Source Of Healthcare-associated Infections Research Articles

Handwashing basins and healthcare associated infections: Bacterial diversity in biofilms on faucets and drains

BackgroundIncreasingly, hospital handwashing basins have been identified as a source of healthcare-associated infections. Biofilms formed on the faucet and drains of handbasins can potentially harbour pathogenic microbes and promote the dissemination of antimicrobial resistance. However, little is known about the diversity of these biofilm communities and the routes of contamination. AimThe aim of this paper was to use 16S rRNA gene amplicon sequencing to investigate the diversity of prokaryote communities present in faucet and drain biofilm samples taken from hospital and residential handbasins. FindingsThe biofilm prokaryotes communities were diverse, with high abundances of potentially corrosive, biofilm forming and pathogenic genera, including those that are not typically waterborne. The β-diversity showed statistically significant differences in the variation of bacterial communities on the basis on building type (hospital vs residential p = 0.0415). However, there was no statistically significant clustering based on sampling site (faucet vs drain p = 0.46). When examining the β-diversity between individual factors, there was a significant difference between drain biofilms of different buildings (hospital drain vs residential drain p = 0.0338). ConclusionThis study demonstrated that biofilms from hospital and residential handbasins contain complex and diverse microbial communities that differ significantly by building type. It also showed biofilms formed on the faucet and drain of a hospital's handbasins were not significantly different. Future research is needed to understand the potential mechanisms of transfer between drains and faucets of hospital handbasins. This information will inform improved infection control guidelines to control this underrecognized source of infections.

Bacterial contamination of healthcare workers’ mobile phones in Africa: a systematic review and meta-analysis

BackgroundMobile phones are potential reservoirs for pathogens and sources of healthcare-associated infections. More microbes can be found on a mobile phone than on a man's lavatory seat, the sole of a shoe, or a door handle. When examining patients, frequent handling of mobile phones can spread bacteria. Nevertheless, evidence of bacterial contamination of mobile phones used by healthcare workers in Africa was inconclusive. Thus, this meta-analysis and systematic review was conducted to estimate the pooled prevalence of bacterial contamination of mobile phones used by healthcare workers and the most frequent bacterial isolates in Africa.MethodsWe systematically retrieved relevant studies using PubMed/MEDLINE, POPLINE, HINARI, Science Direct, Cochrane Library databases, and Google Scholar from July 1, 2023 to August 08, 2023. We included observational studies that reported the prevalence of bacterial contamination of mobile phones among healthcare workers. The DerSimonian–random Laird's effect model was used to calculate effect estimates for the pooled prevalence of bacterial contamination in mobile phones and a 95% confidence interval (CI).ResultsAmong 4544 retrieved studies, 26 eligible articles with a total sample size of 2,887 study participants were included in the meta-analysis. The pooled prevalence of mobile phone bacterial contamination among healthcare workers was 84.5% (95% CI 81.7, 87.4%; I2 = 97.9%, p value < 0.001). The most dominant type of bacteria isolated in this review was coagulase-negative staphylococci (CONS) which accounted for 44.0% of the pooled contamination rate of mobile phones used by healthcare workers, followed by Staphylococcus aureus (31.3%), and Escherichia coli (10.7%).ConclusionsIn this review, the contamination of mobile phones used by HCWs with various bacterial isolates was shown to be considerable. The most prevalent bacteria isolates were coagulase-negative staphylococci, Staphylococcus aurous, and Escherichia coli. The prevalence of bacterial contamination in mobile phones varies by country and sub-region. Hence, healthcare planners and policymakers should establish norms to manage healthcare workers' hand hygiene and disinfection after using mobile phones.

Healthcare-Associated Infections and the Hospital Bed.

Bedframes are a potential source of bacterial contamination, fomites, and healthcare-associated infections for patients with active skin wounds and other underlying conditions. Bedframes also differ in their design, materials, texture, and ease of disassembly for cleaning. In this study, the authors evaluated five hospital bedframes in terms of retained soil and ease of cleaning as rated by volunteers. Hospital mattresses were placed on five different bedframes and soiled with mock bodily fluids containing Geobacillus stearothermophilus endospores as an indicator organism for contamination. In a second set of experiments, volunteers evaluated the bedframes for ease of cleaning; fewer than 30% of the volunteers had experience cleaning in hospitals or had previously received infection-control training. Questionnaires evaluated subjective measures such as ease of cleaning and texture. Researchers observed a strong correlation between the initial amount of soil retained, the most probable number calculations of endospore counts, and the number of washes to reach extinction (no detectable endospores). Although volunteers' rankings for ease of cleaning were independent of the amount of soil retained, their rankings correlated with the actual washes to reach undetectable limits and bedframe materials that were perceived as harder to clean. This study demonstrates the importance of both bedframe design and user cleaning experience in reducing bedframes as a source of healthcare-associated infections.

Level of JMP ladders for water, sanitation, and hygiene (WASH) services among healthcare facilities of Bishoftu Town, Ethiopia: An implication of healthcare-associated infection prevention status

Abstract This study aimed to assess the level of JMP ladders for WASH services. A cross-sectional study was conducted. Forty-four healthcare facilities were enrolled. From each healthcare facility, water samples were collected directly from water storage facilities. In addition to the interview, an observational checklist was used. Descriptive statistics and a chi-square test were conducted to analyze the data. The coverage of advanced and basic drinking water services in healthcare facilities was 4.6 and 70.4%, respectively. However, the healthcare facilities’ access to advanced and basic sanitation services was nil. Similarly, 61.4 and 88.6% of the healthcare facilities had no hygiene and waste disposal services, respectively. While 2.6, 4.5, and 75% of healthcare facilities had advanced, basic, and limited environmental cleaning services, 18.2% lacked environmental cleaning services. Water samples of 15.9, 11.4, and 6.8% of the healthcare facilities were found positive for total coliforms, fecal coliforms, and E. coli, respectively. The WASH services of the healthcare facilities were very low and not on track to achieve the Sustainable Development Goal target. Healthcare facilities could be sources of healthcare-associated infections. Hence, the government and other concerned bodies should take urgent action to improve WASH services.

Nanosilver/DCOIT-containing surface coating effectively and constantly reduces microbial load in emergency room surfaces

Colonization of near-patient surfaces in hospitals plays an important role as a source of healthcare-associated infections. Routine disinfection methods only result in short-term elimination of pathogens. To investigate the efficiency of a newly developed antimicrobial coating containing nanosilver in long-term reduction of bacterial burden in hospital surfaces to close the gap between routine disinfection cycles. In this prospective, double-blinded trial, frequently touched surfaces of a routinely used treatment room in an emergency unit of a level-I hospital were treated with a surface coating (nanosilver/DCOIT-coated surface, NCS) containing nanosilver particles and another organic biocidal agent (4,5-dichloro-2-octyl-4-isothiazolin-3-one, DCOIT), whereas surfaces of another room were treated with a coating missing both the nanosilver- and DCOIT-containing ingredient and served as control. Bacterial contamination of the surfaces was examined using contact plates and liquid-based swabs daily for a total trial duration of 90 days. After incubation, total microbial counts and species were assessed. In a total of 2880 antimicrobial samples, a significant reduction of the overall bacterial load was observed in the NCS room (median: 0.31 cfu/cm2; interquartile range: 0.00-1.13) compared with the control coated surfaces (0.69 cfu/cm2; 0.06-2.00; P < 0.001). The nanosilver- and DCOIT-containing surface coating reduced the relative risk of a critical bacterial load (defined as >5 cfu/cm2) by 60% (odds ratio 0.38, P < 0.001). No significant difference in species distribution was detected between NCS and control group. Nanosilver-/DCOIT-containing surface coating has shown efficiency for sustainable reduction of bacterial load of frequently touched surfaces in a clinical setting.

Bacterial counts of hospital linen and effectiveness of laundry process

Background: Health care linen is a source of healthcare-associated infections. Hospital laundry services play a vital role in linen decontamination. Effective laundry is essential in preventing hospital-acquired infections, especially in multidrug-resistant organisms. Aims and Objectives: The study aimed to check the microbial load in linen after the laundry process and the during the supply chain in the hospital. We investigated the bacterial load in linen before and after the laundering process and the linen from stored linen banks. Materials and Methods: Linens (n=125) from the hospital were collected in different stages of the laundry process [31 linen before decontamination; 94 linen after decontamination (Post washing = 30; Linen Bank = 34; Ward 30)]. A square inch of linen from each linen was vortexed in normal saline, and colony forming units (CFU)/inch of linen were calculated using appropriate media. The identification and susceptibility of organisms were performed using MALDI-TOF MS and CLSI disk diffusion methods, respectively. The difference in the load of the organism was analysed between different stages of the laundry and storage process. Results: We found that100% of pre-decontamination linen harbour viable organisms (22.59% including multidrug-resistant pathogenic organisms: MDROs), which decreased to 40% (no MDROs) post-decontamination. The overall load was reduced by a factor of 103.77. Conclusion: The microbial contamination of linen is common, and there is an urgent need to develop consensus on the microbial examination frequency and acceptable range of organisms on hospital linen worldwide.

Bacterial contamination of mobile phones of healthcare workers at the University Teaching Hospital, Lusaka, Zambia

SummaryBackgroundMobile telephones (henceforth ‘phones’) have become an essential part of everyday life in both healthcare and community settings. However, the widespread use of mobile phones in healthcare facilities is of concern because they can act as vehicles for transmitting pathogenic bacteria. This study aimed to investigate the bacterial contamination of mobile phones of healthcare workers (HCWs) at the University Teaching Hospital, Lusaka, Zambia.MethodsThis cross-sectional study, from May to July 2019, involved 117 HCWs. A self-administered questionnaire was used to gather sociodemographic and phone usage data. The mobile phones of HCWs were swabbed for culture and antimicrobial susceptibility testing.ResultsThe overall prevalence of mobile phone contamination was 79%. The predominant isolates were coagulase-negative staphylococci (50%), Staphylococcus aureus (24.5%) and Bacillus spp. (14.3%). Other isolates were Escherichia coli, Acinetobacter spp., Pseudomonas spp., Klebsiella sp. and Proteus sp. Most isolates were susceptible to tetracycline, gentamicin and cotrimoxazole, while all Gram-positive organisms were resistant to penicillin. Meticillin resistance was detected in 25% and 48% of S. aureus and coagulase-negative staphylococci isolates, respectively. No significant association was found between mobile phone contamination and age group, gender, profession, mobile phone disinfection or work area.ConclusionMobile phones of HCWs carry potentially pathogenic bacteria and can be a source of healthcare-associated infections in healthcare settings. Hence, regulations regarding the use of mobile phones need to be developed, especially in critical areas, to reduce the dissemination of pathogenic bacteria from hands to phones and, potentially, to patients.

Higher genome variability within metabolism genes associates with recurrent Clostridium difficile infection

BackgroundClostridium difficile (C. difficile) is a major source of healthcare-associated infection with a high risk of recurrence, attributable to many factors such as usage of antibiotics, older age and immunocompromised status of the patients. C. difficile has also a highly diverse genome, which may contribute to its high virulence. Herein we examined whether the genome conservation, measured as non-synonymous to synonymous mutations ratio (dN/dS) in core genes, presence of single genes, plasmids and prophages increased the risk of reinfection in a subset of 134 C. difficile isolates from our previous study in a singly hemato-oncology ward.MethodsC. difficile isolates were subjected to whole-genome sequencing (WGS) on Ion Torrent PGM sequencer. Genomes were assembled with MIRA5 and annotated with prokka and VRprofile. Logistic regression was used to asses the relationship between single gene presence and the odds of infection recurrence. DN/dS ratios were computed with codeml. Functional annotation was conducted with eggNOG-Mapper.ResultsWe have found that the presence of certain genes, associated with carbon metabolism and oxidative phosphorylation, increased the odds of infection recurrence. More core genes were under positive selective pressure in recurrent disease isolates – they were mostly associated with the metabolism of aminoacids. Finally, prophage elements were more prevalent in single infection isolates and plasmids did not influence the odds of recurrence.ConclusionsOur findings suggest higher genetic plasticity in isolates causing recurrent infection, associated mainly with metabolism. On the other hand, the presence of prophages seems to reduce the isolates’ virulence.

Healthcare workers' beliefs, attitudes and compliance with mobile phone hygiene in a main operating theatre complex

SummaryBackgroundPhone hygiene is increasingly recognized in infection prevention. We aimed to explore the beliefs, attitudes and performance of phone hygiene amongst healthcare workers (HCWs) in the major operation theatre (MOT) complex of a Singapore tertiary acute care hospital. We also monitored the impact of phone hygiene stations, introduced to improve phone hygiene.MethodsWe sent two online anonymous surveys to the Departments of Anaesthesia and MOT Nurses one month before and after we set up phone hygiene stations. Four phone hygiene stations displaying visual phone hygiene reminders and Mikrozid® sensitive wipes were set up at MOT entrances.ResultsA total of 205 and 91 HCWs responded to the first and second surveys respectively. In the first survey, 11.5% cleaned their phones daily while 9.4% never cleaned their phones. These changed to 16.9% and 3.8% respectively after the introduction of phone hygiene stations. 80.0% in the first survey said they would clean their phones more often if there were a readily accessible disinfection method in the MOT. A majority believed phones are a source of healthcare associated infection. Common reasons for not cleaning phones were ‘lack of available resources’ and ‘I don't think about it.’ Senior doctors were the least compliant to phone hygiene.ConclusionPhone hygiene is easily overlooked during our busy workday. Besides increasing awareness of phone hygiene, having a readily available disinfection method in the MOT complex is important to improve phone hygiene. We suggest HCWs clean their phones before entering and/or after leaving the MOT daily.

Cross-contamination of bacteria-colonized pierced earring holes and fingers in nurses is a potential source of health care-associated infections

In recent years, the wearing of pierced earrings for personal adornment has increased among health care workers in Japan. However, the transmission dynamics between bacteria in pierced earring holes and fingers has not been clearly shown. Earlobes and fingers of 200 nurses (128 nurses with pierced earlobes and 72 nurses with unpierced earlobes) working at a university hospital were sampled to determine whether cross-transmission of bacteria-colonized pierced earring holes and fingers in nurse is possible. Of 128 nurses who had pierced earring holes, Staphylococcus aureus was recovered from earlobes of 24 nurses (18.8%) compared with 7 of 72 nurses without pierced earring holes (9.7%) (P = .09). Of those 15 nurses yielding S aureus from both earlobes and fingers, 12 were from nurses who had pierced earring holes compared with 3 nurses without pierced earring holes. Excluding 1 nurse, antimicrobial susceptibility patterns and genotypes of S aureus from both earlobe and fingers of each nurse were identical. Pierced earlobes can be a source of health care-associated infection via cross-transmission of bacteria from earlobe holes to fingers.

Knowledge and Practice of Nurses on Healthcare Associated Infection

Background: Healthcare associated infections (HCAI) are among the major complications of modern medical therapy. While outbreaks often capture the attention of the media and the public, endemic HCAI represents the majority of infections encountered in healthcare and are associated with significant morbidity, mortality and healthcare costs. Objectives: The objectives of this study were to assess the nurses' level of knowledge on Healthcare Associated Infection, assess the nurses' practice on Healthcare Associated Infection and assess the association between nurses' level of knowledge and their practice on the Healthcare Associated Infection. Method: A cross sectional design study was carried out at King Fahad Hospital of the University in Kingdom of Saudi Arabia including all nurses working in medical, surgical, and emergency department units. Using a self-administered questionnaire for healthcare associated infection designed by (Yunfang Zhou, et al.), engaged the ANOVA test and pearson correlation analysis. Results: According to the results, knowledge and practice of nurses were found to be low; the overall score of HCAI knowledge was 40.20 ± 11.79 while the overall score of HCAI practice was 45.51 ± 11.04. Statistical significance differences were found for studied participants who undergone training programs on infection control their knowledge found to be high. In analyzing the categorical knowledge, it was noticed that nurses scored well in the knowledge of hand hygiene (80.5%) and healthcare workers safety (77%), and the lowest score was in HCAI pathogen identification (36.9%). On the other hand, analysis of categorical practice revealed that nurses were scored well in the HCAI pathogens (86%) and hand hygiene (70.6%), and the lowest score was obtained in sources of HCAI (38%). The Pearson correlation analysis demonstrated a positive relationship between the total knowledge and practice scores, i.e, r = 0.481, which is statistical significant (p &lt;0.001).

Knowledge, attitudes and practices of personal protective measures among hemodialysis nurses in Benghazi

Abstract Background: This study intended to assess knowledge, attitudes, and practices regarding standard precautions concerning health care-associated infections (HAIs) among hemodialysis nurses in hemodialysis centers in Benghazi. Methods: the study was a cross sectional study carried out during the period from 1-3-2014 till 30-9-2014. The data was gathered from hemodialysis nurses in hemodialysis centers in Benghazi by using a questionnaire and by direct interview. Results: There were a total of 59 hemodialysis nurses in hemodialysis centers in Benghazi. All agreed to participate in the study. Although 92% of the nurses knew that their hands could be a source of health care-associated infections, but only 52% of nurses washed their hands before contacting another patient. Gloves were actually used by 98% of the nurses. 46% of the nurses were usually wearing masks when contacting a patient. Books and journals were the main source of information about (HAI) among 52% of the nurses. Conclusion: The nurses' knowledge of health care-associated infections did not modify their adherence to hand hygiene practices. This study recommend training programs for hemodialysis nurses about promoting higher hand hygiene standards and potential use of personal protective measures during their shifts in hemodialyais centers.

The Role of Patient Care Items as a Fomite in Healthcare-Associated Outbreaks and Infection Prevention.

Patient-care items can serve as a source or reservoir for healthcare-associated pathogens in hospitals. We reviewed healthcare- associated outbreaks from medical equipment and provide infection prevention recommendations. Multiple healthcare-associated outbreaks via a contaminated patient-care item were identified, including infections with multidrug-resistant organisms. The type of patient care items implicated as a fomite causing healthcare-associated infections (HAIs) has changed over time. Patient populations at risk were most commonly critically ill patients in adult and neonatal intensive care units. Most fomite related healthcare-associated outbreaks were due to inappropriate disinfection practices. Repeated healthcare-associated outbreaks via medical equipment highlight the need for infectious disease professionals to understand that fomites/medical devices may be a source of HAIs. The introduction of new and more complex medical devices will likely increase the risk that such devices serve as a source of HAIs. Assuring appropriate cleaning and disinfection or sterilization of medical equipment is necessary to prevent future fomite-associated outbreaks.

First report of Candida auris in America: Clinical and microbiological aspects of 18 episodes of candidemia

Characterization of a hospital outbreak of Candida auris candidemia that involved 18 critically ill patients in Venezuela. Bloodstream isolates of C. auris obtained from 18 patients admitted at a medical center in Maracaibo, between March, 2012 and July, 2013 were included. Species identification was confirmed by ITS rDNA sequencing. Isolates were subsequently typed by amplified fragment length polymorphism fingerprinting (AFLP). Susceptibility testing was performed according to CLSI. Clinical data were collected from all cases by using a standard clinical form. A total of 13 critically ill pediatric and 5 adult patients, with a median age of 26 days, were included. All were previously exposed to antibiotics and multiple invasive medical procedures. Clinical management included prompt catheter removal and antifungal therapy. Thirteen patients (72%) survived up to 30 days after onset of candidemia. AFLP fingerprinting of all C. auris isolates suggested a clonal outbreak. The isolates were considered resistant to azoles, but susceptible to anidulafungin and 50% of isolates exhibited amphotericin B MIC values of >1μg/ml. The study demonstrated that C. auris is a multiresistant yeast pathogen that can be a source of health-care associated infections in tertiary care hospitals with a high potential for nosocomial horizontal transmission.

Lessons Learned and Future Directions

Lessons Learned and Future Directions

Surfaces and fomites as a source of healthcare-associated infections

Fomites are inanimate objects in the environment that can become contaminated with pathogenic microorganisms, facilitating their transfer from one patient or surface to another. Understanding how pathogens are spread in the environment and terminating the spread is important for controlling nosocomial outbreaks. Healthcare-associated infections (HAI) are associated with excess morbidity, mortality and healthcare costs 1 . The quality of infection control practices, environmental cleaning, understaffing, overcrowding and poor healthcare facility infrastructure are all factors that can affect HAI rates. The true prevalence of HAI may be underestimated by the presence of unrecognised infections. Within any nosocomial environment, surfaces and fomites serve as reservoirsofinfection,withhealthcare workersactingasvectorsfor transmission 2 .Althoughbacterialspeciesarethebest-studiedexam

Decreased activity of commercially available disinfectants containing quaternary ammonium compounds when exposed to cotton towels

Health care-associated infections (HAIs) are a significant problem in hospitals, and environmental surfaces have been implicated as a source of HAIs in the hospital environment. Furthermore, Gram-negative and Gram-positive bacteria can persist on dry environmental surfaces for as long as several months. Poorly cleaned surfaces may serve as vehicles for microbes, which may then be transferred to patients. Cotton and microfiber towels were both tested for their abilities to bind quaternary ammonium compounds (QACs). The towels were exposed to 3 commercially available disinfectants for 0.5, 30, and 180 minutes. Germicidal spray tests (GSTs) were performed for all towel eluates in accordance with the AOAC International method 961.02. Cotton towel eluates were analyzed for QAC concentration using high-performance liquid chromatography. QAC concentrations were reduced by up to 85.3% after exposure to cotton towels, resulting in failure of the disinfectants exposed to cotton towels in 96% of the GSTs. The use of cotton towels with QAC-based cleansers should be reconsidered, particularly in hospitals where effective cleaning of the patient environment is needed to reduce the risk of HAIs.

Comparison of Methods for Evaluation of the Bactericidal Activity of Copper-Sputtered Surfaces against Methicillin-Resistant Staphylococcus aureus

Bacteria can survive on hospital textiles and surfaces, from which they can be disseminated, representing a source of health care-associated infections (HCAIs). Surfaces containing copper (Cu), which is known for its bactericidal properties, could be an efficient way to lower the burden of potential pathogens. The antimicrobial activity of Cu-sputtered polyester surfaces, obtained by direct-current magnetron sputtering (DCMS), against methicillin-resistant Staphylococcus aureus (MRSA) was tested. The Cu-polyester microstructure was characterized by high-resolution transmission electron microscopy to determine the microstructure of the Cu nanoparticles and by profilometry to assess the thickness of the layers. Sputtering at 300 mA for 160 s led to a Cu film thickness of 20 nm (100 Cu layers) containing 0.209% (wt/wt) polyester. The viability of MRSA strain ATCC 43300 on Cu-sputtered polyester was evaluated by four methods: (i) mechanical detachment, (ii) microcalorimetry, (iii) direct transfer onto plates, and (iv) stereomicroscopy. The low efficacy of mechanical detachment impeded bacterial viability estimations. Microcalorimetry provided only semiquantitative results. Direct transfer onto plates and stereomicroscopy seemed to be the most suitable methods to evaluate the bacterial inactivation potential of Cu-sputtered polyester surfaces, since they presented the least experimental bias. Cu-polyester samples sputtered for 160 s by DCMS were further tested against 10 clinical MRSA isolates and showed a high level of bactericidal activity, with a 4-log(10) reduction in the initial MRSA load (10(6) CFU) within 1 h. Cu-sputtered polyester surfaces might be of use to prevent the transmission of HCAI pathogens.

P224 The impact of implementing a collaborative antimicrobial ward round model within the Respiratory Directorate of a large university teaching hospital

<h3>Introduction</h3> Clostridium difficile Infection (CDI) remains a considerable source of healthcare associated infection. A Department of Health briefing recommends all Trusts establish an antimicrobial management team (AMT) to develop an antibiotic stewardship programme aiming to reduce CDI rates through appropriate antibiotic prescribing.1 As a result, collaborative antimicrobial ward rounds were initiated in the Trust in May 2009. <h3>Aim</h3> To study the impact of collaborative ward rounds on antibiotic prescribing within the Respiratory Directorate. <h3>Method</h3> A weekly collaborative ward round model comprising of a Consultant microbiologist, Respiratory pharmacist and the Consultant Infection Control lead for the Respiratory Directorate was implemented across three acute respiratory wards (comprising 90 beds) in March 2011. Data were collected prospectively over a 6-week period between March and May 2011 using a standardised pro-forma. Patients prescribed antibiotics were identified using the Trust9s electronic prescribing system. During ward rounds, case notes and microbiology data including resistance patterns were reviewed. Treatment plans were discussed with respective clinical teams to facilitate the learning of junior medical staff. Each prescription was reviewed and recorded as appropriate if compliant with the following parameters; indication recorded, correct route, correct dose, course length documented, compliance with hospital formulary or microbiology results. <h3>Results</h3> A total of 156 antibiotic prescriptions were reviewed during the study period; 96 (62%) prescriptions were appropriate, 60 (38%) required intervention. Course lengths were documented for 29 (19%) prescriptions, 11 (7%) antibiotic prescriptions were discontinued, 9 (6%) antibiotic prescriptions were changed to more appropriate therapy and 6 (4%) intravenous antibiotics were switched to oral therapy and 5 (3%) antibiotic course lengths were extended. The defined daily doses (DDD) of antibiotics/1000 bed days over the two periods were 3544 in 2011 and 4335 in 2010 respectively (see Abstract P224 figure 1). <h3>Conclusion</h3> Implementation of a collaborative AMT was associated with an 18% reduction in antibiotic consumption (DDD/1000 bed days) between the two periods within the respiratory directorate of a large urban university teaching hospital.

Evaluation of contact precautions discharges in an acute care setting

The health care environment is increasingly discussed as a source of health care-associated infections. We evaluated patterns of discharges among patients on contact precautions (CP) and assessed correlation of CP discharges with health care acquisition of organisms requiring CP and evaluated the feasibility of targeting CP discharges for additional monitoring.