, University of Udine, Italy
Quality and safety are currently essential characteristics required to
healthcare organizations and to their professionals. Nevertheless how
to measure and report quality and safety is still a debated issue.
Although many experiences using different measures and indicators
have been reported, a clear evidence about their role in increasing
safetyand quality is still lacking. Healthcare Associated Infections (HAI)
because of their long tradition of measurement, because of the
recognized role of an organization wide approach in their reduction
and control, because of the evidences about the most effective ways to
prevent themas well as for their impact in termof morbidity, mortality,
litigations an costs, have been included in almost all available tools and
systems for quality and safety evaluation in healthcare. There are also
many experiences trying to agree about meaningful indicators related
to HAI prevention and control as well as to Antimicrobial Resistance.
The demand of quality and safety indicators in healthcare organiza-
tions is increasing supported by citizens, policymakers, insurers and
professionals. Nevertheless more research is needed to define
indicators focused on outcome more than on intermediate endpoints,
targeted to different healthcare settings, meaningful to a patient
centered perspective and linked to improvement in health outcomes.
Fusobacterium necrophorum
: a greater cause for concern in
adolescents and young adults than group A
Streptococcus
Robert Centor.
Internal Medicine, University of Alabama at Birmingham
Over the past 15 years, a series of studies have established that the
gram negative anaerobe
–
Fusobacterium necrophorum
–
causes
adolescent and young adult pharyngitis. The increasing incidence of
the Lemierre syndrome (pharyngo-tonsillitis followed by rigors,
suppurative internal jugular vein thrombophlebitis and septic
emboli) spurred these investigations. More recently, several groups
(including ours) have shown that Fusobacterium pharyngitis has the
same clinical characteristics as strep pharyngitis, and occurs at least
as often (and possibly more often) as a cause of pharyngitis in the 15
–
30 age group. Epidemiological studies from Denmark provided the
data necessary to simulate the likely risk of Fusobacterium
pharyngitis compared with the risk of strep pharyngitis. In an
opinion piece I compared the risks of the Lemierre syndrome (from
Fusobacterium pharyngitis) with the risk of acute rheumatic fever
(from strep pharyngitis). I did not include peritonsillar abscess,
although more recent data implicates F. necrophorum as the most
common cause of PTA in this age group. The simulation provides
evidence that for this age group, untreated Fusobacterium pharyn-
gitis has greater risk of both mortality and morbidity than untreated
strep pharyngitis.
Is behavioural science the real driver for improving effective
antimicrobial prescribing?
Peter Davey.
University of Dundee Medical School
The pressing need to measure and improve antibiotic use was
recognised >40 years ago, so why have we failed to achieve sustained
improvement at scale? Failure in medicine is largely due to ineptitude
(failure to use existing knowledge) rather than ignorance (lack of
knowledge). Consequently, it is notable that most interventions to
improve antimicrobial prescribing are either designed to educate
individual practitioners or patients about policies or to restrict
prescribing to make practitioners follow policies. Interventions that
enable practitioners to apply existing knowledge through decision
support, feedback and action planning are relatively uncommon. There
is an urgent need to improve the design and reporting of interventions
to change behaviour. However, achieving sustained improvement at
scale will also require a more profound understanding of the role of
context. What makes contexts receptive to change and which
elements of context, under what circumstances, are important for
human performance? Answering these questions will require inter-
disciplinary work with social and behavioural scientists to integrate
complementary approaches from human factors and ergonomics,
psychology, education and organisational research.
Case 1: Acinetobacter outbreak in the Neonatal Unit
–
Are you ready
for this?
Eleri Davies.
IP&C Cardiff and Vale UHB; HCAI Programme Public Health
Wales, Public Health Wales NHS Trust
The whole session is focussed on real infection prevention and control
challenges experienced over the last few years. The Acinetobacter
outbreak on a Neonatal unit will be presented to focus on the practical
challenges faced in managing an outbreak of this nature, with an
opportunity for brief discussion of controversial points.
Treatment of hepatitis B and C in children: catching up?
Suzanne Davison.
Paediatric Hepatology, Leeds Teaching Hospitals NHS
Trust
Eradication of HCV by 2030 and reduction of disease burden of HBV
are national and global targets. To achieve these, affected individuals
need identifying and referring for appropriate management. This
entails a detailed assessment of host, virus and disease, and
availability of treatment. Treating children has additional challenges.
Most acquire infection perinatally with a high rate of chronicity.
Disease manifestations are usually mild. Infection may therefore be
unrecognised or specialist referral deemed unnecessary. However,
treating children with early infection may improve response and
reduce transmission. Another issue is that since relatively few
children are infected compared to adults, clinical trials may be
perceived as more challenging and less rewarding. As improved
therapies emerge rapidly, delay in paediatric trials may lead to a drug
being superseded prior to study conclusion. Approach to viral
hepatitis in children is now
‘
catching up
’
. Concentration of expertise
and a co-ordinated approach through clinical networks provides
access to specialist care. European Medicines Agency has facilitated
development of medicines for children. In 2016, results of the first
paediatric trials of interferon-free regimes for HCV are emerging,
Abstracts of FIS/HIS 2016
–
Invited Speaker Abstracts / Journal of Hospital Infection 94S1 (2016) S1
–
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S2