83 / 150
and it is important, given the associated radiation exposure, that CT
examinations are only carried out when medically necessary.
Aim(s)/Objective(s):
To determine the extent of unnecessary full-body
(chest, abdomen and pelvis) CT scans that are carried out.
Method(s):
All inpatients undergoing a full-body CT scan over a 12
month period from September 2014 to September 2015 across an
infectious diseases/clinical pharmacology directorate were retro-
spectively identified from the radiology database. Clinical description,
indications and outcomes of imaging were all assessed. Appropriate-
ness was assessed against published and available local guidance.
Scan requests due to metastases of unknown origin and the staging of
lymphoma, gastric, colorectal, bladder, testicular, cervical and endo-
metrial malignancies were adjudged to be appropriate requests. All
other requests were recorded as inappropriate unless clear further
information was included.
Results:
A total of 92 admissions were identified. 57 patients (62%)
were judged to have had a full-body CT scan that was not appropriate.
‘
Query malignancy
’
was the most common indication (33%). 43 of the
92 imaging examinations (46.7%) led to a diagnosis. 81% described
unexpected findings, of which over 90% were incidental not requiring
further follow-up.
Discussion and/or Conclusion(s):
Inappropriate total-body CT scan
examinations are a significant problem. This represents an unaccept-
able radiation risk to the patient, financial cost and causes delays for
other patients. Further evidence based guidelines on when a full-body
CT scan should be performed along with strategies to raise awareness
of appropriate indications are required.
ID: 5014
An evaluation of the Check-Direct CPE assay for the detection of
carbapenemase-producing Enterobacteriaceae from routine rectal
screening swabs
Carlene Rowson, David Partridge.
Sheffield Teaching Hospitals
Background:
The reliable and rapid detection of carbapenemase-
producing Enterobacteriaceae (CPE) is vital for the timely implemen-
tation of infection control measures to prevent their wider spread.
Most current screening is performed using selective cultures which
can take several days to provide a result.
Aim(s)/Objective(s):
We intend to evaluate the performance of the
Check-Direct CPE assay for the detection of CPE from routine rectal
screening swabs.
Method(s):
The performance of the test will be evaluated and
compared alongside the selective culture screening method currently
used at our institution. Both tests will be performed on routine rectal
screening samples collected prospectively from adult patients as part
of the local CPE screening protocol. We intend to collect 100 rectal
swabs and report on the sensitivity, specificity and turnaround times.
ID: 5026
Evaluation of a hospital ward point of care testing service for
meticillin resistant
Staphylococcus aureus
,
Clostridium difficile
and
Norovirus
Benjamin Parcell
1
, Diane Vass
2
, Fiona MacKenzie
3
.
1
NHS Grampian,
2
Senior Charge Nurse Stroke Ward & AMAU Dr Grays Hospital Elgin,
3
Scottish Microbiology & Virology Network (SMVN) Manager
Background:
The ScottishMicrobiologyandVirologyNetwork (SMVN)
carried out a national service evaluation of rapid molecular diagnos-
tics to assess its impact on healthcare associated infections (HAIs) and
antimicrobial resistance. Eight sites across Scotland reflecting different
levels of healthcare were recruited. Dr Gray
’
s Hospital in Elgin was
the only site to use the GeneXpert as a point of care test (POCT).
Aim(s)/Objective(s):
To evaluate the GeneXpert as a POCT for
Meticillin Resistant
Staphylococcus aureus
(MRSA),
Clostridium difficile
,
and Norovirus on a hospital ward, assessing its impact on clinical
diagnosis and management of HAIs.
Method(s):
GeneXpert was situated on a Stroke ward and ward
staff were trained to carry out Xpert SA Nasal Complete, Xpert
C.
difficile
and Xpert Norovirus testing from 16/10/14 until 18/01/16.
Questionnaires and interviews were used to gather data from staff on
use and acceptability of POCTon theward. Baseline and test phase data
including clinical turnaround times (CTATs) were compared.
Results:
In total, 1105 tests were carried out. Compared to culture
Xpert SA Nasal Complete had the highest sensitivity and specificity
(100.00% and 98.92% respectively). Norovirus sensitivity was 83.33%
and specificity 98.66% compared with in-house PCR, while
C. difficile
sensitivity was 73.91% and specificity 98.71% compared to glutamate
dehydrogenase (GDH). Feedback from staff was largely positive, with
testing felt to aid bed management for
C. difficile
and Norovirus, and
improving MRSA management.
Discussion and/or Conclusion(s):
Ward staff embraced using the
POCTs, allowing the hospital to extend their local services and improve
turnaround times, positively influencing management of HAIs.
ID: 5032
Phenotypic characterization oxacillin susceptible-methicillin
resistant
Staphylococcus aureus
and coagulase negative
Staphylococcus
(OS-MRSA and OS-MRCoNS)
Rajni Gaind
1
, Indu Biswal
1
, Karnika Saigal
1
, Khusbu Pandey
2
.
1
VMMC
and Safdarjung Hospital,
2
VMMC and Safdarrjung Hospital
Background:
CLSI recommends cefoxitin disc for the routine screen-
ing of MRSA as it is a potent inducer of the
mecA
regulatory system.
There have been scattered reports of functionally oxacillin susceptible,
mecA
-positive
S. aureus
(OS-MRSA) clinical isolates. However there are
no studies available from India regarding the prevalence of OS-MRSA.
Aim(s)/Objective(s):
To observe the prevalence of OS-MRSA strains
in septicaemic patients and to standardize a phenotypic identifica-
tion method to detect OS-MRSA/OS-MR CONS (coagulase negative
Staphylococcus
) using cefoxitin disc induction method
Method(s):
All methicillin sensitive
Staphylococcus
isolates were iden-
tified using cefoxitin disc, oxacillin MIC and PBP2a latex agglutination
tests for
meecA
(primary testing). All tests were interpreted using CLI
guidelines. These isolates were subjected to an induction test using
cefoxitin disc and secondary tests using cefoxitin disc, oxacillin MIC
and PBP2a were performed to detect the presence of OS-MRSA and
OS-MR CoNS.
Results:
157 isolates were collected including 81
Staphylococcus aureus
and 76 coagulase negative
Staphylococcus
strains (CoNS). 36/81 and
25/76
Staphylococcus
strains were methicillin susceptible. Seven of
total 36 MSSA tested were found to be OS-MRSA and four out of 25
MS-CoNS were found to be OS-MR CoNS.
Discussion and/or Conclusion(s):
The emergence of OS-MRSA strains
poses concern over the therapeutic alternatives for a presumed
MSSA infection. These strains may go unrecognized in clinical
specimens, unless the strains are induced prior to testing. Additional
animal models and large scale studies are required to prove clinical
significance of these isolates.
ID: 5050
A regional audit of compliancewith national standards for loading/
unloading of blood cultures across the East Midlands
Michael Weinbren
1
, Vivienne Weston
2
, Shrikant Ambalkar
3
,
Rebecca Walker
3
, Dina El-Zimaity
4
, Manjula Natarajan
4
, Nelun Perera
5
,
Naomi Thompson
6
, Emma Hendry
5
, Felicia Lim
5
.
1
Chesterfield Royal
Hospital Foundation Trust,
2
Queen
’
s Medical Centre Nottingham,
3
King
’
s
Mill Hospital,
4
Kettering General Hospital,
5
University Hospitals of
Leicester,
6
Chesterfield Royal Hospital Foundation Trust
Background:
Blood cultures are a key investigation in the septic
patient forming part of the Sepsis Six Bundle. National guidelines for
blood culture processing issued in 2013 by the standard methods
group of PHE (SMI B37) state 100% of blood cultures should be loaded
on the analyser within 4 hours of collection and 100% of blood cultures
to be removed within 2 hours of flagging positive. NICE guidelines
require
‘
real time
’
reporting of 36 hour negative neonatal blood
cultures.
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S78