S82 Abstracts, 7th International Conference of the Hospital Infection Society, 10–13 October 2010, Liverpool, UK / Journal of Hospital Infection 76S1 (2010) S1–S90

4. We found significant differences in hand hygiene before entering

the room and in the order of fitting the protective equipment

between the different types of HCW.

P29.11

Enhanced surveillance of Clostridium difficile infection

I. Thompson, M. Hanrahan. Belfast Health and Social Care Trust,

United Kingdom

Background: Enhanced Clostridium difficile infection (CDI)

surveillance was conducted over 15 months and analysis of

outcomes was conducted to inform local CDI reduction strategy.

Objectives: To determine demographic and epidemiological data of

patients with CDI. Identify risk factors, monitor clinical outcome

and adherence to Trust targets.

Methods: A Formic form was devised using enhanced CDI

surveillance questions. Infection Prevention and Control Nurses

collected data at days 0, 10&30. Outcome at discharge, death

or after 30 days was determined and findings reported to Trust

management.

Results: Of 417 patients 454 unique episodes were recorded.

Patient’s mean age was 72 years, those aged ≥65 years accounted

for 71.5% with a median length of stay (LOS) of 31 days. Patients

presenting with symptoms ≤48 hours of admission accounted for

38% of total while 44% of this group had a hospital admission in the

preceding 6 weeks. Isolation was achieved within 4 hours in 90%

of episodes. Risk factors such as antimicrobial use, proton pump

inhibitors, naso-gastric feeding and outcomes such as lengths of

stay were determined. LOS was similar for common ribotypes and

ribotype 078.

Discussion: This data determined local epidemiology. Most patients

originate from an elderly population who reside at home. Over a

third had a preceding recent hospital admission and just under

half were symptomatic ≤48 hours of admission. Known risk

factors emerged from our epidemiology and the burden of specific

ribotypes on LOS was determined. CDI reduction strategy needs to

focus now on primary care antimicrobial usage.

P29.12

Can numbers of Staphylococcus aureus bacteraemias and

Clostridium difficile be reduced in the absence of targets?

M. Morgan, S. Harris, V. McClure, E. Davies. Welsh Healthcare

Associated Infection Programme, Public Health Wales NHS Trust,

United Kingdom

Background: Healthcare in the UK is a devolved responsibility.

Administrations have prioritised resources differently and set

different performance targets. Until April 2010, Wales was the

only UK country with no reduction targets for specific organism

healthcare associated infections (HCAI). England targeted MRSA

bacteraemias from 2005, followed by C. difficile. Scotland and

Northern Ireland have since introduced targets for total S. aureus

bacteraemias and C. difficile.

Aim: To compare trends in S. aureus bacteraemias and C. difficile in

Wales with other UK countries.

Methods: Surveillance data for S. aureus bacteraemias have been

collected in Wales since 2001 via a web reporting system and

C. difficile (inpatients >65) data since 2005, by extraction from

microbiology data warehouse.

Trend data for England, Scotland and Northern Ireland were from

regular HCAI reports on websites of the Health Protection Agency,

Health Protection Scotland and Public Health Agency, Northern

Ireland.

Results: Direct comparison of infection rates in UK countries is

difficult because of surveillance scheme differences, but trends can

be compared.

English Trusts have met the 50% reductions for MRSA bacteraemias

and 30% for C. difficile. Scotland and Northern Ireland also report

good progress. A 30% reduction in MRSA bacteraemias occurred

in Wales between 2003/4 and 2008/9; reductions over the entire

surveillance period are larger. In contrast, MSSA bacteraemias have

increased. C. difficile increased significantly between 2006 and 2007

due to ribotype 027; more recent data shows a downward trend.

Discussion: A strategy to tackle all HCAI rather than specific

organisms has been in place in Wales since 2004. MRSA bacter-

aemias have reduced significantly and there has been some recent

reductions in C. difficile. Large reductions in other UK countries

over a shorter time frame indicate targeting specific organisms can

produce results quickly, but only for organisms targeted.

P29.13

Effect of a national control program on the proportions of

MRSA infections contributed by specific ward types in a us

veterans affairs medical center

J. Thurn, T. Jacobson, K. Crossley. Minneapolis VA Medical Center,

United States

Background: MRSA has been an increasing problem in many

countries for years. More recently, efforts to control its spread

through the use of universal screening, isolation and contact

precautions have been widely used. How effective control is may

vary by location, even in one facility. In 2007 the US Dept of

Veteran Affairs nationally introduced ‘Zeroing in on MRSA’ using

these components.

Objective: To assess how a program to control MRSA effects the

percent of all MRSA health-care associated infections contributed

by specific ward types – acute care (ACW), intensive care (ICU) and

community living center (CLC) in a single facility over time.

Methods: In Nov, 2007 a program to control MRSA was started at

the Minneapolis VA Med Centrr using nasal PCR on all patients

admitted and on interward transfer, and chromagar at discharge or

death. Contact precautions were used for those with MRSA, hand

hygiene was promoted and infections defined according to CDC

definitions. The proportions of all MRSA infections in three general

wards plus a stepdown unit (ACW), an MICU and SICU (ICU) and

three community living center wards (CLC) were compared by

fiscal year.

Results: From 2007 through May, 2010, the percent of all MRSA

infections from each setting varied. As a percent of total MRSA

infections, the CLC and ACW reversed in importance (CLC 43% vs

ACW 30% in 2007 and CLC 20% vs ACW 50% in 2010) and the

proportion contributed by ICU intially declined then increased to

about the same proportion from 2007 to 2010.

Conclusions: As a percent of all MRSA infections per year the

percent contributed by CLC decreased over time. Absolute numbers

need to be viewed, but this did not appear to be major influence

on our results. For example, the percent in CLC did not decline over

time because of large increases in the numbers of MRSA infections

in ACW and ICU. In the future, MRSA control will likely need to be

modified by the type of patients and the settings they are in.

P29.14

An integrated approach for appraisal the role of microbial

air contamination and antibiotic prophylaxis in hip and knee

arthroprosthesis surgery

A. Agodi1, F. Auxilia2, M. Barchitta1, D. D’Alessandro3, I. Mura4,

C. Pasquarella5. 1University of Catania, Italy; 2University of Milano,

Italy; 3University of Roma, Italy; 4University of Sassari, Italy;5University of Parma, Italy

Since the MRC study demonstrated an association between

air microbial contamination and deep SSI in hip and knee

arthroprosthesis, it is recommended to perform these procedures in

ultraclean operating theatres (OT) with air microbial contamination

value not higher than 10 cfu/m3 measured by active sampling or

2 cfu/plate/h by passive sampling. A recent retrospective study