bluuebunny/crossref_metadata_2025 huggingface dataset:
1173. Expanding the MAGIC: Engagement of Frontline Nursing Staff in Device Stewardship
Authors: Linsenmeyer Katherine , Gupta Kalpana , Mosesso Suzanne , House Christine , Strymish Judith
Published: October 2019

Background

Nearly 40% of all peripherally inserted central catheter (PICC) placements may be inappropriate. Validated appropriateness criteria (Michigan Appropriateness Guide for Intravenous Catheters or MAGIC) were developed to improve patient safety and decrease adverse events from PICC line use. Recent studies have demonstrated the impact of MAGIC implementation with success but involve multimodal interventions that may not be sustainable. We evaluated the effect of a nursing-driven MAGIC-derived triage tool online utilization.

Methods

We conducted a quasi-experimental before and after study evaluating the effect of a MAGIC-derived triage tool including all patients for whom a PICC consult was ordered. The triage tool was implemented January 1, 2018 as part of the consult order and required providers to identify an indication for placement. All consults were reviewed by the IV Team Nurses who collaborated with ID providers when warranted. Providers were contacted if MAGIC criteria suggested alternate access was more appropriate and encouraged to either place a mid or peripheral line or to consider an oral medication. Rates of line utilization and line infections pre-intervention and post-intervention were compared.

Results

Overall, 242 consults for PICC lines were placed during the one year intervention period January 1, 2018 to December 31, 2018. Indications included: antibiotics (54%), TPN/chemo (21%) difficult access (17%), no response (8%). Thirty-five PICCs were averted directly related to the intervention. Appropriate indication of PICC placement with the tool was 88%. During this same time period, the line utilization ratio (lines/1,000 patient-days of care) decreased from a mean of 3.8 (range 3.3 to 4.2 for years 2015–2017) to 2.6, a 32% reduction (IIR 0.72; P < 0.05). Central line bloodstream infection rates (infections/1,000 line days of care) also decreased from a mean of 0.81 (range 0.56 to 1.18 for years 2015–2017) to 0.37, a 54% reduction (IIR 0.4; P = 0.10).

Conclusion

Even in a setting of low line infection and line utilization rates, further reductions in potential device harm can be achieved using point of care feedback tools. This intervention empowers nursing involvement in device stewardship, thus expanding the range of their involvement in stewardship activities.

Disclosures

All authors: No reported disclosures.
1177. A Spectrum of Infectious Complications in Continuous-Flow Ventricular Assist Devices: A Single-Center Longitudinal Cohort
Authors: Roberts Scott C , Rich Jonathan D , Pham Duc T , Harap Rebecca , Stosor Valentina
Published: October 2019

Background

Infections remain a frequent complication of patients (patients) with ventricular assist devices (VAD). We evaluated the epidemiology and outcomes of VAD infections at our center over a 10-year period.

Methods

We performed a retrospective cohort study of continuous-flow VAD recipients from July 2008-September 2018. VAD-specific and -related infections were characterized according to 2013 ISHLT definitions. Summary and comparative statistics were performed using IBM® SPSS Statistics version 25.0.

Results

433 VADs were implanted into 375 patients. A total of 86 VAD infections occurred in 79 patients, with a mean incidence of 0.19 episodes/VAD and 0.20 episodes/pt. Patients with infections were predominantly male (73.3%) and Caucasian (54.6%), and had mean age of 52.7 years, nonischemic cardiomyopathy (58.1%), and VAD as bridge to transplant (53.5%, n = 46). Types of VAD included 43.0% axial (n = 37) and 57.0% centrifugal flow (n = 49). 78% of patients with infections were colonized with at least one multidrug-resistant organism (MDRO) such as MRSA (29%), VRE (73%), and ESBL (24%).

Notably, 15% of infections (n = 13) occurred within 60 d of VAD implantation, with mean time to onset 36 d (5–60 d) post-VAD. Early infections (<60d) involved driveline exit site (DLES) (n = 4), pocket (n = 3), and pump (n = 7) with 7 VAD-related blood stream infections (BSI), 6 infective endocarditis (IE), and 2 mediastinitis. Early infections involved Gram-positive (GP) bacteria (84.6%, n = 11), Gram-negatives (GN) (45.5%, n = 5), anaerobes (23.1%, n = 3), fungi (30.8%, n = 4), MDRO (61.5%, n = 8) and 32 pathogens (69.2%, n = 9). 85% of infections occurred late (n = 73) with mean time to onset 338 d (69–1215 d). In late infections (>60d), impacted sites included DLES (n = 38), pocket (n = 7), and pump (n = 40), with 42 BSI, 36 IE, and 2 mediastinitis. Pathogens were 68.5% GP (n = 50), 37.0% GN (n = 27), 2.7% anaerobes (n = 2), 2.7% fungi (n = 2), 17.8% MDRO (n = 13), and 26.0% polymicrobial (n = 19).

Conclusion

In this longitudinal retrospective cohort of patients supported with VADs, a majority of infections occurred >9 months post-implantation. GP pathogens predominated at all time-points. GN bacteria, including MDROs, anaerobes, and fungi are increasingly encountered. The vast majority of patients were colonized with ³1 MDRO during the course of VAD implantation.

Disclosures

All authors: No reported disclosures.
1181. Significant Reduction of Non-Ventilator Hospital-Acquired Pneumonia (HAP) with a Prevention Bundle and Clinical and Leadership Feedback in a Large Integrated Healthcare System
Authors: Naik Sejal , Lacerna Cristine , Kevorkova Yulia , Galin Jessica , Patey Donna , Block Lawrence , Parker Melanie , Betts Robin , Parodi Stephen , Witt David J
Published: October 2019

Background

Non-Ventilator Hospital-acquired Pneumonia (HAP) is a prevalent healthcare-associated infection with mortality of 21%. HAP prevention literature is scant. We developed a definition enabling accurate surveillance to support this effort and implemented a prevention bundle based on available literature and characteristics of our high-performing centers.

Methods

Kaiser Permanente Northern California is an integrated healthcare system providing care for 4.4 million patients at 21 medical centers. Discharge diagnoses of HAP cases were reviewed for accuracy and factors permitting programmatic confirmation. A natural language extraction program identified new and persisting imaging findings, providing specificity. No other surveillance factors added specificity. Surgery, altered mental status, sedation, albumin <3 g/dl and tube feedings were identified as predictive risks. Seven interventions became part of a new pneumonia prevention order set for automatically identified high-risk patients: aggressive mobilization, upright posture for meals, swallowing evaluation before feeding, sedation restriction, elevated head of bed, oral care and feeding tube care. The project was fully implemented in 2015.

Results

Results were reported by 1,000 admissions and by 100,000 members served, to address a rapidly growing population. HAP decreased from 5.92 to 1.79/1000 admissions and 24.57 to 6.49/100,000 members and HAP case mortality remained stable (18–19%) while overall HAP mortality decreased from 1.05 to 0.34/1000 admissions (4.37 to 1.24 /100,000 members) (Figure 1 and 2). Carbapenem, quinolone, aminoglycoside and vancomycin use all decreased significantly (Figure 3). Benzodiazepine use decreased from 10.4% of all inpatient-days in 2014 to 8.8% of inpatient-days in 2016.

Conclusion

HAP rates, mortality and broad-spectrum antibiotic use were all reduced significantly, despite the absence of clinical practice guidelines or strong supportive literature for guidance. Some interventions had limited support, but most augmented basic nursing care. None had risks of adverse consequences. This supports the need to examine practices to improve care despite absent literature and even more so supports a need to study these difficult nebulous areas of care.

Disclosures

All authors: No reported disclosures.
1182. Clinical Outcomes of Hospital-Associated Respiratory Virus Infections
Authors: Petrie Joshua G , Lauring Adam S , Kaye Keith S
Published: October 2019

Background

Influenza and respiratory syncytial virus (RSV) are recognized as important causes of hospital-acquired infection. Increased use of multiplex molecular diagnostic testing is shedding light on the incidence of other hospital-associated respiratory virus infections (HA-RVI). However, the incidence and clinical impact of HA-RVI are not well understood.

Methods

We identified hospitalized patients admitted between July 1, 2017 and June 30, 2018 who were clinically tested to diagnose respiratory virus infections. HA-RVI were defined as respiratory virus positivity beginning more than 48 hours after hospital admission. The clinical outcomes of HA-RVI were compared with respiratory virus infections that were not considered hospital-associated (non-HA-RVI).

Results

Respiratory virus testing was performed on 4,690 individuals during 5,942 inpatient encounters. At least 1 virus was identified in 1,871 (31%) encounters, and 229 (12%) were defined as HA-RVI (median hours from admission to positivity [IQR]: 154 [79, 308]). Among the patients with a respiratory virus infection, 56% were adults, 52% were male, 77% were non-Hispanic white, and the median Charlson score was 2 (IQR: 1, (4); HA-RVI patients were more likely to be male (59% vs. 51%, P = 0.01) and had higher median Charlson scores (3 vs. 2, P < 0.001). All 14 respiratory viruses in the diagnostic panel were positive for at least one HA-RVI (Figure 1), but rhino/enterovirus (99), influenza A (27), human metapneumovirus (22) and respiratory syncytial virus (20) were most common. Compared with non-HA-RVI patients, those with HA-RVI had longer post-infection lengths of stay (median: 9 vs. 4 days, P < 0.001) and were more likely to die during hospitalization (odds ratio [95% confidence interval]: 3.4 [2.0, 5.7]) (Table 1).

Conclusion

A substantial number of HA-RVI were identified during the 2017–2018 respiratory virus season, and they were associated with a striking number of severe outcomes. More in depth analyses are required to determine whether severe outcomes are a direct result of HA-RVI or whether HA-RVI are more common in critically ill patients and serve as a marker for severe morbidity. A broader understanding of HA-RVI transmission and prevention strategies is needed.

Disclosures

All authors: No reported disclosures.
1183. Effect of Chlorhexidine Bath on the Prevention of Ventilator-associated Pneumonia: A Meta-Analysis
Authors: Robles Mark Jay M
Published: October 2019

Background

Ventilator-associated pneumonia, defined as pneumonia occurring more than 48 hours after patients have been intubated and received mechanical ventilation, represents one of the most important nosocomial infections in critically ill patients. Chlorhexidine, an antiseptic solution, is a safe and effective product with broad antiseptic activity. This meta-analysis would like to investigate if Chlorhexidine bathing significantly reduced the incidence of Ventilator-associated pneumonia.

Methods

We searched PubMed and Cochrane Central Register database to check for all published studies related to the reduction of VAP with the application of chlorhexidine bath vs. control. Various study designs such as randomized controlled trials, Before-and-After study were included in this meta-analysis.

Results

This meta-analysis analyzed eight studies. One hundred Thirty-nine (139) events developed in the chlorhexidine group over 33,030 patient-days which were significantly lower compared with 183 in the soap and water group over 35,213 patient-days. The overall incidence of Ventilator-associated Pneumonia (VAP) with the application of chlorhexidine was significantly reduced by 23% with a pooled Risk Ratio (RR) of 0.77 with 95% Confidence Interval (CI): 0.62–0.96; I2 = 52%. In the subgroup analysis, a more significant outcome was observed using Before-and-After study as the research design (pooled RR 0.63, 95% Confidence Interval (CI): 0.48–0.83, I2 = 31%). Daily chlorhexidine bath generated a more favorable outcome, compared with every other day application as evident on the pooled RR 0.78, 95% confidence interval (CI): 0.62–0.98, I2=59%

Conclusion

This meta-analysis clearly favors the use of daily chlorhexidine bath in the prevention of ventilator-associated pneumonia.

Disclosures

All authors: No reported disclosures.
1194. Gender Differences in Psychosocial Determinants of Hand Hygiene Among Doctors
Authors: Park Sunghee , Lee Eunjung , Yoon Park Se , Lee Eunyoung , Park Jung-wan , Nae Yu Shi , Kim Tark , Hyok Jeon Min , Ju Choo Eun , Hyong Kim Tae
Published: October 2019

Background

Hand hygiene (HH) is essential in the prevention of hospital-acquired infections. It is known that there are differences in the compliance of HH between men and women but the reason for this phenomenon is unclear.

Methods

A survey on HH was conducted in July 2018 among healthcare workers at four different referral hospitals in South Korea. The differences between male and female doctors were then analyzed. The survey included a structured questionnaire with seven parts: (1) self-assessment of HH execution rate, knowledge, attitude, and behavior regarding HH, (2) internal motivation for better HH, (3) obstacles for HH, (4) emotional motivation, (5) the need for external supervision, (6) preference for alcohol gel, and (7) embarrassment due to supervision.

Results

Of the 1046 healthcare workers that replied to the survey, 201 (19.2%) were doctors, and of these, 129 (63.5%) were men. There was no significant difference between male and female doctors on the questionnaire related to knowledge, attitude, and behavior regarding HH. On the questions regarding internal motivation for better HH, male doctors had a higher tendency to agree that “I would be better at HH if it was related to getting a promotion,” but the results were statistically insignificant (5.08 vs. 4.69, P = 0.08). For the 14 questions about the obstacles for HH, the following five categories showed significantly higher results in men: (1) HH is difficult in emergency situations (4.87 vs. 4.51, P = 0.02), (2) time that could be spent on something more important is wasted on HH (3.12 vs. 2.67, P = 0.008), (3) HH is not a habit (3.26 vs. 2.58, P = 0.002), (4) I often forget about HH situations (3.60 vs. 2.89, P = 0.002), and (5) I do not perform HH because there is no disadvantage when I do not perform it (3.06 vs. 2.42, P = 0.008). In the category “HH causes pain and dryness of hands,” female doctors had a significantly higher tendency to agree (3.62 vs. 4.32, P = 0.003). Among the questions regarding emotional motivation, women had a higher tendency to agree that “Seeing a fellow employee perform bad HH angers me,” but there was no statistical significance (3.73 vs. 4.10, P = 0.07).

Conclusion

There was a significant difference between male and female doctors regarding obstacles for HH. A campaign for HH based on these results could be helpful for increasing HH compliance.

Disclosures

All authors: No reported disclosures.
1197. The Gloves Are Off: The State of Personal Protective Equipment (PPE) Use in Contact, Droplet, and Standard Precautions at a Major Teaching Hospital
Authors: Krishna Sneha , Ben-Aderet Michael , Cuzzolina Jennifer , Fanelli Isabel , Fawcett Sharon E , Garland Jennifer , Madhusudhan Meghan , Grein Jonathan
Published: October 2019

Background

PPE (gowns, gloves and masks) is used in standard precautions (SP) as well as for contact, droplet or airborne isolation. Improper PPE use can lead to self-contamination and transmission of infectious agents, and at our institution the quality of PPE use has not been well assessed. For quality improvement purposes, we conducted an evaluation of healthcare worker (HCW) PPE use and knowledge of SP.

Methods

Two phases, direct observations and a survey, were completed between December 2018 and February 2019 in inpatient areas.

Direct observations of PPE use were done by Infection Prevention nurses (IPs) in contact and droplet isolation rooms during daytime hours using an internally developed observation tool (Figure 1). Observations focused on 3 stages of PPE use: donning, in room clean/dirty activities and doffing. A survey consisting of 15 questions was developed to assess staff knowledge of SP in specific clinical scenarios, perceptions of current practices and barriers to use. The survey was distributed by IPs to HCWs during their regular rounds. Data were recorded and tabulated using RedCap electronic survey tool.

Results

106 observations and 107 surveys were completed. Observations showed appropriate PPE worn in 84% (n = 83) and hand hygiene (HH) post doffing in 95% (n = 79). Common gaps included no HH pre-donning [33% n = 43], PPE not changed between dirty and clean tasks (29% n = 2), incorrect mask removal (20% n = 16) and doffing gloves post-gowns [19% n = 69]. In the survey, answers to SP questions suggest PPE is overused in patients with diarrhea or respiratory illness but underused in draining wound management (Figure 2). HCW felt more compliant than their colleagues in both HH and PPE (Figure 3). The largest misperception was that gowns should be doffed pre-gloves (40% n = 40). Reasons for not using PPE included time (26%, n = 27), and perception that PPE is unnecessary (16%, n = 10). 75% (n = 80) of HCW felt adequately educated about PPE.

Conclusion

At our institution, significant gaps still exist in HCW knowledge and use of PPE. Future QI work should focus on increasing HCW knowledge of standard precautions, HH pre-donning, changing PPE when appropriate in room as well as proper doffing order. The perception that HCW felt adequately educated despite significant gaps may be a barrier.

Disclosures

All authors: No reported disclosures.
1206. #HitMeWithYourFluShot: Consolidating a 3-Week Influenza Vaccination Program into a One-Day Drill
Authors: Drees Marci , Meyer Erin , Durst Ed , Mase Tabe , Ratnayake Hiran , Wetherill Samuel , Sharif Russel , Wroten Kathleen
Published: October 2019

Background

Since 2011 our health system has achieved >90% employee influenza vaccination via a 3-week intensive nonmandatory program offering entrance location vaccinations. We partnered with Emergency Management to consolidate this process into 1 day, fulfilling a dual purpose of conducting an emergency vaccination drill.

Methods

The health system comprises 2 hospitals (913-bed and 250-bed) and campuses, multiple off-campus clinical and nonclinical sites, and a free-standing emergency department, employing nearly 12,000 people in 4 states. A multidisciplinary team planned the drill, scheduled 4 am-9 pm at 3 locations in the 2 hospitals. In addition, roving vaccination teams visited all off-campus sites to either perform vaccinations or deliver supplies. Employees not scheduled to work were encouraged but not required to come in; all eligible employees working that day were expected to be vaccinated. Nonemployees (including physicians, volunteers and retirees) were also included. To promote the event, we developed posters and other communications using a #HitMeWithYourFluShot hashtag, and included radio stations, therapy dogs, photo booths and other activities. After the event we surveyed participants to elicit feedback.

Results

During the 1-day event we vaccinated 7267 (69%) employees, along with 1594 nonemployees, similar to prior 3-week campaigns (figure). Nearly 300 employees volunteered to vaccinate or perform other duties. The roving teams visited 81 practices at 42 separate locations, traveling >250 miles. Of those completing the post-event survey (n = 656), 79% found the event very convenient, and 61% of those who had participated in prior campaigns found this format somewhat or much better. Employee vaccination rates for the entire season was 92%.

Conclusion

This effort demonstrated that we could achieve high levels of employee flu vaccination in a single day in a large and geographically diverse healthcare system, using a mass vaccination drill format that included multiple sites of vaccination as well as roving vaccination and transport teams. We identified the lack of a master list with locations of all off-campus employees as the greatest opportunity. Participants favorably accepted the drill format and employee engagement was high.

Disclosures

All authors: No reported disclosures.
1220. Effective, Novel, Handheld, UV Technology for Surface Disinfection While Patients or Staff Are Nearby
Authors: Gergen-Teague Maria , Garrett Kurt , Semenysheva Svetlana , Weber David J
Published: October 2019

Background

The battle against nosocomial infections is ongoing, and the role the environment plays in these infections has been well established. Because only 50% of the items in a patient’s room are adequately cleaned at the time of discharge, many hospitals are turning to “no-touch” systems to supplement their manual cleaning and disinfection protocols. Lumagenics introduces a safe, novel, handheld, low heat-generating Cool UV™ technology that can be used on a daily basis, while the patient is in the room.

Methods

Templates were drawn on Formica surfaces and inoculated with known amounts of epidemiologically important pathogens (EIP’s) (i.e., MRSA, VRE, CRE Klebsiella pneumoniae, multidrug-resistant Acinetobacter baumannii, and Clostridioides difficile spores). After drying, each surface was exposed to the Cool UV™ at varying times and distances. After exposure, each surface was cultured with a Rodac plate and incubated according to standard microbiological procedures. Following incubation, all growth was quantitated and log10 reductions were calculated.

Results

Without an organic load, vegetative EIP’s were reduced by an average of 3.63–5.08 log10 for 1 and 5 sec., respectively, at 1 inch and by an average of 2.10–4.08 log10 for 1 and 5 sec., respectively, at 5 inches (Table 1). C. difficile spores were reduced an average of 1.84–3.18 log10 in 10–60 secs from a distance of 1 inch, and an average of 1.21–2.58 log10 at 5 inches (Table 2). With an organic load (10% fetal calf serum), the log10 reduction for C. difficile spores was reduced ~0.94 log10, but the reduction achieved for the vegetative EIP’s remained relatively unaffected.

Conclusion

Lumagenics’ Cool UVTM technology, with short exposure times, reduced EIP’s by levels similar to “no touch” room disinfection UV devices and may be a useful adjunct to daily cleaning and chemical disinfection.

Disclosures

All authors: No reported disclosures.
1221. Comparison of the Antimicrobial Efficacy of Mobile Ultraviolet Light Devices in a Simulated Patient Room
Authors: Boyce John M , Cotton Margaret , Donlan Alice , Larochelle John , Hardwick Matthew
Published: October 2019

Background

Multiple mobile ultraviolet (UV) light devices are available for disinfection of hospital rooms, but few data are available on the relative ability of devices to reduce surface contamination and ease of use. The objective of the present study was to compare the antimicrobial efficacy of several devices in a laboratory setting.

Methods

Using a modification of the ASTM International method E2197, spores of Clostridioides difficile(ATCC strain BAA-1870) suspended in phosphate-buffered saline (PBS) with 5% fetal calf serum were inoculated onto 20 mm stainless steel disks and dried. Disks were attached to right and left bedrails, under bed, call button, chair armrest, floor near device, table top, table bottom, floor far from device, toilet seat and grab bar and sink handle in a mock 6.4 × 4.1-meter hospital room with a 1.5 × 2.4-meter bathroom. Disks were exposed using cycle times and device placements recommended by device manufacturers. Spores from exposed disks and unexposed control disks were recovered in PBS with Triton X-100, enumerated using dilution plating, and log10reductions were determined by comparing the number of spores recovered from exposed and control disks. Times for set-up, treatment and resetting the space were recorded for each device. Results were expressed as mean log10reductions and percent reduction/minute of room vacancy. Results were compared using Kruskall-Wallis nonparametric analysis.

Results

Mean log10reductions, percent reductions, run times for patient rooms and bathroom, setup/reset times, total room vacancy times, and percent reduction/minute of room vacancy are shown in the Table. There were no significant differences in percent reductions between different locations for each device. There were, however, statistically significant differences between microbial reductions between the different machines (P < 0.05 for all comparisons).

Conclusion

There are many factors to consider in selecting a UV device. These considerations should include mean log10reduction, total vacancy times and percent reduction achieved/minute of room vacancy.

Disclosures

All authors: No reported disclosures.
1226. Application of a Foam Disinfectant Enhances Sink Drain Decontamination in Hospital Sinks
Authors: Jones Lucas D , Cadnum Jennifer , Sankar Chittoor Mana Thriveen , Jencson Annette , Donskey Curtis
Published: October 2019

Background

Sink drainage systems are a potential reservoir for the dissemination of pathogens in healthcare facilities. Pouring of liquid disinfectants down drains may have limited efficacy due to inadequate contact time and suboptimal penetration into areas harboring biofilm-associated organisms. We hypothesized that a foam application of a disinfectant would enhance sink drain decontamination in comparison to pouring of the same disinfectant.

Methods

We compared the antimicrobial efficacy of 300 mL of a hydrogen peroxide-based liquid disinfectant applied to sink drainage systems (N = 30 sinks per treatment group) using a hand-pumped foaming device vs. poured down the drain. Swabs were used to collect quantitative cultures from the proximal sink drain to depth of 1 inch below the strainer before treatment and at 15 minutes and 1, 2, 3, and 7 days after treatment. We also investigated the efficacy of the foam when applied every 3 days for a 2-week period (N = 10 sinks).

Results

As shown in the figure, pouring the hydrogen peroxide-based disinfectant down the drain significantly reduced the bacterial load on day 0 and day 1, but the bioburden returned to baseline levels within 2 to 3 days. In comparison, the foaming application of the disinfectant resulted in significantly greater reductions in bacterial recovery on days 0, 1, 2, and 3 (P < 0.01). With repeated foam treatments every 3 days, there was a progressive decrease in the bacterial load recovered from sink drains. Application of the foam required ~3 minutes per sink.

Conclusion

An easy-to-use foaming application of a hydrogen peroxide-based disinfectant was effective in suppressing recolonization of the proximal drainage system of sinks for at least 3 days. Intermittent application of the foaming disinfectant could potentially reduce the risk for dissemination of pathogens from sink drains.

Disclosures

All authors: No reported disclosures.
1232. Potential Health and Cost Outcomes of Optimized Statistical Process Control Use for Surgical Site Infection Surveillance
Authors: Nehls Nicole , Ilieş Iulian , Benneyan James C , Baker Arthur W , Anderson Deverick J
Published: October 2019

Background

Surgical site infections (SSIs) are common (160,000–300,000 per year in the United States) and costly ($6,000–$25,500 per event) healthcare-associated infections with potentially lethal outcomes (2.1%–6.7% mortality rate). A prior analysis by our group suggested that statistical process control (SPC) can detect SSI outbreaks earlier than traditional epidemiological surveillance methods. This study aimed to quantify the potential impact of SPC surveillance on patient outcomes (prevented SSIs and deaths) and healthcare costs.

Methods

We retrospectively analyzed 30 SSI outbreaks occurring over a period of 8 years in a network of 50 community hospitals from the Southeastern United States. We applied 24 control chart variations, including 2 optimized for SSI surveillance, 6 with expert-defined pre-outbreak baselines (used in our pilot study), 4 with lagged rolling baselines (idem), and 12 common practice ones (using rolling baselines with no lag or fixed baselines). The charts used procedure-specific data from either the outbreak hospital or the entire network to compute baseline SSI rates. We calculated the average SSI rates during, before and after the outbreaks, and the months elapsed between SPC and traditional detection. We then used these values to estimate the number of SSIs that could have been prevented by SPC, and corresponding deaths avoided and cost savings (Figure 1).

Results

Optimized charts detected 96% of the outbreaks earlier than traditional surveillance, while pilot study and common practice charts did so only 65% (58%) of the time (Figure 2). Optimized charts could potentially prevent 15.2 SSIs, 0.64 deaths, and save $226,000 in excess care costs per outbreak. Overall, charts using network baselines performed better than those relying on local hospital data. Commonly used variations were the least effective, but were still able to improve on traditional surveillance (Figure 3).

Conclusion

SPC methods provide a great opportunity to prevent infections and deaths and generate cost savings, ultimately improving patient safety and care quality. While common practice SPC charts can also speed up outbreak detection, optimized SPC methods have a significantly higher potential to prevent SSIs and reduce healthcare costs.

Disclosures

All authors: No reported disclosures.
1236. Staphylococcus aureus Surgical Site Infection: Epidemiology in Europe (SALT)
Authors: Mellinghoff Sibylle , Bruns Caroline , Albertrsmeier Markus , Bassetti Matteo , Horcajada Juan P , Vehreschild J Janne , Liss Blasius J , Cornely Oliver
Published: October 2019

Background

We conduct a retrospective, multinational cohort study with a nested case–control (NCT03353532). Data from all patients undergoing any surgical procedure in 2016 are collected within the cohort, comprising more than 150,000 procedures. S. aureus SSI cases are documented in an electronic database and matched 1:1 to controls within each center. Criteria for matching include epidemiological data and type of procedure. Participating sites are 14 major surgical centers in France, Germany, Italy, Spain, and the UK. We here present preliminary data from the interim analysis.

Methods

We conduct a retrospective, multinational cohort study with a nested case–control (NCT03353532). Data from all patients undergoing any surgical procedure in 2016 are collected within the cohort, comprising more than 150,000 procedures. S. aureus SSI cases are documented in an electronic database and matched 1:1 to controls within each center. Criteria for matching include epidemiological data and type of procedure. Participating sites are 14 major surgical centers in France, Germany, Italy, Spain, and the UK. We here present preliminary data from the interim analysis.

Results

We determine overall and procedure-specific incidence of S. aureus SSI. To date, 619 cases have been documented with a mean age of 59.0 years, 50,7% male and 49.3% female. Chronic cardiovascular disease (23%), diabetes (22%), and solid tumors (18%) are the most frequent comorbidities. Overall length of hospitalization is 19 days. A total of 20% SSI cases were treated at the intensive care unit, 49% were readmitted to the hospital, and 47% patients needed revision surgery.

Conclusion

The study includes all surgical procedures at participating centers allowing us to determine the incidence for all common surgical procedures aiming to better understand the risk of certain procedures. Furthermore, the study will analyze the risk composition of the surgical patient population to enable the calculation of the number of patients at risk in the overall surgical population in Europe. Predictive factors for S. aureus SSIwill be analyzed and thus allow future investigation into targeted prophylactic strategies such as S. aureus vaccines.

Disclosures

All authors: No reported disclosures.
1238. Alcohol-Based Nasal Antiseptic as Part of a Bundle to Reduce the Incidence of Contact Precautions and Surgical Site Infections
Authors: Stegmeier Heather
Published: October 2019

Background

A 145-bed hospital embarked on a 12-month project to reduce contact precautions (CP) for colonized methicillin-resistant Staphylococcus aureus (MRSA) patients, and to reduce surgical site infections (SSI) for orthopedic patients. Prior to the project all high-risk patients were screened using nasal polymerase chain reaction (PCR) test for MRSA, and if positive, placed on CP. Orthopedic surgical patients were also screened for MRSA, and if positive, received preoperative chlorhexidine (CHG) bath and nasal mupirocin.

Methods

Starting in January 2017, all high-risk patients received twice-daily alcohol-based nasal antiseptic and a daily chlorhexidine (CHG) bath, in place of targeted screening and CP. In addition, an SSI prevention bundle was instituted, comprised of alcohol-based nasal antiseptic in place of mupirocin, retraining perioperative staff on skin preparation, and UV-C disinfection added to manual cleaning in the operating room. Preoperative CHG bathing was already in place and was continued. During this period, there was a total of 868 orthopedic surgery patients. Patients who remained in the hospital post-operatively received twice-daily nasal antiseptic and daily CHG bathing.

Results

There was a reduction in the incidence of CP from 16% to 10% per day, while maintaining a rate of zero MRSA bacteremia. Reduction of gloves, gowns and nasal PCR tests, resulted in an estimated total cost reduction of $200,000. Additionally, there was a statistically significant reduction in total hip SSI from a 2016 baseline of 1.15 infections per 100 procedures to 0.017 infections per 100 procedures (98% reduction, P = 0.014.), and the rate of zero SSI in total knee replacement patients was maintained.

Conclusion

Universal decolonization in place of targeted screening and CP for colonized MRSA patients, reduced costs without increasing MRSA bacteremia. Replacement of mupirocin with a nasal alcohol-based antiseptic, as one component of an SSI prevention bundle, resulted in a marked reduction in SSI after total hip procedures.

Disclosures

All authors: No reported disclosures.
1241. Marked Improvement in Post-Operative Craniotomy Wound Care Using 2% Chlorhexidine (CHG) Cloths for Blood Clots Removal and Hair Cleaning in a Photo-Documentation Survey
Authors: Lee Eunjung , Kovryga Kornick Mariya , Wilhelm Lisa , White Janice , Bancher JeanMarie , Gohil Shruti K , Paff Michelle , Hsu Frank P , Huang Susan S
Published: October 2019

Background

Post-operative wound care can be an important strategy to prevent surgical site infection (SSI) following craniotomy. Insufficient wound care, blood clots, and oily hair near the incision can increase SSI risk.

Methods

We conducted a pre-post prospective cohort evaluation of a quality improvement intervention to address inpatient post-operative craniotomy wounds at an academic hospital. A post-op wound care protocol was jointly developed by neurosurgical wound care nurses, clinicians, and infection preventionists. The protocol began on postoperative day 1, and included use of soft ties to keep adjacent hair away from the incision, use of 2% CHG cloths to clean skin and hair within 2 inches of the incision as well as the proximal 6 inches of any surgical drain, and use of 2% CHG cloths to remove blood clots. Selection of 2% CHG cloths for blood clot removal was made following comparison to several concentrations of peroxide. A twice-weekly photo-survey of all inpatients undergoing craniotomy was undertaken during the baseline period (October–December 2018) and intervention period (March–April 2019), with feedback to wound care nurses occurring during the intervention period only. The proportion of redness, extensive blood clots (>50% incision), and oily hair near the incision were compared between the baseline period and the intervention period using Fisher’s exact tests.

Results

A total of 156 photo assessments were performed in 71 patients (101 assessments in 45 patients in the baseline period, and 55 photo assessments in 26 patients in the intervention period). Demographics, body mass index, emergent status, and prior craniotomy were similar across the baseline and intervention periods. The intervention was associated with significant reductions in redness (27.7% vs. 11%, P = 0.015), blood clots (33.7% vs. 10.9%, P = 0.002), and oily hair near the incision (76.7% vs. 28.6%, P < 0.001) (Figure 1).

Conclusion

The care of post-operative craniotomy wounds and adjacent hair was significantly improved through a standardized protocol to remove blood clots and ensure clean skin and hair adjacent to the incision during the post-operative inpatient stay. Photo documentation and feedback to wound care nurses helped ensure protocol adherence.

Disclosures

All authors: No reported disclosures.
1242. Evaluation of Risk Factors for Development of Total Hip Arthroplasty (THA) Surgical Site Infections (SSI)
Authors: Ingnam Sisham , Flaherty Jennifer , Lustberg Mark , Mangino Julie E , Day Shandra R
Published: October 2019

Background

THA is one of the most commonly performed surgeries for pathologic diseases of the hip. Multiple risk factors have been identified for SSI including: female gender, previous joint surgery, hematoma, joint dislocation, intraarticular glucocorticoid injection, rheumatoid arthritis, uncontrolled diabetes, anemia, malnutrition, and an immunosuppressed state. The objective of our study is to evaluate obesity (body mass index (BMI) >30) as an independent risk factor for THA SSI and identify other risk factors for SSI

Methods

A retrospective case–control (1:3) matched observation study was conducted from January 1, 2014–June 30, 2016. Patients with a THA SSI were identified using NHSN definitions and 3 controls were matched for sex and month of surgery for each SSI case. Patient information was extracted through chart review including BMI, revision surgery, chronic kidney disease (CKD), diabetes mellitus (DM), anemia, malnutrition, smoking, surgery duration, steroid use, pre-operative chlorhexidine (CHG) bathing and nasal povidone–iodine (PI) compliance. Multivariate analysis using a conditional logistic regression model was performed.

Results

Among 906 THA, 29 patients developed an SSI with 87 matched patients over the 2.5 years. The mean age in the SSI group was 61.0 years, and 37.9% were male. Mean age in the control group was 63.1, and 40.1% were male. In both groups, the most common indications for surgery were osteoarthritis followed by osteonecrosis and malignancy. Results of multivariate analysis identified five independent risk factors for SSI (see Table 1).

Conclusion

Obesity (BMI >30) was identified as an independent risk factor for THA SSI as well as CKD, steroid use and revision arthroplasty. While these risk factors are not easily modifiable, noncompliance with pre-operative CHG bathing and PI administration were also identified as significant SSI risk factor. These findings emphasize the importance of evaluating patients for SSI risk factors including obesity and improving compliance with all pre-operative SSI reduction measures.

Disclosures

All authors: No reported disclosures.
1249. Images vs. C-Reactive Protein Follow-up of Patients with Organ/space Surgical Site Infections
Authors: Garcia Allende Natalia , Freuler Cristina , Victoria Sanchez Ana , Ezcurra Cecilia , Mayer Wolf Micaela , Eliana Iglesias Debora , Paz Sandra , Antezana Trigo Ingrid , Risso Patron Agustina , Rodriguez Viviana Elizabeth
Published: October 2019

Background

End-of-treatment images of infections after intra-abdominal infection could increase costs. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are used to define and predict the evolution of infectious diseases. The aim of this study was to describe clinical outcomes of adult patients with end-of-treatment images or CRP and ESR follow-up, during treatment of organ/space (OS) (intra-abdominal) surgical site infection (SSI).

Methods

Observational retrospective cohort. Hospitalized patients older than 16 years were included, who developed OS SSI after abdominal surgery, in a general hospital, from June 2014 to June 2018. Population variables: age, gender, comorbidities (cancer, diabetes mellitus, cirrhosis, chronic renal failure, tobacco, immunosuppressants, Charlson score and obesity), ESR, quantitative CRP, imaging study (tomography (CT)/ ultrasound), type of drainage route (surgical, percutaneous). Outcomes variables: antibiotic patient-days, time to infection (TTI), CRP and ESR at the time of diagnosis (TD) and at the end of treatment (TET), rate of relapsing infection. Statistical analysis: Description of variables sort by patients under images follow-up and patients under CRP and ESR follow-up. Fisher test of relapsing infection was calculated between groups.

Results

Included: 76 patients. Twenty-six were followed with CT or ultrasound and 50 were followed with CRP and ESR. Forty women, with a mean age of 55 years (19–91) and an average score of the Charlson of 3.64 (0–10). Forty patients had cancer before surgery (52.63%). Microbiological diagnosis: 70/76 patients, the majority was polymicrobial. Average of antibiotics patient-days was 24.4 days (14 days of intravenous therapy). TTI: 8.65 days. Average CRP at the TD was 87.5 mg/L and 17.5 mg/L at TET. No differences in ESR values (31.9 mm to 33.5 mm). Percutaneous drainage: 46 patients. Surgical procedure: 27. Relapsing infection: 11,5% in images group vs. 4% in no images group; P = 0.33.

Conclusion

Quantitative CRP monitoring was useful to guide the duration of antimicrobial treatment. No differences of relapsing infection between groups was found.

Disclosures

All authors: No reported disclosures.
1265. Monitoring of Human Immunodeficiency Virus (HIV)-Infection Using the Cepheid HIV-1 Qualitative Assay
Authors: Keizur Erin , Wood-Palmer Drew , Koussa Maryann , Ocasio Manuel , Jane Rotheram-Borus Mary , Klausner Jeffrey
Published: October 2019

Background

Human immunodeficiency virus (HIV)-1 RNA quantification is the primary method of monitoring response to antiretroviral therapy. In the U.S. viral RNA testing is recommended for all HIV-infected patients at entry into care, at initiation or modification of therapy, and on a regular basis thereafter. HIV-1 DNA testing may pose additional advantages. For example, proviral DNA may predict early loss of viral suppression. The Cepheid® (Sunnyvale, CA) HIV-1 Qualitative (HIV Qual) assay detects total nucleic acid for both RNA and DNA and provides a qualitative result (HIV detectable or undetectable).

Methods

We tested participants aged 14–24 years old from the Adolescent Trials Network (ATN) CARES study with known HIV infection in Los Angeles, California and New Orleans, Louisiana. We tested participants using the Cepheid® HIV Qual assay and the quantitative HIV-1 RNA, real-time PCR test using the COBAS P6800 system (Roche, Branchburg, NJ). We used 100 μL of whole blood for the HIV Qual assay and results were provided in 90 minutes. We sent the remainder of the whole blood from the same visit to a commercial laboratory for HIV-RNA PCR testing and results were reported as “detected,” “detected, <20 copies/mL plasma” or “not detected, <20 copies/mL plasma.” We compared HIV Qual and HIV RNA PCR test results from the same visit for each participant.

Results

Overall, 57 HIV Qual tests were performed with concurrent HIV RNA PCR tests. Of those, 9/15 tests were concordant with HIV viral RNA suppression while 39/42 tests were concordant with HIV viral RNA detection. In 6 cases, the HIV RNA was not detected at <20 copies/mL by the Roche PCR while the HIV Qual assay detected HIV DNA. Of those 6 cases, 3 had subsequent HIV RNA PCR testing. All 3 cases had detectable HIV RNA at their next testing date (214 copies/mL, detected <20 copies/mL, 2130 copies/mL).

Conclusion

The HIV Qual test is feasible for the monitoring of HIV-infection. Due to its detection of HIV DNA, it may predict future lack of HIV RNA suppression.

Disclosures

All authors: No reported disclosures.
1266. Cancer among HIV-Positive Patients in Cali, Colombia: A Retrospective Hospital-Based Study
Authors: Parra-Lara Luis Gabriel , Carlos Bravo Juan , Eduardo Bravo Luis , Rosso Fernando
Published: October 2019

Background

Cancer has been a significant feature of the HIV epidemic from the beginning, being the most frequent Kaposi sarcoma (KS) and hematolymphoid malignancies. However, the behavior of these two diseases is limited in our context. The study aimed to determine the trends of cancer among HIV/AIDS patients between 2011 and 2016.

Methods

A retrospective hospital-based study was conducted at Fundación Valle del Lili, Cali, Colombia. The study included HIV-positive patients diagnosed with cancer after infection. HIV registry was cross-linked with a population-based cancer registry to obtain IARC/WHO ICD-O-3 classification and follow-up information on all patients. A descriptive analysis of the variables was performed. Survival analysis was carried out using the Kaplan–Meier method. Differences between cancer survival were assessed through the log-rank test.

Results

From 2,051 HIV-positive patient’s records between 2011 and 2016, 95 patients were diagnosed with cancer after HIV infection. The median age was 43 years (IQR=33–57), and 88% were male. Types of cancer were: Kaposi’s sarcoma 17%, hematolymphoid malignancies 21% and other cancer 62%. The probability of cancer diagnosis after HIV diagnosis was 36.26% (CI 95% [26.53–46.05]) at one-year follow-up for all malignancies. Overall survival of the patients was 77.41% (CI 95% [64.76–86]) at 5 years follow-up, since HIV diagnostic. Hematolymphoid malignancies and KS survival were 50% (CI 95% [20.85–73.61]) and 65.63% (CI 95% [35.80–84.14]) at 5 years follow-up, respectively. There was a statistically significant difference between KS, hematolymphoid and other cancer cases survival (P = 0.0178).

Conclusion

This study showed the role of HIV in cancer survival for KS and hematolymphoid malignancies mainly, in a developing country. It is necessary to join efforts in our context to reduce HIV cases and associated malignancies.

Disclosures

All authors: No reported disclosures.