bluuebunny/crossref_metadata_2025 huggingface dataset:
P-247. Skills in Managing Vascular Catheters: Differences Between Self-Perception and Assessment by an External Auditor
Authors: Paes Lima Valeria , Cardoso Regiane , Silva Sheila , Cláudia Fernandes Ana , Andrade Rafael , Ramos André Augusto , Ramos Marcelo , da Silva Cristiane , Garbero Rodrigo
Published: January 2025

Background

Implementing prevention strategies can be challenging for health services, and it is useful to know new assessment and teaching methods so that educational interventions are more effective.

Adherence to the intravenous medication administration checklist through self-assessment

Methods

Seventy-eight nursing professionals from a inpatient unit were invited to carry out an assessment of skills in intravenous medication administration. Initially, professionals completed a self-assessment questionnaire, in which they were asked to accurately report what corresponds to their usual practice. Then, the same professional administered the medication in a simulated environment while being observed by a trained professional, who filled out a standardized checklist. The observers were clinical nurse educator, an infection control nurse and a vascular access reference nurse. At the end of the procedure, the observer provided individual feedback to the professional on the positive aspects and non-conformities. Then, the professionals answered a questionnaire to evaluate this training modality.

Adherence to the intravenous medication administration checklist by an external observer

Results

In the self-assessment questionnaire, the professionals attributed unsatisfactory practice to 4%, increasing to 19% in the evaluation of the process by an external observer. The average time to respond to the self-assessment questionnaire was 8 minutes and 48 seconds, and to observe the procedure was 11 minutes and 26 seconds. The results are shown in figures 1 and 2.

The difference in the assessment of hand hygiene drew attention: professionals attributed it to be 99% adequate, and external observers, 70.9%. The main non-conformities observed were the failure to apply hand hygiene in the 5 recommended moments, the use of incorrect or incomplete technique and the length of the nails or the presence of dirt. The assessment of catheter insertion was carried out by only 67.9% of professionals.

Conclusion

The difference between self-perception and external assessment indicates the need for more innovative training methods with practical implementation, rather than the simple exposition of technical content. There was a good response from professionals to this method, and we consider the opportunity to provide individualized feedback in a safe environment very valuable.

Disclosures

All Authors: No reported disclosures
P-250. Identifying the Risks Associated with Increased Tissue Expander Infections Amongst Patients Undergoing Mastectomy with Immediate Tissue Expander Placement
Authors: Koplyay Courtney , Ngo Madeline , Davidson Tessy , Sopirala Madhuri
Published: January 2025

Background

Tissue expander (TE) infections are increasingly common in patients undergoing mastectomy with immediate TE placement. Post-mastectomy TE infections prolong recovery time, delay second-stage reconstruction, and confer a significant socioeconomic burden on the patient. In this study, we aim to identify modifiable risk factors associated with TE infections following TE manipulation and assess the infection risk associated with different TE implants (Mentor™ vs. Sientra™).

Univariate Analysis of Modifiable Risk Factors

Univariate analysis of modifiable risk factors associated with the development of tissue expander (TE) infection.

Methods

We identified several lapses in sterile technique during TE manipulation procedures performed at the plastic surgery clinic of a large safety net hospital. We conducted a retrospective review of all adult patients who underwent mastectomy with immediate TE placement and expansion from 2019-2022, collecting demographic, co-morbidity, and infection surveillance data. Cases were defined as patients who developed an infection after a clinic-based TE manipulation procedure and controls as patients who did not develop an infection after a clinic-cased TE manipulation procedure.

Multivariate Logistic Regression of Modifiable Risk Factors

Multivariate logistic regression analysis of modifiable risk factors associated with tissue expander (TE) infection.

Results

Of 292 cases, 16 developed a TE infection after TE manipulation. The total post-manipulation TE infection rate is 6.1 per 100 procedures. The type of implant did not influence infection rates on multivariate analysis (p=0.23). Patients who developed an infection after TE manipulation were more likely to have private insurance than those who did not develop an infection (p<0.01). There was no significant difference in the presence of hypertension, diabetes, obesity, and tobacco use in patients who developed a TE infection compared to those who didn’t develop a TE infection.

Conclusion

There were no identifiable modifiable risk factors associated with increased rates of TE infections following TE manipulation. We found that private insurance was not protective against the development of a TE infection. Suboptimal sterile access to TEs may independently contribute to post-mastectomy TE infections. Implementation of a new sterile technique has yet to confer a significant decrease in TE infection rates. We will continue refining our standardized sterile protocol as we monitor TE infection rates.

Disclosures

All Authors: No reported disclosures
P-263. Sodium dichloroisocyanurate: A promising candidate for the disinfection of resilient drain biofilm
Authors: Martin Abbbie , Rohde Rodney E , O’Mahony Tom , Doyle Natasha
Published: January 2025

Background

Biofilms are complex multicellular communities of microorganisms which can lead to a variety of human diseases and infections. Biofilms consist of microbes which are contained within a protective extra polymeric substance layer, resulting in increased resistance to disinfectants. From an economic perspective, it is estimated that potentially deadly biofilms, which cause 1.7 million hospital acquired infections (HAIs) each year in the US, can result in costs of $11.5 billion in treatment. Biofilms thrive in a variety of diverse environments, including hospital sinks and drains, which can pose a significant threat to patient safety. Sink drains maintain one of the highest burdens of antibiotic resistant bacteria amongst all other surfaces, with Pseudomonas aeruginosa consistently being the most prominent species found within ICU sink drains. Studies have shown that by completely removing sinks from patient rooms, there is a significant reduction in the colonisation of gram-negative bacteria, a leading cause of HAIs.

Methods

The aim of this study was to determine if three hospital-grade disinfectants were capable of killing biofilm, and as such, if they could be used as potential drain disinfectants. Disinfectants were comprised of Sodium Dichloroisocyanurate (NaDCC), Peracetic acid and bleach-based disinfectants. Pseudomonas aeruginosa biofilms were cultivated using the CDC biofilm reactor, a standardised method for determining biofilm efficacy within the United States.

Results

The NaDCC product was successful in completely killing the biofilm (using a one-minute contact time), resulting in a total 8.70 log reduction. Peracetic acid reduced biofilm by 3.82 logs, followed by bleach, which had the lowest reduction at 3.78 logs.

Conclusion

Drain disinfection is critical to ensure patient safety and reduce the instances of HAIs. This experiment can help in predicting the effectiveness of three hospital disinfectants for drain applications. NaDCC could provide a reliable solution for drain applications and subsequent patient safety.

Disclosures

Abbbie Martin, BsC, Kersia Ireland: Employee Tom O'Mahony, PhD, Kersia Ireland: Employee Natasha Doyle, PhD, Kersia Ireland: Employee
P-264. Fournier-transform Infrared spectrometry is a quick, reliable and economical method used to determine clonality and nosocomial transmission of an extended Spectrum β-lactamase E.coli contaminated endoscope
Authors: De Jager Stephen A , Moonen Carolyn , Visser Marit
Published: January 2025

Background

Nosocomial transmission of bacteria via contaminated endoscopes is known to occur due to inadequacies in the complex cleaning process of multi-channel endoscopes. At our institution we do regular surveillance culture screening of endoscopes. Upon receiving positive cultures with an Extended Spectrum β-lactamase producing (ESBL) E.coli we alerted our hospital hygiene unit. After screening potentially exposed patients we determined clonality of ESBL E.coli isolates from 4 patients with expensive en specialized molecular diagnostics, at our local academic hospital using Amplification Fragment Length Polymorphism (AFLP). We were testing the BiotyperIR (Bruker Daltronics) in our laboratory and wanted to see how de FTIR compared to AFLP in our small peripheral hospital setting.

BiotyperIR 3D scatterplot

Cluster of endoscope isolate and exposed patient isolates with 2 non related patient control isolates

Methods

We determined that a total of 16 patients had endoscopic investigations preformed with the contaminated endoscope. We were able to do rectal screening cultures for ESBL positive organisms using ESBL selective media from 11 of the 16 patients. We were unable to screen 5 patients. Of the 11 patients that were screened 4 were positive with an ESBL E.coli. Clonal testing was done on these isolates and 2 non outbreak ESBL E.coli patient isolates with AFLP and FTIR using the BiotyperIR. IR spectra were acquired from dried spots of bacterial suspensions in ethanol solution. Exploratory data analysis of the FTIR spectra was performed by Hierarchical Cluster Analysis (HCA) using Bruker’s updated software.

BiotyperIR dendrogram

Cluster of endoscope isolate and exposed patient isolates with 2 non related patient control isolates

Results

Both results from AFLP and the BiotyperIR showed that all 4 ESBL E.coli patient isolates were identical to the contaminated endoscope isolate and the 2 non outbreak patient control isolates were unrelated to the outbreak isolate. We concluded that there had been nosocomial transmission of an ESBL E.coli. Clonal typing using the BiotyperIR FTIR was done within 24 hours in our own laboratory compared to 2 weeks using AFLP which had to be sent to our local academic hospital.

Conclusion

The BiotyperIR FTIR spectrometry results were identical to molecular typing using AFLP to determine nosocomial transmission of a clonal ESBL E.coli. Results were obtained significantly faster and at a fraction of the cost of molecular AFLP.

Disclosures

Carolyn Moonen, PhD, Bruker Daltonics GmbH & Co. KG: Advisor/Consultant
P-266. Does routine use of sporicidal disinfectants for all post-discharge hospital rooms reduce environmental contamination with Clostridioides difficile spores?
Authors: Plumlee Sarah , Cadnum Jennifer , Varghese Martin , Bartles Rebecca , Memic Samir , Jencson Annette , Donskey Curtis
Published: January 2025

Background

Asymptomatic carriage of Clostridioides difficile is common in healthcare facilities. Routine use of sporicidal disinfectants for all post-discharge rooms has been proposed as a measure to address environmental shedding by carriers, but limited information is available on the effectiveness of this approach.

Recovery of C. difficile from CDI and non-CDI rooms in hospitals using sporicidal disinfectants only in CDI rooms versus in all post-discharge rooms

Methods

We conducted a culture survey to assess environmental contamination with C. difficile in patient rooms after cleaning and disinfection in 30 acute care hospitals, including 17 (57%) using sporicidal disinfectants (11 peracetic acid-based products and 6 chlorine-based products) for all post-discharge rooms and 13 (43%) using sporicidal disinfectants (1 peracetic acid-based product and 12 chlorine-based products) only for C. difficile infection (CDI) rooms. Cultures for C. difficile were collected from 10 rooms per hospital (up to 3 CDI rooms), including high-touch surfaces in the room (N=10 sites) and in the bathroom (N=10 sites). A mixed-effects logistic regression model was used to compare contamination in non-CDI (primary outcome) and CDI rooms in facilities using sporicidal disinfectants in non-CDI and CDI rooms versus only in CDI rooms.

Results

Of 595 total patient rooms and bathrooms cultured, 339 (57%) were in hospitals using sporicidal disinfectants for all post-discharge rooms and 256 (43%) were in hospitals using sporicidal disinfectants only in CDI rooms. As shown in Figure 1, there was a trend toward reduced C. difficile contamination in non-CDI and CDI rooms in facilities using sporicidal disinfectants in all post-discharge rooms versus only in CDI rooms, but the difference was not statistically significant (P>0.62).

Conclusion

In a survey of 30 hospitals, use of sporicidal disinfectants for all post-discharge rooms was not associated with a statistically significant reduction in C. difficile contamination in non-CDI rooms. Additional studies are needed to determine if interventions to improve the effectiveness of sporicidal disinfectant application will reduce C. difficile contamination in real-world settings.

Disclosures

Curtis Donskey, MD, Clorox: Grant/Research Support|Pfizer: Grant/Research Support
P-282. Cost Effectiveness Analysis of Ceftolozane/Tazobactam for the Treatment of Patients with Ventilated Hospital-Acquired Bacterial Pneumonia and Ventilator-Associated Bacterial Pneumonia in the Philippines
Authors: Uy Geovin Dexter c , Paredes Karlo , Camille Abello Gillian , Cameron Carolyn , Yang Joe
Published: January 2025

Background

Ceftolozane/tazobactam (C/T) was licensed by Philippine Food and Drug Administration for the treatment of ventilated hospital-acquired bacterial pneumonia (vHABP) and ventilator-associated bacterial pneumonia (VABP) last 2019. Increasing resistance rates to antibiotics available in the Philippine National Formulary (PNF) by Pseudomonas aeruginosa associated vHABP/VABP has concerned clinicians due to its overall morbidity and mortality. This study assessed the cost-effectiveness of C/T treatment compared with existing antimicrobials among adult patients with confirmed susceptibility profile of Pseudomonas aeruginosa associated vHABP/VABP.

Methods

An economic model was developed to compare the lifetime costs and quality-adjusted life-years (QALYs) associated with C/T and the currently listed antimicrobials (meropenem, aminoglycosides, colistin) in the PNF for the treatment of patients with Pseudomonas aeruginosa associated vHABP/VABP. A short-term decision tree was used for the in-hospital period, followed by a long-term Markov model to depict lifetime costs and outcomes.

Pathogen susceptibility was sourced from the Program to Assess Ceftolozane/Tazobactam Susceptibility (PACTS) database; clinical efficacy was obtained from the published literature. The model assumed a public payer perspective, capturing direct costs incurred by the health system, and direct health outcomes for treated patients. Discount rates applied followed local HTA methods guide.

Results

On treating Pseudomonas aeruginosa associated vHABP/VABP, C/T was associated with a higher absolute cure rate (17%) and lower absolute mortality rate (-3%) than meropenem. The incremental cost-effectiveness ratio (ICER) for C/T compared to meropenem, amikacin, and colistin were ₱267,396, ₱164,570, and ₱47,504 per QALY gained, respectively. C/T generated more QALYs than exiting antimicrobials at an increased cost per patient, but resulting in ICER less than one times the Gross Domestic Product (GDP) of ₱233,902 for amikacin, and colistin, and ∼ 1.2x GDP per capita for meropenem.

Conclusion

C/T represents a cost-effective treatment for payers and an important option to be listed in the PNF for clinicians treating patients with Pseudomonas aeruginosa vHABP/VABP in the Philippines.

Disclosures

GEOVIN DEXTER C. UY, RPh, MPH, MSD Philippines: employee|MSD Philippines: Stocks/Bonds (Private Company) Karlo Paredes, RN, MPH, PhD (cand), MSD Philippines: employee|MSD Philippines: Stocks/Bonds (Private Company) Gillian Camille Abello, MD, MSD Philippines: employee Carolyn Cameron, MPH, MSD Australia: employee|MSD Australia: Stocks/Bonds (Private Company) Joe Yang, PhD, Merck & Co., Inc: employee|Merck & Co., Inc: Stocks/Bonds (Private Company)
P-283. Epidemiology, clinical, phenotypic, and genotypic characteristics of multidrug, extensive and pan-drug resistant Acinetobacter baumannii from Qatar
Authors: Abdel Hadi Hamad
Published: January 2025

Background

Multidrug-resistant Acinetobacter baumannii-calcoaceticus complex is associated with significant morbidity and mortality with limited treatment options. The outlined study aimed to evaluate the epidemiology , clinical , phenotypic and genotypic characteristics of multidrug resistant (MDR) Acinetobacter species from Qatar between 2017-2020 .

Methods

A prospective study was conducted between 2017-2020 for all clinical isolates of Acinetobacter species. Microbial identifications and antimicrobial susceptibility tests were performed using automated MALDI-TOF MS and BD PhoenixTM system according to the manufacturer’s recommendations while additional ASTs were performed with E test . Genomic tests were performed using whole genome sequence

Results

Out of 536 isolates, 62 (11.5%) resistant isolates were identified showing decremental trend over the study period with dominance of sequence types: ST2 (71 %), ST 25 % (8%) and ST 164 (8%). Main age of acquisition was 64 year (38-70). Isolate sites were urinary (42 %), respiratory (29%), bloodstream (16%), skin and soft tissues (13%) mainly acquired at hospitals (97 %). Existing multiple comorbidities and previous antimicrobial exposure were present in most cases. Multiple antimicrobial regimes for management were dominated by colistin, meropenem, amikacin, cotrimoxazole and tigecycline with 30-day mortality of 16 %. Microbiological evaluation demonstrated extensive resistance ranging between 85-100 % for active agents including meropenem and ampicillin-sulbactam at 97.4 % as well as for novel agents: ceftazidime-avibactam (100%), ceftolozane-tazobactam, meropenem-vaborbactam and imipenem- relebactam at 97.4 %. All ST2 isolates carried class D blaOXA-23 and blaOXA-51 family, that confer resistance to carbapenems, as well 7 isolates carried class B MBL blaNDM-1.

Conclusion

Acquisition of resistant Acinetobacter baumannii is infrequent with decremental trend dominated by ST 2, mainly isolated from the elderly with multiple comorbidities and risk factors. Predominant isolation sites are urinary, respiratory, bloodstream, skin and soft tissues. Extensive resistance profiles limit treatment options for conventional and novel agents pointing towards urgent needs for alternative therapy.

Disclosures

All Authors: No reported disclosures
P-307. Antibiotic Exposure and Community Resilience Shape Colonization Resistance to Vancomycin-Resistant Enterococci: Effects of Prior Antiboitics on Colonization Re-emergence
Authors: Treat Ben , Hobeika Joseph , Margolis Ellie
Published: January 2025

Background

For life-threatening healthcare-associated vancomycin-resistant enterococci (VRE), gut colonization is a prerequisite for infection and is not predicted by prior Vancomycin treatment, indicating other selective forces are important. Host characteristics, strain variation and other microbial selective forces determine whether a patient's microbiome resists or permits VRE colonization.

Methods

Two preclinical models study VRE colonization resistance using fluorescently labeled clinical VRE strains. First, human microbiome stool communities were anaerobically cultivated in defined media, resulted in reproducible complex communities retaining 72-89% of microbial members. They are challenged with clinical VRE strains (10^3 cfu) to assess microbiome's role in resistance. Second, BL6 mice were pre-treated with PO Vancomycin, IP Cefepime+ IP Vancomycin, IP Meropenem, IP Pipercillin/Tazobactam, PO Metronidazole, or PO Clindamycin for one week. Post-treatment, they are inoculated with clinical VRE and clearance time was monitored. After a week without VRE detection in stool culture and by FACs, mice resume PO Vancomycin to observe re-emergence.

Results

When complex human stool cultivated microbiomes are exposed to clinical VRE strains, some prevent colonization while others facilitate it. Intriguingly, both the VRE strain and the community composition influence colonization (fig 1). In mice treated with anaerobic-active antibiotics, consistent VRE colonization occured. However, duration varied significantly (e.g. PO Vancomycin cleared in 14-22 days, IP Pipercillin/Tazobactam in 20-54 days). After VRE clearance, re-challenge with antibiotics lead to VRE re-emergence in all previously colonized animals.

Conclusion

Within human microbiome communities there is redundancy and variation in the members that can create a bacterial community barrier to VRE colonization. In mice, previous antibiotic use affects both how long VRE colonizes and its likelihood of returning after further disturbance. This may explain varying findings in studies on factors influencing MDRO colonization.

Disclosures

Ellie Margolis, MD PhD, ICLR: Stocks/Bonds (Private Company)
P-309. Spread of SCCmec IV type Community-acquired MRSA in a Tertiary Care ICU in Japan
Authors: Kawamura Hideki , Okawa Daisuke , Niiyama Syuhei , Imuta Naoko , Nishi Junichiro , Kakihana Yasuyuki
Published: January 2025

Background

In recent years, community-acquired (CA) MRSA has become a problem, but there have been few reports of MRSA genotypes in the ICU. In our ICU, we have reinforced countermeasures such as screening for MRSA carriers using nasal specimens at admission and every week thereafter and decolonizing those who test positive for MRSA using mupirocin. This study aimed to investigate the prevalent strains of MRSA in the intensive care setting and their risk based on the genotyping of MRSA strains from patients admitted to our ICU.Figure 1.Comparison of the number of detections by POT1 value between Period A and Period B

Strains in Period A had more NY/Japan clones with a POT1 value of 93, while those in Period B had more community-acquired strains with a POT1 value of 106.

Methods

We examined two periods of increased nosocomial MRSA infections: 2013 to 2014 (16 strains in Period A) and 2021 to 2022 (23 strains in Period B). We evaluated changes in epidemic strains and assessed the possibility of transmission from ICU patients by genotyping of MRSA strains using PCR-based ORF Typing (POT).Figure 2.Epidemic curves by genotype in Period A and in Period B

There were three cases in Period A and two in Period B with the same genotype strain in hospitalized patients during the same period, all of which in Period A showed a POT1 value of 93.

Results

In Period A, 87.5% (14/16) of the strains showed a POT1 value of 93, presumed to be the NY/Japan clone; however, in Period B, the number of strains showing a POT1 value of 93 decreased to 4.3% (1/23) (p < 0.001). In period A, 6.3% (1/16) of the strains showed a POT1 value of 106, presumed to be a CA strain. However, this increased to 39.1% (9/23) in period B (p = 0.01), and these strains were considered epidemic (Figure 1). There were no PVL-positive strains in Period A and Period B. There were three cases in Period A and two in Period B with the same genotype strain in hospitalized patients during the same period, all of which in Period A showed a POT1 value of 93 (Figure 2). Four cases (25.0%; three cases of pneumonia with bacteremia and one of surgical site infection) in Period A and 8 cases (34.8%; 6 cases of pneumonia (including 3 cases of bacteremia) and 2 cases of central line-associated bloodstream infections) in Period B developed infections.

Conclusion

The results suggest that CA MRSA strains are being brought into the ICU and causing infections, although the number of conventional nosocomial strains has decreased due to enhanced countermeasures. Monitoring of CA MRSA in ICUs is needed.

Disclosures

All Authors: No reported disclosures
P-317. Performance of nasal MRSA PCR screening test in pediatric patients admitted to hospital
Authors: Shrestha Rima , Sehra Amandeep , Gawelda Natalia , Bakir Mustafa
Published: January 2025

Background

Few studies reported Methicillin-Resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) nasal screening as a tool for clinical stewardship in children.

This multicenter study evaluated the diagnostic test characteristics of the MRSA-PCR in predicting the presence of invasive MRSA infection in large number of pediatric patients admitted to hospital.

Methods

A retrospective cohort study is performed by chart review of children over 1 month of age admitted to OSF Health Care System, Illinois, between May 2013 and June 2022 and who has at least one MRSA-PCR nasal screening test and any subsequent culture of sterile body site performed. Data were validated, duplicates were removed, and missing or incomplete information related to screening results were removed before predictive values and post-test probabilities were calculated for MRSA infection in all patients as well as subgroup of high-risk, skin-soft tissue infections, and patients who were presented with respiratory symptoms or diagnosed with pneumonia.

Results

Overall, 373 (7.7%) of 4850 patients were tested positive with MRSA-PCR. Among patients screened positive, 91 (1.9%) had invasive MRSA infection. Sensitivity, specificity, positive and negative predictive value of screening test are 32.9%, 92.8%, 98.6%, and 8.0%, respectively. Table shows the screening test characteristics for various clinical diagnoses.

Conclusion

Large-scale nasal PCR screening test for MRSA in hospital-admitted pediatric patients shows very high negative predictive value, particularly in high-risk group. However, low prevalence of MRSA infection may not allow this screening tool to de-escalate antibiotic coverage in children admitted to hospital and suspected of invasive MRSA infection.

Disclosures

All Authors: No reported disclosures
P-338. Impact of an Educational Program on Hand Hygiene Practice and Healthcare-Associated Infections in a Tertiary Care Hospital in Rural South India
Authors: Raju Jomel , Tom Maria
Published: January 2025

Background

Effective hand hygiene is pivotal in averting healthcare-associated infections (HAIs), especially in resource-limited settings. This study aimed to evaluate baseline hand hygiene practices among healthcare providers (HCPs) and the impact of an educational intervention on reducing HAIs in a rural South Indian tertiary care hospital.

Methods

Over a 12-week period, an observational study was conducted across internal medicine, neurology, pulmonology, urology, pediatrics, and general surgery departments. Hand hygiene compliance among HCPs was meticulously observed, while HAIs were monitored using CDC definitions. Subsequent to the baseline assessment, a targeted hand hygiene education program was initiated, focusing on enhancing compliance among 190 nurses.

Results

A total of 1817 inpatients were enrolled in the study, with 55% male and 45% female, and age ranging from 1 to 90 years (median age: 50 years).

Among the 1817 inpatients, HAIs exhibited varying incidence rates across departments. Notably, pneumonia was the most prevalent HAI in the internal medicine department (incidence: 1.8%), while urinary tract infections were prominent in neurology and pulmonology (incidence: 0.9%), and surgical site infections in urology (incidence: 0.7%). Hand hygiene compliance varied across departments, with internal medicine demonstrating the highest compliance (24.5%). Post-implementation of the education program, compliance significantly improved to 65.2%. Consequently, there was a notable decrease in HAI rates, with pneumonia cases in internal medicine decreasing by 30%, and urinary tract infections in neurology and pulmonology decreasing by 25%.

Conclusion

This study underscores the pivotal role of hand hygiene practices among HCPs in preventing HAIs, particularly in resource-limited settings. The implementation of targeted educational interventions resulted in a substantial improvement in compliance and a subsequent reduction in HAI incidence rates. These findings emphasize the ongoing need for concerted efforts to enhance hand hygiene practices and mitigate the risk of HAIs in rural healthcare settings. Further research and interventions are warranted to sustain these improvements and ensure optimal patient safety outcomes.

Disclosures

All Authors: No reported disclosures
P-344. Nursing Home Rates of Healthcare-associated infections Requiring Hospitalization by Facility Characteristics and Staffing Levels, October 2021 – September 2022
Authors: Walker Lindsey J , Hatfield Kelly M , Reddy Sujan , Currie Dustin , Jacobs Slifka Kara M , Fridkin Scott , Jones Heather N , Rodriguez Andrea , Lutgring Joseph D
Published: January 2025

Background

Healthcare-associated infections (HAIs) contribute to substantial morbidity among nursing home residents. The Centers for Medicare and Medicaid Services (CMS) tracks and reports a rate of HAIs requiring hospitalization per 100 resident stays (HAI rate) annually for nursing homes that is risk standardized by the health status and characteristics of the at-risk residents for each nursing home. We aimed to measure factors, including staffing, associated with nursing homes’ HAI rates.Figure 1.Description of nursing home characteristics among 11,431 nursing homes with a risk-standardized rate of healthcare-associated infections requiring hospitalization in fiscal year 2022. Estimated change in annual risk standardized rate of healthcare-associated infections requiring hospitalization per 100 residents (HAI rate) and p-values are calculated from parameter estimates in a multivariable linear regression model.

Methods

Nursing home characteristics and the annual HAI rate from October 2021 – September 2022 were extracted from Nursing Home Compare. We described the distribution of nursing home characteristics including type of ownership, number of beds, urbanicity, ventilator care capability, location within hospital, and the minority health-social vulnerability index (MH-SVI) of the surrounding county. We quantified nursing homes as meeting minimum staffing standards if they reported ≥0.55 registered nurse hours per resident per day (HPRD), ≥2.45 nurse aide HPRD, and ≥3.48 total nurse staffing HPRD to reflect newly finalized CMS rules. Multivariable linear regression models were used to identify characteristics associated with the HAI rate.

Results

The median annual HAI rate reported for 11,431 nursing homes was 6.79 hospitalizations per 100 residents (Q1-Q3: 5.93-7.87). In multivariable models, all characteristics were associated with the HAI rate (Figure 1). For-profit ownership was associated with 0.66 more infections per 100 residents (95% CI: 0.58, 0.73). Nursing homes located in counties in the highest MH-SVI quartile had 0.44 more HAIs per 100 residents per year (95% CI: 0.34, 0.54) than those in the lowest quartile. The 1,956 (17%) nursing homes that met minimum staffing standards had an estimated 0.44 fewer infections per 100 residents annually (95% CI: -0.52, -0.37) compared to nursing homes that did not, reflecting a 6% decrease in risk in an average facility.

Conclusion

Meeting minimum staffing standards may reduce the rate of HAIs requiring hospitalization in nursing homes. Interventions and outreach efforts focused on increasing support for nursing homes in communities with high levels of vulnerability may also reduce inequities in the rate of HAIs which require hospitalization.

Disclosures

All Authors: No reported disclosures
P-355. Skin Lesions and the Use of Personal Protective Equipment in Healthcare Workers from Lima, Peru during the COVID 19 Pandemic
Authors: Coombes Carolina , Arribas-Garcia Paula , Llerena-Delgado Amira , Carrillo-Larco Rodrigo M , del Solar-Chacaltana Manuel Armando
Published: January 2025

Background

During the COVID-19 pandemic, healthcare workers relied on personal protective equipment (PPE) to mitigate COVID-19 infections. However, prolonged use of PPE led to a risk of developing skin lesions (SL). In our study, we evaluated the frequency, characteristics and factors associated with SL while using PPE.

Methods

We conducted a cross-sectional study to survey 219 healthcare workers in two hospitals in Lima, Peru between September 2020 and May 2021. The survey focused on reporting SL related to PPE use during their time as healthcare workers amidst the pandemic. Eligible participants were required to be hospital personnel that was actively working on-site and utilizing PPE.

Results

Most commonly used PPE items included N95 respirator (96.80%), disposable gown (80.37%), head cover (77.63%), eye gear (60.73%) and surgical masks (59.28%). 176 participants (80.37%) reported skin lesions while using PPE. The most prevalent SL were erythema (63, 36.42%), comedones (26, 15.03%) and erosions (25, 14.45%). Common locations for SL were the nasal bridge (93, 51.96%) and cheeks (43, 24.02%). Additionally, 91 (51.70%) participants reported seeking treatment, with self-medication (47, 51.65%) being the prevalent method. Among the participants, 80 (37.21%) reported using prevention methods being the most common, adhesive tape or bandages (46, 57.50%). SL were associated with being a medical intern (PR 2.46, p=0.014), medical attending (PR 2.35, p=0.019), medical resident (PR 2.69, p=0.006) and nurse (PR 2.44, p=0.014). Eye gear, shoe covers and overalls were found to be risk factors for SL (PR 1.16, p=0.048; PR 1.21, p=0.007; PR 1.15, p=0.031). Participants who had a history of previous skin conditions were 1.19 (p=0.008) times more likely to have SL. In the adjusted model, working in the ICU (PR 1.31, 95%CI 1.02-1.68, p=0.034), working more than 12 hours per day (PR 1.49, 95%CI 1.07-2.08, p=0.017), presenting a skin burning sensation and skin dryness (PR 1.21, 95%CI 1.03-1.42; p=0.021; PR 1.41, 95%CI 1.04-1.92, p=0.026) were associated risk factors.

Conclusion

By documenting the prevalence of skin lesions in healthcare worker due to PPE usage we underscore the need for biosafety monitoring, as the presence of lesions can lead to PPE misusage, increasing the risk of respiratory infections.

Disclosures

All Authors: No reported disclosures
P-356. Reduction of high-touch surface aerobic bacteria and fungi colony counts with the implementation of ActivePure continuous disinfection technology
Authors: Taylor Denise , Lynn Brittney , Trosch Kimberly , Marsh Daniel , Grier Laurie , Malek Alexandre
Published: January 2025

Background

As hospitals nationwide rebound from the effects of the COVID pandemic, reduced staffing and increased hospital-acquired infections (HAIs) are still challenges. Surface disinfection plays a pivotal role in the prevention of HAIs. To improve high-touch surface disinfection and remove the dependence on the human factor, ActivePure continuous disinfection technology devices were installed in the Medical Intensive Care Unit (MICU) HVAC system at Ochsner LSU Health Shreveport in October 2023. ActivePure is a novel technique that kills microbes in the environment by using an advanced photocatalytic oxidation particle.

Methods

A prospective study was conducted in the 19-bed MICU. Two weeks before device activation, 50 high-touch surface samples and 10 reservoir samples were collected by sterile sponge in situ and plated onto Nutritive (tryptic soy) agar for total aerobic microbial counts, Selective (Sabouraud dextrose) agar for total fungal counts, selective (MeReSa) agar for total MRSA counts, and CHROMagar selective for Carbapenem-Resistant Acinetobacter baumannii (CRAB). All agar plates were incubated at 30°C or 37°C (as applicable) for 48-96 hours. For evaluation, serial dilution plate counts were used to calculate the CFU per sponge for each media type. The detection limit was 10 CFU/sponge for each evaluation. After 4 weeks post-activation, 50 high-touch surface samples and 10 reservoir samples from the same pre-activation sample locations were collected and evaluated via the same methods, and the same was repeated at 9 weeks post-activation. Routine cleaning and disinfection protocols were unchanged during the entire study period.

Figure 2

Results

The mean aerobic bacterial and fungi surface CFUs were reduced over 99.78% (Fig 1). The mean MRSA surface CFUs were reduced by 99.99% and the mean CRAB surface CFUs were reduced by 99.75% (Fig 2). There was a 94% reduction in surfaces with greater than 500 CFUs/100cm2 of MRSA. There was a 100% reduction in reservoirs with greater than 500 CFUs/100cm2 of CRAB and 80% reduction in reservoirs with greater than 10 CFUs/100cm2 of CRAB.

Conclusion

The ActivePure continuous disinfection technology devices significantly reduced total aerobic bacteria, including MRSA, difficult-to-treat CRAB, and fungi surface colony counts on high-touch surfaces.

Disclosures

Kimberly Trosch, RN, BSN, ActivePure Technologies: Full time employee Daniel Marsh, n/a, ActivePure Medical: Advisor/Consultant
P-359. Healthcare Practitioners' Infection Prevention Strategies and Associated Factors in Primary Healthcare Facilities of Rohingya Refugee Camps in Bangladesh: A Qualitative Study
Authors: Hasan S M Murshid
Published: January 2025

Background

Healthcare-associated infections (HAIs) pose significant challenges to both patients and healthcare providers. Rohingya refugee camps in Bangladesh are the most densely populated in the world. In the primary healthcare facilities of Rohingya refugee camps, healthcare-associated infections pose major barriers to safe and high-quality healthcare delivery among Rohingya refugees. The study's goal was to evaluate infection prevention strategies and associated factors among primary healthcare practitioners in Rohingya refugee camps.

Methods

In 2023, we conducted a qualitative study among primary healthcare practitioners identified from 15 primary healthcare facilities in 15 Rohingya refugee camps. We conducted 60 in-depth interviews and six focus group discussions with community healthcare providers. We reviewed the collected data, developed a coding system, analyzed the data, and summarized findings according to the study objectives and themes.

Results

Respondents were 60 % men and 40 % women, with a median age of 30 years, and 85% had higher secondary education. All respondents were employed for a median of 3 months (range,1-36 months). Only 42.5% of primary healthcare practitioners were knowledgeable about infection prevention strategies, and 37.2% practiced good infection prevention. Primary healthcare providers who had higher education and formal training in IPC were significantly more likely to have good infection prevention practices. Effective infection prevention practices were linked to the availability and accessibility of hand washing facilities and soap, proper use of personal protective equipment, appropriate cleaning and disinfection protocols, adherence to infection prevention guidelines, surveillance of healthcare-associated infections, and adequate knowledge of infection prevention measures of primary healthcare providers.

Conclusion

Effective infection prevention and control practices are crucial for minimizing the risk of HAIs. This study assessed the infection prevention knowledge and practices, and their associated factors among primary healthcare practitioners in Rohingya refugee camps which would help develop and implement effective interventions to reduce HAIs within Rohingya refugee camps.

Disclosures

All Authors: No reported disclosures
P-360. Impact of a tiered masking intervention on healthcare worker illness and absenteeism during respiratory viral season
Authors: Vergara-Mojica Stephanie , Zodo Alexandra , Niego Meghan , Ali Mirza , Mena Lora Alfredo J
Published: January 2025

Background

High community transmission of respiratory viruses can lead to employee illness, absenteeism, and the risk of spread to both patients and healthcare workers (HCWs). Masking in healthcare settings can mitigate these risks. Our hospital developed a policy to adjust the level of masking required based on current community transmission rates, intensifying or relaxing mandates as necessary. This study aims to evaluate the impact of our tiered masking policy on employee absenteeism.

Weekly respiratory viral metrics and employee influenza-like illness for 2022

Methods

Retrospective review of employee health data, public health respiratory virus surveillance metrics, and infection prevention masking requirements at a 151-bed safety-net hospital. Data from September to December 2022, when universal masking was in place, and September to December 2023, when our new masking policy was implemented was compared. In 2023, four masking levels were created: red always requires masks for HCWs and patients; orange requires them for HCWs; yellow requires masks for HCWs during patient contact; both orange and yellow recommends but doesn’t require masks for patients; green recommends but does not require masks for HCW and patients. Weekly public health respiratory surveillance data, masking requirements and employees reporting influenza-like illness (ILI) were tabulated and compared before and after our new masking policy.

Weekly respiratory viral metrics and employee influenza-like illness for 2023

Results

A total of 66 HCWs reported ILI during the 2022 respiratory viral season compared to 44 in 2023, a 33% reduction. Weekly respiratory viral metrics and HCW ILI is plotted in Figure 1 for 2022 and Figure 2 for 2023. When mask levels were raised to orange on October 6, HCW ILI slightly decreased. Masking changed to yellow on October 22 and correlated with a subsequent increase in ILI. Escalation to red on December 10 was followed by a decline in ILI.

Conclusion

A tiered masking policy in response to fluctuating community transmission appears to be an effective strategy in managing HCW absenteeism due to ILI. Despite higher percent positivity from multiple viruses, a 33% decrease in ILI occurred after implementation of the tiered masking policy, as compared the prior universal masking policy. A tiered masking policy based on percent positivity may be more effective than universal masking.

Disclosures

All Authors: No reported disclosures
P-363. Containing an Outbreak of Carbapenemase-producing Organisms in a Singapore Hospital
Authors: Beh Darius , Tan Glorijoy , Kum Jia Qi , Chia Gabrielle , Kui Huiru , Tan Joanna , Tang Ying Wei , Aung Aung Hein , Chow Angela , Poh Bee Fong , Ang Brenda
Published: January 2025

Background

Tan Tock Seng Hospital is a 1700-bed academic teaching hospital in Singapore. Active surveillance using rapid PCR for the detection of asymptomatic carriage of carbapenemase-producing organisms (CPO) is routinely performed (Fig. 1). Where available, identified carriers are cohorted or isolated under contact precautions. We describe a hospital-wide multispecies OXA-48-like and NDM outbreak, findings from epidemiological investigations and the subsequent infection prevention and control (IPC) measures.

Existing and intensified CPO screening strategies

Methods

Initial response included additional intensified contact tracing (Fig. 1), expansion of isolation bed capacity and audits of IPC practices. Case-control analysis involved 280 cases and 995 controls. Universal admission screening was conducted to validate the accuracy of existing high risk screening (HRS) criteria. Wards with high transmission underwent environmental sampling.

Results

The CPO screening positivity rate was observed to be on a steady increase during 2022/23, from a baseline of 1.3-1.7% in 2020/21, peaking at 6.5% in June 2023 (Fig. 2). Spot audits demonstrated a decrease in hand hygiene compliance, improper cleaning of shared equipment, and poor IPC practices especially during diaper changes. Isolates were predominantly Klebsiella pneumoniae and sequence type 307. OXA was the commonest carbapenemase, followed by NDM. Risk factors for acquisition were presence of an indwelling urinary catheter for OXA (adjusted odds ratio [AOR] 1.62, 95% CI 1.02-2.48, p = 0.028), exposure to third-generation cephalosporins for NDM (AOR 3.83, 95% CI, 1.86-7.92, p < 0.001) and length of stay of 15-21 days for both (AOR 3.19, 95% CI, 2.05-4.96, p < 0.001). 4.8% of OXA carriers developed clinical infection within a median of 17 days (Fig. 3). Sensitivity of HRS criteria was 70%, though compliance to screening was only 60-80%. Periods of higher transmission were associated with lower rates of CPO cohorting (Fig. 4). CPO was found in 6.9% (9/130) of environmental samples.

Rate and time to onset of clinical infection for asymptomatic carriers according to CPO genotype

Conclusion

Drivers of the outbreak were lower rates of CPO cohorting/isolation, a decrease in IPC standards, the inadequate compliance to HRS and the introduction of a highly transmissible bacterial clone. Early detection coupled with isolation remains a key strategy to control the spread of CPO.

Epidemiologic curve of the CPO outbreak in relation to cohorting efforts (%)

Disclosures

Darius Beh, MBBS (S'pore) MMed (Int Med) MRCP (UK), AstraZeneca: Conference Sponsorship|Gilead: Conference Sponsorship
P-364. Outbreak of bla-OXA-48 in the eastern part of Singapore
Authors: Conceicao Edwin , Cheong Hau Yiang , Tan Thean Yen , Jie Li , Nasir Suhailah Binte , Wu Toudi , Theresa Maria , Wong Crystal , Foo Ruby , Yen Tan Seow
Published: January 2025

Background

Changi General hospital (CGH) is a 1000 bed acute hospital that mainly serves the general population in the eastern region of Singapore and community. At the beginning of October 2023 till March 2024, we observed an increase in the number of the Carbapenemase producing Enterobacteriaceae (CP-CRE) bla-OXA-48 cases from the routine long-stayer inpatient surveillance screening in several wards.

Methods

Standard outbreak protocols are executed, including enhanced environmental testing and disinfection, inpatient contact tracing, and Box-PCR typing of Klebsiella pneumoniae spp. isolates.

Results

68% (n = 226) of the bla-OXA-48 are identified from the outbreak wards, of which 15% (n = 33) cases is likely due to the additional beds added in the outbreak wards, reported an OR of 3.6 times (p-value: 0.007, 95%CI: 1.3 – 9.0) of being colonized by bla-OXA-48 CP-CRE compared to the non-outbreak wards. Patients from the outbreak wards have 2.7 times higher odds of requiring significantly more nursing care compared to the non-outbreak wards (p-value: 0.009, 95%CI: 1.3 – 5.7). The limited space to manoeuvre during nursing care, especially during diaper changing for the bed bound patients which is 61% (n = 139) of bla-OXA-48 CP-CRE cases in the outbreak wards. Among the bedbound patients, the odds of being colonized with bla-OXA-48 CP-CRE is 5.6 times (p-value: 0.008, 95%CI: 1.3 – 24.7) in the outbreak wards compared to the non-outbreak wards due to possible surface contamination when the curtains are drawn during the diaper changing or through accidental contact with the adjacent beds by the healthcare workers.

The microbiological typing suggests 2 common types are circulating between patients in the outbreak wards in 79% (n = 58) of the samples tested. 3% (n = 194) of the environmental samples are positive for bla-OXA-48 detected in the toilet and drains, used only by ambulating patients during their hospitalization. No incidences (n = 75) of community onset of bla-OXA-48 CP-CRE is reported form a point prevalence survey (PPS).

Conclusion

Hence, bla-OXA-48 CP-CRE transmission is more likely from healthcare worker transmission. Ensuring adequate spacing between hospital beds is crucial to facilitate the work of healthcare staff, allowing them to move freely and efficiently while providing care.

Disclosures

All Authors: No reported disclosures