CORD-19_Custom_license_subset  

CORD-19:f22b324eec2eaf85f8e70381b13017e64b1e0e5c JSONTXT 8 Projects

Annnotations TAB TSV DIC JSON TextAE Lectin_function

Id Subject Object Predicate Lexical cue
T1 0-31 Sentence denotes Oral presentations Abstract ID:
T2 32-187 Sentence denotes 4444 Outbreak of Panton-Valentine Leucocidin- associated Staphylococcus aureus (PVL-SA) skin infection linked to a diving club at a national sports centre:
T3 188-250 Sentence denotes Case management, environmental assessment and control measures
T4 252-529 Sentence denotes Routine follow-up of a teenage child with a microbiologically confirmed Panton-Valentine Leucocidin-associated Staphylococcus aureus (PVL-SA) skin infection in January 2015 showed the child was a diver and that other children in the competitive club had had similar infections.
T5 530-711 Sentence denotes The club confirmed that 5-10 children and a coach had been affected; at least two children remained symptomatic and the latest case was a new onset, suggesting ongoing transmission.
T6 712-788 Sentence denotes Information was sent to all parents of children attending the diving school.
T7 789-962 Sentence denotes A site visit was undertaken and an online questionnaire was sent to all parents to allow case finding and to further elucidate risk factors for acquisition and transmission.
T8 963-1117 Sentence denotes Three confirmed cases (all spa type t034 PVL-MSSA), two probable and five possible cases, all with soft-tissue infection were identified in this outbreak.
T9 1118-1215 Sentence denotes All confirmed and probable cases had onset in spring 2014 except one, with onset in January 2015.
T10 1216-1285 Sentence denotes Ninety-nine questionnaires were completed (269 clients were emailed).
T11 1286-1412 Sentence denotes Whilst numbers of cases were too small to allow multivariable analysis, several likely routes of transmission were identified:
T12 1413-1450 Sentence denotes Sharing of shammy (diving) towels • •
T13 1451-1601 Sentence denotes Piling shammy towels at poolside • • Infrequent washing of shammy towels • • Shared equipment, e.g. harnesses in dry gym, with no cleaning between use
T14 1602-1712 Sentence denotes Control measures centred on reducing spread of infection by improving cleaning in the dry gym and at poolside.
T15 1713-1822 Sentence denotes Further infection control measures focussed on education around washing and personalisation of shammy towels.
T16 1823-1971 Sentence denotes Outcomes of the investigation were shared with the pool management team and diving club with a view to wider dissemination at national competitions.
T17 1972-2038 Sentence denotes Antimicrobial resistance (AMR) is an urgent public health concern.
T18 2039-2107 Sentence denotes Resistance can be accelerated with the imprudent use of antibiotics.
T19 2108-2236 Sentence denotes Previous research suggests that inappropriate prescribing is apparent in practice; however, much of this has focused on doctors.
T20 2237-2349 Sentence denotes With a growing number of nurses potentially prescribing antimicrobials, their practice is of particular concern.
T21 2350-2711 Sentence denotes The Reasoned Action Approach (RAA) model proposes that behavioural (advantages/disadvantages of carrying out the behaviour), normative (individuals or groups who would approve/disapprove; likely/unlikely to carry out this behaviour) and control beliefs (enablers or inhibitors to carrying out the behaviour) are the psychological foundation for human behaviour.
T22 2712-2857 Sentence denotes In order to assess the beliefs of nurse prescribers, one-to-one, open-ended telephone interviews were carried out using the RAA model's guidance.
T23 2858-2996 Sentence denotes Interviews were recorded and content analysed to identify the population's modal (most frequently occurring) salient (accessible) beliefs.
T24 2997-3109 Sentence denotes Twenty-seven nurse independent prescribers (NIPs), from a variety of settings across Scotland, were interviewed.
T25 3110-3370 Sentence denotes The most frequently occurring advantage for managing patients presenting with upper respiratory tract infections without prescribing an antibiotic was the prevention of AMR (n=21, 78%), the disadvantage was stress from patient pressure/expectation (n=11, 41%).
T26 3371-3520 Sentence denotes Other NIPs were most frequently mentioned as being most likely to manage patients without prescribing (n=11, 41%), with GPs least likely (n=16, 60%).
T27 3521-3699 Sentence denotes Finally, having the time to educate/reassure/advise the patient was the most frequently mentioned enabler (n=24, 89%) and patient pressure was the greatest inhibitor (n=18, 67%).
T28 3700-3954 Sentence denotes Some of these findings are similar to those found in the literature; however, many others have emerged -one of the main categories being patient expectation and the challenges this creates when trying to manage patients without prescribing an antibiotic.
T29 3955-4095 Sentence denotes This elicitation work has therefore identified the salient beliefs for this population and will be used to develop a national questionnaire.
T30 4096-4316 Sentence denotes Semi-invasive ultrasound probes (SIUPs) are a cornerstone in the diagnosis and treatment of patients; however, infection control concerns exist over the use of probes and their role as a vector for pathogen transmission.
T31 4317-4484 Sentence denotes No guidance was available within NHS Scotland, and a number of health boards over recent years have requested expert advice on the use of and decontamination of SIUPs.
T32 4485-4695 Sentence denotes Health Facilities Scotland (HFS) conducted a national survey of transoesophageal (TOE), transvaginal (TV) and transrectal (TR) ultrasound probes to identify current decontamination practice across NHS Scotland.
T33 4696-4856 Sentence denotes A scientific literature review was undertaken by HPS regarding the effectiveness of the decontamination of SIUPs, including a review of manufacturers' guidance.
T34 4857-4970 Sentence denotes The HFS national survey concluded there was an ongoing risk to patient safety regarding decontamination of SIUPs.
T35 4971-5075 Sentence denotes The scientific literature review found SIUPs present a number of challenges in terms of decontamination.
T36 5076-5272 Sentence denotes Studies have shown residual contamination on SIUPs when high level disinfection (HLD) is not performed and cases of cross-infection where transmission was linked to improper reprocessing of SIUPs.
T37 5273-5403 Sentence denotes The literature review found limited evidence upon which to make recommendations on universal HLD methods of decontaminating SIUPs.
T38 5404-5567 Sentence denotes Review of manufacturer instructions highlights variation in decontamination instructions and lack of material compatibility of different makes and models of SIUPs.
T39 5568-5737 Sentence denotes HPS and HFS worked together to produce the NHS Scotland Guidance for Decontamination of Semi-Critical Ultrasound Probes; Semi-invasive and Noninvasive Ultrasound Probes.
T40 5738-5911 Sentence denotes The guidance was developed using a wide consultative method and included some health boards trialling the three decontamination systems covered within the literature review.
T41 5912-6131 Sentence denotes Where evidence was lacking to inform the guidance, expert opinion was sought from the reusable medical devices expert advisory steering group, which consists of national decontamination and infection-prevention experts.
T42 6133-6226 Sentence denotes Surgical site infections (SSI) cause significant morbidity following caesarean sections (CS).
T43 6227-6304 Sentence denotes CS surveillance commenced at Guy's & St Thomas' NHS Foundation Trust in 2010.
T44 6305-6596 Sentence denotes An initial data validation took place in 2013, followed by a series of improvement initiatives which included a CS guideline and care plan both reflecting NICE recommendations, asepsis principles awareness for midwives and introduction of an Aquacel dressing left in situ for 5 days in 2015.
T45 6597-6718 Sentence denotes Data was collected using surveillance forms during inpatient stay and post discharge by community midwives up to 10 days.
T46 6719-6825 Sentence denotes Patient postal questionnaires and telephone surveys were also used for post-discharge SSI data collection.
T47 6826-6931 Sentence denotes Patient feedback was collected on general post-operative experience and experience with the new dressing.
T48 6932-7086 Sentence denotes We have demonstrated a reduction in our SSI rates from 13.3% in 2013 to 6.8% in 2015 through various interventions targeted at improving patient outcomes.
T49 7087-7205 Sentence denotes We used patient feedback to improve patient experience and developed patient information leaflets to empower patients.
T50 7206-7484 Sentence denotes Feedback from the dressing evaluation suggested that dressings were painful at removal, and when additional staff support was provided patients' experience with the dressing improved, highlighting the power of utilising patient feedback to improve patient safety and experience.
T51 7485-7620 Sentence denotes The telephone survey was found to be a powerful method for detecting SSIs post discharge as it captured at least 40% of the infections.
T52 7621-7729 Sentence denotes More than 80% of the infections were detected post discharge with a mean day to SSI presentation of 13 days.
T53 7730-7818 Sentence denotes Our data was reproducible for the two validated quarters in 2013 and 2015, respectively.
T54 7819-7940 Sentence denotes Mupirocin is an important component in MRSA control specifically for nasal decolonisation, but resistance limits its use.
T55 7941-8022 Sentence denotes Medical-grade honey (MGH) is used for the treatment of burns and infected wounds.
T56 8023-8107 Sentence denotes The antimicrobial activity of natural honey may offer potential in MRSA eradication.
T57 8108-8201 Sentence denotes We report the results of a randomised controlled trial (RCT) on nasal decolonisation of MRSA.
T58 8202-8306 Sentence denotes The purpose of this research was to compare the efficacy of MGH to mupirocin 2% to eradicate nasal MRSA.
T59 8307-8411 Sentence denotes Consenting MRSA-colonised patients were recruited and MGH 30% or mupirocin 2% was applied intra-nasally.
T60 8412-8498 Sentence denotes Up to two courses of either treatment, three times a day for 5 days, was administered.
T61 8499-8585 Sentence denotes Three consecutive negative MRSA screening results confirmed successful decolonisation.
T62 8586-8660 Sentence denotes The mean age of the study participants was 73.2 years and 36% were female.
T63 8661-8938 Sentence denotes Of the 100 study participants, 93% were previously known MRSA cases, 89% had had a history of attempted decolonisation with 34% receiving two or more courses of nasal mupirocin, 43% had concomitant multidrug-resistant bacteria colonisation and 68% non-nasal site MRSA carriage.
T64 8939-9037 Sentence denotes In total 57% (57) were isolated either in a single room or were cohorted with contact precautions.
T65 9038-9236 Sentence denotes Of the 86 participants who completed the study protocol, 36% (18) in the intervention group and 50% (25) in the control group were decolonised (p=0.196, c 2 =1.675) in an intention-totreat analysis.
T66 9237-9342 Sentence denotes The success rate for MGH and mupirocin was 43% and 57%, respectively, according to the protocol analysis.
T67 9343-9449 Sentence denotes In total, 14% (14) participants were lost on follow-up, withdrawn or deviated from the allocated protocol.
T68 9450-9523 Sentence denotes The results from this first RCT of its type confirm the potential of MGH.
T69 9524-9620 Sentence denotes However, further work is required to confirm the findings and optimise the concentration of MGH.
T70 9621-9672 Sentence denotes I do not have any conflict of interests to declare.
T71 9673-9779 Sentence denotes Decreased bacterial contamination of dental unit waterlines with the introduction of reverse osmosis water
T72 9781-9872 Sentence denotes Dental unit waterline (DUWL) systems are used to irrigate the oral cavity during treatment.
T73 9873-10021 Sentence denotes These waterlines can become heavily contaminated with bacteria, leading to microbial biofilm formation despite decontamination and regular flushing.
T74 10022-10251 Sentence denotes Leeds Dental Institute (LDI) uses a continuous dosing with 1% Alpron to achieve the water quality; however, we experienced repeated microbiological testing failures with the currently used Alpron system for water decontamination.
T75 10252-10436 Sentence denotes A trial was instigated to investigate the contamination level and prevalence of bacteria in DUWL output water following the addition of reverse osmosis (RO) water instead of tap water.
T76 10437-10597 Sentence denotes RO water has been purified by a process of diffusion and by applying an external pressure to reverse the natural solvent flow through a semi-permeable membrane.
T77 10598-10682 Sentence denotes RO water was added in four different dental chairs in LDI over a period of 18 weeks.
T78 10683-10888 Sentence denotes Weekly microbiological testing of the water was carried out during this period, where a total of 72 water samples were collected from four different dental chairs and the bacteria (CFU/ml) were enumerated.
T79 10889-11101 Sentence denotes Over the 18-week period the introduction of RO water showed a reduction in the levels of bacteria in all four dental chairs when compared with the bacterial levels at baseline when Alpron and tap water were used.
T80 11102-11272 Sentence denotes Mean results for all four dental chairs at baseline (before introduction of RO water) was 7.7×10 3 CFU/ml compared with a mean count of 3.2×10 2 CFU/ml with the RO water.
T81 11273-11400 Sentence denotes In this 18-week trial the introduction of RO water reduced bacterial counts in the routine water testing of four dental chairs.
T82 11401-11574 Sentence denotes As a result of this, we intend to introduce the use of RO into all dental chairs within the dental institute, to provide consistent water quality for our patients and staff.
T83 11575-11626 Sentence denotes I do not have any conflict of interests to declare.
T84 11627-11768 Sentence denotes Hand hygiene to prevent infection in children is becoming increasingly important as Government policy seeks to reduce antibiotic prescribing.
T85 11769-11866 Sentence denotes This study investigates whether hand hygiene education reduces absenteeism among school children.
T86 11867-11990 Sentence denotes Study aims include student participation and engagement in science and development of a partnership with Cokethorpe School.
T87 11991-12067 Sentence denotes First-year A-Level students learnt about bacteria, transmission and hygiene.
T88 12068-12139 Sentence denotes They swabbed sites around the school and took handprints on blood agar.
T89 12140-12242 Sentence denotes An assembly was presented to children in the lower school (aged 4-11 years, approximately 150 pupils).
T90 12243-12353 Sentence denotes Following this, younger students created posters for a competition, with winners receiving a giant Rhinovirus.
T91 12354-12481 Sentence denotes Anonymised data on sick days for 4 weeks following the assembly in January 2016 and the same time-period in 2015 were obtained.
T92 12482-12586 Sentence denotes Older students successfully grew and examined bacteria from hands, door handles and other site cultures.
T93 12587-12721 Sentence denotes Morphology and Gram staining suggested common bacteria were isolated between sites, although formal identification was not undertaken.
T94 12722-12839 Sentence denotes There was no significant difference in the number of episodes between the two time periods (2015: n=43; 2016: n=46) .
T95 12840-12918 Sentence denotes The number of halfdays recorded as sick was similar (2015: n=29; 2016: n=25) .
T96 12919-13041 Sentence denotes There were more episodes of 1 day or more in 2016 due to an outbreak of scarlet fever that coincided with the study (2015:
T97 13042-13051 Sentence denotes 14; 2016:
T98 13052-13074 Sentence denotes 21, not significant) .
T99 13075-13232 Sentence denotes Members of the Crook Public Engagement group chose the winning artwork, now on permanent display in the Children's Hospital, John Radcliffe Hospital, Oxford.
T100 13233-13341 Sentence denotes The null hypothesis was not refuted but secondary goals were successful with older students keen to do more.
T101 13342-13501 Sentence denotes In September the older students plan to develop a questionnaire to establish what (if anything) young children take away from targeted messages around hygiene.
T102 13502-13577 Sentence denotes Ongoing data collection and molecular biology experiments are also planned.
T103 13578-13717 Sentence denotes Once a patient becomes colonised with carbapenemase-producing Enterobacteriaceae (CPE), there are no recommended decolonisation strategies.
T104 13718-13834 Sentence denotes This leads to uncertainty around how to manage known carriers of CPE while in hospital and on subsequent admissions.
T105 13835-13945 Sentence denotes We evaluated the results of repeated CPE screens from known carriers to establish the pattern of colonisation.
T106 13946-14195 Sentence denotes From June 2015, our hospitals performed risk factor-based CPE screening of all admissions, universal screening in high-risk specialties, weekly screening in wards where known carriers were present, and contact tracing around newly detected carriers.
T107 14196-14259 Sentence denotes During June-December 2016, 70 patients were known CPE carriers.
T108 14260-14321 Sentence denotes The result of serial screens of each patient was scrutinised.
T109 14322-14456 Sentence denotes A total of 409 screens were collected from the 70 patients (median 4, range 1-28), with 247 (60.4%) negative and 162 (39.6%) positive.
T110 14457-14589 Sentence denotes Of the 70 patients, 60/64 patients who had more than one screen (93.8%) had at least one negative screen during their hospital stay.
T111 14590-14753 Sentence denotes Of the 51 that had least three screens, 24 (47.1%) had a "+-+" pattern, suggesting that apparent spontaneous decolonisation reverted to a positive carriage status.
T112 14754-15107 Sentence denotes Several factors could explain an apparent reversion from a negative to a positive screen in known CPE carriers, including acquisition of a different CPE following genuine spontaneous decolonisation, natural fluctuation in the level of gastrointestinal colonisation perhaps prompted by antibiotic exposure, or a poorly collected microbiological specimen.
T113 15108-15492 Sentence denotes It is not possible for us to conclude which of these explains the observed apparent changes in carriage status, but the frequent reversion from an apparent negative carriage status to positive carriage status in known CPE carriers suggests that a negative CPE screen should not be interpreted as an indication of loss of colonisation in an individual who has previously been positive.
T114 15493-15544 Sentence denotes I do not have any conflict of interests to declare.
T115 15545-15732 Sentence denotes Safety-engineered devices (SED) became mandatory in UK healthcare facilities in May 2013; however, few publications are available as to the impact of the law on adoption of SED in the UK.
T116 15733-15869 Sentence denotes Monitoring of activation is recommended as non-use and incorrect activation of SED are a common cause of post-procedure sharps injuries.
T117 15870-15962 Sentence denotes This paper outlines a sharps container (SC) contents audit conducted in seven UK NHS trusts.
T118 15963-16097 Sentence denotes Reusable SCs (Sharpsmart, Daniels Corporation, Melbourne) were randomly selected from seven healthcare facilities (HCF) in central UK.
T119 16098-16310 Sentence denotes Wearing protective apparel, the operator opened and decanted the SC and sorted and counted hollow-bore needles (HBN) into: SED and non-SED; capped vs. uncapped non-SED needles; and activated or non-activated SED.
T120 16311-16416 Sentence denotes WinPepi v2.78 was used to calculate probability (p set at 0.05), relative risk and 95% confidence limits.
T121 16417-16505 Sentence denotes In total, 322 L of sharps (59.0 kg) from 22 SCs from seven hospital trusts were audited.
T122 16506-16543 Sentence denotes Many devices were blood-contaminated.
T123 16544-16560 Sentence denotes Of the 2425 HBN:
T124 16561-16618 Sentence denotes 49.9% (1210) were SED; 16% of the SED were not activated.
T125 16619-16685 Sentence denotes Of the 1215 non-SED, 13.4% were capped needles or needle-syringes.
T126 16686-16735 Sentence denotes Overall, 52.7% of devices were discarded "sharp".
T127 16736-16918 Sentence denotes It is disturbing that over 50% of HBN were discarded sharp, indicating that a high proportion of UK clinical staff are unnecessarily at risk of sharps injuries while handling sharps.
T128 16919-17019 Sentence denotes The high non-use of SED and non-activation of SED is also disturbing and needs further confirmation.
T129 17020-17184 Sentence denotes Widespread SED evaluation and adoption (automatic and semi-automatic SED where feasible), repetitive competency training, and safety-ownership by staff, are needed.
T130 17185-17236 Sentence denotes I do not have any conflict of interests to declare.
T131 17237-17351 Sentence denotes Flomoxef belongs to cephamycin antibiotics, which cannot be hydrolysed by extended-spectrum beta-lactamase (ESBL).
T132 17352-17435 Sentence denotes Hence, flomoxef can be used to treat infections caused by ESBL-producing organisms.
T133 17436-17579 Sentence denotes This study was conducted to evaluate whether the susceptibility rates of flomoxef against ESBLproducing organisms were decreasing year by year.
T134 17580-17747 Sentence denotes At a regional hospital in southern Taiwan, from 2012 to 2015, all isolates of ESBL-producing organisms reported by the clinical laboratory were enrolled in this study.
T135 17748-17865 Sentence denotes Screening of ESBL production was according to the recommendation of the Clinical and Laboratory Standards Institutes.
T136 17866-18030 Sentence denotes The screened organisms included Escherichia coli, Klebsiella pneumoniae/oxytoca, and Proteus mirabilis, and a double disc method was used as a method for screening.
T137 18031-18119 Sentence denotes The disc diffusion method was used for antimicrobial susceptibility testing of flomoxef.
T138 18120-18339 Sentence denotes The interpretive criteria of flomoxef recommended by the manufacturer were as follows: zone size of susceptibility was ≥18 mm, that of intermediate resistance was between 13 and 17 mm, and that of resistance was ≤12 mm.
T139 18340-18424 Sentence denotes All intermediate-resistant results were regarded as resistant results in this study.
T140 18426-18523 Sentence denotes A total of 296 CRPA isolates, including 136 in 2014 and 160 in 2015, were enrolled in this study.
T141 18524-18644 Sentence denotes The susceptibility rates of imipenem, meropenem, and doripenem against CRPA were 6%, 4%, and 15%, respectively, in 2014.
T142 18645-18734 Sentence denotes These were 9%, 19%, and 28% of imipenem, meropenem, and doripenem, respectively, in 2015.
T143 18735-18872 Sentence denotes This study found that doripenem had the highest susceptibility rates against CRPA, indicating that doripenem did not readily select CRPA.
T144 18873-18979 Sentence denotes In contrast, imipenem had the lowest susceptibility rates, indicating that imipenem readily selected CRPA.
T145 18980-19019 Sentence denotes These findings echoed previous studies.
T146 19020-19211 Sentence denotes According to the results of this study, we suggest that doripenem should be regarded as the first choice when antipseudomonal carbapenems are used to treat infections caused by P. aeruginosa.
T147 19212-19405 Sentence denotes In addition, doripenem may be the optimal carbapenem for empiric treatment of hospital-acquired infections because P. aeruginosa should be considered as the likely pathogen in these infections.
T148 19406-19596 Sentence denotes Aspergillus species are the most common and life-threatening fungal pathogens among immunocompromised patients, causing a wide range of infections depending on the immune status of the host.
T149 19597-19718 Sentence denotes Notably, A. flavus is the leading cause of invasive aspergillosis in tropical and sub-tropical countries, including Iran.
T150 19719-19918 Sentence denotes We therefore aimed to evaluate in vitro antifungal susceptibility (AFST) of nine antifungals against clinical and environmental Aspergillus section Flavi isolates collected in Iran from 2008 to 2014.
T151 19919-20104 Sentence denotes Acne is a pathological disorder and a chronic inflammation in the sebaceous follicles and one of the most widespread dermatology problems, and has affected millions of people worldwide.
T152 20105-20173 Sentence denotes Bacterial and fungal skin flora agents are involved in its creation.
T153 20174-20359 Sentence denotes In this cross-sectional study, 70 clinical specimens from suspected skin with acne protests were collected by sterile swab and were streaked on an SDA medium containing chloramphenicol.
T154 20360-20407 Sentence denotes The plates were incubated for 48 hours at 37°C.
T155 20408-20632 Sentence denotes Suspected colonies were studied through microscopic examination and subsequent passage in accordance with standard mycology procedures, and the type of fungal colony colour specified in CHROM agar for isolation of the yeast.
T156 20633-20839 Sentence denotes For final approval, the Candida Species Sequencing Method (ITS2, ITS1 regions) was performed, and susceptibility testing was performed to review Candida for drug-resistant isolates based on the CLSI method.
T157 20840-21058 Sentence denotes Of 70 clinical isolates studied, 11 species of Candida including C. parapsilosis (8, 72.73%), C. krusei (1, 12.5%), C. lusitaniae (1, 12.5%), C. kefir (1, 12.5%), and a Trichosporon asahii were identified and isolated.
T158 21059-21350 Sentence denotes Study of susceptibility of C. parapsilosis isolates to various concentrations of the antifungal agents to isolate Cp1 has shown that the isolated Cp8 Cp5 with MIC5 equal to 32, 0.5, 0.25 and MIC90 of <64, <1, <0.5 μg/ml fluconazole, itraconazole and ketoconazole were respectively resistant.
T159 21351-21506 Sentence denotes Apart from the isolation of Cp1 and Cp8, which had relative strength, almost all other species of C. parapsilosis isolates were susceptible to these drugs.
T160 21507-21798 Sentence denotes Current Australian antibiotic therapeutic guidelines recommend that symptomatic catheter-associated urinary tract infections (CAUTIs) should be treated by removing or changing catheters and treating CAUTIs based on results of cultures and susceptibility testing obtained from a new catheter.
T161 21799-21895 Sentence denotes The empirical antibiotic therapy for severe UTIs is intravenous gentamicin and amoxy/ampicillin.
T162 21896-22031 Sentence denotes Persons with spinal cord injury (SCI) with neurogenic bladders who require ongoing catheterisation often have asymptomatic bacteriuria.
T163 22032-22111 Sentence denotes Current treatment of UTI in SCI is not well standardised with limited evidence.
T164 22112-22259 Sentence denotes ProSCIUTTU was a randomised controlled trial investigating whether probiotics reduce UTIs in participants with neurogenic bladder secondary to SCI.
T165 22260-22343 Sentence denotes For study endpoint, participants had to meet clinical and microbiological criteria.
T166 22344-22439 Sentence denotes The urine cultures and antibiotic susceptibility testing of endpoint participants were studied.
T167 22440-22589 Sentence denotes The aim was to see whether empirical antibiotic therapy suggested by the therapeutic guidelines for severe UTI applies to SCI persons with catheters.
T168 22590-22652 Sentence denotes Only a small number were tested for sensitivity to gentamicin.
T169 22653-22719 Sentence denotes 2/6 of the Gram-positive were sensitive to ampicillin/amoxycillin.
T170 22720-22742 Sentence denotes 9/36 grew Pseudomonas.
T171 22743-22834 Sentence denotes Pseudomonas was susceptible to ceftazidime in 5/6 of UTIs and to gentamicin in 8/9 of UTIs.
T172 22835-22948 Sentence denotes Current Australian antibiotic guidelines for severe UTI are applicable for persons with SCI who are catheterised.
T173 22949-23097 Sentence denotes However, if there is a history of prior colonisation or infection with Pseudomonas species, amoxy/ampicillin should be substituted with ceftazidime.
T174 23098-23297 Sentence denotes It is reassuring that, despite prolonged catheterisation and frequent hospitalisation in this cohort of participants, the prevalence of multi-resistant organisms was low in each category of organism.
T175 23298-23349 Sentence denotes I do not have any conflict of interests to declare.
T176 23350-23438 Sentence denotes Urinary tract infections (UTIs) are very common in people with spinal cord injury (SCI).
T177 23439-23546 Sentence denotes UTIs are increasingly difficult to treat as the organisms that cause them become more antibiotic-resistant.
T178 23547-23636 Sentence denotes Probiotics have been found to be efficacious in preventing UTIs in post-menopausal women.
T179 23637-23907 Sentence denotes The main aim of this study is to determine whether probiotic therapy with combinations of Lactobacillus reuteri RC-14 + Lactobacillus GR-1 (RC14-GR1) and/or Lactobacillus rhamnosus GG + Bifidobacterium BB-12 (LGG-BB12) are effective in preventing UTI in people with SCI.
T180 23908-24001 Sentence denotes A double-blind factorial-design randomised controlled trial with 3-year recruitment was used.
T181 24002-24111 Sentence denotes The research took place in multiple spinal units in New South Wales, Australia with their rural affiliations.
T182 24112-24196 Sentence denotes Eligible participants were people with SCI and stable neurogenic bladder management.
T183 24197-24360 Sentence denotes Two hundred and seven participants were randomised to one of four arms: RC14-GR1+LGG-BB12, RC14-GR1+placebo, LGG-BB12+placebo or two placebo capsules for 6 months.
T184 24361-24421 Sentence denotes All regimens were indistinguishable in appearance and taste.
T185 24422-24499 Sentence denotes Randomisation was stratified by bladder management type and inpatient status.
T186 24500-24562 Sentence denotes The primary outcome was time to occurrence of symptomatic UTI.
T187 24563-24659 Sentence denotes Patients randomised to RC14-GR1 did not have a longer time to UTI than placebo (HR 0.68, 95% CI:
T188 24660-24662 Sentence denotes 0.
T189 24664-24870 Sentence denotes We investigated antibiotic treatment of inpatients with indeterminate Clostridium difficile results (GDH positive, toxin negative) over the period October 2014 to May 2015 within one 609-bedded Acute Trust.
T190 24871-25122 Sentence denotes We found that out of 67 patients identified with indeterminate C. difficile results, 26 (40%) were treated for C. difficile infection, including five who tested negative by PCR (Gene Expert) and were therefore treated inappropriately with antibiotics.
T191 25123-25222 Sentence denotes The management of indeterminate C. difficile cases was reviewed and a revised plan was implemented.
T192 25224-25364 Sentence denotes Evaluation of these changes was carried out by reviewing patients with indeterminate C. difficile results from September 2015 to April 2016.
T193 25365-25454 Sentence denotes During this period only 19% (12/64) indeterminate patients were treated with antibiotics.
T194 25455-25701 Sentence denotes An incidental finding was that the average length of stay for these patients decreased by 5 days and the average length of diarrhoeal symptoms decreased by 1 day (as defined as passing a Bristol score type 1 to type 4 and 48 hours symptoms free).
T195 25702-25875 Sentence denotes Further repeat evaluations should be utilised to ensure that this policy change is embedded in our Trust and continues to have a positive impact on patient outcome and care.
T196 25876-25927 Sentence denotes I do not have any conflict of interests to declare.
T197 25929-26017 Sentence denotes Like most developed countries, we take the water that comes out of our taps for granted.
T198 26018-26103 Sentence denotes In reality, a lot of work goes on behind the scenes to ensure that our water is safe.
T199 26104-26171 Sentence denotes Water safety is not the responsibility of one person or department.
T200 26172-26252 Sentence denotes It requires a team approach, uniting outside agencies with in-house cooperation.
T201 26253-26401 Sentence denotes Lapses in water safety can have devastating results, as the Pseudomonas aeruginosa outbreak in the Neo-natal Units in Northern Ireland demonstrated.
T202 26402-26529 Sentence denotes The implementation of HTM 04-01 raised awareness of water safety, not only in augmented care areas but throughout our hospital.
T203 26530-26843 Sentence denotes Echoing the principles of the Saving Lives High Impact Interventions, the Water Safety Care Bundle recognises that all groups -South West Water, Site Services, Pro-economy, Water Assurance Group, Infection Prevention and Control, Serco and clinical staff -must play their part if water safety is to be maintained.
T204 26844-26928 Sentence denotes Each group has specific actions and responsibilities as set out in the Water Policy.
T205 26929-27143 Sentence denotes Measurements of compliance include regular water sampling, total viable counts (TVC), flushing logs, observations on our "water walk arounds" and a review of sink traps during augmented care environmental sampling.
T206 27144-27250 Sentence denotes Standard Operating Procedures are now in place for positive Pseudomonas aeruginosa and Legionella samples.
T207 27251-27360 Sentence denotes The Pseudomonas database for augmented care areas has increased our knowledge of strains within the hospital.
T208 27361-27419 Sentence denotes Increased compliance of flushing is reflected in the TVCs.
T209 27420-27613 Sentence denotes Maintenance and improvement of the Water Safety Care Bundle depends on developing our relationship with South West Water and Pro-economy whilst encouraging clinical engagement within our Trust.
T210 27614-27793 Sentence denotes Our network of infection prevention link practitioners will be essential to ensuring that water safety practices are maintained in a pressurised and fluid healthcare organisation.
T211 27795-27877 Sentence denotes Antimicrobial resistance is one of the defining public health problems of our age.
T212 27878-28001 Sentence denotes New resistance mechanisms continue to emerge, making control of infection both more difficult and more important than ever.
T213 28002-28192 Sentence denotes The rapid spread of carbapenem-resistant Enterobacteriaceae (CPE) is one of the most worrying examples, as it is usually asymptomatic, highly transmissible and is almost impossible to treat.
T214 28193-28330 Sentence denotes In 2015, University Hospitals of South Manchester (UHSM) introduced new initiatives to combat the growing number of CPE cases each month.
T215 28331-28432 Sentence denotes Interventions were as follows: reactive Hydrogen Peroxide Vapour following discharge of CPE patients.
T216 28433-28501 Sentence denotes This ensured that patients were being admitted to safe environments.
T217 28502-28697 Sentence denotes Further to this, we introduced an HPV managed service which enabled us to decontaminate high-risk areas proactively and reduce environmental bioburden in shared areas such as toilets and sluices.
T218 28698-28859 Sentence denotes In 2013, Public Health England published the "Toolkit", a package of interventions to help hospitals detect, manage and control CPE, which UHSM also implemented.
T219 28860-28917 Sentence denotes UHSM had some of the highest rates of CPE in the country.
T220 28918-29007 Sentence denotes The interventions stated above led to substantial reductions in infections and outbreaks.
T221 29008-29099 Sentence denotes The Trust has seen a 58% reduction in CPE incidences in 2015/2016 compared with 2014/ 2015.
T222 29100-29431 Sentence denotes Evaluation suggests that compliance with the CPE Toolkit and the introduction of emergency and elective screening of patients who fit the criteria of admission to a hospital within 12 months, full multi-disciplinary team (MDT) outbreak meetings and the introduction of a HPV managed service has played a key part in this reduction.
T223 29432-29612 Sentence denotes UHSM will continue to identify methods of decontaminating areas we are currently unable to reach with HPV, and potentially look to implement new, faster technology for these areas.
T224 29613-29710 Sentence denotes UHSM will also continue to train staff to ensure an ever greater compliance with the CPE Toolkit.
T225 29711-29882 Sentence denotes Pseudomonas aeruginosa is a ubiquitous and important opportunistic pathogen in the healthcare setting, particularly affecting those with impaired host or mucosal immunity.
T226 29883-30038 Sentence denotes It is found in a wide range of moist, nutrient-limited environments and may colonise hospital and domestic water taps, sinks, drains, toilets, and showers.
T227 30039-30155 Sentence denotes Here we report our experience in reducing the transmission risk of P. aeruginosa from water in a critical care unit.
T228 30156-30458 Sentence denotes To reduce the risk of transmission we examined: the role of disposal of patient waste water; the installation of new tap outlets that are redesigned either to prevent contamination or enable decontamination; the cleaning of taps appropriately; and the frequency of water sampling to identify outbreaks.
T229 30459-30577 Sentence denotes Water samples were taken from the tap outlets and tested for the enumeration of P. aeruginosa via membrane filtration.
T230 30578-30734 Sentence denotes Clinical surveillance of patients acquiring P. aeruginosa was monitored daily, with all strains being molecularly typed via pulse-field gel electrophoresis.
T231 30735-30860 Sentence denotes From the water sampling undertaken on the critical care unit, 25% of the outlets were positive for P. aeruginosa over a year.
T232 30861-31080 Sentence denotes New taps are to be installed on part of the unit; in addition to this a new three-cloth cleaning method has been implemented, as well as using gel sheets to solidify patient waste water being disposed of in a macerator.
T233 31081-31249 Sentence denotes All these initiatives have resulted in a reduced number of tap outlets being colonised with P. aeruginosa and the number of patients acquiring P. aeruginosa infections.
T234 31250-31387 Sentence denotes Superoxide water is composed of a number of active agents that predominantly include hypochlorous acid, sodium hypochlorite and chlorine.
T235 31388-31479 Sentence denotes Different concentrations of these active agents exist in different superoxide compositions.
T236 31480-31713 Sentence denotes Despite this, they are all known to be fast-acting antimicrobials with a broad spectrum of activity on planktonic micro-organisms, as well as clostridium spores, warranting their usage in the area of infection prevention and control.
T237 31714-31832 Sentence denotes The efficacy of the different superoxide water compositions available has been reported on planktonic micro-organisms.
T238 31833-31899 Sentence denotes However, the efficacy of superoxide waters on biofilms is lacking.
T239 31900-32144 Sentence denotes Consequently, the aim of this study was to investigate the efficacy of a new superoxide composition on in vitro mono-culture and polymicrobial biofilms, utilising a range of different biofilm models relevant to infection prevention and control.
T240 32145-32518 Sentence denotes A range of clinically significant Gram-positive (including meticillin-sensitive and meticillin-resistant Staphylococcus aureus), Gram-negative (Pseudomonas aeruginosa, Acinetobacter baumannii), spore-forming bacteria (Clostridium difficile) and yeasts/fungi (Candida albicans and Aspergillus sp) were exposed to a novel superoxide formulation in various non-biofilm models.
T241 32519-32814 Sentence denotes In addition, the anti-biofilm efficacy of the new superoxide composition was evaluated in numerous biofilm models that included the Centers for Disease Control (CDC) Biofilm Bioreactor, the Minimum Biofilm Elimination Concentration (MBEC) model, the drip slide model and a novel poloxamer model.
T242 32815-33031 Sentence denotes All antimicrobial studies evaluated on planktonic microbes demonstrated that the new superoxide composition was a fast-acting and effective broad spectrum antimicrobial following a contact time of only a few minutes.
T243 33032-33252 Sentence denotes Within all the mono-culture and polymicrobial biofilm models evaluated, the new superoxide formulation also demonstrated effective anti-biofilm activity on both monoculture and polymicrobial immature and mature biofilms.
T244 33253-33461 Sentence denotes Overall, this new superoxide water composition has demonstrated both a broad anti-microbial and anti-biofilm activity that would warrant its usage for applications in the prevention and treatment of biofilms.
T245 33462-33609 Sentence denotes Recent evidence has shown persistence of viable organisms in dry biofilms found in clinical settings even after terminal cleaning and disinfection.
T246 33610-33862 Sentence denotes The work presented here demonstrates the use of a dry biofilm model to investigate the efficacy of various disinfectants with the overall aim of eliminating biofilm on dry environmental surfaces following appropriate cleaning/disinfection combinations.
T247 33863-34097 Sentence denotes Staphylococcus aureus (NCIMB 9518) biofilms were grown in tryptone soy broth on 10 mm diameter AISI 430 stainless steel discs at room temperature (20-23°C) for 12 days with rotation between wet and dry phases (at 37°C) every 48 hours.
T248 34098-34243 Sentence denotes Dry biofilms were then exposed to disinfectant solutions with varying exposure times or wiped with disinfectant wipes using the ASTM2967-15 test.
T249 34244-34382 Sentence denotes For comparison, wet biofilm of S. aureus grown for 48 hours and dried S. aureus inoculum on stainless steel discs (BS EN 13727) were used.
T250 34383-34450 Sentence denotes Disinfectants included chlorine, glutaraldehyde and peracetic acid.
T251 34451-34737 Sentence denotes Assessment of efficacy measured biomass reduction by crystal violet staining, biofilm recovery after 24 hours and beyond indicated by a pH indicator colour change in the growth medium and transfer of bacteria from surface to surface immediately and then 24 hours following intervention.
T252 34738-34913 Sentence denotes Dry biofilms were found to persist even after biocidal exposure -with a difference in susceptibility when compared with "wet" biofilm or planktonic bacteria dried on surfaces.
T253 34914-35123 Sentence denotes The complete removal/destruction of dry biofilms from surfaces appears not to be currently achievable using current disinfectants without damaging the surfaces, although disinfectant wipes were more effective.
T254 35124-35247 Sentence denotes Some biofilm recovery was observed with the colorimetric medium after 24-48 hours following some but not all interventions.
T255 35248-35483 Sentence denotes The results highlight that while the aim of eliminating dry biofilm is not currently achievable, a realistic approach may still involve making surfaces safe by controlling biofilm regrowth and by preventing transfer of micro-organisms.
T256 35484-35612 Sentence denotes Hydrogen peroxide vapour (HPV) decontamination systems are increasingly used in hospitals to reduce the incidence of infections.
T257 35613-35824 Sentence denotes Whilst HPV has demonstrated efficacy against many healthcare pathogens, it remains crucial to consider environmental factors (i.e. room-volume, furniture and construction) to ensure decontamination is effective.
T258 35825-35950 Sentence denotes HPV providers validate their systems using biological indicators (BIs) containing 10 6 Geobacillus stearothermophilus spores.
T259 35951-36068 Sentence denotes BIs require specialist facilities for growth, up to 7 days to confirm decontamination efficacy and can be unreliable.
T260 36069-36221 Sentence denotes In this study, the possibility of monitoring decontamination efficacy using a thermostable adenylate kinase (tAK) "enzyme indicator" (EI) was evaluated.
T261 36222-36340 Sentence denotes EIs showed proportional inactivation following HPV exposure and provided quantifiable and audible data within minutes.
T262 36341-36459 Sentence denotes EIs could provide rapid reassurance on process efficacy for hospital infection control teams and HPV system providers.
T263 36460-36542 Sentence denotes BIs and EIs were exposed to HPV in a whole-room setting using a commercial system.
T264 36543-36638 Sentence denotes The process was performed using a range of HPV exposure times, doses and environmental changes.
T265 36639-36863 Sentence denotes Following exposure, remaining viability/ activity was assessed; BIs were incubated at 56°C and monitored for bacterial growth over 7 days whilst tAK activity was measured using ATP-luciferase assay in a benchtop luminometer.
T266 36864-36926 Sentence denotes EIs provided a rapid and sensitive measure of the HPV process.
T267 36927-37053 Sentence denotes Both BIs and EIs were able to demonstrate sub-optimal HPV cycles, resulting from reduced time, dose and environmental factors.
T268 37054-37170 Sentence denotes BIs gave a qualitative pass/fail answer within 7 days whilst EIs provided a quantifiable measurement within minutes.
T269 37171-37423 Sentence denotes High-risk acute and chronic wounds that demonstrate a poor response to prophylactic and therapeutic levels of antiseptics and/or systemic antibiotics, and deteriorate once the antimicrobial is removed, are considered a good marker for biofilm evidence.
T270 37424-37555 Sentence denotes Biofilms in wounds have been documented and are considered to delay wound healing and increase the wound's propensity to infection.
T271 37556-37770 Sentence denotes Consequently, it is important that for those wounds which are infected with a virulent biofilm, new anti-biofilm agents are developed which focus on breaking down the biofilm and preventing microbial re-attachment.
T272 37771-37958 Sentence denotes In addition to this, biofilms are also known to house Acanthamoeba spp, enabling them to act as potential reservoirs of opportunistic pathogens and increasing a wound's risk of infection.
T273 37959-38187 Sentence denotes The aim of this study was to evaluate the anti-microbial and anti-biofilm ability of a new patented broad spectrum anti-biofilm formulation designed to be used in central venous catheters, urinary catheters, skin and wound care.
T274 38188-38585 Sentence denotes The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) was determined against 50 clinical isolates -Gram positive (Staphylococcus epidermidis, S. aureus, meticillin-resistant S. aureus), Gram negative (Enterococcus faecium, E. faecalis, Klebsiella sp, E. coli, Enterobacter cloacae, Pseudomonas aeruginosa, Acinetobacter baumannii and Proteus sp) and yeasts/fungi.
T275 38586-38718 Sentence denotes The anti-biofilm ability of this novel antibiofilm formulation was determined on preformed young (24 h) and old (6 months) biofilms.
T276 38719-38876 Sentence denotes The anti-biofilm activity was also evaluated on pure cultures of Acanthamoeba spp and also Acanthamoeba spp that had ingested viable opportunistic pathogens.
T277 38877-38962 Sentence denotes The anti-biofilm agent was shown to be effective against both young and old biofilms.
T278 38963-39075 Sentence denotes The anti-biofilm efficacy varied between species, with the greatest efficacy observed on Gram-positive bacteria.
T279 39076-39168 Sentence denotes Acanthamoeba spp was eradicated following 24 hours exposure to the anti-biofilm composition.
T280 39169-39274 Sentence denotes The antibiofilm formulation provides a novel alternative for wounds at risk of infection and/or infected.
T281 39275-39326 Sentence denotes I do not have any conflict of interests to declare.
T282 39327-39465 Sentence denotes Stethoscopes have been implied to transmit micro-organisms, including methicillin-resistant Staph aureus (MRSA) and Clostridium difficile.
T283 39466-39592 Sentence denotes Therefore, a contaminated stethoscope could conceivably confer a significant risk of healthcare-associated infections (HCAIs).
T284 39593-39666 Sentence denotes Currently, there is no consensus on optimal stethoscope cleaning methods.
T285 39667-39748 Sentence denotes This study aims to assess current cleaning practices at four sites across the UK.
T286 39749-39850 Sentence denotes One hundred and ninety-nine responses were collected from healthcare providers at four UK NHS trusts.
T287 39851-40044 Sentence denotes Both Likert-style and free-text questions were used to capture attitudes towards cleaning stethoscopes, current cleaning behaviours and potential suggestions to increasing stethoscope cleaning.
T288 40045-40205 Sentence denotes 92.5% of respondents felt it is clinically important to clean the stethoscope regularly and 76.9% felt that clean stethoscopes could reduce the number of HCAIs.
T289 40206-40260 Sentence denotes Reasons given against were that of a lack of evidence.
T290 40261-40385 Sentence denotes Only 7.5% of respondents clean their stethoscope in between every patient, and 11% of respondents have never cleaned theirs.
T291 40386-40556 Sentence denotes 61.3% of respondents noted that they use their stethoscope in isolation rooms, with 23% of those never cleaning their stethoscope either before or after the consultation.
T292 40557-40686 Sentence denotes Better distribution of antiseptic wipes around clinical areas was identified as the best motivator to improve cleaning practices.
T293 40687-40887 Sentence denotes Despite a consensus among medical professionals about the importance of stethoscope cleaning, current stethoscope cleaning practices are inadequate and could therefore play a role in infection spread.
T294 40888-41092 Sentence denotes Personal stethoscopes are frequently used in isolation rooms, which is pertinent in view of previous reports demonstrating contamination of stethoscopes with micro-organisms such as C. difficile and MRSA.
T295 41093-41257 Sentence denotes The study highlights that a better availability of antiseptic wipes in clinical areas may motivate healthcare providers to clean their stethoscopes more frequently.
T296 41258-41427 Sentence denotes Future studies could look at the distribution of antiseptic wipes in clinical areas and also the role of visual reminders such as posters in improving current practices.
T297 41428-41479 Sentence denotes I do not have any conflict of interests to declare.
T298 41480-41861 Sentence denotes Emergency Departments (EDs) are facing an unprecedented future: unannounced audits by Infection Prevention and Control Teams and the Healthcare Environmental Inspectorate; arduous waiting time targets set by the government and treatment of an increasing number of patients with ever more complex conditions and needs -all of which contribute to the extreme challenges within an ED.
T299 41862-41970 Sentence denotes Nevertheless, safe patient care is a fundamental priority in reducing healthcare-associated infection (HAI).
T300 41971-42144 Sentence denotes Six ED patient trolleys were selected from two acute University Hospitals that were either prepared (n=3) or had just been cleaned (n=3) for a new arrival to the department.
T301 42145-42212 Sentence denotes Firstly, the trolleys were inspected for any visible contamination.
T302 42213-42372 Sentence denotes Then, after the swabs were dipped into normal saline, the trolleys were swabbed on a symmetrical 10-15 cm section of the handrail, trolley frame and head rest.
T303 42373-42492 Sentence denotes The swabs were immediately plated onto blood agar, sealed, then taken to the labs for an incubation period of 48 hours.
T304 42493-42551 Sentence denotes Three of the six trolleys had visible blood contamination.
T305 42552-42607 Sentence denotes Total colony count ranged from 5 to >450 for each swab.
T306 42608-42710 Sentence denotes The hand rail had the highest colony count of organisms, followed by the bed frame, then the headrest.
T307 42711-42868 Sentence denotes Organisms included Staphylococcus aureus, Staph sp., Bacillus cereus, Bacillus sp., Dermacoccus nishinomiyaensis, Micrococcus luteus and Kocuria rhizophilia.
T308 42869-42931 Sentence denotes No antimicrobial sensitivities or viral testing was conducted.
T309 42932-43092 Sentence denotes In spite of ED trolleys being cleaned between patient use and as per local protocol, blood and body fluid contamination and substantial bacterial counts remain.
T310 43093-43235 Sentence denotes The number of HAIs which originate from an ED trolley is unknown; likewise, acceptable colony counts or organism species would be speculative.
T311 43236-43426 Sentence denotes Therefore, a more proactive, robust approach is required to decrease visual contamination and potentially pathogenic micro-organisms which may compromise the care and safety of our patients.
T312 43427-43579 Sentence denotes The organisation's previous method of decontamination was to use a two-stage process of detergent and alcohol for patient equipment and medical devices.
T313 43580-43772 Sentence denotes Observational evidence identified that this process was not being followed, with areas using just alcohol to disinfect equipment without prior cleaning, thus rendering the process ineffective.
T314 43773-43930 Sentence denotes The Infection Prevention Team (IPT) explored ways of improving compliance and it was decided that a combined detergent/disinfectant wipe could be beneficial.
T315 43931-44026 Sentence denotes A trial was held to evaluate compliance and staff views on the change in practice and products.
T316 44027-44142 Sentence denotes The areas chosen had been noted on audit to have poor compliance with equipment and medical device decontamination.
T317 44143-44328 Sentence denotes Collaborative working with IPT and Procurement enabled the exploration of a single-stage process for decontamination and the opportunity to standardise products across the organisation.
T318 44329-44403 Sentence denotes The costs for using the single-step and two-stage processes were compared.
T319 44404-44531 Sentence denotes The combined detergent/disinfectant wipe was rolled out to all areas of the organisation across three separate inpatient sites.
T320 44532-44708 Sentence denotes Following successful acute implementation and positive evaluation, the product was rolled out to community sites, ensuring a standardised city-wide approach to decontamination.
T321 44709-44889 Sentence denotes The roll-out was supported by the company, with training sessions delivered to all areas on correct usage, and dispensers were fitted bespoke to all clinical areas based upon need.
T322 44890-45046 Sentence denotes The introduction of a single-step approach to decontamination has shown an increase in compliance and a reduction in healthcare-associated infection (HCAI).
T323 45047-45162 Sentence denotes Environmental assurance data has shown an average increase from 85% to 90% between December 2015 and February 2016.
T324 45163-45298 Sentence denotes The Clostridium difficile infection rate reduced from 29.27 per 100,000 bed days on introduction to 8.65 following full implementation.
T325 45299-45412 Sentence denotes The introduction and the change to a single supplier has also made a significant cost saving to the organisation.
T326 45414-45604 Sentence denotes A small number of patients undergoing cardiac surgery where cardiopulmonary bypass machines were used developed a surgical site infection (SSI) with Mycobacterium sp., including one locally.
T327 45605-45774 Sentence denotes We report the measures implemented to reduce the risk of contaminated aerosols from heater cooler units (HCU) used in cardiothoracic surgery, guided by PHE and the MHRA.
T328 45775-45821 Sentence denotes Water and air sampling commenced in June 2015.
T329 45822-45884 Sentence denotes The frequency of disinfection was increased in September 2015.
T330 45885-46061 Sentence denotes The Trust has purchased a new HCU (an increase from five to six) to allow HCUs to be returned for manufacturer decontamination on a rotational basis, commencing September 2015.
T331 46062-46164 Sentence denotes A dedicated tap with a point-of-use filter has been installed at Hammersmith for filling the machines.
T332 46165-46300 Sentence denotes The HCUs have been located as far from the patient as possible, and surveillance for water-related organisms in SSIs has been enhanced.
T333 46301-46356 Sentence denotes All HCUs have grown Mycobacterium sp. in water and air.
T334 46357-46516 Sentence denotes The proportion of air samples growing Mycobacterium sp. or overgrown with fungi was significantly lower after September 2015 (40% of 50 vs. 16% of 50, p=0.01).
T335 46517-46637 Sentence denotes Use of disposable warming mattresses was maintained and decontamination of connectors included in disinfection routines.
T336 46638-46746 Sentence denotes We are looking at ways of capturing aerosols from the machines, and potentially moving HCUs out of theatres.
T337 46747-46867 Sentence denotes Air and water testing for fungi has commenced to evaluate a potential further risk of aerosolising fungi in the theatre.
T338 46868-46966 Sentence denotes The levels of Mycobacterium sp. are decreased and remain at a static level for both water and air.
T339 46967-47018 Sentence denotes I do not have any conflict of interests to declare.
T340 47019-47031 Sentence denotes Abstract ID:
T341 47032-47036 Sentence denotes 4484
T342 47037-47136 Sentence denotes The impact of implementing a structured educational programme on hospital environmental cleanliness
T343 47137-47202 Sentence denotes McGill University Heath Centre, Royal Victoria Hospital, Montreal
T344 47203-47382 Sentence denotes Clostridium difficile infection (CDI) is considered to be one of the most uncontrolled nosocomial infections in a colorectal surgery unit "4NW" of a tertiary hospital in Montreal.
T345 47383-47498 Sentence denotes Environmental contamination with CDI spores has been associated, in the literature, with its indirect transmission.
T346 47499-47625 Sentence denotes Thus, appropriate environmental cleaning and disinfection in healthcare facilities remain a fundamental aspect of CDI control.
T347 47626-47818 Sentence denotes This study aims to determine whether the establishment of a structured educational programme based on repetitive teaching and cleaning monitoring could improve environmental cleaning practice.
T348 47819-47961 Sentence denotes We used an experimental design pre/post-test with a controlled group represented by 3W (a surgical unit), while 4NW represents the pilot unit.
T349 47962-48098 Sentence denotes In both units, random rooms including frequently touched surfaces and equipment were tested using the fluorescence technique (Glo-Germ).
T350 48099-48220 Sentence denotes Staff on 4NW exclusively received instant feedback on the audit result and were instructed repeatedly on proper cleaning.
T351 48221-48280 Sentence denotes Rooms and equipment were retested on three other occasions.
T352 48281-48333 Sentence denotes Pre-and post-intervention values were then compared.
T353 48334-48474 Sentence denotes Our intervention was guided by the Model for Improvement as a framework using Plan-Do-Study-Act cycles to test the changes on a small scale.
T354 48475-48625 Sentence denotes The percentage of cleaned surfaces improved incrementally on 4NW between the trials and went from 28% pre-intervention to values of 70%, 72%, and 66%.
T355 48626-48729 Sentence denotes The percentage of cleaned equipment had also improved and went from 11% to values of 46%, 71%, and 67%.
T356 48730-48876 Sentence denotes No significant improvement was observed in the controlled unit where the results never reached 15% among nursing equipment and 52% among surfaces.
T357 48877-48966 Sentence denotes An educational programme may result in improvement of hospital environmental cleanliness.
T358 48967-49098 Sentence denotes Such a programme should include efforts to control quality with continuous feedback to employees to effectively support the change.
T359 49100-49481 Sentence denotes This discussion of the evolving role of the Infection Prevention and Control (IPC) Champion takes place in the context of the ever-changing challenge of clinical staff providing support to IPC teams regarding communication and ownership of IPC within a Trust of over 6500 staff, providing mental health and learning disability services to patients across a large geographical area.
T360 49482-49539 Sentence denotes The evolving role 2004-2010 Traditional IPC "Link Nurse".
T361 49540-49555 Sentence denotes Delivery model:
T362 49556-49625 Sentence denotes Face to face on Trust sites, and staff attended educational sessions.
T363 49626-49661 Sentence denotes 2010-2013 IPC "Link Practitioners".
T364 49662-49790 Sentence denotes Commencement of annual study days, basic roles and responsibilities established and electronic quarterly newsletters introduced.
T365 49791-49820 Sentence denotes 2014-Present IPC "Champions".
T366 49821-49879 Sentence denotes Introduced annual induction days to support new champions.
T367 49880-49980 Sentence denotes Continuation of annual study events for all providing training updates and networking opportunities.
T1 49981-50039 Sentence denotes Roles and responsibilities have been reviewed and updated.
T2 50040-50210 Sentence denotes A contract between the champion, IPC team and ward manager has been developed which is linked to Knowledge Skills Framework and Infection Prevention Society competencies.
T3 50211-50322 Sentence denotes An Intranet page and specific email account has been established which facilitates communication and education.
T4 50323-50422 Sentence denotes Biannual champion initiatives address relevant IPC issues and further develops the champion's role.
T5 50423-50521 Sentence denotes Champions complete audits as part of their role to monitor, maintain and improve standards of IPC.
T6 50522-50635 Sentence denotes A questionnaire has been devised and disseminated to all champions to evaluate the success of introduced changes.
T7 50636-50737 Sentence denotes Modern matrons support the role of champion and information is shared at the IPC Committee quarterly.
T8 50738-50773 Sentence denotes Initiatives delivered successfully:
T9 50774-50959 Sentence denotes -A poster was developed explaining the importance of decontaminating multiple patient equipment and is now displayed Trustwide. -Twenty-six areas received a "Sharp Safety" presentation.
T10 50960-51080 Sentence denotes -An electronic version of the Essential Steps Audit Tool was created and guidance for use disseminated to IPC champions.
T11 51081-51192 Sentence denotes Introduction day for champions However, nationally, the rate of improvement for CDI has slowed in recent years.
T12 51193-51346 Sentence denotes A significant proportion of healthcare-acquired infections can be prevented by the adoption of evidence-based infection prevention and control standards.
T13 51347-51536 Sentence denotes Our acute Trust developed a bespoke Diarrhoea Assessment Management Pathway (DAMP record) to assist in the identification and management of the patient with potentially infective diarrhoea.
T14 51537-51656 Sentence denotes The document promotes consistent record keeping and prompts staff to implement a bundle of risk-reducing interventions.
T15 51657-51778 Sentence denotes It is important for clinical staff to understand risk assessment, recognising infection potential in their patient group.
T16 51779-51975 Sentence denotes Comprehensive assessment is required to establish type and possible cause of diarrhoea, to isolate the patient at the earliest opportunity and submit a stool sample for testing, where appropriate.
T17 51976-52078 Sentence denotes The DAMP record should commence following the patient's first episode of Bristol Stool Chart type 5-7.
T18 52079-52138 Sentence denotes The Bristol Stool Chart is incorporated in the DAMP record.
T19 52139-52284 Sentence denotes It is a comprehensive tool, informative guide and monitoring record requiring education and training, engagement and ownership by clinical teams.
T20 52285-52458 Sentence denotes The pathway is subject to continuous audit and development by our team to measure compliance across the Trust, encouraging continuity of care throughout the patient journey.
T21 52459-52581 Sentence denotes The IPC supports ward teams in cultivating clinical excellence, positive communication and reinforcement of best practice.
T22 52582-52680 Sentence denotes We engage with staff, sharing lessons learned as part of our ongoing commitment to patient safety.
T23 52681-52850 Sentence denotes In the Flu Plan for Winter 2014/2015, Public Health England stated that "Flu is an unpredictable but recurring pressure that the NHS and public faces each winter…" (PHE:
T24 52851-52854 Sentence denotes 4).
T25 52855-53021 Sentence denotes The same document also acknowledges that an increase in the uptake of the flu vaccine is still required for all healthcare workers (HCWs) with direct patient contact.
T26 53022-53121 Sentence denotes HCWs are at risk of occupational exposure, and can act as vectors in the transmission of the virus.
T27 53122-53201 Sentence denotes Despite the risks associated with influenza, uptake in HCWs remains suboptimal.
T28 53202-53473 Sentence denotes In order to explore both local and worldwide attitudes toward the uptake of the influenza vaccine, a literature review was conducted as part of the "Management of an Infection Prevention and Control Service" (MICS) course at the University of Manchester, in January 2015.
T29 53474-53618 Sentence denotes The aim was to explore potential methods of improving uptake amongst HCWs, based on some of the reasons given for non-acceptance of the vaccine.
T30 53619-53771 Sentence denotes The literature search included research papers from France, the USA, Srinagar, the United Arab Emirates, Kuwait, Oman, the Republic of Korea and the UK.
T31 53772-53867 Sentence denotes Papers selected were based on quantitative research, with findings expressed as numerical data.
T32 53868-53922 Sentence denotes Primary sources were preferred over secondary sources.
T33 53923-53963 Sentence denotes Common themes were identified worldwide.
T34 53964-54063 Sentence denotes Although influenza causes high numbers of deaths, vaccination rates amongst HCWs remain suboptimal.
T35 54064-54111 Sentence denotes Aspirational rates of 75% were seldom achieved.
T36 54112-54221 Sentence denotes Knowledge and understanding of the aetiology of the influenza virus was seen to directly affect uptake rates.
T37 54222-54308 Sentence denotes Inhibiting factors, barriers and reasons for low uptake were similar across the world.
T38 54309-54518 Sentence denotes There is a general acknowledgement that ongoing education regarding the risks and benefits of the vaccine for HCWs is essential, in order to minimise the effects of popular myths about flu and the flu vaccine.
T39 54519-54573 Sentence denotes Education campaigns need to be innovative and ongoing.
T40 54574-54599 Sentence denotes Information is essential!
T41 54600-54746 Sentence denotes Paediatric critical care units (CCUs) are highly specialist areas managing complex patients at increased risk of healthcare-associated infections.
T42 54747-54865 Sentence denotes As a consequence, staff need more bespoke Infection Prevention Control (IPC) training to address their learning needs.
T43 54866-55030 Sentence denotes Our IPC nursing team therefore wished to assess the existing knowledge of CCU nursing staff in order to provide an IPC training programme tailored to staff's needs.
T44 55031-55152 Sentence denotes A brief electronic survey of 10 questions, taking approximately 5 minutes to complete, was sent to all CCU nursing staff.
T45 55153-55339 Sentence denotes The questions were unambiguous and asked nurses to rate their personal IPC knowledge, self-assess their ability to implement IPC best practices and suggest ideas for future IPC training.
T46 55340-55420 Sentence denotes Out of 269 questionnaires sent out, only 74 staff (26%) responded to the survey.
T47 55421-55517 Sentence denotes The majority of respondents were band 5 or 6, reflecting the commonest nursing bands on our CCU.
T48 55518-55717 Sentence denotes Analysing the responses, there was considerable confusion over the understanding of contact/droplet/airborne IPC isolation precautions and associated use of appropriate personal protective equipment.
T49 55718-55839 Sentence denotes The survey did provide the IPC team with some very positive feedback both on staff engagement and future trainings needs.
T50 55840-55989 Sentence denotes Though most staff rated their personal IPC knowledge as above average, the survey did identify areas of weaknesses which require further IPC support.
T51 55990-56099 Sentence denotes This will allow the IPC team to develop a more in-depth training programme to fit the needs of our CCU staff.
T52 56100-56151 Sentence denotes I do not have any conflict of interests to declare.
T53 56152-56420 Sentence denotes Developments in computer-generated visual imaging and mobile computing devices, combined with new research evidence on the behaviour of people and pathogens in hospitals, present opportunities for innovative training to prevent healthcare-associated infections (HAIs).
T54 56421-56523 Sentence denotes Within this context, this poster summarises the development and evaluation of a new tablet-based tool.
T55 56524-56674 Sentence denotes A three-stage iterative prototyping and co-development process involved doctors, nurses, domestic staff and hospital staff in other job roles (n=150).
T56 56675-57054 Sentence denotes Themes of pathogen location, pathogen survival (before and as a result of cleaning) and pathogen transmission were developed and visualised for each of three pathogens -MRSA, C. difficile and norovirus -using an evidence-based approach, e.g. employing pathogenic data showing recontamination after cleaning and covert observational data on "who touches what" in the ward setting.
T57 57055-57198 Sentence denotes Context was provided through a virtual ward setting, enabling zoom-in and zoom-out to various locations and to provide macro/micro-scale views.
T58 57199-57328 Sentence denotes Learning points, risk to patient and other text-based information relevant to job roles and tasks accompanied the visualisations.
T59 57329-57499 Sentence denotes Data was acquired at each of the three stages from staff completing workbooks as they viewed and interacted with the prototype tool, and participated in group discussion.
T60 57500-57573 Sentence denotes Visualisations were engaging and supportive of different learning styles.
T61 57574-57713 Sentence denotes They offered staff a new perspective on pathogens, being able to "see" them contextualised in the virtual ward, making them seem more real.
T62 57714-57803 Sentence denotes Information proved relevant for different staff cohorts, with a mix of experience levels.
T63 57804-57955 Sentence denotes They increased participants' awareness about pathogens by explaining "why" (through dynamic visuals and information) IPC procedures should be followed.
T64 57956-58083 Sentence denotes Further applications were suggested, including at clinical induction, education in schools/universities, and refresher courses.
T65 58084-58154 Sentence denotes This systematic process has established proof of concept for the tool.
T66 58155-58265 Sentence denotes A stage 4 prototype is now being developed with the intention of trialling by IPC managers during in-ward use.
T67 58266-58317 Sentence denotes I do not have any conflict of interests to declare.
T68 58318-58369 Sentence denotes Increasing influenza vaccine uptake from 44% to 77%
T69 58370-58469 Sentence denotes Each year, particularly during winter, influenza is a significant cause of morbidity and mortality.
T70 58470-58584 Sentence denotes The influenza vaccination has been shown to be effective at reducing the severity of illness and preventing death.
T71 58585-58700 Sentence denotes For this reason the Department of Health has a vaccination policy for vaccinating frontline workers within the NHS.
T72 58701-58834 Sentence denotes In 2013-2014 the target that NHS Trusts needed to meet was increased to 75% and the author's Trust at this time had an uptake of 44%.
T73 58835-59068 Sentence denotes The service improvement to increase uptake of the influenza vaccine had a number of components, which included a multidisciplinary team approach, education, launch events, offering vaccines at meetings and training, and social media.
T74 59069-59212 Sentence denotes The infection prevention team and employee health and wellbeing teams worked collaboratively throughout the campaign as the "flu fighter team".
T75 59213-59461 Sentence denotes Education was provided prior to the campaign commencing, with all teams who had a poor uptake being invited to a presentation on influenza which included how it is spread, signs and symptoms, risk groups and examples of outbreaks in the local area.
T76 59462-59630 Sentence denotes The campaign was launched with events at different venues across the Trust, with staff members being invited to have their vaccine, then enjoy a slice of homemade cake.
T77 59631-59880 Sentence denotes Social media was used to support the campaign, with staff members having their photos taken holding a banner saying "we've had our flu jab have you had yours?" These were shared on social media and got staff members talking about having the flu jab.
T78 59881-60005 Sentence denotes The Trust has increased the uptake from 44% to 77% and has been the top mental health trust in England for the last 2 years.
T79 60006-60188 Sentence denotes Future steps should involve the further development of the educational element prior to commencing vaccinating staff members, in particular targeting areas with lower uptake figures.
T80 60189-60347 Sentence denotes In dental settings where the risk of cross-contamination and occupational infection is high, adequate use of personal protective equipment (PPE) is important.
T81 60348-60488 Sentence denotes We held a series of infection control seminars for dental healthcare personnel and conducted a survey of the participants after the seminar.
T82 60489-60624 Sentence denotes We report the current status of the use of PPE in Japanese dental facilities and the improvements reported after seminar participation.
T83 60625-60742 Sentence denotes A self-administered questionnaire was mailed to the 181 dental facilities who attended our infection control seminar.
T84 60743-60945 Sentence denotes We received a total of 74 responses (response rate 40.9%), of which 39 (52.7%) were from dentists, 24 (32.4%) from dental hygienists, 10 (13.5%) from dental assistants, and one (1.4%) from a pharmacist.
T85 60946-61036 Sentence denotes A total of 43 facilities (69.6%) had been actively using PPE before attending our seminar.
T86 61037-61129 Sentence denotes However, 49 facilities (66.2%) changed and/or increased the use after seminar participation.
T87 61130-61407 Sentence denotes A total of 29 facilities (39.2%) increased glove use, 15 facilities (20.3%) improved correct glove use, 13 facilities (17.6%) started to change gloves between each patient, 29 facilities (39.2%) increased eye protection use, and 10 facilities (13.5%) introduced eye protection.
T88 61408-61566 Sentence denotes In addition, six facilities (8.1%) started to change protective clothing between each patient, and six facilities (8.1%) newly introduced protective clothing.
T89 61567-61639 Sentence denotes Proper use of PPE is essential for infection control in dental settings.
T90 61640-61786 Sentence denotes Although most dental facilities in Japan already comply with PPE, improvements were observed after participating in the infection control seminar.
T91 61787-61884 Sentence denotes It was suggested that the seminar served as an effective learning opportunity for proper PPE use.
T92 61885-62040 Sentence denotes We will continue to promote not only the necessity of PPE but also its correct use, which may contribute to improving infection control in dental settings.
T93 62041-62092 Sentence denotes I do not have any conflict of interests to declare.
T94 62093-62216 Sentence denotes Descriptive study of vaccination programme for nursing students, healthcare workers and caregivers in A prefecture in Japan
T95 62217-62471 Sentence denotes The vaccination programmes of hepatitis B (HBV), hepatitis C (HCV), measles, mumps, varicella, and rubella (ID) for nursing students and healthcarerelated workers (HCRW) including healthcare personnel and care workers have been varied, but not clarified.
T96 62472-62597 Sentence denotes Therefore, the purpose of this study was to investigate the current vaccination programmes for HCRW in A prefecture in Japan.
T97 62598-62829 Sentence denotes After approval from the ethical committee of the institution to which the first author belonged, an anonymous self-reported questionnaire about vaccination programmes and their expense was distributed to the following institutions:
T98 62830-63021 Sentence denotes 305 healthcare facilities, clinics, visit nursing stations, long-term care facilities, and public health centres which were randomly selected, and 14 nursing schools in A prefecture in Japan.
T99 63022-63050 Sentence denotes The response rate was 30.7%.
T100 63051-63133 Sentence denotes Of nursing schools, 86% conducted HBV, HCV, and the above ID antibody titre tests.
T101 63134-63211 Sentence denotes Also, about 60% of the nursing school carried out a tuberculin reaction test.
T102 63212-63358 Sentence denotes Among the healthcare facilities, all employees had to take the HBV antibody titre tests, and 19.2% of them carried out an HIV antibody titre test.
T103 63359-63425 Sentence denotes Approximately 50% of them carried out the above ID antibody tests.
T104 63426-63672 Sentence denotes Although visiting nursing stations, long-term care facilities, clinics, and public health centres carried out HBV antibody titre tests and its vaccinations, the above four IDs antibody titre tests as well as TB screening tests were not conducted.
T105 63673-63742 Sentence denotes The cost of antibody titre tests were paid by 75% of nursing schools.
T106 63743-63858 Sentence denotes The cost of vaccination of HBV and HCV and the above ID antibody titre tests were paid by 87.5% of nursing schools.
T107 63859-64025 Sentence denotes The percentage of nursing schools that performed the vaccination programme was fairly high; however, the percentages for other healthcare-related facilities were low.
T108 64027-64226 Sentence denotes As one of the largest teaching hospitals in the UK, our Trust's Infection Prevention and Control Team (IPCT) receives large numbers of calls each week surrounding personal protective equipment (PPE).
T109 64227-64412 Sentence denotes Despite an isolation guideline outlining PPE use, there appears to be confusion from medical and nursing teams around what PPE to wear for certain infectious pathogens and for how long.
T110 64413-64490 Sentence denotes Research from across the globe indicates this confusion is not a local issue.
T111 64491-64590 Sentence denotes The IPCT recognised the need for a tool to aid staff to learn, remember and recall PPE information.
T112 64591-64699 Sentence denotes It was decided a visual tool should be created, that could be used as reference, but also a learning method.
T113 64700-64723 Sentence denotes The PPE wheel was born.
T114 64724-64859 Sentence denotes The wheel is broken into four sections based on the transmission routes of the pathogens (droplet, contact, airborne, and faecal-oral).
T115 64860-64917 Sentence denotes Each section is broken down into what PPE should be worn.
T116 64918-65022 Sentence denotes In line with epic3 guidance, correct removal of PPE is included due to contamination risks upon removal.
T117 65023-65171 Sentence denotes Focus groups using patient care scenarios conducted across 10 units have established current levels of knowledge and confidence surrounding PPE use.
T118 65172-65269 Sentence denotes These confirm the need for a tool, with widely varying confidence levels across the Trust (range:
T119 65270-65277 Sentence denotes 0-80%).
T120 65278-65359 Sentence denotes Knowledge of PPE was particularly poor when respiratory conditions were involved.
T121 65360-65420 Sentence denotes The tool was previewed at our 2016 IPC link staff study day.
T122 65421-65523 Sentence denotes Staff felt the tool was potentially useful, and multiple requests for the finished tool were received.
T123 65524-65660 Sentence denotes Final prototype development is scheduled for completion by December 2016 and the tool will be disseminated within the Trust during 2017.
T124 65661-65799 Sentence denotes Evaluation of its efficacy in helping staff learn about PPE will be conducted via repeat focus groups at 3, 6, and 12 months after launch.
T125 65801-65910 Sentence denotes Provision of infection prevention and control (IPC) training for domiciliary care workers can be challenging.
T126 65911-66040 Sentence denotes This group of staff are mobile workers with little or no access to electronic training or IPC resources during their working day.
T127 66041-66268 Sentence denotes To support the domiciliary care sector and their care workers with an easy access source of IPC education and information, we have developed an infection prevention workbook containing guidance for staff providing care at home.
T128 66269-66383 Sentence denotes This follows on from the successful workbooks developed for Community Health and Social Care and General Practice.
T129 66384-66624 Sentence denotes This innovative 68-page workbook is A5 size, is suitable for a wide range of staff who provide care at home to service users, such as domiciliary and rehabilitation teams undertaking personal care or who assist with daily living activities.
T130 66625-66754 Sentence denotes It is designed for all levels of staff and each member of staff should receive their own copy, working through at their own pace.
T131 66755-66914 Sentence denotes It provides latest national guidance, evidence-based information, 16 topics including seven standard precautions, four key topics and five specific infections.
T132 66915-66969 Sentence denotes Each section includes "test your knowledge" questions.
T133 66970-67100 Sentence denotes When 100% competence is achieved, managers sign the "Certificate of Completion", providing evidence for registration requirements.
T134 67101-67201 Sentence denotes Staff should keep the workbook as evidence of learning and a reference guide for day-to-day working.
T135 67202-67276 Sentence denotes The workbook, published in March 2016, is now used locally and nationally.
T136 67277-67304 Sentence denotes Positive feedback includes:
T137 67305-67393 Sentence denotes "The workbook is a brilliant resource and staff are lucky you are there to support them.
T138 67394-67504 Sentence denotes Completion of the workbook would be an ideal way for Domiciliary Care agencies to demonstrate staff training".
T139 67505-67590 Sentence denotes "The workbook is excellent and a good source of information for our Support Workers".
T140 67591-67705 Sentence denotes Future steps should include raising awareness of the workbook with key stakeholders in public and private sectors.
T141 67706-67757 Sentence denotes I do not have any conflict of interests to declare.
T142 67758-67914 Sentence denotes Surgical site infection (SSI) rates are particularly high (up to 20%) in vascular surgery patients, reflecting the significant co-morbidities in this group.
T143 67915-68078 Sentence denotes Dressings coated with highly hydrophilic Dialkylcarbamoylchloride (DACC) irreversibly bind multiple types of bacteria and should prevent their ingress into wounds.
T144 68079-68196 Sentence denotes We aimed to determine if the use of coated postoperative dressings could reduce SSIs in non-implant vascular surgery.
T145 68197-68397 Sentence denotes Between August 2015 and February 2016, we followed 100 consecutive patients before and 100 after the introduction of DACC-coated postoperative dressings for surgical sites at a single vascular centre.
T146 68398-68503 Sentence denotes Wounds were reviewed at day 5 and day 30 according to the ASEPSIS score to determine the presence of SSI.
T147 68504-68618 Sentence denotes Dichotomous outcomes of SSI versus no SSI were assessed using a two tailed Chi-squared test with Yates correction.
T148 68619-68747 Sentence denotes The 200 patients included 120 males with mean age 63 (range 27-97) including 184/200 current or ex-smokers and 91/200 diabetics.
T149 68748-68885 Sentence denotes SSI at 5 days was significantly lower in the DACC-coated dressings' group compared with standard dressings (1/100 versus 10/100: p=0.01).
T150 68886-69019 Sentence denotes Subsequent SSI rate from 5 to 30 days between DACC and standard dressings was not significantly different (9/99 versus 9/90: p=0.85).
T151 69020-69120 Sentence denotes DACC-coated dressings showed a significant reduction in SSI rates at 5 days post procedure (p=0.01).
T152 69121-69206 Sentence denotes No statistically significant difference in SSI was seen beyond 5 days post procedure.
T153 69207-69331 Sentence denotes DACC-coated dressings appear to have value in SSI prophylaxis in this patient group and would warrant further investigation.
T154 69332-69383 Sentence denotes I do not have any conflict of interests to declare.
T155 69384-69528 Sentence denotes Nosocomial infection is becoming a leading problem for medical practitioners nowadays, placing an extra burden on individual patients worldwide.
T156 69529-69704 Sentence denotes Nosocomial pneumonia caused by multidrug-resistant (MDR) pathogens is a major threat in intensive care unit patients in developing countries, with increasing numbers in Nepal.
T157 69705-69829 Sentence denotes The aim of this study was to determine the aetiology of nosocomial pneumonia caused by MDR Gram-negative bacterial isolates.
T158 69830-70019 Sentence denotes A total of 100 Gram-negative bacterial strains isolated from patients diagnosed with nosocomial pneumonia were studied during 2011 and 2012 at Tribhuvan University Teaching Hospital (TUTH).
T159 70020-70180 Sentence denotes Antibiotic sensitivity was determined using a modified Kirby Bauer Disc Diffusion method as described by the Clinical and Laboratory Standards Institute (CLSI).
T160 70181-70376 Sentence denotes Nosocomial pneumonia caused by the Acinetobacter calcoaceticus baumannii (Acb) complex was found to be predominant (36%), followed by Klebsiella pneumoniae (28%) and Pseudomonas aeruginosa (17%).
T161 70377-70484 Sentence denotes Of the total isolates, 87% were MDR, which was much higher in Acb complex and Escherichia coli (100% each).
T162 70485-70567 Sentence denotes The emergence of MDR bacterial strains causing nosocomial pneumonia is increasing.
T163 70568-70725 Sentence denotes The high prevalence of MDR has demanded special attention for the management of such patients and prevention of dissemination of such strains into hospitals.
T164 70726-70895 Sentence denotes Caesarean section (CS) surgical site infection (SSI) occurs in 11 to 18% of women in the published literature, with 84% of infections occurring after hospital discharge.
T165 70896-71045 Sentence denotes In 2010 the Advisory Committee on Antimicrobial Resistance and Healthcare-Associated Infection recommended that CS SSI surveillance become mandatory.
T166 71046-71192 Sentence denotes Our 5-year surveillance and quality improvement programme aimed to quantify and reduce SSI in a tertiary hospital delivering 5900 babies annually.
T167 71193-71314 Sentence denotes In 2010 a dedicated SSI surveillance programme was developed, introducing a surveillance form for all women who had a CS.
T168 71315-71372 Sentence denotes Organ space, deep or superficial infections are recorded.
T169 71373-71417 Sentence denotes A programme of practice auditing is ongoing.
T170 71418-71470 Sentence denotes Interventions were introduced in a stepwise fashion.
T171 71471-71691 Sentence denotes These included utilising a 10-day midwifery pathway, disposable head clippers, a change in surgical wound dressings with application duration extended from 1 to 7 days, and a change of surgical site preparation solution.
T172 71692-72005 Sentence denotes Alongside this, the programme focused on interpersonal relationships, and components included a dedicated surveillance co-ordinator, IT analysis of data, specific infection prevention and control training, and quarterly reporting of surveillance data at local governance meetings alongside practice audit results.
T173 72006-72065 Sentence denotes Surveillance form response rates increased from 30% to 62%.
T174 72066-72208 Sentence denotes Initial SSI rate after CS was 19.1% in 2010, reaching and maintaining less than 8% by the end of 2012 and achieving 3.5% in quarter 2 of 2015.
T175 72209-72285 Sentence denotes A sustained improvement in SSI rates is achievable with a focused programme.
T176 72286-72507 Sentence denotes While this involves increased effort initially, collaborative working between surgical, midwifery, and infection prevention and control teams can help the programme become embedded within the department to sustain change.
T177 72508-72559 Sentence denotes I do not have any conflict of interests to declare.
T178 72560-72685 Sentence denotes Enterococci are Gram-positive bacteria that commonly live in the bowel and occasionally colonise or infect the urinary tract.
T179 72686-72791 Sentence denotes When spread occurs beyond the gut they can be responsible for other serious infections like endocarditis.
T180 72792-72898 Sentence denotes Environmental contamination with enterococci can occur and become a source of infection to other patients.
T181 72899-73055 Sentence denotes Enterococci are often sensitive to beta-lactam antibiotics like amoxicillin, glycopeptides (vancomycin, teicoplanin), linezolid, tigecycline and daptomycin.
T182 73056-73174 Sentence denotes In the last 3 years there has been an unexplained increase in beta-lactam and glycopeptide resistance in our hospital.
T183 73175-73295 Sentence denotes In 2011-2013, there were 26 glycopeptide-resistant Enterococcus (GRE) cases while in 2014-2015, there were 60 GRE cases.
T184 73296-73387 Sentence denotes A retrospective analysis of clinical results from January 2011-December 2015 was performed.
T185 73388-73492 Sentence denotes A review of patient notes was undertaken for cases in the last 2 years to identify contributory factors.
T186 73493-73585 Sentence denotes We identified 12 GRE cases in 2011, six in 2012 and eight in 2013 (26 GRE cases in 3 years).
T187 73586-73637 Sentence denotes In 2014 and 2015 there were 19 and 41 cases of GRE.
T188 73638-73812 Sentence denotes The majority of the samples, 57 out of 86 samples, were from urine, while 14 of them were from blood culture, and other samples were from wound swabs, faeces and other sites.
T189 73813-73929 Sentence denotes From October 2014 onwards, a total of 65 isolates were sent for PFGE typing and results revealed several "clusters".
T190 73930-73982 Sentence denotes The most common type was labelled LUTOPEC 5 (16/56).
T191 73983-74136 Sentence denotes Following a review of patients' notes from the last 2 years, most of the patients identified have acquired the GRE within 48 hours of hospital admission.
T192 74137-74179 Sentence denotes The majority of specimens were from urine.
T193 74180-74287 Sentence denotes Twelve patients had been treated with a glycopeptide (teicoplanin or vancomycin) before GRE was identified.
T194 74288-74326 Sentence denotes Other risk factors were also analysed.
T195 74327-74423 Sentence denotes A risk-based screening process may be required locally to limit further spread of this organism.
T196 74424-74475 Sentence denotes I do not have any conflict of interests to declare.
T197 74476-74622 Sentence denotes Enhanced Staphylococcus aureus Bacteraemia Surveillance (eSABS) to standardise the reporting of SAB infections were introduced nationally in 2014.
T198 74623-74810 Sentence denotes This initiative aimed to better understand the cause of the SAB, to determine the potential avoidance and to intervene to minimise the risk of a SAB occurring due to the same cause again.
T199 74811-74921 Sentence denotes The Infection Prevention and Control Team (IPCT) formed a group to facilitate the appropriate data collection.
T200 74922-75140 Sentence denotes Focusing on risk and contributory factors, the group aimed to determine if SABs were avoidable or non-avoidable and engaged with the attributed clinical areas in order to identify any quality improvement opportunities.
T201 75141-75279 Sentence denotes In addition, all cases were reviewed to ensure they were managed in line with guidance on management of proven or suspected SAB in adults.
T202 75280-75420 Sentence denotes Using the Plan Do Study Act cycle and the national eSAB tool, a surveillance form was created for the IPCT to investigate the SAB infection.
T203 75421-75541 Sentence denotes This was used to identify the entry point, determine source and record procedures/interventions within the last 30 days.
T204 75542-75652 Sentence denotes Assessments were made regarding medical history device placement, and whether the patient had any prosthetics.
T205 75653-75818 Sentence denotes For quality improvement approaches the group reviewed the implementation and completion of bundles such as Peripheral, Central Vascular and Urinary Catheter bundles.
T206 75819-75988 Sentence denotes Weekly, the IPCT along with the multidisciplinary team discuss the results of the surveillance, review patient management and identify quality improvement opportunities.
T207 75989-76079 Sentence denotes Hand hygiene and device bundles are audited if the SAB is found to be related to a device.
T208 76080-76179 Sentence denotes IPCT engaged with clinical teams to assist with the implementation of bundles and support auditing.
T209 76180-76312 Sentence denotes Clinicians in charge received a letter detailing the outcome of SAB surveillance, offering the chance to respond to the information.
T210 76313-76424 Sentence denotes The medical microbiologists also offered to attend educational meetings for further SAB discussion if required.
T211 76425-76614 Sentence denotes This poster will demonstrate the reduction of surgical site infection (SSI) 3 years after the introduction of a dedicated SSI Surveillance Team (SSIST) into a large acute NHS Trust in 2012.
T212 76615-76765 Sentence denotes The NHS performed 9.920 million surgical procedures in 2014/2015 (most recent HES data), many posing a risk of SSI which remains largely unquantified.
T213 76766-76907 Sentence denotes Published evidence is that SSI accounts for 16% of all healthcare-associated infection and remains a significant clinical and costly control.
T214 76908-77002 Sentence denotes The team monitors patients who have had knife-to-skin procedures (6195 patients in 2014/2015).
T215 77003-77147 Sentence denotes Telephone questionnaires are completed at 30 days and the surveillance continues at 3 months, 6 months and 12 months if implants have been used.
T216 77148-77286 Sentence denotes An electronic surveillance system (ICNet) is used to identify patients who are included in the surveillance and any subsequent admissions.
T217 77287-77393 Sentence denotes Each SSI is categorised according to the published definition set by the Centre for Disease Control (CDC).
T218 77394-77504 Sentence denotes Data is banded into four groups: patient reported only; post discharge (confirmed); readmission and inpatient.
T219 77505-77619 Sentence denotes Risk factors are collected; however, these are reported on in response to specific enquiries or variances in data.
T220 77620-77797 Sentence denotes Anonymised feedback is provided to surgeons monthly via a data dashboard to allow a wider discussion within the Trust and to enable surgical colleagues to review their own data.
T221 77798-77849 Sentence denotes Confirmed infection rates reduced from 10% to 2.6%.
T222 77850-78014 Sentence denotes In the initial period, savings were gained in bed days saved, reduced readmissions and theatre time through a decrease in patients requiring reoperation due to SSI.
T223 78015-78070 Sentence denotes The reduction in SSI has continued across specialities.
T224 78071-78105 Sentence denotes The average follow-up rate is 58%.
T225 78106-78222 Sentence denotes Continuous all-specialty SSI data provides a measure of continuous quality improvement at relatively low investment.
T226 78223-78288 Sentence denotes The benefits should be discussed in the context of the wider NHS.
T227 78289-78340 Sentence denotes I do not have any conflict of interests to declare.
T228 78341-78480 Sentence denotes During the financial year 2015-2016 there were 34 Trust-apportioned cases of Clostridium difficile at Surrey & Sussex Healthcare NHS Trust.
T229 78481-78651 Sentence denotes A root cause analysis (RCA) investigation was carried out for each case, including a review with the commissioners to assess whether there have been any "lapses in care".
T230 78652-78728 Sentence denotes An RCA theme analysis was carried out, in order to identify lessons learned.
T231 78729-78884 Sentence denotes Each RCA action plan is followed up and signed off by the relevant Division, and lessons learned are disseminated within the division and across the Trust.
T232 78885-78933 Sentence denotes The main themes from the RCA investigations are:
T233 78934-78936 Sentence denotes 1.
T234 78937-79015 Sentence denotes Lack of diarrhoeal risk assessment and MDT review and documentation of this 2.
T235 79016-79061 Sentence denotes Missed opportunity/delay to sample sending 3.
T236 79062-79162 Sentence denotes Delay to patient isolation (requirement for complex patient transfer(s) to available single room) 4.
T237 79163-79203 Sentence denotes Testing delay, e.g. unlabelled sample 5.
T238 79204-79245 Sentence denotes Delay to commencement of CDI treatment 6.
T239 79246-79361 Sentence denotes Prescription errors (inappropriate route of administration; incorrect dose interval; incorrect dose; unsigned dose)
T240 79362-79450 Sentence denotes In order to address the lessons learned, a number of initiatives have been put in place.
T241 79451-79465 Sentence denotes These include:
T242 79466-79569 Sentence denotes A "Stop Assess Send" campaign to increase awareness of the importance of prompt stool and isolation • •
T243 79570-79663 Sentence denotes The management of diarrhoea is included in the quality improvement "Virginia Mason" programme
T244 79665-79795 Sentence denotes Japan Nosocomial Infections Surveillance (JANIS) is a voluntary national surveillance with more than 1800 participating hospitals.
T245 79796-79958 Sentence denotes In Japan, where hospital epidemiologists are not common, surveillance is usually a part of an infection control practitioner's multiple, diverse responsibilities.
T246 79959-80060 Sentence denotes However, the rate of data submission to JANIS is quite high (>95%) and the dropout rate is low (<3%).
T247 80061-80132 Sentence denotes Here we investigate which types of professionals are involved in JANIS.
T248 80133-80262 Sentence denotes We conducted on-site structured interviews using a questionnaire developed by a working group of infection control practitioners.
T249 80263-80437 Sentence denotes Hospitals were chosen from JANIS member hospitals that participate in both the surgical site infection (SSI) and antimicrobial-resistant bacterial infection (ARBI) divisions.
T250 80438-80556 Sentence denotes A total of 20 hospitals in seven areas of Japan with beds counts ranging from 80 to 1063 (median, 355.5) were visited.
T251 80557-80703 Sentence denotes More than two types of professionals are conducting surveillance at 13 (65%) and 17 (85%) hospitals for SSIs and ARBIs surveillance, respectively.
T252 80704-80830 Sentence denotes The most prevalent profession in charge of SSI surveillance was nurse (90%), followed by medical doctor (60%) and clerk (30%).
T253 80831-80937 Sentence denotes For the ARBI surveillance, they were nurse (90%), clinical microbiologist (75%), and medical doctor (60%).
T254 80938-81157 Sentence denotes There was no association between hospital size (bed count) and whether the surveillance involved multiple professions or not (SSI division, 397 beds vs. 299 beds, p=0.57; ARBI division, 380 beds vs. 468.5 beds, p=0.84).
T255 81158-81295 Sentence denotes Most Japanese hospitals are conducting surveillance with multiple professionals that are keen to share data, regardless of hospital size.
T256 81296-81453 Sentence denotes Although nurses and medical doctors play key roles, the workload for surveillance was shared with other professionals, which resulted in high sustainability.
T257 81454-81582 Sentence denotes This interdisciplinary approach to surveillance may help improve infection control practices in all professions and departments.
T258 81583-81634 Sentence denotes I do not have any conflict of interests to declare.
T259 81635-81678 Sentence denotes Reducing CDI below the irreducible minimum:
T260 81679-81703 Sentence denotes A multi-faceted approach
T261 81704-81732 Sentence denotes Walsall Healthcare NHS Trust
T262 81733-81882 Sentence denotes In April 2007 the Department of Health introduced targets to NHS Acute Trusts to focus reduction of Clostridium difficile (CDI) toxin-positive cases.
T263 81883-82049 Sentence denotes C. difficile is the major cause of infective hospital-acquired diarrhoea in the UK, and has been associated with more than 16,000 cases per year in England and Wales.
T264 82050-82269 Sentence denotes The targets look to reduce only the toxin-positive cases once patients are already symptomatic, but prior to this is improving the quality and safety of care by preventing colonisation from occurring in the first place.
T265 82270-82456 Sentence denotes Colonisation can occur in one of three ways: contact with a healthcare worker; contact with a contaminated environment and from direct contact with a patient with C. difficile infection.
T266 82457-82613 Sentence denotes The aim of this work is not to look at the treatment of C. difficile infection, but to explain the measures used to prevent colonisation in the first place.
T267 82614-82862 Sentence denotes A multi-faceted approach has looked at daily side-room utilisation, isolation on diarrhoeal symptoms not results, standard precautions, environmental decontamination, 30-day health economy-wide patient review and self-directed staff learning packs.
T268 82863-82984 Sentence denotes For each intervention, PDSA cycles have been used to evaluate and then disseminate interventions across the organisation.
T269 82985-83146 Sentence denotes The work has resulted in year-on-year reductions over the last 3 years, with results of 33 cases, then 16 and, for 2015/2016, seven cases against a target of 18.
T270 83147-83288 Sentence denotes This has been identified by the Trust Improvement agency as exemplary and our approach is discussed to provide ideas for other organisations.
T271 83289-83511 Sentence denotes Royal Brompton & Harefield NHS Foundation Trust utilises a predictive surgical site infection (SSI) score, the Brompton Harefield Infection Score (BHIS), for patients undergoing coronary artery bypass graft (CABG) surgery.
T272 83512-83649 Sentence denotes In 2015, analysis of over 4000 cases and 42 variables was performed, whilst also determining the impact of interventions to prevent SSIs.
T273 83650-83803 Sentence denotes The study found no significant difference between skin prep solutions based on either chlorhexidine (CHG) 2% in 70% alcohol or povidone iodine (PVI) 10%.
T274 83804-83986 Sentence denotes In this additional study, a separate cohort of 2375 cases was analysed to re-examine SSI as a dependent variable with independent variables of skin preparation and SSI risk category.
T275 83987-84061 Sentence denotes This research involved continuous, prospective surveillance on 2375 cases.
T276 84062-84233 Sentence denotes It included 75 SSIs from January 2013-October 2015 (primary or re-admission), while simultaneously, data was collected for theatre skin prep solutions and BHIS risk group.
T277 84234-84255 Sentence denotes The results indicate:
T278 84256-84345 Sentence denotes The Although not RCT-level evidence, this study is relevant to our cardiac patient group.
T279 84346-84485 Sentence denotes The application of the skin prep products is carried out in a consistent manner, with attention to application technique, drying time, etc.
T280 84486-84606 Sentence denotes Our findings suggest that PVI 10% and CHG 2% products in alcohol are equally efficacious and safe in this patient group.
T281 84607-84700 Sentence denotes This work can provide assurance to commissioners of the best available evidence for practice.
T282 84701-84752 Sentence denotes I do not have any conflict of interests to declare.
T283 84753-84802 Sentence denotes Setting up line surveillance to drive improvement
T284 84803-84977 Sentence denotes Central venous catheter-related blood stream infections (CRBSI) cause increased mortality and morbidity in patients; many of these are preventable using evidenced-based care.
T285 84978-85126 Sentence denotes Matching Michigan is a national project focused on critical care units to reduce central line infection rates using a quality improvement programme.
T286 85127-85349 Sentence denotes Following improvements in critical care, it was agreed that the principles should be adopted across the whole hospital, ensuring that all patients with central venous access devices (CVAD) received safe and effective care.
T287 85350-85513 Sentence denotes A CVAD Steering Group was set up to bring together all key stakeholders involved in the care of CVAD, including a lead clinician to oversee best clinical practice.
T288 85514-85657 Sentence denotes It was important from the outset to establish an outcome measure to demonstrate improvements in practice, with the obvious measure being CRBSI.
T289 85658-85788 Sentence denotes Potential CRBSI were identified by the microbiologists (numerator) and a process to collect the number of line days (denominator).
T290 85789-85935 Sentence denotes All cases of CRBSI are investigated using root cause analysis (RCA) and the learning shared with the Steering Group to action changes to practice.
T291 85936-86170 Sentence denotes During the last 5 years, learning from CRBSI has allowed improvements to practice including standardised care pathways, training and competency framework, routine MSSA and MRSA screening and a change to chlorhexidine island dressings.
T292 86171-86315 Sentence denotes Evidence of the improvement is seen in the surveillance data with the rate of CRBSI falling from 5/1000 line days in 2011 to 0.6/1000 line days.
T293 86316-86515 Sentence denotes We are able to monitor the rate of CRBSI for each department with patients with CVAD and we can accurately assess problems and spot trends at an early stage to implement effective change as required.
T294 86516-86655 Sentence denotes Further work includes the development of a patient-held record and training package for patients in the community with their CVAD in place.
T295 86656-86707 Sentence denotes I do not have any conflict of interests to declare.
T296 86708-86742 Sentence denotes Building works danger on the ward:
T297 86743-86800 Sentence denotes Works can release high numbers of concentrated organisms!
T298 86801-87079 Sentence denotes To keep the buildings in good physical condition means hospital renovation, and it has been proven that hospital-acquired infections occur in higher numbers when hospital renovations are taking place (Pini et al, 2007) ; this includes major and minor works (Chang et al, 2008) .
T299 87080-87307 Sentence denotes Ross et al (2011) state that renovation should be delayed until patients have been moved to an alternative setting; however, this is not always possible and many works are necessary and must be done whilst patients are in situ.
T300 87308-87502 Sentence denotes When emergency renovation is required then the patients may not be able to be moved, but Ross et al (2011) go on to discuss that measures can be put in place to minimise the risk to the patient.
T301 87503-87672 Sentence denotes The Trust's "Better Care Together" strategy states that changes will have to be made to existing facilities to ensure they are appropriate for 21 st century health care.
T302 87673-87857 Sentence denotes As part of the Infection Prevention (IP) annual plan, to maintain a clean and safe environment, the team will be involved in capital planning, supporting refurbishments and new builds.
T303 87858-88054 Sentence denotes The IP team have worked closely with the estates team for IP training; we have invited external contractors to complete the same training focusing on the guidelines that HBN 00-09 (2013) sets out.
T304 88055-88183 Sentence denotes We are working with the staff on the wards to understand the risks involved with works going on whilst patients are on the ward.
T305 88184-88293 Sentence denotes We are undertaking environmental audits with the Infection Prevention Society environmental audits structure.
T306 88294-88400 Sentence denotes Evidence of improvement is the reduction of Clostridium difficile figures shown in the DIPC annual report.
T307 88401-88527 Sentence denotes We will continue to work with all staff that work within the hospital to ensure a clean and safe environment for our patients.
T308 88529-88637 Sentence denotes Vaginal discharge is one of the most common complaints seen in the gynaecology outpatient department (GOPD).
T309 88638-88773 Sentence denotes Alteration in the balance of normal vaginal flora can lead to the overgrowth of other organisms that causes abnormal vaginal discharge.
T310 88774-88988 Sentence denotes One hundred and one patients attending the GOPD of Nepal Medical College and Teaching Hospital (NMCTH) between August 2011 and July 2013 with vaginal discharge were evaluated to determine microbiological aetiology.
T311 88989-89117 Sentence denotes Three high vaginal swabs were taken from each patient who came to the outpatient department with complaint of vaginal discharge.
T312 89118-89231 Sentence denotes These specimens were subjected to different microbiological evaluation using standard microbiological techniques.
T313 89232-89316 Sentence denotes Of the total patients studied, the mean (SD) age was found to be 30.15 (6.93) years.
T314 89317-89392 Sentence denotes Around 57% (57.42%) of women had vaginal discharge of infectious aetiology.
T315 89393-89485 Sentence denotes The most prevalent disease was bacterial vaginosis (29.7%) followed by candidiasis (24.75%).
T316 89486-89655 Sentence denotes Of the total candidal infections, 56% were caused by Candida albicans and the remaining by Candida glabrata, Candida tropicalis, Candida parapsilosis and Candida krusei.
T317 89656-89733 Sentence denotes Trichomoniasis was among the least common cause of vaginal discharge (0.99%).
T318 89734-89797 Sentence denotes Two cases were identified as having intermediate vaginal flora.
T319 89798-89910 Sentence denotes Some 42.57% of females who gave a history of abnormal vaginal discharge were found to have normal vaginal flora.
T320 89911-90026 Sentence denotes Our study concluded that the most common cause of vaginal discharge is bacterial vaginosis followed by candidiasis.
T321 90027-90086 Sentence denotes Trichomoniasis was less prevalent in our part of the world.
T322 90087-90318 Sentence denotes Although the syndromic approach for treatment of vaginal discharge is being followed, this study clearly depicted around 43% of those presenting with vaginal discharge had normal vaginal flora and were not in need of any treatment.
T323 90319-90603 Sentence denotes Therefore, even if simple microbiological tests are employed in the final diagnosis of vaginal discharge, this would avoid unnecessary treatment and thus avoid the economical, social and psychological burden to the women in question, and also will avoid unnecessary exposure to drugs.
T324 90604-90770 Sentence denotes In 2013 the Betsi Cadwaladr University Health Board (BCUHB) had a large outbreak of Clostridium difficile infection (CDI), with background rates the highest in Wales.
T325 90771-90819 Sentence denotes In response a range of actions were implemented.
T326 90820-91078 Sentence denotes This included a collaborative study between BCUHB, Public Health Wales (PHW), and Nuffield Department of Medicine, Oxford, which used whole-genome sequencing in order to better understand the epidemiology of the CDI, and assist in targeting control measures.
T327 91079-91190 Sentence denotes A prospective cohort study of all laboratory-confirmed CDI cases between February and July 2015 was undertaken.
T328 91191-91427 Sentence denotes Risk exposure data on cases, and organisational factors such as cleaning and staffing levels and both hospital and community antibiotic prescribing, were considered alongside phylogenetic information obtained by whole-genome sequencing.
T329 91428-91557 Sentence denotes A comprehensive programme of stakeholder engagement was developed with the aim of using the information obtained to drive change.
T330 91558-91627 Sentence denotes Tableau analytical software was used to aid visualisation of results.
T331 91628-91833 Sentence denotes Phylogenetic analysis of 76% of toxin-positive and 63% of toxin-negative CDI cases that were successfully sequenced indicated that the majority (75.9%) of CDI cases in North Wales were unrelated to others.
T332 91834-91940 Sentence denotes The number of closely related cases was greater in samples from hospital settings than from the community.
T333 91941-92059 Sentence denotes This implies that factors other than immediate healthcare environments are driving the number of cases in North Wales.
T334 92060-92204 Sentence denotes Contextual data indicated considerable scope to improve both antibiotic stewardship and compliance with audits relevant to infection prevention.
T335 92205-92390 Sentence denotes Visualisation of broad but relevant data using interactive analytical software has the potential to support the application of research findings to clinical and wider hospital practice.
T336 92391-92478 Sentence denotes The process of stakeholder engagement to drive action in these areas will be discussed.
T337 92479-92580 Sentence denotes Surgical site infection (SSI) among patients after cardiac surgery is a lifethreatening complication.
T338 92581-92723 Sentence denotes Some existing studies showed the effectiveness of daily chlorhexidine (CHG) bathing as a precaution to reduce bloodstream infections and SSIs.
T339 92724-92840 Sentence denotes However, there is a lack of evidence of the effectiveness of daily CHG bathing among patients after cardiac surgery.
T340 92841-93080 Sentence denotes This study aimed to examine the effectiveness of preoperative CHG bathing on SSIs among patients undergoing urgent cardiac surgery, defined as patients who needed to enter ICU after admission and were scheduled for surgery within 72 hours.
T341 93081-93241 Sentence denotes We analysed patients with cardiovascular disease who underwent cardiac operations at our specialised hospital in Japan between 1 January 2014 and 30 April 2016.
T342 93242-93331 Sentence denotes Preoperative CHG bathing was introduced from 1 January 2015 as a measure to prevent SSIs.
T343 93332-93473 Sentence denotes We compared the data (such as demographic and laboratory data, treatment and drug used, and so on) with and without preoperative CHG bathing.
T344 93474-93552 Sentence denotes SSI was defined using the CDC and National Healthcare Safety Network criteria.
T345 93553-93658 Sentence denotes This study was approved by the Institutional Review Board of the hospital and Miyagi University in Japan.
T346 93659-93805 Sentence denotes Among 35 patients undergoing urgent cardiac surgery, 20 patients received the preoperative CHG bathing (CHG group) and 15 did not (non-CHG group).
T347 93806-93866 Sentence denotes Demographic characteristics were similar between the groups.
T348 93867-94017 Sentence denotes The incidence rates of SSI for CHG and non-CHG groups were 5% and 26.7%, respectively (relative risk 0.145; confidence interval 0.014-1.464; p=0.141).
T349 94018-94208 Sentence denotes There was no statistically significant difference on SSI rates between the two groups; however, the incidence rate of the CHG group was decreased compared with the rate of the non-CHG group.
T350 94209-94370 Sentence denotes The Japanese Society for Infection Prevention and Control launched the device-associated infection surveillance project in neonatal intensive care units (NICUs).
T351 94371-94486 Sentence denotes The purpose of this study was to evaluate the results and to explain our surveillance system during the first year.
T352 94487-94547 Sentence denotes This study was conducted from 1 January to 31 December 2015.
T353 94548-94726 Sentence denotes Two types of device-associated infections in NICUs were selected to be surveyed: central line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP).
T354 94727-94968 Sentence denotes In this surveillance, the protocol was based on the National Healthcare Safety Network (NHSN) surveillance system and used standard infection definitions from the Centers for Disease Control and Prevention (CDC) for international comparison.
T355 94969-95083 Sentence denotes We used the clinical sepsis (CSEP) criterion for CLABSI in addition, to reduce the underestimation of CLABSI rate.
T356 95084-95158 Sentence denotes NICU locations were categorised into two types: level III or level II/III.
T357 95159-95317 Sentence denotes The data were collected for each of five birth-weight categories (<750 g, 751-1000 g, 1001-1500 g, 1501-2500 g, and >2500 g) and were compared with NHSN data.
T358 95318-95353 Sentence denotes A total of nine NICUs participated.
T359 95354-95562 Sentence denotes Pooled mean incidence by birth-weight categories in level III was 3.4, 1.5, 0.0, 2.2, and 2.1 per 1000 central line days for CLABSI; 1.5, 0.0, 2.5, 2.6, and 2.5 per 1000 ventilator-days for VAP, respectively.
T360 95563-95761 Sentence denotes Pooled mean incidence by birth-weight categories in level II/III was 17.7, 4.4, 4.0, 0.7, and 8.5 per 1000 central line days for CLABSI; 1.3, 0.0, 5.4, 5.3, and 9.8 per 1000 ventilator-days for VAP.
T361 95762-95841 Sentence denotes There were 39 CLABSIs, and 26 (66.7%) of them were identified by CSEP criteria.
T362 95842-95930 Sentence denotes We have established the surveillance system of device-associated infections in the NICU.
T363 95931-96002 Sentence denotes Incidence of CLABSI and VAP in this study was higher than that in NHSN.
T364 96004-96169 Sentence denotes In Japan, the durations of indwelling urinary catheters have been reported as longer than those in other developed countries including the United States and England.
T365 96170-96298 Sentence denotes Catheter-related complications (CRC) include catheter-associated urinary tract infections (CAUTI) and catheter obstruction (CO).
T366 96299-96379 Sentence denotes Although CAUTI has been well investigated, there are a lack of studies about CO.
T367 96380-96557 Sentence denotes Therefore, the purpose of this study was to examine the incidence rate and risk factors of CAUTI and CO among patients with silicon-based and silver-coated Foley catheters (FC).
T368 96558-96663 Sentence denotes After the approval of the ethical committee in Miyagi University, a quasi-randomised trial was conducted.
T369 96664-96821 Sentence denotes Adult in-patients with a new indication of indwelling urinary catheter were grouped into silver-coated FC (silver group) or silicon-based FC (silicon group).
T370 96822-96948 Sentence denotes Binary variables were analysed using a chi-square test, and quantitative variables were analysed with the Mann-Whitney U test.
T371 96949-97047 Sentence denotes The results of 42 patients in the silver group and 16 patients in the silicon group were analysed.
T372 97048-97150 Sentence denotes The mean durations of silver group and silicon group were 15.5 (SD 15.7) days and 18.3 (SD 17.9) days.
T373 97151-97249 Sentence denotes The incidence rates of CRC were 4.8% (silver group) and 0% (silicon group) respectively (p=0.374).
T374 97250-97350 Sentence denotes The incidence rates of CO were 28.6% (silver group) and 6.3% (silicon group) respectively (p=0.068).
T375 97351-97465 Sentence denotes Female gender (p=0.005) and administration of antibiotics (p=0.005) were statistically significant factors for CO.
T376 97466-97625 Sentence denotes Although small sample size and non-equal numbers of both groups were the main limitations of this study, the type of FC could be a possible risk factor for CO.
T377 97626-97739 Sentence denotes From the results of this study, CO happened more than CAUTI among inpatients with an indwelling urinary catheter.
T378 97740-97791 Sentence denotes In addition, female gender is a risk factor for CO.
T379 97792-97924 Sentence denotes Administration of antibiotics during indwelling FC showed a preventive effect on CO; however, this issue should be examined further.
T380 97925-98053 Sentence denotes The Japanese Society for Infection Prevention and Control launched the device-associated infection surveillance project in 2009.
T381 98054-98286 Sentence denotes This surveillance project is designed to provide the society members and medical institutions with information on the occurrence of device-associated infections in Japan, and to make an international comparison of surveillance data.
T382 98287-98399 Sentence denotes The objective of this presentation is to explain our surveillance system and to evaluate the results of 6 years.
T383 98400-98649 Sentence denotes Three types of device-associated infections were selected to be surveyed: central line-associated bloodstream infection (CLABSI); catheter-associated urinary tract infection (CAUTI); and ventilator-associated pneumonia (VAP) in intensive care units.
T384 98650-98921 Sentence denotes In this surveillance, definitions and methods for calculating the infection rate used are in line with those specified in the National Healthcare Safety Network (NHSN) manual, in order to compare and analyse nationwide surveillance data from the United States and Europe.
T385 98922-99056 Sentence denotes In terms of comparison with NHSN data from 2013, "medical-surgical ICU less than 15 beds" was selected for similar patient background.
T386 99057-99271 Sentence denotes Pseudomonas aeruginosa-linked catheter-associated urinary tract infections (CAUTIs) being the commonest device-associated infections, modified biomaterial catheters are of great importance as a preventive strategy.
T387 99272-99409 Sentence denotes Azithromycin (AZM) has been proved to be effective against infections caused by Pseudomonas aeruginosa due to its antivirulence property.
T388 99410-99493 Sentence denotes This study was designed to modify a silicone urinary catheter impregnated with AZM.
T389 99494-99598 Sentence denotes Further, we have investigated the efficacy of these catheters in preventing CAUTIs in vitro and in vivo.
T1 99599-99682 Sentence denotes In vitro testing of AZM at Sub-MIC levels for antivirulence property was performed.
T2 99683-99801 Sentence denotes Biocompatible silica sol-gels were tailored to enable a controlled release of AZM at the antivirulence concentrations.
T3 99802-99953 Sentence denotes After characterisation, these catheters were tested for biocompatibility ex vivo using urothelial cell line (SV-HUC-1) as per the ISO-10993 guidelines.
T4 99954-100072 Sentence denotes Further, the efficacy of these modified catheters was exploited to prevent the CAUTIs in an experimental animal model.
T5 100073-100198 Sentence denotes A three-layer coating process of 10% w/v of AZM on R e =32 (ethanol: TEOS) sol-gel system has resulted in controlled release.
T6 100199-100314 Sentence denotes The in vitro release study has confirmed the controlled release at dosages with significant antivirulence activity.
T7 100315-100399 Sentence denotes Further characterisations were performed using AFM, SEM and profilometer techniques.
T8 100400-100650 Sentence denotes This modified biocompatible urinary catheter, confirmed by the ex vivo analyses, showed a reduced bacterial load in the implanted animals' tissues as compared with that of the infected control and silver nanoparticlecoated catheter-implanted animals.
T9 100651-100803 Sentence denotes Decreased production levels of virulence factors were evident from the AZM-impregnated implant group animals in comparison with the other group animals.
T10 100804-100960 Sentence denotes Renal damage markers showed reduced tissue damage in the modified catheter implantation group, which was further supported by histopathological evaluations.
T11 100961-101144 Sentence denotes Given the preparation, characterisation and efficiency of a modified urinary catheter to prevent CAUTIs, the present data suggest great promise to avert nosocomial biofilm infections.
T12 101145-101283 Sentence denotes Screening for carriage of carbapenemase-producing Enterobacteriaceae (CPE) is an important measure in preventing in-hospital transmission.
T13 101284-101399 Sentence denotes We implemented risk factor-based CPE admission screening in June 2015, using a modified version of the PHE Toolkit.
T14 101400-101516 Sentence denotes Risk factors that trigger screening are overnight hospitalisation in the previous 12 months, and overseas residence.
T15 101517-101635 Sentence denotes Implementing CPE risk factor assessment and screening into the admission pathway has proved challenging operationally.
T16 101636-101829 Sentence denotes A private patients ward in an acute NHS hospital Trust was selected for a quality improvement programme in collaboration with NHS Improvement to improve compliance with CPE admission screening.
T17 101830-102093 Sentence denotes A measure of CPE screening compliance was calculated by determining the number of admissions with overnight hospitalisation in our Trust in the past 12 months (denominator) and the number of patients who were screened within 24 hours of admission (the numerator).
T18 102094-102299 Sentence denotes The intervention to improve compliance began in April 2016 and included a range of measures involving staff and patient education, information and investigation of barriers co-developed with the ward team.
T19 102300-102450 Sentence denotes The rate of CPE screening was compared using a Fisher's Exact Test for June 2015-March 2016 (pre-intervention) and April-mid-June 2016 (intervention).
T20 102451-102597 Sentence denotes In total, 150 patients with overnight hospitalisation in the Trust were admitted to the private patients ward between June 2015 and mid-June 2016.
T21 102598-102746 Sentence denotes Of 126 admissions, 71 (56%) were screened within 24 hours pre-intervention compared with 21 (88%) of 24 admissions during the intervention (p<0.05).
T22 102747-102918 Sentence denotes An intervention based on raising staff and patient awareness of the need for risk factor-based CPE screening significantly increased compliance in a private patients ward.
T23 102919-103012 Sentence denotes Identifying patients colonised with CPE is vital for preventing "silent transmission" of CPE.
T24 103013-103172 Sentence denotes We plan to extend this successful intervention across all private patients wards, and then across the Trust to improve compliance with CPE admission screening.
T25 103173-103224 Sentence denotes I do not have any conflict of interests to declare.
T26 103225-103389 Sentence denotes Elizabeth Marchant 1 , Ms Louise Bishop 1 , Mrs Debbie Flaxman 2 , Mrs Jenni Jagodzinski 2 , Dr Mahesh Nanjundapp 2 , Dr Prasanna Muniyappa 2 , Dr Rebecca Cordery 1
T27 103390-103502 Sentence denotes Since the introduction of the MMR vaccination in the UK in 1970, rubella notifications have fallen dramatically.
T28 103503-103659 Sentence denotes Cases of congenital rubella syndrome (CRS) have also fallen significantly, and whilst now rare, three cases have been reported in the UK since January 2014.
T29 103660-103799 Sentence denotes In 2015, the South East London Health Protection Team was notified of a case of rubella infection and suspected CRS in a 17-day-old infant.
T30 103800-103965 Sentence denotes We describe the risk assessment and infection control measures, as well as considerations relating to the cessation of rubella susceptibility screening in pregnancy.
T31 103966-104057 Sentence denotes The risk assessment considered patients, staff and visitors in the delivery suite and NICU.
T32 104058-104182 Sentence denotes Ninety-six staff were identified as involved in the birth or care of the baby and required follow-up by Occupational Health.
T33 104183-104288 Sentence denotes Standard infection control precautions including hand hygiene and use of PPE were assessed as sufficient.
T34 104289-104378 Sentence denotes The baby was isolated in a side room and was cared for by staff with documented immunity.
T35 104379-104571 Sentence denotes Infants with CRS can continue to excrete virus for more than a year, and therefore a weekly oral fluid sample was arranged to monitor duration of virus excretion as a marker of infectiousness.
T36 104572-104995 Sentence denotes A number of lessons learnt are highlighted, including a reminder of the importance of the MMR vaccine for all women of child-bearing age, in particular those arriving in the UK as children or young adults; of asking about history of rash in early pregnancy; the early consideration of CRS in infants with congenital abnormalities; and the importance of consistent staff MMR vaccination policies in healthcare organisations.
T37 104996-105074 Sentence denotes In April 2016, rubella susceptibility screening in pregnancy in England ended.
T38 105075-105238 Sentence denotes This further highlights the importance of asking about history of rash in pregnancy and considering rubella as a possible cause of intrauterine growth restriction.
T39 105239-105290 Sentence denotes I do not have any conflict of interests to declare.
T40 105291-105443 Sentence denotes Limited voluntary surgical site infection surveillance (SSIS) is currently undertaken in England since data collection is considered resource intensive.
T41 105444-105633 Sentence denotes Guy's & St Thomas' NHS Foundation Trust introduced an ICNet SSI module to the organisation in 2012 to improve efficiency in infection control / SSI data collection, management and security.
T42 105634-105699 Sentence denotes This would release more time for other patient safety activities.
T43 105700-105850 Sentence denotes Organisations could take advantage of the "Safer hospitals safer wards technology fund" launched in May 2013 to introduce similar suitable IT systems.
T44 105851-105996 Sentence denotes After initial collaborative work to introduce an efficient IT system, data for eligible surgical patients is now selectively imported into ICNet.
T45 105997-106155 Sentence denotes This system links up a Galaxy theatre management system and Patient Administration system to facilitate eligible patients to be accurately monitored for SSIs.
T46 106156-106326 Sentence denotes This has facilitated our organisation to sustain surveillance of 12 specialties with a surveillance team of only three staff (1 × band 7 team leader and 2 × band 3 HCAs).
T47 106327-106461 Sentence denotes Our surveillance has expanded from mandatory orthopaedic surveillance to effective continuous surveillance of 12 surgical specialties.
T48 106462-106628 Sentence denotes The expansion could not have been achieved without an efficient IT data management system that eased the burden of data collection and gave us the following benefits:
T49 106629-106867 Sentence denotes We have reduced the number of non-communicating password-secured IT applications we used for our surveillance from six to two and released time for effective caesarean section post-discharge surveillance and for raising awareness on SSIS.
T50 106868-106990 Sentence denotes Huge cost savings were realised through reduction of SSIs and not recruiting additional staff to sustain our surveillance.
T51 106991-107061 Sentence denotes We are happy with our SSI module, which we modified to suit our needs.
T52 107062-107149 Sentence denotes We are working hard to incorporate ASA scores in Galaxy to enable us to go "paperless".
T53 107150-107239 Sentence denotes Carbapenemase-producing Enterobacteriaceae (CPE) have begun to cause outbreaks in the UK.
T54 107240-107388 Sentence denotes Risk factor-based screening of admissions for CPE was introduced in June 2015 to enhance universal screening of admissions to high-risk specialties.
T55 107389-107482 Sentence denotes We explore whether increases in CPE screening resulted in the detection of further outbreaks.
T56 107483-107732 Sentence denotes From June 2015, our hospitals performed risk factor-based CPE screening of all admissions, universal screening in high-risk specialties, weekly screening in wards where known carriers were present, and contact tracing around newly detected carriers.
T57 107733-107844 Sentence denotes Each CPE case identified and confirmed by PCR locally was sent to the reference laboratory for VNTR genotyping.
T58 107845-107948 Sentence denotes An outbreak was defined as two of more cases of CPE with the same VNTR type with epidemiological links.
T59 107949-108045 Sentence denotes We report the number of outbreaks of CPE since implementing enhanced CPE screening in June 2015.
T60 108046-108322 Sentence denotes The Trust experienced five separate outbreaks of CPE first identified in the 2015/2016 financial year: two K. pneumoniae NDM outbreaks (40 and four patients), two Klebsiella pneumoniae OXA-48 outbreaks (seven and seven patients), and a K. oxytoca GES-5 outbreak (14 patients).
T61 108323-108399 Sentence denotes Of these patients, 55/72 (76%) were first identified by screening specimens.
T62 108400-108476 Sentence denotes Only one CPE outbreak had been identified in the Trust previously (in 2013).
T63 108477-108741 Sentence denotes Control measures included an emphasis on high-quality hand hygiene, cleaning of equipment and ward environment including hydrogen peroxide vapour (HPV) decontamination of patient rooms at the time of transfer or discharge of case patients, and continued screening.
T64 108742-108777 Sentence denotes All outbreaks have been controlled.
T65 108778-108910 Sentence denotes We believe that enhanced screening for CPE has resulted in the detection of CPE outbreaks that would otherwise have gone undetected.
T66 108911-109059 Sentence denotes Controlling these outbreaks has led to several challenges, including compliance with admission screening, staff education, and limited single rooms.
T67 109060-109139 Sentence denotes We expect to detect more outbreaks of CPE as our screening programme continues.
T68 109140-109191 Sentence denotes I do not have any conflict of interests to declare.
T69 109192-109404 Sentence denotes In this study, we aimed to investigate nasal methicillin-resistant Staphylococcus aureus (MRSA) carriage rates, risk factors and knowledge problems regarding nosocomial infections among nurses in Northern Cyprus.
T70 109405-109546 Sentence denotes In this cross-sectional study a stratified sampling method is used, and two state and two private hospitals were visited for data collection.
T71 109547-109623 Sentence denotes Nasal samples were taken with swabbed liquid media and cultivated overnight.
T72 109624-109767 Sentence denotes Cefoxitin (4 μg/ml) added Mueller Hinton Agar media and usual phenotypical tests were used to differentiate MRSA from other possible pathogens.
T73 109768-109834 Sentence denotes Results were evaluated by using Fisher's Exact Test in SPSS v19.0.
T74 109835-110024 Sentence denotes The rate for nasal MRSA carriage among nurses was one of the highest (57.7%) reported in nurses to date, as the rate of nasal MRSA carriage varies in a range of 3.2-10.5% in such countries.
T75 110025-110185 Sentence denotes The high rate of MRSA carriage among nurses in North Cyprus should be urgently taken into account, as nurses are the most important route for MRSA transmission.
T76 110186-110289 Sentence denotes Moreover, 67.9% of the nurses, of which 54.7% were identified as carriers, had no knowledge about MRSA.
T77 110290-110408 Sentence denotes Nurses who stated that they have information about this problem were found to be carriers with a rate of 64% (p=0.43).
T78 110409-110576 Sentence denotes The most important reason for this emerging rate of MRSA carriage is due to low knowledge among nurses about MRSA precautions and lack of infection control strategies.
T79 110577-110662 Sentence denotes There was a significant increase of nasal MRSA carriage as nurses work and get older.
T80 110663-110816 Sentence denotes Ongoing education in MRSA prevention should be provided to nurses, including an evaluation of sufficient knowledge and skills, to come to a better point.
T81 110818-110994 Sentence denotes The IPS Trent Branch has undertaken a census of the IPC workforce within the Trent region following the findings from The Centre for Workforce Intelligence review in July 2015.
T82 110995-111087 Sentence denotes This was conducted to help understand the IPC workforce and help support workforce planning.
T83 111088-111308 Sentence denotes A survey was conducted which included questions on the demographic data of IPC professionals, service provision, special interests, IPC activity, CPD opportunities and challenges faced by IPC professionals in the region.
T84 111309-111424 Sentence denotes One hundred and thirty-nine people were invited to take part in the survey and this was sent out via Survey Monkey.
T85 111425-111517 Sentence denotes There were 45 responses to the survey, with 32 organisations and 33 teams being represented.
T86 111518-111622 Sentence denotes The survey highlighted that there is no consistency with team structures within IPC in the Trent region.
T87 111623-111720 Sentence denotes Secondary care seems to have more structure and different skill mixes compared with primary care.
T88 111721-111799 Sentence denotes CCGs and local authorities are shown to have much less staffing and skill mix.
T89 111800-111957 Sentence denotes The qualifications of IPC professionals varied and there is no consistency to level of qualification to pay banding, job tiles or roles and responsibilities.
T90 111958-112037 Sentence denotes IPC pay banding ranged from band 8C-band 4, with the most popular being Band 7.
T91 112038-112226 Sentence denotes IPC activities involved 67% support directly to patients, 95% support to HCWs, 83% surveillance, 95% audits, 98% teaching, 50% public engagement, 90% PIR/RCAs, 86% outbreaks, 38% research.
T92 112227-112423 Sentence denotes IPC professionals within Trent are facing the following challenges: lack of resources; lack of staffing; engaging with workforce; strengthening compliance with IPC; and raising the profile of IPC.
T93 112424-112501 Sentence denotes Priorities must be given to exploring possible solutions to these challenges.
T94 112502-112730 Sentence denotes There is now a better understanding of the IPC workforce for Trent, which is crucial for supporting fellow IPC colleagues, understanding professional development requirements and developing proactive and innovative project work.
T95 112731-112782 Sentence denotes I do not have any conflict of interests to declare.
T96 112783-112900 Sentence denotes Optimising the use of bladder ultrasound scanners to improve the quality and safety of patient care and reduce costs:
T97 112901-112923 Sentence denotes An economic assessment
T98 112924-113048 Sentence denotes Portable bladder ultrasound scanning offers a non-invasive, fast and painless method to measure urine volume in the bladder.
T99 113049-113196 Sentence denotes As an alternative to bladder catheterisation, it has been shown to significantly reduce urinary tract infection (UTI) and increase patient comfort.
T100 113197-113296 Sentence denotes However, despite being available for over two decades, its adoption has been slow and inconsistent.
T101 113297-113345 Sentence denotes A detailed, monetised case study was undertaken.
T102 113346-113441 Sentence denotes Cost avoidance analysis was used to demonstrate avoided spend associated with bladder scanning.
T103 113442-113541 Sentence denotes Data on actual use of scanners during a 1-month trust-wide audit was used to inform the assessment.
T104 113542-113616 Sentence denotes The impact of scanning in both high and low-use environments was analysed.
T105 113617-113840 Sentence denotes Cost consequence analysis was used to compare the existing approach to the management of bladder scanners, namely localised management by wards, with a centralised approach using the trust's Medical Equipment Library (MEL).
T106 113841-113912 Sentence denotes Avoided spend was estimated to be in the region of £1,226,822 per year.
T107 113913-114087 Sentence denotes This did not include the cost of bacteraemia attributed to UTI, or benefits of using a scanner, such as avoidance of treatment delays and avoiding overnight stay in hospital.
T108 114088-114294 Sentence denotes The set-up and running costs of a scanner were estimated to be met within 6 to 24 months, depending on usage, after which significant ongoing cost efficiencies would be realised over its 8-10-year lifespan.
T109 114295-114440 Sentence denotes Management of the trust's fleet of bladder scanners within the MEL was considered advantageous in order to create efficiencies within the system.
T110 114441-114522 Sentence denotes Bladder scanners improve the quality and safety of patient care and reduce costs.
T111 114523-114706 Sentence denotes This economic assessment has demonstrated the significant avoided spend associated with scanner use and identified the key benefits to patients, staff and the organisation as a whole.
T112 114707-114823 Sentence denotes There is a compelling case for management of bladder scanners within a MEL to ensure resources are better allocated.
T113 114824-114875 Sentence denotes I do not have any conflict of interests to declare.
T114 114876-114933 Sentence denotes Commissioning for Quality and Innovation (CQINN) project:
T115 114934-115013 Sentence denotes Reducing catheter-associated urinary tract infections, can change be sustained?
T116 115014-115193 Sentence denotes The 2012/2013 data from the monthly national "Safety Thermometer" revealed catheter-associated urinary tract infection (CAUTI) rates were consistently double the national average.
T117 115194-115337 Sentence denotes The IP&C team completed a baseline audit in March 2013 to assess urinary catheter usage, management and associated infections within the trust.
T118 115338-115531 Sentence denotes This audit captured 502 adult in-patients who were reviewed for catheter usage; of these, 23% (113) had a urethral catheter in situ, and 17% (18) of the catheterised patients developed a CAUTI.
T119 115532-115648 Sentence denotes As a result of this audit, North Derbyshire CCG established a Commissioning for Quality and Innovation (CQINN) goal.
T120 115649-115735 Sentence denotes The Trust formulated an action plan to achieve this goal using a multi-modal approach.
T121 115736-115829 Sentence denotes On 6 th January 2015 the infection prevention and control team repeated the prevalence audit.
T122 115830-115843 Sentence denotes Key findings:
T123 115844-116040 Sentence denotes In addition to this, since August 2014 there had been a sustained decrease in the number of hospital-acquired CAUTIs reported via the Trust's "Safety Thermometer" data and this has been sustained.
T124 116041-116313 Sentence denotes The project has seen a significant decrease in harm to patients, reducing length of stay for this patient group, improved patient flow within the organisation, and equating to potential cost savings of approximately £38,578 for CRHFT in line with evidenced-based research.
T125 116314-116365 Sentence denotes I do not have any conflict of interests to declare.
T126 116366-116405 Sentence denotes Cambridgeshire and Peterborough CCG, UK
T127 116406-116511 Sentence denotes Clostridium difficile can be limited through combinations of good practice and adherence to key policies.
T128 116512-116682 Sentence denotes Root cause analysis (RCA) is used to examine the patient pathway with the intent of identifying lapses in care in the prevention, treatment and management of the disease.
T129 116683-116787 Sentence denotes National guidance has focused on taking this a step further using a post-infection review (PIR) process.
T130 116788-116910 Sentence denotes As nurses within the CCG, we have supported our providers to maximise the benefits of PIR and prevent avoidable infection.
T131 116911-117034 Sentence denotes A pilot project set up by NHS England (East) in 2013/2014 was based on a modified PIR used nationally for MRSA bacteraemia.
T132 117035-117165 Sentence denotes Using this template, scrutiny of each individual patient care pathway is enabled for C. difficile cases following the initial RCA.
T133 117166-117218 Sentence denotes All levels of care staff are engaged in the process.
T134 117219-117330 Sentence denotes Providers are supported to embed best practice across their organisations and gain high profile at Board level.
T135 117331-117551 Sentence denotes An agreed local Healthcare-Associated Infection (HCAI) Strategy focuses on the patient experience and recognises good practice by following national guidance to reach the irreducible minimum through non-sanctioned cases.
T136 117552-117683 Sentence denotes The project has reduced the number of C. difficile cases that have associated lapses in care whilst also recognising good practice.
T137 117684-117899 Sentence denotes Over the last 3 years and through strengthening of the process, an increase in the number of non-sanctioned cases, i.e. no breaches in key policy identified, has risen from 17% in the pilot year to 50% in 2015/2016.
T138 117900-118052 Sentence denotes The joined-up whole-economy approach will continue to be key in future developments and the aspiration to further reduce the number of sanctioned cases.
T139 118053-118104 Sentence denotes I do not have any conflict of interests to declare.
T140 118105-118148 Sentence denotes Diane Holland, Lisa Bree, Rebecca Griffiths
T141 118149-118328 Sentence denotes In 2012/2013, data from the monthly national "Safety Thermometer" revealed catheter-associated urinary tract infection (CAUTI) rates were consistently double the national average.
T142 118329-118479 Sentence denotes A baseline point prevalence audit was completed in March 2013 to assess urinary catheter usage, management and associated infections within the trust.
T143 118480-118612 Sentence denotes This audit captured 502 adult in-patients who were reviewed for catheter usage; of these, 23% (113) had a urethral catheter in situ.
T144 118613-118687 Sentence denotes 17% (18) of the catheterised patients developed a catheter-associated UTI.
T145 118688-118802 Sentence denotes North Derbyshire Clinical commissioning group established a Commissioning for Quality and Innovation (CQINN) goal.
T146 118803-118889 Sentence denotes The Trust formulated an action plan to achieve this goal using a multi modal approach.
T147 118890-119095 Sentence denotes The project has seen a significant decrease in harm to patients and shortened length of stay for this group of patients, and therefore has impact on the improvement of patient flow within the organisation.
T148 119096-119316 Sentence denotes Mar 13 n (%) Jan 15 n (%) % Change This paper explores the methodology used to create and sustain a change in practice when commissioners and providers utilise CQINNS to support and promote best practice and reduce harm.
T149 119318-119461 Sentence denotes There has been a plethora of research studies approximating the morbidity and mortality of patients with Clostridium difficile infection (CDI).
T150 119462-119725 Sentence denotes As infection and prevention nurses, we wanted to investigate how to prevent transmission of CDI in the patient areas to prevent further harm to others from asymptomatic carriers, cross-infection, contamination from fomites, staff hands and the equipment they use.
T151 119726-119854 Sentence denotes Following a CDI outbreak, a research forum was assembled and a research question hypothesised to identify asymptomatic carriage.
T152 119855-119963 Sentence denotes The forum, Patient and Public Involvement, aimed to explain the study and how the survey would be conducted.
T153 119964-120069 Sentence denotes The proposed survey was taken forward to the Ethics Committee for approval, who agreed it could go ahead.
T154 120070-120170 Sentence denotes All 11 adult hospital inpatient wards (seven) and inpatient units (four) were included in the study;
T155 120171-120271 Sentence denotes The study took place over the winter 2015-2016; There were a total of 407 patient samples collected:
T156 120272-120630 Sentence denotes 154 faeces samples were analysed; 253 skin swabs were collected and analysed; A total of 22 faecal samples were found to be positive for Clostridium difficile asymptomatic colonisation; 0 (n0) skin swabs were shown not to have any carriage; These results show a prevalence of 14.3% asymptomatic positivity for Clostridium difficile asymptomatic colonisation;
T157 120631-120719 Sentence denotes All positive asymptomatic carriers had received antimicrobials within the last 3 months;
T158 120720-120816 Sentence denotes All positive asymptomatic carriers had received proton pump inhibitors within the last 3 months;
T159 120817-120916 Sentence denotes All positive asymptomatic carriers had received care in an Acute Hospital within the last 3 months.
T160 120917-120991 Sentence denotes It was predicted that the rate of colonisation would be approximately 20%.
T161 120992-121022 Sentence denotes The actual results were 14.3%.
T162 121023-121282 Sentence denotes Isolating identified asymptomatic carriers of as C. difficile potentially confines and prevents further contamination of the environment, and staff employing extra precautions concerned with source isolation protects other vulnerable patients in the vicinity.
T163 121284-121325 Sentence denotes Water is considered to be pure and clean.
T164 121326-121400 Sentence denotes In reality it can be the perfect medium in which micro-organisms can grow.
T165 121401-121518 Sentence denotes Legionella, Pseudomonas Aeruginosa and Mycobacteria have all been associated with hospital outbreaks linked to water.
T166 121519-121606 Sentence denotes Our Trust is a large tertiary hospital that is located within the South West Peninsula.
T167 121607-121755 Sentence denotes Opened in 1981, it is a maze of corridors, wards and departments that have been configured numerous times to meet the changing needs of health care.
T168 121756-121922 Sentence denotes This has led to a cat's cradle of pipework, dead legs, sinks and outlets that present the perfect conditions for the creation of biofilms and the stagnation of water.
T169 121923-122096 Sentence denotes To reduce the risk of water contamination by micro-organisms, the Infection Prevention and Control team joined forces with Site Services to introduce the Water Walk Arounds.
T170 122097-122259 Sentence denotes Every Friday at 10:30, the Infection Control Nurse Consultant and the Mechanical Services Manager rendezvous at a designated location, schematic drawings in hand.
T171 122260-122362 Sentence denotes With the Ward Manager, all water outlets are examined for cleanliness, integrity and frequency of use.
T172 122363-122441 Sentence denotes Actual locations of pipes and outlets are compared with those on the drawings.
T173 122442-122478 Sentence denotes Clinical participation is essential.
T174 122479-122608 Sentence denotes A snap shot of actual clinical practice is gained and all parties can raise concerns directly to those who can facilitate action.
T175 122609-122639 Sentence denotes Remedial works are instigated.
T176 122640-122705 Sentence denotes Sinks no longer in use and discovered dead legs/ends are removed.
T177 122706-122766 Sentence denotes Within the year, the whole hospital is reviewed in this way.
T178 122767-122830 Sentence denotes Three hundred remedial works have been raised via this process.
T179 122831-122902 Sentence denotes Water safety awareness has increased amongst Clinical Managerial staff.
T180 122903-123079 Sentence denotes Schematic drawings are up to date and the Infection Control Team can give assurance to the Trust and the population it serves that a robust system for water safety is in place.
T181 123080-123147 Sentence denotes This system is set to continue as it benefits all parties involved.
T182 123148-123199 Sentence denotes I do not have any conflict of interests to declare.
T183 123200-123424 Sentence denotes The Infection Prevention and Control Team (IPCT) have developed an observation/ training programme to provide increased support and on-going development to improve infection prevention control standards in the clinical area.
T184 123425-123540 Sentence denotes The two assessment units -male and female -were identified as areas that would benefit from the training programme.
T185 123541-123648 Sentence denotes The assessment units are very busy clinical areas that can have up to 60 admissions and discharges per day.
T186 123649-123837 Sentence denotes The aim of the training programme was to increase visibility of the Infection Control Team, to improve infection control practice and identify any learning needs that the areas might need.
T187 123838-123990 Sentence denotes Two infection control nurses visited the Assessment Units daily and observed practice; they collected data such as time spent on discharge bed cleaning.
T188 123991-124055 Sentence denotes To clean a discharge bed area thoroughly should take 20 minutes.
T189 124056-124274 Sentence denotes With the discharges and transfers to other ward areas, it was calculated that up to 6 hours a day could be spent on cleaning discharge bed areas; sometimes, due to pressures on nursing staff, this did not always occur.
T190 124275-124615 Sentence denotes Medication Kardex were audited -the pharmacist had introduced a SPARED (Samples, Policy, Allergy, Reason, End date and Daily review) campaign for the use of antibiotics for doctors and non-medical prescribers and the ERA (End date, Reason and Allergy) for nurses -to see if the end date of antibiotics, reason and allergies were documented.
T191 124616-124796 Sentence denotes The nurses also audited the Diarrhoea Assessment Tool to ensure that it was being utilised correctly and that the medics were aware of patients with suspected infectious diarrhoea.
T192 124797-125044 Sentence denotes Following the project, the Trust introduced Environmental Support Workers (ESWs) to work in the Assessment Units; their role includes cleaning discharge bed areas, preparing beds for new admissions and transferring patients to the receiving wards.
T193 125045-125173 Sentence denotes This allows nurses to care for their patients, and ensures that the bed areas are thoroughly cleaned ready for the next patient.
T194 125174-125375 Sentence denotes Based on the results from other audits, a "toolbox teaching" session on antibiotics, promoting the SPARED and ERA campaign, was devised and nurses were encouraged to sign up to be Antibiotic Guardians.
T195 125376-125565 Sentence denotes Diarrhoea Assessment Tools were not being utilised correctly; therefore, the infection prevention and control nurses (IPCNs) attended the areas and taught the nursing staff how to use them.
T196 125566-125756 Sentence denotes Being visible on the Units allowed the IPCNs to answer any queries that the staff may have had, and also ensured that patients had the correct isolation precautions and isolation stop signs.
T197 125757-125911 Sentence denotes The aim of the poster was to summarise the enhanced observation project the IPCNs had undertaken and hopefully roll out the project to other wards/ areas.
T198 125912-125963 Sentence denotes I do not have any conflict of interests to declare.
T199 125964-125984 Sentence denotes Diane Melling-Picken
T200 125985-126142 Sentence denotes On induction, staff receive theoretical infection control training, including the five moments for hand hygiene, using traditional didactic teaching methods.
T201 126143-126332 Sentence denotes This has proved particularly challenging for nurses when English is not their first language as the lecture is delivered rapidly and provides little or no time for questions and discussion.
T202 126333-126507 Sentence denotes Information from a matron indicated that whilst the overseas nurses on her ward were able to name the five moments for hand hygiene, they were unable to apply it to practice.
T203 126508-126663 Sentence denotes Evidence for this was reflected in the monthly hand hygiene observation audits, which showed that compliance had fallen below the required standard of 85%.
T204 126664-126761 Sentence denotes This suggested that a practical method of education was required to overcome the language issues.
T205 126762-126947 Sentence denotes The infection prevention nurse developed everyday nursing scenarios and, using a manikin rather than a real patient, worked with the overseas nurses who delivered "care" to the manikin.
T206 126948-127021 Sentence denotes Other colleagues observed and questions were encouraged from all parties.
T207 127022-127111 Sentence denotes The correct moment for hand hygiene and the rationale was explained at each intervention.
T208 127112-127181 Sentence denotes A series of six sessions were undertaken, each lasting 20-30 minutes.
T209 127182-127299 Sentence denotes Verbal feedback from the matron and monthly hand hygiene observational audit results were used to measure the impact.
T210 127300-127348 Sentence denotes Compliance prior to the intervention was 75-80%.
T211 127349-127419 Sentence denotes Following the intervention, compliance improved with scores of 85-90%.
T212 127420-127555 Sentence denotes This project has confirmed that demonstration and discussion has improved compliance in a clinical setting, at least in the short term.
T213 127556-127631 Sentence denotes Audit will continue to determine whether the improvement will be sustained.
T214 127632-127777 Sentence denotes Tailored hand hygiene sessions are now incorporated into the infection control training programme delivered to overseas nurses joining the Trust.
T215 127778-127858 Sentence denotes It will be considered whether any other cohorts will benefit from this approach.
T216 127860-128000 Sentence denotes Staring over the abyss at the 2015/2016 C. difficile trajectory, the 6-month position (20 against a 26 annual total) was looking precarious.
T217 128001-128032 Sentence denotes How could we get back on track?
T218 128033-128087 Sentence denotes The light bulb moment: we needed to think differently!
T219 128088-128284 Sentence denotes The Best Practice Express became a Trust-wide theme with screensavers, catchy rhythms asking staff to get on board, and there were A-Z emails with photos updating the Trust on everyone's position.
T220 128285-128401 Sentence denotes We rewarded areas for the number of C. difficile-"free" days rather than focusing on "how many" infections they had.
T221 128402-128574 Sentence denotes Wards received posters, regular league tables, highlighted good and consistent practice, bronze, silver and gold stars, and cakes made to look like the Bristol Stool Chart.
T222 128575-128662 Sentence denotes We introduced a Trust Mascot, ran a competition to name it and "Colin Oscopy" was born.
T223 128663-128793 Sentence denotes He became a "firm" favourite, spending time at the Trust Board, attending meetings, and having his own Twitter and Facebook pages.
T224 128794-128841 Sentence denotes (1) Engagement -the concept got people talking.
T225 128842-128966 Sentence denotes People knew what The Train was, and liked the competition; senior clinicians were refreshed to be rewarded for achievements.
T226 128967-129095 Sentence denotes Using the SIGHT Mnemonic, staff focus changed, engaged them and gave back responsibility for diarrhoea and infection prevention.
T227 129096-129170 Sentence denotes (2) Publicity -People were interested in C. difficile, from Board to Ward.
T228 129171-129327 Sentence denotes We took pictures and sent them out to show involvement in making the trajectory possible. "Where's Colin" was launched, letting staff track his "movements".
T229 129328-129423 Sentence denotes He has a large, "firm" following and goes out with other teams to promote infection prevention.
T230 129424-129512 Sentence denotes We came in on trajectory: at 6 months, if we hadn't changed, we would have been 10 over.
T231 129513-129651 Sentence denotes Continuing the "Best Practice Express" theme, using the same methodology, we will add topic-specific carriages to the train, each quarter.
T232 129652-129703 Sentence denotes I do not have any conflict of interests to declare.
T233 129704-129760 Sentence denotes Cara Hollander 1 , Karin Joubert 1 , Natalie Schellack 2
T234 129761-130030 Sentence denotes In South Africa, administration of the DR-TB medication regimen has been simplified across four weight bands which accommodate the formulations available in the country, while complying with international requirements for minimum, maximum and average dose per kilogram.
T235 130031-130213 Sentence denotes Broadly, at population level, people fall into one of three categories: responders, non-responders, and toxic responders, based on their inter-individual variation in DNA sequencing.
T236 130214-130390 Sentence denotes These differences can result in under or over-dosing of the aminoglycosides (kanamycin/ KM) and polypeptides (capreomycin/CM), which may affect efficacy, or result in toxicity.
T237 130391-130588 Sentence denotes To achieve this ideal concentration, pharmacokinetics and pharmacodynamics of KM/CM could be considered in reducing toxic effects, (ototoxicity and nephrotoxicity) and improving treatment outcomes.
T238 130589-130745 Sentence denotes Thus, the aim of this study was to investigate the pharmacokinetics and pharmacodynamics of KM/ CM in patients with DR-TB and the relationship with hearing.
T239 130746-130869 Sentence denotes This exploratory, quantitative experimental research design is a multi-site study at Helen Joseph and South Rand Hospitals.
T240 130870-131120 Sentence denotes The protocol reached saturation of data after enrolment of 20 participants, while undergoing audiological and pharmacological assessments at baseline and every 2 weeks for the first 3 months of treatment where possible, with 71 study visits in total.
T241 131121-131244 Sentence denotes Creatinine clearance was measured, and overall outcome of treatment is being evaluated in relation to the pharmacokinetics.
T242 131245-131453 Sentence denotes Catheter-associated urinary tract infections (CAUTIs) are the most prevalent healthcare-associated infection globally and are one of the most common infections experienced in hospitals (Tambyah et al, 2012) .
T243 131454-131595 Sentence denotes The Scottish Patient Safety Programme developed a CAUTI care bundle to tackle the problem of CAUTI and assist with its reduction in Scotland.
T244 131596-131759 Sentence denotes As a recent innovation in patient safety, there is much we can learn from the implementation, embedding and normalising of CAUTI care bundles in everyday practice.
T245 131760-131925 Sentence denotes Normalisation process theory (NPT) (May et al, 2009 ) has been used to study the implementation of complex healthcare interventions in a variety of healthcare areas.
T246 131926-132108 Sentence denotes Using qualitative methodology, semi-structured interviews were conducted with 26 clinical leaders responsible for implementation, from 15 NHS Boards using NPT as a guiding framework.
T247 132109-132383 Sentence denotes Framework analysis methods were applied to explore how clinical leaders make sense of the work of implementing the CAUTI care bundle (coherence); how they engage with it (cognitive participation); enact it (collective action) and appraise its effects (reflexive monitoring).
T248 132384-132539 Sentence denotes Clinical leaders perceived the CAUTI care bundle approach to be a different way of working in comparison to previous urinary catheter management practices.
T249 132540-132646 Sentence denotes There was general agreement that CAUTI care bundles met the needs of patients, staff and the organisation.
T250 132647-132738 Sentence denotes A common challenge to implementation has been lack of consensus on the definition of CAUTI.
T251 132739-132864 Sentence denotes Data illustrated that organisational support, staff education, awareness and stakeholder "buy-in" were paramount for success.
T252 132865-133051 Sentence denotes This paper will present findings illustrating key barriers and enablers to the introduction of CAUTI care bundles from the perspective of clinical leaders responsible for implementation.
T253 133052-133103 Sentence denotes I do not have any conflict of interests to declare.
T254 133104-133179 Sentence denotes Multidisciplinary review of urinary catheters to facilitate earlier removal
T255 133180-133317 Sentence denotes The duration of urinary catheterisation is a major risk factor in the development of catheter-associated urinary tract infection (CAUTI).
T256 133318-133441 Sentence denotes Limiting catheter use and minimising the duration the catheter remains in situ are primary strategies for CAUTI prevention.
T257 133442-133631 Sentence denotes There is evidence that nurse-initiated catheter removal protocols significantly reduce the length of time catheters are in situ, with a corresponding reduction in CAUTI (Adams et al, 2012).
T258 133632-133831 Sentence denotes A practice development initiative took place on the Care of the Elderly wards at an acute Trust, the objective being to facilitate a multi-disciplinary review of each patient with a urinary catheter.
T259 133832-133999 Sentence denotes A practice development nurse (PDN) joined the multi-disciplinary (MDT) "whiteboard" meetings on the Care of the Elderly wards twice per week, for a period of 3 months.
T260 134000-134149 Sentence denotes At this meeting, each patient with a urinary catheter was discussed with the aim of reviewing the clinical indication and facilitating early removal.
T261 134150-134253 Sentence denotes The PDN also ran a number of ward-based education sessions on urinary catheter care and TWOC procedure.
T262 134254-134337 Sentence denotes Surveillance of urinary catheter use took place for the duration of the initiative.
T263 134338-134464 Sentence denotes The number of catheters in situ during the surveillance period is shown below, compared with the previous surveillance period:
T264 134466-134641 Sentence denotes The data demonstrates a reduction in the number of urinary catheters in use on the Care of the Elderly wards and an improvement in the number of completed catheter care plans.
T265 134642-134803 Sentence denotes It is acknowledged that the surveillance data is based on a snap shot of practice and the number of urinary catheters in situ at any one time is multi-factorial.
T266 134804-134991 Sentence denotes However, this data provides some assurance that the review of urinary catheters at MDT meetings can facilitate a reduction in the number of catheters in situ and increase staff awareness.
T267 134992-135070 Sentence denotes It is recommended that this initiative be implemented across the organisation.
T268 135071-135122 Sentence denotes I do not have any conflict of interests to declare.
T269 135123-135185 Sentence denotes Collaborative working enables ward teams to "C the difference"
T270 135186-135211 Sentence denotes Holly Slyne, Wendy Foster
T271 135212-135471 Sentence denotes In 2015/2016 the annual trust trajectory for patients developing Clostridium difficile infection (CDI) was exceeded by 48% and a comprehensive thematic analysis of these patients identified two key themes for improvement: prompt sampling and prompt isolation.
T272 135472-135651 Sentence denotes The IPC team joined the NHS Improvement IPC Collaborative in April 2016 and used this driver to challenge three wards to improve quality collaboratively by reducing CDI incidence.
T273 135652-135786 Sentence denotes Plan, Do, Study, Act (PDSA) cycles were implemented to trial various tests of change surrounding prompt sampling and prompt isolation.
T274 135787-135874 Sentence denotes Weekly meetings maintained momentum and drove the PDSA cycles and improvements forward.
T275 135875-135980 Sentence denotes Infection Prevention Society isolation audit results and CDI incidence provided the two outcome measures.
T276 135981-136107 Sentence denotes Five tests of change proved successful and were ramped up through the PDSA cycles to develop products, improve and embed them.
T277 136108-136397 Sentence denotes These were education around sampling myths, a daily bay challenge to identify patients in bays with diarrhoea, a sticker affixed to faecal specimen pots to assist in documentation processes, the inclusion of side room usage on the daily ward huddle sheet and a revised diarrhoea care plan.
T278 136398-136470 Sentence denotes Together these five products have formed the "C the difference" toolkit.
T279 136471-136521 Sentence denotes Isolation audit results improved from 51% to 100%.
T280 136522-136596 Sentence denotes Prior to the collaborative the average days between CDI cases was 12 days.
T281 136597-136662 Sentence denotes Following the collaborative no patient developed CDI for 49 days.
T282 136663-136771 Sentence denotes This is a success that has never before been achieved at the Trust since CDI surveillance commenced in 2009.
T283 136772-136857 Sentence denotes The collaborative generated engagement and IPC quality improvement led by ward teams.
T284 136858-137019 Sentence denotes The next step is to share the "C the difference" toolkit across the Trust and to achieve the next goal, that no patient develops CDI under our care for 100 days.
T285 137020-137071 Sentence denotes I do not have any conflict of interests to declare.
T286 137072-137206 Sentence denotes Clostridium difficile improvement plan Rosslyn Young, Jane Ryan, Nina Fraser, Cindy Sawford, Sharon Clarke, Hilary Duthie, Steve Dolan
T287 137207-137296 Sentence denotes In 2015/2016 Bedford Hospital declared 23 cases of Clostridium difficile infection (CDI).
T288 137297-137414 Sentence denotes Therefore, we commenced an improvement plan with the view to ensure, and decrease lapses in, care in relation to CDI.
T289 137415-137466 Sentence denotes Two wards were chosen for the 90-day collaborative.
T290 137467-137584 Sentence denotes A project team including the Corporate Nursing Team, IPC, matron, ward manager and business administrator was formed.
T291 137585-137691 Sentence denotes We developed a driver diagram and project initiation document, and developed a new stool assessment chart.
T292 137692-137796 Sentence denotes The two wards testing the chart were supported using the plan, do, study, act service improvement model.
T293 137797-137812 Sentence denotes Results Ward 2:
T294 137813-137826 Sentence denotes Week 6 and 7:
T295 137827-137898 Sentence denotes Compliance has improved on Ward 1, but this is not the case for Ward 2.
T296 137899-138045 Sentence denotes The reasons for non-compliance are different, and are now being shared with the wards in greater detail to help to influence a change in practice.
T297 138046-138197 Sentence denotes We have discovered that winning hearts and minds and effective leadership are fundamental to success, and so we are striving to involve the wider team.
T298 138198-138331 Sentence denotes Greater understanding of improvement methodology is a great asset to enable staff to lead similar change in the future independently.
T299 138332-138383 Sentence denotes I do not have any conflict of interests to declare.
T300 138384-138688 Sentence denotes As part of the infection prevention and control (IPC) stabilisation agenda across the Western Cheshire Health Economy, the CWP IPC team offered stabilisation visits to all care homes, including residential care facilities and hospices in the Vale Royal and Western Cheshire Clinical Commissioning Groups.
T301 138689-138726 Sentence denotes This is a total of 85 care providers.
T302 138727-138994 Sentence denotes The aim of the visits was to support care providers with key infection prevention and control information, thus promoting safe and effective care: the opportunity for staff to receive IPC training during the visit and promoting the aseptic non touch technique (ANTT).
T303 138995-139161 Sentence denotes Thirty-five care providers accepted the offer of a stabilisation visit, eight in Vale Royal CCG and 27 in Western Cheshire CCG, which is equal to a 41% response rate.
T304 139162-139284 Sentence denotes The service continues to promote these visits at link meetings, other communications opportunities and in the newsletters.
T305 139285-139414 Sentence denotes This poster presentation will articulate key findings and areas for development following this programme of stabilisation visits.
T306 139415-139430 Sentence denotes Audit synopsis:
T307 139431-139555 Sentence denotes In 2014 the Trust experienced a rise in Clostridium difficile infection and MRSA colonisation Trust-attributable infections.
T308 139556-139623 Sentence denotes This triggered a review of assurance around environmental controls.
T309 139624-139758 Sentence denotes The audit process that was currently adopted was "Credits for Cleaning" (C4C) and the annual Infection Prevention Society (IPS) audit.
T310 139759-139911 Sentence denotes The current methodology of auditing utilising the national Patient-Led Assessment of Care Environment (PLACE) process was not highlighting any concerns.
T311 139912-140035 Sentence denotes There were no noticeable deficits in mandatory training compliance, and clinical areas were reporting 100% in hand hygiene.
T312 140036-140248 Sentence denotes An external inspection highlighted multiple issues around environmental standards and flaws in the environmental assurance process, impacting on patient care and increasing healthcare-associated infection (HCAI).
T313 140249-140376 Sentence denotes The Infection Prevention Team drafted a response and developed an audit tool that incorporated issues not previously addressed.
T314 140377-140562 Sentence denotes The tool was agreed by the organisation and was reviewed by the Infection Prevention and Control Group, Matrons Group, Environment Group and the Patient Safety Information Group (PSIG).
T315 140563-140662 Sentence denotes The audit questions are weighted to low, medium and high risk, and are not viewable by the auditor.
T316 140663-140804 Sentence denotes Results are presented at the Infection Prevention and Control Group and the PSIG by exception, forming part of each ward's quality dashboard.
T317 140805-140879 Sentence denotes The audits were introduced onto the audit programme in all clinical areas.
T318 140880-140935 Sentence denotes The average audit compliance has risen from 34% to 90%.
T319 140936-141109 Sentence denotes This poster will demonstrate an effective method for sustained environmental controls addressing areas of modern healthcare environment not addressed through national tools.
T320 141110-141161 Sentence denotes I do not have any conflict of interests to declare.
T321 141162-141205 Sentence denotes Vickie Lam, Claire Oliver, Dr Richard Cooke
T322 141206-141340 Sentence denotes The role of an "infection prevention and control support worker" (IPCSW) is a newly created role within our existing IPC nursing team.
T323 141341-141555 Sentence denotes Using the principles of a "healthcare assistant", the role has been established specifically to assist the IPC delivery plan and to release the qualified IPC nurses to focus on key strategic and operational issues.
T324 141556-141667 Sentence denotes Over the first 6 months since the post was established, the various tasks delegated to the IPCSW were reviewed.
T325 141668-141755 Sentence denotes Success was measured by evidence of completion of tasks and feedback from the IPC team.
T326 141756-141828 Sentence denotes Using agreed methodologies, five IPC audits were successfully completed.
T327 141829-142009 Sentence denotes These included auditing the storage of breast milk and decontamination of associated equipment, ward pantries, bed pan and commodes, ward environments, and hand hygiene compliance.
T328 142010-142378 Sentence denotes The IPCSW also initiated the following projects: review of staff changing facilities; environmental cleanliness evaluation by ATP monitoring; water sampling for pseudomonas; training ward and domestic staff on disinfection practices; hand hygiene product evaluation on critical care and oncology units; introducing KWIK Isolation screens into the high dependency unit.
T329 142379-142434 Sentence denotes The IPCSW role is well established within the IPC team.
T330 142435-142523 Sentence denotes The role allows for a targeted approach to IPC which is improving compliance Trust wide.
T331 142524-142626 Sentence denotes A future area of role development will be supporting the Trust's surgical site surveillance programme.
T332 142627-142678 Sentence denotes I do not have any conflict of interests to declare.
T333 142679-142833 Sentence denotes In response to the PHE CPE Acute toolkit (2013), we implemented a screening and management protocol for an 1100-bed acute University NHS Foundation Trust.
T334 142834-142999 Sentence denotes There was an unknown prevalence of CPE but considered low risk based on clinical isolates and no reported incidents of CPE within the region prior to implementation.
T335 143000-143142 Sentence denotes We identified existing patient admission pathways and adapted or developed their systems to include a CPE risk assessment with clinical teams.
T336 143143-143263 Sentence denotes Electronic alert systems (via PAS, ICnet and Sunquest ICE) were updated to alert all positive and known "at risk" cases.
T337 143264-143376 Sentence denotes Education and training was implemented by the IP&C team across the Trust, including a visual information poster.
T338 143377-143594 Sentence denotes Between May 2015 and May 2016 there were 171 patients tested for CPE; of these only 92 patients (54%) were reported to IP&C to add to the database and alerts system, with five positive CPE results (3% of 171 screens).
T339 143595-143796 Sentence denotes Of the 92 reported cases, complete screens (three samples) were completed on 53 (56%) patients, with 90% of the incomplete screens due to the patient being discharged before all samples were collected.
T340 143797-143889 Sentence denotes Twenty-seven countries were identified as the trigger for CPE screening from these 92 cases.
T341 143890-144022 Sentence denotes There was one incident during this timeframe due to delayed isolation which required contact screening seven patients (0 positives).
T342 144023-144156 Sentence denotes One issue was that the IP&C team were unaware of 77 patients (46%) and therefore unable to add alerts or track the screening samples.
T343 144157-144312 Sentence denotes Improvements are being developed to capture the data of all patients screened for CPE automatically to remove the need for separate notification processes.
T344 144313-144500 Sentence denotes We propose a combined approach to screening with primary care services, which could address the issue with incomplete screens and offer cost savings, which warrants further consideration.
T345 144502-144549 Sentence denotes Sepsis is a major cause of mortality worldwide.
T346 144550-144622 Sentence denotes Severe sepsis accounts for 1000 admissions to PICU every year in the UK.
T347 144623-144689 Sentence denotes Of these 1000 admissions, 20% will die (i.e. 200 deaths per year).
T348 144690-144846 Sentence denotes Improved pre-PICU care including early recognition, early use of antibiotics, generous fluids and cardiovascular support will greatly improve PICU outcomes.
T349 144847-144970 Sentence denotes Adherence to APLS/ACCM-PALS guidelines is poor and no sepsis algorithm or consistent treatment plan was being used in RACH.
T350 144971-145027 Sentence denotes No prior sepsis data had been collected in our hospital.
T351 145028-145087 Sentence denotes SPSP sepsis 6 protocol was implemented into our ED in 2014.
T352 145088-145194 Sentence denotes We designed a sepsis recognition tool for nurse triage to determine whether a child is potentially septic.
T353 145195-145331 Sentence denotes The tool triggers for an immediate senior doctor review and that doctor review determines whether the child requires sepsis 6 treatment.
T354 145332-145429 Sentence denotes All children that present to the ED with an illness problem are screened by the recognition tool.
T355 145430-145576 Sentence denotes We measure the time it takes from time of arrival to time of antibiotic administration and this is presented on a run chart and submitted to SPSP.
T356 145577-145650 Sentence denotes We also measure many other aspects of our sepsis care (fluids, cultures).
T357 145651-145770 Sentence denotes Of the four patients that have been transferred to PICU after sepsis 6 treatment in the ED we have a 0% mortality rate.
T358 145771-145865 Sentence denotes We have had one death due to sepsis in our ED; this patient had a pre-hospital cardiac arrest.
T359 145866-145981 Sentence denotes Of our 66 patients treated by sepsis 6, 100% have been identified for senior doctor review by our recognition tool.
T360 145982-146169 Sentence denotes We are currently implementing sepsis 6 into our paediatric assessment unit, Dr Gray's (Elgin) emergency department and children's ward, as well as maintaining our standards within our ED.
T361 146170-146237 Sentence denotes We are looking into pre-hospital sepsis management (paramedics/GP).
T362 146238-146289 Sentence denotes I do not have any conflict of interests to declare.
T363 146291-146475 Sentence denotes The Department of Health's High Impact Intervention (HII) -Peripheral intravenous cannula care bundle lists six actions to be performed at the time of insertion of peripheral cannulae.
T364 146476-146512 Sentence denotes The Health and Social Care Act 2008:
T365 146513-146715 Sentence denotes Code of Practice on the prevention and control of infections and related guidance requires that "registered providers must audit compliance against key policies and procedures for infection prevention".
T366 146716-146792 Sentence denotes Effective audit of compliance is only possible if documentation is complete.
T367 146793-146942 Sentence denotes A baseline audit measured documentation of the HII actions on the anaesthetic charts of 50 consecutive patients who had cannulae inserted in theatre.
T368 146943-147062 Sentence denotes Purposemade stickers of the HII care bundle actions were then placed on the anaesthetic charts of patients pre-surgery.
T369 147063-147147 Sentence denotes Re-audit data were collected from a further 50 anaesthetic charts post intervention.
T370 147148-147340 Sentence denotes The six HII actions for peripheral cannula insertion were documented in 1/50 patients (2%) prior to intervention and in 26/50 patients (52%) post intervention (Fisher's exact test p < 0.0001).
T371 147341-147538 Sentence denotes Placement of stickers in anaesthetic charts significantly improves the documentation of the HII peripheral intravenous cannula care bundle actions in patients who have cannulae inserted in theatre.
T372 147539-147629 Sentence denotes This is a low-tech intervention which produces a high-impact improvement in documentation.
T373 147630-147720 Sentence denotes Future print runs of anaesthetic charts will be re-designed to include this documentation.
T374 147721-147772 Sentence denotes I do not have any conflict of interests to declare.
T375 147773-147863 Sentence denotes Kirsty Ferguson 1 , Pamela Joannidis 2 , Infection Prevention & Control Team Audit Group 1
T376 147864-148041 Sentence denotes Healthcare Improvement Scotland (HIS) believes that every person in Scotland should receive the best health care possible every time they come into contact with health services.
T377 148042-148227 Sentence denotes Standards set by HIS request healthcare providers to have in place a systematic programme of audit that includes monitoring of standard infection control precautions (SICPs) compliance.
T378 148228-148463 Sentence denotes This, along with recommendation for an annual audit of infection prevention and control (IPC) policy and the implementation of transmission-based precautions (TBPs), led to development of a new tool in infection prevention and control.
T379 148464-148596 Sentence denotes During 2015 the Infection Prevention and Control Team (IPCT) reviewed existing audit tools to determine gaps as well as duplication.
T380 148597-148781 Sentence denotes The results of this review helped shape a revised infection prevention and control audit tool (IPCAT) comprising four sections: SICPs, TBP, SPE and quality improvement (PVC, CVC, UCC).
T381 148782-148899 Sentence denotes Development of a revised audit tool was followed by user acceptance testing of a web-based platform for data capture.
T382 148900-149032 Sentence denotes Audit data gathered is entered directly onto a tablet device, and once synchronised is available immediately via an audit dashboard.
T383 149033-149176 Sentence denotes The senior charge nurse (SCN) is sent an automated email, and by accessing the dashboard can view audit data including scores and action plans.
T384 149177-149285 Sentence denotes The audit dashboard can provide SCNs with data for their area and service leads with data for areas grouped.
T385 149286-149438 Sentence denotes Software is designed to allow IPCTs access to audit action plans to monitor progress and an automated email is generated in response to overdue actions.
T386 149439-149515 Sentence denotes A scheduler is available via the platform to facilitate IPCT audit planning.
T1 149516-149695 Sentence denotes Development of IPCAT has led to a streamlined audit process for NHS Greater Glasgow & Clyde, resulting in reduced administration time, real-time reporting and improved efficiency.
T2 149696-149825 Sentence denotes IPCAT provides a quality-driven audit process and both IPCNs and service users have reported satisfaction with the audit process.
T3 149827-150026 Sentence denotes Nationally there has been an increasing incidence of carbapenemase-producing Enterobacteriaceae (CPE) colonisation and infection in the UK; this includes a number of outbreaks in healthcare settings.
T4 150027-150179 Sentence denotes Based on the learning from management of these outbreaks, a CPE toolkit was developed by Public Health England (PHE) to support staff in acute settings.
T5 150180-150360 Sentence denotes In December 2014 this trust produced a policy, based on the toolkit, advising staff on the correct actions to ensure prompt detection of CPE and management to prevent transmission.
T6 150361-150440 Sentence denotes Staff knowledge of CPE was very limited prior to implementation of the toolkit.
T7 150441-150631 Sentence denotes Promotion of key messages and a range of multi-faceted initiatives were delivered by the Infection Prevention and Control (IPC) Team to improve this and enhance compliance with the guidance.
T8 150632-150774 Sentence denotes The electronic ordering system was amended to incorporate CPE screening and an alert was created for patients subsequently confirmed positive.
T9 150775-150876 Sentence denotes Also, a question to identify high-risk cases was added to the current adult risk assessment document.
T10 150877-151116 Sentence denotes A quantitative audit was completed over a 1-week period during January 2016; the aims of the audit were to determine compliance with identification of high-risk cases, screening, isolation and addition of an alert to the electronic record.
T11 151117-151213 Sentence denotes Prior to introduction of the toolkit, patients were not routinely screened for CPE on admission.
T12 151214-151302 Sentence denotes During the audit, 93 records were reviewed and 65.6% of high-risk cases were identified.
T13 151303-151456 Sentence denotes All cases requiring screening had at least one sample submitted; however, only 11.1% had all of the required screening samples in accordance with policy.
T14 151457-151547 Sentence denotes Where CPE was confirmed, 100% had the appropriate electronic alert added to their records.
T15 151548-151693 Sentence denotes Continued education to raise CPE awareness and policy across all departments is required; we aim to re-audit compliance with policy in 12 months.
T16 151695-151851 Sentence denotes The Primary Care Infection Prevention and Control (IPC) Team undertook 416 audits of General Practice (GP) and General Dental Practices (GDP) in 2015/ 2016.
T17 151852-152017 Sentence denotes This process was to provide quality assurance that primary care providers are compliant with current IPC practice in line with the Health and Safety Care Act (2015).
T18 152018-152121 Sentence denotes The IPC team used a validated IPC audit tool and provided specialist IPC audit support to GPs and GDPs.
T19 152122-152312 Sentence denotes The team also provided input into new-build and refurbishment projects, working closely with commissioners to provide oversight and receive assurance on IPC across a large geographical area.
T20 152313-152369 Sentence denotes Most practices scored 90% or higher in their IPC audits.
T21 152370-152478 Sentence denotes For areas of noncompliance, the team made recommendations and assisted with the development of action plans.
T22 152479-152597 Sentence denotes Practices that were identified as having sub-standard compliance with a score of <90% were considered for a follow-up.
T23 152598-152669 Sentence denotes The aggregated data identified key themes of non-compliance, including:
T24 152670-152964 Sentence denotes Environmental -challenging environmental conditions, non-compliant taps and hand-washing sinks, tiled splash back with grouted joints, storage of cleaning equipment, storage of vaccines in containers that were not webbed like baskets, and sharps containers not assembled and labelled correctly.
T25 152965-153101 Sentence denotes Staff health -suboptimal completion or information regarding hepatitis B vaccination and measles, varicella and rubella immunity status.
T26 153102-153184 Sentence denotes Staff knowledge -access to training, IPC policies out of date or not standardised.
T27 153185-153295 Sentence denotes The IPC team found that after follow-up on action plans, GPs and GPDs achieved >95% compliance with the audit.
T28 153296-153421 Sentence denotes The IPC team has produced a newsletter to inform other GPs and GDPs of these themes and guidance to how they may be resolved.
T29 153422-153528 Sentence denotes The aggregated data provides an opportunity for shared learning across other primary healthcare providers.
T30 153529-153580 Sentence denotes I do not have any conflict of interests to declare.
T31 153581-153651 Sentence denotes Konstantinos Tsattalios, Colin Macduff, Sarah Henderson, Richard Laing
T32 153652-153680 Sentence denotes The Robert Gordon University
T33 153681-153831 Sentence denotes Healthcare-associated infections (HAIs) remain an important public health problem across the globe, affecting patients, healthcare staff and visitors.
T34 153832-153996 Sentence denotes A prime focus of interventions aiming at tackling HAIs is the prevention and control of pathogens by increasing healthcare staff's adherence to hygiene regulations.
T35 153997-154240 Sentence denotes However, despite the plethora of these interventions, only a few are structured based on theoretical underpinnings and even fewer authors explicitly describe how the design and development of the intervention is informed by the adopted theory.
T36 154241-154406 Sentence denotes Yet, no systematic approach has been undertaken for providing clarity as to the importance of theory when conceptualising an intervention within the medical context.
T37 154407-154577 Sentence denotes Therefore, the current work refers to the design of an integrative literature review that aims at identifying a variety of relevant quantitative and qualitative evidence.
T38 154578-154735 Sentence denotes More specifically, this systematic approach will answer what and how theory can be embedded and implemented at the design and development stage against HAIs.
T39 154736-154895 Sentence denotes All levels of evidence will be reviewed as potentially relevant sources of knowledge, from Level I (e.g. systematic reviews) to Level V (e.g. expert opinions).
T40 154896-155097 Sentence denotes The structure of the search strategy as well as the data collection-analysis will be publically available (PROSPERO protocol registration) prior to, and during the course of, the actual review process.
T41 155098-155195 Sentence denotes Upon its completion, the findings will be disseminated in a health-related peer-reviewed journal.
T42 155196-155360 Sentence denotes To the best of the authors' knowledge, this is the first in-depth systematic attempt to scope and integrate such a wide range of research and non-research evidence.
T43 155361-155702 Sentence denotes The final findings not only will summarise theories implemented within interventions but, more importantly, they will form a useful and practical guide for future research in this field, aiding scientists to decide what theory is more appropriate for their own study and how this can be achieved when developing an intervention against HAIs.
T44 155704-155834 Sentence denotes Dehydration is an increasing problem among older people, with frail, dependent nursing home residents being especially vulnerable.
T45 155835-155915 Sentence denotes Consequences of dehydration include urinary tract infection and other morbidity.
T46 155916-156048 Sentence denotes Infections in older people account for a considerable proportion of antimicrobial prescribing and associated problems of resistance.
T47 156049-156230 Sentence denotes Factors which may lead to inadequate hydration of residents include poor staffing levels, lack of supervision and knowledge, and limited appreciation of the importance of hydration.
T48 156231-156367 Sentence denotes This project used service improvement methodology to optimise the hydration of residents, working in partnership with two nursing homes.
T49 156368-156572 Sentence denotes Process maps and action effect diagrams were developed through observation and input from care home staff and residents/relatives to describe current systems and identify contributory factors and actions.
T50 156573-156646 Sentence denotes Plan-do-study-act (PDSA) cycles were used to develop sustainable changes.
T51 156647-156799 Sentence denotes Improvement was measured using hydrationlinked events, e.g. UTI, laxative/antibiotic use, staff/resident feedback, and number/volume of fluids consumed.
T52 156800-156855 Sentence denotes Data was entered in statistical process control charts.
T53 156856-157053 Sentence denotes Observations identified fluid intakes of commonly less than 1000 ml/day, with fully dependent residents particularly at risk; food promoted in favour of fluids; and opportunities for drinks missed.
T54 157054-157227 Sentence denotes PDSA cycles were used to introduce protected drinks time, testing new equipment to support residents' drinking, mealtime cards, and drinks menus to enhance choice of fluids.
T55 157228-157329 Sentence denotes These changes resulted in more residents receiving drinks and an increase in individual fluid intake.
T56 157330-157470 Sentence denotes A staff training programme on hydration was developed, with attendees reporting an increase in knowledge and anticipated change in practice.
T57 157471-157628 Sentence denotes Small changes to practice in care homes have the potential to ensure sustainable long-term service improvement and reduced morbidity and hospital admissions.
T58 157629-157758 Sentence denotes The package of tested quality improvement initiatives and a staff training programme will be disseminated to other nursing homes.
T59 157759-157811 Sentence denotes Learning could be applicable to acute care settings.
T60 157812-157863 Sentence denotes I do not have any conflict of interests to declare.
T61 157864-157887 Sentence denotes To swab or not to swab?
T62 157888-157923 Sentence denotes That is the question Jane Tideswell
T63 157924-157998 Sentence denotes There are two techniques universally associated with wound swab procedure.
T64 157999-158059 Sentence denotes They are the Z-Track (zig zag) method and the Levine method.
T65 158060-158166 Sentence denotes Anecdotal evidence has shown that healthcare professionals are unaware of the existence of either process.
T66 158167-158319 Sentence denotes I believe that it is necessary to promote that there is a researchbased, scientific process which underpins the rationale behind the swabbing of wounds.
T67 158320-158451 Sentence denotes Definitive guidelines for this supposedly relatively simple procedure have yet to be established, hence my interest in the subject.
T68 158452-158569 Sentence denotes IPC standard precautions, to include hand washing, must be applied at all times before and during the swab procedure.
T69 158570-158685 Sentence denotes In the case of acute wounds which are suspected of being infected, the 10 point, Z-Track method should be executed.
T70 158686-158935 Sentence denotes In the case of chronic wounds, where Biofilm formation may be present, it is argued that the Levine method of wound swabbing be implemented as it is crucial to apply gentle, downward pressure to release fluid from the deeper layers of the wound bed.
T71 158936-159028 Sentence denotes Care should be taken to ensure that the swab only comes into contact with the wound surface.
T72 159029-159126 Sentence denotes Wounds must be cleansed with either tap water or normal saline prior to the swab being performed.
T73 159127-159266 Sentence denotes Research suggests that in the instances of moist wounds, a wound swab may be used without pre-moistening the cotton tip with normal saline.
T74 159267-159485 Sentence denotes Conversely, in the case of drier wounds, research suggests that swabs should always be pre-moistened with normal saline prior to collection to increase the chances recovering micro-organisms from the site of the wound.
T75 159486-159528 Sentence denotes However, much debate surrounds this issue.
T76 159529-159782 Sentence denotes Necrotic tissue, slough or any other contaminated material should be removed from the wound bed before a representative wound swab sample is taken, as failure to do so may confound the microbiology results and lead to inappropriate antibiotic treatment.
T77 159783-159851 Sentence denotes If pus is present it is important that a sample be sent for culture.
T78 159852-159973 Sentence denotes It is advised that aspiration using a sterile syringe to collect exudate (0.5 ml) from the wound is the preferred method.
T79 159974-160164 Sentence denotes Research suggests that there needs to be standardisation around how swabs should be taken, to include the correct labelling and transportation of the specimen to the microbiology laboratory.
T80 160165-160454 Sentence denotes It is important to ensure that the patient's name, date of birth, specimen source, ongoing treatment, underlying co-morbidities as well as the time that the culture was taken be appropriately noted on the biohazard envelope, and to ensure that it is sent to lab within 4 hours if possible.
T81 160455-160670 Sentence denotes There is limited substantial quantitative data available for me to include in my abstract, as research studies into wound swabbing are limited and have generally been done using a small-scale sample of participants.
T82 160671-160811 Sentence denotes Interestingly, numerous studies demonstrate that wound swabbing is historically grounded in ritualistic rather than evidence-based practice.
T83 160812-160917 Sentence denotes Wound swabbing may appear to be a relatively simple procedure, but it is a subject for future discussion.
T84 160918-161097 Sentence denotes I would argue that IPC need to be involved in the development of wound swabbing policies and protocols to ensure that swabs are collected in an evidencebased, consistent approach.
T85 161098-161149 Sentence denotes I do not have any conflict of interests to declare.
T86 161150-161179 Sentence denotes Infection control and cancer:
T87 161180-161222 Sentence denotes A perfect storm Pat Cattini, Sarah Whitney
T88 161223-161259 Sentence denotes This poster will support Session 18b
T89 161260-161327 Sentence denotes Cancer is among the leading causes of death in the developed world.
T90 161328-161390 Sentence denotes Most people with cancer die from infection, not their disease.
T91 161391-161553 Sentence denotes Treatments for cancer including surgery, radiation, chemotherapy, and transplant leave a patient more vulnerable to infection than a healthy adult of similar age.
T92 161554-161637 Sentence denotes On top of this, the global threat of antibiotic resistance poses a particular risk.
T93 161638-161770 Sentence denotes Antibiotics have revolutionised cancer treatment by enabling the use of more aggressive therapies, leading to higher survival rates.
T94 161771-161871 Sentence denotes For this medically vulnerable group the loss of effective antibiotics would have dire ramifications.
T95 161872-162115 Sentence denotes A cancer hospital can be the setting for the perfect storm, with a collection of vulnerable patients, many from overseas, coupled with aggressive treatments which can cause unpleasant side effects such as leucopoenia, mucositis, and diarrhoea.
T96 162116-162500 Sentence denotes Key infection issues will be highlighted and considered, including: CRE, antimicrobial stewardship, treatment of neutropaenic sepsis, use of chemotherapy, C. difficile infection, pre-op screening to prevent SSI, IV lines and other invasive devices, viral respiratory infections, reactivation of viruses, loss of immunity, decontamination of the environment, use of probiotics and FMT.
T97 162501-162666 Sentence denotes As infection prevention specialists, we often focus on preventing exogenous infection and we don't always consider endogenous infection from the patient's own flora.
T98 162667-162904 Sentence denotes The poster will equip the reader with an overview and understanding of some of the complexities of preventing infection in cancer patients, promote discussion, and provide ideas for future strategies to help in the battle against cancer.
T99 162905-162965 Sentence denotes Cancer is the leading cause of death in the developed world.
T100 162966-163056 Sentence denotes It has been predicted that resistant infections will kill more people than cancer by 2050.
T101 163057-163234 Sentence denotes Further work needs to be undertaken to consolidate and strengthen current infection prevention knowledge and to develop new ideas which don't involve reliance on antimicrobials.
T102 163235-163286 Sentence denotes I do not have any conflict of interests to declare.
T103 163287-163622 Sentence denotes The World Health Organization's (WHO) guidance on the Core Components for Infection Prevention and Control (IPC) programmes is being revised with a view to basing this guidance on the best available evidence in order to support the prevention of healthcare-associated infections (HAI) and the global burden of antimicrobial resistance.
T104 163623-163732 Sentence denotes With WHO approval, a systematic review was conducted to identify national core components for IPC programmes.
T105 163733-163860 Sentence denotes Five databases were searched for papers published between 2000 and 2015 reporting the effectiveness of national IPC programmes.
T106 163861-164044 Sentence denotes Papers identified were screened against the eligibility criteria and further assessed according to Cochrane's Effective Practice and Organisation of Care (EPOC) study design criteria.
T107 164045-164105 Sentence denotes Data were extracted and risk of bias assessments undertaken.
T108 164106-164267 Sentence denotes The quality of the body of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, where appropriate.
T109 164268-164373 Sentence denotes One hundred and ten studies met the inclusion criteria, of which 26 studies met the EPOC design criteria.
T110 164374-164571 Sentence denotes Four component themes were identified from the 26 studies: multimodal IPC programmes (n = 16); IPC care bundles (n = 4); IPC policies (n = 4); and IPC surveillance, monitoring and feedback (n = 2).
T111 164572-164796 Sentence denotes The majority of interventions evaluated in the 26 studies focused on preventing a specified infection (central line-associated bloodstream infections being the most frequent) or HAI more generally, or promoting hand hygiene.
T112 164797-164907 Sentence denotes Individual studies demonstrated effectiveness; however, only three (of the 26) studies had a low risk of bias.
T113 164908-165036 Sentence denotes While, impressively, 26 studies had a robust research design, there was variation in the rigour with which these were conducted.
T114 165037-165280 Sentence denotes The range of interventions and outcomes measured limited synthesis of the findings, but strong policylevel recommendations can be made under the guidance of the WHO secretariat and expert group, as well as an outline of existing research gaps.
T115 165281-165504 Sentence denotes On the 2nd October 2016, over the course of 3 days, we moved from our 100-year-old hospital into a 270-bed new state-of-the-art hospital, Alder Hey in the Park, which was designed with the help of children and young people.
T116 165505-165685 Sentence denotes The majority of children and their families now have their own room with en-suite facilities with park views, and patients have easy access to play areas on and outside their ward.
T117 165686-165856 Sentence denotes Despite the move to the new building being meticulously planned and the infection prevention and control team being involved, there have been many challenges to overcome.
T118 165857-165952 Sentence denotes The handover of the building to the Trust took place less than 1 month before the move-in date.
T119 165953-166046 Sentence denotes This reduced the time available for commissioning of the building and areas such as theatres.
T120 166047-166136 Sentence denotes Snagging of building work led to repeat cleans having to be undertaken prior to sign-off.
T121 166137-166264 Sentence denotes The filling of commodities such as paper towel dispensers, soap and sanitiser dispensers not completed at the time of the move.
T122 166265-166298 Sentence denotes Cleaning schedules not completed.
T123 166299-166391 Sentence denotes Financial constraints resulted in equipment having to be brought over from the old hospital.
T124 166392-166576 Sentence denotes •• Increased number of water outlets requiring flushing and sampling for legionella and Pseudomonas. • • IPC signage -when unable to attach to walls and when cubicles have glass doors.
T125 166577-166674 Sentence denotes Being the first site in the UK to introduce equipment or products can create additional problems.
T126 166675-166732 Sentence denotes You can never have too much storage in wards/departments.
T127 166733-166846 Sentence denotes Development of ward/department-based infection control policies enabled staff to engage with IPC before the move.
T128 166847-166909 Sentence denotes The new building with more cubicles can make staff complacent.
T129 166910-167060 Sentence denotes A new hospital building may be easier to clean and to isolate patients, but commissioning and essential commodities must be available before the move.
T130 167061-167112 Sentence denotes I do not have any conflict of interests to declare.
T131 167114-167211 Sentence denotes Ten semi-structured interviews of nursing staff were carried out between February and April 2015.
T132 167212-167306 Sentence denotes The interviews were audio recorded, transcribed verbatim and analysed using thematic analysis.
T133 167307-167381 Sentence denotes Thematic analysis identified two opposing responses from the participants.
T134 167382-167547 Sentence denotes Four nurses commented the unit coped well with neonates on contact precautions whilst conversely four senior staff felt quite strongly there were serious challenges.
T135 167548-167586 Sentence denotes Two staff had a more neutral response.
T136 167587-167727 Sentence denotes Themes were associated with the environment and equipment, knowledge and communication, and concerns about how unintended breaches occurred.
T137 167728-168007 Sentence denotes Two issues identified that appear unique to this unit are a lack of space causing unintended breaches of contact precautions by allowing the staff to multi-task, and delayed removal of signage resulting in some neonates remaining on contact precautions for longer than necessary.
T138 168008-168163 Sentence denotes Issues identified that were common to other research studies were the requirement to challenge staff practice and provision of adequate supplies of gloves.
T139 168164-168305 Sentence denotes Staff suggested changes to their unit that could improve compliance, for example standardisation of cot space, improved signage and training.
T140 168306-168482 Sentence denotes This research study has identified findings that appear unique to this unit and others which are more common to healthcare staff carrying out contact precautions in other NNUs.
T141 168484-168623 Sentence denotes An integrative literature review of factors influencing the effectiveness of handrubbing with ABHRs within clinical practice was conducted.
T142 168624-168762 Sentence denotes The literature search was conducted systematically using CINAHL, MEDLINE, PROSPERO, ScienceDirect and Web of Science electronic databases.
T143 168763-168873 Sentence denotes The search was limited to sources available in the English language and published between the years 1980-2015.
T144 168874-168972 Sentence denotes The search resulted in 26 eligible papers, including 16 experimental and 10 observational studies.
T145 168973-169213 Sentence denotes Six themes emerged, including the effectiveness of handrubbing technique, influence of ABHR volume, duration of the handrubbing procedure, the effect of mechanical rubbing, the effect of hand size and acceptability of handrubbing technique.
T146 169214-169352 Sentence denotes Technique, level of compliance with protocol, ABHR volume, time and friction were all shown to influence the effectiveness of handrubbing.
T147 169353-169496 Sentence denotes Handrubbing with 3 ml of ABHR for at least 30 seconds using the six-step technique appears to yield the best results in antimicrobial efficacy.
T148 169497-169616 Sentence denotes An interesting finding was that certain areas on hands might be more important than others during hand decontamination.
T149 169617-169759 Sentence denotes This review identified factors influencing the effectiveness of the handrubbing procedure which should be standardised for healthcare workers.
T150 169760-170005 Sentence denotes The importance of covering all surfaces of the hands on the efficacy of handrubbing remains uncertain; thus, further research is required to investigate the contribution of each of the six steps to the effectiveness of the handrubbing procedure.
T151 170007-170217 Sentence denotes Bacterial transmission in an operating room from patient to equipment and healthcare providers' hands and even to the next patient in the operating room has been associated with healthcare-associated infection.
T152 170218-170338 Sentence denotes Hand hygiene will interrupt transmission of microbes between patients, healthcare workers and the inanimate environment.
T153 170339-170591 Sentence denotes In 2009, to address this patient safety risk, the Infection Prevention and Control Team began to work with the medical and nursing teams to embed the World Health Organization's concept of "My five moments for hand hygiene" in the Operating Department.
T154 170593-170680 Sentence denotes A graph will display the Operating Room hand hygiene audits results dated 2009-current.
T155 170681-170756 Sentence denotes Healthcare-associated infection (HCAI) is a worldwide patient safety issue.
T156 170757-170963 Sentence denotes Compliance with hand hygiene guidelines has been demonstrated to be an effective method of reducing HCAI; however, it remains suboptimal and poorer amongst physicians compared with other healthcare workers.
T157 170964-171219 Sentence denotes The aim of this study is to determine the relationship between a multimodal quality improvement intervention, incorporating observational hand hygiene auditing with individualised feedback to physicians, and the incidence of surgical site infection (SSI).
T158 171220-171308 Sentence denotes The research design is a quasi-experimental retrospective before and after study design.
T159 171309-171429 Sentence denotes The aim was to test the hypothesis that the multimodal intervention would lead to at least a 1% drop (to 0.44%) in SSIs.
T160 171430-171649 Sentence denotes The intervention incorporated: increased provision of alcohol-based hand rub; education; targeted observational hand hygiene auditing (OHHA) with individual feedback; and the introduction of a surgical site care bundle.
T161 171650-171808 Sentence denotes The outcome measures include: the rate of SSIs in patients who received an orthopaedic implant surgery and the proportion of observed hand hygiene compliance.
T162 171809-171924 Sentence denotes Surgical site surveillance data on 3703 patients were included in the before (n = 1806) and after (n = 1897) study.
T163 171925-172162 Sentence denotes The risk of a patient developing an orthopaedic SSI decreased from 1.44% (n = 26), 95% CI (0.89-1.99) in the preintervention phase to 0.69% (n = 13), 95% CI (0.38-1.21) in the post-intervention phase, c 2 (1, n = 3703) = 5.05, p = 0.024.
T164 172163-172360 Sentence denotes There was a statistically significant increase in observed hand hygiene compliance overall to 91%, 95% CI (0.90-0.91), p < 0.01 and an 18% increase in compliance amongst consultant staff, p < 0.01.
T165 172361-172459 Sentence denotes There is a statistically significant reduction in SSI, with infection rates being reduced by half.
T166 172460-172542 Sentence denotes There are statistically significant increases in observed hand hygiene compliance.
T167 172543-172655 Sentence denotes Providing targeted individualised audit feedback significantly improves compliance with hand hygiene guidelines.
T168 172656-172707 Sentence denotes I do not have any conflict of interests to declare.
T169 172708-172849 Sentence denotes Reasons for poor hand hygiene compliance among healthcare workers in sub-Saharan countries Yetunde Ataiyero, Dr Judith Dyson, Dr Moira Graham
T170 172850-173201 Sentence denotes The prevalence of healthcare-associated infections (HCAI) in developing countries, especially sub-Saharan African (SSA) countries, has been underreported, and whilst the actual magnitude remains unknown due to deficient surveillance studies and lack of reliable data, estimates suggest this to be 2-20 times more prevalent than in developed countries.
T171 173202-173297 Sentence denotes In SSA and South-East Asia, HCAI contribute 4-56% (75%) to all causes of mortality in neonates.
T172 173298-173422 Sentence denotes Contaminated hands of healthcare workers play a significant role in the transfer of these infections to and within patients.
T173 173423-173603 Sentence denotes Conscientious hand hygiene practice is the simplest, most accessible, affordable and effective preventive method, although compliance with hand hygiene guidelines remains very low.
T174 173604-173781 Sentence denotes In developed countries, reasons for poor compliance have been attributed to lack of hand hygiene facilities, type of ward, specialty and procedure and the professional category.
T175 173782-173913 Sentence denotes A systematic review which will assess the barriers to effective hand hygiene practices among healthcare workers from SSA countries.
T176 173914-174053 Sentence denotes Bearing in mind the selection criteria, a systematic literature search through electronic and subject-specific databases will be conducted.
T177 174054-174272 Sentence denotes Peer-reviewed, primary studies published in English, conducted among hospital-based healthcare workers in sub-Saharan Africa and which reported on the barriers of hand hygiene practices will be included in this review.
T178 174273-174446 Sentence denotes A critical appraisal of the included studies will be done using the Critical Appraisal Skills Programme (CASP) tool to identify the strengths and weaknesses of the articles.
T179 174447-174554 Sentence denotes The findings of the review will be analysed using thematic analysis and the key barriers will be presented.
T180 174555-174679 Sentence denotes The similarities/differences in the identified barriers in both SSA and developed/western countries will also be identified.
T181 174680-174899 Sentence denotes We conducted a mixed-method study to develop knowledge of inherent and elective hand hygiene (HH) in clinical practice through the application of a new direct observation measurement tool, enhancing meaningful feedback.
T182 174900-174999 Sentence denotes Difference in HH compliance for clinical activities categorised as inherent or elective was tested.
T183 175000-175092 Sentence denotes Two settings were selected: a cardio-thoracic ward (CT) and a renal-haemodialysis unit (RH).
T184 175093-175228 Sentence denotes A powered sample of 20 (nurses, healthcare support staff) from each unit (N=40) were each observed for up to 1 hour by two researchers.
T185 175229-175362 Sentence denotes Reducing healthcare-associated infections through improving hand hygiene compliance amongst healthcare professionals remains topical.
T186 175363-175510 Sentence denotes However, research evidence suggests that hand hygiene compliance remains sub-optimal across various geographical locations and healthcare settings.
T187 175511-175733 Sentence denotes The aim of this poster is to report the outcomes of a recently published systematic review of peer-reviewed published studies, notably clinical trials, which focus on hand hygiene compliance among healthcare professionals.
T188 175734-175889 Sentence denotes Literature published between December 2009 and February 2014, which is indexed in PubMed and Cinahl, on the topic of hand hygiene compliance, was searched.
T189 175890-175998 Sentence denotes Following examination of the 57 publications initially reviewed, the final number of papers appraised is 16.
T190 175999-176124 Sentence denotes A lack of homogeneity in research design made meta-analysis difficult to achieve; however, comparative analysis was possible.
T191 176125-176246 Sentence denotes The majority of studies were conducted in the USA and Europe, in intensive care units and care of the elderly facilities.
T192 176247-176381 Sentence denotes The nurse, the healthcare assistant and the doctor are the three categories of healthcare worker most often the focus of the research.
T193 176382-176582 Sentence denotes Published studies demonstrate that moderate improvements to hand hygiene compliance rates were achieved when organisations adopted a multimodal approach, incorporating up to six strategies for change.
T194 176583-176746 Sentence denotes The multimodal approaches used were either guided by the World Health Organization (WHO) hand hygiene framework or by an independently tested multimodal framework.
T195 176747-176892 Sentence denotes Hand hygiene compliance remains an important patient safety issue, as we strive to reduce healthcare-associated infection rates across the globe.
T196 176893-177151 Sentence denotes The WHO multimodal hand hygiene framework is transferable to a variety of healthcare and education settings globally, and international research evidence suggests that moderate improvements in hand hygiene compliance rates can be achieved when it is adopted.
T197 177152-177203 Sentence denotes I do not have any conflict of interests to declare.
T198 177204-177216 Sentence denotes Abstract ID:
T199 177217-177321 Sentence denotes 4488 Management of a Streptococcus pyogenes outbreak with macrolide resistance on an acute dementia unit
T200 177322-177448 Sentence denotes Two cases of Group A streptococcal (GAS) infection linked to a mental health unit were reported to the Health Protection Team.
T201 177449-177498 Sentence denotes The cases were on separate male and female wards.
T202 177499-177600 Sentence denotes One patient with invasive GAS (IGAS) was admitted to the hospital and treated, but subsequently died.
T203 177601-177751 Sentence denotes Indirect transmission from the male patient to the female patient via a shared blood pressure monitor was identified as the likely transmission route.
T204 177752-177915 Sentence denotes Five further cases of GAS infection with the same antibiogram were reported from patients with superficial wound infections on the male ward over the next 12 days.
T205 177916-178050 Sentence denotes Typing of isolates supported epidemiological suspicion of patient-to-patient transmission of S. pyogenes with emm ST11.0, on the ward.
T206 178051-178085 Sentence denotes No staff carriers were identified.
T207 178086-178159 Sentence denotes Patients were elderly with severe dementia and a range of co-morbidities.
T208 178160-178277 Sentence denotes Non-compliance with isolation, screening and appropriate antibiotics posed particular challenges to outbreak control.
T209 178278-178477 Sentence denotes In addition to enhanced infection control measures, outbreak decision pathways were developed in collaboration with the mental health team, local microbiologists and PHE reference laboratory experts.
T210 178478-178692 Sentence denotes This aimed to support a multi-disciplinary team in developing individual screening and treatment plans for each patient to, as far as possible, identify carriers and treat all patients within a defined time period.
T211 178693-178766 Sentence denotes No further IGAS cases or transmission of GAS to other wards was reported.
T212 178767-178830 Sentence denotes A low threshold for swabbing superficial wounds was maintained.
T213 178831-178945 Sentence denotes Two further cases of GAS colonisation were detected and treated at 10 and 24 days after mass treatment completion.
T214 178946-179001 Sentence denotes No further cases were detected on subsequent screening.
T215 179002-179100 Sentence denotes The unprecedented outbreak of Ebola Viral Disease (EVD) showed signs of extending internationally.
T216 179101-179176 Sentence denotes The perceived threat would mean non-specialist units could encounter cases.
T217 179177-179340 Sentence denotes Furthermore, two of the UK's high microbiological containment facilities, which handle the virus and deployed staff to West Africa, are within the Trust catchment.
T218 179341-179462 Sentence denotes The infection control team established a plan for the management of suspect cases presenting to the Emergency Department.
T219 179463-179553 Sentence denotes The approach to PPE with EVD was far more complex than the usual procedures involving PPE.
T220 179554-179722 Sentence denotes There was concern that the transmission of EVD in West Africa to some healthcare workers was by an undetermined route, but potentially through incorrect removal of PPE.
T221 179723-179846 Sentence denotes A series of dressing/undressing drills based on military chemical, biological, radiological and nuclear drills was adopted.
T222 179847-179923 Sentence denotes There were various challenges in establishing the plan, which are discussed.
T223 179924-180074 Sentence denotes Myth and misinformation about the virus abounded and was difficult to counter, causing a disproportionate level of fear and making planning difficult.
T224 180075-180180 Sentence denotes Staff perceptions, and what staff were prepared (and not prepared!) to do, remained a factor in planning.
T225 180181-180250 Sentence denotes Problems were encountered with the supply of PPE, due to high demand.
T226 180251-180340 Sentence denotes Training opportunities for staff were limited, with no extra time allocated for training.
T227 180341-180539 Sentence denotes Only staff that had volunteered and were prepared to manage potentially infected patients should be trained; this could limit the pool of available staff, although this was not found to be the case.
T228 180540-180582 Sentence denotes Five suspect cases presented to the Trust.
T229 180583-180663 Sentence denotes Each was demanding on staff and resources, with associated costs and disruption.
T230 180664-180831 Sentence denotes There was extra strain on the Emergency Department, already under pressure from the usual day-to-day activities, exacerbated by delays in sample transport and testing.
T231 180832-181007 Sentence denotes Despite these challenges, the Trust plan ran smoothly and there was increased confidence in managing these patients, although maintaining training standards will be difficult.
T232 181008-181059 Sentence denotes I do not have any conflict of interests to declare.
T233 181060-181161 Sentence denotes Many cases of Middle East Respiratory Syndrome Corona Virus (MERS-CoV) have been confirmed worldwide.
T234 181162-181243 Sentence denotes Around 80% of the cases have been diagnosed in the Kingdom of Saudi Arabia (KSA).
T235 181244-181388 Sentence denotes The risk of international disease spread is especially worrying given the KSA's role as the home of the most important Islamic pilgrimage sites.
T236 181389-181491 Sentence denotes A cross-sectional study was carried out during Ramadan 2015 in the Holy Mosque in Mecca, Saudi Arabia.
T237 181492-181591 Sentence denotes Self-developed questionnaires were collected from 417 Arab participants using convenience sampling.
T238 181592-181660 Sentence denotes The majority of the respondents (91.3%) were familiar with MERS-CoV.
T239 181661-181788 Sentence denotes Saudis had a significantly higher knowledge about MERS-CoV compared with non-Saudis (56.92 ± 18.55 vs. 44.91 ± 25.46, p=0.001).
T240 181789-181895 Sentence denotes The average knowledge was significantly higher in respondents who had received health advice on p=0.024) .
T241 181896-182158 Sentence denotes With respect to stepwise linear regression, knowledge about MERS-CoV tended to increase by 14.23 (B=14.23%, p=0.001) for participants who were familiar with MERS-CoV, and by 8.50 (B=8.50, p=0.001) for respondents who perceived MERS-CoV as a very serious disease.
T242 182159-182454 Sentence denotes The Saudi Ministry of Health (MoH) has published annual recommendations for pilgrims, with special advice for elderly adults, children, pregnant women and those with chronic diseases, to preferably postpone their travel to Mecca, and for those who attend to maintain optimum preventive measures.
T243 182455-182558 Sentence denotes However, many pilgrims are not aware of MERS-CoV infection in Saudi Arabia and its preventive measures.
T244 182559-182833 Sentence denotes For instance, a study conducted in France that addressed MERS-CoV and its prevention among French Hajj pilgrims in pre-Hajj outpatient clinics showed that only 64.3% of the study participants were aware of MERS-CoV, and only 35.5% were aware of the Saudi MoH recommendation.
T245 182834-182979 Sentence denotes Another study among Australian pilgrims showed that only about one-third of the pilgrims responded to the warnings they heard regarding MERS-CoV.
T246 182980-183103 Sentence denotes Multidrug-resistant Acinetobacter baumanii (MDR-Ab) has emerged as an important cause of outbreaks in the hospital setting.
T247 183104-183251 Sentence denotes In 2015 a patient, having suffered a stroke, was repatriated from a developing country and admitted to an acute Trust in the North-East of England.
T248 183252-183329 Sentence denotes Four weeks after admission the patient was found to be colonised with MDR-Ab.
T249 183330-183487 Sentence denotes Logistic considerations dictated that the patient remained in an open bay, alongside other patients, for a total of 6 weeks before being placed in isolation.
T250 183488-183677 Sentence denotes During this time period the patient would have been, by virtue of a vigorous cough, highly infectious to patients and staff, and contamination of the environment would have been inevitable.
T251 183678-183784 Sentence denotes Subsequently, other patients, across two adjoining wards, were found to be positive for the same organism.
T252 183785-183843 Sentence denotes Affected patients were isolated, with barrier precautions.
T253 183844-183883 Sentence denotes Hand hygiene practices were reinforced.
T254 183884-184028 Sentence denotes The entire ward environment and all equipment were cleaned and decontaminated using either hydrogen peroxide or ultraviolet light-based methods.
T255 184029-184101 Sentence denotes All patients and many staff associated with the two wards were screened.
T256 184102-184214 Sentence denotes Affected patients were decolonised with octenidine-related products and, where appropriate, nebulised colomycin.
T257 184215-184348 Sentence denotes Affected patients who displayed signs of infection received antibiotic treatment that included nebulised and/or intravenous colistin.
T258 184349-184381 Sentence denotes Ward practices were scrutinised.
T259 184382-184537 Sentence denotes Over a period of 6 months a total of 10 patients were found to be positive for MDR-Ab; four of these had genuine infection while six were merely colonised.
T260 184538-184614 Sentence denotes Sinks and several items of equipment were found to be colonised with MDR-Ab.
T261 184615-184701 Sentence denotes On one ward, items of respiratory equipment were being inappropriately decontaminated.
T262 184702-184774 Sentence denotes None of the staff members tested were found to be colonised with MDR-Ab.
T263 184775-184873 Sentence denotes Despite the initial high level of spread of MDR-AB the outbreak was controlled relatively rapidly.
T264 184874-184955 Sentence denotes Success was due to teamwork and implementation of established and novel measures.
T265 184956-185007 Sentence denotes I do not have any conflict of interests to declare.
T266 185008-185077 Sentence denotes A multi-speciality approach to an outbreak of Pneumocystis jirovecii:
T267 185078-185381 Sentence denotes Interventions, investigations and further questions Justine Halliwell 1 , Lindsay Chesterton 1 , Deborah Gnanarajah 1 , Rebecca Turner 1 , Malcolm Guiver 2 , Cathy Winfield 1 , David Allotey 1 , Tom Bewick 1 and Richard Puleston 2 1 Derby Teaching Hospitals NHS Foundation Trust, 2 Public Health England
T268 185382-185512 Sentence denotes Pneumocystis jirovecci (PJ) is a host-specific, opportunistic fungal organism which causes pneumonia in immunosuppressed patients.
T269 185513-185632 Sentence denotes Infection occurs via the respiratory route and may be caused by patient-to-patient transmission or via the environment.
T270 185633-185840 Sentence denotes We report from a single centre from 2012 to 2015, highlighting the importance of a multi-disciplinary, collaborative approach and infection control measures during a suspected outbreak of PJ pneumonia (PJP).
T271 185841-186012 Sentence denotes Health Protection Scotland (HPS) produces a quarterly "Current and Emerging Threats (CET) Report", providing a continuous assessment of HAI/AMR threats in/to NHS Scotland.
T272 186013-186315 Sentence denotes The format of this report was recently updated to include a formalised risk assessment and gap analysis to determine if existing health protection programmes, currently available national surveillance intelligence and infection prevention and control guidance are sufficient to mitigate emerging risks.
T273 186316-186542 Sentence denotes The CET report highlights international "threats" identified in the published literature (primarily informed by RSS feeds set up on the main public health websites) and a summary of all outbreaks and incidents reported to HPS.
T274 186543-186811 Sentence denotes All threats are risk assessed using a defined SOP ("very high", "high", "moderate", "low" or "very low") to estimate potential impact on patients/services; for example, severity of disease, routes of ongoing spread and availability of effective treatment and controls.
T275 186812-186919 Sentence denotes Threats assessed as moderate or greater are considered for action; for example, production of new guidance.
T276 186920-187016 Sentence denotes Since the introduction of a risk assessment and gap analysis, 36 "threats" have been identified:
T277 187017-187070 Sentence denotes 10 in the literature and 26 reported by NHS Scotland.
T278 187071-187282 Sentence denotes Of the 36 "threats", 27 were assessed as a moderate or greater risk; a gap analysis found that guidance, tools or other health protection programmes were already in place to mitigate the risk from these threats.
T279 187283-187437 Sentence denotes In one case an alert was issued to clinical microbiologists and ID physicians in response to an identified threat from MCR-1 mediated colistin resistance.
T280 187438-187557 Sentence denotes The ongoing summary of "threats" in/to NHS Scotland provided by the CET report highlights service risk to NHS Scotland.
T281 187558-187719 Sentence denotes The addition of a risk assessment and gap analysis ensures NHS Scotland is sufficiently prepared to respond to current and emerging threats, including epidemics.
T282 187720-187771 Sentence denotes I do not have any conflict of interests to declare.
T283 187772-187804 Sentence denotes Infection control outbreak pack:
T284 187805-187861 Sentence denotes A rough and ready action card-based guide for care homes
T285 187862-188027 Sentence denotes Public Health England South West (PHESW) Health Protection Teams dealt with approximately 74 outbreaks of infections in care homes between October and December 2015.
T286 188028-188190 Sentence denotes To help to reduce risks and to enhance management, a user-friendly outbreak pack was drafted in conjunction with care home managers and other community providers.
T287 188191-188425 Sentence denotes Objectives were: to give clear and consistent advice to protect residents and staff from acquiring infection; to restrict spread; to clarify communication routes; and to provide information on common infectious diseases in care homes.
T288 188426-188615 Sentence denotes As part of my Health Protection/Infection Prevention and Control secondment remit to South Gloucestershire Council, I was in an ideal position to lead on the development of this initiative.
T289 188616-188840 Sentence denotes The health protection practitioner met with care home providers to scope the level of interest and enthusiasm, and contents and format were designed in conjunction with them and other community social care provider managers.
T290 188841-188966 Sentence denotes Hard copies of packs were sent to all care homes in South Gloucestershire and adapted for use in other South West localities.
T291 188967-189074 Sentence denotes This was followed by a 1-day workshop to formally launch the pack and to obtain feedback from stakeholders.
T292 189075-189231 Sentence denotes Pneumocystis jirovecii pneumonia (PCP) remains a very real threat to renal transplant recipients, and is associated with high mortality and morbidity rates.
T293 189232-189345 Sentence denotes Clusters have been reported worldwide, but evidence to support the source and associated risk factors is lacking.
T294 189346-189457 Sentence denotes Studies report cross-transmission of PCP between renal transplant cases particularly in the outpatient setting.
T295 189458-189525 Sentence denotes Acquisition from an environmental source has some credibility also.
T296 189526-189620 Sentence denotes An outbreak of 14 PCP cases in a national renal transplant centre was the focus of this study.
T297 189621-189893 Sentence denotes Following a 2013 national catch-up programme targeting unimmunised and partially immunised adolescents aged 10-16 years, and with continuing high coverage of the routine childhood MMR vaccination programme in England, measles incidence had been at historically low levels.
T298 189894-190002 Sentence denotes However, an increase in measles cases was observed at the end of 2015 across London and the East of England.
T299 190003-190094 Sentence denotes Since the beginning of 2016 there have been almost 200 measles notifications across London.
T300 190095-190133 Sentence denotes To date, 46 cases have been confirmed.
T301 190134-190209 Sentence denotes The age range of confirmed cases is 0-47 years, with 24% being adolescents.
T302 190210-190251 Sentence denotes Some 43% of cases have been hospitalised.
T303 190252-190340 Sentence denotes One of the main challenges is delay in diagnosis in cases presenting to A&E departments.
T304 190341-190435 Sentence denotes Measles is sometimes not recognised, resulting in admissions to acute wards without isolation.
T305 190436-190566 Sentence denotes This places patients at risk of severe disease, for example immunosuppressed individuals and unprotected staff at risk of measles.
T306 190567-190648 Sentence denotes Assessing contacts and providing post-exposure prophylaxis is resource intensive.
T307 190649-190866 Sentence denotes Despite national recommendations that healthcare staff should have evidence of protection from measles, this is not always known and some exposed staff have had to be excluded from work until immunity was established.
T308 190867-190969 Sentence denotes Some staff have been found to be susceptible, and there have also been a few cases confirmed in staff.
T309 190970-191183 Sentence denotes Systems should be in place so that all relevant Trust staff are aware of their responsibilities with regards to diagnosis and investigation of measles, and that all suspected cases are notified in a timely manner.
T310 191184-191266 Sentence denotes Suspected cases should be isolated until a diagnosis of measles has been excluded.
T311 191267-191453 Sentence denotes In addition, occupational health teams in hospitals and primary care should ensure that the measles immune status of all their staff has been assessed and MMR provided where appropriate.
T312 191454-191513 Sentence denotes In February 2016, there was a second outbreak of Norovirus.
T313 191514-191609 Sentence denotes Were there two peaks of the same outbreak, or was it two Norovirus outbreaks one after another?
T314 191610-191702 Sentence denotes This outbreak is compared with two previous outbreaks in the same hospital in 2010 and 2015.
T315 191703-191783 Sentence denotes What have we learnt from these outbreaks, and are we doing anything differently?
T316 191784-191875 Sentence denotes Between 9 February 2016 and 27 May 2016 the PRUH reported 155 confirmed cases of Norovirus.
T317 191876-192028 Sentence denotes At the highest outbreak peak, there were seven wards and eight bays closed, with at least 35 Norovirus inpatients (there are 25 wards in total on site).
T318 192029-192148 Sentence denotes The epidemiology of this year's outbreak is still being studied to determine whether it was two outbreaks or two peaks.
T319 192149-192253 Sentence denotes By 10 April 2016, the epidemic curve had reduced and there were fewer than 10 inpatients with Norovirus.
T320 192254-192407 Sentence denotes After 10 April 2016, the ICNs advised two further wards to close in response to new Norovirus-positive results (including a ward with dementia patients).
T321 192408-192496 Sentence denotes We closed the outbreak on 1 June 2016 after 2 weeks with no new hospital-acquired cases.
T322 192497-193036 Sentence denotes Challenges included: specimens not being collected and sent promptly; delays in obtaining Norovirus results; a prolonged outbreak or second outbreak; the majority of wards have shared facilities; the pressure of managing the outbreak, resources, time, prolonged working and team exhaustion; staff vacancy rate is still high despite a number of new nurses in post from the UK and abroad; low hand hygiene scores in some wards; some commode staining; insufficient patient care equipment on wards to segregate equipment for affected patients.
T323 193037-193167 Sentence denotes Despite higher numbers of Norovirus-positive patients in May 2016 during the second peak, hospital transmission decreased quickly.
T324 193168-193206 Sentence denotes Were there two peaks or two outbreaks?
T325 193207-193263 Sentence denotes Will sending the Norovirus isolates for sequencing help?
T326 193264-193345 Sentence denotes The epidemiology of the Norovirus outbreak needs further analysis and discussion.
T327 193346-193414 Sentence denotes Lessons learnt will be discussed at the after-action review meeting.
T328 193415-193469 Sentence denotes Have we done enough to prevent any future recurrences?
T329 193470-193521 Sentence denotes I do not have any conflict of interests to declare.
T330 193522-193643 Sentence denotes Six patients in an acute ward were identified with Mycobacterium avium in their respiratory secretions during March 2016.
T331 193644-193803 Sentence denotes The source implicated in this outbreak was an ice-making machine used for dispensing ice for patient consumption, located in the kitchen within the acute ward.
T332 193804-193957 Sentence denotes To identify the link of the ice-making machine to the outbreak, an inspection was carried out using a known audit tool with question-set recommendations.
T333 193958-194067 Sentence denotes The machine was decommissioned, and back tubing was removed and sliced open to reveal the state of the lumen.
T334 194068-194206 Sentence denotes Swabs of the lumen were taken and an acid-fast bacilli (AFB) smear was subsequently performed in the acute hospital's in-house laboratory.
T335 194207-194329 Sentence denotes Additional swabs and water sample from the ice-making machine were sent to the Public Health England reference laboratory.
T336 194330-194387 Sentence denotes The ice-making machine complied with the audit tool used.
T337 194388-194457 Sentence denotes Ice was dispensed directly from a nozzle into a receptacle on demand.
T338 194458-194548 Sentence denotes It was cleansed regularly and was maintained according to a planned maintenance programme.
T339 194549-194646 Sentence denotes However, a thick biofilm was found inside the lumen of the tubing connecting to the water supply.
T340 194647-194688 Sentence denotes Bacillus was isolated from the AFB smear.
T341 194689-194809 Sentence denotes Microbiological testing confirmed that the ice-making machine was the likely source of the Mycobacterium avium outbreak.
T342 194810-194936 Sentence denotes The existing infection prevention and control audit tool was not able to reveal the hygiene quality of the ice-making machine.
T343 194937-195082 Sentence denotes This incident was an opportunity to review our audit tools for ice-making machines and assurance processes to prevent recurrence of the outbreak.
T344 195083-195210 Sentence denotes It has opened discussions as to alternatives, such as manually making ice with the use of commercially available ice cube bags.
T345 195211-195302 Sentence denotes Infection Prevention and Control team, in-house laboratory staff and Public Health England.
T346 195303-195452 Sentence denotes Background CPE (carbapenemase-producing Enterobacteriaceae) continues to be an emerging threat to safety of in-patients in acute healthcare settings.
T347 195453-195728 Sentence denotes As part of a CPE outbreak investigation, the infection prevention and control team obtained more than 100 environmental swabs during an outbreak of Klebsiella pneumoniae in two cardiac inpatient wards -one critical care unit and one medical ward -from March 2016 to May 2016.
T348 195729-195867 Sentence denotes The swabs were obtained using an ordinary swab and subjected to the "meropenem Gram negative resistant" laboratory test using a CRE plate.
T349 195868-196075 Sentence denotes Out of 100 swabs, we identified a CPE -K. pneumoniae bla-IMP -from a hand hygiene sink in the kitchen, and multi-drug resistant (MDR) K. pneumoniae in the kitchen sink and in a patient bay hand hygiene sink.
T350 196076-196196 Sentence denotes There were no MDR Gram negative organisms identified from patient equipment, soap dispensers, bed frames and mattresses.
T351 196197-196323 Sentence denotes As the test used was specifically for meropenem-resistant Gram negative bacteria, other important organisms were not captured.
T352 196324-196474 Sentence denotes Five infection control nurses and one clinical support worker, with a total of 9 hours of work, were deployed in this environmental swabbing exercise.
T353 196475-196568 Sentence denotes The activity has time and cost implications for the Infection Prevention and Control Service.
T354 196569-196678 Sentence denotes There is a need to consider alternatives to microbiological sampling to link the environment to CPE outbreak.