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

s from the 8th International Congress of the Asia Pacific Society of Infection Control (APSIC) Bangkok, Thailand. 12-15 February 2017 Published: 22 February 2017 Session: Antimicrobial Resistance AR1 Key stakeholders’ perspectives on the underlying causes of antimicrobial resistance in Thailand Nantanit Sutthiruk, Mari Botti, Julie Considine, Andrea Driscoll, Ana Hutchinson, Kumthorn Malathum Deakin University, Melbourne, Australia; Epworth HealthCare, Deakin University, Melbourne, Australia; Eastern Health, Deakin University, Melbourne, Australia; Austin Health, Deakin University, Melbourne, Australia; Faculty of Medicine, Ramathibodi Hospital, Mahidol University,


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. 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.

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.

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. baumanniiin 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.

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. 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.

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.

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.

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.

Conclusions
The virulence of A. baumannii did not loss with drug resistance. 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.
Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):AS2 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 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. Background Extensively drug-resistant Acinetobacter calcoaceticus-baumannii complex (XDR-ABc) pneumonia is an important cause of healthcareassociated pneumonia. Although tigecycline was not approved for treatment of healthcare-associated pneumonia, it has been used offlabel 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.

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. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):AS8 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 trimethoprimsulfamethoxazole, 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. 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.

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. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):DS1

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 Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):DS2 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. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):DS3 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% chlorhexidinealcohol 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. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):DS4 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 flowmeasures.

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. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):DS5 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%. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):DS6 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 multiparameter 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. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):DS7

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. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):DS8

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.).

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. 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. 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 pointprevalence 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. 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 measlesinfected 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.

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. 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 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.

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.

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 hightouch 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. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):E7

Background
In March 2016, a surge of 34 MRSA acquisitions (30 from screening and 4 from urine cultures) was noted in rehabilitation ward (REHward) 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 overemphasised.

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 multidrugresistant 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 multidrugresistant 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. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):E9

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 nonwoven 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. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):E11

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 multidrugresistant organism Hsuehlan Chao, PinRu ChangChien, WeiFang Chen, ChungHsu Lai E-DA Hospital, Kaohsiung, Taiwan 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.
(2) 50% selected points were over 500RUL both before and after policies at GWs. Only 16.6% selected points were over 250RUL in ICUs.

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. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):H1 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.

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. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):H2

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 selfadministered 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. Sevenpoint 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. Thirtyone 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 alcoholbased 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. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):H3 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. 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.

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 ideatwo 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. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):H6

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. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):H7 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.

Conclusions
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. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):H10 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 evidencedbased interventions can increase hand hygiene compliance. 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. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):H16

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.

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. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):H17

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%. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):H19

Conclusions
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. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):H20

Background
The World Health Organization (WHO) has developed multimodal hand hygiene improvement strategies to support hospitals to improve hand hygiene and thus reduce hospital-acquired infection. The aim of the study was to study the implementation of these multimodal strategies, obstacles, and supports to promote hand hygiene in government hospitals including university hospitals, regional hospitals, and general hospitals.

Materials and methods
The samples were 59 infection control nurses who implement multimodal hand hygiene improvement strategies. The data collection instrument was the Hand Hygiene Self-Assessment Framework questionnaire developed by the WHO. The questionnaire also asked about obstacles and support.

Results
Most of the samples (61.02%) implemented multimodal hand hygiene improvement strategies at an intermediate level, followed by basic and advanced levels (22.03% and 16.95%, respectively). Fifty percent of the university hospitals had an advanced level. Most of the regional hospitals and the general hospitals (57.14% and 67.57% respectively) had an intermediate level. The highest score for implementation was the system change for hand hygiene (median score, 90.00), followed by reminders in the workplace, training and education, evaluation and feedback, and institutional safety climate for hand hygiene (median score, 72.50, 60.00, 60.00 and 50.00, respectively). All samples encountered obstacles and needed support when implementing hand hygiene improvement programs. Personnel were the first obstacle, followed by management, facilitative equipment, and budget, respectively. The greatest need was for environmental and equipment support, followed by support from staff and management support.

Conclusions
The government hospitals should improve implementation of multimodal hand hygiene strategies by addressing obstacles and providing support in order to promote hand hygiene and reduce hospital-acquired infection. Additionally, using E1174, the efficacy of these formulations was compared against seven commercially available ABHRs and WHO recommended formulations containing alcohol from 60% to 90% at a more realistic 2-mL volume application.

Results
The novel ABHR formulations met efficacy requirements for both HCPHW and EN 1500 when tested at volumes typically used in these methods. Moreover, these formulations met HCPHW requirements when tested at 2-mL. In contrast, the commercial ABHRs and World Health Organization formulations failed to meet HCPHW using a 2-mL application. Importantly, product efficacy did not correlate with alcohol concentration and format.
Conclusions ABHR are complex formulations, combining alcohol with various ingredients that can influence the overall antimicrobial efficacy.
Formulation as a whole and is more important than alcohol concentration alone for efficacy. Product format has the same efficacy. When selecting ABHR, ask for the in vivo efficacy results based on standard protocols and the volume of the product used to meet the criteria for HCPHW test. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):HE3

Background
After the earthquake in Kumamoto on April 14th, 2016, Disaster Medical Assistance Team (DMAT) and Japan Medical Association Team (JMAT) immediately supported the shelters and medical facilities in the disaster area. However, the arrivals of DMAT and JMAT to nursing homes were delayed due to lack of information and no transportation by landslides. We started supporting nursing homes as JMAT members 16 days after the quake. This study aimed to report about our infection control intervention in the disaster area.

Materials and methods
We conducted a survey on the occurrences of infectious gastroenteritis and influenza at nursing homes, and interviewed the healthcare workers about problems on infection control. Then, we offered guidance on infection control necessary to each facility.

Results
We visited eleven nursing homes between April 30th and May 2th, 2016 to find two residents with symptoms of influenza and one with symptoms of infectious gastroenteritis. The most frequent questions from the healthcare workers at nursing homes were how to clean and sterilize medical devices, and how to clean their hands appropriately. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):HE8

Background
As Taiwan is situated in the high risk subtropical region, dengue fever has virtually become a seasonal infectious disease. This study aimed to determine risk factors and causes of death in dengue fever.

Materials and methods
Analysis was conducted on the 93 confirmed severe cases of dengue fever or dengue hemorrhagic fever reported to this hospital over the period between July 20 and September 30, 2015 in terms of gender, age, history of chronic diseases, warning signs and diagnostic criteria for severe conditions. Retrospective case study was also conducted to identify risk factors in dengue fever and dengue hemorrhagic fever as well as predictors of death among dengue fever cases for statistical analysis. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):HE9

Background
The importance of influenza is its rapid spreading of the epidemic in a wide range and serious complications, especially bacterial and viral pneumonia. Taiwan medical and public health system experienced huge impacts of such epidemics. Our study integrated epidemiological results to improve the effectiveness of influenza surveillance and assess the effectiveness of health policies for influenza prevention.

Materials and methods
We retrospectively reviewed recorded data of patients admitted in the intensive care unit who were diagnosed as severe influenza with respiratory failure during January 1, 2015 to December 31, 2015. We also recorded their clinical outcomes and history of influenza vaccine administration. We analyzed their prognosis, predictors of death and their possible correlations.

Results
Sensitivity analysis was performed to assess the severity of patients admitted in the ICU. Mechanical ventilation was estimated for epidemiological week of hospitalization. These patients had low proportion of treatment with antiviral medication in the first period of the study.

Conclusions
Influenza deaths were increased. It may contributed from aging of the population, underestimated the needs for better prevention modalities, including more effective vaccines and vaccination programs for elderly persons.  ). Moreover, the length of stay in the hospital of the study group was significantly higher than those in the control group (p < .05).

Conclusions
Controlling and preventing CRE infection in medical ward and surgical ward were important and necessary. Especially among patients who were admitted in the hospital for longer than 4 weeks.  Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):HE13

Session: Hospital Epidemiology& Surveillance
Background Newborn could be seen as patients who are potentially exposed to ventilator associated pneumonia (VAP) at high risk. Identify the incidence as well as risk factors for VAP in newborn would be much necessary for prevention application. This study aimed to identify incidence and risk factors of VAP in NICU at the National Children's Hospital (NCH) in Vietnam.

Materials and methods
This cohort prospective study was conducted between January and December in 2012. After univariate analysis, multivariate regression analysis was used to handle all statistically significant risk factors. and BACTEC FX were used to identify the total blood volume that was obtained.

Results
An average blood volume was 3.80 ml. and the positive rate of blood culture was 10.4%. The emergency room had a lowest mean blood volume (2.20 ml) with a positive blood culture rate of 10.4%. The surgical intensive care unit had a highest mean blood volume (5.70 mL) with a positive blood culture rate 15.6%.

Conclusions
In addition to a number of blood culture set, amount of blood taken for blood culture plays an important role for the positive rate. According to the CLSI M47 blood culture guidelines, the recommended blood volume taken from adult is at least 10 mL per bottle. The recommended blood volume from the blood bottle company is 8-10 ml. Adherence to the CLSI recommendation could improve the positive rate, which would result in reduction of antibiotic overuse, reduction of hospital expenditure as well as improvement of quality of care.

Material and methods
This study was conducted between March and October 2016. A total of 30 stool samples were transferred using 95% EtOH as a transport buffer and were processed by using the chromagar as a selective media. Toxin Screening was performed by using the multiple step EIA kit as. Finally, we used the PCR methods to validate the final result.

Results
Before this process, the culture positive ratio was very low (7%) in our hospital. The CDI ratio is only 69/100,000 patients while the CDI ratio of other Medical in Taiwan is more than 100/100,000 patients. After implementation the new diagnostic scheme, the culture positive ratio increased to 26% and the CDI ratio was higher than before. We also performed the GDH EIA test which revealed the similar results to the culture methods.

Conclusions
Our study confirmed that the GDH EIA may be an alternative option for diagnosis of CDI. Furthermore, use of 95% EtOH as a transport media would improve the CDI ratio. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):M9 Background Chlorhexidine gluconate (CHG) is a cationic bis-biquanide biocide with low mammalian toxicity and broad-spectrum antibacterial activity. Positively charge of CHG molecules bind to negatively charge of phospholipid in bacterial cell wall coursing membrane disruption. Incompatible of anionic thickener in lubricating gel formulation can negate the efficacy benefits of CHG. This study was carried out to investigate the in vitro chemical and biological incompatibilities of marketed lubricating gels with CHG solution.

Materials and methods
Five marketed lubricating gels containing anionic thickener (Carbomer) and two marketed lubricating gels containing nonionic thickener were collected to investigate for in vitro kinetic chemical and biological incompatibilities with 2%w/v CHG in water. The contact time was 15, 30, 45, 60, 90, and 120 seconds.

Results
The results demonstrated that, five marketed lubricating gels containing Carbomer reduced the amount of CHG (32.5 -45.5%), which was measured by reversed-phase HPLC technique and other two marketed lubricating gels containing nonionic thickener maintained the amount of CHG. The antimicrobial activity revealed that 2%w/v CHG solution achieved the 5.69 and 5.45 log 10 reduction for Staphylococcus aureus ATCC25923 and Escherichia coli ATCC25922, respectively. The antimicrobial activity was dramatically reduced to the 1.40 -2.70 log 10 reduction for S. aureus ATCC25923 and 1.02 -2.11 log 10 reduction for E. coli ATCC25922 after 30 seconds mixed with five marketed lubricating gels containing Carbomer. Two marketed containing nonionic thickener maintained the antimicrobial activity of 2%w/v CHG solution.

Conclusions
It can conclude here that, anionic thickeners in lubricating gel formulation may neutralize positively charge and reduce the antibacterial activity of CHG. Mobile phone serves as a major reservoir of pathogenic microbes and may act as major carriers for transmission of pathogens from laboratories. The aim of the study is to determine pathogenic bacterial contamination on mobile phones using by medical technology students in clinical microbiology laboratory practices.

Materials and methods
Bacterial contamination were isolated and identified from overall surface of 50 mobile phones after touching by medical technology students before and during clinical laboratory microbiology practice.

Conclusions
These results indicated that mobile phone can act as a mobile reservoir for laboratory and hospital infection. Therefore, mobile phone using should be prohibited during clinical laboratory practice. In the additional; mobile phone decontamination and hand washing; should be strictly included as essential tools for laboratory safety and infection control. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):NT2

Session: New Technology in Infection Prevention
Background Universal prophylaxis and preemptive therapy are used to prevent cytomegalovirus (CMV) disease after transplantation. However, the optimal strategy has not been identified. This study aimed to evaluate optimal prevention strategies, particularly in high-risk recipients (donor-positive/recipient-negative [D+/R-] CMV serostatus pairs).

We compared CMV infection/disease incidence and patient and graft outcomes in high-risk (D+/R-) and intermediate-risk (D+/R+ or D-/R+) kidney transplant recipients managed by preemptive therapy. Results
We studied 118 recipients (21 high-risk, 97 intermediate-risk; median follow-up >1,100 days). Asymptomatic CMV infection and CMV disease developed significantly more frequently in high-risk than in intermediate-risk patients (38.1% vs. 16.5%, P = 0.04; 28.6% vs. 3.1%, P < 0.01, respectively). A higher peak CMV antigenemia titer (112 vs. 19 cells, P < 0.01) and a longer duration of antigenemia (28 vs. 16 days, P = 0.02) were observed among high-risk patients. Among high-risk patients, all CMV infection and CMV disease cases developed within the first 3 months and 9 months, respectively, after transplantation. Survival analysis showed no significant difference in mortality rates (log-rank P = 0.63) and graft loss rates (log-rank P = 0.50) between the groups. Graft rejection occurred more frequently among high-risk patients, but the difference was not significant (log-rank P = 0.24).
Graft rejection was significantly more common in patients who developed CMV infection/disease than in those who did not (logrank P < 0.0001), regardless of CMV serostatus.

Conclusions
Further studies comparing universal prophylaxis and preemptive therapy, particularly in high-risk patients, are required to identify the optimal strategy to reduce graft rejection rates. Background Japan is a natural disaster-prone archipelago. However few guidelines for public health activities have focused on infectious disease outbreaks during disasters. We have created the risk management guideline for infectious diseases during disasters to develop a comprehensive support system for prevention of infectious disease outbreaks in disasters.

Materials and methods
Interviews were conducted with fifteen nurses who worked in any disasters occurred since the Great Hanshin-Awaji Earthquake in 1995.
The interview data as well as published documents were analyzed. Factors influencing infectious disease outbreaks were extracted as categories by six researchers. Furthermore, measures were extracted while universalizing these measures.

Conclusions
Measures could be visualized as a risk management guideline for infectious diseases outbreaks. This guideline is regarded as useful for preparing future disasters. However, it is necessary to consider that measures vary according to what kind of, where, and when disasters occur as the guideline was extracted from disaster experiences in Japan.

Background
The rapid emergence of resistant bacteria is occurring worldwide. The prevalence of antibiotic resistance among the aforementioned bacteria has been increasing. This study was carried out to develop novel formulation against antibiotic-resistance microbes using for cross-transmission and cross-contamination control.

Materials and methods
The novel formulation was developed using quaternary ammonium compounds as major active ingredient and synergistic with three minor active ingredients. The antimicrobial activity against antibioticresistance microbes, methicillin-resistant S. aureus

Conclusions
It can conclude here that, the novel formulation exhibited the potent antimicrobial activity against antibiotic-resistance microbes and also showed the safety in animal study.

Results
Microbiology laboratory isolated Ralstonia picketti in blood cultures from four patients who underwent hemodialysis on the same day at a same center, similar antibiogram of all these isolates lead to a suspicion of an outbreak. Repeated blood cultures and the jugular venous catheter tip from one of the patient grew the same pathogen leading to the suspicion of this patient as the index case of the outbreak. Routine cleaning, disinfection and sterilization of the water treatment system did not stop further patients from experiencing rigors and infection with the same pathogen. No new patient was identified after the cessation of dialysis reprocessing in the center. This confirms Ralstonia pickettii has infected the dialysis reprocessing system from the index case that was dialyzing via a jugular catheter, and subsequently, infecting other patients in the center.

Conclusions
Ralstonia pickettii can be encountered in dialysis facility through contamination of water treatment and reprocessing system, resulting in outbreaks. Early identification of pathogen is essential to prevent escalation of outbreaks in dialysis centers. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):OI2

Background
Klebsiella pneumoniae are important pathogen in healthcareassociated infections. Therefore, Carbapenem-resistant Klebsiella pneumonia (CRKP) causes infections with high mortality rates, which the ratio of increases in the recent years. This study aimed to investigate the epidemiological characteristics of CRKP in a tertiary hospital in Beijing and seek for control strategy.

Materials and methods
Retrospective survey and temporal-spatial distribution analysis were used to CRKP cases newly diagnosed from Jan to April, 2016 and pulsed-field gel electrophoresis (PFGE) was used to analyze the homology of CRKP isolates.

Results
In the 25 CRKP cases, the median duration of hospitalization within 90 days before detected was 27 days (5-90 days), the duration of using Carbapenems was a median of 12 days (0-43 days), 10 cases had history inpatient of other hospitals before admission. The major sources of specimens with CRKP positive were blood, respiratory tract and urinary tract, with a positive rate of 32%, 32% and 20%, respectively. Homology test was performed in 20 CRKP cases from 11 wards. MLST analysis showed that 19 cases were all ST11 subtype producing KPC-2 enzyme; PFGE results showed that 8 cases were type 1, 10 cases were type 2, with 2 unclassified. Temporal-spatial distribution of type 1 and type 2 cases suggested that there might be contact transmission between cases.

Conclusions
It is necessary to establish regional multidrug-resistant organisms monitoring and tracking network and information should be shared between departments and hospitals during patient referral, which was the key strategy for CRKP prevention and control.

Conclusions
CgMLST, wgMLST and panGenome typing showed ultimate discriminatory power. Concordance between different typing methods were poor at type level, excluding wgMLST-cgMLST. On cluster level, the agreement was better achieving 85% and more. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):OI8 Background Multilocus sequence typing (MLST) as a genotyping methods has been extensively used for study of evolution and population dynamics of S.aureus. The knowledge about genetic distances of genomes within and between MLST types estimated on wgMLST can be useful for understanding the population structure.We explored the variation within and between MLST types of global collection of S.aureus using wgMLST typing. Materials and methods 6645 S.aureus genomes from GenBank were analyzed with SeqSphere + to determine MLST and wgMLST types. Data with more than 10% missing values were excluded from analysis. Genetic distance was calculated with Nei formula (NeiM., 1972) using wgMLST data with 2103 loci.

Conclusions
Analysis of global collection S.aureus isolated from different sources and places demonstrated high genome difference between MLST types differing by 6 alleles. While genetic distances within and between closest STs might be overlapped what makes impossible to find appropriate cut-off for S.aureus clustering using wgMLST data to differentiate MLST with SLV adequately, at least in some cases. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):OI11

Background
In June 2015, three nurses had Flu-like symptoms in our medical, surgical and neurological wards within couple days.

Material and methods
We started outbreak investigation in medical, surgical and neurological wards.

Results
We identified 9 nurses with Influenza A infections. After investigation, we found that compliance of wearing surgical masks while caring patients among healthcare providers is adequate but the compliance of hand hygiene is inadequate. Furthermore, they neglected their Flulike symptoms and did to practice good respiratory hygiene or cough etiquette. Although these healthcare providers are able to follow the infection control standards while taking care a patient, they fail to follow the rule while contacting with staff members. These resulted in outbreak among healthcare providers. The outbreak was successfully controlled by introducing fever surveillance, advocating respiratory hygiene and cough etiquette and reinforcing environmental clearness.

Conclusions
Of these findings, enhanced hand hygiene and associated infection control strategies should be implemented to effectively reduce the transmission of type A influenza. Background This research and development was a cohort study from 2013 to 2015. Firstly, varicella disease had impacts on hospital administration: 1) unable the ward having patient(s) who had varicella infections to admit new patients, 2) infected non-immunized hospital staff. Secondly, the disease interfered normal hospital services: 1) the affected ward was unable to admit new patients for 4 months because it contained the infected patients 2) an affected ward increased amount of new patients in others under limited resources of staff and facilities. In consequences, it increased patients' complains on hospital services. This study aimed to develop a guideline for controlling an outbreak of chickenpox in in-patient department and to evaluate the use of this guideline.

Materials and methods
This study was separated into 3stages: 1) isolating patients having varicella infections, prohibiting admission of new patients in the units and evaluated contact persons by testing for varicella immunoglobulin G (IgG), 2) isolating patients having varicella infections but allowed admission of new patients into the units, evaluated 275 contact persons by testing for varicella IgG and used protective isolation room for patients who were at risk for acquiring the disease and 3)isolating patients having varicella infections, allowed admission of new patients, evaluated 143 contact persons by testing for varicella IgG, used protective isolation room for high-risk patients and vaccinated individuals who had negative results for varicella IgG.

Results
No additional patients having varicella infection were found even though the hospital did not stop accepting new patients.

Conclusions
The study is in progress to create screening criteria to identify patients having varicella infection before hospitalization.

Materials and methods
Infection control personnel had identified this event through routine surveillance, and implemented some infection control measures immediately. The interventions included the following points: (1) cohort care for the infected patients was introduced; (2) daily environmental cleaning with 5000 ppm bleach was implemented; (3) the other patients were followed with active screening for CRKP colonization; (4) environment and healthcare workers were screened for CRKP colonization; (5) healthcare professionals were educated for contact precautions and hand hygiene.

Results
Among 138 swab cultures from RCC environment, CRKP were isolated from a bedside table and a physiological monitor of RCC05 and an infusion pump of RCC15. We collected 12 samples of HCWs' hands and found CRKP from one nurse, who was a key nursing staff of RCC05 patient. Anal swab screening in contact patients showed two of CRKP colonization that contacted withRCC05 and RCC15 patients.

Conclusions
The study showed that poor compliance of hand hygiene among staff and wards' environment contamination was the reasons for this outbreak. The implementation of hand hygiene and ward environment cleaning and disinfection along with other infection control interventions were very important. However, this incident has not yet been ceased. Ongoing monitoring and enforcement of infection control measures are still required. Background Incidence of Clostridium difficile infection (CDI) in Taiwan has not been widely studied, because the yield of culture based diagnostic test was low and the clinical characteristics of CDI had limited studies in the past. However many studies found the incidence of CDI increased in recent years. This study aimed to analysis on patients Clostridium difficile infection to prevent cross infection.

Materials and methods
The following data was retrospectively reviewed; clinical evaluation, operational definition/diagnosis, diagnostic test using rapid molecular detection of toxigenic C. difficile. The medical records was reviewed and collected in case assessment form, which included underlying chronic diseases, past medical history, history of hospitalization, recent operation, past and current medication, particularly antibiotics use, and nutritional status.

Results
One-year incidence in our hospital was 18.1%. Of the patients with CDI, 4 patients underwent chemotherapy, 1 patient had intestinal surgery, 2 patients were on hemodialysis, and 1 patients had diabetes mellitus and long-term use of steroids. All patients were hospitalized within 90 days, and received antibiotics. The medication duration was 1-2 weeks. The hospitalization time was 8-14 days. The mean age of patients was 60 years old.

Conclusions
The development of rapid and reliable diagnostic tools is important to identify CDI. Effective treatment, prevention strategies are needed to control this rising infection. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):OI15

Background
In September 2015, the infection control nurse at a tertiary care hospital, northern Thailand was notified of an influenza-like illness (ILI) outbreak among the health care workers (HCWs) in a medical record department. We conducted an outbreak investigation to determine the etiologic agent, identify additional cases, and implement control measures.

Materials and methods
An outbreak investigation of respiratory infections among HCWs in a medical record department was promptly initiated. HCWs with influenza ILI were enrolled during August -September 2015. Respiratory swabs were collected fromthe HCWs with ILI andwere tested by realtime reverse transcriptase polymerase chain reaction (RT-PCR) for respiratory pathogens.

Results
Mycoplasma pneumoniae is a significant cause of respiratory disease in this outbreak. The infection control team alerted HCWs to the outbreak and recommended prevention measures.

Conclusions
Mycoplasma pneumoniae should be considered as a possible cause of respiratory disease in HCWs in outbreak setting. Morbidity from outbreaks in hospital might be minimized if facilities closely monitor for respiratory disease clusters, promptly report outbreaks to infection control team, prioritize diagnostic testing in outbreak situations, and timely implement strict infection control measures to halt transmission. Background Surgical site infections (SSI) following coronary artery bypass graft (CABG) procedures is a devastating complication with significant morbidity, mortality, and extra-cost. This study aims to describe the incidence of SSI and causative pathogens following CABG surgery in a university hospital during 2013-2015.

Materials and methods
Hospital records and post-discharge surveillance data between 2013 and 2015 were reviewed. SSI was diagnosed according to the US-CDC's surveillance definitions.

Results
There were 682 patients undergone CABG surgery. Of these, 54 (7.92%) had SSI; 23 at sternal sites and 31 at leg harvest sites; 52 classified as superficial SSI and 2 as deep SSI. This prevalence is higher than what have been reported. In this study, proportion of Grampositive and Gram-negative bacteria was 11% each. Of 54 cases with SSI, 3 cases had polymicrobial infection. Gram-positive bacteria included coagulase negative staphylococci 18.2%, Enterococcus spp. 13.6%, and Staphylococcus aureus 9.1%. Gram-negative bacteria were Escherichia coli 13.6%, Klebsiella pneumoniae 4.5%, Enterobacter cloacae 4.5% and Pseudomonas aeruginosa 27.3%. There was no difference in the prevalence of infection among surgeons. One-third of patients received prophylactic antibiotic very closely to operation, (≤30 minutes) and it was discontinued mostly within 48 hours after surgery, while 8.1% of all patients received antibiotic for longer than 48 hours.

Conclusions
Post CABG SSI was high in this study, probably related to inappropriate administration of prophylactic antibiotic. In-depth study is needed to delineate other risk factors which could affect the implementation of preventive strategies. The 4-dose vial (with preservative) of pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (PHiD-CV, GSK Vaccines) was developed to improve logistics of and adherence to immunization programmes. The aim of this study was to assess reactogenicity and safety of the investigational PHiD-CV 4-dose vial presentation in infants.

Results
The total vaccinated cohort comprised 160 infants in each group. The most commonly reported PHiD-CV injection site and general solicited AEs were pain (after 13.1% and 13.4% of doses in 4-dose and 1-dose groups, respectively) and irritability/fussiness (after 23.3% and 26.6% of doses, respectively). The overall/dose incidences of other injection site (redness and swelling; 2.4%-5.9%) and general AEs (drowsiness, loss of appetite and fever [axillary temperature ≥37.5°C]; 10.0%-15.6%) were within similar ranges between groups. Unsolicited AEs were reported after 2.1% and 3.7% of doses, and SAEs were reported for 4 and 9 infants in 4-dose and 1-dose groups, respectively, none was considered as vaccination-related. Two infants died (sepsis, 4-dose; septic shock, 1-dose).

Background
To facilitate multi-dose use, GSK Vaccines developed the pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (PHiD-CV) 4-dose vial, which contains preservative. The aim of this study was to demonstrate non-inferiority of the immunogenicity of investigational PHiD-CV 4-dose versus licensed 1-dose vial presentation in infants.

Conclusions
Immunogenicity of PHiD-CV 4-dose vial (with preservative) was noninferior to 1-dose vial (preservative-free) in terms of antibody GMC ratios for each VT and 19A post-primary vaccination in infants.

Background
Percutaneous injuries resulting from contaminated sharp devices among healthcare workers (HCWs) is a major concern of staff safety in hospitals, with increased risk HIV, hepatitis B and C infections. Percutaneous injuries were at top five risks in our hospital in 2010-2013, with >60% of injuries related to operating theatre (OT). We aimed to study the impact of a multi-interventional strategy on incidence of percutaneous injuries at a non-profit private care hospital in Hong Kong.

Materials and methods
Canossa Hospital (Caritas) is a 148-bed non-profit private care hospital treating approximately 10,000 patients yearly with 400 HCWs. Between 9-10 incidents of percutaneous injury occurred annually in 2010-2013. From 2013, a multi-interventional strategy was introduced to reduce incidence of percutaneous injuries, including: identifying risks of bloodborne infections exposure, formulation of ward policy guidelines, staff education and training to create safe workplace environment, enhancement of reporting system, individual counseling by infection control nurse, provision of safety-engineered sharps devices (e.g. needle counter in OTs), verbal-visual reminder (meetings, posters). Compliance audits were performed in OTs after implementation.

Results
Number of percutaneous injuries declined from between 9-10 incidents in 2010-2013 to 5 and 3 incidents in 2014 and 2015 respectively. The proportion of injured staff showed an initial decrease of 50% (p = 0.1, chi-square test) in 2014 and then significant reduction of 70% (p < 0.05) in 2015.

Conclusions
We achieved reduction in percutaneous injuries using multiinterventional strategy. Implementation of guideline formulation, education, individual counselling after incident, verbal-visual reminders, safety devices and performance audits led to an improvement in hospital staff safety. Surgical Ward (30 cases). During this study period, 19.6% cases occurred sharp injury in relation to blood taking procedure (n = 61). Waste collection is the second commonest situation for sharp injury at 13.8% of reports (n = 43) and 35 cases reported during disposing sharps into sharp bins (11.2%). Doctors reported the highest incident with 126 cases (40.4%) while nurses reported 62 cases (19.9%) and various groups of HCWs constitutes the remaining 39.7%.

Conclusions
All HCWs are at risk of sharp injury however certain groups are at higher risk. The rate of sharp injury is persistently high despite the ongoing education program for HCWs in our institution. Background Influenza can be a serious disease, since health care workers may care for or live with people at high risk for influenza-related complications. This study aimed to increase staff vaccination rates in 2015 and to know whether the additional cost is serving its worth, which shows the incremental cost -benefit ratio of increasing vaccine coverage.

Materials and methods
In 2015, the team conducted unit by unit information campaigns through floor to floor dissemination of information about free vaccination in the Employee Health Clinic, and lastly "I am Asian" jackets were provided to staff who underwent the vaccination.

Results
In

Materials and methods
From 2015 to 2016, the Infection Prevention and Control Office conducted an outbreak investigation on the cases of VZV among healthcare workers. This involved contact tracing and review of medical history of the healthcare workers. A survey on the immunization history of all healthcare workers (HCW) was done. Outbreak control was also recommended through vaccination of all exposed that have no active immunity on the virus. The calculated cost of the treatment for HCWs was done.

Results
Result of the investigation revealed that 18% of the cases are cross transmission from one healthcare worker to his other co-workers.
Most of the healthcare workers who are on the prodromal stage of the virus still reported to work. The cost of the treatment per personnel who have VZV was calculated at 23,400 PHP (479 USD) while the cost of the VZV is at 4,000 PHP (83 USD). Among all HCWs 68% have no active immunity to VZV while 60% have no vaccination to VZV.

Conclusions
There is a need to strengthen VZV information campaign among HCW. Mandatory immunization of all susceptible staff to VZV must be recommended and barriers to vaccination uptake among HCWs must be studied. Reiteration of the sick leave policy must be emphasized.

Session: Occupational Health/Vaccine
O7 Nursing experience with one postoperative oral cancer patient using transdisciplinary care model Ching-I Ting (alice3030301@yahoo.com.tw) Chi-mei medical center intensive care unit, Tainan, Taiwan Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):O7

Background
Oral cancer patients are susceptible to postoperative structural defects of tissues such as in the orofacial region and jaw bones, which cause changes in the facial appearance, defects of physical functions such as dysphagia, slurred speech and eating difficulties and consequent negative impacts on quality of life. Each of these patients, therefore, represents a highly complicated case with multiple problems and requires collaboration between a wider range of specialty departments on case discussion and provision of care to reduce their postoperative complications and improve their quality of life.

Materials and methods
The healthcare provided to the patient and the family through the transdisciplinary care model included: (1) alleviation of wound pain for the patient; (2) planning of training sessions for rehab from dysphagia; and (3) continuing coaching for the patient's mother on caregiving for the patients at home.

Results
This paper, based on the reason for and the definition of transdisciplinary care, presents for the reference of clinical practitioners leaders of medical institutions a specifically addressed strategy of evidence-based transdisciplinary practice, integrating the care plans suggested by all the teams and providing healthcare and rehab plan that reduced and improved the patient's wound pain and dysphasia.

Conclusions
The evidence-based clinical practice of transdisciplinary care is a key trend of care in medical environments. Using transdisciplinary evidence-based care as the foundation helps healthcare professionals across disciplines to understand and respect the spirit of collaborative care and obtain best treatment strategies through communications, thereby providing good quality of care. The introduction of ASEAN Economic Community (AEC) and Thai government's policy in creating an international center for medical treatment, there has been a significant increase in number of patients travelling into Thailand for treatments. Patients are travelling on commercial aircrafts as well as air ambulance when their conditions are urgent or critical. Air ambulance is a well-recognized method of transportation by the insurance company which Medical Wings has been serving patient from around the world since 1999. At Medical Wings, we focus on Safety, quality care and infection control. On occasion, we receive patient from facility which is not able to adequately assess infectious disease so our medical team are the first group to meet patient and preparation is the utmost important in a successful mission. We aimed to prevent the exposure of patients, visitors and healthcare workers to communicable or infectious diseases by stressing maintenance of sound habits in personal hygiene and individual responsibility in infection control, monitoring and investigating potentially harmful infectious exposures, providing care to personnel for work-related illnesses, identifying infection risks related to employment and instituting appropriate preventive measures.

Materials and methods
This study was performed between October 1st, 2015 and March 31st, 2016. The IMU had 20 beds, 2 were single-bed isolation room but the remaining was in a common hallway divided into three 6-bed sections. Space between each bed was only 90 cm. A total of 396 patients were observed. After the first three months to determine the baseline prevalence, we implemented the control measures including cohorting patients with XDR-Ab in the same area, encouraging hand hygiene by providing alcohol hand rub solution at each bed and common areas in the ward, mandatory isolation gown and gloves for caring of patient with XDR-Ab, improving environmental cleaning technique and frequency.

Results
The prevalence of XDR-Ab was gradually decreased, from 16.47 episodes /1,000 patient-days in the first phase to 3.98 episodes /1,000 patient-days in the second phase.

Conclusions
This study suggests that cohorting along with stringent infection prevention technique was effective in controlling spread of drugresistant organisms and it might be an option for the crowded patient care areas. Descriptive statistics were used to analyze the data.

Results
The adherence rate to gloving was highest, followed by gowning and hand hygiene (81%, 56% and 51% respectively). Hand hygiene was performed more after than before giving care to patients. Although they wore gowns and gloves before patient care, HCWs immediately removed gown and gloves infrequently afterward. Forty percent of the HCWs adhered to the guidelines in every step, whereas 14% did not adhere at all. Nurses adhered most to the guidelines (72%). HCWs agreed with the guidelines but were unable to adhere to the guidelines at every step because of the crowded environment and perceived work overload.
Results of this study suggested that adherence to the guidelines for contact precautions needs more cooperation among HCWs and barriers to the adherence should be minimized to prevent widespread multi-drug resistant organisms, and thereby improving the quality of care.

Conclusions
The gloves compliance rate was highest than gown and hand hygiene.
Overall compliance rate 40%. The study finding needs to be concerned by healthcare workers for improving the quality of care.

Materials and methods
The methods of study were used Development and Empowerment Program (DEP), which followed role and competency of Advanced Practice Nurse (APN). Data were gathered from medical and surgical departments from 1 January to 30 September 2015. There were 3 purposive selected groups: 1) Case Manager Team, 2) Medical and Surgical Nursing Teams and 3) XDR infected cases. The research tools were: 1) DEP, 2) Data questionnaires, 3) The XDR IC practice observational forms and 4) The evaluation quality of XDR cases forms. Data were analyzed using descriptive statistics and t-test.

Results
The results of study suggested that a model for nursing care should consisted of 3 components: 1) providing XDR infection control activities in process of care, 2) developed and empowered case managers in role and competency of APN and 3) feedback outcomes of caring and supporting system. After using DEP, the XDR infection rate significantly decreased from 4.1 to 1.6 per 100 patient-days (p < 0.05).

Conclusions
This study showed that using DEP in case managers and nurses promoted participants learning in teams. The DEP also aligned XDR caring processes with IC standard practices that resulted in decreased XDR infection rate in hospital efficiency. Background Transmission of multidrug-resistant organisms in hospitals has a direct impact on patients, health care personnel, the hospital, community, and the nation. This developmental research aimed to develop a clinical pathway for prevention and control of multidrug-resistant organism transmission in the medical department at a regional hospital.

Materials and methods
Study samples included 131 health care personnel who worked in the medical department and related including: hemodialysis, echocardiogram, radiology and ultrasound, CT scan, MRI, and stretcher. Ten patients infected or suspected of multidrug-resistant organism infection at the medical department were included in the test. The process for developing was based on Cheah's (2000) framework.
Three development steps were thus included: assessment and situation analysis, designing, and testing the implementation. The data collection instruments consisted of a demographic data record form and questionnaire assessing the opinions of health care personnel towards. The content validity of the questionnaire was examined by 5 experts and the content validity index was 0.90. Data were analyzed using descriptive statistics and data categorization.

Results
The

Conclusions
We demonstrated that our education-based intervention program was effective to reduce the rate of LCBI 2 among CLBSI. This is primarily due to the lowering the risk of contamination of common commensal in the blood specimen. Improved CAUTI data collection methods IDC reminder system Nurse-led protocol to empower nurses to remove catheters in simple cases Using S hook to keep urine bag below bladder level during ambulation Daily maintenance audit of IDC care Frontline staffs were regularly engaged and feedback gathered.
The changes were modified, tested and improved after (Plan-Do-Study-Act) PDSA cycles.

Results
Preliminary results in the pilot wing showed a reduction in CAUTI rate although it is still early to tell if results are sustainable. Results on compliance to IDC care have also been encouraging.

Conclusions
We plan to test and spread the changes to other wards to reduce CAUTI rate in the hospital. Getting feedback and buy-in from the ground helps in designing sustainable changes. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):P10 Background Ventilator-associated pneumonia (VAP) with VAP bundles, should result in dramatic reductions in the incidence of VAP. Compliance with the VAP bundle has been most successful when all elements are executed together as a \"all or none\" strategy. VAP increases patient mortality, hospital stay and medical expenses. According to the latest VAP criteria of the American Disease Control Agency, there are many difficulties and blind spots in the diagnosis of VAP, and the low rate of VAP in this hospital is expected to be improved by the study of VAP low reporting rate.

Materials and methods
The study of the hospital VAP low reporting rate of the underlying causes: First, the clinical symptoms and chest X-ray interpretation of the lack of uniform standards, lack of education and training and advocacy. Second, the existing receiving process can not immediately grasp the patient condition. Third, to strengthen the quality of X-ray film and rules to track. The team developed the criteria and reporting process for the diagnosis of high-risk VAP patients by the Centers for Disease Control, in order to facilitate VAP bundle in the care of patients with high-risk VAP infection.

Results
The rate of VAP in our hospital increased from 1‰ to 2‰, but it was significantly lower than that of foreign VAP.

Conclusions
Difficulty in diagnosing patients and blind spots in VAP are also a major limitation for clinicians. Of VAPs have a low reporting rate. Therefore, the proposed medical institutions to standardize the hospital medical behavior and infection control measures to cohesion team consensus.

Materials and methods
The CVC bundle was implemented on all patients admitted to the ICU starting April 2013. Data of CRBSI rates from 2012 and 2015 were pooled to compare the differences between observed values and predicted values before and after the intervention. CVC bundle care was implemented since April 2016.

Results
Our study showed that the central catheter bloodstream infection rate was 1.4‰ (P = .039), the ventilator-associated pneumonia (VAP) infection rate was 2.0‰ (P = .72), the catheter associated urinary tract (CA-UTI) infection rate was 2.35‰ (P = .78), and the ICU infection rate was 5.10‰ (P = .025). The overall central catheter utilization rate was 58.88% (P = .086); the mean length of ICU (intensive care unit) stay was 15.72 days, and the average length of a hospital stay was 43.57 days.

Conclusions
The time sequence analysis model was adopted to analyze the catheter-related bloodstream infection rate in 2013. Although it did not decrease, but only slowed down the trend of increase the CRBSI incidence. To effectively reduce the catheter-related bloodstream infection rate is to persistently support the combination of CVC bundle care and to enhance the compliance of the policy.

Session: Prevention of Site Specific Infections P16
The clinical benefit of chlorhexidine gel in severe units was

Results
The use of chlorexidine gel containing chlorhexidine mouthwash compared with the use of oral disinfection can be reduced by about 42,250 yuan. Nursing care hours, about 78.5 hours per month can be reduced. The density of VAP was maintained at 0.64‰.

Conclusions
The use of chlorhexidine gel for mouth disinfection 54% less than the cost of mouthwash and save 33% of the time, not only reduce the cost of medical expenses also save the number of clinical nursing work, effectively improve the medical quality.

Session: Prevention of Site Specific Infections P17
To investigate the feasibility and compliance of the male catheterization in clinical practice Yan-Ru Chen, Yu-Hsiu Lin Chi Mei Medical Center,Liouying, Tainan, Taiwan Correspondence: Yan-Ru Chen (c89040507@yahoo.com.tw) Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):P17 Background Urinary tract infections (UTIs) are one of the most common sites of health care-associated infection, accounting for about 40%, of which about 70% are related to the use of catheters. In our subacute respiratory care unit, 62% of the CAUTI cases were men, whereas those who performed the technique clinically were nurse practitioner, through clinical monitoring and found that nurse practitioner to implement this technology compliance rate of only 25%. The aim of this study was to assess the feasibility and compliance of catheterization among male patients with competition and questionnaires.

Materials and methods
The standard operating procedures of "Male Catheterization" were developed and practiced in clinical practice by means of practical operation and questionnaires. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):P19

Background
Nebulizers are widely used in clinical for treating the disease of respiratory tract, which can aerosolize medicine to 0.5-10 μm to reaching the lower respiratory tract, so as to induce expectorant action or treat the inflammatory of respiratory tract. However, nebulizers can be contaminated by the exogenous route owing to improper care, so that increase risks of oral colonization or respiratory tract infection.
The previous study showed that suggestion about the frequency of replacing nebulizers and nebulizers practices were vary variable and inconsistent. The aim of this study was to evaluate the effect of replacing nebulizers (at 24, 48 or 72 hours) in contamination.

Material and methods
A randomized controlled trial study is conducted from July 9, 2014 to February 2, 2015 in a surgical ward of a medical center in Taipei. During the study period, include above 20 years old people with steam in halation treatment. After participants agree to join the trail, randomise cases into 24, 48 or 72-hour group. In the protocol, researcher collect culture of nebulizers after used.

Results
Total 525 specimens of nebulizes are collected. The rate of contaminated nebulizers at 24 hours is 14.1%, which is significantly higher (p = 0.008) in 48 hours (24.3%) and 72-hour group (25.6%). Multivariate statistical analysis show that steam inhalation increase by one day with the contaminated risk of nebulizers increased by 12% (95% Confidence interval: 1.03-1.21, p = 0.003).

Conclusions
The replacing nebulizers more than two days will increase contaminated rates significantly. Therefore, health care workers should understand and comply with guidelines of steam inhalation clinical care to reduce the contaminated risk of nebulizer.

Session: Prevention of Site Specific Infections P20
Educational programs increase the compliance of bundle care: experience in a regional hospital in Taiwan  Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):P20

Background
Taipei Veterans General Hospital Yuanshan Branch is a 471 bed regional hospital that provides single veterans acute and chronic care. There is a team of care providers helping the nursing staff manage patient's daily care. Urinary tract infections (UTIs) are common hospital-acquired infections accounting for 15% of HAIs. Recent studies and guidelines suggested that multidisciplinary care bundle could effectively reduce the incidence of catheter-related urinary tract infections (CAUTIs). The aim of this study was to evaluate the impact of educational programs for care providers on compliance of CAUTIs bundles.

Materials and methods
The intervention study was conducted over a period of 3 years, between 2012 and 2015. During a pre-intervention phase, parameters of compliance including the correct rate of had hygiene and correct rate of aseptic techniques were collected and compared with those during the post-intervention phase. The educational programs included (1) posters reminders on the walls of bedside, (2) aseptic urine sampling and cleaning technique, (3) correct draining bag positioning, (4) frequent tests and feedbacks to supervisors, (5) hand hygiene.

Results
During the study period,a total of 21 care providers received the training programs. The pre-intervention phase was between 2012 and 2014, the post-intervention phase was 2015. The correct rate of hand hygiene increased from 72.7% to 95.2%; the correct rate of aseptic techniques increased from 54.5% to 92.8%.

Conclusions
Our investigation showed that implementing educational programs for care providers increased the compliance of bundle care of CAU-TIs. However, whether the improvement reduced the incidence of CAUTIs needed further investigations.

Session: Prevention of Site Specific Infections P21
Impact of implementing VAP bundle: experience in a veteran's regional hospital in Taiwan  Tzu  Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):P21

Background
Experience in a veteran's regional hospital is a 471 bed (in intensive care unit is a 10 bed), many critically ill patients need to rely on ventilator for survived. Although preventable, ventilator-associated pneumonia (VAP) is a main cause of death due to healthcare-related infection in the intensive care unit (ICU). Recent studies and guidelines suggested that multidisciplinary care bundle could effectively reduce the incidence of catheter-related infections. The aim of this study was to assess implementation of VAP bundle, can be effective in preventing ventilator-associated pneumonia occurred. Materials and methods VAP bundle care was implemented in a medical ICU of our hospital from March 2015 to March 2016. The contents of VAP bundle checklist including daily (1) readiness-to-wean assessment daily, (2) diary "sedation vacation", (3) hand hygiene, (4) oral care every 12 hours, (5) head-of-bed elevation above 30 degrees. Education, training, and regular feedback from external auditing units can encourage the clinical care team to improve implementation rates.

Results
The results showed a daily goal checklist implementation rate increase from 38% to 100%. The ventilator bundle compliance rate, assessed by external audit, increased from 62% to 98%. The ventilator usage rate decreased 8.1% after implanted VAP bundle. The implementation of the VAP bundle during 1 year. A record of 12-month period of zero VAP case from March 2015 to March 2016 had achieved.

Conclusions
Our experience has shown that the implementation of VAP bundle, can be effective in prevention ventilator-associated pneumonia occurred. In addition, staff education and regular feedback from external audit data can improve implementation rates. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):P22 Background Ventilator-associated pneumonia (VAP) is a major healthcareassociated infection worldwide. The incidence of VAP in our hospital was around 3 episodes/1000 ventilator-days for many years. This study aimed to reduce VAP rates among patients in ICUs.

Materials and methods
This prospective study was done among mechanically ventilated adult patients in every ICU between January 1st, 2014 and December 31st, 2015. A total of 40,601 ventilation days were observed. A 5element care bundle including daily assessment of readiness for ventilator weaning, hand hygiene, aspiration precautions, prevention of contamination and oral care using 0.12% chlorhexidine mouthwash were introduced to all ICU. Infection control nurses regularly visited and supervised the practice and periodic meeting among ICU nurses were arranged. The adherence was monitored.

Results
The incidence of VAP was gradually decreased, from 3.1 in 2013, to 2.8 and 2.5 per 1,000 ventilator-days in 2014 and 2015, respectively. The adherence rate to hand hygiene before tracheal suctioning was 44.7% at the beginning and 66.3% during the last period of the study while adherence to other measures were 93.4% throughout.

Conclusions
This study suggests that participation and experience sharing among nurses, regular monitoring, and supervision significantly contributed to the reduction of VAP.

Material and methods
Surveillance of data for post-craniotomy infection were retrieved from Infection Control Unit of Songklanagarind Hospital. Which surveillance system use the former National Nosocomial Infections Surveillance System (NNIS) risk index for SSI risk adjustment. The data included 2437 patients underwent 3250 brain surgeries in the hospital from September 2004 to June 2016. Medical records were reviewed for additional information including emergency operation, traumatic brain injury, brain cancer, and duration of steroid administration. The predictive performance of the former NNIS risk index, new NHSN model, and our proposed model was then compared by mean of area under receiver operating curve (AUC).

Results
The study identified 157 operations with post craniotomy SSI while the former and new model predicted 64.3 and 174.9 SSIs respectively. AUC of the new model (56.3%; 95%C.I = 52.1-60.4) was significantly (P-value = 0.02) less than the former one (50.7%; 95%C.I = 46.2-55.2). We analyzed the data and construct a model which included brain cancer, duration of operation more than 3 hours, and contaminated or dirty/infected wound class. AUC of our model was 59.8% (95%C.I = 55.7-63.8).

Conclusions
The new CDC NHSN model is poor for risk stratification postcraniotomy SSI and may be improved by adding brain cancer variable into the model. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):P24 Background Catheter-associated urinary tract infections (CAUTIs) are a common infection among elderly in long-term care facilities (LTCFs). Nursing personnel play an important role in prevention of CAUTIs. This study aimed to examine the effects of coaching on nurses' knowledge and practice regarding CAUTIs prevention in elderly in LTCFs.

Materials and methods
A quasi-experimental study was performed during October 2014 to January 2015. The participants were 16 nursing personnel working in LTCFs. All samples attended the four steps of coaching intervention including 1) preparation; 2) discussion; 3) active coaching; and 4) follow-up. The research tools consisted of a demographic data questionnaire, a knowledge test, an observation form, a coaching plan, and a manual for prevention of CAUTIs. Data were analyzed using descriptive statistics, paired t-test, and Chi-square test.

Results
All of participants were female. The mean age was 31.9 years old, and the mean working experience was 8.7 years. Most participants had no experience in training of CAUTI prevention in elderly patients (87.5%). After coaching, average knowledge scores on prevention of CAUTI among nursing personnel increased significantly from 13.3 points to 19.6 points (p < .001) and the proportion of correct practices on prevention of CAUTIs in nursing personnel was statistically higher than the pre-coaching rising from 74.3% to 98.0% (p-value < 0.001).

Conclusions
The findings of this study suggest that coaching could enhance knowledge and practice skills in prevention of CAUTIs among nursing personnel in the LTCFs. Application of coaching may improve knowledge and practices in prevention of CAUTIs among nursing personnel in other LTCFs.

Background
Microbiome-directed therapies are increasingly used preoperatively and postoperatively to improve postoperative outcomes. Recently, the effectiveness of probiotics, prebiotics, and synbiotics in reducing postoperative complications (POCs) has been questioned. This systematic review aimed to examine and rank the effectiveness of these therapies on POCs in adult surgical patients.

Methods and methods
We searched for articles from PubMed, Embase, Cochrane, Web of Science, Scopus, and CINAHL plus. From 2002 to 2015, thirty-one articles meeting the inclusion criteria were identified in the literature. Risk of bias and heterogeneity were assessed. Network meta-analyses (NMA) were performed using random-effects modelling to obtain estimates for study outcomes. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated. We then ranked the comparative effects of all regimens with the surface under the cumulative ranking (SUCRA) probabilities.

Conclusions
This systematic review suggests that synbiotic therapy is the best regimen to reduce SSI, pneumonia, sepsis, hospital stay, and antibiotic use. Surgeons should consider the use of synbiotics as an adjunctive therapy to prevent POCs among adult surgical patients. Increasing use of synbiotics may help to reduce the use of antibiotics and multidrug resistance. Antimicrobial Resistance and Infection Control 2017, 6(Suppl 2):P26

Background
The incidence of catheter-associated urinary tract infection (CAUTI) is a major healthcare-associated infection in Ramathibodi Hospital. The incidence was more than 10 episodes/1000 urinary catheter-day for many years. We studied the effect of the intervention programs to reduce the incidence of catheter-associated urinary tract infection.

Materials and methods
A quasi-experimental research was conducted in the surgical intensive care and medical step-down units. The baseline and intervention period was from January to June 2012; and from September 2012 to May 2013, respectively. The CAUTI bundle according to the CDC's guidelines recommendation was employed.

Results
We found non-significant reduction in the rates of CAUTI (15.83 versus 13.12 episodes/1000 urinary catheter-day) and urinary catheter utilization ratio (0.76 versus 0.67). Removal of catheter was not successful in patients with urinary retention, which were major population in our study. Multiple logistic regression revealed that duration of hospitalization >10 days (OR 2.84, 95% CI = 1.35-5.97), duration of indwelling catheter >7 days (OR 6.03, 95% CI = 2.85-12.75), and female gender (OR 1.97, 95% CI = 1.12-3.49) were associated with a higher incidence of CAUTI in the medical step-down unit, while >8 days of hospitalization was associated with CAUTI (OR 7.42,95% CI = 1.39-39.64) in the surgical intensive care unit. The most common organisms identified in both units were fungus and E. coli.

Conclusions
Prolonged catheterization is associated with higher incidence of CAUTI and early removal of catheter may not be achievable in certain group of patients. Further study is needed to determine the optimum care of patients who need indwelling catheters. Background Surgical site infection (SSI) is the most common hospital acquired infection at obstetrics and gynecology hospital. SSI prolonged hospital stay and increased treatment costs. We aimed to identify incidence and causative organism of surgical site infection among cesarean section and gynecology surgery cases. Materials and methods A prospective cohort study was conducted at Hung Vuong Hospital, Viet Nam from January 2015 to May 2016. Women who underwent caesarean and gynecological surgery were included in the study. CDC criteria (2009) were used to diagnose SSI. Results 29,681 women underwent caesarean and gynecological surgery. SSI rate was 1.1% (95% CI: 0.98 -1.22%), in which 0.96% SSI after caesarean section (95% CI: 0.84 -1.08%) and 1.7% SSI after gynecological surgery (6.26% SSI after hysterectomy with 95% CI: 4.91 -7.79%). Average number of treatment days that with SSI is 9 ± 4.5 days. Staphylococcus aureus and coagulase-negative staphylococci were the most common organism caused SSI after caesarean section (50%) and Escherichia coli was the main organism for SSI after gynecology operation (66.7%).

Conclusions
The incidence of SSIs was limited because we only follow patients with SSIs who were treated in hospital. The incidence of SSIs after hysterectomy surgery was higher than other types of gynecologic surgery. It's necessary to promote infection control to reduce SSI in hysterectomy surgery.