key: cord-0995082-lw2d7w76
authors: nan
title: Abstracts from the 6th international conference on prevention & infection control (ICPIC 2021)
date: 2021-09-03
journal: Antimicrob Resist Infect Control
DOI: 10.1186/s13756-021-00974-z
sha: b07dcc288d5d83847f9cca8fa0ddd10c5f19180b
doc_id: 995082
cord_uid: lw2d7w76

nan

to internal controls. After recovery, skin biopsies were taken and nitro blue tetrazolium (NBT) staining was applied to check viability of skin cells via mitochondrial activity. TUNEL stain revealed the presence of apoptotic skin cells.

The results showed that PDI created an improved MRSA reduction on skin of around 99.99%. Staining of the tissue revealed no noteworthy apoptosis or lack in mitochondrial activity of the human cells due to the application of the photodynamically active hydrogel. Conclusion: PDI should represent an easy, quick and efficient method to decolonize human skin from MRSA. The results of the study are remarkable, as substances on skin like inorganic ions or small organic molecules such as histidine are capable to inhibit the photodynamic efficacy. Since PDI is known to eradicate a large set of pathogens independent of their antibiotic resistance profiles, this new technology should be tested in clinical studies in the near future. Disclosure of Interest: None declared. 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 bacteria 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. 

We built a stochastic compartmental transmission model of SARS-CoV-2 in a 24-ward LTCF, accounting for the various infection states among patients and staff and between-ward connections resulting from staff sharing. The model was specifically parametrized to mimic detailed data from a psychiatric hospital in Western France. We first evaluated the potential of hospital-wide diffusion of local outbreaks. We then assessed control strategies, including a screening area upon patient admission, an isolation ward for COVID-positive patients and changes in staff schedules to 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 healthcare 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.

Our findings highlight the importance of diligent monitoring of COVID-19 transmission in LTCFs and hospitals, which host fragile patients. In particular, hospital-level work organization plays a significant role in driving the spread of infection and should not be overlooked when designing surveillance and control strategies. Disclosure of Interest: None declared. Introduction: Antigen rapid diagnostic testing (Ag-RDT) is more affordable and less logistically demanding than RT-PCR for SARS-CoV-2 surveillance, but less diagnostically sensitive. This trade-off has fuelled debate about whether Ag-RDT convenience outweighs elevated risk of false negative diagnoses. Objectives: To evaluate the public health performance of reactive population screening using Ag-RDT in response to emerging nosocomial SARS-CoV-2 outbreaks. Methods: We simulated SARS-CoV-2 outbreaks across a range of long-term care facilities (LTCFs) with different Covid-19 interventions in place (social distancing, face masks, vaccination). Assuming that individuals with true positive test results were isolated and no longer transmitted, we evaluated performance of routine RT-PCR testing (tests for all individuals with Covid-19 symptoms and all new hospital admissions) and reactive mass screening using Ag-RDT (population-wide testing upon outbreak detection). Imperfect and time-varying diagnostic sensitivity was accounted for. We reported efficacy as the proportion of nosocomial infections averted in the two weeks following outbreak detection, and efficiency as the number of nosocomial infections averted per 1,000 tests used.

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.

For LTCFs alerted to potential SARS-CoV-2 outbreaks, reactive mass Ag-RDT screening is an effective means to detect asymptomatic and pre-symptomatic infections and limit subsequent nosocomial transmission. 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%). Furthermore, 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.

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 occupational (vs. community) exposure for COVID-19 acquisition among employees of a university affiliated LTCF in Switzerland, from March to June 2020. Methods: This is a prospective cohort study with a nested analysis of a COVID-19 seroprevalence study among LTCF staff. We performed Poisson regression to determine risk factors for seropositivity and to measure the influence of community vs. nosocomial exposure to COVID-19 on SARS-CoV-2 seropositivity using adjusted prevalence ratios (aPR). In addition, we conducted a COVID-19 outbreak investigation in a LTCF ward using both epidemiological and genetic sequencing data. We constructed a maximum likelihood phylogenetic tree and evaluated strain relatedness to discriminate between community-vs. hospital-acquired infections among employees. Results: Among 285 LTCF employees, we included 176 participants in the seroprevalence study, of whom 30 (17%) became seropositive for SARS-CoV-2. The majority (141/176, 80%) were healthcare workers and had ≥ 1 symptom compatible with COVID-19 (127/167, 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 SARS-CoV-2 positive person in the community (aPR 1.7; 95%CI 0.8-3.5). Among 18 employees included in the outbreak investigation, phylogenetic analysis suggests that 8 (44%) acquired their infection in the community.

During the first pandemic wave, there was a high burden of COVID-19 among LTCF employees. Both occupational and community exposures contributed to seropositivity and infection risk. These data may allow to better assess occupational health hazards and related legal implications during the COVID-19 pandemic. Disclosure of Interest: None declared.

LTCF specificities regarding distribution of tests, admission and discharge. We also assessed the change in transmission risk after the implementation of contact precautions.

We found that a model considering two separate time periods characterized by their own transmission rate, was better supported by the data. In the first period the rate was estimated at 1.3 (95% confidence interval 0.8-2.4) infections per patient per day in symptomatic infection, corresponding to an R 0 of 8.7 (5. [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] . 3) , and 0.19 (0.10-0.30) in the second phase corresponding to an R 0 of 1.3 (0.7-2.0). These results are consistent with a short period of high transmission, during which hospital members were not aware of ongoing transmission, followed by a moderate transmission rate following implementation of obligatory mask-wearing. Under this assumption, the contact precautions introduced had 85% effectiveness in reducing transmission. We also found substantial heterogeneity in transmission among individual wards. Conclusion: These results provide estimates for nosocomial transmission rates within a healthcare setting containing vulnerable patients, and indicate the efficacy of preventive measures. The model can be readily extended to other datasets. Disclosure of Interest: None declared. To ensure optimal adherence to COVID-19-specific IPC practices, there is a need to understand the factors that influencing them. Objectives: To identify and explain factors that influence the compliance to COVID-19 specific IPC measures among HCWs in LTCFs in Finland.

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 respondent and LTCF as well as behaviour factors. The link to the anonymous survey was distributed to the LTCFs through regional IPC experts and authorities. The outcome was modeled using both ordinary logistic regression and penalized ridge logistic regression using regrouped explanatory variables and original more correlated set of explanatory variables, respectively. The in-depth interviews were conducted by using a semi-structured guide. The subjects were recruited from those who participate in the survey. The interviews were conducted between January and February 2021. Data was analysed thematically using NVIVO12. Introduction: Preoperative skin antisepsis is an established infection control procedure to prevent surgical site infections (SSIs) The choice of antiseptic agent-chlorhexidine (CHX) or iodine (PI) remains matter of debate:

Objectives: To compare rates of surgical site infections after preparation of the skin with alcoholic soluttion with either PVP iodine or Chlorhexidine. Methods: In this multicenter, cluster-randomized, triple -blinded, randomized, controlled trial, we compared the rate of SSIs after preparation of the skin with alcoholic solutions with either CHX or PI. The primary outcome was SSIs within 30 days after abdominal, and one year after cardiac surgery, using CDC definitions. Results: From September 2017 through June 2020, a total of 3321patients from three university hospitals were enrolled: 1155 to PI vs 1011 assigned to CHX. SSIs were diagnosed overall in 80 (5.1%) patients in the PI group vs 97 (5.5%) in the CHX group (relative risk [CI 95 0.92, 0.69-1.23], 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] . The cluster-randomized trial WACH ("SSI and Antibiotics Use in Surgery", 2018-20; German Clinical Trials Register-ID: DRKS00015502) aimed at improving SSI-preventive compliance by adapting the psychological tailoring approach of the PSYGIENE-trial (DRKS00010960) from interventions addressing clinical staff to infection prevention and control (IPC) teams and other stakeholders in non-university hospitals. Methods: After briefing, in each of N = 6 hospitals in-house staff observed compliance for 14 measures in N = 1034 ward rounds and N = 905 surgical procedures (general/visceral and/or orthopedic/trauma surgery) before and after a 3-4 months intervention ("tailoring"-arm) or "usual practice" period. Interventions consisted of written reports and 2-day IPC-workshops incl. coaching, and were tailored based on appraisals of compliance and its determinants (COM-B [1] ) using mixed methods. Data analysis (cluster-level) were performed using OpenEpi 3.01 for compliance estimations, chi-square and Breslow-Day tests. Results: In the "tailoring"-arm, a compliance increase was observed for all measures (mean: 11%), with p < 0.05 in 11 cases. However, for 7 measures baseline rates were lower than in the "usual practice"-arm, in which 1 in-and 3 decreases were significant. Given similar baseline, "tailoring" was superior for hand hygiene during ward rounds (+ 12% vs. + 3%; interaction: p = 0.007) and wearing surgical cap (+ 22% vs. -13%; p < 0.001). For perioperative antibiotic prophylaxis, the interaction was significant (+ 5 vs. -5; p = 0.038). Conclusion: Adapting psychological tailoring to IPC teams in non-university hospitals to promote SSI-preventive compliance showed mixed results partly due to lower baselines in the "tailoring"-arm. Also, hand hygiene tended to be emphasized in the interventions and by their addressees, possibly explaining the positive result. This suggests stricter use of bundles within multimodal strategies. Introduction: Cutibacterium acnes is the hallmark pathogen of healthcare-associated deep surgical site infections (SSI) after shoulder surgery. Objectives: We investigate a topical acne cream to reduce the subcutaneous Cutibacterium acnes in open elective shoulder surgery. The Benzoyl Peroxide-Miconazole Nitrate-cream for acne vulgaris reduces the superficial C. acnes burden, which is the main pathogen of shoulder infections. However, the preventive potential of the cream against SSI in shoulder surgery remains unknown. Methods: We performed a prospective-randomized pilot trial allocating 60 adult patients (1:1) between a 7-days-preoperative application 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 performed deep subcutaneous and capsular samples during shoulder surgery. Registration: Switzerland BASEC 2018-01510; International NCT03949751.

We included 60 patients (mean age 59 years, 55% females) with primary open shoulder surgery (17 Latarjet procedures, 43 arthroplasties) in the study. At baseline, both randomized groups revealed the presence of C. acnes on the skin to 60% (18/30 in the intervention group; 19/30 in the controls; p = 0.79). In the patients with C. acnes skin colonization, the intervention resulted in a significant reduction of the number of positive intraoperative samples compared to the control group (8/18 vs. 16/19; p = 0.01); including regarding the capsular samples (0/18 vs. 4/19; p = 0.04). There were no surgical site infection (SSI) in either group after a mean clinical follow-up of eleven months. The cream was well tolerated. Conclusion: The topical 7 days-preoperative skin application of a commercial acne cream (Benzoyl Peroxide and Miconazole Nitrate) was well tolerated and substantially reduced the intraoperative C. acnes-load in 56% of the patients of the intervention group. Our findings represent a strong rationale for its use as a prevention against SSIs in shoulder surgery. Confirmatory clinical experience and further research are needed. Disclosure of Interest: None declared. Introduction: A preoperative shower is recommended before surgery to prevent surgical site infection (SSI). Objectives: To characterize the benefit of SSI prevention associated with antimicrobial soap (AS), we modelled the use of AS in a University Hospital (UH) in orderto characterize its impact in terms of SSI and its cost compared to shower with a placebo. Methods: The occurrence of SSI and the potentials saving made by patients undergoing AS shower before surgery at a UH was modelled using a decision tree approach. SSI rates, by type and Altemeier classification, were based on healthcare infection database. The impact of AS shower on the risk of SSI was based on a multivariate meta-analysis comparing antiseptic shower vs. shower with a placebo. Baseline mortality for patients undergoing procedures, additional risk of death in patients with SSI and cost of SSI management, including additional care and length of stay (LoS) were obtained from two prospective studies realized at a UH. Costs of AS shower were based on the price of povidone iodine (Betadine scrub 4%), assuming that 10% of patients showered before surgery, while AS performed at home by patients did not incur costs to the hospital. Results were extrapolated to the average annual number of surgeries. Univariate deterministic sensitivity analyses and scenario analyses were performed to assess uncertainty. Results: AS was associated with the prevention of 209 SSI, leading to potential savings of €632,210 compared to the absence of AS. The most interessant impact of the preoperative shower before surgery was mainly on the clean surgeries. Conclusion: AS shower before surgery is a simple procedure that could lead to significant savings through SSI prevention, avoiding additional care and LoS. Disclosure of Interest: None declared.

Introduction: Health care workers (HCW) are exposed to SARS-CoV-2 through patient contact. Objectives: We aimed to assess the seroprevalence for SARS-CoV-2 among HCW in the canton Grisons and analyze risk factors associated with seroconversion. Methods: HCW from 13 health care institutions were recruited. Sera were analyzed for SARS-CoV-2 antibodies using an electro-chemiluminescence immunoassay of Roche Diagnostics in mid-2020 (survey I) and early 2021 (survey II). Participants reported risk factors for COVID-19 in a questionnaire.Odds ratios (OR) and 95% confidence intervals (95% CI) for the association of seropositivity with each risk factor were determined by logistic regression. Results: SARS-CoV2 serology was positive in 99 of 2794 (3.5%) participants in survey I and in 376 of 2315 (13.5%) participants in survey II. By survey II, 86 of 88 (97.7%) initially seropositive participants remained seropositive. In multivariable analysis of both surveys, the strongest association for SARS-CoV-2 seroconversion was contact with a household 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). Significant occupational risk factors included contact with patients with COVID-19 in both surveys (aOR: 2.7, 95% CI: 1.4-5.4, p < 0.001, survey I and aOR: 1.4, 95% CI: 1.0-2.2, p = 0.046, survey II). Contact to a SARS-CoV-2 positive co-worker was a significant risk factor only in survey I, whereas private contact with SARS-CoV-2 positive persons and the COVID-19 incidence in the region of the HCI were associated with seroconversion only in survey II. Conclusion: Contact with patients with COVID-19 was an important risk factor for seroconversion, although the risk was higher for household contacts. These findings highlight the need to optimize preventive measures for SARS-CoV2 infection among HCW. Disclosure of Interest: None declared. p = 0.052) and seroconversion (aOR 0.7, p = 0.053); household exposure was the strongest risk factor (aHR for positive swab 10.1, p < 0.001; aOR for seroconversion 5.0, p < 0.001). In subgroup analysis, FFP2 use was clearly protective among HCW with frequent (> 20 patients) COVID-19 exposure (aHR 0.7, p < 0.001; aOR 0.6, p = 0.036). Universal FFP2 use during AGP showed no additional protective effect (aHR 1.1, p = 0.7; aOR 0.9, p = 0.53).

Conclusion: FFP2 compared to surgical masks may convey additional protection from SARS-CoV-2 for HCW with frequent exposure to COVID-19 patients. Disclosure of Interest: None declared. Introduction: A better understanding of the relative importance of different transmission pathways of SARS-CoV-2 in hospital settings has the potential to help improve targeting of control measures aimed at reducing nosocomial spread. Objectives: To quantify the associations between risks of nosocomial SARS-CoV-2 infection and exposure on the same ward to infected healthcare workers (HCWs), to patients likely to have been infected nosocomially, and to patients with community onset COVID-19. Methods: Ward-level data were collected from four teaching hospitals in Oxfordshire, UK, over an 8 month period in 2020. SARS-CoV-2 infections were identified using both PCR results from symptomatic and asymptomatic testing and serological data coupled with symptom recall. A series of statistical models were used to quantify associations between exposures and probable hospital transmission events. Results: Risk to patients of probable nosocomial acquisition was most strongly associated with exposure to other patients with hospitalacquired 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

1·22,1·71). The association with patients with community onset COVID-19 was weaker (aOR 1·12, 95%CI 0·96,1·26). Transmission to HCWs was associated with exposure to other infectious HCWs and patients with hospital-acquired SARS-CoV-2 (aOR 1·66, 95%CI 1·55,1·78 and aOR 1·45, 95%CI 1·32,1·58 respectively). The introduction of more stringent infection prevention and control 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 symptoms, 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. symptoms associated with a viral syndrome. Of all COVID infections (n = 5486, 11.0%), 1270 (2.6%), 1563 (3.1%), and 2653 (5.3%) were identified as indeterminate, probably nosocomial, and definitely nosocomial, respectively (Fig) . The odds ratio (OR) of in-hospital mortality, comparing (probably + definitely) nosocomial to community acquired (out-of-hospital + indeterminate) COVID, for the entire studied population was 1.62 (95%CI 1.50-1.75). Significant increase in risk was seen only for age categories 40-59 (3.13; 2.18-4.50) and 60-79 (1.5; 1.32-1.71).

Introduction: Identifying probable transmission routes of SARS-CoV-2 in the hospital setting is needed to direct implementation of infection prevention measures to stop transmission. Objectives: We investigated probable transmission routes of clusters of SARS-CoV-2 using both epidemiological data and Next generation sequencing (NGS), and assessed congruence. Methods: All positive SARS-CoV-2 PCR test performed in our hospital from both patients and healthcare workers (HCW) between September and December 2020 were evaluated. When more than two HCW or patients from the same ward tested positive within 14 days (a potential cluster), the ward was contacted to identify transmission routes. Suspected transmission was categorized based on epidemiological data (e.g. attendance, contacts in and outside the hospital). All available samples within clusters with sufficient viral load (CT value < 30) were analysed using NGS. A team of molecular biologists, infection prevention specialists and virologists discussed the NGS results and called possible, probable or unlikely clusters based on phylogenetic reconstruction, background prevalence and the epidemiological data. Results: From 14 possible clusters NGS was performed on 98 samples (Table 1) . Congruence between epidemiological data and expert conclusion was high for probable transmission (89%) and unlikely transmission (76%). In case of possible transmission NGS guided the definite conclusion in 85% towards probable. Four of the five cases in which no transmission was suspected based on epidemiological data, but were identical in NGS analysis, occurred in one cluster. Other disconcordances were dispersed in different clusters. Introduction: Implementation of Infection Prevention and Control (IPC) Programmes is a fundamental strategy to reduce the burden of healthcare-associated infections (HAI) and to contain the spread of emerging and re-emerging pathogens in community and health facilities settings. The World Health Organization IPC Core Components (CC) 1 is a framework with evidence-based recommendations comprising of eight areas for the implementation of IPC Programmes at the national and sub-national levels.

Objectives: This study aims to map and characterize initiatives related to four of the CC in the Region of the Americas. Methods: Descriptive study of mapping valid and current national documents of IPC related with regulatory frameworks, programs, policies (CC1), evidence-based guidelines (CC2), policies on education and training of health workers (CC3), and documents on HAI surveillance (CC4).We conducted a search for documents from August/December 2021 using various sources of information (Ministries of Health official webpages, legal records, official communications, and technical documents). We presented the results in frequencies, percentages, and ranges.

We included a total of 295 documents from 30/41 (73%) Member States in the analysis, with an overall range from 1 to 23 documents per Member State. Due to the variability of the findings regarding the contents, the final classification of the documents was dichotomized as "general" or "specific", considering the overlap of the domains with other areas. We found that CC4 (39,5%) and CC1 (34,3%) had more "general" documents compared to CC2/CC3. There was no "general" policy on education programs in IPC for CC3. In regard to CC2, 83% of the guidelines were "specific" and 65% (80/123) of these related to COVID-19 and IPC. Figure 1 presents the frequencies for each one of the CC according to the subregions of the Americas.

Introduction: Structures established during outbreak preparedness tend to diminish post-outbreak requiring rapid re-activation, re-training and re-orientation at the detection of a new outbreak. Sustainable Infection Prevention and Control (IPC) structures are required to 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 to enhance preparedness activities for COVID-19. Objectives: a) To build and strengthen IPC capacity at regional, district and health facility levels. b) To build and strengthen IPC structures through establishment of IPC committees at district and facility levels. Methods: Didactic, practical and video IPC training materials were developed. The approach was piloted in 3 regions; each regional 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 selected mentors per district. The mentors were supported to conduct facility mentorship visits. A handbook endorsed by the director general of health services was developed to guide the mentorship sessions at facility level. Results: 114 TOTs from 3 regions were trained, cascading the training to 29 districts. 557 district IPC committee members and district mentors attended the district level training and were attached to 1-3 facilities. 976 health facilities were reached and a total of 13,455 health workers were mentored. The mentors continue with the sustainability phase visiting a facility once a month. Conclusion: The sustainability of IPC practices among health workers has an aspect of attitude and behavioural change and therefore cannot be achieved with a one-off training. This strategy provides suggestions for the Ministries of Health to maintain a functional and robust IPC structure at national, regional, district and health facility levels. Impact evaluation assessments are recommended periodically. Objectives: This study aimed to determine the incidence of specified MDROs in Malaysia hospitals using standardized laboratory and clinical criteria.

The surveillance program is a laboratory based which involved 28 MOH and 3 university hospitals. It is a continuous active monitoring of the incidence of specified organisms of clinical interests. Results: A total of 13,966 clinical isolates of 6 alert organisms and other groups were reported from January to December 2019. Out of these isolates, 75% (10,438) were HA-MDRO. The incidence for each MDROs is shown in Table 1 . MDROs rate was highest in Medical department (32.4%) followed by Surgical (15.4%) and Anaesthesia department (15.1%). Majority of the HA-MDRO infection were bloodstream infection (38.1%), followed by pneumonia (14.8%), ventilatorassociated pneumonia (12.4%) and surgical site infection (11.1%). The top 3 commonest antibiotics prescribed within the last 3 months among MDRO patients were Cephalosporins, Beta lactamases and Carbapenems. Conclusion: MDRO surveillance program is crucial in order to monitor the trend of MDRO and to detect newly emerging pathogen or outbreak. Besides that, it is used to monitor the effectiveness of infection prevention and control interventions and to identify areas for improvement. Introduction: Surveillance of multidrug-resistant (MDR) microorganisms is key in national AMR programs, however there is no universally accepted MDR definition in Switzerland so far. Objectives: In this study, we aimed to develop a national definition of MDR-Enterobacterales (MDR-E), adapting international definitions to local testing algorithms and surveillance data available in ANRESIS. Methods: Using interpreted qualitative susceptibility data (SIR) from 2019-2020 from the ANRESIS database, we analyzed the test algorithms applied by swiss laboratories and examined the crossresistance within antibiotic groups. Based on these analyses, two different MDR-E definitions depending on the intended use, a broader one for epidemiological surveillance ("ANRESIS-EPI") and a more restrictive one for infection control ("ANRESIS-IPC") were specified. Using these algorithms, the rates of invasive MDR-E identified in our national dataset were compared with international and national definitions, namely the ECDC-definition, the KRINKO-definition and the definition proposed by the University Hospital Zurich. Results: Aminoglycosides, Piperacillin-Tazobactam, 3 rd /4 th gen. cephalosporins, carbapenems and fluoroquinolones were used for our MDR-E definition. Major differences in testing algorithms between different laboratories were observed. The analysis of crossresistance within an antibiotic group revealed, that the substance most likely to be effective against a specific gram-negative bacterium, is not tested preferentially (e.g. amikacin). For all bacterial species tested, the highest rates of multidrug-resistant isolates were found using the "ECDC-MDR" definition (N = 3664). Introduction: Antimicrobial resistance in health care-associated pathogens is a growing concern for health care and for public health. Thus, studying temporal changes in resistant pathogens causing healthcare-associated infections (HAIs) is crucial in improving local antimicrobial and infection control practices. Objectives: The objective was to describe nine-year trends of resistance in pathogens causing HAIs in a tertiary care setting in Tunisia. Methods: Annual prevalence surveys are part of a quality improvement program promoted by our department in Sahloul university hospital for the prevention and control of HAIs in order to ensure patient safety. The current study focused on data collected from 2012 to 2020. Definitions and methodology of HAIs and antimicrobial resistance were based on CDC. Data collection was carried out using NosoTun plug. Results: Results for microbiological investigation were available for 165 HAIs (55.7%). The proportion of HAIs that was microbiologically confirmed decreased from 58.1% in 2012 to 56.5% in 2020 (p = 0.1). A total of 234 pathogens causing 297 HAI events were included. Gram negative pathogens (GNP) were the most common pathogens. A decreasing trend was notified for Klebsiella spp, Pseudomonas aeruginosa, and Staphylococcus aureus. However, this decrease was not statistically significant. Antimicrobial resistance was found in 32.1% of cases. Significant increasing trend in antimicrobial resistance was noticed (from 15.6% in 2012 to 21% in 2020; p < 10-3). Conclusion: There is a high burden of drug resistance to common antibiotics in Sahloul university hospital. These findings may highlight the need for effective antimicrobial stewardship programs, including monitoring and feedback on antimicrobial use and resistance. Disclosure of Interest: None declared.

Survival analysis of multidrug-resistant organisms infection among patients with different catheterization in ICU J. Yang 1,* , Y. Tan 2 , W. Wu 3 , F. Hu 4 , Y. Wang 5 Introduction: The incidence of nosocomial infection in ICU is significantly higher than that in general wards, and the detection rate of MDRO is much higher than the overall level of the hospital, making ICU the key department of MDRO infection and the high-risk Department of nosocomial infection outbreak. It is reported that ICU patients widely use "three tubes", namely ventilator, catheter 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 points of MDRO infection. It can be seen that the prevention and control of "three tube" infection is the top priority in the prevention and control of nosocomial infection in ICU. Objectives: To reveal the infection time and risk factors of multidrugresistant organisms (MDROs) in different kinds of catheter patients in intensive care unit (ICU), so as to provide a reference time risk point for the prevention and control of MDRO in ICU, and to supplement reasonable evidence of prevention and control time for existing prevention and control measures. Methods: Retrospectively analyzed the basic situation of MDRO infection patients with three different tube placements in a general ICU from January 1, 2019 to December 31, 2019 in a third-class A hospital. The median time, time difference and risk factors of infection in patients with different catheterization were revealed by survival analysis. Results: 5138 cases were included. Age, operation or not, three tube use are high risk factors of MDRO infection (p < 0.05). The median survival time (Infection time) of patients with ventilator, catheter and central vein intubation was (M = 1.00; P 25 = 0.00; P 75 = 5.00)d; (M = 1.00; P 25 = 0.00; P 75 = 5.00)d; (M = 1.00; P 25 = 0.00; P 75 = 6.00)d. Ventilator and catheter were independent risk factors. The coronavirus disease 2019 (COVID-19) pandemic has imposed the use of increased amounts of disinfectants and antibiotics, that will probably influence the features of microbial strains colonizing the hospital surface. Objectives: The purpose was to assess the impact of disinfectants and antibiotics used during the COVID-19 pandemic in hospitals with patients coronavirus positive, by the comparative analysis of the antibiotic resistance and biocides tolerance profiles of bacterial strains isolated before and during COVID-19. Methods: A number of 103 bacterial strains: 61 from 2018 and 42 from 2021 were isolated from the hospitals and identified by MALDI-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. Results: The analyzed strains were mainly E. coli, A.baumannii, S.aureus before and S. haemolyticus, P. aeruginosa and Enterobacter sp. after COVID-19. If before pandemic the resistance rates of Gram-negatives to 3rd and 4th generation cephalosporins reached 73.3% and 70-85% for quinolones and tetracyclines, after the pandemic the resistance rates 3rd generation cephalosporins remained high, i.e. 87.5%, while for the other antibiotics the rates were 25-50%. The MIC for the disinfectants varied between 1.56-25% for Ethanol, Propan-2-ol, 0.78-12.5% for Ethanol/Denatured isopropano and Ethanol, 0.0019-0.125% for menthol, ethyl alcohol/hydrogen peroxide, peracetic acid. Conclusion: By using high amounts of disinfectants and antibiotics for containment of COVID-19 the diversity and resistance features of microbial strains from the hospital environment were modified, an increased microbial diversity after COVID-19, decreased resistance rates to non-beta-lactam antibiotics and higher tolerance to ethanol containing disinfectants. Disclosure of Interest: None declared. Introduction: Antimicrobial stewarship programs(ASP) in hospitals are a vital component of national action plans for antimicrobial resistance(AMR), and have been shown to significantly reduce AMR, in particular in a low-income country such as Madagascar. As part of an ASP, AMR surveillance provides essential information to guide medical practice. We developed an AMR surveillance tool called TSARA with the support of Fondation Mérieux, with the objective of combining patient data with laboratory and epidemiological surveillance data to provide a better understanding of the scope of AMR in Madagascar. Objectives: To describe how the TSARA project was developed in Malagasy hospitals and its outcomes. Methods: Based on the Oxford GRAM protocol, TSARA is a standardized data collection tool deployed since 2018 in five Malagasy hospitals participating to the RESAMAD laboratory network, monitoring microbiological, demographic and clinical data (Figure) . Any hospitalized patient with a positive bacterial sample was included. Results: Individual isolate-level data and antimicrobial susceptibility information on bacteria were collected. These data were compiled with clinical, demographic, and epidemiological information (including current antibiotic prescription) retrieved daily from face-to-face interviews with the patient and completed by medical records where necessary. Data were then entered in an online platform. Results were secondarily discussed with clinicians to provide guidance on the antibiotic prescription adapted to local resistance patterns. As an example, 2018 data showed that 57.8% of empiric antibiotic prescriptions were eligible for de-escalation after reception of antimicrobial susceptibility tests. Finally, results of aggregated data were disseminated to relevant stakeholders to improve awareness among prescribers and hospital gouvernance.

Conclusion: Thanks to TSARA, regular analysis and feedback on surveillance data to healthcare workers helped to optimize patient care. Treatment guidelines were produced by Malagasy experts according to type of patient and type of infection, with consideration of circulating pathogens and local resistance levels.

Introduction: Enterococci is one of the leading cause of highly antibiotic-resistance infections, especially healthcare-associated infections. However, few epidemiological data estimated the burden of antimicrobial resistance in Enterococci in children healthcare settings. Objectives: This study aimed to assess the incidence proportions of antimicrobial resistance profiles in Enterococcus faecalis and Enterococcus faecium in children hospitals in China, using data published in both English and Chinese literatures. 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 PICU were screened on admission and weekly thereafter for MDR-GNB in samples from the nose, trachea and rectum. Environmental sampling was performed from surfaces (sinks, faucets) air and water. Identification of the species isolated from both clinical and environmental samples was performed by Vitek ® 2Compact, bioMérieux, Inc., Durham, North Carolina, USA. Samples with positive isolation were sent to the national reference laboratory of microbiology (ISCIII) for genotypic study by sequencing (PFGE). We performed a spatiotemporal analysis of cases and sequential analyses of the measures taken to determine the effectiveness in cluster. Results: From October 12 through early November 2020, 25 specimens were identified, corresponding to 7 patients positive for MDR-GNB. The attack rate (colonization) was 8.6% (7/81). Four of patients were colonized with extended-spectrum ß-lactamase (ESBL) and the others with carbapenemase-producing Enterobacteriaceae (CPE).Three of the patients (42.9%) had polymicrobial colonization. Of 30 environmental samples, five were positive for CPE (sinks-100% K. pneumoniae VIM). None of the water and air samples tested were positive.Genotypic sequencing by PFGE was performed on the 4 clinical samples (all patient colonized with CPE) and five environmental samples. Different PFGE profiles were found between patients, but environmental samples had similar and indistinguishable PFGE pattern.The initial measures taken were contact isolation of patients, removal of atomizers, and closing the sinks. After implementation of bundle (contact precautions, hand hygiene re-education, waterless cleaning of patient, anti-splash screens, routine cleaning of sinks, routine environmental screening) no cases appeared. Conclusion: Implementation of a focused bundle on patient hygiene and regular environmental cleaning in PICU reduced the MDR-GNB colonization rate. Disclosure of Interest: None declared. Introduction: Estimated ARI mortality is 4 to 5 million children annually in developing countries. Around 15 million episodes of ARI occur in Pakistan every year among children.

The study aimed to examine microbial spectra and antimicrobial susceptibility of bacterial isolates of acute respiratory infections among under-fives. Methods: An observational study was conducted among under 5 children in a public sector hospital of Islamabad Pakistan from Oct 2018 to January 2019. Overall 350 nasal swabs were collected (300 from symptomatic and 50 from asymptomatic children). RT-qPCR was used for screening viral pathogens. Bacteriological culture methodology was used for bacterial pathogens and CLSI guidelines were adapted for antimicrobial susceptibility. Results: Among symptomatic cases (300), 54% were females and median age was 25 months (R = 59-1 months). Most affected age group was 12 months and below. Overall positive samples for microbes were 83% (n = 249). Of 249 infected cases, single bacterial pathogen was detected among 6% (n = 18) of cases, while single viral pathogen was detected among 30% (n = 90) of cases. Remaining 64% (n = 192) had co-infections. Predominantly detected viruses were RSV (32%), human rhinovirus (30%), HMPV (14%), HPIV-3 (11%), HBoV (9%), and adenovirus (4%). Frequently isolated bacteria's were Klebsiella pneumaniae (15%), Streptococcus pneumonia, Enterobacter agglomerans, and Haemophilus influenzae were 13%, 10% and 7%, respectively. HPIV-3, Human rhinovirus, Adenovirus, Klebsiella pneumaniae and Streptococcus pneumonia found significantly involved in co-infections with P values of 0.01, 0.03, 0.01, 0.01 and 0.01. Of 17 multidrug-resistant bacteria, isolate of Enterobacter agglomerans and Klebsiella pneumonia were identified as resistant bacteria against more than 5 different antibiotics. Pathogen detection rate (14%) was significantly lower in asymptomatic group than the symptomatic (P < 0.01). Introduction: Drug resistance among gram-negative bacteria is mainly conferred by Beta (β)-lactamase enzymes. AmpC beinga β-lactamase facilitate resistance to a widerangeof antibiotics.βlactamases are diverse in nature due to existence of frequent mutations. There are multiple ways for the hyper production of β-lactamases in gram-negative bacteria but mutations in the promoter region is the most common mechanism. Objectives: The main objective of the study is to find out the role of promoters in drug resistance. Methods: Analysis of m-RNA expression of three genes of AmpC β-lactamases (ABL) was carried out in fifteen drug-resistant and fifteen sensitive E. coli isolates in children up to five years of age. Three AmpC β-lactamase genes were selected (ACT , DHA and CMY). In order to know the effect of mutation on m-RNA expression level in,sequence analysis of the PCR amplicons (AmpC promoter region) was performed. The promoter sequences were compared with E. coli ATCC 25922, using multiple sequence alignment tool (BioEdit version 7.0.5).and sequences were submitted to NCBI for obtaining accession numbers. Results: Analysis of m-RNA expression of three genes of AmpC β-lactamases (ABL) was carried out in fifteen drug-resistant and fifteen sensitive E. coli isolates in children up to five years of age. Three AmpC β-lactamase genes were selected (ACT , DHA and CMY). In order to know the effect of mutation on m-RNA expression level in,sequence analysis of the PCR amplicons (AmpC promoter region) was performed. The promoter sequences were compared with E. coli ATCC 25922, using multiple sequence alignment tool (BioEdit version 7.0.5).and sequences were submitted to NCBI for obtaining accession numbers. Conclusion: AmpC genes showed many folds increase in the expression levels in resistant isolates due to mutation in their promoter region, indicating their potential role in disease transmission. Strength of expression level of AmpCβ-lactamase genes depends upon the positions of mutation in the promoter region. Hence, strict antibiotic policy has to be implemented in symptomatic and asymptomatic individuals to bring down the rising threat of drug resistance in the community. Disclosure of Interest: None declared. Objectives: This study aimed to assess the fidelity of the treatment process of MDR-TB at the Primary Healthcare level. Methods: The study applied a mixed-method design in all PHCs in Surabaya, Indonesia from March to June 2017. The study population was all MDR-TB patients and staffs who responsible for the MDR-TB treatment service. A survey and in-depth interview were conducted. The quantitative data were analyzed descriptively and the qualitative data were analyzed by content analysis. Results: 23 out of 30 PHCs adhered to the National MDR-TB treatment guideline regarding the treatment delivery components, the counseling and psychosocial support components, and the adverse drug effect management components. However, from the interview, we found that there is no Standard Operating Procedure (SOP) specific for MDR TB treatment at the PHC level, and it was a key factor for staffs did not conduct some core components of the MDR-TB guideline. Those were the TB staffs did not give comprehensive information support 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.

Conclusion: MDR-TB treatment delivery at PHCs showed high fidelity, but it missed in some core points: giving complete informational support, monitoring the patient taking drugs, and counseling the patient. Insufficient mandate due to MDR TB treatment resulted an inadequate patient-centred care. Developing SOP for MDR-TB treatment in Primary Healthcare is needed for improving the compliance of the staffs and the quality of patient care. Disclosure of Interest: None declared. Results: National Tuberculosis Program (NTP) Nepal identifies three levels of infection control measures: administrative, environmental and personal protection. NSP identifies lack of infection control policy, program and mechanisms at treatment centers and lack of awareness on infection control as a major challenge for management of DR TB and emphasizes appointment of focal person for infection control. The major intervention includes improving infection control at all DR TB centres and subcentres based on proposed infection control policy. However, till date national infection control policy is still not in place and focal person has not been appointed. As part of infection control, DR treatment centers were provided with exhaust fans, Ultraviolet Germicidal Irradiation (UVGI), N95 masks and surgical masks. Sessions on infection prevention were incorporated in all TB training. NTP also initiated FAST (Finding Actively, Separate temporarily and Treat effectively) approach in 15 major hospitals to actively find people with cough, testing through rapid molecular diagnostics and enabling prompt treatment, decreasing TB transmission. NTP has also focused on infection control at TB consultation room, DR TB patient isolation room and infection control at home. NTP also recommends health workers to follow all infection control procedures and decrease their risk to TB disease. Conclusion: NTP requires significant efforts for DR TB infection control. The national policy and guidelines on infection control should be in place. Infection control measures should be strengthened with gradual expansion to all centers. A designated focal person should be assigned. In addition, awareness on infection control among all health workers, patients and community members is required. Disclosure of Interest: None declared. Introduction: Tuberculosis (TB) is a major cause of ill health, one of the top 10 causes of death worldwide and leading cause of death from single infectious agent. Drug Resistant (DR) TB continues to be a public health threat. TB is a major public health problem and one of the top 10 causes of deaths in Nepal. However, DR TB is not as high as the regional or global burden. Objectives: The objective of the study was to review and assess the burden of DR TB in Nepal. Methods: Desk review was conducted. Various literatures, reports, policy documents and guidelines related to DR TB in Nepal were reviewed. Descriptive analysis was conducted to present the findings. Results: DR TB services in Nepal are provided through 21 DR TB treatment centers and 81 sub-centers. Although services are ambulatory, facility-based services are being provided through referral centres, DR hostels and DR home. Diagnosis for DR TB is provided through Gene Xpert, culture and DST (Drug Susceptibility Testing) and LPA (Line Probe Assay). DR TB diagnosis is offered to presumptive patients remaining smear-positive on any follow up including failures of first-line treatment and those at high-risk. Responses to treatment is monitored by culture. In 2019, WHO estimated a total of 1,400 DR TB cases for Nepal but only 45.4% (635) were notified and among them only 392 cases (62%) were enrolled for treatment, with 38% primary loss to follow up. Data from previous years also show huge gaps between estimated and notified cases. The achievement for treatment enrollment is below the level of global achievement of 84% notified cases posing high risk of transmission, presenting that progress in detection is outstripping the capacity to provide treatment and follow-up services. The major barriers to adequate access to treatment are centralized services and reliant on hospital-based care model.

Significant efforts are required to identify and notify the missing cases and enroll the notified cases into treatment without any loss to follow up. Decentralization of diagnosis and treatment services, expansion of ambulatory model of care, quality service delivery and patient centered care can improve DR services. Disclosure of Interest: None declared. Objectives: This study was conducted to identify the barriers, enablers and associated factors of tuberculosis infection prevention activities in selected hospitals in Nepal. Methods: A qualitative study was conducted from April to August 2019 in four hospitals in Nepal. Focused group discussion, key informant interviews, and client exit interviews were conducted with 27 purposively sampled health professionals and patients. The transcripts were coded, categorized, and analyzed by using thematic analysis. Results: The study identified that unavailability of a separate room for screening and counseling for TB suspected patients, long waiting 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 supplies from Government are major enabling factors, regular monitoring, 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 private medical colleges and community hospitals were well managed whereas very limited measures were adopted at Government hospitals for infection prevention. Conclusion: This study uncovers the barriers and enablers which help to formulate necessary actions and planning for effectively implementation 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. Introduction: Tuberculosis has emerged as a public health issue especially 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

Objectives: The purpose of this study was to evaluate the nutritional risk factors of Childhood TB at Federal General Hospital Islamabad Pakistan. Methods: A case control study was conducted at Federal General Hospital (FGH) Islamabad. A case was defined as "any culture confirmed patient of Pulmonary TB under 12 years of age registered in DOTS centre of FGH from 1 st January to 31 st July 2019. Against each case a healthy age and sex matched control was selected. Structured questionnaire was used for data collection and odds ratios were calculated with 95% confidence interval. Results: Total 184 children under the age of 12 years with Pulmonary TB were recruited (92 cases and 92 controls), mean age of the cases were 7 years (R = 12-4 years) and 53% cases were males while rest were females. Most affected age group was below 10 years. Significant nutritional factors were undernutrition (OR 8.11, CI 4-16.2), stunting (OR 6.63, CI 3.5-12.5), unhygienic feeding practices (OR 5.3, CI 2.9-9.6), wasting (OR 4.3, CI 2.4-7.5), use of unpasteurised milk (OR 4.1, CI 2.3-7.2), underweight (OR 3.3, CI 2-5.5), inadequate breast feeding (OR 1.9, CI 1.32-2.9). While normal weight, overweight and obesity found insignificant with childhood tuberculosis. Conclusion: Nutritional factors have significant impact on childhood TB. Nutritional education and counselling is required at institutional and community level for prevention of childhood TB. On our recommendation awareness campaign was started at FGH regarding importance of nutritional factors and prevention of childhood TB. Key words: Nutritional Factors, Childhood Tuberculosis, Developing Country, Pakistan. Disclosure of Interest: None declared.

The use of 4-hexylresorcinol as antibiotic adjuvant against mycobacteria A. Tutelyan 1,* , Y. Nikolaev 2 , O. Manzenyk 3 , G. El'Registan 2 , V. Akimkin 1 1 Central Researche Institute of epidemiology, 2 the federal research centre fundamentals of biotechnology" of the Russian Academy of Sciences, Moscow, 3 State research center for applied microbiology and biotechnology of federal service for surveillance on consumer rights protection and human wellbeing, Obolensk, Russian Federation Correspondence: A. Tutelyan Antimicrobial Resistance & Infection Control 10(1): P020 Introduction: Development of antimicrobial agents that are effective against mycobacteria is of great interest. One of promising approaches is to combine known antibiotics and adjuvants chosen from already known compounds ("off-label usage", "repurposed drugs"). Previously we have shown that 4-Hexylresorcinol is one of effective such adjuvants. Objectives: To study effect of 4-Hexylresorcinol (HR), approved for use in medical practice, as adjuvant to fight mycobacteria in the in vivo experiments. Methods: Test object was Mycobacterium smegmatis, a non-pathogenic relative of M. tuberculosis; bacteria were injected to tail venous (0.3 × 10 8 CFU, one time). Studied drugs: isoniazide (INI), anti-tuberculosis drug -0.3 mg/mice/day; 4-hexylresorcinol (HR) (as adjuvant of INI) -3 mg/mice/day; drugs were administrated with water for 4 days. 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 mice spleen at 4 th day by seeding of spleen gomogetate to Sotton solid medium. Results: Amount of M.smegmatis cells in spleen without treatment was 1.2 × 10 4 CFU/g. INI or HR were not effective against this bacterium (bacteria content were 1.9 × 10 4 and 0.8 × 10 4 CFU/g, respectively). When both drugs were administrated, bacteria concentration dropped 20-fold (cells content was 0.06 × 10 4 CFU/g). Conclusion: The use of 4-hexylresorcinol increases anti-mycobacterial activity of antibiotic in one order of magnitude. As 4-hexylresorcinol is allowed to medical use, therefore it is highly possible to use it as a part of combined antimicrobial drugs. Disclosure of Interest: None declared. Introduction: Salmonella enterica remains one of the most important global food origin pathogens and may play an important role in the dissemination of antimicrobial resistance (AMR) and virulence. Objectives: The goal of this work is to perform comparative genomic epidemiology analysis of foodborne multi-drug resistant S. enterica isolates from Russia (SER) and Belarus (SEB) based on whole-genome sequencing (WGS). Methods: WGS was performed on the Illumina HiSeq platform for 65 SEB and 310 SER isolates in the period 2017-2020. The susceptibility to antimicrobial compounds was determined both by the boundary concentration method and disc-diffusion test. Genome assemblies and comparisons were performed using SPAdes, roary, dnadiff, and custom software. Results: Most of the analyzed S. enterica isolates belonged to ST32 and O7 serotype, but ST11 and O9 were prevailing for Belarus. SEB and SER isolates were characterized by 4 and 6 similar profiles of antimicrobial susceptibility, respectively. The data correspond well to the revealed AMR determinants according to WGS results. Both SEB and 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 that some of the isolates were characterized by the presence of several types of plasmids simultaneously. The most common plasmids for SER were IncFIB and IncX1, while IncFIB and IncFII prevailed for SEB. The set of virulence factors in isolates studied was similar and quite extensive (up to 108) and consisted of structural components of the cell, host invasion factors, phage-related compounds, and plasmid genes. Phylogenetic analysis showed high similarity groups consisted of ST11 strains isolated from the same country. However, there was no connection found for ST32 SEB and SER clades. Conclusion: Thus, applying WGS technology enabled us to reveal unique genome features of S. enterica isolates from Russia and Belarus. Such characteristics are important for monitoring of AMR and virulence genes of the pathogens studied in terms of food risk safety and analysis evolutionary changes. Disclosure of Interest: None declared.

Genetic diversity of Russian antibiotic resistant L. monocytogenes isolates of food origin N. Sukharicheva 1,* , A. Shelenkov 1 , A. Egorova 1 , A. Chernyshkov 1 , N. Kulikova 1 , Y. Mikhaylova 1 , V. Akimkin 1 Results: L. monocytogenes has maintained a high rate of susceptibility to the antibiotics. All isolates under investigation were resistant to two antibiotics only of beta-lactam and sulfanilamide groups, but most of the isolates were susceptible to these antimicrobial compounds and macrolides, additionally. WGS analysis showed that all isolates were associated with two evolutionary lineages (II, IV) and can be divided into 10 sequence types (ST) with the prevalence of ST37 (II), ST121 (II) and ST9 (II). ST121 and ST9 were identified in isolates from meat products and from fish. These STs belong to hypovirulent clones. We also identified in our collection hypervirulent ST2 isolates that were obtained from meat while usually such clones are associated with dairy products. All isolates carried gene fosA responsible for resistance to fosfomycin. Some isolates had additional genes of resistance to chloramphenicol and tetracyclin. All isolates under investigation carried 33 common virulence genes, except isolates of ST121 and ST2 that characterized by the absence of actA, inlF, inlJ and ami, aut, inlJ genes, respectively. Conclusion: Thus, WGS-based analysis allowed us to reveal genetic diversity and identify unique genome features of different genetic lines of antibiotic resistant L. monocytogenes isolates. The data obtained will greatly facilitate further investigations in genome epidemiology of food-born pathogens. Disclosure of Interest: None declared.

Antibiotic susceptibility patterns of listeria monocytogenes recovered from common South African ready-to-eat food A. K. J. Kayode 1,* , A. Okoh Introduction: Antimicrobial resistance is gradually becoming a serious challenge to public health with increasing reports of microbial resistance including Listeria monocytogenes (Lm) against useful antimicrobial therapeutic agents. Objectives: The aim of the study was to investigate the antibiogram fingerprint of the Listeria monocytogenes isolates recoverved from common South African ready-to-eat food. Methods: This study investigated the antibiogram profile of Lm isolates (n = 194) recovered from common South African ready-to-eat (RTE) food against a panel of 22 antibiotics using the disc diffusion techniques and to screen for resistance determinants in the isolates using PCR assay. Results: Antimicrobial resistance (> 50%) against trimethoprim (56.19%), sulfamethoxazole (61.86%), streptomycin, ceftriaxone (53.09%), cefotetan (59.28%), vancomycin and oxytetracyclines (62.89%) were observed. Thirty of the isolates (15.46%) resistant to one or two antibiotics, while 162 (83.51%) exhibited phenotypic multidrug resistance to the antibiotics tested. Only two (n = 2, 1.03%) of the isolates did not exhibit phenotypic resistance to any antibiotics. Multiple antibiotic phenotypes (MARPs) revealed high resistance patterns and the Multiple antibiotic indexes were greater than the Krumperman permissible (> 0.2) benchmark. Twenty-two (22) antimicrobial resistance genes were detected in RTE food isolates out of the 44 genes screened including resistance determinants that encodes sulfonamides (n = 125, 64.43%), beta-lactams (n = 86, 44.33%), phenicols (n = 25, 12.89), aminoglycosides (n = 93, 47.94%) resistance. Conclusion: This suggests that the consumption of such RTE food in this study could constitute a health risk. Furthermore, the presence of antimicrobial-resistant Listeria monocytogenes in RTE food could compromise the safety of human consumption. Disclosure of Interest: None declared. The resistance to doxycycline of Vibrio cholerae O1 strains could be the result of the current protocol proposing selective chemoprophylaxis with doxycycline administered to all accompanying persons and health personnel, for whom no contraindication existed in Benin [1] . Resistance to trimethoprim/sulfamethoxazole shows that the use of this drug would contribute to the selection and dissemination of emerging resistant strains in the population [2] . Conclusion: The high percentage of resistance to doxycycline and trimethoprim-sulfamethoxazole insists on reviewing the management protocol.

A cross-sectional study was conducted during January 2016 in Jabra area. Self-administered questionnaires were distributed among respondents, each consisted of items assessing the dispenser's academic qualification (diploma, bachelor or master's degree), years of experience, and knowledge about when to dispense antibiotics in relation to presence of prescriptions, different settings and complains that include (dysuria, diarrhea, ear pain and discharge, sore throat, viral infections and fever), these items were measured on a Likert scale ranging from strongly agree to strongly disagree. Results: A total of 40 pharmacies were visited with a 100% response rate (n = 40), of whom, 22 were males, 35 had a Bachelor degree, and 18 had 1 to 5 years of working experience. Results showed that 32 of respondents indicated that antibiotics should be dispensed in presence or absence of prescriptions. 36 agreed that a dispenser should ask about the reason for requesting antibiotics without prescription. Our respondents disagreed that all clients complaining of diarrhea, ear pain or sore throat should be given an antibiotic (72.5%, 55%, 55.5%), respectively. Majority disagreed with giving antibiotics on client's insistence and that their dispensing habits will not be affected by a monthly required pay up to the pharmacy owner. Conclusion: Our study concluded that despite good knowledge, antibiotics could be obtained in Jabra area without a medical prescription, this warrants further investigations for causes of such practice to reach a better antibiotic stewardship. Disclosure of Interest: None declared.

Knowledge of antimicrobial resistance and antimicrobial prescription among dental practitioners in Chennai city-a cross-sectional study S. S 1,* , R. C 1 , M. P 1 , S. gadde 2 1 public health dentistry, 2 Periodontics, Ragas Dental College and Hospital, Chennai, India Correspondence: S. S Antimicrobial Resistance & Infection Control 10(1): P026

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). Objectives: to assess the knowledge of antimicrobial resistance and antimicrobial prescription among dental practitioners in Chennai city. Methods: A total of 110 registered dental practitioners participated in this study. A pre-validated and self-administered questionnaire was prepared and distributed to the dental practitioners in Chennai city to collect the demographic details and the information regarding knowledge and practice towards antimicrobial resistance and an antimicrobial prescription for the most common oral conditions was obtained. Results: A total of 110 registered dental practitioners participated of which 64.66% were males and 35.4% were females, the respondents were 46.36% MDS (had Master degree in Dental Specialty) and 54.8%BDS (Bachelor of Dental surgery). Majority of dentists were found to prescribe antibiotics for managing oral diseases except for orthodontic treatment. MDS practitioners of 92.16% and BDS of 79.96% recommended amoxicillin as their first choice antibiotic drug, followed by the combination of amoxicillin with clavulanic acid. When comparisons were made between BDS and MDS practitioners, majority of the questions were found to be not significant except for conditions like tooth sensitivity(P = 0.00),dentoalveolar abscess (P = 0.009), tooth fracture (P = 0.029), halitosis (P = 0.003) and periodontal abscess(P = 0.001).With regard to the duration of antibiotic prescription, 42.37% BDS practitioners prescribed antibiotics as a 3-day course and 45.76% resorted to a 5-day course.45.09% MDS practitioners prescribed antibiotics as a 3-day course and 49.01% resorted to a 5-day course which was not statistically significant. There was a general lack of awareness with regard to the guidelines for antibiotic prescribing in both the groups. Conclusion: Dental practitioners relied on drug therapy in many orofacial and general conditions where it was not necessary. Based on this cross-sectional survey the overall knowledge of antimicrobial prescription and antimicrobial resistance among dental practitioners was lower. Disclosure of Interest: None declared. Introduction: Each day, the real prescription is also dependent on non-pharmacological determinants in relation to the behavior of prescribers, hence the objective of this work. Objectives: Knowledge of the attitudes and behavior of hospital physicians on antibiotics use and resistance. Methods: Knowledge of the attitudes and behavior of hospital physicians on antibiotics use and resistance. Results: The response rates were 49%. The majority of the physicians audited were aware of the importance of the antibiotic resistance problem. Physicians were confident in most scenarios, but abstaining to prescribe an antibiotic was the main case where physicians had a significant degree of uncertainty. When prescribing antibiotics, doctors rely mainly on two factors: experience and consultation of practice guidelines. The measure identified as most useful to improve the quality of antibiotic therapy was the organization of training on antibiotic prescribing. The causes of bacterial resistance most often identified in the audited physicians were: too much antibiotic prescription, too much broad-spectrum antibiotic. Conclusion: In order to deal with the problem of resistance and to improve the rigour of antibiotic prescription, it is necessary to know the attitudes and behaviors of doctors. Disclosure of Interest: None declared. Introduction: Diabetic foot infections (DFI) and syndromes (DFS) have multiple negative outcomes in a patient population marked with comorbidities and frailty. Their management requires a quality of care consisting of evidence-based, practical guidance tools for primary care providers together with the implementation of an interprofessional care system including nationally standardized diagnose-relevant best practice recommendations. Objectives: We implement a national best practice guidance for timely and qualitative care of patients with DFI and DFS, including for antibiotic stewardship in DFIs. Methods: Under the umbrella of the national non-profit association QualiCCare, an interprofessional and comprehensive Swiss practical guidance for the timely and standardized quality of care management of acute DFI, DFS and diabetic foot ulcers (DFU) was elaborated in a multi-stakeholder approach including all relevant professions. Before the nation-wide implementation of the primary care triage and treatment guidance and indication-specific recommendations for interprofessional networks and footcare centers, three Swiss regions will pilot the implementation in different possible primary care settings in collaboration with the respective interprofessional footcare centers. Results: Twenty experienced stakeholders from twelve different professions issued four protocols for various aspects of DFS between March 2018 and January 2020 and defined criteria for the triage and treatment in primary care as well as the timely referral of patients with DFS and DFU to multidisciplinary footcare centers. All invited professional societies agreed to work together and have a representative in the working group. The resulting guidance were endorsed by all national professional societies. We propose a framework for specialized footcare networks as well as multidisciplinary footcare centers. The piloting of the proposed concepts is under way. Conclusion: We provide evidence-based tools regarding antibiotic stewardship and other streamlined approaches for Swiss primary care providers and specialists while increasing the accessibility for patients to specialized care of DFS, DFU and DFI. Disclosure of Interest: None declared. Results: Three hundred and ninety-three patients were screened. The mean age of patients was 58.9 years (IQR: 47-71), the prevalence of female gender was 55.8% (95%CI: 49.7%, 61.7%), and the mean duration of hospital stay was 14.4 days (IQR: 10-19). A total of 89.6% of patients were on antibiotics on the survey day. Three hundred and ninety-eight doses of antibiotics were prescribed in these patients. Overall, antimicrobials included in class ATC J01D (other betalactam antibacterials: Cephalosporins and Carbapenems) represented 76.8% from all amtimicrobial prescribed. Conclusion: Althouh the appropriatednes of prescription of antibiotics was not the goal of this study, intensive use of broader spectrum antimicrobials is concerning and suggestive that AMS interventions such as preauthorization and/or audit and feedback, interventions performed in our hospital in pre-pandemic era, could be the solution to improve the empiric prescription of antimicrobials for patients hospitalised for coronavirus disease 2019. Disclosure of Interest: None declared. 

The high rate escalation antimicrobial therapies worsens outcome of patients with SARS-CoV-2. Objectives: Correlate the outcome of SARS-CoV-2 patients and the prescription of antimicrobial therapies within ICU. Methods: A prospective study of 98 patients with SARS-CoV-2 in ICU from april 2020 till february 2021.Age. risk factors, days in the ICU, requirement of invasive mechanical Ventilation (MV), days with MV, SOFA at the admission in the ICU, mean PAFI, complications, ventilator-associated-pneumonia, requirement of one empirical antimicrobial therapy, carbapenen, colistin or vancomycin prescribed antibiotics or multidrug-resistance Gram negative organisms treatment amd outcome, all were tested with linear regression and p value less than 0.01 was significant. Results: Among the 98 patients enrolled: 39% required one empirical antimicrobial therapy during the stay in the ICU, 75% had PAFI less than 210 and 52% of these group died. 25.5% suffered from infections and received carbapenen, vancomycin or colistin therapy, and 60% of them died. 35.7% patients received 3 or more antibiotics and/or antifungal and 48.6% were dead. Those with one empirical antimicrobial therapy 37% suffered from respiratory complications, 42% had MOF (renal, cardiovascular, respiratory, hematologic complications) and 23% develop ventilator-associated pneumonia (VAP). In the group with carbapenens, colistin, vancomycin 28% had respiratory complications, 60% MOF and 40% had VAP. Those who had multi-resistant gram negative organisms treatment 17% had respiratory complications, 71% had MOF and 57 suffered from VAP.

The prescribtion of multidrig-resistant Gram negative organisms therapy increases the risk of MOF,decreases the PAFI and increases VAP and worsens the outcome. Disclosure of Interest: None declared. Introduction: Residents of long-term care facilities are at increased risk of infection and thus of being treated with an antimicrobial. Inappropriate use may lead to the development of resistance. In the Netherlands, the national surveillance network (SNIV) is used to monitor infectious diseases and antimicrobial use in long-term care facilities (LCTFs). We studied trends in antimicrobial use in these Dutch LTCFs. Objectives: To monitor trend in antimicrobial use in LTCFs in order to identify where the risk of resistance is potentially increasing. Methods: In 2017-2019, twice a year in April and/or November a point prevalence study was performed. On the registration day, prescribed antimicrobials with a maximum of three antibiotics or antimycotics per resident, and the indication (infection or prophylactic) was registered. Data were collected by elderly care physicians, nurses or infection control practitioners in participating LCTFs. Palliative care was not included in this study. Data were reported to SNIV through a password protected web-based surveillance system. Results: Over the past three years 136 unique LTCFs [range 23-77 per year] participated with 12,509 residents. The use of antimicrobial agents increased from 6.7% in 2017 to 9.4% in 2019. The percentage of antibiotics remained roughly the same (4.9-5.6%) however the use of antimycotics 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 (66%). The rest of the residents received antimicrobials as prophylaxis. In 2017, 70% of these antimicrobials which were prescribed for treatment of an infection, were antibiotics and 30% antimycotics; in 2019, the percentage of antimycotics has increased to over 50%. The highest increase in antimycotics is seen in the use of ketaconazole. In 2017, ketaconazole was selected in 49% of the cases and in 2019 this has increased to 65%. In 2017 ketaconazole was mostly used as prophylaxis ( 

In low-and middle-income country, the prevalence of SSIs is ranged from 4.5% to 14.3%. Few points prevalence surveys (PPS) have been conducted in Vietnam on SSIs or on antimicrobial use in surgical patient. Objectives: The objective of this study was to estimate the PPS of SSI before and after the implementation of antibiotic stewardship programs (ASP) and the implementation of infection control (IC) in orthopedic department in a large tertiary-care hospital in Haiphong city, Vietnam. Methods: Between 2016 and 2019, ASP and IC practices were implemented in operating rooms and in the orthopedic department including antibiotic training, skin preparation, hand hygiene, gloves and sterile instruments. ASP were implemented in according to WHO 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 December 2019. The PPS was performed in according to ECDC methods. Some characteristics were recorded as surgical, antibiotic prophylaxis, microorganisms and risk factors associated with SSIs (low serum albumin concentration, older age, obesity, smoking and diabetes mellitus). Results: The prevalence of SSI was 7.8% (n = 4/51) and 5.4% (n = 2/37) in 2016 and in 2019 respectively (p > 0.05; Student test). The most common microorganisms was S. aureus. Significate differences were determined on diabetes mellitus, NNIS score, scheduled surgery and prophylactic antibiotics (> 48 h). For antibiotic prophylaxis, a 3rd-generation cephalosporin was prescribed more than 48 h, in the majority of cases for the two periods. Between 2016 and 2019, the skin preparation has improved during several informal surveys. Conclusion: Our finding suggest that IC practices and antibiotic prophylaxis have not become routine in participating facilities. The decrease of prevalence of SSI, even non-statistically significant, lead us to continue this program. It is necessary for hospitals in Vietnam to provide comprehensive education programs, addressing basic IC issues, such as standard precautions and establish more effective institutional IC policies. Disclosure of Interest: None declared. Introduction: Acute pyelonephritis is one of the most common infectious diseases among outpatients and inpatients. ESBL-producing gram-negative pathogens are increasingly responsible for both community and hospital acquired infection. Appropriate and early antibiotic therapy improves clinical outcomes and reduces mortality but rising antibiotic resistance rates make empirical therapy increasingly difficult due to limited treatment options.

We aimed to investigate the demographic, epidemiological and clinical characteristics of patients hospitalized with the diagnosis of uncomplicated and complicated pyelonephritis acquired in community and hospital, and to evaluate appropriateness of empirical treatment. Methods: The study was conducted in patients hospitalized with the diagnosis of uncomplicated or complicated pyelonephritis acquired from the community or hospital between January 1, 2016, and June 30, 2018. Appropriateness of empirical treatment at the 48th-72nd hours was evaluated based on culture results and treatment modification (as escalation/de-escalation/continue) were evaluated. Results: A total of 369 uncomplicated (94) and complicated (275) episodes of pylenonephritis (in 339 patients) were evaluated. Causative pathogen was obtained in 69.4% of baseline cultures. The most common agents were E.coli (71.0) and Klebsiella spp (17.7), and ESBLproduction rate was 64.4%. Ceftriaxone, ertapenem and piperacilintazobactam were used in 26.3%, 53.7%, and 15.7% of the episodes, respectively. When the appropriateness of empirical treatment was evaluated at 48-72nd hours, ceftriaxone treatment had should be escalated in 40.6% of all episodes while ertapenem and piperacillintazobactam had been escalated in only 8.8% and 9.5% of pyelonephritis episodes, respectively. Conclusion: E.coli and Klebsiella spp. are responsible for majority of pyelonephritis. ESBL-pruducing pathogens are guite high even if community-acquired infections. Considering the effect of early treatment on mortality, more extended therapy covering ESBL-producing pathogen at the beginning of the treatment appears a better and life-saving choice. Disclosure of Interest: None declared. Introduction: The safety of antibiotics prescription during pregnancy has been the center of an intensive controversy in recent decades due to problem of drug risks for the fetus and the growing problem of the emergence of bacterial resistance. Objectives: he aim of this study is to evaluate the protocol of antibiotic therapy used in the obstetrics gynecology department of Farhat Hached and to compare it with international recommendations. Methods: A cross-sectional study was conducted among women hospitalized in the peri-partum during their third trimester of pregnancy and the postpartum sector in the service of gynecology obstetrics of Farhat Hached Hospital in Sousse who received antibiotic therapy during 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 indication, dosage, duration, course, tolerance, and the antibiogram. Results: A total of 153 women were enrolled in our study with a mean age of 30 ± 6 years. For first-line antibiotic therapy, the most prescribed family of was Beta-lactams (71.8%), as monotherapy or in association and Amoxicillin (36.3%) was the most prescribed antibiotic. The most used association was beta-lactam, amino glycoside and imidazole (22.2%). A switch of antibiotic adapted to the antibiogram was done only in 23 cases. The average of prescription length was 6 days with favorable outcome mostly. The leading cause of antibiotic prescription was premature rupture of membranes (31.3%) in third trimester of pregnancy and the suspicion of postpartum chorioamnionitis (27.5%) after childbirth. The most frequent isolated germ was Eshirechia coli. Overall, the practice of antibiotic prescription was in accordance with international recommendations of proper use of antibiotic. Objectives: to evaluate the impact of weekly clinical audits conducted by an external infectious diseases specialist and an internal senior physician and multifaceted feedback strategies on reducing the use of protected anti-Gram negative antibiotics, including fluoroquinolones (FQ), 3 rd and 4 th generation cephalosporins (G3C, G4C), piperacillintazobactam (P/T) and carbapenems. Methods: The study included internal medicine, general surgery and intensive care wards of 8 Swiss acute care hospitals. Wards were allocated to either intervention for 6 months (n = 14) or a control group (n = 10). Linear regression models of an interrupted time series was performed to assess the impact of the intervention on the monthly use of protected antibiotics. Results: During the intervention, 9715 in-patients were screened, of whom 1684 (17.3%) received a "targeted antibiotic". The auditing team proposed a modification of the antibiotic therapy in 24% of patients, mainly stops, followed by de-escalation and switch to oral 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 observed a statistically significant decrease use of FQ, G4C and P/T in 5, 3 and 2 intervention wards, respectively, and a significant decrease in the use of 2 antibiotics in 2 wards.The use of G3C and carbapenems showed no significant change. Conclusion: Our pragmatic multicenter study showed a statistically significant impact on consumption of FQ, GC4 and P/T in 8/14 intervention units. It allowed a better overview of the appropriateness of antimicrobial prescriptions. Our study offered the opportunity to raise awareness about antibacterial resistances and encourage best daily practices among prescribers. Disclosure of Interest: None declared. Introduction: Pathophysiological changes and organ dysfunction following sepsis alter antibiotic pharmacokinetics. In the absence of pharmacokinetic data at the time of empirical treatment initiation, available biomarkers could play an important role in predicting the pharmacokinetic parameters. Objectives: This study aimed to evaluate the relationship between the amikacin pharmacokinetics and the biomarkers associated with organ dysfunction in critically ill patients with intra-abdominal sepsis. Methods: A case series involving critically ill patients with intraabdominal sepsis who received an amikacin loading dose of 20-25 mg/kg intravenous infusion, was studied. The 1-, 2-, 4-, and 6-h amikacin serum concentrations were measured to calculate the pharmacokinetic parameters. The available biomarkers associated with organ dysfunction were recorded. A linear regression analysis was performed to examine the relationship between the amikacin pharmacokinetics and the biological parameters. Results: Twenty-one patients were studied. A significant correlation was found between the volume of distribution and ESR (p < 0.05, r = 0.844). Moreover, drug clearance had a significant inverse correlation with serum lactate (p < 0.05, r = -0.603). No other significant correlations were found. Conclusion: ESR and serum lactate were identified as useful predictors of amikacin pharmacokinetics in critically ill patients with intraabdominal sepsis and may help guide the selection of appropriate empirical dosing. Further studies are required to confirm these findings. Disclosure of Interest: None declared. 

The Candida spp is one of the most common causes of bloodstream infections (BSI) in immunocompromised hosts. Their ability of biofilm formation on different implants facilitate the catheterassociated infections. Objectives: The aim of this study is to investigate an outbreak of bloodstream infections in pediatric hematology-oncology patients with totally implantable venous access port systems. Methods: A total of 36 episodes of port system-related bloodstream infections were registered and investigated in 11 patients between January and May, 2021. Blood cultures, needles, saline solutions, i.v. plastic lines,bags, staff hands samples sent to microbiology lab. The Candida spp. isolation on SDA. The isolates identification by VITEK 2, BioMerieux and api20CAUX, BioMerieux, France. Re-identified by MALDI-TOF (MALDI-Biotyper, Bruker. Whole genome sequencing was prepared in the National Reference Lab.

The data from patients notes shows that all patients were neutropenic and with fever at the time of blood cultures and candidemia diagnosis Six of all patient had one sepsis episode each. Five of them had three or four sepsis episodes, mostly in March and May, 2021. The all blood cultures isolates as well as needles' isolates were identified as Candida parapsilosis. In the cases of five patients with persistent candidemia and ongoing fever, additionally to antifungal therapy, the ports were removed, based on the international guidelines and manufacturer's instructions. Various gaps in the Infection Prevention and control practices were found: poor hand hygiene compliance, shortage of staff and incidents of using a common saline solution bottle etc. Conclusion: The totally implantable port systems represent a high risk of bloodstream infections complications in pediatric onco-hematology patients. The healthcare workers hands can be a risk factor for contamination with Candida parapsilosis. Further work need to create a special bundle and develop strategic measures for infection prevention and control of infections in case of totally implantable venous access port systems as well as a medical staff training programme. Disclosure of Interest: None declared. Introduction: Candida auris is an emerging pathogen in hospital infections that can present multi-resistance to antifungals and causes outbreaks. Objectives: The aim is to describe the infection prevention and control for C. auris. Methods: Identification of yeast isolates was performed by MALDI-TOF and confirmed by ITS sequencing. Infection control measures were decided by a multi-disciplinary ad hoc outbreak panel. Patient screening once or twice a week and extensive environmental testing for C. auris was conducted. Results: C. auris was isolated from a urine sample of a COVID-19 patient who had been transferred from an Egyptian hospital to our COVID-19 intensive care unit (ICU). Immediately, disinfection routine was changed, because C. auris is insensitive to quaternary ammonium compounds. The patient had already been isolated from admission due to evidence of 4MRGN Klebsiella pneumoniae. Six days after confirmation of C. auris in the index patient, a second COVID-19 patient was identified with C. auris. Both patients were isolated in a separated area of the ICU. Strict hygiene and infection control measures were implemented promptly. In the nine weeks from initial confirmation of C. auris and discharge of the two affected patients, C. auris was repeatedly identified in clinical samples of them. However, it was not detected in any other patient on the ICU (n = 7) or discharged from it (n = 13) nor in any environmental sample (n = 129). The two C. auris patients had been intubated using the same video laryngoscope seven days apart. Although the equipment and the spatulas had been manually reprocessed using chlorine dioxide-soaked wipes they might serve as transmission vehicle. Therefore, it was recommended to use disposable spatulas. Conclusion: A rapid confirmation of a C. auris in the lab and the immediate implementation of adequate hygiene measures at the ward are crucial in order to prevent transmission of C. auris to other patients. Disclosure of Interest: None declared. Introduction: Multiple-site colonization with Candida spp. is commonly recognized as a risk factor for Invasive Candidiasis (IC) among intensive care unit (ICU) patients. Up to 80% of those patients are colonized one week after their admission. Objectives: Therefore, this study was carried out to assess the relationship between IC and the determination of Candida colonization index (CI) in patients addmitted to an ICU. Methods: A prospective observational study was conducted in 2020 during two months in three intensive care units (ICUs) of the university hospital Sahloul in Sousse, Tunisia. All patients admitted at least for one week in the ICU were included in the study. After 7 days from the admission in the ICU and every week, five of the following samples were collected for mycological screening: tracheal secretions, rectal swab, armpit skin swab, mouth swab, nasal swab and urine. According to Pittet's definitions, the Candida colonization index (CI) was calculated as the proportion of the number of distinct body sites (other than blood culture) colonized with Candida spp. over the total number of sites cultured. Patients with CI ≥ 0.5 were considered heavily colonized. Results: Out of 46 studied patients, a total of 21 patients have had an IC based on both biological and clinical evidences. Using a CI ≥ 0.5, the sensitivity was the highest at the third week from the admission (84,6%) and the positive predictive value (PPV) was excellent from the second week (92,3%). The CI showed also a good specificity (92%) from the first week of the patient's hospitalization. Introduction: Antimicrobial resistance (AMR) is a global problem that has long spilled over from hospitals to the community. Long-term healthcare units (LTHU) represent a transition setting by accommodating patients with compromised immunity, previous hospital admissions, invasive devices and wounds, thus more prone to colonization and/or infection by Enterobacteriaceae, some with multidrug resistance (MDR) features. Objectives: This study scopes for Enterobacteriaceae incidence and related AMR, in a Portuguese LTHU through a longitudinal analysis of its inpatients and environment, to demonstrate the role LTHU have in AMR spread. Methods: During 6 months, clinical (anus, mouth, hands) and environmental samples (bedside table, bed rail, handbell, door handle) were biweekly collected in 2 LTHU rooms. Samples were culture-based processed and antimicrobial susceptibility profiling (ASP) was conducted in all presumptive Enterobacteriaceae (PE), according to EUCAST methodology, testing amoxicillin + clavulanic acid (AMC), cefotaxime (CTX), cefoxitin (FOX), ceftazidime (CAZ), imipenem (IMP), aztreonam (ATM), meropenem (MEM), ciprofloxacin (CIP) and amikacin (AMK). Introduction: CRE can survive not only in a humid environment but also in a dry environment for a long time, is more closely related to hospital environment contamination than other intestinal bacteria, and causes transmission, which is a problem in infection control. Objectives: This study was aimed to compare the extent of cabapenem-resistant Enterobacteriaceae (CRE) contamination of the environmental 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 after CRE was isolated from a tertiary acute care hospital were selected. Eight samples were collected before and after terminal room disinfection, one each from the bed table, mattress, bed railing, door handle, sink surface, drain, toilet, and toilet railing in each hospital room. For a total of 181 specimens, the relative light units (RUL) and colony forming units (CFU) values were measured using the ATP and culture test, respectively. Results: Two CRE cases were isolated from the drains of the two hospital rooms before disinfection, one case on the surface of the sink, and the other case from the toilet seat. Both strains were identical as Klebsiella pneumonia and consistent with the patient's strain. The RUL value was highest in the drain before disinfection, and those of all surfaces except the drain decreased after regular terminal disinfection. After disinfection, all except for the drain (50%) and toilet handrail (90%) was under the environmental surface cleanliness criterion (RLU < 250), and the RLU value for bed table (p = 0.031) and the mattress (p = 0.016) was significantly different before and after disinfection. Conclusion: CRE isolation on the surface of CRE patient's room is less than that of previous studies. Regular terminal disinfection is effective to reduce the contamination of most room surfaces except sink drain. Therefore, additional terminal disinfection methods are required for sink drain. Disclosure of Interest: None declared. Introduction: Wastewater has been increasingly implicated in outbreaks with carbapenem-resistant Pseudomonas aeruginosa. Objectives: The objective of this study is to describe the first nosocomial outbreak of Metallo-β-lactamase-producing Pseudomonas aeruginosa type IMP in the hemato-oncology ward linked to contaminated water-related devices at our center and to describe the set of measures adopted for its control. Methods: Between July 26-October 24, 2019, six consecutive isolates of carbapenem-resistant Pseudomonas aeruginosa producing IMP were detected with the same and non-usual antibiogram (sensitive to piperacillin, piperacillin/tazobactam and colistin). The demographic, clinical-epidemiological and evolutionary characteristics of the patients were analyzed. Cases and environmental samples were sent to a National Reference Laboratory for the corresponding molecular characterization by Pulsed Field Gel Electrophoresis (PFGE). Results: Six patients were affected. Three died. Samples from dry surfaces were negative. Samples from siphons of some patients' rooms sinks were positive; two profiles were found according to molecular characterization by PFGE. The most frequent profile was found in the first four isolated cases in the hemato-oncology ward and traps of sinks of two patients' rooms. The other profile was found in one patient outside hemato-oncology unit and others traps in the ward. There were no more cases after replacement of traps and sinks. Conclusion: It was an outbreak of infection and colonization by a Metallo-β-lactamase-producing Pseudomonas aeruginosa type IMP, associated with rapid torpid evolution among hemato-oncology patients. It was also isolated in environmental samples associated with aqueous devices. Its role as a source and facilitator of transmission was determined by the results of the molecular study, and the control measures taken on the environment corroborated the role of these aqueous elements in the transmission. Disclosure of Interest: None declared. Objectives: This investigation aims to define the molecular epidemiology and transmission dynamics of four cases of hospital-acquired VIM-1-carbapenemase-(some co-harboring mcr-9) E. cloacae complex on a critical care unit and the infection control interventions applied over time. Methods: Infection prevention and control measures introduced were as follows: contact precautions, environmental sampling of all sinks and shower drains (2019 and 2020), replacement/cleaning and disinfection of the drainage, screening, observations, and trainings. Whole genome sequencing was performed (Illumina MiSeq and MinION, cgMLST analysis by Ridom Seqsphere + , JSpeciesWS, PlasmidFinder and ResFinder). Results: Several plausible transmission events from the hospital environment were confirmed: one patient-environment-patient transmission with a VIM-1-producing E. hormaechei subsp. hoffmannii (same genotype in patients and drains; patients treated in the same room 16 months apart) and one environment-patient transmission with an E. hormaechei subsp. xiangfangensis coharbouring bla VIM-1 -and mcr-9 (highly related strain found in the sink drain in the adjacent room before the patient was admitted). Observations carried out revealed possible environment-to-patient transmission events as medical equipment and patient care products were stored nearby the washbasin. Despite persisting bla VIM-1 -and mcr-9-containing biofilms in drains, no more additional patient cases were detected. Conclusion: Transmission of carbapenemase-producing Enterobacterales arising from the hospital waste-water system are often complex, involving several genotypes and resistance genes. As the biofilm is difficult to eradicate, it is important to emphasize standard precautions and include regular compliance observations to achieve a sustainable infection control. Disclosure of Interest: None declared. Introduction: Treatment of infections caused by carbapenemase-producing Enterobacteriaceae leads to high morbidity and mortality due to the limited availability of efficient antibiotic regimens. Monotherapy is associated with higher mortality and the combination of antimicrobials is used as the first choice. This study describes the clinical and microbiological experience of carbapenemase-producing Klebsiella pneumoniae(CPKP)isolates with combination therapy. Objectives: Describe the characteristics of carbapenemase-producing Klebsiella pneumoniae infections treated with polytherapy in two fourth-level care centers in Bucaramanga. January 2015-January 2020. Methods: A retrospective cohort study of the Bucaramanga University Hospital. Patients over 18 years of age with carbapenemase-producing Klebsiella pneumoniae infections were included in patients who had completed at least 48 h with antibiotic combination therapy. Results: During the study period, 550 patients with CPKP infection were identified. 440 patients were excluded and 110 patients were selected for analysis. The combined antibiotic management regimens were Meropenem plus Polymyxin-B (39%); Meropenem plus Ertapenem (34%) and others. The microbiological success was 41% and the clinical success was 77% with a failure rate of 23%. Overall mortality was 26%; 85% of the Kp detected produced class A carbapenemases (KPC), while the rest of the isolates harbored class B Metallo-β-lactamase genes and class D carbapenemases (OXA). Mortality at the end of hospitalization was significantly higher in patients who presented some severity criterion (P < 0.05). On the other hand, the double carbapenems group with Ertapenem presented qualifying mortality compared to the other regimens (p = 0.04). Conclusion: The need for effective management for KPRC persists. This observational analysis shows that the association of ertapenem plus meropenem provides a survival benefit. Larger prospective studies are needed to confirm these findings and to define the role of this unconventional strategy. Disclosure of Interest: None declared. Introduction: The prevalence of extended-spectrum b-lactamaseproducing Enterobacteriaceae (ESBLE) and carbapenemase-producing Enterobacteriaceae (CPE) in hospitalised and community patients is of significant public health concern. Objectives: This study aimed to investigate the fecal carriage and molecular epidemiology of ESBLE and CPE isolated from patients at admission to a medical ward. Methods: From January to July 2019, 100 patients admitted to the medical ward via intensive care unit (ICU) and emergency department (ED) were screened for ESBL and CPE carriage at admission. ESBLE were identified by double-disk synergy test. PCR and sequencing were used to characterize the resistance genes. 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 species, the bla CTX-M-1 group was the most common gene detected (75%), followed by bla TEM (62.5%) and bla SHV (31.2%). Carbapenemase production was found in one E. cloacae and was expressed exclusively by the bla OXA-48 gene. Nucleotide sequence analysis of bla CTX-M-1 demonstrated that all strains carried the CTX-M-15 subgroup. Introduction: Multi Drug Resistant microorganisms (MDR) have been a serious issue for public health for more than fifty years. Carbapenem resistant Klebsiella pneumoniae (KPC) is a highly lethal bacteria, with a mortality rate in order of 40% worldwide. Objectives: In this study we examined data collected from the MDR surveillance team to understand how this life-threating infection impacted during COVID-19 pandemic.

Methods: A retrospective observational study was conducted at the about 950 beds Academic Hospital of Udine, Northeast of Italy. Data about new cases of KPC occurred from 2016 to 2021 were collected from internal datasets. Considering bed occupation, we calculated weekly incidence rate of KPC cases. Using Chi-square test, cumulative incidence rates before and after the 10 th of October 2020, considered as the start of the 2 nd COVID-19 wave in our hospital, were compared. Results: During the observation period, 255 new KPC cases were reported on a total of 1,235,177 days of hospitalization. Cumulative and mean incidence rates on the overall observation period resulted 2.064 and 2.075 new KPC cases per 10,000 hospitalization days, respectively. Cumulative incidence rate were calculated in 1.287 before and 7.467 after the second COVID-19 wave, being the two statistically different (p < 0.001, CI 95%). 

We observed a worrying rise of KPC infection incidence since the 2 nd COVID-19 wave began, suggesting an increased KPC outbreaks risk during pandemic. This observation could be explained by a reduced effectiveness of personal protective equipment wore by healthcare workers or its unsuccessfulness in preventing cross infections within COVID units. Even during a pandemic, contact precautions should not be overlooked in healthcare settings and there is an urgent need to reinforce professionals' attention against the spread of MDR to prevent their rise. Disclosure of Interest: None declared. 

We conducted a longitudinal observational study during six-month between 1 June and 1 December 2018. Rectal and nasal swab cultures were collected to detect VRE and CPE among patients admitted in six ICUs of Sahloul university hospital of Sousse (Tunisia) and more than three times, at least one week apart. Results: During the study period 174 patients were screened. Of them, 69.5% were male and 73.6% were admitted in surgical ICU. In total, 161 and 152 samples were realized respectively for the detection of CPE and VRE. These samples were positive in 15% and 8.5% respectively for CPE and VRE. Klebsiella pneumoniae OXA 48 was the most isolated CPE (80%). Independent risk factors for VRE infection were surgery (aOR = 2.6, CI 95% = [1.9-8.2]), organ failure (aOR = 2.3 CI 95% = [1.5-6.5]), and exposure to antibiotics during the month before screening (aOR = 4.2, CI 95% = [2.3-7.9]), and for CPE, exposure to antibiotics during the month before screening (aOR = 3.9, CI 95% = [2.7-10.6]). Conclusion: The screening system is a complementary axis to the surveillance of infections with eHRB. Our high rates testify the need for a sensitive, specific and cost-effective screening programm that may help in infection control by early identification of patients. Disclosure of Interest: None declared. Introduction: Singapore General Hospital has attempted multiple interventions to prevent CRE transmission in inpatient setting. These include active surveillance of high-risk patients, isolation and cohorting, hand hygiene and enhanced environment hygiene programs. However, the number of CRE carriers continued to rise with time because lack of policy to allow untagging the carrier status for returning inpatients to the hospital. Objectives: The purpose of this study is to determine appropriate period of establishing clearance of CRE in known CRE patients. Methods: Patients with known history of CRE and discharged more than 3-months ago were recruited into the study, where 1 st and 3 rd rectal swabs were taken on day 1 and day 7 respectively and 2 nd rectal swab was taken between day 2 to day 6. CRE was detected using the PCR method from the 1 st and 2 nd samples whilst culture method was used for the 3 rd sample.

Results: Out of 76 participants recruited, 50% of the cases cleared CRE carriage in 304 days (95% CI: 238 to 369 days) from last date of discharge; and more than 80% cleared it within 2 years. 56.6% of study population were male with majority Chinese and median age of 67.0 years. The median length of stay of these 2 groups were 14.0 days for patients who did not clear CRE carriage and 7.0 days for patients who cleared CP-CRE carriage. Sixty-five patients continued antimicrobial treatment after initial discharge, with amoxicillin-clavulanic acid as the frequently used antimicrobial. Median antimicrobial-free days was 118 days for patients who did not clear CRE while for CRE cleared group, it was 281 days. Conclusion: Our study showed that majority (80%) of patients lose CRE carriage if they stayed away from the hospital for at least 2 years. The duration of CRE colonisation is uncertain and is likely to vary between individuals. However, a prospective study with repeated CRE testing at regular interval will be required to determine exact time of CRE clearance before specific guidance can be given as to when one should consider a patient cleared of CRE carriage. Disclosure of Interest: None declared. To determine the identity of the isolates of microorganisms, bacteriological, molecular biological (PCR-RT and MLST) methods were used. Results: All patients after the TSC were in isolated wards. There were 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 to carbapenems was detected in 6 patients with bacteremia. With the development of bacteremia in the same patients, E. coli resistant to carbapenems was detected in rectal smears. In two patients with the development of bacteremia caused by E. coli sensitive to carbapenems, the genes of carbapenemases NDM and CPC were found in rectal smears. When conducting a microbiological study of objects in the hospital environment and samples of biomaterial (pharynx, nose, hands, rectal smear), E. coli and antibiotic resistance genes were not found in the staff of the Department of Hematology. When conducting a comparative analysis of the complete genomes of Escherichia coli isolates isolated from the blood of 6 patients at all common loci (5045 loci in total), it was found that one of the isolates was slightly different from the others (about 100 substitutions), while in all other pairs there were no more than 10. These differences may be caused by differences in the plasmid sequences. In this analysis, no plasmids were isolated, but the results already obtained still allow us to attribute all the isolates to one strain. Conclusion: According to the results of the study, the group colonization of patients with the strain of E. coli, due to the translocation of the intestinal flora, was established. Disclosure of Interest: None declared. Introduction: Acinetobacter baumannii attracts a lot of attention, both with its frequency and extremely developed resistance to antimicrobial agents. Once out of use due to numerous side effects, polymyxins such as colistin acts synergistically with other antibiotics and serve as the last therapeutic option for life-threatening infections caused by this extremely resistant pathogen. For antimicrobial susceptibility testing of colistin, EUCAST recommend the broth microdilution method (BMD). It is a semiquantitative, in vitro method, based on the action of an antimicrobial agent and a bacterial isolate. Objectives: To investigate an increasing trend of colistin resistance in hospital isolates of Acinetobacter baumannii. Methods: This retrospective study was conducted at Clinical microbiology Unit, Clinical Center of the University of Sarajevo, the largest tertiary level hospital in Bosnia and Herzegovina. Study included 219 isolates of Acinetobacter baumannii detected from June 2019 to October 2020 by VITEK ® 2 COMPACT, BioMerieux. MIC values were determined by broth microdilution method, according the EUCAST recommendations with "MIC-Strip Colistin", producer Merlin A Bruker Company, Germany. Results: A.baumannii was isolated most commonly from the ICU 76 (36%) and pediatric clinic 24 (10, 96%). The isolates were recovered mostly from upper respiratory tract 69 (31, 51%), wound and drain swabs 62 (28, 31%). Minimum inhibitory concentration (MIC) value for colistin ranged from 0.25-2 µg/ml. The highest number of isolates, 125 (57%) had a 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 period April to October 2020 and this value was detected in 6 (2.74%) of isolates. Conclusion: Our study showed an increasing trend of colistin MIC value for Acinetobacter baumannii isolates in our hospital. The increase in antimicrobial resistance of this important hospital pathogen has a significant impact on infection control. If this trend continues, simple infections will no longer be curable. Broth microdilution method (BMD) is a good tool for early detection of emerging resistance. Disclosure of Interest: None declared. Introduction: Burkholderia cepacia complex (BCC) was tied to various FDA drug recalls such as nasal spray, curl styler, wipes, oral electrolyte, and anesthetic hydro jell. Burkholderia cenocepacia is a clinically important member of the BCC. These are opportunistic pathogens in patients with respiratory tract infections. Objectives: The main research objective is to compare antibiotic and disinfectant sensitivity of B. cepacia and B. cenocepacia using the Kirby Bauer Method. Methods: Four replicates of the Muller Hinton culture plates with disks embedded with antibiotics and disinfectants were incubated at 37 °C. After incubation, zones of inhibitions were measured. Bacterial growths were measured at 4, 20, 25, and 37 °C and pH 4, 6, 7 and 8. TSB broth cultures set to pH 4, 6, 7, and 8 were incubated over night at 4, 20, 25, and 37 °C. After incubation, transmission readings were obtained using the Spectrophotometer. Transmission is inversely proportional to bacterial growth. Used the ANOVA with a P < 0.05. Results: The bacteria had resistance to Penicillin (P10), Ampicillin (AMP10), Tetracycline (TE30), Erythromycin (E15), and Streptomycin (S10 Background: Acinetobacter spp are important opportunistic pathogens responsible for nosocomial infections. Objectives: detection of EsβL and carbapenemase, the ability of biofilm formation and their relation to antimicrobial resistance. Methodology: A total of 230 clinical samples from patients admitted to Menoufia University Hospitals were obtained. Acinetobacter spp were identified by standard microbiological methods and Vitek-2 system. The antibiogram of Acinetobacter isolates was tested by the modified Kirby Bauer disk diffusion method, detection of extended-spectrum β-lactamases and carbapenemase by EsβL NDP and CANP tests. Biofilm production was detected by modified Congo red agar and PCR. Results Acinetobacter spp. represented (20.8%) of all the collected isolates. Vitek-2 system showed that the predominant spp. was Acinetobacter baumannii complex (80%). Acinetobacter isolates were highly resistant to cefepime and tobramycin (90% for each), ceftriaxone (88%), piperacillin, and ampicillin -sulbactam (86% for each), piperacillin-tazobactam (84%) and tetracycline (78%). About 64% and 68% of the Acinetobacter isolates were susceptible to tigecycline and colistin respectively. The sensitivity of EsβL NDP for detection of EsβL producing Acinetobacter isolates was 93.8%. The Carba NP and carbAcineto NP tests detect carbapenemse production in 6% and 56% of Acinetobacter isolates respectively. Biofilm production was found among 56% isolates by MCRA method, while conventional PCR showed fimH and CsgA genes among 60% and 18% isolates respectively. Conclusion: Acinetobacter spp are serious nosocomial pathogens as they can produce ESβL and carbapenemase, and produce biofilm that is related to their antimicrobial resistance. Therefore, their adequate prevention and control is imperative. Introduction: C. difficile infection (CDI) weighs heavily on healthcare system due to increased incidence, morbidity and mortality, as well as costs. CDI is mainly considered as a health-care associated (HCA) after exposure to broad-spectrum antibiotics (ATB). However, CDI has been reported in people previously thought to be at low risk. Objectives: The objective of this study was to compare characteristics of CDI cases regarding the previous exposure to ATB in the last 30 days before onset of symptoms. Methods: Between January 2007 and December 2020, a prospective surveillance study of CDI was conducted in a 900-bed French university hospital. European definitions of CDI case, relapses and origin of acquisition were applied. Results: A total of 1060 (1182 episodes) patients were included with a mean incidence rate of 2.3 per 1000 hospital-stays. Episodes were HCA (76.7%), community-acquired (CA) (17.7%) or undetermined origin (5.6%). The mean of age was 66.3 years and 51% were women Comparison between the two groups (G) of episodes according to previous exposure to ATB (G#1: 851 (72%) exposed, G#2: 331 (28%) unexposed) showed that the age and sex distribution was similar between the 2 groups. Prior to CDI, exposure to proton pump inhibitors (PPIs), antivirals, immunosuppressants and colonic preparations were significantly more frequent in G#1. Patients in G#1 had a significantly longer mean length of stay than those in G#2 (33 vs 25 days; P = 0.007). CA-CDI was significantly more frequent in G#2 (57.6% vs 42.4% for G#1, P < 0.0001). The complication, relapse and death rates were similar between the 2 groups. CDI in low-risk patients (age < 50 years, no recent exposure to ATB and PPIs) was observed in 4% of patients (mostly CA, P < 0.0001). Conclusion: Our results show that CDI can affect populations previously thought to be at low risk. These findings suggest that other, no yet known, factors may play a role in the acquisition of CDI. Therefore, it is important for physicians to be aware of the changing epidemiology of CDI in order to remain alert to the possibility of CDI in diarrhoea patients, even in the absence of the common/expected risk factors. Disclosure of Interest: None declared. Introduction: Clostridioides difficile (CI) is responsible for healthcare associated diarrhea with possible severe progression. Recurrence of the disease induces higher health system costs, as well as exposes patients to additional health risks. Objectives: The purpose of this study was to determine the incidence and risk factors of post-discharge CD infections (CDI) after hip endoprosthesis. Methods: The study was conducted using the national database containing the data about 55,842 hip and knee arthroplasties, including 192 cases of CDI from 2017. Results: The CDI incidence was 34.4 per 10.000 patients, the median stay in hospital for CDI cases was 7 days, this result is in the third quartile of patients without CDI; 48 patients, 25% of all CDIs had a healthcareassociated infections (HAI) other than CDI. At least one antibiotic in postdischarge period before the CDI symptoms had prescribed 42 patients, 21.9%, (the most common were beta-lactams (J01C and J01D groups), macrolides (308 prescriptions) and quinolone (101 prescriptions). In the multifactorial review, the following turned out to be significant: age > 65 years of age, taking antibiotics: J01C and/or J01D (beta-lactams and other beta-lactams) and/or J01M (quinolone), HAIs other than CDI, trauma as the cause of surgery, stay in the intensive care unit and length of stay in hospital over 7 days. Conclusion: C. difficile is still one of the most common cause of hospitalacquired infectious. Infection prevention and control, as well as responsible prescribing of antibiotics is an important factor in reducing the incidence of CDI in post-surgery period. Disclosure of Interest: None declared. Introduction: Escherichia coli is a major pathogen of hospital-and community-acquired infections and causes a tremendous burden on the healthcare system. Investigating the epidemiology of E. coli is essential, but rarely performed to manage antimicrobial resistance at the hospital level in China. Objectives: To manage E. coli infections in a local healthcare setting. Methods: Demographic, epidemiologic and microbiologic data were retrieved from electronic health records in a tertiary teaching hospital in China between 2015 and 2020 to investigate the incidence and resistance profile of E. coli. Antibiotic susceptibility testing was performed according to the Clinical Laboratory Standards Institute. Results: Among 2630 E. coli isolates included after exclusion of stool specimens, extended-spectrum β-lactamase-producing E. coli (ESBL-PE) was identified in 1287 (48.9%) isolates, and carbapenem-resistant E. coli in 17 (1.0%). Of 413 E. coli isolated from blood, ESBL-PE accounted for 48.7% and 0.154/1000 patient-days. The 3 hospital units with the highest incidence were the medical/surgical intensive care unit and surgical (gastrointestinal, hepatobiliary, urological) and medical units (0.611, 0.304 and 0.171/1000 patient-days, respectively), which reached statistical significance 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 stewardship interventions and effectively monitor and respond in a timely manner to antimicrobial resistance at the hospital level. Disclosure of Interest: None declared. 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 application 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-western region of the Netherlands. A cross-sectional survey was developed, and filled out by a researcher during interviews with infection prevention practitioner(s) (November 2020-April 2021). CI measures were compared to those stated in the ESCMID guideline. Results: Seven hospitals(87.5%) applied CI measures for patients with ESBL-E. All 7 hospitals agreed in their policy on the personal protective equipment(PPE) used by healthcare workers(HCWs) upon room 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 type used for CI, PPE use during physiotherapy outside patient rooms, allowing visitors temporary room leave, and cleaning and disinfection products( Table 1 ). The ESCMID guideline recommends always using PPE upon room entrance. All 7 hospitals followed the ESCMID guideline for HCWs PPE use upon room entrance with anticipated patient contact, however 5 out of 7 hospitals(71.4%) did not require HCWs to use PPE without anticipated patient contact. Furthermore, the ESCMID guideline recommends isolating patients in single-patient rooms, while 5 out of 7 hospitals(71.4%) also allow CI in multiple-occupancy rooms.

This study showed regional variability in applying CI measures for patients with ESBL-E, which can be used to regionally harmonize ESBL-E measures. In the future, the variability in measures can be used to study effects of different elements in a bundle of measures. Disclosure of Interest: None declared.

Characterization of gram-negative bacteria on ambulance stretchers: a descriptive correlational study B. C. Santana 1,* , A. Pereira 1 , P. Oliveira 1 , H. Souza-Junior 2 , E. Watanabe 3 , P. Hermann 1 1 Introduction: Health care-associated infections are a serious problem. The investigation about the role of the ambulance microbiota in healthcare risk is narrow. Objectives: The objective was to characterize gram-negative bacteria resistant to carbapenem isolated from advanced life support land ambulance stretchers. Methods: Descriptive correlational study, quantitative, carried out in the Federal District, Brazil, on 6 ambulance stretchers from a public service and 6 from a private service. Performed for three consecutive unannounced days, at the beginning and end of the day shift. The microbiological samples were collected, using Rayon-tipped swabs, moistened in Stuart medium. The bacteria were cultured in Luria Bertani broth (LB) under selection pressure with Vancomycin to exclude gram-positive and subsequent selection of carbapenem-resistant gram-negative by pressure with meropenem in LB broth, according to EUCAST/BrCAST protocol. For the isolation of colonies and the presumptive identification of bacterial species, ESBL chromogenic agar was used, and the final identification of the isolates was done by MALDI-TOF. Antimicrobial susceptibility testing was performed using polisensidisk according to EUCAST/BrCAST. And, by way of PCR, the presence of the bla KPC , bla NDM , bla IMP , bla VIM , bla OXA48 , ESBL CTX-M of groups 1, 2, and 8 genes and of the transposon Tn4401 was searched. Fisher's exact test was used. Statistical significance was defined as p < 0.05. The study was approved by the Research Ethics Committee. Results: 25 meropenem-resistant gram-negative bacteria were identified, mainly (36%) S. maltophlia. Two isolates of A. baumanni stand out, resistant to 5 antibiotics, from 3 different classes. Six bacteria has carried, unusually, bla CTX-M of group 8, in S. maltophlia and A. baumanni. Two bla KPC genotypes in K. pneumoniae, associated with the transposon Tn4401 were found. Conclusion: The stretchers of ambulances of advanced life support, in this study, were contaminated by meropenem-resistant gram-negative bacteria, most of them S. maltophilia. bla CTX-M from group 8 and bla KPC were the only genes identified, with bla KPC associated with the transposon Tn4401. Disclosure of Interest: None declared. BALB/c mice were randomly divided into four groups, negative control group (aquades), Levofloxacin 100 mg/kg, intraperitoneal injection, the first treatment group (Miana leaf extract/MLE 510 mg/kg) and the second treatment group. (Miana + levofloxacin) for ten consecutive days MLE was administered via gastric gavage. Blood was taken from the first day, the eighth day of the experiment (2 h after treatment), and the day 10. To determine the expression of NRAMP1 mRNA, blood samples were examined by Quantitative Real-Time PCR (qRT-PCR). The growth of Klebsiella pneumonia bacteria in lung tissue was seen using Plate count agar. Results: After administration of Miana extract for 10 days of treatment, the expression of NRAMP1 mRNA in BALB/c mice increased significantly (p < 0.0001). The highest level of mRNA expression was found in the treatment group (Miana + levofloxacin) with an increase before treatment from 8.28 to 13.18 after treatment p < 0.0001. A study carried out by the Cantonal Unit Hygiene, Prevention and Control of Infection (UHPCi) in 2010-2011 showed that adherence with SP is sufficient to contain the spread of MRSA in NHs and hence new recommendations were issued. Additionally, a surveillance of MRSA was initiated in acute care settings on resident admission to hospital. In 2019, we observed an increase in the number of new MRSA colonization diagnosis of residents on admission to acute care settings. Objectives: The objective was to collect and analyze prospectively all news cases of MRSA coming from NHs. Methods: On admission of the resident to hospital, a systematic MRSA screening (nose, throat, inguinal and clinical samples) was performed. In microbiology laboratory, positive MRSA result generated an automatic alert which was sent to the UHPCi. The PCI nurse collected data on risk factors (NH of the resident, age, sex, known infections, previous hospitalizations, comorbidities). Results: A total of 35 residents were screened as newly colonized by MRSA for the time period of 2019 -2021. We collected 23, 7 and 5 cases in 2019, 2020 and early 2021, respectively. Among them, 6% (2/35) were found to be infected with MRSA on their admission. The documented risk factors were 1 dialysis, 5 urinary catheters, 5 chronic wounds and 14 with more than two hospitalizations within one year. Residents came from different NHs: 11 NHs recorded one resident, 5 NHs 2 residents and 3 NHS 3, 4 and 6 residents, respectively. Conclusion: The limited number of newly diagnosed resident does not confirm if living in a NH is a significant risk factor for MRSA acquisition. Therefore, continuous surveillance of MRSA on admission in acute settings for all resident coming from NH is needed in order to monitor a potential increase of this pathogen. Disclosure of Interest: None declared. Introduction: S. aureus is commensal and pathogenic bacteria which can survive in diverse environments and grow in many types of foods. Several surveys have documented the presence of MRSA in foods, but its status as a food-borne pathogen is still unclear. Objectives: The aim of this work is to perform whole genome sequencing (WGS)-based genomic epidemiology analysis of MRSA isolates of clinical and food origin. Methods: WGS was performed on Illumina HiSeq platform for 4 MRSA isolates collected from Moscow medical center and 6 MRSA samples isolated from ready-to-eat food. The susceptibility was determined by the boundary concentration method on VITEK2Compact30 analyzer. Genome assemblies and genome comparisons were performed using SPAdes, roary, dnadiff and custom software. Results: The S. aureus isolates studied were characterized by similar profile of antimicrobial susceptibility. They belonged to ST22 and 4 Spa-variants regardless of their origin. All MRSA isolates analyzed had SCCmec IV type. Another common determinant of antibiotic resistance was penicillin-resistance gene blaZ. All MRSA isolates of food origin carried additional gene of resistance to lincosamide, and two of them also included resistance genes to phenicols and macrolides. The set of virulence factors in S. aureus isolates studied was similar and quite extensive (up to 15 genes), and consisted of both structural 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 origin revealed very close relationship between one food and one clinical isolate. Conclusion: WGS-based analysis enabled us to reveal unique genome features of MRSA isolates of clinical and food origin. The data obtained will allow us to identify new target molecules for differentiation of MRSA isolates belonging to different genetic variants. We also provide microbiological criteria for MRSA in ready to eat foods, in particular, as an important option for controlling the dissemination of antimicrobial resistance and potential Staphylococcus enterotoxins' production. Disclosure of Interest: None declared. Introduction: Antimicrobial resistance is a global crisis that requires urgent attention and action. We report data on meticillin-resistant Staphylococcus aureus and hand hygiene compliance rate in Benin over five years period. Objectives: Assess meticillin-resistant Staphylococcus aureus proportion towards hand hygiene compliance in Benin's healthcare settings from 2014 to 2018. Methods: This was a retrospective study implemented in Benin hospitals between 2014 and 2018. We collected data on meticillin-resistant Staphylococcus aureus proportion and hand hygiene compliance rate. Beta regression was used to conduct statistical analysis. A p-value of 5% was considered statistically significant. Results: Hand hygiene compliance rate was 13%,15%,26%,17.5% and 20% in 2014, 2015, 2016, 2017 and 2018 respectively, p = 0.001. Meticillin-resistant Staphylococcus aureus proportion was 68%, 64%, 54% 50% and 48% in 2014, 2015, 2016, 2017 and 2018 respectively, p = 0.0001. From 2014 to 2018, hand hygiene compliance rate increased while meticillin-resistant Staphylococcus aureus proportion decreased. Discussion: Hand hygiene compliance increased from a baseline 13% to 20%, p = 0.001. Between pre-and postintervention hand hygiene adherence improved by 29% (p < 0.001) but did not change over the 5-year assessment (38.3%; p = 0.47) [1] . When hand hygiene compliance increases meticillin-resistant Staphylococcus aureus proportion decreases. Hand hygiene was associated with a decrease in healthcare associated meticillin-resistant Staphylococcus aureus infections in a large health care system [2] . Methods: Fifty-one male rats weighing 250-300 g were randomly divided into four groups. Surgical procedures were performed under general anesthesia (intraperitoneal injection of ketamine 75 mg/kg −1 ). 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 108 CFU/ml). The incision was cleaned and two minutes later wiped dry. The incision sites were infiltrated subcutaneously with doses of 3 ml of the study drug: normal saline in the control group (group A, n = 13), antiseptic decamethoxine (gr.B, n = 13), 0.5% bupivacaine y (gr.C, n = 13) and combinations thereof in a ratio of 1:1 (gr.D, n = 12). The effectiveness of antiseptic treatment in the wound area was evaluated using von Frey filaments. Statistical processing was performed using standard biometric methods. Differences at p < 0.05 were considered significant. Results: On the third day of the experiment the number of S. aureus on the surface of the wounds was found to decrease significantly when decamethoxin and its combination with bupivacaine 0.5% were used. The use of bupivacaine 0,5% was accompanied by the moderate microbial invasion in the wound area on the 3rd day. The use of the antiseptic and its combination with bupivacaine on the 10th day revealed almost complete eradication of S. aureus on the wound surface, in compared the control group (p < 0,01). In the combination antiseptic with bupivacaine the pain sensitivity threshold increased by 48.6%, which was practically the same as in bupivacaine monotherapy (48.9%).

The combination of antiseptic with bupivacaine 0.5% in the treatment of wounds is accompanied by an equally high antimicrobial efficacy with a marked anesthetic effect, which opens the prospect of their combined topical application in the treatment of wounds. Disclosure of Interest: None declared. Introduction: Statins have anti-inflammatory properties. In several surgical discipülines, statin mediation seems to be preventive of various postoperative complications. Objectives: The intension was to investigate if a long-term perioperative statin medication, primarily given for cardiovascular disorders, might affect rates of surgical site infections (SSI), or other late noninfectious complications after orthopedic surgeries. Methods: A single-center cohort of 20,088 patients (median age 53 years, 49% females, 5% diabetes) who underwent orthopedic surgery during 2014-2019 was investigated to document statin use (n = 2,486, 12%, 222 different brands and doses) and peri-and postoperative complications including SSI. Cox regression analyses, with and without propensity-score matching (nearest neighbor approach) was used to find potential associations. Results: After a median follow-up of 7 months, 1,414 patients (7%) of the 20,088 patients needed a surgical revision: 158 (0.8%) due to deep SSI and 1,256 (6.3%) for non-infectious reasons. In multivariate Cox regression analyses, statin use was unrelated to both SSI (hazard ratio (HR) 0.9; 95% confidence interval (CI) 0.6-1.4) and non-infectious complications (HR 1.1, 95%CI 0.9-1.3). Further, statin use did not increase the risk for SSI in the subgroup of implant-related surgery (HR 0.8, 95%CI 0.4-1.6) or arthroplasties (HR 0.8, 95%CI 0.3-2.6). Propensity-score matched analyses on the variable "statin" equally failed to alter these outcomes. Conclusion: In our large cohort study with over 20,000 orthopedic interventions, we found no protective effect of a statin medication on deep SSI risks; or on other late non-infectious complications requiring revision surgery. Disclosure of Interest: None declared. Introduction: Obesity is a risk for surgical site infections (SSI). Based on retrospective comparisons and pharmacology, many centers adopted a weight-(or a body mass index (BMI))-related antibiotic prophylaxis to prevent SSIs. Objectives: This before-and-after study examined whether doubling of the antibiotic prophylaxis can prevent surgical site infections. Methods: We introduced a hospital-wide double-dose prophylaxis on 3/2017 for patients > 80 kg. In our all-orthopedic cohort, we compared the period 4/2014-3/2017 ("before") to 3/2017-6/2019 ("after") regarding the clinical impact of this dose-doubling on the SSIs. Results: We compared 9,318 surgeries "before" to 7,455 interventions "after". In both periods, baseline demographics (age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA)-Score, revision surgeries, and duration of surgery) were similar. In the period "after", 3,069 episodes (3,069/16,773; 18%), received a double-dose prophylaxis. Overall, we witnessed 82 deep SSIs (0.5%). The pathogens were resistant to the standard cefuroxime prophylaxis during the index surgery in 35 cases (35/82; 43%). By excluding these prophylaxis-resistant cases and all of the five hematogenous SSIs, we remained with 47 SSIs (57%) that could have been prevented by prophylaxis. The doubledosing of parenteral cefuroxime from 1.5 g to 3.0 g in obese patients did not reduce deep SSIs (hazard ratio (HR) 0.7, 95% confidence interval (CI) 0.3-1.6. In the direct group comparison among obese patients > 80 kg, the administered double-dose prophylaxis equally failed to alter outcome (3,088/16,726 non-infections vs. 8/47 deep SSI despite double-dose prophylaxis; Pearson-chi 2 -test; p = 0.78). Conclusion: In our single-center before-and-after-study with almost 17,000 orthopedic surgeries in adult patients, the systemic doubling of the perioperative antibiotic prophylaxis in obese patients clinically failed to reduce the overall deep SSI risks. Disclosure of Interest: None declared. Results: We included 20,088 episodes of primary orthopedic surgery, of which 467 with iliac crest bone sampling (467/20,088; 2%). Only two iliac sites (2/467; 0.4%) become infected. In contrast, surgeries with iliac crest sampling yielded more SSIs at the recipient site than those without (1.9% vs. 0.8%; χ 2 -test; p < 0.01). These patients equally revealed more co-morbidities such as a longer duration of surgery (median 127 vs. 79 min), when compared to the general orthopedic population. In multivariate logistic regression analysis with the outcome "SSI at the recipient site", the iliac harvesting was independently 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 surgeries, the SSI risk of the iliac harvest site was low. In contrast, surgeries with supplementary iliac crest harvesting revealed a higher SSI risk than the general orthopedic population, potentially due to a mix of local independent risks of grafting together with a prolonged surgery time. Disclosure of Interest: None declared. Antimicrob Resist Infect Control 2021, 10(Suppl 1):130

We reported the incidence and mortality rates of healthcare-associated meningitis after neurosurgical procedures in a neurosurgical ICU in Russia. Unique for data gathered from Russia, these results are supported with samples based on a 10-year data collection project, providing high reliability of findings. Disclosure of Interest: None declared. Methods: This is a descriptive longitudinal study for analytical purposes. Data collection was carried out between February 05th and April 10th, 2017 with follow-up until day 30, including all therapeutic interventions in five departments of our CHU: General Surgery, Obstetrics Gynecology, Ophthalmology, ENT and Childhood Surgery. The SSI diagnosis was made according to the criteria of the Atlanta CDC. Data entry and analysis were carried out using the Epi-info 6 software. Results: A total of 828 patients were included and 778 patients were seen again on day 30, a postoperative follow-up rate of 93.96%. The 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 with ASA 1 score was 66.42% (550/828). The NNIS index could not be calculated in the infantile surgery department due to the lack of traceability of the duration of the intervention, the evaluation of the antibiotic prophylaxis could not be carried out for lack of traceability in almost all of the patient records. Of the 778 patients followed on day 30, 39 developed a SSI, an incidence rate of 5.01%. The highest rate was observed in the General surgery department with 16.80% followed by the Obstetric Gynecology department 6.56% and the lowest rate of 0.47% in ophthalmology (p < 0.001). The incidence rate of SSI is 8.01% for the ASA score ≥ 2 versus 3.48% for the ASA score < 2 (p < 0.01), as well as for the Altemeier class ≥ 2 (10.74% versus 1.46%, p < 0.001). Stratified on the NNIS index, the incidence rate is 7.62% for NNIS ≥ 1 versus 5.04% for NNIS < 1 (DNS) interventions.

2017 G. Brahimi 1,* , S. Ait seddik 1 , A. LARINOUNA 1 , A. Rebouh 1 , N. Cheboub 1 , H. Khellaf 1 , A. Chetitah 1 , A. Boudebouz 1 , W. Djouimaa 1 , A. El kechai 1 , R.

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 traceability of the duration of the intervention and of the antibiotic prophylaxis for better use of the data and risk analysis. Disclosure of Interest: None declared. Data collection was carried out between February 1st and May 30th, 2019 with follow-up until day 30 in five departments: General Surgery, Obstetrics Gynecology, Ophthalmology, ENT and Childhood Surgery. 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 length of hospitalization is 5.3 ± 6.5. 62.90% (502/797) had an ASA score of 1. The NNIS index could not be calculated for pediatric surgery and ophthalmology due to lack of traceability of the duration of the operation. 26% of the interventions were carried out urgently. The incidence rate of SSI is 5.70% (43/750), it was significantly higher in gynecology-obstetrics 13.04% (21/161) and in general surgery 12.50% (16/128), no case has been registered in ophthalmology. There are four risk factors, in addition to age which is an endogenous factor (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 (p < 0.001) and NNIS score ≥ 1 (p < 0.001). Conclusion: SSI monitoring has highlighted risk factors that must be taken into account in order to improve treatment. We will first aim to reduce the average length of stay, especially in patients with multiple diseases. Disclosure of Interest: None declared. Introduction: The Covid-19 pandemic entailed a lockdown with total restriction of elective orthopedic surgeries. While the access to the hospital and human contacts were limited, hygiene rules were intensified. Objectives: We investigate the impact of those strict hygiene measures on the risk of deep surgical site infections (SSI), wound healing disorders and other complications after orthopedic surgery, before, during, and after the first Covid-19 lockdown. Methods: In a single-center study, patients during the first Covid-19 lockdown from March 21, 2020 to April 26, 2020 were compared to a cohort that underwent orthopedic intervention in the pre-and postlockdown phase, respectively from October 1, 2019 to October 31, 2020. Adjusted multivariate analyses were used to investigate the occurrence of surgical site infections, wound healing disorders and other complications in three study periods. Results: We included 5,791 patients in this study. After a mean followup of 7 months, the lockdown cohort showed a significant higher SSI rate compared to the pre-and post-lockdown period (2% versus 1% and 0.5%). The revision rate due to other complications was higher in the pre-lockdown cohort compared to the others (5% versus 3%), whereas there was no difference for wound healing disorders between all cohorts. In multivariate Cox regression analyses, the lockdown phase was unrelated to all SSI (hazard ratio (HR) 1.6; 95% confidence interval (CI) 0.6-4.8), wound healing disorders (HR 0.7; 95% CI 0.1-5.7) and other complications (HR 0.7, 95%CI 0.3-1.5). Conclusion: The incidences for deep SSI, wound disorders and other complications in orthopedic surgery were not influenced by the promotion of hygiene measures during lockdown. Disclosure of Interest: None declared. Objectives: In a second phase, based on the process analyses and the results of the pilot hospital, a modular training program for PLP was developed and it was investigated whether the concept could be transferred to other study hospitals. Methods: In the intervention phase, the PLP was trained in IPM according to the "train-the-trainer approach" (patient decolonization before surgery, standardized wound care, etc.), which he/she subsequently implemented in his/her department. In the post-phase, HHA rates as well as NI and SSI rates were collected again. 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 (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. The introduction of the dressing change concept significantly increased HHA of all indications (pre = 72.2%; post = 95.6%, p < 0.001). The strongest increase in HHA occurred in the indication "hand disinfection between unclean and clean phase" (pre = 49.3%; post = 86.5%, p < 0.001). HHA also increased for the other indications "before preparation for dressing change" (pre = 77.0%; post = 98.3%, p < ,001); "directly before dressing change" (pre = 78.9%; post = 98.3%, p < 0.001,); "after dressing change" (pre = 83.5%; post = 100%, p < 0.001). Conclusion: By implementing the IPM, infection rates were also slightly reduced and HHA significantly increased for all indications of dressing change in the study hospital. This suggests that the developed bundle of IPM can be transferred to other trauma surgery departments through tailored training. Continuous process analysis could identify individual weaknesses in patient care and adapt intervention concepts. Disclosure of Interest: None declared. Introduction: Microbiological contamination of air in operating room (OR) is a known risk factor for surgical site infections. Evaluation methodology of ventilation systems regarding infection preventive efficacy and cost benefit ratio is still a topic of discussion. To date there are no uniform standardized specifications and validation criteria established. Objectives: We aimed to assess evaluation methodologies of infection preventive efficacy of OR ventilation systems. 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 analyzed various normative procedures, compared them regarding reliable assessment of efficacy and efficiency and conducted experiments in our research OR and at selected clinical sites. Results: Key for infection prevention is the reduction of airborne pathogens. The OR must be viewed holistically from a workflow perspective as a complex thermodynamic system with several mutually influencing factors, i.e. room size, convection currents of staff and equipment, flow obstacles and ventilation systems design. Our analysis has shown 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 the operating room as a whole is viewed as protected area like in the concept of temperature controlled airflow (TcAF). Comparative measurements of active and passive air sampling show that only active sampling during live surgery allows reliable assessment of microbiological air burden. Conclusion: Not only technical execution should be in focus of standards and normative specifications. The "what is to be achieved" should be more important than the "how it is achieved". This enables optimized risk management. It might be useful to follow rather the requirements of EN ISO 14644 and GMP guidelines than countryspecific non-uniform standards for ventilation technology in ORs. As part of the qualification of OR ventilation systems, PQ (Performance Qualification), the examination of the performance under real conditions, plays a central role. The lack of such a "live" qualification as an "acceptance criterion" could explain the controversial study situation regarding the infection preventive efficacy of OR ventilation systems. Introduction: In developed countries, the population of elderly people is steadily increasing, which is associated with increased needs for permanent institutional care in long-term care facilities (LTCF), there about 20% of infections is due to multi-drug resistant microorganisms. Objectives: The aim of this research was to assess how the situation concerning healthcare associated infections (HAIs) and antimicrobial consumption (AMC) in Polish LTCFs relates to that in other European countries. Methods: The most recent HAIs in long-term care facilities Point prevalence survey (HALT PPS) was carried out in European countries (EU/ 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 residents received at least one antimicrobial agent, with prevalence 4.9%, in Poland, 3.2%. The most frequently used antibacterial were beta-lactams, 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 availability 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. (Table 1) . Overall, means and results indicators were better in NHs with mobile IPCT compared to NHs without ( 

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, especially in the areas of IPC human resources, IPCT-led training, alcohol handrub use, and HCW influenza vaccination rate. Implementation of such teams should be encouraged all over the country. Disclosure of Interest: None declared. Introduction: From March 2020, the nursing homes (NH) staff has been on the front line of the battlefield linked to the CoVID-19 pandemics. The healthcare workers (HCW) are at the heart of the institutional system as they provide care for residents and fight to prevent the spread of the virus within the institution. CoVID-19 highlighted the lack of knowledge regarding infection control measures in NH. In this context, the Cantonal Unit for Infection Control and Prevention developed a simulation-training program to remain these gaps urgently. Objectives: The goal was to strengthen the capacity of NH staff to provide safe and effective care, while protecting the residents and themselves from the spread of infection. Methods: The infection control nurses defined learning objectives, identified the infection control academic content, developed a teaching strategy fitted to any learning styles and selected interactive teaching resources. After drafting scenarios of simples and complex care situations of targeting learning objectives, they defined the ideal environment and the equipment. Finally, a training was organized and simulations scenarios were recorded on video. Results: Each session consisted of a simulation conducted by an infection control nurse with a selected scenario. A session averaged 12 participants including nurse, assistant nurse and medico-technical staff. Participants were placed in work situations through role-playing. Before each simulation session, participants were reminded of the mode of transmission of microorganisms, standard precautions and additional precautions. Debriefing was conducted after each session. Pertinent identified issues included the misuse of disposable gown, (droplet precautions), the failure to comply with the standards of hand hygiene and gloves wearing. The lessons learnt from each session 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 conducted 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 critical care scenarios and have the opportunity to respond without fear or risk for the resident. Disclosure of Interest: None declared.

Introduction: Occupational exposures to communicable diseases that are transmitted through droplet or airborne may place healthcare workers (HCW) at risk. Post-exposure interventions such as immunization, prophylactic antibiotics and work restrictions may be indicated. Objectives: We assessed the unprotected exposures of HCW to communicable diseases before and during the COVID-19 pandemic at the American University of Beirut Medical Center (AUBMC). Methods: Policies and procedures for standard and isolation precautions as well as post-exposure management are well defined at AUBMC. Unprotected exposures to suspected or confirmed communicable diseases that are transmitted through droplet or airborne routes are immediately reported to the Infection Prevention and Control Program (ICPP). Investigation of the exposures is conducted through staff interviews, direct observations and review of the surveillance cameras in the Emergency Department (ED) and the critical care units. List of the staff identified with unprotected exposures is then forwarded to the Employee Health Unit (EHU) for post-exposure management. Results: Between 2017 and May 2021, unprotected exposures to communicable diseases such as varicella-zoster virus, pulmonary tuberculosis, pertussis, mumps, measles, Strep group A infections and meningitis caused by Neisseria meningitidis were managed. The highest number of unprotected exposures was identified in 2019 with 400 HCW exposed to 23 communicable diseases. A dramatic decrease in exposures was noted in 2020 and 2021 with 13 and 0 staff, respectively.

Conclusion: Immediate identification of patients with potential communicable diseases as well as application of standard and transmission-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 decontamination played a vital role in decreasing the occupational exposures at our center. Disclosure of Interest: None declared. 

The potential risk of exposure to blood and body fluids particularly needle stick injuries is high particularly among nursing staff during routine nursing care activities and the use of safety engineered devices (SEDs) can reduce the risk of percutaneous exposures.

In 2018, percutaneous (needles and sharps) injuries in 2018 increased to fifty percent (18 cases) compared to 2017 (9 cases). Objectives: To reduce percutaneous injuries to 50% by the end of December 2019 and beyond using safety engineered devices and staff education and training. Methods: We conducted root cause analysis of all exposures and we developed action plan based on the identified problems. We implemented a multidimensional approach to change the system focused on the physical structures and supplies such as installation of wall-mounted sharp boxes, distribution of available stock items of safety engineered devices and procurement of safety insulin needles. We conducted education and training to all nursing unit preceptors and newly hired nurses about the available safety devices through simulation and with followup of change of practices in the units. Real time reporting of occurrences, counseling of exposed staff for proper management of exposure and feedback to units about preventive measures. Dissemination of blood and body fluid exposure alert and awareness campaigns were organized to increase staff awareness to prevent future occurrences. Results: After implementation of preventive measures, a significant 56% 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 injuries in 2019 (4 cases), compared to 11 cases in 2018 and 50% reduction 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).

After implementation of preventive measures, a significant 56% 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 injuries in 2019 (4 cases), compared to 11 cases in 2018 and 50% reduction 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). Disclosure of Interest: None declared. Introduction: Dental professionals may be exposed to bloodborne viruses (BBV) carried in blood, oral fluids and tissues. Hepatitis C virus (HCV) is one of the principal blood borne pathogens of concern to dentists worldwide. Occupationally acquired hepatitis C viral infection is an important issue in dentistry since there are no known vaccines or effective prophylaxis. Objectives: The aim of our questionnaire was to determine Dental surgeons' perceptions and attitudes regarding the risks of hepatitis C viral infection as well as the precautions used against infection. Methods: A Cross-sectional study was done among 200 dental surgeons, at Mangalore, India using pretested structured questionnaire to determine the attitudes and perception of risks of occupational acquired hepatitis C viral infection as well as precautions among dental surgeons.Chi-square and Fisher's exact tests for categorical variables and student t-test for continuous variables were performed. Results: In all, a total of 145 surgeons responded (72.5%). Of respondents, 101 (70%) had sustained sharps injuries. Only (29%) always reported such injuries, although (84%) expressed concerns of occupationally acquired hepatitis C viral transmission.Most Dentists (58%) were either extremely or very concerned about the possibility of contracting HCV infection. Dental surgeons were mostly unaware of the true prevalence of hepatitis C in high-risk groups. Conclusion: The results of this study revealed that post-exposure management was completely inadequate especially the reporting of occupational exposures. However, post-exposure management protocols exist in all dental clinics, but the implementation of the protocol appears to be suboptimal. Needle stick injuries are also of increasing concern to the dentists.Greater awareness of all aspects of hepatitis C infection and its risks to the practice of dentistry is required. Disclosure of Interest: None declared. Introduction: Vaccination of healthcare workers (HCW) against influenza 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 coverage 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 for the unvaccinated after 2015/16 as well as the influence of the CoVID-19 pandemic with the wearing of a mask required for all professionals on the influenza vaccination coverage in NH of the canton of Vaud. Methods: On behalf of Public Health, the Cantonal Unit Hygiene, Prevention and Control of Infection (UHPCi) collects annually the vaccination rates of HCW of every NH in the canton of Vaud. The UHPCi writes a review to the NH reporting their vaccination rate compared to global 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 of Vaud was 42% at the beginning of the surveillance (2008/09) and then continuously decreased to 35%. Following the directive requiring the wearing of masks for unvaccinated HCW over the epidemic period, this rate gradually increased to 47% in 2019/20. With the obligation to wear a mask for all staff during the 2020/21 season due to CoVID-19 pandemic, this rate dropped to 37%. Conclusion: The obligation to wear a mask for the unvaccinated HCW from 2015/16 has made it possible to increase the influenza vaccination coverage for HCW working in NH. The compulsory wearing of the mask for all in 2020/21 due to the CoVID-19 pandemic had a direct impact on the influenza vaccination rates of HCW with a 10% drop. The seasonal influenza vaccination rate is directly linked to the protective measures imposed on HCW and therefore on the wearing of masks. Primary prevention in the fight against seasonal influenza should be reviewed with the HCW of NH, as vaccination remains the gold standard. Disclosure of Interest: None declared. (table 1a) . For 2020/21 only, results show that it is easier to address team safety culture issues regarding COVID-19 vaccination compared to influenza vaccination (figure 1 not attached). Perceived leadership for infection prevention by direct supervisor increased across all items during the COVID-19 pandemic (table2b).

Conclusion: It will be important to maintain the increase in team safety culture and leadership in 2020/21. The differences in the ease to discuss either influenza or COVID-19 vaccination in respect to safety issues need to be addressed in by prevention initiatives. Disclosure of Interest: None declared. 

The exceptional zero Influenza cases encountered during the 2020-2021 Influenza season at our center in comparison to the previous 2 seasons is reasonably explained. The dramatic 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.

Introduction: Seasonal influenza vaccination of healthcare workers (HCWs) is recommended in order to protect themselves and patients. During the COVID-19 pandemic, several studies highlighted the benefit of Influenza vaccination in reducing COVID-19 burden especially in developing countries. However, Influenza vaccination coverage among HCWs is unknown in the majority of these countries.

To investigate the acceptance of Influenza vaccination during the COVID-19 pandemic among Tunisian HCWs. Methods: An online cross-sectional study was led between the 7 th and the 21 th of January 2021 among 493 Tunisian health professionals. A pre-established and pre-tested questionnaire recorded in a free Google form was self-administrated to participants anonymously. The generated online Google Sheet was uploaded and exported to the Statistical Package for the Social Sciences 10.0 software for analysis. Results: The mean age of participants was 37.4 (± 9.5) years. The males/females ratio was 0.38.The rates of influenza vaccine acceptance were: 68% among medical doctors, 65.7% among pharmacists, 55.8% among paramedical professionals and 50% among dental surgeons. Working in the public sector and having a chronic condition predicted more acceptance of influenza vaccine with adjusted odds ratio of 1.9 (95% CI: 1.3-3.9) and 2.1 (95% CI: 1.3-3.5) respectively. Having been infected by the SARS-COV2 predicted fewer acceptances with and adjusted odds ratio of 0.3 (95% CI: 0.1-0.7). Conclusion: More attention should be paid to Tunisian paramedical professionals and dental surgeons in order to increase influenza vaccine uptake among them. Involving HCWs in the national information campaign about COVID-19 and Influenza vaccination would ensure more vaccines acceptance among them. Disclosure of Interest: None declared. Introduction: Nosocomial influenza (NI) is regularly reported in hospitalised patients. Exposure to healthcare workers (HCW) or patients potentially infected with influenza increases this risk. Objectives: The objective of this study was to estimate the effect of influenza vaccine coverage (IVC) of HCW on the risk of NI in hospitalised patients. Methods: A case-control study was nested in a multicentre prospective cohort study conducted in two university hospitals during two influenza seasons (2013-14 and 2014-15). An influenza-like illness (ILI) was defined as fever ≥ 37.8 °C (in the absence of antipyretics) and/or cough or sore throat. Each inpatient with ILI included had a nasal swab and a systematic search of influenza by PCR testing. A NI case was a patient with a virological confirmation of influenza with onset of symptoms ≥ 72 h after admission to the ward. A control was a patient with an ILI during his hospitalisation but with PCR negative for influenza. The IVC rate of HCW in each participating ward was calculated from the data shared by the occupational health departments. A logistic regression was performed with adjustments on patient gender, age, the presence of a potential source of influenza on the ward in the 5 days prior to the start of the ILI, type of ward and influenza season. Results: A total of 165 patients were included: 24 NI cases and 141 controls. The median age of the patients was 84 years, 94 (57%) were women and 68 (41%) were vaccinated against influenza. The median 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 NI cases versus 21% in controls (P < 10 -2 ). The crude Odds Ratio (OR) of NI decreased from 0.52 (95% confidence interval (CI95%) 0.21-1.29) to 0.14 (CI95% 0.03-0.63) when the IVC threshold of HCW on the ward increased from 20 to 50% (figure). Similarly, after adjustment, the Adjusted OR decreased from 0.86 (CI95% 0.28-2.60) to 0.29 (CI95% 0.04-1.98).

The prevention and control of NI involves multiple preventive measures including the vaccination of HCW. Based on these observational data, vaccination of HCW is a determinant that contributes strongly to the NI control. Disclosure of Interest: None declared. Introduction: Health care workers (HCWs) are at risk of acquiring vaccine preventable diseases, Increasing awareness of physicians about adult immunization, one of the reason for low adult vaccination rate,will provide success in improving adult vaccination coverage. Objectives: The aim of current study is to establish knowledge and attitude of physician about adult vaccination. Methods: A cross sectional survey was performed among physicians via a self-administered questionnaire. Out of 200, 117 complete forms filled by physicians were included in the study. Results: Majority of the participant were female ( 62%).The physicians' own vaccination status was not satisfactory as 108 physicians (92%) had received HBV vaccine, 54(46%) influenza vaccine, 41 (35%) MMR vaccine and 37( 31%) vaccine against tetanus. Majority ( n 106, 90%) stated that they are not able to get updated information related to adult vaccine recommendations and main source of knowledge about adult vaccination were books or guidelines. Nearly half of the study participants (n 57,49%) had received training about adult immunization at undergraduate level and even less no of participant ( 37%) had received formal education related to adult vaccination during postgraduate training period. Regarding vaccine efficacy, only 82 (70%) of participants believes that vaccine have overall protective effect on community health & wellness.Physicians believed that high cost of vaccines, lack of vaccination center for adult immunization, lack of structured program or campaign for adult vaccination and lack of awareness regarding adult vaccines among community are important factors for low adult vaccination rate in our population. Regarding problems related to prescribing vaccines, lack of patient's interest, high patients burden in clinics, non-availability of vaccines and high vaccine cost were considered to be barriers for not advising vaccines to adult patients by study participants. Conclusion: Healthcare worker's knowledge and attitude play a key role in improving vaccine coverage of community. Education interventions are necessary to improve awareness of HCWs and public in order to protect community against vaccine preventable diseases particularly in countries with low implementation of immunization. Disclosure of Interest: None declared. Introduction: In order to maintain high results in the field of vaccineregulated 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. Methods: Quantitative correlation study using questionnaires. Study included 351 parents and 30 medical staff from vaccination institutions. Data were collected and coded in Microsoft Excel, IBM SPSS Statistics 22. descriptive statistics, for the determination of relationships (correlations) Spearman rank correlation coefficient, non-parametric statistical correlation analysis. Results: Parents are not really clear about vaccines and vaccinations due to very contradictory answers (parents do not know the composition of combined vaccines against which diseases are vaccinated, also not clear and not in a timely manner provided information about vaccination calendar). 55% of parents consider infectious diseases to be a serious threat to their child 's health, but 45% do not. Parents most often refuse flu, varicella vaccine, and tick-borne encephalitis vaccine. 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 been offered vaccination. 86% of cases vaccination of children is performed in the practice of family doctors.. 1/3 vaccination facilities not working after 17:00, vaccination planned only 2-3 days a week. Information to parents is provided during the visit, less often by telephone, even fewer make reminder notes in the vaccination passport,a very small number of information are provided in letters-letters, invitation. Conclusion: Timely manner provided information, planned vaccination visits must be organized. Also information regards refused vaccination and individual reminders could contribute vaccination coverage. Disclosure of Interest: None declared. Introduction: Despite the widespread availability of vaccines, the incidence of vaccine-preventablechildhood diseases (VPCD) started to grow in recent years. Objectives: The aim of study was comparingthe incidence of selected VPCDs in the EU and EFTA countries in 2014-2019, and thecountryspecific vaccine schedules.

Methods: VPCD incidence rates in Europe based on "The Surveillance Atlas of Infectious Diseases" by ECDC, vaccination schedules based on ECDC reports. Results: The obligation to vaccinate is not universal and it generally only applies to 2 preparations: the MMR vaccine and the one against 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 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 dynamic situation concerns measles. The total median was 2.4 cases per 100,000 population, the only one country with falling incidence was Germany. The diseases associated with Streptococcus pneumoniae and Neisseria meningitidis remained at a stable level in all analysed countries. Conclusion: Vaccine schedules differ among the countries, so does the epidemiological situation of selected diseases. Morbidity on measles is the most disturbing phenomenon: the incidence rate increased in almost 40% of all countries, regardless of the obligation to vaccinate. The increasing incidence of VPCD may be due to antivaccine movements, the activity of which is often caused by mistrust and spreading information. In order to better prevent the increase in morbidity, standardisation of vaccine schedules and documentation should be considered in the EU countries. Disclosure of Interest: None declared. Introduction: Worldwide, healthcare waste management (HCWM) is a high priority public health and environmental concern issue. During the Corona Virus Disease 2019 (COVID-19) pandemic, hygiene measures were more strictly applied in hospital setting. Objectives: The aim of this study was to assess HCWM before and during the COVID 19 pandemic in Sahloul University Hospital (2019-2021). Methods: A pre experimental study, based on two audits of HCWM, was carried out at Sahloul University Hospital (2019-2021).. The intervention consisted on repeated training sessions on standard hygiene precautions among all healthcare workers. The data was collected by trained auditors using a pre established observation grid based on the manual of good HCWM techniques and practices (ANGED). Results: Between 2019 and 2021 the overall compliance with the sorting of HCWs has increased from 44.7% to 68.9%: it passed from 75% to 87.2% for needle containers, from 23.9%to 48.8% for yellow bags reserved for infectious risk waste and from X to 70.9% for black bags reserved for ordinary waste. For the intra-service collection step the overall score passed from 28.51% to 58.2%; The most improved dimensions were "The filling level of the yellow bags is respected" (passed from 28.6% to 76.6%) and "Absence of HCWs outside containers or waste bags" 19.9% to 90.9%). Nevertheless, a lack of improvement in labeling practice was noted, such as the labeling of bags containing infectious risk wastes, which went from 0 to 0.9%; labeling of needle containersfrom6% to 3.2% and the traceability of the waste disposal time from 0 to 7.3%. Conclusion: The pandemic may present a unique chance to improve compliance with recommendations regarding HCWsM on the long term, therefore, we should focus on how to maintain high adherence to recommendations and improve deficiencies during and after the COVID-19 pandemic. Disclosure of Interest: None declared. 

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing the global pandemic is an enveloped virus and expected to be susceptible to some surfactants. The efficacy of the commercially available disinfectants and cleaners against this virus has been well examined so far, but only few reports mentioned about the efficacy of each surfactant alone. Objectives: This study aimed to evaluate the virucidal efficacy of various surfactants against SARS-CoV-2 (JPN/TY/WK-521). In addition, it also aimed to examine the presence of correlation between the virucidal efficacy and cytotoxicity of each surfactant. Methods: For this study, the experiments dealing with the novel coronavirus were carried out at the Research Institute for Microbial Diseases (Osaka University), while the cytotoxicity tests were performed at the Saraya Microbiologicial Research Center (Saraya Co., Ltd). The virucidal efficacy of each surfactant (cationic, anionic, amphoteric and non-ionic surfactant; 0.01% ~ 5.00%) was evaluated according to EN 14476 (dirty conditions). Their cytotoxicity was then examined by MTT assay. Results: The performance of EN 14476 with SARS-CoV-2 demonstrated that the cationic surfactant showed high virucidal efficacy.

Although not as high as that of the cationic surfactant, some nonionic and amphoteric surfactants also showed relatively good virucidal efficacy, while the rest did not. After evaluation of cytotoxicity, a good correlation between the virucidal efficacy and the cytotoxicity of each surfactant was observed; the higher the cytotoxicity, the higher the virucidal efficacy. Objectives: This study aims to: i) assess the spread of SARS-CoV-2 by collecting data on the NH of the resident and their microbiologic data in order to control the transmission of the virus. ii) improve the nursing practices of infection control and to adapt the preventive strategies. Methods: Data were collected from the register of the cantonal office 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 NH staff or visits the NH. The IPC nurse recommended IPC measures and the screening strategy to control an outbreak. A daily or a biweekly follow-up was required until the resolution of the outbreak. When the NH has no more isolated COVID-19 positive resident, we wrote a final report. Results: The first wave of the COVID-19 pandemic in NHs lasted from 09.03.2020 to 23.06.2020. 62 NHs/163 have been affected, 38% of NHs in the canton. The mean attack rate was 16% (1-62%). About 700/5178 residents (14%) have been infected by COVID-19: 400 residents with a laboratory confirmation of infection while 300 were clinical suspicions of COVID-19. There were 5% of deaths (255/5178). The second wave lasted from 10.08.2020 to 31.12.2020. 104NHs/163 (64%) have been affected. The mean attack rate was 38% (6-91%). 1914/5178 (37%) residents have been infected by the virus; more than twice as much as the first wave. The rate of death of the second wave was 8% (426/5178). The mean duration of outbreak cases was 5 weeks (2-10 Weeks). Conclusion: NHs have been highly impacted by the second wave. The systematic screening for SARS-Cov-2 was crucial in detecting asymptomatic residents. The implementation of adequate IPC measures, the NH collaboration and the interventions of IPC nurses were a successful approach to limit the spread of the virus. Knowledge of NH staff in IPC was improved. Disclosure of Interest: None declared. Objectives: The authorities ordered on April, the 10th, an unprecedented 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 hospital in collaboration with the departmental fire station and the departmental 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 identified, the IPC department was directly informed by the IPCT to initiate an extensive assistance operation. Although most of the establishments had implemented good management to face the pandemic, the IPC department conducted emergency field support operations in establishments with uncontrolled outbreaks to implement corrective actions and provide staff/equipment. Conclusion: To our knowledge, this mission is the first support action for Health and Social institutions facing the pandemic in France. As no major outbreaks were later noticed, this mission was a success and met the establishment's need for support in this critical time. Through this mission, many facilities have expressed the need to cooperate with IPC specialists during crises, but also in daily practice. The prospects are obvious: maintain support and implement a permanent collaboration between Health establishments and Health and social Institutions. Disclosure of Interest: None declared. Introduction: The unprecedented COVID-19 pandemic saw a plethora of infection prevention and control (IPC) recommendations. However, implementing these within a compassionate milieu appeared to present a universal challenge. We highlighted the need for action in an open letter (https:// www. nursi ngtim es. net/ opini on/ open-letter-infec tion-preve ntion-and-contr ol-should-never-be-at-the-expen se-ofcompa ssion ate-care-16-10-2020/) and identified real life scenarios as one solution to address the perceived IPC-induced compassion catastrophe reported to be taking place in many long term care (LTC) facilities. Objectives: To apply workflow analysis techniques in LTC in order to present IPC measures in the context of COVID-19. Methods: First hand narrative descriptions of carer/relative journeys in a LTC facility were obtained. Individuals were asked to recall a recent scenario, breaking it down into its smallest unit of activity, as outlined by WHO in a 2012 document on hand hygiene and long term care. The findings were reviewed and modified by a sample of people working in LTC, relatives/carers and IPC experts, with the experts applying IPC recommendations within the flow of activities. Results: Simulation of the flow of activity for two commonly encountered LTC scenarios, uniquely from the perspective of carers/relatives, was created. A table and a visual outlining the two scenarios were developed (figure 1 illustrates an example scenario: Spending time with a loved one outside/on a car journey) and launched on a unique website with site traffic monitored. At each step, the relevant IPC measures and their rationale were described with the aim of empowering those in LTCs to act with both compassion and safety.

We used a robust, evidence-based approach to develop a data bank of workflow information related to activities within LTC, as well as visual representations. These constitute a de novo implementation resource designed to promote safe access to LTC in the context of a global pandemic. The end products and website (www. enabl esafe care. org) go some way to redress the imbalance between IPC and compassion and have been made freely available for universal adaptation and use. Methods: According to European guidelines, virucidal activity was determined with a quantitative suspension test with 30 s exposure time on VeroE6 cells. Mechanistic analysis to reveal the mode of action of antiseptic agents included density gradient centrifugation and a capsid protection assay. Results: Three of the eight oral rinses as well as two nasal sprays significantly reduced viral infectivity to up to three orders of magnitude to background levels. Mechanistic analysis revealed that treatment with benzalconiumchloride and other antiseptic agents used in mouth rinses primarily disrupted the viral envelope, without affecting viral RNA integrity. Conclusion: In summary, we provide evidence that SARS-CoV-2 can be efficiently inactivated by commercially available oral rinses and nasal sprays with respect to their compound composition, within Introduction: Inhalation therapy allows conveying drugs directly into the airways while minimizing the systemic exposure. Nebulizers can be used by patients unable to use metered-dose inhalers or other inhalers. However, this procedure generates aerosol and causes environmental contamination or disease transmission. Thus, the usage of inhalation therapy should be cautious, especially in the current COVID-19 pandemic. Besides, the device can also be a reservoir for pathogens and lead to further infection. The use of nebulizers also requires disassembly and cleaning of after each dose. Objectives: This survey aimed to evaluate the compliance of hospital policy regarding the use of inhalation therapy. Methods: This survey was conducted as a part of infection prevention and control program in a 2600-bed teaching hospital. Infection control personnel designed a structured questionnaire and visited the in-patient services during Dec. 1, 2020 to Dec. 31, 2020. The survey included the environment control (single room, close door, or close curtain if more than one bed), cleaning methods after use, and who handle the procedure. Results: A total of 84 wards were audited. 38% of the wards did not close the door and 33% did not close the curtain while performing nebulization. To clean the devise after use, the use of tap water flowed by boiled water was most common (32%), followed by sterile water (21%) and 6% used tap water only. The cleaning procedure was performed by nurses (30%) or family/care givers (19%). Table 1 describes the main efficacy outcomes for each of the study arms. Ixekizumab arm presented the greatest improvement in the WHO scale (71.4%), while colchicine arm presented the lowest mortality rate (0%), but no statistically significant differences have been observed, so far. 

The trends illustrating occupied beds and mortality rates in Lebanon were similar to our trends at AUBMC. The decline in cases and in deaths is primarily related to offering the vaccines based on occupation, age and medical condition. Improving the preparedness at our center is a lesson learnt in the event of another threat. Despite the decline in cases, hospital staff are at risk. The continued importance of masking is mandatory and indispensable in poorly ventilated areas or crowded places. Disclosure of Interest: None declared. We added a logistic regression model with the outcome "Covid-19 infection" to adjust for the case-mix of different localizations or opportunities 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).

In Zurich, the daily use of public transport was not associated with an additional risk of being diagnosed with Covid-19 among the young population of HCWs, not even during the peak of a pandemic wave. Other factors are more relevant. Disclosure of Interest: None declared. Objectives: To estimate the risk of COVID-19 infection among HCWs in quarantine-hospital settings and assess the relative contribution of HCW-to-HCW (HtoH) and patient-to-HCW (PtoH) transmissions. Methods: Detailed longitudinal data was collected in two Egyptian healthcare facilities (hereafter denoted by Hosp1 and Hosp2), during the 2020 first wave of the COVID-19 epidemic (Hosp1: March 14 th -August 1st; Hosp2: June 6 th -July 11th). In both hospitals, only HCWs with no SARS-CoV-2 antibodies were allowed to start working shifts. During shifts, HCWs were tested using RT-PCR on nasopharyngeal swabs: i) routinely at the end of the shift, ii) upon symptoms, and iii) in case of outbreak suspicion (> 2 positive tests among HCWs).

Using a stochastic compartmental model for the spread of SARS-CoV-2 in each hospital, we assessed the risk of SARS-CoV-2 acquisition overall and by transmission route (HtoH vs PtoH). We estimated the model parameters using Markov Chain Monte Carlo approaches. Results: Over a total follow-up of 6,601 person-days (PD), we estimated an incidence rate of 0.97 (95% CrI: 0.56-1.53) per 100 PD at Hosp1 and 8.98 (95% CrI: 3.81-17.75) per 100 PD at Hosp2. The probability for a HCW to be infected at the end of a shift was 12.8% (95% CrI: 7.6%-19.5%) for a 2-week shift at Hosp1, which lies within the range of risk levels previously documented in standard healthcare settings, whereas it was > threefold higher for a 7-day shift at Hosp2 (48.2%, 95%CrI: 23.8%-74.5%). Infection risk was mostly driven by HtoH transmission in both hospitals, although a substantial contribution from PtoH transmission was also found in Hosp2.

The large variation in the infection risk found between the two quarantine hospitals we studied suggests that HCWs may face a high risk of infection, but that, with sufficient anticipation and infection control measures, especially those preventing patient-to-HCW transmission, this risk can be brought down to levels similar to those observed in standard healthcare settings. Disclosure of Interest: None declared. Methods: A descriptive cross sectional study was conducted in a tertiary hospital among 62 nasopharyngeal swabs confirmed infected with COVID-19 healthcare workers from July and August 2020, Saudi Arabia. Demographic, adhesion to prevention measures, pre-exciting condition and symptoms data were collected and analyzed as demonstrated by the WHO protocol. Hospital COVID-19 acquired infection was defined as the onset of clinical features of COVID-19 7 days or more after admission or between days 3 and 6 after admission if epidemiologically linked to hospital exposure. Results: About 61% Nurses with mean age 34 years old were the major exposed to COVID-19 infection. 37% were considered as hospital acquired COVID-19 infection. About 66-72% of victims had headache, muscle ache, fatigue and sore throat, 51-58% had loss of small, fever, diarrhea, cough and lose of appetite. Obesity was the most frequent (N = 6, 9.7%) followed by diabetes mellitus and asthma (N = 3,4.8% of each). All healthcare workers were fully protected when dealing with the patient, however 20% of healthcare workers were not sure about wearing surgical mask when contacted with colleagues. Fortunately, 98% had mild infection with home or quarantine isolation and recovered.

Although all healthcare workers were fully protected during patient care, acquiring COVID-19 infection could be expected during either from the community or within the hospital environment from asymptomatic carriers of healthcare workers and consequences spread between healthcare workers in a short time period. Minor symptomatic healthcare workers should be considered for suspected of SARS-CoV-2 carrier and early laboratory detection is highly recommended to avoid the spread on COVID-19 infection between healthcare workers. Disclosure of Interest: None declared. ) 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 20 th 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: ("coronavirus infection" OR "COVID-19" OR "SARS-CoV-2″)" AND ("health personnel") 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 generating 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: Lack of PPE, exposure to infected patients, work overload, poor infection control, and preexisting medical conditions put HCWs at risk of COVID-19 infection. Identifying these factors is of paramount importance to develop sustainable measures that protect HCWs especially those with higher risk levels. Disclosure of Interest: None declared. 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 (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 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. Introduction: Protecting healthcare workers (HCWs) from exposure to SARS-CoV-2 during patient care is central to managing the current pandemic. Higher levels of trust in personal protective equipment (PPE) and infection prevention and control (IPC) strategies have been previously related to lower levels of emotional exhaustion, yet little is known on how to achieve such a perception of safety. Objectives: We sought to identify institutional actions, strategies and policies related to HCW's safety perception during the early phase of the pandemic at a tertiary care center in Switzerland by interviewing HCWs from different clinics, professions and positions. Methods: For this qualitative study, 36 face-to-face semi-structured interviews were performed. Interviews were based on a guide addressing the perception of institutional strategies and policies during the first phase of the pandemic in March 2020. The participants included doctors (n = 19) and nurses (n = 17) in senior and non-senior positions from eight clinics in the University Hospital Basel, Switzerland, all involved in patient care. All interviews were audio-recorded and transcribed verbatim. Data were analyzed using qualitative content analysis and organized using MAXQDA (VERBI Software GmbH, Berlin). Results: Five recurring themes were identified to affect perceived safety of HCWs during the SARS-CoV-2 pandemic: 1) transparency and clarity of information, 2) communication on the availability of PPE (with provision of information alone increasing the feeling of safety 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 superior in terms of strengthening safety perception) and 5) support and appreciation for the work performed. Methods: We conducted a cross-sectional pre-and post-intervention study between april 2020 and march 2021. This consisted of a baseline assessment, in-person training, an immediate post-training follow-up and a three months follow-up. Participants were HCWs from the Faranah Regional Hospital (HRF) and two health care centres (HCC). The assessment was carried-out using a questionnaire developed based on WHO recommendations. Data was analysed using STATA Version 17. For the data collection we used a pretested self-administered questionnaire. sociodemographic characters, psychosocial data, perception of preventive measure implementation in the worksite and attitudes towards COVID19 were recorded. The data analysis was performed using SPSS software 20. Results: A total of 506 HCWs were enrolled in the study with a mean age of 33.8 ± 8.4 years. The sex-ratio was 0.33. About 63% (n = 314) of the participants were afraid to contract the COVID19 infection and 93% (n = 461) were frightened of transmetting the virus to their families. More than half of the HCWs declared that they washed hands regularly and weared masks more frequently than the previous infection wave. Nearly 91% of HCWs respected the social distanciation. Three in four respondents (74%) totally agreed that preventive measures were implemented and 62% claimed that the responsibles at the worksite take care of the employees' health. the majority of HCWs (99%) respected the preventive measures and declared that the clinics' responsibles will support them in infection case. Isolation of infected staff and restriction from the work for 14 days was applied and followed by clinical assessment for back to the work. Room size was standardized to 4 square meters for two persons as recommended by the CDC guidelines. Male residency is completely physically separated from the female hostel. Results: Ninety-eight non-clinical healthcare workers were confirmed positive for SARS-CoV-2. There were sixty-five cases reported in June and gradually declined to thirty, three, and zero in July, August, and September, respectively. The bulk of the cases occurred among the male gender of biomedical, general engineering staff, and administration personnel (36%) followed by other categories. The most affected age group was (30-39 years old) with five hospitalized and two deaths. All male of biomedical staff was got the infection within two weeks which is correlated to the congested basement work location. However, none of the biomedical female staff were reported positive due to fully physical separation workplace area; compared to the male section. Objectives: The aim of our study was to determine the personal protective equipment (PPE) knowledge and attitudes of health workers in tertiary hospital.

A cross-sectional study design was used. The knowledge, attitudes and practices (KAP) survey was part of a rapid appraisal of the COVID-19 occupational health and safety response in the intensive care and emergency departments of the hospital of Angre. A structured self-administered questionnaire was used. Only doctors, nurses and nursing assistants were included in may 2021. Results: A total of 50 health workers at different levels of care participated in the survey. Nurses were the first to know the usefulness of PPE in 51% of cases followed by doctors 37%. Regarding the surgical masks, 90% of the participants knew their usefulness. only 23.8% knew the characteristics of the mask type N95 and 21% did not know which of the masks protected most against covid-19. A few participants did not know the need to wear gloves. Half of participants indicated they receive training on the correct use of PPE (58%).

Our results showed that personal protective equipment are used inappropriately by healthcare workers (HCWs). We recommended that public health education be targeted towards the categories of HCWs with high-risk practices and attitudes to achieve the necessary control measure been instituted by the hospital. Disclosure of Interest: None declared. virus as a pandemic, Al-Azhar University Specialized Hospital has been allocated as an isolation hospital. In June 2020, the number of admitted Covid-19 patients was decreased gradually. So, an integrated plan has been designed for safe opening.

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 employees and for the hospital's keenness to work proactively. Methods: A general framework for proactive measures to restart and return to work was laid by a group of infection control, quality improvement, safety, maintenance and administration in May 2020. The implementation steps were based on three axes: environmental insurance, safe work environment and employee safe return. Results: The implementation of this plan has been started in July 2020. In the 1 st axis, the hospital was closed for one week with a complete clearance of the work site and maintenance of all floors and walls was done using antibacterial paints. In the 2 nd axis, offices were redistributed (at least 1.5 m between desks) and cleaned on a daily basis. Thermal examination was done at external hospital gates. Staff health clinic was ready just in case for those with symptoms of high temperature, fatigue, etc. Awareness panels on hand hygiene were distributed. A timetable was made for daily collection of waste. Elevators were cleaned and disinfected daily and as required. In the 3 rd axis, employees were asked to conduct Covid-19 markers and CT Scan (Chest). Approval to return was taken by chest consultant, directors of infection control and human resources. Conclusion: Safe opening was a challenge in in our hospital. A plan with proactive measures are still in place. The plan was designed to ensure safe hospital and work environment. It also stressed on safe return for employees and visitors. A triage clinic was also launched for both employee and patients, Disclosure of Interest: None declared. Results: Within three days, the building was completely cleared of patients, the territories for finding patients (infectious zone) and medical personnel (clean zone) were determined, which were separated by erected sanitary checkpoints for medical personnel. In order to minimize the risk of inhalation of the viral aerosol, the infectious zone of the sanitary checkpoint was divided into two rooms, the first -to remove the protective suit, the second-to remove the second pair of gloves, a respirator, a cap and further treatment of exposed areas of the body with 70% alcohol. The separation of the traffic flow of cars, employees 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 Hospital, rooms were organized for food, rest and work of the staff, with the installation of dispensers to ensure regular hand treatment. The

Hospital deployed autonomous clinical diagnostic and microbiological laboratories to exclude the possibility of delivering potentially dangerous material to other buildings of the Center, which was especially important given the ongoing planned work in other buildings of the Center. A disinfection chamber and a site for decontamination of medical waste were allocated. Prior to the admission of patients, practical training was conducted for all Hospital staff. In order to prevent the spread of COVID-19, a smear test for SARS-CoV-2 was organized for all Hospital staff once a week. In the premises of the clean zone in accessible places were installed skin antiseptics for hand treatment. Objectives: to investigate adherence of a nursing professionals regarding SP during the COVID-19 pandemic and to examine the association among length of experience, professionals with graduate degrees and workplace setting with the percentage of adherence. Methods: A pilot cross-sectional study was conducted using a validated questionnaire. Nursing professionals working in the front line of the COVID-19 pandemic in the State of São Paulo, Brazil, participated in the study. Data were analyzed using descriptive statistics and presented using absolute and relative frequency. Pearson's Chi-square test (X 2 ) was used to verify the association between length of experience (years working in nursing), completion of postgraduate studies (certification, master's and doctorate), workplace (public or private) of nursing professionals, and the percentage of total adherence to SP. Results: 169 nursing professionals were evaluated, being 49 (29%) aged between 18 and 24 years old, 44 (26%) with ≤ 1 year of experience in nursing, 81 (48%) with postgraduate studies, and 91 (53.8%) were employed in private health institutions. In terms of adherence to the SP, 157 (92.9%) performed hand hygiene in the intervals of care, with greater adherence after being in contact with biological material 165 (97.6%). The majority of the participants reported always using gloves. There was no adequate adherence to the use of safety glasses, hats, handling with sharps or the notification of accidents at work. Chi-square test did not reveal significant association among the conditions: length of experience, completion of graduate studies and workplace of nursing professionals, with the percentage of total adherence to SP (X 2 (1) = 0.033; p = 0.855), (X 2 (1) = 0.006; p = 0.940), (X 2 (2) = 1.031; p = 0.597), respectively. Conclusion: Nursing professionals' adherence to SP was found to be below the ideal recommendation. Length of experience, having an advanced degree or workplace setting did not influence adherence to SP. Disclosure of Interest: None declared. Objectives: The project conducted initial readiness and behavioral observations followed by training using quality improvement methodologies, provision of IPC supplies and equipment, and infrastructure rehabilitation and will be followed by an endline assessment. This presentation will explore the findings of these assessments. Methods: The project developed a standard weighted IPC and WASH readiness assessment tools based on the WHO Infection Prevention and Control Assessment Framework and the WHO/UNCIEF Joint Monitoring Program indicators for WASH in healthcare facilities, then incorporated additional questions based on national tools and guidelines. Data was collected using digital tools and dashboards were developed to facilitate data sharing. The data collected guided a quality improvement strategy using a hub and spoke approach using both in-person and virtual trainings along with training visits by staff specializing in IPC and moderated WhatsApp groups to facilitate dialogue between Quality Improvement facilitators and facility staff. Monthly behavioral audits were also conducted to gauge improvements in hygiene behaviors and use of personal protective equipment. Results: Except for Ghana, the initial readiness assessment scores for the facilities were low: Sierra Leone (39.35%), Ghana (83.52%), Uganda (50.89%), India (45.71%) and Bangladesh (41.07%). Final assessments are to be completed by July 2021, except for Sierra Leone, which completed its endline assessments in April 2021. Sierra Leone saw its facility IPC readiness scores improve from 39.35% in October 2020 to 67.77% in February 2021. Behavioral audits also saw improvement in outpatient handwashing behaviors increaseing from 49 to 84%. PPE use increase by 25% (64% to 89%). Conclusion: Preliminary findings demonstrate the importance of adequate supplies and infrastructure coupled with training on best practices and monitoring of behaviors, to improve IPC readiness. Disclosure of Interest: None declared. Methods: We collected data on 3 pilot wards during Influenzaseason 19/20 and 20/21 in the cantonal hospital of St.Gallen, a tertiary 700-bed hospital in eastern Switzerland. Adherence with hand hygiene was recorded by clean care monitor from Swissnoso 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 influenza preventive measures were assessed with a questionnaire. In 20/21 the questions were adapted to cover for COVID-19. Results: Observed adherence with hand hygiene increased significantly from 68 to 78% (p < 0.001) as did self-reported adherence to wearing mask from 10 to 98% (p < 0.001). The other observed behaviours where not significant (table1a). Influenza vaccination rate reminded low over both seasons. Self-reported and observed Covid-19 vaccination rate was significantly higher than influenzavaccination rate (32% versus 17% and 27% versus 10%). The perceived importance of hand hygiene remained high, the attitudes toward own influenza vaccination did not change over the seasons(Table1b). A relevant change can be observed in mask wearing which was perceived as with low importance(2 out of 10) before the SARS-CoV2 pandemic and most important(10out of10) thereafter.

The emergence of the COVID-19 pandemic had an important impact on attitudes and behaviour of infectious disease prevention measures. As expected the change could be perceived in attitude and the behaviour toward wearing a mask but also increased the adherence with hand hygiene. Vaccination coverage has been and remains low for both COVID-19 and Influenza but the significantly lower readiness for influenza underscores the specific vaccination scepticism about influenza. Disclosure of Interest: None declared. Participants were randomly selected from the new declared cases in the governorate of Sousse during November 2020. Data were collected using a pre-established and pre-tested questionnaire administered during phone calls interviews with trained medical doctors. The frequency of the compliance with hygiene measures was evaluated using a five item scale with the following possible responses: ("do not remember"; "never";"sometimes"; "often" and "all the time"). 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, during the confinement, 95 (25.4%) participants declared not respecting the quarantine and 111 (29.6%) participants transmitted the infection to their family members.

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. 

To promote protocols and standardize the desire actions at the right time, illustrated friendly reminders were posted on the door of rooms.

The ICP and the occupational health department carried out training sessions for HCS leaders from each department and shift. There were 78 participants among nurses, auxiliary nurses, medical doctors, porters, and general service staff. More than half were nurses (53.8%), and the medical area staff had more participation than surgical, emergency, ICU, and midwifery area. Monitoring and feedback: From 696 observations across wards, in the beginning, the compliance of the appropriate use of PPE was 58.6% however in February increased to 81.3%. Reminders and communications: Each door of the rooms had a reminder about the use of preventive measures: hand hygiene when entering and leaving the room, use of gloves, gown, and facemask inside the room, use shields/goggles if necessary, and keep the door closed unless the patient has no respiratory symptoms. Conclusion: Multimodal strategies may be applicable to promote preventive measures in the pandemic context. Improvement in PPE compliance was observed after training, monitoring, and feedback. Disclosure of Interest: None declared. 

The highest compliance was for excreta management 87.2%, followed by prevention of accidents with exposure to blood 79.4%, then Respiratory Hygiene 69.6%, environmental management 68.1%, Personal Protective Equipment 60.9% and Hand Hygiene was the lowest 57.1%. Conclusion: These results demonstrate an acceptable level of engagement in the prevention and control of the infectious risk in the hospital besides of an institutional mobilization to face the Covid-19 epidemic. therefore, it is recommended to multiply the evaluations to verify these conclusions. Likewise, the training axis is essential to perpetuate the optimal practice of standard precautions. Disclosure of Interest: None declared. Introduction: To COVID-19's facing strategies is important to ensure the rational and appropiate use of aff PPE, not only masks, wich requires correct and rigorous behavior from heath care workers-HCWs, but particularly in doffing procedures off personal protective equipment-PPE and hand hygiene-HH practices (WHO,2020). Objectives: The objective of this study was to evaluate the appropriate use of PPE in the isolation precautions-IP, the HH compliance among HCWs and the hospital's structure to support these practices. Methods: A prevalence study was conducted in a group of 16 hospitals from four different states in Brazil, during the period of three months (April to June 2020). Our approach consisted of assessing the HCWs regarding the IP (contact + droplets) and HH compliance, associated with a evaluation of hospital structure to supporting HCWs in these practices. For this assessment, a check list was built based on the WHO recommendations for prevention of COVID-19. We considered: the professional category; appropriate PPE use according to the activity performed; PPE proper placement; PPE proper withdrawal; HH at the right moments (5 moments), and proper hospital structure (including: availability of PPE and alcoolic solution in the point of care). Results: 1867 observations were performed among 225 health care professionals. The HCWs were: nurses, nursing technicians, doctors and physiotherapists. The data were stratified into IP conformity, hand higyene compliance and appropriate struture of hospitals to supporting the IP and HH (table 1). The overall rate conformity of HCWs related the IP were 84%. General HH compliance of HCWs evaluated were 56%. Considering the structure of the hospitals to supporting IP and HH practices, we identified that 81% of the hospitals had an appropriate structure.

We identified an important weakness in adherence to hand hygiene among health professionals, despite the most part of hospitals presented an appropriated structure to supporting this practice and the IP. These findings can be explained by the fear that professionals would become infected at the beginning of the COVID-19 pandemic. This led us to work specifically and strongly to align this practice, ensuring the safety of patients and HCWs. Disclosure of Interest: None declared. , if existing) . In 2020, a rapid review of WHO IPC guidance, including for COVID-19, was undertaken to address WHO European region country needs with regards to implementation and improvement tools. Objectives: To develop targeted improvement tools to support IPC guidance into action (GTA) in WHO European region countries. Methods: The topics for new improvement tools were decided upon and text drafted. A first online consultation (29 June-13 July 2020) included WHO and country experts. The questions took account of theory of change concepts, resource use, values and preferences (figure 1). Feedback informed significant changes to the tools. The second consultation, November 2020, involved WHO headquarters and regional office experts. It comprised an interactive 90-min virtual discussion, with materials shared in advance and by asking three key questions, iteratively seeking final validation. A final follow up exercise in 2021 verified accuracies in the final products. Results: A new WHO Europe document consisting of three focused, improvement tools called aide-memoires was launched in May 2021, targeted at IPC focal points. The three aide-memoires are; 1) respiratory and hand hygiene, 2) personal protective equipment and 3) environmental cleaning, waste and linen management. Each consists of action checks structured around the five elements of the MMIS https:// www. euro. who. int/ en/ health-topics/ disea se-preve ntion/ antim icrob ial-resis tance/ publi catio ns/ 2021/ infec tion-preve ntion-and-contr olguida nce-to-action-tools-2021.

These are the first GTA tools to focus on the detail of 'how' to improve standard and transmission-based precaution practices and behaviours by describing actions that comprise the five elements of the WHO MMIS. The action checks included in each are informed by WHO IPC guidance, as well as input from experts, and are importantly rooted in a proven improvement approach acting as reminders of things to do in the real world. Disclosure of Interest: None declared. Introduction: Information on non-healthcare setting Infection control measures, especially in the Context of the COVID-19 pandemic is scarce. The Ministry of Health Uganda instituted national lockdown to minimize the spread of the SARS CoV2 virus, which has progressively 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 measures at IDI. This survey's feedback informed an enhancement of workplace safety measures, including encouraging working from home, reducing office occupancy to about 30% of the pre-pandemic capacity, 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.

Over the two months, the overall staff compliance with screening efforts increased from 59 to 89%, with the most considerable improvements seen in mask possession and recording of contact details at the entrance. Correct mask use within the premises improved from 23 to 47% and ownership of personal ABHR from 39%-61%. Conclusion: Strengthened administrative controls lead to measurable improvement in compliance with IPC. Workplace settings should actively monitor for compliance, with constant reminders on best practices for occupational exposure to COVID-19 since changing behaviour takes time. Disclosure of Interest: None declared. 

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 manpower crisis, the government of India announced to utilize services of final year MBBS students. This study was aimed to train the medical students and prepare them to work as frontline workers. Objectives: The objective of the study was to assess the effectiveness of flipped classroom teaching of MBBS students for infection prevention and control practices. Methods: A quasiexperimental cross-sectional study with pre-test and post-test design, using Google Questionnaire forms for tests, was conducted 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 standard and additional precautions. Data was analysed using descriptive statistics, Chi-square test, Fisher's t-test and ANOVA.

The results of study suggested that the training format was efficient with significant increase in level of knowledge post training from 16.3% of students with scores more than 70% in pre-test to 57% of students with > 70% scores post-test. The mean scores of students in pre and post tests are shown in Table 1 . There was significant association found in between gain of knowledge and gender and status of previous training received during last 6 months.Comparison of Mean knowledge scores. 

A-or presymptomatic SARS-CoV-2 infected individuals 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. However, little is known on the yield of this approach in different epidemiological settings. Objectives: We aimed to describe the rate of asymptomatic SARS-CoV-2 infected patients identified in universal admission screening, and its correlation with the population incidence. Methods: Publicly available cantonal data were used to describe the population incidence. All patients admitted to the University Hospital Zurich, Switzerland, were tested for SARS-CoV-2 by polymerase chain reaction (PCR). SARS-CoV-2 positive patients were retrospectively categorized as symptomatic or asymptomatic at admission and history for prior COVID-19 assessed by medical chart review. For correlation analyses, we calculated the positivity rates per calendar week for the admission screening and incidence rates per calendar week and 100′000 inhabitants for the cantonal data. 

The SARS-CoV-2 RNA frequency increased from 0.49% in August to 4.02% in October (p < 0.001). Concentration of SARS-CoV-2 RNA varied from approximately 10 10 in 1 ml of respiratory swab to the limit of detection (1000 copies/ml). Close contact with respiratory infection person reported 3.14% of participants. SARS-CoV-2 RNA was found in 3.8% of such persons in comparison to 1.66% in whole group. Persons whose profession is associated with a high level of social contacts in October were infected less often than representatives of the same age group: SARS-CoV-2 was detected in 3.4% and 6.8%, respectively (p = 0.001). The use of surgical masks reduced the risk of infection with SARS-CoV-2 by 34%. In order to provide more effective protection during prolonged contact with a COVID-19 patient, healthy individuals should use a respirator. Wearing of medical masks in community is a necessary anti-epidemic measure, since it reduces the spread of the virus and the likelihood of infection. Higher compliance with anti-epidemic measures of persons whose profession is associated with frequent social contacts contributed to a decrease in the level of their infection. Disclosure of Interest: None declared.

A. Hosseininasab 1,* , A. Khalooei 

The mandatory wearing of mouth-nose covers is, in addition to maintaining distance, a central component of the transmission prevention of COVID-19 and is intended to protect potential contact persons from ingesting pathogen-containing material. Objectives: The study examined whether the population's motivation to comply with the oral-nasal coverage requirement was higher immediately after its implementation than in the weeks that followed, as declining coronavirus disease-19 (COVID-19) case rates and the end of the initial lockdown on May 15, 2020, may have led to a decrease in risk awareness and thus noncompliance with the established behavioral rules. Methods: In a covert observational study in mask-required settings (public transportation and retail stores), mask types used and observed mask use errors were recorded over two time periods in a total of 9131 individuals. In addition, the importance of individual mask features, wearing behavior, and reasons for choosing current mouth-to-nose coverage, as well as attitudes toward COVID-19 protective measures, were collected in an online survey. Individuals observed in public and individuals in the online surveys represent two separate cohorts. Results: Over the time (07.05.-13.05.2020/12.06.-08.07.2020), the mask wear adherence increased in from 97.2% to 98.6% (p < 0.001).

In addition, a percentage decrease in the number of people without mouth-nose cover (p < 0.001) and an increase in the correct mask application was observed (p = 0.024). In the online survey, 84% of respondents identified comfort/convenience and 81% of respondents identified fit as the most important mask attributes. The reasons for the choice of the mouth-nose cover used were heterogeneous and varied. The respondents stated that they found the wearing of a mouth-nose-covering annoying (57%) but useful (60%), but would not wear a mask if there was no mask obligation or recommendation to wear the masks (67% Objectives: The aim of the study was to evaluate correct usage of PPE and compliance of hand hygiene among HCWs before and after touching patients. Methods: During a 6 months period from June till November2020,we observed HCWs in two university hospitals in Mashhad, Iran. Standard 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 university 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 medical wards compared to ICU and surgical wards. p value = 0.05. Introduction: Urinary tract infections (UTI) represent at least 40% of all hospital-acquired infections. The majority of cases are catheter-associated. Objectives: Our goal was to clarify whether uropathogens and antimicrobial resistance (AMR) characteristics vary depending on catheter association. Methods: We analyzed a dataset containing 27,158 urine cultures from the Swiss Centre for Antibiotic Resistance (ANRESIS) database from calendar year 2019. Group differences in the proportions of bacterial species and antibiotic-resistant isolates from catheter-associated 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 pathogens and clinically relevant antibiotics. Results: The most often identified pathogens were E.coli, K.pneumoniae, P.aeruginosa, P.mirabilis (cf Table) . E.coli from CAUTI samples were more often resistant compared to E.coli from non-CAUTI samples. Third generation cephalosporin (surrogate for ESBL), ciprofloxacin (CIP), norfloxacin (NOR) exhibited large differences (p < 0.001) (cf Figure) . For K.pneumoniae, difference in susceptibility was highly significant for CIP (p = 0.001) and NOR (p = 0.03). For P.mirabilis, difference in susceptibility was significant only for NOR (p = 0.01). P.aeruginosa from non-CAUTI samples were significantly less often resistant to cefepim (p = 0.02) and piperacillin-tazobactam (p = 0.04). Results: Totally, 62% and 54% of the patients were male in COVID-9 and non-COVID-19 groups, respectively. In COVID-19 group, 98 (74.2%) were adult and 34 (25.8%) children (under 18 years of age). The age of 147 patients in non-COVID-19 group was unknown (19.2%) and 381(48.5%) were adult and 259 (32.3%) children. As revealed, in COVID-19 group, adults with BSI outnumbered the children (74.2% vs. 25.8%, respectively); however, the difference in non-COVID-19 groupwas 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 two most common bacterial isolates in COVID-19 group were Achromobacter species (spp.) (24, 18%) and Klebsiella app. In non-COVID-19 group, the most common pathogens were Escherchia coli (89,11%) and Staphylococcus aureus (103,13%). Conclusion: BSI among hospitalized adult patients with COVID-19 infection was more frequent than that among children. It could be explained by the fact that the total number of adult patients with COVID-19 who needed hospitalization is much higher than children. Also, the two most frequently isolated pathogens associated with BSI were different in two groups of patients hospitalized in a tertiary hospital of a developing country, that is, Iran. Nevertheless, the etiology of BSI in hospitalized patients with COVID-19 needs further investigations which could help physicians to choose the most effective empiric therapy in respective patients. Disclosure of Interest: None declared. Objectives: Implementation of CHG dressings in adults with CVC during COVID-19 pandemic. Methods: Approval was obtained in 2019 to implement its use but we were only able to launch implementation from 16 July 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 CHG dressing to their respective wards. Infection Prevention Nurses (IPNs) conducted audits via interviews with the ward nurses on their knowledge and compliance to usage of CHG dressing in August and November 2020. In addition, audits on proper application and documentation on the usage of CHG dressing was done from January 2021 to March 2021. Results: Interview results.

In the August 2020 interviews, 7 out of 37 wards (19%) were unaware of the implementation, where the products were kept and unable to describe the indications of the CHG dressing. Immediate action was taken to remind ward nurses through the IPLO newsletter as well as through daily huddles done by IPNs with ward IPLOs. By November 2020, only 2 out 40 wards (5%) interviewed were unaware of the above -a substantial improvement. Practices results.

In January 2021, audits on proper application and documentation on the usage of CHG dressing showed a low compliance of 71%, which subsequently improved to 100% compliance in February and March 2021.

We were able to successfully implement the use of CHG dressing during the pandemic through the education of stakeholders. Regular audits were conducted to validate successful implementation.

In conclusion, engaging IP champions, training, and audits greatly aided in the successful implementation of a new practice in the clinical setting despite challenges posed by the pandemic. Disclosure of Interest: None declared. To describe the relationship between the importance and utilization of the CLABSI prevention bundle based on the nurses' opinions.

Methods: This study used a descriptive research design using Q methodology approach. Q methodology is one of the methods used to study opinions. The study was done at one of the public academic hospitals in Gauteng. Data was collected using a Q sort technique from thirty nurses in Intensive Care Unit (ICU). The nurses had to sort a set of thirty statements about the CLABSI prevention bundle. The sorting (Q sort) was done on a Q diagram under specific conditions of instruction. Pictures of completed Q sorts were taken and transcribed on smaller Q diagram and that was used for data analysis. Factor analysis was used to interpret data by means of a software PQ Method version 2.35 package.

The overall finding is that opinions are related to human behaviour. The results of the study revealed mixed opinions among the nurses in ICU. Some value aseptic technique during insertion of the central line. Some value maintenance of the central line, while some value some elements on both the insertion and maintenance of the central line. The study revealed that those elements that the nurses believe to be important, are the ones that they also utilize. Conclusion: Nurses opinions differ from one another and judging by their opinions, it is evident that not all CLABSI prevention bundle elements are believed to be important, nor are all bundle elements utilized. Recommendations have been proposed for nursing education, practice, management and research. Disclosure of Interest: None declared. Objectives: The objective of this study was to assess the risk of intravascular 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.

We included all neonates hospitalised in NICU with at least one central intravascular catheter insertion from January 2017 to December 2020. Dwell time was considered as the number of full days 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 multivariable marginal Cox regression models for clustered data to evaluate the CABSI-risk according to the catheter type among umbilical catheters.

We observed 1103 intravascular catheters in 574 neonates. Among them, 55 (9.6%) were very low birth weight (< 1000 g) and 323 (56.27%) were low birth weight (< 2500 g). Overall, 388 (67.6%) were preterm and among them 101 (17.6%) were extremely preterm, 170 (29.6%) were very preterm and 117 (20.4%) were moderate to late preterm. 264 were female (46%). We identified 581 VUC, 198 AUC and 324 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 17 CABSIs in AUC and VUC, respectively. The CABSI risk were increased after two days of catheter maintenance for umbilical catheters (Figure) . Among umbilical catheters and using univariable Cox models, we observed a similar CABSI-risk between VUC and AUC (HR 1.09, 95% CI: 0.38-3.08., p = 0.87). After adjustment for sex, prematurity and gestational age, we observed a similar CABSI-risk between VUC and AUC (HR 0.57, 95% CI 0.156-2.081 p = 0.394). Conclusion: Implementing a strategy to reduce duration of umbilical catheters in NICU may be an effective measure to reduce CABSI in this population and requires further exploration. Disclosure of Interest: None declared. Objectives: This project aims to improve the compliance of CVC care bundle, identify barriers in compliance and establish CLABSI incidence in the Medical wards of Hospital Pulau Pinang, Malaysia. Methods: Subjects audited (> 18 years old) were in-patients with central venous catheters inserted during working hours. This audit is divided into 3 phases: 1st phase: Baseline audit on subjects with CVC inserted in medical wards, CVC insertion subjects identified, and follow-ups conducted. During the CVC insertion, the process was audited with a checklist with the information such as site selection, correct antiseptic use and maximum barrier protection. A checklist form produced by the Ministry of Health was given to nurses for daily review. The 2nd phase consisted of interventions were as follows:

• Continuous medical education using lectures and training videos on proper CVC bundle care during line insertion.

• Short quiz on central catheter care maintenance.

• Regular hand hygiene awareness and promotion.

• Dedicated CVC carts/procedure room for CVC insertion. 3rd phase: a post-intervention audit on CLABSI rate and data analysis.

Pre 

The optimal duration of systemic antimicrobial treatment for catheter-related bloodstream infections (CRBSI) is unknown. Objectives: In this systematic review, we aimed to assess the efficacy of short-course treatment for CRBSI due to Gram-negative bacteria, coagulase-negative staphylococci and enterococci. Methods: We systematically searched the electronic bibliographic databases MEDLINE, EMBASE and Cochrane Library for studies published before February 2021. All studies that investigated the duration of adequate systemic antibiotic treatment in adult patients with uncomplicated intravascular catheter infections due to Gram-negative bacteria, coagulase-negative staphylococci or enterococci were eligible for inclusion. Studies including concomitant treatment with antibiotic lock therapy were excluded. The primary outcomes were clinical failure/cure, mortality and microbiologic-confirmed relapse. Results: Seven retrospective cohort studies and one case-cohort study met the inclusion criteria. No randomized controlled studies met inclusion criteria. The quality of the included studies was low (n = 7) to moderate (n = 1). No significant differences were observed regarding mortality and microbiological relapse between short-course and long-course systemic antibiotic treatment in patients with CRBSI due to coagulase-negative staphylococci or Gram-negative bacteria. No association was found between mortality and treatment duration in the two studies assessing enterococcal CRBSI.

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 confirm these findings. Introduction: Healthcare-associated bacteremia is a real public health problem because of its high morbidity and mortality. Objectives: The objectives of this study were to describe the characteristics of bacteremia and to identify death -associated factors.

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-associated bacteremia was retained during the study period from January 1, 2016 to December 31, 2017. Results: Fifty-two cases of healthcare-associated bacteremia were collected. The hospital prevalence was 2.6%. Male sex was predominant with a sex ratio = 1.2. The average age was 42 ± 16 years. Twenty-two patients were HIV-infected. The majority of patients (32 cases) had been on antibiotics before their current hospitalization. Regarding the reasons for hospitalization, pulmonary signs dominated the series, followed by neurological and gastrointestinal signs with respectively 27, 26 and 18 cases. Invasive devices were dominated by peripheral venous catheters (100%) followed by urinary catheterization (87%). The main germs found were Staphylococci (26.6%), Enterobacter spp (23.5%), Klebsiella pneumonia (18.7%) and Escherichia coli (14.1%). Staphylococci were highly resistant to cefoxitin (88.2%) and methicillin (70%). There was a high level of resistance of gram-negative bacilli to 3rd line cephalosporin. Case fatality was 35%. Acute renal failure (p = 0.01) and male gender (p = 0.05) were associated with the occurrence of death. Conclusion: Healthcare-associated bacteremia is a real public health problem. Standard hygiene measures play an important role in the control of these infections. Disclosure of Interest: None declared.

With the outbreak of the Covid-19 pandemic in late 2019, Polymerase chain reaction (PCR) assay has become the accepted standard for diagnosing this disease. As the prevalence rate increases, some countries face shortages of test kits. A growing need for a method that can determine the necessity of laboratory testing using clinical symptoms is an inevitable outcome of this pandemic. Objectives: The objective of this study was to design and develop an algorithm using intelligent methods, to predict the necessity of PCR using the patient's clinical symptoms.

The dataset used in this study consists of 226,777 suspected cases of Covid-19 with known PCR results (145,752 positive and 81,025 negative), with one or more clinical symptoms including fever, shortness of breath, chest pain, cough, sore throat, and chills. Furthermore, information such as age, gender, BMI, background disease, being in a high-risk group, and any close contact with a positive covid-19 patient 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 positive PCR and probable negative PCR. KNN and DT had higher accuracy (> 80%) and less processing time. The risk of classifying a positive PCR as negative is greater than classifying a negative PCR as positive. Therefore, weighted matrices were involved in the algorithm so that the false positive classification error was much greater than the false negative classification error. Results: Eventually, the KNN algorithm with 82% precision, 91% recall, and 63% specificity was selected as the optimal method and was used for predicting PCR necessity. This expresses that the designed algorithm is able to suggest 91% of patients with future positive PCR to take a PCR, and 82% of patients that the designed algorithm introduced to undergo a PCR, will have positive PCR result. In addition, using the designed algorithm will reduce taking PCR from patients with future negative PCR result, down to 37%. Conclusion: Applying the designed algorithm in countries with a shortage of PCR kits will optimize resources with minimum inaccuracy. The outcome of this study and the designed algorithm can be used at health centers as a criterion to determine whether a patient should undergo a PCR.

Introduction: Once sepsis is suspected, a minimum of 2 sets of blood cultures (BCs) should be obtained prior to administration of antimicrobial therapy (AT) to support identification of pathogens and to allow de-escalating AT. Objectives: Appropriate BC (2 sets of BCs prior to administration of AT) sampling was investigated in three emergency departments (EDs).

We performed a retrospective cohort study of patients admitted via one of 3 EDs with the hospital discharge diagnosis "sepsis" according to ICD-10 System A40-A41 in 2018. Exclusion criteria were nosocomial sepsis, elective admissions and transfers from external hospitals and direct transfers to intensive care units. Administrative and clinical data were retrospectively collected from patients' charts. Independent factors associated with appropriate BC were analyzed by multivariable logistic regression analysis. Ethical approval was obtained from Charité -Universitätsmedizin Berlin. Introduction: Storage and transportation of samples for microbial culture is critical for correct diagnosis and treatment of patient diseases. When samples are collected from the ward, in most cases, nurses are responsible for storing and transporting samples.

The purpose of this study is to provide multifaceted interventions for nurses and to confirm the changes on knowledge, sample management practice and blood culture transport time.

Methods: A one-group pretest-posttest experimental design was conducted with 41 nurses in two general wards of tertiary acute care 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 transport of samples from May 2019 to January 2020. The outcomes were measured in three ways before and after intervention; the knowledge on sample management using self-reported questionnaire, sample management practice at wards by observation, and time from blood sampling to arrival at the laboratory. Results: Among the participants, 31.7% have trained in storage and transportation of samples. After intervention, the average knowledge was significantly increased from 1.20 points (± 1.12) to 5.10 points (± 3.20) out of 9 for transportation(p < 0.001). The average knowledge on sample storage was also increased but insignificant. The proportion of appropriate sample storage room, condition and transportation time were significantly increased from 43% (46/107) to 77.1% (84/109) (p < 0.001). Average transportation time to the laboratory of blood sample significantly decreased from 3 h 36 min(± 1 h 52 min) to 3 h 01 min(± 1 h 41 min), and the arrival within 2 h increased significantly from 22.9% to 39.2% (p = 0.021). Conclusion: Multifaceted interventions for this study are effective for nurse to improve the knowledge and practice to store and transport samples properly. However, some samples remain in the ward longer than expected after intervention and require further intervention. Disclosure of Interest: None declared. Results: An existing product entitled TEACH CLEAN was identified as suitable for modification. Permission was granted and adaptations and updates were made. A consultation was performed and a twopart WHO prototype was created. Other publications featuring the latest standards on IPC and environmental cleaning were also identified and informed the content. The components of the package stayed true to the original educational concept, which has been tested in a range of countries. An outline of the contents of the WHO resource is in Figure 1 .

This resource is the first WHO-developed training curriculum aimed at those who clean, a priority that has assumed greater significance in recent years including due to COVID-19. Further validation of the prototype is planned in a sample of WHO regions. Disclosure of Interest: None declared. Introduction: Environmental hygiene is a key component of infection prevention in healthcare, and a driver of healthcare associated infections. Staff who clean in many low resource countries receive no formal training on cleaning, waste disposal and linen handling. This issue has been execrated by the COVID-19 pandemic. The only recommended training on environmental hygiene for low resourced facilities, TEACH CLEAN, uses a training of trainers model. A selected cadre "champions" which in turn train their peers with responsibilities on environmental hygiene at the facility level. Early pilot data to test its effecteveness of this training package are very promising.

The main objective is to evaluate the effectiveness of an environmental cleaning bundle to improve microbiological cleanliness in Cambodian hospitals. Methods: TEACH CLEAN will be implemented across all hospitals (13) of three provinces in Cambodia. A stepped wedge randomised trial will be used to evaluate the effectiveness of TEACH CLEAN to improve microbiological cleanliness in Cambodian hospitals. All facilities will receive the intervention. Hospitals are arranged in groups of three or four based on the randomisation with staggered commencement 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 cleanliness 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 commence 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. Introduction: Environmental cleaning plays an important role in the prevention of healthcare associated infections. A multimodal improvement strategy includes the creation and uptake of standard operational procedures through appropriate staffing, training, monitoring and feedback. Objectives: Given the lack of (inter)national standards, the objective of this study was to determine staffing levels for environmental cleaning in non-critical adult care units in an acute care hospital in Brussels.

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 marking prior to cleaning, were included in the analysis. Build-upon the time measurements and findings from a systematic literature review, we estimated the time needed to perform different types of cleaning for different types of rooms, cleaning of non-patient areas and non-cleaning tasks performed by a cleaner in a unit. Bed management data of 2019 were used to calculate the average number of times the different types of cleaning occurred per day in a unit. Finally, we calculated the full-time equivalents (FTE) in accordance with data from the human resources department.

The mean time to perform a daily cleaning of a single room was 18,87 (CI 15,09 -22,65) minutes. With bed occupancy rates between 59 and 86% in units with on average 30 beds in single and double rooms, we need on average 6 h 37 min per unit to clean the patient rooms. Once we add the 107 min to perform the cleaning of non-patient areas and other tasks of the cleaning staff, we end up with an average need of 8 h 24 min per day, which results in 1,96 FTE per unit (given the 10 public holidays, 25 leave and 20 absenteeism days per year).

We were able to determine staffing levels for environmental cleaning in non-critical adult care units in an acute care hospital in Brussels. The presented benchmarks need to be validated to determine the degree of applicability in other settings. We underline the need of a transparent, easy to use and effective tool to calculate staffing levels for environmental cleaning in the healthcare setting. Disclosure of Interest: None declared. Introduction: Environmental cleaning and disinfection is paramount in minimising and preventing hospital acquired infections. One of the most important responsibilities of healthcare facilities is to ensure high standards of the environmental cleaning and disinfection. However, there is a lack of standard process to check and assess cleaning effectiveness.

Objectives: To be able to establish a new standard method to assess the effectiveness and improve the environmental cleaning and disinfection in an acute district general hospital.

Methods: A quality improvement model based on Plan Do Study Act (PDSA) Cycle approach was utilised for this project. Process mapping, stakeholder analysis and a driver diagram were undertaken to understand the current practice. A questionnaire was developed for cleaning staff in the hospital in order to understand and establish their current knowledge and practice. This survey helped to identify gaps and establish the focus of the intervention. An invisible fluorescent marker gel was used as the method of assessment in conjunction with the traditional visual inspection, feedback and education. Ten high touch areas around the patient's bed space were identified where the fluorescent gel was applied and these were checked using a portable ultraviolet light by the author and later on the project he was joined by the zonal managers from the cleaning team at a weekly to twice weekly intervals.

The survey showed that there is a need for further training among the cleaning staff. At the initiation of the new assessment method in February 2021, compliance with the cleaning and disinfection standard was 27%. Weekly to twice weekly assessment, education and feedback was commenced. At the end of the implementation phase, the compliance had increased to 91%. In addition, the cleaning staff morale had increased and they now feel more valued and appreciated. This is demonstrated by the improvement in quality of cleaning they have consistently delivered throughout the duration of the project.

The introduction of the fluorescent marker gel and the portable UV light, in conjunction with visual inspection, training and feedback has improved and sustained the quality of environmental cleaning and disinfection. Disclosure of Interest: None declared. Objectives: This study aimed to observe the effect of monitoring of cleaning and disinfection practices using an ATP bioluminescence assay during the ongoing COVID-19 pandemic. Methods: The study was performed over a period of two and a half 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 cleaning of these surfaces, samples were collected and tested using Adenosine Triphosphate bioluminescence (ATP) based assay. Results: A total of 416 testing at various sites were performed during the study duration. Results were non satisfactory (> 250 RLU) at 123 sites and the testing was repeated after repeat cleaning and disinfection. All the tests except two performed following repeat disinfection were satisfactory (< 250 RLU). Decrease in ATP content (RLUs) following repeat cleaning at these 123 sites was significant (p < 0.0001). A decreasing trend in the ATP content as measured in the first reading was noted over a period of two and a half months.

The role of monitoring cleaning and disinfection practices in healthcare settings cannot be underscored. ATP bioluminescence based assay is a rapid, easy to perform test providing early feedback which can result in an early corrective action. Though ATP bioluminescence based assay cannot specifically detect SARS-CoV-2, however, give a measure of general cleanliness. However, use of sodium hypochlorite is an EPA (Environmental Protection Agency) approved disinfectant for SARS-CoV-2 along with satisfactory hospital cleaning and disinfection practices may indirectly indicate satisfactory disinfection against SARS-CoV-2. Disclosure of Interest: None declared. Introduction: Acquisition of community-associated methicillin resistant Staphylococcus aureus (MRSA) and extended spectrum beta-lactamase (ESBL) producing Gram negative bacteria from environmental sources and surfaces is widely reported in Nigeria. Objectives: A study was designed to assess the role of discharged environmental wastes, hands and frequently shared and touched surfaces as potential reservoirs of antibiotic resistant pathogens. Methods: A total of 818 samples of wastes which include sewage, sullage, diapers, food remnants, sands, plastics, water sachets, and swabs of restroom floors, corridors, door handle, bowls and hands of vulnerable and non vulnerable children (VC and NVC) were analyzed and susceptibility of isolates recovered from them to different antibiotics were determined. The moderately resistant S. aureus and Gram negative bacilli were further screened for methicilin resistance and ESBL production.

Results: Result showed that sewage, sullage, diapers, food remnants and restroom floors were frequently contaminated with PPB that are highly and moderately resistant to penicillins and flouroquinolones. Nearly all the isolates were susceptible to a carbapenem and cephalosporins. Hands and high-touch surfaces of VC such as bowl were contaminated with E. coli, S. aureus and K. pneumoniae. No ESBL-E. coli was isolated from all the samples. Two ESBL-K.pneumoniae, 2 MRSA and 1 ESBL-P. aeruginosa were recovered from VC bowls, sewage, sullage, and diapers. Conclusion: Sewage, sullage, some solid wastes, restroom floors, VC's hand, and their bowl serve as potential reservoir for some resistant bacteria. Disclosure of Interest: None declared. Introduction: Contaminated environment plays an important role in the acquisition of nosocomial pathogens by patients hospitalized in Intensive Care Units (ICUs). Immediate zones around patient's bed can be a reservoir of potential pathogens, where they can survive for many months.

Objectives: In this study conducted in a French University Hospital, we aimed to describe the microbial ecology of two rooms in two ICUs, and to explore the potential link between environmental contamination and patient's colonization and/or infection. Methods: In 2020 during 5 months, environmental samples from room surfaces (i.e. foot side bed barriers; worktop of nurse cart; computer keyboard and mouse; adaptable; washbasin and lever hydroalcoholic solution/soap; dedicated stethoscope) have been carried out with sterile wipes once monthly. Fifty samples were performed, just before daily cleaning. Wipes were incubated 48 h at 30 °C in tryptone soy broth, and then samples were plated on four culture media. Identified bacteria were compared to those isolated from patients hospitalized in the same rooms.

The main bacteria found in the environment were: E.faecalis (15,5%); P.agglomerans (11,7%); E.faecium (10,7%); B.cereus (5,8%); A.baumannii (5,8%). In six cases, the same bacteria were found in both environmental and clinical samples with a time interval < 10 days. For five of them, a transmission environment-patient was suspected (table 1) . Introduction: Pseudomonas aeruginosa is a rare pathogen in neonatal intensive care unit (NICU). Following P.aeruginosa bacteremia in two NICU patients hospitalized in two different rooms with dedicated nurses, we performed an epidemiological investigation. Objectives: To find environmental sources and routes of transmission 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 incubators, 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 analysed 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 differences and the closest patient isolate had 27-30 loci difference. The later was recovered from a patient in the adult ICU with no link with the NICU.

The thorough investigation of the environment of our NICU showed that sink traps were the main reservoir of P.aeruginosa. However, none of the environmental isolates was genetically close enough to be considered as the source of infection. The sole use of standard molecular typing (DLST) would have lead us to a false conclusion that sink traps were the source of infection. Disclosure of Interest: None declared. Introduction: In the context of the pandemic caused by SARS-CoV-2, reports of increased incidence of Health Care-Related Infections have been published. Variability in environmental cleaning practices and differences in the microbiome composition of high-touch surfaces may be related to this trend. Objectives: To assess hospital cleaning practices and microbiome compositions of COVID and non-COVID ICUs. Methods: Prospective observational study in COVID and non-COVID intensive care units (ICU) of 3 Brazilian´ hospitals. After informed consent, environmental cleaning practices were studied by mean of a qualitative instrument through Plan-Do-Study-ACT cycles that was composed by a leadership, an operation/cleaning professionals assessment, and 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 and real-time PCR. Results: Environmental hygiene practices observed were different among the 3 hospitals regarding. IPCAF scores were similar. Surface microbiomes in COVID/non-COVID ICUs were similar within hospitals, but each one presented an unique diversity profile. Low impact was found of terminal cleaning processes in gram-positive bacteria (specially, Corynebacterium, Strepococcus e Staphylococcus). In 2 out 12 sanitizers samples were positive for Burkholderia Cenocepacia, Pseudomonas, Enterobacteriaceae, Stenotrophomonas. Resistance genes mec-A were found in more than 50% of the samples in 2 out 3 hospitals, reaching higher still higher rates in COVID units (71.1% and 86.7%). KPC were also found in all ICUs, indistinctly, followed by OXA23 and VanA (in much lower rate, not in all ICUs).

Conclusion: Surface microbiome within hospitals in COVID and non-COVID ICUs of did not present significant differences. Conversely, each hospitals presented very distinct diversity profiles. Although presumed, clinical impact of environment-related findings, as well as differences between environmental hygiene practices and contamination of sanitizing agents deserves further investigation future studies. Disclosure of Interest: None declared. Objectives: Aim of this study was to monitor environmental contamination in Division of Immunohematology and Transfusion Medicine of Papa Giovanni XXIII General Hospital in Bergamo (Italy), comparing Copan SRK ® with FLOQSwabs ® to traditional cotton swabs and contact plates. Methods: On a seasonal basis for 1 year, collection points (workbenches, 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 crosssampled, 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 surfaces 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 cotton swabs, allowing to detect Gram negative bacteria (such Escherichia coli), yeast and filamentous fungi on the joint surfaces.

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. Disclosure of Interest: None declared. Introduction: Hospital drainage systems are becoming increasingly implicated as a source of outbreaks with organisms such as CPEs. It is therefore important to give thought to the design of drainage systems when building new hospitals, to mitigate the risk. Objectives: We aim to describe the abnormalities in sink drains found in a new build hospital.We discuss how improvements could be made in future design and the importance of addressing human behaviour in mitigating risk from drains. Methods: Drains were investigated following reports of relux of material back up into sinks by staff and patient infections. Drain components were removed for inspection and analysis by the laboratory. Assessment of biofilm reaction, bacterial burden and chemical analysis of drain debris was undertaken. Results: Drains were found not to be flush with the back of the sink with a lip present where water was stagnating. Excess sealant was present in the drains and there was corrosion of an aluminium component. Several plastic objects were retrieved and some scrub sinks were completely occluded by surgeons nail picks. Mature biofilm and high bacterial counts were detected along with evidence of nutrients in the drains.

Conclusion: Several problems with drain design and installation were identified. Firstly the drain was not contiguous with the back of the sink which promoted stagnation and pooling of water. Excess sealant present in the drain led to occlusion and further excacerbated stagnation as the drain was not free flowing. Corrosion and splitting of an aluminimum spigot enhanced the occlusion and provided an uneven damaged surface for bacteria to adhere to. Together these conditions promoted biofilm formation,excacerabted by the presence of foreign material and nutirients. There are several lessions from these findings that should be applied to future design of drains. 1) The drain should be completlely flush with the back of the sink 2) Overzealous use of sealant should be avoided as this can lead to obstruction and poor flow 3) Components used in drains should be with a material not liable to corrosion 4) Workmanship should be of a high standard. It is also important to address behavioural aspects and infection control teams should ensure staff/ patients are aware of the importance of drain hygiene. Objects and fluids should not be decanted in drains and alternative disposal methods should be provided. Methods: This was a cross-sectional study at two referral hospitals in Uganda between May and October 2020. Self-administered questionnaires were provided to the participants after informed consent. Mobile phones of the healthcare workers in different departments of the hospitals were randomly swabbed. Samples were collected, transported to the microbiology laboratory for bacterial culture and antimicrobial susceptibility tests. Results were entered into Microsoft excel for analysis. Results: Our study revealed that 93% of the screened mobile phones were contaminated with one or more species of bacteria, interestingly 46% were multi-drug resistant; the majority of them being resistant to penicillin, cotrimoxazole, ciprofloxacin and Gentamycin respectively, this is a time bomb of MDR transmission. and only 8% of the participants cleaned their hands after using a mobile phone. Organisms isolated were E.coli, Micrococcus spp, CoNS and Bacillus spp. 15% of the isolated organisms are potential pathogens (n = 13). Conclusion: Realization of the role the Healthcare workers' mobile phones play in the spread of hospital-acquired infections is paramount. Advancements in telemedicine and automated healthcare have not been matched by advancements in sanitizing and decontaminating protocols specifically for phones and other mobile devices, this study provides strong evidence for developing and strengthening disinfection protocols of mobile phones. In future, there is a need to correlate the bacterial isolates and resistance patterns with nosocomial infections identified in similar settings. The need to study the efficacy of different mobile phone disinfection protocols is also paramount. Disclosure of Interest: None declared. Introduction: Medical tapes are used routinely and stored in various patient areas, supply carts, and healthcare personnel pockets once removed from packaging. Many publications discuss how common practices around medical tapes can lead to infection transmission. To minimize risk, some manufacturers already offer tape rolls with antimicrobial spools or for single-patient use. Objectives: Our purpose was to quantify the contamination of tape rolls found in different locations within a hospital in Germany. Methods: A test method was developed using RODAC plates and swabs to optimize conditions. Each roll was sampled in 4 sites: top layer of the tape, deeper layer of the tape, side of the roll, and inside ring of the spool. Results were normalized to colony forming units (CFU) per plate (24 cm 2 ). Since no microbial standard limits exist for the acceptability of medical tape other than "low bacterial contamination with absence of pathogens", we categorized our results based on limits offered by GMP (European Pharmacopoeia) and the hygienic monitoring of air conditioning systems (VDI 6022). Categories were: no bacterial detection ("very good"), 1-24 cfu/plate ("good"), 25-49 cfu/ plate ("conspicuous"), 50-100 cfu/plate ("borderline"), or > 100 cfu/ plate ("insufficient"). Results: 32 tape rolls (19 with an antimicrobial spool and 13 without) were examined. Of 128 total samples, 71 had evidence of skin and environmental bacteria, 1 had Enterococcus sp, and 56 had no bacteria 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 and the side of the roll, regardless of the presence of an antimicrobial spool. Two rolls ranked "very good", 16 ranked "good", 4 ranked "conspicuous", 2 ranked "borderline", and 8 ranked "insufficient". None of the rolls were contaminated with pathogenic bacteria, but only 2 rolls had no bacterial detection at all. Conclusion: Tape rolls used repetitively in a hospital very often carry microbial flora and therefore may contribute to bacterial transmission in hospitals. An antimicrobial spool does not offer complete protection since bacteria can be found even on most of those tape rolls. Disclosure of Interest: None declared. Results: There are no reprocessing rooms arranged in 75 (16.3%) of 460 endoscopic departments. 369 (91,1%) of 405 respondents do not violate the precleaning procedure; 29.9%-carry out the leak test irregularly. 325 (73,5%) of 442 respondents never violate the guidelines when carrying out the manual cleaning, 7.2% skip the step of soaking in washing solution, 5.7% reduce a number of brushing passes through channels, 6,8% of respondents miss out the rinsing before an endoscope is connected to an AER/EWD. High-level disinfection (HLD) in AER is performed at 65.2% of endoscopy departments. Among HLD applied agents the aldehyde share is 47,9%, oxygen active compounds-38,7%, the rest 13,4% of agents are not included into the list of recommended for such a purpose. More than a third of endoscopy departments do not check the minimum effective concentration in a high-level disinfection solution. Final manual rinsing of gastrointestinal (GI) endoscopes are made by tap water at all endoscopy departments which were questioned. Microbiological studies of the effectiveness of the endoscopes reprocessing cycles are not carried at 56 (12.7%) of 460 endoscopy departments, at 82 departments (17.9%) it is performed less than once per a quarter. Unsatisfactory results were received for 4.4% of samples. Conclusion: Obtained results analysis revealed the main risk factors for patient's infection associated with ineffectively reprocessed endoscopes and has allowed to improve the requirements to separate components of ESS: technical fit-out and material support of the endoscopes processing, microbiological water quality for final rinsing of GI endoscopes, carrying out of cleaning quality control and HLD of endoscopes. Disclosure of Interest: None declared. Results: Percutaneous probes clean 280 (38.7%), clean and disinfect 443 (61.3%) of the 723 respondents; 132 (18.2%) of the respondents say that they never use disposable transducer covers. Intracavity probes were only cleaned by 105 (16.8%) out of the 627 respondents, cleaned and low-level disinfected by 294 (46.9%), cleaned and high-levels disinfected (HLD) by 228 (36.3%). Only 31.6% of the respondents use effective disinfectants for HLD standards achieving. Single-use transducers covers were used in 97.0% of intracavity examinations, but 34.3% of them were not sterile. All 54 respondents, performing intraoperative ultrasound procedures, clean and disinfect probes after use, but only half of them sterilize or perform HLD additionally. 90.7% of respondents use sterile single-use transducer cover on a permanent basis. Ultrasound practitioners named three main reasons that impede the safety of ultrasound diagnostics: the lack of conditions for the introduction of HLD (57.7%), the lack of national guidelines (48.2%), and insufficient knowledge in this area (32.2%).

The study revealed the potential risks of infection for patients during ultrasound examinations associated with the lack of standardized approaches for ensuring this medical technology epidemiological safety. The development and implementation of IPC national guidelines in ultrasound diagnosis into clinical practice is a priority. Disclosure of Interest: None declared. Existing literature is contradictory when determining the association between particle counts and microbiological colony-forming units (CFU), and a particle count cut-off point has never been determined to safely guarantee the absence of microbiological contamination. Objectives: The objective of this study was to establish a cut-off point in the number of air particles in critical areas in hospitals that could potentially avoid microbiological sampling. Methods: Diagnostic validity and reliability study conducted using particle counting (number of 0.3, 0.5 and 5.0 μm/mm3 particles) and microbiological sampling (bacterial and fungal CFUs) in the air of critical 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 corresponding microbiological samples. Out of the three particle diameters, we selected 0.3 μm particles for having the highest diagnostic performance. 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. Introduction: Good practices in healthcare environmental hygiene (HEH) are key to infection prevention and control, and decrease the risk of healthcare associated infections. HEH includes anything in the healthcare environment not directly on the patient, including surfaces, sterilization, device reprocessing, air, water management, laundry and waste management. HEH is often a neglected field, and little is known about the topography of practices and challenges globally. Objectives: Our survey aims to show how HEH programs work around the world and what specific challenges they face. The larger objective of this work is to use the data collected to develop a Healthcare Environmental Hygiene Self-Assessment Framework (HEHSAF), in order to help hospitals improve their HEH in line with the Clean Hospitals ® project. Methods: The online survey is built according to the 5 components of the WHO multimodal improvement strategy. 729 healthcare facilities (HCF) from 175 countries received the HEH survey: 30 HCF answered from 12 high, 9 high-middle, 5 low-middle and 4 low incomes countries. 4 facilities from each income level were selected for semi-structured interviews to obtain qualitative data. Results: Preliminary results indicate that most HCF believe HEH is important (71%). Often, budget allocated for cleaning and disinfection is not sufficient (58%) and the responders do not make decisions for the budget (63%). Detergent (77%), bleach or chlorine-based disinfectant (80%) and mop and bucket systems (87%) are the most frequent products and supplies used. UV disinfection machines are used in 33% HCF surveyed. Environmental service (EVS) staff do not have the possibility to complete certification programmes (83%) nor to advance in management roles (75%). No events about HEH are hosted in over half of the HCF surveyed. Communication between EVS staff and nurse staff is frequent on the workfloor (47%) but in 27% of cases, there is no formal meeting between the EVS staff and nursing staff. Conclusion: There are major differences among HEH programs and the importance they are given by HCF. New approaches in products and supplies are often not used, and there are problems with workplace culture. There is definitely room for improvement on a global level. Disclosure of Interest: None declared. Introduction: Exophiala dermatitidis is a saprophytic black yeast associated with respiratory, soft tissue and blood stream infections. Its prevalence in Cystic Fibrosis (CF) patients ranges from 1-19% worldwide.Whilst previous studies have found evidence of E. dermatitidis in domestic sources there is a paucity of literature on hospital acquisition, sources and relevant control measures. Objectives: To discuss the epidemiology of E. dermatitidis in our hospital, the investigations undertaken to investigate potential hospital sources and recommendations for future control measures. Methods: Data between January 2016 and June 2019 was extracted for all patient isolates of E. dermatitidis from all sample types. Deduplication of positive isolates was undertaken with the first isolate in each patient included in the analysis. Environmental sampling of chilled beams, dishwashers, washing machines, linen and drains was undertaken using cotton swabs. These were plated on to a Sabaroud Agar ( SAB) plate and incubated at 37C for 5 days. E dermatitidis was identified using MALDI. Results: E dermatitidis was isolated predominantly from patients with Cystic fibrosis and more frequently from adults with the condition compared with children. Other patient groups with positive isolates included those with chronic lung conditions and haematological disorders. The majority of sample types were respiratory although five patients had positive blood cultures during the study period. The number of affected patients reached a peak in quarters 3 and 4 of 2017 and fell following the identification of environmental sources and implementation of control measures.

In our study we found evidence of hospital sources of E dermatitidis. The yeast was found in dishwashers, chilled beams and from air sampling. Another potential source was damage to shower flooring and the presence of visible black mould. We implemented the following control measures; 1) Dishwashers were removed from wards housing immunocompromised patients. 2)An increase in cleaning frequency was introduced for chilled beams 3) Damaged showers were repaired. Infection control teams should be aware of the environmental conditions which might promote growth of E dermatitidis and how to mitigate the risks. Disclosure of Interest: None declared.

Introduction: As hospital environment can be a cause of healthcareassociated infection, environment control plays an important role in preventing the spread of pathogens. Particularly, high-touch surfaces frequently contacted by patients or healthcare workers are more easily contaminated than other surfaces, so it is recommended to clean them regularly or more often. Though, the examples of the high-touch surfaces are provided in the guidelines, it has never been studied how frequently the surrounding are contacted, or how consistent is the recognition of the contract frequency between patients or healthcare workers. Objectives: This study was aimed to compare the recognition on the high touch surfaces between nurses and inpatients, and to prioritize cleaning and disinfection. Methods: The participants were 122 nurses working at general wards and 56 patients hospitalized at the 299-bed general hospital in Seoul. Data were collected from 6 to 10 April 2020 using a self-reported questionnaire including 38 items in four sections; 5 items on the medical devices, 13 items on toilets, 10 items on the equipment around sink and door, and 10 items on the bedside area and furniture.

Introduction: Microorganisms form biofilms on any surface. The danger for the food in-dustry is the development of biofilms on abiotic surfaces. The abiotic surface of food production is rough, porous, with joints, seams and a huge number of hard-to-reach places, i.e. there are all conditions that contribute to the localization of biofilms. The structure of the matrix serves as a barrier to prevent the penetration of disinfectants and detergents. Objectives: A study was carried out on the ability of microorganisms Listeria and Pseudomonas species to form biofilms. Methods: As objects of research, 26 strains of various types of microorganisms were selected, isolated from the objects of the production 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 growth rate of the culture was assessed in a photometer at a wavelength of 540 nm. Wells filled with sterile broth served as a control. The excess of the optical density of the crystal violet over the control indicated the formation of biofilms by bacteria. Results: As a result of the studies carried out, it was found that at a low positive temperature, all strains of pathogens formed stable biofilms during the first three days of cultivation. This ability was possessed not only by pathogenic species of Listeria (L. monocytogenes), but also by non-pathogenic ones-L. welshimeri and L. innocua. The results showed that all Salmonella spp. possessed the ability to form biofilms at low positive temperatures, especially intensively during 96 h of incubation. None of the strains formed a large amount of biofilm until 24 h. Of the two studied bacterial strains Pseudomonas gessardi and Pseudomonas azotoformans, both strains showed a high ability to form biofilms at low positive tem-peratures. Conclusion: The ability to form biofilms by pathogens and spoilage microorganisms poses a serious threat to the production of safe products and is one of the reasons for the stable circulation of microorganisms in the conditions of meat processing plants. Introduction: Inappropriate healthcare wastes (HCWs) management may lead to many psychological, environmental and health hazards. Therefore, there has been growing interest among medical organizations in strategies to reduce the quantity of HCWs and developing the recycling programs.. Objectives: The aim of this study was to assess healthcare professional knowledge regarding HCWs management before and after an educational intervention session. Methods: A pre-experimental study design was applied to assess the impact of an intervention program on knowledge and practice regarding HCWs management during March 2021 in Sahloul university hospital. The same questionnaire used in the pre-test was used immediately after the end of the intervention program. Results: A total of 63 healthcare professionals participated in our study. Overall, a significant increase in knowledge after the intervention was detected among all knowledge items. Regarding the knowledge of possible risks caused by healthcare waste, identification of toxicity as a risk increased from 5.7% to 22.5%; of psychological impact from 0 to 32.5%; injuries from 31.4 to 52.5%; infections from 62.9% to 80% and environmental contamination from 28.6% to 57.5%. Concerning the different types of healthcare wastes and their types of packaging; the rate of correct answers passed from 0% for "Flammable or explosive waste"; "Radioactive Hazardous Health Activity Waste" and "Anatomical parts and placentas" to 10%;10% and 5% respectively. Conclusion: The health professional recorded an improvement in their knowledge with regard HCWs management in post-test, but the majority of answers still not exceed 50%. Therefore, we suggest implementing practical training workshops targeting all health personnel. Disclosure of Interest: None declared.

Introduction: In our hospital, sodium hypochlorite and quaternary ammonium + amines are the used products for desinfecting the room surfaces (our standard clinic care: SCC), but they have disadvantages. Objectives: To compare the effectiveness of liquid hydrogen peroxide with SCC on reducing surface contamination. Methods: Pre-post quasi-experimental study with 2 phases comparing the effectiveness of liquid hydrogen peroxide (phase 1) versus SCC (phase2). Quantitative and qualitative evaluation was assessed from February 2019-February 2020, on 5 high-touch hospital room surfaces (upper and lower surfaces of food table, call botton, toilet flap and mattress) in 2 hospitalization units (one surgical and one medical)at Hospital del Mar. For each surface: adenosine triphosphate (ATP), visual assessment (fluorescent marker) and aerobic colony counts (ACC) measurements were collected before and after cleaning. Mann-Whitney U test was used for assessing medians differences in the ATP and ACC. Stratified analysis by hospitalization unit, isolated status and contact surface was performed. P values lower than 0.05 were considered statistically significant. Results: We evaluated 310 surfaces:217 from phase 1 and 93 from phase 2. Compared to post-cleaning values, pre-cleaning surfaces 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 achieved after cleaning with both products. Statistically significant reduction was observed for isolated and not isolated patients. Interestingly, 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 support 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 Diversey, The authors did not receive direct funding from the sponsor. Introduction: Infection through contaminated surfaces is not an abstract risk, but has already been shown by several publications. It has been shown that antimicrobial surfaces can significantly reduce microbiological contamination on surfaces in the long term. However, there have been few studies on how surface properties and reprocessing affect the durability of these coatings. Objectives: This work will therefore examine the influence of different materials and reprocessing methods on the durability of antimicrobial surface technologies. Methods: Test samples made of different materials (glass, plastic) are subsequently provided with an TiO2Ag based antimicrobial coating (HECOSOL GmbH, Bamberg) by electrospray technique and tested for their durability 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 antimicrobial efficacy. All test samples in our experimental setup showed at least slight efficacy. However, only 5 of the 47 tested samples showed a remaining strong efficacy. Conclusion: Our results suggest that the underlying surface material and also the selection of cleaning and disinfection procedures and wipe systems appears to influence the durability of the coatings on the surfaces. In order to be able to make a statement about the longterm activity of these surface technologies, the effectiveness should be tested in the finished product and after several reprocessing cycles. Disclosure of Interest: None declared. Introduction: Copper alloys are frequently used for hand touched places. As copper alloys have higher antibacterial properties, it is expected to reduce contact infection through environmental surfaces. Oxides are formed on the copper alloy surface in an atmosphere. If a treatment method of producing a highly antibacterial oxides can be developed, the antibacterial activities of the copper alloy surface can be maintained. As a result, a reduction of bacterial transmission 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. Methods: Oxygen-free copper (OFC) (99.96%) and brass ((mass%) Cu: 70.0, Zn: 30.0) were used as samples. Coupon specimens (25 mm × 25 mm × 2 mm) were cut out from commercially available plates. Test surface of specimens were polished with emery paper (# 320). The polished specimens were degreased with acetone, and then ultrasonically cleaned in ethanol. Such specimens were called specimen A. Specimen B and C were prepared by applying following treatments to the specimen A. For specimen B, the specimen A was immersed in a 1 M 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 for 100 min in atmosphere. The surface products of the specimens were analyzed using X-ray photoelectron spectroscopy (XPS). The antibacterial activities were evaluated by film contact method designated in ISO 22196 (contact time 30 min). Escherichia coli (NBRC3972 E. coli) was used as the test bacterium. Objectives: This work therefore aimed to assess the impact of commonly used disinfectants on the antibacterial activity of a commercially available brass (AB + ® ). Methods: Stainless steel (control) and brass samples were therefore treated 365 times with a commonly used hospital disinfectant containing 0.3% (W/W) quaternary ammonium (QA) according to the manufacturer's recommendations to simulate one year of cleaning/disinfection. Treatment with an aerosolized product used for terminal decontamination (peracetic acid (PA) 1200 ppm and hydrogen peroxide) was also carried out 30 times on some of these samples.The antibacterial efficacy of variously treated samples was evaluated on six multidrug-resistant clinical strains representing major species involved in HAI, as previously described (Dauvergne et al., Antibiotics 2020, 9, 245) . Results: Results compiled in Table 1 show that brass samples retain a fairly good antibacterial activity after QA ± PA treatment, whatever the strain. The study product, in the presence of an interfering substance, reduced the SARS-CoV-2 below detectable limits, with a reduction of the TCID50 greater than 4 Log 10 already after 30 s of exposure (Table 1A ). In addition, the study product showed a reduction of more than 4 Log 10 of C. auris DSM 21,092, already after 30 s (Table 1B) .

Obtained results on the activity of a 74% ethanol ABHS (Amuchina gel X-GERM) against SARS-CoV-2 and C. auris support the effectiveness of this alcohol-based formulation as a prevention measure for COVID-19 illness and in healthcare C. auris-associated infections. Introduction: Alcoholic beverage ingestion during pregnancy is associated with adverse effects on fetal development. There is a gap in understanding the developmental toxicity potential in nursing children exposed to ethanol via breastmilk from mothers using ethanolcontaining products, such as alcohol-based hand rubs (ABHRs). A previous study showed that ABHR use by healthcare workers (HCWs) resulted in low internal ethanol doses and thus low developmental toxicity potential.

We assessed blood ethanol concentrations (BECs) from ABHR use compared to health related benchmarks for lactational exposures in response to regulatory initiatives in Europe. Methods: Dose-response relationships between ethanol exposures and developmental effects in nursing offspring were examined. Maternal BECs in animals were determined at the estimated onset dose for offspring neurotoxicity. BECs were predicted for breastfeeding women who consume alcohol per public health guidelines. These BECs were compared to predicted BECs of HCWs following various ABHR uses.

Exposures were compared to health benchmarks to identify potential risks for adverse developmental outcomes. Margins were calculated by dividing the BEC from the relevant comparator health benchmark (toxicology or health guideline based) by the BEC from each ABHR use. A margin greater than 1 for health guideline benchmarks and a margin greater than 10 for the toxicology based benchmark are expected to represent low concern. Results: Epidemiology results showed no clear indication of doseresponse relationships between lactation exposure and developmental effects; but the studies have several limitations. Animal studies reported neurodevelopmental effects in nursing pups at ethanol doses that also caused maternal toxicity. Margins of 2.2-1,000 exist 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 breastfeeding child. Introduction: One barrier to participate in interventions to increase one's own hand hygiene (HH) compliance can be overconfidence in terms of overestimating one's performance [1, 2] . In this context, so far no study has compared self-reports of overall compliance vs. compliance specific to the 5 moments of HH. Objectives: Given findings from cognitive psychology that items with a higher difficulty (here: overall compliance) tend to be more strongly associated with overconfidence effects [3] , we tested empirically whether HH overestimation is stronger for self-reported overall compliance than for an index calculated based on self-reported momentspecific compliance rates weighted by the 5 moments' occurrence frequencies.

Methods: In the WACH-trial ("SSI and Antibiotics Use in Surgery"; German Clinical Trials Register-ID: DRKS00015502), a self-administered questionnaire survey on SSI-preventive compliance was conducted in 2019 among N = 93 physicians (response rate: 28.4%) and N = 225 nurses (30.4%) in 9 surgical departments in 6 non-university hospitals in Germany. Self-reported HH compliance was assessed using percentage scales. Introduction: Background Hand Hygiene(HH) has been recommended as an important strategy to help prevent the spread of COVID-19 in hospitals. Monitoring HH compliance is considered as a critical aspect of an effective HH program. The aim of our study was to assess the impact of the COVID-19 pandemic through the direct observation on HH compliance of health care workers(HCW) in hospitals. Objectives: The aim of this study was to assess the impact of the COVID-19 prevention and control program on HH compliance witin health care workers(HCW) at Sahloul University Hospital 2019-2020. Methods: We conducted a pre-experimental study based on a onegroup pretest-posttest among HCWs at Sahloul University Hospital. The intervention consisted in COVID-19 prevention and control program conducted by the prevention and security of care department. As part of this programme, we organised theoretical and practical workshops on standard precautions (mainly HH). All categories of HCW (medical and paramedical staff ) working in the various departments were included. The evaluation tool was a WHO observation form provided among the tools of the multimodal strategy. Results: Prior to pandemic (2019),1515 opportunities for HH were observed and 996 ones in 2020. Overall compliance among all HCW was better during the pandemic than before the pandemic (38.3% vs 49.3%.;p < 0.001). Hand washing remained more frequently practiced than hand rubbing. However, the latter has doubled in percentage after the intervention in 2020 (from7.3 to 14.2%; p < 0.001). The paramedical stuff were the most observant to the HH indications during the 2 years. In 2019, the intensive care units were the most compliant (50.5% vs 54.1%;P < 0.001) while,in 2020, the medical services were the most compliant (38.4 vs 56.5%;P < 0.001).During the 2-year period, the most respected indication to HH was "after touching the patient"(43.6 in 2019 vs 57.0% in 2020;P < 0.001). Conclusion: COVID-19 prevention and control program seems to have a positive impact on the HH compliance. Obtained Data are useful to provide HCW with feedback, to guide further intervention aiming at sustainably HH compliance improvement. Disclosure of Interest: None declared.

We analysed 785 observed deliveries (407 in Kenya and 378 in Malawi) across 392 facilities. The outcomes were hand washing/ rubbing 1)before any initial examination, 2)before labour, and 3)after birth. We used descriptive statistics to assess outcome levels and multivariate multilevel logistic regressions to investigate several determinants. All analyses accounted for survey characteristics. Results: HH compliance in Kenya and Malawi was respectively 37.2% (CI:32.2-42.5) and 60.8% (CI:65.0-74.3) before any initial examination; 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 for potential confounders, greeting the woman (OR 1 Introduction: Hand hygiene (HH) is widely recognized to be one of the most successful and cost-effective measures for reducing the incidence of healthcare-associated infections (HAIs). The compliance of healthcare workers (HCWs)with best practice has nonetheless been sub-optimal. Objectives: To use the Theoretical Domain Frameworks (TDF) to identify the behavioral determinants that may impact HCW'shand-hygiene compliance in a public hospital in Benin. Methods: A qualitative design comprising face-to-face semi-structured interviews with eight sampled HCWs. the interviews included questions on transmission of infections, hand-hygiene practices, problems with their implementation, and way to improve adherence with HH recommendations. Interviews were coded into 14 behavioral domains using the TDF and were subdivided into themes. Interviews transcrips were analyzed using thematic content analysis involving a systematic 3-step approach:coding, generationof specific beliefs, and identification of relevant domains. Results: One of the barriers to good HH adherence most cited in our study was environmental context and resources (such as empty hand-gel dispensers). the interviewees believed that role models had a significant impact on the good practices of others HCWs. Participants were confident of their capabilities to perform appropriate Introduction: Being the second most populous country, India houses around 1.4 billion people, with major of its population in rural setting, who have limited access to health and infrastructural facilities. Lack of clean water coupled with access to contaminated water has only resulted in increase in spread of infectious diseases, especially among the rural children. In addition, there still exists the problem of open defecation, especially in rural India which acts as a nidus in the spread of infection. In spite of the continued efforts by the governmental and private agencies to encourage the habit of adequate hand washing, especially before and after eating and defecation, lack of basic facilities including absence or malfunction of water storage tanks and taps hinder this process. Objectives: The author has proposed a new design of Water Dispenser for hand washing which can be constructed using locally available resources and thus reduces the cost involved in the construction of tanks and the necessary tap facilities. Methods: The design consists of a panel of a round wooden log, preferably of bamboo or any wood which is native to that particular region. The log panel structure consists of two supporting pillars, along with a horizontal wooden platform to support the water dispenser with the strings, as shown in Figure 1 . The users are encouraged to wash their hands, after sensitizing them about the health benefits, along with the handwashing technique and the duration of the same. The user can pull the string to pour the water from the dispenser for washing his/her hands and feet. Results: The feasibility of this design was field tested at a rural setting and around 30 users were questioned regarding the comfort and the usability factors on a scale of 0 (not useful) to 5 (Highly useful). Most of the participants expressed satisfaction in terms of the ease of installation and usage of this model for hand washing.

The advantages of this methods included ease of installation, low cost and avoidance of container to draw water from the water source and hence contaminating the source of water. Though this model has some limitations, the proposer feels that this model could be a viable alternative for water dispensing for hand washing purposes in rural or resource limited settings. Disclosure of Interest: None declared. 

The coronavirus pandemic has disrupted lifestyles for almost two years across the planet. The fight for its prevention in the absence of its eradication involves the implementation of barrier measures including the treatment of hands. So, as part of the International Hand Hygiene Day this year with the theme "One Minute to Save Lives"; health workers from the Calavi Central Clinic in the Republic of Benin, have decided to increase their hand hygiene compliance rate by organizing an awareness and training day for users of the establishment. So each caregiver came out of his office to show the hand washing technique to a user (patient, attendant, or other non-clinical user). This activity, which lasted three hours, saw the participation of 21 clinic agents who taught 42 users. This operation, which deserves to be repeated, showed the good technique of simple hand washing to more than forty users in one morning. Keywords: coronavirus, prevention, hand hygiene. General objective: Participate in the reduction of the transmission of the coronavirus by the practice of hand washing. Specific objectives: Promote hand hygiene in the minds of users. Demonstrate the correct and simple hand washing method to the community. Method and materials: Each health worker revisits their simple handwashing protocol, explains it to a user, and the two do it together. Materials: Two hand washing stations, soap, disposable hand towels, garbage cans. Results: The operation was monitored by all the medical practitioners present at the station, ie 100%, of 06 nurses and 12 health and pharmacy auxiliaries. These health workers of all categories showed the technique to 42 users who practiced simple hand washing, more than 80% of the people who went to the clinic this morning. Conclusion: The practice of hand hygiene is in the headlines as stated by one user. Everyone saw their caregiver come out and discuss the technique and importance of hand washing with them. This will inevitably improve their knowledge of this very important method in infection prevention and control (IPC) in healthcare settings. Disclosure of Interest: None declared. 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 compliance rates. The use of innovative local strategies can help to overcome this tiredness and input a new dynamic, thus maintaining and even improving hand hygiene compliance. Objectives: Revitalize the hand hygiene campaign through an innovative strategy in order to improve the compliance rate. Methods: Figueira da Foz Hospital is a secondary district hospital who joined the WHO's hand hygiene campaign in 2014 and thenceforth, every 5th may, healthcare workers are mobilized to celebrate the World's Hand Hygiene Day. In the first 3 years we used updated 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 healthcare workers children: Once upon a time… in Soap's Realm, an imaginary story in a kingdom where hand hygiene was widely recognised as an important way to keep people healthy. King McClean invested in infrastructures, produced the best world's soap and there even was a troubadour to keep hand washing in people's routines. Until the day the good old king died, his work wasn't continued and everyone got ill after an invasion of microbes. But like all children's stories, this one also has a happy end! Results: The book met a huge success. The pooled hand hygiene compliance rate between periods increased from 62,0% to 72,4% (95% CI: 5,34-15,35; p < ,001); before the intervention it was 63,3% in 2015, 57,1% in 2016 and 59,9% in 2017 and after the intervention the compliance improved to 66,4% in 2018 and 73,5% in 2019. The rate of nosocomial infections also improved from 5,2% in 2015 to 3,5% in 2019, according to institutional prevalence. Conclusion: A different way of communication can change the way we receive the same message, create awareness for hand hygiene compliance thus preventing healthcare associated infections. Disclosure of Interest: None declared. Introduction: Since the beginning of the COVID-19 pandemic, HUG are taking care of patients suspected of having or affected with COVID-19. The majority of the HUG wards became COVID wards; CONTACT and DROPLETS measures replaced SP. When the situation returned to normal, the use of personal protective equipment was inappropriate. A corrective program was implemented. One of its objectives was to address the role of the MED/NURS leaders of the non-COVID wards. In the initial phase of the program, the PCI knowledge of these managers was assessed and updated. The majority of the wards became COVID wards; CONTACT and DROPLETS measures replaced SP. Objectives: To assess the knowledge of MED/NURS leaders of non-COVID wards regarding hand hygiene and wearing of gloves and to evaluate the choice of personal protective equipment by MED/NURS managers in non-COVID wards for frequent clinical situations. Methods: The MED/NURS managers of the non-COVID wards were 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 frequent clinical situations. The quiz was built with an educational purpose. The participants' answers were recorded anonymously by an online survey software. Aggregated responses were presented and commented during the session. Objectives: We aimed to assess the effect of this low-cost, low-effort approach on healthcare workers' (HCWs) HHC in patient rooms using an electronic hand hygiene system. Methods: To avoid the risk of bias associated with direct observations, an electronic hand hygiene system (sani nudge ™ ) was used to obtain HHC data from doctors (n = 6) and nurses (n = 18) in a surgical ward from Dec 2020-Feb 2021. The study was divided into a baseline and an intervention period where pink tape was placed on the floor at the entrance of each patient room next to the ABHR dispensers. The pink colour was identical to the colours of stickers and brochures used during the last hygiene campaign. The hypothesis was that the HCWs would associate the pink-coloured tape (nudge) with hand hygiene, resulting in more frequent ABHR and increased HHC. We used Student's t-test to assess differences between baseline and intervention. Results: The HHC of the doctors was not associated with a significant change from baseline to intervention either before patient contact (25% vs. 23%, p = 0.76) or after patient contact (52% vs. 57%, p = 0.73). As with the doctors, the HHC of the nurses did not change from baseline to intervention either before patient contact (31% vs. 35%, p = 0.10) or after patient contact (49% vs. 46%, p = 0.46). Conclusion: This study demonstrates that interventions can be assessed with an electronic hand hygiene system. We found that colourful tape on the floor at patient room entrances did not have an impact on the HHC of HCWs. The lack of effect may be due to banner blindness due to frequent exposure. More dynamic nudges may be needed to change the hygiene behaviour of HCWs. Disclosure of Interest: None declared. 

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 electronic 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 datadriven group feedback at biweekly staff meetings in which ward management 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 and communicated by management to help focus their improvement work. Staff absenteeism was defined as short term sick leave between 1-28 days and averaged for each month. We used Student's t-test to assess differences in HHC between baseline and intervention, and Pearson correlation test to assess correlations between HHC and staff absenteeism. Two-sided p values < 0.05 were considered statically significant. Results: We included 100 front-line healthcare workers (doctors, n = 31; nurses, n = 69). The average HHC at baseline was 31%. During the intervention period, the average HHC significantly increased to 51% (p < 0.0001) which was associated with a significant decrease in staff absenteeism from 7 to 3% (p < 0.0001). There was a strong negative correlation between HHC and staff absenteeism (r = -0.8, p = 0.0001). Conclusion: The increase in HHC after introducing a data-driven group feedback intervention using an EHHMS was associated with a significant decrease in staff absenteeism. The demonstrated relationship between staff HHC and absenteeism shows a return of investment opportunity for hospital management while also increasing the staff and patient safety. Disclosure of Interest: None declared.

The COVID-19 pandemic has brought new challenges in the field of the healthcare-associated infection (HCAI) caused by multidrug-resistant microorganisms. Objectives: The objective of the study was to describe the burden, epidemiology and outcome of healthcare-associated infection in hospitalized patients with COVID-19. Methods: We conducted a retrospective cohort study which included COVID-19 positive adult (≥ 18 years) admitted between 16 March 2020 and 31 March 2021 to the 638-bed University Hospital Trnava in Slovakia. We analyzed epidemiological and microbiological features as well as outcome data. The European Centers for Disease Control and Prevention definition of HCAI and statistical package R-project were used for data analysis. Results: Overall 1517 patients were hospitalized with COVID-19 during the study period (median age 69 years; IQR 57-78; 54.3% male). A total of 330 (22.0%) HCAI were diagnosed in 220 patients (14.6%) with the median 9 days (IQR 4-14) upon hospital admission. Respiratory infection (38.8%), urogenital infection (27.9%), bloodstream infection (14.5%), and infection caused by Clostridioideus difficile (14.2%) were the most frequent. Overall 550 different microorganisms were isolated: 64,5% gram-negative, 15.3% fungi. The most common cause of HCAI was Klebsiella spp. (24.2%; 40.6% carbapenem producing Klebsiella spp., KPC) and Pseudomonas aeruginosa present in 21.5% of infections (56.2% carbapenem resistant Pseudomonas aeruginosa). The mortality of patients developing HCAI was 19.2%. In-hospital mortality was significantly higher in comparison with patients without HCAI (41.1% vs. 28.6% p < 0.001). Patients who developed HCAI did have higher risk of the dead (OR 1.7; 95% CI 1.2-2.1; p < 0.001). Conclusion: Healthcare-associated infections in COVID-19 patients are an important cause of mortality and morbidity. We identified a higher rate of HCAI in comparison with a reported study which can be caused by a large influx of COVID-19 patients in the second wave of the pandemic. Disclosure of Interest: None declared. Introduction: The coronavirus disease 2019 (COVID-19) pandemic has had an enormous impact on healthcare systems globally. Although these efforts have understandably taken immediate priority, the impacts on traditional healthcare-associated infection (HAI) surveillance and prevention efforts remain concerning. Objectives: This study aimed to describe the trends of healthcareassociated infection rate at Sahloul university hospital of Sousse, Tunisia within the current COVID-19 outbreak. Methods: Since 1991, the infection control team of the prevention and security of care department has conducted annual point prevalence surveys in March and early April, as part of a quality improvement program promoted by our department in Sahloul university hospital for the prevention and control of HAIs. A cross-sectional design was used to assess the HAI rate during and before COVID-19 outbreak in our hospital. Results: The total rate of HAIs was 10.1% in 2021 during the COVID-19 outbreak, which was 15.5% in the past year (p = 0.06). This decrease was observed in all of the three types of wards (surgical, intensive care and medical). However, it was only significant for intensive care units (p = 0.01) and medical wards (p < 10 -3 ). The prevalence of infected patients decreased from 14.9% in 2020 to 9.6% in 2021. However, this decrease was not statistically significant. Except for surgical site infection, the rates of pneumonia/lower respiratory tract infection and other infections, decreased significantly compared the past year (p < 10 -3 ). A 6.5-point increase was observed in the rate of urinary tract infection and a 19.6-point increase in blood stream infection (BSI) during the COVID-19 outbreak compared with the past year; however, this was statistically significant only for BSI.

The results of the present study showed a reduction in the rate of HAIs during the COVID-19 outbreak. Therefore, HAI can be minimized by increasing awareness, creating a positive attitude, improving staff hygiene behaviors, and providing facilities to comply with the standards of infection control protocols. Disclosure of Interest: None declared. Introduction: Worldwide, Health Care-Associated infections (HCAIs) have a significant impact on morbidity, mortality and quality of life. At the local level, the prevalence of HCAIs at Sahloul Hospital was 6.1% in 2018, 9.5% in 2019 and 15.5% in 2020 (following the first wave of COVID-19 in Tunisia). In this particular context, we conducted our annual prevalence study. Objectives: The objective was to determine the prevalence of HCAIs at Sahloul hospital in 2021; the typology of infections as well as the antibiotic resistance profile. Methods: We conducted a cross-sectional study of HCAIs prevalence with a single passage in March. The agreed definition of an HCAIs was any infection that occurs during a hospital stay of at least 48 h and if it was not present at admission. All hospital departments were included in the survey. Results: A total of 228 patients were included in the study with a mean age of 58 years and a sex ratio of 1.15. A total of 23 HCAIs were identified, representing a prevalence of HCAIs of 10.0%. The prevalence of infected patients was particularly higher (20.0%) in intensive care units (ICU) than in other departments of the hospital. The most common infections were urinary tract infections (31%) and bacteremia (26%). Of the 23 HCAIs identified, 20 were microbiologically documented, 23 different germs were isolated (the sample contained two germs in three patients,). Of these 23 isolated germs, 47% (n = 11) were Gram Negative Bacilli and 30% had a high bacterial resistance. Conclusion: The 2021 prevalence does not differ from the rates usually observed in recent years (around 10%) with the exception of the previous year 2020 (15.5%). This return to the "normal" HCAIs prevalence rate in 2021 could be explained by the increasingly rigorous application and adherence to standard hygiene precautions during the COVID-19 pandemic. Disclosure of Interest: None declared.

Introduction: Nosocomial infections (NI) are major patient safety problems in hospitals. As patients infected by SARS-CoV-2 need prolonged hospital stays and heavy treatments, they may be present higher incidence of NI. Objectives: The aim of this study is to compare NI rates and its risk factors between patients presenting COVID 19 infection and other hospitalized patients. Methods: A point-prevalence study was conducted in Sahloul university hospital on March 2021 among patients hospitalized for more than 48 h. Data collection was carried out through anonymous standardized survey record inspired from the NosoTun plug. Data extracted from medical records included diagnoses, laboratory results, microbiological data, and antibiotic use. Microbiologically-confirmed bacterial and fungal pathogens from clinical cultures were evaluated to characterize community-and NI. Results: A total of 228 patients were included with a total prevalence of NI of 10.08% (23 cases). Schematically patients presenting NI were departed into two groups according to their COVID 19 status; the prevalence of NI among patients with COVID19 was 15.4% vs 8.9% among other patients (p = 0.2). Concerning risk factors; there was a significant difference between the two groups in term of mean age (66 vs 47 years respectively; p = 0.014); medical history of diabetes (100% vs 22.2%; p = 0.01); presence of urinary catheter (100% vs 27.8%; p = 0.015); peripheral venous catheter (100% vs 27.8%; p = 0.01) and mechanical ventilation (100% VS 16.7%; p = 0.005). Respiratory infection and Bacteremia were the most common sites of infection in COVID-19 patients and the isolated microorganisms were acinetobacter; while it was sataphylococcus auerus for other patients. Conclusion: Minimizing NI transmission remains a challenge, especially in the COVID 19 pandemic context that has placed a large burden on hospitals and healthcare providers. it is crucial to deepen our understanding transmission pathways of NI in order to implement infection prevention guidelines and enhance protection of patients. Disclosure of Interest: None declared. Introduction: Healthcare associated infections (HAIs) have been identified as a problem of public health in all over the world. In Tunisia, national surveys on the prevalence of HAIs have been routinely taken place in health facilities. In our hospital, we conduct a prevalence survey yearly as part of the prevention and control program of HAIs. Objectives: We aimed to describe the trend of HAIs'S prevalence in Ibn ElJazzar Hospital over 10 yearsas well as the most frequent identified site infections. Methods: It is a cross-sectional study of one-day prevalence with a single pathway, including all patients who had been hospitalized for at least 48 h. Data collection was carried out using Noso-Tun form (national HAI prevalence survey). Results: over 10 years, the prevalence of HAIs ranged from 11.9% in 2010 to 3.19% in 2015 and then to 10.32% in 2020. The most frequent site infectionthat was found in 2010, 2012, 2013 was urinary tract infection with respectively the proportions of 36.7% (11/30), 31.3% (5/16)and 37.5% (3/8). Blood stream infection was the most important infection localization in 2011 (38.5%), in 2014(57.14%) and in 2020 (22.3%). Pneumonia had the higher prevalence over 2 years (2016 and 2017). The bacteriological analysis was performed in 60.3% of HAIs cases. In 46.3% of cases (n = 19), isolated bacteria wasEscherichia Coli. In second position, Klebsiellapneumoniae was identified in 26.8% of cases (n = 11) followed by enterobacteriaccaein 19.5% (n = 8). Conclusion: This prevalence survey showed obviously the evolution of healthcare associated infections over 10 years. It could help us adjust the infection control program in our hospital and implement the different strategies to prevent the increasing rate of HAIs. Disclosure of Interest: None declared. Introduction: Healthcare Associated Infection (HAIs) are a major safety concern for both health care providers and patients. They continue to increase at an alarming rate. Objectives: Aim of the study was to determine prevalence and associated factors of healthcare care associated infections in the University Hospital IbnElJazzar in Kairouan, Tunisia. Methods: This was a cross sectional study conducted in 13 wards in the Teaching HospitalIbnElJazzar in Kairouan, Tunisia in March 2020. All patients hospitalized over 48 h were included in the study. Data were provided from patients' files. Data entry and analysis was done using SPSS version 22. Results: A total of 184 patients were enrolled in this study. The prevalence of healthcare acquired infections was 10.32% (19/184). The ratio of infection/infected was 1.35(19/14). Urinary tract infection was the most frequent site infection (26.3%), followed by:blood stream infection, respiratory tract infection (15.7%), and surgical site infection(10.5%). Risk factors that were associated to healthcare associated infections were: Obesity (p = ≤ 10-3 ), immunodeficiency (p = 0.008), urethral catheterization (p = 0.002), central venous catheter (p = 0.016), peripheral venous catheter (p = 0.005), artificial ventilation (p = 0.001), parenteral nutrition (p = 0.005), surgery (p = 0.041). Conclusion: The prevalence of healthcare associated infection is relatively high. Thus, many recommended measures should be soon taken set up a robust infection control program, describe procedures related to medical device handling, encourage healthcare professionals to respect standard and complementary hygiene measures. Disclosure of Interest: None declared. Introduction: Healthcare-associated infections constitute a real public health problem. To limit the damage in terms of morbidity and mortality, and to develop effective prevention strategies, knowledge of its extent and predisposing factors is essential. Objectives: Determine the prevalence of healthcare-associated infections, identify the risk factors associated and guide prevention strategies. Methods: It was a cross-sectional prevalence study carried out over 7 days, from December 28, 2017 to January 3, 2018 in 19 clinical departments of the Farhat Hached CHU in Sousse. The definition of healthcare-associated infections was that of the Centers for Disease Control and Prevention (CDC). Trained investigators collected data from the medical file and follow-up sheets using standardized sheets. Results: A total of 371 patients were included with an M/F sex ratio of 0.75 and a median age of 38 years. The prevalence of infected patients admissions. The prevalence of each type of HCAI as shown in Table 1 . Meanwhile the prevalence of devices related HCAIs for VAP and CLABSI was 12.6% and 6.7% respectively. The most commonly found risk factors in patient with HCAI were underlying diseases, prolonged hospitalisation and history of surgery. The top 3 antimicrobial resistance (AMR) markers isolated were Methicillin-resistant Staphylococcus aureus (MRSA), 3rd Generation Cephalosporin Resistant Extended-spectrum beta-lactamases (ESBL) producing Klebsiella pneumoniae, and 3rd Generation Cephalosporin Resistant Extended-spectrum beta-lactamases (ESBL) producing Escherichia coli. The top 3 department with highest HCAI prevalence were Critical Care Unit (20.0%) followed by Hematology (7.6%) and Nephrology department (7.3%). 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, long-term disability, increased resistance of microorganisms to antimicrobials, a massive additional financial burden for health systems, high costs for patients and their families, and excess deaths. Objectives: The aim of the study was to determine the incidence and microbiological profile of healthcare-associated infections in a Tunisian surgical intensive care unit. Methods: A prospective cohort study was carried out in surgical ICU in a Tunisian university hospital. 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 Tunisia from January to December 2019. Results: During the study period 84 patients were treated in the ICU, for more than 48 h each. Sex-Ratio was 2.43. Mean age was 50.7 years (SD = 19.7). Median length of stay was 4 days (IQR = 2-9). A HAIs incidence rate of 50 per 100 admissions and incidence of 44.6 per 1,000 patient days was observed. Among 42 HAIs reported, pathogens could be identified for 33 HAI cases (78%). The main types of HAI detected in ICU patients included the following: Pneumonia (60%), Central Line Associated Infections (CLAI) (10%) and Urinary infection (10%). Acinetobacter baumanii was the most common organism isolated (45%) followed by Pseudomonas aeruginosa (21%) and Klebsielle pneumonia (15%). Conclusion: Our results highlight the importance of implementation of active surveillance program. In Tunisia, infection control programmes are a challenge for the future, and their implementation requires increasing the awareness of both medical staff and hospital management. Disclosure of Interest: None declared. Introduction: Healthcare-associated infection (HAI) is a major public health concern. Controlling this fatal scourge should begin with continuous monitoring of HAI frequency and its associated factors. Objectives: The aim of this study was to determine independent factors of HAI in a Tunisian university hospital in 2021. Methods: A cross-sectional survey was conducted within the epidemiological monitoring program at Sahloul University Hospital. The onset of infection within 48 h of hospitalization was used to define HAI. Multivariate analysis by a binary logistic regression step by step descendent 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 had two, giving a prevalence of infected patients of 9.6% and a prevalence of infections of 10.08%. Introduction: Reducing healthcare-associated infections (HAIs) is heavily contingent on proficient infection prevention and control (IPC) teams, with the ability of finding valuable problems that need to be solved. From a Problem-Findind and Problem-Solving Perspective, a valuable problem means a gap between a current and a desired situation, which in this study includes failures, deviations and opportunities for improvements in IPC practices. Once solved, valuable problems generate superior knowledge.

Objectives: This study aims to understand how IPC teams find valuable problems relating to HAIs.

We performed a multiple case study of 3 hospitals located in Brazil and Sweden that recently faced outbreaks caused by Acinetobacter baumannii. We collected data from 3 exploratory and 13 semi-structured interviews with nurses and physicians enrolled in IPC teams. Supplementary documents were used for data triangulation. Data was analyzed using the thematic analysis technique. Results: Our findings suggest an approach based on two different sets of activities for finding valuable problems: practices for HAI prevention and for HAI control. Practices for HAI prevention comprises routinely and elective actions whereas practices for HAI control involve ad hoc and emergent actions. The practices are organized into problem-detection, problem-framing, and problem-formulation activities.

Our study provides a framework (see Figure) to guide IPC teams' attention on how to find valuable problems relating to HAI prevention and control, as well as the criteria on how to prioritize the most important problems that need to be prioritized and solved. This ultimately culminates in valuable knowledge and in high-value solutions to be implemented to reduce HAI occurrence. Besides, our approach provides a range of practices that support IPC teams on how to timely shift from prevention to control decision-making modes.

The study concludes that IPC teams that find valuable problems more quickly and efficiently reduce the occurrence of HAIs and prevent outbreaks. Additionally, IPC teams that differentiate prevention practices from control practices and know when and how to shift from prevention to control decision-making modes obtain valuable problems and high-value solutions in terms while consuming less resources. Disclosure of Interest: None declared.

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 priority for nursing staff. Disclosure of Interest: None declared.

Poster session: infection prevention and control: Implementation and patient safety Knowledge of the participants was assessed before and after conduction of training using a questionnaire consisted of two sections. Section A elicited responses on demographic variables of participants. Section B elicited information on the participants' knowledge about standard precautions. A significant difference was defined as P value < 0.05 (2-tailed). Continuous data were compared with paired t-test. Statistical analysis was performed with SPSS (Version 21).

The knowledge of health care workers differed significantly before and after the training (P = 0.01), emphasizing that the impact of the training was important to improve the knowledge of participants. The average value of improvement of healthcare workers' knowledge was about 26.5%.

The findings emphasized the role of the training to improve the knowledge and education of health care workers about standard precautions as well as prevention of infection during COVID 19 pandemic. Education and training which is the third core component of the IPC should be reinforced for the better health of patients and medical staff, and be considered as one of the key factors in any pandemic response. Disclosure of Interest: None declared.

Application of the CFIR-ERIC tool points to the identification and preparation of champions for the successful implementation of ICLN programs. Further strategies can be tailored to each context with the help of the identified barriers and the use of the tool. Disclosure of Interest: None declared. 

is an indispensable part of an adequate IPC program. For medical students, IPC education should be theoretical and practical, so the student can provide safe patient care. Objectives: At our medical faculty, until 2019 IPC education for medical students consisted of three hours of teaching. Evaluations with students and teachers showed that the program was not considered challenging and the importance of IPC did not affect the student. The teachers indicated there was too little time to cover the important aspects of IPC. Therefore, we developed a new and more inspirational educational IPC program for medical students at the Radboudumc medical faculty. Methods: Since 2019, medical students are educated in IPC according to our newly developed educational program. The program was developed by the IPC team, the medical education director and several peers within the medical and educational domain. The IPC education is planned in the preparatory clinical rotations module. 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 inhouse 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 setting. Students are tested on donning, doffing, hand hygiene, cleaning and disinfection and communication.

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. Feedback shows the program reflects the daily practice and students feel confident to perform IPC measures in a clinical setting. Also they realize what it means for a patient to be isolated, this emphasizes the importance of clear communication on IPC measures.

We are the only medical faculty in the Netherlands where 100% of the graduated medical students are fully IPC trained and examined. We believe that the mandatory exam at the end of the program shows the importance of IPC in patient care. At this moment we are evaluating the program. Disclosure of Interest: None declared. Objectives: We aimed to follow-up patients surviving the acute phase of disease to identify and eventually describe persistent symptoms related to it. Methods: RECOVIDA is a prospective cohort study conducted in a public-affiliated tertiary-care hospital, in Brazil. From May 1 to December 31, 2020, we recruited participants on the Post-Covid-19 ambulatory of the study facility, which offers clinical follow-up to adult patients, most of them discharged after being admitted due to Covid-19. We classified their acute disease following WHO severity of disease criteria. Results: 175 patients were included in the study and evaluated up to 120 days after the onset of symptoms (mean = 57 days). Regarding demographic features, 51.4% of participants were female, and average age was 53 ± 14 years. Past medical history included hypertension (37%), diabetes mellitus (28%) and obesity (mean body mass index of 31.7 ± 7.3). By the time of evaluation, 80% of participants still experienced at least one long-term symptom, as described in Table 1 . Conclusion: Covid-19 disease does not necessarily end with the end of its acute phase. In fact, a large proportion of patients, even after a mild disease, persist with clinically meaningful symptoms up to 120 days after the disease onset. Objectives: we aim to evaluate the risk factors associated with the death of patients with COVID-19 pneumonia. Methods: We analysed data of laboratory confirmed hospitalized patients at the COVID-19 unit of a university hospital in the Tunisian center, between September 2020 and January 2021.Patients' characteristics, comorbidities, and laboratory abnormalities were recorded. Potential predictors of in-hospital mortality were identified by multivariable Cox regression model. Results: A total of 256 patients were included.Mean age was 66 years (SD, 14 years) and 62% (n = 158) patients were males. Forty-eight percent (n = 123) of patients had at least two co-morbidity with hypertension and diabetesas the most common comorbidities.Severe cases accounted for 52% of the study population.The overall in-hospital mortality rate was 29% (n = 72). multivariate analysisrevealed that Age > = 60 years (HR 5.87, p < 0.001); The presence of coronary heart disease (HR 2.47, p = 0.027) and leukocytes ≥ 10,000 (HR 2.25, p = 0.012),were independently associated with increased in-hospital mortality. Conclusion: Predictors could assist clinicians to identify patients with a poor prognosis at an early stage to reduce the Covid-19-related mortality and rationalize the use of limited medical resources. Introduction: Timely identification of COVID-19 patients at high risk of mortality is crucial to improve patient management and resource allocation in hospitals. Objectives: The aim of this study was to identify mortality risk factors at the COVID-19 Intensive Care Unit (ICU) in the region of Mahdia Methods: We conducted a prospective study including patients with severe COVID-19 infection admitted to the ICU of The University Hospital Tahar Sfar Mahdia. The survey was carried out between September 2020 and February 2021. We used "The RAPID CORE CASE REPORT FORM" developed by the World Health Organization. Results: We analyzed the records of 117 patients (59.8% were males). Mean age was 61.4 ± 12.2 years. Common symptoms were shortness 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 51.4% required prone position. The overall mortality rate was 46.2%. Longer stay in the hospital (> 14 days) and longer intubation duration (≥ 7 days) were associated with a higher risk of mortality (61.8% vs 32.3%; p < 0.001 and 77.6% vs 20.6%; p < 0.001 respectively). Mortality was also related to acute respiratory distress syndrome (66.7% vs 13%; p < 0.001) and nosocomial infection (80.8%vs 17%; p < 0.01). Multivariable logistic regression analysis showed increasing odds of mortality with nosocomial infection (OR, 12.41 [95% CI, 3.3-46.57], respiratory distress syndrome (OR 7.52 [95% CI. 1.71-32,95]) and inotropes or vasopressors intake (OR 7.39 [95% CI, 1.57-34.69]). Higher oxygen saturation on admission was found to be a protective factor against mortality (OR 0.91 [95% CI, 0.85-0.97]). Conclusion: Interventions that prevent these risk factors are needed to improve the prognosis of Covid-19 patients. Disclosure of Interest: None declared multi-modal program implementation, the consumption of disinfectant solution decreased to 223,8 L (per day). The average monthly consumption of disinfectant solution was reduced by 5,22 times to 6 714 L per month (p = 0,18). The proportion of microbial contamination of environmental surfaces in the units with high epidemiological risk decreased to 6,7 ± 5,4% in 2018 -2020 years. Conclusion. The usage of the proposed non-bucket cleaning system allows not only faster and better to execute planned measures for disinfection 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 staff's work and discipline. 

77]) were independent risk factors for healthcare-associated infections. Conclusion: The epidemiological surveillance of healthcare-associated infections makes it possible, on the one hand, to orient and better target prevention programs and, on the other hand, makes it easier to evaluate control actions

Infectious diseases following natural disasters: prevention and control measures

PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation

Methods: Since the start of the pandemic, the prevention and secudepartment. Results: From when the first patient with COVID-19 was admitted to May 5, 752 laboratory-confirmed COVID-19 patients had been admitted to our hospital. Most patients were male (55.5%), the mean age was 62.3 ± 14.5 years, with 279 patients (37.1%) being < 60 years of age. The median length of stay was 11 days (IQR 5-14). The most common comorbidities were hypertension (47.7%), diabetes (46.2%), and coronary artery disease (19.9%). Most patients had an important degree of hypoxemia, with 53.7% of patients not requiring supplemental oxygen, and 22.4% needed invasive mechanical ventilation. The overall case fatality rate was 23%. More patients died in the intensive care units (65.8%)

14 University Hospital Basel, Basel, 15 Cantonal Hospital Schaffhausen, Schaffhausen, 16 Hospital Hirslanden Central Switzerland, Lucerne, 17 Cantonal Hospital Nidwalden

A sensor-based platform with automated HH compliance and quality monitoring, real time feedback and comprehensive individual level analysis, improved providers' HH compliance in an ICU. There were significant variations among individual providers. 

HH behaviors. almost all of them (7/8) reported having the necessary knowledge and skills and believed they could carry out appropriate HH behavior. Conclusion: The theoretical Domains Framework provides a useful tool for understanding HH behavior. But while knowledge is necessary for behavior change, it is not sufficient. This study identified several key behavioral constructs aligned with the TDF that can be targeted when developing new HH interventions. These may increase the HH compliance and patient safety. Introduction: The World Health Organization recommends improving hand hygiene (HH) practices of the general public as one aspect of controlling the transmission of novel coronaviruses and influenza virus epidemics or pandemics. Objectives: To systematically review the evidence on the effectiveness of HH interventions for preventing transmission or acquisition of viral infections in the community. Methods: PubMed, MEDLINE, CINAHL and Web of Science databases were searched for empirical studies published between 2002-May 2020, on HH in the general public and acquisition or transmission of novel coronavirus infections or influenza. Study selection, data extraction and quality assessment were conducted by one reviewer, with all decisions checked by another. We conducted a sub-set analysis of intervention studies included in this review, by calculating the effect estimates. Results: The review identified four intervention studies, all of which used cluster randomised designs evaluating the effectiveness of HH education paired with provision of HH products or hand washing with soap and water (HW) against influenza transmission or acquisition amongst the populations of schoolchildren (n = 2) or the general public (n = 2). Three indicated a protective effect of HH interventions ( Figure) ; yet, this effect was significant for only one school-based intervention, which consisted of the provision of HH education and performing HW twice a day (OR: 0.64; 95% CI 0.51, 0.80). However, the risk of bias of this study was assessed as unclear; whereas the remaining three studies were assessed as high risk.Conclusion: There is some limited evidence demonstrating that hand hygiene interventions were effective in preventing influenza in school children. Thus, whilst provision of HH education to school children will be beneficial from a public health perspective, it's impact on influenza transmission is unclear. Research is needed to evaluate the effectiveness of HH interventions for prevention of respiratory infections, including SARS-CoV-2, amongst more diverse groups of the general public populations. Disclosure of Interest: None declared.

What should have worked but didn't really: addressing hand hygiene misinformation in the press A. Peters 1,* , D. Pittet 1 , S. Ghasemi 1 1 HUG, Geneva, Switzerland Correspondence: A. Peters

Introduction: Misinformation about infection prevention is everywhere, and especially widespread and harmful during a destabilizing situation such as a pandemic. Published sources of misinformation in online newspapers are among the most widely read by laypeople. It is important to respond to fake news, though it is difficult to know the impact of such a response. Objectives: We wanted to measure the impact of our ability to reduce the damage done by an article published in the The Express during the COVID-19 pandemic. This article contained a large amount of false and misleading information about hand hygiene. Our objective was to make the publisher correct the misleading article and to analyze how feasible this was, if we had ample time and resources to devote to one piece of fake news. Methods: After discovering the misleading article, we sent an email reporting and denouncing the false information to the publisher. We contacted the Independent Press Standards Organisation (IPSO) to file a complaint and provided a detailed analysis of which points of their Editors' Code of Practice were violated in the concerned article. We contacted the British Institute of Cleaning Science where the "expert" cited in the newspaper article was reported to be a consultant, in order to find out more from them. All inaccurate or misleading elements of the article were analyzed, with full documentation of the scientific literature. Results: Though each inaccuracy was addressed specifically with plenty of evidence, the newspaper refused to take any action to correct or remove the article, claiming to be confident about the content. IPSO rejected the claim we filed, as they considered that the article contained the point of view of the interviewed person. The British Institute of Clean Science specified that the "expert" was an unpaid consultant and released a statement (also sent to IPSO) that specified that the views of their unpaid consultant did not reflect their own. Conclusion: Even with ample resources, it proved to be very difficult, if not impossible, to have a measurable impact on infection prevention misinformation in the lay press. More work needs to be done to address this divide between academics and the lay press, as it is crucial for infection prevention and public health. Disclosure of Interest: None declared.

Perception of healthcare workers towards healthcare-associated infections and hand hygiene exposed to different change agents Y. F. Lee 1,* , W. Introduction: Healthcare-associated infections (HAIs) have affected hundreds of millions of individuals worldwide. Taking that hand hygiene is behaviour driven, improvement strategies can be improved by fostering collaborative multimodal strategies via change agents. Objectives: To understand how the different attitude of change agents shaped the perception of healthcare (HCWs) workers towards HAIs and hand hygiene. Methods: Two acute wards of a tertiary hospital in Malaysia were randomly exposed to hand hygiene improvement interventions delivered by peer-identified change agents (PICAs) in study arm 1, and management selected change agents (MSCAs) in study arm 2. Primary outcome was perception of HCWs towards (i) impact of HAIs and the importance of hand hygiene, (ii) strategies and tools for hand hygiene compliance and; (iii) facilitators' importance for optimum hand hygiene, measured using the WHO Perception Survey for HCWs (revised 2009), applied in the pre-and post-intervention periods. Secondary outcome was perceived leadership styles of PICAs and MSCAs by HCWs, vocalised during question and answer sessions. Results: The number of respondents in pre-and post-intervention was 72 and 70, and 75 and 71 in study arms 1 and 2, respectively. From the pre-to post intervention periods, the perception of HCWs on the impact of HAIs, and the importance of hand hygiene were similar and remain unchanged in both study arms. In the post-intervention period, the proportion of HCWs that perceived improvement in safety climate for hand hygiene was significantly higher in PICA led-ward compared to MSCA led-ward (91% vs 65%, P < 0.001). Proportion of HCWs on the perception of the facilitators' effectiveness on hand hygiene was significantly higher with PICAs compared to MSCAs. Healthcare workers perceived that PICAs lead by example, while MSCAs were authoritative and more desirable for hand hygiene improvement. Conclusion: Although HCWs preferred the authoritative leadership style of MSCAs, they still perceived PICAs to be more effective in improving hand hygiene compliance. Disclosure of Interest: None declared. Introduction: Healthcare-associated infections (HAI) are the most frequent adverse events in healthcare worldwide. The Multimodal Hand Hygiene (HH) Improvement Strategy by the WHO aims at reducing HAI. Hitherto, there is little evidence of the applicability and effectiveness of the WHO HH Strategy at primary care level, especially in healthcare centers (HCC) of resource limited settings such as Guinea. Objectives: The objectives of the present study were to improve HH knowledge and compliance of healthcare workers (HCWs) in two HCC in the region of Faranah, Guinea; to increase the availability of alcoholbased handrub (ABHR) by supplying HCC with locally produced ABHR; and to assess the effectiveness of the WHO Multimodal HH Improvement Strategy on primary care level. Methods: HH knowledge, perception and compliance of HCWs were assessed in baseline prior to the intervention and compared to two follow-up assessments, one immediately and one six months after the intervention. The intervention consisted of HH training and the continuous supply of HCW with ABHR, which was produced in the Regional hospital Faranah. The monthly consumption of ABHR after the training was monitored with respect to consultations. Results: Baseline knowledge score was 11/25, increased significantly to 16/25 upon first and decreased slightly to 15/25 in second followup. Compliance with HH showed a significant increase from 15.6% to 84.4% (p < 0.001) in first follow-up. Compliance in second follow-up was lower than in first follow-up (53.2%, p < 0.001), but was still more than 37% higher than in baseline (p < 0.001). ABHR consumption averaged 0.77 mL per consultation. Conclusion: This study shows that the WHO HH Strategy is an appropriate method to improve HH compliance and knowledge in primary care level, but needs some adjustment of assessment and training procedures. Assessments should include the observation of HH action correctness and trainings should further emphasize on proper HH performance and ABHR amount usage. Moreover, our results highlight the need for continued training and education to maintain a high level of HH. Disclosure of Interest: None declared.

How to go beyond the WHO strategy and build a hand hygiene culture in the regional hospital of Faranah Introduction: The Multimodal WHO Hand Hygiene (HH) Strategy is a widely used and well recognized approach. However, the evidence on the sustainability in low-resource settings is still scarce. The WHO strategy was implemented at the Regional Hospital of Faranah (HRF), but context specific challenges developed. Objectives: We aimed to promote HH culture by addressing these challenges and implementing appropriate solutions. Methods: Over a period of 3 years, the project team used quantitative and qualitative methods to assess HH improvement. Local staff was trained and instructed to track the development, identify barriers and find solutions to build a sustained HH culture. Results: Four main barriers were identified and addressed by targeted measures. 1) The lack of staff for local production was overcome by implementing a train the trainer approach. The initially trained pharmacist trained four other team members. To further strengthen the production team, a national solution of training and sending staff is proposed by the HRF. 2) Difficulties in obtaining production ingredients in high quality were addressed by purchasing large quantities and the establishment of a storage room in the hospital pharmacy. 3) To prepare for sustainable local production, the return, recycling and exchange of empty bottles was planned by opening a register of distribution. 4) To stop the decrease in knowledge and compliance over time, a HH championship every 6 months was initiated. All hospital departments were invited to participate and staff assessed via the WHO knowledge questionnaires and HH observations. Furthermore, refresher trainings and demonstrations of HH were given in daily staff meetings. Conclusion: To build HH culture is feasible in low-resource hospitals such as the HRF. However, context specific challenges require locally designed solutions such as the introduction of recycling systems for ABHR bottles, organizing HH championships, or promoting daily staff trainings to maintain the improvement on HH practises and creating a HH culture. This development of a HH culture and its sustainable local production helped the HRF to respond to the current COVID-19 pandemic. Disclosure of Interest: None declared. Introduction: Hand hygiene (HH) compliance is low and difficult to improve among healthcare workers. Objectives: We aim to validate an electronic HH system and assess the impact of this system on HH compliance and quality changes over time at both group and individual levels. Methods: An automated electronic hand hygiene system was installed in a 10-bed surgical intensive care unit. 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 (27.4%). The partial compliance rate maintained relative consistency between 13.2% to 20.0%. The combined compliance rate (full compliance rate + partial compliance rate) increased from 23.5% in week 1 to 34.6% in week 16 with week 10 being the highest (41.4%). We found significant variations among providers in terms of HH opportunities per shift, full compliance, partial compliance and combined compliance rates. The average duration of hand rubbing over time in partial compliance occurrences did not change significantly over time. Introduction: Healthcare-associated infections (HAIs) represent substantial burden on health care systems in developing countries. Surveillance is one of the most effective prevention methods of HAIs in hospitals worldwide. Objectives: The aim of our study is to describe trends in HAIs in a Tunisian university hospital through repeated point-prevalence surveys over nine years (2012 -2020), and to identify associated factors of HAI. Methods: The current study focused on data collected from 2012 to 2020 from all departments except emergency and hemodialysis services. All types of HAIs as defined by the Centers for Disease Control and Prevention (CDC) were included. Data collection was carried out 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 multivariate logistic analysis were used to identify HAI risk factors. Results: Overall, 2729 patients were observed in the nine surveys; the mean age was 48.3 ± 23.3 years and 57.5% were male. We identified 267 infected patients (9.8%) and 296 HAIs (10.8%). Pneumonia/lower respiratory tract infections were the most frequent HAI (24%), followed by urinary tract infection (20.9%). The prevalence of infected patients increased from 10.6% in 2012 to 14.9% in 2020. However this increase was not statistically significant. The prevalence of HAIs increased significantly from 12.3% to 15.5% (p = 0.003). The only decrease involved bloodstream infections (from 2 to 1%). Independent risk factors significantly associated with HAI were undergoing surgical intervention (aOR = 1.7), the use of antibiotic treatment in 6 months (aOR = 1.8), of peripheral line (aOR = 2), parenteral nutrition (aOR = 2.4), urinary tract within 7 days (aOR = 2.4), central line (aOR = 6.3), and prosthesis (aOR = 12.8), length of stay (aOR = 3), and the year of the survey. Young age was found as protective factor (aOR = 0.98). Conclusion: Sahloul university hospital has a long history of activities aimed at risk management and infection control, based on a multimodal and multidimensional approach which were reinforced after the coronavirus pandemic. Disclosure of Interest: None declared. 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 uncentrifuged 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. 

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. All patients admitted at least 48 h during the study period were investigated. HAIs were defined as infections that occurred at least 48 h after admission to the ICU. Risk factors with a P-value less than 0.20 were initially included in the binary logistic regression model to determine the independent risk factors for hospital mortality. Then, P values ≤ 0.05 were considered statistically significant. The adjusted Population-Risk Attributable 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. Introduction: Hip endoprostheses are one of the most frequently performed procedures, due to their impact on quality of life. Objectives: The purpose of this study was to determine the incidence, risk factors, and clinical implications of post-discharge pneumonia (PNU) after hip endoprosthesis in Polish adults. Methods: This retrospective study was conducted using the database of the National Health Fund, about 55,842 hip arthroplasties performed in 2017. The comparison between groups was based on the Chi-squared test or Fisher's exact test for variables with a very small 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 for 26.6% of all post-discharge infections, (incidence rate of 0.7%). Multivariable analysis showed a significantly higher risk of PNU in patients aged 65-and-older (OR 3.47, 95%CI 2.40-5.03), urgently admitted (OR 3.97, 95%CI 3.16-4.98), operated in the winter (OR 1.7, 95%CI 1.37-2.11) and hospitalized in the intensive care unit (OR 5.88, 95%CI 3.65-9.46). Preventative factors were diseases of the musculoskeletal system (OR 0.73, 95%CI 0.59-0.91) and post-operative rehabilitation (both outpatient and inpatient OR 0.32, 95%CI 0.10-0.99, and OR 0.65, 95%CI 0.42-0.99, respectively). The influenza vaccine in 208 patients (0.5%) had no significant impact on the risk of PNU (p = 0.708). The in-hospital case fatality rate in observed post-discharge PNU was 21.4%. Conclusion: PNU is one of the most common postoperative infections after hip endoprosthesis, especially in the winter. Postoperative rehabilitation reduces the risk of PNU. The low rate of influenza vaccination is resulting in no impact on the risk of PNU. Disclosure of Interest: None declared. 

The interaction between main risk factors of oral microbiota, aspiration, and patient condition has potential to create the opportune atmosphere for hospital acquired pneumonia (HAP) to develop. Oral care is a modifiable risk factor for Non-Ventilator Hospital Acquired Pneumonia (NV-HAP). Yet oral care provision at the selected facility was inconsistent due to inaccessible or unavailable oral care supplies, possible low priority with nursing staff, and lack of a standard oral care protocol. Objectives: An oral care protocol was implemented within the hospital setting to reduce NV-HAP. The protocol included all inpatient adult units, excluding labor and delivery along with the centers for mental health units. Methods: Evaluation of the project was conduction through pre and post intervention comparison of ICD-10 codes, nursing documentation of oral care, oral care prevalence survey, and nursing knowledge survey. Results: Post implementation evaluation data showed an increase in 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. While data was limited, a decrease in NV-HAP was noted the month following the oral care protocol implementation. Conclusion: Implications for practice was a change in culture. While nursing knowledge post implementation survey showed no change in nursing's understanding of the impact of oral care on the patient's overall health, previous perceptions of oral care being a low priority task for patient comfort has changed. This is reflected by increased nursing documentation of oral cares provided, increased patient Introduction: Healthcare delivery is currently undergoing radical changes and so will the demands for effective Infection prevention in healthcare (IPC). Objectives: We initiated a global collaboration among IPC professionals to imagine the status of IPC in 2030 to inform the present. The main emerging themes for Q1 were "multidrug-resistant organisms"; "automatisation of data collection, processing & feedback" with the sub-themes 'robotics' , 'monitoring' , 'surveillance' , 'short-circuit feedback'; "system integration & broadening of IPC" with 'patient participation'; "global perspective" with 'low/middle income country challenges' , 'outpatient'; "behaviour"; and "implementation" (Figure) . The views were predominantly positively (66%) oriented. Q2 and Q3 yielded a broad range of professional profiles, ranging from data, behaviour, implementation, communication know-how and skills, positioning IPC highly in healthcare institutions and beyond. Similarly, Q4 covered a large area including medicine, life-science, data science, social science, organisational and political questions.

The first round of the Future IPC project produced a mainly positive picture of ICP in 2030. The project will continue with further rounds of multi-method inquiry with evolving participation (including an assessment of changes attributable to insights gained during the SARS-CoV-2 pandemic) to serve as a roadmap for developing this critical field of medicine. Disclosure of Interest: None declared. Introduction: Infection control link nurses (ICLN) experience various barriers in daily practice. Identification of strategies to address these barriers can improve current ICLN programs and guide their future implementation. Objectives: To identify strategies for effective implementation of ICLN programs using the Consolidated Framework for Implementation Research (CFIR)-Expert Recommendations for Implementing Change (ERIC) Implementation Strategy Matching tool. Methods: We conducted a Delphi study. A panel of eight experts mapped 19 barriers, found in our previous studies, to the most fitting CFIR constructs. Subsequently, (dis)agreements were discussed and barriers were further clarified. The CFIR-ERIC Matching Tool generated a list of strategies to address these barriers. Outcomes were discussed with the panel and with end-users of these programs (e.g. ICLN and infection control practitioners). Results: Seven main barriers for the implementation of a link nurse program were identified (table 1) . These barriers corresponded with CFIR constructs, predominantly from the domains 'inner setting' (characteristics of the implementing organization) and 'process (stages of implementation). With the ERIC tool strategies were identified to overcome these barriers; they are listed in order of priority in Table 2 . Introduction: The World Health Organization (WHO) Core components of infection prevention and control (IPC) programmes state that patient care activities should be undertaken in a clean, hygienic environment that facilitates safe practices. This includes all elements of water, sanitation and hygiene (WASH) infrastructure and services and includes training as a component. In many low and middle income countries (LMICs), activities are both aimed at and led by WASH and IPC focal points. Feedback from previous trainings and anecdotal evidence suggest that IPC resources are mainly clinically focused and do not fully embrace all aspects of WASH in health care to fulfill country needs. Objectives: To identify relevant resources to inform a new country level WASH and IPC training package as part of a Wimbledon Foundation funded WaterAid project in Malawi. Methods: A desk research exercise was undertaken through a search of Google and key web portals using key words aimed at capturing freely available international, regional and country level resources. Criteria were established to categorise the resources which were finally listed as guidance (G), training (T), assessment (A) or implementation (I) and noted for their focus on LMICs and if they had undergone testing/evalution. Results: In total, 66 resources were found, 33 categorised as training, primarily focused on IPC. A WHO WASH in health care facilities training package was reviewed, however, the cross over with IPC was noted as being limited. A number of relevant international and national guidelines were also identifed, that present the evidence base for informing training materials. Similarly, assessment and implementation materials exist, though most often not combined as IPC/WASH but presented as separate documents. Still they provide content to inform training materials on the aspect of monitoring. Conclusion: A range of training materials are freely available. However the majority of these are focused on IPC and aimed at frontline, clinical improvements and do not fully embarace associated aspects of WASH. The need for a new practical resource to engage WASH focal points appropriately in IPC is deemed necessary to address country needs. Disclosure of Interest: None declared. Objectives: To characterize IPC personnel and programs in MENA countries, with special emphasis on the differences between GCC and non-GCC hospitals.

A cross-sectional online survey was conducted in 2019 among IPC staff joining the Arab Countries Infection Control Network. The survey focused on three domains; demographic and professional characteristics of IPC personnel, organizational structure, and IPC program characteristics. Results: A total 269 participants aged 39.9 ± 8.4 years were included in the study. The majority of participants were female (67.7%), nurses (63.7%), and of Middle Eastern origin (57.3%). Only 32.2% of participants 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 were extremely or very satisfied with their current compensation. Surveillance was the most time consuming task (26.6%), followed by isolation (12.4%), investigation of outbreaks (12.1%), and identification of infection (11.4%). The most frequent ratio of IPC personnel per bed was one per 100 beds (39.5%). The majority of facilities had enoughsupported IPC program (63.9%), formal IPC committee (93.7%), IPC plan (91.4%). Compared with non-GCC countries, GCC countries had significantly more frequent Asian professionals (< 0.001), nursing staff (p = 0.006), CBIC certification (p = 0.003), training in educational services (p = 0.038) and cleaning/sterilization (p = 0.010), higher ratio of IPC personnel per bed (p = 0.047), enough-supported IPC program (p = 0.010), formal IPC committee (p = 0.001), and IPC plan (p = 0.001).

The findings showed generally satisfactory IPC staffing and programs in the MENA region, with considerable variability between countries of different resources. The findings may help policy makers in improving IPC staffing and programs. Disclosure of Interest: None declared. Introduction: Short-term volunteers are susceptible to a wide spectrum of morbidities, mostly infectious diseases preventable with general hygiene and preventive measures. Objectives: This study aims to describe the pre-travel consultation and pre-travel health education received by European short-term volunteers for preventing infectious diseases and to identify the infections that they encountered during their one month stay with a nongovernmental organization (NGO) in Cambodia. Methods: A cross-sectional descriptive observational study was conducted on short-term volunteers who collaborated with an NGO in Cambodia during August 2018. The informed consent and the sociodemographic, clinical and health prevention related questionnaire data were filled in by 198 volunteers before the travel. The health problems they encountered were registered in a local health clinic by healthcare professionals (doctors and nurses). Univariate and bivariate analyses were performed. Results: The volunteers average age was 24.2 years (SD = 7.6), 64% were women, 60.1% were Spanish, 35.4% French and the remaining 4.5% of other nationalities such as British, German, Belgian, Dutch or Italian. Some 18.2% had allergies, 8.6% had pre-existing health conditions and 10.6% were under regular treatment. 77.3% visited the pre-travel consultation clinic, 21.7% took malaria prophylaxis, 92.4% received vaccination against hepatitis A, 82.3% against typhoid fever vaccination, 82.3% against typhoid, 57.1% against tetravalent meningitis; 38.4% against rabies; 36.4% against Japanese encephalitis and 6.6% against cholera. A total of 39.9% completed a specific pre-travel health course. Medical assistance was sought by 112 (57.3%) volunteers. The most prevalent infections were upper respiratory infections (19%), diarrhoea (12.5%) and skin infections (10.4%). Conclusion: Short-term volunteers experienced a high prevalence of infections during their stay in Cambodia but most of them were mild, preventable and were quickly resolved. Pre-travel consultation and specific pre-travel health training seemed to increase prevention measures and disease awareness. Disclosure of Interest: None declared. Only peer-reviewed full text articles published in English between 2000-2020 were included. Results: 12 studies were included in the final analysis. The following IPC priorities were identified: 1. ID Surveillance (outbreak detection) at HC facility level and timely reporting of data to guide IPC interventions. 2. Monitoring of compliance with IPC measures at HC facility level. 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 protective equipment. 6. Safe waste-and water management. 7. Dead body management. In none of the studies it was described how IPC measures were implemented nor was their effect on the incidence of ID evaluated. Conclusion: The identified post-disaster IPC priorities can be found in the WHO core components of IPC in HC facilities, except 8. (3) . While 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 disaster related incidence of ID and how IPC can be successfully implemented in a post-disaster context. Introduction: Improvement requires commitment from healthcare professionals and continuous evaluation, but at the beginning it is 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 doctors and paramedical staff at the maternity services of public health structures in the region of Sousse (Tunisia). Methods: It was an analytical cross-sectional study carried out in in the region of Sousse in 2017 from 1/15/2017 to 03/15/2017, among health professionals, all categories combined (medical and paramedical), working in structures of public health specializing in gynecoobstetrics (central and peripheral maternity hospitals). The study was conducted using a questionnaire specially designed for the purposes of this work. Results: The overall score for this concept was 73.11%. The distribution of responses showed that 83.4% of respondents "judged that the implementation of a process to assess the degree of satisfaction of patients on discharge from maternity could improve safety of care". On the other hand, 85.7% of respondents said that "practice of simulation exercises contributed to improve the quality of care". All the items were perceived more by doctors compared to paramedics. However, this difference was only significant for the item "In our department, errors led to positive changes: implementation of procedures" (82.6% versus 59.3%; p = 0.029). Conclusion: It is essential to operationalize an integrated approach to improve the patient safety culture. The prospects are to develop this type of study in other health establishments in order to better understand the level of development of this concept with the aim of a better adjustment and standardization of our policies and action strategies. Disclosure of Interest: None declared Introduction: Healthcare workers (HCWs) are at an increased risk of exposure to SARS-CoV-2 infection. There is a need for urgent intervention to incease knowledge and practices related to infection prevention and control (IPC) during the current pandemic. Objectives: The objectives of the current study are to assess knowledge, attitude and practices among HCWs regarding IPC practices related to COVID-19 and whether training session can be used as an effective educational tool to improve knowledge. Methods: This cross sectional study was conducted among HCWs from Sindh. After assessment of baseline knowledge, attitude and practices via pre test, a virtual session on COVID-19 IPC practices was conducted, which was followed by post test. Results: Among 240 participant, 141 (59%) were frontline workers dealing with patients with COVID-19. Only 76 (31%) had previous training on IPC before pandemic and even during pandemic, few (n=95, 40%) had attended a training workshop. Majority (70.4%) of participants were working in a facility with an established IPC department. There was an overall statistically significant improvement in knowledge before and after the education workshop (p value < 0.01). The majority of HCWs believed that poor compliance with personal protective equipment (PPE) was due to hot climate, interference with daily work, increased workload and long working hours. The knowledge and reported compliance of hand hygiene were good among majority of participants ( > 90% ). A large number of HCWs (88%) carry hand sanitizers all the time and frequently clean their belongings during current pandemic. Although 75% of HCWs believed that PPE can Introduction: Implementation of a validated twinning partnership approach with clear objectives while maintaining flexibility of inputs and activities during a pandemic, can yield improvements in IPC as a cornerstone of quality of care. Objectives: To apply the World Health Organisation (WHO) TPI 6-step model to guide twinning partners through a systematic process to drive quality of care in health settings.

Cabinet of Quality Assurance in Health was initiated, guided by WHO's TPI objectives and 6-step model. The 2-year TPI included partnership formation, a situational analysis, co-developing a quality improvement (QI) action plan, joint implementation of action and bi-directional learning. IPC at the national, subnational and facility level was as prioritized by the partnership. Three Timor-Leste facilities were chosen for IPC improvements. The WHO IPC assessment framework at the facility level (IPCAF) was used to gather data at baseline and at intervals over the 2-year TPI. Results: Based on the IPCAF results, the action plan focused on 4 areas: 1) establishing IPC team in each of the facilities; 2) training and capacity building in standard precautions; 3) facility infrastructure improvements (including water sanitation and hygiene); and 4) hand hygiene advocacy. The structured TPI methodology and direct partner support resulted in clean water being consistently available at the 3 facilities and capacity building in standard precautions, transmission-based precautions and PPE. COVID-19 realities required adaptation and re-scheduled infrastructure and training activities.Conclusion: Implementation of the partnership plan using the structured TPI approach catalyzed IPC improvements at the three facilities and beyond. Although COVID-19 required adjustment of activities, a robust QI plan supported innovation, flexibility and commitment. Lessons from the experience can be applied to other twinning partnerships. Disclosure of Interest: None declared 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.Objectives: to measure and analyze the degree of development of the concept "Frequency and reporting of adverse events" relating to the of patient safety culture of healthcare professionals. Methods: A cross-sectional study was carried out in 2017 using a validated questionnaire among all health professionals in the five public health structures specializing in gyneco-obstetrics in the governorate of Sousse (Tunisia) (N = 251 and 217 respondents). Results: The overall score for frequency and reporting of adverse events was 69.7%. The distribution of the different items in this dimension showed that 83.4% of respondents felt obliged to report errors that have consequences on patients to their hierarchical superiors, on the other hand only 65.9% felt required to report an error that occurs and is corrected before affecting the patient. All the items in this dimension were perceived without significant difference between physicians and paramedics. Conclusion: The establishment of a surveillance system for adverse events is a central link in any policy to improve the quality and safety of care in health establishments, which must involve all staff (workers, technicians, nurses, doctors…). Introduction: A good relationship between healthcare worker and patient is a main link of the care safety. Objectives: Measure the level of healthcare provider relationship within the framework of healthcare safety culture with health professionals practicing in our establishment. Methods: It was a cross-sectional descriptive study, carried out in 2017 for two months, of interest to all health professionals (medical and paramedical (nurse, midwife and senior technician)) working in public health structures specializing in gyneco-obstetrics in the region of Sousse (Tunisia). Results: The overall score for this concept was 66.8%. The distribution of responses for the different items of this dimension showed that 82.9% of the respondents found that "adverse events could affect the trust relationship between doctor and patient". However, only 37.3% of all healthcare professionals believed that "patient should be informed of the fault as soon as it is committed and of the consequences that may". On the other hand, 66.8% of respondents said that "traditional medicine practices are an obstacle to improving the safety of care". The doctors reported significantly more than the paramedics, the fact that "patient must be informed of the fault as soon as it is committed and of the consequences that may", "the patient has a role to play in improving safety", and finally, traditional medicine practices can constitute an obstacle to improving the safety of care" respectively (60.9% versus 34.5%; p = 0.014), (100% versus 82.5%; p = 0.029) and (87% versus 65.4%; p = 0.03). Conclusion: Our study allowed us to obtain an inventory and a global vision of the perception of healthcare professionals relating to patient safety and to identify gaps. This concept is a central link in the patient safety culture and an inseparable pillar of the strategy for improving the quality and safety of care within a healthcare establishment. Introduction: Patient's safety culture reflects the perceptions of norms, processes, and attitudes relating to a culture of preventable errors. Objectives: To measure and assess the level of development of the concept of "global perception of patient safety" relating to the patient safety culture among health professionals working in the maternity sector in public health structures in Sousse. Methods: A cross-sectional study was carried out in 2017 using a validated questionnaire among all health professionals in five public health structures specializing in gyneco-obstetrics in the governorate of Sousse (Tunisia) (N = 251 of which 217 responded). Results: The overall score for the overall perception of patient safety was 44.1%. Analysis of the responses to the different items showed that only 37.3% of respondents admitted that they had no problems related to the safety of care in their department. But when there is an antenatal death or a complication in the delivery, 79.3% of respondents said they felt this event could have been avoided. Among all the items, there was not a significant difference between physicians and paramedics except the item "the competent physician does not make errors that could harm the patient" which was significantly more perceived among paramedics than physicians. (35.6% versus 8.7%; p = 0.009).

The risk of error in therapeutic choices and in care exists despite the fact that the doctors are highly qualified and competent, which confirms that the error is human and that "zero risk" does not exist. Disclosure of Interest: None declared Introduction: An effective teamwork is essential for patient safety in the context of a complex healthcare system, it minimizes adverse events caused by miscommunication. Objectives: is to measure and analyze the level of development of teamwork and human resources concept of patient safety culture among healthcare professional. Methods: An analytical cross-sectional study was carried out in 2017 using a validated questionnaire among all health professionals in five public health structures specializing in gyneco-obstetrics in the governorate of Sousse (Tunisia) (N = 251 of which 217 responded). Results: The overall score for "teamwork in the department" was 64.4%. Analysis of the responses to the different items showed that a difference in favour of physicians was raised; 65% said they were ready to combine their efforts as a team when the workload is heavy (62.4% versus 37%; p = 0.019), 66.8% thought that everyone considers others with respect (64.4% versus 37%; p = 0.03) and 6.8% thought that more experienced staff will be available on the first call if the situation requires their presence (95.7% versus 63.4%; p = 0.002). The overall score for "Teamwork between services in the facility" was 59.9%. Doctors have affirmed significantly more than paramedics that when transferring a patient to another service we provide all the results of imaging or biology exams that have been performed, in addition to the fact that the services of the institution did not coordinate well with each other (respectively 95.7% 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 that too long working hours could have consequences for patient safety (100% of doctors against 84% of paramedics (p = 0.0038)). Conclusion: Teamwork as well as having sufficient staff is one of the factors influencing the quality of care, the evaluation of health care providers and the satisfaction of patients. Thus, professionals who shared information have a marked improvement in the efficiency of the work unit. Methods: This is an analytical cross-sectional study carried out in 2017 over two months (from 1/15/2017 to 03/15/2017) among health professionals, all categories combined (medical and paramedical), working in structures of public health specializing in gyneco-obstetrics (central and peripheral maternity hospitals) in the region of Sousse (Tunisia). The study was conducted using a questionnaire specially designed for the purposes of this work. Results: The overall score was 43.2%. The distribution of responses showed that 40.1% of respondents said that, in the services, they discussed the means to be put in place in order to avoid repeating the mistakes made. Only 30.4% of respondents said they perceive staff to feel free to argue the decisions or actions of their superiors. A significant difference was noted in favor of physicians for item "the staff express themselves freely if they see something in the care that can have negative consequences on the patients" (78.3% versus 50.5%; p = 0.012). On the other hand, there were significant differences in favor of paramedics for items "in the departments, we discuss the means to put in place so that errors no longer occur", "Staff feel free to discuss the decisions or actions of their superiors" and "staff are afraid of asking questions when something does not seem to be correct" respectively (42.8% versus 17.4%; p = 0.019), (33% versus 3.7%; p = 0.017) and (48.5% versus 21.7%; p = 0.015). Conclusion: This concept has generally been shown to be underdeveloped in our establishment. We must learn to analyze our mistakes, to improve our procedures and our protocols, to better manage and govern our systems, to improve our communication, information and awareness policies. Methods: We conducted a systematic review and meta-analysis to identify recent studies reporting association measures of HCV infection risk that are linked to iatrogenic procedures performed in hospital settings. Invasive procedures were categorized into 10 groups based on an expert opinion for which pooled measures were calculated. Finally, the relationship between pooled measures and the country-level HCV prevalence or the Healthcare Access and Quality (HAQ) index was assessed in meta-regressions. Results: A total of 73 studies were included in the analysis. The most evaluated procedures were blood transfusion and surgery (49 and 34 studies). The pooled OR associated with HCV infection was highest for haemodialysis (6.48, 95%CI: 0.43-97.7) and lowest for endoscopy (1.44, 0.98-2.11). The OR for blood transfusion was higher for transfusions performed before 1996 (3.84, 2.46-6.00) than for those without a specified date (2.38, 1.88-3.01). Finally, there was no significant association between the HAQ index and the country-level overall risk for all procedures, but a significant one was found for HCV prevalence. In procedure-specific analyses, the HCV infection risk was significantly negatively associated with the HAQ for endoscopy and positively associated with HCV prevalence for endoscopy and surgery. Conclusion: Many iatrogenic procedures were found to be related to the risk of HCV infection. However, care must be taken to interpret the results because of: i) limited number of studies for some procedures, leading to uncertainty in the estimates; ii) lack of adjustment on confounding factors in some studies; and iii) heterogeneity in the way the exposure has been assessed across studies. Introduction: Knowledge of hepatitis seem to be insuffisant in the hospital of Banfora. It can negatively impact the quality of care in this hospital. This is why we conducted the study to evaluate the knowledge, attitude and practice regarding hepatitis prevention among medical professionals of Banfora. Objectives: The main objective is to evaluate the kwoledge, attitude and practice regarding hepatitis prevention among medical professionals of Banfora. The secondary objectives are: 1. To determine socio-demographic caracteristics of the study population 2. To determine the proportion of population which did training on hepatitis prevention 3. To determine the proportion of population who got hepatitis B immunization Methods: This was a descriptive cross-sectional study that took place from November 19 to December 18, 2018, at the Banfora Regional Hospital Center. The study covered all categories of health professionals likely to be victims of hepatitis exposure accident. A self-questionnaire on the subject was given to health professionals. Results: The questionnaire was completed by 202 health professionals, representing a 68% completion rate. The average age of the health workers was 38.67 years. Nurses predominated with 62.81% of the sample, followed by hospital hygiene technicians (11.06%). Health care workers who had ever had an hepatitis exposure accident represented 39.80% of our sample. Midwives were the most affected by hepatitis exposure accident with 64.29%. Only 35.86% of patients had received training on hepatitis exposure accident during their professional career. Non-reporting of hepatitis exposure accident was mainly due to personal negligence. The majority of caregivers stated that the hepatitis B virus had the highest infectious potential. In our study, 98% of our sample had been vaccinated against hepatitis B and 61% had received at least 3 doses. A total of 86.94% of the health care workers were aware of the precautions for hepatitis exposure accident. Conclusion: Knowledge of hepatitis exposure accident needs to be improved given the high number of healthcare professionals who have already been victims. Continuing education is therefore needed to increase hepatitis prevention. Introduction: The promotion of well-treatment and its corollary the prevention of mistreatment are currently major issues for health systems. Objectives: To compare the perceptions of well-treatment among the different categories of health professionals. Methods: This is a cross-sectional descriptive study carried out over a period of four months (from May 1, 2018 to August 31, 2018) among health professionals of all categories working in the 19 care services of the Farhat Hached hospital in Sousse (Tunisia). Our study was carried out using a questionnaire inspired by the Health authority of health (HAS). Results: During treatment, significant differences in favor of medical staff are reported for the adaptation of the words and actions to the patient's condition, communication and medical data information respectively 88.7% versus 71%; p < 0.001, 68.7% versus 54%; p = 0.006 and 94% versus 81%; p < 0.001. On the other hand, significant difference in favor of paramedical staff for the items "be careful not to make noise" (94% versus 86%; p = 0.011), knock on the door and wait before entering the patient's room (66.5% versus 54.7%; p = 0.024) and pay attention to non-verbal communications (93.5% versus 86.7%; p = 0.03). In the service, significant differences in favor of the paramedical manager are raised with regard to screening for nutritional disorders (70% versus 56.7%; p = 0.01) and screening for pressure ulcer risk (77% versus 66.7%; p = 0.032). During the course of care, the medical manager reported significantly more perceptions in favor of well-treatment for the information provided to the patient as well on his state of health (77.3% versus 66.5%; p = 0.027) than on the adverse events that occurred (76% versus 66%; p = 0.043). Conclusion: The realization of our study among health professionnal at the Farhat Hached hospital of Sousse should argue the need to establish a whole "culture of well contracting" with the implementation of a strategy promoting the development of this state of mind among healthcare professionals. Introduction: Promoting well-treatment means strengthening a model of comprehensive patient care centered on their needs, expectations, preferences and rights. Objectives: To specify the degree of application of certain concepts of well-treatment according to the perceptions of healthcare professionals. Methods: It was a cross-sectional descriptive study carried out during four months (from May 1, 2018 to August 31, 2018) among health professionals of all categories working in the 19 care services of the Farhat Hached hospital in Sousse. The collect was carried out using a questionnaire developed in 2012 by the high authority of health (HAS). Results: In total, response rate was 66.4% (350/527). More than three quarter of the participants (78.6%) said that they adapt their words and actions to the patient's condition. Of the respondents, 99.4% said that they provided care with respect for privacy and 94.6% said that they respected the functional autonomy of the patient. Respondents declared, in more than two third of cases, that patient information is organized in the same way as the collection of the trusted person. Only one percent of respondents said that regular information is provided to the patient on his condition throughout his care. Conclusion: Therefore, it is necessary to integrate into the Farhat Hached hospital project a prioritization of well-treatment among the primary concerns of the institution requiring immediate support, which implies the mobilization of all institutional actors and that of professionals. Introduction: Accurate attribution of nosocomial COVID-19 is challenging, particularly given wide variation in incubation period. Objectives: Within the multicenter hospital-based prospective NOSO-COR project, we aimed at characterizing the determinants of nosocomial COVID-19. Methods: An observational, prospective and multicenter study was conducted in a university hospital of 5,300 beds. Any patient diagnosed positive for COVID-19, presenting with a cough and/or fever above 37.8 °C, admitted to the hospital and having stayed there for more than 24 h was included. The European Center for Disease Prevention and Control (ECDC) defined nosocomial COVID-19 according to three thresholds: 48 h, seven days and 14 days. Comparison of clinical characteristics of COVID-19 hospitalized patients were performed according to the three ECDC thresholds using a multivariate analysis. Results: A total of 1078 patients were included in the study. The median age was 77 [64-86] years old and a sex ratio equal to 1.06. 996 (92.1%) patients presented at least one comorbidity, with 665 (61,7%) patients presenting a cardiac condition. In addition, 341 (45.5%) patients had a contact in a health care facility with a COVID-19 suspected or confirmed case in the 14 days before symptom onset. Patients aged above 75 (p < 0.01) and having a contact in a healthcare facility with a COVID-19 case 14 days before symptom onset (p < 0.001) 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.

Age above 75 and being identified as a contact case from a healthcare facility were found to be three to five times more at risk of developing a nosocomial COVID-19. Little heterogeneity was found in the application of nosocomial COVID-19 definition. However, in practice a balance between a sensible and specific definition taking into account population at risk would be helpful in this timely framework. 

Introduction: Numerous reports of healthcare-associated COVID-19 (HA-COVID-19) outbreaks have highlighted that hospitals can be a platform for SARS-CoV-2 transmission. Uncertainty remains with regards to clinical outcomes of patients who contracted SARS-CoV-2 in healthcare facilities compared to those hospitalized after community acquisition (CA-COVID-19) . Objectives: The objective of this study was to describe and compare characteristics and clinical outcomes of patients with HA-COVID-19 versus CA-COVID-19. Methods: We used data from 16 hospitals included in the prospective national surveillance on COVID-19 in Switzerland. We included all hospitalized COVID-19 adult cases with a laboratory confirmed infection. HA-COVID-19 cases were defined as those detected > 5 days after hospital admission. Only the first hospital stay after diagnosis for CA-COVID-19 cases, and during diagnosis for HA-COVID-19 cases, were considered. Cases with no information on place of acquisition were excluded. 

Patients not suspected to be infected with SARS-CoV2 but suffering from COVID-19 or patients hospitalized during the incubation period of COVID-19 pose a risk for transmitting SARS-CoV2 to fellow patients. Objectives: We aimed to describe the incidence of patients hospitalized in our tertiary care center with community-and healthcareassociated COVID-19, calculate the number of patients who exposed other patients to SARS-CoV2 and the secondary attack rate of exposed patients, and investigate risk factors for SARS-CoV2 transmission. Methods: In this retrospective study, all patients admitted to the University Hospital Zurich, Switzerland, with a positive SARS-CoV2 PCR were included. Community-or healthcare-associated COVID-19 were defined according to the European Centre for Disease Prevention and Control (ECDC) criteria. Patients receiving standard care during their period of contagiousness were defined as potential index patients. Exposed patients were patients sharing a room with a potential index patient 1) on the general ward for any time, 2) on the intermediate or intensive care unit (IMC/ICU) for ≥ 6 h, or 3) on the IMC/ICU for any time with an index undergoing aerosol-generating procedures.

Of 1131patients with a positive SARS-CoV2 PCR or labeled to be a patient with COVID-19 between October 2020 and April 2021, 90.6% (n = 1025) had community-associated illness, 3.5% (n = 40) had probable and 3.8% (n = 43) had definite healthcare-associated COVID-19, and 2.0% (n = 23) had indeterminate illness. Of all patients, 19.0% (n = 215) were potential index patients, and 56.3% (n = 121) of these exposed at least one other patient. Of 292 exposed patients, 47 were later diagnosed with COVID-19. The mean secondary attack rate per index patient was 14.4%. Transmission of SARS-CoV2 was higher if contact time was longer (adjusted Odds Ratio ( 1) The importance of the prevailing infection control measures, including social distancing, capacity limits for rooms, universal masking in case of < 1.5 m distance and the early testing and domestic quarantine of HCW with symptoms was stressed.2) An infection control practitioner visited the ward each working day during the outbreak period, to advise and observe practice. 3) Contacts were traced and divided into high-risk and low risk contacts in the workplace and in household/social contacts. 4) Voluntary nasopharyngeal swabs were taken twice a week, to detect asymptomatic cases. 5) Potential weak links of infection control measures were discussed with nurses. Results: Nine nurses and two informal caregivers tested RT-PCR positive for SARS-CoV-2 in December 2020. The index nurse tested positive following the earlier infection of a household contact. The outbreak was recognized a day later when the second nurse tested positive and was confirmed by Whole Genome Sequencing. Of the remaining nine cases which tested positive in the following 11 days, one case tested positive after a documented SARS-CoV-2 infection 83 days prior. We found a primary attack rate within the department of 18% and a secondary attack rate of 54% among contacts of positive cases. Short conversations in changing rooms without masks, short periods of lack of social distancing during breaks and the incorrect wearing of masks were mentioned as potential causes for transmission. Observers are trained, validated and interrater reliability tested. Feedback was applied: oral immediate feedback; monthly delayed feedback using a poster for each W with SP' compliance, explaining the results with the hierarchy, and set the goal for next month. A written report was sent to the hospital management. Patients' data are from the prospective national surveillance on COVID-19 identified hospitalized COVID-19 adult cases with a laboratory confirmed infection. NOSO cases were defined as those detected > 5 days after hospital admission. Results: From 24.08.2020 to 23.05.2021, 1863 community acquired COVID cases and 497 NOSO cases were collected. The percentage of NOSO cases decreased after the introduction of the program (before 426/1589 (26.8%) after 71/771 (9.2%), p < 0.001).Conclusion: Following the intervention, the incidence of NOSO cases has markedly decreased Disclosure of Interest: None declared 6-14) . Nosocomial COVID-19 cases were defined as microbiologically documented cases by PCR, diagnosed ≥ 5 days after admission. A cluster was defined based on the detection of ≥ 2 nosocomial COVID-19 cases within a given period (< 72 h) or geographically linked. IPC measures implemented on week 10 to control SARS-CoV-2 transmissions in all non-COVID units were: systematic screening at day 3 after admission; weekly screening of all patients by PCR on saliva; and decreasing the occupancy of all patient rooms with 5 patients to 3. Results: 69 cases were identified, with 57 attributed to 21 clusters and 12 cases considered isolated. Median age was 74 years (IQR 65, 80) and 40.6% were female. All cases had a previous negative test and median time from admission to positive test was 12 days (IQR 8, 17) . 45.1% of nosocomial cases were completely asymptomatic. 60.9% of patients stayed in rooms with 5-patients. Death occurred in 23.2% of cases. The incidence of nosocomial cases was the highest between weeks 8 and 10 with 18 and 17 new cases per week, respectively. After the introduction of IPC measures on week 10, there was a rapid decrease in the number of cases until complete absence of new cases on week 14. Conclusion: Nosocomial infections were frequently asymptomatic, potentially hampering fast diagnosis which is crucial for control of transmission, and were associated with high mortality rate. The implementation of additional IPC measures led to a gradual decrease in nosocomial transmissions and allowed controlling the outbreak. 

The high transmissibility of SARS-CoV-2 is of particular concern for hospitals as hospitalized patients are at risk of severe COVID-19 and related death. Objectives: Describe the contact tracing activity related to nosocomial SARS-CoV-2 cases in our hospital. Methods: The Infection Control Unit received alerts for positive PCR results performed by the Microbiology laboratory in hospitalized patients. Nosocomial infections, occurring after at least 5 days of hospitalization, were further investigated. Contact tracing was performed via an institutional software allowing tracing index patients' movements and their roommates. Patients were considered "contacts" at risk and were placed in quarantine if they shared the same room with the index-case up to 72 h before index's first positive PCR or first symptoms. Contacts systematically had nasopharyngeal SARS-CoV-2 PCR testing at days 0, 10 counting from last contact with the index or at symptom onset. Results: Between November 1 st 2020 until March 31 st 2021, 322 nosocomial SARS-CoV-2 cases were identified, of whom 195 (61%) had previously been in contact with another known case while for 127 (39%) source of infection was unknown. Median time from admission to positive PCR was 13 days (IQR 8 -25). Symptoms where present in 67% of cases. Median age was 76 years (IQR 64 -84) . Of all episodes, 75% were diagnosed in medical units (including 50 cases, 16% in geriatric sections),24% in surgical sectors and 1% in the ICU. Contact tracing activity identified 605 contacts with a median of 2 contacts per index case (range 0-19). Of these, 32% had a positive PCR result during follow-up. Conclusion: A thorough contact tracing with systematic PCR screening is necessary after detection of a nosocomial SARS-CoV-2 case as transmissibility is high and more than 1/3 of cases are asymptomatic. The non-identification of a source for more than a third of cases raises concerns of potential implication of healthcare workers in transmission. Introduction: Diagnosing SARS-CoV-2 infection is essential in stopping the spread of COVID19, yet we have to take into account that onset of symptoms often vary among our exposed patients. Objectives: Investigate the probable causes of conversions among the clusters of patients with negative RT-PCR COVID19 results upon admission who converted to positive PCR after 2-18 days in one of the acute care hospitals in New Jersey, USA. Methods: A descriptive study was conducted to identify cases, trace exposed contacts, and identify the probable causes of conversion. A confirmed case was defined as a positive reverse-transcription polymerase reaction test for SARS-COV-2. COVID19 cases were categorized as community-acquired, and or hospital-acquired. Hospital-acquired is defined as an occurrence of a positive PCR result or onset of symptoms on or after 7 days post admission. Results: There were 18 patients admitted, all tested negative, and were not place on isolation. Within 7 days post admission 11 (61%) tested positive. Review of records showed that 14 (78%) were community-acquired infection and 4 (22%) were HAIs. Symptomatic upon admission 11 (61%) and asymptomatic 7 (39%). Twelve (67%) with 2 or more comorbidities and the rest none. During their stay 5 patients (28%) required high flow oxygenation, 1 required intubation. Thirteen (72%) on nasal cannula/room air. Five (28%) expired, 12 recovered/discharged, and 1 still in the hospital. Conclusion: The conversions among these patients could be due to full reliance on the diagnostic RT-PCR and not considering clinical conditions, breaches in infection control, and gaps in identifying exposed patients from the community prior to admission. Thus, strict infection control measures were implemented which included enhanced surveillance screening through RT-PCR on day 1, day 3 and day 5; more rigid environmental terminal cleaning even in non-Covid units where most of the conversion occurred; increased awareness among physicians and staff for any subtle changes in clinical condition to place in isolation and repeat testing, dedication of staff and equipment, and refresher courses on the use of personal protective equipment. Objectives: To describe the management of 2 consecutive clusters of patients presenting suspect symptoms of Covid-19 in a 19-bed psychogeriatric unit, hosting concomitantly 2 patients with SARS-CoV-2 infection confirmed by RT-PCR on nasopharyngeal swabs (lineage B.1.1.7, viral loads of 6.9E + 8 and 8.0E + 7 copies/ml, respectively) 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 measures were promptly applied. During the following weeks, the clinicians of the ward additionally reported 2 clusters of 3 patients with suspect symptoms. All of these suspect cases were isolated with Droplet Precautions and were investigated by a nasopharyngeal swab for SARS-CoV-2 testing. If the first SARS-CoV-2 RT-PCR was negative, a second test was performed within 24 h. Additionally, we proposed to complete investigations by an extended respiratory multiplex RT-PCR. Results: Among the 6 symptomatic patients, all had 2 consecutively 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 ranging from 3E + 5 to 3E + 9 copies/ml, confirming a nosocomial outbreak of a seasonal coronavirus. For the remaining patient, infection by OC43 coronavirus was considered possible, regarding the close contacts with positive cases during the hospital stay. Conclusion: Even if the actual Covid-19 epidemic setting should conduct to promptly research a SARS-CoV-2 infection in symptomatic hospitalized patients, this report highlights the possibility of cocirculation of different respiratory virus within the same ward. More extended microbiological investigations with specific RT-PCR analysis in symptomatic patients repeatedly tested negative for Covid-19, can conduct to a better understanding of nosocomial outbreaks. Sometimes a coronavirus can hide another! Disclosure of Interest: None declared Methods: A prospective study was carried out between September 2020 and february 2021 among patients admitted in the COVID-19 ICU at the University Hospital Tahar Sfar Mahdia. The measurement tool was the " RAPID CORE CASE REPORT FORM" developed by WHO. Results: A total of 114 participants were enrolled with an average age of 61.4 ± 12.2 years. About 51.4% of patients needed intubation. During the hospitalisation, 12 (21.1%) were eventually extubated and 45 (78.9%) died. Prolonged intubation was recorded in 43.8% of cases. Among them, 35.4% were diabetic, 30.6% have hypertension and 6.1% had chronic heart disease. The main factors significantly associated with longer intubation were: Nosocomial infection (80.8% vs 7.7%; p < 0.01), acute respiratory distress syndrome (60.6% vs 17.8%; p < 0.01), and ionotropic use during the first 24 h (82.4% vs 36%; p < 0.01). Introduction: In Tunisia, the Covid-19 pandemic threatens to overwhelm scarce clinical resources especially in Intensive Care Units (ICUs) Objectives: This study aims at analyzing clinical presentation on admission and the determinants associated with extended hospital stay in (ICUs). Methods: We carried out a prospective study on 117 hospitalized patients in ICUs at the university hospital Tahar Sfar Mahdia which is located in the Central-East part of Tunisia from September 2020 to February 2021 using a valid and reliable tool inspired from the WHO-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 hypertension 38.5% and Diabetes 42.2%. The median length of stay was 14 (IQR: 24-9) days. Approximately the half 47% had an extended stay (> 14 days). Of the 117 patients included, 46.2% died in hospital and 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 those who have developed a health care associated infection 63.5%. The main factor associated with extended hospital stay was invasive intubation (77.6%). Acquiring a nosocomial infection (p = 0.001), developing a complication (p < 0.001), resorting to invasive intubation (p < 0.001) and administering vasopressor drugs (p = 0.001) were found to have significant relationship with extended hospital stay. Results: 175 patients were included in the study and interviewed up to 120 days after symptoms onset. 51.4% of participants were female with average age of 53 ± 14 years. Table 1 describes scores obtained on the WHOQOL-BREF before and after Covid-19. Table 2 focuses on the current situation, where it is shown that most of patients were satisfied with their life after Covid-19. Pairing the individual data of 168 respondents, we observed that for 49 (29.6%) of them quality of life worsened after Covid-19, for 98 (58.3%) it remained on the same level and for 21 (12.5%) it actually improved after Covid-19.

The assessment of COVID-19 associated mortality is crucial to evaluate the impact of the pandemic and to assess the effectiveness of measures. Objectives: We aimed to investigate trends in COVID-19 related mortality over time in Switzerland, using data from the COVID-19 Hospitalbased Surveillance (CH-SUR) database. Methods: Considering four different time periods of COVID-19 epidemic, we calculated crude and adjusted mortality rates and performed competing risks survival analyses for all patients and for patients admitted to intensive care (ICU). Results: Overall, 16,967 COVID-19 related hospitalizations and 2,307 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 was 24% and 31.3%, respectively. The overall adjusted risk of death was lower for hospitalised patients during the 2nd compared to the 1st wave (HR 0.75, 95% CI 0.73 -0.77). In contrast, patients admitted to ICU as well as patients with invasive ventilation presented a higher risk of death during the 2nd wave (HR 1.62, 95% CI 1.54-1.70 and HR 2.10, 95% CI 1.99-2.20, respectively). Conclusion: Our findings may be explained by various changes in the COVID-19 patient management in Swiss hospitals, e.g. with the use of effective drugs against complications or with different guidelines for ICU admission and invasive ventilation use. Objectives: This study aimed to determine early changes of LXA4 levels in the hospitalized patients with confirmed COVID-19 following the clinical management as well as its correlation with common used inflammatory markers, including Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), and ferritin. Methods: Thirty-one adult hospitalized patients with the non-severe COVID-19 were included. LXA4, ESR, and CRP serum levels were collected on the first day of hospitalization, and LXA4 levels were measured 48-72 h later as well. Moreover, the maximum serum ferritin level during the five days of following patients was collected. Results: The mean age of patients was 61.9 ± 17 years, and the male to female ratio was 18:13. LXA4 levels were significantly increased at 48-72 h compared to the baseline concentrations (9.9 ± 0.7 vs. 21.7 ± 15.1 ng/L; P < 0.05). The mean baseline concentrations of CRP and ESR and the mean maximum concentration of ferritin were 74.7 ± 57.3 mg/L, 55.7 ± 34.4 mm/h, and 568.7 ± 530 ng/mL, respectively. Besides, CRP and ESR levels at the time of admission and maximum ferritin levels during the hospitalization were positively correlated to an increase of LXA4 levels (R = 0.499, 0.535, 0.398; P = 0.007, 0.005, 0.043, respectively). Conclusion: LXA4 may be a valuable marker to assess the treatment response compared to ESR, CRP, and ferritin in hospitalized patients with COVID-19. Furthermore, LXA4 could be considered a potential treatment option in inflammatory conditions. Further studies are necessary to clarify LXA4 role in COVID-19 pathogenesis, as well as the balance between such pro-resolving mediators and inflammatory parameters. training; however only four discussed training HCPs on correct PPE use; two countries listed strategies to manage the surge in demand, but only one country discussed managing the shortage of PPE. None of the COVID-19 guidelines recommended training HCPs for correct reuse or extended use of PPE and only one country's guideline outlined mandatory HCP attendance and delivery of training in a regional language. Conclusion: Pandemic plans should be revised to include guiding principles regarding the delivery of pandemic specific OHS (IPC) training, as well as on managing the surge in demand of PPE and HCPs. There is also a need to provide guidance on when countries should consider reuse and extend use of PPE. This discourse should also be reflected in disease specific pandemic guidelines, like COVID-19 (IPC) guidelines. This review may assist international health agencies in subsequent guideline updates. Introduction: All contacts of individuals with a confirmed or probable COVID-19 should be quarantined in a designated facility or at home for 14 days from their last exposure. Although shorter quarantine periods may lessen health system's burdens especially when new infections are rapidly rising, prolonging the quarantine duration could be prudent for high-risk scenarios and in regions with insufficient test resources. Objectives: To describe the rationale for different COVID-19 quarantine durations during the on-going pandemic in select countries. Methods: An online search was conducted to document countries' rationale for different quarantine durations during the ongoing COVID-19 pandemic. Only countries that stated a quarantine duration and its rationale were eligible for inclusion. A country was stated to have no quarantine, reduced, or prolonged its COVID-19 quarantine duration if it recommended 0, 1-< 14, or > 14 days. Country's names were anonymized based on the focus of this study. Results: Countries that did not impose a quarantine period recommended self-isolation or quarantine on a case-by-case basis. E.g. persons who had been at sea for more than 14 days did not have to undergo quarantine. Countries that increased their quarantine period found persons testing positive after the recommended 14-day period, identified mutated viral strains, and did so in response to increased COVID-19 activity. Countries that reduced their quarantine period based it on the virus' incubation period, a day 7 COVID-19 test result, a traveler's vaccination status, the reduced risk of contagion over time and the country's prevailing COVID-19 cases. Quarantine duration was reduced based on a traveler's COVID-19 risk profile, his or her country of origin, to encourage compliance and lessen cost of governmentfunded quarantine. Conclusion: Quarantine durations was adjusted to in country disease burden, disease dynamics, the natural history of the disease, COVID-19 vaccination status, existence of mutant strains and for efficient resources' use. Countries also wanted to encourage vaccination, testing and boost quarantine guideline's compliance. A comprehensive country-specific longitudinal analysis ought to incorporate testing guidelines and vaccination status for each quarantine duration and each country's epidemic curve would provide useful information on best practices. Disclosure of Interest: None declared 

With a first observation of information problem in epidemic cases, it was noted that health care professionals don't have time to get informed by themselves about hygiene hospital news or protocols last updates. The cantonal unit of Hygiene Prevention and Control of Infection in Vaud (HPCi Vaud) in charge of epidemics monitoring in health facilities, worked on a strategy to push in the fastest possible way important information to the health care professionals to prevent diseases' spread as soon as a situation has been detected. Objectives: The objective of this public management is to control epidemics by reducing the communication time in early detection between Public Health (OMC/HPCi Vaud) and the health care professionals 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 managed 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 healthcare 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 responsive to adapt their decision and action according to the information notification, and 83.1% say that the alerts helps to protect patients and residents. Introduction: For members of remote Indigenous communities, accessing healthcare often requires travel to off-reserve locations, which is both burdensome to the individual and increases the risk of contracting COVID-19. Remotely Piloted Aircraft Systems (RPAS), or drones, offer a potentially cost-effective method for reducing that burden and risk by removing geographic barriers and increasing timeliness and accessibility of supplies, equipment, and remote care. Objectives: To demonstrate the potential of RPAS-delivered technology and supplies in diagnosis, evaluation, and treatment, including RPAS-delivered ultrasound (US) machines; to co-develop governance and operating manuals with local Indigenous communities; and to use this work as a scalable model for fully operational RPAS-based medical delivery systems. Methods: Our team is developing and pilot-testing innovative RPASbased medical delivery solutions at the systems, regulatory, technological (software and hardware), and procedural levels. This includes working with Transport Canada for Beyond Visual Line of Sight approval; RPAS fleet development and testing; custom payload system design and fabrication (i.e. refrigerated unit for vaccine delivery); procedural development (i.e. risk and safety assessments); Detect and Avoid System testing and refinement; and pilot-testing COVID-19 test kit fidelity and remote US functionality. Results: We have successfully delivered PPE (gloves, gowns, masks) and COVID-19 test kits. We confirmed that the delivered RNA COVID-19 test samples contained no decay in signal or testing capabilities. We also delivered a sanitized Tele-mentored Self-Diagnostic US and successfully Tele-mentored a patient in performing a proficient selfadministered US at a remote location. Background: The novel coronavirus disease (COVID-19) was reported in Wuhan China in December 2019. SARS-CoV-2 is of a zoonotic origin and is transmitted between humans via respiratory droplets and fomites. As COVID-19 spread globally, Nigeria instituted its pandemic preparedness measures in January 2020 preceding detection of its index case on February 28, 2020. We report the emergence of COVID-19 in Nigeria, describing the public health response up till May 2020. Method: We reviewed the Nigeria's country-level response to COVID-19 at the National level from January -May 2020. Results: The national public health response to the COVID-19 pandemic rapidly progressed from initial containment measures, with early closure of the international airspace and intensive contact tracing, to lockdown in high-burden states, closure of schools, nonessential businesses, and non-pharmaceutical interventions. A level three EOC was activated, the highest level of response in the country intended for public health measures. Following the ease of lockdown, mitigation strategies to address ongoing community transmission include increased testing, isolating all confirmed cases and tracing all contacts. By May 31, 2020, Nigeria had recorded 10,162 confirmed COVID-19 cases from all but one state, with three states Lagos, Kano and Federal Capital Territory, accounting for 64.5% of the cases. Conclusion: Nigeria launched a swift and aggressive response to COVID-19, leveraging on its existing epidemic preparedness and learning from other parts of the globe where transmission began earlier. Future response efforts are focused on targeted non-pharmaceutical interventions at sub-national level. Mobilizing local governments, civil Abstract video clip description: Introduction: In order to promote hand hygiene at St. Olavs Hospital a song and video were composed, recorded and filmed by the Department of communications in cooperation with the Unit for Infection Control. Methods: The song and video focused mainly on the technique of applying and distributing disinfectant to the hands. The different steps of the routine, detailed in WHO guidelines, were given names and represent the chorus of the song. The chorus lasts 30 s, and, if memorized, will give guidance for the right steps and duration for correct hand rub. The launch of the video was carefully planned for World Hand Hygiene Day (May, 5 th 2021) both on the hospitals intranet page and on the hospitals social media sites. It was also released on music streaming platforms. Results: The video gained immediate attention and passed 100.000 hits on social media within two days. The media reach was wide for a small country as Norway with, currently (May, 25 th ), about 236.000 views and 3700 shares on Facebook and almost 40.000 views on You-Tube. It was also referred to in local and national media. Additionally, 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 health care workers and among primary school children, although we do not have data to confirm this in detail. Conclusion: Our song and video promoting the standard WHO hand hygiene routine in a fun and memorisable way gained wide attention and traction both among health care workers and the general public. Abstract video clip description: Dr Yusuf and his colleagues have conducted scientific surveys revealing the appearance and spread of disease-causing antibiotic-resistant bacteria in local communities with Kano State, Nigeria through a new initiative. The initiative developed new model to sensitize and engage students on antimicrobial resistance research and communicating the research to the needed community. Key to this initiative is that students and community members are recruited to help spread the message, and educate others in the community, who may not otherwise listen. Objective: The initiative aimed at safeguarding the efficacy of antibiotics through research and community engagement for prudent use of antibiotic. Methodology: The initiative involves conducting community specific research and travel into the community to educate community leaders, who influence others in their towns and villages, particularly sellers and hawkers of illicit or fake antibiotics. It also involve travelling to remote farming communities, speaking directly with farmers who either give antibiotics to their livestock, or take antibiotics wrongly believing they may act as painkillers. 1. Local/specific researches on drivers of AMR in human, animal and environments Antimicrob Resist Infect Control 2021, 10(Suppl 1):130 2. Community engagements on prudent use of antibiotics based on research findings 3. Dissemination of AMR research findings through various channels such as seminar, conferences, symposium, clubs, debates in secondary schools Results: The initiative has achieved the following results in the last 6 months 1. Direct engagement of literate and illiterate persons in sharing of AMR news in plain language 2. Development of skills of students in AMR research and findings dissemination 3. Development of student's presentation and engagement skills 4. Involvement of non science students of university and secondary schools in AMR knowledge and sharing 5. Communicating AMR knowledge to the grass root community members that abuse antibiotics most Conclusion: Communicating data of abuse and resistance to the grass root community members in language they understand is yielding positive result in fighting antibiotic misuse and resistance development Disclosure of Interest: None declared C04 An awareness about antimicrobial intake and antimicrobial resistance among geriatric population in Chennai city R. C 1,* 1 public health dentistry, ragas dental college and hospital, chennai, India Correspondence: R. C

Abstract video clip description: The devastating threat of antimicrobial resistance (AMR) to global human health is unquestionable. The difficult-to-treat AMR infections require longer hospital stays and more costly treatment, increase morbidity and mortality, and reduce productivity; therefore, increasing the economic burden of the countries. 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 noted. Antibiotic consumption by the elderly population was found to be between 11 to 45%, with a significant rise over the past decade. Healthcare providers face challenges in adequately diagnosing and managing infections in this vulnerable population because of the altered drug metabolism in this particular group. Nursing homes or long term care facilities were found to be a reservoir for AMR pathogens due to excessive, inappropriate and prolonged broad-spectrum antimicrobial use, inadequate infection control and increased risk of pathogen colonization. It is therefore important that both healthcare professionals and the public know the threat antimicrobial resistance poses and the individual actions they can take to combat antimicrobial resistance. The objective of this video is to assess the awareness about antimicrobial intake and antimicrobial resistance among geriatric population in Chennai city. A questionaire was adapted from validated surveys that were previously used and tailored to suit the local population and assure its applicability and modifications were made as necessary so that the questionnaire was simple to understand and answer, yet gave accurate data. Informed consent was obtained from all participants. In the present video, widespread use of antibiotics was reported, most of the antibiotics were being accessed without prescription. Respondents displayed poor knowledge particularly in regard to the role of antibiotics in minor viral illness. Participants had poor attitude toward the use of antibiotics for cold and sore throat. There were also significant malpractices such as failing to take full dose, purchasing antibiotics without prescription. Hence, educational interventions on antibiotics use and its association with drug resistance are needed to promote judicious use of antibiotic. Disclosure of Interest: None declared Abstract video clip description: Infection prevention and control (IPC) is a practical, evidence-based approach which prevents patients and healthcare workers (HCW) from being harmed by avoidable infection. The role of tertiary university hospital is to strengthen the IPC among all category of HCW, students and public using a multimodal approach such as education and training, competency assessment, self-directed learning via online module, video demonstrations and campaigns. This video is a compilation of the IPC measures done in University Malaya Medical Centre to promote IPC measures and patient safety to reduce the risk of acquiring and transmitting healthcare associated infections (HAI). Among the activities done are surveillance for multidrug resistant organisms (MDROs), environment and cleaning, HCAI, hand hygiene, operation theatre audit, surgical site infections (SSIs), reprocessing of endoscopes, and blood stream infections. There is also continuous education and training provided for all category of HCW to educate and increase awareness of the burden of HCAI on the healthcare system. UMMC has won the APSIC Safe Surgery Award 2018 for the SSIs quality improvement project. We also have been selected as a finalist for 2021 Hand Hygiene Excellence Award. The role of antimicrobial stewardship program also plays an important role in reducing the burden of HCAI. To increase the awareness among HCWs, we organized Antibiotic Awareness Week campaign and had a soft launching of UMMC Antibiotic Guideline Edition 2020 which can be accessed online via the staff portal. Apart from that, video demonstrations related to personal protective equipment and hand hygiene are also made available online as a reference for the HCWs. Methods: The analysis of the insourcing multi-modal program results has been carried out in a large multidisciplinary medical center with 602 beds in the following units with high epidemiological risk: hematology unit, intensive care unit, operation rooms. Moreover, the microbiological contamination of highly sensitive objects (HTO) in the hospital environment, which are a source of contamination for personnel and their hands, was assessed. The thoroughness of cleaning was also monitored using fluorescent labels. The costs on purchasing disinfectants have been analyzed. Results: With the usual bucket method cleaning (i.e. 2015 -2017 years), the level of microbial contamination was 8,4 ± 8,1%. The consumption of disinfectant solution (per day) was 1169 L. At the beginning the baseline level result of cleaning the fluorescent marks in operation rooms was 65,90 ± 29,75%. After one month of the program implementation and training of the hospital staff, the second audit showed that the level of cleaning improved to 83,63 ± 20,83% (p = 0,02). As a result of the Abstract video clip description: Healthcare-associated infections have affected hundreds of millions of individuals worldwide, leading to significant mortality, particularly in resource-limited countries. This video demonstrates 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 collaborative strategies, namely by, (1) 

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