bluuebunny/crossref_metadata_2025 huggingface dataset:
Mehr Engagement der Politikwissenschaft in der Anthropozän-Debatte
Authors: Hickmann Thomas , Partzsch Lena , Pattberg Philipp , Weiland Sabine
Published: November 2020

Die aktuelle Debatte um das Anthropozän wird bislang von den Naturwissenschaften dominiert. Dies führt zu einer verkürzten Analyse von Naturzerstörungen und der zugrundliegenden Veränderungen der Mensch-Umwelt-Beziehungen. In diesem Kommentar fordern wir die Politikwissenschaft auf, sich an der Debatte über das sogenannte Menschenzeitalter und seine weitreichenden Implikationen stärker zu beteiligen. Das Anthropozän zeichnet sich insbesondere durch komplexe Wechselwirkungen, nicht-lineare Dynamiken und Kipppunkte aus, an denen Entwicklungen umschlagen. Vor diesem Hintergrund wird deutlich, dass es im Anthropozän kein einfaches Management des menschlichen Einflusses auf das Erdsystem geben kann. Um die Ursachen und potenziellen Lösungen menschengemachter Umweltprobleme zu erforschen, sind Fragen nach Machtverhältnissen, Interessengegensätzen sowie Normkonflikten zentral. Die Politische Theorie ist zudem für die Beantwortung der Frage, wie sich die existierenden politischen Institutionen im Anthropozän reformieren lassen, höchst relevant. Der Politikwissenschaft kommt daher in der Anthropozän-Debatte eine besondere Rolle zu. Das Anthropozän sollte dabei nicht nur ein Thema für die umweltpolitikwissenschaftliche Forschung bleiben. Vielmehr ist ein Beitrag der Politikwissenschaft in der gesamten Breite der Disziplin notwendig, um in einem interdisziplinären Dialog adäquate Antwortstrategien auf systemgefährdende globale Umweltveränderungen zu entwickeln.
Mechanosynthesis of polymer-stabilized lead bromide perovskites: insight into the formation and phase conversion of nanoparticles
Authors: Jiang Guocan , Erdem Onur , Hübner René , Georgi Maximilian , Wei Wei , Fan Xuelin , Wang Jin , Demir Hilmi Volkan , Gaponik Nikolai
Published: November 2020

The application of polymers to replace oleylamine (OLA) and oleic acid (OA) as ligands for perovskite nanocrystals is an effective strategy to improve their stability and durability especially for the solution-based processing. Herein, we report a mechanosynthesis of lead bromide perovskite nanoparticles (NPs) stabilized by partially hydrolyzed poly(methyl methacrylate) (h-PMMA) and high-molecular-weight highly-branched poly(ethylenimine) (PEI-25K). The as-synthesized NP solutions exhibited green emission centered at 516 nm, possessing a narrow full-width at half-maximum of 17 nm and as high photoluminescence quantum yield (PL QY) as 85%, while showing excellent durability and resistance to polar solvents, e.g., methanol. The colloids of polymer-stabilized NPs were directly processable to form stable and strongly-emitting thin films and solids, making them attractive as gain media. Furthermore, the roles of h-PMMA and PEI-25K in the grinding process were studied in depth. The h-PMMA can form micelles in the grinding solvent of dichloromethane to act as size-regulating templates for the growth of NPs. The PEI-25K with large amounts of amino groups induced significant enrichment of PbBr2 in the reaction mixture, which in turn caused the formation of CsPb2Br5-mPbBr2 and CsPbBr3-Cs4PbBr6-nCsBr NPs. The presence of CsPbBr3-Cs4PbBr6-nCsBr NPs was responsible for the high PL QY, as the Cs4PbBr6 phase with a wide energy bandgap can passivate the surface defects of the CsPbBr3 phase. This work describes a direct and facile mechanosynthesis of polymer-coordinated perovskite NPs and promotes in-depth understanding of the formation and phase conversion for perovskite NPs in the grinding process.
The Hushoot Shiveetiin gol section (Baruunhuurai Terrane, Mongolia): sedimentology and facies from a Late Devonian island arc setting
Authors: Munkhjargal A. , Königshof P. , Hartenfels S. , Jansen U. , Nazik A. , Carmichael S. K. , Waters J. A. , Gonchigdorj S. , Crônier C. , Yarinpil A. , Paschall O. , Dombrowski A.
Published: November 2020

A Late Devonian to (?)Early Mississippian section at Hushoot Shiveetiin gol in the Baruunhuurai Terrane of the Central Asian Orogenic Belt (CAOB) exposes large parts of cyclic Famennian shallow-water siliciclastic shelf deposits composed of siltstones, sandstones, shales, volcaniclastics, and intercalated autochthonous carbonates. The youngest part of the section, possibly Early Mississippian, is represented by arkosic sandstones with large plant remains. The facies reflects a range from shallow-intertidal to outer ramp settings. In terms of conodont stratigraphy, the Hushoot Shiveetiin gol section ranges from thePalmatolepis minuta minutaBiozone to at least thePalmatolepis rugosa trachyteraBiozone. Hiatuses of several conodont biozones occur due to the facies setting (erosion and reworked sediments which are recognized by reworked conodonts) rather than thrusting or folding. The environmental setting was characterized by coeval subaerial volcanism resulting in numerous pyroclastic deposits. The depositional environments and intense volcanic activity at the Hushoot Shiveetiin gol section limited the stratigraphic distribution, abundance, and diversity of many elements of the fauna such as brachiopods. Ostracods were very abundant and diverse through many parts of the section. Although limited in stratigraphic distribution, the crinoid fauna is the most diverse Palaeozoic fauna collected from Mongolia to date and supports the hypothesis that the CAOB was a biodiversity hotspot in the aftermath of the Frasnian–Famennian extinction event.
Assessment of environmental water requirement for rivers of the Miankaleh wetland drainage basin
Authors: Gholami V. , Khalili A. , Sahour H. , Khaleghi M. R. , Tehrani E. Nikzad
Published: November 2020

The Miankaleh wetland, one of the richest ecosystems in the north of Iran, has experienced an unprecedented environmental degradation caused by overexploitation of the water resources and climatic changes in recent years. This research aims to estimate the environmental water requirement (EWR) for the rivers that drain into the wetland. For this purpose, comprehensive data were collected through physiographic, climatic, hydrologic, ecologic, and field studies of the wetland and its drainage basin. To estimate the EWR, we applied several methods including the Tenant, the Eco-deficit, the flow duration curve, the Wetted-Perimeter method, and the physical habitat simulation model (PHABSIM) and the results were evaluated based on the natural discharge of the rivers before retrogression of the Miankaleh wetland. Further, the results showed that the consideration should be given to the Wetted-Perimeter and the PHABSIM Model for estimation of the EWR for the rivers of the Miankaleh wetland given the seasonality of the rivers and hydroclimatic condition of the study area. The mean annual EWR of the rivers was estimated between 0.12 and 2.03 m3/s, which is close to the values of the bank full flows. The current discharge of the rivers are less than the estimated EWR, showing the discharge rates do not meet the water requirement for aquatic species of the Miankaleh wetland
Why Ectogestation Is Unlikely to Transform the Abortion Debate: a Discussion of ‘Ectogestation and the Problem of Abortion’
Authors: Rodger Daniel
Published: November 2020

In this commentary, I will consider the implications of the argument made by Christopher Stratman (2020) in ‘Ectogestation and the Problem of Abortion’. Clearly, the possibility of ectogestation will have some effect on the ethical debate on abortion. However, I have become increasingly sceptical that the possibility of ectogestation will transform the problem of abortion. Here, I outline some of my reasons to justify this scepticism. First, I argue that virtually everything we already know about unintended pregnancies, abortion and adoption does not prima facie support the assumption that a large shift to ectogestation would occur. Moreover, if ectogestation does not lead to significant restrictions to abortion, then there will be no radical transformation of the practice of abortion. Second, abortion is already associated with stigma, and so the presence of ectogestation would need to create additional stigma to modify behaviour. Finally, I argue that ectogestation shifts the debate away from the foetus to the human subject of the artificial womb—the gestateling, therefore creating a new category of killing—gestaticide. However, this would only reorient the debate rather than end it.
Effects of Rainfall and Underlying Surface on Flood Recession—The Upper Huaihe River Basin Case
Authors: Cheng Yashan , Sang Yanfang , Wang Zhonggen , Guo Yuhan , Tang Yin
Published: November 2020

The effects of rainfall and underlying surface conditions on flood recession processes are a critical issue for flood risk reduction and water use in a region. In this article, we examined and clarified the issue in the upper Huaihe River Basin where flood disasters frequently occur. Data on 58 rainstorms and flooding events at eight watersheds during 2006–2015 were collected. An exponential equation (with a key flood recession coefficient) was used to fit the flood recession processes, and their correlations with six potential causal factors—decrease rate of rainfall intensity, distance from the storm center to the outlet of the basin, basin area, basin shape coefficient, basin average slope, and basin relief amplitude—were analyzed by the Spearman correlation test and the Kendall tau test. Our results show that 95% of the total flood recession events could be well fitted with the coefficient of determination (R2) values higher than 0.75. When the decrease rate of rainfall intensity (Vi) is smaller than 0.2 mm/h2, rainfall conditions more significantly control the flood recession process; when Vi is greater than 0.2 mm/h2, underlying surface conditions dominate. The result of backward elimination shows that when Vi takes the values of 0.2–0.5 mm/h2 and is greater than 0.5 mm/h2, the flood recession process is primarily influenced by the basin’s average slope and basin area, respectively. The other three factors, however, indicate weak effects in the study area.
Effect of surface roughness on the angular acceleration for a droplet on a super-hydrophobic surface
Authors: Li Longyang , Zhu Jingfang , Zeng Zhixiang , Liu Eryong , Xue Qunji
Published: November 2020

The motion of droplets on a super-hydrophobic surface, whether by sliding or rolling, is a hot research topic. It affects the performance of super-hydrophobic materials in many industrial applications. In this study, a super-hydrophobic surface with a varied roughness is prepared by chemical-etching. The adhesive force of the advancing and receding contact angles for a droplet on a super-hydrophobic surface is characterized. The adhesive force increases with a decreased contact angle, and the minimum value is 0.0169 mN when the contact angle is 151.47°. At the same time, the motion of a droplet on the super-hydrophobic surface is investigated by using a high-speed camera and fluid software. The results show that the droplet rolls instead of sliding and the angular acceleration increases with an increased contact angle. The maximum value of the angular acceleration is 1,203.19 rad/s2 and this occurs when the contact angle is 151.47°. The relationship between the etching time, roughness, angular acceleration, and the adhesion force of the forward and backward contact angle are discussed.
Phenological growth stages and BBCH-identification keys of Chilli (Capsicum annuum L., Capsicum chinense JACQ., Capsicum baccatum L.)
Authors: Feldmann Falko , Rutikanga Arsène
Published: November 2020

Since a decade, the need for experience transfer between production regions of chillies (Capsicum spp.) is developing worldwide. In order to ease communication, we propose here a new description and codification of phenological growth stages of Capsicum spp. according to a modified BBCH scale. In contrast to older descriptions basing on 2-digit macro-stages and 3-digit micro-stages, we use the meso-stages as own, independent codification element. Doing so, it was possible to combine qualitative and quantitative changes in growth stages within the 3-digit system.
Targeting Fatal Traffic Collision Risk from Prior Non-Fatal Collisions in Toronto
Authors: Bavcevic Zeljko , Harinam Vincent
Published: November 2020

Research question

How accurately can all locations of 44 fatal collisions in 1 year be forecasted across 1403 micro-areas in Toronto, based upon locations of all 1482 non-fatal collisions in the preceding 4 years?

Data

All 1482 non-fatal traffic collisions from 2008 through 2011 and all 44 fatal traffic collisions in 2012 in the City of Toronto, Ontario, were geocoded from public records to 1403 micro-areas called ‘hexagonal tessellations’.

Methods

The total number of non-fatal traffic collisions in Period 1 (2008 through 2011) was summed within each micro-area. The areas were then classified into seven categories of frequency of non-fatal collisions: 0, 1, 2, 3, 4, 5, and 6 or more. We then divided the number of micro-areas in each category in Period 1 into the total number of fatal traffic collisions in each category in Period 2 (2012). The sensitivity and specificity of forecasting fatal collision risk based on prior non-fatal collisions were then calculated for five different targeting strategies.

Findings

The micro-locations of 70.5% of fatal collisions in Period 2 had experienced at least 1 non-fatal collision in Period 1. In micro-areas that had zero non-fatal collisions during Period 1, only 1.7% had a fatal collision in Period 2. Across all areas, the probability of a fatal collision in the area during Period 2 increased with the number of non-fatal collisions in Period 1, with 6 or more non-fatal collisions in Period 1 yielding a risk of fatal collision in Period 2 that was 8.7 times higher than in areas with no non-fatal collisions. This pattern is evidence that targeting 25% of micro-areas effectively could cut total traffic fatalities in a given year by up to 50%.

Conclusion

Highly elevated risks of traffic fatalities can be forecasted based on prior non-fatal collisions, targeting a smaller portion of the city for more concentrated investment in saving lives.
Veolia's versatile SIRION reverse osmosis systems range continues to grow
Authors: Atkinson Simon
Published: November 2020

Veolia Water Technologies’ SIRION™ product line, which is based on reverse osmosis technology, has been developed for a range of applications, including the production of pure water, sea-water desalination and efficient water reuse. This focus article looks at the latest addition to this line of versatile systems that already consists of a range of other product categories.
Patrimonialities
Authors: Hafstein Valdimar Tr. , Skrydstrup Martin
Published: November 2020

With empirical touchstones from Europe, North America, Africa, Asia and the Pacific, the authors argue that heritage and property represent different approaches to subject formation, produce distinct bodies of expertise, and belong to different rationalities of government in a global patrimonial field: that cultural property is a technology of sovereignty, part of the order of the modern liberal state, but cultural heritage a technology of reformation that cultivates responsible subjects and entangles them in networks of expertise and management. While particular case trajectories may shift back and forth from rights-based claims and resolutions under the sign of cultural property to ethical claims and solutions under the sign of cultural heritage, the authors contend that there is significant analytical purchase to be gained from their distinction. Using a critical, comparative approach, they make the case for a historically grounded and theoretically informed understanding of the difference between the two terms.
Risk Factors for Cesarean Section Surgical Site Infections: A Systematic Review
Authors: Visan Feah , Castro Jenalyn , Shahada Yousra Siam , Ansari Naser Al , Zakaria Almunzer
Published: November 2020

Background: According to the CDC NHSN, surgical site infections (SSI) are wound infections that develop within 30 days postoperatively for nonimplanted surgeries such as cesarean sections. SSIs is shown to manifest in a continuum of a purulent discharge from surgical site to severe sepsis. It contributes to rising morbidity, mortality and prolonged length of stay. Objective: To describe risk factors to the development of SSI in cesarean section in descriptive studies. Methods: The Preferred Reporting Items for Systematic Reviews (PRISMA) reporting guidelines is used as method for this systematic review. A PubMed literature search was conducted, limited to published articles in English from 1998 to 2016 using the broad key terms “cesarean section,” “surgical site infection,” and “risk factor.” The following inclusion criteria were applied to all reviews: (1) peer-reviewed journal, (2) computed risk factor for SSI development, and (3) calculated SSI rate. Reviews of references of the include studies were conducted, and 7 studies were appraised, with only 1 accepted. Results: After extracting data from 52 article reviews, 23 were finally accepted based on the inclusion criteria. Most studies were multivariate studies (n = 8) followed by cohort studies (n = 6). Unique numerators and denominators for SSI reviews were mentioned in all 23 studies, of which 22 studies followed the CDC NHSN definitions for SSI. Within the 23 studies, most studies showed that obesity (11.46%) is a common maternal risk factor for the development of postoperative cesarean section SSI. Conclusions: Identifying that obesity is a major contributor of surgical site infection in postoperative cesarean section women is a topic that warrants exploration. The relationship of cesarean section SSI to obesity should be investigated, specifically highlighting the level of obesity based on the WHO international body mass index (BMI) classification and the development of SSI. A correlation between increasing wound infection rates and increasing body mass index should be studied further. Published recommendations for preventing SSIs in this population should be reviewed.

Funding: None

Disclosures: None
The Development of an Environmental Surveillance Protocol to Detect Candida auris and Measure the Adequacy of Discharge Room Cleaning Performed by Different Methods
Authors: Solomon Sadie , Phillips Michael , Kelly Anne , Darko Akwasi , Palmeri Frank , Aguilar Peter , Gardner Julia , Medefindt Judith , Sterling Stephanie , Aguero-Rosenfeld Maria , Stachel Anna
Published: November 2020

Background: Contaminated surfaces within patient rooms and on shared equipment is a major driver of healthcare-acquired infections (HAIs). The emergence of Candida auris in the New York City metropolitan area, a multidrug-resistant fungus with extended environmental viability, has made a standardized assessment of cleaning protocols even more urgent for our multihospital academic health system. We therefore sought to create an environmental surveillance protocol to detect C. auris and to assess patient room contamination after discharge cleaning by different chemicals and methods, including touch-free application using an electrostatic sprayer. Surfaces disinfected using touch-free methods may not appear disinfected when assessed by fluorescent tracer dye or ATP bioluminescent assay. Methods: We focused on surfaces within the patient zone which are touched by the patient or healthcare personnel prior to contact with the patient. Our protocol sampled the over-bed table, call button, oxygen meter, privacy curtain, and bed frame using nylon-flocked swabs dipped in nonbacteriostatic sterile saline. We swabbed a 36-cm2 surface area on each sample location shortly after the room was disinfected, immediately inoculated the swab on a blood agar 5% TSA plate, and then incubated the plate for 24 hours at 36°C. The contamination with common environmental bacteria was calculated as CFU per plate over swabbed surface area and a cutoff of 2.5 CFU/cm2 was used to determine whether a surface passed inspection. Limited data exist on acceptable microbial limits for healthcare settings, but the aforementioned cutoff has been used in food preparation. Results: Over a year-long period, terminal cleaning had an overall fail rate of 6.5% for 413 surfaces swabbed. We used the protocol to compare the normal application of either peracetic acid/hydrogen peroxide or bleach using microfiber cloths to a new method using sodium dichloroisocyanurate (NaDCC) applied with microfiber cloths and electrostatic sprayers. The normal protocol had a fail rate of 9%, and NaDCC had a failure rate of 2.5%. The oxygen meter had the highest normal method failure rate (18.2%), whereas the curtain had the highest NaDCC method failure rate (11%). In addition, we swabbed 7 rooms previously occupied by C. auris–colonized patients for C. auris contamination of environmental surfaces, including the mobile medical equipment of the 4 patient care units that contained these rooms. We did not find any C. auris, and we continue data collection. Conclusions: A systematic environmental surveillance system is critical for healthcare systems to assess touch-free disinfection and identify MDRO contamination of surfaces.

Funding: None

Disclosures: None
The Process of Developing and Implementing a Simplified Guideline for Hand Hygiene in the Operating Room
Authors: Dijk Manon van , Breejen Mieke Waltmans-den , Vermeeren Joke , Berg Sonja van den , Beeck Ed van , Vos M.
Published: November 2020

Background:
Most studies on improving hand hygiene compliance (HHC) focus on clinical wards. The 5 Moments of Hand Hygiene, as stated by the WHO, are less easy to identify in an outpatient setting or procedure rooms. Therefore, observing compliance of these moments in an outpatient clinic or among healthcare workers (HCWs) in the operating room (OR), is far more difficult. Nonetheless, proper hand hygiene in the OR is of utmost importance to prevent postoperative wound infection. Objective: We developed and implement a scoring instrument with simplified moments of hand hygiene for nonsterile HCWs in the OR. Methods: All 13 hospitals of the Antibiotic Resistance Network Southwest Netherlands were asked to submit their guidelines on hand hygiene in the OR. These guidelines were, after discussion, combined into 1 guideline, describing different hand hygiene areas for different groups of nonsterile HCWs in the OR. After asking for feedback and incorporating these adjustments, the guideline was converted into a policy document. Based on this document, a paper scoring instrument was developed to observe HHC in the OR in a uniform way across all hospitals. The Erasmus University Medical Center Rotterdam, the Netherlands (Erasmus MC) acted as a pilot hospital where the implementation of the scoring instrument was studied. Results: The policy document has been approved by the infection committees of all 13 hospitals. The preliminary data of the pilot in the Erasmus MC, although still ongoing, are as follows. Hand hygiene in the OR was observed at 4 different time points. The anesthetist was observed once during 4 procedures in 3 different ORs. At the other 3 time points, the OR assistants (ie, OR nurses and circulating nurses) were observed during 4 procedures in 4 different ORs. Hand hygiene moments were easy to identify; the paper scoring instrument could be used to record observations of HHC in the OR. Conclusions: The guideline with the simplified moments of hand hygiene for nonsterile HCWs in the OR has been successfully implemented. The pilot test in the Erasmus MC already showed that, after defining the hand hygiene moments in the OR, the HHC in the OR is easier to observe and record using the scoring instrument. Moreover, the instrument has provided clarity for HCWs regarding the moments ate which they should disinfect their hands.

Funding: None

Disclosures: None
Utilizing Telemedicine During Outbreak Events to Reduce Exposure Risk
Authors: Bisht Anjali , Weinstein Stacey , Uslan Daniel
Published: November 2020

Background: As of October 2019, the United States has seen the greatest number of annual measles cases reported since 1992, of which 2 outbreaks originated in Los Angeles County, California. Media reports and public awareness during outbreak events can result in large numbers of worried well patients or patients with outbreak mimics seeking medical attention. In densely populated cities, utilizing alternative approaches to in-person physician appointments can be beneficial to decrease both the overburden of healthcare resources as well as the spread of potential virus. During these measles outbreaks, we employed the use of telemedicine visits to facilitate triage and determination of in-person examination and testing needs. Methods: During the measles outbreak periods, patients who contacted the patient call center at our institution requesting an appointment for fever, rash, or expressing concerns for acute measles infection were instead routed for a telemedicine visit with a physician. All patients were all seen by the same physician, who was trained in internal medicine and pediatrics. During the telemedicine visit, patients were assessed for signs and symptoms consistent with acute measles based on CDC definition. If there was high enough clinical suspicion to warrant testing for measles, infection prevention coordinated logistics with clinic staff, including ensuring the use of appropriate personal protective equipment (PPE), end-of-day appointment scheduling, and appropriate diagnostic testing. Results: During this outbreak timeline, 7 patients were seen through telemedicine visits with ages ranging 13 months to 49 years. Also, 6 patients were scheduled due to a chief complaint of acute rash and 1 was due to a potential exposure to measles. Of 7 patients, 4 had received 1 dose of the MMR vaccine, and the remaining 3 were immune, unvaccinated, or had unknown immunity. The unvaccinated patient was further tested for measles but was IgM negative. Of those with chief complaint of rash, the diagnosis was determined to be some form of nonmeasles viral exanthem, allergic dermatitis/eczema, or hives. The exposed patient was deemed to be asymptomatic. Conclusions: During an outbreak, patients presenting to clinics with suspected measles symptoms can cause tremendous disruption, including concerns about exposure of staff and patients, need for contact tracing, and anxiety. Utilizing telemedicine appointments aided the management of patients during this outbreak by shifting physician evaluation outside the clinic. When evaluating suspect measles cases during an outbreak with patients who do not require further levels of care, telemedicine can prove to be useful in reducing the burden of potential exposure to others in the community and to the healthcare system.

Funding: None

Disclosures: None
Qualitative Visual Assessment of Hand Hygiene Product Effectiveness
Authors: Czaplicki Mary , Attar Shorook , Green Kristen , Leslie Rachel
Published: November 2020

Background: Effective hand hygiene (HH) is an essential preventative measure for the reduction of hospital-acquired infections (HAIs). Commonly used HH products include alcohol-based hand rubs (ABHRs), antimicrobial soaps, and nonantimicrobial soaps. In vivo clinical studies have demonstrated that levels of bacterial reduction can vary based on the HH product type, formulation, and dose. It has been reported that ABHRs provide the greatest reduction in bacteria, followed by antimicrobial soaps. Objective: We examined the effects of products representative of 3 HH categories on artificially soiled hands, using a hand-stamp procedure. The hand-stamp images provide a clear visualization of product effectiveness and can be used as an educational tool to promote the importance of proper hand hygiene using different product formats. Method: Three commercially available formulations were evaluated in this study, a mild nonantimicrobial soap, an antimicrobial soap containing chloroxylenol (PCMX), and an ABHR containing 70% v/v ethanol. Prior to the hand stamp procedure, the participant’s hands were prewashed with 5 mL of a nonantimicrobial soap and dried. An inoculum of Serratia marcescens containing ∼1 × 109CFU/mL was prepared as described in ASTM E2755. A 0.2-mL aliquot of the inoculum was dispensed onto the palm of the subject’s hand and spread by rubbing over the entire surface of both hands. Following a 30-second dry time, one of the subject’s hands was gently pressed onto the surface of a large petri dish containing tryptic soy agar to obtain a baseline image. Following the baseline sample, 1 pump of the selected test product (∼0.9 mL for soap or 1.1 mL for ABHR) was applied to the participant’s hands. For soap applications, hands were vigorously rubbed for 30 seconds followed by a 30-second water rinse. For ABHR, product was rubbed by the user until dry. The hand-stamp procedure was repeated following product application using the participant’s other hand. Results: Clear qualitative reductions in bacteria were observed with each of the HH interventions. The greatest reduction was observed following the application of ABHR. Antimicrobial soap was less effective than ABHR but more effective than nonantimicrobial soap. Conclusions: The qualitative visual model demonstrates the effectiveness of various HH interventions and correlates with log reductions observed in traditional efficacy test methods. Future efforts should explore hand-stamp repeatability and image utilization to support HH improvement efforts in healthcare systems.

Funding: GOJO Industries provided support for this study.

Disclosures: Mary Rose Czaplicki reports salary from GOJO Industries.
The Effect of Automated Hand Hygiene Monitoring Systems and Other Complementary Behavior-Change Strategies on Performance
Authors: Arbogast James , Moore Lori , DiGiorgio Megan , Boyce John , Parker Albert
Published: November 2020

Background:
Technology and interest for use of automated hand hygiene monitoring systems (AHHMS) as a tool to help improve healthcare personnel hand hygiene has been advancing for the last decade. Emerging evidence indicates that the use of AHHMS plus complementary strategies improves hand hygiene (HH) performance rates and outcomes (eg, healthcare-associated infections). The WHO HH guideline “Multimodal Strategy” teaches the importance of multiple components as necessary to build and sustain HH compliance. Few published data compare the impact of different complementary behavioral strategies in combination with AHHMS on results. Methods: We utilized data from 1 AHHMS that records alcohol-based hand rub and soap dispensing and room entries and exits to provide group HH performance rates. Data were collected from 58 units in 10 hospitals in North America from July 2014 through August 2019. Hospitals were stratified into 4 categories based on their approach to hospital-initiated unit-level interventions and AHHMS vendor support (Table 1). Baseline data were defined for each unit as the initial 1–2 months of execution, before complementary strategies were initiated. Statistical analysis was performed on the annual number of dispenses and opportunities with a mixed-effects Poisson regression with random effects for facility, unit and year and fixed effects for intervention type and unit type. Interactions were not included in the model based on interaction plots and significance tests. Poisson assumptions were verified with Pearson residual plots. Results: HH performance rates overall and compared to the baseline are shown in Table 2. More than 8 million opportunities were achieved in all 58 units combined. An intervention strategy with multiple complementary components (ie, clinical support provided by the AHHMS vendor plus hospital-initiated unit level interventions) yielded significantly better HH performance than all other categories (>20% increase, P < .00001). Somewhat surprisingly, vendor clinical support or hospital-initiated, unit-level interventions alone with the AHHMS yielded a slight decrease in HH performance relative to AHHMS only (P < .00001). Conclusions: AHHMS is a useful tool in understanding HH performance and identifying unit-based initiatives that need attention. Implementation of an AHHMS by itself or with limited complementary behavior-change strategies does not drive improvement. Support provided by the vendor and hospital-initiated, complementary strategies were not sufficient additions to the AHHMS individually, but in combination they resulted in the greatest improvements in HH performance. These findings illustrate the value of a partnership between the hospital and the AHHMS vendor.

Funding: GOJO Industries, Inc., provided support for this study.

Disclosures: James W. Arbogast, Lori D. Moore and Megan DiGiorgio report salary from GOJO Industries.
Characterization of Ceftazidime-Avibactam-Resistant Carbapenem-Resistant Enterobacteriaceae, United States, 2015–2017
Authors: Ansari Uzma , Reses Hannah E. , Grass Julian , Nadle Joelle , Bower Chris , Jacob Jesse , Vaeth Elisabeth , Witwer Medora , Hancock Emily , Dale Suzanne , Dumyati Ghinwa , Beldavs Zintars , Muleta Daniel , Duffy Nadezhda , See Isaac , Lutgring Joseph
Published: November 2020

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are a major public health problem. Ceftazidime-avibactam (CZA) is a treatment option for CRE approved in 2015; however, it does not have activity against isolates with metallo-β-lactamases (MBLs). Emerging resistance to CZA is a cause for concern. Our objective was to describe the microbiologic and epidemiologic characteristics of CZA-resistant (CZA-R) CRE. Methods: From 2015 to 2017, 9 states participated in laboratory- and population-based surveillance for carbapenem-resistant Escherichia coli, Klebsiella pneumoniae, K. oxytoca, K. aerogenes, and Enterobacter cloacae complex isolates from a normally sterile site or urine. A convenience sample of isolates from this surveillance were sent to the CDC for antimicrobial susceptibility testing (AST) using reference broth microdilution (BMD) including an MBL screen, species confirmation with MALDI-TOF, and real-time PCR to detect blaKPC, blaNDM, and blaOXA-48–like genes. Additional AST by BMD was performed on CZA-R isolates using meropenem-vaborbactam (MEV), imipenem-relebactam (IMR), plazomicin (PLZ), and eravacycline (ERV). Epidemiologic data were obtained from a medical record review. Community-associated cases were defined as having no healthcare exposures in the year prior to culture, no devices in place 2 days prior to culture, and culture collected before calendar day 3 after hospital admission. Data were analyzed in 3 groups: CRE that were CZA-susceptible (CZA-S), CZA-R that were due to blaNDM, and CZA-R without blaNDM. Results: Among 606 confirmed CRE tested with CZA, 33 (5.4%) were CZA-R. Of the CZA-R isolates, 16 (48.5%) harbored a blaNDM gene, of which 2 coharbored blaNDM and blaOXA-48-like genes; 9 (27.3%) harbored only a blaKPC gene. Of the 17 CZA-R isolates without blaNDM, all were MBL screen negative. CZA-R due to blaNDM were more frequently community-associated (43.8%) than CZA-S or CZA-R without blaNDM (11.0% and 5.9%, respectively); a higher percentage of CZA-R cases due to blaNDM also had recent international travel (25%) compared to the other groups (1.8% and 5.9%, respectively). CZA-R without blaNDM were more susceptible to MEV (76%), IMR (71%), PLZ (88%), and ERV (65%) compared to CZA-R due to blaNDM (19%, 6%, 56%, and 44%, respectively). Conclusions: The emergence of CZA-R isolates without blaNDM are concerning; however, these isolates are more susceptible to newer antimicrobials than those with blaNDM. In addition to high rates of resistance to newer antimicrobials, isolates with blaNDM are more frequently community-associated than other CRE. This underscores the need for more aggressive measures to stop the spread of CRE.

Funding: None

Disclosures: None
Implementation of a Female External Urinary Catheter Reduces Indwelling Urinary Catheter Use and Catheter-Associated Urinary Tract Infections
Authors: Gentile Paul , Jacob Jesse , Ashraf Shanza
Published: November 2020

Background: Using alternatives to indwelling urinary catheters plays a vital role in reducing catheter-associated urinary tract infections (CAUTIs). We assessed the impact of introducing female external catheters on urinary catheter utilization and CAUTIs. Methods: In a 500-bed academic medical center, female external catheters were implemented on October 1, 2017, with use encouraged for eligible females with urinary incontinence but not meeting other standard indications for urinary catheters. Nurses were educated and trained on female external catheter application and maintenance, and infection prevention staff performed surveillance case reviews with nursing and medical staff. We determined the number of catheter days for both devices based on nursing documentation of device insertion or application, maintenance, and removal. We used the CAUTI and DUR (device utilization ratio) definitions from the CDC NHSN. Our primary outcomes were changes in DUR for both devices 21 months before and 24 months after the intervention in both intensive care units (ICUs) and non-ICU wards. We used a generalized least-squares model to account for temporal autocorrelation and compare the trends before and after the intervention. Our secondary outcome was a reduction in CAUTIs, comparing females to males. Results: In total, there were 346,213 patient days in 35 months. The mean rate of patient days per month increased from 7,436.4 to 7,601.9 after the implementation of female external catheters, with higher catheter days for both urinary catheters (18,040 vs 19,625) and female external catheters (22 vs 12,675). After the intervention, the DUR for female external catheters increased (0 vs 0.07; P < .001) and for urinary catheters the DUR decreased (0.12 vs 0.10; P < .001) (Fig. 1). A reduction in urinary catheter DUR was observed in ICUs (0.29 vs 0.27; P < .001) but not wards (0.08 vs 0.08; P = NS) (Fig. 2). Of the 39 CAUTIs, there was no significant overall change in the rate per 1,000 catheter days (1.22 vs 0.87; P = .27). In females (n = 20 CAUTI), there was a 61% reduction in the CAUTI rate per 1,000 catheter days (0.78 vs 0.31; P = .02), but no significant change in the rate in males (0.44 vs 0.56; P = .64). The CAUTI rate per 1,000 catheter days among females decreased in the ICUs (1.14 vs 0.31; P = .04) but not in wards (0.6 vs 0.33; P = .96). Conclusions: In a setting with a baseline low UC DUR, successful implementation of female external catheters further modestly reduced UC DUR and was associated with a 61% decrease in CAUTI among females in the ICU but not in wards. Further interventions to better identify appropriate patients for female external catheters may improve patient safety and prevent patient harm.

Funding: None

Disclosures: None
Infection Preventionist Run Clostridioides difficile Testing Diagnostic Stewardship Protocol- Experience From a Rural Community Hospital
Authors: Tirupathi Raghavendra , Freshman Ruth , Montoy Norma J , Gross Melissa
Published: November 2020

Background: Distinguishing active Clostridioides difficile infection (CDI) from asymptomatic colonization remains a challenging task in the era of PCR testing. Inappropriate testing leads to overtesting and overdiagnosis, inadvertent treatment, and isolation in addition to laboratory identified (LabID) events, leading to increased incidence to hospital-onset CDI (HO-CDI). The institution has a nurse-driven C. difficile test ordering protocol, and we noted a significant increase in the HO-CDI incidence in 2017 due to inappropriate testing, with rates as high as 0.94 per 1,000 patient days. Methods: In September 2017, a multidisciplinary team reviewed and initiated algorithm-based testing with mandatory audit and review by infection preventionists (IPs) under the guidance of an ID physician of all ordered tests. They reviewed the adequacy and legitimacy of order for multiple parameters, including minimum 3 loose stools in 24 hours, use of laxatives in last 24 hours, consistency of the sample, presence of at least 1 clinical parameters (ie, fever, abdominal pain, leukocytosis, sepsis, or septic shock), recent or concomitant antibiotic use, recent PCR testing in the last 14 days, and chart review for medical and/or surgical history. The IPs served as the gatekeepers to testing and rejected the samples that were deemed inappropriate. Ambiguous cases were discussed with the ID specialist. On the microscope lab side, all specimens sent were batched to be run twice a day at 8:30 a.m. and 2:30 p.m., and testing was performed only on the samples cleared by infection preventionists. Results: The number of PCR tests completed in the comparison quarter of 2016 was 220, which decreased to 157 tests in 2017 with a reduction of 28%. After a full year of implementation of the diagnostic stewardship protocol, the number of completed PCR tests decreased to 626 from 940 PCR tests in 2016, with an overall 34% decrease in testing. In the year following the implementation of diagnostic stewardship, HO-CDI decreased from 60 events in 2017 to 43 events in 2018, with a reduction of 28%. Subsequently, HO-CDI further decreased in 2019 from 43 to 28, with a reduction of 35%. Since the implementation of the project in 2017, HO-CDIs have decreased by 54% overall. The reduction in 314 C. difficile PCR tests in the first year led to a savings of $8,300 in laboratory testing supplies. The reduction of HO CDI by 17 led to cost avoidance of $293,420. Conclusions: Our experience shows that the IP-run diagnostic stewardship program was highly successful in streamlining testing, with cost savings on several fronts.

Funding: None

Disclosures: None

Disclosures:

Commercial Company : If I am presenting research funded by a commercial company, the information presented will be based on generally accepted scientific principals and methods, and will not promote the commercial interest of the funding company.

Disagree

Raghavendra Tirupathi
Data Mining to Guide a Program to Prevent Infection Related Readmissions From Skilled Nursing Facilities
Authors: Stachel Anna , Klock Julie , Ding Dan , Lighter Jennifer , Daniel Kwesi , Waldron Levi
Published: November 2020

Background: Readmissions to hospitals are common, costly and often preventable, notably readmissions due to infections. A 30-day readmission analysis following hospital discharges, found much of the variation in Medicare spending between hospitals was related to readmissions and skilled nursing facility (SNF) care. Although some readmissions of patients with advanced disease are not preventable, efforts to decrease readmission are most effectively directed towards those patients with intermediate levels of a specific risk. A prediction model to identify patients at highest (or intermediate) risk of infection readmission will help healthcare administrators and providers to allocate appropriate resources. Hospitals should use electronic health record (EHR) data with modern data mining techniques to create more curated, sophisticated models as part of a comprehensive transitional care program. We propose using the risk estimates of a validated prediction model to notify stakeholders and develop readmission rate reports by SNF or discharging physician. Methods: We applied machine learning (ML) methods to predict the risk of 30-day readmission due to sepsis and pneumonia of patients discharged to SNF. We used our EHR data during 2012–2017 to train and data from 2018 to validate. We applied ML algorithms to data including logistic regression, random forest, gradient boosting trees, and support vector machine. Data from EDW and EPIC clarity tables were extracted and managed using SAS Base 9.4 and Enterprise Miner 14.3 (SAS Institute, Cary, NC). We assessed the discrimination and calibration to select the most effective prediction model. Using the resulted risk estimates, we created a notification system and reports for key stakeholders. Results: Figures 1 and 2 show the discrimination and calibration results of the final selected gradient boosting model (GBM). For predicting unplanned readmissions with sepsis and with pneumonia within 30 days after discharge to SNF, the c-statistic for final GBM model with 140 features was 0.69 (95% CI 0.65-0.73) and 73 features was 0.71 (95% CI 0.66-0.75), respectively. Table 1 lists features important to the validation set of the prediction model. We used estimates from these models to develop a daily email notification of patients discharged to SNF stratified into a low, medium, and high risk group for sepsis and pneumonia. We additionally created reports with case-mix adjustments to benchmark SNFs and discharging physicians to monitor and understand performance. Conclusions: Hospitals should leverage the plethora of data found in EHRs to curate readmission prediction models, and promote collaboration among transitional care teams and IPC to ultimately reduce readmissions due to sepsis and pneumonia.

Funding: None

Disclosures: None
Mitigating Hospital-Onset Clostridioides difficile: Evaluation of a Standardized Environmental Hygiene Program in Eight Hospitals
Authors: Carling Philip , O'Hara Lyndsay , Harris Anthony , Olmsted Russell
Published: November 2020

Background: Despite ongoing efforts over the past 3 decades, hospital-onset Clostridioides difficile infection (HO-CDI) continues to challenge interventions aimed at its prevention and control. We describe the impact of a model environmental services (EVS) program on the incidence of HO-CDI across 8 hospitals that are part of a nationwide integrated health system. Methods: Eight acute-care hospitals with 44–532 beds (mean, 263 beds) in 6 states with stable endemic HO-CDI incidence densities independently implemented identical sporicidal environmental hygiene interventions in 2017. The program combined the use of a hydrogen peroxide/peroxyacetic acid surface disinfectant for all patient-zone hygienic cleaning combined with a structured model EVS cleaning program that included optimized cleaning and disinfection technique, staff training, and auditing with objective performance feedback, which aligned with 2008 HICPAC/CDC categories I and II as well as 2010 CDC Guidance Level II monitoring program recommendations. After a 3-month phase-in, we compared NHSN-reported LabID HO-CDI SIRs for 18 months before and 12 months after implementation of the program. Results were not shared between sites and data were not collated by the authors until a year after the postintervention results were initially available. Multiple possible confounding factors were evaluated and determined not to have identifiably affected the outcome. Results: Mean preintervention HO-CDI SIRs over the 18 months measured ranged from 0.5 to 1.4 (mean, 1.0 for the group). Following the wash-in period, SIRs decreased precipitously in all sites to a mean of 0.42 for the group by the end of 12 months of the intervention. (P < .0001) (Fig. 1). Individual site improvement ranged from 20% to 92% (mean, 57%) (Fig. 2.) Conclusions: Overall, HO-CDI SIRs decreased almost 60% in the study hospitals following daily sporicidal disinfection cleaning of all patient-zone surfaces in association with ongoing programmatic optimization of cleaning practice. As predicted by earlier single-site studies reporting a favorable impact of sporicidal disinfectant cleaning in outbreak settings, this multisite quasi-experimental study has illustrated the substantial potential impact of hospital-wide sporicidal disinfection integrated with objectively sustained optimized thoroughness of cleaning to decrease the incidence of HO-CDI.

Funding: None

Disclosures: None