bluuebunny/crossref_metadata_2025 huggingface dataset:
405. A Qualitative Study Based on a Case Series of Obstetric COVID-19 Patients to Determine Risks in Management Associated with Severity in a Government Hospital in the Philippines
Authors: Funelas-Santos Sheila Patrice D , Peralta Judith P
Published: December 2021

Background

Enterprise Risk Management (ERM) in healthcare is a method used to identify, assess and reduce risk to patients and the hospital organization. The objective of this study is to identify clinical and organizational challenges and risks in healthcare management caused by COVID-19, and its impact on patients and healthcare workers, in a low-resource obstetric setting.

Methods

From a census of patients from 1 April 2020 to 30 July 2020, four cases of COVID-19 in pregnancy representing different severity levels were selected. A patient tracer activity was done for each patient, documenting events that the patient and healthcare team experienced from admission to discharge. A case series on these patients was written. A focus group consisting of an OB-GYN resident, OB-GYN consultant, OB-GYN nurse, OB-GYN infectious disease consultant, and internal medicine resident and consultant, was formed. Each case was presented to the focus group to establish the context of risk assessment. Risks were identified using the framework of Enterprise Risk Management. Each risk was classified according to their risk domain and severity. Root cause analysis via the fishbone method was used to identify the causes of the risks.

Results

Operational risks identified were delayed swab results, false negative swab results, and delayed patient transport. Clinical/Patient risks identified were COVID-19 exposure of healthcare workers and other non-COVID patients, inadvertent community exposure, risk for severe clinical manifestations of COVID-19, and lack of specific treatment for COVID-19. Risk to human capital identified were COVID-19 infection of hospital staff and decreased quantity of workforce due to quarantine. Most risks were assessed to be moderate risk or high risk in terms of severity. Root cause analysis showed that common causes of risks were due to exposure to asymptomatic patients and delayed and false-negative swab results.

Conclusion

The results of this study may be used towards the final steps of ERM: risk evaluation, treatment and management, in a low resource setting.

Disclosures

Judith P. Peralta, Doctor of Medicine, Fellow of Philippine Obstetrical and Gynecological Society, Fellow of Philippine Infectious Disease Society for Obstetrics and Gynecology, Research Fellow - Harvard Medical School Department of Obstetrics and Gynecology and Reproductive Medicine (2014-2015), Member - International Society of Infectious Diseases (Brookline, MA), Pfizer (Employee, November 2020 to present)
407. Minimum Manufacturing Costs, National Prices and Estimated Global Availability of New Repurposed Therapies for COVID-19
Authors: Wang Junzheng , Levi Jacob , Ellis Leah , Hill Andrew
Published: December 2021

Background

Currently, only dexamethasone, tocilizumab and sarilumab have conclusively been shown to reduce mortality of COVID-19. No drug for prevention or treatment in earlier stages of COVID-19 are yet found, with previously promising drugs such as hydroxychloroquine and remdesivir have been shown to be ineffective. Several new candidates are now being studied in clinical trials. Safe and effective treatments will need to be both affordable and widely available. We therefore revised our original 2020 analysis to reflect recent developments. In this update we analysed the cost of production, current national list prices, and API availability for oral and IV dexamethasone, ivermectin, colchicine, dutasteride, budesonide, baricitinib and monoclonal antibodies tocilizumab and sarilumab.

Methods

Costs of production for new and potential COVID-19 drugs (dexamethasone, ivermectin, dutasteride, budesonide, baricitinib, tocilizumab, sarilumab and colchicine) were estimated using an established and published methodology based on costs of active pharmaceutical ingredients (API), extracted from the global shipping records database Panjiva. This was compared with national pricing data from low, medium, and high-income countries. Annual API export volumes from India were used to estimate the current availability of each drug.

Results

Repurposed therapies can be generically manufactured at very low per-course costs: ranging from &2.58 for IV dexamethasone (or &0.19 orally) to &0.12 for ivermectin. No export price data was available for baricitinib, tocilizumab or sarilumab. When compared against international list prices, we found wide variations between countries. Drug API availability was generally good, with colchicine being the most available with sufficient annual API exported for 59.8 million treatment courses. A summary is shown in Table 1.

Table 1. Summary of list prices, estimated production costs, and current availability of potential COVID-19 drugs selected for analysis. OD = Once daily, BD = twice per day, EUA = Emergency Use Authorisation (only to be given with remdesivir) *In most recent 12-month period.

Conclusion

Successful management of COVID-19 will require equitable access to treatment for all, not just those able to pay. Repurposed drugs can be manufactured at very low costs if shown to be clinically effective, and offers an affordable, widely available option for patients at all stages of the disease from pre-exposure prophylaxis to asymptotic and mild infections, through to critical care until vaccination coverage is expanded.

Disclosures

All Authors: No reported disclosures
409. High Engagement in Social Distancing and Mask Wearing and Associations with Reduced COVID-19 Infection Among California College Students
Authors: Walicek Lindsey , Regan Annette , L’Engle Kelly , Couture Marie-Claude
Published: December 2021

Background

Engaging in preventive behaviors, including face mask wearing and social distancing, has been widely recommended, and in some cases mandated, to limit the spread of the COVID-19 disease. Despite wide-scale use, there is little data available on engagement of mask wearing and social distancing in college students and associated COVID-19 infection.

Methods

A school-wide online survey was conducted (2021) among university students (n=2,132) in California. Frequency of mask-wearing and social distancing (indoors or public settings) and diagnosis with COVID-19 infection were measured. Multiple logistic regression models assessed associations between i) mask-wearing and ii) social distancing and COVID-19 infection, controlling for race, age, gender, and living with people who have high-risk health conditions.

Results

Fourteen percent (14.06%) reported previous COVID-19 infection. Most students reported wearing masks in public settings (77.9%) and indoors (58%). About half (49.9%) reported social distancing in public settings and 44.9% indoors. In multiple logistic regression models, wearing a mask indoors was associated with 30% lower odds of COVID-19 infection (OR= 0.70; 95% CI: 0.54,0.91) but no statistically significant association was observed for wearing a mask outdoors (OR= 0.80; 95% CI: 0.59,1.08). Social distancing indoors and outdoors was associated with a 34% (OR= 0.66; 95% CI: 0.50,0.86) and 32% (OR= 0.68; 95% CI: 0.52,0.88) decrease in the odds of infection, respectively. COVID-19 infection declined as the number of preventive behaviors a student engaged in increased. Compared to those who engaged in no preventive behavior, the odds of infection were 0.71 (95% CI: 0.46,1.11) among students engaging in one behavior, 0.70 (95% CI: 0.46,1.07) in two behaviors, 0.42 (95% CI: 0.25,0.70) in three behaviors, and 0.48 (95% CI: 0.31,0.74) among those who engaged in all four behaviors.

Conclusion

Wearing face masks and social distancing were both associated with lower odds of COVID-19 infection. The more preventive behaviors students engaged in the less frequently they reported COVID-19 infection. Our findings support existing guidelines promoting mask wearing and social distancing to limit the spread of COVID-19 disease.

Disclosures

All Authors: No reported disclosures
410. The Importance of Personal Protective Equipment Education Opportunities and Messages of Encouragement at the Workplace to Reduce Burnout: Cross-sectional Survey After the First Wave of the COVID-19 Pandemic in Japan
Authors: Matsuo Takahiro , Taki Fumika , Kobayashi Daiki , Jinta Torahiko , Suzuki Chiharu , Ayabe Akiko , Sakamoto Fumie , Kitaoka Kazuyo , Uehara Yuki , Mori Nobuyoshi , Fukui Tsuguya
Published: December 2021

Background

The rapid spread of the COVID-19 pandemic has taken a considerable mental strain on frontline healthcare workers (HCWs). Although a number of studies have reported on burnout during the peak of the pandemic, few studies have analyzed it after the pandemic temporally subsided. This study aimed to identify which intervention or support was helpful to reduce the physical and mental burden during the pandemic.

Methods

An online cross-sectional survey of HCWs from June 15 to July 6, 2020, was conducted at a tertiary hospital in Tokyo, Japan. Demographic characteristics, results of the Japanese version of the Maslach Burnout Inventory-General Survey, types of anxiety and stress, changes in life and work after the peak of the pandemic, and types of support aimed at reducing the physical or mental burden, were determined.

Results

Out of 672 HCWs, 149 (22.6%) met the overall burnout criteria. Figure 1 showed the comparison of what helped reduce their physical and mental burden between the burnout group and the non-burnout group. After adjusted by the potential covariates, burnout was more prevalent in women (OR, 3.11; 95% CI, 1.45–6.67; p = .003), and had heightened anxiety due to unfamiliarity with PPE (OR, 1.98; 95% CI, 1.20–3.27; p=.007). Conversely, participants who reported that PPE education opportunities (OR, .484; 95% CI, .236–.993; p = .048) and messages of encouragement at the workplace (OR, .584; 95% CI, .352–.969; p = .037) helped reduce their physical and mental burden had less burnout.

Figure 1. What factors helped reduce the physical or mental burden

Conclusion

The educational interventions for PPE and messages of encouragement at the workplace may be needed to reduce the mental burden for HCWs.

Disclosures

All Authors: No reported disclosures
411. Significance of a Known Epidemiological Link to a COVID-19 Index Case and Severity of COVID-19 Infection
Authors: Kandel Christopher , McGeer Allison , Friedland Joshua , Shigayeva Altynay , Mubareka Samira
Published: December 2021

Background

Several factors have been associated with severity of COVID-19 disease, but there remains a paucity of data surrounding whether the nature of exposure is impactful. Evidence demonstrating the correlation between initial viral exposure dose and disease severity exists for many viral infections. Observational studies have suggested that the exposure context, which can be considered a proxy for magnitude of viral inoculum, may influence severity of COVID-19 infection. We aimed to assess whether having a known exposure, as a proxy for higher inoculum dose to COVID-19, was associated with more severe outcomes for individuals hospitalized with COVID-19.

Methods

We created a retrospective cohort of community-dwelling adults hospitalized for COVID-19 in south-central Ontario from April 1, 2020 - January 14, 2021. Individuals or next of kin were contacted to ascertain exposure history. The primary outcome was death, intensive care unit (ICU) admission, or mechanical ventilation (MV) within 30 days of admission. A multivariable logistic regression model was used to determine whether a known exposure was associated with worse outcomes.

Results

1097 individuals with community acquired COVID-19 required hospitalization; of these, 942 (86%) had available exposure data. In this group, the median age was 65, 44% were women, 84% lived in a private residence, 59% had a frailty score (FS) of 1 – 3 while 40% had a FS of 4 – 9, and 28% had a known exposure. Overall, the primary outcome occurred in 368/942 (39%) patients. Having a known exposure was not associated with worse outcome (OR 1.14, 95% CI 0.84–1.54, p = 0.41). Male gender (OR 1.41, 95% CI 1.06–1.89; p = 0.018), age (OR 1.01/year, 95% CI 1.00–1.03, p = 0.03), frailty (OR 1.22/point, 95% CI 1.09–1.36, p = 0.001) and living with at least one other person (OR 1.57, 95% CI 1.09–2.28, p = 0.017) were all associated with death, ICU admission, or MV within 30 days of admission.

Conclusion

While having a known exposure to a person with COVID-19 was not associated with worse outcome, the identified increased severity of illness associated with cohabitation suggests context of exposure may have a role in disease severity. This data and future studies can be used to guide public health recommendations to not only minimize transmission, but severity of COVID-19 infection.

Disclosures

All Authors: No reported disclosures
412. Estimating the Impact of School Classroom Sizes on the Probability of Severe Acute Respiratory Syndrome Coronavirus-2 Infectivity or Exposure
Authors: Thomas Sanya J , Young Rebecca R , Akinboyo Ibukunoluwa , Smith Michael J , Buckley Tara , Lewis Sarah S
Published: December 2021

Background

Despite schools reopening across the United States in communities with low and high Coronavirus disease 2019 (COVID-19) prevalence, data remain scarce about the effect of classroom size on the transmission of severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) within schools. This study estimates the effect of classroom size on the risk of COVID-19 infection in a closed classroom cohort for varying age groups locally in Durham, North Carolina. Total number of Coronavirus Disease 2019 (COVID-19) infections over a 28-day follow-up period for varying classroom reproduction number (R0) and varying classroom cohort sizes of 15 students, 30 students and 100 students in Durham County, North Carolina.

Methods

Using publicly available population and COVID-19 case count data from Durham County, we calculated a weekly average number of new confirmed COVID-19 cases per week between May 3, 2020 and August 22, 2020 according to age categories: < 5 years, 5-9 years, 10-14 years, and 15-19 years. We collated average classroom cohort sizes and enrollment data for each age group by grade level of education for the first month of the 2019-2020 academic school year. Then, using a SEIR compartmental model, we calculated the number of susceptible (S), exposed (E), infectious (I) and recovered (R) students in a cohort size of 15, 30 and 100 students, modelling for classroom reproduction number (R0) of 0.5, 1.5 and 2.5 within a closed classroom cohort over a 14-day and 28-day follow-up period using age group-specific COVID-19 prevalence rates.

Results

The SEIR model estimated that the increase in cohort size resulted in up to 5 new COVID-19 infections per 10,000 students whereas the classroom R0 had a stronger effect, with up to 88 new infections per 10,000 students in a closed classroom cohort over time. When comparing different follow-up periods in a closed cohort with R0 of 0.5, we estimated 12 more infected students per 10,000 students over 28 days as compared to 14 days irrespective of cohort size. With a R0 of 2.5, there were 49 more infected students per 10,000 students over 28 days as compared to 14 days.

Conclusion

Classroom R0 had a stronger impact in reducing school-based COVID-19 transmission events as compared to cohort size. Additionally, earlier isolation of newly infected students in a closed cohort resulted in fewer new COVID-19 infections within that group. Mitigation strategies should target promoting safe practices within the school setting including early quarantine of newly identified contacts and minimizing COVID-19 community prevalence.

Disclosures

Michael J. Smith, MD, M.S.C.E, Merck (Grant/Research Support)Pfizer (Grant/Research Support)
416. Diagnostic Yield of Serial COVID-19 Testing in Hospitalized Patients
Authors: Li Jeremy , Frenette Charles , Loo Vivian
Published: December 2021

Background

Accurate and rapid diagnosis of SARS-CoV-2 infection is essential to prevent nosocomial transmission. Patients with negative COVID-19 tests at admission may still be in the incubation phase during hospitalisation. False negative results can occur when patients are tested too early. The incidence of COVID-19 infections in Montréal, Canada started to increase in December 2020. Because of this rise, on January 4th, 2021, the Infection Control Service of the McGill University Health Centre (MUHC) recommended serial COVID-19 testing for all admitted patients on days 5 and 10 after admission. The aim of this study is to examine the diagnostic yield of serial COVID-19 testing.

Methods

We retrospectively analyzed SARS-CoV-2 test results for patients admitted to the MUHC between January 4, 2021, and April 30, 2021. Nasopharyngeal swabs were collected from patients for SARS-CoV-2 PCR testing. Multiple testing platforms were used (Roche Cobas 6800, Thermo ScientificTM King Fisher and Cepheid GeneXpert) because of the high volume of samples. Tests were classified as admission, day 5, and day 10 tests if they were done on days 0 to 2, 3 to 7, and 8 to 12 respectively. Patients positive for SARS-CoV-2 on admission were excluded from the analyses. The diagnostic yield of serial testing for patients admitted during each month was calculated by dividing the number of patients testing positive on day 5 or day 10 by the total number of patients who underwent serial testing during that month.

Results

There were 2945 admissions of 5 days or more and 1777 admissions of 10 days or more. Of these, 1509 patients and 841 patients respectively were serially tested for SARS-CoV-2 as recommended for a compliance rate of 51% at day 5 and 47% at day 10. Ten (0.7%) and 12 (1.4%) patients tested positive on days 5 and 10 respectively. The diagnostic yield of serial testing was highest for patients admitted in January 2021 at 2.2%, when the average daily incidence of COVID-19 was highest in Montréal (see Figure).

The diagnostic yield of serial testing for each month, compared to the average daily COVID-19 incidence rate in Montréal, Québec, Canada.

Conclusion

The diagnostic yield of serial SARS-CoV-2 testing in hospitalized patients is low when the overall community incidence is low. However, diagnostic yield of serial testing increases when community incidence of COVID-19 is higher and should be considered in this situation.

Disclosures

All Authors: No reported disclosures
417. COVID-19 Aerostudy: Evaluation of SARS-CoV-2 Virus in the Air of Patients Hospitalized with COVID-19
Authors: Hamza Hamed , Seitsema Margaret , Conroy Lorraine , Mena Lora Alfredo J , Wenzler Eric , Borgetti Scott , Ladner Benjamin , Cable Tracy , Dahlquist ashley , Ismail Nahed , Fisher Steven , Ali Taha , Sweeney Dagmar , Bleasdale Susan C
Published: December 2021

Background

At the onset of the COVID-19 pandemic, hospitals implemented infection control measures with limited data on predictors of nosocomial SARS-CoV-2 transmission. We aimed to quantify SARS-CoV-2 presence in an inpatient setting to understand nosocomial risk.

Methods

Patients admitted with confirmed SARS-CoV-2 infection at an urban academic hospital were enrolled. Demographic/clinical characteristics, a PCR nasal swab(NS), and air samples on filter media in the near- (< 6ft) and far-field ( >6ft) of each patient for 3.5 hours were collected. PCR was used to detect SARS-CoV-2 on filter media. Associations between clinical characteristics and presence of SARS-CoV-2 in air samples used Fisher’s exact and Wilcoxon rank sum tests.

Results

Of 52 subjects, 46% had no detectable virus by nasal swab on the day of sampling. Of 104 room air samples, 16% had detectable virus from 25% of rooms, including 10 near and 7 far field samples. Subjects with a positive room air sample had fewer days from symptom-onset compared with those with a negative air sample (median 6 vs. 8, p=0.24). Being on room air and having a nasal swab positive increased the odds of detecting virus in air samples but were not statistically significant.

Conclusion

A small number of air samples with detectable SARS-CoV-2 may suggest lower nosocomial risk than previously anticipated. Multiple subject and environmental factors may have contributed to this finding including patient source control masking, anti-viral therapies and HEPA filtration. The decreased association of virus in the air of those with more days of symptoms but with the need for supplemental oxygen may be related to what is now known about the COVID-19 inflammatory response after the infectious period.

Disclosures

All Authors: No reported disclosures
418. Low Frequency of Healthcare Worker Infections Following Occupational Exposures to COVID-19
Authors: Seidelman Jessica , Akinboyo Ibukunoluwa , Rinehart Maya , Stiegel Matthew , Moehring Rebekah W , Anderson Deverick J , Said Kristen , Epling Carol A , Lewis Sarah S , Smith Becky
Published: December 2021

Background

Data on occupational acquisition of COVID-19 in healthcare settings are limited. Contact tracing efforts are high resource investments.

Methods

Duke Health developed robust COVID-19 contact tracing methods as part of a comprehensive prevention program. We prospectively collected data on HCW exposures and monitored for development of symptomatic (SYX) and asymptomatic (ASYX) COVID-19 infection after documented high-, medium, and low-risk exposures. HCWs were required to self-report exposures or were identified through contact tracing as potentially exposed to COVID-19 positive HCWs, patients or visitors. Contact tracers interviewed exposed HCWs and assessed the risk of exposure as high-, medium-, or low-risk based on CDC guidance (Table 1). Testing was recommended at 6 days after high- or medium-risk exposures and was provided upon HCW request following low-risk exposures. Our vaccination campaign began in 12/2020.

Results

12,916 HCWs registered in the contact tracing database. From March 2020-May 2021, we identified 6,606 occupational exposures (0.51 exposures/HCW). The highest incidence of workplace exposures per number of HCWs in each job category was among respiratory therapists (RT) (0.95 exposures/RT), nursing assistants (NA) (0.79 exposures/NA), and physicians (0.64 exposures/physician). The most common exposure risk level was medium (51.4%), followed by low (35.5%), and then high (13.1%). A total of 260 (2%) HCW had positive tests/conversions; 28 (10.8%) were ASYX at the time of testing. High-risk exposures had a significantly greater number of post-exposure infections compared to medium- and low-risk exposures (12.5% vs. 4.2%, vs. 0.4%; p < 0.001). The rate of SYX infection following exposure to a fellow HCW (179/3,198; 5.6%) was higher than that following exposure to a patient (81/3,408; 2.4%; p< 0.001).

Conclusion

Conversion following exposure to COVID-19 in the healthcare setting with appropriate protective equipment was low. Incomplete testing of all exposed individuals was a limitation and our data may under-estimate the true conversion rate. Our findings support our local practice of not quarantining HCWs following non-household exposures. Limiting contact tracing to only high or medium risk exposures may best utilize limited personnel resources.

Disclosures

Rebekah W. Moehring, MD, MPH, UpToDate, Inc. (Other Financial or Material Support, Author Royalties)
420. Emergency Nurses’ Experiences over 1 Year of the COVID-19 Pandemic: A Qualitative Study
Authors: Lee Ki Rog , Kang JaHyun
Published: December 2021

Background

At the frontline of fighting against the coronavirus disease 2019 (COVID-19) pandemic, emergency room (ER) nurses are faced with various challenges throughout the provision of emergency care for incoming patients without knowing their COVID-19 status. However, little is known about their work burden, exhaustion, and psychological distress in the pandemic. Therefore, to provide basic data for effective counterstrategies against future emerging infectious diseases in the ER, this study aims to understand ER nurses’ COVID-19 work experiences in depth at one tertiary hospital over 1 year.

Table 1. Summary of Qualitative Responses Regarding Emergency Room Nurses’ COVID-19 Pandemic Experience

Methods

This study was conducted at a 2,715-bed tertiary hospital in Seoul, Korea. Using a purposeful sampling method, we recruited 20 nurses who have worked for more than 1 year in the ER and have capacity for independent care for COVID-19 patients. With institutional review board approval, one-on-one individual, in-depth interviews were completed using a semi-structured questionnaire from February 13 to March 25, 2021. After recording and transcribing interviews, the narrative data were analyzed using a thematic analysis method.

Results

The 20 participants were 29.9 years old on average with 69.2 months’ clinical experience. The overarching theme was derived as ‘COVID-19 highlighted the importance of ER’s infection control and ER nurses’ professional dedication’ covering 6 sub-themes and 16 concepts (Table 1). Sub-themes were ‘psychological burden of handling COVID-19 patients directly’, ‘unprecedented changes for ER’s response to the pandemic’, ‘revealing hospital’s lack of support for ER’, ‘withdrawal from social life as ER nurses’, ‘re-illuminating nurses’ calling for their occupation’, and ‘planning for the post COVID-19 era’.

Conclusion

ER nurses experienced challenges from their drastically changed tasks, received poor compensation from the hospital, and felt pressure from social expectations towards medical personnel. However, nurses showed enough dedication towards their jobs, considered pandemic experience as a valuable asset to their future career, and maintained a positive attitude towards difficulties in ER. Providing comprehensive support for ER nurses is necessary to improve ER infection control to respond to the pandemic.

Disclosures

All Authors: No reported disclosures
424. The Impact of COVID-19 Response on Infection Prevention Programs and Practices in Southeastern United States
Authors: Advani Sonali D , Advani Sonali D , Cromer Andrea , Wood Brittain A , Baker Esther , Crawford Kathryn L , Crane Linda , Roach Linda , Padgette Polly W , Ashley Elizabeth Dodds , Akinboyo Ibukunoluwa , Weber David J , Weber David J , Sickbert-Bennett Emily , Anderson Deverick J
Published: December 2021

Background

Early assessments of COVID19 preparedness reported resource shortages, use of crisis capacity strategies, variations in testing, personal protective equipment (PPE), and policies in US hospitals. One year later, we performed a follow-up survey to assess changes in infection prevention practice and policies in our diverse network of community and academic hospitals.

Methods

This was a cross-sectional electronic survey of infection preventionists in 58 hospitals within the Duke Infection Control Outreach Network (community) and Duke/UNC Health systems (academic) in April-May 2021 to follow-up our initial survey from April 2020. The follow-up survey included 26 questions related to resource availability, crisis capacity strategies, procedures, changes to PPE and testing, and staffing challenges.

Results

We received 54 responses (response rate, 93%). Facilities reported significantly fewer PPE and resource shortages in the follow-up survey compared to our initial survey (Figure 1, P< 0.05). Only 32% of respondents were still reprocessing N95 respirators (compared to 73% in initial survey, P< 0.05). All hospitals performed universal masking, universal symptom screening on entry, and 30% required eye protection. In 2020, most hospitals suspended elective surgical procedures in March-April, and restarted in May-June. Approximately 92% reported in-house testing for SARS-COV-2 by April 2020, at least a third of which had a weekly capacity of >100 tests. Almost 80% performed universal pre-operative testing, while 61% performed universal preadmission testing for SARS-COV-2. Almost all hospitals switched from test-based to time-based strategy for discontinuing isolation precautions, majority in August-September 2020. Twenty-five percent hospitals reported infection prevention furloughs, staffing cuts, and or reassignments, while 81% reported increased use of agency nursing during the pandemic.

Conclusion

Our follow-up survey reveals improvement in resource availability, evolution of PPE guidance, increase in testing capacity, and burdensome staffing changes. Our serial surveys suggest increasing uniformity in infection prevention policies, but also highlight the increase in staff turnover and infection prevention staffing shortages.

Disclosures

Sonali D. Advani, MBBS, MPH, Nothing to disclose David J. Weber, MD, MPH, PDI (Consultant)
427. Healthcare Personnel Perceived Benefit of Infection Prevention Strategies during COVID
Authors: Sickbert-Bennett Emily , Schnell Natalie , Summerlin-Long Shelley , Brewer Brooke , DiBiase Lauren , Stancill Lisa , Teal Lisa , Weber David J , Weber David J
Published: December 2021

Background

During the COVID-19 pandemic, many infection prevention policy and practice changes were introduced to mitigate hospital transmission. Although each change had evidence-based infection prevention rationale, healthcare personnel (HCP) may have variable perceptions of their relative values.

Methods

Between October-December 2020, we conducted a voluntary, anonymous, IRB-approved survey of UNC Medical Center HCP regarding their views on personal protective equipment (PPE) and hospital policies designed to prevent COVID acquisition. The survey collected occupational and primary work location data (COVID unit or not) as well as their views on specific infection prevention practices during COVID. Chi squared tests (two tailed) were used to compare differences in the proportions.

Results

The overall results are displayed (Figure). Among the 694 HCP who responded to the survey, we found HCP were largely (68%) satisfied that the organization was taking all the necessary measures to protect them from COVID-19. A significantly greater proportion (14% more) of HCP (81.7% compared to 67.6%; 95% CI of difference 9.4-18.5%, P< 0.0001) agreed that all PPE was available to them compared to those who were confident that the organization was taking necessary steps for protection, highlighting that safety is more than simply availability of supplies. More than 90% felt that daily screening of patients/visitors and patient/visitor mask requirements were important for protecting them from acquiring COVID in the workplace and that wearing a mask themselves was a key intervention for protecting others. Fewer HCP (72-80%), although still a majority, perceived that eye protection and daily symptom screening for HCP were beneficial. Symptom screening for patients/visitors was perceived by 19% more HCP (90.9% compared to 72.2%; 95% CI of difference 15-23%) to be beneficial than symptom screening of HCP (P< 0.0001).

Figure. HCP Perceived Benefit of Infection Prevention Strategies during COVID

Conclusion

Although infection prevention strategies were implemented based on evidence and in alignment with CDC recommendations, it is important to acknowledge that the perception and acceptance of these recommendations varied among our HCP. Compliance can only be optimized with key interventions when we seek to understand the perceptions of our staff.

Disclosures

David J. Weber, MD, MPH, PDI (Consultant)
428. Assessing the Confidence, Knowledge and Preferences of Hospital Staff with Regards to Personal Protective Equipment (PPE) Practices During the COVID-19 Pandemic
Authors: Brown Rachel , Markman Sharon , Brown Amanda , Mian Rukhshan , Arora Vineet , Umscheid Craig
Published: December 2021

Background

Effective use of personal protective equipment (PPE) by hospital staff is critical to prevent transmission of COVID-19. This study examines hospital staff confidence in and knowledge of effective PPE use, and their preferences for learning about PPE practices.

Methods

Three isolation precautions signs were created for use in the care of those with or under investigation for COVID-19 infection: first, a special respiratory precautions sign designed by infection control; and next, two signs outlining proper donning and doffing practices – one created internally with the support of health literacy, and another developed with a design firm (IDEO) using principles of human-centered design (Figure 1). All signs were used for ≥ 10 weeks prior to distribution of a questionnaire (REDCap) to clinical and non-clinical hospital staff. Those who had not worked on hospital units during the pandemic (after March 15, 2020) were excluded. The 38-item survey was sent by supervisors over email between July 14-31, 2020, and examined demographics, confidence in and knowledge of PPE best practices, and preferences for each precaution sign with regards to trustworthiness, ease of following, informative content, and clarity of image/layout. Responses were reported using descriptive statistics. A non-parametric test of trends compared staff preferences across signs. Logistic regression examined the association between answering all knowledge-based questions correctly and staff role and confidence in PPE practices (Stata).

Results

Of the 531 respondents, 461 were eligible for inclusion. The majority were female, white, and not high risk for COVID-19 (Table 1). Most were confident about PPE use, correctly answered questions examining knowledge of PPE best practices, and found PPE signage helpful (Table 2). Staff preferred the professionally designed sign for informative content (p< 0.01) and clear imagery/layout (p=0.01) (Table 3). Confidence in PPE practices and physician or nurse roles were associated with answering all knowledge-based questions correctly (p< 0.001 and p=0.04, respectively).

Conclusion

In a convenience sample of hospital staff, most were confident and knowledgeable about PPE use, found PPE signage helpful, and preferred professionally designed signs.

Disclosures

All Authors: No reported disclosures
429. Infection Prevention During Use of a Warm Zone Model in Cohort Patient Care Locations during the COVID-19 Pandemic
Authors: Sacht Joseph , Holton Samantha , Yun Mylinh , Varkey Jay
Published: December 2021

Background

The COVID-19 pandemic required hospitals to care for influxes of patients in cohort locations during critical shortages of personal protective equipment (PPE). Safety zones can be used to protect healthcare workers caring for patients with infectious pathogens. During the COVID-19 pandemic, our hospital developed a Warm Zone model (WZM) to streamline the care of patients with COVID. We established specific areas in our COVID cohort units where staff were permitted to bridge between rooms without doffing gowns, but still doffing gloves and performing hand hygiene between patients. We recognized that a WZM could inadvertently increase risk of nosocomial transmission of pathogens if gowns acted as fomites. For this reason, patients with known infectious pathogens were excluded from the WZM. To measure for unintended harmful consequences of the WZM, our Infection Prevention (IP) department performed surveillance for hospital onset (HO) Clostridioides difficile (CDI), Carbapenem-resistant enterobacteriaceae (CRE) and Methicillin-resistant Staphyloccocus aureus (MRSA) bloodstream infections on units that implemented the WZM.

Methods

Two intensive care units and 3 wards where COVID positive patients were cohorted were included in surveillance. The timeframe for this analysis was 7/1/2020 - 3/31/2021. An electronic surveillance system was used to measure HO infections. The National Healthcare Surveillance Network (NHSN) LabID definitions were used when determining HO CDI and MRSA bloodstream infections (BSI).

Results

During the study period, there were no HO CRE, 1 HO CDI, and 2 HO MRSA BSI in cohort units. There was no evidence to suggest that the HO CDI or HO MRSA BSI were associated with use of a WZM. During this time period, there were 14 cases of community onset (CO) CDI, 2 cases of CO MRSA BSI, and one CO CRE.

Conclusion

During use of a WZM in COVID cohort units, IP did not identify significant increase in HO CDI, CRE, or MRSA BSI compared to non-cohort units. We were limited in our ability to measure acquisition of pathogens because active surveillance screening for colonization was not performed. However, we were able to safely employ a WZM to streamline patient care in COVID cohort areas without evidence of causing nosocomial infections via patient-to-patient transmission.

Disclosures

All Authors: No reported disclosures
431. SARS-CoV-2 Environmental Contamination in Hospitalized COVID-19 Patients’ Rooms
Authors: Warren Bobby G , Nelson Alicia , Barrett Aaron , Addison Bechtler S , Graves Amanda M , Lewis Sarah S , Smith Becky A , Weber David J , Weber David J , Sickbert-Bennett Emily , Anderson Deverick J
Published: December 2021

Background

The correlation between SARS-CoV-2 RNA and infectious viral contamination of the hospital environment is poorly understood.

Methods

housed in a dedicated COVID-19 unit at an academic medical center. Environmental samples were taken within 24 hours of the first positive SARS-CoV-2 test (day 1) and again on days 3, 6, 10 and 14. Patients were excluded if samples were not obtained on days 1 and 3. Surface samples were obtained with flocked swabs pre-moistened with viral transport media from seven locations inside (bedrail, sink, medical prep area, room computer, exit door handle) and outside the room (nursing station computer). RNA extractions and RT-PCR were completed on all samples. RT-PCR positive samples were used to inoculate Vero E6 cells for 7 days and monitored for cytopathic effect (CPE). If CPE was observed, RT-PCR was used to confirm the presence of SARS-CoV-2.

Results

We enrolled 14 patients (Table 1, Patient Characteristics) between October 2020 and May 2021. A total of 243 individual samples were obtained – 97 on day 1, 98 on day 3, 34 on day 6, and 14 on day 10. Overall, 18 (7.4%) samples were positive via RT-PCR – 9 from bedrails (12.9%), 4 from sinks (11.4%), 4 from room computers (11.4%) and 1 from the exit door handle (2.9%). Notably, all medical prep and nursing station computer samples were negative (Figure 1). Of the 18 positive samples, 5 were from day 1, 10 on day 3, 1 on day 6 and 2 on day 10. Only one sample, obtained from the bedrails of a symptomatic patient with diarrhea and a fever on day 3, was culture-positive (Figure 2).

Table 1. Patient Characteristics

Figure 1. Proportion of RT-PCR Positive Samples by Sample Day and Location

Figure 2. Cell cultures of negative control (left) and CPE positive sample (right)

Conclusion

Overall, the amount of environmental contamination of viable SARS-CoV-2 virus in rooms housing COVID-19 infected patients was low. As expected, more samples were considered contaminated via RT-PCR compared to cell culture, supporting the conclusion that the discovery of genetic material in the environment is not an indicator of contamination with live infectious virus. More studies including RT-PCR and viral cell culture assays are needed to determine the significance of discovering SARS-CoV-2 RNA versus infectious virus in the clinical environment.

Disclosures

David J. Weber, MD, MPH, PDI (Consultant)
435. Outcomes for E484K Mutation Negative COVID-19 Patients Cohorted with E484K Mutation Positive COVID-19 Patients: A Retrospective Cohort Study
Authors: Buskandar Fahad , Linkneheld-Struk Amber L , Williams Victoria R , Chan Adrienne , Mieusement Lorraine Maze Dit , Salt Natasha , Leis Jerome A
Published: December 2021

Background

The emergence of the E484K mutation of SARS-CoV-2 poses a risk of immune evasion but the risk of re-infection during acute infection is not well defined. Our aim was to assess the risk of re-infection among patients with existing acute E484K mutation negative COVID-19 infection who were exposed to an E484K mutation positive SARS-CoV-2 infected patient.

Methods

We performed a retrospective cohort study of patients admitted with acute E484K negative COVID-19 infection and shared a hospital room with a patient who was E484K mutation positive during their period of communicability. The primary outcome was laboratory confirmed and/or clinical evidence of re-infection within the E484K negative population within 30 days of exposure and the secondary outcome was the 30-day risk of death or re-admission to hospital due to COVID-19.

Results

We identified 41 patients who were E484K mutation negative who shared a hospital room with some of the identified 34 E484K positive patients. Six (14%) underwent repeat COVID-19 testing and remained E484K negative and none developed signs or symptoms of COVID-19 re-infection during the 30 days following exposure. The mortality rate was 7% (3/41) and re-admission rate was zero at 30 days from exposure.

Conclusion

Despite the small sample size, we did not observe any evidence of re-infection among patients with COVID-19 who shared a hospital room with E484K positive patients during their acute infection. If necessary due to high hospital occupancy, patients with discordant E484K results can be safely cohorted in a shared room.

Disclosures

All Authors: No reported disclosures
436. U-shaped-aggressiveness of SARS-CoV-2: Period Between Initial Symptoms and Clinical Progression to COVID-19 Suspicion. A Population-Based Cohort Study
Authors: Buitano Bruno G , Morgenstern Dan , Talavera Juan , Zaldívar Andrea , Martínez Mercedes
Published: December 2021

Background

Until now, studies have been focused on patient-centered risk factors, while SARS-CoV-2 aggressiveness has been established as causing 20% of severe and critical patients. However, there are still many unanswered questions concerning the clinical aggressiveness behavior of SARS-CoV-2. This study focuses on progression of symptoms as a marker of such aggressiveness, using the Period between initial symptoms and clinical progression to COVID-19 suspicion (PISYCS) to determine the risk of severe disease and mortality.

Methods

Historic cohort study of Mexican patients. Data from January-April 2020 were provided by the Health Ministry. Setting: Population-based. Patients registered in the Epidemiologic Surveillance System in Mexico. Participants were subjects who sought medical attention for clinical suspicion of COVID-19. All patients were subjected to RT-PCR testing for SARS-CoV-2. We measured the Period between initial symptoms and clinical progression to COVID-19 suspicion (PISYCS) and compared it to the primary outcomes (mortality and pneumonia)

Results

65,500 patients were included. Reported fatalities and pneumonia were 2176 (3.32%), and 11568 (17.66%), respectively. According to the PISYCS, patients were distributed as follows: 14.89% in < 24 hours, 43.25% between 1–3 days, 31.87% between 4–7 days and 9.97% > 7 days. The distribution for mortality and pneumonia was 5.2% and 22.5% in < 24 hours, 2.5% and 14% between 1–3 days, 3.6% and 19.5% between 4–7 days, 4.1% and 20.6% > 7 days, respectively (p< 0.001). Adjusted-risk of mortality was (OR [95% CI], p-value): < 24 hours = 1.75 [1.55–1.98], p< 0.001; 1–3 days = 1 (reference value); 4–7 days = 1.53 [1.37–1.70], p< 0.001; > 7 days = 1.67 [1.44–1.94], p< 0.001. For pneumonia: < 24 hours = 1.49 [1.39–1.58], p< 0.001; 1–3 days = 1; 4–7 days = 1.48 [1.41–1.56], p< 0.001; > 7 days = 1.57 [1.46–1.69], p< 0.001.

Risk of Mortality vs. PISYCS

Logistic regression anlaysis of mortality based on PISYCS. Note that risk of mortality is significantly higher when PISYCS is > 24 hours and < 7 days

Risk of Pneumonia vs. PISYCS

Logistic regression anlaysis of developing pneumonia based on PISYCS. Note that risk of pneumonia is significantly higher when PISYCS is > 24 hours and < 7 days.

Conclusion

The PISYCS shows a U-shaped SARS-CoV-2 aggressiveness pattern. Further studies are needed to corroborate the time-related pathophysiology behind these findings and possibly justify use of PISYCS as an initial evaluation tool and therapies/monitoring in high-risk patients.

Disclosures

All Authors: No reported disclosures
437. Longitudinal Plasma Cytokine Profiles Differentiating COVID-19 Severity Groups
Authors: Green Amanda M , Souquette Aisha , Agrawal Mona , Wolf Joshua , Wolf Joshua , Gaur Aditya , Allison Kim J , Estepp Jeremie , Allen Emma , Thomas Paul , Smallwood Heather
Published: December 2021

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), an infection with widely varying clinical severity. Severe COVID-19 was initially proposed to be secondary to cytokine storm syndrome (CSS). However, studies since showed that patients with severe COVID-19 rarely display CSS cytokine phenotypes, and may have more limited inflammatory responses instead.

Methods

Prospective cohorts, aged 0-90 years of age who tested positive by polymerase chain reaction (PCR) for SARS-CoV-2 were enrolled from inpatient hospitals and outpatient testing centers in Memphis, TN from May 2020-January 2021. Longitudinal blood samples were obtained including acute, sub-acute and convalescent timepoints. Severity scores of asymptomatic, mild, moderate, and severe COVID-19 were assigned at time of convalescent assessment. Plasma was analyzed with a quantitative human magnetic 38-plex cytokine assay.

Results

: 169 participants were enrolled, including 8 asymptomatic, 117 mild, 22 moderate and 17 severe cases, and 5 children with post-COVID-19 multisystem inflammatory syndrome in children (MIS-C). All moderate and severe patients were hospitalized and received treatment (39%). Clear distinctions were seen between asymptomatic-mild cases and moderate-severe cases at acute timepoints and during disease progression for GCSF, IL-8, IL-10, IL-15, IL-1Ra, IP-10, MIP-1a, MIP-1β, and TGFα. There was a significant difference between participants who did and did not require hospitalization for acute timepoint levels of IL-10, IL-15, MIP-1 β and TGFα (p< 0.01). Only 4 participants with active COVID-19 were found to meet criteria for CSS (2%), only 3 of which were severe. MIS-C participants showed nearly universally elevated cytokine levels compared to those with active COVID-19.

Temporal and severity associations of IL-10 and IP-10

Figure 1. Temporal and severity associations of IL-10 and IP-10 Examples of differentiating cytokine profiles by severity and time. Among SARS-CoV-2 PCR positive participants, IL-10 and IP-10 displayed increased levels in their acute plasma samples as clinical severity increased [A,C]. IL-10 and IP-10 also showed distinct time-dependent responses (ln(Cytokine level (pg/mL)) that differentiated the more severe from the less severe groups [B,D].

Conclusion

Moderate and severe acute COVID-19 has a distinct cytokine profile from asymptomatic and mild cases, as detected from acute, subacute and convalescent plasma.

Disclosures

Joshua Wolf, MBBS, PhD, FRACP, Karius Inc. (Research Grant or Support) Joshua Wolf, MBBS, PhD, FRACP, Nothing to disclose Paul Thomas, PhD, Cytoagents (Consultant)Immunoscape (Consultant)