Part of Thermo Fisher Scientific
13 August 2007
Packed House for 4th Annual Oxoid Infection Control Seminar
Oxoid recently hosted the 4th Oxoid Infection Control Seminar Day in the UK. This annual event, which is provided free of charge to microbiologists, laboratory staff and infection control professionals from around the UK, was attended by over 100 delegates who gathered to hear the latest thinking and current opinion on infection control concerns and practices. During coffee and lunch, delegates also had the opportunity to network with the seminar speakers and colleagues from other hospitals.
The morning seminar session started with a presentation by Dr Tom Lewis, Specialist Registrar at Heartlands Hospital, Birmingham, who spoke on the subject of “Cleaning and Setting Standards for Cleanliness”. Dr Lewis opened his presentation by commenting that patients now cite fear of hospital-acquired infection as a major cause of concern and that staff morale is often low in wards with poor cleaning standards – situations of obvious concern for infection control professionals. He explained that there is a body of evidence to suggest that improvements to cleaning show subsequent reductions in infection rates for MRSA, Clostridium difficile, vancomycin-resistant enterococci (VRE) and Norovirus. The presentation then focused on how a cleaning assessment tool was vital to any cleaning regime. Dr Lewis spoke of the many challenges associated with visual and microbiological assessments, and went on to describe how cleaning protocols can improve outcomes as demonstrated in a study at Walgrave Hospital, Coventry. Conclusions showed that bad cleaning may be worse than no cleaning (ie the organism may actually be spread rather than removed) and that visual inspection does not predict the level of environmental contamination, but that it is possible to devise simple and effective cleaning regimes that will reduce rates of hospital-acquired infection.
Next, Dr Ben Lopman, Head of Viral Infection in the Gastrointestinal Diseases Division, Health Protection Agency, spoke on “Norovirus outbreaks in hospitals: epidemiology, economics and control”. This presentation described The Avon Study, which took place at 3 NHS Trusts in 2002/03, that set out to determine the incidence of outbreaks of gastroenteritis in hospitals to estimate both the health impact and the economic burden of such outbreaks. The survey also identified the characteristics of wards prone to outbreaks and quantified the impact of ward closure as an infection control measure. Dr Lopman gave delegates a comprehensive explanation of the study results and concluded that norovirus was detected in 85% of gastroenteritis outbreaks studied, that these outbreaks affected 1 in 50 NHS patients and 1 in 6 NHS care staff, and that gastroenteritis outbreaks were a highly significant cost to the health sector, coming only second to UTI infections as the most costly hospital-acquired infection1. The latter part of the presentation covered the prevalent epidemiological factors for food-borne viruses during the study period. It was noted that a new norovirus variant had emerged and spread rapidly through Europe and it was shown that the economic burden of norovirus is amplified in epidemic years. Dr Lopman concluded that investigation of norovirus outbreaks is necessary to both control the outbreak and to understand the biology of noroviruses.
The morning session was brought to a close by Dr Jim Gray, Head of Enteric Virus Unit, Colindale, Health Protection Agency, who spoke on “Norovirus: Virus detection, diversity and epidemiology”. Dr Gray explained that Norovirus immunity is not sterilising and protective immunity can be as short-lived as 6 months. He stated that evidence showed that children are a huge reservoir of Norovirus infection in the community and that asymptomatic infection can mean that the virus is excreted while the host has no symptoms. Some specific outbreaks, and the methods of detection used during the outbreaks, were then cited. Dr Gray also presented figures drawn from a study monitoring the environment for gastroenteric viruses within a paediatric Primary Immunodeficiency Unit where it was concluded that human astroviruses, noroviruses and rotaviruses were detected as environmental contaminants in the unit, that all viruses were excreted by one or more patients, that infections were predominantly asymptomatic and that the unit was not free from viral contamination for the 6 month duration of the study. In conclusion, Dr Gray emphasized the importance of control measures such as ward closure to contain and limit outbreaks.
After lunch, Dr Tim Wreghitt, Regional Microbiologist, Neil Bentley, Deputy Laboratory Manager and Rachel Thaxter, Infection Control Nurse, of Addenbrookes Hospital, Cambridge, spoke about their work for the Medical Support in Romania charity and in particular about the trip they had made in 2006. This moving, and at times shocking, presentation showed the paucity of resources in Romania, but emphasized how the knowledge and best practice imparted by those who participate in the charity’s work is truly appreciated by the Romanian hospitals’ staff, leading to improvements in infection control practice, better outcomes for patients and less risk for laboratory staff. The charity also regularly presents to the Romanian government to influence, at high level, policies and procedures in infection prevention and control. At the end of the presentation, Dr Wreghitt invited anyone willing to give their time to the charity to contact him via Addenbrooke’s Hospital.
The last two sessions of the afternoon focussed on Clostridium difficile. Dr Jean O’Driscoll, Consultant Microbiologist, Stoke Mandeville Hospital, spoke about the much publicised 027 C. difficile cases at Stoke Mandeville, and this was followed by a presentation from Professor Ian Poxton, Professor of Microbial Infection and Immunity and Chair of the European Study Group for Clostridium difficile. These sessions looked at the scale of the problem, the pathogenesis, bacterial and clinical features of the disease, the importance of including both Toxin A- and B+ in any diagnostic procedure, outbreak control measures, antibiotic selection and use, and hyper-virulent strains. Dr Poxton concluded the day by stressing the importance of culture in the diagnostic process, in particular for archive strains in case of outbreaks.
1. Plowman et al, JHI, 2001.