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FP1.09 A Novel Method of Skin Preparation
Oral Presentations FP1.07 Do Bacteria Induce the Formation of Encrustations on Double J Ureteric Stents? K. Heaton1 , R. Bayston1 *, D.M. Grant1 , M. Bishop2 . 1 University of Nottingham, UK, 2 City Hospital Nottingham, UK Background: Ureteric stents are tubes which when inserted into the ureter prevent its occlusion and ensure efficient drainage of urine from the kidney to the bladder. Although stents are inserted to alleviate blockages, often they have to be removed due to blockage by microbial biofilms or encrustation. This also occurs in urethral catheters where it has been established that the cause is Proteus mirabilis which produces vast quantities of urease. This alkalinises the urine and causes the magnesium and calcium dissolved in the urine to become insoluble, precipitate out and form crystals on the catheter surface. It is generally assumed that Proteus is also the cause of stent encrustation but review of the literature suggests that this might not be so. Aim: The aim of this research was to identify the bacteria isolated from stents removed from patients after various indwelling periods, and to ascertain if any are capable of elevating the pH and thus inducing the precipitation of encrustation elements from the urine. Methods: Ureteric stents (n = 55) were collected from the City Hospital Nottingham, Nottingham, UK after their removal from patients. Sections were sonicated in 0.85% saline to dislodge bacteria from the stent surface, and sonicates plated semiquantitatively on selective media and incubated at 37ºC for 48 hours. Isolates were identified by colony morphology and API Identification kits (BioM´ erieux, France). Results: No Proteus spp were isolated from any of the removed stents. Bacteria were isolated without the presence of encrustation and no relationship between presence, degree or type of encrustation and isolation of bacteria was found. None of the isolates was a pronounced producer of urease. Conclusion: It seems unlikely that bacteria cause the encrustation of ureteric stents. This has obvious implications for manufacturers who are currently trying to produce antimicrobial stents, one of which has already been withdrawn due to failure to reduce encrustation. FP1.08 Failure to control a multidrug-resistant Enterobacter cloacae outbreak despite adequate implementation of recommended infection control measures A. Paauw, H. Blok, J. Verhoef, A. Fluit, T. Hopmans, A. Troelstra, M. Leverstein-van Hall *. University Medical Center Utrecht, Netherlands Background: Despite the implementation of internationally accepted guidelines on control of multiresistant Enterobacteriaceaea a large outbreak with an aminoglycoside-resistant Enterobacter cloacae (AREC) occurred in the UMCU from 2001 until today. This clone contains a conjugative R-plasmid carrying qnrA1, blaCTX-M-9 , aadB, and sulI, genes encoding resistance to quinolones, extended-spectrum beta-lactams, aminoglycosides and sulphamethoxazole, respectively. Aim: To determine whether the failure to control the outbreak resulted from insufficient guidelines for aminoglycosideresistant E. cloacae strains (ARECs) in general or from insufficient guidelines for this specific outbreak strain. Methods: 617 ARECs and aminoglycoside-susceptible Enterobacter cloacae (ASEC) stored in our laboratory from 2001 through 2005 were genotyped. The degree of dissemination of the outbreak strain, other ARECS, and aminoglycoside-susceptible E. cloacae strains for which no infection control measures were taken, were determined. In addition, 164 isolates from 13 other hospitals were genotyped. Results: Cluster analysis divided the ARECs into 47 different genotypes of which 4 (9%) were represented by more than 2 isolates. Next to the outbreak (131 pts) only 2 very small
S3 other outbreaks had occurred showing that the internationally recommended measures were successful for all strains but one. In contrast, among ASECs, for which no specific infection control measures were taken, 58/174 (33%) genotypes were identified in at least three patients. In addition, the outbreak strain was detected in 10 other hospital and long-term care facilities throughout the country and caused outbreaks in 3 of them. Conclusion: Some MRE are more epidemic than others and these strains may not be controlled by the current infection control guidelines. Strategies to identify such strains in an early phase as well as adapted guidelines for such “super bugs” are needed to prevent these clones to become endemic. FP1.09 A Novel Method of Skin Preparation J. Webb *, S. Hasham, S. Hoque, C. Bainbridge. Derby Royal Infirmary, UK Background: Since Lister introduced the theory of antisepsis in 1867, the practice of cleaning the skin surrounding the surgical site has been widely accepted. Peri-operative infection is a complication in all fields of surgery, but for implant surgery, in particular joint replacement surgery, a post operative infection can be a disaster for the patient. The majority of periprosthetic infections are thought to arise from the patient’s skin flora or air-borne contamination. Many surgeons perform an initial skin disinfection with antiseptic either prior to coming to theatre, or in the anaesthetic room; the limb then being wrapped in a sterile towel or occlusive film (eg Opsite® ) until the patient is on the operating table. This is often messy, with the limb frequently becoming contaminated. To overcome these problems, the senior author has designed a sterile surgical sleeve. The sleeve can be applied to the patient’s limb prior to entering the theatre and antiseptic inserted through a port. The nature of the sleeve promotes an even application of the preparation fluid, is a closed system, is not messy and has less risk of contamination. Aim: To investigate the value of the surgical sleeve in comparison with the traditional method of preparation. Methods: A non-inferiority study, which was a randomised, blinded controlled trial using healthy volunteers. The bacterial colony counts of the hand were compared after preparing the upper limb using the new surgical sleeve or using the traditional method of ‘painting’ on the antiseptic. The ‘glove juice’ method was used to extract the residual bacteria from the volunteer’s hand. Results: 60 volunteers entered the trial. There was a statistically significant reduction in the bacterial colony count after the surgical sleeve compared with the standard skin preparation. Discussion: We will demonstrate the use of the surgical sleeve and discuss its use. FP2.01 Impact of Infection Control (IC) Training Program on Nosocomial Infections (NI) and Perception of Healthcare Workers (HCW) in a Teaching Hospital A. Lenez1 *, H. Jannes1 , B. Heyneman1 , H. Sax2 , D. Pittet2 , D. Vogelaers3 , B. Gordts1 . 1 Sint-Jan General Hospital, Belgium, 2 University Hospitals Geneva, Switzerland, 3 University Hospital Ghent, Belgium Context: A significant increase in the incidence of NI due to multi-resistant nosocomial pathogens (MRNP) was observed hospital-wide throughout 2002 and 2003. The attitude towards and perception of NI due to MRNP among HCW was negative, compromising compliance with IC preventive measures. Objective: To improve the baseline level of knowledge about – and attitudes towards – standard and additional IC precautions among HCW in order to contain NI due to MRNP’s.
S3 other outbreaks had occurred showing that the internationally recommended measures were successful for all strains but one. In contrast, among ASECs, for which no specific infection control measures were taken, 58/174 (33%) genotypes were identified in at least three patients. In addition, the outbreak strain was detected in 10 other hospital and long-term care facilities throughout the country and caused outbreaks in 3 of them. Conclusion: Some MRE are more epidemic than others and these strains may not be controlled by the current infection control guidelines. Strategies to identify such strains in an early phase as well as adapted guidelines for such “super bugs” are needed to prevent these clones to become endemic. FP1.09 A Novel Method of Skin Preparation J. Webb *, S. Hasham, S. Hoque, C. Bainbridge. Derby Royal Infirmary, UK Background: Since Lister introduced the theory of antisepsis in 1867, the practice of cleaning the skin surrounding the surgical site has been widely accepted. Peri-operative infection is a complication in all fields of surgery, but for implant surgery, in particular joint replacement surgery, a post operative infection can be a disaster for the patient. The majority of periprosthetic infections are thought to arise from the patient’s skin flora or air-borne contamination. Many surgeons perform an initial skin disinfection with antiseptic either prior to coming to theatre, or in the anaesthetic room; the limb then being wrapped in a sterile towel or occlusive film (eg Opsite® ) until the patient is on the operating table. This is often messy, with the limb frequently becoming contaminated. To overcome these problems, the senior author has designed a sterile surgical sleeve. The sleeve can be applied to the patient’s limb prior to entering the theatre and antiseptic inserted through a port. The nature of the sleeve promotes an even application of the preparation fluid, is a closed system, is not messy and has less risk of contamination. Aim: To investigate the value of the surgical sleeve in comparison with the traditional method of preparation. Methods: A non-inferiority study, which was a randomised, blinded controlled trial using healthy volunteers. The bacterial colony counts of the hand were compared after preparing the upper limb using the new surgical sleeve or using the traditional method of ‘painting’ on the antiseptic. The ‘glove juice’ method was used to extract the residual bacteria from the volunteer’s hand. Results: 60 volunteers entered the trial. There was a statistically significant reduction in the bacterial colony count after the surgical sleeve compared with the standard skin preparation. Discussion: We will demonstrate the use of the surgical sleeve and discuss its use. FP2.01 Impact of Infection Control (IC) Training Program on Nosocomial Infections (NI) and Perception of Healthcare Workers (HCW) in a Teaching Hospital A. Lenez1 *, H. Jannes1 , B. Heyneman1 , H. Sax2 , D. Pittet2 , D. Vogelaers3 , B. Gordts1 . 1 Sint-Jan General Hospital, Belgium, 2 University Hospitals Geneva, Switzerland, 3 University Hospital Ghent, Belgium Context: A significant increase in the incidence of NI due to multi-resistant nosocomial pathogens (MRNP) was observed hospital-wide throughout 2002 and 2003. The attitude towards and perception of NI due to MRNP among HCW was negative, compromising compliance with IC preventive measures. Objective: To improve the baseline level of knowledge about – and attitudes towards – standard and additional IC precautions among HCW in order to contain NI due to MRNP’s.