- Email: [email protected]
P145 Effect of chlorhexidine mouth-wash on presence of Lactobacillus spp. in saliva of patients with chronic periodontitis
S72
Poster Presentations
P142 Impact of hand washing automatic door on nosocomial infections in the intensive care unit J. Kang1 *, Y. Kim1 , K. Song1 . 1 Good Samaritan Hospital, Pohang, Korea
Conclusion: The practical approach focussing on STS with limited time effort has led to a considerable increase in the consumption of ABHR in our institution indicating better compliance and was accompanied by a decrease in nosocomial MRSA transmission.
Objective: Hand hygiene is the cornerstone of nosocomial infections prevention worldwide. But hand hygiene compliance is usually low. To improve hand hygiene compliance, we made hand washing automatic door in intensive care unit (ICU). Health care workers and visitors must wash their hands to go into the ICU, otherwise they cannot open the door of ICU. The objective of this study was to ascertain the effect of a hand washing automatic door on ICU rates of nosocomial infection. Methods: We monitored the nosocomial infections in medical and surgical ICUs of one hospital in Pohang, Korea, before (phase one) and after setting up hand washing automatic door (phase two). Phase one was conducted from January 2006 to December 2007 and phase two was conducted from May to November 2008. Nosocomial infections in the ICUs were identified according to Centers for Disease Control criteria. Results: During the period of study, 6124 cases were admitted and 305 nosocomial infections were detected. The nosocomial infection rate fell from 10.6 per 1000 patient-days (270/25324) to 5.5 per 1000 patient-days (35/6312) (RR, 0.51; 95% CI, 0.36 0.73; P < 0.01). Ventilator-associated pneumonia rates significantly reduced from 6.3 to 0.8 per 1000 device days (P = 0.01). Device associated urinary tract infection rates also reduced from 5.0 to 2.7 per 1000 device days (P = 0.02). Central line-associated blood stream infection rates were 3.5 per 1000 device days before the intervention, and 0.6 per 1000 device days afterwards (P > 0.05). Conclusions: Hand washing automatic door resulted in significant reductions in rates of nosocomial infection.
P144 Surveillance of nosocomial bloodstream infections and pneumonia in patients with hematopoetic cell transplantation (‘ONKO-KISS’)
P143 Effect of short training sessions on hand hygiene: experiences at a German university hospital A. Conrad1 , K. Kaier1 , C. Reusch1 , R. Babikir1 , M. Bussmann1 , M. Dettenkofer *. 1 University Medical Center Freiburg, Freiburg, Germany Objective: Hand disinfection with an alcohol-based hand rub (ABHR) represents the most essential measure to prevent healthcareassociated infections. Hand hygiene is easy to perform, inexpensive and effective. Nevertheless, compliance at the point of care is usually far too low. Therefore improving hand hygiene is an essential duty. On the basis of the experiences and investigations at the University Medical Center Freiburg, Germany (UMCF), important aspects to improve hand hygiene are summed up. Methods: Participation in the German national hand hygiene campaign (www.aktion-sauberehaende.de), promotion of skin protection and care, introduction of colouring and perfume-free ABHR, use of individual bottles of ABHR in supplement to conventional dispensers and performance of short training sessions (STS). STS provided brief information on indications for hand disinfection, tips on improved hand hygiene and self evaluation of hand disinfection technique using fluorescent disinfectant and a UV-lamp. Results: Two hand hygiene campaigns were performed across the hospital, the first of which was initiated in 2004 within the context of a temporal VRE outbreak and the second took place in 2006. Altogether 32+17 STS were performed predominantly in high risk areas (intensive care and haematology wards). Hospital wide ABHR use increased from on average 50.1 L/1000 patient days in 2004 to 60.3 L/1000 PDs in 2007. In a multivariate model focussing on STS and bed occupancy, STS on hand hygiene were effective in the prevention of transmission of methicillin-resistant S. aureus (MRSA). At UMCF the incidence of nosocomial MRSA (patients infected or colonized with MRSA that turned positive more than 48 h after admission) decreased from 0.17/1000 PDs in 2004 to 0.11 in 2007.
M. Dettenkofer1 *, R. Babikir1 , H. Bertz1 , A. Widmer2 , W. Kern1 , P. Gastmeier3 . 1 University Medical Center Freiburg, Freiburg, Germany, 2 University Hospital Basel, Basel, Switzerland, 3 Charit´ e Berlin, Berlin, Germany Objective: For surveillance of nosocomial bloodstream infections (BSI) and pneumonia during neutropenia in adult patients undergoing hematopoetic cell transplantation (HCT), an ongoing multicenter surveillance project was initiated by the German National Reference Centre for Surveillance of Nosocomial Infections in 2000 (ONKO-KISS). Methods: Nosocomial Infections are identified using CDC definitions for laboratory-confirmed BSI and modified criteria for pneumonia in neutropenic patients [for detailed information see: CID 2005; 40: 926 31, or in German language: http://www.nrzhygiene.de/surveillance/onko.htm]. Results: Over the 60-month period from July 2003 up to June 2008 25 centers participated. Altogether 5,541 patients with 82,119 neutropenic days were investigated. Of these, 3,189 (58%) had undergone allogeneic and 2,352 (42%) autologous HCT. The mean length of neutropenia was 14.8 days (9.1 d after autologous and 19.0 d after allogeneic transplantation). In total, 870 bloodstream infections and 475 cases of pneumonia were identified. Incidence densities for allogeneic transplantation were 16.1 BSI/1,000 neutropenic days (ND) and for pneumonia 5.2/1,000 NDs (for autologous transpl.: 8.6/6.0). Following allogeneic transplantation, 16.5 BSI/100 patients and 11.4 cases of pneumonia/100 patients occurred whereas following autologous transplantation 14.7 cases of BSI/100 patients and 4.8 cases of pneumonia/100 patients were observed. The main pathogens associated with BSI were coagulase-negative staphylococci (49%). Conclusions: The ongoing ONKO-KISS project adds to the improvement of quality of care in HCT-patients by providing sound reference data on the occurrence of BSI and pneumonia during neutropenia. Since 2006, surveillance is extended to neutropenic patients with acute leukemia to allow participation for centers not performing HCT. P145 Effect of chlorhexidine mouth-wash on presence of Lactobacillus spp. in saliva of patients with chronic periodontitis A. Szkaradkiewicz1 *, A. Kuzma1 , T. Karpinski1 . 1 University of Medical Sciences in Poznan, Poznan, Poland Objective: Bacteria of Lactobacillus genus seem to play a key role in securing microecological equilibrium in oral cavity. Among other, the produce H2 O2 of potential anti-microbial activity. In previously presented studies, H2 O2 producing Lactobacillus spp. were demonstrated to have the potential to prevent progression of chronic diseases in periodontium. In turn, in treatment of periodontal diseases mouth-washes with chlorhexidine are routinely employed. The study aimed at analysis of Lactobacillus spp. manifestation in full saliva of patients with chronic periodontitis, in whom therapy with 0.1% chlorhexidine-containing mouth-wash (Eludril; Pierre Fabre) was employed. Methods: The study was conducted on 15 adult patients with a moderate form of chronic periodontitis. In the patients a single mouthwash with 0.1% chlorhexidine (Eludril) was employed. The material for studies involved saliva samples taken from the patients on three occasions: (I) before the mouth wash, (II) 1 2 h and (III) 24 h after the mouth-wash. Saliva samples were plated on Rogosa agar, cultured in anoxic conditions for 48 h and identified using the API 50 CHL test (bioM´ erieux). Ability of Lactobacillus spp. isolates to produce H2 O2
Friday, June 19, 2009 was evaluated on TMB-Plus agar, estimating production intensity as pronounced, moderate or a weak one. Results: Lactobacillus spp. were found to be present in saliva of every patients in all three time points of the studies. The ability of the isolates to produce H2 O2 is listed below: Time point of the study
I II III
Number of Lactobacillus spp. which produced H2 O2 : in a pronounced manner
moderately
weakly
12 8 12
3 5 3
0 2 0
Conclusions: Application of chlorhexidine-containing mouth-wash in patients with chronic periodontitis induces no stable disturbances in production of H2 O2 by Lactobacillus spp. in oral cavity. P146 Assessment of spatial regularity of anthrax spread on the Kyrgyz Republic territory V. Maitieva1 , D. Gaibulin1 , A. Junushov1 . 1 Republican Center of Quarantine and Especially Dangerous Infections, Institute of Biotechnologies of the National Academy of Sciences, Kyrgyz Republic, Bishkek, Bishkek, Kyrgyzstan Objectives: Anthrax sickness rate among people is relevant problem for the Kyrgyz Republic. The sickness rate is registered annually. Epidemiological trouble is connected with a great number of anthrax soil pesthole on the territory of the Republic. The purpose of research: systematization and concentration in a single whole all information in reference about all registered cases on the territorry of the Kyrgyz Republic which has stationary trouble pesthole and identify polution regularity on the territory with anthrax pathogen. 1. Comparing analysis of archival and modern information about stationary trouble on anthrax. 2. Collected information analysis about stationary trouble localization on anthrax with reference of modern administrative-political seperation of the Kyrgyz Republic territory. 3. Interconnection of stationary trouble on anthrax points with the surface maps. 4. Regional division of the territory on the anthrax rate. 5. Recommendations development on difference plannig of activities against the anthrax depending on territory rate trouble. Methods of research: compared-historical, compared-geographical, informational-cartografic. GPS device is used navigator “Magellan Meredian Platinum” for applying to anthrax pesthole on electronical map. Data is copied from GPS-navigator to computer and converted into program of three-dimensional Earth model “Google Earth”. Results: 1. Cadastre of stationary trouble on the points anthrax on the Kyrgyz Republic is established. 2. The assesment on pollution regularity on the territory of Kyrgyzstan by anthrax pathogen is gaven. 3. The most potential trouble regions are identified. 4. Recommendations on difference planning of activities against anthrax are developed. Seasonal anthrax appearace is studied many years analysis (1941 2007) on animal and human anthrax on the Kyrgyz Republic. The most practical interest is given by data of 1983 1992. Acute period of increased intensivity of epizootic process is reduced up to 5 months (May-September), and maximum number of pesthole sickness was registered in May and July. One of the most impointant problem in the research was research of spatial regularity of territorial points anthrax stationary trouble, surface maps (landscape, soil) for identifing concentration pecularities in different regions. On the basis of claster analysis the interconection of 5 main indicators of soil-climate factors was studied; the type of soil and content of humus; soil ratio to relief; the type of soil and quantity of precipitations, the type of soil and climatic zone; the type of soil and amount of days with daily temperature above +10ºC. The concluded results of the research was creating electronical cadastre. Conclusion: This Cadastre on stationary trouble on anthrax points account in planning and implementation of any building, irrigation and
S73
drainage construction geoligical and other works following by grooving and groind dislocation. P147 The importance of temporal and spatial clusters of Clostridium difficile infections (CDI) in a teaching hospital over a 2-year period I. Pavlov1 *, K. Weiss2 , M. Dubreuil2 . 1 Universit´ e de Montr´ eal, Montreal, Canada, 2 Maisonneuve-Rosemont Hospital, Montreal, Canada Objectives: Since 2002, our hospital has witnessed a surge in the incidence of CDI, with over 80% of the cases attributable to the B1/NAP1/027 ribotype. Although rates went down significantly in 2006 2007, we are still facing clusters of CDI cases over time. The main objective of this study was to evaluate the importance of the temporal-spatial link between CDI cases. Methods: Retrospective cohort and nested case-control studies of patients who acquired CDI after admission to Maisonneuve-Rosemont Hospital from April 1st, 2006 to March 31, 2008. Out of 11 units (419 beds), 4 (2 medical, 2 surgical; 159 beds) accounted for 49.7% (185/372) of all the cases and were considered high incidence units. The seven remaining units (5 medical, 2 surgical) formed the low incidence group. Long-term care, psychiatry, obstetrics, neonatal, and short-term units were excluded from the analysis. Clusters of CDI were defined as the occurrence of at least 3 new cases within a 21-day period on the same ward. Results: As much as 250/372 (67.2%) of all CDI cases were part of a cluster. In high incidence units, clusters were significantly more frequent, followed a strikingly sawtooth temporal pattern, with less seasonal variation. No. of cases on same ward within preceding 21 days of a new CDI case (%) 0 1 2 or more
Incidence of new CDI cases (per 1000 admissions) Total Cluster-attributable
4 High incidence units (n = 185)
46 (24.9)
50 (27.0)
89 (48.1)*
17.9
7 Low incidence units (n = 187)
62 (33.2)
58 (31.0)
67 (35.8)*
14.0
8.6† 5.0†
*OR 1.66; 95%CI [1.10 2.52]; † OR 1.72; 95%CI [1.25 2.37].
Conclusion: Time-space clustering explains a sizeable proportion of CDI cases in our hospital. Clusters were more likely to occur in high incidence wards, and abated very rapidly with a multi-pronged intervention reinforcing infection control practices. P148 Improved hand hygiene compliance after education of health care workers in adult intensive care units in Saudi Arabia Z. Memish1 *, A. El-Saed1 , E. Tannous1 . 1 King Abdulaziz Medical City, Riyadh, Saudi Arabia Objectives: to monitor the rates of hand hygiene compliance practices in adult ICUs of King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia, before and after implementation of an intensive educational campaign. Methods: Hand hygiene compliance practices among healthcare workers (HCWs) were monitored in four adult ICUs (general, burns, cardiovascular, and medical-cardiac ICUs) at November and December 2007 (baseline period) and again at August 2008 (follow up period). The HCWs were subjected to series of hand hygiene education sessions at April through July 2008. The WHO five indication moments used to define a hand hygiene opportunity were; before patient contact, before an aseptic task, after body fluid exposure risk, after patient contact, and after contact with patient surroundings. Acceptable action was alcohol rubbing or hand washing. Results: A total of 1658 hand hygiene opportunities were observed (824 baseline and 834 follow up). Hand hygiene compliance rate was 45.3% during baseline and 59.9% during follow up periods. Compared to baseline, rubbing increased (63.8% to 79.2%) while washing decreased (36.2 to 20.8%) during the follow up period (p < 0.001). Compliance rate improvement (average 14.6%) was highest among other HCWs (20.0%) followed by nurses (14.8%) and finally doctors (11.1%). Burns ICU had the highest improvement among adult ICUs (18.6%). The only
Poster Presentations
P142 Impact of hand washing automatic door on nosocomial infections in the intensive care unit J. Kang1 *, Y. Kim1 , K. Song1 . 1 Good Samaritan Hospital, Pohang, Korea
Conclusion: The practical approach focussing on STS with limited time effort has led to a considerable increase in the consumption of ABHR in our institution indicating better compliance and was accompanied by a decrease in nosocomial MRSA transmission.
Objective: Hand hygiene is the cornerstone of nosocomial infections prevention worldwide. But hand hygiene compliance is usually low. To improve hand hygiene compliance, we made hand washing automatic door in intensive care unit (ICU). Health care workers and visitors must wash their hands to go into the ICU, otherwise they cannot open the door of ICU. The objective of this study was to ascertain the effect of a hand washing automatic door on ICU rates of nosocomial infection. Methods: We monitored the nosocomial infections in medical and surgical ICUs of one hospital in Pohang, Korea, before (phase one) and after setting up hand washing automatic door (phase two). Phase one was conducted from January 2006 to December 2007 and phase two was conducted from May to November 2008. Nosocomial infections in the ICUs were identified according to Centers for Disease Control criteria. Results: During the period of study, 6124 cases were admitted and 305 nosocomial infections were detected. The nosocomial infection rate fell from 10.6 per 1000 patient-days (270/25324) to 5.5 per 1000 patient-days (35/6312) (RR, 0.51; 95% CI, 0.36 0.73; P < 0.01). Ventilator-associated pneumonia rates significantly reduced from 6.3 to 0.8 per 1000 device days (P = 0.01). Device associated urinary tract infection rates also reduced from 5.0 to 2.7 per 1000 device days (P = 0.02). Central line-associated blood stream infection rates were 3.5 per 1000 device days before the intervention, and 0.6 per 1000 device days afterwards (P > 0.05). Conclusions: Hand washing automatic door resulted in significant reductions in rates of nosocomial infection.
P144 Surveillance of nosocomial bloodstream infections and pneumonia in patients with hematopoetic cell transplantation (‘ONKO-KISS’)
P143 Effect of short training sessions on hand hygiene: experiences at a German university hospital A. Conrad1 , K. Kaier1 , C. Reusch1 , R. Babikir1 , M. Bussmann1 , M. Dettenkofer *. 1 University Medical Center Freiburg, Freiburg, Germany Objective: Hand disinfection with an alcohol-based hand rub (ABHR) represents the most essential measure to prevent healthcareassociated infections. Hand hygiene is easy to perform, inexpensive and effective. Nevertheless, compliance at the point of care is usually far too low. Therefore improving hand hygiene is an essential duty. On the basis of the experiences and investigations at the University Medical Center Freiburg, Germany (UMCF), important aspects to improve hand hygiene are summed up. Methods: Participation in the German national hand hygiene campaign (www.aktion-sauberehaende.de), promotion of skin protection and care, introduction of colouring and perfume-free ABHR, use of individual bottles of ABHR in supplement to conventional dispensers and performance of short training sessions (STS). STS provided brief information on indications for hand disinfection, tips on improved hand hygiene and self evaluation of hand disinfection technique using fluorescent disinfectant and a UV-lamp. Results: Two hand hygiene campaigns were performed across the hospital, the first of which was initiated in 2004 within the context of a temporal VRE outbreak and the second took place in 2006. Altogether 32+17 STS were performed predominantly in high risk areas (intensive care and haematology wards). Hospital wide ABHR use increased from on average 50.1 L/1000 patient days in 2004 to 60.3 L/1000 PDs in 2007. In a multivariate model focussing on STS and bed occupancy, STS on hand hygiene were effective in the prevention of transmission of methicillin-resistant S. aureus (MRSA). At UMCF the incidence of nosocomial MRSA (patients infected or colonized with MRSA that turned positive more than 48 h after admission) decreased from 0.17/1000 PDs in 2004 to 0.11 in 2007.
M. Dettenkofer1 *, R. Babikir1 , H. Bertz1 , A. Widmer2 , W. Kern1 , P. Gastmeier3 . 1 University Medical Center Freiburg, Freiburg, Germany, 2 University Hospital Basel, Basel, Switzerland, 3 Charit´ e Berlin, Berlin, Germany Objective: For surveillance of nosocomial bloodstream infections (BSI) and pneumonia during neutropenia in adult patients undergoing hematopoetic cell transplantation (HCT), an ongoing multicenter surveillance project was initiated by the German National Reference Centre for Surveillance of Nosocomial Infections in 2000 (ONKO-KISS). Methods: Nosocomial Infections are identified using CDC definitions for laboratory-confirmed BSI and modified criteria for pneumonia in neutropenic patients [for detailed information see: CID 2005; 40: 926 31, or in German language: http://www.nrzhygiene.de/surveillance/onko.htm]. Results: Over the 60-month period from July 2003 up to June 2008 25 centers participated. Altogether 5,541 patients with 82,119 neutropenic days were investigated. Of these, 3,189 (58%) had undergone allogeneic and 2,352 (42%) autologous HCT. The mean length of neutropenia was 14.8 days (9.1 d after autologous and 19.0 d after allogeneic transplantation). In total, 870 bloodstream infections and 475 cases of pneumonia were identified. Incidence densities for allogeneic transplantation were 16.1 BSI/1,000 neutropenic days (ND) and for pneumonia 5.2/1,000 NDs (for autologous transpl.: 8.6/6.0). Following allogeneic transplantation, 16.5 BSI/100 patients and 11.4 cases of pneumonia/100 patients occurred whereas following autologous transplantation 14.7 cases of BSI/100 patients and 4.8 cases of pneumonia/100 patients were observed. The main pathogens associated with BSI were coagulase-negative staphylococci (49%). Conclusions: The ongoing ONKO-KISS project adds to the improvement of quality of care in HCT-patients by providing sound reference data on the occurrence of BSI and pneumonia during neutropenia. Since 2006, surveillance is extended to neutropenic patients with acute leukemia to allow participation for centers not performing HCT. P145 Effect of chlorhexidine mouth-wash on presence of Lactobacillus spp. in saliva of patients with chronic periodontitis A. Szkaradkiewicz1 *, A. Kuzma1 , T. Karpinski1 . 1 University of Medical Sciences in Poznan, Poznan, Poland Objective: Bacteria of Lactobacillus genus seem to play a key role in securing microecological equilibrium in oral cavity. Among other, the produce H2 O2 of potential anti-microbial activity. In previously presented studies, H2 O2 producing Lactobacillus spp. were demonstrated to have the potential to prevent progression of chronic diseases in periodontium. In turn, in treatment of periodontal diseases mouth-washes with chlorhexidine are routinely employed. The study aimed at analysis of Lactobacillus spp. manifestation in full saliva of patients with chronic periodontitis, in whom therapy with 0.1% chlorhexidine-containing mouth-wash (Eludril; Pierre Fabre) was employed. Methods: The study was conducted on 15 adult patients with a moderate form of chronic periodontitis. In the patients a single mouthwash with 0.1% chlorhexidine (Eludril) was employed. The material for studies involved saliva samples taken from the patients on three occasions: (I) before the mouth wash, (II) 1 2 h and (III) 24 h after the mouth-wash. Saliva samples were plated on Rogosa agar, cultured in anoxic conditions for 48 h and identified using the API 50 CHL test (bioM´ erieux). Ability of Lactobacillus spp. isolates to produce H2 O2
Friday, June 19, 2009 was evaluated on TMB-Plus agar, estimating production intensity as pronounced, moderate or a weak one. Results: Lactobacillus spp. were found to be present in saliva of every patients in all three time points of the studies. The ability of the isolates to produce H2 O2 is listed below: Time point of the study
I II III
Number of Lactobacillus spp. which produced H2 O2 : in a pronounced manner
moderately
weakly
12 8 12
3 5 3
0 2 0
Conclusions: Application of chlorhexidine-containing mouth-wash in patients with chronic periodontitis induces no stable disturbances in production of H2 O2 by Lactobacillus spp. in oral cavity. P146 Assessment of spatial regularity of anthrax spread on the Kyrgyz Republic territory V. Maitieva1 , D. Gaibulin1 , A. Junushov1 . 1 Republican Center of Quarantine and Especially Dangerous Infections, Institute of Biotechnologies of the National Academy of Sciences, Kyrgyz Republic, Bishkek, Bishkek, Kyrgyzstan Objectives: Anthrax sickness rate among people is relevant problem for the Kyrgyz Republic. The sickness rate is registered annually. Epidemiological trouble is connected with a great number of anthrax soil pesthole on the territory of the Republic. The purpose of research: systematization and concentration in a single whole all information in reference about all registered cases on the territorry of the Kyrgyz Republic which has stationary trouble pesthole and identify polution regularity on the territory with anthrax pathogen. 1. Comparing analysis of archival and modern information about stationary trouble on anthrax. 2. Collected information analysis about stationary trouble localization on anthrax with reference of modern administrative-political seperation of the Kyrgyz Republic territory. 3. Interconnection of stationary trouble on anthrax points with the surface maps. 4. Regional division of the territory on the anthrax rate. 5. Recommendations development on difference plannig of activities against the anthrax depending on territory rate trouble. Methods of research: compared-historical, compared-geographical, informational-cartografic. GPS device is used navigator “Magellan Meredian Platinum” for applying to anthrax pesthole on electronical map. Data is copied from GPS-navigator to computer and converted into program of three-dimensional Earth model “Google Earth”. Results: 1. Cadastre of stationary trouble on the points anthrax on the Kyrgyz Republic is established. 2. The assesment on pollution regularity on the territory of Kyrgyzstan by anthrax pathogen is gaven. 3. The most potential trouble regions are identified. 4. Recommendations on difference planning of activities against anthrax are developed. Seasonal anthrax appearace is studied many years analysis (1941 2007) on animal and human anthrax on the Kyrgyz Republic. The most practical interest is given by data of 1983 1992. Acute period of increased intensivity of epizootic process is reduced up to 5 months (May-September), and maximum number of pesthole sickness was registered in May and July. One of the most impointant problem in the research was research of spatial regularity of territorial points anthrax stationary trouble, surface maps (landscape, soil) for identifing concentration pecularities in different regions. On the basis of claster analysis the interconection of 5 main indicators of soil-climate factors was studied; the type of soil and content of humus; soil ratio to relief; the type of soil and quantity of precipitations, the type of soil and climatic zone; the type of soil and amount of days with daily temperature above +10ºC. The concluded results of the research was creating electronical cadastre. Conclusion: This Cadastre on stationary trouble on anthrax points account in planning and implementation of any building, irrigation and
S73
drainage construction geoligical and other works following by grooving and groind dislocation. P147 The importance of temporal and spatial clusters of Clostridium difficile infections (CDI) in a teaching hospital over a 2-year period I. Pavlov1 *, K. Weiss2 , M. Dubreuil2 . 1 Universit´ e de Montr´ eal, Montreal, Canada, 2 Maisonneuve-Rosemont Hospital, Montreal, Canada Objectives: Since 2002, our hospital has witnessed a surge in the incidence of CDI, with over 80% of the cases attributable to the B1/NAP1/027 ribotype. Although rates went down significantly in 2006 2007, we are still facing clusters of CDI cases over time. The main objective of this study was to evaluate the importance of the temporal-spatial link between CDI cases. Methods: Retrospective cohort and nested case-control studies of patients who acquired CDI after admission to Maisonneuve-Rosemont Hospital from April 1st, 2006 to March 31, 2008. Out of 11 units (419 beds), 4 (2 medical, 2 surgical; 159 beds) accounted for 49.7% (185/372) of all the cases and were considered high incidence units. The seven remaining units (5 medical, 2 surgical) formed the low incidence group. Long-term care, psychiatry, obstetrics, neonatal, and short-term units were excluded from the analysis. Clusters of CDI were defined as the occurrence of at least 3 new cases within a 21-day period on the same ward. Results: As much as 250/372 (67.2%) of all CDI cases were part of a cluster. In high incidence units, clusters were significantly more frequent, followed a strikingly sawtooth temporal pattern, with less seasonal variation. No. of cases on same ward within preceding 21 days of a new CDI case (%) 0 1 2 or more
Incidence of new CDI cases (per 1000 admissions) Total Cluster-attributable
4 High incidence units (n = 185)
46 (24.9)
50 (27.0)
89 (48.1)*
17.9
7 Low incidence units (n = 187)
62 (33.2)
58 (31.0)
67 (35.8)*
14.0
8.6† 5.0†
*OR 1.66; 95%CI [1.10 2.52]; † OR 1.72; 95%CI [1.25 2.37].
Conclusion: Time-space clustering explains a sizeable proportion of CDI cases in our hospital. Clusters were more likely to occur in high incidence wards, and abated very rapidly with a multi-pronged intervention reinforcing infection control practices. P148 Improved hand hygiene compliance after education of health care workers in adult intensive care units in Saudi Arabia Z. Memish1 *, A. El-Saed1 , E. Tannous1 . 1 King Abdulaziz Medical City, Riyadh, Saudi Arabia Objectives: to monitor the rates of hand hygiene compliance practices in adult ICUs of King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia, before and after implementation of an intensive educational campaign. Methods: Hand hygiene compliance practices among healthcare workers (HCWs) were monitored in four adult ICUs (general, burns, cardiovascular, and medical-cardiac ICUs) at November and December 2007 (baseline period) and again at August 2008 (follow up period). The HCWs were subjected to series of hand hygiene education sessions at April through July 2008. The WHO five indication moments used to define a hand hygiene opportunity were; before patient contact, before an aseptic task, after body fluid exposure risk, after patient contact, and after contact with patient surroundings. Acceptable action was alcohol rubbing or hand washing. Results: A total of 1658 hand hygiene opportunities were observed (824 baseline and 834 follow up). Hand hygiene compliance rate was 45.3% during baseline and 59.9% during follow up periods. Compared to baseline, rubbing increased (63.8% to 79.2%) while washing decreased (36.2 to 20.8%) during the follow up period (p < 0.001). Compliance rate improvement (average 14.6%) was highest among other HCWs (20.0%) followed by nurses (14.8%) and finally doctors (11.1%). Burns ICU had the highest improvement among adult ICUs (18.6%). The only