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ID: 5148
Non-surgical CVC inserted in Pediatric Intensive Care Unit is at high
risk for infection
Achille Yepmo
1
, David Faraoni
2
, Chantal Lerminiaux
3
,
Philippe Van Der Linden
1
.
1
CHU Brugmann- Queen Fabiola University
Hospital Children,
2
CHU Brugmann - Queen Fabiola University Children
Hospital,
3
Queen Fabiola University Children Hospital
Background:
Central line infection is a serious complication.
Aim(s)/Objective(s):
To determine the rate of central venous catheter
(CVC) infection and the predictive factors of CVC infection in Queen
Fabiola University Children Hospital (QFUCH, Brussels, Belgium).
Method(s):
Prospective monocentric observational study that
included all inserted CVC from November 2013 to May 2016.
Outcome variable was CVC infection. Determinants of CVC infection
were analyzed through multivariate logistic regression model that
included the following variables: age of children, surgical vs non-
surgical insertion, place and site of insertion, indication and duration
of CVC.
Results:
577 CVC were inserted. Only 475 CVC were analyzed,
including 91 surgical and 384 non-surgical CVC. The crude rate of
CVC infection was 0.03 and 8.9 per 1000 CVC days respectively for
surgical and non-surgical CVC. There were no difference among
the insertion sites (p = 0.075). The only factor associated with
outcome was non-surgical CVC insertion in PICU (OR 2.02, 95% CI
(1.06
–
3.85), p = 0.032). In contrast, no difference between CVC
inserted in NICU and operating room was observed (OR 0.64, 95% CI
(0.34
–
1.21), p = 0.17).
Discussion and/or Conclusion(s):
CVC insertion in PICU was a risk
factor of infection. Our results are in accordance with the available
literature. CVC inserted in PICU cumulates many risk factors
for infection such as severe medical conditions, multilumen CVC,
many CVC, long duration of CVC, prolonged mechanical ventilation,
parenteral nutrition, blood transfusion. To reduce the overall rate of
CVC infection in QFCUH, a multimodal strategy including education,
training of the staff and implementation of checklist should be set up.
ID: 5164
Modelling catheter-related
Staphylococcus aureus
infections in
vitro
Rasmus Birkholm Grønnemose, Hans Jørn Kolmos,
Thomas Emil Andersen.
University of Southern Denmark
Background:
Recent studies revealing the elaborate interactions
between
Staphylococcus aureus
and the human coagulation system
during vascular infections have prompted the need for more
in vivo
-
like
in vitro
models.
Aim(s)/Objective(s):
In this study we aimed to develop a new
in vitro
model for vascular catheter-related infections with
S. aureus
using
human plasma in a flow system.
Method(s):
The model allowed for continuous monitoring of the
bacteria-coagulation build-up during adhesion and biofilm formation
in a flow chamber by using fluorescent microscopy with GFP-
producing
S. aureus
and human plasma supplemented with fluores-
cent fibrinogen.
Results:
Using the model, we show that
S. aureus
creates an elaborate
biofilm on medical grade silicone containing both human fibrin(ogen)
and bacterial poly-N-acetylglucosamine (PNAG).
Discussion and/or Conclusion(s):
A new catheter biofilmmethod was
established and shown to model the bacteria-coagulation interplay
in
vitro
. This model will allow for future studies of novel catheter loading
agents targeting bacteria-induced thrombosis.
ID: 5181
Access to bladder scanners and specialist urology nurses in NHS
Trusts: room for improvement
Ammar Yusuf, Susan Hopkins.
Royal Free London NHS Foundation Trust
Background:
In England, there are >500,000 hospital onset urinary
tract infections (UTI) each year; 50% associated with a urinary catheter
(UC). At least 1% progress to bloodstream infections (BSI). The overall
effectiveness of bladder scanners in reduction of UTI is 75%. A quality
improvement programme for UC, including clinical nurse specialists
(CNS), reduced UTI by 75%.
Aim(s)/Objective(s):
To assess uptake of bladder scanners and access
to urology CNS in the NHS.
Method(s):
A freedom of information was sent to all NHS acute and
community/care (CC) trusts requesting the number of bladder
scanners registered in their equipment library, recent purchases of
bladder scanners in 2015/2016, number of urology CNS and hospital
training and policy records for bladder scanners.
Results:
A response was returned from 111 Trusts (21 CC; 89 Acute).
There was wide variation in the number of registered bladder
scanners in organisations (mean 17; range 0
–
74); this was not
significantly different between organisation type. In 2015/16, 63
trusts purchased new scanners. Bladder scanner training records
were more frequently available in Acute compared to CC trusts (72%
V 47%) but similar proportions had a policy for scanner use (36%
Acute V 38% CC). CC Trusts reported significantly less urology CNS
than Acute trusts (mean 0.4 V 4.2 whole time equivalent per
organisation).
Discussion and/or Conclusion(s):
Bladder scanners and urology CNS
have proven clinical and cost-effectiveness in reducing UTI but are not
embedded in all NHS organisations. These will be important measures
for organisations to implement to achieve reductions in UTI and Gram-
negative BSI.
Topic: Diagnostics
ID: 4423
Klebsiella pneumonia New Delhi Metallo-beta-lactamase-1
outbreak in a Surgical Ward at Mater Dei Hospital
Noel Abela, Claire Marantidis Cordina, Elizabeth Scicluna,
Andrea Falzon Parascandalo, Michael Borg, Geraldine Borg,
Samuel Tanti.
Mater Dei Hospital
Background:
New Delhi metal-
β
-lactamase (NDM)-producing Gram-
negative bacteria have spread globally and pose a threat to all
healthcare institutions. We reported was the first of NDM outbreak
detected in Malta.
Method(s):
A highly resistant NDM-1
Klebsiella pneumoniae
(KP) was
reported from the rectal swab of a patient in a surgical ward at Mater
Dei Hospital in January, 2016; this was followed by a further case
within the same week. Cross-transmission was suspected; it was
decided to screen all patients rectally for CRE. A third case was
identified after the initial screening and ward was closed to further
admissions. Full contact precautions were implemented with a
dedicated nurse to the 3 confirmed cases. Furthermore all patients
that remained in the ward were screened from wounds, rectal and
those with a urinary catheter inserted for CRE twice weekly and a 4th
case was identified.
Results:
A retrospectively exercise was performed and another 2
patients were traced and identified in the same ward. VNTR typing
confirmed that these isolates were all of the same clone. No further
cases were reported.
Discussion and/or Conclusion(s):
We suspect that that NDM-1
KP was introduced to our hospital in 2011 when Libyan patients
were admitted for treatment during the Libyan crisis. This was not
detected before the outbreak because the PCR was not available at
the time.
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S73