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P1711 Reduction of healthcare-associated infection rates in a Swiss university hospital following hand hygiene promotion
Infection control and nosocomial infections Materials and Methods: A panel of 30 strains was assembled comprising 11 characterised epidemic strains (SE clone, Oxa-23 clones 1 and 2, European clones, etc.) 12 representatives of more minor outbreak strains, and 7 sporadic isolates. The following products (active agent) were tested: 1. Purell gel (62% ethyl alcohol), 2. Desderman gel (78.2% ethanol + 0.1% phenylphenol), 3. Sterzac bath liquid (2% Triclosan, isopropyl alcohol etc.), 4. Hydrex (0.5% chlorhexidine gluconate w/v in 70% v/v DEB), 5. Betadine (10% povidone-iodine). Agents were tested for activity using the prEN 12054 European standard method. Standardised bacterial test suspensions (1 mL) were mixed with products (9 mL) and survival at 30 s, 1 min and 5 min was determined by viable counts on agar. Results: The minimum requirement for bactericidal activity for compliance with prEN 12054 is a 10(5)-fold reduction in viable count within 1 min. Each product tested fulfilled prEN 12054. We conclude that A. baumannii are killed by commonly used topical antiseptics and hand hygiene should be effective in limiting their spread in hospitals.
P1710 Infection risk for filamentous fungi in water in a paediatric haematology/oncology ward H. Kennedy, C. Williams (Glasgow, UK) Objectives: Filamentous fungi from the air, particularly Aspergillus spp., cause severe opportunistic infection in immunocompromised patients. However, there is now some data to suggest that hospital water may also be a potential source of these organisms. The present study examined tap water in a paediatric haematology/oncology unit for the presence of fungi. Methods: Tap water (hot and cold) samples from three rooms in the haematology/oncology ward were collected and passed through sterile 0.45um filters (Millipore). Filters were then transferred to Sabouraud dextrose agar plates supplemented with chloramphenicol and incubated for one week. Fungal isolates were identified by macroscopic and microscopic characteristics. This procedure was repeated one month later. Any fungal isolates, which could not be identified in-house, were sent to the HPA Mycology Reference Laboratory, Bristol, UK for identification. Results: Filamentous fungi were cultured from eleven of the twelve water samples. Exophiala was isolated from 83% of the water samples, Fusarium (not F. solani or F. oxysporum) from 25%, Verticillium from 17%, Phoma from 25%, Penicillium from 8% and a phialidic mould which could not be identified precisely but which resembled Fusarium was isolated from 92%. The distribution of fungi from the two sampling periods was similar. There was no evidence of Aspergillus spp. Conclusion: This study demonstrated that various filamentous fungi were present in the water system but that the major opportunistic pathogen Aspergillus was absent. Exopiaila, Fusarium and Verticullium spp. are widely distributed in soil and plants and may be found in aqueous environments. The absence of Aspergillus spp. is desirable and is probably influenced by the water storage and distribution system (following chlorination), which prevents exposure to large volumes of air from which Aspergillus spores could potentially cause contamination. Further studies on filamentous fungi in hospital water systems are required to investigate the organisms’ ability to persist, their role in biofilm formation and their clinical significance.
P1711 Reduction of healthcare-associated infection rates in a Swiss university hospital following hand hygiene promotion I. U¸ckay, D. Pittet, C. Ginet, H. Sax (Geneva, CH) Background: Hand hygiene is considered the single most effective measure to reduce healthcare-associated infection.
S485 Objective: To measure the prevalence of healthcare-associated infection at the University of Geneva Hospitals before and during participation in a national hand hygiene promotion campaign (www.swisshandhygiene.ch). Methods: Two hospital-wide period-prevalence studies including all healthcare-associated infections according to CDC definitions were conducted in May 2004 and May 2006. The assessment took place two years before and four month after the launch of a multimodal promotional hand hygiene campaign. An experienced infection control team collected data from all hospitalised patients (except for the psychiatric service) according to a standard, unchanged protocol. Other major infection control strategies were ongoing unchanged in parallel since 2003. Results: In 2004, 1,494 patients were included in the study; in 2006, there were 1,560 patients. Overall compliance with hand hygiene recommendations improved from 57% to 64% (p < 0.001). Patient’s case mix between the periods was equivalent based on McCabe score (p = 0.2). The prevalence of nosocomial infections decreased by 20% hospitalwide, from 12.8% to 10.2% (OR, 0.77; p = 0.03; 95% CI, 0.61–0.97). It decreased from 11.8% to 9.6% in the acute care sectors, and from 13.9% to 11.0% in the long-term sectors. The three most prevalent infections in 2006 were urinary tract (26%), respiratory tract (26%) and surgical site infections (19%). By assuming an average attributable cost of €2,200 per infection, saving equalled at least €1.8 million in 2006. Conclusion: A multimodal hand hygiene promotion campaign was associated with a successful reduction of healthcare-acquired infections, in both acute and long-term care sectors. Long-term follow-up is required to assess the continuous impact of the strategy. P1712 Layperson’s technique of hand washing: is it effective in reducing bacterial carriage? Z. Sekawi, F. Jamal (UPM Serdang, MY) Introduction: In spite of major advances in the diagnosis, treatment and prevention of infectious diseases, cross infections in hospitals continue to be a major problem worldwide. Frequent hand washing among healthcare personnel using a proper prescribed technique has been shown to reduce the spread of causative agents of these infections. More often, this technique comprising several systematic steps is considered a nuisance to some personnel and therefore, compliance to this technique may not be desirable and will pose problems such as increase in hospital acquired infections. To encourage compliance, a simple routine household technique of hand washing may be considered as an alternative albeit less superior. Is a layperson’s technique of hand washing effective in reducing bacterial carriage? Objectives: To determine bacterial flora of hands of staff and students in Faculty of Medicine and Health Sciences, Universiti Putra Malaysia and to determine the effectiveness of layperson’s hand washing on bacterial carriage. Method: A cross-sectional study with non-probability convenience sampling was carried out at the faculty premises. Two hundred and twenty eight participants were asked to inoculate their right hand fingertips on the blood agar plates before and after washing their hands with antimicrobial soap using their own usual routine technique. Instruction on proper hand washing was not given. The agar plates were then incubated at 37ºC for 18−24 hours and inspected by standard methods. Results: All participants but four (98.2%) had Staphylococcus aureus on their hands while 80 (35.1%) participants had Bacillus spp. before washing. Other organisms such as Streptococcus spp., Corynebacterium spp., unidentified Gram-negative bacteria and fungus were found on four participants. One hundred and sixty-three (71.5%) of 228 participants had reduction in bacterial hand flora after hand washing. Sociodemographic factors such as gender, age, ethnic groups, occupation and income were analysed and found to be statistically insignificant. Conclusion: It is shown that simple routine household technique of hand washing can reduce the carriage of bacteria on the hands considerably. This implies that healthcare worker’s ignorance on the proper hand washing technique but using their routine layman’s technique of hand
P1710 Infection risk for filamentous fungi in water in a paediatric haematology/oncology ward H. Kennedy, C. Williams (Glasgow, UK) Objectives: Filamentous fungi from the air, particularly Aspergillus spp., cause severe opportunistic infection in immunocompromised patients. However, there is now some data to suggest that hospital water may also be a potential source of these organisms. The present study examined tap water in a paediatric haematology/oncology unit for the presence of fungi. Methods: Tap water (hot and cold) samples from three rooms in the haematology/oncology ward were collected and passed through sterile 0.45um filters (Millipore). Filters were then transferred to Sabouraud dextrose agar plates supplemented with chloramphenicol and incubated for one week. Fungal isolates were identified by macroscopic and microscopic characteristics. This procedure was repeated one month later. Any fungal isolates, which could not be identified in-house, were sent to the HPA Mycology Reference Laboratory, Bristol, UK for identification. Results: Filamentous fungi were cultured from eleven of the twelve water samples. Exophiala was isolated from 83% of the water samples, Fusarium (not F. solani or F. oxysporum) from 25%, Verticillium from 17%, Phoma from 25%, Penicillium from 8% and a phialidic mould which could not be identified precisely but which resembled Fusarium was isolated from 92%. The distribution of fungi from the two sampling periods was similar. There was no evidence of Aspergillus spp. Conclusion: This study demonstrated that various filamentous fungi were present in the water system but that the major opportunistic pathogen Aspergillus was absent. Exopiaila, Fusarium and Verticullium spp. are widely distributed in soil and plants and may be found in aqueous environments. The absence of Aspergillus spp. is desirable and is probably influenced by the water storage and distribution system (following chlorination), which prevents exposure to large volumes of air from which Aspergillus spores could potentially cause contamination. Further studies on filamentous fungi in hospital water systems are required to investigate the organisms’ ability to persist, their role in biofilm formation and their clinical significance.
P1711 Reduction of healthcare-associated infection rates in a Swiss university hospital following hand hygiene promotion I. U¸ckay, D. Pittet, C. Ginet, H. Sax (Geneva, CH) Background: Hand hygiene is considered the single most effective measure to reduce healthcare-associated infection.
S485 Objective: To measure the prevalence of healthcare-associated infection at the University of Geneva Hospitals before and during participation in a national hand hygiene promotion campaign (www.swisshandhygiene.ch). Methods: Two hospital-wide period-prevalence studies including all healthcare-associated infections according to CDC definitions were conducted in May 2004 and May 2006. The assessment took place two years before and four month after the launch of a multimodal promotional hand hygiene campaign. An experienced infection control team collected data from all hospitalised patients (except for the psychiatric service) according to a standard, unchanged protocol. Other major infection control strategies were ongoing unchanged in parallel since 2003. Results: In 2004, 1,494 patients were included in the study; in 2006, there were 1,560 patients. Overall compliance with hand hygiene recommendations improved from 57% to 64% (p < 0.001). Patient’s case mix between the periods was equivalent based on McCabe score (p = 0.2). The prevalence of nosocomial infections decreased by 20% hospitalwide, from 12.8% to 10.2% (OR, 0.77; p = 0.03; 95% CI, 0.61–0.97). It decreased from 11.8% to 9.6% in the acute care sectors, and from 13.9% to 11.0% in the long-term sectors. The three most prevalent infections in 2006 were urinary tract (26%), respiratory tract (26%) and surgical site infections (19%). By assuming an average attributable cost of €2,200 per infection, saving equalled at least €1.8 million in 2006. Conclusion: A multimodal hand hygiene promotion campaign was associated with a successful reduction of healthcare-acquired infections, in both acute and long-term care sectors. Long-term follow-up is required to assess the continuous impact of the strategy. P1712 Layperson’s technique of hand washing: is it effective in reducing bacterial carriage? Z. Sekawi, F. Jamal (UPM Serdang, MY) Introduction: In spite of major advances in the diagnosis, treatment and prevention of infectious diseases, cross infections in hospitals continue to be a major problem worldwide. Frequent hand washing among healthcare personnel using a proper prescribed technique has been shown to reduce the spread of causative agents of these infections. More often, this technique comprising several systematic steps is considered a nuisance to some personnel and therefore, compliance to this technique may not be desirable and will pose problems such as increase in hospital acquired infections. To encourage compliance, a simple routine household technique of hand washing may be considered as an alternative albeit less superior. Is a layperson’s technique of hand washing effective in reducing bacterial carriage? Objectives: To determine bacterial flora of hands of staff and students in Faculty of Medicine and Health Sciences, Universiti Putra Malaysia and to determine the effectiveness of layperson’s hand washing on bacterial carriage. Method: A cross-sectional study with non-probability convenience sampling was carried out at the faculty premises. Two hundred and twenty eight participants were asked to inoculate their right hand fingertips on the blood agar plates before and after washing their hands with antimicrobial soap using their own usual routine technique. Instruction on proper hand washing was not given. The agar plates were then incubated at 37ºC for 18−24 hours and inspected by standard methods. Results: All participants but four (98.2%) had Staphylococcus aureus on their hands while 80 (35.1%) participants had Bacillus spp. before washing. Other organisms such as Streptococcus spp., Corynebacterium spp., unidentified Gram-negative bacteria and fungus were found on four participants. One hundred and sixty-three (71.5%) of 228 participants had reduction in bacterial hand flora after hand washing. Sociodemographic factors such as gender, age, ethnic groups, occupation and income were analysed and found to be statistically insignificant. Conclusion: It is shown that simple routine household technique of hand washing can reduce the carriage of bacteria on the hands considerably. This implies that healthcare worker’s ignorance on the proper hand washing technique but using their routine layman’s technique of hand