84 / 150
Aim(s)/Objective(s):
To audit blood culture load/unload delays across
the region.
Method(s):
Six hospitals in the region participated in the audit each
providing data on 30 consecutive positive blood cultures containing
E.
coli
. This provided data points to calculate load delay, time from
collection to flagging positive and unload delay.
Results:
One hospital met the standard of 100% loaded within 4 hours
of collection, the remaining five hospitals ranging from 7% to 59%,
some samples taking more than 24 hours. Time to positivity correlated
with load delays. No hospital unloaded 100% of samples within 2 hours
of flagging positive; one hospital achieved 97%, with a variation of
14
–
57% with the remaining five. Only one hospital sent out
‘
real time
’
36 hour neonatal negative blood cultures.
Discussion and/or Conclusion(s):
Audit is key to establishing the
effectiveness of the blood culture pathway. Without audit significant
delays may go unrecognised and impact on patient care. Benefits of
optimising the blood culture pathway include early correction of
deficiencies in empirical therapy, improved antibiotic stewardship and
early cessation of antibiotics in neonates.
ID: 5079
Toxic shock syndrome toxin (TSST) positive MSSA in Glasgow
Clare Murphy
1
, Ashutosh Deshpande
1
, Elizabeth Dickson
2
,
Nitish Khanna
2
.
1
NHS GG&C,
2
NHS GGC
Background:
TSST is an exotoxin that acts as a superantigen leading to
signs of toxic shock syndrome in patients with serious Staphylococcal
infections. Roughly 10% of
Staphylococcus aureus
bacteraemia isolates
received at the Scottish MRSA reference lab are TSST positive but the
clinicians are not informed of the results.
Aim(s)/Objective(s):
To assess whether patients with MSSA bacter-
aemias who are TSST positive display clinical signs of toxic shock
syndrome, and if it is appropriate towithhold the TSST PCR result from
clinicians.
Method(s):
Data from the Scottish MRSA reference laboratory was
extracted between January 2013 and July 2014. Isolates of MSSA
bacteraemia were received from 58 patients, of which we were able to
access 39 casenotes. Clinical, demographic and outcome data were
recorded.
Results:
There were 23 male and 16 female patients with a wide age
distribution. 28% of cases appeared to be hospital acquired, and a
number of comorbidities were identified as risk factors with device-
related or skin/soft tissue infection the commonest associations.
Average CRP was 175 and length of duration ranged from 1
–
440 days.
SIRS scores and clinical signs of TSS were poorly documented and
overall mortality was 33%.
Discussion and/or Conclusion(s):
Due to small numbers and poor
documentation it is difficult to concludewhether TSST makes a clinical
impact, however during the study we have identified several methods
to take the project forward constructively.
ID: 5089
Evaluation of CHROMagar
C. difficile
for the direct isolation and
detection of toxigenic
C. difficile
from diarrheal stools
Kanchan Dhamija
1
, Frederick Pink
1
, Anand Sivamakrishnan
2
,
Rohini Manuel
1
, Lynette Phee
1
, DavidW. Wareham
1
.
1
Barts Health Trust,
2
Barking, Havering and Redbridge University Hospitals NHS Trust
Background:
C difficile
associated disease, both antibiotic associated
diarrhea (AAD) and
C. difficile
infection (CDI) impacts on morbidity,
mortality and the use of antimicrobials in hospitalized patients.
Aim(s)/Objective(s):
We evaluated a novel selective fluochromato-
graphic culture media (CHROMagar
C. difficile
) for the rapid detection
of
C. difficile
in diarrheal stools.
Method(s):
Two hundred and nine samples were used in the
analysis. Each sample was tested for GDH and toxin A and B before
inoculation onto CHROMagar
C. difficile
plates (CHROMagar, Paris,
France). Plates were incubated anaerobically at 37°C for 48 hours
and then examined under ultra-violet (UV) light for fluorescent
colonies.
Results:
The
C. difficile
GDH antigen was detected in 58% (n = 121)
of the stool samples with 90% of these (n = 110) also positive for
CDT A or B. When cultured on CHROMagar
C. difficile
, fluorescent
colonies were grown from 97/110 (88%) GDH positive samples.
Absence of flourescent colonies in 13 samples was either because
they failed to grow or they had non flourescent colonies. However
5 samples which were negative for GDH and Toxin had flourescent
colonies.
Discussion and/or Conclusion(s):
Our findings support the use of
CHROMagar
C. difficle
. The test was found to be 89% sensitive and 94%
specific. It is an easy to perform, sensitive and specific method to
detect the presence of
C. difficile
in stool samples.
ID: 5106
Cost implications for the NHS of using the Alere
™
i Influenza A&B
near patient test with nasal swabs
Joy Allen
1
, Susanna Davis
2
, Rachel O
’
Leary
3
, Ashley Price
4
,
John Simpson
3
, Anne Tunbridge
5
, Luke Vale
6
, Michael Whiteside
7
,
Cariad Evans
2
, Mohammad Raza
2
, Michael Power
1
.
1
NIHR Diagnostic
Evidence Co-operative Newcastle,
2
Department of Virology, Sheffield
Teaching Hospitals NHS Foundation Trust,
3
NIHR Diagnostic Evidence
Co-operative,
4
Department of Infectious Diseases, Royal Victoria
Infirmary,
5
Department of Infectious Diseases, Sheffield Teaching
Hospitals NHS Foundation Trust,
6
Health Economics Group, Institute of
Health & Society, Newcastle University,
7
Department of Acute Medicine,
Doncaster Royal Infirmary
Background:
A recent evaluation of the Alere
™
i Influenza A & B near
patient test (NPT) indicated that, when the decision to isolate a
patient with suspected influenza (flu) is based on clinical symptoms
alone (current practice), not all patients with flu are isolated
(increasing the likelihood of onwards transmission), and some
patients without flu are unnecessarily isolated (at increased cost to
the healthcare provider).
Aim(s)/Objective(s):
To evaluate cost implications to the NHS, of using
Alere
™
i with nasal swabs to manage patients with suspected flu.
Method(s):
A budget impact model estimated costs from hospital
admission to discharge, or treatment completion. The model para-
meters were based on published data where possible and expert
opinion otherwise. Uncertainties in the model parameters were
investigated using deterministic one-way sensitivity analyses.
Results:
The total cost of the Alere
™
i Influenza A & B NPT for a cohort
of n = 1000 adults is £132,203 compared with £375,650 for current
practice, resulting in a total saving of £243,477. The NPT is cost saving
in terms of isolation (£190,867 less costly than current practice),
laboratory costs (£465,550) as well as antiviral prescription (£6,652).
However it incurs costs in terms of onward transmission (£622 more
expensive than current practice). Sensitivity analyses show that largest
savings occur when the time to return the standard laboratory result is
greatest.
Discussion and/or Conclusion(s):
The model indicates that Alere
™
i
could have greatest impact on costs associated with diagnosis and
management of patients with suspected flu, in hospitals reliant upon
off-site laboratories, where sample transport time can delay result
availability.
ID: 5126
Is there a point in culturing formed stools
−
What are the
implications of extending the current Scottish
C. difficile
testing
criteria to other enteric pathogens?
Padmaja Polubothu
1
, John Coia
2
, Tony Speekenbrink
2
, Alison Whyte
2
.
1
NHS Greater Glasgow & Clyde,
2
Glasgow Royal Infirmary
Background:
Our laboratory tests approximately 12,500 stool samples
annually for various enteric pathogens. However, in accordance with
Scottish guidance, only unformed stools are tested for
C. difficile
. We
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S79