P12.25 Water from Dental Units as a Potential Source of Infection in Patients and a Dental Team - Bacteriological Assessment

Poster Presentations Conclusions: In subsequent work we will seek to determine if the patient-held record reduces errors in care and how it can interface with other patient information and an MRSA care plan. P12.25 Water from Dental Units as a Potential Source of Infection in Patients and a Dental Team – Bacteriological Assessment J. Szymanska1 *, J. Sitkowska2 . 1 Medical University of Lublin, Poland, 2 Institute of Agricultural Medicine, Lublin, Poland Background: The quality of water from dental unit waterlines (DUWL) is of considerable importance since patients, especially immunocompromised individuals, and dental team may be exposed to water and droplet water aerosol generated from dental unit. Aim: The aim of this study was to determine the concentration and composition of the aerobe and facultative anaerobe bacterial microflora of the DUWL water. Methods: The research was conducted on 25 operative sites (dental units) located in public dental clinics. From each unit, water from the reservoir and the high-speed handpiece was simultaneously collected in an aseptic way. The bacterial flora was determined with the plate culture method. Bacteria were identified with biochemical microtests: API 20E, API 20 NE (bioM´ erieux, France) and GP2 MicroPlateTM (BIOLOG, USA). Results: The average concentration of total bacteria in the water samples collected from reservoirs was 201 039 cfu/ml, and in those from high-speed handpieces it was 151 510 cfu/ml. In all the samples, Ralstonia pickettii (Pseudomonas pickettii) prevailed. In the reservoir water, it constituted 96.5%, and in the handpiece water 68.59% of the total isolated bacteria. Besides, in the handpiece water, ca. 25% of the total bacteria was classified as Sphingomonas paucimobilis, and 4.5% as Streptoccoccus spp. Discussion: Bacteria identified in the DUWL water are mainly species commonly present in water supplying systems. However, the level of bacterial contamination of the DUWL water significantly exceeds recommended norms, and the concentration of Gram-negative bacteria, which are a source of bacterial endotoxin, is high. Among the identified bacterial flora, there are bacteria typical for the human oral cavity. Conclusion: Considering the fact that the examined DUWL water may be a potential source of health risk to patients and a dental team, it is necessary to implement procedures which would significantly improve microbiologial quality of the DUWL water.

S67 sustained, Defined Daily Dose (DDD) and hospital expenditure on “Big-Gun” antibiotics have reduced. Conclusion: Reducing antibiotic resistance requires a concerted effort from all parties. Infection control nurses can play an active role in enhancing effective antibiotic usage. P12.27 Endotracheal Tube Policy and Prevention of Ventilator-Associated Pneumonia and Maxillary Sinusitis, a Systematic Review of Randomised Controlled Trial B.S. Niel-Weise1 *, P.J. Van den Broek2 . 1 Leiden University Medical Center; Office of the Infection Prevention Working Party, Netherlands, 2 Leiden University Medical Centre; Department of Infectious Diseases, Netherlands Introduction: The Dutch Infection Prevention Working Party (WIP) gives recommendations and draws up guidelines for infection control in healthcare. Within the scope of making guidelines evidence-based, the question arose whether nasotracheal intubation should be preferred over orotracheal intubation in terms of prevention of ventilator-associated pneumonia (VAP) and nosocomial maxillary sinusitis (NMS). This question was answered by a systematic review. Methods: Randomised controlled trials (RCTs), quasi-RCTs and systematic reviews/meta-analysis of RCTs or quasi-RCTs were identified by a systematic search strategy in Medline and the Cochrane Controlled Trials Register up to April 2006. Trials investigating mechanically ventilated patients with nasal or oral endotracheal tubes and presenting sufficient data for calculating the risk of VAP and/or NMS in the treatment and control groups were selected. Two reviewers independently assessed trial quality (concealment of allocation, description of dropouts and intention-to-treat analysis) and extracted data on study population, interventions and outcomes. Disagreements were resolved by discussion. Results: Five trials were included in the review. The quality of the trials and the way they were reported were generally unsatisfactory. A single trial found a non significant difference on the incidence of VAP in favour of orotracheal intubation. The pooled results of five trials indicate that orotracheal intubation is associated with a lower incidence of NMS compared with nasotracheal intubation. Just two out of five trials used a strict definition of NMS and showed inconsistent results. Conclusion: There is insufficient evidence to recommend preferential use of either nasotracheal or orotracheal tubes to prevent VAP or NMS. Other advantages/disadvantages of both methods should determine the choice of intubation route.

P12.26 Infection Control Nurses’ Role Extension – Enhancing Prescriptive Practices on ‘Big-Gun’ Antibiotics

P12.28 Evaluation of Guidelines to Prevent Transmission of MRSA in Long-term Care Facilities

Y.F.S. Kwan *. Queen Mary Hospital, Hong Kong, China

C. Ahren1 *, A. Lindqvist2 , U. Ransjo3 . 1 Sahlgrenska University Hospital, Sweden, 2 Regional Unit for Infectious Diseases Control, Goteborg, Sweden, 3 Uppsala University Hospital, Sweden

Background: The emergence of multi-drug resistant microorganisms poses a problem to patients, hospitals and the community at large. Many studies have confirmed antibiotics have been prescribed without clear indication. Antibiotic stewardship programme aims at reducing inappropriate antibiotic usage through education and feedback. Infection control nurses extend their role beyond surveillance and control of nosocomial infections. Objectives: 1. To enhance effectiveness of antibiotic stewardship team; 2. To extend an infection control nurse’s role. Method: On the day after “Big-gun” antibiotic initiation, infection control nurse reviews patient’s indication for prescription and present data at antbiotic stewardship team meeting. If the prescription is deemed inappropriate, a memo containing guidelines will be issued to the prescribing doctor. Result: 1936 cases had been reviewed from September 2004 to March 2006. While conformance to guidelines has been

Background: Transmission of methicillin-resistent Staphyloccocus aureus (MRSA) between hospitals and long-term care facilities (LTCF) is an increasing problem worldwide. During the late 1990s the western part of Sweden had a sudden change in epidemiology that demanded new guidelines for the care of MRSA-patients in LTCF. No guidelines were available in Sweden or countries with comparable MRSA epidemiology at that time. Aim: To evaluate the adherence to the regional guidelines for care of MRSA-patients in LTCF and to investigate possible MRSA transmission by screen cultures. Methods: Seven LTCF where patients with MRSA had been nursed for 6 months–8 years were investigated. Patients, copatients and staff were screened in nose, throat, and if so skin lesions and catheter-urine. Three questionnaires asked for