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Abstracts from the 5th International Conference on Prevention & Infection Control (ICPIC 2019)

Geneva, Switzerland. 10-13 September 2019
Open Access
Meeting abstracts

Slide session: Surgical Site Infection

O1 THE EFFECT OF POSTOPERATIVE CONTINUATION OF ANTIBIOTIC PROPHYLAXIS ON THE INCIDENCE OF SURGICAL SITE INFECTION: A SYSTEMATIC REVIEW AND META-ANALYSIS

S. De Jonge1, Q. Boldingh1, J. Solomkin2, P. Dellinger3, M. Egger4, G. Salanti4, B. Allegranzi5, M. Boermeester1

1Surgery, Amsterdam UMC, Amsterdam, Netherlands; 2Surgery, University of Cincinnati , Cincinnati; 3Surgery, University of Washington, Seatle, United States; 4Institute for Social and Preventive Medicine, University of Bern, Bern; 5Infection Prevention and Control Global Unit, World Health Organization, Geneva, Switzerland
Correspondence: S. De Jonge

Introduction: Surgical antibiotic prophylaxis (SAP) is frequently continued for several days after surgery to prevent surgical site infection (SSI).Continuing SAP after the operation may have no advantage compared to immediate discontinuation and unnecessarily expose patients to risks associated with antibiotic use. In 2016, the World Health Organization (WHO) recommended discontinuation of SAP.

Objectives: We present an update of the evidence that formed the basis for this recommendation.

Methods: For this systematic review and meta-analysis we searched MEDLINE, Embase, CINAHL, CENTRAL, and WHO regional medical databases from Jan 1990 to August 2018 for randomised controlled trials (RCT) comparing the effect of postoperative SAP continuation to its discontinuation. We excluded studies comparing regimens that also differed with regard to dose and agent used, and studies that did not administer the first dose preoperatively by intravenous infusion. We extracted data from published reports and contacted the authors if important information was missing. We combined studies using random effects meta-analysis. We planned subgroup analyses and meta-regression for studies adhering to current standards of practice in SAP.

Results: We identified 83 relevant RCTs. The main meta-analysis included 52RCTs with 19,273 participants. The combined relative risk of SSI comparing postoperative SAP continuation with discontinuation was 0·89 (95% confidence interval: 0·79-1·00). There was little heterogeneity (tau2: 0·001). Subgroup analysis showed that the effectiveness of postoperatively discontinued SAP depends on appropriateness of SAP practices. When SAP best practices (i.e., timely administration of the first dose and redosing when indicated according to the procedure duration) were applied, there was no benefit of postoperative SAP continuation in reducing SSI compared to discontinuation of SAP.

Conclusion: There is no strong evidence for a benefit of postoperative continuation of SAP. These findings support WHO recommendations against this practice. A protocol for this review was registered with at PROSPERO:CRD42017060829.

Disclosure of Interest: None declared

O2 IMPACT OF CLIMATE FACTORS ON SURGICAL SITE INFECTION RATES. DATA FROM 17 YEARS OF SURVEILLANCE IN GERMANY

S. J. S. Aghdassi1, F. Schwab1, P. Hoffmann2, P. Gastmeier1

1Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin; 2Potsdam Institut für Klimafolgenforschung, Potsdam, Germany
Correspondence: S. J. S. Aghdassi

Introduction: Surgical site infections (SSI) are among the most frequent healthcare-associated infections in German hospitals. Besides well-known patient-related and procedure-related risk factors for SSI, a focus has been placed recently on other risk factors, including season and temperature.

Objectives: Our objective was to determine how selected climate factors influence SSI-rates and for which SSI-causing pathogens effects of climate factors are most noticeable.

Methods: SSI-rates were calculated for procedures included in the German SSI surveillance system, which were conducted in the years 2000-2016. The procedures were associated with department- and patient-related data. To investigate the impact of climate factors, data on temperature, precipitation, and other meteorological parameters provided by the German Meteorological Service were utilised. Postcodes were used to match climate data and surveillance data. Due to a high correlation with other climate factors, analyses were executed with a focus on temperature. A descriptive analysis was conducted using chi-squared test. Through multivariable logistic regression adjusted odds ratios (AOR) were calculated for SSI-rates in reference to the mean temperature (both as a categorical and a continuous variable) during the month of surgery. A p-value of <0.05 was considered significant.

Results: Altogether 2,004,793 procedures and 32,118 SSI (13,811 superficial and 18,307 deep) were included. Temperatures ≥20°C were associated with a significantly higher SSI-risk than temperatures <5°C (AOR 1.132). This was observed for SSI caused by gram-positive and gram-negative bacteria. This association was most prominent for superficial SSI with gram-negative pathogens (AOR 1.378). When viewed as a continuous variable, we found that an increase of 1°C in mean temperature resulted in a 0.7% higher overall SSI-risk.

Conclusion: Climate factors influence SSI-rates. Higher temperatures increase the risk of SSI, this effect is especially caused by temperatures ≥20°C which seem to represent a threshold. The expected rise of global temperatures until the end of the century when compared to preindustrial conditions may increase the incidence of SSI and its effect has to be recognised when developing future SSI-prevention strategies.

Disclosure of Interest: None declared

O3 REDUCING STAPHYLOCOCCUS AUREUS SURGICAL SITE INFECTIONS USING AN ANTI-STAPHYLOCOCCAL BUNDLE IN NEW ZEALAND

N. Grae, A. Morris, S. Roberts

1Infection Prevention & Control Programme, New Zealand Health Quality & Safety Commission, Wellington, New Zealand
Correspondence: N. Grae

Introduction: Staphylococcus aureus (S. aureus) is a major cause of cardiac and orthopaedic surgical site infections (SSIs) in New Zealand (NZ). A preoperative bundle to reduce S. aureus SSIs has been implemented in many countries; the evidence supporting this is of moderate quality. A quality improvement (QI) collaborative to develop and implement a preoperative anti-staph bundle to reduce S. aureus SSI rates in target surgical procedures was established.

Objectives: The aim of the collaborative was to implement an anti-staph bundle in different clinical pathways (cardiac and orthopaedic surgery) across numerous hospitals.

Methods: Eight publicly funded and private surgical hospitals were recruited. The ten-month collaborative included three one-day learning sessions, monthly webinars, one-to-one teleconferences, and site visits. The key components of the bundle included pre-operative skin and nasal decolonisation. The choice of agents and method of delivery was at the discretion of the respective teams. Education, auditing, and documentation tools were developed and shared across all teams.

Results: All hospitals fully implemented an anti-staph bundle. The bundle has been applied to over 4,700 procedures; 1977 cardiac, 2732 orthopaedic. Compliance rates for bundle implementation exceeded 95% for all sites. One year post-implementation there has been an overall 49% reduction in S. aureus SSI rates (p-value = 0.004); 38% cardiac (p = 0.076) and 74% orthopaedic (p = 0.006). A decrease in SSI rate [run chart] and standard statistical methods support reduction in the overall S. aureus SSI rate.

Conclusion: Universal preoperative decolonisation reduced the burden of S. aureus SSI in this patient group. The collaborative methodology supported networking and acquisition of QI skills by participants. It also facilitated local adaption of a bundle to suit a hospitals workflow and provided a set of protocols and tools for other NZ hospitals to use.

Disclosure of Interest: None declared

O4 IMPACT OF A BUNDLE INTERVENTION TO REDUCE SURGICAL SITE INFECTION AFTER CRANIOTOMY: A BEFORE-AFTER PROSPECTIVE STUDY

E. Jimenez-Martinez1, G. Cuervo 2, A. Hornero1, P. Ciercoles1, C. Cabellos3, A. Gabarros4, D. Garcia-Somoza5, J. Carratalà3, M. Pujol1

1Infection Control Team; 2Infection diseases; 3Infectious Disease; 4Neurosurgery; 5Microbiology , Bellvitge University Hospital, L'Hospitalet del Llobregat, Spain
Correspondence: E. Jimenez-Martinez

Introduction: Consequences of surgical site infection after craniotomy (SSI-CRAN) can be devastating for both the patient and the health system, given its high morbi-mortality and costs associated.

Objectives: To determine whether the implementation of a surgical care bundle (SCB) is effective to reduce the risk of developing a SSI-CRAN.

Methods: All patients undergoing craniotomy from 2013-2017 were included. Post-discharge surveillance was carried out actively up to 1 year post-surgery. Incidence of SSI-CRAN before and after the SCB implementation was measured. Main SCB measures were: preoperative shower, appropriate hair removal, 1g vancomycin powder in the subgaleal space and a sterile absorbent drape to cover the surgical wound. Given the lack of randomization, a propensity score (PS) matching 1:1 of receiving SCB was estimated.

Results: 1017 patients included, 595 pre-SCB period and 422 SCB period. The overall prevalence of SSI-CRAN in SCB period was lower (15.3%vs.3.5%, p<0.001). For the PS, 421 pairs were matched. Multivariate Cox PS-matched analysis of factors associated with SSI-CRAN found that SCB implementation (AOR:0.23, 95% CI:0.13–0.40; p<0.001) and CSF leak (AOR:3.93, 95% CI:1.11–12.68; p=0.025) were independently associated with this complication.

Conclusion: The implementation of a SCB was effective in reducing the incidence rates of SSI-CRAN in a tertiary university hospital. Hospitals should embrace strategies to increase SCB compliance.

Disclosure of Interest: None declared

O5 MANAGEMENT AND OUTBREAK INVESTIGATION OF SERRATIA MARCESCENS NEUROSURGICAL SITE INFECTIONS ASSOCIATED WITH A CONTAMINATED SHAVING RAZOR USED FOR PREOPERATIVE SCALP SHAVING

E. J. Kim1, W. B. Park2, N. J. Kim2, S. J. Kim1, Y. R. Oh1, W. S. Cho3

1Infection control center, Seoul National University Hospital; 2Department of Internal Medicine, Seoul National University College of Medicine; 3Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea, Republic Of
Correspondence: E. J. Kim

Introduction: Serratia marcescens is an opportunistic pathogen that can cause various healthcare-associated infections. And several sources of outbreaks in hospital have been identified that include contaminated nebulizers, intravenous injection fluids and drugs, disinfectants, and soaps.

Objectives: This study was conducted to identify the source of the outbreak and describe the infection control measures.

Methods: Between October 6 and 21, 2018, 5 SSI cases with S. marcescens occurred in a 1786-bed tertiary care hospital in Seoul, South Korea. Epidemiologic investigation was launched with extensive environmental sampling and screening of healthcare workers and implemented the infection control measures. The whole genome sequencing of environmental samples and patient isolates was used for molecular biological analysis.

Results: During the outbreak periods, a total of 43 neurosurgical operations performed and 5 cases (11.6%) developed SSIs. S. marcescens was isolated from cerebrospinal fluid, wound, pus, tissue and blood. These patients were located in different wards, and their operations were performed by different surgeons in different operative room. 2 patients were adults and 3 patients were pediatrics. But they all took a preoperative scalp shaving on a barbershop in the hospital. Among the 387 surveillance samples, S. marcescens were detected on 2 shaving brushes and 4 razors that had been used to shave multiple patients’ hair before surgery. And the phylogenetic analysis using whole genome sequencing revealed close clustering among isolates from the razors and the 4 patients.

An infection control team recommended to stop using the razors in barbershop, ward or operating room and to let trained doctors or nurses shave scalps using disposable clippers for surgery. The outbreak ended after implementing this infection control measures.

Conclusion: This study found microbiological and epidemiological evidence that contaminated razors in barbershop were the source of this outbreak. As recommendations in many guidelines, proper hair removal using the disposal clippers before surgery is very important for preventing SSIs.

Disclosure of Interest: None declared

O6 BARRIERS AND FACILITATORS TO IMPLEMENTING A BUNDLED INTERVENTION TO PREVENT S. AUREUS SURGICAL SITE INFECTIONS (SSI) AMONG CARDIAC AND ORTHOPEDIC SURGERY PATIENTS: WHY DID IT WORK BETTER FOR ORTHOPEDIC SURGERIES?

M. Schweizer1, S. Hockett-Sherlock2, E. Perencevich1, C. Goedken1, L. Herwaldt2, H. Reisinger2

1Iowa City VA Hospital; 2University of Iowa, Iowa City, United States
Correspondence: M. Schweizer

Introduction: In a prior multicenter study, we implemented an SSI prevention bundle including: 1) S. aureus nasal screening, 2) chlorhexidine (CHG) bathing, 3) mupirocin decolonization for S. aureus carriers, 4) vancomycin & cefazolin prophylaxis for methicillin-resistant S. aureus (MRSA) carriers, & cefazolin for all others. The intervention decreased rates of complex S. aureus SSI by 42%. The decrease was larger for orthopedic compared with cardiac surgery patients.

Objectives: When expanding implementation to additional hospitals, we aimed to identify barriers & facilitators to bundle implementation.

Methods: This bundle was implemented in 11 US Veterans Affairs (VA) hospitals. Individual & group semi-structured interviews were conducted before implementation (7/2014 - 9/2014) & during/after implementation (1/2017 - 12/2017) of the bundle at 6 VA hospitals. We interviewed hospital epidemiologists, infection preventionists, surgeons, case managers, & lab directors/staff. Transcripts & field notes were analyzed for thematic content.

Results: 56 employees were interviewed before implementation & 51 were interviewed during/after implementation. Interviewees stated that most orthopedic patients had a pre-operative clinic visit within 30 days before surgery. At hospitals with rapid PCR testing, S. aureus screening was performed at the beginning of the clinic visit so that the results were known before the patient left the clinic. Thus, the patient could be sent home with mupirocin & CHG as needed. However, cardiac surgery patients did not have standardized clinic visits before surgery. Cardiac surgery patients recovering from angiography might be screened for S. aureus but were discharged before instructions for use of mupirocin or CHG could be provided. This intervention was most successful when a nurse championed the bundle. A barrier was that nurses were not allowed to directly order mupirocin for patients. Requiring physicians to order mupirocin & CHG was a barrier to implementation.

Conclusion: Decolonization agents that do not require patients to be screened for S. aureus or do not require prescriptions could improve implementation for cardiac surgery.

Disclosure of Interest: M. Schweizer Grant/Research support from: PDI Healthcare, S. Hockett-Sherlock: None declared, E. Perencevich: None declared, C. Goedken: None declared, L. Herwaldt: None declared, H. Reisinger: None declared

Innovation Academy - The pitch

I1 MOTION DETECTION AND ARTIFICIAL INTELLIGENCE IN THE AUTOMATIC DOCUMENTATION OF KEY FIGURES FOR HAND HYGIENE COMPLIANCE

E. Khaljani, MBA, S. C. Slama, T. Ebeling

HygNova GmbH, Berlin, Germany
Correspondence: E. Khaljani

Introduction: Direct observation is the gold standard in the detection of hand hygiene compliance, although known biases influence quality of data. In this study, data of motion detection sensors was examined with mathematical algorithms to assess the value of improved technological opportunities in hand hygiene monitoring.

Objectives: The goal of the study was to detect four properties concerning relevant parameters for hand hygiene monitoring in a laboratory setup:

1. Are patients’ beds occupied by patients or not?

2. If patients are present, is it possible to observe direct contact of healthcare professionals (HCPs) with patients as a surrogate for a moment of hand hygiene?

3. Can information be gathered without wearable devices?

4. Can data be gathered without personalization of patients and healthcare professionals?

Methods: Motion detection sensors were mounted over patients’ beds. Presence of patients and the treatment of healthcare professionals were recorded in an operationalized setup. 67 recordings took place which lasted between 2 to 5 minutes. In some recordings, there were duplications of observed cases (bed occupied and direct contact with patient). When HCPs were closer to patients than 10 cm, direct contact was noted. No wearable devices were used to gather data.

Data was analyzed with an algorithm, which was developed for the purpose of the study. Direct observation took place simultaneously to the recordings to validate the results of the algorithm.

Results: In 53 recordings, the presence of the patient in the bed had to be defined. In 52 out of 53 recordings, the presence of the patient could be detected (98,1% of cases compared to 100% by direct observation). There was one false negative case.

In 26 recordings, direct contacts of HCPs were examined. In all 26 cases, direct contacts of HCPs could be determined (100% compared to 100% by direct observation).

In no case patients’ or HCPs could be identified out of the recorded data (0% compared to 100% by direct observation). No wearable devices had to be used in the study.

Conclusion: The results show that algorithmic analysis of motion detection data can lead to information which can be used in the evaluation of hand hygiene compliance. Further studies will be necessary to identify if Artificial Intelligence can detect the 5 moments of hand hygiene out of motion detection data with an acceptable deviation.

Disclosure of Interest: E. Khaljani, MBA Shareholder of: The author is a shareholder of the HygNova GmbH which uses motion detection technology to approximate the 5 WHO moments of hand hygiene in hospitals., S. Slama Shareholder of: The author is a shareholder of the HygNova GmbH which uses motion detection technology to approximate the 5 WHO moments of hand hygiene in hospitals., T. Ebeling Shareholder of: The author is a shareholder of the HygNova GmbH which uses motion detection technology to approximate the 5 WHO moments of hand hygiene in hospitals.

I3 SMARTRUB®: A NEW ELECTRONIC DEVICE TO MEASURE AND PROVIDE INDIVIDUAL FEEDBACK OF THE QUALITY OF HAND HYGIENE ACTION

Y.-A. Robert1, S. Fourquier2, Y. Martin1,3, D. Pires3, C. Guitart3, R. Beuchat2, D. Pittet3

1iQati, Rolle; 2hepia; 3IPC program, Genève, Switzerland
Correspondence: Y.-A. Robert

Introduction: We developed a unique electronic device, “SmartRub® powered by iQatiTM” (SmartRub®), designed to educate and monitor the quality of individual hand hygiene (HH) actions by HCW during routine patient care. The device measures both the duration and volume of alcohol-based handrub (ABHR) used during each HH action, and provides the HCW with real-time feedback (FB).

Objectives: Measure and improve HH quality through individual FB

Methods: SmartRub® is composed of an electronic wristband and an electronic cylinder inserted into a pocket-sized ABHR dispenser. Each HCW has their own designated device. A vibration is activated in the dispenser when the HCW reaches the targeted ABHR volume customized to their hands’ surface, giving HCW FB on the volume. A vibration activated in the wristband after a defined time following the start of the HH gesture, giving HCW FB on the duration of the action. The FB can be fully parametrized, including being activated or not. SmartRub® is compatible with both rinse and gel ABHRs.

Results: To assess the precision of the measures, 5 HCWs performed 2200 ABHR uses and 70 HH friction gestures. The error on the volume measurement averaged -0.02 + (SD) 0.1 mL and the error on the duration -0.1+ (SD) 1.4 sec. SmartRub® was tested in a tertiary hospital for its ability (sensitivity/specificity) to detect HH actions in: (a) laboratory conditions, (b) a simulated path in a clinical ward, and (c) real-life conditions in a clinical ward (overall sensitivity to detect “true” HH actions, 96.8%; specificity, 98.3%). The effect of SmartRub® has been demonstrated in a clinical trial; the quality of the HH gestures improved when FB was used: the average volume of ABHR used increased from 1.4 mL to 2.1 mL and duration of friction increased from 9.3 to 11.1 sec. SmartRub® acceptability was tested among HCWs; the majority found it easy to use and useful; half of them affirmed its use made them change their HH behaviour.

Conclusion: SmartRub® allows HCWs to know in real-time whether the quality of their HH action is appropriate in terms of volume of ABHR used and duration of friction. It encourages them to improve their own performance continuously, thus helping to implement behavior change.

Disclosure of Interest: None declared

I4 EFFECTIVENESS OF WHATS APP IN PROMOTING HAND HYGIENE AWARENESS PLEDGES AMONG HEALTH CARE PERSONALS IN INDIA

D. Sureshkumar1, S. Saravanakumar2, J. Hemalatha3

1Infectious Diseases, Best of IDs, Chennai; 2Medicine, KMC Manipal, Mangalore; 3Pharmacy, Best of IDs, CHENNAI, India
Correspondence: D. Sureshkumar

Introduction: Infection prevention and control organizations encourages health care personals(HCPs) to take a pledge on infection prevention topics such as hand hygiene (HH) to create awareness & actively engage them in infection prevention. Social networking services like WhatsApp are increasingly used by HCPs and organizations to share medical knowledge and to disseminate health information to wider HCP community. However, research is limited on the effectiveness of WhatsApp in promoting HH awareness pledge among HCPs.

Objectives: Our objective was to evaluate the effectiveness of WhatsApp in promoting HH awareness pledge among HCPs.

Methods: This observational study was conducted from May 5 to May 19, 2019 among HCPs belonging to randomly selected different WhatsApp networks operating from India with majority of members engaged or working in Indian health care industry. In the first part of study from May 5 to May 12 education on hand hygiene and the importance of promoting hand hygiene within health care were circulated daily. In the second part from May 12 to May 19, members were encouraged to take HH pledge with periodic daily remainders. The rate of HCPs taking HH awareness pledge was calculated in percentage and reasons for not taking HH pledge were analyzed.

Results: 1111 HCPs belonging to nine WhatsApp networks participated in this study. Majority (718/1111, 3/9 Groups) of the members were belonging to physicians WhatsApp groups. The effectiveness of HH awareness pledge were highest among Infectious disease (ID) physicians (13/23, 56.52%) group followed by hospital based groups (38/115, 28.14%) & Clinical microbiologists (50/187, 26.73%). The HH WhatsApp awareness pledge campaign failed to create awareness among ID trainees and physicians networks in this study.

Conclusion: The effectiveness of WhatsApp networks HH awareness pledge campaign was 13.27% (129/972) among different HCPs WhatsApp groups in India. The reasons for high acceptance to HH awareness pledge in certain groups and failure to create awareness in other groups need to be analyzed in detail to identify ideal WhatsApp networks for future infection control & HH awareness campaigns.

Disclosure of Interest: None declared

I5 SMART MONITORING OF HAND HYGIENE

T. Gebhardt

GWA Hygiene, Stralsund, Germany
Correspondence: T. Gebhardt

Introduction: We believe that monitoring the hand hygiene behavior should be done automized and objectively. These characteristics have been considered during the development of the hand hygiene monitoring "NosoEx".

Objectives: It is the overall goal to reduce hospital-acquired infections. Since our hands are the transmission path number one for germs awareness for hand hygiene must be increased. Direct feedback to healthcare workers is essential because they often overerstimate themselves or do not feel addressed during hygiene trainings. Consequently, NosoEx provides data about the status quo and the development of the hand disinfection numbers over time. This data can be divided into job groups like doctors, nurses and therapists. Ultimately, hygiene trainings can be performed more directly.

Methods: Every existing dispenser model (wall dispensers, point of care dispensers, individual bottles of hand rub) can be upgraded with NosoEx sensors. Moreover, every healthcare worker gets a badge that can be worn at the clothing. The badges have different colors that represent the job groups. Associated with that, the compliance with data protection laws and work councils is ensured. In addition to that, all collected data is visualized in a user-friendly software. There the hospital ward map is digitized and the position of dispensers are shown. Consequently, additional key figures like filling level and use frequency can be seen for every dispenser.

Results: Our client "Hospital Lüneburg" increased the disinfectant use by 35% after NosoEx has been installed. This was important because the selected wards have been under average. Moreover, data patterns have been identified. For example, the use of dispensers on the corridor has been much higher than the use of dispensers in the patient room. The recommendation was that this area of the ward should be analyzed more deeply during the compliance observation. In addition to that, the NosoEx system has been recognized that certain job groups did not reach the minimum amount of 3ml per disinfection. Followed by that, trainings about the correct hand disinfection have been realized.

Conclusion: Hand hygiene monitoring solutions have to be seamlessly integrated into the infrastructure of the hospital and into the job routines of the healthcare workers. Direct feedback with job-group related data can be more sustainable. Moreover, providing the data automized might reduce the workload of data analysis that is done by infection control officers.

Disclosure of Interest: None declared

I6 DEVELOPMENT OF 1,3,5-TRIAZINE–PYRAZOLE AS EFFECTIVE HAND-WASH WITH POTENT ANTIBACTERIAL ACTIVITY

U. P. Singh

Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology & Sciences, Allahabad, India
Correspondence: U. P. Singh

Introduction: Hands are the most vulnerable part of body involved in the transmission of microbes and infections. Therefore, hand hygiene is the most crucial step to prevent further transmission of germs, and bacterial organisms to prevent the infections.

Objectives: The present study was conducted to evaluate the efficacy and antibacterial activity of 1,3,5-triazine–pyrazole as hand sanitizer.

Methods: The compound was developed as hand-wash using surfactant and tested for antibacterial efficacy, viz. zone of inhibition (ZOI) against Staphylococcus aureus, Salmonella, and Escherichia coli using dip well Agar Diffusion Technique. Antioxidant activity (DPPH assay) was also conducted to determine the effect on oxidative stress. The product was subjected to storing at different temperature conditions like 40 ̊C, 25 ̊C & 37 ̊C for 4 weeks for stability testing. The effect of active ingredient of hand-wash was evaluated for inhibition of DNA Gyrase via molecular docking with 3D crystal structure of DNA Gyrase enzyme.

Results: The formulated compound showed excellent antibacterial activity tested organism with ZOI with lowest against E. Coli (1.2 mm) and widest against S. aureus to 4.3 mm, with MIC= 3 - 34 μg/ml against tested organism. The hand-wash showed excellent inhibition of oxidative stress with 87.32%. The compound showed excellent inhibition of DNA Gyrase enzyme via interacting with Glu58 and Ile186 of DNA Gyrase with Ki = 12.34 μM. The hand-wash was found to significantly stable over the period of tested duration, in indicated by no change in color and no phase separation.

Conclusion: The developed 1,3,5-triazine-pyrazole hold promise for prospective hand-sanitizer due to excellent antibacterial activity.

Disclosure of Interest: None declared

I7 A NOVEL OPEN-SOURCE INNOVATION FOR HAND-HYGIENE MONITORING AND COMPLIANCE USING INTERACTION DESIGN (ID): CAPACITY FOR GLOBAL SCALING UP INTERNET OF THINGS (IOT) TECHNOLOGY

M. J. Blaak1, R. DiMaio1, R. Sweetzir2, C. Betuzzi3, J. Vayalumkal3, C. Dowler3, K. McIntyre3, J. Kaufman1, J. Kupis1, J. Conly1,3, G. Hallihan1

1W21C, University of Calgary, Calgary; 2Cisco Systems, Edmonton; 3Alberta Children's Hospital, Alberta Health Services, Calgary, Canada
Correspondence: M. J. Blaak

Introduction: We demonstrated that interactive, real-time visualizations (RtV) of alcohol-based rub (ABR) dispenser Frequency of Use (FoU) could improve hand hygiene compliance (HHC).1 ABR dispensers, with added sensor technology, allowed FoU transmission to visualization platforms visible to staff and patients.

Objectives: Create an open-source, low cost, scalable solution with improved reliability, capable to integrate with enterprise networks. We sought to extend RtV capabilities, develop administrative dash-boards of aggregate data, enhance performance, and improve battery life.

Methods: An iterative design process was used, with a multidisciplinary team of engineers, physicians, infection control professionals, and human factors specialists in a pediatric hospital unit (PHU). A 16-week trial was set-up to evaluate: 1) HHC and FoU with and w/o RtV, 2) hardware/software performance and 3) maintenance burden.

Results: We created a modular network of smart ABR dispensers, using local Wi-Fi network and a MQTT messaging protocol. The current iteration has 11 unique ID pediatric themes (e.g., dinosaurs, animals) for RtV. Data dashboard implementation was achieved and is accessible on any device (IoS, Android, Hospital Network) capable of achieving IoT capability. Independence of the innovation will be assessed by its ability to be maintained by the PHU team without technical assistance. Preliminary data shows trends of increased use of ABR dispensers when RtV is present.

Conclusion: We have created an open source, extensible, IoT ready innovation, which can be scaled to a health system’s network and context, at a fraction of the cost of commercially available systems offering similar functionality, making the innovation inclusive to low- and middle income countries. This low maintenance innovation allows for modular growth within established IT networks. Further development has the potential to expand on the utility of the data captured and promote the use of ABR dispensers. All documents relating to the innovation are publically available on GitHub.

References

1. Kupis, J, et al. Abstracts from ICPIC 2017. ARIC 2017, 6(Suppl 3):O22

Disclosure of Interest: None declared

I8 POLYMER METALLISATION VIA COLD SPRAY AND 3D PRINTING FOR THE MITIGATION OF NOSOCOMIAL INFECTION TRANSMISSION

M. D. I. Lucas1, I. Botef1, S. van Vuuren2

1Faculty of Engineering and the Built Environment, School of Mechanical, Industrial and Aeronautical Engineering; 2Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Correspondence: M. D. I. Lucas

Introduction: Touch-contact transmission of pathogens promotes the aggressive spread of nosocomial infections. Additive manufacturing (AM) techniques and metals with known antimicrobial properties may offer a complementary solution to current disinfection practices.

Objectives: To characterise the antimicrobial activity of AM developed coatings to combat nosocomial infection transmission.

Methods: Polymer metallisation via cold spray and 3D printing was used to develop various copper, silver and zinc coatings. Two independent, in vitro assays were conducted using the prevalent pathogens: Staphylococcus aureus (ATCC 25923), Enterococcus faecalis (ATCC 29212), Pseudomonas aeruginosa (ATCC 27853), Klebsiella pneumoniae (ATCC 13887) and a yeast Candida albicans (ATCC 10231); as well as the associated resistant strains: gentamicin-methicillin-resistant S. aureus (ATCC 33592), P. aeruginosa (DSM 46316) and a clinically resistant C. albicans. A diffusion assay evaluated coating efficacy based on the extent of inhibition zones, while an adapted time kill assay simulated pathogenic exposure via touch-contact in a dry environment, evaluating the rate of antimicrobial efficacy.

Results: Effective, particle-embedded, cold spray coatings were achieved. Against standard pathogens copper-zinc blended coatings exhibited synergistic activity under diffusive test conditions; while under touch-contact conditions copper coatings repeatedly achieved complete microbial elimination within a 15 min. exposure period on polymer substrates and within 7 min. on copper substrates. The addition of 5wt% silver to the latter coating brought microbial elimination down to just 5 min., against the resistant pathogens. Copper metal, in comparison, achieved 92.9% and 85.4% microbial reduction for each respective pathogen type over 3 hrs.

Conclusion: The innovative and adaptable surface coating technology showed enhanced antimicrobial activity and so, its potential use for the mitigation of surface contact transmission of infections was confirmed.

Disclosure of Interest: None declared

I9 OZIRES: AN EX-TOY ROBOT THAT BECAME A PROFESSOR WHO TEACHES HEALTHCARE WORKERS HOW, WHEN, AND WHY WASH THEIR HANDS

B. Couto1, I. Oliveira2, B. Mendes2, M. Nogueira3, M. Peixoto3, M. Vrandecic3, C. Starling4

1Biobyte Sistemas Ltda; 2UniBH; 3Biocor; 4Infection Control Ltda, Belo Horizonte, Brazil
Correspondence: B. Couto

Introduction: We are a team that fights against nosocomial infections. We always argued why people don’t wash their hands! One such answer was that washing hands is so unsophisticated gesture, without any technology, that people just don't do it. So, we imagine a robot in our team, to help healthcare workers clean their hands. But, how to do that, they were so expensive! Then, in 2017 we met a US$ 200 toy robot (http://www.meccano.com/meccanoid-about): 122 cm tall programmable humanoid robot with voice commands.

Objectives: a) How to adapt a toy robot to be an instrument of health training and continuous education of healthcare workers? b) What is the effectiveness of the use of the robot on the compliance with hand hygiene?

Methods: After some adaptations, the robot has changed! We gave him a name (Ozires), a spy camera, a better audio system, an alcohol gel dispenser, a mini-projector, and a purpose: the ex-toy robot became a Professor involved with hand hygiene campaigns. The mini projector allows video lessons even in small rooms. Ozires, accompanied by infection control practitioners, performs short video-lecture presentations and own reports of the institution's data regarding infections and the hand hygiene rate, working from 10 to 15 minutes in each target sector.

Results: After the insertion of Ozires in Hospital A, hand hygiene rate increased from about 36%, between January and July, to 65% after August/2016. Hospital B: Ozires started his lectures in May/2018. Hand hygiene adherence increased from about 23%, between July-Dec/2017, to 60% after July/2018.

Conclusion: We succeeded in adapting a toy robot as training instrument of healthcare workers, creating a new education tool, a robot tutor. Hand hygiene compliance raised significantly after the intervention in both hospitals. Now, we are working in how to change the robot processor to another one like Raspberry Pi to connect him to an artificial intelligence like IBM Watson. One day... one dream: Ozires participating of antimicrobial stewardship!

Disclosure of Interest: None declared

I10 DOES THE APPLICATION OF A SILICON DIOXIDE NANOCOATING FACILITATE THE CLEANING IN PATIENT ROOMS?

D. Jouck1, K. Magerman1,2, L. Waumans1,2, A. Forier1, M. Blommen1

1Department of Infection Prevention and Control; 2Clinical Laboratory, Jessa Hospital, Hasselt, Belgium
Correspondence: D. Jouck

Introduction: In recent years, more attention has been paid to the importance of the environment in the transmission of micro-organisms from one patient to another. Applying a silicon dioxide (SiO2) nanocoating, with particles ≤1 millionth of a millimeter, could facilitate the cleaning of surfaces by making the surface antistatic and hydrophobic, preventing water and dirt from adhering.

Objectives: This study aimed to determine whether nanocoated patient rooms with SiO2 achieve better cleaning results compared to non-coated patient rooms.

Methods: After a thorough cleaning, a SiO2 nanocoating was applied to different surfaces of two patient rooms. Among other things, parts of the floor, bedside table, toilet flush button, toilet seat, medical trolley and light switch were provided with a SiO2 nanocoating. In order not to influence the cleaning results, the cleaning staff were not informed about which rooms were coated. The SiO2 nanocoating itself was also invisible to the naked eye.

One week, 4 weeks and 12 weeks after applying the SiO2 nanocoating, the surfaces on the coated and uncoated patient rooms were checked by 2 measuring methods. First, the degree of contamination of the surface was determined by means of ATP measurements (Hygiena Ultrasnap™ for surface tests in combination with a Hygiena systemSURE II device). The result was expressed in relative light units (RLU). Subsequently, a determination of the total aerobic bacterial count was performed by sampling with a non-selective nutrient medium (RODAC™). This result was expressed in the number of colony forming units (CFU).

The measurements and sampling were always carried out immediately after the final cleaning when the patient was allowed to leave the hospital.

Results: A total of 206 measurements were made. The results of the coated patient rooms were not significantly different from the patient rooms where no SiO2 nanocoating were applied (chi squared test, p = .379 for CFU and p = .204 for RLU).

Conclusion: The added value of applying the SiO2 nanocoating could not be demonstrated in this study. However, this needs to be further investigated, before general conclusions are drawn.

Disclosure of Interest: None declared

Slide session: Burden of healthcare-associated influenza

O7 SEASONAL NOSOCOMIAL INFLUENZA INFECTION: A PROSPECTIVE 13 YEARS SURVEILLANCE AMONG PATIENTS AND HEALTHCARE WORKERS IN LYON, FRANCE

L. Henaff1, V. Escuret2, P. Vanhems1,3

1Laboratoire des Pathogènes Emergents, Epidémiologie et Santé Internationale UMR_S1111, UMR5308, Centre International de Recherche en Infectiologie; 2Laboratoire de virologie, Groupement Hôpitaux du Nord; Centre National de Référence des virus des infections respiratoires; 3Service Hygiène, Epidémiologie et Prévention, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
Correspondence: L. Henaff

Introduction: Whereas the incidence of seasonal influenza infections in healthcare settings is underestimated, the risk of Nosocomial Influenza (NI) outbreaks is real.

Objectives: The objective of this prospective surveillance study was to describe epidemiological characteristics of patients and healthcare workers (HCWs) with Influenza Like Illness (ILI) and compares NI and community-acquired influenza (CAI) over 13 influenza seasons.

Methods: Patients and HCWs were included during influenza seasons (October-April 2004-18) in 46 wards (medicine, surgery, geriatric), in a 1000 beds hospital (Edouard Herriot university-affiliated Hospital, Lyon). A nasal swab was obtained and analyzed by reverse transcriptase polymerase chain reaction in order to detect influenza viruses. An ILI case was defined as temperature ≥37.8° C without prior use of antipyretics, and/or cough or sore throat. A NI was considered if symptoms appeared at least 72 h after admission while CAI was defined if symptom onset until 24 h after admission.

Results: Overall, 837 patients and 274 HCWs were included. 76.9% of ILI patients were hospitalized in geriatric ward, 20.9% in medical ward and 2.2% in surgical ward. Baseline characteristics of these patients were different according to the hospitalization ward. The sex ratio was 1.25 in surgical vs 0.52 in geriatric ward. Influenza vaccine coverage was 55.4% in geriatric vs 27.8% in surgical ward.

A total of 247 people (22%, 188 patients, 59 HCWs) were influenza laboratory-confirmed. Among patients, 59 (31.4%) had NI with a median symptom onset of 12 days; 18.6% presented their symptoms 3 to 5 days after admission and 16.9% between 46 and 71 days. Influenza vaccine coverage among NI cases was 37.9% vs 42.9% for CAI cases. All-cause mortality rate was 3.4% in NI cases vs 3.6% in CAI cases.

Conclusion: The results demonstrated the importance of implementing surveillance of influenza in hospitals to estimate the proportion of NI and to emphasize the need to improve infection control measures implementation and vaccine use for high-risk patients and HCWs.

Disclosure of Interest: None declared

O8 HOSPITAL-BASED SURVEILLANCE OF INFLUENZA IN SWITZERLAND – A PILOT STUDY

A. Iten1, A. Thiabaud2, N. Troillet 3, L. Senn4, D. Flury5, S. Kuster6, C. Balmelli7, C. Gardiol8, L. Kaiser9, O. Keiser2

1Infection Control, HUG; 2Institut de Santé Globale, Université de Genève, Geneva; 3Institut Central , Hôpital du Valais, Sion; 4Centre Hospitalier Universitaire du Canton de Vaud, CHUV, Lausanne; 5Kanstonspital Sankt Gallen , Sankt Gallen; 6Universitätsspital Zürich, Zürich; 7Ente Ospedaliero Cantonale, Bellinzona; 8Office fédéral de la santé publique, Bern; 9Maladies infectieuses, HUG, Geneva, Switzerland
Correspondence: A. Iten

Introduction: Until 2018, the national reporting system for influenza in Switzerland was twofold with: 1) voluntary reports of influenza-like illness (ILI) by selected primary care clinicians. 2) weekly reports of laboratory-confirmed cases. No national surveillance system existed for hospitals. With support from the Federal Office of Public Health (FOPH), we developed a pilot study for hospital-based influenza cases in Switzerland.

Objectives: To test the computerized system developed for influenza surveillance in Swiss hospitals

Methods: Three university hospitals and three cantonal hospitals participated. Data collection followed WHO recommendations using a standardised questionnaire (demographic data, information on the influenza episode, optional information about the patient’s health). Data are collected by study team of the participating sites in a secure REDCap database. Data quality checks and descriptive analyses were done weekly, and results were reported back.

Results: From 01.11.2018 to 24.05.2019, 1705 cases of influenza were announced. Site 3 declared 34.7% of cases, Site 4 16.8%, Site 6 15.5%, Site 2 14.7%, Site 5 12%, and Site 1 6.3%. The Influenza epidemic started during the week 2018-47 in Western Switzerland, and three to four weeks later in other sites. Most patients were old adults (67.2% over age 65). The majority of cases (98.5%) was due to Influenza A; Influenza B was reported in 24 patients. Most cases were diagnosed in medicine (51.3%) and geriatrics (11.5%). The proportion of nosocomial cases was 30% during the beginning of the season, and decreased to 20% in recent weeks, with variation between sites.

Conclusion: Our pilot system allowed us to get a better understanding of the morbidity and spread of severe influenza cases in Switzerland. Simplification of the questionnaire, direct import of existing data, automated analysis, and additional tools for epidemic management will help to reduce the workload and ensure that all data are entered in time. Inclusion of other hospitals is needed.

Disclosure of Interest: None declared

O9 STUDY ASSESSING THE BURDEN OF INFLUENZA IN NURSING HOMES RESIDENTS WITH INFLUENZA-LIKE ILLNESS DURING 2016-2017 AND 2017-2018 INFLUENZA SEASON

L. Qalla-Widmer, D. Héquet, C. Petignat

Unité cantonale HPCI Vaud, Lausanne, Switzerland
Correspondence: L. Qalla-Widmer

Introduction: Influenza is a significant cause of morbidity and mortality in elderly. They are at high risk of complications after influenza virus infection. Data on the epidemiology of influenza within nursing homes (NH) are limited.

Objectives: The purpose of this prospective study was to better describe the burden of influenza among residents of NH of canton of Vaud, Switzerland, with influenza-like illness during 2016-2017 and 2017-2018 influenza seasons.

Methods: First, we determined the proportion of influenza-like illness due to influenza in NH residents. We specifically assessed the impact of a positive influenza PCR on clinical features, morbidity and mortality, 30 and 90 days after diagnosis, as compared to a negative influenza PCR. Moreover, influenza vaccination rates of the residents and the healthcare workers within each nursing home were assessed at the end of each influenza season.

Results: A PCR test was performed on 509 residents from 61 NH. 227 influenza virus infections were diagnosed; 181 influenza A and 46 influenza B. Compared to residents without influenza virus infection (IVI), residents with IVI were more often feverish with a high fever (69.1% and 88.5% respectively, p<0.0001) are significantly more frequently hospitalized within 30 days after diagnosis (17.6 % vs 7.1%, p=0.0003). Any cause mortality at 30 days was similar in both groups (12.8% vs 10.6%, p=0.48). Only 18.1% of IVI residents were treated with an antiviral and 60.4% of them received antibiotics. Influenza vaccination rates of the healthcare workers and residents were respectively 50% and 82%.

Conclusion: During influenza season, the feverish residents should be suspected to have influenza virus infection. Residents should be diagnosed (PCR) and treated with an antiviral where appropriate to limit the risk of hospitalization. Healthcare workers should be encouraged to be vaccinated against influenza in order to acquire a better herd immunity within the NH which will limit the spread of influenza.

Disclosure of Interest: None declared

O10 HEALTH-CARE ASSOCIATED INFLUENZA PREVENTION PROJECT (HAIP): FIRST MULTICENTER SURVEILLANCE RESULTS (NOSOCOMIAL INFLUENZA AND PREVENTION MEASURES

D. Flury1, J. Notter1, R. Kuhn1, D. Nicca2,3, M. Schlegel1 on behalf of HaIP-Team

1Division of Infectious Disease and Infection Control, Kantonsspital St.Gallen, St.Gallen; 2Institut of Nursing Science , University Basel; 3Ressort Pflege/MTT, University Hospital Basel, Basel, Switzerland
Correspondence: D. Flury

Introduction: Widely accepted definitions in the area of influenza prevention measures on a hospital level are sparse but urgently needed to compare data between hospitals.

Objectives: The Health-care associated Influenza Prevention Project (HAIP) is a multicentre project aiming to i) evaluate the burden of nosocomial influenza and the adherence with preventive measures and ii) measure the effectiveness of a complex prevention intervention. Here we present outcomes on nosocomial infection and adherence to preventive measures of two influenza seasons 2017-18 and 2018-19.

Methods: A manual with definitions for nosocomial influenza, adherence measurements for patient isolation, vaccination rate, antiviral treatment, hand-hygiene, wearing masks and cough etiquette was developed, tested at a pilot hospital and rolled out after education and teaching in 4 additional (1private, 3public) secondary and tertiary hospitals in German-speaking Switzerland (145’929 admission/year.) Quality control was done for hand-hygiene adherence (interobserver variability) and for influenza diagnosis (sensitivity and specificity for testing) by a point prevalence study on selected wards.

Results: Rates of nosocomial infection overall in the two season were 2.02/10000 respective 2.32/10000 patient-days during influenza season and 1.24/1000 respective 1.44/1000 admissions during influenza season. Rate of isolation 98% (interhospital range (IR) 91-100%)in the first, and 99% (IR 91-100%) in the second season, antiviral treatment 55% (IR 23-96%) respective 76% (IR 33-100%); adherence with hand-hygiene was 76% in both season, adherence with cough etiquette overall 87% in both season, adherence with mask wearing 96% in the first and 92% in the second season, vaccination rate overall was low in both season. Quality control data showed an interobserver variability of 66% (95%CI 60-72%) and accuracy of influenza-diagnostic showed a sensitivity of 81% and a specificity of 94%.

Conclusion: A harmonised influenza-surveillance is feasible but needs precise instructions, teaching/manual and a regular feedback. Differences in nosocomial infections depend on influenza season due to the virus itself but also on the extend of surveillance and the application of the influenza-protection measures.

References

Disclosure of Interest: None declared

Slide session: Social aspects in infection control implementation

O11 SOCIAL NETWORK ANALYSIS ON THE INFLUENCE EXERTED BY CHANGE AGENTS TO DIFFUSE FAVOURABLE HH BEHAVIOUR IN A DEVELOPING COUNTRY

Y. F. Lee1,2, W. Zingg3, M. McLaws4, L. M. Ong5, S. A. Husin1, H. H. Chua6, S. Y. Wong6, D. Pittet3

1Ministry of Health, Kuala Lumpur, Malaysia; 2Institute of Global Health, Geneva University; 3Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; 4School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia; 5Clinical Research Centre & Department of Medicine, Penang; 6Sarawak General Hospital , Kuching, Malaysia
Correspondence: Y. F. Lee

Introduction: Based on the Diffusion of Innovation Theory, we hypothesised that peer-identified as change agents (CAs) were early adopters who would act as role models to improve hand hygiene (HH) compliance through their social network.

Objectives: To explore the different influence for favourable HH behaviour exerted by peer-identified CAs and management-selected change agents (MSCAs), and desirable attributes of HH leadership within a social network.

Methods: The intervention was conducted in two acute medical wards at Sarawak General Hospital, Malaysia; one with peer-identified CAs, and one with MSCAs. The primary outcome was HH compliance. The secondary outcomes measured (i) desirable HH leadership attributes using questionnaires (ii) opinion of ward staff towards peer-identified CAs and MSCAs through question & answer sessions, and (iii) social network connectedness of healthcare workers (HCWs) for HH improvement using NodeXL Pro software.

Results: Both wards achieved more than 10 percentage point improvement in HH compliance. Healthcare workers on both wards believed ‘strictness’ was the most desirable attribute of HH leadership. Healthcare workers reported peer-identified CAs led by example while MSCAs were authoritative. The distance between HCWs seeking HH advice from their nominated leaders (NLs) were two individuals. Ties between all HCWs were low, and nominations between HCWs to a NLs were low on both wards. Years of working experience of the top five most powerful NLs on both wards were similar.

Conclusion: Leadership by peer-identified CAs achieved equally improved HH as MSCAs lead wards and were regarded as early adopters. Close connectedness of staff with NLs, low ties and low nominations between individual HCWs suggests both wards have a hierarchical organisational structure. The closeness of HCWs with their leaders is common in hierarchical leadership structures, as was the preference on both wards for strict role models, possible reflecting local cultural norms.

Disclosure of Interest: None declared

O12 PATIENT PARTICIPATION IN HEALTHCARE WORKERS’ HAND HYGIENE AUDIT: AN EXPLORATORY STUDY

L. Côté1,2, M. C. Gallani3,4, Y. Longtin5

1Infection prevention and control service, Institut universitaire de cardiologie et de pneumologie de Québec; 2Faculty of Medicine; 3Faculty of Nursing, Université Laval; 4IUCPQ-UL Research Center, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec; 5Faculty of Medicine, McGill University, Montréal, Canada
Correspondence: L. Côté

Introduction: Hand hygiene (HH) is the most important measure to prevent hospital-acquired infections. Audit of HH practices is a key step towards its improvement. The World Health Organization suggests that patients can perform HH audit, but few studies have explored this avenue.

Objectives: Exploratory study among bariatric surgery patients in a tertiary care institute in Québec (Canada) to explore: 1) the feasibility of involving patients to audit healthcare worker’s (HCW) HH practice “before contact with the patient or their environment” (acceptance, competence, performing the behavior), 2) psychosocial variables associated with auditing behavior, and 3) patient-auditors experience.

Methods: In phases A (n=14) and B (n=25) of the study, patients were trained to audit HCWs’ HH. Following verification of their competency, they performed audits over a 24-hour period. In phase B, the behavioral determinants and auditors’ experience were measured with validated questionnaires developed for this study.

Results: The majority of patients agreed to participate (43/79; 54%), demonstrated competence to perform audits (32/39; 82%) and performed ≥ 1 HH audit (32/33; 97%). Patients performed on average 8,6 ±6,2 observations. The main barrier reported was incapacity to visualize HCW behaviour in the corridor while the auditor is in the room. Moral norm and perceived behavioral control accounted for 86% of the variability of the intention to perform the audit (p<0.001, R2=86%). The level of education accounted for 50% of the variability in behavioral frequency (p=0.002, R2=50%). 94% (30/32) of patients reported a positive overall experience. 80% (16/20) found the audits easy to accomplish and felt comfortable auditing HCWs. Most (14/15; 93%) reported that auditing did not modify patient-HCW relationship and 85% (17/20) reported no negative impact on their perception of the quality of care.

Conclusion: Patients can be involved as prospective auditors of HCW’s HH and their overall experience is positive. These results could be taken into account when planning future interventions involving patient-auditors.

Disclosure of Interest: None declared

Slide session: Infection control surveillance revisited

O14 WORKLOAD INDICATORS OF STAFFING NEED AS A TOOL TO DETERMINE INFECTION CONTROL STAFFING IN HOSPITALS: AN OBSERVATIONAL STUDY

L. Wundavalli1, U. S. Agrawal2, S. Satpathy3, B. R. Debnath2, T. A. Agnes2

1Hospital Administration, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong; 2All India Institute of Medical Sciences, Delhi, India; 3Hospital Administration, All India Institute of Medical Sciences, Delhi, India
Correspondence: L. Wundavalli

Introduction: Staffing as a ratio of infection control professionals to inpatient beds does not take into account the complex nature of the work and the varying degree of acuity and risk in different care settings.

Objectives: To calculate the staffing requirement for the infection control unit of a cancer hospital using World Health Organisation's Workload Indicators of Staffing Need (WISN).

Methods: Descriptive study conducted for a period of six months. Hospital: unit of study and type of infection control activity: unit of sampling. Interviews were held with infection control nurses to list all their activities. Unit time taken for each activity was observed. Records were perused to obtain annual workload statistics. WISN was used to calculate the nurse requirement.

Results: We identified 14 broad category infection control activities, miscellaneous support activities and 6 additional activities to be performed by 4 infection control nurses with a total available working time of 6132 hours for an annual load of 6238.25 (+/-372) hours for a 182 bedded cancer hospital with 69,331 annual admissions. 78% of the time was spent on core infection control activities and 22% on other support and additional activities. 44% of the time was spent on active surveillance. 56% of the time was spent on education. WISN ratio for the current workload is 1. If active surveillance is included, the WISN ratio is 0.75. One additional nurse will be required to implement active surveillance.

Conclusion: WISN can measure all infection control activities and translate workload into nursing full time equivalents. The step by step elucidation of the WISN tool in this paper may serve as a reference for manpower planning.

References

Am J Epidemiol 1980;111

Storr J, Twyman A, Zingg W, Damani N , Kilpatrick C , Reilly J, et al and the WHO Guidelines Development Group.Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations. Antimicrobial Resistance & Infection Control 2017; 6:6.

Bartles R, Dickson A, Babade O. A systematic approach to quantifying infection prevention staffing and coverage needs. Am J Infect Control 2018; 46(2018):487-491

Workload Indicators of Staffing Need User’s Manual. World Health Organisation.

Disclosure of Interest: None declared

O15 REDEFINING WHOLE GENOME SNP THRESHOLDS FOR DISTINGUISHING PATHOGENIC BACTERIAL ISOLATES IN CLINICAL SETTINGS

A. Shelenkov1, D. Shagin1, Y. Mikhaylova1, Y. Yanushevich1, V. Fomina2, V. Akimkin1

1Central Research Institute of Epidemiology; 2Pirogov National Medical and Surgical Center, Moscow, Russian Federation
Correspondence: A. Shelenkov

Introduction: To effectively control the pathogenic bacteria spread in hospital settings it is critically important to develop accurate and reliable protocols of isolates’ comparison between different patients and departments. However, traditional typing methods may be insufficient in the cases of multi-drug resistant strains with high level of genome variability.

Objectives: Facilitate the developing of a reliable procedure for distinguishing pathogenic bacteria strains based on their whole genomes.

Methods: 6 isolates of Klebsiella pneumoniae, 5 of Pseudomonas aeruginosa and 4 of Staphylococcus aureus were obtained from peripheral blood, urine and soft tissues of 81-year old female patient of intensive care unit in Moscow hospital during the period of four months. Genomic DNA was isolated with DNeasy kit (Qiagen) and used for paired-end library preparation with Nextera Kit (Illumina) and sequencing on Hiseq platform. Genome assemblies were made using SPAdes program and genomic comparison were performed using roary, dnadiff and custom software. The isolates were classified using MLST-based scheme and, in addition, capsular gene scheme (K- and O-loci) for K. pneumoniae.

Results: Although the bacterial isolates of each species did have the same types (ST11,KL27,O2v2 for K.pneumoniae, ST2613 for P.aeruginosa and ST8 for S.aureus, respectively) and similar core-genome composition, the numbers of single nucleotide polymorphisms (SNP) between the pairs of isolates have significantly exceeded the thresholds previously proposed for strain discrimination in literature (23-31 vs. 18 for K.pneumoniae, 70-85 vs. 37 for P.aeruginosa, 30-53 vs. 15 for S.aureus, respectively). At the same time, the number of SNPs between the isolates of the same MLST-type from different patients were always above 100 and sometimes exceeded 1000.

Conclusion: Our results suggest that although the number of core-genome SNPs proves to be useful measure for distinguishing distant bacterial strains, more research is needed to establish appropriate thresholds for it. We believe that the results obtained will be useful for developing new standards of NGS-based epidemiological surveillance of healthcare-associated infections since they allow to define new strain distinguishing thresholds based on genomic sequences.

Disclosure of Interest: None declared

O16 VALIDATION OF A SEMIAUTOMATED SURVEILLANCE ALGORITHM FOR DEEP SURGICAL SITE INFECTIONS AFTER PRIMARY TOTAL HIP OR KNEE ARTHROPLASTY – INTERIM ANALYSIS OF A MULTICENTRE STUDY

J. Verberk1,2,3, S. van Rooden3, M. Koek2, T. Hopmans2, M. Bonten1,3, S. de Greeff2, M. van Mourik1

1Medical Microbiology, UMC Utrecht, Utrecht; 2Epidemiology and Surveillance, RIVM, Bilthoven; 3Julius Center, UMC Utrecht, Utrecht, Netherlands
Correspondence: J. Verberk

Introduction: Surgical site infections (SSIs) complicate approximately 2% of primary total hip (THA) or total knee arthroplasty (TKA). Accurate and timely identification through surveillance is essential for targeted implementation and monitoring of preventive interventions. The availability of electronic health records facilitates (semi)automated surveillance, enabling high-quality large scale surveillance.

Objectives: This study assesses the validity of a previously published semiautomated surveillance algorithm for deep surgical site infections after THA or TKA, relying on retrospective routine care data.

Methods: Multicentre retrospective cohort study in four independent hospitals in the Netherlands. From all adult patients who underwent a THA or TKA, the following data were extracted from the electronic health records: microbiology results, antibiotics, (re)admissions, and surgical procedures within the 120 days following the primary surgery. Patients were classified with a low and high probability of having developed a deep SSI after THA or TKA, according to a previously developed algorithm. Sensitivity, positive predictive value (PPV) and workload reduction as compared to the traditional (manual) surveillance reported to the national surveillance database PREZIES were calculated.

Results: Four hospitals each extracted data from at least 1000 THA and TKA surgeries performed between 2012-2018. Preliminary analysis for one centre, based on 2395 records, demonstrates 77.4% sensitivity, 75% PPV and a workload reduction of 98.7%. Discrepancy analysis and analysis for the other centres are currently ongoing.

Conclusion: The results of this validation study are a prerequisite for successful broader implementation of semiautomated surveillance for SSIs after THA or TKA in the near future.

Disclosure of Interest: None declared

O17 CLUSTER ANALYSIS WITH ANTIMICROBIAL RESISTANCE (AMR) DATA: DATA FROM SURVEILLANCE AND MONITORING SYSTEMS IN GERMANY

B. Suwono1,2, T. Eckmanns2, H. Kaspar3, B.-A. Tenhagen1

1Epidemiology, Zoonoses and Antimicrobial Resistance, German Federal Institute for Risk Assessment; 2Infectious Diseases Epidemiology, Robert Koch Institute; 3Antimicrobial Resistance Monitoring, Federal Office of Consumer Protection and Food Safety, Berlin, Germany
Correspondence: B. Suwono

Introduction: German One Health Initiative (GOHI) has been initiated as a part of German National Action Plan on AMR.

Objectives: Under this framework, this study aims to cluster data on AMR from German national surveillance and monitoring systems from both human and animal sectors.

Methods: Escherichia coli data are collected from Antibiotic Resistance Surveillance (ARS) for humans, Zoonosis-Monitoring for non-clinical food-producing animal isolates and German Resistance Monitoring for Veterinary Medicine (GERM-Vet) for clinical animal isolates from 2014 to 2017. Human data originated from outpatients, general wards and intensive care units. Food-producing animal data were stratified by animal type and clinical vs. non-clinical origin. Three human origins and thirty-eight animal origins (e.g. broilers from slaughterhouse-non clinical, pigs-clinical, etc.) were analyzed. Ampicillin, cefotaxime, ciprofloxacin and gentamicin were the four antibiotics that were included, since they were frequently tested throughout these three systems. Cluster analysis was run based on sixteen resistance combinations; e.g. all susceptible (0000); using hierarchical clustering (Euclidian; average) in R.

Results: Three different clusters were detected based on the resistance combinations in isolates from each origin. Clinical human isolates clustered together (outpatient, general ward and intensive care unit). The cluster was closely related with isolates from pigs (weaners, clinical piglets, clinical and non-clinical sows, pork, growers < 50kg and fattening pigs). All isolates that having low resistance rates (<20%) against these four antibiotics clustered together (mostly non-clinical food-producing animals). All poultry isolates (turkeys and broilers) except broilers from organic farms grouped together with clinical isolates from pigs and bovines <1 year.

Conclusion: This study is the first study on cluster analysis using the data from national surveillance and monitoring systems for AMR for humans and food-producing animals in Germany. Detecting the closest relationship based on the resistance combination might be helpful for infection and prevention control. However, further analyses to better understand the clusters are necessary.

Disclosure of Interest: None declared

O18 IMPACT OF NATURAL LANGUAGE PROCESSING OF CLINICAL NOTES ON DETECTION OF HEALTHCARE-ASSOCIATED INFECTIONS

J. Kozák1, L. Vraná1, P. Vavřinová2

1Datlowe, s.r.o., Prague; 2Hospital Jihlava, Jihlava, Czech Republic
Correspondence: J. Kozák

Introduction: Manual active surveillance of healthcare-associated infections (HAIs) based on monitoring of all inpatient admissions and outpatient visits is very demanding and time consuming. Various automated methods have been introduced, e.g., monitoring positive microbiological cultivations. Not all HAIs are confirmed microbiologically however, as some relevant information for HAI detection might be hidden in unstructured clinical notes written by physicians and nurses. Sips et al. (2017) presents an overview of automated surveillance methods based on natural language processing (NLP) which allows analyzing unstructured texts. The authors state that NLP shows promising results, but needs further exploration.

Objectives: We measure the impact of NLP on the surveillance of HAIs.

Methods: Cooperating with Hospital Jihlava, treating about 25,000 inpatients annually, we have developed a technology based on NLP, which automatically detects potential HAIs by reading all available electronic health records. Potential HAIs are validated by members of the infection prevention team in Hospital Jihlava and this feedback is used to further improve the performance of NLP analysis.

Results: The technology has been deployed for more than a year. We have collected data on 920 confirmed HAIs during the past 12 months (1.5.2018 – 30.4.2019). 35.7% (328 cases) of those HAIs were initially not detected microbiologically, thus showing serious limitations when using traditional monitoring of positive lab results.

Conclusion: Methods based on NLP have proved the effectivity of detecting HAIs hidden in the unstructured texts, as well as those microbiologically confirmed. NLP does require reliable electronic health records that are not always readily available, but the trend of digitization is undeniable and before long most of the health data will be electronic. Therefore, NLP brings an enormous potential for automating the surveillance of HAIs.

References

Sips, M. E., Bonten, M. J. M., van Mourik, M. S.M.: Automated surveillance of healthcare-associated infections: state of the art, Current Opinion in Infectious Diseases: 2017, Vol. 30 (4), pp. 425–431, doi: 10.1097/QCO.0000000000000376

Disclosure of Interest: J. Kozák Employee of: Datlowe, s.r.o., the company which develops the solution HAIDi for automated detection of HAIs using advanced data analytics, i.e. natural language processing., Shareholder of: Datlowe, s.r.o., L. Vraná Employee of: Datlowe, s.r.o., the company which develops the solution HAIDi for automated detection of HAIs using advanced data analytics, i.e. natural language processing., P. Vavřinová: None declared

O19 ENVIRONMENTAL SHEDDING OF TOXIGENC CLOSTRIDIOIDES DIFFICILE BY ASYMPTOMATIC PATIENTS

M. Gilboa, E. Houri Levi, C. Cohen, I. Tal, O. Feld Simon, A. Brom, Y. Eden Friedman, S. Segal, C. Rubin, G. Rahav, G. Regev Yochay, on behalf of the ShIC research group

Sheba Medical Centre, Ramat-Gan, Israel
Correspondence: M. Gilboa

Introduction: Clostridioides difficile (CD) is a leading cause of health care associated infections. The role of asymptomatic carriers in the shedding and transmission of C. difficile is unclear. This study is a nested study in a larger CD carriage surveillance study.

Objectives: Here, we aimed to determine the burden of environmental shedding of C. difficile among asymptomatic carriers in an inpatient non-epidemic setting.

Methods: CD carriage was determined upon admission in asymptomatic patients by PCR for CD toxin of a rectal swab. Environmental contamination of rooms inhabited by either CD carriers, CDI, or non-CD carrier patients was assessed by obtaining environmental specimens from 10 high-touch sites in the patient's room and bathroom. Specimens were cultured and toxigenic strains were identified by PCR. We created a contamination scale designating each room a level of environmental contamination combining the total number of colony forming units and the number of contaminated sites in the room.

Results: 117 rooms were screened; 70 rooms inhabited by carriers, 30 by active CDI patients and 17 by non CD-carriers (control). In the control group, 94% of the rooms were clean, with no colonies discovered, and one participant (6%) had a medium scale contamination. In the carrier group 27 rooms (39%) had more than residual contamination, from which 14 rooms (20%) had heavy contamination. In the CDI group 10 (33%) rooms had more than residual contamination from which 3 (10%) had heavy contamination. In a multivariate analysis adjusted for age, gender, Independency in ADL activities, and antibiotic use the contamination score of carriers' rooms was significantly higher than those of none carriers (p=0.028). The contamination score of active CDI patients was higher than that of the non-carriers bud did not reach statistical significance (p=0.083), yet, most (75%) of the CDI patients were treated with anti-CDI antibiotics on the day of screening. Patient's bathrooms were not more contaminated than the rooms themselves.

Conclusion: Here we showed that the environment of CD carriers is significantly higher than patients who were non-carriers and at least as contaminated as that of patients with an active CD infection (after initiation of treatment).

Disclosure of Interest: None declared

Slide session: Antimicrobial stewardship

O20 APPROPRIATENESS OF PROTECTED ANTI GRAM-NEGATIVE ANTIBIOTICS IN EIGHT SWISS HOSPITALS: PRELIMINARY RESULTS OF THE NRP72 PROJECT “OPA STUDY”

E. Moulin1, C. Plüss-Suard1, C. Bellini2, L. Christin3, C. Chuard4, O. Clerc5, A. Cometta6, V. Erard4, O. Marchetti7, N. Troillet2, C. Voide2, G. Zanetti1, L. Senn1

1Centre Hospitalier Universitaire Vaudois, Lausanne; 2Institut Central des Hôpitaux, Sion; 3Groupement Hospitalier de l'Ouest lémanique, Nyon; 4Hôpital de Fribourg, Fribourg; 5Hôpital de Pourtalès, Neuchâtel; 6Etablissement hospitalier du nord vaudois, Yverdon-les-Bains; 7Etablissement Hospitalier de la Côte, Morges, Switzerland
Correspondence: E. Moulin

Introduction: Recent data on appropriateness of antibiotic therapies in Swiss hospitals are lacking and the extent of room for improvement is unknown.

Objectives: In the context of the NRP72 on antimicrobial resistance, we initiated the OPA project in eight Swiss hospitals located in the French-speaking part of Switzerland consisting in the evaluation of the impact of weekly clinical audits and multifaceted feedback strategies on reducing the use of anti-Gram-negative antibiotics that deserve a restrictive prescription: quinolones, 3rd- and 4th-generations cephalosporins, piperacillin/tazobactam and carbapenems. We report here the preliminary results on appropriateness.

Methods: Internal medicine, general surgery and intensive care units of participating hospitals were allocated to either intervention or control group. The intervention consisted in one-day weekly audits of protected antibiotic prescriptions over six months by a tandem of an infectious diseases specialist and a senior physician in charge of the patients, using a standardized checklist, followed by immediate feedback to prescribers and monthly reports to the medical team. Additionally, a website with didactic material dedicated to prescribers was created.

Results: Among a total of 9565 in-patients charts reviewed, we identified 1681 (18%) patients receiving a protected antibiotic targeted by the study. The auditing tandem proposed an optimization of the antibiotic therapy in 398/1681 (24%) patients including 167 (42%) stops, 87 (22%) switch to the oral route and 86 (22%) de-escalations.The adhesion rate to the propositions made by the tandem was 54%.

Conclusion: Preliminary results showed that there is room for improvement in prescriptions of protected antibiotics in the Swiss hospital setting. Special attention should focus on shorter durations, early switch to the oral route and de-escalations. Medical directors, head physicians and pharmacists of participating hospitals are aware of antibiotic resistance threat and support local initiatives aiming at antibiotic use optimization.

Disclosure of Interest: None declared

O21 EFFICACY OF GENTAMICIN IN THE PREVENTION OF POST-TRANSPLANT INFECTIONS IN LIVER TRANSPLANT RECIPIENTS; A RANDOMIZED CONTROLLED TRIAL

G. Pouladfar1, M. Shafikhani2, A. Vazin3, S. Nikeghbalian4, A. Abbasian1

1Professor Alborzi Clinical Microbiology Research Center; 2Student Research Committee; 3Pharmaceutical Sciences Research Center; 4Transplant Research Center, Abu Ali Sina for Medicine & Organ Transplant Hospital, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic Of
Correspondence: G. Pouladfar

Introduction: Post-transplant infections (PTIs) are one of the most important causes of mortality and morbidity after liver transplantation (LT).

Objectives: In this study, we aimed to compare the efficacy of combination of ceftizoxime with ampicillin-sulbactam versus combination of gentamicin with ampicillin-sulbactam as prophylactic antibiotic regimens used to prevent early bacterial PTIs in LT recipients.

Methods: All consecutive patients aged 18 years old and over who underwent LT at the Abu-Ali Sina transplantation hospital in Shiraz, Iran from July 2018 to April 2019, were included prospectively in this study. Randomization was performed in permuted blocks. We randomly assigned participants to receive two prophylactic antibiotic regimens: either combination of intravenous ceftizoxime and ampicillin-sulbactam (ceftizoxime group) or gentamicin and ampicillin-sulbactam (gentamicin group). These regimens started one hour before surgery and continued for 48 hours after LT. The rate and type of bacterial infections, the length of hospital and intensive care unit stays, mortality rate and renal function status were assessed during one-month period after LT.

Results: Totally, 230 participants were equally allocated to two groups. One participant in the gentamicin group and five in the ceftizoxime group were excluded due to expiring earlier than 3 days after LT. The rate of bacterial PTI during the first month after transplantation was 25.4% which was significantly lower in gentamicin group (13.16%) than in ceftizoxime group (38.18%) (p-value <0.01). The lengths of ICU and hospital stays and mortality rate were significantly lower in gentamicin group (p-value <0.01). There was no statistically significant difference in renal function status between the two groups. (p-value= 0.16).

Conclusion: The results showed that gentamicin can serve as a promising agent in a prophylactic antibiotic regimen in patients undergoing LT.

Disclosure of Interest: None declared

O22 DE-IMPLEMENTING LOW VALUE ANTIBIOTIC PRESCRIBING ACROSS LEVELS OF CARE

M. Schweizer1, C. Hartmann2, K. Gupta2

1Iowa City VA Hospital, Iowa City; 2Boston VA Healthcare System, Boston, United States
Correspondence: M. Schweizer

Introduction: Performing urinalyses and urine cultures in asymptomatic patients is one of the most common reasons for inappropriate antibiotic use. However, de-implementing this practice has been difficult, especially for clinical scenarios deemed to be high risk for infectious complications, such as among patients with delirium or those undergoing orthopedic implant surgery.

Objectives: Using the dual process theory framework “Developing De-Implementation Strategies Based on Un-Learning and Substitution,” an educational intervention citing new Infectious Diseases Society of America guidelines and providing a pneumonic “ABCs of ASB” was created and delivered didactically to providers. The goal was to increase performance of evidence-based prevention actions in place of low-value urine screening and treating of asymptomatic patients.

Methods: Clinical providers and staff (physicians, nurses, nurse practitioners, trainees) in 3 different levels of care (acute inpatient, long term, and outpatient) were included. A web-based anonymous and confidential pre and post question format was delivered to assess influence on provider behavior.

Results: Responses from a range of 250-279 unique providers were collected. For scenario #1 (patient with delirium and a positive urine culture and no other infectious symptoms), the choice to give antibiotics was reduced from 45% pre to 4% post, Chi-square p < 0.01). For scenario #2 (patient having knee replacement and positive preoperative urine culture, no other symptoms) the choice to give antibiotics was reduced by the same magnitude (~50%) but a lower absolute number (67% pre and 33% post, chi-square p < 0.01). Changes in predicted behavior were similar across levels of care.

Conclusion: Substituting evidence-based practices in place of low value practices is an appealing framework for influencing provider behavior. Our work demonstrates that education can successfully reduce the intention to use antibiotics for asymptomatic patients with positive urine cultures.

Disclosure of Interest: M. Schweizer Grant/Research support from: PDI Healthcare, C. Hartmann: None declared, K. Gupta: None declared

O23 HEALTHCARE-ASSOCIATED INFECTIONS: RESULTS OF THE 2017 AND 2018 GLOBAL POINT PREVALENCE SURVEY OF ANTIMICROBIAL CONSUMPTION AND RESISTANCE (GLOBAL-PPS)

A. Versporten1, I. Pauwels1, S. Le Page2, H. Goossens1 on behalf of the Global-PPS network

1Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium; 2bioMérieux, Marcy l ’Etoile, France
Correspondence: A. Versporten

Introduction: Point Prevalence Surveys of antimicrobial use (AMU) and healthcare-associated infections (HAI) are well established surveillance methods for monitoring AMU and HAI in hospitals. bioMérieux provided unrestricted funding support for the survey.

Objectives: We aimed to asses worldwide variation of quantity and quality of AMU for HAI.

Methods: Validated Global-PPS data was used from 628 hospitals (H) in 57 countries (C), including Europe (20C;179H); Africa (8C;116H), Asia (16C;169H), South-America (10C;90H), North-America (2C;65H), and Oceania (1C;9H) from 2017 to 2018. Detailed data was collected for all inpatients receiving an antimicrobial on the day of the survey. Denominator included all admitted inpatients. A web-based application was used for data-entry, validation and reporting (www.global-pps.com).

Results: Out of 152,966 admitted patients, 40.8% recieved at least one antimicrobial (range: 30.1% in Europe to 63.4% in Africa). HAI prevalence was 9.0% (range: 7.2% in Europe to 13.7% in South-America). Top 3 HAI included pneumonia (28.6%), skin and soft tissue infections (11.3%) and intra-abdominal sepsis (9.4%). Out of all antimicrobials (n=141,169); antibiotics for systemic use represented 89.0% (n=125,705) of which 22.3% (n=28,018) were prescribed to treat a HAI (range: 12.9% in Africa to 32.4% in South-America). Top 3 antibiotics for HAI were penicillin/β-lactamase-inhibitor (21.8%); carbapenems (14.6%; highest in South-America: 22.8%) and quinolones (10.8%; highest in North-America: 13.5%). Among 13,751 patients with at least one HAI, 53.0% got a targeted antibiotic treatment among which an ESBL-producing Enterobacteriaceae was most often reported (12.2%; range: 4.6% in North-America to 22.1% in South-America). The reason to treat a HAI was recorded in 85.1% of antibiotic prescriptions; a stop/review date in 42.2% and local guidelines were missing in 15.9% of antibiotic prescriptions.

Conclusion: The Global-PPS provides quantifiable outcomes to assess and compare quantity and quality of antibiotic prescribing for HAI in hospitalized patients worldwide. Hospitals use these data for quality improvement of antibiotic prescribing, development of local prescribing guidelines, practice changes, and for measuring the impact of interventions through repeated PPS.

Disclosure of Interest: None declared

O24 THE IMPACT OF AN INFECTIOUS DISEASES PHYSICIAN-LED ANTIMICROBIAL STEWARDSHIP PROGRAM ON “HIGH-END” ANTIBIOTIC CONSUMPTION, RESISTANCE, EXPENDITURE AND PATIENT OUTCOME

R. A. Moghnieh, L. Awad, D. Abdallah, M. Jadayel, S. Al-Hassan, R. Dabbagh, S. Droubi, N. Droubi

Makassed General Hospital, 2Beirut Arab University, Beirut, Lebanon
Correspondence: R. A. Moghnieh

Introduction: The rational use of antimicrobials is the key to curb down antimicrobial resistance. Makassed General Hospital adopted an Infectious Diseases specialist (IDS)-led antimicrobial stewardship program (ASP) in September,2016. Previously, broad-spectrum antibiotic (BSAB) dispensing was restricted through an institutional policy set by the hospital Pharmacy and Therapeutics Committee.

Objectives: We studied the effect of this IDS-led ASP on BSAB consumption levels, expenditure, resistance in pathogens causing nosocomial bacteremia. We also assessed the ASP effect on in-hospital and Intensive Care Unit (ICU) mortality.

Methods: Our study comprised of two periods: pre-ASP (Oct.2011-Sep.2015) and post-ASP (Oct.2016-Sep.2018). Both periods were divided to quarters (Q). Each Q comprised of 3 months. The period from Oct.2015 to Sep.2016 was a wash out period and was excluded from the analysis. We calculated the average/Q and the average Q-to-Q variation (AQV) before and after ASP for: BSAB consumption expressed in the number of defined daily dose (DDD)/1000 patient (pt) days (PD), BSAB expenditure expressed in US dollars/PD, the percentage of resistant bacteria from the total number of nosocomial pathogens causing bacteremia, in-hospital mortality (number of deaths/1000PD), and ICU-mortality (number of ICU deaths/1000 ICU days).

Results:
 

Average/Q before ASP

Average/Q after ASP

AQV before ASP(%)

AQV after ASP(%)

BSAB consumption

    

carbapenems(C)

154 DDD/1000PD

157 DDD/1000PD

4.7

-2.8

tigecycline

31 DDD/1000PD

12 DDD/1000PD

12.1

3.0

colistin

68 DDD/1000PD

58 DDD/1000PD

28.9

2.8

Expenditure

46 USD/PD

37 USD/PD

3.6

-0.7

Bacteria causing bacteremia

    

C resistant (R) Acinetobacter baumannii

20%

13%

46.7

14.9

CR Pseudomonas aeruginosa

7%

4%

-57.7

-87.2

Mortality

    

total

8 pt/1000PD

7 pt/1000PD

7.8

3.5

ICU

53 pt/1000 ICU days

47 pt/1000 ICU days

11.6

9.3

Conclusion: Our IDS-led ASP succeeded in controlling BSAB prescription rates and in decreasing the incidence of resistant pathogens causimg bacteremia without compromising pt outcome, not to mention its economic effect in reducing AB expenditure.

Disclosure of Interest: None declared

O25 UPDATE ON SURVEILLANCES TO MITIGATE ANTIBIOTIC RESISTANT CARE INFECTIONS IN BELGIUM

B. Catry1,2, K. Latour1, E. Vandael1

1Healthcare associated infections & Antimicrobial resistance (NSIH), Sciensano; 2Faculty of Medecine, Université libre de Bruxelles, Brussels, Belgium
Correspondence: B. Catry

Introduction: Based upon point prevalence surveys, the latest estimations of healthcare-associated infections in Belgium are 7.3% in acute care facilities (2017) and 3.5% in long-term care facilities (2016).

Objectives: To update the antimicrobial consumption and resistance situation in Belgian acute care hospitals.

Methods: By Royal Decree, Belgian acute care hospitals, mandatorily have to participate in the surveillance of methicillin resistant Staphylococcus aureus (MRSA) and multiresistant Gram-negative bacteria (MRGN). Participation in the surveillance of resistant enterococci is optional. The surveillance of antibiotic use is based on reimbursement data and expresses consumption in defined daily doses (DDDs) per 1000 patient days and per 1000 admissions (World Health Organization version 2018).

Results: The median antibiotic consumption in acute care Belgian hospitals in 2017 (592.6 DDDs/1000 patient days) remained similar to the previous years. In a 15-year period (2003-2017), there was a small increase in the median consumption in DDDs/1000 patients and a small decrease (2008-2016) in DDDs/1000 admissions. The high variation in antibiotic consumption between acute care hospitals and the high use of broad-spectrum antibiotics (especially fluoroquinolones) should be targets for improvement.

In line with surrounding countries, a further decrease of the incidence of nosocomial MRSA was noticed: from 0.36 to 0.08/1000 admissions (2004-2017). The incidence of MRGN (ESBL; extended spectrum beta-lactamase, and to a lesser extent CPE; carbapenemase producing enterobacteriaceae) however is jeopardizing this favorable trend. In 2017, the median of incidence of ESBL+ Escherichia coli (3.79/1000 admissions) and Klebsiella pneumoniae (1.87/1000 admissions) surpassed the incidence of nosocomial MRSA. Also other enteric multidrug resistant organisms (MDRO) like vancomycin resistant Enterococcus faecium (0.068/1000 admissions in 2017) are on the rise.

Conclusion: In summary, while infection control has reduced the incidence of MRSA, the containment of other MDRO, in particular the reservoir in the gastrointestinal tract, now needs priority. To assess the appropriateness of antibiotic use, a diagnosis driven data collection is needed.

Disclosure of Interest: None declared

O26 PILOTING THE GAMIFIED ANTIMICROBIAL STEWARDSHIP DECISION SUPPORT APP (GADSA): INCREASING COMPLIANCE WITH GUIDANCE FOR PRESCRIPTION OF SURGICAL ANTIBIOTIC PROPHYLAXIS IN NIGERIA

C. E. Wood1, O. Olufemi2, F. Ogunsola2, P. Okonji2, E. Kpokiri3, S. Luedtke4, L. Shallcross5, D. Soriano1, C. Lefevre-Lewis5, G. Birjovanu1, A. Hayward5, P. Kostkova1, F. NCube6, A. Molnar7, S. Wiseman1

1IRDR Centre for Digital Public Health in Emergencies, University College London, London, United Kingdom; 2Lagos University College of Medicine, Lagos; 3Niger Delta University Teaching Hospital, Bayelsa State, Nigeria; 4London School of Hygiene and Tropical Medicine; 5University College London; 6Public Health England, London, United Kingdom; 7Swinburne University of Technology, Melbourne, Australia
Correspondence: C. E. Wood

Introduction: 20-50% of surgical antibiotic prophylaxis prescription in Nigeria is thought to be non-compliant with WHO guidance. Game-based decision support mobile apps improve engagement with text-based guidance and develop practical skills. Development of the app involved building decision tree algorithms based on guidance published by WHO and Sanford with co-design input from surgeons at three hospital sites: Lagos University Teaching Hospital (LUTH), Lagos State University Teaching Hospital (LASUTH), Niger Delta University Teaching Hospital (NDUTH).

Objectives: Evaluate preliminary impact of a game-based smartphone app on prescribing behaviour and compliance with guidelines for surgical antibiotic prophylaxis

Methods: Surgeons were recruited by local project leads from the hospital sites. The Android-based app was used for an 8-week period (April-June 2019) to record prescribing decisions for elective surgeries. Pre- and post-pilot, surgeons completed a 20-item questionnaire on prescribing habits, intention to comply and attitudes towards, compliance with guidance. In-app feedback was provided by an interactive ‘mentor’. Badges were awarded for compliant decisions and interaction with the app. Data on decisions and interactions were collected. Feedback on acceptability and usability was collected via focus groups/questionnaires at week 4 and 8.

Results: 80 surgeons (consultant; 5-10yrs experience; 60% male) joined the pilot. Preliminary data (May 2019) shows positive impact on prescribing behaviours and attitudes towards compliance, with reduction in inappropriate prolongation of antibiotics post-surgery. The pilot completes in June, full results available August and presented at ICPIC 2019.

Conclusion: This pilot reflects willingness of surgeons to use an innovative solution with potential to reduce inappropriate use of antibiotics and improve compliance with prescribing guidance.

Disclosure of Interest: None declared

Slide session: Hand hygiene

O27 PREVENTION OF CROSS-TRANSMISSION BEFORE ASEPTIC PROCEDURE (WHO MOMENT 2) USING A SIMPLIFIED METHOD FOR HAND HYGIENE

H. Soule, M. Abbas, J. Sauser, C. Fankhauser, D. Pires, D. Pittet

Infection Control Programme and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals, Geneva 4, Switzerland
Correspondence: H. Soule

Introduction: In previous studies, we have shown that a simplified method for hand hygiene (HH; 15 sec rubbing with a hand size-adjusted volume of alcohol and fingertips first followed by the rest of the hands) can lead to a reduction of approximately 2 log10 on hands artificially contaminated with either Escherichia coli or Staphylococcus aureus.

Objectives: We evaluated the efficacy of this simplified HH method in a laboratory experiment simulating WHO moment 2 (before aseptic procedure).

Methods: Twenty nurses were enrolled in the study. After handwashing with soft soap, 10 μl of a 108 cfu/mL S. aureus NC10788 suspension was deposited on each of their fingertips and let dried for 3 minutes. They then simulated injection in an infusion set, both with and without previous HH with isopropanol 60% (v/v) according to our simplified method (see above). They manipulated the 3-way stopcock integrated in the infusion set and the flow-regulating clamp. The whole procedure lasted approximately 3 minutes. The 3-way stopcock and the flow-regulating clamp were then cut, placed in 100 ml tryptone soy mixture, shaken vigorously, and both dilutions and filtration of the recovering solution were inoculated on agar for 48 hours. We had previously established that our method was able to detect a contamination of those 2 parts of the infusion set inferior to 30 cfu. The number of colonies was counted and Wilcoxon signed-rank test was used to test the difference between the results with and without HH. The Hodges-Lehmann estimator was applied to estimate the difference between the medians.

Results: The median amount of baseline S. aureus on the fingertips of the volunteers was 106.8 cfu. Without HH, bacteria were detected after all 20 experiments (range: 25 to 25 800 cfu), whereas with HH, bacteria were not detected after all 20 experiments. The difference between estimated medians was 351 cfu (95% CI 193-570; p = 0.0001).

Conclusion: Even with a high contamination of the fingertips with S. aureus, when HH was performed with this simplified method before an aseptic procedure, no bacteria were recovered from 2 critical parts of the infusion set, allowing safer care and patient safety.

Disclosure of Interest: None declared

O28 IMPACT OF THE SEVENTH MULTIMODAL COUNTRY-WIDE CAMPAIGN TO PROMOTE HAND HYGIENE IN BELGIAN HOSPITALS

H. De Pauw1, A. Uwineza1, N. Benhammadi1, B. Catry1,2, A. Simon3 on behalf of Working Group Hand Hygiene BAPCOC (Belgian Antibiotic Policy Coordination Committee)

1Healthcare associated infections & Antimicrobial resistance (NSIH), Sciensano; 2Faculty of Medecine, Université libre de Bruxelles; 3Université catholique de Louvain, Brussels, Belgium
Correspondence: H. De Pauw

Introduction: Hand hygiene (HH) compliance by healthcare professionals has been recognized as the most important factor in preventing transmission of healthcare-associated infections to patients (1).

Objectives: We report here the outcome of the seventh Belgian national hand hygiene campaign organized in 2016.

Methods: The campaign was mainly focused on healthcare workers having contact with patients in hospitals (acute, chronic and psychiatric), and also for the first time on the patients themselves (patient questionnaires). Compliance to hand hygiene guidelines was measured using a standardized observation roster (2). An online tool (NSIHweb 2.0) was used to collect the individual or aggregated compliance data, with the possibility to obtain immediate feedback. The patient questionnaire was filled out in paper format and manually introduced in a databank.

Results: A total of a total of 235,816 hand hygiene opportunities were registered from 170 participating hospitals. At the national level, all specialties combined, the compliance (= hand hygiene opportunities with soap and/or alcohol / total number of hand hygiene opportunities observed) was 71.6% before the campaign and 78.0% after the campaign.

Ninety-seven Belgian sites / hospitals voluntarily forwarded patient inquiries and 17,454 received questionnaires were included in the analysis. The survey showed that 59.0% of the participants reported being aware that the hospital was participating in the hand hygiene campaign.

Conclusion: The seventh national campaign was another success in terms of very high participation rates, and a compliance rate tending to approach a 80% margin during post-campaign. Patient empowerment was for the first time positively stimulated.

References

(1) European Centre for Disease Prevention and Control. (2013). Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. Stockholm: ECDC. doi 10.2900/86011

(2) World Health Organization Patient Safety: WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge, Clean Care is Safer Care. Geneva Switzerland: World Health Organization; 2009.

Disclosure of Interest: None declared

O29 IMPACT OF THE MULTIMODAL STRATEGY FOR INCREASING HAND HYGIENE COMPLIANCE: FOURTEEN YEARS’ EXPERIENCE IN A MIDDLE INCOME COUNTRY

E. Alp1, S. Tasgin2, D. Altun2, T. Orhan2, F. Cevahir2, O. Cakir2, E. Aktas2, C. Altay Kurkcu2, A. UluKilic2

1Ministry of Health, Ankara; 2Erciyes University, Kayseri, Turkey
Correspondence: E. Alp

Introduction: Hand hygiene is a gold standard for the prevention of health-care associated infections (HAIs). However, compliance rates are generally poor among healthcare workers (HCWs) in routine practice.

Objectives: We aimed to assess the efficacy of WHO multimodal strategy for improving hand hygiene (HH) compliance in a middle-income country.

Methods: The WHO multimodal HH improvement strategy has been implemented since 2004 in a referral university hospital in Turkey. The intervention consisted of introducing alcohol-based hand rub at bedside and nurses’ treatment and dressing rooms; monitoring HH compliance; providing performance feedback; educating staff; posting reminders in the workplace; and promoting an institutional safety climate. A bundle strategy has been implemented for the prevention of device-associated infections in intensive care units (ICUs). HH compliance in medical, anaesthesiology and ICUs, hand rub consumption and HAIs rates were evaluated at baseline and at follow-up.

Results: The compliance of HH increased in medical, anaesthesiology and ICUs in all five moments. Also, the usage of alcohol based hand rub has increased from 195 litres in 2003 to 11543 litres in 2018. Point prevalence studies revealed a decrease in HAIs from 8.2% to 5.7% between 2007 and 2018. Device-associated infection rates (ventilator-associated pneumonia, catheter associated blood stream infections, catheter associated urinary tract infections) in ICUs also decreased during the time. Furthermore, multi-drug resistant pathogens (Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumonia, Escherichia coli) incidence rates decreased. Small bowel operations, colon, gastric, cholecystectomy, craniotomy, fusion, cranial shunt infection rates decreased over the time.

Conclusion: The WHO multimodal improvement strategy has shown to be effective in improving HH compliance and decreasing HAIs rates in a middle income country with limited nurses and heavy workload.

Disclosure of Interest: None declared

O30 IMPACT OF USING A DEVICE PROVIDING INDIVIDUAL FEEDBACK ON HEALTHCARE WORKERS HAND HYGIENE BEHAVIOUR: A STEPPED WEDGE CLUSTER-RANDOMIZED CLINICAL TRIAL (SMARTRUB®)

D. Pires1, A. Gayet-Ageron1, Y. Robert2, C. Fankhauser1, E. Tartari1, C. G1, A. Peters1, F. Tymurkaynak1, S. Fourquier3, H. Soule1, R. Beuchat3, W. Zingg1, F. Bellissimo-Rodrigues11, Y. Martin1, D. Pittet1

1IPC, University of Geneva Hospitals; 2iQati; 3HEPIA, Geneva, Switzerland
Correspondence: D. Pires

Introduction: We tested the effect of an innovative wristband (SmartRub® powered by iQatiTM) that provides automatic, instantaneous and individual feedback on the correct duration of hand friction and volume of alcohol-based handrub (ABHR).

Objectives: We hypothesised that using it in patient care would improve hand hygiene (HH) compliance by 20%.

Methods: We performed a stepped wedge, cluster-randomized, controlled, open-label clinical trial. All wards of our geriatric university hospital were randomized to 1 of 4 steps. Each step consisted in a unique sequence of 3 phases: baseline (no device;1-4 months), transition (device without feedback;1 month) and intervention (device with feedback;1-4 months). Primary outcome was HH compliance measured by direct HH observation. Secondary outcomes were the duration of HH friction and ABHR volume. Generalized linear mixed models with nested random effects on the intercept (HCW within ward-level) were performed on an intention-to-treat level.

Results: A total of 97 of the 370 HCWs participated (63 nurses, 32 auxiliary nurses, 2 physios). Overall, 6’878 HH opportunities (opp) were observed with a median of 72 opp per HCW (IQR 61-84). Mean HH compliances (95%CI) were 72% (67-76), 70% (65-75) and 62% (57-67) at baseline, transition and intervention, respectively. HH compliance decreased significantly over time (p=0.015) and there was no effect of the duration of active device use (p=0.448). HH compliance was independently and inversely associated with age (p=0.015) and workload (p<0.001). Both ABHR volume and duration of HH friction have increased significantly from transition to intervention (1.4 mL, 95%CI 1.1-1.6 to 2.1 mL 95%CI 1.8-2.3 and 9.3 sec 95%CI 8.5-10.0 to 11.1 sec 95%CI 10.3-11.8).

Conclusion: The use of SmartRub® did not show an effect on HH compliance. We observed a gradual decrease in compliance throughout the study that could be attributed to fading of the initial Hawthorne effect. On the other hand, the use of SmartRub® improved the quality of HH both in ABHR volume and duration of HH friction.

Disclosure of Interest: None declared

O31 EXPLORING INSTITUTIONAL SAFETY CLIMATE TO PROMOTE HAND HYGIENE: RESULTS FROM AN INTERNATIONAL SURVEY

E. Tartari1, M. Borg2, E. Castro-Sánchez3, W. Zingg1, B. Allegranzi4, D. Pittet1

1University Hospital of Geneva, Geneva, Switzerland; 2Mater Dei Hospital , Msida, Malta; 3Imperial College London, London, United Kingdom; 4World Health Organization, Geneva, Switzerland
Correspondence: E. Tartari

Introduction: Institutional safety climate (ie, the safety aspects of organizational culture) is an essential component of the World Health Organization's (WHO) multimodal hand hygiene (HH) improvement strategy for sustained health systems quality.

Objectives: We sought to explore the key elements representing the institutional safety culture.

Methods: We developed a survey based on the WHO Hand Hygiene Self-Assessment Framework (HHSAF). A convenience sample of infection control preventionists (ICPs) from more than 100 countries attending the International Conference on Prevention and Infection Control (ICPIC) in June 2017 was invited by email to complete the survey. The survey included questions regarding the following subcategories within the HHSAF: 1) commitment of leadership; 2) champions and role models; 3) patient participation; 4) system for accountability 5) HH compliance targets and 6) reporting.

Results: 198 ICPs from 71 countries across all WHO regions completed the questionnaire (14% Africa; 11% Americas; 5% South East Asia; 43% Europe; 9% Eastern Mediterranean and 18% Western Pacific). Only 9% of respondents reported having all six elements in place. 36% reported that facility leadership made a clear commitment to support HH improvement and undertook leadership hospital walkabouts. 38% had a designated system of HH champions (HHC), primarily nurses. Significantly less doctors and almost no housekeepers were designated HHC (p= 0.007). It was almost non-existent for patients to challenge nurses (3.7%) and doctors (2.1%) about poor hand hygiene practices. 44% of respondents claimed some form of HH accountability systems was present. However, programmes that reward good HH practices and disincentivize non-compliance were only reported by 26% and 12%, respectively. 42% reported established HH institutional targets, of which only 24% were required to publicly report them.

Conclusion: Our findings demonstrate that there is a general lack of inclusion of key elements constituting institutional safety climate within HH programmes worldwide. Unless political and leadership determinants are addressed, sustained and genuine HH improvement is unlikely.

Disclosure of Interest: None declared

O32 PREVENTATIVE MEASURES TO IMPROVE HAND HEALTH OF HEALTHCARE WORKERS AND THE POTENTIAL IMPACT UPON HAND HYGIENE BEHAVIOUR

J. Hines1, S. Kezic2, T. Rustemeyer3, M. Soltanipoor2,3

1Research & Development, SC Johnson Professional, Derby, United Kingdom; 2Coronel Institute of Occupational Health , Amsterdam Public Health Research Institute, Amsterdam UMC; 3Department of Dermatology, Amsterdam UMC, Amsterdam, Netherlands
Correspondence: J. Hines

Introduction: Healthcare workers (HCWs) are at high risk of developing hand dermatitis (HD). Current guidelines on HD prevention recommend use of emollients however adherence is poor. Compliance to hand hygiene (HH) guidelines depends on several factors including skin health.

Objectives: To assess whether provision of emollient cream, electronic monitoring and feedback on consumption can improve skin care in HCWs and to consider the relationship between improved skin health and HH compliance.

Methods: A cluster randomized controlled trial was conducted on 19 academic hospital wards, including 501 HCWs, for 12 months. Intervention wards were provided with hand cream dispensers equipped with an electronic system to monitor use, regularly communicated using posters. Process measures were self-reported and electronically measured cream use in the intervention group (IG) vs control group (CG). Primary and secondary outcomes were change from baseline in Hand Eczema Severity Index (ΔHECSI) and Natural Moisturizing Factor (ΔNMF). HH compliance was audited independently and trends later compared.

Results: Self-reported cream use at follow-up was significantly higher in IG than in CG before and during shift. At baseline there was no difference between groups. In IG, electronically measured cream use averaged 0.4 events per shift per HCW. HECSI reduced in IG by -6.2 and in CG by -4.2 points. There was no difference in ΔHECSI or ΔNMF between groups however relative improvement was significantly higher in IG (56% vs. 44%). In a subgroup of HCW with mild HD, IG showed significantly larger HECSI decrease than CG (P<0.001). HH compliance on IG wards increased from 55% (Q3 2015) to 70% (Q2 2017) during the project.

Conclusion: The intervention improved hand cream use, however consumption remained low. Although there was no significant effect on the primary outcomes, the intervention showed overall positive effects on HECSI and may be considered a practical means to promote skin care in HCWs. Reported HH compliance increased during the study. While causality cannot be assigned, this suggests a relationship and highlights the importance of HCW skin health in infection prevention strategies.

Disclosure of Interest: J. Hines Employee of: SC Johnson Professional, S. Kezic: None declared, T. Rustemeyer: None declared, M. Soltanipoor: None declared

O33 THE EFFECT OF HAND RUB CONSUMPTION ON HEALTHCARE-ASSOCIATED STAPHYLOCOCCUS AUREUS BLOODSTREAM INFECTIONS IN FINNISH ACUTE CARE HOSPITALS

D. Arifulla, E. Sarvikivi, J. Ollgren, S. Toura, O. Lyytikäinen

NATIONAL INSTITUTE FOR HEALTH AND WELFARE, Helsinki, Finland
Correspondence: D. Arifulla

Introduction: Improved hand hygiene (HH) has been shown to reduce healthcare-associated (HA) Staphylococcus aureus (SA) bloodstream infections (BSI). In the Finnish hospital infection program (SIRO) HA-SA-BSI rates have been increasing.

Objectives: Our aim was to investigate whether HA-SA-BSI rates in Finnish acute care hospitals were associated with HH activities.

Methods: Information on hand rub consumption and HH observations in Finnish acute care hospitals were collected as a part of national web-based surveys in 2014, 2015, 2017 and 2018. During 2014-2018, 20 hospitals conducted laboratory-based surveillance of HA-BSIs with a common protocol. Patient-days were obtained from hospitals’ databases to calculate incidence densities (ID). Association between hand rub consumption and HH observations was estimated with linear mixed regression, and HH and SA-BSI for each hospital was assessed by Locally Weighted Scatterplot Smoothing (LOWESS).

Results: Overall SA-BSI ID was 2.1/10,000 patient-days (range by hospital, 0.7-4.0; range by year, 1.8-2.2). Mean hand rub consumption was 60 liters/1000 patient-days (range by hospital, 23-143), and by survey, 54-94% of the hospitals performed HH observation. Hand rub consumption was 1.5 (95% confidence interval, 1.1-2.0) times greater in hospitals performing HH observation. We detected a slight negative association between SA-BSI IDs and hand rub consumption in the LOWESS analysis.

Conclusion: Hand rub consumption seemed to have an effect on HA-SA-BSI. Hand rub consumption, a rough surrogate of HH compliance, is easily available. Observation would give more accurate picture on HH, but it is resource intensive and needs standardized methods and training if used as a national process indicator.

Disclosure of Interest: None declared

Slide session: Multidrug resistant Gram-negatives

O34 EFFECTIVENESS OF A MULTIMODAL STRATEGY TO REDUCE CARBAPENEM-RESISTANT KLEBSIELLA PNEUMONIAE INFECTIONS: THE TEN YEARS’ EXPERIENCE OF A 400 BEDS TERTIARY HOSPITAL IN NORTHERN ITALY

C. Alicino1, D. Raiteri1, S. Tigano2, L. Santoriello1, S. Brenci1, C. Valle1, P. Pavan1, F. Lillo1, G. Barabino1, G. Riccio2, C. Airoldi3, L. Garra1

1ASL 2 Savonese, Pietra Ligure; 2ASL 2 Savonese, Albenga; 3ASL 2 Savonese, Savona, Italy
Correspondence: C. Alicino

Introduction: In recent years, carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has become endemic in Italy and effective interventions are needed to contrast its burden.

Objectives: The study aimed to evaluate the effectiveness of multimodal strategy for reducing the incidence of CR-Kp pneumoniae infections at the 400 beds tertiary hospital “Santa Corona of Pietra Ligure”, Liguria Region, Northern Italy.

Methods: The intervention effect was analyzed with time series regression analysis. The study included a pre-intervention period (January 2009 – August 2009), a multimodal intervention period without routine rectal screening (September 2009 – December 2014) and with routine rectal screening (January 2015 – December 2018). Multimodal intervention consisted of contact precautions, patient isolation, enhanced environmental cleaning. By negative binomial regression, monthly incidence of Kp-RC isolations on blood culture, urine culture, respiratory samples and on other clinical samples were compared. The analysis was conducted separately for the Intensive Care Unit (ICU) and for the other wards.

Results: Preliminary results demonstrated that multimodal interventions without screening was effective in reducing monthly incidence of Kp-RC isolations on blood culture both in ICU (Incidence Rate Ratio – IRR: 0.90; p<0.001) and in the other wards (IRR: 0.85; p<0.001). The introduction of rectal screening was associated to a further decrease of Kp-RC isolations on blood culture in ICU (IRR: 0.92; p<0.001), while the impact in the remaining wards was modest (IRR: 0.99; p<0.001). A reduction in the incidence of isolation, even though more limited, was observed also in urine culture and other clinical samples. With respect of respiratory samples, the reduction was observed only after the implementation of rectal swab screening and was more pronounced in the ICU (IRR:0.93; p <0.001).

Conclusion: Early adoption of a multimodal strategy has been shown to be effective in reducing the incidence of Kp-RC infections. Routine screening with rectal swab allowed a further reduction to be achieved, particularly in the bloodstream infections occurred in ICU.

Disclosure of Interest: None declared

O35 HOUSEHOLD TRANSMISSION OF ESBL-PRODUCING ESCHERICHIA COLI OR KLEBSIELLA PNEUMONIAE AFTER HOSPITAL DISCHARGE OF A KNOWN ESBL CARRIER

M. E. Riccio1, C. Brossier1, R. Martischang1, G. Renzi2, J. Schrenzel2, S. Harbarth1

1Infection Control Program; 2Bacteriology Laboratory, Geneva University Hospitals (HUG), Geneva, Switzerland
Correspondence: M. E. Riccio

Introduction: The increasing prevalence of ESBL-producing Enterobacteriacae (ESBL-PE) in the community is a cause of concern. ESBL-PE transmission among household members may play an important role in ESBL-PE dissemination, but has been understudied hitherto.

Objectives: The aim of this study was to determine the rate of ESBL-PE transmission within households and estimate the rate of spontaneous ESBL-PE decolonization.

Methods: This was a prospective, observational cohort study of ESBL-PE household transmission, in the context of the multicenter MODERN project, funded by the Joint Programming Initiative on Antimicrobial Resistance. From Nov 2017 to Nov 2018, ESBL-PE carrying inpatients, and their households’ members, were recruited at HUG. During 4-months follow-up, personal information and 4 stool samples were collected from all participants. ESBL-producing E. coli and K. pneumoniae isolates were identified after microbiological work-up of stool samples.

Results: 22 households (52 participants) were enrolled in Geneva. A total of 100/179 stool samples were positive for ESBL-E. coli (n=71) K. pneumoniae (n=17) or both (n=12). Both new colonization (n=8) and decolonization (n=12) events were observed during follow-up. The incidence rate of ESBL-PE acquisition in previously ESBL-PE negative household members was 3.59/100 patient-weeks at risk, while the rate of spontaneous ESBL-PE decolonisation among ESBL-PE positive participants was 1.95/100 patient-weeks of follow-up. 12/20 households with complete follow-up had at least one 2nd ESBL-PE-positive household member. A total of 452 ESBL-PE isolates were stored for further molecular analysis. Based on crude phenotypic comparisons, 10 possible transmission (or acquisition) events were identified.

Conclusion: 60% of households had secondary ESBL-PE cases. Incidence of ESBL-PE acquisition among family members was higher than the rate of spontaneous loss of carriage. Possible transmission events were observed in 50% of the households based on phenotypical comparison; ESBL-PE clonal relatedness will be determined by WGS.

Disclosure of Interest: None declared

O36 CO-CARRIAGE AND ACQUISITION OF ESBL-PRODUCING ENTEROBACTERIACEAE AMONG HOUSEHOLD MEMBERS: A SYSTEMATIC REVIEW

R. Martischang1, E. M. Riccio1, M. Abbas1, A. Stewardson2, J. Kluytmans3, S. Harbarth1

1Geneva University Hospital, Geneva, Switzerland; 2Monash University and Alfred Health, Melbourne, Australia; 3University Medical Center Utrecht, Utrecht, Netherlands
Correspondence: R. Martischang

Introduction: While the epidemiology of ESBL-producing Enterobacteriaceae (ESBL-PE) has been extensively studied in hospitals, the data on community transmission is scarce.

Objectives: We conducted a systematic review to assess the prevalence of ESBL-PE co-carriage and acquisition rate in households.

Methods: We searched Cochrane Library, PubMed, Embase and CINAHL databases for cross-sectional or cohort studies published between 1990 and 2018 evaluating co-carriage proportions and/or acquisition rates of ESBL-PE among household members, with no language restriction. We excluded studies focusing on animal-to-human transmission, non-household settings, or specific settings (e.g. farms, foodborne outbreaks, aboriginal populations). The primary outcomes were co-carriage proportions and acquisition rates, stratified according to the definition of relatedness, which was assessed phenotypically or genotypically. Co-carriage proportions of clonally-related ESBL-PE were transformed via the double-arcsine method and pooled using a random-effects model. Potential biases were assessed manually.

Results: We identified 13 eligible studies. Among 770 household members of index patients colonized or infected by an ESBL-PE, prevalence of ESBL-PE co-carriage ranged from 11% to 37% in 10 studies. Overall, 13% (95%CI: 9-16%) had a clonally-related strain. Those proportions were higher for Klebsiella pneumoniae (20-25%) compared to Escherichia coli (10-20%). Acquisition rates of ESBL-PE among household members of a previously identified carrier ranged between 1.47-18.34 per 1000 person-weeks in 5 studies including 223 initially ESBL-PE free household members. When restricting to clonally-related ESBL-PE, the rates ranged between 2.03-3.92 events in 4 studies with 162 initially ESBL-PE free household members. We identified a high risk of bias, as well as a large amount of heterogeneity between studies.

Conclusion: ESBL-PE household co-carriage is frequent, suggesting intrafamilial acquisition. There is a need for further studies evaluating the intrafamily risk of ESBL-PE transmission.

Disclosure of Interest: None declared

O37 RESULTS OF A FIVE-YEAR ADMISSION-SCREENING FOR MULTIDRUG-RESISTANT GRAM-NEGATIVE BACTERIA IN A TERTIARY CARE CENTER IN EASTERN SWITZERLAND

E. Lemmenmeier1, P. Kohler1, O. Nolte2, M. Schlegel1, W. C. Albrich1

1Infektiologie und Spitalhygiene, Kantonsspital St.Gallen, 9007 St.Gallen; 2Bakteriologie, Mykologie, Parasitologie, Zentrum für Labormedizin, 9001 St.Gallen, Switzerland
Correspondence: E. Lemmenmeier

Introduction: Multidrug-resistant Gram-negative bacteria (MRGN) are a concern worldwide. We analyzed data from a targeted hospital admission screening in order to assess trends over time and to identify risk factors for MRGN colonization.

Objectives: Detection of risk factors could lead to a risk-based screening.

Methods: Patients hospitalised abroad within the last 6 months were rectally screened after admission. Additional samples were obtained from wounds, urinary catheters, tracheal secretions, if applicable. After enrichment in TSB broth samples were streaked on chromogenic ESBL/OXA-48 screening plates. Susceptibility testing was done with the BD PhoenixTMinstrument and ESBL/CPE confirmation with phenotypic methods. The presence of the most relevant carbapenemase genes was confirmed by PCR.

MRGN were defined as Gram-negative bacteria producing an ESBL or a carbapenemase. For risk factor analysis, ESBL E. coli were excluded. Asia, Africa and Southern/Eastern Europe were regarded as high-risk regions, compared to Australia, America and Western/Northern Europe (low-risk).

Results: From 03/13-07/18 458 patients underwent admission screening. 111 (24%) were colonized with MRGN. We found 129 isolates including 21 carbapenemase-producers (16%), 38 non-E. coli ESBL (30%) and 70 E.coli ESBL (54%). Over time, the proportion of E. coli ESBL among all screened patients showed an increasing trend (p=0.09), whereas the other MRGNs remained stable. In univariable analysis, hospitalisation in a high-risk region, central venous and urinary catheters, open wounds, diabetes, antibiotics before screening were identified as risk factors. In multivariable analysis only high-risk region remained significantly associated with MRGN colonization (OR 2.4, 95% CI 1.2-5.0, p=0.017). Among 128 patients hospitalised in low-risk regions, only 4 were colonized with MRGN.

Conclusion: Over 5 years, the proportion of detected colonization with carbapenemase-producers and non-E.coli ESBL remained stable among patients who were recently hospitalised abroad. The predominant risk factor for colonization was hospitalisation in a high-risk region. A negligible proportion of patients hospitalised in low-risk regions was colonized with MRGN, questioning the utility of our screening program for this population.

Disclosure of Interest: None declared

O38 NO OBVIOUS IMPACT OF CONTACT ISOLATION DISCONTINUATION ON NOSOCOMIAL ESBL-ESCHERICHIA COLI SPREAD

B. Clarivet, L. Senn, G. Prod'hom, D. S. Blanc, B. Grandbastien

CHUV - centre hospitalier universitaire vaudois, Lausanne, Switzerland
Correspondence: L. Senn

Introduction: The prevalence of Extended-Spectrum β-Lactamase producing Escherichia coli (ESBL-EC) has increased over the last 10 years. In order to limit their nosocomial transmission, international guidelines recommended contact isolation for ESBL-EC colonized/infected patients. The relevance of this measure was questioned as the transmission is mainly in the community and, in 2014, Swissnoso advocated its discontinuation.

Objectives: The objective of this study was to measure the impact of contact isolation discontinuation on ESBL-EC cases in the Lausanne University Hospital (CHUV).

Methods: A case was defined as a first ESBL-EC bacteriuria between January 1, 2007 and December 31, 2018 in a hospitalized patient. We defined two periods: P1 (1st quarter 2007 to 3rd quarter 2012) and P2 (4th quarter 2012 to 4th quarter 2018), after contact isolation discontinuation for ESBL-EC. We used interrupted time series analysis to measure the impact of this strategy on the incidence of cases occurring >48h after admission.

Results: During the study period, a total of 1’484 ESBL-EC bacteriuria occurred corresponding to 889 cases. The mean incidence was 0.15/1000 patients-days (pd) in P1 and 0.36/1000 pd in P2 (p<10E4). Among them, 488 (54.9%) cases occurred >48h after admission; their mean incidence was 0.09/1000 pd [0.08 - 0.10] in P1 and 0.19/1000 pd [0.17-0.21] in P2. Time series analysis did not show a significant association between contact isolation discontinuation and changes in the incidence of ESBL-EC bacteriuria occurring >48h after admission (p = 0.47). Similarly, the mean incidence of cases at admission was 0.06/1000 pd (95% CI: [0.05 - 0.07]) in P1 and 0.17/1000 pd [0.15-0.19] in P2.

Conclusion: Following the discontinuation of contact isolation, no significant change in the evolution of the incidence of ESBL-EC bacteriuria occurring >48h after admission has been identified. The parallel increase in ESBL-EC bacteriuria detected at admission supports the hypothesis of a predominantly community reservoir.

Disclosure of Interest: None declared

O39 PREVALENCE OF MCR IN SALMONELLA FROM HOSPITAL IN SOUTH CHINA

Y. Yu, R. Y. Sun, L. X. Fang, J. Sun, Y. F. Zhou, X. P. Liao, Y. H. Liu

College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
Correspondence: Y. Yu

Introduction: Salmonella is a major global foodborne pathogen and different serotypes were identified worldwide. In China, Salmonella causes an estimated 22.2% of foodborne diseases, and the majority of diseases are associated with the ingestion of contaminated meat products.

Objectives: The current study aimed to analyze the prevalence and characterization of colistin resistance in Salmonella isolated from hospital in South China.

Methods: From 2009 to 2018, totally 6709 Salmonella strains were collected from hospitals in Guangdong province, including Typhimurium Salmonella (1867), serotype of 1,4,5,12:i:- (3163), Enteritidis Salmonella (1584), Indiana Salmonella (32), and Derby Salmonella (54). Antimicrobial Susceptibility test was performed especially for colistin.

Results: MICs and PCRs shown that 4.41% (296/6709) strains were resistant to colistin and carrying the mcr genes, with ratios of 96.28 % (259/269) and 3.71% (10/269) for mcr-1 and mcr-3, respectively. The genomic analysis of the 74 mcr-1-bearing Typhimurium Salmonella and its variant serotype revealed that the ST34 is the dominant type (70/74), followed by ST19(4/74). The prevalent plasmids carrying mcr-1 gene are IncHI2(69/74), IncX4(3/74), and IncI2 (2/74). Multi-drug resistance to beta-lactams, FFL, fosfomycin and quinolone was observed as well. Meanwhile, all the 10 mcr-3-positive Salmonella strains belong to ST34, and the mcr-3 gene was located on IncA/C-ST3 plasmids (7/10) in size of 140 ~ 160 kb and chromosome (3/10). Interestingly, this IncA/C plasmid is hybridized with IncFII plasmid and dissemination of mcr-3 is possibly mediated by IS26 or IS15DI.

Conclusion: In this study, we found Typhimurium Salmonella variant has a higher resistant rate to colistin. Differently from Escherichia coli, mcr-1 genes were mostly carried by IncHI2 plasmid instead of IncX4 plasmid, and for mcr-3 was bearing by IncA/C plasmid most frequently. Being one of the Highest Priority Critically Important Antimicrobial for human medicine, colistin is often used as the last therapy available for serious bacterial infections in clinics. The discovery of plasmid-borne mcr genes in Salmonella poses a threat to public health globally and further prevent and control strategy is definitely needed.

Disclosure of Interest: None declared

O40 ASSOCIATION OF ULTRAVIOLET-C ENHANCED TERMINAL ROOM DISINFECTION WITH HOSPITAL-ONSET GRAM-NEGATIVE BLOODSTREAM INFECTION: NATIONWIDE STEP-WEDGE TIME-SERIES ANALYSIS

M. Goto, E. C. Balkenende, G. S. Clore, R. Nair, E. N. Perencevich, on behalf of VA-CDC Practice-Based Research Network

Internal Medicine, University of Iowa/Iowa City VAMC, Iowa City, United States
Correspondence: M. Goto

Introduction: The role of the hospital environment is increasingly recognized in the transmission of Gram-negative rod (GNR) pathogens. Enhanced terminal room cleaning with ultraviolet C (UVC) disinfection has become more commonly used as a strategy to reduce the incidence of Clostridioides difficile or vancomycin-resistant enterococci, but its effectiveness in reducing GNR infections has not been evaluated.

Objectives: We aimed to assess the association of UVC disinfection during terminal cleaning with the incidence of hospital-onset (HO) GNR bloodstream infection (BSI) within the nationwide Veterans Health Administration (VHA) System in the United States.

Methods: We obtained information regarding UVC disinfection use and timing of implementation at each hospital through a survey of all acute care hospitals within the VHA system. Episodes of HO GNR BSI (defined as at least 48 hours of acute inpatient stay before the first positive blood culture for GNR) between 1/2010 and 12/2018 were identified, and bed days of care (BDOC) was used as the denominator. We analyzed the association of UVC disinfection with incidence rates of HO GNR BSI using a non-randomized, step-wedge design, using negative binomial regression model with hospital-specific random intercept, the presence or absence of UVC disinfection use for each month, baseline trend, and seasonality as explanatory variables.

Results: Among 143 VHA acute care hospitals, 136 hospitals (95%) responded to the survey and were included in the analysis. UV-C use was reported from 42 hospitals with various implementation start dates (range: 6/2010-6/2017). We identified 14,427 episodes of HO GNR BSI and 25,614,888 BDOC from the 136 hospitals during the study period. In addition to a baseline declining trend (-0.42% per month), UV-C use was associated with a lower incidence rate of HO GNR BSI (incidence rate ratio: 0.915; 95% confidence interval: 0851-0.984; p=0.016).

Conclusion: In this large quasi-experimental analysis within the VHA System, the enhanced terminal room cleaning with UVC disinfection was associated with an 8.5% lower incidence of HO GNR BSI. This finding suggests that UVC disinfection at time of patient discharge is a potentially effective component in infection prevention bundles targeting HO GNR BSI.

Disclosure of Interest: None declared

Slide session: Chlorhexidine baths and mouthwashes

O41 EFFECT OF DAILY CHLORHEXIDINE BATHING ON HOSPITAL-ACQUIRED INFECTION IN INTENSIVE CARE UNITS

F. A. Van Laer, E. Van Cauwenberg, H. Jansens

Infection Control, Antwerp University Hospital, Edegem, Belgium
Correspondence: F. A. Van Laer

Introduction: This study presents the results of the effect of daily chlorhexidine 2% (CHX) bathing on the incidence of hospital-acquired multidrug resistant micro-organisms (HA-MDRO) and central line associated bloodstream infections (CLABSI) in intensive care units (ICU) in the Antwerp University Hospital.

Objectives: To evaluate the impact of daily chlorhexidine bathing on HA-MDRO en CLABSI.

Methods: In July 2014 bathing the patients with CHX-impregnated washcloths was introduced in all five intensive care units (a total of 45 beds). The mean incidence of HA-MDRO per 1000 patient days before the introduction of the CHX-wascloths from 2006 to June 2014 was compared with the mean incidence of HA-MDRO after introduction of the CHX-washcloths from July 2014 to the end of 2018. The incidence of CLABSI per 1000 catheter-days from January 2014 to June 2014 was compared with the incidence from July 2014 to the end of 2016. After 2016 other preventive measures (i.e. the use of needles connectors, disinfecting caps for connectors,…) were implemented to reduce CLABSI.

Results: The incidence of MDRO was 6.51 per 1000 patient-days (from 2006 to June 2014) versus 2.94 per 1000 patient-days (from July 2014 to the end of 2018) after introduction of CHX-impregnated washcloths, the equivalent of a 54,8 % lower rate. There was just a small decrease of HA-MRSA acquisition from 0,31 to 0,28 per 1000 patient-days, the equivalent of a 9.77% lower rate. The incidence of CLABSI in the first six months of 2014 was 2,92 per 1000 catheter-days and decreased after introduction of CHX-washcloths to 2,24 per 1000 catheter-days, the equivalent of a 23,4% lower rate. From 2017 to the end of 2018, after introduction of other additional preventive measures, there was a further decrease in the incidence of CLABSI to 1,32/1000 catheter-days, the equivalent of a 45,2% lower rate compared with the incidence in 2014.

Conclusion: Daily bathing with chlorhexidine-impregnated washcloths reduced the risk of acquisition of MDRO and development of CLABSI in ICU.

Disclosure of Interest: None declared

O42 IMPACT OF CHLORHEXIDINE BATHS ON SUSPECTED SEPSIS AND BLOODSTREAM INFECTIONS IN HOSPITALIZED NEONATES IN ZAMBIA

T. Westling1, C. Cowden2, L. Mwananyanda3, C. Pierre4, D. Hamer5, S. E. Coffin2

1Biostatistics and Epidemiology, UPenn School of Medicine; 2Pediatrics, Children's Hospital of Philadelphia, Philadelphia, United States; 3Right to Care, Lusaka, Zambia; 4Internal Medicine, Boston Medical Center; 5Internal Medicine, Boston University, Boston, United States
Correspondence: S. E. Coffin

Introduction: Sepsis is the leading cause of infectious morbidity and mortality among hospitalized neonates. In high-resource pediatric and adult intensive care units, use of aqueous chlorhexidine (CHG) solution has been associated with reduced risk of bloodstream infections (BSI).

Objectives: To assess the impact of admission bathing of neonates with 2% CHG on BSI, sepsis, and mortality in a low-income hospital setting.

Methods: We conducted a secondary analysis of data from the Sepsis Prevention in Neonates in Zambia (SPINZ) study, a prospective observational cohort study performed at a large public referral hospital in Lusaka, Zambia. The SPINZ study assessed the impact of an infection control bundle (consisting of alcohol hand rub, SMS hygiene reminders, enhanced environmental cleaning, and CHG baths) on sepsis, BSI, and all-cause mortality. Episodic shortages in study staffing resulted in some enrolled babies not receiving a CHG bath. Using the Mantel-Haenszel log-rank test to compare the stratified Kaplan-Meier curves,we compared inborn babies enrolled during the study intervention phase who did and did not receive a CHG bath within the first 3 days of life.

Results: The majority of inborn, enrolled babies >1.5 kg received a CHG bath within 3 days of NICU admission (864 of 1233, 70%). Using survival analysis, we found that neonates who received a CHG bath within the first three days of admission had significantly lower rates of suspected sepsis (p=0.0003) and BSI due to a pathogenic organism (p=0.001), but not statistically significant lower rates of death (p=0.07). Comparing CHG-bathed to not-bathed babies, the hazard ratio for suspected sepsis was 0.66 (CI: 0.53, 0.83; p=0.0003), for BSI due to a pathogen was 0.46 (CI: 0.29, 0.77; p=0.002), and for death was 0.77 (CI: 0.58, 1.03; p=0.08).

Conclusion: In our single center study, CHG bathing at admission was associated with a reduced risk of suspected sepsis and BSI due to a pathogenic organism. Future analysis is required to determine whether this association persists after adjustment for severity of illness and likelihood to receive a CHG bath.

Disclosure of Interest: None declared

O43 CHLORHEXIDINE ORAL TOPICAL APPLICATION FOR CRITICAL PATIENTS: SAVIOR OR KILLER?

W. T. Bellissimo-Rodrigues, M. G. Menegueti, M. G. Mussolin, L. D. Macedo, A. Basile-Filho, R. Martinez, J. P. Souza, F. Bellissimo-Rodrigues

Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
Correspondence: F. Bellissimo-Rodrigues

Introduction: Chlorhexidine (CHX) oral topical application has been extensively used for preventing respiratory tract infections among critical patients, despite controversial effectiveness demonstrated in different clinical trials. More recently, this practice has been found suspect of enhancing mortality in hospitalized patients, for reasons not clearly understood. Acute Respiratory Distress Syndrome (ARDS) was hypothesized as a pathway for this association.

Objectives: To reassess data from a clinical trial evaluating oral care in the intensive care unit (ICU), in order to search for potential pathways for the CHX-associated mortality.

Methods: This is a post-hoc analysis of a randomized clinical trial (RBR-89CP93) evaluating a dental care intervention aimed to prevent respiratory tract infections in the ICU setting, funded by two non-profit foundations (FAPESP and FAEPA). We analyzed data from adult patients who were assigned to receive dental care provided by a dentist (experimental group) or routine oral care provided by the nursing staff (control group). Both groups used 0.12% CHX oral solution, if fully conscious, or 2% CHX oral gel, if unconscious, three times a day throughout their ICU stay. Adverse events potentially related to CHX use were reassessed and their relationship with in-ICU death was evaluated through a logistic regression model.

Results: Among the 254 patients included, 18 (7.09%) developed CHX-induced oral mucositis, which was independently associated with age (OR=1.05; 95%CI: 1.02-1.09) and the intervention (OR=6.53; 95%CI: 1.74-24.48), and inversely associated with being edentulous (OR=0.09; 95%CI: 0.02-0.45). On the other hand, CHX-induced oral mucositis was an independent risk factor for death (OR= 5.62; 95%CI: 1.94-16.25) and death due to respiratory tract infections (OR=3.27; 95%CI: 1.18-9.08). No death due to ARDS was reported.

Conclusion: CHX-induced oral mucositis was found to be a relevant risk factor for death in this clinical trial and may be a clinical pathway explaining why CHX enhances mortality among critical patients. Intensivists should be very cautious when prescribing CHX for critical patients and should immediately suspend it when any sign of oral mucositis is observed.

Disclosure of Interest: None declared

Slide session: Outbreaks and late breakers

O44 QUELLING CANDIDA AURIS OUTBREAK: THE C AURIS PREVENTION PROTOCOL - THE FIGHT BEYOND MEDICINE

K. Alexander, S. Brown, W. Javaid, S. Lorin, J. Ehni, D. Mazo, B. Camins, B. Koll

Infection Prevention and Control, Mount Sinai Health System, Brooklyn, United States
Correspondence: K. Alexander

Introduction: Identifying routes of transmission among hospitalized patients during a C. auris healthcare-associated outbreak can be tedious, particularly among patients with prolonged and complex hospital stays. Currently there are few data available on the effectiveness of interventions to prevent and control the transmission of C. auris. Engagement, education, execution, and evaluation were the cornerstones used by a hospital in New York to develop a C. auris prevention protocol (CAP).

Objectives: To evaluate the post-implementation of the CAP to quell the transmission of C. auris during a period of high incidence in a New York City Hospital.

Methods: A review of patients with C. auris from January 2016 to April 2019 at our hospital was conducted after the CAP bundle was implemented January 2017. The bundle included four elements: engagement, education, execution and evaluation. Education and engagement strategies included multidisciplinary work, debriefing sessions, live simulations, and leadership involvement. Execution strategies standardized the interventions into simple tasks to facilitate seamless comprehension. These consisted of hand hygiene, special contact precaution, dedicated staff and equipment, routine terminal cleaning of a patient’s room and equipment with bleach, secure waste and linen disposal, and hospital-wide communication. Evaluation strategies used a benchmark approach to appraise adherence with interventions and patient outcomes. Cleaning compliance was monitored and 100% compliance was required. This was followed by UV light disinfection.

Results: A total of 42 patients in our facility from January 2016 to April 2019 were noted to be colonized/infected with C. auris. Of the 42, 5 patients were noted to be associated with exposure to in our facility. Findings reveal that there were no new C. auris cases when compliance to cleaning methods was above average (76.9%) and execution of special contact precaution and hand hygiene was above average (69.2%).

Conclusion: The CAP bundle fortified multidisciplinary teamwork, increased staff/patient knowledge, standardized and simplified infection prevention processes, and created a verification and feedback process. The lessons learned at our facility maybe applicable to other hospitals facing the burden of C. auris around the globe.

Disclosure of Interest: None declared

O45 FIRST REPORTED NOSOCOMIAL OUTBREAK OF NDM-1 PRODUCING ESCHERICHIA COLI IN SWITZERLAND

R. Martischang, M.-N. Chraïti, V. Lazarevic, N. Gaïa, C. Bandiera-Clerc, H. Soule, G. Renzi, A. Iten, C. Ginet, D. Pittet, J. Schrenzel, S. Harbarth

Geneva University Hospital, Geneva, Switzerland
Correspondence: R. Martischang

Introduction: Since 2008, NDM-producing Enterobacteriaceae has spread globally. In late 2017, a patient transferred from Dubai was identified as NDM-producing E.coli carrier, and placed under contact precautions during two hospital stays at HUG in Jan & Jul 2018. Between Nov 2018 and May 2019, 3 secondary cases who had not travelled outside Switzerland for the past 12 months were found colonized with NDM-producing E. coli by routine screening swabs or urine cultures. Nosocomial cross-transmission was strongly suspected.

Objectives: We report an outbreak investigation guided through molecular approaches.

Methods: Roommates’ screening (July & Nov 18, May 19), and environmental screening and disinfection (May 19) in the concerned patient room were performed. Following Illumina iSeq sequencing, the relatedness between 4 NDM isolates was assessed by cgMLST and cgSNP analyses.

Results: Spatiotemporal analyses identified the simultaneous passage of 2 patients in a newly opened surgical step-down unit in July 18, and staggered passage of 3 patients in the same room on a private floor from Nov 18 through Apr 19. As of today (May 25), 20 environmental samples and all further contact screening swabs have been negative. Sequencing analysis confirmed cross-transmission with E. coli ST354 NDM-1 (<10SNPs). Standard precautions were reinforced in the concerned units. We implemented a computerized readmission alert system of all contact patients with potential exposition, requiring mandatory screening at re-admission. One of the patients died of surgical complications unrelated to E. coli NDM-1 carriage.

Conclusion: To our knowledge, this cluster represents the first nosocomial NDM-producing E. coli outbreak in Switzerland, with late outbreak detection due to hidden transmission despite strict contact precautions for the index case. This E. coli ST354 clone has so far mostly been reported from animals, and was rarely associated with carbapenemases. This outbreak confirms the high nosocomial transmission potential of these ultraresistant Enterobacteriaceae.

Disclosure of Interest: None declared

O46 MEASLES OUTBREAK IN HONG KONG – FROM THE HONG KONG INTERNATIONAL AIRPORT TO THE HOSPITAL

S. C. WONG1, V. CHENG1, K. Y. YUEN2

1INFECTION CONTROL UNIT, QUEEN MARY HOSPITAL; 2DEPARTMENT OF MICROBIOLOGY, THE UNIVERSITY OF HONG KONG, Hong Kong, Hong Kong
Correspondence: S. C. WONG

Introduction: Global resurgence of measles resulted in outbreaks in international airports, communities, and hospitals. However, a direct linkage of measles transmission from airport to hospital has not been well described.

Objectives: We reported an outbreak of measles with a clear epidemiological link from Hong Kong International Airport (HKIA) to the hospital.

Methods: Epidemiological investigation for the outbreaks in the HKIA and Hospital A were conducted. Infection control preparedness to prevent nosocomial transmission of measles in 43 hospitals under the governance of Hospital Authority included isolation of suspected case with epidemiological link to airborne infection isolation rooms, contact tracing for exposed patients and healthcare workers (HCWs), provision of MMR vaccination, and timely education forum to HCWs. Environmental and air samples were tested for measles RNA. Phylogenetic analysis of hemagglutinin gene of measles virus isolates collected from infected case in the HKIA, Hospital A, and the community was analyzed.

Results: Twenty-nine staff working at the HKIA of diverse rank and working location were infected with measles from 4 March 2019 to 3 April 2019. A significantly lower proportion of affected staff had history of travel compared with non-HKIA related measles cases in Hong Kong (9/29, 31% vs 27/36, 75%, p<0.01). During their incubation period, seven (70%) of 10 staff who could recall the exposure history had visited self-serviced food premises at the HKIA. The food trays were not adequately disinfected after use as observed during the epidemiological field investigation, although measles RNA was undetectable in the environmental and air samples. One baggage handler was admitted to a general ward in Hospital A before the onset of rash, with two HCWs, who had received two doses of MMR vaccine, being infected requiring subsequent contact tracing of 168 persons (97 patients and 71 HCWs). Phylogenetic analysis showed that the measles virus isolated in two infected HCWs was closely related to the HKIA outbreak strain, which was genotype B3.

Conclusion: Pre-exantham transmission of measles poses a great challenge to the hospital infection control. Breakthrough infection of measles may also occur in vaccinated HCWs.

Disclosure of Interest: None declared

Slide session: MRSA-VRE

O47 GENOMIC SURVEILLANCE OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS: A MATHEMATICAL EARLY MODELLING STUDY OF COST EFFECTIVENESS

A. Dymond1, H. Davies1, S. Mealing1, V. Pollit1, F. Coll2, N. M. Brown3, S. J. Peacock4

1York Health Economics Consortium (YHEC), York; 2London School of Hygiene & Tropical Medicine, London; 3Cambridge University Hospitals NHS Foundation Trust; 4Department of Medicine , University of Cambridge, Cambridge, United Kingdom
Correspondence: A. Dymond

Introduction: Used proactively, genomic surveillance of methicillin-resistant Staphylococcus aureus (MRSA) could direct early and highly targeted infection control interventions to prevent ongoing spread.

Objectives: Here, we evaluate the cost-effectiveness of this intervention in a model that compared whole genome sequencing plus current practice versus current practice alone.

Methods: A UK cost-effectiveness study was conducted using an early model from the perspective of the National Health Service (NHS) and personal social services. Effectiveness of sequencing was based on the relative reduction in total MRSA acquisitions in a cohort of hospitalised patients in the year following their index admissions. Resource use and costs were reflective of the UK NHS. Sensitivity analysis was used to illustrate and assess the level of confidence associated with the conclusions of our economic evaluation.

Results: A cohort of 65,000 patients were ran through the model. Assuming that sequencing would result in a 90% reduction in MRSA acquisition, 290 new MRSA cases were avoided. This gave an absolute reduction of 28.8% and avoidance of five MRSA-related deaths. Base case results indicated that the use of routine, proactive MRSA sequencing would be associated with estimated cost savings of over £728,290 per annual hospitalised cohort. The impact in total quality adjusted life years (QALYs) was relatively modest, with sequencing leading to an additional 14.28 QALYs gained. Results were most sensitive to the probability of an MRSA negative patient acquiring MRSA during their hospital admission.

Conclusion: We showed that proactive genomic surveillance of MRSA is likely to be cost-effective, with the model results indicating that routine MRSA sequencing would result in fewer MRSA cases and have a small, positive impact on health-related quality of life.

Routine prospective MRSA sequencing could be used to detect outbreaks and prevent unnecessary action in the event of a pseudo-outbreak. Further evaluation is required in the context of a prospective study.

Disclosure of Interest: A. Dymond Employee of: York Health Economics Consortium, H. Davies Employee of: York Health Economics Consortium, S. Mealing Employee of: York Health Economics Consortium, V. Pollit Employee of: York Health Economics Consortium, F. Coll Consultant for: Next Gen Diagnostics LLC, N. Brown: None declared, S. Peacock Grant/Research support from: Health Innovation Challenge Fund, Consultant for: Specific Technologies and Next Gen Diagnostics LLC

O48 DIAGNOSTIC ACCURACY AND PREDICTION OF FOLLOW-UP POSITIVE CULTURES BY XPERT®-VANA/VANB ASSAY FROM A SELECTIVE ENRICHMENT BROTH DURING A VANB VANCOMYCIN-RESISTANT ENTEROCOCCUS FAECIUM OUTBREAK

V. Piezzi1, A. Lüthi2, F. Suter-Riniker 2, C. Casanova2, S. Droz2, J. Marschall1, S. L. Leib2, R. Sommerstein1, P. Bittel 2

1Infectious Diseases, Bern University Hospital; 2Institute for Infectious Diseases, University of Bern, Bern, Switzerland
Correspondence: V. Piezzi

Introduction: Rapid and precise diagnosis of newly colonized patients during an outbreak with vancomycin-resistant enterococci (VRE) is of utmost importance for infection control. Currently, molecular-based methods lack specificity to identify vanB-VRE from rectal swabs. Additionally, it is unknown whether a molecular-based method can predict a positive culture in follow-up swabs.

Objectives: The aim of this study was to answer these questions by testing swabs following inoculation in a selective enrichment broth.

Methods: Prospective study between July and August 2018 during an vanB-VRE outbreak. All consecutive rectal swabs were tested by both conventional culture and a molecular-based method. Swabs were inoculated in a selective enrichment broth (4.5 mg/L vancomycin, 2 mg/L meropenem, 16 mg/L amoxicillin) at 35°C for 20-25 hours. We then used the Xpert®-vanA/vanB assay to detect the vanB gene. For conventional culture-based testing, the broths were plated on selective/chromogenic plates. We identified colonies by MALDI-TOF MS and confirmed the presence of vanB with the Xpert®-vanA/vanB assay. For data analysis we used pROC package in R.

Results: We included 597 rectal swabs from 396 patients. 32/597 swabs (5.4%) were culture-positive vanB-VRE. Sensitivities and specificity, using culture as the gold standard, per PCR cycling time threshold are shown in Figure 1. The calculated ROC area under the curve was 0.99 (95%CI: 0.98-1). The negative predictive value at a cycling time of 33 was 99% (95%CI: 98%>100%).

128 (32%) patients had a median of 1 (range 1-4) follow-up screenings. In 6/128 (4.7%) patients with >1 screen, a follow-up swab was culture-positive. Preceding cycling time values were not indicative of subsequent culture positivity (Figure 2).

Conclusion: The use of the Xpert®-vanA/vanB assay with prior enrichment in selective broth yielded an excellent specificity for the diagnosis of vanB-VRE and a high negative predictive value for ruling it out. During an outbreak this approach is attractive in that it can quickly exclude VRE carriers. However, the molecular method is unable to predict culture-positive VRE in follow-up swabs.

Disclosure of Interest: None declared

O49 IMPACT OF THE MRSA PREVENTION PROGRAM ON ISOLATION OF MRSA FROM CLINICAL CULTURES AMONG LONG-TERM CARE RESIDENTS IN THE US DEPARTMENT OF VETERANS AFFAIRS HEALTHCARE SYSTEM

V. W. Stevens1, M. Z. David2, M. Jones1, D. Linkin3, M. E. Evans4, R. E. Nelson1, N.-C. N. Chang1, W. Bilker2, T. M. Willson1, E. Lautenbach2

1IDEAS Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City; 2University of Pennsylvania; 3Philadelphia VA Medical Center, Philadelphia; 4National Infectious Diseases Service, US Department of Veterans Affairs, Lexington, United States
Correspondence: V. W. Stevens

Introduction: In 2009, the US Department of Veterans Affairs (VA) expanded its comprehensive methicillin-resistant Staphylococcus aureus (MRSA) prevention program to all long-term care (LTC) facilities.

Objectives: The objective of this study was to examine the impact of the program on the incidence of healthcare-associated MRSA (HA-MRSA) isolated from clinical cultures in LTC residents

Methods: We conducted a retrospective interrupted time series analysis of the monthly rates (per 10,000 resident-days) of HA-MRSA isolated from clinical (i.e., non-surveillance) cultures in VA LTC residents between 1 January 2005 and 30 September 2015. Coagulase negative Staphylococci (CoNS) bloodstream cultures were used as a non-equivalent dependent variable, defined as two positives from different samples in <24 hours. Facilities with at least 12 months of pre- and post-intervention data were included. We used segmented Poisson regression to separately estimate the intercept and slope changes from pre-intervention (1 January 2005 to 31 Dec 2008) to intervention rollout (1 January 2009 to 30 June 2009) and intervention (1 July 2009 to 30 September 2015) periods.

Results: Prior to the intervention, the HA-MRSA rate was significantly declining (b=-.004, p=0.001). There was no change in the slope during the rollout or post-intervention periods (p=.54 and p=0.22, respectively). No significant level (intercept) changes were observed during the same periods (p=0.58 and p=0.91, respectively). Rates of CoNS were stable before and after the intervention

Conclusion: We found a decreasing HA-MRSA trend but no further statistical decrease in trend associated with the expansion of the MRSA initiative to LTC facilities. Future work will assess whether the observed downward trend is due to decreasing importation following the implementation of the program in acute care facilities in 2007 or other factors, and account for hand hygiene and environmental cleaning activities.

Disclosure of Interest: None declared

O50 EVALUATING THE COST-EFFECTIVENESS OF DECOLONIZATION FOR PREVENTION OF MRSA INFECTIONS USING A DYNAMIC TRANSMISSION MODEL

R. E. Nelson1, W. Ray1, M. A. Rubin1, M. Schweizer2

1IDEAS Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City; 2Iowa City Veterans Affairs Health Care System, Iowa City, United States
Correspondence: R. E. Nelson

Introduction: All Veterans admitted to a VA hospital are tested for MRSA carriage and positive patients are placed in contact precautions. An additional strategy for prevention of MRSA transmission is decolonization using an antimicrobial agent such as mupirocin, chlorhexidine, or povidone iodine.

Objectives: Our goal was to perform a cost-effectiveness analysis (CEA) of adding decolonization to the current strategies using a dynamic, agent-based simulation model.

Methods: Our simulation model tracked patients according to MRSA carriage, clinical infection, and detection status and their movement through 3 wards (intensive care unit, surgery, or other) in an acute care hospital over a 1-year period (roughly 22,000 inpatient admissions). We assumed patient-to-patient transmission of MRSA was more common between patients in the same ward than different wards. Rates of MRSA acquisition were calibrated to data from VA acute care hospitals from 2007-2015 and we varied the assumed effectiveness of decolonization in eradicating MRSA from 0-100%. For the CEAs, the effectiveness outcomes were life-years (LYs) gained and HAIs prevented and costs were taken from the VA perspective. We used values for the pre-discharge cost ($24,726, 95% CI: $11,204-$38,249), post-discharge cost ($11,676, 95% CI: $6,260-$17,091), and relative risk of mortality (2.77, 95% CI: 2.39-3.21) associated with MRSA HAIs from published studies using VA data. We ran 10,000 iterations of the model with and without decolonization drawing parameter values from pre-specified distributions.

Results: Decolonization was dominant (i.e., both more effective and less costly) relative to the VA’s current MRSA Initiative in 43.7%, 74.9%, 96.6%, and 99.8% of the 10,000 iterations for which decolonization effectiveness ranged from 0-25%, 25-50%, 50-75%, and 75-100%, respectively, for the HAIs prevented effectiveness measure. For the LYs effectiveness measure, it was cost-effective at a willingness-to-pay threshold of $100,000/LY in 54.3%, 56.8%, 61.4%, 64.5% of the 10,000 iterations of the same ranges for decolonization effectiveness.

Conclusion: Our CEA results using a dynamic transmission model suggest that decolonization of MRSA carriers may be a cost-effective strategy for prevention of MRSA transmission and infections in the VA healthcare system.

Disclosure of Interest: None declared

O51 METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) PREVALENCE AMONG HEALTHCARE WORKERS (HCW) IN CONTACT TRACINGS IN A DUTCH TEACHING HOSPITAL, 2010-2017

V. Weterings1,2, H. Kievits1, J. Kluytmans1,3,4

1Infection control, AMPHIA HOSPITAL, Breda; 2Medical Microbiology, Radboud University Medical Centre, Nijmegen; 3Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Utrecht; 4Microvida Laboratory for Microbiology, AMPHIA HOSPITAL, Breda, Netherlands
Correspondence: V. Weterings

Introduction: In The Netherlands, the national guideline on MRSA prevention and control advocate screening of HCW after unprotected contact to MRSA carriers. Although this strategy is successful, contact tracing of staff is time consuming and costly.

Objectives: We evaluated our contact tracing policy for HCW over the years 2010 – 2017.

Methods: This retrospective, observational study was performed in a large Dutch teaching hospital. In accordance with the national guideline, all HCW who had been in close and unprotected contact with an MRSA carrier were included in contact tracing. When there had been a long period of unprotected admission prior to an MRSA finding, or when the index case was a HCW, than the entire (nursing) team was tested.All samples of HCW who were tested for MRSA carriage as part of contact tracing from 2010 until 2017 were included. A pooled nose, throat and perineum swab was collected using the eSwab medium (Copan) and inoculated on chromID MRSA agar plates (bioMérieux) after enrichment in a broth. Molecular typing was performed using multiple locus variable number of tandem repeat analysis (MLVA).

Results: In total, MRSA carriage was assessed in 8,142 samples (range: 728 – 1,448 samples per year) from 287 contact tracings (range: 26 – 55 contact tracings per year). Thirty HCW were colonized with MRSA (0.37%; 95%CI 0.26 – 0.53). None of them developed a clinical infection. Eight HCW (0.10%;95%CI 0.05 – 0.19) were colonized with the same MLVA type as the index case, and were detected in 6/287 contact tracings (2%). Notable, a different MLVA type as the index case was found in 22 HCW (0,27%; 95%CI 0,18 – 0,41) of which 7/22 HCW (31.8%) were intermittent carriers.

Conclusion: This study shows that when MRSA contact tracing is performed according to the national guideline only 1 out 1000 samples results in a secondary case. This is similar to the population carriage rate of MRSA in The Netherlands. More frequently an unrelated strain is found. These findings raise question marks regarding the validity of the current strategy to perform contact tracing after unprotected exposure.

Disclosure of Interest: None declared

O52 VRE SCREENING PROGRAM AND COSTS OF THREE VRE OUTBREAKS 2012, 2015 AND 2018

I. Pruis1, A. Sandijck1, A. Burggraaf1, P. Smit1, J. V. D. Stel2, M. Damen1

1Department of Medical Microbiology and Infection Prevention, 2Department of quality and safety, Maasstad Hospital, Rotterdam, Netherlands
Correspondence: I. Pruis

Introduction: During 2012, 2015 and 2018, three outbreaks with Vancomycin resistant Enterococcus faecium (VRE) occurred at Maasstad hospital, Rotterdam, The Netherlands.

Objectives: The main objective of this study was to evaluate the response to these outbreaks. The response including, a cost/benefit analysis of our VRE screening program was performed.

Methods: Our VRE screening program involved weekly testing for all >7 days-hospitalized patients. Rectal swabs were screened with PCR after incubation in enrichment broth. If indicated, VRE strains were typed with Multiple Loci Sequence Typing (MLST). The costs of the VRE outbreaks were estimated as well as the costs of our VRE screening program.

Results: In 2012, VRE outbreak occurred with a ST712 strain among 30 positive patients/568 screened on 7 departments (7 months). After the outbreak, the screening program was implemented.In 2015, VRE outbreak occurred with a ST18 strain among 5 positive patients/161 screened on 3 departments (4 months). This outbreak was discovered due to the VRE screening program.In 2018, VRE outbreak occurred with a ST612 strain among 55 positive patients/1300 screened on 7 departments (5 months).Transmission of ST612 VRE in 2018 was undetected for 3 months due to an impaired screening program (implementing a new electronic patient record).Many measures were taken in the 2018 outbreak; intensified screening/typing (€ 73.856), extended isolation precautions (€ 102.500), upgraded cleaning and disinfection (€ 492.000), overtime for employees of infection prevention and laboratory (€ 55.500) and extra nursing staff (€12.936). For the 2018 outbreak, the costs were estimated to be € 740.000 (excluding closing beds, discarded medication, sickleave of staff, reputation damage and other non-material losses). Extrapolating the 2018 outbreak costs to previous outbreaks costs are estimated to be € 199.000 (2015) and € 800.000 (2012). The cost of our VRE screening program is € 107.000/year.

Conclusion: The VRE screening program costs seem to outweigh the costs of outbreak control measures. Early detection of VRE is important to limit the size of the outbreak. If the screening program was not hampered in 2018, the outbreak could have potentially been limited to the 2015 outbreak size. Based on a very crude estimate, this would have saved at least € 300.000.

Disclosure of Interest: None declared

Poster Session: Device associated blood-stream infections 1

P1 A CLUSTER OF PSEUDOMONAS AERUGINOSA BACTEREMIA IN IMMUNOCOMPROMISED PATIENTS IN A TERTIARY CARE CENTER IN LEBANON

N. K. Zahreddine1, R. AHMADIEH1, J. TANNOUS1, Z. KANAFANI2, S. KANJ2

1Infection Control and Prevention Program; 2INFECTIOUS DISEASES, AMERICAN UNIVERSITY OF BEIRUT MEDICAL CENTER, Beirut, Lebanon
Correspondence: N. K. Zahreddine

Introduction: Pseudomonas aeruginosa is an opportunistic pathogen that cause serious conditions in immunocompromised patients. Contaminated water systems have been reported to contribute to P. aeruginosa transmissions in healthcare settings.

Objectives: The purpose of this study is to investigate the source of a cluster of P. aeruginosa bacteremia in immunocompromised patients.

Methods: An ongoing prospective surveillance is conducted in the oncology floor at the American University of Beirut Medical Center. Central Line Blood Stream Infections (CLABSI) was diagnosed using the CDC/NHSN (Centers for Disease Control and Prevention/National health and Safety Network) methodology.

Water samples and environmental cultures from patients’ rooms and sinks were collected when a potential environmental source for CLABSI was suspected. Relatedness of environmental results to CLABSI organisms was studied using phenotypic Antimicrobial Susceptibility (AMS) profiles and molecular typing methods using random amplification of polymorphic DNA (RAPD). Elements of the CLABSI prevention bundle were reemphasized for staff assigned to these units.

Results: Three patients developed CLABSI with P. aeruginosa within a period of 2 weeks during October 2018. One water culture grew P. aeruginosa, whereas negative results were reported from all the remaining environmental cultures during the same period. While molecular typing results showed identical RAPD patterns in both the clinical and the environmental isolates, substantial differences were noted in the phenotypic AMS profiles/patterns among the same isolates suggesting that these isolates are not related.

Conclusion: Hospital water systems can be potentially contaminated with P. aeruginosa and may cause infections in vulnerable patients in healthcare settings. The investigation of this cluster did not reveal the source but was halted following infection control interventions at multiple levels.

The isolated organisms were not thought to be related based on different AMS despite their identical RAPD patterns. Such findings dictate the need for more sensitive and discriminatory molecular test such as Pulse Field Gel Electrophoresis (PFGE), multilocus sequence typing (MLST) or Maximum-entropy Linear Discriminant Analysis (MLDA).

Disclosure of Interest: None declared

P2 FOUR- YEAR RESISTANCE PATTERNS OF GRAM-NEGATIVE BACTERIA ISOLATED FROM BLOODSTREAM INFECTIONS AT A TERTIARY HOSPITAL IN IRAN

G. Pouladfar, Z. Jafarpour, B. Pourabbas, A. Abbasian, M. Anvarinejad, P. Abbasi, M. Hoseini, M. A. Dehyadegari, M. A. Shahidi

Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic Of
Correspondence: G. Pouladfar

Introduction: Antimicrobial resistance, especially in health care setting, is a growing, serious, and potentially preventable public health problem worldwide.

Objectives: We aimed to investigate the antimicrobial resistance pattern of Gram-negative bacteria (GNB) isolated from patients with bloodstream infections (BSI) at a tertiary care hospital in Iran.

Methods: We conducted a cross-sectional study of blood cultures submitted to the Professor Alborzi Clinical Microbiology Research Center at a 1000-bed university-affiliated hospital in Shiraz, southern Iran. All GNB isolated from August 2014 to September 2018 were included. Antimicrobial susceptibility testing was done by Kirby bauer’s disc diffusion method. Extended-spectrum β-lactamase (ESBL) producers were detected by double disc synergy test (DDST). The data entry and analysis were performed using the WHONET 5.6 software.

Results: Overall, among 4869 pathogens isolated from blood culture, GNB were the predominant isolates (3712, 76.2%). The most frequently isolated GNB were Stenterophomonase maltophilia (1318, 35.5%), followed by Pseudomonase spp. (466, 13%), Escherichia coli (n=397, 11%), Acinetobacter baumannii (317, 9%), and Klebsiella pneumonia (253, 7%). The number of Enterobacteriaceae were 947 (25.5%) and non-fermenting Gram-negative bacilli (NFGNB) 2741 (73.8%). Totally, 8.9% of Enterobacteriaceae isolates were carbapenem-resistant. In addition, 492 out of 716 Enterobacteriaceae isolates tested by DDST were ESBL producer (68.7%). On the other hand, 38.1% of NFGNB were carbapenem-resistant and 375 out of 396 NFGNB isolates tested by DDST were ESBL producer (94.7%). The resistance rates of Enterobacteriaceae to amikacin were 19.5%, gentamicin 30.5%, and ciprofloxacin 41.6%. The resistance rates of NFGNB to amikacin were 52.7%, gentamicin 54.5% and ciprofloxacin 35.3%.

Conclusion: GNB were the predominant bacteria isolated from patients with BSI. The high antibiotic resistance rate of these bacteria is a warning about a serious health problem. We need immediate actions including implementations and adhesions to infection control practices and antibiotic stewardship programs to overcome this serious health problem.

Disclosure of Interest: None declared

P3 CHLORHEXIDINE BATHING TO PREVENT HEALTHCARE-ASSOCIATED BLOODSTREAM INFECTIONS IN PATIENTS WITH HAEMATOLOGICAL MALIGNANCIES: A PROSPECTIVE CONTROLLED COHORT STUDY

K.-L. Tien1, J.-T. Wang1, C.-T. Fang2, Y.-C. Chen1

1Center for Infection Control, National Taiwan University Hospital; 2College of Public Health, National Taiwan University, Taipei, Taiwan
Correspondence: K.-L. Tien

Background: Patients with haematological malignancies hospitalised for myelosuppressive chemotherapy are at high risk of serious healthcare-associated infections. Chlorhexidine (CHG) bathing decreases incidence of bloodstream infections at intensive care units, but its effect has not been assessed in patients with haematological malignancies at non-critical-care units.

Methods: This is a prospective, concurrent controlled, cohort study at a university medical centre. Adults with haematological malignancies hospitalised for cytotoxic chemotherapy at non-critical-care units were offered daily 2% CHG bathing. We compared outcomes of patients chose to take CHG bathing (CHG group) and that of those chose not to take (usual care group). The primary outcome was gram-positive cocci, skin-flora-related, or central-line-associated bloodstream infections. The negative-control outcome was gut-origin baecteremia. Outcomes were monitored by a rule-based healthcare associated infections surveillance and classification system. Multivariable Cox regression analyses were used to adjust covariates. (registration no: #201508030RIPD)

Findings: The CHG group (n=485) had a crude incidence rate of primary outcome 60% lower than that in the usual care group (n=408) (3·4 vs. 8·4 per 1,000 patient-days, p< 0·001) but had a similar crude incidence of negative-control outcome (4·5 vs. 3·2 per 1,000 patient-days, p=0·297). In multivariable analyses, CHG bathing was associated with a 70% decrease in the primary outcome (adjusted hazard ratio [HR] 0·3, p<0·001). In contrast, CHG bathing had no effect on the negative-control outcome (adjusted HR=1·0, p=0·923). CHG bathing was well tolerated by participants in the CHG group.

Interpretation: CHG bathing is a highly effective approach to prevent gram-positive-cocci /skin-flora/central-line-associated baecteremia in patients with haematological malignancies hospitalised for cytotoxic chemotherapy at non-critical-care units.

Disclosure of Interest: None declared

P4 THE USE CHLOREXIDINE GLUCONATE IMPREGNATED DRESSING AS PREVENTION CATHETER-RELATED INFECTION: INTEGRATIVE REVIEW

F. D. O. Andrade1, V. D. B. Poveda2, R. T. N. Turrini2, S. G. Esperandio3

1Nursing, Hospital of Clinic of Federal University of Parana, Curitiba; 2Nursing, School Nursing of University of Sao Paulo, Sao Paulo; 3Nursing, Hospital Municipal of Sao Joao do Ivai, Sao Joao do Ivai, Brazil
Correspondence: F. D. O. Andrade

Introduction: Catheter-related infection are associated with increased rates of morbidity, mortality, increased length of hospital stay, and consequent increase in medical costs. It is known that one of the main sources of microbial colonization of central venous catheters is the microorganisms of the patient's own microbiota of the skin (endogenous microorganisms) located at the catheter insertion site.

Objectives: To compare and evaluate the efficacy of chlorhexidine gluconate impregnated transparent dressing compared to conventional dressing (with dry gauze) to reduce the count of skin microorganisms on the site of the catheter insertion, with consequent reduction of the catheter-related infection

Methods: This is an integrative review, performed through the databases: Virtual Health Library, Cranial, Cochrane, Embase, PubMed, using the keywords: antisepsis, chlorhexidine, catheter-related infection.

Results: 68 studies, observational or experimental, of which 2 were included, one (50%) meta-analysis and one (50%) randomized clinical trial, published between 2014 and 2019, in the English language, were produced in the United States and China. The studies analyzed demonstrated that there was a significant reduction of catheter-related infection in patients who used the chlorhexidine gluconate impregnated dressing compared to patients using the conventional dressing because it is believed that the insertion of the catheter to be exposed to continuous antiseptic action, and the easy visibility of the catheter insert.

Conclusion: The use of the chlorhexidine gluconate impregnated transparent dressing has been shown to be effective in reducing infection rates related to the central venous catheter. However, further studies should be conducted to evaluate the cost-effectiveness of chlorhexidine gluconate impregnated transparent dressing in order to provide safe, harmless care to patients who need to use the central venous catheter.

Disclosure of Interest: None declared

P5 Withdrawn

P6 INFECTIOUS COMPLICATIONS RELATED TO THE USE OF CENTRAL VENOUS ACCESS DEVICES AND PERIPHERALLY INSERTED CENTRAL CATHETERS: A COMPARATIVE STUDY

A. N. B. Mota1, V. de Brito Poveda2, R. N. T. Turrini1

1Medical and surgical nursing, University of São Paulo (Universidade de São Paulo-USP); 2Medical and surgical nursing department, UNIVERSITY OF SÃO PAULO, São Paulo, Brazil
Correspondence: V. de Brito Poveda

Introduction: The use of Peripherally Inserted Central Catheters has shown benefits. However, the literature is controversial regarding its superiority for reducing bloodstream infection rates.

Objectives: The objective of the present study was to identify and compare the incidence of infectious complications related to the use of Central Venous Access Devices and Peripherally Inserted Central Catheters.

Methods: This prospective cohort study was carried out in intensive care units and medical and surgical clinics of a university hospital specialized in cardiopulmonology in the city of São Paulo, Brazil. The central venous catheters were evaluated on the day of insertion and monitored on a daily basis in loco throughout the hospitalization, up to their removal or hospital discharge (alive or deceased). The medical records of the patients were also reviewed in search of relevant information related to the catheters.

Results: 189 catheters were analyzed, and catheter-related bloodstream infection was confirmed in one (2.6%) patient with whom a Central Venous Access Device was used. Catheter-related bloodstream infection was be observed in 0.89/1000 catheter-days in Central Venous Access Devices and in 0/1000 catheter-days in Peripherally Inserted Central Catheters.

Conclusion: Overall, there was higher incidence of catheter-related bloodstream infection in patients using Central Venous Access Devices. 7However, the lack of more evidence to corroborate the greater efficacy of Peripherally Inserted Central Catheters compared to Central Venous Access Devices does not support indicating Peripherally Inserted Central

Disclosure of Interest: None declared

P7 AUDIT ON GOOD PRACTICES RELATED TO PERIPHERAL VENOUS CATHETERS IN JANUARY 2019

G. Brahimi1, S. AIT SEDDIK2, H. KHELLAF2, N. CHEBOUB1, A. EL KECHAI1, A. CHETITAH1, K. CHABANE1, M. CHERCHARI1, A. DAHLI1, S. SLAOUTI1, I. BOUFASSA1, A. LARINOUNA1, A. REBOUH3, R. BELKAID1

1ÉPIDÉMIOLOGIE; 2 ÉPIDÉMIOLOGIE, CHU BENI MESSOUS; 3ÉPIDÉMIOLOGIE, INSP, Alger , Algeria
Correspondence: G. Brahimi

Introduction: The practice of peripheral venous catheters (PVC) can be trivialized, and creates gaps from the guidelines.

Objectives: -Measure the application of good practices related to the installation, handling, duration and removal of PVCs.

- Identify the practices to be improved.

Methods: The audit was carried out in 14 medical departments from 30/12/2018 to 07/01/2019. The collection of data was done by direct observation at the time of the care and interview of the staff. The entry and analysis of the data was carried out on the EPIDATA software.

Results: 90 PVC were observed and followed until ablation. The pose was performed by public health nurses in 62.2% of cases. There is no published protocol on PVC's good practices in the audited services. A hand hygiene (HH) before the pose was observed in 6.7% of the cases and the wearing of gloves in 72.2% however their change was not realized in 64.4% neither by opportunity nor by patient. The first three skin preparation steps (debridement, rinsing and drying) weren't observed and the cutaneous antisepsis was carried out in 96.7% with alcohol at 70 ° and povidone iodine in 3.3%. Immediate removal of the mandrel in a nearby collector was observed in 52.2% of cases. There is no traceability of the catheter placement in the patients' file.The manipulation of PVC is preceded by an HH in 32.2% and a disinfection of the opening of the venous line by a sterile compress in 10% of cases. The fixation of the catheter was made using a non-sterile, non-transparent dressing. Surveillance of the perfusion line and insertion site was provided in 100% of cases. 18% of the withdrawals were preceded by a HH and 34.8% by a desinfection of the insertion point using a sterile pad. The duration of maintenance of the device was respected in 100% of the cases.

Conclusion: This audit allowed us to reflect on the need for training of the nursing staff. The installation of PVC must be the subject of a written protocol validated by CLIN.

Disclosure of Interest: None declared

P8 NEW MUTATIONS IN GYRA AND PARC GENES IN CARBAPENEM- RESISTANT E. COLI AND A. BAUMANNII AMONG CATHETER RELATED BLOOD STREAM INFECTION PATIENTS IN EGYPTIAN ICUS

A. R. Elmanakhly, A. A. Elkholy

Infection prevention and control department, Dar Alfouad hospital, Cairo, Egypt
Correspondence: A. R. Elmanakhly

Introduction: Resistance of E. coli and A. baumannii to antimicrobials is a growing global concern. The most serious resistance bacteria that are carrying carbapenem-resistant genes and acquire changes in the structure of DNA gyrase and topoisomerase IV enzymes that lead to fluoroquinolone- resistance.

Objectives: evaluate the presence of mutations in the gyrA and parC genes in Egyptian ICU and their correlation with carbapenem resistant genes E. coli and A. baumannii isolates from patients in ICUs of a tertiary care hospital in Egypt.

Methods: A total of 300 consecutive and non-duplicate A. baumannii and E. coli clinical isolates were isolated from ICU patients in 4 tertiary hospitals in Egypt. The bacterial isolates were identified by VITEK-2 (Bio Merieux, France). Antimicrobial susceptability testeing was preformed according to CLSI guidelines. Phenotypic detection of carbapenemase was done by carba-NP test, followed by molecular identification of carbapenemase encoding genes blaNDM, blaOXA-48 and blaKPC by multiplex PCR. The quinolone resistance-determining regions (QRDRs) of gyrA and parC genes were amplified by singleplex PCR followed by reverse and forward sequencing to detect the gene mutation. The DNA sequences were compared with the sequences of wild type of these genes available in GenBank database. Then, the obtained DNA sequences and their amino acid sequences were analysed using bioinformatics tools.

Results: All isolates showed high level of resistance among tested antimicrobial agents (cephalosporins, aminoglycosides, carbapenems, penicillins) that ranged from 36% to 100%. Carba-NP detected 43.59% of the carbapenem resistant isolates. Multiplex PCR detected that 17.95%, 46.15% and 2.56% of isolates were harbouring blaKPC, blaNDM and blaOXA-48 respectively. PCR and sequencing technique showed combined gene mutation in 8 carbapenem resistant E. coli and A. baumannii isolates and specific new substitutions observed in gyrA and parC. On the other hand, were point mutations were observed in two A. baumannii isolates, whereas Ser172Leu mutation was observed in two E. coli isolates.

Conclusion: presence of carbapenem resistance genes in combination with single and multiple mutations in QRDR causes the presence of highly resistant E. coli and A. baumannii isolates in the Egyptian hospitals.

Disclosure of Interest: None declared

P9 PRACTICES OF NURSES REGARDING HANDLING OF CENTRAL LINE CATHETER AT A TERTIARY CARE CENTER

N. V. Singh, N. V. Singh, S. Ghai, S. Ghai, R. Devi, S. Ghai, N. Vir Singh, GD Puri

NATIONAL INSTITUTE OF NURSING EDUCATION, POSTGRADUATE INSTITUTE OF MEDICAL EDUCATION AND RESEARCH, CHANDIGARH, CHANDIGARH, India
Correspondence: N. V. Singh

Introduction: Central venous catheters(CVC)are used to administer the life supportive medications. These catheters place the patients at risk of complications including blood stream infection. Nurses have an important role in the prevention of such infections. There is a need to develop standard guidelines for these types of procedures.

Objectives: To observe baseline practices of nursing personnel regarding care of central line catheter in ICUs of a tertiary care centre.

Methods: An Observation checklist was developed to assess the baseline practices of nursing personnel. The practices were observed regarding hand washing, maximal barrier precautions, skin asepsis, frequency of central line care and dressing change, replacement of IV fluid administration sets. Focus group discussions were conducted to identify the problems encountered by them during the care of CVC and seeking their suggestions.

Results: Hand washing was performed by 91.7% of the nurses before accessing the insertion site. 66.7% performed hand hygiene before donning gloves to handle CVC and 75% performed hand hygiene after removing the gloves. Extension lines and high pressure lines were changed after 72 hrs by 91.6% of the nurses. Everyone secured the CVC line well to the patients. None of the nurses wiped the catheter lumen after use, before and after sampling and before connecting new drug. 91.6% wore clean gloves to remove the old dressing, stabilized the catheter hub while removing the old dressing and performed proper cleaning of CVC line. Only 41.6% documented the date and time of dressing change in nurses’ record.

Conclusion: Total 6 focus group discussions were conducted. The problems verbalized by the nursing personnel that hindered the proper care of the central venous catheter line were the none availability of a written protocol on CVC line care, Inadequate nurse patient ratio and supply of articles, absence of inservice education programme and lack of coordination between the members of the health care team

Disclosure of Interest: None declared

P10 CONTROLLING HEALTHCARE ASSOCIATED PRIMARY BLOODSTREAM INFECTION IN NEONATAL INTENSIVE CARE UNIT

W. A. Mazi1, N. A. Bouafia1, T. J. Kalarikkal2, S. H. Al Wagdani1, R. I. Abutaha2

1Infection Prevention and Control; 2Neonatal Intensive Care Unit, King Faisal Medical Complex, Taif, Saudi Arabia
Correspondence: W. A. Mazi

Introduction: Health care-associated blood stream infections (HABSIs) are cause of morbidity and mortality in very low birth weight neonates.

Objectives: To reduce HABSI.

Methods: A prospective study was conducted in a 92-bed capacity level II/III NICU category at King Faisal Medical Complex, Taif, Saudi Arabia, from January 2018 to April 2019. Criteria of HABSI was carried out using the Centers for Disease Control and Prevention and National Healthcare Safety Network (CDC/NHSN, USA) guidelines. Incidence rate, utilization ratio, benchmarking, and statistical analysis were carried out using the NHSN recommendations.

NICU was segregated into 5 zones based on patient clinical condition; NICU zone1 for admission till improved, NICU zone 2 for respiratory support without ventilator, NICU zone 3 for high dependency care, gaining weight with minimal respiratory support without nutrition support, NICU zone 4 for special care baby, weighted more than 1500 gram and preparing for discharge home and NICU zone 5 for chronic patients and stay until discharge home. Each zone was assigned nurses based on patient to nurse ratio as 1:4, 1:5, 1:6 and 1:7 and 1:8; respectively. Hand hygiene compliance was emphasized with continuous monitoring hand hygiene using camera observation located in the unit with regular feedback. Central-line bundle prevention measures were implemented.

Results: Hand hygiene and central-line bundle compliance rates were sustained in high level (ranged from 78% to 89% and 90%, respectively).

The incidence rate per 1000-central line days among each birth-weight category exceeded 90th percentile before intervention and declined to 75th percentile after intervention with different utilization ratio benchmarking to NHSN, USA.

Two outbreak episodes were reported caused by extended spectrum beta lactamase (ESBL) Klebsiella pneumonia and Escherichia coli. After intervention in August 2018, no case of ESBL E. coli with only one case of ESBL K. pneumonia were reported since January to April 2019. There is significant reduction in incidence of primary bloodstream infection (2.14- vs 0.48/100 admission) (p-value 0.0001).

Conclusion: Segregation patients with maintain in patient to nurse ration and compliance to hand hygiene assumed significant role in managing and controlling of primary bloodstream infection in NICU.

References

Not applicable.

Disclosure of Interest: None declared

P11 APPLICATION OF SOCIETY HEALTHCARE EPIDEMIOLOGY OF AMERICA/INFECTIOUS DISEASES SOCIETY OF AMERICA BASIC RECOMMENDATIONS TO REDUCE CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS IN INTENSIVE CARE UNIT

W. A. Mazi1, M. H. Abdulwahab1, M. M. Al Ashqar1, Y. S. Aldecoa1, Z. R. Bahat1, O. S. Yasin2

1Infection Prevention and Control; 2Intensive Care Unit, King Faisal Medical Complex, Taif, Saudi Arabia
Correspondence: W. A. Mazi

Introduction: Healthcare associated infections (HAIs) increase mortality, length of hospital stay, cost of care, bacterial resistance, antibiotic usage and other adverse events. Central line-associated bloodstream infection (CLABSI) remains an important cause of morbidity and mortality in intensive care units (ICUs), particularly in developing countries.

Objectives: To reduce CLABSI rate targeting the National Healthcare Safety Network, USA (NHSN) Benchmark.

Methods: A prospective intervention was conducted in the 27-bed medical/surgical intensive care unit of King Faisal Medical Complex-Taif, Kingdom of Saudi Arabia from January to December 2018. The basic Society Healthcare Epidemiology of America/Infectious diseases Society of America (SHEA/IDSA) practice recommendations to reduce CLABSI were introduced and implemented during the year 2018. CLABSI was identified using the Centers for Disease Control and Prevention and NHSN criteria. Incidence rate, ratio, benchmarking, and statistical analysis were carried out using the NHSN recommendations. Bacterial identification and antimicrobial susceptibility of isolates were determined according to Clinical Laboratory Standards Institute guidelines, 2016. External validation surveillance was conducted to ensure no any missed CLABSI case.

Results: The number of reported CLABSI cases was 4 cases in 2018. The incidence rate was 0.67/1000 central line-days with utilization ratio 0.51 indicated achievement to the NHSN benchmark as planned (standardized infection ratio 1).

Klebsiella pneumonia extended spectrum beta lactamase (ESBL) was the most common microorganisms causative agent. No outbreak was observed during the study period.

Conclusion: CLABSI incidence rate and ratio in medical-surgical ICU in King Faisal Medical Complex is within the NHSN benchmark, 2018.

Disclosure of Interest: None declared

P12 HEALTHCARE-ASSOCIATED BLOODSTREAM INFECTION RATE REDUCTION IN THE NEURO-ICU IN RUSSIA

K. Ershova1, I. Savin2, O. Ershova3, G. Danilov2, N. Kurdumova2, M. Shifrin4, I. Alexandrova5

1Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, United States; 2Department of Critical Care; 3Department of Infection Control; 4Department of Statistics; 5Department of Microbiology, Burdenko Neurosurgery Institute, Moscow, Russian Federation
Correspondence: O. Ershova

Introduction: According to the CDC, the rate of healthcare-associated bloodstream infections (HABSI) can be decreased by infection control programs [1].

Objectives: The goal of the study was to evaluate the effect of the infection control program on the rate and etiologic profile of HABSI in the Russian neuro-ICU.

Methods: This prospective study included high-risk patients (LOS in the ICU >2 days). Data was collected as a part of the infection control program and surveillance. We defined HABSI cases according to the 2008 CDC definition. We conducted microbiologic assay of all central line catheters removed from patients in the ICU, and blood samples when HABSI was suspected.

Results: A total of 3178 patients was included in the study from 2011 to 2018. We observed 156 HABSI including 131 CLABSI. The incidence of HABSI declined from 7.0% in 2011 to 2.7% in 2018, p-value=0.041. The incidence of CLABSI did not change, averaging at 3.96 per 1000 catheter-days with a maximum of 4.9 in 2014 and a minimum of 1.9 in 2013. The average mortality rate was 19.9 per 100 patients with HABSI which is higher than an overall mortality rate in the ICU (15%).

On average we tested 320 central line catheters annually. The bacterial growth was detected in 39 per 100 tested catheters in 2011 and in 21 per 100 in 2018, that constitutes the significant decrease, p-value=0.03. Among the most frequent pathogens identified at the catheters, there were 28% of coagulase-negative Staphylococcus spp., 14% of Acinetobacter baumannii, and 11% of Klebsiella pneumoniae.

The etiologic spectrum of CLABSI remained stable over time and on average contained 26% of coagulase-negative Staphylococcus spp., 17.8% of Klebsiella pneumoniae, 10.5% of S. aureus, and 6.2% of Candida spp.

Conclusion: We found that the infection control and surveillance program is associated with a declining incidence of HABSI in the ICU and with a declining rate of bacterial contamination of central catheters. The most frequent pathogens identified on catheters and in blood samples was coagulase-negative Staphylococcus spp.

References

1. https://www.cdc.gov/hai/pdfs/progress-report/2017-Progress-Report-Executive-Summary-H.pdf.

Disclosure of Interest: None declared

P12b BLOODSTREAM INFECTION ANTIBIOGRAM IN SYRIAN FEBRILE NEUTROPENIC PATIENTS

A. Alrstom* 1, N. Daher1, R. Abouharb1

1Internal Medicine, DAMASCUS UNIVERSITY, DAMASCUS, Syrian Arab Republic
Correspondence: A. Alrstom

Introduction: The local antibiogram is so important to guide antimicrobial therapy especially in febrile neutropenic patients. Hence early appropriate antimicrobial therapy improves patients’ outcome.

Objectives: This research study aimed to record the microbiological profile of organisms which cause bloodstream infections in febrile neutropenic patients.

Methods: Prospective cohort study included all patients with febrile neutropenia (FN) with haematological malignancies who admitted to Al-Mouwasat university hospital (a tertiary care centre) over a period of 18 months. The characteristics of patients were recorded and thorough physical examinations were performed then routine blood culture samples were drawn before antibiotics administration and standard bacterial culture protocol was applied to identify isolates and antimicrobial susceptibility profile.

Results: In our study, 123 febrile neutropenia episodes developing in 109 patients. The most underlying malignancy was acute myeloid leukaemia. Fever of unknown origin was the most predominant clinical features (32.8%). Out of the 123 episodes of neutropenic fever, 42 (34.1%) of blood culture specimens yielded positive growth. Gram-negative bacilli (GNB) were the most common pathogen (n=37; 88%) with a high rate of extended-spectrum beta-lactamase (ESBL) suggestive pattern at antibiotic susceptibility tests (n=18; 48.6%). Carbapenem-resistant was demonstrated in 8.1% of all cultivated isolates; suggestive carbapenemresistant Enterobacteriaceae (CRE) pattern. The presence of past neutropenic fever episode within the previous 3 months was the most risk factor associated with ESBL and CRE positive pathogens acquisition.

Conclusion: Gram-negative bacilli are the predominant pathogens in Syrian febrile neutropenic patients and most are still resistant to all first-line antibiotics. Empirical antibiotic therapy for neutropenic patients should be tailored according to local antibiograms.

Infection control and infectious diseases practitioners may need to apply tougher infection control measures to prevent nosocomial infections in this population.

Disclosure of Interest: None Declared

Poster Session: Surgical site infection: Intervention to reduce the burden 1

P13 SUCCESSFUL POST-PROCEDURE INTERVENTION IN A TERTIARY CARE SETTING WITH HIGH RATE OF SURGICAL SITE INFECTION AMONG PATIENTS WITH CORONARY ARTERY BYPASS GRAFT

O. Slim1, M. Alshamrani1, B. Abukhzam1, S. Abdulebdeh2, D. Abagguey1, A. El-Saed1, H. Balkhy3

1Infection Prevention & Control; 2cardiac department, King Abulaziz Medical City, Riyadh, Saudi Arabia; 3Antimicrobial Resistance, World Health Organization , Genva, Switzerland
Correspondence: O. Slim

Introduction: The rate of surgical site infection (SSI) among our patients who underwent coronary artery bypass graft (CABG) has been consistently higher than reported by the US National Healthcare Safety Network (NHSN). Post-discharge personal hygiene has been raised as a possible contributing factor.

Objectives: The objective was to examine the impact of using post-procedure antiseptic body shower on infection and mortality in CABG patients.

Methods: Interventional study was conducted among all patients who underwent CABG at king Abulaziz Medical City, Riyadh, Saudi Arabia between October 2018 and March 2019. The intervention was educational sessions focusing on appropriate usage of chlorhexidine gluconate 4% antiseptic body shower during hospital stay and 7 days post-discharge. The outcome was the development of superficial SSI according to NHSN criteria. This was assessed from outpatient records, emergency visits, and a phone call. Additionally, the phone call was used to confirm the compliance with the intervention.

Results: Out of 111 patients included in the current study, 87 (78.4%) were compliant with the post-procedure antiseptic body shower and 13 (11.7%) developed superficial SSI. Compared with non-compliant patients, patients who were compliant with the intervention had markedly low SSI rate (2.3% vs. 45.8%, p<0.001) and no mortality (0.0% vs. 8.3%, p=0.045). The difference in SSI remained significant after adjustment for the risk index categories in both groups (p<0.001). Additionally, total and post-procedure length of hospital stay were shorter among compliant patients compared with non-compliant patients (17.8±8.4 vs.31.1±30.3 days, p<0.001 and 11.5±6.6 vs. 24.1±29.2 days, p<0.001, respectively).

Conclusion: The current findings indicate that the use of chlorhexidine gluconate 4% antiseptic body shower was very effective in reducing the risk of infection, mortality, and length of stay. Additionally, the findings highlight the importance of patient education and personal hygiene. The findings still need to be confirmed in large randomized studies.

Disclosure of Interest: None declared

P14 THE IMPACT OF ENDOSCOPIC VEIN HARVESTING TECHNIQUE ON SECONDARY SURGICAL SITE INFECTION AMONG PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFT

M. Alshamrani1, A. Arifi2, O. Slim1, B. Abukhzam1, H. Eid1, A. El-Saed1, H. Balkhy3

1Infection Control; 2cardiac department, King Abulaziz Medical City, Riyadh, Saudi Arabia; 3Antimicrobial resistance, WHO, Geneva, Switzerland
Correspondence: M. Alshamrani

Introduction: The rate of surgical site infection (SSI) at the donor site of patients undergoing coronary artery bypass graft (CABG) at our hospital used to be threefold higher than reported by the US National Healthcare Safety Network (NHSN). In an effort to reduce the SSI, saphenous vein harvesting using endoscope was implemented in June 2016.

Objectives: The objective was to compare the impact of using endoscopic vein harvesting (EVH) versus traditional open vein harvesting (OVH) on secondary SSI among CABG patients.

Methods: Prospective surveillance was done among patients who underwent CABG at king Abulaziz Medical City (KAMC), Riyadh, Saudi Arabia between June 2016 and March 2019. The surveillance methodology and secondary SSI definition was similar to NHSN ones. Post-discharge surveillance included surgical follow-up, outpatient clinic visits, and emergency visits. Endoscopic vein harvesting was done only by one surgeon who had the clinical skills for the technique.

Results: A total 474 patients were included in the current analysis. The average age was 60.9±10.1 years and 70.0% were males. Out of 474 patients, endoscopic vein harvesting was done among 275 (58.0%) patients and secondary SSI was detected in 11 (2.3%) patients. Compared with OVH, EVH was associated with lower secondary SSI rate, which was marginally significant (1.1% vs. 4.0%, p=0.059). Compared with NHSN, standardized infection ratios (SIRs) adjusted for differences in risk index categories between KAMC and NHSN were similar in KAMC patients with EVH (SIR=1.23, 95% CI=0.25-3.58, p=0.737) but much higher in KAMC patients with OVH (SIR=4.07, 95% CI=1.75-8.02, p=0.004).

Conclusion: The current findings indicate that endoscopic vein harvesting was effective in reducing the risk of SSI at the donor site among our cohort of patients. Implementing the endoscopic vein harvesting technique to all CABG patients may further reduce the secondary SSI rate.

Disclosure of Interest: None declared

P15 SWISSNOSO SSI INTERVENTION MODULE: RESULTS FROM THE PILOT STUDY, APRIL 2017-MARCH 2019

A. C. Szelecsenyi1, A. S. Schweiger1,2, M. Schlegel3, N. Troillet4,5, S. P. Kuster6, D. Vuichard Gysin1,2, R. Sommerstein7, A. F. Widmer2, on behalf of Swissnoso

1Swissnoso, National Center for Infection Control, Bern; 2Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel; 3Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St. Gallen, St. Gallen; 4Service of Infectious Diseases, Central Institute of the Valais Hospitals, Sion; 5Service of Preventive Medicine, University Hospital of Lausanne, Lausanne; 6Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital Zurich, Zürich; 7Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
Correspondence: A. C. Szelecsenyi

Introduction: Surgical site infections (SSI) are the most common health-care associated infections. A large fraction of these can be prevented.

Objectives: In parallel with the existing Swissnoso SSI surveillance, a pilot study was set up in 10 acute-care hospitals, aiming at implementing a nationwide SSI intervention module measuring compliance with SSI prevention process parameters.

Methods: From April 2017 to March 2019, every participating hospital set up an interdisciplinary working group and collected data on its compliance with the three major elements of preoperative management: hair removal, skin disinfection and perioperative antimicrobial prophylaxis. Each hospital had to monitor a minimum of 10 operations per quarter. Compliance with the individual elements and the overall compliance were determined according to the process parameters observed. Poisson regression was used to determine increase with compliance throughout the pilot period.

Results: A total of 590 observations were performed. The overall compliance measured in 8 hospitals increased from 55% (95% CI, 45-67) in Q2 2017 to 78% (95% CI, 65-92) in Q1 2019 (p=0.029). The relative increase per quarter was 5.2% (95% CI, 0.5-10%, p=0.029). The lowest compliance rate was observed for perioperative antimicrobial prophylaxis in Q3 2017 with 68% (95% CI, 56-80). Errors were particularly due to incorrect redosing practice. Best compliance was achieved with hair removal in Q1 2018 with 100%.

Conclusion: The introduction of the bundle for prevention of SSI led to a continuous and significant increase of the overall compliance. This module will thus be proposed to all Swiss acute care hospitals that already participate in the Swissnoso SSI surveillance aiming at reducing SSI rates on a national level.

Disclosure of Interest: None declared

P16 RESULTS OF AN INSTITUTIONAL BUNDLE TO REDUCE THE SURGICAL SITE INFECTION (SSI) IN COLO-RECTAL SURGERY

V. Pomar1, M. A. Cotura1, G. Azparren2, J. Bollo3, J. A. Fernández2, G. Horta4, M. V. Moral2, P. Pascual1, M. P. Pallares4, S. Piñol2, L. Ramírez3, N. Roch3, E. Targarona3, N. Benito1, M. Gurgui1, A. Moral3, J. Lopez-Contreras1

1Infectious Diseases Unit; 2Anesthesiology; 3Surgery; 4Operating room, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Correspondence: J. Lopez-Contreras

Introduction: Multidisciplinary teams allow to join forces and improve the healthcare outcomes, it is important the implementation of the institucional bundles to reduce incidence of surgical site infection (SSI)

Objectives: To determine the colo-rectal surgical site infection (SSI) incidence after the implementation of a specific bundle.

Methods: Colo-rectal SSI was 25% and 26% in 2013 and 2014 in our Hospital. In 2014 a multidisciplinary team was created to improve results which included General Surgeons, Anaesthesiologist, nurses from the operating room (OR) and surgical ward and infection control practitioners.

The team measured the following measures: pre-surgical body hygiene, hair removal, perioperative normothermia, normoglycemia, antibiotic prophylaxis, laparoscopic approach and aseptic measures in the OR. Moreover the measures below have been implemented:

During this period a nurse has been hired to manage the cases. The team maintaines quarterly sessions to follow up the evolution of the different indicators and the incidence of SSI.

Results: The SSI incidence, adequate antibiotic prophylaxis and normothermia are summarized in the table:

SSI Incidence

2012

N=141

2013

N=183

2014

N=162

2015

N=241

2016

N=263

2017

N=255

 

Global n (%)

35 (25)

48 (26)

34 (21)

44 (18)

34 (13)

30 (12)

P=0.02

Organ-space n(%)

17 (12)

33 (18)

22 (14)

35 (14)

22 (8)

22 (9)

P=0.64

Measures

2012

N=141

2013

N=183

2014

N=162

2015

N=241

2016

N=263

2017

N=255

 

Adequate AB prophylaxis (%)

100 (71)

101 (55)

138 (85)

206 (86)

222 (84)

217 (85)

P=0.04

Normothermia n(%)

57 (40)

66 (36)

34 (49)

104 (58)

125 (64)

175 (69)

P<0.001

Conclusion: The creation of this multidisciplinary team has been associated with an improvement of the process measures compliance and also with an important reduction of colo-rectal SSI.

Disclosure of Interest: None declared

P17 REDUCING THE INCIDENCE OF SURGICAL SITE INFECTION POST CESAREAN SECTION AFTER IMPLEMENTING AN IMPROVEMENT PROJECT AT TERTIARY HEALTHCARE CENTER

N. A. Bouafia1, W. A. Mazi1, W. A. Sayed2, S. H. Alwagdani1, A. A. AlTalhi3, M. H. AlZahrani4, A. A. AlAmri4, A. M. Dahlawi5, M. R. ALYAMI6

1INFECTION PREVENTION AND CONTROL, KING FAISAL MEDICAL COMPLEX; 2OBSTETRIC AND GYNECOLOGY DEPARTMENT, MATERNITY TOWER -KING FAISAL MEDICAL COMPLEX; 3HEAD OF OPERATING ROOM and MEDICAL DIRECTOR, KING FAISAL MEDICAL COMPLEX; 4OPERATING ROOM; 5MEDICAL DIRECTOR, MATERNITY TOWER -KING FAISAL MEDICAL COMPLEX; 6HOSPITAL DIRECTOR, KING FAISAL MEDICAL COMPLEX, TAIF, Saudi Arabia
Correspondence: N. A. Bouafia

Introduction: Surgical site infections (SSI) constitute a significant problem in surgical procedures, particularly with caesarean sections (CS).

Objectives: To reduce the CS-SSI rate by improving compliance with the guideline of Society of Healthcare Epidemiology of America (SHEA).

Methods: A quality improvement project was implemented based on prospective surveillance data of post-CS SSI conducted for all women undergone caesarean delivery at King Faisal Medical Complex-Taif, Saudi Arabia between January and April 2018 (pre-interventional period). This was followed by intervention and follow up period between May and October 2018. CS-SSI was identified using the Centers for Disease Control and Prevention and National Healthcare Safety Network (NHSN, USA) criteria based on ongoing and re-admission surveillance methods. Risk factors for CS-SSI was assessed according to SHEA recommendations and appropriate interventions were implemented according to findings.

Results: During the pre-interventional phase, CS-SSI incidence increased from 0.67% to 2.21%. Almost half of SSI occurred during the first week following the CS (52%). There was no statistical significant difference between the women undergone CS during the pre- and post-interventional phase regarding specific risk factors. Analysis of risk practices showed that seven among eighteen recommendations of SHEA were not applied. Principle interventions were: revision of surgical prophylaxis policy and procedures, training of new staff, appropriate skin preparation, better compliance to SSI bundle, follow-up patient within a week of hospital discharge and patient’s education on wound care. After intervention, 94% of SHEA recommendations were applied and SSI incidence rate decreased to reach 0.39% in October 2018.

Conclusion: Our quality Improvement project to reduce SSI incidence rate achieved its target and is sustained by continuous preventive actions.

Disclosure of Interest: None declared

P18 PROMOTING SAFE SURGERY IN CORONARY ARTERY BYPASS (CABG) IN A TERTIARY HOSPITAL IN MALAYSIA

S. S. Samsudin1,2, S. S. L. Goh1, S. Saaibon1,2, R. Zhazali1,2, R. Ramli2, N. Hashim3, M. F. Zainal Abidin3, A. Amin4, M. Kumaran4, I. Azmi4, S. Krishnasamy4, Z. Zulkifli4, S. Hashim4, A. Mokhtar4, S. Ponnampalavanar1,5

1Infection Control; 2Nursing; 3Anesthesia; 4Surgery, University Malaya Medical Centre; 5Medicine, University Malaya, Kuala Lumpur, Malaysia
Correspondence: S. S. Samsudin

Introduction: Surgical site infections (SSIs) following coronary artery bypass graft (CABG) procedures is a global public health problem.

Objectives: To determine the incidence of SSIs and the impact of implementation of perioperative preventive measures in patient who underwent CABG in University Malaya Medical Centre (UMMC).

Methods: Patients who underwent CABG in UMMC from January 2017 to December 2018 were prospectively followed up by the infection control nurse for 90 days post operation using electronic medical records (EMR). The study periods were divided into pre-intervention (January-May 2017), implementation of intervention (June-December 2017) and post intervention (January-December 2018). Data was collected using standardized SSI surveillance form and analyzed using SPSS version 20.

Results: A total of 260 patients were included (pre-intervention, intervention and post intervention period were 53, 76, 131 patients respectively). The incidence of SSI reduced from 21/100 procedures to 14/100 procedures during the pre and post-intervention periods respectively. The rate of sternal infections (SI) was 8% and 9% in the pre and post intervention periods respectively. Venous graft site (VGS) infection reduced from 13% to 7.6%. The interventions implemented were pre-operative bathing, clipping instead of shaving, using 2% chlorhexidine gluconate in 70% alcohol solution for surgical skin preparation, appropriate antibiotic prophylaxis and intraoperative redosing.

Conclusion: The SSI rates post CABG, especially VGS infections reduced after implementation of evidence based interventions. These interventions should be implemented as a standard of care for all surgical procedures in UMMC. The reason sternal SSI did not improve needs further investigation.

Disclosure of Interest: None declared

P19 REDUCTION IN THE SURGICAL SITE INFECTION (SSI) RATE FOLLOWING SUSTAINED IMPROVEMENT IN PROCESS MEASURES

N. Grae, A. Morris, S. Roberts

Infection Prevention & Control Programme, New Zealand Health Quality & Safety Commission, Wellington, New Zealand
Correspondence: N. Grae

Introduction: The Health Quality & Safety Commission's national Surgical Site Infection Improvement (SSII) programme started in 2012 with hip and knee arthroplasty data reported from July 2013 and cardiac procedures from July 2016. The programme aims to improve the standard of care by measuring compliance with interventions known to reduce the risk of surgical site infections (SSI) and to use high quality data to inform quality improvement initiatives that reduce harm.

Objectives: The programme aims to improve standard of care to reduce the risk of SSI in orthopaedic and cardiac surgery.

Methods: Performance with process measures (surgical antimicrobial prophylaxis (SAP) and skin antisepsis) collected on all publicly-funded hip and knee arthroplasty and cardiac procedures; approximately 12,500 procedures annually. Quality and Safety Markers (QSMs) were established to set the expected levels of performance. The outcome measure is the SSI rate. Public reporting is quarterly through an online dashboard.

Results: Between July 2013 and December 2018; over 56,000 hip and knee arthroplasty procedures were performed. A significant aggregated improvement in the QSM performance for the timing, choice and dose of SAP and a significant improvement in the outcome measure; orthopaedic SSI rate mean decreasing from 1.23% (SD = 0.34) to 0.92% (SD = 0.39) (p-value = 0.0008).

Between July 2016 and December 2018, over 6800 adult and paediatric cardiac procedures were performed. The aggregated QSM compliance for antibiotic timing, choice and dose and skin prep was high at the start and has been sustained. The cardiac SSI rate mean is 4.4% (SD = 1.27).

Conclusion: The process measures for most orthopaedic procedures achieve the QSM targets. Concurrent with this is the improved outcome measure, reduced SSI rate, for orthopaedic procedures.

Five District Health Board hospitals perform publicly-funded cardiac surgery. Compliance with the process measures was high from the start of the programme suggesting that spread of best practice beyond the orthopaedic operating rooms may have occurred in these hospitals.

There has been a high level of engagement with the programme by the respected surgical services supported by timely feedback of process and outcome measures.

Disclosure of Interest: None declared

P20 PROMOTING COMPLIANCE WITH SURGICAL SITE INFECTION PREVENTION GUIDELINES BY PSYCHOLOGICALLY TAILORED INTERVENTIONS: STUDY PROTOCOL OF THE MULTI-CENTER PARALLEL-GROUP CLUSTER-RANDOMIZED CONTROLLED "WACH"-TRIAL

T. von Lengerke1, B. Schock2, I. Hartlep2, P. Schipper2, I. Tomsic1, C. Krauth3, I. F. Chaberny2

1Department of Medical Psychology, Hannover Medical School, Centre of Public Health and Healthcare, Hannover; 2Institute of Hygiene, Hospital Hygiene and Environmental Medicine, Leipzig University Hospital, Leipzig; 3 Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Centre of Public Health and Healthcare, Hannover, Germany
Correspondence: T. von Lengerke

Introduction: Surgical site infections (SSI) are among the most prevalent nosocomial infections in Germany [1]. Despite national recommendations [2], evidence both on compliance with pre-, intra- and postoperative measures and interventions to promote compliance is lacking.

Objectives: To present the rationale and protocol of the WACH-trial ("Wundinfektionen und Antibiotikaverbrauch in der Chirurgie"), funded by the German Federal Ministry of Health (grant-ID: ANNIE2016-55-038; DRKS-ID: DRKS00015502) and approved by the Ethics Committee at the Faculty of Medicine of Leipzig University on June 12th, 2018 (034/18ek), based on the protocol co-developed with the Clinical Trial Centre Leipzig.

Methods: Study protocol.

Results: WACH is multi-center parallel-group cluster-randomized controlled trial. It expands the PSYGIENE-trial's approach of psychological tailoring [3-4; DRKS00010960] from hygienic hand disinfection in intensive care at one tertiary university hospital to SSI-prevention in six general hospitals. Target groups are physicians and nurses in surgical/anesthesiological wards/operating theatres. First, compliance and its determinants (COM-B-model [5]) are empirically assessed. Second, tailored interventions will both be developed in and suggested to three of the hospitals. Third, the hypothesis will be tested whether tailored interventions lead to stronger compliance improvements and SSI-reductions than usual implementation interventions.

Conclusion: First multi-center data on compliance with pre-, intra- and postoperative SSI-preventive measures and its promotion in German healthcare is expected.

References

[1] Behnke et al. The prevalence of nosocomial infection and antibiotic use in German hospitals. Dtsch Arztebl Int 2017;114:851-7

[2] KRINKO. [Prevention of surgical site infections]. Bundesgesundheitsbl 2018; 61:448-73

[3] von Lengerke et al. Promoting hand hygiene compliance. Dtsch Arztebl Int 2017;114:29-36

[4] von Lengerke et al. Impact of psychologically tailored hand hygiene interventions on nosocomial infections with multidrug-resistant organisms. Antimicrob Resist Infect Control 2019;8:56

[5] Michie et al. The behaviour change wheel. Implement Sci 2011;6:42

Disclosure of Interest: None declared

P21 TRICLOSAN-COATED SUTURES REDUCE THE RISK OF SURGICAL SITE INFECTIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS

T. Mulder1, M. Abbas2, S. Harbarth2, J. Kluytmans1

1Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands; 2Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
Correspondence: T. Mulder

Introduction: The effect of triclosan-coated sutures (TCS) on surgical site infection (SSI) risk has been extensively studied, yet several studies have been published recently.

Objectives: The aim of this study was to systematically review and update the available evidence regarding the effectiveness of TCS to reduce SSI.

Methods: PubMed, MEDLINE, Embase, Scopus and Cochrane library were searched for studies that compared TCS with non-coated sutures (NCS) for SSI prevention. Observational studies could be included if they met the EPOC quality criteria. A pooled risk ratio (RR) with 95% confidence interval (CI) was calculated and a random effects model was used to account for potential clinical heterogeneity. The primary outcome was SSI of any type, and the secondary outcome was deep incisional and organ/space SSI.

Results: 27 studies with a total of 12,850 patients were included in the meta-analysis. These were all randomized clinical trials (RCTs) as none of the observational studies met the predefined quality standard. The risk of SSI was 7.0% (TCS group) versus 9.2% (NCS group). Pooling all studies demonstrated a risk reduction of 27% with TCS compared to NCS (RR 0.73 [95% CI 0.62 - 0.85]) corresponding to a number needed to treat (NNT) of 45 patients to prevent 1 SSI. Statistical heterogeneity (I2) was 34%. Evaluation of the effectiveness of TCS on the development of deep and organ/space SSI was based on 13 studies (n = 8,584). The risk of deep and organ/space SSI reduced from 2.5% (NCS) to 1.7% (TCS) (RR 0.75 [95% CI 0.56-1.02]; NNT 125).

Conclusion: This meta-analysis of 27 RCTs shows that TCS are associated with a significant reduction of SSI risk. Subgroup analysis shows a statistically non-significant association between TCS and risk of deep and organ/space SSI. Data on adverse events related to TCS, such as development of biocide resistance remain scarce.

Disclosure of Interest: None declared

Poster Session: Surgical site infection: Risk factors

P22 RISK FACTORS FOR 30 - DAY SURGICAL SITE INFECTIONS AFTER TOTAL HIP AND KNEE ARTHROPLASTY - A SINGLE-CENTER EXPERIENCE

V. Marusic1, L. Markovic-Denic1, V. Nikolic1, O. Djuric1,2,3, E. Dubljanin-Raspopovic4, M. Kadija5

1Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, Center for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), University of Modena and Reggio Emilia; 3Servizio Epidemiologia, Direzione Sanitaria-Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; 4Centre for Rheumatology; 5Institute for Orthopedic Surgery and Traumatology, Clinical Centre of Serbia, Belgrade, Serbia
Correspondence: V. Marusic

Introduction: Very few studies from the Southern European countries have assessed the risk factors for the development of surgical site infections (SSIs) after primarily clean orthopedic procedures with prosthetic joint implantation.

Objectives: To analyze risk factors (RF) for the development of 30-days SSIs after total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Methods: A prospective cohort study was conducted at University Clinic for orthopedic surgery, Clinical Center of Serbia, from December 2016 to December 2017. All patients undergoing THA and TKA were enrolled in the study. SSIs were diagnosed on the basis of the Centers for Disease Control and Prevention definitions. Univariate and multivariate logistic regressions were performed.

Results: Out of 319 operative procedures (OP) performed, 67.1% were THA and 32.9% TKA. SSI occurred in 25 cases, with incidence rate of 7.8%. For THA and TKA, rates of total SSI were 7.48 (95% CI, 3.96-11.03) and 8.57 (95% CI, 3.32-13.92) respectively. Out of all SSI, the most represented were superficial incisional infections (64%) while others were deep infections. SSI cases mean age was 67.96±9.03 years and nearly half were females (52%). SSI patients required prolonged hospitalization (30.2 vs. 19.4 days; p<0.001). Spinal anesthesia (56% vs. 36.4%, SSI vs. w/o SSI; p=0.052) and prolonged AMP (> 1 day) (8.9 vs. 7.2 days, p=0.029), were risk factors for SSI development, while AMP on time, within 1h before operation was protective factor (p=0.040). First-generation cephalosporin was chosen in highest percentage (31.5%) for the AMP, then third-generation cephalosporin in 24.5%, and in 30.7% it was a combination of three antibiotics which included Vankomycin. Multivariate analysis identified only one major risk factor for SSIs: prolonged AMP (RR=1.17; 95%CI: 1.02-1.34; p=0.019).

Conclusion: Risk factors for the SSIs in orthopedic patients who undergo THA and TKA in Serbia do not influence heavily SSI risk except AMP. More adequate antimicrobial stewardship programs should be taken into account according to new hospital guideline.

Disclosure of Interest: None declared

P23 RISK FACTOR ANALYSIS OF SURGICAL SITE INFECTIONS IN ELDERLY PATIENTS WITH INTESTINAL OBSTRUCTION AFTER EMERGENCY SURGERY

B. Gao1, S. Feng2, X. Xie3, H. Ge4, Z. Tang4, X. Yang4, W. An5, S. Hu5

1Infectious diseases unit, Tianjin 4th Centre Hospital affiliated to Tianjin Medical University and Nankai University, Tianjin; 2Infection Control Department, First People’s Hospital of Zunyi; 3Department of Gastrointestinal Surgery, First People’s Hospital of Zunyi and 3rdaffiliated hospital of Zunyi Medical University, Zunyi; 4Department of Gastrointestinal Surgery, First People’s Hospital of Zunyi and 3rdaffiliated hospital of Zunyi Medical University; 5Infection Control Department, First People’s Hospital of Zunyi and 3rd affiliated hospital of Zunyi Medical University, Zunyi, Guizhou, China
Correspondence: B. Gao

Introduction: Infection control and prevention is one of core elements of healthcare quality improvement.

Objectives: To investigate the etiology of surgical site infections (SSIs) in elderly patients with intestinal obstruction after emergency surgery in order to reduce their occurrence.

Methods: We conducted a retrospective study of all patients aged≥60 years with an ileus who underwent an emergency surgery from Jan 2014 to Feb 2019 in a tertiary teaching hospital in western China. Clinical variables included age, sex, NNIS indexes, prophylactic use of antimicrobial agents, perioperative hemoglobin levels, serum albumin levels, hemorrhage and postoperative morbidity. Multivariate analysis was used to identify variables independently associated with SSIs. SSI was defined by the criteria of the Chinese national guideline for the prevention and control of SSIs persistent wound discharge or dehiscence, visible abscess or gangrene and bacterial contamination confirmed by discharge liquid culture.

Results: One hundred and eleven ileac patients aged≥60 years were included. All had documented antimicrobial prophylaxis of more than one dose; initial doses were not determinately administered within 30 min to 1 hour before the surgical procedures. Thirty-four patients were diagnosed with SSIs. A total of 38 bacterial strains were isolated from SSI patients, mainly Escherichia coli (15/38), Enterococcus (7/38), Proteus species (6/38) and other enterobacter (5/38). Multivariate logistic regression analysis indicated that the classification of incision site was an independent risk factor for SSI. Hospital length of stay of patients with SSIs was significantly longer than those without SSIs (30.91±10.91days vs 23.94±10.64 days, respectively; P=0.008).

Conclusion: Prevention kits and reasonable prophylactic use of antimicrobial agents should be introduced to reduce SSIs in the setting of elderly ileac patients undergoing an emergency surgery.

Disclosure of Interest: None declared

P24 ETIOLOGY, INCIDENCE AND RISK FACTORS FOR MENINGITIS AFTER VENTRICULOPERITONEAL SHUNT PROCEDURES: A MULTICENTER STUDY

L. G. Giarola1, D. C. Silva1, H. R. Couto1, F. A. Bracarense1, F. L. Carvalho1, G. L. Souza1, R. F. Rocha1, A. N. Silveira1, C. D. Oliveira1, H. D. Carvalho1, B. R. Couto2, H. O. Pereira3

1Centro universitário de Belo Horizonte; 2Hospital Lifecenter; 3Hospital Metropolitano Odilon Behrens, Belo Horizonte, Brazil
Correspondence: D. C. Silva

Introduction: Surgical site infection associated with shunt placement, treatment for hydrocephalus, is the most common complication and cause of mortality.

Objectives: The objective is to answer three questions: a) What is the risk of meningitis after shunt placement? b) What are the risk factors for meningitis? c) What main microorganisms cause meningitis?

Methods: Data based on NHSN/CDC protocols were collected between Jul/2015-Jun/2018 from 12 hospitals at Belo Horizonte, Brazil. Outcomes: meningitis, hospital death and total length of hospital stay. 26 independent variables evaluated by univariate and multivariate analysis. Sample size=926.

Results: 71 cases of meningitis diagnosed (risk=7.7% [I.C.95%=6.1%;9.6%]).. Mortality rate in patients without infection was 10%; hospital death of infected patients was 13%. Hospital days of stay in non-infected patients: mean=21; median = 9, std.dev. = 28; hospital stay in infected patients: mean =34, median =27, std. dev. = 37 (p=0.025). Three main risk factors identified by logistic regression model: age beneath two years (Odds Ratio = 3.20), preoperative hospital length of stay greater than four days (OR = 2.02) and surgical procedures besides ventricular shunt. 31% of all patients were <2 years old. 430 patients had more than four preoperative days. If a patient two years old has surgery four days post hospital admission, the risk of meningitis is increased from 9% to 18% (p=0.026). From 71 meningitis, in 45 (63%) the etiologic agent was identified: Staphylococcus aureus (33%), Staphylococcus epidermidis (22%), Acinetobacter sp (7%), Enterococcus sp (7%), Escherichia coli (7%), Pseudomonas sp (7%), and other (18%).

Conclusion: We identified two intrinsic risk factors for meningitis after ventricular shunt, age less than two years and multiple surgical procedures, and one extrinsic risk factor, the preoperative length of hospital stay.

Disclosure of Interest: None declared

P25 PATIENTS WITH LOWER LEG SURGERIES AND MALE PATIENTS AS RISK GROUPS FOR POSTOPERATIVE WOUND INFECTIONS

M. M. Strybos, R. Otchwemah, J. Hoffmann, F. Mattner

Institute for Hygiene, Kliniken der Stadt Köln gGmbH, Cologne, Germany
Correspondence: M. M. Strybos

Introduction:

The project "HygArzt" (ZMVI1-2516FSB111), funded by the Federal Ministry of Health, is intended to investigate the effects of infection protection measures (IPM) by physicians responsible for hygiene.

Objectives:

As a starting point for the development of tailored IPM, the pre-intervention phase of the study was used to analyse which body parts after surgery (SX) and which patient groups entail a particular risk of postoperative wound infections (SSI).

Methods:

In order to identify SSI, clinical signs of infection were recorded according to KISS and CDC definitions. For this purpose, data of previous illnesses as well as of current and previous infections from the hospital management system, admission forms, discharge letters and nursing documentation were aggregated with current patient data and laboratory findings. In addition, early visits were made three times a week to record signs of infection that had not yet been documented.

For the evaluation "infections brought along" (165 SX) as well as multiple surgeries from the time of the occurrence of the SSI (91 SX) were excluded and only new infections (42 SX) were considered.

Results:

In the pre-intervention phase of the study, 1978 surgeries were executed (in 469 cases several surgeries on the same patient) with a total SSI infection rate (InfR) of 2.44% (CI 95% 1.7; 3.1) for the surgeries. The body parts with the most surgeries were the knee (552 surgeries) with an infection rate of 1.44%, lower leg (487) InfR = 4.22%, hip (311) InfR = 3.49%, shoulder (179) InfR = 1.21%, forearm (153) InfR = 2.82%, thigh (89) InfR = 2.49%. A χ²-test showed that the risk of getting an SSI with a lower leg surgery was significantly higher (p = .008) than with all other surgeries. The evaluation of wound infections by sex (♂ = 1171 SX; ♀ = 807 SX) showed a higher probability of men receiving SSI for all surgeries (♂ = 37 SSI; ♀ = 10 SSI) (p = .024). This was also shown in relation to SSI only for lower legs (♂ = 325 SX, 16 SSI; ♀ = 152 SX, 1 SSI) (p = .019).

Conclusion:

The analysis of the patient data identified two risk groups with an increased risk to develop an SSI. When developing preventive measures, these risk groups should be specifically targeted.

Disclosure of Interest: None declared

P26 IS THERE A NEED FOR CHANGING PERIOPERATIVE PROPHYLAXIS DURING ANTIBIOTIC THERAPY AND REPETITIVE DEBRIDEMENT FOR ORTHOPEDIC INFECTIONS?

I. Uçkay1, M. Abbas2, T. Studhalter3, L. Wuarin2, S. Harbarth2

1Balgrist University Hospital; 2Geneva University Hospitals, Geneva; 3Balgrist University Hospital, Zürich, Switzerland
Correspondence: I. Uçkay

Introduction: The appropriate antibiotic prophylaxis for repetitive debridement on infected orthopedic sites is unclear.

Objectives: We establish the epidemiology of surgical site infections of surgical site infections in adult orthopedic surgery.

Methods: We performed a retrospective cohort study examining repetitive SSIs occurring in infected adult orthopedic patients; and by performing group comparisons and logistic regression analyses.

Results: Among 2480 first episodes of various orthopedic infections (median patient age 56 years, 833 immunosuppressed: implant-related (n=648); osteoarticular (n=1153); soft tissue infection (n=1327), 862 (862/2480; 35%) revealed multiple debridements for the same episode. The median number of debridements was 1 (range, 1-15 interventions). Upon repetitive intraoperative sampling, we detected pathogens in 507 cases (507/862; 59%), of which 265 new SSIs (265/862; 31%), of which the microorganisms of 174 episodes (20%) were resistant to current antibiotic therapy. In multivariate analysis, repetitive debridements were associated with new SSIs (odds ratio regarding the “second look” 13.7, 95%CI 8.8-21.2). These new and resistant pathogens were Gram-positive in 64% and Gram-negative in 36%. We failed to identify a predicative microbiological pattern. Likewise, we failed to identify an optimal theoretical antibiotic prophylaxis during re-debridement for cases that were already under treatment.

Conclusion: In our single-center large cohort and regarding multi-debrided orthopedic infections, new SSIs with resistant pathogens occurred in 20%; and already after the 2nd look; with no ideal supplementary prophylaxis regimen identified.

Disclosure of Interest: None declared

P27 HYPERGLYCEMIA MANAGEMENT AND ITS ASSOCIATION WITH STERNAL SITE INFECTIONS AMONG CABG PATIENTS IN A QUATERNARY CARE HOSPITAL

A. M. Alexander

Quality Assurance, Aster Medcity, Cochin, Kerala, Cochin, India
Correspondence: A. M. Alexander

Introduction: Peri-operative hyperglycemia is identified as a significant risk factor for deep sternal wound infection. During HIC surveillance, a higher than usual SSI rates were noted.A preliminary audit done showed poor Post-OP glycemic control among patients who developed SSI despite of having an established in- hospital protocol.Gaps in adherence towards the glycemia protocol were identified and the protocol was re-introduced.All CABG patients were tracked via watsapp messenger to ensure RBS <200mg% at home during their post-op period,up to 2 weeks.

Objectives: The Objectives of this project was to assess the adherence towards Glycaemic management among CABG patients during pre and post implementation phase and to assess the association of post discharge Glycemic management and Occurrence of sternal site infections among CABG patients.

Methods: A prospective data collection method with Purposive sampling and PDCA Cycle was adopted for the entire framework of this project. All CABG patients with sternal site infections from January 2018 to June 2018, were taken as the control group. All CABG cases between the months of October 2018 to December 2018 were taken as study samples during the process of study. Point surveillance of those CABG patients, prior to surgery, entire peri-op period and post discharge follow up via watsapp messenger up to 2 weeks, was done to ensure RBS <200mg%. The patients who acquired sternal site infections between the months of October 2018 to December 2018 were considered as the experimental group.

Results: During the course of post implementation phase, Weekly feedbacks on perioperative glycemic control were given to the respective departments to improve their outcome. Tracking of discharged CABG patients via watsapp messenger ensured the patients compliance to RBS< 200mg/dl. Adherence towards Glycemic management protocol in post-op period was improved in the post implementation phase (82.195%).In the Post-Implementation Phase,the average sternal site infections reduced to 0.33%.The study conducted concluded that, there is a significant association between sternal site infection rates and the post discharge glycemic management, as ‘p’-value (P = < 0. 001) was significant.

Conclusion: This project demonstrated that post discharge glycemic control is an important risk factor which can be favorably modified by patient education and engagement.

Disclosure of Interest: None declared

P28 SURGICAL SITE INFECTION AFTER BARIATRIC SURGERY: A SMALL RISK THAT DEFINES LIFE AND DEATH OF PATIENTS

L. G. Giarola1, G. G. Gianeschi1, J. C. Maciel1, R. C. Á. P. Paranhos1, T. G. Pinheiro1, Y. A. M. Amaral1, D. C. Silva1, H. R. Couto1, C. E. F. Starling2, B. R. G. M. Couto2

1Centro universitário de Belo Horizonte; 2Hospital Lifecenter, Belo Horizonte, Brazil
Correspondence: L. G. Giarola

Introduction: Surgical site infection (SSI) in bariatric surgery can lead to devastating outcomessuch as peritonitis, sepsis, septic shock and organ space infection.

Objectives: The objective of our study is to answer four questions: a) What is the SSI risk after bariatric surgery? b) What are the risk factors for SSI after bariatric surgery? c) What are the main outcomes to SSI in bariatric surgery? d) What are the main bacteria responsible for SSI in bariatric surgery?

Methods: A retrospective cohort study assessed 8,672 patients undergoing bariatric surgery between 2014/Jan and 2018/Dec from two hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. Outcome: SSI, hospital death and total length of hospital stay. 20 preoperative and operative variables were evaluated by univariate and multivariate analysis (logistic regression).

Results: 77 SSI were diagnosed (risk = 0.9% [C.I.95% = 0.7%;1.1%]). Mortality rate in patients, without infection was 0.03% (3/8,589) while hospital death of infected patients was 4% (3/77; RR = 112; p < 0.001). Hospital length of stay in non-infected patients (days): mean = 2, std.dev.= 0.9; hospital stay in infected patients: mean = 7, std. dev. = 15.6 (p < 0.001). Two main factors associated with SSI after bariatric surgery were identified by logistic regression: duration of procedure (hours), OR = 1.4;p=0.001, and laparoscopy procedure, OR = 0.3;p=0.020. From 77 SSIs, in 28 (36%) we identified 34 etiologic agents. The majority of SSI (59%) was caused by species of Streptococcus (32%), Klebsiella (15%), and Enterobacter (12%).

Conclusion: SSI is rare after bariatric surgery, however, when it happens, it’s a disaster for the patient and is mainly caused by species of Streptococcus. The incidence of SSI can be reduced significantly when laparoscopy procedure is used and the surgeon is able to perform a rapid surgery.

Disclosure of Interest: None declared

P29 MAJOR RISK FACTORS CONTRIBUTING TO SURGICAL SITE INFECTIONS POST-CAESARIAN SECTION

N. A. Bouafia1, W. A. Mazi1, W. S. Ahmad2, S. H. Alwagdani1, A. A. AlTalhy3, M. H. AlZahrani4, A. A. AlAmri4, A. M. Dahlawi5, M. R. ALYAMI6

1INFECTION PREVENTION AND CONTROL, KING FAISAL MEDICAL COMPLEX; 2OBSTETRIC AND GYNECOLOGY DEPARTMENT, MATERNITY TOWER -KING FAISAL MEDICAL COMPLEX; 3HEAD OF OPERATING ROOM AND MEDICAL DIRECTOR, KING FAISAL MEDICAL COMPLEX; 4OPERATING ROOM; 5MEDICAL DIRECTOR, MATERNITY TOWER -KING FAISAL MEDICAL COMPLEX; 6HOSPITAL DIRECTOR, KING FAISAL MEDICAL COMPLEX, TAIF, Saudi Arabia
Correspondence: N. A. Bouafia

Introduction: Surgical site infection post cesarian section (CS-SSI) is a major cause of prolonged hospital stay and poses a burden to the health care system

Objectives: To determine risk factors associated with CS-SSI in order to improve patient care

Methods: A prospective study was conducted for all women undergone caesarean section procedures during 2018 in King Faisal Medical Complex-Taif, Kingdom of Saudi Arabia. Patients’ socio-demographic and clinical data were collected from patient’s file. CS-SSI was identified and incidence rate was calculated using the Centers for Disease Control and Prevention and National Healthcare Safety Network (NHSN, USA) criteria based on ongoing and re-admission surveillance methods. Risk factor for CS-SSI was assessed and analysed using SPSS version 18.

Results: In total, 30 patients developed CS-SSI among 3268 women underwent CS in 2018. The cumulative incidence rate of CS-SSI was 0.82 % (ranged from 0.24-2.21%). CS-SSIs were classified as superficial (66.7%), deep (30%) and organ (3.3%) infections. More than half of SSI (53.3%) occurred during the first week following the CS. The most frequent risk factors for CS-SSI revealed in our study were: immediate emergency CS (83.3%) followed by higher body mass index (BMI > 30 kg/m2) with standard dosage of cefazoline 2 gram prophylactic antibiotic within 60 minutes before incision (76.7%), multiple gravida patients (60%), general anesthesia (60%), previous CS (40%) and Premature rupture of membrane (33.3%).

Conclusion: Our incidence rate of CS-SSI is lower than NHSN hospitals and risk factors revealed in this study are mostly associated to population characteristics and are worldwide documented. However, more research regarding adjustment of antibio-prophylaxis dose to BMI are needed.

Disclosure of Interest: None declared

P30 INCIDENCE AND RISK FACTORS FOR SURGICAL SITE INFECTIONS IN COLON SURGERY: A MULTICENTERED STUDY IN TWELVE BRAZILIAN HOSPITALS

G. Lauar E Souza, H. Dias Duarte de Carvalho, C. de Deus Martins Oliveira, A. André Martins de Araújo, B. Roberto Gonçalves Marinho Couto

Instituto de Ciências Biológicas e da Saúde, Centro Universitário de Belo Horizonte, Belo Horizonte, Brazil
Correspondence: G. Lauar E Souza

Introduction: Infection in colon surgery, and all surgery, is very harmful for the patient. Better understanding of its risk factors may help improve patient safety.

Objectives: This quantitative, multicentered study calculates surgical site infection (SSI) risk, describes risk factors, average hospital length of stay, compares length of stay in infected and non-infected patients, infection impact on mortality rates in colon surgery.

Methods: Data was collected between 2012 and 2017 from 12 hospitals from Belo Horizonte, a major city in Brazil (2.5 million inhabitants). Outcome variables were: SSI, hospital death and total length of hospital stay(days). The 23 independent variables were analyzed using Epi Info and applying statistical two-tailed test hypothesis with significance level of 5%.

Results: A total of 8,261 surgeries were analyzed and 284 patients presented SSI, a risk of 3.4% (Confidence interval (CI) of 95%=[3.1%;3.9%]).The variables associated to SSI risk were: patient age above 70 years (Relative Risk (RR)=1.9;p<0.001), general anesthesia (RR=7.9;p<0.001), ASA Score above 2 (RR=2.2;p<0.001), surgery duration above 2h (RR=4.8;p<0.001), emergency surgery (RR1.7;p=0.022), concomitant surgical procedure (RR=4.4;p<0.001), first hospitalization of the patient(RR=0.65;p=0.002), postoperative hospital stay above 4 days (RR=2.6;p<0.001). The average time of hospital stay in infected patients was 25 days (standard deviation-SD=30.5 days). In non-infected patients, average time was 7 days (SD=16 days; p<0.001). The mortality among patients with SSI was 22%, observed to be 4% in non-infected (p<0.001). General anesthesia, with the highest associated relative risk, is the main risk factor for SSI in colon surgery.

Conclusion: There is a 95% chance of incidence of infection in 3 out of 100 patients. The average length of stay in infected patients was 3.6 times higher, and mortality rates in infected patients is 5.5 times higher. Lengthier surgery time (>2hours) is a risk factor for SSI. Evidence suggest that healthcare professionals should be concerned about SSI, and surgeons should look forward to reduce the time of surgery when possible, without neglecting patient safety.

Disclosure of Interest: None declared

P31 RISK PREDICTION FOR SURGICAL SITE INFECTION IN CRANIOTOMY PATIENTS

F. H. B. D. Souza, B. R. G. M. Couto, J. D. O. Matias, L. L. de Araújo, L. S. Rossati, L. R. Polidoro

Centro Universitário de Belo Horizonte - UNIBH, Belo Horizonte, Brazil
Correspondence: F. H. B. D. Souza

Introduction: Based on data obtained from hospitals in the region of Belo Horizonte city (Brazil), the evaluation of relevant factors such as: deaths, age, duration of surgery, number of hospitalizations, potential contamination and surgical site infection (SSI) resulting from surgeries of craniotomy was performed. The possibility of predictions of SSI was analyzed through pattern recognition algorithms based on Artificial Neural Networks of the MLP (Multilayer Perceptron) type.

Objectives: This article aims to demonstrate the SSI predictive power of pattern recognition algorithms as an analysis of the event with the aid of current technologies.

Methods: Data were collected by Hospital Infection Control Committees in hospitals of Belo Horizonte between 2016 and 2018. Noisy records were filtered and the occurrences were analyzed. Finally, the predictive power of MLPs to predict SSI was evaluated, where were experimented: 5 types of MLPs (Momentum, Backpropagation Standard, Weight Decay, Resilient Propagation and Quick Propagation); 3, 5, 7 and 10 neurons in the hidden layer; with varying resampling in quantity of records for test (65% and 75%) and for validation (35% and 25%). Comparisons occurred by measuring the AUC (Area Under the ROC Curve - ranging from 0 to 1).

Results: From 1096 records, 289 were intact for analysis, where: 16% were deaths; an age group of 40 to 65 years (average of 56); average time of 186 minutes of surgery (ranging from 95 to 250 minutes); the number of hospitalizations ranged from 1 (90.6%) to 8 (0.3%); potential contamination was in 2.7% as contaminated, 23.5% potentially contaminated and 72.3% as clean; the occurrence of SSI reached 4%. The prediction AUCs ranging from 0.7 to 0.994.

Conclusion: After filtering all the records, a high index of noise was recorded due to subjectivity at the moments of data collection. Considering the data used, 16% of deaths were reported. Linking the deaths to SSI alone would not be possible (only 4%). Finally, the analyzed structures (MLPs) demonstrated a relevant predictive power capable of guiding intelligent monitoring software.

Disclosure of Interest: None declared

P32 POWER OF PREDICTION OF SURGICAL SITE INFECTION IN CAESAREAN SURGERY USING PATTERN-BASED ANALYSIS BASED ON MULTILAYER PERCEPTRON ARTIFICIAL NEURAL NETWORKS

F. H. B. D. Souza, B. R. G. M. Couto, A. M. R. Maroca, I. H. S. Soares, J. M. D. C. Duarte, S. C. Costa

Centro Universitário de Belo Horizonte - UNIBH, Belo Horizonte, Brazil
Correspondence: F. H. B. D. Souza

Introduction: The purpose of this paper is to report the power of predictions of surgical site infections (SSI) in obstetrics, using neural networks based on MLPs (Multi Layer Perceptron). Data were collected from hospitals in Belo Horizonte city (Brazil) between 2016 and 2018.

Objectives: This paper aims to statistically evaluate the profile of surgeries and test the predictive power of SSI of pattern recognition algorithms, in the case of Artificial Neural Networks of the type MLP (Multilayer Perceptron).

Methods: A data collection in 6 different hospitals was performed and filtered noisy records, which enabled a statistical analysis of the profile of the evaluated hospitals. Thus, an SSI prediction power of five types of MLPs (Backpropagation Standard, Momentum, Resilient Propagation, Weight Decay and Quick Propagation) was made with configurations: 3, 5, 7 and 10 neurons in the hidden layer; a division of the database for the resampling process 65% (or 75%) for learning, 35% (or 25%) for validation; and a comparison by measuring the AUC (Area Under the Curve - ranging from 0 to 1).

Results: A total of 7,698 records (with 46 characteristics) were collected, with 3,517 consistent evaluated. It was recorded: average of 33 years of the patients; 80% the surgical accomplishment occurred in the first hospitalization; the majority of surgeries had estimated durations between 44 minutes and 88 minutes; potential contamination around 90%; 73.1% of emergency surgeries; 99.6% of cases with 2 professionals and 2.5% of SSI. The MLPs reached AUCs of 0.98.

Conclusion: Despite the high noise index of the database, it was possible to sample relevant for the evaluation of the profile of hospitals in Belo Horizonte. The predictive process presented an accuracy of extreme relevance, reaching 0.98 for the SSI prediction power.

Disclosure of Interest: None declared

P33 MEDICINE ALLIED TO TECHNOLOGY: THE USE OF ARTIFICIAL NEURAL NETWORKS IN THE PREDICTION OF SURGICAL SITE INFECTION FOR GENERAL SURGERY SERVICE

F. H. B. D. Souza, B. R. G. M. Couto, G. M. Braga, J. A. Teixeira, R. C. Santos, J. M. C. Martins, K. S. D. Sousa, D. N. De Souza, G. B. Alves

Centro Universitário de Belo Horizonte - UNIBH, Belo Horizonte, Brazil
Correspondence: F. H. B. D. Souza

Introduction: This research represents a trial of surgical site infection (SSI) in patients submitted to general surgery procedures in hospitals in Belo Horizonte, a 3,000,000 inhabitants city from Brazil.

Objectives: The objective is to statistically evaluate these incidences and to enable a study of the SSI prediction power of pattern recognition algorithms, in the case of Artificial Neural Networks of the type MLP (Multilayer Perceptron).

Methods: Data collection on SSI was performed in 5 different hospitals between July 2016 and June 2018 and performed three procedures: a preprocessing of the database collected for valid sample use; a statistical analysis on the profile of the hospitals collected and; an evaluation of the predictive power of five types of MLPs (Backpropagation Standard, Momentum, Resilient Propagation, Weight Decay and Quick Propagation) for SSI prediction. The MLPs were tested with 3, 5, 7 and 10 neurons in the hidden layer and with a partitioning of the database for the resampling process (65% or 75% for test, 35% or 25% for validation). They were compared by measuring the AUC (Area Under the Curve - ranging from 0 to 1) presented for each of the configurations.

Results: 13,383 data were collected and 7,566 records were usable where: 2.0% of SSI; the predominance of patients' ages was between 35 and 62 years; the mean duration of the procedure was 101 minutes; the mean hospitalization time (without SSI) was 4 days, versus 17 days in the positive cases. The predictive power of the proposed settings was between 0 and 0.6.

Conclusion: Despite the high noise index of the database, it was possible to sample relevant for the evaluation of the profile of General Surgery Service patients. However, for the predictive process, although there are results higher than 0.5, the database requires more SSI case samples, since only 2% of positive samples unbalanced the database.

Disclosure of Interest: None declared

P34 USING ARTIFICIAL NEURAL NETWORKS TO PREDICT OF SURGICAL SITE INFECTION IN ORTHOPEDIC PATIENTS

F. H. B. D. Souza, B. R. G. M. Couto, G. S. D. M. Serpa, I. P. D. A. L. Abelha, L. F. Valadão, M. E. C. Bernardes, M. C. B. Vidigal, Y. D. A. E. S. Haddad

Centro Universitário de Belo Horizonte - UNIBH, Belo Horizonte, Brazil
Correspondence: F. H. B. D. Souza

Introduction: This paper demonstrates an initial experiment to predict the risk of surgical site infection (SSI) after Orthopedic procedures in Belo Horizonte, a 3,000,000 inhabitants city from Brazil.

Objectives: The objectives are: collect data in 6 hospitals between 2016 and 2018; filtering the resulting database; benchmarking statistical assessments; to submit the resulting database to an initial experiment with MLP (Multilayer Perceptron) based pattern recognition algorithms for the evaluation of SSI occurrence prediction power.

Methods: The data were collected and the resulting database was filtered for use of intact samples. A statistical analysis was applied defining the behavioral profile. An evaluation of the SSI predictive power of five types of MLPs (Backpropagation Standard, Momentum, Resilient Propagation, Weight Decay and Quick Propagation) was performed. The MLPs were tested with 3, 5, 7 and 10 neurons in the hidden layer; a resampling process of 65% (and 75%) for learning and 35% (and 25%) for validation; and measuring the AUCs (Area Under the ROC Curve - between 0 and 1).

Results: 10069 records were collected with 46 variables each. Only 3673 were intact for study, where: 77 contracted SSI; length of hospitalization ranged from 0 to 186 days (mean 5 days for normal and 22 for SSI cases); 29 cases of death; duration of surgeries of 125 minutes (the majority concentrated between 90 and 190) and the mean age of the patients is approximately 50 years old. The initial experiments for SSI prediction showed a maximum AUC of 0.5845.

Conclusion: Despite the high noise index of the database, a relevant sample was obtained for the hospitals evaluated. However, for the predictive process, despite some results higher than 0.5, the database requires more SSI case samples, since only less than 1% of SSI samples generated an unbalance of the database.

Disclosure of Interest: None declared

P35 RISK OF SURGICAL SITE INFECTION AFTER CARDIAC SURGERIES: PATTERN-BASED ANALYSIS BASED ON MULTILAYER PERCEPTRON ARTIFICIAL NEURAL NETWORKS

F. H. B. D. Souza, B. R. G. M. Couto, A. C. L. Michelini, A. P. R. de Melo, L. G. Guerra, L. M. B. Costa, M. V. Melo, O. J. de Oliveira Junior

1Centro Universitário de Belo Horizonte - UNIBH, Belo Horizonte, Brazil
Correspondence: F. H. B. D. Souza

Introduction: This paper proposes a pattern-based analysis to predict the probability of surgical site infection (SSI) in cardiac surgeries in four hospitals in Belo Horizonte (Brazil), according to a data collection between 2016 and 2018.

Objectives: As specific objectives this work is to carry out a data collection and processing process; perform a statistical evaluation on the data involved and then a battery of experiments based on Multilayer Perceptron to analyze the probability of SSI prediction.

Methods: After the data collection: a filtering of the database collected for use of intact sample was performed; a statistical analysis on the profile of the hospitals collected; and finally, experiments to evaluate the SSI predictive power of five types of MLPs (Backpropagation Standard, Momentum, Resilient Propagation, Weight Decay and Quick Propagation), each with: 3, 5, 7 and 10 neurons in the hidden layer; a resampling process with 65% (and 75%) data for learning, 35% (and 25%) for validation; a comparison by measuring the AUC (Area Under the Curve - ranging from 0 to 1) for accuracy.

Results: 3078 records were collected, each with 46 variables, where 459 were used. It was found: average age of 65 years; approximately 250 surgeries with general anesthesia; the average time of surgery in 183 minutes (between 95 and 280 minutes); post-surgery hospitalization time ranging from 0 to 115 days (average 13 days); incidence of SSI 4.1% (these patients remained on average 29 hospitalized days) and a mortality rate of 10.0%. The predictive power ranged from 0.46 to 0.73.

Conclusion: In spite of the high index of noise in the database, it was possible an interesting sample for the evaluation of the profile of the hospitals. The predictive process, had achieved results higher than 0.5, figuring a very promising technique for predict process.

Disclosure of Interest: None declared

P36 ALGORITHMS FOR PATTERN RECOGNITION FOR PREDICTION OF SURGICAL SITE INFECTION IN VASCULAR SURGERIES

F. H. B. D. Souza, B. R. G. M. Couto, F. B. de Mello, I. Caldeira, J. S. F. R. de Morais, L. G. Mota, M. F. Dumont, R. W. Savio, S. M. Mazzoni

1Centro Universitário de Belo Horizonte - UNIBH, Belo Horizonte, Brazil
Correspondence: F. H. B. D. Souza

Introduction: This paper demonstrates an analysis based on pattern recognition algorithms based on artificial neural networks (type MLP - Multilayer Perceptron) for the prediction of surgical site infection (SSI) for vascular surgery.

Objectives: The main objective of this study is to demonstrate the predictive power of recognition algorithms based on MLP for vascular surgery in hospitals in Belo Horizonte.

Methods: Firstly, a data collection was performed between 2016 and 2018 in hospitals in Belo Horizonte, a 3,000,000 inhabitants city from Brazil, by the Hospital Infection Control Committees (CCIH). Thus, a filtering of the collected records (removal of noisy) and a behavioral analysis of the hospitals was performed. Finally, it was evaluated the SSI predictive power of five types of MLPs (Momentum, Backpropagation Standard, Weight Decay, Resilient Propagation and Quick Propagation). The MLP’s were tested with 3, 5, 7 and 10 neurons in the hidden layer. In the resampling process, the configurations of 65% (or 75%) for testing and 35% (or 25%) for validation were executed. They were compared by measuring the AUC (Area Under the ROC Curve - ranging from 0 to 1) for each configuration.

Results: From 3882 collected records, 2286 were intact. In a behavioral analysis: 2.4% present SSI; almost 80% of the cases vascular surgeries were in the peripheral regions of the body, 90% were not of urgency or emergency; cases of limb amputation reached 462 (approximately 25% of cases). Finally, the 40 experiments with MLPs showed AUCs between 0.85 and 0.996 for SSI prediction.

Conclusion: SSI values are lower than 2.5%, confirming the low degree of life risk, due to the time it takes to perform procedures to clean the surgical sites, which avoids contamination and because they are low impact surgeries. life of the patient. The database was useful for the prediction process of SSIs with AUCs of 0.996, allowing for intelligent software for monitoring with prediction of considerable SSI assertiveness, even with a considerable noise index and with imbalance (only 2,4% of SSI cases) for such surgery.

Disclosure of Interest: None declared

Poster session: Clostridium difficile

P37 DIARRHEAL SYMPTOMS EXTRACTED FROM CLINICAL NOTES FOR PATIENTS TESTING POSITIVE FOR CLOSTRIDIOIDES DIFFICILE IN THE INPATIENT, OUTPATIENT, AND LONG-TERM CARE SETTINGS

V. W. Stevens, G. Divita, K. Khader, M. Samore

IDEAS Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, United States
Correspondence: V. W. Stevens

Introduction: A clinical diagnosis of Clostridioides difficile infection (CDI) requires the presence of diarrheal symptoms and adequate documentation, posing substantial challenges for electronic surveillance efforts and large-scale epidemiological studies in electronic health record data

Objectives: To describe patterns in mentions of diarrheal symptoms in clinical notes among patients with a positive laboratory test for C. difficile

Methods: We conducted a retrospective cohort study of all positive tests for C. difficile in the US Department of Veterans Affairs health system in 2016. Episodes were classified as healthcare-acquired (HA), community onset-healthcare associated (CO-HCA), or presumed community-acquired (p-CA) based on Centers for Disease Control surveillance criteria. All clinical notes within the 7 days before and after the positive test were selected. Mentions of diarrhea were extracted using an ontology and dictionary-based natural language processing pipeline built using the V3NLP framework. Two reviewers manually classified 600 asserted snippets as true positive or false positive. NLP performance was measured using the positive predictive value (PPV).

Results: In 2016, there were 11,826 positive laboratory tests for C. difficile. Of these, 2,735 (23%) were HA, 3,576 (30%) were CO-HCA, and 5,515 (47%) were p-CA. The positive predictive value of the NLP tool was 86.4%. We identified mentions of diarrhea within 2 days before or after a positive test in 7,361 (62.2%) of all episodes: 1,803 (65.9%), 2,524 (70.6%), and 3,034 (55.0%) of HA, CO-HCA, and p-CA episodes, respectively. Removing duplicates within 14 days of a prior positive only slightly increased the yield (62.9% of all episodes). 60% of mentions occurred between 2 days before to 2 days after the positive test.

Conclusion: Extraction of diarrheal symptoms from clinical note text has the potential to enhance studies of the epidemiology and transmission of CDI. We identified evidence of diarrhea within 2 days of a positive test in approximately 62% of episodes. Further work is needed to determine whether the absence of diarrhea mentions reflects inappropriate testing of patients without diarrhea, under-documentation of diarrheal symptoms, or other factors.

Disclosure of Interest: None declared

P38 COMMUNITY VERSUS HEALTHCARE-ASSOCIATED CLOSTRIDIUM DIFFICILE INFECTION: A 12 YEARS PROSPECTIVE STUDY IN A FRENCH UNIVERSITY HOSPITAL

N. Khanafer1,2, C. U. Edouard Herriot Hospital2, L. Oltra2, V. Pergay1,2, O. Dauwalder2, F. Vandenesch1,2, P. Vanhems1,2

1Lyon 1 University; 2Hospices Civils de Lyon, Lyon, France
Correspondence: N. Khanafer

Introduction: C. difficile infection (CDI) weighs heavily on healthcare system due to increased incidence, morbidity and mortality, as well as costs. CDI is mainly considered as a health-care associated (HCA) after exposure to broad-spectrum antibiotics. However, CDI has been reported outside health care institutions in people previously thought to be at low risk.

Objectives: The objective of this study was to compare characteristics of CDI cases regarding the infection presumed acquired in the community or in the hospital.

Methods: Between November 2006 and December 2018, a prospective surveillance study of CDI was conducted in a 900-bed French university hospital. National and European definitions of CDI case, relapses and origin of acquisition were applied. Standardized questionnaire was used for data collection.

Results: A total of 931 (=989 episodes) patients were included with a mean incidence rate of 2.3 per 1000 hospital-stays. Most of episodes were HCA (76.5%). The remaining cases were community-acquired (CA) (18.3%) or unknown origin (5.2%). The mean age of patients was 60.1 and 67.5 years for CA and HCA cases respectively (P<0.001) and 30.7% of CA patients were ≤45 years (P<0.001). In CA cases, women were more prevalent (59.2% vs 48.9% in HCA-CDI, P=0.01). CA-CDI group had lower rate of recent antimicrobial exposure (41% vs 79%, P<0.001), proton pomp inhibitor (39.5% vs 61.7%, P<0.001) and gastrointestinal surgery (2.37% vs 7.8%, P=0.008). Fever (>38°C), abdominal pain and ileus were significantly more frequent in CA cases (37.3% vs 26.6%; 45.5% vs 24.1% and 4.3% vs 1.2% respectively). Pseudomembranous colitis was more frequent in CA group compared to HCA cases (7.7% vs 4.5%, P=0.07). However, relapses and death were more frequent in HCA-CDI (8.5% vs 5.7% and 11% vs 6.6% respectively).

Conclusion: We found that approximately 20% of all CDI cases were CA with most of half not exposed to antimicrobial or proton pomp inhibitor drugs. Monitoring and active surveillance of CDI is needed to improve our understanding of the changing epidemiology of the disease.

Disclosure of Interest: None declared

P39 MULTI-COMPONENT STRATEGY TO PREVENT C. DIFFICILE INFECTIONS IN ACUTE CARE HOSPITAL

P. Grzesiowski1, D. Pawlik2, A. Kadecka3, A. Sakowska4

1Centre of Postgraduate Medical Education, Foundation for Infection Prevention Institute, Warsaw; 2Microbiology, Primary Hospital Makow Maz., Makow; 3Secondary Hospital , Ciechanow, Poland; 4Microbiology, Secondary Hospital, Ciechanow, Poland
Correspondence: P. Grzesiowski

Introduction: Clostridioides difficile infections are currently one of the most important public health threats in developed countries. In Poland, during last 10 years, hospital C. difficile infections increased significantly, reaching over 15,000 cases per year associated with high morbidity, mortality, and economic costs.

Objectives: In order to reduce the incidence of hospital C. difficile infections, we performed the prospective, single center observational study, on the assessment of the effectiveness of multi-component strategy.

Methods: Study setting: secondary acute 650-bed hospital

Study period: 2014-2018

Study method: single center, prospective, observational study

Bundle intervention: multi-component strategy consisted of hand hygiene implementation according to WHO guidelines, environmental cleaning improvement, fumigation of isolation rooms with hydrogen peroxide after patient discharge, regular quality control of cleaning procedures by using fluorescent marking gel (UV-DAZO), single room isolation of infected patients, antibiotic stewardship and medical staff education with regular feedback.

Results: During study period we observed significant, gradual, 4-fold decrease of hospital C. difficile infections (145 vs 38 cases), with increase of hand hygiene procedures as measured by alcohol hand rub usage (5,4L vs 27 L/1000 patient days) and improvement in cleaning high-touch surfaces as measured by removed fluorescent gel marks (45% vs 98%).

Conclusion: The bundle intervention significantly reduced C. difficile hospital infection rates. Results of our study support effectiveness the multi-component strategy based on hand hygiene, environmental cleaning, isolation procedures, antibiotic stewardship and staff education.

References

Barker A., Ngam C., Musuuza J. et al: Reducing Clostridium difficile in the inpatient setting: A systematic review of the adherence to and effectiveness of C. difficile prevention bundles. Infect Control Hosp Epidemiol. 2017; 38(6): 639–650.

Dubberke E, Carling P, Carrico R, et al. Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35:628–645.

Mattner F, Winterfeld I, Oswald B, Solbach W. Successful bundle of prevention measures against a high CDAD incidence at a university hospital. Hyg Med. 2008;33:346–352.

Disclosure of Interest: None declared

P40 CLOSTRIDIOIDES DIFFICILE INFECTION: APPLICATION OF A 4 DAYS CUT-OFF CLASSIFICATION

R. Loss1, L. Arnoldo2, R. Aschbacher3, M. Lopez1, P. Santa1, E. Pagani3, M. Bombonato1, F. Girardi1

1Hospital Hygiene , Bozen; 2University of Udine, Udine; 3Laboratory of Microbiology , Bozen, Italy
Correspondence: R. Loss

Introduction: Clostridioides difficile infection (CDI) is the leading cause of antibiotic associated diarrhea in hospitalized patients, with a variable incubation time ranging from 2 to 19 days. According to a recent proposal (Mc Lure et al. 2018), the recommended 48 h cut- off can overestimate the incidence of hospital acquired CDI (HA CDI), because of high sensitivity but poor specificity to detect infection acquired during hospital staying.

Objectives: We conducted a retrospective study to evaluate the incidence and epidemiology of CDI in an Italian tertiary care hospital and we reclassified CDI cases using a cut-off of 4 days.

Methods: All laboratory diagnosis based cases of CDI of a 3 years period were reviewed. Each case was classified according to ECDC criteria as HA CDI, Community -acquired CDI (CA CDI) and indeterminate and reclassified using a cut-off of 4 days as HA CDI and non HA CDI.

Results: Out of 183 CD positive patients, 120 cases referred to hospitalized patients and were analyzed. Incidence remained stable around 3,20/10.000 patient days; 42,5% of patients had previous admission to hospital in last 4 weeks and 74% came from home. For HA CDI, median interval to diagnosis was 10,7 days. According to ECDC definition 80,8% of cases (97/120) were HA CDI , 16,7% CA-CDI, 2,5% indeterminate. Among the HA-CDI onset of symptoms was in the community in 27 cases, for 70 cases onset was in hospital. Using the classification based on a 4 day cut-off, HA CDI drop to 57 (47,5%) and not hospital related CDI increase to 63 (52,5 %). Lacking 13 CDI cases developed at 3 and 4 day and can be probably imported from community.

Conclusion: Our study showed variability of CDI in terms of characteristics, origin, incubation time. This study applied the 4 days cut-off classification, showing that half of the HA cases developed very late in the hospitalization. More analysis are required to verify if these cases classified as hospitals cases were rather already colonized and coming from the community.

References

Disclosure of Interest: None declared

Poster session: Influenza 1

P41 DOES INTRODUCTION OF A RAPID INFLUENZA PCR IMPROVE PATIENT CARE OF ACUTE HOSPITALIZED PATIENTS DUE TO INFLUENZA LIKE ILLNESS?

M. Boonstra1, O. Pontesilli1, P. Smit1, T. van der Graaf2, R. El Moussaoui3, C. van Noord3, M. Damen1

1Medical Microbiology and Infection Prevention; 2Business Intelligence; 3Internal Medicine, Maasstad Hospital, Rotterdam, Netherlands
Correspondence: M. Boonstra

Introduction: In our hospital contact-droplet isolation should be applied to adult patients with influenza (flu) and influenza like symptoms (ILS) of unknown cause. During the flu season isolation beds are scarce and acceleration of diagnosis and patient flow is preferred.

Objectives: Objectives were (1) to determine if introduction of a rapid polymerase chain reaction (PCR) for flu virus (Xpert Flu) would reduce isolation days per flu negative patient with ILS by comparing flu season 2017-2018 to 2018-2019,(2) the number of patients admitted to correct wards (pulmonary/internal medicine) and (3) frequency of reassignment to different wards/rooms.

Methods: Adult patients who underwent a flu test were included. During December 2017-April 2018 (season 1, S1) an in-house viral respiratory PCR panel, including flu A/B, was performed (24-48 hours). In December 2018-April 2019 (season 2, S2) the Xpert Flu was performed (2 hours). Information on hospital admittance and duration of isolation per patient, based on labelling of patients was retrieved from the electronic patient record (EPR).

Results: 429 (S1) and 478 (S2) patients were included in the analysis. Comparing S1 and S2: 70% (100/142) and 72% (96/133) flu positive admitted patients were labelled for isolation, mean isolation duration was 83 hours (±14,8 95% confidence interval (CI)) and 129 hours (±64,2 95% CI), one flu negative patient and zero patients were labelled for isolation, 64% (239/374) and 70% (374/408) were admitted to the correct ward, and the mean frequency of bed reassignment per patient was 0.54 (±0.08 95% CI) and 0.46 (±0.07 95% CI).

Conclusion: The effect on isolation could not be determined because labels were incorrectly placed in the EPR, therefore not accessible for automatic analysis. Frequency of admittance to correct wards, and mean frequency of reassignment to different wards tended to be improved in S2, however not significantly. Overall, patient care seems to be improved in the rapid-PCR season, however data are biased by differences in influenza prevalence and other improvements in patient care, moreover isolation should be registered differently in order to evaluate quality of care.

Disclosure of Interest: None declared

P42 INFLUENZA IMMUNIZATION: KNOWLEDGE AND ATTITUDES AMONG OFFICE BASED PRACTITIONERS IN PARIS AREA IN 2018/2019

A. DESLANDES, E. SERINGE, K. LEBASCLE, P. ASTAGNEAU

CPIAS ILE-DE-FRANCE, PARIS, France
Correspondence: A. DESLANDES

Introduction: Influenza virus is a major public health concern, causing high morbidity and mortality every year. As virus transmission could be mediated by healthcare workers (HCW), their vaccination remains the main prevention measure. In France, despite recommendations to be vaccinated annually, the vaccination rate of HCW remains poor in healthcare facilities (around 25%). However, few data are available in office based practitioners (OBP).

Objectives: To assess vaccine coverage among OBP and identify barriers to vaccination.

To evaluate knowledge and attitudes regarding influenza transmission and preventing methods.

Methods: A descriptive study was performed during the 2018-2019 flu epidemic based on an online questionnaire sent to office based physicians, midwives, nurses and physiotherapists in Paris area. They were asked to report their influenza immunization status and reasons for accepting or refusing vaccination. The survey also assessed knowledge and attitudes regarding influenza virus transmission and prevention methods (masks and vaccination).

Results: A total of 556 practitioners completed the survey, mostly nurses (56%) and physiotherapists (43%). Neither physicians nor midwives responded to the study. The overall reported influenza vaccination coverage (95% CI) was 63% [59.3-67.5]. The main reasons for being vaccinated were to protect themselves (51%) and to protect patients (37%). Among HCW refusing influenza vaccination (n=182), the 3 most common reasons were: using other prevention methods (37%), doubts regarding the efficacy of influenza vaccination (30%) and opposition to influenza vaccination (30%).

HCW refusing vaccination had more misconceptions about the vaccine. Only 59% of them knew that the vaccine was not able to transmit the flu whereas 79% of vaccinated people knew that fact (p<0.0001).

Conclusion: The influenza immunization coverage of OBP is higher than those reported in healthcare facilities.

However, barriers against vaccination remain important issues, especially misconceptions regarding the vaccine efficacy or safety. Addressing these knowledge gaps in both initial formation and continuing medical education of HCW could lead to better protection and reduced morbidity among patients.

Disclosure of Interest: None declared

P43 HOW TO ACHIEVE 80% INFLUENZA VACCINATION COVERAGE IN A LARGE NORWEGIAN UNIVERSITY HOSPITAL

M. E. Gjerde, K. S. Kilhus

Department of Research and Development, Division of Patient safety and Infection Control, HELSE BERGEN, Bergen, Norway
Correspondence: M. E. Gjerde

Introduction: The World Health organization recommend 75% influenza vaccination coverage among healthcare workers (HCWs). In 2017, the total vaccination coverage among HCWs in Norway was approx. 17%. In 2018, Norwegian health authorities followed up by explicitly stating the objective of 75% coverage among HCW. We describe the strategy accomplishing 80% vaccination coverage among all employees in a Norwegian University Hospital with 12 000 employees.

Objectives: Achieve and sustain 75% influenza vaccination coverage as a patient safety measure.

Methods: The last 20 years seasonal influenza vaccine has been offered free of charge to employees. In 2015, the Hospital Management and Infection Control team introduced an Infection Control program using Quality Improvement methodology. The main objective was to empower leaders to take responsibility and put infection control on the daily agenda by setting local goals. The Infection Control team created a toolkit and offered to facilitate departments. Measures to improve vaccination coverage are management commitment, education, vaccination availability, communication strategies and comparing results within the hospital. The national objective enabled hospital management to set an explicit goal for vaccination coverage stimulating competition within and between hospitals.

Results: The vaccination coverage among employees in Haukeland University hospital was 19% from 2006-2014. After introducing the Infection Control program in 2015, the coverage reached 41%. The health authorities introduced an explicit objective 2018, contributing to an all-time high of 80% vaccination coverage.

Conclusion: Introducing an Infection Control program ensuring patient safety, continuous quality improvement and management commitment is an important foundation for achieving increased coverage. The introduction of an explicit national objective was a necessary measure to be able to achieve satisfying results.

Disclosure of Interest: None declared

P44 RELENTLESS EDUCATION EFFORTS TO COUNTER ‘BELIEFS’ ASSOCIATED WITH UPTAKE OF STAFF FLU VACCINATIONS

H. K. Lam1, K. Rajwinder2

1Clinical Operations, Matilda International Hospital, Hong Kong; 241 mount kellett road, matilda international hospital, the peak, Hong Kong
Correspondence: H. K. Lam

Introduction: It is common knowledge that influenza can kill and the best way to prevent its spread is through vaccination. However, it is often noted that “belief” which exists around the effectiveness and side effects of flu vaccines hinders uptake by healthcare workers. Even though education is delivered year on year to counter these “beliefs”, however, health promotion conducted during non-stormy waters do not impact or change perspectives.

Objectives: In order to further increase uptake for this year, various measures over the past year were designed to examine the real reasons behind staff’s refusal of vaccination, with the ultimate aim of steamrolling the reasons to increase uptake.

Methods: At the kick-off of the 2017/18 Staff Flu Vaccination Campaign, the infection control team(ICT) created various educational opportunities encompassing booth games in the staff canteen supplemented by on-site education followed by interviews of staff by means of using iPads. A survey was designed to be offered in both English and Chinese and was launched online and staff who refused to receive a flu jab during the 2017/18 campaign were invited to complete it.

Results: 72 submissions with 7% claiming that they did not know where to receive a jab. In examining the “beliefs”, 35% answered “others” as reasons for refusing which included “no time to get a jab”, “being sick at that moment” or “the lack of vaccine stock during that particular period”. 20% indicated “a fear of side effects”. Same number of staff (18%) claimed “the fear of needles” and “ineffectiveness of vaccine demonstrated by past experience”.

Conclusion: With all feedbacks attained over the year, ICT concluded that the main reason of refusal was because of a lack of knowledge on influenza. Thus to kick start the 2018/19 campaign, a microbiologist was invited to give an educational talk on influenza to counter “beliefs” in relation to side effects, effectiveness etc. were all addressed supported by scientific data and etiology. Learning from past experience, more stock of vaccines was purchased to prevent insufficient supply. To allow more opportunities to receive a jab, ICT set up a vaccination booth in staff canteen and provided on-site injection in a bi-weekly basis. As a result of these series of improvement strategies, the overall staff flu vaccination compliance rate increased steadily to 60% in 2018/19.

Disclosure of Interest: None declared

P45 INFLUENZA IMMUNIZATION : HOW TO ENCOURAGE HEALTHCARE WORKERS TO GET VACCINATED ?

S. CYRILLE, E. SERINGE, K. LEBASCLE, P. ASTAGNEAU

CPIAS ILE-DE-FRANCE, PARIS, France
Correspondence: S. CYRILLE

Introduction: Influenza vaccination is important to prevent influenza transmission and associated morbidity among patients in all healthcare facilities (HCF). Despite French recommendations for all healthcare workers (HCW) to be vaccinated annually against influenza, the vaccination rate is suboptimal.

Objectives: To assess vaccine coverage among HCW and identify barriers to vaccination in order to promote specific measures that could improve vaccination coverage.

Methods: A descriptive study was conducted during the 2018-2019 flu epidemic based on an online questionnaire sent to all hospital infection control teams in Paris area. Participants were asked to report their HCW influenza immunization coverage and select potential barriers of influenza vaccination as identified from the literature. They were also invited to assess the effectiveness of various strategies known to improve influenza vaccination compliance.

Results: Overall, 35% (N=141) of healthcare facilities responded to the study. The overall influenza vaccination coverage (95% CI) was reported to be 24.4% [22.2-26.6] including 43.5% [38.5-48.5] for physicians and midwives, and 22.6% [19.9-25.3] for nurses and nursing assistants. Low compliance with seasonal influenza vaccination among HCW was primarily attributed to doubts regarding the efficacy of influenza vaccination (86%), followed by concerns regarding vaccine safety (66%) and social media influence (45%) (n=141). The most effective strategies proposed to increase influenza vaccination uptake were 1) being vaccinated directly in the hospital wards by a colleague (n=119; 79%), 2) use a mobile vaccination cart (n=79; 78%), 3) set up a vaccination stand (n=62; 61%).

Conclusion: Although slightly in progress as compared to previous years, the influenza immunization coverage among HCW remains below expectation in these healthcare settings. The identification of barriers suggests the need for better information on flu vaccine towards healthcare professionals in addition to implementation of active vaccination campaign.

Disclosure of Interest: None declared

P46 STAFF INFLUENZA VACCINATION MEETING THE JOINT COMMISSION REQUIREMENTS OF 90% BY 2020

A. Dababneh1, S. Bowman 2, K. Dixon 3, C. McHenry 2, M. Moran 3, J. Rybarczyk4, S. spah2, J. streets Benningfield 3, R. Varathraj Palraj 1, C. Wilker 5, B. Withers 2

1Infectious diseases, Mayo Clinic, Rochester; 2occupational health; 3IPAC , MCHS La Crosse , La Crosse; 4IPAC , MCHS Sparta , Sparta; 5Internal medicine , MCHS La Crosse , La Crosse , United States
Correspondence: A. Dababneh

Introduction: Influenza vaccination for health care workers on an annual basis is currently recommended by CDC, the Advisory Committee on Immunization Practices (ACIP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommend that all U.S.. Joint commission has set a goal of achieving 90 % vaccination by 20201. At Mayo Clinic Health System in La Crosse WI vaccination rates for 2015 influenza season was 86.9%.

Objectives: improve staff influenza vaccination rates to above 90% and sustain it.

Methods: A multidisciplinary team approach was developed to promote influenza vaccination as a Patient Safety initiative. Compliance with influenza program included vaccination, provide proof of medical contraindication from a Medical Provider, provide proof of vaccination at another location, or declination. Influenza vaccine clinic was made available. Departments were allowed to administer vaccine to staff, egg free vaccine was made available, promotional campaign was implemented, email updates and letters of non-compliant staff. Attendance of a physician led face to face education was mandatory prior to declination. Questionnaire was provided to employees before and after the lecture to asses barriers to vaccination.

Results: By the compliance due date, January 11, 2017 the 2016-2017 influenza season staff vaccination, vaccination rate was 91.7% 3,128/3,412. 5.9 % improvement compared to 2015-2016 influenza season vaccination rate . 239 questionnaires were completed. 47.3% had patient care responsibilities,52 % reporting prior flu like illness. 89.1% found the educational component informative. 67.2% believe that the vaccine is safe. 41.1% thought that the influenza vaccine was effective. 29.4% have objections to vaccines in general and 1.3% changed their mind after hearing the lecture.

Conclusion: mulideisicplinary team approach with education for influenza vaccine declination is a useful tool to improve vaccination rates among hospital employees

References

1. Strengthened stardards onf flu vaccinations to pressure hospitals to progress. ED management 2012 Mar 24 : SUPPL 1-3

Disclosure of Interest: None declared

P47 GIVING HEALTHCARE WORKERS (HCW) A CHOICE BETWEEN VACCINATION AND WEARING A MASK DURING SEASONAL INFLUENZA EPIDEMIC: A POSSIBLE STRATEGY TO INCREASE VACCINATION COVERAGE

A. Iten1, C. Bonfillon2, C.-A. Siegrist3, D. Pittet1

1Infection Control Program; 2Hospital Health Service; 3Pediatrics, HUG, Geneva, Switzerland
Correspondence: A. Iten

Introduction: Vaccination against seasonal influenza is the cornerstone of protection for both patients and hospital staff (HCW). Various actions are recommended to increase hospital staff adherence to seasonal influenza vaccination: information campaigns, management support, and vaccination available directly in patient care wards, day and night, at no cost. Despite the implementation of these measures, the vaccination rate of our institution remained stable at around 24% for a decade. As Swiss law does not allow vaccination to be mandatory, an alternative solution was tried: the obligation for staff to choose between vaccine and wear of a mask during the epidemic period.

Objectives: To describe the evolution of the vaccination rate among HCW, following the introduction of a strategy that consists in choosing between vaccination and the wear of a mask during the epidemic period.

Methods: The vaccination campaign takes place every year from late October to mid-December, with the option for the hospital staff vaccinated until the peak of the influenza epidemic. Vaccination is offered by dedicated and trained staff. Personal information and hospital sector of the vaccinated persons are systematically collected.

Results: From October 2011 to February 2019, seasonal influenza vaccination was offered to 91,181 people. During this period, the averaged vaccination rate increased by 9.7% for all staff (season 2011/2012: 29.3%; season 2018/2019: 39.0%), by 11.6% for medical staff and by 6.2% for the rest of staff. The champions of this evolution were doctors (+11.6%) and social workers (+11.5%). This increase differs from one sector to another: max. +18.5% for the gynaecology/obstetrics department; min. +3.9% for the operations department.

Conclusion: The requirement to choose between the vaccine and wearing a mask during an epidemic increases adherence to influenza vaccination. However, the effect of this measure is inhomogeneous: a detailed analysis of the results is necessary to plan additional measures.

Disclosure of Interest: None declared

P48 EVALUATION OF A MULTIMODAL STRATEGY TO PROMOTE INFLUENZA VACCINATION OF HEALTHCARE WORKERS

P. Bressin, L. Senn, P. Genoud, D. Christen, M. Cote, J. Scheurer, G. Zanetti, C. Lazor Blanchet

CHUV - centre hospitalier universitaire vaudois, Lausanne, Switzerland
Correspondence: L. Senn

Introduction: Influenza vaccination of healthcare workers (HCWs) remains one major preventive measure against nosocomial Influenza. However, many HCWs still decline vaccination. Our University Hospital have implemented an active promotion of this vaccination.

Objectives: To evaluate the impact of a multimodal strategy to promote Influenza vaccination in HCWs.

Methods: A multimodal strategy has been implemented in 2015. It was based on i) posters throughout the hospital, ii) a ‘treasure hunt’ (stickers with QR codes opening short videos) and iii) messages on intranet and in internal newsletters. Access to the vaccine has been facilitated through several vaccination points located at strategic places (changing rooms, hospital entrances, cafeterias, etc.), and the deployment of ‘vaccine delegates’ in each ward (n = 100). The number of vaccines administrated was collected to calculate the vaccination coverage (VC). During the Influenza season, an institutional directive obligates to wear a mask by all unvaccinated HCWs in contact with patients. The evolution of VC and the proportion of putative nosocomial influenza cases were monitored.

Results: Between the 2011-12 and 2018-19 Influenza seasons, the VC of HCWs in contact with patients increased from 29.5% to 50% (p<10-6), in both nurses (+75%) and physicians (+57%). Physicians’VC remained higher than nurses’VC (respectively 55% vs. 42%). The proportion of vaccinations carried out by vaccine delegates was 36% in 2018-19. The proportion of nosocomial Influenza was 22% and 18% respectively over the last two seasons. The campaign tools were shared with partner hospitals.

Conclusion: Since the implementation of this multimodal strategy to promote Influenza vaccination, we observed a significant increase in VC. Strong support from the hospital direction seems to have been a factor of success. This experience reinforces the interest for a multimodal strategy.

Disclosure of Interest: None declared

Poster session: Epidemiology of Carbapenemases

P49 INCIDENCE OF MULTIDRUG-RESISTANT, EXTENSIVELY DRUG-RESISTANT AND PANDRUG-RESISTANT GRAM-NEGATIVE BACTERIA IN BRAZILIAN INTENSIVE CARE UNITS

G. L. E. Souza1, R. F. de Andrade Rocha1, A. D. N. Silveira1, H. D. D. D. Carvalho1, C. D. D. M. Oliveira1, L. G. Giarolla1, E. M. M. Leite2, E. U. Silva3, B. R. G. M. Couto4, C. E. F. Starling5, on behalf of NOIS Project

1Instituto de Ciências Biológicas e da Saúde, Centro Universitário de Belo Horizonte; 2Risoleta Tolentino Neves Hospital; 3Madre Teresa Hospital; 4Avenida Professor Mario Werneck, 1685, Centro Universitário de Belo Horizonte; 5Lifecenter Hospital, Belo Horizonte, Brazil
Correspondence: G. L. E. Souza

Introduction: Understanding the incidence of multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR) can ultimately result in accurate treatment of healthcare associated infections (HAI) in intensive care units (ICU's).

Objectives: This research provides a public report, and benchmarks for the resistance rate of gram-negative MDR, XDR and PDR bacteria causing HAI's in 12 ICU's from Belo Horizonte, a brazillian city with aproximately 2,5 million inhabitants.

Methods: Data was collected between Jan/2013 to Dec/2017. All hospitals complied with ECDC HAI surveillance protocols. Antimicrobial resistance from 6 gram-negatives were evaluated: Acinetobacter sp., Klebsiella sp., Proteus sp., Enterobacter sp., Escherichia coli, and Pseudomonas sp.. Benchmarks were defined as p10, p20, p50 and p70 percentiles for total multi-resistance rate, or TMR (MDR+XDR+PDR = TMR).

Results: A total of 6,242 strains were tested: no PDR were found. Acinetobacter sp.: 1432 out of 1858 (77%) were MDR, and 206 (11%) were XDR. Klebsiella sp.: 813/1.566 (52%) MDR; 2/1566 (0,1%) XDR. Proteus sp.: 163/507 (32%) MDR; 0/507 (0%) XDR. Enterobacter sp.: 148/471 (31%) MDR; 0/471 (0%) XDR. Escherichia coli: 0/681 = 157/681 (23%) MDR; (0%) XDR. Pseudomonas sp.: 180/1159 (15%) MDR; 41/1159 (3%) XDR. Benchmarks: Acinetobacter sp. [74, 82, 91.5, 93]. Klebsiella sp. [31,39, 53.5, 62]. Proteus sp. [17,18, 28.5, 33]. Enterobacter sp. [16, 19, 30, 42]. E. coli [13, 13, 22.5, 29]. Pseudomonas sp. [7, 7, 18.5, 26].

Conclusion: Acinetobacter sp. presented highest prevalence, and a TMR of 88%. Pseudomonas sp. was the 3rd most prevalent strain, but had the lowest TMR and second highest XDR rate. Benchmarks can be used for healthcare quality assessment.

Disclosure of Interest: None declared

P50 PREVALENCE OF ESBL AND MBL ENCODING GENES IN ACINETOBACTER BAUMANNII STRAINS ISOLATED FROM PATIENTS OF INTENSIVE CARE UNITS IN KURDISTAN, IRAQ

S. T. Baban, P. Akram, D. Jalal

Infection control and prevention, Surgical Specality Hospital, Erbil, Iraq
Correspondence: S. T. Baban

Antibiotic resistance in Acinetobacter spp., particularly Acinetobacter baumannii, is increasing rapidly. A. baumannii possesses two intrinsic b-lactamase genes, in addition to weak permeability and efflux systems, that together confer a natural reduced susceptibility to antibiotics. The aim of this study was to investigate the prevalence of ESBL and MBL encoding genes among A. baumannii isolates. In this study, 300 A. baumannii strains were isolated from ICU wards of three hospitals of Erbil City, Iraq in 2019. Phenotypic identification of the production of ESBLs and MBLs has been carried out by using DDST methods. PCR technique was used for amplification of the ESBL and MBL encoding genes, namely: CTX-M, SHV, TEM, OXA-51, VIM-Family, IMP-Family, SPM-1, SIM-1, and GIM-1. Eighty seven (87%), 95 (95%), 98 (98%) and 95 (95%) out of 100 A. baumannii isolates were resistant to imipenem, meropenem, ceftazidime and cefotaxime, respectively. Also, 99% and 7% of the isolates were MBLs and ESBLs produced phenotypically. Ninety (30%), 60 (20%) and 180 (60%) out of 100 A. baumannii isolates have been confirmed to harbor the blaVIM-family, TEM and SHV genes, respectively. Our results show no significant relationship between the detected gens with production of MBLs and ESBLs in spite of high prevalence of MBL encoding and drug resistant A. baumannii. Probably some other genes rather than what we studied are involved in phenotypic production of MBLs and ESBLs and subsequent drug resistance in Kurdistan area, Iraq.

Disclosure of Interest: S. Baban Employee of: No conflict of interest, Grant/Research support from: No conflict of interest, Speaker's bureau of: No conflict of interest, Shareholder of: No conflict of interest, Consultant for: No conflict of interest, Paid instructor for: No conflict of interest, Other conflict with: No conflict of interest, P. Akram: None declared, D. Jalal: None declared

P51 RESISTANCE TO THIRD GENERATION CEPHALOSPORIN DUE TO TEM AND CTX-M-1 TYPE EXTENDED-SPECTRUM Β-LACTAMASE GENES AMONG CLINICAL ISOLATES OF GRAM-NEGATIVE BACILLI IN ASELLA, CENTRAL ETHIOPIA

T. B. Tufa1,2, F. André 1,2, S. Abdissa1,2, K. Achim 3, M. Colin 3, P. Klaus 3, F. Torsten 1,2, H. Dieter 1,2

1DGHID, University Hospital, Düsseldorf, Germany; 2Hirsch Institute of Tropical Medicine, Asella, Ethiopia; 3Institute of Medical Microbiology and Hospital Hygiene, Düsseldorf, Germany
Correspondence: T. B. Tufa

Introduction: Lack of local data concerning causative pathogens and resistance patterns results in suboptimal empirical treatment and unfavorable clinical outcomes.

Objectives: to characterize antimicrobial resistance patterns of Gram-negative bacteria isolated from hospitalized patients with febrile infections in Central Ethiopia.

Methods: In total, 684 Patients ≥1 year of age admitted to the Asella Teaching Hospital with fever from April 2016 to June 2018 were included. Blood and other appropriate clinical specimens were cultured. Susceptibility testing was performed using the Kirby-Bauer method and VITEK2. Confirmation of species identification and identification of resistance-genes were conducted using MALDI-ToF-MS and PCR at a microbiology laboratory in Düsseldorf, Germany.

Results: In total, 684 study participants were included; 54% were male and the mean age was 26.7 years. At sample collection, 57.2% (391/684) patients received antibiotic therapy. Ceftriaxone was the most commonly prescribed antibiotic (78%).

The overall culture positivity rate was 7.5%. Of 83 cultured organisms, 38(46%) were Gram-negative, 43(52%) Gram-positive and 2(2%) Candida species. Among the 38 Gram-negative isolates, 16 (42%) were E. coli, 15 (39%) K. pneumoniae and 4 (11%) P. aeruginosa. Resistance against commonly used antibiotics for Gram-negative bacteria at the study site was: piperacillin/tazobactam 48%(13), ampicillin/sulbactam 93%(25), cefotaxime 89%(24), ceftazidime 74%(20), cefipime74%(20), and amikacin 4%(1). Of 27 Gram-negative bacteria available for resistance-gene detection, blaNDM-1 was detected in one K. pneumoniae isolate and blaNDM-1 plus blaOXA-51 in A. baumannii. 81% (22/27) of the Gram-negative rods were confirmed to contain ESBL-genes as follows: TEM 17 (77%), CTX-M-1-group 15(68%), and SHV-6(27%).

Conclusion: We found a high prevalence (81%) of ESBL-producing bacteria and 7.4% carbapenem-resistance. The 3rd generation cephalosporin were the most prescribed drugs at the study site. Strengthening of antimicrobial stewardship programs is required in order to face the threat of multidrug-resistant bacteria.

Disclosure of Interest: None declared

P52 BURDEN OF A ST258 KPC-KLEBSIELLA PNEUMONIAE CLONE HARBOURING KPC-2 AND RMTB METHYLASE IN A BRAZILIAN TERTIARY CENTRE

D. O. Andrey1,2, P. Dantas3, W. B. Brasileiro Martins4, K. Sands2, E. Portal2, T. R. Walsh2, E. A. Medeiros3, A. C. Gales4

1Infectious Diseases Division, Geneva University Hospitals and Medical School, Geneva, Switzerland; 2School of Medicine, Cardiff University, Cardiff, United Kingdom; 3Infection Control; 4Alerta Lab, Division of infectious Diseases Escola Paulista de Medicina, Hospital Sao Paulo, UNIFESP, Sao Paulo, Brazil
Correspondence: D. O. Andrey

Introduction: KPC-K. pneumoniae (KPC-KP) infections are challenging, and not least in middle-income countries, where novel b-lactams/b-lactamase inhibitors are often not available. Remaining options are often restricted to "old antibiotics" such as aminoglycosides and polymyxins.

Objectives: Hospital São Paulo (HSP) is a Brazilian teaching hospital, where KPC-KP are endemic. The role of aminoglycoside resistance in bloodstream infections (BSI) due to KPC-KP was examined.

Methods: This is a subanalysis within a retrospective clinical-microbiological study of 125 BSI due to KPC-KP during 2014-16 at HSP (one isolate per BSI). AST was determined by agar dilution (EUCAST interpretation). BSI cases caused by KPC-KP non-susceptible (NS) to aminoglycoside (both amikacin and gentamicin) were compared to the remaining cases. PFGE of all isolates and WGS (Illumina, MinIon long-reads) of a subset of isolates were carried out. Clinical data was compared between both groups.

Results: Forty-nine (39%) of 125 KPC-KP isolates were amikacin and gentamicin NS (>128mg/L MIC for both in 45 cases). Among NS isolates, PFGE analysis coupled with in silico MLST identified 40 isolates belonging to ST258, 6 to ST11, 2 to ST16 and one to ST437. Among those, a subset of 31 were sequenced showing 84% positivity for rmtB 16S-rRNA methylase gene (ST258 isolates N=24, ST11 N=1 and ST16 N=1). No other 16S-rRNA methylase was identified. Genomic assembly of one ST258, one ST11, and one ST16 isolate showed highly similar 177 kb IncA/C2 plasmids, harbouring rmtB. Outcome analysis showed 65% all-cause 30-day mortality for the cohort, 61% in the aminoglycoside-NS group vs 66% in the aminoglycoside susceptible group (p=0.6).

Conclusion: We report the burden and clonal spread of a KPC-2 rmtB+ ST258 KP clone in a tertiary hospital, and in two cases probable horizontal acquisition of an IncA/C2 plasmid by ST11 and ST16 KPC-KP isolates. Although we did not identify an impact on mortality, the dissemination of 16S-rRNA methylase rmtB plasmids in an endemic setting for KPC-producing CC258 clones, providing resistance to most available aminoglycosides including new therapeutic options as plazomicin, is worrisome.

Disclosure of Interest: None declared

P53 THE EMERGENCE OF BLANDM-5 POSITIVE ESCHERICHIA COLI IN A BANGLADESHI HOSPITAL: LINKAGE BETWEEN CLINICAL INFECTIONS AND FAECAL CARRIAGE

R. Farzana1, L. S. Jones2, M. A. Rahman3, K. Sands4, E. Portal1, I. Boostrom1, B. Hasan1, T. R. Walsh1

1Cardiff University; 2Public Health Wales, Cardiff, United Kingdom; 3Dhaka Medical College, Dhaka; 4Cardiff University, Cardiff, Bangladesh
Correspondence: R. Farzana

Introduction: Carbapenem resistance has become global concern, and in particular blaNDM-5 which is emerging worldwide.

Objectives: To investigate the epidemiology and transmission dynamics of blaNDM-5 positive Escherichia coli in Bangladeshi hospital

Methods: We performed this study at Dhaka Medical College Hospital (DMCH), comprised of 700 rectal swabs from inpatients and OPD during 13.05.17 to 17.07.18 and clinical samples between 20.10.16 and 31.07.17. Microbiology was undertaken at Cardiff University and included MALDI-TOF, agar dilution MIC, illumina MiSeq and S1 PFGE with blaNDM probing.

Results: Rectal swabs yielded 457 single growth (65.3%), 147 mixed growth (21%) and 96 no growth (13.7%), of which the proportion of E. coli was 41.7%. E. coli (n=292) showed resistance to antimicrobials: amoxiclav (97.9%), piperacillin-tazobactam (86%), ceftriaxone (96.6%), ceftazidime (96.6%), cefotaxime (95.9%), cefepime (93.2%), ciprofloxacin (91.4%), levofloxacin (88%), co-trimoxazole (82.2%), meropenem (71.6%), imipenem (67.9%), gentamicin (58.5%), amikacin (50%), fosfomycin (1%) and colistin (0.3%). Faecal carriage of blaNDM was 28.3% (198/700); blaNDM variants were blaNDM-5 (n=165), blaNDM-1 (n=17), blaNDM-7 (n=13) and blaNDM-4 (n=3). Patients visited to OPD had no history of antibiotic intake during sample collection, however, 88.7% (340/383) of inpatients were on antibiotics. E. coli harbouring blaNDM-5 was isolated from inpatients more than outpatients (p<0.1). There was a significant association in burn patients (p<0.00001). We observe a high prevalence of blaNDM-5 (38/223, 17.4%) among clinical E. coli. Faecal NDM-5 positive E. coli was distributed in 28 different sequence types (STs); the majority belonged to ST167 (n=38) followed by ST405 (n=18). There was association between faecal NDM-5 positive E. coli and ST167 (p<0.01). Similarly, clinical NDM-5 positive E. coli were significantly related to ST167 (p<0.001). We did not observe any relation between plasmids of specific size and clonal type.

Conclusion: Gut colonization of blaNDM-5 is a reservoir for clinical infections by MDR bacteria via horizontal transfer in selective antibiotic pressure along with clonal spread.

Disclosure of Interest: None declared

P54 MOLECULAR CHARACTERIZATION OF CARBAPENEM RESISTANT KLEBSIELLA PNEUMONIAE ISOLATES COLLECTED FROM A CENTRAL PUBLIC HOSPITAL IN DURBAN, SOUTH AFRICA BETWEEN 2016 AND 2017

Y. Ramsamy1,2,3, K. P. Mlisana4, M. Allam 5, D. Amoako6, A. Ismail7, A. Akebe6, S. Y. Essack6

1Antimicrobial Research Unit , KwaZulu Natal; 2Medical Microbiology , National Health Laboratory Services; 3Medical Microbiology , University of KwaZulu Natal , Durban; 4Medical Microbiology , National Health Laboratory Services, University of KwaZulu Natal, Johannesburg; 5Sequencing Core Facility, National Institute for Communicable Diseases, Sandringham; 6Antimicrobial Research Unit , University of KwaZulu Natal , Durban; 7Sequencing Core Facility, , National Institute for Communicable Diseases, Sandringham , South Africa
Correspondence: Y. Ramsamy

Introduction: Ongoing dissemination of carbapenemase-producing Enterobacteriaceae (CPE) represents a public health issue. Early detection and infection prevention and control strategies are key in limiting spread of CPE within healthcare systems.

Objectives: The study aimed to investigate the genomic epidemiology and clonal relationships among the carbapenem-resistant K. pneumoniae isolated. This is important in evaluating the effectiveness of infection prevention and control programs and provides information for the development of new antimicrobial targets.

Methods: Between May 2016 and May 2017, 10 isolates(5 rectal swabs and 5 blood stream infections) were obtained from patients admitted to intensive care unit in Durban, South Africa.Following phenotypic microbial identification and antibiotic susceptibility tests,isolates were subjected to whole genome sequencing.

Results: All isolates were extensively drug-resistant with detectable phenotypic and genotypic resistance to tested β-lactams. Resistance to carbapenems were conferred by NDM-1 mediated by the acquisition the p18-43_01-like multi-replicon [ColRNAI, IncFIB(pB171), Col440I, IncFII, IncFIB(K) and IncFII(Yp)] plasmids. Interestingly, all the ten isolates had the same plasmid multilocus sequence type (IncF[K12:A-:B36]) and capsular serotype KL149, affirming the epidemiological linkage between the K. pneumoniae clones. All but one isolate belonged to ST152 sequence type. A novel sequence type, ST3136 differed from the primary clone by a single-locus variant in the rpob allele. Findings suggest an independent plasmid acquisition followed by local dissemination revealing horizontal spread of this blaNDM-1-bearing plasmid structure.

Conclusion: The acquisition of resistance-encoding plasmids, horizontal transfer and clonal dissemination facilitate the spread of carbapenemase genes in a public hospital. The valuable information provides a better understanding of the molecular mechanisms and spread of drug-resistant strains within healthcare settings

References

Disclosure of Interest: None declared

P55 ACTIVE SURVEILLANCE CULTURE OF CARBAPENEM-RESISTANT KLEBSIELLA PNEUMONIAE AND CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII IN AN EMERGENCY ICU IN A TEACHING HOSPITAL IN CHINA

F. Qiao, W. Huang

Infection Control Department, WEST CHINA HOSPITAL,SICHUAN UNIVERSITY, Chengdu, China
Correspondence: F. Qiao

Introduction: Carbapenem-resistant Klebsiella pneumoniae (CRKP) and carbapenem-resistant Acinetobacter baumannii (CRAB) represent an urgent health concern in China.

Objectives: To understand the prevalence and risk factors associated with rectal CRKP and CRAB colonization among emergency ICU patients on admission and their infection during their stay in mainland China.

Methods: A prospective observational study was performed in an 18-bed emergency ICU in a teaching hospital in China in 2018. Rectal swabs for CRKP and CRAB detection were obtained on emergency ICU admission.

Results: During the study period, 531 patients were screened with rectal swab, and the screening rate was 81.94%. A total of 18 patients (3.39%, 95% confidence interval [CI]: 1.85%>4.93%) and 38 (7.16%, 95% confidence interval [CI]: 4.97%>9.35%) were already colonized with CRKP on EICU admission. Patients who were already colonized with CRKP on EICU admission were more likely to develop a CRKP infection compared with those without CRKP colonization at admission (20.0% vs 2.2%, RR=9.02, 95% CI: 3.58-22.76, P<0.001). While there’s no difference in CRAB infection between patients with or without CRAB colonization (26.0% vs 17.0%, RR=1.53, 95% CI: 0.91-2.57, P=0.118).

Conclusion: The CRKP and CRAB colonization rate among EICU patients in mainland China is very high. Patients with CRKP-positive rectal swabs were more likely to develop CRKP infections during their stay in the hospital.

Disclosure of Interest: None declared

P56 DETECTION OF CARBAPENEMASE-PRODUCING GRAM-NEGATIVE BACTERIA FROM HOSPITAL ENVIRONMENT IN SLOVAKIA: THREE-YEARS MULTICENTRE STUDY HOSPITAL-ENVIRO-REZ

L. Michalikova1,2,3, S. Kissová4, L. Pazderka1,2,3, S. Kucharíková1, J. Prnová5,6, J. Brňová1,3,6

1Department of Laboratory Medicine, TRNAVA UNIVERSITY; 2Department of Clinical Microbiology, Analytx s.r.o.; 3Centre of Microbiology and Infection Prevention, Trnava university, Trnava; 4Medirex , Bratislava; 5Department of Public Health, Trnava university; 6Department of Hospital Hygiene and Epidemiology, University Hospital Trnava, Trnava, Slovakia
Correspondence: L. Michalikova

Introduction: Hospital environments are potential reservoirs of bacteria associated with nosocomial infections. Carbapenems producing Gram-negative bacteria (CPE-GNB) can survive on inanimate surfaces for months, thus serving as a transmission source to healthcare workers and susceptible patients.

Objectives: In this study we assess the occurrence of carbapenems producing Gram-negative from hospital environment in Slovakia.

Methods: Multicentre national study was performed to monitor prevalence of carbapenemases-producing Gram-negative bacteria from January 2015 to December 2017. The bacterial ability to produce these enzymes were analysed with rapid imunochromatographic assay (NG-Test Carba 5) and with rapid molecular assay (Gene Xpert Carba-R).

Results: Overall 2114 samples from hospital environment (Klebsiella spp., Pseudomonas spp., Escherichia coliEnterobacter spp., Staphylococcus aureus and Enterococcus spp.) were analysed. Of all Gram-negative environmental bacteria (n=985) were confirmed 57 (5,8%) resistant to meropenem. Isolates were further tested for ability to produce carbapenemases. Molecular testing with Gene Xpert CarbaR method identified 5 blaVIM possesing Pseudomonas spp. and 3 blaNDM possessing Klebsiella pneumoniae. Immunochromatographic method NG-Test were identified 11 carbapenemases-producers, 5 VIM producers (Pseudomonas spp.), 3 NDM producers (Klebsiella pneumoniae), and 3 IMP producers (Pseudomonas spp.) respectivelly. CPE-GNB isolates were detected from sink (6), manometer cuff (2), aspirator (2) and one ready to use whipes respectively.

Conclusion: Detection of carbapenems producing Gram-negative bacteria from various sampling sites indicated decontamination processes failures and the surfaces in the hospitals were potential exogenous sources of nosocomial infection.

This study was supported by a research grant from the MŠVVaŠ SR.

Disclosure of Interest: None declared

P57 HIGH RATE OF EXTENDED-SPECTRUM BETA-LACTAMASE PRODUCING GRAM-NEGATIVE INFECTIONS AND ASSOCIATED MORTALITY IN ETHIOPIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

T. B. Tufa1,2, T. Tufa3, F. André 1,2, K. Achim 4, M. Colin 4, F. Torsten 1,2, P. Klaus 4, H. Dieter 1,2

1Hirsch Institute of Tropical Medicine, Asella, Ethiopia; 2DGHID, University Hospital, Düsseldorf, Germany; 3Addis Ababa University, Addis Ababa, Ethiopia; 4Institute of Medical Microbiology and Hospital Hygiene, Düsseldorf, Germany
Correspondence: T. B. Tufa

Introduction: Extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria have become a serious threat to global health. To date, regular surveillance of multidrug-resistant (MDR) pathogens is lacking in Ethiopia.

Objectives: To summarize and analyze published data regarding ESBL-producing bacteria in different regions of Ethiopia.

Methods: A systematic search was conducted on PubMed, PubMed Central, and Google Scholar until March 2019. Eligible studies were selected using the following criteria. A random effect model estimated the pooled proportion of ESBL- producing Gram-negative bacteria. The publication bias and the variation in proportion estimates attributed to heterogenicity were also assessed.

Results: Totally, 1782 Gram-negative bacteria isolated from 5191 clinical samples were included. The pooled proportion estimates of ESBL-producing Gram-negative was 52% (95% CI: 49–54%; P< 0.01).There was a high level of heterogeneity, random model methods (I2 = 95%, P <0.01). Among different species, ESBL rates were 65.7% (262) Klebsiella spp., 60.6% (n=20) for Enterobacter spp., 47.8% (n=22) for Citrobacter spp., 47.0% (n=383) for E. coli, 45.7% (n=85) for Salmonella spp., 28.6% (n=14) for Proteus spp., 16.7% (n=4) for P. aeruginosa, and 14.3% (n=3) for Acinetobacter spp. A total 81 isolates were positive for the ESBL-encoding genes: 82.7% (67/81) CTX-M-1 group, 17.3 %(14/81) blaTEM were reported. Two studies reported mortality associated with infections by ESBL-producing pathogens or resistant to the 3rd generation cephalosporins was12 of 14 (86%) of patients infected with ESBL-producing bacteria died.

Conclusion: In this meta-analysis, the pooled phenotypic prevalence of ESBL-producing pathogens is high and is associated with a high mortality, however the available data is scarce. This highlights the need for establishing and upgrading clinical microbiology laboratories in the country for routine antibiotic susceptibility testing. CTX-M-1 group is the highest predominantly detected resistant genes. The capacity to detect ESBL genes is desirable for continuous surveillance of MDR.

Disclosure of Interest: None declared

P58 BELGIAN ANTIMICROBIAL RESISTANCE SURVEILLANCE EXTENDED: ISOLATES FROM URINARY SAMPLES

L. Catteau, K. Mertens, B. Catry

Sciensano, Brussels, Belgium
Correspondence: L. Catteau

Introduction: International comparisons related to the burden of antimicrobial resistant infections requires standardization of surveillance tools. From 2017 onwards, the national EARS-Net subproject for Belgium (EARS-BE) included isolates from urine samples next to blood and cerebrospinal fluid (CSF) samples.

Objectives: We report here the antimicrobial resistance results for 3 major Gram-negative species and stratify the results by sample and laboratory type.

Methods: EARS-BE methodology is described in detail elsewhere (1). Briefly, all Belgian laboratories (hospital and non-hospital) that performed routine antimicrobial susceptibility tests (AST) in 2017 were invited to transfer their results to Sciensano. For each patient, only the 1st specimen within the study year was included.

Results: 31 hospital labs submitted results for blood/CSF while 24 (19 hospital & 5 non-hospital labs) participated for urine samples. Within hospital labs, levels of resistance for E. coli isolates from urine samples were only slightly lower as compared to blood/CSF isolates. For K. pneumonia, all antibiotic resistance levels are very similar between both sample types. Concerning P. aeruginosa, lower levels of resistance were observed in urine isolates for ceftazidime (5.3% vs 7.2%), carbapenems (6.3% vs 8.2%), but slightly higher for aminoglycosides (9.5% vs 7.7%) and fluoroquinolones (13.7% vs 10.4%). Concerning urine isolates, much lower levels of resistance were observed in non-hospital labs in comparison to hospital labs, except for the fluoroquinolones in P. aeruginosa (14.6% for non-hospital labs vs 13.7% for hospital labs).

Conclusion: For urine isolates analyzed in hospital laboratories, overall resistance levels of Gram-negative bacteria followed more or less those of blood/CSF isolates. These bacteria from non-hospital labs are in general more susceptible. This shows the interest to include urine isolates in EARS-BE given the size of collected data and the opportunity to monitor the antimicrobial resistance in non-hospital settings.

References

(1) Struyf T, Mertens K. The European Antimicrobial Resistance Surveillance Network Belgium (EARS-Net BE) protocol 2017: Including data call, instructions for participating laboratories, data definition, reporting procedure (Version 3, 26/02/2018). Sciensano. 2018.

Disclosure of Interest: None declared

P59 COMBINED STRATEGIES TO REDUCE THE IMPACT OF MULTIDRUG-RESISTANT GRAM-NEGATIVE BACTERIA IN A LOW RESOURCE SETTING IN BRAZIL: PRELIMINARY RESULTS

C. B. Pinheiro1, V. L. P. de Amorim1, T. D. Correa2, J. M. B. D. M. Anacleto3, J. Y. Kawagoe4, C. B. Dal Forno1

1Infection Prevention and Control, Hospital Municipal Dr. Moysés Deutsch; 2Intensive Care Unit, Hospital Israelita Albert Einstein; 3Intensive Care Unit, Hospital Municipal Dr. Moysés Deutsch; 4Professional Master's Degree in Nursing, Albert Einstein Israelite School of Health Sciences, São Paulo, Brazil
Correspondence: C. B. Dal Forno

Introduction: Multidrug-resistant Gram-negative bacteria (MRGNB) are a worldwide challenge, especially in resource-limited settings.

Objectives: To evaluate the impact of three main interventions implemented in an intensive care unit (ICU) of a resource-limited hospital.

Methods: Before-after study conducted from July 2017- April 2019 in a 20-bed ICU at 300-bed public hospital. Three main pillar of interventions were applied to control MRGNB: 1-July 2017: antimicrobial stewardship program (ASP) led by infectious disease physician to reduce carbapenems prescriptions 2- September 2018: new alcohol-based hand rub (ABHR)- an ethanol/n-propanol product at point of care to increase hand hygiene (HH) compliance and 3- December 2018: new cleaning product (n-propanol/quaternary ammonium) to improve cleaning/disinfection of frequently-touched surfaces. The main outcomes evaluated were: antibiotic use, point prevalence of MRGNB colonization by rectal swab specimens (October 2017, January 2018, April 2019), annual ABHR consumption (mL/patient-day) and incidence of hospital-acquired infections (HAI) by MRGNB by semester (sem).

Results: There were a significant decrease: carbapenem prescription from July 2017 to April 2019: 1.400 g/DDD/month to 770 g/DDD/month) and the prevalence of MRGNB patients colonization: October 2017 (50%); January 2018 (50%) and April (11.1%). ABHR consumption (mL/patient-day) increased from 36.4 (2017) to 54.2 (2018) and 72.81 (jan-apr 2019). The incidence of HAI by MRGNB/1000 patient-days increased from the 2nd sem 2017 (2.60) to 1st sem 2018 (3.22), but decreased in the 2nd sem 2018 (2.30) and jan-apr (2.64).

Conclusion: There were a favorable impact of ASP in reducing the utilization of carbapenems and the prevalence of patient colonization with MRGNB, but not a impact on the incidence of HAI by MRGNB. Other infection prevention and control measures must be evaluated.

References

CDC. The Core Elements of Human Antibiotic Stewardship Programs in Resource-Limited Settings: National and Hospital Levels. Atlanta, GA:US Department of Health and Human Services, CDC; 2018

Disclosure of Interest: C. Pinheiro: None declared, V. de Amorim: None declared, T. Correa: None declared, J. Anacleto: None declared, J. Kawagoe Employee of: Patient Safety Consultant - B Braun, C. Dal Forno: None declared

P60 PREVALENCE OF ANTIBIOTIC-RESISTANT ENTEROBACTERIACEAE IN A LARGE NETWORK OF NURSING HOMES

C. Legeay1, B. Fuchs2, T. Haudebourg2, S. Corvec2, G. Birgand2 on behalf of CARBEHPAD Study Group (RTH Pays de la Loire, Raymond F, Poulain C)

1Infection Control and Prevention, CHU d'Angers, Angers; 2CHU Nantes, Nantes, France
Correspondence: C. Legeay

Introduction: Nursing homes (NH) have been described to be a reservoir of extended spectrum beta-lacatamase producing Enterobacteriaceae (ESBLPE). In a regional context of recurrent carbapenemase producing Enterobacteriaceae (CPE) outbreaks in acute care settings, we suspect the same phenomenon for CPE.

Objectives: This study aimed to evaluate the prevalence of, and factors associated with, ESBLPE and CPE digestive carriage in a large network of NHs in western France.

Methods: Fifty NH from the 5 departments of the Pays de la Loire region were randomly selected considering the geographical situation and the density of NHs. In each facility, one third of residents was included in the study. Stool samples were collected with swab and cultured on selective chromogenic media. Mass spectrometry was used to identify Enterobacteriaceae species. ESBL or AmpC production was confirmed with MAST® test. Carbapenemase production was tested through CORIS® test. Antibiotic susceptibility tests were performed using Vitek 2. Demographic and clinical data were collected prospectively on the day of the survey. Proportions were compared using Chi-square or Fisher exact test.

Results: Overall, 734 residents (30 NHs) were included. Among them, 83 (11.3%) were ESBLPE carriers (71% Escherichia coli) and 44 (6%) AmpC carriers (41% Citrobacter spp, 31% Enterobacter spp). No CPE was identified. Among 146 strains, 91% were susceptible to nitrofurantoin, 64% to ciprofloxacin, 55% to cefoxitin and 75% to trimethoprim. Among all residents, 522 (75%) were female, mean age was 85 years old. 412 (60%) were dement, 29 (4%) travelled abroad in the prior 12 months, respectively 26 (4%) and 5 (0.7%) had a a urinary tract or peripheral venous catheter and respectively 389 (58%) and 446 (67%) had fecal or urinary incontinence. The prevalence of ESBLPE carriage varied from 0 (four NHs) to 45% across nursing homes and 6.0 to 16.4% across departments (p=0.16). Factors associated with the ESBLPE carriage were history of travel abroad (n=9 [31%] ESBLPE+ vs 67 [10%]; OR=3.9; IC95=1.7–8.9; p<0.01), and dementia (n=35 [8%] ESBLPE+ vs 41 [15%]; OR=0.5; IC95=0.3–0.9; p<0.01).

Conclusion: This study suggests that NH do not represent a large CPE reservoir in an endemo-epidemic context. The results provide clinical information on the ESBLPE risk among resident for the antimicrobial stewardship in this region.

Disclosure of Interest: None declared

P61 COLONIZATION WITH MULTIDRUG-RESISTANT BACTERIA IN AN INFECTIOUS DISEASES INTENSIVE CARE UNIT

M. Lupse1, T. Szilagyi2, L. Herbel3, D. Miclaus3, M. Flonta4, A. Dicea3, A. Muntean3

1Infectious Diseases, University of Medicine and Pharmacy Cluj-Napoca; 2Infectious Diseases; 3ICU; 4Microbiology, University Hospital of Infectious Diseases, Cluj-Napoca, Romania
Correspondence: M. Lupse

Introduction: Bacterial resistance is an important issue in Intensive care Units (ICU). Screening patients admitted into ICU for multidrug-resistant (MDR) bacteria nasal and fecal carriage became a rule in Romania

Objectives: To monitorize colonization with MDR bacteria and the persistence of carriage of such pathogens among patients admitted to the ICU of the University Hospital of Infectious Diseases Cluj-Napoca, Romania and to determine the incidence for nosocomial infections associated with colonization with MDR pathogens, considering that colonization precedes infection.

Methods: Prospective observational study: from 01.10.2017 to 15.08.2018 we have included all adult patients admitted directly to the ICU (only first admittance) or with previous admittance in the general wards for less than 48 hours. We performed nasal and rectal swab screening for MDR bacteria (Meticilin Resistant Staphylococcus Aureus (MRSA), ESBL producing Enterobacteriaceae (ESBL-EN), Carbapenemases Producing Gram negative bacteria (CBP-GNB), Vancomycin resistant Enterococcus (VRE), during hospitalization on days 0, 7 and 14.

Results: We have included 75 patients, 34 women (45,3%), average age 62.9 years (min 22, max 88 years) with average length of hospitalization of 15 days (min 2 days, max 58 days). Upon admission, 42 patients (56%) were colonized with MDR bacteria, in day 7 there were 65 colonized patients and in day 14, 39 patients. 10 out of 30 CBP-GNB colonized patients and 7 out of 34 VRE colonized patients developed infections with MDR bacteria during hospitalization.

Conclusion: MDR bacterial colonization is frequent in patients admitted to the ICU. Colonization with MDR bacteria during hospitalization in the ICU is highest in the first week and decreases significantly later. Colonization could represent a risk factor for increased rates of infection, especially with CBP-GNB and VRE. Active surveillance program for identification of MDR bacteria colonized patients is necessary and useful.

Disclosure of Interest: None declared

P62 COLONIZATION BY MULTIDRUG-RESISTANT BACTERIA IN ONCOLOGICAL PATIENTS AT A UNIVERSITY HOSPITAL IN SOUTHERN BRAZIL

T. C. R. Klein1, S. B. Filho1, G. T. D. Sasso2, F. Lunardi2, E. O. Luz2

1Infection Control, University Hospital – UFSC; 2Nursing Department, UFSC, Florianópolis, Brazil
Correspondence: T. C. R. Klein

Introduction: Oncological patients frequently present with recurrent infections and require use of broad-spectrum antimicrobials, which may induce microbial resistance.This study shows the prevalence of colonization by multidrug-resistant (MDR) bacteria in cancer patients in 2016 and 2017 in a brasilian hospital.

Objectives: To show the prevalence of colonization by MDR bacteria in cancer patients in 2016 and 2017 in a brasilian hospital.

Methods: Observational retrospective study from the results of cultures performed in the hospital laboratory. Inclusion criteria: adults with oncologic disease with MDR colonization related to health care admitted in 2016 and 2017. The following microorganisms were identified as MDR bacteria: carbapenem-resistant Enterobacteriaceae with or without carbapenemase production (Pseudomonas spp, Acinetobacter spp, Klebsiella spp, Escherichia spp, Enterobacter spp, Citrobacter spp), methicillin-resistant S. aureus and vancomycin-resistant Enterococcus faecium (VRE).

Results: 426 new MDR bacteria cases of colonization were recorded. 69 patients met the inclusion criteria. Of these, 62% were men and 37.68%, women.15% were hospitalized in internal medicine wards, 34.78% in intensive care units and 14.49% in surgical wards. 47.82% of patients had hemato-oncological diseases, 33.33% had gastrointestinal cancer, and 13% had other types of cancer. Overall, 66.66% had a central venous catheter, 52.17% had an urinary catheter, and 43.47% underwent surgical procedures. Carbapenemase-producing Enterobacteriaceae(CPE) were identified in 52.17% of patients, VRE in 20%, carbapenem resistant Paeruginosain 18.84%, other multidrug-resistant Enterobacteriaceae 14.49%, and the remaining 11.59%. Time between hospitalization and colonization ranged from 4 to 61 days.

Conclusion: Colonization by MDR bacteria in cancer patients in this study was more frequent in men admitted to an internal medicine ward with hemato-oncological diseases. More than half had central venous catheter or urinary catheter. Many patients went through surgical procedures. CPEs were the most frequently identified microorganisms. Time for colonization identification had wide variation, but in the first week the colonization rate was lower.

Disclosure of Interest: None declared

Poster session: Microbiological detection of Carbapenemases

P63 MICROBIOTA OF DIGESTIVE SYSTEM IN COMMUNITY VERSUS HOSPITAL SETTINGS

M. M. Abdelhalim

Clinical Pathology Department, Faculty of medicine- Cairo University, Cairo, Egypt
Correspondence: M. M. Abdelhalim

Introduction: The healthy microbiota provides protective functions, which refers to the microbiota's ability to prevent colonization and/or expansion of pathogens. Antibiotics use and other exposures in hospitalized patients are associated with disruptions of intestinal microbiota that may select for antibiotic resistance

Objectives: Investigation of the effect of hospitalization on intestinal environment that favors the proliferation and virulence of ESBLs producing Enterobacteriaceae

Methods: A total of 230 rectal swabs were collected from 165 patients from different departments and outpatient clinics of Cairo University Specialized Pediatric Hospital. Out of the 230 total samples,130/230 pre and 48 hours post admission samples, were collected from 65 inpatients, and100/230 samples from 100 outpatients, with no GIT infection symptoms nor previous known antibiotic exposure or hospital admission. Antibiotics susceptibility, with screening of ESBL and AMPC antimicrobial activity were performed according to CLSI 2015 guidelines.Genotypic identification of resistance mechanisms was achieved using PCR assays targeting blaTEM, blaSHV, and blaCTX-M genes

Results: ESBL producers were isolated from 40% of outpatients compared to 72.3% and 84.6% of inpatients 1st and 2nd samples respectively, with P- value(< 0.05). Hospitalization has worsen the resistance pattern of isolates of 31/65 (47.7%) cases. Molecular study of ESBL genes showed that, CTX was the most common ESBL gene detected in 78.6% of screened isolates

Conclusion: Antibiotics create dysbiosis of microbiota, thereby exposed human microbiome has become a significant reservoir of resistance genes, contributing to the increasing difficulty in controlling bacterial infections.

Disclosure of Interest: None declared

P64 PHENOTYPIC AND GENOTYPIC DETECTION OF CARBAPENEM RESISTANT ACINETOBACTER BAUMANNII IN SURGICAL AND INTENSIVE CARE UNITS (ICUS) IN AL AZHAR UNIVERSITY HOSPITAL – NEW DAMIETTA, EGYPT

M. G. M. Elsherbeny1, M. Abdelnasser Aly2, E. S. A. Gouda2, M. M. A. Saleh1, M. M. Balboula3

1Microbiology and Immunology, Faculty of Medicine, Al-Azhar University, New Damietta; 2Microbiology and Immunology, Faculty of Medicine, Al-Azhar University, cairo; 3Surgery, Al-Azhar University, New Damietta, Egypt
Correspondence: M. G. M. Elsherbeny

Introduction: Acinetobacter baumannii has emerged as a healthcare-associated pathogen worldwide. Several epidemiological studies have reported the occurrence of multi-drug resistant A. baumannii infections in different regions of the world. The spread of carbapenem-resistant A. baumannii is of global concern.

Objectives: This work was carried out to detect Carbapenem-Resistant A. baumannii in Surgical Departments and ICUs. It also aimed to determine the occurrence of blaoxa-51-like, bla OXA-23, blaIMP and blaVIM genes among the isolated strains.

Methods: The current study was conducted on 500 patients attending Surgical Departments and ICUs, Al Azhar University Hospital, New Damietta, Faculty of Medicine in the period between May 2016 and Sept 2018. All samples were traced to the species level using API 20NE system followed by assesment of the different phenotypic assays for detection of carbapenemase production using multiplex polymerase chain reaction (PCR).

Results: Postoperative infections was detected in 217 (43.4%) out of 500 of patients. A. baumannii was considered to be the third most common Gram-negative organism isolated (27, 12.3 %). A. baumannii isolates were predominant in ICUs (14, 51.9%). Carbapenemase production was detected in A. baumannii isolates using the modified carbapenem inactivation method (mCIM), the modified Hodge test (MHT) and the Carba NP test (p value = 0.000). Using multiplex PCR analysis, most isolates (12; 44.4%) carried bla OXA-51-like gene, followed by ten (37%) isolates that carried both blaOXA-51-like and bla OXA-23-like genes. Only one (3.7%) isolate carried blaOXA-23-like gene. Metallo-β-lactamase encoding (MBLs) genes were most frequently detected with bla IMP in 13 (48.1%) of isolates.

Conclusion: The current study suggests that A. baumannii is one of the most commonly detected isolate in our hospitals. The mCIM assay is the most useful phenotypic method for detection of Carbapenemase production. Detection of Carbapenem resistance genes is alarming a serious healthcare problem in our hospital.

Disclosure of Interest: None declared

P65 MOLECULAR EPIDEMIOLOGY OF BETA-LACTAM RESISTANCE AMONG ETEROBACTERIACEAE IN FOUR TERTIARY- CARE HOSPITALS IN EGYPT

A. Elkholy1, S. A. Girgis2, A. R. Elmanakhly3, D. H. Abdel hamid2, M. A. Zahran3

1Microbiology and immunology, Cairo university, Faculty of midicine; 2Microbiology and immunology, Ain Shams university, Faculty of medicine; 3Infection control, Dar Alfouad hospital, Cairo, Egypt
Correspondence: A. Elkholy

Introduction: Monitoring the trends in antimicrobial resistance is essential to guide patient therapy and to take preventive actions.

Objectives: We report here the molecular epidemiology of B- lactem resistance among Gram-negative pathogens isolated from ICUs in 4 major tertiary hospitals in Egypt by multiplex PCR assays for extended – spectrum β-lactamase (ESBL), carbapenemases genes and Amp-C β-lactamases, as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART).

Methods: This study was conducted in 4 major tertiary- care hospitals participating in the (SMART) from 2012 to 2016. Enterobacteriaceae isolates were isolated from respiratory (RTI), urinary (UTI) and intra- abdominal infections (IAI). Molecular testing was done by multiplex PCR in a reference laboratory.

Results: A total of 493 isolates were identified from IAI (37.53%), UTI (33.67%), RTI (25.15%) and others (3.65%). As regards EsβL, the blaCTX-M-15 was detected in 73.83% of the isolates followed by blaTEM-OSBL (48.68%), and blaSHV-OSBL (44.02%). 51.12% of K. pneumoniea isolates harbored blaSHV-OSBL and 12.78% harbored blaSHV-12 gene. E. coli didn’t show any predominance of SHV genes otherwise it showed a high prevalence of blaTEM-OSBL (47.48%) and blaCTX-M15 (68.475%). Carbapenemase genes were detected in 20% of isolates from 2012 till 2014; with a marked increase in the resistance rate to more than 50% of isolates in 2015 and 2016. K. pneumoniae isolates showed high rates of blaOXA-48 (40.60%), followed by blaNDM-1 (23.68%). E. coli isolates showed 2.28% of blaOXA48 , 5.47% of blaOXA-181 and 9.58% of blaNDM-5.

Nevertheless, 3 (0.45%) isolates harboring blaVIM were first detected in K. pneumoniea and E. coli in 2016 and only 2 (0.75%) isolates of blaKPC were detected in 2015.

The rate of AmpC β-lactamases ranged from 2.56% in 2014 to 15.11% in 2016 with a total rate of 9.74%, which is significantly lower than ESBL and carbapenem- resistance patterns. However, there is an emergence of new CMY-59 and CMY-42 in Egypt.

Conclusion: The high rate of resistance is alarming, which calls for a national antimicrobial stewardship program, not only in hospitals, but also in the community, among animals and in the environment.

Disclosure of Interest: None declared

P66 EXTENDED-SPECTRUM-BETA-LACTAMASE PRODUCING BACTERIA RELATED URINARY TRACT INFECTION IN RENAL TRANSPLANT RECIPIENTS

M. Wysocka1, B. Krawczyk1, J. Gołębiewska2, M. R. Oggioni3, M. Fordon1

1Gdańsk University of Technology; 2Medical University of Gdańsk, Gdańsk, Poland; 3University of Leicester, Leicester, United Kingdom
Correspondence: M. Wysocka

Introduction: Urinary tract infection (UTI) is a common complication after kidney transplantation, often associated to graft loss and increased healthcare costs. The recent rise in incidence of extended-spectrum beta-lactamase+ (ESBL) producing bacteria causing UTI among renal transplant patients (RTx) poses new and significant challenges in terms of management and outcome.

Objectives: We examined the molecular epidemiology of ESBL producing bacteria causing UTI in these patients.

Methods: Detection of ESBLs and carbapenemases produced by studied strains was performed using PCR. Phylogenetic background of Klebsiella pneumoniae isolates was analyzed by PCR Melting Profiles (MP) and the following VFs genes: fimH-1, uge, irp-2, kpn, ycfM, mrkD, rmpA, magA, hlyA, cnf-1 by multiplex PCR. Multiple patient characteristics including demographics, immunosuppression, recurrences, allograft function and outcome were analyzed.

Results: A total of 64 K. pneumoniae strains isolated from renal transplant patients were recovered from clinical specimens in a university hospital. More than 80% strains carried ESBL genes. A highly resistant NDM-1 K. pneumoniae were reported. PCR MP typing showed a diverse population, among which different genetic profiles appeared in isolates from two or more patients, suggesting nosocomial infections. VF gene profiles were highly homogenous.

Conclusion: RTx patients are at a higher risk for developing ESBL producing bacteria associated UTI. Overall, the coexistence of virulence and carbapenem resistance in clinical K. pneumoniae isolates is a serious concern. Moreover, the emergence of NDM-1 among isolates warrants stringent surveillance and control measures.

Disclosure of Interest: None declared

P67 DIVERSITY OF Β-LACTAMASES OF BROAD HYDROLYTIC SPECTRUMS IN MDR GRAM NEGATIVE NOSOCOMIAL ISOLATES FROM AN EGYPTIAN HOSPITAL

A. K. Abdulall1, H. A. El-Mahallawy2, A. H. El-Manakhly3 on behalf of Antimicrobial resistance

1Microbiology and Immunology, Faculty of Pharmacy - Al-Azhar University; 2clinical pathology, clinical pathology; 3clinical microbiology lab., Dar El foad hospital, Giza, Egypt
Correspondence: A. K. Abdulall

Introduction: Introduction: Hospital acquired infections due to MDR Gram-negative bacilli are becoming a global health care issue. Productions of multiple types of β-lactamases with broad hydrolytic spectrum have been observed lately in MDR phenotypes. These include the extended spectrum β-lactamases (ESβLs), AmpC β-lactamases, class A, Klebsiella pneumoniae carbapenemases (KPC) and class B carbapenemases, metallo-β-lactamases (MBL).

Objectives: Therefore, rapid detection and proper reporting of such multidrug resistance markers is mandatory to avoid their dissemination.

Methods: 100 MDR Gram negative isolates recovered from inpatients hospitalized at the National Cancer Institute, Cairo, Egypt. They were tested for production of ESβLs, Amp C β-lactamases, MBL and KPC by several phenotypic detection tests.

Results: 25% of the studied isolates were further classified as extensive drug resistant (XDR) phenotypes. E.coli and Klebsiellae pneumoniae were the predominant species in this study. 78% of the studied isolates were ESβL producers, 29% were Amp C β-lactamases producers, 17% had MBL and only 6% were KPC producers. This was the first report on emergence of KPC producing phenotypes in Egypt. Klebsiella pneumoniae was the major producers of ESβL, MBL and KPC B-lactamases, while Escherichia coli were the predominant Amp C β-lactamase producing isolates. The coexistence of the four types of β-lactamases detected in this study was observed in two XDR K. pneumoniae isolates.

Conclusion: Phenotypic detection methods of indicator mechanisms of multidrug resistance should be employed in routine laboratory work. Phenotypic methods were efficient, subjective, and easy to carry and have relative low costs. It is an economic solution for infection control in hospital settings in developing countries with limited financial resources

Disclosure of Interest: A. Abdulall Employee of: no, Grant/Research support from: no, Speaker's bureau of: no, Shareholder of: no, Consultant for: no, Paid instructor for: no, Other conflict with: no, H. El-Mahallawy: None declared, A. El-Manakhly: None declared

P68 Withdrawn

P69 A NEW MULTIPLEX PCR TO DETECT CONCURRENT EXISTENCE OF QNRB, AAC(6’) AND RMTA GENES AMONG (MDR)P. AERUGINOSA ISOLATES FROM BURN WOUND INFECTIONS

M. Hakemi-Vala1, A. Shaban Ghahrood2, A. Hashemi1, G. Talebi3

1Microbiology, Shahid Beheshti University of Medical Sciences; 2Microbiology, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran; 3Microbiology, Faculty of Basic Sciences, Tehran Science and Research Branch, Islamic Azad University, Tehran, Iran , Tehran, Iran, Islamic Republic Of
Correspondence: M. Hakemi-Vala

Introduction: Recently by emerging and increasing of multi drug resistant bacteria (MDR), need to design new fast methods of detection is mandatory.

Objectives: The aim of this study was to design a new multiplex PCR to detect concurrent existence of qnrB, aac(6’) and rmtA genes among (MDR)P. aeruginosa isolates from burn wound infections.

Methods: 92 isolates of P. aeruginosa of burn wound infections of Motahhari hospital in Tehran were collected during 2017-2018. Antimicrobial susceptibility test (AST) was done according to CLSI protocol by using disk diffusion method. The frequency of each of qnrB, aac(6’) and rmtA genes were determined by PCR and confirmation was done by sequencing.. Then, a new multiplex PCR was used to evaluate the presence of these three genes, simultaneously. P. aeruginosa ATCC 27853 was used as a control strain.

Results: Based on AST the resistant profile of collected isolates was, 81 (88.32%) to Ciprofloxacin, 80 (87.4%) to Meropenem, 78 (84.64%) to Gentamicin, 79 (85.56%) to Cefepime, 75 (81.88%) to Amikacin, 66 (71.74%) to Aztreonam, 63 (69%) to Ceftazidime. All isolates were susceptible to Colistin. of The frequency of qnrB, aac(6’) and rmtA genes were 0(0%), 8(9.2%) and 38(41.4%) respectively. Concurrent presence of aac(6’) and rmtA genes was confirmed in 2 (1.84%) isolates by the new designed multiplex PCR.

Conclusion: The results of this study showed; A) high rate of antibiotic resistance among Pseudomonas aeruginosa isolates from burn patients, B) Colistin is the best choice for treatment, C) the frequency of rmtA gene is higher than aac (6’) gene among these bacteria and D) the newly designed multiplex PCR was qualified to detect concurrent existence of qnrB, aac(6’) and rmtA resistant genes in these bacteria in just one reaction.

Disclosure of Interest: None declared

P70 COMPARATIVE GENOMICS AND GENETIC CHARACTERIZATION OF INCX3 PLASMIDS

Y. Yu, R. S. Yang, J. Sun, Y. F. Zhou, X. P. Liao, Y. H. Liu

College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
Correspondence: X. P. Liao

Introduction: IncX3 plasmid is associated with the dissemination of the ESBL (blaSHV) and carbapenemase genes (blaNDM, blaOXA, blaKPC) from multiple species of Enterobacteriaceae.

Objectives: To characterize the underlying evolution process of IncX3 plasmid in Enterobacteriaceae.

Methods: 152 IncX3 plasmids were retrieved from Genbank nucleotide database in July 2018, excluding the hybrid, uncompleted sequence and replicon deleted plasmids. All plasmids were applied for core-genome alignments to construct the phylogenetic tree and gain insights into the phylogeny of all IncX3 plasmids.

Results: The most prevalent region of IncX3 plasmid is China (63/152), followed by the United States (24/152). Escherichia coli (74/152) and Klebsiella pneumoniae (46/152) are the most frequently host strains, on the other hand blaNDM (93/152) and blaSHV (59/152) are the most prevalent resistance genes carried by IncX3 plasmid. Phylogenetic tree revealed the high stability of the plasmid core genome, and 152 plasmids were divided into 4 clades, among which146 plasmids were belonged to clade 1.

Conclusion: The analysis of variable region uncovered that the IncX3 type plasmid may only harbor blaSHV gene in the early stage, and blaNDM, blaOXA and blaKPC are possibly inserted into the plasmid by the insertion sequence or further evolved by different recombination events.

Disclosure of Interest: None declared

P71 REAL-TIME PCR-BASED DETECTION OF ESBL- AND CARBAPENEMASE GENES POSSESSING ENTEROBACTERALES IN URINE SPECIMENS FROM ADULT PATIENTS WITH SUSPECTED URINARY TRACT INFECTIONS

O. Timoshina1, Y. Savochkina1, S. Polikarpova2, O. Timofeeva2, A. Guschin1, D. Shagin1, V. Akimkin1

1Federal Budget Institution of Science "Central Research Institute for Epidemiology" of The Federal Service on Customers' Rights Protection and Human Well-being Surveillance; 2State Budgetary Healthcare Institution "Municipal Clinical Hospital №15 named O.M. Filatov", Moscow, Russian Federation
Correspondence: O. Timoshina

Introduction: The spread of resistance to cephalosporins and carbapenems among pathogens causing urinary tract infections (UTI) poses an important threat to public health.

Objectives: The aim of this study was to evaluate prevalence of Enterobacterales possessing ESBL and carbapenemase genes revealed in urine specimens from adult patients with suspected UTI.

Methods: A retrospective analysis of 260 urine samples obtained from adult patients, who were examined for diagnosis of UTI at 1265-bed hospital in Moscow between October 2017 and January 2018, was performed using two real-time PCR assays. The first PCR assay composed of two multiplex tests allowing quantitative detection of E.coli, K. pneumoniae, Proteus spp. and other Enterobacterales DNA. The second PCR assay composed of three multiplex tests: the first one was for CTX-M group ESBL genes detection (“Amplisens ESBL CTX-M-FL”), the second one was for KPC- and OXA-48-like carbapenemase genes detection (“Amplisens MDR KPC/OXA-48–FL”), and the last one – for VIM-, IMP-, and NDM metallo-beta-lactamase (MBL) genes detection (“Amplisens MDR MBL–FL”). All these real-time PCR-based assays had been developed and evaluated previousely in our laboratory.

Results: According to the results of real-time PCR Enterobacterales DNA load exceeding 2x104 GE/ml (genome equivalents per milliliter) was revealed in 95 urine samples. In most of these cases (N=77) E.coli DNA was revealed and also K. pneumoniae (N=11) and Proteus spp (N=9) DNA were detected.

The CTX-M group ESBL genes were detected in 37/95 (39%) samples with Enterobacterales DNA load more than 2x104 GE/ml. The OXA-48-like carbapenemase genes were found in 2/95 cases (2%). The NDM group MBL genes were revealed in 4/95 cases (4%). In every of these 5 samples carbapenemase genes were detected along with blaCTX-M genes. The presence of blaNDM along with blaOXA-48-like and blaCTX-M was shown in one sample containing K. pneumoniae.

Conclusion: Using real-time PCR-based technique a significant prevalence of Enterobacterales possessing group NDM MBL genes (4%), OXA-48-like carbapenemase genes (2%), and CTX-M group ESBL genes (39%) was revealed in urine from patients with suspected UTI.

Disclosure of Interest: None declared

P72 THE EFFECT OF VARYING MULTIDRUG-RESISTENCE (MDR) DEFINITIONS ON RATES OF MDR GRAM-NEGATIVE RODS

A. Wolfensberger1, S. P. Kuster1, M. Marchesi2, R. Zbinden2, M. Hombach2,3

1Department of Infectious Diseases and Hospital Epidemiology, UNIVERSITY HOSPITAL ZÜRICH; 2Institute of Medical Microbiology, University of Zurich, Zürich; 3Present affiliation: Roche Diagnostics International AG, Rotkreuz, Switzerland , Rotkreuz, Switzerland
Correspondence: A. Wolfensberger

Introduction: The number of Gram-negative bacteria that are resistant to multiple antibiotics is on a constant rise and infections due to these resistant organisms pose an increasing threat to the achievements of modern medicine. Definitions of multidrug resistance (MDR) are neither harmonized between countries, nor between hospitals in the same country, nor do guidelines on IPC standards for patients with GN-MDRO exist to date.

Objectives: To determine the effects of different definitions of multidrug-resistance on rates of Gram-negative multidrug-resistant organisms (GN-MDRO).

Methods: MDR definitions of the European Centre for Disease Prevention and Control (ECDC), the German Commission of Hospital Hygiene and Infection Prevention (KRINKO) and the University Hospital Zurich (UHZ) were applied on a dataset comprising isolates of Escherichia coli, Klebsiella pneumoniae, Enterobacter sp., Pseudomonas aeruginosa, and Acinetobacter baumannii complex. Rates of GN-MDRO were compared and the percentage of patients ever having had a GN-MDRO was calculated.

Results: In total 11’407 isolates from a three year period were included. For Enterobacteriaceae and P. aeruginosa, highest MDR-rates resulted from applying the ‘ECDC-MDR’ definition. ‘ECDC-MDR’ rates were up to four times higher compared to ‘KRINKO-3MRGN’ rates, and up to six times higher compared to UHZ rates. Lowest rates were observed when applying the ‘KRINKO-4MRGN’ definitions. Comparing the ‘KRINKO-3MRGN’ with the UHZ definitions did not show uniform trends, but yielded higher rates for E. coli and lower rates for P. aeruginosa. On the patient level, the percentages of GN-MDRO carriers were 2.1%, 5.5%, 6.6%, and 18.2% when applying the ‘KRINKO-4MRGN’, ‘UHZ-2015’, ‘KRINKO-3MRGN’, and the ‘ECDC-MDR’ definition, respectively.

Conclusion: Different MDR-definitions lead to considerable variation in rates of GN-MDRO. Differences arise from the number of antibiotic categories required to be resistant, the categories and drugs considered relevant, and the antibiotic panel tested. MDR definitions should be chosen carefully depending on their purpose and local resistance rates, as definitions guiding isolation precautions have direct effects on costs and patient care.

Disclosure of Interest: None declared

P73 RECTAL CARRIAGE OF CIPROFLOXACIN-RESISTANT ENTEROBACTERIACEAE AMONG PATIENTS IN TWO DUTCH HOSPITALS: RESULTS FROM THE I-4-1-HEALTH PROJECT

M. Kluytmans - van den Bergh1,2, C. Verhulst1, B. Diederen3, E. Maas3, V. Weterings1, I. Willemsen1, J. Kluytmans1,2, on behalf of the i-4-1-Health Study Group

1Amphia Hospital, Breda; 2UMC Utrecht, Utrecht; 3ZorgSaam Hospital, Terneuzen, Netherlands
Correspondence: C. Verhulst

Introduction: Antimicrobial resistance (AMR) in Gram-negatives poses a threat to global public health, with the gut as main reservoir.

Objectives: To determine the prevalence and predictors of rectal carriage of ciprofloxacin-resistant Enterobacteriaceae (cipR-E) among patients in Dutch hospitals, and the occurrence of co-carriage of cipR-E and extended-spectrum beta-lactamase-producing (ESBL-E) or carbapenem-resistant Enterobacteriaceae (CRE).

Methods: Repeated AMR prevalence surveys were performed in 9 wards of 2 Dutch hospitals in 2017/2018. Perianal or, if appropriate, gastrointestinal stoma swabs (Fecal Swab, COPAN Italy) were pre-enriched in a non-selective tryptic soy broth (COPAN Italy) and subsequently cultured on selective agar plates (McC cipro 2 mg/L, in-house; ChromID ESBL/CARBA/OXA48, bioMérieux) to identify cipR-E, ESBL-E and CRE. Cultures with a negative growth control or transport time >72 h were invalid. Vitek2 (bioMérieux) and combined disk diffusion (Rosco) were used for susceptibility testing and confirmation of ESBL production. EUCAST guidelines were used for interpretation. Demographic patient data were retrieved from the medical record. A multivariable logistic regression model was used to identify independent predictors for cipR-E rectal carriage.

Results: Of 1,226 patients hospitalised, 887 (72%) had a valid culture. The prevalence of cipR-E carriage was 12% (109/887). Independent predictors for cipR-E carriage were age (ORadj 1.020; 95% CI 1.003–1.039) and days since hospital admission (ORadj 1.017; 95% CI 1.005–1.030). Hospital, year of culture, specialty, sex, nursing home residency or previous hospitalisation (1 yr) were not independently associated with cipR-E carriage. Data on antibiotic use were not available. E. coli was the predominant cipR-E (70%; 94/135). Co-carriage with ESBL-E was identified in 31% (34/109) of cipR-E carriers compared to 4% (35/778) of non-cipR-E carriers (RR 6.9; 95% CI 4.4–10.8). Co-carriage with CRE was <1% for cipR-E carriers and non-carriers.

Conclusion: Rectal carriage of cipR-E is common among patients in Dutch hospitals, with age and days since hospital admission being independent predictors. CipR-E carriers are at increased risk for ESBL-E carriage.

Disclosure of Interest: M. Kluytmans - van den Bergh Grant/Research support from: Interreg Vlaanderen-Nederland / COPAN Italy / bioMérieux , C. Verhulst Grant/Research support from: Interreg Vlaanderen-Nederland / COPAN Italy / bioMérieux, B. Diederen Grant/Research support from: Interreg Vlaanderen-Nederland / COPAN Italy / bioMérieux, E. Maas Grant/Research support from: Interreg Vlaanderen-Nederland / COPAN Italy / bioMérieux, V. Weterings Grant/Research support from: Interreg Vlaanderen-Nederland / COPAN Italy / bioMérieux, I. Willemsen Grant/Research support from: Interreg Vlaanderen-Nederland / COPAN Italy / bioMérieux, J. Kluytmans Grant/Research support from: Interreg Vlaanderen-Nederland / COPAN Italy / bioMérieux

P74 PREDICTIVE ACCURACY OF RISK PREDICTION MODEL OF CARBAPENEM-RESISTANT ENTEROBACTERIACEAE (CRE) COLONIZATION: A PROSPECTIVE COHORT STUDY IN INTENSIVE CARE UNITS

J. Y. Song2, I. Jeong1

1PUSAN NATIONAL UNIVERSITY; 2PUSAN NATIONAL UNIVERSITY Yangsan Hospital, Yangsan, Korea, Republic Of
Correspondence: I. Jeong

Introduction: We had developed the risk model of carbapenem-resistant Enterobacteriaceae (CRE) colonization through retrospective cohort study. The risk prediction logistic model for CRE colonization was E (logit of CRE colonization) = -2.821 + 1.606 (isolation of multi-drug resistant organisms) + 1.347 (≥15 days of cephalosporin administration) + 0.980 (≥15 days of carbapenem administration) + 0.544 (≥21 points of APACHEII score). The risk prediction model showed .795 of area under receiver operator characteristic (ROC) curve, and 68.9% of correct classification, 79.8% of sensitivity and 66.2% of specificity at .20 of cutting point.

Objectives: : This study was aimed to externally validate the predictive accuracy of previous risk prediction model of CRE colonization developed by researchers.

Methods: This retrospective cohort study was done with medical record review at a tertiary hospital between November 1, 2017 and May 31, 2018. The subjects were 414 adult patients (48 CRE carriers and 366 no-CRE carriers) admitted to intensive care units during the study time.

Results: The area under the ROC curve (AUC) of The risk prediction model was 0.883. When predicted probability values for CRE colonization in the curve of 0.20 and 0.25 were used as the cutoff point to distinguish between CRE carriers and no-CRE carriers, the sensitivity was 52.1% and 45.8%, the specificity was 92.6% and 95.1%, the positive predictive value was 48.1% and 55.0%, the negative predictive value was 93.6% and 93.0%, and the classification accuracy was 87.9% and 89.4%, respectively.

Conclusion: The risk prediction model of carbapenem-resistant Enterobacteriaceae (CRE) colonization showed higher AUC in validation stage than that in developmental stage. Therefore, we recommend for nurse in ICUs to utilize the model to identify the high risk population of CRE.

Disclosure of Interest: None declared

Poster session: Candida Auris

P75 CONTROL OF CANDIDA AURIS IN HEALTHCARE INSTITUTIONS. OUTCOME OF AN INTERNATIONAL SOCIETY OF ANTIMICROBIAL CHEMOTHERAPY EXPERT MEETING

N. Kenters1, on behalf of International Society of Antimicrobial Chemotherapy, Working Group Infection Prevention and Control, M. Kiernan2, A. Chowdhary3, D. W. Denning4, J. Pemán5, S. Schelenz6, E. Tartari7, A. Widmer8, J. F. Meis9, A. Voss1,10 on behalf of an International Society of Antimicrobial Chemotherapy, Working Group Infection Prevention and Control

1Medical microbiology, CWZ, Nijmegen, Netherlands; 2Richard Wells Research Centre, University of West London, United Kingdom; 3Department of Medical Mycology, University of Delhi, Dehli, India; 4Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and National Aspergillosis Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom; 5Department of Clinical Microbiology, Hospital Universitari i Politècni La Fe, Valencia, Spain; 6Department of Microbiology, Royal Brompton Hospital, London, United Kingdom; 7Faculty of Health Sciences, University of Malta, Msida, Malta; 8University of Basel Hospitals & Clinics, Basel, Switzerland; 9Centre of Expertise in Mycology Radboudumc/CWZ; 10Medical Microbiology, Radboudumc, Nijmegen, Netherlands
Correspondence: N. Kenters

Introduction: Candida auris is a difficult to detect, emerging fungal pathogen responsible for invasive infections and outbreaks in healthcare facilities worldwide, which have been difficult to control. Evidence for infection prevention and control (IPC) remains scarce.

Objectives: To provide pragmatic guidance and recommendations for IPC measures

Methods: A group of infection prevention and mycology experts reviewed the published literature on C. auris and identified best practice based on available scientific evidence, existing guidelines and expert opinion. The available literature from both laboratory and clinical settings was reviewed, drawing on the expert experience of outbreaks in order to formulate implementable guidance.

Results: We have proposed a set of recommendations on key interventions needed to contain a single case or C. auris outbreak including: screening, standard and extra precautions, cleaning and disinfection, patient transfers, outbreak management, decolonization and treatment. Measures to contain a C. auris single case or outbreak need a different approach than for other MDROs since transmission before the first clinical case appears is likely.

Conclusion: Healthcare facilities can use the IPC recommendations identified by international experts and current epidemiology on C. auris to prevent transmission and control outbreaks.

Disclosure of Interest: None declared

P76 ANTIMICROBIAL PHOTODYNAMIC THERAPY FOR CONTROL OF THE NEWLY EMERGING NOSOCOMIAL PATHOGEN, C. AURIS

C. Cross, C. Romo, N. Loebel

Ondine Research Labs, Bothell, United States
Correspondence: N. Loebel

Introduction: Multi-drug resistant C. auris infections are being increasingly reported from around the world. C. auris is difficult to identify with standard laboratory methods and infections can be invasive and deadly. In many cases, C. auris is resistant to any of the drug classes used to treat fungal infections and therefore has high potential to cause outbreaks in healthcare facilities.

Objectives: Antimicrobial devices such as ultraviolet robots and disinfectant sprays are helpful to decolonize facilities and equipment, but are unsafe for direct human use. A new approach to safe elimination of Candida auris from the nares and skin of colonized patients and healthcare workers would contribute to reducing infections by this evolving nosocomial threat. Antimicrobial photodynamic therapy (aPDT) has been successfully deployed in tens of thousands of patients in Canada (MRSAid/Steriwave nasal decolonization system, Ondine Biomedical Inc., Canada), with the goal of eradicating MRSA from the anterior nares as a means of reducing post-surgical staphylococcal infections. The objective of the present work was to demonstrate expanded effectiveness of aPDT against both planktonic and biofilm forms of C. auris.

Methods: 48-hr planktonic and biofilm cultures of Candida auris clinical isolates (CDC, Atlanta, GA) were established in 96-well black polystyrene plates with clear well bottoms. Cultures were exposed to photosensitizer and light, as well as standard positive and negative controls. Experiments were also conducted to demonstrate absence of cross-resistance induction to standard antifungals including azoles and Amphotericin B.

Results: aPDT using standard clinical parameters completely eradicated (106 logs) both planktonic and biofilm forms of all C. auris strains tested. Experiments at sublethal aPDT doses demonstrated no increase in MIC to any tested antifungal. Intriguingly, the MIC of Amphotericin B to C. auris decreased 8-fold after sublethal aPDT exposure, implying an increase in susceptibility to this Amphotericin B which was inherited across successive fungal generations.

Conclusion: aPDT using standard clinical parameters proved highly effective at eradicating all clinical isolates of C. auris tested, including multi-drug resistant strains. This work establishes a potential foundation for control of C. auris as a newly emerging nosocomial pathogen.

Disclosure of Interest: C. Cross Employee of: Ondine Research Labs, C. Romo Employee of: Ondine Research Labs, N. Loebel Employee of: Ondine Research Labs

P77 MANAGEMENT OF CANDIDA AURIS EXPOSURE AMONG PATIENTS AND HEALTHCARE WORKERS AT TERTIARY CARE SETTING

A. Mohammed1, M. M. Alshamrani1, A. El-Saed1, M. Alghoribi2, S. Al Johani3, H. Cabanalan1, H. Balkhy4

1Infection Prevention & Control, King Abulaziz Medical City; 2Infectious Diseases, King Abdullah International Medical Research Center; 3Microbiology, King Abulaziz Medical City, Riyadh, Saudi Arabia; 4Antimicrobial Resistance, World Health Organization, Geneva, Switzerland
Correspondence: A. Mohammed

Introduction: Candida auris is an emerging multidrug-resistant fungal pathogen that has been implicated in a number of invasive infections and outbreaks in healthcare facilities.

Objectives: The objective was to describe our local experience with candida auris exposure at a tertiary care hospital at Riyadh, Saudi Arabia.

Methods: A surveillance study has been conducted at King Abdulaziz Medical City, Riyadh between March 2018 and May 2019. After detecting the index cases, screening of all exposed healthcare workers (HCWs) and patients began. Post-exposure screening included those who had direct contact or shared the same location with a laboratory confirmed case. A total of 707 HCWs and 253 patients were screened. Screening procedure for HCWs included swabbing of nares, axilla, and groin for fungal culture. For patients, screening procedure included additionally rectal swab.

Results: During the study, a total 23 primary cases have been detected. Post-exposure screening identified 11 more cases, all were patients. The cases gradually increased to reach peak in April 2019 with much reduction in May 2019. For primary cases, positive clinical specimens were mainly urine (65.2%), blood (26.1%), and tracheal aspirate (13.0%). Males represented 67.6% of the patients and the average age was 63.9±19.8 years. At the time of diagnosis, 52.9% of patients were admitted to intensive care units and 47.1% to wards. The median (IQR) duration before diagnosis was 30 (12.8-73) days. All primary cases were isolated on the day of results release (median 4.0 days from sampling). All screened patients were under isolation during screening. The median (IQR) length of hospital stay was 80.5 (33.8-134.5) days. The mortality by the end of the study was (4/34) 11.8%, with 38.2% discharged and 50.0% still in the hospital.

Conclusion: This study demonstrates a risk of cross transmission of candida auris in healthcare facilities among patients. As all screened HCWs were negative, colonization among them is unlikely. Active screening of exposed individuals followed by appropriate infection control measures may help early detection of candida auris and guard against future large scale spread in healthcare settings.

Disclosure of Interest: None declared

P78 ORAL COLONIZATION BY CANDIDA SPP. IN LIVER TRANSPLANT PATIENTS: MOLECULAR IDENTIFICATION, ANTIFUNGAL SUSCEPTIBILITY TESTING AND ASSOCIATED FACTORS

C. S. Sabadin1, S. L. Lopes1, D. A. Da Matta1, L. Rigo2, A. S. Melo1, O. F. Gompertz1, D. A. Barbosa1

1Federal University of São Paulo , São Paulo; 2Meridional Faculty , Passo Fundo, Brazil
Correspondence: C. S. Sabadin

Introduction: Oral colonization by Candida spp. has been associated with increased risk of systemic infection in transplant recipient patients.

Objectives: To investigate oral colonization by Candida spp., identify to species level, evaluate antifungal susceptibility profile and associated factors.

Methods: A prospective cohort study was carried out with 97 liver transplant patients attended by a hospital transplant center, which is a reference for liver transplants in southern Brazil. All patients were submitted to two oral swab collections, with a 6-month interval. The samples were cultured in CHROMagar® Candida for yeast isolation and the identification was carried out by sequencing the ITS region of rDNA. The susceptibility test was performed to Fluconazole (FLC), Amphotericin B (AMB) and Micafungin (MFG) using the broth microdilution method recommended by CLSI, document M27-A3. Pearson's Chi-square test was used to analyze the qualitative variables (p> 0.05).

Results: Eighty-two patients were investigated for colonization and fifteen were excluded for presenting oral candidiasis. The total of 82 patients, 50 were colonized in the first collection and 49 in the second. C. albicans was the most prevalent species in both collections (n=31/50 and n=29/49 respectively). It is worth highlighting the finding of 11 isolates of C. dubliniensis and one of C. fermentati in the study. In 23 patients the yeast species remained the same and in 25 the species substitution occurred. Regarding FLC, 38 isolates from the first collection were susceptible (S), 7 susceptible dose dependent (SDD) and 5 resistant (R). In the second collection, there were 32 isolates S, 11 SDD and 6 R. For AMB and MFG all the isolates were susceptible. In the analysis of factors associated with colonization, none of them presented statistically significant difference.

Conclusion: Colonization of the oral cavity of liver transplant patients by Candida spp. surpassed 50%. The prevalent species was C. albicans. Most of the isolates were susceptible to antifungal agents, however, species resistant to FLC were identified, which may be considered a risk factor for infections resistant to treatment with this agent.

Disclosure of Interest: None declared

Poster session: Antimicrobial resistance in Low and Middle Income Countries 1

P79 IDENTIFICATION AND ANTIMICROBIAL RESISTANCE PROFILLING OF PSEUDOMONAS AERUGINOSA USING HIGH-THROUGHPUT SEQUENCING

D. Shagin1, Y. Mikhaylova1, A. Shelenkov1, Y. Yanushevich1, V. Fomina2, M. Zamyatin2, V. Akimkin1

1Central Research Institute of Epidemiology; 2Pirogov National Medical and Surgical Center, Moscow, Russian Federation
Correspondence: D. Shagin

Introduction: Pseudomonas aeruginosa is a dangerous opportunistic pathogen and the most abundant bacterial species causing nosocomial infections in Russia. Clinical isolates P. aeruginosa are characterized by rapid acquisition to antimicrobial resistance.

Objectives: The problem of increasing prevalence in hospitals of multiresistant bacteria, especially those that are resistant to carbapenem antibiotics, emphasize the need of typing methods that allow to comprehensively identify and compare intra- and interlaboratory isolates easily.

Methods: In this work whole-genome sequencing was carried out on 70 isolates of P. aeruginosa including 5 environmental isolates collected from Pirogov National Medical and Surgical Center on an Illumina HiSeq platform. Sensitivity spectrum to antimicrobial drugs was determined by disc-diffusion method. The assembly was performed with Spades. Determinants of antimicrobial resistance, genes of virulence, sequence-types were revealed with Resfinder 2.1, Virulence finder and MLST 1.8, respectively.

Results: According to MLST analysis, 70 P. aeruginosa strains can be divided into 16 different sequence types (ST) with the prevalence of ST654 (35 isolates). Six samples characterized by new sequence types. All of the strains carried β-lactamase genes of PAO-type. 52% of strains possessed β-lactamase genes of VIM type, 20% - of OXA type. 77% of strains carried β-lactamase genes of several types simultaneously. All of the isolates examined had fosA gene responsible for fosfomicin resistance.

Conclusion: The data of whole genome analysis were consistent with the results of disc-diffusion method, especially for carbapenemases. Nonetheless, some cases of discrepancy were revealed. Phylogenetic analysis displayed high similarity groups consisted of strains isolated both from the same patient (different clinical sources) and from different patients. Thus, application of Next Generation Sequencing technologies allowed us to get the most complete information regarding the hospital strains studied . High-throughput sequencing can be used both to predict the sensitivity / resistance of microorganisms to antimicrobial drugs and for the epidemiological surveillance of P. aeruginosa strains.

Disclosure of Interest: None declared

P80 BURKHOLDERIA CEPACIA COMPLEX (BCC) AMONG NON-CYSTIC FIBROSIS HOSPITALIZED PATIENTS IN KUWAIT

L. Vali, D. Al-Kayyali, A. A. Dashti

Medical Laboratory Sciences, KUWAIT UNIVERSITY, Kuwait, Kuwait
Correspondence: L. Vali

Introduction: Burkholderia cepacia complex (BCC) is a group of opportunistic pathogens that colonize in the lung of cystic fibrosis patients, however recently colonization and infections among hospitalized patients without cystic fibrosis and hospital outbreaks have been increasingly reported.

Objectives: In this study we characterized 8 BCC isolates from 7 non-cystic fribrosis patients from different sources of infection in Kuwait.

Methods: Isolates were identified to the species level by PCR-RFLP for recA gene and Multi-locus sequence typing (MLST). They were tested for antibiotic sensitivity using E-Test and agar dilution method. Pulsed-field Gel Electrophoresis (PFGE) was applied. Whole genome sequencing was performed for four of the isolates based on the antibiotic sensitivity results.

Results: Six solates were identified as Bcenocepacia (genomovar IIIA), 1 as B. cepacia (genomovar I) and 1 as B. multivorans (genomovar II). Results of PFGE using SpeI for Bcenocepacia illustrated diversity of these isolates. Three novel STs (ST-1282, ST-1284, ST-1288) and three novel allelic profiles for gltB (563), lepA (523) and gyrB (846) for the newly identified ST 1288 were identified. MIC values showed all isolates were resistant to at least one group of antibiotics: ceftazidime (n=1), meropenem (n=2), minocycline (n=1), levofloxacin (n=1), and chloramphenicol (n=8) and one resistant to trimethoprim-sulfamethoxazole. Isolates 38 and 39 were obtained from one ICU patient diagnosed with Hypoxemic Respiratory Failure due to secondary pneumonia at two different time points before and after ceftazidime treatment. B.cenocepacia IIIA ST306 isolated from blood (isolate 38) was not resistant to ceftazidime but resistance was observed in the second blood specimen (isolate 39). Isolate 39 ultimately resulted in sepsis and death of the patient. WGS showed an allele difference in a polysaccharide capsule I gene (wcbT) putative acyl CoA transferase, which may cause an exclusion of the antibiotic (locus_tag=BCAL3218). Isolate 39 may have also survived the antibiotic treatment by orbE gene (ornibactin biosynthesis ABC transport protein).

Conclusion: This study confirms the ability of BCC to adapt to environmental changes and a potential problem for infection control team to eliminate BCC from hospital environment.

Disclosure of Interest: None declared

P81 BURDEN OF MULTIDRUG-RESISTANT BACTERIA IN HOSPITAL ENVIRONMENT IN SLOVAKIA: RESULTS FROM THREE-YEAR MULTICENTRE PREVALENCE STUDY HOSPITAL-ENVIRO-REZ

L. Pazderka1,2,3, J. Brňová1,2,4, L. Michalikova1,2,3, S. Kissová5, A. Liskova6, S. Kucharíková1, J. Prnová4,7, P. Petruš8, V. Krčméry6

1Department of Laboratory Medicine; 2Centre of Microbiology and Infection Prevention, Trnava University; 3Department of Clinical Microbiology, AnalytX s.r.o.; 4Department of Hospital Hygiene and Epidemiology, University Hospital Trnava, Trnava; 5Medirex; 6Department of Molecular Microbiology, St. Elisabeth University, Bratislava; 7Department of Public Health, Trnava University, Trnava; 8Clinic of Surgery and Transplant Center, Comenius University, Jessenius Faculty of Medicine in Martin, Martin, Slovakia
Correspondence: L. Pazderka

Introduction: The role of hospital environment in harboring and transmitting multidrug-resistant (MDR) organisms has become clearer due to a series of publications linking environmental contamination with increased risk of hospital-associated infections.

Objectives: The aim of this study was to assess burden of antibiotic resistance in bacteria isolated from hospital environment in Slovakia.

Methods: Three-year multicentre prevalence study was performed in January 2015 to December 2017. Clinically significant positive strains isolated from hospital environment of all Slovak hospitals were included. Antimicrobial susceptibility was determined using disc diffusion and colorimetric test (EUCAST). The presence of genes encoding multiresistance were performed by polymerase chain reaction and imunochromatographic assay. Statistical analyses were performed using R-project and P<0,05 was considered significant.

Results: Overall 2114 samples from hospital environment (Klebsiella spp., Pseudomonas spp., Escherichia coli, Enterobacter spp., Staphylococcus aureus and Enterococcus spp.) were analysed. Phenotype of MDR was confirmed in 492 (23,3%) isolates, and occurrence was similar in Gram-negative and Gram-positive bacteria (49,0% vs. 51,0%; P>0,05). MRSA and VRE from all Staphylococcus aureus and Enterococuss spp. positive swabs were found in 16,8,% and 5,8% respectively. None VRSA was isolated from hospital environment in Slovakia. Carbapenem and colistin resistant isolates were found in Gram-negative bacteria (985) in 6,1% and 2,5% respectively.

Conclusion: This is the first study concerning on burden of MDR bacteria in hospital environment in Slovakia. These results highlight the significance of better infection control practise and performing effective measures to reduce spreading of MDR bacteria within Slovakia health care facilities.

This study was supported by a research grant from the MŠVVaŠ SR.

Disclosure of Interest: None declared

P82 EPIDEMIOLOGICAL ANALYSIS OF CONTACT PRECAUTIONS FOR MRDO´S IN A HOSPITAL IN SOUTHERN BRAZIL

C. C. Ponzi, N. V. Polezze, B. V. Biavatti, K. Catapan, L. J. C. de Mendonça

Health Care Associated Infections Control, Hospital Unimed Chapecó, Chapecó, Brazil
Correspondence: C. C. Ponzi

Introduction: MDRO colonization implies higher morbidity and hospital costs, and efforts to control cross-transmission must be persued.

Objectives: to describe the epidemiological characteristics of preemptive contact precautions (PCP) in a reference private hospital in Souther Brazil.

Methods: All patients with risk for colonization by MDRO´s (CDC criteria) are set to PCP at admission and oral, axillary and inguinal swabs are collected, and data was prospectivelly colected from Jan. 2015 to Dec. 2018 and analyzed by descriptive statistics and Fisher´s Exact Test

Results: 516 patients met criteria for PCP. 44,8% were transfered from a lower-complexity institution and 28,3% had more than 4 hospital stays in the previous 6 months. Most patients (63,2%) had positive result for MDRO (42,5% MRSA, 17,3% ESBL or KPC and 3,4% associated other Gram-negative MDRO and MRSA). Consireding data from the National Association of Private Hospitals in Brazil, patients colonized by MDRO had longer lenght of stay (p < 0,00001). In hospital all-causes mortality of MDRO colonized patients was 10%, compared to 5% of MDRO-negative patients.

Conclusion: Reference hospitals usually receive patients from smaller institutions, and the fact that most of the patietns were colonized by MDRO´s may imply lack of adequate infection control practices in those institutions. PCP, hand hygiene and rational use of antimicrobials must be strongly encouraged in all size health-care facilities.

Disclosure of Interest: None declared

P83 DETECTIONS OF EXTENSIVELY DRUG-RESISTANT GRAM NEGATIVE BACILLI AMONGST IMMUNE-COMPROMISED PATIENTS IN A TERTIARY FEDERAL MEDICAL CENTRE IN THE NIGERIAN STATE OF KATSINA

I. Yusuf1, A. S. Kankara2

1Microbiology, Bayero University, Kano, Kano; 2Microbiology, Federal Medical Center Katsina, Katsina, Nigeria
Correspondence: I. Yusuf

Introduction: The rate at which pathogenic Gram negative bacteria (GNB) are defying any form of treatment with different antibiotics is worrisome and need for the study arises.

Objectives: Study on occurrence of extensively drug resistant (XDR) GNB was conducted on immune compromised patients (ICP) in intensive care, accidents and emergency, and special care baby units as well as Obstetrics and Gynaecology, surgical and Medical wards of a tertiary medical centre in Nigerian state of Katsina, North West Nigeria.

Methods: The GNB isolated from urine, stool, sputum, wound swabs and catheter tips were tested for susceptibility to 12 categories of antimicrobials using disc diffusion method according to Clinical Laboratory Standards Institute (CLSI) 2018 break points.

Results: Out of 68 GNB isolated from 400 different clinical samples of ICPs, 15 (22.1%) exhibited extensively drug resistance. The majority of the XDR GNB were recovered from patients that had stayed on admission between the range of 0-9 days in the hospital. Variable resistances were expressed by Escherichia coli (37.5%), Klebsiella pneumoniae (60%) and 100% (n=1) by Enterobacter spp. against carbapenem (meropenem). Equally alarming is the resistance to colistin by Escherichia coli 50%, Klebsiella pneumoniae 20% as well as 75% resistance against Tigecycline expressed by Escherichia coli and 60% by Klebsiella pneumoniae. The isolates were phenotypically screened for ESBLs (53%), AmpC (13%), carbapenemase (0%) and metallo beta-lactamases (0%). Co- production of ESBL and AmpC were expressed by 25% Escherichia coli isolates. Piperacillin+Tazobactam antibiotic combinations with commonly prescribed antibiotics: ceftriaxone, ceftazidime, gentamicin, exhibited more synergistic performances than similar antibiotic combinations with amoxicillin.

Conclusion: Detection of XDR GNB among critically ill patients will have great impacts on patient care, infection control, and need to establish or resuscitate antibiotic stewardship in the facility is highly advised.

References

CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 28th ed. CLSI supplement M100, Wayne, PA: Clinical and Laboratory Standards institute 2018.

Disclosure of Interest: None declared

P84 CIPROFLOXACIN RESISTANCE IN SALMONELLA ENTERICA BLOODSTREAM INFECTIONS FROM HOSPITALIZED PATIENTS, CAMBODIA 2015-2018

S. Ho, S. Chea, S. Seng, S. Tuy, T. Sok, K. Hour, S. Thai, L. Eng

Laboratory, Calmette Hospital, Phnom Penh, Cambodia
Correspondence: S. Ho

Introduction: Salmonella enterica serovar Typhi (Salmonella Typhi) and Salmonella enterica serovar Paratyphi (Salmonella Paratyphi A, B, C) are among the most common bloodstream pathogens in low and middle income countries. In Cambodia, however, there is limited data on common serotypes and antibiotic susceptibility patterns.

Objectives: The study aims to identify the most common serotypes of S. enterica causing bloodstream infections in Cambodia as well as their antibiotic susceptibility patterns

Methods: We reviewed and analyzed hospital microbiology and antibiotic susceptibility data from 2015-2018.

Results: We found 166 cases of Salmonella infection, among which 125 (75%) were S. Paratyphi A, 25 (15%) were S. Typhi and 16 (10%) were other Salmonella spp. The most affected age groups were patients 20-29 years old (38.5%), 30-39 years old (18%), and 10-19 years old (9.6%). For S. Paratyphi A, 52% were resistant and 28.8% were intermediately susceptible to ciprofloxacin. S. Paratyphi A had very low resistance to commonly used antibiotics including Trimethoprim/sulfamethoxazole (0.8%), Amoxicillin (1.6%) and Chloramphenicol (0.8%). 28% of S. Typhi infections were resistant and 44% were intermediately susceptible to ciprofloxacin while higher was found for trimethoprim/sulfamethoxazole (60%), amoxicillin (64%) and chloramphenicol (52%).

Conclusion: Our study, in line with previous work, found that S. Paratyphi A was the most common serotype among S.enterica bloodstream infection in Cambodia, but we found very high ciprofloxacin resistance in S. Paratyphi A, while previous studies had shown low ciprofloxacin resistance. Antibiotic resistance in the second-most common serotype S. Typhi was also higher than that of S. Paratyphi A. This review contributes valuable clinical information for use in guiding physician decisions on antibiotic use, formulating national antibiotic guidelines, and educating the community on the prevention and control of salmonellosis.

Keywords: Resistance, Salmonella, Serotype, Bloodstream infection, ciprofloxacin

Disclosure of Interest: None declared

P85 DRUG-RESISTANT BACTERIAL SEPTICAEMIA IN HOSPITALIZED PATIENTS, PHNOM PENH, CAMBODIA

L. Eng, S. H. Ho, S. Chea, T. Sok, S. Seng, S. Tuy, K. Hour, S. Thai, S. Ek, S. Bory, on behalf of Laboratory staffs and Infectious Diseases Team at Calmette hospital

Laboratory, Calmette Hospital, Phnom Penh, Cambodia
Correspondence: L. Eng

Introduction: Septicaemia is a leading cause of death in Intensive Care Units (ICUs). With more than 30 million cases and 6 million deaths worldwide per year, early detection and confirmation are critical to successful treatment while specific information on the situation Cambodia is lacking.

Objectives: The objectives of our study were to identify the common causes of septicaemia in the ICUs and on the General Medicine wards (GMWs) as well as to determine their antimicrobial resistance profiles.

Methods: We reviewed the laboratory results from the clinical laboratory of a tertiary care hospital in Phnom Penh, Cambodia from January to December 2018.

Results: From January to December 2018, bacterial septicaemia was confirmed in 25% (147/577) of ICU specimens and 18% (495/2751) of GMW specimens. In the ICUs, isolated species were E. coli 10%, B. pseudomallei (10%), E. faecium (5%), S. maltophilia (5%), K. pneumoniae (3%), B. cepacia (3%), A. xylosoxidans (3%), Sphingomonas spp. (3%), A. baumannii (2%), and S. aureus (1%). In the GMWs, we found E. coli (11%), S. paratyphi A (10%), B. cepaciae (8%), S. maltophilia (7%), B. pseudomallei (6%), S. aureus (4%), A. xylosoxidans (4%), and K. pneumoniae (1%).

Seven percent of E. coli spp. isolated from the ICUs were resistant to carbapenems, compared to 2% of those isolated from the GMWs, and 87% from the ICUs were resistant to fluoroquinolones compared to 62% from the GMWs. 100% of S. aureus in the ICUs and 65% in the GMW was methicillin-resistant, or MRSA. There was some resistance of S. paratyphi A to fluoroquinolones (37%) and trimethoprim-sulfamethoxazole (12%) in the GMWs, but all S. paratyphi A was sensitive to third generation cephalosporines. A. baumannii infections from the ICUs were all resistant to all beta-lactamines and fluoroquinolones.

Conclusion: Patients hospitalised in the ICUs have a higher chance of resistant bacterial blood infections that are than those in the GWMs. Our results should inform Cambodian physicians the different management for patients in the ICUs from those on the GMWs to improve clinical outcomes and infection control, and can be used to develop national and international policies and guidelines.

Disclosure of Interest: None declared

P86 ANTIBACTERIAL RESISTANCE SURVEILLANCE OF CLINICAL ISOLATES AT AN ONCOLOGY CENTRE

V. Bhat1, R. Kelkar2, S. Biswas2, N. Khattry3, S. Gupta3

1Microbiology, ACTREC, Tata Memorial Centre; 2Microbiology, Tata Memorial Centre; 3Medical Oncology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
Correspondence: V. Bhat

Introduction: Increasing antibiotic resistance in bacterial pathogens is a major cause for concern in recent times. Regular Surveillance of antibiotic resistance helps in earlier detection of resistance trends.

Objectives: In this study, we present the results of bacterial antibiotic resistance surveillance in an oncology setting

Methods: This study includes bacterial isolates recovered from infections cancer patients in the year 2018. Samples included blood cultures, pus/wound swabs, urine, tissue biopsies, sterile body fluids and respiratory specimens. All samples were processed in the microbiology laboratory as per Standard Laboratory Protocols. Organisms were identified to species level and susceptibility testing was performed and interpreted as per Clinical laboratory Standards Institute (CLSI) guidelines. Antibiotic resistance percentages to individual organisms was computed.

Results: A total of 4728 blood cultures, 681 urine cultures, 987 pus/tissue/swabs, 73 sterile body fluids and 241 respiratory cultures were processed for bacterial cultures. Positive cultures yielded 299 Gram positive and 806 Gram negative isolates. Escherichia coli(263) was the commonest organism followed by Klebsiella pneumoniae(173), Pseudomonas aeruginosa(180), Staphylococcus aureus(97), Enterococcus spp(74) and Acininetobacter(46). Resistance of K. pneumoniae and E. coli to cefotaxime and ceftazidime was high at > 60%. Imipenem resistance was also high at >50% for both organisms. Resistance to piperacillin- tazobactam was seen in 36.1% of E.coli and 48.6% of K.pneumoniae. Resistance of P. aeruginosa to ceftazidime, piperacillin –tazobactam, amikacin and meropenem was 27.2, 25, 26.1 and 22.2 % respectively. Among Acinetobacter spp, resistance to cefotaxime, piperacillin-tazobactam, meropenem and amikacin was high at 78.2%, 60.9%, 52.1 and 67.4% respectively. Vancomycin resistance (VRE) was seen in 6.8% of Enterococci. Of the S. aureus isolates, methicillin resistance was seen in 38.1% (MRSA).

Conclusion: There is a high degree of antibiotic resistance among commonly isolated Gram negative bacteria such as E.coli, K. pneumoniae and Acinetobacter spp to cephalosporins, β- lactam/β-lactamase inhibitor combinations, fluoroquinolones and carbapenems in our setting.

Disclosure of Interest: None declared

P87 SURVEILLANCE OF ANTIMICROBIAL RESISTANCE AT A UNIVERSITY HOSPITAL IN BENIN

T. A. Ahoyo1, S. ASSAVEDO2, P. D. FONTON1

1BIOLOGIE HUMAINE, EPAC/UAC, ABOMEY CALAVI; 2MINISTERE SANTE, CABINET MINISTERE SANTE, COTONOU, Benin
Correspondence: T. A. Ahoyo

Introduction: Several antibiotics were routinely used in the treatment of healthcare associated infections, and may have contributed to the emergence of antibiotic-resistant strains in our context. Widespread resistance severely complicates management of infections

Objectives: we assess the activity of three antibiotics doxycycline, trimethoprim -sulfamethoxazole and meropenem during the management of infection control program.

Methods: Using standard microbiological methods for identification of microorganisms, all clinical bacterial isolates from inpatients received in hospital laboratory during an 18 months' period (december 2015 to Jun 2017) were recorded and analyzed. Antibiotics susceptibility was performed using agar disk diffusion method on Mueller Hinton. Mycobacteria and anaerobic bacteria were not included in the study.

Results: A total of 3478 bacterial isolates were collected of which 64% (n = 2226) were Gram negative (2005 Enterobactericea and others 221) and 36% (n = 1252) Gram-positive. The proportions of the strains varied depending on the types of infection. Almost 37% of the collected strains originated from Bloostream, followed by strains of venous and urinary catheter infection 35%, wound infection after clean surgy 10% and others 13%. A high proportion of strains showed resistance to doxycycline 60%, trimetroprim/sulfamethoxazol 87% and meropenem 7%. No significant difference in the antibiotic resistance of the strains based on their origin. A disk diffusion method is not optimal for testing certain important resistance.

Conclusion: Reasonably priced antibiotics such as, doxycycline, trimethoprim/sulfamethoxazole are now of limited benefit in the treatment of Healthcare Associated Infections. The surveillance generate valuable information on antibiotics resistance, which can be used to prepare locally applicable recommendations.

References

Ahoyo T. A., Bankolé H., Adéoti F., Attolou A., Assavedo S., Amoussou-guenou M., Kindé-gazard D. and Pittet D. 2014 Prevalence of nosocomial infections and anti-infective therapy in Benin: results of the first nationwide survey in 2012 . Antimicrobial Resistance and Infection Control, 3:17http://www.aricjournal.com/content/3/1/17

Keywords: Pathogens, Health care Associated Infections, antibiotic resistance Benin

Disclosure of Interest: None declared

P88 Withdrawn

P89 Withdrawn

P90 DISTRIBUTION OF BLATEM GENE AMONG ESCHERICHIA COLI STRAINS ISOLATED FROM DIFFERENT CLINICAL SAMPLES

S. T. Baban

Infection control and prevention, Surgical Specality Hospital, Erbil, Iraq
Correspondence: S. T. Baban

Emerging antibiotic resistance and Extended-Spectrum Beta-Lactamase (ESBL) producing Escherichia coli causing different nosocomial infections are rapidly increasing at alarming levels and it poses a major health burden in the 21st century globally. The aim of this study is to determine the distribution of blaTEM gene ESBL-producing E. coli from clinical specimens in hospitals in Erbil city. A total of 200 samples were collected from urine, human vaginal secretions and stool at all hospitals. The isolation and identification of Escherichia coli and antimicrobial susceptibility were performed by using Vitek compact system. Phenotypic screening of Extended Spectrum β-lactamase production in E.coli was confirmed by using both Double disk diffusion and Standard disk diffusion techniques. Moreover, PCR technique was used for genotypic detection of an ESBL gene blaTEM according to the standard protocol. This study showed that 66.6% of E. coli isolates were identified as producing extended-spectrum β-lactamase enzymes isolated from different clinical specimens. The ESBL-producing E. coli isolates were detected using double disk synergy test (76.7%) in comparison to standard disk diffusion test (80%). Genotypic screening results confirmed that all ESBL-producing E. coli isolates (66.7%) were carried blaTEM gene (700 bp) in clinical specimens (50% urine, 13.33% wound and 3.33% sputum). All ESBL-positive E. coli isolates showed high rates of susceptibility to Carbapenems antibiotic group including Imipenem (83.3%), Meropenem (81.7%), and Ertapenemes (80.0%). The increased prevalence of TEM β-lactamase gene in ESBL-producing E. coli observed in this study for the first time is considered as alarming because there is a limited treatment options remained for infections. Attempts to reduce the dissemination of multi-drug resistant E. coli through compliance with strict hospital infection control and prevention standards are imperative. Findings of this study may help clinicians selecting appropriate antimicrobial therapy in patients with different infections caused by ESBL-producing E. coli.

Disclosure of Interest: None declared

P91 HIGH PREVALENCE OF PLASMID-MEDIATED QUINOLONE RESISTANCE DETERMINANTS IN ESCHERICHIA COLI IN CAMEROON

E. E. Lyonga Mbamyah1, M. Toukam1, C. Nkenfou2, A. M. Smith3, M. T. Mesembe4, H. K. Gonsu5, A. C. Betbeui6, A. B. Eyoh4, G. M. Ikomey1, S. Koulla-Shiro1

1Faculty of Medicine and Biomedical Sciences, Department of Microbiology; 2Higher Teachers' Training College, University of Yaounde 1, Yaounde, Cameroon; 3Center for Enteric Diseases, National Institute for Communicable Diseases, Johanesburg, South Africa; 4CSCCD, FMBS; 5Faculty of Medicne and Biomedical Sciences, Department of Microbiology, University of Yaounde 1, Yaounde; 6Faculty of Science, University of Buea, Buea, Cameroon
Correspondence: E. E. Lyonga Mbamyah

Introduction: Plasmid carrying genes may contribute to the development of higher levels of fluoroquinolone resistance and may pose a threat by allowing the rapid spread of resistance among organisms.

Objectives: · Identify E. coli isolates and describe the antimicrobial resistance profile of these isolates.

· Detect the presence, prevalence and diversity of genes responsible for quinolone resistance among these E. coli

· Genotypically characterize selected plasmid mediated quinolone resistant (PMQR) E. coli strains.

Methods: Identification and antimicrobial susceptibility testing of E. coli species was done using VITEK 2. The detection, prevalence and diversity of plamid-mediated quinolone resistance (PMQR) genes were carried out using conventional PCR. Sequencing was done using the Applied Biosystem 3500 genetic analyser. DNA fingerprint was obtained using Pulsed-Field Gel electrophoresis.

Results: The prevalence E. coli was 178/440(39.5%). The resistance rates were: ampicillin 77.0%; amoxicillin/clavulanic acid 48.9%; CI=ciprofloxacin 39.7%; cefuroxime axetil 36.2%; cefuroxime 34.5%; gentamicin 30.5%; cefotaxime 28.7%; ceftazidime 24.7%; amikacin 13.8%; nitrofurantoin 10.1%; piperacillin/tazobactam 2.8%; and imipenem 1.1%. The detected plasmid mediated quinolone resistance (PMQR) genes were: qnrA 0; qnrB 4; qnrS 3: Aac(6`)Ib-cr 33 and qepA, 2. There were several mutations detected for the parC-E. coli. At position 80 serine (S) is replaced by Aspartic acid in strain K08 and asparagine in strain 402. All E. coli strains were non-human diarrhoeagenic strains. One pair of E. coli strains was 93.6% identical and another pair 92.7% similarity in the phylogenetic tree.

Conclusion: Fluoroquinolone resistance was high and the PMQR determinant causing this resistance was also high. To avoid the spreading of these PMQR determinants continuous surveillance of antimicrobial resistance should be carried out.

Disclosure of Interest: None declared

Poster session: Antimicrobial use and stewardship 1

P92 THE GLOBAL POINT PREVALENCE SURVEY OF ANTIMICROBIAL CONSUMPTION AND RESISTANCE (GLOBAL-PPS): RESULTS OF ANTIMICROBIAL PRESCRIBING FOR A GENERAL HOSPITAL IN URMIA, IRAN

C. Alinia1, S. Gheibi2, A. Versporten3, I. Pauwels3, H. Goossens3

1Public health; 2Maternal and Childhood Obesity Research Center, Urmia University of Medical Sciences, Urmia, Iran, Islamic Republic Of; 3Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
Correspondence: C. Alinia

Introduction: This study has done to monitor antimicrobial prescribing and resistance rates in Iran

Objectives: To measure the prevalence rate of antimicrobial prescription at hospital level

To address the quality of antibiotics prescription

Methods: A uniform and standardized method for surveillance of antimicrobial use in hospitals was used to assess the variation in antimicrobial prescribing in West Azerbaijan province, Iran. PPS was conducted in 2018, in child and neonatal wards in a teaching and general hospital. The survey included all inpatients receiving an antimicrobial on the day of the PPS. Data collected included details on the antimicrobial agents, reasons and indications for treatment as well as a set of quality indicators. A web-based application was used for data-entry, validation and reporting as designed by the University of Antwerp (www.global-pps.com). bioMérieux provided unrestricted funding support for the survey.

Results: The overall prevalence rate was achieved as 60.6%. Among the different specialized wards, the lowest and highest prevalence rates was related to Haematology−Oncology Medical (30%) and Neonatal Medical (77.8%) Wards, respectively. The most antibiotic use in Pediatric and neonatals wards were other beta-lactams and Penicillins, respectively. Pneumonia, prophylactic urinary tract infection, and prophylaxis of central nervous system infections, were the three most common diagnosis treated with therapeutic antibiotics. Overall, the reason for treatment was recorded in 84.97% of antimicrobial prescriptions, and a stop or review date in 3%. Local antibiotic guidelines were missing for 88.6% of the prescriptions. None of the patients received a targeted antibacterial treatment for systemic use.

Conclusion: The findings indicate that Iran has the highest prevalence rate of antibiotic prescription related to child and neonatal wards among all countries studied in Global PPS study. In addition to, the indicators confirmed the low quality of antibiotic prescription.

Disclosure of Interest: None declared

P93 BITTER OR SWEET: THE INCREASING USAGE OF ANTIBIOTICS OVER THE GLOBE

H. K. Lam1, K. Rajwinder2

1Clinical Operations, Matilda International Hospital, Hong Kong; 241 mount kellett road, matilda international hospital, the peak, Hong Kong
Correspondence: H. K. Lam

Introduction: Antibiotic is a sugarcoating poison as it saves many lives from fatal infections. It can also be a potential bomb if it is being misused and will lead to the growth of antibiotic-resistance in human.

Objectives: To prevent most infections from being incurable in the future, our hospital has set up an Antibiotic Stewardship Programme (ASP) with a team to monitor the usage of Big Gun (BG) antibiotics. Our ASP team is composed of the executive medical director (EMD), infection control officer (ICO), pharmacist, infection control coordinator(ICC) with a microbiologist as our honorably consultant.

Methods: In hardware, we have a BG Prescribing form. In software, we have a computer system which audits on the usage of BG antibiotics with indication, patient’s diagnosis, medical history, culture result, inflammation markers recorded. Once a BG antibiotic is prescribed, pharmacist will attach the form together with MAR in the dispensing process. The physician has to complete the form before ICC’s collection who will then input the data into the system. Afterwards, an email will automatically be sent to the case physician and the ASP team. EMD and ICO act as auditors and will send feedback to the physician on the appropriateness of the prescription with reference to IMPACT, a local antibiotic guideline, and according to patient’s information given.

Results: From September 2018 to March 2019, 54 BG was antibiotics have been recorded. Most (44%) were prescribed by family doctors. Among the types of BG prescribed, Piperacillin & Tazobactam (25%) is mostly prescribed. Most indications are respiratory infection(36%) followed by orthopaedic(20%). The purpose of prescription are recorded as 55% empirical, 27% pathogenic and 18% prophylactic. 67% are regarded “appropriate”, with 24% “not-appropriate” and 9% “don’t know”. 9% of physicians replied disagree to the audit outcome with the remaining either agree or no comment.

Conclusion: Seeing the high prescription rate from family doctors, the issue has been discussed and evaluated in doctors’ meeting. Physicians are open to feedback the rational for their prescription if it is regarded as Not Appropriate or Don’t Know. The audit allows for discussions between the auditors prior to finalizing a ‘verdict’ which reduces the likelihood of wrongly affecting clinical practice. ASP raised physicians’ awareness and a decrease of BG prescription is noted.

Disclosure of Interest: None declared

P94 POINT PREVALENCE STUDY OF ANTIBIOTIC COMPLIANCE ACROSS DISCIPLINES AT A TERTIARY MALAYSIAN HOSPITAL

M. K. Yin, C. L. Lau

Pharmacy, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
Correspondence: M. K. Yin

Introduction: Point prevalence study of antibiotics is the audit of judicious antibiotic use in accordance to local and national antibiotic guidelines. Inappropriate antibiotic use is associated with prolonged hospitalization, increased healthcare costs and development of antimicrobial resistance.

Objectives: To determine the rate of antibiotic compliance in accordance to local and national antibiotic guidelines across various disciplines in a tertiary hospital.

Methods: All antibiotic prescriptions from 43 wards of various disciplines were audited daily over a span of 2 weeks. Screening of prescriptions started at 8am using information obtained from case notes for indication and diagnosis pertaining to each antibiotic. Any discrepancies were discussed with the primary discipline team and infectious disease consultant. Data collected was then analyzed for compliance to local therapeutic guidelines, appropriateness of therapy in terms of dosage, spectrum of coverage, duration and choice by a team of pharmacists and infectious disease consultant.

Results: Of the 346 cases screened, obstetric and gynaecology was shown to have the lowest level of compliance to local guidelines for empirical antibiotic use (33.3%, n=15), followed by orthopedics (36.0%, n=25), surgery (42.4%, n=59), medical (52.6%, n=95), pediatrics (54.2%, n = 35), and intensive care (60.0%, n =5).

Conclusion: Compliance to local and national antibiotic guidelines was seen to be lowest among obstetricians for empirical use. Lack of up to date knowledge on antibiotic guidelines was seen as the possible barrier for appropriate antibiotic use.

Disclosure of Interest: None declared

P95 POINT PREVALENCE SURVEY OF ANTIMICROBIAL USE IN A TERTIARY TEACHING HOSPITAL IN THE PHILIPPINES

A. F. G. Malundo1, F. A. R. Palabrica1, R. P. Berba2

1Philippine General Hospital, Manila, Philippines; 2Hospital Infection Control Unit, Philippine General Hospital, Manila, Philippines
Correspondence: A. R. Palabrica

Introduction: The overuse and misuse of antimicrobials drives antimicrobial resistance.

Objectives: This study aimed to evaluate antimicrobial prescribing practices and determine areas for quality improvement.

Methods: A point prevalence survey of antimicrobial use among patients admitted in the Philippine General Hospital was conducted in 2017 and 2018 using the Global Point Prevalence Survey protocol. The study was conducted as part of a nationwide project headed by the Philippine Antimicrobial Point Prevalence Survey team. A descriptive analysis of the prevalence of antimicrobial use was reported along with relative frequencies of antimicrobials. Findings were compared using chi-square test.

Results: The prevalence of antimicrobial use was 49.83% and 47.73% in 2017 and 2018, respectively (p=0.21). A significant decline in antimicrobial use was noted in the neonatal and pediatric ICU (p<0.05), while usage increased in the neonatal medical ward (p=0.02). Antimicrobials were prescribed mostly for community-acquired infections, and as empiric therapy, with pneumonia being the most common infection requiring antimicrobials. About three fourths of antibiotics for surgical prophylaxis were given for >24 hours, with cefuroxime being the preferred agent. In 2017, cefuroxime was the most prescribed antibiotic, but was surpassed by meropenem in 2018. Broad-spectrum antibiotics were used often in critically-ill, and in medical patients.

Physician documentation of indication for antimicrobials improved from 68.80% in 2017 to 74.74% in 2018 (p<0.05). Guideline compliance increased from 63.50% to 74.96%, though not statistically significant (p=0.40). Nearly half of noncompliant prescriptions were for surgical prophylaxis. Documentation of antibiotic stop-date was not common practice, that is <30% in two years of survey.

Conclusion: Overall prevalence of antimicrobial use did not change from 2017 to 2018, however was evident in specific areas. Antimicrobial use varied depending on hospital area, patient profile, and indication. Interventions should focus on (1) improving physician awareness of guidelines, (2) education on appropriate surgical prophylaxis, (3) antibiotic deescalation, and (4) proper documentation.

Disclosure of Interest: None declared

P96 HEALTHCARE ASSOCIATED INFECTIONS (HAI) AND ANTIBIOTIC USE SURVEY AT FOUR REGIONAL HOSPITALS IN SIERRA LEONE

A. Maruta1, H. Benya2, N. S. Kamara3

1IPC, World health organisation, 2IPC, CDC, 3IPC, Ministry of Health and Sanitation, Freetown, Sierra Leone
Correspondence: A. Maruta

Introduction: Healthcare-associated infections (HAI) are a safety concern globally for both patients and healthcare providers. Healthcare-associated infections are a major threat for patient safety and the impact on health and well-being are longer duration of illness, longer treatment, higher mortality, treatment with expensive medicines, increased burden on the health system and huge economic impact. Surveillance of HAIs is an important infection control activity and also an indicator of quality patient outcomes. Knowledge of the prevalence of antibiotic resistance is a pre-requisite for infection prevention and control and is essential for healthcare policy makers to conduct effective responses.

Objectives: The main aim was to gather baseline data and information required for the development of an HAI and AMR strategy in Sierra Leone and to determine the prevalence of healthcare-associated infections

Methods: The point prevalence survey was conducted at four regional hospitals in Sierra Leone. A questionnaire-based survey was designed to collect information on the prevalence of HAI, antibiotic prescribing patterns and capacity of the health facility to promote an antibiotic stewardship program. The multi-disciplinary surveillance team included doctors, nurses, pharmacists and laboratory personnel. A questionnaire-based survey was designed to collect information on the prevalence of HAI, antibiotic prescribing patterns and capacity of the health facility to promote an antibiotic stewardship program.

Results: Data from 327 patients were collected out of 441 inpatients. About 114 patients were not included in the survey as they did not meet the inclusion criteria. The most common type of antibiotic prescribed was Ceftriaxone (54%) followed by Metronidazole (49%). Overall the prevalence of antibiotic use was 73.7% (95% CI: 69.3-77.7). Highest antibiotic use was in neonatal unit followed by ICU and paediatric wards across all hospitals

Conclusion: The survey has demonstrated that a point-prevalence survey methodology can be applied successfully to surveillance of HAI and antibiotic use across hospitals in Sierra Leone and the results can identify targets for patient safety and quality improvement.

Disclosure of Interest: None declared

P97 EVALUATION OF ANTIBIOTIC PRESCRIPTION IN A GENERAL HOSPITAL OF DR CONGO: SPECIFIC CASE OF NYANKUNDE HOSPITAL

E. K. Kabululu1, K. Mutendela2, S. Linda3, M. Jeanne4, G. Ray-Barruel5

1Infection control, CME Nyankunde, Beni, Congo, The Democratic Republic of the; 2Medecine interne, Hopitaux de lannemezan, lannemezan, France; 3communication, UCB, Bukavu; 4Gynecology, CME nyankunde, Beni, Congo, The Democratic Republic of the; 5Research, Griffith University, Bisbane, Australia
Correspondence: E. K. Kabululu

Introduction: Antibiotic overuse or misuse is one of the main antimicrobial drug prescription problems in low income countries, which leads to substantial modification of the bacterial ecology in health care facilities. In African hospitals, the list of essential antibiotics available is very restricted and contains less than ten antibiotics. However, resistance to older antibiotics is increasing and the development of new molecules has stalled.

Objectives: To monitor the using of antimicrobial in the D R C facility

Methods: We conducted a cross-sectional study to determine the prevalence of patients who received one or more antibiotics during their hospitalization. Data were collected on two different days in a 2-week period at Nyankunde Hospital, Beni city, in the province of North Kivu, DR Congo.

Results: In this study, the overall antibiotherapy rate was 43.2% (59/137 inpatients). Patients with antimicrobial therapy were aged between 4 months and 84 years; gender included 29 women and 30 men. Patients receiving antimicrobial therapy were admitted to different wards, as follows: Surgery (5%), Obstetrics (9%), Pediatrics (18%), Internal Medicine (30%), VIP ward (18%), Emergencies (11%) and Intensive care (6%). The common first diagnosis was sepsis syndrome (59%), and 47% of inpatients had also a second associated diagnosis. No bacterial culture tests were performed on any patient. However, 19% of patients had positive Widal Felix serodiagnosis testing and 15% had positive malaria rapid diagnostic tests (RDT). For those receiving single antibiotics (n=27), patients received mainly ceftriaxone (n=22, 37%) or ampicillin (n=20, 34%). Those receiving two antibiotics (n=32) usually had gentamicin (n=21, 35%) added, and for those who received three antibiotics (n=6) metronidazole (n=5, 8%) was the most common addition.

Conclusion: At this DR Congo hospital, 43.2% of inpatients had antibiotic therapy. The main reason was sepsis (proven or suspected), either as first or second syndrome. Microbial cultures are not feasible, and only RDTs of malaria and Salmonella infectious diseases are available. In these conditions, it is not possible to monitor antimicrobial resistance

Disclosure of Interest: None declared

P98 EVALUATION OF INJECTABLE ANTIBIOTICS RECONSTITUTION AND ADMINISTRATION IN THE PEDIATRIC SERVICE OF GABRIEL TOURÉ UNIVERSITY HOSPITAL

L. Bengaly1, A. T. Traoré2, A. Fané1

1Pharmacie, Hôpital Universitaire Gabriel Touré; 2Pharmacie, Hôpital du Mali, Bamako, Mali
Correspondence: L. Bengaly

Introduction: Bacterial resistance to antibiotics is a public health problem that spares no health system in the world. Antibiotics misuse in health facilities is one of the main factors behind the emergence of this antimicrobial resistance. Good reconstitution practices contribute to the proper use of injectable antibiotics in hospitals.

Objectives: The aim was to evaluate antibiotic dilution and administration techniques in the pediatric service and specifically to identify dilution solvents, their volumes and modes of administration.

Methods: The study was prospective and focused on children hospitalized in the pediatric service between March and September, 2016. Data were collected by direct observations of care practices associated with additional informations by interviewing care staff.

Results: A total of 2737 replenishment and administration sessions were collected. Distilled water was the most used solvent (87.9%) followed by sodium chloride 0.9% injectable solution (with 6.60%), glucose 5% injectable solution (2.10%), glucose 10%solution (with 1.7%) and sodium lactate, compound injectable solution (1.5%). Solvent volumes between 2.5ml and 10ml were the most used for reconstitution and were used for direct intravenous administration. The prescribed dilution volumes and dosages were respected in 77.34% of cases. Ceftriaxone was the most reconstituted antibiotic (65.07%) followed by amoxicillin (12.46%). Combinations of antibiotics or with other products in the same syringe have been reported (495 cases or 18.08%): ceftriaxone + gentamicin (96.16%) Ceftriaxone + Gentamicin + dexametaxone (2.22%) Cefotaxime + Gentamicin + Methylprednisolone (0.81%). Combinations of drugs in the same administration syringe were contrary to medical prescription guidelines. A single vial of solution (sodium chloride 0.9%, glucose 5% or glucose 10%) was used to reconstitute the several antibiotics for different children and was used by all teams with risks of contamination.

Conclusion: The shortcomings identified made it possible to formulate recommendations for better patient care, which will enhance the care quality.

Disclosure of Interest: None declared

P99 PREVALENCE OF ANTIBIOTIC USE AND ADMINISTRATION AMONG HOSPITALIZED ADULT PATIENTS AT A TERTIARY CARE HOSPITAL IN KILIMANJARO TANZANIA

F. J. Muro1,2,3, F. Lyamuya2,3,4, R. Mallya3,5, B. Mmbaga2,3,6,7, G. Tillekeratne 6

1Community Health, Kilimanjaro Christian Medical Centre; 2Faculty of Medicine, Kilimanjaro Christian Medical University College; 3Research, Kilimanjaro Clinical Research Institute; 4Faculty of Medicine; 5Maternal and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of; 6Global Health, Duke Global Health Institute, Durham, United States; 7Paediatric, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
Correspondence: F. J. Muro

Introduction: Antimicrobial stewardship programs (ASPs) have been shown to improve the appropriate use of antimicrobials, especially in high-income countries. However, ASPs are relatively less well implemented in low-or-middle income countries. To improve the effectiveness of ASPs in these settings, it is important to determine the core actions and targets for improving antimicrobial use.

Objectives: To describe the prevalence and patterns of antibiotic use at a tertiary care hospital in Tanzania.

Methods: Consecutive patients admitted to an adult medical ward at a tertiary care hospital, Kilimanjaro Christian Medical Centre in Moshi, Tanzania were enrolled from June 2018 to March 2019. The medical record was reviewed for data regarding antibiotics prescribed, indications for use, and microbiologic testing ordered.

Results: Of 1103 patient’s enrolled majority were males (663, 60.1%), with the median age being 54 years (IQR 39-70). About one-third (390, 35.4%) of the patients received antimicrobials during hospitalization, with pneumonia being the leading indication for antimicrobial use (158, 40.5%). Most commonly used antibiotics included ceftriaxone 285 (73.1%), metronidazole 155 (39.7%), and amoxicillin/ampicillin 46 (11.8%) patients. Median duration of antimicrobial use was 5 days (IQR 3-7). Few patients on antimicrobials (27, 6.9%) had culture results, of which half (15, 55.6%) were positive for an organism and a minority (8, 29.6%) were susceptible to the antibiotics being used. Overall mortality in the cohort was 22.7% and median duration of hospitalization was 5 days (IQR 3-8).

Conclusion: Antibiotics were used in a substantial proportion of admitted patients. However, in most cases, treatment was empirical with limited use of culture results. Future ASP efforts can target the improved use of microbiologic cultures to target antimicrobial use.

Disclosure of Interest: None declared

P100 THE GLOBAL POINT PREVALENCE SURVEY OF ANTIMICROBIAL CONSUMPTION AND RESISTANCE (GLOBAL-PPS) IN TOGO

M. Salou1, F. Nounhou1, A. Versporten2, I. Pauwels2, K. D. Ekouevi3, H. Goossens2, A. Y. Dagnra1

1Laboratory of Medical Microbiology, University of Lomé, Lomé, Togo; 2Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium; 3Public health department, University of Lomé, Lomé, Togo
Correspondence: A. Versporten

Introduction: The Global-PPS is a standardized tool to assess antimicrobial use (AMU) and resistance and helps to establish antibiotic stewardship programs.

Objectives: We aim to report results of the survey in 9 hospitals in Togo.

Methods: The standardized Global-PPS method was used to assess variation in antimicrobial prescribing in 9 hospitals in December 2018. The survey included all inpatients receiving an antimicrobial on the day of the PPS. Data included details on antimicrobial agents, reasons and indications for treatment and a set of quality indicators. bioMérieux provided unrestricted funding support for the survey.

Results: Of the 9 hospitals, 2 were tertiary care hospitals. The survey included 713 patients of which 89.8% were treated with at least one antimicrobial. Top 3 indications for AMU were malaria (32.2%), other undefined (17%) and gastro-intestinal infections (6.3%). Out of 1062 antimicrobials, 16.9% were antimalarials and 74.7% antibacterials for systemic use of which ceftriaxone (27.2%), amoxicillin (17.8%) and metronidazole (11.7%) were most frequent prescribed. Therapeutic prescribing (n=716) accounted for 67.4% of which 95.8% for a community and 4.2% for a hospital acquired infection. Antimicrobials used for medical or surgical prophylaxis (SP) accounted for 13.8% and 17.4%. Ceftriaxone, ciprofloxacin and amoxicillin were most often prescribed for SP (30.2%, 19.2%, 17.4% respectively). Prolonged SP (≥1 day) in adults and children was common (69%). The reason for antimicrobial prescription was documented in 83.3% of cases while a stop/review date was only documented in 25.0% of cases. Guideline compliance reached 98.1%. No patients were reported to have received a microbiology−based treatment.

Conclusion: This survey was the first conducted in the country. It is important setting-up a tailored antimicrobial stewardship program in each hospital. The challenge remains reinforcement of infection prevention and the medical bacteriology lab capacity by offering antimicrobial susceptibility testing to monitor prescription.

Disclosure of Interest: None declared

P101 THE GLOBAL POINT PREVALENCE SURVEY OF ANTIMICROBIAL CONSUMPTION AND RESISTANCE (GLOBAL-PPS) IN BURKINA FASO

A.-S. Ouedraogo1, A. Versporten2, A. Nagalo3, I. Pauwels2, H. Goossens2, A. Ouedraogo3, A. Poda4

1Department of Medical Bacteriology and Virology Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso, Bobo Dioulasso, Burkina Faso; 2Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium; 3Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso; 41Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso , Bobo Dioulasso, Burkina Faso
Correspondence: A.-S. Ouedraogo

Introduction: Burkina Faso experiences difficulties in the management of increased antimicrobial resistance.

Objectives: We aimed to assess for the first time, antimicrobial use in hospitals in Burkina Faso.

Methods: The standardized Global-PPS method assessed antimicrobial prescribing in 7 hospitals in Burkina Faso in February-March 2019. The survey included all inpatients receiving an antimicrobial on the day of the PPS. Data included details on the antimicrobial agents, reasons and indications as well as a set of quality indicators. bioMérieux provided unrestricted funding support for the survey.

Results: The survey included 1190 inpatients. Overall antimicrobial (AM) prescription rate was 71.8% with highest rates found in newborn wards (89.2%). Prophylaxis in neonates (12.4%) and digestive tract infections (11.9%) were the most common indications. Out of 1080 AMs, systemic antibacterials (78.9% of which 26.8% ceftriaxone), antiparasitics (13.4% of which 9.5% artesunate), and antimycobacterials (3.2%) were the most prescribed antimicrobial classes. Community acquired infections were common (85.2%). Healthcare-associated infections accounted for less than 5% of antimicrobials and included mainly surgical site infections (55.6%) and infections on invasive materials (27.8%). Surgical prophylaxis (n=62 antibiotics; 5.7%) lasted mostly for more than 2 days (87.1%). The reason for the antimicrobial prescription was documented in 82% of cases, but this corresponded only half to national or international guidelines (52.9%). A stop/review date was rarely reported (6.2%). Most antimicrobials were prescribed empirically (99%). Antimicrobial therapy was oriented towards ESBL (3 cases/7), MRSA (2cases/7) and non-fermenter gram negative bacilli producer of ESBL (1case/7) only.

Conclusion: Antimicrobial prevalence in hospitals in Burkina Faso is high. Continued education of caregivers on rational antimicrobial use and improved access to microbiological investigations is needed. We will expand the study to all health regions to provide a picture of the national situation and needs.

Disclosure of Interest: None declared

P102 THE GLOBAL POINT PREVALENCE SURVEY OF ANTIMICROBIAL CONSUMPTION AND RESISTANCE: 2018-2019 RESULTS FOR HOSPITAL-ACQUIRED PNEUMONIA IN 8 MEXICAN HOSPITALS

E. Gonzalez-Diaz1, A. Versporten2, S. Loza3, J. Corona4, I. Pauwels2, J. Araujo5, D. Basurto6, N. Hernández7, M. Almaraz8, J. Molina9, D. Torres10, H. Goossens2

1Unidad de Vigilancia Epidemiologica Hospitalaria & Medicina Preventiva, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico; 2Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium; 3Hospital de Especialidades CMN Siglo XXI , IMSS, Mexico City; 4Hospital Angeles del Carmen, Guadalajara; 5Hospital Central Dr. Morones Prieto, San Luis Potosí; 6Hospital General Regional 200 IMSS, Estado de Mexico; 7bioMerieux, Guadalajara; 8HGR 1 IMSS Dr. Carlos McGregor Sánchez, HGR 1 IMSS Dr. Carlos McGregor Sánchez, Ciudad de Mexico; 9Hospital Cardiología IMSS, Monterrey; 10HR de Alta Especialidad de la Península de Yucatán, Mérida, Mexico
Correspondence: I. Pauwels

Introduction: Despite advances in HAP and VAP, they continue to account for 22% of all HAIs. In an effort to minimize patient harm and unnecessary antibiotics and reduce antibiotic resistance development a recommendation is generate local antibiograms to guide healthcare professionals to the optimal choice of antibiotics and antimicrobial stewardships programs be implemented.

Objectives: The Global-PPS (www.global-pps.com) [G-PPS] aims to assess variation of antimicrobial prescribing worldwide. We describe antibiotic treatment for Hospital-Acquired Pneumonia (HAP) in Mexico.

Methods: A standardized surveillance of antimicrobial use assessed HAP prevalence and variation in antimicrobial therapy in 8 Mexican hospitals. The G-PPS was conducted from May 2018 and April 2019, in 6 tertiary and 2 secondary care hospitals. Data collected included antimicrobials, indications for treatment and quality indicators.

Results: The G-PPS included 2,181 patients on antimicrobials, 1,930 on adult, 193 on pediatric and 58 on neonatal wards.Of all treated adults, 315 patients (16.3%) were diagnosed with pneumonia, 57.5% (n=181) had HAP.For adult HAP patients, 36.5%of prescriptions were targeted, of which 49.1% against at least one multidrug resistant organism (MDRO). Of all targeted prescriptions, 37% were targeting ESBL Gram-negatives and 18.5% targeted other MDROs. In the adult ward,reason for prescription was documented in 95.6% of cases and 83%complied with local guidelines. Biomarkers were used to progress treatment in 41.4% of cases. Overall, the most commonly prescribed antibiotics were meropenem (23%), linezolid (8.8%) and vancomycin (7.4%).

Conclusion: These finding show the need to implement antimicrobial stewardship in all hospitals to improve antibiotic prescribing by reducing carbapenem use, enhancing compliance to guidelines and performing post-prescription review.

Disclosure of Interest: None declared

P103 ANTIBIOTIC USE TRENDS IN A PEDIATRIC HEART SURGERY HOSPITAL IN GUATEMALA

H. G. Maldonado1, J. Guerra1, G. Calvimontes2, R. Mack3, J. Barnoya4

1Control y Prevención de Infecciones Intrahospitalarias; 2Departamento de Cirugía Cardiovascular Pediátrica y Cardiología Pediátrica “Dr. Aldo Castañeda”; 3Unidad de Terapia Intensiva Cardiovascular; 4Departamento de Investigación, Unidad de Cirugía Cardiovascular de Guatemala, Guatemala, Guatemala
Correspondence: H. G. Maldonado

Introduction: Hospitalized children often receive inappropriate antibiotics. However, scant data are available on antibiotic use in congenital heart surgery (CHS), particularly from low-middle income countries (LMICs).

Objectives: We assessed antibiotic use trends in patients undergoing CHS in Guatemala, a LMIC.

Methods: From Jan 2015 to Mar 2019 we measured days of therapy (DOT), length of treatment (LOT), and antibiotic-free days (AFD). All rates were adjusted to 1000 patient-days. Trends for DOT rate per antibiotic family type and quarterly series were analyzed using Pearson correlation. Analyses were done in STATA.

Results: 1335 children underwent to CHS, using a total of 11351 days of antibiotic therapy in 14172 patient-days. Mean rates were 801 DOT, 477 LOT, and 523 AFD per 1000 patient-days. DOT (r = -0.25, p= 0.32), and LOT (r = -0.49, p= 0.04) rates showed a downward trend. The observed mean DOT rates by antibiotic family per 1000 patient-days were: 167 for anti-pseudomonal penicillins, 148 carbapenems, 136 vancomycin, 85 amynoglucosides, 84 cephalosporins, 44 fluoroquinolones, and 32 fosfomycin. A downward trend was observed for piperacillin-tazobactam (r = -0.50, p = 0.03), aminoglycosides (r = -0.48, p = 0.049) and fluoroquinolones (r = -0.41, p = 0.04). An upward trend was observed for cephalosporins (r = 0.54, p = 0.02), and fosfomycin (r = 0.6, p = 0.01). Carbapenems (r = -0.12, p = 0.63), and vancomycin (r = 0.07, p = 0.78) maintained a stationary trend.

Conclusion: Our findings suggest that DOT rates are similar in Guatemala to those reported in high-income countries, however carbapenems and vancomycin had greater DOT rates. Interventions are needed in order to decrease inappropriate antibiotic prescription in this resource-limited setting.

Disclosure of Interest: None declared

P104 QUANTITY AND QUALITY OF ANTIBIOTIC PRESCRIBING FOR SEPSIS IN HOSPITALISED ADULTS: RESULTS OF THE 2015, 2017 AND 2018 GLOBAL POINT PREVALENCE SURVEY OF ANTIMICROBIAL CONSUMPTION AND RESISTANCE (GLOBAL-PPS)

I. Pauwels1, A. Versporten1, S. Le Page2, H. Goossens1, on behalf of the Global-PPS network

1Laboratory of Medical Microbiology, University of Antwerp, Wilrijk, Belgium; 2bioMérieux, Marcy l’Etoile, France
Correspondence: I. Pauwels

Introduction: Sepsis is a severe condition, requiring rapid initiation of antimicrobial therapy.

Objectives: We aimed to describe the quantity and quality of hospital antibiotic prescribing in adult sepsis patients in five continental regions.

Methods: The Global-PPS assessed hospital antimicrobial prescribing patterns using a standardised method. A total of 662 hospitals in 67 countries participated in a PPS of antimicrobial use at least once in 2015, 2017 or 2018. We descriptively analysed data on adult patients receiving a systemic antibiotic (ATC J01) on the day of the survey. bioMérieux provided unrestricted funding support for the survey.

Results: Of 73,080 adults on systemic antibiotics, 2.6% were being treated for sepsis, 51.7% of which were on antibiotics for a healthcare-associated (HA) sepsis, ranging from 38.5% in Africa to 77% in South America. Overall, 21.7% of HA sepsis cases were related to the use of invasive devices. Microbiological results were used to inform treatment in 26.7% of prescriptions. Of all patients, 69.3% were on single-agent therapy, ranging from 48.7% in South America to 80.4% in Europe. A penicillin/β-lactamase-inhibitor was the most common regimen (25.7%), followed by a carbapenem (12.1%) and a 3rd generation cephalosporin (10.1%). Overall, 12.1% of sepsis patients were being treated with one or more Reserve antibiotic, ranging from 7.7% in Africa to 25.6% in South America. Stop/review date and reason for treatment were documented in 35.9% and 80.7% of prescriptions respectively. Guideline compliance was reported to be up to 79.8%, yet guidelines were missing in 22.9% of prescriptions.

Conclusion: These data illustrate challenges related to antibiotic prescribing for sepsis patients, such as the use of broad-spectrum agents, low documentation of stop/review date, sub-optimal use of microbiology to inform treatment and a high proportion of Reserve prescribing. The use of Reserve antibiotics was particularly high in South America, with 1 in 4 sepsis patients exposed to these last-resort drugs. PPS results can support local stewardship teams in designing contextualised interventions, even for critical conditions such as sepsis.

Disclosure of Interest: None declared

P105 POINT PREVALENCE SURVEY OF ANTIMICROBIAL USE AND RESISTANCE IN THE INTENSIVE CARE UNITS OF GEORGIA

M. Tsereteli1,2, G. Chakhunashvili2, O. Tsagareishvili2, D. Tsereteli2

1High Technology Medical Center, University Clinic; 2Communicable Disease, National Center for Disease Control and Public Health, Tbilisi, Georgia
Correspondence: M. Tsereteli

Introduction: Antimicrobial resistance (AMR) is predominantly due to inappropriate use of antibiotics, so it is mandatory for healthcare facilities to monitor antimicrobial consumption.

Objectives: Assessment of antibiotic use and AMR in intensive care units (ICUs) of Georgian hospitals through point-prevalence survey.

Methods: Point Prevalence Survey (PPS) of Antimicrobial Consumption and Resistance was conducted according to the Global-PPS protocol in ICUs of 10 multi-profile hospitals of three biggest cities of Georgia (Tbilisi, Kutaisi, and Batumi). PPS was performed in June, 2018.

Results: On the day of the survey, total number of beds at the ICUs was 176, with 119 patients (bed occupancy percentage of 67.6%).

Antibiotics were administered to 74 patients (62.2%). 46 (62.2%) patients received empirical antibiotic therapy. Among them, 16 (34.8%) had administered two or more antibiotics. Empirically, the following antibiotics were used most frequently: Ceftriaxone – 17 (37.0%), Vancomycin – 8 (17.4%) and Carbapenems 6 (13.0%).

Only 28 (37.8%) patients have received etiotropic antibiotics therapy, moreover, 15 (53.8%) patients have received it with two or more antibiotics.

Healthcare-associated infections were seen in 34 patients (28.6% of ICU patients), including: ventilator-associated pneumonia - 22 cases (64.7% of all nosocomial infections), surgical site infection - 7 cases (20.6%), catheter-associated bloodstream infection – 2 cases (5.9%), catheter-associated urinary tract infection – 2 cases (5.9%), C. difficile-associated infection - 1 case (2.9%).

Among enrolled patients, following multi-resistant strains were isolated and identified from clinical samples: 5 ESBL-producing non-fermenting gram negative bacilli, 4 ESBL-producing Enterobacteriaceae, 3 carbapenem-resistant Enterobacteriaceae, 3 carbapenem-resistant non-fermenting gram negative bacilli, 1 methicillin-resistant Staphylococcus aureus.

Conclusion: PPS revealed the necessity of interventions in several directions in order to improve quality of antibiotic prescriptions. In the future PPS can be used as a forceful tool to monitor appropriate use of antibiotics.

Disclosure of Interest: None declared

P106 THE GLOBAL POINT PREVALENCE SURVEY OF ANTIMICROBIAL CONSUMPTION AND RESISTANCE (GLOBAL-PPS): 2015, 2017 AND 2018 RESULTS OF ANTIBIOTIC PRESCRIBING FOR PNEUMONIA IN GEORGIA

I. Korinteli, I. Pauwels2, A. Versporten2, H. Goossens2, H. Phagava1, K. Pagava1

1Tbilisi state medical university, Tbilisi, Georgia; 2University of Antwerp, Antwerp, Belgium
Correspondence: I. Korinteli

Introduction: Pneumonia is a frequent reason for antibiotic use and a common cause for hospitalisation, both in children and adults.

Objectives: We aimed to assess antibiotic prescribing patterns for pneumonia in Georgian hospitals to identify potential targets for antimicrobial stewardship.

Methods: The Global-PPS was conducted in 18 Georgian hospitals in 2015, 2017 and 2018. The survey included all inpatients receiving an antimicrobial on the day of PPS. Data included details on antimicrobial agents, reasons and indications for treatment and a set of quality indicators.

Results: In total 79 wards with 895 inpatients were surveyed of which 77.8% were admitted to hospitals in Tbilisi. Of all patients on antibiotics, 29.8% were treated for pneumonia, with the highest rates on paediatric intensive care units (18.9%) and paediatric medical wards (45.3%). Up to 98.6% of pneumonia, cases were community-acquired infections (CAI). Regarding the antimicrobial quality indicators, documentation of the reason of prescription was 100%, yet the stop/review date was missing in 93.1% of cases. Overall compliance to antibiotic guidelines was 91.9% and treatment was mostly empiric (87.0%). Of targeted prescriptions, 75.0% was for treatment of MRSA. CRP was used in the decision to treat in 98.1% of patients. CRP levels in blood were 123 mg/L on average. For adults, commonly prescribed antibacterial drugs for systemic use (ATC J01) were ceftriaxone (26.4%), followed by cefepime (10.7%) and meropenem (9.1%). In paediatric and neonatal units, the top 3 consisted of ceftriaxone (31.0%) ampicillin/enzyme inhibitor (25.4%) and meropenem (14.3%).

Conclusion: The high proportion of CAI pneumonia, empirical prescribing and the use of broad-spectrum antibiotics are worrisome findings. In addition, documentation of the stop/review date is remarkably low, yet high use of CRP in the decision to treat indicates an attempt to rationalise antibiotic use. For optimisation it is essential to plan specific stewardship interventions such as introduction of a cut off policy after 72 hours, increase of targeted treatment and availability of updated guidelines.

Disclosure of Interest: None declared

P107 ASSESSING THE LEARNING NEEDS AND BARRIERS FOR IMPLEMENTATION OF ANTIMICROBIAL STEWARDSHIP IN HOSPITALS THAT HAVE PARTICIPATED IN THE GLOBAL POINT PREVALENCE SURVEY ON ANTIMICROBIAL CONSUMPTION AND RESISTANCE (GLOBAL-PPS)

I. Pauwels1, A. Versporten1, E. Vlieghe2, H. Goossens1

1Laboratory of Medical Microbiology, University of Antwerp, Wilrijk; 2Department of General Internal Medicine, Infectious Diseases and Tropical Medicine, University Hospital Antwerp, Edegem, Belgium
Correspondence: I. Pauwels

Introduction: Point prevalence surveys (PPS) have proven to be instrumental in informing antimicrobial stewardship (AMS) activities, yet translating PPS findings into contextualised interventions can be challenging.

Objectives: We aim to evaluate the impact of the Global-PPS on local AMS programmes and assess health care professionals’ educational needs and barriers for implementing AMS.

Methods: An internet-based survey containing 24 questions was disseminated within the Global-PPS network, including contacts from participating and non-participating hospitals. Responses were collected from February up to May 2019 and were descriptively analysed.

Results: A total of 250 respondents from 73 different countries completed the survey, 198 of which were Global-PPS participants. Up to 70% (n=176) of responses were from low-and middle-income (LMIC) countries. When asked which AMS components were present in their hospital, 69.2% (HIC 89.2%; LMIC 60.8%) replied they had local prescribing guidelines and 50% (HIC 70.3%; LMIC 41.5%) reported the presence of an AMS committee. Of the Global-PPS participants who reported AMS activities (n=187), 69% stated that one or more of those activities was initiated as a result of PPS findings. Prolonged surgical antibiotic prophylaxis was the most common (63.6%; n=126) target for improvement, identified from Global-PPS findings. Out of 18 possible barriers, a lack of time was most commonly (33.8%) reported as the number one barrier for implementation of AMS in HIC, as compared to a lack of cooperation from prescribers (13.1%), time (12.5%) and qualified personnel (12.5%) in LMIC. Overall learning needs were: skills to optimise therapeutic (62%) and prophylactic antibiotic use (54.8%), followed by the design of PPS-based interventions (52.7%) in HIC and the management of multidrug-resistant infections (44.3%) in LMIC.

Conclusion: These results will inform the development of a dedicated e-learning course, targeting Global-PPS participants worldwide and focused at the translation of PPS-findings into locally tailored AMS interventions, thus contributing to a sustained response to AMR in hospitals worldwide.

Disclosure of Interest: None declared

P108 SURVEILLANCE OF ANTIMICROBIAL STEWARDSHIP PROGRAM AND ANTIMICROBIAL CONSUMPTION: PILOT SURVEILLANCE OF JAPAN SURVEILLANCE FOR INFECTION PREVENTION AND HEALTHCARE EPIDEMIOLOGY (J-SIPHE)

M. Endo1, K. Hayakawa1,2, T. Tajima1, K. Suzuki1, T. Suzuki1,2, S. Tsuzuki1, N. Matsunaga1, N. Ohmagari,1,2

1AMR Clinical Reference Center; 2Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
Correspondence: M. Endo

Introduction: We constructed J-SIPHE system to facilitate AMR measures in Japan. Along with other AMR related parameters, J-SIPHE collects data on antimicrobial stewardship program (ASP) as well as antimicrobial use (AMU) at healthcare facilities.

Objectives: We evaluated the data of ASP and AMU during the J-SIPHE pilot surveillance period.

Methods: From April to November 2018, 28 facilities provided data on ASP and AMU. AMU data (such as Antimicrobial Use Density [AUD] and Days of Therapy [DOT]) can be registered semi-automatically using the medical fee statement (receipt) file at each facility. Both AMU and ASP data (such as available antibiotics and ASP practice) were registered by the online surveillance system. ASP data were required for targeted antibiotics classes (anti-P. aeruginosa [anti-PA] penicillins/cephalosporins, carbapenems, anti-MRSA agents, fluoroquinolones, colistin, tigecycline, antifungal agents).

Results: The median number of beds at participating facilities were 396 (IQR: 309–496) and the median average hospital stay was 12.3 days (IQR: 9.9–14.6). Carbapenems and linezolid were the most commonly targeted antibiotics by ASP (carbapenems: 15 [53.6%] required notification [RN], 13 [46.4%] RN and prospective audit and feedback [PAF]; linezolid: 13 [46.4%] RN, 11 [39.3%] RN and PAF, 4 [14.3%] pre-authorization), followed by other anti-MRSA agents. Among ASP targeted antibiotics, anti-PA penicillin was the most prescribed (median AUD: 2.4 [IQR: 1.7–2.7], median DOT: 3.1 [IQR: 2.4–3.7]), followed by carbapenems (median AUD: 2.2 [IQR: 1.7–2.9], median DOT: 2.3 [IQR: 1.9–3.9]). For anti-MRSA agents, glycopeptides (median AUD: 0.7 [IQR: 0.4–1.2], median DOT: 1.0 [0.6–1.7]) were mainly used.

Conclusion: Our system combined ASP practice with semi-automated AMU surveillance enabling comparison among facilities and monitoring trends of ASP targeted antibiotics. Widespread use of J-SIPHE could provide useful information on the current status of ASP/AMU and on high priority targets of ASP in Japan.

Disclosure of Interest: None declared

P109 INFLUENCE OF ANTIMICROBIAL STEWARDSHIP IN THE ADEQUACY OF ANTIMICROBIAL PRESCRIPTION - A CROSS-SECTIONAL SURVEY

A. Silva-Pinto, R. Duro, N. Rocha-Pereira, P. Andrade, J. Mourato-Torres, C. Lima-Alves

Infection Control and Antimicrobial Stewardship Unit, CENTRO HOSPITALAR UNIVERSITÁRIO SÃO JOÃO, Porto, Portugal
Correspondence: A. Silva-Pinto

Introduction: Antimicrobial stewardship is a multimodal strategy to optimize adequacy of antimicrobial prescription, crucial in the approach to decrease antimicrobial resistance.

Objectives: To assess the adequacy of antimicrobial prescription in a university hospital and to compare the adequacy in departments with or without antimicrobial stewardship interventions.

Methods: We performed a cross-sectional study based on the point prevalence survey rules from WHO. One third of the patients in each department were randomly selected. After selection, we classified the adequacy of each antimicrobial prescribed (considering necessity of treatment, spectrum, dose, administration route and duration of therapy), according to local recommendations and, in its absence, national/international guidelines. We compared antimicrobial prescription adequacy in departments with specific ongoing antimicrobial stewardship interventions (Cardiothoracic Surgery, Haematology, Orthopaedics, Plastic Surgery, Urology, Vascular Surgery) and those without such interventions.

Results: On the day of the study, 898 patients were hospitalized. We randomly included 316 (35%). Of those, 119 had at least one antimicrobial prescription (37,7%), corresponding to 172 antimicrobials (33 (19,2%) were prescribed as prophylaxis and 139 (80,8%) as treatment). Table 1 depicts some variables of interest. We considered antimicrobial prescription as adequate in 107 patients (62,2%). Comparing departments with and without antimicrobial stewardship interventions, we noticed a statistically significant difference: 76,6% vs. 56,8% (p=0,021; Chi Squared test).

Conclusion: Antimicrobial stewardship is a multimodal strategy with a positive impact in the adequacy of antimicrobial prescriptions.

Disclosure of Interest: None declared

P110 SECONDARY ANALYSIS OF THE HALT STUDY DATA IRELAND

A. Vellinga1, K. Burns2, H. Murphy2, M. Tandan1

1National University of Ireland, Galway, Galway; 2Health Protection and Surveillance Centre, Dublin, Ireland
Correspondence: A. Vellinga

Introduction: Ireland participated in repeated point prevalence surveys (PPS) of healthcare-associated infections (HAI) and antimicrobial use (AMU) in long-term care facilities (LTCF) in 2012 and 2016, known as the HALT surveys.

Objectives: To explore risk factors of AMU and HAI in Irish LTCF.

Methods: Data for the HALT study are collected at institutional level, which provides aggregated prevalence and makes in-depth analysis difficult due to low numbers. To increase the power of the study, all LTCF participating in HALT 2016 were contacted to ask for additional data on all current residents; age, sex, urinary catheter use and presence of disorientation. The individual data was matched to the existing 2016 HALT database and multilevel analyses were performed.

Results: The prevalence of AMU and HAI in Irish LTCF in 2016 was 9.8% and 4.4% respectively

Prophylactic AMU (40%) was identified as a particular concern in the LTCF setting, more often recorded for females, residents living in LTCFs for more than one year, residents with an intellectual disability, and residents with a urinary catheter.

Additional data was obtained from 80 LTCF (out of 224) and 3,816 residents. Analyses showed that decreased AMU was associated with the number of health care assistants, presence of a coordinating physician in the LTFC, an antimicrobial stewardship committee, feedback on antimicrobial consumption, and medical care by residents’ personal GP. Less HAI was associated with feedback on surveillance of infection prevention & control practices in LTCF.

Almost half of the antimicrobials prescribed were second-line choices, with substantial inter-facility variation. In LTCF that provided education on antimicrobial prescribing, significantly less second-line antimicrobials were prescribed.

Conclusion: With limited additional data, important risk factors of AMU and HAI could be identified which help to target AMU stewardship and infection prevention and control programs in LTCF.

Disclosure of Interest: None declared

P111 ANTIMICROBIAL PRESCRIBING PATTERN IN HEALTHCARE-ASSOCIATED INFECTIONS IN 26 BRAZILIAN HOSPITALS: 2017 AND 2018 POINT PREVALENCE SURVEYS

A. P. Matos Porto1, on behalf of Brazilian Global PPS group, I. Pauwels2, A. Versporten3, H. Goossens3, S. F. Costa1, on behalf of Brazilian Global PPS group: Thais Guimarães (Instituto Central-HC-FMUSP and Hospital do Servidor Publico Estadual de São Paulo, São Paulo, Brazil), Evelyne Girão (Hospital Universitário Walter Cantídio UFC, Hospital Regional Unimed Fortaleza and Hospital

1Faculty of Medicine, University of São Paulo, São Paulo, Brazil; 2Faculty of Medicine and Health Science, University of Antwerp; 3Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
Correspondence: I. Pauwels

Introduction: Healthcare-associated infections (HAI) are a common indication for the prescription of antimicrobials (ATM) and the inappropriate use of ATM is a key driver of ATM resistance.

Objectives: The aim of this study was to evaluate the ATM prescribing pattern in HAI in 26 Brazilian hospitals using the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global PPS) 2017 and 2018 data (www.global-pps.com).

Methods: 18 Brazilian hospitals conducted the PPS in 2017 and 17 in 2018 (9 hospitals participated in both years). The study included inpatients on antimicrobials on the day of the PPS. Data collection included details on the ATM prescriptions and a set of quality indicators. A web-based program was used for data-entry, validation and reporting. The Global PPS was developed by the University of Antwerp and bioMérieux provided funding support.

Results: 1801 patients were evaluated in 2017 and 2433 in 2018, of which 941 (52.2%) and 1168 (48%) were on ATM. HAI was the indication for ATM in 328 (34.8%) and 377 (32.3%) patients in 2017 and 2018, respectively. Surgical site infection and device related infection together accounted for 50.6% of the prescriptions in 2017 and 44.6% in 2018. Pneumonia (2017-24.3%; 2018-25.1%) was by far the most common specific diagnosis in the surveys. Both in 2017 and 2018, the most frequent ATM prescribed were meropenem (2017-22.1%; 2018-21.9%), vancomycin (2017-16.6%; 2018-14.8%) and piperacillin-tazobactam (2017-11.2%; 2018-11.7%). About 95% of the drugs were given parenterally. The use of biomarkers to guide therapy was observed in 33.3% of the prescriptions in 2017 and 39.9% in 2018. Empiric use accounted for 65.7% and 69.7% of all ATM prescriptions for HAI in 2017 and 2018, respectively. Out of all the targeted therapies, most were aimed at multidrug-resistant (77.7 to 82.6%), mainly gram-negative bacteria.

Conclusion: HAI were the indication for ATM use in about one third of patients and pneumonia was the most common diagnosis. ATM were prescribed mainly empirically and there was a low use of biomarkers to guide ATM therapy. Three broad-spectrum ATM accounted for about half of the prescriptions for HAI showing that reinforcement of de-escalation strategy is needed in Brazilian hospitals.

Disclosure of Interest: None declared

P112 THE BASIC PRINCIPLES OF ANTIMICROBIAL STEWARDSHIP IN DUTCH LONG-TERM CARE FACILITIES

A. Eikelenboom-Boskamp1,2, M. van Loosbroek2, E. Lutke-Schipholt3, M. Nelissen4, M. Verkaaik2, P. Geels4, S. Natsch5,6, A. Voss1,7

1Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Ziekenhuis; 2ZZG Zorggroep; 3Canisius Wilhelmina Ziekenhuis, Nijmegen; 4Dutch Institute for Rational Use of Medicine, Utrecht; 5The Dutch Working Party on Antibiotic Policy, Leiden; 6Department of Pharmacy; 7Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
Correspondence: A. Eikelenboom-Boskamp

Introduction: As residents in long-term care (LTC) settings increasingly suffer from multiresistant microorganisms, adequate use of antibiotics is of outmost importance.

Objectives: Adaptation and implementation of 'hospital' Antimicrobial Stewardship (AMS) into the LTC setting.

Methods: A project was launched within one of the providers of LTC in the South-east of the Netherlands to set up an AMS program. The antibiotic treatment protocol for urinary tract infection (UTI), lower respiratory tract infections and skin infections have been revised. Score-lists for data collection were created. New rules about applying urine dipstick test and culturing were implemented. The A-team monitored all antibiotic descriptions during a period of 5 months in 4 nursing homes. For nurses, e-learning was developed and tested. A focus group for patients/family members was organized to find out more about their needs.

Results: In total, 75 antibiotics prescriptions were reviewed of which 73.3% were assessed as correct. The e-learning needed minor adjustments after testing in 29 nurses. For the most important item UTI indicated by patients/family members, we contributed to an informative flyer developed by the association of elderly care physicians.

Conclusion: We recommend collecting periodic retrospective data for discussion in the A-team, prior to pharmacotherapeutic consultations to achieve a learning effect for future quality of the antibiotic prescriptions overall. In addition to the A-team activities, it's essential to involve nurses and patients/family members in the AMS program. As our project was limited to 4 locations, the generalizability and expected workload need further evaluation.

Disclosure of Interest: None declared

P113 PROPHYLACTIC ANTIMICROBIAL USE IS COMMON IN FINNISH LONG-TERM CARE FACILITIES: RESULTS OF A POINT PREVALENCE SURVEY, 2017

S. Toura, D. Arifulla, E. Sarvikivi, J. Ollgren, O. Lyytikäinen

National Institute for Health and Welfare, Helsinki, Finland
Correspondence: S. Toura

Introduction: Antimicrobials are commonly used in long-term care facilities (LTCFs) and may contribute development of antimicrobial resistance. Particular concern is inappropriate use of prophylactic antimicrobials.

Objectives: We investigated current use of antimicrobials in LTCFs in Finland, with special emphasis in prophylaxis.

Methods: Antimicrobial use of LTCFs was investigated as a part of the third European point prevalence survey (HALT) coordinated by European Centre for Disease Prevention and Control. All residents present in LTCFs and receiving at least one systemic antimicrobial on the day of the survey were included. Local data collectors completed questionnaires including data on resident characteristics, antimicrobials and their indications. Information on antimicrobial policy was gathered using institutional questionnaire. To identify factors associated for prophylactic antimicrobial use, we conducted a multivariate beta-binomial regression model with logit link.

Results: In total, 175 LTCFs with 6762 eligible residents participated in the survey during September-November 2017. On the day of the survey, 462 residents received at least one antimicrobial agent (6.8%; range by LTCFs, 0–42%). Antimicrobials were more frequently prescribed for prophylaxis than for treatment (62% vs. 38%) and vast majority (88%) for prophylaxis of urinary tract infection (UTI). Methenamine (43%) was the most common UTI prophylaxis, followed by trimethoprim (38%) and nitrofurantoin (11%). There was no documented end date for 77% of prophylactic agents; 72% were prescribed in the current facility. Presence of written guideline for appropriate antimicrobial use (odds ratio (OR), 0.34; 95% confidence interval (CI), 0.16–0.73) and therapeutic guideline for UTIs (OR, 0.69; 95% CI, 0.47–0.99) were associated with less use of prophylactic antimicrobials.

Conclusion: Prophylactic antimicrobial use was common in Finnish LTCFs and most were prescribed for UTI prophylaxis. Increasing awareness and easy access to the national Current Care Guidelines for UTI could decrease inappropriate UTI prophylaxis and the use of methenamine.

Disclosure of Interest: None declared

P114 PARTICIPATORY-ACTION RESEARCH FOR DESIGNING A GLOBAL ANTIBIOTIC STEWARDSHIP NETWORK IN THE PORTUGUESE-SPEAKING COUNTRIES' CONTEXT: A MIXED-METHOD STUDY IN CAPE VERDE

M. R. Maia, L. V. Lapão

Global Health and Tropical Medicine, NOVA IHMT, Lisboa, Portugal
Correspondence: L. V. Lapão

Introduction: The antibiotic stewardship services (ABS) contribute to healthcare-associated infections and antibiotic resistance (AR) global monitoring, providing clinical decision-support, through multidisciplinary team-work.

Objectives: Aiming at co-implement an ABS network within the Portuguese-speaking setting (CPLP), by enabling the evidence translation and second opinion between the countries, we surveyed Cape Verdean (CV) health professionals' (HP) perceptions about AR prevention and control, assessing ABS opportunities.

Methods: A Design Science Research Methodology under a Participatory Action Research approach establishes a contextualized ABS participatory process1. This mixed-method study addressed the first 2 stages, the problem and objectives. Quantitative study considered the HP’s answers (56 HP; 2 hospitals) to a questionnaire, about their perception on AR and ABS. Qualitative study set-up 10 open-ended structured interviews, clinical shift observation in 2 pilot-services (1 hospital), and meetings with key-elements for ABS, including leadership.

Results: Key-stakeholders for ABS multidisciplinary teamwork were identified. Preliminary results are:

1. HP reveal some knowledge but lack of awareness on AR and ABS (eg. 34% don’t recognize the AR local threat);

2. The absence of guidelines and lack of access to key-information affect prescribing confidence (eg. only 46% HP consider microbiology results in deciding antibiotherapy);

3. Priorities for a pilot service are the lack of qualified HP, the need to optimize material resources management and stock procurement, and the need for better access to patient's clinical and prescription information;

4. Digital resources and telemedicine system can be facilitators. Top-down communication and support are essential for the ABS process sustainability.

Conclusion: A Global (Portuguese-speaking) ABS network can be important in promoting prevention and effective control of AR, reducing differences between the CPLP countries. In CV, an educational program to support the co-design of ABS service and a decision-support information system are identified priorities. Digital health, like telemedicine, can be ABS facilitators.

References

1. Simões AS, Maia MR, Gregório J, Couto I, Asfeldt AM, Simonsen GS, et al. Journal of Hospital Infection 2018. doi:10.1016/j.jhin.2018.07.034.

Disclosure of Interest: M. Maia Grant/Research support from: FCT-POCH, L. Lapão Employee of: NOVA IHMT

P115 ANTIMICROBIAL USE GUIDELINES IN LARGE HOSPITALS IN SWITZERLAND: AN ANALYSIS OF DIFFERENCES AMONG CENTERS

V. Naef1, G. Catho2, A. Ranzani2, B. Huttner2, S. Tschudin-Sutter3

1University of Geneva; 2Hôpitaux Universitaires de Genève, Geneva; 3University Hospital Basel, Basel, Switzerland
Correspondence: V. Naef

Introduction: Clear and consistent guidelines for the improvement of the antibiotic use are a key element for antibiotic stewardship (ABS). International ABS guidance documents recommend that all hospitals should regularly update the treatment guidelines.

Objectives: In this study we aimed to review the recommendations for antibiotic use for 3 commons infectious pathologies in Swiss academic hospitals and to explore the differences among these guidelines.

Methods: We reviewed the treatment recommendations for community-acquired pneumonia requiring hospitalization (CAP), hospital-acquired pneumonia and uncomplicated urinary tract infections (UTI). We analyzed the guidelines from the 6 largest hospitals in Switzerland, which consider all the university hospitals and the largest non-university hospital. Further, we have take into account aspects such as molecules recommended, dose, administration mode and duration.

Results: The preliminary analysis of our data reveals significant differences among the guidelines. Although the antibiotic regimens are often similar, other parameters, such as the recommended dose, duration and the degree of detail of the recommendations (e.g. differentiating between different subsets of pneumonia or taking into account allergies) show considerable variability. Furthermore, the number of subcategories within an infectious syndrome varied widely. With regard to CAP, we have observed 13 different categories (ranging from 3 to 7) increasing the complexity of the comparison. With the exception of lower uncomplicated UTI, institutional guidelines are not always aligned with the corresponding Swiss and/or Europeans guidelines.

Conclusion: Our data show that there is a significant heterogeneity in the antibiotic treatment recommendations in large hospitals in Switzerland. This feature is not justified by differences in the epidemiology of infectious diseases. Efforts should be undertaken to harmonize the treatment recommendations in Swiss hospitals.

Disclosure of Interest: None declared

P116 USE OF ANTIBIOTICS AMONG END-OF-LIFE HOSPITALIZED PATIENTS WITH ADVANCED CARE DIRECTIVES: INVESTIGATION OF FACTORS RELATED TO PHYSICIANS BEHAVIORAL INTENTIONS

R. Fedorowsky1, Y. Bachner2, A. Borer2, P. Ciobotaro3, T. Kushnir2

1Infection Control Unit, Rabin Medical Center, Hasharon Hospital, Petach Tikva; 2Ben-Gurion University, Beer-Sheva; 3Infection Control Unit, Kaplan medical center, Rehovot, Israel
Correspondence: R. Fedorowsky

Introduction: over-use of antibiotics by physicians at the end of life (EOL) in patients with advance care directives (ADs) contributes to the evolution of antibiotic resistance bacteria (ARB) which increases mortality, and healthcare costs. The present study investigated factors related to physician use of antibiotics, based on the Theory of Planned Behavior, which predicts an individual's intention to engage in a behavior.

Objectives: 1. to investigate several factors (socio-demographic/organizational, motivational, infectious disease physicians (IDP) consultation, burnout) associated with physician behavioral intentions (PBI) to withhold antibiotics in EOL patients with ADs 2. to compare study variables across medical specialties and professional status.

Methods: a descriptive-correlational research in which 213 physicians were sampled in 27 wards, in acute and post acute-care hospitals.

Results: PBI to withhold antibiotics in EOL patient with and without ADs was rated "sometimes"/"rarely" respectively. Mean positive attitudes towards withholding antibiotics in EOL patients with ADs, awareness of ARB, system-related barriers (lack of guidelines) and mean pressure from families to prescribe antibiotic, were above the average. Physicians reported fewer IDP consultations in EOL patients than in other patients. The overall rate of burnout among all physicians was 44.5%.

Predictive/related factors for PBI were: managerial positions, seniority, board certification, type of hospitalization, system-related barrier, positive attitudes and consultations with IDP demanded by physicians, in EOL patient.

IDP reported the highest levels of: awareness of ARB, positive attitudes, PBI, barriers and burnout. Physicians in post acute-care reported the lowest levels of awareness of ARB, and PBI. Physicians in oncology reported the lowest positive attitudes levels. Attending compared to other physicians, reported the highest level of patient pressure, barriers and respectively the lowest positive attitudes and PBI.

Conclusion: IDPs are the potential change agents to improve antibiotics use in EOL patients with ADs. Intervention programs should be focused on oncology, post acute-care hospitals and attending physicians.

Disclosure of Interest: None declared

P117 THEORETICAL APPROACHES IN THE DEVELOPMENT AND EVALUATION OF BEHAVIOUR CHANGE INTERVENTIONS THAT IMPROVE CLINICIANS’ ANTIMICROBIAL PRESCRIBING: A SYSTEMATIC REVIEW

H. Talkhan1, D. Stewart1, T. McIntosh1, M. Al Hail2, P. Abdulrouf2, H. Ziglam2, S. Cunningham1

1School of Pharmacy and life sciences, Robert Gordon University, Aberdeen, United Kingdom; 2Hamad Medical Corporation, Doha, Qatar
Correspondence: P. Abdulrouf

Introduction: Antimicrobial resistance (AMR) and its threats have long been recognised. Many countries have developed antimicrobial stewardship programmes with strategies to optimise antimicrobial prescribing, minimise AMR and improve outcomes. There remains a need for behaviour change interventions at clinician level to promote appropriate prescribing practice.

Objectives: The aim of this review was to critically appraise, synthesise and present the available evidence for theoretical approaches in the development and evaluation of behaviour change interventions that improve clinicians' antimicrobial prescribing.

Methods: Eleven electronic databases and search engines were searched for peer-reviewed, English language studies investigating theoretically based behaviour change interventions that improve clinicians’ antimicrobial prescribing in any healthcare setting. The Theory Coding Scheme was utilised to evaluate the methods by which theories have been used. Clinical and methodological heterogeneity limited data synthesis.

Results: The searches resulted in 4227 potentially relevant papers after duplicates removal. Screening of titles/abstracts led to retrieval and dual assessment of 38 full-text papers. Of those, 12 studies met the inclusion criteria and were included in the systematic review. Most of studies included were from the UK (n = 8) and most were published in 2012 (n = 3); none was published before 2008. The majority of studies were carried out in primary care settings (n = 10) targeting upper respiratory tract infections (n = 9). Theoretical approaches used to inform the design and choice of intervention varied across included studies. The most common included: Theory of Planned Behaviour, Social Cognitive Theory and Operant Learning Theory.

Conclusion: This systematic review is the first to investigate theoretically based behaviour change interventions for antimicrobial prescribing. Only a small number of primary research studies involving theory in intervention development and evaluation were identified. There is a need for further research in this area.

Disclosure of Interest: None declared

Poster session: Hand hygiene: compliance

P118 SELF REPORTED COMPLIANCE TO THE 5 MOMENTS OF HAND HYGIENE REPORTS FROM THREE TERTIARY CARE HOSPITALS IN GERMANY

T. S. Kramer1,2,3, T. Holzmann4, A. Ambrosch5, W. Schneider4, H. Niesalla6, S. Diefenbacher7

1Institute for hygiene and environmental medicine; 2National reference center for the surveillance of nosocomial infections; 3"Aktion Saubere Hände", Charité university medicine Berlin, Berlin; 4Institute for microbiology and hygiene, University hospital Regensburg; 5Instituts für Labormedizin, Mikrobiologie und Krankenhaushygiene, Krankenhaus Barmherzige Brüder, Regensburg; 6BODE SCIENCE CENTER, Bode Chemie GmbH, Hamburg; 7IDepartment of social psychology, University Ulm, Ulm, Germany
Correspondence: T. S. Kramer

Introduction: Hand hygiene is one of the most effective measures to prevent infections and transmission of pathogens in health care settings. However improvement of compliance can only be achieved through contious efforts. Feedback of results in compliance and consumption of alcoholic hand rub to healthcare workers can help to improve their compliance and increase awareness to hand hygiene.

Objectives: Objective of the study is to investigate self reported compliance to hand hygiene in comparison to directly observed compliance and annual hand rub consumption in health care workers.

Methods: A questionnaire was designed to ask for compliance to the 5 moment of hand hygiene during daily practice. Wards that finished direct observation of hand hygiene compliance within 8 month prior to questioning were included. Healthcare workers from three tertiary care medical centers were questioned.

Results: Data from 15 wards (n=4 ICUs ; n=1 IMC; n=1 4 regular wards) were included. Overall 186 HCW participated in the survey. Their self reported compliance was 78.2% (IQR:79.5-81.25). 2570 moments were directly observed with median compliance of 80% (IQR:67-84). Median alcoholic handrub consumption was 73.8ml/patient day (IQR: 41.3-127.55) in the year during direct observation. Nine wards self-reported their average compliance rate within a 5% margin of the directly observed compliance, while 5 wards underestimated their performance by more than 5%, and one ward overestimated their compliance by more than 5%. Overall a significant positive correlation between self-reported and observed compliance was found (r = .549, p = .034).

Conclusion: Self reported does correlate with directly observed compliance on a ward level, but might offer additional information on awareness of importance of hand hygiene.

Disclosure of Interest: T. Kramer: None declared, T. Holzmann: None declared, A. Ambrosch: None declared, W. Schneider: None declared, H. Niesalla Employee of: Bode Science Center, S. Diefenbacher Grant/Research support from: Bode Science Center

P119 ADHERENCE TO HAND HYGIENE AND ITS ASSOCIATED FACTORS IN MATERNITY SETTINGS IN A TERTIARY REFERRAL HOSPITAL IN BLANTYRE, MALAWI: AN OBSERVATIONAL CROSS-SECTIONAL STUDY

C. Cohen* 1, C. Dunlop2, A. Blennerhassett2, P. Bonongwe3, L. Gadama3, D. Lissauer4

1University of Birmingham, Birmingham, United Kingdom; 2Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, United Kingdom; 3Malawi College of Medicine, Blantyre, Malawi; 4Institute of Metabolism and Systems Research (IMSR, University of Birmingham, Birmingham, United Kingdom
Correspondence: C. Cohen

Introduction: Hand hygiene (HH) in maternity settings in low income countries is often low, despite its importance in preventing peripartum infection and sepsis. Malawi has a high maternal mortality ratio, and to date no study has adequately ascertained the baseline HH adherence and its associated factors in maternity settings at a tertiary level hospital.

Objectives: To determine the baseline adherence to WHO standards of HH in maternity settings, assess ward infrastructure and assess the knowledge and behaviour of healthcare professionals.

Methods: Data was collected on labour, gynaecology, antenatal and postnatal wards for 4 weeks, and antenatal clinic for 2 weeks. Adherence was determined using a modified version of the WHO Observation Tool and adherence rates calculated. Ward Infrastructure was assessed using the modified WHO Ward Infrastructure Survey and compared graphically over time and by ward. Behaviour was assessed using the WHO Healthcare Worker Knowledge Questionnaire that was modified to include questions assessing knowledge and behaviour in terms of capability, opportunity and motivation in keeping with the COM-B model.

Results: HH Adherence to WHO guidelines in inpatient wards was 12.2%, and 57.1% in antenatal clinic. Adherence was lowest on labour ward (7.55%) and highest on antenatal (16.5%). Doctors had higher adherence than nurses (20% versus 13.5% p=0.160). Soap and water availability was higher in antenatal clinic (100% and 94.4% respectively) compared to inpatient wards (65.1% and 25.2% respectively). The majority of HH actions were hand rubbing (71.9%). Adherence did not correlate with soap and water availability by inpatient ward or over time. Healthcare worker knowledge was low, and doctors scored higher than nurses (61.4% versus 52.2% p=0.032). COM-B targets identified for behavioural change were psychological capability, physical opportunity and reflective motivation.

Conclusion: Adherence to WHO standards of HH in maternity settings is low. Ward infrastructure does not correlate with adherence. Knowledge is poor but is greater among doctors than nurses, who also had better adherence rates. Physical opportunity, reflective motivation and psychological capability should be addressed to change hand hygiene behaviour. Improving education could therefore improve adherence.

Disclosure of Interest: None declared

P120 HAND HYGIENE COMPLIANCE IN THE INTENSIVE CARE UNIT: A SYSTEMATIC REVIEW

A. Vellinga, K. Lambe, S. Lydon, C. Madden, A. Hehir, M. Walsh, P. O'Connor

Irish Centre for Applied Patient Safety and Simulation, National University of Ireland, Galway, Galway, Ireland
Correspondence: A. Vellinga

Introduction: Hand hygiene (HH) is acknowledged as the most effective safeguard against HAI and is of particular concern in the Intensive Care Unit (ICU). The WHO five moments for hand hygiene has been widely adopted but HH compliance in the ICU is reported to be low.

Objectives: To derive HH compliance according to the WHO guidelines in the ICU and explore differences by region, ICU type, healthcare worker (HCW), method of observation, and each ‘moment’.

Methods: Electronic searches were conducted using Medline, CINAHL, PsycInfo, Embase, and Web of Science. Information was extracted and compliance recorded. Mean compliance, effect size and heterogeneity was calculated overall and for each category.

Results: More than 5,480 papers were screened of which 61 met the inclusion criteria for data extraction.

The median number of opportunities observed per study was 903 (mean = 3,026). Overall compliance ranged from 1.4% to 100% and the weighted mean compliance was 60% (n=184,597 opportunities). The effect size for all studies was 0.47 (CI=.04-.05), but heterogeneity was extremely high (I²=99.7).

HH compliance varied across geographic region from 65% in high-income countries to 9% in low-income countries. HH compliance also showed distinctive differences by ICU type; neonatal 67%, paediatric 41%, and adult 58%, and HCW; nursing staff 43%, physicians 33%, other staff 54%.

Conclusion: HH compliance in the ICU appears notably lower than international targets. The data collated offers a benchmark when evaluating or improving HH compliance in ICUs internationally.

Disclosure of Interest: None declared

P121 HAND HYGIENE IN LONG-TERM CARE FACILITIES (LTCFS): EVERY MOMENT MATTERS!

A. Haenen1, M. Hulscher1, J. Liefers1, A. Voss1, A. Huis1, S. de Greeff2

1IQ Healthcare, RADBOUDUMC, Nijmegen; 2Centre for Infectious Disaese research, RIVM, Bilthoven, Netherlands
Correspondence: A. Haenen

Introduction: The WHO ‘five moments for hand hygiene ‘are the key moments for hand hygiene and provide the fundament to any hand hygiene improvement strategy.

Objectives: We studied the baseline compliance and whether our tailored intervention is equally effective at all five moments.

Methods: Taking into account the barriers and facilitators we developed tailor-made interventions for 23 LTCF in the Netherlands. In a stepped wedge design we observed the five moments of hand hygiene, using the WHO “my five moments” methodology, before and after this tailored intervention.

Results: We observed 6365 opportunities for hand hygiene, of which moment 3 “after body fluid exposure risk” (n=2585) was the most common seen and moment 2 “before clean/aseptic procedures” (n=328) the least . The overall hand hygiene compliance increased with 17.5% from 18.2% before to 35.7% directly after the intervention. All five moments of hand hygiene improved following the intervention, however the compliance of moment 4 “after touching a patient” was the highest before the intervention (27.2%), highest after the intervention (54.5%) and increased the most (27.3%). The compliance “after body fluid exposure risk” was the lowest before (12.1%) and lowest after the intervention (25.2%) and also increased the least (13%).

Conclusion: Our preliminary results show that our tailored intervention appears to improve overall hand hygiene compliance, however, not at all moments a substantial increase was achieved. Hand hygiene “after body fluid exposure risk” is the most common opportunity observed, but compliance is the lowest as is compliance improvement after the intervention. Although the overall hand hygiene compliance increased after the intervention, the five moments of hand hygiene should be considered separately when looking at the effectiveness of the intervention.

Disclosure of Interest: None declared

P122 ASSESSMENT OF HAND HYGIENE COMPLIANCE AMONG 4 WARDS AT THE UNIVERSITY OF SIERRA LEONE TEACHING HOSPITAL

R. E. Ngauja1,1, C. A. Conteh1, A. Maruta2

1National Infection Prevention and Control Unit, Ministry of Health and sanitation; 2Health security and emergencies, World Health Organisation, Freetiown, Sierra Leone
Correspondence: R. E. Ngauja

Introduction: Although hand hygiene remains the most important strategy to prevent infections in the health care setting, compliance still remains unsatisfactory.. Many years after the multimodal strategy to improve hand hygiene compliance was introduced, hand hygiene compliance still remains unacceptably low across the globe. During the Ebola response period hand hygiene played an integral part of the response phase. Sierra Leone is among the countries that signed the pledge with WHO on Hand Hygiene Campaign to improve patient safety by reducing healthcare-associated infection. There is continuous need to scale up hand hygiene practices in health care facilities to reduce healthcare associated infections and combat AMR.

Objectives: The aim was to assess hand hygiene practices among Healhcare workers in four main wards of the hospital.

Methods: A situational analysis was conducted in 4 wards at the University of Sierra Leone Teaching Hospital Complex to assess compliance to hand hygiene. The observational form which is used to audit hand hygiene compliance was used in 4 wards at University of Sierra Leone Teaching Hospital, these are ward 1 (Paediatrics ward), Ward 4 (female Surgical), Ward 6 (male medical ward) and Accident and Emergency ward (Trauma). The WHO hand hygiene observational tool hand hygiene audit tool was used to collect data in the four wards; this tool involved the direct observation of hand hygiene practices among health care providers.

Results: Hand hygiene practices were below the normal standards in the 4 wards observed. The results were noted as Paediatric ward, 38.9%, Female Surgical ward 49.2%, Male Medical Ward 55% and Accident and Emergency 48.1%. The overall compliance for the four wards was 48%.

Conclusion: Healthcare workers still believe hand hygiene is not relevant to them and they always relate it as an Ebola reduction measure and had no interest on it since Ebola era ended. There is need to set accurate targets for hand hygiene compliance and as the local production of alcohol-based hand rub has started using WHO formulation in two major hospitals in the country. More support is needed from our implementing partners.

Disclosure of Interest: None declared

P123 HAND HYGIENE IN BENIN SURGERY CARE UNITS: OPPORTUNITIES AND CHALLENGES

C. L. Yehouenou1,2, A. DOHOU1,3, A. D. FIOGBE3,4, C. DEGBE5, A. SIMON6,7, O. DALLEUR8

1clinical Pharmacy Research Group (CLIP), Louvain Drug research Institute (LDRI), Brussels, Belgium; 2Faculté des Sciences de la Santé (FSS), Université d'Abomey calavi (UAC); 3Université d'abomey Calavi, faculté des sciences de la santé, Cotonou, Benin; 4Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute, Brussels, Belgium; 5Clinique d'hygiène hospitalière (CNHU), Institut regional de santé publique , cotonou, Benin; 6Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain UClouvain; 7Microbiologie, Clinique Universitaire de saint Luc, Brussels; 8Louvain drug research institute, CLIP/ Uclouvain, Bruxelles, Belgium
Correspondence: C. L. Yehouenou

Introduction: Hand hygiene (HH) has been described as the cornerstone and starting point in all infection control programs.

Objectives: This study aimed to evaluate HH compliance among Healthcare Workers (HCWs) in Benin surgery care units.

Methods: We conducted an observational study for two months through six public hospitals in obstetrics and visceral surgery. The World Health Organization HH observation tool was used. HH compliance was calculated by dividing the number of hand hygiene action by the total number of opportunities.

Results: We observed 432 HCWs: 55,6% of nurses, 25,7% of auxiliaries, 13,4% of physicians and 5,3% of others. Among the 1315 observed opportunities for HH, average compliance was 33,3%. The compliance rates differed (p<0,001) between obstetrics (49,4%) and abdominal surgery (24,3%).The assumption that HCWs prefer to protect themselves to a greater extent than patients was noted: HH compliance was better after body fluid exposure (54,5%) and after patient contact (37,5%) than for the other opportunities.(p<0,001).

Among 438 hand hygiene actions, only 122 (27,9%) were attributed to the hand rubbing while 316 (72,1%) were to hand washing. Hand washing remains the most preferred HH action for all of WHO five moments. When HH was applied, technique and duration were often inappropriate. Median duration of HH was respectively 10 ± 7 seconds for hand washing and 9 ± 6 seconds for the hand rubbing. Hand hygiene duration was appropriate in< 6% for ABHR and 0,5% for hand washing. Fortunately, most HCWs respected the prerequisites of HH (91% had natural short and without polished fingernails). We observed lack of infrastructures required for HH (i.e. sink, clean water, provision of alcohol solution) in all of hospitals.

Conclusion: HCWs missed two opportunities out of three to apply HH and didn’t apply the good techniques. HH practices education should be a priority to improve patient safety in Benin.

Disclosure of Interest: None declared

P124 HAND HYGIENE PROGRAM IN A TERTIARY CARE TEACHING HOSPITAL IN WEST BANK:2017-2019

S. Belkebir, A. Kanaan, R. Jeetawi

Preventive medicine, An Najah National University Hospital, 00000, Palestinian, State of
Correspondence: A. Kanaan

Introduction: For the implementation and monitoring of Hand Hygiene practice among healthcare workers, the Infection control program at An-Najah National University Hospital, a tertiary care referral teaching hospital in the North of Palestine, uses Direct Observation as recommended by the World Health Organization.

Objectives: This descriptive study aims at reporting the prevalence of HH across the institution from January 2017 to April 2019

Methods: To monitor improvements, WHO toolkit for direct observation of HH compliance was used by IPCP team and anonymously by trained observers. Compliance was assessed and reported on monthly basis. PDSA, root cause analysis and groups discussions were used as improvement tools. Training was reinforced by the use of ultraviolet light and fluorescent alcohol hand rub. Yearly, staff was engaged in HH day activities. Leadership support was constant by securing annual budget for the HH program and the enforcement of HH policy.

Results: The overall compliance rates during the period of study were: 44%(R:31-57%) in 2017, 53%(R:30-72%) in 2018 and 58%(R:55-60%) from January to April 2019.During 2018,an increase in 23% in HH compliance was observed among Nursing staff and 14% among doctors. The most frequent missed opportunity was the compliance with Moment 1“before patient” by 59%, which was mainly due to a misuse of gloves. Qualitative analysis of the results reflected barriers to an optimal hand hygiene rate (set at 85%) such as: high turnover among nursing and residents, shortage of alcohol sanitizer in some months, reported skin irritation problems related to alcohol gel and poor engagement to HH.

Conclusion: A steady increase in HH compliance was observed among the institution from 2017 to 2019.Efforts in improving the commitment of the staff to HH is needed as well administrative support and training (especially in the good use of gloves).

Disclosure of Interest: None declared

P125 CAUSES OF NON-COMPLIANCE OF HAND HYGIENE USING A COVERT OBSERVATION METHODOLOGY

A. El-Saed1, M. Alshamrani1, S. Noushad1, H. Balkhy2

1Infection control, King Abulaziz Medical City, Riyadh, Saudi Arabia; 2Antimicrobial Resistance, WHO, Geneva, Switzerland
Correspondence: A. El-Saed

Introduction: Covert hand hygiene (HH) observation was suggested as a tool to overcome the Hawthorne bias, which tends to overestimate the routinely observed compliance of HH.

Objectives: As HH observation done secretly at our institution showed a low HH compliance, we thought to examine the professional and healthcare causes of non-compliance of HH.

Methods: A cross-sectional study design was conducted among healthcare workers (HCWs) at King Abdulaziz Medical City, Riyadh, Saudi Arabia between October 2012 and July 2013. HH observation was done secretly by temporarily-hired professionally-trained observers. Non-compliance was defined as failure to perform hand rubbing (with alcohol-based formulation) or hand washing (with soap and water) during one of the WHO five-moment HH opportunities. HH observation was followed by a questionnaire about the possible causes of non-compliance of HH filled by the HCW and assessment of HH infrastructure at the service location reviewed by the observer.

Results: A total 502 HCWs with a total of 5680 opportunities were observed in 28 service locations. The overall non-compliance was 54.1%. The factors that were significantly associated with non-compliance included lack of HH education/training in last 2 years, long working hours, lack of job recognition, lack of HH auditing, lack of alcohol hand rub pocket bottle, lack of conveniently placed water sinks and alcohol hand rub wall dispensers, non-frequent replacement of empty wall dispensers, and lack of nearby promoting posters. Incorrect HH technique was significantly associated with professional category, attending HH education/training, presence of HH auditing at the service location, and the place of alcohol hand rub wall dispenser.

Conclusion: The current findings list a number of professional and healthcare factors associated with non-compliance of HH. The covert observation of HH done before the questionnaire is likely to avoid bias in estimating non-compliance and its causes. The findings may potentially help decision maker to identify specific work-environment factors that need to be modified to improve the compliance of HH. Further research may be required to assess the impact of these suggested changes on the compliance of HH.

Disclosure of Interest: None declared

P126 NEW CONCEPT OF HAND HYGIENE SURVEILLANCE IN NURSING HOMES - CANTON DE VAUD

M. Attinger Querzoli, C. Petignat, I. N. Tessemo

Direction générale de la santé, unité HPCi, Lausanne, Switzerland
Correspondence: M. Attinger Querzoli

Introduction: Health care-associated infections constitute a concern for the safety of patients and are considered by the experts a major issue in public health.Hand hygiene (HH) is the most important measure to avoid the transmission of harmful germs and to prevent cross transmission of such germs. The promotion of HH, according to the five WHO indications is integrated into the cantonal strategy of infection control in nursing homes introduced by Cantonal Unit for Prevention and Infection Control (unité HPCi). Since 2004, in nursing homes, the promotion has been applied through the yearly surveillance of hand rub solution consumption and in 2010 began a surveillance of HH compliance via audits. While audits reveals a 80% HH compliance, the consumption of hand rub solution is only 2.5 disinfections/day/resident (target = 5). There was no correlation between HH observations and the volume of hand rub used, when comparing the two surveillances.

Objectives: The unité HPCi developed a new tool for nursing homes, to evaluate the consumption of hand rub solution, taking into account, nursing homes missions and the number of delivered cares per day (degree of dependency of residents).

Methods: Elaboration of the form survey for data collection; tutoring; calculation of the average number of opportunities of HH for the nursing home; determination of the expected averages of consumption of hand rub solution; quarterly calculation of the consumption of hand rub solution before collecting the number of delivered cares per day (base line); determination of the minimum personalized target of consumption of hand rub solution, which the nursing home has to reach ; new quarterly calculation of the consumption of hand rub solution.

Results: In 2018, a test phase allowed the adjustment of the tool, in collaboration with healthcare workers involved in this new concept.

Conclusion: This new concept aims to promote HH by means of a personalized indirect tool. The method can help healthcare workers to adhere to correct HH procedures and favors a better adoption of HH surveillance. It allows the determination of personalized objectives of progress regarding HH compliance. This tool has been implemented in 2019 in all nursing homes of canton de Vaud.

Disclosure of Interest: None declared

P127 COMPLIANCE WITH HAND HYGIENE (HH) PRACTICES UNDER STANDARD (SP) VS. CONTACT PRECAUTIONS (CP) IN A TERTIARY CARE HOSPITAL

C. Fankhauser, F. Timurkaynak, D. Pires, E. Tartari, A. Peters, C. Guitart, J. Sztajzel, A. Iten, D. Pittet

Infection Control Program, HUG, Geneva, Switzerland
Correspondence: C. Fankhauser

Introduction: The impact of glove use on HH practices is not well known. Some reports describe low adherence with the use of gloves, gowns, and HH while CP are applied, others show noncompliance with HH when donning or removing gloves, or absence of glove change in between HH indications. Understanding noncompliance can improve HH and the judicious use of gloves.

Objectives: To compare HH compliance when caring for a patient under CP vs. SP. To assess the impact of glove use on HH compliance.

Methods: Trained, validated observers performed HH monitoring using the WHO 5 moments for HH. HH observations were categorized for three conditions: Overall (total HH observations); CP: when CP was indicated; SP: (Overall - CP). Results were compared across 4 healthcare (HC) sectors, periodic HH observation sessions conducted from 2014 to 2017 hospital-wide at HUG (A), Geriatric (B), and Orthopedic (C) wards, and from 01/06/2017 to 30/03/2018 among volunteer HC workers in Geriatric wards (D).

Results: Proportions of HH opportunities observed when CP was indicated were: A) 4.57% (1075/23541), B) 9.09% (257/2827), C) 2.11% (47/2232) and D) 4.12% (165/4006).

Conclusion: HH compliance was significantly lower for opportunities identified as CP. Both SP and CP showed lower HH compliance while using gloves. The impact is higher under CP.

Disclosure of Interest: None declared

Table 1 (abstract P109).

See text for description

Variables

Total

n=316

Department with antimicrobial stewardship

n=89

Department without antimicrobial stewardship

n=227

p

Age (in years)

Mean - 62,78

SD - 18,07

Mean - 62,24

SD - 16,30

Mean - 62,99

SD - 18,75

0,725

Male Gender (%)

56,3

59,6

55,1

0,529

Hospitalization days

Median - 7

IQR - 13

Median - 8

IQR - 21,5

Median - 7

IQR - 12

0,049

Antimicrobial prescription (%)

37,7

41,6

36,1

0,370

P128 IMPROVING COMPLIANCE WITH HAND ANTISEPSIS WITHOUT DECREASED EFFICACY BY SHORTENING THE RUB-IN TIME OF ALCOHOL-BASED HANDRUBS TO 15 SECONDS

J. Harnoss1, S. Dancer2,3, C. Kaden4, R. Baguhl5, T. Kohlmann6, R. Papke5, M. Zygmunt7, O. Assadian8, M. Suchomel9, D. Pittet10, A. Kramer5

1University of Heidelberg, Heidelberg, Germany; 2Hairmyres Hospital, Hairmyres; 3Edinburgh Napier University, Edinburgh, United Kingdom; 4Greifswald; 5University Medicine Greifswald, Greifswald, Germany; 6Institute for Community Medicine ; 7Gynaecology and Obstetrics, University Medicine Greifswald, Greifswald, Germany; 8Medical University of Vienna & Hospital Landesklinikum Neunkirchen; 9Medical University of Vienna, Vienna, Austria, 10University of Geneva, Geneva, Switzerland
Correspondence: A. Kramer

Introduction: A previous study among neonatal intensive care unit (NICU) nurses showed that the antibacterial effectiveness of alcohol-based handrubs (ABHR) can be achieved in 15s instead of 30s with a significant increase in the frequency of hand antisepsis.

Objectives: To examine 15s vs 30s antisepsis performance by measuring microbial load on fingertips and compliance among nurses in a low-risk gynaecological ward.

Methods: An independent trained observer monitored the frequency and compliance with hand antisepsis during shifts in a crossover design. Fingertips including thumbs were rinsed in soy broth before hand rubbing at the beginning of a shift and then hourly to determine the bacterial load. Performance activity was assigned to the contamination class of the Fulkerson scale. Immediately before the lunch break, volunteers cleaned their hands for a randomly determined exposure time of 15 or 30 seconds.

Results: For participants rubbing for 15 seconds, both the frequency of hand antisepsis and compliance were significantly higher (p

Conclusion: The observed improvement in compliance resulting from shortening the ABHRs application time confirms that time acts as a psychological barrier for optimal compliance with hand antisepsis. Therefore, shortening the application time to 15 s should be considered within the critical components of a successful multimodal intervention strategy to improve compliance with hand hygiene in clinical practice.

Disclosure of Interest: None declared

Poster session: Hand hygiene: Monitoring at large level

P129 BACK TO BASICS: USING NEW GLOBAL DATA ON HEALTH CARE WASTE MANAGEMENT AND HAND HYGIENE FACILITIES TO TARGET INVESTMENTS, PREVENT INFECTIONS AND SAVE LIVES

M. Montgomery1, R. Johnston1,2, J. Storr2, C. Kilpatrick1

1Water, Sanitation, Hygiene and Health Unit; 2WHO, Geneva, Switzerland
Correspondence: J. Storr

Introduction: In April 2019, the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene published harmonized baseline estimates for water, sanitation, hand hygiene, health care waste management, and environmental cleaning (WASH) services in health care facilities. The new JMP global database on WASH in health care facilities includes national data from 125 countries drawing upon assessments of over 560,000 health care facilities.

Objectives: To describe the current global status on WASH in healthcare facilities focusing on waste management and hand hygiene

Methods: A compilation and analysis of existing monitoring data that countries have already collected was undertaken. Data were extracted from 260 nationally-representative facility assessments and mapped to a standardized set of global indicators.

Results: Globally, 42% of health care facilities have neither alcohol-based handrub nor soap and water at points of care. Availability varies widely with at least one country in every region having less than 50% coverage. In some middle- and upper-income countries, where arguably there should be sufficient resources to ensure that universal coverage, less than half of health care facilities had hand hygiene facilities. Globally 40% of health care facilities lack systems to segregate waste. Waste segregation in least developed countries ranges from above 90% to less than 5%. Practices are generally better in hospitals compared to smaller health facilities.

Conclusion: These estimates comprise the most comprehensive assessment to date, drawing upon nationally representative surveys covering over half a million health care facilities, and confirm an unacceptable WASH situation. Addressing these major shortfalls can be done with relatively few resources and would result in large cost savings through averting infections and improving the quality of care. WHO and UNICEF are leading global efforts to ensure that all countries and health care facilities look to strengthen collaboration between WASH and IPC, adopting innovative and sustainable approaches to achieve improvement.

References

WHO/UNICEF. WASH in health care facilities. Global baseline report 2019. https://www.who.int/water_sanitation_health/publications/wash-in-health-care-facilities-global-report/en/

Disclosure of Interest: None declared

P130 HAND HYGIENE IN HOSPITALS – THE EVOLUTION OF A GLOBAL CAMPAIGN

C. Kilpatrick1, B. Allegranzi1, D. Piitet2

1World Health Organization; 2WHO collaborating centre for patient safety and infection control, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Correspondence: C. Kilpatrick

Introduction: In the last 20 years, a paradigm shift has occurred in hand hygiene. In order to put this evolution into context, it is important to understand how a World Health Organization (WHO) global annual hand hygiene campaign has played its role and reached healthcare settings in all corners of the globe. WHO launched the SAVE LIVES: Clean Your Hands global campaign on 5 May in 2009, marking the first international day of hand hygiene in healthcare.

Objectives: To examine how a ubiquitous but local set of ideas led to a global phenomenon in part supported by a global campaign, and to outline how committed organizations are championing hand hygiene improvement stimulated by the WHO campaign.

Methods: A desk exercise was undertaken to review the WHO web pages in order to summarise the themes and calls to action presented for each year of the global campaign, mapping their relevance to other global health agendas. A preliminary review of 10 years of campaign registrations using data from the WHO web ‘sign up’ page was also conducted, alongside an analysis of supporting organizations over time.

Results: One of the key findings from the campaign themes highlighted an evolution of focus, from pure hand hygiene to wider global health issues. These health issues were considered in some way to be interconnected with the need for hand hygiene improvement and prevention of avoidable harm. Healthcare facility campaign registration numbers have continued to increase year on year, with the current status being 22 144 health-care facilities in 182 countries. A range of national and global organizations have continually promoted the campaign.

Conclusion: While a clear target and denominator for demonstrating global campaign success should be employed, these preliminary results outline a useful starting point in understanding a global campaign's reach. Research has begun to be published showing the upward trend in hand hygiene improvement linked to promotional campaigns. The continued annual commitment of organizations, in part, demonstrates sustainability of campaign messaging framing. However, more analysis of the impact of the global campaign is needed to understand the curve of commitments, which would be of interest to any other global health care campaign.

Disclosure of Interest: None declared

P131 CURRENT STATUS OF HAND HYGIENE MONITORING AND PERFORMANCE FEEDBACK ACROSS LOW-, MIDDLE- AND HIGH-INCOME COUNTRIES

E. Tartari1, M. Borg2, E. Castro-Sánchez3, W. Zingg1, B. Allegranzi4, D. Pittet1

1University Hospital of Geneva, Geneva, Switzerland; 2Mater Dei Hospital , Msida, Malta; 3Imperial College, London, United Kingdom; 4WHO, Geneva, Switzerland
Correspondence: E. Tartari

Introduction: Hand hygiene (HH) monitoring with performance feedback is considered a key quality indicator; however, differing practices exist in healthcare facilities worldwide.

Objectives: To obtain a snapshot of HH monitoring and performance feedback practices internationally.

Methods: We developed a survey based on the WHO Hand Hygiene Self-Assessment Framework (HHSAF) and invited a convenience sample of infection preventionists (ICPs) from more than 100 countries attending the International Conference on Prevention and Infection Control (ICPIC) in June 2017 to complete it. The survey included questions on the following HHSAF subcategories: 1) availability of HH products 2) direct monitoring of HH compliance; 3) monitoring consumption of alcohol-based handrub (ABHR); 4) feedback to key stakeholders.

Results: 198 ICPs from 71 countries across all income levels completed the questionnaire (22 low-income countries [LIC], 71 middle-income countries [MICs] and 105 high-income countries [HIC). All four HHSAF subcategories were reported to be in place in 0/22 hospitals in LIC, 31/71 in MICsand 38/105 in HIC. Overall 55% reported a monitoring system to ensure that HH products were available at point of care (60% HIC; 35% MIC; 5% LIC). 50% of respondents monitored consumption of ABHR as a proxy measure of HH compliance (69% HIC; 30% MIC; 1% LIC). 47% of hospitals performed direct monitoring of HH compliance in all wards (71/105 HIC; 22/71 MIC; 0/22 LIC) with another 27% doing so only for specific wards (21/105 HIC; 23/71 MIC; 9/22 LIC). Of these, 46% used a combination of ICPs and ward staff to perform HH compliance audits, 40% used only ICPs, 10% relied only on ward staff while 4% used a system of ‘shoppers’/video cameras. HH monitoring was primarily performed overtly after informing ward managers (45%). Covert audits with no notification to ward leadership were done by 16% and after informing observed staff in 14%. HH audit results were fed back to key stakeholders in 67% of institutions.

Conclusion: Significant challenges remain in implementing the HHSAF recommendations, even in HIC. However the problem is greatest in LMIC where increased infrastructures, resourcing and stability to implement robust IPC programmes are urgently needed.

Disclosure of Interest: None declared

P132 HAND HYGIENE ENABLERS AND PRACTICES AMONG HEALTH CARE WORKERS IN UGANDA; FINDINGS FROM A NATIONAL INFECTION PREVENTION AND CONTROL (IPC) SURVEY

W. Omuut1, R. Walwema1, M. Lamorde1, M. Kesande1

1Global Health Security Program, Infectious Diseases Institute, Makerere University, Kampala, Uganda
Correspondence: W. Omuut

Introduction: The World Health Organizations’(WHO) annual global campaign to promote hand hygiene (HH) aims to renew global commitment to a low-cost lifesaving infection prevention control (IPC) standard. Ahead of the 2018 national HH celebrations in Uganda, a survey was conducted to establish the status of HH practices in Ugandan health care facilities (HCFs).

Objectives: To: Determine HH capacity in Ugandan HCFs. Establish HH compliance of health workers.

Methods: A cross sectional survey was conducted in April 2018 at 14 regional referral hospitals (RRHs). 14 IPC leaders were interviewed to assess HH capacity and 412 health care workers observed for compliance to WHO 5 moments of HH. WHO standard tools: HH self-assessment frame work 2010 and HH observation tool 2009, were adopted and assessors trained before data collection. HH capacity was assessed using five components of the WHO multi-modal HH improvement strategy: system change, education and training, evaluation and feedback, reminders at the work place and institutional safety climate. Data were analysed using excel and epi info and summarised using scores, colour schemes and percentages.

Results: Most RRHs attained the basic level (126 - 250 out of 500) of hand hygiene capacity. Lowest performance was seen in the ‘evaluation and feedback’ component (24.3 out of 100). The best performing facility (Mubende RRH) had an intermediate level (330 out of 500), attributed to committed leadership, a vibrant IPC committee and innovations like local production of alcohol-based hand sanitizer.

Overall HH compliance using WHO 5 moments was (mean, range) 21% (7% - 54%). Highest compliance was seen for the measures ‘after patient contact’ (36%) and ‘after body fluid exposure risk’ (33%). Compliance to ‘before touching a patient’ and ‘before clean/aseptic procedure’ were lowest (16%). Reasons for inadequate practice were; inadequate supplies, lack of awareness of standard policies of hand hygiene, lack of locally adapted monitoring and evaluation frameworks and poor health worker attitudes.

Conclusion: Inadequate HH practice of health workers in Uganda is attributed to gaps in supplies, inadequate knowledge and poor attitudes. Scale up innovations such as local manufacture of alcohol based hand sanitizer and increased leadership commitment should be harnessed to improve practice.

Disclosure of Interest: None declared

P133 SELF-REPORTED HANDWASHING COMPLIANCE IN THE GENERAL POPULATION IN GERMANY: AN IN-DEPTH ANALYSIS OF THE FIRST BZGA-SURVEY ON HYGIENE AND INFECTION CONTROL

T. von Lengerke, A. A. Mardiko

Department of Medical Psychology, Hannover Medical School, Centre of Public Health and Healthcare, Department of Medical Psychology, Hannover Medical School, Centre of Public Health and Healthcare, Hannover, Germany
Correspondence: T. von Lengerke

Introduction: Promoting handwashing in the general population is a key public health area not only in pandemics but also perennial infection prevention.[1] Thus, it is crucial to know how compliant the general population is, and perceives themselves to be. The German Federal Centre for Health Education (BZgA) has conducted thre relevant representative surveys.[2] Regarding single parameters of handwashing, self-reported compliance rates of up to 96% (indication "after using the toilet") were found.[2] However, comprehensive compliance (in terms of correct indications, duration ≥20 sec., AND technique using soap, washing between fingers, and drying off) has not been reported.

Objectives: To provide comprehensive handwashing compliance rate estimates for German adults, and report associations with recalling handwashing instruction signs in public restrooms.

Methods: In 2012, N=4483 residents living in a household in Germany aged 16-85 years were surveyed by computer-aided telephone interviews (response: 49.7%).[3] Handwashing \parameters were coded as (non-)compliant based on BZgA-recommendations. Respondents indicated whether they had ever seen instruction signs in public restrooms. Statistics were calculated and regression analyses conducted via IBM® SPSS® v24.

Results: The rate of compliance defined as a pattern of self-reported duration of handwashing of ≥20 sec., correct technique, and washing hands in more than 6 of 9 indications, was 8% (men: 6%, women: 9%), while 31% were totally non-compliant (29%/33%). Compared to non-compliance, the odds of total compliance were more than twice as high among respondents recalling handwashing instruction signs in public restrooms (men: OR=2.15) and women (OR=2.08; p<.0001), however with rates still being low (e.g. 10% in women).

Conclusion: In 2012, self-reported handwashing compliance in the general population in Germany was low when defined by a pattern of compliant duration, technique, and situational indication. Intensified promotion is obviously needed, and may use instruction signs (e.g. in public restrooms) as a starting point.

References

1. Meilicke et al. Hygiene perception changes during the influenza A H1N1 pandemic in Germany. BMC Public Health 2013; 13: 959

2. BZgA. [Infection control via hygiene]. Cologne: BZgA; 2018

3. BZgA. [Infection control 2012. doi:10.4232/1.5175] Mannheim: GESIS Data Archive; 2015

Disclosure of Interest: None declared

P134 HYPOTHESIS - APPLYING NEW METHODS OF MODERN COMMUNITY-BASED HEALTH EDUCATION IS THE WAY TO SUCCEED IN A HAND HYGIENE EDUCATIONAL PROGRAM IN THE HOSPITAL ENVIRONMENT

M. Dadgarmoghaddam1, A. Alipour Tabrizi2, N. Lotfinejad3

1Assistant professor of community medicine, Community medicine department, Research deputy of school of medicine, Mashhad University of Medical Sciences, Mashhad; 2Iranian legal medicine research center, Legal medicine organization, Tehran; 3Department of research, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic Of
Correspondence: M. Dadgarmoghaddam

Introduction: Despite various efforts in the field of infection prevention and control regarding hand hygiene (HH) at hospitals, the level of HH compliance among healthcare workers (HCWs) is still not acceptable. In one study conducted in one of the Mashhad's hospitals in Iran, even warning signs of hand-borne infection in the elevators were more noticeable to the audience and statistics revealed that this was more effective than pamphlets.

Objectives: We formulated a hypothesis about the best approach to succeed in HH educational program in hospital environment.

Methods: A qualitative study identified the effects of HH education in the population.

Results: Considering the history of HH, infectious diseases and Ignaz Philipp Semmelweis’s practices, HH has been a challenging human behavior although it is very simple. Reasons for failing in health-related education, such as HH in hospitals, are categorized as: culture-related issues, inappropriate information system to achieve educational goals, non-realistic behavioral changes, inappropriate target population and inadequacy of teaching methodology. Educators of the health system believe that health-related education is only achievable by holding classes and providing brochures and guides. Perhaps it should be noted that the traditional teaching methods need to be transformed and they should be replaced by novel strategies such as using technological advances including emojis, cartoons, and games.

Social behaviors hinge on a larger social system, and sustainable changes in health-related behaviors such as HH require altering behavior starting from lower age groups and supportive changes across a community as a system by using modern learning methods.

Conclusion: Based on our findings, we recommend this hypothesis to be be tested in a community trial and results observed in a prospectively followed cohort subject to a community intervention.

Disclosure of Interest: None declared

P135 NATIONAL GROUP FOR HAND HYGIENE - PRACTICE AND EXPERIENCES

L. Hobzova1, D. Vaculikova2

1Hygiene, epidemiology and infection control department , University Hospital Hradec Králové, Hradec Králové; 2Hygiene, epidemiology and infection control department , Masaryk City Hospital , ÚSTÍ NAD LABEM, Czech Republic
Correspondence: L. Hobzova

Abstract video clip: The National workong group for hand hygiene is a self-governing and voluntary association bringing together people working or related to work in the field of public health with a focus on promoting hand hygiene or training health and non-health workers in this area to pursue and fulfill common interests and goals, namely:· Support and maintain the development of the highest possible standards of hand hygiene· setting up the system of education of employees of individual professions in the area of health care in the hands· supporting scientific research activities and putting new knowledge into practice

· by submitting proposals to the authorities of state authority and other organizations and institutions.

Group was based in 2018, the goal is to present practice, experiences, achievements, options.

In 2018, as part of the World Day of Hand Hygiene, we focused on septic conditions, where hand hygiene is a key prevention factor in order to alert the professional and lay public to the importance of hand hygiene and to influence not only these serious conditions through good hand hygiene practice. We held a press conference on this subject.

Disclosure of Interest: None declared

P136 TRAIN-THE-TRAINERS PROGRAM AS A TOOL TO IMPROVE HAND HYGIENE PROMOTION CAPACITY IN PUBLIC MEXICAN HOSPITALS

H. Marquez Villarreal1, M. Hernández De Mezerville2, O. Gálvez De la Cruz1, D. Pittet3

1Universidad de Guadalajara, Guadalajara, Jalisco, Mexico; 2Hospital Nacional de Niños de Costa Rica Dr. Carlos Sáenz Herrera, San José, Costa Rica; 3The University of Geneva Hospitals, Geneve, Switzerland
Correspondence: H. Marquez Villarreal

Introduction: Hand hygiene (HH) is fundamental to prevent healthcare-associated infections (HAI), is promoted by WHO through the Multimodal HH Improvement Strategy (MHHIS) implementation. A useful tool to identify the promote hospitals capacity to HH is the HH Self-Assessment Framework (HHSAF), that serves as a diagnostic to identify key issues for improvement and to facilitate action plans formulation. A very useful tool to standardize training and intensify HH actions and interventions is the Train-The-Trainers (TTT) program, which contains promotional, conceptual and practical elements of HH implementation

Objectives: To determine the level of HH promotion capacity of Mexican public hospitals through the HHSAF application and to monitor the TTT program impact

Methods: It´s a prospective multicenter study using a mixed, quantitative and qualitative approach in 2017 and 2018. With a convenience sample of 23 public hospitals. TTT program was replicated in Nov/17 and May/18 to IPC teams members of the hospitals participating. Data were obtained through the HHSAF, that addresses 5 MHHIS elements, each with a maximum value of 100 points. The statistical analysis was descriptive and inferential, included measures of central tendency, frequencies and dispersion and the application of the Shapiro-Wilk and Student's T tests

Results: According to HHSAF, the institutions capacity to promote HH increased by a average of 21.74 points between 2017 & 2018, from 306.43+96.3 to 328.17+78.9, p<.05. Two MHHIS components were strengthened to a greater extent were "Reminders in the workplace" and "Institutional safety climate". Regarding the overall capacity of hospitals to promote HH, 8-34.8% hospitals were classified as intermediate, 8-34.4% as basic, 6-26.1% as advanced, and 1-4.3% as inadequate in 2017. In 2018, 15-65.2% as intermediate, 5-21.7% at advanced and 3-13% at basic

Conclusion: TTT program based on the WHO HHMIS proved to be effective in improving HH promotion, in particular to influence the safety culture in hospitals. It is important to highlight that programs must be implemented to replicate the courses within each hospital, since continuous training favors HH actions among all health workers, not only those participating to the TTT

Disclosure of Interest: None declared

Poster session: Promoting hand hygiene

P137 IDENTIFYING WHAT CONTRIBUTES TO THE SUCCESS OF INTERVENTIONS TO PROMOTE HAND HYGIENE IN PATIENT CARE: FINDINGS OF A SYSTEMATIC LITERATURE REVIEW AND THEMATIC SYNTHESIS

D. Gould, D. Gould

Cardiff University, Cardiff, United Kingdom
Correspondence: D. Gould

Introduction: Hand hygiene is the most important way of preventing healthcare-associated infection but is poorly undertaken by health workers. A Cochrane systematic review published in 2017 demonstrated that interventions to improve adherence to hand hygiene protocols are moderately effective but impact varies between organisations and sites.

Objectives: Undertake thematic synthesis to identify what contributes to a successful hand hygiene intervention

Methods: We undertook thematic synthesis to analyse interpretive information and commentary contained in the Cochrane-included publications to explore how hand hygiene interventions operate their effectiveness and suggest reasons for variations in success.

Results: Twenty one papers were reviewed: eleven randomised trials, one non-randomised trial and nine interrupted times series studies. In twenty papers methodological limitations were perceived to affect ability of the intervention to exert its effects. The Hawthorne effect arising when hand hygiene is documented manually was the most important methodological challenge, followed by other sources of bias. In eleven papers need for the intervention to align with local context was perceived to be important. In eleven papers need for organisational support was perceived to be important.

Conclusion: Thematic synthesis identified factors likely to affect the uptake of hand hygiene interventions and suggested new directions for research. More accurate and detailed reporting of contextual information in epidemiological studies could help explain how hand hygiene interventions operate in specific settings and help to identify messages to inform sustainability and transferability. Much could be learnt from the emerging disciplines of implementation science and quality improvement. Combining traditional systematic reviews with thematic synthesis maximised understanding of how hand hygiene interventions operate. This approach could improve understanding of how other infection prevention interventions exert their effects.

Disclosure of Interest: None declared

P138 IMPLEMENTATION OF THE WORLD HEALTH ORGANIZATION MULTIMODAL HAND HYGIENE IMPROVEMENT STRATEGY IN A UNIVERSITY HOSPITAL IN MOROCCO

S. ELHASSOUNI1, M. C. BENJELLOUN2, B. OUMOKHTAR1

1laboratory of microbiology and molecular biology., faculty of medicine and pharmacy; 2Department of pneumology, Hassan II University Hospital of Fez, fez, Morocco
Correspondence: S. ELHASSOUNI

Introduction: Hand hygiene (HH) is the most effective practice for health associated infections (HAI’s) prevention; however, this simple gesture is not always respected by healthcare workers (HCW’s)

Objectives: aimed to assess the effect of a multimodal improvement strategy on hand hygiene compliance in the Hassan II University Hospital in Fez, Morocco

Methods: We conducted a before-and-after interventional study between January and June 2018, in four wards of the University Hospital; two medicine wards, a chirurgical ward and a neonatal intensive care unit (NICU), direct observation was used to evaluate the effectiveness of a multimodal improvement strategy on the compliance of HH according to the “My 5 Moments of Hand Hygiene” defined by the World Health Organization (WHO). The intervention consisted of providing alcohol-based handrub dispensers at points of care, designing educational and training sessions on HH for all HCW’s, placement of general and individual reminders in the workplace and providing feedback on HH performance. Statistical analysis was performed using SPSS 21 for Windows (SPSS, Chicago, IL), and differences between variables were analyzed using the χ2 test

Results: A total of 1837 opportunities for HH were observed, with 921 opportunities at baseline and 916 opportunities at follow-up. The overall HH compliance improved significantly from 33,3% at baseline to 49,8% at follow-up (p<.05). Compliance of nurses increased from 33,9% to 53,5% (p<.05), and compliance of physicians improved from 30,3% to 50% (p<.05), however, compliance of nursing assistants (35,9% to 43,5%, p= 0,3) was low and did not improve significantly.

When stratified by indication, compliance with HH improved for all indications after intervention (P<.05) except for “before touching patient” and “after touching patient’s surroundings”

Conclusion: The implementation of a multimodal improvement strategy has significantly improved the HH compliance of HCW’s in the Hassan II University Hospital

Disclosure of Interest: None declared

P139 SAVING COSTS BY REDUCING THE DENSITY OF CENTRAL- LINE ASSOCIATED BLOODSTREAM INFECTION BECOMES FEASIBLE THE IMPLEMENTATION OF BEST QUALITY ALCOHOL IN PEDIATRIC INTENSIVE CARE UNITS

H. I. G. Giamberardino1, P. Krys2, J. Y. Kawagoe3, on behalf of Hospital Pequeno Principe

1Epidemiology and Infection Control Department, Hospital Pequeno Prinicpe; 2Epidemiology and Infection Control Department, Hospital Pequeno Principe, Curitiba; 3Prof.Master's Degree Nursing, Albert Einstein School of Health Sciences, Sao Paulo, Brazil
Correspondence: H. I. G. Giamberardino

Introduction:

Central- Line associated Blood Stream Infection (CLABSI) is the main quality indicator for pediatric hospitals, especially in neonatal units, and Hand Hygiene (HH) is the primary prevention measure for Health Care-associated Infections (HCAI), but guaranteeing its implementation in the various assistance situations, has been a great challenge. Analyzes of costs of are still little practiced by infection control teams, but their reduction can make investment in prevention possible.

Objectives: Analyze the impact of the improvement in the quality of the alcohol-based handrub in CLABSI desinties in three Intensive Care Units of a pediatric hospital and to calculate the possible savings costs that this prevention may bring.

Methods: The densities of IPCS were compared in the three ICUs: Cardiac, Pediatric and Neonatal. After the post-implantation (2016-2018) of better quality alcoholic solution in pediatric reference hospital. The cost of the IPCS was composed by the analysis of the number of extra days of hospitalization multiplied by the average cost / day of the patient in each ICU.

Results: Comparing the period before and after implantation of the new alcohol-based handrub we observed a reduction in the densities of CLABSI: 57.2% Cardiac ICU, 47.7% Pediatric ICU and 43.5% Neonatal ICU. The alcohol-based handrub consumption showed an average increase of 10% when compared with the pre-implantation and post-implantation period. The mean cost of CLABSI in these ICUs ranged from US $ 2500 to US $ 9000.00 and the average number of extra days of hospitalization was 10.4 days.

Conclusion:

Although there are other factors that interfere with the occurrence of IPCS, as a technique for insertion and manipulation of the central catheters, we observed that with the improvement of alcohol-based handrub quality, there was better adhesion to HH in these units and it was associatedwith the reduction in CLABSI desinties. Cost analysis and its preventive potential should also be considered and may helpin the allocation of resources that are already scarce in the health area, for the incorporation of better products and medical-hospital materials.

Disclosure of Interest: H. Giamberardino: None declared, P. Krys: None declared, J. Kawagoe Employee of: Patient Safety Consultant BBraun

P140 CAN THE CONSUMPTION OF ALCOHOL-BASED HANDRUB (ABHR) BE AN INDICATOR OF HAND HYGIENE (HH) COMPLIANCE?

A. Iten, J. Sztajzel, A. Peters, D. Pittet

Infection Control Program, HUG, Geneva, Switzerland
Correspondence: A. Iten

Introduction: WHO recommends regular assessment of hand hygiene (HH) compliance by healthcare workers during their care activities. Such assessment of the HH behavior of caregivers is essential for evaluating the success of an institution’s HH promotion strategy. Quantifying the consumption of the alcohol-based handrub (ABHR) formulation(s) is often considered a surrogate marker of HH compliance in[IA1] hospitals that don’t have the means to observe sufficiently.

Objectives: We compared HH compliance data and ABHR consumption collected from 2005 to 2018 at HUG

Methods: HH compliance is assessed by observers trained according to WHO recommendations (“My 5 Moments for HH”). The ABHR consumption is measured by the volume of ABHR delivered each year by HUG hospital pharmacy to the different wards and departments, expressed in L/1000 patient-days. We divided the overall time period into 3 phases (2005-2007; 2008-2010; 2011-2018) to account for the 2009 H1N1 pandemic typically associated with increased ABHR worldwide.

Results:
 

Years

(n)

Compliance rate at HH

(%)

ABHR distribution

(L/ 1000 day-patients)

2005-2007

Implementation phase

1

57

25.4

1

65

30.3

1

66

35.0

2008-2010

Pandemic 2009

1

61

35.9

1

62

50.3

1

64

40.2

2011-2018

Stabilization phase

1

67

43.3

3

69

47.7

Min. 47 ; Max. 48.1

4

70

44.2

Min. 43.2 ; Max 45.6

Conclusion: According to our results, the consumption/distribution of ABHR should not be considered as an indicator for HH compliance. It reflects the distribution of ABHR in a healthcare facility and should be interpreted according to the circumstances and the stage at which the HH promotion strategy is.

Disclosure of Interest: None declared

P141 MEASURING HAND HYGIENE PERFORMANCE BASED ON ALCOHOL-BASED HAND RUB USAGE IN HOSPITALS: A CROSS- BORDER PROJECT (I-4-1 HEALTH)

M. Verelst1, I. Willemsen2, V. Weterings2, A. Schuermans3, I. Leroux-Roels4, J. Kluytmans5 on behalf of i-4-1 Health study group

1Infection control, UZ Leuven, Leuven, Belgium; 2Infection control, Amphia hospital, Breda, Netherlands; 3Infection control, University hospital, Leuven; 4Infection control, University hospital, Gent, Belgium; 5Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands
Correspondence: M. Verelst

Introduction: Observation of healthcare workers is considered the golden standard to evaluate hand hygiene compliance (HHC). However, HHC can be threefold higher in eyesight of an auditor. Another indicator can be the consumption of alcohol based hand rub (ABHR).

Objectives: The goal of this study was to get more insight in the hand hygiene performance in different hospitals and countries by using the ABHR indicator.

Methods: Nine hospitals were asked to collect data on ABHR usage and patient days. The number of disinfection moments performed by patient day was calculated by dividing the volume of ABHR per patient days by the volume of ABHR per disinfection moment (approximately 2.5 ml).

Results: ABHR consumption data was collected over a period of time of at least 6 months, in 3 university hospitals (12 wards) and 3 general hospitals (12 wards). Three hospitals were not able to deliver data. The median number of disinfection moments per patient day was 10, with a range of 4 to 20. The median number of disinfection moments per day was significantly higher in university hospitals (13) than in general hospitals, 6 (p<0.001). The median amount of disinfection moments per patient day differed per medical specialty, however not significantly (cardiology and internal medicine 6; orthopaedics 10; surgery and urology 11; pulmonary diseases 13 and geriatrics 14).

Conclusion: This study showed that the majority of the hospitals (6) were able to collect consumption data of ABHR and gain objective information about HH performance. Large differences in ABHR use and number of disinfection moments between hospitals were found, with a significant difference between university and general hospitals.

Disclosure of Interest: None declared

P142 IMPLEMENTATION OF HAND HYGIENE PROGRAM IN TRNAVA UNIVERSITY HOSPITAL DURING PERIOD 2013-2019

J. Prnova1,2,3, V. Rusnakova1, J. Brnova2,3

1Department of Public Health, School of Health Sciences and Social Work, Trnava University, Slovakia; 2Department of Hospital Hygiene and Epidemiology, University Hospital Trnava, Slovakia; 3Centre of Microbiology and Infection Prevention, Trnava University, Slovakia, Trnava, Slovakia
Correspondence: J. Prnova

Introduction: Hand hygiene is a primary strategy to prevent healthcare-associated infections and the spread of antimicrobial resistance. The application of hand hygiene improvement program is required in Slovakia, but results are still not enough.

Objectives: Our objective was to evaluate the impact of implementing World Health Organization’s Multimodal Hand Hygiene Improvement Strategy in University Hospital Trnava.

Methods: We conducted before and after study in 638 beds University Hospital Trnava during 2013-2019. Key strategies included providing and revisiting alcohol-hand rub dispenser at the department, designed educational program, reminders for hand hygiene was placed and evaluated for hand hygiene compliance and alcohol hand rub consumptions.

Results: Alcohol hand rub consumptions significantly increased during 2013 to 2018 from 15.7 l/1,000 patient day up to 24.3 l/1,000 patient day (p<0.05). There was significant improvement of hand hygiene compliance from 39.9% (95% CI: 37.4 – 41.9) to 61.2% (95% CI: 58.2 – 65.4), (p<0.05).

Conclusion: Even though alcohol hand rub consumption has been increasing, compliance of hand hygiene among health care workers was found to be still low, but during interventions increased. The findings suggest continuous monitoring, education and immediate feedback are critical to success hand hygiene program.

This work was supported by a research grant from the MŠVVaŠ SR.

Disclosure of Interest: None declared

P143 SUCCESSFUL IMPROVEMENT OF HAND HYGIENE COMPLIANCE RATE BY IMPLEMENTING MULTIMODAL INTERVENTIONS AT TERTIARY HEALTHCARE CENTER IN SAUDI ARABIA

N. A. Bouafia1, W. A. Mazi1, M. A. Hamdi1, S. H. Alwagdani1, H. AlSofieni2, A. M. Dahlawi3, M. R. ALYAMI4

1INFECTION PREVENTION AND CONTROL, KING FAISAL MEDICAL COMPLEX; 2DELIVERY DEPARTMENT; 3MEDICAL DIRECTOR, MATERNITY TOWER - KING FAISAL MEDICAL COMPLEX; 4HOSPITAL DIRECTOR, KING FAISAL MEDICAL COMPLEX, TAIF, Saudi Arabia
Correspondence: N. A. Bouafia

Introduction: Hand hygiene (HH) is a growing concern among populations and is a crucial element in ensuring patient safety and prevention of healthcare associated infection.

Objectives: To reach a HH compliance rate of 80% within 3 months

Methods: Maternity Tower is a new building opened on January 2018 and annexed to King Faisal Medical complex – Taif, KSA. HH compliance rate monitored, during the first trimester 2018 (pre-interventional period), by direct observation of health care workers (HCW), using WHO Observational Tool, was about 63%. A quality improvement project based on FOCUS Plan-Do-Check-Act (PDCA) strategy was decided to be implemented particularly in area with low compliance rates. Delivery ward (DW) had the lowest rate with a pooled mean of 50% (61% nurses, 42% doctors).

An anonymous questionnaire was distributed to HCW (n=51) in order to understand barriers to HH compliance and guide the quality improvement team to implement the appropriate interventions.

Results: 40 HCW completed the questionnaire. Lack of knowledge (78.8%), skepticism of the value of hand hygiene (77.5%), simple forgetfulness (72.5%) and lack of role model (58.8%) were the most frequent factors affecting HH compliance.

Interventions implemented were: HH Campaign based on daily HH awareness in-service walk round, weekly educational sessions using WHO simulation scenario, monthly feedback about HH compliance, competitive creativity and educational messages (video, posters, brochures, etc.) with monthly awardees of HCW and involvement of patients in the project.

Thus, the H.H compliance rate reached 80 % in June 2018 with respectively 81 % and 78% for Nurses and doctors.

Conclusion: The objective of our project was achieved for nurses. Continuous training education is undergone hospital wide, mainly for doctors to achieve the MOH standard (80%)

Disclosure of Interest: None declared

P144 HAND HYGIENE EXCELLENCE AMERICA LATINA(HHEA-LATAM): EXPERIENCE OF A PEDIATRIC HOSPITAL

H. I. G. Giamberardino1, J. Y. Kawagoe2, A. P. O. Pacheco3, B. D. Matucheski1, L. P. Carvalho1 on behalf of Hospital Pequeno Principe - Department of Epidemiology and Infection Control

1Epidemiology and Infection Control Department, Hospital Pequeno Principe, Curitiba; 2Professional Master's Degree in Nursing, Albert Einstein Israelite School of Health Sciences, Sao Paulo; 3Epidemiology and Infection Control, Hospital Pequeno Principe, Curitiba, Brazil
Correspondence: H. I. G. Giamberardino

Introduction: Hand hygiene (HH) is the main pillar for the prevention of Health Care-Associated Infections (HCAIs) and in the Pequeno Principe Hospital (HPP) is considered a strategic institutional goal.

Objectives: Describe the actions to apply for HHEA-LATAM 2018.

Methods: The HPP is the largest pediatric hospital in Brazil, Curitiba-PR.It is philanthropic and university hospital, with 360 beds, 66 of which distributed in four intensive care units In September of 2017 we submited form to the HHEA-LATAM, a platform to identify hospitals and groups who improving patient safety, this process was developed by WHO and the Collaborating Centre on Patient Safety, University of Geneva Hospitals . In August 2018 experts in infection control evaluated hospital performance.The HPP has progressively implemented the five key components of the WHO multimodal HH improvement strategy The preparation for this evaluation involved all hospital staff, within 11 months period.

Results: Several actions were implemented and intensified: 1) relocation of HH products 2) improvement in the quality of the alcohol-based handrub;3) training in the admission of new employees, for multidisciplinary teams, academicians and residents of medicine, pharmacy, nursing, biomedicine, volunteers and family members ;4) improvement of HH indicators, consumption of alcohol-based handrub by patients-day and units,adherence to the five moments of HH, degree of family satisfaction with HH by HCWs; 5) created the "vigiometer" specific form to share the indicators with each unit / team, 6) periodic updates on HH reminders and educational materials 6)innovative approaches such as global icon (Pelé) involvement in video showing that every time the HCW practices HH is making a "goal" for the prevention of HCAI.

Conclusion: Being one of the winning hospitals was a great learning opportunity, reinforcing the importance of continuous self-evaluation over the time, and more future responsibility in the continuous search for excellence in HH.

References

Guide to Implementation of the WHO Multimodal Hand Hygiene Improvement Strategy(https://www.who.int/gpsc/5may/Guide_to_Implementation.pdf)

Disclosure of Interest: H. Giamberardino: None declared, J. Kawagoe Employee of: Patient Safety Consultant BBraun, A. P. Pacheco: None declared, B. Matucheski: None declared, L. Carvalho: None declared

P145 IMPROVING HAND HYGIENE COMPLIANCE AND REDUCING HEALTHCARE-ASSOCIATED INFECTIONS: LEADERSHIP AND MANAGERIAL SUPPORT CREATES THE TIPPING POINT

B. Du Toit, on behalf of Corporate Hand hygiene Committee

Clinical, Mediclinic Southern Africa, Stellenbosch , South Africa
Correspondence: B. Du Toit

Introduction: Hand hygiene is one of the most important interventions to prevent healthcare-associated infections (HAIs). Compliance is often suboptimal, contributing to the spread of multidrug resistant pathogens and the development of HAIs. Improving compliance is ongoing and requires leadership and managerial support.

Objectives: To reduce HAIs by improving hand hygiene compliance.

Methods: Improving compliance has been seen as the sole responsibility of the IPC practitioner. In 2017 a project was initiated to improve hand hygiene compliance and clinical outcomes in 52 hospitals in Southern Africa. A task team, consisting of the Chief Operating Officer, Chief Clinical Officer and senior managers developed a strategy, based on the multimodal hand hygiene strategy of the World Health Organisation (WHO). Interventions included a baseline knowledge and facility assessment utilising the tools provided by the WHO. A system change ensured that alcohol handrub is available at the point of care and training focused on practical scenarios to ensure theory practise integration. An electronic tool was developed to capture compliance and the institutional safety climate was enhanced by adding hand hygiene as a key performance indicator, displaying compliance rates and discussing it at meetings. The strategy and a position paper were circulated to doctors. A Pearson’s correlation and simple linear regression test was performed, utilising STATA software to establish whether there was a statistical significant correlation between improvement in hand hygiene compliance and reduction in HAI rate.

Results: Since the commencement of the project 6053 healthcare workers were trained on hand hygiene. Compliance amongst healthcare workers improved with 33.4% from 56% in June 2013 to 74.4% in April 2019. A statistical significant inverse correlation between hand hygiene compliance and reduction in HAI rate was furthermore observed (R2 = 0.14, p=0.001). No statistical significant shift has been observed in the use of alcohol handrub compared to hand washing.

Conclusion: It is not sufficient to only improve the knowledge of staff and to provide alcohol at the point of care to improve compliance. Management and leadership support are critical factors for sustainable improvement in compliance.

References

Disclosure of Interest: None declared

P146 THE RIGHT ACTION AT THE RIGHT TIME: ANALYSIS OF SPECIFIC HAND HYGIENE CONDUCTS AND ITS INFLUENCE IN THE IMPLEMENTATION OF LONG-TERM HAND HYGIENE BUNDLES IN MEXICO

O. Y. Bello-Chavolla1, M. A. Guedez2, M. E. Navarrete-Romero2, J. A. Pacheco-Martínez2

1Universidad Nacional Autónoma de México; 2B.Braun Mexico, Mexico City, Mexico
Correspondence: O. Y. Bello-Chavolla

Introduction: Hand hygiene bundles (HHBs) are strategies to facilitate implementation of the WHO multimodal strategy to increase HH compliance (HHC). The hand-rub (HR) to handwashing (HW) ratio (HHr) as recommended by WHO consists of 5 actions of HR per action of HW to decrease time dedicated to HH and increase HHC.

Objectives: To demonstrate that HHr compared to HHC rates is a better index of resistance to changes in HH conducts and thus a better marker of the efficacy of HHBs implementations, using evidence from real-life implementation of HHBs in Mexico.

Methods: We conducted a 3-year follow-up in three medical facilities in which HHBs were implemented. Monthly direct observation measurements were carried out by trained personal according to WHO’s HH moments and health personnel. HH actions were registered as HR with alcohol solution, HW, omission and inappropriate use of gloves. The HHr was calculated as well as HHC rates during follow-up.

Results: During the first 12 months of follow-up we observed a significant increase in HHC with steady increases from baseline HHC between 10-20% to rates ranging 45-55% (R2=0.6579) with an average HHr of 1.8. The second period of assessment from months 12-24 saw a decrease in the rate of HHC increases from 45-55% to 55-65% (R2=0.1099, an 18% increase); in contrast, the HHr had an average of 3.5 actions of HR per HW actions, representing a 94% increase from the previous period. Finally, during the third year HHC rates remained steady, oscillating between 55-70% in all facilities (R2=0.0034); nevertheless, we observed a steady increase in the HHr (R2=0.5538) with an average of 4.5 HR per HW actions, representing a 28.6% increase. When assessed by personnel category, nurse personal had steadier increases in HHC rates but not HHr (p<0.001), indicating higher resistance to change compared to physicians and in-training personnel. We observed no direct relationship between HHC rates and the HHr in any of the evaluated facilities.

Conclusion: HHBs for the implementation of the multimodal strategy of WHO to increase HHC has the potential to offer strategic recommendations per service, personnel category and HH moment using the HHr as an indicative of resistance to change instead of HHC rates.

Disclosure of Interest: O. Y. Bello-Chavolla Consultant for: B. Braun Mexico, M. Guedez Employee of: B. Braun Mexico, M. Navarrete-Romero Employee of: B. Braun Mexico, J. A. Pacheco-Martínez: None declared

P147 NEW ZEALAND HAND HYGIENE PROGRAMME: REQUIREMENTS TO SUSTAIN IMPROVEMENT IN A CHANGING ENVIRONMENT

S. Roberts, N. Grae

Infection Prevention & Control Programme, Health Quality & Safety Commission, Wellington, New Zealand
Correspondence: S. Roberts

Introduction: A national hand hygiene programme (HHNZ) across all publicly-funded hospitals started in 2011. Public reporting of performance started in July 2012. HHNZ provided coordination, communication expertise, clinical leadership and auditor training. In February 2016 it was felt that the necessary structure was in place for HHNZ to be self-sustaining and funding was reduced. Three years later we reflect on the outcome of this decision.

Objectives: We reflect on the essential requirements to sustain a successful national hand hygiene programme.

Methods: Qualitative information was gathered from webinars held with hand hygiene coordinators in 2017, follow-up interviews with individual hand hygiene coordinators in late 2017-2018, feedback at a national workshop in 2018, discussions at regional meetings, and through discussion with hand hygiene coordinators unable to sustain nationally agreed auditing requirements. This allowed the key challenges to sustaining a successful programme at a local level to be identified.

Results: The success of the regional networks was variable. Outside of the main centres the geographical distance between some hospitals was an impediment to participating in regional networks. As a result the support for training of auditors by the regional network was limited. Equally, there were limited auditor training opportunities throughout the year and the demand exceeded the capacity for auditor training. For smaller hospitals, if key staff left, they often struggled to maintain the programme.

Without national coordination, oversight of gold auditors was not optimal; annual validation was not always undertaken, nor did newly trained gold auditors remain active auditors suggesting that the selection of auditors may not be optimal.

Public reporting and national leadership for activities such as World Hand Hygiene Day and Patient Safety Week were seen as key drivers for changing behaviour.

Conclusion: The key elements required to support the HHNZ programme were identified. These include a nationally-led process to support the training of gold auditor trainers and of gold auditors and also to ensure annual validation by gold auditors. Regular updates, either via online meetings or face-to-face workshops, are necessary to ensure hand hygiene remains a priority regardless of staff turnover.

Disclosure of Interest: None declared

P148 A SUCCESSFUL HAND HYGIENE PROGRAM IN SAUDI ARABIA

B. Molaeb

Infection Prevention and Control, Almoosa Specialist Hospital, Al-Ahsa, Saudi Arabia

Introduction: Hand hygiene (HH) is the primary measure to reduce infections. ​Improving HH compliance and implementing sustainable interventions constitute major challenges in healthcare.

Objectives: To provide an overview of a successful HH program that improved HH compliance for healthcare workers (HCW) and increased HH awareness in community.

Methods: Beginning in 2016, new multimodal strategies for HH improvement based on the World Health Organization (WHO) initiatives were implemented. These included adopting the WHO HH surveillance tool, introducing interactive HH training tools, developing goals for compliance, using visual HH reminders, ensuring leadership support, providing performance feedback, rewarding compliant HCWs, conducting massive HH awareness campaigns and introducing mobile app technology for direct observations in all units. Hospital-wide HH observations were collected and analyzed. Patient feedback on HCWs’ HH practices was obtained through Press Ganey surveys. Z-test was used to compare the percentage change and a p-value less than 0.05 was considered significant. Community HH activities included booths in the facility, visits to schools, universities and parks. In May 2018, an attempt to achieve Guinness World Record (GWR) for the largest HH lesson was made. In May 2019, the campaign was concluded by forming a large human image of a hand.

Results: The overall HH rate increased from 76% in 2015 to 87% in 2018 (14.5% increase, p-value<0.05) and has been maintained above that level till date. HH compliance increased by 24% for both doctors and nurses, 32% for technicians and 39% for other HCWs. Patient satisfaction with HCW’s HH practice increased from 75% in 2015 to 89% in 2018 (19% increase, p- value<0.05). Community campaigns covered 6,300 individuals, achieved GWR with 714 participants and included 300 persons forming the largest human image of a clean hand in Saudi Arabia.

Conclusion: Multimodal innovative approaches to HH measurement, monitoring and education have been successful in improving HH compliance rates, maximizing community coverage and resulting in sustained improvement.

Disclosure of Interest: None declared

P149 IMPLEMENTATION OF THE WHO HAND HYGIENE STRATEGY IN FARANAH REGIONAL HOSPITAL, GUINEA

A. Diallo1, S. Müller2, SA. Müller1, AOK. Diallo2, R. Wood1, O. Tounkara2, M. Arvand1, M. Diallo2, M. Borchert1

1PASQUALE, PASQUALE, Faranah, Guinea; 2PASQUALE, RKI, Berlin, Germany
Correspondence: A. Diallo

Introduction: Nosocomial infections are the most frequent adverse events in healthcare worldwide, with limited available evidence suggesting highest burden in resource-limited settings. Recent epidemics emphasize the disastrous impact that spread of infectious agents within healthcare facilities can have, accentuating the need for improvement of infection control practices. Hand hygiene (HH) measures are considered to be the most effective tool to prevent nosocomial infections. However, HH knowledge and compliance are low, especially in vulnerable settings such as Guinea.

Objectives: To assess knowledge and compliance with HH, improve HH and strengthen hospital performance by incorporating the WHO HH Strategy including the local production of alcohol-based hand-rub (ABHR).

Methods: All currently contracted healthcare workers in the Faranah Regional Hospital (HRF) were invited to participate. A baseline assessment of HH knowledge, perception and compliance was performed 12 months before the intervention. The tailored intervention consisted of a training adapted to the needs identified in the baseline assessment and the reintroduction of local production of ABHR. A first follow-up assessment was conducted directly after the intervention, with a second planned at the six month interval. Effectiveness of the implementation was assessed via before-and-after comparison.

Results: The survey included a vast majority of all health care workers. Baseline knowledge and compliance were low (52.4%; 23.4%, respectively), but showed a significant increase (75.6%; 71.3%; respectively) upon follow-up. The reintroduction of ABHR production resulted in a four-fold increase of monthly hospital consumption. The WHO HH Strategy was rated to be effective in perception surveys throughout.

Conclusion: This study demonstrated that the WHO HH strategy is an adaptable and effective method to improve HH knowledge and compliance in the resource-limited setting of HRF. Local production is a feasible method for providing self-sufficient supply of ABHR to regional hospitals such as HRF. Participatory approaches, such as hygiene committee ownership of regular trainings and project-specific tasks, enhance prospects of sustainability.

Disclosure of Interest: None declared

P150 IMPROVEMENT OF HAND HYGIENE (HH) COMPLIANCE, USING THE WHO MULTIMODAL STRATEGY: RESULTS FROM A ROMANIAN HOSPITAL

T. Ionescu1, N. Georgescu1, D. Bandrabur1, E. Tartari2, L. Stingaciu1, D. Rusu1, M. Muscalu1, F. Staicu1, M. Florica1, N. Nitu1, C. Mocanu1, D. Dunca1, M. Vengher1, H. Rahimian1, C. Palade1, D. Pittet2

1Baneasa Hospital, Regina Maria Private Healthcare Network, Bucharest, Romania, 2The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Correspondence: T. Ionescu

Introduction: The hospital has enrolled in an international accreditation system for quality and patient safety. To date no HH compliance data have been published in Romania.

Objectives: We describe our HH improvement programme and compliance trends between 2013-2018.

Methods: Between 2013 and 2016, we developed checklists for the quality audits, including a programme for HH. In 2017, HH compliance data were collected regularly based on the WHO HH observation form by trained practitioners. Alcohol based hand rub (ABHR) was introduced at the point of care at the start of the HH programme and the number of ABHR dispensers has increased progressively. In 2018, the Ministry of Health pledged to join the WHO Clean Care is Safer Care to promote best HH practices in the country. The hospital registered for the WHO Save Lives: Clean Your Hands campaign and has applied for the Hand Hygiene Excellence Award (HHEA).

Results: The Joint Commission International (JCI) accredited the hospital in 2014 and 2017. Reducing the risk of healthcare-associated infections through hand hygiene is one of the six mandatory International Patient Safety Goals of JCI. A total of 400 HH opportunities were observed in 2013, while a three-fold increase was recorded in 2018 (1500). We developed educational materials and HH courses for healthcare workers. Audit sessions showed increased compliance in 2014 (90%), the year of an international accreditation, and lower rates in the following years. At the introduction of WHO observation form, in 2017, HH compliance averaged 74%, peaking at 87.5% before a re-accreditation visit. The highest compliance rate (95%) was achieved in 2018, at the time of the HHEA experts visit. ABHR has increased to more than 40L/1000 pt-days. The programme at our hospital has extended throughout the entire network (hospitals and outpatient).

Conclusion: The international accreditation process and the HHEA enrollment have been instrumental in improving HH compliance, but sustainability is a continuous challenge. Continuous initiatives and leadership commitment are significant.

Disclosure of Interest: None declared

P151 EFFECTIVE IMPLEMENTATION OF THE WORLD HEALTH ORGANISATION MULTIMODAL HANG HYGIENE IMPROVEMENT STRATEGY IN A INTENSIVE CARE UNIT OF A UNIVERSITY HOSPITAL IN MADAGASCAR

S. Gaimard1, P. Nerrant1, T. Rakotovao2, C. Andrinalimanana2, C. Guittard3, L. Di Trapani1

1PAH, pharmaciens humanitaires, Paris, France; 2CHU Tambohobe, Fianarantosa, Madagascar; 3spci, HUG, Genève, Switzerland
Correspondence: S. Gaimard

Introduction: Each year, hundreds of millions of patients around the world are affected by health care-associated infections (HAI), according to the World Health Organisation (WHO). Adequate hand hygiene (HH) is considered the most effective measure to prevent HAI1. Lack of hygiene products and access to drinking-water are the main reasons for failure in HH compliance in Madagascar.

Objectives: We assessed the effectiveness of the WHO multimodal HH improvement strategy (MHHSI) in an Intensive Care Unit (ICU) in a university hospital in Madagascar.

Methods: We conducted a before and after study from January to March with a pre and post-intervention period of 2 weeks. The intervention was an adaptation of the WHO MHHSI to the local requirements. It consisted of introducing a locally manufactured alcohol-based handrub (ABHR), designing an educational program for health care workers (HCW), providing monitoring and feedback and posting reminders at workplaces. We evaluated HCW knowledge and perceptions; ABHR access; HH ‘WHO 5 moments’ and prerequisite compliances and ABHR consumption.

Results: HCW knowledge increased with an average score of 61% before and 83.5% after the educational program. Even if HCW have a good understanding of HH theoretical prerequisites (average mark of 82%), only 44% apply it correctly after our intervention. HH compliance increased from 18% before to 35% after our intervention (p<0.0018). In March 89% of HCW said they had better access to ABHR due to 30% reduction in price for patients and a monthly free endowment of 100mL per HCW. ABHR consumption enhanced from 0.95L/month to 6L/month.

Conclusion: Setting up WHO’s MHHSI promotion campaign allowed us to make HCW aware of HH, to increase ABHR’s provision in the ICU, and also their compliance to HH.However we need to continue to promote HH and extend this project to the entire hospital. To maintain and pursue this project, we must introduce an institutional safety climate with regular teaching courses and audits throughout the hospital.

References

1 Pittet D, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme’ Lancet. 2000;356(9238):1307–1312.

Disclosure of Interest: None declared

P152 IMPACT OF HAND HYGIENE COMPLIANCE IN VARIOUS WARDS IN KABALE REGIONAL REFFERAL HOSPITAL

E. John, B. LILIAN, M. Namutebi, S. Namasopo, F. Kizito

SURGERY, MINISTRY OF HEALTH UGANDA, KABALE REGIONAL REFERRAL HOSPITAL, KAMPALA/KABALE, Uganda
Correspondence: E. John

Introduction: The WHO guide lines 2017 posed question, how significant is the problem of infection s in the health care across the world and suggested that the problem is huge, and estimated that about 1.4 million cases of hospital acquired infections among others surgical site infections and said it was likely to be low due to lack of proper surveillance. Most cases these infections are attributed to poor hand hygiene among other causes. Hand hygiene compliance is still a challenge in Kabale Regional Referral Hospital, with 24% compliance rates in 2016 to 2018.

METHOD: Introduction of quality improvement project on hand hygiene compliance by staff and students which identified the following tested changes at various service delivery points. Training of the appointed staffs on how to manufacture locally Alcohol Based Hand Rub (ABHR), Installation of the ABHR Dispensers, monthly continuous medical educations, monthly monitoring of hand hygiene compliance using the World Health Organization (WHO) standard checklist and Monthly feedback to the various wards.

RESULTS: Proper hand hygiene compliance among staff and students has resulted in reduced levels of hospital acquired infections and reduced risks of contracting contagious infections in wards with 50% improvement in 2019.

DISCUSION: Hand hygiene compliance is the first and easiest way of addressing the risks of contracting contagious infections reduction on the levels of cross infections and also has reduction on anti-microbial resistance in Kabale Regional Referral Hospital.

CONCLUSION: Hand hygiene compliance is the first and easiest way of reducing the spread of the infections among staffs, students and patients at large only if absorbed everywhere in addressing gaps in infection prevention and control in various health care settings.

Disclosure of Interest: None declared

P153 ADAPT TO ADOPT: SPREADING THE MESSAGE OF HAND HYGIENE THROUGH A SONG

A. Peters, C. Guitart, T. Borzykowski, F. Timurkaynak, M. De Kraker, D. Pittet

SPCI, HUG, Geneva, Switzerland
Correspondence: A. Peters

Introduction: Finding new ways to increase compliance with hand hygiene (HH) and avoid campaign fatigue is central to sustain improvement. Implementation of interventions that target healthcare worker behavior change is challenging. As the largest patient safety initiative in the world, the global HH promotion campaign SAVE LIVES: Clean Your Hands has been a leader in creative approaches to keeping a worldwide audience engaged.

Objectives: To create a song for promoting HH worldwide and to implement an assessment approach to compare several HH campaign communication tools.

Methods: This year, in honor of World HH Day on May 5th, the WHO Collaborating Center on Patient Safety at the University of Geneva Hospitals composed an original song incorporating key messages and slogans defined by WHO. We produced a video and shared it on YouTube with our contacts around the world. We studied the diffusion of the video on several social media and compared it to prior initiatives and tools we developed in the past.

Results: The video for “It’s in Your Hands” was posted online on 24 April 2019, and has been seen over 28,000 times (28,342 as of 25 May; www.tinyurl.com/ItsInYourHands). Numerous countries have already requested the translations; and a hospital team in Vietnam even translated and recorded the song and made a music video in Vietnamese. Currently, we are working on a promotion strategy and on making subtitles in different languages so that people around the world can adapt the message to fit their own social context. Data will be presented to highlight the spread of the song, as a marker of the HH campaign endorsement, and compared to other indicators of the SAVE LIVES: Clean Your Hands campaign spread at 1, 2, 3, 4 months, and include predictions at 6, 12, 18 and 24 months. Comparisons will be made between the spread of the song “It’s in Your Hands” launched in 2019 and the HH dance (> 0.5 million view on YouTube; launched on the first World HH Day, 5 May 2009).

Conclusion: Incorporating innovative tools such as songs can be an effective way to help engage healthcare workers and institutions. A possible next step would be to quantify the impact that such an engagement.

Disclosure of Interest: None declared

P154 FIVE MOMENTS TO CARE: ASSESSING ROLE OF SEQUENTIAL MMI ON HCWS’ 5 MOMENTS FOR HAND HYGIENE IN BANGLADESH

L. Ara, F. Hossain, M. E. H. Tamal, M. Ibrahim, M. R. H. Khan Abir, M. N. H. Alam, M. S. A. Sarker

Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
Correspondence: L. Ara

Introduction: Adequate adherence to hand hygiene (HH) is a global healthcare challenge. To enhance this fundamental infection prevention and control (IPC) practice among healthcare workers (HCWs), WHO recommended a multimodal design and five prime moments (FPMs) for HH.

Objectives: Our study aimed to evaluate the role of individual components of multimodal intervention (MMI) in improving HCWs’ HH compliance (HHC) to the FPMs in Bangladesh.

Methods: A quasi experimental study was conducted in 2 intervention and 1 control hospitals of Bangladesh. Data were collected at baseline, endline and the consecutive weeks following implementation of each MMI component (system change, education and training, visual reminder, feedback/incentive) in sequence. Doctors and nurses were directly observed practicing HH in the FPMs: (1) before touching a patient, (2) before aseptic procedure, (3) after risk of fluid exposure, (4) after touching a patient and (5) after touching patient surroundings. Additionally, the feedback component of MMI was replaced with incentive provision (certificate) in one intervention hospital.

Results: A total of 6223 HH opportunities were observed from both arms. At intervention arm, doctors’ HHC exhibited maximum improvements to Moments 2 (from 4.7% to 76.6%, OR:66.9, CI:25.3-176.8, p<0.01) and 3 (from 8.0% to 81.6%, OR:50.3, CI:23.1-111.6, p<0.01) after education and training (ET) intervention. Similarly, nurses adhered to HHC more in Moments 2 (from 1.9% to 38.9%, OR:33.8, CI:10.3-110.9, p<0.01) and 3 (from 2.5% to 42.2% OR:29.0, CI:10.2-82.3, p<0.01) following implementations of visual reminders (VR) and ET interventions respectively, while the control arm remained unaltered. HHC was more complaint in incentive (13.3%) than the feedback arm (8.8%).

Conclusion: Study findings substantiate the success of ET and VR components of MMI in enhancing HCWs’ HHC to Moments 2 and 3. Therefore such evidence-based strategies can be further incorporated in healthcare policies of Bangladesh and other resource-constrained settings for effective IPC.

Disclosure of Interest: None declared

P155 HANDHYGIENE COMPLIANCE WITH THE FIVE MOMENTS BY HEALTH WORKERS IN BENIN HOSPITAL’S

T. A. Ahoyo1, S. ASSAVEDO2, P. F. D. FONTON1

1BIOLOGIE HUMAINE, EPAC/UAC, ABOMEY CALAVI; 2MINISTERE SANTE CABINET, MINISTERE SANTE, COTONOU, Benin
Correspondence: T. A. Ahoyo

Introduction: In the context of outbreak of LASSA fever in Benin 2014, WorldHealth Organization and other partners, have initiated and supported the implementation of a program to prevent and control infection. A national hand hygiene promotion campaign based on WHO multimodal strategy was launched in 2015.

Objectives: We assessed the feasibility and compliance with the five moments for hand hygiene by healthworkers in Benin hospitals

Methods: The study was carried out between June 2015 to September 2018 in ten (10) tertiary hospitals included in IPC progam. Data were collected in 10 intense care units using methods and tools provide by WHO, a particular attention was paid to handling devices such as intravenous catheter, urinary catheter and dressing. We used R version 3.5.2 for statistics

Results: HCW’S compliance with the five moments for hand hygiene increased from baseline 16.83 % CI 95% (16.32- 17.36) to 40. 2% CI 95% (39.6 - 41.1), the indication 3 was the most observed from baseline 31% CI 95% (29.49 - 32.64) to 55.7 % CI 95% (54.21 - 57.3), The most commonly observed handlings were the manipulation of venous catheters 63,2%, the higtestest compliance was noticed with the manipulation of dressing 75, 3 %. Bloodstream infection decrease from 18% CI 95% (17.09- 18.26 to 4.8% CI 95% (4.49- 5.04)

A wide variation in handhygiène compliance among hospitals was observed, the most important result was the lower incidence of blooostream during these 3 years

Conclusion: Efforts to involve more hospitals in hand hygiene program should be intensified,with local financing

Keywords: Patient safety, World Health Organisation, Behavior change, Hand hygiène

References

1 Allegranzi B, Sax H, Bengaly L, et al. Successful Implementation of the world health organization hand hygiene improvement strategy in a referral hospital in Mali, Africa. Infect Control Hosp Epidemiol 2010; 31(2): 133-141

2 Abdulsalam M, Ibrahim A, Michael G, et al. Hand washing practicesand techniques among health professionals in a tertiary hospital in Kano. J Med Investig Pract 2015; 10(1): 8-12

Disclosure of Interest: None declared

P156 INVESTIGATING THE EFFECT OF SHORT DAILY HAND HYGIENE PRACTICE ON ACHIEVING PROFICIENCY: A PROSPECTIVE COHORT STUDY

L. Price, L. Gozdzielewska, K. McAloney

School of Health & Life Sciences/Institute for Applied Health Research, GLASGOW CALEDONIAN UNIVERSITY, Glasgow, United Kingdom
Correspondence: L. Price

Introduction: Hand hygiene training aims to develop participants’ proficiency in performing the World Health Organization technique without prompts. In this study we explored the impact of short daily hand hygiene practice with feedback (deliberate practice) in achieving proficiency.

Objectives:

Methods: Staff and students in a university volunteered to practice hand hygiene using the SureWash® app on their phone or tablet on a daily basis for four weeks. App data provided information on the frequency of practice and the achieved level of performance. In addition, once a week participants were observed, by the researchers, performing hand hygiene using the SureWash® ELITE system to assess their level of performance.

The assessment at which proficiency was achieved was translated into the number of training sessions required, and investigated in relation to data gathered on the participants’ gender, age group, previous training experiences, manual dexterity, and adherence with the protocol, using T-tests.

Results: Data from 47 participants demonstrated that 38 (81%) achieved proficiency. The mean number of sessions to achieve proficiency was 24.3 (sd = 17.8). Daily practice decreased from 28% (N = 13) in week 1 to 15% (N = 7) in week 4. There was no significant difference in age, previous training or manual dexterity but males required fewer training sessions to achieve proficiency (15.3 v 27.83, t (35.92) = -2.914, p = .006). The analysis was power calculated for moderate effects.

Conclusion: Our results suggest that the use of short daily hand hygiene practice shows promise in promoting proficiency. They challenge the current culture of single training sessions repeated annually or biannually as being sufficient to achieve proficiency. We recommended that infection prevention and control teams consider the use of deliberate practice for use in hand hygiene training along with concurrent longitudinal evaluation of its effectiveness in comparison to current practice.

Disclosure of Interest: None declared

P157 ACCEPTABILITY AND TOLERABILITY OF ALCOHOL-BASED HAND HYGIENE PRODUCTS FOR ELDERLY RESIDENTS IN LONG-TERM CARE; A CROSSOVER STUDY

M. O’Donoghue1, J. M. Ho1, D. Pittet2, L. K. Suen1

1Squina International Centre for Infection Control, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong; 2Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland
Correspondence: M. O’Donoghue

Introduction: Efforts to improve hand hygiene in healthcare settings have largely targeted healthcare worker (HCW) compliance but its importance for patients, including those in long-term care facilities (LTCFs), is receiving increased attention. Alcohol-based hand rub (ABHR) can lead to improved compliance.

Objectives: To determine acceptability and tolerability of two ABHRs for hand hygiene of elderly LTCF residents using a modified version of the WHO protocol.

Methods: 36 elderly LTCF residents participated in this crossover study. A modified and translated (Chinese) version of the WHO protocol for evaluation of two or more ABHRs was used to evaluate product acceptability and tolerability for one gel (bottle with reclosable cap) and one foam (pump). During each 3-day testing period, participants received their own portable bottle of ABHR. A research nurse objectively assessed hand skin integrity at baseline and throughout the study. Skin moisture content was determined using a Moisture Checker (STR, Ca, USA). Participants rated ABHR tolerability and acceptability using the WHO checklist at the end of each test period.

Results: Both products passed the WHO criteria for acceptability and tolerability. The foam (86%) scored higher than the gel (51%) for ease of use possibly because some participants found the cap of the gel bottle difficult to open due to finger stiffness. No evidence of damage to skin integrity was observed. Overall, skin moisture content improved by the end of the study. Residents preferred either test product to the ABHR rinse currently in use by the LTCF.

Conclusion: Elderly LTCF residents were willing to use ABHR for hand hygiene. Both ABHRs were well tolerated and preferred over the usual product. Forgetfulness and difficulties in hand rubbing due to finger stiffness was a barrier for some residents. HCW-assisted hand hygiene at specified times daily and reminders to perform hand hygiene could offer a feasible and sustainable strategy to overcome these challenges.

Disclosure of Interest: None declared

Poster session: Behaviour

P158 IMPROVING WASTE MANAGEMENT PRACTICES AMONG HEALTH CARE WORKERS IN A LARGE PUBLIC HOSPITAL IN UGANDA.

M. S. Kesande1, W. Omuut1, J. Agwang2, J. Nanyondo1, M. Lamorde1

1Global Health Security Project, Infectious Diseases Institute, Makerere University, Kampala, Kampala; 2IPC focal person, Jinja Regional Referral Hospital, Jinja, Uganda
Correspondence: M. S. Kesande

Introduction: Waste management is one of the IPC standards with poorest performance in developing countries; this can be attributed to deficiencies in supplies, poor attitude of health workers and limited involvement of facility leadership. The Infectious Diseases Institute (IDI) Global Health Security project designed a model to improve waste management at Jinja Regional Referral Hospital.

Objectives: To demonstrate a model to improve waste management practices among health workers.

Methods: In a bid to improve Infection Prevention and Control (IPC) in health facilities, IPC committees have been formulated to lead the process. IDI trains these committees on standard precautions, roles and responsibilities of committee members and institutes routine waste quantification and feedback exercises in regional referral hospitals. Waste handlers are also trained on use of Personal Protective Equipment (PPE), waste collection, transportation and disposal.

Engaging IPC committees as drivers of the process; the committee members have trained 170 fellow health workers and 41waste handlers on waste management components. Waste quantification and feedback exercises have been instituted as well as involvement of the hospital leadership in planning meetings of the waste management subcommittee.

Results: More CMEs targeting waste management components have been conducted quarterly. Improved waste segregation demonstrated by increase in percentage of non-infectious waste from 0% in July to 69% in September 2018. This demonstrated less mixing of waste though the facility has not yet reached the expected standard of 85% for non-infectious waste. The training and routine CMEs have instigated improved use of Personal Protective Equipment (PPE) and proper waste disposal among waste handlers.

Conclusion: Use of IPC committees should be utilized as change agents to improve compliance to waste management practices. Improved practices will help to leverage cost savings that can be redirected for further improvements.

Disclosure of Interest: None declared

P159 DEVELOPING A PROTOCOL TO DEAL WITH DISINFORMATION AND FAKE NEWS IN INFECTION PREVENTION AND CONTROL

A. Peters1, R. Martischang1, C. Guitart1, N. Lotfinejad2, D. Pittet1

1University Hospitals of Geneva, Geneva, Switzerland, 2Mashhad University of Medical Sciences, Mashad, Iran, Islamic Republic Of
Correspondence: A. Peters

Introduction: Although misinformation has always existed, the scope and speed at which fake news can reach even the most remote corners of the globe is a modern phenomenon. In the field of infection prevention and control (IPC), we like to believe that our dedication to the field and the process of conducting science protects us from the ravages of 'bad buzz' and fake news. This misconception leads medical professionals to underestimate the negative effects of misinformation on public health.

Objectives: To create a protocol for evaluating and categorizing misinformation.

Methods: We conducted a literature search of the role of fake news in general and in IPC, and of ways that is being addressed by governments, the media, and the scientific community. We then thoroughly analyse different instances of bad buzz in IPC that affected us directly, and began developing a standardized protocol of systematically evaluating analysing, reporting, and reacting to misinformation.

Results: The resulting protocol has two parts, one that helps readers analyse all types of media around a certain piece of misinformation and includes steps to analyse the hypotheses put forward, assertions made, implied associations, causality, clinical relevance, etc. in a systematic way. The second part is a reporting template that would help homogenize the resulting analyses in a form that could be compiled and organized easily, even if written by different people. Multiple examples will be given, ranging from misinformation to intentional fake news, and their analysis presented.

Conclusion: We would like to validate this protocol and make it an implementable tool for IPC researchers to use when trying to combat the detrimental effects of bad buzz and fake news. In the future, it would be desirable to create an online repository for this information, where IPC researchers from all over the world could upload their work and have it be organized by subject. We believe that this would greatly strengthen the response to disinformation and help to reduce the potential damage to patients.

Disclosure of Interest: None declared

P160 COMPARATIVE ASSESSMENT OF INFECTION PREVENTION AND CONTROL PRACTICE AMONG MATERNITY UNIT HEALTH WORKERS IN PUBLIC AND PRIVATE SECONDARY HEALTH FACILITIES IN KADUNA STATE, NIGERIA

J. Sunday1, M. B. Sufiyan2, C. L. Ejembi2, B. N. Natie1, A. A. Olorukooba2, C. J.-C. Igboanusi3, M. Onoja-Alexander4, Y. Musa2, E. E. Ajumuka2

1Department of Planning Research and Statistics, Ministry of Health and Human Services, Kaduna State; 2Department of Community Medicine, College of Health Sciences, Ahmadu Bello University, Zaria; 3Department of Public Health, Headquarters, 2 Division Medical Services/Hospital, 2 Division, Nigerian Army, Adekunle Fajuyi Cantonment, Ibadan; 4Department of Community Medicine, College of Health Sciences,Kogi State University, Anyigba, Lokoja, Nigeria
Correspondence: M. Onoja-Alexander

Introduction: Infection Prevention and Control (IPC) practice in health facilities is abysmally low in developing countries, resulting in significant preventable morbidity and mortality.

Objectives: This study assessed and compared health workers’ practice of IPC strategies in public and private secondary health facilities in Kaduna State.

Methods: An analytic cross-sectional comparative study was employed. Multistage sampling technique was used to select 227 participants each comprising of doctors, midwives and nurses drawn from public and private health facilities. Data was collected using interviewer-administered questionnaire and observation checklist. Data was analysed using both bivariate and multivariate analysis. Statistical significance was determined at p value < 0.05.

Results: The practice of infection prevention is poor. Overall, 48% of the HW used plain soap to wash their hands, and 35.1% of them used hand operated faucet to turn water on and off during hand washing. These practices were significantly poorer in public health facilities (40.1% and 30.0% respectively) compared to private health facilities (55.9% and 40.5% respectively) (p < 0.001 and P<0002 respectively). Overall, 42.3% of the health workers did not change their gowns in-between seeing patients, with the significantly higher rates in 73.1% of private compared to 42.3% of public health facility workers (p < 0.001). Additionally, 30.5% and 10.1% of health workers do not use face mask and eye goggle respectively when conducting procedures likely to generate splash of body fluids, however, there was no significant difference in these poor practices in public compared to private health facilities. The mean IPC practice was 51.6%±12.5, this was significantly lower among public (48.8%±12.5) compared to private (54.5%±11.9) health facility workers (p value <0.0001). Private HF workers were three times more likely to implement IPC interventions compared to public health facility workers.

Conclusion: IPC practice especially among public health facility workers was poor.

Disclosure of Interest: None declared

P161 RAISING AWARENESS ABOUT HAND WASHING WHILE CONTACTING WITH NEWBORN PATIENT - WHAT APPROACH IS BETTER FOR MEDICAL STAFF COMING OUTSIDE NICU?

O. Turcanu, M. Guzun

Neonatal Reanimation Unit no.1, Clinical Municipal Hospital no.1 / Perinatal Center, Chisinau, Moldova, Republic of
Correspondence: O. Turcanu

Introduction: Besides the NICU staff, who is trained/monitored tightly on hand hygiene, babies in our unit are contacting with general "visiting" staff: - laboratory workers (taking WBC & blood gases), USG specialists (same as for adult ICU), engineers (contacting with the circuits of ventilators).

Starting with 14.01.2018 we have a registry of nosocomial culture results. Our spectrum (St.epidermidis) of nosocomial bacterias is different than adult ICU (P.aeruginosa & A.baumanii), but most difficult cases, dangerous to neonatal ICU were with last 2 bacterias.

Objectives: Bimensual cultures from surfaces, staff hands, equipement etc. didn't show that the source of Pseudomonas & Acinetobacter is in our unit. Anonimous observations showed insufficient compliance with hand washing procedures by "visiting" staff. So, we tested a few interventions - what will better motivate them to change this risky behavior.

Methods: a) Periodic evaluation meetings, usually relying on professional reprimands (still a tactique in former soviet countries).

b) Using a "paper requests" with inserted nice reminder about hand washing at the end (for every "visiting" staff in unit.

c) 15th October action "a flower for clean hands".

Results: Qualitative measurement by provider: - Colleagues from "visiting" scaled the interventions they considered more willing to be subjected - the best was "paper requests" & the action "a flower for clean hands", and worst - unpleasant meetings.

Observational results: - The fastest improvement both in remembering when to wash hands while contacting with baby/equipment and hand washing technique - middle level personnel (65% of lab workers) & technical personel (70% engineers) and slowest (35%) among physicians.

Indirect results: - Blood/traheal aspirates - since 10.11.2018 we don't have any +culture of P.Aeruginosa or A.baumanii (no proved cases of their transmission from other hospital units), all cases of bacterial growth being St.epidermidis (main nosocomial bacteria of our unit).

Conclusion: Although visual information on hand washing (ex. WHO posters) is useful in promoting hand hygiene; when speaking about targeting medical staff from different hospital settings - a more personal approach in raising awareness is likely to have a better outcome & efficient feedback. Especially if this is done in a user-friendly way (not punishment tactic)

Disclosure of Interest: None declared

P162 CONSTRUCTION AND CONTENT VALIDATION OF A QUESTIONNAIRE TO EVALUATE THE NURSES’ KNOWLEDGE, ATTITUDES AND PRACTICES TOWARDS ORAL CARE OF CRITICALLY PATIENTS

I. D. T. A. Amaral, A. Felix, B. R. Paz, J. A. Silva, B. R. Santos, M. S. Coyado, L. A. Gomes

1Enfermagem, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
Correspondence: A. Felix

Introduction: Oral care of critically patients is a standard part of the daily nursing care and is one of the strategies of lowering the incidence of ventilator-associated pneumonia (VAP). In Brazil, there is no tool that measure the nurses’ knowledge, attitudes and practices towards oral care of critically ill patients.

Objectives: To describe the process of elaborating and validating a questionnaire about the nurses’ knowledge, attitudes and practices towards oral care of critically ill patients.

Methods: Methodological study, performed from May 2018 to December 2018. The content of items that composed the questionnaire was based on present evidence-based recommendations for preventing VAP. The questionnaire was submitted to the content validation of eight nurses specialized in Infection Control and four nurses specialized in Intensive Care who gave their opinions on clarity, pertinence and relevance of the items, in two rounds of the Delphi Technique. Content Validity Index (CVI) was used to verify consistency and items with CVI ≥ 0.80 were considered valid.

Results: The questionnaire included 29 items (Knowlede=13 items; Attitudes and Practices=15 items) and was considered relevant, clear and pertinent by the specialists, with an average agreement of 0.94, 0.90 and 0.92 respectively. The overall CVI was 0.92, evidencing a satisfactory level of agreement among the specialists.

Conclusion: The questionnaire was considered valid by the specialists; thus, it can be implemented to evaluate the nurse’s knowledge, attitudes and practices towards oral care of critically ill patients.

Disclosure of Interest: None declared

P163 PLANNING IS DISTINCT FROM MOTIVATION AND CAPABILITIES IN EXPLAINING SURGICAL SITE INFECTION-PREVENTIVE COMPLIANCE: RESULTS FROM A SINGLE-CENTRE, SMALL SAMPLE BUT HIGH RESPONSE SURVEY OF ORTHOPAEDIC PHYSICIANS IN HANNOVER, GERMANY

T. von Lengerke1, I. Tomsic1, F. Gossé2, E. Ebadi3, I. Hartlep4, P. Schipper4, B. Schock4, I. F. Chaberny4

1Department of Medical Psychology, Hannover Medical School, Centre of Public Health and Healthcare; 2Department of Spinal Surgery and Conservative Orthopaedics, Clinic of Orthopaedics of Hannover Medical School at DIAKOVERE Annastift, Hannover; 3Institute of Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Centre for Laboratory Medicine; 4Institute of Hygiene, Hospital Hygiene and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany
Correspondence: I. Tomsic

Introduction: Preventing surgical site infections (SSI) implies compliance with many pre-, intra- and postoperative measures [1]. Evidence is lacking on psychological determinants of comprehensive compliance, i.e. with as many measures as possible. Among others, orthopaedic surgery physicians represent an underresearched group.

Objectives: To identify associations between self-reported SSI-preventive compliance and determinants as specified by the COM-B- (capability, opportunities, motivation and behaviour-) model [2].

Methods: In a pretest to the "WACH"-trial (funding: German Federal Ministry of Health, grant-ID: ANNIE2016-55-038; German Clinical Trials Register-ID: DRKS00015502), N=52 orthopaedic surgeons and anaesthetists of an orthopaedic clinic participated in a questionnaire survey. The response rate was 73.2%. Compliance regarding 26 SSI-preventive measures respondents felt responsible for was assessed by self-reports as well as COM-determinants (18 items). Statistically, factor analysis and linear regression models were used.

Results: Using oblimin rotation on the COM-items, 4 factors emerged: capabilities (4 items/Cronbachs alpha=0.88), motivation (4/0.83), opportunities (3/0.90), and planning (2/0.82). In the final backward linear regression model of self-reported compliance rate across all 26 measures (mean: 89.8%), the number of measures responsible for had a negative regression weight (beta=-0.31/p=0.04), while capabilities (0.35/0.02) and planning (0.26/0.09) showed positive effects.

Conclusion: Action and coping planning of SSI-preventive measures may be distinct from motivation and capabilities as a construct and determinant of self-reported compliance. Like in the realm of hand hygiene interventions [3], promotion of SSI-prevention should stress planning skills and social support.

References

[1] WHO. Global Guidelines for the Prevention of Surgical Site Infection. Geneva: WHO; 2018[2] Michie et al. The Behaviour Change Wheel. Implement Sci 2011;6:42[3] von Lengerke et al. Impact of Psychologically Tailored Hand Hygiene Interventions on Nosocomial Infections with Multidrug-Resistant Organisms. Antimicrob Resist Infect Control 2019;8:56

Disclosure of Interest: None declared

P164 IMPLEMENTATION INTERVENTIONS TO IMPROVE COMPLIANCE WITH SURGICAL SITE INFECTION PREVENTIVE MEASURES IN ABDOMINAL SURGERY: A SYSTEMATIC REVIEW

I. Tomsic1, N. R. Heinze2, I. F. Chaberny3, C. Krauth2, B. Schock3, T. von Lengerke1

1Department of Medical Psychology; 2Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Centre of Public Health and Healthcare, Hannover; 3Institute of Hygiene, Hospital Hygiene and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany
Correspondence: I. Tomsic

Introduction: Despite several guidelines that recommend measures to prevent surgical site infections (SSIs) [1], there is a high prevalence in abdominal surgery [2]. Also, compliance with these measures is often insufficient [3]. At the same time, there exist several implementation interventions to promote compliance with preventive measures [4].

Objectives: The aim of this systematic review is to identify implementation interventions that are used in the field of abdominal surgery to prevent SSIs, and determine associations between implementation interventions and reductions in SSI-rates.

Methods: Literature was searched in April 2018. Implementation interventions were classified using the Cochrane Review Group Effective Practice and Organisation of Care’s “EPOC Taxonomy” [3]. In addition, an effectiveness analysis was conducted on the association between number of implementation strategies and reduction of SSI-rates.

Results: Forty studies were included. Implementation strategies used most frequently were audit and feedback (80% of the studies), organisational culture (70%), monitoring the performance of healthcare delivery (65%), reminders (53%), and educational meetings (45%). Twenty-nine studies used a multimodal strategy with ≥3 implementation interventions. There was a tendency for strategies with 3-5 strategies to be most effective in reducing SSI rates, however starting from a comparably high baseline level.

Conclusion: In abdominal surgery, mostly standard multimodal implementation strategies are applied to improve compliance with SSI preventive measures. Further research is needed on which implementation strategies, or bundles of these, are most effective in promoting compliance in abdominal surgery.

References

1. World Health Organization (WHO). Global Guidelines for the Prevention of Surgical Site Infection, 2nd ed. Geneva:WHO;2018.

2. Azoury et al. Postoperative abdominal wound infection - epidemiology, risk factors, identification, and management. Chronic Wound Care Manage Res 2015;2:137-148.

3. Leaper et al. Surgical site infection: poor compliance with guidelines and care bundles. Int Wound J 2015;12:357-362.

4. Effective Practice and Organisation of Care (EPOC). EPOC Taxonomy;2015. (https://epoc.cochrane.org/epoc-taxonomy).

Disclosure of Interest: None declared

P165 GAMIFICATION – AN INNOVATIVE INTERVENTION TO INCREASE HAND-HYGIENE COMPLIANCE

G. Regev-Yochay1, O. Berezovsky1, I. Tal1, E. Konan2, O. Barnet3, E. zimlichman4

1Infection Prevention & Control; 2Radiology department, Sheba Medical Center, Ramat Gan; 3Entropy, Tel Aviv; 4Sheba Medical Center, Ramat Gan, Israel
Correspondence: G. Regev-Yochay

Introduction: Full adherence to infection control measures is frequently difficult to achieve. The Radiology department, which is a central intersection, with large patient movement and difficult to measure infection outcomes, is a particular challenge. Gamification and positive psychology have been previously successfully used to modify organizational culture in other settings.

Objectives: To engage the Radiology team to IC culture.

Methods: The Radiology department team of the Sheba Medical Center includes 120 technicians, 60 physicians and 12 nurses. Hand hygiene compliance was low (70%) despite routine IC measures (observation & feedback, annual training, etc) before the intervention. A positive-feedback game was carried out during 4 months, focusing on hand-hygiene compliance, adherence to cleaning and isolation policy guidelines.

Intervention-agents were recruited from different HCW sectors of the department. They received a short IC creative training (2h) using quizzes and games. During 3 months, they gave positive feedback and marked HCW who they observed adhering to IC measures. From the second month of the game, patients waiting for a radiologic procedure, were also recruited to mark HCW whom they observed performing hand hygiene. Weekly honours & prizes where distributed by the department director to HCWs with highest marks.

Results: Rapidly all HCW in the department were engaged to the game. Hand hygiene compliance increased to 90% in all the different units of the Radiology Departent. A 'whatsup' group was established within the game and positive feedbacks with pictures and slogans were posted.

Currently, one year after the formal game has ended, the hand hygiene compliance is still >90% in all department units and pictures & slogans are continuously posted.

Conclusion: Engaging teams by positive feedback and gamification is an efficient methodology to achieve IC adherence, particularly in challenging circumstances.

Disclosure of Interest: G. Regev-Yochay: None declared, O. Berezovsky: None declared, I. Tal: None declared, E. Konan: None declared, O. Barnet Shareholder of: Entropy group, E. zimlichman: None declared

P166 THE “PATIENT ZONE” AND ITS CONCEPTUAL HURDLES FOR HEALTHCARE PROVIDERS – A QUALITATIVE CONTENT ANALYSIS

J. Bogdanovic1,2, S. Petralito1, S. Passerini1, H. Sax1, T. Manser3, L. Clack1

1Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, 2Institute of Nursing Science, University Basel, Basel, 3School of Applied Psychology, University of Applied Sciences and Arts Northwestern, Olten, Switzerland
Correspondence: S. Petralito

Introduction: The “patient zone” concept was introduced in 2007 to guide infection prevention and control (IPC) efforts and to anchor indications for hand hygiene.

Objectives: The present study aims to understand how the patient zone is interpreted and applied by healthcare providers (HCP).

Methods: Ten nurses and physicians allocated 30 items from the healthcare environment to “inside” or “outside” the patient zone with simultaneous verbal think-aloud. Allocations were subsequently compared with those of two IPC-experts. Utterances from the think-aloud process were included in a content analysis to understand HCPs’ interpretations of the patient zone.

Results: A total of 68% of item allocations were consistent with expert consensus and seven out of thirty items achieved a 100% agreement among participants. Our content analysis revealed ambiguity and variation in participants’ interpretations of the patient zone and its practical implications. Participants often interpreted that items with direct patient contact should be allocated to “inside” the patient zone or they interpreted the zone as a physical perimeter, where all objects inside, i.e. a patient room, were allocated to “inside” the patient zone. Furthermore, participants often deduced allocation based on the observed need to disinfect hands and objects. Furthermore, participants interpreted that an item’s allocation could change depending on the context of the item’s use.

Conclusion: Variation in HCPs’ interpretations of the patient zone led to low agreement with expert consensus and discrepancies among participants. HCPs’ interpretations were based on simplifying concepts, such as equating the patient zone to a physical perimeter or to items with patient contact, and thus failed to accurately capture the concept’s subtleties. Our results provide first insights into how the patient zone is interpreted and applied by HCPs. Our findings suggest that a revised concept and didactic strategies may be promising approaches to improve understanding and application of the patient zone.

Disclosure of Interest: None declared

P167 KNOWLEDGE AND SELF-REPORTED COMPETENCE IN STANDARD PRECAUTIONS (SP): A SURVEY AMONG HEALTHCARE WORKERS (HCW) IN A MULTI-SITE HOSPITAL

D. Vuichard-Gysin1, R. Fulchini1, P. Kohler2, M. Schlegel2

1Infectious Diseases & Hospital Epidemiology, Thurgau Hospital Group, Muensterlingen; 2Infectious Diseases & Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
Correspondence: D. Vuichard-Gysin

Introduction: SP are fundamental to reduce the risk of transmission of bloodborne and other pathogens from identifiable and unrecognized sources. The Thurgau hospital group comprises two acute-care hospitals, a rehabilitation and a psychiatry clinic. The concepts of SP are outlined in the local infection control guidelines but levels of knowledge and competence in implementation remain largely unknown.

Objectives: To increase awareness on the importance of SP and to identify knowledge gaps, a questionnaire was addressed to HCW involved in patient care.

Methods: A 15-item survey with single and multiple-choice questions was distributed by e-mail. Two reminders were sent out to enhance participation. Depending on the importance of the respective question, one to three points were awarded for each correct answer (3 points = highly important). HCW were also asked to rate their overall competence in SP on a scale from 1 to 4 (1 = feeling overburdened, 4 = competent). After completion, the correct answers along with the total score (max. 35 points) and a feedback about the overall performance were automatically displayed.

Results: From July to August 2018, a total of 898 HCW (37% response rate) participated in the survey. Of these, 63% were nurses, 18% were doctors and 19% were others. Of 754 participants answering the knowledge questions, 355 (47%) had good knowledge (> 26 points). The following proportions of HCW correctly identified these measures as component of SP: hand hygiene (98%), wearing of personal protective equipment (78%), cough etiquette (64%) and vaccinations (23%). Only 46% considered SP indicated in patients under transmission-based precautions. Of 177 respondents in the lowest total score category (<23 points), 154 (89%) judged themselves as (rather) competent.

Conclusion: Knowledge of SP among HCW was moderate and revealed important gaps in the understanding of the basic concepts of SP. The discrepancy between knowledge scores and self-reported competence suggests that HCW overestimate themselves in their competence. These results serve as basis for planning multi-faceted educational interventions.

Disclosure of Interest: None declared

P168 INPUT FROM IMPLEMENTATION SCIENCE: REVISION OF THE WORLD HEALTH ORGANIZATION MULTIMODAL HAND HYGIENE IMPROVEMENT STRATEGY IN LIGHT OF THE BEHAVIOUR CHANGE WHEEL

P. Muthukumaran 1, A. Peters2, C. Guitart2, D. Pittet2

1University of Geneva; 2University Hospitals of Geneva, Geneva, Switzerland
Correspondence: P. Muthukumaran

Introduction: Hand hygiene (HH) remains the most important measure to prevent healthcare associated infections (HAI). The World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy (MMHHIS) is currently the most effective documented method for implementing HH practices in hospital settings worldwide. While this model has had great success in clinical settings, other models and tools available from the field of implementation science, such as the Behaviour Change Wheel (BCW), incorporate some potentially useful elements that are not explored in the MMHHIS.

Objectives: The objective of this research is to analyse and compare the MMHHIS and the BCW, and identify elements from the latter that might be used to improve the MMHHIS.

Methods: A literature review was performed using Google Scholar in order to explore behaviour change frameworks applicable to healthcare settings. The BCW was chosen because it is the most comprehensive of the models available (built using 19 other frameworks), and has already been applied in healthcare settings. The review was followed by a qualitative analysis of the suitability of the BCW to help refine the MMHHIS.

Results: Elements from the BCW can be incorporated into the MMHHIS and may result in a more comprehensive approach to designing interventions for improving HH compliance. The MMHHIS focuses on healthcare workers (HCW) in a hospital setting, doesn’t comprise elements of early stages of HCWs’ education, or emphasis on the importance of role-models, which are addressed in the BCW. The BCW also offers a more visually comprehensible model that is easily adaptable to suit each setting, facilitating the adoption of the framework.

Conclusion: The BCW offers a new lens through which to review the WHO MMHHIS; it uncovers new avenues to potentially improve HH practices. Thus, the current research suggests that an updated multimodal strategy should be developed by incorporating elements of the BCW. This model should then be tested in a clinical setting in order to compare it with the existing strategy.

Disclosure of Interest: None declared

P169 Withdrawn

P170 ACCEPTABILITY OF WHO HAND HYGIENE REMINDERS IN MATERNITY SETTINGS; PRELIMINARY RESULTS OF A MIXED METHODS STUDY

C. L. Dunlop1, C. Kilpatrick2, M. Bonet3, V. Brizuela3, W. Graham4, A. Thompson5, L. Jones6, D. Lissauer1

1Institute of Metabolism and Systems Research, University of Birmingham, Birmingham; 2Consultant, The Soapbox Collaborative, London, United Kingdom; 3UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organisation, Geneva, Switzerland; 4The Soapbox Collaborative, London; 5College of Medical and Dental Sciences; 6Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
Correspondence: C. L. Dunlop

Introduction: Hand hygiene is fundamental to prevent healthcare associated infections. Currently there are no World Health Organisation (WHO) hand hygiene reminders specific to maternity settings. Maternity settings may benefit from these due to: WHO recommendations that reminders be part of a multimodal improvement strategy; clinical circumstances unique to pregnancy and childbirth; and to support prevention of maternal sepsis.

Objectives: We sought to investigate if healthcare workers find the current WHO hand hygiene reminders acceptable for use in maternity settings and if adaptations could improve their relevance.

Methods: An integrative mixed-methods approach was used to assess acceptability of WHO hand hygiene reminders in maternity settings. Informed by a valid acceptability domains framework, a multi-language survey was launched, sampling participants via a WHO multi-country study network and snowballing. Purposively sampled qualitative interviews and a focus group were conducted with maternal health clinicians and public health practitioners with experience working in high and low resource settings.

Results: The survey (n=342), interview and focus group (n=19) responses represented 48 countries. Preliminary results demonstrate that acceptability of hand hygiene reminders was high, with 76% scoring ‘agree’ or ‘strongly agree’ across pooled domains. Campaign posters from World Sepsis Day 2018 were deemed equally or more acceptable for maternity settings than the original reminders, across all domains. Acceptability could be improved by including: images that represent maternity settings; clear explanations of the importance of hand hygiene; and infographic examples of the 5 moments of hand hygiene in this setting.

Conclusion: Preliminary results demonstrate that the WHO hand hygiene reminders were well received by healthcare workers, but acceptability for maternity settings could be improved with adaptions. Work is underway to address this, in a reminder specific to maternity care that would be acceptable in high and low resource settings.

Disclosure of Interest: None declared

P171 BUILD IT, TEACH IT, CHECK IT, SELL IT, LIVE IT – A CONVERSATION ABOUT WRITING YOUR PLAYBOOK FOR IPC IMPROVEMENT

J. Storr1, C. Kilpatrick2

1Global Health, S3 Global, MORETON IN MARSH; 2S3 Global, Glasgow, United Kingdom
Correspondence: J. Storr

Introduction: Implementation of infection prevention and control (IPC) evidence is challenging and complex. The global multimodal improvement approach that is now a cornerstone of World Health Organization (WHO) implementation documents aims to overcome these challenges and to support and empower end users to take a systematic approach, applicable to their settings. With the goal of improving outcomes and behaviours, it is one of the evidence-based IPC core components.

Objectives: To present a synthesis of intelligence and practical learnings on the application of a multimodal improvement strategy (MMIS) in a range of countries. To outline how understanding of the MMIS can be enhanced by the use of a novel ‘mantra’.To stimulate reflection and discussion on the current and future utility of the MMIS, using country and healthcare facility examples.

Methods: A review of published IPC literature and resources was undertaken. Personal interactions, including peer-to-peer feedback and social media engagement, were also used to determine perceptions of the current understanding and use of all five elements of the MMIS.

Results: The MMIS can be summarised as follows; system change (build it), training and education (teach it), monitoring and feedback (check it), reminders and communication (sell it), institutional safety climate and culture change (live it). The current situation suggests that its elements are used but that comprehensive and widespread understanding and acceptance of the approach in its entirety and the ability to clearly articulate its value remains sub-optimal. At the global level, the approach has already been applied to hand hygiene, IPC generally, surgical site infection surveillance and carbapenem-resistantorganism control.

Conclusion: The MMIS is an IPC evidence-based recommendation. The approach still needs to be promoted for full adoption in all countries, in all health care settings and adaption of global documents into local ‘playbooks’ is needed.

Disclosure of Interest: None declared

P172 SUCCESSFUL APPLICATION OF NATIONAL PATIENT SAFETY INITIATIVE PROGRAM STRATEGY TO REDUCE HEALTHCARE ASSOCIATED INFECTIONS IN KING FAISAL MEDICAL COMPLEX-TAIF, KINGDOM OF SAUDI ARABIA

W. A. Mazi1, M. H. Abdulwahab1, M. A. Al-Ashqar1, N. A. Bouafia1, N. A. Hamoda1, Y. S. Aldecoa1, Z. R. Bhat1, S. H. Al Wagdani1, O. S. Yasin2, S. A. Al Sayali2, W. S. Ahmed3, A. A. Al Talhi4, S. Thomas4, A. M. Dahlawi5, S. A.-D. M. Mahfouz6, M. R. Al Yami7

1Infection Prevention and Control; 2Intensive Care Unit; 3Gynecology Department; 4Operation Room Department; 5Maternity Medical Director; 6Surgey Department; 7Hospital Director, King Faisal Medical Complex, Taif, Saudi Arabia
Correspondence: W. A. Mazi

Introduction: National Patient Safety Initiative Program 2018 was introduced in King Faisal Medical Complex-Taif as a part of national transition program 2020 for achievement the national vision 2030.

Objectives: To reduce HAIs benchmarking to the National Healthcare Safety Network (NHSN), USA.

Methods: A prospective study was conducted in the 27-bed intensive care unit and maternity tower of King Faisal Medical Complex (KFMC)-Taif, Kingdom of Saudi Arabia. Central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilated associated pneumonia (VAP) and CS-SSI were identified using the Centers for Disease Control and Prevention and National Healthcare Safety Network (NHSN, USA) criteria. Incidence rate, utilization ratio, benchmarking, and statistical analysis were carried out using the NHSN recommendations. NPSIP was introduced in January 2018 using three steps strategy; 1) identify indicator based on NHSN benchmark, 2) assess risk factors using Society Healthcare Epidemiology of America/Infectious Diseases society of America (SHEA/IDSA) basic practice recommendations, and 3) perform gap analysis strategy for intervention.

Results: CLABSI incidence rate is between 50th-75th percentile benchmarking to NHSN despite of higher in utilization ratio. CAUTI incidence rate is between 25th-50th percentile benchmarking to NHSN with lower in utilization ratio . VAP incidence rate was declined from 5.0- to 3.19/1000 ventilated days but still above 90th percentile with same in utilization ratio 0.28.

The CS-SSI incidence rate is lower than the NHSN using re-admission surveillance method.

Conclusion: KFMC-Taif successfully achieving the NHSN, USA benchmark using the three strategy method.

References

Not applicable.

Disclosure of Interest: None declared

Poster session: Surveillance 1

P173 SIX YEARS OF POINT PREVALENCE SURVEY OF HEALTHCARE-ASSOCIATED INFECTIONS AND ANTIMICROBIAL USE AT A TERTIARY ACUTE-CARE UNIVERSITY HOSPITAL IN NORTH-WEST ITALY

F. Tassinari1, M. Zacconi1, I. Barberis1, M. Astengo1, V. Tisa1, S. Schenone1, D. de Florentiis2, V. Daturi2, R. Ziferro2, A. M. Di Bella2, A. Talamini2, M. K. Mikulska1, C. Viscoli1, G. Icardi1

1University of Genoa; 2Ospedale Policlinico San Martino, Genova, Italy
Correspondence: F. Tassinari

Introduction: Healthcare-associated infections (HAI) point prevalence surveys (PPS), repeated periodically, provide an effective epidemiological tool for evaluations of preventive and control strategies.

Objectives: To estimate HAI prevalence and antimicrobial use prevalence, (ii) to describe the characteristics of patients and HAIs, (iii) to evaluate for HAI risk of factors.

Methods: During February-April of 6 consecutive years (2014-2019), and in November 2016, we conducted 7 PPS adopting the protocol of the European Center for Disease Prevention and Control (ECDC), Versions 4.3 – 5.3, at the 1300 acute-care beds San Martino Policlinic Hospital, a teaching hospital located in Genoa, North-West Italy. Multivariate linear regression was used to assess risk of factor for HAI insurgence.

Results: Overall, 6499 patients were enrolled, with a median age of 72 years (IQR: 57 – 81), a male:female ratio = 0.99:1 and a median HAI onset time of 15 days (IQR: 7 – 29). 50.0% of the patient had a Non-fatal McCabe score; 31.2% had an Ultimately-fatal, 17.1% had a Rapidly-fatal and 2.7% had an Unknown score. HAI prevalence decreased from 15.5% in 2014 to 11.2% in 2019 (Chi Square for linear trend, p < 0.01), while patients in antibiotic therapy decreased from 44.0% in 2014 to 42.4% 2019. Bloodstream and low-respiratory tract infections were the most frequent HAI. Staphylococcus aureus (12.4%) Staphylococcus epidermidis (12.0%) and Klebsiella pneumoniae (10.0%) were the most frequent microorganisms isolated overall bloodstream infections. In the multivariate logistic regression analysis, ultimately or rapid McCabe score, surgery, hospitalization in intensive care unit, central line catheter use and urinary catheter use were associated with a higher risk of developing an HAI.

Conclusion: PPS repeated over time have proved to be a valid tool to evaluate the trend of HAI and the use of antibiotics as an effect of prevention strategies adopted by the hospital health management.

Disclosure of Interest: None declared

P174 POINT PREVALENCE SURVEY OF HEALTHCARE-ASSOCIATED INFECTIONS IN SLOVAKIA: COMPARISON DATA FROM SURVEY IN 2012 AND 2017

M. Stefkovicova1, S. Litvova1, M. K. Garabasova1, J. Brnova2

1National Reference Centre for HAI, Public Health Authority , Trenčín; 2Centre of Microbiology and Infection Prevention, Trnava university, Trnava, Slovakia
Correspondence: J. Brnova

Introduction: Inadequate compliance to surveillance systems and lack of infection control professionals still exist in Slovakia, making it difficult to accurately assess the present burden of health care-associated infections (HAI).

Objectives: We compared data from European Centre for Disease Prevention and Control (ECDC) point prevalence study of HAI in Slovakia between year 2012 vs 2017.

Methods: Point prevalence survey of HAI was carried out according to a standardized methodology developed by the ECDC in Slovakia providing acute health care in June 2012 (40 hospitals) and June 2017 (50 hospitals). Data were collected at the country level, hospital level and the patient level according to standard protocol. Overall 8397 patients were included in the survey in 2012 and 9145 in 2017.

Results: Prevalence of HAI were similar in both survey (3,5 %/2012 vs. 4%/2017). The highest prevalence of HAI was found on the intensive care units. The most common types of HAI were urinary tract infections (25,8%/2012 vs. 26,2%/2017). The most frequent microorganisms were Escherichia coli (15,0 %) in 2012, but in 2017 Clostridium difficile (17,4%). We observed significant increasing consumption of alcohol hand disinfection from 9 L per 1000 patients’ day in 2012 to 18 L per 1000 patient’s day in 2017. Proportion of single bed hospital room increased from 5% to 17,2%, but only 10,2% single bed hospitals rooms have own hygiene facilities. Increasing proportion of Infection Control Practitioner in Slovak hospitals was observed (0,15/2012 vs. 0,3/2017). No change in administration of antibiotic prophylaxis between two periods was observed (80/2012 vs. 76/2017).

Conclusion: In Slovakia, we urgently need to establish infection control teams in health care facilities according ECDC standards and improving compliance to surveillance systems and antibiotic stewardship.

Disclosure of Interest: None declared

P175 ANNUAL SURVEYS FOR POINT-PREVALENCE OF HEALTHCARE-ASSOCIATED INFECTION IN A TERTIARY TEACHING HOSPITAL IN MALAYSIA, 2016-2018

S. Ponnampalavanar1,2, S. Saaibon2,3, R. Zhazali2,3, S. S. Samsudin2,3, H. Che Hamzah2,3, N. Ghazali2,3, T. M. D. Tengku Mat2,3, R. Hassan2,3, J. Sarijo2,3, N. Razali2,3, S. N. Zainon2,3, M. Ishak 2,3, E. S. Y. Liew 2, S. S. L. L. Goh2, H. C. Ong 1, A. Kukreja1

1Medicine, University of Malaya; 2Infection Control, 3Nursing, University Malaya Medical Centre, Kuala Lumpur, Malaysia
Correspondence: S. Ponnampalavanar

Introduction: Health care-associated infection (HAI) cause increased in morbidity and mortality in hospitalized patients. Little has known to the prevalence of HAIs in Malaysia.

Objectives: to investigate the point-prevalence of HAI in University Malaya Medical Centre (UMMC).

Methods: Three cross sectional studies was performed from 2016-2018 of hospitalized patients who had been diagnosed with HAI in UMMC. The data were collected using a structured data collection form by infection control nurses. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 20.

Results: Out of 2465 hospitalized patients, 135(5.5%) were diagnosed with HAI. The rate if HAI was 4.5%, 5.1% and 6.9% in 2016, 2017 and 2018 respectively. The medical department had the highest rate of HAI (24.4%) followed by surgical (21.5%) and the intensive care unit (15.9%). The most common HAI was pneumonia (37.8%), followed by bloodstream infection (BSI) (19.3%) and surgical site infection (SSI) (10.4%). The prevalence of hospital acquired pneumonia (HAP) and BSI were found reducing from 2016 to 2018. The rate of HAP reduced from 40% to 35.6% in 2016 and 2018 respectively; BSI decreases from 31.4% in 2016 and 10.9 % in 2018. HAI was higher in males (57.8%), prolonged hospitalization (65.2%) and those who had intravenous lines (74.8%). Pseudomonas Aeruginosa-non multidrug resistant (12.6%) was the most common pathogen followed by extended-spectrum β-lactamase (ESBL) producing Klebsiella pneumonia (8.9%).

Conclusion: The study found the prevalence of HAI in our hospital is similar to previous studies across Asia, especially due to HAP, BSI and SSI. Interventions focusing on reduction of these HAIs in healthcare facilities should be prioritised to ensure patient safety while receiving care in acute care hopsitals.

Disclosure of Interest: None declared

P176 THE PROCESS TRAINING FOR THE PILOT POINT PREVALENCE SURVEY OF HEALTHCARE-ASSOCIATED INFECTIONS AND ANTIMICROBIAL USE IN SELECTED ACUTE CARE HOSPITALS IN ALBANIA

A. Vasili, Z. Sulejmani, R. Daja, S. Bino, A. Fico

Institute of Public Health, Tirane, Albania, Tirane, Albania
Correspondence: A. Vasili

Introduction: Surveillance of HAI and antimicrobial use is an essential part of infection prevention and antimicrobial stewardship. It drives action by planning and implementing more effective, evidence based policies, surveillance and strategies

Objectives: Prepare hospital teams for the best knowledge of case definition for HAI and prepare for setting up and strengthening the Infection Prevention and Control programs.

Methods: The PPS will follow the standardized protocol and methodology devised by ECDC. The selection of hospitals in Albania, at least one general hospital will be enrolled. Hospital participation is voluntary.

Results: The consultant in close cooperation with the WHO Local Offices in Albania and a representative of the Institute of Public Health identified a national coordinator and a coordination center that will managed the PPS rollout in Albania.

The national coordinator in cooperation with the consultant identified the trainees at the national level and at the national level. Coordinator assisted in providing training.

Two hospitals, Tirana University Hospital Center and the Durres Regional Hospital were selected. The national coordinator in cooperation with the coordinators of each hospital appointed the team of the hospital. The Durres hospital team consisted of 6 people, 3 physicians and 3 nurses. The Tirana hospital team consisted of 6 physicians and 5 nurses, in total 11 persons.

During the training, people learned to look at participating hospitals: the prevalence of HAI and antimicrobial use in acute care; describes patients, invasive procedures, infections (sites, microorganisms including antimicrobial resistance markers) and the described antimicrobials. Much important in training was the standardization of HAI definition of cases and the recognition of participants with these definitions.

Conclusion: The information in this survey will help create policies and procedures to reduce HAIs, to improve methods to collect data on HAIs, support appropriate use of antimicrobial drugs and strength the implementation of Infection Prevention and Control programs at national and local levels.

The results obtained with this survey will assist national and local IPC teams to identify series of priorities for the prevention of HAIs and antimicrobial resistance in the selected hospitals.

Disclosure of Interest: None declared

P177 FOUR NATIONAL POINT PREVALENCE SURVEYS OF HEALTHCARE-ASSOCIATED INFECTIONS IN SERBIA; WHAT WE HAVE LEARNED?

L. Markovic-Denic1, V. Suljagic2, G. Dragovac3, V. Mioljevic4, B. Mijovic5, I. Cirkovic1

1University of Belgrade, Faculty of Medicine; 2Military Academy, Belgrade; 3University of Novi Sad, Faculty of Medicine, Novi Sad; 4Clinical Center of Serbia, Belgrade, Serbia; 5Faculty of Eastern Sarajevo, Foca, Bosnia and Herzegovina
Correspondence: L. Markovic-Denic

Introduction: Healthcare-associated infections (HAIs) represent an important public health challenge worldwide, especially in less developed counties. National HAI point prevalence surveys (PPS) allow identification of priorities and strategies for HAI prevention and control.

Objectives: To investigate prevalence of HCIs and to evaluate changes over time.

Methods: Four national PPSs of HAI were undertaken in Serbia; in 1998, 2005, 2010 and 2017. The first three national PPS applied CDC definitions, while the 4th PPS applied ECDC definitions and methods. Trained infection control staff reviewed medical records to identify HAI active at the time of the survey. Data were collected in a single day in one ward with a maximum time frame of 2 weeks in one hospital and within one month for whole national survey.

Results: In first PPS participated 27 acute hospitals, 56 in second, 59 in the third, and 65 in 4th survey. Increased number of included hospitals reflected increased awareness and recognition of the importance of HAI. The prevalence of patients with at least one HAI and the overall prevalence of HAI were 6.3% and 7.5% in 1998, 3.1% and 3.5% in 2005, 4.9% and 5.3% in 2010, and 4.3% and 4.6% in 2017. While three PPSs were conducted in autumn season, the second survey was conducted in May, and the lowest prevalence was recorded in this study, which pointing to the possible seasonal variation of HAI. The most frequent were surgical site infections (SSI) in first study (34.1% of all HAIs), and urinary tract infections (UTI) in the other three surveys (29.0%, 25.9% and 21.3%). After first study, first national HAI guidelines were prepared and started to implement in the practice. Validity survey which was organized along with 4th PPS, showed that sensitivity of HAI detection was 85.1% and specificity 99.1%.

Conclusion: Repeated national PPSs provide data on the effectiveness and progress of infection control measures.

Disclosure of Interest: None declared

P178 POINT PREVALENCE OF HOSPITAL ACQUIRED INFECTION IN THREE REGIONAL HOSPITALS IN BURKINA

Z. Gansane1, S. COULIBALY1, S. Yao1, A. Ouedraogo1, H. Hien2

1Burkinabe Observatory for Healthcare Quality and Safety, 2Institut National de la Sante Publique, OUAGADOUGOU, Burkina Faso
Correspondence: Z. Gansane

Introduction: Healthcare-associated infections are a major public health problem, threatening the safety and well-being of patients. In Burkina Faso, HAI are common in health care facilities but their epidemiology is poorly described namely in regional hospitals.

Objectives: to perform a situational analysis through an epidemiological description in country's regional hospitals

Methods: We conducted in September 2018, a cross-sectional survey in three regional hospitals. All eligible inpatients admitted for at least 48 hours on the day of the survey were included. HAI was diagnosed based on CDC Atlanta's definition. The information was collected by physicians using the paper CRF and the patients' folder served as sources of information. Bacteriological samples were taken for the isolation of the germ and the sensitivity testing if needed. Data were analyzed with STATA 13 and R software. Univariate analyzes and a multi-varied logistic regression were performed to determine associated factors.

Results: During the survey, 216 patients were included in our sample. The median age of the patients was 23.6 years. Thirty-eight (38) cases of HAI were reported in our study, leading to an estimated prevalence of 17.59%, IC95 = [13.04-23.30]. Most of patients had received antibiotic therapy on the day of the survey (90.23%). Surgical site infections were the most frequent (34.21%). In multivariate analysis, patients over 55 years (OR = 0.13, CI = 0.02-0.65), pediatric patient (OR = 0.27, IC = 0.05-0.95) gynecological / obstetrical patient (OR = 0.13; 0.02-0.65), Koudougou hospital (OR = 0.19, IC = 0.06-0.52), intravenous catheter presence (OR = 4.06, IC = 1.15-15.45), length of stay over than 7 days since admission (OR = 2.35, CI = 1.01-5.48) were independent factors associated with the occurrence of HAIs. The Culture’s results showed that Staphylococcus aureus (57.8%) and Escherichia coli (26.3%) were most commonly isolated HAI-causing pathogens.

Conclusion: HAI’s prevalence remains high in our context and could be explained by the persistence of several factors related to the organization, the availability of human and material resources, human factors, the hospital environment

Disclosure of Interest: None declared

P189 NATIONAL PREVALENCE SURVEY OF HEALTHCARE ASSOCIATED INFECTIONS: LESSONS LEARNED IN SENEGAL IN 2017

B. Ndoye1, N. N. KONATE2

1ICAN, WHO Consultant; 2Coordonnatrice PRONALIN, MSAS, Dakar, Senegal
Correspondence: B. Ndoye

Introduction: Healthcare Associated Infections (HAIs) is a global public health scourge for which there is little reliable data available in Africa. The prevalence survey is currently the most accessible and realistic method in Africa, to have quantified data on the impact and put in place appropriate preventive measures.

Objectives: The objectives were to have quantified estimates of the prevalence rates of the main HAIs, the main bacteria responsible and resistance levels, but also to evaluate the practices in the antibiotics prescription.

Methods: The 2017 CDC and ECDC protocols were used as benchmarks and were adapted to the local context by a local technical working group, supported by experts from WHO and CDC. Ten hospitals were selected on the basis of criteria of representativeness, but also of functionality.

Results: Overall prevalence: 6%, although the collection of suspected cases by referring physicians gives 23%. Predominance of surgical site infections (52%) and low laboratory input with only 28% of cases where a sample for bacteriological diagnostic purposes was performed. Bacteriological aspects marked by the multi-resistance, even if the number of strains was low (11 strains of Klebsiella pneumoniae of which 20% resistant to carbapenems). Antibiotic patients on the day of the survey or the day before: 65% of patients included, of whom 22% had no documented infection or substantiation, third-generation cephalosporins being the most prescribed class. The 48th / 72nd hour assessments were not documented in 84% of cases and the justification for continued treatment beyond the first week was not documented in 75% of cases. Surgical antibiotic prophylaxis exceeded 24 hours in 65% of cases.

Conclusion: The prevalence is broadly comparable to previous studies, with rates underestimated, due to lack of information in patient records. The innovation of collecting the suspected cases by the treating physicians has allowed getting a clearer idea, and better reflecting the reality of the scourge in the African context, hence the importance of involving these staff in the survey, but also improving the quality of patient records.

The study also confirmed the predominance of infections in surgery, the low contribution of bacteriological diagnosis, as well as the misuse of antibiotics and the tendency towards bacterial multi-resistance, even with respect to carbapenems.

References

Disclosure of Interest: None declared

P180 ESTABLISHING HEALTH CARE ASSOCIATED INFECTION (HCAI) SURVEILLANCE SYSTEMS IN PUBLIC REGIONAL HOSPITALS IN UGANDA

W. Omuut 1, M. Lammorde1, S. Jacob 2, J. Okware 3

1Global health Security Program, Infectious Diseases Institute, Makerere University, Kampala, Uganda; 2Medicine , Liverpool School of Tropical Medicine, Liverpool , United Kingdom; 3Quality Assurance and Inspection Department, Ministry of Health, Uganda , Kampala , Uganda
Correspondence: W. Omuut

Introduction: The prevalence of HCAIs is arguably the most plausible indicator to measure effectiveness of health facility Infection Prevention and Control (IPC) programs. However, HCAI burden remains largely unknown in Uganda because no national system is in place for comprehensive and routine investigation.

Objectives: To establish HCAI surveillance systems in Public hospitals in Uganda.

Methods: In partnership with Ministry of Health a project was initiated to establish HCAI surveillance systems at select health care facilities. We reactivated and trained IPC committees at 8 regional referral hospitals (RRHs) to support HCAI investigation and drive necessary improvements. In April 2018, the first national HCAI Point prevalence survey (PPS) was conducted in 14 RRHs. Assessments were conducted using a World Health Organisation (WHO) 2002 PPS tool. Survey teams were pre-trained and site assessments conducted for 1 day per HCF for admitted patients.

HCAIs were classified as 1. Systemic defined as presence of two or more of the following: Heart Rate > 90 beats/min, Fever >38°C, Hypothermia < 36°C, hypotension < 90/60 mmHg, altered mental status, tachypnea > 25 breaths/min at least 48 hours after admission 2. Surgical Site Infections (SSIs); defined as contaminated, dirty or infected wounds for a surgery performed during the current hospitalization.

Survey results including prescription findings were summarized using descriptive statistics and disseminated at facility and national level to inform improvement. IPC Committees used results to design and implement improvements at respective health facilities.

Results: In the 14 RRHs,1100 patients were included in the survey. Mean prevalence (range) of HCAIs was 14% (6% - 24%). SSIs occurred most frequently at 44% then line related infections 13%, pneumonia 6%, blood stream infections 5%, urinary tract infections 2%. Microbiology investigation was not conducted. Most of the HCAIs (38%) were treated with a third or fourth generation cephalosporin; mostly intravenous ceftriaxone.

Conclusion: The project demonstrates feasibility of setting up HAI surveillance systems in a low-income country. We recommend integrating HCAI surveillance indicators into national monitoring and evaluation frameworks and to develop linkages with microbiology testing.

Disclosure of Interest: None declared

P181 HEALTHCARE ASSOCIATED INFECTION IN RIBAT TEACHING HOSPITAL , SUDAN

M. Gamar Elanbya

Sudan, Khartoum, Sudan

Introduction: Healthcare associated infections in limited resources countries is a major patient safety problem, it is essential to understand the magnitude of the problem and address it.

Objectives: To assess the rate of health care associated infection and pathogen associated with it.

Methods: Active surveillance was carried for all inpatient who had been in the hospital for at least 48 hours, trained nurses were assigned for data collection, blood, urine and wound swabs were collected to determine the causative microorganism. Sample size was 504, calculated using the equation of z2 p q/d2.

Results: The rate of infection was 9.7%. 53% of infection are SSI, 32.7 % BSI and 14.3 % UTI (91% of UTI in female) 56.5 % of the sample no growth is detected. Klebsiella species causes 66.7 % of the infection, Staphylococcus species causes 22.2% of infection and pseudomonas species causes 11.1 % of the infection

Conclusion: The health care associated infection is considered high and surgical site infection is the most common one, further investigation is needed for the causes of no growth media

References

1- Benedetta Allegranzi,Julie Storr,Gerald Dziekan, Agnes leotsakos, liam Donaldson, Didier Pittet.The First Global Patient safety challenge" Clean Care is Safer Care":from Launch to current progress and achievements. Journal of hospital infection (2007)65(S2)115-123 p2

2-  WHO, Department of communicable disease surveillance and response: Prevention of hospital acquired infections, practical guide, second edition.

3-  SURGICAL SITE INFECTIONS, INTERNATIONAL NOSOCOMIAL INFECTION CONTROL CONSORTIUM REPORT, DATA SUMMARY OF 30 COUNTRIES, 2005–2010

IINFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY june 2013, vol. 34, no. 6

4- May.O.Gamar Elanbya, an Assessment of Implementation of the Infection Control Program in six main Sudanese federal hospitals during the period from March-April 2006.

Disclosure of Interest: None declared

P182 HEALTHCARE- ASSOCIATED INFECTIONS HAI SURVEILLANCE IN A PRIVATE HOSPITAL. A SUCCESS STORY OF SURVEILLANCE IN A CAIRO, EGYPT

J. A. A. Elkholy

Cairo University Hospitals, Dar Al Fouad Hospitals, Cairo, Egypt

Introduction: Health care-associated infections are the most frequent adverse event in health-care delivery worldwide. Limited data are available from low- and middle-income countries [1-2].

Objectives: To describe the results of the surveillance system from August 2018 till 27 May 2019.

Methods: Standardized active prospective surveillance system was conducted HAI definitions used were the same 2008 NHSN case definitions [4]. Antimicrobial susceptibility testing was performed using CLSI guidelines.

Results: Intensive care units ICUs contributed to 19 HAIs. Of these 6 (31.6%) are ICU acquired and 13 (68.4%) are infections present on ICU admission. Of the infections BSI represented 50% (primary BSI: LCBSI- CLABSI), UTI represented 33% (ABUTI- CAUTI) and pneumonia represented 17% (pneumonia type 1). The incidence of HAI were 2.1/ 1000 patient- days, CLABSI was 1.6/ 1000 central line days and CAUTI was 1/ 1000 urinary catheter days. Mechanical ventilation utilization ratio was 0.3 and central line and urinary catheter utilization ratio was 0.7 each. Culture of microorganisms showed that gram negative pathogens constituted 52.6% of the total pathogens, mainly Klebsiella spp. constituted (36.8%) and Acinetobacter spp. (15.8%).

Conclusion: Having a continuous and sustainable surveillance system is a success. Surveillance is fundamental to have benchmark of infections, to plan for prevention strategies, to record the antimicrobial resistance pattern and to plan for an antimicrobial stewardship program[4].

References

(1) Zimlichman E, Henderson D, Tamir O, et al. Health Care–Associated Infections: A Meta-analysis of Costs and Financial Impact on the US Health Care System. JAMA Intern Med. 2013;173(22):2039-2046. doi:10.1001/jamainternmed.2013.9763.

(2) Magill S., Jonathan R. Edwards, M.Stat., Bamberg W., Beldavs Z. Multistate Point-Prevalence Survey of Health Care–Associated Infections N Engl J Med 2014;370:1198-208

(3) See I., Lessa F., Incidence and Pathogen Distribution of Healthcare-Associated Infections in Pilot Hospitals in Egypt. Infection Control and Hospital Epidemiology, Vol. 34, No. 12 (December 2013), pp.1281-1288

(4) Gordts B, Vrijens F, Hulstaert F, Devriese S, Van de Sande S. The 2007 Belgian national prevalence survey for hospital-acquired infections. J Hosp Infect 2010; 75:163-167..

Disclosure of Interest: None declared

P183 THE STATUS OF HOSPITAL INFECTION CONTROL PROGRAMS IN GOVERNMENT HEALTH FACILITIES IN METRO MANILA, PHILIPPINES

R. P. Berba, A. V. Dy Echo, M. A. Lansang, P. M. Pagkatipunan, R. Caro, A. Mejia

1College of Medicine, University of the Philippines, Manila, Philippines
Correspondence: R. P. Berba

Introduction: Infection prevention and control (IPC) programs constitute one of the pillars of patient safety. Evaluation of existing IPC programs is key to planning educational and program interventions for quality improvement. To date, there has been no published report on the status of IPC in any group of hospitals in the Philippines.

Objectives: To evaluate the current status of IPC among 10 government healthcare facilities in Metro Manila Philippines.

Methods: This cross-sectional descriptive study evaluated 10 government hospitals in Metro Manila, Philippines. The pre-validated public domain instrument called the Infection Control Assessment Tool (ICAT)1 was used. This includes 22 modules, each focused on a specific IPC topic. Each hospital was surveyed by trained ICAT assessors using in-depth interviews with key staff, observation of hospital practices and record review. At the end of each hospital visit, a summary score of either A, B, or C was given according to the criteria set by the ICAT. Hospital performances were summarized and compared.

Results: Using the ICAT, the 10 health facilities were comprehensively evaluated. The common strengths were: (1) presence of an organized,recognized and active Infection Control Committees (ICC) in all the surveyed hospitals; (2) The ICC functions were broad and expansive. Most have IPC policies in place; (3) Significant portion of time and resources of the ICC committees was spent on IPC education of staff. The three IPC areas which need improvement are: (1) Surveillance of HAI is almost uniformly incomplete; (2) Antimicrobial stewardship is lacking; (3) Critical portions of isolation precautions particularly implementation of proper personal protective equipment (PPE) is poor.

Conclusion: Survey on IPC in 10 government hospitals in Metro Manila using the ICAT identified the top 3 strengths and weaknesses in their practice of IPC. It became evident that the need for IPC programs in these Philippine hospitals is recognized and valued; and that in general the implementation of IPC have a strong foundation and able to perform within expectations. Gaps identified include need for technical support and skills-building activities, training and financing of relevant materials, infrastructure and manpower.

References

1. https://www.cdc.gov/infectioncontrol/pdf/icat/hospital.pdf.

Disclosure of Interest: None declared

P184 DEVICE ASSOCIATED INFECTION RATE AND BACTERIAL RESISTENCE IN AN EGYPTIAN UNIVERSITY HOSPITAL

M. M. Abdelhalim, on behalf of Mona Mohamed El_Khlousy**, Radwa Ahmed Rabea** Clinical Pathology Department - Faculty of medicine- Beni-Suef University** - Egypt

Clinical Pathology Department, Faculty of medicine- Cairo University, Cairo, Egypt
Correspondence: M. M. Abdelhalim

Introduction: Device-associated (DA)health care–associated infection(HAI) DA-HAIs are considered the principal threat to patient safety in the ICU and are among the main causes of patient morbidity and mortality.Standardized surveillance method allows for the determination of DA-HAI rates,comparable among health care centers,and provides infection control practitioners with a detailed picture of the institutional problems that they face, allowing them to devise effective solutions.

Objectives: To determine DAI rates, and the microbiological and antibiotic resistance profiles of infecting pathogens in ICUs of Beni-Suef University Hospital-Egypt

Methods: Prospective surveillance of HAIs was performed for adult and newborn patients admitted to adult and neonatal ICUs (NICU)of Beni-Suef university hospital from June 2012 to May 2013.DAIs rates were registered based on definitions applied by the Centers for Disease Control andPrevention᾽s National Healthcare Safety Network.

Results: The study included 303 patients were followed in ICUs for a total of 2,636 patient days.DAIs rate was88.5/1000 device days.VAP posed the greatest risk (68.7/1,000 ventilator days in the adult ICU, and 77.7/1,000 ventilator days in the neonatal ICU), followed by catheter associated urinary tract infections(CAUTI), then central line-associated bloodstream infections(CLABSI).The most frequently isolated pathogens inVAP were Acinitobacter Spp. (75%) in adultICU and Klebsiella Spp.(55%) in NICU. Candida Spp.were the leading pathogens in patients with CAUTI.InCLABSI, Enterococcus Spp.was the most frequently isolated pathogens (33%)in adultICUandKlebsiella Spp.(45%)inNICU.All Staphylococcus aureus infections were caused by methicillin-resistant strains, 88.9% of Pseudomonusaeruginosa were resistant to piperacillin-tazobactam, 45.6% were resistant to imipenem and flouroquinolones.Crude extra mortality was 10% among patients withVAPin adult ICU while66.7%in NICU,20% among patients with CLABSI in adult ICU while 26.7%in NICU, and 20% in patients with CAUTI.

Conclusion: The overall rate of DAIs was88.5/1000 device inICUs of our hospital.VAP was the most common DAI showing Acenitobacter Spp. as the commonest isolated organisms in adult ICU and Klebsiella Spp.in NICU. Establishment of active infection control programs that involve infection surveillance and implement guidelines for infection prevention can improve patient safety and quality of medical service

Disclosure of Interest: None declared

P185 INCIDENCE OF BLOOD STREAM INFECTION (BSI) ASSOCIATED WITH ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN A TERTIARY HOSPITAL; 3 YEARS PROSPECTIVE SURVEILLANCE STUDY

Y. Leharova1, R. Rodrigues1, C. Frenette2

1MONTREAL UNIVERSITY HEALTH CARE CENTER, Montreal, Canada; 2Infection Control & Prevention, MONTREAL UNIVERSITY HEALTH CARE CENTER, Montreal, Canada
Correspondence: Y. Leharova

Introduction: Our center is a 350 beds tertiary care referral center for hepatobiliary diseases and liver transplantation. Surveillance of health care associated BSI revealed that a significant proportion (12%) of HA-BSI were related to invasive procedures and the most frequent associated procedure being endoscopic retrograde cholangiopancreatography (ERCP) from 2016 to 2018.

Objectives: The goal of this study was to determine the incidence of bacteremia associated with ERCP, identify associated risk factors, complications and evaluate use of antibiotic prophylaxis regimen.

Methods: All BSI are reviewed to identify if associated with procedure within 7 days prior. The following variables were collected: primary diagnosis, types of hepatobiliary procedure performed indication and usage of antibiotic prophylaxis, dose, timing, complications and identified pathogen. The indications for the antibiotic prophylaxis were immunocompromised patient, liver transplant, biliary tree infection, neutropenic patient, etc.

Results: Over the three years, 44 BSI occurred following 1517 ERCP, at a rate of 3.0%. Indications were underlying Diagnosis: 18% cases were liver transplant cases, 9% cases were Gallbladder cancer, 61% cases were pancreatic or liver cancer, 30% cases were on chemotherapy; Symptoms prior ERCP procedure: Cholangitis 16%, liver obstruction 50%, stent stenosis 16%, liver abscess 7% and liver diseases. The most prevalent bacteria isolated were Klebsiella sp. 25%, Escherichia coli 25%and Enterobacter sp. 10%; Enterococcus sp. represented 11%. Prophylaxis antibiotic was not given prior to the procedure in 72% of cases; 14% cases received Ciprofloxacin and other antibiotics 14%. 72 % were hospitalized prior the procedure, 62 % required hospitalization, including 14 % to ICU. #30 day mortality was 9%.

Conclusion: The study reveals that many patients with ERCP associated BSI did not receive recommended antibiotic prophylaxis. This study indicates the need to improve prophylaxis through a standardized preprinted order for antibiotic prophylaxis that was developed, along with a high risk patient evaluation tool to evaluate patient’s risk factors prior to ERCP. These post-preventative measures implemented need to be evaluated for the outcome.

Disclosure of Interest: None declared

P186 Withdrawn

P187 CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTION & CATHETER ASSOCIATED URINARY TRACT INFECTION : EPIDEMIOLOGY FROM A TERTIARY CARE HOSPITAL IN INDIA

M. P. Pillai1, A. Warrier2, S. Joy3, R. Babu3, S. Bernadit1, K. Charles1 on behalf of Aster Medcity

1Infection Control; 2Infectious Diseases and Infection Control, 3Microbiology, Aster DM Healthcare LTD, Kochi, India
Correspondence: R. Babu

Introduction: Heath care associated infections (HAI) are important causes of morbidity and mortality world wide. In India, these infections are often under-reported and there are few reliable data. Given the paucity of data the objective of this study was thus to describe the epidemiology of HAIs, mainly CLABSI (Central line Associated Blood Stream Infection) & CAUTI (Catheter Associated Urinary Tract Infection) in our hospital - a quaternary care centre in India.

Objectives: To describe the epidemiology of HAIs, mainly CLABSI (Central line Associated Blood Stream Infection) & CAUTI (Catheter Associated Urinary Tract Infection) in our hospital - a quaternary care centre in India.

Methods: A retrospective study of case files of patients identified with a HAI during the period of January 2018 to December 2018 was conducted. HAIs were identified as part of routine infection control and prevention surveillance using the Centre for Disease control & National Healthcare Safety Network Criteria (CDC NHSN 2018) definitions. Rates were calculated and analyzed. The microorganism isolated and their antibiograms were also analyzed.

Results: Of 7484 patients included in the study, 2652 patients had a central line and 6711 had an indwelling urinary catheter. The rate of CLABSI was 3.8 per 1000 catheter days. The age group most affected was less than 20years. Gram Negative bacilli was the most common isolate of which Klebsiella pneumonia accounted for 30.7% . 41.66% of the Klebsiella pneumoniae strains showed multidrug resistance (MDR) and were resistant to the Carbapenems.

62 CAUTIs were identified during the study period with an incidence rate of 2.94/ 1000 catheter days. The most common age group was over 60 years (41.9%) and male sex was more commonly affected (51%). 51.6% of the patients were admitted with neurological diseases of which 24 required neurosurgery and had long duration of catheterization. The most common pathogen isolated was Klebsiella pneumoniae with around 59% being resistant to the Carbapenems and MDR

Conclusion: Key factors like competency assessment for staff involved in insertion and care of devices, and strict adherence to preventive bundles of care remain a challenge.

Disclosure of Interest: None declared

P188 SEASONAL INCIDENCE TRENDS OF SURGICAL SITE INFECTION - THE RESULT OF ACTIVE SURVEILLANCE PROGRAM OF POLISH SOCIETY OF HOSPITAL INFECTIONS

A. Różańska1, J. Wójkowska-Mach1, A. Jarynowski2, M. Wałaszek3 on behalf of Polish Society of Hospital Infections

1Jagiellonian University Medical College, Kraków; 2Interdisciplinary Research Institute in Wroclaw, Wrocław; 3State Higher Vocational School in Tarnów, Tarnów, Poland
Correspondence: J. Wójkowska-Mach

Introduction: Surgical site infections (SSI) surveillance and registration are necessary to determine the epidemiological situation and to launche effective preventive strategies. European Centre for Diseas Control and Prevention (ECDC) HAI-Net SSI program recommends the registration of SSI after selected surgical procedures for a period of at least three months.

Objectives: The aim of the study was to analyze the incidence trends for SSI registered as part of the active surveillance program run by Polish Society of Hospital Infections in accordance with the ECDC HAI-Net SSI protocol.

Methods: Definitions, infections detection criteria and registration forms in the Polish version were developed on the basis of the ECDC protocol.

SSI registration was carried out using the active method in various types of surgical procedures. In the years 2013-2018 eight hositals participated in the program, for the period time not shorter than one year.

Results: The study involved 33467 patients undergoing surgery (numer of operations), in which 477 cases of SSI were registered. Most of the SSI cases form of SSI was not given. The average incidence was 1.4% and ranged from 1.1% to 3.3% depending on the type of surgery. Incidence rates were significantly different depending on the month of infection detection. The highest rates were recorded in the winter months (December, January) and summer (June, July, August) in which fewer operations were performed than in other periods. No seasonality was observed for the distribution of etiological factors, among which Gram-negative rods from the Enterobacteriacae were dominant (24%).

Conclusion: The study has certain limitations. They are for example a small number of hospitals, lack of effective post-discharge surveillance or classification based on the systems, not specific operating procedures choosen for analysis. However, observation of the seasonally significant variability of incidence has practical implications. Firstly, the need for detailed control and validation of SSI prevention procedures during winter and summer holidays of staff. Secondly, the need of continuous targeted suveillance longer than three months period as a necessary condition of obtaining reliable epidemiological data and effective infection prevention.

Disclosure of Interest: None declared

P189 VALIDATION OF AN INSTRUMENT FOR POSTOPERATIVE SURVELLANCE IN SURGICAL SITE INFECTION

G. B. Guatura, V. Poveda

PROESA, University of Sao Paulo, São Jose dos Campos, Brazil
Correspondence: G. B. Guatura

Introduction: Surgical site infection (SSI) represents the third cause of infectionrelated to health care. Considering hospital discharges that are becoming more precocious, post-discharge surveillance is extremely necessary, since its failure to perform can lead to underreporting, making it difficult to prevention and control actions. There is a lack,until now, of tools that have been validated for the identification of potential cases of SSI during post-discharge surveillance.

Objectives: To create and validate an instrument for the post-discharge detection of potential cases of surgical site infection through post-discharge surveillance.

Methods: Methodological study, using psychometric analysis, for the elaboration and validation of an instrument for the post-discharge surveillance of surgical site infection.

Results: The instrument had coefficient of validity of total content equal to 0.87. In the criterion and construct validation, it was applied to a sample of 100 patients and compared to the medical and nursing physical examination to detect surgical site infection resulting in Cohen´s kappa (0.83), Cronbach´s alpha (0.87) and Comparative Fit Index (0.998). The sensitivity was 76.4%; specificity of 100%; negative predictive values ​​of 92.5% and positive of 100%, and; accuracy of 94%.

Conclusion: The instrument was validated in the content, criteria and construct stages.

References

1. Berríos-Torres S, Umscheid C, Bratzler D, Leas B, Stone E, Kelz R et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surgery. 2017;152(8):784. DOI: http://dx.doi.org/10.1001/jamasurg.2017.0904

2. World Health Organization (WHO). Global Guidelines for the Prevention of Surgical Site Infection. [Internet]. 2016. Available from:http://apps.who.int/iris/bitstream/10665/250680/1/9789241549882-eng.pdf?ua=1

3. United States of America. Centers for Disease Control and Prevention. Procedure associated module: Surgical Site Infection. [Internet]. Atlanta; 2018. [cited 2017 Oct 25]. Available from: https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf

6. National Institute for Health and Clinical Excelence/NICE. Guideline for Preventing, Identifying and Managing Wound Infection. [Internet]. 2017 [cited 2017 Oct 25]; Available from: https://www.nice.org.uk/guidance/CG74/chapter/1-Guidance#preoperative-phase

Disclosure of Interest: None declared

P190 ASSESSING INFECTION PREVENTION, CONTROL, AND SURVEILLANCE IN KENYAN HOSPITALS PROVIDING CAESAREAN SECTIONS

S. Senglaub1, A. Sway1, A. Wanyoro2, A. Oburu3, J. Solomkin1 on behalf of World Surgical Infection Society

1World Surgical Infection Society, Cincinnati, OH, United States; 2Obstetrics and Gynaecology, Kenyatta University, Nairobi; 3ACE Research, Kisumu, Kenya
Correspondence: S. Senglaub

Introduction: Caesarean section (CS) is a commonly performed major surgical procedure in Kenya; however, there is limited data available that describes infection prevention and control (IPC) readiness and surveillance in hospitals that perform this procedure.

Objectives: To assess IPC capacity including health care-associated infection (HAI) surveillance in Kenyan hospitals that perform CS.

Methods: We conducted a cross-sectional survey on IPC practices by adapting the World Health Organization IPC Assessment Framework. Surveys addressed four areas: IPC guidelines, surveillance, workload, and environment. Purposive sampling was used to identify 23 level-4 and -5, primary and secondary hospitals across 7 counties in southwest Kenya that provide CS. County-level permissions were obtained and data was collected from March through May 2019.

Results: IPC programmes were present in all 23 hospitals with 21 reporting leadership support and 14 with dedicated IPC budgets. While laboratory support was available in 21 hospitals, only 16 could support HAI surveillance. On-site labs were present in 8 of these hospitals while the remaining sent specimens off-site. Surveillance was conducted for: surgical site infections (11/23; 48%), device-associated infections (7/23; 30%), multidrug resistant pathogens (5/23; 22%), and infections in vulnerable populations (8/23; 35%). Antimicrobial drug resistance was analyzed regularly in 17% of hospitals and surveillance data was used for quality improvement in 44%. Functioning hygiene stations were available in 65% of hospitals. Water services and power supply were sufficient in 91% and 95% of hospitals, respectively.

Conclusion: Critical components of IPC programmes were lacking in the majority of hospitals including financial support, dedicated surveillance resources, and laboratory infrastructure. Moving forward, hospitals should consider identifying local champions, developing educational campaigns, and utilizing the IPC Core Component Guideline for self-assessment and recommendations to improve programme capacity.

Disclosure of Interest: None declared

P191 SURVEILLANCE OF SURGICAL SITE INFECTIONS IN INDIA- ACTIVE VERSUS PASSIVE METHOD

D. Sureshkumar1, S. Saravanakumar2, J. Hemalatha3, A. Jennifer4

1Infectious Diseases, Best of IDs, Chennai; 2Medicine, KMC Manipal, Mangalore; 3Pharmacy, Best of IDs; 4Infectious Disease, Madras Medical Mission, Chennai, India
Correspondence: D. Sureshkumar

Introduction: Surgical site infections (SSIs) are one of the most common health care associated infections (HAIs) in the developing world as well as most feared HAIs. Despite the availability of standard definitions and surveillance methods there are major concerns are there in the consistency & completeness of SSIs surveillance in the developing world.

Objectives: The main objective of this study was to describe & to compare the surveillance methods used by two accredited hospitals in South India in the estimation of SSIs burden.

Methods: Retrospective analysis of the SSIs case records prepared by infection control nurses working in 2 tertiary referral & accredited hospitals in South India between January 2017 and September 2018. The key parameters analyzed were total number of surgeries performed, SSI rate, timing of SSIs (before hospital discharge or after hospital discharge) and surveillance method (passive- microbiology positive cultures or active- case finding by daily bed side rounds, outpatient follow ups telephonic follow up of discharged patients).

Results: Totally 8042 surgical procedures with 149 SSIs (1.85%) occurred during the study period. 2899 surgeries happened in the first hospital with 26 SSIs (0.89%). However, in second hospital 5143 surgeries happened at the same time with 123 SSIs (2.39%). Majority of the SSIs happened after the discharge from both the hospitals (103/149, 69.12%). Passive surveillance method (culture positive reports from microbiology laboratory) identified 143 of 149 SSIs (95.97%). Very few cases surgeon identified the SSIs and informed the infection control nurses in this study.

Conclusion: : Most of the SSIs happened after discharge and passive surveillance method was the main method used to identify SSIs in the Indian hospitals. Urgent measures are required to improve the active SSIs surveillance and to find the real SSIs burden in India.

Disclosure of Interest: None declared

Poster session: Outbreak

P192 FUSARIUM SPP OUTBREAK IN ONCOHEMATOLOGIC UNIT

W. Cornistein1, A. Novau1, L. Fabbro1, L. Paulosky1, G. Pineda2, M. L. Pereyra3

1Prevention and Infection Control; 2Microbiology; 3Infectious Disease, Austral University Hospital, Buenos Aires, Argentina
Correspondence: W. Cornistein

Introduction: Fusarium spp can disseminate causing an invasive fusariosis (IF) with mortality rate of 75% in immunocompromised (IC) hosts. Fusarium sp are ubiquitous molds which can be found in the soil, water, and air. In our hospital, the incidence of IF increased from 0.56 ( 2° semester of 2018) to 5.3 (1° trimester 2019) 1000 IC patiens day

Objectives: To describe a Fusarium spp outbreak in oncohematological patients and the strategies to control it.

Methods: This study was performed at a 210-bed private tertiary-care university hospital located in Buenos Aires. The Bone Marrow Transplant (BMT) ward has 8 individual rooms, HEPA filters and positive pressure airflow. The hematology ward has 8 private rooms with no controlled air. All patients with hematologic malignancies were hospitalized in this ward.

The Infection Control Department performed:1-Case analysis and possible source of infection; 2-Inspection of the hospital infrastructure and rooms; 3-Environmental samples from air, surfaces and water; 4- Examination of cleaning and disinfection policies; 5. Specific measures on patients regarding shower and use of drinking water.

Results: From Jun 2018 to january 2019, we detected 5 cases of IF caused by Fusarium solanii. Most patients presented neutropenia, fever with cutaneous portal entry. All patients were treated with a combination of antifungal drugs. Mortality was 40%.

72% of the rooms had either visible fungi in bathroom walls or uneven surfaces which made imposible an adequate cleaning. We remodeled each room and bathrooms.

Air samples were negative. All showers and sink surfaces samples in BMT unit, hematologic and general wards were positive to Fusarium spp.proving the hypothesis of waterborne dissemination. External faucets were uncoupled and both pieces and surfaces were cleaned with hyperchlorination and 20% quaternary ammonium. A water filter was installed in one room.

The patients' bathroom and the use of water were suspended. No more cases have been detected.

Conclusion: The environmental study of an outbreak identifies risk factors for IC patients making it possible to improve conditions and reduce the incidence of serious and potentially lethal cases.

Disclosure of Interest: None declared

P193 INFLUENZA A OUTBREAK IN A HEMODIALYSIS UNIT AT A TERTIARY CARE CENTER IN LEBANON

J. Tannous1, N. K. Zahreddine1, R. M. Attieh 2, H. Mezher 3, Z. Kanafani4, S. Kanj4

1Infection Prevention and control; 2internal medicine; 3nursing services; 4infectious diseases , AUBMC, Beirut, Lebanon
Correspondence: J. Tannous

Introduction: Patients undergoing hemodialysis (HD) are at an increased risk for Influenza and its complications. Annual influenza immunization is recommended for eligible HD patients and Healthcare Workers (HCWs) working in Hemodialysis units (HDUs). The vaccine is presumed to induce immunity despite reports of insufficient effectiveness in HD patients.

Objectives: The aim of the study is to describe an outbreak of influenza A among patients undergoing dialysis.

Methods: An outbreak caused by Influenza A virus occurred between February 19 and March 14, 2019 in the 24-chairs HDU at the American University of Beirut Medical Center. Influenza infections were confirmed by either Rapid Influenza Diagnostic or Reverse Transcription Polymerase Chain Reaction (RT-PCR) tests. All patients, staff and visitors were required to wear face masks when accessing HDU as directed by the Infection Control (IC) team. All exposed patients received prophylactic oseltamivir. Exposure management for HCWs was also initiated. Exposed HCWs were referred to Employee Health Clinic (EHC) for medical assessment and work restriction when indicated.

Results: A total of 11 patients out of the 100 HD enlisted patients (11%) were confirmed to have Influenza A infection during the outbreak period. 10 out of the 11 patients were hospitalized (91%) and all patients recovered. 5 patients gave a positive history of flu vaccination. The flu vaccination uptake rate for the 100 patients was 66%. One patient developed influenza despite prophylactic oseltamivir. Moreover, 6 of the 8 exposed nurses developed flu like illnesses, but none were tested. None of them had received vaccination and all were restricted from work until cleared by EHC.

Conclusion: The IC measures that were implemented were effective in halting the transmission to other patients. A mandatory Influenza vaccination targeting HD staff and patients was adopted for the coming seasons. Additional research is needed to resolve dosage (high-dose or booster) requirements of the flu vaccine in HD patients. Furthermore, screening HD patients at the point of entry for flu-like illnesses is essential during the Influenza season for proper implementation of IC measures.

Disclosure of Interest: None declared

P194 EMERGENCE OF ELIZABETHKINGIA MENINGOSEPTICA AND RALSTONIA PICKETTI IN CRITICALLY ILL PATIENTS – INNOCENT BYSTANDERS OR POTENTIAL THREAT?

M. C. Dimabuyu1, S. Santos2, S. Abad Santos3

1Medicine, St. Luke's Medical Center; 2St Luke's Medical Center, Taguig; 3St. Luke's Medical Center, Taguig City, Philippines
Correspondence: M. C. Dimabuyu

Introduction: Elizabethkingia meningoseptica and Ralstonia picketti are both gram-negative bacilli of low virulence that is ubiquitously found in hospital environments, hence associated with various nosocomial infections. Immunocompromised individuals are particularly at increased risk for developing severe infections with high mortality rates partly due to multidrug resistance.

Objectives: We described here 2 cases of E. meningoseptica bacteremia and 2 cases of hospital acquired pneumonia with R. picketti showing resistance to multiple antibiotics, ensuing treatment and investigation in our institution.

Methods: Over a period of 4 months, two critically ill patients were positive for E. meningoseptica from blood cultures. Isolates were identified using rpoB sequence cluster analysis. Another two patients both intubated and on hemodialysis were identified with R. picketti isolates from respiratory tract.

Results: E. meningosepticum isolates has shown resistance to most antibiotics useful against Gram-negative bacteria (aminoglycosides, beta-lactams, chloramphenicols) but it is susceptible to Vancomycin and Ciprofloxacin. Resistance may be due to both class A extended spectrum beta lactamases (ESBL) and class B metallo-β-lactamases (MBLs). Both cases were given Vancomycin which showed clearance from repeat blood cultures done after 7 days.

Resistance of R. pickettii infections could be due to the presence of mobile genetic elements: blaOXA-22 which has activity against benzylpenicillin, cloxacillin and restricted-spectrum cephalosporins and blaOXA-60 which has activity against imipenem. Both were given Tigecycline based on sensitivity results. Repeat cultures were negative.

Infection control had been alerted and investigation revealed no commonalities between patients other than having been inpatient on the same unit at different times. Hemodialysis machine used were different. Water samples from outlet were negative.

Conclusion: When the isolation of unusual microorganisms occurs, an active search should be initiated that includes microbiological examination of administered fluids, medications, hemodialysis water, mechanical ventilators and culture materials. Such cases must be reported to the committee for infection control to prevent and control outbreaks.

Disclosure of Interest: None declared

P195 RAPID CONTROL OF SERRATIA MARCESCENS OUTBREAK IN NICU, OMAN, SEPTEMBER-OCTOBER 2018

Z. A. Al Maskari1, M. AL Hinnai2, K. AL Riyami3, L. AL Ghabshi4, A. AL Rashdi4, A. K. AL Jardani4

1Infection prevention & control, Royal Hospital, Muscat; 2Infection prevention & control; 3NICU, Royal Hospital; 4Medical Microbiology, Central Public Health Laboratory, Muscat, Oman
Correspondence: Z. A. Al Maskari

Introduction: Serratia marcescens is an important opportunistic pathogen combining a propensity for healthcare-associated infection and antimicrobial resistance. Outbreaks are frequently reported in neonatal intensive care units.

Objectives: The aim of this study to describe the outcome of infected neonates, emphasize on the importance of enhancing various infection control practices to control the outbreak and describe the role of molecular typing.

Methods: from september to October 2018, the NICU of our hospital experienced an outbreak of Serratia marcescens. The screening for Serratia was initiated for all neonates at risk after the second case detected positive, a total of 9 cases involved (5 had bacteremia, 4 were colonized). Extensive environmental microbiological sampling conducted, and five clinical isolates were typed using PFGE. Cohorting of infected/colonized neonates done, healthcare workers awareness and hand hygiene practices were enhanced, frequent environmental and non-critical medical equipment disinfections were carried out.

Results: During outbreak surveillance, 90 neonates were screened by rectal swab and other swabs taken based on the case (ET for ventilated neonates, wound swabs). 5 neonates detected by screening,1 of them had bacteremia. Three of the cases that had bacteremia had negative screening. Unfortunately, 3 of the bacteremia cases died with sepsis being the direct cause. Factors contributed to the outbreak were overcrowding, low compliance among the unit staff and among external medical staff visiting the unit with infection control practices after working hours and late start of appropriate antibiotics in septic neonates. 86 environmental samples were cultured results of which came negative. Molecular typing showed only two strains were identical, one was un-typable, and the other two were closely related.

Conclusion: Serratia marcescens bacteremia has a high mortality. Enhancing various infection control practices is very vital for rapid control of Serratia marcescens outbreak.

Disclosure of Interest: None declared

P196 CANDIDA AURIS OUTBREAK EXPERIENCE IN A MEDICAL INTENSIVE CARE UNIT OF A TERTIARY, GENERAL HOSPITAL IN QATAR, 2019

F. Altura - Visan1, N. Al Ansari2, W. Al Wali1, A. Zakaria3, E. Karic4 on behalf of Critical Care Outbreak Team members, J. Al Ajmi5, M. Al Jonidi4 on behalf of Critical Care Outbreak Team members, O. Al Hasanat6, J. Castro6, G. Hudaib6, M. Asuncion6, U. Ummer6, D. Hamdani7 on behalf of Candida auris Outbreak Group, Al Wakra Hospital

1Infection Prevention and Control, Al Wakra Hospital - Hamad Medical Corporation; 2Infection Prevention and Control, Al Wakra Hospital; 3Infection Prevention and Control, AL Wakar Hospital - Hamad Medical Corporation; 4Critical Care Division, Al Wakra Hospital - Hamad Medical Corporation, Al Wakra; 5Corporate Infection Prevention and Control, Hamad Medical Corporation, Doha; 6INFECTION PREVENTION AND CONTROL OFFICE, Al Wakra Hospital - Hamad Medical Corporation, Al Wakra Hospital - Hamad Medical Corporation, Al Wakra; 7INFECTION PREVENTION AND CONTROL OFFICE, Al Wakra Hospital - Hamad Medical Corporation, Ministry of Public Health, Doha, Qatar
Correspondence: F. Altura - Visan

Introduction: Candida auris is known to be invasive, multidrug resistant and can cause outbreaks in hospitals. Mode of transmission is through contaminated hospital items i.e. fomites and intervention of staff. The outbreak of Candida auris affecting four patients at the Medical Intensive Care Unit (MICU) either in the form of infection or colonization is the first documented outbreak occurring in the State of Qatar.

Objectives: The objectives for this presentation are to identify the risks of patients involved, discuss interventions for outbreak control and add knowledge to IPC community regarding Candida auris.

Methods: First case identified on 11/2018 in a patient colonized in respiratory tract. Candida auris biweekly tests were conducted. Outbreak cases were identified as second case colonized in the decubitus ulcer. Third case as bloodstream infection, treated accordingly with recovery from septicemia. Fourth case colonized in the axillae.

Results: Root cause analysis suggests, index case imported from Pakistan (known Candida auris infection), followed by subsequent transmission to other patients in MICU. Geographically a particular room number 2 where all four patients have occupied is the potential source of transmission. Multiple evidence-based infection prevention and control actions, were pursued including stricter monitoring programme, decolonizing by using topical antifungals, environmental sampling, terminal cleaning, and increasing awareness.

Conclusion: The outbreak is not yet terminated, there's continuous IPC interventions. Outbreak control was conducted within a strong MDT using latest scientific evidence. We recommend it is imperative that everybody complies with IPC practices. Unfortunately there are still colleagues even senior consultants refusing to comply. The need for Hydrogen Peroxide vapor disinfection machine to kill highly contaminated environments.

Disclosure of Interest: None declared

P197 OUTBREAK AND CONTROL OF ACHROMOBACTER DENTRIFCANS INFECTIONS AT A TERTIARY HOSPITAL IN PRETORIA, SOUTH AFRICA

M. Said1, Y. Dangor2, R. Naidoo2, B. Mitton2, N. Mbelle2, M. Naicker2, K. Katlego2, V. Amutenya2

1NATIONAL HEALTH LABORATORY SERVICES; 2Medical Microbiology, University of Pretoria, Pretoria, South Africa
Correspondence: M. Said

Introduction: From June-October 2018, the Tshwane Academic Microbiology lab cultured 38 Achromobacter dentrificans patient isolates (baseline was 1-2 isolates per month) from the Steve Biko Academic Hospital (SBAH). The majority of the isolates were cultured from blood (n=23).

Objectives: To determine the source of the Achromobacter dentrificans outbreak

Methods: A line list was developed for each case. Each case had an interview conducted with the attending clinician, the patient and the person who collected the lab specimens. A common feature was that for all procedures, the antiseptic used was chlorhexidine and water solution prepared at the hospital pharmacy. The chlorhexidine and water solutions from various wards were collected for investigations. The pharmacy was visited and swabs were taken from empty bottles and caps of the bottles used for chlorhexidine and water solutions, water used for the preparation, the stock chlorhexidine solution, the solution colourant, utensils used in the preparation, the dispenser nozzle used to dispense the solution into the bottles and the final product. The chlorhexidine and water solutions as well as the swabs were plated on to 5% blood agar, chocolate agar and MacConkey agar and incubated at 35-37oC for 48 hours. Final identification and antimicrobial susceptibilities (AST) of colonies was done using Vitek 2 (Biomerieux, France). REP-PCR was performed to determine molecular relatedness of the isolates.

Results: Growth of Achromobacter dentrificans was noted from all chlorhexidine and water solutions tested from the wards as well as the dispenser nozzle from the pharmacy. According to REP-PCR, two strains of Achromobacter dentrificans were identified from the pharmacy. Both these strains were identified in patient samples. The majority of patients were not clinically septic.

Conclusion: The hospital pharmacy was advised to recall chlorhexidine and water solutions from all wards at the end of October 2018. It was advised that 4% chlorhexidine gluconate be used in future for skin antisepsis and no further chlorhexidine and water preparations be made in pharmacy. Following this intervention, the number of clinical isolates decreased dramatically to the baseline of 1-2 isolates per month from November to May 2019.

Disclosure of Interest: None declared

P198 A CLUSTER EPIDEMIC CAUSED BY E.COLI INFECTION AMONG PATIENTS WHO WERE UNDERGOING URODYNAMIC TESTING IN A TEACHING HOSPITAL IN CHINA

L. Li

Department for HAI control, West China Hospital of Sichuan university, Chengdu, China

Introduction: As a valid tool to evaluate the urinary incontinence, the urodynamic testing is usually applied in clinical practice. However, it was frequently associated with nosocomial infections due to lack of standard precautions.

Objectives: To confirm the cluster epidemic and explore the source of the epidemic, we investigated a cluster epidemic of E.coli infection after the urodynamic testing in a teaching hospital.

Methods: Field investigation was used to collect the demographic and clinical data through HIS system. Case control study was implemented to assess the risk of getting infection. Environmental samples from urodynamic device and related wards were tested by PCR. ERIC-PCR was used to test the similarity between urinary specimens and environmental samples. Medical records were reviewed finally to identify new infections in one month afterwards.

Results: Totally there were 25 inpatients underwent urodynamic testing during the epidemic period. Case control study showed urodynamic testing was a risk factor for the patients to get urinary infection(OR=2.44, P=0.003).5 specimens of 5 patients, which mainly came from ward A and ward B, and one environmental sample were tested positive of E.coli. and the ERIC-PCR result between the E.coli strain isolated from the 4 specimens of 4 patients and one environmental sample from a urinary funnel showed highly similarity. Field investigation showed bleach of infection control policy during the testing.

Conclusion: Undertaking urodynamic testing is a risk factor of getting E.coli. infection, and bleach of infection control policy during Urodynamic testing is commen. Strict infection control measures must be followed and the active surveillance for nosocomial infection in hospital played a key role to identify the unexpected event.

Disclosure of Interest: None declared

P199 INVASIVE FUNGAL INFECTION IN AN INTENSIVE CARE UNIT RELATED TO STRUCTURAL COMPONENTS AND HEALTHCARE WORKERS BEHAVIOURS

D. Hilliquin, A. Regard, N. Khanafer, E. Marion, P. Cassier, T. Rimmelé, M. Bertin-Maghit, O. Martin, P. Vanhems

Hospices civils de Lyon, Lyon, France
Correspondence: D. Hilliquin

Introduction: Nosocomial infection can occur from care or environmental contamination like airborne pathogens. To reduce this risk, air treatment is set up in units which admit high-risk patients of invasive fungal infections

Objectives: Evaluate relationship between serious fungal infection and structural components and healthcare workers (HCW) behaviours

Methods: In December 2018, the burn intensive care unit (ICU) of a French university hospital alerted the infection control unit of 3 nosocomial invasive fungal infections. Two Mucorales (1 Rhizopus microsporus and 1 Lichtheimia spp.) and 1 Aspergillus fumigatus infections were reported in 3 patients hospitalized in 3 different rooms. Investigations by the infection control team (ICT) were conducted including air samples, structural (environmental and technical constituents) and HCW behaviours

Results: Burn-ICU is composed of 10 rooms with positive air flow. Two of them have a flow reversal system. Each room is composed of two doors (1) corridor - airlocks door and (2) airlock - room door. Two 500L air samples were performed in each room of patients with Mucorales infection. In one room, 4 CFU/m3 Aspergillus versicolor and 12 CFU/m3 Penicillium sp. were isolated in one sample and 6 CFU/m3 A. versicolor were found in the second one. Inspection of structural components showed: dust in some supply grids and inappropriate fixing of some false ceiling panels. Front doors without windows were opened frequently because of the lack of visibility. Regarding organizational components, removing cardboard were performed in the corridor with opened front doors. Cardboard were also found in airlock rooms. Moreover at least 1 of the 2 doors was opened in the majority of rooms conducting to an ineffective air treatment or a flow inversion. Following the investigations, the technical unit intervened to create windows for front doors and to fix ceiling panels. Moreover, ICT achieved training session for HCW about the importance of air treatment

Conclusion: This investigation shows the importance of air treatment in unit with patient at high-risk of developing severe invasive infection linked to environment. HCW behaviour should be considered as a principal actor to improve control measures against the spreading of airborne infection in hospital

Disclosure of Interest: None declared

P200 CONTROL OF CARBAPENEM RESISTANT ACINETOBECTER BAUMANII INFECTIONS IN AN ENDEMIC HOSPITAL SETTING

K. Labay1, I. Aharon1, I. Asael2, O. Nitzan1,3, A. Peretz4, S. Soboh2, H. Zayyad1

1Infectious Disease Unit; 2Internal Medicine B, Poriya medical center, Poriya; 3Faculty of medicine, Bar Ilan university, Zefat; 4Microbiology Unit, Poriya medical center, Poriya, Israel
Correspondence: K. Labay

Introduction: Introduction: Carbapenem resistant Acinetobacter baumanii (CRAB) is one of the most common resistant pathogens causing hospital acquired infections.

Objectives: Following an outbreak of CRAB infections in an internal medicine ward, we used a multimodal approach to implement guidelines and reduce the incidence of CRAB acquisition at the hospital level.

Methods: Methods: We conducted a study of the incidence of CRAB infections during the years 2017-2019 at our 350 bed hospital. An intervention was implemented during July-September 2018 after an outbreak of CRAB infections in an internal medicine ward. Before intervention, infection control measures included contact precautions and environmental disinfection. Our intervention included cohorting or single room isolation, monitoring environmental disinfection, screening cultures of at-risk patients. Patients screened positive for CRAB were isolated as well. To facilitate implementation of the intervention we engaged the hospital management, department leaders, teams in charge of environmental disinfection and the microbiology laboratory.

The primary outcome was CRAB infection rate (Incidence rate) per 100,000 patient days each year, before, during and after the intervention.

Results: Results: During the baseline period (2017), the rate of CRAB infections was 57 cases per 100,000 patient-days; 20 cases per 100,000 patient days were acquired during the year of intervention, 2018, relative risk reduction (RRR) 0.65 (p<0.0001); and during the first 5 months of 2019 rates declined further to 6 cases per 100,000 patient-days (RRR 0.89, p<0.0001).

Conclusion: Conclusion: We believe the outbreak served as a booster for implementing infection control measures. An intervention involving the ward medical staffs, ward leaders, cleaning teams, and the hospital management prevented outbreak escalation, and caused a sustained decline in CRAB acquisition at the hospital level. CRAB outbreaks can be controlled using a multimodal approach of infection control measures.

Disclosure of Interest: None declared

P201 INFECTION PREVENTION AND CONTROL (IPC) IN NATURAL DISASTERS AND OUTBREAKS – EXPERIENCES FROM HUMANITARIAN RESPONSE TO TROPICAL CYCLONE (TC) IDAI IN MOZAMBIQUE, FOLLOWED BY AN OUTBREAK OF CHOLERA

D. Peter1, N. Stücke2, F. Mattner1

1Institute of Hospital Hygiene, Kliniken Köln, Lehrstuhl für Hygiene und Umweltmedizin, Universität Witten-Herdecke; 2Arbeiter-Samariter Bund Deutschland e.V. (ASB), Köln, Germany
Correspondence: D. Peter

Introduction: In the aftermath of TC Idai an outbreak of cholera occurred in the district of Beira, Mozambique.

Objectives: Embedded in the humanitarian response ASB’s WHO-classified Emergency Medical Team (EMT) focused on the implementation of IPC measures to support health centers (HC) in Beira District during the outbreak. Here we report our approach, experiences and lessons learnt from this deployment, implementing an IPC-tool that has been developed and pilot-tested in Zambia in 2018/2019.

Methods: A multidisciplinary team consisting of WASH-experts (water, sanitation and hygiene) and IPC professionals conducted a structured assessment of 4 health centers, each providing care for 120-150 patients per day. Contents for an IPC-training (software) and construction needs to facilitate the implementation of IPC-measures (hardware) were identified. A training was tailored to the needs and local circumstances in close collaboration with local health care workers, health authorities and the WHO.

Results: Sings of infectious diseases, transmission of pathogens and transmission-based precautions, safe handling of personal protective equipment (PPE), relevant diseases and reporting pathways were part of the training in which representatives from 12 (of 17) HC in Beira District participated. Hardware installed in 4 HC included hand wash facilities, safe waste management areas, water filters and additional waiting areas for infectious patients.

Conclusion: A relatively short intervention in the midst of an outbreak cannot aim at sustainably implementing IPC-measures. Whilst the threat is immanent however a bundle of needs-based and context-adapted soft- and hardware measures can help increase the safety of HC when managing infectious patients. This may help to protect the valuable resource of health professionals, preserve the population’s trust in the local health system and prevent the spread of infections between patients during humanitarian crises. A complementary approach that combines training and necessary materials and structural preconditions to put theory into practice is crucial.

Disclosure of Interest: None declared

P202 DEVELOPMENT AND PILOT TESTING OF AN INFECTION PREVENTION AND CONTROL (IPC) TOOL FOR HUMANITARIAN RESPONSE TO OUTBREAKS AND NATURAL DISASTERS

D. Peters1, N. Stücke2, F. Mattner1

1Institute of Hospital Hygiene, Kliniken Köln, Lehrstuhl für Hygiene und Umweltmedizin, Universität Witten-Herdecke; 2Arbeiter-Samariter Bund Deutschland e.V. (ASB), Köln, Germany
Correspondence: D. Peters

Introduction: Outbreaks occur worldwide independent of or in the aftermath of natural disasters. The WHO Emergency Medical Teams (EMT) initiative has contributed to quality assurance in humanitarian response. The response to outbreaks has recently gained relevance for EMTs.

Objectives: Here we report the development and pilot testing of an IPC-tool by ASB’s WHO-classified EMT.

Methods: 1. CDC’s Infection Prevention and Control Assessment Tool1 was adapted to the context of rural health centers (RHC) in Mumbwa District, Zambia. 2. A structured focus group discussion was conducted to identify relevant contents of an IPC-curriculum with representatives of the district health office (n=2) and local health care workers (HCW, n=5). 3. A workshop was held to identify preferred didactic methods. 4. A table-top exercise (TTEX) was developed to measure HCWs’ performance when managing infectious patients.

Results: A training curriculum was developed followed by a 3-day training held in Feb. 2019. 15 participants of 13 RHC participated. 13 participants completed a pre-/post-training multiplechoice IPC-questionnaire (MCQ). 7/13 RHC, providing care for a population of over 36.000, completed a full evaluation cycle consisting of: 1. Structured assessment of the RHC1 2. Pre-/post-/post-post (3 months after training) MCQ of training participants 3. Pre-/post-post MCQ of one non-participant health worker per RHC to evaluate multiplication activities of participants 4. Pre-/post-post TTEX to evaluate participants’ performance when managing infectious patients in the RHC Participants of these 7 RHC included 4 environmental health technicians, 2 clinical officers and 1 nurse. Preliminary results show an improvement of HCWs’ performance when managing infectious patients in their RHC. The final data are currently being analyzed.

Conclusion: A structured IPC-assessment of a RHC can be performed within hours, allowing IPCprofessionals to identify risks of pathogen transmission. A tailored training can help prepare RHC in Zambia for the management of infectious patients.

References

1) CDC, Version 2.3 – September 2016, https://www.cdc.gov/infectioncontrol/pdf/icar/outpatient.pdf

Disclosure of Interest: None declared

Poster session: Long-term care facilities & nursing homes

P203 ANTIMICROBIAL USE AND URINARY TRACT INFECTIONS IN FINNISH LONG-TERM CARE FACILITIES: RESULTS FROM TWO DIFFERENT SURVEILLANCE SYSTEMS

S. Toura, D. Arifulla, E. Sarvikivi, M. Mäkelä, O. Lyytikäinen

National Institute for Health and Welfare, Helsinki, Finland
Correspondence: S. Toura

Introduction: Prevalence of healthcare-associated infections (HAIs) and antimicrobial use (AMU) in Finnish long-term care facilities (LTCFs) were investigated recently as a part of the third European point prevalence survey (HALT) coordinated by European Centre for Disease Prevention and Control. In Finland, the RAI Long Term Care (LTC) and Home Care Instruments have previously been considered feasible tools for collecting AMU and HAI data from LTCF residents.

Objectives: We explored the prevalences of AMU and HAIs in Finnish LTCFs and compared the results in two different surveillance systems.

Methods: In Finland, HALT survey was conducted during September-November 2017, gathering information on resident characteristics, active HAIs and AMU on the day of the survey. HAIs had to meet the criteria of the standardized case definitions. Second, we used data on characteristics, AMU and urinary tract infections (UTI) of all residents for whom RAI-LTC form was completed by LTCFs during October 2017-March 2018. RAI collected AMU within 7 days prior to the assessment and infection data was based on a checklist. Descriptive statistics were used to summarize and to compare the data.

Results: In total, HALT survey covered 175 LTCFs with 6762 residents and RAI 1369 LTCFs with 21 943 residents. The proportion of residents over 85 years of age, females and usage of urinary catheter did not differ between the two surveillance systems. In HALT and RAI, 5% and 6% of the residents received at least one antimicrobial (other than methenamine) and the proportion of residents using methenamine was 2% and 3%, respectively. In HALT the most common infection type was UTI. UTI prevalence was higher in RAI than in HALT (5% vs. 1%).

Conclusion: Although the data collection methods differed, the two surveillance systems provided rather similar estimates for AMU. AMU and UTI prevalences were lower than in the previous study which was also based on RAI data. RAI-LTC could be used as an alternative tool for data collection on AMU and HAI in LTCFs. However, adding or implementing case definitions/or implementing case definitions for HAIs would improve the data.

Disclosure of Interest: None declared

P204 Withdrawn

P205 SCABIES IN NURSING HOMES : EXPERIENCES IN CANTON DE VAUD, SWITZERLAND?

D. Hequet, B. Sobgoui, C. Petignat

Unité cantonale vaudoise HPCI, Lausanne, Switzerland
Correspondence: B. Sobgoui

Introduction: Cases of scabies in nursing homes (NH) can be problematic to manage, mainly because diagnosing scabies is difficult. Indeed, the elderly can be paucisymptomatic and the identification of the parasite is complex and requires expertise. Because diagnosis is often delayed, additional measures are not immediately implemented.

Objectives: The main purpose of this review is to demonstrate the importance of rapid identification and management of cases and contacts

Methods: We reviewed scabies cases reported in four NH between June 2017 and March 2019.

Results: Among residents, sixteen cases were identified with three close contact cases. Moreover, one case engendered two contact cases in healthcare workers. A treatment was given to the sixteen cases, the three close contacts among residents and the two healthcare workers. We describe the special situation of a NH with seventy-two residents on four floors and two healthcare workers teams (floors 1-2 and floors 3-4). In December 2018, a case of Norwegian scabies in a hospital was confirmed. The case and two healthcare workers as secondary cases were diagnosed and treated accurately. All the residents and healthcare workers of the same floor (second floor) received a treatment. In January 2019, three residents (to the first and second floor) were diagnosed with Norwegian scabies; none contact case was identified. Unfortunately, the treatment of the forty-four contact residents was not concomitant (time differential from 1 to 5 days due to the availability of drugs). In March 2019, four cases were diagnosed (first and third floor), without reported contact cases. The treatment was once again given to all the forty-four contact residents and to all the healthcare workers of the institution. Within three months, all residents and healthcare workers had to take the treatment at least two times, which represents more than 150 treated people.

Conclusion: This analysis demonstrates the importance of applying the PCI recommendations (identifying contact cases and the concomitant treatment of residents and healthcare workers) are essential to eradicate scabies in NH, in particular in case of Norwegian scabies.

Disclosure of Interest: None declared

P206 FIRST NATIONAL PREVALENCE STUDY OF HEALTHCARE-ASSOCIATED INFECTIONS AND ANTIBIOTIC USE IN SERBIAN LONG-TERM CARE FACILITIES

Z. Djordjevic1, G. Dragovac2, G. Krtinic3, I. Janicijevic4, V. Rakic5, L. Markovic-Denic6

1Clinical Center of Kragujevac, Kragujevac; 2University of Novi Sad, Faculty of Medicine, Novi Sad; 3General Hospital, Subotica; 4Institute of Public Health, Nis; 5Institute of Public Health of Serbia; 6University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Correspondence: L. Markovic-Denic

Introduction: Although less invasive medical care is provided in long-term care facilities (LTCF) than in hospitals, healthcare-associated infections (HAIs) and antimicrobial (AM) use are common in residents of these institutions.

Objectives: To identify institution and resident associated risk factors of HAI and AM use.

Methods: Six LTCF from different regions in Serbia were included in a 1-day point prevalence survey in July 2017, applying ECDC definitions and methods. Data collecting staff were previously trained physicians and infection control (IC) nurses from LTCFs and IC doctors from the regional institutes of public health. Data on LTCF organization and resources, HAIs, and AM use were collected.

Results: A total of 1168 eligible LTCF full-time residents were included (male-female ratio was 0.40; 32.1% >85 yrs). The prevalence of residents with at least one HAI was 3.2% (95% CI 1.5-4.6), and prevalence of all HAI was 3.5% (95% CI 1.6-5.4). Urinary tract infections and respiratory tract infection were more frequent with prevalence 1.5% and 1.0%, respectively, following with skin infections, than the eye, ear, nose, mouth infections and unexplained fever (prevalence 0.3% vs. 0.2% vs. 0.1%, respectively). At higher risk of HAI were residents with an indwelling urinary catheter (OR=5. 949, 95%CI), pressure sores (OR=14.208, 95% CI 5.838-34.577; p<0.001), impaired mobility (OR=3.395, 95%CI 1.518-7.591; p=0.003), and disorientation in time and/or space (OR=4.288 95%CI 2.057-8.938; p<0.001). At least one antimicrobial received 4.9% (95%CI 3.7-6.3) of residents; prevalence of total AMs was 6.0% (95%CI 3.4-15.4). AMs were mainly administered orally (77%). Most frequent AM were quinolones (30.5%), cephalosporins, carbapenems (22.0%) and aminoglycosides (16.9%).

Conclusion: The prevalence of HAIs and AM use at LTCF residents in Serbia were similar to LTCF residents in EU.

Disclosure of Interest: None declared

P207 INFECTION CONTROL MEASURES IN BAVARIAN LONG-TERM CARE FACILITIES – A SURVEY

T. Kolberg1, C. Naß1, S. Fries1, G. Todorovic1, G. Valenza2, V. Lehner-Reindl2, A. Zeckey1, N. Frank1, C. Höller1

1Hygiene, BAVARIAN HEALTH AND FOOD SAFETY AUTHORITY, Oberschleißheim; 2Hygiene, BAVARIAN HEALTH AND FOOD SAFETY AUTHORITY, Erlangen, Germany
Correspondence: N. Frank

Introduction: Infection control is becoming more and more important in long-term care facilities (LTCF) like nursing homes and residential homes. This is not only due to the demographic development and the associated changes in the health situation of the population, but also because changes in hospital care with earlier discharge of patients, increasingly complex treatments as well as the emergence of antibiotic-resistant bacteria outside of hospitals lead to higher demands on infection control in these facilities.

Objectives: In order to evaluate the infection control measures in Bavarian LTCFs and to derive possible necessary actions a questionnaire was developed and applied in 40 LTCFs, which were inspected by the project-team.

Methods: Considering number of rooms, rural or urban surroundings, private or public ownership the selection of LTCFs was representative for institutions that can be found in Bavaria.

Results: Infection control staff with a corresponding comprehensive training could be contacted by 73% of LTCFs, 9% had someone even available in-house. The local staff had a rather limited training in infection control and felt often insecure in special situations like management of residents colonized with antibiotic-resistant bacteria. 20% of the LTCFs had no standard to deal with an outbreak situation, for instance caused by norovirus or influenza virus. In 30% of the facilities laundry from infectious residents was not disinfected and only 52% stored the laundry in an adequate way. Storage areas were often not sufficiently available so that work according to infection control rules was impeded. More than half of the LTCFs had only a water-pressure-dependent decentralized disinfectant dosing unit, which may cause problems and was therefore considered as unreliable.

Subsequent to our survey a questionnaire asking about risk factors and more details about infection control training was distributed to all 1.500 LTCFs in Bavaria in order to evaluate if a common training course has to be established. In addition, educational films are currently being produced that will be made available to all LTCFs free of charge.

Conclusion: Infection control is an important issue. Although the staff was involved, it became clear that more needs to be done in this area.

Disclosure of Interest: None declared

P208 UNIFORM PREFERENCE FOR HEALTHCARE WORKERS BY RESIDENTS AND HEALTHCARE WORKERS IN NURSING HOMES

N. Kenters1, A. Eikelenboom1, M. de Leeuw1, K. Saris1, M. Hulscher2, A. Huis2, A. Voss1,3

1Medical Microbiology, CWZ; 2IQ Healthcare; 3Medical Microbiology, Radboudumc, Nijmegen, Netherlands
Correspondence: A. Eikelenboom

Introduction: In Dutch nursing homes it is found of great importance that residents feel at home. Therefore, white uniforms or service clothes for the healthcare workers (HCWs) have been abolished in most nursing homes. The choice for uniforms or private clothing lies solely with the organization. Private clothing for infection control measures are far from ideal to prevent transmission of microorganisms. No research has yet described which care-givers attire is preferred by residents in nursing homes.

Objectives: The aim of the study was to research the preference for HCWs clothing during care giving by HCWs and residents in nursing homes.

Methods: A quasi-experimental cross-sectional study was conducted in which two propositions regarding the clothing of health care personnel are presented to nursing home residents and HCWs. In total 20 residents and 13 HCWs were questioned in an intramural somatic care organization. Other nursing homes will follow in the upcoming months.

Two questions were asked, on preference by care provided, and on were residents/HCWs felt most comfortable with. The nursing home resident / HCWs had to choose between 4 different clothing outfits with the test – retest principle. The choices were casual, only a professional polo, only a professional nursing jacket and a complete white uniform.

Results: The primary outcome measure of the study is the preference of residents / HCWs for a specific clothing combination. Overall 38% had a preference for a professional nursing jacket with their own trousers. With a difference of 10% between residents and HCWs. In total the casual outfit was chosen the least, 9% of the times, with a minor difference of 3% between the HCWs and residents.

Conclusion: Most of the HCWs and residents in the nursing home both choose for a HCWs to dress in a professional outfit. The least chosen outfit was the casual outfit. With a professional outfit the chance of transmission of microorganisms via clothes of HCWs would be reduced.

Results of the additional nursing homes will be included in the scientific poster.

Disclosure of Interest: None declared

P209 INFECTION PREVENTION IN NURSING HOMES: A QUALITATIVE STUDY OF FAMILY PRACTITIONERS’ AND RESIDENTS’ SUBJECTIVE NORMS, ATTITUDES AND BEHAVIORS WHILE VISITS

J. Hammerschmidt, L. Heier, N. Ernstmann

Institute for Patient Safety , University Hospital Bonn, Bonn, Germany
Correspondence: J. Hammerschmidt

Introduction: The post-antibiotic era poses increasing economic and ethical challenges for society.1 426. 277 cases of infections with multi drug resistant (MDR) bacteria in health care were registered in the EU.2 The role of general practitioners (GPs) in the treatment of nursing home residents in counselling to prevent infections is not sufficiently understood.3 Although there are guidelines for hand hygiene in German nursing homes, for GPs, it is still unclear to what extent these are implemented, and if so, whether they are communicated to the residents. 4

Objectives: The aim of the study is to gain a first understanding of the perspectives and attitudes of residents and visiting GPs towards counselling health literacy regarding the prevention of MDR infections.

Methods: Qualitative semi-structured interviews with 12 GPs and thematically focused conversations with 12 nursing home residents (cognitively not impaired) were conducted and content analysed.

Results: GPs (Øage 44, 3 fem.) reported deviant behaviour in consultation from the guidelines. Nursing home residents are rarely given advice on improving their health literacy. They (Øage 84, 10 fem.) reported that GPs do not perform this advisory function, although many residents have already had experiences with MDR.

Conclusion: Health literacy in infection prevention in nursing homes during GPs visits has hardly been researched to date. The research is mainly focused on results and recommendations for existing infections.

References

1) Tacconelli, E.; Pezzani, M. D. Public health burden of antimicrobial resistance in Europe, The Lancet Infectious Diseases. (2018), DOI:10.1016/S1473-3099(18)30648-0.

2) Cassini, A. et. al, Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: A population-level modelling analysis. The Lancet Infectious Diseases. (2018), DOI: 10.1016/S1473-3099(18)30605-4.

3) Nicolle, L. E. Infection prevention issues in long-term care, Current opinion in infectious diseases. (2014), DOI:10.1097/QCO.0000000000000071.

4) Fassbender B., Rösing C., Weckbecker K. MRSA-eine Handreichung für Hausärzte Teil 1-3: Altenpflegeheime AWMF-Registernr. 053/034c Klasse S1; DEGAM, 2013.

Disclosure of Interest: None declared

P210 RESPIRATORY SYNCYTIAL VIRUS, A THREAT FOR NURSING HOMES RESIDENTS?

D. Hequet, A. Rochat, C. Petignat

Unité cantonale vaudoise HPCI, Lausanne, Switzerland
Correspondence: A. Rochat

Introduction: Nursing home residents live confined, in close contact with one another and staff, increasing opportunities for viral spread. During winter season, Respiratory Syncytial Virus (RSV) might affect the residents as much as influenza virus. However, data estimating RSV morbidity and mortality in nursing homes remain scarce.

Objectives: Describe epidemiology of RSV in nursing homes during influenza season

Methods: In influenza seasons 2016-2017 and 2017-2018, a study on the burden of influenza was led in nursing homes of canton de Vaud. Nasal swabs were collected in residents symptomatic with an influenza-like illness. The samples were analyzed with a coupled PCR diagnosing influenza A/B as well as RSV. As a result, the diagnosis of RSV was underlined, even though it was not the purpose of the study.Demographic characteristics of resident were recorded (clinical data, hospitalization, mortality).

Results: 509 residents with influenza-like illness (ILI) symptoms were included. 38 RSV infected residents (7.5%) were diagnosed in 15 different nursing homes. 10 of these nursing homes experienced an epidemic situation with ≥2 residents diagnosed and 2 of them with 5 and 6 simultaneous cases respectively. Median age was 87 years (SD 7). Median temperature at diagnosis was 37.9°C (SD 1.1). The three most represented symptoms were cough (89.5%), malaise (73.7%) and fever (71.1%). 12 residents (31.2%) required oxygen therapy and 26 residents (68.4%) were treated with an antibiotic. 3 residents were hospitalized within 30 days after diagnosis (7.9%). 8 residents died within the first 30 days (21%) and a total of 14 residents died within 90 days (37%).

Conclusion: This study revealed that RSV infections in the institutionalized elderly is an underestimated threat. Residents with a RSV infection encounter a risk for hospitalization and mortality. Although the study was conducted on a relatively small number of residents, it reveals the need to take into account this pathogen in case of influenza-like illness outbreak in nursing home. Moreover, RSV outbreaks can occur in nursing homes. In case of influenza-like illness epidemic in a nursing home, if samples are negative for influenza, RSV should be looked for.

Disclosure of Interest: None declared

Poster session: Infection Control & Prevention in developing world

P211 Withdrawn

P212 Withdrawn

P213 BEHAVIORAL AND ENVIRONMENTAL RISK FACTORS ASSOCIATED WITH NEONATAL SEPSIS IN UGANDAN HEALTHCARE FACILITIES

H. Yakubu on behalf of Center for Global Safe WASH, Emory University

Center for Global Safe Water, Sanitation and Hygiene, Hubert Department of Global Health, EMORY UNIVERSITY, Cantonments, Ghana
Correspondence: H. Yakubu

Introduction: Neonates’ exposure to pathogens in the healthcare facility environment can cause healthcare associated infections including sepsis. Sepsis is estimated to be responsible for 15%>20% of neonatal deaths globally and about 30%>40% occur at the time of birth. Low resource setting are disproportionally affected by the burden of neonatal deaths. In Uganda, new born deaths constitute 38% of the all infant mortality and an estimated 31% of new born deaths are attributed to sepsis. However, little evidence exists on behavioral and environmental risk factors that cause sepsis

Objectives: The objective of this study is to assess environmental and behavioral risk factors associated with neonatal sepsis in maternal and post natal wards

Methods: Two public healthcare facilities (HCF) in Kampala, Uganda with contrasting differences in water, sanitation and hygiene (WASH) conditions and infrastructure were purposively selected. They were classified as WASH poor and WASH good HCF. A qualitative approach was adopted to understand what patients, caregivers and health care staff come into daily contact with that may lead to neonatal exposure to pathogens in the health facility environment. Structured and unstructured observation were conducted to understand who frequently come in touch with neonates and their frequency of contact with surfaces and equipment’s to inform environmental sampling and exposure pathways. Structured observation was subsequently conducted using the checklist for 3 hours each in the morning, afternoon and evening for 2 weeks by trained enumerators

Results: In the post natal wards, bedsheets (26%) and the walls (21%) were the most frequently touched in the WASH good HCF whilst in the WASH poor HCF, the most frequently touched were mobile phones (10%) and delivery kits (9%). In the delivery and labor ward, fetal scope (16%) and bedrail (13%) were the most frequently touched in the WASH good HCF whilst in sink faucet (7%) and bed lining (6%) were the most frequently touched in the WASH poor HCF

Conclusion: This information was used to target environmental sampling to determine pathways of exposure that may have the greatest risk to neonates. Analysis of the sampling results in conjunction with the behaviors observed will be useful in planning evidence based interventions in the healthcare facilities.

Disclosure of Interest: None declared

P214 PROFILE OF PSEUDOMONAS INFECTIONS DIAGNOSED IN AN INFECTIOUS CLINIC IN DAKAR (SENEGAL)

N. A. LAKHE, K. DIALLO MBAYE, A. MASSALY, V. M. P. CISSE DIALLO, N. M. FALL, D. THIOUB, A. BADIANE, D. KA, L. FORTES DEGUENONVO, C. T. NDOUR, M. SEYDI

SERVICE DES MALADIES INFECTIEUSES/ CENTRE HOSPITALIER DE FANN, DAKAR, Senegal
Correspondence: N. A. LAKHE

Introduction: Pseudomonas infections are opportunistic infections marked in some situations by their great severity and their nosocomial character. The resistance to carbapenems is actually a great issue by reducing therapeutic options.

Objectives: The objectives of this study were to determine the epidemiological, clinical, resistance and therapeutic profile of Pseudomonas infections.

Methods: A descriptive retrospective study was performed, based on hospitalized patients’ records in the department of infectious and tropical diseases, for whom Pseudomonas infections was diagnosed from 1 January 2013 to 31 December 2017.

Results: Forty-three cases (2.1%) of Pseudomonas infections were collected among 2,061 inpatients. The sex ratio was 0.95. The mean age was 43 ± 16. Nearly half of the patients (21 cases) had HIV infection. Bacteremia and urinary tract infections were the most common with 18 cases, followed by lower respiratory tract infections (5 cases) and skin and soft tissues (4 cases). The isolated strains were Pseudomonas aeruginosa (68.8%), Pseudomonas spp (28.8%) and one strain for Pseudomonas oryzyhabitans (2.2%). Antibiotic resistance was higher for Aztreonam, piperacillin-tazobactam and fosfomycin with 19.4%, 12.9% and 9.7% respectively. One strain producing carbapenemase (3.2%) and another one resistant to colistin (3.2%) were isolated. Also, only one strain was resistant to ciprofloxacin. All strains tested were sensitive to amikacin. More than 6 out of 10 patients (61.2%) had received probabilistic antibiotic therapy. The lethality was 30.2%.

Conclusion: Pseudomonas infections are common in our context and have high mortality. They pose the problem of their management with the appearance Pseudomonas to imipenem and colistin. Strategies for rational use of antibiotics must be implemented.

Disclosure of Interest: None declared

P215 PREVALENCE AND EPIDEMIOLOGICAL PROFILE OF HEPATITIS B VIRAL INFECTION AMONG PREGNANT WOMEN IN TAIF GOVERNORATE, SAUDI ARABIA

N. M. Alzahrani1, F. S. Alghamdi2 , Y. H. Alam-Eldin3,4 , M. Bahaa Eldin Foda5

1Communicable Diseases & Vector Control Administration, Ministry of Health, Taif, KSA; 2Blood Banks Administration, Ministry of Health, Taif, KSA
Correspondence: N. M. Alzahrani

Introduction: Hepatitis B virus (HBV) infection is the most predominant type of hepatitis infection in Saudi Arabia. HBV-infected mothers are important source of infection in children.

Objectives: This study aims to estimate the magnitude of HBV infection and to identify the most important risk factors among the pregnant female in Taif city, Saudi Arabia.

Methods: We performed a cross-sectional study on Taif governorate from January 2018 to January 2019. Blood samples were collected from pregnant women who followed up for antenatal care clinics at primary healthcare centers (PHC) and hospitals of Taif. Samples were processed by Enzygnost® Hepatitis B surface Antigen (HBsAg) 6.0 enzyme immunoassay for qualitative detection of HBsAg. Positive results were confirmed by neutralization of HBsAg and Hepatitis B core Antibody (HBcAb).

Results: The seroprevalence of positive HBsAg among 11370 pregnant females was 0.88%. The age range of seropositive pregnant females was from 20 to 49 years (yrs) with an average of 34 + 4.86; 10% from 20-29 yrs, 79% from 30-39 yrs and 11% from 40-49 yrs. Seroprevalence in rural areas was 61% and 39% in urban areas. 47% of seropositive cases were diagnosed during antenatal screening, 27% during premarriage screening, and 8% during peripartum screening. 5% of the seropositive pregnant females were vaccinated and 65% were unaware about their vaccination status. The most important risk factors of HBV infection in this study were attributed to history of dental procedures 36.8% and contact with infected-family member 32.9%.

Conclusion: The seroprevalence of HBV infection among the pregnant females in Taif was lower than other regions of KSA, reflects the success of the HBV vaccination program in Taif. Consequently, awareness about importance of antenatal screening and routes of transmission of HBV infection especially in rural areas should be raised.

Disclosure of Interest: None declared

P216 KNOWLEDGE OF HEALTHCARE ASSOCIATED INFECTIONS AND RISKS FACTORS IN THE INFECTIOUS DISEASES SERVICE IN FANN HOSPITAL (DAKAR-SENEGAL)

N. A. Lakhe, B. A. Niang, K. Diallo Mbaye, D. Ka, A. Massaly, V. M. P. Cisse Diallo, L. Fortes Deguenonvo, C. T. Ndour, M. Seydi

SERVICE DES MALADIES INFECTIEUSES/ CENTRE HOSPITALIER DE FANN, DAKAR, Senegal
Correspondence: N. A. Lakhe

Introduction: Healthcare-associated infections are a major public health concern. These infections are marked by an increase frequency, their gravity, not to mention the medico-legal aspect raised, as well as the economic increase generated.

Objectives: The main objective was to assess the state of knowledge of medical and paramedical personnel on health care-associated infections and their risk factors.

Methods: A cross-sectional and observational survey was conducted from 12 to 14 December 2018 among staff of the infectious diseases department of CHNU Fann. A pre-established questionnaire was administered to the participants by direct interview. The questions were mostly closed.

Results: A total of 76 people was surveyed during this study. Two-thirds were women and the median age of the study population was 31 [19; 64]. As for their qualification, half of the respondents were nurses, 19.7% doctors and 13.2% trainees. Almost 6 out of 10 (59.2%) had less than 5 years of seniority in the service. Only 35.5% of respondents were trained in infection prevention and control (IPC). A correct definition of HAI’s was provided by 49 participants (64.5%). Three-quarters of the participants were not knowledgeable about hygiene’s standard precautions and 9 of 10 about additional hygiene precautions. More than half of the respondents (51.3%) were unable to cite a HAI’s. The main factors favoring HAI’s identified by the respondents were urinary catheter (98.7%), vascular catheter (94.7%), insufficient surgical asepsis (93.4%) and nasotracheal aspiration (81.6%).

Conclusion: Overall knowledge of healthcare-associated infections and their contributing factors is insufficient. Regular training program of health personnel with a well-established schedule should be undertaken.

Disclosure of Interest: None declared

P217 SMALL IS BEAUTIFUL: HOW A TINY NGO BROUGHT ABOUT A BIG CHANGE IN INFECTION PREVENTION AT BIRTH

C. Kilpatrick1, G. Gon2, E. Morrison1, S. Woodd2, S. Virgo2, W. Graham2

1The Soapbox Collobrative, Aberdeen; 2London School of Hygiene and Tropical Medicine, London, United Kingdom
Correspondence: C. Kilpatrick

Introduction: Launched in 2012, The Soapbox Collaborative’s primary goal was to inform and influence action by policy-makers, managers and the healthcare workforce to reduce the recently reported global burden of healthcare associated infections (HAI), particularly in mothers and newborns in hospitals in low and middle-income countries (LMIC).

Objectives: To outline how a small NGO can affect change in knowledge and behaviours towards infection prevention and control (IPC).

Methods: Between 2013 and 2017, needs assessments were undertaken with country partners in eight LMICs. A mixed methods approach using validated tools assessed the state and drivers of hygiene, measured by visual cleanliness inspection, surface microbiology to detect potential pathogens, hand hygiene audits, document reviews, structured interviews and focus group discussions.

Results: Inadequate training and supervision, insufficient resources and poor infrastructure were found to be limiting facility cleaners from maintaining a safe and hygienic health care environment. Soapbox's participatory training package (TEACH CLEAN) was developed to address this gap, and first pre-tested in The Gambia. It has since been acknowledged by major international agencies, and applied in several countries, including Cameroon, Myanmar and the United Republic of Tanzania. Recent inclusion of indicators in global best practice and monitoring platforms has resulted in TEACH CLEAN being recognised as a ready resource. Increasing concern of the antimicrobial resistance burden and the need to improve water, sanitaion and hygiene in healthcare facilities has meant that this NGO's novel contribution is informing action to prevent HAI in maternity units and exceeding reasonable expectations that it can play a crucial influential role in global and country partner work.

Conclusion: The role of NGOs in supporting global IPC initiatives is often not dependent on size of the organization but rather the timeliness of its activities and the opportunity to align with local and global partners. The Soapbox Collaborative has highlighted the neglected role of cleaners and cleaning in the prevention of HAI in maternity units in LMICs and provided a sustainable training package, accepted at global and nationla level, to improve hygiene practices which will result in an impact on HAI.

Disclosure of Interest: None declared

P218 REGISTER OF INFECTION PREVENTION AFTER PROFESSIONAL ACCIDENTAL EXPOSURE TO BIOLOGICAL AGENTS AND SEXUAL ABUSE IN THE REGIONAL PUBLIC HOSPITAL OF BANFORA (BURKINA FASO)

K. C. C. Sawadogo1, I. F. BAKO2,3

1Medical information, Public regional hospital, Banfora; 2Health science department, Joseph KI-ZERBO University; 3Neurosurgery, Yalgado OUEDRAOGO University hospital, Ouagadougou, Burkina Faso
Correspondence: K. C. C. Sawadogo
Introduction: Post-exposure prophylaxis (PEP) relies on procedures allowing quick access to treatment in case of accidental exposure to viral risk (AEV). There are 2 types of AEVs:
  • occupational blood exposure concerns mainly health-care professionals

  • sexual exposure for which there is currently no monitoring [1].

The register of the hospital of Banfora has been created since 2013 in order to collect these data.

Objectives: The main objective was to evaluate the use of the paper register for the prevention of accidental exposure to infections.

Secondary objectives were:

- to determine the types of cases notified in the register;

- to determine the occupational profiles most at risk of infectious accidents;

- to determine the most implicated material in infectious accidents.

Methods: A retrospective study had been conducted from January 1st to April 1st 2019 on the paper-based registry of infections exposures in the Cascades region (Burkina Faso). An exhaustive inclusion had been made and paper questionnaires were completed. The study was approved by the hospital administration. Data were analyzed using EPI INFO 3.5.3.

Results: From 2013 to May, 1st 2019, 39 cases of AEV have been reported, including 34 cases of exposure accident to biological fluid, four cases of sexual assault and one case of condom rupture. The average age of our patients was 30.57 years. Nurses and biomedical technicians are the most affected occupational profiles, with 35.9% and 23.1% of notified cases respectively. Care and handling constituted the majority of the accident occurrences, with 68.6% and 17.1% of the notified cases respectively. The syringe needle was the most implicated material with 67.6% of cases. Sexual assault involved women whose average age was 19. No patients had reported positive HIV and hepatitis markers.

Conclusion: In 6 years of using the register, it is clear that it is under notified. It is appropriate to make health staff and the population of the Cascades region aware of the need to consult for adequate management in the event of an accident of exposure.

References

1. Rouveix, E., Bouvet, E., Vernat, F. et al. (2014). Prise en charge des expositions accidentelles au VIH : rapport d’activité 2011 des COREVIH, Médecine et maladies infectieuses, 44, 112– 16.

Disclosure of Interest: None declared

P219 ABOUT DIFFICULTIES TO MAKE SUSTAINABLE IPC PROJECTS IN AFRICA: EXAMPLE OF FANN HOSPITAL IN SENEGAL

B. Ndoye1, N. A. LAKHE2, C. T. Diop3

1ICAN, WHO Consultant; 2Fann Hospital,IPC Coordinator; 3Fann Hospital,General Director, Dakar, Senegal
Correspondence: B. Ndoye

Introduction: Healthcare-associated infections (HAIs) are currently a global public health problem. However, there are very few concrete and effective actions to sustainably improve the situation in African hospitals. We report here the example of the Fann hospital in Senegal where an initiative was taken in this direction

Objectives: After many previous attempts to improve current IPC program in situation of lethargy, the objective was to provide the hospital with a functional IPC committee and to develop a concrete and sustainable action plan, adapted to local needs.

Methods: The methodological approach was very inclusive, with the participation of all stakeholders, both technical services and the administration. The following activities were carried out with the technical and financial support of partners (WHO and CDC):

- Information and awareness meeting chaired by the Hospital General Director to inform all staff

- Evaluation of the PCI situation using WHO's IPCAF tool [1], including an analysis of strengths and weaknesses, but also opportunities and threats

- Inclusive and participatory development of an operational action plan based on core components recommended by WHO, and a follow-up plan on the activities to be carried out

Results: A concrete and realistic operational action plan was available since July 2018, but no planned activity has been implemented so far, one year after.The hospital is waiting for potential partners to fund the activities.

Conclusion: This IPC project, as many of others, stops at the withdrawal of partners, and goals were not achieved. The causes are undoubtedly numerous and intricate in the context of limited resources. In any case, at the hospital level, serious consultation between the technical services and the administration is needed, while at the national level it is time for African countries to make IPC a national priority for public health. This must result in the development of a national IPC policy validated by the authorities and implemented in concrete terms by a program equipped with the necessary means of action. The WHO-CDC Africa project to develop recommendations on minimum standards for IPC will certainly have to bring a new dimension to the fight against the scourge in the continent.

References

[1] http://www.who.int/infection-prevention/tools/core-components/en/

Disclosure of Interest: None declared

Poster session: Occupational Health

P220 OCCUPATIONAL RISK OF BLOOD-BORNE VIRUSES IN HEALTHCARE WORKERS: A 20-YEAR SURVEILLANCE

F. A. Van Laer1, E. Coenen2, H. Jansens1

1Infection Control; 2Occupational Medicine Department, Antwerp University Hospital, Edegem, Belgium
Correspondence: F. A. Van Laer

Introduction: This study presents the results of a 20-years surveillance program involving the prospective follow-up of health-care workers (HCWs) in the Antwerp University Hospital exposed to blood-borne viruses (hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodeficiency virus (HIV)).

Objectives: To evaluate the risk of transmission of blood-borne viruses to health-care workers.

Methods: From 1998 through 2018, all HCWs reporting an occupational exposure (through sharp objects, bites, mucous membrane exposure or damaged skin) to blood-borne viruses were included in the surveillance. After the exposure a serum sample from the patient whose blood caused the contamination was tested for viral markers: HIV 1&2 As/Ag, HBsAg and anti-HCV. Only if one these markers was positive the HCW was also tested and a postexposure follow-up for six months was done. No postexposure follow-up was done for HBV of HCW with anti-HBs levels higher than 10 IU/ml. Postexposure prophylaxis for HIV (a co-formulation of elvitegravir, cobicistat , emtricitabine and tenofovir disoproxil fumarate) was offered to the HCW if the source was positive for HIV as recommended by the Belgian Superior Health Council. All HCWs with anti-HBs levels of less than 10 IU/mL were vaccinated against hepatitis B virus infection.

Results: A total of 2495 exposures were reported: 7 (0,3%) through bites, 290 (11,6%) through mucous membrane exposure, 2122 (85,1%) through needles and other sharp objects and 76 (3,0%) through damaged skin. Among the patients involved 105 (4,2%) were positive for HCV, 48 (1,9%) were positive for HBV, 125 (5,0%) were positive for HIV and 2217 (88,9%) were negative for all viral markers. During the serologic follow-up no transmission of HBV, HCV or HIV was observed among the HCW.

Conclusion: Our postexposure follow-up among HCW revealed a lack of transmission of HBV, HCV and HIV. These results are confirmed by other published surveillance programs.

Disclosure of Interest: None declared

P221 DECREASING EXPOSURE OF HEALTH CARE WORKERS TO INFECTIOUS DISEASES: A STEP TOWARDS EMPLOYEE HEALTH AND SAFETY

R. Roshanali, N. K. Virani, Z. Rafique, R. Khowaja, S. F. Mahmood

Aga Khan University Hospital Karachi Pakistan, Aga Khan University Hospital Karachi Pakistan, Karachi, Pakistan
Correspondence: R. Roshanali

Introduction: Safety of employees should be one of the top most concern for any organization. Accidental exposure to any pathogens carries risk of infection and is responsible for transmission of fatal diseases. Health care workers (HCWs) occupational exposure to various communicable diseases must be an area of concern for all infection preventionists.

Objectives: The objectives of this study were as follows:

- To reduce health care workers exposure rate to infectious/communicable diseases atleast by 60% from 6.7 to to 2.5 in next one year.

- To decrease the cost of investigation incurred by the organization after an employee is exposed to infectious disease. To minimize risk of acquiring infectious diseases to the employees.

- To reduce the cost of investigation incurred by the organization after an employee is exposed to the infectious diseases

- To identify causes of noncompliance to institutional policies

Methods: Define Measure Analyze Improve Control (DMAIC) six sigma methodology of quality Improvement was utilize. Each step were done systematically, after defining the problem, data was measured and analyzed to target the interventions. In improve phase major actions were taken and implementation of each action was done on ground and finally controls were set in the systems to ensure sustainability of the project.

Results: Results showed significant reduction in the overall rate of exposure of health care workers to infectious diseases i.e. from 6.7 to 1.5 %. Particularly TB exposure decreased from 16 to 3.3, Measles from 3.6 to 2.4, Chickenpox from 10 to 3.6, CCHF from 3.8 to 0.3, Pertussis from 3.5 to 1.5 etc. Ultimately reduced the cost incurred by organization after employee exposure also decreased.

Conclusion: Health care workers exposure were decreased significantly, employees safety was optimized by minimizing the risk of acquiring infectious diseases. In addition the cost incurred post exposure for post exposure prophylaxis also decreased.

References

Steege, A. L., Boiano, J. M., & Sweeney, M. H. (2014). NIOSH health and safety practices survey of healthcare workers: training and awareness of employer safety procedures. American journal of industrial medicine, 57(6), 640-652.

Disclosure of Interest: None declared

P222 REDUCING THE RISK OF SHARP INJURY AT TERTIARY CARE HOSPITAL (AKUH.K) A STEP TOWARDS HEALTH CARE WORKER SAFETY

Z. Rafique, R. Roshanali, N. Virani, R. Khowaja, S. F. Mahmood

Infection Prevention and Hospital Epidemiology, Aga Khan University and Hospital, Karachi, Pakistan
Correspondence: Z. Rafique

Introduction: Sharp injuries are a major occupational health and safety issues globally. Health care workers (HCW) are on highest risk of getting blood borne pathogen due to contaminated sharp objects.

Objectives: It has been observed that there was a sudden rise of sharp injuries in Q2 2017 from 59 to 72 and the NSI rates were high form benchmark i.e. >1.Thus Infection Control Department (IC) aimed to:
  • To reduce number of exposure from sharp injuries i.e. from 72 to 60

  • To decrease sharp injuries rates and target was set below the bench mark >1

  • Reduction in number of NSI exposures i.e. 50% in service line were rates are higher.

Methods: The PDSA model, a continuous quality improvement (CQI) tool, was used to decrease the preventable exposure to sharp injuries. Plan: AKUH’s IC department analyzed that number of sharp injuries among HCW has drastically increased in few service lines i.e. laboratory (0 to 11), GI and GS (05 to 16) and mind brain (01 to 06). Do: educational sessions were conducted for HCW through case based scenario activity, reinforcement was done to avoid recapping, flyers circulated to all patient care areas, disseminate pocket guide to HCW, fixed danger box in brackets to avoid spillage, introduce safe lancet to check blood glucose, explore retractable butterflies Check: Observed staff practices, malpractices were notified to supervisors. Act: Increase frequency of audits to ensure safe disposal of sharps and checked for overfilled danger box. Monthly sharing of exposure data with supervisors.

Results: A significant decline was observed in Q2 2018 after implementing all strategies. The number and rates of sharp injuries exposure decreased i.e. from 72 to 57 and 1.19 to 0.94 respectively. The number of NSI were decreased in the respective service line i.e. laboratory (11 to 06), GI and GS service line (16 to 18) and mind brain service line (06 to 02).

Conclusion: IC department continue to worked with individual department/service lines to decrease NSI and promote staff safety.

Disclosure of Interest: None declared

P223 EVALUATION OF THE MEASLES, MUMPS, RUBELLA ANTIBODY IN ONE SOUTHERN HOSPITAL EMPLOYEE

H. Chao 1, C. Huang2, C. Tsou3, T. Chang4, H. Chung 5

1Infection Control Unit, E-Da Cancer Hospital; 2Division of Infectious Diseases / Department of Medicine; 3Occupational Safety and Health office, E-Da Hospital; 4Occupational Safety and Health office; 5Division of Infectious Diseases / Department of Medicine, E-Da Cancer Hospital, Kaohsiung, Taiwan
Correspondence: H. Chao

Introduction: There are outbreak episodes of measles, mumps in Taiwan in recent years because of frequent International interactions, new immigrant groups, a decline of childhood vaccine efficacy in the 20-40 year old groups, et al. Similar outbreaks also occurred in different countries. The healthcare workers are at higher risk than the normal populations of acquiring diseases due to occupational exposure to measles, mumps and rubella (MMR) patients.

Objectives: we analyze the trend of seropositive prevalence within 2 years and in different occupations and age groups. This study gives a reference to develop a health policy in the future in this hospital.

Methods: MMR data in annual health checkups of healthcare workers in 2016 and 2017 is collected. Seropositive cases define all Immunoglobulin G(IgG) are positive in MMR. Seronegative cases defined anyone of MMR IgG is negative or low titer. We separate occupations to doctors, nurse, medical laboratory technicians and administrative assistant groups. Descriptive statistics and Chi-square test are used.

Results: In 2016, a total of 2,106 subjects(78.1%) received exams of MMR, and the seropositive rate was 42.3%. In 2017, a total of 2,440 subjects (88.4%) received exams of MMR, and the seropositive rate was up to 63.9% which contributed to 509 subjects (30%) received one booster vaccine in the prior year. The compared 2-year seropositive prevalence was significant (P<0.001).The seropositive rate of mumps and measles increased from 63.8%,61.7% to 80.7%,80.0% respectively.The 2-year prevalence comparison is significant (P<0.001). The seropositive rate of measles was 80.5% which was best in the nurse group with aged 20 to 40-year-old.

Conclusion: A policy of providing vaccines constructs a healthy and safe occupational environment and a preventive effect of outbreaks. After one dose of MMR vaccine in the seronegative group, a total seropositive rate was 63.9%. The seropositive rates of measles and mumps were both up to 80% and significant. The seropositive rate was up to 80% in the aged 20~40-year-old nurse group.

References

Disclosure of Interest: None declared

P224 PREVALENCE AND PERCEPTION OF NEEDLE STICK INJURY AMONG HEALTH CARE PROFESSIONALS AT A TERTIARY CARE HOSPITAL, KARACHI, PAKISTAN

R. Nisar, on behalf of Shahid Saleem ,Saima Bashir, Sunil Dodani, Asma Nasim

Infection control department, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
Correspondence: R. Nisar

Abstract video clip: Introduction: Needle stick injury (NSIs) is a percutaneous injury occurs through sharp objects among health care professionals (HCP). Sharp injury can happen due to mishandling, recapping, passing of sharps or leaving the sharps on surfaces. World Health Organization (WHO) reported an average of 4 NSIs /year/HCP. Our study objective is to find the knowledge, prevalence of NSIs and current status of hepatitis B vaccination (HBV) among HCP.

Methods: A cross sectional survey conducted through questionnaire among HCP. Data collection was done between December 2018 and January 2019. Data analysis was done using SPSS version 20.

Results: A total of 117 participants were surveyed and majority was females. There were 23% doctors, 35% nurses and 46% technicians. Around 64% experienced NSIs in the last one year. Out of whom 8% got NSIs 3 times and 12% >4 times. Around 78% NSIs was unreported. NSIs were considered harmful by 97%. A total of 65% believe that HBV, Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) can be transmitted by NSIs. Mostly the cause of NSIs was rush hours 33%. Around 47% NSIs were percutaneous and gloves were used by 79%. Only 12% washed their hands with soap and water after NSI. Around 77% HCP received health safety training. HBV vaccine series was completed in 71%, however, only 39% know about their antibodies titers.

Conclusion: NSIs has high prevalence in our setting. The reporting system, improvement in vaccination status, regular educational sessions with emphasis on standard precautions can decrease NSI rates in our hospital.

Disclosure of Interest: R. Nisar Employee of: Do not have any conflict of interest.

P225 NEEDLE STICK INJURIES AMONG HEALTH CARE WORKERS IN A TERTIARY CARE TEACHING HOSPITAL IN PALESTINE, 2016-2018

S. Belkebir, A. Kanaan, R. Jeetawi

Preventive medicine, An Najah National University Hospital, 00000, Palestinian, State of
Correspondence: A. Kanaan

Introduction: Injuries among healthcare workers (HCW) from needles(NSI) and sharps remain a serious problem due to high risk of transmission of blood-borne pathogens (BBP)

Objectives: This study aims at reporting the numbers of NSIs from 2016 to 2018 and the main characteristics of affected HCWs at NNUH

Methods: An-Najah National University hospital(NNUH), a tertiary care hospital located in the north of Palestine, implemented since 2016,a strategy to prevent and surveille NSI among HCWs including the enforcement of evidence based policy, annual training about safety injection, waste management and universal precautions. Incidents are self-reported after what HCWs and the source are screened for BBP and appropriate management (Counseling, education, dose of HBV vaccine or Specific Ig) is applied according to setting policy and in collaboration with the Palestinian Ministry of health (MoH)who provides the HBV vaccine.In 2018, vacutainers were provided and intensive training and education were applied across the institution.

Results: The total number of NSI reported was 139(29,62 and 48 cases for 2016,2017 and 2018 respectively). 56%(78) were male and 44%(61) were female. The mean age was 26.5years (SD 7.4).All HCWs were VHC and HIV non-reactive. Nurses had the highest percentages 51.1%(71) of NSIs, followed by students 23%(32),doctors 12.2%(17), Cleaners 11.5%(16) and others such as lab technicians 2.2%(3).The most common mode of injury was during blood sampling 32.4% (45), followed by injuries at the moment of needle disposal 20.1%(28) , cleaning or waste disposal 10.8%(15), cannula insertion/removal 9.4%(13), glucose level testing 7.9%(11) and accidentally by other co-worker 4.3%(6).Recapping was the cause in only 2.2%(3). Regarding the management, 70.5%(98) did not need post-exposure prophylaxis (PEP), 28.1%(39) were referred to MoH to receive a single dose of VHB vaccine and only 1.4%(2) needed the specific Immunoglobulin+ vaccine.PEP for HIV is not available.

Conclusion: HCWs at NNUH are at great risk of contracting blood-borne infections. It is crucial then reinforce both the reporting system and the training program and the provision of PEP and adequate equipment.

Disclosure of Interest: None declared

P226 OCCUPATIONAL EXPOSURE TO BLOOD AND BODY FLUIDS AMONG HEALTHCARE WORKERS AT MARMARA UNIVERSITY EDUCATIONAL AND RESEARCH HOSPITAL IN ISTANBUL, TURKEY.

D. N. M. Al-Khalili1, A. A. I. Muhsen1, M. Karavuş2, N. S. Al-Kayyali3

1Medicine, Marmara University, Amman, Jordan; 2Medicine, Marmara University, Istanbul, Turkey; 3Actuarial Science, King Fahd University of Petroleum & Minerals, Amman, Jordan
Correspondence: A. A. I. Muhsen

Introduction: While healthcare workers are focused on tending to their patients, they become vulnerable to occupational exposure to blood and body fluids in the workplace. This poses and puts them in high risk of attaining blood-borne pathogens including Hepatitis B and HIV.

Objectives: The aim of the study was to investigate the exposure, awareness, and practices of healthcare workers related to occupational exposure to blood and/or body fluids in a teaching hospital in Istanbul, Turkey.

Methods: The study was cross-sectional in design. The residents and nurses (n=384) of the hospital were the target population of this study. Data were collected anonymously using a predesigned self-administered structured questionnaire consisting of 23 questions pertaining to different categories including demographic characteristics, awareness and precautions used by HCWs, frequency and exposure routes to blood and body fluids.

Results: The participants comprised 48.2% residents and 51.8% nurses. 86.7% had encountered an occupational exposure. Needle-stick injury was the most common mode of occupational exposure being 72.4% of total exposures. On average, residents generally encounter a needle-stick injury (NSI) at least 2.30 times per year, while nurses on the other hand, encounter a total of 2.67 needle-stick injuries per year.