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Page Background

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


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


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


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