Meeting abstracts from International Conference on Prevention & Infection Control (ICPIC 2017)

Antimicrobial Resistance and Infection Control, Jun 2017

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Meeting abstracts from International Conference on Prevention & Infection Control (ICPIC 2017)

American Journal of Epidemiology Abstracts from the 4th International Conference on Prevention & Infection Control (ICPIC 2017) perspectives Vasily Akimkin 2 3 6 9 11 12 14 16 17 24 26 27 33 35 36 40 42 43 48 49 52 54 55 59 61 62 64 65 67 68 71 72 77 78 82 83 85 86 89 90 96 97 Nikolay Shestopalov 2 3 6 9 11 12 14 16 17 24 26 27 33 35 36 40 42 43 48 49 52 54 55 59 61 62 64 65 67 68 71 72 77 78 82 83 85 86 89 90 96 97 Vladimir Shumilov 1 2 3 5 6 9 10 11 12 14 15 17 24 25 27 33 34 36 40 41 43 47 49 52 53 55 59 60 62 26 65 66 68 70 72 76 78 81 83 84 86 88 90 95 97 Tatiana Salmina 1 2 3 5 6 9 10 11 12 14 15 17 24 25 27 33 34 36 40 41 43 47 49 52 53 55 59 60 62 26 65 66 68 70 72 76 78 81 83 84 86 88 90 95 97 Aleksandra Dabizheva 0 2 3 4 6 8 9 11 12 13 14 17 23 24 27 32 33 36 39 40 43 46 49 51 52 55 58 59 62 63 65 68 69 72 75 78 80 83 86 87 90 97 Petr Kanygin 0 2 3 4 6 8 9 11 12 13 14 17 23 24 27 32 33 36 39 40 43 46 49 51 52 55 58 59 62 63 65 68 69 72 75 78 80 83 86 87 90 97 Izabella Khrapunova 2 3 6 9 11 12 14 16 17 24 26 27 33 35 36 40 42 43 48 49 52 54 55 59 61 62 64 65 67 68 71 72 77 78 82 83 85 86 89 90 96 97 Tatiana Shestopalova 2 3 6 9 11 12 14 16 17 24 26 27 33 35 36 40 42 43 48 49 52 54 55 59 61 62 64 65 67 68 71 72 77 78 82 83 85 86 89 90 96 97 Lyudmila Fedorova 2 3 6 9 11 12 14 16 17 24 26 27 33 35 36 40 42 43 48 49 52 54 55 59 61 62 64 65 67 68 71 72 77 78 82 83 85 86 89 90 96 97 0 Research and Production Association "Microgen" of the Ministry of Health of the Russian Federation , Moscow, Russian Federation Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):I1 1 Identification of anti-virulence compounds for combating staphylococcus aureus infections by High-Throughput Screening (HTS) Richard Y. Kao, Peng Gao Microbiology, The University of Hong Kong , Hong Kong, Hong Kong Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):I2 2 Institute” of Federal Service for Surveillance on Consumer Rights Protection and Human Well-being 3 I6 Welcome on board! - An edutainment movie to promote basic infection prevention measures Aline Wolfensberger, Marie-Theres Meier, Lauren Clack, Hugo Sax Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich , Zürich, Switzerland Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):I6 4 University of Geneva Hospitals 5 Infection Control Unit 6 I11 Impact of the “save lives: clean your hands 5th of May” campaign on the press: 2005-2016 Virginie Zimmerli 7 Faculty of Medicine , Geneva, Switzerland Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):I11 8 Faculty of Medicine , Geneva, Switzerland Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):I12 9 I13 Infection control on the movie screen Borbála Szél, Kamilla Nagy Infection Control Unit, Albert Szent-Györgyi Health Center at University of Szeged , Szeged, Hungary Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):I13 10 Infection control Unit, University of Geneva Hospitals 11 I12 Uses of twitter in health: the case of hand hygiene and infection control Melissa Baudrillart 12 O6 Isolation of Nontuberculous Mycobacterium (NTM) from heater cooler devices, in a tertiary care center in Lebanon Nada K. Zahreddine 13 Department of General Anesthesia 14 O5 Transmission of pathogens from dry surface biofilms: effect of glove type Karen Vickery 15 Department of Internal Medicine 16 Infection Control and Prevention Program 17 O4 AN international survey of cleaning and disinfection practices in the healthcare environment Nikki Kenters 18 Department of Medical Microbiology, Canisius Wilhelmina Hospital 19 Department of Epidemiology, College of Public Health Department of Internal Medicine , Iowa , United States 20 Department of Medical Microbiology , Radboudumc, Nijmegen , Netherlands 21 Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center , Beirut, Lebanon Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O6 22 Department of Medical Microbiology, Radboud University Medical Centre , Nijmegen, Netherlands Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O4 23 Université de Lorraine , EA 4360 APEMAC, Nancy , France 24 O8 Barriers and facilitators of responsible systemic antibiotic use from the patient's perspective: a systematic review Benedikt Huttner 25 Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine , Geneva , Switzerland 26 Infection Control Program 27 O7 Outcomes of methicillin-susceptible staphylococcus aureus bacteremia in patients with and without beta-lactam allergies Daniel J. Livorsi 28 Scientific Center for Quality of Healthcare, Radboud University Medical Center , Nijmegen, Netherlands Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O8 29 Department of Clinical Pharmacology, University Hospital Rijeka , Rijeka , Croatia 30 CHRU de Nancy, Service de Maladies Infectieuses et Tropicales , Nancy , France 31 Department of Internal Medicine, Radboud University Medical Center , Nijmegen , Netherlands 32 School of Architecture, Civil and Environmental Engineering, EPFL , Lausanne , Switzerland 33 O14 Integrated videography and environmental microbial sampling to model hand contamination: insights from Tanzania , Vietnam, and South Africa Timothy R. Julian 34 Civil and Environmental Engineering, University of California at Davis , Davis, California , United States 35 Department of Environmental Microbiology , Eawag, Dübendorf , Switzerland 36 O13 Infection control of VRE in hospitals: A modeling analysis of A French outbreak Rania Assab 37 Univ. Versailles St Quentin, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris , Versailles, Garches, France Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O13 38 Graduate School of Global Environmental Studies, University of Kyoto , Kyoto, Japan Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O14 39 Alberta Health Services , Calgary 40 O22 Interaction design methodology as an innovative tool to enhance hand hygiene: the intersection of art and science Julia Kupis 41 Alberta Health Services Infection Prevention and Control 42 W21C, University of Calgary and Alberta Health Services 43 O21 "Money makes money"-effects in hand hygiene promotion: earlier adopter wards benefit stronger from tailored interventions than later adopters Thomas von Lengerke 44 Medicine, University of Calgary and Alberta Health Services , Calgary , Canada Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O22 45 Emily Carr University of Art and Design , Vancouver 46 Monash Health 47 Hand Hygiene Australia 48 Austin Health 49 O24 Determinants of hand hygiene behavior in Australian emergency departments Andrew J. Stewardson 50 Melbourne Health , Melbourne, Australia Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O24 51 Infection Control Programme, University of Geneva Hospitals , Geneva, Switzerland Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O28 52 O28 Burden of healthcare-associated infections in outpatient care - a systematic review Qiao Fu 53 Infection Control Programme, Hospital Santa Maria Centro Hospitalar de Lisboa Norte , Lisbon , Portugal 54 Infection Control Programme, West China Hospital, Sichuan University , Chengdu , China 55 O26 Alcohol-based hand rub and incidence of healthcare associated infections in a rural regional referral and teaching hospital in Uganda Hiroki Saito 56 University of Liverpool , Liverpool , United Kingdom Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O26 57 Mbale Regional Referral Hospital , Mbale , Uganda 58 Institute of Hygiene/Hospital Epidemiology, Leipzig University Hospital , Leipzig, Germany Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O36 59 O36 Cost-effectiveness of psychologically tailored hand hygiene interventions: results of the psygiene-trial Thomas von Lengerke 60 Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School , Hannover 61 Medical Psychology Unit, Hannover Medical School , Hannover , Germany 62 O35 Are contact precautions associated with physical adverse events? a systematic literature review and meta-analysis Marin Schweizer 63 Bacteriology Laboratory, HUG , Geneva, Switzerland Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O39 64 Genomics Research Laboratory 65 O39 Prevalence of ST131 clone Among ESBL-Producing E. Coli responsible for Bloodstream Infection (BSI) at Geneva University Hospitals (HUG) Patrice Francois 66 Intensive Care, Hadassah- Hebrew University Medical Center , Jerusalem, Israel Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P360 67 Clinical Microbiology and Infectious Diseases 68 P360 Resource consumption due to healthcare-acquired infections Shmuel Benenson 69 Infection Control and In-service Education, IRCH, All India Institute of Medical Sciences , New Delhi, - 70 All India Institute of Medical Sciences , New Delhi , India 71 Hospital Administration, All India Institute of Medical Sciences , New Delhi 72 P366 Infection control in the stem cell transplant unit: a quality improvement initiative Laxmitej Wundavalli 73 Infection Control and In-service Education, IRCH, All India Institute of Medical Sciences , New Delhi , India Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P366 74 Directorate General of Health Services, Ministry of Health and Family Welfare 75 Department of Clinical Nursing, University of Ulsan College of Medicine 76 Department of Infection Control, Konkuk University Medical Center 77 Department of Clinical Nursing, University of Ulsan Graduate School of Industrial Technology 78 P382 The effect of multimodal intervention for the prevention of needlestick injury on the improvement of safety behaviors and incidence of needlestick injury among nurses Eunkyung Lee 79 Department of Nursing, University of Ulsan College of Medicine , Seoul, Korea, Republic Of Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P382 80 Epidemiology, Nigerian Field Epidemiology and Laboratory Training Network , Abuja, Nigeria Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P387 81 Community Medicine, Ministry of Health Katsina State , Katsina 82 Community Medicine, Ahmadu Bello University Zaria , Zaria 83 P387 Knowledge of occupational risk and practice of risk prevention among hairdressers in a North-Western Community , Nigeria Olorukooba A. Abdulhakeem 84 Department of Internal Medicine, Yonsei University College of Medicine , Seoul, Korea, Republic Of Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P397 85 Department of infection control, Severance hospital 86 P397 Development and effectiveness of clinical pathway for emerging infectious diseases Ju Hyun Lee 87 Hawai University , Hawai , United States 88 Microbiology / Immunology, School of Health Sciences, Catholic University of Central Africa , Yaoundé , Cameroon 89 Biochemistry, Biotechnology Center, University of Yaoundé I 90 P399 Saliva as an alternative sample for malaria detection and epidemiological surveillance: a cross sectional study in the centre and South West Regions in Cameroon Palmer Masumbe Netongo 91 Genotek , Ontario , Canada Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P399 92 Cheikh-Anta-Diop University , Dakar , Senegal 93 Centre International de Reference Chantal Biya , Yaoundé , Cameroon 94 Biotechnology Center, University of Yaoundé I 95 Lahijan unit, Islamic Azad University , Lahijan, Iran, Islamic Republic Of Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P402 96 Pasteur Institute of Iran , Tehran 97 P402 Seroparasitology investigation of trichomoniasis in women referred to health centers of Rasht City , Iran Zarrintaj Valadkhani INNOVATION ACADEMY Innovation Academy Introduction Application of bacteriophages for biological disinfection to decontaminate environmental objects in epidemiologically significant departments of medical organizations (intensive care units, burns units, surgical departments) represents one of the modern directions for bacteriophage usage. Indicative results of biological disinfection carried out in 20152016 in a large surgical hospital are reported. Objectives Epidemiological objective of conducting biological disinfection was determined by a necessity to eliminate hospital P. aeruginosa strains from the environment of purulent surgery department. Methods Product "Pyobacteriophag polyvalent" (lot No. 60, produced by Research and Production Association "Microgen" (Russia)) containing a mixture of sterile filtrates of phagolysates of staphylococci, streptococci, enterococci, proteus, klebsiella (pneumoniae and oxytoca), P. aeruginosa and E. coli was used for 4-time treatment of surfaces in corresponding department with determination and further checking of 140 control points. A biological disinfection of more than 700 m2 was performed per a single treatment. Results The results of the biological disinfection were as follows: 1. Complete elimination of hospital strains of P. aeruginosa, K. pneumoniae in one month after treatment. 2. Significant decrease of E. coli bacteria group (more than 3 times) and 2-fold decrease of S. aureus strains. 3. Pronounced positive dynamics of "microbiological cleanliness flora" that was not present in the department before: appearance and persistent prevalence of Bacillus cereus and Bacillus subtilis in microbiological studies suggesting displacement of nosocomial HAI-inducing microorganisms from the environment. Conclusion The biological disinfection by correponding bacteriophage preparation was found to be an effective measure for the environmental disinfection. The effect of the conducted treatment was observed for 10 months, during which there were no nosocomial cases of patients diseases caused by hospital strain of P. aeruginosa. Disclosure of Interest None Declared. Introduction: The indiscriminately use of antimicrobial drugs has led to the rapid emerging of multidrug resistant (MDR) bacteria including methicillin resistant Staphylococcus aureus (MRSA). Treatment by killing bacteria using antibiotics seems not to be an effective and sustainable way of controlling infections. Alternative ways for treating bacterial infections without incubating the emergence of drug resistant bacteria are highly valued. Objectives: dentification of therapeutic agents that suppress the expression and production of S. aureus virulence factors without inhibiting bacteria growth. Methods: The promoters of major virulence factors of S. aureus were cloned into a reporter vector using bacterial luciferase (Lux) and green fluorescent protein (GFP) as the reporter genes. Promoter activities were monitored by the measurement of luminescence and fluorescence readings. HTS of a chemical library with 50,240 compounds was carried out using S. aureus harboring an alpha-hemolysin gene (hla) promoter reporter plasmid and compounds that reduced the hla promoter activities considerably were selected as hits. Selected hit compounds were tested on other S. aureus virulence promoters for the identification of compounds that could suppress multiple virulence gene expressions. Compounds with potent suppressive effects on multiple virulence promoters were selected for further examinations using mammalian cell-based infection assays and mice in vivo infection models. Results: S. aureus hla promoter together with 14 other promoters of major virulence factors or virulence associated genes were successfully constructed. HTS of 50,240 compounds using the hla promoter-based reporter system yielded 670 hits that exerted suppressive effects in hla promoter activities. The anti-virulence activities of one compound were successfully demonstrated in mammalian cell-based infection assays and a mice in vivo infection model. Conclusion: HTS of 50,240 compounds were successfully implemented for the identification of anti-virulence compounds for S. aureus infections. Hit compounds with suppressive effects on multiple virulence gene promoters were identified and mammalian cell-based infection assays and a mice in vivo infection model showed the potential of applying antivirulence compounds in treating S. aureus and other bacterial infections. Disclosure of Interest None Declared. I3 Constructional/structural infection control strategy - architectural analysis, rating and solution strategy to control infectious pathways in building systems Jan Holzhausen, Wolfgang Sunder IIKE, TU Braunschweig, Braunschweig, Germany Correspondence: Jan Holzhausen Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):I3 Introduction: In order to achieve a significant improvement in the fight against infection, innovations must be generated across scientific boundaries. This development of new anti-infective strategies can only be achieved through a highly transdisciplinary approach. Objectives: In the context of this "one-health-concept" [1] and the holistic approach to infection prevention [2], the study deals with the understanding of direct and indirect infection transmission in the interplay of process, actor (person, vector, etc.), space or architecture and the influence of these parameters towards optimized conditions for structural infection prevention. Methods: The classical medical aspects of the epidemiology are extended by the procedural and spatial references in the sentence to the built environment (architecture/infrastructure). The work crystallizes through this procedure the neuralgic parameters in the building infrastructure, which must be considered for structural infection prevention. After analyzing the structural parameters in relation to the chain of infection and assessing the relevance of the infection disease and its localization, the work on this study records the requirements placed on the structural components and their influencing processes within the scope of the infection prevention. These requirements can be defined by criteria. Results: In order to establish these criteria in a structured manner and thus to establish a holistic strategy in the highly complex field of infection prevention across all types of buildings, the present work develops a classification model for the prevention of structural infectious diseases as an entry into a prevention strategy. Conclusion: The development of a solution strategy with the aid of a classification model could support the work of the planners/architects under the aspect of infection prevention and thus make the corresponding buildings more secure. Introduction To improve awareness and understanding of antimicrobial resistance, direct experiment with serious games offers an interesting complement to communication programs. Games help sensitizing the public by simulating the population dynamics of microbial resistance. However, modeling its evolutionary dynamics is much more difficult as it requires to model the interaction between genomic, phenotypic and population levels. Yet, such multi-scale models are mandatory to efficiently train health professionals. Objectives We propose a new approach to develop serious games by using In Silico Experimental Evolution (ISEE) as a game engine. ISEE is a recent research field in which simulated bugs evolve in silico through the joint pressure of both a mutation and a selection model. It enables to conduct large-scale simulation experiments to decipher the intertwined pressures that drive evolution. Methods Aevol (see www.aevol.fr and references therein) is an ISEE platform that models bacteria at the genomic level and includes an explicit mutational process. In Aevol, the bacterial phenotype is modeled by a mathematical function, thus allowing to simulate efficiently the evolution of large populations over thousands of generations. ISEEResistance uses Aevol as the engine of a serious game devoted to teach antibiotic resistance to healthcare providers. We divided the phenotypic function into a set of “core” and “resistance” traits. By submitting bacterial populations to different antibiotic dosages, one can observe the emergence of resistance traits through mutations and their spreading in the population owing to the selection pressure caused by the antibiotic treatment. One can then analyze the causes of resistance fixation and the effect of treatment strategies on the fate of the infection. Results First experiments have shown the ability of the game engine to finely follow the dynamics of antibiotic resistance emergence and spreading under e.g., inappropriate dosage or discontinued drug usage. Conclusion Our aim is now to turn the ISEE-Resistance core engine into a full game by developing a user-friendly interface and by offering various scenarii mimicking real situations. We then wish to provide it as an e-learning tool in faculties of medicine and sciences. Disclosure of Interest None Declared. Introduction Healthcare-associated infections (HAI) caused by antibiotic-resistant pathogens are linked with high-levels of morbidity and mortality. To prevent and control antibiotic-resistant HAI, strategies based on surveillance/monitoring systems are imperative, especially if they are well-matched with the local social-cultural background. Objectives To decrease antimicrobial-resistant HAI an antibiotic-prescription decision-supporting-system (HAITool) was co-designed to reduce antibiotic misuse and HAI. Methods Three public hospitals participate in the research, following the Design Science Research Methodology: (i) problem identification; (ii) solution definition by eliciting an Antibiotic Stewardship information system (IS); (iii) design, collaboratively with healthcare workers (aligning working processes), a toolkit that assist physicians and infection control team to manage antibiotic use and antibiotic-resistant HAI; (iv) implementation of the toolkit in the hospitals; and (v) toolkit evaluation in the control of antibiotic-resistant HAI. Results To feed the toolkit, patient, microbiology and pharmacy data are extracted, from the current hospitals IS by web services, in real-time. The information is then processed and aggregated in a unique database. A display module allows real-time visualization through innovative graphics presentation: Inform about the accuracy of antibiotic prescription, providing timely and appropriate information related with antibiotics use; monitoring the data about antibiotic use and resistant bacteria. The evaluation of the toolkit, based on a focus group questioner about the toolkit functionalities, revealed that it was considered helpful in monitoring antibiotic use, helping antibiotic prescription, and can be used to improve infection control interventions (e.g. improve communication between professionals). Conclusion This toolkit brings digital innovation to support health professionals’ performance and it is an important step forward for the reduction of antibiotic misuse and in the control and prevention of antibioticresistant HAI, and overall patient safety. Disclosure of Interest L. Lapao Employee of: IHMT-UNL, Grant/Research support from: EEA Grants, A. Simões Employee of: IHMT-UNL, Grant/Research support from: EEA Grants, M. Maia: None Declared, J. Gregório: None Declared, P. Póvoa: None Declared. Abstract video clip: Introduction Standard Precautions (SP) include a group of infection prevention and control (IPC) practices that apply to all patients and are meant to ensure safety for patients, healthcare workers (HCW), and visitors. The HCW knowledge of SP, however, often proves to be scarce. We therefore produced an educational video about SP to improve HCW knowledge at the University Hospital Zurich, Switzerland, and potentially in healthcare institutions worldwide. Since it is well known that emotions help learners to focus and facilitate uptake of information into long-term memory, we chose to use humor as a central feature in this project, making it what is called ‘edutainment’. Methods As safety management in healthcare and aviation are often compared, we decided to produce a ‘mash-up’ between an in-flight safety video and infection prevention instructions. The audience witnesses a cabin crew/infection prevention team member giving instructions to a novice cabin crew member/healthcare worker. Six fundamental topics of SP are covered in the 5’ movie: hand hygiene, use of personal protective equipment, professional appearance, respiratory hygiene, aseptic technique, environmental cleaning, and device disposal and reprocessing. The scenes were set inside an airplane (mock-up at a Swiss aviation crew training facility) with passengers appearing as patients. Fun and surprising moments chase each other throughout the script, including fast wordplay, exaggerations, and slapstick. The film was conceived and executed in a collaboration between ICP professionals and a professional film director and crew including a cast of two actors, 20 extras, a camera operator, a sound technician, a gaffer, a costume designer, a make-up artist, and two production assistants Disclosure of Interest None Declared. I7 integrating patients' experiences, understandings and enactments of infection prevention and control into clinicians’ everyday care: a video-reflexive-ethnographic exploratory intervention Mary Wyer1, Rick Iedema2, Suyin Hor1 1Westmead Institute for Medical Research Research, Sydney, Australia; 2Kings College, London, United Kingdom Correspondence: Mary Wyer Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):I7 Introduction Efforts to promote patient empowerment and involvement have become core components of global and national infection prevention and control initiatives. However, relatively little is known about how frontline healthcare professionals understand, implement or support patient involvement in general, and still less is known about patient involvement in infection control. Objectives This PhD study used video-reflexive ethnography to explore and strengthen clinicians’ awareness of and commitment to patient involvement in infection prevention and control. Methods Hospital inpatients were invited to scrutinise footage of their own clinical care to look for cross-contamination risks. Group reflexive sessions were then conducted with nurses in which footage of everyday patient care interactions were presented alongside patients’ observations of the same events. Results The findings show that patients were actively contributing to IPC in ways that clinicians and researchers were not fully aware of. Some of the strategies were effective and some were counterproductive. Engaging with these contributions enabled the clinicians to appreciate the importance of discussing cross-contamination risks and risk containment behaviours with patients. Conclusion The study enabled clinicians to understand how the quality of their patient-provider relationships and IPC conversations shaped patients’ attention and precautions around infection risks and behaviours and motivated clinicians to develop strategies to promote greater patient involvement. Disclosure of Interest None Declared. Introduction Hospital-acquired infections are still a major patient safety problem. Their occurrence can lead to higher morbidity and mortality rates, increased length of stay and higher costs for both hospital and patients. Performing hand hygiene (HH) is a simple and inexpensive prevention measure, but healthcare workers’ compliance with it is often far from ideal. Objectives To raise awareness regarding HH compliance, individual behaviour change and performance optimization, we aimed to develop an Internet-of-Things (IoT) solution that collects data and provides realtime feedback accurately in an engaging way. Methods A Design Science Research Methodology (DSRM) was used in this research. DSRM is useful to study the link between research and professional practices by designing, implementing and evaluating systems that address a specific need. It follows a development cycle composed by six activities. Two work iterations were performed applying gamification components, each using a different indoor location technology. Preliminary experiments, simulations and field studies were performed in an Intensive Care Unit (ICU) of a Portuguese tertiary hospital. Nurses working on this ICU were engage during the research, participating in several sessions across the implementation process. Results Nurses enjoyed the concept and considered that it allows for a unique opportunity to receive feedback regarding their performance. Tests performed on the indoor location technology applied in the first iteration regarding distances estimation presented an unacceptable lack of accuracy. Using a proximity-based technique, it was possible to identify the sequence of positions but with low precision. In the second work iteration, a different indoor location technology was explored but it did not work properly, showing the limitation of present IoT technology to respond to the ward demands. Conclusion Combining automated monitoring systems with gamification seems to be an innovative and promising approach based on the already achieved results. Involving nurses in the project since the beginning allowed to align the solution with their needs. Despite strong evolution through recent years, IoT technologies are still not ready to be applied in the healthcare setting. Disclosure of Interest L. Lapao Employee of: IHMT-UNL, Grant/Research support from: FCTPortugal, J. Gregório: None Declared, P. Póvoa: None Declared. I9 Withdrawn I10 How we talk about hand hygiene matters – an exploration of hand hygiene etymology Claire Kilpatrick, Jules Storr S3 Global, London, United Kingdom Correspondence: Claire Kilpatrick Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):I10 Introduction Numerous studies have focused on health care workers’ perceptions of hand hygiene but few have addressed the etymology of hand hygiene and its influence. Words influence behaviour. The increasing use of social marketing in infection prevention is testament to the value of words in campaigning for change. However, an exploration of the use of words related to hand hygiene improvement and the World Health Organisation’s (WHO) recommendations has until now received scant attention. Compliance with hand hygiene remains sub-optimal across the globe and novel approaches for behavioural impact have the potential to offer valuable adjuncts to current strategies. Objectives To describe the feelings evoked by five words commonly used in a hand hygiene context. Methods An exploratory exercise assessed the feelings evoked by five words commonly used in a hand hygiene context. A classic psychology experiment was used to evoke an instant, emotional reaction. From June 2013 to May 2014, a total of 23 face to face exercises were undertaken in seven different countries. This convenience sample totaled 2100 people consisting of nurses, doctors, senior management and a diverse range of other health workers and managers. The words tested were alcohol based handrub, compliance, monitoring, moment and system. Qualitative analysis of the findings was undertaken. Results Responses i.e. the words captured, were categorized as “warm” and “cold”. During the exercises 240 words representing alcohol based handrub were collected, 510 representing compliance, 402 representing monitoring, 480 representing moment and 200 representing system. Compliance in particular evoked negative feelings, with ‘cold words’ being described on hearing this word. The word moment evoked the most positive reactions (‘warm words’). Conclusion WHO guidelines state that clear and uniform language in hand hygiene matters. Social marketing falls into the fourth component of the WHO multimodal strategy, described as “reminders in the workplace”. This novel exercise has potential to stimulate the infection prevention (and academic) community to revisit the words it uses within policies/guidelines and day-to-day communications in their quest to bring about the socially desired change [hand hygiene at the right time] as a part of a multimodal approach. Disclosure of Interest C. Kilpatrick Consultant for: GOJO Industries, J. Storr Consultant for: GOJO Industries. Introduction In 2005, the World Health Organization (WHO) launched "Clean Care is Safer Care" program to promote hand hygiene (HH) worldwide. In addition, since 2009, the “Save Lives: Clean Your Hands” global campaign calls health care workers (HCWs) to actively engage with HH every 5th of May. This global Hand Hygiene Day is also a moment to promote awareness on the prevention of health care-associated infections (HAI) to policy makers, stakeholders, patients and the general public. Objectives We aimed to evaluate for the first time the impact of the 5th of May campaign on the press. Methods We used the Nexis database to identify English-language press articles containing at least one of 9 keywords related to HH. We analysed the number and the evolution of HH related articles published on the 5th of May every year from 2005 to 2016. In those years, we have additionally compared the number of HH articles published in 5th of February, 5th of May and 5th of November to ascertain the impact of the global HH Day. The keywords chosen had been previously selected and tested in the Nexis database to assess accuracy of press articles identified. Results In 2009, the first year of the global HH Day, the number of articles published on the 5th of May was higher than on any other year (2005:115, 2007:54, 2009:419, 2012:78, 2014:159, 2016:253). The total number of articles relating to HH on the 5th of May in press has more than doubled in 12 years. Additionally, after 2009, we found that there was a tendency to have more articles about the theme of HH published on the 5th of May than on the 5th of February or 5th November. Conclusion The highest number of HH related articles was attained in 2009 and this number has never been repeated after. Furthermore, from 2009, there has been more often HH related articles in the press on 5th of May than on other days of the year. Even if it remains difficult to prove causality, it is very probable that the “Save Lives: Clean Your Hands” global campaign celebrated every 5th of May since 2009 has a significant impact on the number of articles in the press related to HH. Disclosure of Interest None Declared. Introduction Since 2005 the World Health Organization (WHO) "Clean Care is Safer Care" program has been promoting hand hygiene (HH) worldwide. There has been an increase use of social networks, Twitter in particular, to disseminate health care messages, but little is known about its actors and networks. Objectives We aimed to identify who were the main communicators of information about HH in Twitter and explored their connections and use of Twitter. Methods Between 9th Jan and 5th Feb 2017, we used Twitter API (Application Programming Interface) to continuously collect tweets containing 17 previously tested key terms related to HH (words and hashtags). Users who tweeted more than 10 times were identified and categorized according to their sector of activity. Additionally, we analysed the network of these users based on their subscriptions on Twitter by performing follow relationships graph and social networks analysis. Results A total of 14’638 unique tweets were collected from 11’724 Twitter accounts. Of these users, 10’605 (90.5%) tweeted only once during this period and 47 (0.4%) more than 10 times. These 47 users were: healthcare workers (HCWs) (8), companies (13), alcohol-based handrub sellers (14), media (newspaper, magazine) ( 2 ) and others (10). Based on the follow relationships graph, our results showed that a user belonging to the HCWs category receives more Twitter subscriptions, is more retweeted and is more mentioned in tweets than users from other categories. Furthermore, social networks analysis indicated that these 47 accounts used more Twitter to disseminate information on HH (low information centralization in the network:5.42%) than to grow their network (low connectivity between users:5.4%). Conclusion Our results show that Twitter is actively used by several actors to disseminate HH information. We found that although HCWs are relatively few among those who use Twitter the most, they are the ones who generate more engagement, making them probably the ideal ambassadors to promote HH on Twitter. An important step to improve the use of Twitter as a tool to promote HH would be to urge the different stakeholders to connect between each other and create a community. Disclosure of Interest None Declared. Introduction Due to the unstoppable spread of the media, patients receive information about their health not only form health care facilities but also from the TV by commercials, talkshows, documentary films, even series and movies. It is well proven that these audiovisual tools have great impact on people’s behaviour and opinion. Furthermore they hold the unique possibility of reaching out and educating the people not involved directly in healthcare or maybe even a whole nation without them knowing about it. Objectives The aim of this study was to reveal the infection control scenes in non-healthcare-themed movies. Methods Randomized data were gathered from a reliable internet movie database. The samples (87 movies) were non-healthcare-themed movies released from 1984 to 2016. The exclusion criteria were the absence of infection control scenes. Results 13 movies (containing 19 infection control scene) met the criteria and were involved in the study. The samples could be divided into 4 main groups based on their main infection control themes: hand hygiene (9 scenes), infection control in general (4 scenes), surface disinfection and sterilization (3 scenes), hospital hygiene for laypeople (3 scenes). It is worth noting that movies released after 2005 presented more likely infection control scenes. Conclusion In conclusion, this novel study shed new light on infection control, because 15% of the samples indicated infection control as an intuitive action, a model to follow or a precaution and raising awareness with it. It seems that worldwide hand hygiene campaigns and infection prevention programs excercised influence also on the movie industry, because movie directors are presenting this topic in comedies, romantic and action movies. These movies are excellent examples for the importance of patient education at a base level while hopefully leading to more educated patients having better compliance thus more effective patient safety can be accomplished. Disclosure of Interest None Declared. ORAL PRESENTATIONS Environment, cleaning and Clostridium difficile O1 Risk of nosocomial clostridium difficile infection following exposure to antimicrobial agents Michael Rubin1,2, Vanessa Stevens1,2, Molly Leecaster1,2, Jian Ying2, Tao He1,2, Brian Sauer1,2 1VA Salt Lake IDEAS Center, Department of Veterans Affairs; 2Internal Medicine, University of Utah, Salt Lake City, United States Correspondence: Michael Rubin Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O1 Introduction Clostridium difficile infection (CDI) is one of the most common nosocomial infections worldwide. While exposure to antibiotics is the most important risk factor for CDI, the magnitude of the risk from different antibiotics has not been well quantified through big data analysis of large healthcare systems. Objectives Estimate the risk of nosocomial CDI (nCDI) from exposure to different antibiotic classes using nationwide data from all US Veterans Affairs (VA) hospitals. Methods We used a historical cohort of patients admitted to acute care wards of all US VA hospitals between 1/1/08 and 12/31/13. CDI was defined according to the US Centers for Disease Control laboratory-identified (LabID) event definition. nCDI was defined as a first positive LabID event occurring >72 h after admission, occurring on the collection date of the positive test. Patient-level characteristics were collected for each hospitalization and for one year prior to admission. Patients with a history of CDI within 56d of admission were excluded. Antimicrobials were grouped according to suspected CDI risk (high, medium, or neutral) based on literature and expert opinion. Each patient day was categorized as Pre-, On, or Post-treatment according to exposure to the three groups. Days following CDI diagnosis were excluded. Survival analysis was performed using exposure category defined above as a time-varying covariate to assess the risk of CDI by antimicrobial group. Results A total of 1,138,822 first admissions covering 6,521,327 patient-days were included, with 3,760 first episodes of nCDI. Relative to days without antimicrobial exposure, the hazard ratio for developing nCDI was 2.11 while on high-risk (p < 0.001), 1.66 while on medium-risk (p < 0.001), and 0.72 while on neutral antimicrobials (p = 0.01). In the post-treatment period, the hazard ratios were 1.98 (p < 0.001), 2.63 (p < 0.001), and 0.89 for high-, medium-, and neutral-risk antimicrobials, respectively. Conclusion This big data analysis from a single, large healthcare system has helped to better quantify the risk of nCDI during and after receiving different categories of antimicrobials. Further work will assess the risk associated with individual antimicrobial classes. Disclosure of Interest None Declared. Introduction The efficacy of dry-mist hydrogen peroxide decontamination has been determined in various healthcare settings. Objectives The aim of this work is to evaluate the clinical impact of implementing hydrogen peroxide and silver cations micro-nebulization disinfection of rooms vacated by patients with Clostridium difficile infection (CDI). Methods The levels of CDI incidence in the wards of ASST of Lodi, (Italy) were monitored for three 12-month periods between 2014 and 2016. In 2015, a decontamination system based on a solution of 5-8% hydrogen peroxide and 60 ppm active silver ions (HyperDRYMist®, 99Technologies) was added as the sole additional hygiene and prophylaxis measure after room change at patient’s dismissal of all CDI’s affected individuals. A ‘breakpoint’ time series analysis model was used to detect any significant changes in the monthly CDI rate per 1000 patient-days. Results In total, 160 patient rooms previously occupied by infected/colonised patients were disinfected in 2015 and 135 patient rooms in 2016. The compliance to the procedure of disinfection was around 80% in 2015 and 95% in 2016. The CDI rate decreased from 1.73 cases per 1000 patient-days in the 12 months before HDM® usage to 1.32 compared with the first 12 months of HDM® usage and to 0.93 compared with the second 12 months of HDM® usage (60% reduction). The breakpoint model identified significant changes in the CDI rate. The first occurred in August 2014, with 95% confidence intervals around this breakpoint spanning the spring and summer months, suggesting that this first breakpoint is explained by seasonal variation. The second breakpoint occurred in March 2016, which was when HDM® disinfection procedure was fully implemented. The hypotesis that is second breakpoint is likely to be explained by the introduction of HDM® disinfection is also supported by the fact that data on hand hygiene performance and data on defined daily doses (DDD) of cephalosporins, fluoroquinolones and proton pump inhibitors didn’t change during the period of observation. Conclusion Our data indicate that the hydrogen peroxide and active silver ions disinfection system, should be considered to augment the terminal disinfection of rooms vacated by patients with CDI. Disclosure of Interest None Declared. O3 Improving real world evidence around hospital cleaning – the role of a pragmatic, implementation focussed trial Lisa Hall, on behalf of the Researching Effective Approaches to Cleaning in Hospitals (REACH) Study team Queensland University of Technology, Brisbane, Australia Correspondence: Lisa Hall Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O3 Introduction A clean hospital environment plays a vital role in reducing healthcare associated infections. However strong evidence, using well designed studies is limited. Most studies have focussed on a single intervention or product, and have failed to take into account contextual issues that may influence feasibility and sustainability in hospital settings. Data on cost-effectiveness is also lacking. A challenge for researchers in this area is how to maintain study validity and integrity, whilst allowing for flexibility in implementation. Objectives To evaluate the effectiveness and cost-effectiveness of an evidencebased environmental cleaning bundle implemented in 11 different hospitals nationally, in Australia. Methods Using a randomised stepped wedge design, and an implementation science framework we systematically examined and documented existing practices and contextual factors at each trial hospital. We used this information to identify gaps and strengths in relation to the bundle components, organisational culture and readiness for change. This then informed the development of responsive implementation plans for each site. Results Improving hospital cleaning was complex. Existing cleaning practices were diverse, as were the policy, contracts, staffing and governance arrangements. Considerable effort had to be put into a developing a bespoke strategy for each site that allowed for optimal implementation, so that hospitals could transition effectively to the ‘best practice’ bundle. The trial design allowed researchers to stagger the intervention, and for hospitals to act as their own controls in the effectiveness analysis. Combining this with high quality economic analysis will allow us to evaluate value for money in different scenarios. Conclusion We need better quality research in infection prevention, moving beyond effectiveness to also consider context, feasibility, sustainability and cost. Pragmatic trials combining the best of epidemiology, implementation science and economic methods are an innovative approach, providing a unique insight into what works, how it works, and how much it costs, in a variety of real world settings. Disclosure of Interest None Declared. Introduction Antimicrobial resistance has become an urgent global health priority. Basic hygiene practices and cleaning and disinfection of the hospital environment are key area in preventing pathogen cross-transmission. The ISC Infection Prevention and Control Working Group, represents professionals from 50 different countries. Objectives To assess adequacy of cleaning and disinfection practices in healthcare settings globally an electronic survey was developed. Methods The survey comprised of 30 multiple-choice questions. Data was collected from July 2016 to December 2016. Results A total of 110 healthcare professionals, representing 23 countries (33% Europe, 17% Australia, 28% Asia, 18% North America, 3% South America, 1% Africa) participated in the survey. Of respondents, 96% have a written cleaning policy for clinical areas and 82% for shared clinical equipment. Training of staff occurs in 70% of the facilities at employment, 46% receive yearly training, 15% twice yearly, and 20% sporadic training. Worldwide, microfiber cloths and mops are the most common method of delivery for routine cleaning (65%), followed by the cotton cloths and mops (29%). Enhanced cleaning and/or disinfection practices while patients under contact precautions (eg. MDRO) vary; no extra cleaning (15%), extra cleaning in outbreaks (31%), more frequently cleaning (19%), disinfection added to regular cleaning (9%), extra cleaning and disinfection (26%). Halogens (82%) are the most commonly used routine disinfectants, QATs and alcohols in 33%. Most of respondents rely only on visual daily monitoring for the assessment of cleaning (47%). Further survey results will be presented. Conclusion The survey enabled assessment and recognition of widely differing global practices in approaches to environmental cleaning and disinfection. Development of guideline recommendations for cleaning and disinfection could improve practices and set minimum standards. Disclosure of Interest None Declared. Introduction Pathogens can survive on dry hospital environmental surfaces for extended periods especially when incorporated into dry surface biofilms. Bacteria in biofilms are protected from desiccation and have increased tolerance to removal by cleaning agents and disinfectants. We have shown that bare hands can transmit biofilm bacteria from surface to surface and hence could play a significant role in healthcare associated infections (HAI). Objectives To determine the effect of glove composition on the transfer rate of Staphylococcus aureus from biofilm. Methods S. aureus biofilm was grown in vitro on polycarbonate coupons in the CDC bioreactor, using our validated methods of with periodic nutrition interspersed with long periods of dehydration, over a period of 12 days. Each coupon had approximately 107 bacterial cells. Transmission was tested by touching coupons, with either nitrile, latex or surgical gloved hands, and then pressing the finger and thumb onto the sterile horse blood agar (HBA) surface up to 19 consecutive times. The number of colony forming units (CFU) were recorded for each touch after incubating HBA plates at 37 °C for 48 hours. The experiment was repeated following coupon treatment with 5% neutral detergent for 5 seconds. Results Bacterial cells were readily transmitted via all three types of gloves, commonly used by healthcare workers (HCWs). Although less than 1% of the biofilm was transferred, S. aureus was transferred in sufficient numbers to cause infection, to 19 surfaces from touching the biofilm once. Six times more bacteria were transferred by nitrile and surgical gloves when compared to latex gloves (P < 0.001). Wetting the biofilm with 5% neutral detergent increased the transmission rate of bacteria by seven-fold (P < 0.01). Conclusion Despite bacteria being incorporated into environmental biofilm and covered by exopolymeric substances (EPS or slime), bacteria are readily transferred by HCW’s gloved hands and this confirms the possibility that biofilm contributes towards patient colonization with pathogens and development of HAI. Disclosure of Interest None Declared Introduction An investigation was initiated at the American University of Beirut Medical Center following the FDA safety communication report about the contamination of heater cooler devices (HCDs) associated with NTM infections. Mycobacterium chimaera and other NTM species were reported internationally. Objectives To assess the effectiveness of cleaning and disinfection methods of HCDs and to retrospectively evaluate infections in patients who underwent cardiac surgery. Methods Bacterial and mycobacterial cultures were taken on January 26, 2017, from 2 HCDs (Terumo-A and Terumo-B) manufactured by Terumo and from a newly purchased HCD (Maquet-C) made by Maquet. Cultures were obtained following regular cleaning and disinfection and included the parts of the devices that are difficult for the disinfectant to penetrate such as: water tanks, filters, tubing and air outflow surface. The water source was also cultured. Results After 6 weeks of incubation, NTM was isolated from Terumo-B only. Terumo-A results were negative; speciation of the bacterial NTM culture was conducted using 16S rRNA sequencing test that identified a Mycobacterium simiae. The device was immediately removed from service. The method of cleaning and disinfection was reviewed and modified using sodium hypochlorite at 10% dilution following the visit of the Engineer Clinical Specialist from Terumo. Cultures were repeated and results of Terumo-B are negative so far. However, the new Maquet-C grew NTM and the isolate was sent for speciation. Conclusion Clinicians at AUBMC were alerted of the risk of NTM infections in patients who underwent cardiac surgeries and to consider it as a potential cause of unexplained chronic infection when encountered. A new procedure for cleaning and disinfection of HCDs was introduced with an ongoing schedule for cultures. Of note, M. simiae is the most commonly isolated NTM species from pulmonary specimen of Lebanese patients. Investigation is underway to retrospectively evaluate NTM recovered from patients who developed chronic pulmonary infections post cardiac surgery over the last 3 years. Disclosure of Interest None Declared Antibiotic use, stewardship and cost of resistance Introduction: Definitive therapy for methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia with beta-lactam antibiotics is associated with improved outcomes. However, patients with betalactam allergies may be treated with less efficacious antibiotics. Objectives: Our objective was to define the prevalence of betalactam allergies in patients with MSSA bacteremia and to determine whether the documentation of a beta-lactam allergy influences clinical outcomes. Methods: A retrospective cohort that included all patients with MSSA bacteremia admitted to the Veterans Health Administration during 2003-2014 was analyzed. Allergic reactions were classified as Type 1 or non-Type 1 using standardized criteria. First-line beta-lactam therapy included anti-staphylococcal penicillins and first generation cephalosporins. Results: There were 17,642 unique episodes of MSSA bacteremia across 115 facilities. The median age was 64 years. An allergy to a beta-lactam was documented in 2,531 (14.4%) patients. Based on the allergy's description, 746 (29.5%) cases had a potential Type 1 reaction. Type 1 reactions were associated with penicillins and cephalosporins in 93% and 7%, respectively. Patients with any beta-lactam allergy or a Type 1 allergy were less likely than non-allergic patients to receive first-line beta-lactam therapy prior to discharge (any allergy vs. no allergy: 33.3 vs. 55.2%, p < 0.01 and Type 1 vs. non-Type 1: 30.7 vs. 53.0%, p < 0.01). The 30-day all-cause mortality rate for MSSA bacteremia was 17.5%.On univariate analysis, neither the documentation of any betalactam allergy or a Type 1 reaction was associated with 30-day mortality (OR 0.99, 95% CI 0.88-1.10 and OR 0.84, 95% CI 0.69-1.03, respectively). Conclusion: Beta-lactam allergies were commonly documented in patients with MSSA bacteremia, but less than a third of allergies were potential Type 1 reactions. The documentation of a beta-lactam allergy was not associated with increased mortality at 30 days even though allergic patients were less likely to receive optimal antibiotic therapy. Further analyses will adjust for potential confounders of the association between documented allergy and outcomes. Disclosure of Interest None Declared. Introduction: Both appropriate and inappropriate antibiotic use can be affected by patient-related factors. Objectives: To perform a systematic review assessing patient-related factors potentially influencing antibiotic use. Methods: Studies published in MEDLINE until 30/09/2015 were identified using combinations of terms for concepts “barriers/facilitators”, “antibiotics” and “patients”. Qualitative studies reporting determinants of antibiotic use from the patient’s perspective and quantitative studies reporting factors associated with antibiotic use practices were included. Factors were categorized as “barriers” (B) (eg. factors associated with a higher likelihood of self-medication) or “facilitators” (F) (eg. factors associated with higher compliance to the prescribed treatment) of responsible antibiotic use. Results: 87 studies met inclusion criteria (12 qualitative and 75 quantitative studies) We identified 7 categories of patient-related factors: · Demographic and socio/economic factors (eg. age (B/F depending on the study); B > F; meaning that in this category barriers > facilitators). · Patient-doctor interactions (eg. counseling (receiving counseling F); F > B). · Characteristics of the received regimen (eg. administration frequency (multiple daily doses B); B > F). · Attitudes (eg. expecting antibiotics (demanding antibiotics B); B > F). · Access to treatment (eg. patients' direct costs (lower costs F); B > F). · Characteristics of the condition for which the antibiotic was prescribed (eg. duration of symptoms (longer duration B); B > F). · Knowledge (eg. regarding antibiotic indication (greater knowledge F); B > F). Results of this study will also be presented at ECCMID 2017. Conclusion: A large variety of patient-related factors impact antibiotic use. It’s noteworthy that we identified many more barriers than facilitators. Further studies should try to better understand patient’s views and experiences in order to facilitate responsible antibiotic use. References DRIVE-AB is supported by IMI/EU and EFPIA. Disclosure of Interest None Declared. Introduction: Abuse of antibiotics through self-treatment is of public health concern, and is mainly due to easy assess to antibiotics and lack of regulatory control of their sales and prescriptions in communities. Objectives: A study was conducted to evaluate the prevalence of self medication with five broad spectrum antibiotics among non health workers living in rural communities in Kano, the second most populous state in Nigeria. Methods: A cross-sectional survey of 300 randomly selected adult villagers (150 males and 150 females) at ten randomly selected locations of 5 local governments in the state from August to September, 2016 was conducted with self-administered questionnaire and interview. Questions pertaining to 5 commonly self medicated antibiotics (ampiclox, amoxillin, co-trimoxazole, metronidazole and tetracycline), their usage patterns, how to purchase them and reasons for their selection were included. Results: A total of 211 (70.3%) out of the 300 respondents which are between the ages of 20-40 had experienced self-medication with at least one of the antibiotics before. The most self-medicated antibiotic is ampiclox followed by tetracycline, amoxicillin, co-trimoxazole and metronidazole. Over fifty percent of the respondents (166, 55.3%) purchased substandard antibiotics which cost between $0.1-0.5 per dose from non health care workers selling drugs in their communities. While only 29 respondents (11 males and 18 females) ever completed the dosage of the self medicated antibiotics, about 22% took the antibiotics for 2 days and 41% took only 1 dose. A total of 154 (51.3%) self used tetracycline and metronidazole for treating diarrhoea, while 30.6% and 62% used ampiclox and amoxicillin to treat undiagnosed urinary tract infections and typhoid fever respectively. Only 33% self treat themselves with antibiotics previously prescribed by health care worker but majority used them as a result of family and friends recommendation. Surprisingly, only 19 out of 300 believed that self medication is a problem, but majority (168) have contrary believe and 35 have no idea. Conclusion: Antibiotic self medication is on increase in rural communities, the need to develop a viable antibiotic stewardship programs in rural areas is highly stressed. Disclosure of Interest None Declared O10 The impact of antibiotic stewardship programs in Asia: a systematic review and meta-analysis Chun Fan Lee, Benjamin J. Cowling1, Shuo Feng1, Hanae Aso1, Peng Wu1, Keiji Fukuda1, Wing Hong Seto1 School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong Correspondence: Chun Fan Lee Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O10 Introduction: The use of antimicrobial stewardship programs (ASPs) is increasing in Asia but their effectiveness in reducing the consumption of antibiotics and their impact on clinical outcomes is not known. Objectives: To review published data on the consumption of antibiotics and the impact on clinical outcomes of ASPs conducted in Asia. Methods: We conducted a systematic search in the Embase and Medline (PubMed) databases for studies that compared the consumption of antibiotics or clinical outcomes of patients in an Asian hospital or clinic with an ASP (intervention group) with those in a similar setting without an ASP (control group). Meta-analyses of all-cause mortality and hospitalacquired infection (HAI) were performed using random-effects models. Results: The search identified 77 studies of which 22 and 19 reported on antibiotic usage and cost, respectively. Among these, 20 (91%) studies reported reduced antibiotic usage and 19 (100%) reported cost savings in the intervention group compared to the control. Duration of antibiotic therapy was reported in 7 studies; all but one reported that duration was reduced in association with an ASP. In the meta-analyses, rates of all-cause mortality and HAI were not significantly different between the intervention and control groups, but mortality rates were significantly improved by ASPs using drug monitoring, while HAI rates were also improved by ASPs that included infection control or hand hygiene programs. Conclusion: ASPs reduce the consumption of antibiotics in hospital and clinic settings and are not associated with worse clinical outcomes. The findings support the broad implementation of antimicrobial stewardship interventions conducted in hospital and clinic setting in Asia. Disclosure of Interest None Declared. O11 National prevalence study of healthcare associated infections and antibiotic use in nursing homes (France 2016) Anne Savey1,2, Anais Machut2, Gaetan Gavazzi3, Yann Lestrat4, Anne Berger-Carbonne4 on behalf of RAISIN working group 1CIRI /UCBL1; 2CClin Sud-Est, Lyon; 3CHU, Grenoble, 4Sante Publique France, Paris, France Correspondence: Anne Savey Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O11 Introduction The first national point prevalence study (PPS) of Healthcare-associated infections (HAI) and antibiotic use (AB) was conducted in French nursing homes (NH). Objectives 1) describe & measure prevalence of HAI and AB use 2) raise awareness of HCW and prescribers 3) identify & prioritize needs for intervention, training or additional resources. Methods PPS was proposed to a sample of 719 NH selected at random among 7,387 French NH. Data were collected on a single day in May-June 2016 concerning: NH organization and resources, HAI and systemic AB among residents. We focused on urinary tract inf./UTI including germs and resistance pattern, C. difficile inf./CDI, pneumonia/PNE, low respiratory tract inf./LRTI, influenza/FLU, skin & soft tissue inf. /SSTI, wound & pressure sores inf./WPSI, scabies/ SCA, catheter-related inf./CRI. NH were provided with standardized protocol, training, software for data input/report. National data were analyzed with STATA11; results were weighed according to sampling design. Results Data concerned 367/719 NH (51%) including 28277 residents (sex-ratio 0.36; 63.4% >85 yrs). Exposure to invasive procedures was low: 3.3% catheters (mostly subcutaneous), 1.7% urinary catheters and 0.9% surgery < 30 days. National prevalence rates were 2.9%[CI95 2.57-3.29] residents with HAI (med 2.5, range 0-21.1) or 3.0%[2.65-3.42] HAI, and 2.8%[2.46-3.07] residents with AB (med 2.3, range 0-21.1). Variations were analysed according to NH and resident characteristics. Among HAI, 36.9% were UTI, 24.0% IRB, 11.0% PNE, 20.4% SSTI, 5.6% WPSI, 1.3% CRI and 0.3% SCAB, 0.1% CDI. Only 68.8% of UTI were confirmed microbiologically: E.coli, P.mirabilis and K.pneumoniae were predominant; 26.3% of Enterobacteriaceae strains were resistant to 3rd gen. cephalosporins (3GC) and 13.3% produced EBSL. Concerning AB use, oral administration route was the most frequent (85.1%) followed by subcutaneous (8,3%). A high level of prophylactic use was observed (13.7%). Most frequent AB were 20.9% 3GC, 19.0% penic. A, 16.0% amoxicillin-clavulan., 12.3% macrolides, and 11.4% fluoroquinolones. Conclusion This PPS will provide French NH with reference data and appears effective in monitoring local and national strategies for HAI prevention and AB use. Disclosure of Interest None Declared. Models to better understand infection control measures O12 Recommended classification of clostridium difficile infections overestimates the proportion acquired during current hospitalisation Angus Mclure, Archie C. A. Clements, Martyn Kirk, Kathyrn Glass Research School of Population Health, Australian National University, Canberra, Australia Correspondence: Angus Mclure Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O12 Introduction The Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America recommend that Clostridium difficile infections (CDIs) be classified as healthcare facility associated if the onset of symptoms was more than two days after hospital admission. The incubation period for C. difficile is often much longer than two days, which may result in significant misclassification. Objectives We used a mathematical model to assess the current guidelines for classification of the origin of CDI and identified potential improvements to the method of classification. Methods We simulated C. difficile transmission in a healthcare setting from patient admission through to discharge to determine the time from admission to onset of symptoms for CDIs acquired during the current hospitalisation and CDIs acquired prior to the current hospitalisation. We conducted sensitivity analyses to compare our base scenario with a range of plausible alternative scenarios. Results In our base scenario, the recommended two-day classification had good sensitivity, but poor specificity to identify CDIs acquired in the current hospitalisation, overestimating their incidence by nearly 100%. A six-day cut-off accurately estimated the incidence of CDIs acquired during the current hospitalisation and CDIs acquired prior to the current hospitalisation. In the sensitivity analysis, a two-day cut-off overestimated the incidence of CDIs acquired in the current hospitalisation by 30-350%, with the greatest error in settings with low within-hospital transmission. Conclusion: The recommended two-day cut-off for healthcareacquired CDIs systematically overestimates the proportion of infections acquired in hospital. This may make policymakers overly optimistic about the potential benefits of interventions that only address within-hospital transmission. We recommend that infection control practitioners use a 5-day or longer cut-off to assess acquisition of CDI in healthcare settings. Disclosure of Interest None Declared. Introduction Implementation of effective control measures against nosocomial pathogens is crucial for hospitals but can lead to important disorganization and costs. Evidence is mostly focused on Staphylococcus aureus, while Vancomycin-Resistant Enterococci (VRE) received much less attention, despite a potential high burden. Assessing VRE control strategies at the hospital level is therefore of major importance. Objectives To analyze the impact of several control strategies during a VRE outbreak in a hospital. Methods We analyzed a VRE outbreak which occurred in a French hospital over 2012-2013. Detailed individual data were collected, to gather information about control measures implementation, inter-wards patients’ transfers, VRE colonization and associated costs. We developed a spatially-explicit stochastic individual-based model and used statistical inference to estimate ward-specific transmission rates and simulate the impact of control measures. Different scenarios, including various screening schedules, detection techniques (PCR and cellular culture), hygiene level and cohorting strategies were simulated and compared regarding their impact on the outbreak size and associated costs. Results The outbreak affected 22 patients in 5 different wards. It was controlled after 22 weeks, following at-risk patients cohorting, interruption of admissions in affected wards and transfer to purposely set-up wards. In total, it resulted in a ~230 k€ additional cost and ~820 k€ lost revenues. Estimated transmission rates ranged 0.19-0.49 ind-1.day-1. Assuming no control measures, model simulations predicted an outbreak of 44 colonized patients [43.7,44.9]. Increasing hygiene measures reduced the global incidence in average by a factor 6.5, and lead to VRE eradication after ~7 weeks ( 2,13 ). The best scenario included optimized cohorting procedures and screening strategies (using PCR) resulting in ~10-fold reduction of global incidence. Conclusion Mathematical models are useful tools to design optimal cost effective control strategies. Optimized cohorting of at-risk patients and screening schedule are key to control VRE outbreaks. Disclosure of Interest None Declared. Introduction: Hands transport microorganisms through the environment, contributing to infectious disease transmission. To understand the relative importance of hands in transmission, we typically rely on simplistic models of hand-surface interactions. For example, a constrained sequence of events (e.g., a hand touches the surface, then the hand touches the mouth). Models rarely account for the sporadic and sequential nature of multiple individual contacts between hands and surfaces in the environment. Objectives: The objective of this study is to capture, quantify, and model the impact of sporadic and sequential hand-surface contacts on microbial transmission. Methods: In three countries (South Africa, Tanzania, and Vietnam), we recorded people’s activities using first person videography. Aided with Video Translation Software, we converted videos into time series of contact events for each persons’ hands. Microbial sampling for fecal indicator bacteria on the person’s hands and in their environment was integrated with MLATS to model microbial contamination of hands over time. Results: Almost 50 hours of videography data were collected from more than 35 people: In South Africa, workers were recorded while collecting and processing urine for nutrient recovery. In Tanzania, women were recorded while performing daily activities. In Vietnam, farmers were recorded while collecting and applying human excreta to agricultural fields. Translation demonstrated high frequency of hands contacted surfaces (average (standard deviation) of 270 (66) / hr in South Africa, 290 (75) / hr in Tanzania, and 326 (401) / hr in Vietnam). A subset of participants exposed themselves to microorganisms from hand to mouth contacts, on average (standard deviation) 5( 3 )/ hr in South Africa, 3.6 (1.1) times per hour in Tanzania, and 6(6) / hr in Vietnam. Conclusion: The model provides insight on the importance of rare – but high risk – contact events on hand contamination, and demonstrates stark differences in microbial transport across different settings and activities. Disclosure of Interest None Declared. Device-related infections O15 Peripherally inserted central venous catheters associated bloodstream infections: a systematic review and meta-analysis Jiancong Wang1, Mercedes G. Gasalla2, Walter Zingg1 1Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; 2Infectious diseases dept, Hospital Son Llátzer, Palma de Mallorca, Spain Correspondence: Jiancong Wang Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O15 Introduction: Peripherally inserted central venous catheters (PICCs) are increasingly used for therapeutic purposes in various clinical settings. However, there is a paucity of studies systematically assessing the incidence density of PICC-associated bloodstream infections (PABSI) over time. Objectives: It was the aim of this systematic review to assess the PABSI-incidence in different patient populations and clinical settings. Methods: We searched PubMed, EmBASE, and the Cochrane database between 1 Jan 1987 and 31 July 2016 without language restriction. Any study reporting PABSI incidence density (PABSI per 1000 PICC-days) in an inpatient or outpatient medical setting was eligible. Only baseline results and rates from control groups were included for intervention studies. Results were stratified in adults (hematology, inpatient, and outpatient), children and neonates. Weighted PICC incidence densities were calculated using a randomeffects model. Results: A total of 490 publications were identified, of which 104 were eligible for final analysis. PABSI incidence densities per 1000 PICC-days in the adults, children and neonates were 0.98 (0.84-1.12), 1.82 (1.23-2.41), and 6.11 (5.24-6.97), respectively. Statistical heterogeneity among adults allowed subgroup analyses in hematology/oncology, inpatient, and outpatient where PABSI incidence densities per 1000 PICC-days were 0.58 (0.39-0.77), 1.03 (0.86-1.20), and 0.94 (0.42-1.47), respectively. Conclusion: This is the first systematic review addressing PABSI incidence densities in various patient populations and clinical settings. PABSI incidence density among neonates was significantly higher compared other groups. There was no significant difference between using PICC lines in inpatient and outpatient settings. Although the incidence density in adults is similar to numbers of non-tunneled central-venous lines, there is trend towards lower PABSI incidence densities over time. Disclosure of Interest None Declared. O16 Iintervention strategy consisting of education, bundle checklist, and feedback was insufficient to reduce central line-associated blood stream infection (CLABSI) rates in Korea: 2-year experience in 26 hospitals Pyoeng Gyun Choe1, Myoung Jin Shin2, Kyung Hee Lee3, Eun Jin Kwon4, Moon Hee Hong5, In Young Jeon6, Kyoung-Ho Song1, Eu Suk Kim1, 2, Hee-Chang Jang7, Sun Hee Lee8, Hong Bin Kim1 on behalf of Korean Infectious Disease (KIND) Study Group 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul; 2Infection Control Team, Seoul National University Bundang Hospital, Seongnam; 3Center of Infection Control, Dongsan Medical Center Keimyung University, Daegu; 4Infection Control Service, Chonbuk National University Hosptial, Jeonju; 5Infection Control Team, Yeungnam University Medical Center, Daegu; 6Infection Control Department, Chungnam National University Hospital, Daejeon; 7Department of Infectious Diseases, Chonnam National University Medical School, Gwangju; 8Department of Internal medicine, Pusan National University Hospital, Pusan, Korea, Republic Of Correspondence: Pyoeng Gyun Choe Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O16 Introduction: There are a number of evidences based guidelines for CLABSI prevention, however implementation of these guidelines in real clinical practice is a challenge. Objectives: To evaluate the impact of comprehensive approach to prevent CLABSI in adult ICUs participating in Korean National healthcare-associated Infection Surveillance System (KONIS). Methods: This study was prospective multicenter quasi-experimental study, which was divided in two phases: pre-intervention observation period (Oct 2014 to Feb 2015) and intervention period (Mar 2015 to Dec 2016). In pre-intervention period, we performed surveillance for CLABSI rates and monitoring of compliances with practice guidelines. In intervention period, we had continued surveillance and performed three interventions; ( 1 ) education program for ICU staffs, ( 2 ) application of insertion checklist, ( 3 ) monthly feedback to ICU staffs on CLABSI rates and compliance with practice guidelines. Results: Of 166 ICUs in 94 hospitals participating in KONIS, 58 ICUs of 26 hospitals were enrolled in this study on a voluntary basis. During the study period, 340,792 catheter-days were monitored and 742 CLABSI were occurred. After implementation of intervention, compliance with practice guidelines significantly improved; hand hygiene before insertion (93% to 95%, P = 0.010), use of sterile full body drape (81% to 88%, P < 0.001), skin preparation with > 0.5% chlorhexidine tincture (83% to 91%, P < 0.001). The pooled mean CLABSI rate was 2.1 per 1,000 catheter-days in pre-intervention period and 2.2 per 1,000 catheter-days during intervention (95% confidence interval, 1.8-2.5 versus 2.0-2.4, P = 0.593). Conclusion: Comprehensive implementation strategy using education program, bundle checklist, and feedback was feasible in real clinical practice of Korean ICUs and improved performance standards, but had no further effect on CLABSI rates. To achieve zero tolerance, more aggressive intervention targeting maintenance practice is needed. Disclosure of Interest None Declared. O17 Nurse-driven protocol for urinary catheter removal: 3 questions for easy assessment Bispo S. Ana, Carlos Palos Infection Control Comittee, Hospital Beatriz Ângelo, Loures, Portugal Correspondence: Bispo S. Ana Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O17 Introduction: Hospital Beatriz Ângelo(HBA) is a JCI-accredited, 425bed general hospital. Urinary catheterization(UC), a major drive for Catheter-Associated Urinary Tract Infection(CAUTI), is influenced by nurse’s and physician’s awareness and perceptions, not only by indications. Decreasing inappropriate UC is a challenge for infection control and antibiotics committees(ICAC). Objectives: Reducing inappropriate urinary catheterization with a nurse-driven protocol for urinary catheter removal Methods: In order to reduce inappropriate UC, a nurse-driven protocol(NDP) for urinary catheter removal was implemented, based on OnTheCusp:STOP HAI(APIC, 2012). Adaptations were made in the question whether or not the catheter should be in place as well in the Post Discontinuation Observation Algorithm (no nurse ultrasound). Questions(Q) for NDP were as follows:Q1-Is the catheter in place for at least one of acceptable reasons(pick-list from evidence-based guidelines)?;Q2-Impossibility of urinary condom (male gender)?;Q3-Is this a patient who underwent urologic, gynecologic or general surgery procedure involving urinary tract/had difficult catheterization/had previous false passage? NDP assessment was done in the beginning of every shift. With No answer to all 3Q, nurses proceeded to UC removal. Implementation started successfully on 2014, in 1 surgical wards and 2 medical wards with significantly higher internal rates of CAUTI. In 2016, NDP was generalized to the entire hospital wards(excluding ICU, NICU and OR) and impact of such intervention in terms of device utilization ratio(DUR), mean number of catheterization days per patient (MNCD) and CAUTI incidence rate was evaluated. Results: Comparing to 2015, in 2016 DUR decreased 21%(16.54% vs. 13.07%;statistically significant (ANOVA, f = 0.79,alpha = 0.05)), even if inpatient days increased by 1.42%. MNCD per patient decreased from 5,10 to 4.76.CAUTI increased from 2.93 to 3‰device-days(+2,4%). Conclusion: Introduction of a NDP for UC removal was successful in decreasing both DUR and MNCD per patient. However, it didn’t decreased CAUTI rate, what can be explained by an increased patient severity index, a low CAUTI starting value (2,93‰device-days) as well a worsening problem with Carbapenem-resistant Enterobacteriacea. Implementation of a nurse-driven protocol for urinary catheter removal bypasses lack of awareness and knowledge of nurses and physicians. Disclosure of Interest None Declared. O18 Incidental unmasking of lapses in bronchoscope re-processing by tuberculosis PCR-in a tertiary care hospital in Kolkata, India Debkishore Gupta1, Ajoy K. Sarkar2 1Calcutta Medical Research Institute; 2Peerless Hospital, Kolkata, India Correspondence: Debkishore Gupta Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O18 Introduction: Very low concentration of Rifampicin resistant Mycobacterium tuberculosis was detected by nested Tuberculosis (TB) PCR (GeneXpert MTB/RIF) from bronchoalveolar lavage (BAL) samples from seven patients where there were no clinical suspicions (sent as per department protocol) except the first case who was a known drugresistant TB patient. A single bronchoscope was involved. This molecular diagnosis was also supported by rapid TB culture (BACTEC MGIT) upon extended incubation beyond 12 weeks. Objectives: To identify the source of infection, gaps in standard operating procedures (SOP), especially in the re-processing of bronchoscope. Methods: A retrospective cohort study was conducted. Medical records of all the patients who underwent bronchoscopy were thoroughly checked. Also, all the steps recommended by the manufacturers for reprocessing of semi-critical devices such as bronchoscopes were evaluated by infection control team. Finally, re-processing was done exactly as per the SOP and under the supervision of infection control team. Three wash samples were sent for GeneXpert MTB/RIF and rapid TB culture after the completion of re-processing. Results: Only the first case among the cluster had a history of Rifampicin resistant tuberculosis and the patient was on antitubercular drugs. Other patients did not have any past or present clinical evidence suggestive of active or latent tuberculosis. Following gaps were found in the steps of disinfection process: I) During leakage testing it was observed only for few seconds, not 30 seconds as recommended by the manufacturer. II) Before high level disinfection by orthophthalaldehyde, internal lumens were not washed with alternate suction using water and air. III) Before storage, the channel interiors were not dried by alcohol purging as per recommendation. Post re-processing as per protocol, all three samples came negative. Conclusion: Lapses in re-processing of bronchoscopes can be accurately identified with the help of GeneXpert MTB/RIF and corrective action can be taken in quick time. This study emphasizes the need for establishing a bronchoscope surveillance protocol especially in high TB burden countries to curb the risk of spread by bronchoscopes. Disclosure of Interest None Declared. Introduction: Pneumonia is one of the most common and deadly nosocomial infections among critical patients. Several preventive measures have been pointed as effective by the literature, but scarce evidence is available about how to implement it. Objectives: To investigate the impact of a check list application during clinical rounds on the compliance with preventive measures against ventilator-associated pneumonia. Methods: This was a quasi-experimental study performed in a general Intensive care unit (ICU) of a tertiary-care university hospital, from 2014 to 2016. In the pre-intervention period, compliance with preventive measures was assessed weekly by the ICU medical staff. The intervention consisted of having a nurse and physician from the infection control service evaluating herself the mentioned compliance along with the intensive care team, during clinical rounds. VAP diagnosis was performed based on the Centers for Disease Control and Prevention (CDC) criteria. The intervention period was initiated from January 2015 on. Results: As for the preventive measures the rates after and before intervention were, respectively: 1) semi-recumbent position: 83%/98%; 2) Prevention of thromboembolic disease as indicated: 94%/97%; 3) oral hygiene with chlorhexidine 94%/95%; 4) Prophylaxis of gastrointestinal hemorrhage as indicated: 90%/ 97%. The incidence density of VAP in the years 2014, 2015 and 2016 were respectively 5.65; 3.30 and 2.32 episodes per 1,000 ventilated patients-day. The rate of use of mechanical ventilation was 71.21%; 74.27% and 76.53%. Conclusion: In conclusion, our results suggest that check list application through the nurse and physician from the infection control service along with the intensive care team during clinical rounds on improve the compliance with preventive measures against VAP. Disclosure of Interest None Declared. O20 Simplified selective digestive decontaminatiom may reduce acquired gram negative bacteremia in the ICU Yaron P. Bar-Lavie1, Ahlam Abu Ahmad2 1Critical Care Medicine, Rambam Medical Center, Haifa, Israel; 2Critical Care Medicine, Technion-Israel Institute of Technology, Haifa, Israel Correspondence: Yaron P. Bar-Lavie Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O20 Introduction: Acquired infections are a common problem in intensive care units (ICU). Most of these infections are caused by aerobic gram negative bacteria. In recent years, we saw a rise in the development of multi drug resistant organisms (MDRO). The main reservoir of these bacteria is the digestive tract, therefore Selective Digestive Decontamination (SDD) may reduce infection rate. Objectives: We examined whether Simplified SDD (SSDD) given in 2011-13 to our mechanically ventilated patients lead to a reduction of bacterial infecion in comparison to the 2008-10 patients with no SSDD. Methods: A retrospective-prospective interventional cohort study of two periods: 2008-2010 : 500 ICU control patients, 2011-2013: 427 SSDD protocol patients (enteral Polymyxin E and Neomycin four times daily).Data for 927 patients were included: demographic and clinical characteristics, ICU length of stay, hospital length of stay, blood and lower respiratory tract cultures, ventilator associated pneumonia (VAP), antibiotic use and development of MDRO. SPSS (Version 21) was used for the statistical analysis. A P < 0.05 was considered significant. Results: Patients who received the SSDD protocol were older and with a higher severity of illness. Still, in those who received SSDD we found a 38.8% reduction in clinically significant bacteremia (p < 0.0001), a 6% decline in lower respiratory tract cultures of aerobic gram negative bacteria (p = 0.36), a non significant 7.27% decline in respiratory tract cultures of fungi and gram positive bacteria (p = 0.57), a 9.65% decline of VAP (p = 0.43), a small 2.9% rise in the use of antibiotics (p = 0.16) Patients who received the Simplified SDD protocol had a significant reduction in the incidence of clinically significant bacteremia. The mechanism for this reduction may be caused by less bacterial translocation from gut lumen to blood. A small reduction was found in VAP incidence, and in gram negative lower respiratory tract cultures. There was no rise of bacterial resistance or respiratory tract fungal /gram positive cultures. Conclusion: This study was done in an ICU with a high endemic rate of antibiotic resistance. SSDD may show promise in prevention of gram negative bacteremia in mechanically ventilated patients and should further be explored in prospective randomized, controlled studies. Disclosure of Interest None Declared. Hand hygiene Introduction: The cluster-randomized controlled trial PSYGIENE has shown that psychologically tailored hand hygiene interventions in intensive care units (ICUs) at Hannover Medical School (MHH) led to more sustainable compliance rebounds than the standard German Clean Care is Safer Care-campaign (Aktion Saubere Hände, ASH) [1]. However, unexplained variations in compliance persist. Objectives: To test whether the PSYGIENE-interventions worked equally well on wards with a high vs. low mean pretrial compliance (earlier vs. later adopter-wards). Methods: Interventions targeted 10 ICUs and 2 hematopoietic stem cell transplantation units at MHH. Tailoring was based on the Health Action Process Approach (HAPA). Determinants were assessed among employees via questionnaire (response: physicians: 71%; nurses: 63%) and stakeholders via problem-focused interviews (100%). In the “tailoring”-study arm (6 wards), 29 behaviour change techniques were implemented in training sessions and feedback discussions, while in the control arm, usual ASH-campaign sessions were conducted (all 2013). Outcomes were 2014-15 compliance rates assessed by WHO’s gold-standard. Earlier adopter-wards were defined by a mean 2008-12 compliance of ≥63%. Results: Among earlier adopter-wards, in 2015 those in the “tailoring”arm had a 12% higher compliance than the ASH-arm (75% vs. 63%, p < 0.001). This corresponded to a differential increase from 201315 (“tailoring”: +15%, ASH: +6%, p = 0.003), and similar baseline compliance in 2013 (60% vs. 57%, p = 0.216). Among later adopterwards, neither the difference between study arms in 2015 (“tailoring”: 61%, ASH: 65%, p = 0.135) nor the difference in the increase from 201315 (+12% vs. +11%, p = 0.911) were significant. Conclusion: Early adopter-wards receiving tailored interventions achieved highest levels of and increases in hand hygiene compliance. This points to "Money makes money”-effects in infection prevention, and raises issues of how to reach later adopters more successfully Introduction: Strategies for improving hand hygiene compliance (HHC) are necessary in health care settings. Objectives: We sought to implement and evaluate an innovative interaction design (ID) methodology developed by the Emily Carr Health Design Lab (ECHDL) to remotely monitor and enhance HHC. Methods: Alcohol-based-rub (ABR) dispensers (n = 29) on a 36 bed medical teaching unit were modified to monitor their frequency of use (FoU) and transmit data to local servers over a personal area network. Real-time data visualization developed by ECHDL, presented FoU data to users on the unit as an approach to incentivize HHC. FoU data was collected simultaneously with in-person audits using iScrub Lite (V1.5.1 U of Iowa). Audited compliance and FoU data was modelled through linear regression and before-after comparisons were made using a Student’s ttest. The FoU of ABR dispensers among HCW were analyzed before and after ID (visualizing FoU), with respect to peak and trough trends. Results: FoU predicted a significant proportion of variance in compliance R2 = .37, β =7.51, t(125) = 8.54, p < 0.001. The mean frequency of dispenser use per hour with visualization was higher (M = 5.10, SD = 3.04) than with no visualization (M = 3.55, SD = 2.00), t(22) = 1.72, p ≤ 0.01. The distinct FoU of ABR dispensers among HCW before and after ID revealed consistent peak and trough trends throughout the day. Peaks/troughs at specific hours revealed cyclical patterns. There were also stochastic events such as codes, visitors to a patient and intense care periods. Conclusion: These data indicate ID may improve overall compliance of HH. HCW feedback indicated an increase in motivation for HHC. User feedback provided novel insights into additional uses for this technology, including remotely monitoring ABR dispenser fluid levels and spatial-temporal trends. HCW often volunteered feedback for alternative ways to visualize the data, revealing the potential for the codesign of ID interventions. Open sourcing the hardware and software components could offer a significant social innovation. Disclosure of Interest None Declared. O23 A situation analysis of the world health organization multimodal hand hygiene strategy in African health care facilities Shaheen Mehtar1, Awa Ndir2, Getchachew Belay2, Andre Bulabula3, Yomna Satate3, Angela Dramowski2 on behalf of Infection Control Africa Network (ICAN) hand hygiene working group 1ICAN; 2Stellenbosch University, Tygerberg, South Africa; 3Stellenbosch University, Tygerberg, Switzerland Correspondence: Shaheen Mehtar Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O23 Introduction: Health care associated (HAIs) infections are a major threat to patient safety worldwide, particularly in developing countries. HH compliance with recommendations remains low. Objectives: To assess the effect of WHO strategy for improvement of HH by using the HH self-assessment framework (HHSAF) in 5 ICAN regions. Methods: The HHSAF tool was disseminated to the five regions of ICAN via the regional ICAN representatives. Each representative perform a situation analysis from at least five hospitals in the region and return the information electronically to the coordinator during the 2 weeks of this pilot study. The HHSAF is divided into five components and 27 indicators which reflect the 5 Moments of Hand Hygiene. Based on the score achieved for the five components, the facility is assigned to one of four levels of hand hygiene promotion and practice: Inadequate, basic, intermediate, and advanced. Results: Sixty-two facilities completed the survey, from 12 countries, South Africa, Botswana, Malawi, Sudan, Egypt, Cameroon, Ethiopia, Nigeria, Democratic Republic of Congo, Senegal, Guinea, Cote d’Ivoire. The majority from acute care, whilst others from long term care facilties. There were 66% (41/62) from the state sector and 24% (15/62) private hospitals. The average bed number was 542 (range 227-1384), total staff number ranged from 449- 4000. Infection prevention nurse were employed in 33.8% (21/62) facilities, and 17.7% (11/62) had infection prevention doctors. Only 13% (8/62) had registered for the Save Lives campaign, and only 22.5% (14/62) had participated in a national HH campaign. The highest scores were reported for training and education followed by system change; evaluation, feedback, reminders in the workplace and safety climate performed less well. The overall assessment reflecting the level of HH achieved for advanced and intermediate was 35% and for basic or inadequate was 62.4%. The section on the leadership was only completed by 10 respondents. Conclusion: This ICAN initiative identified that HH activities are taking place in African facilities, however the HH improvement strategy requires further consolidation in terms of leadership and commitment. Disclosure of Interest None Declared. Introduction: Hand hygiene compliance (HHC) is lower in Australian Emergency Departments (EDs) than acute inpatient wards. Objectives: To identify modifiable determinants of HHC in the ED setting. Methods: We performed enhanced hand hygiene (HH) audits in EDs at five hospitals in Melbourne, Australia. Audits were performed by direct observation by trained auditors using the ‘HHA-My 5 Moments’ method. In addition to standard data on healthcare worker (HCW) profession, moment, glove use, and HH action, auditors recorded information about the environment, patient, HCW and care activity. To account for the impact of workload on HHC, we extracted 'ED occupancy' for start time of each audit. We built a mixed-effects logistic regression model to assess predictors of HHC, with audit session and hospital campus as random effects. Results: Twenty-four auditors recorded 1,856 HH moments involving 789 patients during 98 sessions. Overall HHC was 60.1% (95% CI, 57.8–62.3). Alcohol-based handrub was available at the point-of-care for 98% (1813/1856) of moments. Only 1.5% of moments involved a ‘non-cooperative’ patient (28/1856). After adjusting for traditional HH predictors (profession and indication), the regression model suggested that HHC was higher in the afternoon (adjusted odds ratio [aOR], 1.73 [1.23–2.44]; reference, morning); lower during medium and high ED occupancy (medium, 0.73 [95% 0.56-0.96]; high 0.67 [0.52-0.87]) compared with low occupancy; and lower for both hospital staff visiting the ED (0.57 [0.37–0.87]) and temporary staff (0.36 [0.17– 0.75]) compared with hospital ED staff. Hand hygiene compliance was 4.9% (95% CI, 1.4–12.2) among ambulance staff. Anecdotally, patient privacy curtains represented a key barrier to good HH. Conclusion: Understanding the barriers and activities that influence HHC in unique clinical settings is of fundamental importance in supporting improved HH practices. These results should inform the development of improvement strategies that are focused on conditions that currently impede HHC in EDs. Disclosure of Interest None Declared. Introduction: Hand hygiene is critical for prevention of healthcare associated infections. Adherence measurement by direct observation is resource intensive and biased by the Hawthorne effect. Group emonitoring systems require knowing the expected rate of hand hygiene opportunities (HHOs) per patient care hour in each ward/department. This measurement is a challenge in emergency departments (EDs) because of wide variety of care provided. Objectives: We aimed to characterize the type and frequency of HHO’s in the ambulatory care (AC) zones of our ED by following patients throughout their ED visit. Methods: During June and July 2016, patients who triaged to AC were enrolled in our ED waiting room. A hand hygiene observer stayed with consenting patients during their ED visit, and recorded the number of HHOs as defined by Ontario’s 4 Moments for Hand Hygiene ( 1 ). Patient type, age, chief complaint and Canadian Triage and Acuity Scale score (CTAS) were recorded. Results: 27 of 28 patients consented to be observed; 13 patients were at risk of deterioration (CTAS score 2/3) and 14 were less/ non-urgent (CTAS 4/5). Median ED visit duration was 1.3 hr (0.36.1). 201 HHOs occurred in 51 hours of observation; 179 in the ED and 22 in medical imaging. Moments 1 and 4 (before/after contact with patient/environment) comprised 39% and 31% of HHOs respectively; moments 2 and 3 comprised 14% and 16%. 41% of the HHOs involved nurses, 52% physicians/nurse practitioners, 6% medical imaging technologists, and 1% others. The mean HHO/pt hour was 4.3 (95% CI 3.4-5.1); the mean HHO/visit was 6.6 (95% CI 5.2-8.1). Interactions with HHOs occurred at a relatively constant rate over each ED visit, and there was a strong correlation between visit length and number of HHOs (R2 = 0.65, P < .001). Conclusion: HHO rates in AC in our ED are somewhat lower than those in major care areas ( 2 ). Physicians contribute a relatively high proportion of HHOs. These data will assist in defining expected rates of HHOs for our ED to enable e-monitoring of adherence. Introduction: Good hand hygiene (HH) practice is crucial to reducing healthcare associated infections (HAIs). Use of alcohol-based hand rub (ABHR) is strongly recommended but it is limited in Uganda. Data on HH and HAIs is sparse in resource-limited settings. Objectives: 1. To assess the baseline HH practice among health care providers (HCPs) and the impact of ABHR and training in its use 2. To determine the incidence of HAIs and the effectiveness of ABHR on the reduction of HAIs Methods: HH compliance among HCPs and the incidence of HAIs were assessed at a teaching hospital in rural Uganda. Inpatients from the obstetrics/gynecology (OB/GYN), pediatric and surgical departments were enrolled on their day of admission and followed up during their hospital stay. The baseline phase of 12-weeks was followed by a 12-week intervention phase where training for HH practice was provided and ABHR was supplied. Incidence of HAIs and or Systemic Inflammatory Response Syndrome (SIRS) was measured and compared between the two phases. Results: A total of 3,335 patients were enrolled into the study. HH compliance rate significantly improved from 9.2% at baseline to 56.4% during the intervention phase (p < 0.001). The incidence of HAIs/SIRS was not significantly changed between the two phases (incidence rate ratio (IRR) 1.07, 95% CI: 0.79–1.44). However, subgroup analyses showed significant reduction in HAIs/SIRS on the pediatric and surgical wards (IRR 0.21 (95% CI: 0.10–0.47) and IRR 0.39 (95% CI: 0.16–0.92), respectively) while a significant increase in HAIs/SIRS was found on the OB/GYN ward (IRR 2.99 (95% CI: 1.92–4.66)). Multivariate survival analysis showed a significant reduction in HAIs with ABHR use on pediatric and surgical departments (adjusted hazard ratio 0.26 (95% CI: 0.15–0.45)). Conclusion: To our knowledge, this study is one of the largest studies that address HAIs in Africa. Significant improvement in HH compliance was observed by providing training and ABHR. The intervention was associated with a significant reduction in HAIs/SIRS on the pediatric and surgical wards. Further research is warranted to identify measures to further prevent HAIs in resource limited settings. Disclosure of Interest None Declared. O27 Hand hygiene with alcohol-based solutions: a note of caution for hand wiping versus hand rubbing Jérôme Ory, Hervé Soule, Marlieke De Kraker, Walter Zingg, Didier Pittet Infection Control Program, University of Geneva Hospitals, Geneva, Switzerland Correspondence: Jérôme Ory Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O27 Introduction: According to the World Health Organization (WHO) and the Centers for Disease Control and Prevention guidelines, hand hygiene with alcohol-based handrub (ABHR) is the gold standard to prevent cross-transmission of microorganisms and subsequent infections in the hospital environment. Some companies have recently developed alcohol-based hand wipes (ABHW) and have brought them to the market. Although ABHW could serve as an alternative to conventional handrub with rinse and gel, no norm exists to evaluate their effectiveness for hand hygiene. Objectives: The objective of this study was to compare the efficacy of hand rubbing and hand wiping to clean hands. Methods: Efficacy tests were performed in accordance with the European Norm 1500. Primary outcome was non-inferiority of hand wiping vs. hand rubbing in reducing bacterial count on hands. Hand wiping was carried out with 2 different homemade wipes: cotton and polypropylene (PP) wipes. Dry PP wipes (DHW) were used as control. Hand rubbing was performed applying WHO technique. The isopropanol 60% (v/v) (3 ml) was used. A Generalized Linear Mixed Model (GLMM) with random intercepts for each participant, taking into account the repeated measures design, was used to assess the log10 reduction for each hand hygiene technique, compared to hand rubbing. Results: Twelve volunteers carried out all 4 tests (ABHR, 2 ABHW, DHW), and 8 volunteers carried out 3 tests (ABHR, 2 ABHWs). Hand rubbing reduced the bacterial count by a mean of 3.57 UFC/ml (95% CI 0.94-6.20), hand wiping with PP wipes by a mean of 2.39 UFC/ml (95% CI 0.95-3.82), hand wiping with cotton wipes by a mean of 2.35 UFC/ml (95% CI 0.76– 3.93), and wiping with dry PP wipes by a mean of 1.92 UFC/ml (95% CI 0.52- 3.33), respectively. The GLMM showed that hand wiping was inferior to hand rubbing, as the difference in log10 reduction was more than 0.6. In a secondary analysis, including only wiping techniques, none gave a significantly larger reduction, including a comparison between ABHW and DHW. Conclusion: This study demonstrates that hand rubbing is more effective than hand wiping to reduce microbacterial burden on hands. The results suggest that a note of caution is justified when using wipes to disinfect hands. ABHWs should not be recommended for hand hygiene neither in hospitals nor in the community. Disclosure of Interest None Declared. Surveillance of healthcare-associated infections Introduction: Healthcare delivery has shifted towards the outpatient setting over the past several years. There is little evidence about healthcare-associated infections (HAIs) in outpatient care. Objectives: To assess the burden of HAI in outpatient care. Methods: A systematic review was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Metaanalyses) guidelines. Studies referring directly or indirectly to HAI or transmission of pathogens in any patient undergoing medical care in an outpatient setting or at home were eligible for analysis. Medline, Embase, the Cochrance database and the outbreak database were searched for reports published between January 1996 to July 2016 without age restriction. Results: Of a total of 7830 identified titles and abstracts, 126 reports fulfilled the inclusion criteria. Twenty reported on surgical site infections (SSIs) in various outpatient settings. The incidence varied between 0.1% and 8.6% with superficial SSIs being higher (1.7% > 8.6%) than other SS types. Bloodstream infection (BSI) was the most commonly reported outcome: 42 in total, with 17 in haemodialysis and 15 on home parenteral nutrition. Vascular access-related BSI ranged from 0.73 to 3.51 per 100 patient months, and 3.90-6.51 per 1000 catheter-days. Catheter-related BSI in home parenteral nutrition varied from 0.05 to 10.0 per 1000 catheter-days. Catheter-related urinary tract infection in homecare ranged from 1.2 to 4.5 per 1000 catheter-days. Hepatitis C seroconversion in haemodialysis varied from 0.0% to 29.4%. A total of 33 outbreaks were identified, of which six in the context of endoscopy and 16 in hemodialysis. Conclusion: The incidence of BSI in haemodialysis is very high, followed by the incidence of catheter-related BSI due to the application of parenteral nutrition in homecare. The incidence of SSIs is comparable to inpatient settings but there is a high incidence of superficial incisional infections in private practices. Worrying numbers of hepatitis C transmissions have been identified for both incidence and outbreak reports. Disclosure of Interest None Declared. O29 Bacteremias surveillance in hospitals and clinics of three cantons of Switzerland: a fifteen year report (2001-2015) Delphine Hequet1, Christiane Petignat1 Unité HPCI, CHUV, Lausanne, Switzerland Correspondence: Delphine Hequet Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O29 Introduction: Bloodstream infections (BSI) are a leading cause of morbidity and mortality in hospitalized patients. Moreover a significant concern is antibiotic resistance among causative agents. Objectives: We report a 15 year surveillance of community and nosocomial bacteremias in hospitals and clinics of three Cantons of Switzerland (VD, NE, JU). Methods: Data were collected by infection control nurses and centralized in a database. We analyzed the data according to 3 distinct periods: 2001-2005, 2006-2010 and 2011-2015. Results: From 2001-2015, we observed 11’788 BSI, 8858 community (75%) and 2930 nosocomial (25%). Community BSI proportion increased over the observation period (respectively 6.8, 8.39 and 10.11/ 1000 admissions). Mean age significantly increased over the years (from 64-69 years, p < 0.001). The proportion of urinary related BSI increased over time from 15.1-25.9% (p < 0.001). However, the proportion linked to a urinary catheter remained stable (from 44.1-47.4, p = 0.69). E.coli is the most common microorganism (36.3% of community and 22.4% of nosocomial BSI). Proportion of Enterococci in nosocomial BSI significantly increased over time (from 6.1-10.4%, p = 0.03). Moreover, the proportion of S.aureus with methicillin resistance (MRSA) significantly decreased over surveillance period from 5.7-2.9% (p = 0.05) in community BSI and from 11.6-7.9% (p = 0.27) in nosocomial BSI. Concomitantly, the proportion of E.coli with extended spectrum beta-lactamase (ESBL) significantly increased among community E.coli BSI, but not in nosocomial BSI (from 1.3-4.5% p < 0.001 and 4.87.0% p = 0.32, respectively). Conclusion: Proportion of community BSI increased over time contributing to risk factors for developing nosocomial infections. Urinary related infections should be a priority target in order to prevent nosocomial BSI. Multidrug resistant bacteria distribution changed gradually, resulting in a significant MRSA decrease and an increase in ESBL E,coli in the community. This tendency, also not significant, is also true in nosocomial BSI and should be taken into account when treating the patient. Concomitantly, a special attention should be made to Enterococci seen the recent vancomycin-resistant Enterococci outbreaks in this part of Switzerland. Disclosure of Interest None Declared. Introduction: The demographics and epidemiology of healthcareassociated infections (HAIs) in Taiwan, South Korea, and Japan are captured by their respective nationwide surveillance system. Objectives: This study aims to describe the temporal trends of HAIs in the intensive care units (ICUs) of Taiwan, South Korea, and Japan from 2008 to 2015, and the causative pathogens in each country. Methods: Incidence density of urinary tract infection (UTI), bloodstream infection (BSI), hospital-acquired pneumonia (HAP), catheterassociated UTI (CAUTI), central line-associated BSI (CLABSI), and ventilator-associated pneumonia (VAP) were calculated. Temporal trends across the eight-year study period were determined using the Poisson regression. Critical causative pathogens for each country were also recorded. Results: Overall, all the three countries revealed significant reduction of HAI during the 2008-2015 period (from 9.34 episodes to 5.03 episodes per 1,000 patient-days in Taiwan; 7.56 to 2.76 in South Korea; 4.41 to 2.74 in Japan; all P < 0.001). The most significant improvement was noted among UTI in South Korea, which experienced an 82% decrease in UTI incidence from 2008 to 2015 (P < 0.001). For causative pathogens of UTI, all three countries revealed similar pattern as Candida albicans and Escherichia coli were the predominant strains. In CLABSI, Acinetobacter baumannii (AB) was the leading pathogen in Taiwan, while Staphylococcus aureus was predominant in South Korea and coagulase-negative staphylococci in Japan. In VAP, Pseudomonas aeruginosa was the leading pathogen in Taiwan, while AB was predominant in South Korea and SA in Japan. Conclusion: This study identified significant decrease of HAI rate across the three countries since 2008. Both similarity and unique features of causative pathogens were noted. Currently there is only comparable data in UTI, CLABSI, and VAP since some countries provided different measurement methods. We suggest establishing an HAI surveillance network in East Asia to better identify the HAI epidemiology and develop targeted infection control policy in this region. Disclosure of Interest None Declared. O31 Comparison of CDC/NHSN surveillance definitions and ECDC criteria in diagnosis of health care associated infections in Serbian ICU patients Olivera Djuric1,2, Ljiljana Markovic-Denic1,2, Bojan Jovanovic2,3, Milena Stopic2, Vesna Bumbasirevic2,3 1Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 3Centre for Anaesthesiology, Clinical Centre of Serbia, Belgrade, Serbia Correspondence: Olivera Djuric Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O31 Introduction: After three national point prevalence studies (PPS) conducted in Serbian acute care hospitals using American (CDC/NHSN) surveillance definitions, Serbia is about to switch to European (ECDC) criteria for the purpose of the fourth PPS. For the better comparability of the results, the impact of using different definitions on the HAI identification is needed. Objectives: To compare American and European criteria for diagnosis of the most common types of HAI in Serbian intensive care unit (ICU). Methods: Prospective surveillance was performed at two surgicaltrauma ICUs of the Emergency department of Clinical center of Serbia during the period from November 2014 to April 2016. Pneumonia (PN), bloodstream infections (BSI), urinary tract infections (UTI) and surgical site infections (SSI) were prospectively diagnosed by experienced clinician and epidemiologist using both types of HAI definitions simultaneously. The level of agreement between two criteria (CDC/NHSN and ECDC) was assessed by Cohen’s kappa statistic (k). Results: Of 406 patients, 111 (27.3%) acquired at least one HAI (total of 134 according to American definitions and 151 HAIs when using European criteria). When considering all PN, agreement was k = 1.00. For microbiologically confirmed PN it was k = 0.99 (95% CI, 0.96-1.01) and for clinically defined k = 0.86 (95% CI, 0.58-1.13). Agreement for BSI was k = 0.79 (CI 95%, 0.70-0.89). When secondary BSI was excluded from the European classification, i.e. cases secondary to another infection site (30.9% of all BSI) concordance was k = 1.00 and when microbiologically confirmed catheter related BSI were reported separately as recommended by latest ECDC protocol update, i.e. those with same pathogen isolated from vascular catheter (20.0% of all BSI), concordance was k = 0.60 (CI 95%, 0.41-0.80). Agreement for UTIs and SSIs was perfect (k = 1.00). Conclusion: Microbiological confirmation of PN should be stimulated and comparison of BSI should be done with emphasis on whether catheter related BSI is included. Disclosure of Interest None Declared. Introduction: A pilot study lead by ECDC was set up to collect additional data on Structure & Process Indicators (SPI) linked with the healthcare-acquired infection (HAI) surveillance in intensive care unit (ICU). Objectives: The aim was to integrate a limited number of SPI chosen for their strong link to prevention of HAI and antimicrobial resistance in ICU, to raise awareness and improve risk management. Methods: An optional module SPI was proposed in 2015 to the 188 ICU participating in the French National surveillance network REA RAISIN, consisting of a self-assessment during 1 to 2 weeks. Five topics were evaluated, combining unit data, direct observation and chart review: 1. Hand hygiene: annual alcohol hand rub consumption (HRC) 2. ICU staffing: nurse to patient ratio (NPR) calculated for 7 days 3. Antimicrobial use: systematic antibiotic treatment review within 3 days after prescription (ATR) 4. Intubation: cuff pressure control (CP), oral decontamination (OD), patient position (POS) 5. CVC: dressing site conformity (CD). Results: 27 ICU participated in SPI module. Distribution of SPI by unit was (median [IQR]): – compliance with ATR 80.0%[70-91.4], CP 85.0%[16-95.7], OD 91.2%[80-100], POS 95.0%[81-100] and CD 90.0%[85.7-100] – HRC: 118.3 L/1000 pat.-days [81.4-132.3] – NPR: 0.43 [0.36-0.72]. A score was calculated for each ICU giving 1 point if compliance ≥ 80% for ATR, CP, POS (OD excluded), HRC ≥ 120 L/1000 pat-day and NPR ≥ 0.4. For the 23 ICU, median and mean score was at 3 points. Only one unit reached 5 and none had zero. There was no correlation between overall compliance and HAI rates. Conclusion: Evaluation of SPI allows a follow-up of key prevention measures. This pilot study demonstrates the feasibility of such an embarked study in the surveillance. The level of conformity is high but heterogeneous (need to understand reasons for non compliance need especially for HRC, ATR and CP). Repeating this study annually with more ICU will allow a better follow-up, and determination of possible process/outcome correlations. Disclosure of Interest None Declared. Introduction: Surgical site infection (SSI) surveillance has been performed in Switzerland since 2011, with open public reporting starting in 2014. Objectives: We aimed to validate structure and process of surveillance data acquisition and the accuracy of outcome detection in participating hospitals. Methods: We performed site visits with on-site structured interviews and review of a random sample of ten patient records (with or without infection) and five additional randomly selected patient records with infection per hospital between November 20, 2011, and October 20, 2015. Process and structure were rated in nine domains and a weighted overall score (maximum 50 points) was calculated. Sensitivity, specificity, positive and negative predictive value were calculated for the surveillance. Results: One hundred and forty-seven hospitals or hospital units were visited, with a median (range) time of participation in the surveillance of 3.4 (0.8-15.8) years and a median (range) score of 35.5 (16.25-48.5) out of 50 points. Domains that contributed most to lower scores were the quality of chart review (weighted mean difference (SD) from maximum score: 3.97 (2.30) points) and the quality of data extraction from patient charts (weighted mean difference (SD) from maximum score: 3.22 (1.64) points). Public hospitals (P < 0.001), hospitals in the Italian speaking part of Switzerland (P = 0.021) and hospitals with longer participation in the surveillance (P = 0.018) had higher scores than others. Among 1110 randomly selected cases, there were 49 infections and 1061 without infection. Fifteen infections (1.4% of all cases; 30.6% of all infections) were incorrectly classified as non-infection (false negative) and one non-infection (0.09%) was classified as infection (false positive), accounting for a sensitivity (95% confidence interval (CI)) of the surveillance of 69.4% (54.6% − 81.7%), a specificity of 99.9% (99.5% − 100%), a positive predictive value of 97.1% (85.1% − 99.9%) and a negative predictive value of 98.6% (97.7% − 99.2%). Conclusion: Despite a well-defined and thorough SSI surveillance methodology, we encountered a wide variation of surveillance quality. Almost 30% of cases with infections were missed. Quality of chart review and accuracy of data collection are the main areas requiring improvement. Disclosure of Interest None Declared O34 An electronic surgical site infection surveillance based on the electronic self-reporting and additional targeted audit Choi Jongrim1, Sun Young Cho1,2, DooMi Kim1, DooRyeon Chung1,2 1Center for Infection Prevention and Control, Samsung Medical Center; 2Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center,Sungkyunkwan University School of Medicine, Seoul, Korea, Republic Of Correspondence: Choi Jongrim Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O34 Introduction: Conventional Surgical Site Infection (SSI) surveillance methods dependent on comprehensive chart review are resourceintensive. Objectives: We evaluated an electronic SSI surveillance method based on the electronic self-reporting and additional targeted audit. Methods: All surgical procedures under SSI surveillancebetween Jan 2013 and Dec 2014 were included. Since 2013, we have performed SSI surveillance for 38 surgical categories through electronic selfreporting by surgeons and additional prospective audit through the review of the electronic medical records for all procedures by trained infection preventionists. In 2016, this comprehensive audit was changed to the targeted audit focusing on the cases extracted from the computerized program according to the algorithm satisfying any of the following criteria: 1) microbial cultures were requested; 2) antibiotics were ordered; 3) infectious diseases specialist consultation was requested. We verified the new surveillance method by determining the sensitivity of SSI detection and the number of cases requiring the review by the infection preventionists and total estimated time for the review compared to the comprehensive audit method. Results: During the study period, 40516 surgical procedures were included in SSI surveillance. A total of 575 SSIs (1.42%), which were identified by the comprehensive audit method, included 205 superficial incisional, 69 deep incisional, and 301 organ/space SSIs. Switching to the targeted audit method decreased the number of cases requiring the review to 15229 cases (62.4% decrease) and total estimated time for the review from 2139.97 to 875.53 man-hours. The sensitivity of SSI detection was 97.9% (563 SSI events). Twelve cases of superficial incisional SSI were missing compared to the comprehensive audit method. Conclusion: The electronic SSI surveillance method based on the electronic self-reporting and additional targeted audit could reduce workload compared to comprehensive audit method while maintaining high sensitivity of SSI detection. Disclosure of Interest None Declared. Behaviour and harm Introduction: Contact precautions (CP) are typically used to prevent transmission of multidrug-resistant organisms from infected/colonized patients to other hospitalized patients. CP are complex behavioral interventions that may adversely affect quality of care and lead to physical adverse events in patients. Objectives: Systematically review studies on the association between CP and physical adverse events. Methods: We conducted a systematic literature review using PubMed, CINAHL, EMBASE, and PsychInfo. Studies published from 2008-2016 and systematic reviews of studies published from 1970-2008 were included. Studies without a control group were excluded. A metaanalysis was performed by pooling risk ratios using random effects models with inverse variance weighting. Heterogeneity was assessed using the Cochran Q and I2 statistics. A statistically significant p-value signifies heterogeneity between studies. Results: Five thousand three hundred thirty-five titles were screened for inclusion. Overall, 9 studies evaluated falls, pressure ulcers, and/or thromboembolic events. None of the pooled analyses of these 3 adverse events were statistically significantly associated with CP. Among the 6 homogeneous studies (Cochran p = 0.61; I2 = 0%) that evaluated falls, there was no significant association between CP and falls (pooled risk ratio (pRR): 1.17; 95% confidence interval (CI): 0.71, 1.93). Among the 5 homogeneous studies (Cochran p = 0.55; I2 = 0%) that evaluated pressure ulcers, there was no significant association between CP and pressure ulcers (pRR = 1.22; 95% CI: 0.72, 2.08). Five studies evaluated thromboembolic events including pulmonary embolisms and venous thromboembolic events. When pooled, there was no significant association between CP and thromboembolic events (pRR = 1.65; 95% CI: 0.85, 3.21), however, these studies were heterogeneous (Cochran p < 0.01; I2 = 71%). Conclusion: In this meta-analysis, CP were not associated with increased risk of falls, pressure ulcers or thromboembolic events. More high-quality studies should be done to evaluate these relationships and the relationship between CP and other preventable adverse events. Disclosure of Interest None Declared Introduction: The cluster-randomized controlled trial PSYGIENE on the intensive care and hematopoietic stem cell transplantation units at Hannover Medical School, Germany, has shown that psychologically tailored interventions led to more sustainable hand hygiene compliance increases than the German Clean Care is Safer Care-campaign (ASH) [1]. However, so far it has remained unclear whether this tailoring approach was cost-effective. Objectives: To test whether the tailored PSYGIENE-interventions have been cost-effective in terms of lower incidences of nosocomial infections (NI) and reduced health care costs. Methods: The control group received ASH education. The tailoringarm received educational sessions and feedback discussions psychologically tailored based on Health Action Process Approach using behaviour change techniques. Nosocomial multi-resistant gram-negative bacteria (MRGN), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcal (VRE) infections were surveyed following German National Reference Center for the Surveillance of Nosocomial Infections (KISS) protocol. Intervention costs were calculated using standard health-economic micro-costing procedures. Results: NI incidence rates in the tailoring-arm fell from 0.84 (2013) to 0.58 (2014) and 0.35 (2015; vs. 2013: p = 0.017), thus inversely relating to hand hygiene compliance (54%, 64%, 70%; 2015 vs. 2013: p < 0.001). Results in the ASH-arm differed in that incidences, like compliance, initially developed positively (0.69 to 0.58/55% to 68%), but then worsened again (0.67 and 64%). Controlling for patient days differences between the study arms, at least 10.1 more infections were prevented in the tailoring- vs. the ASH-arm when comparing 2015 to 2013, representing cost reductions of at least 105,318€. Since tailoring costs exceeded that of the ASH by 31,591€ (35,551€ - 3,960€), the tailored interventions were above break-even. Conclusion: Psychologically tailored hand hygiene interventions can be cost-effective in preventing NI. Epidemiology and control of multi-resistant bacteria Introduction: Few studies have estimated the excess inpatient cost due to nosocomial multi-drug resistant (MDR) Gram-negative bacteria cultures and those that do are often subject to time-dependent bias. Objectives: Our objective was to generate estimates of the cost of these nosocomial cultures using a unique inpatient cost dataset from the US Department of Veterans Affairs (VA) that allowed us to reduce time-dependent bias. Methods: Our study included data from inpatient admissions lasting longer than 48 hours between 10/1/2007 and 11/30/2010 were included. Nosocomial MDR Gram-negative bacteria, identified from microbiology reports in the VA electronic medical record, were defined as positive clinical cultures for Acinetobacter, Pseudomonas, or Enterobacterieceae from 48 hours after admission to discharge. Positive cultures were further classified as invasive if they were taken from a normally sterile site and otherwise were classified as noninvasive. Organisms were deemed MDR if they were resistant to 3 or more classes of antibiotics. VA inpatient cost data separate the costs incurred during patient stays by calendar month. We restricted our analysis to inpatients who were discharged in a calendar month after the month in which they were admitted. We then used multivariable generalized linear models to compare the inpatient costs and LOS in the 2nd calendar month between patients with and without a nosocomial MDR Gram-negative bacteria cultures on the 1st day of the 2nd calendar month. Results: Of the 135,479 patients included in our analysis, 205 had a nosocomial MDR Gram-negative bacteria culture. The excess cost of invasive and non-invasive nosocomial MDR Gram-negative bacteria cultures was $43,675 (p < 0.017) and $34,031 (<0.0001), respectively. Costs were highest for Acinetobacter ($56,319, p = 0.015) followed by Pseudomonas ($37,067, p < 0.0001) and Enterobacterieceae ($32,691, p < 0.0001). Overall, the increased LOS was 18.0 (p < 0.0001) days. Conclusion: We found that nosocomial MDR Gram-negative bacteria cultures significantly increased inpatient cost and LOS. This was true both for invasive cultures, which are likely to be true infections, and those that were non-invasive, which are possibly colonizations. Disclosure of Interest None Declared. O38 Surveillance of bloodstream infections due to Extended-Spectrum Beta-Lactamase-Enterobacteriaceae (ESBLE), between 2012 and 2015 in France Isabelle Arnaud1, Odile Bajolet1, Olivier Barraud1, Anne Berger-Carbonne2, Xavier Bertrand1, Hervé Blanchard1, Emmanuelle Caillat-Vallet1, Laurent Cavalié1, Mélanie Colomb-Cotinat2, Lory Dugravot1, Catherine Dumartin1, Thierry Fosse1, Sophie Glorion1, Emmanuelle Reyreaud1, Anne Savey1, Loïc Simon1, Elisabeth Sousa1, David Trystram1, Vincent Jarlier1, Pascal Astagneau1 1CClin-Arlin, Paris; 2Santé Publique France, Saint-Maurice, France Correspondence: Isabelle Arnaud Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O38 Introduction: In France as in other European Countries, for many years, ESBLE (especially E. coli, K. pneumonia (Kp) and E. cloacae) infections have been increasing for the last 10 years despite specific guidelines. Apart from the global incidence of ESBLE, special focus is now made on surveillance of severe infections such bloodstream infections (BSI). Objectives: The aim of this study was to illustrate the temporal trends of the BSI of ESBLE, ESBL E. coli, ESBL Kp and ESBL E. cloacae from 2012 to 2015. Methods: A cohort of 698 Health care facilities (HCF) was studied from 2012 to 2015 through the national monitoring network of multidrug resistant bacteria in hospital (BMR-RAISIN) implemented since 2002. HCF participated within a 3-months period per year on a voluntary basis. Strains were isolated from blood culture issued for diagnostic purposes (a single strain of the same species per patient). Incidences of ESBLE BSI were calculated per 1,000 patient-days (PD) from 2012 to 2015. An Univariate Poisson regression was used to estimate temporal trends. Results: From 2012 to 2015, the incidence of EBLSE BSI increased from 0.045 to 0.063 per 1,000 PD (587 to 894 BSI), representing a 39% increase (p < 0.001). The same upward trends were observed for ESBL E. coli (0.026 to 0.034, +33%, ESBL Kp (0.011 to 0.019, +76%) and ESBL E. cloacae (0.006 to 0.007, +13%). 92% of BSI were observed in acute care unit (ACU), of which 17% in intensive care unit (ICU), and 8% in long-term care facilities (R-LTCF). 57% of ACU and R-LTCF ESBLE BSI were due to E. coli, 27% to Kp and 11% to E. cloacae except for ICU where the proportion of E. coli, Kp and E. cloacae was 38%, 37% and 16% respectively. Conclusion: In France, incidences of ESBLE BSI continue to increase despite control efforts, especially those due to E. coli, Kp and E. cloacae. This result must encourage HCF to upgrade their preventive measures, in particular for contact precautions, excreta management and device-related BSI which are potentially preventable. Disclosure of Interest None Declared Introduction: The routine BSI surveillance at HUG recorded an important increase in cases due to ESBL-producing E. coli in 2015. Objectives: To assess the prevalence of clone ST131 among ESBLproducing E. coli BSI at HUG in 2015. To identify potential cases of hospital transmission. Methods: From Jan 1 to Dec 31, 2015, 75 patients presenting 84 episodes of BSI due to ESBL producing E. coli were analyzed for the presence of clone ST131. A PCR assay based on a unique combination of mutations harbored by the ST131 lineage of E. coli was developed. Consequently, all isolates were subjected to whole genome sequencing (WGS) and compared at the nucleotide level to evaluate strain relatedness. Clinical and epidemiological data were also retrieved. Results: 44/75 (59%) of patients suffered BSI due to E.coli ESBL ST131. Age and gender were similar for non ST131 vs ST131 patients. Comparing non-ST131 vs ST131 cases, 61% (19/31) and 59% (30/51) of BSI episodes were healthcare-acquired; 64% (20/31) vs 59% (30/ 51) were secondary BSI (mainly UTI). E. coli ST131 and non-ST131 isolates showed similar resistance profiles except for ciprofloxacin and norfloxacin (higher resistance in ST131) and cefoxitin and furans (higher susceptibility in ST131). The rapid PCR assay and MLST results deduced from WGS yielded identical results for ST131 identification. 40% of all ST131 isolates presented the profile ST131-H30Rx. Pairwise comparisons showed 2 strains with 25 single nucleotide substitutions (SNPs); the rest showed >100 SNPs revealing isolates from different origins. Comparative genomics performed on ST131 from various countries revealed parallel evolution of ST131 clones, following different introduction events of a common ancestor in our area. Conclusion: In 2015, the incidence of BSI involving E. coli ST131 at HUG was high. WGS demonstrated the frequent presence of H30Rx virulent profiles in our area. Nosocomial cross contamination was not a likely cause of this ST131 increase. Disclosure of Interest None Declared. O40 Factors influencing the acceptability of screening for carbapenemase producing enterobacteriaceae; mixed method study of the general publics’ views Kay Currie, Jacqui Reilly on behalf of AMR-BESH Study Group Glasgow Caledonian University, Glasgow, United Kingdom Correspondence: Kay Currie Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O40 Introduction: The World Health Organisation has prioritised antimicrobial resistance as a global health threat. Carbapenemase Producing Enterobacteriaceae (CPE) is a growing challenge, with evidence of rapid spread within Europe. However, screening for CPE may involve a rectal swab, potentially considered invasive and embarrassing, and colonised patients are cared for in isolation to protect others. Whilst these measures are sound infection prevention precautions, the acceptability of CPE screening and its consequences are unknown. Objectives: This mixed methods study investigated the publics’ views on the acceptability of CPE screening and management. Methods: Data collection and analysis was guided by Theoretical Domains Framework1, which explores how psychological perspectives affect individual’s decisions to act in specific situations. Data from three focus groups (n = 14) was analysed thematically; findings were used to inform subsequent survey design. Descriptive and inferential analysis of survey data (n = 261) was used to identify variables for inclusion in a linear regression analysis. Results: Results demonstrate ‘strong agreement’ with the acceptability of CPE screening (median score 9, on a scale of 1-10); acceptability of rectal swabs (median score 9); and acceptability of being cared for in isolation (median score 8). Linear regression modelling identified acceptability of CPE screening was significantly associated with five predictor variables: knowledge of the problem of antimicrobial resistance (β -.108, p = .012), social influences (β .140, p = .032), acceptability of being isolated if colonised (β .221, p = .000), beliefs about the acceptability of rectal swabbing (β .147, p = .003), beliefs about the impact of careful explanation from a health professional (β .316, p = .000). Conclusion: Findings indicate that interventions to enhance public acceptability of CPE screening should focus on shaping public knowledge of CPE by providing information about antimicrobial resistance and capitalising on social influences by harnessing ideas of collective action or the public good. Introduction: In Argentina, the prevalence of carbapenem resistant Klebsiella pneumoniae(CRKp) reaches 10%.In our institution, there was an increase in cases of colonization and infection by CRKp in the last years. A multimodal strategy (MMS) can improve health personnel behaviour with better outcomes. Objectives: Determine the impact of a MMS to control colonization and infection by CRKp Methods: Prospective, interventional study, July-September 2016 in a general university acute care hospital in Buenos Aires (Argentina) with 145 beds (15 in the adults ICU). A multimodal program was implemented that included 1-structural changes of the unit; 2-on-spot training, 3-discontinuing universal contact precautions (modification of isolation policy); 4 - Continuous assessment of Health Care Associated Infection (HCAI) rates, Hand Hygiene (HH) compliance, ATB consumption and audit room disinfection protocol(RDP); 5-feedback of information; 6reminders in the workplace; 7- periodic meetings with leaders with hands-on workshops to foster a culture of security. The CRKp infection and colonization rate were measured and the pre-intervention rate (PreI) January-June (1st semester 2016) was compared with postintervention (PosI) from July to December (2nd semester 2016). Results: A decrease in the rate of colonization/infection by CRKp PreI 15.87/ 1000 patient days (pd) vs PosI 8.71/1000 pd was observed. (p 0.0406). Patient unit reforms were performed to facilitate the surface cleaning. Personal staff were trained by Infection control nurses weekly. Regular Conferences with all sector nursing and staff leaders took place monthly. HH compliance was 77-80%, HAIs remained stable at 8.4/1000 pd, RDP compliance was 93%, and a 30% reduction in carbapenem consumption. (PreI 1450 DDD vs PosI 1003 DDD). Changes in unit isolation policies had a positive impact on the staff, increasing adherence to the strategy. Conclusion: The implementation of a MMS can reduce the incidence of infection and colonization by CRKp. Disclosure of Interest None Declared O42 Impact of universal methicillin resistant staphylococcus aureus (mrsa) admission screening on mrsa bacteraemia incidence at Mater Dei Hospital, Malta Michael Borg, Claire Farrugia, Elizabeth Scicluna 1Infection prevention and control department, Mater Dei Hospital, Msida, Malta Correspondence: Claire Farrugia Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):O42 accessing the GPH standards’ level of application and the respect of health rules by direct and repeated observations but also by interviewing the staff of both intensive care and pharmacy. Results: A total of 86 observations and discussions with healthcare staff have been conducted. The overall hygiene standards’ compliance rate applied to the whole process was 65%. The most non compliant step was the storage at hospital central pharmacy (52.5%). On the other hand, despite shortcomings, the highest average compliance rate was patients’ administration of the products (75%). Failures’ causes have been analyzed by Ichikawa diagram of causes-effect and the SWOT (Strength-Weakness /Opportunities-Threats) analysis. Conclusion: Our study has revealed defects along artificial feeding process, in our hospital, which can be remedied by GPH’s application. In order to strengthen food security’s systems, all establishment stakeholders must federate their effort and assume their responsibilities. Disclosure of Interest None Declared Introduction: Umbilical cord care is a cause of concern for mothers’ right from birth until its separation. Good cord care practices reduces incidence of neonatal morbidity and mortality while cord care practices vary from place to place, some can be harmful to a newborn Objectives: 1. The aim was to establish various cord care practices and the health related implications among newborns in Milgoma 3. Methods: A descriptive cross-sectional study was conducted among 110 mothers using systematic random sampling. Data was collected using semi-structured interviewer administered questionnaire,on sociodemographic characteristics,cord care practices and health related implications among newborns. Data was analyzed using SPSS version 20.0 and results were presented using Chi square tables and charts Results: Majority of the respondents were within the age group 20-29 years, Hausa, Muslims. Thirty eight percent of respondents used hot compress, while 30% use of methylated spirit, herbs (15%), toothpaste(10%), use of garlic and ginger (4%) and only 1.5% knew about use of cow dung. 31.8% of respondents children have had complication of poor cord practices. Localized infection was the most common poor cord care complication (33.2%), bleeding (25.3%), sepsis (21.8%) burns(9.6%), neonatal tetanus 5.2% and neonatal jaundice has the least (4.8%).There was a significant statistical relationship between educational status of respondents and knowledge of scores(P =0.000) Conclusion: Respondents demonstrated a fair knowledge towards cord care, however majority of them practiced harmful cord care practices and majority of the cord-related complications developed were cord infections. Thus the need for enlightenment of mothers by local heath authorities to stop harmful traditional practices and adopt beneficial ones. Disclosure of Interest None Declared P355 Infection prevention and control (ipc) performance monitoring in 5 medico-communal centers (CMC) in Conakry, Republic of Guinea Abdoulaye Diallo1, Jacqueline Aribot1, Mamadou Malal Diallo2, Aly Doumbia3, Yolande Hyjazi4 1M&E; 2Pre service education; 3Infection prevention and Control; 4Country Director, Jhpiego, Conakry, Guinea Correspondence: Abdoulaye Diallo Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P355 Introduction: In order to monitor IPC activities in the 5 CMC of Conakry following the training of the providers, periodic evaluations are carried out to measure the level of implementation of IPC performance standards. Objectives: Assess IPC practices in health care facility using IPC performance standards Methods: The evaluation is done through direct observation, an interview and a documentary review by a team of 2 evaluators in 2 days per facility, A summary sheet is used to summarize the results obtained by standards. Results: From December 2014 to October 2016, 5 IPC performance evaluation visits were conducted in the 5 CMC of Conakry, with an average of 5 months interval. Analysis of findings from 8 out of 32 IPC standards showed median performances ranging from 38% to 80%. 100% of CMC reached the required performance threshold (75%) at the 5th assessment. Conclusion: The use of IPC standards for self-assessments improves the performance of health workers. The best performance is linked to the regular use of performance standards for self-assessments to address identified and persistence gaps P356 Infection control in acute care hospitals, Finland, 2014 Dinah K. Arifulla, Jukka Ollgren, Jere Veltheim, Outi Lyytikäinen NATIONAL INSTITUTE FOR HEALTH AND WELFARE, Helsinki, Finland Correspondence: Dinah K. Arifulla Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P356 Introduction: Infection control (IC) requires adequate human resources and activities. Objectives: A nation survey was conducted to describe the coverage and characteristics of these issues in Finland and to evaluate progress during recent years. Methods: Web-based survey was provided via E-mail and mail to all Finnish acute care hospitals. The questionnaire covered information on hospital characteristics, IC staff and activities in 2014. We also asked which information is feasible to update annually and which could be reported publicly. Results: A total of 43 (94%) hospitals responded (5 tertiary, 15 secondary and 23 primary care hospitals); 33 provided intensive care and 38 performed surgery. Of the hospitals, 77% had infectious disease specialists and 30% clinical microbiologists participating in IC activities. They used a median of 26% (range by region, 21–33%) and 9% (range, 0–30%) of their work time on IC activities, respectively. All hospitals had trained infection control nurses (ICN), who used a median of 59% (range, 33–68%) of their work time on IC activities of their own hospitals. The median of hospital beds per full-time equivalent ICN was 204 (range, 175–274). All but one hospital had a link nurse system. The written prevention and control guidelines for urinary tract infection, surgical site infection, bloodstream infection, and pneumonia were available in 37-84% of the hospitals and were variously implemented in practice by training (range by infection type, 37-63%), check list (5-23%), auditing (0-2%), surveillance (5679%) and feedback (42-60%). Of the hospitals, 15/38 surveyed timing of surgical antibiotic prophylaxis. Influenza vaccine coverage among staff varied regionally between 31-74%. The latter information was favored for public reporting beside the ICN to bed ratio and hand rub consumption. Conclusion: In comparison with the results from our previous survey in 2008, the ICN to bed ratio has improved (2008: 257 vs. 2014: 204). However, the doctors’ input in IC is still limited. The unavailability of infection prevention guidelines for the most common infections and lack of tools in implementation cause concern. National guidelines with implementation tools could improve this issue. Disclosure of Interest None Declared P357 Reporting of infections associated with care: the barriers to reporting between different actors REGIONAL FRENCH STUDY FROM 01/01/2012 TO 02/05/2016 Narbey David1, Marie-Antoinette INGABIRE1, Claude BERNET2, ANNE SAVEY2, PASCAL FASCIA1 1ARLIN RHONE-ALPES; 2CCLIN SUD EST, SAINT-GENIS-LAVAL, France Correspondence: Narbey David Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P357 Introduction: The reporting of nosocomial infections (NI) has become mandatory since 26/07/2001. However, although the data show a trend towards increased reporting, many institutions still report too little. Objectives: Make an inventory of the reports in a region and then to try to understand the obstacles to this report. Methods: Longitudinal observational retrospective study of the reports of the identified region from 01/01/12 to 02/05/16 from the esin database. Qualitative variables will be described in terms of enrollment and percentage; The quantitative variables, as a mean and their standard deviation. To identify the factors favoring NI reporting, logistic regression analysis will be performed, with the dependent variable being the reporting of at least one report versus more than one report. Results: 902 reports were issued over the study period (164 different institutions). We notice a gradual increase in the number of reports. Public institutions report the most. Infections related to the nature, characteristics or profile of resistance to antiinfectives of the pathogen involved as well as epidemic cases are the most common. After adjustment, 2 variables seem to influence the reporting: NI of a rare or particular character, in relation to local, regional or national epidemiological data, as a result of the pathogen in question and having an infection versus colonization. It should be noted that the large size of the institution which appeared significant in univariate no longer appears after adjustment. Conclusion: In order to try to improve the reporting, it would be useful to have a permanent referral officer in each establishment since it has been shown that the absence of a hygienist practitioner was an obstacle to the validation of an external report. On the other hand, the notions of colonization and infection, even if they represent a difference from a clinical point of view, represent the same risk in terms of hygiene measures. One must not lose sight of the usefulness of reporting which is to rapidly detect unusual infections and take measures for the management of serious and / or elevated nosocomial infectious risk situations. Disclosure of Interest None Declared P358 Management of healthcare infectious risks outside health establishments: a survey among liberal practitioners Mohamed Mahjoub1, Rym Bouriga2, Nabiha Bouafia1, Hela Ghali1, Asma Ammar1, Asma Ben Cheikh1, Olfa Ezzi1, Waadia Bannour1, Radhia Héllali1, Mansour Njah1 1Hospital Hygiene; 2medical oncology, university hospital Farhat Hached Sousse Tunisia, Jawhara, Tunisia Correspondence: Mohamed Mahjoub Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P358 Introduction: Liberal medical practice, outside health establishments, may supply healthcare associated infections. Good application degree of hygienic practice depends on doctors’ perception and training (academic and continuous). Objectives: Our objectives were to specify good hygienic practice (GHP)’s observance degree according to physicians in private practice and to compare two groups’ answers relatively to the practitioners age (more or less than 50 years). Methods: A descriptive cross-sectional study was realized in 2016 by means of a pre-tested and auto-administered questionnaire with all the general practitioners of private practice in a coastal city of the Tunisian central east region Results: Participation’s rate is 93,1% with a sex-ratio of 1,7. Sixty-two per cent of the general practitioners are less than 50-years-old. A significant difference in favors of people under 50 was reported for the GHP’s observance relatively to healthcare activities’ waste management (87,3% versus 45,6%; p 10-4). Respondents of less than 50 years formulate significantly more their wishes to do a training course in BPH (91,5% versus 54%; p = 10-4). The victims of blood exposure accidents (BEA) are significantly more prevailing among people over 50 years (62,2% versus 21,1%; p = 10-4) Conclusion: Our study reveals importance of in-service training’s strengthening for general physicians, especially the oldest at medical exercise with incentive reminders of the updated recommendations to improve the healthcare associated infections (HAI)’ risks awareness and their daily optimal management. Wills to organize HAI’ fight and prevention in liberal medical practice are essential. These initiatives require from professionals to seize HAI problem and to launch evaluation process. It is justifiable to develop motivational and compensatory measures to favor work between peers. Disclosure of Interest None Declared Introduction: Health alert including medical device vigilance (MDV) contribute to care safety in health institutions. Evaluation of MDV systems in different environments of medical practice represents an essential step to support improvement of healthcare’s quality. Objectives: The objective is to estimate the knowledge, attitudes and practices (KAP) of physicians relating to the MDV and to compare it between medical and surgical specialties, in the various hospital services of a Tunisian Central East University-Hospital. Methods: A descriptive cross-sectional study was conducted in 2016 including 183 incumbent physicians performing in 24 hospital services, using a pre-established, pretested and self-administered questionnaire,. Seizure and Analysis of the data were made by SPSS software 20.0 Results: Response rate was 81.9%, Practicing physicians in medical services accounted for 81.1% of the participants. The doctors who recognize the existence of a standard form of reporting was significantly greater in the medical services than surgical ones (51.9% versus 27.8%; p = 0.04).In addition, physicians who are convinced by the importance of reporting under the MDV was significantly more frequent in surgical services (66.7% versus 32.5%; p = 0.007). The importance of efficient and organized MDV’s management was more frequently reported by physicians of surgical services than medical ones (83.3% versus 14.3%; p < 0.001). Conclusion: The institutional strategies for the development of safety culture of care relating to the MDV must take account of the specialty of medical practice in order to better manage healthcare risks and to improve its quality and safety. Adaptation of doctors’ KAP about MDV with training-information programs is crucial since they are influenced by the environment of medical practice. Disclosure of Interest None Declared Introduction: Available reports of the financial burden incurred by healthcare-acquired infection (HAI) are dependent on local reimbursement contracts and costs limiting the applicability for generation of valid financial schemes. Objectives: We sought to generate a detailed and valid report of the differences in resource consumption between patients who acquired infections during hospital care and severity-status-matched controls. Methods: Matched cohort study; Patients with Central Line Associated Blood Stream Infection (CLABSI), Surgical Site infections (SSI) and Clostridium difficile infection (CDI) were identified between 2014 and 2015. We matched three control per patient according to accepted severity indices (SAPS-II, ASA and Charlson, respectively), age, sex, hospital unit, time since admission and surgery type (for SSIs). All resources used during patient care were identified, as were length of stay and mortality. Results: We identified 62 CLABSI events, with 179 control; 76 SSIs, 213 controls; 92 CDI cases, 276 controls. Respective in-hospital mortality rates were 63% vs. 47% (p = 0.03), 4% vs. 1% (p = 0.11) and 27% vs. 12% (p < 0.001). There was an average increase of 28 (CLABSI), 11 (SSI), and 12 (CDI) antibiotic treatment days. CLABSI led to an average increase of 58 blood tests, 11 imaging tests, and 12 more cultures. The respective SSI estimates are 16, 3 and 3 and the CDI estimates are 17, 2 and 4 (all p < 0.001). There were similar average hospital stays between cases and controls: early mortality among cases evened other longer stays. Results were stable under sensitivity analysis examining the control group results' maximum and minimum consumption records. Various other additional resources (TPN, dialysis, repeat surgery etc.) were required for patient care and differed between cases and controls. Conclusion: Our study provides a detailed report of the resource consumption associated with HAI. Unlike previous financial analyses, institutions, administrative bodies and healthcare policy leaders can adapt our findings to identify the local financial implications of HAI and devise incentive/disincentive imbursement schemes to augment infection control initiatives and reduce HAI. Disclosure of Interest None Declared Infection and prevention in immunocompromised hosts Introduction: In the sub-urban slums of Nigeria fraught with poor sewage disposal practices, sewage spills, lack of sanitation and low socio economic status, prevalence of infectious diseases is high especially amongst immune-compromised patients. Immune-compromised patients are often vulnerable to opportunistic infections including gastroenteric infections. Such opportunistic infections present with severe clinical symptoms which are more difficult to treat in this group of patients compared to infections in otherwise healthy people. Objectives: To examine the impact of poor sanitation practices on prevalence of gastro-enteric infections amongst HIV patients living in sub-urban slums. Methods: Stool specimens from 202 HIV patients accessing care and treatment services at two sub-urban clinics, were collected and examined through direct observation in saline (0.85% NaCl solution). Lugol’s iodine method was used for the detection of ova, larvae, trophozoites and cysts of intestinal parasites using light microscopy. Smears of direct and concentrated specimens were examined by modified acid fast staining for Cryptosporidium parvum, Isospora belli and Cyclospora spp. CD4 T-lymphocyte count of each patient was estimated using the Becton Dickenson FACS-count system. Results: Enteric parasites were detected in 91(45%) stool samples, of which 54 (59.3%) were opportunistic and 37(40.7%) were non opportunistic. Opportunistic parasites isolated include C. parvum, I. belli and Cyclospora spp. C. parvum (30.8%) was the most frequently encountered pathogen followed by I. belli (24.2%) and Entamoeba histolytica (23.1%). Opportunistic parasites were isolated in all 42 (20.8%) patients with CD4 count <200 cells/ul. Overall, C.parvum and E. histolytica were the most frequently occurring parasites. Opportunistic parasites were undetectable at CD4 count >500 cells/ul while nonopportunistic parasites were detectable only in 3 patients with CD4 count >500 cells/ul. Conclusion: Infection prevention and control strategies in immunecompromised patients living in sub-urban slums of Nigeria should not only focus on the administration of drugs for opportunistic infections but also on the provision of basic sanitary facilities, health education campaigns and resuscitation of the public sanitary inspector’s act. Disclosure of Interest None Declared P362 Multidrug resistant bacteria in surveillance cultures from hematopoietic stem cell transplant (HSCT) patients Prasanth C. Bhat1, Vivek Bhat2, Navin Khattry3 1Medical Administration, ADVANCED CENTRE FOR TREATMENT, RESEARCH AND EDUCATION IN CANCER (ACTREC), TATA MEMORIAL CENTRE; 2Microbiology, TACTREC, TATA MEMORIAL CENTRE; 3Medical Oncology, ACTREC, TATA MEMORIAL CENTRE, Navi Mumbai, India Correspondence: Prasanth C. Bhat Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P362 Introduction: Infections due to multi-drug resistant bacteria is a major contributor to morbidiy and mortality in oncology setting and is particularly true in hematopoietic stem cell transplant (HSCT) patients who have profound underlying immunosuppression. Patients’ endogenous flora from the bowel, mouth and skin may be responsible for many of the serious bacterial infections. Surveillance cultures for drug resistant organisms may have a role in alerting the clinician to the possible etiology of subsequently developing infections. Objectives: 1. To conduct bacterial surveillance culture and to understand multi drug resistance pattern of organsim from HSCT patient sample 2. To provide evidence based antibiotic choice for empirical treatment during HSCT Methods: 68 patients who underwent hematopoietic stem transplant were included in the study. Swabs for surveillance culture were collected from the anterior nares and axilla to look for the presence of Methicillin Resistant Staphylococcus aureus (MRSA). Faeces cultures were performed to screen for multi-drug resistant Gram negative bacilli including resistance to third and fourth generation cephalosporins, beta- lactam –beta lactamase inhibitor combinations (BLBLIs), vancomycin resistent enterococci and carbapenems. Results: Escherichia coli (66) was the commonest organisms isolated followed by Klebsiella pneumonaie (17) in the faecal surveillance cultures. Resistance to 3rd and 4th generation cephalosporins was > 50% in E. coli, resistance to meropenem was 13.67% and piperacillin-tazobactam was at 30%. Among K. pneumoniae, resistance to cefotxime and cefepime was at 35.29%, however all strains were susceptible to the carbapenems. There were 27 isolates of enterococci, of which 18.52% were vancomycin resistant. Five nasal swabs grew Staphylococcus aureus, of which one was methicillin resistant (MRSA). Conclusion: There is a high level of antibiotic resistance to cephlosporins and BLBLIs in the endogenous Gram negative organisms of our HSCT patients as evident from surveillance faecal cultures. This information can be useful in empirical treatment of subsequently developing infections. Disclosure of Interest None Declared Introduction: Central venous catheters (CVCs) are essential in the care of patients with severe processes treated in surgical units, intensive care units and hemato-oncological units. In our hospital since 2014, echocardiographic peripherally inserted CVCs have been introduced as an alternative to traditional CVCs Objectives: Describe the characteristics of infectious complications (IC) that occurred during the use of venous catheters central peripheral insertion (PICC) guided eco technique Methods: A prospective, observational, analytical, and unicentric study of all oncohaematological patients who had a PICC inserted. Study period from March 2014 to September 2016. All sociodemographic variables, mechanical and infectious complications were collected during PICC use. Statistical analysis with SPSS Statistic 23 Results: During the study period, 591 PICCs were inserted, of which 344 were oncohematologic patients, of whom 54.9% were women and 45.1% were men. The avarege number of days of implantation was 124.31. The inherent oncological pathology was mainly solid tumor (81.1%), followed by lymphoma (12.25) and leukemia (5.8%). The main reason for requesting the PICC was chemotherapy (84.6%). The complications during catheter use were: suspected infection 5 (3.5%), microbiologically confirmed bacteremia 2 (1.4%), accidental removal of catheter 8 (5.7), local infection and obstruction of PICC 6 (4.3%), rest By termination of treatment or by patient's exitus (not related to infectious complications). The incidence density of IPCC-related bacteremia was 0.6‰. The main reason for catheter removal was completion of treatment (56%) followed by exitus 32 (22.7%) (not related to infectious complication), suspicion of infection 5 (3.5%), bacteriemia confirmed microbiologically 2 (1.4%), Accidental withdrawal of catheter 8 (5.7), the rest were mechanical complications Conclusion: The incidence density of IPCC-related bacteraemias was lower than those published in the national registry (Envin) and a study conducted in our Hematology Unit in 2012. It seems reasonable to assume that the use of CCIPs is associated with a lower Incidence of serious complications, related not only to their insertion, but during their use (fewer infectious or thrombotic complications) Disclosure of Interest None Declared P364 Pseudo-outbreak of methylobacterium species in a hematological department Katrine H. Hansen, Marlene Høg, Leif P. Andersen Department of Clinical Microbiology, RIGSHOSPITALET, Copenhagen, Denmark Correspondence: Katrine H. Hansen Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P364 Introduction: Methylobacterium species are low pathogenic water borne bacteria occasionally involved in outbreaks in hospital settings. It has been reported as an opportunistic pathogen that may infect immunocompromised hosts. Objectives: Here we describe four patients with central venous catheter (CVC)-related Methylobacterium spp. infections in the same department within a period of three months. Methods: Four patients with acute myelogenous leukemia were admitted to the hematological department. Blood samples were drawn routinely from the CVC from all patients and cultured in a commercial blood culture bottles system for seven days. Positive blood cultures were examined by microscopy and grown on blood agar plates. Water samples were collected from taps located at all patient rooms where the patients had been and filtrated on TSA media. Bacteria colonies were identified by the API 20 NE system. Ribotyping was performed on an automatized Riboprinter on isolates from the four patients and two water samples. Results: From April through June 2005 four patients within the same hematological unit had positive blood cultures drawn from CVCs with Methylobacterium spp. This indicated that there could be an outbreak with this species since four cases of a rare bacterium occurred in the same unit at the same time. Methylobacterium spp. were identified in two water samples from two different taps located at the same patient room where all patients had been. At the time of blood culturing, one patient had symptoms of pneumonia and presented with fever, neutropenia and increased C-reactive protein. The remaining patients had no symptoms, showed no fever and were not neutropenic. Ribotyping of the six isolates of Methylobacterium spp. revealed that isolates from two patients admitted at the same time had 92% similarity while the remaining isolates had different ribotypes with less than 80% similarity. Isolates from water were Methylobacterium radiotolerans, whereas isolates from the patients all were Methylobacterium mesophilicum. Conclusion: The results of the ribotyping indicate the presence of a pseudo-outbreak with potential cross-contamination between two patients in the hospital unit not related to the water distribution system. Disclosure of Interest None Declared P365 Prevalence of respiratory viruses in immunosupressed patients in an oncological hospital in São Paulo – Brazil Adriana M. C. E. Silva1, Joseanne L. Lima1, Juliana Virolli1, Paula Vidal1, Beatriz Quental1, Sayonara Scota2, Andreia Schunck2, Ivan L. A. França e Silva1 1Serviço de Controle de Infecção Hospitalar, Hospital A.C.Camargo Cancer Center; 2Serviço de Controle de Infecção Hospitalar, Instituto de Infectologia Emilio Ribas, são paulo, Brazil Correspondence: Joseanne L. Lima Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P365 Introduction: It is estimated that half of all acute respiratory infections are caused by viruses, mainly affecting immunosuppressed patients and the elderly. Objectives: To verify the prevalence of respiratory virus in immunosuppressed patients of a Cancer Hospital of the State of São Paulo. Methods: Retrospective study performed from January to December, 2016, at a Cancer Hospital of São Paulo. In the patients presenting respiratory symptoms, the viral panel was collected. Detection is done by the RT-PCR technique (reverse transcriptase polymerase chain reaction). Results: In this period, 312 viral panel samples were analyzed, of which 48.71% (152) were female patients and 51.28% (160) male patients; 52.88% (165) had hematological tumors and 46.47% (145) solid tumors; 40.38% (126) of the patients were older than 60 years and 59.60% (186) were under 60 years of age. Prevalence was found in this study of 44.55% (139) of respiratory virus. Among them 34.53% (48) of Rhinovirus, 7.19% (10) of Influenza, 5.03% (7) Metapneumonvirus, 25.89% (36) Influenza Virus H1N1, 7.19% (10) Parainfluenza, 15.82% (22) RSV, 2.15% ( 3 ) Bocavirus, 0.71% (1) Enterovirus, 1.43% ( 2 ) Adenovirus. Conclusion: The importance of diagnosis is not only due to the large variety of pathogens involved but also to the high frequency of co-infections. In addition, the correct identification of the agents can avoid the excessive use of antibiotics and antivirals in the treatment of respiratory infections and pneumonia. The diagnosis of the viral etiology of respiratory infections, besides contributing to the prevention of the transmission of respiratory viruses, can lead to a reduction in hospitalization time, the use of antibiotics and antivirals, specific isolation precautions and laboratory tests, rationalizing costs. Introduction: Prevalence of Healthcare Associated Infections(HAI) varies between 5.7 and 19.1% in developing countries. Multimodal interventions have been found to be more effective than single interventions in prevention and control of HAIs. The success of any initiative is further dependent upon the participation of various stakeholders with differing perspectives, priorities and behaviours. A Quality Improvement(QI) initiative was undertaken to improve infection control practices in the stem cell transplant unit of a cancer hospital in Delhi, India. Objectives: To improve the infection control practices in the stem cell transplant unit using QI techniques and tools. To increase hand hygiene compliance to 70% or above by 8 weeks. To reduce the HAI rate to 6% in one year. Methods: Magnitude of the problem was assessed via surveillance through open air sampling of Mannitol Salt Agar plates and direct observation to assess hand hygiene compliance, brain storming done for root cause analyses using QI tools, 10 priority interventions were identified which were ranked based on 5 parameters in a feasibility matrix. PDCA cycles were done. Results: Pre-intervention, overall hand hygiene compliance was 47.5% and it was lowest in hospital orderlies and sanitation attendants (9.09%). Post-intervention, it significantly increased to 66, 70 and 70% at 3rd, 6th and 9th week respectively. Among hospital orderlies and sanitation attendants, it rose to 69, 65 and 64 per cent in 3rd, 6th and 9th week respectively. Intervention was continued till 9 weeks and compliance to hand hygiene followed till 24 weeks. There was no significant decline in compliance of HCWs related to hand hygiene till 24th week. Pre-intervention, the average bacterial colony count and Staph aureus colony count reduced from 12.9 and 5.45 to 1.65 and 1 respectively. Conclusion: QI initiatives for infection prevention and control based on interventions identified and executed through involvement of all stakeholders is an effective strategy to bring a significant reduction in risks of acquiring HAIs. Disclosure of Interest None Declared Introduction: Elizabethkingia sp are Gram negative organisms, ubiquitous in the environment. E. meningoseptica can cause sepsis, endocarditis and respiratory infection. E. miricola is rare, first identified in condensation from the space station Mir (2003). The first clinical isolate of E. miricola was identified in 2008 from an adult with lymphoma. MALDI-TOF is unreliable in distinguishing Elizabethkingia species.This may be the reason for the paucity of reported infections with E. miricola. The only method currently available to correctly identify Elizabethkingia subspecies is rpoB sequence cluster analysis. Objectives: We describe 3 cases of E.Miricola bacteraemia and the ensuing investigations. Methods: 3 paediatric haematology patients were positive for E. meningoseptica from blood cultures in a 6 month period.Isolates were sent to the ARHAI Reference Unit and identified as E. miricola. Results: Isolates were identified by the reference unit as E.miricola using rpoB sequence cluster analysis. Typing revealed three unique strains of the organism. The three isolates were ESBL producers and meropenem resistant due to the production of a metallo-βlactamase. All three patients required treatment of E. miricola bacteraemia. Infection control investigation revealed no commonalities between patients other than having been an inpatient on the same ward at different times. Water samples from outlets and chilled beams on the ward tested negative for Elizabethkingia sp. Conclusion: Following its identification in 2003 clinical isolates and case reports of E. miricola have been rare. It was unusual for us to encounter three bacteraemias over a six month period. Typing revealed three different strains making a point source unlikely. Water testing of outlets and chilled beams were all negative. Patients required treatment and the isolates were multi-resistant meaning treatment options were limited. Our isolates were misidentified initially as E. meningoseptica. Diagnostic labs should consider sending E.meningoseptica to reference units to identify rarer species such as E. miricola. Disclosure of Interest None Declared P368 Bacteraemia following faecal microbiota transplantation for recurrent clostridium difficile infection in an immunosuppressed patient Mingjuan Tan1, Nares Smitasin2, David Ong3,4, Alison J. Lee5, Roland Jureen6, Paul Tambyah2,4, Nicholas Chew2,4 1University Medicine Cluster; 2Division of Infectious Diseases, National University Hospital; 3National University of Singapore (NUS) Yong Loo Lin School of Medicine; 4Division of Gastroenterology & Hepatology; 5Department of Paediatrics; 6Department of Laboratory Medicine, National University Hospital, Singapore, Singapore Correspondence: Mingjuan Tan Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P368 Introduction: Faecal microbiota transplantation (FMT) is a widely used treatment option in refractory and recurrent Clostridum difficile infection (CDI). The experience in immunosuppressed patients has been largely safe and effective. Objectives: To highlight a potential complication of FMT in immunosuppressed hosts. Methods: We report a case of a young immunosuppressed woman who developed polymicrobial bacteraemia after FMT for recurrent CDI. Results: The patient was a 25 year old woman with a primary immunodeficiency syndrome of unclear aetiology, multiple hypersensitivities and autoimmune polyglandular syndrome: type 1 diabetes mellitus, adrenal insufficiency and hypothyroidism. She was on immunoglobulin replacement as well as insulin, prednisolone and levothyroxine. Previous infections included Mycobacterium fortuitum osteomyelitis, multiple bacterial and fungal wound infections, acute cholecystitis, a chronic rectal ulcer requiring partial resection, and catheter-related bloodstream infections. Due to prior treatment with broad-spectrum antibiotics, she developed recurrent CDI despite multiple courses of oral metronidazole and vancomycin. She underwent FMT via colonoscopy. Six hours later, she developed septic shock with a 40 °C fever, tachycardia and hypotension. Blood cultures grew Enterococcus faecalis, Escherichia coli and Klebsiella pneumoniae. She was treated with intravenous antibiotics. She recovered well enough to be discharged, but soon returned with fever. Unfortunately, she continued to have CDI, and eventually underwent total colectomy with end ileostomy formation. Conclusion: While FMT is an effective treatment for recurrent CDI, it should be carefully considered in immunosuppressed patients, in whom we do not understand the interaction between the faecal microbiome and host immune system. Disclosure of Interest None Declared Introduction: Infections caused by multiresistant microorganisms are associated with prolonged hospital stays, high costs, and increased morbidity and mortality. Objectives: To verify the incidence of multiresistant bacteria (Enterococcus spp resistant to vancomycin, Acinetobacter baumannii and Klebsiella pneumoniae producing carbapenemase) in surveillance swabs in HIV/AIDS patients of a Hospital of Infectology of the State of São Paulo. Methods: Retrospective study conducted from October 2016 to February 2017, in a Hospital of infectious diseases in the State of São Paulo. The surveillance swab was collected weekly from all patients admitted to the Intensive Care Unit. Results: In this period, 130 surveillance swab cultures collected from HIV/AIDS patients, with an incidence of 24.6% (32) were analyzed for multiresistant microorganisms. Sixty percent (2 cases) of Acinetobacter baumannii, 60.6% (20 cases) of Enterococcus spp resistant to vancomycin (VRE) and 33.3% (11 cases) of Klebsiella pneumoniae producing carbapenemase (KPC) were isolated. This study shows the importance of identifying these microorganisms for preventive measures to be implemented: colonized patients are placed in contact precautions, the hygienization of the environment is performed with 0.5% sodium hypochlorite, hygienization of the hands with chlorhexidine degermant and is Performed an audit by the Hospital Infection Control Service. Conclusion: Several factors are related to the persistence of these microorganisms within hospital units, such as individual vulnerability of patients, prolonged use of antimicrobials generating selective pressure, cross-transmission by colonized and/or infected patients, and the impact of adherence to prevention and control measures of infections. The simple act of sanitizing hands before and after patient care can prevent these transmissions. P370 Incidence of healthcare-associated infections in hiv / aids patients at the intensive therapy unit of an institute of infectology of São Paulo - Brazil Andreia C. B. P. D. Schunck, Adriana M. Costa e Silva, Sayonara Scota, Regia D. F. Feijó, Rosana Richtmann, Nilton J. F. Cavalcante Serviço de Controle de Infecção Hospitalar, INSTITUTO DE INFECTOLOGIA EMILIO RIBAS, São Paulo, Brazil Correspondence: Andreia C. B. P. D. Schunck Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P370 Introduction: Healthcare-associated Infections (HAI) represents one of the main problems in the quality of health care due to an increase in hospitalization time, morbidity and mortality, as well as disorders caused by pain, malaise, isolation, and finally by patient suffering. Patients with HIV/AIDS are potentially a population at higher risk for acquisition of HAI when compared to other groups of hospitalized patients. Objectives: To verify the incidence density of the infections related to health care in a Hospital of Infectious Diseases of the State of São Paulo. Methods: Descriptive, retrospective and quantitative study, whose objective was to analyze the occurrence of hospital infections in patients of the Intensive Care Unit from January to December, 2016, in a reference Hospital in Infectology of the State of São Paulo. Results: 90 infections related to health care were verified between January and December 2016 in patients with HIV/AIDS. Of these infections, the incidence density ratio was 13.6 (41) of primary laboratory bloodstream infections; 19.7 (28) of pneumonia associated with mechanical ventilation; 2.0 (6) for pneumonia, 2.9 (7) for infection related to central vascular access and 1.7 ( 5 ) for urinary tract infection. The highest incidence density of HAI observed in the Intensive Care Unit was pneumonia associated with mechanical ventilation, corroborating with the study by Romcy YM (2009). Conclusion: The importance of approach and application of the Bundle of Prevention of Pneumonia Associated with Mechanical Ventilation, besides the early withdrawal of invasive devices that act as important risk factors and are determinant in the occurrence of infections. P371 Care-seeking behaviors among hiv-infected adults in Mozambique: barriers and facilitators to timely enrollment in HIV care and treatment Amilcar J. Magaco1, Reka Cane2, Carlos Botao1, Francisco Mbofana1 1NATIONAL INSTITUTE OF HEALTH, Maputo, Mozambique; 2Malhangalene B, 53, NATIONAL INSTITUTE OF HEALTH, Maputo, Mozambique Correspondence: Amilcar J. Magaco Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P371 Introduction: The Ministry of Health of Mozambique pledged to eliminate vertical transmission, reduce sexual transmission by 50% and increase antiretroviral therapy coverage up to 80%. To achieve these goals, it is essential that HIV-infected persons must access HIV care services in a timely manner. However, HIV-infected persons in Mozambique are continuously accessing care and treatment services at an advanced stage of the disease. Objectives: To explore reasons why patients with positive diagnosis do not adhere to services and care of HIV, regardless of the disease stage. Methods: In-depth interviews were conducted to 90 newly diagnosed HIV-positive patients in one health facility in Maputo City and two urban and rural health facilities in the province of Zambézia. Interviews were recorded, transcribed and translated prior to analysis by NVivo. Results: According with patients, issues such as long distances to the health facility, long waiting time, lack of access to transport, lack of money, stigma and side-effects were the most frequently barriers to timely enrollment in HIV care and treatment after testing. Most of the participants living in Zambezia stated that they had difficulties of accessing to the clinic because of the distance. One of the facilitators for the timely enrollment of patients in the care and treatment of HIV is related to the fact that enrollment’s process in HIV care happens the next day after the test completion. Family support associated with the basic knowledge related to HIV was mentioned as one of the main factors that led to an early onset of ART therapy. While some patients reported that the sensation of feeling good while doing the medication is one of the factors that mostalso contributes to ART therapy adherence, others showed to feel motivated for the treatment due to the encouragement given by their social networking. Conclusion: Adherence to treatment is influenced by the desire of feeling healthy. Our results sugest that one of the major facilitators for a timely enrollment of patients in care services and treatment of HIV is the flexibilate process of enrollment in HIV care at health facilities. The stigma and side-effects were the most frequently barriers to timely enrollment in HIV care and treatment. Disclosure of Interest None Declared Challenges with endoscopes P372 Protein and atp concentrations found in clinical soil from flexible endoscopes are correlated Henning Reuter1, Maren David2, Marco Bommarito2 13M Germany, Neuss, Germany; 23M Healthcare, St Paul, United States Correspondence: Henning Reuter Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P372 Introduction: Deadly outbreaks of CRE and other MDROs, have been associated with flexible endoscopes, highlighting the importance of effective cleaning and disinfection. Objectives: The objective of this study is to quantify how protein and adenosine tri-phosphate (ATP) concentrations vary in clinical soil removed from patient-used endoscopes as the device is cleaned and disinfected. Methods: The study measured levels of protein and ATP in 89 endoscopes (48 colonoscopes, 38 gastroscopes, 3 duodenoscopes) at two US clinical sites for three points during reprocessing: bedside cleaning, post-manual cleaning, and after high level disinfection (HLD). ATP concentrations in Relative Light Units (RLUs) were determined using a luminometer. Protein concentrations in mg/mL were determined using a bicinchoninic acid (BCA) assay. A non-linear least squares regression was used to determine the relationship between the two markers. Results: A Log Normal function was found to provide the best fit to the data (solid red line, R2 = 0.72; 95% confidence intervals shown as dotted red lines). The analysis shows that ATP and protein levels are linearly correlated (dashed black line, R2 = 0.68) for protein concentrations greater than 8 mg/ml and ATP values greater than 20 RLUs (corresponding to an ATP concentration of ~7 fmoles/ml). Also shown on Deviation from linearity of the ATP-protein correlation occurs well below the intersection point of cleanliness criterions found in ANSI/AAMI ST-91:2015. A BCA assay was chosen because it has a limit of detection < 1 mg/ml. Conclusion: This study found that the concentration of ATP and protein found in clinical soil collected from patient used endoscopes, are linearly correlated to levels well-below those defined by currently accepted cleanliness criterions. Disclosure of Interest H. Reuter Employee of: 3 M Germany, M. David Employee of: 3 M Healthcare, St Paul, M. Bommarito Employee of: 3 M Healthcare, St Paul Introduction: Several recent deadly outbreaks of CRE and other MDROs, have been associated with flexible endoscopes, highlighting the importance of effective cleaning and disinfection. Objectives: The objective of this study is to quantify how clinical soil is removed from patient-used endoscopes as the device progresses through cleaning and disinfection. Methods: The study measured levels of adenosine tri-phosphate (ATP) and protein in 118 endoscopes (53 colonoscopes, 59 gastroscopes, 6 duodenoscopes) at four clinical sites (2 in the US and 2 in Germany) for three points during reprocessing: bedside cleaning, post-manual cleaning, and after high level disinfection (HLD). ATP concentrations in Relative Light Units (RLUs) were determined using a luminometer. Protein concentrations in μg/mL were determined using a bicinchoninic acid (BCA) assay. A general linear model (GLM) employing three factors (clinical site, endoscope type and reprocessing step) was used for the statistical analysis. P-values < 0.01 indicated significance. Results: GLM analysis the ATP data showed that the only significant factors were the endoscope type and the reprocessing step, whereas for the protein data, only reprocessing step was a significant factor. Importantly, clinical site was not a significant factor for either marker. Mean values of ATP and protein are summarized by workflow step and endoscope type respectively. Also shown are the differences in the means by each factor. A Tukey pairwise comparisons identified significant differences in the means. Conclusion: This study found that levels of clinical soil, characterized by the concentrations of ATP and protein, decrease as the endoscope is decontaminated, independently of clinical site. The study also found that contamination levels in gastroscopes and duodenoscopes were significantly higher than in colonoscopes at each step of the process. These findings imply that the process used to clean and disinfect these devices can only remove a fixed amount of contamination at each step, and may not be capable of properly decontaminating endoscopes with excessive initial amounts of clinical soil. Disclosure of Interest H. Reuter Employee of: 3 M Germany, M. Bommarito Employee of: 3 M Healthcare, St Paul, USA, S. Heiligtag Employee of: 3 M Germany P374 Columbu’s egg for endoscopes reprocessing traceability? Bispo S. Ana1, Carlos Palos1, Filipa Pires2 1Infection Control Comittee; 2special exams and ambulatory surgery, Hospital Beatriz Ângelo, Loures, Portugal Correspondence: Bispo S. Ana Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P374 Introduction: Hospital Beatriz Ângelo(HBA) is a JCI-accredited, 425-bed general hospital. Proving adequacy and conformity to endoscope reprocessing guidelines has quality, safety and legal implications.In HBA, endoscopies are performed at a special unit, comprising 2 Automatic Washer-Disinfector(AWD). 23 scopes are in use, with a mean daily number of 32 exams(8793 last year).The will of starting a traceability system lead to design an easy manual system, allowing the knowledge of sequence of all patients submitted to exam with each scope. Objectives: Implementing a traceability system to correlate scopes and patients. Methods: Our traceability system is a manual registry that only uses AWD validation ticket and patient’s identification tags.Tags and tickets are organized in a specific order, one folder per scope.We start by introducing the previous patient ID number(patient A) in the subsequent AWD cycle, so that this information ends up in AWD validation ticket of that cycle.In the first raw of scope’s folder, this ticket is stamped on the left. Next patient submitted to exam with that scope identification’s tag(patient B)is stamped on the right, and so on. In doing so, we are able to know:1)who underwent previous examination(patient A); 2) if the reprocessing process was valid;and 3)who was the patient that went to next examination(patient B).In the row beneath we repeat this scheme, starting with patient B post AWD validation ticket to the left and next patient submitted to exam identification tag(patient C)to the right. Results: Currently, traceability is possible for all exams performed in each scope since implementation.If any problem occurs we are able to identify every patient that underwent previous and afterwards endoscopic procedure with a specific scope.We do this without access to any software or data processing module, but only by organizing data with specific scheme, using solely AWD validation cycle ticket. Conclusion: Traceability of reprocessing processes is a gold standard for critical devices.Semi-critical devices however lack this information support, which is critical in the recent outbreaks associated to scope design.Our data organization allows any unit with standard AWD machines to have a traceability system and to proof adequate reprocessing procedure prior to any exam in any point of time, with no need of additional IT requirements. Disclosure of Interest None Declared P375 Why audit endoscopic reprocessing processes? Fernanda Vieira1, Ilda Devesa1, Alexandra Fernandes1, David Peres1, Isabel Neves1,2 1Infection Control and Antimicrobial Resistance Unit; 2Infectious Diseases Unit, Matosinhos Local Health Unit, Matosinhos, Portugal Correspondence: Fernanda Vieira Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P375 Introduction: The endoscopic technology is increasingly complex, devices reprocessing requires detailed description of the procedure and a close monitoring. We consider that current guidelines are not objective enough, and it is necessary to effectiveness monitor the washing, the most basic procedure. All medical devices should be thoroughly rinsed prior to any disinfection or sterilization process. The presence of organic matter inhibits contact with the disinfection/ sterilization agent and may interfere with the high disinfection effectiveness.Quality control of the all phases involved cleaning endoscopes has been associated with patient infections reduction. Objectives: To enhance the importance of audit endoscopy cleaning. Methods: 1. Cleaning process audit in two times, initial and after institution of corrective measures, using biochemical methods with ATP technology (RLU). Such detect dirt and infer quality of cleaning, but are not reliable for detect microbial contamination.All hospital endoscopes were audited: mechanical automatic lavage (gastroenterology and pneumology) and manual lavage (urology, gynecology and otorhinology).2. Sharing of initial audit results to the operational team and discussion of corrective measures which should be implemented. Subsequently, new audit was made to infer the improvements. Results: The endoscopes subject to mechanical automatic lavage were clean; in manual lavage we detected two nonconformity: one related with an cystoscopy and one related with a endovaginal probe. In the second audit, the results were very positive, in the cystoscopy we’ve found a reduction from 6791 to 31 RLU; in the endovaginal probe reduction from 298 RLU to 128 RLU. Conclusion: Periodic auditing for the cleaning procedure is essential as an indicator of quality control. Audits of reprocessing practices promote identification of failures and consequent opportunity for continuous quality improvement. Incorrect reprocessing steps, such as pre-cleaning and cleaning, may cause a wrong disinfection. A visual assessment is not enough. This audit using ATP technology was useful to monitor and control the process of cleaning medical devices, identifying problems, promoting improvements and patient safety. Disclosure of Interest None Declared P376 A microbiologic surveillance study of reprocessed endoscopes at MNGHA Ahmad Ibrahim, MAJED SHOMRANI, THAMER ENAZI, Mishal Johani, MOHAMAD NOR FAYZAH, Awaji Ahmed, Winger Dawn, Dagunton Nimfa, BACHU SHAKILLA, Gysman Laura, Balkhy Hanan INFECTION PREVENTION & CONTROL, MNGHA, RIyadh, Saudi Arabia Correspondence: Ahmad Ibrahim Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P376 Introduction: Gastrointestinal (GI) endoscopy is an important tool for the diagnosis and management of GI tract disorders. GI endoscopy is performed in body cavities heavily colonized with microorganisms. The reprocessing of the endoscope to allow for its use in multiple patients involves multiple steps: pre-cleaning, cleaning, disinfection, rinsing, drying, and then storage. There are effective protocols for the reprocessing of endoscopes. However the accepted time interval (hang time) for the storage of reprocessed endoscope is not well defined. There is a strong paucity of research in this area. At the MNGHA, the practice has been reprocessing every 24 hours regardless of whether the endoscope has been used or not. We decided to conduct a microbiological surveillance on selected endoscopes to evaluate any potential growth of microorganisms. Objectives: To assess if there is an association between the duration of hanging reprocessed endoscopes and contamination, the results finding will yield in changing the hang time storage of reprocessed endoscopes. Methods Four reprocessed endoscopes were selected to undergo microbiological surveillance testing at 48 hours after reprocessing and 72 hours after. Swabs were obtained from the Tip, Knob and Lumen fluid from each endoscope. A total of 240 culture samples were obtained for aperiod of 66 days. Results Of the 240 samples 5 colonies were detected. Comparison of the two groups (48 hrs & 72 hrs) showed the following : Growth of coagulase negative Staphylococcus aureus in two colonies at the tip at 48 hours but none at 72 hours. Growth of Bacillus species from the lumen fluid at 48 hours but none at 72 hours and Corynebacterium from lumen fluid in two colonies at 72 hours. These 3 pathogens are classified under ‘’low- concern bacteria” (normal commensals of skin and environment) Conclusion No growth of pathogenic bacteria was observed, concluding that any potential contamination identified during early storage could not be found.We therefore recommend that the hanging time of reprocessed endoscopes be 72 hours until the appropriate storage cabinet becomes available. In the absence of evidence-based guidelines for unresolved issues, every effort should be made in a timely and efficacious manner to ensure patient safety. Disclosure of Interest None Declared Occupational health P377 Withdrawn Introduction: The risks associated with a blood and body fluid exposure are serious in healthcare personnel(HCP). Objectives: The aim of this study is to verify the seroconversion rate of occupational exposures. Methods: An observational prospective study was done at a 2,322-bed teaching hospital in Korea from January 2010 to December 2015. The prevention approaches including education, use of personal protective equipment and safety-engineered devices has been maintained through this period and the injury rate per 100 occupied beds per year did not changed significantly(average of 21.4). At the time of self-reporting of exposure, blood sample of HCP and the source was collected for baseline HBV, HCV, and HIV serum markers. The HCP exposed, susceptible to HBV or exposed to HIV was administered postexposure prophylaxis(PEP) according to CDC recommendations. Follow-up laboratory testing was obtained on HCP exposed to HBV, HCV and HIV up to maximum 6 months. Results: A total of 2,975 injuries were reported. Percutaneous injury was the most common(88.9%), mucous membrane exposure was following(10.4%). Serologic test results of the source identified were obtained in 2,180 cases(388 HBV-positive, 188 HCVpositive, 38 HIV-positive and 11 multiple seropositive). Sixty eight among exposed HCP to HBV had Anti-HBs titers <10 mIU/mL (17.6%), 7 of them had already vaccinated. No HBV seroconversion case has been detected. No HIV seroconversion after exposure to HIV-infected source was found. Among exposed HCP to HCV, 172 were finished follow-up laboratory testing. Two cases had positive results for HCV-PCR conducted at 4 weeks after exposure and seroconversion rate was 1.2%. One was associated to disposal of a suture needle, the other was to remove a hollow-bore phlebotomy needle. Conclusion: Since most HCP is immune to HBV as the result of preexposure vaccination and PEP is used for exposures to sources known to be HIV-infected, no seroconversion of HBV and HIV was seen. HCV seroconversion rate is similar to other studies. Vaccination, prevention of percutaneous injuries and other blood exposures and prompt and appropriate PEP intervention are important in preventing the transmission of bloodborne viruses to HCP. Disclosure of Interest None Declared P379 Surgeon’s knowledge, attitudes and practices related to blood exposure in the operating rooms of a Tunisian Tertiary Care Hospital Nawel Zammit1, Mohamed Mahjoub1, Rym Bouriga2, Nabiha Bouafia1, Asma Ammar1, Hela Ghali1, Olfa Ezzi1, Asma Ben Cheikh1, Wadiaa Bannour1, Radhia hellali1, Mansour Njah1 1Hospital Hygiene; 2medical oncology, university hospital Farhat Hached Sousse Tunisia, Jawhara, Tunisia Correspondence: Mohamed Mahjoub Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P379 Introduction: Accidental blood exposure is frequent among surgeons and may cause severe consequences such HIV and hepatitis B and C infections. Objectives: To determine the Surgeon’s knowledge, attitudes and practices related to accidental blood exposure in the operating rooms of a Tunisian tertiary care hospital. Methods: Cross sectional study was conducted in the four operating rooms of a tertiary care Tunisian hospital between July and December 2016. All surgeons of the hospital were included. A self-administrated questionnaire was used to collect data about knowledge, attitudes and practices related to accidental blood exposure. Results: The prevalence of blood exposure was 79.7%. The higher prevalence was reported in Gynaecology (100%) followed by General surgery (91.7) then Ophthalmology (75%) and finally Oto-rhinolaryngology (71.4%) (p = 0.047). Gynaecologists were the most surgeons who underestimated the protective role of double gloving during interventions (29.6%) compared to the surgeons from the General surgery (16.6%), Ophthalmology (16.2%) and Oto-rhino-laryngology (0%). While this difference was not statistically significant (p = 0.27). Compared to the other surgeons, Gynaecologists were the surgeons who request serology for themselves after blood exposure the less frequently: 50% versus 75% in both: General surgery and Otorhino-laryngology and 92% in Ophthalmology (p = 0.05). Moreover, Gynaecologists were the surgeons who registered blood exposure accidents the less frequently (24%), compared to Ophthalmologists (73%), General surgeons (25%) and Oto-rhino-laryngologists (25%) (p = 0.01). Conclusion: The prevalence of accidental blood exposure in the Tunisian operating rooms is high, especially in Gynaecology. Interventions to improve the surgeon’s attitudes and practices related to blood exposure prevention are required. Disclosure of Interest None Declared Introduction: Some specialties are deemed to be at increased risk of blood exposure accidents (BEA) at hospital. Surgeons are known as the most exposed caregivers to the risk of BEA. Objectives: Our objective was to clarify the prevalence of BEA among surgeons and to describe their perceptions and practical attitudes following the occurrence of a BEA. Methods: A descriptive cross-sectional study was conducted in 2016 including all surgeons, holders or in training (residents), in surgical services of our University-Hospital that were present during the period of the study. Collection of data was made by a selfadministered pre-established and pre-tested questionnaire. Seizure and analysis of the data were made by the SPSS software v20.0 Results: Overall response rate was 83.1% (64/77). History of BEA was reported by 79.7% of the participants. BEA’s reported average number was 3. The BEA had occurred by stitch in 75% of cases. The BEA most provider specialties were: gynecology (95%), general surgery (91.7%), ophthalmology (75%) and finally the otorhinolaryngology (71.4%) (p = 0.047). Following a BEA, 25% of the victims report that they have not conducted the first care (especially no application of an antiseptic), 9.8% have consulted to emergencies, 29.4% have stated and have benefited from viral serologies and 15.7% have had the agreement of the source patients for their practice of serologies. Conclusion: Better mastery of the infectious risk linked to the BEA among surgeons remains a health issue. It is essential to opt for the strengthening of the training and information about universal measures of BEA prevention; and to opt for dissemination of safety equipment. Implementation of BEA structured prevention strategy, according to the updated and clearly defined modalities, is essential in order to better manage risks of infection and to improve quality and safety of surgical practices. Disclosure of Interest None Declared P381 Withdrawn Introduction: Needlestick injuries are most prevalent among nurses who frequently handle a syringes or needles. Objectives: The study was carried out with the aim of improving the safety behaviors and reducing the incidence of needlestick injurie through various interventions. Methods: Before and after experiment design was adopted. A total of 29 nurses in the internal medicine department of a university hospital in Seoul, Korea were conveniently sampled. The interventions included the use of needle transfer trays, lecture education, needle safety behavior video viewing, and blood sampling practice using safety devices. The needle safety behavior scores were collected by direct observation and self-assessment questionnaires. The incidence of needlestick injuries was collected through the questionnaire and reported to the infection control office. Results: The total number of injuries before intervention was 26 out of 29 subjects and decreased to 13 in post intervention surveys. The proportion of nurses who experienced needlestick injuries were significantly reduced from 89.7% before the intervention to 44.8% after the intervention (p = .033). In the selfassessment score for safety behaviors, the total score before the intervention was 38.31 ± 3.02, and the total score after the intervention was 39.97 ± 4.18 points (p = .026). The observation score of the needle safety behaviors was 6.24 ± 0.82 points at 10 points before intervention and 7.75 ± 1.24 points after intervention (p < .001). In addition, it increased from 5.13 ± 0.94 to 7.14 ± 0.89 (p < .001) for venous sampling, and from 6.35 ± 0.99 to 7.61 ± 0.8 (p < .001) for intravenous injection, and the increases were all statistically significant. Conclusion: Multimodal interventions were found to be very effective in promoting the incidence and safety behaviors of the needlestick injuries. However, there is no difference in some safety behaviors, so it is necessary to identify the cause. Disclosure of Interest None Declared Introduction: A safe injection is one that does not harm the recipient, does not expose the provider to any avoidable risks and does not result in waste that is dangerous for the community. This is the first clinical audit in the Gaza-Strip to observe the application of different protective practices while giving injections to patients. Objectives: To evaluate adherence of healthcare professionals of injections safety measures. Methods: This was a prospective clinical audit conducted in the emergency room at Al-Shifaa Hospital from January to March 2017 according to WHO guidelines. The data was analyzed using SPSS program. Results: In total, 100 cases were observed, of which 40% were for venous access. Among the performers of injections, 50% were females. Sixty percent were nurses, 20% were medical students and 20% were nursing students. The overall compliance rate for all practices was 20%. It was noted that the highest compliance rate was among nursing students (p = 0.2) and a higher rate was obtained among males than females (p = 0.3). Interestingly, the highest rate was observed for those in the 20 to 30 year age group (p = 0.4). The hands of the performer were visibly clean in all observations. Only 20% washed their hands just after patient contact. Although wearing non-sterile gloves is recommended for venous access, this was only done in 5%. Disinfecting skin with 60–70% alcohol-based solution was performed in all cases. However, inappropriate technique, touching the puncture site and no waiting for at least 30 seconds after disinfection were observed in 60%, 20% and 90% respectively. The needle and syringe were immediately discarded into a robust sharp container in 80% but recapping the needle using one-hand scoop technique was practiced in none of them while injecting blood into a laboratory tube while holding it with the other hand was done in 80%, which is not recommended, as it poses a risk for needle stick injury. Conclusion: Infection control measures concerning the administration of injections is shockingly poor among all healthcare professionals, including those still in training, who should show higher guideline adherence. As this is a serious shortfall in patient safety practices, it requires urgent address in form of implementation and training in infection control practices among healthcare staff. Disclosure of Interest None Declared P384 Factors influencing take-up rate of influenza vaccine amongst healthcare workers in a cancer centre in Singapore Ming Zhen Priscilla Han1, Whee Sze Ong2, Sin Hui Wong1 1Infection Control Unit; 2Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore, Singapore Correspondence: Ming Zhen Priscilla Han Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P384 Introduction: In Singapore, all healthcare workers who come in contact with patients and patient specimens are recommended for annual seasonal influenza vaccination. Although the seasonal influenza vaccination is free and offered at our Ambulatory Cancer Centre, the uptake among HCW has seen a gradual decline from 41% in 2007 to 28% in 2015. Objectives: The objectives of this study were to examine motivators and barriers influencing healthcare worker’s compliance with influenza vaccination; and identify modifiable factors that can improve vaccine take-up rate. Methods: A cross-sectional anonymous survey was distributed to 906 healthcare workers (HCW) at Cancer Centre with a response rate of 56% in 2016. The survey consisted of 3 sections; demographic data, vaccination history and Health Belief Model Categories Scale. Results: A total of 205 HCW (41%) were vaccinated in 2015. About half of HCW had ≥ 5 years working experience, and 74% had patient contact. HCW who received seasonal influenza vaccines in the past 5 years (p < 0.001) and those with patient contact (p = 0.05) were more likely to be vaccinated. Nineteen of the 21 HBM factors were also associated with influenza vaccine uptake (p < 0.05). On multivariate analysis, independent factors associated with vaccination uptake were ( 1 ) history of receiving influenza vaccine in the past 5 years (OR = 28.75; 95% CI, 12.01–68.83); ( 2 ) perceived protection after the influenza vaccination (OR = 2.77; 1.64-4.69); ( 3 ) concur the use of talks/ poster as reminder for influenza vaccination (OR = 2.01; 1.18-3.43); and ( 4 ) concerns about the serious adverse reactions after receiving influenza vaccine (OR = 0.41; 0.22-0.76). Conclusion: This study allowed an in-depth insight into the fundamental reasons of healthcare workers’ reluctance to receive influenza vaccination. With the identification of factors influencing vaccination, tailoring promotion programmes targeted at addressing HWC’s concerns; giving positive motivations thereby leading to increase uptake of vaccinations is invaluable. Disclosure of Interest None Declared P385 Infection control: health care workers screening at selected facilities Francina M. Tjtiuka Quality Assurance, Ministry of Health, Windhoek, Namibia Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P385 Introduction: The national Infection Control guideline recommends a package for preventing TB transmission amongst Health care workers (HCWs) The burden of TB disease among HCWs is unknown despite the high prevalence in the region. Objectives: To assess the TB burden among HCW in the region Methods: Namibia notified 10,610 cases of all forms of TB in 2013. Ohangwena region accounted for 10% of these cases and 15% of the country’s Drug Resistant TB cases. Sensitization meetings were held with the Nurse Managers and all HCWs, and symptom screening was done for all HCWs (747) with a standardized questionnaire. Symptomatic staff submitted sputum samples, which were tested using Gene Xpert. Results: Out of 747 HCW screened, 316 (42%) had at least one symptom of TB. Of these, 291 (92%) submitted sputum for further laboratory investigation with Gene Xpert. M.tb was detected in 20 (7%) of the samples; none of these had rifampicin resistance. Nurses constituted 8 (40%) of the confirmed cases Conclusion: There is a high incidence of TB among HCWs in the region, possibly due to occupational exposure. Infection Prevention and Control (IPC) measures need to be strengthen including airborne infection precautions. Nurse Manger’s need to ensure that facilities conduct risk assessment and develop facility Infection Control plans. There is a need to strengthen routine TB screening of HCWs and evaluate role of occupational exposure in TB transmission. Disclosure of Interest None Declared P386 Compliance with who tb laboratory biosafety measures in public health laboratories in Kisumu County, Kenya, 2015 Barbara K. Burmen, Tobias Oloo HIV and TB Implementation Science and Services, KENYA MEDICAL RESEARCH INSTITUTE/CENTERS FOR DISEASE CONTROL RESEARCH AND PUBLIC HEALTH COLLABORATION, Kisumu, Kenya Correspondence: Barbara K. Burmen Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P386 Introduction: In 2014, Tuberculosis (TB) laboratories (labs) in Kenya processed approximately 600,000 sputum samples.The same year, Kisumu county of Kenya had a high TB Case Notification Rate (CNR) per 100,000 population; 302 vs 210 nationally. Objectives: To assess laboratories biosafety measures in TB laboratories in Kisumu County. Methods: A cross sectional survey was conducted within TB diagnostic labs in Kisumu County in 2015 using an adopted version of the World Health Organization’s (WHO) biosafety recommendations for TB labs (18 administrative, 14 Post Exposure Prophylaxis, 22 codes of practice and 14 Lab Design measures). Overall compliance was defined adherence to at least 75% of each of the four measures. Chi square statistics were used to describe lab characteristics by compliance status. Results: Thirty-seven (32/ 86) TB diagnostic centers in the county were assessed. Majority were based in government-owned health facilities (50%), of level 3 (41%), were not undergoing accreditation (84%), had ≥2 lab technologists (49%), had a lab cleaner (94%) did not have a sample receptionist (84%), and had an average monthly workload of <20 sputum smears. Only 7 (22%) of laboratories were compliant. A significantly higher proportion of compliant labs were observed in level 4 and 5 facilities compared to level 2 and 3 (44% vs. 13%), where there was a specimen receptionist compared to where there wasn’t (80% vs. 11%), and among labs undergoing accreditation compared to those that weren’t (100% vs. 7%), (p < 0.05). A higher proportion of compliant labs was also observed among mission-owned compared to privately-owned and government-owned health facilities (29% vs. 22% and 19% respectively); and where, there were ≥2 lab technologists compared to where there was one (26% vs. 15%), there was a biosafety officer compared to where there wasn’t (29% vs. 135) and where the workload was ≥20 sputum smear per month compared to where it was less (33% vs. 10%) (p ≥ 0.05). Conversely, a lower proportion of labs that had a lab cleaner were complaint compared to where there wasn’t (20% vs 50%; p = 0.3) Conclusion: Kisumu county Lab personnel operate under suboptimal biosafety conditions. The TB control program ought to enhance and routinely monitor Tb laboratory biosafety measures. Disclosure of Interest None Declared Introduction: It is a fact that hair and beauty salon workers as well as their customers are at risk of infection. The knowledge and practice of risk prevention among this group in developing countries has been shown to be poor thus increasing the risk of infection transmission. Objectives: To determine the knowledge of occupational risk and the practice of risk prevention among hair dressers in Sabon Gari Local Government Area, Kaduna state. Methods: A cross sectional descriptive study was carried out within the months of April and May of 2016. Cluster sampling technique was used to obtain a sample of 56 hairdressers. A pretested semistructured interviewer administered questionnaire was used to elicit information from the respondents. Data was entered and analysed using IBM SPSS version 21. Chi square test or Fisher’s exact test were used as test of association between categorical variables. Results: Majority (76.8%) of the hairdressers were aware of the occupational risk associated with their work. Only 16.3% and 20% of the respondents agreed that HIV and Hepatitis (B and C) respectively can be transmitted in the salon. About three-fifths of the respondents had a good knowledge score. The practice of handwashing before each client was present in 57.1% of respondents while only 79.6% of the hairdressers used new razor blade for each client. Majority (96.4%) sterilized sharp equipment before use. The overall practice of risk prevention was found to be good in 68.5% of the respondents. There was a statistically significant relationship between level of education of the respondents and knowledge score(P = 0.003). However, no statistically significant relationship was found between their knowledge and practice of risk prevention (P = 0.713). Conclusion: Although the overall knowledge and practice of risk prevention was found to be high, their knowledge and practices on certain aspects of the risk was unacceptable. It is recommended that the local government health authorities should institute specific health trainings focused on deficient areas in order to prevent spread of infections. Disclosure of Interest None Declared P388 Development of an exposure decision pathway in a suburban fire department Christine McGuire-Wolfe1,2, Donna J. Haiduven1 1Global Health, University of South Florida College of Public Health, Tampa; 2Infection Control Officer, Pasco County Fire Rescue, Land O'Lakes, United States Correspondence: Donna J. Haiduven Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P388 Introduction: Pasco County Fire Rescue (PCFR) provides fire suppression and emergency medical services (EMS) response in a suburban area of Florida (United States). The department employs approximately 475 emergency medical technicians (EMTs) and paramedics and operates 24 hours a day, 365 days a year. Exposure responses are necessary 24 hours per day, including when the Infection Control Officer (ICO) is not in the office. Objectives: The objective of this project was to develop a system to assist field personnel without background in infection prevention in forming a decision regarding exposure response when the ICO was not in the office. Methods: Current guidelines from the United States Centers for Disease Control and Prevention were used to develop a summary decision pathway. Once the questions in the pathway were answered, a “level” was determined which instructed the employee that immediate, moderate, or delayed response from the ICO was appropriate. Results: A color-coded algorithm was developed to detrmine decision levels for each possible exposure situation. For example, questions that indicated a bloodborne pathogen exposure may have occurred were coded green and required an immediate notification of the ICO. Suspicions of exposure to tuberculosis were coded yellow, as baseline testing could be arranged during the next business day. Conclusion: Implementation of a color-coded, binary decision pathway has empowered field personnel to seek professional guidance from the Infection Control Officer when appropriate and has reduced unnecessary after hours calls for issues that could be appropriately delayed until normal working hours. Disclosure of Interest None Declared P389 The role of an infection preventionist in a fire department providing emergency medical services (EMS) response Donna J. Haiduven1, Christine McGuire-Wolfe1,2 1Global Health, University of South Florida College of Public Health, Tampa; 2Infection Control Officer, Pasco County Fire Rescue, Land O'Lakes, United States Correspondence: Donna J. Haiduven Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P389 Introduction: Emergency Medical Services (EMS) personnel are not typically included in discussion regarding traditional healthcare workers. However, EMS personnel operate in an environment that increases the risk for exposure to pathogens. Pasco County Fire Rescue utilizes approximately 475 emergency medical technicians (EMTs) and paramedics to provide emergency medical services in the community. Infection Prevention services are provided by the Infection Control Officer (IC0). Objectives: The objectives of this project were to: 1) describe exposure scenarios to personnel within a Fire Department and 2) to demonstrate how such exposures justify the need for an Infection Preventionist in this type of setting. Methods: The two week period from February 1st to February 14th, 2017 was reviewed to delineate the issues and concerns that required attention from the ICO. Results: Within a 14 day period, 4 significant exposures were reported by field personnel (EMTs and paramedics): 1) scabies 2) norovirus 3) hepatitis B and 4) hepatitis C. In addition, the ICO continued to work to promote voluntary tuberculosis (TB) screening program that was implemented. During this time period, the ICO also participated in a newly formed coalition of community partners assembled by the local Health Department to address a significant increase in acute Hepatitis B cases locally. Conclusion: There is a demonstrated need for the guidance and expertise of an Infection Preventionist within agencies providing EMS response. Disclosure of Interest None Declared Coated surfaces P390 Nanoshield surface coating protection combination with cleaning product cleaner for removal bacterial contamination Lenka Michalikova, Sona Hnilicova, Jaroslava Brnova Department of Laboratory Medicine, School of Health Sciences and Social Work, Trnava University, Trnava, Slovakia Correspondence: Lenka Michalikova Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P390 Introduction: NANOSHIELD (Nanosystem s.r.o) is a nanotechnology products for surface protection, especially for concrete surfaces, interior and exterior plaster, painted and unpainted metals, glass, natural and synthetic textiles, ceramics and plastics. Combination with cleaning product Cleaner (Nanosystem s.r.o.) inhibited bacteria and destroyed its molecular structure by disrupting the membrane of their cells. It has high cleaning and antibacterial properties. There is no need to use gloves or other protective equipment due to its natural composition. Objectives: We performed monitoring of bacterial contamination in a public toilets using an ATP bioluminescence assay (3 M). We compared bacterial contamination on NANOSHIELD treated surface cleaned with CLEANER and surface without NANOSHIELD cleaned with traditional cleaning products. Statistical analyses were performed using R-project and P < 0, 05 were considered significant. Methods: We performed monitoring of bacterial contamination in a public toilets using an ATP bioluminescence assay (3 M). We compared bacterial contamination on NANOSHIELD treated surface cleaned with CLEANER and surface without NANOSHIELD cleaned with traditional cleaning products. Statistical analyses were performed using R-project and P < 0, 05 were considered significant. Results: NANOSHIELD was applicate on different surface in public toilets (button flushing, toilet seat, interior door handle on the toilet, faucets, flush). Median RLU on surfaces in public toilet treated with NANOSHIELD cleaned with CLEANER was significant lower (P < 0,05) than surface without NANOSHIELD cleaned with common cleaning products [80 RLU (IQR = 101 – 1569) vs. 2325 RLU (IQR = 1481 – 8483); P < 0,05]. Conclusion: On the basis of the measurements ATP, surfaces treated with NANOSHIELD plus CLEANER have significant lower bacterial contamination than surface without NANOSHIELD cleaned with common products. Further studies are necessary to assess the effect this products on microbial contamination of environment, especially in health care setting. Disclosure of Interest None Declared P391 “A multi-level antimicrobial coating for patient privacy curtains: implication of a new system to combat hospital acquired infections (HAIS)” Awais Farid1, King L. Yeung2 1ENVR; 2CBME, Hong Kong University of Science and Technology, Kowloon, Hong Kong Correspondence: Awais Farid Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P391 Abstract video clip: Background: Microorganisms are ubiquitous in the environment. Many bacteria including multi-drug resistant organisms (MDRO), such as Methicillinresistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter Baumannii (CRAB), multi-drug resistant Acinetobacter (MDRA) and Vancomycin-resistant Enterococcus (VRE), can survive and persist in the hospital environment, and cause significant mortality and morbidity among patients. Although significant efforts have been made to disinfect hard surfaces in the hospital environment, soft and porous materials such as hospital textiles have been generally ignored. This study aims to investigate the efficacy and long-term performance of a new multi-level antimicrobial system for hospital textiles via laboratory investigation to implement in hospital environment for future. Methodology: A cationic antimicrobial coating in a compatible micellar structure was produced in the laboratory to generate contact-killing and antiadhesion property from FDA-approved polymeric materials. An interventional study was designed to assess the antimicrobial activity of polymeric coating against most commonly found hospital acquired infections. The study was completed in 6 months by analyzing the log reduction in treatment arm (antimicrobial coating) against control arm (bleach) on patient privacy curtains. Results: The results of 1 minute contact time of targeted pathogens including MDRO with coated surface on patient privacy curtains in lab showed more than 3 log reduction and 99.97% antimicrobial efficacy. This new micellar antimicrobial formulation has proved to be very efficient against common bacteria, pathogens and MDROs found in the hospital environment. Results also demonstrated the formulation to be durable and providing long-term surface disinfection against microorganisms. Conclusion: As a consequence, this will have the beneficial impact of reducing the risk of transmission of pathogens from environment to patient host, and thus lower the number of HAIs. It will have an immediate impact of decreasing the viability of MDRO and other pathogens in the environment, reduce transmission of diseases and improve both individual wellness and public health. Disclosure of Interest None Declared P392 Impact of thermal and mechanical treatment simulating long-term use on antimicrobial effectiveness of selected copper alloys intended for use as touch surfaces in healthcare facilities Anna Różańska1, Agnieszka Chmielarczyk1, Dorota Romaniszyn1, Małgorzata Bulanda1, Monika Walkowicz2, Piotr Osuch2, Tadeusz Knych2 1Chair of Microbiology, JAGIELLONIAN UNIVERSITY MEDICAL COLLEGE; 2Faculty of Non-Ferrous Metals, AHG University of Science and Technology, Kraków, Poland Correspondence: Anna Różańska Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P392 Introduction: An enhancement for traditional disinfection methods used in healthcare facilities are touch surfaces made from materials with antimicrobial properties, including copper alloys. A certain downside of copper alloys is their susceptibility to oxidation, which in some extent decreases aesthetic qualities. Therefore, studies concerning the selection of the best antimicrobial effectiveness and utility values for alloys are conducted in different centers. Objectives: The aim of this work was to assess the antimicrobial properties of selected copper alloys, after thermal and mechanical treatment simulating long-term use Methods: The present study involved representatives of Grampositive (S. aureus) and Gram-negative (E. coli) bacteria. The experiments employed two variants of the so-called wet exposure – bacterial suspension in NaCl vs. TSB (simulation of clean and dirty environmental conditions), in time periods from 30 to 300 min and quantitative culture. Results: The highest efficiency of ETP copper was confirmed along with bacteriostatic and bactericidal properties for the studied alloys. As regards individual strains tested, a slightly different rate of complete reduction in bacterial suspension density was observed, compared to the results of other authors. For bacterial suspension in NaCl, complete reduction was observed in under 30 min for EC and 120 min for SA, depending on the alloy. For suspension in TSB (SA and EC, simulation of dirty conditions), for each of the alloys tested, reduction higher or equal to 3log was observed in less than 300 min. No significant differences were found as regards the efficiency of antimicrobial activity for non-oxidized alloys and the ones with smooth surfaces, in comparison with alloys subjected to thermal and mechanical treatment (simulation of oxidation and microdamage to the surface during normal use). Conclusion: Prolonged use of touch surfaces made from copper alloys does not influence the effectiveness of their antimicrobial activity. The project was financially supported by The Polish National Center for Research and Development awarded on the basis of decision PBS3/A9/32/2015 Disclosure of Interest None Declared P393 Effects of surface stain and wiping using detergents on antibacterial activities of copper Hiroshi KAWAKAMI, Pengyuan WANG, Yoshihiro SATO, Yasushi KIKUCHI Department of Mechanical and Physical Engineering, Osaka City University, Osaka, Japan Correspondence: Hiroshi KAWAKAMI Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P393 Introduction: Frequently hand-tuched places in hospitals and health care facilities are periodically wiped using detergents. While the wiping will reactivate antibacterial activities of copper, which are inactivated by surface staining, the detergents may degrade the surfaces and inactivate antibacterial activities of copper. Objectives: Effects of oily surface stain and wiping using detergents on antibacterial activities of a copper were investigated. Methods: Sample used was oxygen free copper (>99.6%). Triolein was employed as a model surface stain. Detergents used for wiping were hypochlorites (NaOCl aq.) and ethanol (EtOH). The test surface of specimens was firstly stained by triolein and then subjected to wiping using a sterile wipe loaded with a detergent. The strain used was E. coli (NBRC 3972). Antibacterial tests were carried out according to the ISO 22196. All data reported were the averages of at least three replicate data sets. The Scheffé test was employed for multiple comparison test and a p-value of less than 0.05 was considered statistically significant. Prior to application of the Scheffé test, analysis of variance was carried out to confirm the significance of the data. Results: The bacterial counts for specimens wiped using the detergents were not significantly different from the value for specimens with clean surface (<10 colony forming unit (CFU)). Antibacterial activities of specimens immersed in a detergent for 24 hours were also measured. While the bacterial counts for EtOH treated specimens were about 10 ~ 20 CFU, the bacterial counts for NaOCl aq. treated specimens were 10 ~ 1.0 × 105 CFU depending on the concentration of free available chlorine. Conclusion: Wiping using detergents, as well as dry wiping, reactivates antibacterial activities of copper, which was inactivated by oily surface staining. Hypochlorites can be harmful to copper surfaces: the wiping using hypochlorites degrades copper surfaces resulting in inactivate antibacterial activities of copper. Further study on the effects of hypochlorites on the antibacterial activities of copper under practical conditions are required. Disclosure of Interest None Declared Introduction: The antimicrobial activity of copper is recognized and it is used as an antimicrobial agent. Objectives: To evaluate the antimicrobial activity of copper against microorganisms obtained from chronic cutaneous wound infections. Methods: We developed a prospective study on bacteria isolated from wound patients and evaluated the antimicrobial activity of five copper particles. These particles were characterized by UV spectrophotometry assays, X-ray diffraction, scanning electron microscopy and mass spectrometry. The activity was evaluated by minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) by macrodilution method following CLSI recommendations. Internationally required ethical standards were met. Results: 104 baterial strains were isolated from 74 patients, 12 of these strains presented multiresistance and were used with five Cu + 2 ions. We selected two copper particles, the MIC for acetate monohydrate copper has an average of 826.6 μg / ml, with ranges of 400 to 1200 μg / ml and mode of 1000 μg / ml. For nitrate trihydrate copper the mean MIC was 1133.3 μg / ml, with ranges from 400 to 1800 μg / ml and 1000 μg /ml. The MBC ranges for acetate monohydrate copper was 600 μg / ml to 2000 μg / ml and for nitrate trihydrate copper was 400 μg / ml to 1600 μg / ml. Conclusion: 1) The release capacity and antibacterial activity determining that both compounds, acetate monohydrate copper and nitrate trihydrate copper are capable of eliminating resistant bacteria; 2) The MIC and MBC values are very close showing high antimicribial activity in safe ranges for humans. Disclosure of Interest None Declared P395 Effective antimicrobial banknotes for preventing cross contamination Henri ROSSET1, Nathalie VAST2, Jean GARNIER3, François RENAUD4 1Research & Development, ARJOWIGGINS SECURITY, APPRIEU; 2Marketing, ARJOWIGGINS SECURITY, Paris, France; 3Silkscreen Laboratory, SICPA SA, Prilly, Switzerland; 4Education, Lyon 1 University, Lyon, France Correspondence: Henri ROSSET Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P395 Introduction: Banknotes carry bacteria, fungi and virus. Thus, banknote handling could lead to the potential risk of cross contamination. Objectives: To manage this risk, we have adopted a new approach by enhancing the antimicrobial performance of banknotes through the use of specific active components incorporated in the banknote paper (Bioguard®) and in post-printing varnish (SICPAPROTECT®). Methods: Specimen banknotes for the study were treated by means of 2 processes: incorporation of agents in the paper (Bioguard®), and/ or incorporation of agents in the post-printing varnish (SICPAPROTECT®). The antibacterial activities of the specimens have been measured by means of the standard ISO 20743 against Staphylococcus aureus (SA) and Escherichia coli (EC). Antifungal activity has been assessed using the AATCC test method 30:2004 part III with Aspergillus niger (AN). Moreover, treated Bioguard® paper has been studied in a field test on Philippine banknotes. Results: The antimicrobial performances of untreated and unvarnished paper were 78% (SA) and 16% (EC). The unvarnished but treated paper (Bioguard®) showed antimicrobial activities of up to 99.6% (SA) and 99.01% (EC). Varnished and treated paper has even higher performance of 99.84% (SA) and 100% (EC). Untreated paper with post-printing varnish SICPAPROTECT® containing agents against pathogens showed antimicrobial performance of 98.7% (SA) and 99.73% (EC). In the real-life circulation test, uncirculated treated banknotes showed antibacterial performance between 99.98% and 100% against SA and EC. The performance remained at 99.97% (SA) and 100% (EC) for banknotes after 8 and 12 months in circulation. Most of the circulated banknotes were protected against AN. Conclusion: Effective antimicrobial performance of treated banknotes with Bioguard® can be observed. The banknotes with Bioguard® treatment and/or SICPAPROTECT® varnishes can achieve durable antimicrobial performance. Using banknotes with Bioguard® paper and/or post-printing varnishes SICPAPROTECT® could be an efficient way for reducing transmission risk of germs during banknote handling. Disclosure of Interest None Declared Global health P396 Effectiveness of public health education by lecture on improving the knowledge, attitude and practices on leptospirosis and its management among adolescents in a public school in Manila Jenna Angela D. Rubio1, carlos T. Nunez2, jennie A. Wong2 1Pediatrics, Pamantasan ng Lungsod ng Maynila-Ospital ng Maynila Medical Center, Las Pinas; 2Pamantasan ng Lungsod ng Maynila-Ospital ng Maynila Medical Center, Manila, Philippines Correspondence: Jenna Angela D. Rubio Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P396 Introduction: Leptospirosis is endemic worldwide. Based on the Philippine Pediatric Society Disease Registry, there were 800 cases of leptospirosis from May 2006 to August 2016. Making it a public health concern for health care facilities. Case fatality rate is about 89%, with increased prevalence of the disease among adults and adolescents. Objectives: To evaluate the effectiveness of public health education by lecture on improving the knowledge, attitude and practices about leptospirosis among adolescents in grade 7-10 in a public school in Manila. Methods: This is a prospective cross-sectional analytical study design. A pre-tested, self-administered questionnaire was administered among 357 students in a public school in Intramuros, Manila. Lecture regarding leptospirosis was done by the author. A post-test was done after the lecture. Statistical method used was Paired t-test. Results: A total of 357 students were included in this study, with 88.37% response rate. Total mean pre-test knowledge score was 88.64% for the topic of leptospirosis. For the attitude associated with leptospirosis, total mean pre-test score was 80.97%. For the practices related to leptospirosis, respondents had a total mean pre-test score of 72.12%. Pre-test knowledge scores were compared to the posttest scores. After a lecture was conducted, there was a significant increase on their knowledge on leptospirosis (p = <0.0001). There was also an improvement on post-test scores on attitude, as well as the practices regarding leptospirosis (p = <0.0001). Conclusion: The results showed that there is a significant improvement in knowledge, attitude and practices for leptospirosis after an informative lecture. Positive attitude should be complemented with knowledge, to enhance the ability of individuals to integrate preventive measures into daily practice. One of the more important findings in this study, with respect to public health impact, is increasing the awareness regarding leptospirosis may help in the prevention of the disease in the adolescent population. Disclosure of Interest None Declared Introduction: Delayed screening of emerging infectious diseases may lead to a massive epidemic such as that of the Middle East Respiratory Syndrome (MERS) in Korea in 2015. Objectives: Severance is a 2,400-bed hospital treating more than 16 thousand patients from abroad annually, demands for a system that promptly discovers and isolates patients with an emerging infectious disease. Methods: In January 2016, an emerging infectious disease CP was developed by the Infectious Disease Response Team. Information on countries of breakout and symptoms of emerging infectious diseases were posted on the electronic bulletin board and was updated weekly. When patients were admitted or visited the hospital, the physician in charge was instructed to record countries of recent visit, date of entry, and symptoms. Patients with suspected emerging infectious disease were transferred to the negative pressure isolation room located outside the hospital, and patient information was text messaged to the director of infectious diseases. Once the director of infectious diseases activated CP, the patient information was forwarded to all members of the infectious disease response team, and the medical staff provided care with proper personal protective equipments. Furthermore, patients were reported to the public healthcare center then transferred to the designated isolation hospital according to the instructions by the Korea Centers for Disease Control. Results: Six patients were CP-activated as suspected MERS patients from February, 2016 to January, 2017. With the exception of two patients whose CP was deactivated after being treated, the remaining four patients underwent the standard procedure and were transferred to a nationally designated isolation hospital in an average of 4 hours and 30 minutes. We were able to minimize worker exposure to MERS suspect patients to an average of 17.5 people, and the management protocol for exposed individuals was concluded when all of the suspected case results were negative on the MERS test. Conclusion: The CP for emerging infectious diseases was effective in minimizing exposure time and individuals that were exposed by standardizing the early response protocol for patients suspected to have an emerging infectious disease. Disclosure of Interest None Declared P398 Effects of local climate variables on the dengue morbidity in Davao Region, Philippines Jesavel Iguchi1, Xerxes Seposo1, Yasushi Honda2 1Graduate School of Comprehensive Human Sciences; 2Faculty of Health and Sports Sciences, University of Tsukuba, Tsukuba City, Japan Correspondence: Jesavel Iguchi Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P398 Introduction: Dengue fever is a major public health concern. It causes 390 million infections annually ( 1 ). It is one of the significant causes of hospitalization and death among young children in the Philippines ( 2 ). According to CDC, dengue is highly sensitive to climate where temperature, precipitation, and humidity are critical to mosquitoes’ survival, reproduction, and development ( 3 ). Objectives: This study aims to evaluate the effects of climate variables on the dengue morbidity in Davao Region, Philippines. Methods: The secondary data, i.e., the weekly dengue incidences (2011-2015) in Davao Region, Philippines were obtained from the Department of Health-Davao (DOH-Region IX). The case classifications are suspected cases and are not laboratory confirmed. For the weekly local climate variables, the data were obtained from the National Oceanic and Atmospheric Administration (NOAA-USA, NCDC) website. The report covers the weekly average temperature, rainfall, and dew point. Using a Poisson regression combined with distributed lag nonlinear model (DLNM), we evaluated the non-linear and delayed effects of climate variables on the dengue incidences. Wavelet coherence analysis was also used to detect dengue periodicity. Results: From the time series plot of weekly dengue incidences by year, we found peaks of dengue incidences around the months of June, July, August and September which are the rainy months in the Philippines. The wavelet coherence analysis showed that there were strong coherence between dengue incidences and rainfall between the year 2012-2015. The DLNM showed, that the estimated effect of rainfall on dengue cases obviously differed for low and high cumulated rainfall. There was a high Relative Risk (RR) at high cumulated rainfall for the period of 8 weeks (lag 8). And there was a rapid increase of RR at above cumulative rainfall of 80-100 mm. Conclusion: Our results showed that climate variables affects dengue incidences. In particular, we found that rainfall is positively correlated with dengue incidences. Introduction: Malaria is a serious public health burden in Cameroon. Accurate diagnosis of malaria is essential for the avoidance of unnecessary presumptive treatment. Notwithstanding the benefits of blood-based tests, their invasive nature requires trained personnel and raises the risk of accidental transmission of infectious diseases. To overcome these obstacles, alternatives were explored. In contrast to blood, saliva presents a reduced biohazard and can be painlessly collected in relatively large quantities by individuals with moderate training. Objectives: Determine the sensitivity of saliva comparing to blood in the molecular detection of Plasmodium falciparum using PCR. Methods: A cross-sectional study was carried out in the Obala (centre region) and Kumba district hospitals (South west region). Blood and saliva were collected from each participant and analyzed by nested PCR, targeting the species-specific nucleotide sequence of the small subunit ribosomal RNAgene (18S rRNA) of P. falciparum. R-software version 3.0.2 was used to carry out the statistical analysis. Results: From the 100 participants included, 52% was male and 48% female with a sex ratio male / female of 1.08. Malaria prevalence using PCR was 57% and 35% respectively with blood and saliva. When compared to blood, saliva showed a sensitivity; specificity; positive predictive value and negative predictive value of 49.20%; 71.42%; 75.60% and 43.85%. The agreement between saliva and blood was weak but significant (к = 0.181; p-value = 0.024). In addition, the observed agreement (57.14%) was higher than the expected (47.67%). Conclusion: Saliva is a suitable alternative specimen for malaria diagnostic and epidemiological surveillance. Disclosure of Interest None Declared P400 Detection of plasmodium falciparum DNA in human saliva: loopmediated isothermal amplification for malaria diagnosis Palmer MASUMBE NETONGO1, Ardin Marius OUAYOUE NOUTONG1, Severin Donald KAMDEM2, Barbara ATOGHO-TIEDEU1, Jean Paul CHEDJOU1, Theophile Patrick DJIOKENG2, Sophie WANKIO2, Obadia KENDJI3, Jessica YONGA1, Eric Berenger TCHOUPE KAMOUA1, Prisca DJIVIDA1, Irene DOMKAM4, Magatte NDIAYE5, David VISANUVIMOL6, Wilfred MBACHAM1, Rose LEKE7 on behalf of The MOLECULAR DIAGNOSTICS RESEARCH GROUP 1Biochemistry, University of Yaounde I; 2Microbiology/Immunology, School of Health Sciences, Catholic University of Central Africa, Yaounde, Cameroon; 3University of Hawaii, Honolulu, United States; 4Centre International de Reference Chantal Biya, Yaounde, Cameroon; 5Université Cheikh-Anta-Diop, Dakar, Senegal; 6DNA Genotek inc, Ottawa, Canada, 7Biotechnology centre, University of Yaounde I, Yaounde, Cameroon Correspondence: Ardin Marius OUAYOUE NOUTONG Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P400 Introduction: Current malaria diagnostic methods use blood which increases the risk of blood-borne infectious diseases. Saliva is readily available and easy to collect but has not received much attention hitherto. Molecular methods such as PCR showed great benefit but the high cost and availability only in well-equipped laboratories render this technique inadequate for routine diagnosis. Recently, a new, rapid, simple, and sensitive molecular technique called Loopmediated isothermal amplification (LAMP) was developed. Objectives: Assess the sensitivity and specificity of LAMP for the detection of Plasmodium falciparum DNA in saliva of malaria patients. Methods: From 1st to 23rd December 2015, 100 febrile patients referred to the District Hospitals in Kumba and Obala towns found in the South-West and Centre Regions of Cameroon participated in the study. Saliva and blood samples were collected and analyzed by LAMP, targeting the species-specific nucleotide sequence of the small subunit ribosomal RNA gene (18S rRNA) of P. falciparum. Rsoftware version 3.0.2 was used to carry out the statistical analysis. Results: When compared to LAMP Blood as standard, the Observed Agreement of Saliva-LAMP was 49% against an Expected Agreement of 43.88% (кappa = 0.091, Standard Error = 0.064, Z = 1.42, P value = 0.078). The sensitivity was 44.04%, a Positive Predictive Value of 90.24% while specificity was 75% with a Negative Predictive Value of 20.33%. Conclusion: LAMP technology matches the WHO recommendations for an ideal diagnostic test for developing countries. Considering the field adaptability of LAMP technology and the ease of saliva sampling, further research into the method is worthwhile. Disclosure of Interest None Declared P401 The roles of periplaneta americana cockroaches in dissemination and genetic alteration of Oral Polio Vaccine (OPV) virus in Nigeria Okikiola M. Olajide1, Olajide O. Agbede2, Amase Nyamngee2, Bamidele S. Oderinde3 1Microbiology, Ahmadu Bello University, Zaria; 2Medical Microbiology and Parasitology, University of Ilorin, Ilorin; 3Microbiology, University of Maiduguri, Maiduguri, Nigeria Correspondence: Okikiola M. Olajide Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P401 Introduction: Poliovirus is an enterovirus transmitted by the faecaloral route. The Oral Polio Vaccine (OPV) given to children in Nigeria continues to be shed in faeces weeks after vaccination. Objectives: As the polio eradication programme in Nigeria progresses, it is expedient to confirm the role of coprophagous insects such as cockroaches, known to feed on sewage, in the transmission and genetic modification of the virus. Methods: In-bred Periplaneta americana cockroaches were fed with trivalent oral polio vaccine (tOPV) and their products were harvested continuously for 30 days for virus isolation by culture on L20B and Rhabdomyosarcoma cell lines. Samples collected from both test and control groups of cockroaches in 30 days (faeces, saliva, body, legs, shedded skin and oothecae) were processed and 200 μl of the resulting supernatant was inoculated on the respective monolayered cell lines. Positive samples identified with evidence of cytopathic effects were harvested and intratypic differentiation (ITD) screening was carried out using rRT-PCR. Results: Faecal samples of days 1, 3, and 5 had poliovirus serotypes P1, P2, P3; P1; and P1 respectively. The saliva collected on day 1 also had P1, the body collected on day 1 had P3, and the oothecae had the three serotypes. The Sabin vaccine-derived poliovirus (VDPV) assay done using rRT-PCR showed that there was no genetic change in the virus isolated and none had sequences divergent to Sabin strains present in tOPV. Conclusion: Results showed that it is possible for Periplaneta americana cockroaches to mechanically transmit poliovirus at the earliest stage of contact especially through the faeces, saliva and body. Genetic modification of the tOPV virus does not occur within Periplaneta americana cockroaches, however, some serotypes of the virus are lost in the cockroaches. The study suggests that the oothecae could be a key source of infection, and also shows the higher potency of poliovirus serotype 1 followed by type 3. Introduction: Trichomoniasis is one of the most common sexually transmitted disease that caused by trophozoite Trichomonas vaginalis. This parasite can infect urogenital tract in women. The most important point about this infection is diagnosis and treatment of the patients and their sexual partners, in order to prevent from vaginal discharge with an unpleasant smell, vaginal spotting, genital burning or itching, frequent urge to urinate, pain during urination or sexual intercourse. This infection also has impact on premature rupture of membranes and low birth rate,as well as it is considered to be a significant cause of neonatal morbidity. Objectives: In the present study the referring women’s samples were investigated with direct smear, staining, culture and indirect immunoflourscent antibody methods for Trichomonas vaginalis infection. Methods: This study was conducted on 120 women who were referred to health centers in Rasht city, Iran. The history of the patients was collected by questionnaires. The vaginal-cervical secretions were collected for direct and staining methods as well as for TYI-S-33 culture media. Meanwhile the serum samples also were collected for doing immune-fluorescent antibody (IFA) test. Results: Out of 120 women that were checked by gynecologist, some suspected patients based on their clinical observation/complain had faced. But only one of them was confirmed by culture media and direct smear (0.83%). By using IFA test, the numbers of infected patients to Trichomonas vaginalis were increased to seven (5.83%). All these infected patients were symptomatic for trichomoniasis. Conclusion: The sexually transmitted diseases have similar symptoms and signs in the patients, thus it is recomended the gynecologist use the laboratory diagnostic methods in order to prescribe the suitable drugs. Using culture media as diagnostic method has special criteria for its growth, however contamination with bacteria is a major problem, other methods in this study also have low sensitivity and specificity, however due to high sensitivity and specificity of IFA test, using this method is recommended. Although the infected men are mostly asymptomatic, but it should be considered that the couple’s treatment is simultaneously. Disclosure of Interest None Declared P403 Confirmatory assays for detection of neisseria gonorrhoeae using real‐time pcr base methods Edobor P. Imarenezor Microbiology, Federal University Wukari, Taraba State, Wukari, Nigeria Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P403 Introduction: Ever since the advent of molecular techniques, diagnosis of Neisseria gonorrhoeae has been ruin by false positive results when compared with culture, which is currently the gold standard. False positives results are often due to the cross‐reaction of nucleic acid amplification test (NAAT) with closely related non-pathogenic Neisseria species. Objectives: This study aimed to institute and compare the sensitivity and specificity of previously available N. gonorrhoeae real‐time assays which target the following genes: porA pseudogene and cppB gene. Methods: Optimization of the PorA pseudogene real‐time PCR was carried out by varying the concentration of magnesium chloride as follow: 5 mM ranges between 19.08 (4.31) and 23.27 (17.57), 4 mM ranges from 17.18 (1.15) and 22.01 (16.43) and for 3 mM the ranges is from 21.71 (2.20) and 27.33 (15.27) with the standard deviation in bracket and as well as the forward and reverse primers which has varying concentration as 50 mM, 300 mM and 900 mM for both the forward and reverse primers. Results: The 30 non gonococci specimens gave negative results. This shows that PorA pseudogene real time PCR is a suitable assay for the confirmation of putative N. gonorrhoeae cultures and can assist in identification. The potential of the PorA pseudogene real‐time PCR to detect the presence of N.gonorrhoeae specific DNA directly from clinical samples was then evaluated. An initial experiment was performed which involved the addition of a primer and probe set which acted as an internal control, it was determined that the internal control did not compromised the sensitivity of the PorA pseudogene real‐time PCR assay and could be used reliably to screen for assay inhibition. The PorA pseudogene real‐time PCR was then used to examine some clinical specimens which had been examined previously at three laboratories, each of which different commercial N. gonorrhoeae NAAT platforms was used. The results from this investigation show a high specificity evidence of PorA pseudogene real-time PCR when compared to previous results obtained from the other laboratories. Conclusion: The study has succeeded in establishing to very large extent that the PorA pseudogene real‐time PCR is a very valuable assay for the detection and confirmation of N. gonorrhoeae specific DNA from both putative cultures and directly from clinical samples. Disclosure of Interest E. Imarenezor Employee of: federal university wukari, taraba state Environmental control and cleansing P404 Effectiveness of isopropyl alcohol and ultraviolet based sanitizer on decontamination of mobile phones used by dental personnel Srikanthan Sriram, Parangimalai Diwakar Madan kumar PUBLIC HEALTH DENTISTRY, RAGAS DENTAL COLLEGE & HOSPITAL, CHENNAI, India Correspondence: Srikanthan Sriram Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P404 Introduction: Mobile phones have become an inevitable mode of communication. Dental office and the dental operators along with their personal equipment (mobile phones) are exposed to numerous pathogens as a part of their profession, which serve as an exogenous source of nosocomial infection. Objectives: This study aimed at assessing the effectiveness of isopropyl alcohol and a customized Ultaviolet chamber,in decontamination of mobile phones. Methods: A cross sectional study was carried out on 30 touch screen mobile phones belonging to dental professionals in a college setting. Swabs were collected along the screen, camera lens and on/off buttons of mobile phones which are frequently contacted. Swabs were streaked onto nutrient agar (NA) and incubated at 37 °C for twenty four hours for assessment of microbial load before and after the disinfection procedures. The disinfection process was performed using 70% isopropyl alcohol and an Ultra Violet chamber (TUV/15 W/ G15 T8). Mann Whitney- U test was used to compare the values between the two groups. Wilcoxon Signed Ranks Test was used to compare the values within each group Results: There was a statistically significant reduction in the mean number of colonies (p = 0.001) after decontamination by the two groups (Isopropyl alcohol and UV chamber) indicating that both agents were effective in disinfection. The reduction in microbial load in the mobile phones post intervention was 79.89% in the isopropyl alcohol group and 71% in the UV chamber group. Conclusion: The study concluded that the percentage reduction in microbial load of the mobile phones was better with isopropyl alcohol compared to UV chamber. It is recommended that mobile phones in the dental setup be regularly decontaminated and dentists must adhere to strict infection control protocols specifically in relation to hand hygiene. Disclosure of Interest None Declared P405 Mobile phones: a boon or bane in the hospital setting? James M. Maragia Laboratory, Lodwar County and Referral Hospital, Lodwar, Kenya Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P405 This abstract is not included here as it has already been published. Introduction: Stethoscopes may serve as vectors in the transmission of infectious agents. Objectives: Evaluate efficacy of introducing an alcohol-free wipe (AFW) in reducing biological burden in stethoscopes (BBS). Evaluate stethoscopes cleaning practices. Methods: A quasi-experimental before and after study was performed in a general medical ward during 11/2015. All healthcare workers or students using a stethoscope were included after consent. Introduction of AFW Mikrobac®), 5-minute talk and response to a questionnaire evaluating hand hygiene and stethoscopes cleaning practices composed the intervention. BBS was measured with a bioluminescence ATP monitoring device. Continuous variables were summarized by median and interquartile range, while categorical variables were presented as proportions. Statistical significance was admitted when p < 0,05. Results: 144 individuals were included in the study, 72 preintervention and 72 post-intervention. A significant reduction in BBS was noticed [Median ATP count:73(IQR 27–379,5) VS 31,5(IQR 5104,25), p = 0,001]. In pre-intervention evaluation, 11(15,3%) individuals reported cleaning before and after each patient and 27(37,5%) reported weekly cleaning. After intervention, 27(37,5%) professionals reported daily cleaning and 23 (31,9%) cleaned every other day. Before intervention 36 (50,0%) individuals used dressings soaked in alcohol for cleaning and 28 (38,9%) dressings soaked in alcoholic hand hygiene solution; after intervention 41 (56,9%) professionals reported use of AFW and 11 (15,3%) dressings soaked in alcohol. Conclusion: Introduction of AFW alongside with educational intervention showed short-term efficacy in reducing BBS in a general medical ward. Intervention also changed professionals’ cleaning practices. Further investigation is needed about potential impact of this kind of strategy in reducing healthcare associated infections and about the durability of intervention’s effect. Disclosure of Interest None Declared P407 Microbial contamination on transvaginal ultrasound probes in a gineco-obstetrics department of a tertiary hospital in Spain Paula Peremiquel Trillas1, José Ángel Rodrigo-Pendás1, Lluís ArmadansGil1, Jessica Gonzalez-Montes1, Maria Goya-Canino2, Elisa Llurba-Olivé2, Juliana Esperalba-Esquerra3, Virginia Rodríguez-Garrido3, Glòria RoigCarbajosa3, Elena Carreras-Moratonas2, Magda Campins-Martí4 1Preventive Medicine and Epidemiology Department; 2Obstetrics and Gynaecology Department; 3Microbiology Department; 4reventive Medicine and Epidemiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain Correspondence: Paula Peremiquel Trillas Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P407 Introduction: Transvaginal ultrasound (TVUS) probes are semicritical devices routinely used with disposable protective covers. These covers can suffer ruptures (between 1-9% as described in literature) that facilitate probe contamination with pathogenic microorganisms present in the vagina. Transmission to other patients can occur if disinfection of probes is not done properly after each use. Objectives: The objective of this study is to determine the prevalence of microbial contamination of TVUS probes in our hospital. Methods: Cross-sectional study. Swap samples were taken from TVUS probes available for use in the exploration units, theoretically after standard chemical disinfection at point of use. Investigation of any bacteria and fungi growing was done by culture and detection of Human papillomavirus (HPV), Chlamydia trachomatis and Neisseria gonorrhoeae by molecular techniques. Results: A total of 51 samples were taken from 17 TVUS probes. The prevalence of contamination was 70.59% (36/51). 64.71% (33/51) of the samples contained skin and environmental flora. In 19.61% (10/ 51) of the samples nonfermenting Gram-negative bacteria grew and in 5.88% (3/51) of them methicillin-sensitive S. aureus grew. Two samples were HPV positive for 3 different genotypes. None of the samples were positive for fungi, Chlamydia trachomatis or Neisseria gonorrhoeae. Conclusion: Skin and environmental flora are frequently isolated in TVUS probes. HPV contamination is significant on TVUS probes, as described by other authors. As there is a risk of transmitting infections via TVUS procedures, TVUS probes must be properly disinfected, using high-level disinfectants. Healthcare workers must be educated about the risks associated with this procedure and the importance of the proper disinfection technique. Disclosure of Interest None Declared P408 Global survey on the handling of human waste and bedpan management Gertie V. Knippenberg-Gordebeke1, Tim T. Lieske2, Pola Brenner 3, Jim Gauthier4 1KNIP KNowhow Infection Prevention, Consultancy Infection prevention, Venlo, Netherlands; 2 Hospital Hygiene, Uni. Hospital, Essen, Germany; 3Department of Microbiology, Universidad de Valparaiso, Valparaiso, Chile; 4Infection Prevention, Sealed Air Diversey Care, Mississauga, Ontario, Canada Correspondence: Gertie V. Knippenberg-Gordebeke Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P408 Introduction: It is estimated that 10% of the global population are carriers of multi drug resistant organisms (MDRO). Unsafe disposal of faeces and urine and improper decontamination of bedpans and urine bottles (medical devices) pose risks for transmission of MDRO. Many healthcare settings do not have clear steps to outline bedpan management. Improper handling can lead to contamination of the environment and the hands. Safer disposal of faeces can help to minimize the risk for Healthcare Associated Infections (HAIs). Objectives: To determine and assess the awareness for procedures related to bedpan management within the participant’s setting. Methods: 60 observations, 69 standardized interviews and 399 experience exchanges about bedpan management with infection prevention professionals in 30 countries were performed (2013-2017) A global digital survey in English and Spanish (2017) was sent to professionals in healthcare settings Results: Insufficient procedures to address the transport of full bedpans and urine bottles and insufficient decontamination methods. Dirty utility rooms are poorly equipped and potential reservoirs of MDRO. Preliminary questionnaire results 24/03 (Final results to be presented at ICPIC) 177 responders from 32 countries 24% local guidelines for bedpan management in case of MDRO 47% no equipment for emptying and decontamination for bedpan/ urine bottle 10% use a Macerator, 45% use a Washer/Disinfector(WD),14% use a Liner (Coverbag) 88% bedpan emptied in toilets or slophoppers 32% no separation of clean and dirty items in the sluice room Role bedpan management in outbreaks: 35% never searched, 5% Macerator, 9% WD,17% bedpans Infections: urinary tract, gastrointestinal, wound, other Publishing of these outbreaks: No: 89%, Yes: 5% Conclusion: The handling of human waste, and proper bedpan management needs to be addressed in all healthcare facilities as a risk reduction initiative for (HAIs). Reusable bedpans are medical devices and require more rigorous decontamination with improvements in implementation of new strategies. References IFIC Basic concepts http://theific.org/wp-content/uploads/2016/04/12 Cleaning_2016.pdf ISO 15883-3 Requirements for washer-disinfectors employing thermal disinfection for human waste containers 2006 Disclosure of Interest G. Knippenberg-Gordebeke Consultant for: MEIKO, CLEANIS, T. Lieske: None Declared, P. Brenner : None Declared, J. Gauthier: None Declared Introduction: The role of the hospital environment in transmission of healthcare-associated infections (HAIs) in recent years has gained increased attention. Although flushing toilets are known to generate droplets and aerosols, their potential contribution to pathogen transmission and environmental contamination in hospitals has not received due attention. Objectives: This study aimed to evaluate airborne dissemination of Gram negative and Gram positive organisms, and a norovirus-surrogate (MS2 bacteriophage) from a flushing toilet in a patient bathroom. Methods: We used an Escherichia coli and Enterococcus faecalis inoculum, as well as a norovirus-surrogate, MS2 bateriophage, inoculum to evaluate bioaerosol generation from a patient washroom in an acute care facility, by sampling at multiple time points post-flush and at four locations in close proximity to the toilet. Our analysis included calculating measures of central tendency (geometric mean), variance (geometric standard deviation), and upper 95% confidence limits for airborne concentrations. Results: Airborne E. coli were more abundant than E. faecalis immediately post-flush and at the closest sampling location (866 CFU/m3 vs. 533 CFUm3). At all other time points and locations, E. faecalis concentrations were significantly higher than E. coli. Based on the upper confidence limits, airborne E. faecalis concentrations may be greater than 1000 CFU/m3 8 minutes post-flush and 140 CFU/m3 up to 30 minutes post-flush. MS2 bacteriophage may be present at over 1000 PFU/m3 up to 8 minutes post-flush and 400 PFU/m3 45 minutes post-flush. Conclusion: The Gram positive organism used in this study persisted longer in the toilet plume, with significantly higher airborne concentrations compared to Gram negative E. coli. This finding is consistent with studies showing Gram positive bacteria displaying greater resistance to desiccation both in air and on surfaces. Thus, the toilet plume may pose a greater risk for transmission of Gram positive organisms compared with Gram negative. Based on MS2 bacteriophage persistence, airborne norovirus from toilet flushing may significantly exceed its infectious dose of 18 virions up to forty-five minutes post-flush. Disclosure of Interest None Declared P410 Mattresses and covers: sleeping with the enemy! Carlos A. Palos, Patricia Pereira, Ana S. Bispo Infection Control Comittee, Hospital Beatriz Ângelo, Loures, Portugal Correspondence: Carlos A. Palos Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P410 Introduction: Hospital Beatriz Ângelo (HBA) is a JCI-accredited, 425bed, paper-free, general hospital, opened in 2012. In 2014, HBA started to notice problems with mattresses, in parallel with a huge increase in the incidence of Carbapenem-Resistant Bacteriae (CRE), mainly Klebsiella (CRK). Mattresses and covers are the environment component closer to patients. Several safety alerts have been issued since 2010. In particular, covers might be OK on visual inspection after patient discharge. However, this may not be true, and microperfurations, mainly where patient’s pelvic zone is applied, can be revealed only by opening the covers. Objectives: Uncover infection risk on hospital covers and mattresses Methods: In order to improve detection of damaged covers, in addition to recommended procedures, opening of covers was implemented after patient’s discharge. If soiled covers were detected, mattresses where then removed from use. This was a part of a sequential intervention, comprising implementation/reinforcement of several aspects: real-time antibiotic stewardship, hand hygiene awareness and auditing, environmental cleaning (including moving on to hydrogen peroxide and 1-step cleaning approach), inclusion of CRE on the Electronic Epidemiologic Questionary on Admission tool, creation of dedicated beds for cohorting patients and staff and, finally, replacement of all mattresses. Results: After opening apparently well covers, heavy contamination was found in the internal side and mattresses were also contaminated and microbiologic studies revealed the presence of bacteria, mainly Gram negative, such as CRK and Carbapenem-resistant Pseudomonas on mattresses. Conclusion: Covers for hospital bed mattresses can be damaged, even if in normal visual inspection they are apparently in good condition. Addition of an opening test after patient’s discharge can reveal spoil and be a sign to discard both covers and mattresses. In addition, there’s an urgent need to improve technical specifications for manufacturers in order to increase safety. Mattresses can be the main environmental reservoirs for multi-drug resistant bacteria, contributing to outbreaks and endemic situations. Disclosure of Interest None Declared P411 Using a multidisciplinary approach in infection prevention and control to provide safe patient’s care Yveta Leharova, BScN, ICC, Ramona Rodrigues, BScN., M.Sc(A), CIC, CNS, IPC, FAPIC, Valerie Cass, BScN., MBA, Charles Frenette, MD, FRCP(C) MONTREAL UNIVERSITY HEALTH CARE CENTER, Montreal, Canada Correspondence: Yveta Leharova Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P411 Introduction: BACKGROUND: In April 2015 the Royal Victoria moved to a new 500 single bed hospital. Three months following the move, the 36 single bed transplant unit, declared a Vancomycin resistant enterococcus (VRE) outbreak and subsequently confirmed additional C.difficile (CDI) outbreaks. Objectives: This retrospective comparison study focused on the impact of implementing a multidisciplinary prevention program over two fiscal years. Methods: METHODS: The Head nurse and Infection Control consultant were regularly implementing Environmental and hand hygiene audits. In October 2016 weekly multidisciplinary and bi-weekly housekeeping supervisors’ huddles were held to discuss and implement corrective measures. Environmental and Hand Hygiene audit were collected pre/ post implementation of the multidisciplinary prevention program. VRE and C.difficile cases isolates were molecular subtyped for some of the outbreaks to confirm transmission among patients. Results: RESULTS: Environmental/instrument cleaning and hand hygiene audits were poor in 2015/16 but improved during the course of the 2016/17. In 2016-17 there were no outbreaks on this single unit following close collaboration between Nursing, Infection Control and the multidisciplinary prevention initiative compare to previous year. Overall, the number of VRE nosocomial cases has decreased by 58% and CDI nosocomial cases decreased 38%. Conclusion: The multidisciplinary prevention program benefits patient’s care in this hospital setting by providing a safe clean environment. Disclosure of Interest Y. Leharova, BScN, ICC Employee of: No conflict of interest, R. Rodrigues, BScN., M.Sc(A), CIC, CNS, IPC, FAPIC: None Declared, V. Cass, BScN., MBA: None Declared, C. Frenette, MD, FRCP(C): None Declared P412 The role of clean and safe health facilities(cash) initiative in infection prevention and control practices in selected health facilities, Ethiopia Molla G. Fisehatsion Health Service Quality Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P412 Introduction: Making health facility clean and safe is an important determinant of quality of care and patient satisfaction. Health care provided in health facilities should be safe, effective, patientcentered, timely, efficient and equitable. Health facilities should ensure that patients/Clients are the corner-stone in the whole health care delivery process Objectives: The ultimate goal of a clean and safe health facility (CASH) include clean, comfortable and safe environment for patients, attendants, visitors, staff and members of the general public; increased patient satisfaction and confidence in local health care settings in relation to environmental hygiene and the organizations commitment to reduce the incidence of hospital acquired infections Methods: Out of the public hospitals which implemented CASH initiative, five of them were selected randomly.Regarding to CASH progress, national CASH audit tool which is very comprehensive was used and based on the audit tool a progressive assessment was conducted and compared with the baseline data.Regarding to infection prevention and patient safety practices, Ethiopian Hospitals Reform Implementation Guideline (EHRIG) report which consists IPPS as one chapter and collected at quarter basis was used Results: When the CASH initiative was launched on October 2014, the hospitals infection prevention and control practices was very low. The score of Alamata, D/brhan, St.Peter, Minilik and Yekatit Hospitals was (62%, 70%, 40%, 35% &25%) respectively. After the implementation of CASH initiative Alamata, D/Birhan, St.Peter, Minilik and yekatit (80%,84%,82%,75%, & 65%) respectively in 2016. The mean score of the selected five hospitals in regard to infection prevention and control practices was 46% initially and it is improved to 77% in 2016. Conclusion: The Ethiopian Federal Ministry of Health has been implementing this initiative in complement to the infection prevention and control program with high government commitment at all levels and creating a competitive environment among health facilities and bringing a successful result Disclosure of Interest M. Fisehatsion Employee of: Federal Ministry of health,Ethiopia: As part of a regulatory, legislative or judicial process, I haven't provided an expert opinion or testimony, related to the subject of the meeting or work, or a commercial entity or other organization P413 Eco-friendly hospitals – are they a risk for hospital hygiene? Christiane Höller1, Bertram Knörr2 1Hygiene, Bavarian Health and Food Safety Authority, Oberschleißheim; 2Hygiene, Bavarian Health and Food Safety Authority, Erlangen, Germany Correspondence: Christiane Höller Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P413 Introduction: High energy costs as well as the trend to build environmentally sustainable has reached hospital architecture. In order to receive funds, hospitals in Bavaria have submitted during the last years several corresponding ideas to the ministry which finances hospital buildings. Some of these ideas give cause for concern. Objectives: A hospital environment is energy consuming. A big part of the energy is allocated to ventilation, heating/cooling, and supply with hot water. Although some ways to save energy are conceivable, they can not be easily implemented in a hospital and some should not be considered at all. Methods: The application documents, which had been submitted to the Bavarian Ministry for eco-friendly funding were examined for proposals with a hygienic risk. Results: Ventilation systems in operation rooms can save energy by using overflowing air for adjoining rooms or by overnight shutdown, however some principles must be adhered to in order to guarantee a functioning ventilation. Passive ventilation, which is increasingly common in residential construction, must be viewed very critically due to the high levels of heat, moisture and odor in a hospital. As supply with hot water is very costly, there are attempts to lower these by lowering the water temperature. In order to prevent microbiological growth at these temperatures either a prophylactic disinfection or the insertion of ultrafiltration devices right after the water meter are modern countermeasures that create more problems than solutions. In order to offer the patients nature-near materials and moreover to save chemicals and disinfectants there are attempts to switch to pure soap as a sole cleaning agent, preferably on parquet floors. While in the best case this can lead to high costs due to material damage, hygienic problems can also arise. Another way to save disinfectants is promoted by some companies that develop self-disinfecting surfaces. This might be a promising future technique, but there are still a lot of open questions that have to be answered before it can be recommended. Conclusion: If an eco-friendly construction or operation of a hospital is planned, the infection control staff should be involved in advance in order to avoid risks for the patients and the staff. Disclosure of Interest None Declared P414 Cleaning and disinfection procedures in Bavarian Hospitals: survey of the current status Ulla Kandler1, Cora Ertl2, Silke Nickel1, Verena Lehner-Reindl1, Christiane Höller2 1Hygiene, Bavarian Health and Food Safety Administration, Erlangen; 2Hygiene, Bavarian Health and Food Safety Administration, Oberschleißheim, Germany Correspondence: Ulla Kandler Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P414 Introduction: Appropriate cleaning and disinfection of environmental surfaces plays a crucial role in infection prevention in hospitals. From the choice of detergents and disinfectants to the education of staff there are numerous critical points with the opportunity for mistakes. Objectives: The purpose of this study was to assess current practice in cleaning and disinfection in Bavarian hospitals and to detect critical points, which need further attention and show room for improvement. Methods: The department of hospital hygiene and infection prevention at the LGL created a standardized checklist which was sent to all local health administrations in Bavaria. They were asked to choose one area of interest in each hospital in their district, to inspect these areas including the observation of a cleaning and disinfection procedure. Results from the inspection were documented in the prepared checklist. The completed checklists were sent back to the LGL. The collected data were read into a data base and were analyzed with IBM SPSS Statistics 23. Results: All 357 Bavarian hospitals were inspected with respect to their cleaning and disinfection procedures. Obligatory guidelines for these procedures were found in 99% of the visited wards. However, asking for details revealed discrepancies between the guideline and the situation seen during the inspection, because 15% of the procedures were not correctly performed. Other topics of concern were for example cleaning frequency on weekends and bank holidays, the adequate processing of used cleaning materials, the training of cleaning staff, the correct dosage of disinfectant and clarification of responsibilities especially with housekeepers from external enterprises. Conclusion: All hospitals cover cleaning and disinfection in their standard operation procedures, but the discrepancies and inadequacies seen during the inspection show clearly that more emphasis is necessary in regard to structural and process quality. Out-sourcing may have an impact on the outcome of the overall quality. This and further questions like training of staff are looked into more thoroughly at the time being. Disclosure of Interest None Declared P415 Using education to improve the knowledge and beliefs of environmental service workers Mei Wen Chen, I-Chen Hung National Taiwan University Hospital, Taipei, Taiwan, Province of China Correspondence: Mei Wen Chen Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P415 Introduction: Improvements in hospital cleaning have been associated with reductions the risk of multidrug-resistant organisms transmission in hospital rooms. Understanding the knowledge and beliefs of environmental service workers(ESWs) may help to improve cleaning quality and to ensure effective practices. Objectives: The aim of survey is using education to improve the knowledge and beliefs of ESWs. Methods: We used pre-test and post-test of educational program to examine ESWs' beliefs and knowledge about environmental cleaning. Questions were developed based on observations of ESWs performing their duties and from previous studies. The education topics were included knowledge related to cleaning practices and workflow challenges. Results: 120 ESWs participated in the survey, including 51 outsourcing staffs and 69 self-employed staffs. There were 72 ESWs (60%) had over three years experience in environmental services. After educational program, ESWs agreed that they had been trained to properly perform cleaning from 83.3% to 94.1%, ESWs were confident in their abilities to do so from 75.0% to 88.1%. In pre-test, only five of fourteen high-touch equipment were been considered to clean carefully by more than 90% ESWs, another three equipment, including suction controllers, vital signs monitor panels, respiratory ventilator controllers were ignored. After educational program, all of the hightouch equipment were be notice. Conclusion: Through the educational program, we provide ESWs with knowledge and strategies to do environmental cleaning better and effective. P416 Investigations on the influence of architecture and design on the occurrence of nosocomial infections and multiresistant pathogens Wolfgang Sunder, Jan Holzhausen Technical University (TU) Braunschweig, IIKE, Braunschweig, Germany Correspondence: Wolfgang Sunder Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P416 Introduction: The study aims to provide important data for the decision as to whether, in the future, much more single bed rooms should be installed in hospitals in response to the increased incidence of multiresistant pathogens in Germany. Or, alternatively, to install upgraded twin rooms in the sense of infection prevention. Objectives: National and international guidelines require the isolation of patients with multidirectional pathogens into single-bed rooms. However, the implementation of the recommendations has become ever more difficult due to the increasing incidence of these pathogens ( 1 ). As a result, some countries have begun to implement new hospitals with single-bed rooms only. This entails various disadvantages and higher costs ( 2 ), ( 3 ). A recent survey at 621 KISS hospitals showed that currently in Germany only 2 out of 36 beds per station can be found in single rooms ( 4 ). Methods: Identification and evaluation of the infection-critical constructional interfaces and procedural sequences of the patient's room and sanitary cell (a). Creation of a requirements catalog and a infection-proof innovative concept (b). Development of drawing sets, detail solutions and cost estimation (c). Basic assessment of the demonstrator's suitability; Optimization (d). Results: The aim of the study is to create an infection-proof twin room with a sanitary cell as an alternative to single rooms and to realize it as a demonstrator. Conclusion: The consequences of the described architecture and design investigations have not yet been scientifically evaluated as a basis for decision-making. With the results an architect/hospitals is able to consider actions timely to support prevention in new building or alterative planning. P417 Prevention of healthcare-associated infections in intensive care units – potential for improvement due to construction design and operational actions Inka Dreßler1, Jan Holzhausen2, Wolfgang Sunder2, Harald Budelmann1 1iBMB; 2IIKE, TU Braunschweig, Braunschweig, Germany Correspondence: Inka Dreßler Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P417 Introduction: The prevalence of healthcare associated infections (HAI) can be reduced with suitable actions by approximately 30% [1]. Considering exogenous infections, the relevance of infections induced by contact transmission(80-90%) outweigh infections induced by media(10-20%) [4]. Hence, the prevention of contact infections with construction design and operational actions in ICUs is focused. Objectives: According to the multi-barrier concept to reduce the HAIrisk, there are several approaches conceivable: a) Physical barriers, b) hand hygiene infrastructure, c) cleaning and disinfectant strategies as well as d) construction design. Approaches a) und b) are described in literature [5] and are judged so far as inadequately implemented in Germany. It is the goal to provide a better basis for approach c) and d). Methods: Therefore, cleaning und cleanability experiments are conducted and experts are interviewed. Results: Proper hygienic implementation of cleaning routines in hospitals is indispensable since in literature (e.g. [2, 3]) onsets from surfaces in the environment are described. The conducted experiments show that there are different optimal cleaning strategies depending on the cleaning procedure. Moreover, structural ideal layouts for ICUs as well as recommendations for hygienic materials under consideration of the experiments are given. Conclusion: Nowadays horizontal prevention measures in German ICUs are poorly integrated. Especially the risk for contact infections can be reduced by taking suitable measures into account. Analyzing prevalent deficits as well as the development of construction design and operational approaches such as an optimized cleaning strategy an improvement of the Status Quo is possible. With this an architect/ building engineer is able to consider actions timely to support prevention of HAIs in new building or alteration planning. P418 Spatial remodeling of a central sterile supply department of a Brazilian University Hospital: a case report Christian E. S. Pelaes, Rodrigues, CM; Napoleao, AA; Locilento, AFB; Lucenti, FL; Avo, LRS; Gabassa, VC; Neves, FF; Suzuki, MN; Martins, BR; Figueiredo, RM Health Surveillance and Patient Safety Department, UNIVERSITY HOSPITAL OF UNIVERSITY OF SAO CARLOS / EBSERH, Sao Carlos, Brazil Correspondence: Christian E. S. Pelaes Antimicrobial Resistance and Infection Control 2017, 6(Suppl 3):P418 Introduction: The central sterile supply department (CSSD) comprises that service within the hospital in which medical/surgical supplies and equipments are prepared for reuse. The steps for processing each material include:pre-cleaning, reception,cleaning,drying,evaluation,preparation,disinfection/sterilization,storage,distribution. The CSSD physical layout should favor a unidirectional flow, avoiding the crossing of cleaned and contaminated materials 1-2. References 1. Anvisa. National Health Surveillance Agency (Brazil). Collegiate Board Resolution #50.Provides for the Technical Regulation for planning, programming, elaboration and evaluation of physical projects of health care establishments, 2002. 2. Centers for Disease Control.Guideline for Disinfection and Sterilization in Healthcare Facilities,2008,Atlanta,GA,1998. Disclosure of Interest None Declared (1) Gastmeier P , Schröder C . Dramatic increase in vancomycin-resistant enterococci in Germany . J Antimicrob Chemother . 2014 ;Epub March 9. (2) Pennington H , Isles C . Should hospitals provide all patients with single rooms? BMJ. 2013 ; 347 : f5695 . (3) Florey L , Flynn R , Isles C . Patient preferences for single rooms or shared accommodation in a district hospital . Scott Med . 2009 ; 54 : 5 - 8 . (4) Stiller A , Sunder W. Untersuchung zur aktuellen Krankenhausbaustruktur in Deutschland im Hinblick auf die Infektionsprävention . in Vorbereitung zur Publikation . 2015 . [3] Hanna et . al ( 2001 ) : Infection control & Hospital Epidemiology 22 , 4 , p. 217 - 219 [4] Lenfestey et . al ( 2013 ): In: HERD, Vol. 7 , p. 31 - 45 [5] Stiller at. al ( 2016 ): Bundesgesundheitsblatt, 59 , 8 , p. 986 - 991


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Meeting abstracts from International Conference on Prevention & Infection Control (ICPIC 2017), Antimicrobial Resistance and Infection Control, 2017, 52, DOI: 10.1186/s13756-017-0201-4