Trends in antibiotic resistance pattern against ESKAPE pathogens from tertiary care teaching institute – South India

142 THE ROLE OF TEAM ENGAGEMENT AND A DEFINED BUNDLE APPROACH IN THE REDUCTION OF SURGICAL SITE INFECTIONS ASSOCIATED WITH LOWER SEGMENT CAESAREAN SECTION Beth Bint, Joanna Harris Illawarra Shoalhaven Local Health District, Wollongong, Australia Introduction: This presentation describes our response to an 80% increase in the monthly rate of LSCS associated surgical site infections (SSI) in a 500 bed tertiary referral hospital in NSW. The service undertakes almost 650 LSCS annually with a monthly SSI rate of 1.7% (January 2012 to July 2014). In August 2014 the SSI rate was 12.3% (nZ7). Methods: A multimodal intervention strategy was implemented which included establishing a multi-disciplinary team and, following literature review, the development of a compliance bundle that was audited in tandem with the SSI surveillance process. Following implementation ongoing auditing identified any gaps that were addressed with the relevant discipline to ensure understanding of the management required and to improve bundled compliance. Results: Key stakeholder engagement provided opportunity for disciplines to take responsibility of the individual practice changes required for a standardised approach to reduce LSCS SSI rates. Initial overall bundle compliance was 63%. Timely reporting of bundle compliance enabled practice review opportunities and improved compliance. 12 months after the implementation of the bundle the compliance rate was 88% representing a 25% improvement. During the 12 months following the implementation of the bundle the number of average monthly SSI was 1 (range 0-3). The average rate being 1.9% (range 0% - 5.7%) Conclusion: A multimodal approach that incorporates key stake-holder teams, active surveillance and continuous auditing of a compliance bundle can have an immediate and positive impact on surgical site infections associated with LSCS.

THE USE OF PHOTOVOICE AS A MEANS TO EXPLORE THE UNDERSTANDING OF INFECTION PREVENTION AND CONTROL IN A RURAL HOSPITAL IN THE SOLOMON ISLANDS Vanessa Sparke 1, Caryn West, Associate Professor1, David McLaren, Dr1, Jane Mills, Professor2 1 James Cook University, Smithfield, Australia 2 RMIT University, Bundoora, Australia Photovoice is a process whereby participants use photography to document their needs, experiences and perceptions. Introduced in the 1990’s, photovoice has three main goals: to enable people to record and reflect their community’s strengths and concerns, to promote dialogue and knowledge about issues through the discussion of photographs, and to reach policy makers. Atoifi Adventist Hospital (AAH) serves a population of approximately 80,000 people, many living in small remote villages with no modern amenities. Selfidentified as willing to implement infection prevention and control (IP&C) measures within their health facility, the people and staff of Atoifi are no strangers to communicable diseases. The 2014 local measles outbreak and a dysentry outbreak in 2015 resulted in a 56% hospitalisation rate. Although community response to the outbreaks was high, the response lacked formalised IP&C practices and disease control expertise. As part of a larger WHO funded grant, an audit of (IP&C) processes and practices was undertaken at AAH, Solomon Islands in April 2016. During the audit it became clear that a lack of consumable resources, an unsupportive built environment, and a knowledge-practice gap meant that a top down approach to developing an IP&C plan was unsuitable. Photovoice can be powerful for people who are unable to express themselves using the language of IP&C. Photovoice can provide insight into staff perceptions of IP&C issues, enabling the staff of AAH, who have expertise and insight into their own community (which an outsider lacks) to assist in the bottom-up development of an appropriate IP&C plan.

THREE CASE STUDIES SHOWING HOW UVGI CAN BE USED AS AN ADJUVANT FOR RENTAL PROPERTY MOULD DECONTAMINATION Cameron Jones, Dr Biological Health Services, Toorak, Australia Introduction: Property managers are increasingly presented with claims of adverse health complaints from residential and commercial tenants

Abstracts especially following unexpected water ingress. There is a need for a rapid and cost effective OHS first-response while claims are verified. Ultraviolet germicidal irradiation (UVGI) is produced at a wavelength of 254nm within the UV-C bandwidth. Bacterial, yeast and fungal DNA deactivation is dose dependent and varies across Taxa. This poster reviews three case studies where UVGI was used in mould and water damage remediation in typical tenancy situations. Methods: Ultraviolet germicidal irradiation used a pair of Phillips TUV 30Watt tubes fitted on a mobile pushcart. HEPA units were Guardian R. Results: Three case studies are given: 1. Whole of room volume treatment where the resident considers porous personal property to be mould contaminated 2. Treatment of water damaged carpets that have not been replaced 3. Pre-treatment of room surfaces as part of ‘make-safe’ works before more extensive strip out or during strip out to minimise spore dispersal of viable cells Viable plate counts showed significant decrease in viable moulds. Enhanced results are achieved with 24-hour UVGI cycling + HEPA. Conclusion: UVGI is a photodynamic light-based method and is considered a green-sterilant at the correct distance and exposure level. It does not involve chemicals and is user-friendly for those with multiple chemical sensitivities or those who avoid hypochlorite or other liquid disinfectants. It is best used in combination with other decontamination methods like steam disinfection, HEPA air extraction, HEPA vacuuming and microfiber wiping.

TO SCREEN OR NOT TO SCREEN, THAT IS THE VRE QUESTION Helen Cadwallader 1, David Speers, Dr1,2, Michelle Harvey Sir Charles Gairdner Hospital, Nedlands, Australia 2 PathWest Laboratory Medicine WA, Nedlands, Australia

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Background: VRE screening and isolation for higher risk patients has been performed by WA hospitals for many years. Despite this, the number of VRE detections in WA has been increasing since 2001. A two year alternative horizontal strategy for VRE management is being undertaken at SCGH, an adult tertiary hospital offering transplantation, haematology and intensive care services. The expected benefits include improved patient flow, reduced transmission of all multi-resistant organisms on the higher risk wards, and reduced personal protective equipment (PPE) and pathology costs. Method: The cessation of screening and isolation of higher risk patients has been replaced with universal measures to minimise the transmission of VRE on the higher risk wards. This approach includes:  hand hygiene compliance to the state benchmark and compliance with the dress code policy  compliance with correct use of PPE and aseptic technique  enhanced environmental cleaning services  dedicated equipment policy with limited shared equipment and betweenpatient cleaning and/or disinfection of shared equipment  chlorhexidine patient bathing  antimicrobial stewardship program. The rate of VRE infections is reviewed by the Infection Prevention and Control Unit and reported to the Healthcare Associated Infection Unit of WA Health. Results: Quarterly reporting of staff compliance with the new approach to the hospital executive occurs with an action plan to address suboptimal performance. Conclusion: The alternative approach is in the early stages. Over the two year trial the number of VRE infections at SCGH will be compared to several peer group hospitals in WA.

TRENDS IN ANTIBIOTIC RESISTANCE PATTERN AGAINST ESKAPE PATHOGENS FROM TERTIARY CARE TEACHING INSTITUTE e SOUTH INDIA Shanmuga Vadivoo Natarajan, Dr, Usha Dhanasekar, Dr. Annapoorana Medical College & Hospitals, Salem, India Introduction: This study aimed to assess the trend in resistance pattern for ESKAPE Pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter, Pseudomonas aeruginosa, and Enterobacter /E.coli species) and to inform the health care providers to choose appropriate infection control measures.

Abstracts Methods: All the mentioned Drug resistant Pathogens were confirmed as per CLSI Guidelines from biological samples during retrospective cohort from 01 Jan 2013 to 31 Dec 2015. Trend in antibiotic resistance was analysed using chi square for trend. Results: During the reference period, Vancomycin resistant Enterococci (VRE) prevalence reduced over the years from 6.0% in 2013 to 2.6%in 2014 and 1.2% in 2015 (p for trendZ0.04). Similarly, Methicillin Resistant Staphylococcus aureus resistance was 41.2%, 25% and 20% respectively from 2013-15 (p for trend >0.05) and for ESBL Klebsiella pneumoniae 89%, 74% & 51% ( p for trend is <0.0001).Despite, the prevalence of MDR Acinetobacter resistance was high at baseline over the years it followed a declining trend: 52%, 71%, 25%, though not significantly so (p for trend >0.05).Of all the samples tested for ESKAPE organisms, Klebsiella & Pseudomonas showed least proportion of resistance (»2%) with a very good susceptibility profile. VRE, MRSA and MDR Acinetobacter were most commonly isolated from UTI (43%), wound swabs (50%) and Respiratory tract infections (76%) respectively. Conclusion: This study shows declining trend in resistance pattern from the recent past on the emerging global threat against ESKAPE organisms. Infection control training for health care providers emphasizes these findings to facilitate better clinical decisions.

TURNING POLICY INTO PRACTICE e INFECTION CONTROL PRACTITIONER PERSPECTIVES ON IMPLEMENTATION OF STANDARD 3 CRITERIA 10 ASEPTIC TECHNIQUE OF THE NSQHS STANDARDS Sally Havers 1,2, Lisa Hall, Dr2, Katie Page, Dr2, Andrew Wilson, Professor3 1 Hand Hygiene Australia, Heidelberg, Australia 2 QUT, Kelvin Grove, Australia 3 Menzies Centre for Health Policy, University of Sydney, Sydney, Australia Introduction: In 2010 the National Safety and Quality Health Service (NSQHS) Standards were introduced including a criterion addressing aseptic technique (AT) practices. Minimal understanding of AT practice in Australia existed and it was unknown how hospitals would implement AT in line with new requirements. This study investigated Infection Control Practitioner (ICP) perspectives on this process and aimed to identify contextual factors that influenced how policy was implemented. Methods: An exploratory qualitative research approach was used and data collected via focus groups (nZ4). ICPs were invited to participate and purposeful sampling provided representation from public and private, regional and metropolitan services. All participants had been involved in implementation of AT policy in their hospital. Focus group questions were guided by the Theoretical Domain Framework, a validated framework used in implementation research. A thematic analysis using interpretive description was undertaken to determine key themes discussed. Results: Data was collected in early 2015. Three focus groups were held in Melbourne, Adelaide and Brisbane. A fourth session (conducted via teleconference) included ICPs from regional settings. Analysis identified several key organisational factors that influenced implementation including preparedness and resourcing; internal systems and processes; and roles, responsibilities and relationships. Other key themes included perception of policy (including the trigger for policy) and competency of clinical staff prior to implementation. Conclusion: Identification of key factors that influence infection control policy implementation provides practitioners and policy makers with better understanding of implementation processes and with further research, the potential to maximise impact of policy on patient care.

143 (reprocessing of RMDs in accordance with relevant International standards and IFUs); 3.17 (Systems to enable identification of a process to a patient) and 3.18 (ensuring workforce to decontaminate RMDs undertake competency based training. This is an actual account of how a typical medium sized HSO goes through every day. Methods: The objective of this presentation is to present to the IPC community, daily routines the reprocessing technician is confronted with and the different approaches with common goal: all for patient care. Competency, validation, monitoring, processes and workflows, a never ending quest to excellence in service. Evidence for compliance is documented every day and contingencies attached. Results: ISO 17664 and the challenges of product grouping for an ISO 17665 validation. The perils of the requirement of complex devices validated in situ and the attached IFUs reprocessing departments need to accommodate. What is in it for us as IPC professionals? Conclusion: Collaboration has always been an integral part of success in the healthcare setting. Sharing information relevant to decisions concerning patient safety has never been more important to improve reprocessing of reusable medical devices for IPC professionals. Its all for patient care.

USE OF A NEW DECISION SUPPORT TOOL TO REDUCE URINARY CATHETER DWELL TIMES AND THE VOLUME OF URINE SPECIMENS COLLECTED IN AN ACUTE AGED CARE UNIT Belinda Straube 1, Jan Gralton, Dr2,3, Christine Cook 1, Kerrie Thomas 1, Peter Taylor, Dr1,4,5, Alice Kizny Gordon, Dr1,4, Peter Smerdely, Dr1,3, Gwen Hughes 1, Margaret Louey 1, Paul Curtis, Dr2 1 St George Hospital, Kogarah, Australia 2 Clinical Excellence Commission, Sydney, Australia 3 School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia 4 South East Area Laboratory Services, St George Hospital, Kogarah, Australia 5 School of Medical Sciences, University of New South Wales, Kensington, Australia Introduction: The collection of a urine specimen from a patient with a urinary catheter presents an opportunity for microorganisms to enter into drainage system and cause infection. Inappropriate urine specimen collection and culture can result in the misdiagnosis of urinary tract infections and the administration of unnecessary antimicrobial therapy. In turn, this limits the success of pathology and antimicrobial stewardship efforts. Recently, the Clinical Excellence Commission (CEC) developed a new decision support tool to guide appropriate urine specimen collection and culture from patients with urinary catheters. This new tool was pilot tested for effectiveness and practicality in a 30-bed acute aged care unit of large metropolitan hospital. Methods: A before and after time series study design was to pilot the tool. Specimen collection, catheter utilisation and infection rates were collected for eight weeks prior to the implementation of the tool. The tool was implemented over a four week period and involved the provision of targeted nursing and medical education. After the implementation period, data collection was repeated again for another eight weeks. Results: Significantly less catheter days were observed during the postimplementation period, suggesting a reduction in catheter dwell times. The total volume of all urine specimens collected during the post-implementation period was significantly less than what was collected during the preimplementation period. Conclusions: When coupled with targeted nursing and medical education, the new decision support tool was effective in reducing the total volume of urine specimens collected and catheter dwell times in the acute aged care setting.

TYPICAL AUSTRALIAN CSSD: FEDERAL COMPLIANCE AND PASSING WITH MERIT Roel Castillo Macquarie University Hospital, Macquarie University, Australia Introduction: The Australian Commission on Safety and Quality in Healthcare requires health service organizations to comply with 10 standards ensuring risk is minimized and patients get the quality of care they truly deserve. CSSDs all throughout Australia are responsible for Standard 3.16

USING A CLINICAL GOVERNANCE FRAMEWORK TO IDENTIFY BARRIERS TO INFECTION CONTROL PRACTICE Kate Halton, Dr1, Lisa Hall, Dr1, Anne Gardner, Professor2, Deborough MacBeth, Dr3, Brett Mitchell, Associate Professor4,5 1 Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia