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P210

Hand hygiene and catheter related blood stream infection control in intensive care unit, University Hospital in Latvia

Agita Melbarde-Kelmere

Riga Eastern University Hospital, Riga, Latvia

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P210

Introduction:Pauls Stradins University Intensive care unit (ICU) staff has a hand hygiene intervention study and CVC bundle intervention study. The organization of infection control at the hospital ICU was changed by updating and implementing patient treatment procedures.

Methods: A time-series prospective study about bacteraemias was carried out in ICU. One of the major aims of the study was to define and to summarise different indicators, perform interventions, and re- duce the NI incidence rates.The duration of the study was 4.5 years (from 20 August 2008 until the end of June 2013). Throughout the study, bacteraemia results for ICU patients were collected and the re- sult of the performed interventions was constantly evaluated, in addition also hand hygiene monitoring was performed. A special pro- cedure for CVC usage (insertion, treatment and removal) was imple- mented in PSCUH in 2009. For hand hygiene (HH) monitoring, the WHO Hand Hygiene Monitoring Tool was used.

Results:From 20 August 2008 to 28 June 2013, 5739 hand hygiene observations were performed. Higher ratio of the hand hygiene com- pliance was seen when the feedback with the medical staff concern- ing the acquired results and their changes was established. The average hand hygiene compliance within the study was 36.7%. From January 2011 to June 2013, 1066 adult patients with CVC enrolled (12 485 CVC days). The incidence of CRBSI during pre-intervention period was high (10.1 per 1000 CVC days, CI = 7.9-12.8) but after_…

bundle” implementation CRBSI rate decreased (3.8 per 1000 CVC days, CI = 2.5-5.8).

Conclusion:Implementation of infection control has proved its ef- ficiency, by carrying out intensive training programme related to hand hygiene, CVC usage and treatment for nurses and doctors; it was possible to reduce CRB more than seven times. Although the results obtained during the hand hygiene intervention are not long-lasting, it is possible to improve those by repeating the intervention.

Disclosure of Interest

None Declared

P211

5 Year surveillance of clabsi in a tertiary care private sector nicu in Pakistan

Ali S. Hussain, Shabina Ariff

The Aga khan university hospital, Karachi, Pakistan

Correspondence:Ali S. Hussain

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P211

Introduction:Amongst HAI, CLABSI are the most important cause of morbidity and mortality especially in critically ill patients. Due to many factors in low resource countries, CLABSI are either underre- ported, meaning that the impact of CLABSI may be much higher than what is reported.

Objectives: To determine the frequency,Characteristics and micro- organism profile of CLABSI from our NICU.

Methods:We retrospectively analyzed our prospectively collected infection control surveillance data base from 2011-2015. All cases who were classified by our hospital’s infection control team as CLABSI using the CDC NSHN definition were enrolled. Microorgan- isms that caused CLABSI were identified. Basic demographic and anthropometric data along with outcomes were recorded. Cath- eter type and its dwell time was recorded. Amongst risk factors, TPN days, Line days and line day at which CLABSI confirmed were recorded. CLABSI rates/1000 central line days and Device utilization ratio were calculated.

Results: 2046 babies were admitted in our NICU during the study period with a total of 17881 patient days and 6467 de- vice days.Average yearly central line utilization ratio was 0.36/ year. A total of 183 patients had 245 blood stream infection out of which 57(31%) were labelled CLABSI. Our cumulative CLABSI rates were 8.9/1000 CL days.Amongst CLABSI,37(65%)babies were male.Median weight was 1.68 kg (IQR 1.25, 2.64) whereas median gestational age was 33 weeks(IQR 29, 37).Median time from line insertion to CLABSI was 10 days(IQR 5 to 18 day- s).Combination of UA and UV constituted 17(30%) CLABSI epi- sodes followed by PICC line 15(26%).Gram-ve organisms were most common followed by CONS and candida. Klebsiella and Acinetobacter constituted 45% of the total infections.Distribu- tion of microorganisms amongst different central lines were similar except for acinetobacter in which 9 out of 10 CLABSI were associated with UA/UV lines. 28 (49%) of our CLABSI pa- tients died.In adjusted multivariate analysis only duration of central line >30 days was found as independent predictor for CLABSI(IRR 2.5, 95%CI 1.24-5.06)

Conclusion:We report a high CLABSI rate with substantial CLABSI re- lated mortality. Higher CLABSI rates translating into eventual morbid- ity and mortality in developing countries projects the poor state of affairs and highlights the importance and need of investment in health care infrastructure.

Disclosure of Interest

None Declared

P212

Epidemiology of central line associated blood stream infections (CLABSI) over ten years in a medical-surgical ICU in a tertiary care center in Lebanon

Nada K. Zahreddine1, Joseph Tannous2, Tala Kardas1, Rihab Ahmadieh1, Zeina Kanafani3_{, Souha Kanj Sharara}3

1_{Infection Control and Prevention Program;}2_{American University of}

Beirut Medical Center, Beirut, Lebanon;3Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon

Correspondence:Nada K. Zahreddine

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P212

Introduction:CLABSI have been associated with significant morbidity and attributable mortality in patients admitted to Intensive Care Units (ICU).

Objectives:The study was conducted to determine CLABSI rates in ICU at the American University of Beirut Medical Center; and to de- scribe the most frequently found causative microorganisms in blood- stream isolates and their resistance profiles.

Methods:Infection Control (IC) Preventionists conducted an ac- tive and prospective surveillance between January 2007 and February 2017 in a 10-beds ICU using the National Health Safety Network (NHSN) methodology. The CLABSI standardized rates were compared to the international reports of NHSN and the International Nosocomial Infection Control Consortium (INICC). The distribution of microorganisms associated with CLABSI was also analyzed.

Results:A total of 96 CLABSI were identified during a 10 years period covering 15765 central line (CL) days. The overall CLABSI rate was 6.1 per 1000 CL days. CLABSI rates were higher than the pooled NHSN rates reflecting hospitals from developed countries and higher than the benchmark from developing countries participating in INICC. Multidrug Resistant Acinetobacter baumannii was most commonly recovered (23.0%) followed by coagulase negative staphylococci (21.0%).

Conclusion:The risk of acquiring CLABSI associated with MDR-ACB in ICU patients is high and is strongly correlated with MDR-ACB colonization pressure. Multidisciplinary efforts were adopted through- out the study period to minimize this risk by applying an evidence based CL bundle in addition to introducing active surveillance for MDR-ACB on each patient admitted to ICU. The CLABSI rates were decreasing overtime until a sustained Zero CLABSI rate was reached over the last 8 months of the study period proving the success of the IC interventions. Disclosure of Interest None Declared P213 Withdrawn P215

Just do it! incidence registration of clabsi and cauti may be easier than you think

Mette Walberg

Infection Control Department, Vestre Viken HT, Baerum hospital, Drammen, Norway

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P215

Introduction:Hospital leadership need knowledge of nosocomial in- fection rates for implementing optimum measures. We established incidence registration for central line associated blood stream infec- tion (CLABSI) and catheter-associated urinary tract infection (CAUTI) in chosen units of a Norwegian hospital trust with ca. 250.000 annual bed days. The registration was based on data collected on paper.

Objectives: We wanted to know whether prospective incidence registration of CLABSI and CAUTI was possible despite lack of tailored electronic registration tools.

Methods:We used CDC criteria and Windows software (Excel). Clin- ical staff (CS) collected daily data on number of patients with central lines and urinary catheters and emailed scanned copies of results monthly to infection control personnel (ICP). The lists also included necessity for urinary catheter, number of admitted patients (catheter utilization rate) and CAUTI incidents. ICP updated incidence results for CLABSI and CAUTI, forwarded the results to CS monthly, and cop- ied leaders into the email loops. ICP also collected CLABSI incident data. CS and ICP met regularly for data quality control.

Results:During one calendar year (2015-2016) we collected data for 1755 central lines in one infection disease unit. Only one CLABSI was found, i.e. an incidence of 0.57 per 1000 central line days. Correspond- ing numbers registered in an intensive care unit were 488 line days (21 weeks), no CLABSIs observed. In one urology unit we collected data for 652 urinary catheter days (47 weeks) and found 5 CAUTIs, an inci- dence of 7.7 per 1000 catheter days. Clinical staff in each unit spent 15

–30 min daily for collection of data, while ICP used about 60 min monthly for collection of CLABSI incidents. ICP spent some hours monthly to update results for CLABSI and CAUTI. 30 min monthly was used for quality control of data from each unit. Before kickoff we spent several hours for project planning and design.

Conclusion: We experienced that incidence registration of CLABSI and CAUTI was easier than assumed. Careful planning and sharing of responsibilities between involved personnel was essential. The regis- trations ran smoothly when CS handled denominator data and nu- merator data for CLABSI were collected by ICP and CS took care of numerator data for CAUTI. We experienced that our work was vital for patient safety in our hospital trust.

Disclosure of Interest

None Declared

P216

Impact of automated surveillance, hand hygiene and preventive interventions on device associated infections at a tertiary care Indian Hospital

Neha Rastogi, Purva Mathur, Alphina Karoung, Jacinta Gunjiyal Microbiology and Infection Control, JPNATC, AIIMS,New Delhi, New Delhi, India

Correspondence:Neha Rastogi

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P216

Introduction:Device associated infections (DAI) poses a grave con- cern to patient outcomes. Systematic surveillance is quintessential to curtail DAIs. However, its implementation especially in developing countries is challenging.

Objectives:This study reports the impact of automated surveillance and preventive interventions on DAIs using indigenously developed cost effective software at an Indian Trauma Care Center.

Methods:This was a prospective observational study for a period of 3 years. We developed our own software for algorithmic and coherent detection of DAIs based on CDC’s NHSN definitions. The rates of DAIs, compliance to hand hygiene and preventive bundles for DAIs were me- ticulously entered into software and reported as feedback. All cadres of healthcare workers were imparted training on a regular basis. The ef- fect of an intensive surveillance and awareness on the DAI rates, com- pliance to preventive bundles and hand hygiene were assessed.

Results: During the study, a total of 7,890 patients were assessed amounting to 39,980 patient days. The rates of VAP, CLABSI and CA- UTI at pre-implementation stage were 8.2, 2.4 and 4.8 /1,000 device days respectively. There was significant correlation between device days and the propensity to develop DAIs (p value = 0.04). In-hospital mortality attributing to infectious complications was 2.6% (n = 208). Rates of VAP, CLABSI and CA-UTI were significantly reduced to 7.07, 2.1 and 3.6/1,000 device days respectively (p value = 0.03). The com- pliance to hand hygiene increased from 58.9% to 61.3% (p value = 0.6). Increased adherence to preventive bundles for DAI was ob- served with statistically significant reduction of DAI rates(p value =

0.03).Acinetobacter baumanniiwas the most common pathogen im- plicated in VAP and CLABSI (37.3%). Klebsiella pneumoniaewas the most common in CA-UTI (14.7%). Increasing multi-drug resistance was observed among bacterial isolates(63%).

Conclusion:Active and systematic surveillance with regular feed- back are essential prerequisites to combat complications of DAIs. Stringent surveillance should be considered as a sustainable mechanism to facilitate performance improvement and infection control in hospitals.

Disclosure of Interest

None Declared

P217

Investigation of an outbreak of klebsiella oxytoca bloodstream infections on a neonatal population

Seila I. Do Prado, Mayra G. Menegueti, Ana E. R. Lopes, Fabiana M. R. Molina, Gilberto G. Gaspar, Lécio R. Ferreira, Marisa M. Mussi, Lucimara B. Hisamitsu, Fernando Bellissimo-Rodrigues

Ribeirão Preto Medical School, Ribeirão Preto, Brazil

Correspondence:Seila I. Do Prado

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P217

Introduction: Bloodstream infection (BSI) nosocomial outbreaks are uncommon but potentially life-threating. Most nosocomial outbreaks of BSI have been associated with microbial contamination of infused fluids during manufacturing.

Objectives:To describe and investigate an outbreak of BSI caused by

Klebsiella oxytocaon a neonatal population.

Methods: This was a retrospective cohort study performed in a tertiary-care university hospital in October 2016. All neonates admit- ted during the outbreak period were included and BSI diagnosis was performed based on the Centers for Disease Control and Prevention (CDC) criteria. Selected clinical and demographic characteristics were evaluated on the patient’s medical records as potential risk factors for BSI. We used Two-tailed Fisher's exact and Mann-Whitney tests for statistical analysis.

Results:Among 35 patients admitted in the study period, 6 (17%) de- veloped a BSI due toK. oxytoca. The following variables yielded similar values among those who experienced BSI versus those who did not, re- spectively: median age (19.5 vs. 24 days, p = 0.895), gestational age at birth (31.5 vs. 34 weeks, p = 0.468), birth weight (1185 vs. 1840 g, p = 0.470), 1-minute Apgar score (6.5 vs. 6, p = 0.580); 5-minutes Apgar score (9 vs. 8, p = 0.497). On the other hand, exposure to central venous catheter was far more common among those who had a BSI versus those who had not (100% vs. 17.2%, p < 0.001), as well as exposure to total parenteral nutrition (100% vs. 34.5%, p = 0.005). After replacement of the parenteral nutrition provider, the outbreak was ended. All af- fected patients were adequately treated and no death attributable to the infection was observed during the study.

Conclusion:From the present investigation, we can state that expos- ure to central venous catheter and parenteral nutrition were impli- cated as the main drivers of thisK. oxytocaBSI outbreak.

Disclosure of Interest

None Declared

P218

Infections after patent ductus arteriosus surgical correction procedures in infants with very low birth weight

Katarzyna Kopeć-Godlewska1_{, Anna Różańska}2_{, Jadwiga Wójkowska-}

Mach2

1_{JAGIELLONIAN UNIVERSITY MEDICAL COLLEGE, Kraków, Poland;}2_Chair

of Microbiology, JAGIELLONIAN UNIVERSITY MEDICAL COLLEGE, Kraków, Poland

Correspondence:Anna Różańska

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P218

Introduction:Very low birth weight (VLBW) neonates <1500 grams, comprise approx. 1% of liveborn infants in Poland. Owing to prema- ture rupture of membranes, these children are born immature, with

such structures as patent ductus arteriosus (PDA). PDA results in many complications that could compromise the health and survival of the neonates. In some of them it is necessary to use surgical methods to surgically close the PDA.

Objectives:The aim of the study was to see how many VLBW neo- nates treated in the participating wards needed surgical correction of PDA and also to analyse the incidence risk of various types of post- surgical infections together with their etiological factors.

Methods:Continuous prospective monitoring of infections was done in the years 2009-2013 in 6 neonatology departments. The studied group was made up of VLBW neonates that needed surgical correction of PDA. Infections were detected based on criteria according to Gastmeier.

Results:2039 VLBW neonates were included in this study. PDA that needed surgical intervention was confirmed in 103 newborns (5.1%), significantly more frequently in children from multiple pregnancy and labour complicated by amnionitis. The surgical PDA correction was performed on average in the 19th day of life of the newborns. Infection was registered in 48.5% (n = 50) of neonates: 27 developed sepsisis (incidence 26.2%) and 23 pneumonia (incidence 22.3%). A correlation was observed between the day the procedure was per- formed and the time of infection: the earlier the newborn was oper- ated on, the earlier was the infection manifested (p = 0.032). High CRIB score and amnionitis in the mother were significant risk factors for the infection.

Conclusion:Infections incidence after surgical correction of PDA in VLBW neonates is reported at a similar level to infections in all hospi- talized VLBW neonates. The later the PDA surgery was done, the later the infections manifested.

None Declared

P219

Identification and control of klebsiella oxytoca outbreak in the neonatal intensive care unit

Sheroline P. Primus, on behalf of Infection Control Nurse, Simone Keizer- Beache,Chief Medical Officer (Ministry of Health wellness and the Environment)

1

Infection Prevention and Control Department, Milton Cato Memorial Hospital, Kingstown ST.Vincent, Kingstown, Saint Vincent and the Grenadines

Correspondence:Sheroline P. Primus

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P219

Introduction:An outbreak of klebsiella oxytoca occurred in the Neo- natal Intensive Care Unit (NICU) in January, 2015.

Objectives:This study sought to identify the source of this outbreak and to contain the nosocomial spread.

Methods:An investigation was launched in response to the isolation of klebsiella oxytoca in the 8 bed (NICU), with one death. An Infec- tion Control Nurse Team conducted a document review and col- lected demographics, birth weight, clinical manifestations, diagnoses, antibiotic use, date of admission and reports of initial blood cultures. The NICU staff was interviewed using an unstructured questionnaire. Infection prevention and control practices were monitored with em- phasis on hand hygiene, cleaning, disinfection and maintenance of the liquid soap dispenser. An environmental assessment was later conducted. Swabs were taken from the hands of five nurses and three doctors, reconstituted intravenous antibiotics, water for injec- tion, liquid antimicrobial soap, stethescopes, cotton swabs, linen and incubators. The Clinical Microbiology Laboratory database was searched for additional cases of klebsiella oxytoca blood stream in- fections. Staff on the Paediatric ward/(NICU) participated in educa- tional sessions on the prevention of infections. Adherence to previously issued guidelines was reinforced and a cleaning schedule was outlined.

Results:Admission blood cultures showed no bacterial growth. Kleb- siella oxytoca was isolated from blood cultures of four neonates taken between January6th_{and 26}th_{, 2015 with two resultant deaths.}

The Microbiology Laboratory database revealed two additional cases of Klebsiella oxytoca. klebsiella oxytoca was isolated from a liquid soap dispenser. This contaminated dispenser was discarded and re- placed with single-use Chlorhexidine Gluconate 4% Antiseptic Solu- tion. Follow-up observation indicated compliance with practices. Repeat blood cultures showed no bacterial growth.

Conclusion: The outbreak of klebsiella oxytoca bloodstream infec- tions was associated with insufficient cleaning and disinfection prac- tices of the liquid soap dispenser. Health care workers must understand how practices and procedures can contribute to infec- tions. Knowledge and adherence to guidelines can avert similar outbreaks.

Disclosure of Interest

None Declared

P220

Influence of coagulase negative staphylococci in blood culture on catheter-related infections diagnosis

Jérôme Ory, Magali Vidal, Natacha Mrozek, Olivier Lesens, Claire Aumeran

Service Maladies infectieuses et tropicales, CHU Clermont-Ferrand, Clermont-Ferrand, France

Correspondence:Jérôme Ory

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P220

Introduction: Coagulase negative staphylococci (CNS)are the main pathogens isolated from central lines blood cultures and are respon- sible for most catheter-related infections.

Objectives:The objective of this study was to determine the clinical significance ofCNSisolated from central line blood cultures.

Methods: CNS positive central lines blood cultures were prospect- ively collected over a 5-month period in a university hospital. Periph- eral blood cultures, clinical and biological data were gathered. Using these data, 4 groups were defined: bacteraemia, probable bacter- aemia, catheter colonization (CC) and blood culture contamination (BCC). Each group was described by Charlson score, antibiotic ther- apy and complications.

Results:From 680 positive central line blood cultures, 129 were posi- tive with CNS. CNS was responsible for 28 bacteraemia, 9 probable