bluuebunny/crossref_metadata_2025 huggingface dataset:
How Standard Are Standard Precautions? Knowledge and Attitudes Toward Standard Precautions at an Academic Medical Center
Authors: Faller Rebecca , Sampathkumar Priya , Ung Stacy (Tram)
Published: November 2020

Background: Standard precautions are the basis of infection prevention and include a set of common-sense infection control practices that prevent transmission of diseases acquired by contact with blood, body fluids, nonintact skin, and mucous membranes. These measures include hand hygiene, personal protective equipment (PPE), cleaning and disinfecting, linen handling, waste disposal, sharps safety and respiratory etiquette. Standard precautions require that the risk for exposure be assessed and appropriate precautions taken based on risk. Observations and anecdotal evidence have led us to believe that understanding of standard precautions is lacking among healthcare personnel. Methods: A survey was conducted at a large health system to assess knowledge and practices related to specific elements of standard precautions. Results: More than 3,000 HCWs responded from inpatient settings (41%), outpatient settings (37%), and both settings (22%). Nurses comprised the majority of respondents (54%), and others included physicians (9%), respiratory therapists, as well as physical and occupational therapists. Discussion: The vast majority (96%) of respondents agreed that standard precautions were required in the care of all patients, but a significant proportion (34%) interpreted that to mean that standard precautions always involve wearing gloves, and 22.5% thought that PPE was always required for standard precautions. Hand hygiene and sharps safety were identified as the best understood elements of standard precautions. Respiratory etiquette and cleaning and disinfection were reported as the least understood elements, with PPE, waste disposal, and linen handling also being reported as inadequately understood components of standard precautions (Fig. 1). Conclusions: In an era of increasing drug resistance and fewer effective antibiotics, standard precautions are our best defense against the spread of infections in the healthcare setting. Our survey showed that there is room for improvement among healthcare workers in understanding of the elements of standard precautions. We plan to use the survey to craft a targeted education campaign to improve understanding of and adherence to standard precautions.

Funding: None

Disclosures: None
Identification of Aminoglycoside Resistance Genes From Bacteria Isolated From Selected Municipal Drinking Water Distribution Systems in Southwestern Nigeria
Authors: Adesoji Ayodele T. , Ogunjobi Adeniyi A.
Published: November 2020

Background: Multidrug-resistant bacteria can lead to treatment failure, resulting in infectious diseases being transferred through nonpotable water. Aminoglycosides are an important class of antibiotics that are abused in Nigeria. Few studies have investigated aminoglycoside-modifying genes (AMGs) that are likely responsible for resistance in Nigeria bacteria isolates. Therefore, we aimed to characterize AMGs from isolates in drinking water distribution systems (DWDS) in southwestern Nigeria. Methods: Multidrug-resistant bacteria (n = 181) that had been previously characterized by 16S rDNA sequencing and that were positive for resistance to at least 1 aminoglycoside antibiotic were selected from 6 treated and untreated water distribution systems. Strains were PCR genotyped for 3 AMGs: aph(3)c, ant(3)b and aph(6)-1dd. Results: Of 181 MDR bacteria tested, 69 (38.12%) were positive for at least 1 of the AMGs. The most common was ant(3)c (27.6%), followed by aph(3")c (18.23%). Both aph(3)c and ant(3")b were found in 7.73% of tested isolates, ant(3)b was most commonly found in Alcaligenes spp (50%). Furthermore, aph(3")c was most commonly detected in Proteus spp (50%). Other genera positive for AMGs included Acinetobacter, Aeromonas, Bordetella, Brevundimonas, Chromobacterium, Klebsiella, Leucobacter, Morganella, Pantoae, Proteus, Providencia, Psychrobacter, and Serratia. Conclusions: High occurrence of ant(3)c and aph(3)c among these bacteria call for urgent attention among public health workers because these genes can be easily disseminated to consumers if present on mobile genetic elements like plasmids, integrons, and transposons.

Funding: None

Disclosures: None
Impact of a Critical National Shortage of Cefazolin on Antimicrobial Practice at a Tertiary-Care Center in Japan
Authors: Murakami Shutaro , Hiroi Junko , Tagashira Yasuaki , Takamatsu Akane , Hasegawa Shinya , Honda Hitoshi
Published: November 2020

Background: Shortages of essential medicines, a long-standing issue in healthcare, apply equally to antimicrobial agents, a group of essential drugs necessary for sustainable healthcare. The WHO categorized essential medicines into the access, watch, and reserve groups. Older antimicrobials, in particular, were categorized into the access group, meaning that these drugs are in theory widely available at an affordable cost. The shortage of essential antimicrobial agents like cefazolin leads to increased consumption of alternative antimicrobial agents with broad-spectrum activity, which often has the undesirable consequence of defeating antimicrobial stewardship efforts in inpatient settings and potentially promoting antimicrobial resistance. In Japan, cefazolin has been in critically short supply since March 2019. Cefazolin is a first-line agent against common infectious diseases and in surgical antimicrobial prophylaxis, and its shortage has substantially impacted inpatient care. The aim of the present study was to investigate changes in antimicrobial practice at a tertiary-care center in Japan following the emergence of the national cefazolin shortage in March 2019. Methods: Data on each antimicrobial use are logged as days of therapy (DOT) per 1,000 patient days (PD) for antimicrobial stewardship purposes at the study institution. We extracted weekly data from September 2018 to September 2019 to evaluate the impact of the national cefazolin shortage on antimicrobial use at our tertiary-care center. Changes in weekly antimicrobial use and the weekly incidence of Clostridium difficile infections were analyzed by interrupted time series analysis. We also investigated changes in antimicrobial practice at selected situations. Results: As weekly cefazolin use significantly declined after the emergence of the national shortage, use of third-generation cephalosporin (+18.9 DOT per 1,000 PD for intercept [P < .001] and +0.65 DOT per 1,000 PD per week for trend [P = .037]) and clindamycin (18 DOT per 1,000 PD for intercept [P = .008] and 0.12 DOT per 1,000 PD per week for trend [P = .003]) significantly increased. Significant changes in antimicrobial practice were also observed in surgical antimicrobial prophylaxis: third-generation cephalosporin use increased from 1.0% (31 of 3,032) to 62.9% (2,237 of 3,554) (P < .001). However, no significant change in the incidence of Clostridium difficile infection was observed during the study period: +1.72 per 10,000 PD for intercept (P = .12) and 0.12 per 10,000 PD per week for the trend (P = .09). Conclusions: The national cefazolin shortage had a significantly negative impact on patient care and led to increased use of alternative, broader-spectrum antimicrobials, which are not ideal choices either for prophylaxis or treatment.

Funding: None

Disclosures: None
Impact of UV-Light Use on the Quality of Manual Cleaning and Room Turnover Times at a Large Tertiary-Care Hospital, 2019
Authors: Abosi Oluchi , Holley Stephanie , Kukla Mary , Dains Angie , Jenn Kyle , Meacham Holly , Rogers Glen , Millard Bill , Diekema Daniel , Edmond Michael , Salinas Jorge
Published: November 2020

Background: Manual cleaning is the recommended method of environmental disinfection; it plays a key role in the prevention of healthcare-associated infections. Recently, automated no-touch disinfection technologies, such as ultraviolet (UV) light, have been proposed as a supplement to manual cleaning. However, UV light adds time to the cleaning process and may decrease the quality of manual cleaning. We evaluated the impact of adding UV light on the quality of manual cleaning and on room turnover times. Methods: During January–September 2019, we assessed the thoroughness of disinfection cleaning (TDC) of environmental surfaces in rooms identified for discharge. According to hospital policy, contact precautions rooms use UV light after manual cleaning with an EPA-approved sporicidal agent (bleach). Non–contact precautions rooms are disinfected using quaternary ammonium only. Rooms were identified after patient admission, selected randomly, and marked once discharge orders were placed. Fluorescent markers were applied on high-touch surfaces before discharge and were assessed after the cleaning process was completed. TDC scores were defined as the percentage of cleaned surfaces of the total of examined surfaces. UV-light disinfection time is determined automatically based on room size. We compared TDC scores and manual cleaning times between contact precautions rooms and noncontact precautions rooms. We also calculated UV-light cycle durations. Results: We assessed 2,383 surfaces in 24 contact precautions rooms with UV-light disinfection and 201 noncontact precautions rooms without UV-light disinfection. The TDC score was similar in contact precautions rooms (243 of 273 surfaces) and noncontact precautions rooms (1,835 of 2,110 surfaces; 89% vs 87%). The median manual cleaning time for contact precautions rooms was 56 minutes (IQR, 37–79), and for noncontact precautions rooms the median manual cleaning time was 33 minutes (IQR, 22–43). UV-light use added a median of 49 minutes (IQR, 35–67) to the overall cleaning process. The median turnover time for contact precautions rooms was 156 minutes (IQR, 87–216) versus 58 minutes (IQR, 40–86) in noncontact precautions room. Conclusions: In a setting with an objective assessment of environmental cleaning, there was no difference in quality of manual cleaning between contact precautions rooms (UV light) and noncontact precautions rooms (UV light). Adding UV light following manual disinfection increased the overall cleaning time and delayed room availability.

Funding: None

Disclosures: None
Impact on National Policy on the Hand Hygiene Promotion Activities in Hospitals in Korea
Authors: Choe Pyoeng Gyun , Lim Jihee , Kim Eun Jin , Kim zeong Hee , Shin Myoung Jin , Kim Sung Ran , Choi Jun Yong , Choi Young Hwa , Lee Kyung Won , Koo Hyunsook , Lee Hyunmin , Song Kyoung-Ho , Kim Eu Suk , Kim Nam Joong , Oh Myoung-don , Kim Hong Bin
Published: November 2020

Background: After the Middle East respiratory syndrome coronavirus outbreak in Korea in 2015, the government newly established the additional reimbursement for infection prevention to encourage infection control activities in the hospitals. The new policy was announced in December 2015 and was implemented in September 2016. We evaluated how infection control activities improved in hospitals after the change of government policy in Korea. Methods: Three cross-sectional surveys using the WHO Hand Hygiene Self-Assessment Framework (HHSAF) were conducted in 2013, 2015, and 2017. Using multivariable linear regression model including hospital characteristics, we analyzed the changes in total HHSAF scores according to the survey time. Results: In total, 32 hospitals participated in the survey in 2013, 52 in 2015, and 101 in 2017. The number of inpatient beds per infection control professionals decreased from 324 in 2013 to 303 in 2015 and 179 in 2017. Most hospitals were at intermediate or advanced levels of progress (90.6% in 2013, 86.6% in 2015, and 94.1% in 2017). In a multivariable linear regression model, the total HHSAF scores were significantly associated with hospital teaching status (β coefficient of major teaching hospital, 52.6; 95% CI, 8.9–96.4; P = .018), bed size (β coefficient of 100-bed increase, 5.1; 95% CI, 0.3–9.8; P = .038), and survey time (β coefficient of 2017 survey, 45.1; 95% CI, 19.3–70.9; P = .001). Conclusions: After the national policy implementation, the number of infection control professionals increased, and the promotion of hand hygiene activities was strengthened in Korean hospitals.

Funding: None

Disclosures: None
Implementation of Hospital-Based Candida auris Surveillance Screening Among At-Risk Patients
Authors: de St. Maurice Annabelle , Hallmark Amy , Hilt Evan , Price Travis , Uslan Daniel , Bisht Anjali , Yang Shangxin , Garner Omai
Published: November 2020

Background:Candida auris is an emerging multidrug-resistant pathogen associated with outbreaks in hospitals and skilled nursing facilities (SNFs). Patients with C. auris can have invasive disease or asymptomatic colonization. Because C. auris can be difficult to treat and eradicate in the environment, the CDC recommends using contact precautions and sporicidal agents during patient care. After C. auris was identified in a patient from an LA County SNF (SNF-X), our institution initiated surveillance screening on high-risk patients. Methods: Nurses identified patients residing at SNF-X on admission and contacted infection prevention. These patients were placed on contact or spore precautions. Bilateral axilla and inguinal folds were swabbed with an Eswab and sent for testing by a clinical laboratory-developed RT PCR assay, which can detect C. auris with high sensitivity and specificity with a rapid turnaround time (4–6 hours). This PCR assay was based on a commercial platform IntegratedCycler (Diasorin) and reagents from the same vendor. Environmental swabs from the index patient’s room were sent for PCR by HardyCHROM Candida agar (Hardy Diagnostics) before and after cleaning with OxyCideTM. PCR-positive samples were set up for culture. Results: In total, 27 patients from SNF-X were screened by PCR. Of these patients, 15 (55%) had a tracheostomy present on admission. Moreover, 26 swabs were negative; 1 was positive in the index patient (cycle threshold [Ct] value, 26). Clinical specimens from the index patient’s blood did not grow C. auris; the tracheostomy sample grew predominantly C. albicans which made identification of C. auris challenging by culture. However, investigational testing of this sample by PCR was positive (Ct value, 31). Environmental swabs collected from the patient room were obtained before and after cleaning (Table 1); all environmental cultures were negative at 5 days. Conclusions: Developing hospital-based, high-risk patient screening for C. auris is feasible and may be useful for controlling the spread of C. auris within the community. Further study is needed to determine the usefulness of PCR for environmental testing to assess the risk of nosocomial transmission of C. auris.

Funding: None

Disclosures: None
Implementing an Automated Pneumonia Surveillance System
Authors: Ding Dan , Phillips Michael , Iturrate Eduardo , Hochman Sarah , Stachel Anna
Published: November 2020

Background: Although definitions from the CDC were developed to increase the reliability of surveillance data, reduce the burden of surveillance in healthcare facilities, and enhance the utility of surveillance data for improving patient safety, the algorithm is still laborious for manual use. We implemented an automated surveillance system that combines 2 CDC pneumonia surveillance definitions to identify pneumonia infection in inpatients. Methods: The program was implemented at an academic health center with >40,000 inpatient admission per year. We used Window Task Scheduler with a batch file daily to run a validated pneumonia surveillance algorithm program written with SAS version 9.4 software (SAS Institute, Cary, NC) and a natural language processing tool that queries variables (Table 1) and text found in the electronic medical records (EMR) to identify pneumonia cases (Fig. 1). We uploaded all computer-identified positive cases into a Microsoft Access database daily to be reviewed by a hospital epidemiologist. Every week, we also validated 5 computer-identified negative cases from the prior 2 weeks to ensure accuracy of the computer algorithm. We defined negative cases as pneumonia present on admission or chest x-ray indicative of pneumonia but without CDC-defined surveillance symptoms. We also wrote a program to automatically send e-mails to key stakeholders and to prepare summary reports. Results: Since November 2019, we have successfully implemented the automated computer algorithm or program to notify, via e-mail, infection prevention staff and respiratory therapy providers of CDC-defined pneumonia cases on a daily basis. This automated program has reduced the number of manual hours spent reviewing each admission case for pneumonia. A summary report is created each week and month for distribution to hospital staff and the Department of Health, respectively. Conclusions: The implementation of an automated pneumonia surveillance system proves to be a timelier, more cost-effective approach compared to manual pneumonia surveillance. By allowing an automated algorithm to review pneumonia, timely reports can be sent to infection prevention control staff, respiratory therapy providers, and unit staff about individual cases. Hospitals should leverage current technology to automate surveillance definitions because automated programs allow near real-time identification and critical review for infection and prevention activities.

Funding: None

Disclosures: None
Implementing an Electronic Screening Tool to Identify Patients at Risk for Candida auris
Authors: Silkaitis Christina , Arnold Lea Ann , Mikolajczak Anessa , Makula Elizabeth , Salim Asra , Stehlik Anne , Barnard Cindy , Dolgin Gina , Voss Heather , Qi Chao , Zembower Teresa
Published: November 2020

Background:Candida auris is an emerging fungus that presents a serious threat to healthcare facilities. Because Chicago is a locus of high prevalence, the Illinois Department of Public Health (IDPH) released guidelines for acute-care hospitals to screen and isolate patients who are directly admitted from either a skilled nursing or long-term acute-care facility (SNF or LTAC) with a tracheostomy or on a ventilator. This project was undertaken to evaluate applicability of IDPH criteria to our inpatient population and to develop effective tools to implement a surveillance system. Methods: To assess IDPH criteria, we reviewed local case epidemiology and conducted a point-prevalence survey of all inpatients on May 22, 2019. To implement a new surveillance program, we convened a multidisciplinary team to assess the functionality of the electronic health record (EHR), to create clinician education, and to develop new electronic tools. Results: Between June 2018 and August 2019, 20 unique C. auris patients were admitted to our facility, and only 2 (10%) met IDPH criteria. During the point-prevalence survey, 609 inpatients were assessed, and only 7 (1%) met IDPH criteria (Table 1). Therefore, we created a new surveillance program tailored to our local epidemiology. To do this, we convened a multidisciplinary team with representatives from infection prevention, nursing informatics, patient care, microbiology and information technology (IT). The IT build took 5 months, and the work products included a screening questionnaire integrated into the nurse admission navigator, new microbiology laboratory orders for C. auris culture, a new internal isolation category that we deemed prior location-based isolation (PLI), and an electronic report to automatically aggregate data. To streamline workflow, best-practice alerts (BPAs) were designed to automatically order isolation and laboratory tests based on responses to the admission questionnaire (Fig. 1). Additionally, tools were created catch missed opportunities for isolation and to automatically update isolation status based on final culture results. Conclusions: Local epidemiology must be considered when designing C. auris surveillance programs. Stakeholder engagement and informatics were key to successful program implementation. The EHR must be nimble to address updated recommendations for organisms of concern. Data must be continuously evaluated to measure success of a targeted screening and surveillance program.

Funding: None

Disclosures: None
Important but Impractical: Hand Hygiene Among Operating Room Anesthesia Providers
Authors: Moseley Sadie Mae , Ankrum Andrea , Jimenez Normidaris , Guthrie Alyssa , Huang Felicia Scaggs , Schaffzin Joshua
Published: November 2020

Background: Use of the WHO 5 Moments of Hand Hygiene (HH) by operating room (OR) anesthesia personnel has been called by some logistically unfeasible, despite evidence that HH can reduce patients’ risk of pathogen acquisition. We developed and implemented a set of 7 moments based on WHO guidance (Fig 1) with high adherence. We conducted this study 6 months later to determine whether the improvement was sustained. In addition, we sought to understand practices, beliefs, barriers, and perceptions among anesthesia providers regarding HH. Methods: We measured HH adherence by direct observation using locally developed 7 moments tailored to the anesthesia workflow during June–August 2019. Adherence was defined as the percentage of observed HH performed when a moment occurred. We used the theory of planned behavior (TPB) as a framework to conduct 11 individual interviews (8 attending anesthesiologists and 3 certified nurse anesthetists) with a semistructured instrument that included Likert scale and open-ended questions. Interview transcripts were reviewed and a codebook of themes was created through inductive thematic analysis. Resultant themes and Likert scale averages were grouped by the 3 key TPB variables. Results: In total, 294 HH moments were observed for 50 anesthesia providers during 36 cases. The average HH adherence was 21.1% with the highest adherence moment being after patient contact (61.7%). Interview participants stated universally that HH was important for patient care, but acknowledged barriers to performance. Barriers cited included interruption in workflow, a lack of evidence, lack of clarity of HH standard, and limited availability of product. Conclusions: Adherence to the 7 moments of HH for anesthesia providers was not sustained after 6 months. Providers identified numerous barriers to HH, including a lack of knowledge of a standard, as reasons for suboptimal adherence. These data suggest future interventions could be designed to address gaps in knowledge and remove barriers to improve HH adherence among OR anesthesia providers.

Funding: None

Disclosures: None
Imunocromatografic Tests Improving Point-of-Care Management of Respiratory Virus Infection in Children
Authors: Mendes Elisa Teixeira , Paranhos Hadassa Louback , Santos Isabela Cristina Moreira , Barbosa Nathália Reis Sartori , da Silva Raquel Vieira , Lima Maria Patelli Juliani Souza
Published: November 2020

Background: Respiratory syncytial virus (RSV) and influenza virus (flu) contribute substantially to the overall burden of severe respiratory tract infection in children. However, the molecular etiological diagnostic methods of viral infection are still insufficiently accessible in public hospitals. Rapid immunochromatographic tests can add important information at the point of care, including antiviral or antibiotic indication, viral , and effective precaution measures to prevent outbreaks. The aim of this study was to evaluate this impact for pediatric patients under 5 years of age in our hospital. Methods: We conducted a retrospective, observational study of clinical outcomes of children under 5 years requiring hospitalization from 2013 to 2018 for viral respiratory disease, and who had positive RSV and/or flu immunochromatographic rapid test results. Results: In total, we identified 221 cases: RSV, 193; flu, 6; codetections, 19. (Table 1). The mortality rate was 1.8% (2 cases), and 88% of our patients were <1 year of age. Variables significantly associated with orotracheal intubation, the most intensive intervention, were younger age in months, comorbidities, RSV and flu codetection, and bacterial pneumonia diagnosis during hospitalization. Conclusions: In the multivariate analysis, RSV and flu codetection was associated with the least favorable clinical prognoses. Rapid test diagnosis may provide important information at the point of care, and molecular panels are not yet widely accessible in public hospitals. Hence, we believe that immunochromatographic rapid tests represent a valuable and feasible diagnostic alternative facilitating timely evaluation and treatment implementation.

Funding: None

Disclosures: None
Increasing Mupirocin Resistance Among MRSA Nasal Surveillance Isolates in the Chicago Area
Authors: Schora Donna , McElvania Erin , Sabatini Linda , Singh Kamaljit
Published: November 2020

Background: In 2005, our healthcare system began universal admission screening for nasal colonization with MRSA and decolonization of MRSA positive patients with mupirocin. In 2010–2012, we studied the impact of nasal MRSA decolonization and concluded that it does not add benefit when contact precautions are used; plus, it resulted in increased rates of mupirocin resistance up to 9.4% in 2012. In September 2012 routine decolonization of hospitalized patients was discontinued. In the 2 years following discontinuation of mupirocin use for decolonization of MRSA carriers, the rate of mupirocin resistance gradually declined. We undertook a contemporary review of mupirocin resistance rates to ensure that the rates were stable. Methods: NorthShore University HealthSystem, Illinois, consists of 4 hospitals in the northern suburbs of Chicago, with 750 beds and 60,000 annual admissions. Admission nasal swab samples were collected from at-risk hospitalized patients based on a risk-adjusted algorithm. Nasal swabs were tested using the BD MAX MRSA assay. Positive samples were cultured onto BD BBL CHROMagar MRSA to recover the organism and were tested for the mupA gene, which confers high-level mupirocin resistance using an in-house PCR test. Data for mupirocin orders were provided by the pharmacy. Results: Mupirocin resistance rates and prescription orders are shown in Figs. 1 and 2. Conclusions: Mupirocin resistance rates plateaued between 2012 and 2014 and then increased from 9.1% in 2015 to 18.1% in 2019, despite discontinuation of routine decolonization of hospitalized patients. The reason for the increase is unclear; inpatient mupirocin orders were stable from 2015 to 2017.

Funding: None

Disclosures: None
Infection Control Center of Excellence Experience
Authors: Amer Hala , Alenizi Ahmed
Published: November 2020

Background: In 2018, the Ministry of Health (MOH) in Saudi Arabia launched the Infection Control Excellence Center (ICEC) program among healthcare governmental institutions to create an exceptionally high concentration of expertise and resources within the infection prevention and control discipline to afford the best patient outcomes possible. King Saud Medical City (KSMC), one of the main healthcare institutions in Riyadh, was selected to be among the 10 facilities participating in ICEC 2019 competition. It is expected to qualify the facility to lead the Kingdom infection prevention and control as well as sharing expertise at regional and international levels. Methods: The infection control team at KSMCA used a business model canvas to present the project vision, resources, partners, values, and revenue streams (Fig. 1). All project stakeholders were engaged, including core infection control team, various hospital departments as internal partners, along with the MOH team as external partners. The ICEC program was presented at the KSMC executive council to earn leadership support. The following assessment areas were included in the presentation: (1) quality assurance and patient care through sustain basic infection control standards and improve key performance indicators (KPIs); (2) enhance the development and structure of the infection control team; (3) pursue innovative ideas in infection control practices. Overall, 17 projects arranged into 4 programs have been proposed (Fig. 2). Results: The institution successfully passed the eligibility criteria assessment in the first quarter of 2019. Infection control KPIs have been corporatized with KSMC strategic KPIs that support infection control improvement initiatives. The infection control team continues to grow in function and capacity. Also, 4 additional were awarded CIC certification in 2019 to reach total of 11 CICs, which represent 30% of the team (including 1 recertification). A dashboard designed by the project management office facilitates follow-up with the proposed projects in progress. Completion levels ranging between 30% and 100% have been achieved among these projects. A final evaluation was conducted in December 2019, including a field visit by the MOH ICEC team as well as a written MCQs exams and interviews with the core infection control team. Communication among the stakeholders and leadership involvement were considered among the assessment criteria. Conclusions: The ICEC supports and motivates investment in human capital and encourages innovative, cost-effective solutions in infection control field in Saudi Arabia. It is also aligned with Saudi Arabia healthcare transformation and the 2030 vision through integrated programs in healthcare facilities.

Funding: None

Disclosures: None
Investigation of Surgical Site Infection Outbreak Among Neurosurgical Patients
Authors: Ramos Luísa , Pessoa Jussara , Santos Leonardo , Starling Carlos , Couto Braulio
Published: November 2020

Background: The infection control service of a private hospital in Belo Horizonte, Brazil, performs continuous surveillance of surgical patients according to the CDC NHSN protocols. In a routine analysis of the neurosurgical service, we identified a subtle increase in the incidence of surgical site infection (SSI): in 5 months (June–October 2018), 6 patients developed an SSI. From January 2017 until May 2018, there were no cases of infection in neurosurgery, which led us to suspect an outbreak. Methods: A cohort study was used to investigate the factors associated with risk of SSI. We investigated the following variables: ASA score, number of hospital admissions, age, preoperative hospital length of stay, duration of surgery, wound class, general anesthesia, emergency, trauma, prosthesis, surgical procedures, surgeon. Furthermore, 9 key steps were followed to investigate the outbreak: case definition (step 1), search for new SSI cases (step 2); confirmation of the outbreak (step 3); analysis of SSI cases by London Protocol (step 4); analysis of the cohort data (step 5); inspections in the surgical ward (step 6); qualitative and quantitative reports sent to the neurosurgical departments (step 7); continuing with active surveillance (stage 8); announcement of research findings (step 9). Results: The outbreak was confirmed: SSI incidence in the pre-epidemic period (January–May 2018) was 0 of 218 (0%); in the epidemic period (June–October 2018), SSI incidence was 6 of 94 (6.4%) (P < .001). We identified 3 SSI etiologic agents: 2 Klebsiella pneumoniae, 2 S. aureus, and 1 Serratia marcescens. It was unlikely that there was a common source for the outbreak. We identified the following risk factors: second or third hospital admissions (RR, 3.7; P = .041), and preoperative hospital length of stay: SSI patients (4.3±5.7 days) versus control patients (0.7 ± 2.1 days) (P = .048). None of the surgeons presented an SSI rate significantly different from each other. We used the London protocol to identify antibiotic prophylaxis failures in most cases. Conclusions: New cases of infections can be prevented if the length of preoperative hospital stay becomes as short as possible and, most importantly, if antibiotic prophylaxis does not fail.

Funding: None

Disclosures: None
Leveraging Local Expertise in Stewardship, Hospital Epidemiology and Public Health to Enrich Postgraduate Training in NYC
Authors: Cowman Kelsie , Ostrowsky Belinda , Seo Susan , Chen Victor , Bartash Rachel , Nori Priya
Published: November 2020

Background: New York City is a gateway for emerging pathogens and global threats. In 2013, faculty from Montefiore Medical Center and Memorial Sloan Kettering developed a free half-day workshop for postgraduate trainees in antimicrobial stewardship (AS), infection prevention (IP), hospital epidemiology, and public health. This annual workshop, sponsored by the Infectious Diseases Society of New York (IDSNY), incorporates case studies and expert panel discussions on timely topics such as Ebola, Candida auris, Clostridiodes difficile, measles, nosocomial influenza, drug shortages, and AS/IP “big data.” Methods: From 2013 through 2017, the workshop involved 10–15 interactive AS/IP cases with audience response questions and panel discussions. In 2018–2019, based on feedback, the format was revised to emphasize breakout sessions in which participants actively practiced AS/IP tools, (eg, medication utilization evaluations, epidemiologic curves, and performance improvement devices). Examples of 2018–2019 cases are shown in Figure 1. A pre- and postseminar paper survey was conducted yearly to understand baseline training in AS/IP, desire for future AS/IP careers, and self-reported effectiveness of the workshop. Results: Initially, the primary audience was NYC ID fellows. From 2018 onward, we opened enrollment to pharmacy residents. Approximately 45 NYC ID fellows were eligible for the course each year. Results from 2013 to 2016 surveys were reported previously (Fig. 2). There were 32 attendees in 2018, 42 in 2019. The survey response rate was 88% in 2018 and 95% in 2019, with 68 (92%) total participants. Most participants had received previous training in IP (82%) and AS (94%) (Fig. 3). Most participants reported that the program was a good supplement to their ID training (98%) and that case studies were an effective means of learning IP (100%) and AS (98%). Furthermore, 92% stated they would like additional AS/IP training, and many since 2013 have requested a full-day course. Self-reported interest in future involvement in AS/IP increased after the workshop: IP, 68%–83% (P =.04) and AS, 88%–91% (P = .61). Conclusions: Most trainees reported satisfaction with the workshop and case-study learning method; interest in future AS/IP careers increased after the seminar. We intend to explore Funding: to expand to a full-day program for all NYC postgraduate trainees and AS/IP junior faculty. As such, we hope to obtain the endorsement of professional societies such as SHEA. This workshop could address a crucial educational gap in AS/IP postgraduate training and help sustain our future workforce.

Funding: None

Disclosures: None
Meta-analysis of Outcomes Using Ceftolozane-Tazobactam and Ceftazidime-Avibactam for Multidrug-Resistant Organism Infections
Authors: Wilson Geneva , Fitzpatrick Margaret , Walding Kyle , Gonzalez Beverly , Evans Charlesnika
Published: November 2020

Background: Ceftolozane-tazobactam (C/T) and ceftazidime-avibactam (C/A) are new β-lactam/β-lactamase combination antibiotics that were approved by the FDA in 2014 and 2015, respectively, to treat complicated intra-abdominal and urinary tract infections. They are commonly used to treat multidrug-resistant Pseudomonas aeruginosa (MDRPA) and carbapenem-resistant Enterobacteriaceae (CRE) infections at any site. Both medications are also often used as salvage therapy when empiric therapy has failed or when the infectious organism tests resistant to all other available antibiotics. The purpose of this review is to present the clinical experience and reported clinical success rates of C/T and C/A. Methods: PubMed, EMBASE, and Google Scholar were searched from January 1, 2013, through October 1, 2019, for publications detailing clinical experience with C/T and C/A in patients with CRE and MDRPA infections. Included study designs were extended cases series and clinical observational studies. Information on infection type, bacterial agent, salvage therapy uses, clinical success, and resistance development during treatment were abstracted. Meta-regression analysis was used to determine the pooled effectiveness of C/T and C/A among included studies. Results: The literature search returned 1,645 publications. After exclusion criteria were applied, 16 publications representing 769 patients were retained. The study population was mostly male (pooled average, 62%). The major comorbidities represented in the pooled population were solid organ transplantation (20.0%), kidney disease (19.5%), cardiovascular disease (15.3%), and diabetes (15.3%). Pneumonia was the predominant infection type (41.4%) and MDRPA was the pathogen most frequently evaluated (57.7%). The pooled clinical success rate was 70.2% (95% CI, 64.5%–75.3%). Also, 10 studies explicitly evaluated C/A or C/T as salvage therapy. The pooled clinical success rate for salvage therapy studies was 75.2% (95% CI, 69.7%–80.0%). Development of resistance to C/T or C/A during or after treatment was reported for 2.0% of the population. Conclusion: Overall, these medications have a high clinical success rate in patients with severe and complicated infections and limited treatment options. Pooled clinical success rates were high (70.2%) and the medications were particularly effective as salvage therapy. Resistance rates were low, although this could have been biased by the small percentage of studies that reported on this outcome. More longitudinal studies comparing the effectiveness of C/T and C/A against other antibiotic regimens are needed.

Funding: None

Disclosures: None
Methicillin-Resistant Staphylococcus aureus Prevalence Among Healthcare Workers in Contact Tracings in a Dutch Hospital
Authors: Weterings Veronica , Kievits Heidi , van Rijen Miranda , Kluytmans Jan
Published: November 2020

Background: In The Netherlands, the national guidelines on Methicillin-Resistant Staphylococcus aureus (MRSA) prevention and control advocate screening of healthcare workers (HCWs) after unprotected exposure to MRSA carriers. Although this strategy is largely successful, contact tracing of staff is a time-consuming and costly component. We evaluated our contact tracing policy for HCWs over the years 2010–2018. Methods: A retrospective, observational study was performed in a Dutch teaching hospital. All HCWs 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 an HCW, 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. Molecular typing was performed using multiple-locus variable number of tandem repeat analysis (MLVA). Results: In total, we included 8,849 samples (range, 677–1,448 samples per year) from 287 contact tracings (range, 26–55 contact tracings per year). Overall, 32 HCWs were colonized with MRSA (0.36%; 95% CI, 0.26%–0.51%). None of them developed a clinical infection. Moreover, 8 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 of 287 contact tracings (2%). In 4 of 8 of these cases, a positive HCW was the index for undertaking contact tracing. In 3 of 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 whom 7 of 24 HCWs (29.2%) were intermittent carriers. Conclusions: This study revealed a sustained low MRSA prevalence among samples in contact tracing of HCWs over 9 years. Furthermore, it shows that when MRSA contact tracing is performed according to the national guideline, only 1 of 1,000 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 questions regarding the efficacy of the current strategy to perform contact tracing after unprotected exposure.

Funding: None

Disclosures: None
Occupational Exposure to Varicella Zoster in a Tertiary-Care Healthcare Setting
Authors: Yetmar Zachary , Apenhorst Debra , Sampathkumar Priya , Beam Elena
Published: November 2020

Background: Disseminated varicella zoster virus (dVZV) infection is a feared complication of varicella zoster virus (VZV) reactivation in immunocompromised patients. The CDC recommends contact and airborne precautions for localized VZV in immunocompromised patients until dissemination has been ruled out. Pre-emptive isolation can be problematic for medical centers without access to negative-pressure rooms. When we identify a case of dVZV at our facility, we perform an investigation to identify occupational exposures. Methods: We conducted a retrospective, descriptive review of occupational exposure investigations related to dVZV from January 2016 to December 2018. We collected baseline characteristics of the dVZV patient, and we evaluated whether the exposure occurred due to a delay in diagnosis or a progression from “localized” to disseminated VZV disease. Results: We identified 21 immunosuppressed patients with dVZV whose infection resulted in an occupational exposure during the specified study period. Average age was 58.6 years, with 10 males and 12 females. The immunocompromised patients included 11 with hematologic malignancy, 5 with solid-organ malignancy, 3 with rheumatologic disease on immunosuppressive therapy, and 2 with a solid-organ transplant. Most of the exposures (72.7%) occurred in an inpatient setting. The exposures resulted from either delayed recognition of dVZV or delayed initiation of appropriate precautions for all of the immunosuppressed patients. Two additional exposures occurred as a result of a change from “localized” to “disseminated” VZV. These patients whose diagnosis changed from localized to dVZV were considered previously immunocompetent, and dissemination took place 2 days after seeking healthcare evaluation. Conclusions: Most occupational exposures to varicella zoster are the result of delayed initiation of appropriate isolation precautions due to delayed diagnosis of dVZV infection or failure to recognize the need for instituting precautions in disseminated disease. Instituting preemptive airborne precautions for immunocompromised patients with localized varicella zoster would be unlikely to reduce occupational exposures.

Funding: None

Disclosures: Consulting fee- Merck Priya Sampathkumar
Onsite-Assessment of Infection Prevention Preparedness in Community Healthcare Settings
Authors: Cook Evelyn , Hernandez Julie , Lamm Wanda , Lewis James , Powell Amy , Ridge Heather , Weber David Jay , Rutala William
Published: November 2020

Background: Well-designed infection prevention programs include basic elements aimed at reducing the risk of transmission of infectious agents in healthcare settings. Although most acute-care facilities have robust infection prevention programs, data are sporadic and often lacking in other healthcare settings. Infection control assessment tools were developed by the CDC to assist health departments in assessing infection prevention preparedness across a wide spectrum of health care including acute care, long-term care, outpatient care, and hemodialysis. Methods: The North Carolina Division of Public Health collaborated with the North Carolina Statewide Program for Infection Control and Epidemiology (SPICE) to conduct a targeted number of on-site assessments for each healthcare setting. Three experienced infection preventionists recruited facilities, conducted on-site assessments, provided detailed assessment findings, and developed educational resources. Results: The goal of 250 assessments was exceeded, with 277 on-site assessments completed across 75% of North Carolina counties (Table 1). Compliance with key observations varied by domain and type of care setting (Table 2). Conclusions: Comprehensive on-site assessments of infection prevention programs are an effective way to identify gaps or breaches in infection prevention practices. Gaps identified in acute care primarily related to competency validation: however, gaps presenting a threat to patient safety (ie, reuse of single dose vials, noncompliance with sterilization and/or high-level disinfection processes) were identified in other care settings. Infection control assessment and response findings underscore the need for ongoing assessment, education, and collaboration among all healthcare settings.

Funding: None

Disclosures: None
Outcomes for Community-Acquired Extended-Spectrum Beta-Lactamase (ESBL) Escherichia coli Urinary Tract Infections (UTIs) in Children Treated With Empiric Noncarbapenem Antibiotic Therapy
Authors: Holmen Jenna
Published: November 2020

Background: Empiric therapy with a cephalosporin antibiotic is the current standard of care for children with urinary tract infections (UTIs). However, as the rate of UTI due to extended-spectrum β-lactamase (ESBL)–producing organisms rises, there is concern that treatment failures may increase. Carbapenems are the most reliable antimicrobials for treating ESBL organisms, but empiric coverage with carbapenems necessitates hospitalization for intravenous therapy. Objective: We evaluated whether empiric noncarbapenem therapy in patients with ESBL Escherichia coli UTI is associated with poorer outcomes. Methods: We conducted a case-control study of patients with UTIs treated with empiric penicillin- or cephalosporin-based antibiotics from January 1, 2017, to December 31, 2018. We compared outcomes in cases with ESBL E. coli UTI with age-matched controls with a cephalosporin-susceptible E. coli UTI. Logistic regression was used to compare the odds of clinical failure (persistent symptoms and/or fever) at 48–72 hours. We further evaluated the odds of hospitalization and UTI recurrence between groups. Results: Of the 228 enrolled patients, 51 were cases and 177 controls. Cases were more likely to have underlying medical conditions (45% vs 21%). The odd ratio of clinical failure at 48–72 hours after initiation for cases compared to controls was 4.83 (95% CI, 0.94–24.92; P = .06). These odds were was not influenced by age, presence of an underlying medical condition, or fever. The overall adjusted odd ratio of hospitalization for cases compared to controls was 12.09 (95% CI, 0.995–4.38, P = .052). Most patients admitted at presentation had an underlying medical condition (30 of 64, 47%) and/or fever (54 of 64, 84%). Among 30 cases initially managed as outpatients, only 2 (7%) were later admitted due to clinical failure. There was no difference in the likelihood of UTI recurrence within 60 days for the 2 groups (adjusted OR, 1.34; 95% CI, 0.47–3.78; P = .58). Conclusions: At 48–72 hours, there was no significant difference in the odds of clinical failure for patients with ESBL E. coli UTI compared to patients with non-ESBL E. coli UTI receiving empiric noncarbapenem therapy. Although we detected a trend toward a higher odds of hospitalization among cases, this result was largely due to a higher clinical complexity among cases at baseline. Only 2 cases required admission for failure of outpatient therapy. There was no increased risk of UTI recurrence among cases. This study suggests that initial discordant antibiotic therapy may not increase the risk of a poor outcome in children with ESBL E. coli UTI.

Funding: None

Disclosures: None