P13.07 Low Nosocomial Transmission Rate of C. Difficile (CD) in a University Hospital with High CD Infection Incidences

s, 7th International Conference of the Hospital Infection Society, 10–13 October 2010, Liverpool, UK / Journal of Hospital Infection 76S1 (2010) S1–S90 S43 57% (11/21) were not or could not remember. 48% (10/21) received information about CDI from a medical professional. 48% (10/21) observed doctors and nurses regularly wash their hands with soap and water after patient contact. 43% (9/21) confirm that gloves and aprons were worn while 43% (9/21) can not recall. Key statements in patients’ own words include: “I lack information and knowledge about my illness”; “distressful experience,”; “unpleasant”; “The nurses & doctors are so caring”; etc. Conclusion: Blackpool Victoria Hospital has an effective CDI containment programme – 58% reduction (0.47/1000 bed days from 1.13/1000 beddays in 2007–08). High emphasis to quality of care, patient safety and experience. This study was carried out to inform, refine and improve the programme with special emphasis to raising patient experience and re-assurance. Details to be presented. P13.06 Germinate to exterminate: a novel way of eliminating Clostridium difficile spores L. Wheeldon, T. Worthington, P.A. Lambert. Aston University, United Kingdom Background: Clostridium difficile is still a leading cause of nosocomial diarrhoea in the UK. A contributing factor is the persistence of C. difficile spores on surfaces in the clinical environment and their resistance to common antimicrobials. However, it is well documented that germinating spores are more susceptible to antimicrobials. This investigation aimed to determine which agents initiate germination of C. difficile spores and assess the susceptibility of spores following exposure to the germinant(s). Objectives: The efficacy of 19 amino acids to act as co-germinants with sodium taurocholate for C. difficile spores was investigated together with the susceptibility of germinating spores to benzyl alcohol (BZA) and benzalkonium chloride (BKC). Methods: C. difficile spore suspensions were incubated with a germinant solution, containing 6.9mM (w/v) sodium taurocholate (ST), 0.2% (w/v) glycine and an additional amino acid at 0.2% (w/v). After aerobic incubation at room temperature for 1 hour, solutions were heat shocked (to kill germinated cells) or chilled on ice to determine the proportion of germinated spores. Amino acids with the greatest co-germination potential were combined in solution with ST, BZA and BKC. The efficacy of this solution to germinate and eliminate C. difficile spores was then determined using the same method. Results: A number of amino acids, including valine, alanine, arginine, histidine and aspartic acid demonstrated co-germination potential for C. difficile spores when combined with glycine and ST. A solution containing these amino acids, ST, BKC and BZA produced up to a 3 log (99.9%) reduction in C. difficile spores in 1 hour, both with and without heat shocking. Conclusion: These findings enhance current knowledge regarding agents required for effective germination and subsequent elimination of C. difficile spores. These results may be utilised in the development of a novel germination solution to eliminate the spores of C. difficile. P13.07 Low nosocomial transmission rate of C. difficile (CD) in a university hospital with high CD infection incidences F. Mattner, I. Winterfeld, E. Kramme, M. Martin. Universitatsklinikum Witten-Herdecke, Germany; Universitatsklinikum Schleswig-Holstein, Germany; Universitatsklinikum Freiburg, Germany Background: Nosocomial aquired C. difficile infection (CDI) has been recognized to belong to one of the most important emerging hospital-acquired infections over the last years. In a university hospital in Germany a high incidence of CDI (0.98 per 1000 patient days) was observed. In 2007 a bundle of preventive measures comprising use of sporicidal disinfectants, single room isolation, wearing gloves and gowns, implementation of a prospective surveillance of all CDI patients and addition of a sensitive culture method were introduced. Objective: To determine to which proportion C. difficile was transmitted during hospital stay under intensified isolation precautions. Patients and Methods: Between 1.1.2008 and 11.7.2008 all loose stool samples sent to the microbiological laboratory were tested for toxin A/B and toxigenic culture. 233 patients showed toxigenic cultures. All isolated strains were typed by pulsed-field-gelelectrophoresis (PFGE) (Sma I digest). Comparison of PFGE-patterns was performed using GelCompar software. 85% similiarity index (Dice-correlation) was used as the limit for strain identity. Patients with identical strains were investigated for epidemiologic relation. If treated in the same unit during a time-frame of 14 days or less nosocomial transmission between patients was assumed. Results: All isolates were typable by PFGE and yielded to 86 different PFGE patterns. 99 (42%) isolates belonged to one unique strain. The pattern of ribotyp 027 was not found in the set of investigated consecutive strains. 10 (4.2%) transmissions occurring in small clusters involving 2 to 4 patients were identified. Patients of all other pairor group-wise identical isolates had no spatial or temporal relation. Discussion: Under intensified isolation precautions and no change of antibiotic use we observed a CDI transmission rate of not more than 4.2%. To further control CDI an antibiotic stewardship should be introduced in future. P13.08 A comparison of the PCR-ribotype distribution of Clostridium difficile in primary care and hospital settings K.V. Patel, M.R.J. Clokie, D.J. Malik, G. Shama. University of Leicester, United Kingdom; Loughborough University, United Kingdom Background: Clostridium difficile is a leading and potentially fatal cause of antibiotic-associated diarrhoea and pseudomembranous colitis in the UK. In recent years, there has also been an increase in community acquired disease. Currently, C. difficile is detected in patients by using an ELISA test which identifies the presence the toxin A and/or toxin B which it commonly encodes. Strain typing is not routinely performed on patients, but surveys on strains carried by patients have suggested the recent emergence of ribotype 027 amongst hospital patients is associated with more severe disease. The strain typing method of choice throughout the UK is PCR ribotyping which is generally carried out on a conventional agarose gel-based system. Early reports however have suggested capillarybased PCR-ribotyping has advantages over standard techniques in terms of reproducibility, discriminatory power, accuracy and standardisation. Aims: This study aims to determine the distribution and ribotype of C. difficile strains isolated from patients in hospital and community settings. Methods: The patient cohort represents all the patients who presented with C. difficile within the UHL health trust from May – November 2009. The ribotypes of this patient set were determined using both capillary and gel based systems. Data are analysed to characterise the respective ribotype distributions of community and hospital-acquired disease. Results: A significant proportion of these samples appear to be ribotype 027. Conclusion: Additional analysis into the collection sites of the samples provides an insight into strain prevalence and transmission in an epidemiological context.