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
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