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Data management for infection prevention and antimicrobial stewardship
122 administered normal human immunoglobulin (NHIG) at birth. A PCR swab was taken from the baby at birth and was found to be positive for measles RNA, confirming congenital measles infection. The baby remained remarkably well and had no clinical signs of infection. The baby was nursed in isolation and remained on home isolation post discharge until two negative naso-pharyngeal PCR swabs had been completed. Conclusion: This complex case required extensive input from Public Health, Infection Control, Neonatology, Obstetric and Infectious Diseases teams. Lessons have been learnt which can be applied to future cases.
CONTACT PRECAUTIONS FOR MULTI-RESISTANT PATHOGENS e IS IT TIME TO GO HORIZONTAL? Joanna Harris Illawarra Shoalhaven Local Health District, Wollongong, Australia Introduction: Contact Precautions (CP), first prescribed in managing patients with multi-resistant organisms (MROs) in the 1970s, continue to be used in today’s healthcare across the developed world. This presentation summarises the literature, to explore the application of CP in contemporary healthcare, from an ethics perspective. Method: A review of the literature surrounding healthcare ethics and the use of CP in acute hospital settings. Results: Despite consistent terminology there is a wide variation in the implementation of CP within policy documents, and in clinical practice. This may explain the conflicting evidence surrounding the efficacy of CP, and their impact on patients, although poor study design may also contribute. It is identified that healthcare workers (HCW) find CP difficult to maintain and their decision-making may be founded upon outdated or incomplete microbiological information. It is known that the mortality-rate from significant MRO infections may not differ from the rate when an antibioticsensitive strain is responsible. The effect of CP on patient and HCW autonomy, the potential for CP to precipitate adverse events, healthcare inequities and stigmatisation, are recognised as they were in 1985 when, in response to concerns about human immunodeficiency virus (HIV), horizontal strategies for blood contact, known as Universal Precautions, were developed. Conclusion: Conflicting evidence for the efficacy of CP, along with ethical concerns, mean it is time to reconsider CP for MRO management. Horizontal infection prevention and control strategies would fulfil the aims of primary health promotion by reducing transmission of MROs whilst safeguarding key principles of healthcare ethics.
CREATING A HOSPITAL-SPECIFIC SEWAGE CLEAN-UP MANAGEMENT PLAN Brad Prezant Validair Sciences, Nunawading, Australia Introduction: Small and large sewage leaks occur periodically in health care environments, resulting in potential infection risks to patients, staff, and clean-up personnel. Biological proliferation, including bacterial and fungal growth, can occur following all water release incidents, including sewage release incidents. There is little published guidance on choosing and evaluating a sewage clean-up contractor, and specifying the work processes and verification processes to successfully minimise risk. This document presents a step-by-step protocol for planning and conducting a response to such an incident, from the perspective of infection control. Methods: The document addresses critical issues including pre-planning administration and organisation, evacuation, isolation, personal protective equipment (PPE), HVAC management, specific clean-up and decontamination techniques, methods of verification of work practices, and close-out documentation. Results: Development of a hospital-specific sewage spill response plan is facilitated with the issues and protocols identified in this plan. Conclusion: Appropriate management of a sewage release incident in a health care facility requires pre-planning, excellent contractor communication, agreement on appropriate protocols, appropriate health and safety measures, and agreed verification methodology to insure minimising risk to patients, staff, and clean-up personnel. Involvement of infection control
Abstracts personnel is essential to insuring that this work is conducted in an appropriate manner.
CULTURE INDEPENDENT DETECTION OF CHLORHEXIDINE RESISTANCE GENES QACA/B AND SMR IN BACTERIAL DNA RECOVERED FROM BODY SITES TREATED WITH CHLORHEXIDINE CONTAINING DRESSINGS Abu Choudhury, Dr Md1,2,3,4, Hanna Sidjabat, Dr4, Irani Rathnayake, Dr5, Nicole Gavin 1,2,6, Raymond Chan, A/Professor1,2,5,6, Shahera Banu, Dr5, Flavia Huygens, A/Professor5, David Paterson, Professor4, Claire Rickard, Professor1,2,6, David McMillan, Dr2,3 1 NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia 2 Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Australia 3 Inflammation and Healing Research Cluster, School of Health and Sports Sciences, University of the Sunshine Coast, Sippy Downs, Brisbane, Australia 4 University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital Campus, Brisbane, Australia 5 Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia 6 Royal Brisbane and Women’s Hospital, Brisbane, Australia Chlorhexidine gluconate (CHG) containing dressings are increasingly used in clinical environments for prevention of infection at central venous catheter insertion sites. Increased tolerance to this biocide in Staphylococci is primarily associated with the presence of qacA/B and smr genes. Here we used a culture independent method to assess the prevalence of these genes in 78 DNA specimens recovered from the skin of 43 patients at catheter insertion sites in the arm that were covered with CHG-dressings. Of the 78 DNA specimens analysed, 52 (67%) possessed qacA/B and 14 (18%) contained smr; all sample positive for smr were also positive for qacA/B. These prevalence rates was not statistically greater than that observed in a subsample of specimens taken from non-CHG treated arms. A statistically greater proportion of specimens with greater than 72 hours exposure to CHG dressings were qac-positive (pZ 0.04), suggesting the patients were contaminated with bacteria or DNA containing qacA/B during their hospital stay. The presence of qacA/B was also positively associated with the presence of DNA specific for S epidermidis and S. aureus in these specimens. Our results show that CHG-genes are highly prevalent on hospital patients’ skin, even in the absence of viable bacteria.
DATA MANAGEMENT FOR INFECTION PREVENTION AND ANTIMICROBIAL STEWARDSHIP Trent Yarwood, Dr Cairns and Hinterland Hospital and Health Service, Cairns, Australia Introduction: Infection prevention and antimicrobial stewardship activities generate a large amount of data e rates of hand hygiene, isolation of multiresistant organisms and information about quantity and quality of antimicrobial use. Collected data by itself does not result in improved patient outcomes; it may not even be useful to inform the practice of infection control practitioners or infectious diseases physicians, unless it first undergoes data entry, but then even more importantly is analysed. Providing feedback on the data to clinicians and to hospital administrators may improve staff awareness of infection prevention activities and draw attention to issues of concern to the infection prevention team This presentation will highlight some of the ways that infection control teams can make their collected data more accessible both to the team, but also to a broader audience in and outside their facility. It will look at some of the tools available for collating and analysing the data, and for turning it into useful tools for tracking infection-related outcomes. It will also discuss the potential impact of the open data movement on infection prevention. Conclusions: An increasing amount of data has been matched by an increase in tools which can be used to manage it; infection control teams should increase their awareness to improve engagement, and ultimately, patient outcomes.
CONTACT PRECAUTIONS FOR MULTI-RESISTANT PATHOGENS e IS IT TIME TO GO HORIZONTAL? Joanna Harris Illawarra Shoalhaven Local Health District, Wollongong, Australia Introduction: Contact Precautions (CP), first prescribed in managing patients with multi-resistant organisms (MROs) in the 1970s, continue to be used in today’s healthcare across the developed world. This presentation summarises the literature, to explore the application of CP in contemporary healthcare, from an ethics perspective. Method: A review of the literature surrounding healthcare ethics and the use of CP in acute hospital settings. Results: Despite consistent terminology there is a wide variation in the implementation of CP within policy documents, and in clinical practice. This may explain the conflicting evidence surrounding the efficacy of CP, and their impact on patients, although poor study design may also contribute. It is identified that healthcare workers (HCW) find CP difficult to maintain and their decision-making may be founded upon outdated or incomplete microbiological information. It is known that the mortality-rate from significant MRO infections may not differ from the rate when an antibioticsensitive strain is responsible. The effect of CP on patient and HCW autonomy, the potential for CP to precipitate adverse events, healthcare inequities and stigmatisation, are recognised as they were in 1985 when, in response to concerns about human immunodeficiency virus (HIV), horizontal strategies for blood contact, known as Universal Precautions, were developed. Conclusion: Conflicting evidence for the efficacy of CP, along with ethical concerns, mean it is time to reconsider CP for MRO management. Horizontal infection prevention and control strategies would fulfil the aims of primary health promotion by reducing transmission of MROs whilst safeguarding key principles of healthcare ethics.
CREATING A HOSPITAL-SPECIFIC SEWAGE CLEAN-UP MANAGEMENT PLAN Brad Prezant Validair Sciences, Nunawading, Australia Introduction: Small and large sewage leaks occur periodically in health care environments, resulting in potential infection risks to patients, staff, and clean-up personnel. Biological proliferation, including bacterial and fungal growth, can occur following all water release incidents, including sewage release incidents. There is little published guidance on choosing and evaluating a sewage clean-up contractor, and specifying the work processes and verification processes to successfully minimise risk. This document presents a step-by-step protocol for planning and conducting a response to such an incident, from the perspective of infection control. Methods: The document addresses critical issues including pre-planning administration and organisation, evacuation, isolation, personal protective equipment (PPE), HVAC management, specific clean-up and decontamination techniques, methods of verification of work practices, and close-out documentation. Results: Development of a hospital-specific sewage spill response plan is facilitated with the issues and protocols identified in this plan. Conclusion: Appropriate management of a sewage release incident in a health care facility requires pre-planning, excellent contractor communication, agreement on appropriate protocols, appropriate health and safety measures, and agreed verification methodology to insure minimising risk to patients, staff, and clean-up personnel. Involvement of infection control
Abstracts personnel is essential to insuring that this work is conducted in an appropriate manner.
CULTURE INDEPENDENT DETECTION OF CHLORHEXIDINE RESISTANCE GENES QACA/B AND SMR IN BACTERIAL DNA RECOVERED FROM BODY SITES TREATED WITH CHLORHEXIDINE CONTAINING DRESSINGS Abu Choudhury, Dr Md1,2,3,4, Hanna Sidjabat, Dr4, Irani Rathnayake, Dr5, Nicole Gavin 1,2,6, Raymond Chan, A/Professor1,2,5,6, Shahera Banu, Dr5, Flavia Huygens, A/Professor5, David Paterson, Professor4, Claire Rickard, Professor1,2,6, David McMillan, Dr2,3 1 NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia 2 Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Australia 3 Inflammation and Healing Research Cluster, School of Health and Sports Sciences, University of the Sunshine Coast, Sippy Downs, Brisbane, Australia 4 University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital Campus, Brisbane, Australia 5 Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia 6 Royal Brisbane and Women’s Hospital, Brisbane, Australia Chlorhexidine gluconate (CHG) containing dressings are increasingly used in clinical environments for prevention of infection at central venous catheter insertion sites. Increased tolerance to this biocide in Staphylococci is primarily associated with the presence of qacA/B and smr genes. Here we used a culture independent method to assess the prevalence of these genes in 78 DNA specimens recovered from the skin of 43 patients at catheter insertion sites in the arm that were covered with CHG-dressings. Of the 78 DNA specimens analysed, 52 (67%) possessed qacA/B and 14 (18%) contained smr; all sample positive for smr were also positive for qacA/B. These prevalence rates was not statistically greater than that observed in a subsample of specimens taken from non-CHG treated arms. A statistically greater proportion of specimens with greater than 72 hours exposure to CHG dressings were qac-positive (pZ 0.04), suggesting the patients were contaminated with bacteria or DNA containing qacA/B during their hospital stay. The presence of qacA/B was also positively associated with the presence of DNA specific for S epidermidis and S. aureus in these specimens. Our results show that CHG-genes are highly prevalent on hospital patients’ skin, even in the absence of viable bacteria.
DATA MANAGEMENT FOR INFECTION PREVENTION AND ANTIMICROBIAL STEWARDSHIP Trent Yarwood, Dr Cairns and Hinterland Hospital and Health Service, Cairns, Australia Introduction: Infection prevention and antimicrobial stewardship activities generate a large amount of data e rates of hand hygiene, isolation of multiresistant organisms and information about quantity and quality of antimicrobial use. Collected data by itself does not result in improved patient outcomes; it may not even be useful to inform the practice of infection control practitioners or infectious diseases physicians, unless it first undergoes data entry, but then even more importantly is analysed. Providing feedback on the data to clinicians and to hospital administrators may improve staff awareness of infection prevention activities and draw attention to issues of concern to the infection prevention team This presentation will highlight some of the ways that infection control teams can make their collected data more accessible both to the team, but also to a broader audience in and outside their facility. It will look at some of the tools available for collating and analysing the data, and for turning it into useful tools for tracking infection-related outcomes. It will also discuss the potential impact of the open data movement on infection prevention. Conclusions: An increasing amount of data has been matched by an increase in tools which can be used to manage it; infection control teams should increase their awareness to improve engagement, and ultimately, patient outcomes.