DELITOS EXCLUIDOS DE LA GRACIA RECUENTO HISTÓRICO.

P135

Healthcare-associated bloodstream infections in Finland–adjusted ranking of hospitals by staphylococcus aureus rates and effect of infection control resources and practices on rankings

Emmi Sarvikivi, Jukka Ollgren, Tommi Kärki, Outi Lyytikäinen NATIONAL INSTITUTE FOR HEALTH AND WELFARE, Helsinki, Finland

Correspondence:Emmi Sarvikivi

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P135

Introduction: Healthcare-associated bloodstream infections (BSI), especially those caused byStaphylococcus aureus(SA-BSI) are often preventable. Rate of SA-BSI has been used as an indicator for hospital performance in infection control (IC).

Objectives:Our aim was to analyze the Finnish surveillance data in order to assess hospital rankings according to crude and adjusted rates of SA-BSI, and to investigate if IC resources and practices in the hospitals were reflected in the rankings.

Methods: 20 Finnish hospitals conducted prospective incidence surveillance for healthcare-associated BSIs in 1999-2015. A com- mon protocol for laboratory-based case finding was used, and only BSIs with onset >48 h after admission were included. Patient-days with specialties were obtained from hospitals’ data- bases to calculate incidence densities (ID) with 95% confidence intervals (CI). The hospitals’crude IDs and IDs adjusted by special- ties in mixed effect's negative binomial regression model were calculated; rankings of hospitals were assessed by standardized morbidity ratio (SMR) rank method. The effects in the model were considered to be constant over selected time period. Re- sults of a national survey on IC resources and practices in each hospital were also evaluated in the model. Analyses were per- formed by Stata 14.2 and WinBUGS 1.4.3.

Results: We identified 13942 BSIs, including 1966 SA-BSIs. For SA- BSIs, IDs varied between hospitals from 0 to 0.12 per 1000 patient- days. There were clear differences in crude and adjusted ranking positions of hospitals, but CIs were wide and mostly overlapped. Of the specialties, surgery seemed to increase risk for SA-BSIs (p = 0.02). The IC survey was completed by 17 hospitals. In the model, number of blood cultures per 1000 patient-days, and catheter-related proce- dures (e.g., guidelines, check-lists) remained significant (p = 0.013 and p = 0.015, respectively). If the hospital had implemented several of catheter-related procedures, the protective effect seemed to strengthen.

Conclusion:Adjusting by specialties may be needed when ranking SA-BSI rates. However, the rankings must be interpreted with caution.

Standardized procedures regarding catheters appeared to be benefi- cial in prevention of SA-BSIs.

Disclosure of Interest

None Declared

P136

Bacteriemia diagnosed in a infectious diseases clinic in Dakar

Ndeye Aïssatou Lakhe1,2_{, Khardiata Diallo Mbaye}3_{, Viviane M P Cisse Diallo}4_,

Daye Ka4, Louise Fortes Deguenonvo4, Cheikh Tidiane Ndour4, Moussa Seydi4

1

Service des Maladies Infectieuses, Service des Maladies Infectieuses/ Centre Hospitalier de Fann/;2_{Faculté de Médecine, Université Cheikh}

Anta Diop;3Service des Maladies Infectieuses, Centre Hospitalier de Fann/;4_{Service des Maladies Infectieuses, Centre Hospitalier de Fann,}

DAKAR, Senegal

Correspondence:Ndeye Aïssatou Lakhe

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P136

Introduction:Bacteremia have important consequences in terms of mortality, morbidity and cost. Their prognosis depends on several factors, among them, the rapidity and above all the efficacy of first line antibiotics.

Objectives:The objective of our study was to describe the epidemio- logical, clinical, therapeutic and evolution aspects of bacteraemia.

Methods:We realized a descriptive retrospective study based on re- cords of patients hospitalized in the department of infectious and tropical diseases, for which bacteraemia was diagnosed from 1 Janu- ary 2013 to 31 December 2014.

Results: Seventy nine (4.11%) cases of bacteraemia were collected among the 1922 hospitalized patients and 85 strains had been iso- lated. The female predominance was clear with 44 cases (55.9%) The mean age of the study population was 26.97 ± 16.49. The most fre- quent reasons for hospitalization were sepsis in more than half of cases (55.69%). Tuberculosis was the most frequent diagnosis associ- ated with 15 cases (18.98%). The portal was mostly urinary (21 cases). The most common agents isolated were Staphylococci (31.76%), Pseudomonas (15.29%), streptococci (9.41%), Escherichia (8.23%) and Acinetobacter (8.23%). The strains isolated were sensitive to imipe- nem, vancomycin, fusidic acid, piperacillin, colistin (except Pseudo- monas) in more than 90%. The majority of patients (69.6%) had received two or more antibiotics. Thirty-three patients (41.77%) died.

Conclusion:Bacteremia in our context has a high mortality. The iso- lated bacterial strains are increasingly resistant to the antibiotics available. Rational use of antibiotics is more necessary than ever.

Disclosure of Interest

None Declared

P137

A comprehensive inventory of infectious risk moments during acute care

Lauren Clack1_{, Simone Passerini}1_{, Tanja Manser}2_{, Hugo Sax}1 1

Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland;2_{Institute for Patient Safety, University}

Hospital Bonn, Bonn, Germany

Correspondence:Lauren Clack

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P137

Introduction: The practice of hand hygiene (HH) has been well studied over the last decade for its role in infection prevention, yet less knowledge exists regarding other important infection-related be- haviours. We hypothesize that an important portion of infectious risks lies at“infectious risk moments”(IRM)– seemingly innocuous, yet frequently occurring care manipulations resulting in transfer of pathogens – which include and go beyond indications for hand hygiene.

Objectives:We conducted 1)exploratory observationsto establish a comprehensive inventory of IRM, and 2)structured observations to quantify the frequency and nature of IRM.

Methods:Exploratory observationswere carried out in three settings (intensive care, medical, emergency) by single observers, who noted the care process being observed and any potential IRM. An inventory of all observed IRM was established and systematically coded according to the source, pathway, and endpoint from, through, and to which pathogens were transferred, respectively. This formed the taxonomy for thestructured observations,which were carried out using a mobile observation tool programmed with Filemaker 14 in the same three set- tings by two observers to ensure systematic documentation of all IRM.

Results: 129.17 hours of exploratory observations resulted in the identification of 292 unique potential IRM. IRM were categorized ac- cording to the source (e.g. medical device, mobile object, physical environment), pathway (e.g. hands, gloves, mobile objects) and end- point (e.g. patient critical site, non-critical site) of pathogens. 53.77 hours of structured observations (31.25 hours of active care) resulted in the identification of 1’338 potential IRM, for an average density of 42.8 IRM/active care hour. The average densities of IRM/ active care hour were 34.9, 36.8, and 56.3 in the intensive care, medical, and emergency wards, respectively. 566 unique moments were identified, which fell into 71 main categories.

Conclusion:Exploratory and structured observations resulted in the successful identification of IRM including, yet going beyond indica- tions for hand hygiene to include moments involving glove use, mo- bile objects, medical devices, healthcare worker clothing, and invasive devices. This inventory may serve as a tool for identifcation and prioritization of future infection prevention efforts.

Disclosure of Interest

None Declared

P138

Assessing the burden and trends of healthcare associated infection in a tertiary care hospital through point prevalence survey

Rushika Saksena1, Shilpee Kumar1, Rajni Gaind1, Sunita Nagpal2, Premrose Suri2

1

Microbiology;2Infection control, Vardhman Mahavir medical college and Safdarjung hospital, Delhi, India

Correspondence:Rushika Saksena

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P138

Introduction:To obtain basic Healthcare-Associated Infections (HAIs) information, such as prevalence, isolated pathogens and type of HAI, cross-sectional survey is a relatively cost-effective method. Repeated cross sectional surveys can also provide meaningful data to investi- gate potential trends of HAIs.

Objectives:To understand HAI epidemiology and to improve infec- tion control program, four annual point prevalence surveys were conducted from 2012 to 2016.

Methods:Settting - 1531 bedded, tertiary care, government hospital with 8 ICUs and 41 wards (21 clinical departments)

We conducted 4 annual point prevalence surveys on HAI from 2012 to 2016. Before the survey, the questionnaires and definitions of the investigated variables in the questionnaire were circulated to all linked-nurses. On the day of survey, all in- patients were surveyed and questionnaires were completed. The data was extracted from all relevant sources including clinical records, temperature charts, la- boratory reports and radiographs. Trained Infection control nurses reviewed medical records retrospectively to identify HAIs active at the time of the survey.

Results: A total of 5194 patients were included (1229 patients in 2012, 1447 in 2014, 1311 in 2015 and 1207 in 2016). Overall preva- lence of HAI showed a decreasing trend over 4 years (7.4, 5.3, 8.8, & 5.9% respectively). Most departments have HAI rate varying between 0 and 10% except ICUs (44-62%) and burn & plastic wards (22-27%). Wound infections (41-47%) are the most common HAI in all the years. The rate of UTI has an upward trend (23, 12, 24 & 38% respectively) while rate of BSI has downward trend (15, 18, 11& 5% respectively). Gram-negative bacteria (E.coli, Klebsiella & Acinetobacter) are most iso- lated pathogens. There is increased rate of isolation ofE.coli(15, 11, 21 & 25% respectively) andAcinetobacter(18, 10,13 &19% respectively) while

decreased rate of isolation ofS.aureus(15,16,13 & 4% respectively) over the years.

Conclusion:Despite the limitations of Point prevalence survey, our study yielded valuable data on the epidemiology of HAI. The study underscore the surveillance of HAI by repeated prevalence surveys for a better understanding of trends in the epidemiology of HAIs and prevention success.

Disclosure of Interest

None Declared

P139

Healthcare associated infections: prevalence and risk factors

Héla Ghali, Sihem Ben Fredj, Salwa Khefacha, Mohamed Ben Rejeb, Houyem Said Latiri

Departement of Prevention and Security of Care, Sahloul-Sousse, Tunisia

Correspondence:Héla Ghali

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P139

Introduction: Healthcare associated infections (HAI) are the most fre- quent adverse event in health-care delivery worldwide. The endemic burden of HAI is also significantly higher in low- and middle-income than in high-income countries, in particular in patients admitted to intensive care units and in neonates. Tunisia is not spared from this scourge. The national surveys of prevalence HAI were held regularly in the health insti- tutions in the framework of the strategic axis "Surveillance of HAI" of the National Strategy of the hygiene and safety of care.

Objectives:Our study aimed to evaluate the prevalence of HAI in the university hospital of center-east of Tunisia and to assess its risk factors.

Methods:A cross-sectional study of prevalence was conducted from April 11thto April 28th2016. All services have been included in the investigation, except those of emergencies and of haemodialysis due to their very short duration of hospitalization. The collection of data was performed by the plug of the survey of national prevalence of nosocomial infections.

Results:Among 287 eligible patients, 28 had a HAI. The prevalence of patients infected was 9.8%. 33 HAI have been identified in these pa- tients. The prevalence of HAI was 11.5%. This prevalence was more im- portant in intensive care units (29.2%). The most frequent infections were respiratory infections (39.4%) and urinary tract infections (18.18%). The multivariate analysis of intrinsic and extrinsic factors has highlighted a significant association between the HAI and the presence of central venous catheter (OR = 4.11; IC 95% = [1,04–16,28] ; p = 0,044), setting of prosthesis (OR = 28,80; IC 95% = [4,44–186,42] ; p = <10-3), the artificial nutrition(OR = 4,34; IC 95% = [1,03–18,23] ; p = 0,045), and the antibiotic therapy in the past 6 months (OR = 2,78; IC 95% = [1,09–7,09] ; p = 0,032). 16 infections were microbiologically documented (57.14%). In total, 21 pathogens have been identified, which the most frequent was Klebsiella pneumoniae.

Conclusion:Actions of prevention of HAI have already been con- ducted at the hospital. The results of this survey suggest a strengthening of these actions, including: the improvement of the system of monitoring, the promotion of the hygiene of hands, the training of the health staff and the quality approach relative to the safety of care.

Disclosure of Interest

None Declared

P140

Outbreak of lassa fever in a healthcare setting : epidemiologic surveillance and risk stratification for contact persons - Saki Oyo State, Nigeria 2014

Olukemi T. Olugbade1_{, Oluwaseyi Israel}1_{, Rhoda Fadahunsi}1_,

Abiodun Ogunniyi1, Abisola Oladimeji1, Adebola Olayinka1,2

1_{Field Epidemiology Practice, Nigeria Field Epidemiology and Laboratory}

Training Programme, Asokoro;2Medical Microbiology, Ahmadu Bello University, Zaria, Nigeria

Correspondence:Olukemi T. Olugbade

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P140

Introduction: Lassa Fever (LF) is an infectious viral hemorrhagic disease transmitted through contact with effluents (fecal matter and urine) ofMastomys natalensis- a multi-mammate rat species, and in- fected persons.LF is endemic in West Africa. Outbreaks of LF oc- curred in 23 of the 36 states in Nigeria with 1,656 cases and 112 deaths in 2013. Secondary transmission from person to person has been established, presenting a healthcare risk for health workers.In February 2014, a laboratory confirmed case of LF was reported in a health worker in Saki,Oyo state.

Objectives: We investigated the outbreak, identified and traced contacts with follow up and contained transmission

Methods:We conducted active case search/record review of hospi- tals records, contact risk stratification assessment, environmental as- sessment and laboratory analysis.

Results: Twenty contacts were classified as 13 probable and 7 sus- pected cases. For risk stratification we collected socio-demographic information, extent of contact, observed signs or symptoms suggestive of LF, and use or non - use of PPE; this revealed 77 contacts with 73 (95%) being health workers who were in contact with confirmed case during the acute phase of illness. Categorization of risk showed 18 (23.3%) were category 1(no risk), 54(70.1%) category 2 (low risk) and 5 (6.5%) category3 (high risk). The 25 samples collected were all negative for LF. None of the 97 identified contacts developed LF after a 21 day follow up period. Environmental assessment showed bush burning, poor food handling, poor refuse disposal and rodent consumption practices. Poor infection control practices were observed in 2 of the 4(50%)health facilities where the confirmed case received care with just one facility (25%) having an isolation ward.

Conclusion:Epidemiologic surveillance, contact tracing and risk as- sessment are important elements in an outbreak response. We trained health workers on good Infection control practices, prompt isolation and optimal LF case managemen. We conducted commu- nity based advocacy and sensitization.We recommend that active surveillance and public enlightenment should be continuous to ef- fectively sustain LF control and prevent further outbreaks in this community and Oyo State

Disclosure of Interest

None Declared

P141

Survival anlysis of the incidence of health-care associated respiratory syncytial virus in selected referral hospitals in Kenya, 2009-2011

Lilian Mayieka1_{, Samuel Mwalili}2_{, Geofrey Arunga}3_{, Leonard Cosmas}4_,

Linus Ndegwa2

1_{Kenya Medical Research Institute;}2_{Centers for Disease Control;}3_Ipas

Africa Alliance;4World Health Organization, Nairobi, Kenya

Correspondence:Lilian Mayieka

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P141

Introduction: In Sub Saharan Africa, there is severe overcrowding and frequent breakdown of essential services like water and hygiene in hospitals hence facilitating spread of infections.

Objectives:We sought to document the incidence of health-care as- sociated RSV in the three referral hospitals and evaluate the factors that affect its infection using adjusted hazard ratio.

Methods: We retrospectively studied acquisition of RSV 72 hours post admission among patients admitted in three hospitals in Kenya: Kenyatta National-KNH, New Nyanza and Mbgathi District hospitals. Screening was done using RT-PCR on naso/oro pharyngeal samples collected from patients who developed influenza-like illness. Cox pro- portional hazard model was used for analyses.Hazard ratio associated with risk factors were given as the exponent of the cox model coefficient.

Results:Two-hundred and fifty-five samples were analyzed from pa- tients admitted in the hospital. Forty (16%) of the samples were RSV positive, 25 (62.5%) of them being from male. Twenty-six (65.0%) of the patients were aged below <2 years, 8 between 2-4 years and 6 patients were≥5 years. Majority (33, 82.5%) of the patients was from pediatric wards.KNH contributed the most number of patients (24,

60.0%). Cox regression analysis showed that males had 82% chance of contracting RSV faster (aHR = 4.5; CI = 1.7-11.7; P = 0.003). Admitted patients aged >5 years had 99% chance of contracting RSV faster than those <2 years (aHR = 81.7; CI = 4.8-139.5; P = 0.001). Patients ad- mitted at Mbagathi and New Nyanza had 92%(aHR = 11.5; CI = 3.7- 35.5;P < 0.001) and 94% (aHR = 17.02;CI = 5.9-49;P < 0.001) chance of contracting RSV faster than those in KNH respectively. Patients in the ICU had a 91% chance of contracting RSV faster than those admitted in the pediatric wards (aHR = 10.1; CI = 4.0-24.9; P = 0.028)

Conclusion:Being male, aged 5 years or more, admitted in the ICU increased the chance of contracting RSV faster. Therefore, target in- terventions should be aimed at patients in these wards.

Disclosure of Interest

None Declared

P142

Prevalence of health care acquired infections among new mothers and newborns in the Kyrgyz Republic

Gulmira A. Djumalieva, Aleksey Kravcov, Nadira Soronbaeva

National Scientific and Practical Center for Infection Control, "Preventive Medicine" Scientific Association under the Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgyztan

Correspondence:Gulmira A. Djumalieva

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P142

Introduction:This paper serves as the research report on prevalence of Health Care Acquired Infections (HCAI) among new mothers and newborns in the Kyrgyz Republic as an indicator of the effectiveness of infection control measures.

Objectives:Objective of the study is to investigate the prevalence of Health Care Acquired Infections (HCAI) among new mothers and newborns in the Kyrgyz Republic as an indicator of the effectiveness of infection control measures.

Methods:Two point prevalence surveys of the Health Care Acquired Infections among new mothers and newborns were conducted be- tween 2013 and 2016. The point prevalence surveys were conducted in 10 public health hospitals. In total, 657 new mothers and 720 new- borns were examined in the first study, and 552 new mothers and 623 newborns - in the second study. We used the method of active detection of infections using the CDC case standard definitions, and with the use of forms specifically designed for epidemiological sur- veillance. The studies were conducted by appropriately trained infec- tion control specialists and epidemiologists.

In quantitative terms, point prevalence was defined as the ratio of the number of people who have an infection, at a particular point in time, to the total amount of people in the population, at risk, at the same point in time.

Results:Prevalence of infections among the new mothers was 6.8% in the first study, and 3.1% - in the 2nd study. Amongst the new mothers with the C-section, prevalence was 19.8% in the first study, and 8.5% - in the second study. Amongst the new mothers with nat- ural delivery, prevalence was 3.6% at the first study, and 1.4% - in the second. Incidence of the HCAI among newborns was 8.9% in the first study, and 5.1% - in the second study. In the period between the two studies, infectious control measures were actively introduced through trainings and equipping of the clinical departments of the hospitals.

Conclusion:Introduction of the infection control measures, such as the hand hygiene, the safety standards for the medical procedures, and the appropriate use of antibiotics for the preventive purpose, en- able the reduction of prevalence by a factor of 1.5-2. The point prevalence survey allows to determine the effectiveness of the mea- sures undertaken, as well as to determine priority areas for interventions.

Disclosure of Interest

None Declared

P143

Real time analysis of local 2016 point prevalence study data and investigation of risk factors

Padma Polubothu1, Ann Kerr2, Teresa Inkster1

1

Microbiology, Queen Elizabeth University Hospital, Glasgow;2Infection control, NHS GGC, Glasgow, United Kingdom

Correspondence:Teresa Inkster

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P143

Introduction: Our hospitals participated in the European HAI point prevalence survey (PPS) 2016. Real time analysis of data was under- taken by hospital and then collated for the health board.

Objectives:To describe findings from the 2016 PPS and investigate risk factors for the most common hospital acquired infections(HAIs).It was hoped that risk factor analysis would enable us to identify areas for quality improvement.

Methods:Ten hospitals were visited and 3834 patients were included