Abstracts from the 8th International Congress of the Asia Pacific Society of Infection Control (APSIC)

Session: Antimicrobial Resistance

AR1 Key stakeholders’ perspectives on the underlying causes of antimicrobial resistance in Thailand

Nantanit Sutthiruk¹, Mari Botti², Julie Considine³, Andrea Driscoll⁴, Ana Hutchinson², Kumthorn Malathum⁵

¹Deakin University, Melbourne, Australia; ²Epworth HealthCare, Deakin University, Melbourne, Australia; ³Eastern Health, Deakin University, Melbourne, Australia; ⁴Austin Health, Deakin University, Melbourne, Australia; ⁵Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Correspondence: Nantanit Sutthiruk (nsutthir@deakin.edu.au)

Background

Antimicrobial resistance (AMR) is a major problem worldwide. Antimicrobial stewardship (AMS) has the vital aim of ensuring optimal use of antimicrobial medicines to minimize AMR. New strategies are needed to reduce AMR. It is vital to ensure that key stakeholders are involved in the development of these strategies. This study aimed to examine key stakeholders’ perspectives on the underlying causes of AMR in Thailand.

Materials and methods

Semi-structured interviews were conducted with 15 key multidisciplinary clinicians, heads of department and healthcare administrators who were involved in AMS programs in a 1,000-bed university hospital in Bangkok Thailand. Qualitative content analysis was used to analyze the interview data.

Results

One of the key themes that emerged was lack of regulatory control resulting in widespread antibiotic availability and use both in health and agriculture in Thailand, including over-the-counter availability of antibiotics. This ease of accessibility combined with poor consumer knowledge was considered one of the most important contributors to the increasing prevalence of AMR. The development and implementation of more effective infection prevention and control strategies was identified as a priority, particularly in healthcare. Three major concerns related to the perception that many patients admitted to hospital already have AMR infections, that staff prescribing behaviors are not ideal, and that the lack of resources to develop and implement AMS programs is an important barrier to decreasing the overuse of antibiotics.

Conclusions

Participants recognized that AMR is a major problem in Thailand and in healthcare. There was agreement that what is required is better regulatory control of antibiotics and medical engagement in AMS.

Session: Antimicrobial Resistance

AR2 Bacteriological profile of neurosurgical infections in a secondary care centre, Tangerang, Indonesia: implication for empirical antibiotic treatment

Cucunawangsih Cucunawangsih¹, Veronica Wiwing¹, Vivien Puspitasari²

¹Microbiology Department, Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia; ²Neuro Department, Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia

Correspondence: Cucunawangsih Cucunawangsih (cucunawangsih.fk@uph.edu)

Background

Antimicrobial resistance is a major problem of post-operative neurosurgical infection over the recent years. This study aimed to evaluate an increasing trend of infection in neurosurgical patients and susceptibility pattern of the causative pathogen.

Material and methods

Over a period of five years (June 2010 to June 2015), 216 cerebrospinal fluid and pus samples derived from clinically suspected cases of post-operative neurosurgical infection were processed using the standard procedures for culture and antibiotic susceptibility testing.

Results

Of these 216 patients, causative pathogens were identified in 55 patients (25.5%). Majority of infections were caused by multidrug- resistant gram-negative bacilli (MDRGNB) including Pseudomonas aeruginosa (n = 7, 12.7%), Acinetobacter baumannii (n = 6, 10.9%), Sphingomonas paucimobilis (n = 5, 9.0%), Escherichia coli(n = 4, 7.3%), Aeromonas salmonocida (n = 3, 5.4%), and Klebsiella pneumoniae (n = 3, 5.4%). The common isolates showed a high susceptibility to tigecycline (86.7%) and amikacin (90%), ceftriaxone (76.9%) and ceftazidime (70%). All Gram-positive bacteria isolates were susceptible to tigecycline and vancomycin.

Conclusions

Based on our result of susceptibility pattern, a combination of tigecycline and amikacin should be considered for empirical therapy to treat MDRGNB infections. This finding pointed that strict antibiotic policies were required to work out the issue of emerging MDR-GNB infections.

Session: Antimicrobial Resistance

AR3 A newly developed single-strand tag hybridization – printed array strip technique for identification of carbapenemase-producing Enterobacteriaceae

Rathina Kumar Shanmugakani^1,2,3, Yukihiro Akeda^1,2,3, Takuya Kodera⁴, PitakSantanirand⁵, Kazunori Tomono^1,2

¹Department of Infection Control and Prevention, Graduate School of Medicine, Osaka University, Osaka, Japan; ²Division of Infection Control and Prevention, Osaka University Hospital, Osaka, Japan; ³Research Institute for Microbial Diseases, Osaka University, Osaka, Japan; ⁴Tohoku Bio-Array, Sendai, Japan; ⁵Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Correspondence: Rathina Kumar Shanmugakani (rathinabiotech@gmail.com)

Background

Carbapenem resistant organisms are known to risk the life of both immunocompromised and immunocompetent patients due to their resistance towards the drug of the last resort. In carbapenemase-producing Enterobacteriaceae (CPE), carbapenemase genes serve as the main reservoir of carbapenem resistance due to their plasmid-mediated transferability to naïve Enterobacteriaceae. In this regard, CPE infections are a global health issue due to their hasty dissemination throughout the world. The detection of CPE at the earliest is crucial to control its transmission. Several detection systems are being developed and modified for CPE detection but have various constraints in different criteria.

Materials and methods

We attempted to develop single-strand tag hybridization –printed array strip (STH-PAS), a new genotypic multiplex detection system to detect CPE directly in clinical samples. STH-PAS is a PCR-based technique that targets the four major carbapenemase genes - bla _NDM, bla _KPC, bla _IMP, and bla _OXA-48 for CPE detection. The sensitivity and specificity of STH-PAS in detecting the CPE were determined for the clinical isolates and direct clinical specimens.

Results

STH-PAS showed 100% sensitivity and specificity in detecting the CPE clinical isolates in comparison with the culture methods and PCR. For detection of CPE directly in stool specimens, STH-PAS showed a sensitivity and specificity of 92% and 99.4%, respectively.

Conclusions

The results of the current study depict that STH-PAS possesses several advantages as a good detection system for CPE. The simplicity and rapidity of STH-PAS show that it could serve as an effective tool for surveillance and infection control purposes

Session: Antimicrobial Resistance

AR4 Invasive infections due to multidrug-resistant gram-negative bacilli among Japanese children

Takayuki Yamanaka¹, Hiroyuki Moriuchi², Hiroyuki Kitajima³, Yuho Horikoshi¹

¹Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan; ²Department of Pediatrics, Nagasaki University Hospital, Nagasaki, Japan; ³Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan

Correspondence: Takayuki Yamanaka (t.yamanaka122@gmail.com)

Background

Although multidrug-resistant (MDR) gram-negative bacilli (GNB) become a global concern, the disease burden of MDR GNB in children has not been reported yet in Japan. We elucidate the impact of invasive MDR GNB infections among Japanese children in the hospital setting.

Materials and methods

A primary questionnaire was sent to 520 pediatric training facilities. A secondary questionnaire was sent to determine whether any cases showed a positive blood or cerebral spinal fluid culture for Extended Spectrum Beta-lactamase (ESBL) producing GNB, AmpC β-lactamases producing GNB, or carbapenem-resistant enterobacteriacae (CRE) between April 2012 and March 2015.The following data were collected; demographic data pertaining to both the care facilities and patients, clinical diagnosis, and outcomes.

Results

The response rate for the primary questionnaire was 57%. Among facilities that responded, 66 facilities were eligible for the secondary questionnaire. The response rate for secondary questionnaire was 48%. A total of 92 pediatric patients had invasive MDR GNB infection. The median age was 2.5 years old (interquartile range 3 months–10 years old). The number of patients with bacteremia caused by ESBL GNB, AmpC GNB, and CRE were 66 (72%), 22 (24%), and 4 (4%), respectively. The clinical diagnosis of ESBL and AmpC GNB showed 53 cases of sepsis. The clinical diagnosis of CRE showed 2 cases of catheter related blood stream infection and 2 cases of sepsis. Mortality at 30 days for ESBL, AmpC and CRE bacteremia was 6%, 9% and 0%, respectively.

Conclusions

The most common MDR GNB bacteremia was ESBL GNB among children in this survey.

Session: Antimicrobial Resistance

AR5 The role of non-specific microflora in patients with tuberculosis

Alyona Lavrinenko¹, Ilya Azizov², Nurlan Tabriz¹, Margulan Kozhamuratov¹, Yekatherine Serbo¹

¹Karaganda State Medical University, Karaganda, Kazakhstan; ²Institute of Antimicrobial Chemotherapy, Smolensk, Russia

Correspondence: Alyona Lavrinenko (lavrinenko.alena@gmail.com)

Background

Tuberculosis is often complicated by the addition of non-specific inflammation, which changes not only the clinical manifestation of tuberculosis, but the course and outcome of disease. This study aimed to study the spectrum of non-specific microflora from patients with active tuberculosis and to evaluate its susceptibility to antimicrobial agents.

Materials and methods

The study was conducted in 2014-2015; 343 sputum samples were investigated. Identification of microorganisms was carried out by MALDI-TOF methods using mass-spectrometer Microflex (Bruker Daltonics, Germany). The sensitivity of microorganisms to antibiotics was determined by disk-diffusion methods (CLSI 2012). Statistical processing and data analysis was performed using WhoNet 6.3 program.

Results

The growth of non-specific microflora in patients with tuberculosis was obtained in 21% of cases. The predominant etiologic role in non-specific inflammation belonged to S. aureus (22%), K. pneumoniae were isolated in 12.5%, A. baumannii – in 11.1%. Remaining microorganisms were isolated in individual cases. 12.5% staphylococci were MRSA, to other anti-staphylococcal drugs S. aureus has kept a high sensitivity. Isolated K. pneumoniae strains were resistant to cephalosporins of the 3rd generation in 12.5%, the resistance to meropenem marked in 11.1%. A. baumannii was characterized by a high resistance to antibiotics – 85.7% ESBL-producing strains, 37.5% and 62.5% strains were resistant to imipenem and meropenem, 80% A. baumannii strains were resistant to fluoroquinolones.

Conclusions

According to antibioticogram data, the isolated microorganisms obtained from non-specific microflora of patients with tuberculosis, may adversely affect the course of the disease and impede the selection of antibacterial drugs and affect the outcome of the disease.

Session: Antimicrobial Resistance

AR6 Antimicrobial susceptibility of clinical isolates of Enterococcus faecium and Enterococcus faecalis in Korea

Dahae Yang¹, Woonhyoung Lee¹, Il Kwon Bae², Jae Hyun Lee³, Hyukmin Lee⁴, Jung Ok Kim⁴, Seok Hoon Jeong⁴, Kyungwon Lee⁴

¹Department of Laboratory Medicine, Kosin University College of Medicine, Busan, Korea; ²Department of Dental Hygiene, Silla University, Busan, Korea; ³Yeongam-gun Public Health Center, Yeongam, Korea; ⁴Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea

Correspondence: Dahae Yang (laluna1628@gmail.com)

Background

Enterococcus species become a leading problem of nosocomial infections with their multidrug resistance (MDR) potential. This study was performed to investigate antimicrobial susceptibility of E. faecium and E. faecalis clinical isolates in Korea.

Materials and methods

A total of 152 non-duplicated E. faecium and 112 E. faecalis isolates recovered from clinical blood specimen were collected from 19 hospitals at various regions in Korea during 2014. Species identification was performed using MALDI-TOF (Bruker) and 16S rRNA gene sequencing. Antimicrobial susceptibility was tested by CLSI disk diffusion methods. The presence of vanA and vanB genes was detected by PCR experiments.

Results

All E. faecalis isolates were susceptible to ampicillin, while only 11.8% (18/152) E. faecium isolates were susceptible. E. faecalis isolates (96.4%, 108/112) exhibited higher susceptibility rate to vancomycin than E. faecium isolates (66.4%, 101/152). None of E. faecalis and E. faecium isolates showed resistance to linezolid. Only 52.6% (80/152) of E. faecium isolates were susceptible to quinupristin-dalfopristin. E. faecalis and E. faecium isolates exhibited high-level resistance to gentamicin (50% and 57.9%, respectively). PCR experiments showed that all vancomycin-resistant E. faecium and E. faecalis isolates carried the vanA. Interestingly, two vancomycin-susceptible E. faecalis and three vancomycin-susceptible E. faecium isolates carried the vanA gene.

Conclusions

This study shows further dissemination of MDR enterococci in Korea. Antimicrobial susceptibility of quinupristin-dalfopristin and gentamicin for E. faecium has lowered to near 50%. Discrepancy between antimicrobial susceptibility tests and PCR for vanA gene might be due to loss of some elements consisting transposon Tn1546 carrying the vanA gene.

Session: Antimicrobial Resistance

AR7 Antifungal susceptibilities, biofilms, phospholipase and protease activities in Candida rugosa and Candida pararugosa isolated from tertiary teaching hospitals

Thiba Peremalo¹, Priya Madhavan², Sharina Hamzah¹, Leslie Than³, Eng Hwa Wong², Mohd Nasir Mohd Desa⁴, Kee Peng Ng⁵

¹School of Pharmacy, Taylor’s University Lakeside Campus, Subang Jaya, Selangor Darul Ehsan, Malaysia; ²School of Medicine, Taylor’s University, Subang Jaya, Selangor, Malaysia; ³Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia; ⁴Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor Darul Ehsan, Malaysia; ⁵Department of Microbiology, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia

Correspondence: Priya Madhavan (Priya.Madhavan@taylors.edu.my)

Background

Rising number of candidiasis significantly contribute towards resistance of commonly used antifungal agents. Lately, Candida species such as C. rugosa and C. pararugosa have emerged as fungal pathogens that cause invasive infections.

Material and methods

Clinical isolates were from two tertiary referral hospitals in Malaysia. Test for antifungal susceptibility, biofilm, protease and phospholipase activities, all of which contribute to their virulence were performed. Biofilms were quantified using crystal violet (CV) and tetrazolium (XTT) reduction assays in 96-well microtiter plates. Time point reading was done on all strains incubated at 6, 12, 24, 48 and 72 hours.

Results

There were seven isolates of C. rugosa and one isolate of C. pararugosa in this study. E-test antifungal tests showed that all Candida rugosa strains were susceptible-dose dependent towards voriconazole and resistant to fluconazole, amphotericin B and caspofungin based on Clinical and Laboratory Standard Institute guidelines. Highest biomass was observed in one of the C. rugosa strains, followed by C. pararugosa at 12 hours of incubation. However, highest bioactivity was observed in the ATCC at 24 hours, followed by C. pararugosa at 48 hours and the same C. rugosa train at 24 hours. Virulence was also contributed by secretion of protease enzymes by all the clinical strains. None of the C. rugosa and C. pararugosa trains showed any phospholipase activity.

Conclusions

C. rugosa and C. pararugosa clinical isolates should be considered pathogenic species because of their resistance against commonly used antifungal drugs and their contributing virulence factors.

Session: Antimicrobial Resistance

AR8 Comparison of antimicrobial resistance of respiratory isolates after introduction of a second tier of antimicrobial stewardship program in the medical city hospital

Marionne Geronimo, Maria Fe Tayzon, Maria Jesusa Maño

Hospital Infection Control and Epidemiology Center, The Medical City, Marilao, Bulacan, Philippines

Correspondence: Marionne Geronimo (marionnegeronimo@gmail.com)

Background

In response to an antimicrobial resistance "apocalypse" The Medical City, a private tertiary hospital in the Philippines, conducts microbiologic surveillance and has an existing "prior approval of restricted antibiotics" wherein release of identified broad spectrum antibiotics were done only upon approval of ID consultants. In June 2015, a second tier of ASP was introduced. The "drug duration, audit and feedback" (DDAF) program monitors and audits the duration of empiric antibiotics prescribed by clinicians. Sticker reminders are being placed on the chart on day 3 as a reminder to de-escalate and on day 10 as a reminder to consider stopping the antibiotics. This study aimed to present a comparative study of the antimicrobial resistance of the top 3 bacteriologic agents from respiratory isolates in a tertiary care hospital in the Philippines, from January to June 2015 versus January to June 2016, as a surrogate marker to the success of the second tier of ASP recently introduced

Materials and methods

Most prevalent organisms from sputum, endotracheal aspirate and bronchoalveolar lavage were determined through laboratory surveillance comparing their resistance pattern from January to June 2015 versus January to June 2016.

Results

The top 3 respiratory pathogens in the ICU were identified. Some decrease in the resistance data of the most common isolate, Klebsiella pneumoniae were as follows: 12% decrease in resistance to ceftriaxone, 9% to levofloxacin and 4% to piperacillin-tazobactam. Similar decreases in resistance were seen with Pseudomonas aeruginosa and other organisms.

Conclusions

The study showed decrease in resistance of most common bacteriologic agents from respiratory isolates upon introduction of DDAF program.

Session: Antimicrobial Resistance

AR9 Do daily universal octenidine baths lead to the development of octenidine resistance in methicillin-resistant Staphylococcus aureus (MRSA)?

Angela Chow, Pei-Yun Hon, Mar-Kyaw Win, Brenda Ang, Yee-Sin Leo

Tan Tock Seng Hospital, Singapore, Singapore

Correspondence: Angela Chow (Angela_Chow@ttsh.com.sg)

Background

Methicillin-resistant Staphylococcus aureus (MRSA) colonization has not declined in acute hospitals, despite active surveillance and enhanced contact precautions. Universal antiseptic baths could reduce MRSA transmission, but there are concerns about antiseptic resistance. To evaluate the prevalence of octenidine resistance in MRSA isolated from inpatients exposed to octenidine baths during hospitalization.

Materials and methods

We conducted a cross-sectional study, testing for resistance to octenidine in MRSA isolates obtained from discharge screening cultures from inpatients of a dermatology/infectious disease ward from July 2013 to June 2014. During that period, daily universal octenidine baths was implemented in the ward. The minimum inhibitory concentration (MIC) of octenidine was determined by the modified Clinical and Laboratory Standards Institute (CLSI) methods, with microbroth dilution susceptibility testing for a range of 0.125-8 ug/ml. There is no defined MIC breakpoint for antiseptics by CLSI.

Results

Of 600 patients screened negative for MRSA on entry to the ward, 21 were identified to be colonized with MRSA at discharge. Eighteen of the isolates were available for resistance testing. Median duration of exposure to octenidine baths was 8.5 (IQR 7-12) days. Majority (77.8%) of isolates had MIC = 0.5, with the remaining had MIC = 1. Duration of exposure to antiseptic baths was not associated with higher octenidine MIC levels (OR 0.84, 95%CI 0.62-1.12, P = 0.236).

Conclusions

Resistance to octenidine in MRSA was not observed among patients who were colonized during a hospitalization episode where they were exposed to daily octenidine baths. This study is limited by the small number of MRSA acquisitions and the findings should be verified in larger studies.

Session: Antimicrobial Resistance

AR10 Antiseptic susceptibility in methicillin-resistant Staphylococcus aureus (MRSA) in subacute wards

Angela Chow, Pei-Yun Hon, Tina See, Brenda Ang

Tan Tock Seng Hospital, Singapore, Singapore

Correspondence: Angela Chow (Angela_Chow@ttsh.com.sg)

Background

Methicillin-resistant Staphylococcus aureus (MRSA) is a growing clinical problem in subacute wards where patients have a longer length of stay than in acute wards. Universal antiseptic baths could be added to the armamentarium for MRSA prevention and control. Our study aimed to assess for the baseline antiseptic susceptibilities in MRSA, prior to the institution of universal antiseptic baths in subacute wards.

Materials and methods

We conducted a cross-sectional study, testing for susceptibilities to chlorhexidine and octenidine in MRSA isolates obtained from inpatients of two subacute wards from May-July 2013. Minimum inhibitory concentrations (MICs) of chlorhexidine and octenidine were determined by the modified Clinical and Laboratory Standards Institute (CLSI) methods, with microbroth dilution susceptibility testing for a range of 0.125-8 ug/ml.

Results

A total of 43 MRSA isolates were tested: 10 in May, 14 in June, and 19 in July. For chlorhexidine, all except for one had MIC = 2. The remaining with MIC = 4 had occurred in July 2013. In comparison, the majority (90.7%) of the isolates had MIC = 0.5 when tested for octenidine susceptibility, with the remaining having an MIC = 1. A higher proportion of MRSA isolates with the higher MIC level (MIC = 1) to octenidine was observed in June 2013 than in the other months, although statistical significance was not achieved due to the small sample size (OR 7.64, 95%CI 0.72-81.54, P = 0.092).

Conclusions

MRSA isolated from patients from subacute wards were highly susceptible to chlorhexidine and octenidine. Universal antiseptic baths could be implemented in subacute wards, with follow-up studies conducted to monitor for any development of antiseptic resistance.

Session: Antimicrobial Resistance

AR11 Antimicrobial activity of octenidine against multidrug-resistant gram-negative pathogens

Rocio Alvarez Marin^1,2, Marta Aires de Sousa³, Nicolas Kieffer¹, Patrice Nordmann^1,4, Laurent Poirel¹

¹Medical and Molecular Microbiology Unit, Department of Medicine, University of Fribourg, Fribourg, Switzerland; ²Hospital UniversitarioVirgen del Rocio y Virgen Macarena, Seville, Spain; ³Escola Superior de Saude da Cruz Vermelha Portuguesa, Lisbon, Portugal; ⁴University of Lausanne and University Hospital Center, Lausanne, Switzerland

Correspondence: Laurent Poirel (laurent.poirel@unifr.ch)

Background

Multidrug-resistant gram-negative (MRGN) pathogens pose a major and growing threat for health care systems, as therapy of infections is often limited due to the lack of available systemic antibiotics. Well tolerated antiseptic molecules may be a very useful implementation in infection control,not only to reduce the dissemination of methicillin-resistant Staphylococcus aureus (MRSA), but also MRGN.

Material and methods

As decolonization strategies with regard to MRSA are already implemented in high risk areas (i.e. ICUs), this study aimed to investigate, if the same protocol might be concomitantly efficient against MRGN. A series of 5 different species (Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Acinetobacter baumannii, Pseudomonas aeruginosa) was studied to prove efficacy under clinically relevant conditions according to an official test norm (EN13727). We used 5 clonally-unrelated isolates per species, including a single wild-type strain, and four MRGN isolates, corresponding either to the 3 MGRN or 4 MGRN definition of multidrug resistance. Octenidine (OCT, Schuelke&Mayr GmbH, Germany) susceptibility was evaluated with and without organic load.

Results

A contact time of 30 seconds or 1 minute was fully effective for all isolates by using different OCT concentrations (0.01% and 0.05%), with a bacterial reduction factor of >5 log systematically observed. Growth kinetics were determined with two different wild-type strains (A. baumannii and K. pneumoniae), proving a time-dependent efficacy of OCT, mirroring what has been previously observed for MRSA.

Conclusions

These results highlight that OCT, besides being a very effective agent against MRSA, may also be extremely useful to eradicate emerging highly resistant gram-negative pathogens associated with nosocomial infections.

Session: Antimicrobial Resistance

AR12 Comparison of mortality of patients with Acinetobacter baumannii bacteremia caused by different levels of drug resistance

Wison Laochareonsuk, Sireekul Petyu, Pawin Wanasitchaiwat, Sutasinee Thana, Chollathip Bunyaphongphan, Woranan Boonsomsuk, Pakpoom Maneepongpermpoon, Silom Jamulitrat

Prince of Songkla University, Hat Yai, Songkla, Thailand

Correspondence: Wison Laochareonsuk (ic_conference@yahoo.com)

Background

Acinetobacter baumannii is an important opportunistic nosocomial pathogen causing a variety of infections. The intrinsic virulence of drug-resistant A. baumannii has remained controversial. We compared mortality rates and sepsis score of patients with A. baumannii bacteremia caused by different level of drug resistance.

Materials and methods

A retrospective study was conducted in adult patients (age > 15 years) admitted to Songklanagarind hospital during 2009 and 2015 and blood culture positive for A. baumannii after 3 days of admission. Antimicrobial resistance was categorized into four levels comprising of non-multidrug resistance (non-MDR), multidrug-resistant (MDR), extensively drug-resistant (XDR), and possible pandrug-resistant (possible-PDR). Severity of underlying disease of the patients immediately before onset of bacteremia was determined by sequential organ failure (SOFA) score and American Association of Anesthesia (ASA) score. Virulence of A. baumannii was assessed in terms of sepsis score and in hospital mortality rate.

Results

The study identified 38, 110, 168, and 14 cases of bacteremia caused by non-MDR, MDR, XDR, and possible PDR, respectively. After adjusting for confounding effect by using Cox proportional hazard model, mortality rates attributable to A. baumannii was significantly associated to levels of drug resistance. Using non-MDR as a reference, the incidence rate ratios and corresponding 95% confidence intervals (95% C.I) of MDR, XDR, and possible PDR were 2.3 (95% C.I = 0.9-4.9), 3.1(95% C.I = 1.4-7.0), and 1.9(95% C.I = 0.6-5.5) respectively.

Conclusions

The virulence of A. baumannii did not loss with drug resistance.

Session: Antimicrobial Stewardship

AS1 Antibiotic associated diarrhea in Indian hospitals: common or commonly missed?

Dorairajan Sureshkumar, Kalyanaraman Supraja, Soundararajan Sharmila

Madras Medical Mission, Chennai, Tamil Nadu, India

Correspondence: Dorairajan Sureshkumar (dskinfdis@gmail.com)

Background

Most of the antibiotic stewardship programs (ASP) in the developing world measure antibiotic consumption, adherence to antibiotic guidelines and antibiotic resistance. However, antibiotic associated diarrhea (AAD) is a common medical problem of antibiotic treatment and important quality monitor of ASP was not monitored commonly in India. This study aimed to measure the prevalence of AAD in hospitalized patients receiving antibiotics.

Materials and methods

A point prevalence study was conducted in a 300-bed tertiary care cardiac hospital in Chennai, South India. All hospitalized patients in cardiology wards and intensive care units (ICUs) receiving at least one dose of either oral or intravenous antibiotic were audited by physician assistant for the symptoms of diarrhea and cross checked by interviewing patients.

Results

During the study period, 107 eligible patients had available records for analysis. There were 58 patients (54.20%) receiving antibiotics. Of these, there were 34 receiving single antibiotic, 17 receiving two antibiotic combinations, 4 receiving three antibiotic combinations and 3 were taking four antibiotic combinations. The details of diarrhea was missing in 3 patients’ medical records. Only 2 patients (3.44%) developed diarrhea and they received two antibiotics combination.

Conclusions

Although more than half of the patients received antibiotics, AAD was not common in our hospital. However, regular monitoring of AAD along with other parameters were required for better implementation of ASP in the hospital.

Session: Antimicrobial Stewardship

AS2 Antibiotic prescription after restricted antimicrobial program

Cucunawangsih Cucunawangsih¹, Benny Setiawan², Nicolaski Lumbuun³

¹Department of Microbiology, Faculty of Medicine, University of Pelita Harapan,Tangerang, Banten, Indonesia; ²Department of Pharmacy, Siloam Teaching Hospitals, Lippo Village, Tangerang, Indonesia; ³Department of Internal Medicine, Faculty of Medicine, University of Pelita Harapan, Tangerang, Banten,Indonesia

Correspondence: Cucunawangsih Cucunawangsih (cucunawangsih.fk@uph.edu)

Background

Infections caused by antibiotic-resistant bacteria have led to increase burden on the healthcare system. Effective antimicrobial stewardship control program (ASCP) requires the clinician acceptance of program recommendation. We evaluate the antibiotic consumption and antibiotic susceptibility after ASCP implementation in 2013 in a teaching hospital in Tangerang, Indonesia.

Materials and methods

Our ASCP restrict the prescription of carbapenems, fourth generation cephalosporins, and tigecycline. Antibioticsusceptibility and consumption of restricted antibiotics were extracted from database. Antibiotics use was measured by the number of DDDs per 100 bed-days

Results

The proportion of susceptible bacteria against; cefpirome increased from 57% to 73%, cefepime 63% to 64%, imipenem 78% to 83%, and tigecycline 74% to 75% during 2013 to 2015. The proportion of meropenem susceptibility remained the same at 70% in 2013 and 2015. The defined daily doses (DDDs) per 100 bed-days was significantly reduced in all restricted antibiotics from 2013 to 2015 except tigecycline. The consumption of 1.0 g cefepime was 2190, 1035 and 107, 1.0 g cefpirome was 313, 473 and 140, 1.0 g meropenem was 16047, 11271 and 5281, 0.05 g teicoplanin was 40.4, 58.8 and 0, 0.5 g vancomycin was 716, 731 and 212.5, and 0.6 g linezolid was 129.6, 72 and 0 in 2013, 2014 and 2015, respectively

Conclusions

Our ASCP was effective in terms of lowering broad spectrum antibiotic consumption and improving the antibiotic susceptibility.

Session: Antimicrobial Stewardship

AS3 Utilization of diagnosis–procedure combination data for advancing the antimicrobial stewardship program

Haruo Nakayama, Toshiko Ota, Naoko Shirane, Chikako Matuoka, Kentaro Kodama, Masanobu Ohtsuka

Toho University Ohashi medical center, Tokyo, Japan

Correspondence: Haruo Nakayama (haruonakayama@med.toho-u.ac.jp)

Background

Infection with antibiotic-resistant bacteria results in increased morbidity, mortality and economic burden. Antimicrobial stewardship program (ASP) has been widely implemented to guide appropriate antibiotic use, in order to minimize antibiotic resistance. However, establishment of ASP is not always possible due to lack of interest. We examined the application of diagnosis-procedure combination (DPC) data as an incentive for achieving the target of ASP.

Materials and methods

The Toho University Ohashi Medical Center inpatient initiated ASP focusing on reduction of inappropriate perioperative antibiotics and anti-MRSA drugs. The DPC data was extracted for antibiotic consumption and duration in each patient from April 2013 to March 2016.

Results

The consumption of the first-generation and second-generation cephalosporins as perioperative antimicrobial agents was 62% during observation period. This proportion was below the initial benchmark. On the other hand, the consumption of anti-MRSA agents was 2.26% higher than the benchmark. More than half of patients undergoing surgery received perioperative antibiotics only one day. The majority was cardiovascular surgery patients used intraoperatively.

Conclusions

Our study shows that utilization of the DPC database for advancing the ASP is possible. It is convenient process to measure outcome of ASP at the group or organizational level.

Session: Antimicrobial Stewardship

AS4 Impact of antimicrobial stewardship on prescribing practices of physicians, antibiotic utilization and rates of multiple drug resistant organisms in Manila Doctors hospital, Philippines

Silverose Ann Andales Bacolcol, Melecia Velmonte, Allan Alde, Keithleen Chavez, Arlene Joy Esteban, Aisa Jensen Lee

Manila Doctors Hospital, Manila, Philippines

Correspondence: Silverose Ann Andales Bacolcol (silveroseann@yahoo.com)

Background

Manila Doctors Hospital (MDH), a tertiary hospital in the Philippines had initiated antimicrobial stewardship (AMS) to reduce antimicrobial resistance(AMR) in the institution. The impact of AMS on prescribing practices of physicians, antibiotic utilization and rates of multiple drug resistant organisms (MDROs) were evaluated.

Materials and methods

From 2011 to 2013, a multi-disciplinary AMS team initiated educational campaigns, developed AMS policies and antimicrobial guidelines based on the local antibiogram. Pilot implementation of policies was conducted in 2014 to 2016. Outcome measures included compliance rate of physicians to the surgical prophylaxis guideline, utilization of carbapenems and vancomycin in defined daily doses (DDDs per 100 patient-days) and rates of multi-drug resistant organisms.

Results

The utilization of carbapenems was 47.48, and 31.72 DDDs/100 patient days in 2014 and 2015, respectively (33% reduction). The utilization of vancomycin increased from 3.76 DDDs/100 patient-days in 2014 to 4.93 DDDs/100 patient-days in 2015. There was increased compliance to timing of surgical prophylaxis from 53% in 2014 to 89% in 2016. The proportion of Methicillin-resistant S. aureus (MRSA) decreased from 60% in 2013 to 47% in 2015. The proportion of Extended spectrum beta-lactamase (ESBL)-producing K. pneumoniae decreased from 12% in 2013 to 10% in 2015, whereas proportion of ESBL-producing E. coli increased from 11% in 2013, to 20% in 2014, and 23% in 2015. The proportion of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae was 16% in 2013, 23% in 2014, and 16% in 2015.

Conclusions

The AMS program resulted in increased compliance to the surgical prophylaxis policy, decreased utilization of carbapenems, and decreased proportion of MRSA, ESBL-producing K. pneumoniae. There is a room for improvement in reduction vancomycin use in this setting.

Session: Antimicrobial Stewardship

AS5 Comparison of the clinical efficacy between aerosolized colistin methanesulfonate plus tigecycline and aerosolized colistin methanesulfonate alone against extensively drug-resistant Acinetobacter calcoaceticus –baumannii complex pneumonia

Tai-Chin Hsieh³, Shio-Shin Jean^1,2

¹Emergency Medicine, Department of Emergency and Critical Care Medicine, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan; ²Department of emergency and critical care medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei , Taiwan; ³Division of Infectious Diseases, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital,Taipei, Taiwan

Correspondence: Shio-Shin Jean (jeanshioshin168@gmail.com)

Background

Extensively drug-resistant Acinetobacter calcoaceticus-baumannii complex (XDR-ABc) pneumonia is an important cause of healthcare-associated pneumonia. Although tigecycline was not approved for treatment of healthcare-associated pneumonia, it has been used off-label for XDR-ABc pneumonia. We evaluated whether the clinical efficacy of tigecycline combined with aerosolized colistin methanesulfonate (CMS) is superior to aerosolized CMS alone.

Materials and methods

This is a retrospective case-control study, conducted in Wan-Fang Medical Center, Taipei Medical University, Taipei, Taiwan from November 2014 to February 2015. The definition of XDR-ABc pneumonia was pneumonia caused by ABc with susceptibility only to colistin and tigecycline. Cases were patients who received aerosolized CMS in combination with intravenous tigecycline for at least 5 days to treat XDR-ABc pneumonia. Controls were those who received inhaled CMS alone and were selected based on the following matching criteria to cases; age (±5 years), Acute Physiology and Chronic Health Evaluation (APACHE) II score (±4 points).

Results

There were 53 patients in each group. The mean age of patients was 80 years old. The proportion of patients underwent mechanical ventilation were 35.8% and 28.3% in cases and controls, respectively (p = 0.45). The median APACHE II score was 17.5 (15.3-19.6) in cases and 17.3 (15.3-19.2) in control group (p = 0.9). The mean length of hospital stay was 32 days (p = 0.524), 30-days mortality rate was 34% and 22.6%(p = 0.02), and overall mortality was 46.2% and 33.3% (p = 0.19)in cases and controls, respectively.

Conclusions

Despite the active in-vitro susceptibility of tigecycline against XDR-ABc, combination therapy with tigecycline and aerosolized CMS for XDR-ABc pneumonia showed no additional clinical benefit.

Session: Antimicrobial Stewardship

AS6

Withdrawn

Session: Antimicrobial Stewardship

AS7 The effectiveness of reducing the amount of antibiotic resistant strains by Promoting Antibiotic Stewardship Program of a medical center

Huey-Jen Huang¹, Shu-Ju Huang¹,Yu-Huan Huang¹,Pei-Chen Cheng¹, Su-Fang Yu¹, Shih-Ming Tsao^1,2, Yuan-Ti Lee^1,2,Chien-Feng Li^1,2, Min-Chi Lu³

¹Infection Control Team, Chung Shan Medical University Hospital, Taichung, Taiwan; ²Infectious Diseases Division, Chung Shan Medical University Hospital, Taichung, Taiwan; ³Infectious Diseases Division, China Medical University Hospital, Taichung, Taiwan

Correspondence: Huey-Jen Huang (vivian.sunia@gmail.com)

Background

In 2013, the amount of antibiotics in this medical center accounted for 8.4% of its total drug amount. The calculated DID dosage of inpatient antibiotics was 917 and the rate of antibiotic-resistant strains has been on the rise. To cope with the development of drug resistance, from 2014 to 2015, the Antibiotic Stewardship Program (ASP) was executed to promote proper use and therefore to decrease the volume of antibiotics, and to reinforce MDRO isolation.

Materials and methods

A multi-discipline team for antibiotic stewardship was reformed. ID doctors and infection control practitioners developed regulations for antibiotic use, conducted training programs, reviewed antibiotic uses and gave feedback. The compliance and accuracy of hand hygiene, and isolation precaution and protection were strengthened by nursing personnel. The pharmacist team division provided daily antibiotic assessment and statistics. Microbiology laboratory was responsible for drug-resistant data.

Results

The expenditure of consumed antibiotic, as a ratio of total drug, declined from 8.4% in 2013 to 5.6% in 2015. From 2013 to 2015, the DID from 917 to 824, carbapenems from 53.4 to 47.4, quinolones from 95.6 to 81.9, and glycopeptides from 28.4 to 21.9. Furthermore, CRPA from 16.7% to 5.7%, CRAB from 55.7% to 26.2%, MRSA from 52.2% to 43.5%, VRE from 60% to 45%. However, a little elevation of CRKP from 9.62% to 11.3% was observed.

Conclusions

Employing ASP, we have enhanced the cooperation among antibiotic team members. As a result, the correct use of antibiotics was improved, the amount of antibiotics was less consumed, and the ratios of most MDRO declined.

Session: Antimicrobial Stewardship

AS8 Inappropriate empiric antibiotic treatment of uncomplicated cystitis: a prospective observational study in a tertiary care center in Thailand

Nattapol Pruetpongpun¹, Thana Khawcharoenporn¹, Pansachee Damronglerd¹, Nuntra Suwantarat², Anucha Apisarnthanarak², Sasinuch Rutjanawech²

¹Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Bangkok, Thailand; ²Chulabhorn International College of Medicine, Thammasat University, Bangkok, Thailand

Correspondence: Nattapol Pruetpongpun (Natprathan@hotmail.com)

Background

Increased antibiotic resistance among Escherichia coli has led to inappropriate empirical antibiotic use (IAU) for associated infections. Limited data exists for IAU among cases with acute uncomplicated cystitis (AUC).

Material and methods

We conducted a prospective observational study at a General Practice (GP) Clinic from December 2014 to February 2016. Eligible participants included women aged 15-60 years with AUC. All participants’ urine cultures were sent before empirical antibiotics were prescribed at the GP physicians’ discretion. The rate of IAU was subsequently identified by the investigators. Strategies to minimize IAU were then determined based on the relevant data of AUC treatment in this study.

Results

Eighty participants were enrolled. E. coli was the most common pathogen isolated (78.3%) with resistance rates to trimethoprim-sulfamethoxazole, fluoroquinolone, ceftriaxone, amoxicillin-clavulanate and ertapenemof61.7%, 42.6%, 21.3%, 2.1% and 0%, respectively. Extended-beta-lactamase production was confirmed in 12.5% of E. coli isolates. The rate of IAU was 91.3%. Ciprofloxacin use was the only independent risk factor for IAU (adjusted odds ratio, 6.471; 1.089-38.461; P =0.04). Based on the study results, including the in-vitro susceptibility data and the risk factors for acquisition of antibiotic-resistant E.coli, a specific algorithm for AUC treatment was created. If this algorithm was used along with education about IAU and antibiotic stewardship program focusing on ciprofloxacin use, the rate of IAU would have decreased to 3.8%.

Conclusions

Our findings suggest the high rate of IAU in AUC treatment in a GP setting and underlie the need for multifaceted interventions to reduce IAU.

Session: Antimicrobial Stewardship

AS9 Synergy between antimicrobial stewardship programs and infection control efforts

Lisa Cushinotto, Patty McBride, Harding Williams Jr, Hans Liu

Bryn Mawr Hospital, MainLine Health Care, Bryn Mawr, Pennsylvania, USA

Correspondence: Hans Liu (liuliang@aol.com)

Background

Infection control/prevention (IC) programs seek to prevent infections via surveillance and outbreak investigation, hand hygiene, isolation precautions, environmental disinfection, evaluating IC products, and policy development. Antimicrobial stewardship programs (ASP) try to optimize antibiotic use for better outcomes and less toxicity. Both reduce antimicrobial resistance in pathogens, educate healthcare staff, patients, and families, and optimize resource use.

Material and methods

Our study objectives were to define areas of synergy between IC and ASP efforts with specific examples and to determine how best to promote these.

Bryn Mawr Hospital: 250-bed community-teaching hospital with 3 IC practitioners; ASP team has one infectious diseases (ID) physician and an ID-trained Pharm.D. It is part of a 5 hospital system with microbiology laboratory. ASP has been in placed for 5-1/2 years.

Synergy between ASP and IC: (1) collaborative identification of outbreaks (e.g., regional babesiosis in 2015, ongoing C. difficile cases), (2) monitoring antimicrobial resistance via complementary computer surveillance systems, (3) coordinating presentation of microbiology antibiograms, (4) collaboration on healthcare staff educational programs, and (5) joint presentations to system wide committees and accrediting organizations.

Results

From 2011 to 2015 dosage days for selected antibiotics decreased 58-90% per 1000 patient-days and total antibiotic cost decreased $577,680 (54%) per year.

Conclusions

IC and ASP programs should work together to the benefit of both and the institution and health system as a whole. This can be facilitated by regular communications and meetings, ongoing review of microbiological pathogen and susceptibility trends, and collaboration on research and educational programs.

Session: Antimicrobial Stewardship

AS10 Awareness survey regarding antibiotic among healthcare workers in Hungvuong hospital

Phan Thi Hang¹, Dinh Pham Phuong Anh²

¹Quality management division in Hung Vuong hospital, Ho Chi Minh, Viet Nam; ²Infection control department in Hung Vuong Hospital, Ho Chi Minh, Vietnam

Correspondence: Dinh Pham Phuong Anh (thuyhangytcc@gmail.com)

Background

Healthcare workers (HCWs) play an important role to be a consultant about antibiotic use for patients. This would be helpful to reduce antibiotic overuse and prevent emergence of antimicrobial resistance in the hospital and public settings.

Materials and methods

We conducted across sectional study by using a self-assessment validated questionnaires, to determine current awareness and common habits related to antibiotic usage and antimicrobial resistance among HCWs in Hung Vuong hospital; an obstetrics and gynecology hospital in Vietnam.

Results

A total of 161 HCWs were enrolled in the survey. Although 99% of HCWs responded correctly "Many infections are becoming increasingly resistant to treatment by antibiotics", 77% of them thought that “antibiotic resistance occurs when your body becomes resistant to antibiotics”. A total of 19% (95% CI: 0.13 – 0.26) and 8% (95% CI: 0.04 – 0.13) of HCWs have correct knowledge about antibiotic usage and antimicrobial resistance. A total of 16% of HCWs answered that they have to prescribe antibiotic because they cannot follow up the patients' condition. Twenty-two percent of HCWs answered that it is necessary to take antibiotic when people have fever.

Conclusions

Majority of HCWs have incorrectly awareness about definition of antibiotic resistance. Furthermore, their habit of antibiotic use is inappropriate. We should have intervention programs to improve HCWs’ knowledge and control their antibiotic usage.

Session: Antimicrobial Stewardship

AS11 High prevalence of HAIs caused by gram negative carbapenem resistant strains in Vietnamese paediatric ICUs

Ngai Le, Dung Khu, Lam Nguyen

National Children's Hospital, Dong Da, Hanoi, Viet Nam

Correspondence: Ngai Le (ngai.lekien@nhp.org.vn)

Background

It is necessary to understand on the prevalence of hospital acquired infections and carbapenem-resistant gram negative bacteria (CR-GNB) in children’s hospital in resource constrained settings.

Material and methods

During a 1-year study period (2012-2013), we conducted a monthly point prevalence surveys (PPS) using the protocol of ECDC in 2 major Vietnamese children’s hospitals and 3 referral hospitals with pediatric intensive care units (PICU).

Results

1363 cases were included in the PPS. Average age was 11 months (median 3 months). Major reasons for admission were infection 66%. Admission source was other hospital 49.3%, current hospital 36.5%. Intubation 47.8%, CVC 29.4%, PVC 86.2%. HAI prevalence was 33.1%, of these 2 HAI in 9.9% and 3 HAI in 1.3%. Intubation had a significant (p < 0.001) correlation with HAI. The most common diagnosis was pneumonia 52.2%, sepsis 26.4%, the SSI and NE 9 cases (2%) each. Positive laboratory findings were 212 (43%). Carbapenem resistance were 40%; 46% of K. pneumoniae were carbapenem-resistant and 76% cephalosporin-resistant. 56% of P. aeruginosa and 64% of A. baumannii were carbapenem-resistant; 78% of S. aureus were MRSA. Antibiotics were given to 1307 (88.6%), one antibiotic 39.9%, 2 antibiotics 44.7%, 3 antibiotics 10.6% and 4 antibiotics 0.8%, average 1.7 antibiotics per case. Colistin was given to 97 cases, of these 49% had reported carbapenem-resistant strains; 49% carbapenem-resistant cases were treated with colistin.

Conclusions

There is a high prevalence of HAI in Vietnamese PICUs, usually caused by GNB with a very high antibiotic resistant rate. Colistin is commonly used in combination with other antibiotics to treat these resistant infections.

Session: Disinfection/ sterilization

DS1 Processing of reusable medical devices in health service organizations: preventing HAIs at Macquarie University hospital: an Australian experience

Roel Beltran Castillo

Central Sterilizing Services Department, Manager Macquarie University Hospital, North Ryde, New South Wales, Australia

Correspondence: Roel Beltran Castillo (roel.castillo@muh.org.au)

Background

The global community demands standardization to approaches in patient safety. Protocols differ to meet the specific demands of health care facilities; patient safety has always been the common end. An introduction and understanding of compliance under the Australian setting would reaffirm this common end. Our similarities and differences in achieving the purpose are interesting to note.This study aimed to share information between infection control professionals, how Australia kept pace with the technological evolution of reusable medical devices (RMDs) and caters to specific reprocessing requirements to ensure patient safety. How RMDs are reprocessed to minimize, control and prevent healthcare-associated infections (HAIs)

Materials and methods

The Australian Commission on Safety and Quality in Healthcare requires health service organizations to comply with 10 standards ensuring patients get the quality of care they truly deserve. All CSSD throughout Australia are responsible for:

Standard 3.16: Reprocessing of RMDs in accordance with relevant International standards and instructions for reprocessing or IFUs;

Standard 3.17: Systems to enable identification of a process to a patient;

Standard 3.18: Ensuring workforces to decontaminate RMDs undertake competency based training.

Are RMDs reprocessed to minimize the risk of infection at Macquarie University Hospital?

Results

Macquarie University Hospital: ISO accredited and CSSD received on all criteria: Meet with Merit – this is the highest possible achievement on an ISO accreditation

Conclusions

Prevention of healthcare associated infections in patients undergoing surgeries is an essential component of patient safety. Compliance with standards is a critical aspect.

Session: Disinfection/ sterilization

DS2 Fumigation free operating rooms in developing world- a reality

Dorairajan Sureshkumar¹, Ram Gopalakrishnan¹, Venkatasubramanian Ramasubramanian¹, Subramanian Sreevidya², Ranganathan Jayapradha²

¹Apollo Hospitals, Chennai, Tamil Nadu, India; ²Apollo Hospitals, Karapakkam, Tamil Nadu, India

Correspondence: Dorairajan Sureshkumar (dskinfdis@gmail.com)

Background

Fumigation of operating rooms (OR) with high concentration of toxic chemicals is an age old tradition practiced in most of the developing world to control hospital acquired infections. This approach lost favor in the developed world due to questionable efficacy and toxicity concerns. However, most of the hospitals in developing world continue to use fumigation practices with variable frequency. Here we report our experience of fumigation free OR in India.

Materials and methods

This quasi-experimental before and after intervention study was conducted in a 50-bed tertiary care referral women and children hospital in Chennai (South India) between January 2015 and September 2016. The practice of OR disinfection using quaternary ammonium compounds fumigation was allowed in addition to standard cleaning methods in before-intervention phase (Jan 2015 to Dec 2015). In after-intervention phase (Jan 2016) onwards the fumigation practice was stopped and standard cleaning methods alone followed. The monthly environmental microbiological surveillance cultures and surgical site infection (SSI) rates were compared and analyzed.

Results

In the before-intervention phase there were 715 surgical procedures were carried out with 2 SSIs and 156 environmental samples tested all were within acceptable limits as per defined standards. In the after-intervention phase 535 surgeries were carried out with no SSIs and all 117 environmental samples collected were within acceptable limits.

Conclusions

The standard cleaning methods alone without chemical fumigation is sufficient for operating rooms disinfection in India. However, this finding should be confirmed in large multi-site studies before universal recommendation.

Session: Disinfection/ sterilization

DS3 Change of the contamination rate caused by skin antiseptic change during blood culture collection

Atsushi Umetsu, Tetsuhiro Noda, Kenyuu Hashimoto, Akihiro Hayashi, Mikie Kabashima

Shin Koga Hospital, Kurume, Fukuoka, Japan

Correspondence: Atsushi Umetsu (spas3bq9@future.ocn.ne.jp)

Background

It is reported that skin antiseptic with a chlorhexidine-alcohol concentration of more than 0.5% usedduring blood cultures lowers contamination rate more effectively than povidone-iodine skin antiseptic. As an approach to enhance precision of blood cultures, I heldcampaigns for appropriate sterilization methods in 2010 also changed 10% povidone-iodine to 1% chlorhexidine-alcohol antiseptic during blood cultures in 2012, and reported results.

Material and methods

Study periods:April,2010-March,2011(A), August,2011-July,2012 after the sterilization methods campaign(B), and August,2012-July,2013 after the antiseptic change(C). I investigated and compared each period. The contamination was calculated by dividing the number of cases in which there was only one positive result of two sets or more of blood culture specimens submitted on the same day by the total of all paired sets collected. The contaminants were defined as CoNS, Bacillus spp., Corynebacterium spp., Micrococcus spp., Propinonibacterium spp. which a doctor took as causative organism of the infection were excluded.

Results

The contamination of the blood culture for periods A: 2.25%, B: 0.98%, and C: 1.05%.

Conclusions

There’s significant decrease in the contamination during blood cultures after sterilization methods campaign (A-B)(p < 0.05). It suggests contamination decreased by performing appropriate sterilization methods. There were no contamination differences in B-C after changing disinfectant (p = 0.86). It was suggested that an equal skin sterilization effect was provided when I performed the sterilization with1% chlorhexidine-alcohol and10% povidone-iodine, which was appropriate.The 1% chlorhexidine-alcohol has an immediate effect and durability in comparison with povidone-iodine, shorting the time for drawing blood after sterilization. Reflecting importance for busy on-site blood cultures.

Session: Disinfection/ sterilization

DS4 Flexible endoscope decontamination - is it good enough?

Ursula Jadczak¹, Knut Elvelund¹, Marit Johnsen¹, Bente Borgen², Egil Lingaas²

¹Lovisenberg Diakonale Hospital, Oslo, Norway; ²Oslo Univerisity Hospital, Oslo, Norway

Correspondence: Ursula Jadczak (ursula.agnes@yahoo.no)

Background

Lovisenberg Diakonale Hospital has Olympus EDT machines for cleaning of endoscopes. In the standard program the wash time is 3 minutes with special detergent and the disinfection time is 5 minutes. Periodical testing of final rinse-water is performed regularly with good results. Microbiological control of the final rinse-water from the washer-disinfector for endoscopes (EWD) is the most widely used methods for detecting growth of bacteria. The validation process is a comprehensive procedure that requires both resources, time, knowledge, special equipment and access to the microbiological laboratory. The hospital wanted to assure the quality of decontamination of their endoscopes. We have established a partnership with the Department of Infection Control at Oslo University Hospital in order to validate the EWD.

Materials and methods

The decontamination of flexible endoscopes must be tested and validated according to the standard EN ISO 15883. To validate the disinfection process and secure a repeatable method, we used a surrogate endoscope (Spypach). This is equipped with biological indicators, temperature sensors and pressure- and flow-measures.

Results

Microbiological control of final rinse-water: satisfactory results according to standard.Cultivation of biological indicators: unsatisfactory results according to standard. Discovery of protein and fibrin in surrogate endoscope: unsatisfactory results according to standard. Measurement of temperature, pressure and flow: no deviation

Conclusions

The endoscope was not adequately cleaned during decontamination. Final rinse-water had satisfactory quality but remaining biological indicators and protein residues showed that the decontamination was not satisfactory. Alternative solutions may include: increasing the wash time and/ or modify the contents of detergent.

Session: Disinfection/ sterilization

DS5 Can we use the super rapid readout biological indicator to replace traditional biological indicator

Chia-Hua Mao¹, Fu-Chieh Chang², Chang-Pan Liu²

¹Central Supply Room, Department of Nursing, Mackay memorial hospital, Taipei, Taiwan; ²Infection control center, Mackay memorial hospital, Taipei, Taiwan

Correspondence: Fu-Chieh Chang (maple0711@gmail.com)

Background

As we know, the biological indicators are the most accepted means of the QC in sterilization. Because the biological indicators contain Geobacillus stearothermophilus that have spore inside the cell, if the sterilization were successful, the G.sterothermophilus should be killed, and the Biological indicator can’t detected by color or machine. So, in this study, we aimed to make sure whether the super Rapid Biological Indicator can replace the traditional Biological Indicator or not. According to the instruction of the super Biological Indicator, after 60 minutes, the data will show pass or not. So we using the culture method to make sure the result are the same or not.

Materials and methods

In this study, we collected 214 super Rapid Readout Biological Indicators from Feb.2016 to Mar. 2016, and all the result showed that was no bacteria growth after 1 hour incubated. Then we used thioglycolate and TSA to make sure the results .

Results

According to the experiment’s result, all of the culture data showed that 214 super Rapid Readout Biological Indicators were the same. The accuracy were 100% and the sensitivity and specificity were 100% and 100%.

Conclusions

Based on this study, we assented that super Rapid Readout Biological Indicator can replace the traditional Biological Indicator. Otherwise, BI results are available about the time (1 hour) it takes to cool a load, and instruments and implants can be released to the OR much sooner

Session: Disinfection/ sterilization

DS6 Using crepe paper to substitute cotton in sterilization

Ru-Hui Chao¹, Fu-chieh Chang², Chang-pan Liu²

¹Central Supply Room, Department of Nursing, Mackay memorial hospital, Taipei, Taiwan; ²Infection control center, Mackay memorial hospital, Taipei, Taiwan

Correspondence: Fu-chieh Chang (maple0711@gmail.com)

Background

Sterilization wrap is commonly used for instrument trays or cassettes. There are many different types and sizes of wraps available. Typically, two sheets are needed to provide an effective barrier and a specific technique is recommended [CDC, AAMI ST79] to allow for aseptic opening. Wrapped instruments should be secured with sterilization tape that also serves as an external indicator. Before closing, a multi-parameter chemical indicator should be included inside along with the instruments. Before this study, we used cotton of wraps. And the problem we focused was the expiry date. According to the Taiwan CDC suggestion, the cotton’s expiry date is 7 days. But it’s too short for us. This study aimed to find some types that can replace the cotton.

Materials and methods

In this study, we used the crepe paper of wraps to replace cotton. Otherwise, we want to elongate the expiry date. So we collected the instruments that cover by crepe paper and that storage in CSR (HEPA level: 100000) for 1, 4, 8, 12, 16, 20, 24, 28 weeks. Then we used the broth methods to make sure whether the instruments were contamination or not.

Results

In this study, we found all of the instruments were clean on 20 weeks. After 20 weeks, the culture result showed that some bacteria were growth on the instruments.

Conclusions

According to the experiment’s results, we suggested that the crepe paper can replace the cotton of wraps, and it could elongate the expiry date for 20 weeks in our CSR.

Session: Disinfection/ sterilization

DS7 Development of the sterilization process to prevent the breakage of mouth mirror in central sterile supply department at Wanonniwas hospital

Junpen Pawapotako

Wanonniwas Hospital, Wanonniwas, Sakonnakhon, Thailand

Correspondence: Junpen Pawapotako (peemon2009@hotmail.com)

Background

In 2014, 47 pieces of the mouth mirrors from dental unit were broken as they were packed and mixed with the other tools that were heavy, shape, and without protection. It broke the mouth mirrors from a process of packaging. The important is to prevent the broke of mouth mirror in order to have the good quality and enough instruments to service patients.This study aimed to determine the result of development of sterilization process toprevent the broke of mouth mirror in CSSD of Wanonniwas hospital.

Materials and methods

The sample group was composed of 1) Mouth mirror and 2) Personnel from the CSSD 8 persons.The process included 3 steps: 1) prepare process is to learn the reason of the breaking of mouth mirror and create the system in every process from caring, washing, packaging, sterilization, keeping, sending to dental unit, 2) methods process is inform the personnel about the reason, why mouth mirror were broken, change the methods of sterilization of mouth mirror, and 3) evaluation : This study were collected during fiscal year 2014 through 2016.

Results

The breaking of mouth mirror in year 2014, 2015, and 2016 (May) were 48 pieces, 33, and 4 pieces, respectively. It has a clearly decrease.

Conclusions

The sterilization to prevent the broke of mouth mirror that caring keep the mouth mirror into the box with a lid. The process of washing and drying, sorting the mouth mirror. Packing cloth wrapped. Sterilization, distribution and storage kit for the side impact protection.

Session: Disinfection/ sterilization

DS8 Evaluation on the cleaning performance of different cleaning processes using the protein residue check test

Chadanan Prasertpan¹, Wantanee Malaihuan¹, Phisit Uirungroj²

¹CSSD, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; ²Pose Health Care Co., Ltd., Kannayao, Bangkok, Thailand

Correspondence: Chadanan Prasertpan (cprasert.morn@gmail.com)

Background

The medical instrument cleaning and disinfection procedures are important process to remove organic and inorganic matter, due to concerns about contamination risks especially protein residue, to prevent cross-contamination and ensure the safety. This study aimed to determine the cleaning efficacy of two different cleaning methods, manual cleaning process and an automatic washer disinfector machine, using the protein residue check test in the Central Sterile Supply Department (CSSD), Maharaj Nakorn Chiang Mai Hospital.

Materials and methods

The 35, 40, and 25 samples of medical instrument washed and cleaned by manual cleaning process, the automatic washer disinfector machine, and re-sterile (without washing process), respectively, were collected from July to August, 2014 to determine the protein residue. The protein residue was detected with two different detections, the protein residue check test (Pose Health Care Co., Ltd., Thailand) and fluorescence-based protein detection test (Lab Focus Co., Ltd.).

Results

The 27 (77.14%), 33 (82.50%), and 11 (44.00%) samples of manual cleaning process, the automatic washer disinfector machine, and re-sterile produced undetectable protein residues, respectively (p-value = 0.002). The 8 (22.86%), 7 (17.50%), and 14 (56.00%) samples of manual cleaning process, the automatic washer disinfector machine, and re-sterile produced detectable protein residues, respectively.

Conclusions

The results indicated that, the medical instrument using the re-sterile process should pre-clean instrument with enzymatic detergent to remove gross soil immediately and must be thoroughly washed and cleaned before being sterile. Moreover, the manual cleaning process and an automatic washer disinfector machine must be optimized to eliminate protein contamination and minimize the cross-contamination.

Session: Disinfection/ sterilization

DS9 Evaluation on the cleaning performance of an alkaline detergent used in an automatic washer disinfector machine

Chadanan Prasertpan¹, Chalermpong Saenjum², Teerapat Ouirungrog³, Phisit Uirungroj³

¹Central sterile services department (CSSD), Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; ²Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; ³Pose Health Care Co., Ltd., Kannayao, Bangkok, Thailand

Correspondence: Chalermpong Saenjum (chalermpong.saenjum@gmail.com)

Background

Different medical device cleaning and disinfection procedures are used on a large scale. It is an important procedure to remove organic and inorganic from medical device to prevent cross-contamination. This study aimed to determine the cleaning efficacy of an alkaline detergent used in an automatic washer disinfector machine in the Central Sterile Supply Department (CSSD), Maharaj Nakorn Chiang Mai Hospital.

Materials and methods

An alkaline detergent was developed by Pose Health Care Co., Ltd., Thailand. The programs were designed with different concentrations of alkaline detergent 50, 60, 80, and 100 mL (0.15, 0.18, 0.24, and 0.30 v/v, respectively) and two different temperatures (60 and 65 °C). The cleaning efficacy was monitored using a TOSI (EN ISO 15883) and Brown STF loaded check strips. Each program used three TOSI test kits and five Brown STF strips to evaluate the cleaning efficacy. Additionally, protein residue was detected with the Pyromol® test, protein residue check test, and fluorescence-based protein detection test. Moreover, biofilm and microorganisms were determined using a scanning electron microscope (SEM).

Results

The optimum concentration of the alkaline-based cleaning detergent and temperature were 60 mL (0.18 v/v) and 60 °C, respectively. This program (60 mL and 60 °C) produced undetectable protein residues, biofilm, and microorganisms on medical instruments after the cleaning process.

Conclusions

Comparable to the recent condition of 100 mL (0.30 v/v) concentration and at 65 °C, the optimum condition of 60 mL concentration and at 60 °C reduced the cleaning costs by 40% per each cleaning process.

Session: Emerging Infectious Diseases

EID1 Implementing standardised guidelines for management of carbapenemase-producing enterobacteriaceae in Australia: experience of a large tertiary healthcare facility

Sue Borrell, Pauline Bass, Leon Worth

Infection Prevention and Hospital Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, Australia

Correspondence: Sue Borrell (S.Borrell@alfred.org.au)

Background

Carbapenemase-producing Enterobacteriaceae (CPE) infections are an emerging threat in specific regions of South East Asia, Europe, and the United States. CPE occurs sporadically in Australia with isolated genomic clusters. Different classes of carbapenemases are prevalent by region worldwide, and in Australia, imipenemase-producing CPE (bla IMP-4) is endemic at low levels. In our healthcare facility, carbapenemases other than IMP demonstrate epidemiological links to recent overseas healthcare or residency. Following retrospective recognition of a cluster of CPE cases linked to a single healthcare facility in Melbourne, the local health authority, the Victorian Department of Health and Human Services, released comprehensive consensus guidelines for the management of CPE in December 2015.

Materials and methods

Based on a “Search and Destroy” strategy, instruction is provided regarding identification of CPE, centralised reporting, contact tracing and screening, the need for alerts, clearance protocols for contacts, cleaning validation and 6-monthly point-prevalence surveys. Oversight of outbreaks is provided by a state incident management team and a single state reference laboratory performs genomic analysis of all isolates.

Results

This presentation will outline the experience and lessons learned in implementing these CPE guidelines in our healthcare facility. Examples include the development of new systems to identify and communicate CPE cases, electronic alerts for isolation and screening, a CPE staff education program and methods for conducting point-prevalence surveys in high-risk wards.

Conclusions

Early identification and screening of patients hospitalised abroad and the need for a functional IT platform to facilitate electronic flagging/alerts represent challenges likely to be faced by many healthcare facilities in our region.

Session: Emerging Infectious Diseases

EID2

Withdrawn

Session: Environmental control

E1 Analysis of risk factors among 51 measles patients infected with multiple drug-resistant bacteria

Zhao Xian-li, Li Xiao-long, Yao Xue-hua, Ren Wei, Zhang Xia Zeng

Gai-huan Henan Provincial Infectious Disease Hospital, Zhengzhou, China

Correspondence: Zhao Xian-li (zzlygrb@163.com)

Background

In recent years, we found rising in trends of measles infections, even in a small local epidemic. It may because of the measles virus’ genes per se, antigenic variation or other factors. Infected with measles virus can cause temporarily decline in human’s immune, especially cellular immunity. Lack of effective immune reactions can lead to secondary bacterial and multiple infections. We investigated measles-infected patients and evaluated susceptible factors for multiple drug-resistant bacteria infections. We also examined hospital infection prevention and control protocol in controlling measles outbreaks in our hospital.

Materials and methods

During 2013 to July 2015, 492 cases of patients with measles were detected in our hospital. We retrospectively reviewed and analyzed 51 measles-infected cases who had multiple drug-resistant bacteria infection data.

Results

We found that the main risk factors to be infected with multiple drug-resistant bacteria included: 1) age under 8 months, 2) abnormal cardiac functions, 3) having malnutrition and 4) having encephalitis.

Conclusions

The hospital should focus on patients under 8 months of age, with abnormal cardiac functions, having malnutrition or encephalitis to avoid multiple drug resistant bacteria infections and decrease mortality by strengthening treatment and implementation of infection prevention and control protocols.

Session: Environmental control

E2 A local experience sharing: hand wash basin as a potential source of carbapenemase-producing Enterobacteriaceae transmission in hospital environments

Man Ying Kong, Christopher Koon Chi Lai, Suet Yi Lee, Ngai Chong Tsang

Queen Elizabeth Hospital, Hong Kong, China

Correspondence: Man Ying Kong (kongmy@ha.org.hk)

Background

The global spread of Carbapenemase-producing Enterobacteriaceae (CPE) is a major challenge for infection control practitioners.We adopted a proactive approach that all CPE carriers were isolated in a designated ward with strict contact precautions. Here, we investigated if CPE can survive terminal disinfection in hospital environment. Our study aimed to evaluate the extent of CPE contamination in patient care environment after terminal disinfection using microbiological sampling.

Materials and methods

Microbiological samples for CPE were taken from the general wards’ environment whenever a patient newly identified with CPE was removed for isolation. Environmental samplings were collected by trained personnel. High-touch and wet surfaces were sampled using sterile Polywipe sponge. ChromID CARBA agar was used for selective cultivation of CPE. Suspicious colonies grown after overnight incubation at 35 °C were further examined for carbapenemase production using CARBA-NP. We confirmed carbapenemase production using GeneXpert CARBA.

Results

Between 7 April 2014 and 4 October 2016, 468 environmental samples were collected from 23 wards. We found 1.92%tested positive for CPE that included7 hand-wash basins, one sink and one hospital curtain. These isolates were IMP-producing CPE. Six affected basins/sinks were cleared from CPE after cleaned with detergent followed by disinfection with 5.25% sodium hypochlorite solution (1,000 ppm) daily for one week. The CPE in the remaining two hand-wash basins survived for 21 days after daily decontamination and the basins need to be replaced.

Conclusions

Our results highlighted hand-wash basins may serve as a potential environmental reservoir for CPE. As standardized decontamination regimen for sinks was lacking, we recommended hand-wash basins should not be used for the disposal of body fluids.

Session: Environmental control

E3 Effectiveness of decontamination of isolation wards using the spectra 1000 ultra-violet c light system

MM O’Donoghue¹, MV Boost¹, LKP Suen¹, GK Siu², KW Mui³, CKC Lai⁴, DNC Tsang⁴

¹Squina International Centre for Infection Control, School of Nursing, The Hong Kong Polytechnic University (PolyU),Hong Kong, China; ²Department of Health Technology and Informatics, The Hong Kong Polytechnic University (PolyU),Hong Kong, China; ³Department of Building Services Engineering, The Hong Kong Polytechnic University (PolyU),Hong Kong, China; ⁴Queen Elizabeth Hospital,Hong Kong, China

Correspondence: MM O'Donoghue (margaret.o.donoghue@polyu.edu.hk)

Background

Terminal cleaning of isolation rooms is an essential step in infection control. However, traditional cleaning and disinfection may be inadequately performed by time limitation. Ultra-violet (UV) devices are effective in environmental decontamination but their cost can be prohibitive. Recently, a more economical version of a UV-C sterilizing unit has become available but its effectiveness for environmental decontamination has not yet been independently evaluated. Our study aimed to evaluate the effectiveness of the Spectra 1000 UVC light system to reduce viability of healthcare-associated pathogens in a ward environment.

Materials and methods

Four organisms (Staphylococcus aureus, Enterococcus faecalis, Acinetobacter baumannii and Klebsiella pneumoniae) were coated onto designated areas of formica that were then attached to eight locations in the room. The room was irradiated for 15 minutes and the lamp was moved to a second position then treatment was repeated. Cultures were performed and resulting colonies were enumerated. Surviving numbers were compared with non-irradiated controls.

Results

All organisms were rendered non-viable in areas receiving direct irradiation or substantial reflected light. At two sites where heavily shaded (rear of bedside lockers and armchairs), a 2-log reduction in viability of E. faecalis was observed.

Conclusions

Spectra 1000 UVC light offered an effective adjunct to conventional terminal disinfection of isolation rooms. Although two irradiation periods using two positions of the lamp were needed, to ensure that shaded areas would receive adequate treatment, the total time for disinfection was only 30 minutes. As UV treatment does not produce residues, there is no down time after use.

Session: Environmental control

E4 The current status of cross-infection risks in hotels

Yuka Sato, Mariko Tateishi, Mutsuko Mihashi

Kurume University, Kurume, Fukuoka, Japan

Correspondence: Yuka Sato (yukasato503@gmail.com)

Background

In Japan, the Ministry of Health, Labour, and Welfare published the “Guidelines for the Prevention of New Strains of Influenza Infections in Employers and Employees [1]”. However, our survey, which investigated infection control for new strains of influenza in 2014, revealed that recognition of these guidelines was low, showing that infection prevention control had been insufficiently implemented in hotels. Our study aimed to identify the current status of cross-infection risks in hotels, and use the results to improvethe control of infectious diseases in such areas.

Materials and methods

The study ran from March 17-18, 2016. The study volunteers were members of the All Japan Ryokan Hotel Association. To assess environmental contamination levels in hotel settings, the ATP and AMP swab test kits (Kikkoman Lumitester PD-20) were used. Frequently touched surfaces were measured for contamination. Measurement sites included 30 that were measured intermittently, and 39 that were measured before and after cleaning.

Results

There were 5 intermittently measured monitoring sites that exceeded 5,000 RLU including the open/close buttons inside the kitchen elevator and first floor handrails. There were 5 monitoring sites measured before and after cleaning that exceeded 5,000 RLU even after cleaning, including the inner sides of restaurants’ sliding doors and the inner washroom door knobs of guest rooms.

Conclusions

ATP values of more than 5,000 RLU were detected at some monitoring sites, suggesting the need to reconsider methods and frequency of cleaning by taking risk of cross-infection into account.

References

1. Ministry of Health, Labour, and Welfare websate. Guidelines for the Prevention of New Strains of Influenza Infections in Employers and Employees (update 2009 Feb 17); http://www.mhlw.go.jp/bunya/kenkou/kekkaku-kansenshou04/pdf/090217keikaku-08.pdf (cited 2014 Oct 25)

Session: Environmental control

E5 Utilization of infection control risk assessment tool in improving the compliance to infection prevention and control during construction activities in the hospital

Jose Paulo Flor, Marko Bautista, V Jay De Roxas, Justine Vergara, Nicolo Andrei Añonuevo, Marion Kwek, Jose Acuin, Anna Josea Sanchez, Avel Bathan

Asian Hospital and Medical Center, Muntinlupa, National Capital Region, Philippines

Correspondence: Nicolo Andrei Añonuevo (naanonuevo@asianhospital.com)

Background

The purpose of this study was to test the effectively of the Infection Control Risk Assessment (ICRA) monitoring tool developed by the Infection Prevention and Control Unit (IPCU) of Asian Hospital and Medical Center with the aim to increase the compliance of construction workers to recommended infection prevention and control measures during construction, renovation and demolition in the hospital.

Materials and methods

Indicated in the ICRA monitoring tool were the details of the activity and the infection risk level (Class I,II,III and IV). The design used wasa quasi-experimental designwhich was conducted among all construction projects in the hospital within a 1-year period. The percent compliance was computed by number of compliant projects per month over total number of monthly projects which thenmultiplied by 100.

Results

There were a total of 151 construction projects monitored by direct observation which utilized the ICRA tool. Other interventions included orientation of construction workers to the tool, acknowledgment and accountability of recommended infection prevention and control measures by signing the tool and lastly, making use of the tool to provide feedback. Results show an improvement in the compliance to infection prevention and control interventions from average of 84% during pre-intervention to 91% post intervention.

Conclusions

Having an ICRA tool paved the way for construction workers to be pro-active and be involved in preventing infections brought by construction, renovation and demolition.

Session: Environmental control

E6 Garnering staff towards a cleaner and safer environment: the national kidney foundation experience

Jamilah Binte Jantan¹, Chua Chor Guek¹, Eu Chiow Kian¹, Pampe Anak Pirido¹, Nur Fadilah Binte Mohd Aron², Leah May Estacio³, Francis Alvarez Palana⁴, Michelle Gracia⁵, Nur Syafiqah Binte Shamsuddin⁶, Kersten Timbad Castro⁷, Madonna Baloria⁸, Faezah Binte Adam⁹

¹National kidney foundation, Singapore, Singapore; ²Jurong West1 Dialysis Centre, Singapore, Singapore; ³Kolam Ayer Dialysis Centre, Singapore, Singapore; ⁴Woodlands1 Dialysis Centre, Singapore, Singapore; ⁵Teck Whye Dialysis Centre, Singapore, Singapore; ⁶Yishun1 Dialysis Centre, Singapore, Singapore; ⁷Hougang1 Dialysis Centre, Singapore, Singapore; ⁸Kim Keat Dialysis Centre, Singapore, Singapore; ⁹Tampines2 Dialysis Centre, Singapore, Singapore

Correspondence: Jamilah Binte Jantan (jamilah.jantan@nkfs.org)

Background

In the dialysis centre, there is potential for cross transmission of infectious agents through contaminated devices, hands, equipment, supplies and environmental surface during haemodialysis (HD) treatment. To reduce the risk of acquiring infections, staff routinely clean and disinfect medical equipment and high-touch areas after each patient's HD treatment at the National Kidney Foundation (NKF). This study aim of the study is to assess environmental cleaning of high-touch areas and develop intervention program to achieve compliance ≥85%.

Materials and methods

This is a quantitative study involving 29 Infection Control Link Nurses (ICLNs) at the Community-based Dialysis Centres (CB-DCs), NKF from October 2015 to April 2016. In November 2015, ICLNs conducted an environmental cleaning assessment of high-touch areas using a checklist and Glo Germ Kits, to ascertain the efficacy of environmental cleaning at 29 CB-DCs. Pre-study data showed an overall average of 67% compliance. RCA revealed the absence of an audit tool for high-touch areas, a lack of training leading to knowledge deficit, poor cleaning techniques and staff incompetency. Interventions included a checklist (audit tool) for environmental cleaning assessment of high-touch areas, a "Train the Trainer" programme for the 29 ICLNs, an annual competency assessment and video tutorials on environmental hygiene to standardise practice.

Results

Following the interventions, environmental cleaning assessment of high-touch areas showed an overall average of 86% compliance, with 17 CB-DCs achieving ≥85% compliance in environmental cleaning of high-touch areas.

Conclusions

This study illustrated that the intervention programme increased staff awareness, thereby improving compliance. Besides promoting positive outcomes, it enhanced the internal monitoring system at NKF.

Session: Environmental control

E7 Are surfaces of gym equipment a source of methicillin-resistant Staphylococcus aureus (MRSA) colonisation in the rehabilitation centre?

Zhang Wei¹, Poh Bee Fong², Marimuthu Kalisvar³, Angela Chow⁴, Brenda Ang⁵

¹Infection Control Unit, Tan Tock Seng Hospital, Singapore, Singapore; ²Infection Control Unit, Tan Tock Seng Hospital, Singapore, Singapore; ³Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore; ⁴Clinical Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore; ⁵Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore

Correspondence: Zhang Wei (zhang_wei@ttsh.com.sg)

Background

In March 2016, a surge of 34 MRSA acquisitions (30 from screening and 4 from urine cultures) was noted in rehabilitation ward (REH-ward) at Tan Tock Seng Hospital, Singapore. Our objective was to investigate if fomite transmission could be a cause of these acquisitions. We conducted one-day surveillance screening of the gym equipment and REH-ward’s environment.

Materials and methods

Samples were collected by rolling swabs moistened with sterile saline five times on the surfaces of gym equipment before and after use. In the ward, selected patients’ beds and common items or equipment in shared area were also sampled. Samples were cultured for MRSA using selective chromogenic media.

Results

In the gym, all 156 samples collected from equipment pre-use were negative for MRSA. However, 7.3% (6/85) of the samples collected after use were MRSA positive. In the wards, all swabs (55) that were taken from the common shared area such as computers, case notes carts, were negative. Two out of 12 beds (16.7%) occupied by MRSA carriers and 3 out of 53 beds (5.7%) occupied by non-MRSA carriers were contaminated with MRSA (OR 3.33, 95%CI 0.24- 32.46, p = 0.23). Overall rates of MRSA-positive swabs were comparable between the wards and gym (2.5% vs. 2.2%, p = 0.82).

Conclusions

Gym equipment was not more likely than the ward environment to contribute to MRSA acquisition. The importance of environmental cleaning in all areas including rehabilitation facilities cannot be over-emphasised.

Session: Environmental control

E8 Reforming program of environmental cleaning

I-Ju Chuang, Yi-ChunCho, Yu-Fen Chiu, Lung-Chih Chen, Yi-Chun Lin, Shao-Xing Dong, Yi-Chieh Lee, Hui-Chen Kuan, Hsin-Hua Lin, Chia-Chun Chi, Chin-Te Lu

Lo-Tung Pohai Hospital, Lo-Hsu Foundation, Incl, Ilan, Luodong Town, Taiwan

Correspondence: I-Ju Chuang (897077@mail.pohai.org.tw)

Background

With the widespread use of antibiotics in the treatment of human bacterial infections, the multidrug-resistant microorganisms also appear to threaten human health. Environmental cleaning to avoid the spread of bacteria and healthcare-associated infection is an important part of healthcare infection control practice. Through this program, our hospital aimed to improve the environmental cleaning, reduce the bacterial antibiotics resistance, and further reduce the use of antibiotics.

Materials and methods

We reformed program of environmental cleaning and measured incidence of multidrug-resistant bacteria and consumption of designated antibiotics.

Results

Our results were shown below. The unqualified rate in environmental cleanliness of our cleaners was 39.1% before this program was implemented and 21.7% after this program that demonstrated 44.5% reduction. The numbers of healthcare-associated infections with multidrug-resistant bacteria was 30 before this program, and 8 after this program (73% reduction). The consumption of anti-methicillin-resistant Staphylococcus aureus was 142.0 defined daily dose (DDD) /1000 bed-days before this program, and 101.5 DDD /1000 bed-days after this program (28.5% reduction). The consumption of glycopeptides was 120.0 DDD /1000 bed-days before this program, and 83.2 DDD /1000 bed-days after this program (30.8% reduction). The consumption of carbapenems was 164.5 DDD /1000 bed-days before this program, and 98.1 DDD /1000 bed-days after this program (40.4% reduction).

Conclusions

According to our results, environmental cleaning may effectively reduce the number of healthcare-associated infections with multidrug-resistant bacteria and used of broad-spectrum antibiotics. If it can be promoted consistently, in accordance to the qualified data, the use of antibiotics could be reduced and the prevention of bacterial resistance occurred.

Session: Environmental control

E9 To investigate the expiry date of antimicrobial curtain

Fu-chieh Chang, Chang-pan Liu

Infection control center, Mackay memorial hospital, Hsinchu, Taiwan

Correspondence: Fu-chieh Chang (maple0711@gmail.com)

Background

The invention related to an antibacterial treatment process of a curtain fabric material with functions of free washing and environmental protection. They were used for the antibacterial treatment of a non-woven fabric made from polypropylene fibers and as the curtain fabric material with functions of free washing and environmental protection. Before our hospital use this production, we aimed to investigate the expiry date of antimicrobial curtain to establish our protocol.

Materials and methods

We conducted this experiment from August to October 2016. In this study, we used three companies’ antimicrobial curtains. We used the C.difficile, MRSA and A. baumannii as study models. Then we putted the antimicrobial curtain on the agar then see the bacteria growth or not.

Results

According to our study, C. difficile, MRSA and A. baumannii were not detected in the antimicrobial curtains. After 11 weeks, there were no bacteria growths on the curtain.

Conclusions

The curtain fabric material produced by the invention has the advantages of good air permeability, easy maintenance of dry curtain fabric surfaces, dirt resistance, free washing, no toxicity and irritative peculiar smell, easy recycling, environmental protection, good antibacterial property and low antibacterial treatment cost.

Session: Environmental control

E10

Withdrawn

Session: Environmental control

E11 Evaluation of the appropriateness of the standard operating procedure and propose amendments to ensure of the cleaning/disinfection in Intensive Care Unit

Tang Ya-Fen^1,2, Su Li-Hsiang¹, Liu Jien-Wei^1,3,4

¹Committee of Infection Control, Chang Gung University Medical College, Kaohsiung, Taiwan; ²Departments of Clinical Pathology, Chang Gung University Medical College, Kaohsiung, Taiwan; ³Division of Infectious Diseases, Chang Gung University Medical College, Kaohsiung, Taiwan; ⁴Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

Correspondence: Tang Ya-Fen (yafen@cgmh.org.tw)

Background

Environmental contamination is the important source for bacterial spread causing hospital-acquired infections. Environmental cleaning with an established standard operation procedure (SOP) and cleaning staff’s strict adherence to the SOP are therefore extremely important. However, evaluation of the effects of environmental cleaning in general has not been fully reported in the literature. This study aim to elucidate the effects of environmental cleaning with the established SOP and by the well trained cleaners in Kaohsiung Chang Gung Memorial Hospital (KSCGMH). Environmental cleaning was based on the SOP which followed the principle of cleaning from higher locations to lower ones, and from the contaminate areas to the comparatively cleaner ones in rooms where patients were staying.

Materials and methods

Before and after daily environmental cleaning routine, environmental surfaces were swabbed for sampling specimens for bacterial culture and for bacterial count evaluation in case of culture positive.

Results

Data showed that before and after cleaning environmental, bacterial burdens in environmental surfaces of the bedroom were significantly reduced (p < 0.0001).

Conclusions

Indicating the environmental cleaning with the current cleaning SOP and by these well trained cleaners has been effective.

Session: Environmental control

E12 Hospital-wide environmental cleaning monitoring program reduces healthcare-associated infections related to multidrug-resistant organism

Hsuehlan Chao, PinRu ChangChien, WeiFang Chen, ChungHsu Lai

E-DA Hospital, Kaohsiung, Taiwan

Correspondence: Hsuehlan Chao (lan3428519@gmail.com)

Background

The evidence-based policies to clean hospital environment can reduce the colonization and infection of multidrug-resistant organisms (MDROs). The purpose of this study is to measure the effectiveness of environmental cleaning policies.

Materials and methods

(1) The effectiveness of policies was examined by adenosine triphosphate (ATP) and microbial cultures (MCs) before and after the implementation of policies at both the general wards (GWs) and the intensive care units(ICUs). (2)The study audited selected 20 points related to MDROs, including bed rails, bed button beds (the desktop corner), etc.(3)The standard values: ATP less than 250 RLU at ICU and less than 500 RLU at GW. Bacterial colonies count < 100 CFU.

Results

(1)20/49 ATPs (41%) had been detected over 500RUL before policies, but 28/67 (42%) after policies without statistical difference (p = 0.45) in GWs. However, in ICUs, before policies 40/81 ATPs (49%) over250 RLU and after policies 30/67 ATPs over 250 RLU, no statistical difference (p = 0.29). (2) 50% selected points were over 500RUL both before and after policies at GWs. Only 16.6% selected points were over 250RUL in ICUs. (3) MCs had statistically significant (p = 0.01) before and after policies at GWs, including Oxacillin-Resistant Staphylococcus aureus (ORSA), Enterococcus faecium (VRE), Acinetobacter baumannii, (XDR).But ICUs were not dirty over standard both before and after policies.

Conclusions

This survey helps us understand how much dirty and contamination in the environment. Especially, bed rails, button, isolation unit, car-related equipment, room telephone, curtains. Establishing good environmental policies are very important to prevent healthcare-associated infections. ICUs environment is cleaner than GWs in this study.

Session: Hand hygiene

H1 Promoting effective hand hygiene practices through implementing standard guidelines at the healthcare facilities in Bangladesh

Lutfe Ara, Syed Mohammad Niaz Mowla, Shaikh Mahmud Kamal Vashkar

Clinical Governance Unit, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh

Correspondence: Lutfe Ara (lutfeara@icddrb.org)

Background

Contaminated hands are the foremost source of spreading infections in healthcare facilities. Wellness and safety of patients and healthcare workers (HCWs) can be achieved by promoting best practices in infection control through education and advocacy. We aimed to develop effective hand hygiene (HH) practices among HCWs by improving their knowledge, attitude and practices through implementing standard HH guidelines.

Materials and methods

A year-long project was conducted at two hospitals of Bangladesh. This included a baseline survey, intervention by implementing standard HH guidelines through classroom and hands-on training, and a post intervention survey. Pretest-posttest was conducted with preformed questionnaire and observation checklist during pre and post intervention surveys. Total of 600 physicians and nurses were trained on standard HH practices.

Results

At the Institute of Child and Mother Health, rate of HH compliance before patient contact improved from 4% to45.32%(p < 0.0001) among physicians and 2.07% to 60% (p < 0.0001) among nurses. After patient contact, it increased from 4.8% to 50.36% (p < 0.0001) among physicians and 5.93% to 59.51% (p < 0.0001) among nurses. At General Hospital, Sirajgonj, rate of compliance before patient contact increased from 2.25% to 49.18% (p < 0.0001) among physicians and 3.10% to 53.57% (p < 0.0001) among nurses. After patient contact, it increased from 2.25% to 58.20% (p < 0.0001) among physicians and 5.31% to 60.71% (p < 0.0001) among nurses.

Conclusions

The project outcomes signify that implementing standard HH guidelines improves the knowledge, attitude and practices of the HCWs. The results emphasize the necessity of continuous education and advocacy in improving HH compliance to promote excellence in infection prevention and control.

Session: Hand hygiene

H2 The effective hand hygiene promotional measures in hospital: listen to your staff

Wai Fong Chan

The Hong Kong Polytechnic University, North Point, Hong Kong, China

Correspondence: Wai Fong Chan (wfchan@alumni.cuhk.net)

Background

The World Health Organization multi-modal intervention to increase hand hygiene compliance was adopted in a rehabilitation hospital since 2008. However, the effectiveness of the individual measure was unknown. This study was conducted for evaluating the effectiveness of hand hygiene promotion activities used in the hospital.

Materials and methods

A cross-sectional survey was applied in 2012. A 16-item self-administered questionnaire was adopted to collect the opinion on the effectiveness of measures previously used on hand hygiene promotion. Nurses and healthcare assistants working in the inpatient settings of hospital were invited to participate in the survey. Seven-point Likert-type scale from “extremely ineffective” to “extremely effective” was used for ratingindividual items. Rasch measurement was employed for data analysis by Winsteps version 3.92.1.

Results

One hundred and seventy-nine questionnaires were returned contributing 97.2% of the response rate. The categories in the rating scale were collapsed into 4-point scale before further analysis. Thirty-one misfitting persons and three misfitting items were removed after examination in quantitative and qualitative manners. No differential item functioning was found between subgroups. The final scale was considered as unidimensional with reliabilities ranged at 0.95-0.96 and 0.91-0.92for persons and items respectively. “Placing the alcohol-based handrub” was identified as the most effective measure on hand hygiene promotion and “Set up an annual target of hand hygiene compliance” was considered as the least effective.

Conclusions

The survey identified and located the effective measures on hand hygiene promotion. For a more efficient approach, the hospital may prioritize the most effective items in hand hygiene promotion.

Session: Hand hygiene

H3 Effective hand hygiene with individual hand microbial profiles through validating scores of bioluminescene assay with actual microbial load

Mabel Yin ChunYau¹, Karen Kam LingChong², Tze OnLi¹, Rajwinder Kaur ³

¹School of Medical and Health Sciences Tung Wah College, Hong Kong, China; ²Dietetic Department, Matilda International Hospital, Hong Kong, China; ³Nursing Department, Matilda International Hospital, Hong Kong, China

Correspondence: Mabel Yin ChunYau (mabelyau@twc.edu.hk)

Background

Adenosine-Triphosphate (ATP) bioluminescence assay has been popularly adopted in clinical and catering industry due to its ease of use and immediate results. ATP bioluminescence assay picks up cellular discharged ATP, which can also be found on cellular debris or organic components that are not microbial in nature.Its measurement on animate objects can be misleading. This study was developed for the catering crew of a private hospital as a Hand Hygiene (HH) practice monitoring. Microbial viable count was used as a validating reference for the ATP Relative Light Units (RLUs) as a control measure of HH effectiveness. A set of basal microbial values was developed for each staff member. This provided a convenient but reliable protocol for ATP luminometry users.

Materials and methods

Swab sampling was collected from crews’ hand for bacterial culture. Selective media and serological tests were used for pathogen screenings, which included Staphylococcus aureus, coliform and salmonella. Standard curves to demonstrate the correlation between the viable microbial counts and the corresponding RLUs of the ATP measurements were developed.

Results

The study showed the actual viable microbial density of individuals after handwashing did not correlate positively with RLUs. Each individual had his/her own confidence regarding to the limitation of RLUs. However, the HH compliance could be reflected by the viable microbial counts.Individual skin condition played a role in this association.

Conclusions

The measurement instilled a positive effect on the crew. Hand hygiene compliance can be reflected with the bench marking standard technique. Hand hygiene compliance was increased and microbial load was significantly reduced.

Session: Hand hygiene

H4 I pledge on hand hygiene: hand hygiene campaign in Caritas Medical Centre (CMC)

Ng Po Yan (carolpoyan@gmail.com)

Infection Control Team, Caritas Medical Centre, Hospital Authority, Hong Kong, China

Background

Hand hygiene is the single and most effective way to prevent the spread of microorganisms in hospital. When health care workers (HCWs) have own sense and aware of the importance of hand hygiene, it yields twice the result with half the effort in infection control. The study aimed to promulgate hand hygiene is the responsibility of every HCW and maintain hand hygiene as the standard of care in the daily work of HCWs

Materials and methods

On the International Hand Hygiene Day 5th May, a hand hygiene campaign was held in CMC. HCWs were invited to take photo and pledged on hand hygiene compliance. Hand hygiene technique was also taught personally by infection control nurses and return demonstration was needed during the activity. An instant photo was taken when they pledged. These photos were shown on a board during the hand hygiene promotion activity and returned to each colleague as a souvenir afterward.

Results

Hospital managers, frontline doctors and nurses, allied health professionals and supporting staff, total over 100 colleagues in CMC were pledged on hand hygiene on that day. This pledge motivated other colleagues to compile in hand hygiene. The hand hygiene compliance rate in CMC maintained over 90%.

Conclusions

Motivate health care workers to perform hand hygiene by a soft commitment is another way to promote and raise their awareness of hand hygiene.

Session: Hand hygiene

H5 Hand hygiene: dreams come true “clean care is safer care”

Gloria Chor Shan Chiu¹, Christina WY Cheung², Patricia TY Ching¹, Radley HC Ching¹, Conita HS Lam³, CH Kan², Shirley SY Lee¹, CP Chen¹, Regina FY Chan¹, Annie FY Leung¹, Isadora LC Wong¹, S S Lam¹, Queenie WL Chan⁴

¹Hospital Authority, Hong Kong, China; ²Baptist Hospital, Hong Kong, China; ³HKICNA, Hong Kong, China; ⁴HK Sanatorium & Hospital, Hong Kong, China

Correspondence: Gloria Chor Shan Chiu (gloriacatcat2@yahoo.com.hk)

Background

More than hundreds of millions of worldwide people are suffered from infection regardless of acquiring in the Community or Healthcare setting. Most of the infections especially the Healthcare associated Infections (HCAIs) are preventable through adherence to patient care practices. Hand hygiene (HH) is the most effective and easier way to prevent and control the infections in which also being the major component in WHO the First Global Patient Safety Challenge.

Materials and methods

To introduce the “WHO hand hygiene save life campaign” and enhance the awareness of public and healthcare workers for the importance of hand hygiene. Hong Kong Infection Control Nurse Association (HKICNA) has joined actively in the community events such as “World Health Day Carnival” since 2008. In these few years, there were over a thousand public to participate in HH and infection control related educational game booths and talks.

Results

Further to extend the engagement of public and healthcare workers, a poster design competition for promotion of Hand Hygiene was organized in 2012; the winning poster was used as “Talking Wall” in community and healthcare settings and the background of HKICNA’s souvenirs.

In 2014, a creative reminder- hand-held electric fan with visual lit up “Hand Hygiene" was distributed.

In addition, another innovative idea – two HH Dances were designed to continuously promote the HH; they stress that HH practice should start from children to adulthood, from healthcare worker to all in the community. Both of them were used as a tool for promoting in hospitals and schools and assessable in YouTube which was gained thousands of 'Likes'

Conclusions

HKICNA is working hard on introducing hand hygiene concept for infections prevention and control in healthcare settings and community. The concept of "Clean Hand Save Lives" will continue be emphasized.

Session: Hand hygiene

H6 Unforgettable 7 steps & 5 moments” – critique on staff’s technique and accuracy

Cecilia Chan, Rajwinder Kaur

Matilda International Hospital, Hong Kong, China

Correspondence: Cecilia Chan (cecilia@matilda.org)

Background

Hand hygiene (HH) is recognized as the most effective measure to prevent the spread of micro-organisms through hand contact during patient care. Besides yearly mandatory infection control training through On-line Learning Management System, Matilda International Hospital (MIH) also provides relentless training to staff emphasizing the importance of proper hand hygiene and embracing WHO 5 moments. In June 2016, educational booth game – “Unforgettable 5 moments and 7 steps” was held to assess knowledge and techniques of both clinical and non-clinical. This study aimed to evaluate the techniques of staff’s hand hygiene practice, compliance to rubbing time and accuracy in reiterating the 5 moments.

Materials and methods

Observational methods were used to evaluate HH technique and rubbing time. Staff were required to accurately call to remembrance the 5 moments through direct questioning and demonstrate 7 steps of hand hygiene technique with at least 20 seconds of rubbing time. Immediate feedbacks were supplemented.

Results

The overall accuracy of all assessed criteria’s was 90.53%. Majority of HH steps achieved greater than 90% compliance rate except “Between finger” and “Back of finger”. “Before clean aseptic procedure” demonstrated to be the most difficult to recall.

Conclusions

The audit allowed for gaps and in-depth understanding of staff HH practices to be more accurately identified with subsequent staff training strategies to be drawn and implemented.

Session: Hand hygiene

H7 Knowledge and self-reported hand hygiene compliance among nurses in Shiraz, Iran, 2016

Seyed Sadeq Seyed Nematian¹, Charles John Palenik², Mehrdad Askarian¹

¹Shiraz University of Medical Sciences, Shiraz, Iran; ²Indiana University School of Dentistry, Indianapolis, IN, USA

Correspondence: Mehrdad Askarian (askariam@sums.ac.ir)

Background

Alcohol-based hand rubs (ABHRs) are the preferred methods for performing routine hand hygiene (HH) in healthcare facilities. However, soap-and-water hand washing is still popular. This study measured the HH knowledge and self-reported practices of Shiraz Nemazee Hospital nurses.

Materials and methods

This study employed two questionnaires. A six-question survey covered HH knowledge, (19 possible points), while HH practices were monitored in a second survey containing four multi-part self-reporting inquiries (37 possible points) in 2016. Surveys were voluntarily completed at work. Responses were analyzed anonymously.

Results

342 nurses completed the questionnaire.54.4%had formal HH training in the past year.55.6%reported using ABHRs for more than a year. 53.8% preferred traditional soap-and-water hand washing. Eleven nurses never used ABHRs. Nursing experience varied - 15.1% (>ten years), 10.8% (5-10 years), 35.2% (2-5 years) and 28.9% (<2 years). Knowledge scores ranged from 11-15 (high score was17). Self-reported HH compliance scores ranged from 24-31 (high score of 37). A positive, but weak correlation existed between knowledge and self-reported practice scores (r =0.28, p <0.001). No correlation existed between years of experience and knowledge (p =0.85, r = 0.011) or self –reported practice scores (p = 0.86, r = 0.01). Also, no correlation was found between age and self-reported practices (p =0.4, r = - 0.048) and/or knowledge scores (p =0.85, r = -0.011).

Conclusions

HH training needs to be increased for all nurses. Stressing benefits of ABHR use could improve HH compliance and effectiveness.

Session: Hand hygiene

H8 Observing hand hygiene compliance among hospital nurses in southern Iran, 2016

Seyed Sadeq Seyed Nematian¹, Charles John Palenik²,Nahid Hatam¹, Mehrdad Askarian¹

¹Shiraz University of Medical Sciences, Shiraz, Iran; ²Indiana University School of Dentistry, Indianapolis, IN, USA

Correspondence: Nahid Hatam (hatamn@sums.ac.ir)

Background

Hand hygiene (HH) is the most effective way to prevent healthcare-associated infections. Unfortunately, HH compliance worldwide is suboptimal. In this study, we measured HH compliance among Shiraz Nemazee Hospital nurses.

Materials and methods

A WHO method for direct observation of HH was used. We observed staff members (nurses, paramedics and auxiliaries) HH practices. A single trained observer made all determinations. Nurses were not informed of being observed. The study was conducted in 29 hospitals wards involving four major services (intensive care, internal medicine, surgery and pediatrics) during January through June 2016.

Results

1097 observations were made. The overall HH compliance rate was 39.23% with greatest compliance (44.12%) occurring in intensive care wards, while internal disease ward shad the lowest (26.88%) rates. HH compliance in surgical and pediatrics wards was 39.15% and 38.30%.HH compliance between intensive care and internal disease wards was significantly (p < 0.001) different. However, no significant differences were noted between intensive care and surgical wards (p = 0.16) and intensive care and pediatric wards (p = 0.24). Also, there was no statistically significance difference between professional nursing categories (p = 0.66). Alcohol- based hand rubs were used during 81% of HH events. Soap-and-water hand washing was used the remainder of times.

Conclusions

Type of nursing position was not a reliable predictor of higher HH compliance. HH policies in intensive care wards appear more effective than those of other wards. Alcohol-based hand rubs proved to be the preferred HH methods.

Session: Hand hygiene

H9 Scenario-based simulation healthcare education for hand hygiene

Itaru Nakamura¹, Hiroaki Fujita^1,2, Ayaka Tsukimori^1,2,Takehito Kobayashi^1,2, Akihiro Sato¹, Shinji Fukushima¹, Tetsuya Matsumoto²

¹Department of Infection Prevention and Control, Tokyo Medical University Hospital, Tokyo, Japan; ²Department of Microbiology, Tokyo Medical University, Tokyo, Japan

Correspondence: Itaru Nakamura (task300@tokyo-med.ac.jp)

Background

Simulation healthcare education is widely used in medical education and has great potential. However, scenario-based simulation healthcare education for preventing nosocomial infections has not been described. This study aimed to determine the effectiveness of scenario-based simulation education to improve hand hygiene.

Materials and methods

A single-centre, prospective, cohort study was conducted at Tokyo Medical University Hospital (1015 beds), an acute-care teaching hospital, from January 2011 to December 2014. Each infection-control training course (ICTC) was held every month and lasted 2 hours. Trainees put on and removed personal protective equipment under scenarios of standard precaution (two scenarios) and contact precaution with Methicillin-resistant Staphylococcus aureus (one scenario), while considering timing of hand hygiene. We determined the correlations between the participation rate in the simulation education and use of alcohol-based hand disinfection and reduction of catheter-related blood stream infection (CRBSI).

Results

There were 1077 trainees. The total participation rate for hospital staff was 76% by the end of the study. The overall correlation between use of alcohol-based hand disinfection in the hospital and the course participation rate was significant (correlation coefficient, 0.97). An inverse correlation (−0.94) was observed for the relation between the ICTC participation rate and the incidence of CRBSI. With participation in the ICTC, CRBSIs due to Staphylococcus spp. and Enterobacteriaceae were significantly lower than those due to Candida spp.

Conclusions

Our ICTC had a positive effect on hand hygiene and reducing CRBSI. This study is the first effective scenario-based simulation healthcare education to hand hygiene and control of nosocomial infection.

Session: Hand hygiene

H10 Increasing hand hygiene compliance through an evidenced-based strategy

Jose Paulo Flor, Nicolo Andrei Añonuevo, Marko Bautista, Justine Vergara, V James De Roxas, Marion Kwek

Asian Hospital and Medical Center, Muntinlupa, National Capital Region, Philippines

Correspondence: Nicolo Andrei Añonuevo (naanonuevo@asianhospital.com)

Background

The purpose of this study is to increase and sustain hand hygiene compliance through evidence-based approach and to relate compliance with the trend of healthcare associated infections in the hospital.

Materials and methods

The study was conducted over a 1 year period from September 2015 to August 2016. The methods used in monitoring hand hygiene compliance are “Direct Observation” which includes self-reporting and by the use of secret shoppers. Another is “Electronic Monitoring” through the use of Radio Frequency Identification Device. Surveillance of healthcare associated infection (HAI) is conducted in the General Nursing Units, Telemetry and Intensive Care Units. Interventions to increase hand hygiene compliance were implemented such as Training of nurse LINC representatives in monitoring hand hygiene compliance, use of social media (Facebook) in promoting hand hygiene, recognition of individuals and department with high compliance.

Results

After the implementation of interventions, result showed an increase in the hand hygiene compliance from below 50%, during the start of the period monitored, to above 80% during the succeeding months. Comparison of hand hygiene compliance versus healthcare associated infection rates was shown through a graph, this information was cascaded to the different departments during unit meetings. Correlation showed a contrasting trend between Hand hygiene compliance and healthcare associated infection rates.

Conclusions

It was therefore concluded that an increase in the compliance to hand hygiene can decrease the healthcare associated infections among patients. In addition, feedback methods and other evidenced-based interventions can increase hand hygiene compliance.

Session: Hand hygiene

H11 Implementing multiple interventions through the use of an electronic monitoring system in increasing the hand hygiene compliance in medical surgical ICU

Jose Paulo Flor, Marko Bautista, Justine Vergara, V James De Roxas, Nicolo AndreiAñonuevo, Marion Kwek

Asian Hospital and Medical Center, Muntinlupa, National Capital Region, Philippines

Correspondence: Nicolo AndreiAñonuevo (naanonuevo@asianhospital.com)

Background

There is no single solution in addressing poor compliance to hand hygiene. The purpose of this study is to increase the compliance of hand hygiene in the Medical Surgical Intensive Care Unit (MSICU) by the use of multiple interventions and the aid of an electronic monitoring system. The Infection Prevention and Control Unit (IPCU) would also like to correlate the trend of hand hygiene rate with healthcare associated infections in the MSICU.

Materials and methods

The data collected is generated by an automated system through the use of radio frequency badges worn by the healthcare worker and sensors attached to the hand rubs and soap dispensers. Badges provide real time feedback by means of an alarm system. A quasi-experimental design was used to test the effectiveness of the interventions implemented. The utilization of visual boards in providing feedback, converting the door entrance into a giant hand hygiene poster, use of social media, and reward system were included in the interventions.

Results

Total number of opportunities captured is 121,252. Post intervention data showed an increase in the compliance from below 50% to above 80%.

Conclusions

It was therefore concluded that the multiple strategic approach, through the use of electronic monitoring, helped in increasing compliance of healthcare workers to hand hygiene. Moreover, when hand hygiene trend was compared to the healthcare associated infection, a contrasting trend was evident.

Session: Hand hygiene

H12 Hand hygiene compliance audits – is there a role for the ‘link doctor’?

Yeng May Ho, Jia Qi Kum, Bee Fong Poh, Kalisvar Marimuthu, Brenda Ang

Tan Tock Seng Hospital, Singapore, Singapore

Correspondence: Brenda Ang (Brenda_Ang@ttsh.com.sg)

Background

Auditing of Hand Hygiene compliance is usually done by the Infection Control (IC) team. Because it is time consuming and resource intensive, hospitals often rely on ‘link nurses’ to do audits. There are questions as to how these results would correspond to that done by other observers who do not belong to the same unit. As part of a hospital-wide Hand Hygiene program, an initiative to involve young doctors in Hand Hygiene activities was mooted and residents nominated by heads of departments to be hand hygiene auditors.

Materials and methods

These residents (‘link doctors’) were first trained by the Infection Control nurses, following WHO Five Moments, and underwent inter-rater reliability testing. They were tasked with doing audits on Hand Hygiene compliance for their own departments, at times of their choosing. The study period was from February to Sep 2015. The results of their audits were submitted to the Infection Control Unit, and compared with the results done by the IC unit.

Results

While the overall compliance rate when audits were done by the ‘link doctors’ was 76%, it was 46% when done by IC team. The only ‘moment’ where there was no difference in compliance rates between them was ‘after patient contact’.

Conclusions

There was significant difference in hand hygiene compliance rates when audits were done by ‘link doctors’. While there might be concerns about the validity of their results, such exercises could lead to improved understanding, ownership of, and participation in activities to improve hand hygiene.

Session: Hand hygiene

H13 A workshop for training hand hygiene observers and evaluating learning outcomes

Tzu-Yin Liu, Sin-Man Chu, Hui-Zhu Chen, Tun-chieh Chen

Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung,Cianjin District, Taiwan

Correspondence: Tzu-Yin Liu (ned740206@yahoo.com.tw)

Background

To achieve good compliance and correct hand hygiene for healthcare workers in clinical setting, we conducted quality audit by non-fixed observers to prevent the Hawthorne effect.This study aimed to train hand hygiene observers who can educate hand hygiene audit ability and reinforce the concepts of good compliance of correct hand hygiene

Materials and methods

The process included 1.Set up the standard of hand hygiene audit; 2. Hold the lecture for the perception of the importance of hand hygiene; 3. Correct hand hygiene hands-on practice: using fluorescent cream on hands and washing hands with water and soap and then checked hands under fluorescent lamp; 4. Teaching hand hygiene audit in real clinical settings; 5. Hand hygiene Q &A, sharing and discussion.

Results

The workshop trained 23 nurses as hand hygiene observers and all passed the assessment. The average learning outcome evaluation is 86.3%. The average satisfactory rate of the workshop is 98.3% via the 5 domains of the value of learning, applicability, enhancing professional knowledge, the appropriate application of educational materials, the achievement of learning expectation. All trained hand hygiene observers can apply the concepts in clinical settings.

Conclusions

The workshop composed with hands-on practice, teaching in real clinical settings and sharing-discussion instead of one-way lecturing. This multimodal educational program integrated with lecturing, idea sharing, experiments and teach-reply methods to enhance learning outcomes and reinforce the hand hygiene perception. Through the educational program, we transferred the hand hygiene knowledge to modify healthcare workers’ perception and then their quality improvement attitude to cooperate the patient safety strategies in the whole institute.

Session: Hand hygiene

H14 Evaluation direct observation methods to measure compliance with hand hygiene rates in regional hospital

Yichun Chen (clh30004@mail.chimei.org.tw)

Department of Nursing, Chi Mei Medical Center, Liouying, Tainan, Taiwan

Background

Compliance with hand hygiene is the most important concept in preventing infection to patients in health care settings. The World Health Organization (WHO) guidelines on hand hygiene in health care indicate that the direct observation methods to measure compliance with hand hygiene are the gold standard, also the most reliable methods of measurement.The study aimed to explore the compliance with hand hygiene rates in regional hospital.

Materials and methods

Direct observation methods were performed to measure compliance with hand hygiene in physicians, nurses, nurse practitioners and nurse assistants from January 1, 2016 to September 30, 2016 of a regional hospital in Taiwan.

Results

Compliance with hand hygiene rates 87.37% (83/95), physicians 80% (8/10), nurses 92.5% (62/67), nurse practitioners 76.9% (10/13) and nurse assistants 80% (4/5).

Conclusions

Compliance with hand hygiene rates were higher than reported in the literature (CDC). Another problem with direct observation was the Hawthorne effect produced by the observation. When a medical practitioner discovered that he or she was observed, he or she would be conscious of his or her own observation and deliberately changed his or her behavior to increase the frequency of hand hygiene. In the pursuit of the desired positive results, and affect the hand hygiene compliance measurement results. Recommendation to regular change auditor or monitoring type, ex: video recorder, but given these measurement limitations, more valid, practical, and less costly methods are needed.

Session: Hand hygiene

H15 The efficiency of patients and visitors’ education for promoting handwashing and respiratory hygiene compliance in a local community hospital

Ya-Ching Tsao (supersunshine2011@gmail.com)

Infection control office, Longtan Min-Sheng hospital, Longtan, Taoyuan, Taiwan

Background

Hand washing and respiratory hygiene are fundamental in infection control management. They seem a global language in health settings. A majority studies investigate the relationship between hand hygiene and infectious diseases transmission among healthcare staffs. The aim of this survey was to discover the efficiency of hand hygiene and cough manners education model among patients and visitors.

Materials and methods

This study measured by questionnaires with hand hygiene and cough manner observation compliance tools. Duration of data collection was from July, 2015 to August, 2016. 428 patients and visitors of a local community hospital in North Taiwan were submitted their questionnaire.

Results

83.41% participants were over 61 years old (age group: 57.24% 61-64 years old, 26.17%over 65 years old). The finding from cough manner observation revealed that only 33.04% participants allowed cough manners while they have sneezing, coughing or flu symptoms. This had significant difference to the same question of questionnaire (82.24%). The difference also appeared in hand hygiene observation, 59.65% observers performed hand washing in their hand hygiene opportunities which was considerably lower than the questionnaire result (98.83%). These findings investigate the attitudes toward hand washing and respiratory hygiene compliance among patients and visitors. Thus, a patients and visitors’ education model was applied for promoting hand hygiene and cough manners actions.

Conclusions

As the evaluation of education model, the percentage of observers allowed hand washing actions (86.09%) and cough manners (68.87%) after the education were increased. Therefore, the patients and visitors’ education model is efficient in promoting hand washing and respiratory hygiene compliance.

Session: Hand hygiene

H16 The effectiveness of alcohol-based hand rub bottle holder: an assessment with hand hygiene compliance rate and a satisfaction of emergency department personnel.

Sumawadee Skuntaniyom, Kumthorn Malathum, Pirawadee Tipluy

Ramathibodi Hospital, Bangkok, Thailand

Correspondence: Sumawadee Skuntaniyom (su_meaw@hotmail.com)

Background

Hand hygiene (HH) is a known effective measure for the prevention of healthcare-associated infections and spread of antimicrobial resistant organisms. Unfortunately a compliance rate with healthcare workers in emergency department is very low because of rushed working environment. The objective of this study focused on the interventions at the point of care (POC) to improve the compliance, or “system change” according to the WHO hand hygiene strategies, which key aspect was the provision of alcohol based hand rub on a new design bottle holder that optimized the acceptance and usage.

Materials and methods

The first phase was the baseline period set on 3 months baseline (January to March 2015) observation of HH compliance and continue the second phase using the bottle holder (April to June 2015). An anonymous, self-administered questionnaire, had distributed to 126 emergency healthcare workers (HCWs) to assess their behaviors and attitudes toward hand hygiene compliance and their satisfaction.

Results

Overall, 86.5% (109 of 126)of HCWs (36 nurses, 19 physicians) satisfied with the device and 87.3% believed they could improve HH compliance.Overall compliance significantly increased from 19.7% to 59% (P-valve = .045), 0 to 27.3% before patient contact, 11.5% to 57.7% after patient contact, 27.3% to 60.0% before clean/aseptic procedures, 48.1% to 64.0% after body fluid exposure/risk, and 17.1% to 61.9% after touching patient surroundings.

Conclusions

The device successfully provide easy access to the bottle holder, which is critical for its success in improving HH compliance in one of the busiest area in the hospital.

Session: Hand hygiene

H17 Electronic hand hygiene auditing tool in a Thai tertiary care hospital

Sangwan Paengta, Ratchanee wongsaen, Sutthiphun thanomphan, Samettanet Tariyo

Infection Control and Prevention Unit, Nakornping Hospital, ChaingMai, Thailand

Correspondence: Sangwan Paengta (kundaeng11@gmail.com)

Background

Hand Hygiene compliance among hospitalized personnel is a one of safety indicator. In the past, our hospital had used the paper-based system for auditing hand hygiene compliance. The majority of the data entry, collection and analysis were performed manually which was complicated and time-consuming.We aimed to create an electronic Hand Hygiene Auditing Tool to measure hand hygiene compliance.

Materials and methods

The study was conducted in a tertiary-care hospital in Thailand. A development process using five steps of the Program Development Life cycle(PDLC). 1) Requirement gathering and analysis 2.)Design on Google Docs access methods transition.3.)Program testing. 4.) Implementation on mobile phones. 5.) Maintain the program/system. All steps were conducted in a month (April 2016). The Electronic Hand Hygiene Auditing Tool is the result of this study.

Results

Both methods of data collection were compared. The results demonstrated that the duration of the processes decreased from 5 months to 1 month. Questionnaires return rate increased from 86% to 100%.The assessors’ satisfaction rate was 80%.

Conclusions

The Electronic Hand Hygiene Auditing Tool was qualified by reducing the number of hours. Rapid assessment and real time reporting provided valuable information to Infection Control and Prevention team.

Session: Hand hygiene

H18 Effects of using hand hygiene program to knowledge and infection prevention and control practices for multi-drug resistant organisms (MDROs) among nursing personnel and patients with care-givers in Surgical and Orthopedic Department in Nakornping hospital

Buachan Thongchuea, Pattama Khamfu, Sutthiphan Thanomphan

Nakornping Hospital, Chiang Mai, Thailand

Correspondence: Sutthiphan Thanomphan (kaynine@hotmail.co.th)

Background

Hand hygiene is the efficiency and low cost policy to prevent hospital-associated infections (HAIs) with multi-drug resistant organisms (MDROs). The quasi- experimental research aimed to evaluate the effect of the Hand Hygiene Program (HHP) on knowledge and practices in prevention of MDROs. Participants are 27 ICWNS, 140 RNs, 75 nurse aides, and 218 patients and their caregivers.

Material and methods

The study design was before-and after design, conducted during 1 February 2016 to 31 August 2016 in Surgical department and Orthopedics department. Participants were examined by questionnaire regarding knowledge about hand hygiene to assess their knowledge.A structured observation form was used to evaluate hand hygiene practice.The questionnaire in which the content validity was examined by 5 panel experts and the validity index was 0.8.The reliability observer was 1. Data were analyzed by Student’s t-test and descriptive statistics as appropriate.

Results

The study revealed that participants’ knowledge in hand hygiene increased from 75.7% to 89.0% in ICWNs, from 64.5% to 80.4% in nursing personnel, and from 62.3% to 79.4% in patients and care givers for significant ( p <0.001). Hand washing rates increased from 43.0% to 51.1% in moment 1, and from 66.5% to 92.7% in moment 5.

Conclusions

The collaboration of the ICWN network in Surgical and Orthopedics department contribute to the successful in increasing hand hygiene knowledge and behavior motivation. Nevertheless HAIs with MDROs was increased in this study. Other measures such as isolation precautions may be needed.

Session: Hand hygiene

H19 Impact of a multimodal intervention programme on hand hygiene compliance at the paediatric intensive care unit and immunocompromised ward of King Chulalongkorn Memorial hospital, Bangkok, Thailand

Wipaporn Natalie Songtaweesin¹, Suvaporn Anugulruengkit^1,2, Rujipat Samransamruajkit³, Darintr Sosothikul⁴, Ornanong Tansrijitdee⁵, Anry Nakphunsung⁵, Patchareeyawan Srimuan¹, Jirachaya Sophonphan², ThanyaweePuthanakit^1,2

¹Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; ²Research Unit in Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; ³Division of Critical Critical Care, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; ⁴Division of Hematology-Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; ⁵Department of Pediatrics, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

Correspondence: Wipaporn Natalie Songtaweesin (wipaporn@doctors.org.uk)

Background

Good hand hygiene (HH) practices are a simple and cost-effective strategy to limit pathogen transmission between patients. This study explores the effect of a multimodal hand hygiene promotion program on HH compliance amongst healthcare workers.

Materials and methods

A prospective study was conducted at the pediatric intensive care unit (PICU) and pediatric immunocompromised ward at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Interventions performed were: HH promotion videos sent to staff via mobile phone, hand hygiene signs at the bedside, distribution of portable alcohol gel bottles, and HH promotion culture led by senior staff members. All interventions were tailored according to pre-intervention opinion surveys with staff. HH compliance was assessed by direct observation using the WHO 5-moments for hand hygiene (WHO5HH) – before touching patients, before clean/aseptic procedures, after body fluid exposure risk, after touching patients, and after touching patient surroundings. 200 opportunities in total were observed monthly.

Results

In December 2015, pre-intervention, overall HH compliance rates were 50%. Between January and June 2016, post-intervention, overall HH compliance increased to 72%. When divided into the five moments for hand hygiene, hand washing prior to touching patients significantly improved following intervention from 43.8% to 85.1% (p < 0.001) on the immunocompromised ward and from 44.4% to 88.9% (p < 0.001) on the PICU. Hand hygiene after touching patient surroundings remained low. HH compliance was highest amongst nurses.

Conclusions

A multimodal HH promotion campaign tailored towards the local population was effective in increasing HH compliance overall. However, HH after touching patient surroundings remained low post campaign.

Session: Hand hygiene

H20 Implementation of multimodal hand hygiene improvement strategies in government hospitals

Kunyanut Payuk¹, Wilawan Picheansathian², Nongkran Viseskul²

¹Chao Phya Abhaibhubejhr Hospital, Prachinburi, Thailand; ²Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand