The Journal of Hospital Infection - Supplement 1

S. aureus

BSI has guided our haemodialysis infection prevention

strategy.

Aim(s)/Objective(s):

To describe the results of the first three years of

this programme.

Method(s):

BSI rates are calculated per 100 patient months (PM). Root

cause analysis (RCA) is performed for each haemodialysis catheter-

associated

S. aureus

BSI. Results are discussed at biannual multi-

disciplinary team meetings, focusing on patient risk factors, BSI

complications, team response, follow-up actions and agreed improve-

ment plans.

Results:

The rate of haemodialysis catheter-associated BSI decreased

by 46% over the study period from 0.753 per 100 PM (13 patients, 77%

of haemodialysis

S. aureus

BSI) in 2013 to 0.406 per 100 PM (8 patients,

47% of haemodialysis

S. aureus

BSI) in 2015. Documenting action plans

and awareness of previous relevant

S. aureus

microbiology, e.g.

previous exit site infections, were the most significant risk factors

targeted for improvement. Several practice initiatives were also

introduced across all dialysis units such as introducing pre-insertion

protocols, displaying audit results locally, and, engaging staff and

patients to continually raise awareness of best practice.

Discussion and/or Conclusion(s):

Active surveillance, timely RCA,

with feedback and interventions, along with a multi-disciplinary team

approach has significantly reduced both the rate and proportion of

haemodialysis catheter-associated

S. aureus

BSI (by 46% and 38%

respectively).

ID: 4938

The effect a line care bundle on central line catheter Candida

colonisation rates in the critical care area

Luke Bedford

, Margaret Gilham

, Stephen Webb

Papworth NHS

Foundation Hospitals Trust,

Papworth Hospital NHS Foundation Trust

Background:

Invasive Candidiasis can be a devasting infection for

patients, particularly those in the critical care area (CCA). Whilst

numerous risk factors are present in these patients, line colonisation

with Candida is significant but preventable

Catheter line care bundles have been shown to reduce line associated

infection. Papworth hospital introduced a trustwide line care

programme in 2010, which involved a line-care bundle, antimicrobial

impregnated catheters and an educational programme, to reduce

episodes of infection and catheter colonisation.

Aim(s)/Objective(s):

We investigated the impact of the programme on

colonisation rates of central venous catheters (CVC) sent from the

Papworth CCA from 2010 to 2015.

Method(s):

We ascertained all CVC line cultures sent from the

Papworth CCA which grew Candidia species from the laboratory

information system. The number of patient line tip days had been

prospectively recorded from the start of the programme introduction,

and was used to calculate the rate of line tip colonisation per 1000

patient CVC days.

Results:

There was a falling trend in line tip colonisation by

Candida species over the study period, with a fall from a median of 2

episodes per month in 2010 to 1 episode per month in 2015. This

translated into a fall from 3.41 episodes per 1000 patient CVC days to

1.03 in 2015.

Discussion and/or Conclusion(s):

We found a sustained reduction in

candida line tip colonisation rates frompatients in the critical care area

as part of a CVC care programme. We would expect this to have

prevented episodes of invasive candidaemia and exposure to unnec-

cesary antifungal agents.

ID: 5029

Analysis of disinfected endoscopes channels surface

Lissandra Chaves de Sousa Santos, Khalid Aljohani, Honghua Hu,

Karen Vickery.

Faculty of Medicine and Health Sciences, Macquarie

University

Background:

In 2004 we showed that 100% of patient-ready

endoscopes were contaminated with biofilm either in their air-water

channels or working channels. The presence of biofilms was more

evident in damaged areas of the channel. Since then improved

methods of decontaminating endoscopes have been developed.

Aim(s)/Objective(s):

In this study we have evaluated disinfected

endoscopes for presence of bacterial contamination and surface

damage.

Method(s):

40 air-water channels and 23 working channels including

12 gastroscopes and 11 colonoscopes were examined. Surface

’

roughness was analysed and compared with never used channels.

Live bacteria were isolated and identified by 16s rDNA sequencing.

Quantitative real-time PCR of 16s rRNA gene was used to quantify the

total number of bacteria present. Live/dead viability staining in

conjunction with confocal laser scanning microscopy and scanning

electron microscopy were used to visually confirm bacterial viability

and biofilm presence respectively.

Results:

40% of air-water channels and 50% of working channels were

bacterial culture positive. PCR demonstrated an average of 2.8 × 10

and up to 3.1 × 10

bacteria/cm contaminating air-water channels

whilst an average of 1.6 × 10

and up to 4.6 × 10

bacteria/cm

contaminating working channels. The bacteria in these samples

were visually confirmed to be present as a biofilm by SEM. Bacteria

within the biofilm were shown to be viable by live/dead staining and

CLSM. Used endoscopes channels presented higher roughness values

when compared with new channels.

Discussion and/or Conclusion(s):

Despite the improvement on

disinfection process showed by decreased contamination on endo-

scopes channels, viable biofilm containing pathogenic species still can

be found in processed endoscopes channels.

ID: 5102

Investigation of attached microorganisms in the lumens and

balloons of indwelling urethral urinary catheters

Katherine Belfield

, Sajitha Kalith

, Jannifer Adcock

Richard Parkinson

, Roger Bayston

University of Nottingham,

Nottingham University Hospitals NHS Trust

Background:

Urinary catheters are associated with a high risk of

urinary tract infection (CAUTI) and are a major clinical and financial

burden. Examination of lumens and balloons (representative of

bladder environment) of catheters may offer insight as to why some

patients develop symptoms and others do not.

Aim(s)/Objective(s):

This study aims to quantify and identify micro-

organisms attached to the lumens and balloons of indwelling urinary

catheters and relate this to patient-specific information.

Method(s):

Indwelling urethral urinary catheters in situ for

≥

14 days

were collected from patients at Nottingham University Hospitals

NHS Trust. The balloon was separated and placed in sterile phos-

phate buffered saline (PBS). The remaining catheter lumen (ports

were discarded) was drained, filled with PBS and ends clamped.

The catheter components were sonicated. Microorganisms in the

sonicate were enumerated, identified, and susceptibility testing was

performed.

Results:

Sixty-one catheters were collected. The most commonly

isolated organisms were

Escherichia coli

and

Enterococcus faecalis

19.7% of patients received antibiotics while catheterised and 25% of

those had a multi-drug resistant (MDR) organism attached to the

lumen (all lumens were colonised irrespective of antibiotic use).

Conversely, 2.04% of catheters from patients not known to be receiving

antibiotics had a MDR organism present. Symptom presentation does

not correlate to numbers of colonising organisms (7/61 patients were

symptomatic). Five lumens were blocked and

Proteus mirabilis

was

present in 2/5.

Discussion and/or Conclusion(s):

Lumens and balloons of urinary

catheters were colonised irrespective of presence of antibiotics.

Results suggest that antibiotic use does not reduce microorganism

colonisation. The data also emphasises the lack of correlation between

microorganism growth and symptomatic CAUTI.

Abstracts of FIS/HIS 2016

–

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

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S134

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