Abstracts from the 6th international conference on prevention & infection control (ICPIC 2021)
Abstracts from the 6th international conference on prevention & infection control (ICPIC 2021)
2021-09-03 00:00:00
Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 https://doi.org/10.1186/s13756-021-00974-z0 Open Access MEE TING ABSTR AC TS Abstracts from the 6th international conference on prevention & infection control (ICPIC 2021) Switzerland. 14–17 September 2021 Published: 3 September 2021 ICPIC 2021 Innovation Academy Results: In an environment with no background noise, the innovation of the re-usable elastomeric respirator, yielded the highest STI rating compared to other elastomeric respirators (0.90–0.91) or excellent rat- I01 ing. Other elastomeric respirators tested, showing fair, to low excellent Evaluating the acoustical performance of elastomeric half range. The re-usable elastomeric respirator innovation had a 0.03 less mask respirators, surgical masks, and single use N95 using in speech intelligibility than, single use N95 STI rating. measurements of speech test intelligibility 1,* Conclusion: Speech intelligibility is complex, and incorporates subjec- E. Rodgers on behalf of David Larson, Graeme Fridlay, Heather Smart, tive (listener) criteria, objective speech intelligibility, and background Trevor Penner noise, as well as the environment. Additional subjective testing, with Precision Medical, Winnipeg, Canada the recorded sound files, with a randomized control clinical trial would Correspondence: E. Rodgers benefit this research. Antimicrobial Resistance & Infection Control 10(1): 101 Disclosure of Interest: E. Rodgers Consultant for: Precision Medical. Introduction: With the use of elastomeric-half mask respirators in healthcare settings, it has been reported that the verbal communica- I02 tion is decreased or compromised when wearing the masks (Palmiero, Proximity, frequency and duration of close patient contacts Symons, Morgan and Schaffer, 2016). This study examines the commu- among nurses in a COVID‑19 intensive care unit: an electronic nication effectiveness of this innovation (elastomeric reusable respi- measurement rator) and others in the industry, using speech intelligibility objective 1,* 2 1 1 M. M. Neuwirth, T. Pommeranz , F. Mattner , R. Otchwemah scoring, and qualitative research. 1 2 Institute for Hygiene, Lung Clinic, Cologne Merheim Medical Centre, Objectives: This research measured the acoustical performance, University Hospital Witten/Herdecke, Cologne, Germany speech transmission index (STI) (Palmeiro, et al., 2016) on an innova- Correspondence: M. M. Neuwirth tive elastomeric respirator, and others utilized in health care, accord- Antimicrobial Resistance & Infection Control 10(1): 102 ing to IEC 60268-16 Objective rating of speech intelligibility standard. Methods: STI measurements were obtained in a semi-anechoic acous- Introduction: SARS-CoV-2 is mainly transmitted via respiratory inges- tic test chamber/quiet room with background noise levels of less than tion of virus-containing particles. In principle, the likelihood of expo- 15 dBA. Then higher levels of background noise (57.6 dBA and 72 dBA, sure to infectious particles of any size is increased within a distance of Zunn and Downey, 2005) was added to the test room and additional 1–2 m to an infected person. Nurses are particularly at risk of contract- STI tests will be conducted in the presence of these elevated back- ing COVID-19 from patients due to the close patient contact and the ground noise levels. number of intensive contacts. The “voice” signal was emitted by the artificial voice of an acoustic Objectives: It has not yet been investigated, how long and often head and torso simulator (HATS) and was one of two types of sound: nurses are exposed to a close patient contact due to the intensive care the STI test waveform or the the Harvard sentences sound waveform during their service. The study aimed to determine the duration and (phonetically balanced and very clearly spoken human speech). The frequency of close patient contacts between nurses and COVID-19 background noise portion, when used, was added separately by a high patients during nursing activities. fidelity loudspeaker. The speech and STI waveform sounds were pro - Methods: In the period from 14.12.2020 to 28.02.2021, 12 beds duced inside the test room at the sound level of 60 dBA (1 m micro- of a COVID-19 pulmonary intensive care unit were equipped with phone distance). © The Author(s) 2021. 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The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 2 of 140 Bluetooth Low Energy (BLE) transmitters and 12 nurses were equipped with BLE wearables (Clinaris GmbH, Germany) in order to record the frequency and duration of patient contact as well as the distance of nurses to the headboard (face) of the patient bed. For the data evalu- ation, only the measurement data with at least two directly consecu- tive (chained) measurement contacts longer than 1 s. and a maximum distance of 1.5 m from the patient’s head were considered as relevant. Results: Per eight-hour shift a nurse had an average of 73.6 relevant patient contacts with a mean length of stay of 45.7 s. per contact. The most frequent and longest contacts occurred during the early shift (6:00–14:00 o’clock) with an average number of 87.7 contacts and an average duration of 47.9 s. This was followed by the late shift (14:00– 22:00; 85.1 contacts; duration 44.1 s.) and the night shift (22:00–6:00; 42.6 contacts; 44.6 s.). A nurse was closer than 1.5 m to patients’ heads for an average of 60.29 min. per shift. Conclusion: The results show for the first time how many relevant contacts take place when caring for Covid-19 intensive care patients and provide initial indications for assessing the risk of infection Conclusion: Take together, our results support that application of in the daily work of intensive care nurses. In general, nurses work Asc-JM-17 and Asc-JM-176 through targeting AR degradation is a approx. 1/8 of their working time closer than 1.5 m to the head area novel strategy for therapy and prevention of respiratoy viral infection of COVID-19 infected patients and are, directly exposed to SARS- such as SARS-CoV-2. Suppression of SARS-CoV-2 viral culture and ani- CoV-2 within the typical droplet distance. mal model with AR degradation enhancers merit further study. Disclosure of Interest: None declared. Disclosure of Interest: None declared. I04 Antimicrobial photodynamic disinfection of SARS‑COV‑2 I03 in a thin‑film intranasal model Targeting TMPRSS2 and ACE2 through AR degradation inhibits 1 1 1 1,* C. Romo , C. Cross , R. Andersen , N. Loebel SARS‑COV‑2 pseudotype viral entry 1,* Ondine Research Labs, Bothell, United States S.‑D. Yeh Correspondence: N. Loebel Department of Urology and Cancer Center, Taipei Medical University Antimicrobial Resistance & Infection Control 10(1): 104 Hospital, Taipei, Taiwan, Province of China Correspondence: S.‑D. Yeh Introduction: SARS-CoV-2 infection initiates in the upper respiratory Antimicrobial Resistance & Infection Control 10(1): 103 tract with viral shedding prior to onset of symptoms. Asymptomatic carriers are associated with the majority of COVID-19 transmissions, Introduction: TMPRSS2 and ACE2 are critical surface proteins ena- complicating prophylaxis. Up to half of all clinical cases of COVID-19 bling cell infection by SARS-CoV-2 and some respiratory viruses. develop secondary bacterial infections, primarily secondary bacterial Androgen receptor regulates TMPRSS2 and ACE2 expression. Male pneumonia which may prove lethal. Effective intranasal antiviral treat - gender is one of the risk factors in the increasing mortality and severe ment options for SARS-CoV-2 carriers are limited. COVID-19 infection. Targeting androgen receptor degradation is a pro- Objectives: Higher viral titer is associated with increased severity of posed strategy for therapy and prevention of SARS-CoV-2 infections. symptoms and mortality risk. Targeting SARS-CoV-2 colonization sites Objectives: We study the expression of AR, TMPRSS2 and ACE2 by in the upper airway with a potent, safe, antiviral modality may mitigate treating with small molecule AR degradation enhancers, then examine the severity of lower tract respiratory disease as well as reduce hospi- the effect of supression SARS-CoV-2 pseudotyped viral particles entry talization and mortality rates. Intranasal APDT has been deployed for after inducing AR degradation. 10 years in Canadian hospitals as an effective, broad-spectrum nasal Methods: Small molecule AR degradation enhencers Asc-JM-17 and antimicrobial for reduction of post-surgical infections. The objective of Asc-JM-176 were obtained from ALLIANZ PHARMASCIENCE LTD. (Tai- this work was to evaluate effectiveness of APDT against SARS-CoV-2 pei, TWN). The expression of AR, TMPRSS2 and ACE2 were studied by in vitro. western blotting. Small hairpin RNA lentivirus against AR and con- Methods: Studies were carried out using wild-type virus (SARS- trol lentivirus were tranfected to knockdown AR in A549, H1299 and Related Coronavirus 2, Isolate USA-WA1/2020, Cat# NR-52286, CL1-5 cell lines. SARS-CoV-2 spike fusion protein pseudotyped viral heat-inactivated, US Centers for Disease Control and Prevention/BEI particles were purchased from RNAi Core Lab in Academia Sinica. Peu- Resources, NIAID, NIH). APDT was carried out by exposing the viral dotyped viral assay was performed in HEK293T/17 ACE2-pBsd cells. culture to a photosensitizer formulation containing 320 uM meth- DHT, hydroxyflutamide, enzalutamide(MDV3100), Asc-JM-17, and Asc- ylene blue in an aqueous carrier, immediately followed by 36 J/cm JM-176 were applied to A549, H1299, CL1-5, HEK293T/17 ACE2-pBsd of non-thermal laser light at 664 nm. Illumination was conducted in cells. a custom thin-film cell replicating the anterior nasal architecture. Results: Asc-JM-17 and Asc-JM-176 rather than hydroxyflutamide and Studies were repeated at 72 J/cm for comparison purposes. RNA enzalutamide inhibits AR, TMPRSS2 and ACE2 in a dose- and time- quantitation was carried out using RT-qPCR with N1/N2 primers and dependent manner. The suppression effect of Asc-JM-17 and Asc- probes and bacteriophage controls. All experiments were repeated JM-176 on TMPRSS2 expression was partially reversed by knockdown in triplicate. AR with shAR lentivirus infection. Asc-JM-17 and Asc-JM-176 rather Results: Results demonstrated APDT was capable of completely elimi- then hydroxyflutamid and enzalutamide robustly prevent the pseudo - nating the RNA signature of SARS-CoV-2. Reduction of threshold count typed viral particles in entry of HEK293T/17 ACE2-pBsd cells with EC50 ΔC = 22 was accomplished in a linear light-dose-dependent manner at 1.2 µM and 3.3 µM respectively. Finally Asc-JM-17 and Asc-JM-176 t (starting Ct = 23, ending Ct > 45 nondetectable) with light doses up to were safely administered in mice for 35 days without obvious toxicity. 8 min (p < 0.001). Conclusion: Using standard clinical parameters for intranasal patho- gen reduction, APDT proved capable of eliminating the RNA sig- nature of wild-type SARS-CoV-2 in vitro. This work supports further Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 3 of 140 development of APDT as a potent, antiviral modality for inhibition of points in the room. An active air sampling is also performed before SARS-CoV-2 transmission. and after the decontamination cycle to determine the air decontami- Disclosure of Interest: C. Romo Employee of: Ondine Research Labs, nation properties. C. Cross Employee of: Ondine Research Labs, R. Andersen Employee of: Results: The examination of the efficacy in accordance with the EN Ondine Research Labs, N. Loebel Employee of: Ondine Research Labs. 16615 standard consistently showed a strong efficacy of the tested disinfectant. In the airborne germ measurement, this effect was a reduction of approx. 66% of the microbiological room contamination. This germ-reducing effect could be shown at all measuring points. I05 Similarly, decontamination of the surfaces was shown to be effec - Virucidal efficacy of an ozone‑generating system for automated tive at all measuring points in the test setup we selected. Based on room disinfection the calculated maximum contamination of 5 × 105 CFU, the fogging 1,* 2 1 1 2 1 F. H. H. Brill, T. Burkard , B. Becker , D. Paulmann, D. Todt , B. Bischoff , E. achieved an efficiency of > 3 log on some of these surfaces. How- 2 1 Steinmann , J. Steinmann ever, this decontaminating effect depends on the accessibility of the DR. BRILL + PARTNER GMBH INSTIUTE FOR HYGIENE AND MICROBIOL‑ surfaces. OGY, Bremen, Institute for Medical and Molecular Virology, Ruhr‑Univer ‑ Conclusion: Our results could confirm the general antibacterial sity, Bochum, Germany efficacy of the fogging technology. However, there were strong dif- Correspondence: F. H. H. Brill ferences in efficacy depending on the accessibility of the test sam- Antimicrobial Resistance & Infection Control 10(1): 105 ples. The test procedure must also be refined in order to be able to accurately determine the actual germ reduction by means of dilution Introduction: Besides conventional prevention measures, no-touch levels. Further tests are needed to determine the potential of the tech- technologies based on gaseous systems have been introduced in hos- nology more precisely. pital hygiene for room disinfection. These results will help to establish Disclosure of Interest: None declared. realistic conditions for virus inactivation and assessment of efficacy of ozone technology against non-enveloped and enveloped viruses. I07 Objectives: The aim of the study was evaluate the activity of ozon for Evaluation of an UVC robot for terminal disinfection of hospital automated disinfection of surfaces in a room. rooms Methods: A whole-room disinfectant device which creates ozone as 1,* 2 3 4 J. E. Sierra Garcia , F. Guillen‑Grima , M. P. Garcia‑Garcia , L. Cascajar , F. biocidal agent, was tested for its virucidal efficacy based on the NF T Rodriguez‑Merino 72-281:2014 AFNOR Standard against modified Vacciniavirus strain 1 2 Electromechanical Engineering, University of Burgos, Burgos, Preven‑ Ankara murine Norovirus, simian virus 40 and Adenovirus in a stand- tive Medicine, Preventive Medicine, Clinica Universidad de Navarra, ardized room on practice relevant surfaces. 4 5 Pamplona, ASTI Mobile Robotics, Burgos, Boos Technical Lighting, Results: All test virus titers were reduced after 150 and 300 min of Valladolid, Spain decontamination with mean reduction factors (RF) ranging from 2.63 Correspondence: (murine norovirus) to 3.94 (simian virus 40). Antimicrobial Resistance & Infection Control 10(1): 107 Conclusion: These results will help to establish realistic conditions for virus inactivation and assessment of efficacy of ozone technology Introduction: The dramatic spread of COVID-19 has disrupted lives, against non-enveloped and enveloped viruses. communities and businesses worldwide. A new autonomous robot, Disclosure of Interest: None declared. equipped with UVC light to perform fast and reliable disinfections while it is on movement, has been developed to contribute to the I06 reduction of the impact on public health. Efficiency of a dry‑fog based decontamination method Objectives: In this work, we have scientifically evaluated the ability of for the reduction of bacterial contamination this robot to disinfect hospital rooms. 1,* 1 1 S. Buhl , A. Stich , C. Bulitta Methods: We selected empty rooms just after patient discharge and medical engineering, Ostbayerische Technische Hochschule before terminal cleaning. We took 94 microbiological samples of highly Amberg‑Weiden, Weiden in der Oberpfalz, Germany touched surfaces inside the hospital patient’s rooms using Rodac Correspondence: S. Buhl plates, before introducing the robot in the room. After the robot opera- Antimicrobial Resistance & Infection Control 10(1): 106 tion, samples were taken in the same places. The plates were incubated and read after 5 days. We performed descriptive statistics, and non-par- Introduction: Dry fog disinfection, which has been a topic in the food ametric Wilcoxon test for repeated measures, using IBM SPSS and OPE- industry for a long time, has the potential to be an alternative to com- NEPI. Results are presented in colony-forming units per plate (cfu/p) mon disinfection methods. The possibility of the technology to decon- per plate. Patients are considered to be at risk when the bacterial count taminate the whole room in one disinfection cycle has also led to on hospital surfaces exceeds 120 FCU/plate (5 fcu/cm2). serious exposure to this technology during the pandemic. Results: The initial situation was that in 4% of the locations there was Objectives: In this work, the disinfecting potential of the TBT dry fog- a risk for the patients (more than 120 cfu per plaque). After applying ging technology (TBT Desinfektion GmbH & Co. KG, Germany) and the this robot there were no locations with risk for the patients. The table corresponding disinfectant Defeat AR (Biofluid GmbH, Germany) with shows that the mean colony reduction is 81.96% and the median regard to microbiological contamination will be examined. experiments a reduction of 94.8%. In any case, both levels mean and Methods: Defeat AR is a HOCl-based active ingredient and the princi- median are below the threshold for disinfection that is 10 fcu/plate. ple disinfection potential of the disinfectant is tested by means of the The Wilcoxon test for related samples indicates that the differences are standardized 4-field test (EN 16615) in a first step. Then TBT dry fog statistically significant (P < 0.0001). The normal procedure is to clean method for decontaminating microbiological contamination is tested the room using a Chloramine-based disinfectant after the UVC, so the in an experimental setup. Ceramic tiles are soiled with a suspension of cumulated effect will be even higher. Staphylococcus aureus (ATCC 6538) and distributed at predetermined Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 4 of 140 was developed to navigate through electronic medical records and lab systems. Buy-in was sought from all relevant stakeholders including PREPOST Hospital management, Data protection, Information Technology, Pro- Mean 30.71* 5.54** curement, Laboratory, Infection Prevention & Control and UiPath. A solu- SD 34.69.5 tion design document was developed and agreed along with controls CI 95% 23.6-37.8 3.60-7.49 and risk assessment. Three key processes were assigned to RPA: Micro- Median 17.51 biology Results for MDROs, COVID-19 & MDROs Surveillance and Nurse Quartile deviation213 Task Admin Handover. Results: At present, Uipath robot works 24/7, 365 days a year with no * FCU per plate break requirements and eliminates human error. RPA reduced admin- ** Disinfection treshold < 10 FCU per Plate istration time by 3 h a day, which equates to 18 h per week or 936 h a Table 1: Reduction of the colony-forming units. year. In addition, RPA saved substantial amount of time required for processing COVID-19 results and surveillance. In fact, RPA facilitated more efficient work flow. RPA liberated resources to deliver essential IPC services such as surgical site infection surveillance, PPE training and education, guideline development, COVID-19 and CPE contact tracing. Conclusion: RPA could be implemented across the wider healthcare Conclusion: The use of this robot allowed to reduce the colony-form- environment to optimise use of Infection Prevention and Control Nurses ing units below the risk threshold. Therefore it is a valid technique for time. terminal disinfection of hospital rooms. Disclosure of Interest: None declared. Disclosure of Interest: None declared. I09 Decolonization of human skin by application I08 of a photodynamically active hydrogel Use of robotic process automation (RPA) for rapid analysis 1,* 1 1 2 1 D. B. Eckl , A. Hoffmann , N. Landgraf , A. Eichner , H. Huber , W. and interpretation of multidrug resistant organisms Bäumler and COVID‑19 results 1 2 Department of Microbiology, University Regensburg, Department 1,* 1 J. Jerry , D. A. O’malley of Dermatology, University Hospital Regensburg, Regensburg, Germany Infection Prevention and Control, Mater Misericordiae University Hospi‑ Correspondence: D. B. Eckl tal, Dublin 7, Ireland Antimicrobial Resistance & Infection Control 10(1): 109 Correspondence: J. Jerry Antimicrobial Resistance & Infection Control 10(1): 108 Introduction: Skin colonization with pathogenic, even multi-resistant bacteria is a potential source of infections. Photodynamic inactivation Introduction: The IPC (Infection Prevention & Control) nurses work- (PDI) of bacteria is a promising, new approach for the decolonization load had trebled in the last 5 years due to increased number of of the human skin. PDI needs a dye molecule (photosensitizer), which patients diagnosed with known Multi Drug Resistant Organisms generates mainly singlet oxygen upon light exposure. Thereby bacte- (MRDOs). IPC nurse resources were saturated with downloading and ria are oxidative destroyed regardless their type and resistance profile. processing essential microbiology results from an old laboratory sys- Preliminary PDI experiments already provided a decontamination effi- tem. The potential for human error whilst collating the microbiology cacy on human ex vivo skin of 99.9% using an aqueous photosensi- results from the laboratory system was moderate as some parts of the tizer solution. process required items to be transcribed. Objectives: Based on findings mentioned before, we aimed to Objectives: 1. To employ Robotic Process Automation (RPA) to lift improve the decolonization efficacy by applying a photodynamically the burden of repetitive tasks from IPC team and reduce the sig- active hydrogel in a follow-up study. nificant amount of time spent on daily processing of lab results and Methods: Fresh ex vivo human skin was inoculated with bacterial administrative work. 2. Redirect the specialist nurses’ time saved by suspensions of methicillin-resistant Staphylococcus aureus (MRSA). using RPA towards quality improvement initiatives and patient care. After visible drying of bacteria, different hydrogels containing dif- 3. Improve job satisfaction and reduce turnover of staff in the IPC ferent photosensitizers were added to the inoculated skin surface. team. 4. Eliminate human error. Subsequently, the skin surface were irradiated with visible blue light Methods: IPC team identified RPA as the best solution to lift the at different radiant exposures (J/cm ). Then, bacteria were recovered administrative burden. A process check was undertaken by UiPath from skin with a swap and plated via drop-plate method on Mueller Software Team to identify tasks which could be automated. The RPA Hinton Agar. Colony count unfold reduction efficacy when referenced Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 5 of 140 to internal controls. After recovery, skin biopsies were taken and nitro Slide session: Epidemiology and spread of MDRO in hospital blue tetrazolium (NBT) staining was applied to check viability of skin and community cells via mitochondrial activity. TUNEL stain revealed the presence of apoptotic skin cells. O01 Results: The results showed that PDI created an improved MRSA Colonization pressure as a risk factor for acquisiton reduction on skin of around 99.99%. Staining of the tissue revealed no of ESBL‑producing enterobacterales 1,* 1 1 1 noteworthy apoptosis or lack in mitochondrial activity of the human F. Maechler , F. Schwab , S. Hansen , P. Gastmeier on behalf of R‑Gnosis cells due to the application of the photodynamically active hydrogel. WP5 Study Group Conclusion: PDI should represent an easy, quick and efficient method Institute of Hygiene, Charité Universitätsmedizin, Berlin, Germany to decolonize human skin from MRSA. The results of the study are Correspondence: F. Maechler remarkable, as substances on skin like inorganic ions or small organic Antimicrobial Resistance & Infection Control 10(1): O01 molecules such as histidine are capable to inhibit the photodynamic efficacy. Since PDI is known to eradicate a large set of pathogens inde - Introduction: The so-called colonization pressure, which is the pro- pendent of their antibiotic resistance profiles, this new technology portion of patients colonized with certain microorganisms, affects the should be tested in clinical studies in the near future. spread of these microorganisms in hospitals. Disclosure of Interest: None declared. Objectives: The aim of this project was to analyze the impact of coloni- zation pressure on the acquisition of ESBL-producing Enterobacterales in I10 adult non-ICU wards. Development of the first washable, fluorescent alcohol‑based Methods: The project was a subanalysis of a trial that compared differ - hand rubbing training solution ent infection control strategies (Maechler et. al; LID 2020;20:575-84). 1,* 1 1 2 P. G. Szeremy, V. Sari, P. Vezse, T. Haidegger Patients admitted to 20 adult medical and surgical non-ICUs in four Euro- 1 2 HandInScan Zrt., Research, Innovation and Service Center (EKIK), Óbuda pean countries were screened for ESBL-E carriage on admission, weekly University, Budapest, Hungary thereafter and on discharge. We defined colonization pressure as the Correspondence: P. G. Szeremy number of ESBL-E days per 100 patient days during the previous 7 days. Antimicrobial Resistance & Infection Control 10(1): 110 For each calendar day and ward, we associated the number of ESBL-E acquisitions and the colonization pressure. The multivariate analysis Introduction: Fluorescent, alcohol-based hand hygiene training solu- adjusted for clustering, season, infection control strategy, ward type, and tions combined with a UV lamp are a well-established tool to teach unscreened patient days (days to first screening per 100 patient days). and survey hand rubbing performance. One of their main drawbacks is Results: Between January 2014 and August 2016, 50,870 patients were that these training rubs stain the hand, and remain detectable for 24 h admitted to the participating wards, accounting for 356,298 patient days. on the skin. As a consequence these are only applicable once a day, Of those, 32,254 patients had a length of stay ≥ 3 days and ≥ 1 screening and prohibited from many applications. Washable non-liquid (i.e., gel culture, accounting for 296,298 patient days with information on ESBL- and lotion consistency) fluorescent training products are known, but E carriage. The median time to first sample was 2 days (IQR 1–3); the they are creamy, not alcohol based, therefore inadequate to properly median number of samples per screened patient was 2 (IQR 1–2); ESBL-E train the act of hand rubbing. admission prevalence was 11% (95%CI 9.3–10.2), and the incidence den- Objectives: To develop and assess a novel fluorescent-labeled hand sity of ward-acquired ESBL-E per 1000 patient days was 4.0 (95%CI 3.7– hygiene training product which is completely removable and rinsi- 4.3). Across all wards, the median 7 day-colonization pressure was 13.5% ble by soap and water, thus providing repeatable and universal hand (IQR 8.2–20.5), and the median percentage of unscreened patient days hygiene training. was 22.7% (IQR 13.2–34.2). The table shows the results of the multivariate Methods: A new compound was selected to meet the strict health analysis. and safety regulations in the food, pharma and healthcare industry. All fluorophore candidates were tested from the narrow cross section ParameterIncidence Rate Ratio95%Confidence Interval P-Value TypIII Colonization pressure, ESBL days per 1.0221.011-1.033 0.0071 of the aforementioned industries. The washability, detectability, visual 100 patient days (per 1%) Contact isolation (compared to standard 1.0400.862-1.255 0.6794 staining and skin protection was optimized. Instead of the traditional precaution) Unscreened patient days per 100 patient 0.9890.981-0.998 0.0181 UV-A light, a completely harmless blue light was picked. It was further days (per 1%) Surgical ward (compared to medical 1.2841.039-1.586 0.1011 field tested for two weeks in a food processing plant, supporting a ward) Summer 1.3291.104-1.6 0.0174 hand hygiene training intervention. Autumn 1.2091.052-1.390.0252 Results: A first in class training solution was successfully experi- mented to support cross-industry hand hygiene training. The solution was registered as a cosmetic product in the EU according to the EU Conclusion: Per 1% increase of colonization pressure, the adjusted Regulation (EC) No 1223/2009 (Article 13). risk of ESBL-E acquisition increased by 2.2%. During the performance assessment, 654 hand hygiene actions were Disclosure of Interest: None declared. performed by 75 users. No skin complaints or other usability issues were detected. The intervention resulted an increase of 13 percentage point from a 86% hand coverage baseline to a 99% final result. O02 Conclusion: The usability and performance tests of a new, washable An interventional study to evaluate the impact of a rapid hand hygiene training solution was performed, with identical out- screening strategy in improving nosocomial ESBL and CPE control comes to the traditional UV fluorescent training. The chosen labeling in critically ill patients compound is a common food and drug additive, without known aller- 1,* 2 3 2 3 R. Martischang , P. François , A. Cherkaoui , E.‑J. Bonetti , G. Renzi , J. gic reactions. The complete removal of the fluorescent label by hand 3 4 1 Schrenzel , J. Pugin , S. Harbarth washing makes the new solution optimal for objective, sustained 1 2 3 Infection Prevention and Control, Genomic Research Laboratory, Bac‑ hand rubbing and hand washing training, assessment and quality teriology Laboratory, Intensive Care Units, HUG, Geneva, Switzerland assurance. Correspondence: R. Martischang Disclosure of Interest: P. Szeremy Employee of: HandInScan Zrt., V. Sari Antimicrobial Resistance & Infection Control 10(1): O02 Employee of: HandInScan Zrt., P. Vezse Employee of: HandInScan Zrt., T. Haidegger Employee of: HandInScan Zrt. Introduction: Current phenotypic screening methods may delay timely infection control measures for carriers of Extended-Spectrum Beta-Lactamase Producing Enterobacterales (ESBL-PE) and Carbapen- emase Producing Enterobacterales (CPE). Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 6 of 140 Objectives: We compared a rapid molecular assay against culture- Antimicrobial Resistance & Infection Control 10(1): O03 based method to discontinue preemptive contact precautions (CP) for negative patients at-risk, or to accelerate implementation of CP for Introduction: Infections due to extended spectrum beta-lactamase newly positive patients. producing Enterobacteriales (ESBL-PE) are the leading causes of sep- Methods: This interventional quasi-experimental cohort study com- sis among hospitalized neonates in Botswana, yet ESBL-PE transmis- pared the diagnostic performance of the Loop-Mediated Isothermal sion dynamics are not well-characterized in the neonatal intensive Amplification (LAMP) Eazyplex SuperBug CRE assay (AxonLab, Swit - care unit (NICU) environment. st zerland) during a 1 period (Apr 2019-Mar 2020) with culture-based Objectives: This study aimed to assess the efficiency and feasibil- nd method implemented during a 2 period (May-Oct 2020) to detect ity of a chromogenic-culture-media-based environmental sampling ESBL-PE and CPE carriage among critically ill patients at Geneva Uni- strategy characterizing the ESBL-PE bioburden within a NICU. versity Hospitals. Survival analysis assessed time to discontinue unnec- Methods: The study took place at a 36-bed NICU in a tertiary care essary preemptive CP in patients at-risk, and time to implement CP for hospital in Botswana from January-April 2021. Samples were col- newly positive patients. lected on 3 occasions under semi-sterile technique using 1) flocked Results: We included 1′044 patients, 147 (14%) patients at risk screened swabs & templates (flat surfaces); 2) sterile syringe & tubing (water at admission, 813 (78%) patients with either weekly or fortuitous aspiration); 3) structured swabbing techniques (hands & equip- screenings, and 84 (8%) patients with both screenings. Prevalence was ment). Swabs were transported in physiological saline-containing 16% and 0.8% for ESBL-PE and CPE. The LAMP assay for CPE detection tubes, vortexed, and 10 µL was inoculated onto chromogenic-agar yielded a positive predictive value (PPV) of 44.0% [95%CI 24.5–63.5], (CHROMagarTM ESBL, Paris, France; selective/differential for ESBL- and negative predictive value (NPV) of 99.9% [95%CI 99.7–100.0], and PE), streaking plates to isolate individual colonies. Bacterial colonies for ESBL-PE a PPV of 88.5% [95%CI 82.3–94.6], and NPV of 95.0% [95%CI were quantified and phenotypically characterized using biochemi- 93.6–96.3]. Respectively, 92 and 47 patients at-risk were negative dur- cal identification tests. ing the interventional and control period. Median time to de-implement Results: In total, 393 samples were collected. Dense and consistent unnecessary CP was respectively 88.3 versus 80.5 h (p = 0.47). Due to ESBL-PE contamination was detected in and around sinks and cer- poor PPV, CP were not implemented based on positive LAMP results. tain high-touch surfaces, while transient contamination was demon- strated on medical equipment, caregivers/healthcare worker hands, insects, and feeding stations (including formula powder) (Figure 1). Results were available within 24–72 h of collection. To collect, plate, and analyse 50 samples, we estimated a total expenditure of $269.40 USD and 13.5 cumulative work hours. Conclusion: LAMP directly performed on rectal swabs has an excellent NPV to exclude ESBL and CPE carriage, but did not significantly accel- erate discontinuation of preemptive CP. Implementation of ESBL and CPE control measures based on this rapid test was however impossi- ble due to poor positive predictive values. Disclosure of Interest: R. Martischang Grant/Research support from: AxonLab provided the device, and a discount on LAMP reagents, P. François: None declared, A. Cherkaoui: None declared, E.-J. Bonetti: None declared, G. Renzi: None declared, J. Schrenzel: None declared, J. Pugin: None declared, S. Harbarth: None declared. O03 Characterizing the bioburden of ESBL‑producing enterobacteriales in a neonatal unit in Botswana: a feasible Conclusion: Using basic environmental sampling and laboratory and efficient environmental sampling method using chromogenic techniques aided by chromogenic culture media, we identified ESBL- culture media PE reservoirs (sinks) and plausible transmission vehicles (medical 1,* 2,3 3 2 M. Vurayai , J. Strysko , C. McGann , O. Bayani on behalf of Neonatal equipment, infant formula, hands of caregivers/healthcare workers, & Infections & Microbiome Working Group, S. Coffin insects) in this NICU environment. This strategy was a simple and cost- 1 2 Biological Sciences, Paediatric & Adolescent Health, University of Bot‑ efficient method to assess ESBL-PE bioburden and may be feasible for swana, Gaborone, Botswana, Global Health Center, Children’s Hospital use in other settings to support ongoing infection control assessments of Philadelphia, Philadelphia, United States and outbreak investigations. Correspondence: M. Vurayai Disclosure of Interest: None declared. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 7 of 140 O04 Methods: From 2010 through 2020, we performed 11 prevalence The transmission risk of multidrug‑resistant organisms studies (Jan/Feb of each year) with screening for digestive car- between pets and humans – preliminary results of an exploratory riage of ESBL-EC among residents in a university-affiliated LCTF. case control study All available isolates were typed for ST131-H30 and a selection was 1,* 1 2 2 1 C. Hackmann , P. G astmeier , S. Schwarz , A. Lübke‑Becker , R. Leistner sequenced. Institute of Hygiene and Environmental Medicine, Charité—Universitäts‑ Results: We included 2′403 LTCF residents, with 252 (10.5%) posi- medizin Berlin, Department of Veterinary Medicine, Freie Universität tive for ESBL-EC. Among the 238 ESBL-EC isolates available for typ- Berlin, Berlin, Germany ing, 58.0% belonged to the ST131 lineage, including 94/138 (68.1%) Correspondence: C. Hackmann ST131 H30 isolates. An increasing yearly prevalence was observed Antimicrobial Resistance & Infection Control 10(1): O04 for ESBL-EC (4.6% to 9.4%; p = 0.106 for linear trend), but not for the ST131 H30 subclone, which peaked in 2015 and declined thereaf- Introduction: Up to 60% of German residents own at least one pet, ter. Since 2017, we noted the clonal expansion of a ST131 non-H30 who live in close contact to their owners. Colonization with multidrug- subclone harboring CTX-M-14 and CTX-M-24. Multiple silent ESBL- resistant organisms (MDROs) occurs in humans and pets. However, it is EC outbreaks occurred, mostly before the withdrawal of contact still unclear if pets play a significant role as a reservoir for MDROs. precautions for ESBL-EC carriers in 2019. No rebound effect was Objectives: This project aims to assess the relevance of pet hus- observed in ESBL-EC prevalence nor in the different subclones fol- bandry in the colonization of MDROs of hospital patients. The lowing discontinuation of contact precautions. project focusses on the most common MDROs in pet owners, methi- cillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant rd enterococci (VRE), 3 generation cephalosporin-resistant Entero- bacterales (3GCRE) and carbapenem-resistant Enterobacterales (CRE). Methods: We perform an exploratory, unmatched case–control- study. Among questions about well-known risk factors, study par- ticipants are queried regarding their contact to dogs and cats. To assess the genetic relatedness of the human and pet MDROs, we collect nasal and rectal swabs of participants and their pets to test them for MDROs. Phenotypically matching MDROs in the samples of participants and their pets will be tested for genetic relatedness using whole genome sequencing (WGS). The study is currently being performed at the Charité Universitätsmedizin Berlin. The sam- ple size will comprise about 4,000 human participants and aims at 1,000 animal samples. The study is funded by the Federal Depart- ment of Health (BMG). Results: Among 3,285 participants so far, 25% (820/3,285) tested posi- tive for MDROs. 21% of the participants (701/3,285) stated to own at Conclusion: Clonal fluctuation was observed for ST131-H30 ESBL-EC least one pet dog or cat (range 1–10). Among the first 345 returned with a current decline in prevalence. Surveillance should include the and analyzed pet samples, 12% (42/345) were positive for MDROs. In evolution of ST131 non-H30 subclones, which may spread in LTCFs. three cases MDROs of pet and owner were phenotypically matching. Discontinuation of contact precautions for ESBL-EC carriers in LTCFs The matching pathogens were in two cases VRE and in the other case may be safely implemented, in support of European recommenda- 3GCRE. WGS analyses revealed that two of the pairs were also geno- tions to limit ESBL-producing Enterobacteriaceae control measures in typically matching. endemic settings to non-E.coli. Conclusion: The investigation of pet husbandry as a risk factor for col- Disclosure of Interest: None declared. onization or infection with MDROs in this study creates an opportunity to identify patients at risk and develop potential prevention strategies. O06 Although it is known that transmission between humans and pets Vancomycin‑resistant enterococcus—a health economic ccurs, the likelihood of this transmission is still unclear and the effect evaluation of a healthcare outbreak in Switzerland size needs to be investigated. 1,* 2 2 2 T. Berkes , O. Endr ich , M. Fiedler , J. Marschall Disclosure of Interest: None declared. 1 2 University Bayreuth, Murrhardt, Germany, Inselspital Bern, Bern, Swit‑ zerland Correspondence: T. Berkes Antimicrobial Resistance & Infection Control 10(1): O06 O05 Epidemiology of ESBL‑producing Escherichia coli Introduction: Nosocomial infections caused by Vancomycin-resistant (ESBL‑EC) from repeated prevalence studies over 11 years Enterococcus (VRE) are on the rise worldwide. A few studies estimated in a long‑term‑care facility (LTCF) 1,* 2 3 2 2 the economic impact of nosocomial outbreaks and revealed that R. Martischang , P. François , A. Cherkaoui , E.‑J. Bonetti , N. Gaïa , G. 3 1 4 1 nosocomial infections caused by VRE are associated with prolonged Renzi , M. Perez , C. Graf , S. Harbarth 1 2 3 hospital stays and higher hospital costs. Infection Prevention and Control, Genomic Research Laboratory, Bac‑ Objectives: The research was performed to evaluate the economic teriology Laboratory, Department of Rehabilitation and Geriatrics, HUG, impact of nosocomial pathogens (here VRE) on hospitals. Geneva, Switzerland Methods: We implemented a retrospective cost analysis on infected Correspondence: R. Martischang or colonised patients between January 2018 and June 2019 in three Antimicrobial Resistance & Infection Control 10(1): O05 hospitals: Bern, Tiefenau and Münsingen. We used a clinical process modelling for patients who might be or are affected by nosocomial Introduction: Escherichia coli Sequence type 131-H30 are emerg- pathogens (here VRE). Data was collected on true hospital costs (in ing multidrug resistant subclones, known to spread and cause out- CHF) and closed beds with regard to clinical process indicators and breaks in LTCFs. clinical risk factors. We used cost unit accounting (REKOLE) to iden- Objectives: We aim to assess temporal trends in the prevalence and tify, assign and differentiate the collected costs. This process made it epidemic potential of ESBL-EC subclones, and to evaluate a poten- possible to calculate extra costs per VRE case, a comparison between tial rebound effect following discontinuation of contact precautions for ESBL-EC carriers in January 2019. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 8 of 140 colonised/infected vs. non colonised patients and the calculation of Slide session: Other healthcare‑associated infections the total outbreak costs. Results: Overall we identified 500 cases of Vancomycin-resistant O08 Enterococcus caused mostly by E. faecium of sequence type ST 796. Peripheral venous catheters (PVCS) inserted in the hand are Multivariable analyses revealed that several factors increased the risk associated with lower PVC‑related bloodstream infection (BSI) 1,* 1 1 1 1 1 of being colonised with VRE: age, pre-existing condition, stay in ICU, N. Buetti , M. Abbas , D. P ittet , M.‑N. Chraiti, V. Sauvan , M. de Kraker , 1 1 2 1 exposure to antibiotics, number of involved healthcare workers, expo- M. Boisson, D. Teixeira, W. Zingg , S. Harbarth 1 2 sure to specific rooms and to contaminated medical devices. They led Geneva University Hospitals, Geneve, Department of Infectious to prolonged hospital stays and higher economical impact. The overall Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, hospital costs were significantly higher in VRE cases as compared to Switzerland non colonised patients (22´908 CHF vs. 21´048 CHF). The additional Correspondence: N. Buetti costs due to extra microbiological diagnostics and extra materials Antimicrobial Resistance & Infection Control 10(1): O08 were about 1´860 CHF per VRE case. The total costs generated by the nosocomial outbreak were about 7.2 Mio. CHF. Introduction: Little is known about the risk of bloodstream infection Conclusion: Nosocomial transmissions caused by multidrug-resistant (BSI) associated with peripheral venous catheters (PVCs) and no large pathogens are associated with an increase of marginal costs by around study has previously investigated the insertion site-related risk for 10%. These costs are avoidable. Cost drivers are closed hospital beds, PVC-BSI. diagnostics, and infection preventions activities (including personnel Objectives: The objective of this study was to investigate the asso- costs). Prevention is the most important measure to avoid nosocomial ciation between anatomical PVC insertion site and risk of BSI using a outbreaks and is likely to be cost-effective. large prospective database. Disclosure of Interest: None declared. Methods: We included all patients hospitalized in the University of Geneva Hospitals between 1st January 2016 and 29th February 2020 O07 with at least one PVC insertion on the upper extremity. We used uni- Whole genome sequencing sustains cross‑transmission variable and multivariable marginal Cox regression models for clus- of pseudomonas aeruginosa in a neonatal intensive care unit tered data to evaluate the risk of PVC-BSI according to the insertion during an outbreak site (hand versus proximal sites in the upper extremities). 1,* 1 1 1 1 1 D. S. Blanc , L. Senn , I. Federli , E. Giannoni , F. Legault , M. Roth‑Kleiner , Results: 403′206 upper extremity PVCs with documented insertion B. Grandbastien site were included. There were 73′325 females (54%); median age was Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland 49y (IQR 32–69). The median time from hospital admission to catheter Correspondence: D. S. Blanc insertion was 1 day (IQR 1–4). 109′686 (27%) PVCs were inserted in Antimicrobial Resistance & Infection Control 10(1): O07 the hand. During the study period, 61 PVC-BSIs were documented, 6 originating from PVCs in the hand, and 55 from PVCs at other insertion Introduction: Pseudomonas aeruginosa is a rare pathogen in neona- sites. Hand insertion was associated with statistically significant lower tal intensive care unit (NICU). Following P. aeruginosa infections in risk of PVC-BSI than proximal insertion in both univariable models (HR three NICU patients in June 2020, we performed an epidemiological 0.42, 95% CI 0.18–0.99, p = 0.046) and after adjusting for gender, age investigation. and time from admission to catheter insertion (adjusted HR 0.42, 95% Objectives: To find possible sources and routes of transmission of P. CI 0.18–0.98, p = 0.046). In a sensitivity analysis for PVCs with ≥ 3 days aeruginosa infections in NICU patients using standard and genomic of catheter maintenance, we confirmed a decreased PVC-BSI risk after typing methods. hand insertion (HR 0.37, 95% CI 0.15–0.93, p = 0.035). Methods: Retrospective analysis of P. aeruginosa isolates from Conclusion: Hand insertion showed a decreased daily risk of PVC-BSI, patients hospitalized in NICU was performed and we initiated a pro- particularly for catheters in place for ≥ 3 days. spective weekly screening of all patients for P. aeruginosa (which Disclosure of Interest: N. Buetti Grant/Research support from: Post. included naso-pharyngeal and rectal swabs). Based on previous doc Mobility grant from the Swiss National Science Foundation (grant investigation, environmental samples targeting sink traps were per- number: P4P4PM_194449), M. Abbas: None declared, D. Pittet: None formed to identify P. aeruginosa. Isolates were first typed by double declared, M.-N. Chraiti: None declared, V. Sauvan: None declared, M. locus sequence typing (www. dlst. org/ Paeru ginosa) and all isolates de Kraker: None declared, M. Boisson: None declared, D. Teixeira: None identical to the outbreak isolates, were further analysed by whole declared, W. Zingg: None declared, S. Harbarth: None declared. genome Multi Locus Sequence Typing (wgMLST, BioNumerics v.7.6.3). O09 Results: The three patients harboured isolates from the same DLST62- First COVID‑19 wave in Dutch hospitals: effects on central venous 56 genotype. Retrospective analysis of isolates from patients hospital- catheter care and distribution of bacteremia pathogens 1,* 1 1 1 ized in the NICU revealed five other patients with this genotype from T. van der K ooi , W. Altorf‑van der Kuil , A. Schoffelen , S. van Rooden , S. April to July 2020. Weekly screening implemented in August revealed de Greeff on behalf of the ISIS‑AR study group eight new patients with P. aeruginosa, of whom only three with the Healthcare‑associated infections and Antimicrobial resistance, National epidemic genotype. No isolate from the environment belonged to this Institute for Public Health and the Environment (RIVM), Bilthoven, Neth‑ genotype. Whole genome sequencing revealed that all DLST62-56 iso- erlands lates belonged to the MLST ST667. wgMLST of NICU isolates from this Correspondence: T. van der Kooi genotype revealed they clustered all in the same group with 0 to 6 loci Antimicrobial Resistance & Infection Control 10(1): O09 differences between isolates. Conclusion: The absence of the epidemic DLST in the environment Introduction: Due to COVID-19, care capacity has been put to the test. favoured the hypothesis of cross-transmission. This was corroborated Objectives: We investigated how the first wave affected the frequency by the fact that the outbreak stopped when weekly screenings were of bloodstream infection (BSI), the distribution of associated pathogens implemented and additional contact measures were taken with posi- and the care for patients with a CVC. tive patients. Molecular typing with DLST in the first approach allowed Methods: Hospitals can monitor CVC-related (CR)BSI in the national a rapid identification of a putative problem and selecting isolates for PREZIES surveillance. All 24 hospitals participating in 2020 received a sur- finer typing with whole genome sequencing. wgMLST confirmed vey on changes in care for patients with CVCs on COVID-19 ICU/wards. the close genetic relatedness between these isolates, sustaining the The frequency and distribution of pathogens were studied in data on patient-to-patient chain of transmission. blood isolates from patients sampled before (October 2019 to February Disclosure of Interest: None declared. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 9 of 140 2020), during (March to May 2020), and after (June to September 2020) 467 respectively. The rate of CLABSI reduced from 12.63/1000 line the first COVID-19 wave from the Dutch Infectious Disease Surveillance days (pre-intervention) to 5.91/1000 line days (P1), 3.55/1000 l line System-Antimicrobial Resistance (ISIS-AR) database. days (P2), 7.94/ 1000 line days (P3) and 5.70/ 1000line days (P4). The Results: CRBSI data entry is delayed by COVID-19, but increased rates compliance rate of the CVC care bundle in pre- intervention phase were observed. Nine hospitals responded to the survey. During the wave was 80.65% and post intervention was 85.65% (P1), 85.43% (P2), bed capacity increased (9 ICU; 3 wards) and external staff assisted (ICU 9; 90.61%(P3) and 92.51%(P4). wards 8). Hospitals reported less frequent oral care and/or washing (5), Conclusion: Implementation of the WHO multimodal strategy dressing (2), and CVC set changes in the ICU (1), due to the prone posi- improved the compliance to CVC care bundle and showed a decrease tion of the patient and/or work pressure. in the CLABSI rate. Thus, to ensure the success of a CVC care bundle, The total number of patients with a positive diagnostic blood sample it is important to use a well-designed multimodal implementation during the first wave remained similar to before, but the mean monthly strategy. number of patients with a positive sample in the ICU increased from Disclosure of Interest: None declared. 268 (10% [95% CI = 10–11]) to 409 (15% [14-16]), and decreased again to 246 (9% [9-10]) after the first wave. In the ICU the proportion of sev- O11 eral pathogens changed during the wave (table). All values normalized Epidemiology, risk factors and clinical outcomes afterwards. of healthcare‑associated bloodstream infections due to multidrug‑resistant microorganisms in a single‑center cohort Pathogens in ICUBefore During in northwestern China wave wave 1,2 3 2 2 4 5 6,* F. Liu , K. Lei, H. Wang , Y. Wu , J. Wang , D. P ittet, W. Zingg on behalf % (95% CI) % (95% CI) Coagulase negative Staphylococcus spp. (CNS) 45 (42-47)56 (53-58) of Institute of Global Health, Faculty of Medicine, University of Geneva Enterococcus faecium9 (8-11) 18 (16-19) 1 Institute of Global Health, Faculty of Medicine, University of Geneva, E. faecalis 3 (2-4)7 (6-9) Escherichia coli 10 (9-12) 4 (3-5) Geneva, Switzerland, Department of Nosocomial Infection Management, Klebsiella pneumoniae 3 (2-4)1 (0-1) 3 Clinical Microbiology Laboratory, The Second Affiliated Hospital, Xi’an S. aureus 9 (7-10) 5 (4-6) Jiaotong University, Xi’an, China, Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University, Magdeburg, Germany, Infection Control Program and WHO Collaborat‑ Conclusion: All hospitals reported increased demand of care, sup- ing Centre on Patient Safety, University of Geneva Hospitals and Faculty port of external staff and in some downscaled or hampered CVC and 6 of Medicine, Geneva, Department of Infectious Diseases and Hospital patient care. This may partly explain the more frequently sampled CNS Epidemiology, University Hospital Zurich, Zurich, Switzerland in blood during the first COVID-19 wave. Correspondence: W. Zingg Disclosure of Interest: None declared. Antimicrobial Resistance & Infection Control 10(1): O011 Introduction: Healthcare-associated BSI (HABSI) due to multidrug- O10 resistant microorganisms (MDROs) is a serious concern worldwide, The effectiveness of introducing a multimodal strategy associated with high morbidity and mortality. Unfortunately, epidemi- to improve the CVC care bundle and reduce the rates of CLABSI ological burden, attributable risk factors and clinical outcome remain in a tertiary teaching hospital, Malaysia 1,2,* 2 2 2 unknown in China. S. Ponnampalavanar , A. Rajandra , I. N. Ismail , S. Z. Mohamad Razali , 3 1 3 2 2 2 Objectives: This study aimed to investigate the burden of HABSI due S. Basri , S. F. Syed Omar , A. Kukreja , H. Zainol , S. Saaibon , N. R. Hassan , to MDRO in terms of both morbidity and mortality among inpatients S. N. Zainon @Md Ali 1 2 3 in Shaanxi. Medicine, University of Malaya, Infection Control, Infectious Disease, Methods: Prospective surveillance of HABSI due to MDRO was con- University Malaya Medical Centre, Kuala Lumpur, Malaysia ducted in a tertiary-teaching hospital in Xi’an, Shaanxi, from 2013 to Correspondence: S. Ponnampalavanar 2017. We analyzed first HABSI episodes due to MDRO from clinical Antimicrobial Resistance & Infection Control 10(1): O10 samples. Results: 141 inpatients were diagnosed with bloodstream infec- Introduction: A Central venous catheters (CVC) care bundle was tions due to MDROs for an overall incidence of 39 per 100,000 introduced in October 2016 to prevent Central Line Associated Blood- inpatients (141/361,715). Of these, HABSI was responsible for stream Infection (CLABSI) in University Malaya Medical Centre, a 73.1%. The incidence of HABSI due to MDRO was 28 per 100,000 tertiary teaching hospital in Malaysia. However, compliance to inter- inpatients. Median length of stay for inpatients with HABSI due to ventions are usually low and effective implementation strategies are MDRO was 24 days. Among inpatients suffering from HABSI due needed for its success. to MDRO, most (75.7%) were secondary bloodstream infections. Objectives: The aim of this study was to assess the impact of an exist- Lower respiratory tract (41.7%) was the most frequent primary ing CVC Care Bundle in reducing the rates of CLABSI after implementa- infection site, followed by peritoneal cavity and abdominal organs tion using multimodal improvement strategy. (14.1%), and skin and soft tissues (9.0%). The mortality rates of Methods: This quasi-experimental study was conducted in all adult HABSI due to MDRO within 7 and 28 days were 11.7% and 69.9%, medical wards from July 2018 till December 2020. The World Health respectively (P = 0.001). Overall, gram-negative pathogens were Organization (WHO) multimodal improvement strategy was used to identified in a large number of HABSI episodes (N = 58 strains, implement the existing CVC in January 2019. The pre intervention 56.3%). Importantly, 28 day-mortality associated with Gram-nega- period was from July 2018 to December 2018 and post intervention tive MDROs was significantly higher (40.6%) compared with Gram- was from January 2019 to December 2020 which was further catego- positive MRDOs (13.9%; P < 0.001). Septic shock, central venous rized into 4 periods of 6 months duration each (P1, P2, P3 and P4) to catheterization, age ≥ 60 years, HABSI due to Acinetobacter bau- reflect the various implementation strategies. Data on adherence to mannii, and a Pitt Bacteremia Score ≥ 6 were independent risk fac- CVC Care bundle compliance and incidence rates of CLABSI were col- tors for death at 28 days by multivariable regression analysis. lected by the infection control nurse using a standardized checklist. Conclusion: This study offers detailed epidemiology of HABSI due Data was analyzed using SPSS version 23.0. to MDRO among inpatients in Shaanxi. Prospective surveillance and Results: The total central line analyzed in the pre-intervention infection control measures to prevent cross-transmission and infection was 93 and in the P1, P2, P3 and P4 periods was 261, 398,181 and Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 10 of 140 are needed to reduce the burden of HABSI due to MDRO and its asso- Slide session: hand hygiene ciated mortality. Disclosure of Interest: None declared. O13 Hand hygiene implementation strongly associated O12 with availability of funds: results from the WHO hand hygiene Impact of a dental care intervention on the hospital mortality self‑assessment framework global survey 2019 1,2,* 2,3 4 4 5 of critically ill patients: a quasi‑experimental study M. De Kraker, E. Tartari, S. Tomczyk, A. Twymann , L. Francioli , A. 1 1 1 1 4 4 2,6 I. Ribeiro , W. Bellissimo‑Rodrigues , L. Innocentini , L. Macedo , F. Cassini , B. Allegranzi , D. P ittet 1 1,2 1 1 1,2 1 2 Barbosa‑Júnior , A. P. Pereira , H. Souza, W. Lovato , M. Menegueti , G. Infection Control Program, Geneva University Hospitals, WHO Collabo‑ 1 1 1 1 1 3 Gaspar , A. Schmidt , C. Miranda , M. Auxiliadora‑Martins , A. Basile‑Filho , rating Centre on Patient Safety, Geneva, Switzerland, Infection Control 1,* 4 F. Bellissimo‑Rodrigues Unit, Mater Dei Hospital, Msida, Malta, Infection Prevention and Control 1 2 Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto Technical and Clinical Hub, Department of Integrated Health Services, Nursing School, University of São Paulo, Ribeirão Preto, Brazil WHO, Geneva, Switzerland, Program in Medical and Population Genetics, Correspondence: F. Bellissimo‑Rodrigues Broad Institute of MIT and Harvard, Cambridge, United States, Infection Antimicrobial Resistance & Infection Control 10(1): O12 Control Program, HUG, Geneva, Switzerland Correspondence: M. De Kraker Introduction: It has been previously demonstrated that providing Antimicrobial Resistance & Infection Control 10(1): O13 dental care to critically ill patients improves the prevention of respira- tory tract infections. However, no studies have explored the impact of Introduction: Healthcare-associated infections (HAIs) impact the this intervention on hospital mortality. quality of healthcare services, jeopardize patient safety and increase Objectives: To evaluate the impact of providing regular dental care healthcare costs. Improvement in hand hygiene compliance has on the risk of in-hospital death and ventilator-associated pneumo- been highlighted as the most effective measure to lower the inci- nia (VAP) among critically ill patients admitted to intensive care units dence of HAI. (ICU). Objectives: Ten years after the development of the World Health Methods: A quasi-experimental study through an interrupted time Organization (WHO) Multimodal Hand Hygiene Improvement series analysis (2016–2019) was conducted in two ICU, one medical Strategy, a global survey was conducted, using the Hand Hygiene ICU and one specialized in emergency care. The intervention began Self Assesment Framework (HHSAF), to ascertain the level of hand in January 1st 2019, and consisted of implementing routine dental hygiene implementation and its drivers in healthcare facilities (HCF) care three times a week for patients admitted to the study units. worldwide. Dental care was focused on oral hygiene and subgingival instrumen- Methods: In 2019, IPC professionals were invited through email/ tation. On the pre-intervention period, dentists provided punctual campaigns to complete the online HHSAF. A geospatial clustering care to patients, focusing more on dental extraction and abscess algorithm selected unique HCF responses, surveys from countries drainage, as necessary. The primary outcome of the study was the with low response rates were excluded, and post-stratification mortality rate, evaluated at the end of the ICU stay. Secondary study weighting was applied to improve representativeness. Weighted, outcome was VAP rate. Data was analyzed using the ARIMA (autore- median HHSAF scores and interquartile ranges (IQR) were reported. gressive integrated moving average) time series model in R software Drivers of the HHSAF score were determined through a generalized (version 4.03). estimation equation, considering country clustering and weights. Results: During the intervention period, 5,147 dental procedures were Results: In total, 3206 unique responses from 90 countries (46% of performed among 355 adult patients. The time series showed that the WHO member states) were included. The weighted, median HHSAF ICU death rates were 36.11%, 32.71%, and 32.30% within the three score indicated an intermediate hand hygiene level (350 points, years before the intervention, and 28.71% during the intervention IQR 248–430), which was positively associated with country income period (p = 0.016), as demonstrated in Figure 1. VAP rates were 5.21%, level and HCF funding structure. Overall, System Change had the 5.02% and 4.19% within the three years before the intervention, and highest score (85 points, IQR 55–100), and Institutional Safety Cli- 3.59% during the intervention period (p = 0.072). mate the lowest (55 points, IQR 35–75). In low-income countries, Evaluation and Feedback was the weakest element (34 points, IQR 15–65). From 2015 to 2019, the median HHSAF score stagnated. Conclusion: Most HCFs had an intermediate level of hand hygiene implementation or higher, for which HCF funding and country income level were important drivers. Availability of resources, leadership and organizational support are key elements to further improve quality of care and provide access to safe care for all. Disclosure of Interest: None declared. O14 Strengthening infection prevention and control programme in Turkey according to WHO’s multimodal strategy 1,* 1 1 1 1 E. Alp , D. Altun , C. H. Hekimoglu , E. Batir , E. Yildirim Gozel , F. 2 3 Timurkaynak , M.‑L. McLaws 1 2 Ministry of Health, Ankara, Turkey, University of Geneva, Geneva, Swit‑ zerland, UNSW, Sydney, Australia Correspondence: E. Alp Antimicrobial Resistance & Infection Control 10(1): O14 Introduction: Implementation of WHO’s multimodal (MM) strategy is essential for strengthening infection prevention and control programme Conclusion: A dental care intervention focused on oral hygiene (IPC) in a country. and subgingival instrumentation provided by dentists to critically ill patients significantly decreases their risk of dying in the ICU. Funding: FAPESP (process 2017/19166–7, 2018/17531–2) and FAEPA. Trial registration: RBR-4jmz36. Disclosure of Interest: None declared. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 11 of 140 Objectives: To share the experience of Turkey about the strengthening PASQUALE aimed to establish the WHO multimodal HH strategy at the infection prevention and control programme. University Hospital Bouaké, Côte d’Ivoire. Methods: In Turkey, structured IPC (infection control committees, train- Objectives: The project PASQUALE aimed to establish the WHO mul- ing, surveillance, hand hygiene activities) has been put into practice since timodal HH strategy at the University Hospital Bouaké, Côte d’Ivoire. 2006 by MoH. However, after 2018 MoH focused on IPC core components Methods: The improvement of HH knowledge and HH compliance for strengthening IPC. Electronic surveillance was strengthened. Turkey was assessed in a before-and-after intervention study. The interven- signed the pledge of hand hygiene and Train the Trainers (TTT) pro- tion consisted of a HH training for staff of all departments regardless gramme was organised for standardized approach based on the WHO’ of their participation in the initial assessment and the introduction of MM Hand Hygiene Improvement Strategy. In TTT programme, 34 IPC local production of ABHR. Assessment of HH knowledge and compli- professionals from 18 hospitals were trained for multimodal HH improve- ance was performed 12 months before (06/2018), right after the inter- ment strategy and a short TTT programme was organized with 32 partici- vention (10/2019) and at a ten months interval (08/2020), whereby pants in the largest teaching hospital in Turkey. After Covid-19 pandemic, knowledge was assessed through a self-administered questionnaire videos about multimodal hand hygiene strategy were used for e-learning and HH compliance through direct observations. by MoH. To this e-learning programme, 1845 IPC professionals registered Results: Baseline knowledge score was 14/25, increased significantly and 1287 of them completed. National Infection Control Committee to 17/25 upon the first and decreased to 13/25 in the second assess- was established in 2018 and National Infection Control Programme and ment. HH compliance showed a significant increase from 12.7% to Action Plan was introduced in 2019. The Hand Hygiene Self-Assessment 36.8% (p < 0.001) in first and remained at 36.4% in second follow-up. Framework (HHSAF) was first used nationally in 2019 for the documen- An average of 74.4L ABHR per month were produced from 07/2019 tation of HH situation and also focus on the future plans and challenges. until 03/2020, when the first COVID-19 infection was confirmed in HHSAF was translated in Turkish to increase participation of facilities. Côte d’Ivoire, and 138L per month from 04/2020 onwards. Monthly Results: HHSAF was sent to 216 hospitals and 125 (58%) submitted consumption of ABHR in the same time increased from 76 to 125L. their HHSAF. Of these hospitals, 92 (74%) were state hospital, 20 (16%) Conclusion: The implementation of the WHO HH improvement strat- were university hospital and 13 (10%) were private hospital. Responses egy led to sustained improvements in HH compliance without relying to HHSAF questions related to key indicators of the WHO improvement on costly interventions. This study emphasized that the implementa- strategy implementation were shown in Figure 1. tion of the strategy is feasible and has effectively contributed to the IPC response during the COVID-19 pandemic. Disclosure of Interest: None declared. O16 Knowledge and perception on hand hygiene and correlation with IPC practices and structures in health facilities in Uganda 1,* 1 1 1 2 H. Kasujja , J. P. Waswa , R. Kiggundu , M. Murungi , A. Zagorski , D. 2 2 2 2 Tjipura , M. Josh, T. Hafner , F. Alombah 1 2 USAID, MTaPS, MSH, Kampala, Uganda, USAID, MTaPS, MSH, Washing‑ ton, United States Correspondence: H. Kasujja Antimicrobial Resistance & Infection Control 10(1): O16 Introduction: IPC is an evidence-based approach to improve patient safety and contain AMR. This reqiures HR capacity building and ensur- ing system change for IPC programs. Objectives: To assess knowledge and perception of hand hygiene (HH) among HCWs in Uganda. To assess the correlation between HH knowlegde & perception (KaP) with IPC practices and structues in Ugandan facilities. Conclusion: The survey shows that improvement was achieved on Methods: We conducted a cross-sectional study in March 2021. having alcohol-based handrubs available, undertaking staff training, Included a random sample of 140 HCW and 28 senior managers (SMs) evaluation and feedback and displaying posters on hand hygiene from 14 hospitals selected by cluster sampling. We assessed HH KaP around their hospital. However, a dedicated budget in infection con- using the WHO HH Knowledge Questionnaire and Perception Surveys trol and improvements in institutional safety climate are gaps that for HCWs & SMs. Facility HH and IPC practices and structures were should be focused on. assessed using the WHO HHSAF and IPCAF tools. Data was collected Disclosure of Interest: None declared. concurently and analyzed using STATA to compute means, standard deviations (SD) and correlations. Results: 140 HCWs; 74 (52.86%) female and 66 (47.14%) male, and 28 O15 senior managers; 13 (46.43%) female and 15 (53.57%) male were sam- Eec ff tiveness and sustainability of the WHO multimodal hand pled. The average score of HH knowledge was 42.41% (SD 10.93), a hygiene improvement strategy in the university hospital Bouaké, closely similar study in Ugandan medical students revealed 49.4%. Republic of Côte D’ivoire in the context of the COVID‑19 pandemic The HCWs believe that HH is 84.39% (SD 5.52) effective in reducing 1,* 2 1 1 1 S. Müller , M. N’Guessan, R. Wood , L. Landsmann , C. Rocha , B. J. hospital acquired infections (HAIs). The SMs believe that the HH pro- 2 2 1 1 1 2 Kouame , D. Djadji , K. Abrokwa, S. Tomczyk , M. Arvand , B. Diané , M. gram proposed by WHO is 78.09% effective (SD 9.93) in increasing Borchert HH compliance. The average IPCAF score was 453.61(SD 130.02) cor- 1 2 Robert Koch Institute, Berlin, Germany, CHU, Bouaké, Côte d’Ivoire responding to intermediate level. The mean HHSAF score was 226.69 Correspondence: S. Müller (SD 49.22) which means a basic hand hygiene level. Knowledge on HH Antimicrobial Resistance & Infection Control 10(1): O15 postively correlated with IPCAF (0.395078) yet negatively correlated with HHSAF (-0.13303). There was a strong correlation (1) between Introduction: Healthcare worker adherence to proper Hand Hygiene perception of SMs on IPC and knowledge of HCWs. (HH) practices and access to alcohol-based hand-rub (ABHR) remains Conclusion: The results indicate need for increasing knowledge limited in many low-resource settings. An effective HH improvement and behavioral interventions on IPC, particularly HH among HCWs. strategy is a critical element of infection prevention and control (IPC) The moderate scores on IPCAF and HHSAF reflect efforts being programmes, as seen in the ongoing COVID-19 pandemic. The project made in building the national IPC program. The correlation between Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 12 of 140 knowledge and perception between senior managers and HCWs sug- Introduction: The WHO and US CDC have called for the development gest that educating and supporting managers could be a good way to of improved methods for evaluating efficacy of hand hygiene prod- increase knowledge among other HCWs. We intend to use the results ucts, which more closely reflect typical clinical use. in addressing key knowledge gaps. Objectives: The aim of the study was to select test organisms with Disclosure of Interest: None declared. high environmental stability known for their potential to be spread by contaminated hands. In addition, the application of contamination and preparations volume should simulate practical conditions. Indi- O17 vidual conditions such as hand size were considered. Reduction of multidrug resistant pathogens and clostioides Methods: Methodology was based on EN 1500:2017. Test organisms difficile after implementation of an individualised behavior were Enterococcus faecalis (ATCC 47,077) or Escherichia coli K12 (NCTC monitoring system to increase hand hygiene compliance 1,* 2 10,538). Hand contamination was performed either via the immersion C. Alefelder , R. Brinks method from EN 1500 or via spreading of 0.5 mL of a high titer virus Hosptial Hygiene and Infection prevention, Helios University Hospital suspension over all surfaces of both hands (“low volume contamina- Wuppertal, Wuppertal, Chair for Medical Biometry and Epidemiology, tion”) according to ASTM E2755. 50 subjects were categorized among University Witten‑Herdecke, Witten, Germany 3 groups of either small, medium, or large hand sizes and 1, 2, or 3 mL Correspondence: C. Alefelder volumes of 60% v/v 2-propanol were applied and rubbed in until dry, Antimicrobial Resistance & Infection Control 10(1): O17 respectively. Results: Mean log pre-values for E. faecalis contamination by immer- Introduction: Hospital aquired infections with multidrugresistant sion were 6.56 ± 0.27 and 6.29 ± 0.60 and mean log reduction factors pathogens (MDRO) and CIostridioides difficile associated diarrhea (RF) were 5.68 ± 0.92 and 4.63 ± 0.26, at the respective labs. Mean (CDAD) are a major thread to patients. Improving hand hygiene com- log pre-value for E. coli contamination by immersion was 5.38 ± 0.55 pliance among health care professionals (HCPs) is the most effective and mean log RF was 4.61 ± 0.74. Mean log pre-values for E. faecalis way to reduce nosocomial infections (NI). contamination by low volume contamination were 5.78 ± 0.40 and Objectives: Aim of this pilot study was to assess efficiacy of a personal 6.82 ± 0.09 and mean log RFs were 5.03 ± 0.91 and 5.16 ± 0.56, at the technological behaviour monitor system to increase the hand hygiene respective labs. Mean log pre-value for E. coli contamination by rub- compliance and reduce the incidence of MDRO and CDAD. bing in was 4.76 ± 0.52 and mean log RF was 3.86 ± 0.95. E. faecalis Methods: We conducted a prospective, pre- post study over two years yielded pre-values that exceeded those of E. coli by approximately 1–2 on two university non intensive-care hospital wards. Every HCP had to log units using either mode of contamination, suggesting greater sur- wear a smart badge with an alcohol vapour sensor. This device collects vival of E. faecalis during the drying procedure. The activity is depend- data and gives direct feedback about hand hygiene related behavior via ing on application volume and hand size. light, vibration and display information. Furthermore, summary data is Conclusion: E. faecalis demonstrates strong potential as a test organ- presented automatically to all HCPs on the ward. We calculated the inci- ism representing a pathogen with high environmental stability known dence density per 100.000 patients days (pd) for infections with MDRO to be spread by contaminated hands in healthcare settings. Addition- (MRSA, MRGN, VRE) and CDAD at each ward according to the protocol ally, the low-volume contamination procedure simulates the condition of the National Reference Center (NRZ) for NI in Germany. A Poisson of hands when ABHR use is indicated in clinical settings more closely. model was used to estimate the effect of the intervention in terms of NI Disclosure of Interest: None declared. incidence density reduction (IDR) with 95% confidence interval (CI). To evaluate the hand hygiene compliance and consumption of hand dis- infectant, we used a linear regression for the logit-transformed compli- O19 ance and a linear regression over the two years, respectively. Hand sampling: what’s the best method? 1,* 1 1 1 1 Results: The incidence density of NI with MDRO and CDAD for ward A H. Soule , R. Martischang , N. Akoum , C. Fankhauser , J. Sauser , D. was in the pre period 66.4 (CI:65.2–67.7) and in the intervention period Pittet 40.0 (CI: 39.3- 40.8) (per 100,000 pds). Ward B could reduce the inci- Infection Control Programme and WHO Collaborating Centre on Patient dence density from 75.7 (CI:74.7–76.8) to 32.5 (CI:32.0–33.0). IDR was Safety, Geneva University Hospitals, Geneva 4, Switzerland 51.5% (CI: 39.0–61.4, p = 0.0251). Due to the intervention, the hand Correspondence: H. Soule hygiene compliance rate increased by factor 1.293 (CI:0.437–2.148, Antimicrobial Resistance & Infection Control 10(1): O19 p = 0.098) and the consumption about 4.285 ml per pd (CI:1.863– 6.707, p = 0.074). Introduction: Hands are often sampled when assessing hand hygiene Conclusion: The implementation of a personal behavior monitoring programs or studying microorganisms’ transmission and the hand system increased the hand hygiene compliance and hand desinfec- microbiome. The most common methods used are agar print or tion consumption and reduced the rate of MDRO and CDAD. Due to rubbing with a swab. But the sensitivity of these methods is poorly different electronic monitoring systems and the question of sustain- understood. ability, there is a need for further studies. Objectives: In a laboratory experiment, we compared 4 methods for Disclosure of Interest: None declared. sampling artificially contaminated hands. Methods: Ten volunteers randomly performed 6 tests. In each test, the following sequence was repeated 4 times: hand hygiene with O18 isopropanol 60%, contamination of the fingertips of one hand with a Development of practice‑simulation in vivo efficacy test method known amount of bacteria, drying for 3 min, and sampling with one for alcohol‑based hand rubs based on EN 1500 and ASTM E2755 1,* 2 2 1 3 2 of the 4 tested methods in random order. Fingertips were contami- F. H. H. Brill , R. Leslie R., T. Neal , S. Pahl , M. Suchomel , D. R. Macinga 2 4 6 nated with E coli NCTC 10,538 in 3 tests (with about 10 or 10 or 10 DR. BRILL + PARTNER GMBH INSTIUTE FOR HYGIENE AND MICROBIOL‑ bacteria) and with S aureus NC10788 in the 3 other tests. The 4 meth- OGY, Hamburg, Germany, GOJO Industries, Akron, Ohio, United States, ods tested were: M1/fingerprint on agar plate, M2/fingertips rubbing Medical University Vienna, Wien, Austria with a swab which was vigorously shaken in 10 ml nutritive broth, M3/ Correspondence: F. H. H. Brill fingertips rubbing in a plate containing 10 ml nutritive broth and M4/ Antimicrobial Resistance & Infection Control 10(1): O18 massage of fingertips in a sterile bag containing 10 ml nutritive broth. For the 3 last methods, both dilutions and filtration of the recovering Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 13 of 140 solution were inoculated on agar. All agar plates were incubated for 48 h. Colonies number was compared to the baseline inoculum. A linear mixed model was used with the inoculum, the species and the sampling method as fixed effect. Results: Pairwise comparisons between the 4 methods demonstrate that M3 and M4 were not significantly different but superior to M1 and M2. The ratio of geometric means of bacteria recovered with M3 vs M1 and vs M2 were respectively 23.91 and 4.78, and with M4 vs M1 and vs M2, it was respectively 40.62 and 8.12 (p < 0.001). The amount of bac- teria recovered was different between the 2 species for each method: the numbers of bacteria recovered with M3 and M4 were respectively 29 and 64 times higher for S aureus than for E coli (p < 0.001). With E coli, less than 1% of the inoculum was recovered with M4, whereas for S aureus, it was 37% (p < 0.001). Conclusion: Many more bacteria were collected when fingers were sampled in a liquid, either by rubbing or by massage, in relation to the agar print or swab. Regardless of the inoculum, the dose recovered was significantly higher for S aureus compared to E coli. Disclosure of Interest: None declared. Conclusion: This study showed that the environment plays a role in CPE transmission. Targeted measures as the installation of easy-to- clean toilets with limited dead spaces (rim-free), enhanced daily clean- ing, the education of patients regarding hand hygiene might help to Slide session: Outbreak control these CPE outbreaks. Disclosure of Interest: None declared. O20 Role of the environmental reservoir in carbapenem‑resistant O21 enterobacteriaceae (CPE) outbreaks 1,2,* 1 3 4 5 An azole‑resistant C. parapsilosis outbreak in a Spanish hospital: C. Dananché , S. Gardes , O. Dauwalder , P. Ceruse , S. Couraud , G. 6 7 2,8 1,2 an emerging challenge during the COVID‑19 pandemic Devouassoux , L. Dortet , P. Cassier, P. Vanhems 1,* 1 1 1 2 1 2 M. Puig‑Asensio , E. Jiménez , M. Aguilar , J. Ayats , O. Zarago za , L. Infection control unit, Hospices Civils de Lyon, Centre International de 1 1 2 1 1 3 Gavaldà , C. Gutiérrez , L. Alcázar‑Fuoli , C. Ardanuy , A. Padullés , J. recherche en infectiologie, Université Claude Bernard Lyon 1, Microbiol‑ 1 1 4 Carratalà , M. Pujol ogy laboratory, Hospices Civils de Lyon, Lyon, ENT unit, Hospices Civils 1 2 5 Bellvitge University Hospital, Barcelona, Spanish National Centre de Lyon, France, Pneumology Unit, Hospices Civils de Lyon Groupement 6 for Microbiology, Madrid, Spain Sud, Pneumology unit, Hospices Civils de Lyon Groupement Nord, Lyon, 7 Correspondence: M. Puig‑Asensio CNR Résistance aux Antibiotiques, Assistance Publique Hôpitaux de 8 Antimicrobial Resistance & Infection Control 10(1): O21 Paris, Paris, Environmental Microbiology Laboratory, Hospices Civils de Lyon, Lyon, France Introduction: Candida parapsilosis is the second leading cause of can- Correspondence: C. Dananché didemia and fluconazole is the treatment of choice. In July 2020, an Antimicrobial Resistance & Infection Control 10(1): O20 outbreak caused by azole-resistant C. parapsilosis (ARCP) strains was detected in the Intensive Care Unit (ICU) of a tertiary-care center in Introduction: Since 2019, four outbreaks of carbapenemase-pro- Spain. ducing Enterobacteriaceae (CPE) digestive colonizations, involving 73 Objectives: This study aims to describe an ongoing ARCP outbreak patients, occurred in 4 wards of a multi-site universitary-affilated hos- that started during the COVID-19 pandemic. pital. Citrobacter freundii OXA-48 was the most frequently isolated bac- Methods: We implemented a package of interventions: 1) collection teria in patient samples. of surveillance cultures (throat, axilla, and groin) on patient admis- Objectives: The aim of this study was to assess the role of environ- sion and weekly thereafter; 2) daily chlorhexidine bathing of patients; ment (and particularly toilet bowls) during CPE outbreaks and the effi- 3) change of daily routine cleaning from 1% sodium hypochlorite ciency of enhanced cleaning of the toilet bowls. to hydrogen peroxide. The presence of ERG11 mutations and the Methods: Visual observations and environmental sampling of bath- genotyping of 17 random ARCP isolates were performed by micros- rooms were performed between 03/2019 and 01/2020. Patients with atellite analysis. Changes in annual defined daily doses (DDD) of anti- CPE digestive colonization were not hospitalized in rooms when fungals/100 patient-days from 2019 to 2020 were reported to assess samples were collected. During one outbreak, OXA-48-producing C. antifungal overuse. Cultures from the environment and gowns were freundii isolates were sequenced using whole genome sequencing. obtained with a sterile gauze soaked in saline solution. Enhanced cleaning of toilet bowls was performed using steam and Results: Between April 2020–May 2021, 239 patients (2 retrospec- hydrochloric acid. tively identified) were found to be colonized or infected with an Results: The presence of crevices and dead space (rim, water supply ARCP. Patients were initially identified in a COVID-19 ICU ward, but line) in toilets complicated the cleaning and disinfection with a toilet other units were affected after transferring colonized patients. Micro - brush. 234 environmental samples were collected in bathrooms of the biological analysis: 15/17 (88.2%) strains had the Y132F mutation in wards. CPE (mainly C. freundii OXA-48) were isolated in 37% to 59% of the ERG11 gene, 1 had the K143R mutation, and 1 did not have any the sampled toilets bowls and 11 to 29% of the close environment of mutations. Most ARCP isolates belonged to the same genotype III. the toilet (Table). The use of antifungals increased 1.4-fold from 2019 to 2020 (2.7 to In one unit, a specific clone of C. freundii OXA-48 was isolated from the 3.7 DDD/100 patient-days). Environmental cultures obtained before toilet bowl of a room on 01/07/2019. A patient without CPE digestive daily routine cleaning were positive for ARCP strains in 34/88 (38.6%). colonization at admission was hospitalized in the same room between Patient care equipment, surfaces in close contact to the patient, and 01/10/2019 and 30/10/2019, and acquired the same C. freundii OXA- high-touch surfaces were frequently contaminated. Two out of 3 reus- 48 clone on 30/10/2019. After discharge of the patient and cleaning able gowns (99% polyester), cultured after patient care, and 1 sink of the toilet bowl, the same clone was found again on 31/10/2019. were contaminated with ARCP. Enhanced cleaning showed a mild efficacy. Conclusion: The frequent contamination of the environment coupled with suboptimal infection prevention practices during the COVID-19 Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 14 of 140 pandemic (shared gowns between patients) have been important Conclusion: WGS can highlight in-hospital transmission events with challenges to control an ARCP outbreak. multi-susceptible strains that could go undetected. Reinforced infec- Disclosure of Interest: None declared. tion control measures, particularly hand hygiene, proved effective in terminating the outbreak. Disclosure of Interest: None declared. O22 Outbreak of wildtype klebsiella pneumoniae in a neonatal intensive care unit Slide session: COVID‑19 in long‑term care facilities 1,* 2 3 3 4 G. Catho, V. Sauvan , F. Rosa Mangeret , O. Baud , G. Renzi , J. 4 2 Schrenzel , S. Harbarth O23 Infection Prevention Control, Geneva University Hospitals and Fac‑ 2 3 Hospital‑level work organization drives the spread of SARS‑COV‑2 ulty of Medicine, Switzerland, Infection Prevention Control, Division within hospitals: insights from a multi‑ward model of Neonatology and Pediatric Intensive Care, Bacteriology Laboratory, 1,2,3,* 1,2,3,4 5 5 A. Oodally , P. Hammami , A. Reilhac , G. Guérineau de Lamérie , Division of Laboratory Medicine,, Geneva University Hospitals and Faculty 1,2 3,6 L. Opatowski, L. Temime of Medicine, Geneva, Switzerland Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion Correspondence: G. Catho (EMAE), Paris, Université Paris‑Saclay, UVSQ, Inserm, CESP, Anti‑infective Antimicrobial Resistance & Infection Control 10(1): O22 evasion and pharmacoepidemiology team, Montigny‑Le‑Bretonneux, Modélisation, épidémiologie et surveillance des risques sanitaires Introduction: Outbreaks of multidrug resistant (MDR) Klebsiella pneu- (MESuRS), Conservatoire national des arts et métiers, Paris, ANSES, moniae in neonatal intensive care units (NICU) have largely been French Agency for Food, Environmental and Occupational Health & reported but wildtype K. pneumoniae outbreaks have rarely been Safety Epidemiology, Health and Welfare Research Unit, Ploufragan‑Plou‑ described. zané‑Niort Laboratory, Ploufragan, Département d’information médicale, Objectives: We describe the investigation of a K. pneumoniae out- Centre hospitalier Guillaume Régnier, Rennes, PACRI unit, Institut Pasteur, break in a NICU and the control measures implemented. Conservatoire national des arts et métiers, Paris, France Methods: Three consecutive point prevalence surveys (PPS) search- Correspondence: A. Oodally ing for intestinal or cutaneous colonisation by K. pneumoniae among Antimicrobial Resistance & Infection Control 10(1): O23 neonates were performed between November 2020 and March 2021. We also conducted environmental sampling of incubators, ultrasound Introduction: Despite extensive protective measures, SARS-CoV-2 gel and sinks. All K. pneumoniae isolates were investigated by whole extensively circulates within health care facilities, threatening those genome sequencing (WGS) using RidomSeqSphere v.5.1.0. essential to the fight against the pandemic while putting vulnerable Results: Between October and November 2020, 7 neonates hos- patients at risk. Several control strategies have been proposed; how- pitalised in the NICU of a university-affiliated tertiary care centre in ever, the global efficacy of local measures implemented at the ward Switzerland, were found to be infected (3 bloodstream infection, 1 level may depend on hospital-level organizational factors. intra-abdominal infection) or colonised at a catheter insertion site (3) Objectives: We aimed at better understanding the role of between- by a wildtype, multi-susceptible K. pneumoniae strain. Eight additional ward interactions on nosocomial outbreaks and their control in a neonates were found colonised by a wildtype K. pneumoniae strain dur- multi-ward Long Term Care Facility (LTCF). ing the first PPS, 1 during the second PPS and none during the third Methods: We built a stochastic compartmental transmission model PPS, leading to a total number of 13 neonates infected or colonised. of SARS-CoV-2 in a 24-ward LTCF, accounting for the various infec- WGS identified two distinct clusters of respectively 2 and 10 cases (ST- tion states among patients and staff and between-ward con- 282 and ST 20) and one strain (ST-3132) was only found in one patient nections resulting from staff sharing. The model was specifically (Figure 1). All environmental samples were negative. Audits of best parametrized to mimic detailed data from a psychiatric hospital in practices were performed and a working group with IPC practitioners Western France. We first evaluated the potential of hospital-wide and NICU staff members was implemented to reinforce hand hygiene diffusion of local outbreaks. We then assessed control strategies, and environmental cleaning, provide feedback and re-assess infection including a screening area upon patient admission, an isolation control procedures. No further invasive infection due to K. pneumoniae ward for COVID-positive patients and changes in staff schedules to occurred over the 6 months following the outbreak detection. limit between-ward mixing. Results: Much larger and more frequent outbreaks occurred when the index case originated in one of the most connected hospital wards with up to four times more transmissions when compared to the more isolated wards. The number of wards affected was decreased by 62% on average after limiting the number of health- care workers shared between wards while the reverse led to a 75% decrease. In addition, we found that setting up an isolation ward for all COVID-positive patients reduced the number of transmissions by up to 60%, while adding a screening area before admission seemed ineffective. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 15 of 140 Results: Across LTCFs, routine RT-PCR testing prevented a mean 40–47% of nosocomial infections. With the addition of a single round of reactive Ag-RDT screening, 58–63% of infections were averted. This increased to up to 69–75% when conducting a further second round of screening, with greatest performance 4–5 days after the first round. In addition to routine RT-PCR, a single round of well-timed Ag-RDT screening prevented a mean 15.2 infections/1000 Ag-RDT tests in a high-risk LTCF, but in a low-risk LTCF just 0.5 infections/1000 test. Conclusion: Our findings highlight the importance of diligent moni- Conclusion: For LTCFs alerted to potential SARS-CoV-2 outbreaks, toring of COVID-19 transmission in LTCFs and hospitals, which host reactive mass Ag-RDT screening is an effective means to detect fragile patients. In particular, hospital-level work organization plays asymptomatic and pre-symptomatic infections and limit subse- a significant role in driving the spread of infection and should not be quent nosocomial transmission. A well-timed second round of overlooked when designing surveillance and control strategies. follow-up screening can help overcome limited and time-varying Disclosure of Interest: None declared. nature of Ag-RDT sensitivity. Health-economic gains of Ag-RDT screening scale with outbreak risk. Disclosure of Interest: None declared. O24 Mass rapid diagnostic testing as a public health response O25 to SARS‑COV‑2 outbreaks in long‑term care settings 1,2,3,4,* 1,2,3 4 1,2,3 Explosive nosocomial outbreak of SARS‑COV‑2 in a rehabilitation D. Smith , A. Duval, L. Temime , L. Opatowski 1 2 3 4 clinic: the limits of genomics for outbreak reconstruction Institut Pasteur, UVSQ, Inserm, Conservatoire National des Arts et 1,* 1 2 1 1 M. Abbas , T. Robalo Nunes , A. Cori , S. Cordey , F. Laubscher , S. Métiers, Paris, France 1 3 1 1 1 1 1 Baggio, T. Jombart , A. Iten, L. Vieux, D. Teixeira , M. Perez , D. P ittet , E. Correspondence: D. Smith 1 1 1 1 Frangos , C. Graf, W. Zingg , S. Harbarth Antimicrobial Resistance & Infection Control 10(1): O24 1 2 Geneva University Hospitals, Geneva, Switzerland, Imperial College London, London School of Hygiene and Tropical Medicine, London, Introduction: Antigen rapid diagnostic testing (Ag-RDT) is more United Kingdom affordable and less logistically demanding than RT-PCR for SARS- Correspondence: M. Abbas CoV-2 surveillance, but less diagnostically sensitive. This trade-off has Antimicrobial Resistance & Infection Control 10(1): O25 fuelled debate about whether Ag-RDT convenience outweighs ele- vated risk of false negative diagnoses. Introduction: Nosocomial outbreaks of SARS-CoV-2 are frequent Objectives: To evaluate the public health performance of reactive despite implementation of conventional infection control measures. population screening using Ag-RDT in response to emerging nosoco- Objectives: To use advanced genomic and statistical techniques mial SARS-CoV-2 outbreaks. to reconstruct transmission chains and assess the role of healthcare Methods: We simulated SARS-CoV-2 outbreaks across a range of workers (HCWs) in SARS-CoV-2 transmission. long-term care facilities (LTCFs) with different Covid-19 interven- Methods: We investigated a nosocomial SARS-CoV-2 outbreak in a tions in place (social distancing, face masks, vaccination). Assum- university-affiliated rehabilitation clinic, involving patients and HCWs, ing that individuals with true positive test results were isolated with high coverage of pathogen whole genome sequences. We esti- and no longer transmitted, we evaluated performance of routine mated the time-varying reproduction number (R ) and produced a RT-PCR testing (tests for all individuals with Covid-19 symptoms maximum likelihood phylogenetic tree. We combined genomic and and all new hospital admissions) and reactive mass screening using epidemiological data into a Bayesian framework to model directional- Ag-RDT (population-wide testing upon outbreak detection). Imper- ity of transmission. We performed a case–control study to investigate fect and time-varying diagnostic sensitivity was accounted for. risk factors for nosocomial SARS-CoV-2 acquisition in patients. We reported efficacy as the proportion of nosocomial infections Results: The outbreak spanned from 14.03–12.04.2020 and involved averted in the two weeks following outbreak detection, and effi- 37 patients and 39 employees (37 HCWs). We estimated a peak R ciency as the number of nosocomial infections averted per 1,000 between 2.2–3.6. The phylogenetic tree showed showed genetically tests used. almost identical isolates, as 97% of isolates formed one large clus- ter. Despite uncertainty in reconstructed transmission events, our Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 16 of 140 analyses suggest that HCWs (one of whom was the index case) had a significantly larger fraction of infections (p < 2.2e-16) attributable to HCWs (71%) than expected given the number of HCW cases (47%). The excess of transmission from HCWs was larger when considering infection of patients (79%; 95%CI 78.5% > 79.5%), and especially frail patients (Clinical Frailty Scale > 5: 82%; 95%CI 81.8% > 83.4%). Further- more, frail patients were found to be at higher risk for nosocomial COVID-19 than other patients (adjusted OR 6.9; 95%CI 2.1–22.5). Conclusion: This outbreak report highlights the essential role of HCWs in SARS-CoV-2 transmission dynamics in healthcare settings. Limited genetic diversity in pathogen genomes hampered the reconstruction of individual transmission events, resulting in substantial uncertainty in who infected whom. However, our study shows that despite such uncertainty, significant transmission patterns can be observed. Disclosure of Interest: None declared. O26 Is COVID‑19 in hospital employees automatically an occupational disease? SARS‑COV‑2 acquisition modes and rates among employees in a long‑term care facility (LTCF) during the first pandemic wave 1,* 1 1 1 2 L. Lenggenhager , R. Martischang , J. Sauser , M. Perez, L. Vieux , C. 3 4,5 4 1 1 6 Graf , S. Cordey , F. Laubscher , T. Robalo Nunes, W. Zingg , A. Cori , M. 1,7 1,5 Abbas , S. Harbarth 1 2 3 Infection Control Program, Occupational Health Service, Department 4 5 of Rehabilitation and Geriatrics, Laboratory of Virology, HUG, Faculty 6 7 of Medicine, UniGE, GE, Switzerland, MRC GIDA, HPRU, Imperial College London, London, United Kingdom. Correspondence: L. Lenggenhager Antimicrobial Resistance & Infection Control 10(1): O26 Introduction: LTCFs are at risk of COVID-19 outbreaks but evidence regarding SARS-CoV-2 acquisition and transmission routes among their employees remains weak. Objectives: We investigated the relative contribution of occupa- Conclusion: During the first pandemic wave, there was a high burden tional (vs. community) exposure for COVID-19 acquisition among of COVID-19 among LTCF employees. Both occupational and commu- employees of a university affiliated LTCF in Switzerland, from March nity exposures contributed to seropositivity and infection risk. These to June 2020. data may allow to better assess occupational health hazards and Methods: This is a prospective cohort study with a nested analy- related legal implications during the COVID-19 pandemic. sis of a COVID-19 seroprevalence study among LTCF staff. We Disclosure of Interest: None declared. performed Poisson regression to determine risk factors for seroposi- tivity and to measure the influence of community vs. nosocomial O27 exposure to COVID-19 on SARS-CoV-2 seropositivity using adjusted Estimating SARS‑COV‑2 transmission and efficacy of preventive prevalence ratios (aPR). In addition, we conducted a COVID-19 out- measures in a long‑term care facility break investigation in a LTCF ward using both epidemiological and 1,2,3,* 4 1,5 2,3 G. Shirreff , J.‑R. Zahar, L. Temime , L. Opatowski genetic sequencing data. We constructed a maximum likelihood 1 2 Laboratoire MESuRS, Conservatoire National des Arts et Métiers, Epide‑ phylogenetic tree and evaluated strain relatedness to discrimi- miology and Modelling of Antibiotic Evasion unit, Institut Pasteur, Paris, nate between community- vs. hospital-acquired infections among Laboratoire UMR1018, University of Versailles Saint‑Quentin‑en‑Yvelines, employees. Montigny‑le‑Bretonneux, Infection Control Unit, Hôpital Avicenne, Results: Among 285 LTCF employees, we included 176 participants AP‑HP, PACRI Unit, Institut Pasteur, Conservatoire national des arts et in the seroprevalence study, of whom 30 (17%) became seroposi- métiers, Paris, France tive for SARS-CoV-2. The majority (141/176, 80%) were healthcare Correspondence: G. Shirreff workers and had ≥ 1 symptom compatible with COVID-19 (127/167, Antimicrobial Resistance & Infection Control 10(1): O27 76%). Risk factors for seropositivity included exposure to a COVID- 19 patient in the LTCF (aPR 2.6; 95%CI 0.9–8.1) and exposure to a Introduction: Hospitals and nursing homes are particularly at risk of SARS-CoV-2 positive person in the community (aPR 1.7; 95%CI 0.8– nosocomial dissemination of SARS-CoV-2 everywhere in the world, and 3.5). Among 18 employees included in the outbreak investigation, understanding this transmission is key to implementing efficient control phylogenetic analysis suggests that 8 (44%) acquired their infection measures. However, estimates of nosocomial transmission rates are miss- in the community. ing, and are challenging due to stochasticity, heterogeneity of the envi- ronments, and lack of appropriate test data. Objectives: Mechanistic modelling applied to detailed data were used to quantify nosocomial transmission rates. Methods: We developed a stochastic compartmental model of SARS- CoV-2 transmission in hospitalized patients and fit it to data from an outbreak in a 350-bed long-term care facility (LTCF) in Paris during the first wave of COVID-19. Reported cases occurred in March and April 2020, during which 312/459 patients present received a PCR test, and 152 tested positive, many being asymptomatic. The model captures Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 17 of 140 LTCF specificities regarding distribution of tests, admission and dis- Slide session: Surgical site infections charge. We also assessed the change in transmission risk after the implementation of contact precautions. O29 Results: We found that a model considering two separate time periods PVP iodine vs chlorhexidine in alcohol for preparation characterized by their own transmission rate, was better supported by of the surgical site: a cluster‑randomized multicenter cross‑over trial the data. In the first period the rate was estimated at 1.3 (95% confi- 1,* 2 3 4 5 6 A. F. Widmer , A. Atkinson , H. Sax , P. Jent , S. Kuster , R. Sommerstein , J. dence interval 0.8–2.4) infections per patient per day in symptomatic 6 1 Marschall , A. Schweiger infection, corresponding to an R of 8.7 (5.1–16.3), and 0.19 (0.10–0.30) 1 2 Hospital Epidemiology, University Hospital Basel, Basel, Infectious in the second phase corresponding to an R of 1.3 (0.7–2.0). These 3 disease, Bern University Hospital, Inselspital, University o, Bern, Hospi‑ results are consistent with a short period of high transmission, during 4 tal Epidemiology, Universitätsspital, Zürich, Hospitabl Epidemiology, which hospital members were not aware of ongoing transmission, fol- 5 Inselspital bern, bern, Hospital Epidemiology, Universitätsspital Zürich, lowed by a moderate transmission rate following implementation of 6 Zürich, Hospital Epidemiology, Inselspital bern, bern, Switzerland obligatory mask-wearing. Under this assumption, the contact precau- Correspondence: A. F. Widmer tions introduced had 85% effectiveness in reducing transmission. We Antimicrobial Resistance & Infection Control 10(1): O29 also found substantial heterogeneity in transmission among individual wards. Introduction: Preoperative skin antisepsis is an established infection Conclusion: These results provide estimates for nosocomial transmis- control procedure to prevent surgical site infections (SSIs) The choice of sion rates within a healthcare setting containing vulnerable patients, antiseptic agent—chlorhexidine (CHX) or iodine (PI) remains matter of and indicate the efficacy of preventive measures. The model can be debate: readily extended to other datasets. Objectives: To compare rates of surgical site infections after prepa- Disclosure of Interest: None declared. ration of the skin with alcoholic soluttion with either PVP iodine or Chlorhexidine. Methods: In this multicenter, cluster-randomized, triple -blinded, rand- omized, controlled trial, we compared the rate of SSIs after preparation O28 of the skin with alcoholic solutions with either CHX or PI. The primary Exploring behavioral factors influencing COVID19 specific outcome was SSIs within 30 days after abdominal, and one year after car- infection prevention and control measures in Finland—a mixed diac surgery, using CDC definitions. methods study 1,* 1 1 1 1 Results: From September 2017 through June 2020, a total of A.‑L. Lohiniva, S. Toura , D. Arifulla , J. Ollg ren , O. Lyytikäinen 1 3321patients from three university hospitals were enrolled: 1155 to PI vs Finnish Institute for Health and Welfare, Helsinki, Finland 1011 assigned to CHX. SSIs were diagnosed overall in 80 (5.1%) patients Correspondence: A.‑L. Lohiniva in the PI group vs 97 (5.5%) in the CHX group (relative risk [CI 0.92, 0.69– Antimicrobial Resistance & Infection Control 10(1): O28 1.23], P = 0.50). PI was superior to CHX in abdominal surgeries (P = 0.06), but slightly less active to prevent SSIs in cardiac surgery (P = 0.29) [ Table]. Introduction: Healthcare worker (HCW) compliance with infection prevention and control (IPC) measures plays a critical role in prevent- Iodine-alcohol CHX-alcohol Relative risk p- Adjusted relative risk*P ing COVID-19 transmission in healthcare settings. To ensure opti- N=1570 N=1751 value value Overall SSI, n (%)80 (5.1%) 97 (5.5%) 0.92 [0.69, 1.23]0.600.88 [0.64, 1.21]0.50 mal adherence to COVID-19-specific IPC practices, there is a need to Abdominal38 (6.8%) 59 (9.9%) 0.69 [0.46, 1.02]0.06 understand the factors that influencing them. Cardiac42 (4.2%) 38 (3.3%) 1.26 [0.82, 1.94]0.29 Objectives: To identify and explain factors that influence the com- Type of SSI, n (%) Superficial32 (2.0%) 29 (1.7%) 1.22 [0.74, 2.01]0.400.83 [0.50, 1.38]0.50 pliance to COVID-19 specific IPC measures among HCWs in LTCFs in Deep 15 (1.0%) 20 (1.1%) 1.31 [0.66, 2.60]0.401.20 [0.61, 2.35]0.40 organ space29 (1.8%) 40 (2.3%) 0.81 [0.51, 1.30]0.401.29 [0.80, 2.10]0.40 Finland. Methods: The study included a web-based survey and a qualitative research study based on the Theoretical Domains Framework (TDF). The questions in the survey covered background information of the Conclusion: This largest cluster randomized trial demonstrated minus- respondent and LTCF as well as behaviour factors. The link to the anony- cule difference in the rates of SSIs, independent of the choice of PI or mous survey was distributed to the LTCFs through regional IPC experts CHX to prepare the surgical site. Discordant results of other studies and authorities. The outcome was modeled using both ordinary logis- might be related to the type of intervention studied, the high free avail- tic regression and penalized ridge logistic regression using regrouped able content of PI tested, and the different products under investigation. explanatory variables and original more correlated set of explanatory Disclosure of Interest: A. Widmer Grant/Research support from: Funded variables, respectively. The in-depth interviews were conducted by using by the Swiss National Science Foundation # 33IC30_173534. Clinicaltri- a semi-structured guide. The subjects were recruited from those who als.org identifier: NCT03685604 and Swiss National Clinical Trials Portal # participate in the survey. The interviews were conducted between Janu- NCT03685604, A. Atkinson: None declared, H. Sax: None declared, P. Jent: ary and February 2021. Data was analysed thematically using NVIVO12. None declared, S. Kuster: None declared, R. Sommerstein: None declared, Results: A total of 422 HCWs from 17/20 regions responded to the sur- J. Marschall: None declared, A. Schweiger: None declared. vey. The study findings suggested that three TDF domains influence the compliance with COVID19 specific IPC measures: environmental factors and resources (inadequate staffing), beliefs about capabilities O30 and reinforcement (follow up and feedback of the management). The SSI‑Preventive compliance after tailored interventions qualitative study included 20 HCWs consisting of nurses and assis- for infection prevention and control teams: results tant nurses who provided care in LTCFs during the pandemic. The of the cluster‑randomized controlled wach‑trial in six study identified two themes that explain environmental factors and non‑university centres 1,* 2 2 3 4 5 resources; lack of planning for emergency; changing work responsi- T. von Lengerke , I. Hartlep , P. Schipper , M. Stolz, I. Tomsic , C. Krauth , bilities. Beliefs in capabilities were linked with knowledge, resources I. F. Chaberny and responsibilities, and reinforcement was linked with management Department of Medical Psychology, Hannover Medical School, Centre absence and culture. for Public Health and Healthcare, Hannover, Institute of Hygiene, Conclusion: This study provides insights into TDF domains that can Hospital Epidemiology and Environmental Medicine, Leipzig University be used to develop evidence-based behaviour change interventions Hospital, Centre for Infection Medicine, Leipzig, Institute of Epidemi‑ to support HCW compliance with pandemic-specific IPC measures in ology, Social Medicine and Health Systems Research, Department LTCFs during future epidemics. of Medical Psychology, Hannover Medical School, Centre of Public Health Disclosure of Interest: None declared. and Healthcare, Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Centre for Public Health Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 18 of 140 and Healthcare, Hannover, Germany Results: We included 60 patients (mean age 59 years, 55% females) Correspondence: T. von Lengerke with primary open shoulder surgery (17 Latarjet procedures, 43 arthro- Antimicrobial Resistance & Infection Control 10(1): O30 plasties) in the study. At baseline, both randomized groups revealed the presence of C. acnes on the skin to 60% (18/30 in the intervention Introduction: Preventing surgical site infections (SSI) implies com- group; 19/30 in the controls; p = 0.79). In the patients with C. acnes pliance with numerous measures. Few randomized studies have skin colonization, the intervention resulted in a significant reduc - addressed compliance promotion in this context. tion of the number of positive intraoperative samples compared to Objectives: The cluster-randomized trial WACH (“SSI and Antibi- the control group (8/18 vs. 16/19; p = 0.01); including regarding the otics Use in Surgery”, 2018-20; German Clinical Trials Register-ID: capsular samples (0/18 vs. 4/19; p = 0.04). There were no surgical site DRKS00015502) aimed at improving SSI-preventive compliance by infection (SSI) in either group after a mean clinical follow-up of eleven adapting the psychological tailoring approach of the PSYGIENE-trial months. The cream was well tolerated. (DRKS00010960) from interventions addressing clinical staff to infec - Conclusion: The topical 7 days-preoperative skin application of a com- tion prevention and control (IPC) teams and other stakeholders in mercial acne cream (Benzoyl Peroxide and Miconazole Nitrate) was well non-university hospitals. tolerated and substantially reduced the intraoperative C. acnes-load in Methods: After briefing, in each of N = 6 hospitals in-house staff 56% of the patients of the intervention group. Our findings represent a observed compliance for 14 measures in N = 1034 ward rounds strong rationale for its use as a prevention against SSIs in shoulder sur- and N = 905 surgical procedures (general/visceral and/or ortho- gery. Confirmatory clinical experience and further research are needed. pedic/trauma surgery) before and after a 3–4 months intervention Disclosure of Interest: None declared. (“tailoring”-arm) or “usual practice” period. Interventions consisted of written reports and 2-day IPC-workshops incl. coaching, and were tai- O32 lored based on appraisals of compliance and its determinants (COM-B Economic evaluation of preoperative shower with antiseptic [1]) using mixed methods. Data analysis (cluster-level) were performed shower to prevent surgical site infections 1,* 2 2 using OpenEpi 3.01 for compliance estimations, chi-square and Bres- J. Ory , R. Moreau , M. Masseti 1 2 low–Day tests. Univesity hospital, NImes, Public Health Expertise, Paris, France Results: In the “tailoring”-arm, a compliance increase was observed Correspondence: J. Ory for all measures (mean: 11%), with p < 0.05 in 11 cases. However, for 7 Antimicrobial Resistance & Infection Control 10(1): O32 measures baseline rates were lower than in the “usual practice”-arm, in which 1 in- and 3 decreases were significant. Given similar baseline, Introduction: A preoperative shower is recommended before surgery to “tailoring” was superior for hand hygiene during ward rounds (+ 12% prevent surgical site infection (SSI). vs. + 3%; interaction: p = 0.007) and wearing surgical cap (+ 22% vs. Objectives: To characterize the benefit of SSI prevention associated -13%; p < 0.001). For perioperative antibiotic prophylaxis, the interac- with antimicrobial soap (AS), we modelled the use of AS in a University tion was significant (+ 5 vs. -5; p = 0.038). Hospital (UH) in orderto characterize its impact in terms of SSI and its Conclusion: Adapting psychological tailoring to IPC teams in non-uni- cost compared to shower with a placebo. versity hospitals to promote SSI-preventive compliance showed mixed Methods: The occurrence of SSI and the potentials saving made by results partly due to lower baselines in the “tailoring”-arm. Also, hand patients undergoing AS shower before surgery at a UH was modelled hygiene tended to be emphasized in the interventions and by their using a decision tree approach. SSI rates, by type and Altemeier clas- addressees, possibly explaining the positive result. This suggests stricter sification, were based on healthcare infection database. The impact of use of bundles within multimodal strategies. AS shower on the risk of SSI was based on a multivariate meta-analysis Ref. 1. https:// doi. org/ 10. 1186/ s13756- 021- 00932-9 comparing antiseptic shower vs. shower with a placebo. Disclosure of Interest: None declared. Baseline mortality for patients undergoing procedures, additional risk of death in patients with SSI and cost of SSI management, including O31 additional care and length of stay (LoS) were obtained from two pro- Acne cream reduces the deep cutibacterium acnes tissue load spective studies realized at a UH. Costs of AS shower were based on before elective open shoulder surgery: a randomized‑controlled the price of povidone iodine (Betadine scrub 4%), assuming that 10% pilot trial of patients showered before surgery, while AS performed at home by 1,* 1 1 1 I. Uçkay , I. Unterfrauner, K. Wieser , S. Bouaicha patients did not incur costs to the hospital. Results were extrapolated Balgrist University Hospital, Zürich, Switzerland to the average annual number of surgeries. Univariate deterministic Correspondence: I. Uçkay sensitivity analyses and scenario analyses were performed to assess Antimicrobial Resistance & Infection Control 10(1): O31 uncertainty. Results: AS was associated with the prevention of 209 SSI, leading Introduction: Cutibacterium acnes is the hallmark pathogen of to potential savings of €632,210 compared to the absence of AS. The healthcare-associated deep surgical site infections (SSI) after shoulder most interessant impact of the preoperative shower before surgery surgery. was mainly on the clean surgeries. Objectives: We investigate a topical acne cream to reduce the sub- All types of surgeriesClean surgeriesContaminated surgeries cutaneous Cutibacterium acnes in open elective shoulder surgery. The SSI Saving/pati Saving/ SSI Saving/pati Saving/ SSI Saving/pati Saving/ Benzoyl Peroxide-Miconazole Nitrate-cream for acne vulgaris reduces avoi ent year avoi ent year avoi ent year ded ded ded All type of the superficial C. acnes burden, which is the main pathogen of shoul- 209 4.76 632,210 193 4.38 582,470636 14.651,946,90 surgeries 2 der infections. However, the preventive potential of the cream against Orthopedics 93.7126,5379 3.71 26,507 21 9.14 65,349 Digestive 55.4614,3774 4.35 11,450 13 14.6938,695 SSI in shoulder surgery remains unknown. Gynecology 75.5520,5206 5.219,2366 5.23 19,339 Obstetrics Methods: We performed a prospective-randomized pilot trial allocat- Urologic 47.0513,3764 6.81 12,930 12 19.0436,133 Neurosurgery 12.193,897 12.1 3,73480138.51246,277 ing 60 adult patients (1:1) between a 7-days-preoperative application Bariatric 04.611,380 04.571,366 18.592,567 of a commercial acne cream (Benzoyl Peroxide; Miconazole Nitrate) on the pre-operative skin (intervention group) versus no cream (controls). We sampled the superficial skin at enrolment, before incision, and Conclusion: AS shower before surgery is a simple procedure that performed deep subcutaneous and capsular samples during shoulder could lead to significant savings through SSI prevention, avoiding surgery. additional care and LoS. Registration: Switzerland BASEC 2018-01510; International Disclosure of Interest: None declared. NCT03949751. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 19 of 140 O33 electro-chemiluminescence immunoassay of Roche Diagnostics in Evaluating a management team training by measuring mid-2020 (survey I) and early 2021 (survey II). Participants reported the adherence to a surgical site infection (SSI)‑bundle risk factors for COVID-19 in a questionnaire.Odds ratios (OR) and 95% 1,* 2 3 4 2 M. van Dijk , E. van Beeck , A. Huis , B. van der Gun , S. Polinder , A. van confidence intervals (95% CI) for the association of seropositivity with 2 2 1 2 Eijsden , A. Burdorf, M. Vos, V. Erasmus each risk factor were determined by logistic regression. 1 2 Medical Microbiology and Infectious Diseases, Public Health, Erasmus Results: SARS-CoV2 serology was positive in 99 of 2794 (3.5%) partici- MC University Medical Centre Rotterdam, Rotterdam, IQ healthcare, pants in survey I and in 376 of 2315 (13.5%) participants in survey II. By Radboud University Nijmegen Medical Centre, Nijmegen, Medical Micro‑ survey II, 86 of 88 (97.7%) initially seropositive participants remained biology, University Medical Centre Groningen, Groningen, Netherlands seropositive. In multivariable analysis of both surveys, the strongest Correspondence: M. van Dijk association for SARS-CoV-2 seroconversion was contact with a house- Antimicrobial Resistance & Infection Control 10(1): O33 hold member with COVID-19 (adjusted OR: 21.2, 95% CI: 8.5–51.4, p < 0.001, survey I; aOR: 8.5, 95% CI: 6.0–12.1, p < 0.001, survey II). Sig- Introduction: Hospitals trying to reduce Surgical Site Infections (SSI) nificant occupational risk factors included contact with patients with encounter difficulties since implementing a SSI-bundle requires coop - COVID-19 in both surveys (aOR: 2.7, 95% CI: 1.4–5.4, p < 0.001, survey eration between different management levels. I and aOR: 1.4, 95% CI: 1.0–2.2, p = 0.046, survey II). Contact to a SARS- Objectives: We aimed to evaluate a Quality Improvement(QI) CoV-2 positive co-worker was a significant risk factor only in survey I, teamtraining intervention focussed on improving cooperation whereas private contact with SARS-CoV-2 positive persons and the between the Executive Board, medical specialists, quality advisors COVID-19 incidence in the region of the HCI were associated with and infection control specialists. The QI-teamtraining was executed by seroconversion only in survey II. implementing a SSI bundle. Conclusion: Contact with patients with COVID-19 was an important Methods: This was a multicentre before-after study, in 4 hospitals in risk factor for seroconversion, although the risk was higher for house- the Netherlands. The intervention consisted of 4 sessions and stimu- hold contacts. These findings highlight the need to optimize preven- lated participants to set culture norms and targets, identify barriers, tive measures for SARS-CoV2 infection among HCW. take leadership, empower employees and formulate management Disclosure of Interest: None declared. activities to improve patient safety. SSI-bundle adherence was meas- ured by observing standard operating procedures(SOP) and hand O35 hygiene(HH) at baseline and post-intervention. To analyse change in Use of respirator vs. surgical masks in healthcare personnel compliance, generalized random effects modelling was used. and its impact on SARS‑COV‑2 acquisition—a prospective Results: The main difference between the 4 hospitals was involvement multicentre cohort study 1 2 1 1 1 3 of the Executive Board, but also involvement of medical specialists and S. Haller , S. Güsewell, T. Egger , G. Scanferla, R. Thoma , O. Leal‑Neto , 1 4 5 6 7 8 quality advisors differed per hospital. In hospitals where mainly quality D. Flury , A. Brucher , E. Lemmenmeier , C. Möller , P. Rieder , M. Rütti , 7 9 10 11 12 advisors were involved, only local actions in the OR were executed. In R. Stocker , D. Vuichard‑Gysin, B. Wiggli , U. Besold , S. Kuster , A. 13 14 1 10 1 1 1 hospital, with 3 actively involved medical specialists, also actions at McGeer , L. Risch , M. Schlegel , A. Friedl, P. Vernazza , C. Kahlert , P. 1,* manager level were executed. The effect of the QI-teamtraining was Kohler 1 2 evaluated by determining adherence to a SSI-bundle at baseline(B)(296 Division of Infectious Diseases and Hospital Epidemiology, Clinical Trials operations) and post-intervention(PI)(387 operations). The average door Unit, Cantonal Hospital St Gallen, St. Gallen, Switzerland, Epitrack, Recife, movements decreased (B:11,PI:10), timely antibiotic prophylaxis admin- Brazil, Psychiatry Services of the Canton of St. Gallen (South), St. Gallen, 5 6 istration improved (B:58%,PI:68%), preoperative shaving scores were Clienia Littenheid AG, Littenheid, Center for Neurological Rehabilitation, 7 8 maintained (B:94%,PI:96%) and adherence to normotherapy guidelines Zihlschlacht, Hirslanden Clinic, Zurich, Hospital Region Fürstenland improved (B:38%,PI:50%). Adherence to all 4 SOP (B:1%,PI:19%) and HH Toggenburg, Wil, Division of Infectious Diseases and Hospital Epidemiol‑ compliance (B:5%,PI:10%) improved, but stayed low. ogy, Thurgau Hospital Group, Muensterlingen, Division of Infectious Conclusion: This study showed that including different management Diseases and Hospital Epidemiology, Cantonal Hospital Baden, Baden, 11 12 levels in discussions on QI-interventions could increase the adherence. It Geriatric Clinic St. Gallen, St. Gallen, Division of Infectious Diseases also showed that modest involvement of managers will result in moder- and Hospital Epidemiology, University Hospital and University of Zurich, 13 14 ate effect. Thus, involvement of all management levels is essential. Zurich, Switzerland, Sinai Health System, Toronto, Canada, Labor‑ Disclosure of Interest: None declared. medizinisches Zentrum Dr Risch Ostschweiz AG, Buchs, Switzerland Correspondence: P. Kohler Slide session: Nosocomial COVID‑19: The chicken or the egg Antimicrobial Resistance & Infection Control 10(1): O35 Introduction: There is insufficient evidence regarding the role of res- O34 pirators in the prevention of SARS-CoV-2 infection. Seroconversion for SARS‑COV‑2 in health care workers Objectives: We analysed the impact of filtering facepiece class 2 after the first and the second wave of COVID‑19 in the canton (FFP2) vs. surgical masks on the risk of SARS-CoV-2 acquisition in Swiss of Grisons in Switzerland 1 2 3 4 5 6 healthcare workers (HCW ). K. Szajek , S. Güsewell , S. Hutter, T. Bechmann , M. Risch , F. Fleisich , V. 7 8 9,* Methods: Our prospective multicentre cohort enrolled HCW from June to Luyckx , C. Hirzel , A. Cusini 1 2 August 2020, who were asked about COVID-19 risk exposures/behaviours, Internal Medicine, Cantonal Hospital Grisons, Chur, CTU, Cantonal 3 4 5 including preferred mask type when caring for COVID-19 patients outside Hospital St.GAllen, St.Gallen, Laboratory, ICT, Labortory, Cantonal Hos‑ 6 7 of aerosol-generating procedures (AGP). HCW performing AGP were also pital Grisons, Infectious Diseases, Cantonal Hospital, Cantonal Hospital 8 9 asked about universal FFP2 use (i.e. irrespective of patients’ COVID-19 Grisons, Chur, Infectious Diseases, University Hospital Bern, Bern, Infec‑ status). We assessed the impact of FFP2 on i) self-reported SARS-CoV- tious Diseases, Cantonal Hospital Grisons, Chur, Switzerland 2-positive nasopharyngeal PCR/rapid antigen tests (weekly surveys), and Correspondence: A. Cusini ii) SARS-CoV-2 seroconversion (baseline to January/February 2021). Antimicrobial Resistance & Infection Control 10(1): O34 Results: We enrolled 3′259 participants from nine healthcare institu- tions, whereof 716 (22%) preferentially used FFP2 respirators. Among Introduction: Health care workers (HCW) are exposed to SARS-CoV-2 these, 81/716 (11%) reported a SARS-CoV-2-positive swab, compared through patient contact. to 352/2543 (14%) surgical mask users (median follow-up 242 days); Objectives: We aimed to assess the seroprevalence for SARS-CoV-2 seroconversion was documented in 85/656 (13%) FFP2 and 426/2255 among HCW in the canton Grisons and analyze risk factors associated (19%) surgical mask users. Adjusted for baseline characteristics, with seroconversion. COVID-19 exposure, and risk behaviour, FFP2 use was marginally asso- Methods: HCW from 13 health care institutions were recruited. ciated with a decreased risk for SARS-CoV-2-positive swab (aHR 0.8, Sera were analyzed for SARS-CoV-2 antibodies using an Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 20 of 140 p = 0.052) and seroconversion (aOR 0.7, p = 0.053); household expo- 1·22,1·71). The association with patients with community onset COVID- sure was the strongest risk factor (aHR for positive swab 10.1, p < 0.001; 19 was weaker (aOR 1·12, 95%CI 0·96,1·26). aOR for seroconversion 5.0, p < 0.001). In subgroup analysis, FFP2 Transmission to HCWs was associated with exposure to other infec- use was clearly protective among HCW with frequent (> 20 patients) tious HCWs and patients with hospital-acquired SARS-CoV-2 (aOR COVID-19 exposure (aHR 0.7, p < 0.001; aOR 0.6, p = 0.036). Universal 1·66, 95%CI 1·55,1·78 and aOR 1·45, 95%CI 1·32,1·58 respectively). FFP2 use during AGP showed no additional protective effect (aHR 1.1, The introduction of more stringent infection prevention and control p = 0.7; aOR 0.9, p = 0.53). measures which included testing all patients for SARS-CoV-2 by PCR on admission and at weekly intervals was associated with substantial reduction in transmission risk to both patients (adjusted odds ratio, aOR 0·25, 95%CI 0·14, 0·42) and HCWs (aOR 0·43, 95%CI 0·34, 0·53). Conclusion: Patients who acquired SARS-CoV-2 in the hospital and, to a lesser degree, infectious HCWs likely working prior to the onset of symp- toms, were the most strongly associated with increased risk of SARS- CoV-2 transmission. In contrast, exposure to patients who had acquired SARS-CoV-2 in the community was associated with, at most, modest increases in the daily risk of infection for both healthcare staff and the other patients. Disclosure of Interest: None declared. O37 Nosocomial COVID‑19 infections in Belgian hospitals: a longitudinal study 1 2 2 3 3,4,* J. Claes , K. Blot , B. Serrien , K. Mertens , B. Catry 1 2 3 Ghent University, Ghent, Sciensano, Brussels, Belgium, Healthcare asso‑ ciated infections & Antimicrobial resistance (NSIH), Sciensano, Faculty Conclusion: FFP2 compared to surgical masks may convey addi- of Medicine, Université libre de Bruxelles, Brussels, Belgium tional protection from SARS-CoV-2 for HCW with frequent exposure to Correspondence: B. Catry COVID-19 patients. Antimicrobial Resistance & Infection Control 10(1): O37 Disclosure of Interest: None declared. Introduction: COVID-19 has posed an immense burden on healthcare systems. O36 Objectives: The objective of this study was to estimate the proportion Transmission of SARS‑COV‑2 in the hospital setting: who of nosocomial infections in the Belgian hospitals since the start of the is infecting whom? 1 1,* 1 1 2 2 pandemic, as well as the main characteristics of patients involved. Y. Mo , D. Eyre , S. Lumley, T. Walker , R. Shaw , D. O’Donnell , L. 2 2 1 1 Methods: Surveillance data were extracted from the Clinical Hospital Sur- Butcher , K. Jeffery , C. Donnelly , B. S. Cooper on behalf of Oxford veillance established by Sciensano (ca 66% coverage, March 2020–March COVID infection review team 1 2 2021, n = 51,293). European Centres for Disease Control and Prevention University of Oxford, Oxford University Hospitals, Oxford, United King‑ (ECDC) definitions for nosocomial COVID19 were applied; out-of-hospi- dom tal: < = d2; indeterminate: d3 to d7, probably nosocomial: d8-d14 or defi- Correspondence: D. Eyre nitely nosocomial: > d14 after admission. Logistic regression was used to Antimicrobial Resistance & Infection Control 10(1): O36 identify risk factors for mortality. Results: Inclusion criteria (dates of admission, diagnosis and/or symp- Introduction: A better understanding of the relative importance of ton onset) were met for 49,623 patients (median age 72, IQR 57–83). different transmission pathways of SARS-CoV-2 in hospital settings has 22,445 observations (45.23%) were tested due to symptoms indicative the potential to help improve targeting of control measures aimed at of a COVID-19 infection, 7868 (15.86%) due to systematic screening, reducing nosocomial spread. 1042 (2.1%) for reasons described as ‘other’, and for 18,268 (36.81%) as Objectives: To quantify the associations between risks of nosocomial ‘unknown’. 7076 observations (14.26%) were considered asymptomatic, SARS-CoV-2 infection and exposure on the same ward to infected 23,533 (47.42%) had fever-related symptoms, 3819 (7.7%) upper respira- healthcare workers (HCWs), to patients likely to have been infected tory, 30,782 (62.03%) lower respiratory symptoms, 2656 (5.35%) had anos- nosocomially, and to patients with community onset COVID-19. mia, 11,147 (22.46%) gastro-intestinal symptoms, and 11,147 (22.46%) Methods: Ward-level data were collected from four teaching hospitals symptoms associated with a viral syndrome. Of all COVID infections in Oxfordshire, UK, over an 8 month period in 2020. SARS-CoV-2 infec- (n = 5486, 11.0%), 1270 (2.6%), 1563 (3.1%), and 2653 (5.3%) were identi- tions were identified using both PCR results from symptomatic and fied as indeterminate, probably nosocomial, and definitely nosocomial, asymptomatic testing and serological data coupled with symptom respectively (Fig). The odds ratio (OR) of in-hospital mortality, comparing recall. A series of statistical models were used to quantify associations (probably + definitely) nosocomial to community acquired (out-of-hos- between exposures and probable hospital transmission events. pital + indeterminate) COVID, for the entire studied population was 1.62 Results: Risk to patients of probable nosocomial acquisition was most (95%CI 1.50–1.75). Significant increase in risk was seen only for age cat - strongly associated with exposure to other patients with hospital- egories 40–59 (3.13; 2.18–4.50) and 60–79 (1.5; 1.32–1.71). acquired SARS-CoV-2 (aOR, 1·76, 95%CI 1·51, 2·04), followed by the presence of an infected HCW on the same ward (aOR 1·45, 95%CI Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 21 of 140 Conclusion: Determining origin infection due to the ambiguousness around incubation periods, asymptomatic transmission and viral load over time needs further research. The proportion of nosocomial cases Conclusion: Increased numbers of infected HCW shortly before the out- after the second wave emphasizes the need to further investigate the break seem to be a risk factor for nosocomial SARS-CoV-2 outbreaks. This compliance of infection prevention measures over long periods. supports the notion that infected HCW are an important source of noso- Disclosure of Interest: None declared. comial COVID-19 and underscores the importance of adequate infection control- and prevention measures of HCW in- and outside the hospital. Disclosure of Interest: None declared. O38 Evaluation of ward‑level risk factors for nosocomial COVID‑19 outbreaks: a matched case–control study O39 1,* 1 1 1 1 1 R. Thoma , P. Kohler , S. Haller , J. M aenner , M. Schlegel , D. Flury Value of SARS‑COV‑2 genomic characterization in elucidating Division of Infectious diseases and hospital epidemiology, Cantonal within‑hospital transmission 1,* 1 1 1 1 Hospital St. Gallen, St. Gallen, Switzerland L. Cadenau, M. Welkers , M. Jonges , J. Schinkel , I. Spijkerman , M. de 1 1 Correspondence: R. Thoma Jong , R. van Mansfeld Antimicrobial Resistance & Infection Control 10(1): O38 Department of Medical Microbiology and Infection Prevention, Amster‑ dam UMC, University of Amsterdam, Amsterdam, Netherlands Introduction: The prevention of SARS-CoV-2 outbreaks in acute care Correspondence: L. Cadenau hospitals is a major challenge. In the second wave of the pandemic, we Antimicrobial Resistance & Infection Control 10(1): O39 observed several wards with outbreaks whereas others were spared. Objectives: We aimed to investigate risk factors for nosocomial Introduction: Identifying probable transmission routes of SARS-CoV-2 COVID-19 outbreaks on a ward level. in the hospital setting is needed to direct implementation of infection Methods: We conducted a matched case–control study in our tertiary prevention measures to stop transmission. care centre with over 700 beds by defining outbreak (≥ 2 nosocomial Objectives: We investigated probable transmission routes of clusters patients infected within a 14-day period) and control wards. Nosocomial of SARS-CoV-2 using both epidemiological data and Next generation infection was defined if a patient tested positive for COVID-19 on day 5 sequencing (NGS), and assessed congruence. or later of hospitalisation. Matching was done 1:1 for approximate num- Methods: All positive SARS-CoV-2 PCR test performed in our hospital ber of beds (± 10) and the time of the outbreak. The beginning of the from both patients and healthcare workers (HCW) between Septem- outbreak was defined as the day of the first positively tested nosocomial ber and December 2020 were evaluated. When more than two HCW or COVID-19 case on the ward. Intensive care units and designated COVID- patients from the same ward tested positive within 14 days (a poten- 19 wards were excluded. Presumed ward-, patient- and staff-specific tial cluster), the ward was contacted to identify transmission routes. variables were investigated. Paired Wilcoxon signed-rank test was used Suspected transmission was categorized based on epidemiological to compare variables between outbreak- and control wards. data (e.g. attendance, contacts in and outside the hospital). All avail- Results: From July to December 2020, we observed 9 outbreak wards able samples within clusters with sufficient viral load (CT value < 30) (surgical and medical, range of beds 17 – 31, range nurses 19 – 41 per were analysed using NGS. A team of molecular biologists, infection ward) with a total of 40 patients infected (range 2—7 per ward). The per- prevention specialists and virologists discussed the NGS results and centage of healthcare workers (HCW) tested positive within a period of called possible, probable or unlikely clusters based on phylogenetic 14 days prior until 2 days after the start of the outbreak was the only sig- reconstruction, background prevalence and the epidemiological data. nificant risk factor (9.7% vs 2.7%, p = 0.04). No difference in the percent - Results: From 14 possible clusters NGS was performed on 98 sam- age of infected HCW was observed in a time period further preceding ples (Table 1). Congruence between epidemiological data and expert the start of the outbreak (3 months to 2 weeks). Outbreak wards trended conclusion was high for probable transmission (89%) and unlikely towards a higher number of beds per room (2.22 vs 1.97, p = 0.09) and transmission (76%). In case of possible transmission NGS guided the a younger HCW age (33.3 vs 36.2 years, p = 0.17) compared to control definite conclusion in 85% towards probable. Four of the five cases in wards. No association was found for factors reflecting work-load, patient which no transmission was suspected based on epidemiological data, turnover, or work experience of HCW (Table). but were identical in NGS analysis, occurred in one cluster. Other dis- concordances were dispersed in different clusters. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 22 of 140 Expert interpret ation (with NGS) Epidemiological data Ye N s o (73 (25 ) ) Yes (56) 50 6 Possible (21) 18 3 No (21)5 16 Conclusion: In 33% NGS changed the conclusion on transmission events. NGS analysis enables confirmation that transmission has ended and thereby helps evaluate outbreak management(OM). Besides, concerns of HCW can be managed by definite results on spe - Conclusion: A bundle of preventive measures was effective in control- cific transmission events. One of fourteen clusters was only detected ling this outbreak. The screening of asymptomatic patients and HCW by NGS. Epidemiological data alone can give direction to OM, however was very helpful in ending it. NGS analysis gives essential feedback on OM and specific transmission Disclosure of Interest: None declared. events. Disclosure of Interest: None declared. Slide session: Global infection control O40 O41 Management of a COVID outbreak on a hematology‑oncology Current status of the initiatives related to infection prevention ward 1,* 2 1 1 and control programs in the region of the Americas W. Van Der Zwet , A. Demandt , E. Klomp , J. Dingemans , L. van 1,* 1 1 1 1 J. Toledo , E. Chapman , S. Aldighieri Alphen , P. Sa velkoul 1 2 Pan American Health Organization (PAHO), Washington, United States Medical Microbiology, Hematology, MUMC + , Maastricht, Netherlands Correspondence: J. Toledo Correspondence: W. Van Der Zwet Antimicrobial Resistance & Infection Control 10(1): O41 Antimicrobial Resistance & Infection Control 10(1): O40 Introduction: Implementation of Infection Prevention and Control Introduction: Within one week, 11 members of the nursing staff and (IPC) Programmes is a fundamental strategy to reduce the burden of one patient of the hematology-oncology tested positive for COVID-19. healthcare-associated infections (HAI) and to contain the spread of Transmission of SARS-COV-2 on the ward was suspected. emerging and re-emerging pathogens in community and health facili- Objectives: Description of measures to end this outbreak. ties settings. The World Health Organization IPC Core Components Methods: Additional to standard COVID-19 precautions in our hos- (CC) is a framework with evidence-based recommendations compris- pital, all admitted asymptomatic patients were investigated by PCR- ing of eight areas for the implementation of IPC Programmes at the screening on a regular basis and positive specimens were investigated national and sub-national levels. via Whole Genome Sequencing (WGS). The following measures were Objectives: This study aims to map and characterize initiatives related installed: 1) Temporary closure of the ward for new admissions; to four of the CC in the Region of the Americas. 2) Restriction of number of visitors to a minimum; 3) Cohorting of Methods: Descriptive study of mapping valid and current national patients and healthcare workers (HCW); 4) Nursing personnel was documents of IPC related with regulatory frameworks, programs, poli- required to change their FFP-2 mask every hour; 5) Transfer of positive cies (CC1), evidence-based guidelines (CC2), policies on education and patients to the specialized COVID-ward, if medically safely possible. training of health workers (CC3), and documents on HAI surveillance Additional measures were employed when new cases occurred despite (CC4).We conducted a search for documents from August/December measures: a) Pre-admission PCR-screening of new admissions; b) Critical 2021 using various sources of information (Ministries of Health official appraisal of all non-patient-related activities of HCW and improvement webpages, legal records, official communications, and technical docu- where possible; c) Expansion of use of FFP-2 masks in care of asympto- ments). We presented the results in frequencies, percentages, and matic non-COVID patients to some long-lasting non-aerosol forming ranges. close-contact procedures; d) Avoidance of the use of multiple person Results: We included a total of 295 documents from 30/41 (73%) rooms for the non-COVID cohort as much as possible; e) Expansion of Member States in the analysis, with an overall range from 1 to 23 a working ban for COVID-19 positive HCW with CT-values < 30 to any documents per Member State. Due to the variability of the findings positive result, as it became evident that early detected patients/HCW regarding the contents, the final classification of the documents was frequently had a high initial CT-value which decreased dramatically in dichotomized as “general” or “specific”, considering the overlap of the follow-up samples. domains with other areas. We found that CC4 (39,5%) and CC1 (34,3%) Results: WGS results proved the transmission of a particular SARS- had more “general” documents compared to CC2/CC3. There was no COV-2 variant (B.1.221 lineage, unique mutation A26513G) on the “general” policy on education programs in IPC for CC3. In regard to ward. New cases occurred for 3 weeks. After installing extra measures, CC2, 83% of the guidelines were “specific” and 65% (80/123) of these the incidence of new cases declined gradually. related to COVID-19 and IPC. Figure 1 presents the frequencies for The total outbreak eventually comprised 19 patients and 33 HCW. An each one of the CC according to the subregions of the Americas. important part of COVID-19 positive healthcare workers had long-last- ing complaints of the infection and remained incapacitated far longer than the period that their CT-value required them to be banned from work. Therefore, extra personnel had to be recruited. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 23 of 140 Key words: IPC, IPCAF, IPCAT2, IPC program implementation, WHO IPC core components, Orange Network. Disclosure of Interest: None declared. O43 Infection prevention and control multi‑level capacity building for health workers—a cascade training and mentorship approach 1,* 1 1 1 M. S. Kesande , D. Ak ankwatsa , P. Kabagambe , R. Ayebare , E. 2 1 1 2 1 Katwesigye , D. Bulwadda , S. Nakato , S. Okware , E. Ayebazibwe , J. 1 1 1 Nanyondo, R. Walwema , M. Lamorde on behalf of n/a 1 2 Global Health Security, Resolve to Save Lives, Infectious Diseases Insti‑ tute, Makerere University, Kampala, Uganda Conclusion: This study provides an overview of the current status of Correspondence: M. S. Kesande the initiatives related to IPC Programs in the Region of the Americas Antimicrobial Resistance & Infection Control 10(1): O43 and an understanding of its evolution during the COVID-19 pandemic. However, it remains as priorities (i) improvement of health education Introduction: Structures established during outbreak preparedness and (ii) monitoring and evaluation strategies of the IPC practices at the tend to diminish post-outbreak requiring rapid re-activation, re-train- health facilities level. ing and re-orientation at the detection of a new outbreak. Sustain- (REF: —https:// www. who. int/ gpsc/ ipc- compo nents/ en/). able Infection Prevention and Control (IPC) structures are required to Disclosure of Interest: None declared. offset rapid preparedness activities. Implementation of a district led IPC capacity building approach during the 2018 Ebola outbreak in Kasese, Uganda registered improved IPC compliance for majority of the health facilities. The same approach was scaled up to national level O42 to enhance preparedness activities for COVID-19. Building a network of infection prevention and control model Objectives: a) To build and strengthen IPC capacity at regional, dis- hospitals: the turn Nigeria orange strategy trict and health facility levels. b) To build and strengthen IPC structures 1 1 1 1 1,* M. Gadanya , B. Okoro , A. Ogunniyi , A.‑B. A. Sambo, T. Okwor through establishment of IPC committees at district and facility levels. Nigeria Centre for Disease Control, Abuja, Nigeria Methods: Didactic, practical and video IPC training materials were Correspondence: T. Okwor developed. The approach was piloted in 3 regions; each regional Antimicrobial Resistance & Infection Control 10(1):O42. team underwent a training of trainers (TOT). At district level, the TOTs conducted a 3-day training of the district IPC committee and 10–20 Introduction: The Nigeria Centre for Disease Control coordinates the selected mentors per district. The mentors were supported to con- National IPC programme and implements other IPC core components, duct facility mentorship visits. A handbook endorsed by the director aimed at supporting implementation of IHR 2005 and the Nigeria general of health services was developed to guide the mentorship ses- AMR-NAP. Nigeria has signed on to the WHO Global Patient Safety sions at facility level. Initiative. Results: 114 TOTs from 3 regions were trained, cascading the train- Objectives: We describe our experience in building the National IPC ing to 29 districts. 557 district IPC committee members and district programme using a stepwise implementation strategy called “Turn mentors attended the district level training and were attached to 1–3 Nigeria Orange”. Launched in 2019, the TNO supports a network of facilities. 976 health facilities were reached and a total of 13,455 health health facilities (Orange Network) across Nigeria, in setting up func- workers were mentored. The mentors continue with the sustainability tional IPC programs; in line with WHO recommendations. phase visiting a facility once a month. Methods: Situational assessment conducted in 33/58 tertiary health Conclusion: The sustainability of IPC practices among health workers facilities. Dedicated personnel to IPC were appointed and trained. has an aspect of attitude and behavioural change and therefore can- IPC committees were set up with clear roles. Facilities identified into not be achieved with a one-off training. This strategy provides sugges- the Orange Network using WHO recommended criteria. Baseline IPC tions for the Ministries of Health to maintain a functional and robust evaluation at national and facility levels, using structured close-ended IPC structure at national, regional, district and health facility levels. questionnaires (IPCAT2 and IPCAF) with a scoring system, was con- Impact evaluation assessments are recommended periodically. ducted from July to September 2020. Data was analyzed, workplans Disclosure of Interest: None declared. developed and ratified by IPC team and leadership. Advocacy visits to relevant stakeholders conducted. O44 Results: At National level, baseline assessments revealed following Institutional safety climate: is it important for infection scores for IPC programs (64%), IPC guidelines (36%), IPC education prevention and control nurses? and training (61%), HAI surveillance (24%), multimodal strategies 1 1 1 1 2 C. H. Hekimoglu , E. Batır , E. Yildirim Gozel , D. Altun , M.‑L. McLaws , E. (71%), monitoring/audit of IPC practices, feedback and control activi- 1,* Alp ties (25%). The median score from the facilities was 433 (IQR: 178–637), 1 2 Ministry of Health, Ankara, Turkey, UNSW, Sydney, Australia with a mean of 416. Using the 4 IPCAF sub-categories classified thus: Correspondence: E. Alp none was Inadequate, while 17, 13 and 2 were in Basic, Intermediate Antimicrobial Resistance & Infection Control 10(1): O44 and Advanced categories respectively. Conclusion: The scores placed TNO facilities largely in basic & inter- Introduction: Infection prevention and control (IPC) programme in mediate category. IPC program implementation requires strength- Turkey has been carried out at the national and hospitals level with ening HAI surveillance, monitoring/audit of IPC practices using the publication of “Inpatient Treatment Institutions Infection Control multimodal strategy. At national level, IPC guidelines development, Regulation” in 2006. According to the regulation, the IPC committees monitoring/adherence and training of end-users is required. Mid- were established and IPC doctors and nurses were assigned in all hos- action review of the TNO strategy will be done in 2022 and impact pitals with > 200 beds. IPC nurse training, consisting of theoretical and evaluation is planned for 2024. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 24 of 140 practical parts, has been introduced since 2007. Many IPC programme activities (surveillance, training of healthcare workers, hand hygiene Figure: observation, etc.) are carried out by IPC nurses. Table 1: Incidence of HA-MDROs per 1000 admission Type of MDROS Incidence per 1000 admission Objectives: This study was conducted in order to evaluate institu- Carbapenem-resistant Enterobacteriaceae (CRE) 0.54 th Extended-spectrum beta-lactamases (ESBL) producing Escherichia coli 0.80 tional safety climate for IPC nurses at the 15 year of national IPC pro- Extended-spectrum beta-lactamases (ESBL) producing Klebsiella pneumoniae 1.30 Methicillin-resistant Staphylococcus aureus (MRSA) 1.00 gramme of MoH. Multidrug-resistant Acinetobacterbaaumanii 1.10 Vancomycin-resistant Enterococcus (VRE) 0.04 Methods: IPC nurses completed the self-questionnaire on a voluntary Others 0.60 basis, via the online link, between 09/12/2019 and 31/12/2019. Mini- mum sample size was calculated to be 749, assuming the number of IPC nurses 2500, expected prevalence 50%, absolute certainty ± 3 and Conclusion: MDRO surveillance program is crucial in order to moni- confidence level 0.05. The analysis was done institutionally and indi- tor the trend of MDRO and to detect newly emerging pathogen or vidually according to the variables. In institutional evaluations, if there outbreak. Besides that, it is used to monitor the effectiveness of infec - is more than one IPC nurses participated in an institution, one of them tion prevention and control interventions and to identify areas for was chosen as "random". improvement. Results: A total of 879 nurses from 693 hospitals participated in the Disclosure of Interest: N. F. Bakhtiar Employee of: Ministry of Health study. It was determined that administrators actually fully attended Malaysia, S. Amir Husin Employee of: Ministry of Health Malaysia. national IPC nurse training programme in 75.0%, partially attended in 22.7% and not attended in 2.3% of the hospitals. The ratio of working with an IPC doctor is 80.5% and have a regular IPC team meeting is 69.6%. A microbiologist routinely attends IPC team meetings in 43.3% P002 of facilities. The facility leadership made a clear commitment to sup- High adherence to national IPC guidelines as key to sustainable port IPC decisions in 66.4% of the hospitals, partially in 32.9% and VRE control in Swiss hospitals? 1,2,* 3 4 5 not in 2.5%. All the IPC nurses are full time assigned according to the D. Vuichard‑Gysin , R. Sommerstein , N. Buetti , A. Kronenberg , C. 6 4 7 regulation, however 59.0% are commissioned other than IPC activities. Gardiol , S. Harbarth, A. Widmer on behalf of Swissnoso 1 2 IPC nurses stated that they mostly need training programme on new Swiss Center for Infection Prevention, Swissnoso, Bern, Infectious epidemiological criteria and new diagnostic criteria, and 24.2% stated Diseases, Thurgau Hospital Group, Muensterlingen, Infectious Diseases, that they need a full re-training about IPC. Hirslanden Central Switzerland, Lucerne, Infection Control Programme, Conclusion: The survey results indicate the importance of institutional University of Geneva Hospitals, Geneva, Infectious Diseases, University 6 7 support and continuous training in IPC for infection control nurses of Bern, Federal Office of Public Health, Bern, Infectious Diseases, Uni‑ after national regulations. versity of Basel Hospitals, Basel, Switzerland Disclosure of Interest: None declared. Correspondence: D. Vuichard‑Gysin Antimicrobial Resistance & Infection Control 10(1): P002 Poster Session: Antimicrobial resistance—Surveillance Introduction: In 2018, the national center for infection prevention (Swissnoso) elaborated guidelines to prevent nosocomial outbreaks P001 with vancomycin resistant enterococci (VRE). Healthcare associated multidrug resistant organism (HA‑MDRO) Objectives: To evaluate the level of adherence to this new guideline incidence in Malaysia public hospitals from January to December and its impact on the VRE epidemiology in Swiss acute hospitals. Methods: In a survey, we asked Swiss acute care hospitals about 1 1,* N. F. Bakhtiar on behalf of Infection control unit, S. Amir Husin changes in infection prevention and control (IPC) measures, details on Infection Control Unit, Ministry of Health Malaysia, Putrajaya, Malaysia VRE surveillance and outbreaks in the years 2018 and 2019. Correspondence: S. Amir Husin Results: Overall, 97/146 (66%) hospitals participated and 72/81 (88%) Antimicrobial Resistance & Infection Control 10(1): P001 have adopted the Swissnoso guideline. Since 2018, 57 hospitals have changed their IPC measures: 89.5% introduced admission screening, Introduction: Healthcare associated infections due to Multidrug 56% screening and 58% preventive contact precaution (CP) for sus- Resistant Organism (MDRO) present a growing threat to global health. pected VRE cases. Hospitals with VRE cases were significantly more Objectives: This study aimed to determine the incidence of specified likely to have changed their IPC strategies (38/51) than those hospitals MDROs in Malaysia hospitals using standardized laboratory and clini- without VRE cases (19/38) (p = 0.015). 52 hospitals reported 569 new cal criteria. VRE cases (14 bacteremia) in 2018, and 472 new cases (10 bacteremia) Methods: The surveillance program is a laboratory based which in 2019. The 10 largest outbreaks accounted for 671 (64%) VRE cases, involved 28 MOH and 3 university hospitals. It is a continuous active 93% were colonization events, 4% infections and 2% bacteremia. Of monitoring of the incidence of specified organisms of clinical interests. 85 respondents, 13 (15.3%) reported difficulties in implementing all Results: A total of 13,966 clinical isolates of 6 alert organisms and recommendations. 9 reservations were related to implementation of other groups were reported from January to December 2019. Out CP for VRE cases (2/84, 2.1%), adoption of preventive CP for VRE con- of these isolates, 75% (10,438) were HA-MDRO. The incidence for tacts (3/84, 3.1%) and admission screening (4/85, 4.1%). each MDROs is shown in Table 1. MDROs rate was highest in Medical Conclusion: Acceptance and adherence with the new national department (32.4%) followed by Surgical (15.4%) and Anaesthesia VRE control guideline among Swiss hospitals seem high. However, department (15.1%). Majority of the HA-MDRO infection were blood- whether this has a sustained effect on VRE control at the national level stream infection (38.1%), followed by pneumonia (14.8%), ventilator- remains to be seen. associated pneumonia (12.4%) and surgical site infection (11.1%). Disclosure of Interest: None declared. The top 3 commonest antibiotics prescribed within the last 3 months among MDRO patients were Cephalosporins, Beta lactamases and P003 Carbapenems. Proposal of a national definition of multidrug‑resistant invasive gram‑negative organisms by ANRESIS 1,* 1 O. Friedli , A. Kronenberg Institute for Infectious Diseases (IFID), University of Bern, Bern, Switzer‑ land Correspondence: O. Friedli Antimicrobial Resistance & Infection Control 10(1):P003. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 25 of 140 Introduction: Surveillance of multidrug-resistant (MDR) microorgan- (MDRO) surveillance data within the Hospital Infection Surveillance isms is key in national AMR programs, however there is no universally System (KISS), and to compare them with published outbreak data accepted MDR definition in Switzerland so far. from the health authorities. Objectives: In this study, we aimed to develop a national definition Methods: We used surveillance data on Methicillin-resistant Staphy- of MDR-Enterobacterales (MDR-E), adapting international definitions lococcus aureus (MRSA), Vancomycin-resistant Enterococci (VRE), to local testing algorithms and surveillance data available in ANRESIS. multidrug-resistant Escherichia coli (MDR-Ec) and Klebsiella pneumo- Methods: Using interpreted qualitative susceptibility data (SIR) niae (MDR-Kp) from the ICU-based MDRO surveillance within KISS. from 2019–2020 from the ANRESIS database, we analyzed the test The patient-based data comprise the day of admission, and the days algorithms applied by swiss laboratories and examined the cross- of MDRO acquisition and infection, if applicable. ICU clusters were resistance within antibiotic groups. Based on these analyses, two defined as ≥ 2 ICU-acquired MDRO infections within 14 days, and all different MDR-E definitions depending on the intended use, a subsequent ICU-acquired MDRO infections or colonisations in corre- broader one for epidemiological surveillance ("ANRESIS-EPI") and sponding 14 day-periods. a more restrictive one for infection control ("ANRESIS-IPC") were Results: Between 2015–2019, 608 ICUs from 428 hospitals partici- specified. Using these algorithms, the rates of invasive MDR-E iden- pated, representing 22% of German hospitals. 223 MDRO clusters tified in our national dataset were compared with international and that met reporting criteria were identified. The table presents the national definitions, namely the ECDC-definition, the KRINKO-defini- description of cases and clusters per MDRO. Published data from the tion and the definition proposed by the University Hospital Zurich. health authorities reported hospital outbreaks with Enterococcus spp. rd th Results: Aminoglycosides, Piperacillin-Tazobactam, 3 /4 gen. (N = 68), Staphylococcus spp. (N = 93), Escherichia coli (N = 12) and cephalosporins, carbapenems and fluoroquinolones were used Klebsiella spp. (63) during the same time, without specified antimicro - for our MDR-E definition. Major differences in testing algorithms bial phenotype and without restriction to ICUs. between different laboratories were observed. The analysis of cross- resistance within an antibiotic group revealed, that the substance VREMRSAMDR-EcMDR-Kp ICUs N571 580 575575 most likely to be effective against a specific gram-negative bac - Patients N1,900,128 1,936,4211,925,967 1,925,967 terium, is not tested preferentially (e.g. amikacin). For all bacterial MDRO casesN 24,490 23,915 25,705 6,589 Colonisations/Infections 21,246/3,24 19,516/4,39 20,211/5,49 4750/183 species tested, the highest rates of multidrug-resistant isolates were 4 9 4 9 found using the "ECDC-MDR" definition (N = 3664). The number of Acquired N6,789 2,4523,207 1,343 Clusters N91685328 MDR-E identified by using the ANRESIS-IPC (N = 277) definition was Median clusters/ICU N(max) 1(8) 1(6)1(3)1(2) comparable to those detected with the KRINKO (N = 267) respec- CasesinclustersN (% acquired cases) 298(4%)176(7%) 137(4%) 77 (6%) tively UHZ definition (N = 193). However, the isolates classified as Median cases/cluster N(min, max) 3(2-13) 2(2-7)2(2-7)2(2-7) MDR-E by KRINKO, UHZ and ANRESIS-IPC (N = 387) differed signifi- cantly. Only 101 of the isolates (26.1%) were uniformly classified as MDR-E according to the KRINKO, UHZ and ANRESIS-IPC definitions. Conclusion: MDRO outbreaks from ICU-based KISS surveillance alone would account for 223 of 260 (86%) of all published hospital out- breaks. Compared to hospital-wide outbreak data from the health authorities which include more bacterial species and phenotypes, our data indicate underreporting of hospital outbreaks. Disclosure of Interest: None declared. P005 Bacteriological profile and trends of antimicrobial resistance in healthcare‑associated pathogens in Tunisian teaching hospital 1,* 1 1 2 2 2 H. Ghali , A. Ben Cheikh , S. Bhiri , R. Bannour, W. Dhouib , S. Khefacha , 1 1 H. Said Latiri , M. Ben Rejeb Department of Prevention and Security of Care, Sahloul university hos‑ pital, Faculty of Medicine of Sousse, University of Sousse, Department of Prevention and Security of Care, Sahloul university hospital, Sousse, Tunisia Correspondence: H. Ghali Conclusion: The application of different MDR definitions leads not Antimicrobial Resistance & Infection Control 10(1): P005 only to considerable variations in the rates of MDR-E, but also in the isolates that are finally classified as MDR-E. Different testing algo - Introduction: Antimicrobial resistance in health care-associated rithms complicate an uniform MDRO definition. pathogens is a growing concern for health care and for public Disclosure of Interest: None declared. health. Thus, studying temporal changes in resistant pathogens causing healthcare-associated infections (HAIs) is crucial in improv- P004 ing local antimicrobial and infection control practices. Hospital outbreaks of multidrug‑resistant bacteria—ICU‑based Objectives: The objective was to describe nine-year trends of resist- surveillance data indicate underreporting to health authorities ance in pathogens causing HAIs in a tertiary care setting in Tunisia. 1 1 1 1,* C. Schroeder , M. Behnke , P. Gastmeier , F. Maechler Methods: Annual prevalence surveys are part of a quality improve- Institute of Hygiene, Charité Universitätsmedizin, Berlin, Germany ment program promoted by our department in Sahloul university Correspondence: F. Maechler hospital for the prevention and control of HAIs in order to ensure Antimicrobial Resistance & Infection Control 10(1): P004 patient safety. The current study focused on data collected from 2012 to 2020. Definitions and methodology of HAIs and antimicro - Introduction: In Germany, ≥ 2 hospital acquired infections with an bial resistance were based on CDC. Data collection was carried out epidemiological link and subsequent colonisations with the same using NosoTun plug. organism are subject to reporting obligations to the public health Results: Results for microbiological investigation were available authorities. for 165 HAIs (55.7%). The proportion of HAIs that was microbio- Objectives: We aimed to calculate the number of clusters which met logically confirmed decreased from 58.1% in 2012 to 56.5% in 2020 the reporting criteria from ICU-based multidrug resistant organisms (p = 0.1). A total of 234 pathogens causing 297 HAI events were included. Gram negative pathogens (GNP) were the most common Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 26 of 140 pathogens. A decreasing trend was notified for Klebsiella spp, Pseu- Introduction: The coronavirus disease 2019 (COVID-19) pandemic domonas aeruginosa, and Staphylococcus aureus. However, this has imposed the use of increased amounts of disinfectants and anti- decrease was not statistically significant. Antimicrobial resistance biotics, that will probably influence the features of microbial strains was found in 32.1% of cases. colonizing the hospital surface. Significant increasing trend in antimicrobial resistance was noticed Objectives: The purpose was to assess the impact of disinfectants (from 15.6% in 2012 to 21% in 2020; p < 10–3). and antibiotics used during the COVID-19 pandemic in hospitals Conclusion: There is a high burden of drug resistance to common with patients coronavirus positive, by the comparative analysis of antibiotics in Sahloul university hospital. These findings may high- the antibiotic resistance and biocides tolerance profiles of bacterial light the need for effective antimicrobial stewardship programs, strains isolated before and during COVID-19. including monitoring and feedback on antimicrobial use and Methods: A number of 103 bacterial strains: 61 from 2018 and 42 resistance. from 2021 were isolated from the hospitals and identified by MALDI- Disclosure of Interest: None declared. TOF. The antibiotic resistance phenotypes were established by disk diffusion and the minimal inhibitory concentrations (MIC) for five disinfectants were determined by broth microdilution method. P006 Results: The analyzed strains were mainly E. coli, A.baumannii, Survival analysis of multidrug‑resistant organisms infection S.aureus before and S. haemolyticus, P. aeruginosa and Enterobac- among patients with different catheterization in ICU 1,* 2 3 4 5 ter sp. after COVID-19. If before pandemic the resistance rates of J. Yang, Y. Tan , W. W u , F. Hu, Y. Wang Gram-negatives to 3rd and 4th generation cephalosporins reached Tongji Medical College, Huazhong University of Science and Technology, 73.3% and 70–85% for quinolones and tetracyclines, after the pan- Department of Nosocomial Infection Management, Zhongnan Hospital demic the resistance rates 3rd generation cephalosporins remained of Wuhan University, Wuhan, Hubei University of Medicine, Shiyan, high, i.e. 87.5%, while for the other antibiotics the rates were Department of critical care medicine, Zhongnan Hospital of Wuhan 25–50%. The MIC for the disinfectants varied between 1.56–25% for University, Zhongnan Hospital of Wuhan University, Wuhan, China Ethanol, Propan-2-ol, 0.78–12.5% for Ethanol/Denatured isopropano Correspondence: J. Yang and Ethanol, 0.0019- 0.125% for menthol, ethyl alcohol/hydrogen Antimicrobial Resistance & Infection Control 10(1): P006 peroxide, peracetic acid. Conclusion: By using high amounts of disinfectants and antibiotics Introduction: The incidence of nosocomial infection in ICU is sig- for containment of COVID-19 the diversity and resistance features of nificantly higher than that in general wards, and the detection rate microbial strains from the hospital environment were modified, an of MDRO is much higher than the overall level of the hospital, mak- increased microbial diversity after COVID-19, decreased resistance ing ICU the key department of MDRO infection and the high-risk rates to non-beta-lactam antibiotics and higher tolerance to ethanol Department of nosocomial infection outbreak. It is reported that containing disinfectants. ICU patients widely use "three tubes", namely ventilator, catheter Disclosure of Interest: None declared. and central venous catheter, with application rates of 10.8%, 53.5% and 47.2% respectively. However, in the whole process of catheter insertion, pipeline maintenance and extubating, there are many risk P008 points of MDRO infection. It can be seen that the prevention and Implementing an antimicrobial resistance surveillance tool control of "three tube" infection is the top priority in the prevention in a low–income country: the TSARA project in Madagascar 1,* 2 2 3 2 2 and control of nosocomial infection in ICU.C. Elias , M. Raad, Y. Mallet , L. Rakotoarisoa , L. Raskine , F.‑X. Babin , M. Objectives: To reveal the infection time and risk factors of multidrug- Randria 1 2 3 resistant organisms (MDROs) in different kinds of catheter patients in Lyon University Hospital, Fondation Mérieux, Lyon, France, Fondation intensive care unit (ICU), so as to provide a reference time risk point for Mérieux, HUJR Befelatanana, Antananarivo, Madagascar the prevention and control of MDRO in ICU, and to supplement rea- Correspondence: C. Elias sonable evidence of prevention and control time for existing preven- Antimicrobial Resistance & Infection Control 10(1): P008 tion and control measures. Methods: Retrospectively analyzed the basic situation of MDRO infec- Introduction: Antimicrobial stewarship programs(ASP) in hospi- tion patients with three different tube placements in a general ICU tals are a vital component of national action plans for antimicrobial from January 1, 2019 to December 31, 2019 in a third-class A hospi- resistance(AMR), and have been shown to significantly reduce AMR, in tal. The median time, time difference and risk factors of infection particular in a low-income country such as Madagascar. As part of an in patients with different catheterization were revealed by survival ASP, AMR surveillance provides essential information to guide medical analysis. practice. We developed an AMR surveillance tool called TSARA with the Results: 5138 cases were included. Age, operation or not, three tube support of Fondation Mérieux, with the objective of combining patient use are high risk factors of MDRO infection (p < 0.05). The median sur- data with laboratory and epidemiological surveillance data to provide a vival time (Infection time) of patients with ventilator, catheter and cen- better understanding of the scope of AMR in Madagascar. tral vein intubation was (M = 1.00; P = 0.00; P = 5.00)d; (M = 1.00; Objectives: To describe how the TSARA project was developed in Mala- 25 75 P = 0.00; P = 5.00)d; (M = 1.00; P = 0.00; P = 6.00)d. Ventilator gasy hospitals and its outcomes. 25 75 25 75 and catheter were independent risk factors. Methods: Based on the Oxford GRAM protocol, TSARA is a standard- Conclusion: It is an important measure to reduce MDRO infection in ized data collection tool deployed since 2018 in five Malagasy hospitals ICU by reducing the use days of ventilator and catheter. participating to the RESAMAD laboratory network, monitoring microbio- Disclosure of Interest: None declared. logical, demographic and clinical data (Figure). Any hospitalized patient with a positive bacterial sample was included. Results: Individual isolate-level data and antimicrobial susceptibility P007 information on bacteria were collected. These data were compiled with Resistance features in bacterial strains isolated from the hospital clinical, demographic, and epidemiological information (including cur- environment before and during COVID‑19 1,2,3,* 3 2,4 3 rent antibiotic prescription) retrieved daily from face-to-face interviews M. Mitache , L. Marutescu , O. Nicolescu , I. Gheorghe , E. 3 1 3 3 with the patient and completed by medical records where necessary. Hassanzadeh , E. Rusu , C. Curutiu , C. Chifiriuc 1 2 Data were then entered in an online platform. Results were secondar- Faculty of Medicine,University Titu Maiorescu Bucharest, Public Health ily discussed with clinicians to provide guidance on the antibiotic pre- Directorate Bucharest Romania, Faculty of Biology University of Bucha‑ scription adapted to local resistance patterns. As an example, 2018 data rest, Faculty of Medicine, Carol Davila University, Bucuresti, Romania showed that 57.8% of empiric antibiotic prescriptions were eligible for Correspondence: M. Mitache de-escalation after reception of antimicrobial susceptibility tests. Finally, Antimicrobial Resistance & Infection Control 10(1): P007 Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 27 of 140 results of aggregated data were disseminated to relevant stakeholders P010 to improve awareness among prescribers and hospital gouvernance. Implementation of a bundle to control of MDR‑gram negative bacteria spreading and clinical impact in a pediatric intensive care unit 1 1,* 2 3 L. M. Parra Ramírez , E. Doñate , M. Nieto , B. Hernandez on behalf of Infection Prevention and Control Unit 1 2 3 Preventive Medicine Department, Intensive care unit, Department of Microbiology, Niño Jesús University Hospital, Madrid, Spain Correspondence: E. Doñate Antimicrobial Resistance & Infection Control 10(1): P010 Introduction: During October and November 2020, we observed a significance increase of MDR-GNB in clinical specimens from patients cared in a pediatric intensive care unit (PICU). Objectives: We conducted an epidemiological investigation. Methods: In addition to clinical samples, all hospitalized patients in Conclusion: Thanks to TSARA, regular analysis and feedback on sur- PICU were screened on admission and weekly thereafter for MDR-GNB veillance data to healthcare workers helped to optimize patient care. in samples from the nose, trachea and rectum. Environmental sam- Treatment guidelines were produced by Malagasy experts according pling was performed from surfaces (sinks, faucets) air and water. to type of patient and type of infection, with consideration of circulat- Identification of the species isolated from both clinical and environ- ing pathogens and local resistance levels. mental samples was performed by Vitek 2Compact, bioMérieux, Inc., Disclosure of Interest: None declared. Durham, North Carolina, USA. Samples with positive isolation were sent to the national reference laboratory of microbiology (ISCIII) for Poster Session: Antimicrobial resistance in paediatrics genotypic study by sequencing (PFGE). We performed a spatiotemporal analysis of cases and sequential anal- yses of the measures taken to determine the effectiveness in cluster. P009 Results: From October 12 through early November 2020, 25 speci- Antimicrobial resistance in enterococcus faecalis mens were identified, corresponding to 7 patients positive for and enterococcus faecium in children hospitals in China: MDR-GNB. a meta‑analysis 1,* 2 3 4 The attack rate (colonization) was 8.6% (7/81). Four of patients were J. Wang , M. Zhou , F. Liu , Y. F. Lee 1 colonized with extended-spectrum ß-lactamase (ESBL) and the others Institute of Social Medicine and Health Systems Research, Medical 2 with carbapenemase-producing Enterobacteriaceae (CPE).Three of the Faculty, Otto von Guericke University, Magdeburg, Germany, Depart‑ patients (42.9%) had polymicrobial colonization. ment of Infection Control, Dongguan Tung Wah Hospital, Dongguan 3 Of 30 environmental samples, five were positive for CPE (sinks- 100% city, China, Institute of Global Health, Faculty of Medicine, University 4 K. pneumoniae VIM). None of the water and air samples tested were of Geneva, Geneva, Switzerland, Sarawak General Hospital, Kuching, positive.Genotypic sequencing by PFGE was performed on the 4 clini- Malaysia cal samples (all patient colonized with CPE) and five environmental Correspondence: J. Wang samples. Different PFGE profiles were found between patients, but Antimicrobial Resistance & Infection Control 10(1): P009 environmental samples had similar and indistinguishable PFGE pat- tern.The initial measures taken were contact isolation of patients, Introduction: Enterococci is one of the leading cause of highly antibi- removal of atomizers, and closing the sinks. otic-resistance infections, especially healthcare-associated infections. After implementation of bundle (contact precautions, hand hygiene However, few epidemiological data estimated the burden of antimi- re-education, waterless cleaning of patient, anti-splash screens, rou- crobial resistance in Enterococci in children healthcare settings. tine cleaning of sinks, routine environmental screening) no cases Objectives: This study aimed to assess the incidence proportions of appeared. antimicrobial resistance profiles in Enterococcus faecalis and Enterococ- Conclusion: Implementation of a focused bundle on patient hygiene cus faecium in children hospitals in China, using data published in both and regular environmental cleaning in PICU reduced the MDR-GNB English and Chinese literatures. colonization rate. Methods: We searched PubMed, the China National Knowledge Infra- Disclosure of Interest: None declared. structure for antimicrobial resistance surveillance reports in the chil- dren hospitals in China from January 2019 until May 2021. Results: Seven studies were eligible for final analysis. Most of stud- P011 ies were conducted in higher socioeconomic regions in China (e.g. “Neonatal sepsis”—gram positive & negative bacteria’s and their Beijing, Shanghai, and Guangdong). Among E. faecalis of 1608 antibiotic susceptibility in NICU 1,* strains from all samples, the weighted incidence proportion of J. Thankachan vancomycin-resistant E. faecalis, nitrofurantoin-resistant E. faecalis, King Saud Medical City, Riyadh, Saudi Arabia linezolid-resistant E. faecalis, ampicillin-resistant E. faecalis, levofloxa- Correspondence: J. Thankachan cin-resistant E. faecalis, and gentamicin-resistant E. faecalis were 0.2%, Antimicrobial Resistance & Infection Control 10(1): P011 4.4%, 3.2%, 11.7%, 12.2%, and 40.3%, respectively. Among E. faecium of 2872 strains from all samples, the weighted incidence proportion Introduction: Neonatal sepsis is one of the most common causes of of vancomycin-resistant E. faecium, nitrofurantoin-resistant E. faecium, Neonatal Mortality and Morbidity in developing countries. Its causa- linezolid-resistant E. faecium, ampicillin-resistant E. faecium, levofloxa- tive bacteria’s and their sensitive patterns are different in each hos- cin-resistant E. faecium, and gentamicin-resistant E. faecium were 0.8%, pitals and regions. The objective of the study was to determine the 59.2%, 0.9%, 92.5%, 78.9%, and 48.7%, respectively. causation bacteria’s and their pattern of susceptibility to antibiotic s in Conclusion: This is the first review estimating about epidemiological NICU of a tertiary care center. burden of antimicrobial resistance in E. faecalis and E. faecium in the Objectives: Gram Positive & Negative Bacteria’s and to identify their children hospitals in China. The identified burden of vancomycin- Antibiotic Susceptibility. resistant E. faecium was similar to the 2017 CHINET report for general Methods: The prospective study was carried out at a tertiary care hos- hospitals, but lower compared to 2019 ECDC AMR report for general pital during the period from January 2020 to January 2021. A total of hospitals. 1712 blood cultures sent from different sites of the patients in NICU Disclosure of Interest: None declared. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 28 of 140 during this period. Out of which 1011 cultures came with positive bac- patterns should be considered along with proper infection control terial growth. measures. (Includes gram + ve & -ve, Cons and other Recognized pathogens). All Key words: Microbial spectra, Antibiotic susceptibility, ARI, Pakistan. cultures were screened by using a micro ESR & Culture and Sensitivity Disclosure of Interest: None declared. methods. Results: A total of 1011 cultures were found to be positive out of 1712 P013 cultures sent. Out of 1011 positive cultures 450 + are of gram positive Microbiology patterns of otorrhea at the university hospital organisms and remaining are of positive results with growth. of Cocody, Abidjan 1,* 2 2 1 1 3 The most common organisms isolated was Staph Epidermidis (68%), E. Ngoran , A. I. Yapi , J. A. Bahan , M. A. NGuiachi , E. Angora, B. TEA , A. followed by Staph Heamolyticus (10%), Staph Hominis(7%), Ente- KACOU N’DOUBA 1 2 rococcus Fecalis(5%). Other Organisms where much less in number Parasitology Mycology, Microbiology, University Hospital Center which includes Pathogenic Streptococcus, Enterococcus Feacium, of Angre, OtoRhinoLaryngology, Faculty of medicine, University Felix Staph Capitis, Bacillus Species etc. Houphouet Boigny, Medical Biology, University Hospital Center of Angre, There was Incidence of Gram Negative Organisms like E. coli, Proteus Abidjan, Côte d’Ivoire Mirabilis, Serratia Marcescens were also got isolated from Cultures. Correspondence: E. Ngoran The Gram Positive Organisms except Streptococcus displayed a high Antimicrobial Resistance & Infection Control 10(1): P013 degree of resistance to most Penicillin and Ciprofloxacin and were most time sensitive to Vancomycin, Amikacin and Cefepime. In some Introduction: Otorrhea is a frequent symptom in routine clinical prac- cases high incidence of resistance noted with Ampicillin, Gentamicin tice and a source of complications. The treatment is often empirical by amongst most Gram Negative Organisms, where in Cefepime, Amika- prescribing topical antibiotics. The interest based on etiological diag- cin and Meropenem were effective in most cases. nosis in order to improve the management of otorrhea. Conclusion: There is an increasing trend of antibiotic resistance to the Objectives: This study aimed to characterize the microbiology etiol- commonly used front line drugs. Continuo’s surveillance for antibiotic ogy of otorrhea. susceptibility is needed to ensure proper empirical therapy. Methods: This was a descriptive cross-sectional study extending from Disclosure of Interest: None declared. 2009 to 2019. We enrolled patients with otorrhea who presented to ear nose and throat (ENT ) consultation of the Cocody University Hospi- P012 tal. Sociodemographic, clinical and therapeutic data were collected in Microbial spectra and antibiotic susceptibility of acute respiratory patient records. Microbiology data were recorded at Pasteur Institute infections among children under 5 years of age in a developing of Côte dIvoire where ear fluid samples were analyzed. country Results: The global prevalence of otorrhea was 3.27% (555/16921). 1,* M. M. Bullo Children aged 0 to 15 years predominated with 40.2% (223/555). Ministry Of Health Islamabad, Federal General Hospital Islamabad, Female patients accounted for 53% (298/555). Islamabad, Pakistan The performance of microbiological analysis was low 13.7% (76/555). Correspondence: M. M. Bullo Bacterial etiology was observed in 11.2% (62/555) versus 2.9% (16/555) Antimicrobial Resistance & Infection Control 10(1): P012 of mycosis. The association of germs was found in 10 cases ie 1.8%. The main bacteria were Pseudomonas aeruginosa 4.3% (24/555) and Introduction: Estimated ARI mortality is 4 to 5 million children annu- Staphylococcus aureus 3.1% (17/555). The isolation rate of yeast were ally in developing countries. Around 15 million episodes of ARI occur Candida albicans 1.1% (6/555), Candida sp 0,9% (5/555) and Aspergil- in Pakistan every year among children. lus niger 0,5% (3/555). Antibiotic and antifungal susceptibility test was Objectives: The study aimed to examine microbial spectra and anti- performed respectively in 6.8% (38/555) and 0.7% (4/555). microbial susceptibility of bacterial isolates of acute respiratory infec- Conclusion: This study showed that the frequency of the germs iso- tions among under-fives. lated in otorrhea remains low in Côte d’Ivoire. Knowledge of microbio- Methods: An observational study was conducted among under 5 chil- logical etiology of otorrhea may improve their management. dren in a public sector hospital of Islamabad Pakistan from Oct 2018 to Disclosure of Interest: None declared. January 2019. Overall 350 nasal swabs were collected (300 from symp- tomatic and 50 from asymptomatic children). RT-qPCR was used for P014 screening viral pathogens. Bacteriological culture methodology was Eec ff t of mutation on ampc promoter in multidrug resistant used for bacterial pathogens and CLSI guidelines were adapted for isolates of diarrheagenic Escherichia coli in children 1,* 1 antimicrobial susceptibility. T. Singh , S. Das Results: Among symptomatic cases (300), 54% were females and Microbiology, University of Delhi, Delhi, India median age was 25 months (R = 59–1 months). Most affected age Correspondence: T. Singh group was 12 months and below. Overall positive samples for Antimicrobial Resistance & Infection Control 10(1): P014 microbes were 83% (n = 249). Of 249 infected cases, single bacte- rial pathogen was detected among 6% (n = 18) of cases, while single Introduction: Drug resistance among gram-negative bacteria is viral pathogen was detected among 30% (n = 90) of cases. Remain- mainly conferred by Beta (β)-lactamase enzymes. AmpC beinga ing 64% (n = 192) had co-infections. Predominantly detected viruses β-lactamase facilitate resistance to a widerangeof antibiotics.β- were RSV (32%), human rhinovirus (30%), HMPV (14%), HPIV-3 (11%), lactamases are diverse in nature due to existence of frequent HBoV (9%), and adenovirus (4%). Frequently isolated bacteria’s were mutations. There are multiple ways for the hyper production of Klebsiella pneumaniae (15%), Streptococcus pneumonia, Enterobacter β-lactamases in gram-negative bacteria but mutations in the pro- agglomerans, and Haemophilus influenzae were 13%, 10% and 7%, moter region is the most common mechanism. respectively. HPIV-3, Human rhinovirus, Adenovirus, Klebsiella pneu- Objectives: The main objective of the study is to find out the role of maniae and Streptococcus pneumonia found significantly involved promoters in drug resistance. in co-infections with P values of 0.01, 0.03, 0.01, 0.01 and 0.01. Of 17 Methods: Analysis of m-RNA expression of three genes of AmpC multidrug-resistant bacteria, isolate of Enterobacter agglomerans and β-lactamases (ABL) was carried out in fifteen drug-resistant and fif- Klebsiella pneumonia were identified as resistant bacteria against more teen sensitive E. coli isolates in children up to five years of age. Three than 5 different antibiotics. Pathogen detection rate (14%) was signifi- AmpC β-lactamase genes were selected (ACT , DHA and CMY). In order cantly lower in asymptomatic group than the symptomatic (P < 0.01). to know the effect of mutation on m-RNA expression level in,sequence Conclusion: Under five children are at high risk of ARI and prone analysis of the PCR amplicons (AmpC promoter region) was performed. to AMR. Regular surveillance of the type of isolates and their AMR The promoter sequences were compared with E. coli ATCC 25922, Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 29 of 140 using multiple sequence alignment tool (BioEdit version 7.0.5).and Conclusion: MDR-TB treatment delivery at PHCs showed high fidelity, sequences were submitted to NCBI for obtaining accession numbers. but it missed in some core points: giving complete informational sup- Results: Analysis of m-RNA expression of three genes of AmpC port, monitoring the patient taking drugs, and counseling the patient. β-lactamases (ABL) was carried out in fifteen drug-resistant and fif- Insufficient mandate due to MDR TB treatment resulted an inadequate teen sensitive E. coli isolates in children up to five years of age. Three patient-centred care. Developing SOP for MDR-TB treatment in Pri- AmpC β-lactamase genes were selected (ACT , DHA and CMY). In order mary Healthcare is needed for improving the compliance of the staffs to know the effect of mutation on m-RNA expression level in,sequence and the quality of patient care. analysis of the PCR amplicons (AmpC promoter region) was performed. Disclosure of Interest: None declared. The promoter sequences were compared with E. coli ATCC 25922, using multiple sequence alignment tool (BioEdit version 7.0.5).and P016 sequences were submitted to NCBI for obtaining accession numbers. Status of drug resistant (DR) tuberculosis (TB) infection control Conclusion: AmpC genes showed many folds increase in the expres- in Nepal sion levels in resistant isolates due to mutation in their promoter 1,* P. Shrestha region, indicating their potential role in disease transmission. Strength Young Professional Development Society Nepal (YPDSN), Kathmandu, of expression level of AmpCβ-lactamase genes depends upon the Nepal positions of mutation in the promoter region. Hence, strict antibiotic Correspondence: P. Shrestha policy has to be implemented in symptomatic and asymptomatic Antimicrobial Resistance & Infection Control 10(1): P016 individuals to bring down the rising threat of drug resistance in the community. Introduction: Infection control involves combination of measures that Disclosure of Interest: None declared. minimizes risk of TB transmission. Infection control is a major compo- nent of END TB Strategy. In Nepal, infection control is a key component of TB preventive services. The National Strategic Plan (NSP) 2016–2021 Poster Session: Antimicrobial resistance in the community envisions TB infection control as a part of national infection prevention and control policy throughout the country. Objectives: To identify the status of DR TB infection control in Nepal. P015 Methods: Desk review was conducted. Different literatures, reports and Treatment fidelity of drug‑resistant tuberculosis treatment policy documents related to infection control were reviewed and descrip- delivery in primary healthcare in Surabaya city, East Java tive analysis was conducted. Province, Indonesia: an implementary research 1,* 2 3 Results: National Tuberculosis Program (NTP) Nepal identifies three A. E. Noveyani , A. N. Probandari, Y. Mahendradhata levels of infection control measures: administrative, environmental Epidemiology, Faculty of Public Health, University of Jember, Jember, 2 3 and personal protection. NSP identifies lack of infection control policy, Faculty of Medicine, University of Sebelas Maret, Surakarta, Faculty program and mechanisms at treatment centers and lack of awareness of Medicine, Public Health, and Nursing, University of Gadjah Mada, on infection control as a major challenge for management of DR TB Yogyakarta, Indonesia and emphasizes appointment of focal person for infection control. The Correspondence: A. E. Noveyani major intervention includes improving infection control at all DR TB Antimicrobial Resistance & Infection Control 10(1): P015 centres and subcentres based on proposed infection control policy. However, till date national infection control policy is still not in place Introduction: The nearest service for Multidrug-resistant tuberculo- and focal person has not been appointed. sis (MDR-TB) may increase treatment adherence. Since 2014, MDR-TB As part of infection control, DR treatment centers were provided with patients are able to get treatment from the nearest Primary Healthcare exhaust fans, Ultraviolet Germicidal Irradiation (UVGI), N95 masks and (PHC). However, the patients’ loss of follow-up remains high (20%) in surgical masks. Sessions on infection prevention were incorporated in all TB training. NTP also initiated FAST (Finding Actively, Separate tem- Objectives: This study aimed to assess the fidelity of the treatment porarily and Treat effectively) approach in 15 major hospitals to actively process of MDR-TB at the Primary Healthcare level. find people with cough, testing through rapid molecular diagnostics and Methods: The study applied a mixed-method design in all PHCs in enabling prompt treatment, decreasing TB transmission. NTP has also Surabaya, Indonesia from March to June 2017. The study population focused on infection control at TB consultation room, DR TB patient isola- was all MDR-TB patients and staffs who responsible for the MDR-TB tion room and infection control at home. NTP also recommends health treatment service. A survey and in-depth interview were conducted. workers to follow all infection control procedures and decrease their risk The quantitative data were analyzed descriptively and the qualitative to TB disease. data were analyzed by content analysis. Conclusion: NTP requires significant efforts for DR TB infection con- Results: 23 out of 30 PHCs adhered to the National MDR-TB treatment trol. The national policy and guidelines on infection control should guideline regarding the treatment delivery components, the coun- be in place. Infection control measures should be strengthened with seling and psychosocial support components, and the adverse drug gradual expansion to all centers. A designated focal person should be effect management components. However, from the interview, we assigned. In addition, awareness on infection control among all health found that there is no Standard Operating Procedure (SOP) specific for workers, patients and community members is required. MDR TB treatment at the PHC level, and it was a key factor for staffs Disclosure of Interest: None declared. did not conduct some core components of the MDR-TB guideline. Those were the TB staffs did not give comprehensive information sup - port at the beginning of MDR TB treatment; The staff did not monitor the patient during the treatment, and even rarely gave counseling to the MDR TB patient. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 30 of 140 P017 Conclusion: Significant efforts are required to identify and notify the Burden of drug resistant (DR) tuberculosis (TB) in Nepal missing cases and enroll the notified cases into treatment without any 1,* P. Shrestha loss to follow up. Decentralization of diagnosis and treatment services, Young Professional Development Society Nepal (YPDSN), Kathmandu, expansion of ambulatory model of care, quality service delivery and Nepal patient centered care can improve DR services. Correspondence: P. Shrestha Disclosure of Interest: None declared. Antimicrobial Resistance & Infection Control 10(1): P017 Introduction: Tuberculosis (TB) is a major cause of ill health, one of P018 the top 10 causes of death worldwide and leading cause of death from Barriers and enablers of tuberculosis infection prevention single infectious agent. Drug Resistant (DR) TB continues to be a pub- and control activities in selected hospitals in Nepal 1,2,* 3 2 2 lic health threat. TB is a major public health problem and one of the S. Paudel , R. S. Padmawati , A. Ghimire , C. Lama Yonzon , Y. top 10 causes of deaths in Nepal. However, DR TB is not as high as the Mahendradhata 1 2 regional or global burden. Public Health Youth Society of Nepal, Pokhara, Nepal, Faculty of Medi‑ Objectives: The objective of the study was to review and assess the cine, Public Health and Nursing, Department of Health Behavior, Envi‑ burden of DR TB in Nepal. ronment, and Social Medicine, Department of Health Policy and Man‑ Methods: Desk review was conducted. Various literatures, reports, agement, Universitas Gadjah Mada, Yogyakarta, Indonesia policy documents and guidelines related to DR TB in Nepal were Correspondence: S. Paudel reviewed. Descriptive analysis was conducted to present the findings. Antimicrobial Resistance & Infection Control 10(1): P018 Results: DR TB services in Nepal are provided through 21 DR TB treat- ment centers and 81 sub-centers. Although services are ambulatory, Introduction: Tuberculosis (TB) is a major public health problem in facility-based services are being provided through referral centres, DR Nepal. Prevention of the spread of TB infection from the hospital & hostels and DR home. Diagnosis for DR TB is provided through Gene healthcare setting is one of the important interventions to reduce the Xpert, culture and DST (Drug Susceptibility Testing) and LPA (Line Probe burden of disease. The government of Nepal, Nepal TB Control Center, Assay). DR TB diagnosis is offered to presumptive patients remaining realized the importance of hospital-based intervention to prevent TB smear-positive on any follow up including failures of first-line treatment infection in a clinical setting and initiated an intervention in major and those at high-risk. Responses to treatment is monitored by culture. hospitals in high TB burden districts. In 2019, WHO estimated a total of 1,400 DR TB cases for Nepal but only Objectives: This study was conducted to identify the barriers, ena- 45.4% (635) were notified and among them only 392 cases (62%) were blers and associated factors of tuberculosis infection prevention activi- enrolled for treatment, with 38% primary loss to follow up. Data from ties in selected hospitals in Nepal. previous years also show huge gaps between estimated and notified Methods: A qualitative study was conducted from April to August cases. The achievement for treatment enrollment is below the level of 2019 in four hospitals in Nepal. Focused group discussion, key inform- global achievement of 84% notified cases posing high risk of transmis- ant interviews, and client exit interviews were conducted with 27 pur- sion, presenting that progress in detection is outstripping the capac- posively sampled health professionals and patients. The transcripts ity to provide treatment and follow-up services. The major barriers to were coded, categorized, and analyzed by using thematic analysis. adequate access to treatment are centralized services and reliant on Results: The study identified that unavailability of a separate room hospital-based care model. for screening and counseling for TB suspected patients, long wait- ing period for laboratory report due to limited capacity of GeneXpert machine were commonly reported barriers for infection prevention measures. Similarly, it was found that free TB service, equipment sup- plies from Government are major enabling factors, regular monitor- ing, and onsite coaching help to create an enabling environment.The use of wallpapers and the distribution of brochures to the patients plays an important role to increate awareness. It was found that pri- vate medical colleges and community hospitals were well managed whereas very limited measures were adopted at Government hospi- tals for infection prevention. Conclusion: This study uncovers the barriers and enablers which help to formulate necessary actions and planning for effectively implemen- tation of IPC measures. A separate waiting room, sputum collection booth, dedicated health worker for TB infection prevention activities, and well coordination between departments of the hospitals is a step forward to prevent the spread of TB infection in a hospital setting. Disclosure of Interest: None declared. P019 Nutritionals factors of childhood tuberculosis in a developing country: a case control study 1,* M. M. Bullo Ministry of Health Islamabad, Federal General Hospital Islamabad, Islamabad, Pakistan Correspondence: M. M. Bullo Antimicrobial Resistance & Infection Control 10(1): P019 Introduction: Tuberculosis has emerged as a public health issue espe- cially in developing countries like Pakistan and undernutrition is one of the important predictor of Childhood TB. Tuberculosis is considered as significant cause of mortality and morbidity among young children. An adequate and baseline epidemiological information on Childhood TB is critical for its effective control and prevention. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 31 of 140 Objectives: The purpose of this study was to evaluate the nutritional P021 risk factors of Childhood TB at Federal General Hospital Islamabad Comparative analysis of foodborne multi‑drug resistant Pakistan. salmonella enterica isolates from Russia and Belarus 1,* 1 1 1 1 Methods: A case control study was conducted at Federal General Hos-A. Egorova , A. Shelenkov , A. Chernyshkov , N. Kulikova, Y. Mikhaylova , pital (FGH) Islamabad. A case was defined as “any culture confirmed V. Akimkin patient of Pulmonary TB under 12 years of age registered in DOTS Central Research Institute of Epidemiology, Moscow, Russian Federation st st centre of FGH from 1 January to 31 July 2019. Against each case a Correspondence: A. Egorova healthy age and sex matched control was selected. Structured ques- Antimicrobial Resistance & Infection Control 10(1): P021 tionnaire was used for data collection and odds ratios were calculated with 95% confidence interval. Introduction: Salmonella enterica remains one of the most important Results: Total 184 children under the age of 12 years with Pulmonary global food origin pathogens and may play an important role in the TB were recruited (92 cases and 92 controls), mean age of the cases dissemination of antimicrobial resistance (AMR) and virulence. were 7 years (R = 12–4 years) and 53% cases were males while rest Objectives: The goal of this work is to perform comparative genomic were females. Most affected age group was below 10 years. Significant epidemiology analysis of foodborne multi-drug resistant S. enterica nutritional factors were undernutrition (OR 8.11, CI 4–16.2), stunting isolates from Russia (SER) and Belarus (SEB) based on whole-genome (OR 6.63, CI 3.5–12.5), unhygienic feeding practices (OR 5.3, CI 2.9–9.6), sequencing (WGS). wasting (OR 4.3, CI 2.4–7.5), use of unpasteurised milk (OR 4.1, CI 2.3– Methods: WGS was performed on the Illumina HiSeq platform for 65 7.2), underweight (OR 3.3, CI 2–5.5), inadequate breast feeding (OR SEB and 310 SER isolates in the period 2017–2020. The susceptibility 1.9, CI 1.32–2.9). While normal weight, overweight and obesity found to antimicrobial compounds was determined both by the boundary insignificant with childhood tuberculosis. concentration method and disc-diffusion test. Genome assemblies Conclusion: Nutritional factors have significant impact on childhood and comparisons were performed using SPAdes, roary, dnadiff, and TB. Nutritional education and counselling is required at institutional custom software. and community level for prevention of childhood TB. On our recom- Results: Most of the analyzed S. enterica isolates belonged to ST32 mendation awareness campaign was started at FGH regarding impor- and O7 serotype, but ST11 and O9 were prevailing for Belarus. SEB and tance of nutritional factors and prevention of childhood TB. SER isolates were characterized by 4 and 6 similar profiles of antimi- Key words: Nutritional Factors, Childhood Tuberculosis, Developing crobial susceptibility, respectively. The data correspond well to the Country, Pakistan. revealed AMR determinants according to WGS results. Both SEB and Disclosure of Interest: None declared. SER isolates had common genes to aminoglycosides, beta-lactam, and chloramphenicol. Additionally, Russian samples had tetracycline and quinolones resistance genes. In silico search for plasmids showed P020 that some of the isolates were characterized by the presence of several The use of 4‑hexylresorcinol as antibiotic adjuvant types of plasmids simultaneously. The most common plasmids for SER against mycobacteria 1,* 2 3 2 1 were IncFIB and IncX1, while IncFIB and IncFII prevailed for SEB. The A. Tutelyan, Y. Nikolaev , O. Manzenyk , G. El’Registan, V. Akimkin 1 2 set of virulence factors in isolates studied was similar and quite exten- Central Researche Institute of epidemiology, the federal research centre sive (up to 108) and consisted of structural components of the cell, fundamentals of biotechnology” of the Russian Academy of Sciences, host invasion factors, phage-related compounds, and plasmid genes. Moscow, State research center for applied microbiology and biotech‑ Phylogenetic analysis showed high similarity groups consisted of ST11 nology of federal service for surveillance on consumer rights protection strains isolated from the same country. However, there was no con- and human wellbeing, Obolensk, Russian Federation nection found for ST32 SEB and SER clades. Correspondence: A. Tutelyan Conclusion: Thus, applying WGS technology enabled us to reveal Antimicrobial Resistance & Infection Control 10(1): P020 unique genome features of S. enterica isolates from Russia and Bela- rus. Such characteristics are important for monitoring of AMR and viru- Introduction: Development of antimicrobial agents that are effec - lence genes of the pathogens studied in terms of food risk safety and tive against mycobacteria is of great interest. One of promising analysis evolutionary changes. approaches is to combine known antibiotics and adjuvants chosen Disclosure of Interest: None declared. from already known compounds (“off-label usage”, “repurposed drugs”). Previously we have shown that 4-Hexylresorcinol is one of effective such adjuvants. P022 Objectives: To study effect of 4-Hexylresorcinol (HR), approved Genetic diversity of Russian antibiotic resistant L. monocytogenes for use in medical practice, as adjuvant to fight mycobacteria in the isolates of food origin 1,* 1 1 1 in vivo experiments.N. Sukharicheva , A. Shelenkov , A. Egorova , A. Chernyshkov , N. 1 1 1 Methods: Test object was Mycobacterium smegmatis, a non-patho- Kulikova , Y. Mikhaylova , V. Akimkin genic relative of M. tuberculosis; bacteria were injected to tail venous Central research institute of epidemiology, Moscow, Russia, Moscow, (0.3 × 10 CFU, one time). Studied drugs: isoniazide (INI), anti-tuber- Russian Federation culosis drug – 0.3 mg/mice/day; 4-hexylresorcinol (HR) (as adjuvant of Correspondence: N. Sukharicheva INI) – 3 mg/mice/day; drugs were administrated with water for 4 days. Antimicrobial Resistance & Infection Control 10(1): P022 Effect of HR was studied in in vivo experiments with the use of white mice of BALB/c line. Amount of M.smegmatis cells was determined in Introduction: Listeria monocytogenes is a Gram-positive bacterial th mice spleen at 4 day by seeding of spleen gomogetate to Sotton pathogen. The food products contaminated by L. monocytogenes, solid medium. especially ready-to-eat food, may cause different clinical syndromes Results: Amount of M.smegmatis cells in spleen without treatment and is dangerous for immunocompromised people and pregnant was 1.2 × 10 CFU/g. INI or HR were not effective against this bacte - women. 4 4 rium (bacteria content were 1.9 × 10 and 0.8 × 10 CFU/g, respec- Objectives: The aim of this work is the molecular–genetic analysis tively). When both drugs were administrated, bacteria concentration of antibiotic resistant L. monocytogenes isolates of food origin using dropped 20-fold (cells content was 0.06 × 10 CFU/g). whole genome sequencing (WGS). Conclusion: The use of 4-hexylresorcinol increases anti-mycobacterial Methods: WGS was performed on Illumina HiSeq platform for 35 iso- activity of antibiotic in one order of magnitude. lates collected from meat, fish and ready-to-eat food from different As 4-hexylresorcinol is allowed to medical use, therefore it is highly geographical regions of Russia. The susceptibility was determined by possible to use it as a part of combined antimicrobial drugs. the boundary concentration method on VITEK2Compact30 analyzer. Disclosure of Interest: None declared. Genome assemblies and genome comparisons were performed using SPAdes, roary, dnadiff and custom software. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 32 of 140 Results: L. monocytogenes has maintained a high rate of susceptibility P024 to the antibiotics. All isolates under investigation were resistant to two Antibiotic resistance profiles of vibrio cholerae 01 strains antibiotics only of beta-lactam and sulfanilamide groups, but most of of human origin isolated in Benin from 2012 to 2016 1,* 2 2 the isolates were susceptible to these antimicrobial compounds and B. Boya , P. F. Djidjoho Fonton , T. A. AHO YO 1 2 macrolides, additionally. WGS analysis showed that all isolates were Laboratory of Biology and Molecular Typing in Microbiology, Ecole associated with two evolutionary lineages (II, IV) and can be divided Polytechnique d’Abomey‑Calavi, Ecole Polytechnique d’Abomey‑Calavi, into 10 sequence types (ST) with the prevalence of ST37 (II), ST121 Cotonou, Benin (II) and ST9 (II). ST121 and ST9 were identified in isolates from meat Correspondence: B. Boya products and from fish. These STs belong to hypovirulent clones. We Antimicrobial Resistance & Infection Control 10(1): P024 also identified in our collection hypervirulent ST2 isolates that were obtained from meat while usually such clones are associated with Introduction: The use of antibiotics during cholera epidemics in both dairy products. All isolates carried gene fosA responsible for resist- patients and contacts has contributed significantly to the emergence ance to fosfomycin. Some isolates had additional genes of resistance of resistant bacteria. to chloramphenicol and tetracyclin. All isolates under investigation Objectives: To determine the antibiotic resistance profile of Vibrio carried 33 common virulence genes, except isolates of ST121 and ST2 cholerae O1 strains isolated during the 2012–2016 cholera epidemics that characterized by the absence of actA, inlF, inlJ and ami, aut, inlJ in Benin. genes, respectively. Methods: Strains isolated from stools of sick subjects from different Conclusion: Thus, WGS-based analysis allowed us to reveal genetic regions of Benin were used for susceptibility testing. These strains diversity and identify unique genome features of different genetic were stored at the National Laboratory of the Ministry of Health (LNSP) lines of antibiotic resistant L. monocytogenes isolates. The data of Benin. Strain identification was done according to standard bacteri- obtained will greatly facilitate further investigations in genome epide- ology methods. Antibiotic susceptibility testing was performed using miology of food-born pathogens. the agar diffusion technique. Disclosure of Interest: None declared. Results: Over a four-year epidemic period, our results showed that the proportion of doxycline (DOX)-resistant strains was 66.67%, 66.67%, 75%, and 92.59% in 2012, 2013, 2014, and 2016, respectively, with P023 p < 0.05. The proportion of Vibrio cholerae O1 resistant to Erythromy- Antibiotic susceptibility patterns of listeria monocytogenes cin (E) was 66.67%, 100%, 100%, and 100% respectively in 2012, 2013, recovered from common South African ready‑to‑eat food 1,* 1 2014, and 2016 with p < 0.001. Trimethoprim/sulfamethoxazole resist- A. K. J. Kayode , A. Okoh ance rate was 70% for the tested strains. Department of Biochemistry and Microbiology, University of Fort Hare, Discussion: The resistance to doxycycline of Vibrio cholerae O1 strains Alice, South Africa, University of Fort Hare, Alice, South Africa could be the result of the current protocol proposing selective chemo- Correspondence: A. K. J. Kayode prophylaxis with doxycycline administered to all accompanying per- Antimicrobial Resistance & Infection Control 10(1): P023 sons and health personnel, for whom no contraindication existed in Benin [1]. Resistance to trimethoprim/sulfamethoxazole shows that Introduction: Antimicrobial resistance is gradually becoming a seri- the use of this drug would contribute to the selection and dissemina- ous challenge to public health with increasing reports of microbial tion of emerging resistant strains in the population [2]. resistance including Listeria monocytogenes (Lm) against useful antimi- Conclusion: The high percentage of resistance to doxycycline and crobial therapeutic agents. trimethoprim-sulfamethoxazole insists on reviewing the management Objectives: The aim of the study was to investigate the antibiogram protocol. fingerprint of the Listeria monocytogenes isolates recoverved from common South African ready-to-eat food. Référence Methods: This study investigated the antibiogram profile of Lm iso - 1. Makoutode M. F., Diallo V., Mongbo E., Guevart E., Bazira L., 2010. La riposte à lates (n = 194) recovered from common South African ready-to-eat l’épidémie de choléra de 2008 à Cotonou. Santé publique. 22; 435–425. (RTE) food against a panel of 22 antibiotics using the disc diffusion 2. Campos LC, Zahner V, Avelar KE, Alves RM, Pereira DS, Vital BJ, Freitas FS, techniques and to screen for resistance determinants in the isolates Salles CA, Karaolis DK. Genetic diversity and antibiotic resistance of clini‑ using PCR assay. cal and environmental Vibrio Cholerae suggests that many serogroups Results: Antimicrobial resistance (> 50%) against trimethoprim are reservoirs of resistance. Epidemiol Infect. 2004; 132(5):985–92. (56.19%), sulfamethoxazole (61.86%), streptomycin, ceftriaxone (53.09%), cefotetan (59.28%), vancomycin and oxytetracyclines Disclosure of Interest: None declared. (62.89%) were observed. Thirty of the isolates (15.46%) resistant to one or two antibiotics, while 162 (83.51%) exhibited phenotypic multid- Poster Session: Antimicrobial stewardship rug resistance to the antibiotics tested. Only two (n = 2, 1.03%) of the isolates did not exhibit phenotypic resistance to any antibiotics. Multi- ple antibiotic phenotypes (MARPs) revealed high resistance patterns P025 and the Multiple antibiotic indexes were greater than the Krumper- Knowledge of community pharmacy dispensers on providing man permissible (> 0.2) benchmark. Twenty-two (22) antimicrobial antibiotics in Khartoum State, Sudan 1,* resistance genes were detected in RTE food isolates out of the 44 A. H. S. Saad genes screened including resistance determinants that encodes sul- University of Medical Sciences and Technology, Khartoum, Sudan fonamides (n = 125, 64.43%), beta-lactams (n = 86, 44.33%), phenicols Correspondence: A. H. S. Saad (n = 25, 12.89), aminoglycosides (n = 93, 47.94%) resistance. Antimicrobial Resistance & Infection Control 10(1): P025 Conclusion: This suggests that the consumption of such RTE food in this study could constitute a health risk. Furthermore, the presence of Introduction: The irrational use of antibiotics has become very alarm- antimicrobial-resistant Listeria monocytogenes in RTE food could com- ing because of the major effects that it inflicts on healthcare. Of these promise the safety of human consumption. effects is the antimicrobial resistance. As resistance to older antibiotics Disclosure of Interest: None declared. is increasing, development of newer agents has stalled. Objectives: To asses knowledge of community pharmacy dispensers towards providing antibiotics. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 33 of 140 Methods: A cross-sectional study was conducted during January prescription and antimicrobial resistance among dental practitioners 2016 in Jabra area. Self-administered questionnaires were distributed was lower. among respondents, each consisted of items assessing the dispenser’s Disclosure of Interest: None declared. academic qualification (diploma, bachelor or master’s degree), years of experience, and knowledge about when to dispense antibiotics in P027 relation to presence of prescriptions, different settings and complains Attitudes and behavior of Algerian hospital doctors on antibiotic that include (dysuria, diarrhea, ear pain and discharge, sore throat, use and resistance viral infections and fever), these items were measured on a Likert scale 1,* 1 T. Morghad , H. Hassaine ranging from strongly agree to strongly disagree. Laboratoire De Microbiologie Appliquée à L’Agroalimentaire Au Bio‑ Results: A total of 40 pharmacies were visited with a 100% response médical et à L’Environnement (LAMAABE), Tlemcen university ( Algeria), rate (n = 40), of whom, 22 were males, 35 had a Bachelor degree, and Tlemcen, Algeria 18 had 1 to 5 years of working experience. Results showed that 32 of Correspondence: T. Morghad respondents indicated that antibiotics should be dispensed in pres- Antimicrobial Resistance & Infection Control 10(1): P027 ence or absence of prescriptions. 36 agreed that a dispenser should ask about the reason for requesting antibiotics without prescription. Introduction: Each day, the real prescription is also dependent on Our respondents disagreed that all clients complaining of diarrhea, ear non-pharmacological determinants in relation to the behavior of pre- pain or sore throat should be given an antibiotic (72.5%, 55%, 55.5%), scribers, hence the objective of this work. respectively. Majority disagreed with giving antibiotics on client’s Objectives: Knowledge of the attitudes and behavior of hospital phy- insistence and that their dispensing habits will not be affected by a sicians on antibiotics use and resistance. monthly required pay up to the pharmacy owner. Methods: Knowledge of the attitudes and behavior of hospital physi- Conclusion: Our study concluded that despite good knowledge, anti- cians on antibiotics use and resistance. biotics could be obtained in Jabra area without a medical prescription, Results: The response rates were 49%. The majority of the physicians this warrants further investigations for causes of such practice to reach audited were aware of the importance of the antibiotic resistance a better antibiotic stewardship. problem. Physicians were confident in most scenarios, but abstaining Disclosure of Interest: None declared. to prescribe an antibiotic was the main case where physicians had a significant degree of uncertainty. When prescribing antibiotics, doc - P026 tors rely mainly on two factors: experience and consultation of prac- Knowledge of antimicrobial resistance and antimicrobial tice guidelines. The measure identified as most useful to improve the prescription among dental practitioners in Chennai city—a quality of antibiotic therapy was the organization of training on antibi- cross‑sectional study otic prescribing. The causes of bacterial resistance most often identi- 1,* 1 1 2 S. S , R. C , M. P , S. gadde fied in the audited physicians were: too much antibiotic prescription, 1 2 public health dentistry, Periodontics, Ragas Dental College and Hospi‑ too much broad-spectrum antibiotic. tal, Chennai, India Conclusion: In order to deal with the problem of resistance and to Correspondence: S. S improve the rigour of antibiotic prescription, it is necessary to know Antimicrobial Resistance & Infection Control 10(1): P026 the attitudes and behaviors of doctors. Disclosure of Interest: None declared. Introduction: The use of antimicrobials in recent years has become more aggressive and more common. The inappropriate use, to be more precise, the abuse of these prescriptions, is the root cause for increasing anti microbial resistance(AMR). P028 Objectives: to assess the knowledge of antimicrobial resistance and Swiss interprofessional guidance of good practice of acute antimicrobial prescription among dental practitioners in Chennai city. and complicated diabetic foot infections and syndromes—a Methods: A total of 110 registered dental practitioners participated national project 1,* 2 3 in this study. A pre-validated and self-administered questionnaire was I. Uçkay , A. Czock , B. Peter‑Riesch on behalf of Interdisciplinary prepared and distributed to the dental practitioners in Chennai city to Expert Group for the Diabetic Foot of Swiss Society of Endocrinology collect the demographic details and the information regarding knowl- and Diabetology 1 2 3 edge and practice towards antimicrobial resistance and an antimicro- Balgrist University Hospital, Zürich, QualiCCare, Baden, General Beaul‑ bial prescription for the most common oral conditions was obtained. ieu, Geneva, Switzerland Results: A total of 110 registered dental practitioners participated Correspondence: I. Uçkay of which 64.66% were males and 35.4% were females, the respond- Antimicrobial Resistance & Infection Control 10(1): P028 ents were 46.36% MDS (had Master degree in Dental Specialty) and 54.8%BDS (Bachelor of Dental surgery). Majority of dentists were Introduction: Diabetic foot infections (DFI) and syndromes (DFS) have found to prescribe antibiotics for managing oral diseases except multiple negative outcomes in a patient population marked with co- for orthodontic treatment. MDS practitioners of 92.16% and BDS of morbidities and frailty. Their management requires a quality of care 79.96% recommended amoxicillin as their first choice antibiotic drug, consisting of evidence-based, practical guidance tools for primary care followed by the combination of amoxicillin with clavulanic acid. When providers together with the implementation of an interprofessional comparisons were made between BDS and MDS practitioners, major- care system including nationally standardized diagnose-relevant best ity of the questions were found to be not significant except for condi- practice recommendations. tions like tooth sensitivity(P = 0.00),dentoalveolar abscess (P = 0.009), Objectives: We implement a national best practice guidance for tooth fracture (P = 0.029), halitosis (P = 0.003) and periodontal timely and qualitative care of patients with DFI and DFS, including for abscess(P = 0.001).With regard to the duration of antibiotic prescrip- antibiotic stewardship in DFIs. tion, 42.37% BDS practitioners prescribed antibiotics as a 3-day course Methods: Under the umbrella of the national non-profit association and 45.76% resorted to a 5-day course.45.09% MDS practitioners pre- QualiCCare, an interprofessional and comprehensive Swiss practical scribed antibiotics as a 3-day course and 49.01% resorted to a 5-day guidance for the timely and standardized quality of care management course which was not statistically significant. There was a general lack of acute DFI, DFS and diabetic foot ulcers (DFU) was elaborated in a of awareness with regard to the guidelines for antibiotic prescribing in multi-stakeholder approach including all relevant professions. Before both the groups. the nation-wide implementation of the primary care triage and treat- Conclusion: Dental practitioners relied on drug therapy in many ment guidance and indication-specific recommendations for interpro - orofacial and general conditions where it was not necessary. Based fessional networks and footcare centers, three Swiss regions will pilot on this cross-sectional survey the overall knowledge of antimicrobial Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 34 of 140 the implementation in different possible primary care settings in col- Introduction: The high rate escalation antimicrobial therapies wors- laboration with the respective interprofessional footcare centers. ens outcome of patients with SARS-CoV-2. Results: Twenty experienced stakeholders from twelve different pro - Objectives: Correlate the outcome of SARS-CoV-2 patients and the fessions issued four protocols for various aspects of DFS between prescription of antimicrobial therapies within ICU. March 2018 and January 2020 and defined criteria for the triage and Methods: A prospective study of 98 patients with SARS-CoV-2 in treatment in primary care as well as the timely referral of patients with ICU from april 2020 till february 2021.Age. risk factors, days in the DFS and DFU to multidisciplinary footcare centers. All invited profes- ICU, requirement of invasive mechanical Ventilation (MV), days with sional societies agreed to work together and have a representative MV, SOFA at the admission in the ICU, mean PAFI, complications, in the working group. The resulting guidance were endorsed by all ventilator-associated-pneumonia, requirement of one empirical anti- national professional societies. microbial therapy, carbapenen, colistin or vancomycin prescribed anti- We propose a framework for specialized footcare networks as well as biotics or multidrug-resistance Gram negative organisms treatment multidisciplinary footcare centers. The piloting of the proposed con- amd outcome, all were tested with linear regression and p value less cepts is under way. than 0.01 was significant. Conclusion: We provide evidence-based tools regarding antibiotic Results: Among the 98 patients enrolled: 39% required one empiri- stewardship and other streamlined approaches for Swiss primary care cal antimicrobial therapy during the stay in the ICU, 75% had PAFI less providers and specialists while increasing the accessibility for patients than 210 and 52% of these group died. 25.5% suffered from infections to specialized care of DFS, DFU and DFI. and received carbapenen, vancomycin or colistin therapy, and 60% of Disclosure of Interest: None declared. them died. 35.7% patients received 3 or more antibiotics and/or anti- fungal and 48.6% were dead. Those with one empirical antimicrobial therapy 37% suffered from respiratory complications, 42% had MOF P029 (renal, cardiovascular, respiratory, hematologic complications) and Assesing of antibiotic prescribing in patients hospitalized 23% develop ventilator-associated pneumonia (VAP). In the group with confirmed coronavirus disease 2019 (COVID‑19)—results with carbapenens, colistin, vancomycin 28% had respiratory compli- of a point prevalence survey 1,* 2 cations, 60% MOF and 40% had VAP. Those who had multi-resistant N. Ion Nedelcu , S.‑A. Florescu 1 2 gram negative organisms treatment 17% had respiratory complica- Infection Control, Infectious and Tropical Diseases Hospital "Dr Victor tions, 71% had MOF and 57 suffered from VAP. Babes", Bucharest, Romania Conclusion: The prescribtion of multidrig-resistant Gram negative Correspondence: N. Ion Nedelcu organisms therapy increases the risk of MOF,decreases the PAFI and Antimicrobial Resistance & Infection Control 10(1): P029 increases VAP and worsens the outcome. Disclosure of Interest: None declared. Introduction: Recent reports have drawn attention to the high antibi- otic use in patients hospitalised for coronavirus disease 2019 (COVID- 19), resulting in concerns of increasing antimicrobial resistance with P031 increase antibiotic use in this pandemic. Point prevalence survey (PPS) Antimicrobial use in long‑term care facilities in the Netherlands 1,* 1 1 1 can be a quick tool to provide antibiotic prescribing information to aid K. Halonen , A. Haenen , M. Biesheuvel , S. de Greeff antimicrobial stewardship (AMS) activities. RIVM, Bilthoven, Netherlands Objectives: To describe the magnitude and structure of antibiotic uti- Correspondence: K. Halonen lization in COVID-19 patients using PPS. Antimicrobial Resistance & Infection Control 10(1): P031 Methods: Adapting Global-PPS on antimicrobial use, the survey was conducted in a 490 beds COVID-19 hospital in Bucharest on 18 March Introduction: Residents of long-term care facilities are at increased risk 2021at 0800 h. Patients on systemic antibiotics were included and the of infection and thus of being treated with an antimicrobial. Inappropri- prevalence of systemic (J01) antimicrobials used was calculated by ate use may lead to the development of resistance. In the Netherlands, WHO ATC classes. the national surveillance network (SNIV) is used to monitor infectious dis- Results: Three hundred and ninety-three patients were screened. The eases and antimicrobial use in long-term care facilities (LCTFs). We stud- mean age of patients was 58.9 years (IQR: 47–71), the prevalence of ied trends in antimicrobial use in these Dutch LTCFs. female gender was 55.8% (95%CI: 49.7%, 61.7%), and the mean dura- Objectives: To monitor trend in antimicrobial use in LTCFs in order to tion of hospital stay was 14.4 days (IQR: 10–19). A total of 89.6% of identify where the risk of resistance is potentially increasing. patients were on antibiotics on the survey day. Three hundred and Methods: In 2017–2019, twice a year in April and/or November a point ninety-eight doses of antibiotics were prescribed in these patients. prevalence study was performed. On the registration day, prescribed Overall, antimicrobials included in class ATC J01D (other betalactam antimicrobials with a maximum of three antibiotics or antimycotics per antibacterials: Cephalosporins and Carbapenems) represented 76.8% resident, and the indication (infection or prophylactic) was registered. from all amtimicrobial prescribed. Data were collected by elderly care physicians, nurses or infection con- Conclusion: Althouh the appropriatednes of prescription of antibiot- trol practitioners in participating LCTFs. Palliative care was not included ics was not the goal of this study, intensive use of broader spectrum in this study. Data were reported to SNIV through a password protected antimicrobials is concerning and suggestive that AMS interventions web-based surveillance system. such as preauthorization and/or audit and feedback, interventions Results: Over the past three years 136 unique LTCFs [range 23–77 per performed in our hospital in pre-pandemic era, could be the solution year] participated with 12,509 residents. The use of antimicrobial agents to improve the empiric prescription of antimicrobials for patients hos- increased from 6.7% in 2017 to 9.4% in 2019. The percentage of antibi- pitalised for coronavirus disease 2019. otics remained roughly the same (4.9–5.6%) however the use of antimy- Disclosure of Interest: None declared. cotics increased from 2.3% in 2017 to 4.8% in 2019. In 2017, 267 out of 448 (60%) antimicrobials were prescribed to residents with an infection, in 2018 it was 153/240 (64%) and in 2019 163/247 P030 (66%). The rest of the residents received antimicrobials as prophylaxis. Different antimicrobial therapies in the treatment of patients In 2017, 70% of these antimicrobials which were prescribed for treat- with SARS‑COV‑2 in the ICU worsens the outcome 1,* 1 1 ment of an infection, were antibiotics and 30% antimycotics; in 2019, K. Ugo , E. Mikulic, Y. Lamberto on behalf of Residents of the ICU the percentage of antimycotics has increased to over 50%. The highest at HMC increase in antimycotics is seen in the use of ketaconazole. In 2017, keta- critical care unit, CENTRAL MILITARY HOSPITAL, Buenos Aires, Argentina conazole was selected in 49% of the cases and in 2019 this has increased Correspondence: K. Ugo to 65%. In 2017 ketaconazole was mostly used as prophylaxis (67% in Antimicrobial Resistance & Infection Control 10(1): P030 2017), while in in 2019 69% was for the treatment of infections. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 35 of 140 Conclusion: Prescription of antimycotics in LCTFs increased in the past Objectives: We aimed to investigate the demographic, epidemiologi- three years. More research is needed to find out the clinical significance cal and clinical characteristics of patients hospitalized with the diag- of this increasing antimycotic use. nosis of uncomplicated and complicated pyelonephritis acquired in Disclosure of Interest: None declared. community and hospital, and to evaluate appropriateness of empirical treatment. Methods: The study was conducted in patients hospitalized with the P032 diagnosis of uncomplicated or complicated pyelonephritis acquired Impact of antibiotic stewardship and implementation of infection from the community or hospital between January 1, 2016, and June control on prevalence of surgical site infections in a large 30, 2018. Appropriateness of empirical treatment at the 48th-72nd tertiary‑care hospital in Haiphong city 1,* 2 2 1 2 1 hours was evaluated based on culture results and treatment modifica- J. Ory , H. Phan Tien , V. Vu Hai , C. Elodie , L. M. Quang , L. Didier , J. P. 1 1 tion (as escalation/de-escalation/continue) were evaluated. Lavigne , A. Sotto 1 2 Results: A total of 369 uncomplicated (94) and complicated (275) CHU, Nîmes, France, CHU Viet Tiep, Haiphong, Viet Nam episodes of pylenonephritis (in 339 patients) were evaluated. Causa- Correspondence: J. Ory tive pathogen was obtained in 69.4% of baseline cultures. The most Antimicrobial Resistance & Infection Control 10(1): P032 common agents were E.coli (71.0) and Klebsiella spp (17.7), and ESBL- production rate was 64.4%. Ceftriaxone, ertapenem and piperacilin- Introduction: In low- and middle-income country, the prevalence tazobactam were used in 26.3%, 53.7%, and 15.7% of the episodes, of SSIs is ranged from 4.5% to 14.3%. Few points prevalence surveys respectively. When the appropriateness of empirical treatment was (PPS) have been conducted in Vietnam on SSIs or on antimicrobial use evaluated at 48-72nd hours, ceftriaxone treatment had should be in surgical patient. escalated in 40.6% of all episodes while ertapenem and piperacillin- Objectives: The objective of this study was to estimate the PPS of SSI tazobactam had been escalated in only 8.8% and 9.5% of pyelonephri- before and after the implementation of antibiotic stewardship pro- tis episodes, respectively. grams (ASP) and the implementation of infection control (IC) in ortho- Conclusion: E.coli and Klebsiella spp. are responsible for majority of pedic department in a large tertiary-care hospital in Haiphong city, pyelonephritis. ESBL-pruducing pathogens are guite high even if com- Vietnam. munity-acquired infections. Considering the effect of early treatment Methods: Between 2016 and 2019, ASP and IC practices were imple- on mortality, more extended therapy covering ESBL-producing patho- mented in operating rooms and in the orthopedic department includ- gen at the beginning of the treatment appears a better and life-saving ing antibiotic training, skin preparation, hand hygiene, gloves and choice. sterile instruments. ASP were implemented in according to WHO Disclosure of Interest: None declared. guidelines including training and the risk factor of SSIs. In January 2016, before implementation of ASP and IC practices, a 1st PPS of SSIs and antimicrobial use was performed. The 2nd PPS was performed in P034 December 2019. The PPS was performed in according to ECDC meth- Evaluation of antibiotic prescription among pregnant women ods. Some characteristics were recorded as surgical, antibiotic prophy- in a Tunisian hospital 1 2 1 2,* 1 2 laxis, microorganisms and risk factors associated with SSIs (low serum N. Fathallah , I. Bannour , G. Derouich , R. Bannour , B. Ouni , H. Kheiri albumin concentration, older age, obesity, smoking and diabetes Department of Pharmacovigilance, Faculty of Medicine of Sousse, mellitus). Departement of Obstetrics and Gynecology, university hospital Farhat Results: The prevalence of SSI was 7.8% (n = 4/51) and 5.4% (n = 2/37) Hached Sousse, Sousse, Tunisia in 2016 and in 2019 respectively (p > 0.05; Student test). The most Correspondence: R. Bannour common microorganisms was S. aureus. Significate differences were Antimicrobial Resistance & Infection Control 10(1): P034 determined on diabetes mellitus, NNIS score, scheduled surgery and prophylactic antibiotics (> 48 h). For antibiotic prophylaxis, a 3rd-gen- Introduction: The safety of antibiotics prescription during pregnancy eration cephalosporin was prescribed more than 48 h, in the majority has been the center of an intensive controversy in recent decades due of cases for the two periods. Between 2016 and 2019, the skin prepara- to problem of drug risks for the fetus and the growing problem of the tion has improved during several informal surveys. emergence of bacterial resistance. Conclusion: Our finding suggest that IC practices and antibiotic Objectives: he aim of this study is to evaluate the protocol of antibi- prophylaxis have not become routine in participating facilities. The otic therapy used in the obstetrics gynecology department of Farhat decrease of prevalence of SSI, even non-statistically significant, lead Hached and to compare it with international recommendations. us to continue this program. It is necessary for hospitals in Vietnam Methods: A cross-sectional study was conducted among women hos- to provide comprehensive education programs, addressing basic IC pitalized in the peri-partum during their third trimester of pregnancy issues, such as standard precautions and establish more effective insti- and the postpartum sector in the service of gynecology obstetrics of tutional IC policies. Farhat Hached Hospital in Sousse who received antibiotic therapy dur- Disclosure of Interest: None declared. ing the period from 01/01/2020 until 03/31/2020. Data was collected using a pre tested grid treating epidemiological, socio-professional, clinical data, prescribed antibiotic therapy the indi- P033 cation, dosage, duration, course, tolerance, and the antibiogram. Evaluation of empirical antibiotic treatment in uncomplicated Results: A total of 153 women were enrolled in our study with a mean and complicated pyelonephritis cases and determination of risk age of 30 ± 6 years. factors for infection with esbl‑producing gram‑negative pathogen 1 1 1 1 1 1 For first-line antibiotic therapy, the most prescribed family of was B. Kayaaslan , Z. Oktay , I. Hasanoglu , A. K. Kalem , F. Eser , M. Ayhan , R. 1 2,* Beta-lactams (71.8%), as monotherapy or in association and Amoxicil- Guner , E. Alp 1 2 lin (36.3%) was the most prescribed antibiotic. The most used associa- Ankara City Hospital, Ministry of Health, Ankara, Turkey tion was beta-lactam, amino glycoside and imidazole (22.2%). Correspondence: E. Alp A switch of antibiotic adapted to the antibiogram was done only in 23 Antimicrobial Resistance & Infection Control 10(1): P033 cases. The average of prescription length was 6 days with favorable outcome mostly. The leading cause of antibiotic prescription was pre- Introduction: Acute pyelonephritis is one of the most common infec- mature rupture of membranes (31.3%) in third trimester of pregnancy tious diseases among outpatients and inpatients. ESBL-producing and the suspicion of postpartum chorioamnionitis (27.5%) after child- gram-negative pathogens are increasingly responsible for both com- birth. The most frequent isolated germ was Eshirechia coli. munity and hospital acquired infection. Appropriate and early anti- Overall, the practice of antibiotic prescription was in accordance with biotic therapy improves clinical outcomes and reduces mortality but international recommendations of proper use of antibiotic. rising antibiotic resistance rates make empirical therapy increasingly difficult due to limited treatment options. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 36 of 140 Conclusion: The prescription of an antibiotic during pregnancy in hospitals. Nevertheless such interventions are so far limited in should take into account both the maternal prognosis and the safety Switzerland. for the fetus. Collaboration between gynecologists, microbiologists, Objectives: to evaluate the impact of weekly clinical audits conducted infectilogists and pharmacologists is necessary in order to establish an by an external infectious diseases specialist and an internal senior phy- updated antibitherapy protocol. sician and multifaceted feedback strategies on reducing the use of Disclosure of Interest: None declared. protected anti-Gram negative antibiotics, including fluoroquinolones rd th (FQ), 3 and 4 generation cephalosporins (G3C, G4C), piperacillin- tazobactam (P/T ) and carbapenems. P035 Methods: The study included internal medicine, general surgery and Antibiotic prescription assessment in public hospitals in Abidjan, intensive care wards of 8 Swiss acute care hospitals. Wards were allo- Côte D’ivoire: a global point prevalence survey 1,* 2 3 4 cated to either intervention for 6 months (n = 14) or a control group I. A. D. Yapi , A. A. Kacou, A. Versporten , I. pauwel , Y. M. 1 1 5 (n = 10). Linear regression models of an interrupted time series was coulibaly‑diallo , G. A. J. bahan , A. kacou n’douba 1 2 3 performed to assess the impact of the intervention on the monthly biology, pharmacy, chu angre, abidjan, Côte d’Ivoire, microbiol‑ use of protected antibiotics. ogy, vaccine and infectious diseasesinstitute, microbiology, vaccine Results: During the intervention, 9715 in-patients were screened, and infectious diseases institute, antwerpen, Belgium, microbiology, chu of whom 1684 (17.3%) received a “targeted antibiotic”. The audit- angre, abidjan, Côte d’Ivoire ing team proposed a modification of the antibiotic therapy in 24% of Correspondence: I. A. D. Yapi patients, mainly stops, followed by de-escalation and switch to oral Antimicrobial Resistance & Infection Control 10(1): P035 route. The rate of inappropriateness varied from 8% in ICU to 32% in surgical wards, and from 15% for carbapenems to 38% for FQ. We Introduction: Antimicrobial resistance is an emerging global challenge. observed a statistically significant decrease use of FQ, G4C and P/T in It is correlated with the consumption of antibiotics. Inappropriate use of 5, 3 and 2 intervention wards, respectively, and a significant decrease antibiotics has been fuelled by lack of surveillance and diagnostic capa- in the use of 2 antibiotics in 2 wards.The use of G3C and carbapenems bilities and lack of treatment guidelines. The government of Côte d’Ivoire showed no significant change. in 2019 launched the national action plan on antimicrobial resistance. Conclusion: Our pragmatic multicenter study showed a statistically Objectives: Our objective was to describe the prescription patterns of significant impact on consumption of FQ, GC4 and P/T in 8/14 inter - antibiotics among hospitalised patients. vention units. It allowed a better overview of the appropriateness Methods: The standardized Global Point Prevalence Survey (Global PPS) of antimicrobial prescriptions. Our study offered the opportunity to method assessed antimicrobial prescribing in 11 hospitals in Abidjan, raise awareness about antibacterial resistances and encourage best including 7 secondary level hospitals and 4 tertiary level hospitals from daily practices among prescribers. August to December 2020. Data on antimicrobial agents and their indi- Disclosure of Interest: None declared. cations have been collected. Results: Out of 740 inpatients, 511 (69%) received an antimicrobial treatment and 491 (66,35%) antimicrobial prescription being antibiot- ics. This prevalence was respectively 64.49% and 74.56% for tertiary and P037 secondary level hospitals. Therapeutic prescribing accounted for 44% Organ dysfunction markers may predict aminoglycoside (tertiary level) and 43% (secondary level). For global prophylaxis, it was pharmacokinetics in critically ill patients with abdominal sepsis 52% (tertiary level) and 54% (secondary level). The main antibiotics used 1,* 2 1 3 B. Shahrami , A. Sefidani Forough , F. Najmeddin , A. A. Arabzadeh , M. in tertiary and secondary level hospitals were ceftriaxone (27% vs 44%), 1 Mojtahedzadeh metronidazole (13% vs 24%) and amoxicillin (12% vs 15%). In both thera- 1 Department of Clinical Pharmacy, Tehran University of Medical Sciences, peutic and prophylaxis, ceftriaxone (54%) was used the most in any hos- 2 Tehran, Iran, Islamic Republic Of, Department of Clinical Pharmacy, pital. In tertiary hospitals; central nervous system and lower respiratory 3 Queensland University of Technology, Brisbane, Australia, Department infections were the most common indications. Sepsis predominated in of Surgery, Ardabil University of Medical Sciences, Ardabil, Iran, Islamic secondary hospitals. Globally, the duration of prophylaxis was 36,40% for Republic Of single dose, 37,71% for one day, and 25.87% for more than one day. Correspondence: B. Shahrami Conclusion: Antimicrobial prescription mainly antibiotics is high in Côte Antimicrobial Resistance & Infection Control 10(1): P037 d’Ivoire. This situation may be improve by stewardship activities. Key words: Prescription, Antibiotics, Point Prevalence Survey, Hospital, Introduction: Pathophysiological changes and organ dysfunction Abidjan. following sepsis alter antibiotic pharmacokinetics. In the absence of Disclosure of Interest: None declared. pharmacokinetic data at the time of empirical treatment initiation, available biomarkers could play an important role in predicting the P036 pharmacokinetic parameters. Impact of weekly clinical audits and feedback on consumption Objectives: This study aimed to evaluate the relationship between of protected anti‑gram negative antibiotics in 8 hospitals the amikacin pharmacokinetics and the biomarkers associated with of the French‑speaking part of Switzerland organ dysfunction in critically ill patients with intra-abdominal sepsis. 1,* 2 E. Moulin , C. Plüss Suard on behalf of contributed equally Methods: A case series involving critically ill patients with intra- 3 4 5 6 as submitting author, C. Bellini , L. Christin , C. Chuard , O. Clerc , A. abdominal sepsis who received an amikacin loading dose of 7 5 8 3 3 9 Cometta, V. Erard , O. Marchetti, N. Troillet, C. Voide , G. Zanetti , L. 20–25 mg/kg intravenous infusion, was studied. The 1-, 2-, 4-, and 6-h Senn . amikacin serum concentrations were measured to calculate the phar- 1 2 Centre Hospitalier Universitaire Vaudois, Lausanne, Institute for Infec‑ macokinetic parameters. The available biomarkers associated with tious Diseases, University of Bern, Swiss Centre for Antibiotic Resistance organ dysfunction were recorded. A linear regression analysis was per- 3 4 (ANRESIS), Berne, Institut Central des Hôpitaux, Sion, Groupement formed to examine the relationship between the amikacin pharma- Hospitalier de l’Ouest lémanique, Nyon, Hôpital de Fribourg, Fribourg, cokinetics and the biological parameters. 6 7 Hôpital de Pourtalès, Neuchâtel, Etablissement hospitalier du nord Results: Twenty-one patients were studied. A significant correla- vaudois, Yverdon‑les‑Bains, Etablissement Hospitalier de la Côte, Morges, tion was found between the volume of distribution and ESR (p < 0.05, Université de Lausanne, Lausanne, Switzerland r = 0.844). Moreover, drug clearance had a significant inverse correla- Correspondence: E. Moulin tion with serum lactate (p < 0.05, r = -0.603). No other significant cor - Antimicrobial Resistance & Infection Control 10(1): P036 relations were found. Conclusion: ESR and serum lactate were identified as useful predic - Introduction: Multiple antibiotic stewardship proactive interven- tors of amikacin pharmacokinetics in critically ill patients with intra- tions have been shown to improve antibacterials prescribing practices abdominal sepsis and may help guide the selection of appropriate Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 37 of 140 empirical dosing. Further studies are required to confirm these Introduction: Candida auris is an emerging pathogen in hospital findings. infections that can present multi-resistance to antifungals and causes Disclosure of Interest: None declared. outbreaks. Objectives: The aim is to describe the infection prevention and con- trol for C. auris. Poster Session: Nosocomial Candida infections Methods: Identification of yeast isolates was performed by MALDI- TOF and confirmed by ITS sequencing. Infection control measures P038 were decided by a multi-disciplinary ad hoc outbreak panel. Patient An outbreak of candida parapsilosis bloodstream infections screening once or twice a week and extensive environmental testing in pediatric oncohemathology unit for C. auris was conducted. 1,* 1 1 2 R. Vatcheva‑Dobrevska , P. Stefanova, V. Dicheva , I. Philipova , T. Results: C. auris was isolated from a urine sample of a COVID-19 Kantardjiev patient who had been transferred from an Egyptian hospital to our 1 2 Microbiology, University Hospital "Queen Joanna" Sofia, National Refer‑ COVID-19 intensive care unit (ICU). Immediately, disinfection routine ence Lab Fungal and STI, Director, National Center Infectiouse and Para‑ was changed, because C. auris is insensitive to quaternary ammonium sitic Diseases, Sofia, Bulgaria compounds. The patient had already been isolated from admission Correspondence: R. Vatcheva‑Dobrevska due to evidence of 4MRGN Klebsiella pneumoniae. Six days after con- Antimicrobial Resistance & Infection Control 10(1): P038 firmation of C. auris in the index patient, a second COVID-19 patient was identified with C. auris. Both patients were isolated in a separated Introduction: The Candida spp is one of the most common causes of area of the ICU. Strict hygiene and infection control measures were bloodstream infections (BSI) in immunocompromised hosts. Their abil- implemented promptly. In the nine weeks from initial confirmation ity of biofilm formation on different implants facilitate the catheter- of C. auris and discharge of the two affected patients, C. auris was associated infections. repeatedly identified in clinical samples of them. However, it was not Objectives: The aim of this study is to investigate an outbreak of detected in any other patient on the ICU (n = 7) or discharged from it bloodstream infections in pediatric hematology-oncology patients (n = 13) nor in any environmental sample (n = 129). The two C. auris with totally implantable venous access port systems. patients had been intubated using the same video laryngoscope Methods: A total of 36 episodes of port system-related bloodstream seven days apart. Although the equipment and the spatulas had been infections were registered and investigated in 11 patients between manually reprocessed using chlorine dioxide-soaked wipes they might January and May, 2021. Blood cultures, needles, saline solutions, i.v. serve as transmission vehicle. Therefore, it was recommended to use plastic lines,bags, staff hands samples sent to microbiology lab. The disposable spatulas. Candida spp. isolation on SDA. The isolates identification by VITEK Conclusion: A rapid confirmation of a C. auris in the lab and the immedi- 2, BioMerieux and api20CAUX, BioMerieux, France. Re-identified by ate implementation of adequate hygiene measures at the ward are cru- MALDI-TOF (MALDI-Biotyper, Bruker. Whole genome sequencing was cial in order to prevent transmission of C. auris to other patients. prepared in the National Reference Lab. Disclosure of Interest: None declared. Results: The data from patients notes shows that all patients were neutropenic and with fever at the time of blood cultures and candi- P040 demia diagnosis Six of all patient had one sepsis episode each. Five Prospective evaluation of Candida colonization index in intensive of them had three or four sepsis episodes, mostly in March and May, care unit patients, in Tunisia 2021. The all blood cultures isolates as well as needles’ isolates were 1,* 2 1 1 1 M. Ben Brahim , N. Haddad , S. Boughattas , A. Farah, L. Tilouche , W. identified as Candida parapsilosis. In the cases of five patients with per - 3 4 1 1 Naija , H. Hmouda, A. Trabelsi , S. Ketata sistent candidemia and ongoing fever, additionally to antifungal ther- 1 2 Laboratory of microbiology, University Hospital Sahloul, Department apy, the ports were removed, based on the international guidelines of preventive and community medicine, Faculty of Medicine of Sousse, and manufacturer’s instructions. Various gaps in the Infection Preven- 3 4 : Surgical intensive care unit, Medical intensive care unit, University tion and control practices were found: poor hand hygiene compliance, Hospital Sahloul, Sousse, Tunisia shortage of staff and incidents of using a common saline solution bot - Correspondence: M. Ben Brahim tle etc. Antimicrobial Resistance & Infection Control 10(1): P040 Conclusion: The totally implantable port systems represent a high risk of bloodstream infections complications in pediatric onco-hema- Introduction: Multiple-site colonization with Candida spp. is commonly tology patients. The healthcare workers hands can be a risk factor for recognized as a risk factor for Invasive Candidiasis (IC) among intensive contamination with Candida parapsilosis. Further work need to create care unit (ICU) patients. Up to 80% of those patients are colonized one a special bundle and develop strategic measures for infection preven- week after their admission. tion and control of infections in case of totally implantable venous Objectives: Therefore, this study was carried out to assess the relation- access port systems as well as a medical staff training programme. ship between IC and the determination of Candida colonization index Disclosure of Interest: None declared. (CI) in patients addmitted to an ICU. Methods: A prospective observational study was conducted in 2020 P039 during two months in three intensive care units (ICUs) of the university Infection control in two COVID‑19 patients with evidence hospital Sahloul in Sousse, Tunisia. for Candida Auris, Germany All patients admitted at least for one week in the ICU were included in 1,* 2 1 3 2 M. Wiese‑Posselt , C. Hinrichs, B. Weikert , B. Graf , P. Enghard , R. the study. 2 3 3 1 4,5 2 Körner , A. Schrauder , A. Knaust , C. Geffers , O. Kurzai , K.‑U. Eckardt , After 7 days from the admission in the ICU and every week, five of the fol- P. Gastmeier . lowing samples were collected for mycological screening: tracheal secre- 1 2 Institute of Hygiene and Environmental Medicine, Department tions, rectal swab, armpit skin swab, mouth swab, nasal swab and urine. of Nephrology and Medical Intensive Care, Charité – Universitätsmedizin According to Pittet’s definitions, the Candida colonization index (CI) was Berlin corporate member of Freie Universität Berlin, Humboldt‑Universität calculated as the proportion of the number of distinct body sites (other 3 4 zu Berlin, Labor Berlin – Charité Vivantes GmbH, Berlin, Berlin, University than blood culture) colonized with Candida spp. over the total number of of Würzburg, Institute of Hygiene and Microbiology, Würzburg, National sites cultured. Patients with CI ≥ 0.5 were considered heavily colonized. Reference Center for Invasive Fungal Infections NRZMyk, Leibniz Institut Results: Out of 46 studied patients, a total of 21 patients have had an IC für Naturstoff‑Forschung und Infektionsbiologie – Hans‑Knöll‑Institut, based on both biological and clinical evidences. Using a CI ≥ 0.5, the sen- Jena, Germany. sitivity was the highest at the third week from the admission (84,6%) and Correspondence: M. Wiese‑Posselt the positive predictive value (PPV) was excellent from the second week Antimicrobial Resistance & Infection Control 10(1): P039 Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 38 of 140 (92,3%). The CI showed also a good specificity (92%) from the first week Poster session: control of carbapenem‑resistant enterobacteriaceae of the patient’s hospitalization. (CRE) and acinetobacter baumannii (CRAB) Table1: Distribution of patients according to the status of invasive candidiasis, the value of the Candida P042 colonization index at day 7, day 14 and day 21 Factors related to carbapenemase producing Value of colonization indexT1 T2 T3 (day7) (day14) (day 21) carbapenem‑resistant enterobacteriaceae colonization Number of Paitents with proven IC (n=21) < 0,5 18 72 1,* 2 3 ≥ 0.5 31211 I. S. Jeong , J. Y. Song , J. S. Jeong Other patients < 0,5 23 11 5 1 2 (n=25) ≥ 0.5 21 1 Pusan National University, Pusan National University Yangsan Hospital, Total of patients (n=46) 46 31 19 Sensibility 14,3%63,2% 84,6% Yangsan, Ulsan University, Seoul, Korea, Republic Of Specificity 92%91,7% 83,3% Positive predective value (PPV) 60%92,3% 91,7% Correspondence: I. S. Jeong Negative predective value (NPV) 56,1%61,1% 71,4% Antimicrobial Resistance & Infection Control 10(1): P042 Introduction: Carbapenem-resistant Enterobacteriaceae (CRE) is Conclusion: Our study suggested that monitoring Candida coloniza- regarded as one of the most urgent threats because of broad resist- tion index after two weeks of hospitalization could be helpful to iden- ance to ß-lactam antibiotics including carbapenem and a high mortal- tify patients at risk for IC (CI ≥ 0.5) allowing therefore the initiation of ity rate from infection. CP-CRE is big threat as it has spread rapidly, and empirical antifungal therapy. On the other hand, its specificity could is associated with high mortality rates, but few studies on risk factors be used to exclude the presence of IC in patients with CI < 0.5. for CP-CRE have been reported. Disclosure of Interest: None declared. Objectives: This study was aimed to identify the risk factors of car- bapenemase producing carbapenem-resistant Enterobacteriaceae (CP-CRE). Methods: This retrospective cohort study included 137 CRE colonized P041 patients from previous cohort to develop and assess the external Evaluation of « Candida score» in intensive care unit patients: validity of a CRE colonization risk prediction model. The subjects were a prospective observational study in Tunisia 1,* 2 1 1 1 patients hospitalized in intensive care units of a high-level general M. Ben Brahim , N. Haddad, L. Tilouche , S. Boughattas , F. Azouzi , W. 3 4 1 1 hospital located in city Y of Gyeongsang Province, South Korea from Naija , H. hmouda , A. trabelsi , S. Ketata 1 2 October 1, 2016 to May 31, 2018. Every patient admitted these units Laboratory of microbiology, University Hospital Sahloul, : Department have perirectal swab to check CRE colonization within 7 days of hospi- of preventive and community medicine., Faculty of Medicine of Sousse, 3 4 talization, and weekly thereafter until 7 days after discharge. Patients Surgical intensive care unit, Medical intensive care unit, University with confirmatory findings of CRE colonization were included. CRE Hospital Sahloul, sousse, Tunisia colonization was confirmed by carbapenem antimicrobial susceptibil- Correspondence: M. Ben Brahim ity testing (imipenem, ertapenem) by disk diffusion method. The col- Antimicrobial Resistance & Infection Control 10(1): P041 lected data were analyzed using SPSS version 21.0 (IBM Corp., Armonk, NY, USA). A two-tailed test was performed with a significance level (α) Introduction: Key challenges to the management of Invasive candidi- of 0.05. The identification of risk factors were done by chi-squared test. asis (IC) include early diagnosis and rapid as well as appropriate anti- Results: Among 137 CRE colonized patients, 24 (17.5%) patients had fungal therapy. CP-CRE. The factors related with CP-CRE were length of stay in inten- Objectives: Hence, this study aimed to evaluate the performance of sive care units (p = 0.025), use of urinary catheterization (p = 0.012), Candida Score (CS) for early diagnosis of IC in non-neutropenic criti- use of mechanical ventilation (p = 0.021), and use of nasogastric tube cally ill patients. (p = 0.004) for 1–14 days. Methods: A prospective observational study was conducted from Conclusion: Short-term invasive instrumentation of less than two February to September 2020 in three intensive care units (ICU) of the weeks is related to CP-CRE. Therefore, more frequent monitoring of university hospital Sahloul in Sousse, Tunisia. All patients admitted at the occurrence of CP-CRE is necessary when invasive procedures are least for one week in the ICU were included in the study. The compo- required among the CRE colonized. nents of « Candida Score» were severe sepsis, total parenteral nutri- Disclosure of Interest: None declared. tion, surgery and multifocal Candida colonization. Sepsis was given a score of 2 if present and 0 if absent. The other variables were given a score of 1 if present and 0 if absent. A score more than 2.5 was consid- ered significant. P043 Results: Out of 112 studied patients a total of 30 patients have had Carbapenem resistant enterobacteriaceae (CRE) acquisition rate an IC, i.e.an overall incidence of 11.7 IC per 1000 patient days. Can- and risk factors in adult patients, general intensive care unit, dida albicans was the most common Candida species (40%). Using a hospital pulau Pinang: an observational, cohort, and prospective CS > 3, the sensitivity was 40%, and the specificity was 95,1%. The study 1,* 2 2 2 2 positive predictive value (PPV) was 75%, and the negative predictive L. Kok S oon , L. Wei Chyuan , W. Peng Shyan , L. Kar Nim , C. Ting Soo 1 2 value (NPV) was 81,2%. The rate of IC in patients with CS > 3 was 40% Infectious Disease, Hospital Sultanah Aminah, Johor Bahru, Infectious (p < 0.0001) and the mortality rate was 66,6%. Disease, Hospital Pulau Pinang, Pulau Pinang, Malaysia Conclusion: Unlikely to the recommended CS > 2.5 established by Correspondence: L. Kok Soon León et al., in our study, Antimicrobial Resistance & Infection Control 10(1): P043 a CS > 3 was found to be a useful tool to predict IC in critically ill patients, allowing therefore the initiation of antifungal therapy. With a Introduction: Carbapenem-resistant Enterobacteriacaea (CRE) is a CS = 2 or 3, we must remain vigilant and do more clinical and biologi- multidrug-resistant bacterium.Critically ill patients in Intensive Care cal investigations. In fact, with a CS ≤ 2, an IC is highly improbable and Units have a high burden of CRE.We conducted an observational study empirical antifungal treatment is not recommended in the absence of to establish baseline CRE acquisition rate in the General Intensive Care positive culture. Unit(GICU)of Hospital Pulau Pinang. Disclosure of Interest: None declared. Objectives: To determine the CRE acquisition rate,demographic characteristic,risk factors, and mortality rate of CRE infected patients. Methods: The study was conducted using active surveillance of rectal swabs for CRE from February to June 2020. Adult subjects (> 18 years old) had a baseline screening swab done upon admission.Baseline positive swab or known colonizer were excluded.Weekly rectal swabs were performed.Followed up was done until transfer out.Subjects Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 39 of 140 who acquired CRE were monitored for CRE related infections.Those Cephalosporin susceptibility rates ranged from 91.5% to 90.6% in CI who expired or were transferred out from GICU within 7 days were and 81.0% to 76.2% in EI. CIP, a fluoroquinolone, showed 93.2%/95.2% excluded from study. susceptibility rates and AMK, an aminoglycoside, 70.1%/90.5% suscep- Results: From 237 admissions to GICU,50 subjects had more than tibility rates in CI/EI, respectively. More importantly, 16 (13.7%) CI and 1 week stay in GICU and were monitored for CRE acquisition.Twelve 2 (7.0%) EI had a MDR profile. subjects tested positive for CRE,resulting CRE acquisition rate 24%. Conclusion: PE and MDR isolates detected in LTHU patients may be CRE isolated were Klebsiella pneumoniae (91.7%) and Escherichia spreading to the environment. Surveillance studies are important to coli (8.3%). No polymycin resistance were detected.Four patients characterize and help fight AMR development and spread in LTHU, by acquired CRE at week 2, 6 patients at week 3, and 1 patient each at adjusting IPC programs to this new reality in LTHU settings. week 5 and week 6 respectively. Disclosure of Interest: None declared. From 33% deaths among the subjects who acquired CRE,half was CRE Acquired(%) (n=12) Non-CRE Acquired(%)(n=38) Age (mean) 45 46 P045 Days of admission(mean)24 14.5 Gender:Male 25 71 The effect of terminal disinfection on environmental Female 75 29 contamination in cabapenem‑resistant Comorbidities7575 History of antibiotic enterobacteriaceae‑carrying patient rooms <3days 0 0 1,* 1 2 3 3 to 7 days 33.3 2.6 J. Kim , J. S. Jeong , E. S. Park , M.‑N. Kim >7days 66.7 97.4 1 2 Department of Clinical Nursing, University of Ulsan, Infection Control History of Carbapenem 91.747 History of Healthcare Contact25 18.4 3 Team, Yonsei University Severance Hospital, Department of Laboratory History of CRE Contact8.3 0 History of Ventilation 100 89.4 Medicine, Asan Medical Center University of Ulsan College of Medicine, History of Urinary Catheter 100 97.3 History of Central Venous Line 91.7 81.6 Seoul, Korea, Republic Of History of Dialysis Catheter 25 39.5 Correspondence: J. Kim Clinical Outcome Expired 33.3 39.5 Antimicrobial Resistance & Infection Control 10(1): P045 Survived 66.7 60.5 Introduction: CRE can survive not only in a humid environment but attributed to CRE-related infections. also in a dry environment for a long time, is more closely related to Conclusion: The high acquisition rate shows that CRE is a major issue hospital environment contamination than other intestinal bacteria, to be addressed.Early modification of risk factors are paramount and causes transmission, which is a problem in infection control. in reducing CRE acquisition.Usage of active surveillance screening Objectives: This study was aimed to compare the extent of cabape- should be considered as may prevent CRE transmission. nem-resistant Enterobacteriaceae (CRE) contamination of the environ- Disclosure of Interest: None declared. mental surfaces before and after disinfection by using both Adenosin Triphosphate (ATP) measurement and microbial culture tests. Methods: From April to May 2021, 10 hospital rooms of patients 48 h P044 after CRE was isolated from a tertiary acute care hospital were selected. Enterobacteriaceae—a clinical and environmental longitudinal Eight samples were collected before and after terminal room disinfec- study in a long‑term healthcare unit 1,2,* 1,3 2 1 tion, one each from the bed table, mattress, bed railing, door handle, C. Santos‑Marques , F. Amorim , H. Ferreira , S. Gonçalves Pereira 1 sink surface, drain, toilet, and toilet railing in each hospital room. For a Center for Innovative Care and Health Technology, Polytechnic of Leiria, 2 total of 181 specimens, the relative light units (RUL) and colony form- Leiria, UCIBIO/Microbiology, Faculty of Pharmacy of University of Porto, 3 ing units (CFU) values were measured using the ATP and culture test, Porto, School of Tourism and Maritime Technology, Polytechnic of Leiria, respectively. Peniche, Portugal Results: Two CRE cases were isolated from the drains of the two hospi- Correspondence: C. Santos‑Marques tal rooms before disinfection, one case on the surface of the sink, and Antimicrobial Resistance & Infection Control 10(1): P044 the other case from the toilet seat. Both strains were identical as Kleb- siella pneumonia and consistent with the patient’s strain. The RUL value Introduction: Antimicrobial resistance (AMR) is a global problem that was highest in the drain before disinfection, and those of all surfaces has long spilled over from hospitals to the community. Long-term except the drain decreased after regular terminal disinfection. After healthcare units (LTHU) represent a transition setting by accommodat- disinfection, all except for the drain (50%) and toilet handrail (90%) was ing patients with compromised immunity, previous hospital admis- under the environmental surface cleanliness criterion (RLU < 250), and sions, invasive devices and wounds, thus more prone to colonization the RLU value for bed table (p = 0.031) and the mattress (p = 0.016) was and/or infection by Enterobacteriaceae, some with multidrug resist- significantly different before and after disinfection. ance (MDR) features. Conclusion: CRE isolation on the surface of CRE patient’s room is less Objectives: This study scopes for Enterobacteriaceae incidence and than that of previous studies. Regular terminal disinfection is effective related AMR, in a Portuguese LTHU through a longitudinal analysis of its to reduce the contamination of most room surfaces except sink drain. inpatients and environment, to demonstrate the role LTHU have in AMR Therefore, additional terminal disinfection methods are required for spread. sink drain. Methods: During 6 months, clinical (anus, mouth, hands) and environ- Disclosure of Interest: None declared. mental samples (bedside table, bed rail, handbell, door handle) were biweekly collected in 2 LTHU rooms. Samples were culture-based pro- cessed and antimicrobial susceptibility profiling (ASP) was conducted P046 in all presumptive Enterobacteriaceae (PE), according to EUCAST meth- Nosocomial outbreak caused odology, testing amoxicillin + clavulanic acid (AMC), cefotaxime (CTX), by metallo‑βeta‑lactamase‑producing pseudomonas aeruginosa cefoxitin (FOX), ceftazidime (CAZ), imipenem (IMP), aztreonam (ATM), type IMP linked to contaminated water‑related devices meropenem (MEM), ciprofloxacin (CIP) and amikacin (AMK). in a tertiary hospital, Spain 1,* 1 1 1 1 Results: A total of 615 samples were collected (129 clinical; 486 envi-M. T. Beca , E. Muñoz, Y. Cogolludo , P. Zamarrón , J. D. Martín , T. 1 1 1 1 1 ronmental) returning a total of 138 PE isolates. Of those, 117 were clin- Arevalillo , B. Martínez , R. Perea , A. Morano , B. Fernández‑Pacheco , H. 1 1 1 1 1 ical (92: anus, 20: mouth; 5: hands) and 21 environmental (6: bedside Burggraaf , L. Calvo , P. Romero , L. García de la Rosa , F. Paulino table; 5: bed rail; 5: handbell; 5: door handle). Toledo Hospital Complex, Toledo, Spain The best antimicrobial agents against clinical isolates (CI) were car- Correspondence: M. T. Beca bapenems, MEM (100%) and IMP (97.4%), and the worst AMC (17,9%). Antimicrobial Resistance & Infection Control 10(1): P046 Regarding environmental isolates (EI), results were similar: MEM and IMP (100%, both) as the best agents, AMC (19,0%) the worst. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 40 of 140 Introduction: Wastewater has been increasingly implicated in out- transmission with a VIM-1-producing E. hormaechei subsp. hoffman- breaks with carbapenem-resistant Pseudomonas aeruginosa. nii (same genotype in patients and drains; patients treated in the Objectives: The objective of this study is to describe the first nosoco - same room 16 months apart) and one environment-patient trans- mial outbreak of Metallo-β-lactamase-producing Pseudomonas aerug- mission with an E. hormaechei subsp. xiangfangensis coharbouring inosa type IMP in the hemato-oncology ward linked to contaminated bla - and mcr-9 (highly related strain found in the sink drain in VIM-1 water-related devices at our center and to describe the set of meas- the adjacent room before the patient was admitted). Observations ures adopted for its control. carried out revealed possible environment-to-patient transmission Methods: Between July 26–October 24, 2019, six consecutive isolates events as medical equipment and patient care products were stored of carbapenem-resistant Pseudomonas aeruginosa producing IMP nearby the washbasin. Despite persisting bla - and mcr-9-con- VIM-1 were detected with the same and non-usual antibiogram (sensitive to taining biofilms in drains, no more additional patient cases were piperacillin, piperacillin/tazobactam and colistin). The demographic, detected. clinical-epidemiological and evolutionary characteristics of the Conclusion: Transmission of carbapenemase-producing Entero- patients were analyzed. Cases and environmental samples were sent bacterales arising from the hospital waste-water system are often to a National Reference Laboratory for the corresponding molecular complex, involving several genotypes and resistance genes. As the characterization by Pulsed Field Gel Electrophoresis (PFGE). biofilm is difficult to eradicate, it is important to emphasize stand- Results: Six patients were affected. Three died. Samples from dry sur - ard precautions and include regular compliance observations to faces were negative. Samples from siphons of some patients’ rooms achieve a sustainable infection control. sinks were positive; two profiles were found according to molecu- Disclosure of Interest: None declared. lar characterization by PFGE. The most frequent profile was found in the first four isolated cases in the hemato-oncology ward and traps P048 of sinks of two patients’ rooms. The other profile was found in one Polytherapy as a strategy for the treatment patient outside hemato-oncology unit and others traps in the ward. of carbapenemase‑producing klebsiella pneumoniae infections: There were no more cases after replacement of traps and sinks. a two‑center, in Bucaramanga‑Colombia 1,* 2 1 1 1 Conclusion: It was an outbreak of infection and colonization by a K. S. Rodríguez Díaz , L. G. Uribe , A. Vega , C. Figueroa , M. P. Torres , 2 1 Metallo-β-lactamase-producing Pseudomonas aeruginosa type IMP, A. Maldonado , J. Lopez Aldana on behalf of GERMINA (Group associated with rapid torpid evolution among hemato-oncology for the Educational Renewal of Internal Medicine) 1 2 patients. It was also isolated in environmental samples associated with Industrial University of Santander, Los Comuneros University Hospital, aqueous devices. Its role as a source and facilitator of transmission Bucaramanga, Colombia was determined by the results of the molecular study, and the control Correspondence: K. S. Rodríguez Díaz measures taken on the environment corroborated the role of these Antimicrobial Resistance & Infection Control 10(1): P048 aqueous elements in the transmission. Disclosure of Interest: None declared. Introduction: Treatment of infections caused by carbapenemase-pro- ducing Enterobacteriaceae leads to high morbidity and mortality due P047 to the limited availability of efficient antibiotic regimens. Monother - Sporadic transmission of VIM‑1‑ and MCR‑9‑harbouring apy is associated with higher mortality and the combination of antimi- enterobacter cloacae complex from drains: safe patient care crobials is used as the first choice. This study describes the clinical and despite persisting biofilms microbiological experience of carbapenemase-producing Klebsiella 1 1 1 1 2 M. Thieme , M. Malecki , A. Kirchler , R. Hellmuth , P. G. Higgins , K. pneumoniae(CPKP)isolates with combination therapy. 2 2 1 1,* Xanthopoulou , H. Seifert , F. Mattner , A. F. Wendel Objectives: Describe the characteristics of carbapenemase-producing Institute of Hygiene, Cologne Merheim Medical Centre, University Hospi‑ Klebsiella pneumoniae infections treated with polytherapy in two tal of Witten/Herdecke, Institute for Medical Microbiology, Immunology fourth-level care centers in Bucaramanga. January 2015—January and Hygiene, University of Cologne, Cologne, Germany 2020. Correspondence: A. F. Wendel Methods: A retrospective cohort study of the Bucaramanga University Antimicrobial Resistance & Infection Control 10(1): P047 Hospital. Patients over 18 years of age with carbapenemase-produc- ing Klebsiella pneumoniae infections were included in patients who Introduction: The hospital environment is a source for sporadic had completed at least 48 h with antibiotic combination therapy. transmissions or outbreaks of carbapenemase- or colistin resistance Results: During the study period, 550 patients with CPKP infection gene-harboring bacteria. The detection of VIM-producing Enterobacter were identified. 440 patients were excluded and 110 patients were species in four patients hospitalized in two adjacent single rooms of selected for analysis. The combined antibiotic management regi- an intermediate care ward over a period of 20 months led to further mens were Meropenem plus Polymyxin-B (39%); Meropenem plus investigations. Ertapenem (34%) and others. The microbiological success was 41% Objectives: This investigation aims to define the molecular epidemi- and the clinical success was 77% with a failure rate of 23%. Overall ology and transmission dynamics of four cases of hospital-acquired mortality was 26%; 85% of the Kp detected produced class A car- VIM-1-carbapenemase- (some co-harboring mcr-9) E. cloacae complex bapenemases (KPC), while the rest of the isolates harbored class B on a critical care unit and the infection control interventions applied Metallo-β-lactamase genes and class D carbapenemases (OXA). Mor- over time. tality at the end of hospitalization was significantly higher in patients Methods: Infection prevention and control measures introduced were who presented some severity criterion (P < 0.05). On the other hand, as follows: contact precautions, environmental sampling of all sinks the double carbapenems group with Ertapenem presented qualifying and shower drains (2019 and 2020), replacement/cleaning and disin- mortality compared to the other regimens (p = 0.04). fection of the drainage, screening, observations, and trainings. Whole Conclusion: The need for effective management for KPRC persists. genome sequencing was performed (Illumina MiSeq and MinION, This observational analysis shows that the association of ertapenem cgMLST analysis by Ridom Seqsphere + , JSpeciesWS, PlasmidFinder plus meropenem provides a survival benefit. Larger prospective stud- and ResFinder). ies are needed to confirm these findings and to define the role of this Results: Several plausible transmission events from the hospital unconventional strategy. environment were confirmed: one patient-environment-patient Disclosure of Interest: None declared. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 41 of 140 P049 Methods: A retrospective observational study was conducted at the Fecal carriage of extended‑spectrum β‑lactamase‑ about 950 beds Academic Hospital of Udine, Northeast of Italy. Data and carbapenemase‑producing enterobacteriaceae in Moroccan about new cases of KPC occurred from 2016 to 2021 were collected from hospitalized patients in a university hospital internal datasets. Considering bed occupation, we calculated weekly 1,* 1 1 S. El Hassouni , M. C. Benjelloun , B. Oumokhtar incidence rate of KPC cases. Using Chi-square test, cumulative incidence 1 th microbiology, faculty of medicine and pharmacy, fez, Morocco rates before and after the 10 of October 2020, considered as the start of nd Correspondence: S. El Hassounithe 2 COVID-19 wave in our hospital, were compared. Antimicrobial Resistance & Infection Control 10(1): P049 Results: During the observation period, 255 new KPC cases were reported on a total of 1,235,177 days of hospitalization. Cumulative and Introduction: The prevalence of extended-spectrum b-lactamase- mean incidence rates on the overall observation period resulted 2.064 producing Enterobacteriaceae (ESBLE) and carbapenemase-producing and 2.075 new KPC cases per 10,000 hospitalization days, respectively. Enterobacteriaceae (CPE) in hospitalised and community patients is of Cumulative incidence rate were calculated in 1.287 before and 7.467 significant public health concern. after the second COVID-19 wave, being the two statistically different Objectives: This study aimed to investigate the fecal carriage and (p < 0.001, CI 95%). molecular epidemiology of ESBLE and CPE isolated from patients at admission to a medical ward. Year Hospitalization days New Eve Mean Weekly Incidence Rate s nts Methods: From January to July 2019, 100 patients admitted to the 2016 64,831 71.097 medical ward via intensive care unit (ICU) and emergency department 2017 278,119652.304 (ED) were screened for ESBL and CPE carriage at admission. ESBLE 2018 277,499301.067 2019 271,174250.941 were identified by double-disk synergy test. PCR and sequencing were 2020 249,924160.638 used to characterize the resistance genes. 2021 93,630 11211.857 Tota 1,235,177255 2.075 Results: In the present study, 127 strains of Enterobacteriaceae were collected, the prevalence of faecal carriage of ESBLE was 12.6% (16/127), E. coli was the predominant specie (9/16; 56.2%). A high rate of multiresistance in ESBLE was detected, 87.5% were resistant to Gentamicin, 81,2% to SXT, 87.5% were resistant to Nalidixic Acid and Norfloxacin, and 75% were resistant to Ciprofloxacin. All isolates were susceptible to Amikacin, Imipenem and Fosfomycin. Among all spe- cies, the bla group was the most common gene detected (75%), CTX-M-1 followed by bla (62.5%) and bla (31.2%). Carbapenemase pro- TEM SHV duction was found in one E. cloacae and was expressed exclusively by the bla gene. Nucleotide sequence analysis of bla CTX-M-1 dem- OXA-48 onstrated that all strains carried the CTX-M-15 subgroup. Conclusion: These findings suggest the need for action to better han- dle the burden of multidrug-resistant bacteria. Education of healthcare workers on basic procedures of infection control is recommended, as well as the implementation of antimicrobial stewardship program in all departments of healthcare facilities. Disclosure of Interest: None declared. P050 KPC rise in an Italian academic hospital during COVID‑19 pandemic 1,* 1 1,2 2 G. Giammarini Barsanti , M. Driutti , L. Brunelli , R. Cocconi 1 2 Conclusion: We observed a worrying rise of KPC infection incidence Dipartimento di Area Medica, Università degli Studi di Udine, SOC nd since the 2 COVID-19 wave began, suggesting an increased KPC Accreditamento, Gestione Rischio Clinico e Valutazione delle Perfor‑ outbreaks risk during pandemic. This observation could be explained mance Sanitarie, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy by a reduced effectiveness of personal protective equipment wore by Correspondence: G. Giammarini Barsanti healthcare workers or its unsuccessfulness in preventing cross infec- Antimicrobial Resistance & Infection Control 10(1): P050 tions within COVID units. Even during a pandemic, contact precau- tions should not be overlooked in healthcare settings and there is an Introduction: Multi Drug Resistant microorganisms (MDR) have been urgent need to reinforce professionals’ attention against the spread of a serious issue for public health for more than fifty years. Carbapenem MDR to prevent their rise. resistant Klebsiella pneumoniae (KPC) is a highly lethal bacteria, with a Disclosure of Interest: None declared. mortality rate in order of 40% worldwide. Objectives: In this study we examined data collected from the MDR sur- veillance team to understand how this life-threating infection impacted during COVID-19 pandemic. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 42 of 140 P052 Results: Out of 76 participants recruited, 50% of the cases cleared CRE Outcomes of screening for VRE and carbapenemase producing carriage in 304 days (95% CI: 238 to 369 days) from last date of dis- enterobacteriaceae in Tunisian intensive care units: rates and risk charge; and more than 80% cleared it within 2 years. 56.6% of study factors population were male with majority Chinese and median age of 1 2,* 2 2 1 1 W. Dhouib , H. Ghali , A. Ben Cheikh , S. Bhiri , R. Bannour , S. Khefacha , 67.0 years. The median length of stay of these 2 groups were 14.0 days 2 2 H. Said Latiri , M. Ben Rejeb for patients who did not clear CRE carriage and 7.0 days for patients Department of prevention and security of care, Sahloul university hos‑ who cleared CP-CRE carriage. Sixty-five patients continued antimicro - pital, Department of prevention and security of care, Sahloul university bial treatment after initial discharge, with amoxicillin-clavulanic acid hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse, as the frequently used antimicrobial. Median antimicrobial-free days Tunisia was 118 days for patients who did not clear CRE while for CRE cleared Correspondence: H. Ghali group, it was 281 days. Antimicrobial Resistance & Infection Control 10(1): P052 Conclusion: Our study showed that majority (80%) of patients lose CRE carriage if they stayed away from the hospital for at least 2 years. Introduction: Emerging Highly Resistant Bacteria (eHRB) constitute a The duration of CRE colonisation is uncertain and is likely to vary major public health problem in Tunisia and in the world. Rates of infec- between individuals. However, a prospective study with repeated CRE tions by eHRB are significantly higher in intensive care units (ICUs), jus- testing at regular interval will be required to determine exact time of tifying the implementation of a screening system for their control. CRE clearance before specific guidance can be given as to when one Objectives: We aimed to describe outcomes of eHBR screening in should consider a patient cleared of CRE carriage. ICUs of Sahloul university hospital of Sousse (Tunisia) and to deter- Disclosure of Interest: None declared. mine risk factors of infection by Vancomycin resistant enterococcus (VRE) or Carbapenemase producing Enterobacteriaceae (CPE). P054 Methods: We conducted a longitudinal observational study during Cases of bacteremia caused by carbapenem‑resistant E. coli six-month between 1 June and 1 December 2018. Rectal and nasal 1,2,* 1 1 2 2 O. Orlova , A. Shelenkov, Y. Mikhaylova, V. Gusarov , N. Iumtsunova , L. swab cultures were collected to detect VRE and CPE among patients 2 1 Petrova, V. Akimkin admitted in six ICUs of Sahloul university hospital of Sousse (Tunisia) «Central Research Institute of Epidemiology» of The Federal Service and more than three times, at least one week apart. on Customers’ Rights Protection and Human Well‑being Surveillance, Results: During the study period 174 patients were screened. Of Pirogov National Medical and Surgical Center, Russian Federation, Mos‑ them, 69.5% were male and 73.6% were admitted in surgical ICU. In cow, Russian Federation total, 161 and 152 samples were realized respectively for the detection Correspondence: O. Orlova of CPE and VRE. These samples were positive in 15% and 8.5% respec- Antimicrobial Resistance & Infection Control 10(1): P054 tively for CPE and VRE. Klebsiella pneumoniae OXA 48 was the most isolated CPE (80%). Introduction: Genomic analysis of microbial isolates makes it possible Independent risk factors for VRE infection were surgery (aOR = 2.6, to carry out epidemiological decoding of single cases and outbreaks CI = [1.9–8.2]), organ failure (aOR = 2.3 CI = [1.5–6.5]), and expo- 95% 95% of infectious diseases. sure to antibiotics during the month before screening (aOR = 4.2, Objectives: To identify an epidemiological link between patients with CI = [2.3–7.9]), and for CPE, exposure to antibiotics during the 95% carbapenem-resistant E. coli. month before screening (aOR = 3.9, CI = [2.7–10.6]). 95% Methods: During the month of 2020, cases of bacteremia caused by E. Conclusion: The screening system is a complementary axis to the sur- coli were registered in the Department of Hematology in 10 patients. veillance of infections with eHRB. Our high rates testify the need for To determine the identity of the isolates of microorganisms, bacterio- a sensitive, specific and cost-effective screening programm that may logical, molecular biological (PCR-RT and MLST ) methods were used. help in infection control by early identification of patients. Results: All patients after the TSC were in isolated wards. There were Disclosure of Interest: None declared. no signs of CAIC in the patients. E. coli sensitive to carbapenems was detected in 8 patients on admission in a rectal smear. E. coli resistant P053 to carbapenems was detected in 6 patients with bacteremia. With CRE carriage: is it for life or can it be cleared? the development of bacteremia in the same patients, E. coli resistant 1,* 1 1 M. L. Ling , M. How , M. O. Aung to carbapenems was detected in rectal smears. In two patients with Infection Prevention & Epidemiology, Singapore General Hospital, the development of bacteremia caused by E. coli sensitive to carbap- Singapore, Singapore enems, the genes of carbapenemases NDM and CPC were found in Correspondence: M. L. Ling rectal smears. When conducting a microbiological study of objects in Antimicrobial Resistance & Infection Control 10(1): P053 the hospital environment and samples of biomaterial (pharynx, nose, hands, rectal smear), E. coli and antibiotic resistance genes were not Introduction: Singapore General Hospital has attempted multiple found in the staff of the Department of Hematology. When conduct - interventions to prevent CRE transmission in inpatient setting. These ing a comparative analysis of the complete genomes of Escherichia coli include active surveillance of high-risk patients, isolation and cohort- isolates isolated from the blood of 6 patients at all common loci (5045 ing, hand hygiene and enhanced environment hygiene programs. loci in total), it was found that one of the isolates was slightly differ - However, the number of CRE carriers continued to rise with time ent from the others (about 100 substitutions), while in all other pairs because lack of policy to allow untagging the carrier status for return- there were no more than 10. These differences may be caused by dif- ing inpatients to the hospital. ferences in the plasmid sequences. In this analysis, no plasmids were Objectives: The purpose of this study is to determine appropriate isolated, but the results already obtained still allow us to attribute all period of establishing clearance of CRE in known CRE patients. the isolates to one strain. Methods: Patients with known history of CRE and discharged more Conclusion: According to the results of the study, the group coloniza- st rd than 3-months ago were recruited into the study, where 1and 3 rec- tion of patients with the strain of E. coli, due to the translocation of the nd tal swabs were taken on day 1 and day 7 respectively and 2 rectal intestinal flora, was established. swab was taken between day 2 to day 6. CRE was detected using the Disclosure of Interest: None declared. st nd PCR method from the 1 and 2 samples whilst culture method was rd used for the 3 sample. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 43 of 140 P055 growths were measured at 4, 20, 25, and 37 °C and pH 4, 6, 7 and 8. The importance of monitoring increasing trend of colistin TSB broth cultures set to pH 4, 6, 7, and 8 were incubated over night resistance in clinical isolates of Acinetobacter baumannii at 4, 20, 25, and 37 °C. After incubation, transmission readings were 1,* 1 1 1 1 A. Dedeic‑Ljubovic , J. Halk ovic , Ð. Granov , Ð. Gačanović , E. Husić , obtained using the Spectrophotometer. Transmission is inversely pro- E.‑J. Đulić portional to bacterial growth. Used the ANOVA with a P < 0.05. Clinical Center of the University of Sarajevo, Sarajevo, Bosnia and Herze‑ Results: The bacteria had resistance to Penicillin (P10), Ampicillin govina (AMP10), Tetracycline (TE30), Erythromycin (E15), and Streptomy- Correspondence: A. Dedeic‑Ljubovic cin (S10). Only Chloramphenicol (30 mg) could inhibit the growth of Antimicrobial Resistance & Infection Control 10(1): P055 BCC and B. cenocepacia with 22.6 mm and 22.3 mm zone of inhibition, respectively. Bacteria were resistant to Roccal, 409, Listerine, Lysol, and Introduction: Acinetobacter baumannii attracts a lot of attention, Bleach. At 4 °C, BCC and B. cenocepacia had 100% transmission in pH both with its frequency and extremely developed resistance to anti- 4 and pH 6. At 4 °C, transmission of BCC in pH 7 and 8 was 100 and microbial agents. Once out of use due to numerous side effects, poly - 99.4% and B. cenocepacia was 99.8 and 98.3%, respectively. At 20 °C myxins such as colistin acts synergistically with other antibiotics and transmission of B. cepacia in pH 4, 6, 7, 8 was 100, 91.9, 88.6, 93.9%, serve as the last therapeutic option for life-threatening infections and B cenocepacia was 99.6, 84.8, 88.4, 93.7%, respectively. At 25 °C, caused by this extremely resistant pathogen. transmission of BCC in pH 4, 6, 7, 8, was 99, 79.6, 80.8, and 79.5% and For antimicrobial susceptibility testing of colistin, EUCAST recommend B. cenocepacia was 99.6, 70.1, 77.7, and 84.0%, respectively. At 37 °C, the broth microdilution method (BMD). It is a semiquantitative, in vitro transmission of BCC in pH 4, 6, 7, 8, was 99, 7.3, 59.2, and 48.8% and B. method, based on the action of an antimicrobial agent and a bacterial cenocepacia was 99, 10.1, 17.0, 26.1%, respectively. isolate. Conclusion: Results suggested that BCC and B. cenocepacia have Objectives: To investigate an increasing trend of colistin resistance in slower growth in any pH at 4 °C and in pH 4 at any temperature. Bacte- hospital isolates of Acinetobacter baumannii. rial growth increased with increasing temperature and pH. B. cepacia Methods: This retrospective study was conducted at Clinical micro- and B. cenocepacia have resistance for many antibiotics, except Chlo- biology Unit, Clinical Center of the University of Sarajevo, the largest ramphenicol (30 mg), and all disinfectants used. tertiary level hospital in Bosnia and Herzegovina. Study included 219 Disclosure of Interest: None declared. isolates of Acinetobacter baumannii detected from June 2019 to Octo- ber 2020 by VITEK 2 COMPACT, BioMerieux. MIC values were determined by broth microdilution method, accord- P057 ing the EUCAST recommendations with “MIC-Strip Colistin”, producer fimH and csgA adhesion genes among acinetobacter SPP. Merlin A Bruker Company, Germany. isolates and their relation to biofilm formation and antimicrobial Results: A.baumannii was isolated most commonly from the ICU 76 resistance pattern (36%) and pediatric clinic 24 (10, 96%). The isolates were recovered 1,* 2 2 D. M. Ali , A. Baker , M. eldahshan mostly from upper respiratory tract 69 (31, 51%), wound and drain 1 2 microbiology and immunology, faculty of medicine, microbiology swabs 62 (28, 31%). and immunology, Menoufia university, menofia university, Egypt Minimum inhibitory concentration (MIC) value for colistin ranged Correspondence: D. M. Ali from 0.25-2 µg/ml. The highest number of isolates, 125 (57%) had a Antimicrobial Resistance & Infection Control 10(1): P057 MIC value of 0.5 µg/ml, followed by 1 µg/ml (64/29.22%) and 0.25 µg/ ml (24/10.96%), respectively. MIC to colistin increased to 2 µg/ml in Background: Acinetobacter spp are important opportunistic patho- period April to October 2020 and this value was detected in 6 (2.74%) gens responsible for nosocomial infections. Objectives: detection of of isolates. EsβL and carbapenemase, the ability of biofilm formation and their Conclusion: Our study showed an increasing trend of colistin MIC relation to antimicrobial resistance. Methodology: A total of 230 clini- value for Acinetobacter baumannii isolates in our hospital. The increase cal samples from patients admitted to Menoufia University Hospitals in antimicrobial resistance of this important hospital pathogen has a were obtained. Acinetobacter spp were identified by standard micro - significant impact on infection control. If this trend continues, sim- biological methods and Vitek-2 system. The antibiogram of Acineto- ple infections will no longer be curable. Broth microdilution method bacter isolates was tested by the modified Kirby Bauer disk diffusion (BMD) is a good tool for early detection of emerging resistance. method, detection of extended-spectrum β-lactamases and carbapen- Disclosure of Interest: None declared. emase by EsβL NDP and CANP tests. Biofilm production was detected by modified Congo red agar and PCR. Results Acinetobacter spp. rep - P056 resented (20.8%) of all the collected isolates. Vitek-2 system showed Comparison of antibiotic sensitivity of Burkholderia cepacia that the predominant spp. was Acinetobacter baumannii complex and Bukholderia cenocepacia (80%). Acinetobacter isolates were highly resistant to cefepime and 1,* 1 1 K. A. Munasinghe , O. Ukpu , S. Bakattah tobramycin (90% for each), ceftriaxone (88%), piperacillin, and ampi- Frostburg State University, Frostburg, United States cillin –sulbactam (86% for each), piperacillin- tazobactam (84%) and Correspondence: K. A. Munasinghe tetracycline (78%). About 64% and 68% of the Acinetobacter isolates Antimicrobial Resistance & Infection Control 10(1): P056 were susceptible to tigecycline and colistin respectively. The sen- sitivity of EsβL NDP for detection of EsβL producing Acinetobacter Introduction: Burkholderia cepacia complex (BCC) was tied to various isolates was 93.8%. The Carba NP and carbAcineto NP tests detect FDA drug recalls such as nasal spray, curl styler, wipes, oral electro- carbapenemse production in 6% and 56% of Acinetobacter isolates lyte, and anesthetic hydro jell. Burkholderia cenocepacia is a clinically respectively. Biofilm production was found among 56% isolates by important member of the BCC. These are opportunistic pathogens in MCRA method, while conventional PCR showed fimH and CsgA genes patients with respiratory tract infections. among 60% and 18% isolates respectively. Conclusion: Acinetobacter Objectives: The main research objective is to compare antibiotic and spp are serious nosocomial pathogens as they can produce ESβL and disinfectant sensitivity of B. cepacia and B. cenocepacia using the Kirby carbapenemase, and produce biofilm that is related to their antimi- Bauer Method. crobial resistance. Therefore, their adequate prevention and control is Methods: Four replicates of the Muller Hinton culture plates with imperative. disks embedded with antibiotics and disinfectants were incubated at Disclosure of Interest: D. Ali Employee of: non, Grant/Research 37 °C. After incubation, zones of inhibitions were measured. Bacterial support from: non, Speaker bureau of: non, Shareholder of: non, Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 44 of 140 Consultant for: non, Paid instructor for: non, Conflict with: non, A. Introduction: Clostridioides difficile (CI) is responsible for healthcare associ- Baker: None declared, M. eldahshan: None declared. ated diarrhea with possible severe progression. Recurrence of the disease induces higher health system costs, as well as exposes patients to addi- tional health risks. Poster Session: Clostridium difficile Objectives: The purpose of this study was to determine the inci- dence and risk factors of post-discharge CD infections (CDI) after hip P058 endoprosthesis. Clostridioides difficile infection in patients not exposed Methods: The study was conducted using the national database con- to antibiotics: a 14 years prospective study in a French university taining the data about 55,842 hip and knee arthroplasties, including 192 hospital cases of CDI from 2017. 1,* 1 1 1 N. Khanafer , C. U. Edouard Herriot hospital , L. Oltra , L. Gerster , O. Results: The CDI incidence was 34.4 per 10.000 patients, the median 1 1 Dauwalder, P. Vanhems stay in hospital for CDI cases was 7 days, this result is in the third quartile Hospices Civils de Lyon, Lyon, France of patients without CDI; 48 patients, 25% of all CDIs had a healthcare- Correspondence: N. Khanafer associated infections (HAI) other than CDI. At least one antibiotic in post- Antimicrobial Resistance & Infection Control 10(1): P058 discharge period before the CDI symptoms had prescribed 42 patients, 21.9%, (the most common were beta-lactams (J01C and J01D groups), Introduction: C. difficile infection (CDI) weighs heavily on healthcare macrolides (308 prescriptions) and quinolone (101 prescriptions). In system due to increased incidence, morbidity and mortality, as well as the multifactorial review, the following turned out to be significant: costs. CDI is mainly considered as a health-care associated (HCA) after age > 65 years of age, taking antibiotics: J01C and/or J01D (beta-lactams exposure to broad-spectrum antibiotics (ATB). However, CDI has been and other beta-lactams) and/or J01M (quinolone), HAIs other than CDI, reported in people previously thought to be at low risk. trauma as the cause of surgery, stay in the intensive care unit and length Objectives: The objective of this study was to compare characteristics of stay in hospital over 7 days. of CDI cases regarding the previous exposure to ATB in the last 30 days Conclusion: C. difficile is still one of the most common cause of hospital- before onset of symptoms. acquired infectious. Infection prevention and control, as well as respon- Methods: Between January 2007 and December 2020, a prospective sible prescribing of antibiotics is an important factor in reducing the surveillance study of CDI was conducted in a 900-bed French university incidence of CDI in post-surgery period. hospital. European definitions of CDI case, relapses and origin of acquisi- Disclosure of Interest: None declared. tion were applied. Results: A total of 1060 (1182 episodes) patients were included with a Poster session: control and epidemiologiy of extended spectrum mean incidence rate of 2.3 per 1000 hospital-stays. Episodes were HCA beta‑lactamases (ESBL) (76.7%), community-acquired (CA) (17.7%) or undetermined origin (5.6%). The mean of age was 66.3 years and 51% were women Com- parison between the two groups (G) of episodes according to previous P060 exposure to ATB (G#1: 851 (72%) exposed, G#2: 331 (28%) unexposed) Six‑year retrospective review of the prevalence showed that the age and sex distribution was similar between the 2 of extended‑spectrum Β‑lactamase‑producing Escherichia coli groups. Prior to CDI, exposure to proton pump inhibitors (PPIs), antivi- in patients with identified or suspected infection in a tertiary rals, immunosuppressants and colonic preparations were significantly teaching hospital in China 1,* 2 2 3 4 5 more frequent in G#1. Patients in G#1 had a significantly longer mean B. Gao, W. LV, W. Sun, W. Su , C. Ma , Q. F u length of stay than those in G#2 (33 vs 25 days; P = 0.007). CA-CDI was Infectious diseases unit, Tianjin 4th Centre Hospital; Graduate Faculty, significantly more frequent in G#2 (57.6% vs 42.4% for G#1, P < 0.0001). Tianjin Medical University, Postgraduate Institute, Tianjin Medical 3 4 The complication, relapse and death rates were similar between the 2 University, Clinical Laboratory Unit, Nosocomial Infection Management groups. CDI in low-risk patients (age < 50 years, no recent exposure to Department, Intensive Care Unit, Tianjin 4th Centre Hospital, Tianjin, ATB and PPIs) was observed in 4% of patients (mostly CA, P < 0.0001). China Conclusion: Our results show that CDI can affect populations previ- Correspondence: B. Gao ously thought to be at low risk. These findings suggest that other, no Antimicrobial Resistance & Infection Control 10(1): P060 yet known, factors may play a role in the acquisition of CDI. Therefore, it is important for physicians to be aware of the changing epidemiol- Introduction: Escherichia coli is a major pathogen of hospital- and ogy of CDI in order to remain alert to the possibility of CDI in diarrhoea community-acquired infections and causes a tremendous burden patients, even in the absence of the common/expected risk factors. on the healthcare system. Investigating the epidemiology of E. coli is Disclosure of Interest: None declared. essential, but rarely performed to manage antimicrobial resistance at the hospital level in China. Objectives: To manage E. coli infections in a local healthcare P059 setting. Incidence and risk factors of post‑discharge clostridioides difficile Methods: Demographic, epidemiologic and microbiologic data were infections after hip and knee arthroplasty, a population‑based retrieved from electronic health records in a tertiary teaching hospi- study of 55,842 patients in Poland 1 2,* 3 4 1 tal in China between 2015 and 2020 to investigate the incidence and E. Jachowicz , M. Gajda , M. Brudło , A. Pac , A. Różańska , B. 5 1 resistance profile of E. coli. Antibiotic susceptibility testing was per - Gryglewska , J. Wójkowska‑Mach 1 2 formed according to the Clinical Laboratory Standards Institute. Department of Microbiology, Doctoral School of Medical Sciences Results: Among 2630 E. coli isolates included after exclusion of stool and Health Sciences, Jagiellonian University Medical College, Krakow, specimens, extended-spectrum β-lactamase-producing E. coli (ESBL-PE) Poland, Department of Epidemiology, Chair of Epidemiology and Pre‑ was identified in 1287 (48.9%) isolates, and carbapenem-resistant E. coli ventive Medicine, 4 Department of Internal Medicine and Gerontology, in 17 (1.0%). Of 413 E. coli isolated from blood, ESBL-PE accounted for Jagiellonian University Medical College, Krakow, Poland 48.7% and 0.154/1000 patient-days. The 3 hospital units with the highest Correspondence: M. Gajda incidence were the medical/surgical intensive care unit and surgical (gas- Antimicrobial Resistance & Infection Control 10(1): P059 trointestinal, hepatobiliary, urological) and medical units (0.611, 0.304 Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 45 of 140 and 0.171/1000 patient-days, respectively), which reached statistical sig- nificance when compared with obstetrics/gynecology and other surgical units (0.030 and 0.007/1000 patient-days, P = 0.00). ESBL-PE incidence was higher in hospital-acquired than in community acquired isolates (P = 0.26). Conclusion: A comprehensive visualization of routinely-collected laboratory data allows professionals to conduct antimicrobial stew- ardship interventions and effectively monitor and respond in a timely manner to antimicrobial resistance at the hospital level. Disclosure of Interest: None declared. P061 Regional variability in the interpretation of contact precautions for extended‑spectrum beta‑lactamase‑producing enterobacterales (ESBL‑E): a cross‑sectional survey 1,* 1 1 2 3 A. van Veen , M. van Dijk , I. de Goeij , M. Damen , E. Huijskens , S. 4 5 6 1 1 Paltansing , M. van Rijn , R. Bentvelsen, M. Vos , J. Severin on behalf of Infection Prevention & Antimicrobial Resistance Care Network South‑Western Netherlands Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Department of Medical Microbiology, Maasstad General Hospital, Rotterdam, Department of Medical Micro‑ biology, Albert Schweitzer Hospital, Dordrecht, Department of Medical Microbiology and Infection Prevention, Franciscus Gasthuis & Vlietland, Department of Medical Microbiology and Infectious Diseases, Ikazia Hospital, Rotterdam, Department of Infection Prevention, Zorgsaam Hospital, Terneuzen, Netherlands Correspondence: A. van Veen Antimicrobial Resistance & Infection Control 10(1): P061 Introduction: Guidelines recommend the use of contact precautions(CP) when caring for patients colonized or infected with ESBL-E. Objectives: The aim was to determine regional variability in the appli- cation of contact isolation(CI) measures for patients with ESBL-E and to compare these with the ESCMID guideline. Methods: This study was performed in 8 hospitals in the South-west- ern region of the Netherlands. A cross-sectional survey was developed, and filled out by a researcher during interviews with infection preven- Conclusion: This study showed regional variability in applying CI tion practitioner(s) (November 2020-April 2021). CI measures were measures for patients with ESBL-E, which can be used to regionally compared to those stated in the ESCMID guideline. harmonize ESBL-E measures. In the future, the variability in meas- Results: Seven hospitals(87.5%) applied CI measures for patients with ures can be used to study effects of different elements in a bundle of ESBL-E. All 7 hospitals agreed in their policy on the personal protec- measures. tive equipment(PPE) used by healthcare workers(HCWs) upon room Disclosure of Interest: None declared. entrance with anticipated patient contact, providing physiotherapy in corridors/stairwells, requiring CP for visitors and in not changing window curtains after CI(Table 1). Regional variability was observed in the room P062 type used for CI, PPE use during physiotherapy outside patient rooms, Characterization of gram‑negative bacteria on ambulance allowing visitors temporary room leave, and cleaning and disinfection stretchers: a descriptive correlational study products(Table 1). The ESCMID guideline recommends always using PPE 1,* 1 1 2 3 B. C. Santana , A. Pereira , P. Oliveira , H. Souza‑Junior, E. Watanabe , P. upon room entrance. All 7 hospitals followed the ESCMID guideline for 1 Hermann HCWs PPE use upon room entrance with anticipated patient contact, how- 1 2 University of Brasilia, Ceilândia Sul, Federal Institute of Goias, Aguas ever 5 out of 7 hospitals(71.4%) did not require HCWs to use PPE without 3 Lindas, University of Sao Paulo, Ribeirao Preto, Brazil anticipated patient contact. Furthermore, the ESCMID guideline recom- Correspondence: B. C. Santana mends isolating patients in single-patient rooms, while 5 out of 7 hospi- Antimicrobial Resistance & Infection Control 10(1): P062 tals(71.4%) also allow CI in multiple-occupancy rooms. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 46 of 140 Introduction: Health care-associated infections are a serious prob- BALB/c mice were randomly divided into four groups, negative con- lem. The investigation about the role of the ambulance microbiota in trol group (aquades), Levofloxacin 100 mg/kg, intraperitoneal injec - healthcare risk is narrow. tion, the first treatment group (Miana leaf extract/MLE 510 mg/kg) Objectives: The objective was to characterize gram-negative bacte- and the second treatment group. (Miana + levofloxacin) for ten con- ria resistant to carbapenem isolated from advanced life support land secutive days MLE was administered via gastric gavage. Blood was ambulance stretchers. taken from the first day, the eighth day of the experiment (2 h after Methods: Descriptive correlational study, quantitative, carried out in treatment), and the day 10. To determine the expression of NRAMP1 the Federal District, Brazil, on 6 ambulance stretchers from a public mRNA, blood samples were examined by Quantitative Real-Time service and 6 from a private service. Performed for three consecutive PCR (qRT-PCR). The growth of Klebsiella pneumonia bacteria in lung unannounced days, at the beginning and end of the day shift. The tissue was seen using Plate count agar. microbiological samples were collected, using Rayon-tipped swabs, Results: After administration of Miana extract for 10 days of treat- moistened in Stuart medium. The bacteria were cultured in Luria Ber- ment, the expression of NRAMP1 mRNA in BALB/c mice increased tani broth (LB) under selection pressure with Vancomycin to exclude significantly (p < 0.0001). The highest level of mRNA expression was gram-positive and subsequent selection of carbapenem-resistant found in the treatment group (Miana + levofloxacin) with an increase gram-negative by pressure with meropenem in LB broth, accord- before treatment from 8.28 to 13.18 after treatment p < 0.0001. ing to EUCAST/BrCAST protocol. For the isolation of colonies and the Conclusion: In BALB/c mice, NRAMP1 mRNA expression had the high- presumptive identification of bacterial species, ESBL chromogenic est increase after administration of Miana and Levofloxacin extracts agar was used, and the final identification of the isolates was done by compared to Miana or Levofloxacin alone and was clinically proven MALDI-TOF. Antimicrobial susceptibility testing was performed using to have a comparable effect in suppressing the growth of Klebsiella polisensidisk according to EUCAST/BrCAST. And, by way of PCR, the pneumoniae. presence of the bla , bla , bla , bla , bla , ESBL CTX-M of Disclosure of Interest: None declared. KPC NDM IMP VIM OXA48 groups 1, 2, and 8 genes and of the transposon Tn4401 was searched. Fisher’s exact test was used. Statistical significance was defined as Poster Session: Methicillin‑resistant Staphylococcus aureus p < 0.05. The study was approved by the Research Ethics Committee. Results: 25 meropenem-resistant gram-negative bacteria were identi- P065 fied, mainly (36%) S. maltophlia. Two isolates of A. baumanni stand out, Are nursing homes a risk factor of transmission resistant to 5 antibiotics, from 3 different classes. Six bacteria has car - of methicillin‑resistant staphylococcus aureus? ried, unusually, bla of group 8, in S. maltophlia and A. baumanni. CTX-M 1,* F. F. Battistella ( Battistella) Two bla genotypes in K. pneumoniae, associated with the transpo- KPC 1 Unité cantonale Hygiène, contrôle et prévention de l’infection, Laus‑ son Tn4401 were found. anne, Switzerland Conclusion: The stretchers of ambulances of advanced life support, Correspondence: F. F. Battistella in this study, were contaminated by meropenem-resistant gram-neg- Antimicrobial Resistance & Infection Control 10(1): P065 ative bacteria, most of them S. maltophilia. bla from group 8 and CTX-M bla were the only genes identified, with bla associated with the KPC KPC Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) in transposon Tn4401. Nursing Home (NHs) is directly associated to numerous comorbidities Disclosure of Interest: None declared. of the residents and to the frequent use of antibiotics. Close contact between residents and non-compliance with Standard Precautions (SP) among healthcare workers might play a crucial role in the spread P064 of multidrug-resistant bacteria. Suppressing klebsiella pneumoniae growth and increasing A study carried out by the Cantonal Unit Hygiene, Prevention and Con- natural resistance associated macrophage protein 1 MRNA trol of Infection (UHPCi) in 2010–2011 showed that adherence with SP expression after administration of levofloxacin and Miana is sufficient to contain the spread of MRSA in NHs and hence new rec - (coleus scutellarioides (L) benth) leaf extract treatment in BALB/c ommendations were issued. Additionally, a surveillance of MRSA was experimental research initiated in acute care settings on resident admission to hospital. 1,* 2 3 4 5 T. D. D. Wahyuni , M. Hatta , A. Bukhari , A. Santoso , M. N. M assi In 2019, we observed an increase in the number of new MRSA coloni- Internal Medicine, Faculty Medicine Universitas Pelita Harapan, Jakarta, zation diagnosis of residents on admission to acute care settings. 2 3 4 Molecular Biology and Immunology, Nutrition, Pulmonology and Res‑ Objectives: The objective was to collect and analyze prospectively all piration, Microbiology, Faculty Medicine Universitas Hasanuddin, Makas‑ news cases of MRSA coming from NHs. sar, Indonesia Methods: On admission of the resident to hospital, a systematic MRSA Correspondence: T. D. D. Wahyuni screening (nose, throat, inguinal and clinical samples) was performed. Antimicrobial Resistance & Infection Control 10(1): P064 In microbiology laboratory, positive MRSA result generated an auto- matic alert which was sent to the UHPCi. The PCI nurse collected data Introduction: The growth of pathogenic bacteria in macrophages is on risk factors (NH of the resident, age, sex, known infections, previous inhibited by Miana (Coleus Scutellariodes [L] Benth). hospitalizations, comorbidities). Objectives: This study aims to determine after giving Miana extract Results: A total of 35 residents were screened as newly colonized to BALB/c mice induced by Klebsiella pneumoniae how the expres- by MRSA for the time period of 2019 – 2021. We collected 23, 7 and sion of mRNA Natural Resistance Associated Macrophage Protein 1 5 cases in 2019, 2020 and early 2021, respectively. Among them, 6% (NRAMP1). (2/35) were found to be infected with MRSA on their admission. Methods: This experimental research is a post test only control The documented risk factors were 1 dialysis, 5 urinary catheters, 5 group design on an animal model. Twenty healthy adult male chronic wounds and 14 with more than two hospitalizations within Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 47 of 140 one year. Residents came from different NHs: 11 NHs recorded one Introduction: Antimicrobial resistance is a global crisis that requires resident, 5 NHs 2 residents and 3 NHS 3, 4 and 6 residents, respectively. urgent attention and action. We report data on meticillin-resistant Conclusion: The limited number of newly diagnosed resident does Staphylococcus aureus and hand hygiene compliance rate in Benin not confirm if living in a NH is a significant risk factor for MRSA acqui- over five years period. sition. Therefore, continuous surveillance of MRSA on admission in Objectives: Assess meticillin-resistant Staphylococcus aureus propor- acute settings for all resident coming from NH is needed in order to tion towards hand hygiene compliance in Benin’s healthcare settings monitor a potential increase of this pathogen. from 2014 to 2018. Disclosure of Interest: None declared. Methods: This was a retrospective study implemented in Benin hospi- tals between 2014 and 2018. We collected data on meticillin-resistant Staphylococcus aureus proportion and hand hygiene compliance rate. P066 Beta regression was used to conduct statistical analysis. A p-value of Comparative analysis of methicillin‑resistant staphylococcus 5% was considered statistically significant. aureus isolates of clinical and food origin 1,* 1 1 1 2 Results: Hand hygiene compliance rate was 13%,15%,26%,17.5% Y. Mikhaylova , A. Shelenkov , A. Egorova , A. Chernyshkov , L. Petrova , 2 1 and 20% in 2014, 2015, 2016, 2017 and 2018 respectively, p = 0.001. M. Zamyatin, V. Akimkin 1 2 Meticillin-resistant Staphylococcus aureus proportion was 68%, Central Research Inctitute of Epidemiology, Pirogov National Medical 64%, 54% 50% and 48% in 2014, 2015, 2016, 2017 and 2018 respec- and Surgical Center, Moscow, Russian Federation tively, p = 0.0001. From 2014 to 2018, hand hygiene compliance rate Correspondence: Y. Mikhaylova increased while meticillin-resistant Staphylococcus aureus proportion Antimicrobial Resistance & Infection Control 10(1): P066 decreased. Discussion: Hand hygiene compliance increased from a baseline 13% Introduction: S. aureus is commensal and pathogenic bacteria which to 20%, p = 0.001. Between pre- and postintervention hand hygiene can survive in diverse environments and grow in many types of foods. adherence improved by 29% (p < 0.001) but did not change over the Several surveys have documented the presence of MRSA in foods, but 5-year assessment (38.3%; p = 0.47) [1]. When hand hygiene compli- its status as a food-borne pathogen is still unclear. ance increases meticillin-resistant Staphylococcus aureus proportion Objectives: The aim of this work is to perform whole genome decreases. Hand hygiene was associated with a decrease in healthcare sequencing (WGS)-based genomic epidemiology analysis of MRSA iso- associated meticillin-resistant Staphylococcus aureus infections in a lates of clinical and food origin. large health care system [2]. Methods: WGS was performed on Illumina HiSeq platform for 4 MRSA Conclusion: From 2014 to 2018 hand hygiene compliance increased isolates collected from Moscow medical center and 6 MRSA samples significantly. This suggests the implementation of hand hygiene pro - isolated from ready-to-eat food. The susceptibility was determined by gram in order to control spread of Meticillin-resistant Staphylococcus the boundary concentration method on VITEK2Compact30 analyzer. aureus. Genome assemblies and genome comparisons were performed using Keywords: Hand Hygiene – Meticillin-resistant Staphylococcus aureus SPAdes, roary, dnadiff and custom software. – Five years – Benin. Results: The S. aureus isolates studied were characterized by similar profile of antimicrobial susceptibility. They belonged to ST22 and 4 References Spa-variants regardless of their origin. All MRSA isolates analyzed had 1. T. Sakihama et al., 2020. Assessing sustainability of hand hygiene adherence SCCmec IV type. Another common determinant of antibiotic resist- 5 years after a contest‑based intervention in 3 Japanese hospitals. Ameri‑ ance was penicillin-resistance gene blaZ. All MRSA isolates of food can Journal of Infection Control. origin carried additional gene of resistance to lincosamide, and two 2. R. Jain et al., 2011. Veterans Affairs Initiative to Prevent Methicillin Resistant of them also included resistance genes to phenicols and macrolides. Staphylococcus aureus Infections. The new england journal medecine. The set of virulence factors in S. aureus isolates studied was similar and quite extensive (up to 15 genes), and consisted of both structural Disclosure of Interest: None declared. components of the cell and secreted products including enterotoxins. Pairwise comparisons of core-genome composition and the number of single nucleotide polymorphisms of the isolates having different P068 origin revealed very close relationship between one food and one Results of an infection and microbiological surveillance clinical isolate. of panton‑valentine leucocidin (PVL)‑forming S. aureus strains 1,* 1 1 1 Conclusion: WGS-based analysis enabled us to reveal unique genome M. M. Neuwirth , A. F. Wendel , M. Malecki , F. Mattner features of MRSA isolates of clinical and food origin. The data obtained Division of Hygiene and Environmental Medicine, Witten/Herdecke will allow us to identify new target molecules for differentiation of University, Cologne, Germany MRSA isolates belonging to different genetic variants. We also provide Correspondence: M. M. Neuwirth microbiological criteria for MRSA in ready to eat foods, in particular, as Antimicrobial Resistance & Infection Control 10(1): P068 an important option for controlling the dissemination of antimicrobial resistance and potential Staphylococcus enterotoxins’ production. Introduction: The toxin PVL can be produced by both methicillin- Disclosure of Interest: None declared. resistant (MRSA) and methicillin-susceptible (MSSA) Staphylococcus aureus strains. Due to the lysing effect of PVL on leukocytes, severe infections can be caused by the producing bacteria. A microbiological and infection surveillance of PVL-producing S. aureus was performed P067 in three Cologne hospitals between 2014 and 2020 and triggered by Impact of hand hygiene compliance on meticillin‑resistant the detection of S. aureus in combination with recurrent skin infec- staphylococcus aureus proportion in healthcare setting over five tions, severe pneumonia or possible outbreaks. years period: a retrospective study in Benin Objectives: Aim of the study was to investigate if several strains are 1,* 1 2 P. F. D. Fonton , A. T. Ahoyo , B. Boya endemic in the population and if there is an epidemic situation with 1 2 Ecole Polytechnique d’Abomey‑calavi, Laboratoire de Biologie et de one strain or a mixture of several strains. The study aimed to investi- Typage Moléculaire en Microbiologie, University of Abomey‑calavi, gate if multiple strains are endemic in the population and if there is Cotonou, Benin an epidemic situation with one strain or a mixture of multiple strains. Correspondence: P. F. D. Fonton Methods: In case of skin infection or pneumonia and detection of Antimicrobial Resistance & Infection Control 10(1): P067 community-acquired S. aureus, bacterial isolates were tested by PCR for the production of PVL by amplifying the encoding gene lukS and included in the surveillance if positive. 46 from 55 bacterial isolates Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 48 of 140 were available for further next generation sequencing. Assembled P070 genomes were analysed (core genome MLST by SeqSphere + , Ridom; Reluctance for implementing surgical skin preparation ResFinder analysis). guidelines: infection control practitioners’ opinion 1,* 1 1 1 1 Results: A total of 55 patients (30♂;25♀) aged 0–81 years D. VerjatT ‑ rannoy , C. Daniel , J. Sambourg , K. Lebascle , P. Astagneau (M = 15.4 ± 16.9; MD = 10), with an S. aureus strain with lukS gene CPIAS ILE‑DE‑FRANCE, PARIS, France were recorded (34 patients with PVL-MSSA; 21 with PVL-MRSA). In Correspondence: D. VerjatT ‑ rannoy 10 patients, rehospitalization was necessary due to recurrent infec- Antimicrobial Resistance & Infection Control 10(1): P070 tions caused by PVL-positive S. aureus strains. After positive lukS gene detection, decolonization was performed in 9 individuals, no decolo- Introduction: In the context of a new national surgical site infection nization was performed in 39, and no information was available for (SSI) control program, a study was implemented to evaluate what 7 individuals. Infections occurred most frequently on the buttocks infection control practitioners (ICP) think about pre-operative skin (N = 10) and thighs (N = 8). A high clonal diversity was detected com- preparation (PSP) recommendations, updated in 2013 and 2016. prising 16 cgMLST types of PVL-positv S. aureus. 5 small clusters were Objectives: The aim of the study was to quantify the integration identified, however transmissions were confirmed in only one cluster of the infection control (IC) measures in the local protocols and the (tempo-spatial overlap). potential obstacles for their implementation by surgical teams. Conclusion: Epidemiologically, an endemic situation with PVL-positv Methods: In 2020, a national on-line questionnaire was addressed to S. aureus and few transmissions were identified in this study. Active all ICP working in a healthcare facility (HCF) with surgical activity. Data surveillance is nevertheless necessary to identify a cluster of PVL-pos- included the ICP opinion on 8 measures of PSP (cf. table). A descriptive itive cases and possibly an outbreak and to guide therapy and infec- statistical analysis of closed responses (Y/N) was completed by a ver- tion control measures. bal analysis over the ICP comments. Disclosure of Interest: None declared. Results: A total of 485 HCF participated to the study (public: 47%/pri- vate: 53%; representative of the distribution of HCF with surgery). Two first obstacles were identified:1-the unfavorable opinion of ICP about Poster Session: Surgical site infections the guidelines 2-the impossible agreement between ICP and surgical teams or in between surgical teams. P069 Experimental study of the pharmacological activity Table: Proportion of the protocols integrating the PSP and potential associated obstacles of the combined use of decamethoxin and bupivacaine at local Type of IC IC Measures for PSPMeasures Main obstacle measures integrated in the identified for non- injection into the wound HCF protocol integration of the 1,* 2 1 Y. Babina , O. Nazarchuk , D. Dmytriiev (% of HCF) PSP measures (% of 1 2 HCF) Department of anesthesiology and intensive care, microbiology, Measures Use of an alcoholic antiseptic 94% None National Pirogov Memorial Medical University, Vinnytsia, Ukraine modified to product improve No systematic hair removal85% Force of habits Correspondence: Y. Babina infection (55%) Antimicrobial Resistance & Infection Control 10(1): P069 control No systematic use of 35%Force of habits (nc) (priority) impregnated adhesive drapes Minimum Non-antiseptic soap at shower 62%Lack of Introduction: High risk of infections in surgery is associated with measures to time medicalization of guaranty care (33%) microbial contamination by conditionally pathogenic microorganisms infection Single shower 54% Concern about of Staphylococcus aureus. control increase of SSI without (41%) Objectives: Investigation of the efficacy of combined administration spending too Shampooing limited to head 48%Preference for of antiseptic and local anesthetic in the area of postoperative infec- much money and neck surgery harmonized or time measure (36%) tious wounds. Skin cleaning limited to visible 35% Concern about Methods: Fifty-one male rats weighing 250–300 g were randomly soiling increase of SSI (32%) divided into four groups. Surgical procedures were performed under −1 Non-antiseptic soap for skin 23%Force of habits general anesthesia (intraperitoneal injection of ketamine 75 mg/kg ). cleaning (36%) The hair on the back of the animal was shaved after loss of corneal reflex and reaction to the retraction of the limbs. The wounds were infected with an additional culture of clinical strain S. aureus 47 (dose Conclusion: Our results showed a good integration of priority meas- 108 CFU/ml). The incision was cleaned and two minutes later wiped ures in healthcare protocols, except for impregnated adhesive drapes. dry. The incision sites were infiltrated subcutaneously with doses of As obstacles to implementation varied according to PSP measures, 3 ml of the study drug: normal saline in the control group (group A, training and communication efforts should focus first on key measures n = 13), antiseptic decamethoxine (gr.B, n = 13), 0.5% bupivacaine y where ICP and surgical teams are the most reluctant. (gr.C, n = 13) and combinations thereof in a ratio of 1:1 (gr.D, n = 12). Disclosure of Interest: None declared. The effectiveness of antiseptic treatment in the wound area was evalu- ated using von Frey filaments. Statistical processing was performed using standard biometric methods. Differences at p < 0.05 were con- P071 sidered significant. The effect of statin medication on surgical site infections or other Results: On the third day of the experiment the number of S. aureus complications needing revisions after orthopedic surgery 1,* 1 1 1 on the surface of the wounds was found to decrease significantly when I. Uçkay , I. Unterfrauner , M. Olthof , P. Jans decamethoxin and its combination with bupivacaine 0.5% were used. The Balgrist University Hospital, Zürich, Switzerland use of bupivacaine 0,5% was accompanied by the moderate microbial Correspondence: I. Uçkay invasion in the wound area on the 3rd day. The use of the antiseptic and Antimicrobial Resistance & Infection Control 10(1): P071 its combination with bupivacaine on the 10th day revealed almost com- plete eradication of S. aureus on the wound surface, in compared the con- Introduction: Statins have anti-inflammatory properties. In several trol group (p < 0,01). In the combination antiseptic with bupivacaine the surgical discipülines, statin mediation seems to be preventive of vari- pain sensitivity threshold increased by 48.6%, which was practically the ous postoperative complications. same as in bupivacaine monotherapy (48.9%). Objectives: The intension was to investigate if a long-term periop- Conclusion: The combination of antiseptic with bupivacaine 0.5% in erative statin medication, primarily given for cardiovascular disorders, the treatment of wounds is accompanied by an equally high antimi- might affect rates of surgical site infections (SSI), or other late non- crobial efficacy with a marked anesthetic effect, which opens the pros- infectious complications after orthopedic surgeries. pect of their combined topical application in the treatment of wounds. Methods: A single-center cohort of 20,088 patients (median age Disclosure of Interest: None declared. 53 years, 49% females, 5% diabetes) who underwent orthopedic Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 49 of 140 surgery during 2014–2019 was investigated to document statin use Introduction: Surgeons harvest the iliac crest for bone grafting. The (n = 2,486, 12%, 222 different brands and doses) and peri- and postop - epidemiology of surgical site infections (SSI) associated with this pro- erative complications including SSI. Cox regression analyses, with and cedure at the donor, or recipient site, is unknown. without propensity-score matching (nearest neighbor approach) was Objectives: We perform a retrospective pilot evaluation of adult used to find potential associations. patients undergoing first-time orthopedic surgery at the Balgrist Uni- Results: After a median follow-up of 7 months, 1,414 patients (7%) of the versity Hospital between 2014–2019. 20,088 patients needed a surgical revision: 158 (0.8%) due to deep SSI Methods: Single-center retrospective cohort study 2014–2019. We and 1,256 (6.3%) for non-infectious reasons. In multivariate Cox regres- excluded patients with infection at the index surgery, diabetic foot sion analyses, statin use was unrelated to both SSI (hazard ratio (HR) 0.9; surgeries, superficial SSIs, and revision surgeries. 95% confidence interval (CI) 0.6–1.4) and non-infectious complications Results: We included 20,088 episodes of primary orthopedic surgery, (HR 1.1, 95%CI 0.9–1.3). Further, statin use did not increase the risk for of which 467 with iliac crest bone sampling (467/20,088; 2%). Only SSI in the subgroup of implant-related surgery (HR 0.8, 95%CI 0.4–1.6) or two iliac sites (2/467; 0.4%) become infected. In contrast, surgeries arthroplasties (HR 0.8, 95%CI 0.3–2.6). Propensity-score matched analy- with iliac crest sampling yielded more SSIs at the recipient site than ses on the variable “statin” equally failed to alter these outcomes. those without (1.9% vs. 0.8%; χ -test; p < 0.01). These patients equally Conclusion: In our large cohort study with over 20,000 orthopedic revealed more co-morbidities such as a longer duration of surgery interventions, we found no protective effect of a statin medication on (median 127 vs. 79 min), when compared to the general orthopedic deep SSI risks; or on other late non-infectious complications requiring population. In multivariate logistic regression analysis with the out- revision surgery. come “SSI at the recipient site”, the iliac harvesting was independently Disclosure of Interest: None declared. associated with deep SSIs requiring surgical revision (odds ratio 2.1; 95% confidence interval 1.1–4.2). Conclusion: In our pilot evaluation with 20,088 primary orthopedic P072 surgeries, the SSI risk of the iliac harvest site was low. In contrast, sur- Deep surgical site infections following double‑dose perioperative geries with supplementary iliac crest harvesting revealed a higher SSI antibiotic prophylaxis in adult obese orthopedic patients—a risk than the general orthopedic population, potentially due to a mix before‑after clinical cohort study of local independent risks of grafting together with a prolonged sur- 1,* 1 1 1 1 I. Uçkay , A. Hasler , I. Unterfrauner , M. Olthof , P. Jans gery time. Balgrist University Hospital, Zürich, Switzerland Disclosure of Interest: None declared. Correspondence: I. Uçkay Antimicrobial Resistance & Infection Control 10(1): P072 P074 Meningitis after neurosurgical procedures: results of a 10‑year Introduction: Obesity is a risk for surgical site infections (SSI). Based surveillance in a Russian neurosurgical ICU on retrospective comparisons and pharmacology, many centers 1,* 2 2 2 2 2 K. Ershova , O. Ersho va , I. Savin , G. Danilov , M. Shifrin , I. Alexandrova , adopted a weight- (or a body mass index (BMI))-related antibiotic N. Kurdumova prophylaxis to prevent SSIs. 1 2 University of Washington, Seattle, United States, Burdenko National Objectives: This before-and-after study examined whether doubling Medical Research Center for Neurosurgery, Moscow, Russian Federation of the antibiotic prophylaxis can prevent surgical site infections. Correspondence: K. Ershova Methods: We introduced a hospital-wide double-dose prophylaxis Antimicrobial Resistance & Infection Control 10(1): P074 on 3/2017 for patients > 80 kg. In our all-orthopedic cohort, we com- pared the period 4/2014–3/2017 ("before") to 3/2017–6/2019 ("after") Introduction: Healthcare-associated meningitis after neurosurgi- regarding the clinical impact of this dose-doubling on the SSIs. cal procedures is associated with poor patient outcomes, increased Results: We compared 9,318 surgeries "before" to 7,455 interven- healthcare costs, and is difficult to diagnose due to subtle CSF tions "after". In both periods, baseline demographics (age, sex, body changes and variable clinical presentation. mass index (BMI), American Society of Anesthesiologists (ASA)-Score, Objectives: The goal of this study was to examine the incidence revision surgeries, and duration of surgery) were similar. In the period and outcomes of meningitis based on infection surveillance data "after", 3,069 episodes (3,069/16,773; 18%), received a double-dose from a neurosurgical ICU. prophylaxis. Overall, we witnessed 82 deep SSIs (0.5%). The pathogens Methods: The study was conducted in the neurosurgical ICU at Bur- were resistant to the standard cefuroxime prophylaxis during the index denko Center for Neurosurgery in Moscow from 2011 to 2020. The surgery in 35 cases (35/82; 43%). By excluding these prophylaxis-resist- data was collected prospectively as a part of infection surveillance ant cases and all of the five hematogenous SSIs, we remained with 47 protocol; all patients with an ICU length of stay > 48 h were included. SSIs (57%) that could have been prevented by prophylaxis. The double- Diagnostic criteria for meningitis included status post neurosurgical dosing of parenteral cefuroxime from 1.5 g to 3.0 g in obese patients procedure, CSF glucose < 50% of blood glucose, increased CSF cell did not reduce deep SSIs (hazard ratio (HR) 0.7, 95% confidence count, positive CSF cultures, and clinical symptoms. The meningitis interval (CI) 0.3–1.6. In the direct group comparison among obese prevention protocol was introduced in 2011 and included periop- patients > 80 kg, the administered double-dose prophylaxis equally erative antibacterial prophylaxis, cross infection control, improved failed to alter outcome (3,088/16,726 non-infections vs. 8/47 deep SSI hand hygiene (average 10-year compliance 85%), and oxygen-con- despite double-dose prophylaxis; Pearson-chi -test; p = 0.78). taining antiseptics; closed EVD systems were introduced in 2016. Conclusion: In our single-center before-and-after-study with almost Results: A total of 4021 patients were included and 359 were diag- 17,000 orthopedic surgeries in adult patients, the systemic doubling nosed with meningitis resulting in an incidence of 8.9% (95% CI: of the perioperative antibiotic prophylaxis in obese patients clinically 8.45–9.38). The incidence of meningitis decreased from 15.6% failed to reduce the overall deep SSI risks. to 6.5% during the study period (Figure 1). The mortality rate in Disclosure of Interest: None declared. patients with meningitis was 23.4% (95% CI: 22.2–243.6) that did not change over time. The etiological spectrum was dominated by CoN Staphilococcus (30%) followed by Acinetobacter baumannii (23%) P073 and Klebsiella pneumoniae (23%). The mortality rate was higher Surgical site infections at donor and recipient sites in patients in patients infected with Acinetobacter baumannii. The data from with iliac crest harvesting for autologous bone grafting—a pilot other neurosurgical ICUs in Russia is neither available for compari- evaluation 1,* son nor routinely reported to Russia’s health surveillance agency. I. Uçkay Balgrist University Hospital, Zürich, Switzerland Correspondence: I. Uçkay Antimicrobial Resistance & Infection Control 10(1): P073 Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 50 of 140 Conclusion: Unlike previous years when SSIs occurred in patients at low risk of infection, this year we were able to highlight the usual risk factors. However, efforts must be continued with regard to the trace - ability of the duration of the intervention and of the antibiotic prophy- laxis for better use of the data and risk analysis. Disclosure of Interest: None declared. P076 Surveillance of surgical site infections in five surgical departments 2019 1,* 1 1 1 1 G. Brahimi , A. Chetitah , N. Cheboub , A. El Kechai , A. Boudebouz , S. 1 1 1 1 1 Slaouti , K. Chabane , M. Charchari , A. Dahli , S. Ait seddik , A. Larinouna 1 1 1 , A. Rebouh , R. Belkaid CHU BENI MESSOUS, ÉPIDÉMIOLOGIE, ALGER, Algeria Correspondence: G. Brahimi Antimicrobial Resistance & Infection Control 10(1): P076 Introduction: The incidence rate of surgical site infections (SSI) has significantly decreased in our establishment since the establishment of the active surveillance network in 2006. Objectives: ‑ Calculate the incidence rate of SSIs. Conclusion: We reported the incidence and mortality rates of health- - Identify the risk factors related to the occurrence of SSI. care-associated meningitis after neurosurgical procedures in a neu- Methods: Longitudinal descriptive study for analytical purposes. rosurgical ICU in Russia. Unique for data gathered from Russia, these Data collection was carried out between February 1st and May 30th, results are supported with samples based on a 10-year data collection 2019 with follow-up until day 30 in five departments: General Surgery, project, providing high reliability of findings. Obstetrics Gynecology, Ophthalmology, ENT and Childhood Surgery. Disclosure of Interest: None declared. The SSI diagnosis was made according to the criteria of the Atlanta CDC. Data entry and analysis were done using the Epi-info6 software. Results: A total of 797 interventions were included. 94.10% (750/797) patients were seen again in consultation on day 30. The average P075 length of hospitalization is 5.3 ± 6.5. 62.90% (502/797) had an ASA Surveillance of surgical site infections in surgical departments score of 1. The NNIS index could not be calculated for pediatric sur- 1,* 1 1 1 1 gery and ophthalmology due to lack of traceability of the duration G. Brahimi , S. Ait seddik , A. LARINOUNA , A. Rebouh , N. Cheboub , 1 1 1 1 1 of the operation. 26% of the interventions were carried out urgently. H. Khellaf , A. Chetitah , A. Boudebouz, W. Djouimaa , A. El kechai , R. The incidence rate of SSI is 5.70% (43/750), it was significantly higher Belkaid in gynecology-obstetrics 13.04% (21/161) and in general surgery CHU BENI MESSOUS, ÉPIDÉMIOLOGIE, ALGER, Algeria 12.50% (16/128), no case has been registered in ophthalmology. There Correspondence: G. Brahimi are four risk factors, in addition to age which is an endogenous fac- Antimicrobial Resistance & Infection Control 10(1): P075 tor (40.4 + -15.9 years versus 33.8 ± 18.2 p < 0.04), it is the average total length of stay (p < 0.01), ASA score ≥ 2, (p < 0.001), Altemeier class ≥ 2 Introduction: Surveillance of surgical site infections (SSI) is a priority (p < 0.001) and NNIS score ≥ 1 (p < 0.001). in our hospital. The SSI incidence rate has significantly decreased since Conclusion: SSI monitoring has highlighted risk factors that must be the establishment of the active surveillance network in 2006 in certain taken into account in order to improve treatment. We will first aim to surgical departments, particularly in ophthalmology. reduce the average length of stay, especially in patients with multiple Objectives: Main objective: Measure the incidence rate of stratified diseases. SSIs on the level of risk. Specific objectives: Determine the character - Disclosure of Interest: None declared. istics of ISOs—Identify the risk factors linked to the occurrence of SSIs. Methods: This is a descriptive longitudinal study for analytical pur- poses. Data collection was carried out between February 05th and P077 April 10th, 2017 with follow-up until day 30, including all therapeutic The impact of a COVID‑19 total lockdown on deep surgical interventions in five departments of our CHU: General Surgery, Obstet - site infections and other non‑infectious complications rics Gynecology, Ophthalmology, ENT and Childhood Surgery. The SSI after orthopedic surgery diagnosis was made according to the criteria of the Atlanta CDC. Data 1,* 2 2 2 I. Uçkay , I. Unterfrauner , L. Hruby , P. Jans entry and analysis were carried out using the Epi-info 6 software. Dr, Balgrist University Hospital, Zürich, Switzerland Results: A total of 828 patients were included and 778 patients were Correspondence: I. Uçkay seen again on day 30, a postoperative follow-up rate of 93.96%. The Antimicrobial Resistance & Infection Control 10(1): P077 average age of operated patients is 53.8 years ± 31.3. The average length of hospitalization is 5.3 days ± 7.0. The proportion of patients Introduction: The Covid-19 pandemic entailed a lockdown with with ASA 1 score was 66.42% (550/828). The NNIS index could not total restriction of elective orthopedic surgeries. While the access to be calculated in the infantile surgery department due to the lack of the hospital and human contacts were limited, hygiene rules were traceability of the duration of the intervention, the evaluation of the intensified. antibiotic prophylaxis could not be carried out for lack of traceability Objectives: We investigate the impact of those strict hygiene meas- in almost all of the patient records. Of the 778 patients followed on ures on the risk of deep surgical site infections (SSI), wound healing day 30, 39 developed a SSI, an incidence rate of 5.01%. The highest disorders and other complications after orthopedic surgery, before, rate was observed in the General surgery department with 16.80% during, and after the first Covid-19 lockdown. followed by the Obstetric Gynecology department 6.56% and the low- Methods: In a single-center study, patients during the first Covid-19 est rate of 0.47% in ophthalmology (p < 0.001). The incidence rate of lockdown from March 21, 2020 to April 26, 2020 were compared to a SSI is 8.01% for the ASA score ≥ 2 versus 3.48% for the ASA score < 2 cohort that underwent orthopedic intervention in the pre- and post- (p < 0.01), as well as for the Altemeier class ≥ 2 (10.74% versus 1.46%, lockdown phase, respectively from October 1, 2019 to October 31, p < 0.001). Stratified on the NNIS index, the incidence rate is 7.62% for 2020. Adjusted multivariate analyses were used to investigate the NNIS ≥ 1 versus 5.04% for NNIS < 1 (DNS) interventions. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 51 of 140 occurrence of surgical site infections, wound healing disorders and P079 other complications in three study periods. Assessment of evaluation methodologies of infection preventive Results: We included 5,791 patients in this study. After a mean follow- efficacy of ventilation systems in operating rooms 1,* up of 7 months, the lockdown cohort showed a significant higher SSI C. Bulitta rate compared to the pre- and post-lockdown period (2% versus 1% Ostbayerische Technische Hochschule (OTH), Weiden, Germany and 0.5%). The revision rate due to other complications was higher Correspondence: C. Bulitta in the pre-lockdown cohort compared to the others (5% versus 3%), Antimicrobial Resistance & Infection Control 10(1): P079 whereas there was no difference for wound healing disorders between all cohorts. In multivariate Cox regression analyses, the lockdown Introduction: Microbiological contamination of air in operating room phase was unrelated to all SSI (hazard ratio (HR) 1.6; 95% confidence (OR) is a known risk factor for surgical site infections. Evaluation meth- interval (CI) 0.6–4.8), wound healing disorders (HR 0.7; 95% CI 0.1–5.7) odology of ventilation systems regarding infection preventive efficacy and other complications (HR 0.7, 95%CI 0.3–1.5). and cost benefit ratio is still a topic of discussion. To date there are no Conclusion: The incidences for deep SSI, wound disorders and other uniform standardized specifications and validation criteria established. complications in orthopedic surgery were not influenced by the pro - Objectives: We aimed to assess evaluation methodologies of infec- motion of hygiene measures during lockdown. tion preventive efficacy of OR ventilation systems. Disclosure of Interest: None declared. Methods: We have systematically reviewed and compared different international standards and the current literature regarding validation of ventilation systems and their infection preventive efficacy. We have P078 analyzed various normative procedures, compared them regarding Transferability of an infection prevention concept reliable assessment of efficacy and efficiency and conducted experi- for the reduction of nosocomial infections especially surgical site ments in our research OR and at selected clinical sites. infections Results: Key for infection prevention is the reduction of airborne path- 1,* 1 1 1 M. M. Neuwirth , S. Maczewski , R. Otchwemah , F. Mattner ogens. The OR must be viewed holistically from a workflow perspective Institute for Hygiene, Cologne Merheim Medical Centre, University as a complex thermodynamic system with several mutually influenc - Hospital Witten/Herdecke Cologne, Cologne, Germany ing factors, i.e. room size, convection currents of staff and equipment, Correspondence: M. M. Neuwirth flow obstacles and ventilation systems design. Our analysis has shown Antimicrobial Resistance & Infection Control 10(1): P078 that protected areas of TAV systems are usually too small. The required size of a protected area can only be determined case by case, unless Introduction: The “HygArzt” project investigated the effectiveness, the operating room as a whole is viewed as protected area like in the efficiency of infection prevention measures (IPM) implemented by concept of temperature controlled airflow (TcAF). Comparative meas- an infection prevention link physician (PLP) in the trauma surgery/ urements of active and passive air sampling show that only active sam- orthopaedics department. In the first phase of the project, the IPM pling during live surgery allows reliable assessment of microbiological implemented in a pilot hospital led to increases in adherence for all air burden. indications of hand hygiene and dressing change as well as to a reduc- Conclusion: Not only technical execution should be in focus of tion in the rate of nosocomial infections (NI), especially postoperative standards and normative specifications. The “what is to be achieved” wound infections (SSI). should be more important than the “how it is achieved”. This ena- Objectives: In a second phase, based on the process analyses and the bles optimized risk management. It might be useful to follow rather results of the pilot hospital, a modular training program for PLP was the requirements of EN ISO 14644 and GMP guidelines than country- developed and it was investigated whether the concept could be specific non-uniform standards for ventilation technology in ORs. As transferred to other study hospitals. part of the qualification of OR ventilation systems, PQ (Performance Methods: In the intervention phase, the PLP was trained in IPM Qualification), the examination of the performance under real condi- according to the "train-the-trainer approach" (patient decolonization tions, plays a central role. The lack of such a “live” qualification as an before surgery, standardized wound care, etc.), which he/she subse- "acceptance criterion" could explain the controversial study situation quently implemented in his/her department. In the post-phase, HHA regarding the infection preventive efficacy of OR ventilation systems. rates as well as NI and SSI rates were collected again. Disclosure of Interest: C. Bulitta Consultant for: Avidicare AB. Results: To examine the impact of implemented IPM on infection rates (NI, SSI), pre- and post-data were compared. In the pre-phase (237 surgeries), NI rate (N = 12) was 5.1% (CI 95% 2.4; 7.8) and SSI rate Poster session: long‑term care facilities (N = 5) was 2.1% (CI 95% 0.3; 3.9). In the post-phase (177 surgeries), a NI rate (N = 7) of 4.1% (CI 95% 1.3; 7.0) was found and no SSI. P080 The introduction of the dressing change concept significantly Antibiotic consumption in long‑term care facilities in Poland increased HHA of all indications (pre = 72.2%; post = 95.6%, and other European countries in the healthcare‑associated p < 0.001). The strongest increase in HHA occurred in the indication infections in long‑term care facilities HALT‑3study "hand disinfection between unclean and clean phase" (pre = 49.3%; 1 2 2 3,* 2 M. Brudło , E. Jachowicz , A. Różańska , M. Gajda , J. Wójkowska‑Mach post = 86.5%, p < 0.001). HHA also increased for the other indications 1 2 Jagiellonian University Medical College, Krakow, Poland, Department "before preparation for dressing change" (pre = 77.0%; post = 98.3%, 3 of Microbiology, Doctoral School of Medical Sciences and Health Sci‑ p < ,001); "directly before dressing change" (pre = 78.9%; post = 98.3%, ences, Jagiellonian University Medical College, Krakow, Poland p < 0.001,); "after dressing change" (pre = 83.5%; post = 100%, Correspondence: M. Gajda p < 0.001). Antimicrobial Resistance & Infection Control 10(1): P080 Conclusion: By implementing the IPM, infection rates were also slightly reduced and HHA significantly increased for all indications of Introduction: In developed countries, the population of elderly peo- dressing change in the study hospital. This suggests that the devel- ple is steadily increasing, which is associated with increased needs for oped bundle of IPM can be transferred to other trauma surgery permanent institutional care in long-term care facilities (LTCF), there departments through tailored training. Continuous process analysis about 20% of infections is due to multi-drug resistant microorganisms. could identify individual weaknesses in patient care and adapt inter- Objectives: The aim of this research was to assess how the situation vention concepts. concerning healthcare associated infections (HAIs) and antimicrobial Disclosure of Interest: None declared. consumption (AMC) in Polish LTCFs relates to that in other European countries. Methods: The most recent HAIs in long-term care facilities Point prev- alence survey (HALT PPS) was carried out in European countries (EU/ Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 52 of 140 EEA) in 2016–2017, and in Poland it was carried out in April-June 2017 in 24 LTCFs. Results: The most common HAIs was UTI (32% of all), but in Poland skin infection (30.4% of all). In total 5,035 of the 102,301 eligible resi- dents received at least one antimicrobial agent, with prevalence 4.9%, in Poland, 3.2%. The most frequently used antibacterial were beta-lac- tams, especially ‘amoxicillin and enzyme inhibitor’, in total 13.7%, but in Poland in 26%. The statistically significant relationships were found: positive – between the ratios of the elderly persons and physicians and the ratio of physicians and AMC in LTCF, negative – for the availa- bility to nurses’ care and the ratio of the elderly persons in the general population; and the share of the elderly population and AMC in LTCF. Conclusion: The presented data indicate major problems regarding antimicrobial consumption in LTCF. The lower AMC in Poland than in the overall was found but this is mainly due to the relatively young population in Poland. Disclosure of Interest: None declared. Conclusion: The increasing number of NHs with mobile IPCT is due to the ongoing extension project to the whole region. Mobile IPC teams had a measurable impact in NHs over the years in the region, espe- P081 cially in the areas of IPC human resources, IPCT-led training, alcohol Impact of mobile infection prevention and control (IPC) teams handrub use, and HCW influenza vaccination rate. Implementation of for nursing homes 1,* 2 2 3 3 4 such teams should be encouraged all over the country. K. Trouilloud , M. Giard , A. Machut , F. Duplatre , O. Baud , P. Fascia , N. 2 2 Disclosure of Interest: None declared. Khouider , A. Savey Equipe Mobile d’Hygiène EHPAD (EMHE), Hospices Civils de Lyon, Saint Genis Laval, CPias Auvergne‑Rhône‑Alpes, Regional Coordinating Centre P082 for Infection Prevention and Control, Hospices Civils de Lyon, Lyon, CPias Implementation of simulation training in nursing homes Auvergne‑Rhône‑Alpes, Regional Coordinating Centre for Infection during COVID‑19 pandemics 1,* 1 1 Prevention and Control, Centre Hospitalier Universitaire de Clermont‑Fer ‑ L. Qalla‑Widmer , D. Héquet , C. Petignat 4 1 rand, Clermont‑Ferrand, Service d’Hygiène, Epidémiologie, Infectiovigi‑ Unité cantonale HPCI Vaud, CHUV, Lausanne, Switzerland lance et Prévention, Hospices Civils de Lyon, Lyon, France Correspondence: L. Qalla‑Widmer Correspondence: K. Trouilloud Antimicrobial Resistance & Infection Control 10(1): P082 Antimicrobial Resistance & Infection Control 10(1): P081 Introduction: From March 2020, the nursing homes (NH) staff has Introduction: Building on the experience of a mobile infection pre- been on the front line of the battlefield linked to the CoVID-19 pan- vention and control team (IPCT) established by Valence hospital since demics. The healthcare workers (HCW) are at the heart of the institu- 2007, the Regional Health Agency (ARS) in Auvergne-Rhône-Alpes tional system as they provide care for residents and fight to prevent began financing mobile IPCT for medicalized nursing homes (NHs) in the spread of the virus within the institution. CoVID-19 highlighted the 2013–2014 in the Eastern part, and extended the project to the whole lack of knowledge regarding infection control measures in NH. In this region in 2018–2019. context, the Cantonal Unit for Infection Control and Prevention devel- Objectives: To describe the measured impact of 22 to 27 mobile IPCT oped a simulation-training program to remain these gaps urgently. in the ARA region from 2017 to 2019, using benchmarking indicators. Objectives: The goal was to strengthen the capacity of NH staff to Methods: NHs with mobile IPCT or without IPCT available reported provide safe and effective care, while protecting the residents and annually on main indicator categories that evolved since 2015. They themselves from the spread of infection. include IPC human resources and organisation, IPC team-led trainings, Methods: The infection control nurses defined learning objectives, alcohol handrub consumption (ICSHA), influenza vaccination rates, identified the infection control academic content, developed a teach- pneumococcal vaccination policy, and environmental surveillance ing strategy fitted to any learning styles and selected interactive (mainly for prevention of Legionella risk). Data from hospital-affiliated teaching resources. After drafting scenarios of simples and complex NHs (monitored by hospital IPCT) were excluded. Indicators of NHs care situations of targeting learning objectives, they defined the ideal with mobile IPCT were compared with those without IPCT. environment and the equipment. Finally, a training was organized and Results: Before exclusion of hospital-affiliated NHs, 59.9% of simulations scenarios were recorded on video. requested NHs sent their report about 2019 vs 78.7% about 2017. Results: Each session consisted of a simulation conducted by an infec- A total of 615, 610 and 472 NHs were included in the study in 2017, tion control nurse with a selected scenario. A session averaged 12 par- 2018, and 2019 respectively (Table 1). ticipants including nurse, assistant nurse and medico-technical staff. Overall, means and results indicators were better in NHs with mobile Participants were placed in work situations through role-playing. IPCT compared to NHs without (Table 2). Human resources allocated Before each simulation session, participants were reminded of the were higher (med referent 56.8% vs 18.5%; paramed referent 77% vs mode of transmission of microorganisms, standard precautions and 48.5%; unit correspondent 78.7% vs 36.5%). More NHs had IPC training additional precautions. Debriefing was conducted after each session. organised (94.2% vs 61.7%). ICSHA indicator was significantly higher Pertinent identified issues included the misuse of disposable gown, (35.8% vs 10.9%). Influenza vaccination rates for residents were similar (droplet precautions), the failure to comply with the standards of hand in both groups (86.3% vs 85.8%), but significantly higher for healthcare hygiene and gloves wearing. The lessons learnt from each session workers (HCW ) in NHs with IPCT (32.1% vs 22%). were quickly disseminated to other NH staff. From June 2020 to March 2021, 67/160 (42%) NH participated in this simulation-training program. 109 sessions of simulation were con- ducted over 10 months. Over 1,800 HCW were trained. Conclusion: Through simulation scenarios, essential elements of infection control can be emphasized. NH staff can be exposed to criti- cal care scenarios and have the opportunity to respond without fear or risk for the resident. Disclosure of Interest: None declared. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 53 of 140 Poster Session: Occupational exposure Antimicrobial Resistance & Infection Control 10(1): P084 Introduction: Occupational exposures to communicable diseases P083 that are transmitted through droplet or airborne may place healthcare Quality improvement initiative in prevention of occupational workers (HCW) at risk. Post-exposure interventions such as immuniza- exposure to needle‑ stick/sharp injuries and blood or body fluid tion, prophylactic antibiotics and work restrictions may be indicated. exposures in a tertiary care centre in north India 1,* 1 1 1 1 Objectives: We assessed the unprotected exposures of HCW to com- A. Prasad, V. Singh , S. Sinha , P. Kumar Gupta , P. Gupta municable diseases before and during the COVID-19 pandemic at the All India Institute of Medical Sciences Rishikesh, Rishikesh, India American University of Beirut Medical Center (AUBMC). Correspondence: A. Prasad Methods: Policies and procedures for standard and isolation pre- Antimicrobial Resistance & Infection Control 10(1): P083 cautions as well as post-exposure management are well defined at AUBMC. Unprotected exposures to suspected or confirmed communi- Introduction: Healthcare workers are exposed to several occupational cable diseases that are transmitted through droplet or airborne routes health and safety hazards,especially to blood-borne disease transmis- are immediately reported to the Infection Prevention and Control Pro- sion via sharp injuries or blood/body fluid exposures. gram (ICPP). Investigation of the exposures is conducted through staff Objectives: To analyse effect of a continuous quality improvement interviews, direct observations and review of the surveillance cameras initiative program used for preventing needle stick injuries and blood/ in the Emergency Department (ED) and the critical care units. List of body fluid exposure.To find root cause and take adequate corrective the staff identified with unprotected exposures is then forwarded to and preventive action. the Employee Health Unit (EHU) for post-exposure management. Methods: The study was conducted at a tertiary care centre in North Results: Between 2017 and May 2021, unprotected exposures to India and all consecutive needlestick/sharp injuries and blood or communicable diseases such as varicella-zoster virus, pulmonary body fluid exposures that occurred from January 2020 to April 2021 tuberculosis, pertussis, mumps, measles, Strep group A infections were included in the study.Based on the analysis of incidence rates and meningitis caused by Neisseria meningitidis were managed. The of NSI during first 6 months of study period from January 2020 to highest number of unprotected exposures was identified in 2019 June 2020(Phase I),a Quality Improvement Initiative plan was for- with 400 HCW exposed to 23 communicable diseases. A dramatic mulated using PDSA model.Thorough Root Cause Analysis (RCA) of decrease in exposures was noted in 2020 and 2021 with 13 and 0 staff, each case was done using 5 why’s method during second phase of respectively. study from July,2020 to December 2020.In phase 3,due to COVID- 19 pandemic,trainings were given to HCWs via virtual sessions to improve practices of HCWs. Results: The incidence rate decreased from 0.44 incidences per 1000 patient days to 0.11 in December 2020(end of phase 2).Phase 3,rates increased to 0.33 due to new recruitment of untrained students.After training interventions,rate decreased to 0.22.Maximum incidents reported in Nursing officers(46.2%),sanitation workers(22.6%) and doctors (21.5%).No significant difference among males (53.8%) and females (46.2%). 65.6% of the source was non-reactive.Maximum reac- tive cases were of Hepatitis C.Those expoed to HIV reactive source (3.2%) were started on ART.Only 2/12 exposed to HBV required HBIG. Conclusion: Immediate identification of patients with potential com- municable diseases as well as application of standard and transmis- sion-based precautions are essential in halting the transmission of infections among patients and HCW. The mandatory masking policy for patients, visitors and HCW during the COVID-19 pandemic as the well as ongoing educational and training activities including increased awareness about Hand Hygiene practices and environmental decon- tamination played a vital role in decreasing the occupational expo- sures at our center. Disclosure of Interest: None declared. P085 A journey in reducing percutaneous injuries 1,* 1 1 2 3 Conclusion: Integrated approach to perform RCA and induction and M. L. B. G arcia , C. Simbulan , F. Mohamed , E. El Magboul , E. Al Omari , reinforcement trainings,audits can help in reducing sharp injuries. F. Ali Disclosure of Interest: None declared. Quality and Patient Safety, Hamad Medical Corporation—Heart Hospital, 2 3 Laboratory Department, Hamad Medical Corporation, Nursing, Hamad Medical Corporation—Heart Hospital, Doha, Qatar Correspondence: M. L. B. Garcia P084 Antimicrobial Resistance & Infection Control 10(1): P085 Decrease in occupational exposures to communicable diseases other than COVID‑19 in a tertiary care center in Lebanon Introduction: The potential risk of exposure to blood and body flu- 1 1 1 1 2,* J. Tannous , N. Zahreddine , A. Ibrahim , R. Ahmadieh , S. Kanj ids particularly needle stick injuries is high particularly among nursing 1 2 Infection Control and Prevention Program, Infectious disease, AMERI‑ staff during routine nursing care activities and the use of safety engi- CAN UNIVERSITY OF BEIRUT MEDICAL CENTER, Beirut, Lebanon neered devices (SEDs) can reduce the risk of percutaneous exposures. Correspondence: S. Kanj Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 54 of 140 In 2018, percutaneous (needles and sharps) injuries in 2018 increased to determine the attitudes and perception of risks of occupational to fifty percent (18 cases) compared to 2017 (9 cases). acquired hepatitis C viral infection as well as precautions among den- Objectives: To reduce percutaneous injuries to 50% by the end of tal surgeons.Chi-square and Fisher’s exact tests for categorical vari- December 2019 and beyond using safety engineered devices and staff ables and student t-test for continuous variables were performed. education and training. Results: In all, a total of 145 surgeons responded (72.5%). Of respond- Methods: We conducted root cause analysis of all exposures and we ents, 101 (70%) had sustained sharps injuries. Only (29%) always developed action plan based on the identified problems. We imple - reported such injuries, although (84%) expressed concerns of occu- mented a multidimensional approach to change the system focused on pationally acquired hepatitis C viral transmission.Most Dentists (58%) the physical structures and supplies such as installation of wall-mounted were either extremely or very concerned about the possibility of con- sharp boxes, distribution of available stock items of safety engineered tracting HCV infection. Dental surgeons were mostly unaware of the devices and procurement of safety insulin needles. We conducted edu- true prevalence of hepatitis C in high-risk groups. cation and training to all nursing unit preceptors and newly hired nurses Conclusion: The results of this study revealed that post-exposure about the available safety devices through simulation and with follow- management was completely inadequate especially the reporting of up of change of practices in the units. Real time reporting of occurrences, occupational exposures. However, post-exposure management proto- counseling of exposed staff for proper management of exposure and cols exist in all dental clinics, but the implementation of the protocol feedback to units about preventive measures. Dissemination of blood appears to be suboptimal. Needle stick injuries are also of increasing and body fluid exposure alert and awareness campaigns were organized concern to the dentists.Greater awareness of all aspects of hepatitis C to increase staff awareness to prevent future occurrences. infection and its risks to the practice of dentistry is required. Results: After implementation of preventive measures, a significant 56% Disclosure of Interest: None declared. reduction of exposed staff from 2018 baseline (18 cases) to 2019 (8 cases) and 38% reduction in 2020 (5 cases). A 64% reduction in needle stick Poster session: influenza + vaccination injuries in 2019 (4 cases), compared to 11 cases in 2018 and 50% reduc- tion in 2020 (2 cases). In sharp injuries, 43% reduction in 2019 (4 cases) compared to 2018 baseline (7 cases) and 25% reduction in 2020 (3 cases). P087 Influence of wearing a mask during the COVID‑19 pandemic on the influenza vaccination rate among healthcare workers in nursing homes in the canton of Vaud, Switzerland 1,* 1 B. Van Der Kaa , D. Hequet UHPCi, Canton of Vaud, Switzerland Correspondence: B. Van Der Kaa Antimicrobial Resistance & Infection Control 10(1): P087 Introduction: Vaccination of healthcare workers (HCW) against influ- enza reduces morbidity and mortality among residents of nursing homes (NH). Therefore, HCW in NH are encouraged to be vaccinated against influenza. In the canton of Vaud (Switzerland), the vaccine is provided by Public Health to HCW who can be vaccinated free of charge at their workplace. Following a constant decrease in vaccination cover- age among HCW over several years, wearing a mask became mandatory in 2015/16 for HCW who were not vaccinated, as soon as the epidemic threshold was crossed and throughout the epidemic period. Objectives: We wish to assess the impact of the obligation to wear a mask Conclusion: After implementation of preventive measures, a signifi- for the unvaccinated after 2015/16 as well as the influence of the CoVID- cant 56% reduction of exposed staff from 2018 baseline (18 cases) to 19 pandemic with the wearing of a mask required for all professionals on 2019 (8 cases) and 38% reduction in 2020 (5 cases). A 64% reduction the influenza vaccination coverage in NH of the canton of Vaud. in needle stick injuries in 2019 (4 cases), compared to 11 cases in 2018 Methods: On behalf of Public Health, the Cantonal Unit Hygiene, Pre- and 50% reduction in 2020 (2 cases). In sharp injuries, 43% reduction vention and Control of Infection (UHPCi) collects annually the vaccina- in 2019 (4 cases) compared to 2018 baseline (7 cases) and 25% reduc- tion rates of HCW of every NH in the canton of Vaud. The UHPCi writes tion in 2020 (3 cases). a review to the NH reporting their vaccination rate compared to global Disclosure of Interest: None declared. vaccination rates of the NH. We analyzed these rates of the 2008/09 to 2020/21 seasons. Results: The influenza vaccination rate of HCW in NH of the canton P086 of Vaud was 42% at the beginning of the surveillance (2008/09) and Occupational risk of infection with hepatitis C virus: the dentist’s then continuously decreased to 35%. Following the directive requiring perspective the wearing of masks for unvaccinated HCW over the epidemic period, 1,* S. S. Kp this rate gradually increased to 47% in 2019/20. With the obligation to mes dental college and hospital, malappuram, India wear a mask for all staff during the 2020/21 season due to CoVID-19 Correspondence: S. S. Kp pandemic, this rate dropped to 37%. Antimicrobial Resistance & Infection Control 10(1): P086 Conclusion: The obligation to wear a mask for the unvaccinated HCW from 2015/16 has made it possible to increase the influenza vacci- Introduction: Dental professionals may be exposed to bloodborne nation coverage for HCW working in NH. The compulsory wearing viruses (BBV) carried in blood, oral fluids and tissues. Hepatitis C virus of the mask for all in 2020/21 due to the CoVID-19 pandemic had a (HCV) is one of the principal blood borne pathogens of concern to direct impact on the influenza vaccination rates of HCW with a 10% dentists worldwide. Occupationally acquired hepatitis C viral infection drop. The seasonal influenza vaccination rate is directly linked to the is an important issue in dentistry since there are no known vaccines or protective measures imposed on HCW and therefore on the wearing effective prophylaxis. of masks. Primary prevention in the fight against seasonal influenza Objectives: The aim of our questionnaire was to determine Dental should be reviewed with the HCW of NH, as vaccination remains the surgeons’ perceptions and attitudes regarding the risks of hepatitis C gold standard. viral infection as well as the precautions used against infection. Disclosure of Interest: None declared. Methods: A Cross-sectional study was done among 200 dental sur- geons, at Mangalore, India using pretested structured questionnaire Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 55 of 140 P088 Conclusion: It will be important to maintain the increase in team Longitudinal assessment of team safety culture and leadership safety culture and leadership in 2020/21. The differences in the ease regarding influenza and COVID‑19 preventive measures: to discuss either influenza or COVID-19 vaccination in respect to safety the hospital associated influenza prevention study (HAIP)N issues need to be addressed in by prevention initiatives. 1,* 2 3 3 2 D. Nicca , I. Kramer , D. Flury , M. Schlegel , M. Schubert Disclosure of Interest: None declared. Institut of Epidemiology, Biostatistic and Public Health, University of Zürich, Zürich, Institute of Nursing, Zurich University of Applied Sci‑ P089 ences, Winterthur, Infectious disease and hospital hygiene, Kantonsspital Shift in influenza activity during COVID‑19 at a tertiary care St. Gallen, St. Gallen, Switzerland center in Lebanon 1 1 1 1 2 Correspondence: D. Nicca J. Tannous , N. Kara Zahr eddine , A. Ibrahim , R. Ahmadieh , G. Dbaibo , 1,* Antimicrobial Resistance & Infection Control 10(1): P088 S. Kanj 1 2 Infection Control and Prevention Program, Department Pediatrics Introduction: Prevention of hospital associated infections requires and Adolescent Medicine, AMERICAN UNIVERSITY OF BEIRUT MEDICAL continuous monitoring and intervention. Team safety culture and CENTER, Beirut, Lebanon leadership are key dimensions associated with infection prevention. Correspondence: S. Kanj Objectives: The aim of this study was to compare team safety cul- Antimicrobial Resistance & Infection Control 10(1): P089 ture and leadership in health care workers (HCW) regarding influ- enza and COVID-19 preventive measures before and during the Introduction: Lebanon suffers from a seasonal increase in severe COVID-19 pandemic. acute respiratory infections caused by Influenza viruses each year. Methods: A longitudinal descriptive design was used to analyze Patients present with mild to severe symptoms which may require data collected in a tertiary hospital in Switzerland across 2 years hospitalization. The increase in morbidity and mortality is usually (2019/20 and 2020/21) reflecting the situation before and during noted in elderly and in patients with comorbidities. COVID-19. Team safety culture was assessed for hand hygiene, Objectives: We studied the Influenza activity at the American Uni- mask wearing and vaccination (influenza/COVID-19 20/21) with versity of Beirut Medical Center (AUBMC) before and during the adapted items of the safety attitude questionnaire (SAQ, Sexton COVID-19 pandemic. et al., 2006) and adapted items of the Leadership Practices Inven- Methods: In Lebanon, the Influenza season extends from Septem- tory (LPI, Kouzes & Posner, 2003). Data were analyzed descrip- ber to May with a noted peak during winter. Close monitoring of tively with frequencies and percentages, median and interquartile the Influenza activity is performed at our center by the Infection ranges. Control team. Patients with suspected or confirmed Influenza are Results: In 2019/2020 49 HCW participated in the study and 59 in placed in a single room under droplet precautions. Influenza infec- 2020/21. In both years, the majority were nurses, midwives and female tions are confirmed by either Rapid Influenza Diagnostic test or (98%), about two thirds were below 40 years. Overall participants Reverse Transcription Polymerase Chain Reaction (RT-PCR) test. rated team safety culture as high for preventive measures with the During COVID-19 pandemic, public health measures such as lock- exception of influenza vaccination coverage. For all three preventive down, mandatory masking and physical distancing were imple- measures there is an increase from 2019/20 to 2020/21 (table 1a). For mented in the country with discrepancy in compliance between 2020/21 only, results show that it is easier to address team safety cul- geographical regions. ture issues regarding COVID-19 vaccination compared to influenza Results: Since September 2020, all the respiratory specimens that vaccination (figure 1 not attached). Perceived leadership for infection were tested for Influenza at AUBMC came back negative. While prevention by direct supervisor increased across all items during the positive results reached 27% in 2019–2020 season and 20% in COVID-19 pandemic (table2b). 2018–2019 Influenza season. The number of specimens tested dur- ing season 20–21 was 150 compared to 4592 and 4457 samples tested during the last 2 seasons, respectively. Conclusion: The exceptional zero Influenza cases encountered during the 2020–2021 Influenza season at our center in compari- son to the previous 2 seasons is reasonably explained. The dra- matic decrease in Influenza cases, hospitalization, morbidities, and mortalities is the result of the public health measures that were imposed by the authorities to control the spread of COVID- 19 in the country. A similar decline in Influenza cases is similarly observed in the United States where the positivity rate is reported at 0.1% during the same season. Disclosure of Interest: None declared. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 56 of 140 P090 Objectives: To investigate the acceptance of Influenza vaccination Eec ff t of a multimodal strategy for prevention of nosocomial during the COVID-19 pandemic among Tunisian HCWs. th influenza Methods: An online cross-sectional study was led between the 7 1,2,* 1 3 1,3 1,4 th M. Gallouche, H. Terrisse , S. Larrat , P. Morand, V. Bonneterre , J. L. and the 21 of January 2021 among 493 Tunisian health profes- 1,5 1,2 Bosson , C. Landelle sionals. A pre-established and pre-tested questionnaire recorded 1 2 3 Grenoble Alpes University, Infection Control Unit, Virology laboratory, in a free Google form was self-administrated to participants anon- 4 5 Occupational Health Unit, Public Health Department, Grenoble Alpes ymously. The generated online Google Sheet was uploaded and University Hospital, Grenoble, France exported to the Statistical Package for the Social Sciences 10.0 soft- Correspondence: M. Gallouche ware for analysis. Antimicrobial Resistance & Infection Control 10(1): P090 Results: The mean age of participants was 37.4 (± 9.5) years. The males/females ratio was 0.38.The rates of influenza vaccine accept - Introduction: A multimodal strategy to prevent nosocomial influ- ance were: 68% among medical doctors, 65.7% among pharmacists, enza (NI) was implemented in our institution from the 2015–2016 55.8% among paramedical professionals and 50% among dental epidemic season onwards. Three modalities were implemented surgeons. Working in the public sector and having a chronic condi- in all units: promotion of vaccination among healthcare workers tion predicted more acceptance of influenza vaccine with adjusted (HCW), epidemiologic surveillance and communication campaign. odds ratio of 1.9 (95% CI: 1.3–3.9) and 2.1 (95% CI: 1.3–3.5) respec- Units receiving a high number of patients with influenza imple - tively. Having been infected by the SARS-COV2 predicted fewer mented 2 additional modalities: improvement of diagnosis capaci- acceptances with and adjusted odds ratio of 0.3 (95% CI: 0.1–0.7). ties and systematic surgical mask use for HCW and visitors. Conclusion: More attention should be paid to Tunisian paramedical Objectives: Our objective was to assess the effectiveness of the 2 professionals and dental surgeons in order to increase influenza vac - strategies for reducing the risk of NI. cine uptake among them. Involving HCWs in the national information Methods: A retrospective study was conducted over 5 epidemic campaign about COVID-19 and Influenza vaccination would ensure seasons (2014–2015 to 2018–2019) including all adult patients more vaccines acceptance among them. hospitalised with a positive influenza test in our institution. NI was Disclosure of Interest: None declared. defined as a time interval between admission and symptoms onset superior to 72 h. The weekly number of NI cases was analysed by P092 Poisson regression and incidence rate ratios (IRR) were estimated. Influenza vaccination of HCW and risk of nosocomial influenza Seasons when the strategy was applied were compared to the refer- in patients hospitalised in short stay units 1,* 1 2 1 3 1 ence season (2014–2015) and units implementing 3 modalities were S. Amour , T. Bénet , C. Regis , O. Robert , L. Fontana , B. Lina , B. 3 3 1 compared to those implementing 5 modalities. Pozzetto , P. Berthelot, P. Vanhems 1 2 3 Results: A total of 1559 stays were included. The proportion of NI Hospices Civils de Lyon, Université de Lyon, LYON, CHU Saint‑Etienne, ranged from 18.10% to 26.49% between seasons (p = 0.074). There Saint‑Etienne, France was no significant difference for the occurrence of NI between the Correspondence: S. Amour 5 seasons in the units applying only 3 measures. In those imple- Antimicrobial Resistance & Infection Control 10(1): P092 menting 5 measures, there was a rough reduction of 50% in NI occurrence over the 4 epidemic seasons when the strategy was Introduction: Nosocomial influenza (NI) is regularly reported in hospital- applied, compared to the 2014–2015 season. This reduction was sta- ised patients. Exposure to healthcare workers (HCW) or patients poten- tistically significant for 2 seasons (IRR = 0.56, 95%CI = 0.23–1.34 in tially infected with influenza increases this risk. 2015–2016; IRR = 0.39, 95%CI = 0.19–0.81 in 2016–2017; IRR = 0.50, Objectives: The objective of this study was to estimate the effect of 95%CI = 0.24–1.03 in 2017–2018; IRR = 0.48, 95%CI = 0.23–0.97 in influenza vaccine coverage (IVC) of HCW on the risk of NI in hospitalised 2018–2019). patients. Conclusion: The application of the strategy with 5 modalities, Methods: A case–control study was nested in a multicentre prospective including systematic surgical mask use and rapid diagnosis, could cohort study conducted in two university hospitals during two influenza reduce the risk of NI. Further data, including medico-economic stud- seasons (2013–14 and 2014–15). An influenza-like illness (ILI) was defined ies, are still necessary. as fever ≥ 37.8 °C (in the absence of antipyretics) and/or cough or sore Disclosure of Interest: None declared. throat. Each inpatient with ILI included had a nasal swab and a system- atic search of influenza by PCR testing. A NI case was a patient with a P091 virological confirmation of influenza with onset of symptoms ≥ 72 h Acceptance of influenza vaccination during the COVID‑19 after admission to the ward. A control was a patient with an ILI during his pandemic among the Tunisian healthcare workers hospitalisation but with PCR negative for influenza. The IVC rate of HCW 1,* 2 3 1 1 N. Zammit , A. Braham , C. Bennasrallah , E. G. Amani , I. Ayouni , R. in each participating ward was calculated from the data shared by the 1 1 2 2 2 Ghammem , S. Ben Fredj , C. Sridi , A. Chouchane , H. Kalboussi , O. occupational health departments. A logistic regression was performed 2 2 1 1 2 ElMaalel , S. Chatti , J. Maatoug , H. Ghannem , N. Mrizak with adjustments on patient gender, age, the presence of a potential 1 2 Department of Epidemiology (LR19SP03), Department of Occupational source of influenza on the ward in the 5 days prior to the start of the ILI, Medicine and environmental pathology (LR19SP03), Farhat Hached type of ward and influenza season. University Hospital, Faculty of Medicine of Sousse, University of Sousse, Results: A total of 165 patients were included: 24 NI cases and 141 Sousse, Faculty of Medicine of Monastir, Monastir, Tunisia controls. The median age of the patients was 84 years, 94 (57%) were Correspondence: N. Zammit women and 68 (41%) were vaccinated against influenza. The median Antimicrobial Resistance & Infection Control 10(1): P091 IVC rate of HCW on the wards was 18% (1% to 71%) with a mean of 32%. The percentage of a potential hospital source of influenza was 50% in –2 Introduction: Seasonal influenza vaccination of healthcare work - NI cases versus 21% in controls (P < 10 ). The crude Odds Ratio (OR) of ers (HCWs) is recommended in order to protect themselves and NI decreased from 0.52 (95% confidence interval (CI95%) 0.21–1.29) patients. During the COVID-19 pandemic, several studies high- to 0.14 (CI95% 0.03–0.63) when the IVC threshold of HCW on the ward lighted the benefit of Influenza vaccination in reducing COVID-19 increased from 20 to 50% (figure). Similarly, after adjustment, the Adjust- burden especially in developing countries. However, Influenza vac - OR decreased from 0.86 (CI95% 0.28–2.60) to 0.29 (CI95% 0.04–1.98). ed cination coverage among HCWs is unknown in the majority of these countries. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 57 of 140 to protect community against vaccine preventable diseases particu- larly in countries with low implementation of immunization. Disclosure of Interest: None declared. P094 Hindering reasons of children vaccination in one city of Latvia 1,* 1 A. Melbarde‑Kelmere, V. Sesunova Nurse and Midwife faculty, Riga Stradins University, Riga, Latvia Correspondence: A. Melbarde‑Kelmere Antimicrobial Resistance & Infection Control 10(1): P094 Introduction: In order to maintain high results in the field of vaccine- regulated infectious diseases, it is necessary to achieve vaccination coverage of up to 95% or more, but the level of vaccination tends to decrease. There is a set number of children each year who have not been vaccinated at all against any infectious disease or who have been vaccinated in part, as a result of which vaccination has been delayed (vaccination is not carried out at a certain age). Objectives: Find out the reasons that hinder children’s vaccination in one of Latvian city. Conclusion: The prevention and control of NI involves multiple pre- Methods: Quantitative correlation study using questionnaires. Study ventive measures including the vaccination of HCW. Based on these included 351 parents and 30 medical staff from vaccination institu- observational data, vaccination of HCW is a determinant that contrib- tions. Data were collected and coded in Microsoft Excel, IBM SPSS Sta- utes strongly to the NI control. tistics 22. descriptive statistics, for the determination of relationships Disclosure of Interest: None declared. (correlations) Spearman rank correlation coefficient, non-parametric statistical correlation analysis. Results: Parents are not really clear about vaccines and vaccinations P093 due to very contradictory answers (parents do not know the composi- Knowledge, attitude and practices (KAP) of physician about adult tion of combined vaccines against which diseases are vaccinated, also immunization – a study from developing country not clear and not in a timely manner provided information about vac- 1,* I. Khanum cination calendar). 55% of parents consider infectious diseases to be Aga Khan University Hospital, Karachi, Pakistan, Pakistan a serious threat to their child ’s health, but 45% do not. Parents most Correspondence: I. Khanum often refuse flu, varicella vaccine, and tick-borne encephalitis vaccine. Antimicrobial Resistance & Infection Control 10(1): P093 65.8% of parents had not refused vaccination, 32.2% had refused to be vaccinated and 7% of respondents indicated that the child had never Introduction: Health care workers (HCWs) are at risk of acquiring vac- been offered vaccination. cine preventable diseases, Increasing awareness of physicians about 86% of cases vaccination of children is performed in the practice adult immunization, one of the reason for low adult vaccination of family doctors.. 1/3 vaccination facilities not working after 17:00, rate,will provide success in improving adult vaccination coverage. vaccination planned only 2–3 days a week. Information to parents is Objectives: The aim of current study is to establish knowledge and provided during the visit, less often by telephone, even fewer make attitude of physician about adult vaccination. reminder notes in the vaccination passport,a very small number of Methods: A cross sectional survey was performed among physicians information are provided in letters—letters, invitation. via a self-administered questionnaire. Out of 200, 117 complete forms Conclusion: Timely manner provided information, planned vac- filled by physicians were included in the study. cination visits must be organized. Also information regards refused Results: Majority of the participant were female ( 62%).The physicians’ vaccination and individual reminders could contribute vaccination own vaccination status was not satisfactory as 108 physicians (92%) coverage. had received HBV vaccine, 54(46%) influenza vaccine, 41 (35%) MMR Disclosure of Interest: None declared. vaccine and 37( 31%) vaccine against tetanus. Majority ( n 106, 90%) stated that they are not able to get updated information related to P095 adult vaccine recommendations and main source of knowledge about Incidence of vaccine‑preventable childhood diseases (VPCD) adult vaccination were books or guidelines. Nearly half of the study in the European Union (EU) and in the European free trade participants (n 57,49%) had received training about adult immuniza- association (EFTA) countries tion at undergraduate level and even less no of participant ( 37%) had 1 2 3,* 4 4 E. Jachowicz , M. Gębicka , M. Gajda , D. P lakhtyr , M. Shynkarenko , J. received formal education related to adult vaccination during post- 4 5 6 1 Urbanowicz , J. Czepiel , M. Mach , J. Wójkowska‑Mach graduate training period. 1 2 3 Department of Microbiology, Department of Immunology, Doctoral Regarding vaccine efficacy, only 82 (70%) of participants believes School of Medical Sciences and Health Sciences, Jagiellonian University that vaccine have overall protective effect on community health & Medical College, Krakow, Poland, Department of Infectious and Tropical wellness.Physicians believed that high cost of vaccines, lack of vacci- Diseases, Jagiellonian University Medical College, Krakow, SGH Warsaw nation center for adult immunization, lack of structured program or School of Economics, Warsaw, Poland campaign for adult vaccination and lack of awareness regarding adult Correspondence: M. Gajda vaccines among community are important factors for low adult vac- Antimicrobial Resistance & Infection Control 10(1): P095 cination rate in our population. Regarding problems related to prescribing vaccines, lack of patient’s Introduction: Despite the widespread availability of vaccines, the interest, high patients burden in clinics, non-availability of vaccines incidence of vaccine-preventablechildhood diseases (VPCD) started to and high vaccine cost were considered to be barriers for not advising grow in recent years. vaccines to adult patients by study participants. Objectives: The aim of study was comparingthe incidence of selected Conclusion: Healthcare worker’s knowledge and attitude play a key VPCDs in the EU and EFTA countries in 2014–2019, and thecountry- role in improving vaccine coverage of community. Education interven- specific vaccine schedules. tions are necessary to improve awareness of HCWs and public in order Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 58 of 140 Methods: VPCD incidence rates in Europe based on “The Surveillance communication between health professionals in order to increase Atlas of Infectious Diseases” by ECDC, vaccination schedules based on public confidence in vaccination and motivate each country with best ECDC reports. practice. the introduction of compulsory vaccination against prevent- Results: The obligation to vaccinate is not universal and it generally able diseases. only applies to 2 preparations: the MMR vaccine and the one against Disclosure of Interest: None declared. polio. During the study, the situation associated with mumps did not change or improve in individual countries, the median incidence amounted to 18 cases per 100,000 population. The median incidence Poster session: COVID‑19: environmental control associated with rubella amounted to 1 case, but in a few countries, it grew very rapidly, i.e. in Germany, Italy and Romania, In Poland, the incidence was clearly decreasing, from 5,923 to 1,532 cases. The most P097 dynamic situation concerns measles. The total median was 2.4 cases Impact of COVID‑19 pandemic on healthcare waste management: per 100,000 population, the only one country with falling incidence a pre experimental study from a Tunisian hospital 1,* 1 1,2 1,2 1 was Germany. The diseases associated with Streptococcus pneumo-R. Bannour , A. Ben Cheikh , S. Bhiri , H. Ghali, W. Dhouib , S. 1 1,2 1,2 niae and Neisseria meningitidis remained at a stable level in all ana- Khefacha , H. Said Latiri , M. Ben Rejeb lysed countries. Department of Prevention and Security of Care,, Sahloul University Conclusion: Vaccine schedules differ among the countries, so does Hospital, Faculty of Medicine of Sousse,, University of Sousse, Sousse, the epidemiological situation of selected diseases. Morbidity on Tunisia, Sousse, Tunisia measles is the most disturbing phenomenon: the incidence rate Correspondence: R. Bannour increased in almost 40% of all countries, regardless of the obligation Antimicrobial Resistance & Infection Control 10(1): P097 to vaccinate. The increasing incidence of VPCD may be due to anti- vaccine movements, the activity of which is often caused by mistrust Introduction: Worldwide, healthcare waste management (HCWM) is and spreading information. In order to better prevent the increase in a high priority public health and environmental concern issue. During morbidity, standardisation of vaccine schedules and documentation the Corona Virus Disease 2019 (COVID-19) pandemic, hygiene meas- should be considered in the EU countries. ures were more strictly applied in hospital setting. Disclosure of Interest: None declared. Objectives: The aim of this study was to assess HCWM before and during the COVID 19 pandemic in Sahloul University Hospital (2019–2021). P096 Methods: A pre experimental study, based on two audits of HCWM, The epidemiological patterns of measles in CEE countries 1,* 1 was carried out at Sahloul University Hospital (2019–2021).. The inter- J. Pekarcikova , A. Plskova vention consisted on repeated training sessions on standard hygiene Trnava University, Faculty of Health Sciences and Social Work, Trnava, precautions among all healthcare workers. The data was collected by Slovakia trained auditors using a pre established observation grid based on the Correspondence: J. Pekarcikova manual of good HCWM techniques and practices (ANGED). Antimicrobial Resistance & Infection Control 10(1): P096 Results: Between 2019 and 2021 the overall compliance with the sort- ing of HCWs has increased from 44.7% to 68.9%: it passed from 75% Introduction: Within the WHO European Region, measles occurs to 87.2% for needle containers, from 23.9%to 48.8% for yellow bags mainly in populations with low vaccination coverage, whether chil- reserved for infectious risk waste and from X to 70.9% for black bags dren or adults. reserved for ordinary waste. Objectives: To describe the current occurrence of measles in selected For the intra-service collection step the overall score passed from EU/EAA countries, focusing on selected countries of Central and East- 28.51% to 58.2%; ern Europe and the level of measles vaccination levels in the study The most improved dimensions were “The filling level of the yellow population. bags is respected” (passed from 28.6% to 76.6%) and “Absence of Methods: In a descriptive analysis focused on the occurrence of mea- HCWs outside containers or waste bags” 19.9% to 90.9%). sles in selected EU countries with a focus on the countries of Central Nevertheless, a lack of improvement in labeling practice was noted, and Eastern Europe (CEE) for the period 2014–2019, 6 countries were such as the labeling of bags containing infectious risk wastes, which selected—Bulgaria, the Czech Republic, Hungary, Poland, Romania went from 0 to 0.9%; labeling of needle containersfrom6% to 3.2% and and Slovakia. Epidemiological data on measles were obtained from the traceability of the waste disposal time from 0 to 7.3%. the ECDC Atlas for the Surveillance of Infectious Diseases and from the Conclusion: The pandemic may present a unique chance to improve evaluation of administrative vaccination controls in Slovakia. Age-spe- compliance with recommendations regarding HCWsM on the long cific morbidity is reported per 1,000,000 people. Vaccination data were term, therefore, we should focus on how to maintain high adherence available in selected parameters for the last year 2018. to recommendations and improve deficiencies during and after the Results: Among the monitored countries of CEE, the prevalence of COVID-19 pandemic. measles in Romania dominated in 2016–2018. In Romania, measles Disclosure of Interest: None declared. affected up to 96% of people without vaccination. No cases of mea- sles have been reported in Hungary. It is interesting to note that the last year—2019 there has been a significant increase in all moni- tored countries of Central and Eastern Europe, with the exception of P099 Romania, where a slight decrease is observed in new cases. In Slova- Inactivation of SARS‑COV‑2 by various surfactants 1,* 1 1 1 1 1 kia, the measles epidemic affected children under the age of 15, who M. Nishida, Y. Harada , H. Amo , H. Murai, T. Ono, M. Yoshikawa , Y. 1 2 2 2 could not be vaccinated earlier due to age, and people living in poor Hirata, T. Sasaki, T. Shioda , M. Ikawa 1 2 hygiene standards. The most significant coverage of MCV1 (95.7%) Biochemical Laboratory, Saraya Co., Ltd., Research Institute for Microbial and MCV2 (93.5%) was recorded in the countries of CEE in 2014. The Diseases, Osaka University, Osaka, Japan situation in Hungary can be assessed positively, where the vaccination Correspondence: M. Nishida coverage of MCV1 and MCV2 reached 99%. The level of MCV1 cover- Antimicrobial Resistance & Infection Control 10(1): P099 age in Slovakia ranged from 95 to 99% and MCV2 between 97 and 98% in the period under review. The optimal value of the measles vac- Introduction: The novel severe acute respiratory syndrome coronavi- cination is set at 95%. rus 2 (SARS-CoV-2) causing the global pandemic is an enveloped virus Conclusion: Within the EU, measures need to be taken to increase the and expected to be susceptible to some surfactants. The efficacy of effectiveness of immunization programs, including through vaccina- the commercially available disinfectants and cleaners against this virus tion, to at least 95% in each EU country, to promote and build effective Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 59 of 140 has been well examined so far, but only few reports mentioned about Compared with surgical mask, the use of FFP2 respirator did not pre- the efficacy of each surfactant alone. vent the risk of SARS-CoV-2 in healthcare workers [RR = 0.99 (0.32 Objectives: This study aimed to evaluate the virucidal efficacy of vari- -2.99), P = 0.91]. ous surfactants against SARS-CoV-2 (JPN/TY/WK-521). In addition, it Conclusion: Fifty-two (52) residents and 31 members of staff had a also aimed to examine the presence of correlation between the viru- history of laboratory confirmed Covid-19. Most of them were con- cidal efficacy and cytotoxicity of each surfactant. taminated during a first Covid-19 outbreak occurred in the facility by Methods: For this study, the experiments dealing with the novel cor- the end of March 2020. No case of reinfection was reported. Infection onavirus were carried out at the Research Institute for Microbial Dis- with SARS-CoV-2 appears to provide strong protection from reinfec- eases (Osaka University), while the cytotoxicity tests were performed tion for up to nine months including for the elderly. Further studies are at the Saraya Microbiologicial Research Center (Saraya Co., Ltd). The needed to confirm this finding. virucidal efficacy of each surfactant (cationic, anionic, amphoteric and Disclosure of Interest: None declared. non-ionic surfactant; 0.01% ~ 5.00%) was evaluated according to EN 14476 (dirty conditions). Their cytotoxicity was then examined by MTT P101 assay. Local epidemiology of the SARS‑COV 2 pandemic in nursing Results: The performance of EN 14476 with SARS-CoV-2 demon- homes: a Swiss experience 1,* 1 1 1 strated that the cationic surfactant showed high virucidal efficacy. C. Riccio , I. Nahimana , L. Qalla Widmer , C. Petignat Although not as high as that of the cationic surfactant, some nonionic Unité cantonale HPCI Vaud, Lausanne, Switzerland and amphoteric surfactants also showed relatively good virucidal effi- Correspondence: C. Riccio cacy, while the rest did not. After evaluation of cytotoxicity, a good Antimicrobial Resistance & Infection Control 10(1): P101 correlation between the virucidal efficacy and the cytotoxicity of each surfactant was observed; the higher the cytotoxicity, the higher the Introduction: The SARS-CoV-2 pandemic has affected many nursing virucidal efficacy. homes (NH)s. Residents are more susceptible to coronavirus disease Conclusion: All of the tested cationic surfactants showed high viru- 2019 (COVID-19) complications due to their age, dependency and cidal efficacy and some nonionic and amphoteric surfactants had rela- sometimes their psychiatric illness. Early identification and care posi- tively highly virucidal efficacy. The evaluation of this strain has been tive residents are a powerful approach to limit the spread of the virus. finished. Further studies on the comparison of surfactant efficacy to Objectives: This study aims to: i) assess the spread of SARS-CoV-2 by other enveloped viruses with the original strain would bring some collecting data on the NH of the resident and their microbiologic data new insights to this research. in order to control the transmission of the virus. ii) improve the nursing Disclosure of Interest: None declared. practices of infection control and to adapt the preventive strategies. Methods: Data were collected from the register of the cantonal office Poster session: COVID‑19: long‑term care facilities of public health Vaud, from the NH staff, or from an on-line reporting platform. Immediately upon identification of a case, a cantonal nurse specialized in infection prevention and control (IPC) speaks with the P100 NH staff or visits the NH. The IPC nurse recommended IPC measures Investigation of clustered cases of SARS‑COV‑2 infection and the screening strategy to control an outbreak. A daily or a bi- (COVID‑19) in nursing home settings, Etampes, France, Decembre weekly follow-up was required until the resolution of the outbreak. 2020–Januray 2021 1,* 2 3 4 5 When the NH has no more isolated COVID-19 positive resident, we E. Elghouati , C. Farrugia , A. Emirian , S. Siami , H. Benhabib 1 2 3 wrote a final report. Infection control unit, Department of Laboratory Medicine, Depart‑ 4 5 Results: The first wave of the COVID-19 pandemic in NHs lasted from ment of Laboratory Medicine, Intensive care unit, Department of geriat‑ 09.03.2020 to 23.06.2020. 62 NHs/163 have been affected, 38% of NHs rics, Centre Hospitalier Sud Essonne, Etampes, France in the canton. The mean attack rate was 16% (1–62%). About 700/5178 Correspondence: E. Elghouati residents (14%) have been infected by COVID-19: 400 residents with Antimicrobial Resistance & Infection Control 10(1): P100 a laboratory confirmation of infection while 300 were clinical suspi- cions of COVID-19. There were 5% of deaths (255/5178). The second Introduction: A cluster of cases of Covid-19 was reported among resi- wave lasted from 10.08.2020 to 31.12.2020. 104NHs/163 (64%) have dents and staff at a nursing home in December 2020. been affected. The mean attack rate was 38% (6–91%). 1914/5178 Objectives: An epidemiological investigation was undertaken in order (37%) residents have been infected by the virus; more than twice as to describe the outbreak, identify factors associated with SARS-CoV-2 much as the first wave. The rate of death of the second wave was 8% infection and adjust control measures. (426/5178). The mean duration of outbreak cases was 5 weeks (2–10 Methods: A retrospective cohort study was conducted. SARS-CoV-2 Weeks). was identified by reverse-transcriptase polymerase chain reaction Conclusion: NHs have been highly impacted by the second wave. The assay (RT-PCR) or antigen tests. systematic screening for SARS-Cov-2 was crucial in detecting asymp- Questionnaires were documented for demographic and clinical char- tomatic residents. The implementation of adequate IPC measures, the acteristics. Poisson regression was used to estimate the risk factors of NH collaboration and the interventions of IPC nurses were a successful infection for Covid-19. approach to limit the spread of the virus. Knowledge of NH staff in IPC Results: Sixty-two (62) cases of Covid-19 were identified, divided was improved. into 46 residents and 16 staff. The mean age of the residents was Disclosure of Interest: None declared. 86.7 years. The overall Attack Rate (AR) was 31% (62/200): residents AR = 40.7% (46/113), staff AR = 18.4% (16/87). The fatality rate of resi- dents with confirmed Covid-19 was 19.5% (9/46). P102 The distribution of cases over time spanned a period of about two An unprecedented and large‑scale departmental support mission months (from December 2nd 2020 to January 30th 2021). The epi- to assist living facilities for elderly people facing the COVID‑19 demic curve revealed two successive waves of contamination. Two pandemic 1,2,* 1 1 1,2 of the three floors of the facility were affected. No “British variant” of A. Colas , A. Baudet , M. Regad , A. Florentin 1 2 SARS-CoV-2 was identified. CHRU NANCY, DHREAS—Université de Lorraine, Vandoeuvre les Nancy, The multi-variate analysis identified history of laboratory confirmed France Covid-19 as an independent protective factor for both residents and Correspondence: A. Colas staff [RRs were respectively 0.03 (0.0004–0.19), P < 0.001 and 0.11 Antimicrobial Resistance & Infection Control 10(1): P102 (0.016–0.82), P < 0.001]. Introduction: In March 2020, a notable proportion of COVID-19 cases have occurred among Health and Social Institutions. Mid-April, early Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 60 of 140 outbreaks among assisted living facilities for elderly people have been recorded in the Meurthe et Moselle French department. Objectives: The authorities ordered on April, the 10th, an unprec- edented and large-scale departmental support mission to assist living facilities at this very critical time. Methods: Mobile units were formed under the coordination of the infection prevention and control (IPC) department of a teaching hospi- tal in collaboration with the departmental fire station and the depart - mental council. These IPC teams (IPCT) consisted of three members: a nurse, a fireman and a medical administrator. In total, eight teams were formed and a field visit had been scheduled for each establishment. IPCT went to the facility to meet the management and the ward staff in order to assess the situation and identify any support needs. Report describing strengths, limitations and corrective measures to implement was written and electronically sent to the facilities and to the authorities. Results: Over a five-day period, all the facilities (n = 66, 6029 places) of the French department were visited. If urgent needs were identi- fied, the IPC department was directly informed by the IPCT to initiate an extensive assistance operation. Although most of the establish- ments had implemented good management to face the pandemic, the IPC department conducted emergency field support operations in establishments with uncontrolled outbreaks to implement corrective Conclusion: We used a robust, evidence-based approach to develop actions and provide staff/equipment. a data bank of workflow information related to activities within LTC, Conclusion: To our knowledge, this mission is the first support action as well as visual representations. These constitute a de novo imple- for Health and Social institutions facing the pandemic in France. As mentation resource designed to promote safe access to LTC in the no major outbreaks were later noticed, this mission was a success and context of a global pandemic. The end products and website (www. met the establishment’s need for support in this critical time. Through enabl esafe care. org) go some way to redress the imbalance between this mission, many facilities have expressed the need to cooperate IPC and compassion and have been made freely available for universal with IPC specialists during crises, but also in daily practice. The pros- adaptation and use. pects are obvious: maintain support and implement a permanent Disclosure of Interest: None declared. collaboration between Health establishments and Health and social Institutions. Disclosure of Interest: None declared. Poster Session: COVID‑19: Treatment P103 P104 Applying workflow analysis techniques in care homes Virucidal potential of oral rinses and nasal sprays in the context of IPC and COVID‑19 against SARS‑COV‑2 and their mode of action 1,* 1 2 3 1,* 1 1,2 1 1 J. Storr , C. Kilpatrick , S. Hall , M.‑N. Chraiti T. L. M eister , N. Heinen, D. Todt , Y. Brüggemann , S. Pfaender , F. H. H. 1 2 3 1 KS Healthcare Consulting, Carer/Relative, Glasgow, United Kingdom, Brill , E. Steinmann Geneva University Hospitals, Geneva, Switzerland Molecular and Medical Virology, Ruhr University Bochum, Bochum, 2 3 Correspondence: J. Storr European Virus Bioinformatics Center, Jena, Dr. Brill + Partner GmbH Antimicrobial Resistance & Infection Control 10(1): P103 Institute for Hygiene and Microbiology, Hamburg, Germany Correspondence: T. L. Meister Introduction: The unprecedented COVID-19 pandemic saw a plethora Antimicrobial Resistance & Infection Control 10(1): P104 of infection prevention and control (IPC) recommendations. However, implementing these within a compassionate milieu appeared to pre- Introduction: The ongoing SARS-CoV-2 pandemic creates a signifi- sent a universal challenge. We highlighted the need for action in an cant threat to global health. Recent studies suggested the significance open letter (https:// www. nursi ngtim es. net/ opini on/ open- letter- infec of throat and salivary glands as major sites of virus replication and t i o n - p r e v e n t i o n - a n d - c o n t r o l - s h o u l d - n e v e r - b e - a t - t h e - e x p e n s e - o f - transmission during early COVID-19 thus advocating application of compa ssion ate- care- 16- 10- 2020/) and identified real life scenarios oral antiseptics. as one solution to address the perceived IPC-induced compassion Objectives: Here, we evaluated the virucidal activity of different avail- catastrophe reported to be taking place in many long term care (LTC) able oral rinses, nasal sprays as well as individual compounds found facilities. in oral rinses against SARS-CoV-2. These experiments were performed Objectives: To apply workflow analysis techniques in LTC in order to under conditions mimicking nasopharyngeal secretions and investi- present IPC measures in the context of COVID-19. gated their respective virucidal modes of action. Methods: First hand narrative descriptions of carer/relative journeys Methods: According to European guidelines, virucidal activity was in a LTC facility were obtained. Individuals were asked to recall a recent determined with a quantitative suspension test with 30 s exposure scenario, breaking it down into its smallest unit of activity, as outlined time on VeroE6 cells. Mechanistic analysis to reveal the mode of action by WHO in a 2012 document on hand hygiene and long term care. The of antiseptic agents included density gradient centrifugation and a findings were reviewed and modified by a sample of people working capsid protection assay. in LTC, relatives/carers and IPC experts, with the experts applying IPC Results: Three of the eight oral rinses as well as two nasal sprays sig- recommendations within the flow of activities. nificantly reduced viral infectivity to up to three orders of magnitude Results: Simulation of the flow of activity for two commonly encoun- to background levels. Mechanistic analysis revealed that treatment tered LTC scenarios, uniquely from the perspective of carers/relatives, with benzalconiumchloride and other antiseptic agents used in mouth was created. A table and a visual outlining the two scenarios were rinses primarily disrupted the viral envelope, without affecting viral developed (figure 1 illustrates an example scenario: Spending time RNA integrity. with a loved one outside/on a car journey) and launched on a unique Conclusion: In summary, we provide evidence that SARS-CoV-2 can website with site traffic monitored. At each step, the relevant IPC be efficiently inactivated by commercially available oral rinses and measures and their rationale were described with the aim of empow- nasal sprays with respect to their compound composition, within ering those in LTCs to act with both compassion and safety. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 61 of 140 short exposure times, thus possibly lowering the transmission of inhalation therapy should be cautious, especially in the current COVID- SARS-CoV-2. 19 pandemic. Besides, the device can also be a reservoir for pathogens Disclosure of Interest: None declared. and lead to further infection. The use of nebulizers also requires disas- sembly and cleaning of after each dose. Objectives: This survey aimed to evaluate the compliance of hospital policy regarding the use of inhalation therapy. P105 Methods: This survey was conducted as a part of infection preven- Survival analysis of COVID‑19 patients treated with different tion and control program in a 2600-bed teaching hospital. Infection modes of respiratory support in the ICU control personnel designed a structured questionnaire and visited the 1,* 2 3 4 5 6 7 8 Y. Wang , B. Deng , F. Qiao , K. Liang , W. Wu , K. Li , L. Lin , C. Li , Z. in-patient services during Dec. 1, 2020 to Dec. 31, 2020. The survey 2 6 Peng , Y. Yuan included the environment control (single room, close door, or close Department of Nosocomial Infection Management, Zhongnan Hospital curtain if more than one bed), cleaning methods after use, and who of Wuhan University, Department of Critical Care Medicine, Zhongnan handle the procedure. Hospital of Wuhan University, Wuhan, Infection Prevention and Con‑ Results: A total of 84 wards were audited. 38% of the wards did not trol Department, West China Hospital, Sichuan University, Chengdu, close the door and 33% did not close the curtain while performing Department of Nosocomial Infection Management, Zhongnan Hospital nebulization. To clean the devise after use, the use of tap water flowed of Wuhan University, Wuhan, Hubei University of Medicine, Shiyan, by boiled water was most common (32%), followed by sterile water Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan Uni‑ (21%) and 6% used tap water only. The cleaning procedure was per- 7 8 versity, Hospital Management Institute, Wuhan University, Information formed by nurses (30%) or family/care givers (19%). Center, Zhongnan Hospital of Wuhan University, Wuhan, China After the survey, Center for Infection Control had made a consen- Correspondence: Y. Wang sus with Department of Integrated Diagnostics & Therapeutics and Antimicrobial Resistance & Infection Control 10(1): P105 Department of Nursing. The main guidance include: 1) suggest use nebulization in single room only and close the door, if not feasible, Introduction: This study is the first to focus on the different respira- suggest close the curtain around the patient area; 2) sterile water or tory support modes and outcomes of critically ill patients with COVID- boiled water should be used as the last step in cleaning; 3) the cleans- 19 in Wuhan. ing procedure should be performed by nurse and trained family/ The cohort study design is persuasive. caregiver. The number of studies retrieved is limited in patients with MDRO co- Conclusion: In the era of COVID-19 pandemic, nebulization therapy infected with COVID-19. may carry the risk of inducing aerosol and increase the risk of disease This study only selected critically ill patients with COVID-19 in Leishen- transmission. Through the survey, we notice the infection control shan Hospital. practice of nebulization in the hospital should be strengthen. Isola- Objectives: We aimed to describe the clinical characteristics and out- tion methods (door/curtain) and cleaning procedure are the two key comes of five different modes of respiratory support among critically points need improvement. ill patients with coronavirus disease 2019 (COVID-19). Disclosure of Interest: None declared. Methods: This was a hospital-based, retrospective cohort study which setting on Leishenshan hospital in Wuhan, central China. Patients with COVID-19 admitted to the ICU of Leishenshan Hospital from February 8, P107 2020 to April 18, 2020 were recruited. The outcome was living status and Efficacy of ixekizumab vs. IL‑2 vs. colchicine vs. standard of care survival time. for the treatment of hospitalized patients with COVID‑19: Results: Thirty-five patients died among 114 hospitalization patients preliminary results of a randomized clinical trial (struck: survival (mortality rate, 30.7%), and 56 patients (49.12%) used mechanical ven- trial using cytokine inhibitors) 1,* 2 2 1 1 1 tilation. The mean survival time (days) of patients without respiratory L. Bonifácio , E. Ramacciotti , L. Agati, F. Vilar, A. Tojal , H. Souza , P. 1 1 3 4 1 support, noninvasive positive-pressure ventilation (NIPPV), endotracheal Louzada‑Júnior , B. Fonseca , R. Lopes , E. Kallas , F. Bellissimo‑Rodrigues intubation, tracheotomy, or endotracheal intubation before and after Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 2 3 tracheotomy (EI + T) was 15, 34, 32, 12.5, and 6, respectively (p < 0.000). Science Valley Research Institute, São Paulo, Brazil, Duke University, Eighteen (15.79%) patients were co-infected with MDROs, primarily in the Durham, United States, School of Medicine, University of São Paulo, São EI + T group (83.33%). The mortality risk of patients treated with NIPPV Paulo, Brazil and EI + T was 0.20 and 0.21 times higher than that of patients without Correspondence: L. Bonifácio any respiratory support (95% confidence interval [CI] = 0.002–0.203; 95% Antimicrobial Resistance & Infection Control 10(1): P107 CI = 0.002–0.218). The mode of respiratory support was an independent factor affecting the survival of ICU patients with COVID-19. Introduction: There are currently scarce approved treatments for Conclusion: Mortality risk in patients with NIPPV and EI + T was lower Covid-19 and new options are needed. than in those without any respiratory support. Timely and correct res- Objectives: To evaluate the efficacy of an IL-17 inhibitor vs. low-dose piratory support mode is the key to reducing the death of critically ill IL-2 vs. colchicine vs. standard of care for the treatment of hospitalized patients with COVID-19. patients with Covid-19. Disclosure of Interest: None declared. Methods: This is an on-going multicenter, open-label, prospective, ran- domized, active-controlled, adaptive 4-arm study. Patients hospitalized with moderate to severe presentation of Covid-19 are being recruited P106 according to predetermined eligibility criteria. Patients are randomized Inhalation therapy in the context of the COVID‑19 pandemic to one of the trial arms: ixekizumab (IL-17 inhibitor), low dose IL-2, col- 1,* 1,2 1,2 H.‑H. Chang , S.‑C. Pan, Y.‑C. Chen chicine (indirect IL-6 inhibitor), or standard treatment, each according 1 2 Center for Infection Control, Department of Internal medicine, National to the pre-established periods and doses. The primary study outcome Taiwan University Hospital, Taipei, Taiwan, Province of China is the proportion of patients with clinical improvement, defined by an Correspondence: H.‑H. Chang increase of two points on the WHO’s ordinal scale at day 28. Secondary Antimicrobial Resistance & Infection Control 10(1): P106 study outcome is in-hospital mortality. Results: Until May 27, 30 patients with similar baseline clinical and demo- Introduction: Inhalation therapy allows conveying drugs directly graphic features have been enrolled in the study. Table 1 describes the into the airways while minimizing the systemic exposure. Nebulizers main efficacy outcomes for each of the study arms. Ixekizumab arm pre - can be used by patients unable to use metered-dose inhalers or other sented the greatest improvement in the WHO scale (71.4%), while col- inhalers. However, this procedure generates aerosol and causes envi- chicine arm presented the lowest mortality rate (0%), but no statistically ronmental contamination or disease transmission. Thus, the usage of significant differences have been observed, so far. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 62 of 140 Disclosure of Interest: None declared. Table 1 – Efficacy outcomes of each one of the treatments approach for patients admitted with Covid-19 Study armImpr In- P109 ovem hosp ent of ital Vaccine hesitancy among healthcare providers during COVID‑19 2 deat point h pandemic 1,* 1 s in n (%) F. Algabbani , A. Algabbani WHO scale PSMMC, Riyadh, Saudi Arabia n (%) Ixekizumab (n=7)5 71, 114, Correspondence: F. Algabbani 4 3 Antimicrobial Resistance & Infection Control 10(1): P109 Low dose IL-2 (n=5)2 40, 120, 0 0 Colchicine (n=10) 550, 00,0 0 0 Introduction: Public trust in vaccines is a major global health issue. Standard of care (n=8)5 62, 112, Objectives: This study aims to assess the vaccine acceptance among 5 5 Total (n=30) 1 56, 310, healthcare workers and their confidence and hesitancy of the COVID19 7 7 0 vaccine. Methods: This was a multicenter cross-sectional survey conducted among healthcare providers in Riyadh, the capital of Saudi Arabia. Conclusion: These preliminary results suggest that Ixekizumab and Data collection was carried out between October and November of colchicine should be further studied as potential therapeutic drugs for 2020 through a web-based survey. COVID19 vaccine hesitancy was treating patients with moderate to severe Covid-19. assessed using eight structured items adapted from the 5Cs. Trial registration: NCT402422/2020–1. Results: About 34.6% (95% CI: 27.6% > 42.4%) of participants were Funding: Rede Vírus (MCTI) and CNPq (402,422/2020–1). willing to vaccinate against COVID-19 and 44% (95% CI: 36.5% > 51.9%) Disclosure of Interest: None declared. will recommend the vaccine to their patients. About 45% of partici- pants were neutral regarding vaccine safety and 40% were neutral regarding vaccine effectiveness. Almost 70% believe that the duration of clinical studies of the COVID-19 vaccines affects their confidence in Poster Session: COVID‑19: Vaccination the efficacy and safety of the vaccine. Those who never hesitated or delayed taking any of the recommended vaccination were more likely P108 to be willing to vaccinate COVID-19 (OR 5.46, 95% CI: 2.49–11.98). Intention to accept COVID‑19 vaccine and its associated factors Conclusion: Assessing the level of vaccine confidence in the population among Tunisian people and associated factors will help implement an effective national vaccine 1 1,* 1 1 1 1 A. Maatouk , A. Ammar, W. Bannour , O. Ezzi , R. Helali, B. Trabelsi , M. program to enhance vaccination uptake and control COVID19 spread dur- 1 1 Njah , M. Mahjoub ing this pandemic. Infection Prevention and Control, University Hospital of Farhat Hached, Disclosure of Interest: None declared. Sousse, Tunisia Correspondence: A. Ammar Antimicrobial Resistance & Infection Control 10(1): P108 P110 Social media and hesitancy towards SARS‑COV2 vaccination Introduction: Coronavirus Disease 2019 (COVID-19) represents an among the Tunisian health professionals 1,* 2 3 emergence putting public health systems on high alert worldwide. In C. Ben Nasrallah on behalf of 1, N. Zammit on behalf of 2, A. Brahem 2 2 order to prevent the spread of the coronavirus and its related morbid- on behalf of 3, A. El Guedr on behalf of 2, I. A youni on behalf of 2, R. 2 2 3 ity and mortality, appropriate strategies are needed such as vaccina- Ghammam on behalf of 2, S. Ben F redj on behalf of 2, C. Sr idi on behalf 3 3 tion. However, this vaccination is the subject of controversy. of 3, A. Chouchene on behalf of 3, H. Kalboussi on behalf of 3, O. 3 3 2 Objectives: Our study aimed to determine the intention to accept ElMaalel on behalf of 3, S. Chatti on behalf of 3, J. Maatoug on behalf 3 2 COVID-19 vaccine and its associated factors among Tunisian people of 2, N. Mrizak on behalf of 3, H. Ghannem on behalf of 2. 1 2 during the COVID-19 pandemic. Faculty of Medicine of Monastir, Monastir, Department of Epidemiology Methods: We conducted a cross-sectional study among Tunisian peo- (LR19SP03), Farhat Hached University Hospital, Department of Occupa‑ ple from December 2021 to January 2021 (before the availability of tional Medicine and environmental pathology (LR19SP03), Farhat Hached COVID-19 vaccine in Tunisia) using an online questionnaire developed University Hospital, Faculty of Medicine of Sousse, University of Sousse, with Google Forms and submitted through social media. Healthcare Sousse, Tunisia professionals were not included in the study. The participation was Correspondence: C. Ben Nasrallah completely voluntary. Data analysis was performed using the Statisti- Antimicrobial Resistance & Infection Control 10(1): P110 cal Package for Social Sciences (SPSS) version 21.0. Factors associated with intention to accept coronavirus vaccine were analyzed using mul- Introduction: Health professionals are the leaders of the war against the tiple multinomial logistic regression. SARS-COV2 pandemic. Their adherence to the vaccination against this Results: A total of 169 Tunisians participated in the study. Most of new virus is crucial to ensure a sufficient coverage in the community. them were female (85.2%) with mean age of 48.3 ± 11.8 years. In Objectives: To evaluate hesitancy towards SARS-COV2 vaccines our study, 11.8% of participants were infected by SARS-CoV-2. Only among the Tunisian health professionals and their use of information 33.1% intended to accept to be vaccinated when COVID-19 vaccine sources about these vaccines. th will be available in Tunisia and 22.5% have not decided yet. Reasons Methods: A cross-sectional study was led online between the 7 and th for avoidance or hesitancy concerning the vaccine were suspicion on the 21 of January 2021 among Tunisian health professionals. A num- safety (84%), on efficacy or quality (53%), and on utility (26.5%). Mul- ber of at least 460 participants were required. Data were collected tiple multinomial regression showed that those having a high or very anonymously using a pre-established and pre-tested questionnaire high perceived personal risk of being infected by the SARS-CoV-2 and recorded in a free Google form. those who underwent seasonal influenza vaccination were less likely Results: A total of 493 responses were obtained. The mean age of par- to refuse the vaccine rather than those who have not yet decided ticipants was 37.4 (± 9.5) years. Females represented 70.2% of partici- about it with respective OR, [CI]: 0.420[0.178.-0.992] and 0.076 pants. The rate of hesitancy towards COVID-19 vaccines was 51.9%. Lack 95% [0.015–0.382]. of information about the COVID19 vaccines was reported by 81.7% of Conclusion: The acceptance rate of COVID-19 vaccine in our study popu- participants. Social media were the most used source of information by lation was moderate. Therefore, a good communication and health educa- them (66.9%) while 7.9% of them used the national information site for tion at the community level are needed to increase the COVID-19 vaccine health professionals. Use of social media more than two hours per day coverage. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 63 of 140 was positively associated with hesitancy towards vaccination against Antimicrobial Resistance & Infection Control 10(1): P112 SARS-COV2 with an OR of 2.5 (95% CI: 1.5–4.2) contrary to the use of the national website for information for health professionals which was neg- Introduction: Healthcare personnel (HCP) are at the frontline of the atively associated with hesitancy with an OR of 0.5 (95% CI:0.2–0.9). COVID-19 pandemic and are recognized as a priority target group for Conclusion: The current information strategy should be reinforced in COVID-19 vaccines. However, the acceptance or refusal of vaccination Tunisia. Social media may represent a good channel for disseminat- among HCP is debated. ing valid messages and tackling misinformation. Engaging health care Objectives: To investigate the prevalence and the predictors of professionals in social media to counter the vaccine related misinfor- COVID-19 vaccination refusal among Tunisian HCP. mation would boost the national information strategy. Methods: A cross sectional study was conducted using an anonymous th Disclosure of Interest: None declared. online survey among Tunisian HCP from 7 to 21 of January 2021. Primary endpoints were the intention to decline vaccination against COVID-19 if a vaccine was available. Logistic regression analysis was P111 used to assess the factors associated with the intention to decline the COVID‑19 vaccine perception and attitude among Tunisian COVID-19 vaccination. healthcare workers 1 1,* 1 1 1 1 Results: Of the 546 responses, 493 were retrieved. Among included A. Maatouk , A. Ammar , O. Ezzi, W. Bannour , S. Chelly , R. Helali , B. 1 1 1 HCP, 292 (59.2%) were physicians, 53 (10.8%) were paramedical per- Trabelsi , M. Njah , M. Mahjoub sonnel, 70 (14.2%) were pharmacists and 78 (15.8%) were dentists. Infection Prevention and Control department, University Hospital Overall, 62 of 493 HCP (12.6%) stated their intention to refuse vaccina- of Farhat Hached, Sousse, Tunisia tion. Logistic regression analysis revealed that being aged more than Correspondence: A. Ammar 40 years-old was a predictor of COVID-19 vaccination refusal among Antimicrobial Resistance & Infection Control 10(1): P111 HCP with an adjusted odds ratio (AOR) of 2 (95%CI: 1.2–3.6). A history of vaccination against influenza during the current season and the use Introduction: During COVID-19 pandemic, vaccination is a required of television as a source of information about COVID-19 vaccination strategy to overcome this disease especially for healthcare workers predicted a lower risk of refusing COVID-19 vaccination with AORs of (HCWs) given their increased risk of exposure to COVID-19. However, 0.2(95%CI: 0.1–0.4) and 0.5 (95%CI: 0.3–0.8) respectively. vaccination hesitancy is one of the significant obstacles to make this Conclusion: The current information campaign about COVID-19 vac- strategy successful. cination should be reinforced among Tunisian HCP. Older ones may Objectives: We aimed in this study to determine perception and atti- be involved in this campaign as leaders. The use of the official media tude toward COVID-19 vaccine among HCWs in Tunisia, and factors seems to be a good communication channel for this campaign. associated with their acceptability of this vaccine. Disclosure of Interest: None declared. Methods: We conducted a cross-sectional study among Tunisian HCWs from December 2021 to January 2021 using an online question- naire submitted electronically using the most popular online groups P113 of HCWs on Facebook. Data analysis was performed using the Statisti- The impact of SARS‑COV‑2 and SARS‑COV‑2 vaccination cal Package for Social Sciences (SPSS) version 21.0. on workforce absenteeism in an academic, tertiary care, Results: A total of 257 HCWs participated in the study with median four‑hospital medical center 1,* 2 age of 40 [34; 50] years. Among them, 21% were tested positive to T. Lee , S. McClanahan 1 2 SARS-CoV-2. Almost 44% of the respondents were caring for COVID-19 Infection Prevention/ Employee Health, Infection Prevention/Employee patients. Almost a third of the respondents (27.6%) had no intention to Health, Charleston Area Medical Center, Charleston West Virginia, United be vaccinated, and 21.8% were hesitant. COVID-19 vaccine avoidance States or hesitancy was justified by the suspicion on safety (92.1%), on effi- Correspondence: T. Lee cacy or quality (66.1%), and on utility (15.7%). Most of the HCWs who Antimicrobial Resistance & Infection Control 10(1): P113 had no intention to accept COVID-19 vaccine, did not receive seasonal influenza vaccination (84.5%) compared to 59.2% of those accepting Introduction: We conducted prospective surveillance of workforce the vaccine and 73.2% of hesitant HCWs (p = 0.001). Most of the HCWs (WF) illness related to SARS-Cov-2 as routine Employee Health Depart- who had the intention to accept COVID-19 vaccine were female (80%) ment (EHD) activities. We then evaluated associated absenteeism and (p = 0.16) and had a high or very high perceived risk of being infected the introduction of SARS-Cov-2 vaccination on absenteeism patterns by the SARS-CoV-2 in 60% of cases. Most HCWs who had the intention to determine the impact of those vaccinations. to refuse COVID-19 vaccine did not have serious cases of COVID-19 Objectives: 1. Examine trends in absenteeism among medical center among their patients (73.2%) (p = 0.89). WF during the SARS-Cov-2 pandemic. 2. Demonstrate impact of SARS- Conclusion: Almost half of HCWs were either hesitant or not accepting Cov-2 vaccination on WF absences. COVID-19 vaccine in our study. This high percentage may be explained Methods: This was an observational descriptive study. Data related by the lack of communication and information about the vaccine and to WF illnesses, exposures, and positive SARS-Cov-2 test results were can represent an obstacle to the achievement of COVID-19. obtained using a questionnaire, telephone interviews, and review of Disclosure of Interest: None declared. laboratory records. Case investigation was started when the healthcare personnel (HCP), a laboratory, or public health worker reported a hos- pital WF exposure, illness, or positive test result to EHD or to Infection P112 Prevention Department. Reason for WF absence was documented daily Predictors of COVID‑19 vaccination refusal among Tunisian for each occurrence. Vaccination data were obtained via vaccination healthcare personnel 1,* 2 3 databases within the hospital or the State immunization database. C. Ben Nasrallah on behalf of 1, A. Brahem on behalf of 2, N. Zammit 3 3 Results: Formal data collection began on 01/05/20. Daily absences on behalf of 3, I. Ayouni on behalf of 3, A. El Guedr on behalf of 3, S. 3 3 2 continued to rise, with the highest peak of 193 in December 2020 On Ben Fredj on behalf of 3, R. Ghammam on behalf of 3, A. Chouchene 2 2 December 15, prior to community vaccination programs, prime doses of on behalf of 2, C. Sridi on behalf of 2, H. Kalboussi on behalf of 2, S. 2 2 3 a two-dose SARS-Cov-2 vaccine (Pfizer-BioNTech) were administered to Chatti on behalf of 2, O. ElMaalel on behalf of 2, J. Maatoug on behalf 2 3 members of high-risk departments of the WF, with expanded WF vac- of 3, N. Mrizak on behalf of 2, H. Ghannem on behalf of 3 1 2 cinations administered over the next 5 months. In the weeks follow- Faculty of Medicine of Monastir, Monastir, Department of Occupational ing the first prime vaccinations, WF daily absences dropped to as low Medicine and environmental pathology (LR19SP03), Farhat Hached as 89 but began to increase until just after the booster doses of vaccine University Hospital, Department of Epidemiology (LR19SP03), Farhat were begun on 5/01/21. By 1/03/21, daily absences had decreased to Hached University Hospital, Faculty of Medicine of Sousse, University between 9 and 35. A total of 103 SARS-Cov-2 cases occurred among WF of Sousse, Sousse, Tunisia. between 19/02/21 and 25/05/21, the majority of which were among WF Correspondence: C. Ben Nasrallah Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 64 of 140 not vaccinated. Of those cases, 17 were breakthrough cases (among Conclusion:: The entire cohort developed antibodies after immuni- fully vaccinated WF) but were clinically mild events. zation with Sputnik V with no difference in concentration between Conclusion: Absenteeism due to SARS-Cov-2 was reduced and sus- extraction 20—40 days from second dose and more than 40 days. Fur- tained when WF SARS-Cov-2 vaccinations were administered. ther studies are needed to determine duration of immunity, influence Disclosure of Interest: None declared. of variants of concern, and to establish concentrations of IgG corre- lated with neutralizing antibodies. Disclosure of Interest: None declared. P114 Seroprevalence in Argentinian health care workers after vaccination with Sputnik V P115 1,* 1 1 2 2 3 D. Santonato , A. Malvicini , A. Novau, S. Torres , A. Siaba , L. Pereyra , V. Eec ff t of COVID‑19 vaccination on prevention of COVID‑19 4 4 1 Romano , P. Brenzoni, W. Cornistein in a tertiary care center in Lebanon 1 2 3 1 1 2 1 1 Infection Control Department, Paediatric Intensive Care Unit, Infec‑J. Tannous , N. Kara Zahr eddine , C. Sakr , A. Ibrahim , R. Ahmadieh , R. 4 3 4 5,* tious Diseases, Central Laboratory, Hospital Universitario Austral, Pilar, Mahfouz , U. M usharrafieh , S. Kanj 1 2 Argentina Infection Control and Prevention Program, Employee Health Unit, 3 4 5 Correspondence: D. Santonato Pathology and Laboratory Medicine, University Health Services, Infec‑ Antimicrobial Resistance & Infection Control 10(1): P114 tious Diseases, AMERICAN UNIVERSITY OF BEIRUT MEDICAL CENTER, Beirut, Lebanon Introduction: Health care workers (HCW) are at increased risk of Coro- Correspondence: S. Kanj navirus Disease 2019 (COVID-19). It is essential to guarantee protection Antimicrobial Resistance & Infection Control 10(1): P115 in this population. In Argentina, the vaccination campaign began on December 29, 2020 and HCW were among first beneficiaries. The first Introduction: Lebanon received its first batch of Pfizer-BioNTech vaccines available vaccine was Sputnik V. Previous studies showed efficacy over on February 13, 2021 to launch a free nationwide vaccination campaign 91%. We aimed to corroborate this. led by the Ministry of Public Health. The country has suffered an increase in Objectives: To determine presence and quantity of Anti-RBD IgG anti- cases and fatalities after the Beirut explosion in August 4, 2021. bodies in HCW at Hospital Universitario Austral. Objectives: We analyzed the efficacy of vaccination on preventing Methods: Seroprevalence study in HCW 3 or more weeks after the COVID-19 among staff at the American University of Beirut Medical second dose of Sputnik V. We excluded those with history of COVID- Center (AUBMC). 19 (positive RT-PCR, positive IgG before vaccination, symptoms not Methods: The COVID-19 vaccination campaign started in different cent - evaluated). Participants had a blood sample taken and processed using ers including AUBMC on February 14, 2021. Two doses of vaccine were Abbott SARS-CoV-2 IgG II Quant. A chemiluminescent microparticle administered at 3 weeks interval. Infection Control (IC) Program and immunoassay (CMIA) used for qualitative and quantitative determina- Employee Health Unit (EHU) continued to raise awareness and investi- tion of IgG antibodies to SARS-CoV-2 on the Alinity and ARCHITECT i gate COVID-19 infections among staff. Positivity of cases is confirmed by Systems. Quantitative results were used in analyses. As per manufactur- antigen and/or PCR testing. er’s instructions, a value ≥ 50 AU/ml was considered positive. Descrip- Results: Till May 26, 2021, Lebanon reported 538,991 COVID cases (8% tive analysis; Stata 10.0 Software. of population) and 7,690 deaths. While at AUBMC, a total of 1,133 (29%) Results: Characteristics of the cohort (Table 1). All of the participants staff developed COVID-19. To date, 8.6% of the population received the developed Anti-RBD IgG. Antibody concentrations (Picture 1). No dif- first dose of the vaccine, and 4.5% received the second dose. Eighty five ference was found in antibody concentrations between 20 to 40 days percent of the hospital staff received the first dose and 80% received the versus 40 to 100 days from second vaccine dose. second dose. The trend depicting COVID-19 cases at AUBMC followed the one observed in Lebanon. Following the end of year’s celebrations Table 1. Characteristics of the cohort an increase of cases was observed at AUBMC and in Lebanon during Jan- Characteristic n (%) uary. Inversely, we observed a decrease in the number of positive cases Masculine sex57 (36) in May 2021 nationwide and at AUBMC. Agemedian 45 (range 25-80) ComorbiditiesNone 154 (90.6) Diabetes Mellitus 1 (0.6) Cardiovascular disease 3 (1.9) Hypertension 2 (1.3) Overweight/obesity 9 (5.6) Time to extraction from second vaccine dose Mean 41.3 (SD 22.45; p5 21 –p95 88) Anti-RBD IgG concentrationMean 2359.501 (SD 3109.585; p5 191.7 –p95 7166) Conclusion: The trend in COVID-19 cases declined at the national level starting April 2021 similar to our trend. The decline at AUBMC was more pronounced most likely because of the rapidity of the immunization as most of the workforce was vaccinated within 4 weeks. The spread of the virus in Lebanon decreased due to vaccination and the natural immuni- zation secondary to the infection. IC practices, mandatory masking, hand hygiene, and physical distancing, remain instrumental in halting COVID- 19 transmissions in the community in view of the slow vaccination roll- out in Lebanon. Disclosure of Interest: None declared. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 65 of 140 P116 Conclusion: The trends illustrating occupied beds and mortality Decrease in demand for hospital beds in a tertiary care center rates in Lebanon were similar to our trends at AUBMC. The decline in Lebanon following COVID‑19 vaccination and governmental in cases and in deaths is primarily related to offering the vaccines lockdown measures based on occupation, age and medical condition. Improving the 1 1 1 1 2 A. Ibrahim , N. Kara Zahreddine, J. Tannous , R. Ahmadieh , A. R. Bizri , I. preparedness at our center is a lesson learnt in the event of another 3 1,2,* Bou Akl , S. Kanj threat. Despite the decline in cases, hospital staff are at risk. The con- 1 2 3 Infection Control and Prevention Program, Infectious Diseases, Depart‑ tinued importance of masking is mandatory and indispensable in ment of Internal Medicine, AMERICAN UNIVERSITY OF BEIRUT MEDICAL poorly ventilated areas or crowded places. CENTER, Beirut, Lebanon Disclosure of Interest: None declared. Correspondence: S. Kanj Antimicrobial Resistance & Infection Control 10(1): P116 Poster session: COVID‑19 among healthcare workers Introduction: The outbreak of COVID-19 in Lebanon created substan- tial demand for hospital beds. Hospitals were bound to equip units to admit such patients. A national vaccine rollout was planned by the P117 Ministry of Public Health (MOPH). Is the daily use of public transport facilities an enhanced Objectives: We evaluated the impact of a COVID-19 vaccination epidemiological risk for diagnosing COVID‑19 among healthcare campaign and governmental measures on reducing hospitalization workers with mild respiratory symptoms? 1 1 1 1,* and mortality among COVID-19 patients at a tertiary care center in L. Steinwender , D. Holy , J. Burkhard , I. Uçkay Lebanon. Balgrist University Hospital, Zürich, Switzerland Methods: Nationwide lockdown measures were imposed following a Correspondence: I. Uçkay rise in COVID-19 cases. Our facility, a tertiary care center, designated a Antimicrobial Resistance & Infection Control 10(1): P117 building in March 2020 to accommodate COVID-19 patients (regular and critical). During the second week of February 2021, the COVID-19 Introduction: Many people in Switzerland think that the daily use of vaccination rollout started. Two doses of Pfizer-BioNTech vaccine were the public transport facilities, during a pandemic peak wave, could be administered at 3 weeks interval. Other vaccines such as Oxford-Astra- associated with an enhanced risk for Covid-19. Zeneca and Sputnik V were administered by the private sector. Objectives: To investigate the association between the daily use of Results: In Lebanon, the daily number of COVID-19 cases showed the public transport and acquisition of Covid-19 in Zurch during a a rapid increase in January 2021. The highest percentages were peak wave of the pandemics. recorded during the first quarter of 2021 with 7% infections and 6% Methods: Retrospective cohort analysis of hospital-own databases at mortality. At AUBMC, 100% bed occupancy with increased mortality the Balgrist University Hospital in Zurich, between 1 October and 31 were noted in the COVID-19 dedicated units during the same period. December 2020. We specifically interviewed our healthcare workers The drop in cases started to appear when the country reached 4% (HCW ) about the use of public transport (with mandatory masking). nd to 7% vaccinated persons with first and second dose, respectively. Results: During the three most intensive months of the 2 wave, we In May 2021, bed occupancy continued to drop and the pattern was investigated 376 episodes of Covid-19-compatible respiratory symp- comparable to the decrease in new COVID-19 cases and deaths at the toms and exposures among our HCW (median age 37 years), of which national level. 94 (25%) revealed a positive PCR result for Covid-19. Overall, 225 HCW (225/376; 60%) reportedly used the public transport (train, bus, tram- way). In group comparison, the HCWs using the public transport sys- tem acquired no more Covid-19 than using a private transport (58/225 vs. 36/151; Pearson-chi -test; p = 0.67). We added a logistic regression model with the outcome “Covid-19 infection” to adjust for the case-mix of different localizations or oppor - tunities of potential contamination such as a documented exposure in the hospital, among the team members, in the family, or after a close contact to a PCR-confirmed case. In the multivariate results, using the public transport was irrelevant concerning the acquisition of Covid- 19 (odds ratio (OR) 0.98, 95%CI 0.59–1.62), in contrast, for example, to being exposed to a sick team member (OR 2.28, 95%CI 1.20–4.34). Conclusion: In Zurich, the daily use of public transport was not associ- ated with an additional risk of being diagnosed with Covid-19 among the young population of HCWs, not even during the peak of a pan- demic wave. Other factors are more relevant. Disclosure of Interest: None declared. P118 Risk of incident SARS‑COV‑2 infection among healthcare workers residing in Egyptian quarantine hospitals 1,* 2 1 2 1 S. Jijón , A. Al Shafie, L. Temime , M. El Kassas , K. Jean Laboratoire MESuRS, Conservatoire National des Arts et Metiers, Paris, France, Faculty of Medicine, Helwan University, Cairo, Egypt Correspondence: S. Jijón Antimicrobial Resistance & Infection Control 10(1): P118 Introduction: In response to the COVID-19 epidemic, Egypt estab- lished a unique care model based on quarantine hospitals where only externally-referred confirmed COVID-19 patients were admitted, and healthcare workers (HCWs) resided continuously over 1- to 2-week working shifts. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 66 of 140 Objectives: To estimate the risk of COVID-19 infection among HCWs implementation of preventive measures among all HCWs, including in quarantine-hospital settings and assess the relative contribution of those performing non-clinical services. HCW-to-HCW (HtoH) and patient-to-HCW (PtoH) transmissions. Disclosure of Interest: None declared. Methods: Detailed longitudinal data was collected in two Egyptian healthcare facilities (hereafter denoted by Hosp1 and Hosp2), dur- ing the 2020 first wave of the COVID-19 epidemic (Hosp1: March th th P120 14 -August 1st; Hosp2: June 6 -July 11th). In both hospitals, only Assessment the risk factors for SARS‑COV‑2 infection in a tertiary HCWs with no SARS-CoV-2 antibodies were allowed to start working hospital healthcare worker shifts. During shifts, HCWs were tested using RT-PCR on nasopharyn- 1,* 1,2 3 1 W. A. Mazi , S. Abdelhafeez, W. Althubaiti , A. Felimban geal swabs: i) routinely at the end of the shift, ii) upon symptoms, and Infection Prevention and Control, King Abdulaziz Specialist Hospi‑ iii) in case of outbreak suspicion (> 2 positive tests among HCWs). tal‑Taif, Infectious Disease Control Directorate, Directorate of Health Using a stochastic compartmental model for the spread of SARS-CoV-2 Affairs, Training and Education Department, King Abdulaziz Specialist in each hospital, we assessed the risk of SARS-CoV-2 acquisition over- Hospital‑Taif, Taif, Saudi Arabia all and by transmission route (HtoH vs PtoH). We estimated the model Correspondence: W. A. Mazi parameters using Markov Chain Monte Carlo approaches. Antimicrobial Resistance & Infection Control 10(1): P120 Results: Over a total follow-up of 6,601 person-days (PD), we esti- mated an incidence rate of 0.97 (95% CrI: 0.56–1.53) per 100 PD at Introduction: The spread of severe acute respiratory syndrome coro- Hosp1 and 8.98 (95% CrI: 3.81–17.75) per 100 PD at Hosp2. The proba- navirus 2 (SARS-CoV-2) is accompanied by uncertainty its ability to bility for a HCW to be infected at the end of a shift was 12.8% (95% CrI: spread in the human population and its virulence. In May 2020, World 7.6%–19.5%) for a 2-week shift at Hosp1, which lies within the range Health Organization (WHO) released a protocol assessment of risk fac- of risk levels previously documented in standard healthcare settings, tors for coronavirus disease 2019 (COVID-19) in health workers. whereas it was > threefold higher for a 7-day shift at Hosp2 (48.2%, Objectives: To characterize and assess the risk factors for COVID-19 95%CrI: 23.8%–74.5%). Infection risk was mostly driven by HtoH trans- infection in a tertiary hospital health worker. mission in both hospitals, although a substantial contribution from Methods: A descriptive cross sectional study was conducted in a ter- PtoH transmission was also found in Hosp2. tiary hospital among 62 nasopharyngeal swabs confirmed infected Conclusion: The large variation in the infection risk found between with COVID-19 healthcare workers from July and August 2020, Saudi the two quarantine hospitals we studied suggests that HCWs may face Arabia. Demographic, adhesion to prevention measures, pre-exciting a high risk of infection, but that, with sufficient anticipation and infec - condition and symptoms data were collected and analyzed as dem- tion control measures, especially those preventing patient-to-HCW onstrated by the WHO protocol. Hospital COVID-19 acquired infec- transmission, this risk can be brought down to levels similar to those tion was defined as the onset of clinical features of COVID-19 7 days or observed in standard healthcare settings. more after admission or between days 3 and 6 after admission if epi- Disclosure of Interest: None declared. demiologically linked to hospital exposure. Results: About 61% Nurses with mean age 34 years old were the P119 major exposed to COVID-19 infection. 37% were considered as hos- Risk of COVID‑19 in healthcare workers working in intensive care pital acquired COVID-19 infection. About 66–72% of victims had setting headache, muscle ache, fatigue and sore throat, 51–58% had loss of 1,* 1 2 3 1 M. Alshamrani , A. El‑Saed, Y. Arabi , M. Al Zunitan , F. Farahat , M. small, fever, diarrhea, cough and lose of appetite. Obesity was the 1 4 Matalqa , S. Almohrij most frequent (N = 6, 9.7%) followed by diabetes mellitus and asthma 1 2 Infection control, Critical Care Medicine, King Abdulaziz Medical City, (N = 3,4.8% of each). All healthcare workers were fully protected when 3 4 Infection control, King Abdullah Specialist Children Hospital, Chief dealing with the patient, however 20% of healthcare workers were not medical office, King Abdulaziz Medical City, Riyadh, Saudi Arabia sure about wearing surgical mask when contacted with colleagues. Correspondence: M. Alshamrani Fortunately, 98% had mild infection with home or quarantine isolation Antimicrobial Resistance & Infection Control 10(1): P119 and recovered. Conclusion: COVID-19 is a community-based infection affects all ages. Introduction: The higher risk of COVID-19 in healthcare workers Although all healthcare workers were fully protected during patient (HCWs) is well-known. However, the risk within HCWs is not fully care, acquiring COVID-19 infection could be expected during either understood. from the community or within the hospital environment from asymp- Objectives: The objective was to compare the COVID-19 risk in inten- tomatic carriers of healthcare workers and consequences spread sive care unit (ICU) versus non-ICU locations. Additionally, to examine between healthcare workers in a short time period. Minor sympto- the interaction between hospital locations and professional category. matic healthcare workers should be considered for suspected of SARS- Methods: A prospective surveillance study was conducted among CoV-2 carrier and early laboratory detection is highly recommended to HCWs at a large tertiary care facility in Riyadh between March 1st to avoid the spread on COVID-19 infection between healthcare workers. November 30th, 2020. HCWs included both clinical (provide direct Disclosure of Interest: None declared. patient care) and non-clinical positions (do not provide direct patient care). Results: A total 1,594 HCWs with COVID-19 were included; 103 (6.5%) P121 working in ICU and 1491 (93.5%) working in non-ICU locations. Com- Risk factors of COVID‑19 in frontline healthcare workers pared with non-ICU locations, ICU had more nurses (54.4% versus in Mashhad university hospitals 1 2 3 1 22.1%, p < 0.001) and less support staff (2.9% versus 53.1%, p < 0.001). A. Saeidinia , A. Khorsand Vakilzadeh , L. Golnari , G. Ghanbari , B. 3 3,* COVID-19 infection was similar in ICU and non-ICU locations (9.0% Bonyadi , M. H. A elami 1 2 3 versus 9.8%, p = 0.374). However, it was significantly higher in ICU Pediatrics, Acupuncture, Infection Control and Hand Hygiene Research nurses (12.3% versus 6.5%, p < 0.001). Support staff had higher risk Center, Imam Reza Hospital, MASHHAD UNIVERSITY OF MEDICAL SCI‑ than other HCWs, irrespective of ICU working status (15.1% versus ENCES, Mashhad, Iran, Islamic Republic Of 7.2%, p < 0.001). The crude relative risk (RR) of COVID-19 in ICU versus Correspondence: M. H. Aelami non-ICU locations was 0.92, 95% confidence interval [CI] was 0.76–1.11 Antimicrobial Resistance & Infection Control 10(1): P121 (p = 0.374). However, RR adjusted for professional category was signif- icantly increased to 1.23, 95% CI 1.01–1.50 (p = 0.036). Introduction: After emerging COVID-19, it became a worldwide con- Conclusion: ICU had a significantly higher risk of COVID-19 infection cern. Healthcare workers (HCWs) are at high risk of getting infection only after adjusting for the distribution and risk of different profes- and they have the capability to transmit virus to patients and also to sional categories. The finding underscores the importance of strict coworkers.There are few studies about risk factors of frontline HCWs. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 67 of 140 Objectives: In this study, we evaluated the risks of infection in front- P123 line HCWs in Mashhad university hospitals. Risk factors and transmission dynamics of COVID‑19 Methods: This was a cross sectional study in HCWs of Mashhad Uni- among resident doctors—a retrospective analysis in a non‑COVID versity Hospitals between March till July 2020. Participants were asked tertiary care centre 1 2,* 1 by telephone about the risk factors of getting COVID-19 infection. The V. K. HB , E. Manuel , N. S checklist was researcher-made and was on the basis of WHO risk fac- Neuromicrobiology, National Institute of Mental Health and Neuro‑ tors regarded to COVID-19, MERS and SARS. sciences, Neuromicrobiology, NIMHANS, Bengaluru, India Results: In this study, 534 HCWs with positive PCR test for COVID- Correspondence: E. Manuel 19 were enrolled. The response rate in our study was 64.04%. The Antimicrobial Resistance & Infection Control 10(1): P123 mean age of participants was 36.02 ± 8.5 years. Among them 176 and 239 were participated in infection control workshop and hand Introduction: The national registry of Indian Medical Association hygiene workshop before COVID-19 pandemic respectively. Most of (IMA) shows that 747 doctors have died of COVID 19 as on 1.4.2021 & the frontline HCWs were nurse. Malaise (269, 78.7%), fever (233, 68.1) there is paucity of data on the risk factors for COVID 19 among health- and headache (189, 55.3) were the most common symptoms. Having care workers from India. underlying disease was related to hospitalization (P = 0.012). Being Objectives: To identify the risk factors and challenges in breaking the smoker and participating in intubation procedure were independent chain of infection among COVID infected resident doctors. predictors of hospitalization in HCWs. Methods: A cross sectional study using a structured questionnaire to Conclusion: Frontline HCWs had a significantly increased risk of interview 67 COVID affected resident doctors, was done at National COVID-19 infection. Although adequate supplies of PPE were neces- Institute of Mental Health and Neurosciences, a non-COVID tertiary sary, it did not completely mitigate high-risk exposures. Being smoker healthcare centre, Bengaluru, India, during March 2020 to April 2021. and participating in intubation procedure were independent predic- The data was analysed statistically using the SPSS software version 17. tors of hospitalization in HCWs. Results: 67 resident doctors participated, with a median age of Disclosure of Interest: None declared. 29 years Male to female ratio was 3:2. Patient-facing resident doc- tors (91%) were affected more than the nonpatient-facing(9%)0.55% were fully vaccinated against COVID, 9% infected after first dose, 3% P122 infected within 14 days of the second dose. 33% were unvaccinated SARS‑COV‑2 Risk factors in health care workers: a systematic All were symptomatic and 97% resumed duty after 14 days of isola- review 1,* 1 1 tion. No mortality reported. C. Ben Nasrallah on behalf of 1, I. Zemni on behalf of 1, M. Kacem 2 1 on behalf of 1, A. Ben Cheikh on behalf of 2, W. Dhouib on behalf of 1, 1 1 1 Table 1: Summary of risk factors & challenges in breaking the chain of infection D. Ben Hassine on behalf of 1, H. Abroug on behalf of 1, M. Ben Fredj Risk factorsPercentage* 1 1 on behalf of 1, I. Bouanène on behalf of 1, A. Belguith Sriha on behalf Prioritised practices in the emergency room 24 Long(>6) working hours39 of 1 Overcrowding 3 Department of Preventive Medicine and Epidemiology, Fattouma Bour‑ Inadequate ventilation3 Care of psychiatry patients 3 guiba University Hospital, Monastir, Department of Prevention and Care Interviewing patient bystanders (Psychiatry OPD & wards) 3 Safety, Sahloul University Hospital, Sousse, Tunisia *25% did not identify any risk factor. Correspondence: C. Ben Nasrallah Challenges % Antimicrobial Resistance & Infection Control 10(1): P122 Compromised social distancing in the hospital 45 Inadequate work distribution 21 Delay in testing15 Introduction: Health-care workers (HCWs) are at the frontline of response to coronavirus disease 2019 (COVID-19) and subsequently at higher risk of acquiring the disease. Objectives: We aimed to investigate SARS-CoV-2 risk factors among HCWs using a systematic review. Methods: A systematic review was carried out from January 2020 to th 20 March 2021 on COVID-19 risk factors among HCWs in PubMed and Google Scholar. Medical subject headings (MeSH) were searched using Boolean operators “OR/AND”. The search terms were: (“corona- virus infection” OR “COVID-19” OR “SARS-CoV-2″)” AND (“health per- sonnel”) AND (“risk factors” OR “risk assessment”). We included in our review only papers published in peer-reviewed journals. Results: Twenty-one articles were included in this review. The main associated factors of COVID-19 infection among HCWs were personal protective equipment (PPE) shortage, exposure to infected patients mainly through working in high-risk departments, aerosol generat- ing procedures, working overload, lack of knowledge on SARS-CoV-2 infection control and suboptimal hand hygiene. Our review showed a higher risk of infection among physicians compared with nurses and general services employees. Pre-existing medical conditions, age and male gender were also associated with COVID-19 infection among HCWs. Conclusion: The above observations expose the vulnerability of resi- Conclusion: Lack of PPE, exposure to infected patients, work overload, dent doctors in contracting the infection during patient care due to poor infection control, and preexisting medical conditions put HCWs longer exposure, unavoidable suboptimal compliance to infection at risk of COVID-19 infection. Identifying these factors is of paramount prevention & control practices, inadequate work redistribution strate- importance to develop sustainable measures that protect HCWs espe- gies etc. cially those with higher risk levels. Disclosure of Interest: None declared. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 68 of 140 The analysis of these risk factors is pointing to the need for more effec - tive interventions and occupational health policies. Limitations of the study is that, being a non-covid speciality, the outcome cannot be extrapolated onto a covid care facility. Disclosure of Interest: None declared. P124 Clustering of COVID‑19 infections among healthcare workers: experience from a tertiary care center in Saudi Arabia 1,* 1 2 B. S. Molaeb , M. Saad , Z. Almoosa on behalf of Infection Prevention and Control Department: Dr. Ahmed Sanad, Mrs. Shaymaa El Gamal, Mr. Fadi Mahmoud, Mrs. Bindu Sureendran, Mrs. Carmela Maranon, Mrs. Basma Mowafy 1 2 Infection Prevention and Control Department, Academic Affairs Depart ‑ ment, Almoosa Specialist Hospital, Al‑Ahsa, Saudi Arabia Correspondence: B. S. Molaeb Antimicrobial Resistance & Infection Control 10(1): P124 Introduction: Healthcare workers (HCWs) face an increased risk of infection with the novel coronavirus disease (COVID-19) when effec - tive infection prevention and control (IPC) measures are not care- fully implemented. Little is known about the COVID-19 acquired infections in HCWs and how clusters of infections occur inside and outside hospitals. Objectives: This study aims to provide an overview of the sources of COVID-19 infections in HCWs with emphasis on the identified clusters and highlight the measures taken to mitigate further trans- missions at our institution during the COVID-19 pandemic. Methods: We conducted a retrospective non-interventional study of all HCWs who were diagnosed with COVID-19 infection based on real-time reverse transcription polymerase chain reaction (PCR) test. Clusters were defined as 2 or more COVID-19 infected HCWs with a unique source exposure. Cases were included from April 1, 2020 until February 28, 2021. Contact tracing, active screening and IPC surveillance were performed to investigate all cases and guide effective IPC measures to contain COVID-19 spread among exposed Conclusion: Clustering of COVID-19 infection was common among HCWs. HCWs in our setting. Working in COVID-19 designated wards was not Results: A total of 327 HCWs were diagnosed with COVID-19 infec- associated with an increased risk of acquiring COVID-19 infection. tion; the majority of cases (58%) were community-acquired. Ten Individual-level compliance among HCWs in addition to an integrated clusters involving 55 HCWs were identified. Nine clusters were surveillance strategy and outbreak management are crucial to support related to HCWs who shared hospital accommodations (34 HCWs) the ongoing COVID-19 response. and had social/personal interactions such as sharing meals and Disclosure of Interest: None declared. gathering in same place (19 HCWs). One cluster involved 2 HCWs who were exposed to a COVID-19 patient and was a consequence of failing to abide with IPC measures. None of the clusters occurred in the COVID-19 designated units in which HCWs were more P125 adherent to the IPC measures. Active screening and effective IPC COVID‑19 In healthcare workers: an estimate of the rate plans (including universal masking, optimized cleaning, and rais- of infection in a population sample from Saudi Arabia 1,* 2 1 1 1 ing awareness) resulted in preserving continuity of service during R. Alazmi , M. AlAhmari , H. Alyousif , S. Alsuwaie , Z. Alabdrabalnabi 1 2 the ongoing pandemic. No transmissions from HCWs to patients Infection Preventionist, Respiratory Care, Eastern Health Cluster, Dam‑ occurred. mam, Saudi Arabia Correspondence: R. Alazmi Antimicrobial Resistance & Infection Control 10(1): P125 Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 69 of 140 Abstract video clip description: Introduction: Coronavirus disease Results: By end 2020, DRC notified 17,850 cases of SARS-Cov2, with 2019 (COVID-19) is a devastating ongoing pandemic that has led 78.8% in Kinshasa. 679 frontline staff (FLS) were confirmed positive to millions of deaths in the world. Healthcare workers (HCW) on the for SARS-Cov2, 38.0% of them in Kinshasa. Table I below shows the frontline have also lost their lives and have been at the highest risk of infected FLS by occupational category. infection compared to the general population [1]. This is the first study Category* # infected FLS to estimate the rate of infection among HCW in the Eastern Province n(%) of Saudi Arabia. Nurse240 (41%) Medical doctor 195 (33%) Methods: This is a retrospective cross-sectional study of HCWs work- Lab technician 39 (7%) Hygienist21 (4%) ing at the Eastern Health Cluster in the Eastern Province of Saudi Other** 90 (15%) TOTAL585 (100%) Arabia. Subjects diagnosed with COVID-19 were identified from the *Missing=94 **Paramedical groups: midwives, nutritionists, physiotherapists and security guards. health cluster database and from phone interviews of HCWs with lab- Among the mitigating measures to contain the first wave and strengthen preventive measures in health care settings at the start of the epidemic, a triage system was set up in Kinshasa, in priority health zones, with high incidence in the last 21 days oratory-confirmed SARS-CoV-2 infection. Data related to the possible (Gombe, Limete, Binza Ozone, Binza Météo, Kinshasa and Lemba).The triage system aimed to early detect and transfer all suspicious cases to the treatment center preventing them from entering the health facility. The contamination rate of FLS source of infection, socio-demographics, the containment zone, the infected during the second wave is far lower than the first wave (0.1% vs 3.4%), thanks to the triage system in place and possible infection-induced immunity, despite the emergence of a new wave of cases. type of exposure, and symptoms were collected. The data were ana- lyzed using GraphPad Prism 9 software. The descriptive statistics for the categorical variables were given as frequencies and percentages (n [%]). Results: A total of 4104 HCWs were included in this study. Most of the HCWs (87.1%) with COVID-19 were working in hospitals, and 13.4% were working at primary health care facilities (Table 1). The majority (82.1%) of the HCWs with COVID-19 were symptomatic, and 17.9% were asymptomatic, with only about 2.41% having a travel history. Table 2 shows that 79% of the HCWs acquired the virus in the commu- nity, while only 15% were infected at the hospital. Of those who were infected at the hospital, 62% were infected by co-workers, while 38% were infected by patients. Due to the country’s lockdown, only 2.4% carried COVID-19 from other countries in the world. Conclusions: Health care workers are considered to have the high- est risk of getting SARS-CoV-2. In this study, the majority of infected HCWs acquired the infection in the community and suffered from mild symptoms. References 1. Transmission of SARS‑ CoV‑2: implications for infection prevention precau‑ tions: scientific brief, 09 July 2020 [Internet]. Geneva: World Health Conclusion: With this SARS-CoV-2 pandemic still ongoing, it remains Organization; 2020. (https:// apps. who. int/ iris/ handle/ 10665/ 33311 4,acces imperative to continue work on infection control in healthcare set- sed 22 May 2021). tings to protect FLS and already vulnerable patients. Disclosure of Interest: None declared. Disclosure of Interest: None declared. P128 P127 A qualitative study on safety perception among healthcare Impact of the hospital triage system on SARS‑COV2 infection workers of a tertiary academic care center during the SARS‑COV‑2 among frontline health personnel in Kinshasa, Democratic pandemic Republic of Congo (DRC). 1,* 2 3 4 1,* 1 1 1 1 S. Ehrenzeller , A. Durovic , R. Kühl , A. Martinez , M. Battegay , A. B. Houndjo , N. T. Guinko , R. OKUM , P. Mirindi 1 2 2 1 1 Fringer , M. von Rotz , S. Tschudin Sutter IPC, WHO, Conakry, Guinea, WHO, kinshasa, Congo, The Democratic 3 1 Division of Infectious Diseases and Hospital Epidemiology, University Republic of the, IPC, WHO, kinshasa, Congo, The Democratic Republic 4 2 Hospital Basel, Basel, School of Health Professions, Institute of Nursing, of the, CIP (IPC), World Health Organization, Conakry, Guinea Winterthur, Switzerland Correspondence: B. Houndjo Correspondence: S. Ehrenzeller Antimicrobial Resistance & Infection Control 10(1): P127 Antimicrobial Resistance & Infection Control 10(1): P128 Introduction: In the fight against the pandemic, no country knows Introduction: Protecting healthcare workers (HCWs) from exposure the exact number of SARS-CoV-2 infected people, especially among to SARS-CoV-2 during patient care is central to managing the current health workers: infections in healthcare account for 12–29% of cases pandemic. Higher levels of trust in personal protective equipment (1, 2), and the SARS-Cov-2 severity and mortality in healthcare set- (PPE) and infection prevention and control (IPC) strategies have been tings are higher than in the community (3). Thus, health Personnel previously related to lower levels of emotional exhaustion, yet little is constitutes a priority of infection prevention and control activities known on how to achieve such a perception of safety. when implementing a triage system. Objectives: We sought to identify institutional actions, strategies and Objectives: Describe the impact of implementing a triage system at policies related to HCW’s safety perception during the early phase of health facility level on health workers SARS-CoV2 infection. the pandemic at a tertiary care center in Switzerland by interviewing Methods: We proceed to an in-depth investigation of the SARS-Cov2 HCWs from different clinics, professions and positions. reported cases among healthcare workers and the isolation of suspected Methods: For this qualitative study, 36 face-to-face semi-struc- cases from triages at a SARS-Cov2 treatment center between Mar 10 and tured interviews were performed. Interviews were based on a guide Dec 31, 2020. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 70 of 140 addressing the perception of institutional strategies and policies dur- towards Covid-19 pandemic revealed that 48.6% of participants ing the first phase of the pandemic in March 2020. The participants responded feeling helpless regarding the pandemic at baseline, while included doctors (n = 19) and nurses (n = 17) in senior and non-senior only 12.9% responded this way after second follow-up. positions from eight clinics in the University Hospital Basel, Switzer- Conclusion: The study highlighted optimal level of preparedness land, all involved in patient care. All interviews were audio-recorded towards COVID-19 and its IPC measures among HCWs in both HRF and transcribed verbatim. Data were analyzed using qualitative con- and HCC as reflected by the good knowledge score noted in both tent analysis and organized using MAXQDA (VERBI Software GmbH, baseline and follow-ups. Knowledge was further strengthened in the Berlin). HCC—relatively low resourced facilities as compared to HRF, as shown Results: Five recurring themes were identified to affect perceived by improvement in knowledge after training. Furthermore, IPC train- safety of HCWs during the SARS-CoV-2 pandemic: 1) transparency ing was a key component in improving certain perceptions HCW’s had and clarity of information, 2) communication on the availability of PPE towards COVID-19. (with provision of information alone increasing the feeling of safety Disclosure of Interest: None declared. even if supplies of PPE were reported to be low), 3) uniformity and consistency of guidelines, 4) digital resources to support face-to-face teaching (with personal information transfer still being considered P130 superior in terms of strengthening safety perception) and 5) support Perception and attitude of Tunisian healthcare workers and appreciation for the work performed. towards COVID19 infection prevention Conclusion: This study identifies institutional policies and actions, the 1 2 2 2,* 2 S. Ben Fredj , R. Ghammem , N. Zammit , C. Ben Nasrallah , J. Maatoug , most important of which being transparent communication, influenc - H. Ghannem ing HCW’s safety perception during the first wave of the COVID-19 1 2 Service d’Epidémiologie, “LR 19SP033”, Hôpital Farhat Hached, Service pandemic. Such knowledge reveals potential areas of action critical to d’Epidémiologie, “LR 19SP033”, Université de Sousse, Faculté de Médecine improving preparedness and management in hospitals faced with an de Sousse, Hôpital Farhat Hached, Sousse, Tunisia infectious disease threat. Correspondence: C. Ben Nasrallah Disclosure of Interest: None declared. Antimicrobial Resistance & Infection Control 10(1): P130 Introduction: The covid19 pandemic has been associated with signifi- P129 cant challenges for Healthcare workers (HCWs) due to the high risk to Healthcare workers’ knowledge and perception of COVID‑19 be infected. Inadequate attitudes among HCWs can directly influence pandemic in Faranah, Guinea 1,* 2 1 1 1 practices and lead to spread of disease in the healthcare-settings. L. Landsmann , A. O. Diallo , S. K. Abrokwa , A. Borodova , C. Rocha , R. 1 1 2 1 Objectives: To assess the attitudes of the Tunisian HCWs towards the Wood , M. Arvand , M. Diallo , M. Borchert 1 2 COVID-19 disease and the perception of preventive measures in the Robert Koch Institut, berlin, Germany, Regional Hospital Faranah, worksite. Faranah, Guinea Methods: This cross-sectional healthcare-setting study of HCWs in Correspondence: L. Landsmann private sector, Tunisia, was conducted during the last quarter of 2020, Antimicrobial Resistance & Infection Control 10(1): P129 from September to December 2020. Two-stage cluster sample was performed for needed sample size of 399 participants. For the data Introduction: In response to the COVID-19 pandemic, the WHO collection we used a pretested self-administered questionnaire. soci- launched a strategic preparedness and response plan, outlining public odemographic characters, psychosocial data, perception of preven- health measures to support countries worldwide. tive measure implementation in the worksite and attitudes towards Objectives: Our study aimed to assess the level of preparedness of COVID19 were recorded. The data analysis was performed using SPSS health care workers (HCWs) towards COVID-19 and strenghten HCWs software 20. knowledge and perception of the SARS-COV-2 pandemic and its Results: A total of 506 HCWs were enrolled in the study with a mean related Infection prevention and control (IPC) measures in Faranah, age of 33.8 ± 8.4 years. The sex-ratio was 0.33. About 63% (n = 314) Guinea. of the participants were afraid to contract the COVID19 infection Methods: We conducted a cross-sectional pre- and post-intervention and 93% (n = 461) were frightened of transmetting the virus to their study between april 2020 and march 2021. This consisted of a baseline families. More than half of the HCWs declared that they washed hands assessment, in-person training, an immediate post-training follow-up regularly and weared masks more frequently than the previous infec- and a three months follow-up. Participants were HCWs from the Far- tion wave. Nearly 91% of HCWs respected the social distanciation. anah Regional Hospital (HRF) and two health care centres (HCC). The Three in four respondents (74%) totally agreed that preventive meas- assessment was carried-out using a questionnaire developed based ures were implemented and 62% claimed that the responsibles at the on WHO recommendations. Data was analysed using STATA Version worksite take care of the employees’ health. the majority of HCWs (99%) respected the preventive measures and declared that the clin- Results: There was no significant difference in the overall mean ics’ responsibles will support them in infection case. knowledge score during baseline (32.67 ± 5.81) and second follow-up Conclusion: HCWs reported in this study a high rate of positive per- (33.96 ± 4.04 p < 0.467). Subgroup analysis found significant improve - ceptions and attitudes towards the preventive measures to slow down ment in knowledge for the HCC, but not for the hospital, comparing the COVID19 spreading. Adequate attitudes represent a key compo- baseline (29.35 ± 6.89) and second follow-up (34.38 ± 3.89, p < 0.007). nent for HCWs’ well-being as part of public health measures during Overall, there was significant improvement in knowledge among Aux - this pandemic. iliary Nurses in the HCC (baseline 28.21 ± 6.68, follow-up 33.87 ± 4.26 Disclosure of Interest: None declared. p < 0.010), while no significant improvement was observed in other profession groups in both HRF and HCC. Assessment of perception Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 71 of 140 P131 Introduction: The first case of COVID-19 in healthcare personnel Control measures of COVID‑19 outbreak among non‑clinical (HCP) in Kenya was reported on March 30, 2020 in Nairobi, leading healthcare workers to the closure of a health facility for 41 days from April 1, 2020. This 1,* 1 2 3 H. Ibrahim , S. Alghamdy , S. Abdulhafeez, W. Mazi resulted in the cessation of healthcare services in this 16-bed primary 1 2 3 Public Health, Academic Affairs and Training, Infection Prevention health facility with 61 staff, attending to 300 outpatients and 600 and control, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia methadone access treatment clients daily. Correspondence: H. Ibrahim Objectives: To describe steps taken to re-open a facility after closure Antimicrobial Resistance & Infection Control 10(1): P131 due to SARS-CoV2. Methods: The Kenya Ministry of Health and the United States Cent- Introduction: Coronavirus disease (COVID-19) is a disease caused by ers for Disease Control and Prevention (CDC) jointly conducted a risk the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) assessment of the facility, using a modified World Health Organization and transmitted by both respiratory droplets and contact with respira- six-element infection prevention and control (IPC) facility risk assess- tory secretions. Community, hospital, and residency outbreaks have ment tool. been reported worldwide. Results: Of the six domains assessed, the IPC program scored 40% Objectives: To describe the pattern and control measures of COVID- across all elements, personal protective equipment (PPE) 60%, and 19 outbreak among non-clinical healthcare workers. cleaning and disinfection 70%. Key findings from the assessment Methods: A retrospective study to control COVID-19 outbreak among included breaches in IPC measures including poor ventilation in most non-clinical healthcare workers was applied from June to August service delivery areas; observed lack of physical distancing; inad- 2020 in a tertiary hospital, Saudi Arabia. Active surveillance and traced equate information, education, and communication (IEC) materials their contacts were conducted using the MOH standards tracing related to COVID-19; lack of standard operating procedures (SOPs) form. Nasopharyngeal swabs were taken for SARS-CoV-2 screening. on cleaning and disinfection of the high touch areas, insufficient IPC Infected staff was quarantined immediately. Intervention measures training, inadequate hand hygiene facilities and PPE supplies, and an were implemented including, hand hygiene, social distance restric- inactive IPC committee. tions, universal masks, and daily monitoring of symptomatic workers. We recommended improving the ventilation and changing patient Isolation of infected staff and restriction from the work for 14 days flow patterns in the facility and serving pharmacy clients outside, was applied and followed by clinical assessment for back to the work. enhanced cleaning and disinfection of high touch surfaces, providing Room size was standardized to 4 square meters for two persons as PPE to HCP and clients, installing PPE donning and doffing stations, recommended by the CDC guidelines. Male residency is completely displaying IEC materials in strategic locations, disseminating SOPs for physically separated from the female hostel. HCP risk assessments, activating the IPC committee, and establishing Results: Ninety-eight non-clinical healthcare workers were confirmed an OSH program. The health facility re-opened on May 11, 2020. positive for SARS-CoV-2. There were sixty-five cases reported in June Conclusion: The IPC facility risk assessment tool was useful in identify- and gradually declined to thirty, three, and zero in July, August, and ing problem areas leading to remediation measures. September, respectively. The bulk of the cases occurred among the Disclosure of Interest: None declared. male gender of biomedical, general engineering staff, and administra- tion personnel (36%) followed by other categories. The most affected age group was (30–39 years old) with five hospitalized and two P134 deaths. All male of biomedical staff was got the infection within two Assessment of protective measures for healthcare workers weeks which is correlated to the congested basement work location. in the context of the COVID‑19 pandemic at university hospital However, none of the biomedical female staff were reported positive center of Angre, (Abidjan ‑ Cote D’ivoire) due to fully physical separation workplace area; compared to the male 1,* 2 I. Kouakou , N. E. fatto section. medical biology chu angre, université felix houphouet boigny, abidjan, Conclusion: Congestion with closed and poor ventilated workplace medical radiology, université felix houphouet boigny, abidan, Côte areas increase the risk of SARS-CoV-2 transmission. Physical separation d’Ivoire limits the spread transmission of the infection. Infection prevention Correspondence: I. Kouakou measures should be implemented for all healthcare workers including Antimicrobial Resistance & Infection Control 10(1): P134 non-clinical healthcare workers. Disclosure of Interest: None declared. Introduction: Healthcare personnel are at an increased risk of acquir- ing COVID-19 infection especially in resource-restricted healthcare set- P133 tings. Health workers are crucial to the successful implementation of Safely re‑opening a healthcare facility in Nairobi, Kenya infection prevention and control strategies to limit the transmission of after closure due to SARS‑COV‑2 infection in healthcare personnel SARS-CoV-2 at healthcare facilities. 1,* 2 2 L. K. Ndegwa , D. Kimani , M. Njeru Objectives: The aim of our study was to determine the personal pro- 1 2 DGHP, DGHT, CDC, Nairobi, Kenya tective equipment (PPE) knowledge and attitudes of health workers in Correspondence: L. K. Ndegwa tertiary hospital. Antimicrobial Resistance & Infection Control 10(1): P133 Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 72 of 140 Methods: A cross-sectional study design was used. The knowledge, P136 attitudes and practices (KAP) survey was part of a rapid appraisal of Outcomes of asymptomatic hospital employees the COVID-19 occupational health and safety response in the intensive in COVID‑19‑post‑exposition quarantine during the 2nd care and emergency departments of the hospital of Angre. A struc- pandemic wave in Zurich 1 1 1 1,* tured self-administered questionnaire was used. Only doctors, nurses L. Steinwender , J. Burkhard , D. Holy , I. Uçkay and nursing assistants were included in may 2021. Balgrist University Hospital, Zürich, Switzerland Results: A total of 50 health workers at different levels of care partici- Correspondence: I. Uçkay pated in the survey. Nurses were the first to know the usefulness of Antimicrobial Resistance & Infection Control 10(1): P136 PPE in 51% of cases followed by doctors 37%. Regarding the surgical masks, 90% of the participants knew their usefulness. only 23.8% knew Introduction: The benefit of routinely putting asymptomatic hospital the characteristics of the mask type N95 and 21% did not know which employees, after close contact to Covid-19 cases, into a ten-days’ post- of the masks protected most against covid-19. A few participants did exposition quarantine must be evaluated. not know the need to wear gloves. Half of participants indicated they Objectives: Evaluate the clinical accuracy of the auarantine measures receive training on the correct use of PPE (58%). among young asymptomatic healthcare workers. To define substrata fpr Conclusion: Our results showed that personal protective equipment exposition, fow which the quarantine is rasonable. are used inappropriately by healthcare workers (HCWs). We recom- Methods: Retrospective cohort analysis of hospital-own databases of mended that public health education be targeted towards the cat- the Services of Human Resources, Occupational Medicine, and of Infec- egories of HCWs with high-risk practices and attitudes to achieve the tion Control at the Balgrist University Hospital in Zurich, Switzerland, st necessary control measure been instituted by the hospital. between October 1 and 31 December 31, 2020. nd Disclosure of Interest: None declared. Results: During the most intensive months of the pandemic 2 wave, we assessed 376 episodes of Covid-19-compatible symptoms; of whom 94 (25%) were positive. Among all positive episodes, the proportion of P135 those with prior quarantine was 11% (10/94 cases). The reason for the From isolation to safe opening; a proposal for safe healthcare quarantine order was transient exposure in 278 cases, and an iterative delivery in Al‑Azhar university hospitals (permanent) exposure (e.g. within the family) in 98 episodes. Among 1 2 3 4 1 R. Alsharnoby , S. Fawaz , A. Hamada , S. Hatmalla , E. Gamal , M. the 81 employees in quarantine, ten (12%) became symptomatic after 5,* Abdelnasser a median interval of five days following the last exposure (range, 3–11 1 2 3 4 Infection Control, Quality, Director, Deputy, Maintenace, Al‑Azhar d). All ten secondary Covid-19 cases during quarantine were due to a Specialized Hospital, Microbiology & Immunology, Faculty of Medicine, permanent exposure. No employee with transient exposure developed Al‑Azhar University, Cairo, Egypt. symptoms. The quarantine led to an estimated loss of 810 full workdays Correspondence: M. Abdelnasser within three months. Antimicrobial Resistance & Infection Control 10(1): P135 Conclusion: Among our hospital employees and during the peak nd months of the 2 pandemic wave, the risk for developing a sympto- Introduction: In March 2020, when the WHO announced COVID-19 matic, PCR-confirmed, Covid-19 disease during a post-expositional virus as a pandemic, Al-Azhar University Specialized Hospital has been quarantine was 12%, and essentially concerned persons with a history allocated as an isolation hospital. In June 2020, the number of admit- of iterative exposure. In hospitals, the decision for quarantine among ted Covid-19 patients was decreased gradually. So, an integrated plan employees should equally base on nature of the individual exposure. has been designed for safe opening. Disclosure of Interest: None declared. Objectives: The aim of this plan was to control and limit the spread of Covid-19 virus, in order to ensure the safety of the hospital’s employ- Poster session: SARS‑CoV2: infection control measures ees and for the hospital’s keenness to work proactively. and transmission Methods: A general framework for proactive measures to restart and return to work was laid by a group of infection control, quality P137 improvement, safety, maintenance and administration in May 2020. Infection control in the COVID hospital The implementation steps were based on three axes: environmental 1,* 1 1 1 O. Orlova , O. K arpov, V. Gusarov , A. Pivkina insurance, safe work environment and employee safe return. Pirogov National Medical and Surgical Center, Moscow, Russian Federation Results: The implementation of this plan has been started in July st Correspondence: O. Orlova 2020. In the 1 axis, the hospital was closed for one week with a com- Antimicrobial Resistance & Infection Control 10(1): P137 plete clearance of the work site and maintenance of all floors and walls nd was done using antibacterial paints. In the 2 axis, offices were redis- Introduction: The increase in the incidence of new coronavirus infec- tributed (at least 1.5 m between desks) and cleaned on a daily basis. tion (COVID-19) has led to the re-profiling of hospitals for the treat - Thermal examination was done at external hospital gates. Staff health ment of this group of patients. clinic was ready just in case for those with symptoms of high tempera- Objectives: To convert the surgical center into a COVID Hospital in ture, fatigue, etc. Awareness panels on hand hygiene were distributed. compliance with infection safety measures. A timetable was made for daily collection of waste. Elevators were rd Methods: Carrying out a complex of organizational, engineering and cleaned and disinfected daily and as required. In the 3 axis, employ- epidemiological measures. ees were asked to conduct Covid-19 markers and CT Scan (Chest). Results: Within three days, the building was completely cleared of Approval to return was taken by chest consultant, directors of infec- patients, the territories for finding patients (infectious zone) and medi- tion control and human resources. cal personnel (clean zone) were determined, which were separated by Conclusion: Safe opening was a challenge in in our hospital. A plan with erected sanitary checkpoints for medical personnel. In order to mini- proactive measures are still in place. The plan was designed to ensure mize the risk of inhalation of the viral aerosol, the infectious zone of the safe hospital and work environment. It also stressed on safe return sanitary checkpoint was divided into two rooms, the first – to remove for employees and visitors. A triage clinic was also launched for both the protective suit, the second—to remove the second pair of gloves, employee and patients, a respirator, a cap and further treatment of exposed areas of the body Disclosure of Interest: None declared. with 70% alcohol. The separation of the traffic flow of cars, employ - ees and patients was carried out. The traffic flows in the Hospital were determined, and elevators for traffic flows of different epidemiological significance were identified and marked. In the clean area of the Hos- pital, rooms were organized for food, rest and work of the staff, with the installation of dispensers to ensure regular hand treatment. The Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 73 of 140 Hospital deployed autonomous clinical diagnostic and microbiologi- Introduction: In July of 2020, USAID’s MOMENTUM and Country Global cal laboratories to exclude the possibility of delivering potentially dan- Leadership began implementation of a water, sanitation, and hygiene gerous material to other buildings of the Center, which was especially (WASH) and Infection Prevention and Control (IPC) intervention aimed at important given the ongoing planned work in other buildings of the improving outbreak readiness and behaviors in five countries in 154 pri- Center. A disinfection chamber and a site for decontamination of medi- mary and secondary facilities: Sierra Leone (26), Ghana (25), Uganda (25), cal waste were allocated. Prior to the admission of patients, practical India (61), and Bangladesh (17). training was conducted for all Hospital staff. In order to prevent the Objectives: The project conducted initial readiness and behavioral spread of COVID-19, a smear test for SARS-CoV-2 was organized for all observations followed by training using quality improvement meth- Hospital staff once a week. In the premises of the clean zone in acces- odologies, provision of IPC supplies and equipment, and infrastruc- sible places were installed skin antiseptics for hand treatment. ture rehabilitation and will be followed by an endline assessment. This Conclusion: The result of the conversion was the deployment of a presentation will explore the findings of these assessments. hospital with 280 beds, including 33 intensive care units. The hospital Methods: The project developed a standard weighted IPC and WASH was open for three months. During the operation of the hospital, 1149 readiness assessment tools based on the WHO Infection Prevention and patients were treated, of which 154 (13.4%) were treated in intensive Control Assessment Framework and the WHO/UNCIEF Joint Monitoring care units. Program indicators for WASH in healthcare facilities, then incorporated Disclosure of Interest: None declared. additional questions based on national tools and guidelines. Data was collected using digital tools and dashboards were developed to facili- tate data sharing. The data collected guided a quality improvement P138 strategy using a hub and spoke approach using both in-person and vir- Standard precautions and nursing professionals: a pilot study tual trainings along with training visits by staff specializing in IPC and on adherence in times of COVID‑19 pandemic 1,* 1 1 1 moderated WhatsApp groups to facilitate dialogue between Quality J. F. F. C. Cordeiro , D. C. Cordeiro , T. A. D. Cruz , I. F. L. Fracarolli , T. G. 1 1 1 1 Improvement facilitators and facility staff. Monthly behavioral audits Santos , E. B. G. Gomide , D. D. Andrade , A. P. D. Santos were also conducted to gauge improvements in hygiene behaviors and Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto, Brazil use of personal protective equipment. Correspondence: J. F. F. C. Cordeiro Results: Except for Ghana, the initial readiness assessment scores for Antimicrobial Resistance & Infection Control 10(1): P138 the facilities were low: Sierra Leone (39.35%), Ghana (83.52%), Uganda (50.89%), India (45.71%) and Bangladesh (41.07%). Final assessments Introduction: Standard precautions (SP) are measures recommended are to be completed by July 2021, except for Sierra Leone, which by the World Health Organization for infection control. There are wide- completed its endline assessments in April 2021. Sierra Leone saw its spread recommendations of security measures during the COVID-19 facility IPC readiness scores improve from 39.35% in October 2020 to pandemic. 67.77% in February 2021. Behavioral audits also saw improvement in Objectives: to investigate adherence of a nursing professionals outpatient handwashing behaviors increaseing from 49 to 84%. PPE regarding SP during the COVID-19 pandemic and to examine the use increase by 25% (64% to 89%). association among length of experience, professionals with graduate Conclusion: Preliminary findings demonstrate the importance of ade - degrees and workplace setting with the percentage of adherence. quate supplies and infrastructure coupled with training on best prac- Methods: A pilot cross-sectional study was conducted using a vali- tices and monitoring of behaviors, to improve IPC readiness. dated questionnaire. Nursing professionals working in the front line of Disclosure of Interest: None declared. the COVID-19 pandemic in the State of São Paulo, Brazil, participated in the study. Data were analyzed using descriptive statistics and pre- sented using absolute and relative frequency. Pearson’s Chi-square P140 test (X ) was used to verify the association between length of experi- Does COVID‑19 trigger changes in attitudes and behaviour ence (years working in nursing), completion of postgraduate studies of respiratory infection prevention measures? First results (certification, master’s and doctorate), workplace (public or private) of of health‑care‑associated influenza prevention project (HAIP) 1,* 1 2 2 3 nursing professionals, and the percentage of total adherence to SP.D. Flury , M. Schlegel , I. Kramer , M. Schubert , D. N icca Results: 169 nursing professionals were evaluated, being 49 (29%) Infectious disease and hospital hygiene, Kantonsspital St.Gallen, aged between 18 and 24 years old, 44 (26%) with ≤ 1 year of experi- St.Gallen, Zürich university of applied Science, University of applied Sci‑ ence in nursing, 81 (48%) with postgraduate studies, and 91 (53.8%) ence, Winterthur, Institute for Epidemiology, Biostatistics and Prevention, were employed in private health institutions. In terms of adherence to University of Zürich, Zürich, Switzerland the SP, 157 (92.9%) performed hand hygiene in the intervals of care, Correspondence: D. Flury with greater adherence after being in contact with biological material Antimicrobial Resistance & Infection Control 10(1): P140 165 (97.6%). The majority of the participants reported always using gloves. There was no adequate adherence to the use of safety glasses, Introduction: Results of the HaIP showed that during the last influenza hats, handling with sharps or the notification of accidents at work. seasons attitudes and adherence with infection preventive measures Chi-square test did not reveal significant association among the condi- against the transmission of influenza remained stable. tions: length of experience, completion of graduate studies and work- Objectives: To describe changes in attitudes and behaviour of health place of nursing professionals, with the percentage of total adherence care worker (HCW) in infection prevention measures (wearing mask, 2 2 2 to SP ( X = 0.033; p = 0.855), (X = 0.006; p = 0.940), (X = 1.031; hand hygiene, Influenza vaccination) during winter season before and (1) (1) (2) p = 0.597), respectively. after COVID-19. Conclusion: Nursing professionals’ adherence to SP was found to be Methods: We collected data on 3 pilot wards during Influenza- below the ideal recommendation. Length of experience, having an season 19/20 and 20/21 in the cantonal hospital of St.Gallen, a advanced degree or workplace setting did not influence adherence to tertiary 700-bed hospital in eastern Switzerland. Adherence with SP. hand hygiene was recorded by clean care monitor from Swissnoso Disclosure of Interest: None declared. according to the 5 moments ( WHO). Data on Influenza and COVID- 19 vaccination rates were obtained by personal medical services. HCW’s perceived importance of- and self-reported behaviour of P139 influenza preventive measures were assessed with a question- Improving wash and IPC readiness and behaviors in five naire. In 20/21 the questions were adapted to cover for COVID-19. low‑income countries in response to COVID‑19 1,* 1 1 Results: Observed adherence with hand hygiene increased signifi- J. Lopez, T. Ashengo , S. Sara cantly from 68 to 78% (p < 0.001) as did self-reported adherence Momentum Country and Global Leadership, Washington, United States to wearing mask from 10 to 98% (p < 0.001). The other observed Correspondence: J. Lopez behaviours where not significant (table1a). Influenza vaccination Antimicrobial Resistance & Infection Control 10(1): P139 Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 74 of 140 rate reminded low over both seasons. Self-reported and observed Participants were randomly selected from the new declared cases in Covid-19 vaccination rate was significantly higher than influenza- the governorate of Sousse during November 2020. vaccination rate (32% versus 17% and 27% versus 10%). The Data were collected using a pre-established and pre-tested question- perceived importance of hand hygiene remained high, the atti- naire administered during phone calls interviews with trained medi- tudes toward own influenza vaccination did not change over the cal doctors. The frequency of the compliance with hygiene measures seasons(Table1b). A relevant change can be observed in mask was evaluated using a five item scale with the following possible wearing which was perceived as with low importance(2 out of 10) responses: (“do not remember”; “never”;”sometimes”; “often” and “all before the SARS-CoV2 pandemic and most important(10out of10) the time”). thereafter. Results: A total of 375 participants were included. The median age of participants was 40.0 (IQR: 29.75–54.25) years. Females represented 60% of them. Among participants, 359 (95.7%) consider that social distancing is an efficient collective preventive action. Before the COVID-19 infection episode, this measure was not easy to respect for 121 (32.3%) participants. Besides, compliance all the time with mask wearing, coughing into the elbow and hand hygiene were reported by 49.1%, 41.9% and 58.9% of participants respectively. Otherwise, dur- ing the confinement, 95 (25.4%) participants declared not respecting the quarantine and 111 (29.6%) participants transmitted the infection to their family members. Conclusion: The current national awareness compaign should be reinforced in Tunisia in order to enhance compliance with collective and individual preventive measures. Use of social media, involving leaders and enforcing the law may increase people’s adherence to hygiene rules. Disclosure of Interest: None declared. P142 SARS‑COV‑2 infection control measures in a Spanish tertiary hospital: a multimodal strategy 1,* 1 1 1 1 2 P. Puche , M. Herranz , C. Hidalgo , S. Suclupe , A. Paez , S. Ruiz , M. M. 3 1 Montero , C. Gonzalez Infection Control Program, Department of Epidemiology and Evaluation, 2 3 Occupational Health Department, Infectious Disease Department, Parc Salut Mar, Barcelona, Spain Correspondence: P. Puche Antimicrobial Resistance & Infection Control 10(1): P142 Introduction: There are different elements of a multimodal strategy Conclusion: The emergence of the COVID-19 pandemic had an impor- to implement preventive measures and control the nosocomial trans- tant impact on attitudes and behaviour of infectious disease preven- mission by SARS-CoV-2. tion measures. As expected the change could be perceived in attitude Objectives: To describe multimodal strategies used with the frontline and the behaviour toward wearing a mask but also increased the healthcare staff (HCS) to implement SARS-Cov-2 preventive measures adherence with hand hygiene. Vaccination coverage has been and in the hospital. remains low for both COVID-19 and Influenza but the significantly Methods: Design: Descriptive study of preventive measures in Hospi- lower readiness for influenza underscores the specific vaccination tal del Mar, from August 2020 to February 2021. scepticism about influenza. Inclusion Criteria: Medical and surgical departments; Exclusion Crite- Disclosure of Interest: None declared. ria: Outpatient visits department. Strategies implemented: Strategies were led by the nurses of Infec- tion Control Program (ICP) with interested allies across the hospital. P141 Education and Training: HCS were taught when and what type of Per- Compliance with preventive measures before and during home sonal Protective Equipment (PPE) to use and how both donning and quarantine among a Tunisian cohort of COVID‑19 patients doffing them. 1,* 1,2 1,2 1,2 1 R. Bannour , N. Zammit , R. Ghammam , S. Ben F redj , A. Eleuchi , I. Monitoring and feedback: Observations, one to one conversations, 1 1,2 1,2 Mlouki , J. Maatoug , H. Ghannem and supportive supervision helped the staff to improve performance. Department of Epidemiology (LR19SP03), university hospital Farhat Reminders and communications: To promote protocols and stand- Hached Sousse, Faculty of Medicine of Sousse,, University of Sousse, ardize the desire actions at the right time, illustrated friendly remind- Sousse, Tunisia, Sousse, Tunisia ers were posted on the door of rooms. Correspondence: R. Bannour Results: Education and training: The ICP and the occupational health Antimicrobial Resistance & Infection Control 10(1): P141 department carried out training sessions for HCS leaders from each department and shift. There were 78 participants among nurses, aux- Introduction: Until now, there is no specific treatment to beat the iliary nurses, medical doctors, porters, and general service staff. More COVID-19 disease. Regarding the scarcity of vaccines, compliance with than half were nurses (53.8%), and the medical area staff had more collective and individual preventive measures remain the most impor- participation than surgical, emergency, ICU, and midwifery area. tant weapon against this new disease in developed countries. Monitoring and feedback: From 696 observations across wards, in the Objectives: To assess compliance with collective and individual pre- beginning, the compliance of the appropriate use of PPE was 58.6% ventive measures among COVID-19 patients before and during home however in February increased to 81.3%. quarantine in the governorate of Sousse. Reminders and communications: Each door of the rooms had a Methods: A prospective longitudinal study of three months was led reminder about the use of preventive measures: hand hygiene when among a cohort of 375 patients with COVID-19 isolated at home. entering and leaving the room, use of gloves, gown, and facemask Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 75 of 140 inside the room, use shields/goggles if necessary, and keep the door (April to June 2020). Our approach consisted of assessing the HCWs closed unless the patient has no respiratory symptoms. regarding the IP (contact + droplets) and HH compliance, associated Conclusion: Multimodal strategies may be applicable to promote pre- with a evaluation of hospital structure to supporting HCWs in these ventive measures in the pandemic context. Improvement in PPE com- practices. For this assessment, a check list was built based on the WHO pliance was observed after training, monitoring, and feedback. recommendations for prevention of COVID-19. We considered: the pro- Disclosure of Interest: None declared. fessional category; appropriate PPE use according to the activity per- formed; PPE proper placement; PPE proper withdrawal; HH at the right moments (5 moments), and proper hospital structure (including: avail- P143 ability of PPE and alcoolic solution in the point of care). Practice of standard precautions by Tunisian teaching hospital Results: 1867 observations were performed among 225 health care health care workers (HCW) within the COVID‑19 epidemic professionals. The HCWs were: nurses, nursing technicians, doctors and in March 2020 physiotherapists. The data were stratified into IP conformity, hand higy - 1,* 1,2 1,2 1,2 1 1 A. Gara , B. Sana , A. Ben Cheik h , H. Ghali, W. Dhouib , R. Bannour , ene compliance and appropriate struture of hospitals to supporting the 1 1,2 1,2 S. Khfecha , H. Said Latir i , M. Ben Rejeb IP and HH (table 1). The overall rate conformity of HCWs related the IP Department of Prevention and Security of Care, Sahloul university hos‑ were 84%. General HH compliance of HCWs evaluated were 56%. Con- pital, Sousse, Tunisia, Sahloul university hospital, Sousse, Tunisia, Faculty sidering the structure of the hospitals to supporting IP and HH practices, of Medicine of Sousse, University of Sousse, Sousse, Tunisia, sousse, we identified that 81% of the hospitals had an appropriate structure. Tunisia Correspondence: A. Gara Antimicrobial Resistance & Infection Control 10(1): P143 Introduction: The current outbreak of the SARS-CoV-2 all over the world requires strengthening the practice of preventing measures particularly in healthcare settings. Standard Precautions (SP) are the minimum infection prevention practices designed to both protect and prevent from spreading infection among patients. Within this frame- work we aimed to assess the practice of standard precautions among healthcare workers (HCWs) in a tunisian teaching hospital over this outbreak in March 2020. Objectives: degree of compliance with standard precautions by health care workers and readness to face the Covid-19 epidemic in a tunisian teaching hospital over this outbreak in March 2020. Methods: This is an audit of the practice of SP by direct observation over a period of one month during the first wave of the covid- 19 Conclusion: We identified an important weakness in adherence to hand outbreak (March 2020).We implemented an observation grid gather- hygiene among health professionals, despite the most part of hospitals ing recommandations relative to the six axes of SP. This grid was built presented an appropriated structure to supporting this practice and the considering the new recommandations supported by French Society IP. These findings can be explained by the fear that professionals would of Hospital Hygiene in 2017. become infected at the beginning of the COVID-19 pandemic. This led Results: The highest compliance was for excreta management 87.2%, us to work specifically and strongly to align this practice, ensuring the followed by prevention of accidents with exposure to blood 79.4%, safety of patients and HCWs. then Respiratory Hygiene 69.6%, environmental management 68.1%, Disclosure of Interest: None declared. Personal Protective Equipment 60.9% and Hand Hygiene was the low- est 57.1%. P145 Conclusion: These results demonstrate an acceptable level of engage- Development of three aide‑memoires to improve standard, ment in the prevention and control of the infectious risk in the hos- droplet/contact and airborne transmission practices pital besides of an institutional mobilization to face the Covid-19 and behaviours 1,* 1 epidemic. therefore, it is recommended to multiply the evaluations to C. Kilpatrick , A. P. Coutinho‑Rehse verify these conclusions. Likewise, the training axis is essential to per- WORLD HEALTH ORGANISATION, Copenhagan, Denmark petuate the optimal practice of standard precautions. Correspondence: C. Kilpatrick Disclosure of Interest: None declared. Antimicrobial Resistance & Infection Control 10(1): P145 Introduction: The World Health Organization (WHO) recommends P144 the use of multimodal improvement strategies (MMIS) to implement Isolation precautions and hand hygiene compliance facing IPC interventions. These include each item of standard and transmis- COVID‑19 pandemic: analysis of a group of Brazilian hospitals sion-based precautions according to national guidelines or standard 1,* 1 1 2 L. M. Abraão , D. Cais , S. Lessa Pires , F. Colombari operating procedures and under the coordination of the national IPC 1 2 Infection Control Service, Medical Practices, Americas Medical Ser‑ focal point (or team, if existing). In 2020, a rapid review of WHO IPC vices—UHG Brazil, Sao Paulo, Brazil guidance, including for COVID-19, was undertaken to address WHO Correspondence: L. M. Abraão European region country needs with regards to implementation and Antimicrobial Resistance & Infection Control 10(1): P144 improvement tools. Objectives: To develop targeted improvement tools to support IPC Introduction: To COVID-19’s facing strategies is important to ensure guidance into action (GTA) in WHO European region countries. the rational and appropiate use of aff PPE, not only masks, wich Methods: The topics for new improvement tools were decided upon requires correct and rigorous behavior from heath care workers— and text drafted. A first online consultation (29 June-13 July 2020) HCWs, but particularly in doffing procedures off personal protective included WHO and country experts. The questions took account of equipment- PPE and hand hygiene—HH practices (WHO,2020). theory of change concepts, resource use, values and preferences Objectives: The objective of this study was to evaluate the appropri- (figure 1). Feedback informed significant changes to the tools. The ate use of PPE in the isolation precautions—IP, the HH compliance second consultation, November 2020, involved WHO headquarters among HCWs and the hospital’s structure to support these practices. and regional office experts. It comprised an interactive 90-min virtual Methods: A prevalence study was conducted in a group of 16 hospitals discussion, with materials shared in advance and by asking three key from four different states in Brazil, during the period of three months Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 76 of 140 questions, iteratively seeking final validation. A final follow up exercise Results: Over the two months, the overall staff compliance with screen- in 2021 verified accuracies in the final products. ing efforts increased from 59 to 89%, with the most considerable Results: A new WHO Europe document consisting of three focused, improvements seen in mask possession and recording of contact details improvement tools called aide-memoires was launched in May 2021, at the entrance. Correct mask use within the premises improved from 23 targeted at IPC focal points. The three aide-memoires are; 1) respira- to 47% and ownership of personal ABHR from 39%—61%. tory and hand hygiene, 2) personal protective equipment and 3) envi- Conclusion: Strengthened administrative controls lead to measurable ronmental cleaning, waste and linen management. Each consists of improvement in compliance with IPC. Workplace settings should actively action checks structured around the five elements of the MMIS https:// monitor for compliance, with constant reminders on best practices for w w w . eur o. who. in t/ en/ health- t opics/ disea se - pr ev e n tion/ an tim icr ob occupational exposure to COVID-19 since changing behaviour takes time. ial- r esis tanc e/ publi ca tio ns/ 2021/ inf ec tion- pr ev e n tion- and- c on tr ol- Disclosure of Interest: None declared. guida nce- to- action- tools- 2021. P147 Strengthening infection prevention and control practises at grassroot level 1,* 1 2 3 1 V. Singh , A. Prasad , P. Gupta , S. Rao , P. Gupta Microbiology, All India Institute of Medical Sciences Rishikesh, Rishikesh, 2 3 Microbiology, AIIMS Bilaspur, Bilaspur, Pathology, All India Institute of Medical Sciences Rishikesh, Rishikesh, India Correspondence: V. Singh Antimicrobial Resistance & Infection Control 10(1): P147 Introduction: The emergence of COVID-19 pandemic across the globe has underlined the need to enable the medical graduates to be prepared for the unknown. The health sector has been severely affected by the COVID-19 pandemic and there is acute need to maximize trained health care task force and improve the existing healthcare facilities. Due to man- power crisis, the government of India announced to utilize services of Conclusion: These are the first GTA tools to focus on the detail of final year MBBS students. This study was aimed to train the medical stu- ‘how’ to improve standard and transmission-based precaution prac- dents and prepare them to work as frontline workers. tices and behaviours by describing actions that comprise the five Objectives: The objective of the study was to assess the effectiveness elements of the WHO MMIS. The action checks included in each are of flipped classroom teaching of MBBS students for infection preven- informed by WHO IPC guidance, as well as input from experts, and tion and control practices. are importantly rooted in a proven improvement approach acting as Methods: A quasiexperimental cross-sectional study with pre-test and reminders of things to do in the real world. post-test design, using Google Questionnaire forms for tests, was con- Disclosure of Interest: None declared. ducted at a tertiary care center in North India. Pre-test was conducted 2 days prior to training class and then the students were provided with study material including powerpoint and video lectures pertinent to P146 standard and additional precautions. Data was analysed using descrip- Improving compliance to workplace prevention and control (IPC) tive statistics, Chi-square test, Fisher’s t-test and ANOVA. measures during the COVID‑19 pandemic in a non‑healthcare Results: The results of study suggested that the training format was effi- setting cient with significant increase in level of knowledge post training from 1,* 1 1 1 1 A. Wailagala , R. Ayebare , F. Mayanja , M. Kesande , D. Omagor , M. 16.3% of students with scores more than 70% in pre-test to 57% of stu- 1 1 1 1 Laker , S. Lamunu , M. Lamorde , A. Kambugu dents with > 70% scores post-test. The mean scores of students in pre and Infectious Diseases Institute, Kampala, Uganda post tests are shown in Table 1. There was significant association found in Correspondence: A. Wailagala between gain of knowledge and gender and status of previous training Antimicrobial Resistance & Infection Control 10(1): P146 received during last 6 months.Comparison of Mean knowledge scores. Introduction: Information on non-healthcare setting Infection con- TOTAL TEST SCORE=36 PRE-TEST POST-TEST Sig (2-tail) trol measures, especially in the Context of the COVID-19 pandemic is scarce. The Ministry of Health Uganda instituted national lockdown MEAN (S.D.) 22.76 (2.74) 26.39 (4.06) 0.001 to minimize the spread of the SARS CoV2 virus, which has progres- sively eased since July 2020. The Infectious Diseases Institute (IDI) established measures to ensure workplace safety for staff, visitors, and service providers. However, monitoring compliance is crucial for the standards to have an impact. Objectives: This survey aimed to monitor and improve staff compliance with the prescribed criteria for workplace safety for over two months. Methods: A baseline survey using a pretested tool was done in August 2020 to check staff compliance to the different IPC mitigation meas- ures at IDI. This survey’s feedback informed an enhancement of work- place safety measures, including encouraging working from home, reducing office occupancy to about 30% of the pre-pandemic capac - ity, and mandatory use of face coverings. The evaluation was followed by a second survey in October 2020 to assess changes in compliance following the enhancement of IPC mitigation measures. The metrics assessed include; Compliance with screening procedures at the entrance (Hand hygiene, face mask possession, Temperature measurement, and Registration). Assessment of proper face-covering use and number of staff carrying personal ABHR was done by directly observing and asking a convenient sample of staff on each of the building complex’s six levels, respectively. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 77 of 140 Conclusion: In the present scenario, there is constant need to train Introduction: Cho Ray is the largest general hospital in the south of the medical students regarding infection control especially regard- Vietnam with daily 3,000 inpatients and 6,000 outpatients. Daily, Cho ing standard and additional precautions. Infection prevtion & control Ray hospital (CRH) receives 20,000 people including; patients, patient’s should be included in curriculum of medical students. The Flipped relatives, and healthcare workers. Annually, CRH deals with several Classroom model may not be perfect answer for training of MBBS outbreaks such as season influenza A/H1N1 and a potential invasion students amidst COVID-19, nonetheless this model was found to be of other severe infection from foreign countries such as bird flu A/ immensely relevant in this study. H5N1, A/H7N9, Ebola, MER-CoV. COVID-19 pandemic appeared as the Disclosure of Interest: None declared. first case in CRH and a second case outside of China in January, 2020. To successful handle of COVID-19 pandemic, we make cross-sectional descriptive study to find factors to contribute the success in COVID-19 P148 pandemic control and prevention in Cho Ray hospital. Impact of the COVID‑19 pandemic on infection control Objectives: Finding factors to contribute for well COVID-19 control practices in a tertiary‑care Spanish hospital: preliminary results and prevention in Cho Ray hospital. from a survey Methods: Using infection surveillance system and cross-sectional 1,* 1 1 1 G. Abelenda‑Alonso , M. Puig‑Asensio , A. Hornero , A. Rombauts , C. descriptive study to review all factors that can be effect on COVID-19 1 1 1 1 1 Gutiérrez , E. García‑Lerma , E. Jiménez‑Martínez , C. Tebé , M. Pujol , J. control in Cho Ray hospital. Carratalà Results: Our research demonstrates that these factors are keywords to Bellvitge University Hospital, Barcelona, Spain succeed COVID-19 control and prevention in Cho Ray hospital includ- Correspondence: G. Abelenda‑Alonso ing; 1) administrative control; 2) establishment of protocols and treat- Antimicrobial Resistance & Infection Control 10(1): P148 ment zones for COVID-19 in preparation for all scenarios of increasing outbreak; one department knockdown, more than two departments Introduction: Hospitals rapidly prepared to identify, isolate, and take knockdown, and hospital knockdown; 3) infection control training care of SARS-COV-2 cases while ensuring health-care workers (HCWs) for healthcare workers in pandemic: 2000 healthcare workers annual safety. Initial shortages in personal protective equipment (PPE) and and pandemic training. 4) proactive preparation of PPE, environment lack of hospital preparedness posed at risk infection control practices. and surface disinfectant for all hospitals: 300 special and 1000 com- Objectives: To assess the impact of COVID-19 pandemic on infection mon PPE suit available; 5) enhancement of hospital environment, and control practices in a tertiary-care hospital in Spain. usage of medical mask, hand hygiene: over 90% wearing mask and Methods: An electronic survey was sent to 753 frontline HCWs on 81% hand hygiene compliance; 6) establishment of COVID-19 urgent March, 2021. The survey included questions about hand hygiene, cath- response team: supported more 10 provinces; 7) screening SARS- eter maintenance, and PPE. More questions focused on the impact of CoV-2 test: 100% people in hospital. COVID-19 on infection preventionists daily routine. Conclusion: Our study reveals that leadership, proactive infection Results: A total of 163 HCWs (21.6%) completed the survey [Intensive control and prevention, flexible strategy based on COVID-19 dynamic care unit: 32.5%; Infectious diseases unit: 22.7%; Pulmonology unit: are the most important factors to well handle COVID-19 pandemic in 20.4%]. Sixty-seven were physicians, sixty-four nurses, twenty nursing Cho Ray hospital, but still remains developing economy. assistants, four infection preventionists and eight other groups. Low Disclosure of Interest: None declared. compliance with hand hygiene prior to an aseptic procedure and after touching patient´s environment was reported in 70.6% (115/163) and P150 82.2% (134/163) respondents. Barriers to infection control practices Examining the discourse regarding the delivery of occupational were: 1) Glove use was an interfering factor for compliance with the health and safety training in infection prevention and control 5-moments of hand hygiene in 44.8% (53/163); 2) regarding catheter guidelines 1,* 1 1 care, 23.1% (15/65) of nurses reported problems with catheter dress- M. O. Qur eshi , A. Chughtai , H. Seale ings and, among them, 53.3% stated that dressing change was difficult University of New South Wales, Sydney, Australia with glove use. Further, 65.6% of nurses (42/65) recognized drawing Correspondence: M. O. Qureshi blood cultures from the central venous catheter, instead of venipunc- Antimicrobial Resistance & Infection Control 10(1): P150 ture 3) the incorporation of untrained personnel during the pandemic was perceived as a limiting factor for appropriate infection control Introduction: Events such as the COVID-19 pandemic, continue to practices in 47.2% (77/163). Finally, infection preventionists reported highlight that healthcare providers are at heightened risk of acquir- that during the first COVID-19 wave (March-June 2020), 70–90% of ing healthcare associated infections. Reducing the risk requires a mul- their activities shifted to COVID-19 issues, and this interfered in other timodal approach and a culture of safety. Occupational health and duties. safety (OHS) training, focused on infection prevention and control Conclusion: COVID-19 pandemic negatively affected infection control (IPC) is one element of this approach. Currently, there is limited under- practices, namely hand hygiene and catheter use. The use of gloves standing of the framing and dialogue focused on OHS (IPC) training and the need to rapidly incorporate untrained personnel were per- globally. ceived as barriers for optimal infection control practices. Objectives: This study aimed to examine IPC guidelines from selected Disclosure of Interest: None declared. high, low, and middle-income countries (LMIC) and other transna- tional health agencies, to examine the inclusion of OHS (IPC) training P149 and to report on areas of inconsistencies and gaps. How to COVID‑19 pandemic infection control and prevention In Methods: For this review the IPC guidelines from the World Health Cho Ray hospital, Vietnam Organization, US Centers for Disease Control and Prevention, Gulf 1,* 2 T. M. Phung Manh , T. Nguyen Tri Cooperation Council, as well as three high-income countries (Aus- 1 2 Infection Control, Arrhythmia, Cho Ray hospital, Ho Chi Minh City, Viet tralia, Canada, and United Kingdom) and four LMIC (India, Indonesia, Nam Pakistan and Philippines) were reviewed. Correspondence: T. M. Phung Manh Antimicrobial Resistance & Infection Control 10(1): P149 Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 78 of 140 Results: All the guidelines recommended job specific IPC train- ing but only two discussed the need for delivery of OHS training on IPC at undergraduate and/or post graduate level, as well as part of a workplace induction. The recommendations around mode of deliv- ery and curriculum elements differed across the guidelines and only two acknowledged the need to adopt adult learning principles. Lastly, none of the LMIC guidelines included recommendations about evalu- ating training programs. Conclusion: Although all the guidelines suggest OHS (IPC) training be provided to HCPs, there is a lack of focus on the impact that HCPs prior experience should have on the content development, style of approach and evaluation of training programs. This may lead to unde- sirable outcomes like poor delivery of quality OHS (IPC) training pro- grams. Developing a culture of learning in healthcare organizations, along with integration of appropriate adult learning principles would help to improve the development of training programs. Disclosure of Interest: None declared. P152 Conclusion: In line with prior studies, approximately 0.5% of all admis- Largely varying yield of universal SARS‑COV‑2 admission sion screenings were positive in asymptomatic individuals. A strong screening by population incidence 1 1 1 1 1 correlation of the rate of asymptomatic SARS-CoV-2 infected individu- T. Scheier, A. Wolfensberger , D. Saleschus , R. Kouyos, M. Vazquez , W. 1 1,* als with the population incidence was detected. Zingg , P. W. S chreiber Disclosure of Interest: T. Scheier: None declared, A. Wolfensberger: Division of Infectious Diseases and Hospital Epidemiology, University None declared, D. Saleschus: None declared, R. Kouyos: None declared, Hospital Zurich, Zürich, Switzerland M. Vazquez: None declared, W. Zingg: None declared, P. W. Schreiber Correspondence: P. W. Schreiber Grant/Research support from: "Filling the Gap" of the Medical Faculty Antimicrobial Resistance & Infection Control 10(1): P152 of the University of Zurich, Conflict with: speaker honoraries from Pfizer, travel grant support from Pfizer and Gilead outside of the sub - Introduction: A- or presymptomatic SARS-CoV-2 infected individu- mitted work. als pose a potential threat for health care facilities due to the risk of secondary cases. To prevent unnoticed introduction of SARS-CoV-2, several institutions implemented universal admission screening. How- ever, little is known on the yield of this approach in different epide - P153 miological settings. Prevalence of COVID‑19 in individuals without respiratory Objectives: We aimed to describe the rate of asymptomatic SARS- symptoms CoV-2 infected patients identified in universal admission screening, 1 1,* 1 1 S. Yatsyshina , M. Mamoshina , M. Elkina, V. Akimkin and its correlation with the population incidence. Central Research Institute of Epidemiology, Moscow, Russian Federation Methods: Publicly available cantonal data were used to describe the Correspondence: M. Mamoshina population incidence. All patients admitted to the University Hospital Antimicrobial Resistance & Infection Control 10(1): P153 Zurich, Switzerland, were tested for SARS-CoV-2 by polymerase chain reaction (PCR). SARS-CoV-2 positive patients were retrospectively Introduction: Asymptomatic COVID-19 persons may be involved in categorized as symptomatic or asymptomatic at admission and his- the spreading of SARS-CoV-2. tory for prior COVID-19 assessed by medical chart review. For correla- Objectives: The aim of our study was to determine the prevalence of tion analyses, we calculated the positivity rates per calendar week for SARS-CoV-2 in people without respiratory symptoms and evaluate the the admission screening and incidence rates per calendar week and effectiveness of surgical masks for the prevention of COVID-19. 100′000 inhabitants for the cantonal data. Methods: The study, conducted in August and October 2020 in 26 Results: In the canton of Zurich, median SARS-CoV-2 incidence was regions of Russia, involved 14,119 persons (4582 children) without res- 34.3 infections per calendar week and 100′000 inhabitants (interquar- piratory symptoms in the last 2 weeks, who have not traveled outside tile range: 9.9 to 250.2). A total of 21′512 admissions screenings were the country. Naso-oropharyngeal swabs were sampled and tested for performed in a 44-week period between calendar week 18 2020 and detection of SARS-CoV-2 RNA with the “AmpliSens Cov-Bat-FL” rea- calendar week 8 2021. SARS-CoV-2 PCR was positive in 647 (3.0%) gent kits (CRIE, Moscow). Participants were questioned about occu- individuals. In 89 (13.8%) individuals, the positive test result was con- pation, if they were wearing surgical masks and if they had had close sidered as residual viral replication after recent COVID-19 and not contact with someone with a respiratory infection within last 2 weeks. reflecting contagiousness. 457 (70.6%) SARS-CoV-2 positive individu- Results: The SARS-CoV-2 RNA frequency increased from 0.49% in als presented with COVID-19 symptoms at admission, whereas 101 August to 4.02% in October (p < 0.001). Concentration of SARS-CoV-2 (15.6%) SARS-CoV-2 individuals did not show any COVID-19 symp- RNA varied from approximately 10 in 1 ml of respiratory swab to toms. Both, the rate of SARS-CoV-2 positive individuals (r = 0.88, the limit of detection (1000 copies/ml). Close contact with respiratory P < 0.001) and the rate of asymptomatic SARS-CoV-2 positive indi- infection person reported 3.14% of participants. SARS-CoV-2 RNA was viduals (r = 0.84, P < 0.001) correlated with the population incidence found in 3.8% of such persons in comparison to 1.66% in whole group. (Figure). Persons whose profession is associated with a high level of social con- tacts in October were infected less often than representatives of the same age group: SARS-CoV-2 was detected in 3.4% and 6.8%, respec- tively (p = 0.001). Conclusion: Individuals with asymptomatic COVID-19 may have high concentrations of SARS-CoV-2 and serve as a dangerous source of infection, especially when not wearing medical masks. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 79 of 140 The use of surgical masks reduced the risk of infection with SARS- Introduction: The mandatory wearing of mouth-nose covers is, in CoV-2 by 34%. In order to provide more effective protection dur- addition to maintaining distance, a central component of the trans- ing prolonged contact with a COVID-19 patient, healthy individuals mission prevention of COVID-19 and is intended to protect potential should use a respirator. Wearing of medical masks in community is contact persons from ingesting pathogen-containing material. a necessary anti-epidemic measure, since it reduces the spread of Objectives: The study examined whether the population’s motiva- the virus and the likelihood of infection. Higher compliance with tion to comply with the oral-nasal coverage requirement was higher anti-epidemic measures of persons whose profession is associated immediately after its implementation than in the weeks that followed, with frequent social contacts contributed to a decrease in the level as declining coronavirus disease-19 (COVID-19) case rates and the end of their infection. of the initial lockdown on May 15, 2020, may have led to a decrease in Disclosure of Interest: None declared. risk awareness and thus noncompliance with the established behav- ioral rules. Methods: In a covert observational study in mask-required set- tings (public transportation and retail stores), mask types used and P154 observed mask use errors were recorded over two time periods in a SARS‑COV‑2 infection in children in close contact with households total of 9131 individuals. In addition, the importance of individual with COVID‑19 mask features, wearing behavior, and reasons for choosing current 1,* 2 A. Hosseininasab , A. Khalooei mouth-to-nose coverage, as well as attitudes toward COVID-19 pro- 1 2 Pediatrics, Social medicin, KMU, Kerman, Iran, Islamic Republic Of tective measures, were collected in an online survey. Individuals Correspondence: A. Hosseininasab observed in public and individuals in the online surveys represent two Antimicrobial Resistance & Infection Control 10(1): P154 separate cohorts. Results: Over the time (07.05.–13.05.2020/12.06.–08.07.2020), the Introduction: Many vital issues, characteristics, quarantine meas- mask wear adherence increased in from 97.2% to 98.6% (p < 0.001). ures and the treatment of children live in infected families with In addition, a percentage decrease in the number of people without SARS-CoV-2 remain unknown. mouth-nose cover (p < 0.001) and an increase in the correct mask Objectives: This study aimed to assess clinical features and fre- application was observed (p = 0.024). In the online survey, 84% of quency of PCR positive test among children in close contact with respondents identified comfort/convenience and 81% of respond- household COVID-19 cases. ents identified fit as the most important mask attributes. The reasons Methods: In this study, on111 children in family clusters with con- for the choice of the mouth-nose cover used were heterogeneous firmed COVID-19 infection we defined the characteristics of children and varied. The respondents stated that they found the wearing of a with COVID-19 infection from infected family clusters and addresses mouth-nose-covering annoying (57%) but useful (60%), but would not the need for medical attention to children infected with COVID-19 wear a mask if there was no mask obligation or recommendation to under the current viral crisis.In this study, on111 children in family wear the masks (67%). clusters with confirmed COVID-19 infection wedefined the char - Conclusion: Despite improvement, a high frequency of errors (31%) in acteristics of children with COVID-19 infection from infected fami- wearing face masks were still observed, indicating the need for better lyclusters and addresses the need for medical attention to children clarification of the population on the correct wearing of a mask. infected with COVID-19 under the current viral crisis. Disclosure of Interest: None declared. Results: The mean (SD) and median age of the children were 8.18 (3.96) and 8 years,respectively. Almost half (n = 55) of the children had at least one sign or symptomrelated to COVID-19. More than P156 42% (n = 47) of all the children had at least onegeneral sign or symp- Knowledge, attitude, and practice regarding the use tom related to COVID-19, followed by respiratory (27.9%, n = 31) and of personal protective equipment among healthcare workers gastrointestinal (26.1, n = 29) signs and symptoms. Of the children during COVID‑19 pandemic in Tunisian health care facilities 1,* 1 1 1 1 1 exposed tocases with COVID-19 in their families, 42.3% (n = 47) were A. Ammar , A. Maatouk , O. Ezzi , N. Omri, W. Bannour , R. Helali , M. 1 1 PCR positive for COVID-19and only four cases were hospitalized. The Njah , M. Mahjoub frequencies of SARS-CoV-2 infection insymptomatic children and Infection Prevention and Control, University Hospital of Farhat Hached, asymptomatic ones were 43.6% and 41.1%, respectively (P > 0.5). Also, Sousse, Tunisia the frequency of SARS-CoV-2 infection showed no significant differ - Correspondence: A. Ammar ence interms of sex, age, child birth order, and number of family mem- Antimicrobial Resistance & Infection Control 10(1): P156 bers, underlyingdisease, and a history of drug use (P > 0.05). Conclusion: Almost all SARS-CoV-2 infection is mainly asymptomatic Introduction: Working at the frontlines against the COVID-19 pan- or mild during childhood in this study. The importance of asympto- demic, healthcare workers (HCWs) should have adequate knowledge, matic pediatric infection in the transmission of the disease to others positive attitude, and proper practice of personal protective equip- needs further study. ment (PPE) to get protection from COVID-19 infection. Disclosure of Interest: None declared. Objectives: we aimed in this study to assess the knowledge, attitude, and practice (KAP) regarding personal protective equipment (PPE) among HCWs in the University hospital of Farhat Hached (Sousse, Poster session: SARS‑CoV2: PPE Tunisia). Methods: A cross-sectional study during COVID-19 pandemic using an online self-administered French language questionnaire. The ques- P155 tionnaire was submitted electronically during November and Decem- Development of wearing practice and common use errors ber 2020 using the most popular online groups of HCWs on Facebook of mouth‑nose coverings as well as preference in the choice in Tunisia. Data analysis was performed using the Statistical Package of masks in the population during the COVID‑19 pandemic in two for Social Sciences (SPSS) version 21.0. cities of North RhineW ‑ estphalia, Germany 1,* 2 1 1 Results: In total, 140 health workers from 6 different Tunisian uni- M. M. Neuwirth , M. Neuwirth , V. Montilva Ludewig , F. Mattner , R. versity hospitals participated in this study with median age of 31[28, Otchwemah 38] years. Most of them were doctors (64%). In total, participants Institute for Hygiene, Cologne Merheim Medical Centre, University responded correctly in 74% of questions related to knowledge about Hospital Witten/Herdecke Cologne, Cologne, Department of Technol‑ COVID-19 pandemic and proper use of PPE. According to 41.1% of the ogy and Operations Management, University Duisburg‑Essen, Duisburg, HCWs, PPE were not sufficiently available in their departments. Only Germany 56% of them considered that their departments were adequately pre- Correspondence: M. M. Neuwirth pared to manage COVID-19 patients, and 68% of them perceived that Antimicrobial Resistance & Infection Control 10(1): P155 Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 80 of 140 they have received a good training for COVID-19 prevention. Most of Antimicrobial Resistance & Infection Control 10(1): P158 the participants (66.2%) managed a suspected or confirmed COVID-19 patient. Whatever the type of care provided, they always wear a pro- Introduction: Urinary tract infections (UTI) represent at least tective mask, an overblouse or combination, gloves, protective glasses 40% of all hospital-acquired infections. The majority of cases are or a visor and headdress in respectively 71.4%, 57.1%, 62.6%, 47.3% catheter-associated. and 68.1% of cases. Undressing PPE was considered safe in only 65.9% Objectives: Our goal was to clarify whether uropathogens and anti- of cases. microbial resistance (AMR) characteristics vary depending on catheter Conclusion: The findings demonstrated that the HCWs had an over - association. all good knowledge but a poor practice regarding PPE. This finding Methods: We analyzed a dataset containing 27,158 urine cultures relieves the need for further training and practice evaluation con- from the Swiss Centre for Antibiotic Resistance (ANRESIS) database cerning the use of PPE among HCWs. from calendar year 2019. Group differences in the proportions of Disclosure of Interest: None declared. bacterial species and antibiotic-resistant isolates from catheter-asso- ciated UTI (CAUTI) and non-CAUTI samples were investigated using the chi-squared test (or variants). A two-sided p-value of < 0.05 was considered statistically significant. We analyzed the 4 most common P157 pathogens and clinically relevant antibiotics. Personal protective equipment and hand hygiene status Results: The most often identified pathogens were E.coli, in healthcare workers during COVID‑19 pandemic in Mashhad K.pneumoniae, P.aeruginosa, P.mirabilis (cf Table). E.coli from CAUTI university hospitals samples were more often resistant compared to E.coli from non-CAUTI 1 2 2 2 N. Pourbadakhshan , M. Parhizkar , M. Mohammadi Keshouk , F. Pelian , samples. Third generation cephalosporin (surrogate for ESBL), cipro- 3,* M. H. Aelami floxacin (CIP), norfloxacin (NOR) exhibited large differences (p < 0.001) Hand Hygiene and Infection Control Research Center, Imam Reza Hos‑ (cf Figure). For K.pneumoniae, difference in susceptibility was highly pital, Hand Hygiene and Infection Control Research Center Imam Reza significant for CIP (p = 0.001) and NOR (p = 0.03). For P.mirabilis, dif- Hospital, Hand Hygiene and Infection Control Research Center Imam ference in susceptibility was significant only for NOR (p = 0.01). Reza Hospital, MASHHAD UNIVERSITY OF MEDICAL SCIENCES, Mashhad, P.aeruginosa from non-CAUTI samples were significantly less often Iran, Islamic Republic Of resistant to cefepim (p = 0.02) and piperacillin-tazobactam (p = 0.04). Correspondence: M. H. Aelami Antimicrobial Resistance & Infection Control 10(1): P157 CAUTINon-CAUTI p 5317 21841 Introduction: Health- care workers (HCWs) are in great danger of Pathogen (%)<0.00 infection with COVID-19. They can transmit virus to coworkers and also their patients. Proper hand hygiene(HH) and correct usage of per- 1 sonal protective equipment (PPE) could prevent healthcare associated E. coli 1694 (31.9) 11960 (54.8) <0.00 infections including COVID-19. Objectives: The aim of the study was to evaluate correct usage of K.pneumoniae 591 (11.1) 2162 (9.9) 0.008 PPE and compliance of hand hygiene among HCWs before and after P.aeruginosa 535 (10.1) 711 (3.3) <0.00 touching patients. Methods: During a 6 months period from June till November2020,we P.mirabilis283 (5.3)870 (4.0) <0.00 observed HCWs in two university hospitals in Mashhad, Iran. Stand- ard questionnaire using WHO compliance check list for HH and WHO check list for PPE were filled by infection control nurses. Data were analyzed using SPSS software 2016. Results: Seventy-one HCWs in medical and ICU wards of two univer- sity hospitals entered our study. There were 21 men and 50 women, most of them were nurses 62(87.3%). Thirty HCWs (42.3%) from ICU wards and 37(52.1%) from medical wards and 4 (5.6%) from surgical ward entered our research. Thirty-two (45.1%) 0f them washed their hands with alcohol -based hand rub correctly. The HH compliance rate was 45.1% before touching patients and 67.6% after touching patients.Most HCWs in our study 69(97.2%) wore masks the right way.Wearing personal protective kit in a proper method was done in 42(59.2%) of them and taking off only in 34(47.9%) of HCWs.Hand hygiene compliance rate before touching patients was higher in medi- cal wards compared to ICU and surgical wards. p value = 0.05. Conclusion: Frequent education and training of HCWs is necessary for the standard of care. Disclosure of Interest: None declared. Conclusion: The pathogen distribution found in CAUTI and non- Poster Session: Catheter‑associated urinary tract infections (CAUTI) CAUTI samples was similar, with the exception of Pseudomonas being more often detected in CAUTI samples. CAUTI pathogens exhibited antibiotic resistance more frequently than non-CAUTI pathogens. Of P158 note, some often-prescribed antibiotics for empirical treatment such Comparison of bacterial species and antimicrobial resistance as CIP and TMP-SMX exhibited resistance rates of up to 30% in some between catheter and non‑catheter associated urinary tract of the most common pathogens. This emphasizes the need for urine infections 1,* 1 2 3 2 sampling for culturing before initiating a therapy in case of CAUTI and S. D’incau , A. Atkinson , L. Leitner , A. Kronenberg , T. M. Kessler , J. the need for therapeutic alternatives. Marschall Disclosure of Interest: None declared. Infectious Diseases, Inselspital, Bern University Hospital, Bern, 2 3 Neuro‑Urology, Balgrist University Hospital, Zürich, Institute for Infec‑ tious Diseases, University of Bern, Bern, Switzerland Correspondence: S. D’incau Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 81 of 140 P159 Results: Totally, 62% and 54% of the patients were male in COVID-9 Reducing urinary catheter use and urinary tract infections and non-COVID-19 groups, respectively. In COVID-19 group, 98 in geriatric patients—results of a pilot interventional study (74.2%) were adult and 34 (25.8%) children (under 18 years of age). 1,* 2 2 2 L. Mrziglod , S. Saydan , P. Gastmeier , S. Hansen The age of 147 patients in non-COVID-19 group was unknown (19.2%) 1 2 Department of Infectious Diseases, Institute of Hygiene and Environ‑ and 381(48.5%) were adult and 259 (32.3%) children. As revealed, in mental Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany COVID-19 group, adults with BSI outnumbered the children (74.2% vs. Correspondence: L. Mrziglod 25.8%, respectively); however, the difference in non-COVID-19 group - Antimicrobial Resistance & Infection Control 10(1): P159 was less (48.5% vs. 32.3%, respectively), even if all the patients with unknown age in the latter were considered to be adult (528, 67%). The Introduction: Indwelling urinary tract (UT) catheters (UTC) are a well- two most common bacterial isolates in COVID-19 group were Achro- known risk factor for UT infection (UTI). mobacter species (spp.) (24, 18%) and Klebsiella app. In non-COVID-19 Objectives: Since geriatric patients are at high risk for infections an group, the most common pathogens were Escherchia coli (89,11%) and intervention was initialized in 4 geriatric wards of a secondary care Staphylococcus aureus (103,13%). hospital. Conclusion: BSI among hospitalized adult patients with COVID-19 Methods: Between 11/2018 and 1/2020 unit-based data on UTC use infection was more frequent than that among children. It could be and nosocomial UTI were collected according to methods of the Ger- explained by the fact that the total number of adult patients with man national surveillance system KISS. Wards received data feedback COVID-19 who needed hospitalization is much higher than children. in 5/2019. From 7/2019 to 1/2020 the intervention focusing on i.) edu- Also, the two most frequently isolated pathogens associated with cation and training on UTC insertion and care, ii.) daily assessment of BSI were different in two groups of patients hospitalized in a tertiary UTC need with so called “catheter indication sheets (CS)” in patients hospital of a developing country, that is, Iran. Nevertheless, the etiol- with UTC ≥ 2 days and iii.) timely removal of unnecessary UTCs was ogy of BSI in hospitalized patients with COVID-19 needs further inves- realized. A team-based approach was initiated by introducing the tigations which could help physicians to choose the most effective intervention to ward physicians and nurses. empiric therapy in respective patients. UTC use, incidences and incidence densities for UTC-associated Disclosure of Interest: None declared. (ass.) UTI were calculated before and during the intervention and differences were tested. Additionally, the use of CS in patients with P162 UTC ≥ 2 days was analyzed during the intervention. Successful implementation of chlorhexidine‑impregnated Results: 3,564 patients with 53,954 patient days (pd) and 9,208 UTC dressings in adults with central venous catheter days were included. Overall the pooled UTC use rate decreased from 1,* 1 1 1 1 Q. Liu , H. X. Toh , L. C. Lee , K. B. How , M. L. Ling 19.1/100 pd to 15.2/100 pd (p < 0.001).The pooled incidence of UTC- Infection Prevention and Epidemiology, Singapore General Hospital, ass. UTI decreased from 2.07 to 1.40 UTC-ass. UTI per 100 patients Singapore, Singapore (p = 0.128) and the pooled incidence density of UTC-ass. UTI decreased Correspondence: Q. Liu from 1.34 to 0.95 UTC-ass. UTI per 1000 pd (p = 0.18). During the inter- Antimicrobial Resistance & Infection Control 10(1): P162 vention 186 from 351 patients with a UTC ≥ 2 days received a CS for daily UTC assessment (53%). Patients with a CS had in median 9 UTC Introduction: Singapore General Hospital (SGH) has been using days (IQR 5,15) whereby patients without CS had 10 UTC days (IQR Central line-associated bloodstream infections (CLABSIs) insertion 7,16) (p = 0.07). and maintenance bundles as part of our efforts to prevent CLABSIs Conclusion: Our data show that a surveillance-based prevention in patients. CDC (2017) updated the recommendations on the use of intervention reduces UTC use and UTC-ass. UTI in geriatric patients. chlorhexidine-impregnated (CHG) dressings for prevention of intra- Further studies are needed to show an effect in larger populations. To vascular catheter-related infections. Thereafter, SGH embarked on what extent the usage of checklists for daily UTC assessment affects CDC’s recommended implementation. UTI prevention has to be further investigated. Objectives: Implementation of CHG dressings in adults with CVC dur- Disclosure of Interest: None declared. ing COVID-19 pandemic. Methods: Approval was obtained in 2019 to implement its use but we were only able to launch implementation from 16 July Poster Session: Catheter‑related bloodstream infection 2020. During the COVID-19 pandemic, training was conducted via e-learning platforms. Infection Prevention Liaison Officers (IPLOs) of the wards were trained and tasked with cascading information on P161 CHG dressing to their respective wards. Infection Prevention Nurses Bloodstream infection among the patients infected (IPNs) conducted audits via interviews with the ward nurses on their with COVID‑19 in a tertiary hospital in Iran knowledge and compliance to usage of CHG dressing in August and 1,* G. Pouladfar on behalf of Zahra Jafarpour November 2020. In addition, audits on proper application and doc- Professor Alborzi Clinical Microbiology Research Center, Shiraz University umentation on the usage of CHG dressing was done from January of Medical Sciences, Shiraz, Iran, Islamic Republic Of 2021 to March 2021. Correspondence: G. Pouladfar Results: Interview results. Antimicrobial Resistance & Infection Control 10(1): P161 In the August 2020 interviews, 7 out of 37 wards (19%) were unaware of the implementation, where the products were kept and unable to Introduction: Bacterial co-infection, especially bloodstream infec- describe the indications of the CHG dressing. Immediate action was tion (BSI) could be a leading cause of morbidity and mortality in hos- taken to remind ward nurses through the IPLO newsletter as well pitalized patients with coronavirus disease 2019 (COVID19) infection, as through daily huddles done by IPNs with ward IPLOs. By Novem- demanding a proper empirical antibacterial therapy. ber 2020, only 2 out 40 wards (5%) interviewed were unaware of the Objectives: This study aimed to investigate the bacterial etiology of above – a substantial improvement. BSI in two groups of patients (i.e., COVID-19 and non-COVID-19) in a Practices results. tertiary hospital in Iran. In January 2021, audits on proper application and documentation on Methods: We investigated all bacterial etiologies of BSIs among the the usage of CHG dressing showed a low compliance of 71%, which patients hospitalized in Nemazi Teaching Hospital in Shiraz, during subsequently improved to 100% compliance in February and March March 2020-March 2021. Using an automated blood culture system for BSI diagnosis, we detected 919 pathogenic bacteria by standard bio- Conclusion: We were able to successfully implement the use of CHG chemical methods: 132 in COVID-19 group and 787 in non-COVID-19 dressing during the pandemic through the education of stakeholders. one. Regular audits were conducted to validate successful implementation. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 82 of 140 In conclusion, engaging IP champions, training, and audits greatly Methods: We included all neonates hospitalised in NICU with at least aided in the successful implementation of a new practice in the clinical one central intravascular catheter insertion from January 2017 to setting despite challenges posed by the pandemic. December 2020. Dwell time was considered as the number of full days Disclosure of Interest: None declared. a catheter was in place. Firstly, we described CABSI according to the catheter type (arterial [AUC], venous umbilical catheters [VUC]) during the catheter maintenance. Secondly, we used univariable and multi- variable marginal Cox regression models for clustered data to evalu- P163 ate the CABSI-risk according to the catheter type among umbilical Opinions of nurses in ICU on the importance and utilization catheters. of the CLABSI prevention bundle in an academic hospital Results: We observed 1103 intravascular catheters in 574 neonates. in Gauteng Among them, 55 (9.6%) were very low birth weight (< 1000 g) and 323 1,* 2 D. Ng’ambi , S. Armstrong (56.27%) were low birth weight (< 2500 g). Overall, 388 (67.6%) were 1 2 Kamuzu Central Hospital, Lilongwe, Malawi, University of the Witwa‑ preterm and among them 101 (17.6%) were extremely preterm, 170 tersrand, Johannesburg, South Africa (29.6%) were very preterm and 117 (20.4%) were moderate to late pre- Correspondence: D. Ng’ambi term. 264 were female (46%). We identified 581 VUC, 198 AUC and 324 Antimicrobial Resistance & Infection Control 10(1): P163 PICC. The median dwell-time was 2 (IQR: 0; 4), 3 (IQR: 2; 5) and 6 (IQR: 4; 13) days for UVC, AUC and PICC, respectively. We identified 4 and Introduction: The Central Line Associated Blood Stream Infections 17 CABSIs in AUC and VUC, respectively. The CABSI risk were increased (CLABSI) prevention bundle has proven to prevent CLABSI when all after two days of catheter maintenance for umbilical catheters (Fig- elements are utilized. While the bundle is evidence based, if nurses ure). Among umbilical catheters and using univariable Cox models, do not believe it is important, they are unlikely to use it. The purpose we observed a similar CABSI-risk between VUC and AUC (HR 1.09, 95% of the study was to describe the nurses’ opinions on the importance CI: 0.38–3.08., p = 0.87). After adjustment for sex, prematurity and ges- and utilization of the CLABSI prevention bundle with a view, at a later tational age, we observed a similar CABSI-risk between VUC and AUC stage, to inform the infection control unit on what to consider when (HR 0.57, 95% CI 0.156–2.081 p = 0.394). teaching and implementing the CLABSI prevention bundle. Conclusion: Implementing a strategy to reduce duration of umbilical Objectives: To describe the opinions of the nurses in ICU of the catheters in NICU may be an effective measure to reduce CABSI in this importance and the usefulness of the CLABSI prevention bundle. population and requires further exploration. To describe the relationship between the importance and utilization Disclosure of Interest: None declared. of the CLABSI prevention bundle based on the nurses’ opinions. Methods: This study used a descriptive research design using Q P165 methodology approach. Q methodology is one of the methods used Survey of central venous catheter care bundle compliance to study opinions. The study was done at one of the public academic in medical wards, hospital Pulau Pinang, Malaysia hospitals in Gauteng. Data was collected using a Q sort technique 1,* 2 2 2 2 L. Kok S oon , L. Wei Chyuan , W. Peng Shyan , L. Kar Nim , C. Ting Soo from thirty nurses in Intensive Care Unit (ICU). The nurses had to sort 1 2 Infectious Disease, Hospital Sultanah Aminah, Johor Bahru, Infectious a set of thirty statements about the CLABSI prevention bundle. The Disease, Hospital Pulau Pinang, Pulau Pinang, Malaysia sorting (Q sort) was done on a Q diagram under specific conditions of Correspondence: L. Kok Soon instruction. Pictures of completed Q sorts were taken and transcribed Antimicrobial Resistance & Infection Control 10(1): P165 on smaller Q diagram and that was used for data analysis. Factor anal- ysis was used to interpret data by means of a software PQ Method ver- Introduction: Central venous catheter (CVC) care is important in pre- sion 2.35 package. venting line-related infection. Periodic surveillance in Hospital Pulau Results: The overall finding is that opinions are related to human Pinang showed a compliance rate of 63.2% for CVC care bundle and behaviour. The results of the study revealed mixed opinions among 9 out of 24 patients diagnosed to have bloodstream infection were the nurses in ICU. Some value aseptic technique during insertion of associated with a central line in April 2018. the central line. Some value maintenance of the central line, while Objectives: This project aims to improve the compliance of CVC care some value some elements on both the insertion and maintenance bundle, identify barriers in compliance and establish CLABSI incidence of the central line. The study revealed that those elements that the in the Medical wards of Hospital Pulau Pinang, Malaysia. nurses believe to be important, are the ones that they also utilize. Methods: Subjects audited (> 18 years old) were in-patients with cen- Conclusion: Nurses opinions differ from one another and judging by tral venous catheters inserted during working hours. their opinions, it is evident that not all CLABSI prevention bundle ele- This audit is divided into 3 phases: ments are believed to be important, nor are all bundle elements uti- 1st phase: Baseline audit on subjects with CVC inserted in medical lized. Recommendations have been proposed for nursing education, wards, CVC insertion subjects identified, and follow-ups conducted. practice, management and research. During the CVC insertion, the process was audited with a checklist Disclosure of Interest: None declared. with the information such as site selection, correct antiseptic use and maximum barrier protection. P164 A checklist form produced by the Ministry of Health was given to Risk of catheter associated bloodstream infection by catheter nurses for daily review. type in neonatal intensive care unit The 2nd phase consisted of interventions were as follows: 1,* 1 2 1 1 G. Catho, V. Sauvan , F. Rosa Mangeret , M.‑N. Chraiti , O. Baud , S. ● Continuous medical education using lectures and training videos 1 1 Harbarth , N. Buetti on proper CVC bundle care during line insertion. 1 2 Infection Control Division, Division of Neonatology and Pediatric Inten‑ ● Short quiz on central catheter care maintenance. sive Care,, Geneva University Hospitals and Faculty of Medicine, Geneva, ● Regular hand hygiene awareness and promotion. Switzerland ● Dedicated CVC carts/procedure room for CVC insertion. Correspondence: G. Catho 3rd phase: a post-intervention audit on CLABSI rate and data analysis. Antimicrobial Resistance & Infection Control 10(1): P164 Introduction: Little is known about the bloodstream infection (BSI) risk associated with umbilical intravascular catheter in neonates. Objectives: The objective of this study was to assess the risk of intra- vascular catheter-associated BSI (CABSI) among the different catheter types using a large prospective database at the neonatal intensive care unit (NICU) in the Geneva University Hospitals. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 83 of 140 Results: bacteria, coagulase-negative staphylococci or enterococci were eligi- ble for inclusion. Studies including concomitant treatment with anti- Pre intervention Survey (n=36) Post Intervention Survey (n=34) biotic lock therapy were excluded. The primary outcomes were clinical Age (mean) 59 years52 years failure/cure, mortality and microbiologic-confirmed relapse. Gender Male 41.7% 55.8% Results: Seven retrospective cohort studies and one case-cohort Female 58.3% 44.2% Types of Catheters study met the inclusion criteria. No randomized controlled studies met Double lumens 8.3% 5.8% Triple lumens 38.8% 32.4% inclusion criteria. The quality of the included studies was low (n = 7) Triple lumens (dialysis) 52.7% 61.8% to moderate (n = 1). No significant differences were observed regard- Indication Inotropic support 8.3% 8.8% ing mortality and microbiological relapse between short-course and Intravenous 30.5% 6.5% Haemodialysis 58.3% 61.7% long-course systemic antibiotic treatment in patients with CRBSI due CVP monitoring 2.7% 0% to coagulase-negative staphylococci or Gram-negative bacteria. No Mean Duration 8 days 6 days association was found between mortality and treatment duration in the two studies assessing enterococcal CRBSI. Conclusion: The limited data available suggests that shorter systemic antibiotic treatment duration may be sufficient for uncomplicated CRBSI. Further well-designed prospective studies are needed to con- firm these findings. Disclosure of Interest: S. Muff: None declared, A. Tabah: None declared, Y.-A. Que: None declared, J.-F. Timsit Grant/Research sup- port from: Astellas, 3 M, MSD, and Pfizer, Consultant for: 3 M, MSD, Bayer Pharma, Nabriva, and Pfizer, Conflict with: 3 M, MSD, Pfizer, and Biomerieux, L. Mermel Consultant for: Citius Pharmaceuticals, Mar- vao Medical, Leonard-Meron Biosciences, Destiny Pharma, and Nobio unrelated to the submitted work, S. Harbarth: None declared, N. Buetti: None declared. P167 Prevalence and death‑associated factors in healthcare‑associated bacteremia in the department of infectious and tropical diseases of Fann hospital, Dakar 1,* 1 1 1 1 1 D. KA , A. Massaly , N. M. Fall , V. M. P. Cisse Diallo , C. T. Ndour , M. Seydi Conclusion: This project indicated components of the CVC bundle Dakar, Centre Hosptalier de Fann, Université Cheikh Anta Diop de Dakar, care with improved compliance, notably maximal barrier usage, cor- Dakar, Senegal rect antiseptic, and proper cleaning method. Areas for improvement Correspondence: D. KA are choice of site for CVC insertion and daily CVC review. Recommen- Antimicrobial Resistance & Infection Control 10(1): P167 dations from this audit are for employment of continuous medical education and regular audits to increase knowledge and awareness of Introduction: Healthcare-associated bacteremia is a real public health CVC care bundles. Due to a low sample size, the CLABSI rate was una- problem because of its high morbidity and mortality. ble to be established. Objectives: The objectives of this study were to describe the charac- teristics of bacteremia and to identify death – associated factors. Disclosure of Interest: None declared. Methods: This was a retrospective, descriptive and analytical study based on the records of patients hospitalized in the department of infectious and tropical diseases, whose diagnosis of healthcare-associ- P166 ated bacteremia was retained during the study period from January 1, Short‑course versus long‑course systemic antibiotic treatment 2016 to December 31, 2017. for uncomplicated intravascular catheter‑related bloodstream Results: Fifty-two cases of healthcare-associated bacteremia were col- infections due to gram‑negative bacteria, enterococci lected. The hospital prevalence was 2.6%. Male sex was predominant or coagulase‑negative staphylococci: a systematic review 1,* 2 3 4 5 1 with a sex ratio = 1.2. The average age was 42 ± 16 years. Twenty-two S. Muff, A. Tabah, Y.‑A. Que, J.‑F. Timsit , L. Mermel , S. Harbarth , N. patients were HIV-infected. The majority of patients (32 cases) had Buetti been on antibiotics before their current hospitalization. Regarding University of Geneva Hospitals and Faculty of Medicine, Geneva, Swit‑ 2 3 the reasons for hospitalization, pulmonary signs dominated the series, zerland, Redcliffe Hospital, Brisbane, Australia, University Hospital Bern, 4 5 followed by neurological and gastrointestinal signs with respectively Bern, Switzerland, University of Paris, Paris, France, Rhode Island Hospital 27, 26 and 18 cases. Invasive devices were dominated by peripheral and Department of Medicine, Providence, United States venous catheters (100%) followed by urinary catheterization (87%). Correspondence: S. Muff The main germs found were Staphylococci (26.6%), Enterobacter spp Antimicrobial Resistance & Infection Control 10(1): P166 (23.5%), Klebsiella pneumonia (18.7%) and Escherichia coli (14.1%). Staphylococci were highly resistant to cefoxitin (88.2%) and methicil- Introduction: The optimal duration of systemic antimicrobial treat- lin (70%). There was a high level of resistance of gram-negative bacilli ment for catheter-related bloodstream infections (CRBSI) is unknown. to 3rd line cephalosporin. Case fatality was 35%. Acute renal failure Objectives: In this systematic review, we aimed to assess the efficacy (p = 0.01) and male gender (p = 0.05) were associated with the occur- of short-course treatment for CRBSI due to Gram-negative bacteria, rence of death. coagulase-negative staphylococci and enterococci. Conclusion: Healthcare-associated bacteremia is a real public health Methods: We systematically searched the electronic bibliographic problem. Standard hygiene measures play an important role in the databases MEDLINE, EMBASE and Cochrane Library for studies pub- control of these infections. lished before February 2021. All studies that investigated the dura- Disclosure of Interest: None declared. tion of adequate systemic antibiotic treatment in adult patients with uncomplicated intravascular catheter infections due to Gram-negative Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 84 of 140 Poster Session: Diagnostic Stewardship was taken from the cases. Using three supervised methods (support vector machine (SVM), K-Nearest Neighbor (KNN), and Decision Tree (DT)), the dataset was classified into two categories: probable posi- P168 tive PCR and probable negative PCR. KNN and DT had higher accu- Performance evaluation of genexpert SARS‑COV‑2 in early racy (> 80%) and less processing time. The risk of classifying a positive diagnosis of COVID‑19 1,2,3,4,* 5 5 5 PCR as negative is greater than classifying a negative PCR as positive. S. M. Aljohani , A. Alshehri , A. ALSHEHRI, T. Alsalmi 1 2 Therefore, weighted matrices were involved in the algorithm so that Consultant Microbiologist, KAMC‑Riyadh, Associate professor, King Saud the false positive classification error was much greater than the false Bin AbdulAziz University for Health Sciences, Adjunct Associate Profes‑ negative classification error. sor, King Abdullah International Medical Research Centre, Editor‑in‑Chief, Results: Eventually, the KNN algorithm with 82% precision, 91% recall, Journal Of Infection and Public Health, Molecular Microbiology, KAMC‑R, and 63% specificity was selected as the optimal method and was used RIYADH, Saudi Arabia for predicting PCR necessity. This expresses that the designed algo- Correspondence: S. M. Aljohani rithm is able to suggest 91% of patients with future positive PCR to Antimicrobial Resistance & Infection Control 10(1): P168 take a PCR, and 82% of patients that the designed algorithm intro- duced to undergo a PCR, will have positive PCR result. In addition, Introduction: Rapid diagnostics of SARS-CoV-2, are a very critical in using the designed algorithm will reduce taking PCR from patients critically ill patients. The routinely used real-time RT-PCR is sensitive, with future negative PCR result, down to 37%. specific and able to process large batches of samples. However, turna- Conclusion: Applying the designed algorithm in countries with a round time is long and in cases where fast obtained results are critical, shortage of PCR kits will optimize resources with minimum inaccu- molecular point of care tests (POCT ) can be an alternative. racy. The outcome of this study and the designed algorithm can be Objectives: In our study, we evaluate Cepheid Xpert Xpress used at health centers as a criterion to determine whether a patient SARS-CoV-2 point-of-care test for rapid and accurate diagnosis of should undergo a PCR. SARS-CoV-2. Disclosure of Interest: None declared. Methods: The Xpert Xpress SARS-CoV-2 assay was evaluated against the routine real-time RT-PCR assays using RealStar SARS-CoV-2 RT- PCR Kit 1.0 (Altona). A sensitivity and specificity was calculated using different samples with different concentration and different viral load. P170 A total of 300 samples were enrolled into this evaluation. 45 positive Diagnostic stewardship in emergency medicine: results samples and 255 negative samples. of a retrospective cohort study Results: Xpert Xpress SARS-CoV-2 point of care test showed great 1,* 2 3 4 C. Berninghausen , F. Schwab , L. Hottenbacher , R. Somasundaram , P. performance compared to routine in-house testing with a limit of 2 2 Gastmeier , S. Hansen detection. Other seasonal respiratory viruses were not detected. In 1 Department of Cardiology and Intensive care, Vivantes Wenckebach clinical samples Xpert Xpress SARS-CoV-2 reaches an agreement of 2 Klinikum, Institute of Hygiene and Environmental Medicine, Charité 100% compared to all in-house RT-PCRs. The PPA was 97.8% (95% CI: 3 – Universitätsmedizin Berlin, Department of Emergency Medicine, 88.4%—99.6%) and the NPA was 95.6% (95% CI: 85.2%—98.8%). Vivantes AugusteV ‑ iktoria Klinikum and Vivantes Wenckebach Klinikum, Conclusion: Cepheids GeneXpert Xpert Xpress SARS-CoV-2 is a valu- 4 Department of Emergency Medicine, Charité – Universitätsmedizin able addition for laboratories in situations where rapid and accurate Berlin, Berlin, Germany diagnostics are of the essence. It’s great tool to diagnose/ role out Correspondence: C. Berninghausen patients in Emergency room, Labor & delivery wards and pre-emer- Antimicrobial Resistance & Infection Control 10(1): P170 gency surgeries or interventions. Disclosure of Interest: None declared. Introduction: Once sepsis is suspected, a minimum of 2 sets of blood cultures (BCs) should be obtained prior to administration of P169 antimicrobial therapy (AT) to support identification of pathogens Predicting PCR test necessity using inteligent methods and to allow de-escalating AT. 1,* 2 2 A. Taherzadeh , E. M. Farkhani , I. Mostafavi Objectives: Appropriate BC (2 sets of BCs prior to administration 1 2 Isfahan University of technology, Tehran, Mashhad University of Medical of AT) sampling was investigated in three emergency departments Sciences, Mashhad, Iran, Islamic Republic Of (EDs). Correspondence: A. Taherzadeh Methods: We performed a retrospective cohort study of patients Antimicrobial Resistance & Infection Control 10(1): P169 admitted via one of 3 EDs with the hospital discharge diagnosis “sepsis” according to ICD-10 System A40- A41 in 2018. Exclusion cri- Introduction: With the outbreak of the Covid-19 pandemic in late teria were nosocomial sepsis, elective admissions and transfers from 2019, Polymerase chain reaction (PCR) assay has become the accepted external hospitals and direct transfers to intensive care units. standard for diagnosing this disease. As the prevalence rate increases, Administrative and clinical data were retrospectively collected from some countries face shortages of test kits. A growing need for a patients’ charts. Independent factors associated with appropriate method that can determine the necessity of laboratory testing using BC were analyzed by multivariable logistic regression analysis. Ethi- clinical symptoms is an inevitable outcome of this pandemic. cal approval was obtained from Charité – Universitätsmedizin Berlin. Objectives: The objective of this study was to design and develop an Results: From 1,761 admitted patients 1,143 (676 male, 466 female) algorithm using intelligent methods, to predict the necessity of PCR patients were analyzed. 542 (31%) patients were immunocompro- using the patient’s clinical symptoms. mised, 522 (46%) presented with a temperature > 38 °C. 993 patients Methods: The dataset used in this study consists of 226,777 suspected (87%) showed organ dysfunction. 946 patients (83%) received BCs cases of Covid-19 with known PCR results (145,752 positive and 81,025 whereby 520 (45%) patients received 1 set and 426 (37%) patients negative), with one or more clinical symptoms including fever, short- at least 2 sets. ness of breath, chest pain, cough, sore throat, and chills. Furthermore, 349 (31%) patients received appropriate sampling of ≥ 2 BC sets information such as age, gender, BMI, background disease, being in a before AT. Factors independently associated with appropriate BC col- high-risk group, and any close contact with a positive covid-19 patient lection are shown in table 1. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 85 of 140 P172 Place of blood cultures in sepsis in a resource‑limited setting, Abidjan, Côte D’ivoire 1,* 1 1 1 G. A.‑J. Bahan , A. D. Yapi , Y. M. Coulibaly , N. A. Kacou Bacteriology Unit, Medical Biology Department, Abidjan, Côte d’Ivoire Correspondence: G. A.‑J. Bahan Antimicrobial Resistance & Infection Control 10(1): P172 Introduction: Sepsis have a substantial impact on morbidity and mor- tality. Its early management requires appropriate antibiotic therapy which involves detection of the pathogens agents by blood culture. Blood cultures are the reference method for diagnosis of sepsis. Objectives: The purpose of this study was to determine the blood culture completion rate in sepsis at the Treichville University Hospital Center. Methods: It’s a cross-sectional study included hospitalized patients in the intensive care unit and tropical infectious diseases unit at the Treichville University Hospital Center, from 2016 to 2018. Data collec- tion was based on socio-demographic, clinical, microbiological (blood Conclusion: Data show that BC sampling varies among EDs and culture) characteristics and biological infectious markers such as blood among individual patients. Awareness for appropriate BC sampling count, C-reactive protein and procalcitonin. should be increased in order to provide adequate AT to all patients Results: The overall prevalence of sepsis was 15.52% (232 cases out of with the suspicion of sepsis. 2191 hospitalized patients). The mean age was 40 years (± 12 years). Disclosure of Interest: None declared. The sex ratio was 0.96. The frequent sources of infection were pulmo- nary (17.67%), urogenital (9.48%) and digestive (8.62%). Blood cultures had been performed to 49 patients (21.12%). The positivity rate was P171 46.93% (23/49). Gram negative bacilli was dominated with 11 isolates The effect of multifaceted interventions on storage and transport of Enterobacteriaceae (11/23). The most common bacteria species of samples for microbial culture were Escherichia coli in 5, Enterobacter cloacaein 3, Klebsiella pneumo- 1 2,* 1 3 1 M. J. Cho , J. S. Jeong , Y. H. K im , I. S. Jeong , S. H. Kim niaein 2 and Enterobacter aerogenes in 1 patients. Biological infectious 1 2 Department of Nursing, Asan Medical Center, Seoul, Clinical Nursing, markers were performed in 42 (22.41%) for the C-Reactive Protein, University of Ulsan, Ulsan, College of Nursing, Pusan National University, 31 (13.36%) for procalcitonin and 230 (99.13%) for the whole blood Busan, Korea, Republic Of count. Antibiotics associations have been used empirically in 96.98% Correspondence: S. Jeong (225/232) including bi-antibiotic therapy (141) and tri-antibiotic ther- Antimicrobial Resistance & Infection Control 10(1): P171 apy (84). The most used antibiotics were ceftriaxone (27.47%), genta- mycin (24.67%) and metronidazole (14.95%). Deaths occurred in 150 Introduction: Storage and transportation of samples for microbial cul- cases (64.65%). ture is critical for correct diagnosis and treatment of patient diseases. Conclusion: Blood culture may help to improve sepsis management When samples are collected from the ward, in most cases, nurses are in low-income countries.Antibiotic therapy should be guided by the responsible for storing and transporting samples. patterns of bacteria and their susceptibility to antibiotics. Objectives: The purpose of this study is to provide multifaceted inter- Keywords: Blood culture, Sepsis, Biomarkers, Abidjan. ventions for nurses and to confirm the changes on knowledge, sample Disclosure of Interest: None declared. management practice and blood culture transport time. Methods: A one-group pretest–posttest experimental design was Poster Session: Environment: Surface contamination conducted with 41 nurses in two general wards of tertiary acute care and decontamination hospital in Seoul, South Korea. Multifaceted interventions including education, feedback, posting guidelines and reminders, and system improvement were provided to ensure that proper storage and timely P173 transport of samples from May 2019 to January 2020. The outcomes Development of a training resource focused on those who clean were measured in three ways before and after intervention; the knowl- health care facilities 1,* 1 2 3 4 edge on sample management using self-reported questionnaire, C. Kilpatrick , J. Storr , K. Lee , S. Nurse Findlay, W. Graham 1 2 sample management practice at wards by observation, and time from KS Healthcare Consulting, Glasgow, Independent researcher, Dundee, 3 4 blood sampling to arrival at the laboratory. United Kingdom, World Health Organization, Geneva, Switzerland, Lon‑ Results: Among the participants, 31.7% have trained in storage and don School of Hygiene and Tropical Medicine, London, United Kingdom transportation of samples. After intervention, the average knowledge Correspondence: C. Kilpatrick was significantly increased from 1.20 points (± 1.12) to 5.10 points Antimicrobial Resistance & Infection Control 10(1): P173 (± 3.20) out of 9 for transportation(p < 0.001). The average knowledge on sample storage was also increased but insignificant. The propor - Introduction: The workforce who clean health care facilities are over- tion of appropriate sample storage room, condition and transporta- looked and undervalued. Strengthening the training of this important tion time were significantly increased from 43% (46/107) to 77.1% cadre of staff in all countries will support infection prevention and (84/109) (p < 0.001). Average transportation time to the laboratory of control (IPC), water, sanitation and hygiene and antimicrobial resist- blood sample significantly decreased from 3 h 36 min(± 1 h 52 min) to ance (AMR). 3 h 01 min(± 1 h 41 min), and the arrival within 2 h increased signifi- Objectives: To explore existing materials and develop a new World cantly from 22.9% to 39.2% (p = 0.021). Health Organization (WHO) training resource aimed at those who Conclusion: Multifaceted interventions for this study are effective for clean, initially in maternity wards. nurse to improve the knowledge and practice to store and transport Methods: Electronic databases were searched using mesh terms for samples properly. However, some samples remain in the ward longer cleaners/cleaning, IPC and AMR, low and middle income countries, than expected after intervention and require further intervention. maternal and newborn health, training and development. Relevant Disclosure of Interest: None declared. web portals were also searched. After an initial assessment of all Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 86 of 140 sourced publications, four scientific publications and 44 resources environmental hygiene at the facility level. Early pilot data to test its were further reviewed against a list of criteria. effecteveness of this training package are very promising. Results: An existing product entitled TEACH CLEAN was identified as Objectives: The main objective is to evaluate the effectiveness of an suitable for modification. Permission was granted and adaptations environmental cleaning bundle to improve microbiological cleanli- and updates were made. A consultation was performed and a two- ness in Cambodian hospitals. part WHO prototype was created. Other publications featuring the lat- Methods: TEACH CLEAN will be implemented across all hospitals est standards on IPC and environmental cleaning were also identified (13) of three provinces in Cambodia. A stepped wedge randomised and informed the content. The components of the package stayed trial will be used to evaluate the effectiveness of TEACH CLEAN to true to the original educational concept, which has been tested in a improve microbiological cleanliness in Cambodian hospitals. All facili- range of countries. An outline of the contents of the WHO resource is ties will receive the intervention. Hospitals are arranged in groups of in Figure 1. three or four based on the randomisation with staggered commence- ment dates of the intervention at four distinct time points. The design will include nine months of data collection. Intervention months will vary between two and seven. We expect one month gap between the training of champions and the training of staff at the facility level. The main outcome is microbiological cleanliness (< 2.5 cfu/ cm2 = clean; ≥ 2.5 cfu/cm2 = not clean) measured using a non-specific agar on one side for measuring total Aerobic Colony Counts (ACC/ cm2). A secondary outcome will be presence/absence of S.Aureus. With 30 sampling sites in each hospital and with a pre-training cleanli- ness proportion ranging from 30 to 50% will give us over 85% power to detect a 10% absolute post-intervention increase in cleanliness. Results: NOTE: This is a trial protocol presentaiton as the trial will com- mence in June 2021. Conclusion: Evidence from the this trial will contribute to future policy and practice guidelines about hospital environmental hygiene and ultimately reduce healthcare associated infections. This would be the first randomised trial on environmental hygiene in low resource settings. Disclosure of Interest: None declared. P175 Determining staffing levels for environmental cleaning: time measurements in non‑critical care units in an acute care hospital in Brussels 1,* 2 3 A. Caluwaerts , L. Pintelon , J. Hopman 1 2 3 IPC, Kliniek Sint Jan, Brussels, CIB, KUL, Leuven, Belgium, Quality and Safety, Radboudumc, Nijmegen, Netherlands Correspondence: A. Caluwaerts Antimicrobial Resistance & Infection Control 10(1): P175 Introduction: Environmental cleaning plays an important role in the prevention of healthcare associated infections. A multimodal improve- ment strategy includes the creation and uptake of standard opera- tional procedures through appropriate staffing, training, monitoring Conclusion: This resource is the first WHO-developed training curricu- and feedback. lum aimed at those who clean, a priority that has assumed greater sig- Objectives: Given the lack of (inter)national standards, the objective nificance in recent years including due to COVID-19. Further validation of this study was to determine staffing levels for environmental clean- of the prototype is planned in a sample of WHO regions. ing in non-critical adult care units in an acute care hospital in Brussels. Disclosure of Interest: None declared. Methods: We performed time measurements to define the time needed to accomplish the daily cleaning of single patient rooms. Only rooms that were considered thoroughly cleaned, based on fluorescent P174 marking prior to cleaning, were included in the analysis. Build-upon Clean frontline: a stepped wedge cluster trial of an environmental the time measurements and findings from a systematic literature hygiene educational intervention across thirteen Cambodian review, we estimated the time needed to perform different types of hospitals cleaning for different types of rooms, cleaning of non-patient areas 1,* G. Gon on behalf of Clean Frontline working group and non-cleaning tasks performed by a cleaner in a unit. Bed man- Infectious Disease Epidemiology, London School of Hygiene and Tropi‑ agement data of 2019 were used to calculate the average number of cal Medicine, London, United Kingdom times the different types of cleaning occurred per day in a unit. Finally, Correspondence: G. Gon we calculated the full-time equivalents (FTE) in accordance with data Antimicrobial Resistance & Infection Control 10(1): P174 from the human resources department. Results: The mean time to perform a daily cleaning of a single room Introduction: Environmental hygiene is a key component of infec- was 18,87 (CI 15,09 – 22,65) minutes. With bed occupancy rates tion prevention in healthcare, and a driver of healthcare associated between 59 and 86% in units with on average 30 beds in single and infections. Staff who clean in many low resource countries receive no double rooms, we need on average 6 h 37 min per unit to clean the formal training on cleaning, waste disposal and linen handling. This patient rooms. Once we add the 107 min to perform the cleaning of issue has been execrated by the COVID-19 pandemic. The only recom- non-patient areas and other tasks of the cleaning staff, we end up with mended training on environmental hygiene for low resourced facili- an average need of 8 h 24 min per day, which results in 1,96 FTE per ties, TEACH CLEAN, uses a training of trainers model. A selected cadre unit (given the 10 public holidays, 25 leave and 20 absenteeism days “champions” which in turn train their peers with responsibilities on per year). Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 87 of 140 Conclusion: We were able to determine staffing levels for environ- this ongoing COVID-19 pandemic. Appropriate disinfection practices mental cleaning in non-critical adult care units in an acute care hos- play a crucial role in their prevention. pital in Brussels. The presented benchmarks need to be validated to Objectives: This study aimed to observe the effect of monitoring of determine the degree of applicability in other settings. We underline cleaning and disinfection practices using an ATP bioluminescence the need of a transparent, easy to use and effective tool to calculate assay during the ongoing COVID-19 pandemic. staffing levels for environmental cleaning in the healthcare setting. Methods: The study was performed over a period of two and a half Disclosure of Interest: None declared. months in a tertiary health care centre in India. High touch surfaces were identified where cleaning with freshly prepared 1% Sodium hypochlorite was performed as a part of routine cleaning. Post clean- P176 ing of these surfaces, samples were collected and tested using Adeno- Establishing a new standard method to assess the effectiveness sine Triphosphate bioluminescence (ATP) based assay. and improve the environmental cleaning and disinfection Results: A total of 416 testing at various sites were performed during in an acute district general hospital 1,* the study duration. Results were non satisfactory (> 250 RLU) at 123 M. M. Dalauidao sites and the testing was repeated after repeat cleaning and disinfec- King’s College Hospital NHS Foundation Trust, London, United Kingdom tion. All the tests except two performed following repeat disinfection Correspondence: M. M. Dalauidao were satisfactory (< 250 RLU). Decrease in ATP content (RLUs) follow- Antimicrobial Resistance & Infection Control 10(1): P176 ing repeat cleaning at these 123 sites was significant (p < 0.0001). A decreasing trend in the ATP content as measured in the first reading Introduction: Environmental cleaning and disinfection is paramount was noted over a period of two and a half months. in minimising and preventing hospital acquired infections. One of Conclusion: The role of monitoring cleaning and disinfection prac- the most important responsibilities of healthcare facilities is to ensure tices in healthcare settings cannot be underscored. ATP biolumi- high standards of the environmental cleaning and disinfection. How- nescence based assay is a rapid, easy to perform test providing early ever, there is a lack of standard process to check and assess cleaning feedback which can result in an early corrective action. Though ATP effectiveness. bioluminescence based assay cannot specifically detect SARS-CoV-2, Objectives: To be able to establish a new standard method to assess however, give a measure of general cleanliness. However, use of the effectiveness and improve the environmental cleaning and disin- sodium hypochlorite is an EPA (Environmental Protection Agency) fection in an acute district general hospital. approved disinfectant for SARS-CoV-2 along with satisfactory hospital Methods: A quality improvement model based on Plan Do Study Act cleaning and disinfection practices may indirectly indicate satisfactory (PDSA) Cycle approach was utilised for this project. Process mapping, disinfection against SARS-CoV-2. stakeholder analysis and a driver diagram were undertaken to under- Disclosure of Interest: None declared. stand the current practice. A questionnaire was developed for clean- ing staff in the hospital in order to understand and establish their current knowledge and practice. This survey helped to identify gaps P178 and establish the focus of the intervention. An invisible fluorescent Wastes and surfaces as reservoir of antibiotic resistant bacteria marker gel was used as the method of assessment in conjunction with in Nigeria 1,* 1 1 1 the traditional visual inspection, feedback and education. Ten high I. Yusuf , Z. Muhammad Damji , M. Danladi Shuaibu , N. Hamza , N. touch areas around the patient’s bed space were identified where the Abdullahi Bako fluorescent gel was applied and these were checked using a portable Microbiology, Bayero University, Kano, Kano, Nigeria ultraviolet light by the author and later on the project he was joined Correspondence: I. Yusuf by the zonal managers from the cleaning team at a weekly to twice Antimicrobial Resistance & Infection Control 10(1): P178 weekly intervals. Results: The survey showed that there is a need for further training Introduction: Acquisition of community-associated methicillin resist- among the cleaning staff. At the initiation of the new assessment ant Staphylococcus aureus (MRSA) and extended spectrum beta-lac- method in February 2021, compliance with the cleaning and disinfec- tamase (ESBL) producing Gram negative bacteria from environmental tion standard was 27%. Weekly to twice weekly assessment, education sources and surfaces is widely reported in Nigeria. and feedback was commenced. At the end of the implementation Objectives: A study was designed to assess the role of discharged phase, the compliance had increased to 91%. In addition, the cleaning environmental wastes, hands and frequently shared and touched sur- staff morale had increased and they now feel more valued and appre - faces as potential reservoirs of antibiotic resistant pathogens. ciated. This is demonstrated by the improvement in quality of clean- Methods: A total of 818 samples of wastes which include sewage, sul- ing they have consistently delivered throughout the duration of the lage, diapers, food remnants, sands, plastics, water sachets, and swabs project. of restroom floors, corridors, door handle, bowls and hands of vulner - Conclusion: The introduction of the fluorescent marker gel and the able and non vulnerable children (VC and NVC) were analyzed and portable UV light, in conjunction with visual inspection, training and susceptibility of isolates recovered from them to different antibiotics feedback has improved and sustained the quality of environmental were determined. The moderately resistant S. aureus and Gram nega- cleaning and disinfection. tive bacilli were further screened for methicilin resistance and ESBL Disclosure of Interest: None declared. production. Results: Result showed that sewage, sullage, diapers, food remnants and restroom floors were frequently contaminated with PPB that are P177 highly and moderately resistant to penicillins and flouroquinolones. Environmental surface disinfection monitoring by adenosine Nearly all the isolates were susceptible to a carbapenem and cephalo- triphosphate (ATP) bioluminescence based assay in a tertiary sporins. Hands and high-touch surfaces of VC such as bowl were con- health care setting 1,* 2 1 1 1 taminated with E. coli, S. aureus and K. pneumoniae. No ESBL-E. coli was H. Gautam , A. H. Choudhary , S. Khullar , B. K. Das , A. Kapil 1 2 isolated from all the samples. Two ESBL-K.pneumoniae, 2 MRSA and Microbiology, Hospital Administration, AIIMS, New Delhi, New Delhi, 1 ESBL- P. aeruginosa were recovered from VC bowls, sewage, sullage, India and diapers. Correspondence: H. Gautam Conclusion: Sewage, sullage, some solid wastes, restroom floors, VC’s Antimicrobial Resistance & Infection Control 10(1): P177 hand, and their bowl serve as potential reservoir for some resistant bacteria. Introduction: Environmental surfaces in hospitals can be a possible Disclosure of Interest: None declared. reservoir for microorganisms. Proper cleaning and disinfection of hos- pital environmental surfaces has become even more crucial during Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 88 of 140 P179 hydroalcoholic solution/soap; dedicated stethoscope) have been Results of an audit on bio‑cleaning in the operating room in 2019 carried out with sterile wipes once monthly. Fifty samples were per- authors formed, just before daily cleaning. Wipes were incubated 48 h at 30 °C 1,* 1 1 1 1 G. Brahimi , K. Chabane , A. Dahli , M. Charchari , A. Boudebouz , S. Ait in tryptone soy broth, and then samples were plated on four culture 1 1 1 1 1 1 seddik , S. Slaouti , M. Charchari , A. Larinouna , A. El kechai , A. Chetitah , media. Identified bacteria were compared to those isolated from 1 1 A. Rebouh , R. Belkaid patients hospitalized in the same rooms. CHU BENI MESSOUS, ÉPIDÉMIOLOGIE, ALGER, Algeria Results: The main bacteria found in the environment were: E.faecalis Correspondence: G. Brahimi (15,5%); P.agglomerans (11,7%); E.faecium (10,7%); B.cereus (5,8%); Antimicrobial Resistance & Infection Control 10(1): P179 A.baumannii (5,8%). In six cases, the same bacteria were found in both environmental and clinical samples with a time interval < 10 days. Introduction: The bio-cleaning of the premises may seem like a very For five of them, a transmission environment-patient was suspected trivial act. However, it takes on all its importance in a hospital environ- (table 1). ment and more particularly in the operating theater (OR), a place with Table 1 a high risk of infection. Bacteria Environmental Clinical Time between positive environmental and clinical location samples sampling (days) Objectives: Evaluate the compliance of bio-cleaning practices for E.faecalis Bed barriers; Urine culture 5 adaptable (indwelling floors and surfaces in relation to the standards in the BOs of our CHU. catheter) E.faecalis Adaptable Urine culture 5 Methods: The audit took place in the eight medico-surgical depart- (indwelling catheter) ments with operating rooms (General surgery, Urology, ENT, Oph- E.faecalis Bed barriersUrine culture 3 (indwelling thalmology, Pneumo-phthisiology, Pneumo-allergology, CCI and catheter) E.coli washbasin/lever Urine culture 6 Gynecology) from December 8 to 19, 2019. Data was collected by hydroalcoholic (indwelling solution / soap catheter) observation of staff during the performance of their duties. Data entry K.pneumonia Bed barriersbronco-alveolar 10 e lavage (BAL) and processing were carried out using EPI info 6 software. S.aureus washbasin/lever peripheral blood -1 hydroalcoholic culture Results: A total of 17 agents were audited, of which 58.8% (10/17) solution / soap are affiliated with the hospital and 41.17% with two private compa- nies (H.N. and E.N.). 41.2% of those audited have an average level of education and 35% participated in the training on bio-cleaning. Each Conclusion: This study confirms that the close environment of the employee has his own equipment, but it isn’t appropriate for the patient is a reservoir of opportunistic or pathogenic microorganisms. requirements of the hospital. Disinfection of floors is done by bleach This source of infection should not be underestimated in the occur- in 62.5% and by disinfectant detergent in 37.5%. The disinfection rence of infections in critically ill patients. products used are not labeled in 62.5% of the departments. 100% of Disclosure of Interest: E. Kuczewski Grant/Research support from: staff do not respect the storage, dilution and contact time of bleach. Anios, L. Henaff: None declared, N. Khanafer: None declared, S. Loef- Agents affiliated with the hospital do not maintain the BO when the fert Employee of: Anios, P. Cassier: None declared, T. Rimmelé: None room opens in 40% and between two operations in 60%. Cleaning of declared, L. Argaud: None declared, P. Vanhems: None declared. horizontal surfaces is not performed by 60% of agents affiliated with the hospital. Between two interventions, 77% of those audited do not wet sweep and 69.2% of those audited do not clean the furniture. At the end of the program, 64.7% of those audited do not clean the walls P181 at mid-height. All of the HN Company staff, 60% of the E. N. Company’s Evaluation of the environmental monitoring after an outbreak bio-cleaning agents and 60% of the hospital’s bio-cleaning agents of bacillus cereus infections in a neonatal intensive care unit perform weekly maintenance. The logical order in the of operations is (NICU) 1 1 2 1 1 not respected and the notion of clean to dirty and from top to bottom A. Davias , C. Terreaux‑Masson , I. Pelloux , C. Giner , M.‑R. Mallaret , C. 1,* within the same room is unknown by all staff. Landelle 1 2 Conclusion: Despite the training carried out on the application of the Infection Control Unit, Bacteriology Laboratory, Grenoble Alpes Univer‑ protocols, discrepancies are observed, this is due to the turnover of sity Hospital, Grenoble, France bio-cleaning agents, hence the need to repeat the training and display Correspondence: C. Landelle the development of the protocols. Antimicrobial Resistance & Infection Control 10(1): P181 Disclosure of Interest: None declared. Introduction: In 2009, our French University Hospital has known an outbreak of Bacillus cereus infections in newborns of NICU. Nine P180 patients have got a positive biologic sample to B. cereus, 5 of them had Bacterial cross‑transmission between inanimate surfaces a real infection. An important cleaning has been realized in the unit and patients in ICU rooms 1,* 2 1 3 1 and an environmental monitoring was implemented since 2009. E. Kuczewski , L. Henaff , N. Khanafer , S. Loeffert , P. Cassier , T. 1 1 1,2 Objectives: Our objective was to evaluate the efficacy of the environ- Rimmelé , L. Argaud, P. Vanhems 1 2 3 mental monitoring on the onset of infections in new-born hospitalized Hospices Civils de Lyon, University Lyon 1, Lyon, Laboratoires in neonatology, considering the absence of any guidelines developing ANIOS‑ECOLAB, Lezennes, France acceptable B. cereus thresholds in hospital environment. Correspondence: E. Kuczewski Methods: We conducted a retrospective observational study in our Antimicrobial Resistance & Infection Control 10(1): P180 3 units of a neonatology (1 NICU, 1 neonatal intermediate care unit and 1 neonatal medicine unit) of 36-beds between 2009 and 2019. We Introduction: Contaminated environment plays an important role in defined a case of B. cereus infection as a newborn with clinical symp - the acquisition of nosocomial pathogens by patients hospitalized in toms of infection and with at least one biological sample positive to Intensive Care Units (ICUs). Immediate zones around patient’s bed can B. cereus. Every room of NICU was controlled twice by year and every be a reservoir of potential pathogens, where they can survive for many room of neonatology was controlled once by year, with a campaign months. of 10 environmental samples. Samples were made with Count-Tact Objectives: In this study conducted in a French University Hospital, agar and swabs. The average proportion of B. cereus and Bacillus spp we aimed to describe the microbial ecology of two rooms in two ICUs, by campaign were calculated. and to explore the potential link between environmental contamina- Results: Since 2009, 18 patients were identified with a positive biolog- tion and patient’s colonization and/or infection. ical sample to B. cereus and 11 patients had a real infection. Number of Methods: In 2020 during 5 months, environmental samples from cases decreased until 2011 and fluctuated between 2011 and 2019. All room surfaces (i.e. foot side bed barriers; worktop of nurse cart; units combined, environmental B. cereus and total Bacillus proportion computer keyboard and mouse; adaptable; washbasin and lever Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 89 of 140 averages have both decreased since the establishment of the envi- differences in the microbiome composition of high-touch surfaces ronmental monitoring and never exceeded 12% and 7% respectively may be related to this trend. since 2011. Objectives: To assess hospital cleaning practices and microbiome Conclusion: A strengthened environmental monitoring during compositions of COVID and non-COVID ICUs. 11 years in 3 units receiving patients susceptible to B. cereus infections Methods: Prospective observational study in COVID and non-COVID is showing a decrease of Bacillus spp proportions in the environment, intensive care units (ICU) of 3 Brazilian´ hospitals. After informed consent, and a decrease of B. cereus contaminations and infections in hospital- environmental cleaning practices were studied by mean of a qualita- ized new-born. It didn’t allow to completely stop the occurrence of tive instrument through Plan-Do-Study-ACT cycles that was composed cases but to greatly decrease them. by a leadership, an operation/cleaning professionals assessment, and Disclosure of Interest: None declared. the core component 8 of the Infection Prevention and Control Assessment Framework. 38 swabs of high-touch surfaces were collected to evaluate bacterial profile and resistance genes, using large-scale DNA sequencing P182 and real-time PCR. Whole genome sequencing excluded the environment Results: Environmental hygiene practices observed were different as the source of infection of pseudomonas aeruginosa among the 3 hospitals regarding. IPCAF scores were similar. Surface in a neonatal intensive care unit microbiomes in COVID/non-COVID ICUs were similar within hospitals, 1,* 1 1 1 1 1 D. S. Blanc , L. Senn , I. Federli , I. Koening , E. Giannoni , F. Legault , M. but each one presented an unique diversity profile. Low impact was 1 1 Roth‑Kleiner , B. Grandbastien found of terminal cleaning processes in gram-positive bacteria (specially, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland Corynebacterium, Strepococcus e Staphylococcus). In 2 out 12 sanitizers Correspondence: D. S. Blanc samples were positive for Burkholderia Cenocepacia, Pseudomonas, Enter- Antimicrobial Resistance & Infection Control 10(1): P182 obacteriaceae, Stenotrophomonas. Resistance genes mec-A were found in more than 50% of the samples in 2 out 3 hospitals, reaching higher Introduction: Pseudomonas aeruginosa is a rare pathogen in neona- still higher rates in COVID units (71.1% and 86.7%). KPC were also found tal intensive care unit (NICU). Following P.aeruginosa bacteremia in in all ICUs, indistinctly, followed by OXA23 and VanA (in much lower rate, two NICU patients hospitalized in two different rooms with dedicated not in all ICUs). nurses, we performed an epidemiological investigation. Objectives: To find environmental sources and routes of transmis- sion of P. aeruginosa infections in NICU patients using standard and genomic typing methods. Methods: All humid environments were screened for P.aeruginosa. This included tap water, faucets, sink traps, water reservoirs of incu- bators, cosmetics, and disinfectants. Sink traps were dismantled and 10 samples were done at different sites of each sink trap. Isolates were first typed by double locus sequence typing (www. dlst. org/ Paeru ginosa) and all isolates identical to the three patient’s isolates (DLST 28–77), were further analysed by whole genome Multi Locus Sequence Typing (wgMLST, BioNumerics v.7.6.3). As control, we ana- lysed 15 isolates of DLST 28–77 not related to the outbreak. Results: Among the 287 environmental samples analysed for the presence of P.aeruginosa, 99 were positive, mostly from sink traps. Typing revealed 35 isolates belonging to DLST 28–77. Whole genome sequencing revealed that all DLST28-77 isolates (N = 53) belonged to the MLST ST395. wgMLST analysis showed differences of 0 to 180 loci between all isolates. Only 0 to 2 loci differences were observed between the three isolates from the two NICU patients. The closest environmental isolates from the two NICU patients had > 70 loci dif- ferences and the closest patient isolate had 27–30 loci difference. The Conclusion: Surface microbiome within hospitals in COVID and non- later was recovered from a patient in the adult ICU with no link with COVID ICUs of did not present significant differences. Conversely, each the NICU. hospitals presented very distinct diversity profiles. Although presumed, Conclusion: The thorough investigation of the environment of our clinical impact of environment-related findings, as well as differences NICU showed that sink traps were the main reservoir of P.aeruginosa. between environmental hygiene practices and contamination of sanitiz- However, none of the environmental isolates was genetically close ing agents deserves further investigation future studies. enough to be considered as the source of infection. The sole use of Disclosure of Interest: None declared. standard molecular typing (DLST) would have lead us to a false con- clusion that sink traps were the source of infection. P184 Disclosure of Interest: None declared. Evaluation of environmental sampling kit to monitoring of microbial contamination in immunohematology and transfusion unit of general hospital in North Italy P183 1,2,* 3 1 3 1 G. Ortalli , E. Diani, F. Vailati , A. Falanga , C. Farina Environmental cleaning practices and microbiome of high‑touch 1 2 Microbiology Institute, ASST "Papa Giovanni XXIII, Bergamo, Laborato‑ surfaces in covid and non‑COVID ICUs—a pilot study 1,* 1 1 2 1,3 rio di Microbiologia e Virologia, Hosptal Santa Chiara, Trento, Division E. Y. Kumoto , A. Guimarães , C. Silva , R. Chaves , A. Pereira on behalf of Immunohematology and Transfusion Medicine, ASST "Papa Giovanni of Impacto MR group 1 2 3 XXIII, Bergamo, Italy Intensive Care Unit, Department of Anesthesiology, Big Data, Hospital Correspondence: G. Ortalli Israelita Albert Einstein, São Paulo, Brazil Antimicrobial Resistance & Infection Control 10(1): P184 Correspondence: E. Y. Kumoto Antimicrobial Resistance & Infection Control 10(1): P183 Introduction: Healthcare associated infections (HAI) in hospital are caused by environment agents transferred between surfaces. Introduction: In the context of the pandemic caused by SARS-CoV-2, Objectives: Aim of this study was to monitor environmental con- reports of increased incidence of Health Care-Related Infections have tamination in Division of Immunohematology and Transfusion been published. Variability in environmental cleaning practices and Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 90 of 140 Medicine of Papa Giovanni XXIII General Hospital in Bergamo ® ® (Italy), comparing Copan SRK with FLOQSwabs to traditional cot- ton swabs and contact plates. Methods: On a seasonal basis for 1 year, collection points (work- benches, trolleys, glasses, handles and keyboards) were identified and sampled. Flat surfaces were tested comparing contact plates (55 mm TSA) and SRK samples. Articulated surfaces were cross- sampled, to avoid analysis bias, comparing cotton swabs and SRK samples. After sampling, SRK medium and cotton swabs were inoculated and incubated on 90 mm TSA plates (35 ± 2 °C, aerobic atmosphere, 7 days). Identification of isolates was performed with MALDI-TOF. Results: Data from environmental samples, are resumed in table 1. Probably due to a wider sampling area, contact plates from flat sur- faces showed more species detected compared to SRK, but a lower value of total CFU in summer and autumn, probably related to a better sampling procedure with flocked swabs. From articulated surfaces: SRK detected more species and isolates compared to cot- ton swabs, allowing to detect Gram negative bacteria (such Escheri- chia coli), yeast and filamentous fungi on the joint surfaces. Conclusion: Copan SRK, associated with FLOQSwabs, showed to be effective for sampling procedure where compared with standard methods. While results for flat surfaces were slightly different, on a seasonal basis, between reference and test methods, for articulated surfaces Copan SRK showed to be more effective in monitoring microbial environmental contamination. Conclusion: Several problems with drain design and installa- Disclosure of Interest: None declared. tion were identified. Firstly the drain was not contiguous with the back of the sink which promoted stagnation and pooling of P185 water. Excess sealant present in the drain led to occlusion and An investigation down the drain further excacerbated stagnation as the drain was not free flow - 1,* 2 T. Inkster, M. Weinbren ing. Corrosion and splitting of an aluminimum spigot enhanced 1 2 Microbiology, Queen Elizabeth University Hospital, Glasgow, NHS the occlusion and provided an uneven damaged surface for bac- Assure, NSS, Edinburgh, United Kingdom teria to adhere to. Together these conditions promoted biofilm Correspondence: T. Inkster formation,excacerabted by the presence of foreign material and Antimicrobial Resistance & Infection Control 10(1): P185 nutirients. There are several lessions from these findings that should be applied Introduction: Hospital drainage systems are becoming increasingly to future design of drains. 1) The drain should be completlely flush implicated as a source of outbreaks with organisms such as CPEs. It with the back of the sink 2) Overzealous use of sealant should be is therefore important to give thought to the design of drainage sys- avoided as this can lead to obstruction and poor flow 3) Compo - tems when building new hospitals, to mitigate the risk. nents used in drains should be with a material not liable to corro- Objectives: We aim to describe the abnormalities in sink drains sion 4) Workmanship should be of a high standard. found in a new build hospital.We discuss how improvements could It is also important to address behavioural aspects and infection con- be made in future design and the importance of addressing human trol teams should ensure staff/ patients are aware of the importance behaviour in mitigating risk from drains. of drain hygiene. Objects and fluids should not be decanted in drains Methods: Drains were investigated following reports of relux of and alternative disposal methods should be provided. material back up into sinks by staff and patient infections. Drain Disclosure of Interest: None declared. components were removed for inspection and analysis by the labo- ratory. Assessment of biofilm reaction, bacterial burden and chemi- Poster Session: Environmental control: Medical devices cal analysis of drain debris was undertaken. Results: Drains were found not to be flush with the back of the P186 sink with a lip present where water was stagnating. Excess sealant Bacterial contamination of healthcare workers’ mobile phones; was present in the drains and there was corrosion of an aluminium case study at two referral hospitals in Uganda component. Several plastic objects were retrieved and some scrub 1,* 1 1 2 3 F. Tusabe , M. Kesande , J. Nanyondo , H. A. Afreenish , I. Olivia , R. R. sinks were completely occluded by surgeons nail picks. Mature bio- Ayebare film and high bacterial counts were detected along with evidence of Global health security, Infectious Diseases Institute, Kampala, Uganda, nutrients in the drains. 2 3 Microbiology, NIH, Pakistan, Islamabad, Pakistan, Policy, 3Barbaricum LLC Washington,, Washington, United States Correspondence: F. Tusabe Antimicrobial Resistance & Infection Control 10(1): P186 Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 91 of 140 Introduction: Hospital and Community-acquired infections are esca- staphylococci (10.9%), Klebsiella pneumonia (9.4%), Escherichia coli lating and pose significant public health unhealthiness worldwide. (7.0%), Dephtroids (6.3%), Acinetobacter spp. (5.5%), Enterobacter spp. The advancements of telemedicine and automation of healthcare (3.9%), Staphylococcus aureus (2.3%), and Streptococcus (1.6%). Out records are supported by cell phones, laptops and wearable devices. of 113 CLMA devices tested in the post-interventional assessment, 19 Objectives: To establish incidence of healthcare workers’ mobile (16.8%) were positive with one Gram positive microorganism. They phones becoming contaminated with pathogenic bacteria and their included Coagulase-negative staphylococci (84.2%), Micrococcus spe- possible roles as vehicles of transmission of antimicrobial-resistant cies (10.5%), and Bacillus species (5.3%). bacteria. Conclusion: The findings confirm the success of a multidisciplinary Methods: This was a cross-sectional study at two referral hospitals intervention focused on improving disinfection and infection control in Uganda between May and October 2020. Self-administered ques- practices in reducing the bio-burden on portable devices used in ter- tionnaires were provided to the participants after informed consent. tiary care setting. In our hospital where the majority of HAIs are caused Mobile phones of the healthcare workers in different departments of by Gram-negative pathogens, this intervention many positively the hospitals were randomly swabbed. Samples were collected, trans- impact the fight against HAIs. ported to the microbiology laboratory for bacterial culture and antimi- Disclosure of Interest: None declared. crobial susceptibility tests. Results were entered into Microsoft excel for analysis. P188 Results: Our study revealed that 93% of the screened mobile phones Pilot study on medical tape contamination in a hospital setting 1,* 2 3 3 4 were contaminated with one or more species of bacteria, interestingly H. Reuter , D. Ember ger , N. Parohl, W. Popp , M. Roßburg 1 2 46% were multi-drug resistant; the majority of them being resistant to 3 M Deutschland GmbH, Neuss, Marien Hospital Herne St. Elisabeth 3 4 penicillin, cotrimoxazole, ciprofloxacin and Gentamycin respectively, Gruppe GmbH, Herne, HyKoMed GmbH, MVZ Dr. Eberhard & Partner, this is a time bomb of MDR transmission. and only 8% of the partici- Dortmund, Germany pants cleaned their hands after using a mobile phone. Organisms iso- Correspondence: H. Reuter lated were E.coli, Micrococcus spp, CoNS and Bacillus spp. 15% of the Antimicrobial Resistance & Infection Control 10(1): P188 isolated organisms are potential pathogens (n = 13). Conclusion: Realization of the role the Healthcare workers’ mobile Introduction: Medical tapes are used routinely and stored in various phones play in the spread of hospital-acquired infections is para- patient areas, supply carts, and healthcare personnel pockets once mount. Advancements in telemedicine and automated healthcare removed from packaging. Many publications discuss how common have not been matched by advancements in sanitizing and decon- practices around medical tapes can lead to infection transmission. To taminating protocols specifically for phones and other mobile devices, minimize risk, some manufacturers already offer tape rolls with antimi- this study provides strong evidence for developing and strengthening crobial spools or for single-patient use. disinfection protocols of mobile phones. Objectives: Our purpose was to quantify the contamination of tape In future, there is a need to correlate the bacterial isolates and resist- rolls found in different locations within a hospital in Germany. ance patterns with nosocomial infections identified in similar settings. Methods: A test method was developed using RODAC plates and The need to study the efficacy of different mobile phone disinfection swabs to optimize conditions. Each roll was sampled in 4 sites: top protocols is also paramount. layer of the tape, deeper layer of the tape, side of the roll, and inside Disclosure of Interest: None declared. ring of the spool. Results were normalized to colony forming units (CFU) per plate (24 cm ). Since no microbial standard limits exist for P187 the acceptability of medical tape other than “low bacterial contami- The impact of a multidisciplinary infection control intervention nation with absence of pathogens”, we categorized our results based on contamination of portable computerized devices in healthcare on limits offered by GMP (European Pharmacopoeia) and the hygienic settings monitoring of air conditioning systems (VDI 6022). Categories were: no 1,* 2 1 2 1 M. Alshamrani, K. Yassine , A. El‑Saed , K. Ameer , M. Hawthan , S. bacterial detection (“very good”), 1–24 cfu/plate (“good”), 25–49 cfu/ 3 3 1 2 Ramou , B. Al Alwan , F. Othman , M. Al Zunitan plate (“conspicuous”), 50–100 cfu/plate (“borderline”), or > 100 cfu/ 1 2 3 Infection control, King Abdulaziz Medical City, Infection control, Micro‑ plate (“insufficient”). biology laboratory, King Abdullah Specialist Children Hospital, Riyadh, Results: 32 tape rolls (19 with an antimicrobial spool and 13 without) Saudi Arabia were examined. Of 128 total samples, 71 had evidence of skin and Correspondence: M. Alshamrani environmental bacteria, 1 had Enterococcus sp, and 56 had no bacte- Antimicrobial Resistance & Infection Control 10(1): P187 ria detected. 53 samples had 1 species, 16 had 2 species, and 3 had 3 species. The large majority of CFUs came from the top layer of the tape Introduction: Use of portable computerized devices on multiple and the side of the roll, regardless of the presence of an antimicrobial patients carry the risk of spreading healthcare-associated infec- spool. Two rolls ranked “very good”, 16 ranked “good”, 4 ranked “con- tions (HAIs), if appropriate infection control practices are not strictly spicuous”, 2 ranked “borderline”, and 8 ranked “insufficient”. None of followed. the rolls were contaminated with pathogenic bacteria, but only 2 rolls Objectives: To quantify the bacterial burden of these devices and to had no bacterial detection at all. assess the impact of a multidisciplinary intervention on reducing the Conclusion: Tape rolls used repetitively in a hospital very often carry risk of cross-contamination. microbial flora and therefore may contribute to bacterial transmission Methods: A pre and post-interventional study was carried out in dif- in hospitals. An antimicrobial spool does not offer complete protec - ferent units of a tertiary care hospital. The study target was Close Loop tion since bacteria can be found even on most of those tape rolls. Medication Administration (CLMA) device. In April 2019, environmen- Disclosure of Interest: None declared. tal swap samples were collected from the surfaces of CLMA devices and tested for bacterial contamination. This was followed by the for- P189 mulation and implementation of a multidisciplinary intervention that Main risk factors for patient’s infection associated included training of 200 healthcare workers (HCWs). In March 2020, with reprocessing endoscopes in Russia environmental swap samples were re-collected from CLMA devices 1,* 1 T. Grenkova , E. Selkova and tested in the same way. Moscow Gabrichevsky Research Institute of Epidemiology and Microbi‑ Results: Out of 111 CLMA devices tested in the pre-interventional ology, Moscow, Russian Federation assessment, 57 (51.4%) were positive. Out of 128 microorganisms Correspondence: T. Grenkova retrieved, 74 (57.8%) were Gram-positive and 54 (42.2%) were Gram- Antimicrobial Resistance & Infection Control 10(1): P189 negative. They included Bacillus species (19.5%), Micrococcus spe- cies (17.2%), Pseudomonas aeruginosa (16.4%), Coagulase-negative Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 92 of 140 Introduction: About 14 million endoscopic interventions are car- Results: Percutaneous probes clean 280 (38.7%), clean and disinfect ried out in Russia every year and a few score of HAI cases, which are 443 (61.3%) of the 723 respondents; 132 (18.2%) of the respondents related to them are officially registered. The epidemiological safety say that they never use disposable transducer covers. system (ESS) of endoscopic interventions and the method of safety Intracavity probes were only cleaned by 105 (16.8%) out of the 627 level detection in a certain medical facility have been worked out in respondents, cleaned and low-level disinfected by 294 (46.9%), the country. cleaned and high-levels disinfected (HLD) by 228 (36.3%). Only 31.6% Objectives: Reveal the risk factors for patient’s infection at endoscopy of the respondents use effective disinfectants for HLD standards departments to improve the ESS. achieving. Single-use transducers covers were used in 97.0% of intra- Methods: 460 of doctors and nurses of endoscopy hospital depart- cavity examinations, but 34.3% of them were not sterile. ments from 80 regions of Russia were interviewed. The form con- All 54 respondents, performing intraoperative ultrasound procedures, tained 47 questions. Some questions have not been answered by all clean and disinfect probes after use, but only half of them sterilize or respondents. perform HLD additionally. 90.7% of respondents use sterile single-use Results: There are no reprocessing rooms arranged in 75 (16.3%) of transducer cover on a permanent basis. 460 endoscopic departments. 369 (91,1%) of 405 respondents do not Ultrasound practitioners named three main reasons that impede the violate the precleaning procedure; 29.9%—carry out the leak test safety of ultrasound diagnostics: the lack of conditions for the intro- irregularly. 325 (73,5%) of 442 respondents never violate the guide- duction of HLD (57.7%), the lack of national guidelines (48.2%), and lines when carrying out the manual cleaning, 7.2% skip the step insufficient knowledge in this area (32.2%). of soaking in washing solution, 5.7% reduce a number of brushing Conclusion: The study revealed the potential risks of infection for passes through channels, 6,8% of respondents miss out the rinsing patients during ultrasound examinations associated with the lack of before an endoscope is connected to an AER/EWD. High-level disinfec- standardized approaches for ensuring this medical technology epide- tion (HLD) in AER is performed at 65.2% of endoscopy departments. miological safety. The development and implementation of IPC national Among HLD applied agents the aldehyde share is 47,9%, oxygen guidelines in ultrasound diagnosis into clinical practice is a priority. active compounds—38,7%, the rest 13,4% of agents are not included Disclosure of Interest: None declared. into the list of recommended for such a purpose. More than a third of endoscopy departments do not check the minimum effective con- Poster session: environmental control: others centration in a high-level disinfection solution. Final manual rinsing of gastrointestinal (GI) endoscopes are made by tap water at all endos- P191 copy departments which were questioned. Microbiological studies of Importance of the hospital environment in the transmission the effectiveness of the endoscopes reprocessing cycles are not car - of infections by multidrug‑resistant microorganisms: a systematic ried at 56 (12.7%) of 460 endoscopy departments, at 82 departments review of literature (17.9%) it is performed less than once per a quarter. Unsatisfactory 1,* 1,2 2,3 1 1 A. Guimarães , A. Pereira , R. Chaves, C. Vallone , E. Kumoto results were received for 4.4% of samples. on behalf of IMPACTO MR Group Conclusion: Obtained results analysis revealed the main risk fac- 1 2 3 Big Data, Critical Care Unit, Anesthesiology, Hospital Israelita Albert tors for patient’s infection associated with ineffectively reprocessed Einstein, São Paulo/SP, Brazil endoscopes and has allowed to improve the requirements to sepa- Correspondence: A. Guimarães rate components of ESS: technical fit-out and material support of the Antimicrobial Resistance & Infection Control 10(1): P191 endoscopes processing, microbiological water quality for final rinsing of GI endoscopes, carrying out of cleaning quality control and HLD of Introduction: Despite of healthcare environment is an important reser- endoscopes. voir for multidrug-resistant microorganisms (MDROs), the impact of envi- Disclosure of Interest: None declared. ronmental interventions in clinically relevant outcomes is unclear. Objectives: To review the literature about the impact of environmental interventions (non-related to sanitizers) in the clinical impact of MDROs. P190 Methods: Studies were identified through electronic literature search of Epidemiolodgycal safety of ultrasound diagnostics PubMed, CINAHL, and SCOPUS, by two independent authors. Any type 1 2 1,* 2 E. Selkova, V. Mitkov, T. Grenkova , M. Mitkova of environmental interventions in surgical centers, ICUs and wards were Moscow Gabrichevsky Research Institute of Epidemiology and Microbi‑ evaluated. No restrictions regarding patients and microorganisms were ology, Russian Medical Academy of Continuous Professional Education, applied. Bench studies, MDROs inocula on surfaces, studies based on Moscow, Russian Federation sanitizers (disinfectants or detergents) or animal studies were excluded. Correspondence: T. Grenkova Quality of randomized controlled trials and non-randomized ones were Antimicrobial Resistance & Infection Control 10(1): P190 evaluated by the Cochrane Collaboration’s tool, and Newcastle–Ottawa scale, respectively. Introduction: Infection prevention and control (IPC) in ultrasound Results: The search strategy identified 1173 studies. Of those, 20 stud- (US) examination remains a subject of serious disagreement among ies were included in systematic review. Only 4 studies were randomized, specialists. Several countries developed and implemented guidelines and those, only 1 (a bundle-based intervention), assessed the impact to ensure IPC in this area. In Russia, there are no such national guide- on clinical outcomes. Bundle of interventions (including educational lines, but the need for them is recognized. procedures) were the most frequently non-sanitiser method found (7 Objectives: To analyze the type of ultrasound transducers (probes) studies). Ultraviolet light (UV, 2 studies) and hydrogen peroxide vapor reprocessing and the use of single-use covers for them (for external, (HPV, 4 studies) seemed to be promising methods to improve cleaning intracavitary and intraoperative procedures) in medical organizations processes. Wipe-based methods were assessed in 2 prospective studies, of the Russian Federation. and one of them highlights the potential of spread MDROs in case of not Methods: 869 ultrasound doctors from 77 regions of Russia were properly used. Other cleaning methods (for instance, testing more cloths, interviewed. The questionnaire contained 21 questions about the electrolysed water, extra cleaning etc.), were evaluated in 5 studies. reprocessing of US probes and the use of single-use probe covers for them. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 93 of 140 selected 0.3 μm particles for having the highest diagnostic perfor- mance. Our selected cut-off points were 770,000 particles (AUC = 0.80, NPV = 94%) for fungi and 9,900,000 particles (AUC = 0.76, NPV = 96.5%) for bacteria, which could have avoided 58.6% and 85% of microbiological sampling procedures for fungi and bacteria respectively. Conclusion: Microbiological contamination varies significantly with the number of particles in the air. A reasonable cut-off point can be established to guarantee environmental biosecurity in hospitals while reducing monitoring time and economic costs. Disclosure of Interest: None declared. P193 Healthcare environmental hygiene: preliminary results of an international sentinel survey of hospital practices in healthcare environmental hygiene 1,* 2 1 1 A. Peters , M. N. Schmid , M. DeKraker , D. P ittet Infection Control Programme & WHO collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine of Geneva, University of Geneva, Geneva, Switzerland Correspondence: A. Peters Antimicrobial Resistance & Infection Control 10(1): P193 Introduction: Good practices in healthcare environmental hygiene (HEH) are key to infection prevention and control, and decrease the Conclusion: UV, HPV, and bundle-based approaches seem to be risk of healthcare associated infections. HEH includes anything in the potential complementary environmental interventions to sanitizers healthcare environment not directly on the patient, including surfaces, in hospitals. However, only few, low-quality interventional studies sterilization, device reprocessing, air, water management, laundry and are available, most of them focused in microbiological, and not clini- waste management. HEH is often a neglected field, and little is known cal outcomes. Future research in this area should focus in randomized about the topography of practices and challenges globally. clinical trials (including cluster) evaluating the potential intervention Objectives: Our survey aims to show how HEH programs work around in clinically relevant outcomes. the world and what specific challenges they face. The larger objective Disclosure of Interest: None declared. of this work is to use the data collected to develop a Healthcare Envi- ronmental Hygiene Self-Assessment Framework (HEHSAF), in order to help hospitals improve their HEH in line with the Clean Hospitals project. P192 Methods: The online survey is built according to the 5 components of Optimizing air monitoring procedures in critical areas of a third the WHO multimodal improvement strategy. 729 healthcare facilities level hospital 1,* 1 1 (HCF) from 175 countries received the HEH survey: 30 HCF answered K. Bliek Bueno , C. Lapresta Moros , A. Del Cura Bilbao , J. M. Celorrio 1 1 1 from 12 high, 9 high-middle, 5 low-middle and 4 low incomes coun- Pascual , T. Giménez Júlvez , A. M. Cortés Ramas , M. J. Hernández tries. 4 facilities from each income level were selected for semi-struc- Navarrete tured interviews to obtain qualitative data. Preventive Medicine and Public Health, Miguel Servet University Hospi‑ Results: Preliminary results indicate that most HCF believe HEH is tal, Zaragoza, Spain important (71%). Often, budget allocated for cleaning and disinfec- Correspondence: K. Bliek Bueno tion is not sufficient (58%) and the responders do not make decisions Antimicrobial Resistance & Infection Control 10(1): P192 for the budget (63%). Detergent (77%), bleach or chlorine-based dis- infectant (80%) and mop and bucket systems (87%) are the most fre- Introduction: Critical areas in hospitals in Spain (operating rooms, quent products and supplies used. UV disinfection machines are used intensive care units, burns units, transplant units, etc.) follow the parti- in 33% HCF surveyed. Environmental service (EVS) staff do not have cle counting and microbiological sampling limits in the air established the possibility to complete certification programmes (83%) nor to in the ISO 171340:2012 and 14,644–1 standard requirements. Existing advance in management roles (75%). No events about HEH are hosted literature is contradictory when determining the association between in over half of the HCF surveyed. Communication between EVS staff particle counts and microbiological colony-forming units (CFU), and a and nurse staff is frequent on the workfloor (47%) but in 27% of cases, particle count cut-off point has never been determined to safely guar - there is no formal meeting between the EVS staff and nursing staff. antee the absence of microbiological contamination. Conclusion: There are major differences among HEH programs and Objectives: The objective of this study was to establish a cut-off point the importance they are given by HCF. New approaches in products in the number of air particles in critical areas in hospitals that could and supplies are often not used, and there are problems with work- potentially avoid microbiological sampling. place culture. There is definitely room for improvement on a global Methods: Diagnostic validity and reliability study conducted using level. particle counting (number of 0.3, 0.5 and 5.0 μm/mm3 particles) and Disclosure of Interest: None declared. microbiological sampling (bacterial and fungal CFUs) in the air of criti- cal areas of the Miguel Servet University Hospital collected between January 2010 and August 2019. The particle cut-off point with greater diagnostic validity was established using the area under the ROC curve (AUC), the Youden index, and the positive (PPV) and negative (NPV ) predictive values. Results: We obtained 442 particle counts with their correspond- ing microbiological samples. Out of the three particle diameters, we Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 94 of 140 P194 were plated on to a Sabaroud Agar ( SAB) plate and incubated at 37C Essential supply list for infection prevention and control for 5 days. E dermatitidis was identified using MALDI. in healthcare facilities Results: E dermatitidis was isolated predominantly from patients 1,* 1 1 J. Lopez , T. Ashengo , S. Sara with Cystic fibrosis and more frequently from adults with the condi- Momentum Country and Global Leadership, Washington, United States tion compared with children. Other patient groups with positive iso- Correspondence: J. Lopez lates included those with chronic lung conditions and haematological Antimicrobial Resistance & Infection Control 10(1): P194 disorders. The majority of sample types were respiratory although five patients had positive blood cultures during the study period. Introduction: Maintaining infection prevention and control (IPC) The number of affected patients reached a peak in quarters 3 and 4 standards is vital to ensuring that healthcare staff provide services that of 2017 and fell following the identification of environmental sources are safe for patients and staff. To meet basic levels of IPC readiness, and implementation of control measures. healthcare facilities need access to essential supplies and equipment like soap and water, proper medical waste receptacles, and sufficient stocks of personal protective equipment (PPE) for staff, patients, and visitors. Objectives: In response, USAID’s Momentum Country and Global Leadership (MCGL) project developed an Essential Supply List for healthcare facilities (HCFs) to maintain basic standard IPC practices for all healthcare service levels and contexts. The list complements existing guidance and standard documents by providing centralized global guidance on essential IPC supplies and equipment, along with transmission-based precautions, minimum supply specifications and recommended stocking quantities. While certain clinical contexts may require additional standards and supplies, these basic standards remain universal. Methods: The list is non-exhaustive and focuses on the essential sup- plies required for IPC based on a review of the literature, interviews with IPC experts and review of available guidance. While this docu- ment was not written to respond directly to the COVID-19 pandemic, Conclusion: In our study we found evidence of hospital sources of E it does include essential IPC supplies required for delivery of safe dermatitidis. The yeast was found in dishwashers, chilled beams and healthcare services in the context of COVID-19. from air sampling. Another potential source was damage to shower Results: The final list of essential supplies was compiled into the flooring and the presence of visible black mould. We implemented the following sections: Healthcare workers, Envrionmental Cleaning, following control measures; 1) Dishwashers were removed from wards Instrument Processing, Wate Managment, and Infrastructure and housing immunocompromised patients. 2)An increase in cleaning fre- Maintenance. The sections are further divided by IPC materials and quency was introduced for chilled beams 3) Damaged showers were PPE. repaired. Infection control teams should be aware of the environmen- Conclusion: The presentation will provide an overview of the docu- tal conditions which might promote growth of E dermatitidis and how ment and how it can support national and sub-national health author- to mitigate the risks. ities by incorporating it into their Logistic Management information Disclosure of Interest: None declared. Systems (LMIS) and inventory control systems, along with develop- ment of forecasting plans for PPE and IPC consumables that prioritize P196 needs, stockpiling and deployment plans and continued communica- Recognition on the high‑touch surfaces among nurses tion with facilities to ensure supply. and inpatients Disclosure of Interest: None declared. 1,2 1,* 1 3 1 Y. J. Heo , J. S. Jeong , H. R. Choi , I. S. Jeong , Y. H. Kim 1 2 Department of Clinical Nursing, University of Ulsan, Seoul, Department P195 of Infection Control, H Plus Yangji Hospital, Seoul, College of Nursing, Epidemiology of exophiala dermatitidis in a Glasgow hospital, Pusan National University, Yangsan, Korea, Republic Of potential hospital sources and control measures Correspondence: J. S. Jeong 1,* 1 2 T. Inkster , C. Peters , G. Macgregor Antimicrobial Resistance & Infection Control 10(1): P196 1 2 Microbiology, Respiratory Medicine, Queen Elizabeth University Hospi‑ tal, Glasgow, United Kingdom Introduction: As hospital environment can be a cause of healthcare- Correspondence: T. Inkster associated infection, environment control plays an important role in Antimicrobial Resistance & Infection Control 10(1): P195 preventing the spread of pathogens. Particularly, high-touch surfaces frequently contacted by patients or healthcare workers are more eas- Introduction: Exophiala dermatitidis is a saprophytic black yeast asso- ily contaminated than other surfaces, so it is recommended to clean ciated with respiratory, soft tissue and blood stream infections. Its them regularly or more often. Though, the examples of the high-touch prevalence in Cystic Fibrosis (CF) patients ranges from 1–19% world- surfaces are provided in the guidelines, it has never been studied how wide.Whilst previous studies have found evidence of E. dermatitidis in frequently the surrounding are contacted, or how consistent is the domestic sources there is a paucity of literature on hospital acquisi- recognition of the contract frequency between patients or healthcare tion, sources and relevant control measures. workers. Objectives: To discuss the epidemiology of E. dermatitidis in our hos- Objectives: This study was aimed to compare the recognition on the pital, the investigations undertaken to investigate potential hospital high touch surfaces between nurses and inpatients, and to prioritize sources and recommendations for future control measures. cleaning and disinfection. Methods: Data between January 2016 and June 2019 was extracted Methods: The participants were 122 nurses working at general wards for all patient isolates of E. dermatitidis from all sample types. Dedupli- and 56 patients hospitalized at the 299-bed general hospital in Seoul. cation of positive isolates was undertaken with the first isolate in each Data were collected from 6 to 10 April 2020 using a self-reported ques- patient included in the analysis. tionnaire including 38 items in four sections; 5 items on the medical Environmental sampling of chilled beams, dishwashers, washing devices, 13 items on toilets, 10 items on the equipment around sink machines, linen and drains was undertaken using cotton swabs. These and door, and 10 items on the bedside area and furniture. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 95 of 140 Results: Average recognition on high touch surfaces was significantly miology, Moscow, Russian Federation higher in nurses than patients. (5.96 ± 1.47 vs. 2.35 ± 1.98, p < 0.001). Correspondence: A. V. Tutelyan Top seven high touch surfaces included IV poles, bed side rail, bed Antimicrobial Resistance & Infection Control 10(1): P198 height remote control, bed table, restroom door handle, bedside per- sonal locks, and restroom seat, the ranking of which was the different Introduction: Microorganisms form biofilms on any surface. The dan- between nurses and patients. The recognition on high touch surfaces ger for the food in-dustry is the development of biofilms on abiotic was related to the position (p = 0.020), work department (p = 0.004), surfaces. The abiotic surface of food production is rough, porous, with and work experience at current department (p = 0.013) for nurses and joints, seams and a huge number of hard-to-reach places, i.e. there are gender (p < 0.001) and ability to move alone (p = 0.003) for patients. all conditions that contribute to the localization of biofilms. The struc - Conclusion: Though nurses and patients show consensus on major ture of the matrix serves as a barrier to prevent the penetration of dis- high touch surfaces, there is a big difference in touch frequency. Fur - infectants and detergents. ther researches are required to confirm high touch surfaces through Objectives: A study was carried out on the ability of microorganisms observation. Listeria and Pseudomonas species to form biofilms. Keywords: Patient’s rooms; Environment; Disinfection; Recognition; Methods: As objects of research, 26 strains of various types of micro- Nurses; Patient. organisms were selected, isolated from the objects of the produc- Disclosure of Interest: None declared. tion environment of a meat processing plant and a poultry plant, as well as from meat products. Biofilm formation was studied in vitro on microtiter plates. The ability to form biofilms was evaluated + 4° C, the P197 growth rate of the culture was assessed in a photometer at a wave- A first report of qacδe1 detection in pseudomonas species length of 540 nm. Wells filled with sterile broth served as a control. The from hospital environment in Slovakia excess of the optical density of the crystal violet over the control indi- 1 1,* 1 1 1 2 M. Havrisko , J. Brnova , L. Reizigova , L. Pazderka , J. P rnova , A. Liskova , cated the formation of biofilms by bacteria. 3 4 5 Z. Sirotna , A. Streharova, V. Krcmery Results: As a result of the studies carried out, it was found that at a Centre for Microbiology and Infection Prevention, School of Health low positive temperature, all strains of pathogens formed stable bio- Sciences and Social Work, Trnava University, Trnava, Department of Clini‑ films during the first three days of cultivation. This ability was pos- cal Microbiology, University Hospital Nitra, Nitra, National Reference sessed not only by pathogenic species of Listeria (L. monocytogenes), Centre of Environmental Microbiology, Public Health Authority, Bratislava, but also by non-pathogenic ones—L. welshimeri and L. innocua. The Department of Infectious Diseases, Trnava Univeristy Hospital, Trnava, results showed that all Salmonella spp. possessed the ability to form Tropicteam, St. Elisabeth University, Bratislava, Slovakia biofilms at low positive temperatures, especially intensively dur - Correspondence: J. Brnova ing 96 h of incubation. None of the strains formed a large amount of Antimicrobial Resistance & Infection Control 10(1): P197 biofilm until 24 h. Of the two studied bacterial strains Pseudomonas gessardi and Pseudomonas azotoformans, both strains showed a high Introduction: Quaternary ammonium compounds (QAC) are often ability to form biofilms at low positive tem-peratures. employed as disinfectants in hospitals. The resistance mechanism to Conclusion: The ability to form biofilms by pathogens and spoilage disinfectants is usually determine by genes qacΔE1 that are found microorganisms poses a serious threat to the production of safe prod- in Gram-negative bacteria, mainly in the Enterobacteriaceae family ucts and is one of the reasons for the stable circulation of microorgan- and with Pseudomonas species. isms in the conditions of meat processing plants. Objectives: The aim of this study was to analysed the frequency of Disclosure of Interest: None declared. biocide resistant gene qacΔE1 in Pseudomonas species isolated from hospital environment during HOSPITAL-ENVIRO-REZ study in 2015— 2019 in Slovakia. P199 Methods: In this study 274 environmental isolates of Pseudomonas Impact of health education on knowledge of hospital staff species from 93 Slovakia hospitals were screened for the pres- regarding healthcare wastes management in Tunisian university ence of biocide resistant genes qacΔE1(by the PCR and visualised hospital 1,* 1,2 1,2 1,2 1 by ELFO) and resistance to antibiotics genes bla , bla, bla , R. Bannour , H. Ghali , A. Ben Cheikh , S. Bhiri, W. Dhouib , S. KPC NDM VIM 1 1,2 1,2 bla , and bla (GeneXpert, Cepheid) and immunochromato- Khefacha , H. Said Latiri , M. Ben Rejeb OXA-48 IMP graphic rapid tests (NG-Test CARBA 5, NG Biotech). Department of Prevention and Security of Care,, Sahloul University Results: Out of the 274 isolates of Pseudomonas species from hospital Hospital, Faculty of Medicine of Sousse,, University of Sousse, Sousse, environment 78 isolates (28,5%) were positive for qacΔE1 gene. Over- Tunisia, Sousse, Tunisia all 62 (79,5%) were from hospital sanitary facilities (sinks, sink drains, Correspondence: R. Bannour faucets, showers, washing basins and soaps). Within all qacΔE1 Pseu- Antimicrobial Resistance & Infection Control 10(1): P199 domonas spp. isolates were 57 (73%) multidrug resistant. Carbapenem resistance were detected in 32 (41%) isolates, of which two were bla Introduction: Inappropriate healthcare wastes (HCWs) management IMP and six bla positive. may lead to many psychological, environmental and health hazards. VIM Conclusion: This study shows that the multidrug resistant Pseu- Therefore, there has been growing interest among medical organiza- domonas species with qacΔE1 gene which harboured resistance to tions in strategies to reduce the quantity of HCWs and developing the quaternary ammonium compound biocides are widespread in hospi- recycling programs.. tal sanitary facilities in Slovakia. Objectives: The aim of this study was to assess healthcare profes- This study was supported by a research grant from the MŠVVaŠ SR and sional knowledge regarding HCWs management before and after an grant fromTrnava University. educational intervention session. Disclosure of Interest: None declared. Methods: A pre-experimental study design was applied to assess the impact of an intervention program on knowledge and practice regard- ing HCWs management during March 2021 in Sahloul university hospital. The same questionnaire used in the pre-test was used imme- P198 diately after the end of the intervention program. Peculiarities of formation of biofilms by pathogens Results: A total of 63 healthcare professionals participated in our and microorganisms of damage of food production study. Overall, a significant increase in knowledge after the interven- 1,* 2 A. V. Tutelyan , Y. Yushina on behalf of A.A. Semenova, E.V.Zayko, D.S. tion was detected among all knowledge items. Regarding the knowl- 2 3 Bataeva, M. Grudistova, V. Akimkin edge of possible risks caused by healthcare waste, identification of 1 2 Central Research Institute of Epidemiology, V. M. Gorbatov Federal toxicity as a risk increased from 5.7% to 22.5%; of psychological impact Research Center for Food Systems, Central Researche Institute of epide‑ Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 96 of 140 from 0 to 32.5%; injuries from 31.4 to 52.5%; infections from 62.9% to P201 80% and environmental contamination from 28.6% to 57.5%. The effect of various surface disinfectants and their method Concerning the different types of healthcare wastes and their types of use on bactericidal efficacy 1,* 1 1 of packaging; the rate of correct answers passed from 0% for “Flam-J. Ochi , R. Matsumura, Y. Hirata mable or explosive waste”; “Radioactive Hazardous Health Activity Biochemical Laboratory, Saraya Co., Ltd., Osaka, Japan Waste” and “Anatomical parts and placentas” to 10%;10% and 5% Correspondence: J. Ochi respectively. Antimicrobial Resistance & Infection Control 10(1): P201 Conclusion: The health professional recorded an improvement in their knowledge with regard HCWs management in post-test, but the Introduction: Quaternary ammonium compounds (QAC) are common majority of answers still not exceed 50%. disinfecting agents used for environmental disinfection of health care Therefore, we suggest implementing practical training workshops tar- facilities in Japan. Products are usually available in spray and wet wipe geting all health personnel. types to disinfect environmental surfaces. However, there are still a lot Disclosure of Interest: None declared. to understand about environmental disinfectants containing QAC in terms of their types and different methods of use. Objectives: This study aimed to the bactericidal efficacy of QAC-con- taining surface disinfectants with different method of use. Poster session: environmental control: products Methods: QAC-containing liquid formulation was evaluated with EN13727 and EN13697. P200 Different types of QAC-containing surface disinfectants were evalu- Ewash—a multi‑period cross‑over trial comparing hypochlorous ated according to EN16615 in their actual use. Spray and wet wipe acid and bleach on hospital surfaces types were used in test. For spraying, two types of methods were used: 1,* G. Gon on behalf of EWASH working group 1) Spray directly on the environmental surface and wipe off with a dry Infectious Disease Epidemiology, London School of Hygiene and Tropi‑ wipe, 2) Spray on a dry wipe and wipe the environmental surface. The cal Medicine, London, United Kingdom wet wipe type was used as is. Correspondence: G. Gon Results: The high efficacy of QAC-containing liquid formulation was Antimicrobial Resistance & Infection Control 10(1): P200 confirmed with EN13727 and EN13697. Regarding bactericidal efficacy of QAC-containing surface disinfectants in their actual use, the results Introduction: Environmental hygiene is crucia for preventing hospi- of EN16615 varied depending on their type and method of use. tal associated infections. Cleaning practices in low-income hospitals Conclusion: Although bactericidal efficacy of liquid formulation is continue to rely on sodium hypochlorite, which is corrosive, requires important for surface disinfectants, it is also important to understand accurate dilution on a daily basis and is toxic if in contact with skin the performance characteristics of each type in before use. or mucous membranes. Neutral Electrolyzed Water (EW) is an inno- Disclosure of Interest: None declared. vative surface disinfectant produced by passing an electrical current through saline water, whose active ingredient is hypochlorous acid. EW is neither toxic nor corrosive and it presents no environmental haz- P202 ard, as it slowly reverts to saline during the period of chemical relaxa- Liquid hydrogen peroxide efficacy compared with standard tion. The proven broad-spectrum antimicrobial activity of EW enables cleaning care on surfaces disinfection high-level surface disinfection. Surprisingly, the use of EW is currently 1,* 1 2 3 4 1 C. Hidalgo , M. Posso , A. Ramírez , L. Martínez , R. Bover , M. Herranz , E. largely unknown in the health sector. 2 1 Padilla , C. González Objectives: The main objective is to evaluate the efficacy of Electro - 1 2 Epidemiology & Evaluation Department, Parc de Salut Mar, Microbi‑ lyzed Water for disinfection of near-patient hospital surfaces as com- ology Department, LRC, Traumatology & Orthopedics Department, pared to standard disinfection. General Services Department, Parc de Salut Mar, Barcelona, Spain Methods: A multi-period cluster randomised trial (EWASH trial) will be Correspondence: C. Hidalgo used to evaluate the efficacy of EW for surface disinfection compared Antimicrobial Resistance & Infection Control 10(1): P202 to standard disinfectant (chlorine-based bleach) in three hospitals in Abuja, Nigeria, over six weeks. Four wards will be selected in each hos- Introduction: In our hospital, sodium hypochlorite and quaternary pital and will be randomly allocated to one of the two intervention- ammonium + amines are the used products for desinfecting the room control sequences. Each week either EW or the standard disinfectant is surfaces (our standard clinic care: SCC), but they have disadvantages. provided to these wards for surface cleaning. Objectives: To compare the effectiveness of liquid hydrogen peroxide Microbiological cleanliness will be measured using double sided dip- with SCC on reducing surface contamination. slides with non-selective agar for Aerobic Colony Count (< 2.5 cfu/ Methods: Pre-post quasi-experimental study with 2 phases compar- cm2 = clean; ≥ 2.5 cfu/cm2 = not clean). The presence of S.aureus will ing the effectiveness of liquid hydrogen peroxide (phase 1) versus SCC be a secondary outcome. The study design is expected to have 87% (phase2). Quantitative and qualitative evaluation was assessed from power to demonstrate non-inferiority at a 5% margin with 15 sam- February 2019-February 2020, on 5 high-touch hospital room surfaces pling sites in each ward (cohort structure) and a baseline of cleanliness (upper and lower surfaces of food table, call botton, toilet flap and ranging from 30 to 50%. mattress) in 2 hospitalization units (one surgical and one medical)at Focus group discussions (FGDs) will be conducted with the cleaners Hospital del Mar. For each surface: adenosine triphosphate (ATP), vis- to understand their perception of the product, barriers and enablers. ual assessment (fluorescent marker) and aerobic colony counts (ACC) Results: The trial is under way and data completion is planned for July measurements were collected before and after cleaning. Mann–Whit- ney U test was used for assessing medians differences in the ATP and Conclusion: EW has never been tested in low-resource settings, the ACC. Stratified analysis by hospitalization unit, isolated status and con- EWASH study will contribute to provide evidence on its efficacy for tact surface was performed. P values lower than 0.05 were considered environmental hygiene. The study could provide evidence for further statistically significant. applications of EW in hospital settings such as cleaning medical equip- Results: We evaluated 310 surfaces:217 from phase 1 and 93 from ment, use for burns wounds and diabetic foot infections. phase 2. Compared to post-cleaning values, pre-cleaning surfaces Disclosure of Interest: None declared. showed a statistically higher median of ATP relative light units (RLU) and ACC for both products: a) hydrogen peroxide: 316 vs. 52 ATP RLU, and 30 vs. 7 ACC; and b) standard cleaning 136 vs. 23 ATP RLU, and 34 vs. 5 ACC. Medical unit surfaces presented higher pre-cleaning RLU rates than in surgical unit, in both cases a significant reduction was Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 97 of 140 achieved after cleaning with both products. Statistically significant reduction was observed for isolated and not isolated patients. Inter- estingly, not isolated patient’s room’s surfaces revealed higher median pre-cleaning RLU and ACC values than in isolated patient’s. Conclusion: Both cleaning procedures have a similar effectiveness in cleaning and disinfection. It’s important to emphasize the relevance of performing properly these processes by the housekeepers. Disclosure of Interest: C. Hidalgo Grant/Research support from: This study was partly funded by Diversey, The authors did not receive direct funding from the sponsor, M. Posso Grant/Research support from: This study was partly funded by Diversey, The authors did not receive direct funding from the sponsor, A. Ramírez Grant/Research support from: This study was partly funded by Diversey, The authors did not receive direct funding from the sponsor, L. Martínez Grant/Research support from: This study was partly funded by Diversey, The authors did not receive direct funding from the sponsor, R. Bover Grant/Research sup- port from: This study was partly funded by Diversey, The authors did not receive direct funding from the sponsor, M. Herranz Grant/Research support from: This study was partly funded by Diversey, The authors did not receive direct funding from the sponsor, E. Padilla Grant/ Research support from: This study was partly funded by Diversey, The authors did not receive direct funding from the sponsor, C. González Grant/Research support from: This study was partly funded by Diver- sey, The authors did not receive direct funding from the sponsor. P203 Conclusion: We validated the disinfecting effects of HOCl in suspen- Antimicrobial activity in the gasphase with hypochloric acid sions. We confirmed our hypothesis of the high disinfecting power of 1,* 2 3 4 D. Boecker , R. Breves , C. Bulitta , Z. Zhang HOCl in-air at safe levels for populated indoor places. The investigated 1 2 TOTO Consulting, San Jose, United States, Corporate Microbiology, Gram-positive and -negative bacteria can be understood as a general Henkel AG & Co KGaA, Duesseldorf, Institut für Medizintechnik (IfMZ), model system for infectious particles, including enveloped viruses (to Ostbayerische Technische Hochschule Amberg‑Weiden, Amberg Weiden, which Coronavirus belongs). These early results suggest that HOCl TOTO Consulting, Berlin, Germany should be further evaluated as an air-cleaning method which may Correspondence: D. Boecker complement established concepts. Antimicrobial Resistance & Infection Control 10(1): P203 Disclosure of Interest: D. Boecker Consultant for: Consultant to the device company, R. Breves Conflict with: Member of oji scientific advi- Introduction: Virus-carrying aerosol particles are recognized as infec- sory panel, C. Bulitta Conflict with: Member of oji scientific advisory tion carriers in the current Corona pandemic, but their high-risk poten- panel, Z. Zhang Consultant for: Consultant to the device company. tial is often underestimated and represents the infection route that has been least systematically countered to date. As a result, aerosols P204 currently represent an insufficiently contained mode of disease trans- Factors influencing the durability of antimicrobial coatings mission at public indoor spaces (e.g.: offices, schools, gastronomy). on different surfaces Objectives: The study investigated if the disinfecting potential of 1,* 1 1 2 1 S. Buhl , A. Stich, J. Vogt , R. Brückner , C. Bulitta HOCl in suspensions are transferrable to in-air cleaning applications 1 medical engineering, Ostbayerische Technische Hochschule and to what extent aerosolized HOCl solutions can deactivate indoor 2 Amberg‑Weiden, Weiden in der Oberpfalz, HECOSOL GmbH, Bamberg, microbial contaminations in-air at or below legal limits. Germany Methods: For the liquid disinfection we used a standard suspension Correspondence: S. Buhl disinfection test protocol. For the in-air tests we conducted several Antimicrobial Resistance & Infection Control 10(1): P204 experiments where aerosolized bacterial suspensions were injected into lab chambers preloaded with different HOCl gas concentrations. Introduction: Infection through contaminated surfaces is not an Results: In suspension experiments we found sufficient efficacies for all abstract risk, but has already been shown by several publications. It studied organisms (Staphylococcus aureus, Pseudomonas aeruginosa, has been shown that antimicrobial surfaces can significantly reduce Escherichia coli K12 and Staphylococcus warnerii according to EN 1276, microbiological contamination on surfaces in the long term. However, C. albicans according to EN 13,624 as well as vaccinia virus according there have been few studies on how surface properties and reprocess- to EN 14,476) at minimum concentrations of 200 ppm HOCL. The in-air ing affect the durability of these coatings. measurement set-up allows to follow microbe deactivation by HOCl Objectives: This work will therefore examine the influence of different interaction. The deactivation rate increases with the HOCl concentra- materials and reprocessing methods on the durability of antimicrobial tion, and the values are greatest for Gram-negative germs. surface technologies. Methods: Test samples made of different materials (glass, plastic) are sub - sequently provided with an TiO2Ag based antimicrobial coating (HECOSOL GmbH, Bamberg) by electrospray technique and tested for their durabil- ity and remaining activity by standard methods (ISO 22196). In a second step, abrasion tests and microbiological activity tests were done on coated wallpaper bonded to plasterboard using various cleaning and disinfecting agents and cloth systems (microfiber cloth, cotton cloth, foam cloth). Results: While strong antimicrobial efficacy can still be demonstrated on glass surfaces even after several hundred abrasion cycles, this is no longer present on plastic surfaces after just a few cycles. The abrasion tests with various cleaning agents, disinfectants and wipe systems also showed an influence of the material and the preparation on the anti- microbial efficacy. All test samples in our experimental setup showed Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 98 of 140 at least slight efficacy. However, only 5 of the 47 tested samples have so far evaluated the impact of hospital cleaning and disinfection showed a remaining strong efficacy. practices on brass antimicrobial properties. Conclusion: Our results suggest that the underlying surface material Objectives: This work therefore aimed to assess the impact of com- and also the selection of cleaning and disinfection procedures and monly used disinfectants on the antibacterial activity of a commer- wipe systems appears to influence the durability of the coatings on cially available brass (AB + ). the surfaces. In order to be able to make a statement about the long- Methods: Stainless steel (control) and brass samples were therefore term activity of these surface technologies, the effectiveness should treated 365 times with a commonly used hospital disinfectant contain- be tested in the finished product and after several reprocessing cycles. ing 0.3% (W/W) quaternary ammonium (QA) according to the manufac- Disclosure of Interest: None declared. turer’s recommendations to simulate one year of cleaning/disinfection. Treatment with an aerosolized product used for terminal decontamina- tion (peracetic acid (PA) 1200 ppm and hydrogen peroxide) was also P205 carried out 30 times on some of these samples.The antibacterial efficacy Antibacterial activities of metal oxides on copper alloy surfaces 1,* 1 of variously treated samples was evaluated on six multidrug-resistant H. Komura , H. Kawakami clinical strains representing major species involved in HAI, as previously Osaka city university, Sugimoto, Sumiyoshi‑ku, Osaka‑shi, Japan described (Dauvergne et al., Antibiotics 2020, 9, 245). Correspondence: H. Komura Results: Results compiled in Table 1 show that brass samples retain Antimicrobial Resistance & Infection Control 10(1): P205 a fairly good antibacterial activity after QA ± PA treatment, whatever the strain. Introduction: Copper alloys are frequently used for hand touched Table 1. Reduction in bacterial recovery on brass as compared to stainless steel expressed as percentages (mean±SD). places. As copper alloys have higher antibacterial properties, it is Strain UntreatedQAQA+ PA Acinetobacter baumannii 99.95±0.05199.27±0.420 99.91±0.137 expected to reduce contact infection through environmental surfaces. Klebsiella pneumonia 99.16±0.58299.20±0.255 99.77±0.398 Oxides are formed on the copper alloy surface in an atmosphere. If Enterobacter cloacae 99.44±0.91399.63±0.072 100.00±0.001 Pseudomonas aeruginosa 100±0.099.86±0.087 ND a treatment method of producing a highly antibacterial oxides can Enterococcus faecium 99.92±0.01097.96±0.046 99.38±0.936 Staphylococcus aureus 99.85±0.129100±0.0 99.81±0.090 be developed, the antibacterial activities of the copper alloy surface ND: Not Determined; QA: quaternary ammonium; PA: peracetic acid. can be maintained. As a result, a reduction of bacterial transmission No significant difference in antibacterial efficacy (Wilcoxon test) could be seen between the untreated brass samples and the treated ones, be it with QA alone or QA+PA. through the environmental surface is expected. Objectives: We investigated the antibacterial activities of metal oxides on the copper alloy surface, using brass as a sample. Conclusion: The simulated cleaning/disinfection process therefore Methods: Oxygen-free copper (OFC) (99.96%) and brass ((mass%) did not impair significantly the antibacterial activity of AB + brass Cu: 70.0, Zn: 30.0) were used as samples. Coupon specimens on the panel of strains tested. These preliminary results support the (25 mm × 25 mm × 2 mm) were cut out from commercially available use of this type of surface in healthcare settings to reduce environ- plates. Test surface of specimens were polished with emery paper (# mental transmission of pathogens. 320). The polished specimens were degreased with acetone, and then Disclosure of Interest: E. Dauvergne Employee of: FAVI S.A., Grant/ ultrasonically cleaned in ethanol. Such specimens were called specimen Research support from: PhD grant funded by ANRT and FAVI S.A., D. A. Specimen B and C were prepared by applying following treatments to Declerck Employee of: FAVI S.A., C. Lacquemant Employee of: FAVI the specimen A. For specimen B, the specimen A was immersed in a 1 M S.A., C. Mulllié: None declared. LiCl aqueous solution for 1 h. Then, the specimen was kept at 300° C for 3 h in atmosphere. For specimen C, the specimen A was kept at 350° C Poster session: hand hygiene: alcohol handrub efficacy, tolerability for 100 min in atmosphere. The surface products of the specimens were and system change analyzed using X-ray photoelectron spectroscopy (XPS). The antibacte- rial activities were evaluated by film contact method designated in ISO P207 22196 (contact time 30 min). Escherichia coli (NBRC3972 E. coli) was used Publication trends in hand hygiene: pandemics serve as wake‑up calls as the test bacterium. 1,* 1 1 N. Lotfinejad , D. P ires , D. P ittet Results: Both Cu and Cu O were detected on the OFC specimen A Infection Control Programme, University of Geneva Hospitals and Fac‑ (OFC-A) surface. Only Cu O was detected on the OFC-B surface, while ulty of Medicine, Geneva, Switzerland only CuO on the OFC-C surface. Antibacterial activities were confirmed Correspondence: N. Lotfinejad in all specimens. The viable cell counts of the OFC-A and B were about Antimicrobial Resistance & Infection Control 10(1): P207 3 order lower than the value for the negative control(3.5 × 10 CFU/ cm ). OFC-C had a higher viable cell count in comparison with A and B, Introduction: Hand hygiene with alcohol-based handrub (ABHR) indicating lower in antibacterial activity. is the global standard of care in preventing healthcare-associated For Brass-A Cu, Cu O, Zn, ZnO were detected, while only ZnO was on infections that are known among the most common adverse events the Brass-B and C surfaces. The viable cell counts of Brass-B and C were in healthcare settings. There has been a growing body of knowl- about 2 order higher than that of the Brass-A. edge and evidence in this area in the past few decades in order to Conclusion: The antibacterial activities of metal oxides on a brass are improve this lifesaving action. inferior to them on an untreated brass. Objectives: To investigate the annual number of publications using Disclosure of Interest: None declared. hand hygiene-related keywords in the medical literature and ana- lyze publication trends in this field. Methods: This review is based on Medline search until December P206 2020, using MEdical Subject Headings (MESH) search terms and key- Antibacterial activity of brass post‑cleaning/disinfection words. We searched the most commonly used words to describe hand treatments hygiene and analyzed the number of publications retrieved yearly. 1,* 2 2 1 E. Dauvergne , D. Declerck , C. Lacquemant , C. Mulllié Results: From 1921 to December 2020, we found 12,737 publications 1 2 Laboratoire AGIR‑UR UPJV 4294, Université de Picardie, Amiens, FAVI using hand hygiene-related keywords. The most prevalent keywords S.A., Hallencourt, France were hand hygiene, hand disinfection, hand washing, handrub, hand Correspondence: E. Dauvergne sanitizer and ABHR. Searching all keywords revealed that the number Antimicrobial Resistance & Infection Control 10(1): P206 of publications in the field of hand hygiene has doubled in 2020 com- pared to 2019. We observed a significant growth in using the hand Introduction: Brass can be used as an antimicrobial surface in health- hygiene keyword, over the past 20 years, with a major peak in 2020. care facilities to help reducing Hospital Acquired Infections (HAI) mediated by an environmental transmission. However, few studies Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 99 of 140 Conclusion: Periodically auditing handrub dispensers is necessary, Conclusion: Advances in the hand hygiene literature have been feasible, yet cumbersome. Evaluation criteria should be wisely chosen remarkable over the past few years and particularly significant during to maximize the predictive potential of this test. Optimizing the time the recent COVID-19 pandemic. We identified significant changes over requirement of any new quality test is a critical factor towards clinical time, with a major shift from using soap and water to the preference of applicability. ABHR. Higher peaks of research studies during the recent major pan- Disclosure of Interest: S. Bansaghi Grant/Research support from: S.B. demics, in particular the COVID-19, highlight the capacity for continu- is supported by the ÚNKP-20–3-II-SE-24 New National Excellence Pro- ous improvements in hand hygiene science and practices. gram of the Ministry for Innovation and Technology from the source Disclosure of Interest: None declared. of the National Research, Development and Innovation Fund., T. Haid- egger: None declared. P208 Standard monitoring of handrub dispensers’ time‑dependent behavior 1,* 2 P209 S. Bansaghi, T. Haidegger 1 2 A randomized crossover study to test the tolerability of three Doctoral School of Health Sciences, Semmelweis University, University alcohol‑based handrubs: preliminary results Research and Innovation Center (EKIK), Óbuda University, Budapest, 1,* 2 3 1 1 A. Peters , C. Cave , J. Carry , J. Sauser , D. P ittet Hungary 1 2 Infection prevention and control, HUG, Geneva, Switzerland, Faculty Correspondence: S. Bansaghi of Pharmacy, University of Bordeaux, Bordeaux, France, Faculty of Medi‑ Antimicrobial Resistance & Infection Control 10(1): P208 cine, University of Geneva, Geneva, Switzerland Correspondence: A. Peters Introduction: Hand hygiene with alcohol-based handrub is essential Antimicrobial Resistance & Infection Control 10(1): P209 in every hospital to avoid the spread of infections, thus, ABHR dispens- ers belong to the critical infrastructure. The decrease in dispensed Introduction: Hand hygiene with alcohol-based handrubs (ABHR) is volume over time was reported to be a generic phenomenon among the gold standard of care in healthcare facilities (HCF), and prevents commonly used dispensers. To prevent under-dosage, dispensers healthcare-associated infections. The COVID-19 pandemic caused a should be audited even before purchasing, and periodically thereafter. global shortage of ABHR, which resulted healthcare facilities often Objectives: The aim of this work was to create an effortless yet reli- using different products than normally. Consumption of ABHR more able protocol for that regular audit. than doubled at HUG, and compliance stayed the same. Other HCF Methods: Properly assessing time-dependency of the dispensing is showed a decrease in compliance among healthcare workers (HCWs). time-consuming, and therefore not feasible in clinical settings, while Some of this effect could be due to the differences in tolerability the quality-assurance driven goal is to audit all dispensers. To comply of various formulations. Low tolerability is a known barrier to hand with all such requirements, a short protocol was developed, where the hygiene compliance, but there is little literature about which types of whole procedure takes 15 min/dispenser. This is considered to be a handrub have better dermal tolerance. quick test, built on the following: push the dispenser at least 3-times, Objectives: This crossover study aimed to compare the tolerabil- to set it back to its baseline. Push the dispenser 5 times, collect the ity and acceptability of 3 different ABHR formulations in 39 volun- dispensed handrub. Let the dispenser rest for 5 min, then collect the teers. The ABHRs tested are already used in HCF and have passed the first 2 doses separately. Repeat this last, 5-min cycle. The result of this EN1500 norms. The main objective of the study is to determine which “quick” test was compared with a 3-day extensive, ground-truth test types of ABHRs and emollients are most likely to have high dermal tol- by outcome. erability in heavy use settings. Results: From 11 various dispensers, 234 quick test results were col- Methods: The methods for this study were adapted from the WHO lected. If the volume-loss in 5 min exceeded a threshold value (var- Protocol for evaluating handrub tolerability (Method 2). The partici- ied between 5–15%), the dispenser was categorized as ‘Problematic’. pant population consisted of people that did not already use ABHR In each case, the result of the quick test was compared with the dis- heavily, thus excluding most categories of HCW. 39 participants were penser’s baseline test, and the measurements was categorized as false randomized to 3 different ABHR formulations: 3 are ethanol-based negative, true negative, false positive or true negative. Sensitivity, (one with superfatting agents), and one is isopropanol-based. Partici- specificity, positive and negative predictive value was determined in pants tested each of the 3 solutions over a series of 5-day interven- case of different threshold values (Figure 1). tion weeks, each followed by a 9-day washout week. They kept a daily Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 100 of 140 log of handrubbing sessions, and returned to investigators for a skin P211 assessment after each intervention period. Alcohol‑based hand rub in vitro activity against SARS‑COV‑2 Results: Product acceptability and skin condition and were evaluated and candida auris 1,* 1 1 1 both by the participants themselves and a trained observer. A total A. Capezzone De Joannon, A. Testa , N. Falsetto , M. Procaccini , L. of 24 components related to tolerability were analyzed for each par- Ragni ticipant weekly. Preliminary results show a marked difference in the Angelini ACRAF s.p.a., ancona, Italy acceptability of the formulations. Full results will be analyzed in July, Correspondence: A. Capezzone De Joannon 2021. Antimicrobial Resistance & Infection Control 10(1): P211 Conclusion: Compliance of caregivers is crucial for patient safety, and determining which ABHRs have the best tolerability is likely to Introduction: Alcohol-based hand sanitizers (ABHS) are highly increase HCW satisfaction and compliance. effective at inactivating virus and other microbials. For this reason, Disclosure of Interest: None declared. their use is strongly recommended as an infection prevention meas- ure, in particular, for healthcare personnel when caring for infected patients. Of note, ABHS sales have grown exponentially in the first P210 months of the COVID-19 pandemic, extending their use to the Efficacy of hand hygiene products against SARS COV‑2 whole population and generating a constant need for ABHS on the 1,* 1 2 3 3 K. Ormandy , G. Oxley , D. Falbo , S. Zhou, C. Wilde market. 1 2 3 SCJ Professional, Denby, United Kingdom, SC Johnson, Racine, Micro‑ Objectives: The aim of this study is to evaluate the activity of a 74% bac Laboratories, Sterling, United States ethanol ABHS (Amuchina gel X-GERM) against SARS-CoV-2, accord- Correspondence: K. Ormandy ing to the European Standard EN14476:2013 + A2:2019 guidelines Antimicrobial Resistance & Infection Control 10(1): P210 and against Candida auris, according to the European Standard EN 13,624:2013 guidelines. Introduction: Hand hygiene is the primary measure in preventing Methods: Virucidal activity of the study product was evalu- transmission of pathogens to patients and healthcare workers. With ated against the SARS-CoV-2 strain USAWA1/2020 (BEI Resources more than 150 million reported COVID-19 cases worldwide of which NR-52281) in the presence of 0.3 g/l of bovine serum albumin, for 30 many require hospital care, it is vital that essential hand hygiene prod- and 60 s. Dilutions of the neutralized reaction mixture were inocu- ucts are sufficiently efficacious against SARS-CoV-2. lated onto Vero E6 cells to evaluate cytopathic effect. Objectives: Microbicidal actives (e.g. ethanol) have been shown to To assess the activity against C. auris DSM 21,092, 8 mL of the product be efficacious against other coronaviruses. The objective of this study were added to 1 mL of yeast in presence of 0.3 g/l of bovine serum is to demonstrate viricidal activity of a range of formulated skin care albumin, for 30 and 60 s. The resulting suspension was neutralized, products against SARS-CoV-2 specifically. plated onto SAB agar and incubated at 37 °C for 48 h. Methods: Testing was conducted using ASTM E1052-20 and Results: The study product, in the presence of an interfering sub- EN14476:2013 + A2:2019 test methods. The test product was chal- stance, reduced the SARS-CoV-2 below detectable limits, with a reduc- lenged with an aliquot of viral inoculum as well as an interference tion of the TCID50 greater than 4 L og already after 30 s of exposure substance (for EN14476) then held for an exposure (contact) time. (Table 1A). In addition, the study product showed a reduction of more Immediately after the contact time, the reaction mixture was neutral- than 4 Log of C. auris DSM 21,092, already after 30 s (Table 1B). ized. The neutralized sample was assayed for infectious virus via a cell culture-based viral infectivity assay (TCID50 assay). The results were compared to a mock-treated Virus Recovery Control to determine the virucidal activity (Log reduction) by the test product. Results: Table I shows activity against SARS-CoV-2 following expo- sure to 4 products according to EN14476 and 1 product according to E1052. Name Active (%)MethodContact time Log10 reduction Instant FOAM Complete / Alcare 80% w/w EthanolEN1447 30s≥4.36 Extra 6 Microsan Encore / Alcare Enhanced 65% w/w Ethanol and 10% w/w N- EN1447 30s≥4.38 propanol 6 Instant GEL Complete 80% w/w EthanolEN1447 30s≥4.38 Instant FOAM Non-Alcohol Sanitiser0.13% BZKE1052 60s≥3.10 Conclusion: Obtained results on the activity of a 74% ethanol ABHS Oxybac 2% H O + 5% Phenoxyethanol EN1447 30s≥4.10 2 2 (Amuchina gel X-GERM) against SARS-CoV-2 and C. auris support the effectiveness of this alcohol-based formulation as a prevention * a complete inactivation of virus was achieved in all these cases; no virus survivor was detected. measure for COVID-19 illness and in healthcare C. auris-associated infections. Disclosure of Interest: A. Capezzone De Joannon Employee of: Angelini Pharma S.p.A., A. Testa Employee of: Angelini Pharma Conclusion: Alcohol-based sanitizers are effective against SARS- S.p.A., N. Falsetto Employee of: Angelini Pharma S.p.A., M. Procaccini CoV-2. This effectiveness is not strongly affected either by product for - Employee of: Angelini Pharma S.p.A., L. Ragni Employee of: Angelini mat or by alcohol composition if a sufficient concentration is applied. Pharma S.p.A. SCJ Professional BZK based hand sanitizer and Hydrogen Peroxide/ Phenoxyethanol based antimicrobial foam soap are also both effective against SARS-CoV-2. As a result, we would recommend the use of product formulations P212 meeting those specifications in health care, community, and home The impact of H1N1 and COVID‑19 on the consumption environments as part of hand hygiene practices to control the trans- of alcohol‑based handrub at the university of Geneva hospitals, mission of COVID-19. Switzerland Disclosure of Interest: None declared. 1,* 1 1 N. Lotfinejad , A. Iten , D. P ittet Infection Control Programme, University of Geneva Hospitals and Fac‑ ulty of Medicine, Geneva, Switzerland Correspondence: N. Lotfinejad Antimicrobial Resistance & Infection Control 10(1): P212 Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 101 of 140 Introduction: Hand hygiene with alcohol-based handrub (ABHR) is Objectives: We assessed blood ethanol concentrations (BECs) from the standard of care against healthcare-associated infections, which ABHR use compared to health related benchmarks for lactational represents a major adverse event when providing care at hospitals. exposures in response to regulatory initiatives in Europe. Continuous monitoring of hand hygiene compliance is one of the Methods: Dose–response relationships between ethanol exposures main components of the WHO multimodal hand hygiene improve- and developmental effects in nursing offspring were examined. Mater - ment strategy. Measuring the consumption of ABHRs is considered nal BECs in animals were determined at the estimated onset dose for as a surrogate marker of hand hygiene compliance. offspring neurotoxicity. BECs were predicted for breastfeeding women Objectives: To study the impact of the most recent major pandem- who consume alcohol per public health guidelines. These BECs were ics, H1N1 and coronavirus disease 2019 (COVID-19), on ABHR con- compared to predicted BECs of HCWs following various ABHR uses. sumption at University of Geneva Hospitals (HUG). Exposures were compared to health benchmarks to identify potential Methods: We analyzed the ABHR consumption amounts at HUG risks for adverse developmental outcomes. Margins were calculated from 1994 to 2020. The hospital pharmacy gathers data regard- by dividing the BEC from the relevant comparator health benchmark ing the volume of ABHR consumption as L/1000 patient-days, first (toxicology or health guideline based) by the BEC from each ABHR use. started in 1994. The data provided from the pharmacy refers to the A margin greater than 1 for health guideline benchmarks and a mar- hospital as a whole. gin greater than 10 for the toxicology based benchmark are expected Results: We observed two peaks in the consumption of ABHR at to represent low concern. HUG, in 2009 and 2020. The consumption of ABHR increased from Results: Epidemiology results showed no clear indication of dose– 35.38 L/1000 patient-days in 2008 to 50.33 L/1000 patient-days response relationships between lactation exposure and develop- in 2009, when H1N1 pandemic emerged. The rise in using ABHRs mental effects; but the studies have several limitations. Animal was even more significant during the COVID-19 pandemic, which studies reported neurodevelopmental effects in nursing pups at etha- increased from 41.75 L/1000 patient-days in 2019 to 99.33 L/1000 nol doses that also caused maternal toxicity. Margins of 2.2–1,000 exist patient-days in 2020 with the emergence of the current pandemic. between BECs associated with ABHR use and BECs associated with neurotoxicity or oral intake within public health guidelines. Conclusion: Estimated BECs from even intensive use of ABHR by HCWs are below those likely to create a health concern for a breast- feeding child. Disclosure of Interest: A. Quiñones-Rivera Grant/Research support from: GOJO Industries, A. Han Grant/Research support from: GOJO Industries, A. Buerger Grant/Research support from: GOJO Indus- tries, M. Vincent Grant/Research support from: GOJO Industries, H. Allen Grant/Research support from: GOJO Industries, A. Maier Grant/ Research support from: GOJO Industries. P214 Assessing the quality of hand hygiene in the community 1,* 1 1 1 1 1 H. Soule , N. Akoum , D. P ires , C. Fankhauser , J. Sauser , D. P ittet Infection Control Programme and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals, Geneva 4, Switzerland Correspondence: H. Soule Antimicrobial Resistance & Infection Control 10(1): P214 Conclusion: ABHRs are increasingly used at HUG and more than 99% Introduction: To protect against coronavirus, hand hygiene (HH) of of hand hygiene actions are currently performed with ABHRs. Dur- good quality, i.e. covering all the surfaces of the hands with alcohol ing major infectious disease outbreaks, the consumption of ABHR based handrub (ABHR), is paramount. It was shown that the WHO increases dramatically, considering its efficacy against cross-transmis- method is rarely performed correctly by healthcare workers. It is thus sion of various microorganisms. Therefore, ensuring the global and likely that HH performance in the community is even worse. equitable access to high quality ABHRs and considering local produc- Objectives: In this descriptive study, we measured the quality of HH tion in times of crisis are necessary in order to prevent lack of supplies, performed by visitors at the entry of an hospital according to different especially during pandemics. HH methods. Disclosure of Interest: None declared. Methods: Due to the Covid-19 pandemic, visitors passed on a check- point at the entry of Geneva Hospitals where they had to sanitize their hands with an ABHR containing a fluorescent component. We per - formed 2 interventions that consisted in placing posters at the check- P213 point explaining 2 simplified HH methods: “Fingertips first” with focus Assessment of ethanol exposure from alcohol‑based hand rub use given to the fingertips and “Spray based” with a controlled volume of among healthcare workers: potential for developmental toxicity ABHR sprayed on the hands. We also formed a control group without in nursing offspring any instructions. Visitors ignored that their HH would be assessed. We 1,* 2 2 2 2 2 A. Quiñones‑Rivera , A. Han , A. Buerger, M. Vincent , H. Allen , A. Maier used the Semmelweis Hand Hygiene Scanner (SHHS) to evaluate 1 2 GOJO Industries, Inc., Akron, Cardno ChemRisk, Cincinnati, United States the quality of HH. The investigator approached the visitors after they Correspondence: A. Quiñones‑Rivera passed the checkpoint to evaluate their hands. During each period Antimicrobial Resistance & Infection Control 10(1): P213 of observations, 30 visitors were enrolled in each of the 3 arms of the study. The primary outcome was the % of hand surface covered Introduction: Alcoholic beverage ingestion during pregnancy is by ABHR as measured by the SHHS. It was good when the result was associated with adverse effects on fetal development. There is a gap superior to 95%. in understanding the developmental toxicity potential in nursing chil- Results: The study lasted from February to April 2021. In the control dren exposed to ethanol via breastmilk from mothers using ethanol- group, HH of 405 visitors were assessed; the % of hand coverage was containing products, such as alcohol-based hand rubs (ABHRs). A 80.4% and 29.6% of the visitors performed good HH. In the “Finger- previous study showed that ABHR use by healthcare workers (HCWs) tips first” group, out of 425 participants, the result was good for 27.5% resulted in low internal ethanol doses and thus low developmental and the coverage was 81.2%. And, in the “Spray based” group, 26.9% toxicity potential. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 102 of 140 out of 498 visitors obtained a good result and the coverage was 83.3%. Introduction: One barrier to participate in interventions to increase The results were not significantly different between the 3 groups. one’s own hand hygiene (HH) compliance can be overconfidence in Conclusion: The quality of HH was better than expected. The qual- terms of overestimating one’s performance [1, 2]. In this context, so far ity was not different with or without instructions and between the no study has compared self-reports of overall compliance vs. compli- methods with a regular dispenser and a spray dispenser. We actually ance specific to the 5 moments of HH. observed that visitors didn’t paid attention to the instructions. Those Objectives: Given findings from cognitive psychology that items with results may overestimated HH in the community because our study a higher difficulty (here: overall compliance) tend to be more strongly took place in an hospital and visitors rubbed their hands with ABHR associated with overconfidence effects [3], we tested empirically more carefully not to contaminate the patients. whether HH overestimation is stronger for self-reported overall com- Disclosure of Interest: None declared. pliance than for an index calculated based on self-reported moment- specific compliance rates weighted by the 5 moments’ occurrence frequencies. Poster session: hand hygiene: behaviour & compliance Methods: In the WACH-trial (“SSI and Antibiotics Use in Surgery”; Ger- man Clinical Trials Register-ID: DRKS00015502), a self-administered P215 questionnaire survey on SSI-preventive compliance was conducted A systematic review on hand hygiene compliance in hospitals in 2019 among N = 93 physicians (response rate: 28.4%) and N = 225 as the most effective measure for patient safety nurses (30.4%) in 9 surgical departments in 6 non-university hospitals 1,* 1 S. Damianova Radeva , A. B. Arredondo P rovecho in Germany. Self-reported HH compliance was assessed using percent- Hospital Universitario Fundación Alcorcón, Alcorcón, Spain age scales. The 5 moments’ occurrence frequencies were estimated Correspondence: S. Damianova Radeva based on a systematized review by the 1st author. For t-tests for paired Antimicrobial Resistance & Infection Control 10(1): P215 samples, IBM© SPSS© v26 was used. Results: Among physicians, there was a tendency towards greater Introduction: Hand hygiene (HH) is the most effective, inexpensive overestimation in the self-reported than in the calculated overall com- and easy-to-implement measure that effectively prevents cross-trans- pliance rate (means: 87.2 vs. 84.6%, p = 0.072; nurses: 84.4 vs. 85.9%, mission of pathogens and microorganisms that cause healthcare-asso- p = 0.153). Compared with HH compliance rates during ward rounds ciated infections (HAIs). observed in the study hospitals before the survey (physicians: 59.1%, Objectives: A systematic review is written with the purpose to recall nurses: 65.9%), overestimation was higher among physicians as well that HCWs’ hands are the main source by which nosocomial infections (+ 9.6% based on self-reported overall compliance and + 5.5% based can be transmitted to the patients. Moreover, with this review is dem- on the calculated rates). onstrated that sanitary hand hygiene (HH) is the main way to protect Conclusion: The tendency for HH overestimation among physicians patients from HAIs. (not nurses) is consistent with the general finding of lower HH com- Methods: A literature search and analysis of the literature on sani- pliance in this professional group, and suggests that overconfidence tary hand hygiene (HH), compliance with the "five-moments for hand effects may be relevant causal mechanisms. hygiene", the implementation of multimodal strategies in hospitals, the implementation of new strategies for monitoring HH and HCWs Ref.: compliance with hand hygiene (HH), was carried out. 1. https:// doi. org/ 10. 1016/j. ajic. 2018. 10. 022 Results: HAIs can increase morbimortality and public health social 2. https:// doi. org/ 10. 1017/ ice. 2019. 156 costs. It is true that there is sufficient evidence which demonstrates 3. https:// doi. org/ 10. 1007/ s11409‑ 019‑ 09198‑4 that HH reduces 75% of HAIs cases, but protocols established by the World Health Organization (WHO) are still not correctly followed by Disclosure of Interest: None declared. healthcare workers (HCWs). Also, another reason why HCWs do not follow WHO’s protocols is because they claim that there is lack of sci- entific information of the definitive impact of improved HH on noso - P217 comial infections rates. The hawthorne effect (HE) in hand hygiene (HH) Conclusion: So, what this systematic review demonstrates is that the in a subpopulation of volunteer healthcare professionals (HCPS) correct compliance with hand hygiene can considerably reduce the followed by direct observation (DO) during 6 months 1,* 1 1 1 1 1 number of healthcare-associated infections (HAIs) and other emerging C. Fankhauser , J. Sauser, F. Timurkaynak , A. Peters , D. P ires , D. Pittet viruses as SARS-CoV-2, in patients and healthcare workers. Infection Control Program, Geneva university hospital, Geneva, Switzerland Disclosure of Interest: None declared. Correspondence: C. Fankhauser Antimicrobial Resistance & Infection Control 10(1): P217 P216 Introduction: The HE is when individuals change behaviour due to Overconfidence regarding one’s own hand hygiene compliance their awareness of being observed. It is considered the main bias of among physicians and nurses in surgery: results of the WACH‑trial’s DO, increasing HH compliance by 30%-50%. In a clinical trial, volun- baseline survey in six non‑university hospitals in Germany 1 1 2 2 3 3 teer HCPs wore an electronic device delivering feedback on dura- J. Lamping, I. Tomsic , I. Hartlep , P. Schipper , M. Stolz , C. Krauth , I. F. 2 1,* tion of handrubbing and customized AHBR volume for their hands. Chaberny , T. von Lengerke The device provoked no improvement on HH compliance. A gradual Department of Medical Psychology, Hannover Medical School, Centre decline of HH compliance was observed, evoking habituation of the of Public Health and Healthcare, Hannover, Institute of Hygiene, Hospital HCPs to the observer, or a regression of the HE. Epidemiology and Environmental Medicine, Leipzig University Hospital, Objectives: To assess the impact of habituation to HH-DO on HCPs Centre for Infection Medicine, Leipzig, Institute of Epidemiology, Social and to compare HH compliance differences between consecutive Medicine and Health Systems Research, Hannover Medical School, Centre observations. of Public Health and Healthcare, Hannover, Germany Methods: From June 1, 2017 to January 6, 2018, in a 300 bed-Ger- Correspondence: T. von Lengerke iatrics hospital in Geneva, Switzerland, 89 voluntary HCPs partici- Antimicrobial Resistance & Infection Control 10(1): P216 pated in a cluster randomized, stepped-wedge clinical trial described Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 103 of 140 elsewhere*. HH observers were trained and validated according to P218 the WHO method. Each HCP was observed at least once a month for a A cluster randomised trial in residential homes testing a nudging minimum of 6 opportunities. To model HH compliance, a linear mixed- intervention to improve hand hygiene compliance among health effects model was used with the intervention, observation number workers in Northern Italy 1,* 1 1 2 and observation time as fixed effects. A subject-specific random inter -B. Braut, T. Medda , D. P ennesi , G. Gon 1 2 cept was considered. Observation numbers 10 to12 were excluded University of Turin, Torino, Italy, London School of Hygiene and Tropical from the analysis due to small sample size. Pairwise comparisons were Medicine, London, United Kingdom performed between observation numbers to estimate their effect on Correspondence: B. Braut HH compliance. Antimicrobial Resistance & Infection Control 10(1): P218 Results: Table 1 summarizes HH compliance according to the obser- vation order and the number of HCPs included. Table 2 presents a Introduction: SARS-CoV-2 pandemic has aroused attention to infec- Model-based estimated effects between observation numbers. Esti- tious diseases’ transmission in long term facilities. While other meas- mate shows the difference in compliance between observation num- ures adopted to fight transmission in these structures are temporary, th bers. There is a significant decrease in HH compliance as from the 4 hand hygiene is here to stay. th observation, 4.1% up to the 9 , 19.4%. Objectives: We develop a nudge strategy aimed to increase hand hygiene, especially through the use of hydro-alcoholic gel. We focus on health workers hand hygiene compliance during the morning washing routine. The intervention is based on three main drivers of poor hand hygiene identified during formative research: accessibility of hand hygiene material, knowledge and instrumental beliefs. The intervention is cost-effective and scalable. We provided health work - ers with a handrub bottle placed in a portable basket. Health workers are trained to bring the bottle near the patient zone. We introduce a delimitation mark indicating the patient zone. The interventions were preceded by a briefing and accompanied by iconographic represen- tations which explained the interventions. The intervention is con- ducted in three residential homes in Northern Italy. Methods: The study is a cluster randomised control trial where each health worker pair (they work in pairs) is randomised to receiving the handrub bottle or not. In addition, each guest room is randomised to receive the demarcation line or not. The primary outcome is hand hygiene compliance across the four moments prescribed by the WHO for residential homes. The outcome will be measured over three weeks after the intervention. The study design is expected to have 80% power to demonstrate superiority of the intervention (compared to the control: pairs without handrub and rooms without demarcation) at a 5% margin with 30 observations per health worker pair/room, and 20 pairs/rooms, an expected effect size of 1.3 and a baseline of hand hygiene compliance ranging from 30 to 50%. Results: The trial is under way and data completion is planned for July Conclusion: Effective hand hygiene intervention studies in residen- tial homes are lacking, the present epidemic has emphasized this void. This study could provide evidence of successful strategies to be implemented in this context to improve hand hygiene and hence Conclusion: The HE seems to decrease with habituation of HCP of prevent healthcare associated infections. being observed. The reduction on HH compliance after repetitive Disclosure of Interest: None declared. observations ranges from 4.1–19.4%. Disclosure of Interest: None declared. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 104 of 140 P221 individual feedback (IIF) is very useful for the understanding of HH by Assessing sustainability of hand hygiene compliance 33 months HCWs during patient care. after change agents‑based intervention Objectives: To evaluate HH compliance improvement when immediate 1,* 2 1 3 4 Y. F. Lee, W. Zingg , H. U. Ngian , Z. H. Chin , M.‑L. McLaws , S. Amir or delayed feedback is provided and to assess the impact of glove use on 5 1 6 7 8 Husin , H. H. Chua , W. H. Lai, J. Wang , D. Pittet compliance. 1 2 Sarawak General Hospital, Kuching, Department of Infectious Diseases Methods: The study was conducted at HUG from 1 January to 30 June and Hospital Epidemiology, University Hospital Zurich, Zurich, Sarawak 2021. Trained, validated and interrater reliability-tested observers moni- State Health Department, Kuching, Malaysia, University of New South tored HH using the WHO DO method, for a minimum of 30 opportuni- Wales, Sydney, Australia, Infection Prevention & Control Unit, MoH, ties/ward/month. Feedback were applied using a series of approaches: 6 7 Putrajaya, Clinical Research Centre, Kuching, Malaysia, Otto von Guer‑ immediate oral individual feedback (IIF) to HCW, a monthly delayed icke University, Magdeburg, Germany, Infection Control Programme feedback by the IPC nurse through a poster figuring the average ward and WHO Collaborating Centre on Patient Safety, University of Geneva, compliance observed and goal setting for the next month. A written Geneva, Switzerland report of HH compliance including the rate of missed actions while the Correspondence: Y. F. Lee HCW was wearing gloves was also provided. Final results for the total Antimicrobial Resistance & Infection Control 10(1): P221 study period with statistical evaluation will be provided at ICPIC. Results: Between 1 Jan and 30 April 2021, a total of 10,332 opportuni- ties were observed. Table 1 shows preliminary results of overall monthly Introduction: Hand hygiene is an effective, low-cost practice to HH compliance, levels of IIF and frequencies of missed HH actions in the reduce health care-associated infections. Given that hand hygiene is presence of gloves. a behavior-driven action, innovative improvement strategies should be promoted using suitable change agents for sustained compliance. Objectives: Our study aimed to evaluate the 33 months sustainabil- ity of hand hygiene compliance between wards exposed to change agents with different leadership style. Methods: We conducted a randomized—controlled study using the World Health Organization hand hygiene gold standard audit- ing method in two acute wards of a public tertiary care hospital in Malaysia. The intervention was hand hygiene promotion delivered Conclusion: The intervention was associated with improvement in HH by peer-identified change agents (PICAs) in study arm 1 or by Man- compliance. Glove use was associated with a high number of missed HH agement-Selected change agents (MSCAs) in study arm 2. Primary actions. Reduction of glove use together with individual feedback were outcome was hand hygiene compliance rate in four periods; pre- associated with a decreased frequency of missed actions. intervention, intervention, 8-weeks post-intervention, and 33-months Disclosure of Interest: None declared. post-intervention. Results: Mean hand hygiene compliance rate improved significantly P223 by 10 percentage points (PPs) from 48 to 58%, and 14 PPs from 50 Hand hygiene behaviors in the intensive care unit to 64%, between the pre- to the 8-weeks post- intervention period 1,* 1 1 1 2 2 2 J. Huang , Q. Xu , M. Kong , A. Jerde , D. Cepulis , Y. Liu , P. Liu (P < 0.001) for study arms 1 and 2, respectively. Mean Hand hygiene 1 2 University of Louisville, Louisville, Microsensor Labs, Chicago, United compliance rate improved significantly by 15 PPs from 48 to 64%, and States 21 PPs from 50 to 70% between the pre- and 33-months post-inter- Correspondence: J. Huang vention period (P < 0.001) for study arms 1 and 2, respectively. There Antimicrobial Resistance & Infection Control 10(1): P223 was no statistically significant difference in hand hygiene improve - ment 33 months post-intervention between the two study arms Introduction: Hand hygiene (HH) compliance is hard to improve (P = 0.25). and underlying behaviors are not clearly understood among health- Conclusion: Both PICAs and MSCAs-led interventions achieved signifi- care workers. cant sustained improvement in hand hygiene compliance 33-months Objectives: We aim to use an electronic HH system to study the HH after the original intervention. compliance and patient contact time among ICU providers by day of Disclosure of Interest: None declared. the way, hour of the day, and dispenser location. Methods: An automated electronic hand hygiene system was installed in a 10-bed surgical intensive care unit. HH opportunities P222 and compliance rates were captured automatically by the system Compliance with hand hygiene (HH) practices under standard with time and location stamps at individual levels. precautions (SP) in non COVID‑19 wards in a tertiary care hospital Results: For different day of the week, HH compliance rate decreased 1,* 1 1 1 1 C. Fankhauser, F. Timurkaynak , E. Sallansonnet , I. Grangier, V. Belpaire , from 31.4% on Mondays to 27.2% on Sundays with Wednesdays being 1 1 1 1 1 1,2 L. Baltazar , A. Dumps , A. Peters, V. Camus , A. Iten , D. Pittet the highest (35.2%), and there was no significant time effect (P = 0.077). 1 2 Infection Control Program, Faculty of Medicine, Geneva University For different hour of the day, the HH compliance rate decreased from Hospitals, Geneva, Switzerland 36.8% in 7AM-8PM to 20.4% in 7PM-8PM with 7AM-8PM being the Correspondence: C. Fankhauser highest, and there was no significant time effect (P = 0.224). For alcohol Antimicrobial Resistance & Infection Control 10(1): P222 solution dispenser locations, the HH compliance rates of going out of the room events was significantly higher than those of coming into the Introduction: Since the beginning of the COVID-19 pandemic, HUG room events (37.3% vs 26.1%, P-value < 0.001). For patient contact time, took care of a large number of patients suspected of having or affected the hourly average patient contact time per provider per day decreased by COVID; the majority of HUG wards became temporarily COVID wards. from 872 s on Mondays to 709 s on Sundays, with Mondays being the When the situation returned to normal, the practice of SP needed to longest, and no significant time effect (P = 0.399). The hourly average be strengthened. Among SP, HH is the most important. Monitoring HH patient contact time per provider per hour had 8AM-9AM being the by direct observation (DO) and performance feedback are essential to highest (1284 s) and 5PM-6PM being another peak (901 s), and there improve and sustain compliance. Glove use remains a challenge for HH was no significant time effect (P = 0.125). compliance, particularly before donning or after doffing. Immediate Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 105 of 140 Results: A total of 214 observations were enrolled of which 143 HCWs were observed. Approximately a quarter 24.6% were medical profes- sionals and 53.2% were nursing personnel with a female predomi- nance (sex-ratio = 0.33).Nearly two thirds of the observations 61.5% concerned high-risk departments and 56.6% were collected during the morning shift. The Half of HCWs observed 50.3% met the require- ments of efficacy for hand hygiene. The majority 91.3% did not respect the technique of simple washing hand against 75% the technique of hydro alcoholic friction. The hand hygiene compliance rate before observation was 19% compared to 20.3% after. The overall conformity rate was 6.5%. Being male (p < 0.001), working at a high risk department (p < 0.01) and working during the morning shift (p = 0.003) were found to have significant relationship with good HHP. Conclusion: HCWs must modify their behaviors to face the risk pro- pensity of the Covid-19 pandemic. However, to improve the poor compliance a culture of rigorous HHP should be established. Disclosure of Interest: None declared. P225 Hand hygiene adherence at a university hospital: a comparative study between the first and the second COVID‑19 waves in Tunisia 1,2,3,* 1,3 1,2,3 4 1 1 I. Mlouki , N. Omri , F. Ben youssef , H. Sfar , F. Chebbi , N. Rezg , A. 1 1 1,2,3 Khouildi , A. Hadj Sassi , S. El Mhamdi Departement of Preventive and Community Medicine, University Hospi‑ 2 3 tal Taher Sfar, Mahdia, Department of Community Medicine, Research laboratory “Epidemiology Applied to Maternal and Child Health” 12SP17, Faculty of Medicine of Monastir, Monastir, Departement of Preventive and Community Medicine, Hopital Taher Sfar Mahdia, Mahdia, Tunisia Correspondence: I. Mlouki Conclusion: Hand hygiene behaviors are complex and provider Antimicrobial Resistance & Infection Control 10(1): P225 dependent. HH compliance and patient contact time vary by day of the week, hour of the day, and dispenser locations. Introduction: Hand hygiene is the most effective measure in reduc - Disclosure of Interest: J. Huang Shareholder of: Microsensor Labs, Q. ing healthcare-associated infections. Accordingly, it has been recom- Xu Grant/Research support from: Microsensor Labs, M. Kong Grant/ mended as an important strategy to prevent the spread of COVID-19 Research support from: Microsensor Labs, A. Jerde Grant/Research in health care settings. support from: Microsensor Labs, D. Cepulis Employee of: Microsensor Objectives: We aimed to measure the adhesion and the relevance of Labs, Y. Liu Shareholder of: Microsensor Labs, P. Liu Shareholder of: hand washing during the first and the second COVID-19 waves at the Microsensor Labs. University Hospital Taher Sfar Mahdia (Tunisia). Methods: We performed a prospective study recruiting a cohort of randomly selected health care professionals at the University Hospital Taher Sfar Mahdia. Direct hand hygiene observations were conducted P224 on July 2020 (during the first wave of COVID-19 in Tunisia) and Janu- Hand hygiene practices assessment among health care workers ary 2021(during the second wave), then evaluated using the hand at an university hospital in Tunisia during the COVID‑19 hygiene audit developed by WHO. pandemic: an observation audit Results: We performed 378 observations of hand hygiene (214 on 1,2,3,* 1,2,3 1,2,3 1 1,2,3 N. Omri , I. Mlouki , F. Ben youssef , H. Sfar , S. El mhamdi July 2020 and 166 on January 2021) among 286 health workers with Preventive and Community Medicine, University Hospital Tahar Sfar a female predominance (74.8% and 66.4%, respectively). About 26.6% Mahdia, Mahdia, Community Medicine, Faculty of Medicine of Mona‑ and 37.1% of the sample were medical professionals during the first stir, Research laboratory, Epidemiology Applied to Maternal and Child and the second waves respectively. The rate of health workers in Health, Monastir, Tunisia Intensive Care Units (ICU) ranged from 38.5% to 36.4% between the Correspondence: N. Omri two periods. Antimicrobial Resistance & Infection Control 10(1): P224 From July 2020 to January 2021, the global relevance rate signifi- cantly increased from 6.5% to 21.3% (p < 0.001). Hand hygiene adher- Introduction: The ongoing Covid-19 pandemic provides the opportu- ence ‘before patient contact’ improved from 19% to 31.4%, and ‘after nity to demonstrate the potential benefit of the good hand hygiene patient contact’ from 20.3% to 31.9%. The correct execution of hand practices (HHP) in controlling health care-associated transmission of hygiene technique increased from 8.7% to 50% (p < 0.001). Covid-19. The rates of hand hygiene relevance were higher in males (p = 0.003), Objectives: The present study aims at evaluating hand hygiene prac- in ICU (p < 0.001) and the morning shift period (p = 0.01). tices of health care workers (HCWs) during the first wave of Covid-19 Conclusion: Although the COVID-19 improved hand hygiene adhe- pandemic at the university hospital Tahar Sfar Mahdia (Tunisia). sion rates, relevance remains challenging. It is important to continue Methods: We carried out an observation audit among HCWs staff at the promotion of hand washing with the same enthusiasm and com- the university hospital Tahar Sfar Mahdia in Tunisia during the first mitment even after this outbreak. wave of Covid-19 pandemic (April–May 2020) using four pretested Disclosure of Interest: None declared. and reliable audit sheets. The first one concerned the simple washing hand, the second and third sheet were used to evaluate respectively the hygienic washing and the hydro alcoholic friction and the fourth sheet to assess the compliance and conformity rates. We excluded the outpatients departments. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 106 of 140 P226 Methods: We analysed 785 observed deliveries (407 in Kenya and 378 The impact of the COVID‑19 prevention and control program in Malawi) across 392 facilities. The outcomes were hand washing/ on hand hygiene compliance at Sahloul university hospital Tunisia rubbing 1)before any initial examination, 2)before labour, and 3)after 1,2 1 1,2 1,2,* 1 1 S. Bhiri, W. Dhouib , A. Ben Cheik h , H. Ghali , R. Bannour , A. Gara , birth. We used descriptive statistics to assess outcome levels and mul- 1 1,2 1,2 S. Khefacha , H. Said Latir i , M. Ben Rejeb tivariate multilevel logistic regressions to investigate several determi- Department of Prevention and Security of Care, sahloul university hospi‑ nants. All analyses accounted for survey characteristics. tal, Faculty of Medicine of Sousse,, University of Sousse, Sousse,, Tunisia Results: HH compliance in Kenya and Malawi was respectively 37.2% Correspondence: H. Ghali (CI:32.2–42.5) and 60.8% (CI:65.0–74.3) before any initial examination; Antimicrobial Resistance & Infection Control 10(1): P226 34.7% (CI:29.8–39.9) and 63.7% (CI:58.8–68.4) before labour, 80.7% (CI:75.6–84.9) and 83.1% (CI:78.9–86.5) after birth. After accounting Introduction: for potential confounders, greeting the woman ( OR = 10.65, CI:2.71– Background 41.8, p-value: 0.001; OR = 14.12, CI:3.08–64.73; p-value: 0.001), birth Hand Hygiene(HH) has been recommended as an important strat- attendants’ years of delivery experience (OR = 1.14, CI:1.04- 1.24, p egy to help prevent the spread of COVID-19 in hospitals. Monitoring value: 0.004; OR = 1.16, CI:1.07–1.27,p-value:0.001) and managing HH compliance is considered as a critical aspect of an effective HH authority of the facilities (OR = 4.21, CI:1.02–17.27, p-value: 0.046) program. were found to be associated with HH before initial examination and The aim of our study was to assess the impact of the COVID-19 pan- labour in Kenya. In Malawi greeting the woman (OR = 4.05, CI:0.82– demic through the direct observation on HH compliance of health 19.93, p-value: 0.085; OR = 12.5, CI:1.4–112.2, p-value:0.024) and the care workers(HCW ) in hospitals. presence of any danger signs for the woman ( OR = 2.26, CI:1.15–4.47, Objectives: The aim of this study was to assess the impact of the p-value:0.018; OR = 3.04 CI:0.96–9.5, p-value:0.057) were associated COVID-19 prevention and control program on HH compliance witin with HH before labour and after birth. Other variables (e.g. availability health care workers(HCW ) at Sahloul University Hospital 2019–2020. of hand-disifectant) were not associated with HH in this dataset. Methods: We conducted a pre-experimental study based on a one- Conclusion: Hand hygiene compliance was low in both countries, but group pretest–posttest among HCWs at Sahloul University Hospital. substantially lower in Kenya. Greeting the woman, years of delivery The intervention consisted in COVID-19 prevention and control pro- experience, presence of danger signs were important determinants of gram conducted by the prevention and security of care department. HH compliance in Kenya and Malawi. As part of this programme, we organised theoretical and practical Disclosure of Interest: None declared. workshops on standard precautions (mainly HH). All categories of HCW (medical and paramedical staff) working in P229 the various departments were included. The evaluation tool was a Understanding hand hygiene behavior in a public hospital WHO observation form provided among the tools of the multimodal in Benin using the theoretical domain frameworks 1,2,* 3 4 5 strategy. C. Yehouenou , A. ABEDINZADEH , R. HOUNGNIHIN , F. DOSSOU , A. 6 7 Results: Prior to pandemic (2019),1515 opportunities for HH were Simon , O. DALLEUR observed and 996 ones in 2020. Overall compliance among all HCW Université catholique de Louvain/Louvain drug research institute, Brus‑ was better during the pandemic than before the pandemic (38.3% vs sels, Belgium, Reference laboratory of Mycobacteria, Cotonou, Benin, 49.3%.;p < 0.001). Hand washing remained more frequently practiced Pharmacy, Clinique universitaire Saint Luc;Université catholique de Lou‑ than hand rubbing. However, the latter has doubled in percentage vain, Brussels, Belgium, Laboratoire d’Anthropologie Médicale Appliquée after the intervention in 2020 (from7.3 to 14.2%; p < 0.001). The para- (LAMA), Université d’Abomey‑Calavi, Department of surgery and surgical medical stuff were the most observant to the HH indications during specialties, Faculty of Health sciences,Campus universitaire Champs de the 2 years. In 2019, the intensive care units were the most compliant Foire, PO Box; 01BP118,, Cotonou, Benin, centres hospitaliers joliment, (50.5% vs 54.1%;P < 0.001) while,in 2020, the medical services were the Prevention et contrôle des infections, Groupe Jolimont sable, Rue Ferrer, most compliant (38.4 vs 56.5%;P < 0.001).During the 2-year period, the 159–7100 Haine‑Saint‑Paul., Pharmacy, clinique universitaire Saint‑Luc, most respected indication to HH was "after touching the patient"(43.6 Clinical Pharmacy Research group (CLIP), Louvain Drug Research Institute in 2019 vs 57.0% in 2020;P < 0.001). (LDRI), Université catholique de Louvain, Brussels, Belgium Conclusion: COVID-19 prevention and control program seems to have Correspondence: C. Yehouenou a positive impact on the HH compliance. Obtained Data are useful to Antimicrobial Resistance & Infection Control 10(1): P229 provide HCW with feedback, to guide further intervention aiming at sustainably HH compliance improvement. Introduction: Hand hygiene (HH) is widely recognized to be one of Disclosure of Interest: None declared. the most successful and cost-effective measures for reducing the inci- dence of healthcare-associated infections (HAIs). The compliance of healthcare workers (HCWs)with best practice has nonetheless been P228 sub-optimal. “Investigating the determinants of hand hygiene compliance Objectives: To use the Theoretical Domain Frameworks (TDF) to iden- among birth attendants in Kenya and Malawi using the service tify the behavioral determinants that may impact HCW’shand-hygiene provision assessments (SPA)” compliance in a public hospital in Benin. 1,* 1 L. Dansero , G. Gon Methods: A qualitative design comprising face-to-face semi-struc- Infectious Disease Epidemiology, London School of Hygiene and Tropi‑ tured interviews with eight sampled HCWs. the interviews included cal Medicine, London, United Kingdom questions on transmission of infections, hand-hygiene practices, Correspondence: L. Dansero problems with their implementation, and way to improve adherence Antimicrobial Resistance & Infection Control 10(1): P228 with HH recommendations. Interviews were coded into 14 behavioral domains using the TDF and were subdivided into themes. Interviews Introduction: Hand hygiene (HH) is an essential element of Infection transcrips were analyzed using thematic content analysis involving a Prevention and Control (IPC). Birth attendants’ HH is pivotal to pre- systematic 3-step approach:coding, generationof specific beliefs, and venting new-born and maternal infection. Compliance with HH and its identification of relevant domains. determinants are underinvestigated in Low and Middle-Income Coun- Results: One of the barriers to good HH adherence most cited in tries. We analysed the Kenya and Malawi Service Provision Assess- our study was environmental context and resources (such as empty ments (SPA, 2010 – 2013), which are nationwide surveys that provides hand-gel dispensers). the interviewees believed that role models an extensive overview of a country’s health service. had a significant impact on the good practices of others HCWs. Par - Objectives: The main objective was to analyse HH compliance and ticipants were confident of their capabilities to perform appropriate its determinants during delivery in Kenya and Malawi using the SPA dataset. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 107 of 140 HH behaviors. almost all of them (7/8) reported having the necessary be beneficial from a public health perspective, it’s impact on influenza knowledge and skills and believed they could carry out appropriate transmission is unclear. Research is needed to evaluate the effective - HH behavior. ness of HH interventions for prevention of respiratory infections, Conclusion: The theoretical Domains Framework provides a useful including SARS-CoV-2, amongst more diverse groups of the general tool for understanding HH behavior. But while knowledge is necessary public populations. for behavior change, it is not sufficient. This study identified several Disclosure of Interest: None declared. key behavioral constructs aligned with the TDF that can be targeted when developing new HH interventions. These may increase the HH P231 compliance and patient safety. What should have worked but didn’t really: addressing hand Disclosure of Interest: None declared. hygiene misinformation in the press 1,* 1 1 A. Peters , D. P ittet , S. Ghasemi Poster session: hand hygiene: communication and promotion 1 HUG, Geneva, Switzerland across the globe Correspondence: A. Peters Antimicrobial Resistance & Infection Control 10(1): P231 P230 The effectiveness of hand hygiene interventions for preventing Introduction: Misinformation about infection prevention is every- transmission or acquisition of viral infections in the community: where, and especially widespread and harmful during a destabilizing findings from a systematic review situation such as a pandemic. Published sources of misinformation in 1,* 2 1 1 1 L. Gozdzielewska , C. Kilpatrick , J. R eilly , S. Stewart , J. But cher , A. online newspapers are among the most widely read by laypeople. It is 1 3 3 1 Kalule , O. Cumming, J. Watson , L. Price important to respond to fake news, though it is difficult to know the 1 2 Research Centre for Health, Glasgow Caledonian University, KSHealth‑ impact of such a response. care Consulting, Glasgow, Department of Disease Control, London Objectives: We wanted to measure the impact of our ability to reduce School of Hygiene and Tropical Medicine, London, United Kingdom the damage done by an article published in the The Express during Correspondence: L. Gozdzielewska the COVID-19 pandemic. This article contained a large amount of false Antimicrobial Resistance & Infection Control 10(1): P230 and misleading information about hand hygiene. Our objective was to make the publisher correct the misleading article and to analyze how Introduction: The World Health Organization recommends improv- feasible this was, if we had ample time and resources to devote to one ing hand hygiene (HH) practices of the general public as one aspect piece of fake news. of controlling the transmission of novel coronaviruses and influenza Methods: After discovering the misleading article, we sent an email virus epidemics or pandemics. reporting and denouncing the false information to the publisher. We Objectives: To systematically review the evidence on the effective - contacted the Independent Press Standards Organisation (IPSO) to ness of HH interventions for preventing transmission or acquisition of file a complaint and provided a detailed analysis of which points of viral infections in the community. their Editors’ Code of Practice were violated in the concerned arti- Methods: PubMed, MEDLINE, CINAHL and Web of Science databases cle. We contacted the British Institute of Cleaning Science where the were searched for empirical studies published between 2002-May “expert” cited in the newspaper article was reported to be a consult- 2020, on HH in the general public and acquisition or transmission of ant, in order to find out more from them. All inaccurate or misleading novel coronavirus infections or influenza. Study selection, data extrac - elements of the article were analyzed, with full documentation of the tion and quality assessment were conducted by one reviewer, with scientific literature. all decisions checked by another. We conducted a sub-set analysis of Results: Though each inaccuracy was addressed specifically with intervention studies included in this review, by calculating the effect plenty of evidence, the newspaper refused to take any action to cor- estimates. rect or remove the article, claiming to be confident about the content. Results: The review identified four intervention studies, all of which IPSO rejected the claim we filed, as they considered that the article used cluster randomised designs evaluating the effectiveness of HH contained the point of view of the interviewed person. The British education paired with provision of HH products or hand washing Institute of Clean Science specified that the “expert” was an unpaid with soap and water (HW) against influenza transmission or acquisi- consultant and released a statement (also sent to IPSO) that specified tion amongst the populations of schoolchildren (n = 2) or the general that the views of their unpaid consultant did not reflect their own. public (n = 2). Three indicated a protective effect of HH interventions Conclusion: Even with ample resources, it proved to be very difficult, (Figure); yet, this effect was significant for only one school-based inter - if not impossible, to have a measurable impact on infection preven- vention, which consisted of the provision of HH education and per- tion misinformation in the lay press. More work needs to be done to forming HW twice a day (OR: 0.64; 95% CI 0.51, 0.80). However, the risk address this divide between academics and the lay press, as it is crucial of bias of this study was assessed as unclear; whereas the remaining for infection prevention and public health. three studies were assessed as high risk. Disclosure of Interest: None declared. P232 Perception of healthcare workers towards healthcare‑associated infections and hand hygiene exposed to different change agents 1,* 2 1 3 4 Y. F. Lee, W. Zingg , H. U. Ng ian , Z. H. Chin , M.‑L. McLaws , S. Amir 5 1 6 7 Husin , H. H. Chua, J. Wang , D. P ittet 1 2 Sarawak General Hospital, Kuching, Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Sarawak State Health Department, Kuching, Malaysia, University of New South Wales, Sydney, Australia, Infection Prevention & Control Unit, MoH, Putrajaya, Malaysia, Otto von Guericke University, Magdeburg, Germany, Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva, Geneva, Switzerland Correspondence: Y. F. Lee Conclusion: There is some limited evidence demonstrating that hand Antimicrobial Resistance & Infection Control 10(1): P232 hygiene interventions were effective in preventing influenza in school children. Thus, whilst provision of HH education to school children will Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 108 of 140 Introduction: Healthcare-associated infections (HAIs) have affected hospital Faranah. The monthly consumption of ABHR after the training hundreds of millions of individuals worldwide. Taking that hand was monitored with respect to consultations. hygiene is behaviour driven, improvement strategies can be Results: Baseline knowledge score was 11/25, increased significantly improved by fostering collaborative multimodal strategies via to 16/25 upon first and decreased slightly to 15/25 in second follow- change agents. up. Compliance with HH showed a significant increase from 15.6% to Objectives: To understand how the different attitude of change 84.4% (p < 0.001) in first follow-up. Compliance in second follow-up agents shaped the perception of healthcare (HCWs) workers was lower than in first follow-up (53.2%, p < 0.001), but was still more towards HAIs and hand hygiene. than 37% higher than in baseline (p < 0.001). ABHR consumption aver- Methods: Two acute wards of a tertiary hospital in Malaysia were aged 0.77 mL per consultation. randomly exposed to hand hygiene improvement interventions Conclusion: This study shows that the WHO HH Strategy is an appro- delivered by peer-identified change agents (PICAs) in study arm priate method to improve HH compliance and knowledge in primary 1, and management selected change agents (MSCAs) in study arm care level, but needs some adjustment of assessment and training 2. Primary outcome was perception of HCWs towards (i) impact of procedures. Assessments should include the observation of HH action HAIs and the importance of hand hygiene, (ii) strategies and tools correctness and trainings should further emphasize on proper HH per- for hand hygiene compliance and; (iii) facilitators’ importance for formance and ABHR amount usage. Moreover, our results highlight optimum hand hygiene, measured using the WHO Perception Sur- the need for continued training and education to maintain a high level vey for HCWs (revised 2009), applied in the pre- and post- interven- of HH. tion periods. Secondary outcome was perceived leadership styles of Disclosure of Interest: None declared. PICAs and MSCAs by HCWs, vocalised during question and answer sessions. P234 Results: The number of respondents in pre- and post-intervention How to go beyond the WHO strategy and build a hand hygiene was 72 and 70, and 75 and 71 in study arms 1 and 2, respectively. culture in the regional hospital of Faranah 1,* 2 2 2 2 1 From the pre- to post intervention periods, the perception of HCWs A. Diallo , S. Müller , L. Landsmann , C. Rocha , R. Wood , O. Tounkara , 2 2 1 on the impact of HAIs, and the importance of hand hygiene were M. Borchert , M. Arvand , M. Diallo 1 2 similar and remain unchanged in both study arms. In the post-inter- Regional Hospital of Faranah, Faranah, Guinea, Robert Koch Institute, vention period, the proportion of HCWs that perceived improve- Berlin, Germany ment in safety climate for hand hygiene was significantly higher in Correspondence: A. Diallo PICA led-ward compared to MSCA led-ward (91% vs 65%, P < 0.001). Antimicrobial Resistance & Infection Control 10(1): P234 Proportion of HCWs on the perception of the facilitators’ effective - ness on hand hygiene was significantly higher with PICAs compared Introduction: The Multimodal WHO Hand Hygiene (HH) Strategy is to MSCAs. Healthcare workers perceived that PICAs lead by exam- a widely used and well recognized approach. However, the evidence ple, while MSCAs were authoritative and more desirable for hand on the sustainability in low-resource settings is still scarce. The WHO hygiene improvement. strategy was implemented at the Regional Hospital of Faranah Conclusion: Although HCWs preferred the authoritative leader- (HRF), but context specific challenges developed. ship style of MSCAs, they still perceived PICAs to be more effective in Objectives: We aimed to promote HH culture by addressing these improving hand hygiene compliance. challenges and implementing appropriate solutions. Disclosure of Interest: None declared. Methods: Over a period of 3 years, the project team used quantita- tive and qualitative methods to assess HH improvement. Local staff P233 was trained and instructed to track the development, identify barri- Is the WHO multimodal hand hygiene strategy applicable ers and find solutions to build a sustained HH culture. and effective at the primary care level in resource‑limited Results: Four main barriers were identified and addressed by tar - settings?—a quantitative analysis in healthcare centers geted measures. 1) The lack of staff for local production was over - of Faranah, Guinea come by implementing a train the trainer approach. The initially 1,* 1 2 1 1 S. Müller , L. Landsmann , A. O. K. Diallo, R. Wood , C. Rocha , O. trained pharmacist trained four other team members. To further 2 1 2 1 Tounkara , M. Arvand , M. Diallo , M. Borchert strengthen the production team, a national solution of training and 1 2 Robert Koch Institute, Berlin, Germany, Regional Hospital, Faranah, sending staff is proposed by the HRF. 2) Difficulties in obtaining Guinea production ingredients in high quality were addressed by purchas- Correspondence: S. Müller ing large quantities and the establishment of a storage room in the Antimicrobial Resistance & Infection Control 10(1): P233 hospital pharmacy. 3) To prepare for sustainable local production, the return, recycling and exchange of empty bottles was planned by Introduction: Healthcare-associated infections (HAI) are the most fre- opening a register of distribution. 4) To stop the decrease in knowl- quent adverse events in healthcare worldwide. The Multimodal Hand edge and compliance over time, a HH championship every 6 months Hygiene (HH) Improvement Strategy by the WHO aims at reducing was initiated. All hospital departments were invited to participate HAI. Hitherto, there is little evidence of the applicability and effec - and staff assessed via the WHO knowledge questionnaires and HH tiveness of the WHO HH Strategy at primary care level, especially in observations. Furthermore, refresher trainings and demonstrations healthcare centers (HCC) of resource limited settings such as Guinea. of HH were given in daily staff meetings. Objectives: The objectives of the present study were to improve HH Conclusion: To build HH culture is feasible in low-resource hospitals knowledge and compliance of healthcare workers (HCWs) in two HCC such as the HRF. However, context specific challenges require locally in the region of Faranah, Guinea; to increase the availability of alcohol- designed solutions such as the introduction of recycling systems for based handrub (ABHR) by supplying HCC with locally produced ABHR; ABHR bottles, organizing HH championships, or promoting daily staff and to assess the effectiveness of the WHO Multimodal HH Improve - trainings to maintain the improvement on HH practises and creating ment Strategy on primary care level. a HH culture. This development of a HH culture and its sustainable Methods: HH knowledge, perception and compliance of HCWs were local production helped the HRF to respond to the current COVID-19 assessed in baseline prior to the intervention and compared to two pandemic. follow-up assessments, one immediately and one six months after the Disclosure of Interest: None declared. intervention. The intervention consisted of HH training and the contin- uous supply of HCW with ABHR, which was produced in the Regional Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 109 of 140 P235 Abstract video clip description: The coronavirus pandemic has dis- Development of a cost‑effective water dispenser for hand rupted lifestyles for almost two years across the planet. The fight for its washing at a rural/resource limited setting prevention in the absence of its eradication involves the implementa- 1,* S. Parangimalai Madan Kumar tion of barrier measures including the treatment of hands. So, as part Vidya Mandir Senior Secondary School, Chennai, India of the International Hand Hygiene Day this year with the theme "One Correspondence: S. Parangimalai Madan Kumar Minute to Save Lives"; health workers from the Calavi Central Clinic in Antimicrobial Resistance & Infection Control 10(1): P235 the Republic of Benin, have decided to increase their hand hygiene compliance rate by organizing an awareness and training day for Introduction: Being the second most populous country, India houses users of the establishment. So each caregiver came out of his office around 1.4 billion people, with major of its population in rural setting, to show the hand washing technique to a user (patient, attendant, or who have limited access to health and infrastructural facilities. Lack of other non-clinical user). This activity, which lasted three hours, saw the clean water coupled with access to contaminated water has only resulted participation of 21 clinic agents who taught 42 users. This operation, in increase in spread of infectious diseases, especially among the rural which deserves to be repeated, showed the good technique of simple children. In addition, there still exists the problem of open defecation, hand washing to more than forty users in one morning. especially in rural India which acts as a nidus in the spread of infection. In Keywords: coronavirus, prevention, hand hygiene. spite of the continued efforts by the governmental and private agencies General objective: Participate in the reduction of the transmission of to encourage the habit of adequate hand washing, especially before and the coronavirus by the practice of hand washing. after eating and defecation, lack of basic facilities including absence or Specific objectives: Promote hand hygiene in the minds of users. malfunction of water storage tanks and taps hinder this process. Demonstrate the correct and simple hand washing method to the Objectives: The author has proposed a new design of Water Dis- community. penser for hand washing which can be constructed using locally Method and materials: Each health worker revisits their simple hand- available resources and thus reduces the cost involved in the con- washing protocol, explains it to a user, and the two do it together. struction of tanks and the necessary tap facilities. Materials: Two hand washing stations, soap, disposable hand towels, Methods: The design consists of a panel of a round wooden log, garbage cans. preferably of bamboo or any wood which is native to that particu- Results: The operation was monitored by all the medical practitioners lar region. The log panel structure consists of two supporting pillars, present at the station, ie 100%, of 06 nurses and 12 health and phar- along with a horizontal wooden platform to support the water dis- macy auxiliaries. These health workers of all categories showed the penser with the strings, as shown in Figure 1. The users are encour- technique to 42 users who practiced simple hand washing, more than aged to wash their hands, after sensitizing them about the health 80% of the people who went to the clinic this morning. benefits, along with the handwashing technique and the duration Conclusion: The practice of hand hygiene is in the headlines as stated of the same. The user can pull the string to pour the water from the by one user. Everyone saw their caregiver come out and discuss the dispenser for washing his/her hands and feet. technique and importance of hand washing with them. This will inevi- Results: The feasibility of this design was field tested at a rural set - tably improve their knowledge of this very important method in infec- ting and around 30 users were questioned regarding the comfort tion prevention and control (IPC) in healthcare settings. and the usability factors on a scale of 0 (not useful) to 5 (Highly use- Disclosure of Interest: None declared. ful). Most of the participants expressed satisfaction in terms of the ease of installation and usage of this model for hand washing. P237 Hand hygiene in the soap’s realm 1,* 1 2 3 S. M. Filipe Gonçalves , D. M oderno , A. Agostinho , F. Paiva‑Santos , E. Noriega 1 2 Figueira da Foz District Hospital, Figueira da Foz, Portugal, Geneva Uni‑ versity Hospitals, Geneva, Switzerland, Nursing School of Coimbra, Coim‑ bra, National Infection Prevention and Control Group, Lisbon, Portugal Correspondence: S. M. Filipe Gonçalves Antimicrobial Resistance & Infection Control 10(1): P237 Introduction: Promoting hand hygiene among healthcare workers every year is a constant challenge. The material provided by “Clean Care is Safer Care” from the World Health Organization (WHO) team helps to mobilize all professionals as a whole, however year after year they resent the tiredness leading to a decrease in hand hygiene com- pliance rates. The use of innovative local strategies can help to over- come this tiredness and input a new dynamic, thus maintaining and even improving hand hygiene compliance. Conclusion: The advantages of this methods included ease of instal- Objectives: Revitalize the hand hygiene campaign through an inno- lation, low cost and avoidance of container to draw water from the vative strategy in order to improve the compliance rate. water source and hence contaminating the source of water. Though Methods: Figueira da Foz Hospital is a secondary district hospital this model has some limitations, the proposer feels that this model who joined the WHO’s hand hygiene campaign in 2014 and thence- could be a viable alternative for water dispensing for hand washing forth, every 5th may, healthcare workers are mobilized to celebrate purposes in rural or resource limited settings. the World’s Hand Hygiene Day. In the first 3 years we used updated Disclosure of Interest: None declared. posters, banners and screen-savers. In 2018 we decided to bring a new approach: we made a small illustrated book with a story for the health- care workers children: Once upon a time… in Soap’s Realm, an imagi- P236 nary story in a kingdom where hand hygiene was widely recognised One minute to keep coronavirus away, teaching community good as an important way to keep people healthy. King McClean invested hand hygiene practices in infrastructures, produced the best world’s soap and there even was 1,* M. Fawwaaz a troubadour to keep hand washing in people’s routines. Until the day Atlantique, Clinique Centrale de Calavi, Abomey‑Calavi, Benin the good old king died, his work wasn’t continued and everyone got Correspondence: M. Fawwaaz ill after an invasion of microbes. But like all children’s stories, this one Antimicrobial Resistance & Infection Control 10(1): P236 also has a happy end! Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 110 of 140 Results: The book met a huge success. The pooled hand hygiene P239 compliance rate between periods increased from 62,0% to 72,4% Health care workers knowledege about hand hygiene (95% CI: 5,34–15,35; p < ,001); before the intervention it was 63,3% in within the COVID‑19 epidemic in Tunisia 2020 1,* 1 1,2 1,2 1 1 2015, 57,1% in 2016 and 59,9% in 2017 and after the intervention the A. Gara , A. ben cheikh , S. bhiri , H. ghali, W. dhouib , R. bannour , S. 1 1 1,2 compliance improved to 66,4% in 2018 and 73,5% in 2019. The rate khfecha , H. Said Latiri , M. ben rejeb of nosocomial infections also improved from 5,2% in 2015 to 3,5% in Department of Prevention and Security of Care, Sahloul university hos‑ 2019, according to institutional prevalence. pital, Sousse, Tunisia, Faculty of Medicine of Sousse, University of Sousse, Conclusion: A different way of communication can change the way Sousse, Tunisia, sousse, Tunisia we receive the same message, create awareness for hand hygiene Correspondence: A. Gara compliance thus preventing healthcare associated infections. Antimicrobial Resistance & Infection Control 10(1): P239 Disclosure of Interest: None declared. Introduction: The coronavirus COVID-19 pandemic is the defining global health crisis of our time. Poster session: hand hygiene: multimodal implementation Current evidence indicates that the COVID-19 virus is transmit- including electronic monitoring ted through respiratory droplets or contact. So, to reduce the speed spread of the infection, hand hygiene (HH) is considered as a corner stone measure. We aimed to describe the knowledge about HH of P238 health care workers (HCWs) in a Tunisian teaching hospital over this Knowledge of medical/nursing (MED/NURS) leaders about hand outbreak in May 2020. hygiene and standard precautions (SP) in non COVID‑19 wards Objectives: The aim of this study was to determine the knowledge in a tertiary care hospital 1 1,* 1 2 regarding hand hygiene practices amongst health care workers. A. Iten, V. Camus , C. Fankhauser , Z. Horcik 1 2 Methods: It was a descriptive study of the knowledge of HCWs about Infection control program, Learning center, HUG, Genève, Switzerland HH performed over a period of one-month (May) 2020. We imple- Correspondence: V. Camus mented a self-administered questionnaire written in French focusing Antimicrobial Resistance & Infection Control 10(1): P238 on the importance of HH in prevention and control of infection, then general information about HH (5 moments for HH, handwashing vs Introduction: Since the beginning of the COVID-19 pandemic, HUG hand rub, conditions before HH). are taking care of patients suspected of having or affected with COVID- Results: A total of 466 participants (67.4%) were enrolled to the study, 19. The majority of the HUG wards became COVID wards; CONTACT among them 50.2% were doctors (n = 234) vs 49.8% were staff nursing and DROPLETS measures replaced SP. When the situation returned to (n = 234). The majority of participants belonged to surgical services normal, the use of personal protective equipment was inappropriate. (n = 234), then medical services (n = 153) then annexes (n = 79) with A corrective program was implemented. One of its objectives was to respective rates of 50%, 33% and 17%. The importance of HH in the address the role of the MED/NURS leaders of the non-COVID wards. In reduction of the risk of Covid-19 was recognized by 52.6% of HCWs. the initial phase of the program, the PCI knowledge of these managers Fifty eight percent of them knew that the virus SARS-CoV-2 survived was assessed and updated. The majority of the wards became COVID only 10 min on the hands. wards; CONTACT and DROPLETS measures replaced SP. Staff nursing’ HH knowledge in different items was higher than that of Objectives: To assess the knowledge of MED/NURS leaders of non- the medical staff. COVID wards regarding hand hygiene and wearing of gloves and to Conclusion: Opting for sustainable programs to control the COVID-19 evaluate the choice of personal protective equipment by MED/NURS outbreak, it appears that HH promotion and training is crucial espe- managers in non-COVID wards for frequent clinical situations. cially among doctors. Methods: The MED/NURS managers of the non-COVID wards were Disclosure of Interest: None declared. invited to participate in a training session. 3 ICP professionals and 1 adult education specialist: 1. described the context and presented the project; 2.tested the participants’ knowledge about hand hygiene, gloves’ wearing and personal protective equipment to be used in P240 frequent clinical situations. The quiz was built with an educational Train‑the‑trainers program to improve hand hygiene promotion purpose. capacity in Iranian hospitals The participants’ answers were recorded anonymously by an online 1,* 2 1 1 N. Lotfinejad , M. H. A elami, E. Tartari , C. Fankhauser‑Rodriguez , D. survey software. Aggregated responses were presented and com- Pittet mented during the session. Infection Control Programme, University of Geneva Hospitals and Fac‑ Results: 11 training sessions were held from 27.01.2021 to 26.02.2021; ulty of Medicine, Geneva, Switzerland, Pediatrics & Infection Control 286 MED/NURS leaders were invited: 177 (61.8%) attended. More than and Hand Hygiene Research Center, Mashhad University of Medical 75% of the participants appreciated this type of training. Sciences, Mashhad, Iran, Islamic Republic Of Correspondence: N. Lotfinejad Topic of questionsCorrect answers Antimicrobial Resistance & Infection Control 10(1): P240 Hand hygien 87.15(CI +8.53) Introduction: Healthcare-associated infections (HAIs) are considered Gloves 92.85(CI +1.73) to be the most prevalent harmful event in healthcare that threaten Clinical situations 59.32(CI +5.56) patients worldwide. Hand hygiene is the cornerstone of prevent- ing HAIs and it is promoted by the World Health Organization (WHO) multimodal hand hygiene improvement strategy (MHHIS). The hand hygiene self-assessment framework (HHSAF) and the Train-The-Train- Conclusion: Knowledge about hand hygiene and gloves’ wearing is ers (TTT ) program are among the tools to improve hand hygiene prac- satisfactory: it was enough to answer true or false to a statement. tices according to the MHHIS. The percentage of correct answers given to clinical situations is insuf- Objectives: To determine the hand hygiene promotion capacity of ficient: knowing which personal protective equipment to use with Iranian public hospitals through the HHSAF application, as well as regard on transmission risk remains complicated. This is one of the evaluating the impact of TTT program. topics on which our program must focus. Methods: A two-part program on implementation of the MHHIS Disclosure of Interest: None declared. was conducted by a group of four infection prevention and control Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 111 of 140 practitioners from Geneva. A total of 13 university hospitals from dif- P242 ferent regions of Iran participated in the HHSAF survey and a 3-day Integrating infection prevention and control training TTT hands-on simulation-based hand hygiene training program took into advanced cardiac life support training—a single center study 1,* 1 1 1 2 place in Shiraz, Iran.S. Hansen , F. Schwab, M. Weisker, T. Jeske , R. Somasundaram , B. A. Results: In total, 53 individuals participated in completing the HHSAF Leidel 1 2 survey during the survey period from September 2018 to December Institute of Hygiene and Environmental Medicine, Department of Emer‑ 2019. We found that facility scores varied, with the majority at inter- gency Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany mediate or advanced levels. The TTT program was performed from 16 Correspondence: S. Hansen to 19 April in Shiraz, Iran, with 44 participants, among which 37 com- Antimicrobial Resistance & Infection Control 10(1): P242 pleted both pre and post TTT course tests. The overall mean of correct answers of the tests before and after the TTT course were 62.41% and Introduction: Hand hygiene (HH) compliance of healthcare work- 75.30%, respectively. ers (HCW) in emergency departments (ED) has been shown low and Conclusion: This report presents the current status of Iranian facilities described as potentially infeasible especially during resuscitation on the hand hygiene improvement continuum. Further completion of [Haac 2017]. the HHSAF should be undertaken throughout the country in support Objectives: To what extent Infection Prevention and Control (IPC) of hand hygiene action. According to the TTT test results, participants’ training is practicable during Advanced Cardiac Life Support (ACLS) knowledge improved following this training program. This standard training was analyzed in an observational study. training method should be applied in different settings worldwide to Methods: Prospective analysis of HH compliance observation (CO) disseminate knowledge to health care workers. and feedback during an American Heart Association certified ACLS Disclosure of Interest: None declared. training of ED HCW in 03–04/2021. CO were realized according to WHO’s 5 moments by experienced IPC staff during 3 consecutive ACLS cases in each of 8 training sessions. Compliance rates (CR) were calcu- P241 lated as ratio of performed and recommended HH procedures. Feed- University training as the key point for student nurses’ behaviour back was given after each case. Further IPC aspects were discussed on hand hygiene compliance when recognized by EDs’ HCW. Pooled CR were calculated, differences 1,* 2 3 A.‑P. Ana Belén , L. G.‑M. Sara , D. R. Silvia were tested between the 1st and 3rd ACLS case. Preventive Medicine, Hospital Universitario Fundación Alcorcón. Adjunct Results: 60 HCWs participated in the training (22 nurses, 7 physi- faculty at Rey Juan Carlos University, Alumna enfermería, Universidad cians). 486 recommended HH opportunities were observed, the major- Rey Juan carlos, Madrid, Universidad de Alcalá de Henares., Alcalá de ity related to indication 2 (204; 42%). As shown in table 1 pooled CR Henares.Madrid, Spain increased for WHO indications 1–4 and in total from 41.3% to 77.8% Correspondence: A.‑P. Ana Belén (p < 0.001). Antimicrobial Resistance & Infection Control 10(1): P241 Table 1: Pooled data of hand hygiene performance Training Compliance (performed / recommended hand hygiene; (%)) Abstract video clip description: Introduction: Hand hygiene (HH) case Hand hygiene WHO indications 1234 5total is the most effective, inexpensive and easy-to-implement measure First 21/3919/65 4/11 20/400 64/155 which prevents healthcare-associated infections (HAIs). The SARS- (53.8) (29.2) (36.4) (50.0) (41.3) CoV-2 pandemic has highlighted its importance not only in patient Second 34/3630/63 9/16 27/400 100/155 care, but also in preventing the transmission of microorganisms in (94.4) (47.6) (56.3) (68.0) (64.5) both inside and outside the hospital. Third 35/4153/76 15/1934/40 0 137/176 Objectives: to describe the knowledge level about HH, to detect the (85.4) (69.7) (78.9) (85.0) (77.8) weaknesses and to plan unified training activities for the 4th year stu- total90/116102/204 28/4681/1200 301/486 dent nurses at Madrid’s Community public universities. (77.6) (50.0) (60.9) (67.5) (61.9) Methodology: A cross-sectional study was done. It consisted on filling RR (95%CI), 1.6 (1.2-2.2), 2.4 (1.6-3.6), 2.2 (0.9-4.9), 1.7 (1.2-2.4), N 1.9 (1.5-2.3), p-value Third vs p=0.002 p<0.001 p=0.053 p<0.001 A p<0.001 the World Health Organisation survey about HH knowledge in a vol- First untary and anonymous way. It was distributed, on the social network- RR, risk ratio; CI, confidence interval; NA, not applicable. n total = 486 recommended HH opportunities ing sites of the 4th year student nurses, through google drive, to the 4 public universities to which this study was intended for. Results: The survey was answered by 22.4% of the 4th year student Conclusion: HH CO and immediate feedback improves HCWs HH nurses of Madrid’s public universities. Of all the participants, 43.7% adherence during ACLS training. Further evaluation is needed to ana- were from Rey Juan Carlos University, 20.4% were from Autónoma lyze translation of IPC training into real patient care. University of Madrid, 19% were from Complutense University of Disclosure of Interest: None declared. Madrid and 16.9% were from University of Alcalá de Henares. 84.5% of the participants were female, and 15.5% were male. Among the differ - P243 ent items included in the survey, the following are worth mentioning. Electronic hand hygiene systems can be used to assess clinically 96.5% of the survey respondents affirm that during their degree they relevant interventions have received training about HH. The overall average number of cor- 1 2 2 3,* 1 M. Stangerup , R. Hansen , L. Sode , M. B. Hansen , B. Hesselbo , H. rect answers was 17.18 out of 25. 1,4 5 Calum , B. Olesen Discussion: Nevertheless, certain deficiencies in terms of knowledge 1 2 Infection Control Unit, Bispebjerg and Frederiksberg Hospitals, Depart‑ about the importance, timing and technique of Hand Hygiene were ment of Orthopaedic, Bispebjerg University Hospital, Konduto ApS, observed. So, some unified training activities of a theoretical-practical Department of Clinical Microbiology, Amager and Hvidovre Hospitals, nature are proposed to reinforce knowledge of HH in the four universi- Department of Clinical Microbiology, Herlev, Gentofte and Nordsjæl‑ ties to which the survey was aimed at. lands Hospitals, Copenhagen, Denmark. We considered introducing simulation as a method of learning HH Correspondence: M. B. Hansen moments in care tasks. This method allows reaching an agreement Antimicrobial Resistance & Infection Control 10(1): P243 about some of the systematic activities, since it implements the differ - ent moments on HH during care tasks, in this way it ensures patient Introduction: There is a need to identify the most effective hand safety. In addition, its use and evaluation show positive results. hygiene interventions. A previous study showed that hand hygiene Disclosure of Interest: None declared. compliance (HHC) of hospital visitors increased using colourful tape on the floor as a visual reminder at the main entrance next to alcohol- based hand rub (ABHR) dispensers. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 112 of 140 Objectives: We aimed to assess the effect of this low-cost, low-effort to 51% (p < 0.0001) which was associated with a significant decrease approach on healthcare workers’ (HCWs) HHC in patient rooms using in staff absenteeism from 7 to 3% (p < 0.0001). There was a strong an electronic hand hygiene system. negative correlation between HHC and staff absenteeism (r = -0.8, Methods: To avoid the risk of bias associated with direct observations, p = 0.0001). an electronic hand hygiene system (sani nudge ) was used to obtain Conclusion: The increase in HHC after introducing a data-driven HHC data from doctors (n = 6) and nurses (n = 18) in a surgical ward group feedback intervention using an EHHMS was associated with a from Dec 2020-Feb 2021. significant decrease in staff absenteeism. The demonstrated relation- The study was divided into a baseline and an intervention period ship between staff HHC and absenteeism shows a return of invest - where pink tape was placed on the floor at the entrance of each ment opportunity for hospital management while also increasing the patient room next to the ABHR dispensers. The pink colour was iden- staff and patient safety. tical to the colours of stickers and brochures used during the last Disclosure of Interest: None declared. hygiene campaign. The hypothesis was that the HCWs would associate the pink-coloured P245 tape (nudge) with hand hygiene, resulting in more frequent ABHR and Implementing an electronic hand hygiene system improved increased HHC. We used Student’s t-test to assess differences between compliance in the intensive care unit 1,* 2 2 3 3 2 3 baseline and intervention. J. Huang , Q. Xu , M. Kong, Y. Liu , P. Liu , A. Jerde , D. C epulis 1 2 Results: The HHC of the doctors was not associated with a significant Anesthesiology & Perioperative Medicine, University of Louisville, Louis‑ change from baseline to intervention either before patient contact ville, Microsensor Labs, Chicago, United States (25% vs. 23%, p = 0.76) or after patient contact (52% vs. 57%, p = 0.73). Correspondence: J. Huang As with the doctors, the HHC of the nurses did not change from Antimicrobial Resistance & Infection Control 10(1): P245 baseline to intervention either before patient contact (31% vs. 35%, p = 0.10) or after patient contact (49% vs. 46%, p = 0.46). Introduction: Hand hygiene (HH) compliance is low and difficult to Conclusion: This study demonstrates that interventions can be improve among healthcare workers. assessed with an electronic hand hygiene system. We found that col- Objectives: We aim to validate an electronic HH system and assess ourful tape on the floor at patient room entrances did not have an the impact of this system on HH compliance and quality changes over impact on the HHC of HCWs. The lack of effect may be due to banner time at both group and individual levels. blindness due to frequent exposure. More dynamic nudges may be Methods: An automated electronic hand hygiene system was needed to change the hygiene behaviour of HCWs. installed in a 10-bed surgical intensive care unit. Disclosure of Interest: None declared. Results: The full HH compliance rate increased significantly from 8.4% in week 1 to 20.5% in week 16 with week 10 being the highest P244 (27.4%). The partial compliance rate maintained relative consistency Use of an electronic hand hygiene monitoring system between 13.2% to 20.0%. The combined compliance rate (full compli- is associated with decreased staff absenteeism ance rate + partial compliance rate) increased from 23.5% in week 1 to 1 2,* M. B. Hansen , H. J. Kolmos 34.6% in week 16 with week 10 being the highest (41.4%). We found 1 2 Medical & Science, Konduto, København K, Clinical Microbiology, Uni‑ significant variations among providers in terms of HH opportunities versity of Southern Denmark, Odense, Denmark per shift, full compliance, partial compliance and combined compli- Correspondence: H. J. Kolmos ance rates. The average duration of hand rubbing over time in partial Antimicrobial Resistance & Infection Control 10(1): P244 compliance occurrences did not change significantly over time. Introduction: The World Health Organization promotes the use of alcohol-based hand rubs (ABHR) at the point of care to protect patients and staff from healthcare-associated infections. Objectives: We aimed to assess the effect of implementing an elec - tronic hand hygiene monitoring system (EHHMS) on staff hand hygiene compliance (HHC) and staff absenteeism. Methods: An EHHMS (sani nudge ) was implemented in an internal medicine department at a university hospital for an 18-months period (Aug 2017-Jan 2019). Anonymous sensors were placed on existing ABHR dispenser solutions, staff name badges and at patient beds to measure hand hygiene opportunities and actions. The study was designed with a 7-months baseline period followed by an 11-months intervention period. The intervention consisted of data- driven group feedback at biweekly staff meetings in which ward man- agement presented the HHC levels according to profession and room types. A copy of the results was put on a bulletin board after each meeting to serve as a reminder. Monthly HHC goals were decided Conclusion: A sensor-based platform with automated HH compliance and communicated by management to help focus their improvement and quality monitoring, real time feedback and comprehensive indi- work. vidual level analysis, improved providers’ HH compliance in an ICU. Staff absenteeism was defined as short term sick leave between There were significant variations among individual providers. 1–28 days and averaged for each month. Disclosure of Interest: J. Huang Shareholder of: Microsensor Labs, Q. We used Student’s t-test to assess differences in HHC between base - Xu Grant/Research support from: Microsensor Labs, M. Kong Grant/ line and intervention, and Pearson correlation test to assess correla- Research support from: Microsensor Labs, Y. Liu Shareholder of: Micro- tions between HHC and staff absenteeism. Two-sided p values < 0.05 sensor Labs, P. Liu Shareholder of: Microsensor Labs, A. Jerde Grant/ were considered statically significant. Research support from: Microsensor Labs, D. Cepulis Employee of: Results: We included 100 front-line healthcare workers (doctors, Microsensor Labs. n = 31; nurses, n = 69). The average HHC at baseline was 31%. Dur- ing the intervention period, the average HHC significantly increased Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 113 of 140 Poster Session: Healthcare‑associated infections—General issues pneumonia (44/152) and bacteremia (44/152). About 55.7% of isolated bacteria were multi-resistant to antibiotics. The overall mortality was 53.7%. It was associated significantly with P246 a higher mean age (54.2 ± 11.5 vs 40.8 ± 12.9, OR 2, CI 95% 1.5–4.8; Impact of infection prevention and control precautions taken p = 0.02), nosocomial infection (OR 5, CI 95% 2.2–15; p < 0.001) and a during COVID‑19 pandemic on healthcare associated infections higher number of co-infection (≥ 2 episodes) (OR 7, CI 95% 1.3–10.8; (HAIS) 1,* 1 1 p = 0.01). M. L. Ling , M. How , M. O. Aung Conclusion: These alarming findings emphasize the urgent need of Infection Prevention & Epidemiology, Singapore General Hospital, a proper management of bacterial nosocomial infection in COVID-19 Singapore, Singapore intensive care units to prevent mortality and critical situations. Correspondence: M. L. Ling Disclosure of Interest: None declared. Antimicrobial Resistance & Infection Control 10(1): P246 Introduction: From the start of the COVID-19 pandemic, heightened P248 awareness and diligent efforts are made to ensure zero healthcare- Hospital‑acquired infections associated to COVID‑19 intensive associated COVID-19 amongst healthcare workers. Hand hygiene, care unit at a Tunisian hospital: determinants factors environment hygiene and use of appropriate personal protective 1,2,3,* 4 5 1,6 1 I. Mlouki , H. Khelij , O. Jaoued , F. Ben youssef , N. Omri , H. equipment (PPE) are emphasized and daily audits are done to ensure 7 1 8 5 5 5 Bayoudh , H. Sfar , N. Sebai , H. Nouira , M. F. Hassen , S. Atrouss , S. El compliance. 1,2,3 Mhamdi Objectives: We are interested to know if these enhanced meas- 1 Preventive and Community Medicine, University Hospital Taher Sfar ures help towards reducing healthcare associated infections (HAIs) 2 3 Mahdia, Mahdia, Community Medicine, Research laboratory “Epidemiol‑ amongst inpatients at the Singapore General Hospital, a 1750-bedded ogy Applied to Maternal and Child Health” 12SP17, Faculty of Medicine acute tertiary care hospital. 4 of Monastir, Monastir, Department of Microbiology, University Hospital Methods: We compared standardized infection ratios (SIRs) of health- 5 Taher Sfar, Intensive Care Unit, University Hospital Taher Sfar Mahdia, care-onset (HO)—MRSA bacteremia, HO-Clostridium difficile, CLABSI 6 Mahdia, Preventive and Community Medicine, Faculty of Medicine and CAUTI rates pre-COVID (Nov 2017—Dec 2019) and during COVID- 7 8 of Monastir, Monastir, Family Medicine, Department of Microbiology, 19 pandemic (Mar—Sep 2020). SIRs were computed following NHSN University Hospital Taher Sfar Mahdia, Mahdia, Tunisia methodology. Correspondence: I. Mlouki Results: SIR values were less than 1 for HO-MRSA bacteremia, HO- Antimicrobial Resistance & Infection Control 10(1): P248 Clostridium difficile, CLABSI during the peak of COVID-19 pandemic, Mar-Sep 2020 (0.38, 0.44 and 0.31 respectively). Control charts plot- Introduction: Hospital-acquired infections pose a serious challenge to ted from Nov 2017 confirmed that there was a shift in data points for healthcare workers during the COVID-19 pandemic. CLABSI from Sep 2019 – Oct 2020. However, there was no significant Objectives: We aimed at assessing associated factors to hospital- impact on the other 3 indicators. Our institution has zero healthcare acquired infection in the COVID-19 Intensive Care Unit (ICU) in the associated COVID-19 amongst staff to date. region of Mahdia (Tunisia). Conclusion: The enhanced IPC precautions instituted during COVID- Methods: We conducted a prospective study from September 2020 to 19 pandemic succeeded in sustaining decreased CLABSI rates likely February 2021 among COVID-19 patients in the ICU of the University because of increased compliance to CLABSI bundle. We have dem- Hospital Taher Sfar Mahdia from hospital admission to discharge or onstrated that enhanced infection prevention and control horizontal death. We used the “Rapid core case report form” developed by World measures viz. hand hygiene, environment hygiene help towards keep- Health Organization (WHO) for the COVID-19 data plateform. ing HAIs low in our hospital. These should continue post-pandemic as Results: A total of 114 patients were enrolled with a mean age of they are part of Standard Precautions. 61.28 ± 12.19 years and median length stay of 14 days (IQR 9–24). Disclosure of Interest: None declared. Diabetes (43.4%) and hypertension (38.6%) were the most frequent underlying diseases. Fifty-four patients (54.2%) developed nosocomial infection after a median of 7 days (IQR 4–11) of admission. Pneumonia P247 (29.8%) and bacteremia (28%) were the most common infection sites. Mortality and its etiological factors in a COVID‑19 intensive care In 34.2% of cases, infection was related to resistant bacteria (100% of unit in Tunisia multi-resistance for Acinetobacter baumanii and 90.5% for Klebsiella 1,* 1 1 1 I. Mlouki , H. Khelij , N. Sebai , M. Khedhr pneumonia). Department of Microbiology, University Hopital Taher Sfar, Mahdia, Infection was significantly associated with severe acute respiratory dis- Tunisia tress syndrome (OR 4.4, 95% CI 1.3–10.9, p = 0.018) and longer invasive Correspondence: I. Mlouki ventilation (more than 7 days) (OR 10.4, 95% CI 9.7–20.5, p < 0.001). Antimicrobial Resistance & Infection Control 10(1): P247 Conclusion: Measures to reduce Hospital-acquired infections such as implementing antimicrobial stewardship programmes are needed in Introduction: High death rates were recorded during the COVID-19 order to achieve better therapeutic outcomes. pandemic with a major negative impact worldwide. Disclosure of Interest: None declared. Objectives: We aimed at determining etiological factors of mortality among COVID-19 patients admitted in intensive care unit in the region of Mahdia (Tunisia). P249 Methods: We performed a cross sectional study between October The burden of healthcare‑associated infections in COVID‑19 2020 and February 2021 among all patients admitted in the COVID-19 patients in Trnava university hospital during first year intensive care unit of the University Hospital Taher Sfar Mahdia. We of pandemic collected data about nosocomial infection, characteristics of etiologi- 1,2,* 1 1 3 1,2 J. Prnová , Z. Škvarková , H. Straková , A. Strehárová , J. Brňová cal bacterial and fungal species and death. 1 Department of Hospital Hygiene and Epidemiology, University Hospital Results: A total of 95 patients admitted in the COVID intensive care Trnava, Centre for Microbiology and Infection Prevention, School unit were enrolled with a mean age of 60.6 ± 13.5 years. Regarding the of Health Sciences and Social Work, Trnava University, Trnava,, Trnava stay duration, we recorded a median of 16 days (IQR 9–25). University, University Hospital Trnava, Trnava, Slovakia. About 67.4% of participants had nosocomial infection with 49 patients Correspondence: J. Prnová had at least 2 different episodes of infection. The most common infec - Antimicrobial Resistance & Infection Control 10(1): P249 tion types were urinary tract infection (50/152), ventilator-associated Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 114 of 140 Introduction: The COVID-19 pandemic has brought new challenges this decrease was not statistically significant. Except for surgical site in the field of the healthcare-associated infection (HCAI) caused by infection, the rates of pneumonia/lower respiratory tract infection multidrug-resistant microorganisms. and other infections, decreased significantly compared the past year –3 Objectives: The objective of the study was to describe the burden, (p < 10 ). A 6.5-point increase was observed in the rate of urinary tract epidemiology and outcome of healthcare-associated infection in hos- infection and a 19.6-point increase in blood stream infection (BSI) dur- pitalized patients with COVID-19. ing the COVID-19 outbreak compared with the past year; however, Methods: We conducted a retrospective cohort study which included this was statistically significant only for BSI. COVID-19 positive adult (≥ 18 years) admitted between 16 March 2020 Conclusion: The results of the present study showed a reduction in and 31 March 2021 to the 638-bed University Hospital Trnava in Slova- the rate of HAIs during the COVID-19 outbreak. Therefore, HAI can kia. We analyzed epidemiological and microbiological features as well be minimized by increasing awareness, creating a positive attitude, as outcome data. The European Centers for Disease Control and Pre- improving staff hygiene behaviors, and providing facilities to comply vention definition of HCAI and statistical package R-project were used with the standards of infection control protocols. for data analysis. Disclosure of Interest: None declared. Results: Overall 1517 patients were hospitalized with COVID-19 dur- ing the study period (median age 69 years; IQR 57–78; 54.3% male). P251 A total of 330 (22.0%) HCAI were diagnosed in 220 patients (14.6%) Prevalence of health care‑associated infections with the median 9 days (IQR 4–14) upon hospital admission. Respira- during the COVID‑19 pandemic at a university hospital in Sousse. tory infection (38.8%), urogenital infection (27.9%), bloodstream infec- Tunisia 2021 1 1,2 1,2 1,2,* 1 tion (14.5%), and infection caused by Clostridioideus difficile (14.2%) W. Dhouib , S. Bhiri , A. Ben Cheikh , H. Ghali , R. Bannour , S. 1 1,2 1,2 were the most frequent. Overall 550 different microorganisms were Khefacha , H. Said Latiri , M. Ben Rejeb isolated: 64,5% gram-negative, 15.3% fungi. The most common cause Department of Prevention and Security of Care, sahloul university hospi‑ of HCAI was Klebsiella spp. (24.2%; 40.6% carbapenem producing tal, Faculty of Medicine of Sousse,, University of Sousse, Sousse,, Tunisia Klebsiella spp., KPC) and Pseudomonas aeruginosa present in 21.5% of Correspondence: H. Ghali infections (56.2% carbapenem resistant Pseudomonas aeruginosa). The Antimicrobial Resistance & Infection Control 10(1): P251 mortality of patients developing HCAI was 19.2%. In-hospital mortal- ity was significantly higher in comparison with patients without HCAI Introduction: Worldwide, Health Care-Associated infections (HCAIs) (41.1% vs. 28.6% p < 0.001). Patients who developed HCAI did have have a significant impact on morbidity, mortality and quality of life. At higher risk of the dead (OR 1.7; 95% CI 1.2–2.1; p < 0.001). the local level, the prevalence of HCAIs at Sahloul Hospital was 6.1% Conclusion: Healthcare-associated infections in COVID-19 patients in 2018, 9.5% in 2019 and 15.5% in 2020 (following the first wave of are an important cause of mortality and morbidity. We identified a COVID-19 in Tunisia). higher rate of HCAI in comparison with a reported study which can be In this particular context, we conducted our annual prevalence study. caused by a large influx of COVID-19 patients in the second wave of Objectives: The objective was to determine the prevalence of HCAIs the pandemic. at Sahloul hospital in 2021; the typology of infections as well as the Disclosure of Interest: None declared. antibiotic resistance profile. Methods: We conducted a cross-sectional study of HCAIs prevalence P250 with a single passage in March. The agreed definition of an HCAIs was Impact of the COVID‑19 outbreak on the trend any infection that occurs during a hospital stay of at least 48 h and if it of healthcare‑associated infection rate in a teaching hospital was not present at admission. All hospital departments were included of Tunisia in the survey. 1 1,* 1 2 2 2 S. Bhiri , H. Ghali , A. Ben Cheikh, W. Dhouib , R. Bannour , S. Khefacha , Results: A total of 228 patients were included in the study with a mean 1 1 H. Said Latiri , M. Ben Rejeb age of 58 years and a sex ratio of 1.15. A total of 23 HCAIs were identi- Department of prevention and security of care, Sahloul university hos‑ fied, representing a prevalence of HCAIs of 10.0%. The prevalence of pital, Faculty of Medicine of Sousse, University of Sousse, Department infected patients was particularly higher (20.0%) in intensive care units of prevention and security of care, Sahloul university hospital, Sousse, (ICU) than in other departments of the hospital. The most common Tunisia infections were urinary tract infections (31%) and bacteremia (26%). Of Correspondence: H. Ghali the 23 HCAIs identified, 20 were microbiologically documented, 23 dif- Antimicrobial Resistance & Infection Control 10(1): P250 ferent germs were isolated (the sample contained two germs in three patients,). Of these 23 isolated germs, 47% (n = 11) were Gram Nega- Introduction: The coronavirus disease 2019 (COVID-19) pandemic has tive Bacilli and 30% had a high bacterial resistance. had an enormous impact on healthcare systems globally. Although Conclusion: The 2021 prevalence does not differ from the rates usu- these efforts have understandably taken immediate priority, the ally observed in recent years (around 10%) with the exception of the impacts on traditional healthcare-associated infection (HAI) surveil- previous year 2020 (15.5%). This return to the “normal” HCAIs preva- lance and prevention efforts remain concerning. lence rate in 2021 could be explained by the increasingly rigorous Objectives: This study aimed to describe the trends of healthcare- application and adherence to standard hygiene precautions during associated infection rate at Sahloul university hospital of Sousse, Tuni- the COVID-19 pandemic. sia within the current COVID-19 outbreak. Disclosure of Interest: None declared. Methods: Since 1991, the infection control team of the prevention and security of care department has conducted annual point prevalence P252 surveys in March and early April, as part of a quality improvement Nosocomial infection: a comparative study between COVID19 program promoted by our department in Sahloul university hospital patients and other hospitalized patients in a Tunisian university for the prevention and control of HAIs. A cross-sectional design was hospital used to assess the HAI rate during and before COVID-19 outbreak in 1,* 1,2 1 1,2 1 R. Bannour , S. Bhiri , A. Ben Cheikh , H. Ghali, W. Dhouib , S. our hospital. 1 1,2 1,2 Khefacha , H. Said Latiri , M. Ben Rejeb Results: The total rate of HAIs was 10.1% in 2021 during the COVID-19 Department of Prevention and Security of Care,, Sahloul University outbreak, which was 15.5% in the past year (p = 0.06). This decrease Hospital, Faculty of Medicine of Sousse,, University of Sousse, Sousse, was observed in all of the three types of wards (surgical, intensive care Tunisia, Sousse, Tunisia and medical). However, it was only significant for intensive care units –3 Correspondence: R. Bannour (p = 0.01) and medical wards (p < 10 ). The prevalence of infected Antimicrobial Resistance & Infection Control 10(1): P252 patients decreased from 14.9% in 2020 to 9.6% in 2021. However, Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 115 of 140 Introduction: Nosocomial infections (NI) are major patient safety wasEscherichia Coli. In second position, Klebsiellapneumoniae was problems in hospitals. As patients infected by SARS-CoV-2 need pro- identified in 26.8% of cases (n = 11) followed by enterobacteriac- longed hospital stays and heavy treatments, they may be present caein 19.5% (n = 8). higher incidence of NI. Conclusion: This prevalence survey showed obviously the evolution Objectives: The aim of this study is to compare NI rates and its risk of healthcare associated infections over 10 years. It could help us factors between patients presenting COVID 19 infection and other adjust the infection control program in our hospital and implement hospitalized patients. the different strategies to prevent the increasing rate of HAIs. Methods: A point-prevalence study was conducted in Sahloul uni- Disclosure of Interest: None declared. versity hospital on March 2021 among patients hospitalized for more than 48 h. P254 Data collection was carried out through anonymous standardized Prevalence and determinants of healthcare associated infection survey record inspired from the NosoTun plug. Data extracted from in a teaching hospital in a country of North Africa medical records included diagnoses, laboratory results, microbiologi- 1,2,* 1,2 1 1,2 1 D. chebil , H. hannachi , D. ben hassine , S. chelly , E. arfaoui , L. cal data, and antibiotic use. Microbiologically-confirmed bacterial and 1,2 merzougui fungal pathogens from clinical cultures were evaluated to characterize 1 2 prevention and infection control department, kairouan, Faculty community- and NI. of medicine of Sousse, University of Sousse, SOUSSE, Tunisia Results: A total of 228 patients were included with a total prevalence Correspondence: D. chebil of NI of 10.08% (23 cases). Schematically patients presenting NI were Antimicrobial Resistance & Infection Control 10(1): P254 departed into two groups according to their COVID 19 status; the prevalence of NI among patients with COVID19 was 15.4% vs 8.9% Introduction: Healthcare Associated Infection (HAIs) are a major among other patients (p = 0.2). safety concern for both health care providers and patients. They con- Concerning risk factors; there was a significant difference between tinue to increase at an alarming rate. the two groups in term of mean age (66 vs 47 years respectively; Objectives: Aim of the study was to determine prevalence and associ- p = 0.014); medical history of diabetes (100% vs 22.2%; p = 0.01); pres- ated factors of healthcare care associated infections in the University ence of urinary catheter (100% vs 27.8%; p = 0.015); peripheral venous Hospital IbnElJazzar in Kairouan, Tunisia. catheter (100% vs 27.8%; p = 0.01) and mechanical ventilation (100% Methods: This was a cross sectional study conducted in 13 wards in VS 16.7%; p = 0.005). the Teaching HospitalIbnElJazzar in Kairouan, Tunisia in March 2020. Respiratory infection and Bacteremia were the most common sites of All patients hospitalized over 48 h were included in the study. Data infection in COVID-19 patients and the isolated microorganisms were were provided from patients’ files. Data entry and analysis was done acinetobacter; while it was sataphylococcus auerus for other patients. using SPSS version 22. Conclusion: Minimizing NI transmission remains a challenge, espe- Results: A total of 184 patients were enrolled in this study. The cially in the COVID 19 pandemic context that has placed a large bur- prevalence of healthcare acquired infections was 10.32% (19/184). den on hospitals and healthcare providers. it is crucial to deepen our The ratio of infection/infected was 1.35(19/14). Urinary tract infec- understanding transmission pathways of NI in order to implement tion was the most frequent site infection (26.3%), followed by:blood infection prevention guidelines and enhance protection of patients. stream infection, respiratory tract infection (15.7%), and surgical Disclosure of Interest: None declared. site infection(10.5%). Risk factors that were associated to healthcare associated infections were: Obesity (p = ≤ 10– ), immunodeficiency (p = 0.008), urethral catheterization (p = 0.002), central venous cath- eter (p = 0.016), peripheral venous catheter (p = 0.005), artificial ven- P253 tilation (p = 0.001), parenteral nutrition (p = 0.005), surgery (p = 0.041). Trend of healthcare associated infection’s prevalence over 10 Conclusion: The prevalence of healthcare associated infection is rela- years (2010–2020) in a teaching hospital in Tunisia 1,2 1,2 1 1,2 1 tively high. Thus, many recommended measures should be soon taken H. Hannachi , D. Chebil , D. ben hassine , S. chelly , E. arfaoui , L. 1,2,* set up a robust infection control program, describe procedures related merzougui on behalf of all the staff of prevention an infection control 1 2 to medical device handling, encourage healthcare professionals to prevention and infection control department, kairouan, Faculty respect standard and complementary hygiene measures. of medicine of Sousse, University of Sousse, SOUSSE, Tunisia Disclosure of Interest: None declared. Correspondence: L. merzougui Antimicrobial Resistance & Infection Control 10(1): P253 P255 Introduction: Healthcare associated infections (HAIs) have been Healthcare‑associated infections in a hospital in central eastern identified as a problem of public health in all over the world. In Tuni- Tunisia: particularities and prevention strategies 1 1,* 1 1 1 1 1 sia, national surveys on the prevalence of HAIs have been routinely M. Mohamed , S. Chelly , O. Ezzi , A. Asma, B. Trabelsi , M. Sahnoun , M. Njah taken place in health facilities. In our hospital, we conduct a preva- Hospital hygiene department Farhat Hached teaching hospital, Sousse, lence survey yearly as part of the prevention and control program Tunisia of HAIs. Correspondence: S. Chelly Objectives: We aimed to describe the trend of HAIs’S prevalence in Antimicrobial Resistance & Infection Control 10(1): P255 Ibn ElJazzar Hospital over 10 yearsas well as the most frequent iden- tified site infections. Introduction: Healthcare-associated infections constitute a real pub- Methods: It is a cross-sectional study of one-day prevalence with a lic health problem. To limit the damage in terms of morbidity and single pathway, including all patients who had been hospitalized for mortality, and to develop effective prevention strategies, knowledge at least 48 h. Data collection was carried out using Noso-Tun form of its extent and predisposing factors is essential. (national HAI prevalence survey). Objectives: Determine the prevalence of healthcare-associated infec- Results: over 10 years, the prevalence of HAIs ranged from 11.9% tions, identify the risk factors associated and guide prevention strategies. in 2010 to 3.19% in 2015 and then to 10.32% in 2020. The most fre- Methods: It was a cross-sectional prevalence study carried out over quent site infectionthat was found in 2010, 2012, 2013 was urinary 7 days, from December 28, 2017 to January 3, 2018 in 19 clinical tract infection with respectively the proportions of 36.7% (11/30), departments of the Farhat Hached CHU in Sousse. The definition of 31.3% (5/16)and 37.5% (3/8). Blood stream infection was the most healthcare-associated infections was that of the Centers for Disease important infection localization in 2011 (38.5%), in 2014(57.14%) Control and Prevention (CDC). Trained investigators collected data and in 2020 (22.3%). Pneumonia had the higher prevalence over from the medical file and follow-up sheets using standardized sheets. 2 years (2016 and 2017). The bacteriological analysis was performed Results: A total of 371 patients were included with an M/F sex ratio of in 60.3% of HAIs cases. In 46.3% of cases (n = 19), isolated bacteria 0.75 and a median age of 38 years. The prevalence of infected patients Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 116 of 140 was 15.9% and the number of healthcare-associated infections was P257 18%. Lung infections were the most common (22.3%). Multivariate Prevalence of healthcare‑associated infections at a Tunisian analysis showed that age ≤ 16 (OR = 3.69 [1.88–7.26]), immunosup- university hospital 1,2,3,* 1,2,3 1,2,3 1 1,2,3 pression (OR = 2.07 [1.04–4.12]), antibiotic therapy in the six months F. B. Ben Youssef , I. Mlouki , N. Omri , H. Sfar , S. El Mhamdi before admission ( OR = 2.11 [1.13–3.92]), admission by transfer Preventive and Community Medicine, University Hospital Taher Sfar, 2 3 (OR = 2.33 [1.08–5]), gastric catheterization (OR = 3.72 []), peripheral Community Medicine, Faculty of Medicine of Monastir, Research A A vascular catheterization (OR = 2.42 [1.13–5.19]) and central vascular laboratory, “Epidemiology Applied to Maternal and Child Health”, Mahdia, catheterization (OR = 4.41 [1.65–11.77]) were independent risk fac- Tunisia tors for healthcare-associated infections. Correspondence: F. B. Ben Youssef Conclusion: The epidemiological surveillance of healthcare-associ- Antimicrobial Resistance & Infection Control 10(1): P257 ated infections makes it possible, on the one hand, to orient and bet- ter target prevention programs and, on the other hand, makes it easier Introduction: The fight against Healthcare Associated Infections to evaluate control actions. Prevention can only be conceived in the (HAI) is a challenge to health care providers. The epidemiological form of comprehensive and multidisciplinary action. surveillance strategy for HAI is based on several actions such as car- Disclosure of Interest: None declared. rying out regular local prevalence surveys in hospitals. Objectives: The aim of the study was to estimate the prevalence of HAI at the University Hospital Tahar Sfar Mahdia ( Tunisia). P256 st Methods: A cross sectional study was performed from the 1 to Assessment of trends in healthcare–associated infections th the 6 of February 2021 among patients admitted for ≥ 48 h in all in a Tunisian university hospital through repeated departments of the Hospital of Tahar Sfar Mahdia.. We used a stand- point‑prevalence surveys (2012 – 2020) 1,* 1 1 2 2 2 ardised measurement tool developed by experts in the Department H. Ghali , A. Ben Cheikh , S. Bhiri, W. Dhouib , R. Bannour , S. Khefacha , 1 1 of Preventive Medicine. H. Said Latiri , M. Ben Rejeb Results: We included 128 patients (52.3% male) with a mean age of Department of Prevention and Security of Care, Sahloul university hos‑ 49.15 ± 26.01 years and extremes ranging from 2 days to 96 years. pital, Faculty of Medicine of Sousse, University of Sousse, Department Among them, 41 (32%) were infected and 61 (47.7%) were taking of Prevention and Security of Care, Sahloul university hospital, Sousse, antibiotics the day of the study. About 16.4% of patients were hos- Tunisia pitalized in intensive care units. Correspondence: H. Ghali Twenty three participants had at least one HAI, for a prevalence rate Antimicrobial Resistance & Infection Control 10(1): P256 of infected patients of 18%. A total of 33 co-infections were identified among these patients (7 Introduction: Healthcare-associated infections (HAIs) represent sub- patients with two infections each and 1 patient with 3 infections), stantial burden on health care systems in developing countries. Sur- for a prevalence of nosocomial infections of 25.7%. The most com- veillance is one of the most effective prevention methods of HAIs in mon infection sites were: urinary tract infection (33%), septicemia hospitals worldwide. (21.2%) and Respiratory infection (15.1%). Objectives: The aim of our study is to describe trends in HAIs in a Pseudomonas Aeruginosa, Escherichia coli and Acinetobacter bau- Tunisian university hospital through repeated point-prevalence sur- mannii were the most frequently responsible for nosocomial infec- veys over nine years (2012 – 2020), and to identify associated factors tions (respectively 21%, 18.7% and 18.7%) with 100% of bacterial of HAI. resistance for Acinetobacter (6/6). Methods: The current study focused on data collected from 2012 to Conclusion: The surveillance of HAI is crucial in order to measure 2020 from all departments except emergency and hemodialysis ser- the level of infectious risks, define the prevention policy to be car - vices. All types of HAIs as defined by the Centers for Disease Control ried out, and evaluate the effectiveness of this prevention policy. and Prevention (CDC) were included. Data collection was carried out Disclosure of Interest: None declared. using NosoTun plug. Patient data form was structured according to the following sections: demographic data, admission data, clinical data, antimicrobials (AM) use and HAI data. Univariate and multivari- ate logistic analysis were used to identify HAI risk factors. P258 Results: Overall, 2729 patients were observed in the nine surveys; the Point prevalence survey (PPS) of healthcare associated infections mean age was 48.3 ± 23.3 years and 57.5% were male. We identified (HCAI) in selected hospital in Malaysia 267 infected patients (9.8%) and 296 HAIs (10.8%). Pneumonia/lower 1 1,* N. F. Bakhtiar on behalf of Infection Control Unit, S. Amir Husin respiratory tract infections were the most frequent HAI (24%), followed on behalf of Infection Control Unit by urinary tract infection (20.9%). The prevalence of infected patients 1 Infection Control Unit, Ministry of Health Malaysia, Putrajaya, Malaysia increased from 10.6% in 2012 to 14.9% in 2020. However this increase Correspondence: S. Amir Husin was not statistically significant. The prevalence of HAIs increased sig- Antimicrobial Resistance & Infection Control 10(1): P258 nificantly from 12.3% to 15.5% (p = 0.003). The only decrease involved bloodstream infections (from 2 to 1%). Introduction: Surveillance on HCAI helps to determine the epidemi- Independent risk factors significantly associated with HAI were under - ological of HCAI and one of the tools to prevent HCAI. In Ministry of going surgical intervention (aOR = 1.7), the use of antibiotic treat- Health (MOH), National HCAI surveillance was conducted since 2012. ment in 6 months (aOR = 1.8), of peripheral line (aOR = 2), parenteral Objectives: The aim of this study is to determine the prevalence of HCAI, nutrition (aOR = 2.4), urinary tract within 7 days (aOR = 2.4), central the types of HCAI, the organisms causing HCAI and the risk factors asso- line (aOR = 6.3), and prosthesis (aOR = 12.8), length of stay (aOR = 3), ciated with HCAI. and the year of the survey. Young age was found as protective factor Methods: A one-day hospital wide PPS conducted over a period of (aOR = 0.98). 2 weeks in November 2019 involving 20 Ministry of Health (MOH) and 3 Conclusion: Sahloul university hospital has a long history of activities University Hospitals. The survey is based on the existing MOH guidelines aimed at risk management and infection control, based on a multi- and Center for Disease Prevention and Control (CDC)/National Health- modal and multidimensional approach which were reinforced after care Safety Network (NHSN) Surveillance Definition of HCAI and Criteria the coronavirus pandemic. for Specific Types of Infections in the Acute Care Setting and European Disclosure of Interest: None declared. Centre for Disease Prevention and Control (ECDC), PPS of HCAI and anti- biotics use in European acute care hospitals- protocol version 4.3. Stock- holm: ECDC; 2012. Results: A total of 962 HCAI cases were reported from 23 participat- ing hospitals in November 2019. The HCAI prevalence was 5.2 per 100 Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 117 of 140 admissions. The prevalence of each type of HCAI as shown in Table 1. P260 Meanwhile the prevalence of devices related HCAIs for VAP and CLABSI Risk factors of healthcare associated infections (HAIS) was 12.6% and 6.7% respectively. The most commonly found risk factors in a Tunisian hospital in 2021 1,* 1,2 1 1,2 1 in patient with HCAI were underlying diseases, prolonged hospitalisation R. Bannour , S. Bhiri , A. Ben Cheikh , H. Ghali, W. Dhouib , S. 1 1,2 1,2 and history of surgery. The top 3 antimicrobial resistance (AMR) mark- Khefacha , H. Said Latiri , M. Ben Rejeb ers isolated were Methicillin-resistant Staphylococcus aureus (MRSA), Department of Prevention and Security of Care,, Sahloul University 3rd Generation Cephalosporin Resistant Extended-spectrum beta-lac- Hospital, Faculty of Medicine of Sousse,, University of Sousse, Sousse, tamases (ESBL) producing Klebsiella pneumoniae, and 3rd Generation Tunisia, Sousse, Tunisia Cephalosporin Resistant Extended-spectrum beta-lactamases (ESBL) Correspondence: R. Bannour producing Escherichia coli. The top 3 department with highest HCAI prev- Antimicrobial Resistance & Infection Control 10(1): P260 alence were Critical Care Unit (20.0%) followed by Hematology (7.6%) and Nephrology department (7.3%). Introduction: Healthcare-associated infection (HAI) is a major public health concern. Controlling this fatal scourge should begin with con- tinuous monitoring of HAI frequency and its associated factors. Table 1: Prevalence of each type of HCAI Types of HCAI Incidence per 1000 admission Objectives: The aim of this study was to determine independent fac- Pneumonia 17.9 tors of HAI in a Tunisian university hospital in 2021. Surgical site infection (SSI) 11.3 Methods: A cross-sectional survey was conducted within the epidemi- Blood stream infection (BSI) 11.0 ological monitoring program at Sahloul University Hospital. The onset Urinary tract infection (UTI)2.0 Clinical sepsis (CS) 4.5 of infection within 48 h of hospitalization was used to define HAI. Mul- Others 4.7 tivariate analysis by a binary logistic regression step by step descend- ent was performed to assess the Independent factors of HAI. Results: Overall, 228 patients were enrolled with a median age of 53.5 years old. Among them, 22 had at least one HAI and one patient Conclusion: National surveillance of HCAI is an important component had two, giving a prevalence of infected patients of 9.6% and a preva- in infection prevention and control (IPC) program as part of the quality lence of infections of 10.08%. The prevalence of infected patients was improvement tool in reducing HCAI in healthcare facility. particularly higher (25%) in intensive care units (ICUs) than in other Disclosure of Interest: N. F. Bakhtiar Employee of: Ministry of Health departments of the hospital. Multivariate analysis of HAI gave these Malaysia, S. Amir Husin Employee of: Ministry of Health Malaysia. independent risk factors: Diabetes (OR = 3.97 [1.23 – 12.81], Central venous catheter (OR = 17.69 [2.74– 113.94], and history of prosthesis P259 during the previous year (OR = 31.84 [5.17–196.07]). Incidence and microbiological profile of healthcare‑associated Conclusion: Although aware of its limits, cross sectional study remains infections in a Tunisian surgical intensive care unit 1,* 1 1 1 1 1 a simple research design suitable for HAI monitoring, feasible in our O. Ezzi , A. Ammar, Y. Ayedi , F. Ferhi , K. Ben Jazia , M. Njah , M. 1 context of reduced resources. The prevalence HAI was 9.6%. which Mahjoub 1 drew a fairly stable trend in recent years, at around 10%. Device-asso- CHU Farhat Hached_Sousse_Tunisie, Sousse, Tunisia ciated infections, particularly in critically ill patients should be targeted Correspondence: O. Ezzi when scheduling Incidence studies and when tailoring HAI prevention Antimicrobial Resistance & Infection Control 10(1): P259 actions. Disclosure of Interest: None declared. Introduction: Healthcare-associated infections (HAIs) occurring in patients treated in an intensive care unit (ICU) are serious complications in the treatment process. Their impact implies prolonged hospital stay, P261 long-term disability, increased resistance of microorganisms to antimi- What’s the problem? How infection prevention and control teams crobials, a massive additional financial burden for health systems, high find valuable problems with healthcare‑associated infections costs for patients and their families, and excess deaths. 1,* 1 1 L. F. Irgang , F. Gama , M. Holmén on behalf of CIEL—Center Objectives: The aim of the study was to determine the incidence and for Innovation, Entrepreneurship and Learning research microbiological profile of healthcare-associated infections in a Tunisian 1 School of Business, Innovation and Sustainability, Halmstad University, surgical intensive care unit. Halmstad, Sweden Methods: A prospective cohort study was carried out in surgical ICU in a Correspondence: L. F. Irgang Tunisian university hospital. Antimicrobial Resistance & Infection Control 10(1): P261 An active surveillance method was used to detect HAIs in adult patients who spent over 48 h in a surgical ICU ward located in Central Eastern Introduction: Reducing healthcare-associated infections (HAIs) is Tunisia from January to December 2019. heavily contingent on proficient infection prevention and control Results: During the study period 84 patients were treated in the ICU, (IPC) teams, with the ability of finding valuable problems that need for more than 48 h each. Sex-Ratio was 2.43. Mean age was 50.7 years to be solved. From a Problem-Findind and Problem-Solving Per- (SD = 19.7). Median length of stay was 4 days (IQR = 2–9). spective, a valuable problem means a gap between a current and A HAIs incidence rate of 50 per 100 admissions and incidence of 44.6 per a desired situation, which in this study includes failures, deviations 1,000 patient days was observed. Among 42 HAIs reported, pathogens and opportunities for improvements in IPC practices. Once solved, could be identified for 33 HAI cases (78%). valuable problems generate superior knowledge. The main types of HAI detected in ICU patients included the following: Objectives: This study aims to understand how IPC teams find valu- Pneumonia (60%), Central Line Associated Infections (CLAI) (10%) and able problems relating to HAIs. Urinary infection (10%). Methods: We performed a multiple case study of 3 hospitals located Acinetobacter baumanii was the most common organism isolated (45%) in Brazil and Sweden that recently faced outbreaks caused by Acine- followed by Pseudomonas aeruginosa (21%) and Klebsielle pneumonia tobacter baumannii. We collected data from 3 exploratory and 13 (15%). semi-structured interviews with nurses and physicians enrolled in Conclusion: Our results highlight the importance of implementation of IPC teams. Supplementary documents were used for data triangula- active surveillance program. tion. Data was analyzed using the thematic analysis technique. In Tunisia, infection control programmes are a challenge for the future, Results: Our findings suggest an approach based on two different and their implementation requires increasing the awareness of both sets of activities for finding valuable problems: practices for HAI pre - medical staff and hospital management. vention and for HAI control. Practices for HAI prevention comprises Disclosure of Interest: None declared. routinely and elective actions whereas practices for HAI control involve ad hoc and emergent actions. The practices are organized Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 118 of 140 into problem-detection, problem-framing, and problem-formula- P262 tion activities. Improving the peritoneal dialysis program in a pediatric hospital Our study provides a framework (see Figure) to guide IPC teams’ using six sigma methodology 1 2,* 3 attention on how to find valuable problems relating to HAI pre - S. E. Rivera Molina , L. A. Madrid Rivera , C. M. Romero Quiroz , N. Rubio 4 4 vention and control, as well as the criteria on how to prioritize the Zerón, Y. V. Donaire 1 2 3 4 most important problems that need to be prioritized and solved. Infectious Diseases, Medical Student, General Doctor, IPC Nurse, Hos‑ This ultimately culminates in valuable knowledge and in high-value pital Maria Especialidades Pediátricas, Tegucigalpa, Honduras solutions to be implemented to reduce HAI occurrence. Besides, Correspondence: L. A. Madrid Rivera our approach provides a range of practices that support IPC teams Antimicrobial Resistance & Infection Control 10(1): P262 on how to timely shift from prevention to control decision-making modes. Introduction: Peritoneal dialysis (PD) improves survival in chronic kidney disease. Unfortunately there are complications associated with the use of PD catheters, 85% are of infectious origin carrying high burden of morbidity and mortality. Objectives: Describe the PD program improvement recolecting data from an active 3-year surveillance. Methods: We conducted a PD infection surveillance from 3 years to improve quality of care. An event of peritonitis was diagnosed with at least 2/3 criteria:1.Clinical signs or symptoms(cloudy effluent or abdominal pain with fever or vomiting);2.Altered peritoneal fluid cell count(after a dwell time of 2 h:WBC above 100 cells/mm3 in an uncen- trifuged sample, with at least 50% neutrophils;or any WBC count with at least 50% neutrophils if the dwell time was less than 2 h);3.Positive peritoneal fluid culture. Patient and event data were recorded and analyzed using descriptive statistics.(StataCorp. 2019. Release 16.) Results: We present results from December 1st, 2017 through December 31st, 2020 in 112 pediatric patients who required PD(13,327 catheter-days). 45 peritonitis episodes occurred in 42 individuals(42/112, 37.5%). Peritonitis rate: 1.23 infections per patient-years(ideally < 0.67). Thirty eight(84.4%)of events were healthcare-associated. The median time from catheter place- ment to the event was 28 days(1–500 days). All patients had clinical signs or symptoms of peritonitis. Peritoneal fluid cultures were positive in only 18 events (40%):61% Gram-negative(Escherichia coli and Klebsiella pneumoniae the most common),33% Gram-positive(Staphylococcus epidermidis the most common) and 1 Aspergillus spp. Thirteen events(29%)required removal and permanent transfer to hemodialysis, six(13%)died due to infection. Conclusion: Recolecting data of PD infections during this period allowed us to identify risk factors and quantify the magnitude of the problem to recognize the major issues. This supported the infection prevention and control team with to implement and improve pre- ventive measures for the PD Program. Disclosure of Interest: None declared. P263 Mortality in intensive care units: risk factors and attributable risk of healthcare associated infections, Tunisia (2018) 1 2 1 1,* 2 A. Ben Cheikh , N. Haddad , S. Bhiri , H. Ghali , S. Khefacha , H. Said 1 1 Latiri , M. Ben Rejeb Department of Prevention and Security of Care, Sahloul university hospital, Faculty of Medicine of Sousse, University of Sousse, Department of Preven‑ tion and Security of Care, Sahloul university hospital, Sousse, Tunisia Correspondence: H. Ghali Antimicrobial Resistance & Infection Control 10(1): P263 Introduction: The mortality in Intensive Care Units (ICUs) is estimated to represent one of the higher hospital mortality rates. Moreover, patients in ICUs are at a higher risk to develop Health care associated infections (HAIs) than other patients. Objectives: To determine the risk factors of mortality ICUs in Tunisia and to identify the attributable mortality of HAIs. Methods: This was a longitudinal descriptive study performed during 3 months in all ICUs of our University Hospital in Sousse, Tunisia in 2018. Conclusion: The study concludes that IPC teams that find valuable prob - All patients admitted at least 48 h during the study period were investi- lems more quickly and efficiently reduce the occurrence of HAIs and gated. HAIs were defined as infections that occurred at least 48 h after prevent outbreaks. Additionally, IPC teams that differentiate prevention admission to the ICU. Risk factors with a P-value less than 0.20 were ini- practices from control practices and know when and how to shift from tially included in the binary logistic regression model to determine the prevention to control decision-making modes obtain valuable problems independent risk factors for hospital mortality. Then, P values ≤ 0.05 were and high-value solutions in terms while consuming less resources. considered statistically significant. The adjusted Population-Risk Attribut - Disclosure of Interest: None declared. able to HAIs was calculated by the following formula: (aPAR) = [p(aOR— 1)/p(aOR -1) + 1] × 100. P: was the incidence rate of HAIs. aOR: was the adjusted Odds Ratio. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 119 of 140 Results: A total, 202 patients were enrolled in the study period. The of Microbiology, Jagiellonian University Medical College, Krakow, Poland Median age was 53 years old (IQR: 24 – 66).The Sex ratio was 1.62. Correspondence: M. Gajda The total mortality incidence was 19.3%, IC [13.9—24.7]. The inci- Antimicrobial Resistance & Infection Control 10(1): P265 95% dence rate of HAIs was 32.6%. The independent risk factors of ICU mortality were: Intubation [OR 7.54;IC (1.85 – 30.74)], Tracheotomy Introduction: Hip endoprostheses are one of the most frequently per- 95% [OR 3.01;IC (1.11- 8.78)], Dialysis [OR 31.71; IC (5.37- 187.27)] formed procedures, due to their impact on quality of life. 95% 95% and HAIs [OR 3.30;IC (1.11- 9.80)].The attributable mortality of ICU Objectives: The purpose of this study was to determine the incidence, 95% acquired HAIs was about 45% with an attributable mortality of pneu- risk factors, and clinical implications of post-discharge pneumonia monia at 7% and bloodstream infection at 26%. (PNU) after hip endoprosthesis in Polish adults. Conclusion: This study suggested that Intubation, tracheotomy, dialysis Methods: This retrospective study was conducted using the data- and HAIs are predictors of mortality in ICUs in Tunisia and that 45% of base of the National Health Fund, about 55,842 hip arthroplasties per- deaths in ICUs were attributable to HAIs. Paying attention to reduce this formed in 2017. The comparison between groups was based on the major preventable complication would only translate better outcomes. Chi-squared test or Fisher’s exact test for variables with a very small Disclosure of Interest: None declared. number of observations. The risk of PNU development was assessed in the multivariable logistic regression model. Results: ost-discharge PNU was identified in 371 patients and accounted P264 for 26.6% of all post-discharge infections, (incidence rate of 0.7%). Incredible cost of non‑acting in infection prevention and control Multivariable analysis showed a significantly higher risk of PNU in in Turkey 1,* 1 1 1 1 2 patients aged 65-and-older (OR 3.47, 95%CI 2.40–5.03), urgently E. Alp , H. O. Ari, Y. Ozatkan , E. Islek , C. H. Hekimoglu , M.‑L. McLaws 1 2 admitted (OR 3.97, 95%CI 3.16–4.98), operated in the winter (OR 1.7, Ministry of Health, Ankara, Turkey, NSW Health Department, Sydney, Australia 95%CI 1.37–2.11) and hospitalized in the intensive care unit (OR 5.88, Correspondence: E. Alp 95%CI 3.65–9.46). Preventative factors were diseases of the musculo- Antimicrobial Resistance & Infection Control 10(1): P264 skeletal system (OR 0.73, 95%CI 0.59–0.91) and post-operative reha- bilitation (both outpatient and inpatient OR 0.32, 95%CI 0.10–0.99, Introduction: The implementation of national infection prevention and OR 0.65, 95%CI 0.42–0.99, respectively). The influenza vaccine and control programme (IPC) including national surveillance system in 208 patients (0.5%) had no significant impact on the risk of PNU and multi-modal hand hygiene strategy is essential for decreasing (p = 0.708). The in-hospital case fatality rate in observed post-dis- healthcare associated infections (HAIs) and cost. charge PNU was 21.4%. Objectives: A cost modeling study to show how cost-effective the Conclusion: PNU is one of the most common postoperative infections reduction in hospital infection rates. after hip endoprosthesis, especially in the winter. Postoperative reha- Methods: The structured IPC (infection control committees, training, sur- bilitation reduces the risk of PNU. The low rate of influenza vaccination veillance, multimodal hand hygiene activities) has been put into practice is resulting in no impact on the risk of PNU. since 2006 by MoH. All these activities since 2006 significantly reduced Disclosure of Interest: None declared. HAIs in Turkey and published in the literature (Gozel et al.). We conducted an analysis to reveal the gain in health expenditures from the reduction seen in Device associated (DA)-HAIs types examined in the article. The P267 simulation study was carried out under the assumption that if the infection Implementing an oral care protocol in the hospital setting control program mentioned in the study had not been applied, the rates of to reduce non‑ventilator hospital acquired pneumonia hospital infections in 2008 would remain the same in the following years. 1,* J. Simmons As a first step, we considered the patient day’s figures between 2008 and 1 Purdue University Global, Kirkland, United States 2017 years in the intensive care units in Turkey. Next, we made a simula- Correspondence: J. Simmons tion analyze in order to obtain the number of infections expected to occur Antimicrobial Resistance & Infection Control 10(1): P267 for each year taking account the number of patient days for each year and the infection rates in 2008. In this way, we estimated the number of infec- Introduction: The interaction between main risk factors of oral micro- tions that would have occurred if the infection control program was not biota, aspiration, and patient condition has potential to create the implemented. Cost data was obtained from cost studies conducted by opportune atmosphere for hospital acquired pneumonia (HAP) to Ağırbaş et al. regarding Device associated (DA)-HAIs for hospitals in Turkey develop. Oral care is a modifiable risk factor for Non-Ventilator Hos- in 2011. The costs obtained in the relevant study were updated for each pital Acquired Pneumonia (NV-HAP). Yet oral care provision at the year by considering the inflation rates published by Turkish Statistical Insti- selected facility was inconsistent due to inaccessible or unavailable tute for the following years and used in the calculations. oral care supplies, possible low priority with nursing staff, and lack of a Results: It has been found that, due to interventions for the prevention standard oral care protocol. of hospital infections, especially in intensive care units in Turkey, between Objectives: An oral care protocol was implemented within the hospi- 2009–2017 it is estimated that a total of 3,107,192,116 TRL cost savings tal setting to reduce NV-HAP. The protocol included all inpatient adult were obtained. This corresponds to approximately 1,159,174,148 USD. units, excluding labor and delivery along with the centers for mental Conclusion: Interventions implemented to reduce hospital infections health units. have significantly reduced the costs of hospital infections and have Methods: Evaluation of the project was conduction through pre and had a decreasing effect on health expenditures in Turkey. post intervention comparison of ICD-10 codes, nursing documenta- Disclosure of Interest: None declared. tion of oral care, oral care prevalence survey, and nursing knowledge survey. Poster session: hospital‑acquired and ventilator‑associated Results: Post implementation evaluation data showed an increase in pneumonia (HAP and VAP) oral care practice based on nursing documentation, availability and use of oral care supplies. Improved understanding of providing oral care to prevent HAP, made oral care a higher priority for nursing staff. P265 While data was limited, a decrease in NV-HAP was noted the month Incidence, risk factors and clinical implications of post‑discharge following the oral care protocol implementation. pneumonia after HIP arthroplasty, a population‑based study Conclusion: Implications for practice was a change in culture. While of 55,842 patients in Poland 1,* 2 3 4 2 nursing knowledge post implementation survey showed no change M. Gajda , A. Pac , B. Gryglewska , A. Różańska , P. Gajda , J. in nursing’s understanding of the impact of oral care on the patient’s Wójkowska‑Mach 1 2 overall health, previous perceptions of oral care being a low priority Doctoral School of Medical Sciences and Health Sciences, Depart‑ task for patient comfort has changed. This is reflected by increased ment of Epidemiology, Chair of Epidemiology and Preventive Medicine, 3 4 nursing documentation of oral cares provided, increased patient 4 Department of Internal Medicine and Gerontology, Department Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 120 of 140 access and use of oral care supplies, more reported patient assistance and education, as well as knowledge of independent patient’s oral care habits during hospitalization. Oral care has become a higher pri- ority for nursing staff. Disclosure of Interest: None declared. Poster session: infection prevention and control: Implementation and patient safety P268 What will infection prevention look like in 2030—results of the first round of a global crystal ball exercise 1,* 2 1 3 4 1 H. Sax , L. Clack , S. Kuster , J. M arschall , M. Schlegel , P. W. Schreiber , A. Wolfensberger on behalf of Future IPC Collective & Swissnoso Infectious Diseases and Hospital Epidemiology, University Hospital Conclusion: The first round of the Future IPC project produced a Zurich, University of Zurich, Implementation Science In Healthcare, mainly positive picture of ICP in 2030. The project will continue with University Zurich, Zurich, Infectious Diseases, Bern University Hospital further rounds of multi-method inquiry with evolving participation and University of Bern, Bern, Cantonal Hospital St Gallen, St Gallen, (including an assessment of changes attributable to insights gained Switzerland during the SARS-CoV-2 pandemic) to serve as a roadmap for develop- Correspondence: H. Sax ing this critical field of medicine. Antimicrobial Resistance & Infection Control 10(1): P268 Disclosure of Interest: None declared. Introduction: Healthcare delivery is currently undergoing radical changes and so will the demands for effective Infection prevention in P269 healthcare (IPC). Strategies to improve infection control link nurse programs Objectives: We initiated a global collaboration among IPC profession- 1,* 2 2 1 M. Dekker , I. Jongerden , M. de Bruijne , C. Vandenbroucke‑Grauls , R. als to imagine the status of IPC in 2030 to inform the present. van Mansfeld Methods: In JAN 2019, a purposive sample of 44 IPC professionals 1 2 Department of Medical Microbiology and Infection Prevention, Depart‑ around the globe were invited to answer a 10-item online question- ment of Public and Occupational Health, Amsterdam UMC, Amsterdam, naire, including 2 demographics, 4 housekeeping and 4 open-ended Netherlands core questions: (Q1) “status of IPC in 2030”, (Q2) “position & people Correspondence: M. Dekker in charge of IPC”, (Q3) “necessary skills”, and (Q4) “open questions”. Antimicrobial Resistance & Infection Control 10(1): P269 The latter were each submitted to inductive content analysis and displayed by semi-quantitative network mapping, the remainder Introduction: Infection control link nurses (ICLN) experience various reported descriptively. barriers in daily practice. Identification of strategies to address these Results: Overall, 18 of 44 (41%) invited responded JAN-MAR 2019 (6 barriers can improve current ICLN programs and guide their future US, 2 CA, 2 CH, 1 FR, DE, MX, NL, SG, UK, each; 15 with physician, 3 with implementation. nurse, and 1 with management background; all in senior positions). Objectives: To identify strategies for effective implementation of ICLN The main emerging themes for Q1 were “multidrug-resistant organ- programs using the Consolidated Framework for Implementation isms”; “automatisation of data collection, processing & feedback” with Research (CFIR)-Expert Recommendations for Implementing Change the sub-themes ‘robotics’, ‘monitoring’, ‘surveillance’, ‘short-circuit (ERIC) Implementation Strategy Matching tool. feedback’; “system integration & broadening of IPC” with ‘patient Methods: We conducted a Delphi study. A panel of eight experts participation’; “global perspective” with ‘low/middle income country mapped 19 barriers, found in our previous studies, to the most fitting challenges’, ‘outpatient’; “behaviour”; and “implementation” (Figure). CFIR constructs. Subsequently, (dis)agreements were discussed and bar- The views were predominantly positively (66%) oriented. Q2 and Q3 riers were further clarified. The CFIR- ERIC Matching Tool generated a list yielded a broad range of professional profiles, ranging from data, of strategies to address these barriers. Outcomes were discussed with behaviour, implementation, communication know-how and skills, the panel and with end-users of these programs (e.g. ICLN and infection positioning IPC highly in healthcare institutions and beyond. Similarly, control practitioners). Q4 covered a large area including medicine, life-science, data science, Results: Seven main barriers for the implementation of a link nurse social science, organisational and political questions. program were identified (table 1). These barriers corresponded with CFIR constructs, predominantly from the domains ‘inner setting’ (char- acteristics of the implementing organization) and ‘process (stages of implementation). With the ERIC tool strategies were identified to over - come these barriers; they are listed in order of priority in Table 2. Table 1. Barriers Infection control has no priority at the hospital level The role of link nurses is not defined ICLN are not accepted by medical staff ICLN programs are initiated, developed and implemented solely by infection control practitioners Responsibility to educate link nurses lies with infection control practitioners Interconnecting link nurses from various departments to exchange experiences and best practices is challenging Only half of link nurse programs are evaluated Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 121 of 140 Table 2. ERIC Strategies Identify and prepare champions Conduct local consensus discussions Assess for readiness and identify barriers and facilitators Inform local opinion leaders Facilitate interactive problem solving Conclusion: Application of the CFIR-ERIC tool points to the identifica- P271 tion and preparation of champions for the successful implementation Eec ff t of training on knowledge regarding infection control of ICLN programs. Further strategies can be tailored to each context measures among healthcare workers in 10 selected states with the help of the identified barriers and the use of the tool. in Sudan, 2021 Disclosure of Interest: None declared. 1,* H. Azrag Infection Control Directorate, Federal Ministry of Health, Khartoum, P270 Sudan Let’s get in infection control modus! ALL the medical students Correspondence: H. Azrag in Nijmegen IPC trained and examined before starting their Antimicrobial Resistance & Infection Control 10(1): P271 clinical rotations 1,* 1 1 1 O. Coenen, M. Tingen , E. Bowles, A. Tostmann Introduction: Healthcare workers are at a high risk of infection. Medical Microbiology, dept Infection Control, Radboudumc, Nijmegen, Infection prevention and control (IPC) is a practical, evidence- Netherlands based approach preventing patients and health workers from being Correspondence: O. Coenen harmed by avoidable infections. Antimicrobial Resistance & Infection Control 10(1): P270 Objectives: This study was conducted to assess the effect of the training on the knowledge of the healthcare workers on how to Introduction: Education in infection prevention and control (IPC) protect themselves and their patients from being infected during is an indispensable part of an adequate IPC program. For medical COVID 19 pandemic in Sudan. students, IPC education should be theoretical and practical, so the Methods: During March 2021, 471 healthcare workers were selected student can provide safe patient care. from the most COVID-19 Pandemic affected States in Sudan. The Objectives: At our medical faculty, until 2019 IPC education for Knowledge of the participants was assessed before and after con- medical students consisted of three hours of teaching. Evaluations duction of training using a questionnaire consisted of two sections. with students and teachers showed that the program was not con- Section A elicited responses on demographic variables of partici- sidered challenging and the importance of IPC did not affect the pants. Section B elicited information on the participants’ knowledge student. The teachers indicated there was too little time to cover about standard precautions. A significant difference was defined the important aspects of IPC. Therefore, we developed a new and as P value < 0.05 (2-tailed). Continuous data were compared with more inspirational educational IPC program for medical students at paired t-test. Statistical analysis was performed with SPSS (Version the Radboudumc medical faculty. 21). Methods: Since 2019, medical students are educated in IPC accord- Results: The knowledge of health care workers differed significantly ing to our newly developed educational program. The program before and after the training (P = 0.01), emphasizing that the impact was developed by the IPC team, the medical education director of the training was important to improve the knowledge of partici- and several peers within the medical and educational domain. The pants. The average value of improvement of healthcare workers’ IPC education is planned in the preparatory clinical rotations mod- knowledge was about 26.5%. ule. Students must pass an exam before they can start their clinical rotations. The education program consists of: - Self-study: scientific literature, theoretical assignments and an in- house developed IPC E-learning module. - Q&A session with IPC expert. - Practical training: in small groups IPC measures are practiced in an simulated patient environment. - Individual examination: a practical exam in a realistic isolation set- ting. Students are tested on donning, doffing, hand hygiene, clean- ing and disinfection and communication. Results: The new educational program for medical students has been in place for two years now. There is a 100% attendance during the teaching activities and the students are actively involved. Feed- back shows the program reflects the daily practice and students feel confident to perform IPC measures in a clinical setting. Also Conclusion: The findings emphasized the role of the training to they realize what it means for a patient to be isolated, this empha- improve the knowledge and education of health care workers about sizes the importance of clear communication on IPC measures. standard precautions as well as prevention of infection during Conclusion: We are the only medical faculty in the Netherlands COVID 19 pandemic. Education and training which is the third core where 100% of the graduated medical students are fully IPC trained component of the IPC should be reinforced for the better health of and examined. We believe that the mandatory exam at the end of patients and medical staff, and be considered as one of the key fac - the program shows the importance of IPC in patient care. tors in any pandemic response. At this moment we are evaluating the program. Disclosure of Interest: None declared. Disclosure of Interest: None declared. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 122 of 140 P272 Methods: A cross-sectional online survey was conducted in 2019 Identification of resources to inform a new country level infection among IPC staff joining the Arab Countries Infection Control Network. prevention and wash training package The survey focused on three domains; demographic and professional 1,* 1 2 2 3 C. Kilpatrick , J. Storr , K. Smith , H. Hamilton , N. Mwenda , M. characteristics of IPC personnel, organizational structure, and IPC pro- 2 2 Narracott, A. Woodland gram characteristics. 1 2 KS Healthcare Consulting, Glasgow, WaterAid, London, United King‑ Results: A total 269 participants aged 39.9 ± 8.4 years were included dom, WaterAid, Lilongwe, Malawi in the study. The majority of participants were female (67.7%), nurses Correspondence: C. Kilpatrick (63.7%), and of Middle Eastern origin (57.3%). Only 32.2% of partici- Antimicrobial Resistance & Infection Control 10(1): P272 pants had certification board of infection control (CBIC) while 80.1% of those who did not have it planned to get it. Only 22.7% of participants Introduction: The World Health Organization (WHO) Core compo- were extremely or very satisfied with their current compensation. Sur - nents of infection prevention and control (IPC) programmes state that veillance was the most time consuming task (26.6%), followed by iso- patient care activities should be undertaken in a clean, hygienic envi- lation (12.4%), investigation of outbreaks (12.1%), and identification ronment that facilitates safe practices. This includes all elements of of infection (11.4%). The most frequent ratio of IPC personnel per bed water, sanitation and hygiene (WASH) infrastructure and services and was one per 100 beds (39.5%). The majority of facilities had enough- includes training as a component. In many low and middle income supported IPC program (63.9%), formal IPC committee (93.7%), IPC countries (LMICs), activities are both aimed at and led by WASH and plan (91.4%). Compared with non-GCC countries, GCC countries had IPC focal points. Feedback from previous trainings and anecdotal evi- significantly more frequent Asian professionals (< 0.001), nursing staff dence suggest that IPC resources are mainly clinically focused and do (p = 0.006), CBIC certification (p = 0.003), training in educational ser- not fully embrace all aspects of WASH in health care to fulfill country vices (p = 0.038) and cleaning/sterilization (p = 0.010), higher ratio of needs. IPC personnel per bed (p = 0.047), enough-supported IPC program Objectives: To identify relevant resources to inform a new country (p = 0.010), formal IPC committee (p = 0.001), and IPC plan (p = 0.001). level WASH and IPC training package as part of a Wimbledon Founda- Conclusion: The findings showed generally satisfactory IPC staff- tion funded WaterAid project in Malawi. ing and programs in the MENA region, with considerable variability Methods: A desk research exercise was undertaken through a search between countries of different resources. The findings may help policy of Google and key web portals using key words aimed at capturing makers in improving IPC staffing and programs. freely available international, regional and country level resources. Cri- Disclosure of Interest: None declared. teria were established to categorise the resources which were finally listed as guidance (G), training (T), assessment (A) or implementa- P274 tion (I) and noted for their focus on LMICs and if they had undergone Prevention and infection control for short‑term volunteers testing/evalution. of a non‑governmental organization in a developing country Results: In total, 66 resources were found, 33 categorised as training, 1,* 1 1 1 J. Barrio Cortes , C. Rojas Muñoz , M. Á. Acosta Benito , Á. Hidalgo Baz , primarily focused on IPC. A WHO WASH in health care facilities training 1 1 1 Á. Vicario Merino , M. T. Beca Martínez , M. Ruiz López package was reviewed, however, the cross over with IPC was noted as Camilo José Cela University, Madrid, Spain being limited. A number of relevant international and national guide- Correspondence: J. Barrio Cortes lines were also identifed, that present the evidence base for informing Antimicrobial Resistance & Infection Control 10(1): P274 training materials. Similarly, assessment and implementation materials exist, though most often not combined as IPC/WASH but presented Introduction: Short-term volunteers are susceptible to a wide spec- as separate documents. Still they provide content to inform training trum of morbidities, mostly infectious diseases preventable with gen- materials on the aspect of monitoring. eral hygiene and preventive measures. Conclusion: A range of training materials are freely available. How- Objectives: This study aims to describe the pre-travel consultation ever the majority of these are focused on IPC and aimed at frontline, and pre-travel health education received by European short-term clinical improvements and do not fully embarace associated aspects volunteers for preventing infectious diseases and to identify the infec- of WASH. The need for a new practical resource to engage WASH focal tions that they encountered during their one month stay with a non- points appropriately in IPC is deemed necessary to address country governmental organization (NGO) in Cambodia. needs. Methods: A cross-sectional descriptive observational study was con- Disclosure of Interest: None declared. ducted on short-term volunteers who collaborated with an NGO in Cambodia during August 2018. The informed consent and the soci- P273 odemographic, clinical and health prevention related questionnaire Infection prevention and control staffing and programs in Middle data were filled in by 198 volunteers before the travel. The health Eastern countries problems they encountered were registered in a local health clinic by 1,* 2 2 3 1 E. Tannous , A. El‑Saed , K. Ameer , A. Khalaf , S. Mohammad , B. healthcare professionals (doctors and nurses). Univariate and bivariate 4 2 2 Molaeb , F. Othman , M. Alshamrani analyses were performed. Infection control, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Results: The volunteers average age was 24.2 years (SD = 7.6), 64% Emirates, Infection control, King Abdulaziz Medical City, Riyadh, Saudi were women, 60.1% were Spanish, 35.4% French and the remaining Arabia, Infection control, Sheikh Khalifa Medical City, Abu Dhabi, United 4.5% of other nationalities such as British, German, Belgian, Dutch or Arab Emirates, Infection control, Al‑Moosa Specialist Hospital, Al‑Ahsa, Italian. Some 18.2% had allergies, 8.6% had pre-existing health con- Saudi Arabia ditions and 10.6% were under regular treatment. 77.3% visited the Correspondence: E. Tannous pre-travel consultation clinic, 21.7% took malaria prophylaxis, 92.4% Antimicrobial Resistance & Infection Control 10(1): P273 received vaccination against hepatitis A, 82.3% against typhoid fever vaccination, 82.3% against typhoid, 57.1% against tetravalent menin- Introduction: Infection prevention and control (IPC) programs are gitis; 38.4% against rabies; 36.4% against Japanese encephalitis and well-established in North American and the European countries. On 6.6% against cholera. A total of 39.9% completed a specific pre-travel the other hand, these programs are still evolving in the Middle Eastern health course. Medical assistance was sought by 112 (57.3%) volun- and North African (MENA) countries. Gulf Cooperation Council (GCC) teers. The most prevalent infections were upper respiratory infections states have much better financial resources than the rest of MENA (19%), diarrhoea (12.5%) and skin infections (10.4%). countries. Conclusion: Short-term volunteers experienced a high prevalence Objectives: To characterize IPC personnel and programs in MENA of infections during their stay in Cambodia but most of them were countries, with special emphasis on the differences between GCC and mild, preventable and were quickly resolved. Pre-travel consultation non-GCC hospitals. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 123 of 140 and specific pre-travel health training seemed to increase prevention Introduction: Improvement requires commitment from healthcare measures and disease awareness. professionals and continuous evaluation, but at the beginning it is Disclosure of Interest: None declared. necessary to is necessary to carry out an inventory of their practices in order to determine the priority points to be improved. Objectives: is to compare the level of the learning organization and continuous improvement as a part of the patient safety culture among P276 doctors and paramedical staff at the maternity services of public Identification and implementation of infection prevention health structures in the region of Sousse (Tunisia). and control (IPC) priorities in health care (HC) facilities Methods: It was an analytical cross-sectional study carried out in in in post‑disaster contexts in low‑ and middle‑income countries the region of Sousse in 2017 from 1/15/2017 to 03/15/2017, among (LMIC) health professionals, all categories combined (medical and paramedi- 1,* 2 2 J. K. R. E. Letsch , F. Mattner , D. Peter cal), working in structures of public health specializing in gyneco- 1 2 Orthopaedic surgery, Vivantes Klinikum Spandau, Berlin, Institute obstetrics (central and peripheral maternity hospitals). The study was of Hospital Hygiene, Kliniken Köln, Lehrstuhl für Hygiene und Umwelt‑ conducted using a questionnaire specially designed for the purposes medizin, Witten/Herdecke University, Germany of this work. Correspondence: J. K. R. E. Letsch Results: The overall score for this concept was 73.11%. The distribu- Antimicrobial Resistance & Infection Control 10(1): P276 tion of responses showed that 83.4% of respondents “judged that the implementation of a process to assess the degree of satisfaction of Introduction: Natural disasters are often associated with an increased patients on discharge from maternity could improve safety of care”. incidence of infectious diseases (ID), especially if population displace- On the other hand, 85.7% of respondents said that “practice of simula- ment occurs (1). tion exercises contributed to improve the quality of care”. All the items Objectives: To identify HC-based IPC priorities implemented in post- were perceived more by doctors compared to paramedics. However, disaster contexts in LMIC. this difference was only significant for the item "In our department, Methods: Scoping review (2): Database search using defined search errors led to positive changes: implementation of procedures" (82.6% terms, followed by a review of citation indices of the included articles. versus 59.3%; p = 0.029). Only peer-reviewed full text articles published in English between Conclusion: It is essential to operationalize an integrated approach 2000–2020 were included. to improve the patient safety culture. The prospects are to develop Results: 12 studies were included in the final analysis. The following this type of study in other health establishments in order to better IPC priorities were identified: understand the level of development of this concept with the aim of 1. ID Surveillance (outbreak detection) at HC facility level and timely a better adjustment and standardization of our policies and action reporting of data to guide IPC interventions. strategies. 2. Monitoring of compliance with IPC measures at HC facility level. Disclosure of Interest: None declared 3. Implement screening of outpatients for signs of ID. 4. Avoid crowding of HC facilities by referring inpatients to other facilities. 5. Use of hand- and surface disinfection and appropriate personal pro- P278 tective equipment. Impact of education intervention on knowledge of infection 6. Safe waste- and water management. control practices among healthcare providers during COVID‑19 7. Dead body management. pandemic 1,* 1 1 In none of the studies it was described how IPC measures were imple-I. Khanum , K. Habib , B. Jamil mented nor was their effect on the incidence of ID evaluated. Aga Khan University Hospital, Karachi, Pakistan, Pakistan Conclusion: The identified post-disaster IPC priorities can be found in Correspondence: I. khanum the WHO core components of IPC in HC facilities, except 8. (3). While Antimicrobial Resistance & Infection Control 10(1): P278 the benefit of IPC in post-disaster contexts has been clearly stated, future research is needed to examine the effect of IPC priorities on the Introduction: Healthcare workers (HCWs) are at an increased risk of disaster related incidence of ID and how IPC can be successfully imple- exposure to SARS-CoV-2 infection. There is a need for urgent interven- mented in a post-disaster context. tion to incease knowledge and practices related to infection preven- tion and control (IPC) during the current pandemic. References: Objectives: The objectives of the current study are to assess knowl- 1. Kouadio IK et al. Infectious diseases following natural disasters: prevention edge, attitude and practices among HCWs regarding IPC practices and control measures. Expert Rev Anti Infect Ther. 2012 Jan;10(1):95‑104. related to COVID-19 and whether training session can be used as an https:// doi. org/ 10. 1586/ eri. 11. 155. PMID: 22149618. effective educational tool to improve knowledge. 2. Tricco, AC et al. PRISMA extension for scoping reviews (PRISMA‑ScR): check ‑ Methods: This cross sectional study was conducted among HCWs list and explanation. Ann Intern Med. 2018,169(7):467‑473. https:// doi. from Sindh. After assessment of baseline knowledge, attitude and org/ 10. 7326/ M18‑ 0850. practices via pre test, a virtual session on COVID-19 IPC practices was 3. Guidelines on core components of infection prevention and control conducted, which was followed by post test. programmes at the national and acute health care facility level. Geneva: Results: Among 240 participant, 141 (59%) were frontline workers World Health Organization; 2016. Licence: CC BY‑NC‑SA 3.0 IGO. dealing with patients with COVID-19. Only 76 (31%) had previous training on IPC before pandemic and even during pandemic, few Disclosure of Interest: None declared (n=95, 40%) had attended a training workshop. Majority (70.4%) of participants were working in a facility with an established IPC depart- ment. There was an overall statistically significant improvement in P277 knowledge before and after the education workshop (p value < 0.01). Learning organization and continuous improvement The majority of HCWs believed that poor compliance with personal 1 1 1,* 1 1 1 M. Mahjoub, B. Trabelsi , C. Souhir , O. Ezzi , A. Asma , A. Abbadi , M. protective equipment (PPE) was due to hot climate, interference with Njah daily work, increased workload and long working hours. The knowl- Hospital hygiene department, Farhat Hached teaching hospital, Sousse, edge and reported compliance of hand hygiene were good among Tunisia majority of participants ( > 90% ). A large number of HCWs (88%) carry Correspondence: C. Souhir hand sanitizers all the time and frequently clean their belongings dur- Antimicrobial Resistance & Infection Control 10(1): P277 ing current pandemic. Although 75% of HCWs believed that PPE can Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 124 of 140 protect them from contracting infections, a poor compliance of wear- P280 ing PPE was reported while dealing with patients with COVID-19. Safe PPE: user needs for an interactive ppe training tool 1,* 2 2 2 3 3 Conclusion: Frequent awareness sessions can help in improving knowl-G. Lacey , J. Cahill , A. Kay, V. Howard , R. Harte , F. O’Reilly , E. 4,5 4,5 6 6 7 edge related to infection control and practices among HCWs. Ziampra , F. Fitzpatrick , B. Mulcahy , S. George , R. Nolan 1 2 3 Disclosure of Interest: None declared Computer Science and Statistics, Psychology, Learnovate, Trinity Col‑ 4 5 lege Dublin, Royal College of Surgeons, Beaumont Hospital, Dublin, 6 7 Bon Secours Hospital, Cork, Tallaght University Hospital, Dublin, Ireland P279 Correspondence: G. Lacey Applying the who twinning partnerships for improvement (TPI) Antimicrobial Resistance & Infection Control 10(1): P280 6‑step model to drive infection prevention and control (IPC) during the COVID‑19 pandemic: setting objectives and delivering Introduction: Staff competency and access to PPE training became activities to achieve outcomes during crisis 1,* 2 3 3 critical early in the COVID 19 pandemic. This placed demands on infec- cM. Bingham , J. Storr , K. Aparicio Reyes , S. Syed 1 2 tion prevention & control staff when already busy with COVID-19-re - Independent Consultant, Denver, United States, Independent Consult‑ lated tasks. ant, London, United Kingdom, Integrated Health Services, WHO, Geneva, Objectives: To be prepared for the next pandemic, we investigated Switzerland the role of mindfullness and technology in PPE training. Correspondence: I. khanum Methods: Human factors research involving three clinical sites Antimicrobial Resistance & Infection Control 10(1): P279 (N = 174) consiting of interviews, workshops and participatory co- design sessions. This was extended by interviews with 14 IPC experts Introduction: Implementation of a validated twinning partnership from 7 sites in UK and USA. approach with clear objectives while maintaining flexibility of inputs and Results: Existing PPE & HH Training: activities during a pandemic, can yield improvements in IPC as a corner- - Addressed the lived experience of using PPE stone of quality of care. - Variety of training formats e.g. classroom (15%) and in-unit training Objectives: To apply the World Health Organisation (WHO) TPI 6-step (85%) model to guide twinning partners through a systematic process to drive - One (1/10) site assessed PPE competency quality of care in health settings. - Four (4/10) sites used a Virtual Learning Environment to track the Methods: A partnership between Macau Health Bureau and Timor-Leste learner journey Cabinet of Quality Assurance in Health was initiated, guided by WHO’s - One (1/10) site used a mobile phone based training TPI objectives and 6-step model. The 2-year TPI included partnership for- Performance Shaping Factors: mation, a situational analysis, co-developing a quality improvement (QI) - Training, Fatigue, Distraction, Rushing, Stress, etc. action plan, joint implementation of action and bi-directional learning. - Changing types of PPE with different quality and fit IPC at the national, subnational and facility level was as prioritized by the - Changing PPE guidelines as IPC knowledge evolved partnership. Three Timor-Leste facilities were chosen for IPC improve- Emerging Mobile Learning App Concept & Requirements: ments. The WHO IPC assessment framework at the facility level (IPCAF) - All trainers expressed concerns of low engagement with phone- was used to gather data at baseline and at intervals over the 2-year TPI. based training Results: Based on the IPCAF results, the action plan focused on 4 areas: - Online and in-person training must be consistent 1) establishing IPC team in each of the facilities; 2) training and capacity - Assessment should be carried out on-site, with special-purpose building in standard precautions; 3) facility infrastructure improvements equipment (including water sanitation and hygiene); and 4) hand hygiene advocacy. - PPE and Hand Hygiene training should incorporate self-care & The structured TPI methodology and direct partner support resulted in mindfulness clean water being consistently available at the 3 facilities and capacity - Scenario-based training needed to support different clinical roles building in standard precautions, transmission-based precautions and and needs PPE. COVID-19 realities required adaptation and re-scheduled infrastruc- - Customise training to local guidelines ture and training activities. Conclusion: Mindfulness is a protective factor for effective and safe performance. Organisations should consider integrating wellness into IPC training. Technology can support in-person training but it is not a replacement and must be available 24–7. A variety of training access pathways are good but the Learner Journey should be tracked to ensure everyone is trained and skills are maintained over time Disclosure of Interest: G. Lacey Consultant for: surewash, J. Cahill: None declared, A. Kay: None declared, V. Howard: None declared, R. Harte: None declared, F. O’Reilly: None declared, E. Ziampra: None declared, F. Fitzpatrick: None declared, B. Mulcahy: None declared, S. George: None declared, R. Nolan: None declared P281 Frequency and reporting of adverse events: dimension of patient safety culture 1 1,* 1 1 1 1 Conclusion: Implementation of the partnership plan using the struc- M. Mahjoub , S. Chelly , O. Ezzi , A. Asma, B. Trabelsi , A. Abbadi , M. tured TPI approach catalyzed IPC improvements at the three facilities Njah and beyond. Although COVID-19 required adjustment of activities, a Hospital hygiene department Farhat Hached teaching hospital, Sousse, robust QI plan supported innovation, flexibility and commitment. Les- Tunisia sons from the experience can be applied to other twinning partnerships. Correspondence: S. Chelly Disclosure of Interest: None declared Antimicrobial Resistance & Infection Control 10(1): P281 Introduction: Adverse events represent not only a problem of safety and quality of care for patients, but also an economic problem which their financial consequences were considerable. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 125 of 140 Objectives: to measure and analyze the degree of development of the Introduction: Patient’s safety culture reflects the perceptions of norms, concept "Frequency and reporting of adverse events" relating to the of processes, and attitudes relating to a culture of preventable errors. patient safety culture of healthcare professionals. Objectives: To measure and assess the level of development of the con- Methods: A cross-sectional study was carried out in 2017 using a vali- cept of "global perception of patient safety" relating to the patient safety dated questionnaire among all health professionals in the five public culture among health professionals working in the maternity sector in health structures specializing in gyneco-obstetrics in the governorate public health structures in Sousse. of Sousse (Tunisia) (N = 251 and 217 respondents). Methods: A cross-sectional study was carried out in 2017 using a vali- Results: The overall score for frequency and reporting of adverse dated questionnaire among all health professionals in five public health events was 69.7%. The distribution of the different items in this dimen- structures specializing in gyneco-obstetrics in the governorate of Sousse sion showed that 83.4% of respondents felt obliged to report errors (Tunisia) (N = 251 of which 217 responded). that have consequences on patients to their hierarchical superiors, Results: The overall score for the overall perception of patient safety was on the other hand only 65.9% felt required to report an error that 44.1%. Analysis of the responses to the different items showed that only occurs and is corrected before affecting the patient. All the items in 37.3% of respondents admitted that they had no problems related to the this dimension were perceived without significant difference between safety of care in their department. But when there is an antenatal death physicians and paramedics. or a complication in the delivery, 79.3% of respondents said they felt Conclusion: The establishment of a surveillance system for adverse this event could have been avoided. Among all the items, there was not events is a central link in any policy to improve the quality and safety a significant difference between physicians and paramedics except the of care in health establishments, which must involve all staff (workers, item "the competent physician does not make errors that could harm technicians, nurses, doctors…). the patient" which was significantly more perceived among paramedics Disclosure of Interest: None declared than physicians. (35.6% versus 8.7%; p = 0.009). Conclusion: The risk of error in therapeutic choices and in care exists despite the fact that the doctors are highly qualified and competent, P282 which confirms that the error is human and that "zero risk" does not exist. Healthcare worker–patient relationship and patient safety culture 1 1 1,* 1 1 1 1 Disclosure of Interest: None declared M. Mahjoub, B. Trabelsi , S. Chelly , O. Ezzi , A. Asma , A. Abbadi , M. Njah Hospital hygiene department, Farhat Hached teaching hospital, Sousse, Tunisia P284 Correspondence: S. Chelly Patient safety culture based on teamwork and human resources Antimicrobial Resistance & Infection Control 10(1): P282 of healthcare professionals in the maternity services in Sousse (Tunisia) 1 1,* 1 1 1 1 Introduction: A good relationship between healthcare worker and M. Mahjoub , S. Chelly , O. Ezzi , A. Asma, B. Trabelsi , A. Abbadi , M. patient is a main link of the care safety. Njah Objectives: Measure the level of healthcare provider relationship Hospital hygiene department Farhat Hached teaching hospital, Sousse, within the framework of healthcare safety culture with health profes- Tunisia sionals practicing in our establishment. Correspondence: S. Chelly Methods: It was a cross-sectional descriptive study, carried out in Antimicrobial Resistance & Infection Control 10(1): P284 2017 for two months, of interest to all health professionals (medical and paramedical (nurse, midwife and senior technician)) working in Introduction: An effective teamwork is essential for patient safety public health structures specializing in gyneco-obstetrics in the region in the context of a complex healthcare system, it minimizes adverse of Sousse (Tunisia). events caused by miscommunication. Results: The overall score for this concept was 66.8%. The distribu- Objectives: is to measure and analyze the level of development of tion of responses for the different items of this dimension showed teamwork and human resources concept of patient safety culture that 82.9% of the respondents found that “adverse events could affect among healthcare professional. the trust relationship between doctor and patient”. However, only Methods: An analytical cross-sectional study was carried out in 2017 37.3% of all healthcare professionals believed that “patient should using a validated questionnaire among all health professionals in five be informed of the fault as soon as it is committed and of the conse- public health structures specializing in gyneco-obstetrics in the gover- quences that may”. On the other hand, 66.8% of respondents said that norate of Sousse (Tunisia) (N = 251 of which 217 responded). “traditional medicine practices are an obstacle to improving the safety Results: The overall score for "teamwork in the department" was 64.4%. of care”. The doctors reported significantly more than the paramed- Analysis of the responses to the different items showed that a difference ics, the fact that “patient must be informed of the fault as soon as it is in favour of physicians was raised; 65% said they were ready to combine committed and of the consequences that may”, “the patient has a role their efforts as a team when the workload is heavy (62.4% versus 37%; to play in improving safety”, and finally, traditional medicine practices p = 0.019), 66.8% thought that everyone considers others with respect can constitute an obstacle to improving the safety of care” respec- (64.4% versus 37%; p = 0.03) and 6.8% thought that more experienced tively (60.9% versus 34.5%; p = 0.014), (100% versus 82.5%; p = 0.029) staff will be available on the first call if the situation requires their pres- and (87% versus 65.4%; p = 0.03). ence (95.7% versus 63.4%; p = 0.002). The overall score for “Teamwork Conclusion: Our study allowed us to obtain an inventory and a global between services in the facility” was 59.9%. Doctors have affirmed sig- vision of the perception of healthcare professionals relating to patient nificantly more than paramedics that when transferring a patient to safety and to identify gaps. This concept is a central link in the patient another service we provide all the results of imaging or biology exams safety culture and an inseparable pillar of the strategy for improving the that have been performed, in addition to the fact that the services of the quality and safety of care within a healthcare establishment. institution did not coordinate well with each other (respectively 95.7% Disclosure of Interest: None declared versus 61.3%; p = 0.001 and 87% versus 64.4%; p = 0.03). The overall “Human Resources” score was 65.65%. Among its items; 45.6% believed that they had enough staff to cope with the workload and 85.7% said P283 that too long working hours could have consequences for patient safety Overall perception of patients’ safety among health professionals (100% of doctors against 84% of paramedics (p = 0.0038)). working in the maternity sector in public health structures Conclusion: Teamwork as well as having sufficient staff is one of the in Sousse (Tunisia) 1 1,* 1 1 1 1 factors influencing the quality of care, the evaluation of health care M. Mahjoub , S. Chelly , O. Ezzi , A. Asma, B. Trabelsi , A. Abbadi , M. providers and the satisfaction of patients. Thus, professionals who Njah shared information have a marked improvement in the efficiency of Hospital hygiene department Farhat Hached teaching hospital, Sousse, Tunisia the work unit. Correspondence: S. Chelly Disclosure of Interest: None declared Antimicrobial Resistance & Infection Control 10(1): P283 Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 126 of 140 P285 country-level HCV prevalence or the Healthcare Access and Quality Culture of patient safety based on non‑punitive response to error (HAQ) index was assessed in meta-regressions. and freedom of expression of healthcare professionals Results: A total of 73 studies were included in the analysis. The most 1 1 1,* 1 1 1 M. Mahjoub, B. Trabelsi , S. Chelly , O. Ezzi , A. Asma , A. Abbadi , M. evaluated procedures were blood transfusion and surgery (49 and 34 Njah studies). The pooled OR associated with HCV infection was highest Hospital hygiene department, Farhat Hached teaching hospital, Sousse, for haemodialysis (6.48, 95%CI: 0.43–97.7) and lowest for endoscopy Tunisia (1.44, 0.98–2.11). The OR for blood transfusion was higher for transfu- Correspondence: S. Chelly sions performed before 1996 (3.84, 2.46–6.00) than for those without a Antimicrobial Resistance & Infection Control 10(1): P285 specified date (2.38, 1.88–3.01). Finally, there was no significant asso - ciation between the HAQ index and the country-level overall risk for Introduction: Freedom of expression and the non-punitive response all procedures, but a significant one was found for HCV prevalence. In to error is a central concept of culture of patient safety among health- procedure-specific analyses, the HCV infection risk was significantly care professionals since it reflects the climate and general atmosphere negatively associated with the HAQ for endoscopy and positively of the professional environment. associated with HCV prevalence for endoscopy and surgery. Objectives: Measure and analyze the degree of development of the Conclusion: Many iatrogenic procedures were found to be related to concept Freedom of expression and non-punitive response to error in the risk of HCV infection. However, care must be taken to interpret the the culture of patient safety. results because of: i) limited number of studies for some procedures, Methods: This is an analytical cross-sectional study carried out in 2017 leading to uncertainty in the estimates; ii) lack of adjustment on con- over two months (from 1/15/2017 to 03/15/2017) among health pro- founding factors in some studies; and iii) heterogeneity in the way the fessionals, all categories combined (medical and paramedical), work- exposure has been assessed across studies. ing in structures of public health specializing in gyneco-obstetrics Disclosure of Interest: None declared (central and peripheral maternity hospitals) in the region of Sousse (Tunisia). The study was conducted using a questionnaire specially P287 designed for the purposes of this work. Knowledge, attitude and practice regarding hepatitis prevention Results: The overall score was 43.2%. The distribution of responses among medical professionals of Banfora (Burkina Faso) 1,* 1 1 2 showed that 40.1% of respondents said that, in the services, they dis- K. C. C. Sawadogo , I. F. BAKO , B. BAGUE , M. S. HIEN cussed the means to be put in place in order to avoid repeating the Health science department, Joseph KI‑ZERBO University, Ouagadougou, mistakes made. Only 30.4% of respondents said they perceive staff Day hospital, Regional hospital of Banfora, Banfora, Burkina Faso to feel free to argue the decisions or actions of their superiors. A sig- Correspondence: K. C. C. Sawadogo nificant difference was noted in favor of physicians for item “the staff Antimicrobial Resistance & Infection Control 10(1): P287 express themselves freely if they see something in the care that can have negative consequences on the patients” (78.3% versus 50.5%; Introduction: Knowledge of hepatitis seem to be insuffisant in the p = 0.012). On the other hand, there were significant differences in hospital of Banfora. It can negatively impact the quality of care in this favor of paramedics for items “in the departments, we discuss the hospital. This is why we conducted the study to evaluate the knowl- means to put in place so that errors no longer occur”, "Staff feel free edge, attitude and practice regarding hepatitis prevention among to discuss the decisions or actions of their superiors" and "staff are medical professionals of Banfora. afraid of asking questions when something does not seem to be cor- Objectives: The main objective is to evaluate the kwoledge, attitude rect” respectively (42.8% versus 17.4%; p = 0.019), (33% versus 3.7%; and practice regarding hepatitis prevention among medical profes- p = 0.017) and (48.5% versus 21.7%; p = 0.015). sionals of Banfora. Conclusion: This concept has generally been shown to be underde- The secondary objectives are: veloped in our establishment. We must learn to analyze our mistakes, 1. To determine socio-demographic caracteristics of the study to improve our procedures and our protocols, to better manage and population govern our systems, to improve our communication, information and 2. To determine the proportion of population which did training on awareness policies. hepatitis prevention Disclosure of Interest: None declared 3. To determine the proportion of population who got hepatitis B immunization P286 Methods: This was a descriptive cross-sectional study that took place Risk of HCV infection associated with different hospital‑based from November 19 to December 18, 2018, at the Banfora Regional invasive procedures: a systematic review and meta‑analysis Hospital Center. The study covered all categories of health profession- 1,* 2 3,4 1,4 1,4 P. Henriot , M. Castry, Y. Shimakawa , K. Jean, L. Temime als likely to be victims of hepatitis exposure accident. A self-question- 1 2 MESuRS Laboratory, Conservatoire national des arts & métiers, INSERM, naire on the subject was given to health professionals. 3 4 IAME, Emerging Disease Epidemilogy Unit, Institut Pasteur, PACRI Unit, Results: The questionnaire was completed by 202 health profes- Institut Pasteur‑CNAM, Paris, France sionals, representing a 68% completion rate. The average age of the Correspondence: P. Henriot health workers was 38.67 years. Nurses predominated with 62.81% of Antimicrobial Resistance & Infection Control 10(1): P286 the sample, followed by hospital hygiene technicians (11.06%). Health care workers who had ever had an hepatitis exposure accident rep- Introduction: Healthcare settings may play an important role in the resented 39.80% of our sample. Midwives were the most affected by transmission dynamics of blood-borne pathogens when invasive pro- hepatitis exposure accident with 64.29%. Only 35.86% of patients had cedures are performed while compliance with infection control pre- received training on hepatitis exposure accident during their profes- cautions remains imperfect. sional career. Non-reporting of hepatitis exposure accident was mainly Objectives: This study aims at summarizing the evidence on the risks due to personal negligence. The majority of caregivers stated that the of hepatitis C virus (HCV) infection across hospital-based invasive hepatitis B virus had the highest infectious potential. In our study, 98% procedures and understanding the role of these procedures in HCV of our sample had been vaccinated against hepatitis B and 61% had transmission. received at least 3 doses. A total of 86.94% of the health care workers Methods: We conducted a systematic review and meta-analysis to were aware of the precautions for hepatitis exposure accident. identify recent studies reporting association measures of HCV infec- Conclusion: Knowledge of hepatitis exposure accident needs to be tion risk that are linked to iatrogenic procedures performed in hos- improved given the high number of healthcare professionals who pital settings. Invasive procedures were categorized into 10 groups have already been victims. Continuing education is therefore needed based on an expert opinion for which pooled measures were cal- to increase hepatitis prevention. culated. Finally, the relationship between pooled measures and the Disclosure of Interest: None declared Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 127 of 140 P288 they respected the functional autonomy of the patient. Respondents Comparison of perceptions of well‑treatment between medical declared, in more than two third of cases, that patient information and paramedical staff in a teaching hospital in SousseT ‑ unisia is organized in the same way as the collection of the trusted person. 1 1,* 1 1 1 1 M. Mahjoub , S. Chelly , O. Ezzi , A. Asma, B. Trabelsi , M. Besbes , M. Only one percent of respondents said that regular information is pro- Njah vided to the patient on his condition throughout his care. Hospital hygiene department, Farhat Hached teaching hospital, Sousse, Conclusion: Therefore, it is necessary to integrate into the Farhat Hached Tunisia hospital project a prioritization of well-treatment among the primary Correspondence: S. Chelly concerns of the institution requiring immediate support, which implies Antimicrobial Resistance & Infection Control 10(1): P288 the mobilization of all institutional actors and that of professionals. Disclosure of Interest: None declared Introduction: The promotion of well-treatment and its corollary the prevention of mistreatment are currently major issues for health Poster Session: Nosocomial COVID‑19 outbreaks systems. Objectives: To compare the perceptions of well-treatment among the P290 different categories of health professionals. Risk factors of nosocomial COVID‑19 at Grenoble Alpes university Methods: This is a cross-sectional descriptive study carried out over a hospital period of four months (from May 1, 2018 to August 31, 2018) among 1,* 1,2 1 1 2 1,3 C. Dinh , M. Gallouche, H. Terrisse , K. Gam , C. Giner , J. Giai , J.‑L. health professionals of all categories working in the 19 care services of 1,3 1 1,2 Bosson , S. Lambert‑Lacroix , C. Landelle the Farhat Hached hospital in Sousse (Tunisia). Our study was carried 1 2 3 Grenoble Alpes/CNRS University, Hospital Hygiene Service, Public out using a questionnaire inspired by the Health authority of health health department, CHU Grenoble Alpes, Grenoble, France (HAS). Correspondence: C. Dinh Results: During treatment, significant differences in favor of medical Antimicrobial Resistance & Infection Control 10(1): P290 staff are reported for the adaptation of the words and actions to the patient’s condition, communication and medical data information Introduction: During the COVID-19 pandemic, hospitals implemented respectively 88.7% versus 71%; p < 0.001, 68.7% versus 54%; p = 0.006 infection prevention strategies to reduce nosocomial transmission. and 94% versus 81%; p < 0.001. On the other hand, significant differ - Nevertheless, these strategies sometimes failed and determination of ence in favor of paramedical staff for the items "be careful not to make risk factors of transmission is crucial. noise" (94% versus 86%; p = 0.011), knock on the door and wait before Objectives: Our main objective was to determine the risk factors of entering the patient’s room (66.5% versus 54.7%; p = 0.024) and nosocomial Covid-19 at Grenoble Alpes University hospital (CHUGA). pay attention to non-verbal communications (93.5% versus 86.7%; Methods: A case–control study was conducted at CHUGA. A retro- p = 0.03). In the service, significant differences in favor of the para- spective data collection was performed between 01/09/2020 and medical manager are raised with regard to screening for nutritional 31/01/2021. Adults patients hospitalized in medicine or surgery units disorders (70% versus 56.7%; p = 0.01) and screening for pressure were included. Infants or patients hospitalized in ICU were excluded. ulcer risk (77% versus 66.7%; p = 0.032). During the course of care, the Case patients were patients with a nosocomial Covid-19 (clinical medical manager reported significantly more perceptions in favor of symptoms and positive PCR for SARS-CoV-2 or positive PCR for SARS- well-treatment for the information provided to the patient as well on CoV-2 ≤ 28CT ); control patients were patients without infection (nega- his state of health (77.3% versus 66.5%; p = 0.027) than on the adverse tive PCR for SARS-CoV-2). They were matched by their length of stay events that occurred (76% versus 66%; p = 0.043). and their period of admission. Bivariate and multivariate analysis were Conclusion: The realization of our study among health profession- performed with a conditional logistic regression by Stata 12.0. nal at the Farhat Hached hospital of Sousse should argue the need to Results: A total of 1393 patients with Covid-19 were hospitalized; establish a whole "culture of well contracting” with the implementa- 722 patients were included in the case–control analysis (n = 281; case tion of a strategy promoting the development of this state of mind n = 441). In bivariate analysis, case patients were significantly older control among healthcare professionals. (OR:1.25; CI95% [1.12; 1.40]), had more often a roommate (OR:1.74; CI95% Disclosure of Interest: None declared [1.23; 2.43]), more often a co-infection (OR:1.73; CI95% [1.26; 2.36]), more often a severity risk factor of Covid-19 (OR:2.06; CI95% [1.14; 3.71]) and P289 a higher Charlson comorbidity index (OR:1,09; CI95% [1,01; 1,20] than Ell‑treatment in hospitals: perceptions of health professionals control patients. In an adjusted model that included the admission in in a central tunisian hospital the emergency room and the existence of a severity risk factor, the risk 1 1,* 1 1 1 1 1 M. Mahjoub , S. Chelly , O. Ezzi , A. Asma, B. Trabelsi , M. Besbes , M. Njah factors of nosocomial Covid-19 were: older age (aOR:1.24 per 10 years; Hospital hygiene department, Farhat Hached teaching hospital, Sousse, CI95% [1.08; 4.41]), having a roommate (aOR:1.63; CI95% [1.14; 2.33]), and Tunisia having a co-infection (aOR:1.62; CI95% [1.17; 2.26]). Correspondence: S. Chelly Conclusion: Older patients with co-infection hospitalized in a multiple Antimicrobial Resistance & Infection Control 10(1): P289 room were more susceptible to nosocomial Covid-19. These prelimi- nary results need to be consolidated taking into account exposition to Introduction: Promoting well-treatment means strengthening a contagious healthcare workers or contagious patients. model of comprehensive patient care centered on their needs, expec- Disclosure of Interest: None declared tations, preferences and rights. Objectives: To specify the degree of application of certain con- cepts of well-treatment according to the perceptions of healthcare P291 professionals. Does the COVID‑19 patients have a higher cross infection Methods: It was a cross-sectional descriptive study carried out during prevalence? A cross sectional study on healthcare aquired four months (from May 1, 2018 to August 31, 2018) among health pro- infection at the Tunisian university hospital in 2021 1 1,2 1,2 1,2,* 1 fessionals of all categories working in the 19 care services of the Farhat W. Dhouib , S. Bhiri , A. Ben Cheikh , H. Ghali , R. Bannour , S. 1 1,2 1,2 Hached hospital in Sousse. The collect was carried out using a ques- Khefacha , H. Said Latiri , M. Ben Rejeb tionnaire developed in 2012 by the high authority of health (HAS). Department of Prevention and Security of Care, sahloul university hospi‑ Results: In total, response rate was 66.4% (350/527). More than three tal, Faculty of Medicine of Sousse,, University of Sousse, Sousse,, Tunisia quarter of the participants (78.6%) said that they adapt their words Correspondence: H. Ghali and actions to the patient’s condition. Of the respondents, 99.4% said Antimicrobial Resistance & Infection Control 10(1): P291 that they provided care with respect for privacy and 94.6% said that Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 128 of 140 Introduction: Since the second of March 2020 Tunisia has faced three P292 COVID-19 waves. Until May 16, 2021, the total number of COVID-19 Determinants of nosocomial COVID‑19: a prospective, multicenter cases reached 327,473, with a fatality rate of 3.63%. The rate of hospi- hospital‑based study 1 1 1 1 1 talized patients in public and private hospitals was 4.7%. Health Care-K. Chen , S. Ghantous , L. Henaff , M. Saadatian‑Elahi, P. Vanhems , C. 1,* Associated infections (HCAIs) could worsen hospital management and Elias increase the burden of COVID-19. Lyon University Hospital, Lyon, France Objectives: The objective was to determine the prevalence of HCAIs Correspondence: C. Elias among patients with Covid-19 diagnosis at a Tunisian university hos- Antimicrobial Resistance & Infection Control 10(1): P292 pital in 2021. Methods: The Prevention and Security of Care Department, carried out Introduction: Accurate attribution of nosocomial COVID-19 is chal- the prevalence survey for the year 2021. It was a cross-sectional study of lenging, particularly given wide variation in incubation period. HCAIs prevalence with a single passage in March. The agreed definition Objectives: Within the multicenter hospital-based prospective NOSO- of an HCAIs was any infection that occurs during a hospital stay of at least COR project, we aimed at characterizing the determinants of nosocomial 48 h and if it was not present at admission. All hospital departments were COVID-19. included in the survey. Patients with Covid-19 diagnosis were hosted in Methods: An observational, prospective and multicenter study was three departments rearranged for this purpose: an Intensive Care Unit conducted in a university hospital of 5,300 beds. Any patient diag- (ICU) for the most severe patients, a semi critical unit and a non critical unit. nosed positive for COVID-19, presenting with a cough and/or fever Results: At our passage in the COVID-19 Departments, 25 patients above 37.8 °C, admitted to the hospital and having stayed there for were included in the study, representing 10.9% of the total sample that more than 24 h was included. The European Center for Disease Pre- included 228 patients. The median age of these Covid-19 patients was vention and Control (ECDC) defined nosocomial COVID-19 according 69 years IQR[61–73] with a sex ratio of 0.47. The prevalence of HCAIs in to three thresholds: 48 h, seven days and 14 days. Comparison of clini- COVID-19 patients was 20% (5/25) with a 95%CI 16,86–23,13]. All the five cal characteristics of COVID-19 hospitalized patients were performed HCAIs were notified in the ICU, corresponding to a prevalence of 71.4 according to the three ECDC thresholds using a multivariate analysis. with a 95% CI[67.8 – 74.9]. Two of the 5 infections were highly resistant Results: A total of 1078 patients were included in the study. The bacterimia with acinetobacter baumanii complex, 1 multiresistant germ median age was 77 [64–86] years old and a sex ratio equal to 1.06. urinary infection and 2 nonresistant germ respiratory infection. 996 (92.1%) patients presented at least one comorbidity, with 665 Conclusion: The prevalence of HAIs in COVID-19 patients was particu- (61,7%) patients presenting a cardiac condition. In addition, 341 larly high in patients with severe conditions requiring hospitalisation (45.5%) patients had a contact in a health care facility with a COVID- in ICU. This could highlight the need to strengthen training on stand- 19 suspected or confirmed case in the 14 days before symptom onset. ard precautions. In addition, an incidence study is required to deter- Patients aged above 75 (p < 0.01) and having a contact in a healthcare mine risk factors for HAIS acquisition in COVID-19 patients. facility with a COVID-19 case 14 days before symptom onset (p < 0.001) Disclosure of Interest: None declared were found as determinants of nosocomial COVID-19 regardless of the threshold (Table 1a, 1b, 1c). Diabetes was significantly associated with nosocomial COVID-19 (p < 0.05) when the delay between admission and symptom onset was greater than 7 days. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 129 of 140 P293 Conclusion: Age above 75 and being identified as a contact case from Comparison between healthcare‑associated a healthcare facility were found to be three to five times more at risk of and community‑acquired hospitalised COVID‑19 cases developing a nosocomial COVID-19. Little heterogeneity was found in from the Swiss prospective COVID‑19 cohort the application of nosocomial COVID-19 definition. However, in prac - 1,* 2 2 1 2 1 G. Catho , A. Atkinson , S. D’incau , N. Buetti , J. Marschall , S. Harbarth , tice a balance between a sensible and specific definition taking into A. Iten account population at risk would be helpful in this timely framework. Division of Infection Control, Geneva University Hospitals and Faculty Disclosure of Interest: None declared of Medicine, Geneva, Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland Correspondence: G. Catho Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 130 of 140 Antimicrobial Resistance & Infection Control 10(1): P293 Results: Of 1131patients with a positive SARS-CoV2 PCR or labeled to be a patient with COVID-19 between October 2020 and April 2021, Introduction: Numerous reports of healthcare-associated COVID- 90.6% (n = 1025) had community-associated illness, 3.5% (n = 40) had 19 (HA-COVID-19) outbreaks have highlighted that hospitals can be probable and 3.8% (n = 43) had definite healthcare-associated COVID- a platform for SARS-CoV-2 transmission. Uncertainty remains with 19, and 2.0% (n = 23) had indeterminate illness. Of all patients, 19.0% regards to clinical outcomes of patients who contracted SARS-CoV-2 (n = 215) were potential index patients, and 56.3% (n = 121) of these in healthcare facilities compared to those hospitalized after commu- exposed at least one other patient. Of 292 exposed patients, 47 were nity acquisition (CA-COVID-19). later diagnosed with COVID-19. The mean secondary attack rate per Objectives: The objective of this study was to describe and compare index patient was 14.4%. Transmission of SARS-CoV2 was higher if characteristics and clinical outcomes of patients with HA-COVID-19 contact time was longer (adjusted Odds Ratio (aOR): 1.03, 95%CI: 1.02– versus CA-COVID-19. 1.04) and if CT-value of index was lower (aOR: 0.92, 95%CI: 0.87–0.97). Methods: We used data from 16 hospitals included in the prospec- Conclusion: The secondary attack rate after exposure to SARS-CoV2 tive national surveillance on COVID-19 in Switzerland. We included all of patients in the hospital setting is comparable to rates reported from hospitalized COVID-19 adult cases with a laboratory confirmed infec - the household setting. The risk of an incident SARS-CoV2 infection tion. HA-COVID-19 cases were defined as those detected > 5 days after increases with longer duration of exposure and higher viral load of hospital admission. Only the first hospital stay after diagnosis for CA- index patient COVID-19 cases, and during diagnosis for HA-COVID-19 cases, were Disclosure of Interest: None declared considered. Cases with no information on place of acquisition were excluded. P295 Results: Between February and December 2020, 1′389 HA-COVID-19 A SARS‑COV‑2 (B.1.1.7) outbreak at a non‑COVID inpatient ward cases and 9′139 CA-COVID-19 were included. HA-COVID-19 patients at a hospital: lessons learned 1,* 1 1 1 were older than CA-COVID-19 (median [IQR] age: 79 [70–86] versus 70 M. Dekker , J. Koopsen , J. Schinkel , I. Spijkerman [57–80], predominantly female (48.2% versus 39.6%), and were more Department of Medical Microbiology & Infection Prevention, Amster‑ likely to have a Charlson comorbidity index > 4 (78.2% versus 54.9%). dam UMC, Amsterdam, Netherlands At the time of diagnosis, HA-COVID cases were most frequently hos- Correspondence: M. Dekker pitalized in general medical (570, 41%) and Geriatric/Rehabilitation Antimicrobial Resistance & Infection Control 10(1): P295 wards (409, 29.4%). Length of stay was shorter for CA-COVID-19 cases (median 15, IQR [10-23] days from admission) than for HA-COVID-19 Introduction: The severe acute respiratory syndrome coronavirus 2 (17 [9-30] days from COVID-19 diagnosis). Fewer HA-COVID-19 patients (SARS-CoV-2) lineage B.1.1.7 has an increased transmissibility com- stayed in intermediate or intensive care units (ICU) (223 [16.1%] versus pared to predecessor lineages. Healthcare workers (HCWs) are at an 2′031 [22%] of CA-COVID-19 cases) (p < 0.001), and fewer HA-COVID-19 increased risk of being exposed to SARS-CoV-2 but also of being a cases experienced any COVID-19 complications (770 (65.7%) versus source of transmission. 6665 (83.5%), p < 0.001). Overally, 350 (26.6%) HA-COVID-19 and 1225 Objectives: To describe the lessons learned from a B.1.1.7 outbreak in (13.9%) CA-COVID-19 died. a tertiary hospital. Conclusion: Patients who acquired COVID-19 within the hospital were Methods: An Outbreak Management Team developed a mitigation older and more comorbid. They were less frequently transferred to the strategy. intermediate or ICU and experienced fewer COVID-19 complications, 1) The importance of the prevailing infection control measures, includ- but suffered from higher rates of hospital mortality. ing social distancing, capacity limits for rooms, universal masking in Disclosure of Interest: None declared case of < 1.5 m distance and the early testing and domestic quarantine of HCW with symptoms was stressed. P294 2) An infection control practitioner visited the ward each working day Nosocomial COVID‑19 in a tertiary care center – incidence during the outbreak period, to advise and observe practice. and secondary attack rates after exposure 3) Contacts were traced and divided into high-risk and low risk con- 1,* 1 1 1 1 A. Wolfensberger , P. W. S chreiber , A. Frey , V. Schärer , C. O. Hundal , D. tacts in the workplace and in household/social contacts. 1 1 1 Saleschus, M. Vazquez, W. Zingg 4) Voluntary nasopharyngeal swabs were taken twice a week, to Department of Infectious Diseases and Hospital Epidemiology, UNIVER‑ detect asymptomatic cases. SITY HOSPITAL ZÜRICH, Zürich, Switzerland 5) Potential weak links of infection control measures were discussed Correspondence: A. Wolfensberger with nurses. Antimicrobial Resistance & Infection Control 10(1): P294 Results: Nine nurses and two informal caregivers tested RT-PCR posi- tive for SARS-CoV-2 in December 2020. The index nurse tested positive Introduction: Patients not suspected to be infected with SARS-CoV2 following the earlier infection of a household contact. The outbreak but suffering from COVID-19 or patients hospitalized during the incu- was recognized a day later when the second nurse tested positive and bation period of COVID-19 pose a risk for transmitting SARS-CoV2 to was confirmed by Whole Genome Sequencing. Of the remaining nine fellow patients. cases which tested positive in the following 11 days, one case tested Objectives: We aimed to describe the incidence of patients hospi- positive after a documented SARS-CoV-2 infection 83 days prior. talized in our tertiary care center with community- and healthcare- We found a primary attack rate within the department of 18% and a associated COVID-19, calculate the number of patients who exposed secondary attack rate of 54% among contacts of positive cases. other patients to SARS-CoV2 and the secondary attack rate of exposed Short conversations in changing rooms without masks, short periods patients, and investigate risk factors for SARS-CoV2 transmission. of lack of social distancing during breaks and the incorrect wearing of Methods: In this retrospective study, all patients admitted to the Uni- masks were mentioned as potential causes for transmission. versity Hospital Zurich, Switzerland, with a positive SARS-CoV2 PCR Conclusion: Two keys point were taken from this outbreak with line- were included. Community- or healthcare-associated COVID-19 were age B.1.1.7. First, it was controlled by adherence to guidelines in place, defined according to the European Centre for Disease Prevention and despite increased transmissibility of the variant. Second, reinfections Control (ECDC) criteria. Patients receiving standard care during their with lineage B.1.1.7 can occur rapidly after primary infection. period of contagiousness were defined as potential index patients. These lessons, reiterate the importance of adherence to prevailing Exposed patients were patients sharing a room with a potential index infection prevention methods to prevent transmission among HCW. patient 1) on the general ward for any time, 2) on the intermediate or Disclosure of Interest: None declared intensive care unit (IMC/ICU) for ≥ 6 h, or 3) on the IMC/ICU for any time with an index undergoing aerosol-generating procedures. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 131 of 140 P296 P297 Would the reinforcement of standard precautions help to reduce Control of nosocomial transmission of SARS‑COV‑2 in the service the occurrence of nosocomial COVID cases in non‑COVID wards? of internal medicine in Lausanne university hospital 1,* 1 1 1 1 1 1,2,* 1 1 1 1 A. Iten, V. Camus , C. Fankhauser , M. Ares , A. Graindorge , F. Favre , E. Kampouri , E. Glampedakis , E. Moulin , G. Chaillou , I. Federli , M. 1 1 1 1 1 3 3 3 3 1 M. Rousseau‑Chadegg , M. Steiner , G. Golaz , J. C arry , J. C astro , L. Gouffon, J. Vaucher , C. Sartori , P. Vollenweider , B. Grandbastien , L. 1 1 1 Thivolet , D. Pittet Senn 1 1 2 Prevention Control Program, HUG, Genève, Switzerland Service of Hospital Preventive Medicine, Infectious Diseases Service, Correspondence: A. Iten Service of Internal Medicine, Lausanne University Hospital and University Antimicrobial Resistance & Infection Control 10(1): P296 of Lausanne, Lausanne, Switzerland Correspondence: E. Kampouri Introduction: Since the beginning of the COVID-19 pandemic, Antimicrobial Resistance & Infection Control 10(1): P297 HUG hospital is mandated to care for patients suspected of hav- ing or affected by COVID-19. The majority of the wards (W) at HUG Introduction: Transmission of SARS-CoV-2 inside the hospital has sig- became COVID W; CONTACT and DOPLETS measures replaced nificant implications for patients and healthcare workers. standard precautions (SP). Additional measures were implemented Objectives: We describe a nosocomial outbreak of SARS-CoV-2 infec- to prevent nosocomial (NOSO) cases: control of visitors and staff at tions in the Service of Internal Medicine, the implemented infection the entrance of the hospital, surgical mask wearing, screening of prevention and control (IPC) measures and their impact. patients and staff, epidemiological surveillance. Vaccination started Methods: We report all consecutive nosocomial cases in a 206-bed in January 2021. On 26.05.2021, 17.3% of the general population service from February 8 until April 8, 2021 (weeks 6–14). Nosocomial and 57.5% of the hospital staff received at least one dose. COVID-19 cases were defined as microbiologically documented cases Objectives: To reduce the occurrence of NOSO cases in non-COVID by PCR, diagnosed ≥ 5 days after admission. A cluster was defined W based on the detection of ≥ 2 nosocomial COVID-19 cases within a Methods: The program covers the period from 01.01 to 30.06.2021 given period (< 72 h) or geographically linked. IPC measures imple- and concerns non-COVID units. It is based on several axes of inter- mented on week 10 to control SARS-CoV-2 transmissions in all non- vention, including: 1.Training: medical-nursing managers of the COVID units were: systematic screening at day 3 after admission; non-COVID W were invited to participate in a training session on the weekly screening of all patients by PCR on saliva; and decreasing the topic “SP”. Trainers were 3 IPC professionals and 1 adult education occupancy of all patient rooms with 5 patients to 3. specialist. 2. Monitoring of compliance with hand hygiene, mask Results: 69 cases were identified, with 57 attributed to 21 clusters and wearing and provision of alcohol based handrub at the W entrance. 12 cases considered isolated. Median age was 74 years (IQR 65, 80) and Observers are trained, validated and interrater reliability tested. 40.6% were female. All cases had a previous negative test and median Feedback was applied: oral immediate feedback; monthly delayed time from admission to positive test was 12 days (IQR 8, 17). 45.1% of feedback using a poster for each W with SP’ compliance, explaining nosocomial cases were completely asymptomatic. 60.9% of patients the results with the hierarchy, and set the goal for next month. A stayed in rooms with 5-patients. Death occurred in 23.2% of cases. The written report was sent to the hospital management. incidence of nosocomial cases was the highest between weeks 8 and Patients’ data are from the prospective national surveillance on 10 with 18 and 17 new cases per week, respectively. After the intro- COVID-19 identified hospitalized COVID-19 adult cases with a duction of IPC measures on week 10, there was a rapid decrease in the laboratory confirmed infection. NOSO cases were defined as those number of cases until complete absence of new cases on week 14. detected > 5 days after hospital admission. Conclusion: Nosocomial infections were frequently asymptomatic, Results: From 24.08.2020 to 23.05.2021, 1863 community acquired potentially hampering fast diagnosis which is crucial for control of COVID cases and 497 NOSO cases were collected. The percentage of transmission, and were associated with high mortality rate. The imple- NOSO cases decreased after the introduction of the program (before mentation of additional IPC measures led to a gradual decrease in 426/1589 (26.8%) after 71/771 (9.2%), p < 0.001). nosocomial transmissions and allowed controlling the outbreak. Disclosure of Interest: None declared P298 Nosocomial transmission of SARS‑COV‑2: experience from the contact tracing activity of the infection control unit for the university hospital of lausanne 1,* 1 1 1 1 E. Glampedakis , E. Kampouri , E. Moulin , F. Boiron , P. Bressin , I. 1 1 1 1 Federli Hanachi , G. Chaillou , D. Gustin , M. Gyger Wanzenried , L. 1 1 1 1 1 Kalbermatter , I. Koenig , A. Lacot , M. Limet‑Dutoit , G. H. Salehi , M.‑J. 1 1 1 1 1 Thevenin, E. Viaccoz , A. Vital‑Heilbronn , B. Grandbastien , L. Senn Service de médecine préventive et Hospitalière, Département de Médicine, Centre Hospitalier Universitaire Vaudois (CHUV ), Lausanne, Switzerland Correspondence: E. Glampedakis Antimicrobial Resistance & Infection Control 10(1): P298 Introduction: The high transmissibility of SARS-CoV-2 is of particu- lar concern for hospitals as hospitalized patients are at risk of severe COVID-19 and related death. Objectives: Describe the contact tracing activity related to nosoco- mial SARS-CoV-2 cases in our hospital. Conclusion: Following the intervention, the incidence of NOSO cases Methods: The Infection Control Unit received alerts for positive PCR has markedly decreased results performed by the Microbiology laboratory in hospitalized Disclosure of Interest: None declared patients. Nosocomial infections, occurring after at least 5 days of hos- pitalization, were further investigated. Contact tracing was performed via an institutional software allowing tracing index patients’ move- ments and their roommates. Patients were considered “contacts” at risk and were placed in quarantine if they shared the same room Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 132 of 140 with the index-case up to 72 h before index’s first positive PCR or first P300 symptoms. Contacts systematically had nasopharyngeal SARS-CoV-2 Outbreaks of seasonal OC43 coronavirus with nosocomial PCR testing at days 0, 10 counting from last contact with the index or transmission during COVID‑19 pandemic setting: at symptom onset. when a coronavirus hides another st st 1,* 1 1 1 Results: Between November 1 2020 until March 31 2021, 322 noso-E. Moulin , E. Kampouri , E. Glampedakis , M. Gyger Wanzenried , E. 2 3 1 comial SARS-CoV-2 cases were identified, of whom 195 (61%) had pre - Gilles de Pélichy , O. Opota , L. Senn 1 2 3 viously been in contact with another known case while for 127 (39%) Infection Control, Psychiatry Department, Departement of Pathol‑ source of infection was unknown. Median time from admission to pos- ogy and Laboratory Medicine, Centre Hospitalier Universitaire Vaudois, itive PCR was 13 days (IQR 8 – 25). Symptoms where present in 67% Lausanne, Switzerland of cases. Median age was 76 years (IQR 64 – 84). Of all episodes, 75% Correspondence: E. Moulin were diagnosed in medical units (including 50 cases, 16% in geriatric Antimicrobial Resistance & Infection Control 10(1): P300 sections),24% in surgical sectors and 1% in the ICU. Contact tracing activity identified 605 contacts with a median of 2 contacts per index Introduction: Management and control of COVID-19 outbreaks in case (range 0–19). Of these, 32% had a positive PCR result during hospital settings represent a major challenge. Any suspicion of noso- follow-up. comial transmissions require prompt investigations and control Conclusion: A thorough contact tracing with systematic PCR screen- measures. ing is necessary after detection of a nosocomial SARS-CoV-2 case Objectives: To describe the management of 2 consecutive clusters of as transmissibility is high and more than 1/3 of cases are asympto- patients presenting suspect symptoms of Covid-19 in a 19-bed psy- matic. The non-identification of a source for more than a third of chogeriatric unit, hosting concomitantly 2 patients with SARS-CoV-2 cases raises concerns of potential implication of healthcare workers in infection confirmed by RT-PCR on nasopharyngeal swabs (lineage transmission. B.1.1.7, viral loads of 6.9E + 8 and 8.0E + 7 copies/ml, respectively) Disclosure of Interest: None declared among whom one was a nosocomial case with persistence of a high viral load at day 14 (8.9E + 6 copies/ml). Methods: After identification of the SARS-CoV-2 cases, control meas- P299 ures were promptly applied. During the following weeks, the clinicians Clusters of patients who had initial negative RT‑PCR then of the ward additionally reported 2 clusters of 3 patients with suspect converted to positive COVID‑19 symptoms. All of these suspect cases were isolated with Droplet Pre- 1,* 1 2 3 1 3 N. Dagunton , H. Rahman , J. Rimmer , N. Rosso , M. Brizuela , K. Erbeck , cautions and were investigated by a nasopharyngeal swab for SARS- 3 3 H. Vyas , G. Espiritu on behalf of no CoV-2 testing. If the first SARS-CoV-2 RT-PCR was negative, a second 1 2 3 Infection Control, medical staff, nursing, Hoboken University Medical test was performed within 24 h. Additionally, we proposed to com- Center, Hoboken, United States plete investigations by an extended respiratory multiplex RT-PCR. Correspondence: N. Dagunton Results: Among the 6 symptomatic patients, all had 2 consecutively Antimicrobial Resistance & Infection Control 10(1): P299 negative SARS-CoV-2 RT-PCR. The respiratory virus panel test revealed a positive PCR for OC43 coronavirus in 5/6 patients, with viral load Introduction: Diagnosing SARS-CoV-2 infection is essential in stop- ranging from 3E + 5 to 3E + 9 copies/ml, confirming a nosocomial out - ping the spread of COVID19, yet we have to take into account that break of a seasonal coronavirus. For the remaining patient, infection onset of symptoms often vary among our exposed patients. by OC43 coronavirus was considered possible, regarding the close Objectives: Investigate the probable causes of conversions among contacts with positive cases during the hospital stay. the clusters of patients with negative RT-PCR COVID19 results upon Conclusion: Even if the actual Covid-19 epidemic setting should con- admission who converted to positive PCR after 2–18 days in one of the duct to promptly research a SARS-CoV-2 infection in symptomatic acute care hospitals in New Jersey, USA. hospitalized patients, this report highlights the possibility of co- Methods: A descriptive study was conducted to identify cases, trace circulation of different respiratory virus within the same ward. More exposed contacts, and identify the probable causes of conversion. A extended microbiological investigations with specific RT-PCR analysis confirmed case was defined as a positive reverse-transcription poly - in symptomatic patients repeatedly tested negative for Covid-19, can merase reaction test for SARS-COV-2. COVID19 cases were categorized conduct to a better understanding of nosocomial outbreaks. Some- as community-acquired, and or hospital-acquired. Hospital-acquired times a coronavirus can hide another! is defined as an occurrence of a positive PCR result or onset of symp - Disclosure of Interest: None declared toms on or after 7 days post admission. Results: There were 18 patients admitted, all tested negative, and Poster Session: COVID‑19 outcomes and prediction were not place on isolation. Within 7 days post admission 11 (61%) tested positive. Review of records showed that 14 (78%) were com- P301 munity-acquired infection and 4 (22%) were HAIs. Symptomatic upon Factors associated with prolonged intubation among COVID‑19 admission 11 (61%) and asymptomatic 7 (39%). Twelve (67%) with 2 or patients in the region of Mahdia (Tunisia) more comorbidities and the rest none. 1,* 2,3,4 5 2,3,4 2,3,4 H. B. Bayoudh , F. Ben Youssef , O. Jawed , I. Mlouki , N. Omri , H. During their stay 5 patients (28%) required high flow oxygenation, 1 3 5 5 5 2,3,4 Sfar , H. Nouira , M. F. Hassen , S. el atrous , S. El Mhamdi required intubation. Thirteen (72%) on nasal cannula/room air. Five Department of Family Medicine, University Hospital Tahar Sfar, Mahdia, (28%) expired, 12 recovered/discharged, and 1 still in the hospital. Department of Community Medicine, Faculty of Medicine, Monastir, Conclusion: The conversions among these patients could be due to Department of Preventive and Community Medicine, University Hospital full reliance on the diagnostic RT-PCR and not considering clinical con- Tahar Sfar, Research laboratory, “Epidemiology Applied to Maternal ditions, breaches in infection control, and gaps in identifying exposed and Child Health” 12SP17, Department of Intensive Care Medecine, patients from the community prior to admission. University Hospital Tahar Sfar, Mahdia, Tunisia Thus, strict infection control measures were implemented which Correspondence: H. B. Bayoudh included enhanced surveillance screening through RT-PCR on day 1, Antimicrobial Resistance & Infection Control 10(1): P301 day 3 and day 5; more rigid environmental terminal cleaning even in non-Covid units where most of the conversion occurred; increased Introduction: The high mortality among intubated COVID-19 patients awareness among physicians and staff for any subtle changes in clini- in Intensive Care Unit (ICU) has given rise to a debate over risk factors cal condition to place in isolation and repeat testing, dedication of related to a prolonged intubation period. staff and equipment, and refresher courses on the use of personal pro - Objectives: In this study, we aimed to identify individual risk factors tective equipment. associated with prolonged intubation (≥ 7 days) among patients with Disclosure of Interest: None declared COVID-19. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 133 of 140 Methods: A prospective study was carried out between September P303 2020 and february 2021 among patients admitted in the COVID-19 ICU Evaluation of the long‑term impact of COVID‑19 on the quality at the University Hospital Tahar Sfar Mahdia. The measurement tool of life among disease survivors: preliminary results was the “ RAPID CORE CASE REPORT FORM” developed by WHO. of a prospective cohort study (Recovida) 1,* 1 1 1 1 Results: A total of 114 participants were enrolled with an average age L. Bonifácio , F. Barbosa‑Júnior, V. Csizmar , A. P. P ereira , F. Carvalho , F. 1 1 1 1 of 61.4 ± 12.2 years. Guioti , A. Dal Fabro , J. P. Souza , F. Bellissimo‑Rodrigues About 51.4% of patients needed intubation. During the hospitali- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, sation, 12 (21.1%) were eventually extubated and 45 (78.9%) died. Brazil Prolonged intubation was recorded in 43.8% of cases. Among them, Correspondence: L. Bonifácio 35.4% were diabetic, 30.6% have hypertension and 6.1% had chronic Antimicrobial Resistance & Infection Control 10(1): P303 heart disease. The main factors significantly associated with longer intubation were: Introduction: There is scarce information on how long-term clinical, Nosocomial infection (80.8% vs 7.7%; p < 0.01), acute respiratory dis- psychological and social consequences of Covid-19 affects the quality tress syndrome (60.6% vs 17.8%; p < 0.01), and ionotropic use during of life of people surviving it. the first 24 h (82.4% vs 36%; p < 0.01). Objectives: We aimed to follow up patients surviving Covid-19 to Multivariable logistic regression analysis identified nosocomial infec - evaluate and to compare their quality of life status before and after tion (OR, 20.54 [95% CI, 5.44–77.57] and early invasive intubation (dur- the acute phase of disease. ing the first 24 h) (OR, 4.65[95% CI, 1.1–19.56]) as predictive factors of Methods: RECOVIDA is a prospective cohort study conducted in a prolonged intubation. public tertiary hospital in Brazil. From May 1 to December 31, 2020, Conclusion: As COVID-19 infection continue to rapidly consume the we recruited participants on the Hospital Post-Covid-19 outpatient health care system’s limited resources, technicians consulted for air- clinic, which offers clinical follow-up to adult patients, most of them way management should consider these factors in their decision discharged after being admitted due to Covid-19. Quality of life was making evaluated through an interview based on The World Health Organiza- Disclosure of Interest: None declared tion Quality of Life (WHOQOL-BREF) tool. Results: 175 patients were included in the study and interviewed up to 120 days after symptoms onset. 51.4% of participants were female P302 with average age of 53 ± 14 years. Table 1 describes scores obtained Associated factors with extended hospital stay among COVID‑19 on the WHOQOL-BREF before and after Covid-19. Table 2 focuses on patients in intensive care unit at an university hospital in Tunisia 1,2,3,* 1,2,3 4 1,2,3 5 the current situation, where it is shown that most of patients were sat- N. Omri , F. Ben y oussef , O. Jaoued , I. Mlouki , H. Bayoudh , H. 1 4 4 4 1,2,3 isfied with their life after Covid-19. Pairing the individual data of 168 Sfar , H. Nouira , M. Fekih hassen , S. El atrous , S. El mhamdi respondents, we observed that for 49 (29.6%) of them quality of life Preventive and Community Medicine, University Hospital Tahar Sfar worsened after Covid-19, for 98 (58.3%) it remained on the same level Mahdia, Mahdia, Community Medicine, Faculty of Medicine of Mona‑ and for 21 (12.5%) it actually improved after Covid-19. stir, Research laboratory, Epidemiology Applied to Maternal and Child 4 5 Health, Monastir, Intensive care Medicine, Family Medicine, University Table 1 – WHOQOL-Bref scores before and after Covid-19 Hospital Tahar Sfar Mahdia, Mahdia, Tunisia Quality of life assessment Before Covid-19 (n=175)After Covid-19 (n=171) Correspondence: N. Omri Very poor 1 (0.6%) 5 (2.9%) Poor 3 (1.7%) 6 (3.5%) Antimicrobial Resistance & Infection Control 10(1): P302 Neither poor nor good 29 (16%)43 (25%) Good 113 (64%) 96 (56%) Very good 29 (16%)21 (12%) Introduction: In Tunisia, the Covid-19 pandemic threatens to over- whelm scarce clinical resources especially in Intensive Care Units (ICUs) Objectives: This study aims at analyzing clinical presentation on Table 2 - WHOQOL-Bref scores after Covid-19 admission and the determinants associated with extended hospital Satisfaction with your health (in the last 15 days) n=171 Very dissatisfied 4 (2%) stay in (ICUs). Dissatisfied 20 (11%) Neither satisfied nor dissatisfied 50 (29%) Methods: We carried out a prospective study on 117 hospitalized Satisfied 78 (45%) Very satisfied19 (11%) patients in ICUs at the university hospital Tahar Sfar Mahdia which is Domains WHOQOl-Bref (n=168)Mean (Likert 1-5) located in the Central-East part of Tunisia from September 2020 to Physical domain 3.4 Psychological domain 3.7 February 2021 using a valid and reliable tool inspired from the WHO- Social Relationships domain 3.9 Environment domain 3.6 2019-nCOV-Clinical platform observation. Results: A total of 117 patients were recruited with a mean age of 61.4 ± 12.2 years. Males outnumbered (60%, sex ratio = 0.67).The majority 85.5% had pre-existing chronic diseases mainly hyperten- Conclusion: Covid-19 disease may last longer than its acute phase. sion 38.5% and Diabetes 42.2%. The median length of stay was 14 Around 30% of patients have their quality of life significantly compro - (IQR: 24–9) days. Approximately the half 47% had an extended stay mised up to 120 days after the disease onset. (> 14 days). Of the 117 patients included, 46.2% died in hospital and Disclosure of Interest: None declared almost the half 50.1% required mechanical ventilation. Our survey shows a significantly longer hospital stay among older patients (52.9%), patients having oxygen saturation < 90% (51%) and P304 those who have developed a health care associated infection 63.5%. Evaluation of long‑term clinical findings among COVID‑19 The main factor associated with extended hospital stay was invasive survivors: preliminary results of a prospective cohort study intubation (77.6%). (Recovida) Acquiring a nosocomial infection (p = 0.001), developing a complica- 1 1 1 1 1 L. Bonifácio, V. Csizmar , A. P. P ereira , F. Barbosa‑Júnior, V. Bollela , R. tion (p < 0.001), resorting to invasive intubation (p < 0.001) and admin- 1 1 1,* Santana , J. P. Souza , F. Bellissimo‑Rodrigues istering vasopressor drugs (p = 0.001) were found to have significant Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, relationship with extended hospital stay. Brazil Conclusion: This close look at the length of Covid-19 IUCs stay could Correspondence: F. Bellissimo‑Rodrigues provide an overview and would improve the prognosis of Covid-19 Antimicrobial Resistance & Infection Control 10(1): P304 patients. Disclosure of Interest: None declared Introduction: Little is known about long-term clinical consequences of Covid-19. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 134 of 140 Objectives: We aimed to follow-up patients surviving the acute phase heart disease (HR 2.47, p = 0.027) and leukocytes ≥ 10,000 (HR 2.25, of disease to identify and eventually describe persistent symptoms p = 0.012),were independently associated with increased in-hospital related to it. mortality. Methods: RECOVIDA is a prospective cohort study conducted in a Conclusion: Predictors could assist clinicians to identify patients with public-affiliated tertiary-care hospital, in Brazil. From May 1 to Decem- a poor prognosis at an early stage to reduce the Covid-19-related mor- ber 31, 2020, we recruited participants on the Post-Covid-19 ambu- tality and rationalize the use of limited medical resources. latory of the study facility, which offers clinical follow-up to adult Disclosure of Interest: None declared patients, most of them discharged after being admitted due to Covid- 19. We classified their acute disease following WHO severity of disease P307 criteria. Mortality risk factors for COVID‑19 patients in the region Results: 175 patients were included in the study and evaluated up to of Mahdia (Tunisia) 120 days after the onset of symptoms (mean = 57 days). Regarding 1,2,3,* 4 1,2,3 1,2,3 5 F. B. Youssef , O. Jawed , I. Mlouki , N. Omri , H. Bayoudh , H. demographic features, 51.4% of participants were female, and aver- 1 4 4 4 1,2,3 Sfar , H. Nouira , M. F. Hassen , S. El Atrous , S. El Mhamdi age age was 53 ± 14 years. Past medical history included hypertension Preventive and Community Medicine, University Hospital Taher Sfar, (37%), diabetes mellitus (28%) and obesity (mean body mass index of 2 3 Community Medicine, Faculty of Medicine of Monastir, Research labora‑ 31.7 ± 7.3). By the time of evaluation, 80% of participants still experi- tory, “Epidemiology Applied to Maternal and Child Health”, Intensive Care enced at least one long-term symptom, as described in Table 1. Medicine, Family Medicine, University Hospital Taher Sfar, Mahdia, Tunisia Correspondence: F. B. Youssef Table 1 – Distribution of long-term symptoms observed among Covid-19 survivors, according to disease severity Mild/Moderate (n=35) Severe Critical Total Antimicrobial Resistance & Infection Control 10(1): P307 (n=80) (n=60) (n=175 Average time from disease onset to observation (days) 51 ± 27 48 ± 23 72 ± 26 57 ± 27 Prevalence of long-term symptoms 25 (71.4%)59 56 140 Introduction: Timely identification of COVID-19 patients at high risk (73.8% (93.3%) (80%) of mortality is crucial to improve patient management and resource Respiratory symptoms Dyspnea 25.7% 27.5% 25% 26.3% allocation in hospitals. Cough 11.4% 25% 25.6% 22.8% Cardiovascular symptoms Objectives: The aim of this study was to identify mortality risk factors Swelling 5.7% 7.5% 8.3% 7.4% Hypertension 2.8% 0% 1.6% 1.1% at the COVID-19 Intensive Care Unit (ICU) in the region of Mahdia Hypotension 0% 1.2% 1.6% 1.1% Neurological symptoms Methods: We conducted a prospective study including patients with Headache 28.6% 20% 16.6% 20.5% Altered skin sensitivity 2.8% 5% 35% 14.8% severe COVID-19 infection admitted to the ICU of The University Hos- Hypogeusia/Dysgeusia 25.7% 16.2% 16.6% 18.3% Hyposmia 20% 8.7% 6.6% 10.3% pital Tahar Sfar Mahdia. The survey was carried out between Septem- Brain fog 5.7% 3.7% 5% 4.5% Gastrointestinal symptoms ber 2020 and February 2021. We used “The RAPID CORE CASE REPORT Diarrhea 0% 2.5% 6.6% 3.4% Dyspepsia 5.7% 0% 0% 1.1% FORM” developed by the World Health Organization. Other symptoms Fatigue 28.5% 28.7% 35% 30.8% Results: We analyzed the records of 117 patients (59.8% were males). Weakness 8.5% 13.7% 35% 20% Vision problem 2.8% 1.2% 13.3% 5.7% Mean age was 61.4 ± 12.2 years. Common symptoms were shortness Hair loss 5.7% 3.7% 6.6% 5.1% of breath (82.6%), cough (71.1%) and fever (69.3%). The median length of stay in the unit was 18.3 days (IQR: 2–66). About 48.7% of patients had invasive ventilation, 30.3% required vasopressors intake and Conclusion: Covid-19 disease does not necessarily end with the end 51.4% required prone position. of its acute phase. In fact, a large proportion of patients, even after The overall mortality rate was 46.2%. Longer stay in the hospital a mild disease, persist with clinically meaningful symptoms up to (> 14 days) and longer intubation duration (≥ 7 days) were associated 120 days after the disease onset. with a higher risk of mortality (61.8% vs 32.3%; p < 0.001 and 77.6% vs Disclosure of Interest: None declared 20.6%; p < 0.001 respectively). Mortality was also related to acute res- piratory distress syndrome (66.7% vs 13%; p < 0.001) and nosocomial infection (80.8%vs 17%; p < 0.01). P306 Multivariable logistic regression analysis showed increasing odds of Predictors of mortality in hospitalized COVID‑19 patients mortality with nosocomial infection (OR, 12.41 [95% CI, 3.3–46.57], in a Tunisian university hospital 1,2,* 2,3 1 1,2 1,2 respiratory distress syndrome (OR 7.52 [95% CI. 1.71–32,95]) and ino- D. chebil , S. rouis , E. arfaoui , H. hannachi , L. merzougui 1 2 tropes or vasopressors intake (OR 7.39 [95% CI, 1.57–34.69]). Higher prevention and infection control department, kairouan, Faculty 3 oxygen saturation on admission was found to be a protective factor of medicine of Sousse, University of Sousse, SOUSSE, infectious diseases against mortality (OR 0.91 [95% CI, 0.85–0.97]). department, kairouan, Tunisia Conclusion: Interventions that prevent these risk factors are needed Correspondence: D. chebil to improve the prognosis of Covid-19 patients. Antimicrobial Resistance & Infection Control 10(1): P306 Disclosure of Interest: None declared Introduction: Mortality rates of coronavirus disease 2019 (COVID-19) continue to rise across the world. The predictors of mortality in COVID- P308 19 patients are under study. Clinical characteristics, outcomes, and risk factors for mortality Objectives: we aim to evaluate the risk factors associated with the in hospitalized patients with COVID‑19 from the start death of patients with COVID-19 pneumonia. of the pandemic in Sahloul university hospital Methods: We analysed data of laboratory confirmed hospitalized 1 1,* 1 2 2 2 A. Ben Cheikh , H. Ghali , S. Bhiri , R. Bannour, W. Dhouib , S. Khefacha , patients at the COVID-19 unit of a university hospital in the Tunisian 1 1 H. Said Latiri , M. Ben Rejeb center, between September 2020 and January 2021.Patients’ charac- Department of Prevention and Security of Care, Sahloul university hos‑ teristics, comorbidities, and laboratory abnormalities were recorded. pital, Faculty of Medicine of Sousse, University of Sousse, Department Potential predictors of in-hospital mortality were identified by multi- of Prevention and Security of Care, Sahloul university hospital, Sousse, variable Cox regression model. Tunisia Results: A total of 256 patients were included.Mean age was 66 years Correspondence: H. Ghali (SD, 14 years) and 62% (n = 158) patients were males. Forty-eight per- Antimicrobial Resistance & Infection Control 10(1): P308 cent (n = 123) of patients had at least two co-morbidity with hyper- tension and diabetesas the most common comorbidities.Severe Introduction: Tunisia was one of the countries with the highest cases accounted for 52% of the study population.The overall in-hos- COVID-19 mortality worldwide, especially during this last stage of pital mortality rate was 29% (n = 72). multivariate analysisrevealed the pandemic. Although risk factors for severe disease in COVID- that Age > = 60 years (HR 5.87, p < 0.001); The presence of coronary 19 patients have been described in Chinese and United States (US) Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 135 of 140 cohorts, studies reporting on clinical characteristics, risk factors and 1st wave (HR 0.75, 95% CI 0.73 – 0.77). In contrast, patients admitted to outcome of Tunisian COVID-19 patients are still scarce. ICU as well as patients with invasive ventilation presented a higher risk Objectives: The aim of our study was to describe the clinical charac- of death during the 2nd wave (HR 1.62, 95% CI 1.54—1.70 and HR 2.10, teristics of COVID-19 patients in a tertiary care center since the start 95% CI 1.99—2.20, respectively). of the pandemic (from first hospitalization until May 5), and identify Conclusion: Our findings may be explained by various changes in the independent risk factors for hospital mortality. COVID-19 patient management in Swiss hospitals, e.g. with the use of Methods: Since the start of the pandemic, the prevention and secu- effective drugs against complications or with different guidelines for rity of care department has been recording all new cases of COVID_19 ICU admission and invasive ventilation use. hospitalized in the various units taking care of these patients. Daily Disclosure of Interest: None declared monitoring of the evolution of the patient’s condition is provided by the hygienist technicians of our department. Results: From when the first patient with COVID-19 was admitted to P310 May 5, 752 laboratory-confirmed COVID-19 patients had been admit - Changes of lipoxina4 levels following early hospital management ted to our hospital. Most patients were male (55.5%), the mean age of patients with COVID‑19 was 62.3 ± 14.5 years, with 279 patients (37.1%) being < 60 years 1 1 1 2 3 F. Jamali , B. Shahrami , F. Najmeddin , A. Haddadi , M. Sharifzadeh , A. A. of age. The median length of stay was 11 days (IQR 5–14). The most 4,* 1 A. Arabzadeh , M. Mojtahedzadeh common comorbidities were hypertension (47.7%), diabetes (46.2%), 1 2 Department of Clinical Pharmacy, Department of Infectious Disease, and coronary artery disease (19.9%). Most patients had an important Department of Pharmacology, Tehran University of Medical Sciences, degree of hypoxemia, with 53.7% of patients not requiring supple- Tehran, Department of Surgery, Ardabil University of Medical Sciences, mental oxygen, and 22.4% needed invasive mechanical ventilation. Ardabil, Iran, Islamic Republic Of The overall case fatality rate was 23%. More patients died in the inten- Correspondence: A. A. A. Arabzadeh sive care units (65.8%). Multivariate analysis model showed that his- Antimicrobial Resistance & Infection Control 10(1): P310 tory of comorbidity (p = 0.015), Non-invasive ventilation (p = 0.041), and mechanical ventilation (p = 0.028) were associated with an Introduction: LipoxinA4 (LXA4) is an anti-inflammatory biomarker increased risk of death. that participates in the active process of inflammation resolution Conclusion: The risk factors found allow the identification of vulner - which is suggested to be beneficial in infectious and inflammatory dis- able groups in whom monitoring and early identification of symptoms eases like the coronavirus disease 2019 (COVID-19). should be prioritized in order to reduce mortality. Objectives: This study aimed to determine early changes of LXA4 Disclosure of Interest: None declared levels in the hospitalized patients with confirmed COVID-19 follow - ing the clinical management as well as its correlation with common P309 used inflammatory markers, including Erythrocyte Sedimentation Rate Evolution of mortality over time: results from the COVID‑19 Swiss (ESR), C-reactive protein (CRP), and ferritin. hospital surveillance system (CH‑SUR) Methods: Thirty-one adult hospitalized patients with the non-severe 1,* 1 2 M. Roelens , A. Martin, B. Vidondo on behalf of CH Sur Consortium, COVID-19 were included. LXA4, ESR, and CRP serum levels were col- 1 3 4 5 6 7 A. Thiabaud , A. Iten , A. Cusini , D. Flury , M. Buettcher , F. Zucol , lected on the first day of hospitalization, and LXA4 levels were meas- 8 9 10 11 C. Balmelli , P. Zimmermann, N. Troillet , D. Vuichard‑Gysin , P. ured 48–72 h later as well. Moreover, the maximum serum ferritin level 12 13 14 W. Schreiber , S. Bernhard‑Stirnemann , S. Tschudin‑Sutter , Y. during the five days of following patients was collected. 15 16 17 18 Nussbaumer‑Ochsner , R. Sommerstein , R. Gaudenz , J. M arschall , Results: The mean age of patients was 61.9 ± 17 years, and the male 2 2 2 19 F. Maximiano Sousa , B. Friker , G. Schuepbach , M. Maeusezahl , M. to female ratio was 18:13. LXA4 levels were significantly increased 19 20 19 1 Wymann , S. Harbarth , C. Gardiol , O. Keiser on behalf of CH Sur at 48–72 h compared to the baseline concentrations (9.9 ± 0.7 vs. Consortium 21.7 ± 15.1 ng/L; P < 0.05). The mean baseline concentrations of 1 2 3 University of Geneva, Geneva, University of Bern, Bern, Cantonal Hospi‑ CRP and ESR and the mean maximum concentration of ferritin were 4 5 tal Geneva, Geneva, Cantonal Hospital Graubünden, Chur, Canton Hos‑ 74.7 ± 57.3 mg/L, 55.7 ± 34.4 mm/h, and 568.7 ± 530 ng/mL, respec- 6 7 pital St Gall, St Gall, Cantonal Hospital Lucerne, Lucerne, Cantonal Hos‑ tively. Besides, CRP and ESR levels at the time of admission and 8 9 pital Winterthur, Winterthur, Cantonal Hospital Ticino, Ticino, University maximum ferritin levels during the hospitalization were positively cor- 10 11 of Fribourg, Fribourg, Valais Hospitals, Sion, Thurgau Hospital Group, related to an increase of LXA4 levels (R = 0.499, 0.535, 0.398; P = 0.007, 12 13 Münsterlingen, Zurich University Hospital, Zurich, Children Hospital 0.005, 0.043, respectively). 14 15 Aarau, Aarau, University Hospital Basel, Basel, Cantonal Hospital Conclusion: LXA4 may be a valuable marker to assess the treatment Schaffhausen, Schaffhausen, Hospital Hirslanden Central Switzerland, response compared to ESR, CRP, and ferritin in hospitalized patients 17 18 Lucerne, Cantonal Hospital Nidwalden, Stans, Cantonal Hospital Bern with COVID-19. Furthermore, LXA4 could be considered a potential 19 20 (Insel), Swiss Federal Office Public Health, Bern, University Hospital treatment option in inflammatory conditions. Further studies are nec - Geneva, Geneva, Switzerland essary to clarify LXA4 role in COVID-19 pathogenesis, as well as the Correspondence: M. Roelens balance between such pro-resolving mediators and inflammatory Antimicrobial Resistance & Infection Control 10(1): P309 parameters. Disclosure of Interest: None declared Introduction: The assessment of COVID-19 associated mortality is cru- cial to evaluate the impact of the pandemic and to assess the effec - Poster Session: Public Health issues of COVID‑19 tiveness of measures. Objectives: We aimed to investigate trends in COVID-19 related mor- P311 tality over time in Switzerland, using data from the COVID-19 Hospital- Examining the discourse regarding the delivery of occupational based Surveillance (CH-SUR) database. health and safety training to healthcare workers: a review Methods: Considering four different time periods of COVID-19 epi- of pandemic plans of 23 countries demic, we calculated crude and adjusted mortality rates and per- 1,* 1 1 M. O. Qur eshi , A. Chughtai , H. Seale formed competing risks survival analyses for all patients and for University of New South Wales, Sydney, Australia patients admitted to intensive care (ICU). Correspondence: M. O. Qureshi Results: Overall, 16,967 COVID-19 related hospitalizations and 2,307 Antimicrobial Resistance & Infection Control 10(1): P311 deaths of adult patients were recorded. Crude hospital mortality rates were 15.6% in the 1st and 14.4% in the 2nd wave; for ICU patients it Introduction: COVID-19 pandemic has highlighted gaps in health ser- was 24% and 31.3%, respectively. The overall adjusted risk of death vice responses and has exposed ongoing risks for healthcare providers was lower for hospitalised patients during the 2nd compared to the Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 136 of 140 (HCPs). Mitigating these risks requires multiple measures, including a traveler’s vaccination status, the reduced risk of contagion over time the delivery of pandemic specific occupational health and safety and the country’s prevailing COVID-19 cases. Quarantine duration was (PSOHS) training focused on infection prevention and control (IPC). reduced based on a traveler’s COVID-19 risk profile, his or her country Objectives: This study aimed to compare national and transnational of origin, to encourage compliance and lessen cost of government- pandemic plans and COVID-19 guidelines for the inclusion of PSOHS funded quarantine. (IPC) training, as well as strategies for managing the surge in PPE Conclusion: Quarantine durations was adjusted to in country disease needs and staffing. burden, disease dynamics, the natural history of the disease, COVID- Methods: For this review pandemic plans and COVID-19 (IPC) guide- 19 vaccination status, existence of mutant strains and for efficient lines of the World Health Organization (WHO), the European Centre resources’ use. Countries also wanted to encourage vaccination, test- for Disease Prevention and Control (ECDC) and 23 countries from six ing and boost quarantine guideline’s compliance. A comprehensive WHO defined world regions were reviewed including United States country-specific longitudinal analysis ought to incorporate testing of America, Peru, Chile, Canada from Region of the Americas (PAHO); guidelines and vaccination status for each quarantine duration and Spain, United Kingdom, Italy, Germany from European Region (EURO); each country’s epidemic curve would provide useful information on Nigeria, Algeria from African Region (AFRO); Saudi Arabia, Oman, Bah- best practices. rain, Jordan from Eastern Mediterranean region (EMRO); Bangladesh, Disclosure of Interest: None declared Thailand, Sri Lanka, Myanmar from South-East Asia region (SEARO); China, Singapore, Philippines, Japan and Australia from Western P313 Pacific Region (WPRO). Web‑queries as an evaluation marker for epidemiological Results: The WHO, ECDC and nine countries reported PSOHS (IPC) situation of SARS‑COV‑2 infection in Russia 1,* 1 1 training; however only four discussed training HCPs on correct PPE K. Momynaliev , D. K horoshun, V. Akimkin use; two countries listed strategies to manage the surge in demand, Federal Budget Institution of Science "Central Research Institute but only one country discussed managing the shortage of PPE. None of Epidemiology" of The Federal Service on Customers Rights Protection of the COVID-19 guidelines recommended training HCPs for correct and Human Well‑being Surveillance, Moscow, Russian Federation reuse or extended use of PPE and only one country’s guideline out- Correspondence: K. Momynaliev lined mandatory HCP attendance and delivery of training in a regional Antimicrobial Resistance & Infection Control 10(1): P313 language. Conclusion: Pandemic plans should be revised to include guiding Introduction: In recent years, the study of large amounts of Internet principles regarding the delivery of pandemic specific OHS (IPC) train- data has become a valuable way of monitoring and analyzing public ing, as well as on managing the surge in demand of PPE and HCPs. health behavior. Changes in smell and taste are characteristic symp- There is also a need to provide guidance on when countries should toms of COVID-19, so monitoring dynamics of these queries on the consider reuse and extend use of PPE. This discourse should also be Internet can provide early information on the spread of COVID-19 in reflected in disease specific pandemic guidelines, like COVID-19 (IPC) order to assess the effectiveness of anti-epidemic measures against guidelines. This review may assist international health agencies in sub- COVID-19. sequent guideline updates. Objectives: Evaluation of the usefulness of Internet queries related to Disclosure of Interest: None declared the smell to assess the effectiveness of anti-epidemic measures of pre - vent the spread of COVID-19 in some regions of Russia. P312 Methods: Data on new (confirmed) cases of the disease by weeks Rationale for different quarantine durations during the COVID‑19 in the indicated regions were obtained from the Internet resources pandemichttps:// cтoпкopoнaвиpyc. pф. For the analysis of Internet queries, we 1,* 2 B. K. Burmen , D. bii used the Yandex.Wordstat database of search queries. Searches were Center for Respiratory Disease Research, KENYA MEDICAL RESEARCH analyzed that included the words "smell". Data on were received INSTITUTE, Nairobi, KENYA MEDICAL RESEARCH INSTITUTE, Kisumu, weekly from 16–22.03.2020 to 15–21.02.2021. Kenya Results: A strong temporal relationship has been shown between self- Correspondence: B. K. Burmen reported odor changes (for example, "loss of smell") and new cases of Antimicrobial Resistance & Infection Control 10(1): P312 COVID-19 infection in the studied areas of the Central region of Rus- sia. A correlation was found between the number of queries related Introduction: All contacts of individuals with a confirmed or probable to smell and new confirmed cases of COVID-19 infection: very high for COVID-19 should be quarantined in a designated facility or at home Moscow city (r = 0.96), high for Bryansk and Ryazan regions (r > 0.70), for 14 days from their last exposure. Although shorter quarantine peri- average for Vladimir, Ivanovo, Kaluga, Moscow, Smolensk and Tula ods may lessen health system’s burdens especially when new infec- regions (0.5 < r < 0.7). During the "second wave" of the pandemic tions are rapidly rising, prolonging the quarantine duration could be in Russia, the increase in the number of queries related to the smell prudent for high-risk scenarios and in regions with insufficient test outpaced the increase in the number of new confirmed cases in Mos- resources. cow (city), Moscow (region), Ryazan, Smolensk, Vladimir and Ivanovo Objectives: To describe the rationale for different COVID-19 quaran- regions by 2 weeks, for the Tula region—by 3. For Bryansk and In tine durations during the on-going pandemic in select countries. Kaluga regions, no such dependence was observed. Methods: An online search was conducted to document countries’ Conclusion: The rise in sudden interest in smell among Internet users rationale for different quarantine durations during the ongoing can be seen as a valuable minimally invasive indicator of the spread COVID-19 pandemic. Only countries that stated a quarantine duration of the coronavirus in the population, as well as to assess the effective - and its rationale were eligible for inclusion. A country was stated to ness of anti-epidemic measures against COVID-19. have no quarantine, reduced, or prolonged its COVID-19 quarantine Disclosure of Interest: None declared duration if it recommended 0, 1- < 14, or > 14 days. Country’s names were anonymized based on the focus of this study. P314 Results: Countries that did not impose a quarantine period recom- Alerte infection, a tool for an innovative public management mended self-isolation or quarantine on a case-by-case basis. E.g. of health care professionals to prevent epidemics in the vaud persons who had been at sea for more than 14 days did not have to canton undergo quarantine. Countries that increased their quarantine period 1,* 1 M. K. M. Ku Moroni , C. Petignat found persons testing positive after the recommended 14-day period, Office du Médecin Cantonal, HPCI Vaud, Lausanne, Switzerland identified mutated viral strains, and did so in response to increased Correspondence: M. K. M. Ku Moroni COVID-19 activity. Countries that reduced their quarantine period Antimicrobial Resistance & Infection Control 10(1): P314 based it on the virus’ incubation period, a day 7 COVID-19 test result, Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 137 of 140 Introduction: With a first observation of information problem in epi- approval; RPAS fleet development and testing; custom payload sys- demic cases, it was noted that health care professionals don’t have tem design and fabrication (i.e. refrigerated unit for vaccine delivery); time to get informed by themselves about hygiene hospital news or procedural development (i.e. risk and safety assessments); Detect and protocols last updates. The cantonal unit of Hygiene Prevention and Avoid System testing and refinement; and pilot-testing COVID-19 test Control of Infection in Vaud (HPCi Vaud) in charge of epidemics moni- kit fidelity and remote US functionality. toring in health facilities, worked on a strategy to push in the fastest Results: We have successfully delivered PPE (gloves, gowns, masks) possible way important information to the health care professionals to and COVID-19 test kits. We confirmed that the delivered RNA COVID- prevent diseases’ spread as soon as a situation has been detected. 19 test samples contained no decay in signal or testing capabilities. Objectives: The objective of this public management is to control We also delivered a sanitized Tele-mentored Self-Diagnostic US and epidemics by reducing the communication time in early detection successfully Tele-mentored a patient in performing a proficient self- between Public Health (OMC/HPCi Vaud) and the health care profes- administered US at a remote location. sionals who are main actors on the field, in order to improve their responsiveness in decision or action. The global goal of this Public Health administration is to protect patients in acute care and nursing home residents from infections and communicable diseases in the Vaud canton. Methods: As an information problem. This solution has been man- aged according to communications methods and strategies. On that occasion, the long process of management and communication from public health passing by several intermediaries to reach the health- care workers as been optimised to be shorter with no intermediary. Results: A free mobile application has been released at the end of 2019 for care workers in Vaud health facilities. This app sends HPCI alerts classified by category that users can enable/disable according to their needs. Results of a sample of users showed that over 95,2% say they are more Conclusion: RPAS-based medical delivery models offer an innovative responsive to adapt their decision and action according to the infor- approach to addressing longstanding issues of healthcare access and mation notification, and 83.1% say that the alerts helps to protect equity, and are particularly relevant in the context of COVID-19 and patients and residents. preventing pandemic spread. Conclusion: In the current context of the CoVID-19 pandemic, this Disclosure of Interest: None declared tool has been very useful to communicate as fast as possible with the health care professionals about the details of the patient care and the multiple updates of pandemic recommendations. The effective impact P316 of responsiveness thanks to the tool confirmed by users’ feedback is A public health response to the global COVID‑19 pandemic: very positive.The mobile app has not been yet installed by all the care the Nigerian story, January–May,2020 1,* 1 1 1 1 workers in the Vaud canton and this implicates launching comple- S. C. Mba , C. Dan‑Nwafor , C. Ochu , E. Ilori , J. Oladejo , C. 2 1 2 1 mentary communications and thinking about new improvements. Umeokonkwo , N. Mba , P. Nguku , C. Ihekweazu 1 2 Disclosure of Interest: None declared Nigeria Centre for Disease Control, African Field Epidemiology Network, Abuja, Nigeria Correspondence: S. C. Mba P315 Antimicrobial Resistance & Infection Control 10(1): P316 The use of drones for the delivery of supplies, medical equipment, diagnostic testing, and medical treatments to remote first nations Background: The novel coronavirus disease (COVID-19) was reported communities in Alberta during COVID‑19 in Wuhan China in December 2019. SARS-CoV-2 is of a zoonotic ori- 1 2,3 4 2,3 1 W. Hawkins , B. Baylis , A. Khan , A. Kirkpatrick, K. Whitehead , S. gin and is transmitted between humans via respiratory droplets and 1 1 3 2 2,3,* Moeini , S. Lapointe , B. Berenger , K. Flemons , J. C only fomites. As COVID-19 spread globally, Nigeria instituted its pandemic 1 2 3 Southern Alberta Institute of Technology, University of Calgary, Alberta preparedness measures in January 2020 preceding detection of its Health Services, Stoney Health Services, Calgary, Canada index case on February 28, 2020. We report the emergence of COVID- Correspondence: J. Conly 19 in Nigeria, describing the public health response up till May 2020. Antimicrobial Resistance & Infection Control 10(1): P315 Method: We reviewed the Nigeria’s country-level response to COVID- 19 at the National level from January – May 2020. Introduction: For members of remote Indigenous communities, Results: The national public health response to the COVID-19 pan- accessing healthcare often requires travel to off-reserve locations, demic rapidly progressed from initial containment measures, with which is both burdensome to the individual and increases the risk of early closure of the international airspace and intensive contact contracting COVID-19. Remotely Piloted Aircraft Systems (RPAS), or tracing, to lockdown in high-burden states, closure of schools, non- drones, offer a potentially cost-effective method for reducing that bur - essential businesses, and non-pharmaceutical interventions. A level den and risk by removing geographic barriers and increasing timeli- three EOC was activated, the highest level of response in the country ness and accessibility of supplies, equipment, and remote care. intended for public health measures. Following the ease of lockdown, Objectives: To demonstrate the potential of RPAS-delivered technol- mitigation strategies to address ongoing community transmission ogy and supplies in diagnosis, evaluation, and treatment, including include increased testing, isolating all confirmed cases and tracing RPAS-delivered ultrasound (US) machines; to co-develop governance all contacts. By May 31, 2020, Nigeria had recorded 10,162 confirmed and operating manuals with local Indigenous communities; and to use COVID-19 cases from all but one state, with three states Lagos, Kano this work as a scalable model for fully operational RPAS-based medical and Federal Capital Territory, accounting for 64.5% of the cases. delivery systems. Conclusion: Nigeria launched a swift and aggressive response to Methods: Our team is developing and pilot-testing innovative RPAS- COVID-19, leveraging on its existing epidemic preparedness and learn- based medical delivery solutions at the systems, regulatory, techno- ing from other parts of the globe where transmission began earlier. logical (software and hardware), and procedural levels. This includes Future response efforts are focused on targeted non-pharmaceutical working with Transport Canada for Beyond Visual Line of Sight interventions at sub-national level. Mobilizing local governments, civil Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 138 of 140 society, and citizens to take ownership of these strategies in addition and on the hospitals social media sites. It was also released on music to a cohesive whole-of-government approach is critical to combating streaming platforms. the pandemic in Nigeria. By rapidly implementing this set of interven- Results: The video gained immediate attention and passed 100.000 tions, Nigeria likely slowed down the rate of virus transmission and hits on social media within two days. The media reach was wide for th bought extra time to implement a robust case detection, testing, and a small country as Norway with, currently (May, 25 ), about 236.000 treatment centre capacity. views and 3700 shares on Facebook and almost 40.000 views on You- Key words: COVID-19, Nigeria, Pandemic, Response Tube. It was also referred to in local and national media. Addition- Disclosure of Interest: None declared ally, it also caught attention in Sweden through a popular Instragram account (@dyngbaggegalan) which generated 400.000 views. Through commentary we learned that the song was especially well received by P317 health care workers and among primary school children, although we The COVID‑19 pandemic through the eyes of youth: exploratory do not have data to confirm this in detail. study in Geneva, Switzerland Conclusion: Our song and video promoting the standard WHO hand 1,* 1 1 1 1 1 C. Tuor , R. Rey , P. Bigarella , A. Peters , P. Hudelson , C. Guitart , D. hygiene routine in a fun and memorisable way gained wide attention Pittet and traction both among health care workers and the general public. Faculty of Medicine, Infection Control Programme, and Primary Care Disclosure of Interest: None declared Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland C02 Correspondence: C. Tuor Clean hands, save lives international children`s painting festival Antimicrobial Resistance & Infection Control 10(1): P317 1 2 2 1 2 M. H. Aelami , E. Zerehsaz , S. Khajehnejad , B. Bonyadi , H. Aelami , P. 2 3,* Ghahremani Nejad , A. Mohajeran Introduction: During the SARS-CoV-2 pandemic, youth have Hand Hygiene and Infection Control Research Center Imam Reza accounted for a large share of confirmed cases compared to other age Hospital, MASHHAD UNIVERSITY OF MEDICAL SCIENCES, The institute groups. This has led to portrayals of youth during the pandemic as for the intellectual development of children and young adults of Kho‑ reckless and irresponsible. rasan Razavi, Hand Hygiene and Infection Control Research Center Imam Objectives: The objective of our study was to explore the perceptions Reza Hospital, MASHHAD UNIVERSITY OF MEDICAL SCIENCES, Mashhad, and experiences of youth during the first wave of the SARS-CoV-2 Iran, Islamic Republic Of health crisis, with the aim of providing information useful for adapting Correspondence: A. Mohajeran COVID-19 prevention information and activities aimed at youth. Antimicrobial Resistance & Infection Control 10(1): C02 Methods: We conducted street interviews with a convenience sample of youth in several selected locations in Geneva, Switzerland, and key Abstract video clip description: Hand hygiene is the most important informant interviews with adults who had frequent contact with youth ways for prevention of infections especialy during COVID-19 pan- in Geneva. demic. Painting is the universal language and very popular among Results: We approached 107 youth; 101 (94.4%) participated. We children. We announced an international painting competition about interviewed 101 youth between 15 and 29 years old (51/101 were clean hands save lives from March 15 till July 15 2020. We received female) and 8 key informants. Eight respondents reported having 8452 paintings from 29 countries of different continents. Selected been previously tested for COVID-19, two because of family contact paintings of this festival act in this clip to show importance of hand tested postitive for COVID-19. Only one respondent reported a fam- hygiene and role of health care workers in COVID-19 pandemic. ily member being hospitalized for COVID-19. The average duration Disclosure of Interest: None declared of the interview was 10 min. Most youth in our study did not fear for their own health but did worry about their family and loved ones. They C03 described the emotional and behavioral impact of the pandemic and Combating antimicrobial resistance through research of misinformation about COVID-19. and community engagement in Nigeria Conclusion: Our study results challenge some of the preconceived 1,* 2 I. Yusuf , S. Umar ideas about youth during COVID-19, and illustrate their difficulties and 1 2 Microbiology, Bayero University, Kano, Kano, Chemistry, Federal Univer‑ concerns during the pandemic. sity Dutsimma, Dutsimma, Katsina, Nigeria Disclosure of Interest: None declared Correspondence: I. Yusuf Antimicrobial Resistance & Infection Control 10(1): C03 Video Clip Award Abstract video clip description: Dr Yusuf and his colleagues have C01 conducted scientific surveys revealing the appearance and spread of DR. Radtke’s routine (karusell (DR. Radtkes Metode)) disease-causing antibiotic-resistant bacteria in local communities with 1 2,* 1 1 1 E. F. Snøfugl , A. Radtke , K. H. McDonagh , C. O. Kalland , N. Lian Kano State, Nigeria through a new initiative. The initiative developed 1 2 Department of communications, Unit for Infection Control, St. Olavs new model to sensitize and engage students on antimicrobial resist- hospital HF, Trondheim University Hospital, Trondheim, Norway ance research and communicating the research to the needed com- Correspondence: A. Radtke munity. Key to this initiative is that students and community members Antimicrobial Resistance & Infection Control 10(1): C01 are recruited to help spread the message, and educate others in the community, who may not otherwise listen. Abstract video clip description: Objective: The initiative aimed at safeguarding the efficacy of antibi- Introduction: In order to promote hand hygiene at St. Olavs Hospital otics through research and community engagement for prudent use a song and video were composed, recorded and filmed by the Depart - of antibiotic. ment of communications in cooperation with the Unit for Infection Methodology: The initiative involves conducting community specific Control. research and travel into the community to educate community lead- Methods: The song and video focused mainly on the technique of ers, who influence others in their towns and villages, particularly sell- applying and distributing disinfectant to the hands. The different ers and hawkers of illicit or fake antibiotics. It also involve travelling steps of the routine, detailed in WHO guidelines, were given names to remote farming communities, speaking directly with farmers who and represent the chorus of the song. The chorus lasts 30 s, and, if either give antibiotics to their livestock, or take antibiotics wrongly memorized, will give guidance for the right steps and duration for cor- believing they may act as painkillers. rect hand rub. The launch of the video was carefully planned for World 1. Local/specific researches on drivers of AMR in human, animal and th Hand Hygiene Day (May, 5 2021) both on the hospitals intranet page environments Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 139 of 140 C05 2. Community engagements on prudent use of antibiotics based on Role of infection control in a tertiary teaching hospital research findings 1,* 1,2,3 1 S. Z. Mohamad Razali , S. Sri La Sri Ponnampalavanar , I. N. Ismail 3. Dissemination of AMR research findings through various channels 1 2 Infection Control, University Malaya Medical Centre, Medicine, Univer‑ such as seminar, conferences, symposium, clubs, debates in secondary sity of Malaya, Infectious Disease Unit, University Malaya Medical Centre, schools Lembah Pantai, Malaysia Results: The initiative has achieved the following results in the last Correspondence: S. Z. Mohamad Razali 6 months Antimicrobial Resistance & Infection Control 10(1): C05 1. Direct engagement of literate and illiterate persons in sharing of AMR news in plain language Abstract video clip description: Infection prevention and control 2. Development of skills of students in AMR research and findings (IPC) is a practical, evidence-based approach which prevents patients dissemination and healthcare workers (HCW) from being harmed by avoidable infec- 3. Development of student’s presentation and engagement skills tion. The role of tertiary university hospital is to strengthen the IPC 4. Involvement of non science students of university and secondary among all category of HCW, students and public using a multimodal schools in AMR knowledge and sharing approach such as education and training, competency assessment, 5. Communicating AMR knowledge to the grass root community self-directed learning via online module, video demonstrations and members that abuse antibiotics most campaigns. This video is a compilation of the IPC measures done Conclusion: Communicating data of abuse and resistance to the in University Malaya Medical Centre to promote IPC measures and grass root community members in language they understand is patient safety to reduce the risk of acquiring and transmitting health- yielding positive result in fighting antibiotic misuse and resistance care associated infections (HAI). Among the activities done are surveil- development lance for multidrug resistant organisms (MDROs), environment and Disclosure of Interest: None declared cleaning, HCAI, hand hygiene, operation theatre audit, surgical site infections (SSIs), reprocessing of endoscopes, and blood stream infec- C04 tions. There is also continuous education and training provided for all An awareness about antimicrobial intake and antimicrobial category of HCW to educate and increase awareness of the burden of resistance among geriatric population in Chennai city 1,* HCAI on the healthcare system. UMMC has won the APSIC Safe Surgery R. C 1 Award 2018 for the SSIs quality improvement project. We also have public health dentistry, ragas dental college and hospital, chennai, India been selected as a finalist for 2021 Hand Hygiene Excellence Award. Correspondence: R. C The role of antimicrobial stewardship program also plays an important Antimicrobial Resistance & Infection Control 10(1): C04 role in reducing the burden of HCAI. To increase the awareness among HCWs, we organized Antibiotic Awareness Week campaign and had a Abstract video clip description: The devastating threat of antimi- soft launching of UMMC Antibiotic Guideline Edition 2020 which can crobial resistance (AMR) to global human health is unquestionable. be accessed online via the staff portal. Apart from that, video demon- The difficult-to-treat AMR infections require longer hospital stays and strations related to personal protective equipment and hand hygiene more costly treatment, increase morbidity and mortality, and reduce are also made available online as a reference for the HCWs. productivity; therefore, increasing the economic burden of the coun- Disclosure of Interest: None declared tries. The major contributing factors of AMR are known to be overuse and misuse of antimicrobials. Antibiotics are commonly prescribed among older adults, and inappropriate use of antibiotics has been C06 noted. Antibiotic consumption by the elderly population was found Infection prevention and control: the role of insourcing to be between 11 to 45%, with a significant rise over the past dec - 1,* 1 1 1 O. Orlova , O. K arpov, N. Yumtsunova , A. Zotova ade. Healthcare providers face challenges in adequately diagnosing Pirogov National Medical and Surgical Center, Moscow, Russian Federation and managing infections in this vulnerable population because of the Correspondence: O. Orlova altered drug metabolism in this particular group. Nursing homes or Antimicrobial Resistance & Infection Control 10(1): C06 long term care facilities were found to be a reservoir for AMR patho- gens due to excessive, inappropriate and prolonged broad-spectrum Abstract video clip description: antimicrobial use, inadequate infection control and increased risk of Introduction: Complex of disinfection measures which includes rou- pathogen colonization. It is therefore important that both healthcare tine and general cleaning, plays an important role in interrupting the professionals and the public know the threat antimicrobial resistance direct transmission of infection diseases pathogens which are often poses and the individual actions they can take to combat antimicro- present on the environmental surfaces surrounding patients. bial resistance. Objective: Determine the role of insourcing in the prevention of infec- The objective of this video is to assess the awareness about antimicro- tious diseases. bial intake and antimicrobial resistance among geriatric population in Methods: The analysis of the insourcing multi-modal program results has Chennai city. A questionaire was adapted from validated surveys that been carried out in a large multidisciplinary medical center with 602 beds were previously used and tailored to suit the local population and in the following units with high epidemiological risk: hematology unit, assure its applicability and modifications were made as necessary so intensive care unit, operation rooms. Moreover, the microbiological con- that the questionnaire was simple to understand and answer, yet gave tamination of highly sensitive objects (HTO) in the hospital environment, accurate data. Informed consent was obtained from all participants. which are a source of contamination for personnel and their hands, was In the present video, widespread use of antibiotics was reported, assessed. The thoroughness of cleaning was also monitored using fluo - most of the antibiotics were being accessed without prescription. rescent labels. The costs on purchasing disinfectants have been analyzed. Respondents displayed poor knowledge particularly in regard to the Results: With the usual bucket method cleaning (i.e. 2015 – 2017 years), role of antibiotics in minor viral illness. Participants had poor attitude the level of microbial contamination was 8,4 ± 8,1%. The consumption toward the use of antibiotics for cold and sore throat. There were also of disinfectant solution (per day) was 1169 L. At the beginning the base- significant malpractices such as failing to take full dose, purchasing line level result of cleaning the fluorescent marks in operation rooms antibiotics without prescription. Hence, educational interventions on was 65,90 ± 29,75%. After one month of the program implementation antibiotics use and its association with drug resistance are needed to and training of the hospital staff, the second audit showed that the level promote judicious use of antibiotic. of cleaning improved to 83,63 ± 20,83% (p = 0,02). As a result of the Disclosure of Interest: None declared Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 Page 140 of 140 Abstract video clip description: This video Clip demonstrated hand multi-modal program implementation, the consumption of disinfectant hygiene compaign for patients and their relatives in Cho Ray hospital. solution decreased to 223,8 L (per day). The average monthly consumption Patients recieved treatment in Vietnam and Cho Ray hospital usually take of disinfectant solution was reduced by 5,22 times to 6 714 L per month part in not only healthcare worker but also a lot of people from their fam- (p = 0,18). The proportion of microbial contamination of environmental ilies. Therefore, improvement of knowledge hand hygiene for patients surfaces in the units with high epidemiological risk decreased to 6,7 ± 5,4% and their families are very important in Vietnam and Cho Ray hospital to in 2018 – 2020 years. reduce healthcare associated infection. This Clip is really effect to enhace Conclusion. The usage of the proposed non-bucket cleaning system hand hygiene compliance in Cho Ray hospital up to 81% in recent year. allows not only faster and better to execute planned measures for dis- Disclosure of Interest: None declared infection of the environmental surfaces in hospitals, to improve clinical, operational and financial metrics, but also to monitor quality of hospital staff’s work and discipline.metrics, but also to monitor quality of hospital C09 staff ’s work and discipline. COVID‑19 prevention im your wokplace 1,* 2 2 2 2 2 Disclosure of Interest: None declared R. S. Al Azmi , S. Al Zayani , H. saleh , A. Ahmed , A. Nasser, T. khairallah , 2 2 T. t , M. M 1 2 Infection Prevention & Control, Media Center, Eastern Health Cluster, C07 dammam, Saudi Arabia Applying the who multimodal strategy for successful infection Correspondence: R. S. Al Azmi prevention improvements in healthcare! 1,* 1 2 1 Antimicrobial Resistance & Infection Control 10(1): C09 Y. F. Lee , H. U. Ngian , Z. H. Chin , H. H. Chua , S. Sri La 3 4 5 5 6 Ponnampalavanar , T. S. Chow , J. A. K. Lam , K. S. Chai , S. Amir Husin 1 2 Abstract video clip description: Neglecting the infection control measure Sarawak General Hospital, Sarawak State Health Department, Kuching, 3 4 5 during COVID-19 pandemic at workplace from the employee like not dis- Universiti Malaya, Kuala Lumpur, Hospital Pulau Pinang, Penang, Malay‑ close having respiratory symptoms before showing to work, sharing per- sia Red Crescent Society, Sarawak, Infection Prevention & Control Unit, sonal items, not wearing the mask all time or follow cough etiquette and MoH, Putrajaya, Malaysia social distances. lead to transmit the infection among the healthcare work- Correspondence: Y. F. Lee ers, result to be infected and expose to an infected case. Antimicrobial Resistance & Infection Control 10(1): C07 Objective: Motivate the awareness of COVID-19 Prevention measures at Workplace Abstract video clip description: Healthcare-associated infections have Disclosure of Interest: None declared affected hundreds of millions of individuals worldwide, leading to signifi- cant mortality, particularly in resource-limited countries. This video dem- onstrates the application of the World Health Organization multimodal strategy in hand hygiene for successful infection prevention improvement in healthcare settings, by providing examplary action plans on the five key Publisher’s Note collaborative strategies, namely by, (1) ’Building it’ with System Change, (2) Springer Nature remains neutral with regard to jurisdictional claims in pub‑ ’Teaching it’ with Training and Education, (3) ’Checking it’ with Evaluation lished maps and institutional affiliations. and Feedback, (4) ’Selling it’ with Reminers in Workplace, and (5) ’Living it’ for Instititutional Safety Climate, to improve and sustain infection preven- tion and control across different cultures and geographic regions. Disclosure of Interest: None declared C08 How to COVID‑19 pandemic infection control and prevention in Cho Ray hospital, Vietnam 1,* 2 T. M. Phung Manh , T. Nguyen Tri 1 2 Infection Control, Arrhythmia, CHO RAY HOSPITAL, Ho Chi Minh city, Viet Nam Correspondence: T. M. Phung Manh Antimicrobial Resistance & Infection Control 10(1): C08
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