bluuebunny/crossref_metadata_2025 huggingface dataset:
854. Infection Prevention vs. Antimicrobial Stewardship: Does Nasal Povidone-Iodine Interfere with Methicillin Resistant Staphylococcus aureus (MRSA) Screening?
Authors: Harrison Cecelia K , Zent Robie , Schneck Elyse , Flynn Cynthia E , Drees Marci
Published: January 2021

Background

As part of universal decolonization, intensive care unit (ICU) patients may receive intranasal mupirocin to reduce MRSA infections. However, due to concerns about widespread use of mupirocin promoting resistance, some have proposed a bactericidal antiseptic, povidone-iodine (P-I), as an alternative. There are few data as to whether either agent reduces the sensitivity of MRSA nares screening. This study aimed to discern whether intranasal P-I interferes with MRSA screening via polymerase chain reaction (PCR) and/or culture.

Methods

We performed a prospective proof-of-concept cohort study at our >1200-bed, community-based academic health care system, enrolling 20 patients who screened MRSA-positive by PCR on admission to a medical ICU, medical-surgical ICU, or medical stepdown unit. All patients received twice-daily intranasal P-I (7.5%) for 5 days or until unit discharge. We obtained follow-up nasal MRSA PCR tests after 4-6 days, and confirmed all PCR results with MRSA cultures using CHROMagar™. We calculated sensitivity of MRSA PCR at follow-up using culture as the gold standard.

Results

Twenty patients were enrolled, with a median age of 72 years (range, 53-91). Most (75%) were admitted with active infection, and 40% had known MRSA history. All baseline PCRs were confirmed by positive culture. Patients underwent a mean of 8.1 (range, 4-13) nasal P-I applications prior to follow-up testing. At follow up, 16/20 (80%) remained MRSA-positive via both PCR and culture. Of the 4 patients with negative follow-up results, 1 was both PCR-/culture-, 2 were PCR+/culture- and 1 was PCR-/culture+. All 4 had received ≥1 doses of vancomycin, and one person had received ≥1 doses of linezolid. The sensitivity of MRSA PCR at follow-up was 94%.

Conclusion

MRSA PCR remains highly sensitive even after multiple applications of P-I, and may be more sensitive than culture. If clinicians wish to screen for MRSA for stewardship or other purposes, receipt of nasal P-I should not be a deterrent. However, the fact that most patients remained culture-positive after 4-13 applications raises concerns that P-I is less effective than mupirocin for clearing nasal colonization. We recommend using quantitative cultures to further investigate the effectiveness of nasal P-I.

Disclosures

All Authors: No reported disclosures
860. A Proposed Standard for Hospital Bioaerosol Monitoring in Avoiding Nosocomial Mould Infections
Authors: Seiler Garret T , Ostrosky-Zeichner Luis , Ferguson Lance , Boston Kelly , Grant Mike , Koehn Jan
Published: January 2021

Background

Recent nosocomial outbreaks of mould infections have been linked to bioaerosols. Active and passive environmental sampling is a primary method of quantifying airborne contamination in the hospital, but currently there are no standardized Occupational Exposure Limits (OELs) for the avoidance of nosocomial infections.

Methods

Between March 2016 and December 2019, 186 post-construction/post-cleaning air samples were collected to measure particle counts based on defined size criteria Lighthouse handheld Particle Counter) and viable air fungal cultures (Anderson single stage N6 Viable Particulate Sampler) across wards of a 1,082 bed hospital in Houston, Texas, and compared with outdoor controls. Areas were cleared for occupancy if the ≤ 0.3micron particle counts were reduced by the expected efficacy of the HVAC unit and if indoor fungi airborne concentrations in CFU/m³ were also reduced or did not exceed the outdoor ambient reference levels for each separate day of site assessment.

Results

The mean counts of particles ≤ 0.3microns were as follows: floors 37,427.50 (-32% reduction), operating rooms 8,163.88 (95% reduction), OR sterile core 15,001.31 (89% reduction), ICU 7,640.15 (93% reduction), radiology suites 1,046.25 (97% reduction), and outpatient areas 17,891.58 (82% reduction). The table indicates the reported mean density (CFU/m³) data and species of fungi isolated in viable bioaerosol samples, 13 of which matched outdoor reference isolates. The mean density of outdoor cultures was 292.37 compared to all indoor units 24.53 (91.61% reduction), floors 25.44 (91.3% reduction), ICUs 28.19 (90.4% reduction), radiology suites 22.5 (92.3% reduction), and ORs 12.79 (95.6% reduction). During this time, no nosocomial fungal infections or outbreaks were documented for the institution.

Table 1: Mean Density (cfu/mm3) of Fungal Species per Location

Conclusion

An indoor air quality standard comprised of particle count data reduced by the expected efficacy of the operating HVAC unit and also existing indoor viable fungi in units of CFU/m³ that did not exceed the outdoor reference could potentially be correlated with avoidance of nosocomial mould infections.

Disclosures

Luis Ostrosky-Zeichner, MD, Amplyx (Scientific Research Study Investigator)Astellas (Consultant, Scientific Research Study Investigator, Other Financial or Material Support, Non-branded educational speaking)Biotoscana (Consultant, Other Financial or Material Support, Non-branded educational speaking)Cidara (Consultant, Scientific Research Study Investigator)F2G (Consultant)Gilead (Consultant)Mayne (Consultant)Octapharma (Consultant)Pfizer (Other Financial or Material Support, Non-branded educational speaking)Scynexis (Consultant, Grant/Research Support, Scientific Research Study Investigator)Stendhal (Consultant)Viracor (Consultant)
864. Whole Genome Sequencing is Unable to Track Candida auris Transmission
Authors: Roberts Scott C , Ozer Egon A , Zembower Teresa , Qi Chao
Published: January 2021

Background

Candida auris (C. auris), an emerging yeast species, is often drug-resistant and has caused outbreaks in healthcare settings. Surging C. auris cases at our institution prompted whole genome sequencing (WGS) of patient and environmental specimens and comparison to local and international isolates.

Methods

WGS was performed on clinical and environmental isolates obtained from Northwestern Memorial Hospital (NMH) from June 2018 to December 2019. Genome sequences were compared against isolates from other institutions in the Chicagoland area obtained from a reference lab (ACL) and from the CDC. Two isolates underwent long-read sequencing on the Oxford Nanopore GridION platform to obtain closed genomes. WGS was performed on the remaining isolates with the Illumina MiSeq platform.

Results

Twenty isolates from NMH, five from ACL, and two from the CDC underwent WGS to yield 12.6 Mb genomes. Any two NMH isolates differed from each other by a maximum of 36 single nucleotide variants (SNV) (Figure 1). Two patients thought to be part of a transmission cluster (isolates CA06 and CA07), differed by 7 SNVs. No phylogenetic grouping between hospital systems across Chicagoland was observed. Isolates from room surfaces from a C. auris patient differed by 1-6 SNVs from each other and from 7-8 SNVs from the patient isolate. Samples taken from different body sites of another patient differed by 4-9 SNVs. Average SNV counts were lower among nosocomially acquired cases when compared to C. auris isolates present on admission (Figure 2). All NMH isolates were fluconazole sensitive, but a fluconazole resistant ACL isolate differed from a sensitive NMH isolate by only 4 SNVs.

Figure 1: Phylogenetic tree of all NMH and ACL isolates with fluconazole sensitivities

Figure 2: Observed pairwise SNP differences between nosocomial and POA strains

Conclusion

WGS of C. auris did not reveal identical isolates in any instance, even from the same patient or the patients and their environment. Generally, lower numbers of SNVs were observed for intra- versus inter-institutional isolates. More work is needed to determine the use, if any, of WGS in outbreak investigations.

Disclosures

All Authors: No reported disclosures
865. Methicillin-resistant Staphylococcus aureus (MRSA) prevalence among healthcare workers (HCW) in contact tracings in a Dutch teaching hospital, 2010-2018
Authors: Weterings veronica , Kievits Heidi , van Rijen Miranda , kluytmans Jan
Published: January 2021

Background

In The Netherlands, the national guidelines on MRSA prevention and control advocate screening of HCW after unprotected exposure to MRSA carriers. Although this strategy at large is successful, contact tracing of staff is a time consuming and costly component. We evaluated our contact tracing policy for HCW over the years 2010 – 2018.

MRSA prevalence among samples in contact tracing

Methods

A retrospective, observational study was performed in a Dutch teaching hospital. All HCW who had unprotected contact with an MRSA carrier were included in contact tracing. When there had been a long period of unprotected admission prior to an MRSA finding, or when the index case was a HCW, than the entire (nursing) team was tested. All samples of HCWs who were tested for MRSA carriage as part of contact tracing from 2010 until 2018 were included. A pooled nose, throat and perineum swab was collected using the eSwab medium (Copan) and inoculated on chromID MRSA agar plates (bioMérieux) after enrichment in a broth.

Results

In total, we included 8,849 samples (range: 677 – 1,448 samples per year) from a total of 287 contact tracings (range: 26 – 55 contact tracings per year). Thirty two HCWs were colonized with MRSA (0.36%; 95%CI 0.26 – 0.51). None of them developed a clinical infection.

Eight HCWs (0.10%; 95%CI 0.05% – 0.19%) were colonized with the same MLVA type as the index case, and were detected in 6/287 contact tracings (2%). In 4/8 of these cases, a positive HCW was the index for undertaking contact tracing. In 3/8 cases it was clear that the HCW who was identified in the contact tracing was the source of the outbreak and was the cause of invasive MRSA infections in patients.

Notably, a different MLVA type as the index case was found in 24 HCWs (0,27%; 95%CI 0,18 – 0,40) of which 7/24 HCW (29,2%) were intermittent carriers.

Conclusion

This study revealed a sustained low MRSA prevalence among samples in contact tracing of healthcare workers, over nine years. Furthermore, it shows that when MRSA contact tracing is performed according to the national guideline only 1 out 1000 samples results in a secondary case. This is similar to the population carriage rate of MRSA in The Netherlands. More frequently, an unrelated strain is found. These findings raise question marks regarding the efficacy of the current strategy to perform contact tracing after unprotected exposure.

Disclosures

All Authors: No reported disclosures
866. Assessment of Infection Control Training among Healthcare Workers in Three Tertiary Care Public Hospitals, Bangladesh, 2015-17
Authors: Sumon Md Shariful Amin , Parveen Shahana , Hassan Md Zakiul , Babar Md Reaj Khan , Chanda Kanij Fatima , Rahman Mahmudur
Published: January 2021

Background

Hospital-acquired infections (HAI) are a rising global public health concern that disproportionately affects low and middle-income countries. Healthcare workers (HCWs) are the frontline work-stream against HAIs in healthcare settings. As part of a pilot infection prevention and control (IPC) program, we assessed the acceptability of infection control training in practice among HCWs in three public hospitals in Bangladesh to better mitigate HAI risks and occupational exposures.

Methods

We piloted an IPC intervention, as a part of the emergency preparedness, from 2015 to 2017 and IPC training was one of the key components. Trained IPC staff conducted a half-day training session for each three different level HCW groups, doctors, nurses and support staff. The training comprised of instructive method on standard and transmission-based precautions with infection control techniques. A practical demonstration was held followed by hands-on training on hand hygiene steps and mask, gloves use. The participants’ attitudes and practices on infection control measures were obtained through structured observation and qualitative interviews.

Training on Infection Control And Prevention with Healthcare workers (Nurses)

Training on Infection Control And Prevention with Healthcare workers (Doctors)

Results

A total of 1562 HCW’s participated in the training: 804 doctors, 445 nurses and 313 support staff in 26 training sessions. Majority of the participants (85%) did not receive any formal training earlier on infection control and often provided incorrect responses on basic IPC during interactive session. None of the hospitals had an IPC committee. After the training, we found a significant increase from 0% at baseline to 24% (p< 0.001) in hand hygiene including 43% (p< 0.001) and 45% (p< 0.001) in mask and gloves use respectively. All respondents (n=84) from the qualitative assessment, reported the training as highly effective which reinforce their learning in action in the hospitals. Participants from all three groups urged to arrange refresher training more frequently and in small groups to uphold the practices.

Conclusion

This pilot program demonstrated HCWs lack basic IPC principals and tailored IPC training sessions can significantly improve HCWs IPC practice. Formation of active IPC committee could enable arranging periodic refresher and in-service training updates for HCWs with the reallocation of resources to adopt regular IPC practices.

Disclosures

All Authors: No reported disclosures
867. The Scope of a Weekly Infection Control Team Rounding in an Acute-care Teaching Hospital
Authors: Park Se Yoon , Son Hyo-Ju , Lee Seungjae , Lee Eunjung , Kim Tae Hyong
Published: January 2021

Background

Activities of infection control and prevention are diverse and complicated. Regular and well-organized inspection of infection control is essential element of infection control program. The aim of study was to identify strong points and limitations of weekly infection control rounding (ICTR) in an acute care hospital.

Methods

We conducted weekly ICTR to improve the compliance of infection control in the real field at a 734-bed academic hospital in Republic of Korea. The monitoring team consists of five infection prevention practitioners and four infectious diseases physicians. Total 85 practices of infection control and prevention belonging to the respective category among 9 categories were observed. The result of the rounding are categorized well maintained, improvement is needed, long-term support such as space or manpower is needed, not applicable and could not observed. We investigated retrospectively the functional coverage of a weekly ICTR from January to December 2018.

Results

During the study period, weekly ICTR were performed total 47 times in 37 departments. ICTR visited median 7 times [interquartile range (IQR) 6-7 times] per department. When visiting a department, ICTR observed median 16 practices (IQR 12-22). During the monitoring period, we could observe 7511 practices in total. Of those results, Most of the practices (74.8%) were able to be monitored properly by ICTR, while some of the practices were not applicable (21.3%) or difficult to observe through ICTR (3.9%)(Table 1). The most common practices among the difficult-to-observe group belong to strategies to prevent catheter-related or surgical site infection and pneumonia (13%, 68/538), safety injection practices (8%, 65/758), linen and laundry management (7%, 33/496), followed by strategies to prevent occupationally-acquired infection (6%, 37/578).

Table 1.

Conclusion

ICTR has strength in regular visits to each department. However, additional observation is necessary, especially for prevention of cathether-related infection and surgical site infection.

Disclosures

All Authors: No reported disclosures
868. Investigations of Healthcare-Associated Elizabethkingia Infections – United States, 2013-2019
Authors: Crist Matthew B , McQuiston John R , Walters Maroya Spalding , Soda Elizabeth , Moulton-Meissner Heather , Nicholson Ainsley , Perkins Kiran
Published: January 2021

Background

Elizabethkingia (EK) are non-motile gram-negative rods found in soil and water and are an emerging cause of healthcare-associated infections (HAIs). We describe Centers for Disease Control and Prevention (CDC) consultations for healthcare-associated EK infections and outbreaks.

Methods

CDC maintains records of consultations with state or local health departments related to HAI outbreaks and infection control breaches. We reviewed consultations involving EK species as the primary pathogen of concern January 1, 2013 to December 31, 2019 and summarized data on healthcare settings, infection types, laboratory analysis, and control measures.

Results

We identified 9 consultations among 8 states involving 73 patient infections. Long-term acute-care hospitals (LTACHs) accounted for 4 consultations and 32 (43%) infections, and skilled nursing facilities with ventilated patients (VSNFs) accounted for 2 consultations and 31 (42%) infections. Other settings included an acute care hospital, an assisted living facility, and an outpatient ear, nose, and throat clinic.

Culture sites included the respiratory tract (n=7 consultations), blood (n=4), and sinus tract (n=1), and E. anophelis was the most commonly identified species. Six consultations utilized whole genome sequencing (WGS); 4 identified closely related isolates from different patients and 2 also identified closely related environmental and patient isolates.

Mitigation measures included efforts to reduce EK in facility water systems, such as the development of water management plans, consulting water management specialists, flushing water outlets, and monitoring water quality, as well as efforts to minimize patient exposure such as cleaning of shower facilities and equipment, storage of respiratory therapy supplies away from water sources, and use of splash guards on sinks.

Conclusion

EK is an important emerging pathogen that causes HAI outbreaks, particularly among chronically ventilated patients. LTACHs and VSNFs accounted for the majority of EK consultations and patient infections. Robust water management plans and infection control practices to minimize patient exposure to contaminated water in these settings are important measures to reduce infection risk among vulnerable patients.

Disclosures

All Authors: No reported disclosures
872. Burden of Influenza Outbreaks in Long-Term Care Facilities in Philadelphia, 2012-2020
Authors: Kunz Kurt M , Perella Dana , Peritz Tiina , Feemster Kristen , Coffin Susan E , Coffin Susan E
Published: January 2021

Background

In the United States, influenza and other acute respiratory viruses contribute to a high burden of disease in long-term care facility (LTCF) residents. We aim to characterize the disease patterns and inter-seasonal variation of influenza virus outbreaks in LTCFs and identify institutional, environmental, and public health interventions associated with differences in outbreak outcomes and characteristics.

Methods

We conducted a retrospective, longitudinal study of influenza outbreaks in LTCFs reported to the Philadelphia Department of Public Health (PDPH) over eight consecutive seasons (November 2012 through March 2020). Characteristics of individual outbreaks, facilities, and infection control measures were reported in the PDPH Influenza Outbreak database, while quality measures and other facility-level data were extracted from the CMS Nursing Home Compare (NHC) database. Cases of influenza-like illness (ILI) in residents and staff were reported.

Results

131 influenza outbreaks were reported among 56 facilities, leading to 1196 cases of ILI, 227 influenza-related hospitalizations and 20 deaths. The median number of facility residents affected per outbreak was 4 (range, 0-52), and the resident attack rate was 3.0% (IQR, 1.6-7.4). Facility staff were affected in 56 (43%) of outbreaks. A greater number of facility beds was associated with sites reporting 3 or more outbreaks compared to those that did not (180 vs 133 beds, p=0.019). Public health measures were associated with lower total attack rates for surveillance (1.9% vs 4.3%, p=0.0015), education (1.9% vs 5.1%, p=0.0004), visitation restrictions (1.8% vs 3.1%, p=0.049), and vaccination policies of staff and/or residents (1.6% vs 2.7%, p=0.047). Smaller outbreaks were associated with the implementation of droplet precautions (3 vs 6, p=0.0071), antiviral treatment and prophylaxis (3 vs 6, p=0.024), and admission restrictions (4 vs 7, p=0.015).

Conclusion

Larger facility size was associated with an increased frequency of outbreaks. Public health measures may reduce the size and severity of influenza outbreaks in LTCFs. These results emphasize the importance of ensuring consistent utilization of recommended infection prevention strategies.

Disclosures

All Authors: No reported disclosures
874. Pseudo-outbreak of Adenovirus in Bronchoscopy Suite
Authors: Seidelman Jessica L , Akinboyo Ibukunoluwa , Taylor Bonnie , McLay Carol , Smith Becky , Lewis Sarah S
Published: January 2021

Background

Adenoviruses (Adv) are non-enveloped viruses that can survive for long periods on environmental surfaces. However, only 1 prior publication describes an adenovirus pseudo-outbreak associated with bronchoscopes. In 1/ 2020 infectious disease physicians noted a cluster of Adv PCR-positive bronchiolar lavage (BAL) samples, which prompted an outbreak investigation.

Methods

We reviewed medical charts, clinical microbiology, procedure logs, bronchoscope reprocessing logs, bronchoscope cleaning, and high-level disinfection (HLD) practices.

Results

On 1/28/20 an infectious diseases physician alerted infection prevention to a cluster of 5 lung transplant patients diagnosed with Adv positive BAL samples. Four out of the 5 patients had the bronchoscopy in the same bronchoscopy suite. We reviewed BAL results from all bronchoscopies performed in this suite from 11/1/19 to 1/24/20 and found a total of 10 patients with positive Adv PCR results. Eight out of the 10 patients had bronchoscopies with one of two bronchoscopes. Of all patients who had a bronchoscopy with the bronchoscope from 11/1/19 to 1/24/20 and had respiratory viral panel sent at that time, 6 of 11 (55%) who underwent procedure with Scope A and 4 of 24 (17%) who underwent procedure with Scope B had positive Adv PCR results. Sham BALs were performed on both bronchoscopes and testing for Adv was negative. However, on inspection by the manufacturer, one scope failed both wet and dry leak tests and had several physical defects. Following removal of both bronchoscopes from service we did not find any positive Adv samples from the bronchoscopy unit.

Conclusion

Previously, very few pseudo-outbreaks of Adv have been linked to bronchoscopes. We identified a pseudo-outbreak of Adv associated with 2 bronchoscopes in a hospital-based bronchoscopy suite that stopped once we removed the associated bronchoscopes from the procedural unit. Bronchoscopy-related pseudo-outbreaks occur despite standardized procedures for HLD. Bronchoscopy clinics, particularly those with a high volume of immunocompromised patients, should prospectively review BAL cultures to identify unusual pathogen trends. These trends may be a sign of damaged equipment that would otherwise go undetected.

Disclosures

All Authors: No reported disclosures
878. Antimicrobial Susceptibility of Pathogens Isolated from Surgical Site Infections in Japan: Comparison of Data from Nationwide Surveillance Studies Conducted in 2010, 2014–2015 and 2018-2019
Authors: Takesue Yoshio , Hanaki Hideaki , Kusachi Shinya , Mikamo Hiroshige , Ueda Takashi , Tateda Kazuhiro , Kiyota Hiroshi
Published: January 2021

Background

A nationwide survey was conducted in Japan from 2018–2019 to investigate the antimicrobial susceptibility of pathogens isolated from surgical site infections (SSI).

Methods

The resulting data were compared with that obtained in earlier surveys, conducted in 2010, 2014–2015, and 2018-2019.

Results

Seven main organisms were collected, and in total 2081 isolates were studied. Although a significant increase of extended-spectrum β-lactamase (ESBL) producing organisms among Enterobacteriaceae was demonstrated in 2014–15 (13.5%) compared with 2010 (5.3%), the incidence remained 6.6% in 2018–19. Only one carbapenemase-producing Enterobacteriaceae isolates were identified in the 2018–2019 study. The geometric mean (GM) MICs for ESBL producing isolates in 2018–2019 were 0.08 µg/mL for meropenem, 2.67 µg/mL for tazobactam/piperacillin, 0.40 µg/mL for tazobactam/ceftolozane, 6.35 µg/mL for cefoxitin, and 1.12 µg/mL for gentamycin. Antibiotic susceptible rate in Pseudomonas aeruginosa was 95.5% in meropenem, 93.9% in piperacillin/tazobactam, 100% in tazobactam/ceftolozane, 97.0% in cefepime, 90.9% in ciprofloxacin, and 86.4% in gentamycin. There was no significant difference in methicillin resistance rate of Staphylococcus aureus isolates among 3 study periods (72.0% in 2010, 53.4% in 2014–2015, and 63% in 2018-19). MRSA isolates with a vancomycin MIC of 2μg/mL accounted for 9.7% in 2010, 1.2% in 2014–2015, and 3.1% in 2018-19. GM MICs for MRSA isolates were 2.09 µg/mL for linezolid, 0.32 µg/mL for tedizolid, and 0.61 µg/mL for daptomycin. GM MICs in linezolid and daptomycin for the isolates in 2018–19 tended to be increased compared with isolates in 2010 (1.74 to 2.09 and 0.35 to 0.61 µg/mL, respectively). More than 90% of isolates belonging to the Bacteroides fragilis group remained susceptible to tazobactam/piperacillin, meropenem, and metronidazole. In contrast, lower levels of susceptibility were observed for moxifloxacin (65.3%), cefmetazole (47.2%) and clindamycin (38.9%). In cefoxitin, non-fragilis Bacteroides isolates had lower rates of antibiotic susceptibility compared with B. fragilis. (51.3% vs. 81.8%).

Conclusion

Overall, the surveillance data clarified trends in antimicrobial susceptibility for organisms commonly associated with SSI.

Disclosures

Yoshio Takesue, M.D, Ph.D, Astellas Pharma Inc (Speaker’s Bureau)MSD Japan (Speaker’s Bureau)Sumitomo Dainippon Pharma Co. Ltd. (Grant/Research Support) Hiroshige Mikamo, M.D, Ph.D, Astellas Pharma Inc. (Grant/Research Support, Speaker’s Bureau)MSD Japan (Grant/Research Support, Speaker’s Bureau)Pfizer Japan Inc. (Grant/Research Support)Sumitomo Dainippon Pharma Co., Ltd (Grant/Research Support, Speaker’s Bureau)
62. Factors Associated with 30-Day ED Readmission Following Initial ED Discharge for Suspected Sepsis
Authors: Moscowitz Anna E , Bae Esther Y , Hoz Ricardo M La , Cutrell James B , Monogue Marguerite
Published: January 2021

Background

Given the increased mortality associated with delayed recognition of sepsis, emergency departments (ED) often use protocols to rapidly identify and treat suspected sepsis. However, screening criteria such as systemic inflammatory response syndrome (SIRS) lack specificity and may over-diagnose sepsis in patients otherwise stable for discharge. Our study describes outcomes and identifies factors associated with ED readmission in those initially discharged directly from the ED who met sepsis criteria.

Methods

This retrospective cohort study evaluated adult patients (≥ 18 years) seen in the ED at UTSW Medical Center from January to June 2018 who met all the following: ≥ 2 SIRS criteria; received ≥ 1 dose of intravenous (IV) broad-spectrum antibiotic(s) in the ED; were discharged home. A multivariable logistic regression model identified factors associated with 30-day re-admission to our ED, using clinically significant variables parsimoniously. A two-sided P value < 0.05 was considered significant.

Results

A total of 179 patients were included. Forty-four patients (25%) returned to the ED within 30 days of their initial visit; of those 44, 63.6% (28) returned for issues related to their prior visit, and 50% (22) were admitted to the hospital. Table 1 compares baseline demographics of patients with suspected sepsis readmitted to the ED with those not readmitted within 30 days after initial ED discharge. In univariable analysis, quick Sequential Organ Failure Assessment (qSOFA), and length of antibiotic therapy (ED plus discharge antibiotics) were associated with ED re-admission (table 1). Receipt of antibiotics on discharge was not significant. In the final multivariable analysis (table 2), initial qSOFA ≥ 2 alone was associated with increased risk of ED re-admission (OR 7.5, p=0.01).

Table 1. Baseline demographics of patients readmitted and not readmitted to the ED within 30 days after ED discharge with suspected sepsis

Table 2. Multivariable logistic regression of risk factors for patients readmitted and not readmitted to the ED within 30 days after ED discharge with suspected sepsis

Conclusion

In this cohort, 25% of patients with suspected sepsis initially discharged from the ED were readmitted to our ED within 30 days. A qSOFA ≥ 2 at the initial ED visit was associated with increased risk of readmission, suggesting a potential use of qSOFA to triage those warranting admission or closer follow-up. Larger prospective studies are warranted in this understudied population of patients who meet screening sepsis criteria but are discharged from the ED.

Disclosures

All Authors: No reported disclosures
885. Feasibility of Observing Traffic Patterns (FOOT Patter) in Veterans Health Administration Operating Rooms
Authors: Ewers Tola , Aryanfar Babak , Bittner Marvin J , Balkenende Erin C , Bradley Suzanne F , Brown Madisen , Goetz Matthew B , Gupta Kalpana , Hostler Christopher J , Perencevich Eli N , Strymish Judith , Urdaneta Gisel , Crnich Christopher J
Published: January 2021

Background

Surgical site infections (SSIs) complicate nearly 6% of surgeries performed in Veterans Health Administration (VA) hospitals and occur despite adoption of practices known to reduce them. SSIs are associated with prolonged hospitalization and an increased risk of readmission, reoperation and mortality. Operating room (OR) door openings may increase SSI through disruption of desired OR air flow patterns and increased wound microbe counts. Our study objectives were to: 1) develop a methodological approach for collecting data on entry/exit traffic patterns in VA ORs and 2) characterize patterns across different surgery types.

Methods

Trained researchers from 10 VA-Centers for Disease Control and Prevention (CDC) Practice-based Research Network sites observed staff entering and exiting VA ORs. Staff were categorized and identified by role. Exits/entries were recorded on a standardized tracking sheet. Surgery type and observation duration from incision to closure were noted. Mean hourly door openings across procedure and role types were compared via a one-way ANOVA using Stata ver. 15.0.

Results

We observed 56 surgeries on 55 patients (Fig. 1). During 9,801 observation minutes, 766 staff opened doors 3,882 times. Door openings by role differed significantly (p < 0.001) with nurses, perfusionists, anesthesia and vendors having the highest mean door-opening rate. Coronary artery bypass grafts (CABGs) accounted for most door openings and significantly greater surgical duration than other procedures (p=0.012). Time-adjusted OR door opening rate was similar across procedure types at ~22-26 hourly openings (p=0.186).

Figure 1. FOOT Patter results

Conclusion

The hourly rate of door openings varied notably by staff role. Our data show that measurement of OR movements is feasible although gaining access and approval to observe, achieving ideal observer positioning in complex floor plans, and potential misidentification of entering/exiting staff are challenges of direct methods. Scaling this study up may require automated processes. Studies exploring influences of traffic patterns on OR air quality metrics and impact on risk of SSI, identifying rationale and necessity for door openings and effective strategies for reducing unneeded door openings are needed.

Disclosures

All Authors: No reported disclosures
888. Improving outcomes with revised preoperative universal decolonization protocol
Authors: Gnass Silvia I
Published: January 2021

Background

In order to improve outcomes, including reduced surgical infection rate and costs, a revised universal preoperative decolonization protocol was implemented on a trial basis.

Methods

In a 12 month before and after study at a public teaching hospital in southern California, an alcohol based nasal antiseptic was introduced in place of nasal povidone iodine (PVI) for all surgical patients pre-operatively, paired with chlorhexidine (CHG) bathing which was already in place. All surgical procedures were included, the most common being cholecystectomy, cesarean section and hip fracture. The alcohol nasal antiseptic was selected to replace the PVI nasal antiseptic based on efficacy, staff preference and cost. At the same time, surgical team members began self-application of the alcohol nasal antiseptic each day prior to surgical procedures. This was not mandatory and compliance was not tracked, though informal feedback and observation revealed most surgical team members were applying the nasal antiseptic prior to cases daily.

Results

In comparison to the 6 month baseline period where there were 27 SSI in 1188 procedures, during the 6 month study period there were 10 SSI in 1253 procedures, representing a 63% reduction (p=.0162) for all types of procedures. We have observed a reduction of 17 SSIs in 2019, compared to the previous year, during the 6 months period. That means a saving of $589,420 during the same period.

Conclusion

Preoperative universal decolonization with alcohol based nasal antiseptic in place of nasal PVI, paired with CHG bathing, was effective in reducing SSI rate and associated costs. Further study is needed to measure and assess the impact of surgical team member nasal decolonization on patient infection risk and rate.

Disclosures

All Authors: No reported disclosures
890. Incidence and Microbiology of Surgical Site Infection (SSI) after Breast Surgery
Authors: Tanveer Farah , Youssef Dima , Youssef Mamta , Szpunar Susanna , Flood Michelle
Published: January 2021

Background

Surgical site infection (SSI) after breast surgery is much more common than expected after a clean surgical procedure. Although

breast SSIs are primarily Gram-positive; recent literature shows an increase in Gram-negative infections. We assessed the risk factors and microbiology of SSI following breast surgery at our institution.

Methods

We conducted a historical cohort study of all (³ 18 y) females who had surgery from 1/1/2014-3/31/2019 and subsequent SSI within 90 days of the procedure. Two controls, matched for surgery type, were selected per case. Data were collected on demographic and clinical characteristics, surgery type, microbiology and antibiotics. Data were analyzed using the χ 2 test, Student’s t-test and multivariable logistic regression with a forward likelihood ratio algorithm.

Results

After excluding patients with limited data, we reviewed 284 charts: 95 of 132 cases and 189 controls. The 90-day incidence of SSI was 3.5 % (132/3755). Cases were younger than controls: 53.9 ± 12.4 years vs. 58.3± 13.7 years, respectively, p=0.02. Controls had more comorbidities: 1.8 ± 1.3 vs. 1.4 ± 0.7,respectively, p=0.001. Tissue expanders were placed in 65 (70%) cases versus 11 (5.8%) controls (p < 0.0001). After controlling for age, BMI, comorbidities and post-operative antibiotics, only tissue expanders were associated with infection (OR=35.1, p< 0.0001, 95% CI: 16.6, 74.0).

Microbiological data were available for 84 cases. Gram-positive organisms accounted for 45 (53.6%) infections and Gram-negative organisms accounted for 39 (46.4%) infections. Over 72% of African Americans (p= 0.014), 76.5% of patients with diabetes (p=0.005) and 57.1 % with tissue expanders (p= 0.02) had Gram-negative infections. The table shows the multivariable predictors of Gram-negative infection. Tissue expander removal was required in 61.5% of patients with Gram-negative infections compared to 39% with Gram-positive infections.

Predictors of Gram-negative SSI after breast surgery

Conclusion

Patients with tissue expanders had a higher incidence of SSI after breast surgery; removal was often required in Gram-negative infections. Diabetes and post-operative antibiotics were significant predictors of Gram-negative infection. Knowledge of local epidemiology is a key factor in deciding empiric therapy for SSI.

Disclosures

All Authors: No reported disclosures
63. Frequency and Outcomes of Patients Prescribed Antibiotics for Extended Durations on Discharge from the Hospital to Nursing Homes
Authors: Molina Kaitlyn E , Noble Brie N , Crnich Christopher J , McGregor Jessina C , Bearden David T , Chan Dominic , Furuno Jon P , Furuno Jon P
Published: January 2021

Background

Nursing home (NH) residents are at increased risk of being prescribed antibiotic for extended durations and experiencing antibiotic-associated adverse events. However, many of these antibiotics are prescribed in the hospital prior to NH admission. We quantified the frequency, characteristics and outcomes of patients receiving antibiotic treatment in the hospital and discharged to NHs with an antibiotic prescription for greater than 7 days.

Methods

This was a retrospective cohort study of adult (age >18 years) patients with a prescription for an antibiotic on discharge from Oregon Health & Science University Hospital (OHSU) to a NH between January 1, 2016 and December 31, 2018. Study data were collected from an electronic repository of patients’ electronic health record data. Outcomes of interest included having an emergency department (ED) visit, inpatient hospital admission, or inpatient admission for Clostridioides difficile infection (CDI) at the index facility within 30 days of discharge.

Results

Among 2969 antibiotic prescriptions on discharge, 1267 (42.7%) were prescribed for greater than 7 days to a total of 1059 patients. A diagnosis of a bacterial infection was present for 902 (85.2%) patients. The most frequent diagnoses were bloodstream/endocarditis (21.8%), osteomyelitis (11.6%), and skin and soft tissue infections (10.6%). The most frequently prescribed antibiotics were cephalosporins (24.2%), penicillins (14.1%), glycopeptides (12.9%), and fluoroquinolones (12.6%). Of the 1059 identified patients, 126 (11.9%) had an ED visit, 216 (20.4%) inpatient admission, and 16 (1.5%) had an admission for CDI within 30 days of discharge.

Conclusion

More than 40% of antibiotic prescriptions on discharge to a NH were for greater than 7 days. This frequency and associated poor outcomes suggest extended antibiotic duration are a high-value target to improve antibiotic prescribing on discharge to NHs.

Disclosures

All Authors: No reported disclosures
892. Meningitis after Ventricular Shunt Operations: Multicenter Study to Identify Etiology, Incidence and Risk Factors
Authors: Giarola Lucca G , de Carvalho Handerson Dias Duarte , Couto Braulio Roberto Gonçalves Marinho , Starling Carlos Ernesto Ferreira
Published: January 2021

Background

A Ventriculoperitoneal shunt is the main treatment for communicating hydrocephalus. Surgical site infection associated with the shunt device is the most common complication and an expressive cause of morbidity and mortality of the treatment.

The objective of our study is to answer three questions: a)What is the risk of meningitis after ventricular shunt operations? b) What are the risk factors for meningitis? c) What are the main microorganisms causing meningitis?

Methods

A retrospective cohort study assessed meningitis and risk factors in patients undergoing ventricular shunt operations between 2015/Jul and 2018/Jun from 12 hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. Sample size = 926.

26 variables were evaluated by univariate and multivariate analysis (logistic regression).

Results

71 patients were diagnosed with meningitis which represent a risk of 7.7% (C.I.95%= 6.1%; 9.6%). From the 26 variables, three were acknoleged as risk factors: age < two years old (OR = 3.20; p < 0.001), preoperative hospital length of stay > four days (OR = 2.02; p = 0.007) and more than one surgical procedure (OR = 3.23; p = 0.043). Patients two or more years old, who had surgery four days after hospital admission, had increased risk of meningitis from 4% to 6% (p = 0.140). If a patient < two years had surgery four days post hospital admission, the risk is increased from 9% to 18% (p = 0.026). 71 meningitis = > 45 (63%) the etiologic agent identified: Staphylococcus aureus (33%), Staphylococcus epidermidis (22%), Acinetobacter sp (7%), Enterococcus sp (7%), Pseudomonas sp (7%), and other (18%). Hospital length of stay in non-infected patients (days): mean = 21 (sd = 28), median = 9; hospital stay in infected patients: mean = 34 (sd = 37), median = 27 (p=0.025). Mortality rate in patients without infection was 10% while hospital death of infected patients was 13% (p=0.544).

Conclusion

Two intrinsic risk factors for meningitis post ventricular shunt, age under two years old and multiple surgeries, and one extrinsic risk factor, preoperative length of hospital stay, were identified. Incidence of meningitis post VP shunt decreases with urgent surgical treatment.

Disclosures

All Authors: No reported disclosures
896. Prediction of Surgical Site Infection Risk in Patients Undergoing Bariatric Surgery
Authors: de Souza Flávio Henrique Batista , Couto Braulio Roberto Gonçalves Marinho , da Conceição Felipe Leandro Andrade , da Silva Gabriel Henrique Silvestre , Dias Igor Gonçalves , Rigueira Rafael Vieira Magno , Pimenta Gustavo Maciel , Martins Maurilio B , Mendes Júlio César O , Januário Guilherme Brangioni , Oliveira Rayane Thamires , de Vasconcelos Laura Ferraz , de Araújo Laís L , Rodrigues Ana Clara Resende , Silva Camila Morais Oliveira E , De Souza Eduarda Viana , Melo Júlia Faria , De Sá Maria Cláudia Assunção , Silva Walquíria Magalhães , Barbosa Alicy Verônica Alves , Talim Amanda Torres , Alcasar Laura Daldegan , Avelar Luiza Magalhaes , Neto Marcella Brito Pinheiro Oliveira , Santos Paula Araújo Pessoa , Porto Vitoria Sturzeneker
Published: January 2021

Background

In the hospitals of Belo Horizonte (a city with more than 3,000,000 inhabitants), a survey was conducted between July 2016 and June 2018, focused on surgical site infection (SSI) in patients undergoing bariatric surgery procedures. The main objective is to statistically evaluate such incidences and enable a study of the prediction power of SSI through MLPs (Multilayer Perceptron), a pattern recognition algorithm.

Methods

Data were collected on SSI by the Hospital Infection Control Committees (CCIH) of the hospitals involved in the research. After data collection, three procedures were performed: a treatment of the database collected for the use of intact samples; a statistical analysis on the profile of the hospitals collected and; an assessment of the predictive power of five types of MLP (Backpropagation Standard, Momentum, Resilient Propagation, Weight Decay, and Quick Propagation) for SSI prediction. MLPs were tested with 3, 5, 7, and 10 hidden layer neurons and a database split for the resampling process (65% or 75% for testing, 35% or 25% for validation). They were compared by measuring AUC (Area Under the Curve - ranging from 0 to 1) presented for each of the configurations.

Results

From 3473 initial data, only 2491 were intact for analysis. Statistically, it was found that: the average age of the patients was 39 years (ranging from 16 to 65); the average duration of surgery was 138 minutes; and 0.8% of patients had SSI. Regarding the predictive power of SSI, the experiments have a minimum value of 0.350 and a maximum of 0.756.

Conclusion

Despite the loss rate of almost 30% of the database samples due to the presence of noise, it was possible to have a relevant sampling for the profile evaluation of Belo Horizonte hospitals. Moreover, for the predictive process, although some configurations have results that reached 0.755, which makes promising the use of the structure for automated SSI monitoring for patients undergoing bariatric surgery. To optimize data collection and enable other hospitals to use the SSI prediction tool (available in www.sacihweb.com), two mobile application were developed: one for monitoring the patient in the hospital and the other for monitoring after hospital discharge.

Disclosures

All Authors: No reported disclosures
64. Impact of a Duration Bundle on Antimicrobial Use in a Pediatric Hospital
Authors: Weslander Erin , Li Diana , Wang Xuanqing
Published: January 2021

Background

Limiting antibiotic durations to the shortest effective duration is a strong recommendation with moderate-quality evidence in the 2016 IDSA Antimicrobial Stewardship Program (ASP) guidelines. An ASP bundle including a decrease in antimicrobial automatic stop dates from 14 days to 10 days along with a guideline for standard durations for 48 specific indications was implemented at a tertiary pediatric hospital in November 2019. The purpose of this review and was to assess the impact of this ASP initiative on patient outcomes and hospital cost-savings by comparison of pre-intervention and post-intervention data.

Methods

A set of antimicrobial duration recommendations for pediatric patients was created by the Antimicrobial Stewardship Program, Pediatric Hospital Medicine providers, and Infectious Disease providers specific to indication, agent, or pathogen. After education of medical care providers and distribution of the recommendations, automatic stop dates in the Electronic Medical Record (EMR) were updated from 14 days to 10 days for all antimicrobials. Concomitant advertising campaigns were shown on all hospital screensavers. Data were collected for a one month pre-intervention period of Nov.15 - Dec.15, 2018 including 133 patients and a one month intervention period of Nov.15 - Dec.15, 2019 including 125 patients.

Results

The average length of stay decreased from an average of 8.3 days pre-implementation to 6.7 days (p=0.043) post implementation. The ratio of actual to recommended duration also decreased from 1.56 to 1.30 (p< 0.001) when comparing pre vs. post initiative. Balancing measures did not change for restarting treatment within 48 hours of stopping or readmission within 30 days for the same infection. The decrease in inpatient therapy translated to more than $10,000 per year in direct drug cost.

Conclusion

This intervention lead to a significant reduction in average length of stay per admission and significantly reduced the secondary outcomes of the total duration of antimicrobial therapy and the ratio of actual duration compared to recommended duration. This lead to cost savings and decreased inappropriate antibiotic exposure.

Disclosures

All Authors: No reported disclosures