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Antimicrobial Resistance and Infection Control 2013, Volume 2 Suppl 1

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MEETING ABSTRACTS

Open Access

Antimicrobial Resistance and Infection Control


Geneva, Switzerland. 25-28 June 2013
Edited by Didier Pittet, Stephan Harbarth and Andreas Voss
Published: 20 June 2013
These abstracts are available online at http://www.aricjournal.com/supplements/2/S1

ORAL PRESENTATIONS
O1
O001: Getting the unexpected: no association between hand hygiene
and workload
S Scheithauer1,2*, M Dangel1, B Batzer1, C Pino Molina3, A Widmer1
1
Infection Control, University Hospital Basel, Basel, Switzerland; 2Infection
Control & Infectious Diseases, University Hospital Aachen, RWTH Aachen,
Aachen, Germany; 3Hematology, University Hospital Basel, Basel, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O1
Introduction: A high compliance with hand hygiene is a cornerstone of
any infection control program. However, a high workload and a lack of
time are most commonly used argues against an appropriate compliance.
Objectives: In order to assess the relationship between the hand hygiene
events (HHE) and the workload, we correlated HHEs per patient-day (PD)
with the staff time/PD (h), the nursing effort/PD (h) and the C-value
indexing the workload, respectively.
Methods: All HHEs at a hematology ward (University Hospital Basel,
Switzerland) were continuously recorded from 01.03.12 to 28.02.213 using
the Ingo-man Weco (Ophardt Hygienetechnik, Issum; Germany) and could
be analyzed dispenser-, day-, shift-, localization-specifically. Daily data on
patients, staff time (h), nursing effort (h), C-value (1 (nursing effort /
weighted staff time)*100) were calculated with regard to the workday
from the electronic patient documentation sheets. For statistics SPSS was
used.
Results: During the one year investigation 208.184 HHE translating into
57 (10) HHE/PD were performed. HHE from Monday to Friday
exceeded HHE during the weekends with 59 (10) versus 51 (9) /PD.
HHE/PD were significantly associated with the staff time with r=0.37
(p=0.01) and with the nursing effort with r=0.41 (p=0.01), respectively.
These associations could be verified during workdays as well as during
the weekends. In contrary, HHE/PD did not depend on workload in
general indexed by the C-value with r=-0.04. However, during Monday
and Friday HHE/PD seemed to correlate even inversely with the C-value
(r=0.20; p=0.01).
Conclusion: HHE/PD were associated with the staff time and the nursing
effort indicating a constant compliance regardless the workload. This
hypothesis was confirmed by the lack of a positive association between
the C-value and the HHE/PD. Thus compliance seemed not to be affected
by workload at the hematology ward enrolled in this investigation.
Disclosure of interest: None declared.

O2
O002: Patient and healthcare worker perception about patient
participation in improving hand hygiene practices: impact of a patient
participation intervention
AJ Stewardson1*, N Farquet1, A Gayet-Ageron1, S Touveneau1, Y Longtin2,
A Iten1, D Pittet1, H Sax3
1
The Univ. of Geneva Hosp. and Fac. of Medicine, Geneva, Switzerland;
2
Laval University, Quebec, Canada; 3Univ. and University Hosp. of Zurich,
Zurich, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O2
Introduction: We implemented a cluster-randomized study at a 2200-bed
academic medical centre to assess the impact of novel strategies to
promote hand hygiene (HH). Wards in one of the three study arms were
exposed to a patient participation (PP) program.
Objectives: To investigate the impact of a formal PP program on
healthcare worker (HCW) and patient perception of PP for improving HH
compliance.
Methods: We performed two cross-sectional studies with written, selfadministered, anonymous questionnaires: one each for patients and HCWs.
Adult patients were eligible if hospitalized for more than 24 hours in one
or more of 66 study wards and discharged between May 16 and May 31,
2012 to their usual place of residence. Patients were defined as exposed
(to PP) if they stayed 24 hours in one ward in the PP study arm during
their admission. Completed surveys were returned via postal mail. HCWs
working in all study wards were eligible. HCWs were defined as exposed
if they currently worked in a PP ward. Surveys were brought to each study
ward by a member of the study team and completed surveys were
returned via internal mail. For each survey, non-respondents received
reminders 2 and 4 weeks after initial distribution.
Results: The response rate was similar among exposed and non-exposed
patients: 167/316 (53%) and 378/686 (55%), respectively. Compared with
non-exposed patients, exposed patients were no more likely to agree that
patients should remind healthcare workers to perform hand hygiene (31%
vs 26%, p=.25) or to report having reminded a nurse (5% vs 3%, p=.16) or a
doctor (2% vs 5%, p=.29) during their last admission. The response rate was
also similar among exposed and non-exposed HCWs: 230/531 (43%) and
436/999 (44%), respectively. The concept of patients reminding HCWs to
perform HH was accepted by 67% of HCWs. HCW acceptance was
independently associated with PP exposure (OR 1.51, CI95% 1.00-2.29,
p=.048) and nursing profession (OR 1.69, CI95% 1.03-2.79, p=.039).

2013 various authors, licensee BioMed Central Ltd. All articles published in this supplement are distributed under the terms of the
Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.

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Conclusion: Compared with control wards, HCWs (but not patients)


present in intervention wards had a more favourable perception of PP in
HH promotion.
Disclosure of interest: None declared.

Results: We observed 426 hand hygiene indications before the policy


change and 492 six months after policy change. Compared to 2009, we
observed a significantly higher compliance with hand hygiene in patients
colonized with MDR microorganism in 2012 [85.4%, (95% CI 82.2-88.5)
versus 51.9 %, (95% CI 47.1-56.6); p < 0.001]. In particular, compliance
improved before performing invasive procedures: [72.0% (95%CI 61.6-82.4)
vs. 23.9% (95%CI 14.8-32.9); p< 0.001] , and before patient contact [76.7%
(95%CI 68.9-84.5) vs. 32.3 (95%CI 24.0-40.5); p<0.001]. Hand hygiene
compliance after patient contact remained high [93.5% (95%CI 89.2-97.9) in
2012 vs. 94.3% (95%CI 89.8.2-98.8) in 2009; NS]. During the same period, we
observed a smaller increase in hand hygiene compliance for the entire
hospital (17.5% hospital-wide versus 33.5% in patients on contact
precautions).
Conclusion: Eliminating mandatory glove use in contact with isolated
patients increased hand hygiene compliance, particularly before invasive
procedures and before patient contacts. Glove use may cause healthcare
workers to bypass hand hygiene. The potential impact on the risk of MDR
organism transmission should be determined next.
Disclosure of interest: None declared.

O3
O003: The misuse of clinical gloves: risk of cross-infection and factors
influencing the decision of healthcare workers to wear gloves
J Wilson1*, S Lynam2, J Singleton3, H Loveday4
1
Institute of Practice, Interdisciplinary Research & Enterprise, UK; 2Psychology,
Social Care & Human Sciences, University of West London, UK; 3Infection
Control Directorate, Imperial College Healthcare NHS Trust, UK; 4Richard
Wells Research Centre, University of West London, London, UK
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O3
Introduction: Clinical gloves are routinely used in the delivery of patient
care but unless integrated with the 5 moments of hand hygiene have
the potential to increase the risk of HCAI transmission.
Objectives: To examine glove use in an acute care setting, the extent to
which they are associated with a risk of cross contamination, and factors
that influence healthcare workers (HCW) decision to wear them.
Methods: Observation of the use of clinical gloves was conducted in 6
wards by two trained observers. Independent observations were compared
for inter-rater reliability. Glove use was considered appropriate if the
episode involved potential contact with blood/body fluid (BBF). Risk of
cross contamination was defined as violation of one or more of the
moments of hand hygiene during the glove-use episode. Semi-structured
interviews were conducted with a purposive sample of 25 HCW from
audited wards to explore attitudes towards the use of gloves.
Results: 164 glove use episodes were observed over 13 hours. Glove use
was appropriate in 58% (95/164) of episodes, but gloves were commonly
used for procedures with minimal risk of exposure to BBF. In 39% of gloveuse episodes there was a risk of cross contamination, this was significantly
more likely to occur where gloves were used inappropriately (58.4% vs
28.4%; Chi 2 p < 0.01). In 24% (39) episodes more than 5 objects were
touched by a gloved hand before the procedure was performed. In one
third of episodes, hand hygiene was not performed after glove removal.
The key themes from qualitative interviews with HCW indicated that the
decision to wear gloves was influenced by multidimensional socialisation
and emotion. Key emotions were disgust and fear, but assumptions about
patients and their preferences regards glove use, confusion about when to
wear them and peer pressure, were also important influences.
Conclusion: Glove use in acute clinical settings is associated with a
significant risk of cross contamination and needs to be more explicitly
integrated into hand hygiene policy. An understanding of drivers of glove
use behaviour is required to design interventions to reduce their misuse and
overuse.
Disclosure of interest: None declared.
O4
O004: Improved hand hygiene compliance after eliminating mandatory
glove use for patients on contact precautions
A Cusini1, D Nydegger1*, T Lhri1, K Mhlemann1, J Marschall2
1
Clinic of Infectious Diseases and Hospital Epidemiology, University Hospital
Bern, Bern, Switzerland; 2Division of Infectious Diseases, Washington
University School of Medicine, St. Louis, USA
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O4
Introduction: The requirement to wear gloves when caring for patients
on contact precautions may cause personnel to neglect hand hygiene
before aseptic procedures, thereby increasing infection transmission.
Objectives: The aim of this study was to assess the compliance with
hand hygiene before and after eliminating mandatory glove use for
patients on contact precaution at our institution.
Methods: We assessed hand hygiene compliance of HCW taking care of 50
adult patients colonized with MDR microorganisms before (2009) and six
months after (2012) eliminating the mandatory wearing of gloves. This
policy change was implemented by our infection control team and
communicated to all hospital floors. Along with this policy change, we
routinely provided hand hygiene training to HCW on all floors. Hand
hygiene observation was performed by two trained infection control nurses
during routine care using a standardized questionnaire.

O5
O005: Results of the french national audit on standard precautions
M Giard1,2*, E Laprugne-Garcia1, E Caillat-Vallet1, I Russell1, D Verjat-Trannoy3,
M-A Ertzscheid4, N Vernier5, C Laland6, A Savey1,2, GREPHH1
1
CClin Sud-Est, Lyon, France; 2UMR5558, LBBE, Lyon 1 University,
Villeurbanne, France; 3CClin Paris-Nord, Paris, France; 4CClin Ouest, Rennes,
France; 5CClin Est, Nancy, France; 6CClin Sud-Ouest, Poitiers, France
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O5
Introduction: Standard precautions (SP) aim to protect healthcare
workers (HCW) and patients from infectious diseases arising from
bloodborne pathogens and reduce the risk of cross transmission of
micro-organisms. They must be applied in all circumstances, regardless of
the infectious status of the patient.
Objectives: The objectives were to assess: 1) institutional policies for SP
promotion; 2) available resources for SP implementation; and 3) education
of HCW and their compliance with SP.
Methods: The study was a mixed audit of procedures, resources and
attitudes. It was conducted between February 1st and December 31st 2011,
supported by the Ministry of Health. Inclusion criteria were voluntary
public and private hospitals in France, medical, surgical and medicotechnical wards therein and HCW working with patients in these wards.
Self-assessment questionnaires were administered at three levels:
institutional, ward and HCW. At institutional and ward levels, results were
given as a percentage of objectives attained; at professional level,
percentages of responses reported as never, sometimes, often or
always were calculated for each question.
Results: A total of 1,599 hospitals participated, including 14,968 wards
and 203,840 HCW. At institutional level, the overall score was 88%,
covering: SP promotion (91%), procedures (99%) and SP evaluation (63%).
At ward level, the overall score was 94%, covering: procedures (95%) and
resources (93%). Among the 165,722 (81.3%) HCW who reported having
participated in a training session on SP, 69.6% had had it in the last five
years. A total of 88.1% of HCW knew where to find the appropriate
written procedure in the event of a blood exposure. HCW reported the
best compliance for glove changing between two patients (94.5%
always). The less respected criteria were glove use for intramuscular or
subcutaneous injection and eye protection use in the event of blood
exposure risk (34.5% and 24.4% always, respectively).
Conclusion: No study on SP exists in literature which includes such a
large participation as this one. It will form a refence basis leading to
actions for improvement at local and national level.
Disclosure of interest: None declared.

O6
O006: Development of a method to simulate practical use conditions
of hygienic handrubs
J Rutter1, DR Macinga1,2*
1
GOJO Industries, Inc., Akron, USA; 2Northeast Ohio Medical University,
Rootstown, USA
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O6

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Introduction: The World Health Organization has recognized the


shortcomings of current standards for evaluating the in vivo efficacy of
hand hygiene products, and has called for methods which are realistic
under practical conditions.
Objectives: The objective of this study was to develop a method to
evaluate the efficacy of alcohol-based handrubs, which reflects the mode
of hand contamination typical in healthcare settings to provide an
accurate assessment of product performance under in-use conditions.
Methods: Stainless steel discs 1 cm in diameter were contaminated with
10 l of a liquid suspension of S. aureus ATCC 6538 (8 log CFU/ml) and
allowed to dry. Discs were stored in a humidity chamber at 50% RH for up
to 72 hours prior to use. Hands were contaminated by firmly pressing each
fingerpad to a contaminated disc for 2 seconds. Two fingers on each hand
were sampled individually by kneading in a neutralizer solution for
30 seconds to obtain pre-treatment counts. A hand hygiene intervention
was performed after which the remaining fingers were sampled to obtain
post-treatment values. Recovered bacteria were quantified and mean log
reductions per finger were calculated.
Results: S. aureus was stable on stainless steel discs for several days.
Transfer and recovery of S. aureus from fingers was highly reproducible both
between the fingers of individual subjects and between different subjects
(mean recovery = 5.90.2 log CFU per finger pad; N=65). The organism was
stable on the fingers with no die off for at least 40 minutes. A 15 second
non-antimicrobial handwash, 0.5 ml, and 1 ml of an alcohol based hand rub
achieved log reductions of 3.20.5, 2.91.3 and 3.71.0, respectively.
Consistent with other hygienic hand rub methods, intra-subject variability
was low and inter-subject variability was high.
Conclusion: Contamination of the fingers via contact with a dry surface
appears to be a simple and highly reproducible means of evaluating the
efficacy of hand hygiene products under practical use conditions.
Furthermore, this method utilizes a relevant marker organism, and simulates
the primary mode of hand contamination in healthcare settings. Finally, the
sampling method may be applied to the clinical setting to perform Phase 3
field studies, to investigate prevention of cross-transmission of pathogens
through use of a hygienic handrub.
Disclosure of interest: None declared.

(ASTM E 1174-06) and fulfilled the US FDA efficacy requirement. Similar


results were obtained according to ASTM E 2755-10.
Conclusion: Our data indicate that hand rubs based on 70% ethanol and
recommended with a volume of 1.1 mL per application are not suitable
to ensure complete coverage of both hands and do not fulfill the current
ASTM efficacy standard requirements. Infection control practitioners
should try to ensure patient safety by not reducing the volume of hand
rub required for adequate for hand disinfection.
Disclosure of interest: G. Kampf Employee of Bode Chemie GmbH,
Hamburg, Germany, S. Ruselack Employee of Bode Chemie GmbH, Hamburg,
Germany, S. Eggerstedt Employee of Bode Chemie GmbH, Hamburg,
Germany, N. Nowak Employee of Bode Chemie GmbH, Hamburg, Germany,
M. Bashir: None declared.

O7
O007: Lesser and lesser the impact of small volumes in hand
disinfection on quality of hand coverage and antimicrobial efficacy
G Kampf1,2*, S Ruselack3, S Eggerstedt3, N Nowak4, M Bashir5
1
Bode Science Center, Bode Chemie GmbH, Hamburg, Germany; 2Institute
for Hygiene and Environmental Medicine, Ernst-Moritz-Arndt University,
Greifswald, Germany; 3Development, Bode Chemie GmbH, Hamburg,
Germany; 4Scientific Affairs, Bode Chemie GmbH, Hamburg, Germany;
5
Microbiology, MicroBioTest, Sterling, USA
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O7
Introduction: With some alcohol-based hand rubs a volume of 1.1 mL
is recommended per application but it is unknown if such a small
volume is sufficient to cover both hands and if it fulfills current efficacy
standards.
Objectives: Aim of our study was to determine hand coverage of three
hand rubs (one gel based on 70% ethanol, one gel based on 85% ethanol,
one foam based on 70% ethanol) applied with various volumes (all
products: 1.1 mL, 2 mL, 2.4 mL, 1 push and 2 pushes; only foam product:
1.1 mL foam, 2 mL foam, 2.4 mL foam).
Methods: Fifteen subjects applied each product, supplemented with a
fluorescent dye with each volume. Quality of coverage was determined
under UV light. The efficacy of the three hand rubs was determined
according to ASTM E 1174-06 and ASTM E 2755-10. The hands of 12
subjects per experiment were artificially contaminated with Serratia
marcescens and the products applied as recommended (1.1 mL for the
products based on 70% v/v ethanol; 2 mL for the product based on 85%
w/w ethanol). The log10-reduction was calculated per product.
Results: A volume < 2 mL yielded a high rate of incomplete coverage
(76% - 87%), a volume 2 mL revealed better results (18% - 40%). There
was a significant difference between the five volumes used with all hand
rubs (p < 0.001; analysis of variance) but not between the three hand rubs
themselves (p = 0.442). Application of 1.1 mL of the hand rubs based on
70% ethanol yielded a log10-reduction of 1.85 or 1.60 log10 (ASTM E 117406) and failed the US FDA efficacy requirement. Application of 2 mL of the
hand rub based on 85% ethanol reduced the contamination by 2.06 log10

O8
O008: A multidisciplinary initiative to save antibiotics: the world
alliance against antibiotic resistance (WAAR)
J Carlet1*, C Pulcini2
1
ICU, Hopital St Joseph, Paris, France; 2Infectious diseases, CHU, Nice, France
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O8
Introduction: Background - Bacterial resistance has reached an alarming
level worldwide. There is a worrying gap between the current worldwide
spread of multiresistant bacteria and the lack of new antimicrobial drugs.
Urgent measures are then needed in order to preserve the efficacy of
antibiotics.
Objectives: Our aim was then to raise awareness and call for action to
save antibiotics.
Results: Objectives and results - We created in 2011 an international
network, named the World Alliance Against Antibiotic resistance (WAAR). It
gathers health professionals, veterinarians, environment specialists,
economists, politicians and delegates of the public. This association is
supported by 51 professional societies (40 in France and 11 non-French
societies) and counts 470 members, from 45 different countries. We have
met with government delegates, have communicated on the topic in the
media (television, radio, internet, journals...) and in the scientific literature.
We have contacted the APUA (Alliance for the Prudent Use of Antibiotics),
the BSAC (British Society of Antimicrobial Chemotherapy), React (Action on
Antibiotic Resistance) and GARP (Global Association of Risk Professionals) in
order to participate in a common international call for action (letter
published in November 2012 in the Financial Times). Our next step in the
coming months is to suggest to government delegates to conduct a strong
initiative showing that antibiotics are a very special class of drugs. Namely,
we will suggest that doctors, including those in the outpatient setting,
prescribe antibiotics on a dedicated form, mentioning the clinical indication
and the duration of therapy. Moreover, a systematic reassessment of
therapy around day 3 is of critical importance. We are planning to evaluate
these strategies in randomized controlled trials, assessing total antibiotic use
as the main outcome. Adding the antibiotics to the UNESCO World Heritage
list would also be very useful.
Conclusion: Conclusion - We believe that such global initiatives are
urgently needed worldwide if antibiotics are to be saved. Those precious
drugs must be considered as special drugs, and actively protected.
Disclosure of interest: J. Carlet Consultant for Astellas, Other Basilea,
C. Pulcini: None declared.

O9
O009: The Chennai declaration - a historic document (for the high
impact paper session)
A Ghafur
Apollo Speciality Hospitals, Chennai, India
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O9
Introduction: There is currently no functioning national antibiotic policy
or a national policy to contain antimicrobial resistance in India.
Objectives: A Roadmap to Tackle the Challenge of Antimicrobial
Resistance the first ever joint meeting of Medical Societies and other
stakeholders in India was held at Chennai on 24th August 2012. The
consensus of this historic event was The Chennai Declaration which was
published in the Indian Journal of Cancer in December 2012.
Methods: 1. The Roadmap symposium, per se received extensive
coverage in news papers and magazines like Nature.

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2. Within 2 months of publication of the Declaration reputed journal like


CID, Lancet ID, JAMA and BMJ published reviews and editorials.
3. Reviews by many other international and Indian journals will be
published in the coming months.
4. Popular newspapers in India wrote about the article (The Hindu wrote
reviews on the document thrice).
5. This document is already submitted to the Government and is currently
being studied by the highest officials. As a result of the Chennai
declaration Ministry of Health (MOH) issued an advertisement regarding
antibiotic usage in many Indian news papers. This is only a beginning of
a series of changes.
6. The document has also caught serious attention of high level political
circles.
7. The article is already accessed by more than 1400 visitors till date from
the parent journal website in which it was published. This is in addition to
more than 5000 viewers through the ISCCM news letter and also by more
than 10,000 physicians in the country, through Association of physicians of
India conference update.
Results: 1. The article, within 2 and a half month of publication has literally
created a stir among the Indian and international scientific media, public
media and the authorities.
2. The paper has in fact changed the attitude of the Indian government
towards resistance issue.
3. The declaration has provided an opportunity to the international
community to view the problem of antimicrobial resistance in developing
countries in a different perspective-A practical and not a perfect policy
being the ideal approach.
Conclusion: The Chennai Declaration is a historic document and will be
the driving force behind an antibiotic policy in India and other
developing countries.
Disclosure of interest: None declared.
Reference
1. [http://www.indianjcancer.com/preprintarticle.asp?id=104065].

Conclusion: The combination of PDT and CHG wipes immediately preoperatively reduces SSIs and is cost-effective.
Disclosure of interest: E. Bryce Grant/Research support from The
Vancouver Hospital Foundation funded this project. Ondine Biomedical
discounted the cost of PDT supplies and provided technical advice
but had no role in data collection, analysis or interpretation of results,
T. Wong Grant/Research support from The Vancouver Hospital Foundation
funded this project. Ondine Biomedical discounted the cost of PDT
supplies and provided technical advice but had no role in data collection,
analysis or interpretation of results, D. Roscoe Grant/Research support from
The Vancouver Hospital Foundation funded this project. Ondine
Biomedical discounted the cost of PDT supplies and provided technical
advice but had no role in data collection, analysis or interpretation of
results, L. Forrester Grant/Research support from The Vancouver Hospital
Foundation funded this project. Ondine Biomedical discounted the cost of
PDT supplies and provided technical advice but had no role in data
collection, analysis or interpretation of results, B. Masri Grant/Research
support from The Vancouver Hospital Foundation funded this project.
Ondine Biomedical discounted the cost of PDT supplies and provided
technical advice but had no role in data collection, analysis or interpretation
of results.

O10
O010: A novel immediate pre-operative decolonization strategy reduces
surgical site infections
E Bryce1*, T Wong1, D Roscoe1, L Forrester2, B Masri3,
The Vancouver General Hospital Pre-operative Decolonization Therapy Team1
1
Medical Microbiology and Infection Prevention and Control, Vancouver Coastal
Health, Vancouver, Canada; 2Quality and Patient Safety, Vancouver Coastal
Health, Vancouver, Canada; 3Department of Surgery, Vancouver Coastal Health,
Vancouver, Canada
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O10
Introduction: Pre-operative decolonization therapy (DcTx) using
chlorhexidine (CHG) body washes and/or intranasal mupirocin can reduce
surgical site infections (SSI) but compliance is often suboptimal. The
effectiveness of a novel approach to immediate pre-operative decolonization
therapy using intranasal antimicrobial photodisinfection therapy (PDT) and
CHG body wipes in reducing SSIs was assessed.
Objectives: To determine if immediate pre-operative decolonization
using PDT and CHG body wipes reduced SSI rates.
Methods: Between Sept 1, 2011 and Aug 31st 2012, 3068 elective
cardiac, orthopedic, spine, vascular, thoracic and neurosurgery patients
were treated with CHG wipes the night prior and day of surgery and
received intranasal PDT in the preoperative waiting area. Weekend cases,
procedures performed after the pre-operative dayshift, and emergency
cases going directly to the operating room were not eligible. SSI
surveillance remained unchanged from previous years and patients were
followed for a minimum of three months. Results were compared to a
historical control group consisting of 12,387 patients over four years and
to a concurrent control group of 196 untreated patients.
Results: A significant reduction in the SSI rate was observed after the
intervention [historical-control group 2.7% and treatment group 1.6% (p <
0.0001 RR 1.0114)]. The risk of having a Staphylococcus aureus infection was
higher in the concurrent untreated (61%=11/18 infections) compared to the
treated group (32%=16/50 infections). The reduction in SSIs compared to
the historical rates resulted in a cost avoidance of approximately $1.2 Million
(Can) and would have permitted approximately 140 additional surgeries to
be performed.

O11
O011: Reduction of resistance by sublingual administration of
antimicrobials
B Catry1*, H Laevens2
1
Healthcare associated infections (NSIH), Scientific Institute of Public Health,
Brussels, Belgium; 2Eyerbos consulting bvba, Merelbeke, Belgium
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O11
Introduction: Changing an antimicrobial regimen has shown to influence
the emergence of antimicrobial resistance, in which the regimen consists of
the dose, the treatment interval, the duration of therapy, and the
formulation. There is substantial evidence to encourage the use of high
dose as short as possible, with a small and regular treatment interval to
minimise the risk for the selection of resistant mutants. However, in contrast
with these first three aspects of the antimicrobial regimen, little attention is
currently paid to formulation in relation to guidelines for a rational
antimicrobial therapy to maintain clinical efficacy while reducing the
opportunity of resistant strains to have a selective advantage. Formulations
of antimicrobial agents have been adjusted in function of the route of
administration, which can be local (topical) or systemical. Systemical
concentrations of a certain antimicrobial molecule can be achieved either
through oral, sublingual, rectal or injectable administration.
Objectives: The purpose of this work is to explore the different routes of
administration with regard to the stimulation of antimicrobial resistance.
Methods: The one health approach combining expertise from human
and veterinary will be used throughout the presentation for gathering
evidence and exploring potential for the application.
Results: The author invites the audience to examine the potential
manufacturing of sublingual (and rectal) application as alternatives for
antimicrobial therapy. Advantages will be explained by terms of correct
dosing and timing, compliance and side effects, influence of feed intake on
pharmacokinetics (absorption, metabolisation, distribution, elimination), and
pharmacokinetic/pharmacodynamic (PK/PD) parameters challenges in
commensal and pathogenic bacteria simultaneously.
Conclusion: Deduced from different observations in human, veterinary
medicine and animal studies, reducing the amounts of oral antimicrobial
agents might be an underestimated approach to cope with antimicrobial
resistant pathogens in both human and veterinary medicine.
Disclosure of interest: None declared.
O12
O012: Can DAV132, a medical device targeting an adsorbent to
the late ileum, decrease significantly the impact of antibiotics
on the fecal microbiota?
N Grall1, E Chachaty2, S Sayah-Jeanne3, J de Gunzburg3, A Andremont1*
1
Lab. de Bacteriologie Hop. Bichat Claude-Bernard, Paris, France; 2Institut
Gustave-Roussy, Villejuif , France; 3Da Volterra, Paris, France
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O12

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Introduction: During antibiotic treatments a fraction of the dose impacts


the intestinal microbiota, promoting spread of resistant bacteria (RB).
Antibiotics can be inactivated by adsorption. DAV132 is an oral medical
device to deliver an adsorbent in the late ileum. We investigated if
DAV132 could reduce fecal antibiotics and RB excreted.
Methods: Three models were used. First, to explore the relationship
between antibiotic exposure and excretion of RB, piglets just received 15 or
1.5 mg/Kg/d of oral ciprofloxacin or placebo X 5 days. We then compared
between groups fecal ciprofloxacin concentrations and the amount of RB
excreted. Second, to explore colonic adsorption of antibiotics by DAV132 in
the colon, dogs received 10.7 mg/kg/d of IV levofloxacin X 5 days together
with 0.3 or 0.6 g/kg/d or placebo of oral DAV132. We then compared
between groups fecal and blood levofloxacin concentrations. Last, to explore
if DAV132 could restore antibiotic-associated disruption of colonization
resistance (CR), mice received 300 mg/kg/d of sc cefotaxime or placebo X
3 days, together with 50 mg/d or placebo of oral DAV131 (DAV132 adapted
to the mice), followed by gastric challenge with 106 CFU of a K. pneumoniae
resistant to third generation cephalosporin (C3GR-Kp). We then compared
between groups fecal cefotaxime and C3GR-Kp concentrations.
Results: In piglets, counts of RB excreted were 9.2, 8.8 and 6.2 log10 CFU in
animals receiving respectively the 15, the 1.5 mg/kg/d and the placebo
regimen respectively (p<0.001). In dogs, reduction of fecal levofloxacin
reached 71 and 82% when 0.3 or 0.6 g/kg/d of DAV132 was given. Blood PK
of levofloxacin was not modified significantly. In mice, all antibiotic
disappeared from the pellets when DAV131 was given to the animals
together with cefotaxime and a significant part of RC by C3GR-Kp was
restored.
Conclusion: Oral DAV132 might reduce exposure of the intestinal flora by
antibiotics which could be associated with decrease in fecal excretion of RB
without affecting blood PK. There appeared to be a relationship between
the dose of DAV132 administered and the effect observed. The possible
clinical use of DAV132 is under investigation.
Disclosure of interest: N. Grall: None declared, E. Chachaty Consultant
for DA VOLTERRA, S. Sayah-Jeanne Employee of DA VOLTERRA, J. de
Gunzburg Shareholder of DA VOLTERRA, A. Andremont Consultant for DA
VOLTERRA.

Results: Release experiments of a hydrophilic dye from various IPNs show


that it is possible to change the release characteristics by altering the
hydrogel chemistry. An amount of 80% of the hydrophilic dye was released
after 21 days by means of an IPN made of silicone and hydrophilic hydrogel.
The IPN technology can further be used to alter mechanical properties of
the device by making the substrate stiffer or softer, depending on hydrogels
and process conditions. Interesting results have been obtained by
preliminary tensile testing studies. CT-scans show that the treatment is
applied throughout the bulk of the material.
Conclusion: A hybrid polymer with a storage facility and transport
network has been produced showing very promising results regarding
loading and release of active components from the surface. This system
may be used for controlled, local and sustained delivery of drugs to
combat catheter-related infections and avoidance of antibiotic resistance
development.
Disclosure of interest: None declared.

O13
O013: Abstract withdrawn

Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O13

O14
O014: A new generation of hybrid biomaterials for antimicrobial
medical devices
N Theilgaard1*, A Svensson1, A Olsen1, P Thomsen2, M Alm2
1
Danish Technological Institute, Denmark; 2Biomodics ApS, Taastrup,
Denmark
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O14
Introduction: The present effective treatment for device related infections
is large doses of systemically applied drugs. There is a high risk of recurring
infections and biofilm formation for patients dependent on long term indwelling catheters and the extended dependency on antibiotics results in
clinical drug resistance. We present a new tool for minimizing drug
resistance by upgrading existing and future medical devices through a
unique self-regenerating surface that prevents biofilm formation.
Methods: An Interpenetrating Polymer Network (IPN) is composed of two
or more networks which are at least partially interlaced on a molecular scale,
but not covalently bonded to each other and cannot be separated unless
chemical bonds are broken. In the present context, a unique approach for
preparing silicone hydrogel IPNs is employed using supercritical carbon
dioxide (scCO2) technology, which allows injection moulded and extruded
silicone elastomers to be applied as substrates and uses scCO2 as an
auxiliary solvent to impregnate the hydrophilic monomer into the silicone.
The loading of an active substance is achieved by either incorporating the
substance during the hydrogel synthesis process, or in a subsequent loading
step, by swelling the material in a solvent containing the substance.

O15
O015: A novel antibacterial material for transparent dressings
W Zingg1*, L Clack1, C Ginet1, H Ney2, G Renzi3, M Black4, M Martin5
1
Infection Control Program, University of Geneva Hospitals, Geneva,
Switzerland; 2Department of Sterilisation, University of Geneva Hospitals,
Geneva, Switzerland; 3Molecular Biology Lab, University of Geneva Hospitals,
Geneva, Switzerland; 4Palm Beach Childrens Hospital, Palm Beach, USA;
5
Infection control program, Regionale Gesundheitsholding
Heilbronn-Franken, Helibronn, Germany
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O15
Introduction: Intravascular lines are indispensable in hospital care. The
main complication of their use is catheter-related bloodstream infection
(CRBSI). Transparent, semipermeable dressings (TSD)are standard in
covering the insertion site. Bionate is a polymer with antibacterial
properties and yet has not been taken up by a company to be marketed
as a medical product. The polymer backbone consists of polyurethane
while the surface consists of self-assembling monolayer end groups of
quaternary ammonium structures. These structure properties make the
material a candidate to produce easy-to-use antibacterial TSD.
Objectives: The aim of the study was to assess the effectiveness of the
material as a growth inhibitor of microorganisms on the skin of healthy
volunteers.
Methods: Sterile Bionate and control patches were applied to undisinfected
skin (upper arm) of 10 healthy volunteers for 3, 5, and 7 days. Five volunteers
tested the patch for 10 days. After removal, a sterile, moistened cotton swab
was taken from the skin site and the patches were put into normal sterile
saline. Skin swabs were transferred into 3ml sterile saline and incubated for
2 minutes at room temperature. Patches in saline were vortexed and
incubated for at least 15 minutes at room temperature. Dilution series were
prepared and 100ul of each probe were put onto trypticase-soy-agar for
growth and colony counts. Agar plates were incubated at 35C for up to 48h
and colony forming units (CFU) were counted thereafter.
Results: Log growth differences of skin swabs between Bionate and
control patches on days 3, 5, 7, and 10 were 1.4, 2.5, 2.0, and 1.4,
respectively. Growth difference was significant from day 7 onwards
(P=0.002). Log growth differences of the Bionate and control patches on
days 3, 5, 7, and 10 were 1.8, 1.8, 2.5, and 1.9, respectively. Growth reduction
was significant from day 5 onwards (P=0.015).
Conclusion: The study identified remarkable growth of microorganisms
on skin covered with polyurethane dressings. Growth reduction of
Bionate as compared to standard polyurethane makes this material
promising to develop a future TSD with inherent antimicrobial properties.
Disclosure of interest: None declared.

O16
O016: Electronic hand hygiene monitoring for the WHO 5-moments
method
T Diller1*, JW Kelly1, C Steed1, D Blackhurst1, S Boeker1, P Alper2
1
Greenville Health System, Greenville SC, USA; 2Deb Worldwide Healthcare
Inc., Charlotte NC, USA
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O16

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Introduction: Two primary hand hygiene (HH) methods exist. The In/Out
method teaches staff to clean their hands at entry to and exit from
patient rooms. This method is easy to measure, but suffers from the
potential for recontamination of staff from fomites after room entry. The
World Health Organization (WHO) 5-Moments method teaches additional
HH opportunities (HHOs) after entry to the patient room. It is difficult to
measure and requires known direct observation. We describe the
development and validation of a 5-Moments electronic monitoring
system (DebMedGMS).
Methods: The (DebMedGMS) captures soap/sanitizer dispenser
activations with an implanted RF circuit board in the dispensers and
transmits data via a wireless network to offsite servers. The activations
represent the numerator. We previously developed an algorithm driven by
patient census and nurse/patient staffing ratios to predict the number of
HHOs (denominator) expected on medical/surgical, ICU or ED units (HOW2
Benchmark Study: AJIC 2011;39). The HH compliance index (HHCI) equals
the activations divided by the predicted HHOs during a time period.
The HOW2 algorithm was derived from direct observation of periods of care
activity, so we performed a validation study using 24 hour video-taped
surveillance. We reviewed 1511 hours of video for 26 patients on a medical
unit over 15 months and compared the actual HH compliance rate from the
video-tape to the predicted HHCI from the (DebMedGMS).
Results: Quarterly HH compliance rates by direct observation ranged from
92 to 99%. The electronic HHCI ranged from 65 to 71%, while actual HH
compliance from video-surveillance ranged from 66 to 75%. Correlation of
the latter two metrics was extremely high (r = 0.976, p=0.004). The number
of HHOs with the In/Out method (2886) was 36% lower than with the 5Moments method (4522).
Conclusion: This study validates the HOW2 Benchmark Study algorithm. It
also documents a 36% deficit in HHOs using the In/Out method and a ~30%
Hawthorne Effect due to direct observation. There is an extremely high
correlation between actual video-taped HH compliance and the electronic
monitoring systems HHCI. We believe that electronic monitoring using the
5-Moments method provides the most accurate and actionable HH
compliance data.
Disclosure of interest: T. Diller Grant/Research support from Deb
Worldwide Healthcare, Inc., J. Kelly Grant/Research support from
Deb Worldwide Healthcare, Inc., C. Steed Grant/Research support from Deb
Worldwide Healthcare, Inc., D. Blackhurst Grant/Research support from
Deb Worldwide Healthcare, Inc., S. Boeker Grant/Research support from
Deb Worldwide Healthcare, Inc., P. Alper Employee of Deb Worldwide
Healthcare, Inc.

on all enveloped viruses tested so far. Importantly, when coated on


non-woven fabrics, Viroblocks technology retains its whole antiviral
property.
Results: Aerosol challenges were performed on a prototype antiviral
facemask composed of a filtration layer associated to a Viroblock-coated
external layer. Results show an overall reduction of more than five Log
TCID50 (99.9997 %) of human Influenza virus H1N1.
Conclusion: The broad spectrum activity coupled to the extreme rapidity
of cholesterol depletion is opening the way to making antimicrobial
fabrics that can inactivate air borne viruses during the very short time it
takes for them to pass through a filter, hence providing an increased
protection against bioaerosols of viral origin.
Disclosure of interest: None declared.

O17
O017: A novel antiviral technology for air filtration
T Pelet*, F Matheux
VIROBLOCK SA, Plan-les-Ouates, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O17
Introduction: Bioaerosols exposure and potential impact on human health
is a growing concern. Bioaerosols are assemblies of particles of variable
biological origin (bacterial, viral, or fungal) suspended in the air and capable
of initiating an infectious process in a susceptible host. They usually consist
of a mixture of mono-dispersed and aggregate cells, spores, or viruses,
carried by other materials, such as respiratory secretions. With rapid
desiccation, the resultant smaller aerosols can remain airborne longer, while
larger aerosols may initially fall out and then become re-suspended after
desiccation.
Objectives: Tests show that filter materials are very efficient at removing
small particles (<0.1 of m diameter) from air streams because electrostatic
charge and Brownian motion trap these fine particles within the matrix of
the fabric. Larger particles (>1.0m in diameter) such as bacteria or fungi are
also efficiently removed by mechanical filtration. However, filtration media
are generally poor at removing particles in the range from 0.1m to 0.5m
in diameter, which are small enough to escape the forces of mechanical
filtration yet are large enough to avoid being entrapped by electrostatic or
Brownian motion. This weakness window unfortunately corresponds to the
mean size of many viruses.
Methods: Viroblocks proprietary antiviral technology uses a combination
of aliphatic lipidic chains, able to form lamellar structures, and specific
cyclodextrins to inactivate enveloped viruses. The mode of action is
based on cholesterol depletion from the viral membranes and, because
cholesterol is present in most viral envelopes, the technology is active

O18
O018: Evaluation of the efficacy of a novel hydrogen peroxide cleaner
disinfectant concentrate
PJ Teska1, A Rushworth1*, M Theelen2, J Jongsma2
1
Global Healthcare, Diversey Inc, Sturtevant, USA; 2R&D, Diversey Inc,
Amsterdam, The Netherlands
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O18
Introduction: Multiple studies have shown that high-touch surfaces such as
bed rails, the tops of bed tables, and supply carts play a role in the
transmission of pathogens to susceptible patients and that there are gaps in
current cleaning practices. While there are no validated studies proving the
value of daily cleaning/disinfection in aiding infection prevention for
patients, there are trends towards increased use of disinfectants in many
areas of Healthcare. Hydrogen peroxide disinfectants are being increasingly
evaluated in Europe due to their superior efficacy, safety, cleaning and
sustainability profiles.
Objectives: We tested a novel hydrogen peroxide cleaner disinfectant
formula concentrate (hereafter the formula) against standardized EN test
methods to determine if the formula was capable of meeting the European
efficacy standards for Healthcare disinfection. We also performed cleaning
tests to determine if the cleaning performance of the formula was
consistent with that of a strong neutral cleaner.
Results: Using EN-1276 and testing against Pseudomonas aeruginosa,
Enterococcus hirae, Staphylococcus aureas, and Escherichia coli, the formula
passed (>5 log reduction) in dirty conditions at 30 seconds at a 3.5%
dilution and at 5 min at a 2.0% dilution.
Using EN-13697 and testing against Pseudomonas aeruginosa, Enterococcus
hirae, Staphylococcus aureas, and Escherichia coli, the formula passed (>4 log
reduction) in dirty conditions at 5 min at a 3.5% dilution.
Using EN-1650 and testing against Candida albicans and Aspergillus niger,
the formula passed (>4 log reduction) in dirty conditions at 15 min at a
3.5% dilution.
Using a standardized Gardner Cleaning Test Method, the cleaning
performance of the formula at 3.5% dilution was 67% soil removal. The
neutral cleaner (Jontec 300) at 2% dilution was 72% and demi
(demineralized) water was 54%. All tests were run in duplicate with results
averaged.
Conclusion: Our study showed that the formula meets the efficacy
standards of multiple EN disinfectant test methods and provided
comparable cleaning efficacy to a standard neutral cleaner. Thus this
formula is a viable candidate for the European Healthcare market for
customers desiring a hydrogen peroxide based one step cleaner disinfectant
that is bactericidal and fungicidal.
Disclosure of interest: P. Teska Employee of Diversey Inc, A. Rushworth
Employee of Diversey Inc, M. Theelen Employee of Diversey Inc,
J. Jongsma Employee of Diversey Inc.

O19
O019: A new genre of surface disinfectant with long residual
bactericidal activity
A Sava*, S Kritzler
Research, Novapharm Research Australia, Sydney, Australia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O19
Introduction: Whilst antibacterial copper is regarded as effective for
continuous antibacterial protection in high traffic areas, high cost and
poor efficacy against some microorganisms restricts its application.

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Evocide is a new genre of liquid surface disinfectant with broad spectrum


antibacterial efficacy on application. Unlike conventional surface disinfectants,
it dries to leave an invisible fingerprint- and water-resistant film that
continues killing bacteria on contact for up to six months. These films readily
dissolve during subsequent applications of Evocide or in >20% ethanol.
We present results of assaying the Evocides bactericidal efficacy both as
liquid and as dried films.
Methods: The bactericidal properties of liquid disinfectant were assayed
as per TGO 54 and relevant AOAC bactericidal protocols.
The bactericidal properties of residual films were tested as per the US
EPAs self-sanitising surface test, where the residual films are inoculated
after alternating wet and dry abrasions to simulate fingerprint traffic.
Results: On application >6log reduction of bacterial inocula is achieved
within 2 minutes for S. aureus, E. coli, P. aeruginosa and within 5 minutes
for M. bovis (TB).
The residual film, even after 10 wet and 10 dry abrasions, reduces the
population of E. coli and Klebsiella pneumoniae by >3-log within 10 min
after inoculation (compared to 2 hours for antimicrobial copper). The
abraded residual films also achieve >3-log reduction of P.aeruginosa and
vegetative C. difficile inocula within 10 minutes. Surprisingly, the films also
exhibit some sporicidal properties with the counts of spore suspensions
of C.difficile and B.subtilis being reduced by 40% and 70% respectively
within 24 hours after inoculation.
Evocide also complies with the relevant criteria for toxicity, biocompatibility
and no-film build-up.
Conclusion: This new genre of surface disinfectant exhibits powerful
residual bactericidal properties combined with good materials
compatibility. It allows for the creation of a potent antimicrobial barrier
on any environmental hard surface at fraction of the cost of copper. It
also offers a simple safeguard for cleaning deficiencies, ensuring that
hard-to-reach surfaces (eg beds, bedside tables) remain hygienic.
Disclosure of interest: None declared.

elimination of MDRBSs from the hospital environment in short terms, it


provides termination of the outbreaks caused by MDRBSs, reduces the
incidence and mortality from HAIs, and it is much cheaper compared to
CAMs.
Disclosure of interest: None declared.

O20
O020: A new method of bacteriophage-based disinfection in
healthcare settings
EB Brusina*, OM Drozdova, AG Kutikhin
Department of Epidemiology, Kemerovo State Medical Academy, Kemerovo,
Russian Federation
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O20
Introduction: One of the most significant features of healthcareassociated infections (HAIs) is the high frequency of multidrug-resistant
bacterial strains (MDRBSs). Even modern chemical antimicrobials (CAMs)
are not efficient enough; a totally different way of prevention of HAIs
caused by MDRBSs is necessary.
Objectives: To develop a monobacteriophage (MBP)-based way of
prevention of HAIs caused by MDRBSs.
Methods: MBPs against Pseudomonas aeruginosa (PA), methicillin-resistant
Staphylococcus aureus (MRSA), Salmonella spp., Shigella spp., and Klebsiella
spp. were sprayed on various surfaces in different healthcare settings
(HCSs) in the case of spread of HAIs caused by these agents. We compared
efficiency of MBPs on different surfaces and in different conditions of
phage circulation. Finally, we assessed the influence of the MBPs on
incidence and mortality of HAIs caused by MDRBSs. The efficiency of the
MBPs was evaluated in the terms of absence of the target bacteria in the
environment, that, in turn, was assessed by classical bacteriological
methods.
Results: Application of MBPs sprayed on surfaces in hospital environment is
significantly more efficient method of elimination of MDRBSs compared to
their usage by any other way. MBPs possessed greater efficiency on glass,
metal, and plastic surfaces compared to textile and paper. Duration of MBP
circulation was determined by time frame, MBP strain, and lytic activity of
the MBP, but not by dose of MBP on the surface. The greatest effect was
revealed against PA; even the single usage of MBP provided total
elimination of PA from the hospital environment. The application of MBPs
led to 15-fold decrease of incidence of Salmonella-caused infections, 4-fold
reduction of incidence of Shigella-caused infections, and 2-fold decrease of
incidence of Klebsiella- and MRSA-caused infections. Finally, CAMs did not
influence the efficiency of MBPs, and no side effects were registered.
Conclusion: The MBP-based way of prevention of HAIs caused by MDRBSs
has certain advantages over CAMs. It may be used without limitations in
different HCSs, particularly in intensive care units, it allows the efficient

O21
O021: Infection control enclosure (ICE) POD: meeting the need
for more single rooms
J Salkeld
Bioquell, Andover, UK
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O21
Introduction: An increase in single occupancy rooms reduces transmission,
improves hand hygiene compliance and increases patient satisfaction. Thus,
there is a demand for more single rooms, particularly in hospitals with a low
proportion of single rooms as is common in Europe. Furthermore, where the
previous room occupant was infected or colonised with a pathogen, the
subsequent admission is significantly less likely to acquire that pathogen if
the room is decontaminated using hydrogen peroxide vapour (HPV) rather
than being cleaned and disinfected using standard methods.
Objectives: Bioquell has developed the Infection Control Enclosure (ICE)pod, a bespoke, semi-permanent structure with a door and an integral air
handling system to provide a negative air-flow, which can be erected
around existing bed spaces without closing wards.
Methods: The ICE-pod combines many of the benefits of single rooms
whilst retaining the primary advantages of bays/open wards. The pods can
also be sealed for HPV decontamination.
Results: ICE-pods can be used to interrupt the spread of nosocomial
pathogens by providing additional capacity to segregate patients known to
be infected or colonised with pathogens, for pre-emptive segregation of
high-risk patients, to provide a single room environment for patients that
require high visibility such as those at risk of falls, and the ability to
decontaminate individual bed spaces using HPV. The ICE-pod will also
improve the privacy and dignity of patients cared for in multi-occupancy
areas, and has the potential to free up side rooms for patients requiring
additional privacy and dignity. There are tangible potential cost-benefit
advantages associated with accelerated discharge from intensive care units
and other high-cost units and avoiding the high cost of permanent
conversion programs. The ICE-pod will provide an overall improvement in
the flexibility of patient flow throughout a hospital, which will increase
throughput and decrease the number of patients placed temporarily in suboptimal specialties.
Conclusion: Implementation is currently underway in the UK and will
include assessment of patient and staff acceptability of the ICE-pod.
Further trials to evaluate the clinical impact of the ICE-pod are planned.
Disclosure of interest: J Salkeld: Employee of Bioquell.

O22
O022: Development of an electronic dashboard to assist surveillance
S Wallace*, N Damani
Infection Prevention and Control, Southern Trust, Craigavon, UK
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O22
Introduction: Collection and timely feedback of process and outcome
surveillance is one of the most challenging tasks faced by the Infection
Prevention and Control (IPC) team. The aim of our project was to develop a
system to ensure timely communication of surveillance information to both
clinical and non-clinical teams using an electronic dashboard.
Methods: Our hospital developed in house e-reporting tools for use on
our IT network. The system was created using Visual Basic programming
and utilised existing word processing and database software. Each PC
terminal in clinical areas was granted access to the e-reporting forms. Staff
were provided with brief 15 minute training sessions detailing how to use
the system.
Results: Since the introduction of the e-dashboard system we have been
able to host all our information in one location, with regular updates,
allowing ease of access for all staff. Staff can now compare their
performance against other departments and by staff grouping. This has
provided a nudge effect and their compliance with IPC practices has
gradually improved as they do not want to feature as an outlier. In addition
to this, the benefit of the online availability of the information dramatically

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reduced the need for sending e-mails, thus saving time and reducing
pressure on the Trusts IT network infrastructure.
Conclusion: Since the introduction of the electronic dashboard, the hospital
within our Trust has seen a substantial improvement in communicating of
both process and outcome surveillance information to both clinical and
non-clinical teams. As a result of this feedback we have seen a substantial
improvement in compliance with process surveillance for example, the hand
hygiene return rates have risen from pre-intervention 62% to 82% post
intervention. As a result of improved compliance in other areas (environmental cleanliness, antibiotic prescribing, commode cleaning etc.) we have
seen over 70% reductions in C. difficile and MRSA bacteraemia infections.
The system used can be replicated by any hospital with minimal resources
when compared to commercial systems that require costly support and
contracts to meet local needs. The system also allows the release of IPC time
crucial in low resource settings where resources are constrained.
Disclosure of interest: None declared.

Introduction: Prevalence surveys are common tools to determine the


prevalence of- and determinants for Healthcare Associated Infections
(HAI). However this only incorporates patient-related variables.
Objectives: We developed a new method, the infection risk scan, which
includes outcome variables, patient-related variables as well as wardrelated variables. This should provide a holistic view on the infection risk
profile of a ward or a hospital.
Methods: Two outcome variables were investigated, prevalence of
healthcare associated infections (HAI) and rectal carriage of Extended
Spectrum B-Lactamase (ESBL) producing bacteria. Two patient-related risk
variables, use of indwelling medical devices and antimicrobial therapy,
and two ward-related variables, environmental contamination and hand
hygiene non-compliance (according to the WHO guideline). Results of all
investigated variables were categorised as low risk, medium risk and high
risk, based on the literature or expert opinion, and presented in a spiderplot.
The infection risk scan was performed in 4 different general nursing
wards.
Results: Large differences were found in outcome variables and risk
factors, with a distribution across all 3 risk categories (low, medium and
high). This resulted in different risk-plots for the different wards.
Handhygiene non-compliance and the environmental contamination were
a cause of concern in all wards. Prevalence of ESBL carriage was low in
all wards, and the ESBL isolates were genotypically not related.
Conclusion: In conclusion, the infection risk plot demonstrated substantial
differentiation. The plot gives an overview that can easily be understood by
the healthcare workers and managers. The problem areas are shown at a
glance. Based on the findings a tailor made, targeted quality improvement
project can be executed and the results can be measured in a repeated
measurement. This makes the infection risk scan a management tool that
can be used to determine the scope and focus of an infection control
program.
Disclosure of interest: None declared.

O23
O023: Combining electronic contacts data and virological data for
studying the transmission of infections at hospital
C Payet1, A Barrat2,3, C Cattuto3, C Rgis1, N Khanafer1,4, J-F Pinton5, B-A Kim6,
B Comte6, B Lina4,7, P Vanhems1,4, N Voirin1,4*
1
Universit Lyon 1, CNRS UMR 5558, Lyon, France; 2CNRS, CPT, UMR 7332,
Marseille, France; 3Data Science Lab, ISI Foundation, Turin, Italy; 4Hospices
Civils de Lyon, France; 5CNRS UMR 5672, France; 6Hpital Edouard Herriot,
Service de griatrie, France; 7Universit Lyon1, CNRS FRE 3011, Lyon, France
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O23
Introduction: Transmission of hospital acquired infections (HAI) depends
mainly on contacts between patients, between health care workers
(HCWs) and between patients and HCWs.
Objectives: The objective of this study was to combine contacts data
and virological data for studying influenza transmission during an
outbreak occurring in a hospital unit.
Methods: Face-to-face proximity between persons was collected during
10 consecutive days using electronic RFID badges. Virological data on
influenza infection status were also collected. Each patient and each HCW
had 2 nasal swabs, one at admission and one at discharge for patients,
and 2 swabs at 7 days interval for HCWs, from which laboratory
confirmation of influenza infection was performed.
Results: A total of 18,766 contacts were recorded among 37 patients and
47 HCWs. Nurses, medical doctor( MD) and patients were involved in
82%, 26% and 24 % of all the contacts respectively. In parallel, during the
10 days, an outbreak occurred involving 15 laboratory-confirmed
influenza cases diagnosed among 10 patients (attack rate 27%) and 5
HCWs (attack rate 10%). We identified 5 (14%) patients and 10 (20%)
HCWs who cumulated nearly 50% of all the contacts involving patients
and HCWs. Among these persons with a high number of contacts, 3
(60%) patients and 1 (10%) HCW had confirmed influenza. Among those
with a lower number of contacts, 7 (22%) patients and 4 (11%) HCWs had
confirmed influenza. Further statistical analyses are ongoing to assess the
relationship between the number and duration of contacts and the risk
of influenza transmission.
Conclusion: Collecting contacts data in the hospital setting and
combining this information with virological data could be an interesting
approach to study the transmission of HAIs. We identified patients and
HCWs with a high number of contacts, who could be considered as
potential super-spreaders of infections. This is key information that may
help to implement prevention and control measures.
Disclosure of interest: None declared.

O24
O024: New holistic approach to determine the infection risk profile of a
hospital; visualised in a easy-to-read plot
I Willemsen1*, J Kluytmans1,2
1
Department for Medical Microbiology and Infection control, VUmc Medical
Center, Amsterdam, The Netherlands; 2Laboratory of Microbiology and
Infection control, Amphia hospital, Breda, The Netherlands
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O24

O25
O025: Organisational transformation the application of novel change
techniques & social media understanding to motivate infection
preventionists
J Storr1*, H Loveday2, L Wharton2, D Flaxman2, D Wright2, E Curran2,
M Tannahil2, G Thirkell2, N Wiggleworth2, P Cattini2, J Wilson2, C Kilpatrick2
1
Infection Prevention Society, West Lothian, UK; 2IPS, IPS, London, UK
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O25
Introduction: The Infection Prevention Society (IPS) is a charity that
supports members to ensure no person is harmed by a preventable
infection. In 2009, IPS began a strategy planning and evaluation exercise
that has acted as the catalyst for transformation, achieved through the
use of innovative change techniques and a social media campaign.
Objectives: To establish a new strategy and social media campaign.
Methods: Qualitative and quantitative approacheswere used; a needs
assessment of members, a creative thinking workshop using 3 novel
techniques drafted a vision, mission, strategic aims and objectives, feedback
exercises followed at IPS annual conferences. This included a Strategy
Decision Tree and Strategy Wall to gather free text that was analysed. In
parallel, a baseline survey of members use of social media was issued and a
follow up process for twitter analysis established.
Results: In 2011, IPS issued strategic objectives: a) to lead, shape and inform
the infection prevention agenda; b) to generate and promote the evidence
base for infection prevention, and c) to be the organisation of choice to
sustain improvement.
The member survey found that equal proportions of members (39%)
thought that use of Twitter would enhance and not enhance IPS.
Implementation and on-going evaluation exercises were designed from this
intelligence. In 2011, 1% of members stated that Twitter would serve a
purpose. In 2013, 37% of IPS members were signed up to Twitter. Within 1
month the impact of the @IPS_infection Twitter account increased 2 and a
half fold, (reach - 8,047 to 27,146 and impressions - 17,502 to 44,529
respectively).
Conclusion: This approach engaged members in strategy development and
allowed for articulation of achievable but stretching objectives. The use of

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social media and Twitter in particular is being used to reinvigorate


networking and influence, and is already yielding results. A range of
measures are being employed to support on-going strategy implementation, to track progress and to role model to other societies.
Disclosure of interest: None declared.

infection control guidelines as a high priority. Such guidelines are


updated and published frequently.
Objective: This national study aims to assess the compliance of
Jordanian RNs with standard Infection Control (IC) guidelines.
Method: Cross-sectional, descriptive design was used. Proportionalmultistage, probability sampling was used to obtain a sample of 10% of all
staff nurses working in Jordanian hospitals. The final sampling frame
consisted of 103 hospitals from different healthcare sectors. Standardized
self-reported instruments used to evaluate the compliance. In the current
study the reliability coefficient of the tool was 0.88. Ethical approval was
obtained from participating hospitals. Informed consent was obtained from
participating nurses.
Results: A 889 RN from 22 hospitals were participated in the study with a
response rate of 89.4%, of which 52.6% were females, 81.9% were
holding a Bachelor degree. The mean age was 29.0 years (SD = 5.9) and
the mean years of experience was 6.9 years (SD = 5.8). The overall mean
compliance score was 119.9 (SD = 14.3). Nurses who received IC training
in the hospital demonstrated higher compliance (M = 120.2, SD = 13.6)
than those who never received such training (M = 115.8, SD = 15.2), p <
0.001. Nurses who work in university affiliated hospitals demonstrated
higher compliance than other types of hospital (p < 0.001).
Conclusion: This study demonstrated the necessity of establishing needbased IC programs especially for newly employed nurses. This study
provides information about infection control practices in various healthcare
sectors in Jordan. Results from this study expected to guide efforts to
develop educational tools, programs, and curricula to improve infection
control practices in the Jordan.
Disclosure of interest: O. Al-Rawajfah Employee of no conflicts of interest,
Grant/Research support from no conflicts of interest, I. Hweidi Employee of
no conflicts of interest, Grant/Research support from no conflicts of interest,
M. Alkhalaileh Employee of no conflicts of interest, Grant/Research support
from no conflicts of interest, Y. Khader Employee of no conflicts of interest,
Grant/Research support from no conflicts of interest, S. Alshboul Employee
of no conflicts of interest, Grant/Research support from no conflicts of
interest.

O26
O026: Countrywide prevalence study of healthcare-associated
infections in brazilian hospitals: preliminary results
CMCB Fortaleza1*, MC Padoveze2, C Kiffer3, AL Barth4, ICRS Carneiro5,
JLN Rodrigues6, L Santos Filho7, MJG Mello8, MD Asensi9, PP Gontijo Filho10,
MS Pereira11, M Rocha9, RS Kuchenbecker12, ES Medeiros13, ACC Pignatari13,
IRAS - BRASIL1
1
Tropical Diseases, Faculdade de Medicina de Botucatu - UNESP - Univ
Estadual Paulista, Botucatu, Brazil; 2Public Health, Escola de Enfermagem USP - Universidade de So Paulo, Brazil; 3Laboratrio Especial de
Microbiologia Clnca, Universidade Federal de So Paulo, So Paulo, Brazil;
4
Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; 5UFPA Universidade Federal do Par, Belm, Brazil; 6UFC - Universidade Federal do
Cear, Fortaleza, Brazil; 7UFPB - Universidade Federal da Paraba, Joo Pessoa,
Brazil; 8IMIP - Pernambuco, Recife, Brazil; 9FIOCRUZ - Rio de Janeiro, Rio de
Janeiro, Brazil; 10Microbiology, UFU - Universidade Federal de Uberlandia,
Uberlandia, Brazil; 11UFGO - Universidade Federal de Gois, Goinia, Brazil;
12
UFRGS - Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil;
13
UNIFESP - Escola Paulista de Medicina, So Paulo, Brazil
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O26
Introduction: The knowledge of burden of Healthcare-Associated Infections
(HAI) in hospitals is essential to drive governmental strategies for its
prevention and control.
Objectives: To identify the prevalence of HAI in a representative sample
of Brazilian hospitals.
Methods: A team of trained nurses carried out a hospital-wide HAI point
prevalence survey in 2012. A sample of hospitals from five Brazilian regions
was evaluated (n=91; total of 8,853 beds).
Results: The overall infection rate was 11.1%, varying from 2.5%
(hospitals with <50 beds) to 18.3% (hospitals with >200 beds). Reference
hospitals showed 11.2% of overall infection rate. The most prevalent
infections were pneumonia (3.6%), bloodstream infection (3.5%), surgical
site infection (1.4%), urinary tract infection (1.1%) and skin infection
(0.4%). Hospitals with >200 beds were likely to have higher HAI rates
(RR=1.71; IC=1.398-2.10; P<0.001). The risk factors more frequently
identified were: central venous catheter (17.8%), surgery (15.5%), urinary
catheter (14.0%), and mechanical ventilators (8.1%). Etiologic agents were
identified only in 9.1% (43/473) of infections. Gram-negative organisms
were more frequent (56.0%), among them, Klebsiella spp (19.0%) and
Pseudomonas aeruginosa (16%) and were predominant. Among Grampositives (35.0%), coagulase-negative Staphylococci were more prevalent
(16%) than Staphylococcus aureus (9.0%) or Enteroccoccus spp (6%).
Yeasts were identified in 9.0% of HAI.
Conclusion: These preliminary results emphasize both the relevance and
the heterogeneity of HAI in Brazilian hospitals.
Disclosure of interest: None declared.

O27
O027: Compliance of jordanian registered nurses with infection control
guidelines: a national population-based study
OM Al-Rawajfah1*, IM Hweidi2, M Alkhalaileh1, YS Khader3, SA Alshboul4
1
Adult health nursing, Al al-Bayt University/ Faculty of Nursing, Mafraq,
Jordan; 2Adult health nursing, Jordan; 3Department of Public Health,
Community, Family Medicine/Faculty of Medicine, Jordan university of
Science and Technology, Irbid, Jordan; 4Faculty of Faculty of Applied Medical
Sciences, Jordan university of Science and Technology, Irbid, Jordan
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O27
Introduction: The CDC recommends that educating health-care workers
regarding infection control measures is the first high priority strategy to
prevent and control Health Care Related Infection (HCRIs). The CDC
recommends periodic assessment of knowledge and adherence to

O28
O028: Impact of a prevention and control infection program in a
tertiary care teaching hospital
RE Quirs*, L Fabbro, A Novau, G Kremer, M Casanova, M Pereyra
Prevention and Infection Control Department, Hospital Universitario Austral,
Caba, Argentina
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O28
Introduction: The implementation of an expanded surveillance system of
healthcare-associated infections (HAIs) at institutional level is necessary since
these events can occur outside of intensive care units. In addition, this
comprehensive information allows evaluating the impact of the Prevention
and Control Infection Program (PCIP) in terms of reduction of HAIs.
Objectives: The aim of this study was to estimate the net savings associated
to the implementation of a PCIP at a tertiary care teaching hospital.
Methods: Since Jan10 different components of PCIP were progressively
implemented (Hand hygiene program, Prevention of emergency and
transmission of multidrug resistant microorganisms through isolation
measures, environmental cleaning and antimicrobial stewardship, Care
bundles for the prevention of device associated infections, and a
Prevention program for surgical site infection). According to this strategy
since Jul10 an expanded surveillance system using National Healthcare
Safety Network (NHSN) methodology was implemented. In order to
evaluate the impact of PICP, the HAIs avoided were estimated by
comparing infection rates, as events per 1000 patient-days, of two years
(2011 vs 2012). All costs are expressed in US dollars. The local attributable
cost of HAIs was estimated by adjusting the present value of previously
reported data[1]. The cost of PCIP was estimated from the incremental
costs associated with human resources and the strategies implemented
as part of the PCIP. Finally, the net savings was estimated as a difference
between the incremental costs and direct costs avoided.
Results: The rate of HAIs in 2011 was 14.17 episodes per patient-days in
comparison with 10.00 episodes per patient-days in 2012 (difference
4.17; CI 95% 2.73 to 5.62; p<0.0001) with 188 HAIs avoided after adjusting

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by patient-days of 2012. While the gross saving associated with these


episodes was $100,730, the overall net saving was $320,421.
Conclusion: A comprehensive PCIP was a cost-effective strategy to reduce
the incidence of HAIs in our institution. This type of analysis is a useful tool
when negotiating additional resources with managers.
Disclosure of interest: None declared.
Reference
1. Quirs RE: Impact of nosocomial infections in Argentina: net cost
associated with implementing effective infection control programs.
5 th Decennial ICHAI Atlanta 2010.

135 (71%) have accepted that to use leftover medications from single dose
or single-use vial for another patient. In addition, 149 (79%) know that drug
incorrectly administered at anatomical site can lead to infection. Also, 137
(72%) were used new and unopened needle and syringe for injection and
reconstitution. Fifty (26%) and 80 (42%) of the health professionals didnt
use aseptic technique and didnt receive training on injection safety
respectively. Currently, 75 (40%) of the study subjects have been
accidentally exposed to needle stick injury and 84 (44%) of the health
professionals were exposed to needle stick injury in the past six months.
Forty five (24%) still had the practice to recapping needles after an injection
and in which 65 (34%) of them recap with one hand and 32 (17%) of them
recap with two hands.
Conclusion: It was confirmed that there is a gap of knowledge, attitude
and practice of health care professionals towards safe injection practice
and needle stick injury is highly prevalent in the study area. Hence,
provision of short term refresher trainings to the health care professionals
to prevent transmission of infection in a clinical setting is needed.
Disclosure of interest: None declared.

O29
O029: Reporting and case management of bloodborne pathogen
exposures among health care workers in Tanzania
M Lahuerta1,2*, D Selenic3, G Mwakitosha1, J Hokororo4, H Ngonyani4,
G Kassa1, R Mbatia5, SV Basavaraju3, C Courtenay-Quirk3, Y Liu3, D Simbeye6,
K Kazura6, G Antelman1, N Bock3
1
ICAP-Columbia University, Mailman School of Public Health, USA;
2
Department of Epidemiology, Mailman School of Public Health, Columbia
University, New York, USA; 3Divisions of Global HIV/AIDS, Centers for Disease
Control and Prevention , Atlanta, USA; 4Ministry of Health and Social Welfare,
Dar es Salaam, Tanzania, United Republic of; 5Tanzania Health Promotion
Support (THPS), Dar es Salaam, Tanzania, United Republic of; 6US Centers for
Disease Control and Prevention, Dar es Salaam, Tanzania, United Republic of
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O29
Introduction: In sub-Saharan Africa, bloodborne pathogens exposure (BPE)
is a serious risk to health care workers (HCW). Reporting BPE is necessary for
effective post-exposure prophylaxis (PEP), an important element of
workplace safety in health facilities. Limited data are available on factors
associated with BPE reporting among HCW.
Methods: We conducted a cross-sectional study assessing experiences of
occupational BPE, history of BPE reporting, and use of PEP among health
care workers at three public hospitals in Tanzania. From August to
November 2012, HCW were interviewed using Audio-Computer Assisted
Self-Interview. All HCW at risk for BPE were invited to participate. Factors
associated with reporting BPE were identified using logistic regression.
Results: Of the 1,102 eligible HCW, 973 (88%) completed the interview. Of
these, 690 (71%) were female and 387 (40%) were nurses. Of 357 HCW who
had a BPE in the past 6 months, 120 (34%) reported it. Among these 120
reported exposures, 93 (78%) HCW reported within 2 hours of exposure, 98
(82%) received pre- and post-HIV test counseling, and 70 (58%) were offered
PEP; 68 (97%) of these 70 HCWs completed PEP. Independent risk factors
associated with reporting BPE were being female (adjusted odds ratio (AOR)=
2.0 [95% confidence interval (CI) 1.2-3.5), having ever-received BPE training
(AOR=2.0, CI 1.2-3.5), knowledge that HCW receive PEP at another facility
(AOR=2.6, CI 1.5-4.4) and HIV testing within the past year (AOR=2.3, CI 1.2-4.4).
Conclusion: Despite the significant proportion of HCW with a recent BPE,
only one in three reported it. Our results highlight the importance of
appropriate and continuous training on the prevention and reporting of
occupational exposures to increase acceptance of HIV testing after BPE.
Disclosure of interest: None declared.

O30
O030: Towards patient safety: health care professionals knowledge,
attitude and practice of safe injection in public hospitals in Mekelle,
Tigray, North Ethiopia
HB Gebru
Nursing, Mekelle University, Mekelle, Ethiopia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O30
Introduction: Safe injection in health facilities is a major health providers,
patients and community problem. Health workers are at risk especially those
in clinical practice.
Objectives: The aim of this study was to assess knowledge, attitude and
practice of health care providers on safe injection.
Methods: This was an institution based study conducted from May June,
2011 using simple random Sampling method. The data was collected by
Nurses using a questionnaire, analyzed by SPSS version 16 and results are
presented in tables and figures.
Results: A total of 189 health care providers were interviewed and only 161
(85%) have knowledge about unsafe injection practice can lead to risks,

O31
O031: Reprocessing of single-use hemodynamic catheters in
cardiology-we do but how best to do it
R Rao*, R Mani, Infection Control Sisters
Microbiology, Apollo Hospital, Jubilee Hills, Hyderabad, India
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O31
Introduction: Hemodynamic single use devices (SUD) namely cardiac
catheters are reused worldwide and in India, where cost and aggressive
intervention take priority over infection prevention, is no exception. An
important issue associated with the reprocessing of any SUD is the potential
for subsequent transmission of infectious agents.
The reprocessing and sterilization methodology of reuse of SUD is often left
to the discretion of the nursing staff (the clinicians do not play any role). The
concerned staff often put the process best they know or is passed on by the
predecessors. Safety, sterility issues are overlooked.
Objectives: To evaluate reprocessing and sterilization methodology. To
develop guidelines and oversee their implementations that result in
standardized practices and improve the safety of hemodynamic device reuse.
Methods: Infection Control team took over the responsibility of the process
initially by a small pilot study. A robust cleaning and sterilization processes
protocol based on basic microbiological principles was developed and tested
for bacterial, viral and endotoxin reminants before using on patients. Initially
twenty cardiac angiogram patients (consent was taken) were followed up for
three months for any adverse events with reuse policy in place. Clinicians
feedback was taken and modification made in the process at the end of
study. It was extended it to a full fledged protocol and implemented.
Results: This system is in place for the past 5 years and there are no
adverse events reported on follow up (over 8000 angiograms so far). The
facility does 12 angiogram per day and reuse is 75%. The protocol
implementation has resulted in determining the number of times each
catheter can be reused. The process is continuously audited and compliance
to the protocol is 100%. The steps for repossessing are easy, adaptable,
outcome measurable, sustainable and cost effective in resource limited
settings.
Conclusion: SUD is reused rampantly. No standard guidelines are
available. The reprocessing is left to the staff who are ill informed of the
consequences of reuse. The reprocessing should be based on sound
microbiological and infection prevention principles and implementable.
Frequent audit and follow up of patients is essential.
Disclosure of interest: None declared.

O32
O032: Patient safety improvement in 14 african hospitals through
partnerships: learning, doing and catalysing change
SB Syed1*, J Storr2, JD Hightower3, R Gooden2, S Bagheri Nejad1, E Kelley1
1
WHO Patient Safety, World Health Organization, Geneva, Switzerland; 2African
Partnerships for Patient Safety, World Health Organization, London, UK; 3African
Partnerships for Patient Safety, World Health Organization, Harare, Zimbabwe
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O32
Introduction: The 58th WHO African Regional Committee in 2008 called
for action in 12 patient safety action areas, including infection prevention

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and control (IPC). Hospital-to hospital partnerships is a mechanism utilized


by the WHO African Partnerships for Patient Safety to respond to this call,
linking policy to local action in 14 African and 3 European countries.
Objectives: Define how a partnership based approach can be utilized to
catalyze patient safety improvement in African hospitals.
Methods: Programme review of WHO African Partnerships for Patient
Safety to capture key transferable lessons. The focus of the examination
was on key parameters of partnership functioning to improve patient
safety.
Results: Seven key parameters of partnership functioning were identified.
First, co-developing a partnership definition is critical to a strong balanced
and effective partnership involving hospital teams. Second, systematic
step-wise improvement necessitates a patient safety situational analysis
that can be periodically repeated by the hospital team to track progress.
Third, structural determinants of patient safety, for example availability of
alcohol based hand rub, needs to be considered alongside training. Fourth,
north-south partnership mechanisms need to be supported through
strong south-south linkages to build African capacity. Fifth, IPC and
specifically hand hygiene can be a tangible entry point for action on
patient safety in African hospitals. Sixth, partnership improvement
activities need to be aligned with national quality improvement frameworks to have a catalytic effect in national systems. Finally, recognition of
culture and context are critical considerations in an effective and mutually
beneficial partnership.
Conclusion: Early programme implementation has focused on learning and
doing at the same time. The urgency of patient safety in African hospitals
negates the possibility of lengthy project design phase. Multiple codeveloped resources and tools are now available that can be utilized by any
hospital-to-hospital partnership focused on patient safety. A technical
platform now allows hospital partnerships to join a global community to
learn, do and catalyse change, together.
Disclosure of interest: None declared.

prevalent patients. A sensitivity analysis is necessary to assess the robustness


of this finding to our assumptions.
Disclosure of interest: None declared.
Reference
1. Ann Intern Med 2012, 157(12):837-845.

O33
O033: Is MRSA inpatient transmission driving high MRSA hospital
importation in the US veterans affairs?
M Jones1*, K Khader1, B Huttner2, A Huttner2, C Nielson3, M Rubin1,
M Samore1
1
Epidemiology, VA Salt Lake City HCS, Salt Lake City, USA; 2Infection Control
Program, Geneva University Hospitals and Faculty of Medicine, Geneva,
Switzerland; 3Veterans Affairs Reno Medical Center, Reno, USA
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O33
Introduction: The prevalence of methicillin-resistant Staphylococcus aureus
(MRSA)-carriage among hospital admissions (importation) is high in United
States Veterans Affairs (VA) hospitals when compared to published studies
from other settings. We investigated whether inpatient transmission alone
could explain this finding.
Methods: We used retrospective clinical data from 112 VA hospitals to
calibrate a stochastic compartmental simulation model. We modeled a
typical VA hospital with 70 beds and its surrounding community with 38,000
enrolled Veterans. The model consisted of 6 patient statessusceptible and
colonized individuals who had never been hospitalized, were currently
hospitalized, or had a history of hospitalization. Admission, length of stay,
inpatient acquisition rates, and mortality rates were calibrated to observed
data for MRSA-positive and negative populations. The relative rate of
admission of MRSA-positive to negative populations was set to 1.2, based
on the relative rate of readmission. Importation among first time admissions
was 6.8%; overall it was 10.5%. Readmission rates were calibrated to reflect
15% 30 day readmission [1]. We compared a base-case scenario assuming
5% assumed MRSA prevalence among new Veterans entering the
population and a scenario without inpatient transmission. Each scenario was
run 200 times.
Results: In the base-case scenario, the median importation was 10.2% (IQR
9.7-10.8%), the median outpatient prevalence was 5.0%, and the median
outpatient acquisition rate was 1.5/100,000 person-years. Without inpatient
transmission, the median importation dropped to 3.5% (IQR 3.3-3.6%).
Conclusion: Dynamic theory predicts that discharge prevalence, outpatient
transmission, and readmission rates influence importation. This modeling
study demonstrated a large impact of inpatient transmission on MRSA
importation prevalence when other factors were held constant. It appears
plausible that the high importation prevalence observed in VA hospitals
may be attributed to the nosocomial acquisition and readmission of

O34
O034: Regional trends in enterobacteriaceae extended-spectrum betalactamase-producing (ESBLE) and methicillin-resistant staphylococcus
aureus (MRSA) between 2007 and 2011
I Arnaud1*, O Bajolet1, X Bertrand1, H Blanchard1, E Caillat-Vallet1, C Dumartin1,
M Eveillard1, T Fosse1, N Garreau1, O Hoff1, N Marty1, S Maugat2, E Reyreaud1,
A Savey1, H Snchal1, L Simon1, E Sousa1, D Trystram1, B Coignard2, V Jarlier1,
P Astagneau1
1
CClin-ARlin, France; 2InVS, Paris, France
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O34
Introduction: In France, for many years, MRSA infections have been
decreasing whereas ESBLE (especially E. coli) infections have been increasing
since 2006 inducing a specific national guideline for the prevention of ESBLE
published in 2010.
Objectives: The aim of this work is to illustrate the evolution of the
regional incidences of MRSA and ESBLE between 2007 and 2011.
Methods: A cohort of 454 Health care facilities (HCF) from 2007 to 2011 is
issued from the national monitoring network of multidrug resistant bacteria
in hospital (BMR-RAISIN) implemented since 2002. HCF participated within a
3 months survey period on a voluntary basis. Strains were isolated from
sample issued for diagnostic purposes (a single strain of the same species
per patient). Incidences of MRSA and ESBLE stratified by region were
calculated per 1,000 patient-days (PD) from 2007 to 2011. An Univariate
Poisson regression was used to estimate temporal trends.
Results: From 2007 to 2011, 454 HCF participated each year in BMRRAISIN network: 377 HCF with acute care unit (ACU), 165 with intensive
care unit (ICU), and 354 with long-term care unit (R-LTCF). In almost all
French regions (with more than 2 HCF participant), incidences of MRSA/
1000 PD decreased significantly from 0.51 to 0.39 between 2007 and
2011 (p=10-3).
Overall incidences of MRSA decreased from 0.67 to 0.50 in ACU, from 1.75
to 1.04 in ICU and from 0.31 to 0.23 in R-LTCF. At the same time, EBLSE/
1000 PD incidences increased significantly (p = 10 -3 ) for all French
regions from 0.24 to 0.50 globally, from 0.32 to 0.65 in ACU, 1.16 to 1.91
in ICU and from 0.14 to 0.28 in R-LTCF.
Conclusion: Although the decrease of the MRSA incidences is
encouraging, ESBLE incidences continue to increase strongly despite
control efforts in all French regions between 2007 and 2011. This steady
increase must incite implementation of HCF to upgrade their preventive
recommended measures, in particular for contacts precautions and
excreta management.
Disclosure of interest: None declared.

O35
O035: Third federal state wide survey on MRSA management in North
Rhine-Westphalian hospitals
A Jurke1*, R Kck2, AW Friedrich3, R Kmmerer4, I Daniels-Haardt5
1
Infectiology and Hygiene, NRW Centre of Health, Germany; 2Institute of
Hygiene, University Hospital Mnster, Mnster, Germany; 3Dept. of Medical
Microbiology and Infection Prevention, University Medical Center Groningen,
Groningen, The Netherlands; 4North Rhine Westphalian Ministery of Health,
Emancipation, Care and Age, Dsseldorf, Germany; 5Health Protection, Health
Reporting, NRW Centre of Health, Mnster, Germany
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O35
Introduction: Staphylococcus aureus (S. aureus) is a major cause of
healthcare-associated infections. In Germany in 2011, about 18.2% of
S. aureus from blood cultures were methicillin-resistant (MRSA).
Objectives: In 2011, the Ministry of Health, Emancipation, Care and Age of
North Rhine-Westphalia (NRW), initiated the third federal state wide survey
in hospitals to inspect the MRSA-management and implementation of the
recommendations of the German national Commission for Hospital Hygiene
and Infection Control (KRINKO).
Methods: All hospitals were requested to submit the number of MRSA
cases per 1,000 patient-days, the number of colonisations or infections,

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stratified in imported or nosocomial, the proportion of MRSA isolates in


all S. aureus isolates from blood cultures and the number of blood culture
samples taken in the year 2011. In addition, the implementation of the
KRINKO recommendations in the hospitals has been assessed by local
health authorities.
Results: The response rate was 97.8%; 92.7% of the 315 hospitals
provided analyzable data.
The mean MRSA incidence density was 2.59 per 1,000 patient days; the
median was 1.35 with quartiles of 0.89 and 1.99. In 254 hospitals a mean of
21.0% (median 18.0%, quartiles of 5.9 and 27.0) of all S. aureus detected in
blood cultures were MRSA. The hospitals screened in average 21.1%
(median 12.0, lower and upper quartiles of 4.8 and 29.7.) of all patients on
admission for the carriage of MRSA. The local health authorities appraised,
that 85% of the responding hospitals have been adequately addressed the
national health recommendations.
Conclusion: The data give insight in MRSA prevalence and management
of hospitals providing service to 18 million inhabitants. The study has led
to a greater awareness about MRSA in regional hospitals and revealed the
progress achieved since 2006. Since 2006 the mean screening rate has
nearly quadrupled and the mean MRSA incidence density increased by
36%. The implementation of the KRINKO recommendations must be
improved further as well as the data quality. The survey is a pragmatic
instrument to monitor the MRSA prevention and control measures in
hospitals in a federal state.
Disclosure of interest: None declared.

None declared, D. Blanc: None declared, G. Coombs: None declared,


G. Daikos: None declared, B. Dhawan: None declared, J. Empel: None
declared, J. Etienne: None declared, A. Figueiredo: None declared, G. Golding:
None declared, L. Han: None declared, L. Hoang: None declared, H. Kim: None
declared, R. Kck: None declared, A. Larsen: None declared, F. Layer:
None declared, J. Lo: None declared, T. Maeda: None declared, M. Mulvey:
None declared, A. Pantosti: None declared, T. Saga: None declared,
J. Schrenzel Consultant for bioMrieux, A. Simor Grant/Research support from
Pfizer Canada, Speakers Bureau of Pfizer Canada, Novartis, and Sunovion, R.
Skov: None declared, M. Van Rijen: None declared, H. Wang: None declared,
Z. Zakaria: None declared, S. Harbarth Grant/Research support from B. Braun,
Pfizer and the European Commission (MOSAR network contract LSHP-CT2007-037941), Speakers Bureau of bioMrieux and Pfizer, Consultant for
Destiny Pharma, DaVolterra and bioMrieux.

O36
O036: Antibiotic resistance and molecular epidemiology of panton
valentine leukocidin positive methicillin-resistant staphylococcus
aureus (PVL+-MRSA): an international survey
M Macedo-Vinas*, J Conly, P Francois, R Aschbacher, D Blanc, G Coombs,
G Daikos, B Dhawan, J Empel, J Etienne, A Figueiredo, G Golding, L Han,
L Hoang, H Kim, R Kck, A Larsen, F Layer, J Lo, T Maeda, M Mulvey,
A Pantosti, T Saga, J Schrenzel, A Simor, R Skov, M Van Rijen, H Wang,
Z Zakaria, S Harbarth, PVL+-MRSA Global Survey
PVL+-MRSA Global Survey Study Group, Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O36
Introduction: PVL is usually associated with non multiresistant communityacquired MRSA. However, the epidemiology of PVL+-MRSA is changing.
Objectives: We describe the resistance patterns and molecular epidemiology
of PVL+-MRSA isolates from 17 countries around the world.
Methods: Retrospective laboratory-based survey from 2008 to 2010.
Participating countries (Australia, Brazil, Canada, China, Denmark, France,
Germany, Greece, Hong Kong, India, Italy, Japan, Korea, Malaysia, Netherland,
Poland, Switzerland) reported on susceptibility to 10 non-beta-lactam
antibiotics and MLST and/or spa typing of PVL+ MRSA isolates. A selection of
49 isolates were analysed by MLVA.
Results: Overall, susceptibility data of 3236 was reported. The lowest
susceptibility was observed for erythromycin in all regions (17.3% in the
Americas and 60% both in Europe and Asia&Oceania). Vancomycinintermediate isolates were reported from Hong Kong and The Netherlands.
Multiresistance (3 or more non-beta-lactams) was reported from all regions.
Isolates belonged to 8 clonal complexes. ST30 was reported worldwide,
being the most frequent type in Brazil and Asia. ST8 was the most frequent
in Canada. In Europe, ST80 and ST8 were both reported in the first place. Six
major clusters were discriminated by this method, showing a certain
geographic specificity and agreement with MLST.
Conclusion: PVL+-MRSA remains frequently susceptible to non-beta-lactam
agents, with in vitro activity of vancomycin, rifampicin, cotrimoxazole and
linezolid. However, multiresistant isolates were reported from all regions.
Our results are in agreement with recent observations that suggest that
USA300 and related clones are gradually replacing the European ST80 clone.
It is imperative to continue monitoring susceptibility patterns and molecular
epidemiology of MRSA to provide clinicians with the most up-to-date
information.
Disclosure of interest: M. Macedo-Vinas: None declared, J. Conly Grant/
Research support from Alberta Heritage Foundation for Medical Research,
the Canadian Institutes for Health Research and Pfizer, Speakers Bureau
of Janssen-Ortho and Pfizer, Consultant for Canadian Agency for Drugs
and Technologies in Health , P. Francois: None declared, R. Aschbacher:

O37
O037: Prevention of Staphylococcus aureus infection in NICU: routine
microbiological surveillance and decolonization
R Richtmann, SR Baltieri*, CDA Silva, FB Mello, TT Rodrigues
Hospital e Maternidade Santa Joana, Sao Paulo, Brazil
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O37
Introduction: Staphylococcus aureus colonization is a risk factor for
endogenous staphylococcal infection in vulnerable neonates. Several studies
describe prophylactic measures for adult population, but very few
recommendations are establish for neonatal intensive care unit (NICU). After
detecting an increase in severe S. aureus infection in the NICU, the present
study has the objective to check if a bundle of measures to decrease
S. aureus colonization in NICU babies have impact in reducing infection.
Methods: Prospective cohort from May/2011 to April/2012 (Period 2-P2) in
a 70 beds Brazilian NICU. Weekly nasal swab to detect S. aureus colonization
in all newborn admitted to the NICU and under intravascular catheter
(peripheral or central) e/or mechanical ventilation. If positive culture, they
were submitted to decolonization with nasal mupirocin ointment topical
and oral hygiene with chlorhexidine 0.12% solution for 7 days. A nasal swab
investigation after decolonization was performed as treatment control and if
it persists positive a second decolonization treatment was indicated. Contact
and droplet precautions were used to the methicillin resistant S. aureus
(MRSA) colonized neonates. The S. aureus infection rate was compared to
the previous year (Period 1-P1: from April 2010 to April 2011).
Results: Both neonatal population in different periods presented similar
device utilization ratio. On P1, 820 neonates were included, 28 (3.4%)
presented S.aureus infection, 17 (2.0%) by MRSA and 11 (1.3%) by methicillin
sensitive (MSSA). On P2 (after bundle implementation), 1012 neonates were
analyzed, S. aureus were diagnosed in 14 (1,3%), 5 (0.4%) MRSA (p=0.03) and
9 (0.8%) MSSA (p=0.37), in comparison to P1. The colonization rate on P2
was 3.4% for MSSA and 5.3% for MRSA. There was no increase of infection
related to other microorganisms. There was no adverse event related to the
decolonization procedures.
Conclusion: The S. aureus bundle including decolonization was effective
in decreasing infection in the NICU babies, especially for MRSA infection.
The impact on MSSA infection was lower. There was no microorganism
replacement phenomenon.
Disclosure of interest: None declared.

O38
O038: Automated/electronic systems for hand hygiene monitoring:
a systematic review
L Arnoldo1, D Pittet2, J Boyce3, H Sax4, B Allegranzi5*
1
University of Udine, Udine, Italy; 2University of Geneva Hospitals, Geneva,
Switzerland; 3Yale-New Haven Hospital, New Haven, USA; 4Zurich University
Hospitals, Zurich, Switzerland; 5World Health Organization (WHO), Geneva,
Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O38
Introduction: Automated/electronic monitoring systems (AEMS) of hand
hygiene (HH) indicators are now available.
Objectives: We evaluated technologies used and evidence regarding their
validity, suitability for use and advantages compared to gold standard
methods.

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Methods: We conducted a systematic review of the literature searching


the Cochrane Library, PubMed and EMBASE up to Feb. 2013, with no
language or time restriction. All studies (observational & interventional)
using AEMS were selected.
Results: The search yielded 341 abstracts. Of 29 selected articles, 19 were
included in the review. Of these, 17 studies were conducted in high-income
countries, mostly in teaching hospitals (11). Technologies used were:
automated count dispensers (7); automated count dispensers associated
with either system detecting entries/exit (5) or electronic personal badge (2),
or system activated by the nurse (1); electronic personal badge for alcohol
vapor detection (2) or entries/exits detection (1); video systems (2). In
studies evaluating HH compliance (9), standard definitions of opportunities
for HH (OHH) were used in 1 study only. Types of OHH were: room entry
and/or exit (10) and WHO Moments 1 and 4 (1). Among studies comparing
HH compliance measured by AEMS with direct observation (6), 2 evaluated
the concordance between methods (95% and 64%).
Conclusion: Strengths of AEMS are the possibility of continuous monitoring
and automatic data download and analysis, mitigation of the Hawthorn
effect and minimal requirement of human resources. Limitations of AEMS
tested were lack of standard definitions of OHH, and inability to identify
healthcare workers and to evaluate HH technique and glove use. Most AEMS
did not measure HH compliance and limited evidence is available to validate
their use compared to direct observation. Finally, their cost-effectiveness
remains unknown and suitability for use in settings with limited resources is
unlikely. These new technologies are promising, provided that they reflect
the WHO 5 moments for HH, but additional research is needed to support
their adoption as a standard.
Disclosure of interest: None declared.

Conclusion: PP with PF may offer a means of improving HH compliance


beyond standard multimodal promotion.
Disclosure of interest: None declared.

O39
O039: Patient participation and performance feedback to improve hand
hygiene adherence in the context of established multimodal hand
hygiene promotion: initial results from a mixed-methods, cluster
randomised trial
AJ Stewardson1*, A Gayet-Ageron1, S Touveneau1, L Clack2, M Schindler3,
W Zingg4, M Bourrier3, D Pittet1, H Sax2
1
The Univ. of Geneva Hosp. and Fac. of Medicine, Geneva, Switzerland;
2
Univ. and University Hosp. of Zurich, Zurich, Switzerland; 3Univ. of Geneva,
Geneva, Switzerland; 4University of Geneva Hospitals and Faculty of
Medicine, Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O39
Introduction: Hand hygiene (HH) compliance amongst healthcare workers
is widely recognised as a key intervention in infection control. Given HH
compliance remains sub-optimal despite standard multimodal promotion,
there is an urgent need for evidence regarding the effectiveness of novel
interventions.
Objectives: To investigate the impact of optimised performance feedback
(PF) and patient participation (PP) on HH compliance in the setting of a wellestablished multimodal HH promotion program.
Methods: Single-centre, cluster-randomised controlled trial. After a 15month baseline phase from April 2009, 66 wards were allocated by stratified
randomisation to one of three arms during a 24-month intervention phase:
control; PF; or PF+PP. Multimodal promotion continued in all three arms. PF
was provided via cards, posters and emails. PP involved a partnership
whereby healthcare workers and patients agree to remind each other to
perform HH. The primary outcome was HH performance measured using the
WHO My 5 Moments methodology and analysed using a mixed effect
logistic regression model. Qualitative data was gathered by focus groups
and interviews with healthcare workers.
Results: Twelve observers recorded 12,627 HH opportunities during 1,358
sessions. HH compliance was similar between arms at baseline and
increased in all three arms during the intervention phase (P=0.04): 65% to
73%, odds ratio 1.36 (CI95% 1.17-1.59); 64% to 74%, OR 1.59 (1.39-1.81); and
64% to 76%, OR 1.77 (1.54-2.04), respectively, in control, PF and PF+PP arms.
Only PP+FB showed a significant effect on HH compliance in our trial (OR
1.33, P=0.04), with PF alone not sufficient (OR 1.17, P=0.25). Qualitative data
showed that acceptance and implementation of PP was gradual, variable
and primarily dependent on ward leadership. Exclusion from intervention
arms motivated control wards to improve HH performance independently.

O40
O040: The effect of improved hand hygiene compliance on nosocomial
transmission of Staphylococcus aureus
V Weterings1*, JV Esser2, RV Etten2, J Kluytmans1,3
1
Microbiology and Infection control, the Netherlands; 2Internal medicine,
Amphia hospital, Breda, the Netherlands; 3Microbiology and Infection
control, VUMC, Amsterdam, the Netherlands
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O40
Objectives: The objective of this prospective interventional study was to
observe the effect of improved hand hygiene compliance(HHC) on
nosocomial transmission of S.aureus between patients.
Methods: The study was conducted between Oct 2011 and Dec 2012 in the
oncology ward of a Dutch Teaching Hospital and contained multiple
consecutive interventions: [I] increase number of hand alcohol dispensers;
[II] education on HH; [III] replacing standard hand alcohol and soap
dispensers by new automated dispensers, no feedback was given;
[IV] personal feedback of HHC.
HHC was manually monitored according to the WHO method, twice a
week during the whole study period. All patients were cultured weekly to
detect nasal carriage of S.aureus. Isolates collected in period [II] and [IV]
were typed using Amplification Fragment Length Polymorphism (AFLP).
The ratio between secondary and primary cases, Transmission Index (TI),
was calculated.
Results: The HHC improved significantly from 31.5%(92/302;CI 25.3-36.0)
in period [II] to 52.9%(139/263;CI 46.6-59.0) in period [IV] (p<0.001).
In period [II] 266 patients were hospitalized on the days of culture; 246 nasal
swabs (92.5%) were collected from 151 unique patients. In total 42/151
patients (27.5%) were S. aureus carriers. AFLP revealed 6 unrelated isolates
and 13 clusters (2-14 isolates, median 3). Number of primary cases (PC) was
19. Transmission of S.aureus from a PC to other patients occurred in 10 out
of 19 (52.6%) PC, resulting in 22 secondary cases (SC). TI of 1.2(22/19).
In period [IV] 314 patients were hospitalized on the days of culture; 268
nasal swabs (85.4%) were collected from 134 unique patients. In total 45/
134 patients (33.6%) were S. aureus carriers. AFLP revealed 16 unrelated
isolates and 9 clusters (2-7 isolates,median 3). Number of PC was 25.
Transmission of S.aureus from a PC to other patients occurred in 9 of 25
(36.0%) PC, resulting in 17 SC. TI of 0.7(17/25).
The ratio of unique versus clustered strains was significantly higher in
period IV (p=0.028).
Conclusion: An improvement of HHC from 31.5% to 52.9% (RR:1.68) was
associated with a 32% reduction of the TI. This study shows that
improvement of HHC using automatic dispensers with personal feedback
reduces the transmission of S.aureus in the hospital substantially.
Disclosure of interest: None declared.
O41
O041: Overcoming hand hygiene campaign fatigue by an effective
innovation involving the infection control link nurses
CWY Cheung1*, SK Luk1, WS Yuen1, YY Wong1, SS Lau1, KH Li2, PTY Ching1,
WH Seto3
1
Infection Control Team, Hong Kong Baptist Hospital, Hong Kong, China;
2
Infection Control Team, Hong Kong Baptist Hospital; Pathology Department,
Hong Kong Baptist Hospital, Hong Kong, China; 3Infection Control Team, Hong
Kong Baptist Hospital; Pathology Department, Hong Kong Baptist Hospital;
WHO Collaborating Centre for Infection Control, Hospital Authority, Hong Kong,
China
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O41
Introduction: Hand hygiene was introduced in the 850-bed Hong Kong
Baptist Hospital (HKBH), using the promotional techniques recommended by
the WHO including a formal kick-off signing ceremony, hospital-wide posters,
talks and use of role models. Significant improvement in compliance was
observed in 2008 from 41% to 58% (p<0.01). Subsequently from 2009 to
2011, it remained below the 55% level in spite of various promotional
activities. This might be related to campaign fatigue.

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Objectives: To improve hand hygiene compliance with the involvement


of ICLNs.
Methods: HKBH has 99 infection control link nurses (ICLNs) in 26 clinical
areas and from these focus groups were formed. These identified four
key deficiencies and for each a program was implemented to resolve
with the help of the ICLNs:
1. Help your doctors for excellence in Hand Hygiene: ICLNs reverse the
low compliance amongst doctors, the accompanying nurses would squirt
alcohol hand rub for them during ward rounds.
2. Competition for Speaking Walls poster: ICLNs helped their own
ward to produce self-made posters, as the present reminders were
deemed ineffective. It was believed that self-designed posters would
have a better effect.
3. Identification locations for Point-of-care hand rubs: ICLNs reported
that there were strategic locations without hand rub facilities. 22 such
locations were identified.
4. Hand Hygiene education program and daily checklist for health
care assistants (HCAs): This was implemented by the ICLNs for the
reduction in compliance for HCAs is the highest.
Results: After implementing the four programs, the hand hygiene
compliance rate increased to 83% in 2012 (n=1743, CI 81-85%), which is
significant (p<0.01) compared to 2009-2011. The alcohol hand rub
consumption showed a similar trend in 2012, increasing from 8.1L per
1000 patient-days in 2011 to 9.1L in 2012.
Conclusion: The strategies described could optimize the end users
participation as not only were ideas extracted from the ICLNs but they also
helped in implementing their own ideas. New innovations are vital as
Hand Hygiene has been introduced now for a long time and campaign
fatigue is likely to occur.
Disclosure of interest: None declared.

5-moments for HH can be applied in the TCM practices. Tool kit and
education for TCM practitioners will be developed. Further studies and
pilot implementation will be conducted.
Disclosure of interest: None declared.

O42
O042: Study on adopting the WHO 5-moment of hand hygiene for
practices in traditional Chinese medicine (TCM) clinics
P Ching
Hong Kong Baptist Hospital, Hong Kong, Hong Kong
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O42
Introduction: Hand hygiene (HH) is effective to prevent nosocomial
infections in healthcare settings. However, the application of the WHO
5-moment for HH in TCM practices has not been reported. This study
was performed to explore the feasibility of applying the WHO 5moments for HH using alcohol-based handrub (ABHR) in TCM clinics.
The objectives were to study when HH should be practiced, the
feasibility of adopting the WHO 5-moments and the practicality of
using ABHR in TCM practices.
Methods: The clinic was visited to interview TCM practitioners and to
understand the different practices performed and the extent of skin and
blood and body fluid contacts during TCM practices. Direct observation of
practices and videos on each procedure were performed to comprehend HH
opportunities and assess the possibility of adopting the 5-moments. The
frequency of HH action per hour and the need for personal protective
equipment were estimated. Possible placement of AHR was identified.
Results: The patient care and treatment practices in the TCM are different
from western medicine and include: visit to a TCM practitioner, acupuncture
with electric stimulation, moxibustion, cupping, and massage. TCM
practitioner consultation, cupping and massage only involve skin contact
and moment 1 and 4 are required. Acupuncture and moxibustion may
cause limited blood exposure and moments 1, 3, 4 and 5 of HH are required
after glove removal. Acupuncture, moxibustion and cupping require HH
when applying related devices and upon removal. Practitioner consultations
might need 3-4 HH actions per hour. Other treatments duration last 30 to
60 minutes and thus HH frequency is 1-2 times per hour. ABHR can be
conveniently placed at couch and treatment trolley for use.
Conclusion: The study demonstrates that TCM include 5 treatment
practices that are different from western medicine. Limited blood
exposures would occur during acupuncture and moxibustion while
moments 1, 3, 4 & 5 are frequently recorded. The HH opportunities range
from 2 to 4 per hour and are practicable. This preliminary study
anticipated that HH using ABHR is doable in TCM clinic and WHO

O43
O043: Early adaptors of a hand hygiene control system
A Lehotsky1*, M Nagy2, P Rona3, L Szilagyi3, G Weber1, T Haidegger4
1
Department of Surgical Research and Techniques, Semmelweis University,
Hungary; 2Clariton Ltd, Budapest, Hungary; 3Dept. of Control Engineering and IT,
Budapest University of Technology and Economics, Budapest, Hungary; 4Austrian
Center for Medical Innovation and Tehnology, Wiener Neustadt, Austria
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O43
Introduction: Ignaz Semmelweis discovered the importance of hand
hygiene in 1858, and 150 years later, it was the Semmelweis University (SU)
in Budapest that first adapted a digital tool to effectively teach proper hand
disinfection technique. The Department of Surgical Research and Techniques
at SU began to employ a UV dye-based, computer-imaging empowered
device after it received the 1st ICPIC Innovation Academy Award.
Objectives: To introduce objective hand hygiene control in the early
stage of medical education.
Methods: The training of 3rd year MD students at SU starts with the
theoretical and practical education of hand disinfection; their performance is
assessed early in and at the end of the semester. In the end, all students
must proof a perfect hand rubbing to qualify for exams. First in 2011, 377
students were tested and next year, 281 students took part. The hand
rubbings were imaged, recorded, and subsequently analyzed to identify
error patterns in coverage. Moreover, comparable results from a week-long
trial in 2011 from the National University Hospital Singapore (NUH) were
also acquired, involving 95 students.
Results: 67% of students completed the rubbing perfectly at first in 2011,
while 64.5% passed in the following year. Most errors occurred on the back
of the hand, at the tips and the thumb, these responsible for 55% and 52%
of errors in 2011 and 2012, respectively. Singapore students presented a
60% pass rate. Failed students were redirected for education, to acquire a
better hand hygiene practice.
Conclusion: Through objective testing, a clear quality feedback was
provided to students. This helped them to correct their errors and should
lead to improved practice regarding safe patient care. Participants reported
highly positively about the use of the digital assessment system.
Furthermore, the device has been employed at major public outreach event
with great success, attracting several hundred visitors at the hand hygiene
booth.
Disclosure of interest: None declared.
Reference
1. Haidegger T, Nagy M, Lehotsky A, Szilagyi L: An Innovative Device for
Objective Hand Disinfection Control,. Proc. of the 1st Intl. Conf. on
Prevention and Infection Control (ICPIC) Geneva 2011, 5(suppl. 6):25-26.

O44
O044: Provision of alcohol-based handrub products to WHO
regions in 2011
D Pittet1, C Kilpatrick2*, A Belloli3, J Storr2, B Allegranzi2, E Kelley2,
POPS working group1
1
University Hospitals Geneva, Geneva, Switzerland; 2World Health
Organisation, 1211 Geneva, Switzerland; 3Imperial College London,
London, UK
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O44
Introduction: A collaboration between WHO Patient Safety and industry
was established in 2012; Private Organisations for Patient Safety (POPS). One
formal POPS project was undertaken at the end of 2012 to meet the aim of
addressing system change, as part of a multimodal strategy to reduce health
care-associated infections; a survey on the provision of alcohol-based
handrub (ABHR), as this has been proven to increase compliance with hand
hygiene and improve patient outcomes.
Objectives: By undertaking surveys, collate and describe information on
global and regional ABHR sales in the year 2011.

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To provide recommendations on addressing the gaps in availability.


Methods: In Nov 12 a survey in the form of a MS Excel spreadsheet sent
to POPS participants, asked for volume of ABHR liters sold to healthcare
by country and region. Basic analysis allowed for collation of total sales
volumes by country; mapping these to the official WHO regions to allow
for regional totals. Quality checks were undertaken by sharing final totals
with participants and data were anonymised. Median and inter-quartile
ranges for country sales were calculated using MS Excel.
Results: In 2011, the global total of ABHR healthcare sales was 41,827,389
liters. The sales in country ranged from 0 to 16,076,612. Totals by WHO
region were Africa 245,585; Americas 15,246,296; Eastern Mediterranean
747,285; Europe 32,849,769; South East Asia 100,794; Western Pacific
2,288,300. Four ranges of countries have been presented against a world
map.
Conclusion: A number of limitations exist including not all global
distributors of ABHR being involved in the survey, the time period covering
only a single year, no true denominator to base the numerator of healthcare
sales being known, and that healthcare delivery varies between countries.
This information has however provided WHO with key intelligence on the
gaps in availability of a life-saving technology that is contributing to the
global burden of health care-associated infections. Zero sales could mean a
data gap, delivery gap or an unknown factor, however these results provide
a solid starting point for the development of POPS project proposals to
ensure affordable, reliable supplies of ABHR in all countries of the world to
support patient safety.
Disclosure of interest: None declared.

O45
O045: Acquisition of extended-spectrum beta-lactamase (ESBL)
positive E.coli in the community: the impact of cultural
background and diet
R Leistner1*, E Meyer1, P Gastmeier1, P Dem1, Y Pfeifer2, C Eller2, F Schwab1,
The RESET research consortium: Resistance in animals and humans1
1
Institute of Hygiene and Environmental Medicine, Charit Berlin, Berlin,
Germany; 2Nosocomial Infections, Robert Koch Institute, Wernigerode,
Germany
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O45
Introduction: The prevalence of ESBL producing E. coli strains in the
community has strongly risen since recent years. Travel to high endemic
countries has been identified as a risk factor for community-acquired
colonization with these bacteria. Until today further factors influencing
the spread of ESBL in the community have not been sufficiently analyzed.
Objectives: The objective of this study was to assess risk factors for a
community-acquired colonization with ESBL positive E. coli.
Methods: From May 2011 to January 2012 we performed a case control
study at the Charit university hospital Berlin. Cases were defined as
patients diagnosed with ESBL positive E. coli colonization within 72 h after
admission. Controls were patients with ESBL negative E. coli colonization.
Cases and controls with ESBL colonization within the last 12 months were
excluded. In a questionnaire based interview we assessed parameters like
body mass index (BMI), nutritional habits, travel habits, recent hospital
admission, recent use of antibiotics and household situation. We assessed
the impact of cultural background by assessing the patients best mastered
language. ESBL positive strains were further analyzed by PCR to determine
the ESBL genotype at the Robert Koch Institute, Wernigerode. Univariable
and multivariable analysis were performed to identify independent risk
factors for acquisition of ESBL positive E. coli strains.
Results: Within the study period we included 85 cases and 170 controls.
Median age was 67 years (IQR 54-73, p=0.482) 56% of the study
population was male (p=0.714). The most common ESBL genotypes were
CTX-M-1 (44%, n=37) and CTX-M-15 (28%, n=24). Asian mother tongue
(OR=13 4; p<0.001) and frequent pork meat consumption (>2 x per week)
(OR=3.5; p<0.001) were independent risk factors for colonization with
ESBL in the conditional regression analysis.
Conclusion: Patients with cultural background of countries where ESBL is
highly endemic might have a higher risk for colonization with ESBL.
Furthermore the frequent consumption of certain types of meat can be
associated with ESBL colonization. Common ESBL genotypes in the
community are CTX-M-1 and CTX-M-15.
Disclosure of interest: None declared.

Page 15 of 143

O46
O046: Impact of infections due to carbapenem resistant gram
negatives on length of hospitalisation: multi state model approach
G De Angelis1*, B Fiori1, T Spanu1, E Tacconelli2
1
Catholic University, Rome, Italy; 2Universittsklinikum Tbingen, Tbingen,
Germany
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O46
Introduction: Infections caused by gram negative bacteria resistant to
carbapenems (CRGNinf) represent a growing problem in many countries,
with mortality rates reaching 50% in several reports. The economic impact
in term of associated extra length of hospital stay (LoS) is less documented,
with most of evidence relying on case-controls studies in intensive care unit.
Objectives: Multistate modelling has been reported to offer a precise
estimation of LoS associated to hospital acquired infections, limiting the
effect of bias of observational studies.
Methods: Data of 58,646 patients hospitalised in 2011 at a 1200-bed
tertiary care hospital in central Italy were retrospectively collected.
A multistate model in which the occurrence of CRGNinf was the timedependent exposure and discharge or death was the study endpoint was
designed. The excess LoS associated to CRGNinf was extracted computing
the Aalen-Johansen estimator of the matrix of transition probabilities.
Multivariate Cox regression analysis was used to assess the independent
effect of CRGNinf on excess LoS. Variables for adjustment included
demographic data, co-morbidities and concurrent bloodstream infections.
Results: Ninety-seven CRGNinf were detected (0.2%), 40 (41.2%) associated
with patients death. CRGNinf prolonged LoS by 14.2 days (95% confidence
interval (CI) 8.1-20.2) compared to uninfected patients. The inclusion of
CRGNinf as a time-dependent variable in a multivariate Cox proportional
hazards model confirmed that the occurrence of infection significantly
reduced the hazard of end of hospital stay and consequently prolonged LoS
in hospital compared to uninfected patients (hazard ratio (HR) 0.60, 95% CI
0.49-0.74). When stratifying the analysis by outcome (discharge or death),
CRGNinf was associated with a further reduced risk of discharge from
hospital (adjusted HR 0.39, 95% CI 0.30-0.51) and, in parallel, to a significant
higher risk of end of hospital stay because of death (adjusted HR 3.45, 95%
CI 2.49-4.77).
Conclusion: This is the first multi-state model study to estimate the excess
LoS associated with CRGNinf in a large hospital cohort. The high mortality of
patients suffering this infection does not impact on LoS, which is confirmed
to be significantly longer compared to CRGN uninfected patients.
Disclosure of interest: None declared.

O47
O047: The effect of active surveillance culture of carbapenem resistant
Acinetobacter baumannii on the occurrence of carbapenem resistant
Acinetobacter baumannii bacteremia in a single intensive care unit
G Kim1*, B Oh2, JS Song2, PG Choe3, WB Park3, HB Kim4, N-J Kim3, EC Kim5,
M-D Oh3
1
Internal Medicine, National Medical Center, Seoul National University Hospital,
Seoul, Korea, Republic Of; 2Infection Control Unit, Seoul National University
Hospital, Seoul, Korea, Republic Of; 3Internal medicine, Seoul National University
Hospital, Seoul, Korea, Republic Of; 4Internal medicine, Seoul National University
Bundang Hospital, Seoul, Korea, Republic Of; 5Laboratory medicine, Seoul
National University Hospital, Seoul, Korea, Republic Of
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O47
Introduction: Carbapenem resistant Acinetobacter baumannii (CRAB) is an
emerging pathogen of healthcare associated infection and little is known
about the effectiveness of the active surveillance culture of CRAB.
Objectives: This study aims at evaluating the effect of active surveillance
culture of CRAB upon intensive care unit (ICU) admission on the occurrence
of new CRAB bacteremia in ICU.
Methods: Since February 2011, the active surveillance culture of CRAB
was performed in all patients admitted to medical ICU in Seoul national
university hospital. Contact precaution was applied for the patients who had
positive surveillance culture results. Respiratory specimen were obtained
and the isolates were cultured overnight in blood agar plates which contain
imipenem. To assess the effectiveness of active surveillance culture of CRAB
and contact precaution, the rate of new CRAB bacteremia was compared

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between baseline period (February 2012-January 2011) and intervention


period (June 2011-February 2012). The new CRAB bacteremia case was
defined as the CRAB bacteremia occurred later than 48 hours of ICU
admission in patients without positive CRAB clinical culture in the prior
12 months and within the 48 hours of ICU admission.
Results: In the baseline period there were 242 total admissions to the
ICU(7355 patients-days) and in the intervention period there were 266
total admissions to the ICU(5432 patients-days). During the intervention
period, 21(7.9%) patients showed positive CRAB surveillance culture
results. The rate of new CRAB bacteremia is 2.72 cases per 1000 patientsdays in the baseline period and 0.92 case per 1000 patients-days in the
intervention period (P=0.019).
Conclusion: When active surveillance culture of CRAB and contact
precaution for the patients of positive results were applied in a medical ICU,
the rate of new CRAB bacteremia was lowered and the time betweennew
CRAB bacteremia and ICU admission was lengthened.
Disclosure of interest: None declared.

Introduction: French recommendations for controlling HRB spread


(carbapenemase producing enterobacteriacae [CPE] and vancomycin
resistant enterococci [VRE]) advocate an aggressive search-and-isolate
strategy.
Objectives: We describe the experience of a teaching hospital, adjusting
control measures to the epidemiological risk analysis (EpiRA).
Methods: From 01/2009 to 12/2012, 31 episodes (13 VRE, 16 CPE, 2 VRE+
CPE [13 OXA-48, 3 KPC, 2 NDM1]) have been identified. An EpiRA was
performed : time from admission to HRB+, number of cases, compliance
with standard (SP) and contact precautions (CP), workload (of the index case
(IC), of the ward), nurse-to-patient (Pt) ratio, antibiotic use. Measures were
adapted to the EpiR assessment, from strict CP for a single case to cohorting
with dedicated staff for carriers, contact Pts and newly admitted Pts (3
distinct areas) when secondary cases (SeC) were identified. Initial and weekly
screening of contact Pts was systematically performed.
Results: Pts were initially hospitalised in intensive care (n=8), medical (n=18)
or surgical units (n=5). Length of stay varied from 3 days to 13 month
(median, 20 days). 14 IC were identified within 48 h. following hospital
admission. Strict CP were started for all IC, transfers and new admissions
were stopped in 9/31 episodes, and after the occurrence of SeC for 5 others.
The nursing staff was reinforced in 6 episodes and carriers were cared by
dedicated staff in 3 other episodes, one with 3 distinct areas. SeC were
identified in 9/31 episodes (7 VRE and 2 CPE), with 1 to 5 SeC/episode (18
SeC). 4 VRE IC identified 7 to 60 days after hospital admission generated 1 to
5 SeC (n=12, 3/episode); 3 VRE episodes with strict CP started at hospital
admission generated 4 SeC (1.3/episode). 2 SeC were identified in 2 CPE
episodes, 1 after 31 days and 1 after 72 days.
Conclusion: This experience is the largest reported in France. SeC were
more frequent in VRE (16 in 15 episodes) than in CPE (2 in 18 episodes). Our
data suggest that control measures could be adapted according to EpiRA, if
several conditions are gathered. However, SeC occurred around Pts under
strict CP, highlighting that this strategy should be used prudently.
Disclosure of interest: None declared.

O48
O048: OXA-181-carbapenemase producing Klebsiella pneumoniae: an
emerging threat? The first reported nosocomial outbreak in Singapore
L Alenton1*, MY Hsann2, P Tambyah3, R Lin4, KS Ng1, S Rethanam1, L Poh1,
SL Soong1, SK Pada3,5
1
Infection Control, Alexandra Hospital, Jurong Health Services, Singapore;
2
Epidemiology, Alexandra Hospital, Jurong Health Services, Singapore;
3
Medicine, National University Health System, Singapore; 4Laboratory
Medicine, National University Health System, Singapore; 5Medicine, Alexandra
Hospital, Jurong Health Services, Singapore, Singapore
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O48
Introduction: Carbapenem-resistant Enterobacteriaceae (CRE) are an
emerging global threat. Most outbreaks have been NDM-1 or KPC. We
describe an outbreak of OXA-181-producing Klebsiella pneumoniae in a
275 bedded acute general hospital in Singapore.
Methods: A patient who was managed in a 24 bedded, Male, Geriatric,
Transition & Rehabilitation unit had a blood culture positive for Klebsiella
pneumoniae resistant to Imipenem and Meropenem (MIC 6.000mg/L and
24.000mg/L ) on 24 January 2013. Contact tracing with rectal swabs was
done for all patients in the same cubicle and then ward. The ward and
adjacent gym were closed, CRE patients were isolated in single rooms,
patient areas and bathroom facilities were cleaned and disinfected. Hand
hygiene and isolation education were reinforced to all healthcare staff. All
patients were swabbed during outpatient follow up and during readmission.
The unit was reopened after 12 days when no new cases of CRE were
identified from remaining patient contacts. All positive CRE isolates were
sent to a reference laboratory for further typing.
Results: Two of five (40%) patients who had stayed in the same 6- bedded
cubicle as the index case were found to have CRE. Three of 9 (33%) of the
rest of the ward patients were CRE positive. A further two contacts had CRE
detected in urine specimens 4 days and a week later. Overall, the attack rate
for patients in the same cubicle was 3/6 (50%) and ward was 3/9 (33%).
A screen of the adjacent ward did not identify any CRE patients among 18
screened. All isolates were identical by Pulsed Field Gel Electrophoresis
bearing blaOXA-181.
Conclusion: This strain of OXA-181-producing Klebsiella pneumonia has
clear outbreak potential. Prompt action with strong multidisciplinary
support and the ability to close the affected ward enabled us to contain
this outbreak. Clinicians worldwide need to be alert to the threat of this
emerging nosocomial pathogen.
Disclosure of interest: None declared.

O49
O049: Can the search-and-isolate strategy for controlling the spread of
highly resistant bacteria (HRB) be mitigated?
G Birgand1, I Lolom1, L Armand-Lefevre2, S Belorgey3, E Rupp2,
A Andremont2, J-C Lucet3*
1
Infection control unit, Claude Bernard Hospital, Paris, France; 2Bacteriology
unit, Claude Bernard Hospital, Paris, France; 3Bichat, Claude Bernard Hospital,
Paris, France
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O49

O50
O050: Antibiotics in 70 German intensive care units: risk factors for
high overall consumption
S Schneider*, F Schwab, P Gastmeier, E Meyer
Hygiene and Environmental Medicine, Charite, Berlin, Germany
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O50
Introduction: Due to increasing burden of multidrug resistant organisms
and the lack of new antimicrobial substances prudent use of antibiotics (AB)
becomes more essential than ever before. Surveillance of antimicrobial use
is an important component of AB stewardship.
Objectives: To explore, whether there are certain risk patterns in intensive
care units (ICUs) determining the total AB use.
Methods: We analysed the AB usage of 70 German ICUs in the year
2011. The data were collected in a standardized way within the SARI
(Surveillance of Antimicrobial Use and Antimicrobial Resistance in ICUs)
system. AB use densities (AD) were calculated as daily defined doses
(DDD) per 1000 patient days (pd) for all systemically applied substances.
We performed a stepwise forward multivariable analysis for the total AB
use as binary outcome (total AD <= or > 75. percentile). The following
variables were included: hospital type (university, teaching, other),
hospital size (<= or > 600 beds), ward type (interdisciplinary, surgical,
medical ICU), ward size (<= or > 12 beds), number of used AB
substances, number of used AB groups, ADs of AB treatment groups and
fractions of most used AB groups.
Results: The median number of AB substances was 28 (range 10-36), the
median number of AB groups was 17 (range 920). Median total AB use
was 1285 DDD/1000 pd (range 639-2393). The fraction of the most used
AB group ranged from 13 to 41% of total AB use (median 23%). In
the multivariable analysis the group ADs of third generation (3G)
cephalosporines, macrolides and methicillin resistant staphylococcus aureus
(MRSA) active AB, respectively, were significantly associated with the total
AB use in the logistic regression model. Interestingly, none of the structural
parameters showed a significant association with total AB use.
Conclusion: Diversity of AB usage is great among German ICUs, but
structural parameters do not seem to determine significantly the extent
of total AB use. Rather, usage of certain AB groups (3G cephalosporines,

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Page 17 of 143

macrolides and MRSA active substances) seems to drive the overall


AB consumption. However, whether this is due to certain patient
characteristics or at least partially to imprudent AB use cannot be
answered by our calculations alone and should be further investigated by
complementary methods.
Disclosure of interest: None declared.

Objectives: To explore whether surgical-site infection (SSI) rates are


suitable for comparing hospitals, taking into account case-mix differences
and random variation.
Methods: Data from the national surveillance network in the
Netherlands, on the eight most frequently registered types of surgery
for the year 2009, were used to calculate SSI rates. The variation in SSI
rates between hospitals was estimated with multivariable fixed- and
random-effects logistic regression models to account for random
variation and case mix. Rankability (as the reliability of ranking) of the
SSI rates was calculated by relating within-hospital variation to
between-hospital variation.
Results: Thirty-four hospitals reported on 13 629 patients, with overall SSI
rates per surgical procedure varying between 0 and 15.1 per cent.
Statistically significant differences in SSI rate between hospitals were found
for colon resection, caesarean section and for all operations combined.
Rankability was 80 per cent for colon resection but 0 per cent for caesarean
section. Rankability was 8 per cent in all operations combined, as the
differences in SSI rates were explained mainly by case mix.
Conclusion: When comparing SSI rates in all operations, differences
between hospitals were explained by case mix. For individual types of
surgery, case mix varied less between hospitals, and differences were
explained largely by random variation. Although SSI rates may be used for
monitoring quality improvement within hospitals, they should not be used
for ranking hospitals.
Disclosure of interest: None declared.

O51
O051: European medical students and antibiotic stewardship: a
multicentre survey of knowledge, attitudes and beliefs
OJ Dyar1*, C Pulcini2, P Howard3, D Nathwani4
1
Oxford University, Oxford, UK; 2Centre Hospitalier Universitaire de Nice, Nice,
France; 3Leeds University, Leeds, UK; 4Dundee University, Dundee, UK
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O51
Objectives: To learn about medical students knowledge and perspectives
on antibiotic stewardship.
Methods: Final year students at seven European medical schools
(Dundee, Geneva, Linkping, Ljubljana, Madrid, Nice, Oxford) were invited
to participate in an anonymous online survey in June 2012. Descriptive
statistics are presented here.
Results: The response rate was 35% (322/961). Regarding prescribing
according to stewardship principles, students at all medical schools felt most
confident in diagnosing infections and choosing the right antibiotic, and
least confident in choosing combination therapies, and making the decision
to not prescribe antibiotics in cases of diagnostic uncertainty.
With respect to the success of stewardship efforts thus far, the majority of
students (83%) incorrectly thought MRSA bacteraemia rates had significantly
increased over the past decade in their countries, and a quarter of students
thought that handwashing was not at all an important contributor to
resistance.
Most students (66%) thought the antibiotics they will prescribe will
contribute to resistance, with almost all (98%) acknowledging that
resistance will be a greater problem in the future. Students were aware
that around 30% of antibiotic usage was unnecessary or inappropriate,
with 83% feeling that such prescribing is unethical. Only 65% of students
had been shown how to access their hospitals guidelines. As in previous
single centre studies of both doctors and students, the majority of
students (74%) in our survey still wanted further education on antibiotic
selection.
Conclusion: Most final year students across seven European medical
schools want further education on antibiotic selection, despite being at the
end of their courses. Areas of non-confidence in prescribing were found,
and comparing results with a similar survey of junior doctors, the students
appear overly confident as to how effectively their current knowledge
prepares them for being doctors. Educational programmes could benefit
from including more cases of diagnostic uncertainty to guide students
through the complexities of decisions in actual clinical practice, and from
highlighting stewardship successes such as MRSA prevention as evidence
for the importance of current interventions.
Disclosure of interest: None declared.

O52
O052: Use of surgical-site infection rates to rank hospital performance
across several types of surgery
AM van Dishoeck1, MB Koek2*, EW Steyerberg1, BH van Benthem2, MC Vos3,
HF Lingsma1
1
Centre of Medical Decision Making, Department of Public Health, Erasmus
MC, Rotterdam, the Netherlands; 2Epidemiology and Surveillance, RIVM,
Bilthoven, the Netherlands; 3Department of Medical Microbiology and
Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O52
Introduction: Comparing and ranking hospitals based on health
outcomes is becoming increasingly popular. Outcome measures such as SSI
rates are being used more and more to compare hospitals performance
using league tables and rank orders. Observed differences between
hospitals may however be partly explained by random variation and by
differences in case mix, causing concerns aboutthe validity of such hospital
comparisons.

O53
O053: What surgical site infection rates in colorectal surgery should be
considered for benchmarking standards?
E Shaw1*, JM Badia2, M Piriz3, R Escofet4, E Limn5, F Gudiol5, M Pujol1,
Vincat and Reipi1
1
Infectious Diseases, Hospital Universitari de Bellvitge, Hospitalet Llobregat,
Spain; 2General Surgery, Hospital de Granollers, Granollers, Spain; 3Infection
Control, Hospital Parc Tauli, Sabadell, Spain; 4Infection Control, Hospital
Universitari de Bellvitge, Spain; 5Vincat Program, Departament de Salut,
Hospitalet Llobregat, Spain
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O53
Introduction: Surgical site infection (SSI) after colorectal procedures
represents a measurable quality indicator of a health care system. There is
interest in comparing SSI rates between different hospitals and countries,
however variability of the data regarding to incidence of SSI makes this
comparison controversial. For the purposes of evaluation, data must be
standardized and include reliable post-discharge surveillance (PDS).
Objectives: To determine rates of SSI after elective colorectal procedures
among hospitals of the VINCat Program.
Methods: VINCat is a nosocomial infection surveillance program in
Catalonia, Spain. Between 2007 and 2012, 59 hospitals joined the program.
The participating hospitals performed active, prospective, standardized
surveillance of elective colorectal resection. PDS was implemented by a
multimodal approach and was mandatory within the first 30 days after
surgery. Since 2011 colon and rectal procedures were also analysed
separately.
Results: During the study period, 17,779 elective colorectal procedures
were included. Mean age was 69y (SD:12y) and 40% were female. SSI
was diagnosed in 3,485 (20.3%) patients. Among them, 782 (22.4%)
were diagnosed during PDS. Median time from surgery to infection was
seven days (IQR 5-9) for in-hospital SSI and 14 days (IQR 10-19) for PDSSSI. Surgical infections due to colon procedures were only slightly lower
(18.8%) than those due to rectal surgery (22.3%). Both, overall SSI rates
and organ/space SSI rates did not change significantly over the study
period and were respectively: 2007 (20.8%/5.3%), 2008 (19.2%/6.9%),
2009 (21%/9%), 2010 (21%/8.5%), 2011 (20.7%/9.3%) and 2012 (19%/
8.9%).
Conclusion: SSI rates in elective colorectal procedures at VINCat hospitals
remained stable over the study period and were higher than those
reported by other national programs. There is a need to clarify what
surgical site infection rates in colorectal surgery should be considered for
benchmarking standards.
Disclosure of interest: None declared.

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O54
O054: Surgical site infections (SSI) and risk factors in breast cancer
surgery (BCS): French survey surviso 2011
M-Y Louis1*, Groupe de Prvention des Infections en Cancrologie (GPIC)1,
F Lemarie2, P Berger3, B Clarisse4
1
Surgeon, Head of Hygiene Hospital Department, France; 2Hygiene Hospital
Department, Centre franois Baclesse, Caen, France; 3Institut Paoli Calmettes,
Marseille, France; 4Clinical Research Department, Centre franois Baclesse,
Caen, France
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O54
Introduction: There are sparse data on SSI in oncology that is more
frequent than in general population. BCS is a clean surgery performed in
patients without co-morbidity. A prospective survey we conducted in 2008
revealed a 4.1% SSI incidence rate in 1686 BCS, resulting in new guidelines.
Objectives: We aimed to assess the SSI incidence rate in BCS and to
identify some risk factors.
Methods: Data collection concerned BCS, classified I or II in the Altemeier
classification, associated or not to immediate breast reconstruction. The
survey concerned at least 100 consecutive BCS performed in each of the 15
participating comprehensive cancer centres in the first semester of 2011.
Data collection was based on the French SSI reporting (age, ASA and NNISS
scores, surgery and SSI dates, involved strain). It was completed with some
data specific to cancer setting.
Results: Data were collected for 2883 BCS, including 2766 initial BCS. The
kind of surgery was available for 2731 initial BCS: 1527 (56%) lumpectomies,
563 (21%) mastectomies, 143 (5%) and 170 (6%) immediate and secondary
reconstructions, respectively, 35 (1%) node dissections, 293 (11%) breast
mammoplasty surgeries.
The SSI incidence rate (median onset delay: 16 days) was 2.86%[CI95%:
2.27-3.55] (79 SSI) as compared to 4.1%[CI95%: 3.20-5.15] in 2008,
corresponding to a 30% decrease. S. aureus was identified in 58 cases.
The multivariate analysis highlighted several factors related to the risk of SSI
onset. A 3-4 ASA score (vs ASA 1) was associated to an adjusted odds ratio
(ORa) of 2.51[1.21-5.18]). As compared to lumpectomies without node
dissection and prophylactic antibiotics, immediate reconstructions were
related to an ORa of 3.65[1.41- 9.42], node dissection without prophylactic
antibiotics and associated or not to lumpectomy to an ORa of 4.58[2.139.87]. Hematoma and lymphocele punctures were respectively related to an
ORa of 3.19[1.33-7.66] and 2.98[1.84-4.83]. No relation was noted for prior
chemo/radiotherapy and for invasive preoperative procedures.
Conclusion: The identification of risk factors specific to cancer setting
argued to a particular attention, notably concerning postoperative
procedures and surgery techniques.
Disclosure of interest: None declared.

O55
O055: Can incidence of surgical site infections (SSI) in hospitals be
predicted from point prevalence surveillance data of SSI?
H Jamaladin1, JA Ferreira1, LD Kuijper2, MC Vos3, M Koek1*
1
Epidemiology and Surveillance, RIVM, Bilthoven, The Netherlands;
2
Department of Health Sciences, VUmc, Amsterdam, The Netherlands;
3
Department of Medical Microbiology and Infectious Diseases, Erasmus MC,
Rotterdam,The Netherlands
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O55
Introduction: SSIs are one of the most frequent nosocomial infections. To
monitor and reduce SSI-rates a good surveillance is crucial. For optimal
information, surveillance of incidence of SSIs is preferred above surveillance
of prevalence of SSIs. Incidence surveillance however is time consuming.
Objectives: To investigate whether the prevalence of SSIs (point
prevalence surveillance) can be used to adequately predict the incidence
of SSIs (cumulative incidence surveillance).
Methods: Data were derived from the Dutch surveillance network for
nosocomial infections (PREZIES) from 2007 to 2011. The suitability of
the Rhame and Sudderth method to estimate incidence of SSIs from
prevalence of SSIs was assessed. Also incidence data were used to simulate
prevalence data, and prediction models were developed to predict
incidence from prevalence and from other relevant variables. Several
statistical indices were used to evaluate the performances of the models.

Page 18 of 143

Results: Use of the Rhame and Sudderth method to estimate incidence


resulted in most estimated incidence rates becoming negative values
(below zero). Simulating prevalence from incidence data showed large
variation in prevalence depending on the day of measurement. The
predictive model best predicting incidence, with a proportion explained
variance of 0.31, was the model including the mean length of hospitalization
of patients with an SSI (LN), the mean interval between admission and onset
of the SSI (INT) and hospital (as random effect). Adding prevalence to the
prediction model did not improve the model.
Conclusion: It proved not reliable to directly convert prevalence into
incidence using the Rhame and Sudderth method. The negative
estimated incidence values were the result of the postdischarge
surveillance man-datory for the SSI-surveillance in the Dutch surveillance
network. Also the simulations and the results of the prediction model
indicate that with the current data available it is not possible to
accurately predict cumulative incidence of SSIs in Dutch hospitals using
point prevalence data.
Disclosure of interest: None declared.

O56
O056: The introduction of a surgical site infection prevention bundle
on a nationwide scale
T Hopmans1*, L Soetens1, J Wille1, P van den Broek2, M Koek1,
B van Benthem1
1
Epidemiology and Surveillance, National Institute of Public Health and the
Environment, Bilthoven, The Netherlands; 2Department of Infectious Diseases,
Leiden University Medical Centre, Leiden, The Netherlands
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O56
Introduction: In 2009 a patient safety program, consisting of a 4-item
surgical site infection (SSI)-prevention-bundle, was introduced in the
Netherlands. The infection prevention bundle consist of: timely antibiotic
prophylaxis, no preoperative surgical site hair removal, perioperative
normothermia and hygiene discipline on the OR.
Objectives: The aim of the SSI-bundle introduced by the safety program is
to reduce the SSI-rate through creating more awareness about the
importance of patient safety among hospital employees. The objective is a
90% compliance with the complete SSI-prevention bundle.
Methods: Data collection (2009-2012) was incorporated in the PREZIES
surveillance network for healthcare associated infections. Compliance with
the four interventions was registered separately and combined in patients,
who underwent a surgical procedure present on the list of indicator
procedures (a selection of 13 procedures of 6 different specialties). Log
binomial regression analysis was used to calculate relative risks (chance) on
compliance, stratified by medical specialty, calendar time and participation
period.
Results: Registration of the complete bundle was around 20% by the end
of 2011 (varying between 28% and 66% for the individual bundle items).
Compliance with the individual bundle items increased over time: by the
end of 2011, three out of four items reached a compliance greater than
75%. However, compliance with the complete bundle reached 27%.
Conclusion: This is the first patient safety program implementing a SSIbundle on a nationwide scale. The objective of 90% compliance with the
complete bundle was not met; although compliance increased over time, it
remained low. Likewise, registration did not exceed 20%. We recommend to
prolong this program, however the implementation process must be
strengthened. A qualitative study is suggested to gain insight in barriers of
this process.
Disclosure of interest: None declared.

O57
O057: Clinical evaluation of the antiseptic efficacy and local
tolerability of a polihexanide-based antiseptic in comparison to a
chlorhexidine-based antiseptic on intact skin
FHH Brill1*, D Egli-Gany2, M Hintzpeter3
1
Dr. Brill + Partner GmbH Instiute for Hygiene and Microbiology, Hamburg,
Germany; 2Private Researcher, Horgen, Switzerland; 3B. Braun Melsungen AG,
Melsungen, Germany
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O57

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Introduction: The antiseptic agent chlorhexidine is internationally widelyused and well-accepted for skin and wound antiseptics. In recent years, the
agent polihexanide is gaining importance for similar purposes. Both agents
are biguanides and therefore similar characteristics may be expected.
Objectives: The primary objective of this study was to compare the
antimicrobial efficacy of polihexanide 0.02% and 0.04% with chlorhexidine
0.05% after 30 min of treatment of healthy skin. The secondary objectives
were to evaluate the local tolerability and the antimicrobial efficacy after 5
and 10 min contact time.
Methods: The study was performed as a double-blind, randomized,
comparator-controlled, 3-arm, crossover study on 20 healthy volunteers
with intact skin in a phase 1 study unit.
Test areas of 5 cm2 on the subjects arms were treated with investigational
and reference products using a polyurethane swab. Skin swabs were taken
before and after treatment for quantitative microbial evaluation.
The main outcome measure was the log10 reduction factor (RF) of colonyforming units (cfu) on the skin after 30 minutes of treatment. Further
endpoints were the RF after 5 and 10 minutes and the local tolerability.
Results: No statistically significant difference was seen between the test
products polihexanide 0.02%, 0.04% and the comparator, chlorhexidine
0.05% after 30 min of treatment (p > 0.1). The analysis of the exposure times
of 5 and 10 minutes revealed that the antiseptic efficacy of polihexanide
0.02% is statistically significantly lower than that for the comparator
chlorhexidine; polihexanide 0.04% on the contrary not. No statistically
significant differences in local tolerability were observed between the three
products [1].
Conclusion: The results of this clinical study indicate that polihexanide is
a suitable alternative to chlorhexidine and shows a comparative efficacy
on the skin.
Disclosure of interest: None declared.
Reference
1. Egli-Gany D, Brill FHH, Hintzpeter M, Andre S, Pavel V: Evaluation of the
Antiseptic Efficacy and Local Tolerability of a Polihexanide-Based
Antiseptic on Resident Skin Flora. Advances in Skin & Wound Care 2012,
25(9):404-408.

Conclusion: The Target CLAB Zero programme has resulted in a significant


reduction in the number of CLAB/1000 line days among ICU patients. It is
now being rolled out in theatres, emergency departments and other areas
in the hospital where CVL are placed. Implementation of this programme
has lead to a culture of cooperation amongst the three ICU that did not
exist previously.
Disclosure of interest: None declared.

O58
O058: Delivering a central line-associated bacteraemia quality
improvement programme in three intensive care units, Auckland City
and Star Ship Childrens Hospitals, Auckland, New Zealand
S Roberts*, Auckland District Health Board Target CLAB Zero Working Group
Department of Microbiology, Auckland District Health Board, Auckland, New
Zealand
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O58
Introduction: In 2011 the New Zealand Health Quality & Safety Commission
implemented three national quality improvement programmes: Hand
Hygiene New Zealand, a surgical site infection surveillance and improvement programme and Target CLAB Zero. The Target CLAB Zero programme,
based on the use bundles of care for central line (CVL) placement and
maintenance was delivered across all 20 District Health Boards (DHB). The
aim was to reduce the rate of CVL-associated bacteremia (CLAB) to <2 /1000
line days.
Methods: The Target CLAB Zero programme, lead by Counties Manukau
DHB and Ko Awatea, used the Institute of Healthcare Improvement
collaborative methodology. At Auckland DHB there are three intensive care
units; paediatric ICU (PICU), adult cardiothoracic and vascular ICU (CICU)
and adult medical and surgical ICU (DCCM). A working group with nursing
staff from each unit developed a single approach to the delivery of the
programme across all three units. This involved education of staff, auditing
and feedback of compliance with the bundles, and monitoring the rate of
CLAB/1000 line days. Baseline rates for CLAB/1000 line days were collected
prospectively for two units and estimated retrospectively for one.
Results: As of March 2013, 15 months after starting the collaborative all
three units had achieved at some stage >100 days without a CLAB
episode and one unit, CICU has not had a CLAB event since February
2012. The overall CLAB rate per quarter (Jan-Dec 2012) across all three
units was 4.2, 0, 0.45 and 1.6 CLAB/1000 line days, respectively.
Other improvement activities include the standardization of blood culture
collection practices within the units, updating organisation-wide CVL
policy and the development of high risk criteria for each unit.

O59
O059: Introducing an intervention bundle to reduce the incidence of
catheter related infections
E Smid, J Wille*, S Greeff de, T Hopmans, M Koek
CIb/PREZIES, RIVM, Bilthoven, The Netherlands
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O59
Introduction: Literature indicates that the incidence of catheter related
infections can be reduced after implementing a so-called intervention bundle.
In line with this, an intervention bundle to prevent catheter related infections
was introduced in The Netherlands, aiming (1) at a 90% compliance with the
bundle and (2) to reduce the incidence of catheter related infections.
Objectives: To assess whether a 90% compliance with the bundle and/or a
reduction in the incidence of catheter related infections in Dutch hospitals
to less than three cases of infection per 1000 catheter-days have been
established.
Methods: In 2009 an intervention bundle consisting of six items was
introduced. The six items were hand hygiene, precautions during insertion,
cleaning the skin, selection insertion site, daily check on indication, and daily
check on insertion site. All Dutch hospitals were asked to register the
compliance with the intervention bundle together with the incidence of
infections for all central venous catheters. Registration took place from
January 2009 until December 2012. The intervention bundle is analysed on
registration and compliance level.
Results: 64 from the 93 hospitals in The Netherlands registered for
participation, 31 hospitals registered infection-data and 27 registered data
about the intervention bundle. Registration of the complete bundle
increased from 7% in 2009 to 61% in 2012. During these four years
compliance with the bundle increased from 76% to 87%. In 2009, 6 out of
the 9 registering hospitals (67%) had an incidence of less than three cases of
infection per 1000 catheter-days. In 2012, 20 out of 25 registering hospitals
(80%) had less than three infections per 1000 catheter-days. Four hospitals
in 2012 (16%) had more than five infections per 1000 catheter-days.
Conclusion: Compliance with the complete bundle increased over the four
years to 87%, but the target of 90% is not yet met. In 2012 a higher
proportion of the hospitals had an incidence of less than three infections
per 1000 catheter-days (not significantly different), but still some hospitals
had more than five infections per 1000 catheter-days. We conclude that for
both compliance and infection-rates there is still room for improvement.
Disclosure of interest: None declared.
O60
O060: Reduction of central-line associated bloodstream infections in a
tertiary care hospital in Saudi Arabia
WA Mazi1*, Z Bejum1, D Abdulmutalib1, A Hisham2, S Maghari2, M Al Thumali2,
A Senok3
1
infection prevention and control, Saudi Arabia; 2Intensive Care Unit, King
Abdul Aziz Specialist Hospital, Taif, Saudi Arabia; 3College of Medicine,
Alfaisal University, Riyadh, Saudi Arabia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O60
Introduction: Central line-associated bloodstream infection (CLABSI)
remains a major problem in critical care units worldwide.
Objectives: This study aimed to assess the impact of the implementation
the Society for Healthcare Epidemiology of America/ Infectious Diseases
Society of America (SHEA/IDSA) practice recommendations in reducing
CLABSI rates in an acute trauma intensive care unit (ICU).
Methods: The prospective study was conducted from January 2011December 2012 at the 23-bed trauma-ICU in King Abdul Aziz Specialist
Hospital, Taif, Saudi Arabia. In 2011, baseline data on CLABSI rates was
collected. In 2012, a CLABSI-Team was established and the basic SHEA/IDSA
practice recommendations implemented. Laboratory-confirmed CLABSI were

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Page 20 of 143

identified using the Centers for Disease Control and Prevention criteria and
antimicrobial susceptibility of isolates determined. For benchmarking with
National Healthcare Safety Network (NHSN, USA), data collection and
analysis were carried out in accordance with NHSN recommendations.
Results: With implementation of the SHEA/IDSA practice recommendations,
a decline in the number of CLABSI in 2012 (n=6) compared to 2011 (n=14)
was observed. This corresponds to a 58% decline in CLABSI incidence rate
from 3.87 to 1.5 per 1000 central-line days in 2011 and 2012 respectively
(Standardized Infection Ratio, 0.42). Benchmarking to NHSN percentiles, the
incidence of CLABSI was 75th-90th percentile in 2011 vs. 50th percentile in
2012. The utilization ratio was 25th-50th percentile in 2011 and 50th-75th
percentile in 2012. Three Klebsiella pneumoniae isolates susceptible only to
imipenem and one pan-drug resistant Acinetobacter baumanii were
identified in 2012. Two patients had Enterococcus faecalis, with one isolate
resistant to vancomycin.
Conclusion: Implementation of the basic SHEA/IDSA practice recommendations resulted in significant reduction in CLABSI in our trauma-ICU where
multidrug resistant isolates are present indicative of the beneficial role of
these recommendations.
Disclosure of interest: None declared.

Introduction: The presence of Staphylococcus epidermidis (SCE) on


umbilical venous (UVC) or artery catheters (UAC) suggests defects either
in catheter care or in hand hygiene compliance.
Objectives: The aim of this study was to assess colonization of UVC and
UAC with SCE before and after care practice of such catheters was changed.
Methods: This observational before-after study was conducted in the
neonatology unit of HUG between January 2002 and December 2012.
SCE-colonization rates before and after protocol change in August 2011
was compared by chi-square test and Poisson regression model. In the
new protocol, UVC and UAC were not covered by a dressing but left at
air. All neonates with the following risk factors were eligible: gestational
age [GA] <32 weeks, birth weight <1500g, invasive device, surgery, use of
parenteral nutrition, systemic antibiotics.
Results: In total, 2832 neonates were analyzed. Mean birth weight (SD)
was 2179g (970) and 213 neonates had GA < 32 weeks (7.5%). SCE
colonization on UVC and UAC was 54/1070 (5.1%) and 16/435 (3.7%),
respectively. Colonization on UVC was significantly higher after procedure
change in the univariate (53.7/1000 catheter-days versus 9.6/1000;
P<0.001) as well as in the multivariate analysis adjusting for GA, birth
weight, and multiple pregnancy (IRR [95% CI]: 2.4 [1.4-4.3]; P=0.003).
Colonization of UAC was significantly higher after procedure change in
the univariate (43.5/1000 cathter-days versus 7.9/1000; P<0.001) as well as
in the multivariate analysis (IRR [95%CI]: 5.0 [1.7-15.2]; P=0.004). No
association was found for catheter-related bloodstream infection.
Conclusion: Leaving umbilical catheters exposed to air rather than
protected by a dressing may result in significant colonization with SCE.
Larger studies must confirm our findings and test the hypothesis whether
such practice promotes bloodstream infection.
Disclosure of interest: None declared.

O61
O061: Impact of process control (PC) implementation and strategies to
improve hand hygiene adherence (HHA), in device-associated infections
(DAI) in an intensive care unit of adults (AICU)
C Giuffre1*, ED Efrn1, AM Azario1, R Jordan1, JV Martinez1, S Verbanaz1,
P Giorgio1, M Khoury2
1
Infection Diseases, Buenos Aires British Hospital, Buenos Aires, Argentina;
2
Research & Teaching, Buenos Aires British Hospital, Buenos Aires, Argentina
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O61
Introduction: DAI are a serious public health problem worldwide. The PC
and optimization of the HHA have proven to be excellent tools for DAI
minimization or elimination.
Objectives: Assess the impact of PC and HHA on DAI in our AICU.
Methods: A quasi-experimental study. We calculated the average rates of
DAI using NHSN,CDC methodology in two periods:pre (Pa) and post
intervention (Pb). Average rates wereexpressed as number of events per
1000 device days (DD). Study periods: ventilator associated pneumonia
(VAP) Pa: January 2004-January 2010, Pb: February 2010-February 2013.
Catheter-associated bacteremia (BACT) Pa: January 2004-June 2010, Pb: July
2010-February 2013. Catheter-associated urinary tract infection (UTI) Pa:
January 2007-October 2011Pb: November 2011-February 2013. The Institute
of Healthcare Improvement (IHI) proposed PC were implemented. PC
adherence was assessed periodically. In October 2009, WHO campaign to
improve HHA was implemented. Periodic measurements of HHA were
performed. Statistical analysis: we compared average rates of HAI in both
periods with Mann-Whitney test. We calculated the Incidence Rate Ratio
(IRR) as Pb average incidence rate/Pa average incidence rate.
Results: NEU rate decreased from 9.88 (Pa) to 2.60 (Pb), P <0.001. IRR 0.26,
74% rate reduction. Attributable risk: 7.28/1000 DD. Cases avoided in Pb:
33.4 (4589 DD in three years). BACT rate decreased from 5.35 (Pa) to 2.34
(Pb), p 0.007. IRR: 0.44, 56% rate reduction. Attributable risk: 3.01/1000 DD.
Cases avoided in Pb: 14.99 (4983 DD in 32 months). ITU rate decreased from
2.45 (Pa) to 1.30 (Pb), P 0.32. IRR: 0.53, 47% rate reduction. Attributable risk:
1.15/1000 DD. Cases avoided in Pb: 3.34 (2908 DD in 16 months). Adherence
to PC and HHA ranged between 80 and 95%.
Conclusion: PC implementation and HHA optimization in our AICU was
associated with statistically significant decreases in VAP and BACT rates,
and similar tendency of UTI rate. The significant number of cases averted,
fully justifies the implementation of these tools.
Disclosure of interest: None declared.

O62
O062: Contamination of umbilical catheters by Staphylococcus epidermidis
in neonatology: is there a link with a change in the standard of care?
I Soulake1*, A Gayet-Ageron1, N Bochaton2, S Touveneau1, P Rimensberger2,
R Pfister2, D Pittet1, W Zingg1
1
Infection Control Programme, University of Geneva Hospitals (HUG), Geneva,
Switzerland; 2Enfant et adolescent, University of Geneva Hospitals (HUG),
Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O62

O63
O063: Healthcare-associated bloodstream infections in Finland, 19992011 adjusted ranking of hospitals by Staphylococcus aureus rates
T Krki*, J Ollgren, O Lyytikinen
National Institute for Health and Welfare, Helsinki, Finland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O63
Introduction: Bloodstream infections (BSI), including those caused by
Staphylococcus aureus (SA-BSI) are often severe. Relatively large
proportion of SA-BSIs are preventable, and their rate has been used as an
indicator for hospital performance in infection control.
Objectives: The objective of this study was to analyze the Finnish
surveillance data in order to assess hospital rankings according to crude
and adjusted rates of overall BSI and SA-BSI.
Methods: 11 Finnish hospitals conducted prospective incidence surveillance
for healthcare-associated BSIs 1999-2011. A common protocol for laboratorybased case finding was used and only BSIs with onset >48 hrs after
admission were included. Patient-days with specialties were obtained from
hospitals information technology departments to calculate incidence
densities (ID) with 95% confidence intervals (CI). The ranking positions of
hospitals were calculated for crude IDs and IDs adjusted by specialties and
hospital type in mixed effects negative binomial regression model. The
effects in the model were considered to be constant over selected time
period. The agreement and the correlation between rankings of the IDs
were assessed by Cohens kappa and Spearmans correlation coefficient,
respectively.
Results: We identified 7855 BSIs of which 990 were SA-BSIs. For all BSIs, IDs
varied from 0.16 per 1,000 patient-days to 0.79 between hospitals and for
SA-BSIs from 0.03 to 0.10. There were clear differences in crude and
adjusted ranking positions of hospitals, but CIs were wide and mostly
overlapped. The agreement between adjusted rankings was more fair than
with crude ranking with its adjusted counterpart, kappa 0.3 (p=0.018) vs. 0.2
(p=0.078). Agreement of the two crude rankings was 0.1 (p=0.63).
Correlation coefficients were 0.81 for adjusted BSI and SA-BSI rankings, and
0.69 for crude rankings.
Conclusion: Both the overall BSI ranking and SA-BSI ranking identified
outliers. Adjusting by specialties and hospital type may be needed when
ranking overall BSI rates but not for SA-BSI rates. SA-BSIs can be a useful
indicator for hospital performance, stimulating the use of surveillance data.
However, the rankings must be interpreted with caution, especially when
numbers are small during a short period of surveillance.
Disclosure of interest: None declared.

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O64
O064: Validation and assessment of the new surveillance paradigm
for ventilator-associated events
MS Van Mourik1*, PM Klein Klouwenberg2,3, DS Ong2,3, MJ Schultz4, J Horn4,
OL Cremer2, MJ Bonten1,3
1
Department of Medical Microbiology, University Medical Center Utrecht,
Utrecht,The Netherlands; 2Department of Intensive Care, University Medical
Center Utrecht, Utrecht, The Netherlands; 3Julius Center for Health Sciences
and Primary Care, University Medical Center Utrecht, Utrecht, The
Netherlands; 4Department of Intensive Care Medicine, Academic Medical
Center, University of Amsterdam, Amsterdam, The Netherlands
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O64
Introduction: Reliable, meaningful surveillance methods are essential for
benchmarking of healthcare-associated infection rates. However casedefinitions for ventilator-associated pneumonia (VAP) are complex and
subjective. A novel surveillance paradigm for detection of ventilatorassociated events (VAE) was recently proposed by the National Healthcare
Safety Network (NHSN).
Objectives: We aimed to validate this new algorithm.
Methods: Retrospective analysis of an ICU cohort with ongoing prospective
assessment of VAP in 2 academic medical centers (January 2011 June
2012). The VAE algorithm was electronically implemented as specified by
NHSN and includes assessment of (infection-related) ventilator-associated
conditions (VAC, IVAC) and possible or probable VAP. Incidence and
concordance of VAE with prospective VAP surveillance was assessed as were
alternative clinical conditions occurring with VAE signals. The attributable
mortality of VAC, IVAC and VAE VAP was assessed by competing-risk survival
analysis.
Results: 2080 patients contributed 2296 episodes of mechanical
ventilation (MV). Incidence of VAC and IVAC were 10.0 and 4.2/1000
ventilation days, respectively. VAP according to the VAE algorithm
occurred in 3.2/1000 MV days, whereas prospective surveillance identified
8 cases per 1000 MV days. VAC detected 32% (38/115) of the patients
affected by VAP, positive predictive value was 25% (38/152). The other
VAE events had lower sensitivity and positive predictive value remained
<40%. VAC signals were most often caused by pulmonary or extrapulmonary infection, volume overload or heart failure. The subdistribution
hazard for mortality was estimated at 3.3 (95% CI 2.4 - 4.4) for VAC, 2.5
(1.5 - 4.1) for IVAC and 2.1 for VAP (1.2 - 3.8).
Conclusion: The VAE algorithm aims to assess complications of mechanical
ventilation. However, concordance between VAE and VAP surveillance is
poor. Future studies will need to assess whether the conditions identified as
VAE are liable to preventive measures.
Disclosure of interest: None declared.

O65
O065: Using adenosine tri-phosphate (ATP)-bioluminescence assay to
compare outcomes of two strategies to perform environmental
cleaning in a hospital setting
R Nativ1*, I Livshiz Riven2,3, A Borer1
1
Infection Control Unit, Sorok University Medical Center, Israel; 2Nursing, Ben
Gurion of the Negev, Israel; 3Infection Control Unit, Soroka University Medical
Center, Beer-Sheva, Israel
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O65
Introduction: Hospital environment poses a substantial risk for transmission
of pathogens. However, assessing cleaning efficiency is difficult and often is
carried out by a subjective visual check only. The ATP-bioluminescence
assay technology was developed to assist in evaluation of the
environmental cleaning process by counting living and non-living organic
matter in Relative Light Units (RLUs). In a 1000-bed university-affiliated
hospital the standard practice following patient discharge includes terminal
cleaning of the patient unit performed by nursing aides associated with the
ward.
Objectives: The purpose of the study was to compare, in RLUs, the outcome
of environmental and terminal cleaning in hospital wards using dedicated
trained maintenance personnel (strategy 1) versus routine departmental
cleaning (strategy 2). An additional purpose was to evaluate the applicability
of the ATP-bioluminescence assay technology.
Methods: An experimental design with an intervention (strategy 1) and
control (strategy 2) was conducted on four comparable medical wards.

Page 21 of 143

Two wards used cleaning strategy 1 for terminal cleaning and the other
two used cleaning strategy 2 as controls. Ten sites were examined in
each ward with ATP-bioluminescence assay: 6 sites of high risk patient
contact areas 30 minutes following terminal cleaning, and 4 sites for
general environmental surroundings.
Results: 770 samples were collected; 373 from the intervention group
wards and 397 from the control group wards. A statistically significant
difference was found in 2 out of 6 high risk patient contact sites in the
patient units: 1) the bed rails, with a median of 397 RLUs in the intervention
group vs. 752 RLUs in the control group (p<0.001); and 2) the call button,
with medians of 338 and 535 RLUs in the intervention and control group,
respectively (p<0.002).
Conclusion: Assigning a dedicated and trained team for terminal cleaning
as a cleaning strategy demonstrated superiority at least in 2/6 high touch
surface areas. The ATP-bioluminescence assay technology is a convenient
way to check general cleanliness.
Disclosure of interest: R. Nativ Grant/Research support from M3 Israel
and CHEMITEC, I. Livshiz Riven: None declared, A. Borer: None declared.

O66
O066: Thermal disinfection of bedpans: European ISO 15883-3
guideline requirements are insufficient to ensure elimination of ARE
and OXA-48 outbreak-strains
LB van der Velden1,2*, MH Nabuurs-Franssen1, A van Leeuwen1, M Isken1,
A Voss1,2
1
Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital
Nijmegen, The Netherlands; 2Medical Microbiology, Radboud University
Nijmegen Medical Center, Nijmegen, The Netherlands
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O66
Introduction: During 2012, our hospital was faced with a vancomycinresistant Enterococcus faecium (VRE) outbreak. Washer-disinfectors are used
for the cleaning and thermal disinfection of bedpans. The European
guideline NEN-ISO 15883-3 (ISO) states that washer-disinfectors have to
achieve a minimum A0 value of 60 for appropriate disinfection of bedpans
( 80 C for 60 seconds or 90 C for 6 seconds). However, previous data have
shown that some E. faecium strains survive 60 seconds at 80 C. Following
ISO, the A0 measurement should include a cold (a minimum interval of
60 minutes since the machine was last used) and hot start.
Objectives: We determining the A0 value of the VRE outbreak-strain and
the outbreak-strain of the OXA-48 K. pneumoniae outbreak in another Dutch
hospital during 2011. Moreover the impact of a cold start measurement on
the A0 value was evaluated.
Methods: The minimum A0 value that results in the killing of all isolates was
determined for both strains. Bacterial suspensions were heated at 65, 75 and
80 C and samples for viable counts were obtained after 1,2,3 and 10 minutes
at each temperature. VRE PCR and cultures were performed on bedpan
swabs after disinfection; hot and cold start measurements were compared.
Results: Adequate killing required a minimum A0 value of 180 for the VRE
outbreak strain and 120 for the OXA-48 K. pneumoniae. The cold start
resulted in a 30% lower A0 value, than the hot start. All washer-disinfectors
in our hospital functioned in agreement with the European guideline,
although the lowest A0 value was 73, only just above 60. Swabs taken from
bedpans processed in these washers with low A0 values , were VRE-positive
by PCR and cultures.
Conclusion: Both outbreak strains survived the A0 value of 60 required in
the ISO. VRE were identified by PCR as well as cultures of bedpans that had
been disinfected by these washer-disinfector. We suggest to increase the
minimal acceptable A 0 value of washer-disinfectors to at least 180.
Furthermore, the cold-start is needed for adequate A0-value measurement.
Disclosure of interest: None declared.

O67
O067: Poorly processed reusable dispensers for surface disinfection
tissues are a possible source of infection
G Kampf1,2*, H von Baum3, C Ostermeyer4
1
Bode Science Center, Bode Chemie GmbH, Hamburg, Germany; 2Institute
for Hygiene and Environmental Medicine, Ernst-Moritz-Arndt University,
Greifswald, Germany; 3Institut fr Med. Mikrobiologie und Hygiene,
Universitt Ulm, Ulm, Germany; 4Microbiology, Bode Chemie GmbH,
Hamburg, Germany
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O67

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Introduction: Reusable surface disinfectant (SD) tissue dispensers are


used in hospitals in many countries because they allow immediate access
to soaked tissues for targeted surface decontamination.
Objectives: We determined the frequency of contaminated SD solutions
in reusable dispensers and the ability of isolates to multiply in different
formulations.
Methods: Dispensers with different SD were randomly collected from
healthcare facilities. Solutions were investigated for bacterial contamination
using standard microbiological methods. Isolates of the same species were
investigated by pulsed-field gel electrophoresis (PFGE) for clonal identity.
The efficacy of two SD was determined in suspension tests (EN 13727)
under dirty conditions against two isolated species directly from a
contaminated solution or after 5 passages without selection pressure in
triplicate. Fresh use solutions of four different types of SD were contaminated with a fresh dispenser isolate to determine its survival or multiplication over 28 days.
Results: 66 dispensers containing SD solutions with surface-active
ingredients were collected from 15 healthcare facilities. 28 dispensers from
nine healthcare facilities were contaminated with approximately 107 cells
per mL of Achromobacter species 3 (9 hospitals), Achromobacter xylosoxidans
or Serratia marcescens (1 hospital each). Clonal non-identity was shown for 8
of 9 Achromobacter species 3 isolates. In none of the hospitals dispenser
processing was adequately performed. Isolates regained susceptibility to the
SD after five passages without selection pressure, for example against
Achromobacter species 3 with a mean log10-reduction of 0.06 initially and
2.37 after 5 passages (Incidin plus 0.5% for 60 min). Adapted and passaged
cells were equally able to multiply in different formulations from different
manufacturers with surface-active ingredients at room temperature within
7 days to a cell count of 10 7 bacteria per mL, only a formulation with
additional aldehyde was able to completely kill the contamination.
Conclusion: Neglecting adequate processing of tissue dispensers has
contributed to frequent and heavy contamination of use-solutions of SD
based on surface active ingredients.
Disclosure of interest: G. Kampf Employee of Bode Chemie GmbH,
Hamburg, Germany, H. von Baum: None declared, C. Ostermeyer Employee
of Bode Chemie GmbH, Hamburg, Germany.
O68
O068: Implementation of antimicrobial copper in neonatal intensive
care unit (NICU)
P Efstathiou1*, M Anagnostakou2, E Kouskouni3, C Petropoulou2, K Karageorgou1,
Z Manolidou1, S Papanikolaou1, M Tseroni1, E Logothetis1, V Karyoti1
1
National Health Operations Centre, Athens, Greece; 2Agia Sophia Childrens
Hospital (NICU), Athens, Greece; 3Medical School of the University of Athens,
Microbiology laboratory of Aretaieio Hospital, Ministry of Health , Athens, Greece
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O68
Objectives: The aim of this study was to investigate the effectiveness of
the application of antimicrobial copper alloys (Cu + ) in a Neonatal
Intensive Care Unit (NICU) in relation to the reduction of microbial flora.
Methods: At a Level III Neonatal Intensive Care Unit of a pediatric hospital,
with the capacity of twenty-six (26) incubators, antimicrobial copper (Cu+)
was implemented on touch surfaces and objects. The copper alloy contains
Cu 63% - Zn 37% (Lead Low). Microbiological cultures were taken in three
different time periods, before and after the application of Cu+, using dry and
wet method technique.
Results: In the above NICU, the reduction of microbial flora after the
implementation of the antimicrobial copper (Cu+) on the selected surfaces
and objects was statistically significant (n = 15, p <0,05) and was recorded at
90%. The pathogens isolated at high rates (CFU / ml) prior to copper
implementation were as follows: Klebsiella spp., Staph. Epidermidis, Staph.
Aureus, Enterococcus spp.
Conclusion: This study highlights the positive impact of antimicrobial
copper (Cu+) and demonstrates that copper implemented surfaces and
objects are effective in neutralizing bacteria, which are responsible for
Health Care Acquired Infections in the nosocomial environment (HCAIs).
The innovative implementation of antimicrobial copper in the NICU and
the significant reduction of microbial flora heralds the reduction of
antimicrobial drugs use, and a possible reduction of hospital acquired
infections and hospitalization time.
Disclosure of interest: None declared.

Page 22 of 143

O69
O069: Efficacy of cleaning methods post-inoculation of pathogenic
microorganisms of conventional and novel cleankeys
computer keyboards
J De Grood1, L Ward1,2, S Harman1, C Duchscherer1, M Ward2, J McClure1,
K Hope2, J Kim1,2, J Vayalumkal1,2, K Zhang1,2, T Louie1,2, J Conly1,2*
1
University of Calgary, Canada; 2Alberta Health Services, Calgary, Canada
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O69
Introduction: Keyboards (KB) may play a role in the spread of healthcare
pathogens (HCP). A survey in our hospitals revealed 58.3% (134/230) were +
for at least 1 HCP with 60.9% contaminated with fecal organisms.
Objectives: We sought to determine the adequacy of cleaning methods
of conventional and novel acrylic and glass Cleankeys KBs, an innovative,
wireless, waterproof KB.
Methods: Ten conventional and 12 Cleankeys KBs were inoculated with
methicillin-resistant S. aureus (MRSA), vancomycin-resistant Enterococcus
(VRE), P. aeruginosa (PA) and C. difficile (CD) using a modified technique
described by Rutala. Every 2nd key was inoculated with 5x10 3 /50ul of
each organism. Cleaning using a standardized protocol was done with
CaviWipes (0.28% quaternary ammonium and 17.2% isopropanol), PCS
1000 Bleach Wipes and Microfibre cloths and dish soap/water. Cultures
were obtained with a standardized method using sterile applicators
moistened with 0.01M PBS. The applicators were transferred into tubes
containing TSB, vortexed, and planted on selective media.
Results: CaviWipes were effective at eliminating MRSA, VRE and PA (97%)
from all 3 types of KBs but were ineffective at eliminating CD with 100% of
keyboards remaining CD+. PCS 1000 Bleach Wipes and Microfiber cloths
eliminated MRSA, VRE and PA from all KB tested, were ineffective for
conventional KBs with 100% remaining culture CD+ but eliminated CD from
both acrylic and glass Cleankeys KBs. Plain dish soap and water were 100%
effective at eliminating CD from both acrylic and glass Cleankeys KBs.
Conventional keyboards could not be immersed in water.
Conclusion: KBs represent a high-touch surface for colonization with HCPs.
The efficacy of conventional cleaning agents may be suboptimal for
conventional KBs harboring CD. An innovative keyboard, washable in plain
soap and water offers distinct advantages in promoting hospital hygiene.
Disclosure of interest: None declared.

O70
O070: Abstract withdrawn

Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O70

O71
O071: Standard precautions (SP) vs search-and-destroy strategy for
control of methicillin-resistant Staphylococcus aureus (MRSA) in nursing
homes (NH): a randomized controlled study
C Bellini1, C Petignat1*, E Masserey2, C Bla1, B Burnand1, D Blanc1, G Zanetti1
1
University Hospital CHUV, Switzerland; 2Public Health, Lausanne, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O71
Introduction: MRSA prevalence among NH residents of Canton Vaud,
Switzerland, rose from 4.5% in 2003 to 12% in 2008. MRSA control
strategy is not clearly defined in this setting.
Objectives: The aim of our study was to measure the 1-year impact of
universal screening followed by decolonization of carriers (intervention),
compared with SP (control), on MRSA prevalence in NH.
Methods: 104/157 NH participated to this randomized controlled study.
In participating NH, SP were enforced and residents underwent MRSA
screening at study entry, upon (re)admission, and at 12 months. All MRSA
carriers in intervention NH underwent a 5-day topical decolonization
(nasal mupirocine, chlorhexidine disinfection of skin and pharynx)
combined with environmental disinfection, except if they had ongoing
MRSA infection or bacteriuria or stage IV skin ulcers. Decolonization was
repeated once in case of failure.

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Results: A total of 6036 residents (51% in control and 49% in intervention


NH) were screened, representing 86% [27-100%] of the NH population in
the control and 87% [20-100%] in the intervention NH. Characteristics of NH
(size, single rooms proportion, healthcare workers/resident) and of residents
(age, gender, diabetes, ulcers, medicals devices, performance score, previous
admission in acute care hospital, previous antibiotics) were similar in both
groups. In intervention NH, 209/274 (76%) MRSA carriers underwent
decolonization, with success in 61%. At study end, proportions of the initial
MRSA carriers who were no longer positive at screening were 65% in
intervention NH and 55 % in control NH (p=.07). Nevertheless, the impact of
the intervention did not reach significance: mean MRSA prevalence
significantly declines from 8.9% in both groups [0- 44%] to 6.6 % in the
control group and to 5.8% in the intervention group (p=.3).
Conclusion: Topical MRSA decolonization was successful in 60% of NH
residents, which opens interesting perspectives for high-risk individuals.
At NH level, however, universal screening followed by decolonization of
carriers had no significant additional impact in reducing prevalence of
MRSA carriage rate at one year compared to SP and spontaneous
decolonization.
Disclosure of interest: None declared.

O72
O072: A targeted MRSA surveillance in long-term-care
facilities - Polish example
J Wojkowska-Mach*, M Pobiega, D Romaniszyn, A Chmielarczyk, PB Heczko
Chair of Microbiology, Jagiellonian University Medical School, Krakw, Poland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O72
Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is no
longer only a nosocomial pathogen. An understanding of the epidemiology
of MRSA in long-term care facilities (LTCF) is essential for preparing effective
infection control guidelines not only for LTCFs, but for hospitals too.
Objectives: The aim of this study was to investigate the prevalence and
resistance of MRSA isolates from LTCF-residents and to analyze the potential
risk factors for MRSA occurrence (defined as MRSA colonization and/or
infection).
Methods: A 1-day point prevalence study (PPS) and 1-year continuous
active surveillance (CS) was carried out on a group of 193 LTCF-residents.
The presence of mecA and mup genes and antimicrobial susceptibility
was tested. The genetic diversity of the isolates was compared.
Results: Overall, 57 residents (26.3%) were colonized with SA, 23 of the
isolates (43.9%) were methicillin-resistant. There was 17 cases of infections
with the Staphylococcus aureus aetiology, of which 10 (58.8%) were caused
by MRSA (8 skin infections and 2 pneumonia). The average age for the
population of whom 63.2% were female was 76.2 years. The MRSA
prevalence in PPS was 11.9%, in CS - MRSA infection incidence was 5.2%.
Factors associated with MRSA presence were: the general status of patients,
limited physical activity, wound infections (odds ratio, OR 4.6), ulcers in PPS
(OR 2.1), diabetes (OR 1.6), urinary catheterization (OR 1.6) and stool
incontinence (OR 1.2). Prevalence of MRSA in the group of residents with
limited physical activity was 65.8% (relative risk, RR 12.1). Results of the
multivariate analysis showed that age, physical activity impairment and
ulcers were significantly associated with the risk of occurrence of MRSA.
Conclusion: The MRSA occurrence in Polish LTCFs was low. Our data
indicate a need to checking MRSA especially in group of residents with
limitations of physical activity i.e. with the highest risk of MRSA. Such
targeted surveillance is particularly important in countries with limited
resources in infection control. Focus on the high-risk population might be
a solution for the cost-effective surveillance. This work was supported by
a grant from the Ministry of Science and Higher Education No N N404
047236.
Disclosure of interest: None declared.
O73
O073: An outbreak of norovirus strain GII.4 Sydney in a geriatric
teaching hospital
B Huttner1*, S Cordey2, V Sauvan1, L Pagani1, A Iten1, L Kaiser2, J-L Reny3,
S Harbarth1
1
Infection Control Programme, Geneva University Hospitals, Geneva,
Switzerland; 2Laboratory of Virology, Geneva University Hospitals, Geneva,

Page 23 of 143

Switzerland; 3Department of Internal Medicine, Geneva University Hospitals,


Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O73

Introduction: In 2012, several countries have reported increased


Norovirus (NoV) activity attributable to the emergence of a new variant
(strain GII.4 Sydney). We describe an outbreak caused by this strain in a
geriatric hospital.
Methods: Active surveillance of gastroenteritis outbreaks in a geriatric
teaching hospital with 294 beds in Geneva (Switzerland) was conducted since
2008. All patients presenting 3 episodes of diarrhoea/day and/or 1 episode
of vomiting not explained by other causes were reported to the infection
control nurse who reviewed all cases. Viral gastroenteritis was defined as
cases presenting the above mentioned symptoms plus (1) either laboratory
confirmation of a viral gastroenteritis pathogen or (2) having shared a room
with a case fulfilling criterion (1). A case was classified as hospital-acquired
(HA) if the onset of symptoms occurred 48 h after admission. Symptomatic
patients were put under contact and droplet precautions; environmental
cleaning was intensified. Testing for NoV in stool using RT-PCR was limited to
index cases. For 3 randomly selected patients symptomatic during the 2012/
2013 outbreak, the NoV genome was extracted from stool samples and the
ORF2 nucleotide sequence was analyzed.
Results: During the period from 18.12.2012 to 02.01.2013 we identified
134 patients fulfilling criteria for HA gastroenteritis among 399 patients at
risk during that period (attack ratio 0.34). 18/21 tested patients had a
positive result for NoV, 0/15 were positive for Rotavirus, while 3 were
positive for Clostridium difficile toxin (all 3 were also positive for NoV).
28 cases were identified among health care workers. All 3 genetically
analyzed NoV samples belonged to the GII.4 Sydney strain. While
outbreaks with gastroenteritis have occurred each winter season since
2008, this was the outbreak with the highest number of cases since winter
2008/2009 (total number of cases by winter: 2008/9 232 cases, 2009/10
113 cases, 2010/2011 18 cases, 2011/2012 88 cases).
Conclusion: This study shows that the NoV GII.4 Sydney 2012 circulated in
Switzerland during winter 2012/2013. An outbreak with this strain was
difficult to control despite prompt instauration of infection control measures.
Disclosure of interest: None declared.

O74
O074: EPIPA, a point prevalence survey of urinary, pulmonary and skin
infections in 334 French nursing homes
A Vincent1, O Baud2, N Armand3, G Gavazzi4, A Savey5, P Fascia1*,
EPIPA working group1
1
ARLIN Rhne-Alpes, Saint Genis Laval, France; 2ARLIN Auvergne, ClermontFerrrand, France; 3Valence General Hospital, Valence, France; 4University
Hospital of Grenoble, Grenoble, France; 5CCLIN Sud-Est, Saint Genis Laval,
France
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O74
Introduction: Since 2009, nursing homes (NHs) in France have developed
their own infection prevention and control programs. Surveillance could help
these facilities put in place efficient preventive measures at a local scale.
Objectives: To provide the participating NHs with baseline data in order
to plan future prevention programs.
Methods: A point-prevalence survey of urinary tract infections (UTI),
respiratory tract infections (RTI) and skin and soft tissues infections (SSTI), as
well as a survey about organisation and policies, were undertaken in the
NHs of 6 regions in the South-East of France. As a validation study, 10% of
the forms collected in a designated region (Rhne-Alpes) were controlled by
external healthcare workers (infection control practitioners or nurses).
Results: A total of 334 NHs (28,345 residents) were included in this survey:
80.4% of the NHs (267 out of 332) are developing an infection control
program. 58.1% (193/332) of the facilities have an infection control
practitioner or infection control nurse (ICT). The proportion of healthcare
professionals who have received a specific formation on the prevention of
Hospital Acquired Infections (HCAI) was considerably higher in NHs
disposing of a part-time ICT than in those without ICT, respectively 72.7%
(136/187) and 27.3% (51/187), p<0.001. Among the 28 345 residents who
were questioned, 1 262 (4.45%) had at least one UTI, RTI or SSTI. SSTI are the
most frequent infection with an overall prevalence of 2.08% (591/28345),
followed by RTI - 1.56% (442/28345) - and finally UTI - 1.33% (378/28345).

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Page 24 of 143

The antimicrobial prevalence was of 3.86% - 1095/28345. Answers to surveys


by external ICT yielded 85.6% (95/111) of validations.
Conclusion: This is the first cross-sectional point prevalence study of this
importance in France. It was undertaken by the NHs themselves, and the
collected datas quality proves that this methodology is reliable. An impact
study is programmed after this first prevalence study in order to assess
practical measures which may have been developed and implemented in
the NHs based on their prevalence results.
Disclosure of interest: None declared.

cycle (AprilDec 2006), compliance improved to 41.6% in experimental


wards and decreased to 18.8% in control wards. When multimodal
interventions were extended to six study sites in the second action research
cycle (JanMay 2007), experimental wards showed sustainability (44.4%),
while no change was observed in control wards (25.6%). During the last
action research cycle (May 07 Feb 2008), overall compliance increased to
54% (experimental wards, 52.6%; controls, 55.3%). Further reinforcement
strategies were implemented from March 2008 and overall hospital
compliance increased to 78.6% in 2012. In parallel, the use of alcohol-based
handrub increased from 2L/1000 patient-days in 2006 to 45L/1000 patientdays in 2012. Methicillin-resistant Staphylococcus aureus bloodstream
infection decreased from 1.53/1000 patient-days in 2006 to 0.87/1000
patient-days in 2012.
Conclusion: The WHO HH promotion strategy, using an action research
approach, is successful with sustained compliance and continuous
reduction in MRSA bloodstream infection rates.
Disclosure of interest: None declared.

O75
O075: Successful implementation of the World Health Organization
hand hygiene improvement strategy in a teaching hospital, China
F Qiao*, Z Zong, W Yin, W Huang, H Zhuang
Infection Control Department, West China Hospital, Sichuan University,
Chengdu, China
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O75
Introduction: Although hand hygiene is the most effective measure for
preventing health care associated infections, overall compliance of hand
hygiene is poor in developing countries, and it is hard to promote HH by
using WHO multi-strategy.
Objectives: To assess the feasibility and effectiveness of the World Health
Organization hand hygiene improvement strategy in a 4300 beds
hospital, a resource-poor area in China.
Methods: A multi-prong approach was used in designing the hand
hygiene program. The intervention consisted of rebuild hand-sinks;
introducing a locally produced, self-branded alcohol-based handrub(ABHR);
use the liquid soap take the place of solid soap; training and educating
staff, students and patients through infection control week and World
Hand Hygiene Day; monitoring hand hygiene compliance and the usage of
ABHR and liquid soap, providing performance feedback; posting reminders
in the workplace; and promoting an institutional safety climate according
to the WHO multimodal hand hygiene improvement strategy.
Results: All the hand-sinks were rebuild and hand-actuated taps were
replaced. One self-branded ABHR has been produced with the cooperation
of local manufacturers using the hand rub formulation provided by WHO.
At follow-up, the usage of ABHR increased from 2.17(2009) to 12.28(2012)
L per 1000 patient-days. And the compliance of hand hygiene increased
from 45.9%(in Jan 2012) to 67.9% (in Dec. 2012). Improvement was
observed across all professional categories. Healthcare-associated MRSA
infection were reduced from 0.21( in January 2012) to 0.06(in Dec 2012)
per 1000 patient-days.
Conclusion: Multimodal hand hygiene improvement strategy is feasible
and effective in a big teaching hospital in developing country. Leaderships
support of the program and the active participation of staff is the key factor
in helping to make the program a true success. The WHO multimodal
inventions work in improving compliance and reducing healthcare
associated infections.
Disclosure of interest: None declared.

O76
O076: Impact of the implementation of the who hand hygiene
promotion strategy in the Hong Kong pilot site: 2006-2012
JWM Tai1*, D Pittet2, WH Seto3, V Cheng4, P Ching5
1
Infection Control, Queen Mary Hospital, Hong Kong, China; 2Infection
Control, University of Geneva Hospitals, Geneva, Switzerland; 3WHO
Collaborating Centre, Hong Kong, Hong Kong; 4Queen Mary Hospital, Hong
Kong, Hong Kong; 5WHO Collaborating Centre, Hong Kong, Hong Kong
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O76
Introduction: The WHO First Global Patient Safety Challenge Clean Care
is Safer Care aims to tackle healthcare-associated infection worldwide
with hand hygiene (HH) as the cornerstone intervention.
Objectives: To assess the impact and sustainability of the WHO hand
hygiene multimodal improvement strategy in the Hong Kong pilot site
hospital.
Methods: Times series design with experimental and control wards. Data
were collected during three cycles of action research targeted at
improving compliance with practices.
Results: Overall hand hygiene compliance was 22% (experimental wards,
18.3%; controls, 25.4%) at baseline. At the end of the first action research

O77
O077: The impact of a multi-faceted approach on the reduction of
peripheral line-associated MRSA bloodstream infections in a high
endemic setting
E Tartari*, MA Borg
Infection Prevention and Control Unit, Mater Dei Hospital, Msida, Malta
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O77
Introduction: The Mediterranean region is characterized by a high
prevalence of methicillin-resistant Staphylococcus aureus (MRSA)
bloodstream infections (BSI). Following root cause analysis (RCA) of MRSA
BSI cases, Mater Dei Hospital, a tertiary care institution in Malta, identified
that a 30% of healthcare associated (HA) MRSA BSI from April 2010 to
December 2011 were associated with Peripheral Venous Catheters (PVC).
Objectives: To identify the impact of the implementation of a bundle of
measures on the rate of catheter-related BSI.
Methods: The study involved a baseline phase (08/2010-2/2011) followed
by an intervention period (3/2011-12/2011) and a sustainability phase (1/
2012-12/2012). During the baseline phase, every HA-MRSA BSI was analysed
through a RCA to identify those caused by PVC. At the same time, practices
related to PVC insertion and maintenance were audited. During the
intervention phase: (1) a new hospital policy, insertion record and
maintenance checklist for daily assessment and documentation were
launched, (2) Visual Infusion Phlebitis (VIP score) tool and PVC duration not
exceeding 72 hrs, (3) hands-on training for junior doctors on insertion and
educational sessions for all nursing staff on PVC ongoing care were
provided, (4) and the introduction of a semi-permeable transparent dressing.
Auditing and feedback with corrective action on non-conformities were
undertaken in all of the hospital wards during the sustainability period.
Results: The number of MRSA BSI cases has halved in our institution, from a
yearly average of 1.85 BSI per 10,000 patient days in 2009 to 0.89 infections
per 10,000 patient days in 2012.From January 2011 to February 2013, the
number of cases have been stratified by yearly quarter. In year 2011, 36
MRSA blood infections with PVC as primary origin were reported. In year
2012, 12 MRSA blood infections were reported in Quarter 1 and 6 cases
were reported in Quarter 2. Over the past 9 months the number of HAMRSA BSI has constantly reduced and dropped to zero cases between July
2012 and February 2013.
Conclusion: CR-BSIs are essentially preventable. We consider multi
disciplinary strategies such as RCA and continuous audits of PVC insertion/
maintenance with real time feedback and corrective action to have
contributed most to the success.
Disclosure of interest: None declared.

O78
O078: 6 years of national German hand hygiene campaign-where
do we come from and where are we heading to?
C Reichardt*, M Behnke, K Bunte-Schnberger, P Gastmeier,
AKTION Saubere Hnde
Institute of Hygiene, Universitiy Medicine Berlin, Charite, Berlin, Germany
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O78
Introduction: The national German hand hygiene (HH) campaign
AKTION Saubere Hnde started at January 1st 2008. The campaign is

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Page 25 of 143

based on the WHO Clean Care is Safer Care campaign and is funded for
six years be the German ministry of health. By March 2013, over 1300
health care institutions are actively participating.
Objectives: We present data on the development of observed
compliance rates, alcohol based hand rub consumption (AHC) and hand
rub dispenser availability over the campaign period.
Methods: All participants have to implement a multimodal intervention
program. Among other parameters, they have to collect the following
data: AHC, hand rub dispenser availability and on a voluntary basis
observed compliance data. All three parameters are collected using a
defined data collection tool. Observers are trained by the campaign team
members. AHC is given unit based yearly in ml per patient day. Hand rub
availability is defined as one dispenser per ICU bed and per two non-ICU
beds. The definition of HH opportunities (HHO) is based on the WHO
Model My 5 moments of hand hygiene. Observations were done before
intervention and after interventions. A minimum of 200 observations per
unit was defined.
Results: There are 1300 health care institutions participating in the
campaign by March 2013. Among those are 815 hospitals (45% of all
hospitals in Germany), 66 rehabilitation clinics, 242 long term care
facilities and 183 outpatient care facilities. There was an increase of AHC
of 47,5% (p<0,001) in 166 hospitals that provided AHC data consecutively
from 2007 to 2011. Hand rub dispenser availability increased to over 90%
in non-ICUs and to over 100% in ICUs (p<0,001). Compliance increased
from 64% before to 74% after one intervention in 82 hospitals with 249
units (136205 HHOs) (P<0,001). 6 hospitals with 25 units have observed
over four periods. Observed HH compliance increased from 60% at
baseline to 71,2% after four observation periods (p<0,001).
Conclusion: Hospitals participating in the campaign have to implement a
multimodal intervention program. The increase of AHC and observed
compliance show, that the multimodal intervention program based on
the WHO strategy led to improved HH compliance.
Disclosure of interest: None declared.

and post surgery care and peripheral, central vascular catheter insertion,
maintenance and removal. The impact of these recommendations is
reviewed through national programmes of HAI reduction work.
Disclosure of interest: None declared.
Reference
1. Health Protection Scotland: Scottish National Point Prevalence Survey
of Healthcare Associated Infection and Antimicrobial Prescribing.
2011.

O79
O079: The rapid delivery of national evidence based recommendations
for HAI care bundles
C Kilpatrick1*, H Murdoch2, A Paterson2
1
World Health Organisation, 1211 Geneva, Switzerland; 2Health Protection
Scotland, Glasgow, UK
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O79
Introduction: In 2011, the Scottish Government asked Health Protection
Scotland (HPS) to deliver evidence based recommendations within 1 year
to update national infection control (IC) care bundles. Aimed to support
frontline staff to reduce healthcare associated infection (HAI) these
featured bundles to prevent bloodstream infections associated with
surgery and intravascular devices. NHSScotland has used national
evidence based bundles since 2008. The results of the recent National
HAI Prevalence Study [1] indicates a temporally associated reduction in
HAI with the implementation of national HAI interventions, including care
bundles.
Objectives: - To prepare a model for rapidly delivering evidence reviews.
- To issue literature reviews on key infection control interventions.
- To issue key recommendations from the reviews to inform the update
of existing care bundles.
Methods: An algorithm of a proposed, chronological rapid evidence
review model was developed including 1) a high level review to identify
relevant mandatory, national/international evidence based guidance, then
assessed using the AGREE instrument 2) to address lack of evidence/
conflicting recommendations, targeted full database searches; Medline,
CINAHL, EMBASE with resulting papers appraised using SIGN checklists
and graded using HICPAC method 3) a decision making framework used
to formulate final key recommendations for practice.
Results: During July to Nov 2012, using the rapid review model identified
a number of existing bundle criteria which required a targeted evidence
review and resulted in changes to recommendations consistent with the
evidence. In total, 13 recommendations were made for preventing
surgical site infection, 12 for peripheral vascular catheters and 13 for
central vascular catheters.
Conclusion: To meet the demands of those aiming to deliver safe care in
NHSScotland, we issued evidence based recommendations within a tight
timescale, which could be adopted into care bundles addressing pre, peri

O80
O080: Amplification of patient safety and infection prevention
systems in southwest uganda: the power of district
based in-hospital training
I Spillman1*, M Ahimbisibwe1, A Fry1, SB Syed2, S Hoyle3, S Walker3,
T Tumwesigye4
1
Kisiizi Hospital, Church of Uganda, Kabale, Uganda; 2African Partnerships for
Patient Safety, World Health Organization, Geneva, Switzerland; 3Countess of
Chester Hospital, NHS, Chester, UK; 4Uganda Protestant Medical Bureau,
Kampala, Uganda
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O80
Introduction: Kisiizi Hospital (KH) in partnership with Countess of Chester
Hospital UK, as part of WHO African Partnerships for Patient Safety (APPS)
has developed a programme to amplify crucial patient safety improvements
to other district health facilities.
Objectives: To describe an effective replicable mechanism of amplification of APPS.
Methods: Using co-developed APPS resources, including in-house videos
and demonstrations, training targeted all hospitals, training schools, and
health centre IVs within Rukungiri and Kabale districts. A Sensitisation Day
aimed at key leaders of institutions was followed by a 2-day Training of
Trainers seminar for those chosen to implement APPS principles. Patient
safety, healthcare associated infections, hand hygiene, safe prescribing, WHO
Safe Surgical Checklist, medical waste management, triage, monitoring,
evaluation and teaching methods were covered, complimented by a tour of
KH. Evaluations were completed and site-specific implementation plans
formulated. Post-event site follow-up assessing progress with specific
implementation goals is scheduled.
Results: Training achieved 100% coverage for health centre IVs, hospitals,
and district staff. In addition another regional hospital, two health educators,
and four colleagues from Ndola Hospital, Zambia participated. Attendee
evaluation was positive with 61% of attendees rating ten out of ten for
overall quality of training. The tour and the varied methodologies utilised
scored very highly.
Conclusion: Key lessons emerge. First, success of regional coverage was
due to good promotion and the innovative use of a Sensitisation Day to
motivate leaders of institutions followed by appropriate staff selection to
ensure implementation. Second, the Uganda-Zambia link enriched the
training and proved mutually beneficial. Third, locating the seminars at an
APPS hospital proved valuable in reality-focused training. Finally,
comprehensive electronic resource compilation including in-house videos
can provide support for on-going implementation. The process and
amplification materials used can be replicated in other districts in Uganda
and Africa to enhance patient safety.
Disclosure of interest: None declared.

O81
O081: Reduction of clostridium difficile infections with enhanced
evidence-based practices and antimicrobial stewardship
K Alexander-Mills1*, A Kish1, F Palmieri1, A Foster1, D Viola2,
F Petersen-Fitzpatrick1
1
Bronx Lebanon Hospital Center, Bronx, USA; 2New York Medical College,
Valhalla, USA
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O81
Introduction: Infection rates, deaths, and excess healthcare costs resulting
from Clostridium difficile infection (CDI) in hospitalized patients are at an
historic high, costing the United States Healthcare system at least an extra
$1 billion annually. This study assesses the incidence of CDI cases at an
inner city hospital in the Northeast Tristate region and determines whether
evidence-based intervention and antimicrobial stewardship showed a
reduction in CDI.

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Methods: A retrospective review of cases with CDI in this facility from


January 2010 to December 2011 was conducted in relation to evidencebased practices and antimicrobial stewardship intervention. In 2008, an
evidence-based bundle was implemented in cooperation with the New
York State Department of Health (NYSDOH). The bundle consisted of
limited adherence to hand washing, environmental cleaning, and
isolating the patient. In 2010 this practice was modified with the
incorporation of a fledging antimicrobial stewardship program. The
antimicrobial stewardship program is designed to use the hospital
antibiogram to empirically treat diseases with the intention of optimizing
antimicrobial use according to the susceptibility patterns of the
organisms.
Results: Prior to implementation of the interventions there were 186 cases
of CDI in 2010. After introducing the modified bundle, there were 121 cases
post intervention in 2011. The empiric treatment of certain medical
conditions per patient days of therapy with antimicrobial agents called
quinolones was decreased with the addition of the antimicrobial
stewardship program. The decrease in days of therapy of quinolones by
75% led to a reduction in CDI cases by 39% and a decrease in the overall
length of stay from 6.83 in 2010 to 6.38 in 2011.
Conclusion: The findings from this study provide further evidence that
evidence-based practices when followed appropriately can reduce the
acquisition and transmission of CDI. Decreasing CDI requires a multifaceted
approach including formulary restrictions, staff education, and guidelines
that will improve patient safety, decrease healthcare costs and enhance
quality of care.
Disclosure of interest: None declared.

O82
O082: Theories behind effectiveness: understanding behavioural
change interventions to improve quality of care
F Secci1*, R Edwards1, W Zingg2, D Pittet2, A Holmes1
1
Imperial College London, London, UK; 2University of Geneva Hospitals,
Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O82
Introduction: Despite increasing efforts to prevent and manage infections,
hospitals struggle to reduce healthcare-associated infections (HCAI), partly
because healthcare workers (HCWs) do not necessarily change their
behaviour to comply with new guidelines in infection prevention and
control (IPC). A number of theoretical approaches could be useful in
mapping factors that influence HCWs behaviour and in supporting more
effective interventions.
Objectives: We aimed to investigate which factors influence effectiveness
of interventions intended to change HCWs behaviour in IPC, and to
understand whether or not such interventions are based on theory and, if
so, on which theory.
Methods: In the context of the ECDC-funded SIGHT project, we
conducted a systematic review to assess effectiveness of behaviour
change and quality of care interventions, identify factors influencing
effectiveness, and explore theoretical basis of interventions. We adopted
an innovative tool (ICROMS) to incorporate and quality assess a broad
range of methodologies.
Results: Factors associated with guideline adherence and intervention
effectiveness can be grouped into six categories: practical, individual,
organisational, coercive, normative, and cultural-cognitive. Practical and
individual categories including availability of facilities and attitudes, are
the most frequently addressed, followed by organisational aspects, such
as staff engagement. Professional norms and socialisation processes are
critical, but rarely explicitly investigated. A number of studies focused on
hand hygiene, but whether and how such findings are applicable to
other IPC behaviours is unclear. The theoretical basis for behaviour
change (e.g. Theory of Planned Behaviour and PRECEDE framework) is
rarely mentioned, and focus mainly on individuals, ignoring how
organisational and contextual variables may influence practice.
Conclusion: Broadening the theoretical grounds of behaviour change
interventions will allow to incorporate relevant, yet currently overlooked
factors that influence HCWs behaviour. This would facilitate planning and
implementation of more successful interventions.
Disclosure of interest: None declared.

Page 26 of 143

O83
O083: Prohibit (preventing hospital-acquired infections by intervention
and training): preliminary results of a European multi-center study on
the effectiveness of a hand hygiene campaign and a central venous
catheter bundle
T van der Kooi1*, M Wolkewitz2, B van Benthem1, S de Greeff1,
H Grundmann1, W Zingg3, PROHIBIT study group1
1
RIVM, Bilthoven , The Netherlands; 2Institute of Medical Biometry and
Medical Informatics, Freiburg, Germany; 3University hospitals of Geneva,
Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O83
Introduction: Differences in the incidence of hospital-acquired infections
among European hospitals are due to a range of factors such as case
mix, variable infection control policies and practices, and culture. The
PROHIBIT study aims at inventorying and analysing national and local
infection prevention policies and practices in Europe. The aim of this
study is to test two interventions of proven efficacy, a hand hygiene (HH)
improvement campaign and an extensive central venous catheter (CVC)
bundle, in reducing CVC-related bloodstream infection (CRBSI).
Methods: Fourteen hospitals from 11 countries take part with one
intensive care units (ICU) since January 2011. Primary outcome is CRBSI,
secondary outcomes compliance with HH and the CVC bundle. After a
baseline of 6 months, every 3 months 3 hospitals were randomized to
implement one or both interventions following a stepped wedge design.
The last 2 started in July 2012 and the study ends in June 2013. The HH
strategy followed the World Health Organization guidelines while the
CRBSI prevention strategy is based on a successfull programme of the
University of Geneva hospitals.
Results: The mean (95% confidence interval) baseline CRBSI rate was 2.5/
1000 CVC days (2.2-2.8) with an interhospital range of 0.0-10.0. The
incidence of most CVC bundle hospitals was 1.0 at baseline already. The
mean rate upon the intervention was 0.9 (0.8-1.2; range: 0.0-5.1). The
mean baseline CVC bundle compliance of 4.3% increased to 40.6% for all
hospitals. The mean baseline HH compliance of 48.6% (range: 16.9-67.1),
improved to 60.0% for all hospitals (range: 36.1-85.3). Multivariate Cox
regression, stratified per hospital, revealed that the HH intervention alone
and both interventions combined were associated with reduced CRBSI
incidence densities (HR 0.4 and 0.5 respectively).
Conclusion: Our findings confirm variation of CRBSI incidence densities
among European ICUs. The interventions appear effective particularly in
hospitals with higher baseline rates. This needs to be confirmed in the
final analysis including competing risks and sensitivity analyses.
Disclosure of interest: None declared.

O84
O084: Implementing a hand hygiene programme in the critical care
department of galway university hospitals, Ireland: an interesting and
challenging journey
TW Boo1,2, J Davitt3*, C Greally4, M Commane3, B Hanahoe5, T van der Kooi6,
J Bates4
1
Bacteriology, School of Medicine, NUI, Galway, Ireland; 2Clinical
Microbiology, Galway University Hospitals (GUH), Galway, Ireland; 3Infection
Control, GUH, Galway, Ireland; 4Critical Care, GUH, Galway, Ireland; 5Clinical
Microbiology, GUH, Galway, Ireland; 6RIVM, Bilthoven, The Netherlands
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O84
Introduction: As a participant of the PROHIBIT (Prevention of Hospital
Infections by Intervention and Training) study, we review interim
outcomes and practical challenges after 18 months of implementing a
hand hygiene programme in our critical care units.
Methods: Following a 6-month baseline audit, a multifaceted programme
was instituted in July 2011. Regular audits tracked the programmes impact
on outcomes. Factors impacting on the programmes implementation were
collated from stakeholders feedback and observations made by the
implementation team. These factors were then used to further inform and
adapt unit based interventions.
Results: There was a significant decrease in central venous catheterrelated bloodstream infection (CRBSI) rates following the programme
implementation. CRBSI rates fell from 5.4 infections / 1,000 CVC days

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(95% confidence interval (CI) 3.1 9.5) in the baseline period to 0.8 (95%
CI 0.3 2.1) during the 18 months of the programme. Hand hygiene
compliance rates rose from 48.8% (baseline period) to 77.2% during
the period of programme implementation, with results maintaining above
75% in the latter 12 months (Jan Dec 2012). Factors facilitating its
implementation include institutional endorsement of outcome measures as
key performance indicators, regular feedback to stakeholders, targeted
educational sessions, and bedside shadowing exercises. Challenges have
also been encountered, eg. maintaining motivation and enthusiasm of staff,
waning of the novelty factor in the study, maintaining hand hygiene as a
priority in challenging times, poorer compliance rates of visiting medical
teams.
Conclusion: Participation in the PROHIBIT study gave us the impetus to
implement an intensive hand hygiene programme in our critical care units.
Although resource-intensive, it has been a success to date. The journey to
improve hand hygiene compliance has also been one about shared vision
and culture change. Our journey continues.
Disclosure of interest: None declared.

O85
O085: A network-based approach using intra-hospital patient transfers
to identify high-risk wards during nosocomial outbreaks
M Ciccolini*, J Arends, H Grundmann, AW Friedrich
Medical Microbiology and Infection Control, University Medical Center
Groningen, University of Groningen, Groningen, The Netherlands
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O85
Introduction: Initial detection of a nosocomial outbreak can sometimes
occur only after a considerable time has passed since the appearance of the
index case(s). During this high-risk period from emergence to detection,
within-hospital patient movements can disseminate the nosocomial
pathogen to different admission wards. Following outbreak detection, a
rapid, robust estimate of potentially exposed wards is of crucial importance
in order to focus the implementation of infection prevention measures.
Methods: We employ a mathematical approach, together with detailed
patient location data and information on suspected cases, to estimate the
potential number of exposed wards during an outbreak high-risk period.
The model allows for different patient-to-patient transmission probability
depending on time since last exposure, relative order in the transmission
chain (first, or higher order contact), and on whether patients were located
in the same room.
Model output consists of a risk score associated with each ward, and an
exposure network, defined as all the exposed wards, together with
precise information on dangerous contacts between them. Standard
software was employed to visualize the exposure network growth
throughout time.
Results: This framework was successfully applied during a recent multiresistant K. pneumoniae outbreak at a large university hospital in the
Netherlands. A 4 month high-risk period resulted in 35 (out of 59)
potentially exposed wards. The 10 wards with the highest modelcalculated risk score were selected for post-exposure microbiological
screening, which resulted in 154 additional screened patients. Further
patients were screened, as controls, on other wards not included in the
calculation. The complete exposure network was reconstructed, and the
potential maximum reach of the outbreak was estimated. No additional
positive patients were found and the outbreak was stopped.
Conclusion: Due to the high level of patient exchange between different
admission wards, determining their level of exposure during a prolonged
high risk period rapidly becomes a complex task. Our network-based
approach has been a valuable tool in reducing this complexity, focusing
infection control interventions during an ongoing outbreak.
Disclosure of interest: None declared.

O86
O086: Antibiotic use and vancomycin-resistant enterococcus (VRE)
carriage during a large outbreak in a dutch hospital
J van Balveren1, LB van der Velden1*, HW Fleuren2, MH Nabuurs-Franssen1,
A Voss1,3, T Sprong1,4
1
Medical Microbiology and Infectious Diseases, Nijmegen, The Netherlands;
2
Clinical Pharmacology, Canisius Wilhelmina Hospital Nijmegen, Nijmegen,

Page 27 of 143

The Netherlands; 3Medical Microbiology, University Hospital Nijmegen


Medical Center, Nijmegen, The Netherlands; 4Internal Medicine, Canisius
Wilhelmina Hospital Nijmegen, Nijmegen,The Netherlands
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O86

Introduction: In 2012 a large number of Dutch hospitals experienced


outbreaks of vancomycin-resistant enterococcus (VRE), including our (560
beds) secondary care hospital.
Objectives: To examine whether (previous) antibiotic use was associated
with VRE-carriage.
Methods: We studied all patients who were found positive for VRE
carriage (rectal swab) by PCR and or culture during admission from an
outbreak in a large (560 beds) secondary care hospital in the Netherlands,
in the period May to August 2012. From these 120 patients antibiotic use
was retrieved from the database of our electronic prescription system.
Results: From the 120 patients identified as VRE carrier, 112 (93,3%) had
used one or more antibiotics in the 3 months before VRE-positivity.
78 (69.6%) patients had used ciprofloxacin and 52 (46.6%) a third-generation
cephalosporin (ceftriaxone or cefotaxime). Interestingly, only 1 patient (0.9%)
had used vancomycin in the 3 months before positivity. Median duration of
admission and time to VRE-positivity were significantly longer in the patients
who had received prior antibiotic therapy (14 days) compared to the
patients who did not receive antibiotic therapy (4 days).
Conclusion: VRE-carriage is almost exclusively seen in patients who have
previously received antimicrobial therapy. The short time to positivity in the
patients who did not receive previous antibiotic therapy may suggest that
they acquired VRE in the community or during an admission >3 months
before VRE positivity. In this outbreak, vancomycin use was not related to
VRE carriage. A retrospective case control study will be performed on these
patients to identify which antibiotics predispose to VRE-carriage.
Disclosure of interest: None declared.

O87
O087: An acinetobacter spp. (GIM-1) pseudo-outbreak due to
contamination of a pneumatic transport system (PTS) in a large
university hospital
BC Grtner1*, S Jungmann1, A Dawson1, A Halfmann1, C Petit1, M Kaase2,
SG Gatermann2, M Klotz1, L von Mller1, P Lttchens3, R Veith3, M Herrmann1
1
Institute of Medical Microbiology and Hygiene, University of the Saarland,
Homburg/Saar, Germany; 2National Reference Laboratory for Gram-negative
Bacilli, University of Bochum, Bochum, Germany; 3Technical Department,
University of the Saarland, Homburg/Saar, Germany
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O87
Introduction: In clinical specimen from 21 patients, two species of
Acinetobacter baumannii complex were isolated with resistance to betalactams
including carbapenems. None of the patients had symptoms indicative for
infection. Patients were treated in various departments and a large spectrum
of age, clinical specimen, and underlying disease was observed.
Objectives: To identify the source of transmission.
Methods: Molecular analysis of the isolated strains and extensive
epidemiologic workup.
Results: Molecular analysis confirmed presence of a metallobetalactamase
of GIM-1 genotype. Extended epidemiologic workup, however, did not
reveal any factors for transmission, previous hospitalizations, common places
of residence moreover Extensive analysis of specimen workup in the
laboratory rendered a laboratory associated pseudo-outbreak highly unlikely.
Identical Acinetobacter spp (GIM-1) was found on 8/13 patient data sheets
accompanying the positive specimen, as well as PTS cartridges prospectively
analyzed. Positive microbiological results were associated with humidity in
the cartridges. Moreover the outbreak strain was detected in air samples
close to the PTS.
Upon identification of the PTS as cause of the pseudo-outbreak, all clinical
infection control measures were lifted, yet, rigorous measures for hygienic
handling of PTS stations, cartridges, and transported specimens were
introduced. Moreover, the PTS was decontaminated with disinfectants.
Conclusion: To our knowledge, this is the worldwide first description of a
large-scale contamination of a hospital PTS. In absence of established
environmental hygiene standards, bacterial contamination of PTS may occur
for extended time periods prior to recognition, and may be the cause not
only for pseudo-outbreaks but also for transmission of nosocomial

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Page 28 of 143

pathogens with yet unknown consequences. This experience suggests that


establishment of standards is necessary for the particular challenge which
PTS may represent for hospital hygiene.
Disclosure of interest: None declared.

Results: There was no recent history of throat infection in patients or their


relatives. Compliance to SSI preventive measures (pre operative showers,
skin antisepsis, and laminar air flow) was adequate, and wearing of mask in
the OR was adequate for 88% of 332 HCWs. A GAS isolate was recovered
from throat swabs of 2 of the 6 HCWs caring for the 1st case, one of which
was identical to the patients isolate. Auditing this HCW revealed a lack of
adequate fitting of the mask during preparation of the OR. Educational
sessions were implemented. After the 2nd case occurred, the same HCW was
again found colonized with a GAS isolate identical to the patients isolate,
but different from the 1st one. A more in-depth investigation revealed that
one of his children had recurrent tonsillitis. Decolonization of the HCW was
attempted, but GAS carriage recurred until tonsillectomy was performed on
his child.
Conclusion: The same staff carrier was involved in the transmission of 2
different GAS strains, likely resulting from household transmission. Throat
carriage of the personnel stopped only after tonsillectomy of his child.
Reinforcing adequate surgical mask wearing in the OR is important, but
100% compliance appears difficult to maintain.
Disclosure of interest: None declared.

O88
O088: Bad design, bad practices, bad bugs Elizabethkingia
meningoseptica outbreak in ICU
S Salmon1*, M Balm2, C Teo1, R Mahdi1, D Fisher1
1
Infection Control Team, National University Hospital Singapore, Singapore,
Singapore; 2Microbiology, National University Hospital Singapore, Singapore,
Singapore
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O88
Introduction: Elizabethkingia meningoseptica is a nosocomial-adapted,
Gram negative bacillus with intrinsic resistance to most antibiotics.
An outbreak investigation was commenced when five patients developed
E. meningoseptica bacteraemia within a three week period in the
Cardiothoracic Intensive Care Unit (CTICU) and Surgical ICU (SICU).
Methods: Analysis of laboratory data, case reviews, workflows within
CTICU and extensive environmental sampling of surfaces and taps within
four ICU wards, four general wards, two dialysis units and eight operating
theatres were performed.
Results: Upon review laboratory data revealed an unrecognized subtle
increasing trend of E. meningoseptica clinical infections in all ICUs over the
preceding 3 years. E. meningoseptica was cultured from aerators of 44% (35/
79) taps. Taps in sinks frequently used for non-sanctioned practices were
more likely to be contaminated (95% CI 1.2-2.3, p<0.003). Elizabethkingia
was not cultured from any other surfaces within patient rooms. Investigation
of ICU nursing practice revealed introduction of non-sanctioned practices
regarding disposal of patient respiratory secretions and cleaning of patient
equipment in designated hand hygiene sinks within patient rooms. An
urgent education programme was instituted to change these practices.
Rooms underwent terminal cleaning. Faucets were systematically cleaned
and aerators were changed. No further cases occurred in SICU or CT-ICU
over the following three months. One month after aerator change, new
aerators remained free of E. meningoseptica.
Conclusion: Introduction of non-sanctioned practices due to suboptimal
unit design may have unintended consequences for vulnerable patients.
Nursing workflows must also be practical to ensure proper waste disposal
and cleaning of medical equipment.
Disclosure of interest: None declared.

O89
O089: Recurrent transmission of group a streptococcus pyogenes (GAS)
during surgery by a health care worker (HCW)
C Landelle1*, P Lesprit1, P Legrand2, P Brehaut1, D Ducellier1, J-F Papon3,
E Allaire4, E Girou1, J-P Becquemin4, C Brun-Buisson5
1
Unit de Contrle, Epidmiologie et Prvention de lInfection, CHU Albert
Chenevier-Henri Mondor, Assistance Publique-Hpitaux de Paris; Universit Paris
12, Crteil, France; 2Service de Bactriologie-Virologie-Hygine, CHU Albert
Chenevier-Henri Mondor, Assistance Publique-Hpitaux de Paris; Universit Paris
12, Crteil, France; 3Service dOto-Rhino-Laryngologie, CHU Albert ChenevierHenri Mondor, Assistance Publique-Hpitaux de Paris; Universit Paris 12, Crteil,
France; 4Service de Chirurgie Vasculaire et Endocrinienne, CHU Albert ChenevierHenri Mondor, Assistance Publique-Hpitaux de Paris; Universit Paris 12, Crteil,
France; 5Service de Ranimation Mdicale, CHU Albert Chenevier-Henri Mondor,
Assistance Publique-Hpitaux de Paris; Universit Paris 12, Crteil, France
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O89
Introduction: Surgical site infections (SSI) due to GAS are rare but
potentially life-threatening.
Objectives: We describe 2 cases occurring after thyroidectomy in two
female patients (aged 36 and 52 years respectively), who developed septic
shock with multi-organ failure, mediastinitis and empyema, respectively 2
and 4 days after surgery performed 4 months apart (Nov. 2009; Feb. 2010).
Methods: We interviewed patients or relatives and operating room (OR)
personnel with regard to recent throat infection, and investigated SSI
prevention measures, surgical masks wearing in the OR, and GAS carriage
by HCWs; GAS isolates were compared by molecular typing.

O90
O090: Impact on nurses of ebola outbreak
D Pululu1*, S Mukendi1, P Formenty2, S Eremin2, CL Pessoa-Silva2
1
Isiro General Hospital, Isiro, Congo, The Democratic Republic of the; 2WHO,
Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O90
Introduction: On August 12, 2012, the DRC government declared
Bundibugyo ebolavirus (BE) outbreak in Isiro city. As of October 15, 2012,
75 (33 confirmed, 17 probable and 25 suspected) cases, and 25 deaths
had been reported among confirmed and probable cases.
Objectives: To describe the occurrence of BE infection among nursess
during the outbreak.
Methods: A case series design was applied. Study period: 28 May to 15
October, 2012. Study population: 166 nurses in main HCFs in Isiro, HCF A
(n=47, 70 beds), HCF B (n=32, 70 beds), HCF C (n=57, 160 beds), HCF D
(n=30, 53 beds). Case definition established suspect, probable and
confirmed (laboratory confirmed by RT-PCR or serology) cases. Active early
case detection and infection prevention and control was promoted in all
HCFs; an isolation unit established in HCF C on August 10, 2012 suspect
cases were referred. Laboratory tests were performed in all suspect cases
and HCWs who expressed interest. To assess potential risk factors, the HCFs
in the Isiro urban-rural health zone were assessed for IPC practices and hand
hygiene facilities, and a structured questionnaire applied to nurses who had
been tested for BE infection to assess contact with BE cases, service and HCF
where the nurse was assigned. Two-tailed exact test was used when
appropriate.
Results: 26% of BE cases were HCWs, and nurses comprised 12/13
affected HCWs (7 confirmed, 5 probable cases). All cases among nurses
occurred in HCF A (attack rate=15%) and HCF B (attack rate=12.5%) and
8 happened in the 1st month. 8/31 nurses tested were confirmed to be
BE infected, and 2 had mild symptoms, not requiring hospitalization. 20/
31 tested nurses acknowledged contact with a confirmed BE case, but
only four had confirmed infection. No statistical significant difference
was observed for service and history of contact. The only factor
associated with BE infection among nurses was being a nurse in HCF
A/B (p<0.001).
Conclusion: This study confirms the HCWs and particularly nurses as at
high risk for infection during Ebola epidemics. The occurrence of most
infection in beginning of the outbreak when HCWs were not alert for the
epidemic and IPC measures not in place highlights the importance of
applying basic IPC precautions at all times.
Disclosure of interest: None declared.
O91
O091: Healthcare associated infections: an overview (videoclip)
C Palos1*, A Bispo2, Infection Control Committee1, E Noriega3, A Arnaut4,
A Cabral5, P Nobre6
1
Infection Control Committee, Portugal; 2Hospital Beatriz ngelo, Loures, Portugal;
3
Infection Control Committee, Hospital do Barlavento Algarvio, Portimo,

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Portugal; 4Nurse Directorate, Esprito Santo Sade Group, Hospital Residencial do


Mar, Lisbon, Portugal; 5ADVITA, Hospital Residencial do Mar, Lisbon, Portugal;
6
Nurse Infection Control, Hospital Residencial do Mar, Lisbon, Portugal
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O91

Background: HAI prevention and control is an essential component of


patient safety. Healthcare workers awareness, knowledge and adherence are
crucial in order to obtain the best results. This videoclip aims to provide
healthcare workers (physicians, nurses, etc) on general concepts and
practices on infection control, using a combination of avatar technology and
real persons. HAI prevention and control is presented as an universal
and timeless challenge, mainly based on adoption of good practices of hand
hygiene and protective individual equipment. The main components and
objectives of HAI prevention and control are also presented. Videoclips are a
part of a global awareness and teaching materials on Infection Control and
Prevention, available on hospital intranet and on infection control
committee sessions.
Introduction: HAI prevention and control is an essential component of
patient safety. Healthcare workers awareness, knowledge and adherence are
crucial in order to obtain the best results.
Objectives: Improve awareness and knowledge on HAI prevention and
control.
Methods: This videoclip aims to provide healthcare workers (physicians,
nurses, etc) on general concepts and practices on infection control, using a
combination of avatar technology and real persons. HAI prevention and
control is presented as an universal and timeless challenge, mainly based on
adoption of good practices of hand hygiene and protective individual
equipment. The main components and objectives of HAI prevention and
control are also presented. Videoclips are a part of a global awareness and
teaching materials on Infection Control and Prevention, available on hospital
intranet and on infection control committee sessions.
Results: N/A
Conclusion: N/A
Disclosure of interest: None declared.

O92
O092: Clean hands: an university extension project
AFV Tipple*, JLU Spagnoli, ZCP Neves, JEM Santos, FCR Cesar, JPDA Trindade,
KCDO Batista
Faculdade de Enfermagem, Universidade Federal de Gois, Goinia, Brazil
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O92
This video presents the story of a university extension project called Clean
Hands which originated from a masters dissertation in 2006, based at the
Center for Studies and Nursing Research for the Prevention and Control of
Healthcare Associated Infections (NEPIH) based at the Center for Studies and
Nursing Research for the Prevention and Control of Healthcare Associated
Infections (NEPIH) at the School of Nursing, Federal University of Gois, Brazil,
and is registered with the Pro-Chancellor of Extension at the university. Since
its creation, the project has developed activities to encourage the
establishment of hand hygiene (HH) in health care, in cooperation with
professionals, academics, patients and caregivers, as well as in scientific
events, with academics and health professionals. After the outbreak of H1N1
in 2009, the project developed campaigns in municipal daycare centers
(CMEI), the Municipal Department of Education, of the city of Goinia, Gois,
Brazil, targeting children, parents and workers. In these campaigns, different
promotion strategies are used: informative stylized banners depicting HH;
educational brochures, a song parody CD, demonstration of proper HH
technique, using poster paints on childrens hands; a puppet theater; and
face-to-face discussions about the importance of, obstacles to, and benefits of
HH. Annually, the project hosts a festival of parodies with the theme of HH,
called CANTA FEN, which brings together academics and healthcare
professionals. The projects day-to-day operations are normally run by five
students, supported by the other members of NEPIH, currently 33 staff
members (faculty, undergraduate and graduate), participating in the activities
of the project. Up to February 2013, the project has performed about 180
campaigns (45 were for children) reaching approximately 8,000 people.
Participation in the project has contributed to the development of skills and
competencies with regard to the implementation of health promotion
strategies with different audiences and requires that students constantly stay
up to date on the subject. The festival of parodies has helped to empower its

Page 29 of 143

members to conduct scientific and cultural events and promote emphasis of


the subject in a playful manner.
Disclosure of interest: None declared.

O93
O093: Hand rub dance: an edutainment tool to remember the steps of
hand hygiene procedure
A-G Venier*, C Bervas, A Chasseuil, P Parneix
CCLIN Sud-Ouest, Bordeaux, France
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O93
Introduction: The need for, and benefits of, hand hygiene technique
training have been identified. However, it usually requires actions which
are often logistically challenging and time-consuming. For the 2012
French hand hygiene day, which was in November due to political
schedule, an edutainment concept was created: the hand rub dance.
Objective: To educate many people in a short time to hand hygiene
technique.
Methods: It was suggested to facilities of South-western France to
perform hand rub dance in November 2012: principle was to teach the
choreography to volunteers, to film the dancers and send videos to create
a compilation. The choreography of the hand rub dance was based on the
different steps of hand hygiene (palm to palm, palm over dorsum, fingers
interlaced, backs of fingers, thumbs, fingertips and wrists). Tool, also
available in an English version, included a methods guide with practical
and technical information, a didactic video, a training video and a royaltyfree original music (http://danse-du-sha.fr/). It was intended for healthcare
facilities and educational institutions and could address a variety of
audiences such as healthcare workers, patients, students, executive
managers or visitors.
Results: The training video was viewed online 5,000 times. Participation rate
was 11% with 88 videos from 51 healthcare facilities and 4 educational
institutions from the whole South-western France. Participants were mostly
public hospitals (24%), rehabilitation centres (16 %), nursing facilities (14 %)
and private hospitals (9 %). More than 1,400 people were filmed (median: 20
people per video, 170 maximum). Healthcare workers appeared in 86 % of
videos. Patients and visitors danced in 12 % of videos. Participants noticed a
rapid memorization by the targeted audience of the seven steps of hand
hygiene. The compilation was set online and viewed 3,000 times since its
release in late February 2013.
Conclusion: Hand rub dance is a complementary tool to promote hand
hygiene; 2012 experience in South-western France motivated and
gathered a large and eclectic public on hand hygiene theme and the
compilation acted as a complementary tool for hand hygiene promotion.
Hand rub dance will be suggested to national and international facilities
for WHO hand hygiene day in May 2013.
Disclosure of interest: None declared.

O94
O094: Avatar approach on hand hygiene
BS Ana*, C Palos
Infection Control Comittee, Hospital Beatriz ngelo, Loures, Portugal
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O94
This videoclip aims to introduce visitors and patients on the hospital hand
hygiene policy and procedures as well as a reminding for professionals on
daily basis. The video explains in a simple and attractive way, how to
proceed, using a combination of avatar technology and real persons.
SPECIAL; SPECIAL;Videoclips are a part of a global awareness and teaching
materials on Infection Control and Prevention, available on hospital intranet
and on infection control committee sessions.SPECIAL; SPECIAL.
Disclosure of interest: None declared.

O95
O095: Isolation videoclip for visitors and patients
BS Ana*, CA Palos
Infection Control Comittee, Hospital Beatriz ngelo, Loures, Portugal
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O95

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HAI prevention and control applies to all settings of care. Screening and
isolation of patients are tools that improve HAI prevention and control
effectiveness. Awareness, understanding and compliance to different
isolation precautions are a major problem for patients and visitors. This
videoclip aims to introduce visitors and patients on the hospital isolation
policy and procedures, explaining them in a simple and attractive way how
to proceed, using a combination of avatar technology and real persons.
Videoclips are a part of a global awareness and teaching materials on
Infection Control and Prevention.
Disclosure of interest: None declared.

Introduction: Within the context of a mission of the regional Health/


Environment departments, CEDDES produced a second training CD-ROM
in november 2010, about hazardous health care waste: infectious,
chemical, toxic, radioactive waste.
Objectives: To respond to needs for training the different categories of staff
in health care, education establishments, research centres in human
medicine and veterinary, and professionals of the environment, in order to
set up an optimal health care waste management.
Methods: Stages :
- Selection of the Steering Committee - period of the mission : 18 months
- Document retrieval
- Writing
Results: Production of a CD-rom of 400 screens divided in 5 chapters:
HCW, infectious HCW, chemical, toxic HCW, radioactive HCW, general
waste; illustrated with 300 photos; glossary of 250 words; repertoire of
240 acronyms; proposals for evaluation quiz; selection of websites.
Conclusion: The CD-rom can be used in developed countries as well as
developing ones.
A suitable HCWM is a complex system with regulatory, organizational,
structural, budgetary components; with sanitary, environmental, economic,
legal implications.
Key elements: - Hand hygiene, control of health care associated infections, in
the context of the new world stakes of patient safety; - Management of
sharps and AES control.
The CD-rom is a teaching aid to set up a long-lasting change of behaviour
towards a common culture of safety. It got the Prize 2012 of the STHSS.
Disclosure of interest: None declared.

O96
O096: Care of patients with tracheostomy
M Abraham
Nursing, Infection Control Nurse, Apollo Hospitals, Hyderabad, India
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O96
Background: Tracheostomy is common in the acute care facility today. The
care for these patients is challenging for the nurses in the ward where
knowledge and skill is tested and often lacking resulting in emergency shift
of these patients to ICU. As we found it difficult to care for this group in the
wards inspite of continous training, we decided to have a dedicated
tracheostomy ward for patient safety and better outcome. As a part of
training, this module on tracheostomy care was developed by the medical
ICU nurses.
Introduction: Tracheostomy is common in the acute care facility today. The
care for these patients is challenging for the nurses in the ward where
knowledge and skill is tested and often lacking resulting in emergency shift
of these patients to ICU. Often chronic patients tend to be overlooked in
Infection control practices (ICP) aspect. This leads increased Health care
associated infections (HAI) along with increased morbidity & mortality.
Objectives: To reduce the HAI in tracheostomy patients by ensuring proper
infection control practices implementation by effective training module.
Methods: As we found it difficult to care for this group in the wards inspite
of continous training, we decided to have a dedicated tracheostomy ward
for patient safety and better outcome. As a part of training, a module on
tracheostomy care was developed by the medical ICU(MICU) nurses.
Infection control issues are discussed in these patients as they are patients
on long term care All the sisters who take care of patients having
Tracheostomy are educated with the help of this audio visual medium. Also
hands on training is provided with the help of a mannequin.
Results: The care is improving in these patients. This is reflected in lower
HAI rates and decrease in number of patients returning to the ICUs from
wards with tube blocks and aspirations.
Conclusion: Continuous training is the most important part for sustaining
ICP in a healthcare setup. We identified the tracheostomy patients as those
falling in the high risk category for HAI. We could successfully train our sisters
and implement the tracheostomy care practices and bring down the HAI
rates.
Disclosure of interest: None declared.

O97
O097: Abstract withdrawn
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O97

O98
O098: Abstract Withdrawn
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O98

O99
O099: Making a training CD-ROM on activity waste at risk care
B Chardon
CEDDES, Montpellier, France
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O99

O100
O100: Abstract withdrawn
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O100

POSTER PRESENTATIONS
P1
P001: Comparison of central line-associated bloodstream infection
rates when changing to a zero fluid displacement intravenous
needleless connector in acute care
C Chernecky1*, D Macklin2, WR Jarvis3, T Joshua1
1
Georgia Regents University, Augusta, USA; 2Consultant Vascular Access,
Marietta, USA; 3Jason & Jarvis Associates, LLC, Hilton Head, USA
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P1
Introduction: The ability to decrease CLA-BSI has seen some improvement
but more is necessary to prevent negative patient outcomes. One area that
has not been researched is the actual technology or connector product and
its effect on bloodstream infections.
Objectives: Using the Healthcare and Technology Synergy (HATS)
model1the purpose of this multicenter study was to compare central lineassociated bloodstream infection (CLA-BSI) rates associated with the use of
intravenous (IV) positive or negative (including mechanical valve and split
septum devices) pressure needleless connectors to a zero fluid displacement
needleless connector.
Methods: Quasi-experimental study over 140 months, 5 states, six specialty
settings (3 intensive care units (ICU), and one each of medical ICU, surgical
ICU, and Long Term Acute Care -LTAC) comparing CLA-BSI rates associated
with positive (6,649 catheter-days) or negative (17,810 catheter-days) IV
needleless connectors. There were a total of 24,459 pre-zero fluid
displacement catheter-days over 70 months compared to 25,621 total post
zero displacement connector catheter-days over 70 months. Paired t-tests
were used to examine differences between catheter-days and CLA-BSI rates
before and after zero fluid displacement connector adoption. Statistical
significance was assessed using an alpha level of 0.05.
Results: The number of catheter days was similar both before and after
zero fluid displacement connector adoption. There was a statistically
significant higher CLA-BSI rate when either negative (p = 0.039) or positive
(p = 0.0158) pressure mechanical IV connectors were used. Overall, a

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decrease in CLA-BSIs per 1000 catheter days was found after changing
from negative, or positive IV connectors to the zero fluid displacement
connector (p = 0.005).
Conclusion: We documented a statistically significant decrease in CLA-BSI
rates when either a negative or positive IV needleless connectors were
changed to a zero fluid displacement connector in multiple acute settings.
The data reveals that IV needleless connector design impacts CLA-BSI rates
and product is a significant variable in the HATS model for comparative
effectiveness.
Disclosure of interest: C. Chernecky: None declared, D. Macklin Shareholder
of RyMed Technologies Inc, Consultant for RyMed Technologies Inc,
W. Jarvis: None declared, T. Joshua: None declared.

P2
P002: The analysis and impact of three successive intervention
programmes directed to reduce central line associated blood stream
infections over a four year period in a tertiary care hospital in India
N Jaggi*, P Nirwan, E Naryana, KP Kaur
Infection control, Artemis Health Insitute, Gurgaon, India
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P2
Introduction: Central line associated blood stream infections(CLABSI) in
the ICU are associated with significant morbidity, mortality and costs.
Supervision programmes have shown to decrease CLABSI rates but
repeated interventions are required.
Objectives: The objectives of this study were to try to bring CLABSI rates
to zero and to promote a culture of saftey in the organization.
Methods: Setting: 300-bed tertiary care private hospital. Study Period:
4 years (Jan 2009 to Dec 2012).
Baseline Period: CLABSI cases were tracked/month from Jan 2009 to
June 2009.
Phase I (July 2009-Jun 2010): The bundle components for the
prevention of CLABSIwere introduced.
Phase II (Jul 2010-Dec 2011): This involved introduction of an active,
dedicated & trained central line team, dedicated central line trolley,
Scrub the Hub campaign and involvement of senior doctors and
management.
Phase III (Jan 2012-Dec 2012): Aim was to reduce CLABSI to zero.
Outcome measurement in terms of reduction in CLABSI rates in the preand post-intervention phases was done. The results were statistically
analyzed by regression analysis and probability assays.
Results: - The mean CLABSI rate was 2.59 (Range: 0-9.16) infections/1000
catheter days in 4 year period. Mean CLABSI rate in the baseline period:
5.18.
- 21.9% and 82.5% increase was observed in hand hygiene and daily
review of line necessity respectively in Phase II as compared to Phase I.
- A significant decrease observed in CLABSI rates after the three
supervision programs as 15.3% in Phase I (4.39 p>0.05), 54.9% in Phase II
(1.98 p<0.05) and 58.6% in Phase III (0.82 p<0.05).
- Zero CLABSI was observed for three quarters in Phase III. Overall 84%
decrease was observed in CLABSI rates in the entire study period.
Conclusion: - Repeated multimodal supervision programs promoting a
culture of safety and zero tolerance effectively reduce CLABSI rates with
dedicated central-line teams and involvement of senior management and
doctors acting as boosters. A zero tolerance approach resulted in the
achievement of a CLABSI free period for three quarters.
Disclosure of interest: None declared.

P3
P003: Current status of infection control practice for prevent of central
venous catheter-associated bloodstream infection in Korea
PG Choe1,2*, HY Shin3, MJ Shin3, K-H Song3, ES Kim3, HY Jin4, YH Choi4,
OJ Choi5, KH Park5, NJ Park6, K-H Kim6, SH Han7, EJ Choo7, HB Kim1,3,
KOrean Study group for Infection Control and prevention (KOSIC)1
1
Seoul National University, Seoul, Korea, Republic Of; 2Seoul National
University Hosptial, Seoul, Korea, Republic Of; 3Seoul National University
Bundang Hospital, Seongnam, Korea, Republic Of; 4Ajou University Hospital,
Suwon, Korea, Republic Of; 5Chonnan National University Hospital, Gwangju,
Korea, Republic Of; 6Pusan National University Hospital, Pusan, Korea,

Page 31 of 143

Republic Of; 7Soon Cheon Hyang University Bucheon Hospital, Bucheon,


Korea, Republic Of
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P3

Introduction: There are evidence-based guidelines for the prevention of


central line-associated bloodstream infections (CLA-BSI), but the current
status of these practices in intensive care units (ICU) of Korea is unknown.
Objectives: To evaluate the current status of infection control practice for
CLA-BSI in ICUs of Korea.
Methods: We conducted a cross-sectional survey in ICUs of the KOrean
Study group for Infection Control and prevention (KOSIC) at April 2012.
Results: Thirty-five ICUs of 15 hospitals were enrolled in this study.
Fourteen of the 35 ICUs (40%) were medical ICUs, 4 (11%) were surgical
ICUs, 9 (26%) were neurosurgical ICUs, and 8 (23%) were combined
medical and surgical ICUs. The median bed size was 15 beds (interquartile
range [IQR], 14-20), and median patient-to-nurse ratio was 1.5 (IQR, 1.3-1.9).
During the survey period, the incident rate of CLA-BSI was 3.33 per 1,000
catheter-days (medical ICUs, 5.12; surgical & neurosurgical ICUs, 1.91;
combined ICUs, 2.25).
All ICUs had documented guidelines for the prevention of CLA-BSI and
conducted surveillance for CLA-BSI. Nineteen (54%) ICUs provided regular
education programs for CLA-BSI prevention and 15 (43%) ICUs accessed
the adherence to guidelines using a central line insertion checklist.
Twenty-nine (83%) ICUs used a sterile full body drape during an insertion
practice and 3 (8%) ICUs used chlorhexidine preparation with alcohol for
an insertion skin preparation. Twenty (57%) ICUs used antimicrobialimpregnated coated central venous catheter.
All ICUs conducted hand hygiene promotion program including adherence
monitoring and 23 (66%) ICUs conducted active surveillance for multidrug
resistant organisms. Hand hygiene adherence was significantly associated
with the patient to nurse ratio in ICU (g = 0.648, P < 0.001).
Conclusion: This study demonstrates that although ICUs in Korea had
documented guideline and surveillance system for CLS-BSI, infection
control practice in real clinic did not meet the recommended practice
standard.
Disclosure of interest: None declared.

P4
P004: Implementing an extensive central venous catheter bundle
in the Ospedale Papa Giovanni XXIII (formerly Ospedali riuniti) of
Bergamo, Italy: experiences and impact
A Raglio1*, T van der Kooi2, G Galbiati1, F Averara1, A Serna Ortega1, E Cucchi1,
M Ghidini1, L Spotti1, C Mirabile1, A Grigis1, S Cesa1, M Casati1, C Farina1,
L Lorini1, L Chiappa1, W Zingg3, PROHIBIT study group1
1
Ospedale Papa Giovanni XXIII, Bergamo, Italy; 2RIVM, Bilthoven, Netherlands;
3
University hospitals of Geneva, Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P4
Introduction: As a participant in the PROHIBIT study (Prevention of Hospital
Infections by Intervention and Training) our hospital was randomized to
evaluate an extensive central venous catheter (CVC) bundle in the intensive
care (ICU). Bundle compliance and catheter-related blood stream infections
(CRBSI) incidence were monitored.
Methods: After local approval a team was created with a clinical
microbiologist, a study nurse, 3 trainers and 5 champions from the ICU
team. After a baseline period of 9 months (January-September 2011), a
multimodal prevention strategy was initiated including 1) 12 4-hour practical
courses for the 260 ICU staff; 2) preparation of a CVC bundle kit; and 3) the
update of the written local CVC insertion protocol.
Results: The baseline CRBSI incidence was 1.0/1000 CVC days (95%
confidence interval: 0.5-2.2) and the compliance with all bundle items
was 0% (0.0-4.6). A total of 184 out of 1654 CVC insertions was observed.
Major bundle limitations were the lack of large sterile drapes (0%), nonobservance of skin antisepsis before gowning and sterile draping (9%),
and the infrequent use of alcohol-based chlorhexidine for skin antisepsis
(27%).
Upon intervention (October 2011 - December 2012) the CRBSI incidence
was 1.6 (1.0-2.6). The compliance with all bundle items was never fully
achieved (0%, (0.0-2.0). However, this was due to the fact that large
drapes could not be purchased due to ICU budget cutbacks.

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The compliance of all items including behavioural aspects but excluding


the use of large drapes, increased from 80% at baseline to 91% upon
intervention.
Conclusion: Despite the introduction of an extensive CVC bundle in our
ICUs, there was no significant difference in CRBSI outcome. The educational
part of the introduction seemed successful as the average compliance of
many items, including behavioural aspects increased. However, the absence
of a reduction shows the limitation of a multimodal intervention strategy in
a high performing setting with low CRBSI rates at the outset.
Disclosure of interest: None declared.

Methods: A retrospective study about all BSI diagnosed during one year.
The pattern resistant pathogen study was EPINE-EPPS project.
Results: 340 patients were included. Median age was 74.5 years
[interquartile range (IQR), 58.5-80.5]; acute physiology and chronic health
evaluation (APACHE II) score was 13 (IQR, 7-29).
BSI were community-acquired in 56% of the cases. The most common
source of BSI was urinary tract (48.3%), intra-abdominal (25.6%) and
lower respiratory tract infections (18.6%). The most commonly isolated
microorganisms were: Escherichia coli, K. pneumoniae, S. aureus (15%
oxacilin resistant) and S. pneumoniae. The 8.6% of enterobacteracea
family produced extended-spectrum B-lactamasas (ESBLs). Inappropriate
treatment was observed in 24.5% and crude mortality rate was 7.7%.
28% BSI were nosocomial-acquired. The sources of BSI were unknown in
31.7% of the cases and catheter-related in 25.7%. The secondary sources
of BSI were intra-abdominal in 57% of the cases. The most common
isolated microorganisms were: S. epidermidis and other coagulasa
negative, Candida, S. aureus (36% oxacilin resistant) and E. coli. 25% of
enterobacteracea family were ESBLs. We found 5 BSI caused by
Acitetobacter carbapenem (CPM) resistant and 2 BSI by P. aeruginosa CPM
resistant. Inappropriate treatment was observed in 52.5% and mortality
rate was 28.7%.
Health-care related BSI produced 15.1% of the cases. The source of BSI
were unknown in 22.6% and catheter-related in 11.3%. The secondary
sources of BSI were urinary tract (60%), intra-abdominal (31.4%)
and respiratory tract infections (8.6%). The most common microorganisms
were: E. coli, S. aureus (25% oxacilin resistant), S. epidermidis and
K. pneumoniae. Inappropriate treatment was noticed in 34% and mortality
rate was 17%.
Conclusion: The knowledge of local epidemiology is a capital information
to improve empiric antimicrobial treatment and to reduce mortalityrelated inappropriate treatment.
Disclosure of interest: None declared.

P5
P005: Effect of improvement activity for decreasing catheter related
bloodstream infection
MN Kim1*, NH Cho1, YG Song2, JH Yoon2
1
Department of Infection Control, Gangnam Severance Hospital, Seoul,
Korea, Democratic Peoples Republic Of; 2Department of Infectious disease,
Gangnam Severance Hospital, Seoul, Korea, Democratic Peoples Republic Of
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P5
Introduction: Insertion of central venous catheter is essential procedure
for treatment of critical patient, but if this procedure is increased,
bloodstream infection (BSI) can be increased. But through fulfillment of
practice guideline, Catheter related Bloodstream Infection (CRBSI) can
be fully prevented, and many hospitals try to decrease BSI like 0
percent.
Objectives: In Intensive care unit (ICU) of this hospital, during the year
2010, BSI was 5.8/1000 device day but, it was increased like 12.2/1000
device day in April 2011. Therefore we started improvement activity to
decrease BSI.
Methods: We carried out improvement activities for three times for the
patients who were inserted with central venous catheter from April 2011
to October 2012. First (2011.04-2011.07), 1) Prevention protocol review
about BSI and sharing the protocol with relevant department, 2) SMS
feedback to medical team about checklists and results with Maximum
sterile barrier precaution, 3) Weekly experts (ID physician and IC nurse)
rounding to ICU and CCU, and checking condition of central venous
catheter. Second (2012.05), 1) Continuing previous improvement activity,
2) Sharing the protocol for sampling method of blood culture with
relevant department, 3) Writing the name who inserted central venous
catheter at the insertion site. Third (2012.08-2012.10), 1) Notifying
above protocols periodically, 2) Changing antiseptic from betadine to 2%
alcoholic chlorhexidine gluconate solution since July 2012 when the
commercial product was available.
Results: When we compared CRBSI from first period (2011.04~06) to third
period (2012.08~10), CRBSI was decreased as 45% from 10.1/1000 device
day to 5.6/1000 device day in ICU and as 50% from 6.0 to 3.0 in whole
wards
Conclusion: We performed three improvement activities for decreasing
CRBSI, we can confirm the effects of those activities. For decreasing CRBSI,
continuous improvement activities are needed than temporary activities,
and monitoring system which can monitor insertion practice of central
venous catheter is also needed. After this, if we develop more effective
system which can monitor the process, we can make larger effect.
Disclosure of interest: None declared.

P6
P006: Highlights in bloodstream infections: where does the patient
acquire the infection?
M Rodriguez-Aguirregabiria*, T Gimenez-Julvez, J Rodriguez-Aguirregabiria,
M Villanova, P Rico Cepeda, E Palencia Herrejon
Hospital Universitario Infanta Leonor, Madrid, Spain
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P6
Introduction: Bloodstream infections (BSI) still account for significant
morbidity and mortality.
Objectives: The objective of this study was to describe the epidemiology,
etiology, sources and adequacy of empiric antimicrobial treatment in BSI.

P7
P007: Risk factors for mortality among non-icu patients with catheterrelated bacteraemia
A Hornero1*, E Shaw1, R Escofet1, T Vidal1, C Ardanuy2, D Garcia2, C Pea1,
J Ariza1, M Pujol1, REIPI1
1
Infection Control, Hospital Universitari de Bellvitge, Hospitalet Llobregat,
Spain; 2Microbiology, Hospital Universitari de Bellvitge, Hospitalet Llobregat,
Spain
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P7
Introduction: The number of episodes of vascular catheter related
bacteraemia (CRB) observed in non-Intensive Care Unit (ICU) patients may
be similar or even higher than those observed in ICUs. While we have a
lot of information regarding the impact of CRB among ICU patients, there
is still lack of information concerning non-ICU patients.
Objectives: To determine predictors of mortality among non-ICU patients
with CRB.
Methods: From Jan 2003 to Dec 2012, a prospective continuous surveillance
of CRB including all adult patients admitted to non-ICU wards for more than
48h, was carried out in a tertiary centre. Monitoring of CRB was performed by
daily meeting of Infection Control Team and microbiology department.
Patients were visited and those cases that fulfilled criteria for CRB were
selected. Patients were followed up until discharge. Mortality was defined as
in-hospital death from any cause occurring in the 30 days after the onset of
CRB. A logistic regression model was performed to identify risk factors for
mortality.
Results: From 2003 to 2012, 590 episodes of CRB were detected in 578
non-ICU patients; 285 in medical wards and 305 in surgical wards. Mean
age was 64y (SD 14y) and 37% were females. Mortality was 16.1%. Among
all episodes of CRB, 332 (56%) were caused by central venous catheter
(19% subclavian, 17% jugular, 12% femoral, 8% peripheral inserted central
catheter) and 258 (44%) by peripheral venous catheter. Gram positive cocii
caused 72% of episodes, gram negative bacilli 28% and fungi 1%. Among
them, S. aureus was identified in 235 episodes (40%), coagulase negative in
174 (29%), enterococci in 23 (4%), P. aeruginosa in 33 (6%) and Candida
spp in 7 episodes (1%). Independent risk factors associated to mortality in
multivariate analysis were: age older than 65y (OR:2.0;95% CI:1.2-3.2),

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hospitalization in medical wards (OR:1.6;95CI:1.0-2.6) and S. aureus


(OR:3.1;95%CI:1.9-5.0), while type of catheter and place of insertion were
not associated.
Conclusion: Among non-critically-ill patients with CRB, those older than
65y, hospitalized in medical wards and with S. aureus aetiology had a
greater risk of mortality.
Disclosure of interest: None declared.

determine differences between the two groups in terms of epidemiology,


treatment and outcome.
Methods: The study was conducted at the University Hospital of Heraklion,
Greece, from March 2010 to November 2011. Patients were classified as
HCAB or CABusing pre-defined selection criteria. Epidemiological, clinical
and therapeutic characteristics, antimicrobial resistance and outcome were
compared in both groups. The statistical analysis was performed using
SPSS 19.0.
Results: mong 145 patients with gram-negative COB, 83 (57.2%) had
HCAB and 62 (42.8%) had CAB. The frequency of malignant tumors, renal
insufficiency and dementia was higher in patients with HCAB than with CAB.
In both groups Escherichia coli was the mostcommon causative agent but
the prevalence of Klebsiella pneumoniae in HCAB was significantly higher
than CAB (19.3% vs. 4.8%). Patients with HCAB had higher Charlson score
and higher Pitt bacteremia score, less frequent administration of appropriate
empirical antibiotic treatment and higher probability of death than patients
with CAB.
The antimicrobial resistance in HCAB a CAB patients respectively, was
found 27/83 (32.5%) vs. 4/62 (6.5%) (P<.001) to third-generation
cephalosporins (3GC), 22/83 (26.5%) vs. 7/62 (11.3%) (P=.021) to
aminoglycosides, 29/83 (34.9%) vs. 9/62 (14.5%) (P=.005) to quinolones.
Bacteria that produced ESBL were 16/76 (21.1%) vs. 2/59 (3.4%) (P=.003),
and carbapenem-resistant were 10/83 (12.0%) vs. 2/62 (3.2%) (P=.056) in
HCAB a CAB patients respectively.
Conclusion: There are significant differences in the severity of underlying
diseases, causative pathogens, antibiotic resistance, outcome and
treatment between the two groups. In our region 3GC, aminoglycosides or
fluoroquinolones are proposed as appropriate empirical treatment for
patients with CAB, whereas in patients with HCAB carbapenems should be
the initial therapy.
Disclosure of interest: None declared.

P8
P008: Salvaging catheters in the era of extensive gram-negative
resistance
N Gupta1*, R Soman1, J Kothari2, A Almeida2, A Shetty3, C Rodrigues3
1
Deparment of Internal Medicine & Infectious Diseases, P.D.Hinduja National
Hospital & MRC , Mumbai, India; 2Department of Nephrolgy, P.D.Hinduja
National Hospital & MRC , Mumbai, India; 3Department of Microbiology,
P.D.Hinduja National Hospital & MRC , Mumbai, India
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P8
Introduction: Central-line associated blood stream infection (CLABSIs)is
associated with increase hospital costs and length of stay. Antibiotic lock
therapy (ALT) along with systemic antibiotics appears to be an option for
catheter salvage. Most studies on ALT have focused on Coagulase-negative
staphylococcal (CoNS) infections. However, CLABSIs due to extended
spectrum b-lactamase (ESBL)-producing Gram-negative bacteria (GNB) is
more common in our setting.
Objectives: Carbapenems are unsuitable for use in ALT because of
instability at body temperature. Hence, there is a need to explore the use of
other antimicrobials like tigecycline and colistin for antibiotic-lock solutions
for management of CLABSIs due to GNB.
Methods: Patients received ALT if they had CLABSI or were symptomatic
with a colonized catheter. The antibiotic-lock solution was instilled into the
retained catheter lumen for dwell times of 24 hours, and therapy was
continued for 14 days. For ALT for Gram-negative CLABSIs we used colistin,
tigecycline, ciprofloxacin, gentamicin and amikacin. An in vitro stability test
of colistin was done with heparin and 20% N-acetylcystiene (NAC) by
bioassay using a disc diffusion method and Bordotella bronchoseptica ATCC
4617.
Results: There were 10 patients with long-term intravascular devices who
developed 12 episodes of bacteremia. Among the 12 episodes, 6 episodes
were of CLABSIs and in the other 6 episodes patients had symptoms and a
colonized catheter.
11 of the 12 episodes were caused by GNB and only 1 episode was
caused by a Gram-positive organism, Enterococcus. Of the other 12
episodes, Acinetobacter baumannii were isolated in 3 episodes and E. coli,
Flavobacterium, and P. aeruginosa were isolated in 2 each. The other
organisms isolated were K. pneumoniae, and B. cepacia (1 episode each).
Successful treatment with ALT was observed in all of the 12 episodes. The
median duration of catheter salvage was 60 days.
Conclusion: The results suggest that these novel antibiotic lock
combinations may be useful options for salvaging the catheters. This
approach will reduce morbidity and the healthcare costs. Such strategies
should be further evaluated for the treatment of CLABSIs in the era of
Gram-negative resistance.
Disclosure of interest: None declared.

P9
P009: Epidemiology, microbiology and outcome of community-nset
gram-negative bacteremias in a Greek University Hospital
A Gikas1*, G Charitaki2, M Gkika1, P Karakosta2, A Christidou2
1
Ind. Diseases Dpt-Inf Control Unit, University Hospiatal of Heraklion,
Heraklion, Greece; 2Clinical Bacteriology, University Hospiatal of Heraklion,
Heraklion, Greece
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P9
Introduction: According to the new classification community-onset
bacteremias (COB) are divided in healthcare-associated (HCAB) and
community-acquired (CAB). The objective of this study was to apply this
classification to a cross-sectional study of patients with COB and to

P10
P010: Bloodstream infections by drug-resistant organisms in a
secondary hospital
T Gimenez-Julvez1*, M Rodriguez-Aguirregabiria1, C Campelo2,
E Palencia-Herrejon1, MJ Moreno Sanchez1, S de Juan-Garca1
1
Hospital Universitario Infanta Leonor, Spain; 2BR-Salud, Madrid, Spain
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P10
Introduction: Bloodstream infections (BSI) are important causes of
morbidity and mortality. Most of all, when are caused by drug-resistant
organisms (DR).
Objectives: To investigate the epidemiology, etiology, systemic response
and treatment of DR-BSI.
Methods: A retrospective study was conducted about all BSI diagnosed
in a secondary hospital during one year. The pattern resistant pathogen
study was EPINE-EPPS project. Comparisons between groups were
performed by means of the X2 test for categorical variables or analysis of
variances (ANOVA) for continuous variables.
Results: We included 60 patients [median and interquartile range (IQR)
age, 73.5 years (60.5-79.5), 57.1% males, median (IQR) Charlson comorbidity index, 3 (2-4), median (IQR) acute physiology and chronic health
evaluation (APACHE) II score, 11 (8-15)] with 63 DR-BSI of which 71.5%
were nosocomial and healthcare-associated BSI.
Unknown and intravascular catheter-related DR-BSI accounted for 49.2%
of cases. Among secundary infections, the source was 37.5% urinary track,
31.2% intra-abdominal and 15.6% respiratory track infections.
Overall DR-BSI, DR-Gram-positive cocci were 55.6%. The most common
isolated pathogens were staphylococcus coagulase-negative and S. aureus.
Among DR-Gram-negative bacilli, 12.2% of enterobacteracea family
produced extended-spectrum B-lactamasas. We found 5 DR-BSI caused by
Acitetobacter carbapenem resistant and 3 DR-BSI by P. aeruginosa
carbapenem resistant.
Median time to diagnosis for DR-Nosocomial BSI was 14 days (IQR), 7-35
days after hospital admission. For Gram-negative was 11 days (7.5-31.5) and
for Gram-positive 19 days (7-29).
Only 31.7% of DR-BSI received appropriate initial empirical antimicrobial
therapy versus 73.5% of non DR-BSI (p<0.001). More than one third (36.5%)
of the episodes occur with significant systemic response (severe sepsis or

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septic shock). The crude mortality rate was 25.4 % (p<0.001). If the patient
developed severe sepsis or septic shock crude mortality rose to 52.2%.
Conclusion: Information about local epidemiology is important to develop
prevention and control strategies in drugresistant microorganism and to
improve the management of BSI.
Disclosure of interest: None declared.

Methods: Since Feb10, a care bundle for insertion and maintenance of


central venous catheter was implemented across our institution. While
CLABSI was defined using NHSN criteria, a definitive diagnosis of CRBSI
required that the same organism grew from at least 1 percutaneous
blood culture and from a semiquantitative culture of the catheter tip, or
that 2 blood samples drawn, one from a catheter hub and the other
from a peripheral vein, showed differential time to positivity (DTP) 2
hours. Episodes with a DTP < 2 hours were categorized as catheter-non
related bloodstream infection (CNRBSI). The impact of care bundle was
estimated comparing 2012 vs 2009, CRBSI and CNRBSI incidence density
rates.
Results: While the CRBSI rate showed a reduction from 8.94 per 1,000
central linedays to 2.93 per 1,000 central linedays (difference 6.01; CI
95%>1.59 to 13.61, p=0.07), CNRBSI showed a marginal reduction from
5.96 per 1,000 central linedays to 4.69 per 1,000 central linedays
(difference 1.28; CI 95%>5.41 to 7.96, p=0.68). While in CNRBSI intestinal
organisms predominated (79%, 23/29), the most common organisms
isolated in CRBSI was coagulase-negative Staphylococcus (78%, 14/18).
Conclusion: Using DTP as part of CRBSI definition allowed us to accurately
assess the impact of a care bundle in the reduction of these DAIs.
Disclosure of interest: None declared.

P11
P011: Clinical utility of initial follow-up blood cultures in patients with
catheter-related Staphylococcus aureus bacteremia
MS Lee1*, KH Park1,2, MH Jung1, YS Kim2
1
Internal Medicine, Kyung Hee University Hospital, Kyung Hee University
School of Medicine, Seoul, Korea, Republic Of; 2Infectious Diseases, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Korea,
Republic Of
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P11
Introduction: Limited data was available on clinical relevance of routine
blood culture follow-up in patients with catheter-related S. aureus
bacteremia (CRSAB). The aim of this study was to determine the clinical
relevance of performing follow-up blood culture (BC) follow-up in patients
with CRSAB.
Methods: All patients with CRSAB were prospectively included between
August 2008 and December 2010. During the study period, infectious
disease specialists strongly encourage the follow-up BCs performed
between 48 and 96 hours after onset of bacteremia. Complication was
considered related to SAB if they were recorded during the antibiotic
treatment for the SAB and confirmed by radiology and/or culture of
S. aureus from a normally sterile site. Recurrence was defined as the isolation
of S. aureus from the bloodstream or other sterile body site during the
12-week post-treatment follow-up period.
Results: Of the 217 patients with CRSAB, follow-up BCs were performed in
175 patients (81%) between 48 and 96 hours. Of these 175 patients, followup BCs were positive in 74 (42%) and negative in 101 (58%) patients.
Follow-up BCs was more like to have positive results in episodes of CRSABs
caused by methicillin-resistant isolates than those caused by methicillinsusceptible isolates (86.5% vs. 57.3%; P < 0.001). Cardiac echocardiography
to detect infective endocarditis was more likely to be performed in patients
with positive follow-up BCs than in patients with negative follow-up BCs
(87.8% vs. 68.3%; P = 0.003). Complication occurred in 54% of patients with
positive follow-up BC results and in 13% of patients with negative follow-up
BC results (P < 0.001). Eight (18%) of the 74 patients with positive follow-up
BC result experienced the recurrence, but 1 (1%) of the 111 patients with
negative follow-up BC result experienced recurrence (P = .005).
Conclusion: In patients with CRSAB, initial follow-up BCs were clinical
predictors for complication and recurrence. This practice is simple and
useful tool to guide the extent of diagnostic evaluation and duration of
treatment in these patients.
Disclosure of interest: None declared.

P12
P012: Why a new definition for central lineassociated bloodstream
infection is necessary for surveillance in immunocompromised patients
RE Quirs*, A Novau, L Fabbro, M Casanova, G Kremer, M Pereyra
Prevention and Infection Control Department, Hospital Universitario Austral,
Caba, Argentina
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P12
Introduction: Accurate surveillance definitions are necessary to evaluate
the impact of interventions to prevent central lineassociated bloodstream
infections (CLABSIs). Although, the National Healthcare Safety Network
(NHSN) definition for CLABSI has been applied extensively in intensive care
units, few studies have examined its performance among bone marrow
transplant (BMT) recipients. As those patients have inherent risks for
bloodstream infections associated with mucosal barrier injury, more specific
definitions are necessary for catheter-related bloodstream infection (CRBSI)
in order to determine the impact of improvement projects to decrease these
device-associated infections (DAIs).
Objectives: To determine the impact of a care bundle in the CRBSI rates
in a BMT population using a specific definition.

P13
P013: Prevalence rate of healthcare associated infection in emergency
critical care for surgery, burns and neurology ward
S Mehtar, JMV Namahoro*
Infection Prevention and Control, Stellenbosch University, Cape Town,
South Africa
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P13
Introduction: Many Healthcare Associated Infections (HAI) are related to
the use of a medical device, especially invasive devices that buy-pass the
normal barriers to entry of microorganisms into the body. HAI rates of
CA-UTI, CLA-BSI and VAP are significantly greater among patients when a
medical device is used.
Objectives: Determine Healthcare Associated infection risk with medical
devices.
To make recommendations for performance improvement.
Methods: Observation study of pilot study. Data was collected for a
period of five weeks. Active surveillance by considering laboratory results
and regular visits to patients in respiratory intensive care unit was a
method used to assess patients at-risk of healthcare associated infection.
The Structured audit sheet was used.
Results: The sample consisted of 92% patients received urinary catheter,
83% patients are exposed on the peripheral lines, 50% patients obtained
central lines and 58% patients acquired endotracheal tube in situ. The
mean length of stay was 4.04. The prevalence rate of HAI was 50%
infections. The predominance of prevalnce rate was found for VAP by
36%, while incidence rate of CLA-BSI was 25% and incidence rate in CAUTI with Urinary tract infection was 14%.
Conclusion: The HAI is very high in C1 Resuscitation ward. The improved
IPC practice is required and further research is needed to identify the
effect of medical devices with prevalence of infection in C1 Resuscitation
ward.
Disclosure of interest: None declared.
References
1. Hajdu, et al: A point prevalence survey of hospital-acquired infections
and antimicrobial use a paeditric hospital in north-western Russia.
Journal of Hospital Infection 2007, 66(4):378-384.
2. Hajdu, et al: A point prevalence survey of hospital-acquired infections
and antimicrobial use a paeditric hospital in north-western Russia.
Journal of Hospital Infection 2007, 66(4):378-384.
3. Mary LM, et al: Basic Concepts of Infection Control. Portadown(N Ireland):
International Federation of Infection Control, 2 2011.
4. Mehtar S: Understanding Infection Prevention and Control. Cape Town:
Juta and Company Ltd, 1 2010.
5. Regina F, et al: Indwelling urinary catheter management and catheter
associated urinary tract infection prevention practices in Nurses
Improving Care for Healthsystem Elders hospitals. American Journal of
Infection Control 2012, 40(8):715-720.

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P14
P014: Acinetobacter is the most common pathogen associated with
late-onset and recurrent ventilator-associated pneumonia in an adult
ICU in Saudi Arabia
HH Balkhy1*, A El-Saed2, HM Al-Dorzi3, R Khan3, AH Rishu3, YM Arabi3
1
Infection Prevention and Control Department, King Abdulaziz Medical City,
Riyadh, Saudi Arabia; 2Department of Infection Prevention and Control, King
Abdulaziz Medical City, Riyadh, Saudi Arabia; 3Intensive Care Department,
King Abdulaziz Medical City, Riyadh, Saudi Arabia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P14
Introduction: The guidelines for initial empiric antimicrobial therapy for
ventilator-associated pneumonia (VAP) are highly dependent on the type of
causative pathogen and the time of diagnosis.
Objectives: The objective was to examine the microbial causes of VAP
and describe any variability by the timing of VAP onset and over-time.
Methods: The current study was a prospective surveillance conducted at
adult general ICU of a tertiary care hospital at Riyadh, Saudi Arabia. Microbial
isolates obtained from blood and different respiratory specimens of patients
diagnosed with VAP (using CDC definition) between August 2003 and June
2009 were included.
Results: A total of 457 pathogens were identified during the study; 380
(83.2%) were associated with primary VAP and 77 (16.8%) were associated
with recurrent VAP. Of primary VAP pathogens, 159 (41.8%) were associated
with early-onset (<5 days) and 221 (58.2%) were associated with lateonset (5 days) VAP. The most common pathogens identified were
Acinetobacter spp. (26.5%) followed by Pseudomonas aeruginosa (21.7%),
Staphylococcus aureus including MRSA (15.3%), Klebsiella spp. (6.8%),
Haemophilus spp. (6.1%), and Enterobacter spp. (5.0%). Acinetobacter spp. and
MRSA were significantly associated with late-onset VAP while Haemophilus
spp. and Streptococcus pneumoniae were significantly associated with earlyonset VAP. Acinetobacter spp. was the only pathogen associated with
recurrent VAP and its incidence showed a significant increasing trend during
the study period. Acinetobacter spp. was significantly associated with
prolonged ventilation, sedation, and nasogastric intubation.
Conclusion: Acinetobacter baumanii is the most common and increasingly
important pathogen associated with VAP in our patients, especially lateonset and recurrent VAP. Our ICU should continue actively screening for
Acinetobacter in all admitted patients, shorten ventilation duration, minimize
sedation, encourage oral gastric rather than nasogastric intubation, and
improve currently implemented infection control measures including
environmental disinfection.
Disclosure of interest: None declared.

Page 35 of 143

preventionist should make a business case of infection control and analyze


the cost- effectiveness of interventions.
Disclosure of interest: None declared.

P16
P016: Device associated infections in adult intensive care units in
public versus private hospitals in Egypt
M Abdelfattah1*, A Elkholy1, M Enany1, I Beheiry1, D Saleh2
1
Clinical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt; 2Public
Health, Faculty of Medicine, Cairo University, Cairo, Egypt
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P16
Introduction: The healthcare system depends on public hospitals
including university hospitals and private hospitals in Egypt. Private
hospitals have more resources, and healthcare workers work under strict
supervision, monitoring and feed-back.
Objectives: We aimed to compare the DAI rates, patient risk factors and
difference in resources between 2 adult medical ICUS, one from a public
and one from a private hospital.
Methods: The study was done as a prospective incidence-based
surveillance on 971 adult patients admitted to one medical ICU and one
respiratory ICU of Cairo University hospital over a period of 9 months. The
same surveillance method was conducted on 250 adult patients in an
adult medical ICU from a tertiary-care private hospital. The standardized
CDC/NHSN protocols and definitions were used.
Results: The CLABSI, VAP and CAUTI rates were 10.0, 5.6, 3.2/1000 device
days respectively in the medical ICU and 3.5, 28.5, 12.4/1000 device days
in the respiratory ICU of the public hospital (CUH) versus 2.3, 0, 1.7/1000
device days respectively in the private hospital (DAF) ICU (p value = 0.08,
< 0.001 and 0.007).
The Central line, ventilator, urinary catheter utilization ratios were 0.19,
0.29, 0.41in the medical ICU and 0.26, 0.27, 0.33 in the respiratory ICU
respectively in the CUH, versus 0.57, 0.15, 0.38 respectively in DAF ICU.
The significant risk factor for DAI was APACH score >15% for DAI in both
ICUs while the length of hospital stay was a significant risk for DAI CUH
ICU only. In CUH ICU, nurse to patient ratio was 1:3 versus 1:1 n DAF ICU.
Hand hygiene compliance was 50% in CUH versus and 85% in DAF.
Conclusion: The increase in LOS, decrease in hand hygiene compliance
and nurse to patient ratio could explain the higher incidence of DAI in
CUH over the private ICUs in Egypt. Rectification of these factors can
reduce the rates of DAI in public hospitals.
Disclosure of interest: None declared.

P15
P015: Prevention of re-use of single-use suction catheter decreased the
vap incidence density in a resource-limited adult ICU in Egypt
M Enany*, M Sherif, AA El Kholy, GL Saeed, E Sobhy
Cairo University, Cairo, Egypt
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P15

P17
P017: Reduction of catheter associated urinary tract infections
following removal of unnecessary urinary catheters in a tertiary care
hospital in Saudi Arabia
DA Abdulmutalib1*, AT Abato1, W Mazi1, A Senok2
1
infection prevention and control, King Abdul Aziz Specialist Hospital, Taif,
Saudi Arabia; 2College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P17

Introduction: Ventilator-associated pneumonia (VAP) had a major impact


on patient morbidity and mortality in our ICU, an adult ICU in a tertiary
hospital, in spite of application of ventilator- associated pneumonia
prevention (VAP) bundle. Between March 2009 and May 2010 the
incidence rate was 17/1,000 device-days.
Objectives: This study aimed to identify and correct unsafe procedures
related to care of the ventilated patient.
Methods: Due to limited resources, the suction catheter was found to be
reused for the same patient during a working shift (6 hours). This practice
was prohibited and the hospital management was convinced to provide
adequate regular supplies of single-use suction catheters. A new policy for
suctioning was written and implemented.
Results: From June 2010 till December 2012, a new sterile single-use
catheter was used for each suction procedure then discarded immediately
after single-use. The incidence rate was decreased to 5.6/1,000 device-days
by the end of 2012 (67% decrease).
Conclusion: Re-use of single-use supplies contributes to increasing the rate
of healthcare-associated infections in low-resource settings. The infection

Introduction: Reduction of catheter associated urinary tract infections


(CAUTI) is important in improving rates of hospital associated infections
as apatient safety.
Objectives: This study aimed to assess the impact of the Society for
Healthcare Epidemiology of America/Infectious Diseases Society of America
(SHEA/IDSA) practice recommendations for removal of unnecessary urinary
catheters to prevent CAUTI.
Methods: The prospective study was conducted from January 2011March 2013 at the Medical/Surgical wards in King Abdul Aziz Specialist
Hospital, Taif, Saudi Arabia. CAUTI was identified using the Centers for
Disease Control and Prevention criteria. Baseline CAUTI rates was collected
in 2011 and in 2012 a CAUTI-Team was established to remove unnecessary
urinary catheters following SHEA/IDSA practice recommendations. To
enable benchmarking with National Healthcare Safety Network (NHSN,
USA), data collection and analysis were carried out in accordance with
NHSN recommendations (DA-Module 2010).
Results: The incidence of CAUTI declined from 3.5 to 2.9 per 1000
catheter-days in 2011 and 2012 with further reduction to 2.2 per 1000

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Page 36 of 143

catheter-days in the first quarter of 2013. Benchmarking with NHSN, the


incidence rate of CAUTI was above 75 th -90 th percentile, while the
utilization ratio was 50th to 75th percentile of NHSN hospitals in 2011.
After implementation of removing unnecessary urinary catheters, the
incidence rate declined 15% in 2012 (Standardized Infection Ratio (SIR)
0.85). Compared to 2011, the reduction rates observed during the fourth
quarter of 2012 and first quarter of 2013 (1.7 and 2.5/1000 catheter-days,
respectively). Escherichia coli and Pseudomonas aeruginosa were the most
common organisms causing CAUTI.
Conclusion: Our findings indicate the beneficial role of removal
unnecessary urinary catheters for reduction of CAUTI rates in our setting.
Disclosure of interest: None declared.

antimicrobial susceptibility of E. coli shown that the highest rate of


resistance was manifested against Amoxicillin (69%), then followed
Amoxicillin + clavulanic Acid (51.1%), Tetracyclin (45.1%), Trimthoprimsulfamethoxazole (42%), and nalidixic acid (35%), Ciprofloxacin (23.5%),
Chloramphenicol (22.1%), Gentamicin (8.1%), and Ceftriaxon (5.1%).
Multiresistance concerned 32% of tested strains.
Conclusion: E. coli strains tested have developed more resistances
against commonly prescribed antibiotics in clinical practice in Benin,
which is not likely to facilitate the appropriate treatment of patients.
Disclosure of interest: None declared.

P18
P018: A prospective study of catheter associated urinary tract
infections and rationalisation of antibiotic use in a tertiary care centre
in North India
N Taneja1*, S Appanwar1, M Biswal1, B Mohan1, MM Aggarwal2, R M2,
AK Mandal2
1
Medical Microbiology, Chandigarh, India; 2AUC, PGIMER, Chandigarh, India
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P18
Introduction: Catheter associated bacteriuria is very common and there
is a need to differentiate symptomatic CA-UTI from asymptomatic
bacteriuria (CA-ASB) to rationalise antibiotic usage.
Objectives: Aim was to evaluate prevalence of catheter CA-ABU v/s CAUTI and to assess the antibiotic usage in CA-ABU and CA-UTI group.
Methods: A prospective cohort longitudinal study was conducted by
recruiting seventy consecutive patients with catheter in situ over a period
of three months. Patients were categorized as symptomatic and
asymptomatic CAUTI based on the CDC definition. Demographic profile,
primary & other co-morbidities, type of catheter, indication and duration
of catheterization, details of surgical procedure performed, antibiotic
prophylaxis and therapy were noted. The bed occupancy rate, device
utilization rates, total device days and device associated infections (DAI)
rate were calculated using standard definitions. Microbiological data were
noted and analysed. Data analysed using SPSS-17.
Results: Out of 70 patients, 52 had bacteriuria of which 10 were
symptomatic. Ratio of urinary catheter use was 0.69. Catheter utilisation
rate was 40.29/1000 device days and the rate of CA-UTI was 12.8 /1000
device days. Median duration of hospitalisation was 29 and 30 days for
CA-ASB and CA-UTI. There was nostatistically significant difference
between median duration of catheterisation (p value>0.5). Overall 737
DDDS were given. Though symptomatic patients received more antibiotics
the difference from asymptomatic bacteriuria was not significant.
Inappropriate antibiotics usage was noted in the form wrong class, 2
antibiotics of same class and wrong indication in many cases.
Conclusion: Pilot study helped us to rationalize the antibiotic usage in
our centre.
Disclosure of interest: None declared.

P19
P019: Resistance evaluation of Escherichia coli strains isolated from
urines in the urban environment in Benin
L Guedezounme*, M Chodaton, TA Ahoyo, H Bankole
GBH / EPAC, University of Abomey-Calavi, Abomey, Benin
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P19
Introduction: Antibiotic resistance represents a serious public health
problem , particularly in resource limited rcountries. So, it is necessary to
have an actualized knowledge about the resistance profile of these
microorganisms.
Objectives: To determine the resistance profile of Escherichia coli strains
isolated from urines.
Methods: This survey assessed 3678 samples of urines received at the
national laboratory from 2009 to 2011. The tests used are urines
cytobacteriologic exam and the disk diffusion method.
Results: In total, 928 Enterobacteriaceae strains were isolated including
52.1% of E. coli, followed by Klebsiella pneumoniae (14%) and Proteus
mirabilis (8.1%). E. coli occurred more frequently in women (75%). The

P20
P020: Multiresistant bacteria in positive urocultures in a Dakar
university hospital (Senegal)
ML Dia1*, CT Ndour2, A Diop1, R Ka1, R Diagne1, NM Dia2, AI Sow1, MF Ciss1
1
Laboratory of Bacteriology-Virology, CHU of Fann, Dakar, Senegal;
2
Infectious diseases department, CHU of Fann, Dakar, Senegal
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P20
Introduction: Multiresistant bacteria in urines are often associated with
nosocomial infections.
Objectives: The aim of this study was to determine the proportion of
multiresistant bacteria in positive urocultures in the Teaching Hospital of
Fann.
Methods: This study was made on data recorded from registers of
bacteriological laboratory between 1st January 2008 and 31 December
2011.
Results: Three hundred and nine multiresistant bacteria (309) among the
709 mutiresistant strains were isolated from urines (43,58 %). The mean
age was 39,73 years [range=1 83] with a sex ratio of 0.88. Most of the
patients were hospitalized (62,5 %). The infectious diseases clinic
provided most of the multiresistant bacteria (41,1 %), followed by the
neurology department (14,24 %) and paediatrics department (12,23 %).
The majority of multiresistant bacteria were constituted by extended
spectrum betalactamase enterobacteriaceae (86, 08 %) and Acinetobacter
spp (5, 50 %). E. coli were the most frequent bacteria (35, 92 %) followed
by Klebsiella pneumoniae (35, 60). Enterobacteriaceae were susceptible to
imipenem, amikacin and colistin but were resistant to quinolones and
other aminosides. Methicillin-resistant Staphylococcus aureus and
methicillin-resistant Staphylococcus saprophyticus were susceptible to
vancomycin. Strains of Acinetobacter were susceptible to imipemem and
colistin.
Conclusion: Most of the multiresistant bacteria in the teaching hospital
of Fann are isolated from urines. Thats why it is important to insist on
prevention by respecting hygiene measures during invasive gestures like
pose of urinary catheters.
Disclosure of interest: None declared.

P21
P021: Effect of urinary tract infections at multiresistant bacteria (MRB)
in hospital of Dakar
R Ka1*, NMD Badiane2, A Ndir3, KL Onanga4, NMD Badiane2, ML Dia1,
R Diagne1, B Ndoye3, AI Sow1, M Seydi2
1
Department of Bacteriology, CHU Fann, Senegal; 2Department of Infectious
Diseases, CHU Fann, Senegal; 3PRONALIN, Ministre of Health and Social
Action, Dakar, Senegal; 4Department of Bacteriology, Fann Hospital, Dakar,
Senegal
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P21
Introduction: The control of the spread of BMR in health facilities is a
national priority in Senegal.
Objectives: Our work aims to study the incidence of urinary tract
infections due to BMR in a university hospital.
Methods: Microbiological monitoring was conducted in three inpatient
wards of a university hospital from April to October 2012 and concerned
only diagnostic urinalysis.
Results: During the study period, 123 patients were followed up and 79
urine samples were made corresponding to 56.4% of all diagnostic
samples. The average age of patients was 55 21.22 and sex ratio of
0.97. Thirty-nine percent of patients were admitted with a neurological

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disorder. These patients were referred by another health facility (56.3%)


came from home (34.4%) or had undergone internal transfer (9.4%). The
attack rate of urinary tract infections was 3.96. These urinary tract
infections were of nosocomial acquisition in 56 cases (78.9%) with an
average delay of 12.75 days. The bacteria isolated were Enterobacteriaceae
61 (77.2%), non-fermenting Gram-negative bacilli 14 (17.7%) and
staphylococci 4 (5.1%). In order of frequency, these were Escherichia coli
25 (31.6%), Klebsiella pneumoniae 21 (26.6%), Pseudomonas 8 (10.2%) and
Enterobacter 5 (6.3%). We found 32 strains (40.5%) producing extendedspectrum beta-lactamase (ESBL) and 2 strains (2.5%) of Staphylococcus
aureus resistant to methicillin (MRSA). From urinary tract infections
associated with ESBL Enterobacteriaceae urinary catheter was potentially
the source of infection in 18 cases. BMR attack rate was 1.80 per 100
admissions and the incidence rate of 1.99 BMR for 1000 days patients. To
wane, 18 patients or 30% died.
Conclusion: The decrease in the incidence of nosocomial urinary tract
infections must be accompanied by antibiotic stewardship and a strict
hygiene policy.
Disclosure of interest: None declared.

P22
P022: Antibiograms of consecutive urinary tract samples in elderly
K Latour1, B Jans2, S Coenen3, R Preal4, B Catry1*
1
Healthcare Associated Infections (NSIH), Brussels, Belgium; 2Scientific
Institute of Public Health, Brussels, Belgium; 3University of Antwerp, Wilrijk,
Brussels, Belgium; 4Intermutualistic Agency, Brussels, Belgium
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P22
Introduction: Urinary tract infections are the main indication for
antimicrobials in elderly.
Objectives: Despite the treat for resistance dissemination and therapy
failure, clinicians are seldom informed on the per patient evolution of
antimicrobial resistance in pathogens.
Methods: Laboratory results were obtained from 13 voluntary diagnostic
laboratories (12 hospital-associated) in Belgium during the year 2005.
Susceptibility profiles were done by Kirby Bauer disk diffusion according
to CLSI. The first two urine samples from patients older than 65 year
were included.
Results: Following organisms were predominantly isolated (N first
samples/N second samples): E. coli (7188/1654), E. faecalis (1282/403),
P. mirabilis (1230/313), K. pneumonia (673/173), P. aeruginosa (293/120),
E. aerogenes (375/203), S. aureus (158/54), M. morganii (347/89), Group B
streptococci (149/31), C. freundii complex (101/29). When comparing first
versus second samples antibiograms for E. coli, a decrease in susceptibility
was found for the following antimicrobial agents: cotrimoxazole -6.9%;
nitrofurantoin -2.8%, fosfomycin 0.0%; ciprofloxacin -10.8%; cefuroxime
-5.6%; amoxicillin-clavulanic acid -5.6%; ampicillin -10.5%. For E. faecalis,
marked decreases were found for nitrofurantoin -2.4%; fosfomycin -2.2%;
-ciprofloxacin -10.3%; and only mild decreases for amoxicillin-clavulanic
acid 0.0%; and ampicillin -1.2%. For K. pneumoniae decreases were in the
range of -2.9 to -4.1% for cotrimoxazole, ciprofloxacine, cefuroxime and
amoxicillin-clavulanic acid, and was -12.4% for nitrofurantoin. For S. aureus
and C. freundii no decrease (<-0.1%) was seen for nitrofurantoin and
fosfomycin. For E. aerogenes, decreases of -18 and -12.5% were found for
cotrimoxazole and fosfomycin, respectively. M. morganii showed in
consecutive samples less susceptibility for cotrimoxazole (-16.2%),
fosfomycine (-13.0%) and ciprofloxacin (-10.5%), while only a marginal
decrease was found for nitrofurantoin (-0.5%).
Conclusion: The resistance selection influence of consecutive samples
depends on the antibiotic-bacterium combinations, and thus might be
taken into account when empiric therapy guidelines for urinary tract
infections in elderly are reviewed.
Disclosure of interest: None declared.

P23
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Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P23

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P24
Abstract withdrawn
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P24

P25
P025: Norovirus inactivation on antimicrobial touch surfaces
B Keevil*, S Warnes
Centre for Biological Sciences, University of Southampton, Southampton, UK
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P25
Introduction: Norovirus is the most common cause of gastroenteritis
worldwide, primarily because of high infectivity, uncontrollable aerosol
formation via vomitus and faeces, resistance to cleaning agents and
persistence in the environment. Even low level surface contamination is a
transmission risk because of the low infectious dose and inadequate hand
hygiene.
Objectives: Laboratory studies and clinical trials have demonstrated the
use of antimicrobial copper alloy touch surfaces to reduce the spread of
bacterial pathogens and antibiotic resistance gene transfer. Here we
investigate the efficacy of copper alloys to inactivate norovirus.
Methods: In the absence of infectivity assays for human norovirus,
Infectivity of surrogate murine MNV-1 norovirus, untreated or exposed to
touch surfaces, was assessed by plaque assay in a RAW 264.7 monocyte
macrophage cell line. Copper alloy surfaces were compared to stainless steel
as touch surfaces. Results are expressed as plaque forming units (pfu) per
cm2. The role of Cu(I) or Cu(II) ions and reactive oxygen species (ROS) was
assessed using specific chelators and quenchers. Viral RNA was extracted
and purified and separated in non-denaturing gel electrophoresis.
Results: Complete inactivation of approximately 5 x104 pfu per cm2 was
observed on copper and copper nickel in 5-10 minutes or in 2 hours at
room temperature for alloys containing lower percentage copper with an
inoculum that dried in seconds, simulating hand contact. Virus exposed to
stainless steel retained high infectivity at 2 hours. Inactivation was slower if
the virus was inoculated as a wet inoculum simulating vomitus: complete
inactivation occurred in 1 hour for copper and copper nickel, with
significant reduction on other alloys but not stainless steel. The highest
rate of inactivation was observed on immediate contact. These results
were similar if virus burden was increased 50-fold. Virus inactivation was
faster at 37 o C and slower at 4o C. Cu(II) and particularly Cu(I) ions were
essential for loss of infectivity but not superoxide or hydroxyl radicals.
Exposure to copper alloys resulted in destruction of the viral genome,
preventing potential mutation to copper resistance.
Conclusion: The results support the use of antimicrobial copper surfaces
to reduce the spread of norovirus in high risk areas such as closed
environments including health care facilities and cruise ships.
Disclosure of interest: B. Keevil Grant/Research support from International
Copper Association, S. Warnes Grant/Research support from International
Copper Association.

P26
P026: Genetic characterization of NSP4 gene form rotavirus infected
Saudi children
M Aly1*, A Alkhairy1, S Aljohani2, H Balkhy1
1
King Abdullah International Medical Research Center, Saudi Arabia; 2King
Abdulaziz Medical City, Riyadh, Saudi Arabia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P26
Introduction: Rotavirus gastroenteritis in Saudi infants is tremendous and
escalating problem. The non-structural viral protein NSP4 is encoded by the
tenth segment of the viral genome. NSP4 is a multifunctional which plays an
important role in the rotavirus pathogenesis as viral endotoxin. Genetic
variations and the prevalent NSP4 genotype in Saudi Arabia remain
unidentified.
Objectives: To characterize the genotype range of NSP4 gene among the
prevalent rotavirus genotypes at a tertiary care hospital in Saudi Arabia.
Methods: Patient stool samples of children aged 6 years or less admitted
to the hospital at King Abdul Aziz Medical City (KAMC) Riyadh with acute

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diarrhea were collected from inpatients. Samples were identified for


rotavirus positive using the ELISA. RNA extractions were done by RNA
isolation kit (Magnapure), followed by RT-PCR. NSP4 genes were
identified using PCR and sequencing technique to detect the prevalent
genotype. NCBI blastn vr2.2 and RotaC2 genotyping tools were used to
explore the genotypic variation among the positive viral infected children.
Results: To date, 428 pediatric patients were screened for rotavirus
infection between January 2011 and February2012. Preliminary results
showed that 39.9% (n=171) faecal samples were positive for HRA. More
than 81% were infants less than 2 years, 60.2% (n=103) males and
females were 39.7%. There was no significant seasonal effect observed,
however, positive samples peaked in July (n=35). G1P[8] is the most
prevalent rotavirus genotype in our region with (62%). NSP4 genotype E1
was prevalent in more than 77 % (n= 132) of the positive rotavirus cases.
Conclusion: Here we identified the NSP4 E1 genotype as ubiquitous in
rotavirus infected Children. Further work is needed to identify the other
NSP4 genotypes and explore their genetic diversity among the Saudi
infected population.
Disclosure of interest: None declared.

P27
P027: Semmelweis versus C. difficile: efficacy of chlorinated lime and
other hand hygiene interventions
S Edmonds1*, C Zapka1, J Rutter1, C Fricker1, J Arbogast1, D Macinga1,
R McCormack2
1
GOJO Industries, Inc, Akron, OH, USA; 2BioScience Laboratories, Inc.,
Bozeman, MT, USA
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P27
Introduction: Clostridium difficile infection is a significant issue in
healthcare facilities, and proper hand hygiene is recommended to help
prevent C. difficile transmission. It is known that alcohol based-handrubs
are ineffective at killing C. difficile spores and recent studies demonstrate
that the efficacy of hand washing is limited.
Objectives: The objective of this study was to evaluate several aggressive
chemistries including chlorinated lime (the Semmelweis hand disinfection
procedure) for reduction of C. difficile spores.
Methods: A modification of the ASTM method E1174 was used to evaluate
C. difficile spore removal and inactivation. Approximately 1x106 spores of
non-toxigenic C. difficile ATCC #700057 were distributed onto the palms of
subjects hands. A series of hand hygiene procedures were evaluated
including a 30-second non-antimicrobial handwash and a 5 minute hand
disinfection procedure with a scrub brush using 4% chlorinated lime, 2000
ppm peracetic acid, or 1000 ppm acidified bleach. Log10 reductions from
baseline for each product were compared using ANOVA and post-hoc
analysis (P<0.05) to identify statistically significant differences.
Results: The handwash, acidified bleach, peracetic acid, and chlorinated
lime achieved log10 reductions of 0.66, 0.79, 1.64, and 2.45, respectively.
Although log 10 reductions were low, those for chlorinated lime and
peracetic acid were statistically superior to acidified bleach and the nonantimicrobial handwash.
Conclusion: These data further reinforce that elimination of C. difficile
spores from hands is very difficult. The two best chemistries, peracetic
acid and chlorinated lime, still only achieved log reductions of <2.5 log10,
despite aggressive and lengthy application procedures not feasible for
healthcare workers. These data reinforce the need for contact precautions
including gloving when caring for a C. difficile infected patient; and the
importance of cleaning and disinfection to reduce environmental spore
contamination. Further research is needed to identify hand hygiene
approaches to effectively eliminate C. difficile from hands and to reduce
patient safety risk.
Disclosure of interest: None declared.

P28
P028: Examining the relationship between fluoroquinolone use and
Clostridium difficile infections (CDI): a meta-analysis
MB Formanek1, L Herwaldt2*, ML Schweizer3
1
Epidemiology/CADRE, University of Iowa College of Public Health/Iowa City
Veterans Affairs Medical Center, Iowa City, IA, USA; 2Internal Medicine/Clinical
Quality, Safety, and Process Improvement, University of Iowa College of

Page 38 of 143

Medicine/University of Iowa Hospitals and Clinics, Iowa City, IA, USA;


3
Internal Medicine/CADRE, University of Iowa College of Medicine/Iowa City
Veterans Affairs Medical Center, Iowa City, IA, USA
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P28

Introduction: The incidence of CDI has increased substantially during the


past decade. C. difficile is now one of the most important causes of
healthcare-associated infections. Antimicrobial use is the primary risk factor
for CDI. Several small studies have assessed whether fluoroquinolones
increase the risk of CDI more than other antimicrobials.
Objectives: To systematically review and evaluate all published studies
on the relationship between fluoroquinolone use and CDI.
Methods: We performed systematic literature searches in PubMed,
Wileys Cochrane Database of Systematic Reviews (CDSR), Wileys
Database of Abstracts of Reviews of Effects (DARE), Wileys Cochrane
Central Register of Controlled Trials (CENTRAL), Scopus (including EMBASE
abstracts), and http://ClinicalTrials.gov. We ran the searches on October
15, 2012 with no limits on date or language. We used a random-effects
model to obtain meta-analysis summary estimates. After reviewing 431
article abstracts and reviewing 22 articles in detail, we pooled risk
estimates from 17 independent study populations.
Results: When we pooled the crude data from all 17 studies in a randomeffects model, fluoroquinolone use was significantly associated with a higher
risk of CDI than other antimicrobials (pooled OR: 2.93; 95% CI: 2.12, 4.05).
Twelve of 17 studies provided adjusted risk estimates. When we pooled the
adjusted data, fluoroquinolone use remained a significant risk factor for CDI,
albeit with a lower pooled OR (pooled OR: 1.71; 95% CI: 1.48, 1.96).
Conclusion: Fluoroquinolone use was associated with increased risk of CDI
compared with other antimicrobials. Antibiotic stewardship campaigns to
limit to overuse of fluoroquinolones may decrease the incidence of
healthcare-associated CDI.
Disclosure of interest: None declared.

P29
P029: Regional differences in Clostridium difficile infections (CDI) in
relation to fluoroquinolone (FQ) and proton pump inhibitor (PPI) use,
Finland, 2008-2011
M Kanerva1*, J Ollgren2, T Voipio3, S Mentula2, O Lyytikinen2
1
Infectious Diseases, Helsnki University Central Hospital, Helsinki, Finland;
2
National Institute for Health and Welfare, Helsinki, Finland; 3Finnish Medical
Agency, Helsinki, Finland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P29
Introduction: In Finland, incidence of CDI increased during 2002-2006,
shown by the population-based analysis of hospital discharge diagnoses,
a trend similar to that in the US. In 2008, toxin-positive C. difficile became
a notifiable disease. During the first 3 years of surveillance, the annual
incidence decreased from 111 to 90/100,000 population, but rose up to
100 in 2011. The epidemic situation and trends differed regionally. Both
PPI and FQ use have been associated with increased risk of CDI.
Objectives: To study whether the use of antibiotics, FQs and PPIs were
associated with regional differences in CDI rates.
Methods: Data on CDI incidence during 2008-2011 in 21 hospital districts
(HD) was obtained from the National Infectious Disease Registry and
consumption of antibiotics and PPIs from the Finnish Medical Agency. The
availability of molecular methods in diagnostics was obtained by a
laboratory survey and data on FQ resistant ribotypes from the national
reference laboratory. Negative binomial regression model was performed
to assess the impact of different antibiotics, PPIs, the presence of ribotype
027 CD and the use of molecular diagnostic methods in the respective HD
on CDI incidence. Variable selection in the model was done by using
Akaike information criteria (AIC).
Results: The level of FQ use was stable during 2008-2011 (although it
had doubled during 1990-2000). The use of PPI increased 50% during
2008-2011. FQ use was strongly associated with the CDI incidence, and
there was a trend between PPI use and the CDI incidence in different
HDs. The presence of molecular methods (including PCR) or the
knowledge of ribotype 027 being detected in the HD was not associated
with the CDI incidence. According to AIC, in the final multivariable model,
we only included FQ use. The incidence rate ratio for FQs was 2.45 (95%
CI, 1.58-3.79; p<0.001).

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Conclusion: FQ use was an important risk factor for CDI, as shown


previously. However, the use has stabilized during the last few years. In
the national guidelines, FQs are included in the choices to treat urinary
tract infections but not respiratory tract infections. The increasing use of
PPIs is of note.
Disclosure of interest: None declared.

total of 1828 cases of CD027. Moreover, one of these regions recorded


more cases in the CD027 registry than in the TBR in 19 of 24 months of the
observation period.
Conclusion: The decrease in number of cases in the CD027 registry may
show a decrease in completeness as it coincided with known changes in
laboratory practices. The observation that more cases from one of the
regions were recorded in the CD027 Registry than in the TBR suggests an
underreporting in the TBR register for this region. This shows there is a need
for a surveillance system with higher completeness, which records ribotypes.
The newly established Danish national microbiology database (MiBa), which
includes all test results from all diagnostic microbiology departments, may
provide the basis for such a system.
Disclosure of interest: None declared.

P30
P030: Role of unnecessary movement of patients in spread
of C. difficile infection
N Damani*, S Wallace
Southern Trust, Craigavon, UK
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P30
Introduction: C. difficile associated diarrhoea (CDAD) has been recognised
as the most common cause of hospital acquired diarrhoea. Among others
the unnecessary movement of patients between wards is one of the
major factors in the spread of CDAD. The aim of this study was to map
the journey of all patients with CDAD during their inpatient stays over a
3 year period and assess the impact on CDAD spread.
Methods: Every patient who was diagnosed with CDAD between January
2008 and December 2010 in our hospital was identified and their inpatient
stay history was mapped using the electronic Patient Administration
System. Cross infection was defined if two patients were in the same ward
simultaneously and had the same ribotype. For cross infection purposes
we used the 078 ribotype as a surrogate marker as this was the predominant strain within our hospital.
Results: Retrospective analysis of all 078 ribotypes in our hospital showed
that that majority of patients were admitted to the Medical Admission
Unit for initial assessment and then transferred onward to other wards.
From this we have identified 13 opportunities of possible cross infection
among patients who had the same ribotype.
Conclusion: The study supports the findings that among other factors,
unnecessary movement of patients must be kept to a minimum to prevent
spread of CDAD. As a result of this study, all unnecessary movements
stopped throughout the hospital and all patients who had a previous history
of CDAD are now directly admitted to a single room or admitted to a
dedicated isolation ward. This change in practice, along with other infection
control measures has resulted in a reduction in newly acquired CDAD cases
from 1.0 (2009-10) to 0.3 (2010-11) cases per 10,000 beds days. Postintervention we have also seen a substantial decline in CDAD cases caused
by 078 ribotypes.
Disclosure of interest: None declared.
P31
P031: Room for improvement of clostridium difficile surveillance and
reporting in denmark
M Chaine1,2*, S Gubbels2, E Tvenstrup Jensen1, M Voldstedlund2, K Mlbak2,
B Kristensen1
1
Microbiology and Infection Control, Copenhagen, Denmark; 2Infectious
Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P31
Introduction: National surveillance of Clostridium Difficile (CD) is
currently performed in two ways in Denmark: by the Enteropathogen
Registry (TBR) for all CD culture positive samples (reported from clinical
microbiology laboratories), and since 2009 by a specific CD027 Registry
with mandatory submission of CD strains for further characterization.
Objectives: In this study the two systems are evaluated with a focus on
completeness.
Methods: From the TBR and the CD027 registry datasets were retrieved
with data from January 1 st 2011 to December 31 st 2012 including
information on date of sample and region of diagnostic microbiology
department. For both, a patient was included only once during the
observation period.
Results: A total of 5342 patients were reported with CD in the TBR registry
and 1971 patients in the CD027 registry. For the whole country the TBR
showed a stable linear trend of percentages over the observation period
with a coefficient of correlation (R2 ) of 0.0072, whereas the CD027 Registry
showed a decreasing trend with R2= 0.52. Two regions accounted for a

P32
P032: Clostridium difficile infection in Tenerife Canary Island, Spain
M Hernndez, M Ramos*, M Lecuona
Microbiologa y Medicina Preventiva, Hospital Universitario de Canarias, La
Laguna, Spain
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P32
Introduction: Clostridium difficile infections(CDI) epidemiology has
changed: elevation in rate and severity of infection and increase in
disease among outpatients.
Objectives: Aim of study was to evaluate the epidemiology of CDI in
North Tenerife Area.
Methods: This is an epidemiological study performed in the Hospital
Universitario de Canarias a tertiary care institution during 2011-2012.
Studied population was outpatients or inpatients attended in this hospital
with CDI suspected. Diagnostic procedures were based in GDH and later
Toxin A/B detection as CDI confirmation in stool samples by EIA. Medical
charts of patient were reviewed to collect: demographic variables,
underlying diseases (diabetes(D), renal disease(RD), liver disease(LD),
respiratory disease(ReD), cardiopathy(C), neoplasia(N)), 3 co-morbidities,
inflammatory boweldisease(IBD), solidorgan transplant(OST), immunocompromised states(IC), treatment previous, treatment of CDI, developed to
Pseudo-membranous colitis(PMC), mortality due to CDI. The episodes were
classificated as nosocomial, healthcare associated (HCA), community,
indeterminate, and recurrence.
Results: In 2011/2012 a total 18/45 episodes (17/41 patients) were
diagnosticated. 50/62% were man and 7/22 (39/49%), <65 years. HCA and
nosocomial CDI incidence were: 0, 7/1, 7 case/104 patientday. The services
distribution was:Internal Medicine 6/12(33/27%), Nephrology 6/4(33/9%),
Hematology 2/5(11/11%). Episodes: Community 4/7(22/15%), Nosocomial
14/27(78/60%), HCA 0/6(0/13%), Indeterminate 0/1(0/2%) and recurrences
0/4 (0/9%). In Nosocomial the time average between admission and CDI
diagnostic was 10,69, 1/2429 d. Underlying diseases: C 10/9(55/20%), RD
5/10(27,7/22%), LD 2/4(11/9%), ReD 2/2(11/4%), N2/10(11/22%). 3 comorbidities 3/3(17/7%). IBD 1/1(6/2%), OST 7/3(39/6,6%),IC 10/20(55/44%),
previous treatment: Omeprazol 6/10(33/22%), Ranitidine 3/1(17/2%),
Aciclovir 1/2(5,6/4,4%), Carbapenems 6/21(33/47%), Fluorquinolones 5/13
(28/29%), Cephalosporins (3-4) 4/11 (22/24%), Vancomycin(VA) 3/6(17/13%),
Amoxicillin-clavunate 2/7(11/16%). CDI Treatment: Metronidazole 18/39(100/
87%), VA 3/9 (17/20%), developed PMC 2/5(11/11%), death for CDI 1/0.
Conclusion: In our hospital there has been an increase in nosocomial CDI
adquisition overtime and a high percentage in young patients. At 2012
OST patients declined and HCA episodes were increased thus we
observed that CDI is not confined to hospitals.
Disclosure of interest: None declared.

P33
P033: Incidence estimate of Clostridium difficile infection in EmiliaRomagna Region by linkage of administrative and laboratory data
M Morandi, R Buttazzi, M Marchi, F Morsillo, C Gagliotti, ML Moro*
Social Health Agency of Emilia-Romagna Region, Bologna, Italy
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P33
Objectives: To estimate the incidence of Clostridium difficile infection
(CDI) in Emilia-Romagna Region (ER) by linking data of Patient Hospital
Discharge Form (PHDF) and microbiological labs.

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Methods: We linked regional data of PHDF and labs by anonymous


patient code and we considered only public hospitals with at least 1
identified positive lab test for CD. CDI was defined as follows: Confirmed
case (Cc) where a specific ICD9 code (00845) was present on the PHDF
or an unspecific code for diarrhoea (or intestinal infection) and positivity
for CD toxin was retrieved from the lab; Probable case (Pc) where either
a specific ICD9 code without positivity for CD toxin test or exclusively CD
toxin positivity was present. We considered only people older than 1 year
and incidence was calculated both for all inpatients and for residents in
ER. By linking dates of hospital admission and discharge and date of lab
testing we defined CDI as hospital-acquired (HA: >2 days from admission
within 28 day from discharge), community-acquired (CA: within 2 days
from admission and after 84 days from possible previous discharge, or
none admission) or indeterminate (IA: all the remaining cases with
hospitalization and lab test).
Results: For 2011, 980 CDI (41.5% were Cc) were identified in 27 ER
public hospitals accounting for more than 2.6 millions hospital-days (65%
of ER hospital-days). Most cases were resident in ER (92.2%), female
(57.2%) and old (median age = 80). Of the total cases, 43.5% had only CD
toxin positivity without a specific or unspecific ICD9 code for CDI and
15.0% had only a specific code without lab confirmatory data. The overall
incidence among the population older than 1 year was 13.7 per 100,000
inhabitants for Cc and 31.8 for Cc and Pc. The HA incidence density was
2.7/10,000 patient-days. The place of transmission for residents in ER was
HA in 76.1% of cases and CA in 9.4%; 5.2% were IA and 9.3% were not
attributable because of lacking of lab results.
Conclusion: The linkage of administrative data allows to improve incidence
estimates of CDI in ER, yielding values in line with European data. It also
allows to assess the locus of CD transmission, which is predominantly the
hospital, though community CDI accounted for almost one tenth of cases.
Disclosure of interest: None declared.

Only 35% of isolation days were implemented for patients with CDI.
Information on prior AB treatment could be a useful decision parameter
to implement isolation precuations.
Point of Care testing to eliminate transportation time to laboratory across
sea could reduce turnaround time.
Both actions may reduce the number of isolation days unrelated to CDI.
Disclosure of interest: None declared.

P34
P034: Daily observation rounds to assess the practice for patients
isolated because of diarrhea
R Mikkelsen1, B Kure2*, K Schnning1
1
Clinical Microbiologi, Hvidovre Hospital, Hvidovre, Denmark; 2Internal
Medicin, Bornholms Hospital, Rnne, Denmark
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P34
Introduction: The study was conducted at Bornholms Hospital located on
an island in the Baltic Sea. In 2011, cases with Clostridium difficile infection
(CDI) doubled to 50 cases. Cases of ribotype 027 increased 5-fold from 5 to
26. In 2012, multiple interventions were initiated reduce the number of CDI
cases.
Methods: Observation rounds during weekdays seeing patients isolated
because of diarrhea was introduced February 1, 2012 in 3 medical wards
(94 beds). The rounds adjusted incorrect interventions and collected data
structured by checkpoints that included:
Indication for and duration of isolation
Turnaround time for microbiological diagnosis
Antibiotic (AB) therapy prior to episode of diarrhea
Compliance to isolation precautions
Data were censored January 31, 2013.
Results: CDI cases decreased to 25 compared to 50 the preceding year
(ribotype 027; 3 from 26).In the study period, 100 patients were isolated
resulting in a total of 486 isolation days. In all, 20 tested positive, of these
3 with ribotype 027. CDI accounted for a total of 173 isolation days.
Average duration of isolation for patients with negative microbiologicial
test results was 4.6 days.
Average turnaroundtime was 3.3 days; transportation to laboratory
accounted for 2.2 days.
55/100 patients had received AB therapy within 2 months prior to the
episode; these included all patients with microbiologically verifiedCDI (RR
3.88; P<0.001).
Compliance with isolation precautions was high throughout the study:
proper signage 95%, proper use of protective gear 95%, and proper
waste management 95%.
Conclusion: Daily rounds to audit implementation of isolation
precautions documented strict adherence to guidelines during the study
period. This may have contributed to the observed decrease in number
of CDI.

P35
P035: Costs of illness analysis of community and hospital acquired
gastroenteritis in a small South Indian town
S Parimalakrishnan*, A Anton Smith, GP Mohanta, PK Manna
Pharmacy, Annamalai University, Annamalai Nagar, India
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P35
Occurrences of gastroenteritis have been increasing and become a threat to
public health. While the morbidity of rotavirus gastroenteritis are extensive
in developing countries like India; the date on the cost of illness are not
easily available. The present study was aimed to analyze and compare the
expenditure incurred during community and hospital acquired rotavirus and
norovirus gastroenteritis in the paediatric and elder patient populations. The
present study was a prospective epidemiologic study conducted in selected
rural areas of Chidambaram, Tamil Nadu, India. Cost of illness was calculated
as average cost per episode per case in ambulatory setup.
Rotavirus and norovirus were identified in 42 of the 68 and 34 out of 79 in
stool samples tested of paediatric and elder patients respectively. Patients
mean age was 18.36 1.35 months and 65.88 4.71 years in paediatric
and elder patients respectively. 7 patients were admitted to hospital due
to severe condition. The average period of fever was observed as 2.1 and
1.9 days while vomiting was present for 1.6 and 1.4 days and diraahoea
was for 3.1 and 2.7 days in paediatric and elder patients respectively. The
total cost per episode varied from 87 1.55 to 309 20.01 and from
112 3.33 to 459 23.27 in the ambulatory setting for paediatric and
elder patients respectively. The total cost includes direct, direct
nonmedical and indirect costs. The majority of hospital-related costs were
paid out of their pocket. No one was reimbursed by health insurance
payers. The average workdays lost by parents, guardians and other
relatives varied between among study population care givers and settings,
ranging from 1.7 to 5.3 days and this was the significant cost spent. From
the result of the present study we conclude that in infants regular
vaccination for rotavirus may improve immunity and decrease cost of
illness whereas in elder patients affected by gastroenteritis, sufficient
improvement in quality of life could be achieved by increasing funds in
health sector.
Disclosure of interest: None declared.

P36
P036: In-hospital epidemics of seasonal influenza a/h3n2 in a
geriatric facility
L Pagani1*, V Sauvan1, Y Thomas2, A Iten1, B Huttner1, L Kaiser2, D Pittet1,
S Harbarth1
1
Infection Control Program, Geneva University Hospitals, Geneva, Switzerland;
2
Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P36
Introduction: Seasonal influenza (SI) infection represents a threat for the
elderly. We investigated a nosocomial outbreak of SI in the 300-bed
geriatric facility of the Geneva University Hospitals.
Methods: Based on surveillance of clinical influenza cases, a nosocomial
outbreak was suspected at the geriatric hospital. Between 15 Jan and 30
Apr 2012, all suspected cases were screened for respiratory viruses
through nasopharyngeal real-time reverse transcription-polymerase chain
reaction (RT-PCR) and infection control procedures (droplet precautions
with single room isolation whenever possible) were implemented. The first
proven case was detected on Feb 3 and the last on Apr 2, 2012. Cases
were defined as nosocomial when symptoms occurred after 72 h following
hospital admission. Patients and healthcare workers (HCWs) vaccination
status were also investigated. All positive viral specimens were processed
and sequenced in order to track the transmission dynamics.
Results: Of 155 suspected cases, 73 (47%) had RT-PCR-proven SI; 62/73
(85%) were nosocomial. 26/155 (17%) were positive for other respiratory

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viruses, and 60 (36%) proved negative. Among all the confirmed cases, four
main clusters of nosocomial transmission were identified by viral
sequencing. 43/73 (60%) patients were given oseltamivir treatment and only
4 (9%) were inappropriately treated (>72 h from disease onset). Of 23/73
(32%) patients who experienced clinical complications, 4 required enhanced
care and 7 died. Over 90% of clinical complications were observed in wards
admitting patients with more severe underlying diseases. Vaccine coverage
among HCWs was low (30%; 116/379).
Conclusion: Influenza remains a severe infection among hospitalized
elderly patients. Very low HCW vaccination rates and gaps in recommended
infection control procedures are likely to have contributed to the
nosocomial spread of SI, together with the observed mismatch between the
vaccine and late circulating H3N2 strain, and the potential weakness of
the immune response to vaccination in the elderly. Improved strategies for
the prevention and control of SI should be implemented for hospitalized
geriatric patients.
Disclosure of interest: None declared.

P37
P037: Nosocomial influenza prevention using multi-modal intervention
strategies; 20-years of experience
A Iten1*, C Bonfillon2, T Bouvard2, C-A Siegrist3, D Pittet1
1
Infection Control Program, University of Geneva Hospitals, Geneva,
Switzerland; 2Department of Health Employees, University of Geneva
Hospitals, Geneva, Switzerland; 3Department of Child and Adolescent,
University of Geneva Hospitals, Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P37
Introduction: Healthcare-acquired influenza is associated with patient
morbidity and mortality. Annual vaccination of healthcare workers (HCW) is
an important preventive measure to avoid the spread of influenza virus, but
HCW vaccination is not mandatory in Switzerland for legal reasons.
Before 1994, HCWs influenza vaccination rate at HUG was very low (<10%).
The use of various intervention strategies (multiple teaching sessions,
institution-wide information campaigns, facilitated access to vaccines)
increased HCW vaccination coverage from 14% in 1994 to 21-27% between
1996 and 2008.
Since 2009, an additional measure has been introduced and a badge with
the message I am vaccinated against influenza to protect you is now
given to all vaccinated HCWs. Non-vaccinated HCWs are required to wear
a mask during the entire seasonal influenza epidemic period. Apart from
2009 (pandemic A/H1N1 2009), vaccination coverage peaked at 29%. In
2011, only 55.4% of HCWs respected the recommendations (vaccination
or correct mask wearing in the proximity of the patients).
Methods: During the seasonal influenza epidemic 2012/13, all HCWs
were obliged to wear a badge that explained their choice to patients/
visitors. If vaccinated, this was clearly stated by the badge message; if
not, the HCW was obliged to wear a mask during the seasonal epidemic
(approximately 12 weeks) and to display a badge with the message I
wear a mask to protect you.
Results: HCW vaccination coverage reached 37% in 2012/13. In early
2013, an audit quantified the observance of recommendations against
seasonal influenza on the hospital wards as follows: 40.4% of HCWs were
vaccinated and 30.6% wore the masks correctly, corresponding to 71% of
HCWs at HUG who contributed actively to prevent the transmission of
influenza virus.
Conclusion: Influenza prevention requires a multi-modal approach. In
countries where HCWs have no obligation to be vaccinated, the choice
between the vaccine and mask wear may be a solution to improve the
observance of recommendations that aim to prevent nosocomial transmission.
Disclosure of interest: None declared.

P38
P038: Efficacy of prevention measures against nosocomial influenza at
a large university hospital
A Iten1*, T Bouvard2, Y Thomas3, C Bonfillon2, C Ginet1, L Kaiser3, C-A Siegrist4,
D Pittet1
1
Infection Control Program, University of Geneva Hospitals (HUG), Geneva,
Switzerland; 2Department of Health Employees, University of Geneva
Hospitals (HUG), Geneva, Switzerland; 3Laboratory of Virology, University of
Geneva Hospitals (HUG), Geneva, Switzerland; 4Department of Child and

Page 41 of 143

Adolescent Medicine, University of Geneva Hospitals (HUG), Geneva,


Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P38

Introduction: At HUG, healthcare workers (HCW) are currently obliged to


be vaccinated or wear masks in ward corridors and patient rooms during
seasonal influenza (SI) epidemics. Since winter 2011-12, HCWs vaccinated
against SI wear a badge with the text I am vaccinated to protect you
and, since winter 2012-13, those who are not vaccinated wear a badge
with the text I wear a mask to protect you. Regular audits have allowed
to quantify compliance with recommendations in parallel with active
recording of influenza cases.
Methods: During the SI epidemic, an audit recorded HCWs with a badge
and those with correct mask wear over 2 periods of 2 weeks each in
FebMarch 2012 and 3 periods of 2 weeks each in JanMarch 2013.
Compliance was assessed as follows: (number of HCWs wearing a colored
badge + number of HCWs wearing a mask correctly)/number of HCWs
observed = number of compliant HCWs/number of HCWs observed,
expressed as a percentage. Suspected cases of SI were confirmed by
positive realtime RT-PCR reaction. Cases were defined as nosocomial (NOSO)
SI when symptoms occurred >72 h post-admission.
Results: Of 1390 HCWs observed in winter 2012, 469 wore a badge or mask
(estimated compliance, 33.5%). In winter 2013, 2070/2937 observed HCWs
were compliant (70.5%). We recorded 84 NOSO SI /152 SI (55.2%) and 96
NOSO SI /267 SI (35.9%) cases during 2011-12 and 2012-13, respectively.
Compliance with recommendations in internal medicine averaged 68.6% in
2012 and 72.2% in 2013. The proportion of NOSO SI cases remained stable
(30.3% and 21.6%, respectively). At the geriatric hospital, compliance
progressed from 58.6% to 72.2%, while the proportion of NOSO SI cases
decreased from 84.9% to 63.3%, respectively. These measures prevented an
estimated number of 115 NOSO SI cases at HUG in 2012-13, together with a
reduced number of deaths among SI patients.
Conclusion: Mandatory badge wear, continuous SI epidemic surveillance
and availability of compliance rates with recommendations decrease the
risk of NOSO SI and improve patient safety.
Disclosure of interest: None declared.

P39
P039: A new method to assess compliance with measures to prevent
nosocomial influenza transmission
A Iten1*, C Bonfillon2, T Bouvard2, C-A Siegrist3, D Pittet1
1
Infection Control Program, University of Geneva Hospitals, Geneva,
Switzerland; 2Department of Health Employees, University of Geneva
Hospitals, Geneva, Switzerland; 3Department of Child and Adolescent
Medicine, University of Geneva Hospitals, Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P39
Introduction: Seasonal influenza (SI) can present a serious threat to some
patients, particularly those with underlying diseases. Healthcare workers
(HCW) should use appropriate means to prevent influenza transmission in
healthcare settings, with vaccination considered as the most important
recommended measure. At our institution, a significant proportion of HCWs
refuse vaccination. As an alternative solution to protect patients from SI,
HCWs at our hospital are now obliged to be vaccinated or wear masks
during SI epidemics. We propose a method for the quantification of
adherence to this recommendation.
Methods: HCWs vaccinated against SI wear an orange badge with the text
I am vaccinated to protect you. HCWs who are not vaccinated wear a
brown badge with the text I wear a mask to protect you and must wear a
mask during the influenza epidemic (about 3 months) in ward corridors and
patient rooms. During the SI epidemic, one investigator audited the
observance of recommendations over three periods of two weeks each
between January and March 2013 by recording HCWs with an orange badge
and HCWs with correct mask wear. To estimate adherence, we calculated:
(number of HCWs wearing an orange badge + number of HCWs wearing a
mask correctly)/number of HCWs observed = number of compliant HCWs/
number of HCWs observed, expressed as a percentage. SI surveillance
included active screening of all suspected cases using nasopharyngeal
samples analyzed by real-time rtPCR.
Results: A total of 2937 HCWs were observed: 1171 HCWs with an orange
badge and 899 HCWs with a mask, corresponding to an estimated
compliance of 70.5% (2070 HCWs) with institutional recommendations.

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This method can be used for a department or ward and it can be linked to
other results, such as the number of nosocomial cases.
Conclusion: This proposed new method to assess process control of
nosocomial influenza transmission measures at the hospital level is simple
and easy to use.
Disclosure of interest: None declared.

Results: A higher proportion of adults hospitalized with laboratoryconfirmed influenza received antiviral treatment during the 2009 influenza
pandemic (997/1,113; 89.6%) compared with the 2010-2011 (873/1,092;
80.0%, p<0.001) and 2011-12 (391/600; 65.2%, p<0.001) influenza seasons.
The decrease in antiviral us . e between the 2009 pandemic season and
the 2010-11 season was statistically significant in all age groups except for
inpatients 65 years. A decrease in antiviral use among inpatients 65
years was not observed until the 2011-2012 season. A median of 3 days
between symptom onset and antiviral treatment was reported for all three
influenza seasons. Among high-risk groups, adults with underlying medical
conditions were significantly more likely to receive antiviral treatment
during the pandemic than during the post-pandemic seasons (89.7% vs.
75.7%, p<0.001). A higher proportion of adults admitted to the ICU during
the 2009 pandemic (94.2%) received antiviral treatment compared with
the 2010-11 and 2011-12 seasons (84.6%, p<0.001). There was no
difference in antiviral treatment among inpatients who died within 30 days
of admission during the pandemic (84.3%) than during the post-pandemic
seasons (78.9%, p=0.370).
Conclusion: Antiviral treatment of adults hospitalized with laboratoryconfirmed influenza significantly fell in the two seasons following the 2009
influenza pandemic. In order to guide strategies aimed at minimizing the
impact of influenza among hospitalized adults, reasons for the decline in
antiviral treatment need to be further explored.
Disclosure of interest: None declared.

P40
P040: Epidemic of seasonal (2012-2013) influenza in a large
teaching hospital
A Iten1*, Y Thomas2, C Landelle1, V Camus1, V Sauvan1, L Kaiser2, D Pittet1
1
Infection Control Program, University of Geneva Hospitals, Geneva, Switzerland;
2
Laboratory of Virology, University of Geneva Hospitals, Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P40
Introduction: Seasonal influenza (SI) is usually a benign, self-limited
disease of 2- to 7-day duration. However, it can present a serious threat to
some patients, particularly those with underlying diseases, who may need
hospitalization due to complications such as pneumonia. We describe an
influenza epidemic in a 1900-bed Swiss university hospital from end
December 2012 to mid-March 2013.
Methods: Suspected cases of SI (respiratory symptoms, fever with chills,
muscular pain, or prostration) were screened using nasopharyngeal
samples and analyzed by real-time reverse transcriptase polymerase chain
reaction. Patients clinical features and complications were evaluated. Cases
were defined as nosocomial (NOSO) when symptoms occurred >72 h
following admission.
Results: Of 261 suspected cases, 171 (65.5%) samples were positive for
influenza A and 90 (34.5%) for influenza B. Among these cases (median age,
76 y [range, 1.5-100.5]), 122 (46.7%) were male. A total of 117 (44.8%) were
treated with oseltamivir and 38 (14.5%) were treated >72 h from disease
onset. Clinical complications are still under investigation. Among these,
43 (16.5%) required intensive care and 9 (3.5%) died. A total of 94 cases
were NOSO (36.1%). Hospital stay before NOSO SI diagnosis was 4 d for 2
cases, and 5 d for 92 cases. Recommended infection control procedures
(droplet precautions with single room isolation whenever possible) were
implemented for 230/261 patients (88.1%). Droplet precautions were
applied for <3 days for 133/167 community-acquired SI (79.6%) cases and
for 57/94 NOSO SI (60.6%). Among the NOSO SI, we observed 9 outbreaks
involving 80 patients. Reliable information on vaccination status revealed
that 53 patients were vaccinated. Healthcare workers vaccination status was
low (~37%).
Conclusion: Our prevention strategy against NOSO SI includes the weekly
provision of SI epidemiological data to staff, and this information has been
useful for the management of SI on the hospital wards. The epidemic is still
active and data collection continues. The presented data will be updated to
April 15, 2013.
Disclosure of interest: None declared.

P41
P041: Trends in antiviral use in hospitalized patients following the
2009 influenza pandemic in Canada
G Taylor1*, R Mitchell2, A McGeer3, C Frenette4, K Suh5, A Wong6, K Katz3,
K Wilkinson2, B Amihod7, D Gravel2,
Canadian Nosocomial Infection Surveillance Program1
1
University of Alberta, Edmonton, Canada; 2Public Health Agency of Canada,
Ottawa, Canada; 3University of Toronto, Toronto, Canada; 4McGill University,
Montreal, Canada; 5University of Ottawa, Ottawa, Canada; 6University of
Saskatchewan, Saskatoon, Canada; 7Jewish General Hospital, Montreal, Canada
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P41
Introduction: Antiviral treatment is associated with reduced mortality,
length of stay and improved clinical outcomes among patients hospitalized
with influenza.
Objectives: We wished to assess trends in use of antiviral treatment of
adults hospitalized with influenza before , during and after the 2009
influenza pandemic
Methods: CNISP has carried out prospective surveillance for laboratory
confirmed influenza in hospitalized adults since 2006. These data were
reviewed to assess antiviral use.

P42
P042: Severe influenza infections requiring intensive care during
winter 2012/2013
C Landelle1*, A Iten1, L Kaiser2, Y Thomas2, E Genevois3, D Joubert1,
J-C Richard3, S Harbarth1, D Pittet1, L Brochard3
1
Infection Control Program, University of Geneva Hospitals, Geneva,
Switzerland; 2Laboratory of Virology, University of Geneva Hospitals,
Geneva, Switzerland; 3Intensive Care Unit, University of Geneva Hospitals,
Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P42
Introduction: Seasonal influenza (SI) is usually a benign self-limited
disease. However, it can present a serious health threat.
Objectives: We describe influenza cases admitted to a 34-bed adult
intensive care unit (ICU) in a Swiss university hospital during winter
season 2012/2013.
Methods: From 28/11/2012 to 11/03/2013, among 268 hospitalized cases
of SI confirmed through nasopharyngeal samples using real-time PCR, 34
were admitted to the ICU. Droplet precautions were applied to all
patients (pts) at ICU admission without single room isolation.
Results: 23 pts (68%) were positive for influenza A and 11 (32%) for
influenza B. 18 pts (53%) were male; median age was 63 years (interquartiles
range [IQR]: 47-74]); 29 pts (85%) presented a least one co-morbidity and 19
(56%) had risk factors for SI: chronic respiratory disease (n=12), diabetes
(n=7), obesity (n=4), chronic cardiac disease (n=4), immunosuppression
(n=3) and pregnancy (n=1). Only 5 pts had received influenza vaccination.
29 cases were community-acquired (85%) while 5 were hospital-acquired
(15%) (symptoms occurring >3 days [d] after admission). No ICU-acquired
influenza was detected. 9 pts (26%) had a documented co-infection with:
S. pneumonia (n=5), S. pyogenes (n=2), methicillin-sensitive S. aureus (n=1)
and Coronavirus (n=1). 27 pts (79%) were treated with oseltamivir, with a
median delay after onset of symptoms of 5 d (IQR: 3-7). 27 pts (79%)
needed ventilatory support: invasive ventilation (n=17 [50%] for a median
duration of 6 d [IQR: 2-13]) or non-invasive ventilation (n=15 [44%] for a
median duration of 2 d [IQR: 2-3]). The median length of ICU and hospital
stay were 5 (IQR: 3-9) and 11 d (IQR: 7-23), respectively. 5 pts (19%) died
of influenza-related complications, including 1 case of nosocomial
superinfection.
Conclusion: Winter season 2012/2013 was characterized by a massive
burden of cases in the ICU, with no co-morbidity for 15% of the patients.
Despite increased workload, use of face mask ventilation and no isolated
rooms, it is remarkable that no clinical case of transmission was
recognized or microbiologically documented inside the ICU during this
period.
Disclosure of interest: None declared.

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P43
P043: Re-emergence of influenza a H1N1 in Saudi Arabia
NA Alzahrani1*, S Al Johani2
1
College of Applied Medical Sciences, King Saud bin Abdulaziz University for
Health Sciences, Saudi Arabia; 2Department of Pathology and Laboratory
Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P43
Introduction: Influenza A H1N1 is a novel influenza virus that is of swine
source. Clinical manifestations of this virus vary from mild respiratory
symptoms to fatal respiratory or/and cardiovascular complications. The
new influenza A H1N1 pandemic was first identified in April 2009 in the
United States and Mexico, and then spread globally. In September 10
2010, the World Health Organization announced that the influenza A H1N1
pandemic had moved into the post-pandemic period and is no longer
considered a dangerous global disease. On the 15th of August 2010, the
Ministry of Health in Saudi Arabia declared that the cases of influenza A
H1N1 in 2010 have drastically declined to 874 cases with no deaths or
serious complications.
Objectives: In this study, we will shed light on the number of cases of
influenza A H1N1 infections in Saudi Arabia from the months of September
to November 2012, and describe the cases where influenza A H1N1 was the
cause of death in these patients, and the underlying co-morbidities that
may have led to severe complications or death.
Methods: This is a retrospective study in which we reviewed our
laboratory records for cases that were tested for influenza A H1N1 in the
months of September, October, and November 2012. All samples were
nasopharyngeal aspirates and were tested using The Xpert Flu assay and
performed on Cepheid GeneXpert medical device system.
Results: 67 patient samples were tested for influenza A H1N1 over the
period from September to November 2012. Overall, there were 19 positive
samples, 13 of those samples were positive for influenza A H1N1, 6 were
positive for influenza A, and none tested positive for influenza B. Two
patients were suffering from other co-morbidities and expired as a result of
influenza A H1N1 infection.
Conclusion: Vaccination for influenza A H1N1 is widely available in Saudi
Arabia. However, some people are resisting vaccination. This resistance
may have caused the re-emergence of influenza A H1N1 in Saudi Arabia.
Public awareness should be improved to aware people of the benefits of
vaccination and the consequences of not getting vaccinated.
Disclosure of interest: None declared.

P44
P044: MRSA-infection prevention potential in a 500-beds tertiary care
hospital
F Mattner, D Peter*, C Weels, S Messler
Institut fr Hygiene, Kliniken der Stadt Kln, Cologne, Germany
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P44
Introduction: Many studies of infection prevention measures (ICM) appear
proving a reduction of methicillin-resistant Staphylococcus aureus (MRSA) colonisation or - infection rates. Infection control personal has to decide if
ICM should be introduced in their hospital. Here we give an example how
an infection prevention potential (IPP) could be calculated for MRSA
patients in a 500-bed tertiary care hospital under a given MRSA-screening,
contact isolation precaution and active surveillance program.
Objectives: To estimate an additional IPP using results of recently
published ICM, demonstrated by daily body washes with chlorhexidine
(CHX) for the reduction of blood stream infections (BSI)(Climo MW et al.
2013), limited to S. aureus infections.
Methods: MRSA screening policy included a general screening for all
medical wards and the intensive care unit; in all other ward screening was
performed as recommended by the Robert-Koch-Institut. A culture based
screening (BD CHROMAgar MRSA II) was performed except PCR-based
(Roche LightCyclerAdvanced) screening in the intensive care unit. We
reported results when MRSA was suspected. Distinct subgroups of MRSA
patients were defined as I/II: colonisation on admission/nosocomial
acquired colonisation without infection during hospital stay; III: nosocomial
MRSA infection after colonisation status at least 3 days before infection.

Page 43 of 143

IV: nosocomial MRSA infection without prior colonisation, V: infection


already present on admission.
Results: In 2011 and 2012, I were 266/225, II: 19/30, III: 23/12, IV: 12/5. V:
25/18 patients, respectively. Preventable infections were III with 23 per
332 and 12 per 285 MRSA cases in 2011 and 2012 respectively, yielding a
prevention potential of only 6,9% and 4,2% of all MRSA positive patients.
There were 17 primary and secondary BSIs. Calculating with 8% reduction
for S. aureus BSI by CHX body washes reported by Climo they would
prevent only one case in our hospital within two years.
Conclusion: Before introduction of new ICM proposed by new studies
MRSA patients could be subgrouped and an IPP can be determined.
Applying published reduction data on the in-house IPP numbers gives a
first estimate if the new ICM could be a benefit.
Disclosure of interest: None declared.
Reference
1. Climo MW, et al: Effect of daily chlorhexidin bathing on hospital-aquired
infections. N Engl J Med 2013, 368:533-542.

P45
P045: A multimodal strategy to improve the application of
decolonisation treatment for the resident carrier of MRSA in nursing
homes in Switzerland
L Qalla-Widmer*, C Bellini, G Zanetti, C Petignat
Unit HPCI, CHUV, Lausanne, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P45
Introduction: In order to evaluate the methicillin resistant Staphyloccus
aureus (MRSA) carriage rate, the cantonal unit for Hygiene, Control and
Prevention of Infections (HPCI unit) undertook, in 2010, a survey of prevalence in104/157 nursing homes of canton Vaud (Western Switzerland).
In the contest of survey, a project on the implementation of decolonisation
protocol was conducted.
Objectives: The objective of this strategy was to improve the success
rate of decolonisation by insuring good practice in the application of
treatment of the MRSA carrier resident by the health care workers in
nursing homes.
Methods: To foster adhesion to the protocol by the nursing staff, a strategy
based on the creation of teaching aids (flyers, video) was to associated to the
written protocol. A training course on Standard Precautions based on the
management of the MRSA carrying resident for the nursing staff was
provided. Audits of practices to observe the quality of the application of
treatment by nursing staff were conducted. The MRSA carriers underwent a
5-day topical decolonisation (nasal mupirocine and chlorhexidine disinfection
of skin and pharynx) combined with environnemental disinfection. The
treatment was repeated once in case of failure. The survey took place
between June and December 2010. Residents with either urinary or wound
(stage IV) colonisation were excluded.
Results: Of the 2941 screened residents, 356 were MRSA carriers, the mean
prevalence was 8.9%. Because of urinary, wound colonisation or death, 92
residents were excluded. Successfull decolonisation was observed in 264
residents (60%) this is higher rate than in acute care facilities. Adherence to
protocol by nursing staff was observed (accordind to establisched criteria)
during audits and the observance rate was 94%.
Conclusion: Multimodal strategy based on coaching nursing staff and
teaching aid availability is an effective way to optimize the adherence to the
decolonisation protocol and to improve success rate of decolonisation.
Disclosure of interest: None declared.

P46
P046: Validation of a simple tool to save resources with previous
MRSA carriers
A Agostinho1*, V Sauvan1, L Pagani1, P Hoffmeyer2, S Harbarth1, I Ukay1
1
Infection Control Program, Geneva University Hospitals, Geneva, Switzerland;
2
Orthopaedic Surgery, Geneva University Hospitals, Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P46
Introduction: According to international recommendations, patients who
previously carried Methicilin Resistant Staphylococcus aureus (MRSA) should
benefit from isolation measures while waiting for MRSA screening results.
All these measures are resource consuming. The use of an algorithm, valid

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and reproducible, for assessing the probability of MRSA carriage on


admission may allow better allocation of resources and economies.
Methods: Cohort study, bi-centric, open from 2010 to 2012, determining
the carrying MRSA based on previous carrier states known.
Phase I (2009-10): Determination of the tool [Department of Orthopaedics,
University Hospitals of Geneva (HUG)].
Phase II (2012): Evaluation of the reproducibility of the tool and extension
of its applicability to other departments of HUG: orthopaedics, neurosurgery, ophthalmology and oto-rhino-laryngology as well as in geriatric
care [3-Chne Hospital].
Inclusion criteria: all patients known to have been MRSA carriers.
Exclusion criteria: all patients not meeting the inclusion criteria.
Results: Phase I: 43/189 patients (23%) known to have been MRSA
carriers had a positive screening on admission. Of these:
- 34 patients (79%) had the last positive result from < 1 year,
- 6 patients (14%) had the last positive screning between 1-2 years,
- 3 patients (7%) had the last positive result from > 2 years.
Phase II: The validity of the algorithm was tested from January to
December 2012. According to the inclusion criteria, 291 acute care and
239 geriatric patients were included.
Considering as only predictive tool of MRSA carriage state the gap of less
than 2 years between the last MRSA positive carrier state and admission,
there were:
- 68% concordance in the application of this rule (358/530),
- 31% mismatch (164/530), of which:
- 93% (153/164) were negative when a positive test had been predicted,
- 7% (11/164) were MRSA carriers when a negative test had been
predicted,
- In 1% of patients (8/530) the algorithm could not be applied due to lack
of samples.
Conclusion: The exclusive use of this algorithm to predict MRSA carrier
state is a very simple and reproducible tool, which allows considerable
savings with the reduction in the number of days of isolation.
Disclosure of interest: None declared.

P47
P047: Fighting MRSA in an high endemic level hospital
I Neves*, V Alves, D Peres, F Vieira, I Devesa
Infection Control Unit, Unidade Local de Sade de Matosinhos., Matosinhos,
Portugal
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P47
Introduction: MRSA remains one of the principal resistant pathogens
causing serious healthcare-associated and community-onset infections [1].
This agent is associated with increased morbidity, mortality risk and costs [2].
Objectives: Monitoring and control of MRSA cases in a high endemic level
scenario using multimodal strategy [3-5] in an 400 bed portuguese hospital.
Methods: Multistep procedure involving isolation measures and active
surveillance cultures (nasal swab using RT-PCR detection technique) in a
selected population (patients from other hospitals and nursing homes;
history of hospitalization/ MRSA; ICU patients and, in other inpatient
services, direct contacts of newly detected MRSA patients). Since 2012, this
cultures are also applied to patients doing hemodialysis. Other parallel
activities: (a) review of isolation and standard precautions policy, (b)
reinforcement of alcohol-based handrubs at point of patient care, (c)
information sessions to health professionals, (d) targeted information flyer
for health professionals, (e) information leaflet for patients/ visitors; (f)
procedure monitoring by audit (g) patient decolonization in ICU, with
follow-up screenings.
Results: Between 2007 and 2012, MRSA surveillance detected a decrease
in proportion from 66% to 57% and in density of incidence from 1.70 to
0,68 cases per thousand days of hospitalization. According to published
data from EARSS, Portugal was the european country with the highest
level of MRSA in 2011 [6]. In this network participated 22 portuguese
hospitals and include 1507 isolates (blood and cerebrospinal fluid, only).
Using this inclusion criteria, our Hospital reveled a proportion of MRSA
below its national level (34% versus 55%) in 2011.
Conclusion: Fighting MRSA using a multimodal strategy is being effective
in a high endemic level hospital, but perseverance is needed through
continuous surveillance of cases, feed-back to professionals and
procedure audits.

Page 44 of 143

Disclosure of interest: None declared.


References
1. Gould IM, et al: . Int J Antimicrob Agents 2012, 39(2):96-104.
2. Grundmann H, et al: . Lancet 2006, 368(9538):874-885.
3. Coia JE, et al: . J Hosp Infect 2006, 63(Suppl 1):S1-S44.
4. APIC: Guide to the Elimination of MRSA. Washington: APIC 2007.
5. Calfee DP, et al: . Infect Control Hosp Epidemiol 2008, 29(Suppl 1):S62-S80.
6. ECDC: Antimicrobial resistance surveillance in Europe 2011. Stockholm:
ECDC 2012.

P48
P048: Effect of methicillin-resistant staphylococcus aureus bundle
approach in a surgical intensive care unit
EJ Kim1*, HS Oh2, Jeong Suk Song1, Young Rock Oh1
1
Infection control office, Seoul National University Hospital, Seoul, Korea,
Republic Of; 2Colleage of Nursing, Woosung Universty, Daejeon, Korea,
Republic Of
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P48
Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) accounts
for more than 70% of S. aureus isolates from tertiary hospital in Korea.
Especially, MRSA is the major pathogen of nosocomial infections in
intensive care units(ICUs).The MRSA bundle approach has been reported
more effective than a single intervention to reduce MRSA in several
studies.
Objectives: The purpose of this study is to evaluate the effect of the MRSA
bundle approach in reducing MRSA infections or colonizations in a surgical
ICU of a university hospital in Korea.
Methods: This study was conducted in surgical ICU(24 beds) in a university
hospital for 8 months. The MRSA bundle approach for this study consisted
of an active surveillance culture, hand hygiene, contact precaution, and
decontamination of the environment and equipment. The MRSA incidence
rate and MRSA nosocomial infection rate during the pre-intervention period
(4 months) and those of the intervention period (4 months) were compared
to identify the effect of the MRSA bundle approach. Data were analyzed by
the Chi-square test, t-test and Mann-Whitney U test using the statistical
software program SPSS(ver. 12.0). Statistical significance was accepted at the
level of p<.05.
Results: MRSA was newly isolated from clinical specimens in 31 patients
(9.8%) during the pre-intervention period: therefore, the incidence rate of
MRSA was 11.9 cases per 1,000 patient-days during the pre-intervention
period. And MRSA was newly isolated from clinical specimens in 21
patients (5.4%) during the intervention period : thus, the incidence rate of
MRSA was 7.6 cases per 1,000 patient-days during the intervention period
(p=0.040).
MRSA nosocomial infections developed in 21 patients (6.8%) during the preintervention period: therefore, the nosocomial infection rate of MRSA was 8.4
cases per 1,000 patient-days. And MRSA nosocomial infections developed in
10 patients (2.6%) during the intervention period : thus, the nosocomial
infection rate of MRSA was 3.6 cases per 1,000 patient-days (p=0.009).
Conclusion: The MRSA bundle approach in the SICU effectively reduced
the incidence rate and the nosocomial infection rate of MRSA.
Disclosure of interest: None declared.
P49
P049: High rate of MRSA respiratory tract colonisation in HIV-positive
children in Cambodia during 2004-2012
J Sokolova1,2, N Kulkova1,2, A Liskova2, A Streharova3*, A Shahum4, G Benca4,
V Krcmery2,4
1
Department of Laboratory Medicine, Trnava University in Trnava, Trnava,
Slovakia; 2Laboratory of Molecular Microbiology, St. Elisabeth University,
Bratislava, Slovakia; 3Department of Public Health, Trnava University in
Trnava, Trnava, Slovakia; 4St. Maximilian Kolbe Clinic, Phnom Penh, Cambodia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P49
Introduction: Children attending child care centres are at increased risk
of infections, including those caused by MRSA (methicillin-resistant
S. aureus).
Objectives: The aim of this study was to evaluate MRSA colonization
among HIV-infected children in two orphanages in Cambodia during

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period 2004-2012 and to assess risk of spreading MRSA within these


specific health-care facilities.
Methods: Totally 137 HIV positive children (39,4% male; median age 7,
IQR= 5-9) were enrolled in our HIV programmes during 2004-2012 (follow
up 5128 months). Every 6 months, respiratory swabs were obtained,
followed by organisms identification and susceptibility testing according
to CLSI guidelines.
Results: We have collected 586 respiratory swabs positive for bacteria.
Considering overall aetiology, S. aureus was predominant (178 isolates;
30,4%), followed by Str. pneumoniae (103; 17,6%) and K. pneumoniae (99;
16,9%). M. catarrhalis and H. influenzae were present in less extent (35;
6,0% and 20; 3,4%, respectively). In relation to resistance, we found out
oxacillin resistance (phenotype MRSA) to be the most prevalent among
S. aureus (112 isolates; 63%) and resistance to other classes of antibiotics
was high in this group of pathogens, too (e.g. clindamycin-59%;
erythromycin-4,3%). However, susceptibility to some other antibiotics, such
as vancomycin, linezolid, ciprofloxacin and co-trimoxazole was very well
(100%; 100%; 96% and 95%, respectively). Typing of hypervariable region
of methicillin resistance gene (HVR-mecA typing) among selected MRSA
isolates revealed six different HVR-types, with the type I being the most
frequent (41,2%).
Conclusion: Despite the TMP/STX prophylaxis, we found out high rates of
MRSA colonisation but resistance to this antibiotic remained rare. This is
supporting assumption that prophylaxis is decreasing exposure to other
pathogens and consequently, selective pressure of antibiotics, too.
Diversity among HVR-mecA-types indicates that MRSA in our study were
not spread clonally in this specific healthcare facility.
Disclosure of interest: None declared.

P50
P050: Containment of methicillin resistant staphylococcus aureus
(MRSA) outbreak in a neonatal intensive care unit (NICU)
O Eluk1*, Y Shachor-Meyouhas1, Y Geffen1, S Blazer2, I stein2, I Kassis1
1
Pediatric Infectious Diseases and Control Unit, Rambam Health Care
Campus, Haifa, Israel; 2Neonatal Intensive Care Unit, Rambam Health Care
Campus, Haifa, Israel
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P50
Introduction: MRSA infections in NICU are associated with significant
morbidity and mortality. Early containment of outbreaks is crucial. Trials
comparing different methods of screening and decolonization are lacking.
Objectives: To describe an epidemiologic and molecular investigation of
MRSA outbreak in NICU.
Methods: Our NICU is a 25 bedslevel III unit. The main space has 9 beds for
critically ill neonates. Two rooms serve as intermediate care (8 beds each).
Almost 540 neonates are admitted a year. The index case was an 8 days old
term baby. MRSA was isolated from his infected eye. Infection control team
set an immediate investigation and emergency policy including: cohorting
of MRSA+ cases, strict isolation and separate nursing team. All infants were
screened for MRSA from nares, throat, axilla, groin, rectum, twice weekly,
until one month after the last case discharged. Health care workers (HCW)
and parents of positive cases were screened, re-educated for infection
control measures and updated daily. NICU was closed until all colonized
infants were detected and isolated. Visiting was restricted. MRSA isolates
were collected for molecular testing.
Results: Four colonized neonates were immediately identified by first
screening. One patient was discharged and the rest were isolated in a
separate room. Another infant was identified 20 days later. The last MRSA+
neonate was discharged 3 month later. HCW and families screening was
negative. MRSA was isolated from five infants by nasal and rectal swabs;
one was detected from axilla only. Two MRSA+ patients already known in
the PediatricIntensive Care Unit (PICU) located near the NICU were
suspected to be the source. All NICU Isolates were identical by PFGE. The
two PICU isolates were different from each other and from NICU isolates.
NICU and one PICU isolates were defined as ST-5 strain by MLST. One PICU
isolate was ST-627. All isolates were PVL negative and SCCmec type IV. No
further cases were detected. No cases of MRSA infection occurred during
the outbreak period.
Conclusion: Outbreaks of MRSA are hazardous in the NICU. Strict
infection control policy and active screening may abort outbreaks.
Disclosure of interest: None declared.

Page 45 of 143

P51
P051: Factors responsible for methicillin-resistant Staphylococcus
aureus outbreak in the neonatal intensive care unit
T Gondo1*, S Yasunaga1, M Kiyosuke2, T Yamada3, M Kadowaki2, M Murata4,
K Toyoda1, T Hoshina1, N Shimono1, J Hayashi1
1
Center for the Study of Global Infection, Kyushu University Hospital,
Fukuoka, Japan; 2Department of Clinical and Laboratory Medicine, Kyushu
University Hospital, Fukuoka, Japan; 3Department of Pharmacy, Kyushu
University Hospital, Fukuoka, Japan; 4Department of General Internal
Medicine, Kyushu University Hospital, Fukuoka, Japan
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P51
Introduction: We observed a high incidence of methicillin-resistant
Staphylococcus aureus (MRSA) outbreaks in the neonatal intensive care
unit (NICU) of Kyushu University Hospital in Japan from 2010 to 2012.
Objectives: This study aimed at analyzing the cause of the outbreaks and
investigating preventive measures.
Methods: This study included 556 subjects admitted to the NICU (18
beds) and the growing care unit (GCU) (13 beds) of our hospital (1,275
beds) from July 2009 to June 2012. We retrospectively evaluated the
factors responsible for MRSA outbreaks. In addition, we performed a
molecular epidemiological analysis of MRSA strains by using polymerase
chain reaction-based open-reading frames typing (POT) method. Based
on the results, the periods were divided into Period I and II.
Results: Periods I and II were set to be July 2009November 2010 and
December 2010June 2012, respectively. The total number of inpatients and
the number of inpatients who were newly detected MRSA during Period I
and II were 15,802 and 17,598, and 43 and 73, respectively. The mean
number of inpatients detected MRSA per month was 2.5 (maximum 8)
during Period I and 3.8 (maximum 11) during Period II, respectively. The
results of the molecular epidemiological analysis indicated that MRSA
clusters detected during Period I had disappeared before Period II, however,
4 new MRSA clusters appeared and spread throughout Period II. The
duration of hospital stays per patient was considered to be a contributing
factor of the outbreaks (odds ratio: 5.93, p < 0.001). Other responsible
factors were bed occupancy rate in Period I (r = 0.57, p = 0.018) and patient
care intensity in Period II (r = 0.52, p = 0.024), respectively. The consumption
of hand sanitizer significantly increased during Period II, when the patient
care intensity increased (p < 0.01).
Conclusion: These results suggested that MRSA outbreak might be
associated with the hospital environment including bed occupancy and
patient care intensity.
Disclosure of interest: None declared.

P52
P052: Molecular epidemiology of methicillin-resistant Staphylococcus
aureus (MRSA) strains at Geneva University Hospitals (HUG) over a
9 year period
C Fankhauser1*, J Schrenzel2, P Franois3, G Renzi2, D Pittet1, S Harbarth1
1
Infection Control Program, Geneva University Hospitals, Geneva, Switzerland;
2
Bacteriology Laboratory, Geneva University Hospitals, Geneva, Switzerland;
3
Genomic Research Laboratory, Geneva University Hospitals, Geneva,
Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P52
Introduction: Changes within the MRSA population of single hospitals
have been observed with certain clones replacing others. Surveillance of
the genetic diversity within a hospital provides useful epidemiological
data. Staphylococcal chromosomic cassettes (SCCmec) of MRSA isolates
are routinely determined at HUG.
Objectives: To describe secular trends of the predominant MRSA clones
retrieved at HUG from 2003-12 using SCCmec genotyping.
Methods: Since 2005, the SCCmec in MRSA isolates (screening swabs or
clinical samples) were routinely assessed by multiplex PCR assay. MLVA
was used to evaluate genomic diversity; representative isolates were
grouped in MLVA clusters and subjected to MLST. All patients 1st positive
MRSA isolate/year was analysed. Frequency distributions and hospitalacquired (HA)-MRSA rates were determined.
Results: HA-MRSA cases/100 admissions increased from 1.36 (2000) to
2.00 (2006) and declined to 0.79 (2012). Overall, 9717 MRSA isolates

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underwent SCCmec genotyping. SCCmecI, the predominant cassette


during the study period, peaked at 88% in 2003 and declined to 64% in
2012. SCCmecIV increased modestly from 10% to 16%, followed by
SCCmecII with a strong increasing trend from 2% to 14%. Other types
were minor contributors (SCCmecV, 3.4%; others <2%). Patients harboring
SCCmecI and SCCmecII were older (median age, 76 and 82 y) compared
to those with SCCmecIV (60 y). Strain distribution differed by hospital
sectors. While SCCmecI remained the prevalent subtype in acute care
(AC) and non-AC settings, the proportion of MRSA containing SCCmecII
and SCCmecIV was higher in non-AC settings. SCCmecII increased from
6% to 32% in geriatrics. Genotyping confirmed ST228 South GermanSCCmecI as the predominant clone. ST105 (CC5) appears to be the
predominant clone of SCCmecII. Individual SCCmec replacement was
observed in 123 patients (incl. 37 within SCCmecI-SCCmecII and 69,
SCCmecI-SCCmecIV).
Conclusion: ST 228 SCCmecI is still the predominant clone in all settings,
but decaying. The prevalence of SCCmecII is higher in geriatrics than in
AC settings. The emerging SCCmecII predominant clone is ST105(CC5).
Disclosure of interest: None declared.

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA)


infections have been associated with increased mortality and hospital
costs. Active surveillance cultures (ASCs) for MRSA and aggressive contact
precautions have been shown to reduce MRSA transmission. Universal
screening incurs financial and physical resources.
Objectives: To determine the prevalence of MRSA colonization at
admission and to identify risk factors associated with MRSA colonization
in adult patients.
Methods: This study was conducted in 2 wards (one medical and one
surgical, each 44 bedded) in Changi General Hospital. ASCs were performed
from 20 Jan 2010 to 7 Jul 2010 on all patients admitted to these wards. ASC
specimens consisted of one swab from the nares and another from axilla/
groin. A random sample of MRSA-positive and MRSA-negative patients were
reviewed for demographics and risk factors for MRSA colonization.
Results: A total of 2090 patients were screened on admission. 129 medical
and 93 surgical patients were MRSA positive on entry (total 222, 10.6%).
136 MRSA-positive patients were randomly selected and analyzed for risk
factors for MRSA colonization. The mean age was 67.3 years (77.1% 60
years old) and average length of stay was 19 days. Among the 136,
patients, 14% had urinary catheter, 38.2% diabetes, 17.6% malignancy,
5.1% chronic kidney disease and 14/7% had skin ulcer. 48 MRSA-negative
patients were randomly selected and analysed as a control group. The
mean age was 57.9 years and average length of stay was 13.6 days.
Among the 48 patients, 4.2% had urinary catheter, 20.8% diabetes, 14.6%
malignancy, 4.2% chronic kidney disease and 6.3% had skin ulcer.
Significant risk factors for MRSA colonization at admission included
residence in a long term care facility, previous MRSA infection or
colonization and diabetes mellitus. The majority of MRSA-positive patients
were >60 years and had prolonged hospitalization.
Conclusion: The prevalence of MRSA colonization was 10.6%. Risk factors
for MRSA colonization included residence in a long term care facility,
diabetes and previous MRSA colonization/infection. This study revealed the
high burden of MRSA in Singapore. Knowledge of risk factors for MRSA
colonization offer selective screening for MRSA based on risk factors as a
more cost-effective strategy in reducing MRSA transmission.
Disclosure of interest: None declared.

P53
P053: Secular trends of methicillin-resistant Staphylococcus aureus
(MRSA) at Geneva University Hospitals (HUG) over a 12-year period
C Fankhauser1*, J Schrenzel2,3, P Francois3, D Pittet1, S Harbarth1
1
Infection Control Program, Geneva University Hospitals, Geneva, Switzerland;
2
Bacteriology Laboratory, Geneva University Hospitals, Geneva, Switzerland;
3
Genomic Research Laboratory, Geneva University Hospitals, Geneva,
Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P53
Introduction: In 2000, the introduction of the highly epidemic ST228
South-German MRSA clone at HUG coincided with a progressive increase
in MRSA burden.
Objectives: To describe secular trends of MRSA rates at HUG, related to
infection control measures.
Methods: In 1993 initiated a multifaceted MRSA prevention program,
including patient screening, decontamination, surveillance, contact isolation,
a computerized alert system and a hospital-wide hand hygiene (HH)
promotion campaign. Since 2003, it was strengthened by an educational
campaign of all personnel; 2005, by routine MRSA genotyping of SCCmec
elements; and 2006 by a 2 nd HH campaign with periodic audits and
feedback. Universal screening on admission, discharge and weekly was only
performed in the intensive care unit since 2004. MRSA surveillance included:
(1) incidence rates of hospital acquired (HA)-MRSA infection or colonization;
(2) HA-MRSA bloodstream infections (BSI); (3) the proportion of MRSA
among S. aureus BSI; (4) incidence rates of MRSA- clinical cultures (CC).
Results: At HUG, from 2000-2012, 12347 patients were documented as
MRSA-colonized or infected (incl. >75% screening swabs; 507 BSI episodes);
8331 were considered HA-MRSA. As from 2000, annual rates of all indicators
showed an increasing trend, and declined in the last few years. New HAMRSA cases per 100 admissions increased from 1.36 to 2.00 (2006) and
declined to 0.79 (2012). Incidence density of cases per 1000 hospital-days
showed the following trends: HA-MRSA, from 0.92 to 1.36 (2007) to 0.55
(2012); ICU-acquired HA-MRSA from 2.3 (2002) to 10.5 (2006) to 2.39 (2012);
MRSA-positive CC rates from 0.68 to 1.44 (2008), to 0.41 (2012); HA-BSI from
0.049 to 0.07 (2009), to 0.016 (2012). The proportion of MRSA among S.
aureus BSI remained over 34% for 10 years, declined to 20% in 2012. The
predominance of MRSA containing SCCmecI decreased from 83% in 2005 to
64% in 2012.
Conclusion: MRSA rates have decreased in the last four years.An ongoing
multifaceted prevention program helped to contain endemic MRSA rates.
The decay of MRSAs predominant clone might also have influenced this
decrease.
Disclosure of interest: None declared.

P54
P054: Prevalence and risk factor analysis for methicillin-resistant
Staphylococcus aureus colonization in an acute care hospital
ML Oh*, SY Tan
Infectious Diseases, Changi General Hospital, Singapore, Singapore
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P54

P55
P055: Roommates colonization rates for multiresistant bacteria in a
tertiary care hospital
MJ Torijano, F Grande, M Cantero, M Grande, V Novkov, P Rodrguez*
Preventive Medicine and Quality Management, General University Hospital
Gregorio Maran, Madrid, Spain
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P55
Introduction: Multiresistant-bacteria infection control measures in hospitals
may include screening of patients at high risk of colonization, patients who
are admitted to high-risk wards, patients submitted to high-risk procedures,
roommates of patients with colonized or infected patients and screening
during outbreaks.
Objectives: To study the rate of multiresistant bacteria colonization in
roommates of patients infected or colonized by multiresistant microorganisms.
Methods: Retrospective observational study of smears collected from
roommates of multiresistant-bacteria positive patients between 2010 and
2012. Percentages and 95% confidence intervals (CI95%) were calculated.
Results: Altogether, 3306 roommates samples were collected, out of
which 172 were positive (rate 5,20% (CI95%: 4,43-5,97)). Rates for MRSA
were 6,50% (CI95%:5,14-7,86), extended-spectrum beta-lactamaseproducing bacteria 4,33%(CI95%:3,3-5,36), and Acinetobacter baumanii
multiresistant 4,48% (CI95%: 1,54-7,42), Carbapenemase-producing
bacteria 1,85% (CI95%: 0,22-6,53). Rates along the study period were:
2010, 4,56% (IC95%: 3,50-5,62), 2011 (CI95%: 5,21-8,52) and 2012 3,82%
(CI95%: 2,58-5,10).
Conclusion: The percentage of positive samples in roommates of
patients colonized or infected by multiresistant bacteria was relatively low
during the studied period. However, further studies are needed to
compare colonization rates between these roommates and other
hospitalised patients to study if colonization can be due to sharing room
in hospitals or not.
Disclosure of interest: None declared.

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P56
P056: The patient experience of the mrsa screening process and the
impact of a MRSA positive result: a qualitative study
H Loveday1, A Tingle1*, K Currie2, C Lafarge1, J Prieto3, O Freeman1,
A Whitfield1
1
University of West London, London, UK; 2Glasgow Caledonian University,
Glasgow, UK; 3University of Southampton, Southampton, UK
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P56
Introduction: Universal screening for methicillin resistant Staphylococcus
aureus (MRSA) of admissions to hospital became mandatory in England in
2010. However, there is little data about the patient experience of MRSA
screening, the impact of receiving a positive result and the confidence
patients have in the care they receive.
Objectives: To explore MRSA screening from the perspective of the
patient, assess its role in maintaining confidence in efforts to prevent
healthcare associated infection, and create patient reported experience
measures (PREMs) to inform the future development of screening policies.
Methods: Semi-structured telephone interviews were conducted with
patients who had a recent experience of MRSA screening in three
National Health Service trusts. Patients found to be MRSA positive were
asked about their experience of decolonisation treatment. Transcripts
from digital audio files of the interviews were entered into NVivo
software and underwent content analysis using a deductive approach.
Results: Interviews were conducted with 23 patients. In general, MRSA
screening was accepted as part of the hospital routine and contributed to
reassuring participants about hospitals commitment and ability to
prevent infection. Participants recommended that more information
about the screening procedure should be provided, particularly the
results of the screen, even if negative. Reactions to being MRSA positive
varied from initial shock, a sense of being embarrassed or stigmatized,
concern over being a danger to others, to frustration with recurrent
colonisation. While decolonisation at home presented few problems,
there was evidence of incorrect use of products.
Conclusion: To secure and sustain patients satisfaction and confidence
in procedures to prevent MRSA infection patients should be provided
with individualised information, both written and verbal. Staff should be
sufficiently knowledgeable and confident to invite questions and
communicate information in a sensitive way. Specific guidelines for
home-based decolonisation are required. The PREMs generated by this
study are an essential tool to enable services to measure and act on
feedback from the patient experience.
Disclosure of interest: None declared.
P57
P057: Epidemiological aspects of MRSA circulation in the industrial
region of Russia
EB Brusina*, LS Glazovskaya, TV Efimova
Department of Epidemiology, Kemerovo State Medical Academy, Kemerovo,
Russian Federation
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P57
Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) represent
one of the major problems related to healthcare-associated infections
(HAIs). Investigation of the regional features of MRSA circulation may lead
to the improvement of the system of MRSA infection control.
Objectives: To study features of MRSA circulation in the industrial region
of Russia.
Methods: MRSA identification and determination of susceptibility to
antibiotics were performed using VITEK 2 identification cards (colorimetric
reading). MRSA DNA was defined using real-time polymerase chain
reaction (PCR) with fluorescent hybridization probes. MecA structural
gene was determined by sequencing, identification of sea, seb, sec, tst,
and pvl genes was performed using PCR. Identification of MRSA clonal
profile was investigated by restriction-modification (RM)-test and by spa
sequence typing.
Results: The share of MRSA among all strains of Staphylococcus aureus in
2012 was 16.63%, that was almost 2-fold lower compared to 2007
(32.09%), and from 2007 till 2012 a steady decrease of this value was
noted. The prevalence of MRSA among healthy population was 13,25 per
1,000. MRSA share among patients with bloodstream infections was the

Page 47 of 143

highest, reaching 21.85% (95%CI=15.55-29.3). The lowest MRSA share was


registered among patients with genital infections (13.17%, 95%CI=11.115.49). In the burn units, the spread of MRSA reached epidemic level
(80%). We found that 49.25% of all strains were sea-positive, 85.07% were
sec-positive, and 13.43% were tst-positive. No seb- or pvl-positive strains
were identified. We also revealed using RM-test that our strains were
mainly classified to CC8/239 clonal complex.
Conclusion: The measures of MRSA infection control should take into
account regional features.
Disclosure of interest: None declared.

P58
P058: How accurate are our estimates of Staphylococcus aureus
antibiotic resistance in Australia?
S Azim1, G Nimmo2, M-L Mclaws3*
1
SPHCM, UNSW Medicine, The University of New South Wales, Sydney,
Australia; 2Pathology Queensland, Queensland Health, Herston, Australia;
3
SPHCM, UNSW Medicine, The University of New South Wales, Sydney,
Australia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P58
Introduction: The Australian Group on Antimicrobial Resistance (AGAR)
provide national reports on Methicillin resistant and methicillin sensitive
Staphylococcus aureus (MRSA) antibiogram patterns for 14 antibiotics
based on a decade of using the First 100 clinical isolates from inpatients
and outpatients tested in participating laboratories. The First 100 isolates
provided by 5 Queensland hospitals to AGAR represent inpatient isolates
for every second year, 2005 to 2009, and outpatients for every second
year, 2000 to 2008. Validity of the resistance patterns idenitfied by the
samples is imperative for national surveillance.
Objectives: AGAR data were tested for ability to demonstrate resistance
patterns similar to the years for full datasets.
Methods: A percentage point (PP) difference between the antibiograms
for the first 100 samples and the corresponding 12-month dataset was
estimated as a measure of validity. Robustness of the consecutive
sampling of the first 100 isolates was tested using 15 random iterations of
100 isolates from the corresponding full 12-month datasets for inpatients
and outpatients. Validity and the effect of phenotypes on the AGAR
resistant patterns was tested against 6 antibiotics for inpatients and 5
antibiotics for outpatients.
Results: AGAR inpatient data for 2007 and 2009 demonstrated
significantly higher resistance levels compared with the full dataset with
exception of Clindamycin and Gentamicin for 2009. In the most recent
outpatient sampling, 2008, AGAR estimated a significantly lower level of
resistance to all 5 antibiotics. Resistance patterns identified from 15
iterations indicated random sampling does not improve the validity of inor outpatient antibiograms. The resistance patterns for inpatient and
outpatient full datasets were driven by AUS-2/3 and EMRSA15 phenotypes
with 95% of resistance removed on removal of these phenotypes.
Conclusion: Given the small numbers of MRSA isolates and the effect of
endemic phenotypes valid antibiograms and annual fluctuations require
the entire annual dataset for validity.
Disclosure of interest: None declared.

P59
P059: MRSA surveillance in a Danish region
RA Leth*, The MRSA Section Group
Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P59
Introduction: Surveillance of MRSA is an important topic in infection
control. In our region we have monitored new MRSA cases since 2010.
Objectives: The aim was to describe surveillance of MRSA in a Danish
region with three clinical microbiology departments. The population in
the region constitutes approximately 1.2 million inhabitants.
Methods: Using data from a laboratory information system (MADS) data on
new MRSA episodes at each of the three clinical microbiology departments
was generated monthly. Data was entered into a common MRSA
surveillance database for further follow-up.
Results: The number of incident MRSA patients has still been increasing
since 2010.

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In 2012 we registered 225 new MRSA patients in our region, an increase


of 24% compared with the number of new MRSA patients in 2011. The
number of new cases of livestock MRSA (clonal complex CC398) has also
been increasing, from 40 cases in 2011 to 65 cases in 2012.
We did not see any hospital clusters either in 2011 nor in 2012. There
were 32 family clusters each including two to five persons.
Totally, more than 62% of the incident patients had an infection with
MRSA. Forty-five per cent were exposed by family-members or pigs; in
16% exposure was unknown; 8% were supposedly exposed on holidays
outside Europe.
The most common spa-types and clonal complex were t034/CC398 (55
cases), t002/CC5 (41 cases), t008/CC8 (12 cases), and t019/CC30 (12 cases).
Conclusion: The number of MRSA patients is still increasing in the
region. In 2012 we did not see any hospital clusters, however, family
clusters accounted for 74 patients. Most MRSA patients were exposed by
family-members or pigs.
Disclosure of interest: None declared.

Introduction: Active surveillance which was introduced in 2008


following the Clostridium difficile outbreak in our hospital enhanced
early detection of vancomycin resistant Enterococcus faeciumoutbreak in
the medical intensive care unit (MICU). Prompt intervention strategies
which were implemented by infection control team facilitated the
successful control.
Background: A maximum of 10 VRE isolates per year has been the norm
between 2008 and 2011 in our 800 bed hospital. These isolates were
from the oncology units. Between the 4 th and 30 th August 2012, 7
patients in MICU had VRE positive cultures from a variety of samples
including blood cultures.
Methods: Sample types and patient clinical data were collected;
movement of infected patients within the hospital was traced to identify
the possible index patient for patients who were not admitted directly
into MICU. Hand washing and contact precautions practises were audited
and reinforced as per VRE policy. Environmental cleaning audits were
done routinely to minimize the bio burden and the unit was closed for
new admission other than VRE positive patients. Infection control
monthly reports were reviewed from May 2012 for possible oversight as
there were no VRE cases in April. Monitoring and recording of new case
is on-going with daily update to the team. One Isolate per patient is
stored for molecular characterization.
Results: 28 patients were identified over 10 months (May 2012 to
February 2013). 42% (12/28) patients from MICU, 25% (7/28) were
dialysed. The environmental cleaning audit revealed a leaking sewage
pipe in the MICU which resulted in a complete closure of the unit and
immediate repairs which was followed by terminal cleaning of the whole
unit.
Conclusion: It is well documented the most transmission of VRE is via
contaminated hands of health care workers or environment or patient
equipments. The findings in this study suggest that environmental
contamination was the source of the VRE.
Disclosure of interest: None declared.

P60
P060: Surveillance and control of community-associated methicillinresistant Staphylococcus aureus in Geneva, Switzerland, 2002 2012
A Huttner1*, E Von Dach1, N Liassine2, M Descombes3, R Auckenthaler4,
G Renzi1, P Franois1, S Harbarth1, P Sudre5,
Cantonal Antibiotic Resistance Group of Geneva1
1
HUG, Geneva, Switzerland; 2Dianalabs, Geneva, Switzerland; 3Unilabs,
Geneva, Switzerland; 4Synlab, Geneva, Switzerland; 5DGS, Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P60
Introduction: Community-associated methicillin-resistant Staphylococcus
aureus (CMRSA) was first reported in Geneva in 2002; a prospective
surveillance system based on voluntary reporting was then established.
Objectives: We report trends in CMRSA infections in Geneva Canton from
2002 through 2012.
Methods: The Cantonal Antibiotic Resistance Group, representing
Genevas Department of Health, University Hospitals and public and
private laboratories, defines a CMRSA case as (1) a clinical infection from
which MRSA is isolated in any adult or child with (2) no hospitalizations
in the previous 12 months (excluding hospital stays for infants at birth),
and (3) residence in Geneva Canton. Four laboratories as well as
physicians from public hospitals and private practice participate. For each
laboratory-reported case, a questionnaire is sent to the clinician for
demographic and clinical information. Contact tracing is performed to
detect clustering. Descriptive analyses were performed using Stata 12.
Results: There were 245 CMRSA cases in the 11-year surveillance period; the
mean attack rate was 4.9 cases/100K inhabitants. Median age at diagnosis
was 31 years (interquartile range, 1348); 20% were under ten. Skin
infections dominated (82%). There were no cases of necrotizing pneumonia,
fasciitis or infection-related death. Incident cases predominated (75%);
recurrences did not increase over time. Most infections (75%) occurred in
persons without comorbidity; chronic dermatologic condition was the
most common comorbidity (15/48, 31%) followed by diabetes mellitus (8/48,
17%). Fifty clusters were identified, most being family-related. After peaking
at 8.4 cases/100K inhabitants in 2005, CMRSA incidence has since plateaued
at a mean of 5.5 cases/100K inhabitants.
Conclusion: After peaking in 2005, CMRSA infections appear to have
stabilized despite continuous introduction of new strains. The surveillance
system and related measures appear to be successful in containing
transmission in Geneva Canton.
Disclosure of interest: None declared.

P61
P061: Early detection and successful control of vancomycin resistant
Enterococcus faecium (VRE) outbreak in an academic hospital in
Pretoria, South Africa
RM Lekalakala1*, E Iewis2, E Silberbauer3
1
Medical Microbiology, NHLS & University of Pretoria, Midrand, South Africa;
2
IPC Division Steve Biko Academic Hospital, South Africa; 3NHLS & University
of Pretoria, Pretoria, South Africa
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P61

P62
P062: Commode chairs not a high-touch surface but a high-risk
surface with regard to VRE transmission
LB van der Velden1,2*, A Voss1,2, SM Wennekes1, MJ van Mourik1,
MH Nabuurs-Franssen1
1
Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital
Nijmegen, The Netherlands; 2Medical Microbiology, University Hospital
Nijmegen Medical Center, Nijmegen, The Netherlands
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P62
Introduction: Contaminated environmental surfaces (especially hightouch surfaces), equipment, and hands of healthcare workers have been
linked to the transmission of nosocomial pathogens, causing outbreaks in
healthcare-settings. With regard to vancomycin-resistant enterococci
(VRE), a contaminated environment seems to be of special importance.
Consequently, many direct their attention to high-touch-surfaces, such as
bed rails, over-bed tables, and i.v. pumps (Huslage et al). In the present
study we would like to redirect the attention to a surface that is less
frequently touched but was shown to be of high-risk during a VRE
outbreak.
Objectives: During a VRE outbreak, we determined on which environmental
sources VRE can be found after terminal room cleaning after discharge of
known VRE positive patients. Commode chairs and shower chairs were
cultured after disinfection by instructed personnel.
Methods: VanB, enterococcus faecium and cc17 PCRs were performed on
environmental surfaces after disinfection. By this combined PCR, both
vancomycin-susceptible (VSE) as well as the cc17+ VRE outbreak-strain
were identified. Beds, bed bells, bedside tables and door knobs were
considered high-touch surfaces, commode chairs and shower chairs were
considered high-risk surfaces.
Results: During the first evaluation of possible environmental VRE
sources, both high-touch and high-risk surfaces were positive for VRE/VSE.
After optimalisation of hand hygiene, increasing the compliance to
contact precautions and intensifying the cleaning, high-touch surfaces
were only rarely found positive for VRE/VSE. Despite these measures, VRE/
VSE were still frequently found on high-risk surfaces.

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Conclusion: Our data show that the cleaning and disinfection of high-risk
surfaces is more difficult than of high-touch surfaces. In controlling a VRE
outbreak in which a contaminated environment is of special importance,
additional measurements are needed to eliminate high-risk surfaces as an
environmental VRE source.
Disclosure of interest: None declared.
Reference
1. Huslage K, Rutala WA, Sickbert-Bennett E, Weber DJ: A quantitative
approach to defining high-touch surfaces in hospitals. Infect Control
Hosp Epidemiol 2010, 31(8):850-853.

essential to prevent the dissemination of VRE. We determined the


possibilities of direct identification of VRE from selective enrichment
broth by mass spectrometry for the shortening of turn-around-time.
Methods: During the one-month period of VRE outbreak investigation, 50
rectal swabs were incubated into enterococcal broth containing 6 g/mL
of vancomycin at 37C for 24 hours. For the rapid identification of VRE,
total 50 pellets obtained after the centrifugation of one mL were applied
on mass spectrometry. The results of the mass spectrometry were
compared to those of standard culture using chromogenic agar for the
detection of VRE.
Results: Among total 39 VRE isolated by standard culture, 32 were
E. faecium only, and seven were mixed with both E. faecium and
E. faecalis. By mass spectrometry total 33 VRE were identified of which 26
were E. faecium only and six were mixed with both E. faecium and
E. faecalis, and one was E. faecalis only. Total 17 VRE-negative cases by
mass spectrometry were four no-peak-found, four no-reliable, two
Lactobacillus, four E. gallinarum, two E. avium, and one Pediococcus.
Compared to chromogenic agar method, the sensitivity and specificity of
mass spectrometry method were 84.6% and 100.0%, respectively.
Conclusion: Direct identification of VRE from selective enrichment broth
by mass spectrometry may be helpful to shorten the turn-around-time.
The mass spectrometry method can detect VRE one day earlier than the
conventional method.
Disclosure of interest: None declared.

P63
P063: Tackling VRE in a community hospital with teamwork and
tenacity: lessons learned
P Raggiunti, S Vinod*, S Vinod
Infection Control, Rouge Valley Health System, Toronto, Canada
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P63
Introduction: A VRE Outbreak was declared November 2010 in a large
community hospital impacting two acute care and two complex
continuing care units. A number of infection control measures were
immediately put into action with an ongoing focus on environmental
controls, adherence to hand hygiene and isolation protocols. Despite
concerted efforts to resolve the VRE outbreak in a timely fashion, ongoing
transmission of VRE continued with three distinct peaks identified
throughout the 17 month period. A total of 110 patients became colonized
with VRE.
Objectives: Outbreak management
Methods: An outbreak management team was established. Control
measures focused on: hand hygiene, contact precautions, personal
protective equipment, dedicated equipment, active surveillance, patient,
staff and visitor control measures, assessment of furniture and
equipment, education, audits, enhanced laboratory testing, cleaning and
disinfection etc.
Results: Three peaks were noted during the 17 month period. The VRE
isolates were tested by PFGE to determine relatedness. The first peak was
noted in Jan 2011, the cluster of isolates revealing to be type A, the
second peak in April 2011 had a cluster of type A1 and the third peak
followed in September 2011 with a cluster of type A14. This indicates
clonal spread of organisms. Resurgence of the outbreak in April 2011
from what appeared to have been controlled, strongly supports the longterm survival of VRE in the environment from our experience.
Environmental reservoirs such as furniture with porous surfaces including
wooden or upholstered furniture, furniture with impaired integrity were
reservoirs for VRE bacteria as evidenced by VRE positive environmental
cultures.
Conclusion: Shared equipment and shared assignments for staff appears
to have spread the organism to different units reflecting indirect spread
of VRE. Patient transfers from acute to continuing care contributed to the
spread. Deeper scrutiny of the outbreak revealed the need to enhance
processes to achieve good infection prevention control practices with a
focus on relentless teamwork and ongoing communication which helped
in mitigating the outbreak. It is very important to maintain the morale of
staff, maintain transparency of the situation and have an ethical approach
towards the management of patients on contact precautions to ensure
the qualtiy of their care.
Disclosure of interest: None declared.

P64
P064: Direct identification of vancomycin-resistant enterococci from
selective enrichment broth by mass spectrometry
B-M Woo*, H Lee, S-I Joo, E-C Kim
Department of Laboratory Medicine, Seoul National University Hospital,
Seoul, Korea, Republic Of
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P64
Introduction: It is mandatory in South Korea that patients and carriers,
from whom vancomycin-resistant enterococci (VRE) are detected, should
be isolated from the other patients. The rapid detection of VRE is

P65
P065: Vancomycin resistant enterococci among patient in Kuala Lumpur
Hospital, Malaysia: the occurence and its associated risk factors
R Ibrahim1*, N Ahmad2, MN Aziz3
1
Microbiology, Cyberjaya University College of Medical Sciences, Cyberjaya,
Malaysia, Selangor; 2Microbiology, Institute of Medical Research, Kuala
Lumpur; 3Microbiology, Kuala Lumpur Hospital, KL, Malaysia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P65
Introduction: Vancomycin-resistant enterococci (VRE) are increasing in
prevalence at many institutions, especially among patients with comorbidity conditions that associated with frequent hospitalisation. It is
important to determine the risk factors for this resistance microorganism
as it will guide the clinician for appropriate antimicrobial therapy and
infection control measures.
Objectives: The descriptive, cross sectional study was carried out to
determine the prevalence and risk factors for vancomycin resistant
enterococci in Kuala Lumpur Hospital (HKL), Malaysia.
Methods: For 12 months period, antimicrobial susceptibility testing for
enterococci species were performed using disk diffusion method. E-test
for vancomycin was proceed for the isolates that exhibit resistance to
vancomycin by disk diffusion method. To identify the risk factors, a
questionnaire was completed for all studied patients and the data were
analysed using chi square and multivariate logistic regression.
Results: The prevalence of VRE among patients in Kuala Lumpur Hospital
was 1%. In chi square analysis, vancomycin usage (p=0.000, RR, 34.615;
95% CI, 5.796-206.723) showed significance risk factor. In multivariate
logistic regression analysis, prolonged hospitalization (p=0.040, RR, 80.194;
95% CI, 1.212-5304.5) and vancomycin use (p=0.009, RR, 18.376; 95% CI,
2.143-165.3) were associated with potential VRE.
Conclusion: The findings of this study will serve as an alert to the
clinicians of the emergence of infections by VRE and it will encourage the
implemention of appropriate infection control measures and judicious
use of vancomycin in order to prevent further rise in VRE prevalence.
Disclosure of interest: None declared.
References
1. European Antimicrobial Resistance Surveillance System: Susceptibility
results for E. faecium isolates in 2006., http://www.rivm.nl/earss/database/
[accessed 29 May 2007].
2. Mehrad Asharian, Rahim Afkhamzadeh, Ahmad Monabbati,
Florian Daxboeck, Ojan Assadian: Risk factor for rectal colonization with
vancomycin-resistant enterococci in Shiraz, Iran. Int. Society for Infectious
Diseases 2008, 12:171-175.
3. Zhannel GG, Laing NM, Nichol KA, et al: Antibiotic activity against urinary
tract infection (UTI) isolates of vancomycin-resistant enterococci. Journal
of Antimicrobial Chemotherapy 2003, 52:382-388.

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P66
P066: Risk factors of vancomycin-resistant enterococcus
colonization in hemologic patients
V Mioljevic1*, L Markovic-Denic2, A Vidovic3,4, D Tomin4,5
1
Department of Hospital Epidemiology and Hygiene, Clinical Center of
Serbia, Serbia; 2Institute of Epidemiology, Faculty of Medicine, University of
Belgrade, Serbia; 3Clinic of Hematology, Clinical Center of Serbia, Serbia;
4
Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 5Clinic of
Hematology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P66
Introduction: Vancomycin-resistant Enterococci (VRE) is one of the most
important hospital pathogens.
Objectives: The aim of the study was to evaluate the VRE colonization in
patients hospitalized at the Hematology Intensive Care Unit and
associated risk factors.
Methods: Prospective cohort study involved 70 patients hospitalized at the
Intensive Care Unit (ICU), Clinic for Hematology, during three months.
Demographic data and data risk factors for VRE colonization during present
and previous hospitalization (within 6 months) were recorded for each
patient using the questionnaire. Feces or rectal swab was collected for
culture from patients on admission and at discharge in case when VRE was
not isolated on admission. The Enterococci were isolated by standard
microbiological methods. Isolate sensitivity was tested by disk-diffusion test
using the 30g/ml (BBL) Vancomycin plates according to CLSI standard.
Results: Upon admission, 7% of patients were already colonized with
VRE. The rate of VRE colonization during present hospitalization was
41.5%. Univariate logistic regression demonstrated statistical significant
differences of acute myeloid leukemia (AML) diagnosis (RR=3.1; 95%CI
1.1-8.6; p=0.03), length of present stay (RR=1.1; 95%CI 1.1-1.2; p=0.002),
use of aminoglycosides (RR=3.9; 95%CI 1.1-13.1; p=0.03), and pip/
tazobactam (RR=4.7; 95%CI 1.6-13.9; p=0.005) in present hospitalization,
duration of use of carbapenem (RR=1.2; 95%CI 1.1-1.3; p=0.05) and pip/
tazobactam (RR=1.4; 95%CI 1.3-1.7; p=0.006) in present hospitalization
between the VRE-colonized and non-colonized patients. AML, use of
carbapenem in previous hospitalization and duration of use of piperacillin/
tazobactam in present hospitalization were independent risk factors of VREcolonized patients according to multivariate logistic regression.
Conclusion: VRE colonization rate was high among patients admitted to
hematology ICU. Rational use of antibiotics and an active surveillance may
be helpful preventive measures for development of bacterial resistance to
antimicrobial agents.
Disclosure of interest: None declared.

P67
P067: Economic burden of methicillin-resistant Staphylococcus aureus,
Clostridium difficile, and vancomycin-resistant enterococci in hospitals
A Mitchell1*, R Rohde2, P Mallow3, D Buskirk1
1
Johnson & Johnson, Irvine, USA; 2Texas State University, San Marcos, USA;
3
S2, Irvine, USA
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P67
Introduction: Methicillin-Resistant Staphylococcus aureus (MRSA),
Clostridium difficile (C. Diff) and Vancomycin-Resistant Enterococci (VRE) are a
significant source of HAIs. Recently, significant attention has been given to
community acquired strains of these infections. However, HAIs with these
pathogens remain a significant cause of infections and associated costs to
the health system.
Objectives: The purpose of this study is to estimate economic burden of
MRSA, CDI, and VRE HAIs among inpatients in US acute care hospitals.
Methods: The economic burden of MRSA, C. Diff, and VRE were calculated
based on incidence rates and costs attributable to the pathogen rates from
the published literature. Studies included were those that estimated national
incident rates of one or more of the HAIs. Cost estimates were used from
studies that specifically stated direct costs associated with the HAIs. The
median incidence rate and cost were derived for the base estimate.
Results: The 2010 estimated total number of HAIs attributed to the three
pathogens was 1.325 million and an economic burden attributable to the
pathogens of $13.1 billion. There were 1.046 million MRSA HAIs, 219,000
C.Diff HAIs, and 59,000 VRE HAIs. Sensitivity analysis of the incidence rate

Page 50 of 143

revealed that the total number of HAIs ranged from 844,000 to 1.81
million and the associated economic burden ranged from $8.46 billion to
$17.73 billion. Sensitivity analysis of the costs ranged from $9.8 billion to
$16.4 billion.
Conclusion: MRSA, C. Diff, and VRE result in significant HAIs and economic
burden in patients hospitalized in US acute care hospitals. For hospitals to
remain profitable, one important step should be a rigorous analysis of HAIs
and comprehensive preventative programs to reduce their occurrence.
Quality improvement programs to reduce preventable HAIs such as MRSA,
C. Diff, and VRE will not only improve patient quality, but will increase
hospital profitability by reducing HAIs that are subject to financial
disincentives.
Disclosure of interest: A. Mitchell Employee of Johnson & Johnson,
R. Rohde: None declared, P. Mallow Consultant for Johnson & Johnson,
D. Buskirk Employee of Johnson & Johnson
References
1. Kohn LT, Corrigan J, Donaldson MS: To err is human: building a safer health
system Washington, D.C.: National Academy Press 2000.
2. Premier Research Services Premier I:, http://www.preimier-inc.com/prs
[Accessed March 2, 2012].

P68
P068: Rapid detection of imipenem-resistant Acinetobacter baumannii
for the surveillance culture using mass spectrometry
D-K Kang1*, H Lee2, S-I Joo2, E-C Kim2
1
Infection Control Office, Seoul National University Hospital, Seoul, Korea,
Republic Of; 2Department of Laboratory Medicine, Seoul National University
Hospital, Seoul, Korea, Republic Of
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P68
Introduction: Korean Antimicrobial Resistance Monitoring System
reported in 2010 that the resistance rate of Acinetobacter baumannii
against imipenem was 71.7%. Increasing requirement of surveillance for
Imipenem-resistant Acinetobacter baumannii (IRAB), specifically designed
to hospital-acquired infection control activities. It needs to detect IRAB
more rapidly to prevent further spread on healthcare facilities.
Methods: Total 69 active surveillance samples were tested, which consist
of 51 endotracheal aspirates, 15 sputum and three nasopharyngeal
swabs. The respiratory samples for the surveillance of IRAB were
inoculated into 2 mL of MacConkey broth containing 10 g/mL of
imipenem and incubated overnight at 37C. For the rapid identification of
IRAB, total 69 pellets obtained after the centrifugation of 1.5 mL were
applied on mass spectrometry. The results of the mass spectrometry were
compared to those of standard culture using MacConkey agar and VITEK2.
Results: 29 IRAB and 32 IRAB were identified by mass spectrometry and
conventional sub-culturing MacConkey agar, respectively. Compared to
the conventional subculture on MacConkey agar, the sensitivity and
specificity of mass spectrometry method were 90.6% and 100%,
respectively. Total 40 IRAB-negative samples by mass spectrometry were
one A. nosocomialis, two A. junii, one Staphylococcus aureus, three
Enterococcus faecium, one Stenotrophomonas maltophilia, one Enterobacter
aerogenes and 31 no-reliables.
Conclusion: The IRAB were detected two days earlier by mass spectrometry, compared to conventional sub-culturing MacConkey agar. Rapid
detection of IRAB for surveillance culture using mass spectrometry must
be a useful method for screening and improving infection control
strategies aimed at limiting the spread of IRAB and shortening the period
of isolation.
Disclosure of interest: None declared.

P69
P069: Drug-resistant acinetobacter ventilator-associated pneumonia: a
time for desperate measures!
HH Balkhy1*, A El-Saed1, R Maghraby2, HH Al-Dorzi3, R Khan3, AH Rishu3,
YM Arabi3
1
Department of Infection Prevention and Control, King Abdulaziz Medical
City, Riyadh, Saudi Arabia; 2Department of Pediatrics, King Abdulaziz Medical
City, Riyadh, Saudi Arabia; 3Intensive Care Department, King Abdulaziz
Medical City, Riyadh, Saudi Arabia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P69

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Introduction: There is a wide geographic and temporal variability of


bacterial resistance among microbial causes of ventilator-associated
pneumonia (VAP). The contribution of multi-drug resistant (MDR)
pathogens to the VAP etiology in Saudi Arabia was never studied.
Objectives: We sought to examine the extent of multiple-drug resistance
among common microbial causes of VAP.
Methods: We conducted a retrospective susceptibility study in the adult
ICU of King Abdulaziz Medical City, Riyadh, Saudi Arabia. Susceptibility
results of isolates from patients diagnosed with VAP between October
2004 and June 2009 were examined. The US National Healthcare Safety
Network (NHSN) definition of MDR was adopted.
Results: A total of 248 isolates including 9 different pathogens were
included. Acinetobacter spp. was highly (70-90%) resistant to all tested
antimicrobials including carbapenems (three- and four-class MDR
prevalence were 86% and 78%, respectively). Pseudomonas aeruginosa was
moderately (20-40%) resistant to all tested antimicrobials including
antipseudomonal penicillins(three- and four-class MDR prevalence were
18% and 10%, respectively). With exception of ampicillin (fully resistant),
Klebsiella spp. had low (0-14%) resistance to other tested antimicrobials
with no detected MDR. Staphylococcus aureus was fully susceptible to
vancomycin with 42% resistance to oxacillin. There were significant
increasing trends of MDR Acinetobacterspp. but not Pseudomonas
aeruginosa during the study.
Conclusion: Acinetobacter in the current study was an increasingly resistant
VAP-associated pathogen more than seen in many parts of the world. The
current finding may impact local choice of initial empiric antibiotic and
emphasize the need to improve currently implemented antimicrobial
stewardship and environmental cleaning. Measures to reduce the burden of
this organism from such sites may assist in reducing the burden of
Acinetobacter as a human pathogen in healthcare settings.
Disclosure of interest: None declared.
P70
P070: Extended spectrum beta lactamase producing Acinetobacter
baumannii in Kuwait
L Vali*, AA Dashti
Medical Laboratory Sciences, Kuwait University, Kuwait, Kuwait
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P70
Introduction: Acinetobacter baumannii is one of the most important
opportunistic pathogens causing serious complications. In Kuwait in recent
years the prevalence of resistance to antibiotics has raised serious concern
especially in the intensive care units. Resistance to carbapenems is mainly
caused by the OXA type enzymes; however resistance to cephalosporins are
caused by chromosomal AmpC or by extended spectrum beta-lactamases,
such as PER.
Objectives: In this study we investigated the epidemiology of the
extended spectrum beta-lactamase PER-like enzymes among the clinical
A. baumannii recovered in a secondary hospital in Kuwait.
Methods: One hundred and ten non-duplicate A. baumannii isolates were
collected from July 2011 to August 2012. Antibiotic susceptibility testing
was performed by Vitek2 and examined according to the CLSI guidelines.
gyrB multiplex PCR was performed to identify A. baumannii species. PCR
was used to amplify bla (OXA-types) carbapenemases, insertion elements,
bla(NDM), bla(PER), bla(GES), bla(VIM) and bla(IMP). PCR products were
sequenced and analyzed. Pulsed-field gel electrophoresis (PFGE) was used
to genotype the isolates.
Results: bla(OXA-23) was identified in 28 A.baumannii isolates, bla(OXA24) in 6, GES-type in 1 and PER-like in 6 isolates. PFGE analysis revealed
the strains containing the PER-7 like enzyme which contained OXA-23
belonged to two different PFGE types. Two point mutations on the loop of the PER-7 protein were detected which can be significant in
increasing resistance to cephalosporins.
Conclusion: We have identified the presence of PER-7 like enzyme in
different genotypes of A. baumannii. The PER-like genes are located on
multi-resistance plasmids and are considered as extended spectrum betalactamases causing increased resistance to cephalosporin antibiotics. In
Kuwait cephalosporins are generally used to treat A. baumannii infections;
therefore it is important to monitor and to control the spread of horizontal
transfer by administering the correct antibiotic and preventing their spread
among hospitalized patients.

Page 51 of 143

Disclosure of interest: None declared.

P71
P071: When rehabilitation and reeducation rhyme with infection and
prevention
J Sztajzel*, D Pittet, B Huttner
Infection Control Programme, HCUGE, Genve 4, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P71
Introduction: The infection control measures implemented for patients
carrying multidrug resistant organisms (MDRO) often interfere drastically
with the arsenal of rehabilitation therapies. In rehabilitation wards these
therapies constitute the main reason for hospitalization, thus creating an
apparent conflict between infection prevention and rehabilitation.
Objectives: The objective of this study was to evaluate the implementation of an itemized document template that allows the adaptation
of specific infection control measures to the particular situation of each
MDRO carrier.
Methods: We implemented a document for the infection control
management of carriers of vancomycin-resistant enterococci, multidrugresistant Acinetobacter baumannii and carbapenem resistant Entero
bacteriaceae in an academic rehabilitation hospital with 193 beds in
Geneva, Switzerland. The document specifies individualized restrictions
regarding the movements of patients within the hospital with the aim to
make it possible for the patient to participate in re-education and
rehabilitation activities that take place outside the patient room as much
as possible (e.g. a patient may be allowed to go to physiotherapy room,
while he may not use the hospital swimming pool). The document is
adapted each week based on the clinical evolution of the patient and
after discussion with the nursing team. In order to assess the perceived
utility of the document we conducted a structured survey with head
nurses (HN) and infection control nurses (ICN).
Results: During the period from October 2011 to February 2013 the
document was used in 9 patients. In March 2013 the survey was sent
to 8 HN and 9 ICN. The overall response rate was 82% (14/17). All
respondents judged the document to be often useful and to be a
frequent reference source, 3/14 (HN only) thought that it sometimes
could be better adapted to the individual patient, yet its level of detail
was judged as good by all participants. Furthermore, 7/14 (HN and ICN)
respondents suggested slight modifications to the document.
Conclusion: Our experience and the results of the survey indicate that an
individualized document allows patients carrying MDRO to better
participate in rehabilitation activities despite the implementation of
adequate infection control measures.
Disclosure of interest: None declared.

P72
P072: Genetic environment and phenotypic analysis of a novel blaKPC
variant produced by Klebsiella pneumonia
J-J Mu
Research and Diagnostic Center, Centers for Disease Control, Taiwan, Taipei,
Taiwan, Province of China
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P72
Introduction: A novel variant of klebsiella pneumonia carbapeneamse
(KPC) was found in multidrug-resistant Klebsiella pneumonia clinical
isolates from Taiwan. The novel KPC variant differs from existing KPC due
to substitution at position 206 (pheLeu). Genetic environment and
phenotypes were analyzed for further understanding the novel KPC
variant.
Objectives: The aim of this study is to characterize the detailedgenetic
environment of the novel blaKPC produced by klebsiella pneumoniaand
analyze the enzymatic activity of the novel KPC variant.
Methods: The antibiotic susceptibility of the clinical isolates and
corresponding transconjugantes was determined and interpreted
according to the CLSI guidelines. The plasmid carrying novel KPC variant
(pKP78) was subjected into whole genome sequencing for resolving the
complete sequence. The GST fusion recombinant KPC proteins were
expressed for detecting the enzymatic activity.

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Results: The antibiotic susceptibilityshowed the KP producing novel KPC


variant was resistant to most of the antibiotics, such as carbapenem
(imipenem, ertapenem and meropenem), aztreonam, cephalosporin
(cefazolin, cefotaxime and ceftazidime), but susceptible to amikacin and
colistin. The whole genome sequencing has been done and resulted in 11
contigs needed to be assembled. The genetic environment surrounding
novel blaKPC flanked by ISKpn8 and ISKpn6-like sequences is similar with
pKP048. The sequences upstream of ISKpn8 in pKP78 were, with gene
order TniA transposase, IS26 transposase and partial Tn3-resolvase
different from Tn3-transposase and Tn3-resolvase in pKP048. The GSTrecombinant proteins were expressed and the detection of enzymatic
activity is undertaken.
Conclusion: The novel KPC variant differs from existing KPC due to
substitution at position 206 (pheLeu). The chimera of several transposonassociated elements indicated a novel genetic environment surrounding the
novel blaKPC gene. This residue seems not to be close to the active site.
Whether it will change the activity remains unknown. The surveillance is
engaging to monitor possible spreading in Taiwan.
Disclosure of interest: None declared.

Introduction: Recently, multidrug resistant Klebsiella pneumoniae


especially Carbapenemase-producing has been identified in Tunisia and
becoming an epidemic emergent widely spread phenomenon.
Objectives: To describe the epidemiologic profile of nosocomial
infections caused by K. pneumoniae.
Methods: A prospective surveillance study was performaed at a
university hospital of Sahloul (Sousse-Tunisia) from july 2011 to march
2012. K. pneumoniae isolates were identified in the clinical laboratory by
biochemical tests and the Analytical Profile index procedure (API 20-NE Biomrieux, France). Antimicrobial susceptibility testing was performed by
standardized methods recommended by the National Committee of
Clinical Laboratory Standards. Occurrence of beta-lactamases was
detected by PCR amplification and sequencing of ESBL genes (blaTEM,
blaSHV, blaCTX-M) and carbapenemase genes (blaOXA-48). ERICPCRgenotyping were used to assess genetic heterogeneity between the
isolates. MIC determinations for carbapenems were performed by Etest
(bioMrieux).
Results: Forty three strains were collected from 43 patients admitted in
the ICU and the urology service. The repeat isolates were excluded from
the study. All the patients in our study have had indwelling intravascular
devices or were exposed to invasive procedures. During the study period
two epidemic periods was declared: the first one occurred between
august and September 2011 and the second between December and
February 2012. Antimicrobial susceptibility pattern of all clinical isolates
revealed four different profiles based on sensivity patterns against
fosfomycin, colistin, co-trimxazole, tygecyclin and aminosides. PCR and
sequencing analysis revealed that the isolates harbored the blaCTX gene,
the blaSHV and the blaOXA-48 gene.
Conclusion: There is a serious need to accentuate on the rational use of
antimicrobials and strictly adhere to the concept of the reserve drug to
minimize the misuse of available antimicrobials. In addition regular
antimicrobial susceptibility surveillance, knowledge and its application is
essential to reduced current drug resistance rate in hospital as well as in
community, in addition to the implementation of basic hygiene precautions.
Disclosure of interest: None declared.

P73
P073: Outbreak of carbapenemase-producing Pseudomonas
aeruginosa in a tertiary care hospital
P Navarro, M Cantero Caballero, I Wijers, I Cern, E Martinez de Albeniz,
P Rodriguez*
Department of Preventive Medicine and Quality Management, General
University Hospital Gregorio Maran, Madrid, Spain
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P73
Introduction: Carbapenemase-mediated resistance to carbapenems in
Pseudomonas Aeruginosa has increased in Spain since 2003.
Objectives: To describe an outbreak of multi-resistant carbapenemaseproducing Pseudomonas Aeruginosa, in a bone marrow transplant unit
(BMTU) of a tertiary care hospital.
Methods: Descriptive study of the outbreak and the control measures
implemented. Surveillance cultures from patients staying in the BMTU
were taken in order to detect colonization, as well as environmental
samples.
Results: In March 2012 a carbapenemase-producing P. Aeruginosa isolate
resistant to carbapenems and beta-lactam antibiotics was isolated from a
wound culture of a patient admitted to our BMTU. The patient had
previously presented a sepsis secondary to ecthyma gangrenosum caused
by carbapenem-resistant but non-carbapenemase-producing P. Aeruginosa
and had prolonged broad-spectrum antibiotic therapy. Carbapenemaseproducing P. Aeruginosa was isolated from all of the following cultures.
During the month of April 2012 two new cases were identified on the
BMTU, both suffering from symptomatic urinary tract infections, with
detection of P. Aeruginosa in urine cultures. PCR was used to confirm that
it was the same VIM-type strain in all of the three cases. Control measures
included: contact isolation in individual rooms, specialized personnel
attending the isolated patients, enhanced standard precautions, additional
cleaning of patient rooms and enhanced cleaning and disinfection of
medical materials. In June 2012, two of the three patients were discharged
and one of them died from an unrelated cause. No new cases have been
detected on the BMTU.
Conclusion: The capacity of microorganisms, and especially P. Aeruginosa,
to acquire new mechanisms of resistance under antibiotic selection
pressure, poses important therapeutic problems and difficulties for the
control of healthcare-associated infections.
Disclosure of interest: None declared.

P74
P074: Incidence of carbapenemase-producing Klebsialla pneumoniae at
the University Hospital of Salloul (Sousse-Tunisia)
O Bouallgue1*, N Jaidane2, L Dhidah3, Aziza Masoudi1, Nourredine Boujaafar1
1
Microbiology Laboratory, Hospital of Sahloul, Sousse, Tunisia; 2Surgical ICU,
Sousse, Tunisia; 3Hospital Hygiene Department, Hospital of Sahloul, Sousse,
Tunisia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P74

P75
P075: Emergence of carbapenem-resistant enterobacteriaceae in surgical
and intensive care units of a hospital with low usage of carbapenem
in Kano, North West Nigeria
I Yusuf1*, AH Arzai2, MI Getso3, A Sherif4, M Haruna5
1
Microbiology, Bayero University Kano, Nigeria; 2Microbiology, Bayero
University, Kano, Nigeria; 3Department of Medical Microbiology, Faculty of
Medicine, Nigeria; 4Department of Medical Microbiology, Bayero University
Kano, Kano, Nigeria; 5Department of Biology, Kano state University of Science
and Technology, Wudil, Nigeria
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P75
Introduction: Carbapenem Resistant Enterobacteriaceae (CRE) have
emerged in surgical (SW) and intensive care units (ICUs) of tertiary health
care centers in North West Nigeria despite their low or no usage in the
hospitals.
Objectives: 1. To determine the antibacterial susceptibility of pathogens
from patients with severe bacterial infections that require rapid and
aggressive antimicrobial treatments to imipenem (IMP) and meropenem
(MEM) 2. Screen the pathogens for carbapenemase and metallo bta
lactamase production 3. Tests their susceptibility to colistin and tigecycline.
4. To evaluate the views of by different health care practitioners on causes,
effects and control of CRE.
Methods: Isolates from patients admitted for atleast 7 days were screened
for susceptibility to IMP and MEM using the CLSI 2012 break points.
Carbapenemase and Metallo-b-lactamase (MBL) production were detected
phenotypically by Modified Hodge Test (MHT) and Combine Disc Test
(CDT) respectively.
Results: Resistance to IMP and MEM was 10.5% and 12.5% respectively.
Carbapenemase production was 34.5% (highest so far in Kano). About
14.4% of the carbapenemase producers produce MBL. All the isolates
were susceptible to colistin and tigecycline, except 2 E. coli and 1
K. pneumoniae which are resistant and also none carbapenemase
producers. Of 486 medical practitioners studied in the region, only 1.2%
have previous knowledge that MBL causes resistance. About 24.5%, 5.9%

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and 3.9% have knowledge of ESBL, AmpC and carbapenemase as a cause


of rising resistance in the state. In addition, only 38.2% doctors have ever
prescribe carbapenems in their professional practices and 12.8% of the
doctors only prescribe in a ratio of 1:20 due to its high cost.
Conclusion: Carbapenem resistance is in increase in hospitals with a low or
no usage of carbapenem and the resistances are mediated by carbapenemase
especially MBL. Awareness of this problem is low among the medical
practitioners that have direct contact with the patients and can contribute to
its wide spread in the community.
Disclosure of interest: None declared.
Reference
1. CLSI: Performance Standards for Antimicrobial Susceptibility Testing.
CLSI, Wayne, PA 2012, M100-S22.

P76
P076: Analysis of resistance, virulence, and phylogenetic groups of
Escherichia coli strains isolated from very-low birth weight
infants in Poland
A Chmielarczyk, M Pobiega, D Romaniszyn, J Wojkowska-Mach*, P Heczko
Microbiology, Jagiellonian University Medical School, Krakw, Poland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P76
Objectives: Infections of the newborns remain one of the most significant
problems of the medicine. This project aims to determine relationship
between illness, resistance, virulence factors (VFs), phylogenetic groups
and genotypes among E.coli isolates coming from 6 Polish Neonatal
Intensive Care Units, NICUs.
Methods: A total of 90 E.coli (EC) were collected in 2009-2011. Isolates
coming from bloodstream infections (BSI) 24, respiratory tract (RT) 50,
urinary tract infections -8 and others 8 were tested.
Species was determined with the Vitek system, drug resistance was
determined by disc diffusion method (according to EUCAST). The nucleotide
sequences of beta-lactamases were obtained. Isolates were checked for the
presence of 16 selected VF genes associated with extraintestinal infections
and classified into 4 ECOR groups using PCR. Clone ST131 was detected.
Genotyping was carried out using PFGE.
Results: The EC infection incidence was 9.3%. ESBL activity was detected
in 25 isolates. Among them 16 were resistant to at least two other groups
of antibiotics. All ESBL isolates carried the bla-CTX-M gene (60% had CTXM-15 and 40% had CTX-M-3) and 12 isolates had also TEM-1 gene. The
clone ST131 was detected in 33 strains and 12 of them carried the CTX-M15 gene.
Most frequently detected adhesion genes were fimH 75% papC 51% and
sfa 44%. From iron-related genes often occurred: fhuA 87%, fecA 75%,
fyuA 56%, iroN 55%, iutA 54%.
The blood isolates were more likely to possess the ibeA than were
isolates from urine and RT (37,5%, 0%, 16% respectively), and urine
isolates - iha (75% vs. 24% - RT vs. 8.3% - blood).
7 isolates clustered in ECOR group A, 5 in B1, 62 - in B2 and 16 in D
group. In B2 group the number of VFs was higher than in A and D (29%
isolates from B2 group had >11 VFs and 56% isolates from A and D
group had <3 VFs).
The majority of the isolates belonging to the ST131 clone were from the
B2 group,
EC isolates showed very different pulsotypes, epidemic clones were not
detected.
Conclusion: EC strains contribute significantly to late RT infections and
BSI in NICUs. More than 1/4 of EC strains showed ESBL phenotype. Most
of the strains belonged to the group B2 (68.8%) and had numerous VFs.
EC isolates showed high genetic diversity.
2011/01/D/NZ7/00104
Disclosure of interest: None declared.

P77
P077: Observations on incidence of quinolone resistance genes and
their association with SHV genotypes and bacterial sequence type
in a Klebsiella pneumoniae outbreak
HH Balkhy1*, S Aljohani2, A Almasood3, T Uzzaman3
1
Infection Prevention and Control, King Abdulaziz Medical City, NGHA,
Riyadh, Saudi Arabia; 2Microbiology, King Abdulaziz Medical City, NGHA,

Page 53 of 143

Riyadh, Saudi Arabia; 3King Abdullah International Medical Research Center,


King Abdulaziz Medical City, NGHA, Riyadh, Saudi Arabia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P77

Introduction: Plasmid-borne genes conferring quinolone resistance have


been increasingly recognized in Klebsiella pneumoniae (Kp) infections.
Objectives: To explore multidrug resistance, we analyzed the presence of
quinolone resistance genes in combination of other ESBL genes in
isolates resulting from a hospital outbreak.
Methods: Twenty three isolates of Kp from a hospital based MultidrugCarbapenem resistant outbreak in 2010 at King Abdulaziz Medical city,
Riyadh are the subject for study. MICs were determined by Microscan
Walkaway system (Siemens) and confirmed using E-test (AB biodisk). DNAs
were extracted using MagNApure kit (Roche Diagnostics). Sequence
typing was performed according to Diancourt et al protocol for MLST. ESBL
genes and genes for aac(6)Ib, OqxB, qnrA, -B and -S were PCR amplified
and sequenced as per published methods.
Results: We found that four different clones of Kp are involved and ST-29 as
the major clone (74%, 17/23) responsible for the outbreak. All isolates are
positive for OqxB gene. Isolate #2 with ST-37 had maximum number of
variations in their OqxB gene sequence resulting in change of amino acid
Asparagine to Glycine at 148 and Arginine to Leucine at position 197 of the
protein. There had been some variations in isolates 3, 6, 8, 19 and 22 but
without any translational change. The isolates with ST-29 presented a normal
OqxB gene. Those isolate with variations in their OqxB gene presented either
SHV-11 or SHV-12 type of ESBL whereas the isolates with ST-29 exhibited
SHV-1. Twenty out of 23 isolates were positive for qnrB gene. QnrA and S
genes were absent in all isolates. Two out of three isolates with ST-709 were
associated with the absence of qnrB gene whereas isolate with ST-37 also
lacked this gene. All isolates were positive for aac(6)Ib except two which had
ST-111.
Conclusion: The data shows that different clone sequence types
presented differences in the genetic make-up of their different resistance
genes in Kp. The predominant clone type-29 in this outbreak presented a
normal qnrB, OqxB, aac(6)Ib in combination with SHV-1.
Disclosure of interest: None declared.

P78
P078: Epidemiology of extended-spectrum beta-lactamase-producing
enterobacteriaceae (ESBL-E) during an epidemic, with screening of
patients and healthcare workers
A Agostinho1*, G Jourdan2, G Renzi3, C Bonfillon4, P Hoffmeyer2, S Harbarth1,
I Ukay1
1
Infection Control Program, Geneva University Hospitals, Geneva, Switzerland;
2
Orthopaedic Surgery, Geneva University Hospitals, Geneva, Switzerland;
3
Central Bacteriology Laboratory, Geneva University Hospitals, Geneva,
Switzerland; 4Occupational Medicine Service, Geneva University Hospitals,
Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P78
Objectives: To determine the nosocomial acquisition rate of ESBL-E
among patients and healthcare workers (HCWs) during an epidemic
(March 2009 to Nov 2010) in an orthopaedics ward at HUG.
Methods: Universal screening made by anal swab of all patients on
admission and every 2 weeks if screening remained negative. 49 samples
were collected from 41 HCW and 60 environmental samples were
analysed. Molecular typing was performed on all ESBL-E isolates. If there
was more than 97.5% similarity, strains were considered identical.
Results: Between March 2009 and November 2010, 1531 admissions
occurred to the orthopaedic ward (12401 patient-days; length of stay of
27 days). Among 565 anal swabs, ESBL-E were detected in 204 samples
from 45 patients.
The ESBL-E found were E. coli (n=39), Klebsiella pneumoniae (n=10),
Enterobacter spp (n=8), Citrobacter spp (n=2), Morganella morganii (n=2),
and Proteus vulgaris (n=1). Two different ESBL-E strains were detected in
6 patients, and 3 others carried three distinct isolates. The ESBL-E
transmitted were E. coli (14 patients), K. pneumoniae (3 patients) and both
in 2 patients.
Identical ESBL-E species with epidemiological links were found in 25
cases. Only 9 of these were attributable to the unit. Most positive
patients (96% [43/45]) were colonized asymptomatically with ESBL-E.

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Among HCWs, 6 samples (12%) were positive. Transmission was only


observed between patients, not HCWs.
None of the environmental samples revealed presence of ESBL-E.
Conclusion: Transmission of ESBL-E strains was only observed between
patients. No transmission between HCWs and patients occurred. HCW
screening and environmental sampling is not useful during ESBL-E
carriage outbreaks.
The main ESBL-E transmitted was E. coli.
ESBL-E transmission can occur in units with extended length of stay,
questioning the new Swiss policy of abandoning contact precautions for
E. coli-ESBL carriers.
Disclosure of interest: None declared.

good in-vivo response in many patients who were treated. Further


detailed evaluation of this combination is required with in-vitro MIC
studies and their correlation with clinical outcomes.
Disclosure of interest: None declared.

P79
P079: Abstract withdrawn

Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P79

P80
P080: Abstract withdrawn

Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P80

P81
P081: Cefepime-tazobactam: a new antibiotic against ESBL producing
enterobacteriaceae in cancer patients
S Biswas*, R Kelkar
Microbiology, Tata Memorial Centre, Mumbai, India, Mumbai, India
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P81
Introduction: India has very high rates of ESBL producing gram negative
organisms and co-production of AmpC & OXA makes majority of
antibiotics resistant, leaving carbapenems only reliable options. In recent
times, E.coli and Klebsiella pneumoniae have also started showing
resistance to carbapenems. Cefepime, a 4th generation cephalosporin, is
stable against AmpC & OXA, but it lacks activity against ESBL producing
organisms. Clavulanate is a highly effective inhibitor of extendedspectrum beta-lactamases (ESBLs) in detection tests. A novel combination
of Cefepime-tazobactam is expected to increase susceptibility of
Enterobacteriaceae otherwise resistant to cefepime if used alone. The
combination of Cefepime-tazobactam may effectively cover all three
major resistance mechanisms (AmpC & OXA by cefepime, ESBLs by
tazobactam).
Objectives: This study was undertaken to estimate the prevalence of the
ESBL producing gram negative bacilli and to evaluate the in vitro activity
of the newer drug cefepime-tazobactam with piperacillin-tazobactum,
cefoperazone sulbactam and carbapenems in a tertiary care cancer
centre.
Methods: This study was conducted between January 2012 to June 2012.
All the samples were processed and identified as per routine microbiological
methods. Antimicrobial susceptibility and ESBL confirmation was done
following CLSI guidelines. Sensitivity of Cefepime-tazobactam was compared
with cefepime, cefoperazone-sulbactam, piperacillin-tazobactam, imipenem,
meropenem.
Results: Of the 269 isolates included in this study, there were 120 E.coli,
109 Klebsiella pneumoniae and 40 Enterobacter spp. 141 isolates were
ESBL positive and 88 were ESBL negative. Carbapenems were the most
sensitive followed by cefepime-tazobactam, cefepime, cefoperazonesulbactam and pieracillin-tazobactam.
Conclusion: ESBLs are novel beta-lactamases produced by a variety of
gram-negative bacilli. Cefepime-tazobactam can be used for treatment
of ESBL producing Enterobacteriaceae. This will help to reduce the usage
of carbapenems in ESBL positive Enterobacteriaceae strains and prevent
development of carbapenem resistance. This combination has shown

P82
P082: Beijing and non-Beijing genotypes detection of mycobacterium
tuberculosis by melting curve analyzes
Z Tavakoli*, A Nazemi
Microbiology, Tonekabon Azad University, Tonekabon, Iran, Islamic Republic
Of
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P82
Introduction: Tuberculosis is one of the most important infectious
diseases in the world today. Rapid diagnosis of drug resistant
Mycobacterium tuberculosis (MTB) is critical to starting of an appropriate
treatment and preventing of more spread drug resistant MTB strains.
Objectives: Due to association of Beijing genotype with drug resistance
in MTB, we developed a rapid and non-culture method for detection
Beijing and non-Beijing MTB in clinical samples.
Methods: We modified Taqman Real time PCR for detection Beijing and
non-Beijing genotypes of Mycobacterium tuberculosis to a free probe
method in presence of a single dye together with a melting curve
analysis. We then performed a blinded screening with both methods on
33 septum samples from treated tuberculosis patients.
Results: We were obtained the same results by both methods. Of the 33
patients, 5 samples were Beijing genotype and 28 were non-Beijing
genotype. In free probe method, we were clearly identified a melting
peak at 81C corresponds to non-Beijing and a melting peak at 88C
corresponds to Beijing genotype.
Conclusion: DNA melting curve analysis is a simple and efficient method
for the specific detection of amplified products and greatly reduces the
cost molecular detection.
Disclosure of interest: None declared.

P83
P083: Prevalence of multi-drug resistant tuberculosis and associated
risk factors in HIV-positive patients registered at Mpilo Opportunistic
Infection clinic, Bulawayo, Zimbabwe
B Murwira Neemanyame
National Tuberculosis Reference laboratory,Zimbabwe, Bulawayo, Zimbabwe
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P83
Introduction: Tuberculosis (TB) is a major public health disease, affecting
one third of the worlds population and killing approximately two million
people yearly. The emergence of resistance to anti-tuberculosis drugs,
particularly MDR-TB.
Objectives: To determine prevalence of multidrug-resistant tuberculosis
(MDR-TB) and associated risk factors among adult (18 years) HIV positive
patients registered at Mpilo Opportunistic Infection (OI) clinic. To assess
the association of CD4 count and MDR-TB.
Methods: A health facility based cross-sectional study was carried out at
Mpilo OI Clinic between 01 March and 31 July 2012. Convenience
sampling was used to recruit 275 adult HIV positive patients into the
study on a daily basis. A single sample for MDR-TB was collected from
each one of these participants. A total of 275 sputum and aspirate (Bone
marrow, Aspirates, pus Cerebrospinal fluid) samples were collected and
cultured for MDR-TB using both the Liquid using BACTEC Mycobacterium
Growth Indicator Tube 960 (MGIT) and the Conventional Solid Lowenstein
Jensen (LJ) culture methods. Whole blood for CD4 count was collected
from each participant and tested using BD FACS Calibur Flow Cytometry
CD4 count machine. Logistic regression was used to determine predictors
of MDR-TB prevalence.
Results: The prevalence of MDR-TB was 2.6% among adult HIV patients
registered at Mpilo OI Clinic and attended the clinic between 01 March
and 31 July 2012. In the multivariate analysis, MDR-TB prevalence was
associated with CD4 count (OR 0.14 p=0.043).
Conclusion: A prevalence of 2.6% of MDR-TB among HIV positive
patients was found. This is very high considering this high MDR-TB risk
group. A CD4 count of >200 cells/ul was found to be protective of high

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MDR-TB prevalence. Targeted interventions of MDR-TB are necessary to


reduce incident MDR-TB cases among HIV positive patients. Increased
MDR-TB case finding through culture and Drug Susceptibility testing
before initiation of First line drugs is necessary to reduce mistreatment.
Infection control measures need to be put in place to reduce transmission of MDR-TB.
Disclosure of interest: None declared.

Shigella infections, the antibiotics which showed 100% susceptibility to all


species identified were ciprofloxacine, cefotaxime, ceftazidine.
Conclusion: The prevalent Salmonella strain circulating in Rwanda is
S. Typhi and two most useful drugs of choice to treat Salmonella sp. and
Shigella sp. infections in Rwanda are cefotaxime and ciprofloxacin.
Disclosure of interest: None declared.

P84
P084: Analysis of therapeutic efficacies of amodiaquine-arstesunate and
artemether-lumefantrine for treatment of uncomplicated falciparum
malaria in Burkina Faso five years after their implementation
FW Nikiema1*, I Zongo1, F Some1, J-B Ouedraogo1, L Penali2
1
Health Research, Institut de Recherche en Science de la Sante de Bobo
Dioulasso, Bobo Dioulasso, Burkina Faso; 2Data management, WorldWide
Antimalarial Resistance Network, West Africa , Dakar, Senegal
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P84
Introduction: Since 2005, Burkina Faso adopted artesunate plus
amodiaquine (ASAQ) and artemether-lumefantrine (AL) as first-line
treatment for uncomplicated malaria. Despite improvement in that
treatment, malaria remains the first cause of morbidity and mortality in
the country.
Objectives: This study aimed to analyze the therapeutic efficacies of
ASAQ and AL for the treatment of uncomplicated falciparum malaria in
Burkina Faso five years after their adoption.
Methods: Per-protocol individual data from four randomized clinical trials
supported by IRSS-DRO Bobo Dioulasso in 2006, 2008, 2009 and 2010,
including 1076 patients with uncomplicated P. falciparum malaria, treated
with the recommended regimen of AL or ASAQ, were analyzed according
to WWARN analytical methods. Patients benefited from a clinical and
biological 28-day follow-up and performed on days 2, 3, 7, 14 and 28 to
evaluate clinical and parasitological outcomes. Treatment failures have
been corrected by PCR.
Results: Using WWARN analytical methods, the unadjusted Kaplan-Meier
survival estimates are 76.4% (95% CI (72.5-79.8)) in the AL group
(N=544) and 87.1% (95% CI (83.9-89.7)) in the ASAQ group (N=532).
After PCR correction, AL was less efficacious than ASAQ respectively
95.8% (95% CI (93.6-97.3)) vs 98.2% (95% CI (96.6-99.1)); OR=0,486 (95%
CI (0.217-1.089). There was no significant correlation between the
occurrence of recrudescent at day 28 end-point and study year in two
groups (coefficient<0).
Conclusion: AL and ASAQ remain effective as treatment for uncomplicated
malaria according to WHO recommendations, though AL was inferior in
preventing recrudescent for 28-day follow-up.
Disclosure of interest: None declared.

P86
P086: Prospective surveillance from the laboratory of
multidrug-resistant bacteria (MDRB) bacteremia
NM Dia1*, A Ndir2, R Ka3, KL Onanga3, ML Dia3, B Ndoye2, AI Sow3, M Seydi1
1
Infectious Diseases Department, Fann Teaching Hospital, Dakar, Senegal;
2
Pronalin, Ministry of Health, Dakar, Senegal; 3Laboratory of Bacteriology,
Fann Teaching Hospital, Dakar, Senegal
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P86
Introduction: The control of the diffusion of the MDRB in health
establishments is a priority.
Objectives: Our work studied the incidence of bacteremia due to MDRB
in a hospital environment.
Methods: Microbiological surveillance was led in three departments of a
teaching hospital during a period of six months going from April till
October 2012 and concerning only blood cultures with diagnostic aim.
Results: During the study period, 123 patients were followed and 30
episodes of bacteremia were described that is 21 % of all the blood cultures
taken. The average age of the patients was 49 years18.31 and the sex-ratio
0.66. The majority of the patients (78.6 %) were sent by a health care
structure, 14.3 % came from the place of residence and 7.1 % were the
object of internal transfer. Thirty six percent of the patients were admitted
for a neurological disorder with an average duration of stay of 19.66 days
14.62. Positive blood cultures were attributed to nosocomial infections in
22 cases (75.9 %) with an average delay of acquisition of 14.55 days. On the
bacteriological plan, the responsible microorganisms were established:
Enterobacteriaceae17 (56.7 %) among which 11 (64.7 %) producing
extended-spectrum beta-lactamases (ESBL), non fermenting Gram- negative
bacteria 4 (13.3 %), Gram-positive bacteria 9 (30 %) among which 4
methicillin-resistant Staphylococcus aureus (MRSA). Klebsiella pneumoniae
was the dominant microorganism 8 (26.7 %). The presence of a catheter was
identified in 7 cases of bacteremia associated with an Enterobacteriaceae
producing ESBL. The rate of attack MDRB was 1.54 for 100 admissions and
the incidence rate was 1.66 for 1000 patient-days. After bacteremia, the
death rate was 61.5 %.
Conclusion: The incidence of the MDRB during bacteremia is high in our
structure. A program of prevention of the diffusion of the MDRB should
be set up, accompanied with a training of nursing staff.
Disclosure of interest: None declared.

P85
P085: Surveillance of drug-resistant Salmonella sp and Shigella sp
infections in Rwanda
JB Gatabazi
Laboratory Department, Rwanda Military Hospital Kigali, Kigali, Rwanda
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P85

P87
P087: Multiresistant bacteria bacteremia cases in a Dakar University
Hospital (Senegal)
ML Dia1*, C Ndour2, R Ka1, R Diagne1, A Diop1, AI Sow1, MF Ciss1
1
Laboratory of Bacteriology-Virology, CHU of Fann, Dakar, Senegal;
2
Infectious Diseases Department, CHU of Fann, Dakar, Senegal
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P87

Introduction: Salmonella sp. and Shigella sp infections are public health


threat worldwide, particularly in Sub-Saharan Africa including in Rwanda.
This study was done to identify Salmonella sp. and Shigella sp. currently
circulating in Rwanda and determine their drug susceptibility pattern.
Objectives: To determine the prevalence of Salmonella spp. and Shigella
spp. strains circulating in Rwanda and their susceptibilty pattern in
Rwanda.
Methods: 196 blood and 24 stool specimens from patients were analyzed
in Laboratory of Rwanda for culture isolation, identification and drugsensitivity testing.
Results: 91 (92.2 %) of them were identified as Salmonella enterica serovar
Typhi, 10 were Shigella sp. The isolates were subsequently subjected to
antibiotic susceptibility tests and the strains of S. Typhi isolates were found
to be susceptible to cefotaxime (100%), and ciprofloxacin (97.9 %) and
resistant to nalidixic acid (89.4%), cotrimoxazole (87.2%). With regard to

Introduction: The emergence of multiresistant bacteria strains


compromises the efficiency of antibiotics usually used in our structures.
Objectives: Our study had for aim to determine the part of multiresistant
strains in bacteremia cases in the Teaching Hospital of Fann.
Methods: This study was made on data recorded from registers of the
bacteriological laboratory between 1 January 2008 and 31 December 2011.
Results: One Hundred and forty six multiresistant bacteria (146) among the
709 multiresistant strains were isolated from blood cultures (20,59 %). The
mean age was 27,18 years [range=1 84] with a sex ratio of 1.15. Most of
the patients were hospitalized (91,1 %). The infectious diseases clinic
provides most of the multiresistant bacteria (39, 72 %), followed by
paediatrics department (37, 6 %) and Thoracic and cardiovascular Surgery
department (6, 8 %). The majority of multiresistant bacteria was constituted
by extended spectrum betalactamase enterobacteriaceae (82, 87 %) and
Methicillin-resistant Staphylococcus (6, 85 %). Klebsiella pneumoniae was the

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most frequent bacteria (39, 72 %) followed by Enterobacter spp (23, 97).


Enterobacteriaceae were susceptible to imipenem, amikacin and colistin but
were resistant to quinolones and other aminosides. Methicillin-resistant
Staphylococcus aureus and methicillin-resistant Staphylococcus saprophyticus
were susceptible to vancomycin. Strains of Acinetobacter and Pseudomonas
were susceptible to imipemem and colistin.
Conclusion: Most of the multiresistant bacteria in the Teaching Hospital
of Fann were isolated from blood cultures. It is important to insist on
prevention by improving hospital hygiene and rational use of antibiotics.
Disclosure of interest: None declared.

Results: On average 40 hospitals per year take part in the monitoring. The
cultures are searched to more than 50 trademarks of biocides. In 2011 we
tested 445 strains. Most of bacteria were susceptible to disinfectants of the
different chemical classes in 2011: 82% were susceptible to biocides based
on quaternary ammonium compounds (QAC)+guanidine, 100% - to
tertiary amines etc. Total incidence of resistant strains was 3.43.0 per 100
tests. It was to 4 chemical classes of disinfectants. The biggest share of
resistant cultures was to the oxygen-contained biocides - 6.3% of 29 strains
tested to this class. On the contrary, the minimal level was to disinfectants
containing QAC+amines (1.7%, n=58).
The resistant strains Acinetobacter sp were predominant (13% of all
cultures of the species). Moreover, the percentage of resistant
Pseudomonas aeruginosa was 5.7% of all cultures of the species. We have
also revealed resistance to disinfectants in Escherichia coli, Proteus
vulgaris, Proteus mirabilis.
In dynamics we found out increase in the incomplete susceptibility of
bacteria to different QACs (p=0.3). The incidence of such susceptibility to
chlorine compounds was significantly lower vs in 2009 and 2010 (p=0.038).
In 2011 there were 2.9 times more resistant bacteria to oxygen-contained
disinfectants (p=0.03). During all years no resistant strains to chlorine
compounds were revealed. The amount of Pseudomonas aeruginosa
decreased 2 times (p=0.06 vs 2009) but it was due to the reduced number
of the strains we have tested.
Conclusion: There were resistant strains to QACs and oxygen-contained
disinfectants which are widely used in the hospitals of the Nizhniy
Novgorod region. The monitoring of resistance to biocides provides an
operative evaluation of the microbial susceptibility in healthcare settings.
Disclosure of interest: None declared.

P88
P088: Monitoring multiresistant bacteria (MRB) to Principal Hospital
Dakar: assessment of 1 year
B Fall1*, B Wade2, B Niang3, MN Seye4, E Dieme5, KB Fall6, KS Ndiaye1,
S Diawara1, SB Gning6, Y Dieme1
1
Laboratories Federation, Dakar, Senegal; 2Directorate, HPD, Dakar, Senegal;
3
Reanimation Department, HPD, Dakar, Senegal; 4Pediatrics, HPD, Dakar,
Senegal; 5Surgical Services, HPD, Dakar, Senegal; 6Medical Services, HPD,
Dakar, Senegal
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P88
Introduction: Bacterial resistance to antibiotics is a public health problem.
Mastering their distribution is thus a priority. Thus, at the Principal Hospital
of Dakar (HPD), a system for collecting and analyzing data of resistance has
been established within the Committee against nosocomial infections.
Objectives: We present here the results compiled over a year to help
guide prevention activities.
Methods: Prospective study from January 1 to December 31, 2012 at the
HPD. Every day, multiresistant bacteria isolated in the laboratory are subject
to a collection of clinical and biological data using a questionnaire.
Enterobacteriaceae producing extended-spectrum beta-lactamase (ESBL)
and derepressed cephalosporinases of Pseudomonas aeruginosa,
multiresistant Acinetobacter and Methicillin Resistant Staphylococcus aureus
isolates were analyzed. The data are then analyzed by Epi info.
Results: 323 BMR were collected during the study period. The average age
was 32 years [4 days, 95 years] and the sex ratio was 1.70. ESBL-producing
Enterobacteriaceae (80%) followed by Acinetobacter multiresistant
respectively (11%), ticarcillin-resistant Pseudomonas aeruginosa (4%) and
methicillin-resistant Staphylococcus aureus (4%) were the most common
isolates. ESBLs were as follows: 55% Klebsiella, E. coli 32% 11% Enterobacter,
and others 2%. Blood cultures were the most common samples (40%),
followed respectively by urinary tract infections (37%) and abscesses (16%).
The pediatrics department was most affected (45%), followed respectively
by the Internal Medicine and Resuscitation (each 23%) and Surgery (9%).
A catheter was present in 91% of patients with sepsis and 66% of ESBL
infections ESBL-producing Enterobacteriaceae were considered nosocomial.
Conclusion: This study shows the important place occupied by multiresistant bacteria Principal Hospital. ESBL-producing Enterobacteriaceae
represent the most common resistant organisms, mainly in the form of
nosocomial infections.
Disclosure of interest: None declared.

P89
P089: Surveillance of bacterial resistance to disinfectants
N Saperkin*, O Kovalishena, A Blagonravova
Epidemiology, Nizhniy Novgorod State Medical Academy, Nizhniy Novgorod,
Russian Federation
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P89
Introduction: The causative agents of healthcare-associated infections
are known to be resistant both to antibiotics, disinfectants, and
antiseptics. Our sampling researches allowed to implement a monitoring
in hospitals.
Objectives: The aim was to study susceptibility of the microflora in 20092011 in order to correct disinfection in good time.
Methods: Our own microbiologic method (patent RF 2378363, 2008)
was used for evaluating the bacterial susceptibility to disinfectants.
Comparative statistical analysis was made by EpiInfo v.7.

P90
P090: Importance of the information system in the fight against
multi-drug resistant bacteria
S Izoard1*, A Brenet1, P Astagneau2, Z Kadi1
1
Picardie regional center for nosocomial infections control, CCLIN Paris Nord,
Amiens, France; 2CCLIN Paris Nord, Paris, France
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P90
Introduction: The Picardie region is one of the regions in which the
incidence of methicillin-resistant Staphylococcus aureus (MRSA) is high
(0.4/1000 Hospitalization Days in Picardie in 2011) compared to the
French national average (0.7/1000 Hospitalization Days in 2011).
Objectives: That is why the regional center for nosocomial infections
control in 2012 made an assessment study on the actions and the resources
involved in prevention and control of MRSA and Multi-Drug Resistant
Bacteria (MDRB).
Methods: The survey was proposed to 82 hospitals in the region using
on-line or paper questionnaires forms. Data were entered and analyzed
using Epi-Info 6.04d software.
Results: Overall 41 hospitals (50% of the hospitals in the region)
participated in this investigation. 66% of them reported having a system of
continuous monitoring of MDRB for the identification of clustered cases and
39% of the hospitals reported having a similar device for the identification
of re-hospitalized cases. In addition, 63% of respondents indicated that they
did not develop transmission means for the patients with MDRB to inform
the hosting facility during a subsequent hospitalization. When a case of
patients with MDRB occurs in a hospital, 88% of them track cases of
re-hospitalized patients thanks to patient records and not via the
administrative software. 57% of the hospitals reported to implement a
policy of MDRB monitoring. More than half patients considered to be at risk
(eg, multiple hospitalizations, previous history of antibiotic treatment) was
concerned in the majority of sectors welcoming patients with emerging
MDRB. The most frequently screened MDRB are respectively MRSA (46%),
carbapenemase-producing Enterobacteriaceae (44%), glycopeptide-resistant
Enterococci (44%) and extended-spectrum beta-lactamase-producing
Enterobacteriaceae (41%).
Conclusion: The components of the MDRB control which are collected
within the hospitals of the region have shown critical points, especially in
the monitoring of patients with MDRB. Specific policy focusing MDRB
should be reinforced in the region.
Disclosure of interest: None declared.

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P91
P091: Timely administering prophylactic antibiotics
Y Yau1*, ICNT1, I Wong2
1
Nursing ICNT, Hong Kong, Hong Kong; 2Nursing CND, DKCH, Hong Kong,
Hong Kong
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P91
Introduction: It is well documented that prophylactic antibiotic could
reduce surgical site infection significantly providing that it is given timely
with right drug and right dose. However, administering prophylactic
antibiotic in a timely manner is not easy. Several factors such as low
awareness of importance of timing on prophylactic antibiotic given, the
workflow, ease of administration and perception of individual responsibility
toward the administration could all contribute to the failure of given timely
antibiotic to reduce surgical infection.
Objectives: To investigate how these problems were tackled in an
elective surgical hospital in order to achieve timely administering surgical
prophylactic antibiotic.
Methods: During the period 2009 to 2012, all anesthetic records of
orthopedic operation performed at the Duchess of Kent Childrens Hospital
at Sandy Bay were reviewed. Data on time, administrator of prophylactic
antibiotic, logistic of antibiotics being issued, methods of safety guide for
administration and infection control rate were collected.
Results: - Total 6061 cases were reviewed.
- 99.9% of the prophylactic antibiotics were given within 15-45 minutes
interval before operation.
- 100% cases went through the safety check list by nurse.
- Anesthesiologist administered all the antibiotics while surgeon
prescribed all prophylactic antibiotics.
- All prophylactic antibiotics were given in operating theater except
Vancomycin.
- However, 99% antibiotics went through their regular route to OT.
- Infection rate was 0.13% over these 4 years.
Conclusion: Clearly defined roles and responsibility in the process of
prophylactic antibiotic administration were essential. Safety check list helped
to enforce the guidelines. Monitoring the outcome alerted stakeholders to
take necessary action. Successful transfer evidence-based guidelines into
daily practice required multiple interventions and support from top
management to frontline staff were vital.
Disclosure of interest: None declared.

P92
P092: Antibiotic usage and appropriateness for a university hospital in
Turkey: point prevalence results
H Gl1, A Karaka1, C Artuk1, G zbek2*, S Kl2, CP Eyign1
1
Infectious Diseases and Clinical Microbiology, Ankara, Turkey; 2Infection
Control, Glhane Military Hospital, Ankara, Turkey
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P92
Objectives: This study aims to determine antibiotic usage rates, causes of
antibiotic usage and inappropriate usage rates in a university hospital
with a 1,200-bed capacity.
Methods: The study assessed antimicrobial drug usage among all
hospitalised patients in the hospital on April 20, 2012, using the point
prevalence method. Data were recorded using pre-prepared forms.
Appropriateness of antibiotic usage was determined according to the
appropriateness for the cause of antibiotic usage, the spectrum of the
chosen antibiotics, usage dose, dose frequency and time of usage.
Results: Of 666 patients staying in the hospital on the day of study, 262
(39.7%) were on antibiotics. Of those, 145 (55.3%) were on surgical wards,
98 (37.4%) were on medical wards and 19 (7.3%) were on paediatric wards.
Of those 262 patients, 157 (59.9%) were taking only one type of antibiotic,
79 (30.2%) were taking two and 26 (9.9%) were taking three or more types
of antibiotic. Antibiotic usage was appropriate in 55.7% and inappropriate
in 44.3%. The inappropriate antibiotic usage rate was 75.9% among
patients on surgical wards. The most common cause of inappropriate
usage was unnecessarily long prophylaxis time (68.2%). Inappropriate
antibiotic usage was found in 24 (24.5%) patients out of 98 patients on
medical wards. When the causes of antibiotic usage were analysed, it was

Page 57 of 143

found that the cause of antibiotic usage was infection in 36.2%,


prophylactic in 35.9%, and empirical in 27.9%. On the day the study was
conducted, 367 antimicrobial drug were prescribed to 262 patients. The
drugs most commonly prescribed were antibiotics from the cephalosporin
(27.0%) and fluoroquinolone (20.2%) groups. When the diagnosis of 95
patients who were on antibiotics due to infection was reviewed, the most
common infections were respiratory tract infections (37.9%), urinary
system infections (12.6%), upper respiratory tract infections (8.4%),
bloodstream infections (6.3%) and prosthesis infections (6.3%).
Conclusion: Inappropriate antibiotic usage rates in surgical wards were
high. This inappropriate usage is especially related to prophylaxis time.
This is why it is necessary for surgeons to be educated regarding
prophylactic antibiotic usage and to stick to the surgical prophylaxis
guidelines.
Disclosure of interest: None declared.

P93
P093: Impact of antimicrobial restriction program on antimicrobial
agents usage
HK Ki1*, H-S Cheong2
1
Internal Medicine, Seoul, Korea, Republic Of; 2KonKuk University Hospital,
Seoul, Korea, Republic Of
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P93
Introduction: Antimicrobial agents have been used inappropriately so far.
Recently antimicrobial stewardship has been stressed for the prevention
of spread of antimicrobial resistant organism. Especially antimicrobial
restriction before usage has been used in many institutions. The impact
of the antimicrobial restriction has not been known adequately.
Objectives: The goal of the study is to know the impact of antimicrobial
restriction program on the pattern of antimicrobial prescription and
antimicrobial resistance.
Methods: We reviewed the prescribed antimicrobial agents and the dosage
of each antimicrobial agents from the year 2005 to year 2012. We collect the
data using computerized antimicrobial usage program.
Results: Antimicrobial restriction program has been launched from the year
2006. ID physicians previewed the necessity of the antimicrobial agents
before the usage. The restricted formula are as followed : 3rd / 4th
genenration cephalosporin, carbapenem, fluoroquinolone, glycopeptide,
aminoglycoside, and antifungals. The average annual prescription amount
was 770,563 DDD (Range 650,225-1,109,740 DDD). The total amount of
prescribed antimicrobial agents showed plauteau from year 2009. Third
generation cephalosporin (34,531 DDD to 22,772 DDD) and aminoglycoside
(4,557 DDD to 2,688 DDD) were less prescribed after introduction of formula
restriction. Quinolone class are also less prescribed (25,521 DDD to 9,662
DDD). While, penicillin (4,500 DDD to 34,034 DDD) and first generation
cephalosporin (4,166 DDD to 15,194 DDD) were more prescribed after
introduction of formula restriction.
Conclusion: Total amount of antimicrobial presciption showed plauteau
after introduction of antimicrobial restriction program. Third generation
cephalosporin, Aminoglycoside, and quinolone were less prescibed than
before. Antimicrobial restriction program wound not increase the total
amount of prescription and even decrease the usage of broad spectrum
antimicrobial agents.
Disclosure of interest: None declared.

P94
P094: Impact of antibiotics changes on the incidence of bloodstream
infection due to extended-spectrum beta-lactamase-producing
Klebsiella pneumoniae in an Algerian neonatal intensive care unit
A Mohamed Lamine*, Fetta Sadaoui, Nora Boubechou,
Abdeldjallil Bezzaoucha, Chawki Ahmed Kaddache, Rachida Boukari
Department of Medicine, University of Blida, Blida, Algeria
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P94
Introduction: Klebsiella pneumoniae is one of the most common
nosocomial bloodstream infection (BSI) pathogens in neonatal intensive
care units (NICUs) of developing countries. Its ability to produce extendedspectrum beta-lactamases (ESBLs) has caused great concern worldwide.

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Early studies reported that high beta-lactam antibiotic consumption was an


independent risk factor for acquisition of ESBL-producing K. pneumoniae
BSI.
Objectives: The objective of this study was to examine the impact of the
reduction of beta-lactam antibiotic consumption on the incidence of
ESBL-producing K. pneumoniae BSI in an Algerian NICU.
Methods: A comprehensive education campaign was undertaken in the
University Hospital of Blida NICU in the beginning of 2008 to reduce the
beta-lactam antibiotic consumption in this unit. To measure the impact of
this campaign on the incidence of ESBL-producing K. pneumoniae BSI, a
prospective surveillance of healthcare-associated BSI was performed from
2008 to 2010 using National Nosocomial Infection Surveillance (NNIS)
System criteria. Antibiotic consumption was measured by dividing the
total days of beta-lactam antibiotic consumption by the total days of
patients NICU stay.
Results: From 2008 to 2010, a total of 3842 neonates who remained in the
NCIU for more than 48 hours were included in the study. These patients
had total patient-days of 44,424 and total beta-lactam antibiotic-days of
25,180. Beta-lactam antibiotic consumption decreased significantly from
71.4 antibiotic-days per 100 patient-days in 2008 to 41.3 antibiotic-days
per 100 patient-days in 2010 (p < .01). Incidence of ESBL-producing
K. pneumoniae BSI decreased significantly from 3.6% in 2008 to 0.2% in
2010 (p < .01), and incidence density decreased significantly from 3.2 per
1000 patient-days in 2008 to 0.2 per 1000 patient-days in 2010 (p<.01).
Conclusion: Our findings highlight the need to minimise unnecessary
and inappropriate antimicrobial use (specifically that of beta-lactam
antibiotics) to prevent the acquisition of ESBL-producing K. pneumoniae
BSI in the NICUs of developing countries.
Disclosure of interest: None declared.

reduction in rate of E. coli and K. pneumoniae with ESBLs from identified


and suspected infections.
Disclosure of interest: None declared.

P95
P095: The 2nd/3rd generation of cephalosprines use in antimicrobial
stewardship program and contemporary carriage of E. coli and
K. pneumoniae with esbls from identified or suspected infection
hospitalized patients
B Gao1*, L-H Zhao2, H-Z Wu3, G-D Wang4, Z-H Guo4, J-G Dai1, W Lu5
1
Nosocomial Infection Control Unit, Tianjin Second Peoples Hospital, Tianjin,
China; 2Pharm Unit, Tianjin Second Peoples Hospital, Tianjin, China; 3Clinical
Microbiological Lab, Tianjin Second Peoples Hospital, Tianjin, China;
4
Graduate School, Tianjin Medical University, Tianjin, China; 5Tianjin Second
Peoples Hospital, Tianjin, China
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P95
Objectives: To implement antimicrobial reasonable use and evaluate its
impact on E. coli and K. pneumoniae with ESBLs isolated from hospitalized
patients.
Methods: The 2nd/3rd generation cephalosprines (GCPs) use from 2006.1 to
2012.12 was converted to DDDs per 1,000 patient-days in a tertiary teaching
infectious disease hospital in Tianjin, China. Multi-strategy, including
contextually appropriate antibiotic use guidelines, active audit, as well as
performance feedback/education in-field, were conducted by antimicrobial
stewardship in the hospital since 2006. E. coli and K. pneumoniae isolated
from all identified and suspected infections were selected at the same time.
For ESBLs status, agar diffusion test with clavulanic acid plus or minus
cefotaxime and ceftazidime was used. Linear correlation was carried
out to analyze the relationship between 2 nd /3 rd GCPs use and major
Enterobacteriaceae producing ESBLs.
Results: The 2nd GCPs consumption was 12.488, 12.563, 12.637, 20.221,
48.598, 6.647, and 8.129 DDDs per 1,000 patient-days during 2006 to 2012
respectively. The 3rd GCPs consumption was 35.248, 32.135, 31.720, 23.661,
31.696, 20.284 and 15.722 DDDs per 1,000 patient-days respectively at the
same time. ESBL-producing strains rates of E. coli and K. pneumoniae were
27.42% (17/62), 26.79% (15/56), 29.09% (16/55), 23.53% (24/102), 39.29%
(66/168), 25.58% (33/129) and 11.46% (18/157) from 2006 to 2012
respectively. Lower 2nd/3rd GCPs annually use was associated with a lower
rate of E. coli and K. pneumoniae with ESBLs isolated from contemporary
hospitalized patients. (r2 = 0.843; P < 0.005).
Conclusion: Multi-strategy intervention by antimicrobial stewardship was
effective on commonly used 2nd/3rd GCPs in the hospital of Tianjin, China.
The decrease of 2 nd /3 rd GCPs represented a significant driver in the

P96
P096: Antibiotic stewardship in intensive care units: a cross sectional
study of 355 ICUs in Germany
F Maechler*, F Schwab, E Meyer, C Geffers, R Leistner, P Gastmeier
Infection Control, Charit Berlin, Berlin, Germany
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P96
Introduction: Little information is available on antibiotic prescription
management in German hospitals.
Objectives: The objective of this cross sectional study was to determine
the prevalence and components of antibiotic stewardship (ABS) measures
in German ICUs.
Methods: A questionnaire survey was sent to all ICU-members of the
German nosocomial infection surveillance system KISS (n=579) in October
2011. Data on antibiotic management structures were collected and
analyzed by structural hospital and ICU factors.
Results: The questionnaire was completed by 355 German ICUs (61%
response rate).
The most common measures used (>80% of the ICUs) were personal
restrictions for antibiotic prescriptions, routine access to unit-based
bacterial resistance data and pharmacy reports on antibiotic costs and
consumption. A small proportion of ICUs (14%) employed ABS
consultants or infectious diseases specialists for the prescription of
antimicrobial medication. Hospitals with their own integrated
microbiological laboratory report twice as much to take part in
surveillance networks of antimicrobial use (34%) and bacterial resistance
(32%) compared with hospitals with external laboratories (15% and 14%,
respectively, p<0.001). Also, non-profit and public hospitals participate
more often in surveillance systems for bacterial resistance than private
hospitals (>23% vs. 11%, p<0.05).
Conclusion: While the majority of ICUs report to have some antibiotic
policies established, the contents and composition of these strategies vary
markedly. Organizational-leveled control strategies to improve antibiotic
control are already quite common in Germany. In contrast, other strategies
widely considered effective such as the continuous surveillance of
antimicrobial use and bacterial resistance or the employment of infectious
disease consultants are still scarce. More effort is required with regard to
incentives for infectious diseases consultants and to the participation in
surveillance networks.
This study provides a benchmark for future antibiotic stewardship
programs.
Disclosure of interest: None declared.

P97
P097: Antimicrobial usage in the treatment of patients with
bloodstream infection
AO Paula*, ACD Oliveira, RF Rocha
UFMG, Belo Horizonte, Brazil
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P97
Introduction: Although indiscriminate use of broad-spectrum antibiotics
is related to the occurrence of bacterial resistance, there is an abusive
use of such drugs.
Objectives: To determine the antimicrobial usage in the treatment of
patients with bloodstream infection (BSI) caused by methicillin-resistant
and susceptible Staphylococcus aureus (MRSA and MSSA, respectively).
Methods: Retrospective cohort study performed in an Intensive Care Unit
of a large hospital in Belo Horizonte. The population is comprised of
patients diagnosed with Staphylococcus aureus BSI from 2007 to 2011.
Data were obtained through patients medical records and Hospital
Infection Control Committee. Therapy were categorized in: empirical
treatment (before the culture test result) or directed (according to the BSI
causing agent). Descriptive and univariate analysis were performed (using
chi-square test or a Fishers exact test). The hospitals Ethics Committee
approved the project.

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Results: 62 patients were included, 31 in each group (MRSA and MSSA).


The most common antibiotics prescribed for empirical treatment were
vancomycin (69.4%), polymyxin B (46.8%), ertapenem (29.0%),
meropenem (24.2%) and cefepime (3.2%). There was no significant
difference between the groups analyzed and the class of antimicrobials
empirically prescribed (p>0.05). For directed treatment, the antibiotics
prescribed were vancomycin (45.2%) and methicillin (40.3%). On one
hand, MRSA group used significantly more vancomycin (p=0,000). On the
other hand, MSSA patients used more methicillin after the culture result
(p=0,000).
Conclusion: A large use of broad-spectrum antibiotics in empirical
treatments was observed, given the hospitals microbiological profile and
the need to initiate appropriate treatment during the first 24 hours.
However, the treatment targeting favored a rational use of antibiotics,
reducing the action spectrum after culture results.
Disclosure of interest: None declared.

threat of infections, Healthcare Workers (HCW) may use ABHR in excess of


120 times per shift. Little is known regarding how alcohol type or high
HHC levels might exacerbate HCW skin condition. This study compares
alcohol type and application frequencies on skin at levels representative
of high HHC for HCWs.
Methods: Panelists representing a HCW demographic were studied over
a two week period. Following a washout period, skin assessments and
treatments were conducted at regular intervals. Three ABHR systems
containing 70% alcohol (ethanol, isopropanol, or n-propanol), water, and
humectant were used in addition to a control (water and humectant
only). Panelist forearms received eight randomized regimens: three
alcohol systems applied 20 times per day (standard frequency; SF); three
alcohol systems applied 100 times per day (high frequency HF); an
untreated skin control; and the water/ humectant system applied 100
times per day. Panelists forearms were also washed six times per day at
scheduled intervals of a minimal HCW daily routine. Skin redness and
dryness, skin hydration, and skin barrier were measured to assess each
unique regimen. Analysis of variance was used to assess the individual
and interactive effects of alcohol type and application rate, and to
compare to the untreated and alcohol-free treatments.
Results: Compared to the control, elevations in TEWL were observed on
days 5 and 8 for the HF-isopropanol regimens. Equally, increased TEWL
was observed for the HF-isopropanol regimen compared with the SF &
HF-ethanol regimen. Both types of alcohol formulations when applied at
HF reduced skin hydration although greater for the isopropanol
formulation.
Conclusion: Both type of alcohol used and the frequency of ABHR
application has measureable influence on skin. As the choice of alcohol
used in an ABHR has consequences, healthcare facilities moving to or
currently at high HHC levels should take this into consideration when
selecting an ABHR.
Disclosure of interest: None declared.

P98
P098: Cost of antimicrobial treatment in patients with bloodstream
infection in an intensive care unit
AO Paula1*, AC Oliveira2, RF Rocha3
1
UFMG, Belo Horizonte, Brazil; 2ENB, UFMG, Brazil; 3Mater Dei Hospital, Belo
Horizonte, Brazil
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P98
Introduction: The study of costs associated with antimicrobials treatment
of patients with bloodstream infection (BSI) are important to sustain
implementation of preventive measures and increase patient safety.
Objectives: Compare the direct cost of treatment of patients with BSI
caused by methicillin-resistant and susceptible Staphylococcus aureus
(MRSA and MSSA).
Methods: A retrospective cohort study performed in an intensive care
unit of a large hospital in Belo Horizonte. The population is comprised of
patients with Staphylococcus aureus BSI from 2007 to 2011. Data were
obtained through patients medical records, hospital infection control
committee and hospitals finance department. Therapy costs were
grouped according to the type of treatment received: empirical (before
the culture test result) or directed (according to the BSI causing agent).
Descriptive and univariate analysis were performed. The hospitals Ethics
Committee approved the project.
Results: 62 patients were included, 31 in each group (MRSA and MSSA).
For empirical treatment, due to the larger doses of meropenem used in
MRSA patients at this stage, patients with MRSA had a statistically
significant (p<0.005) larger cost ($1110.22) when compared to MSSA ones
($ 506.34). For directed and total treatment, difference between groups
was not significant (directed treatment: MRSA $304.74 and MSSA $432.96;
total treatment: MRSA $1061,01 and MSSA $829.40). This occurred due to
the larger oxacillin dosages administered in patients with MSSA when
compared with the treatment of vancomycin for patients with MRSA
However, for both groups together, the costs of directed treatment
($327.57) were smaller than the costs of empirical treatment ($551.43)
(p=0.000) showing that antimicrobial de-escalation reduced the directed
costs.
Conclusion: Bacterial resistance may influence the costs of antimicrobial
treatment. The treatment targeting favored a rational use of antibiotics,
reducing the costs after culture results.
Disclosure of interest: None declared.

P99
P099: High compliance alcohol based hand rub skin tolerability: alcohol
type and application frequency assessment
T Cartner1, AV Rawlings2*, A Saud1, MS Bailey3, PL McOsker3, BT Carr4
1
GOJO Industries, Inc., Akron, OH, USA; 2AVR Consulting Ltd, Cheshire, UK;
3
North Cliff Consultants, Inc., Cincinnati, OH, USA; 4Carr Consulting, Wilmette,
IL, USA
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P99
Introduction: As high Hand Hygiene Compliance (HHC) and AlcoholBased Hand Rub (ABHR) together play a significant role to reduce the

P100
P100: Efficacy of alcohol-based and non-alcohol hand rubs after a
single use and repeated use
DR Macinga1,2*, S Edmonds1, R McCormack3
1
GOJO Industries, Inc., Akron, OH, USA; 2Northeast Ohio Medical University,
Rootstown, OH, USA; 3Bioscience Labs, Bozeman, OH, USA
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P100
Introduction: Alcohol-based hand rubs (ABHR) vary in the type and
concentration of alcohol used, and may include secondary active
ingredients such as chlorhexidine gluconate (CHG). Alcohol-free handrubs
based on quaternary ammonium compounds (QAC) may also be found in
healthcare settings.
Objectives: The objective of this study was to compare the efficacy of
hand rubs containing different active ingredients after both single and
repeated use at application volumes and test conditions closely
representing clinical use conditions.
Methods: Five commercial handrubs; Product A (70% ethanol), Product B
(62% ethanol), Product C (63% 2-propanol), Product D (0.13%
benzalkonium chloride (BAK)), and Product E (70% 2-propanol + 0.5%
CHG) were evaluated according to ASTM E 2755. Fifteen test subjects
evaluated each product at an application volume of 1.5 ml, which was
rubbed over all surfaces of the hands until dry. Products were evaluated
after a single application and after 10 hand contamination and product
application cycles. All subjects used an internal reference (1.5 ml of 60%
2-propanol, rubbed until dry) prior to test product evaluation. Log 10
reductions from baseline were calculated and statistical analysis
conducted to compare products to each other and each product to its
reference.
Results: After a single use, ABHR obtained reductions equivalent to the
internal reference. Product D (0.13% BAK) obtained a 1.70 log10 reduction,
which was inferior to the reference and all ABHR (P<0.05). After 10
consecutive uses, log10 reductions for products A, B, C, D, and E were 4.37,
1.86, 3.82, 1.28, and 1.45, respectively. Products A and C were statistically
superior to the reference, whereas Products B, D, and E were statistically
inferior to the reference. Product A was statistically superior to all other
test products.

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Conclusion: Alcohol-based handrubs performed similarly after a single use


but significantly different with repeated use. Alcohol type and
concentration were not strong predictors of product performance and
inclusion of CHG did not improve efficacy over repeated use. These data
indicate that overall product formulation is a critical component of product
efficacy, and it is inappropriate to assume product performance based
solely on the identity and concentration of active ingredients.
Disclosure of interest: None declared.

Methods: Five fingertip imprints of the dominant hand of 134 healthcare


workers (HCWs) were sampled to establish the average bacterial count
before and after hand hygiene action using: 1) alcohol-based handrub
(ABHR); 2) plain soap and water handwashing with filtered and unfiltered
water; 3) 4% chlorhexidine gluconate (CHG) hand antisepsis with filtered
and unfiltered water.
Results: Average bacterial contamination of hands before hand hygiene
was 1.65 log 10 . Acinetobacter baumannii, Klebsiella pneumonia, and
Staphylococcus aureus were the most commonly isolated bacterial
pathogens. Highest average count before hand hygiene was recovered
from HCWs without direct patient contact (2.10 0.11 log10). Bacterial
counts were markedly reduced after hand hygiene with ABHR (1.4 log10;
p<0.0001) and CHG with filtered water (0.8 log 10 ; p<0.0001). Use of
unfiltered water was associated with non-significant reduction in bacterial
counts.
Conclusion: HCWs carry high levels of bacteria on their dominant hand,
even without direct patient contact. ABHR as an additional step may
overcome the effect of high bacterial counts in unfiltered water when
soap and water handwashing is indicated.
Disclosure of interest: None declared.

P101
P101: Product dose considerations for real-world hand sanitiser efficacy
J Hines1*, P Alper2, A Voss3, A McGeer4
1
Research & Development, Deb Group Ltd, Derby, UK; 2Business
Development, Deb Worldwide Healthcare Inc, Brookline, MA, USA; 3CanisiusWilhelmina Hospital, Nijmegen, the Netherlands; 4Mount Sinai Hospital,
Toronto, ON, Canada
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P101
Introduction: Alcohol based hand rubs (ABHRs) are extremely effective at
reducing microbial contamination and are central to established best
practices for hand hygiene. Modern dispensing systems have brought
benefits such as hygienically sealed cartridges with integral pumps for
dosing liquids, gels or foams. A remaining issue concerns the measured
efficacy of such products and their use in practice as dictated by pump
volume.
Objectives: ABHRs for professional use must demonstrate efficacy through
standard in-vivo tests; either EN1500 or ASTM E1174. Products typically
pass such tests using standard doses not necessarily related to real use by
healthcare workers. In this study we set out to identify the optimal dose
for an ABHR product based on observation of real behavior.
Methods: Data from the DebMed GMS Hand Hygiene Monitoring System
was used to establish product dose applied in clinical settings via the
number of dispenser presses per hand hygiene event. In a separate study
healthcare workers applied ABHR using best-practice methodology to
establish product drying time as a function of dose. Hand coverage was
assessed using a laboratory method based on product coverage. In-vivo
efficacy was established using both ASTM E1174 and EN 1500 methods.
Results: Healthcare workers intuitively calibrate ABHR dose based on
drying time, hand coverage and product ergonomics. In our studies using
Deb dispensers, over 90% of healthcare workers used a single pump of
ABHR, even when multiple pumps are indicated. Our studies established
that 1.5ml of ABHR in foam format dries in approximately 30 seconds and
fully covers most hands. Both ASTM 1174 and EN 1500 tests confirmed
that 1.5ml of Deb ABHR in foam format with 30 seconds contact time was
sufficient to provide effective hand hygiene.
Conclusion: Product drying time, hand coverage and measured efficacy
data are considered to determine the optimal dose for an ABHR in foam
format dispensed from a sealed cartridge wall-mounted unit. This is
combined with observed behaviour of healthcare workers to design a
pump that delivers the optimal dose in a single press, connecting for the
first time measured in-vivo efficacy standards with real-world use to
ensure effective sanitization.
Disclosure of interest: None declared.

P102
P102: Healthcare workers hand contamination levels and antimicrobial
efficacy of different hand hygiene methods used in a Vietnamese
hospital
S Salmon1*, ML McLaws1, TA Truong2, HV Nguyen2, D Pittet3
1
UNSW Medicine, UNSW, Sydney, Australia; 2Infection Control, Bach Mai
Hospital, Ha Noi, Vietnam; 3University of Geneva Hospitals and Faculty of
Medicine, Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P102
Introduction: The quality of water in Viet Nam for handwashing with
soap or other disinfectant solutions is unknown. We assessed the risk for
hand contamination and compared the efficacy of five hand hygiene
methods to remove bacterial contamination in a tertiary Vietnamese
hospital.

P103
P103: Contamination risk of alcohol-based hand disinfectants and skin
antiseptics with bacterial spores
K Steinhauer1*, B Meyer2, C Ostermeyer3, H-J Rdger4, M Hintzpeter5
1
Product Development Hygiene / Bioscience, Schlke & Mayr GmbH,
Norderstedt, Germany; 2Ecolab Deutschland GmbH, Dsseldorf, Germany;
3
Bode Chemie GmbH, Hamburg, Germany; 4Lysoform Dr. Hans Rosemann
GmbH, Berlin, Germany; 5B. Braun Melsungen AG, Melsungen, Germany
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P103
Introduction: Alcohol-based products are regarded as most appropriate
in hand disinfection and in skin antisepsis. While alcohols have an
immediate microbicidal effect against all vegetative microbial forms, they
do not readily kill bacterial spores. This fact raised the question of the
contamination risk of alcohol-based hand disinfectants and skin
antiseptics with bacterial spores.
Objectives: The aim of this study was to evaluate the overall risk of hand
disinfectants and skin antiseptics to get contaminated with bacterial
spores throughout the production process. Additionally the risk of
contamination with bacterial spores throughout the subsequent in-use
period was investigated.
Results: Besides raw materials, primary packaging was identified as a
potential source of bacterial spores. Investigation of a total of 625
containers did not yield any microbial growth in 542 cases. Median
colony count for aerobic spore-forming bacteria was 0.2 cfu/10 ml
container content. No anaerobic spore-forming bacteria were detected.
Additionally, long-term survival of bacterial spores in aliphatic C2-C3
alcohols was investigated. 1-propanol was found to reduce the number
of spores most effectively, with 2-propanol and ethanol having a
somewhat less pronounced impact. Thus 1-propanol was found to give
reduction rates of 1.35 lg after 7 weeks contact time at a concentration
of 30% (v/v), and viability of B. subtilis spores was further decreased to
> 1.5 lg by 30% (v/v) 1-propanol after 14 weeks.
Exemplary in-use tests of a typical hand disinfectant and a typical skin
antiseptic did not detect any microbial contamination or change in the
physico-chemical properties of the tested products over 12 months.
Conclusion: Investigation of primary packaging material and in-use were
found not to pose a hygienic risk for typical alcohol-based disinfectants
regarding bacterial spores. Data from this study revealed that hygienic
safety regarding contamination with bacterial spores can be achieved if
appropriate production processes are in place. In order to control
hygienic safety of alcohol-based hand rubs and antiseptics, a microbial
limit of <1 cfu/10 ml is suggested as a quality-control threshold for
finished goods.
Disclosure of interest: K. Steinhauer Employee of Schlke & Mayr GmbH,
B. Meyer Employee of Ecolab Deutschland GmbH, C. Ostermeyer
Employee of Bode Chemie GmbH, H.-J. Rdger Employee of Lysoform
Dr. Hans Rosemann GmbH, M. Hintzpeter Employee of B. Braun
Melsungen AG.

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P104
Abstract withdrawn

Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P104

P105
P105: Efficacy of a virucidal surgical handrub
Y Kumashita*, P Mohan, M Mine, M Yamamoto
Biochemical laboratory, Saraya CO. LTD., Osaka, Japan
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P105
Introduction: Various alcohol (EtOH (ethanol), IPA (isopropanol) and PA
(n-propanol)) and acid (Phosphoric acid and Lactic acid) combinations
were evaluated to come up with a hand antiseptic formula that is
virucidal (EN14476) and effective as a surgical handrub (EN12791) at a
short contact time.
Methods: Screening tests using bacteriophage MS2 was performed, and
combinations with good results were identified. These combinations were
tested in accordance with EN14476 againt poliovirus, adenovirus, and
feline calicivirus. The alcohol and acid combination with the best results
was chosen, and an emollient was then added. This formulation was
evaluated in accordance with several EN standards including EN12791.
Skin irritation was also investigated.
Results: The mixture of EtOH (ethanol), PA (n-propanol) and Phosphoric
acid exhibited the greatest efficacy among the combinations tested.
When tested against EN standards for hand antiseptic, it was shown to
meet EN14476 virucidal handrub and EN12791 surgical handrub
requirements in relatively short contact times, less than 1 minute and
1 minute, respectively.
Conclusion: The handrub formulation containing EtOH, PA and
Phosphoric acid exhibited excellent bactericidal and virucidal efficacy at a
relatively short contact time and had lower skin irritation, suggesting that
it is suitable for fast-acting hand disinfection.
Disclosure of interest: None declared.

P106
P106: Towards a new methodology in hygienic handrub testing
M Wilkinson1, DR Macinga2,3*, C Bradley1, J Arbogast3, B Okeke3, F Brill4,
A Fraise1
1
University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK;
2
Northeast Ohio Medical University, Rootstown, OH, USA; 3GOJO Industries,
Inc., Akron, OH, USA; 4Dr. Brill + Partner GmbH, Hamburg, Germany
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P106
Introduction: Internationally-recognized standards for evaluating alcohol
based hand rubs (ABHR) differ significantly in methodology and success
criteria. Hand hygiene authorities including the WHO and U.S. CDC have
recognized inherent weaknesses with the current methods and have
highlighted the need for improved in vivo efficacy methods, which reflect
the use conditions and experience of healthcare practitioners.
Methods: Variables within the European Standard EN1500 (Hygienic
Handrub) method and ASTM standard E2755-10 method, including
methods of hand contamination and modes of recovery, were tested on
their ability to provide a consistent, robust method for testing ABHR.
Results: The EN1500 method of contamination did not allow for hands to
be sufficiently dry to adequately test smaller volumes of ABHR, typical of
healthcare practitioner use. Whilst the ASTM E2755 method did allow for
the hands to be sufficiently dry, the glove-juice sampling technique of
recovery was more cumbersome and led to a higher limit of detection, and
thus potentially poor discrimination between products (2 x 3ml of 60% v/v
propan-2-ol gave a mean log10 RF of 3.65; standard deviation 0.472). A
hybrid method consisting of the ASTM E2755 method of contamination
with an EN1500 method of recovery resulted in baseline recoveries of
Escherichia coli K12 that were relatively low (mean log10 precount of 5.57;
standard deviation 0.615). A hybrid method comprising the contamination
of fingerpads with small volumes of microbial broth, coupled with the

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EN1500 method of recovery, appeared to yield a robust method that


allowed dry hands to be tested with ABHR, with a low limit of detection
(2 3ml of 60% v/v propan-2-ol gave a mean log10 RF of 5.62; standard
deviation 1.108).
Conclusion: Whilst further work is needed, it appears that a method
involving the contamination of fingerpads, followed by the EN1500
method of recovery, may be a suitable candidate for inclusion in a single,
globally-recognized in vivo efficacy standard, which would be more
predictive of ABHR performance under clinical use conditions.
Disclosure of interest: None declared.

P107
P107: Moving from standard alcoholic hand rub dispensers to a
wireless LAN based system with continuous monitoring: evaluation
after one year
B Batzer1*, S Scheithauer1,2, C Pino Molina3, A Widmer1
1
Infection Control, Unispital Basel, Basel, Switzerland; 2Infection Control &
Infectious Diseases, University Hospital Aachen; RWTH Aachen, Aachen,
Germany; 3Hematology, Unispital Basel, Basel, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P107
Introduction: Improving hand hygiene compliance is a cornerstone of any
infection control program. Manual observation temporarily improves
adherence, but is time-consuming and rarely feasible long term. Electronic
counting dispensers allowing real time assessment and feedback of hand
hygiene events (HHE) are an effective tool for monitoring compliance
24/7/365.
Objectives: The aim of the study was to evaluate utility and acceptance,
and to identify possible shortcomings of the Ingo-man Weco (Ophardt
Hygienetechnik, Issum; Germany).
Methods: In January 2012 all dispensers (N=63) at a 13 bed hematology
ward with approximately 100 transplantations/year were exchanged by
Ingo-man Weco. The energy for the data transfer derived from pulling the
lever of the dispenser, no battery is necessary or power lines. A built-in
wireless recording equipment sending the information to a server. HHE
event is defined as two activities maximum 2 seconds apart. All HHEs were
continuously recorded from 03-09/12 and could be analyzed dispenser-,
day-, shift-, localization-specifically. At the hematology ward about 280
patients referring to 3600 patient-days were cared for annually.
Results: Overall, 3 dispenser were placed in the each patient room, 13 in the
hallways, and 11 at nursing stations and others locations. The new devices
were well accepted without handling problems. During the pilot phase, 13
dispensers with very low activities were identified and subsequently
relocated.
During the 7-month lasting study, a total of 123171 HHE could be
documented. The majority (65683/123171; 53%) occurred at dispensers
located at patients door entry. Only 8% (10276/123171) referred to
dispensers located in the patient rooms.
Four (6%) dispensers went broken. Two of them were located at the
laminar air flow benches, the damage was probably driven by the UV
exposition.
Conclusion: The Ingo-man Weco is an easy to install and ready to use
device, requiring no battery or power installation, that offers 24/7/365
data on hand hygiene activities. It allows improving dispensers location,
and continuous monitoring.
Disclosure of interest: None declared.

P108
P108: Evaluation of hand hygiene products usability for health-care
workers
SY Baik1*, EK Kim1, SK Hong2
1
Infection Control Office, CHA Bundang Medical Center, CHA university,
Seongnam-si, Gyeonggi-do, Korea, Republic Of; 2Department of Internal
Medicine, CHA Bundang Medical Center, CHA university, Seongnam-si,
Gyeonggi-do, Korea, Republic Of
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P108
Introduction: Hand hygiene is known as the fundamental element for
preventing health-care associated infection. The WHO recommends to
select products in consider of user acceptance. We conducted a survey

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about hand hygiene products usability of health-care workers(HCWs) in


order to figure out problems and utilize in next activity.
Methods: On December 2009, A self-administered questionnaire survey
on HCWs was carried out during 2 weeks in teaching hospital of 865
beds in Korea. The questionnaire was composed of 24 questions in 3
categories: 1) general characteristics 2) hand hygiene practice 3) hand
hygiene product usability. The retrieved answers were analyzed by
descriptive statistical analysis.
Results: The survey was returned by 554 HCWs. The majority of participants
were female (87.2%) and average age was 29.4 (SD=6.15). In profession,
participants were consisted of nurses (62.8%), technologists (17.5%), nursing
assistants (14.6%) and physicians (4.2%). On the perception of practice,
65.7% of HCWs answered they had 10-30 occasions for hand hygiene per
day and 44.6% of HCWs reported self-administered compliance by 50-80%.
In usability, antimicrobial liquid soap (49.1%) was preferred to alcohol gel
(31.6%). The most cleansed part was palm (62.3%) and uncleansed part was
wrist (43.1%)and fingertip (29.8%). The reasons of non-compliance were too
busy (63.5%), skin reaction (20.2%), lack of perception (19.9%), and resource
shortage (17.5%). Many HCWs experienced skin irritation (52.7%). HCWs
thought that alcohol gel is convenient (76.7%), makes hands dry (55.1%),
dry faster (27.1%) and the antimicrobial liquid soap makes hands dry
(51.6%), foam insufficiently (24.7%), inconvenient (14.1%).
Conclusion: In this study, HCWs self-administered performance is end up
in middle level. Also, HCWs frequently misuse products, clean hands in
inappropriate way and have various skin problems. It revealed needs for
education about hand hygiene method, products usage and choice of
products. We suggest further study about knowledge and perception
among HCWs to improve hand hygiene compliance.
Disclosure of interest: None declared.

Objectives: In order to assess the influence of signal coloured hand


disinfectant dispensers the number of dispenser activities was
documented and analyzed in comparison to historical data and with
respect to the number of health-care workers.
Methods: In a 14-bed cardiology ICU all 25 standard dispensers were
exchanged with signal-coloured dispensers (Ophardt Hygiene-Technik;
Issum, Germany). Dispenser activities were documented dispenserspecifically for 12 weeks and analyzed by week. The use of gown
pocket dispensers was forbidden during the investigation. Health care
workers had been trained in hand hygiene for the last three years
continuously.
Results: A total of 81654 dispensers activities translating to 40827 hand
rubs were documented with the majority (72%) occurring at patient-near
dispensers (58852 activities, 29426 hand rubs). There was no timedependency with dispenser activities ranging from 6119 to 8026 per
week. Taking the number of patient days into consideration these
activities led to 39 to 41 hand-rubs per patient day. This ranges between
the 75. and 90. percentile in the national benchmark. Comparison with
historical data revealed no difference. However, the nurse to patient ratio
decreased during the study period by 8.5%. Taking an increased
workload into consideration (hand rubs divided by patient-days and
number of health-care workers) revealed a 6% increase in staff-adjusted
compliance.
Conclusion: Signal-coloured dispensers seem to be a useful additional
tool to improve and maintain hand hygiene compliance even in ICUs
with an already good hand hygiene compliance.
Disclosure of interest: None declared.

P109
P109: Evaluation of the tolerability and acceptability of alcohol-based
hand rub for hand hygiene at Fann Hospital
F Djiby*, Bara Ndiaye, Mery Dia
Fann Hospital, Dakar, Senegal
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P109
Introduction: The use of alcohol-based hand rubis an indirect marker of
the effective implementation of hand hygiene. Caregivers are in direct
contact with patients on a daily basis and use the alcohol-based hand
rub during health care. Discomforts of use of this product seem to be
reported by some practitioners.
Objectives: That is why we are interested in evaluating the tolerability and
acceptability of the product at Fann Hospital in the exposed workers.
Methods: Among caregivers, 40 using the alcohol-based hand rubfor hand
hygiene routine for at least 30 days were subjected to a questionnaire.
Approximately 10 minutes were necessary to complete the questionnaire. A
subjective assessment by the participant on risk factors for skin lesions,
product acceptability and tolerance was thus achieved through the
questionnaire.
Results: Nodermalaggression was reported byinterviewed caregivers.Only
5of the 40 caregivers exposed reported unpleasant odor of alcohol-based
hand rub. All caregivers interviewed reported easy use of the alcoholbased hand rub.
Conclusion: Alcohol-based h and rubs are acceptable and well tolerated
by practitioners during normal use. However, there vision of the WHO
formula for making the product should be considered in the context of
international conferences to improve the smell of the product, a factor
limiting its use.
Disclosure of interest: None declared.

P110
P110: Influence of signal coloured hand disinfectant dispensers on
compliance at an intensive care unit
S Scheithauer*, H Haefner, J Schroeder, K Lewalter, V Krizanovic, S Lemmen
University Hospital Aachen, RWTH Aachen, Aachen, Germany
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P110
Introduction: Improvement of hand hygiene compliance in all-day
setting is crucial and thus a multifaceted approach is generally advocated.

P111
P111: It is not in your hands!
N Damani1*, P Yew2, S Wallace1
1
Infection Prevention and Control, Southern Trust, Craigavon, UK; 2Infection
Prevention and Control, South Eastern Trust, Belfast, UK
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P111
Introduction: Hand hygiene (HH) is well-recognised as part of best
practice in preventing cross infection. In light of the P. aeruginosa
outbreak in neonatal units in the UK, it is recommended that healthcare
workers (HCWs) should routinely use alcohol hand rub after hand
washing in all augmented care areas. Since this practice may lead to
dermatitis, we have conducted this study to assess whether use of
alcohol hand rub was necessary after hand washing (HW) as we were
unable to find any scientific papers to support this recommendation.
Methods: 18 HCWs were recruited for this study. Participants were asked
to perform the 6-step technique for HW using soap and water for 40-60
seconds from P. aeruginosa contaminated tap water. After HW, plate
impressions were performed from wet fingers and thumbs of both hands
onto horse Blood Agar (BA). Participants were then divided equally into
two groups; one group was instructed to air dry their hands and another
group to dry their hands with disposable paper towels. Impressions from
dry fingers and thumbs was taken to BA again from both groups.
Following this, all participants were instructed to decontaminate their
hands with 3 ml of alcohol hand rub for 20-40 seconds and the process
was repeated again for the 3rd time. All BA plates were then incubated at
35oC (aerobic) and read at 24 and 48hrs with colony forming unit (cfu)
counts performed and recorded.
Results: At the beginning of the study, 1500 cfu and 5000 cfu per 100ml
of P. aeruginosa was from hot and cold water taps respectively. At the
end of the study, water was resampled for P. aeruginosa which showed 0
cfu and 200 cfu per 100ml from hot and cold water taps respectively. No
P. aeruginosa was isolated in any of the BA plates from 18 HCWs even
when the hands were wet and washed with P. aeruginosa contaminated
tap water. However, significant reduction in the number of all organisms
on hands was noticed when the alcohol hand rub was used.
Conclusion: Use of alcohol hand rub is the method of choice for hand
hygiene on physically clean hands. Based in this small study, we can
conclude that provided that HW is carried out properly and hands are
dried, further antisepsis of hands with alcohol hand rub after HW is not
necessary. Further study is needed to confirm our findings.
Disclosure of interest: None declared.

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P112
P112: Hand hygiene practice in new zealand hospitals one year into
the hand hygiene New Zealand programme
JT Freeman*, Christine Sieczkowski, Louise Dawson, Hayley Callard,
Andrew Keenan, Sally Roberts
Auckland District Health Board, Auckland, New Zealand
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P112
Introduction: Hand Hygiene New Zealand (HHNZ) is a national quality
improvement programme funded since June 2011 by the Health Quality
and Safety Commission (HQ & SC). The goal of HHNZ is to use the World
Health Organization (WHO) 5 Moments model to improve hand hygiene
compliance nationally. During its first year, HHNZ has benefitted enormously
from support provided by the Hand Hygiene Australia (HHA) programme.
Benefits have included auditor training sessions in NZ led by HHA auditors,
use of the HHA Smartphone auditing application and the HHAcomputerised
data management system.
Methods: For the four monthly audit period ending 31 October 2012, all
20 District Health Boards (DHBs) in NZ submitted data. The total number
of moments audited was 29128 and correct hand hygiene was performed
on 18095/29128 occasions, giving an overall compliance rate of 62.1%
(range: 61.6%-62.7%). When examined by healthcare worker category,
medical practitioners had the lowest rate (57.1%) and phlebotomists the
highest (72.5%). When examined by Moment; higher rates were
observed for after moments than before moments (before patient
contact 56.6% versus after patient contact 71.1%; and before a
procedure 55.7% versus after a procedure or body fluid exposure risk
67.2%).
Conclusion: These results indicate that although there is still much work
to be done, the HHNZ programme is gaining traction in NZ hospitals at the
end of its first year. Important strategies for the coming year include
launching educational initiatives specifically targeting senior doctors and
medical opinion leaders. Such initiatives will focus on when and why
hand hygiene is necessaryto ensure patient safety. Finally, collaboration
with HHA during the last year has been hugely beneficial for the HHNZ
programme andprovides a potential model for future international
collaborations.
Disclosure of interest: None declared.

P113
P113: The World Health Organization multimodal hand hygiene
improvement strategy - a successful experience in a pediatric hospital
AM Ribeiro*, Francisca Luzilene Nogueira Della Guardia,
Virginia Maria Ramos Sampaio, Rivnia Andrade Barros, Diana Maria da Silva,
Maria Mrcia de Sousa Cavalcante, Michely Pinto de Oliveira
Control Infection, Hospital Infantil Albert Sabin, Fortaleza, Brazil
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P113
Introduction: The impact of hand hygiene (HH) in the healthcare associated
infection (HAI) control is already proven. Aiming toimprove adherence to HH,
the Hospital Infantil Albert Sabin (HIAS) implemented the World Health
Organization (WHO) multimodal hand hygiene improvement strategy since
January 2009 and has developed an action plan for its sustainability for the
next five years.
Objectives: Evaluate the outcomes of implementation of the WHO
strategy by analyzing rates of adherence to HH practice by health
workers (HW) and HAI rates, in the period from 2009 to 2012.
Methods: The strategy was implemented in three intensive care units
(ICU) with 32 beds and 240 health workers of a Pediatric Brazilian Hospital.
The protocol followed the WHO recommendations. Compliance to hand
hygiene was monitored by direct observation. The first evaluation of hand
hygiene was conducted in March 2009, before theintervention phase of
the WHO strategy. The second evaluation was immediately after
intervention phase, also in 2009. Two more evaluations were realized in
2010, three in 2011 and three in 2012. The HAI were identified by active
search and the rates calculated according to Portaria 2616/98 Brazil
Ministry of Health. The program Epi Info 6 was used to analyze data.
Results: The average annual rate of adherence to hand hygiene of three
units for the years 2009, 2010, 2011 and 2012 were respectively: 50.8%,

Page 63 of 143

73,8%, 78,8% and 85,8%. HAI incidence density in three ICUs before the
implantation of the strategy (2008) was 21.3 infections per thousand
patient/days. In 2009, 2010, 2011 and 2012 were respectively 17.4; 17.8;
12.6 and 12.2 infections per thousand patient/days.
Conclusion: Increased adherence to HH practices during the study period
and decreased density of nosocomial infection at the same time
demonstrate the successful implementation of this strategy.
Disclosure of interest: None declared.

P114
P114: Gombe Hospital hand hygiene project
L Haruna
Health, Gombe Hospital, Kampala, Uganda
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P114
Introduction: Gombe Hospital is a 100-bed rural General public hospital
situated 70 km west of Kampala, Butambala district in Uganda. Its
catchment area is 300,000 people. The hospital staffing is 55% of the
recommended. The hospital is facing a problem of inadequate water
supply. This therefore made the observation of hand hygiene (HH) as
recommended by WHO very difficult for both healthcare workers (HCW)
and patients leading to high rates of healthcare-associated infections
(HAI). Therefore a HH project was launched.
Objectives: To strengthen hospital infection control in the context of
inadequate water supply.
Methods: Alcohol-based handrub (ABHR) were installed in wards and
pocket size bottles were provided to HCWs, following training of all
HCWs and how to use ABHR. HCWs were monitored for their compliance
with the WHO 5 moments of HH periodically and compliance rates
calculated. The hospital also registered with WHOs Clean Care Safer Care
campaign as part of its commitment to Patient Safety.
Results: HCWs compliance with the WHO five moments increased from
31% to 69% within 6 months of project implementation reflecting a
positive change in attitude of HCWs towards HH. There was variation in
compliance between departments and individual HCWs which was
attributed to HCW attitudes, use of gloves, and time constraint. During a
two weeks period when there was totally no water in the hospital
operating theatre, ABHR was the only solution used for pre-operative
scrubbing in 14 major operations and observed post-operative outcomes
was the same as in the formal scrubbing when water and soap were used.
Reduction in sepsis cases in maternity ward and in cross infection of
diarrhea cases among the children in pediatrics ward was observed, as
well as reduction in duration of hospital stay. ABHR was used also regularly
by attendants and patients on the wards contributing to the noted
reduction in ward sepsis.
Conclusion: Compliance progressively improved over time which was an
indication that HCWs owned the project and integrated the 5 WHO
moments of HH concept. In Uganda and countries where health facility
infrastructure is usually poor including no access to clean water, ABHR
has big potential to improve hygiene condition without minimal
expenditure on infrastructure renovation.
Disclosure of interest: None declared.

P115
P115: Sustained improvement of hand hygiene practice at Tianjin
Infectious Disease Hospital, China
B Gao1*, J-G Dai1, J-P Ma1, W-Y Zhu2, L Liu2, W Lu3
1
Nosocomial Infection Control Unit, Tianjin Second Peoples Hospital, Tianjin,
China; 2Graduate School, Tianjin Medical University, Tianjin, China; 3Tianjin
Second Peoples Hospital, Tianjin, China
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P115
Objectives: To persistently improve HCWs hand hygiene compliance
within an infectious disease hospital in China.
Methods: New technical tools were supplemented and coordinated
within a tertiary teaching infectious disease hospital based in 2011 and
2012 on base of the series of interventions conducted during the five
preceding years. New tools included training of HCWs as trainer to train
hand hygiene to patients and visitors, implementing hand hygiene in

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Health Education to patients admitted, introducing artistic hand hygiene


video play in hospital waiting-hall, and audits being rich efficiency, etc.
Hospital-wide one-day prevalence surveys of NI were performed annually
by HELICS version 7.0 around the end of October of 2011/12. Hand
hygiene opportunity (based on the WHO 5 Moments) data were collected
through direct observations.
Results: During 603.7 hours in 2011 and 657.7 hours in 2012 of observation,
6,690 and 12,442 hand hygiene opportunities were identified respectively.
The trends of consumption of alcohol-based hand rub by HCWs of the
whole hospital administration units increased from 11.624 L/1,000 patientdays in January 2011 to 12.578 L/1,000 patient-days in December 2012
(p<0.001). Compliance with hand hygiene increased significantly from
68.52% in 2011 to 83.50% in 2012 (p=0.000). The one-day prevalence of NI
within the whole hospital decreased from 0.77% (2/260) in 2011 to 0.00%
(0/219) in 2012 (p=0.010).
Conclusion: Multi-modal strategies continuously introduced new
technical tools were necessary to sustained improvement of hand
hygiene compliance with concomitant reduction in nosocomial infections.
Disclosure of interest: None declared.

P116
Abstract withdrawn

Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P116

P117
P117: Hand hygiene compliance in intensive care units in the
Madrid region
M Cantero Caballero, P Rodriguez*, R Pla, AB Jimenez, A Sanchez, C Rodriguez
Department of Preventive Medicine and Quality Management, General
University Hospital Gregorio Maran, Madrid, Spain
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P117
Introduction: HH compliance rates are universally low, leading to
unacceptably high rates of healthcare associated infections (HAI). Sice
2010, the Madrid Regional Healthcare System has implemented a regional
strategy to improve HH compliance, following the WHO multimodal
strategy. HAI rates are especially high in intensive care units (ICU);
therefore an effort should be made to evaluate the HH compliance in
these units.
Objectives: The aim of our study was to evaluate the HH compliance in
ICUs in the Madrid Region after the implementation of a multimodal
strategy.
Methods: Direct observation according to the WHO observation method
was performed before and after the implementation of the multimodal
strategy in 22 medical ICUs belonging to the hospitals of the Madrid
Regional Healthcare System during March and April 2010 and 2011 by
previously trained and evaluated health care professionals.
Results: We observed 1413 HH opportunities in 2010 and 1614 in 2011.
HH compliance was 36,9% (95%CI: 34,4-39,4) in 2010 and 45,11% (95%CI:
42,7-47,5) in 2011. HH compliance rates according to My five moments
for hand hygiene in 2010/2011 were: 1. Before touching a patient 27,1/
38,7%; 2. Before clean/aseptic procedure: 16,3%/21,9%; 3. After body fluid
exposure risk: 40,0%/52,0%; 4. After touching a patient: 57,9%/64,4%;
5. After touching patient surroundings: 29,8%/29,0%. When analyzed by
professional category, nurses achieved the highest HH compliance rates
(43,3%/47,6%) while physician residents ranked the worst (18,2%/15,2%)
in the 2 years of observation. Alcohol-based solutions were used in 55,7%
of the opportunities in 2010 and in 58,0% in 2011.
Conclusion: Despite the fact that HH compliance improvement was
statistically significant after the implementation of a multimodal strategy,
acceptable HH compliance remains an objective yet to be achieved in
ICUs where its compliance should be a must. Lack of hand hygiene is
highly worrisome in the before moments and in physician residents,
and interventions should target these problems.
Disclosure of interest: None declared.

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P118
P118: Implementation of the World Health Organization multimodal
hand hygiene improvement strategy in a pediatric Brazilian hospital
AM Ribeiro*, Francisca Luzilene N Della Guardia, Fernanda Calixto Martins,
Virginia Maria Ramos Sampaio
Control Infection, Hospital Infantil Albert Sabin, Fortaleza, Brazil
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P118
Introduction: Hand hygiene is the cornerstone measure to prevent
healthcare associated infection (HAI) and to ensure safe patient care. To
improve compliance to hand hygiene (HH) and, decrease HAI, the
Hospital Infantil Albert Sabin (HIAS) implemented the World Health
Organization (WHO) Multimodal Hand Hygiene Improvement Strategy.
Objectives: Assess the effectiveness of this strategy in terms of
adherence to hand hygiene practice in a Pediatric hospital in Brazils
northeast.
Methods: The project was supported by the Brazilian government which
formally signed an agreement in November 2007 to participate in the World
Alliance for Patient Safety. The HIAS was selected by the National Health
Surveillance Agency (ANVISA) Sentinel Network. The methodology followed
the recommendations of the WHO and the original design was applied in
three intensive care units (ICU) with 32 beds and 240 health workers in the
period from 2008 to 2009. Compliance to hand hygiene was monitored by
direct observation before and after intervention in the five moments
indicated. The program Epi Info 6 was used to analyze data.
Results: The rate of adherence to hand hygiene was 42% before
intervention and 57.8% after intervention, an increase of 32% (p < 0.001).
The nursing technicians showed the lower adherence rate to HH before
the intervention (35.5%), that increased to 56.1% after the intervention
(p < 0.001). Adherence to HH before touching the patient rate was
38.9% before and 59.7% after intervention (p < 0.001). There was an
increased use of alcohol gel from 8% to 62% in the actions of HH.
Conclusion: It was found an increase in hand hygiene adherence by
health workers in all three ICU during the implantation of the WHO
multimodal strategy. This strategy will be implemented in all areas of the
hospital care.
Disclosure of interest: None declared.

P119
P119: Hand hygiene compliance among nurses in a Japanese tertiary
hospital emergency department
S Ikeda1, K Tokuda2*, H Kanamori2, Y Hirai1, S Endo2, H Kunishima2, M Kaku2
1
Infection Control Unit, Tohoku University Hospital, Sendai, Japan;
2
Department of Infection Control and Laboratory Diagnostics, Internal
Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P119
Introduction: In June 2012, the number of patients in whom MRSA was
detected increased in our hospital emergency department. As hospitalacquired infection was suspected in some of the patients, we conducted
observation-based evaluation of hand hygiene practices.
Objectives: To evaluate the status of hand hygiene compliance in nurses
working at the emergency department.
Methods: We conducted a total of 11 surveys between June and August
2012 on the status of hand hygiene compliance in 60 nurses at the
emergency department. Two infection control practitioners investigated
the five moments requiring hand hygiene. The survey form developed by
WHO was used. For statistical analysis, chi-square test was conducted
using Epi Info 3.5.4.
Results: A total of 435 moments requiring hand hygiene were observed,
including 64 moments before touching a patient (Moment 1), 112
moments before a clean/asceptic procedure (Moment 2), 40 moments
after body fluid exposure (Moment 3), 99 moments after touching a
patient (Moment 4), and 120 moments after touching patient
surroundings (Moment 5). The median of overall compliance rates was
38% (range, 21-69%). The compliance rate was the highest for Moment 3
at 52.5%, followed by Moment 4 at 47.5%, Moment 5 at 35.0%, Moment
2 at 33.9%, and Moment 1 at 33.9%. With regard to Moments 2 to 4, the
compliance rates in nurses wearing gloves were significantly lower than
those not wearing gloves.

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Conclusion: Our data showed that the overall compliance rate in the
emergency department was low as previously reported in other countries.
However, we found that there were differences in compliance rates by
moment, and the compliance rates were particularly low before touching
a patient and before a clean/asceptic procedure. Therefore, education
targeting moments with low compliance rates will be required. As the
compliance rate was unexpectedly low when gloves were worn, reeducation concerning appropriate use of gloves is considered to be
necessary.
Disclosure of interest: None declared.
Reference
1. Erasmus V, Daha TJ, Brug H, Richardus JH, Behrendt MD, Vos MC, van
Beeck EF: Systematic review of studies on compliance with hand
hygiene guidelines in hospital care. Infect Control Hosp Epidemiol 2010,
31(3):283-94.

Introduction: Evidence of the role of hand hygiene (HH) in reducing


morbidity and mortality rates associated with infection stimulated the
creation of the Clean Hands project.
Objectives: To present the experiences and outcomes of the project
Clean Hands that, over the past seven years, has developed a program
to encourage hand hygiene.
Methods: The project is based at the Center for Studies and Nursing
Research for the Prevention and Control of Healthcare Associated
Infections (NEPIH) at the School of Nursing, Federal University of Gois/
Brazil, and has developed activities to encourage HH since 2006 within
the healthcare establishment, with professionals, academics, patients and
caregivers; municipal daycare centers, with children, parents, and workers;
and in scientific events, with academics and healthcare professionals.
Strategies that have incentivized compliance with HH procedures:
informative stylized banners depicting HH; educational brochures, a song
parody CD, demonstration of proper HH technique, using poster paints
on childrens hands; a puppet theater and face-to-face discussions about
the importance of, obstacles to, and benefits of HH. Annually, the project
hosts a festival of parodies about HH, called CANTAFEN, which brings
together academics and healthcare professionals.
Results: The projects day-to-day operations are normally run by five
students, supported by the other members of NEPIH, currently 33 staff
members (faculty, undergraduate and graduate), participating in the
activities. The project has performed about 180 campaigns (45 were for
children) reaching approximately 8.000 people.
Conclusion: Participation in the project has contributed to development
skills and competencies with regard to the implementation of health
promotion strategies with different audiences and requires that students
constantly stay up to date on the subject. The festival of parodies has
helped to empower its members to conduct scientific and cultural events
and promote emphasis of the subject in a playful manner. Although the
nature of the project as an extension program hinders the assessment of
the impact on adherence to HH, it is possible to infer a much larger
number of beneficiaries than those directly benefitted by the actions of
the group.
Disclosure of interest: None declared.

P120
P120: Monitoring hand hygiene compliance and the distribution of
MRSA in paediatric wards
D Lary1*, K Hardie1, J Randle2, A Clavert1
1
School of Molecular Medical Sciences, University of Nottingham,
Nottingham, UK; 2School of Nursing, Midwifery and Physiotherapy, University
of Nottingham, Nottingham, UK
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P120
Introduction: Hand hygiene considered being the single most effective
measure against the spread of healthcare associated infection, but studies
have reported poor hand hygiene compliance among healthcare worker
during interaction with patients, contributing to the spread of disease.
Numerous interventions have aimed to improve the hand hygiene practices
of healthcare workers in healthcare settings, however little attention has
been paid to patients and their visitors hand hygiene.
Objectives: Measure hand hygiene opportunities taken by HCWs, patients
and visitors to gain a picture of theirs hand hygiene compliance and to
examine whether hands of HCWs, patients, visitors and surfaces near touch
sites act as a reservoir for MRSA.
Methods: Observation of HCWs, patients and visitors hand hygiene
compliance was measured over period of 10 weeks across 6 paediatric
wards in a teaching hospital. Additionally, swabs were taken from subjects
hands and surfaces and samples were idntified using molecular identification techniques. Antibiotic susceptibility profiling was applied on S. aureus
isolates to detect the presence of MRSA. Genetic profiles were evaluated
using the spa sequence-based typing method for discriminating between
isolates to evaluate the average linkage within samples.
Results: A total of 1891 hand hygiene opportunities observed consisting
of 1366 for HCW;525 for patients and visitors. Among HCWs, doctors
showing the highest level of complaince compared to other professions
(P<0.001). There was no difference in compliance between patients and
visitors (P=0.53). A total of 105 samples were obtained from hand and 92
from surfaces. MRSA was observed in 5% of hands and environmental
samples. Moreover, samples collected on the same day, from different
hands and surfaces had similar microbial fingerprints and patterns of
antibiotic sensitivity.
Conclusion: Levels of HCWs hand hygiene compliance found in this
study were better than the previously reported. On the other hand, we
were unable to draw conclusions about patients hand hygiene
compliance due to the nature of the clinical environment; however,
visitors compliance was considered to be higher than previous reported
studies. Furthermorer, hand and surfaces may act as reservoir for MRSA
increasing the risk of HCAI.
Disclosure of interest: None declared.

P121
P121: Clean Hands project: seven years of supporting hand hygiene
compliance
AFV Tipple*, JLU Spagnoli, ZCP Neves, JEM Santos, FCR Cesar, JPDA Trindade,
KCDO Batista, KM Mendona
Faculdade de Enfermagem, Universidade Federal de Gois, Goinia, Brazil
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P121

P122
P122: Hand hygiene in Swedish health care past and present work
O Aspevall
Analysis and Prevention, Antibiotics and Infection Control Unit, Swedish
Institute for Communicable Disease Control, Solna, Sweden
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P122
Introduction: Hand hygiene (HH) is widely recognized as one of the
most effective preventive measures against health care associated
infections (HCAI). Alcoholic hand rub (AHR) has been used as standard
HH method in Swedish HC for more than three decades. Infection control
(IC) experts in Sweden regards this as one among several explanations
for the low incidence of antibiotic resistant bacteria, e.g. MRSA
(methicillin resistant Staphylococcus aureus), in Swedish HC.
Objectives: This study describes the development in Sweden regarding
implementing HH in HC from the 1980-ties to the present. The aims are
to find and present the for the implementation of HH most important
professional groups/organizations, events, projects or campaigns, as well
as important factors for success.
Methods: Interview study, key persons with long experience from IC in
Sweden were interviewed.
Results: AHR has been recommended as for HH in Sweden since 1980 [1].
IC within all counties have systematically promoted HH since at least two
to three decades. Compliance measurements, AHR consumption
measurements, as well as local campaigns have been used.
In 2004 the Swedish Association of Local Authorities and Regions (SALAR)
launched a project called VRISS (HCAI should be stopped). This worked
with bundles to reduce e.g. urinary tract infections. All bundles included
HH measures.
The National Board of Health and Welfare published regulations on basic
hygiene including HH in 2007.
All HC participates in prevalence measurements for HCAI since fall 2008.
Results are published nationally.

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Page 66 of 143

All counties participate in nationally reported compliance measurements


since fall 2010. Elderly care provided by municipalities is increasingly
joining this as well.
Last year a national working group adapted the WHO SAVE LIVES: Clean
Your Hands and published a national package to promote HH. Its called
Clean Hands Saves Lives.
For May 7 an inspirational day for hand hygiene is planned.
Conclusion: Focus on HH can never be allowed to decline. Despite a
long tradition of using AHR in HC, there has recently occurred several
outbreaks of resistant bacteria in Swedish hospitals. With renewed
attention to HH compliance among other actions these were successfully
stopped.
Disclosure of interest: None declared.
Reference
1. Ojajarvi J: Effectiveness of hand washing and disinfection methods in
removing transient bacteria after patient nursing. The Journal of hygiene
1980, 85(2):193-203.

surgical, pediatrics, neonatal etc.). The data on all participating hospitals


and units are summarized and published anonymously as HAND-KISS
reference data on a yearly basis. To assess AHC changes over the years,
we selected all hospitals which continuously provided surveillance data
over a period of five years (2008 to 2012). Within this cohort we selected
units which continuously provided data to HAND-KISS. These units were
further stratified in intensive care units (ICU) and normal wards. For all
groups we estimated the median AHC (interquartile range, IQR) for every
year and compared the results.
Results: Five hundred and four hospitals including 4,762 units provided
AHC data for 2008, and 791 hospitals with 9,256 units transmitted AHC data
for 2012. One hundred seventy-seven hospitals, 140 ICUs and 165 normal
wards within these hospitals continuously provided surveillance data over a
5 year period. In 2008, the median AHC in the ICUs was 72 ml/PD (IQR,
58 ml/PD - 93 ml/PD), and in 2012 the result was 97 ml/PD (IQR, 77 ml/PD 124 ml/PD). The median AHC was 18 ml/PD (IQR, 15 ml/PD - 25 ml/PD) in
2008 and 27 ml/PD (IQR, 23 ml/PD - 36 ml/PD) in 2012. In 2008 the median
AHC on normal wards was 16 ml/PD (IQR, 13 ml/PD - 18 ml/PD) and in 2012
the median AHC was 24 ml/PD (IQR 19 ml/PD - 28 ml/PD). There was an
increase of 46% in AHC within the group of analyzed hospitals. On the
analyzed ICUs AHC increased by 36% and on normal wards by 48%.
Conclusion: HAND-KISS observed an increase in AHC and therewith
increased attention to hand hygiene in the participating hospitals. HANDKISS as unit based surveillance system for AHC provides a benchmarking
tool to characterize hand hygiene behavior in an individual institution.
Disclosure of interest: None declared.

P123
P123: Hand hygiene in health care environment from a local action in
El Alia to a national programme in Tunisia
MH Dhaouadi1*, R Hamza2, L Essoussi1, A Gzara1, H Souilah1, L Telhig1,
M Rafrafi1
1
El Alia Hospital, El Alia, Tunisia; 2Regional Directorate of Health Bizerte,
Bizerte, Tunisia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P123
Introduction: In 1996, hand hygiene has been at the heart of the concerns
of hospital staff of El Alia. Starting from a local action, the team was heavily
involved in the development and implementation of the Tunisian national
hand hygiene program that now has more than ten years.
Objectives: We aim to illustrate the contribution of the team of El Alia to
promote hand hygiene at the local, regional and national level and to
diffuse an example of a local public health initiative having given birth to a
national program.
Methods: This is a retrospective descriptive study based on consultation
documents relating to hand hygiene archived at the hospital in El Alia, at
the regional service hygiene Bizerte and the Directorate of Hygiene of
the Ministry of Health.
Results: Three phases could be distinguished:
- Phase I: From 1996 to 2001, marked by the establishment of local action
to promote hand hygiene at the hospital in El Alia
- Phase II: From 2002 to 2008, which saw the launch of the national hand
hygiene with a strong involvement of the team of El Alia in the
development and implementation of this program
- Phase III: From 2009, corresponding to the strengthening of the national
hand hygiene again with involvement of the team of El Alia
Conclusion: This is a beneficial experience on more than one level and
rewarding for all. Sustained efforts are needed to achieve sustainable
success. A comprehensive assessment should be considered in order to
measure the impact of this action.
Conflict of interest: Not stated
Disclosure of interest: None declared.

P124
P124: Increase in alcohol-based hand rub consumption over a period of
five years in German hospitals
M Behnke*, C Reichardt, P Gastmeier
Institute of Hygiene and Environmental Medicine, Charit, Berlin, Germany
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P124
Introduction: In 2008, the German national nosocomial infection surveillance
system (KISS) introduced a new surveillance module: HAND-KISS. HAND-KISS
is a unit-based system for the surveillance of alcohol-based hand rub
consumption (AHC). On the basis of HAND-KISS data, we studied the change
in AHC between 2008 and 2012.
Methods: Participating hospitals annually transfer data on patient days
and AHC per unit to the surveillance system. HAND-KISS then provides
the data as AHC in milliliter (ml) per patient day (PD) stratified by unit
type (intensive care unit and normal ward) and unit speciality (medical,

P125
P125: Promoting hand hygiene in intensive care: a permanent
challenge
D Joubert1*, C Landelle1, E Genevois1, J Pugin2, S Harbarth1, L Brochard2,
D Pittet1
1
Infection Control Program, University of Geneva Hospital, Geneva,
Switzerland; 2Intensive Care Unit, University of Geneva Hospital, Geneva,
Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P125
Introduction: Healthcare workers (HCWs) compliance with hand hygiene
(HH) remains a permanent challenge in ICUs and requires repeated
adaptation of practices.
Objectives: To monitor compliance with HH and appropriate use of
gloves to help improving daily infection control practices.
Methods: We monitored HH according to the WHO My Five Moments for
Hand Hygiene concept and reviewed the appropriate use of gloves in a 36bed mixed adult ICU admitting 2500 patients per year for an average length
of stay of 3 days. The attack rate of methicillin-resistant Staphylococcus aureus
(MRSA) cross-transmission was monitored based on active surveillance
screening. In 2012, 9 % of admitted patients in the ICU carried MRSA. The
intervention to improve HH practices included: simplifying the WHO patient
zone concept in harmony with all wards at HUG; benchmarking of HH
compliance with hospital-wide rates; promoting adherence with HH, with
emphasis on improving adherence with the indication before aseptic care";
stopping the routine use of gloves for contact isolation (except for
C. difficile). Strategy implementation also included: additional installation and
improved localization of alcohol-based handrub dispensers; teaching of glove
use for paramedical staff; simulator training; and targeted training of new
staff and clinical leaders.
Results: A total of 1680 opportunities for HH were observed in 2011/
2012. Overall compliance with HH improved from 51% in 2011 to 60% in
2012, and compliance with the WHO before aseptic task indication
improved from 39% to 49%, respectively. Improvement was significant for
all major HCW categories: nurses (from 59% to 65%), doctors (from 45%
to 59%) and nursing assistants (from 41% to 66%). The MRSA attack rate
decreased in parallel from 4.9 ICU-acquired cases/1000 patient-days in
2011 to 2.4 in 2012.
Conclusion: The significant decrease of MRSA transmission associated
with improved adherence to HH is encouraging. The 2013 target is to
achieve an overall compliance with HH of 70% in ICU. Efforts will focus
on a multimodal innovative approach.
Disclosure of interest: None declared.

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P126
P126: Direct observation survey of practice of alcohol-based
handrubbing in Fann Teaching Hospital, Dakar, Senegal
BA Niang1*, MN Chraiti2, S Bagheri Nejad3, NM Dia1, ML Diouf1, NA Diop1,
J Hightower2, MB Diallo1, M Seydi1
1
Infectious Diseases department, FANN teaching hospital, Dakar, Senegal;
2
Service of control and prevention, HUG, Geneva, Switzerland; 3WHO,
Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P126
Introduction: Health care-associated infections (HCAI) result essentially
from cross-transmission of pathogenic microorganisms by the hands of
healthcare workers (HCW). Their care represents a universal challenge in
practice.
Objectives: Our study aimed to measure HCW compliance with hand
hygiene.
Methods: We conducted a direct observance of hand hygiene
compliance of HCW over a period of three months, based on the WHOs
five indications of the hand hygiene approach.
Results: For a total of 338 opportunities, the rate of global observance of
hand hygiene was 36.1% with 80.3% of handrubbing realized. According
to the department, this rate of observance was variable: Pneumology
(42.3%), Thoracic Surgery and Cardiovascular (58.6%), Neurology (20%),
Neurosurgery (24%), Emergency (25%), Laboratories (30%), Infectious
diseases (39%), Psychiatry (33.3%), ORL (25%), Oral department (44.4%).
According to the professional category, the observance was the following
one: doctors (50.6%), nurses (34%) auxiliaries (29.1%) other nursing staffs
(43.8%). The level of use of Alcohol-based handrub (ABHR) during hand
hygiene was: auxiliaries (93%), doctors (82.1%), nurses (75.8%), others
(14.3%). The observance of ABHR according to five indications was 87.7%
before patient contact, of 83.3% before aseptic procedure, 44.4% after a risk
of body fluid exposure, of 78% after patient contact and of 100% to the
immediate surroundings of patient.
Conclusion: Observance of hand hygiene with ABHR is still low in the
structure. A training program coupled with a sharing experience of
outcomes of the survey should allow to improve it.
Disclosure of interest: None declared.

P127
P127: Hand hygiene survey: a prospective, interventional study of
current practices in a multicentre regional hospital
O Clerc, P Deriaz*, B Duvillard, P Vanderavero, P Erard
Hpital Neuchtelois, Site de Pourtals, 2000 Neuchtel, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P127
Introduction: Hand hygiene (HH) compliance is of paramount importance
to prevent infections in hospital settings.
Objectives: We started an 18 months project of monitoring and
improvement of HH in September 2012. We aimed to modify behaviours
in order to obtain a minimal compliance of 80% by the end of the project.
Methods: All professionals in direct contact with patients are planned to be
evaluated during 8 rounds of observations. Compliance with the five
indications of HH as defined by the World Health Organisation is rated by
direct observation by trained personnel. Excessive indications are also quoted.
An immediate feed-back is transmitted to the observed professionals. Results
are provided to each unit by professional category, and units are secondarily
ranked. Restitution of results occurs using a dedicated journal that is sent to
all hospital collaborators. Other communication and training tools are
sequentially developed. Infection control unit is available on request for
training interventions in units, with priority for the ones showing the lowest
compliance.
Results: Each audit evaluated around 3000 indications for HH in 51 units.
The first round of observations showed a general compliance with HH
indications of 61%, ranging globally from 48% to 69% depending on
heath-care workers categories. Extremes measured for individuals varied
between 6 and 100%. The intervention was well-accepted in the hospital,
and unsatisfying results resulted in spontaneous requests for training in
12 units (24% of all units). Second round of observations showed a global
improvement of compliance with HH to 73%.

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Conclusion: Short term evaluation of an ongoing prospective, interventional


study of hand hygiene evaluation using restitution of results as primary
mean of intervention showed a significant increase in the compliance with
HH in a multicentre, regional hospital. Persistence of this improvement and
active participation of caregivers as a marker of greater awareness to HH will
be prospectively monitored.
Disclosure of interest: None declared.

P128
P128: Improving hand hygiene compliance in a teaching hospital
R Cocconi1*, L Arnoldo2, M Dal Cin2, P Del Giudice2, R Fabro1, A Faruzzo1,
D Tignonsini1, S Brusaferro2
1
Direzione Medica di Presidio, Azienda Ospedaliero-Universitaria Santa Maria
della Misericordia, Italy; 2Department of Medical and Biological Sciences,
University of Udine, UDINE, Italy
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P128
Introduction: Although WHO project Clean care is safer care was
introduced many years ago in our hospital, Hand Hygiene (HH) practice
shows low compliance level in some wards at increased risk of Healthcare
Associated Infections (HAI).
Objectives: The project objective is to determine the causes of HH noncompliance and to identify targeted solutions for improvement.
Methods: The project was carried out with the collaboration of Joint
Commission Center for Transforming Healthcare, using TST methodology,
from April to September 2012. We chose to implement the project in a
pilot ward, an internal medicine ward.
We selected two groups of observers. The first ones, the secret observers,
had the mandate to see whether the individual washed his or her hands
upon entering and exiting the room. The second group had trained to be
just-in-time (JIT) coaches. The JIT coaches approached health care
workers who are found to not be washing hands appropriately and query
them as to the reasons for their non-compliance (non observable
contributing factors).
Results: After 3 weeks of data collection experience, with secret observers,
the baseline HH compliance in the pilot unit was an average of 26.7%.
Entering room was worse than exit room, 22.4% versus 31,7%.
Non-compliance contributing factors were: improper use of gloves (57.3%),
frequently entry or exit room (15.5%), hands full of supplies (7.8%), follow
person in exit or entry room (6.8%) and equipment shared (5.8%).
Non observable contributing factors, coming from JIT coaches, were:
perception that HH is not necessary (50.0%), distracted (41.7%) and skin
irritation (8.3%).
After one month of targeted solution implemented, such us: relocation of
glove dispensers in the ward, standardize work processes, use a code
word for distracted people, etc. HH compliance rose to an average of
65% with a gain of 34,7%.
Disclosure of interest: None declared.
P129
P129: Experience of medical research institute (MRI) in applying WHO
hand hygiene self assessment framework
M Eldeeb1*, M Abo Ollo2, MRI infection Control Team1
1
Clinical Chemistry, Alexandria, Egypt; 2Medical research institute, Alexandria,
Egypt
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P129
Introduction: Many of infectious germs are transferred by hands while
health-care providers or visitors are providing patient care. Using proper
hand hygiene to keep hands clean is critical in order to reduce the risk of
health care-associated infection.
Objectives: Our aim was to identify the causes of noncompliance of
hand hygiene in MRI health workers and co-workers in order to establish
optimal hand hygiene behavior within a strong patient safety culture at
MRI hospital.
Methods: Situational analysis of hand hygiene practices at MRI hospital
and departments were assessed using hand hygiene self assessment
framework from 1st to 15th of April 2012. Results were sent to the WHO in
order to put a corrective action plan to improve the overall hand hygiene
performance of the MRI hospital.

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At 5th of May many activities were done in conjunction with the celebration
of the International Day Of Hand Washing to increase the perception of
health care workers about the importance of hand hygiene. Included.
a) Internal audit for the medical team members on the performance of the
right steps of hand washing. b) Awards were given to passing members.
Results: Results of hand hygiene self assessment framework in conjugation
with WHO helped us in putting corrective action plan to implement and
sustain hand hygiene program at MRI hospital.
Conclusion: The hand hygiene self assessment framework helped
Infection Control Team to: a) Identify the weak points which hinder
proper hand washing at MRI. b) Put corrective action plan & activities
which help to improve the perception of hand hygiene system of health
care workers.
Disclosure of interest: M. Eldeeb Shareholder of participant in the
programme, M. Abo Ollo Consultant for Head Of Infection Control Team.

P130
P130: Assessment of hand hygiene practices at the two childrens
hospitals in Greece
S Kouni1*, K Mougkou1, G Kurlaba1, C Nteli2, A Lourida1, S Maroudi-Manta1,
T Zaoutis1,3, S Coffin3
1
The Stavros Niarchos Foundation-Collaborative Center for Clinical
Epidemiology and Outcomes Research (CLEO), University School of
Medicine, Athens, Greece; 2Pediatric Intensive Care Unit, Aglaia Kyriakou
Childrens Hospital, Athens, Greece; 3Division of Infectious Diseases,
Department of Pediatrics, UPENN School of Medicine, Philadelphia, PA, USA
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P130
Introduction: Hand hygiene (HH) is one of the basic components of the
infection control program and is frequently considered synonymous with
hand washing. The use of a waterless, alcohol-based hand rub (ABHR) is
more effective, saves time and promote better compliance than hand
washing.
Objectives: The aim of the study was to estimate the current HH
practices in order to schedule the future interventions.
Methods: Observational HH data were collected from 13 wards in 2
pediatric hospitals in Athens, including medical/surgical, oncology/transplant
(BMTU), and intensive care units (ICUs), during 65, 1-hour observations
periods, from October 2012 to January 2013. HH opportunities and attempts
were designated as appropriate or inappropriate per WHO criteria.
Results: A total of 1271 HH opportunities were identified during the
observation period. Overall HH compliance was 33% (417/1271) of which
58.8% were appropriate. Compliance differed by role: nurses (49%),
physicians (24%) and others (19 %) (p0.001). Healthcare workers (HCWs)
and visitors were more likely to use soap and water (76.1%) compared to
ABHR (23.9%) and no significant difference was detected among these
groups (p=0.330). In regards to type of department, the use of ABHR was
found to be strongly higher in Surgical wards (71.8%) compared to the rest
of wards which this rate ranges from 11.1% in NICUs to 33.3% in emergency
departments (p<0.001). The HH procedure was appropriate in 63.4% and
45.4% among those used soap and water and ABHR, respectively (p=0.002).
The most commonly identified HH opportunities were after child contact
(381), before child contact (376), after contact with childs surroundings
(358) and before aseptic procedure (95). Despite the fact that all HCWs use
more often hand washing, a minor number of HH opportunities (61) were
identified after contact with body fluids, the step of HH which demands this
HH method.
Conclusion: A low level of HH compliance and use of ABHR was
observed. The education of the appropriate use of ABHR must be the
main intervention for hand hygiene in these health care facilities.
Disclosure of interest: None declared.

P131
P131: Cost-effectiveness of a team and leaders-directed strategy to
improve nurses adherence to hand hygiene
A Huis1*, M Hulscher1, E Adang2, R Grol1, T van Achterberg1,
L Schoonhoven1,3
1
IQ Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the
Netherlands; 2Epidemiology, Biostatistics and HTA, Radboud University

Page 68 of 143

Nijmegen Medical Centre, Nijmegen, the Netherlands; 3Faculty of Health


Sciences, University of Southampton, Southampton, UK
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P131

Introduction: Many strategies have been designed and evaluated to


address poor hand hygiene (HH) compliance. Unfortunately, welldesigned economic evaluations of HH improvement strategies are lacking.
Objectives: We compared the cost-effectiveness of two successful
implementation strategies for improving nurses hand hygiene (HH)
compliance and reducing hospital acquired infections (HAIs).
Methods: A cost-effectiveness analysis alongside a cluster randomised
controlled trial was conducted in 67 nursing wards of three hospitals in the
Netherlands, with inpatient wards as the unit of randomisation. The
evaluation used a hospital perspective. The control group received a stateof-the-art strategy (SAS) including education, reminders, feedback and
optimising materials and facilities. The experimental group received a team
and leaders-directed strategy (TDS) which included all elements of the SAS
supplemented with interventions aimed at social influence within teams and
enhancing leadership. The most efficient strategy was determined by the
incremental cost-effectiveness ratio per extra percentage of HH compliance
gained, and the incremental cost-effectiveness ratio per additional
percentage reduction in the HAI rate. Bootstrap methods were used to
determine confidence intervals for these incremental cost-effectiveness
ratios. Two scenarios of 15 and 30% were used to express the association
between increased HH compliance and the reduction in HAIs
Results: The TDS was significantly more effective in improving HH
compliance. The mean difference effect was 8.91%. This extra increase was
achieved at an average cost of 5497 per ward. The incremental cost per
extra percentage of HH gained on ward level was 622. The incremental
cost per additional percentage reduction in the HAI rate on ward level was
2074 (30% scenario) and 4125 (15% scenario). Within the 30% scenario,
there is a probability of 90% that the TDS is cost-effective and within the
15% scenario, there is a probability of 70% that the TDS is cost-effective.
Conclusion: Optimising hand hygiene compliance through a team and
leaders-directed strategy is cost-effective as compared to a state-of-the-art
strategy.
Disclosure of interest: None declared.

P132
P132: Hand hygiene before aseptic tasks: a critical point even
at a hematology and transplant ward
S Scheithauer1,2*, B Batzer1, C Pino Molina3, A Widmer1
1
Infection Control, University Hospital Basel, Basel, Switzerland; 2Infection
Control & Infectious Diseases, University Hospital Aachen; RWTH Aachen,
Aachen, Germany; 3Hematology, University Hospital Basel, Basel, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P132
Introduction: A high compliance with hand hygiene especially before
aseptic tasks (indication 2) seems to be of greatest importance in order
to minimize hospital acquired infections and bacterial cross transmission.
However, the majority of indication-specific analyses revealed the lowest
compliance with indication 2.
Objectives: In order to evaluate hand hygiene events (HHE) before
aseptic tasks we correlated HHE at the patients` bedside and at the
laminar air flow benches with the number of invasive procedures
performed in the patient room and at the benches, respectively.
Methods: Real time and location-specific assessment of all HHE occuring
at a hematology ward (University Hospital Basel, Switzerland) was
performed from 01.03.12 to 28.02.13 using the Ingo-man Weco; Ophardt
Hygienetechnik, Issum; Germany. The total number of HHE as well as all
HHEs performed in the patient rooms and at the benches were correlated
with the number of invasive procedures performed in the patients rooms
(change of wound dressing; application of i.v. medications, blood withdrawel/
puncture of vessels, lumbar/bone marrow puncture) and at the benches
(preparing i.v. formulations) on a daily basis. Data on invasive procedures
derived from the electronic patient data sheet.
Results: A total of 208.184 HHE occurred, thereof 17.311 (8%) in the
patient rooms. These figures translate into 57 HHE/patient-day (PD) in
general and to 5 HHE in the patient rooms/PD. However, a total of 65.981
invasive procedures (18/PD) were performed in the patient rooms.
Calculating (at least) two HHEs for an invasive procedure at the patient

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side (indication 2 and 3) compliance was only 14% (5/36) for these
indications. At the laminar air flow benches a total of 32.605 HHE (16%)
were performed, translating into 9 HHE/PD. The number of aseptic tasks
(indication 2 only) performed at the benches added up to 28.418 (8/PD).
Thus, compliance while preparing i.v. medications reached 87%.
Conclusion: Compliance before aseptic tasks at the patient room seemed
to be unacceptable low even at wards caring for high risk patients.
Nevertheless, compliance for i.v. preparations performed at the laminar
air flow seemed to be high. The latter may be explained by the great
importance attached to these procedures.
Disclosure of interest: None declared.

Methods: Adherence to hand washing was assessed using three methods


i.e. Direct observation, Product utilization and Survey method, updated by
Joint Commission (JCI).
Results: During two week analysis, 2400 hand washing opportunities were
observed. Hand washing adherence rate was 86.0%, with highest
compliance among nurses (94.0%). Compliance was (95.0%) after patient
contact than 72.5% before contact. More than 90.0% staff was aware about
facts viz. diseases prevented by hand washing (96.2%), ideal duration of
hand washing (92.6%), reduction of HAI with hand washing (98.0%) etc.
Reasons for non-adherence emerged as work pressure (94.2%) and
unavailability of materials (82.4%).
Conclusion: The level of compliance (86%) is below the need to be there in
ICU otherwise. Easy access to hand-rub solutions, adherence measurement
and institutional commitment might contribute to staff sensitivity to hand
hygiene practices.
Disclosure of interest: None declared.

P133
P133: The practice of hand hygiene among manicures and
pedicures in Brazil
JL Garbaccio, AC Oliveira, AO de Paula*
Nursing, Federal University of Minas Gerais - Brazil, Belo Horizonte, Brazil
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P133
Introduction: Hand hygiene is the primary mechanism to control the
dissemination of microorganisms. Manicures and pedicures touch the
hands and the feet of customers that can be very contaminated.
Objectives: This study evaluated the practice of hand hygiene of
manicures/pedicures in Brazil.
Methods: This Survey included a random sample of 200 professionals
older than 18, covering 200 beauty salons of Belo Horizonte, in Brazil. A
questionnaire was used (Jul/12-Jan/13) to obtain information of demographics
and their knowledge about the actual practice of hand washing. The results
were analyzed by the statistical program SPSS. The study was approved by
the Ethics Committee of the Federal University of Minas Gerais.
Results: All professionals interviewed were women with an average age of 30,
more than 10 years of experience (11%), working more than 8 hours per day
(57%), less than a year in that salon (34%). As for education 55% had
completed high school, 54% had done some training course in the field, yet
38% became manicure/pedicure by her own initiative. Moreover, 76% had
never received any training in biosafety. From the knowledge questions,
almost all of the respondents (99%) said it was important to wash their hands
between customers schedules, using liquid soap stored in dispensers (81%)
and dry them with a disposable paper towel (86%). However, 34% reported
that they were not washing their hands, 14% using bar soap and 17% used a
tissue towel without a daily change. The main reason for not joining the
practice was the lack of time between appointments. There was no statistically
significant association between demographics and the practice of hand
washing (p>0.05). We evaluated the use of accessories like rings, bracelets and
watches as well as the length of the nails of the professionals. More than half
(53%) reported not removing the accessories, but on the day of the interview,
60% were found to be using at least one. The nails of 44% of the manicures/
pedicures were long despite 38% stated that they keep them short.
Conclusion: It was concluded that educational actions for manicures/
pedicures should be implemented to encourage them to adhere to the
hand washing practice that is so important for their own health and that
of their customers.
Funding agent: Fundao de Amparo a Pesquisa de Minas Gerais.
Programa Pesquisador Mineiro n 00340-11.
Disclosure of interest: None declared.

P134
P134: Hand washing: a critical measure in prevention and infection control
R Sharma1*, M Sharma2, V Koushal3
1
Hospital Asministration, GMCH 32, Chandigarh, India; 2Public Health,
Chandigarh, India; 3Hospital Asministration, PGIMER, Chandigarh, India
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P134
Introduction: Hand hygiene is the single most important strategy to
prevent HAIs. With the emergence of antibiotic-resistant organisms, the
importance of hand hygiene within hospitals has re-emerged as a priority
for the 21st century hospital administrators.
Objectives: The present cross sectional study was conducted in ICUs to
assess the hand washing practices being followed among ICU health care
workers and factors that motivate or inhibit hand washing.

P135
P135: Changing challenges into projects: a strategy to improve hand
hygiene compliance rates
E Tannous*, B Hanan
King Abdulaziz Medical City, Riyadh, Saudi Arabia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P135
Introduction: In 2007, King Abdulaziz Medical City (KAMC) was selected to
be one of the WHO pilot testing sites to asses and evaluate the feasibility
and acceptability of the recommendations expressed in the WHO draft
guidelines on hand hygiene.
Objectives: To develop a five years hand hygiene following the WHO
project closure.
Methods: A brainstorming session to highlight lessons learned from the
testing phase and to identify challenges to changing Healthcare workers
behavior and to develop strategy accordingly.
Results: Challenges identified were the followings: 1- to involve all HCWs in
the hand hygiene program, 2- to improve commitment through active
participation in the decision making process, 3- to create an opportunity to
network with each other and share knowledge, expertise and expected
outcome towards the shared beliefs and values on the issue of safety, 4- To
avoid the one size fits all strategy, 5- Creating a need for self improvement
(for individuals) due to the team expectation, 6- to raise awareness of the
risks to health when clean care is not attained and explain, in simple terms,
to patients and their families, what are health care-associated infections and
why they occur, 7- talk to patients and their families about hand hygiene
and its role in the battle against health care-associated infections, which can
be spread by hands, 8- SAVING LIVES.
New strategy was developed based on project management principles, the
strategy was Changing Challenges into Projects, in simple words to have a
project in each and every hospital unit/ward to tackle those identified
challenges. The goal was to get to above, and maintain a 90% compliance
rate; the scope, to be implemented in all clinical areas.
In order to eliminate misunderstanding of roles, the concept of program and
project were described the hand hygiene program ownership was assigned
to the Infection control department with a function to coaching and helping
individuals developing internal and external structures that help them
achieve success and to increase their potential by expanding their sense of
what is possible. Projects were assigned to the champions whose role was
to coordinate the projects at units level.
Conclusion: This five year strategy was able to improve compliance rate
at KAMC from 56% in 2008 to 86% in 2012.
Disclosure of interest: None declared.
P136
P136: Multiple strategic approaches to enhance and sustain the hand
hygiene compliance
TK Leung
Infection Control, Prince of Wales Hospital, Hong Kong, China
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P136
Introduction: Hand hygiene (HH) is the single most important practice to
prevent hospital acquired infections. Indeed, HH promotion is one of the

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important tasks for infection control team (ICT). However there is no


single mean to enhance and sustain the HH compliance for the staff.
Objectives: To share and prove multiple strategic approaches can
enhance and sustain hand hygiene compliance.
Results: Prince of Wales Hospital (a teaching hospital of the Chinese
University of Hong Kong) has adopted WHO HH audit protocol since
2007. Initially the HH compliance rate was 37%. In the past few years, HH
promotion relied mainly on poster and through the reminder in different
hospital meeting.
Since 2011, ICT launched a series of promotion program with more
structural and strategic approaches. Apart from posters, banners, foam
board stands and screen savers in clinical computer; ICT increased the
frequency of HH audit from yearly to monthly. The reports were sent to
each departments with breakdown of compliance rate by ward. To address
the problem of poor compliance of doctor, name based audit with monthly
feedback to their department heads. This name based audit also applied to
staff group with low compliance rate in specific departments until their
compliance rate improved.
In addition, ICT provide positive reinforcement; badges or small gifts were
given to staff who performs well in hand hygiene compliance. The overall
HH compliance was 86% in 2012.
Conclusion: In order to enhance staffs awareness and change of their
behavior in HH practice, multiple strategic approaches were necessary
and proved to success.
Disclosure of interest: None declared.

Objectives: The objective of our work is to measure the consumption of


Alcohol-bases-handrub (ABHR) and soap intended for hand hygiene.
Methods: A prospective investigation before the intervention was
realized over a period of six months, of October 1st, 2011 to March 31
2012, with nine clinical departments of a hospital with 347 beds, where a
manufacturing unit of ABHR in its WHO formulation was set up under the
aegis of the APPS WHO program. The index form finalized by WHO was
used.
Results: In this public tertiary care hospital which employs 360 permanent
nursing staff, the monthly average attendance is 2620 patients and
number of admissions of 800 a month. During the study period, 77 % of
the investigated departments used the ABHR among which 57 % in the
form of solutions, 28 % in the form of gels and 15 % in the form of gels
and solutions. The supply in ABHR was made in 58 % in the manufacturing
unit of the central pharmacy. The monthly average ABHR consumption of
the structure was 14.78 liters for a expected quantity of 1635 liters; that of
liquids soaps 192 liters; that of soap bars18.6 liters. The average composite
indicator of consumption of ABHR was 7.82 % with a minimum monthly
use in the Emergency department and a maximum of 30.22 % in the oral
department. The FANN teaching hospital was consequently classified E
according to the achievement of the personalized objective, that is an
establishment under 10 % of ICSHA.
Conclusion: In spite of the existence of a manufacturing unit of ABHR, this
consumption is still very low. The implementation of the WHO multimodal
hand hygiene improvement in particular raising awareness and training, will
help in a better compliance and use.
Disclosure of interest: None declared.

P137
P137: Effectiveness of a hand hygiene improvement program in
doctors: active monitoring and real-time feedback
SR Kim1*, MH Cho1, WJ Kim2, JY Song2, HJ Cheong2
1
Infection Control Unit, Korea University Guro Hospital, Seoul, Korea, Republic
Of; 2Division of Infectious Diseases, Department of Internal Medicine, Korea
University Medical College, Seoul, Korea, Republic Of
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P137
Introduction: Hand hygiene is the single most important intervention to
combat infections in diverse health care settings. However, adherence to
hand hygiene practice remains low among health care workers, especially in
doctors.
Objectives: The aim of study was to promote hand hygiene compliance
in doctors.
Methods: Hand hygiene practice was monitored by trained observers
every three months. We provided performance feedback to doctors using
short message service and posters. Also, we conducted the self-check
questionnaire survey of hand hygiene performance quarterly. We asked
doctors whether they clean hands before contact with patients and clean/
aseptic procedures in wards and out-patient room.
Results: The overall hand hygiene compliance rate increased from a
baseline of 49.7% in fourth quarter of 2011 to 82.3% in fourth quarter of
2012 (p<.001). Response rate of self-check questionnaire increased from a
baseline of 82.9% to 93.8% (p=.004). Compliance with hand hygiene was
higher in Wards and higher before clean/aseptic procedures than before
contact with patients.
Conclusion: The self-check questionnaire survey of hand hygiene
performance would be useful to increase awareness of hand hygiene, and
performance feedback improved the compliance rates in a sustained manner.
Disclosure of interest: None declared.

P138
P138: Soap and handrub consumption survey in Fann Teaching
Hospital in Dakar
NM Dia1*, D Faye2, BA Niang1, M Seydi1
1
Infectious Diseases Department, Fann Teaching Hospital, Fann, Senegal;
2
Central Pharmacy, Fann Teaching Hospital, Fann, Senegal
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P138
Introduction: The prevention of Health care-associated infections (HAI)
remains a stake in Public health. The hand is the main mode of transmission
of microorganisms. So, hand hygiene is considered to be the primary
measure necessary for reducing HAI.

P139
P139: Clean hands fact-finding mission 2012 to Afghanistan:
good intentions, minor results, why?
D Pittet1*, K-W Stahl2
1
Infection Control Programme, University of Geneva Hospitals, Geneva,
Switzerland; 2Waisenmedizin e V, Freiburg, Germany
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P139
Introduction: The Balkh Province Civil Hospital (BBCH), Mazar-e-Sharif,
Afghanistan, has undergone a 20 million major reconstruction financed
by KfW, Germany, a government-owned development bank, and is used
as a teaching hospital by the Balkh Medical Faculty. In 2009, the German
Government sponsored the modernisation of the BBCH leishmania centre
(cutaneous leishmania is endemic in Afghanistan) with 0.1 million, which
allowed to run wound-healing trials. In this outpatient clinic, woundhealing impairment typical of cutaneous leishmania may be aggravated if
combined with neglected basic hand hygiene, particularly as a moist
environment must be maintained for healing.
Methods: We conducted a fact-finding mission in April 2012 to Afghanistan
to evaluate hand hygiene practices in selected hospitals, including the
BBCH. Inspection tours to 5 Afghan hospitals were organized by the WHO
Kabul Office. Lectures were given to medical students and hospital
physicians to raise awareness and understanding of the importance of hand
hygiene.
Results: On 11 April 2012, Afghanistan became the 130th nation of the
194 UN Member States to sign the pledge of the WHO Global Patient
Safety Challenge Clean Care is Safer Care. WHO posters promoting the
My 5 moments for hand hygiene concept were displayed in most
hospitals, but alcohol-based handrub was only available in 2 hospitals
(Rabi Balkhi, Kabul and ANA Hospital, Mazar). This prompted the idea of
installing a local plant for ethanol production from wheat at the
Agricultural Faculty of the Balkh University to be financed by the German
Ministry of Cooperation (BMZ) as a female gender project with refilling of
handrub bottles according to the WHO Mali pilot site model. A
requirement of BMZ funding was a written authorisation from the
provincial governor for bio-ethanol production for medicinal purposes
and his assurance to take responsibility for safe storage, but after more
than 1 year this has not been forthcoming.
Conclusion: In a failed state environment, developmental aid in health
care is not only facing ignorance and eventual religious constraints, but
also corruption and a problem of smuggling, which impedes an easy
solution to implement hand hygiene.
Disclosure of interest: None declared.

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P140
P140: Interventions aiming to raise healthcare workers adherence to
hand hygiene: integrative review
AO Paula1*, ACD Oliveira2
1
UFMG, Belo Horizonte, Brazil; 2ENB, UFMG, Belo Horizonte, Brazil
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P140
Introduction: Hand hygiene is the most important measure to prevent
healthcare associated infections. Although, compliance rates of healthcare
workers to such act remain low, making the promotion of hand hygiene
through several campaigns necessary.
Objectives: identify the most frequent interventions used to improve
compliance to hand hygiene among healthcare workers.
Methods: Integrative review of studies published in English, Spanish and
Portuguese, indexed in the following databases: LILACS, MEDLINE,
SciELO, Science Direct, Isi Web of Knowlegde and SCOPUS, between the
years of 2002 and 2011. The guiding question was: What interventions
have been used to improve compliance to hand hygiene among healthcare
workers and what are the results? The inclusion criteria were: been original
and testing any intervention to improve compliance to hand hygiene
among healthcare workers. 29 studies were included. An electronic
instrument was elaborated in Microsoft Office Excel and descriptive
analysis was performed.
Results: Selected studies presented several methodological discrepancies.
The majority of the studies (89.7%) were before-after interventions.
Different methods were used to monitor compliance rates (direct
observation, product usage and self-reported); 86.2% of the papers
implemented a multimodal strategy and the most frequent ones were
education (65.5%), feedback and availability of alcohol solution (51.7%
each), posters (34.5%), leaders involvement and awards for employees
who stood out (13.8%), written information (10.3%), focus group (6.9%),
patient empowerment, elaboration of protocols, slogans and seminars
(3.4% each) and others (24.1%). There were difficulties in maintaining
high rates of compliance after the intervention period.
Conclusion: Multimodal interventions seems to show better results, but
the major challenge faced was not only to increase rates of adherence to
hand hygiene, but, mainly, to keep them elevated after the intervention
period.
Disclosure of interest: None declared.

P141
P141: Media and hand hygiene: are healthcare workers receiving the
correct example?
E Spierings1*, M Nabuurs-Franssen2, J Hopman3, C Meijer2, P Spierings1,
E Perencevich4, A Voss2,3
1
Medical School, Radboud University Nijmegen, the Netherlands;
2
Department of Medical Microbiology and Infectious Diseases, CanisiusWilhelmina Hospital, the Netherlands; 3Department of Medical Microbiology,
Radboud University Nijmegen, Nijmegen, the Netherlands; 4Division of
Infectious Diseases and Epidemiology, University of Iowa Hospital and
Clinics, Iowa City, IA, USA
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P141
Introduction: Attempts to increase hand hygiene compliance are
complex and are - in parts - based on change of behavior. Especially the
behavior of significant others (role models) was shown to be a strong
motivator. While role models within the working environment are
obviously the most important, some experts suggest that media and
public display cannot be ignored.
Aim of the present study was to examine the display of naked below the
elbow, which is considered a basic requirement for good hand hygiene
in many countries, in sets of professional stock photos.
Methods: From 20 random photo-stock websites we selected, twice 40
pictures with search term doctor or nurse and patient, respectively. In
all selected photos a doctor or nurse and a patient were presented,
HCWs were wearing white coats or uniforms, and the arms of the HCWs
were visible.
Each photo was evaluated with regard to: closure of white coat, sleeve
length, personal clothing covered, wrist watches & jewelry, and hairstyle.

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Results: Overall, 1600 photos were evaluated. The most common


mistakes were with regard to HCWs white coats/uniforms. Overall, 39.9%
of the pictures were correct with regard to all criteria evaluated; 68.6% of
all those displaying nurses, and 11.3% of those displaying doctors.
Conclusion: The results seem to reflect the real world with only 40%
correct behavior and doctors being worse than nurses. It seems that the
stereotype image of a doctor does not agree with the current hand
hygiene guidelines. If we aim for higher compliance rates of HCWs, we
need to change the social image of doctors.
Disclosure of interest: None declared.

P142
P142: Education of key personnel in infection control in hospitals
in the capital region of Copenhagen
AF Madsen1*, D Mogensen2, AJ Jrgensen3, H Neustrup4
1
Dept.of Clinical Microbiology, University of Copenhagen, Hvidovre Hospital,
DK-2650 Hvidovre, Denmark; 2Dept.of Clinical Microbiology, Herlev Hospital,
DK-2730 Herlev, Denmark; 3Dept.of Clinical Microbiology, Hilleroed Hospital,
DK-3400 Hilleroed, Denmark; 4Dept. of infection control 9101, Rigshospitalet,
DK-2100 Copenhagen, Denmark
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P142
Introduction: According to the infection control programme 2011-2012,
a need for education of various professionals in infection prevention and
control is described. The Capital Regions quality-council has aimed to
reduce Hospital acquired infections by 50% over a 3-year period.
Methods: The education is primarily intended for health care workers
with a bachelor degree (RN, MD). The education extends for 5 days and
is a combination of theoretical training, case studies in groups, and in
presentation of the studies. The education is offered 3 times a year with
25 students per course.
The focus is the organization of the infection prevention and control
nationally and locally, helping to create a link between overall policy
objectives and infection prevention and control at each department /
hospital.
The educational programme aims to ensure:
- A uniform basis for practicing infection control for the front line
personnel
- Networking across hospitals
- Implementation of accreditation standards and guidelines in infection
control and patient safety in cooperation with managers and employees
- Introduction to international, regional and local infection control
guidelines
- Evaluation by a questionnaire
Results: The participants (N=159) evaluated the education by a
questionnaire. There are 115-answered questionnaires, a response rate of
72% (N=115). The form is mainly constructed with Likerts Scale, where a
scoring on 4 means very good and 0 means very bad. Results are above
good and does not fluctuating over time (2011-2012).
- Academic achievement 3.22
- Clinically usefull 3.10
- Professional level 3.18
Conclusion: According to the questionnaire survey 115/159 (72%) were
satisfied with the contents and education.
After education of 159 key infection control personnel, local initiatives
have been reinforced at the hospitals within the infection-control area.
The initiative is followed up by 2-4 annual theme days with current topics
to strengthen the networking.
The education is adapted to the Capital Regions overall strategy on
infection control.
Disclosure of interest: None declared.

P143
P143: Teaching the concepts of hand hygiene to undergraduate
medical students: the views of key stakeholders
R Kaur*, H Razee, H Seale
School of Public Health and Community Medicine, University of New South
Wales, Sydney, Australia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P143

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Introduction: Currently, hand hygiene (HH) compliance rates amongst


Australian medical students are below 70% nationally. Previous attempts
to improve medical students knowledge of HH have had only short-term
successes with follow-up studies reporting poor long-term retention of
knowledge worldwide. It has been previously suggested that the
importance of HH must be taught to medical students from the first year
and integrated into their clinical curricula.
Objectives: Our study aimed to examine the current practices around
teaching concepts of hand hygiene in an Australian tertiary educational
institute
Methods: In-depth interviews were conducted with a purposeful sample
of key members of the undergraduate medical teaching team and a
sample of medical students (year 1 to 6). Thematic analysis was
undertaken on the transcripts.
Conclusion: Teaching hand hygiene to medical students was considered
challenging by our participants, as medical students do not rank the subject
as important. It was suggested that medical students are resistant to be
taught concepts such as communication or hand hygiene as they consider
these things their personal habits. Professional modelling was considered
the major barrier in increasing the HH compliance of senior medical
students, as these students tend to mimic the behaviour of the senior
doctors (role models) regardless of all their teaching and training on HH.
Assessing students on their HH knowledge and practice would motivate
them to learn the concepts but would only have a short-term impact. The
use of peer auditing, scenario based activities and patient feedback were
considered as potential options which would reinforce the need to HH and
the potential for new opportunities to teach the concepts. The Medical
students interviewed rated their hand hygiene compliance as high and
hence they felt they would not turn up to classes if hand hygiene were
formally taught. Teaching hand hygiene as infection control within a patient
safety context was considered a major motivator.
Disclosure of interest: None declared.

Conclusion: Elective H.H is influenced by the attitudes which are learnt


in the young ages. H.H is also important for well being of HCW. Though
HCW were aware of the importance of H.H, their awareness about
frequently touched surfaces was low.
Disclosure of interest: None declared.

P144
P144: A study of psycho-social behavior related to hand
hygiene & co-relation with well-being of health care workers
P Sharma1,2*, N Singh2, N Taneja1
1
Medical Microbiology, Pgimer, India; 2Psychology, D.A.V College,
Chandigarh, India
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P144
Introduction: Well-being at work is based on positive psychology,and is
defined as a psychological state with positive affective links towards work
(patient-care) and towards the organization (hospital). Well being of
health care workers (HCWs) directly affects their relationship with
patients. Hand hygiene (H.H) is the most effective measure for preventing
cross-infection, so good compliance is highly desirable among HCWs.
Objectives: To study psychosocial factors affecting H.H compliance &
correlation between psycho-social behavior related to hand hygiene of
HCWs & their wellbeing.
Methods: Study was conducted in 41 nurses. Self made questionnaire
tested five main domains H.H at home, In-Hospital H.H (elective &
inherent), perceived peer group behavior, Attitudes & Non-compliance
regarding H.H. Items were scored on 5 point and 7 point Lickert scales.
WHO 5 Well-being scale was used to measure well being. Spearman
Correlation (rs) & percentages were used to interpret scores.
Results: Hypothesis that H.H behavior at home (rs = 0.36), behavior in
elective (rs=0.34) & inherent (rs=0.45) hospital H.H, perceived peer group
behavior (r s = 0.32) & the attitudes (r s =0.35) will have a positive
relationship with wellbeing whereas non-compliance will have a negative
correlation (r s =-0.42) with wellbeing, was proved. HCW who washed
hands regularly at home also showed good H.H compliance at work, 59%
of the HCW admitted of not washing hands everytime, main reasons
given for non-compliance were less time (50%), minor patient contact
(51.2%) and work overload (52%). HCW had low awareness regarding
frequently touched surfaces. Same peer group behaviour was more likely
to increase compliance. Social desirability and actor-observer role were
observed. Suggestions elicited from the participants to improve
compliance to H.H included: banners in local language, use of electronic
media to grab interest, proper availability of facilities like hand sanitizers,
soaps, cold and warm water, proper placement of wash basins etc.

P145
P145: Teaching concepts of hand hygiene to medical students:
examining current practices across Australian medical schools
R Kaur*, H Razee, H Seale
School of Public Health and Community Medicine, University of New South
Wales, Sydney, Australia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P145
Introduction: Research conducted to date, has documented hand hygiene
(HH) compliance rates for medical students ranging between 8% and 52%.
While compliance rates have increased in recent years for medical
students, they are still well below the ideal levels. The audit data by hand
hygiene Australia indicate that currently hand hygiene of medical studnets
in Australia is below 70% [1].
Objectives: Our study aimed to examine current teaching and
assessment practices used in Australian medical schools to teach students
the concepts of HH.
Methods: A cross-sectional survey was sent to medical education experts
across all Australian medical schools (n= 17). The survey was made up of a
mix of open and closed questions and statistical analysis was undertaken on
all surveys using SPSS version 21.
Results: Sixteen medical schools indicated that concepts of hand hygiene
are taught and reinforced throughout the training program. Skills stations
was reported as the most common teaching method used reported by
fifteen medical schools followed by case scenarios were reported by
twelve medical schools. At sixteen medical schools indicated that the HH
concepts are assessed at least once during the medical training and
assessment is done most commonly during OSCEs (Objectively Structured
Clinical Examinations) and through clinical practical exams and
competency checks. All medical schools rated their students hand hygiene
compliance as high to very high. Teaching and learning of HH was
considered adequate and was supported by good infrastructure. However
half the participants did not consider HH as important as other medical
concepts and role models were considered as important influence in
reinforcing HH practices in a variety of clinical environments.
Conclusion: Appropriate knowledge is a starting point for improving
practice and for instilling the correct attitude to infection prevention. The
frequency and method of teaching, as well as other measures aimed to
enhance HH compliance amongst medical students, must be reexamined.
Disclosure of interest: None declared.
Reference
1. Hand Hygiene Australia: National Data Period Three 2012, Available at http://
www.hha.org.au/LatestNationalData.aspx.
P146
P146: Hands up. Improving hospital hand hygiene compliance rates as
a key patient safety and quality initiative
P Raggiunti*, J Somani, S Peczeniuk, N Smith, S Fotheringham
Infection Control, Rouge Valley Health System, Toronto, Canada
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P146
Introduction: In 2009, the Ministry of Health and Long-Term Care
mandated Ontario hospitals to begin reporting compliance for the four
moments of hand hygiene. Rouge Valley Health System (RVHS)
discovered it had very poor baseline results (200809): 40% for the first
moment and 51% for the fourth moment. RVHS responded by making
hand hygiene compliance a corporate priority, with the goal of attaining
sustained hospital compliance rates of >90% for the first and fourth
moments. To achieve this, RVHS put into action its Hands Up strategy.
Objectives: Education: Deliver hand hygiene education to staff working
in all inpatient care areas; Align education with the Ministrys Just Clean
Your Hands program, and focus training on proper hand hygiene
technique.

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Accountability: Establish a team for each inpatient unit responsible for


conducting compliance audits and providing support; Report results
monthly at all levels of the organization.
Culture: Establish staff, physicians and volunteers as the face of a
promotional campaign, and disseminate campaign widely across many
channels; Build staff buy-in through the use of innovative vehicles and
events.
Methods: Strengthening education: The foundation for hand hygiene
compliance is education. Staff need to be aware of the required practice
and how it should be performed. At Rouge Valley, multiple channels were
offered for staff to receive information and training:
Establishing accountability: Putting education into action on a sustained
basis requires a defined level of accountability. At Rouge Valley, this was
achieved by putting in place a system that ensured accountability for
each inpatient unit.
Creating a culture shift: Culture plays a significant part in hand hygiene
compliance. It establishes what the expected practice is, and reinforces this
behaviour over time. Rouge Valley has been able to develop a rich hand
hygiene culture by fostering it at the grassroots level.
Results: RVHS hand hygiene rates have vastly improved since the launch of
the Hands Up strategy. For fiscal 2011-12 and 2012-13, RVHS has surpassed
the provincial average achieving target compliance with rates at or above
90% for both the first and fourth moments.
Conclusion: The Hands Up Strategy has helped to achieve and sustain
breakthrough hand hygiene performance at RVHS.
Disclosure of interest: None declared.

Conclusion: We adapted a physical method to evaluate the thoroughness


of HH and discovered the parts of the hands that are often neglected
during HH.
Disclosure of interest: None declared.

P147
P147: Assessing the thoroughness of hand hygiene: To see is to
believe
Y-C Chen1*, K-L Tien2, E Chen3, S-C Pan4, I-C Hung2, W-H Sheng1, S-C Chang4
1
Center for Infection Control, Department of Internal Medicine, Taipei,
Taiwan, Province of China; 2Center for Infection Control, National Taiwan
University Hospital and College of Medicine, Taipei, Taiwan, Province of
China; 3Taipei American School, Taipei, Taiwan, Province of China;
4
Department of Internal Medicine, National Taiwan University Hospital and
College of Medicine, Taipei, Taiwan, Province of China
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P147
Introduction: Many staff challenged infection control personnel (ICP)
regarding the rationale of hand rubbing time. Furthermore, few if any
recommendation described how to evaluate correct hand hygiene (HH)
technique. Here we descried the impact of a stress-free, to see is to believe
program on proper HH technique conduced in May 2012 at a 2200-bed
teaching hospital in Taiwan.
Objectives: Adapting a physical method to evaluate the thoroughness
of HH
Methods: The staff volunteered to sign up for the campaign. The
thoroughness of HH was evaluated by physical method. Staff rubbed their
hands with a fluorescent substance as they would normally do with alcoholbased hand rub, and placed their hands under an ultraviolet light box to
identify any areas they might have missed. Two ICP administered the test
and assessed each persons performance and recorded on a graph for
residue points and location (37 parts of the hands). We also recorded the
time of hand rubbing. The results were recorded anonymously. Six months
later, ICPs conducted hospital-wide survey by direct observation of HH
compliance and technique.
Results: Among 85 wards, 388 staff from 30 wards participated in this
study. The hand rubbing time for all participants were more than the
recommended 10-15 seconds with an average of 5726.4 seconds. The
hand rubbing time was not affected by age, gender, and professional
categories. 45.2% have zero residuals. 74.7% had less than 3 residue points.
The average residue point is 22.8 points. There is no correlations among
hand rubbing time, participants preceded confidence, and the residue
points. We found that participants who have damaged skin had more
residues. The highest percentage of the residue points lie in the tips of the
nails (38.6%, 340/880), followed by figure tips (17.4%). Follow-up survey
showed the proportion of staff with correct HH technique increased from
76.6% in 2011 to 81.3% in 2012. The composite compliance rate increased
as well (from 82.7% to 85.5%).

P148
P148: Hand hygiene communication from healthcare workers to
patients: results of a pilot survey in several healthcare facilities
D Verjat-Trannoy1*, A Gauthier1, M-A Ertzscheid2, N Jouzeau3, S Monier4,
D Zaro-Goni5, P Astagneau1,
GRHYM - Reflection Group for Hand Hygiene promotion1
1
CCLIN PARIS-NORD, Paris, France; 2CCLIN OUEST, Rennes, France; 3CCLIN
EST, Nancy, France; 4CCLIN SUD-EST, Lyon, France; 5CCLIN SUD-OUEST,
Bordeaux, France
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P148
Introduction: Hand hygiene (HH) improvement requires a joint involvement of caregivers and patients. Asking patients to remind caregivers to
perform HH is not so easy to perform because of possible damage in
relationship quality. Another approach giving caregivers communication
initiative could improve both patient awareness and caregivers
commitment in HH promotion.
Objectives: In 2012, a pilot study was proposed to voluntary healthcare
facilities (HCF): an evaluation was carried out in order to test the feasibility
and the benefits of such an approach.
Methods: At patient arrival, staff member was asked to implement three
actions: verbal information on HH (about what is required for caregivers and
patients), hand rub technique demonstration and HH flyer distribution. Two
questionnaires (patient/caregiver) were provided to the participating HCF.
Data collected were centralized in order to perform a descriptive analysis.
Results: The collected results concern 8 public or private HCF and 46 clinical
wards. Patients: 270 patients received HH information and 98% of them
completed the questionnaire. This approach was considered as beneficial by
92% of them: increase of their knowledge and easier communication with
caregivers. 92% of patients were willing to pay more attention to their own
HH. Caregivers: over the 69 healthcare workers (HCW) participating,
professionals or students, 91% completed the questionnaire. Most of them
easily adhered to the approach (90%) and communicated to patient without
any difficulty (89%). The time spent for this communication was estimated
at less than 5 minutes by 37% of HCW. 78% of the HCW felt that this
approach was appreciated by patients. 40% of HCW reported a change in
their own HH behavior. 98% considered that this communication should be
integrated in patient care and 91% thought it could be routinely performed.
Conclusion: We note a direct benefit for patients who are rather pleasantly
surprised. This communication also takes parts in the individual and
collective engagement of caregivers about HH by making them do what
they declare. We wish to propose this easy to implement approach to a
greater number of HCF in May 2013.
Disclosure of interest: None declared.
P149
P149: Production and use of an alcohol-based handrub for hand
hygiene in the point G University Hospital of Bamako Mali
L Bengaly1*, A Benedetta2, L Diallo1, AT Traore1, ZH Harouna1, M-N Chraiti2,
P Bonnabry2
1
University Hospital of Point G, Bamako, Mali; 2Hpitaux Universitaire de
Genve, Genve, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P149
Introduction: Heath care-associated infections constitute a public health
problem. Hand hygiene is the most efficient measure for prevention and
alcohol-based handrub (ABHR) is considered as the optimal measure. In
setting the first World Challenge for the Patients Safety, the Point G
University Hospital (PGUH) was one of the pilot sites of the OMS to
implement the multimodal strategy of hand hygiene promotion. ABHR
local production was initiated in this setting.
Objectives: To present the results of ABHR local production for the
period of January 2007 to June 2010.
Methods: The chosen formulation of ABHR contains 80% of ethanol,
1.45% of glycerol and 0.125% of hydrogen peroxide. The concentration of

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the ethanol has been controlled with alcoholmeter and the dosage of the
hydrogen peroxide has been perfomed with the potassium iodine in acidic
conditions and by titration with sodium thiosulfate. ABHR samples have
been sent to the Geneva University Hospital for quality controls. The ABHR
quantities used have been valued from bottles delivered in care units.
Results: A total of 7000 100 ml-bottles have been produced and the
production costs has been estimated to 0.29 $US per bottle. The average
concentration of ethanol was 80.51% v/v ( 1.89) and the one of
the hydrogen peroxide at 0.123% v/v ( 0.0076). Controls done to Geneva
reaffirmed the conformity of component concentrations to specifications of
formulation and confirmed the absence of microbial contamination. The
amount of ABHR global consumption increased from 7.44 ml/patient-day in
2008 to 5.31 ml/ patient-day in 2009, and reached 5.97 ml/ patient-day to the
first semester of 2010.
Conclusion: The principal difficulties were linked to the obtaining of bottles
and caps for the ABHR bottling. Results of this survey showed that ABHR can
be produced locally according to WHO recommendations with a good level
of quality and stability. The example of PGUH can act as model for other
hospitals in Mali and in other countries.
Disclosure of interest: None declared.

Results: We visited 39 pharmacies. In 35 pharmacies we found at least one


pharmacist and a pharmacy technician in each structure. The premises were
compliant production in 70% of cases. Only 12% of pharmacies had
equipment.
Conclusion: In Senegal is located one of the pilot hospital of the African
Patient Safety Partnerships Program supported by the WHO for local
production of alcohol-based hand rub. The experience of this hospitalis used
to establish a partnership between the Department of Health and Intrahealth, USAIDagency involved in the provision of qualitycare. These results
will be shared with the University Hospitals of Geneva.
Disclosure of interest: None declared.

P150
P150: National action plan for the local production of alcohol-based
hand rub for hand hygiene in Senegalese hospitals: situational analysis
F Djiby*, N Awa, K Rokhaya, N Babacar
Fann Hospital, Dakar, Senegal
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P150
Introduction: Hand hygiene is an important measure to reduce the risk of
infections related to care proceedings. WHO proposes to use alcohol-based
hand rubas a strategy for improving hand hygiene in health care settings.
Objectives: As part oftheimplementation of this strategy, Senegal has
initiated anational action planfor the installation ofmanufacturing unitsin
hospital pharmaciesand national medicinessuppliers.
Methods: one of the pilot hospital of the African Patient Safety Partnerships
Program supported by the WHO for local production of alcohol-based hand
rub is located in In Senegal. The experience of this hospitalis used to
establish a partnership between the Department of Health and Intrahealth,
USAIDagency involved inthe provision of quality care. The objective of this
partnership is to strengthen the capacity of all pharmaciesin the local
manufacturing of the product. To install these units the Minister of Health
signed a circular allowing us to do a situational analysis of pharmacies. The
objective was to assess the capabilities of each structure to house a
manufacturing unit. The study was funded by Intrahealth. We visited 39
pharmacies.
Results: In 35 pharmacies we found at least one pharmacist and a
pharmacy technician in each structure. The premises were compliant
production in 70% of cases. Only 12% of pharmacies had equipment.
Conclusion: These results will be shared with the University Hospitals of
Geneva.
Disclosure of interest: None declared.
P151
P151: National action plan for the local production of alcohol-based
hand rub for hand hygiene in Senegalese hospitals: situational analysis
D Faye1*, A Ndir2, R Kande3, B Ndoye1
1
Fann Hospital, Dakar, Senegal; 2PRONALIN, Ministry of Health, Dakar,
Senegal; 3DPM, Dakar, Senegal
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P151
Introduction: Hand hygiene is an important measure to reduce the risk of
infections related to care proceedings. WHO proposes to use alcohol-based
hand rubas a strategy for improving hand hygiene in health care settings.
As part of theimplementation of this strategy, Senegal has initiated
anational action planfor the installation ofmanufacturing unitsin hospital
pharmacies and national medicinessuppliers.
Objectives: The objective is to strengthen the capacity ofall pharmacies in
the local manufacturing of the product and to assess the capabilities of
each structure to house a manufacturing unit.
Methods: To install these units the Minister of Health signed a circular
allowing us to do a situational analysis of pharmacies. The study was
funded by Intrahealth.

P152
P152: Reduction of the prevalence of cholera by observation of hand
hygiene
T Koto*, AT Ahoyo, J Akpovij, M Mensah, Fanou, O Binazon
Health Ministry of Benin, Cotonou, Benin
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P152
Objectives: Benin is endemic to epidemic area for diarrhea and cholrea in
particular. The object is to present the result of the promotion campaign of
sanitary measures which permit to reduce cholera spread in the studied area.
Methods: The study was focused on two areas affected by cholera in
September 2012. The sensitization (close communication) during three
months, by focus group in the families, interviews with people, direct
observation of behavior of affected people was performed from September
to December 2012. Inspections at place selling road food was added to the
different actions.
Results: In an estimated population of 250 000 the handwashing increased
from 23% to 65%, 79% of 2183 contaminated wells and 189 tanks were
systematically treated. Of 506 infected people, we have noticed 276 cured
patients and 02 deaths. The remained were in observation at the end of the
study.
Conclusion: Wells treatment coupled by handwashing with water and
soap permitted to reduce the frequency of cholera in two sanitary areas.
An intensive approach communications work and health education is
necessary to insert hands washing in our best practices.
Disclosure of interest: None declared.

P153
P153: The prevalence of infection among food vendors in Birim
Central of Ghana, West Africa, using biological indicators
S Boison
Environmental Health, Syband Ngo, Accra, Ghana
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P153
Introduction: The operation and patronage of fast-food joints,
restaurants, and chop bars have increased and become common in the
Ghanaian community, especially, in urban areas. Despite the benefits
derived from these food joints, their operation raises public health issues,
since food vendors could be a major transmission source for infections.
Poor knowledge of hygiene and practices in food service establishments
can contribute to outbreaks of foodborne illnesses.
Objectives: This study sought to determine the prevalence of infection
among food vendors in Birim Central of Ghana, West Africa, using biological
indicators. The main purpose of the study was to estimate the level of
infection among food vendors in the Birim Central of Ghana and to initiate
proper measures to control and prevent the spread of the infection.
Methods: A cross-sectional study was conducted in Birim Central. Data
were collected using the results of the laboratory tests done on 4243 food
vendors from 16th January to 15th February 2013. The sampled vendors
were made up of 94.53% females and 5.47% males.
Convenient sampling was used to select 4243 food vendors from the Birim
Central which had a population of about 7000 food vendors. The biological
profiles of urine and blood samples were developed from the vendors
sampled. The blood was tested for widal test (O antegen) levels whilst the
urine was tested for blood and protein levels. The cut-off points for
determining agglutination was titres above 1/160. Those whose samples
agglutinated above 1/160 dilution of the widal test were considered to have
high antibody. Proportions were calculated for the prevalence of infections
among food vendors.

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Results: The results showed that 2.85% of the sampled vendors had
hand infection. It showed that 31.88% did not know the proper method
of washing their hands. The study again showed that 4.22% had protein
in their urine and 7.78% had blood in the urine. Again, 16.64% who had
above 1/160 in the widal test (O antegen) had high anti-body.
Conclusion: There is prevalence of high anti bodies signified by high
widal test. Most of the vendors demonstrated unacceptable hand washing
technique which could be the cause of hand infections among the
vendors.
Disclosure of interest: None declared.

efficiency and accuracy of HH measurement as per the evidence-based


WHO 5 Moments of Hand Hygiene.
Objectives: 1. Determine the current state of measurement at case study
site and identify perceived strengths/weaknesses.
2. Use WHO 5 Moments as benchmark to evaluate electronic monitoring
(EM) technologies designed to capture HH compliance, and assess their
perceived feasibility for use at case study site.
Methods: Data was collected over 15 months. Observation and qualitative
interviewing were used to produce a current state map of measurement.
A structured literature review assessed Fit-For-Purpose of EM technologies.
The current state map was used to assess their feasibility for use at case
study site.
Results: From a target pool of 124, 45 Healthcare Professionals (HP) were
recruited including Infection Control, Nurses and Consultants; all involved in
HH auditing; collecting data, receiving feedback or being subject to
observation.
1. No explicit reference to WHO 5 Moments was included in current
measurement of manual auditing using direct observation based upon
standards for HH Technique (How) and Process (When).
Lack of clarity and consistency in content of audit feedback (AF) and the
feedback process was identified as a weakness by all 30 participants (pp)
interviewed.
A second weakness was lack of synergy between training content and
content of AF data; training incorporates WHO 5 Moments yet AF contains
no reference to performance at these times.
These weaknesses led the majority of pp (22/30) to conclude AF data is
often meaningless.
2. No technologies able to monitor, measure and provide feedback on all 5
WHO Moments; 1, 4, 5 show potential for technology monitoring. HP are
open to technology; all 13 ward based pp interested in potential for
personal development and group improvement. Concerns raised in all
interviews included Big Brother culture and lack of Fit-for-Purpose tools.
Conclusion: Weaknesses in current HH auditing processes can lead to
perceptions of meaningless data. No EM system currently fully supports the
WHO 5 Moments, and whilst HP are open to technology, perceptions
regarding use still exist and require addressing if EM systems are to be
considered alternatives to direct observation.
Disclosure of interest: None declared.

P154
P154: Sanitize the vehicle
S Dudziak1, E Bradshaw2*, L Joseph-Massiah2, J Clark3
1
Revera Inc, Mississauga, Canada; 2Revera Inc, Toronto, Canada; 3Revera Inc,
Ridgetown, Canada
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P154
Introduction: In 2011 driven by our growing concern regarding delivery
of care related to infection control and the transmission of infections a
hand hygiene project was initiated.
Objectives: Increase product accessibility at point of care
Improved knowledge of hand hygiene and overall infection control
processes
Increase in hand hygiene compliance
Methods: A review of the following items was completed using the LEAN
methodology, the 5 Why.
- System Change -Reviewed location of alcohol-based hand rub at point
of care, reviewed accessibility of alcohol-based hand rub to Patients in
wheelchair, reviewed accessibility to water soap and towels, reviewed
accessibility to hand moisturizers, Interdisciplinary team involvement.
- Training / Education -Family, Patients, staff, visitors, and outside
contractors were trained on the moments of hand hygiene and correct
procedures for hand rubbing and hand washing, Trained staff to complete
hand hygiene observation audits, Staff reviews utilization of gloves, All staff
watched a hand hygiene video.
- Evaluation and feedback -Assessed staffs perception of hand hygiene
thru focused groups and surveys, Hand hygiene focused observation
audits were completed prior to initiating the project and post
implementation, Completed environmental Infection control audits to
supplement infection control processes overall.
- Reminders in the workplace -Poster were posted in public areas, audit
results were posted in the quality board for all to see.
- Institutional safety climate -Nurtured a culture of Patients safety,
Implemented Patients hand hygiene champions on each floor, Involved
Patients and Family council.
Results: - Baseline hand observation audits were compiled and repeated
every 3 months. Increase in hand hygiene from 67% to 96% (increase of
29%)
- No outbreaks in 2011, 2012
Conclusion: This project showed a benefit for the Patients, staff and the
community at large.
Disclosure of interest: None declared.
References
1. A Guide to the Implementation of the WHO. Multimodal Hand Hygiene
Improvement Strategy 2009.
2. Health Canada: Its Your Health. The benefits of Hand Washing 2010,
Available at: http://www.hc-sc.gc.ca/hl-vs/alt_formats/pacrb-dgapcr/pdf/iyhvsv/diseases-maladies/hands-mains-eng.pd.
3. Nicolle Lindsay E: Preventing Infections in Non-Hospital Settings: LongTerm Care. CDC 2001, available at: http://www.cdc.gov/ncidod/eid/
vol7no2/nicolle.htm.
P155
P155: Technologies to measure hand hygiene: examining the
incorporation of the World Health Organisation (WHO) 5 moments
C Dawson
Institute of Digital Healthcare, University of Warwick, Coventry, UK
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P155
Introduction: A case study of Hand Hygiene (HH) auditing within a UK
NHS Acute Hospital resulted in the exploration of technology to improve

P156
P156: Ring wearing in healthcare settings: an evidence-based update
A Dyar, OJ Dyar*
Oxford University, Oxford, UK
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P156
Introduction: Tens of thousands of healthcare workers worldwide can only
wear a plain wedding ring at work, if any at all. This arose from policies
citing early laboratory evidence that rings can carry clinically relevant
bacteria, but with little supporting clinical data. Policies that are both
invasive and perceived as lacking evidence create a broader scepticism of
infection control guidelines: it is therefore important to regularly review the
evidence for such guidance.
Methods: A systematic literature review was performed of studies
investigating the infection risk of ring wearing by healthcare workers.
PubMed, Cochrane Library and clinical trials registries were searched. Data
was extracted on study design and quality, and the following outcomes:
hospital acquired infection (HAI) rates, bacterial transmission, and bacterial
contamination of healthcare workers hands.
Results: Two interventional randomised controlled trials (RCTs) and ten
observational studies were identified. No study investigated an association
between ring wearing and HAI rates. The RCTs were very small and used
hand colonization as the primary outcome. One RCT found higher
colonization of hands of healthcare wokers randomised to wear rings than
those not wearing rings, whereas the other RCT found no difference. One
observational study assessed bacterial transmission through handshaking
and found the presence of a ring did not result in higher transmission. Three
observational studies found higher bacterial contamination of hands with
rings, and five studies found no difference. The presence of rings did not
result in higher contamination after handwashing in most studies. No study
identified a significant increase in hand contamination with multiple rings
compared with one ring, nor between different types of ring.
Conclusion: No direct evidence was found that healthcare workers wearing
rings results in higher HAI or bacterial transmission rates. Most studies

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did not identify higher contamination associated with ring wearing;


furthermore, the clinical significance of a statistical difference in the number
of colony forming units is unclear. Guidelines could benefit from
reconsidering ring wearing guidance, and focussing on interventions with a
more defined evidence base; fewer intrusions into healthcare workers
personal autonomy may increase willingness to participate in other
important interventions.
Disclosure of interest: None declared.

We tested this approach in cardiac surgery with defined process


parameters that were regularly monitored.
Methods: In interdisciplinary team-meetings, all process indicators were
discussed, and a well-defined set approved, all being recommended by
WHO. The dashboard was posted monthly at the OR entry, and reported
to the cardiac-thoracic-surgery-team in 2-monthly meetings. The survey
period lasted from 10/2011-11/2012.
Parameters and aims: - Timing of Antibiotic-prophylaxis (30-60 min
before incision)
- Preoperative temperature (core temperature > 36C prior incision)
- Discipline in the OR (hand-disinfection performed at 5 moments WHO;
no jewellery/or covered; correct wearing of surgical mask)
The indicators were surveyed by ~4 control-visits in the OR per month as
well as by analysis of data from the electronic OR chart. The feedback of
adherence was simplified by using a traffic-light-system that was
implemented to show parameters at a glance and posted monthly at the
OR-doors:
Colour-system: - RED (not fulfilled; Score 0 points)
- ORANGE (limited adherence; score 1 point)
- GREEN (fulfilled; score 2 points)
Maximal achievable points are 16.
Results: Analysis of parameters showed an increase in compliance over
time, from an average of 7 points at start of the survey-period to an average
of 15 (p<0.05). However, two time periods showed decreased adherence,
but rapidly exceeded the level of previous months.
Conclusion: The very simple dashboard provided rapid and easy feedback
on compliance to guidelines. It was readily accepted by members of the
interdisciplinary team, and helped to improve the teams performance.
If supported by senior staff and open discussion of not fulfilled parameters
this tool helps to sustain high levels of adherence after an initial
intervention.
Disclosure of interest: None declared.

P157
P157: Face-touching: a frequent habit for self-inoculation of
transmissible infections?
A Kwok*, M-L McLaws
UNSW Medicine, The University of New South Wales, Sydney, Australia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P157
Introduction: Touching the mucous membranes of the nose and mouth
is a potential for transmission and acquisition of a range of infections.
Infection may be spread to others after inoculating ones own hands
during face-touching or infections may be acquired via contaminated
hands after face-touching.
Objectives: To investigate the prevalence of face-touching behaviour in
medical students.
Methods: All fifth year UNSW medical students who had completed 4
hours of infection control education in the prior year attending a lecture
theatre for a 60min lecture were invited to participate in a video recording
for a behaviour observational study. To eliminate bias students were
blinded from the aim of the study. Consented students were instructed to
sit on one side of the lecture theatre where video recorder was set up.
University Ethics approval was obtained. Two researchers observed video
tapes independently and tallied the frequency of hand-to-face contacts for
each participant using a standardised sheet to record the region (nose,
mouth, eye and non-mucous membrane regions) and frequency of each of
these regions.
Results: All 29 students touched their face at least once. 90% (26/29)
touched a mucous membrane on the face at least once during 60min of
observation. Out of the 2346 touches observed, 1175 were to a non-mucous
membrane region and 1171 were touches to nose, mouth or eye regions,
with an average 45 mucous membrane touches per student over the 60
mins period (median 29, min 4, max 153). Touching the mouth was the
most frequent region at 372 touches, followed by the nose 318 touches and
eyes 273 touches. The duration for mouth touching ranged from 1sec to
12sec (median 1sec, mean 2sec), the duration for nose touching ranged
from 1sec to 10sec (median <1sec, mean 1sec), eye touching ranged from
1sec to 5sec (median <1sec, mean 1sec).
Conclusion: The greatest shedding of virus in the community occurs
during the prodromal stage of influenza usually 3 days before symptoms
and signs. During the prodromal period the prevalent behaviour of facetouching provides the opportunity for acquisition and transmission of
infectious material. During public health campaigns to educate and alter
the community about reducing their risk of transmission and acquisition
the campaign should also focus on modifying our unconscious preening
behaviour.
Disclosure of interest: None declared.

P158
P158: Posting a management dashboard improves behaviour in the OR
R Meinke1*, OT Reuthebuch2, J Fassl3, I Gisler3, M Heiberger3, M Seeberger3,
FS Eckstein2, AF Widmer1
1
Infectious Diseases and Hospital Epidemiology, University Hospital Basel,
Basel, Switzerland; 2Cardiac Surgery, University Hospital Basel, Basel,
Switzerland; 3Anaesthesiology, University Hospital Basel, Basel, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P158
Introduction: Surgical site infections (SSIs) lead to increased morbidity
and mortality. Guidelines to prevent SSIs have been issued, but adherence
is commonly low. Interventions in the OR to improve adherence are
frequently short term. A dashboard is a management tool used in
industries showing defined performance indicators at a glance, it is easily
accessible to everyone and recipients are able to influence the indicators.

P159
P159: The views of senior hospital managers on innovative strategies
to improve hand hygiene adherence: a qualitative study
E McInnes1,2*, R Phillips2
1
School of Nursing, Midwifery and Paramedicine, Australian Catholic
University, Sydney, Australia; 2Nursing Research Institute SVMHS & ACU,
Darlinghurst, Australia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P159
Introduction: Hand hygiene (HH) adherence remains low among hospital
clinicians and improvement strategies such as audit and education have
weak or mixed effects.1 Innovative approaches are required to improve
HH and reduce hospital-acquired infection rates; hence we sought the
views of senior hospital managers about new ways to improve HH.
Objectives: To identify the views of senior hospital managers on: 1) the
concept of HH non-adherence as a healthcare error; and 2) innovative
strategies to include within HH improvement programs.
Methods: We conducted a qualitative study at a tertiary referral hospital.
Twelve purposively sampled senior clinical and executive staff
participated in semi-structured interviews that were audio-recorded and
transcribed. Data were thematically analysed.
Results: Four themes emerged. Making hand hygiene part of the mantra
reflects perceptions that HH culture and practice is variable across
disciplines and within different parts of the facility. Shifting the balance of
responsibility reflects views that introducing the concept of HH nonadherence as a healthcare error would strengthen HH programs. Innovative
approaches suggested were: 1) Overdue to start using the hammer: refers to
a tiered system of disciplinary action which may include financial fines and
suspension from practice for repeated lapses, combined with HH education
as a mandatory part of clinical reaccreditation; and 2) Role modelling and
empowering all hospital staff through assertiveness training to remind and
prompt each other about HH. This would be supported and sanctioned by
hospital policies.
Conclusion: Basing HH strategies on the concepts of individual
responsibility and non-adherence as a healthcare error was perceived by
senior hospital leaders as necessary to reinvigorate and increase the impact
of current HH programs. Future developments will involve evaluating the
feasibility of these approaches within HH improvement programs.

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Disclosure of interest: None declared.


Reference
1. Gould DJ, Moralejo D, Drey N, Chudleigh JH: Interventions to improve
hand hygiene compliance in patient care. Cochrane Database of
Systematic Reviews 2011, 8, doi: 10.1002/14651858.CD005186.pub3.

P160
P160: The enablers and barriers to introducing bare below the
elbows for hand hygiene behaviors: an exploratory study
K McKay1*, R Shaban2, E Coyne3
1
Infection Prevention & Control, Eastern Health, Box Hill, Brisbane, Australia;
2
Griffith Health Institute, Brisbane, Australia; 3School of Nursing, Griffith
University, Brisbane, Australia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P160
Introduction: Introduction of the bare below the elbows (BBE) guidelines
within the National Health Service in the United Kingdom was met with
complaints from many health care workers (HCW). BBE has been introduced
in several states of Australia, and is expected to become mandatory in
Victoria. There is no research indentifying the barriers and enablers to BBE
nor any publicly available information on successful implementation
programs. This study examines the barriers and enablers to the introduction
of BBE within the 3 largest hospitals of the Eastern Health (EH) Network in
outer Melbourne, Australia.
Objectives: The aims of this study were to determine the extent to
which the dress and adornment behaviours of HCW at EH were already
consistent with the principles of BBE, and to determine the enablers and
barriers to the introduction of BBE within clinical areas at EH.
Methods: The study was descriptive and utilized both quantitative and
qualitative methodology. Data was collected at the 3 major EH sites in 2
phases, a point prevalence audit which described the current hand
adornment and HCW dress behaviours as compared to the BBE framework
and focus groups to explore HCW opinions and feelings surrounding the
changes inherent in BBE.
Results: The audit showed that overall 11.7% of staff were compliant with
BBE. Data was also examined according to site, gender, ward type, HCW
group and BBE element. A picture of the dress and hand adornment
practices of the target staff was thus able to be quantified. Barriers and
enablers include the lack of a uniform, heating, clocks, pass holders and
storage. In addition broader issues such as consequences, feedback,
evidence, equity, identity, role modelling and organizational support were
also identified.
Conclusion: Achieving compliance with BBE is possible but would require
consideration of multiple factors such as those illuminated by this work;
medical staff may prove a difficult challenge with regard to sleeve length
and the wearing of ties, while the removal of rings is an emotive area. It is
anticipated that this data will allow the formulation of strategies to
introduce these practice changes in an efficient, cost effective and
sustainable way which does not adversely affect other infection prevention
strategies within EH.
Disclosure of interest: None declared.

P161
P161: Knowledge and perception toward hand hygiene among
health- care workers in teaching hospital, Korea
EK Kim1*, MK Joo1, SY Baik1, SK Hong2
1
Infection Control Office, CHA Bundang Medical Center, CHA University,
Soengnam-si, Gyeonggi-do, Korea, Republic Of; 2Department of internal
medicine, CHA Bundang Medical Center, CHA University, Soengnam-si,
Gyeonggi-do, Korea, Republic Of
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P161
Introduction: Hand hygiene is considered the most important infection
control measure in health care setting and forms the core of patient safety.
Despite the activity of hand hygiene promotion continued, we observed
that hand hygiene compliance is congested. This study was performed in
order to survey the knowledge and perception toward hand hygiene for
health-care workers(HCWs) to utilize further activity of hand hygiene
promotion.

Page 77 of 143

Methods: This study was performed between January and March 2013 in
CHA Bundang medical center, 865-beds teaching hospital in Korea. Our
survey material used the WHO questionnaire revised August, 2009. The
questionnaire included 7 questions on general characteristics, 10 on
knowledge issues (25 scoring), 11 on perception issues(96 scoring). The
collected data were analyzed using the SPSS (ver. 20.0) program.
Results: During the study period, 348 HCWs were surveyed. The surveyed
HCWs were nurses (55.5%), physicians (4%), technicians (25.6%), and
nurse assistants (14.7%). The mean age was 30.2 (SD=6.6) and the
majority of participants were female (76.4%). The mean score of hand
hygiene knowledge was 14.25 (SD=2.05), there were significantly
differences in gender (female, t=-2.276, P=.023), clinical experience(above
5years, t=-2.463, P=.014), profession (nurse, F=9.337, P<.01) and no
significantly differences in age, department. Otherwise the mean score of
hand hygiene perception was 75.2 (SD=11.83), there were significantly
differences in age (above 31years, t=-3.224, P=.001), profession(nurse,
F=4.1, P=.007), department (ICU, F=2.57, P=.038) and no significantly
difference in gender, clinical experience. Having had a formal training in
hand hygiene was significantly difference both of knowledge (t=5.50,
P<.01) and perception (t=2.4, P=.017).
Conclusion: In this study, the knowledge and perception of hand hygiene for
HCWs is low, and It could result in congesting hand hygiene compliance.
Therefore, it is necessary to develop a promotion program to build knowledge
and perception of hand hygiene to improve compliance for HCWs.
Disclosure of interest: None declared.

P162
P162: Behavior and infection control/ influencing healthcare workers
PH Mishra
Medical Superintendent, Indian Spinal Injuries Centre, Delhi, India
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P162
Introduction: Health care-associated infections (HAIs) have become more
common 5-8% (30% is preventable) as medical care has grown more
complex and patients have become more knowledgeable and demanding.
Objectives: The objective of this study was to evaluate and suggest for
improvement in Health Care Acquired infection at 150 bedded Indian
Spinal Injuries Centre (ISIC).
Methods: Method included a retrospective study of HAI data for 2 years
(2011-2012).
Results: Result showed that Catheter Associated Blood Stream Infection
(CA-BSI) in 2011 was 0.2% & in 2012 1.3%. CA UTI 2011 was 3% & in 2012
was 3.5%. E. Coli 52% is main cause of Urine infections & most sensitive
to Colistin, Imipenam, Kleibsella 32%, Pseudomonas 15% more sensitive
to Imipenam and Tazobactum.
Respiratory infection E. Coli 33%, Staph 33%, Acinetobacter 34% CDC 4.86/1000 Ventilator days. More sensitive to Colistin.
VAP rates in ISIC in 2011 was 5% & in 2012 was 2.6%.
Conclusion: Interventions: To be effective the infections control
program has included the following:
Organized surveillance and control activities.
Two infection control Nurses have been appointed.
A Trained Hospital Epidemiologist & Microbiologist have been appointed.
A system for reporting surgical wound infection rates and other infection
back to the practicing surgeons and physicians developed.
UTI Guideline: Booklet distributed, bed side teaching is done for
Catheter care, CIC Counseling, Antibiotic Catheter, VAP- Raised head end
30%, Culture 1st day & 3rd Day leads to early detection and treatment.
SSI-Stopped shaving, clipping done, Chlorhexidine & Betadine used for
skin preparation.
Disclosure of interest: None declared.
P163
P163: Patients for patient safety: translating anecdote to evidence base
M Murphy
Patients for Patient Safety, WHO, Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P163
Introduction: Capturing the patient experience in a manner that
supports healthcare in providing quality care in a consistent manner

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while also effecting necessary change, continues to be a challenge for


patients and patient organisations. The patient experience is often
described as the patient story an expression which, in itself, can
sometimes detract from the perceived value of what is being offered as
an accurate representation of the reality in relation to how care is
actually delivered. Particularly in the area of education, the articulation of
these experiences by real people, patients and family members,
elevates the story to being an effective learning tool. This supports the
didactic course material and promotes sustainable culture change to
provide care that is truly patient-centred, especially in the areas of
communication and adherence to guidance and protocols.
Methods: Feedback from students, those engaged in continuing
professional development, frontline staff, and policy makers shows that
exposure to the patient experience directly from the patient is not alone
welcomed, but is valued as an adjunct to the formal processes and is
considered to be motivational in relation to enhancing the quality of clinical
practice.
Results: Healthcare is informed and monitored by clinical audit, process
audit, and outcome audit. There is a singular absence of patient experience
audit. Examples of two incidents of patient experiences show that the
absence of the patient experience audit deprived healthcare of achieving a
true reflection of whether adherence to guidance and protocols exists
outside the audit process in the everyday delivery of care.
Conclusion: Part of the process involves structuring the patient experience
to optimum benefit, e.g., providing a chronology of events, identifying
shortcomings, offering solutions. The resultant change in dynamics means
that the patient and his/her unique experience are accepted as further and
hitherto untapped resources to be harnessed in all areas of activity, such as
policy making, education, research, and regulation.
Disclosure of interest: None declared.

particular for transmission and prevention. Enhancement of public


knowledge and responsibility on MRSA control via multi-disciplines and
multimedia could be helpful in reducing the spread of MRSA.
Disclosure of interest: None declared.

P164
P164: Survey on patients perception of methicillin-resistant
Staphylococcus aureus (MRSA) prevention and control
RFY Chan1*, SC Fung2, SW Chan1, KY Chau1,2, MY Yim1, MC Li1, OT Chau1,
YK Tze1
1
Infection Control Team, United Christian Hospital, The Hospital Authority of
Hong Kong, HKSAR, China; 2Pathology Department, United Christian Hospital,
The Hospital Authority of Hong Kong, HKSAR, China
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P164
Introduction: Methicillin-resistant Staphylococcus aureus has been endemic
in Hong Kong, and accounts for approximately 40-45% of all Staphylococcus
aureus isolates. A territory-wide admission screening of 7387 patients from
Department of Medicine of acute care hospitals in 2011 revealed that 14.2%
carried MRSA. Efforts to enhance infection control from all parties, including
the patients, are keys to prevention of transmission.
Objectives: To assess the patients level of understanding, prevention
and control of MRSA, identify improvement measures from patients
perspective, and explore the public education in relation to MRSA.
Methods: A cross-sectional study was conducted in the out-patient clinics
of the medical department of an acute regional hospital in Hong Kong in
2012. Face-to-face interview using a structured questionnaire was used.
Results: A total of 429 patients completed the interview. There were 203
male and 226 female; 65% aged over 40 years old. 253 (59%) have heard
of MRSA, mainly from the media (85.8%). Around 50% correctly recognized
it as bacteria and 18.2% knew about asymptomatic carriage. 30-40%
associated MRSA with pneumonia and soft tissue infection, whereas 40%
had no idea of disease association. 63.6% considered antibiotics for
treatment and 28.5% had no idea at all. Droplets (37.5%) and direct
contact (30.4%) were considered as common routes of MRSA transmission,
39.7% showed no idea. Around 65% perceived that crowded hospital
environment and having MRSA patients at neighborhood increase the risk
of acquisition. 15-20% regarded surgery, line insertion and total
dependency as risk factors. 20% expressed moderate worry about MRSA
acquisition. Two-third did not consider visitor and family members role are
extremely important in MRSA control.
Conclusion: This study showed that patients general knowledge on MRSA
was low. The main source of information was from the media, and role of
patients visitor or family member in MRSA control is not considered
essential. Patients are interested to get further information about MRSA, in

P165
P165: Perception of health care employee related to handwashing
practice and insertion of the patient in this context
MM Baraldi1*, C Santoro1, C Scmitt1, M Simoneti1, C Lovatto2
1
Scih, Alemo Oswaldo Cruz Hospital, So Paulo, Brazil; 2Uti, Alemo
Oswaldo Cruz Hospital, So Paulo, Brazil
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P165
Introduction: Considering that handwashing responsabilityis mainly on
health area professionals, the survey of employees perception helps to
orientate the implementation of educational measures in the promotion
of improvements and and can also offer subsidies to stimulate patients
active participation in the search for health.
Objectives: Evaluate the health care employees perception regarding the
best practices of handwashing, including the patient involvement in the
shared responsability of this handwashing practice
Methods: It is about a descriptive, quantitative study performed at a
midsize, private hospital located in So Paulo, Brazil.
Among the actions performed in the Annual Handwashing Campaign in
2012, pamphlets with closed questions were distributed, allowing the
evaluation of 363 healthcare employees.
The variables for evaluation were considered: the importance of the 5
moments practice, the performance of handwashing opportunities, the
importance given to the patient involvement, handwashing as part of
care and the quality of alcohol gel.
Results: The analysis of collected data has showed that 99% of employees
consider of much importance the 5 Moments practice, 58% consider fulfill
100% of opportunities. When evaluated the importance given to the patient
involvement in the improvement process, 93% of the employees consider it
very important, 3% indifferent and 4% refer moderate importance. 100% of
the employees consider that handwashing is part of the health process. 81%
of these consider that the family and patient proactivity help increase the
implementation of handwashing measures, while 19% of the employees do
not agree. The employees evaluated the quality of alcohol gel as: 61% very
good and 38% good.
Conclusion: The results found show a homogeneous awareness on the
practice of handwashing and also that the perception of the importance of
the patient participation in the shared responsability already is a fact, which
allows the implementation of new multiprofessional strategies, stimulating
the patient to take an active part in his own care.
Disclosure of interest: None declared.

P166
P166: Improving childrens and their visitors hand hygiene compliance
D Lary1*, K Hardie1, J Randle2
1
School of Molecular Medical Sciences, University of Nottingham,
Nottingham, UK; 2School of Nursing, Midwifery and Physiotherapy, University
of Nottingham, Nottingham, UK
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P166
Introduction: Numerous interventions have aimed to improve the hand
hygiene practices of healthcare workers in healthcare settings, however little
attention has been paid to patients and their visitors hand hygiene.
Children specifically are vulnerable to healthcare-associated infections, and
again few studies have reported on their hand hygiene compliance.
Objectives: The aim of the study was to increase childrens and their
visitors hand hygiene compliance by an interactive educational intervention.
Methods: The study was a cluster randomized control and multi-methods
intervention trial involving; baseline and post-intervention hand hygiene
observations, interactive educational activities using a novel hand
hygiene training aids Glo-Yo and mobile learning technology, and
questionnaires and interviews.
Results: Hand hygiene compliance following the intervention increased
by 8.5% (P <0.001) compared with hand hygiene compliance before the
intervention. There was no difference in compliance between children

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and their visitors (22% vs 28%, P= 0.051). While hand hygiene compliance
varied depending on which of the five moments of hygiene undertaken
(P<0.001), with highest compliance after body fluid exposure 65% (11/17);
before patient contact 31% (86/93); after patient contact 22% (50/225)
and after contact with surroundings 24% (13/54). Regarding the
intervention sessions, 67% of the Glo-Yo group and 55% of mobile
learning technology group has strongly agreed that the session was
successful at raising awareness of the importance of hand hygiene
compared to 30% in the control group. Additionally, 86% of visitors
strongly agreed that the Glo-yo session has increased their childs
knowledge/understanding of when to wash hands and parts of hands
that are difficult to wash compared to MLT and control group.
Conclusion: There was evidence of a significant increase of HH
compliance of patients and visitors during and post intervention (P <
0.001) and that the Glo-yo session was successful at raising awareness of
the importance of HH compared to the MLT and control group.
Disclosure of interest: None declared.

University Hospital Zurich, CH-8091 Zurich, Switzerland; 3Facult des Sciences


Economiques et Sociales, University of Geneva, Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P168

P167
P167: The challenges of implementing patient participation in hand
hygiene results of a qualitative inquiry in the framework of a
randomized controlled effectiveness trial
S Touveneau1*, L Clack2, F Da Liberdade Jantarada1, A Stewardson1,
M Schindler3, M Bourrier3, D Pittet1, H Sax2
1
Infection Control Program, University of Geneva Hospitals, Geneva 14,
Switzerland; 2Division of Infectious Diseases and Hospital Epidemiology,
University Hospital Zurich, Zurich, Switzerland; 3Departement of Sociology,
University of Geneva, Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P167
Introduction: A single center, cluster randomized controlled effectiveness
trial was conducted to compare two novel hand hygiene (HH) promotional
strategies. Sixty six wards were randomized to standard HH promotion
(control), standard promotion plus HH performance feedback (FB), or FB plus
active patient participation (PP). While FB seemed to be well accepted by
HCWs, the introduction of PP proved to be more challenging.
Objectives: Here we focus on PP and report the results of a qualitative
inquiry, designed to investigate the range of success with its implementation.
Methods: A ward-level case study was conducted through 3 focus groups
with ward staff and 6 interviews with ward head nurses. Participants were
selected following an extremes sampling strategy regarding adoption
strength. The hospitals infection control nursing staff participated in
additional focus group. All sessions were audiotaped and transcribed
verbatim. Analysis was deductive (using a framework of themes that had
been previously established) and inductive (grounded theory).
Results: Four main and 12 sub-themes (in parenthesis) emerged: Context
(patient emancipation, behavioral norms, experiential stages of change,
infrastructure); Risk knowledge (nil); Interaction (means of communication,
emotions); Implementation process (study and implementation design,
message delivery, leadership, unintended effects, time and workload,
sustainability). The action of confronting another person about a failure
became less emotionally menacing through positive experiences, innovative
means of communication, and institutionalization of the project. Individual
leadership engagement had a major impact on implementation success.
Exclusion from intervention arms motivated control wards to improve HH
performance independently.
Conclusion: This qualitative research permitted to explain the quantitative
study findings and to explore the evolutionary and complex implementation
process of PP. While PP remains challenging, it is our hope that the findings
of this study may facilitate future patient participation projects.
Disclosure of interest: None declared.

P168
P168: Leadership styles of ward head nurses and implementation
success a qualitative inquiry in the framework of a mixed-method
study on hand hygiene promotion through patient involvement
S Touveneau1*, L Clack2, C Ginet1, A Stewardson1, M Schindler3, M Bourrier3,
D Pittet1, H Sax2
1
Infection Control Program, University of Geneva Hospitals, Geneva 14,
Switzerland; 2Division of Infectious Diseases and Hospital Epidemiology,

Introduction: To actively involve patients in hand hygiene promotion is


now widely advocated but many institutions find this challenging.
Objectives: We sought to understand the role of the ward head nurses
(HN) in the implementation process of a patient participation (PP) module in
a randomized controlled effectiveness trial on hand hygiene promotion.
Methods: A case study was conducted using a mixed deductive and
inductive approach based on the grounded theory (Glaser & Strauss, 1967).
During the active implementation phase we interviewed head nurses of the
19 study wards quarterly regarding their attitude towards PP, their
promotional engagement, their knowledge of the wards implementation
progress, and their account of facilitators and barriers.
Results: The head nurses intrinsic leadership characteristics and their
perception of PP emerged as key elements for successful implementation.
Plotted as a matrix, they formed winning or losing combinations in regards
to implementation success. Promotional activity types refusing and
pretending were unsuccessful, while proactive managing and innovation
were winning combinations. Additionally, we saw perception of PP evolve
over the course of the study as a function of prior implementation experience
and the hierarchical and team support they received. Patients very rarely
reminded healthcare workers (HCW) to do hand hygiene, but awareness of
the importance of hand hygiene rose amongst both patients and HCW.
Conclusion: Intrinsic leadership style in the organizations mid-level
managers and attitude towards the intervention were the most important
predictors for successful implementation of this very challenging task, and
organizational context also played an important modifying role. We saw
unanticipated evolution of attitudes and activities throughout the study
period. Thus, we suggest involving effective leaders and providing them
with continuous organizational support to ensure implementation success.
Disclosure of interest: None declared.

P169
P169: Is patient participation useful to improve staff hand hygiene
compliance in a geriatric hospital?
V Sauvan1*, Y Registe Rameau2, L Pagani1, D Pittet1
1
Infection Control Program, Geneva University Hospitals, Geneva, Switzerland;
2
DMIRG, Geneva University Hospitals, Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P169
Objectives: Patient participation to enhance compliance with hand
hygiene practices may improve the global strategy. We investigated the
ability of geriatric patients to be involved in such a strategy.
Methods: We conducted a survey on the impact of feedback and patient
participation on hand hygiene compliance at our institution in 2012 and
included 5 of 16 wards at the geriatric hospital. Patients were randomly
recruited by an infection control nurse in 2 of the 5 wards to investigate
the potential for patients to be actively engaged in hand hygiene
practices. Inclusion criteria were: a cognitive capability of >19 as measured
by a Mini Mental State examination and a stable health condition. At day
0, patients were trained in hand hygiene indications that should be carried
out by staff and by themselves. Patients were given a training brochure
and a bottle of alcohol-based handrub, together with a questionnaire
about their willingness to either carry out hand hygiene or remind staff of
the procedure, if not accomplished. At day 7, included patients underwent
an interview to assess their active participation.
Results: 91 patients were screened; 39 fulfilled inclusion criteria and 20
accepted to participate. At day 0, participants declared their willingness to
comply with between 35% to 95% of the social recognized and trained
indications related to personalhand hygiene. Four of 20 patients agreed to
remind staff of hand hygiene indications if necessary. At day 7, 7 of 16
patients still hospitalized recalled their engagement; 11 confirmed the use
of alcohol-based handrub and none had reminded staff.
Conclusion: Patient participation in hand hygiene practices remains low
among the elderly. Elderly patients can be taught correct self-use of
alcohol-based handrub, but reminding staff to comply remains quite
difficult. Training the elderly with accessible and targeted information
might also positively impact on staff perception and relieve workload.
Disclosure of interest: None declared.

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P170
P170: Evaluation of knowledge and practices of hospital waste
management in Nigeria: implications for the control of healthcare
associated infections
E Okechukwu1*, A Onyenwenyi2
1
Centre for Health Research & Development, Action Family Foundation,
Nigeria; 2Institute of Child Health & Primary Care, Lagos University Teaching
Hospital, Lagos, Nigeria
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P170
Objectives: The medical waste management is a recognized public
health problem, since it exposes healthcare workers, patients and the
environment to infection, injury and contamination.
In the era of HIV / AIDS, hepatitis and other epidemics, local data are
required to implement policies for prevention and control measures.
Methods: To assess the knowledge and practices of medical waste
management (GDM) in health facilities to facilitate the design activities GDM
capacity building to improve the safety of care.
Results: Internationally validated instruments were used to obtain data
from 32 health facilities in four states on the development of key messages,
advocacy / awareness sessions. 56 health workers and educational
institutions, local authorities were concerned.
After 6 months, capacity building workshops have been made to improve
the immediate impact of the project messages on the dangerous practices
of GDM prevalent in 97% of schools. A self-administered post-intervention
questionnaire was used to compare the pre-test scores.
Conclusion: In 28 workshops, staff and students 2100 16 educational
institutions and health care organizations and 59 civil society have been
affected by training on GDM. The post-intervention evaluation showed an
improvement of 63% on the issues of knowledge and practice.
Conclusions: This study provides a framework for evidence-based
integration of GDM in developing countries to prevent nosocomial
infections, promote patient safety and to ensure the sustainability of the
healthcare environment.
Disclosure of interest: None declared.

P171
P171: Promoting European infection control / hospital hygiene core
competencies (EIC/HHCC): a comparative analysis with related
disciplines
S Brusaferro1, BD Cookson2, R Gallagher3, P Hartemann4, J Holte5, S Kalenic6,
W Popp7, GP Privitera8, CV Santos9, C Suetens9, L Arnoldo10, G Cattani10*,
E Fabbro11
1
Medical and Biological Sciences, University of Udine, Udine, Italy; 2University
College of London, London, UK; 3Royal College of Nursing London, London,
UK; 4Universit de Lorraine- CHU de Nancy, Nancy, France; 5Staten Serum
Institute Copenhagen, Copenhagen, Denmark; 6University of Zagreb, Zagreb,
Croatia; 7University Hospital of Essen, Essen, Germany; 8DTRM University of
Pisa, Pisa, Italy; 9ECDC Stockholm, Stockholm, Sweden; 10Publich Health and
Prevention Medicine, School of Specialization in Medical Hygiene, University
of Udine, Udine, Italy; 11Department of Biological and Medical Sciences,
University of Udine, Udine, Italy
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P171
Introduction: Training Infection Control in Europe (TRICE) in 2010 identified
significant differences within European Countries (EC) in the existence of
Infection Control /Hospital Hygiene (IC/HH) courses and their compliance
with the Improving Patient Safety in Europe (IPSE, 2008) recommended Core
Competencies. The need to improve official recognition of IC/HH degrees
for healthcare professionals also emerged. TRICE further developed, agreed
EIC/HHCC with two tiers, published by ECDC in March 2013 as a Technical
Document.
Objectives: Within the ECDC 2012 commissioned project TRICE-IS
(Implementation Strategy) we conducted a comparative analysis between
EIC/HHCC and IC/HH related disciplines within the broader aim of
promoting mutual recognition of courses based on EIC/HHCC within
European Countries.
Methods: We collected documents about disciplines that in TRICE were
related to IC/HH (Medical Microbiology, Infectious Diseases, Public Health

Page 80 of 143

and Epidemiology) and compared them with European IC/HH Core


Competencies.
Results: Documents collected were referred to:Public Health (ASPHER),
Epidemiology (ECDC) Public Health Microbiology (EUPHEM, ECDC), Medical
Microbiology (UEMS) and Infectious Diseases (UEMS). Global alignment
with the EIC/HHCC competencies (n.101) resulted: 80% for ASPHER, 56%
for epidemiology ECDC, 40% for Infectious Diseases, 20% Medical
Microbiology UEMS and 64,4% for EUPHEM. In the Program Management
area (n. 24 competencies) poor alignment has been identified for
Infectious Diseases 37.5%,and Medical Microbiology (UEMS) 16.7% and
Public Health Microbiology (EUPHEM) 4%.
Conclusion: European documents addressing the training of specialties
related to IC/HH have many topics similar to those reported in the EIC/
HHCC. Almost all of them need to be complemented in order to cover the
topics mentioned in EIC/HHCC.
Disclosure of interest: None declared.

P172
P172: Innovate and educate
M Lin
Singapore General Hospital, Singapore, Singapore
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P172
Introduction: One of the lessons we learnt post-SARS is the value of an
informed healthcare workforce on the importance of infection control and
their competence in its practices. Like many, we instituted mandatory
orientation in Infection Prevention and Control (IPC) since then, for the 9,000
healthcare workers at our 1600-bedded acute tertiary care hospital.
However, we face challenges in having the new hires trained early enough
in their job for their safety.
Methods: An attendance rate for the ICT is set at a goal >90% new staff
completing the orientation within 1 month of hire. With help from Human
Resource, reminders were sent on monthly basis since June 2012 to noshow attendees to their respective managers to attend the next available
session. Secondly, we introduced blended learning, education that
combines face-to-face classroom methods with computer-mediated
activities, in an attempt to enhance our teaching. E-orientation modules on
essential infection control principles and practices were developed and
piloted first amongst medical students in June 2012. E-competency
modules are developed for ICU staffs to help assess their knowledge on
the VAP, CLABSI and CAUTI bundles. These staffs are given a year to
complete these modules and their assessment scores are tracked.
Results: We are able to achieve an improvement in attendance rate at
orientation from an average of 60% to 80% in year 2012. The e-orientation
pilot was a success and hence, the plan is now for it to be next rolled out
hospital-wide.
Conclusion: Todays workforce will see an increasing number of Generation
Y whom are techno savvy and less inclined to sit through a lecture.
Innovative use of technology can enhance staff learning and education in
IPC in these staffs. It is critical to have a workforce that is knowledgeable of
IPC practice. It is equally important that their competency in IPC be assessed
regularly to ensure safe practices.
Disclosure of interest: None declared.

P173
P173: Effectiveness of a hospital-wide educational programme for
infection control to reduce the rate of health-care associated infections
and related sepsis (alerts) first results
S Hagel1*, K Ludewig2, J Frosinski2, R Hutagalung2, P Gastmeier3, S Harbarth4,
FM Brunkhorst5
1
Center for Infectious Diseases and Infection Control, Jena University
Hospital, Jena, Germany; 2Center for Sepsis Control and Care, Jena University
Hospital, Jena, Germany; 3Institute of Hygiene and Environmental Medicine,
University Medicine, Charit, Berlin, Germany; 4Infection Control Programme,
Geneva University Hospitals, Geneva, Switzerland; 5Paul Martini Sepsis
Research Group, Jena University Hospital, Jena, Germany
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P173
Objectives: The overarching objective of this clinical trial is to demonstrate
the feasibility of an institutional programme to reduce the burden of HAIs

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and related sepsis of at least 20%, without targeting only specific


pathogens or hospital wards.
Methods: Prospective, quasi-experimental study covering all acute care
units (27 general wards, 4 ICUs, overall 819 beds) at JUH. Surveillance for
HAIs is performed by computerized antibiotic monitoring in patients with
risk factors for HAIs (i.e. catheters, operations) on a daily basis. Following the
1 st surveillance period a multifaceted, pragmatic infection control
programme, aimed at proper hand hygiene and bundles for the prevention
of the four most common HAIs will be implemented. Subsequently,
2ndsurveillance phase lasting 18 months will be conducted to measure the
effect of the infection control programme, starting in May 2013.
Results: Interim results for the first surveillance period (09/2011 to 08/
2012) are presented. During this period 38.098 patients were admitted to
the participating departments. According to CDC definitions we identified
1727 HAIs, resulting in an overall incidence of 4.5%. Based on clinical
evaluation only, irrespective of the CDC definitions, an additional 868
HAIs were detected (overall HAI rate, 6.8% [n =2595]). A substantial
proportion of patients had severe sepsis/septic shock due their HAI (LRTI,
n=278 (37%); SSI, n=114 (25%); CLABSI, n=124 (33%); UTI, n=45 (8%);
other, n=87 (22%).
Conclusion: Our numbers confirm the current estimates of the incidence
of HAIs in Germany. Furthermore, a high percentage of HAIs results in
severe sepsis/septic shock, requiring ICU treatment.
Disclosure of interest: None declared.

P174
P174: A model for infection control collaboration among municipalities
and 3 university hospitals in the capital region, Denmark
A-M Thye1*, D Mogensen1,2, A-M Mikkelsen3
1
Clinical Microbiology, Herlev Hospital, Copenhagen, Denmark; 2Clinical
Microbiology, Herlev Hospital, Gilleleje, Denmark; 3Clinical Microbiology,
Hvidovre Hospital, Copenhagen, Denmark
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P174
Introduction: Initiatives involved in implementing a health-care strategy
that commits University Hospitals to provide general Infection Control (IC)
guidance to the healthcare sector in the municipalities.
The objective was to establish 3 networks with participants from 29
municipalities, representing both the elderly and the children, IC teams
from the 3 hospitals, and senior managers in hospitals and municipalities.
Methods: Identify and contact by telephone, email or visits relevant
personnel from municipalities, hospitals and relevant institutions, arrange
meetings and write proposals for protocols, agendas etc. Assist the
municipalities in development of IC organizations, establish a link and
dialogue between the municipalities and the IC teams and arrange short
educational courses to health care personal.
In order to prevent healthcare acquired infections, the network meetings
and the educational courses should support IC and prevention of
intersectional spread of infections and multidrug-resistant organisms,
patient safety, occupational health and safety.
Results: After a year
- 3 networks were established and municipalities are represented by 2
network participants
- 4 annual network meetings were arranged and will be customary
- 3 educational courses arranged for annually, 100 participants a year.
- Evaluation 93/100 (93%) were generally satisfied with the contents. The
courses were massively oversubscribed.
A questionnaire completed by senior management in the municipalities
with 21/29 responses:
- Has the initiative supported competency development? Yes: 18/21(86%),
dont know: 3/21(14%).
- Has new knowledge been disseminated in the organizations? Yes: 19/21
(91%), No: 1/21(5%), dont know: 1/21(5%).
- Is dissemination of knowledge formalized in the organization? Yes: 12/
21(57%), No: 6/21(29%), Dont know: 3/21(14%)
Conclusion: The networks support the development of IC skills in the
municipalities. Local networks are trying to disseminate new knowledge,
but formalizing it, is a major challenge. There is a need for training of
frontline staff. It is of great importance that need for IC counseling in the
future is determined.
Disclosure of interest: None declared.

Page 81 of 143

P175
P175: A new training and assessment support of knowledge in hand
hygiene: CD - ROM type quiz prepared by the Department of
Health Bizerte
H Rhida1*, H Souilah2, A Gzara3, H Kammoun1, I Dhaouadi1
1
Regional Directorate of Health Bizerte, Bizerte, Tunisia; 2Kassab Orthopedic
Institute, La Manouba, Tunisia; 3Regional Directoion of Health, Tunis, Tunisia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P175
Introduction: The year 2010 has been very prolific in Tunisia with regard to
educational materials and training on hand hygiene: brochures, pamphlets,
fact sheets, slide shows, quizzes, ... All these documents were developed by
teams of volunteers and designed inspired by the WHO documentation
issued in 2009 (adoption after adaptation). They were gathered in a toolbox
hand hygiene. The Department of Hygiene Bizerte participated in enriching
the content of this toolkit for the development of a CD-ROM training and
knowledge assessment of hand hygiene.
Objectives: The development of this new medium should meet the need of
healthcare workers and hygienists in training materials to hand hygiene
adapted to new technologies and also to standardize and unify the
concepts related to hand hygiene and harmonize methods and preservation
techniques of hand hygiene and evaluation methods of knowledge on the
subject.
Methods: The development of this medium has used a multidisciplinary
working group of volunteers. Validation of documents has been assigned
to resource persons and experts in health care safety.
Results: The CD-ROM has been designed for two types of use: learning and
evaluation. It includes 5 sections: - Section I: Test-Quiz with 50 questions, Section II: Quiz - Training with 50 question and answer pairs, - Section III:
To know consisting of a slideshow that can be used as a medium of
animation training group (5 parts), - Section IV: hands other views,
slideshow featuring illustrations from drawings by hand painting, - Section
V: Hand across cultures section with proverbs and quotes in different
languages on the utility of hand.
Conclusion: Obviously, this is a first version that cant claim to be
complete and final, which will be followed by successive versions
certainly enriched and improved by taking into account the reactions and
feedback from users.
Disclosure of interest: None declared.

P176
P176: Thinking critically on the issue of hand hygiene: a case study
of a clinical seminar, for nursing students, on the subject of
infection control and prevention
I Livshiz Riven1,2, N Hurvitz1, A Kopitman3, JL Reishtein1, V Shor1, R Nativ2*
1
Nursing, Ben Gurion of the Negev, Beer-Sheva, Israel; 2Infection Control
Unit, Soroka University Medical Center, Beer-Sheva, Israel; 3Division of
Obstetrics and Gynecology, Soroka University Medical Center, Beer-Sheva,
Israel
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P176
Introduction: In the complex world of modern healthcare it is vital that
nurses possess good critical thinking skills. Infection control and prevention
(IC&P) in healthcare is a high impact issue, and adherence of health care
workers to Hand Hygiene (HH) guidelines is a major topic.
Objectives: Development of nursing students ability to apply critical
thinking skills in a clinical seminar on the subject of IC&P, using the
example of adherence to HH guidelines.
Methods: A 4-credit course on the subject of IC&P was offered to third year
baccalaureate nursing students as a clinical seminar. During the first
semester students learned to critically evaluate published research and
academic writing. During the second semester the students performed a
research project, as part of the activities of the IC&P Program in a large
tertiary hospital. The students examined the attitudes, knowledge, and
practices regarding HH among nurses and nursing aides in the obstetric
division. They also wrote a portfolio about their experiences.
Results: Seventeen students (20% of the class) chose the IC&P clinical
seminar. Towards the end of the seminar students prepared a critical
analysis of the literature and their findings and explanations. They
presented HH compliance rates, and analyzed the nurses knowledge,

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attitudes, and beliefs regarding HH. They found a growing awareness of


infection control needs and that nurses know that compliance is lower
than desirable; some believe this is due to workloads and others that HH
isnt always necessary for healthy patients (mothers). All of the students
felt that the course contributed to their ability to critically evaluate
behaviors and beliefs regarding the HH challenges.
Conclusion: This course succeeded in making students recognize the need
to challenge common health care setting reasoning. It was a successful
collaboration between the nursing education system and the healthcare
service with awakened awareness to sub-textual information in the context
of HH.
Disclosure of interest: None declared.

These programs should firstly be based on basic processes of IPC, which


are cross-cutting, involve all categories of healthcare workers, and dont
need specialized knowledge and skill. Starting from this entry point, the
programs will be strengthened and adapted to local realities, in order to
become increasingly really national programs for Patient Safety, with the
human resources development.
All this will be achieved through a Senegalese project which aims at
implementation of national patient safety programs in francophone WestAfrica, starting with IPC activities.
Disclosure of interest: None declared.

P177
P177: Community-based learning: medical parasitology in pre-clinical
year, Suranaree University of Technology, Thailand
N Kaewpitoon1*, SJ Kaewpitoon2, N Ueng-Arporn2, P Wongkaewpothong2,
A Ngamnuan2, T Olarnrachin2, P Praphanpracha2, K Rattanakereepun2,
N Namwichaisirikul2, L Martrakul2, V Vanapruek2
1
Pathology, Suranaree University of Technology, Nakhonratchasima, Thailand;
2
Suranaree University of Technology, Nakhonratchasima, Thailand
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P177
Introduction: Medical Parasitology subject is one of basic medical
science. We have integrated subject through community based learning.
Objectives: Assess medical students attitudes toward practice in
laboratory (TC) parasitological examination in the rural community
(MPEC).
Methods: Cross-sectional descriptive study was constructed among 46
medical students during April to July 2012. Attitudes were compared
between practice in laboratory (TC) and mobile parasitological examination
in the community (MPEC).
Results: A total of 46 (22 Males and 24 Females) medical students. Most of
students was highly satisfied with MPEC. Student skill, they could be
identified parasites during community studied. A total of 85 stool sample
was examined and found 7 samples were infected with hookworm (5
patients), Strongyloides stercolaris (1 patient) and Taenia sp. (1 patient),
respectively.
Conclusion: That modification in educational methods. MPEC experience
in particular can favorably influence students attitudes toward basic
sciences.
Disclosure of interest: None declared.

P178
P178: The IPC program in West-Africa: how do you make it feasible
and useful?
B Ndoye
Afrhyquasec, Dakar, Senegal
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P178
Introduction: Africa generally, West-Africa in particular, is characterized by
a remarkable lack of structured national IPC programs. There are numerous
challenges to face, but there are also existing opportunities, which can
enable to improve the current situation by using a rational and adapted
approach.
Objectives: The objective is to present the best way to implement IPC
programs in Francophone West-Africa.
Methods: The author propose a concrete way to implement increasingly a
comprehensive national IPC program, based on main challenges (specially
the lack of human resources), and the numerous opportunities as the
many tools and guidelines currently proposed by WHO to face IPC, NGOs
supporting countries to strengthen the health system, and specially
Senegalese experience.
Results: Recommendations are based above all on two strategic issues:
- Human resources development
- Implementation of a national program, primarily based on basic
processes (Standard Precautions).
Conclusion: Starting national programs in West-Africa is feasible, useful
and necessary, with currently available resources. That implies a political
willingness of the countries and the support of development partners.

P179
P179: Establishing a collaboration with industry to support HAI
reduction
D Pittet1, C Kilpatrick2*, E Kelley2, B Allegranzi2, S Bagheri-Nejad2,
POPS working group1
1
University Hospitals Geneva, Geneva, Switzerland; 2World Health
Organisation, 1211 Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P179
Introduction: Collaboration with industry focused on health improvement
is often viewed sceptically while existing examples show a clear public
health benefit. An approach was adopted to explore the potential for
establishing a collaborative with the World Health Organisation (WHO)
Patient Safety Programme.
Objectives: To establish a transparent WHO industry collaborative for the
benefit of patients, avoiding a focus on the potential for commercial gain.
Methods: Between 2007 and 2012 a number of steps were undertaken;
1) scoping of the potential for a collaborative, the benefits to patients and to
establish an aim, which included desk research and multidisciplinary/agency
discussions 2) interviews with WHO legal department 3) an announcement
to potential participants and informal collaborative face-to-face interviews
with interested parties to strengthen a realistic patient-focused aim.
Results: A formal proposal was approved by WHO legal department in
2012, which includes the overall aim of improving systems, education and
research in order to provide a public health benefit by reducing health careassociated infections (HAI). Criteria for participation are clear and a code of
conduct and finance details are outlined. Implementation was approved as a
protected web-based platform to allow for targeted interaction, with a first
year aim of evaluating this. A total of 14 companies from industries related
to improving patient safety through hand hygiene responded to the call
from WHO and have signed up to the code of conduct and provided
finance. An editorial and note for the media announcing the collaborative
and its name Private Organisations for Patient Safety (POPS) was issued in
2012 to support transparency. One formal collaborative project has been
undertaken.
Conclusion: A transparent collaborative has been established and funded
which presents a clear public health benefit and ensures that those involved
are focused on corporate social responsibility. As the plan for the first year is
to evaluate the platform method of working, this will inform next steps as to
whether it is possible to undertake fair and equitable project working which
can significantly contribute to reducing HAI in the long term.
Disclosure of interest: None declared.

P180
P180: The value of real-time sequence based information in
surveillance of nosocomial viral infections
J Rahamat-Langendoen1*, M Lokate2, A Friedrich2, H Niesters1
1
Department of Medical Microbiology, Division of Clinical Virology, University
of Groningen, University Medical Center Groningen, Groningen, the
Netherlands; 2Department of Medical Microbiology, Division of Infection
Control, University of Groningen, University Medical Center Groningen,
Groningen, the Netherlands
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P180
Introduction: Sequence based information is increasingly used in the
surveillance of viruses, not only to provide insight in viral evolution, but
as a tool to define transmission routes. As most laboratories have not
incorporated sequence analysis in their daily routine, information on typing of
viruses is mostly available retrospectively. Reducing the time needed to get

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sequence based information available during an outbreak, should benefit the


understanding of transmission routes and guide the implementation of
appropriate infection control measures.
Methods: In August 2012, real time sequencing was introduced at our
diagnostic laboratory within the UMCG, a large tertiary referral hospital.
A set of viruses, in particular noro-, rhino-, parecho- and enterovirus, is
immediately further characterized after detection.
Results: Sequence analysis results were available within a week after
detection. Several clusters of identical subtypes of viruses could be identified,
especially in case of norovirus infections. Sequence analysis results confirmed
suspected outbreaks based on epidemiological data. However, real-time
sequencing also enabled us to rapidly detect a pseudo-outbreak on the
childrens oncology ward, in which 5 patients with norovirus infection were
notified within one week, despite the implementation of enhanced infection
control measures. However, four different genotypes were detected,
providing evidence for multiple introductions of different norovirus strains
rather than ongoing nosocomial transmissions. This strengthened us to
maintain the already implemented infection control measures without
closure of the ward.
Conclusion: Real-time sequence based information, made available
immediately after detection, is essential for the understanding of
nosocomial transmission of viral infections. This makes it possible to focus
infection control interventions.
Disclosure of interest: None declared.

P181
P181: Confirming nosocomial legionella pneumophila serogroup 1
infection by sequence-based typing (SBT)
M Schousboe1*, DJ Harte2, R Podmore3
1
Microbiology/Infection Control, Canterbury Health Laboratories, CDHB,
Christchurch, New Zealand; 2Legionella Reference Laboratory, ESR,
Wellington, New Zealand; 3Microbiology, Canterbury Health Laboratories,
CDHB, Christchurch, New Zealand
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P181
Introduction: Sequence-based typing (SBT) is a discriminatory method to
genotype Legionella pneumophila serogroup strains.
Objectives: Use of SBT to prove correlation between patients and
environmental isolates was questioned.
Methods: Regular surveillance cultures for Legionella contamination of a
tertiary level hospitals domestic hot water supply since 1990 recorded
isolation of Legionella pneumophila serogroup from the water. The hospital
received its domestic hot and cold water from its 90 meter deep artesian
water bore. An increase in number of Legionella pneumophila isolates from
water samples and swabs from showerheads were recorded after reduction
in the reticulating water temperature from 600 to 550 C in 1998. Stored
Legionella isolates from 3 patients suspected of possible nosocomial
infections between 1999 and 2006 were tested by Legionella Reference
Laboratory, ESR, New Zealand by SBT and results compared with stored
environmental isolates from 1999 and 2006. The clinical details of the 3
patients were obtained from patient records and previously summarised
reports of the patients nosocomial infection histories.
Results: Legionella isolates from three patients were tested by SBT; two
were adult males, identified in 1999, and 2003 and the third, a child,
identified in 2006. The isolates were from sputum, tracheal aspirates and,
the 2006 isolates, from two bronchial alveolar samples taken with 10 days
interval. The environmental isolates were from two shower swabs from
different wards than those related to the patients, a sample taken from a
water cooler storage tank and one taken from the tap water passing
through a water filter.
All the environmental isolates from the hospital belonged to the same
unique SBT allele profile 7, 6, 17, 3, 13, 11. The two patients diagnose in
1999 and 2006 had the same SBT allele profile as the hospital water,
while the isolates from the patient identified in 2006 had two totally
different profiles.
Conclusion: SBT allele profiles is a useful tool for confirming the relationship between an environmental source and Legionella pneumophila
serogroup 1 isolates from a patient with potential nosocomial infection if
the environmental isolates has got an unique allele profile.
Disclosure of interest: None declared.

Page 83 of 143

P182
P182: Detection of legionella pneumophila DNA from environment
of hospitals
O Chubukova*, O Kovalishena, A Blagonravova
Epidemiology, Nizhniy Novgorod State Medical Academy, Nizhniy Novgorod,
Russian Federation
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P182
Introduction: The risk of infection and epidemiological surveillance and
control of legionellosis depends on the challenges of detecting the
Legionella pneumophila DNA in the hospital environment.
Objectives: The aim was to compare the various hospital departments in
according to the features of existence of L. pneumophila in the environment
of hospitals.
Methods: We conducted real-time PCR of 963 swabs from 40 objects of
the environment, 156 samples of water from the centralized water supply
and swimming pools in 27 departments of 10 healthcare setting in the
Nizhny Novgorod Region.
Results: We have distinguished the following types of the departments.
Type 1: territories of high risk of health-care associated legionellosis due to
high susceptibility of patients, usage of artificial lung ventilation and
moisturing the oxygen and air mixture. It includes intensive care units,
surgical, obstetrical departments, operating theaters. Type 1 is characterized
by the high contamination of environment by L. pneumophila DNA (7,91,3
per 100 tests), by presence of reservoirs the oxygen moisturizers and
water taps (12,0% and 11,4% positive results relatively), by a frequent
isolation of Legionella pneumophila from water (7,11,3 per 100).
Type 2: departments with patients suffering from outpatient pneumonias:
therapeutic, pulmonological, thoracic departments. They are characterized
by the low contamination of environment (2,21,0 per 100) and a
frequent isolation of L. pneumophila from water (4,71,5 per 100).
Type 3: departments of high risk of nosocomial legionellosis. They have
favorable conditions for L. pneumophila and air-borne mechanism of
transmission by means of aerosol-producing facilities. They are balneological
departments which have a high contamination of environment (14,71,4
per 100); reservoirs of L. pneumophila such as the Jacuzzi, therapeutic baths
and showers (25,9% and 22,4% positive results relatively); a rare isolation of
L. pneumophila from water (3,81,4 per 100 tests).
Conclusion: That is, there are different types of hospital departments for
the risk of legionellosis depending on the frequency of detection of
Legionella DNA the hospital environment, data about patients, their
treatment and diagnostics. Different departments require different
approaches to organizing and conducting surveillance of legionellosis.
Disclosure of interest: None declared.

P183
P183: A multi-pronged approach to unravel rhinovirus transmission
in a childrens hospital: towards effective infection control
J Rahamat-Langendoen1*, M Ciccolini2, E Schlvinck3, A Friedrich2, H Niesters1
1
Department of Medical Microbiology, Division of Clinical Virology,
Groningen, the Netherlands; 2Department of Medical Microbiology, Division
of Infectious Disease Epidemiology, Groningen, the Netherlands; 3Beatrix
Childrens Hospital, University of Groningen, UMC Groningen, Groningen, the
Netherlands
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P183
Introduction: Human rhinovirus (HRV) is associated with serious respiratory
illness, particularly in patients with pulmonary comorbidities. Little is known
about nosocomial transmission of HRV. A good understanding of the
hospital epidemiology of HRV is required to evaluate the effect of infection
control strategies.
Methods: We employed a comprehensive approach including classical
and molecular epidemiology, as well as mathematical modeling methods.
Data on HRV detection, clinical symptoms and infection control measures
were retrieved from a prospective project into respiratory infections in
hospitalized children between October 2009 and January 2011. HRVs were
characterized using sequence analysis of the VP4/VP2 genes. An agentbased, multi-ward, stochastic mathematical model was developed to study
the impact of infection control measures on the prevalence of HRV
positive patients.

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Results: 254 HRV disease episodes from 162 patients were included. Based
on first day of illness, 69 episodes (27%) were hospital acquired. Infection
control measures were implemented one day after start of illness (median
value). Using phylogenetic analysis, eight clusters of patients were identified,
where epidemiological data suggested transmission within the same ward.
The model was used to assess the influence of variations in time-to-start and
duration of control measures, changes in admission rate of HRV positive
cases as well in the rate of visitor mediated transmission on the
effectiveness of infection control measures.
Conclusion: Nosocomial HRV infections occur more frequently than
expected. The effectiveness of infection control strategies depends on a
complex set of interrelated factors. Combining epidemiological methods,
sequence based information and mathematical modeling techniques leads
to valuable information on our understanding of nosocomial transmission
dynamics, which contributes to the implementation of appropriate
infection control interventions. This can serve as a model for identifying
intervention points for transmission of respiratory microorganisms in
general.
Disclosure of interest: None declared.

P184
P184: Production and efficacy testing of antimicrobial fabrics for
use in hospitals
G Singh*, JA Beddow, E Joyce, T Mason
Sonochemistry Department (HLS), Coventry University, Coventry, UK
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P184
Introduction: In recent years, hospital acquired infections (HAIs) have
become a major issue of concern in the European health care system. The
most common routes of transmission of HAIs are either by airborne routes
or by direct contact. Direct contact can be mediated through many textile
items including: bedding, clothing, wound dressings and curtains.
Antimicrobial textiles could be used widely in health care environments in
order to reduce the spread of HAIs.
Objectives: The Sonochemistry centre at Coventry University is one of a
group of organisations working on an EU FP7 funded project (SONO) to
develop a new technology for producing antimicrobial textiles. This
technology involves the use of an ultrasonic process (sonochemical) to
coat fabrics with antimicrobial metal oxide nanoparticles (NPs). The aim is
to produce such textiles for routine use in hospitals as bandages, hospital
sheets and uniforms.
Methods: The absorption method from ISO 20743:2007 was used for the
determination of antibacterial efficacy using MRSA strain NCTC 10442 and
P. aeruginosa strain NCTC 13359. Test samples consisted of polyester
cotton coated with copper oxide (CuO) NPs. Sterile pieces of coated and
uncoated fabric were inoculated with 105 CFU/ml of bacteria and then
incubated overnight at 37oC. The number of live bacteria on the samples
post incubation was determined by plate counts.
Results: Results indicated a good level of antibacterial activity against
both MRSA and P. aeruginosa. The microbial population after 24 hours of
incubation at 37C attained 108 CFU/ml on plain cotton controls while it
did not exceed 105 CFU/ml on the CuO NPs treated test fabric, indicating
a 3 log reduction in microbial growth.
Conclusion: The results have demonstrated that sonochemical synthesis
and coating of CuO nanoparticles onto fabrics can be a useful method to
produce antibacterial fabrics. In other work, not presented here, the testing
has been extended to other metal oxide nanoparticles and other species of
bacteria associated with nosocomial infections, with very positive results.
This novel fabric may be useful for many applications in the healthcare
and hygiene sector.
Disclosure of interest: None declared.

P185
P185: The testing procedure of antimicrobial coppers Cu+ final product
as a method of assurance and certification of its antimicrobial efficacy
P Efstathiou1*, E Kouskouni2, K Karageorgou1, Z Manolidou1, S Papanikolaou1,
M Tseroni1, E Logothetis2, C Petropoulou3, V Karyoti1
1
National Health Operations Centre, Athens, Greece; 2Medical School of the
University of Athens, Microbiology Laboratory of Aretaieio Hospital, Athens,

Page 84 of 143

Greece; 3Agia Sofia Childrens Hospital (NICU), Ministry of Health, Athens,


Greece
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P185

Objectives: The aim of this study is to record the testing procedure of


antimicrobial coppers Cu + final products implemented in different
facilities in order to reduce microbial flora.
Methods: In areas where Cu+ [Intensive Care Unit (ICU) and schools] has
already been implemented, random samples were collected for
microbiological cultures using both wet and dry method (technique). The
samples were collected in 3 different time - periods: during, 2 and 6
months after the implementation. All product manufacturing stages were
recorded and taken into account by the construction company as well as
maintenance and cleaning procedures of Cu + surfaces and objects.
Culture techniques in all samples collected were identical. 256 Cu +
surfaces and objects were tested and over 768 cultures for bacteria and
viruses were taken, deriving all from 4 different facilities.
Results: The antimicrobial effectiveness of the surveyed Cu+ objects and
surfaces varied between 90-95%. Parameters such as multiple use,
cleaning materials, conditions of humidity and dryness, appear not to
affect the effectiveness of Cu + . The algorithm of the product testing
procedure was recorded.
Conclusion: The management of the facilities where Cu + was
implemented, demanded that the final Cu+ product was tested.
The testing procedure of the Cu+ final product was a requirement from
the management whose facilities were implemented.
The above procedure is a method of implementations assurance and
certification, gives further value to the innovative implementation of
antimicrobial alloys and ensures the possible side effects of distortion of
the raw material and fake product manufacturing (FALSE).
Disclosure of interest: None declared.

P186
P186: Infection control plan management in primary care
I Neves, F Vieira*, D Peres, I Devesa, V Alves
Infection Control Unit, Unidade Local de Sade de Matosinhos, Matosinhos,
Portugal
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P186
Introduction: There was a significant shift in healthcare delivery from the
acute, inpatient hospital setting to a variety of ambulatory and
community-based settings. This transition of healthcare has demonstrated
the need for understanding and implementation of infection prevention
guidance [1] Portuguese National Infection Control Program includes in its
objectives the community and ambulatory settings [2,3].
Objectives: Implementation and monitoring of an Infection Control Plan
in a community-based setting (with several units), part of a Local Health
Unit (which includes primary, acute and rehabilitation care).
Methods: Application of Demming cycle (Plan, Do, Check; Act) in a
perspective of continuous improvement according to the institutions
Quality Management System [4].
Results: The Infection Control Unit, in collaboration with link professionals
(doctor and nurse in each unit), implements the following strategy: (PLAN)
Draw an Infection Control Plan approved by management. Example (i):
create the conditions for hand hygiene through scheduled audits. Example
(ii): monitoring of good practice, identifying performance critical areas. (DO)
Implementation of the activities according to Plan schedule. Example (i):
audits, with feed-back to health professionals. Example (ii): scheduled visits
to identify areas for improvement. (CHECK) Check compliance of Plan
objectives. Example (i): degree of implementation of the planned audits.
Example (ii): Multidrug-resistant organisms monitoring (epidemiological
surveillance system based on laboratory results); (ACT) Implementation of
corrective measures to the initial Plan. Example (i): reprogramming audits
not conducted. Example (ii): professionals training directed to good practice
(based on critical areas identified and surveillance results).
Conclusion: Application of a strategy based on Demming cycle allows
successful implementation and monitoring of an Infection Control Plan in
a community based setting. Primary care still needs the development of
specific indicators.
Disclosure of interest: None declared.

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References
1. CDC: Guide to Infection Prevention in Outpatient Settings. Atlanta: CDC 2011.
2. PNCI: Portuguese National Infection Control Plan. Lisbon: Direo-Geral de
Sade 2007.
3. Health Regulation Document No. 20/DSQC/DSC - Infection Control Plan
for Primary Care.
4. Quality Standard ISO 9001:2008 - Requirements for Quality Management
Systems.

Paulo-Brazil (2011). Internal consistency was analyzed by Cronbach a


coeficient; the discriminant validity was carried out by comparing the
scores of the indicators between two groups of hospitals (those which
had some type of accredtiation versus those which did not) and
exploratory factor analysis with tetrachoric correlation matrix was used to
analyze the validity of the construct.
Results: The indicators PCET and PCVE varied little, with almost 100%
conformity throughout the sample, whereas the PCDO and PCCP
presented good internal consistency with a variation of 0.67 to 0.80;
discriminant validity showed higher average scores of conformity and
were statistically significant in the group of institutions with accreditation;
in the validation of the construct it was possible to differentiate 2
dimensions for PCDO (1-recommendations for prevention of HI and 2recommendations for the standardization of prophylaxis procedures), with
good correlation of the units of analysis that composed it. The same
occurred for PCCP (1-interface with treatment units and 2-interface with
support units). All of the indicators, except the PCCP, which ranged from
9.5% to 100%, presented scores of > 90%, which show that the HICPPs of
participating hospitals have a good standard of quality, with higher
average scores in the institutions with accreditation.
Conclusion: The study enabled the validation of the measurement
properties of the HICPP indicators and produced a HICPP assessment tool
in an ethical and scientific manner for diagnosis of quality in this area.
Disclosure of interest: None declared.

P187
P187: Harnessing the power of the mind to reduce healthcare associated
infections - a cost effective approach in low resource settings
N Jaggi*, P Nirwan, E Naryana, KP Kaur
Infection control , Artemis Health Insitute, Gurgaon, India
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P187
Introduction: Infection prevention is a mind set and the reasons for non
compliance are related to psychological barriers, preconceived notions,
cultural influences and ineffective time management rather than lack of
available resources or knowledge. Our mind is the most powerful tool. Can
we harness the power of the mind in oneself and others to understand the
psychology of non compliance as also ways to improve implementation of
infection control practices and subsequently reduce healthcare associted
infections ( HAIs ).
Objectives: To expand the skill set of infection preventionists as a cost
effective approach.
Methods: This study was initiated in July 2012 and lasted for 6 months till
December 2012. Twelve infection control team leaders were identified from
each department after conducting a basic technical and psychological
assessment. An advanced psychological assessment was then performed on
them A trained psychologist was employed to impart relevant soft skill
training to them focusing on harnessing the power of the mind to effectively
manage their time as also collaborate with other teams to achieve the
desired result. The training involved didactic lectures as well as simulation to
teach real life skills. A post assessment was conducted after training and
results statistically analyzed. The compliance to infection control guidelines
and healthcare associated infections (HAIs) identified in each of their units
were then correlated with the increase in their behavioral competencies.
Results: 10 of the 12 (83.3%) showed significant improvement in all
aspects of competency in infection prevention. The chief criterion included
were powers of negotiation, ability to get along with peers, juniors and
seniors, leadership skills, communication skills and emotional intelligence.
There was a significant increase (p<0.05) in all separate parameters
considered for assessment. A positive correlation was observed between
the compliance to infection control guidelines and HAIs with the increase
in competencies.
Conclusion: Focusing on power of the mind and improving psychological
competencies in infection preventionists can lead to a cost effective and
rational approach to increasing compliance to guidelines and reduce the
HAIs.
Disclosure of interest: None declared.

P188
P188: Assessment model of hospital infection control programs:
validation of measurement properties
RA Lacerda*, CPR Silva
Medical-Surgical Department, Nursing School of University of So Paulo, So
Paulo, Brazil
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P188
Introduction: The study aimed a system for assessing Hospital Infection
Control Programs-HICPP, which enable application in situational diagnosis,
whose results provide both improvements in the area and reliable
information about the quality of these HICPPs in healthcare facilities.
Objectives: Fully validate and test the reliability of measurement properties.
Methods: Methodological development study by the construction and
validated four indicators: PCET-Technical-operational structure of the
HICPP; PCDO-Operating Guidelines for Control and Prevention of HI;
PCVE-Epidemiological Surveillance System; PCCP-Prevention and Control
Activities. The indicators were applied in 50 healthcare facilities of So

P189
P189: Development of on line continuous education programme in a
tertiary care hospital of a developing country
S Singh
Infection Control, Amrita Institute of Medical Sciences, Kochi, India
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P189
Summary: Training is an essential component of HAIs, wher IT can play a
major role. The objective was to develop an e learning continuous
education programme for knowledge and skill based competency
building in infection control. An interview was conducted and an on line
e learning module was developed by a team. It improved the
participation of HCWs in training. The competency, knowledge, practices
and updating of recent advances was impressive. Process, outcome
indicators improved and it proved to be cost effective.
Introduction: Training with IT aid would be the call of the day.
Objectives: Develop an e learning continuous education programme in
infection control.
Methods: An interview was conducted to understand the impact of
continuous education class room sessions, Pilot study was conducted. Team
was included towards programing and deveopment. Every staff will get a
user id and a password. An article with 10 MCQs, was released by the inservice administrator, open for the staff for the period of two weeks. They can
attempt MCQs and grade them simultaneously and do simlulation training.
Results: 1344 nursing staff, 48% of the staff were able to attend the class
room session. 38% of the lectures were missed. Important topics were
missed by the staff. Skill based learning was appreciated more. 88% of staff
felt that e-learning improved their knowledge, skills and practice. 76% felt it
allows flexibility in attending the sessions. 91% of the staff have started
attending. Quality indicators in infection control and nursing, staffs
knowledge and skills had improved from 43% to 87%. Hand washing
compliance improved from 47% to 78% in the hospital after institution of e
learning and continuous reminders. Cost towards training has reduced from
Rs 7 lacs per annum to 1.5 lacs per annum.
Conclusion: There is a remarkable improvement in knowledge, competency
and skills. Attendance, process, outcome and cost showed improvement.
Disclosure of interest: None declared.

P190
P190: Surgical site infection surveillance system in So Paulo state, Brazil
DS Mello1, MC Padoveze1*, G Madalosso2, SA Ferreira2, DBD Assis2
1
Collective Health Nursing Department, School of Nursing, University of Sao
Paulo, So Paulo, Brazil; 2Division of Infection Control, Health State
Department, So Paulo, Brazil
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P190

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Introduction: Governmental authorities should establish priorities for


surveillance and define what kind of information to be gathered from
healthcare facilities. Many developing countries cannot afford to manage
Surgical Site Infection Surveillance System (SSISS) that includes all types
of surgeries; therefore a criterion should be used to select the best
indicator to be monitored. Since 2004, the SSISS in So Paulo have been
focused only crude rates of Surgical Site Infections (SSI) in clean surgeries.
Objectives: The present study aimed to select and to implement
indicators for a new SSISS in the State.
Methods: Mixed method design including a methodological study and a
prospective descriptive study, carried out from July 2011 to September 2012,
in three phases: 1) Methodological study carried out by means of literature
review and expert validation aiming to identify the best criteria for selection
of SSI indicators to be monitored; 2) Implementation of a new SSISS; 3)
Follow-up of 6 months after implementation. The participating hospitals
(n=306) represented 38.3% of total acute care hospitals in the State.
Results: The main criteria identified to select the SSI indicators were: a)
magnitude of the surgery in the Brazilian Universal Health System; b)
severity of harm in case of SSI; c) potential impact of prevention strategies;
d) recommendation by federal normative; d) potential for benchmarking
against at least other three SSISS worldwide. Outcome indicators of SSI for
the following surgeries were selected: cesarean section, hip and knee
arthroplasty, CABG, craniotomy, mastectomy, and laparoscopic procedures:
cholecystectomy, herniorrhaphy, hysterectomy, appendectomy, and
colectomy. The SSI rates identified (3 rd quartiles) and the number of
surgeries monitored in the period were respectively: 0.9 (n=75816), 2.7
(n=2305), 0.0 (n= 2477), 8.0 (n=1949), 1.2 (n=1789), 0.0 (n=1702), 0.0
(n=13332), 0.0 (n=4904), 0.0 (n=1549), 0.0 (n= 1287), 0.0 (n=364).
Conclusion: The development of criteria supported the rational selection
of indicators for governmental monitoring of SSI. Despite good
adherence to the project, data suggest that SSI may be underestimated.
A longer period of evaluation will be performed next. Efforts should be
focused on the improvement of data quality for SSISS.
Disclosure of interest: None declared.
P191
P191: Validation tool to improve SSI surveillance in Swiss hospitals
M-C Eisenring*, S Kuster, H Sax, N Troillet, Swissnoso
Service de Maladies Infectieuses, Hpital du Valais, Sion, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P191
Introduction: The Swissnoso surgical site infection (SSI) surveillance
module started in 2009. It includes currently >130 Swiss hospitals. To
ensure quality and reliability of the surveillance system and of the data
it provides, a validation tool was developed and implemented since
2012.
Objectives: To describe the first results obtained with this validation tool.
Methods: The validation, based on on-site visits to the participating
hospitals, follows 2 steps: 1st, a questionnaire evaluates on a scale from 0
(bad) to 50 (excellent) the structure and the process of the surveillance;
2nd, 15 randomly selected patients charts are retrospectively reviewed in
details (10 charts selected without consideration of SSI, 5 charts selected
among patients with SSI).
Results: As of March 2013, 23 hospitals had been evaluated. Their mean
score on the evaluation scale was 34.6 (extremes: 20.0 45.6). The main
issues detected in the structure and process of surveillance were:
understaffing (slight in 21.7%, important in 8.7%), lack of participation
in the training sessions organized by Swissnoso (41% of physicians and
29.6% of study nurses did not participate), problems in case inclusions
(partially inadequate in 26.1%, incorrect in 4.3%), difficulties in finding
the required medical information (13.1%), lack of supervision by a
trained physician (rarely done in 8.7%, only sometimes done in 13.1%).
Among the 234 cases reviewed, follow-up at one month was not
available in 5%. Among 221 cases selected without consideration of SSI,
SSI was missed in 5 (false negatives=2.3%). Among 103 cases with SSI,
18 (17.5%) were misclassified regarding the type of SSI (superficial,
deep or organ/space).
Conclusion: On-site visits allowed determining some gaps in the method
of surveillance system at each hospital with potential impact on the
accuracy of their results, in particular on their detected SSI rates.
Disclosure of interest: None declared.

Page 86 of 143

P192
P192: Comparisons of procedure specific surgical site infection rates of
a Turkish university hospital with Turkish national surveillance data
Y Gelebek1, B Cinar1, H Zengin1*, H Aytac1, Z Bastug2, Y Sardan3, C Inkaya4,
S Unal4
1
Infection Control Unit, Hacettepe University Adult Hospital, Ankara, Turkey;
2
Infection Control Unit, Hacettepe University Oncology Hospital, Ankara,
Turkey; 3Guven Hospital, Ankara, Turkey; 4Department of nternal Medicine,
Hacettepe University School of Medicine, Ankara, Turkey
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P192
Introduction: Surgical site infection (SSI) rates are the markers of health
care quality. We have been prospectively following-up procedure specific
surgical interventions in our center since 2005. Turkish National Hospital
nfection surveillance for procedure specific hospital infections was begun
in 2007 and a very first report on this subject was published in 2010.
Objectives: To compare and evaluate procedure specific SSI rates of our
institution and Turkish National surveillance system.
Methods: This study was carried out in Hacettepe University Adult
Hospital between 01 January 2011 and 31 December 2012. Surgical
procedures were selected according to NHSN surgical intervention
categories and local data. (AMP, BILI, NECK, KTP, KPRO, FX, FUSN, GAST,
HYST, SB,CARD, CBGC, CBGB, COLO.CRAN, HPRO,LAM,NEPH, OVRY, PACE,
PRST, REC,SPLE, THOR, XLAP,VSHN) Centers for disease Prevention and
Control (CDC) Hospital Infections Diagnostic Criteria were implemented to
determine SSI rates. Active surveillance for each procedure was carried
out during hospital stay however; surveillance was ended after hospital
discharge. Data were entered in hospital infection program of our
hospital (NosOnline). Procedure specific infection rates were compared
with National data and Standardized Infection Ratio was calculated for
each procedure.
Results: Total of 7075 surgical interventions was followed in 2 years. SSI
rates were found to be higher in BILI, KTP, GAST,CBGB, COLO, OVRY,REC,
XLAP, interventions when compared to National data. SSI rates for other
intervention AMP, NECK, KPRO, FX, FUSN, HYST, SB,CARD, CBGC, CBGB.
CRAN, HPRO,LAM,NEPH, PACE, PRST,SPLE, THOR, VSHN, were found to be
compatible with National data.
Conclusion: As our center is the tertiary referral center in Turkey, many
patients with underlying risk factors for SSI were operated readily.
Duration of postoperative hospital admission was longer when compared
to National data. Longer hospital admissions and risky operations may
lead to higher procedure specific SSI in certain interventions.
Disclosure of interest: None declared.

P193
P193: Nasal carriage of methicillin resistant Staphylococcus aureus in
staff of the surgical services of CHU Sylvanus Olympio Lome-Togo
I Watba1*, M Salou2, D Ekouevi3, D Dosseh4, S Dossim2, SD Tigossou2,
AY Dagnra2,3, M Prince-David2,3
1
Service Respiratory and Infectious Diseases, CHU Sylvanus Olympio, Lom,
Togo; 2Laboratory of Microbiology, CHU Sylvanus Olympio, Lom, Togo;
3
Department of Basic Sciences and Public Health, Togo; 4Department of
General Surgery, CHU Sylvanus Olympio, Lom, Togo
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P193
Introduction: Methicillin resistant Staphylococcus aureus (MRSA) is a
major public health problem found in nosocomial infections. However,
one of the possible sites of carriage in health care workers is the nasal
cavity.
Objectives: To estimate the prevalence of nasal carriage of MRSA in the
surgical staff of the Hospital of Lom Sylvanus Olympio.
Methods: This cross-sectional study was conducted from 1 July 2011 to 31
October 2011. The samples were obtained by nasal swab of healthcare
workers in the surgical services of the hospitak namely the central surgical,
trauma, pediatric surgery, visceral surgery and surgical intensive care wards.
These samples were inoculated on Chapman agar. The identification of
isolated staphylococci was completed by the agglutination test using
Pastorex Staph Plus kit. The susceptibility of S. aureus was performed
according to the recommendations of the French Society for Microbiology.

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The resistance to methicillin was highlighted by the use of cefoxitin disks


and oxacillin.
Results: Ninety-five (95) people participated in the study, 17 (18%) were
MRSA positive. Carriage rates were distributed as follows: Traumatology
5/11, surgical center 6/25, visceral surgery 2/14, pediatric surgery 2/16,
surgical ICU 3/29. The nurses of the first two services and doctors of visceral
surgery were the most colonized with MRSA. MRSA isolates were resistant to
aminoglycosides: kanamycin (88%), tobramycin (82%), Gentamicin (64%),
quinolone: pefloxacin (70%). MRSA strains were more susceptible to
macrolides and related drugs: Erythromycin (76%), Lincomycin (82%),
pristinamycin (100%). No MRSA were resistant to vancomycin.
Conclusion: This study confirmed a high carriage rate of MRSA in the surgical
staff of the Hospital Sylvanus Olympio and should encourage the development of appropriate preventive health measures such as the application of
mupirocin in the context of fight against infections.
Disclosure of interest: None declared.

Objectives: The objective of this study was to analyze the occurrence of


surgical site infections by RGM in patients undergoing orthopedic
procedures.
Methods: The method was the integrative review.
Results: The 21 articles reported 34 cases. The median time of diagnosis
of SSI was 80 days, interquartile range 352 days and mode of 90 days.
The most prevalent signs and symptoms reported by patients were: pain
(61.8%), secretion (50.0%), edema (41.2%), fever (41.2%), erythema
(26.5%), fistula (20.6%), heat (14.7%), tremor (5.9%), abscess (5.9%) and
hematoma (3.0%). Regarding surgical interventions performed in patients
after diagnosis of SSI, the most frequent was antibiotic therapy (100%),
removal of the orthopedic prosthetic device (50.0%), drainage (41.2%),
surgical debridement (41.2%), irrigation (23.5%), surgical revision (17.6%),
replacement of prosthetic devices (8.8%), removal of the prosthetic
components (8.8%), and reimplantation of the prosthesis (2.9%). The
identification of etiological agent(s) of SSI did not follow a routine
methodology, which could influence the reliability of the results, especially
regarding the kind of etiologic agent. The isolated RGM of the infection
sites were M.fortuitum (the most prevalent), M.chelonae, M.abscessus,
M. goodii, M.smegmatis, M.farciongenes and M.wolinsky. When the
sensivity test was performed, it was observed that the strains has
approximately 80.0% of sensitivity to amikacin, claritromycin, ciprofloxacin.
Suspicious sources were hydro massage tub used by a resident surgeon
before operating; liquid components or cement powder of methylmethacrylate or metal prosthesis; cortisone injections for chronic synovitis during
five years before surgery; air conditioning system or soaking solution to rinse
the prosthetic device; soap in the water, where it was accomplished the
immersion of the foot (podiatris recommendations); bioabsorbable screws
used in surgery; intra-articular injections of dexamethasone; however, none of
them could be confirmed.
Conclusion: M. fortuitum was the RGM most frequent, some infections
were diagnosed after one year and it contradicts CDC definition of
surgical site defined by CDC. The authors of the studies analyzed didnt
follow a methodological description what compromised the conclusions.
Disclosure of interest: None declared.

P194
P194: Preoperative screening of patients a small step for the hospital,
a big step for epidemiology
A Moldovan1*, L Dobrin2, I Cotoara1, B Angheloiu1, G Proca1, B Moldovan3
1
SPCIN, Sf. Constantin Hospital, Brasov, Romania; 2Laboratory, Regina
Maria Campus, Brasov, Romania; 3Surgery , Sf. Constantin Hospital, Brasov,
Romania
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P194
Introduction: Preoperative screening, associated with adequate isolation
measures of patients colonized with multidrug-resistant germs and
implementation of effective hand hygiene measures according to the
model HUG Geneva- is a major goal of the activity in Hospital Sf. Constantin,
ensuring effective epidemiological control, adaptation of preoperative
antibiotic prophylaxis, optimization of the medical act and, as final result,
decreased risk of morbidity / mortality.
Objectives: Establishing the actual incidence of colonization with
methicillin-resistant Staphylococcus aureus MRSA and gram-negative
bacteria producing Extended-Spectrum Beta-LactamasesESBL in a sample
of population represented by hospitalized patients and monitoring the
correct implementation of epidemiological isolation measures and
hygiene of hospital staff and environment.
Methods: Observational and statistical study.
Results: from 01.01.2012 to 31.12.2012 MRSA and ESBL screening was
conducted on a number of 2145 admitted patients (sample collection is
done before hospitalization, with results available at the time of
admission). The detected incidence of MRSA colonization is 10.29% and
ESBL 7.8%, with no statistically significant statistic differences between the
various surgical or oncology specialties. The screening results overlapped
the pre-or intraoperative bacteriological examinations in 27 % of cases.
The existence of risk factors for colonization was detected in 54 % of cases.
Knowing particular colonization allows initiation of appropriate
containment measures in 94 % of cases and administration of adequate
preoperative antibiotic prophylaxis to a percentage of 78% of patients
operated. Self-control samples collected from the hospital personnel and
hospital environment, monthly, have not revealed nosocomial germs. The
nosocomial infection rate detected was 0.07%.
Conclusion: Along with the other measures implemented in the hospital
on good medical practice and hand hygiene, preoperative screening is
one of the chain links preventing occurrence of nosocomial infections.
Disclosure of interest: None declared.

P195
P195: Orthopedic surgical infections caused by rapidly growing
mycobacteria: integrative review of literature
RNT Turrini, MPF Azevedo, RA Lacerda*
Medical Surgical Department, Nursing School of So Paulo University, So
Paulo, Brazil
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P195
Introduction: Infections due to rapidly growing mycobacteria (RGM) are
strongly related to failures in the processes of cleaning, disinfection and
sterilization of medical products.

P196
P196: Post-neurosurgical meningitis
S Madan*, R Soman, N Gupta
Medicine and Infectious Diseases, PD Hinduja National Hospital and Medical
Research Centre, Mumbai, India
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P196
Introduction: Post-neurosurgical meningitis represents only 0.4% of all
nosocomial infections. However, it presents enormous diagnostic and
therapeutic challenge with increasing rates of multidrug resistant organisms.
Hence strict infection control is of paramount importance.
Objectives: To study the etiology, management and risk factors of postneurosurgical meningitis.
Methods: A prospective and retrospective observational study of six
patients admitted over a period of one year, who developed meningitis
following various neurosurgical procedures. Antimicrobial treatment was
initiated empirically based on clinical and epidemiological background and
later modified based on results of culture and susceptibility. Retrospectively,
risk factors associated with each case were analyzed.
Results: Patients had undergone either intracranial or spinal neurosurgical
procedures with placement of ventricular or spinal drains. Features of
meningitis developed between 3 days to 2 months after surgery. Various
organisms isolated were Staphylococcus aureus, vancomycin resistant
enterococci (VRE), Escherichia coli, Pseudomonas aeruginosa, Pseudomonas
stutzeri and Klebsiella pneumoniae. Antibiotics used for treatment included
cloxacillin, linezolid, daptomycin, meropenem, ceftriaxone, ciprofloxacin and
colistin; based on organism identification and susceptibility.
1 patient with lumbar drain related meningitis, treated with meropenem and
intrathecal colistin showed dramatic response. 1 patient with external
ventricular drain (EVD) related meningitis caused by Klebsiella pneumoniae
and another with infected pseudomeningocele by Pseudomonas stutzeri,
also improved. 3 patients did not respond well and expired. Of these, 1 had
infection with VRE, and 2 had incomplete source control with retention of
foreign implants.

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Risk factors presumed to have role in etiology and poor outcomes were
uncontrolled diabetes, obesity, non-removal of ventriculoperitoneal shunt,
suboptimal duration of antimicrobial treatment, disconnection of lumbar
drain; prolonged duration (>5 days), blockage and multiple changes of
EVD. Factors related to surgical technique like intraoperative dural tear
and injury to lumbar vertebrae were also involved.
Conclusion: Although post-neurosurgical meningitis is a low incidence
infection, the consequences are grave. Therefore, effective prevention
with stringent infection control measures should be the goal.
Disclosure of interest: None declared.

Methods: We reviewed records of pts who had THA (n=100) or TKA


(n=100) between 21/2/2011-29/6/2011 and we interviewed 50 pts who
had THA or TKA between 21/5/2012-17/7/2012 to assess the association
between sxs of UTI and antimicrobial Rx. We used logistic regression to
identify variables associated with antimicrobial Rx for UTI.
Results: 190/200 (95%) pts had UAs, 91% had micros and 0.5% had urine
cultures preop. 37 (18.5%) pts received antimicrobials for UTI preop.
Positive leukocyte esterase (LE; p<.0001) and white blood cell (WBC)
count > 5 (p=.0098) were associated with antimicrobial Rx for UTI preop.
198 (99%) pts had UAs, 98% had micros, and 2.5% had urine cultures
after Foley removal. 72 (36%) pts received postop antimicrobials for UTI.
Positive (+) LE (p<.0001), WBC count >5 (p=.014) and older age (p=.014)
were associated with antimicrobials for UTI postop. Rx for UTI was related
to LE level (p<.0001). 43/72 (59.7%) pts Rxed for UTIs postop did not
meet criteria for UTI. 28/50 (56%) pts interviewed had sxs consistent with
UTI but pts with sxs were not Rxed more often than pts without sx. 3/250
pts (1.2%) had C. difficile infection (CDI). On the basis of the data, practice
was changed. Urine cultures are obtained from pts w/ + LE and + nitrite
or with sx of UTI. Pts with + cultures are treated for UTI.
Conclusion: 45.5% pts received antibiotics preop or postop for UTI; most
did not meet criteria for UTI. LE results determined whether pts were Rx for
UTI. Antimicrobial use and CDI among pts having THA or TKA could be
reduced if only pts with UTI sxs are screened or if all pts are screened but
only pts with + LE, nitrite, and cultures are treated.
Disclosure of interest: None declared.

P197
P197: Futility of perioperative urinary analysis before elective
total joint arthroplasty
I Uckay1*, L Pagani1, C Bouvet2, A Agostinho1, P Hoffmeyer2, D Pittet1
1
Infection Control Programme, Geneva University Hospitals, Geneva,
Switzerland; 2Orthopaedic Surgery, Geneva University Hospitals, Geneva,
Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P197
Introduction: The search for asymptomatic bacterial urinary tract
colonization (UTC) and its eradication before elective hip and knee
arthroplasty surgery is controversial, but reflects widespread practice. The
influence of perioperative antibiotic prophylaxis on the dynamics of UTC
is unknown.
Objectives: We investigate the role of preoperative urinary tract
colonization in patients undergoing elective joint arthroplasty.
Methods: Prospective observational cohort study (November 2011-October
2012) with urine analyses before and 3 days after surgery. Patients with
symptomatic infections or long-term urinary catheter carriage were
excluded. Post-discharge surveillance included questionnaires to patients
and general practitioners at 3 months.
Results: 480 asymptomatic patients (370 hip arthroplasties; 297 females;
median age 71 y) were enrolled. On admission, 171 patients (35%) had
bacterial UTC, mostly due to E. coli. Urine analysis revealed also 169 episodes
of leukocyturia. Almost all (95%) received a single-dose perioperative
prophylaxis of cefuroxime 1.5 g IV. Median duration of postoperative urinary
catheter carriage was 0 days (range, 0-13).
On postoperative day 3, urinary analysis was abnormal in 90 episodes of
leukocyturia and 198 episodes of UTC, respectively. Day 3 -bacterial UTC was
different from preoperative sampling among 50% of patients and
microbiological results revealed a higher proportion of Gram-positive
organisms.
Only 30 patients (6%) developed a symptomatic urinary tract infection
during a follow-up of 3 months; one-third of pathogens were unrelated to
those found during hospitalization. All symptomatic infections were treated
with oral antibiotics. There was no seeding of joint prostheses. Estimated
minimal laboratory costs for preoperative urinary analyses were 27,300.
Conclusion: Pre- or postoperative routine urine evaluation of asymptomatic
arthroplasty patients is costly and only moderately predicts the pathogen of
a potential urinary tract infection. If symptomatic infection occurs, a targeted
individualized antibiotic therapy prevents urosepsis and hematogenous
spread to joint prosthesis.
Disclosure of interest: None declared.

P198
P198: Antimicrobial treatment for urinary tract infection (UTI) among
patients having total hip (THA) or total knee arthroplasty (TKA)
L Herwaldt1*, S Bailin2, B Johannsson1, N Noiseux3, A Haleem1, S Johnson4
1
Internal Medicine, U of Iowa College of Medicine, Iowa City, IA, USA;
2
University of Iowa College of Medicine, Iowa City, IA, USA; 3Orthopaedics, U
of Iowa College of Medicine, Iowa City, IA, USA; 4Pharmaceutical Care, U of
Iowa Hospitals and Clinics (UIHC), Iowa City, IA, USA
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P198
Introduction: Patients (pts) having THA or TKA were screened preoperatively
(preop) and postoperatively (postop) for UTI with urinalysis (UA) and
microscopic exam (micro), regardless of symptoms (sx).
Objectives: To assess the association between UA and micro results and
antimicrobial treatment (Rx) for UTI in pts having THA or TKA.

P199
P199: Clinical characteristics and therapeutic outcomes of
hematogenous vertebral osteomyelitis caused by methicillin-resistant
Staphylococcus aureus
MS Lee1*, KH Park1,2, MH Jung1, YS Kim2
1
Internal Medicine, Kyung Hee University Hospital, Kyung Hee University
School of Medicine, Korea, Republic Of; 2Infectious Diseases, Asan Medical
Center, University of Ulsan College of Medicine, Seoul, Korea, Republic Of
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P199
Introduction: Hematogenous vertebral osteomyelitis (HVO) caused by
methicillin-resistant S. aureus (MRSA) has increased in recent years. Little
information is available regarding the clinical characteristics and outcomes
of patients with HVO caused by MRSA, compared with patients with HVO
caused by methicillin-susceptible S. aureus (MSSA).
Methods: All patients diagnosed with S. aureus (SA) HVO from January
2005 to December 2011 were included in the study. Clinical features and
outcomes of MRSA HVO were evaluated compared with MSSA HVO.
Molecular and microbiological characteristics of the MRSA isolates were
determined.
Results: Of the 139 patients with SA HVO, MRSA caused 62 (44.6%) cases.
Patients infected with MRSA were more frequently of hospital-onset (35.5 vs.
13.0, P = .002) than MSSA-infected patients. Based on clinical and
microbiological evaluation, a potential portal of entry for SA HVO was
identified in 61 patients (43.9%). Intravenous venous catheters were more
likely to be the origin in MRSA than in MSSA cases (46.7% vs. 22.6%, P =
.048). The mortality rates for MRSA and MSSA HVO were similar (21.0% vs.
19.5%; P = .83). Longer duration of bacteremia (mean 10.1 vs. 3.1 days; P <
.001), longer hospital stay (median 69 vs. 52 days; P = .001), and more
frequent relapse (16.1% vs. 4.3%; P = .03) were observed among MRSA
cases. Among the MRSA cases, relapse rates were lower in patients with a
longer duration of antibiotic therapy: 41.7% (46 weeks), 25.0% (68 weeks),
and 5.6% (8 weeks) (P = .007). Bacteremia was more likely to persist for 7
days in patients with an initial vancomycin trough <15 mg/L than in those
with an initial trough 15 mg/L (79.3% vs. 20.0%; P = .001). A communityassociated MRSA strain, specifically ST72-MRSA-SCCmecIV, was responsible
for 70.8% of community-onset infections and 12.5% of hospital-onset
infections.
Conclusion: MRSA HVO was associated with longer duration of
bacteremia, longer hospital stay, and more frequent relapse compared to
MSSA HVO. Our data indicate that antibiotic therapy for at least 8 weeks
and targeting an initial vancomycin trough of 15 mg/L benefit patients
with MRSA HVO. Community-associated MRSA strain was responsible for
substantial proportion of community-onset MRSA HVO.
Disclosure of interest: None declared.

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P200
P200: No need for initial broad-spectrum empiric antibiotic coverage
after surgical drainage of orthopaedic implant infections
I Uckay1*, M Schindler2, A Agostinho1, P Hoffmeyer2, D Pittet1
1
Infection Control Program, Geneva University Hospitals, Geneva, Switzerland;
2
Orthopaedic Surgery, Geneva University Hospitals, Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P200
Introduction: Empiric broad-spectrum antibiotic treatment for orthopaedic
implant infections after surgical lavage is common practice while awaiting
microbiological results, but lacks evidence.
Objectives: Our objective was to question the indication of broadspectrum empiric therapy in this clinical setting.
Methods: Single-centre cohort study conducted from 1996 to 2011.
Methicillin-resistant Staphylococcus aureus endemicity ranged from 2332% among clinical S. aureus isolates throughout the study period.
Bacteremic cases were excluded.
Results: We retrieved 342 implant infections and followed them for a
median of 3.5 years (61 recurred; 18%). Infected implants were arthroplasties
(n=186), different plates, nails, or other osteosyntheses. Main pathogens
were S. aureus (163; 49 methicillin-resistant) and coagulase-negative
staphylococci (60; 45 methicillin-resistant). Median duration of empiric
antibiotic coverage after surgical drainage was 3 days before switching to
targeted therapy. Vancomycin was the most frequently used initial empiric
agent (147), followed by intravenous co-amoxiclav (44). Most empiric
antibiotic regimens (269; 79%) proved sensitive to the causative pathogen,
but were too broad in 111 episodes (32%). Although they would have
covered 59% of later identified causative pathogens, cephalosporins and
penicillins were used only in 44 and 10 cases, respectively. Empiric
anaerobic coverage was given in 130 episodes (38%), although only five copathogens were anaerobes. Multivariate Cox regression analysis showed
that neither susceptible antibiotic coverage (compared to non-susceptible;
hazard ratio, 0.7, 95% CI, 0.4-1.2) nor exaggerated broad-spectrum use
(hazard ratio, 1.1, 0.8-1.5) changed remission rates.
Conclusion: Provided that surgical drainage is performed, broad-spectrum
antibiotic coverage during the first 3 days does not enhance remission of
orthopaedic implant infections. If empiric agents are prescribed from the
first day of infection, narrow-spectrum penicillins or cephalosporins can be
considered to avoid unnecessary broad-spectrum and anti-anaerobic
antibiotic use. Randomized controlled trials are needed to confirm our
findings.
Disclosure of interest: None declared.

P201
P201: First report in the world of Mycobacterium bacteremicum
causing a cluster of postlaparotomy surgical wound infections
M Biswal1*, G Singh2, V Jain2, SB Appannanavar2, V Hallur2, PK Gupta2,
S Malvi2, N Taneja2, S Sethi2
1
Department of Medical Microbiology, Chandigarh, India; 2Postgraduate
Institute of Medical Education and Research, Chandigarh, India
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P201
Introduction: Uncommon atypical mycobacteria previously known to be
environmental contaminants are an increasingly reported cause of
outbreaks of surgical site wound infections. We investigated a cluster of
post-laparotomy wound infections in 12 patients at our tertiary care hospital
in India. We describe the epidemiology and the methods used to investigate
the outbreak.
Objectives: The objective of this study was to investigate a cluster of
post-laparotomy wound infections in 12 patients at our tertiary care
hospital in India using 16SrRNA typing.
Methods: The outbreak started in October, 2011 and continued till April,
2012. The patients presented with delayed wound healing post laparotomy
surgery. Swabs collected from the gaping wounds were sent for culture of
atypical mycobacteria. Samples were also collected from the environment to
locate the source of the organism. Samples were plated on Middlebrook
7H10 and Lowenstein-Jensen medium. Mycobacteria were identified by
partial 16S r RNA sequencing.
Results: All specimens yielded a yellow pigmented rapidly growing
mycobacterium species. The sequences (Seq1 and Seq2) obtained by PCR

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using 16S rRNA PCR were compared with that in the GenBank database.
The sequences of our isolates gave 99% identity with the ex-type strain
of Mycobacterium bacteremicum (ATCC 25791). Sequence alignment and
phylogenetic tree were constructed using the neighbour-joining method
with MEGA5.1software package. Sequence data were submitted to the
GenBank (Accession No. JX473587 & JX473588).
Conclusion: In conclusion, delayed wound healing in surgical patients
should be investigated for atypical mycobacteria using molecular
methods to reach a diagnosis and institute appropriate and prolonged
antimicrobial treatment. To the best of our knowledge, the causative
agent, M. bacteremicum is being reported to cause post-surgical wound
infection for the first time in world literature.
Disclosure of interest: None declared.

P202
P202: Investigation of a cluster of invasive mold infections in a large
teaching hospital
A Gayet-Ageron1*, N Farquet1, E Von Dach1, C van Delden2, V Camus1,
Y Chalandon3, D Pittet1, A Iten1
1
Infection Control Program, University Hospitals of Geneva, Geneva,
Switzerland; 2Department of Surgery, Transplant service, University Hospitals
of Geneva, Geneva, Switzerland; 3Service of Haematology, University
Hospitals of Geneva, Geneva, Switzerland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P202
Introduction: In July 2010, we observed an increased number of invasive
mold infections (IMI) in the hematology wards of our institution.
Objectives: We assessed risk factors associated with IMI in order to
optimize preventive and protective measures.
Methods: Retrospective matched case-control study conducted in a 1900bed teaching hospital between September 2008 and March 2011. Cases
were defined as proven, probable, or possible according to standardized
international consensus definitions. Controls were at-risk patients (oncohematologic patients and allogeneic hematopoietic stem cell transplant
recipients) hospitalized during the same time period as cases. Data were
recorded by three investigators unblinded to the case-control status using
a standardized case-report form. Conditional logistic regression was
applied.
Results: Between November 2008 and March 2011, a total of 29 cases were
identified: 6 proven (20.7%), 8 probable (27.6%) and 15 possible cases
(51.7%); 102 controls were matched to cases. Cases had a longer hospital
stay (P<0.001) and were exposed to a longer duration of neutropenia
(P<0.001). They differed from controls regarding the hospitalization ward
(P=0.001), chemotherapy use in the prior year (P=0.002), the existence
of prior cytomegalovirus (CMV) infection (P=0.03), and a higher number of
examinations outside the ward before IMI diagnosis (P<0.001). By
multivariate analysis, after adjustment for age, hospitalization ward, duration
of neutropenia, and history of CMV infection, two independent factors were
associated with IMI: length of hospital stay in days (OR 1.06, P=0.02) and the
number of examinations outside the ward (OR 1.47; P=0.02).
Conclusion: Our results suggest that cases were more exposed to
environmental fungi and specific recommendations related to patient
transport within the hospital were reinforced.
Disclosure of interest: None declared.

P203
P203: Outbreak of puerperal fever in an obstetric ward: a reminder of
Ignaz semmelweis
S Benenson1,2, A Moses1, I Gross1,2, C Block1, C Schwartz1,2*
1
Clinical Microbiology and Infectious Diseases, Hadassah Hebrew-University
Medical Center, Jerusalem, Israel; 2Infection Control Team, Hadassah HebrewUniversity Medical Center, Jerusalem, Israel
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P203
Introduction: Group A streptococcus (GAS) puerperal fever was recognized
long ago but unfortunately still poses a serious problem at childbirth. The
source for the infection usually cannot be determined.
Objectives: Description of the epidemiological investigation of an
outbreak of GAS infection in women after childbirth, leading to
recognition of the source of the outbreak. The Clinical Microbiology

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laboratory reported GAS isolated from vaginal specimens from two


women readmitted shortly after delivery, one of whom also had a positive
blood culture.
Methods: An investigation was carried out to identify additional cases of
GAS in the ward. All healthcare workers (HCWs) involved in taking care
of the two women from admission till after delivery were identified, and
requested to submit a throat swab. The specimens from the two women
and from HCWs positive for GAS were compared regarding antibiotic
susceptibility pattern, M protein gene typing (emm typing) and by
Pulsed-field Gel Electrophoresis (PFGE).
Results: No additional cases of GAS were found in the maternity ward.
Both women were treated with intravenous antibiotics and one needed
revision of the uterus.
A single HCW, a midwife present at the deliveries of both affected
women, had a positive throat swab. She reported having recently had a
throat infection that was treated with antibiotics. emm typing of all four
isolates showed them to be of the same type , emm 77, and their PFGE
patterns were identical.
Conclusion: Identification of identical strains of Streptococcus pyogenes
from all specimens points at probable transmission from the midwife to both
patients. We assume that the infection was transmitted by contaminated
hands, although transmission by droplet or other indirect contact cannot be
ruled out.
Ignaz Semmelweis recognized the role of hand hygiene in the prevention of
puerperal fever 150 years ago and his observation is still relevant today.
Disclosure of interest: None declared.

P204
P204: Whats the scope? Pseudomonas aeruginosa outbreak in ICU
S Salmon1*, M Balm1,2, C Teo1, D Fisher1
1
Infection Control Team, National University Hospital Singapore, Singapore,
Singapore; 2Microbiology, National University Hospital Singapore, Singapore,
Singapore
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P204
Introduction: Surgical Intensive Care Unit (SICU) maintains one
bronchoscope for use on its patients. An internal decision to change
manual bronchoscope re-processing practices occurred in July 2012. In
September and October, four consecutive patients cultured Pseudomonas
aeruginosa from bronchial washings following bronchoscopy.
Methods: An outbreak investigation was triggered including analysis of
laboratory data, case reviews, investigation of workflows within SICU and
sampling of bronchoscope and brushes. No molecular typing was performed
as isolates were no longer available.
Results: Patients 1 and 2 cultured multiresistant P. aeruginosa with identical
antibiograms. Patients 3 and 4 cultured multisusceptible P. aeruginosa and
Serratia marcescens. Patient 4 also had Stenotrophomonas maltophilia.
Bronchoscope cultures taken after manual re-processing grew P. aeruginosa,
S. marcescens and S. maltophilia with identical antibiograms to Patient 4.
Procedure review revealed multiple irregularities including reduction of
immersion time in sterilant from 30 to 10 minutes. This change had been
adopted at the vendors suggestion due to concerns regarding damage to
the bronchoscope from exposure to chemical sterilants. In liaison with the
Infection Control team, SICU staff devised a new workflow ensuring reprocessing of bronchoscopes in an automated washer-sanitiser occurred
following use, with sterility checks on the bronchoscope following cleaning.
Conclusion: Changes to protocols and workflows may have unintended
consequences with patient safety implications. Infection Control teams must
be alert to the potential for changes in practice of which they are unaware.
Maintaining a high profile with ward managers and laboratory surveillance
for subtle outbreaks remain important safety nets for patients.
Disclosure of interest: None declared.

P205
P205: An outbreak of polyclonal pseudomonas aeruginosa bacteremia
in hemodialysis patients
P Ciobotaro1*, A Fialko2, E Nadir3, M Oved3, R Bardenstein3, P Gershkoviz4,
O Zimhony3
1
Infectious Diseases Unit, Kpalan Medical Center, Aseret, Israel; 2Harzfeld
Medical Center, Gedera, Israel; 3Infectious Diseases Unit, Kpalan Medical

Page 90 of 143

Center, Rehavot, Israel; 4Infectious Diseases Unit, Harzfeld Medical Center,


Gedera, Israel
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P205

Introduction: Dialysis patients are at increased risk for infections. We


describe an outbreak of Pseudomonas aeruginosa (Pa) bacteremia in
patients with permcath in a dialysis unit of a 150 beds long term care
facility (LTCF).
Objectives: Epidemiological and bacteriological investigation was
conducted to identify patients risk factors, source of infection and modes
of transmission.
Methods: Epidemiological investigation included a plot of outbreaks
curve, observations on working processes, tabulate data of possible
exposures. Bacteriologic & Molecular studies included cultivation of
dialysis-related fluids and medications, health care workers (HCW) hands
and patients surroundings. Positive cultures were analyzed for antibiotic
susceptibility and clonality using random amplification of polymorphic
DNA (RAPD).
In the intervention recommendations for correct working processes and
training were provided to the HCW and were followed by monitoring of
compliance & feedback.
Results: 18 events of Pa bacteremia were recorded in 12 patients who
undergo hemodialysis via a permcath. 9 patients were from the same
ward in the LTCF.No cases were recorded in patients with A-V fistula. All
fluids and intravenous medications cultures were negative for Pa.
Pa strains were isolated from few HCW hands, one permcath dressing,
shower head, patients bathroom floor, bathroom chair and treatment
cart. RAPD analysis revealed polyclonality of the strains with few matches.
One bacteremic strain was identical to the strain from the same patients
bathroom shower head.
Inspections on work processes revealed that the permacath dressings got
wet during bathing and were not changed until the next dialysis.
Intervention that focused on proper permcath care resulted in marked
decrease in incidence of Pa bacteremia for the following months.
Conclusion: The polyclonality of the isolated strains combined with the
matches found between bacteremic and environmental strains suggested
that Pa strains got into permcath tunnels through an improper handling
of the catheters dressing rather than due to a common infected external
source. Improper catheter care resulting in wet dressings is the plausible
cause. Adherence to instructions for catheter care can minimize this risk.
Disclosure of interest: None declared.

P206
P206: Stenotrophomonas maltophilia bacteraemia: analysis of 33
episodes occurred in the ICU at the University Hospital in
Sousse-Tunisia
O Bouallgue*, N Jaidane, H Said laatiri, W Naija, S Khefecha Aissa, N Boujaafar,
L Dhidah
Microbiology Laboratory, Department of Hygiene and Service reanimation,
Hospital of Sahloul, Sousse, Tunisia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P206
Introduction: Stenotrophomonas maltophilia is a gram negative bacillus
that has emerged as an opportunistic pathogen associated with high
morbidity and mortality rates.
Objectives: The aim of this study is to describe the characteristics of
bactaeremia due to this strain, their outcome, the antibiotic sensitivity
patterns of isolates.
Results: In our study, 93% of 33 episodes were nosocomial. There were 22
deaths (71%) 1512 days after the bactaeremia. 17/31 of patients were
exposed to broad-spectrum antibiotic specifically imipinem (IMP) before
their positive culture. Among cases, 23 (74%) patient had mechanical
ventilation and 29 (935%) had central venous catheterization. Antibiotic
susceptibility testing revealed that isolates were most sensitive to
Ciprofloxacin (CIP) (84%), Trimethoprim-sulfamethoxazole (SXT) (71%) and to
Colistin (CS) (58%). Twenty three percent (23%) episodes were polymicrobial.
A probable portal of entry was identified in 273% of bacteraemic episodes
and 57% were catheter-related. Fifty eight percent (58%) of the episodes
were treated with monotherapy specifically CIP (35%). Our results were
similar to those described by others in the last 20 years. These studies have
been mostly retrospective.

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Conclusion: Prevention of S. maltophilia infection relies on the cornerstones


of modern infection control, such as higher emphasis on control of
antimicrobial consumption and consideration of environmental reservoirs.
Disclosure of interest: None declared.

1000 ventilator days respectively). The ICT alerted the critical care team.
An investigation was launched and an outbreak of Acinetobacter
pneumoniae in ventilated patients was detected. A case definition was
established and extent of outbreak assessed through line listing of cases,
laboratory investigations and outcome. A fish bone analysis was done of
the various processes involved. It resulted that the ambu bags which
were used for patients harbored the Acinetobacter inspite of disinfection.
The disinfection protocol was modified and training was imparted to staff
involved in disinfection of the ambu bags. A checklist was introduced for
monitoring all ventilated patients and strict implementation of VAP
bundles was initiated. Surveillance following the above steps over the
next three months showed a significant decrease in VAP rates in the
intensive care unit (3.4 to 6.4 per 1000 ventilator days).
Conclusion: It has been proved that routine prospective surveillance is
an excellent tool to combat HAIs and proves effective in detection of
outbreaks which otherwise would have gone unnoticed.
Disclosure of interest: None declared.

P207
P207: A cluster of panton- and valentin- producing Staphylococcus
aureus infection at a departmental hospital in Benin: possible
association with consumption of contaminated food
TA Ahoyo1*, C Le Brun2, M Makoutode3, S Baba-Moussa1, Y Piemont1,
K Dramane1, G Prevost1, A Sanni1
1
Laboratory of Biochemistry and Molecular Biology, Faculty of Sciences and
Techniques, University of Abomey, Abomey, Benin; 2Institute of Bacteriology,
University Hospital, University Louis Pasteur, UPRES EA-3432, Strasbourg,
France; 3IRSP, University of Abomey, Abomey, Benin
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P207
Introduction: A three-month period in 2005, two distinct types of
methicillin-sensitive Staphylococcus aureus (one producing of PantonValentine leukocidin (PVL) and the other not) were isolated from bronchial
specimens of paediatric inpatient unit at the Zou/Collines Departmental
Hospital (CHDZ/C), who had been previously cared for by the nurses. The
source of outbreak was probably a faulty contamination of specific food
consumed by patients.
Objectives: we aim to determine the source of particular S. aureus strains
and possible relationships with hospital environment.
Methods: An investigation was conducted that involved screening of all
inpatients receiving a specific food, hospital environment sampling and the
follow-up of cases until the end of hospital stay. Isolates were identified,
tested for antimicrobial susceptibility and analysed for PVL, LukE/LukD, and
enterotoxin A production. Pulse Field Gel Electrophoresis (PFGE) was
performed to establish the clonality of the strains.
Results: A total of 36 infected inpatients with S. aureus were identified.
Twenty-eight cases of pneumonia were discovered and PVL-producing
S. aureus concerned 61%. By PFGE an indistinguishable PVL-producing
S. aureus was identified in the food served, 28 patients, the keyboard and
faucet handles in their respective room. Enhanced hygiene measures,
particular hand hygiene, terminated the outbreak.
Conclusion: Our finding suggest an associated between environmental
contamination and patient infection, not limited to the patients rooms.
Transmission of PVL-producing S. aureus can be prevented in the hospital
by a combination of decontamination of the environment, and the
promotion of hand hygiene.
Disclosure of interest: None declared.
P208
P208: Detection of an outbreak through routine surveillance
and its control
P Barman1*, S Sengupta1, R Pande2, M Puri1
1
Microbiology, BLK Super speciality hospital, New Delhi, India; 2Critical Care
Medicine, BLK Super speciality hospital, New Delhi, India
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P208
Introduction: Ventilator associated pneumoniae (VAP) is a major burden of
healthcare associated infections (HAI) and leading cause of death of mortality
and morbidity in critical care patients. NHSN 2010 reported a VAP pooled
mean of 1.2 per 1000 ventilator days. The INICC study reported higher VAP
rates in developing countries. VAP rates of 10.4 were reported from India.
Surveillance has always been an effective tool for reduction of VAP
worldwide. The importance of surveillance is not only to detect infection risk,
process and outcome but also as a tool for recognizing outbreaks.
Objectives: To detect, investigate and control an outbreak of pneumoniae
in ventilated patients in the medical ICU at a tertiary care hospital.
Methods: Prospective surveillance for HAI is routinely carried out following
NHSN/ CDC definitions. Analysis and feedback of this data is presented to
the clinicians by the infection control team (ICT) every quarter.
Results: The VAP rates from January 2011 to July 2011 were between 2.5
to 5.52 per 1000 ventilator days. A marginal increase (7 per 1000
ventilator days) was seen during August and September 2011.A sharp rise
followed in the month of December and January 2012 (16.08 to22.84 per

P209
P209: Governmental surveillance systems for healthcare-associated
infection in the south and Southeast region of Brazil
C Nogueira-Junior1, MC Padoveze2, RA Lacerda3*
1
Nursing Department, Dr. Mario Gatti Hospital, Campinas, Brazil; 2Public
Health Department, Nursing School of University of So Paulo, So Paulo,
Brazil; 3Medical-surgical department, Nursing School of University of So
Paulo, So Paulo, Brazil
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P209
Introduction: A good surveillance is essential to gather information for
measures to prevent and control of healthcare-associated infections(HAI).
The study is aiming at characterize the HAI surveillance systems(HAI-SS)
in 7 States in the South and Southeast region, of Brazil.
Methods: Cross sectional and descriptive study carried out in two steps:
characterization of healthcare system structure by means of consulting of
the National Data Base of Healthcare Facilities; interview with person in
charge of HAI program. HAI-SS were classified in chain, circle or wheel.
Results: A large variation of healthcare facilities were identified. So Paulo
is the State with highest number of healthcare facilities but the State of
Santa Catarina has the highest ratio of healthcare facilities by 1.000.000
habitants(1,99). Human resources for HAI-SS varied, and, in some, they
were not exclusive for data management but accumulated other functions.
Hospital participation in the HAI-SS was mandatory by law in 3 States. HAISS were classified as chain in two, circle in four, and wheel in one State.
HAI-SS were mainly driven toward acute care facilities; ventilator
associated pneumonia, blood stream, urinary tract, and surgical site
infections were included. Participation in the National HAI-SS occurred by
sending data regarding blood stream infections. Routine feedback of
surveillance data was not adopted in two States, one State have been
using data gathered from HAI-SS to develop governmental plans for HAI
rates reduction.
Conclusions: It was identified inequalities in the healthcare services,
potentially inducing to over crowding and posing to risk of low quality in
some States. Human resources are insufficient in some States to carry out an
adequate governmental plan for reduction of HAI rates. The operational
dissimilarities among States may need to be overcome in order to build a
good National HAI-SS.
Disclosure of interest: None declared.

P210
P210: National nosocomial infection surveillance report in Iran in 2012
H Masoumi Asl
Nosocomial Infection Department, Center for Communicable Disease
Control, Tehran, Iran, Islamic Republic Of
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P210
Introduction: Nosocomial Infection(NI) affect hundreds of millions of
patients worldwide every year that lead to more serious illness, prolong
hospital stays, and induce long-term disability. In 2007, a national surveillance
system was established in Iran for NI based on National Nosocomial Infection
Surveillance (NNIS) system definition.

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Objectives: This is the latest report of nosocomial infection surveillance


during 2012 in Iran.
Methods: In this cross sectional study four main group of NI including
urinary tract(UTI), pulmonary(PNEU), surgical site(SSI) and blood stream
(BSI) and other infections was investigated in 400 hospitals in 2012. Data
was gathered through surveillance system that reported to center for
communicable disease and analyzed in Iranian Nosocomial Infection
Surveillance(INIS) software.
Results: During the study, a total of 47380 cases have been registered.
The NI rate was 0.89%. The incidence of UTI was 26.5%, PNEU 24.4%, SSI
15.5%, and BSI 15.5% respectively. The mortality rate was 13.7%. The
highest incidence rate was reported in burn ward (11.8%), followed by
transplantation(9.1%), ICU(7.8%), NICU(3.5%) and PICU(2.6%). 14.5% of
infections were under15 years old. The most invasive measures that have
been taken for cases were as follows : venous catheter (23%), urinary
catheter (18%), suction (22%), tracheal tube (22%), ventilator (22%) and
surgery(22%). 71.3% of diagnosis were laboratory based. Ecoli (16%),
Acinetobacter (14%), Pseudomonas auroginosa (12%), Klebsiella (11%),
Staphylococcus aureus (8%), Entrobacter (7%) and Candida (6%) were most
prevalent causative agents in NI cases.
Conclusion: The results show that it is feasible to collect data from a large
number of hospitals that assist for interventions and resource allocation, but
because of data under-reporting, it is necessary to encourage and change
attitude of authorities and health worker by increasing commitment and
holding more justification and educational sessions.
Disclosure of interest: None declared.

completed questionnaires suggests the infection control in Poland requires


varied educational and practical activities in order to improve safety of
hospitalization.
Disclosure of interest: None declared.

P211
P211: Organization and scope of infection control in Polish hospitals.
First results of the pan-european prohibit survey
A Raska*, J Wjkowska-Mach, PB Heczko, M Bulanda,
the PROHIBIT study group
Chair of Microbiology, Jagiellonian University Medical College, Krakw, Poland
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P211
Introduction: The PROHIBIT Prevention of Hospital Infections by Intervention and Training survey was initiated to obtain data on practices on HAI
prevention and to identify enabling factors or barriers to compliance with
evidence-based recommendations.
Objectives: The paper presents initial descriptive results of a survey on
organization of surveillance programs in Polish hospitals, which is a part
of PROHIBIT project.
Methods: Survey was performed by means of the standardized
questionnaire in the year 2012. Questions were answered by IC personnel.
Completed questionnaires were obtained from 9 hospitals of different
size and type.
Results: Infection control team (ICT) works in every hospital and the head
of the team in 8 hospitals is a physician. In most hospitals number of
epidemiological nurses per 100 beds ranges from 0.4 to 0.8.
In every hospital surveillance comprises all the most important from the
epidemiological point of view forms of infections: SSI, BSI, PNEU, UTI, CDI
and MDRO - in all wards.
Infection cases in 5 hospitals are documented by epidemiological nurse in
collaboration with infection control physician or physician of the ward. In
rest - by infection control physician.
Most hospitals (7 of 9) also declare running the post-discharge
surveillance of SSI.
Feedback on infection rates to HCWs are given twice a year in most
hospitals.
In 7 of 9 hospitals consumption of alcohol-based handrub are monitored
(average usage is about 10 l /100 admissions per year). ICTs in all hospitals
have access to microbiological data. Average number of blood cultures per
100 admissions/year is 14.8.
Conclusion: The results obtained from this small group may suggest that
the surveillance programs are complex and well organized.
But, this kind of process measure data are insufficient for assessing the
safety of hospitalization which demands the outcomes measure data
which are not available in Poland presently. There are just single
publications presenting the epidemiological data on infections in Polish
hospitals in professional literature what with the low percentage of

P212
P212: Antimicrobial resistance and healthcare associated
infections: one and only battle
ML Moro*, C Gagliotti, M Marchi, R Buttazzi, V Cappelli, M Morandi, F Morsillo,
A Pan, M Parenti, E Ricchizzi
Area di Programma Rischio Infettivo, Agenzia Sanitaria e Sociale Regione
Emilia-Romagna, Bologna, Italy
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P212
Introduction: Integrated surveillance of Healthcare infections (HAIs),
antimicrobial resistance (AMR) and antimicrobial consumption (AC) is
essential. Its impact in Emilia-Romagna (4.5 million inhabitants) is
described.
Methods: The following surveillance systems exist: electronic-lab-based
surveillance covering all public and private hospital; AC monitoring system,
covering both hospital (HA) and community; alert system of sentinel HAIs
and outbreaks, both in HA and long-term care facilities (LTCFs); surgical site
infection and intensive care unit surveillance system; repeated prevalence
surveys both in HA and LTCFs; regional databases linkage for selected
infections (eg Clostridium difficile); ad hoc surveillance for high priority AMR
microorganisms (ie carbapenemase-producing Klebsiella pneumoniae-CPK);
monitoring of HAIs and antimicrobial stewardship programs in each LHT
and of hand hygiene products consumption.
Results: Selected results are presented below. The incidence rates of
bacteremia raised from 146 in 2005 to 228 cases per 100.000 inhabitants/
year in 2011 (+56%); the increase was significant for K. pneumoniae (+188%)
and E.coli (+99%), due to spread of multiresistant strains. An intervention
program, launched in July 2011 to fight the spread of CPK, had a positive
impact on this trend. The AC significantly increased until 2009; subsequently,
the trend is still increasing for hospitals (90.8 DDD/100 in hospital-days in
2011) while in the community the consumption has decreased (following
educational campaigns), being still high (18.4 DDD/1.000 inhabitants-day in
2011). In 2007-2011 the coverage of the regional alert system progressively
improved: in 2007 26 HAI outbreaks were notified, and 54 in 2011; 17.9%
occurred in LTCFs and 82.1% in HA. Data on 59,281 non orthopaedic
surgeries from 33 categories of surgical procedures have been collected by
41 hospitals (2007-2011): in HAs participating to the surveillance for at least
two years, the incidence of surgical wound infections was reduced by 24%
(Odds Ratio 0.76, 95%CI 0.66-0.88).
Conclusion: An integrated surveillance system, covering both HAIs and
AMR, is essential to identify critical areas, to monitor interventions and to
demonstrate the success of dedicated efforts.
Disclosure of interest: None declared.

P213
P213: The evaluation of infection control activities and analysis of
influence factors in healthcare setting in Korea
H Koo
Infectious disease control, Korea CDC, Cheongwon-gun, Korea, Republic Of
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P213
Introduction: The healthcare associated infection (HAI) is one of the
most serious threat in patient safety in the process of medical services.
The greater part of these unexpected infections could be prevented with
effective infection control activities.
Objectives: The aim of this study was to evaluate infection control
activities and analyze the influence factors in healthcare setting in Korea.
Methods: The study was conducted in general acute care hospitals in
Korea. In 2012, we surveyed the infection control activities in hospital which
operate the infection control organization by the law. To measure the
infection control activities of hospitals, we applied the the Infection Control
Assessment Tool (ICAT) 2009 restrictively to the surveyed data.
We calculated the infection control activity scores in the indexes of
infection control infrastructure, surveillance, compliance of guidelines,

Antimicrobial Resistance and Infection Control 2013, Volume 2 Suppl 1


http://www.aricjournal.com/supplements/2/S1

education, antibiotics use and indicator monitoring activities. Finally we


analyze the influence factors to the total activity scores.
Results: Among 154 hospitals operating infection control organization,
127 hospitals (82.0%) were participated. The mean score was 77.5 in the
range of 30 to 95 (total possible score was 100). The variables affect to
the total score are university hospital, nurse staffing, work experiences of
infection control nurse (ICN), the certification of ICN, antibiotic
stewardship and education completion of doctors. In multiple linear
regression analysis, the influence factors are antibiotic stewardship (b=8.2,
p=0.001), education completion of doctors (b=4.5, p=0.001) and the
certification of ICN (b=3.6, p=0.011).
Conclusion: Our result shows the important factors to measure or
evaluate the infection control activity are the antibiotics stewardship,
education completion of doctors and the certification of ICN.
Disclosure of interest: None declared.

P214
Abstract withdrawn

Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P214

P215
P215: Tracking infections in outpatient hemodialysis unit in Saudi
Arabia
N Dagunton1*, A El-Saed1, A Al Sayyari2, F Hejaili3, A Azzam1, M Alarcon1,
H Balkhy1
1
Infection Prevention & Control, King Abdulaziz Medical City, Riyadh 11426,
Saudi Arabia; 2Department of Nephrology, King Abdulaziz Medical City,
Riyadh 11426, Saudi Arabia; 3Hemodialysis Program, King Abdulaziz Medical
City, Riyadh 11426, Saudi Arabia
Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P215
Introduction: Bacteremias and localized infections of the vascular access
site are associated with high morbidity and mortality among end-satge
renal (ESRD) patients.
Objectives: At King Abdulaziz Medical City (KAMC) in Riyadh (SA),
surveillance among ESRD patients was conducted to detect trends in dialysis
related infections and evaluate effectiveness of prevention measures.
Methods: Following the methodology set by the National Healthcare
Safety Network (NHSN), a 32-month prospective surveillance (monthly
average of 218 patients-months) was conducted from 2008 to 2012 at
the Outpatient Hemodialysis Unit at KAMC. Patients were monitored for
any of the three dialysis events; outpatient start of an intravenous (IV)
antimicrobial, evidence of local access site infection (LASI) and accessassociated bacteremia.
Infection control measures were instituted throughout the whole period of
study but stringent ones were strictly emphasized starting early 2012.
Interventions implemented included the use of Chlorhexidine impregnated
transparent dressings, strict monitoring of aseptic dressing technique,
provision of an Arabic educational brochure for patient education,
provision of an alcohol hand gel in each patient trolleys and judicious use
of antibiotics.
Results: The combine