- Email: [email protected]
Standard precautions – Translating knowledge into practice
138 SAY NO TO MROs IN ICU: COST-EFFECTIVE METHODS OF INFECTION CONTROL Joshua Philp, Simone Kelly The Sutherland Hospital, Caringbah, Australia Introduction: Improving patient outcomes should be at the centre of project deployment, either directly or indirectly. Multiresistant Pseudomonas bacteria-related infections and deaths were the prompter for change in our intensive care unit (ICU) with significant contributions towards patient mortality by environmental contamination. Methods: A strategy involving multiple elements was implemented followed by an examination of outcomes comparing occupied bed days (OBD) in ICU, multiresistant organism (MRO) infection rate, personal protective equipment, hand hygiene compliance, and the use of hydrogen peroxide cleaning systems over a 2 year period. Results: There were significant reductions in acquisition rates for MROs including vancomycin resistant enterococcus, methicillin resistant staphylococcus aureus and significant reductions in bed block hours. Conclusion: Patient outcomes were improved through the implementation of new environmental and educational strategies.
SCREENING OF HIGH RISK PATIENTS FOR CPE IN A VICTORIAN TERTIARY REFERRAL CENTRE: A PILOT STUDY Marcel Leroi, Dr Microbiologist And Infectious Diseases Physician, Austin Health, Melbourne, VIC, Australia Introduction: Screening of Carbapenemase producing Enterobacteriaceae (CPE) has recently been mandated by the Victorian Department of Health. Local experience in meeting these requirements is limited. Method: The pilot involved surveillance for 3 months in high risk clinical wards for carabapenemases and extended spectrum beta lactamases (ESBL). Screening was performed by rectal swabs in ICU, the Liver Transplant Unit and the Renal and Haematology Units. Samples were collected weekly in all wards except ICU which was tested twice weekly. Results: 2519 tests were performed, with 2273 negative results (90%). Of the 246 positive tests, 5 were due to carbapenemase producing organisms. Greater than 80% of acquired third generation cephalosporin resistant Enterobacteriaceae had ESBLs isolated. ESBL carriage by ward ranged from 6-13.8% patients tested with 3 wards exhibiting a greater than 12% prevalence. Conclusions: While there was no evidence of nosocomial transmission of carbapenemase producing bacteria during the study period, screening revealed five occasions where carbapenemase producing organisms were detected. Furthermore, based on our results, 2 of the 5 organisms were detected only as a consequence of the screening program as they did not have any of the conventional risk factors. Three of the five screened wards had a higher concentration of ESBL producing organisms implying previously undetected nosocomial transmission. Our results indicate more frequent screening than twice yearly testing is justified, and while costly, can be incorporated into standard work practices.
SEXUAL BEHAVIORS REPORTED BY A SAMPLE OF HIV-POSITIVE MEN WHO HAVE SEX WITH MEN: A DESCRIPTIVE STUDY Jiratha Budkaew, Dr Khon Kaen Hospital, Khon Khan, Thailand Background: In Thailand, men who have sex with men (MSMs) have a far higher rate of HIV infections compared to the general population. If these persons do not modify their behavior to safer lifestyles (e.g., consistent condom use with all partners), they may increase the spread of HIV infection. Methods: We conducted a cross-sectional study involving Antiretroviral Clinic (ARV) to explore the sexual behaviors of HIV-positive MSM after the diagnosis of HIV infection. HIV-positive MSM aged 18 years was asked to enrol in the study. The questionnaire was administered to 114 participants. Results: We found that approximately 40% of HIV positive MSM had not have sex with a man (i.e., were abstinent or had sexual with women) during the 12 months preceding the interview. There were 19 subjects reported unprotected sex, 4.31% and 12.28% reported engaging in unprotected anal
Abstracts and oral intercourse, respectively. About 16.6 % reported that they had practiced at- risk sexual behavior and the mean of number of partners in the past 3 months was 1.8. In total, 32.46% (n Z 37) of the participants reported that they had relationships with a stable partner, while 22.80% (nZ 26) indicated they continued relationships with casual partners. Conclusion: The study shows that our sample of HIV-positive MSM, though aware of being infected, engage in sexual behaviors that could sustain transmission of HIV and other STIs. The results of the present study highlight the need for a national prevention programs for persons living with HIV.
STANDARD PRECAUTIONS e TRANSLATING KNOWLEDGE INTO PRACTICE Helen Lorenz, Rachael Court, Marija Juraja The Queen Elizabeth Hospital, Woodville South, Australia Introduction: With the increasing burden of patients with Multi Resistant Organisms (MRO), staff must consistently practice Standard Precautions (SP) for the protection of patients and themselves. As any patient may have an undetected colonisation or infection with a significant organism, SP needs to be an embedded practice. A “Standard Precautions Quiz” and an audit of Personal Protective Equipment (PPE) availability across the wards of a metropolitan hospital showed that improvement was needed. Methods: Scenario training and information handouts were utilised for education. Nurses were encouraged to think about indications for PPE, especially the use of face protection. The pamphlet “Standard Precautions, a Guide for Health Care Workers”, was distributed when auditing staff knowledge - providing ‘on the spot’ education. Ward managers were asked to set up PPE stations to include all required items and to add SP door signs as the default for all patient rooms. Results: All areas of SP identified as a concern showed an improvement post intervention. Staff knowledge of SP increased, PPE availability increased, particularly PPE items needed to prevent splash exposures, and SP signs became the default signage for all patient rooms. Conclusion: Translating knowledge into practice requires improving knowledge and understanding to facilitate desired behaviours. By evaluating work flows and removing barriers desired changes to practice and behaviour is achievable. Appropriate use of PPE depends on readily accessible supplies and an understanding that PPE can be used any time there is a risk of blood and body fluid exposure or contamination of the environment.
STEAM DISINFECTION OF INTERNAL WINDOWS AND FRAMES FOR CONDENSATION MANAGEMENT AND MOULD CONTROL Cameron Jones, Dr Biological Health Services, Toorak, Australia Introduction: Unwanted dampness inside buildings can occur because of rainwater, accidental leaks, human activities or from intrinsic problems caused by building design or construction materials. This poster reports on a practical intervention focussing on mould control in a newly constructed building used for social housing that has had multiple adverse amenity and OHS occupant reports regarding condensation-mediated dampness and mould growth indoors. Methods: Indoor air quality and mould inspections were performed on a small subset of problem apartments representative of the building. A pilot decontamination program treated 12 apartments using steam disinfection in conjunction with HEPA air extractors and a portable dehumidifier before extending this to a further 28 apartments. Steam could be easily applied to both clean (abrasively dislodge with pressure) and disinfect (vapour contact time) mould affected surfaces; while the HEPA extractors removed airborne particulate matter over a two-week period. Results: The ability of steam to penetrate hard to reach areas of the frame, screens and sills, minimised mould re-growth over a 12-month period. Steam + HEPA were regarded as ‘make-safe’ works since fundamental building issues remained. Residents were questioned after the interventions and they self-reported: better health, less mould smell, fewer headaches, few infections, cleaner appearance, windows easier to maintain. Conclusion: Environmental cleaning (steam + HEPA) used no chemicals and was considered a positive intervention that simultaneously removed all of the window-localized mould returning these areas to an ’as new’ condition; whilst also educating residents about the importance of improved ventilation and use of disinfectant wipes.
SCREENING OF HIGH RISK PATIENTS FOR CPE IN A VICTORIAN TERTIARY REFERRAL CENTRE: A PILOT STUDY Marcel Leroi, Dr Microbiologist And Infectious Diseases Physician, Austin Health, Melbourne, VIC, Australia Introduction: Screening of Carbapenemase producing Enterobacteriaceae (CPE) has recently been mandated by the Victorian Department of Health. Local experience in meeting these requirements is limited. Method: The pilot involved surveillance for 3 months in high risk clinical wards for carabapenemases and extended spectrum beta lactamases (ESBL). Screening was performed by rectal swabs in ICU, the Liver Transplant Unit and the Renal and Haematology Units. Samples were collected weekly in all wards except ICU which was tested twice weekly. Results: 2519 tests were performed, with 2273 negative results (90%). Of the 246 positive tests, 5 were due to carbapenemase producing organisms. Greater than 80% of acquired third generation cephalosporin resistant Enterobacteriaceae had ESBLs isolated. ESBL carriage by ward ranged from 6-13.8% patients tested with 3 wards exhibiting a greater than 12% prevalence. Conclusions: While there was no evidence of nosocomial transmission of carbapenemase producing bacteria during the study period, screening revealed five occasions where carbapenemase producing organisms were detected. Furthermore, based on our results, 2 of the 5 organisms were detected only as a consequence of the screening program as they did not have any of the conventional risk factors. Three of the five screened wards had a higher concentration of ESBL producing organisms implying previously undetected nosocomial transmission. Our results indicate more frequent screening than twice yearly testing is justified, and while costly, can be incorporated into standard work practices.
SEXUAL BEHAVIORS REPORTED BY A SAMPLE OF HIV-POSITIVE MEN WHO HAVE SEX WITH MEN: A DESCRIPTIVE STUDY Jiratha Budkaew, Dr Khon Kaen Hospital, Khon Khan, Thailand Background: In Thailand, men who have sex with men (MSMs) have a far higher rate of HIV infections compared to the general population. If these persons do not modify their behavior to safer lifestyles (e.g., consistent condom use with all partners), they may increase the spread of HIV infection. Methods: We conducted a cross-sectional study involving Antiretroviral Clinic (ARV) to explore the sexual behaviors of HIV-positive MSM after the diagnosis of HIV infection. HIV-positive MSM aged 18 years was asked to enrol in the study. The questionnaire was administered to 114 participants. Results: We found that approximately 40% of HIV positive MSM had not have sex with a man (i.e., were abstinent or had sexual with women) during the 12 months preceding the interview. There were 19 subjects reported unprotected sex, 4.31% and 12.28% reported engaging in unprotected anal
Abstracts and oral intercourse, respectively. About 16.6 % reported that they had practiced at- risk sexual behavior and the mean of number of partners in the past 3 months was 1.8. In total, 32.46% (n Z 37) of the participants reported that they had relationships with a stable partner, while 22.80% (nZ 26) indicated they continued relationships with casual partners. Conclusion: The study shows that our sample of HIV-positive MSM, though aware of being infected, engage in sexual behaviors that could sustain transmission of HIV and other STIs. The results of the present study highlight the need for a national prevention programs for persons living with HIV.
STANDARD PRECAUTIONS e TRANSLATING KNOWLEDGE INTO PRACTICE Helen Lorenz, Rachael Court, Marija Juraja The Queen Elizabeth Hospital, Woodville South, Australia Introduction: With the increasing burden of patients with Multi Resistant Organisms (MRO), staff must consistently practice Standard Precautions (SP) for the protection of patients and themselves. As any patient may have an undetected colonisation or infection with a significant organism, SP needs to be an embedded practice. A “Standard Precautions Quiz” and an audit of Personal Protective Equipment (PPE) availability across the wards of a metropolitan hospital showed that improvement was needed. Methods: Scenario training and information handouts were utilised for education. Nurses were encouraged to think about indications for PPE, especially the use of face protection. The pamphlet “Standard Precautions, a Guide for Health Care Workers”, was distributed when auditing staff knowledge - providing ‘on the spot’ education. Ward managers were asked to set up PPE stations to include all required items and to add SP door signs as the default for all patient rooms. Results: All areas of SP identified as a concern showed an improvement post intervention. Staff knowledge of SP increased, PPE availability increased, particularly PPE items needed to prevent splash exposures, and SP signs became the default signage for all patient rooms. Conclusion: Translating knowledge into practice requires improving knowledge and understanding to facilitate desired behaviours. By evaluating work flows and removing barriers desired changes to practice and behaviour is achievable. Appropriate use of PPE depends on readily accessible supplies and an understanding that PPE can be used any time there is a risk of blood and body fluid exposure or contamination of the environment.
STEAM DISINFECTION OF INTERNAL WINDOWS AND FRAMES FOR CONDENSATION MANAGEMENT AND MOULD CONTROL Cameron Jones, Dr Biological Health Services, Toorak, Australia Introduction: Unwanted dampness inside buildings can occur because of rainwater, accidental leaks, human activities or from intrinsic problems caused by building design or construction materials. This poster reports on a practical intervention focussing on mould control in a newly constructed building used for social housing that has had multiple adverse amenity and OHS occupant reports regarding condensation-mediated dampness and mould growth indoors. Methods: Indoor air quality and mould inspections were performed on a small subset of problem apartments representative of the building. A pilot decontamination program treated 12 apartments using steam disinfection in conjunction with HEPA air extractors and a portable dehumidifier before extending this to a further 28 apartments. Steam could be easily applied to both clean (abrasively dislodge with pressure) and disinfect (vapour contact time) mould affected surfaces; while the HEPA extractors removed airborne particulate matter over a two-week period. Results: The ability of steam to penetrate hard to reach areas of the frame, screens and sills, minimised mould re-growth over a 12-month period. Steam + HEPA were regarded as ‘make-safe’ works since fundamental building issues remained. Residents were questioned after the interventions and they self-reported: better health, less mould smell, fewer headaches, few infections, cleaner appearance, windows easier to maintain. Conclusion: Environmental cleaning (steam + HEPA) used no chemicals and was considered a positive intervention that simultaneously removed all of the window-localized mould returning these areas to an ’as new’ condition; whilst also educating residents about the importance of improved ventilation and use of disinfectant wipes.