bluuebunny/crossref_metadata_2025 huggingface dataset:
Multistate Models for the Recovery Process in the Covid-19 Context: An Empirical Study of Chinese Enterprises
Authors: Yang Lijiao , Chen Yu , Jiang Xinyu , Tatano Hirokazu
Published: May 2022

The Covid-19 pandemic has severely affected enterprises worldwide. It is thus of practical significance to study the process of enterprise recovery from Covid-19. However, the research on the effects of relevant determinants of business recovery is limited. This article presents a multistate modeling framework that considers the determinants, recovery time, and transition likelihood of Chinese enterprises by the state of those enterprises as a result of the pandemic (recovery state), with the help of an accelerated failure time model. Empirical data from 750 enterprises were used to evaluate the recovery process. The results indicate that the main problems facing non-manufacturing industries are supply shortages and order cancellations. With the increase of supplies and orders, the probability of transition between different recovery states gradually increases, and the recovery time of enterprises becomes shorter. For manufacturing industries, the factors that hinder recovery are more complex. The main problems are employee panic and order cancellations in the initial stage, employee shortages in the middle stage, and raw material shortages in the full recovery stage. This study can provide a reference for enterprise recovery in the current pandemic context and help policymakers and business managers take necessary measures to accelerate recovery.
A Machine Learning Strategy for Race-Tracking Detection During Manufacturing of Composites by Liquid Moulding
Authors: Fernández-León Joaquín , Keramati Keayvan , Garoz David , Baumela Luis , Miguel Carlos , González Carlos
Published: May 2022

This work presents a supervised machine learning (ML) model to detect race-tracking disturbances during the liquid moulding manufacturing of structural composites. Race-tracking is generated by unexpected resin channels at mould edges that may induce dry spots and porosity formation. The ML model uses the pressure signals recorded by a sensor network as input, providing a classification of the race-tracking event from a set of possible scenarios, and a subsequent variable regression for their position, size and strength. Such a model is based on the residual network (ResNet), a well-known artificial intelligence architecture that makes use of convolutional neural networks for image recognition. Training of the ML classifier and regressors was carried out with the aid of a synthetically generated simulation data set obtained throughout computational fluid dynamics simulations. The time evolution of the pressure sensors was used as grey-level images, or footprints, as inputs to the ResNet ML. The trained model was able to recognise the presence of race-tracking channels from the pressure data yielding good accuracy in terms of label prediction as well as position, size and strength. The model correlation was carried out with a set of injection experiments performed with a constant thickness closed mould containing induced race-tracking channels. The ability of ML models to provide an approximation to the inverse problem, relating the pressure sensor distortions to the cause of such events, is analysed and discussed.
Taking a Deep Breath: an Examination of Current Controversies in Surgical Procedures in Lung Transplantation
Authors: Hirdman Gabriel , Niroomand Anna , Olm Franziska , Lindstedt Sandra
Published: May 2022

Purpose of Review

This article reviews controversial questions within the field of lung transplantation, with a focus on data generated within the last 3 years. We aim to summarize differing opinions on a selection of topics, including bridge-to-transplantation, intraoperative machine circulatory support, bronchial anastomosis, size mismatch, delayed chest closure, and ex vivo lung perfusion.

Recent Findings

With the growing rate of lung transplantations worldwide and increasing numbers of patients placed on waiting lists, the importance of determining best practices has only increased in recent years. Factors which promote successful outcomes have been identified across all the topics, with certain approaches promoted, such as ambulation in bridge-to-transplant and widespread intraoperative ECMO as machine support.

While great strides have been made in the operative procedures involved in lung transplantation, there are still key questions to be answered. The consensus which can be reached will be instrumental in further improving outcomes in recipients.
Machine learning-based framework to cover optimal Pareto-front in many-objective optimization
Authors: Asilian Bidgoli Azam , Rahnamayan Shahryar , Erdem Bilgehan , Erdem Zekiye , Ibrahim Amin , Deb Kalyanmoy , Grami Ali
Published: May 2022

One of the crucial challenges of solving many-objective optimization problems is uniformly well covering of the Pareto-front (PF). However, many the state-of-the-art optimization algorithms are capable of approximating the shape of many-objective PF by generating a limited number of non-dominated solutions. The exponential increase of the population size is an inefficient strategy that increases the computational complexity of the algorithm dramatically—especially when solving many-objective problems. In this paper, we introduce a machine learning-based framework to cover sparse PF surface which is initially generated by many-objective optimization algorithms; either by classical or meta-heuristic methods. The proposed method, called many-objective reverse mapping (MORM), is based on constructing a learning model on the initial PF set as the training data to reversely map the objective values to corresponding decision variables. Using the trained model, a set of candidate solutions can be generated by a variety of inexpensive generative techniques such as Opposition-based Learning and Latin Hypercube Sampling in both objective and decision spaces. Iteratively generated non-dominated candidate solutions cover the initial PF efficiently with no further need to utilize any optimization algorithm. We validate the proposed framework using a set of well-known many-objective optimization benchmarks and two well-known real-world problems. The coverage of PF is illustrated and numerically compared with the state-of-the-art many-objective algorithms. The statistical tests conducted on comparison measures such as HV, IGD, and the contribution ratio on the built PF reveal that the proposed collaborative framework surpasses the competitors on most of the problems. In addition, MORM covers the PF effectively compared to other methods even with the aid of large population size.
Assessing the association between cefepime percentage free trough level and neurotoxicity
Authors: Zia Aleena , Desai Armisha , Tieman Molly , Pritchard Haley
Published: May 2022

Background: Cefepime has a known association with neurotoxicity due to its ability to cross the blood–brain barrier. The symptoms of neurotoxicity are highly variable. It has been postulated that cefepime neurotoxicity is associated with elevated levels of the drug. However, studies assessing for an association between serum drug level and the incidence of neurotoxicity have yet to establish a consistent threshold. We assessed serum cefepime levels and incidence of neurotoxicity to help develop a dosing strategy to minimize adverse effects. Method: In total, 32 inpatients admitted from January 2019 to November 2021 who received cefepime according to institutional standard dosing regimens for at least 72 hours were reviewed by infectious diseases pharmacists who obtained serum cefepime levels and performed pharmacokinetic analyses to obtain percentage free trough levels. Cefepime percentage free trough levels were defined as therapeutic if they were above the known minimum inhibitory concentration (MIC) of the treated organism and were <40 μg/mL. Patient charts were reviewed for clinical findings consistent with cefepime-induced neurotoxicity. Numerical and statistical analyses were performed to assess factors with a significant association with neurotoxicity. Results: Overall, 16 (47.1%) patients showed some evidence of neurotoxicity, 9 (56.3%) of whom had a likely alternate clinical cause of symptoms (Table 1). We did observe that patients with creatinine clearance <60 mL/min were more likely to have symptoms concerning for neurotoxicity. Conclusions: Cefepime percentage free trough levels were highly variable, and no association with neurotoxicity was observed. Patients with decreased creatinine clearance were significantly more likely to develop neurologic findings consistent with cefepime-induced neurotoxicity. Further study is needed to establish a relationship between cefepime pharmacokinetic values and incidence of neurotoxicity.

Funding: None

Disclosures: None
Antibiotic use and impact on illness course in children with influenza-like-illness in the emergency department
Authors: Poole Nicole , O’Leary Sean , Rao Suchitra , Suresh Krithika , Moss Angela
Published: May 2022

Background: Child absenteeism from childcare or school leads to economic loss from parental work absenteeism, overutilization of acute-care resources, and excess medicalization of children with minor illnesses. We sought to determine the difference in days missed from childcare or school and days of illness for children with influenza-like illness (ILI) in the emergency department (ED) who are or are not prescribed an antibiotic. Methods: We conducted a secondary data analysis of a prospective randomized control trial evaluating the impact of rapid molecular testing on provider decision making. The study included children aged 2 months–12 years attending childcare or school seen in the ED from December 2018 through December 2019 with ILI (CDC definition) with parental survey completion 10 days after their ED visit. The primary exposure was receipt of antibiotics over the course of illness, which was assessed by chart review and parent survey. The primary outcome was number of days missed from class. The secondary outcome was number of days of illness after initial ED visit. Wilcoxon tests were used to compare missed class days or illness days by antibiotic receipt. Multivariable negative binomial regression was used to analyze outcomes, controlling for clinically important patient characteristics. Results: Of 251 children included in this study, the median age was 4.2 years (IQR, 1.6–7.0); 52% were male, 40% were White, 54% were Hispanic, and 75% had government insurance. Antibiotics were prescribed in 26% of ILI encounters. There was no statistically significant association between antibiotic receipt and number missed class days (2.0 days [IQR, 1.0–4.0] vs 3.0 days [IQR, 1.0–5.0]; P = .08) or illness days (4.0 days [IQR, 3.0–7.0] vs 5.0 days [IQR, 3.0–7.0]; P = .13) after the initial ED visit. After adjusting for covariates, there was no significant difference in missed class days or illness days for patients prescribed antibiotics in relation to days sick before ED visit. The rates of missed class days and illness days were 87% and 30% greater, respectively, in patients with additional medical visits during the course of illness. Conclusions: Days sick prior to ED presentation and receipt of an antibiotic for ILI had no influence on child absenteeism or illness duration. However, children missed more class and received more antibiotics if they had multiple medical visits during an illness. Further study is needed on sociobehavioral factors leading to medicalization of children with minor illnesses and its impact on the unnecessary use of antibiotics.

Funding: None

Disclosures: None
Human factors analysis of the disinfection of central-line needleless connectors
Authors: Martinello Richard , Hebden Joan , Drews Frank , Pegues David
Published: May 2022

Background: Patients requiring vascular catheters are at risk for bloodstream infections (BSIs), particularly those with central venous access devices (CVADs). Central-line–associated bloodstream infections (CLABSIs) may occur as a result of the introduction of pathogenic microbes during CVAD access procedures, including through the needleless connector. The use of an antiseptic scrub is recommended to disinfect the needleless connector before device access, and this procedure has been shown to reduce the risk for CLABSI. We identified perceived barriers and facilitators and assessed compliance with instructions for use of chlorhexidine or alcohol antisepsis products (CHG or IPA; 5-second scrub time plus 5-second dry time) and alcohol antisepsis products (IPA; facility protocol 15-second scrub time plus let dry) for needleless connector disinfection. Methods: We performed a multiple-methods study involving focus groups composed of a convenience sample of nurses and clinical observations of CVAD needleless-connector access procedures in 3 medical ICUs and 1 surgical ICU at 2 academic medical centers. We used open-ended questions to guide the focus-group discussions. We directly observed nursing staff performing needleless-connector disinfection following a time–motion paradigm using an electronic tool to document the observed needleless-connector access events and to measure needleless-connector antiseptic scrub times and dry times. Results: In total, 8 focus groups involving 28 nurses revealed access to the antiseptic product and lesser workload as best-practice facilitators of needleless-connector disinfection. Identified barriers were often the opposite of the facilitators, particularly the time required per needleless connector access using IPA and knowledge deficits regarding the need for disinfection between multiple needleless-connector accesses. From 36 observations, including a total of 48 access events, we determined that the mean scrub times were below the recommended times, especially for IPA (Table 1). Drying time after use of either antisepsis product was negligible. Conclusions: A lack of access to the disinfection product, emergency situations, and increased workload were perceived barriers to needleless-connector disinfection. Observed scrub times and drying times were shorter than recommended, much more so for IPA. These deficits in the performance of needleless-connector disinfection may increase the risk of CLABSI. Ongoing education and periodic competency evaluation of needleless-connector disinfection are needed to imbed and sustain best practices.

Funding: Professional Disposables, Inc.

Disclosures: None
COVID-19 among healthcare workers of a tertiary-care hospital in Singapore
Authors: Myat Oo Aung , Venkatachalam Indumathi , Jean Sim Xiang Ying , Aung May Kyawt , Edwin Philip Conceicao , Yong Yang , Arora Shalvi , Wee Jin Shawn See , Lester Lee Wai Leong , Tien Fong Yuke , Lee Lai Chee , Ling Moi Lin
Published: May 2022

Background: Singapore General Hospital (SGH) is the largest acute tertiary-care hospital in Singapore. Healthcare workers (HCWs) are at risk of acquiring COVID-19 in both the community and workplaces. SGH has a robust exposure management process including prompt contact tracing, immediate ring fencing, lock down of affected cubicles or single room isolation for patient contacts, and home isolation orders for staff contacts of COVID-19 cases during the containment phase of the pandemic. Contacts were also placed on enhanced surveillance with PCR testing on days 1 and 4 as well as daily antigen rapid tests (ARTs) for 10 days after exposure. Here, we describe the characteristic of HCWs with COVID-19 during the third wave of the COVID-19 pandemic. Methods: This retrospective observational study included all SGH HCWs who acquired COVID-19 during the third wave (ie, the 18-week period from September 1 to December 31, 2021) of the COVID-19 pandemic. Univariate analysis was used to compare characteristics of work-associated infection (WAI) and community-acquired infection (CAI) among HCWs. Results: Among a workforce of >10,000 at SGH, 335 HCWs acquired COVID-19 during study period. CAI (exposure to known clusters or household contact) accounted for 111 HCW infections (33.1%). Also, 48 HCWs (14.3%) had a WAI (ie, acquired at their work places where there was no patient contact). Among WAsI, only 5 HCWs had hospital-acquired infection (confirmed by phylogenetic analysis). The sources of exposure for the remaining 176 HCWs were unknown. Weekly incidence of COVID-19 among HCWs was comparable to the epidemiology curve of all cases in Singapore (Fig. 1 and 2). The mean age of HCWs with COVID-19 was 39.6 years, and most were women. At the time of positive SARS-CoV-2 PCR test, 223 HCWs were symptomatic, and 67 (20.0%) of them had comorbidities. Only 16 HCWs (4.8%) required hospitalization, and all recovered fully with no mortality (Table 1). Being female was associated with community COVID-19 acquisition (OR, 4.6, P Conclusions: During the thrid wave of the COVID-19 pandemic, a higher percentage of HCWs at SGH acquired the infection from the community than from the workplace. Safe management measures, such as universal masking, social distancing, and robust exposure management processes including prompt contact tracing and environmental disinfection, can reduce the risk of COVID-19 in the hospital work environment.

Funding: None

Disclosures: None
Mitigation strategies to control a carbapenem-resistant Acinetobacter baumannii outbreak in a dedicated COVID-19 unit
Authors: Campbell Candace , White Calvin , Estelle Carolee
Published: May 2022

Background: Carbapenem-resistant Acinetobacter baumannii (CRAb) is considered a public health threat, and this pathogen is typically associated with hospital infections. At 3 months after opening the hospital’s dedicated COVID-19 unit, 2 patients were identified with CRAb. Infection prevention staff collaborated with staff in the COVID-19 unit, hospital leadership, and health department partners to develop mitigation strategies and to prevent additional transmission. Methods: Admissions to the COVID-19 unit were stopped. Biweekly surveillance cultures were collected to identify any patients potentially colonized with CRAb. An infection control risk assessment was conducted to determine breaches in infection prevention practices. The risk assessment included environmental rounding of the area, epidemiological investigation, environmental testing, pulsed-field gel electrophoresis (PFGE) testing, and observing infection prevention practices. Results: The risk assessment identified multiple gaps in infection control practices, for example, gaps in hand and environmental hygiene practices. The extended use of personal protective equipment (PPE), staff shortages, fatigue, and staff taking on multiple roles and tasks outside their general job duties were other gaps identified by the team. Between June and September 2020, 43 additional CRAb cases were identified in the facility, with 4 (9.8%) cases outside the COVID-19 unit. Moreover, 29 cases (64%) were considered clinical infections and 16 (36%) were identified from surveillance efforts. Environmental cultures identified 1 positive surface with CRAb. PFGE testing was completed on 44 isolates; 42 isolates had identical PFGE patterns, and 2 isolates were unrelated to the COVID-19 unit; 2 isolates were closely related (with 3-band differences) but were not identified in the COVID-19 unit. Conclusions: The inability to definitively identify the source of transmission made it challenging to determine the best approach to eradicating the pathogen. Mitigation for outbreaks should focus on not deviating from core infection control practices.

Funding: None

Disclosures: None
SARS-CoV-2 N95 contamination worn under a face shield, via medical mask surrogate, in healthcare providers treating COVID-19
Authors: Graves Amanda , Warren Bobby , Barrett Aaron , Lewis Sarah , Smith Becky , Weber David , Vavalle Emily Sickbert-Bennett , Anderson Deverick
Published: May 2022

Background: SARS-CoV-2 N95 mask contamination in healthcare providers (HCPs) treating patients with COVID-19 is poorly understood. Method: We performed a prospective observational study of HCP N95 respirator SARS-CoV-2 contamination during aerosol-generating procedures (AGPs) on SARS-CoV-2–positive patients housed in a COVID-19–specific unit at an academic medical center. Medical masks were used as surrogates for N95 respirators to avoid waste and were worn on top of HCP N95 respirators during study AGPs. Study masks were provided to HCPs while donning PPE and were retrieved during doffing. Additionally, during doffing, face shields were swabbed with Floq swabs premoistened with viral transport media (VTM) prior to disinfection. Medical masks were cut into 9 position-based pieces, placed in VTM, vortexed, and centrifuged (Fig. 1). RNA extraction and RT-PCR were completed on all samples. RT-PCR–positive samples underwent cell culture infection to detect cytopathic effects (CPE). Contamination was characterized by mask location and front and back of face shields. Patient COVID-19 symptoms were collected from routine clinical documentation. Study HCPs completed HCP-role–specific routine care (eg, assessing, administering medications, and maintaining oxygen supplementation) while in patient rooms and were observed by study team members. Results: We enrolled 31 HCPs between September and December 2021. HCP and patient characteristics are presented in Table 1. In total, 330 individual samples were obtained from 31 masks and 26 face shields among 12 patient rooms. Of the 330 samples, 0 samples were positive for SARS-CoV-2 via RT-PCR. Positive controls were successfully performed in the laboratory setting to confirm that the virus was recoverable using these methods. Notably, all samples were collected from HCPs caring for COVID-19 patients on high-flow, high-humidity Optiflow (AGP), with an average of 960 seconds (IQR, 525–1,680) spent in each room. In addition to Optiflow and routine care, study speech pathologists completed an additional AGP of fiberoptic endoscopic evaluation of swallowing. Notably, 29 (94%) of 31 study HCP had physical contact with their patient. Conclusions: Overall, mask contamination in HCPs treating patients with COVID-19 undergoing AGPs was not detectable while wearing face shields, despite patient contact and performing AGP.

Funding: None

Disclosures: None
Disruptions to essential health services in Kenya during the COVID-19 pandemic – February 2020–May 2021
Authors: Hudson Matthew , Herzig Carolyn , Woelk Godfrey , Wesangula Evelyn , Machekano Rhoderick , Masaba Rose , Park Benjamin , Bancroft Elizabeth
Published: May 2022

Background: The COVID-19 pandemic disrupted essential health services (EHS) delivery worldwide; however, there are limited data for healthcare facility (HCF)–level EHS disruptions in low- and middle-income countries. We surveyed HCFs in 3 counties in Kenya to understand the extent of and reasons for EHS disruptions occurring during February 2020–May 2021. Methods: We included 3 counties in Kenya with high burden of COVID-19 at the time of study initiation. Stratified sampling of HCFs occurred by HCF level. HCF administrators were interviewed to collect information on types of EHS disruptions that occurred and reasons for disruptions, including those related to infection prevention and control (IPC). Analyses included descriptive statistics with proportions for categorical variables and median with interquartile range (IQR) for continuous variables. Results: In total, 59 HCFs in Kenya provided complete data. All 59 HCFs (100%) reported EHS disruptions due to COVID-19. Among all HCFs, limiting patient volumes was the most common disruption reported (97%), while 56% of HCFs reduced staffing of EHS and 52% suspended EHS. Median duration of disruptions ranged from 7 weeks (IQR, 0–15) for inpatient ward closures to 25 weeks (IQR, 14–37) for limiting patient volumes accessing EHS. Among HCFs that reported disruptions, the most cited reason (ie, 95% of HCFs) was fewer patients receiving services. The most common IPC-related reason for disruption was diversion of resources to accommodate physical distancing measures (76%) followed by COVID-19 outbreaks among patients or staff (34%); staff shortages due to COVID-19 illness (25%) or perceived infection risk (19%); and lack of adequate personal protective equipment (20%). Conclusions: Most HCFs reported disruptions to EHS during the pandemic, including many that were related to IPC. Some disruptions may be mitigated by strengthening IPC infrastructure and practices, including protecting healthcare personnel to prevent staffing shortages.

Funding: None

Disclosures: None
Characterization of carbapenem-resistant gram-negative bacteria collected in the Sentinel Surveillance Program, 2018–2019
Authors: Spicer Lori , Campbell Davina , Johnson J. Kristie , Longo Cynthia , Balbuena Thomas , Ewing Thomas , Karlsson Maria , Rasheed J. Kamile , Elkins Christopher , Gargis Amy , Lutgring Joseph
Published: May 2022

Background: Carbapenem resistance in gram-negative organisms is an important public health problem. The CDC conducted Sentinel surveillance in 2018–2019 to characterize these organisms from 9 facilities in 9 different states. Methods: Carbapenem-resistant Enterobacterales (CRE), Pseudomonas aeruginosa (CRPA), and Acinetobacter spp (CRA) obtained from clinical samples of patients in acute-care or long-term care facilities were submitted to the CDC. Identification was confirmed using matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF), and antimicrobial susceptibility testing (AST) was performed via broth microdilution for 27 antibiotics. All confirmed CRE and CRPA were tested for carbapenemase production (CP) using the modified carbapenem inactivation method (mCIM). The isolates that were mCIM-positive were assessed by real-time PCR for presence of blaKPC, blaNDM, blaVIM, and blaIMP. CP-CRE were also assessed for blaOXA-48-like. All confirmed CRA were tested for the same genes as CRPA and blaOXA-23–like, blaOXA-24/40-like, blaOXA-58–like, and blaOXA-235–like genes. Difficult-to-treat resistance (DTR) was defined as resistance to all β-lactams (excluding newer β-lactam combination agents) and quinolones tested. Results: The CDC confirmed 208 CRE, 161 CRPA, and 94 CRA. Table 1 summarizes AST results for a selection of drugs. We identified 112 (53.8%) mCIM-positive CRE and 6 (3.7%) mCIM-positive CRPA. The PCR results are summarized in Table 2. One mCIM-positive and PCR-negative isolate was positive in a metallo-β-lactamase screen. Conclusions: Resistance among CRE and CRPA to newer β-lactam combination agents was detected. Options for treating CRA are limited. Of 112 CP-CRE, 85.7% harbored blaKPC; CP-CRPA were rare (3.7%); and most CRA harbored blaOXA-23-like (55.3%) or blaOXA-24/40-like (30.9%). Whole-genome sequencing is planned to better understand gene variants, sequence types, and additional resistance markers present among the isolates.

Funding: None

Disclosures: None
Whole-genome sequencing to assess clonality in a series of prosthetic joint Staphylococcus epidermidis isolates – WITHDRAWN
Authors: Simon Samantha , Sater Mohamad , Herriott Ian , Huntley Miriam , Hollenbeck Brian
Published: May 2022

Background: Prosthetic joint infections (PJIs) are costly and cause increased morbidity and mortality for patients. Staphylococcus epidermidis is a common cause of both early postoperative and late-presenting PJIs. Although S. epidermidis is a normal part of the human skin microflora, its ability to form biofilm on implanted medical devices make it an important causative pathogen of PJIs. We investigated genetic, epidemiologic, and environmental factors contributing to S. epidermidis PJIs by performing whole-genome sequencing and clinical epidemiologic investigation of isolates collected from infected patients between 2017 and 2020. Methods: Patients with S. epidermidis isolated from a prosthetic joint that was placed at our orthopedic specialty hospital were identified using the microbiology laboratory records and electronic medical records. Whole-genome sequencing and single-nucleotide polymorphism (SNP)–based clonality analyses were performed using the epiXact service at Day Zero Diagnostics. These analyses included species identification, in silico MLST typing, phylogenomic analysis, as well as genotypic assessment of the prevalence of specific antibiotic resistance genes, virulence genes, and other relevant genes. For clonal isolates, additional reviews of surgical history and clinical data were performed. Results: In total, 62 S. epidermidis joint isolates were identified from 46 patients. Among these isolates, 52 were of sufficient purity to be used for genomic analysis (Fig. 1). A number of genes appeared in every isolate including sepA, smr, cap, sesB, sesG, and embp. Also, 6 S. epidermidis samples had a discrepancy between phenotypic resistance to oxacillin and the presence of the mecA resistance gene. We also identified 6 distinct clusters of isolates, all of which had SNP distances <10 base pairs (Fig. 2). Each cluster consisted of 2–4 patients. Cluster isolates accounted for 29.8% of all S. epidermidis prosthetic joint isolates. Most clonal isolates occurred in patients who were heavily exposed to different healthcare settings. Further epidemiologic investigation showed that some of these clonal isolates had ties to aspirations or procedures, whereas no clear connection could be determined for others. Conclusions:S. epidermidis isolated from clinical prosthetic joint samples contains a high degree of genetic resistance, including a mismatch between presence of mecA and phenotypic oxacillin resistance and genetic propensity for chlorhexidine resistance. Mupirocin resistance was not observed. Of all isolates, 29.8% belonged to multiple clusters, confirming hospital spread of this commensal organism in some cases.

Funding: None

Disclosures: None
Patient safety and quality care: Time to focus on nonventilator hospital-acquired pneumonia
Authors: Giuliano Karen , Baker Dian
Published: May 2022

Background: A growing body of evidence has reported on the harm and cost of nonventilator hospital-acquired pneumonia (NVHAP), currently the most common hospital-acquired infection (HAI). Although the US Congress and the Center for Medicare and Medicaid Services (CMS) have acted to reduce rates of some HAIs through the Hospital-Acquired Condition Reduction Program (HACRP), NVHAP is not currently included. Thus, most hospitals do not engage in active prevention. Here, we report the findings from our analysis of Medicare claims data on hospital length of stay (LOS), cost for patients with hospital-acquired pneumonia (HAP), including both ventilator-associated pneumonia and NVHAP, and mortality. Methods: We used Medicare claims data for Federal Fiscal Year 2019 for inpatient and postdischarge services. Beneficiaries who died, were without continuous Medicare Part A and B enrollment, and patients eligible for Medicare for end-stage renal disease were excluded. Inpatient payments and 30-, 60-, and 90-day postdischarge episodes for 2,457 beneficiaries with HAP were examined and compared to a non-HAP control group of 2,457 beneficiaries. Groups were matched on age, sex, race, and the diagnosis-related group (DRG) for their index hospitalization. Results: Most HAP was NVHAP (N = 2,222; 89%) versus VAP (N = 275; 11%). LOS stay was significantly (p HAP patients were 2.8 times more likely to die vs non-HAP. Conclusions: These findings provide additional support to previous research on the harm and cost associated with NVHAP. Previous HACRP HAI initiatives, such as catheter-associated urinary tract infection (CAUTI) and surgical-site infection (SSI), have resulted in measurable HAI reductions. Although recent evidence-based NVHAP and initiatives indicate that NVAHP is largely preventable, to date, no acute-care inpatient hospital quality improvement program implemented by Medicare includes measures for NVHAP prevention. The time is right to include NVHAP as an HACRP HAI initiative.

Funding: Stryker

Disclosures: None
Implementation of surgical site infection surveillance in 16 health facilities in Sierra Leone
Authors: Kamara Rugiatu Z. , Foster Monique , Weiss Jamine , Conteh Christiana
Published: May 2022

Background: Surgical site infections (SSIs) are associated with increased healthcare costs, antibiotic resistance, morbidity, and mortality. In low- and middle-income countries (LMICs), SSIs account for most healthcare-acquired infections (HAIs). In Africa, up to 20% of women who undergo a caesarean section develop a wound infection. Surveillance has been shown to be an essential component in the overall strategy to reduce SSIs. Methods: Surgical site infection surveillance is being implemented in 16 health facilities in Sierra Leone, with at least 1 from each of the 5 US Census regions: Eastern, Western, Northern, Northwestern, and Southern. These health facilities were selected based on the availability of a dedicated infection prevention and control (IPC) focal person. Women were observed for 30 days after caesarean section. A standardized surgical safety and surveillance checklist including case definitions and observable criteria (eg, purulent drainage, wound abscess, or intentional reopening) was used. Clinical staff were trained to collect data and to conduct in-person and phone interviews with patients on days 3, 7, and 30 after caesarean section. Results: From March 2021 to July 2021, a total of 2,529 women had caesarean sections in 15 health facilities; most occurred in the Northern region (785 of 2,529). Among these 2,529 women, 1,522 (60%) had an SSI surveillance checklist started, and of those 1,522, 632 (42%) had a completed checklist. Health facilities in most of the rural regions, (Eastern, Northwestern, and Southern) had no completed checklists. The overall SSI rate for the 15 health facilities was 3% (70 of 2,529). The Southern region had the highest SSI rate at 50% (35 of 70), but the Western region did not report any SSIs. Of the 70 cases, 49 (70%) were identified through active inpatient surveillance and 21 (30%) were identified through postdischarge surveillance. Conclusions: One of the priorities of Sierra Leone’s National IPC Action Plan is to establish HAI surveillance. Surgical site surveillance is an essential component of HAI surveillance and leads to timely identification so infections can be treated quickly. This study was limited by inadequate data collection and patients lost to follow-up after discharge. However, this study illustrates that surveillance leads to the diagnosis of most SSI cases after caesarean section while patients are still hospitalized. Simple yet effective SSI surveillance can be conducted in LMICs to identify and ultimately treat SSI after caesarean section. More support is needed in rural and smaller facilities for better implementation of SSI surveillance in Sierra Leone.

Funding: None

Disclosures: None
Reduction in outpatient antibiotic utilization: An unintended benefit of the COVID-19 pandemic?
Authors: Kakiuchi Satoshi , Perencevich Eli , Livorsi Daniel , Goto Michihiko
Published: May 2022

Background: The COVID-19 pandemic heavily affected healthcare delivery systems in the United States. However, little is known about its impact on overall antimicrobial consumption, especially in outpatient settings. We assessed the impact of the COVID-19 pandemic on antimicrobial consumption in both outpatient and inpatient (acute-care, long-term care, and mental health) settings in the Veterans’ Health Administration (VHA) during the 2 years before and after the start of the pandemic. Methods: We conducted a retrospective study for all patients who received care within the VHA from January 2018 to December 2021. We used antibiotic days as the primary outcome measure (days of therapy for inpatient settings and dispensed days supply for outpatient settings), and we obtained data for antimicrobial consumption from the VHA Corporate Data Warehouse. Antibiotics were categorized into classes by the NHSN protocol and included only systemic agents (oral and parenteral). We defined 2018–2019 as the prepandemic period and 2020–2021 as the pandemic period. We compared the relative and absolute difference in antibiotic consumption between the 2 periods. Results: Across all periods, 8.3 million patients received care in the VHA, and an average of 28,709,680 antibiotic days were prescribed per year. Overall, 92.9% of all antibiotic days were outpatient and 7.1% were inpatient. Total antibiotic days during the pandemic period decreased by 12.4% compared to the prepandemic period (pandemic period: 53,613,840 and prepandemic period: 61,224,878). This reduction was primarily driven by reductions in outpatient settings (relative reduction: 12.7% and absolute reduction: 7,254,880 antibiotic days over 2 years), but antibiotic days in inpatient settings decreased more modestly (relative reduction: 8.4% and absolute reduction: 356,158 antibiotic days over 2 years) (Fig. 1). When frequently prescribed antimicrobials were categorized by classes, fluoroquinolones and lincosamides showed the largest decreases (fluoroquinolones: 29.2% reduction and lincosamides: 27.2% reduction). Tetracyclines and sulfamethoxazole–trimethoprim had the smallest reductions (5.2% and 11.2%, respectively). Conclusions: Compared to the prepandemic period, the pandemic was associated with a substantial reduction in overall antibiotic consumption, especially in outpatient settings, which accounted for 95% of the overall reduction despite being outside the domain of most traditional antibiotic stewardship programs. The impact of the pandemic was most modest in the use of tetracyclines and trimethoprim–sulfamethoxazole and was most prominent in the use of fluoroquinolones and lincosamides. Further studies are required to improve the causal inference between the COVID-19 pandemic and this reduction in antibiotic consumption, as well as its impact on patient outcomes.

Funding: None

Disclosures: None
The effect of gender bias on acceptance of antibiotic stewardship recommendations by clinical pharmacists
Authors: Vaughn Valerie , Giesler Daniel , Brancaccio Adamo , Mashrah Daraoun , Sandison Katie , Wu Chaorong , Horowitz Jennifer , Bashaw Linda , Hersh Adam
Published: May 2022

Background: Clinical pharmacists are a critical part of antibiotic stewardship. Stewardship often relies on relationships and persuasion, which may be affected by gender bias. Thus, we aimed to assess the association of sex with the acceptance of antibiotic stewardship recommendations. Methods: Between May and October 2019, medicine pharmacists at single hospital reviewed patients on antibiotics and–when a discharge was anticipated–led an antibiotic discussion (or “timeout”) prior to discharge. To explore differences in antibiotic timeout effectiveness by gender, we assessed the association of pharmacist sex with suggestion and acceptance of antibiotic changes using logistic regression controlling for patient characteristics. We also assessed whether hospitalist sex was associated with or moderated the effect of pharmacist sex on acceptance of timeout recommendations. Results: Between May 1, 2019, and October 31, 2019, pharmacists conducted 295 timeouts (patient characteristics in Fig. 1). Overall, 54% of timeouts were conducted by 12 female pharmacists and the remaining 46% were conducted by 8 male pharmacists. Overall, 82 (29%) of 295 timeouts resulted in a pharmacist recommending an antibiotic change, and male pharmacists were more likely to recommend a change: 52 (38%) of 137 versus 30 (19%) 158 (P Conclusions: In this discharge antibiotic intervention, timeouts conducted by women were less likely to result in an antibiotic change than those conducted by men. The difference in effectiveness resulted both from female pharmacists being less likely to recommend a change and from hospitalists being less likely to accept recommendations from a female pharmacist. These findings suggest that gender bias may play a role acceptance of antibiotic stewardship recommendations, which could affect antibiotic use, pharmacist job satisfaction, and patient outcomes.

Funding: None

Disclosures: None
Creation of data application to facilitate device-monitoring safety for infection prevention
Authors: Moody Julia , Robinson Quint , Townsend Trevor , Forehand Tyler , Blanchard E. Jackie , Sands Kenneth
Published: May 2022

Background: Efficient monitoring of devices to ensure timely removal is an ongoing challenge. There is a need for data visualization products that can aggregate disparate data streams to support device reviews, increase consistency across changes in caregiver teams, and synergize with people and operational processes within and across regional acute-care facilities. Methods: A data display application was developed to provide data from nearly any source in a consistent visual representation that could be used in real time. The infection prevention (IP) overlay combined data related to urinary catheters, central vascular catheters, and femoral vascular catheters from the electronic health record system. Clinical and data experts collaborated to develop data definitions, inclusion criteria, and report components. The application display indicated the current catheter or device status of each patient facility-wide, organized by service unit (Fig. 1). Additional patient information could be accessed from within the application, and a comment feature allowed caregivers to communicate directly through the tool (Fig. 2). Results: Pilot implementation began February 2021, and the NATE IP application was live for all users (unit and facility leaders, providers, infection preventionists, etc) as of July 2021. The tool is currently available for use at 171 acute-care hospitals within the HCA healthcare system, and it accommodated 3 different electronic medical record systems. Usage peaked in August 2021, with an average of 1,700 views per day. Daily utilization maximum ranges from 1,100 to 1,500 views per day, with an average of ~1,300 views per day. The tool is used during daily patient safety rounds, including weekends and holidays. User feedback was overwhelmingly positive, with users reporting an increase in communication, streamlined documentation, improved tracking of reasons to retain, and increased accountability for daily updates. During the proof-of-concept implementation, zero bugs were identified and several feature enhancements were implemented, including addition of port status and device-day reporting counts. Planned enhancements include mupirocin and chlorhexidine bathing use, isolation precaution use, and blood cultures ordered >3 days after admission. Conclusions: The NATE IP tool brings together data related devices into a single view for use by direct caregivers and all levels of leadership. Development of this or similar tools to consolidate various data streams into a central tool facilitates improved communication and consistency between caregiver teams. It also drives operational efficiencies and improves safety. Expansion to incorporate notifications related to potential issue will expand the proactive utility of this tool.

Funding: None

Disclosures: None
A SARS-CoV-2 outbreak due to vaccine breakthrough in an acute-care hospital
Authors: Park Se Yoon , Kim Tae Hyong , Lee Eunjung , Loeb Mark , Jeong Yeon Su , Kim Jin Hwa , Oh Sun Mi , Cheong Sojin , Park Hyein , Jo SoYea
Published: May 2022

Background: The δ (delta) variant has spread rapidly worldwide and has become the predominant strain of SARS-CoV-2. We analyzed an outbreak caused by a vaccine breakthrough infection in a hospital with an active infection control program where 91.9% of healthcare workers were vaccinated. Methods: We investigated a SARS-CoV-2 outbreak between September 9 and October 2, 2021, in a referral teaching hospital in Korea. We retrospectively collected data on demographics, vaccination history, transmission, and clinical features of confirmed COVID-19 in patients, healthcare workers, and caregivers. Results: During the outbreak, 94 individuals tested positive for SARS-CoV-2 using reverse transcription-polymerase chain reaction (rtPCR) testing. Testing identified infections in 61 health care workers, 18 patients, and 15 caregivers, and 70 (74.5%) of 94 cases were vaccine breakthrough infections. We detected 3 superspreading events: in the hospital staff cafeteria and offices (n = 47 cases, 50%), the 8th floor of the main building (n = 22 cases, 23.4%), and the 7th floor in the maternal and child healthcare center (n = 12 cases, 12.8%). These superspreading events accounted for 81 (86.2%) of 94 transmissions (Fig. 1, 2). The median interval between completion of vaccination and COVID-19 infection was 117 days (range, 18–187). There was no significant difference in the mean Ct value of the RdRp/ORF1ab gene between fully vaccinated individuals (mean 20.87, SD±6.28) and unvaccinated individuals (mean 19.94, SD±5.37, P = .52) at the time of diagnosis. Among healthcare workers and caregivers, only 1 required oxygen supplementation. In contrast, among 18 patients, there were 4 fatal cases (22.2%), 3 of whom were unvaccinated (Table 1). Conclusions: Superspreading infection among fully vaccinated individuals occurred in an acute-care hospital while the δ (delta) variant was dominant. Given the potential for severe complications, as this outbreak demonstrated, preventive measures including adequate ventilation should be emphasized to minimize transmission in hospitals.

Funding: None

Disclosures: None
Assessing alternatives to HEPA air purification requirements to reduce viral pathogen transmission in healthcare HVAC systems
Authors: Bischoff Werner , Ornelles David , Ivey Lauren , Payne Bill
Published: May 2022

Background: High-efficiency particulate air (HEPA) filters are currently recommended when using recirculated air to eliminate the risk of pathogen transmission such as SARS-CoV-2 from one patient care area to the next. We tested the efficacy of lower-grade air filters in eliminating airborne virus transmission. Methods: We conducted an experiment in 2 adjacent exam rooms in an unoccupied hospital emergency unit. The HVAC system contained a 15,000-cubic-feet-per-minute rooftop air handler. All outside air and exhaust dampers were closed during the trial (full air recirculation). We conducted experiments in 3 tests arms with varying grades of MERV filters (AAF Flanders, Louisville, KY): (1) control without filters, (2) MERV8+14 filters, and (3) MERV8+16 filters. We repeated 20-minute virus challenge runs 3 times per test arm. Live attenuated influenza vaccine (2 mL LAIV, FluMist Quadrivalent 2020/21, AstraZeneca, Wilmington, DE), was aerosolized into the HVAC system via a commercial nebulizer. Air was sampled using 3 six-stage Andersen air samplers placed in the center of the adjacent room. Environmental particle counts were collected using a particle counter (PEC-PCO-1, PCE Americas). Results: Concentrations of viral RNA were determined by qPCR, and viral concentrations (vg/mL) in each stage of each arm were compared directly. Pairwise comparisons of the virus and particle burdens across each stage of each test arm were made using a general linear model. LAIV was detected in the control arm at a virus burden of 2,277 vg/mL, indicating a >6.5 log reduction of the virus released in the HVAC system (8.8×109 total vg). In the second arm, the MERV8+MERV14 filters demonstrated in a 13-fold decrease in viral burden compared to the control arm (mean virus burden: 169 vg/mL, p Our study demonstrates that viral containing particles can be transported via a hospital HVAC system from one patient room to the next. Considering the decrease in detectable virus within the HVAC system, the combination of MERV8+MERV16 filters reduced the virus burden reaching an adjacent room to levels well below the human infectious dosages for influenza and other highly infective viruses. Conclusions: Our findings indicate that MERV8+MERV16 filters provide protection against virus transmission through HVAC systems and are a cost-conscious alternative to HEPA filters.

Funding: None

Disclosures: None