bluuebunny/crossref_metadata_2025 huggingface dataset:
Experience with Bloodborne Pathogen Exposures Among Operation Room Nurses in Korea: A Qualitative Study
Authors: Kang JaHyun , Lee Hyunsook
Published: November 2021

Background: Operation room (OR) nurses are at a high risk for bloodborne pathogen (BBP) exposures because they are constantly in contact with blood and body fluid (BBF) through surgical sites, and they frequently use sharp surgical instruments and sutures during surgeries. We explored occupational experiences with BBP exposures among OR nurses in South Korea. Methods: With an institutional review board’s approval, this qualitative research was performed with 12 OR nurses who had worked for >3 months and had experienced BBP exposures. Based on the main research question “How is the experience of BBP exposure among OR nurses?” the semistructured questions for in-depth interview were prepared. Narrative data were collected through 1-hour individual interviews from June to September 2020 and were analyzed using a thematical analysis method. Results: The average age of the participants was 34.4 years with an average 9.75 years of clinical experience. The main theme extracted was “The nurses are alerted to their safety after experiencing the aftereffects and emotional trauma from BBP exposures,” with 4 subthemes and 14 concepts. The first subtheme, “OR nurses risking exposure to BBF,” included (1) hurried doctors and hasty nurses; (2) sharp surgical instruments everywhere; (3) deprioritized self-protection due to ongoing surgery; (4) inattentive to BBF risk; and (5) uncomfortable, foggy goggles and receded safety devices. The second subtheme, “BBP exposures occurred in a flash,” included (1) sharp injury occurred in a split second; (2) temporarily treat sharp wounds while hiding frightened feelings; and (3) OR nurses concentrated on surgery by suppressing anxiety and sharp wounds. The third subtheme, “Burdened time that could be overwhelmed alone,” included (1) BBP exposures moments that I wish to reverse; (2) anger over dangerous environments and the turmoil of anxiety; (3) exhausted body and facial discoloration due to taking postexposure prophylaxis; and (4) exposure to BBP that I want to hide from family and friends. The fourth subtheme, “Voice for everyone’s safety,” included (1) establishing a safety culture, which requires everyone’s efforts, and (2) necessity of practical resources for decreasing BBP exposures. Conclusions: The participating OR nurses felt that they were working with a high risk to BBF exposures and called for institutional interventions to reduce the risks, including surgeons’ attentive collaboration. Korean hospitals should make greater efforts to establish safety culture in ORs and to provide repeated, tailored education to prevent BBF exposures. They should also supply high-quality protective equipment and safety-engineered devices for OR nurses.

Funding: No

Disclosures: None
Zero Healthcare-Associated COVID-19
Authors: Lin Ling Moi , How Molly , Yuen Tan Kwee , Wee Elaine , Poh Choo Phoon , Chee Lee Lai
Published: November 2021

Background: The ongoing COVID-19 pandemic tests the healthcare system in many ways. The scarcity of resources poses challenges to infection prevention (IP) practices. We describe our experience in managing such scarcity in our care of COVID-19 patients in the hospital as well as community settings. Methods: The hospital pandemic plan traditionally included only plans for healthcare delivery management within the hospital. However, on March 25, 2020, a decision was made by the Ministry of Health to set up swab isolation (SIFs) and community care facilities (CCFs) to meet the growing demand for isolation beds for migrant workers infected by COVID-19. The CCFs were located in convention halls and resort centers and the SIFs were located in facilities previously functioning as hotels. Mobile medical teams were activated to run clinics at the dormitories housing 200,000 migrant workers. The IP team of an acute- and tertiary-care hospital in Singapore was activated to oversee IP measures at facilities managed by medical teams from the hospital, with the goal of zero healthcare-associated COVID-19 cases among staff. Two IP leaders were set up to oversee the IP program at 8 dormitories, 4 SIFs, and 2 CCFs. In total, 12 IP staff and 15 infection prevention liaison officers (IPLOs) were deployed from 2 acute-care hospitals and 3 specialty centers to conduct training in hand hygiene and the use of personal protective equipment, and to conduct daily audits of compliance to practice guidelines. Education on personal hygiene was also given to patients in these facilities in at least 7 languages. In the SIFs and dormitories, IPLOs were recruited to perform daily audits and feedback to the IP team on issues related to IP at the sites. Results: Since our first COVID-19 patient on January 23, 2020, there has been no report of healthcare-associated COVID-19 within the hospital nor among the medical, administrative, and support service staff working in the external operation facilities. Daily audits showed an average of 99.4% compliance to IP guidelines. Conclusions: IPLOs or IP champions play a significant role in ensuring compliance to IP guidelines. This compliance allows the IP professional to focus on the evaluation of the IP program, managing IP consultations, and planning and implementation of the IP program in nontraditional healthcare settings. The key success factors of the program included the ability to contextualize the planning and implementation of IP programs in various settings, strong leadership support, cohesive teamwork, and effective communication at various levels.

Funding: No

Disclosures: None
How Do Safety Climate Ratings Relate to Attitudes Towards and Knowledge About Surgical Site Infection Prevention Measures?
Authors: Pfeiffer Yvonne , Atkinson Andrew , Maag Judith , Lane Michael , Schwappach David , Marschall Jonas
Published: November 2021

Group Name: Watussi Study Group

Background: A positive safety climate is an important precursor of safe care outcomes. However, only limited evidence supports the association of low surgical-site infection (SSI) rates and positive safety climate. We investigated the role that perceptions of SSI prevention measures play for both safety climate level and strength as a subjective norm, that is, the social pressure perceived to perform the prevention measures, commitment to observe SSI prevention measures despite other situational pressures, and the level of knowledge about the prevention measures. Methods: The safety climate scale of the Safety Attitudes Questionnaire and 3 scales assessing subjective norm, commitment, and knowledge were used. All items were translated and retranslated from German to French and to Italian. All translated scales were pretested for understandability. Operating room (OR) personnel in 54 Swiss acute-care hospitals were surveyed, resulting in 2,769 analyzed responses with data aggregated on the hospital level. Two regression analyses were conducted: one using the percentage of positive responses per hospital as a safety climate level indicator, and another using the standard deviation of the safety climate ratings per hospital as a safety climate strength indicator. As independent variables, the hospital means of subjective norm, commitment, and knowledge were investigated and appropriately adjusted for number of respondents and sample composition. Results: The sample consisted of 1,495 nurses (54%) and 1,101 physicians (40%). Commitment and subjective norm were significant predictors (p < 0.001 and p < .05, respectively) of safety climate level, in the expected positive direction, but KNOW was not (R2, adjusted: 0.48); for safety climate strength, only COM was significant p < 0.001 (R2, adjusted: 0.27). Conclusions: The extent to which OR personnel were committed to perform the measures, such as timely administration of antibiotics, was associated with their safety climate rating level and strength. Thus, the rather general safety climate assessments are related to more specific safety behaviors necessary to achieve good outcomes such as low infection rates. Subjective norm was related to safety climate level only, indicating that in work environments with a good safety climate, the perceived social pressure to adhere to infection prevention measures may be higher. Knowledge about SSI prevention had no significant impact on safety climate, pointing to future research regarding the role of education in implementing prevention measures. Investigating how attitudes and knowledge about measures to prevent specific patient safety outcomes furthers our understanding of the role of safety climate in patient safety improvement.

Funding: No

Disclosures: None
Healthcare-Associated Viral Respiratory Infections in a Pediatric Intensive Care Unit and Cardiovascular Intensive Care Unit
Authors: Feldman Kelly , Singh Jasjit , Gornick Wendi
Published: November 2021

Background: Healthcare-associated infections (HAIs) affect patient health and are tracked closely by infection prevention. Patients in a pediatric intensive care unit (PICU) acquired viral respiratory infections had longer use of respiratory support. We sought to determine the types of viral respiratory HAIs (VR-HAIs) acquired in the PICU and the characteristics of those affected. Methods: CHOC Children’s Hospital is a 334-bed tertiary-care center. Charts were reviewed on patients with VR-HAIs from fiscal years (FY) 2005–2020. High-risk VR-HAI (HR-VR-HAI) were influenza A and B, respiratory syncytial virus (RSV), adenovirus, parainfluenza, and human metapneumovirus (hMPV, added in FY 2014). Patients in the PICU, cardiovascular ICU (CVICU), and oncology ICU (OICU) with HR-VR-HAIs were reviewed. Patients were categorized according to underlying pathology, immunosuppression, and isolation prior to HR-VR-HAI. Increased respiratory support was defined as any increase from a patient’s baseline support ±24 hours of viral diagnosis: increase in oxygen flow or transition from nasal cannula to high-flow nasal cannula or ventilator support. Antibiotic escalation, defined as initiation of antibiotic therapy for ≥2 days ±24 hours of viral diagnosis or broadening the spectrum of antimicrobials for ≥2 days ±24 hours of viral diagnosis. Results: During FY 2005–2020, there were 204 VR-HAIs: 143 HR-VR-HAIs (70%), of which 39 (27.2%) occurred in ICUs (Figure 1). Most of the HR-VR-HAIs were RSV, parainfluenza, and hMPV (Figure 2). Of 39 patients, 10 (25.6%) had underlying oncologic conditions, 9 of whom were immunosuppressed. Of 39 patients, 16 (41%) had structural cardiac disease, 4 (10.3%) had pulmonary disease, 5 (12.8%) had neurologic disease, and the remaining 4 (10.3%) had other comorbidities. Of 39 patients, 12 (31%) required an increase in respiratory support and 13 (33%) had escalation of antibiotics. Of 39 HR-VR-HAI patients, 2 died within 2 weeks of acquisition. Conclusions: HR-VR-HAIs are uncommon in ICUs. RSV, parainfluenza, and hMPV are the most common, and 1 of 3 of patients required escalation in respiratory support and/or escalation in antibiotics. All patients had underlying comorbidities. In our series, there were 2 deaths within 2 weeks of infection.

Funding: No

Disclosures: None
Surveillance of Candidemia in Connecticut: An Epidemiological Comparison Between Two Periods
Authors: Gleason-Vergados Johanna , Banach David , Clogher Paula , Meek James
Published: November 2021

Background: Candidemia is the fourth most common bloodstream infection in hospitalized patients in the United States, with an attributable mortality rate between 30% and 50%. Understanding the epidemiology of candidemia is critical due to its prevalence and association with extended hospital stays, high treatment cost, and significant morbidity and mortality. In 2019 the Connecticut Department of Public Health deemed candidemia a mandatory reportable condition and began state-wide surveillance in conjunction with the CDC’s Emerging Infections Program (EIP). Previously, the EIP had conducted population-based statewide surveillance of candidemia in Connecticut from 1998 to 2000, allowing an opportunity to assess how the epidemiology of candidemia has evolved. The goal of this study is to compare state-wide Connecticut EIP candidemia data from 2 periods (1998–2000 and 2019) to identify trends in infections and incidence, providing insight for potential improvements to current prevention measures and treatments. Methods: The sample population included all Connecticut residents aged ≥20 who tested positive for a candidemia infection during 1998–2000 and 2019. Patients who had positive blood cultures for Candida spp but were < 20 years old or were not Connecticut residents were excluded. Connecticut EIP candidemia case report forms from each time period were compared and matching fields were chosen as variables for univariate analysis to search for statistically significant differences. Selected variables include: Candida species present in blood culture, patient demographics, previous exposures to healthcare settings, length of stay, presence of central venous catheter (CVC), and location of the patient at diagnosis (community vs. hospital onset). De-identified patient-level information was provided by the EIP. Results: In total, 381 candidemia episodes from 1998–2000 were compared to 247 episodes in 2019. The proportion of C. albicans species in 1998–2000 was 49.9% and declined to 40.5% of cases in 2019 (P = .02). Outcomes improved as well, with 65.2% of patients in 2019 having survived compared to 51.4% in 1998–2000 (P = .001). Other findings indicate that patients with candidemia in 2019 were less likely to have a central venous catheter, less likely to have undergone a recent surgery, and were more likely to have community-onset infection (all p < 0.05). Conclusions: The epidemiology of candidemia has changed over the past 20 years, with significant improvements in patient survival and a shift toward community-onset infections and non-Albicans spp. These findings have important implications in designing prevention strategies and optimizing candidemia management, particularly in the community setting where increased intravenous drug use and the availability of home healthcare may be important factors.

Funding: No

Disclosures: None
Impact of a Comprehensive SARS-CoV-2 Infection Prevention Bundle on Rates of Hospital-Acquired Respiratory Viral Infections
Authors: Seidelman Jessica , Smith Becky , Akinboyo Ibukunoluwa , Lewis Sarah
Published: November 2021

Background: We evaluated the impact of a comprehensive SARS-CoV-2 (COVID-19) infection prevention (IP) bundle on rates of non–COVID-19 healthcare-acquired respiratory viral infection (HA-RVI). Methods: We performed a retrospective analysis of prospectively collected respiratory viral data using an infection prevention database from April 2017 to January 2021. We defined HA-RVI as identification of a respiratory virus via nasal or nasopharyngeal swabs collected on or after hospital day 7 for COVID-19 and non–COVID-19 RVI. We compared incident rate ratios (IRRs) of HA-RVI for each of the 3 years (April 2017 to March 2020) prior to and 10 months (April 2020 to January 2021) following full implementation of a comprehensive COVID-19 IP bundle at Duke University Health System. The COVID-19 IP bundle consists of the following elements: universal masking; eye protection; employee, patient, and visitor symptom screening; contact tracing; admission and preprocedure testing; visitor restrictions; discouraging presenteeism; population density control and/or physical distancing; and ongoing attention to basic horizontal IP strategies including hand hygiene, PPE compliance, and environmental cleaning. Results: During the study period, we identified 715 HA-RVIs over 1,899,700 inpatient days, for an overall incidence rate of 0.38 HA-RVI per 1,000 inpatient days. The HA-RVI IRR was significantly higher during each of the 3 years prior to implementing the COVID-19 IP bundle (Table 1). The incidence rate of HA-RVI decreased by 60% after bundle implementation. COVID-19 became the dominant HA-RVI, and no cases of HA-influenza occurred in the postimplementation period (Figure 1). Conclusions: Implementation of a comprehensive COVID-19 IP bundle likely contributed to a reduction in HA-RVI for hospitalized patients in our healthcare system. Augmenting traditional IP interventions in place during the annual respiratory virus season may be a future strategy to reduce rates of HA-RVI for inpatients.
Molecular Epidemiology of Large COVID-19 Clusters at an Academic Medical Center, March–October 2020
Authors: Kobayashi Takaaki , Ortiz Miguel , Holley Stephanie , Etienne William , Jenn Kyle , Abosi Oluchi , Meacham Holly , Sheeler Lorinda , Dains Angie , Kukla Mary , Trannel Alexandra , Marra Alexandre , Alsuhaibani Mohammed , McCray Paul , Perlman Stanley , Ford Bradley , Diekema Daniel , Wellington Melanie , Pezzulo Alejandro , Salinas Jorge
Published: November 2021

Background: COVID-19 in hospitalized patients may be the result of community acquisition or in-hospital transmission. Molecular epidemiology can help confirm hospital COVID-19 transmission and outbreaks. We describe large COVID-19 clusters identified in our hospital and apply molecular epidemiology to confirm outbreaks. Methods: The University of Iowa Hospitals and Clinics is an 811-bed academic medical center. We identified large clusters involving patients with hospital onset COVID-19 detected during March–October 2020. Large clusters included ≥10 individuals (patients, visitors, or HCWs) with a laboratory confirmed COVID-19 diagnosis (RT-PCR) and an epidemiologic link. Epidemiologic links were defined as hospitalization, work, or visiting in the same unit during the incubation or infectious period for the index case. Hospital onset was defined as a COVID-19 diagnosis ≥14 days from admission date. Admission screening has been conducted since May 2020 and serial testing (every 5 days) since July 2020. Nasopharyngeal swab specimens were retrieved for viral whole-genome sequencing (WGS). Cluster patients with a pairwise difference in ≤5 mutations were considered part of an outbreak. WGS was performed using Oxford Nanopore Technology and protocols from the ARTIC network. Results: We identified 2 large clusters involving patients with hospital-onset COVID-19. Cluster 1: 2 hospital-onset cases were identified in a medical-surgical unit in June 2020. Source and contact tracing revealed 4 additional patients, 1 visitor, and 13 employees with COVID-19. Median age for patients was 62 (range, 38–79), and all were male. In total, 17 samples (6 patients, 1 visitor, and 10 HCWs) were available for WGS. Cluster 2: A hospital-onset case was identified via serial testing in a non–COVID-19 intensive care unit in September 2020. Source investigation, contact tracing, and serial testing revealed 3 additional patients, and 8 HCWs. One HCW also had a community exposure. Patient median age was 60 years (range, 48–68) and all were male. In total, 11 samples (4 patients and 7 HCWs) were sequenced. Using WGS, cluster 1 was confirmed to be an outbreak: WGS showed 0–5 mutations in between samples. Cluster 2 was also an outbreak: WGS showed less diversity (0–3 mutations) and ruled out the HCW with a community exposure (20 mutations of difference). Conclusion: Whole-genome sequencing confirmed the outbreaks identified using classic epidemiologic methods. Serial testing allowed for early outbreak detection. Early outbreak detection and implementation of control measures may decrease outbreak size and genetic diversity.

Funding: No

Disclosures: None
Coronavirus in Wisconsin Nursing Homes: A Longitudinal Analysis of the First 10 Months of the Pandemic
Authors: Gmehlin Cameron , Rivera Frida , Ramos-Castaneda Jorge , Pezzin Liliana , Duthie EDmund , Munoz-Price L. Silvia
Published: November 2021

Background: The COVID-19 pandemic has disproportionately affected nursing home residents, and emerging evidence suggests quality, location, resident demographics, and staffing levels may be related to COVID-19 incidence within facilities. We describe the distribution of COVID-19 cases in Wisconsin nursing homes from January 2020 to October 2020, the effect of rural versus urban locations on COVID-19 incidence, and the temporal changes in COVID-19 incidence. Methods: We constructed a database using the Center for Medicaid and Medicare Services’ (CMS) publicly available data. Variables obtained per facility included location, number of beds, ownership type, average census, 5-star ratings (overall, quality, health, staffing, and nurse staffing categories), number of COVID-19 cases, resident Medicaid/Medicare share, area deprivation index, and social vulnerability index. Nursing homes were divided into tertiles based on total COVID-19 cases for descriptive analysis (zero cases, 1–7 cases, >7 cases). Demographic and clinical variables were reported as frequencies, mean (standard deviation) or median (interquartile range). We compared groups using the Pearson χ2 test and the Kruskal-Wallis test. COVID-19 incidence rates were calculated by dividing the number of COVID-19 cases by monthly occupied bed days and multiplied by 10,000. Results: From January 1, 2020, to November 1, 2020, in total, 3,133 SARS-CoV-2–confirmed cases were reported among 248 (70.5%) nursing homes. Urban location (P = .027), overall 5-star rating (P = .035), number of beds (p < 0.001), and average count of residents per day (p < 0.001) were associated with a greater number of COVID-19 cases. Temporal analysis showed that the highest incidence rates of COVID-19 in NHs were observed from January to May and in October 2020 (11.36 and 30.33 cases per 10,000 occupied-bed days, respectively). Urban NHs experienced higher incidence rates until September, then incidence rates among rural facilities surged (Fig.1A). In the first half of the year, NHs with lower quality scores (1-3 stars) had a higher COVID-19 incidence rate; however, in August this trend reversed, and facilities with higher quality scores (4-5 stars) showed the highest incidence rates (Fig.1B). Fig. 2 shows a temporal depiction of the shift from urban to rural settings. Conclusions: Higher COVID-19 incidence rates during the first 5 months of the pandemic were observed in urban, larger facilities with lower 5-star rating. By the end of the year, nursing homes in rural areas and those with higher quality ratings had the highest incidence rates.

Funding: No

Disclosures: None
Evaluating the Relationship between Cycle Threshold Values and Reported COVID-19 Symptoms among Healthcare Workers
Authors: Sampson Mindy , Passaretti Catherine , Priem Jennifer , Kester Shelley , Fischer Kristin , Longshore John
Published: November 2021

Background: SARS-CoV-2 detected by reverse transcription polymerase chain reaction (RT-PCR) can persist for weeks to months in some individuals. Cycle threshold (Ct) values represent the number of cycles needed to amplify viral ribonucleic acid (RNA) to reach a detectable level. As such, Ct values are inversely related to the amount of virus in a sample. As knowledge of SARS-CoV-2 viral dynamics continues to evolve, understanding the relationship between Ct values, type of symptoms, and timing of symptom onset can help determine when infected individuals are most likely to be infectious. Methods: We conducted a retrospective cohort study of 1,027 healthcare workers (HCWs) who tested positive for SARS-CoV-2 by RT-PCR from nasopharyngeal specimens between June 27, 2020, and September 21, 2020. All HCWs were interviewed within 72 hours of their diagnosis for symptom history. Due to multiple PCR platforms being in use in our facility, only 360 HCWs (35%) had Ct values available for analysis. Multivariate linear regression models examined the effect of COVID-19–related symptoms and timing of symptom onset to test on Ct values. Results: The most frequently reported symptoms were congestion (55.6%), cough (50.3%), and headache (46.7%). Other symptoms less commonly reported were fatigue (36.7%), loss of taste or smell (36.4%), fever (35.4%), muscle aches (33.3%), sore throat (27.4%), and diarrhea (26.7%). Symptomatic HCWs (88.3% of sample) had lower Ct values (ORF-1 M = 22.66, SD = 5.17; E-Gene M = 24.34, SD = 6.60) than asymptomatic individuals (ORF-1 M = 25.46, SD = 6.06; E-Gene M = 29.34, SD = 7.96). Of all symptoms measured, only presence of fever, congestion, and muscle aches predicted significantly lower Ct values. Mean Ct values decreased 2 days prior to symptom onset, were lowest the day of symptom onset, then increased in a curvilinear fashion. There were no significant 2-way interactions between symptoms and time of symptom onset to testing. Conclusions: The curvilinear pattern of Ct values over time from symptom onset are consistent with disease progression patterns and support current understanding of infectivity being highest 2 days prior to symptom onset through day 8. Presence of fever, congestion, and muscle aches are significantly correlated with lower Ct values, suggesting that these symptoms are associated with higher viral load. Although Ct values are not without limitations, our findings support the current understanding that presymptomatic and symptomatic individuals, particularly those with fever, congestion, and muscle aches, may pose higher risk of transmission to others.

Funding: No

Disclosures: None
COVID-19 Conversion after Exposure in a Semiprivate Room at a Tertiary Care Center in Iowa, July–December 2020
Authors: Trannel Alexandra , Kobayashi Takaaki , Abosi Oluchi , Jenn Kyle , Meacham Holly , Sheeler Lorinda , Etienne William , Dains Angie , Kukla Mary , Alsuhaibani Mohammed , Holley Stephanie , Marra Alexandre , Ford Bradley , Wellington Melanie , Diekema Daniel , Salinas Jorge
Published: November 2021

Background: Hospital semiprivate rooms may lead to coronavirus disease 2019 (COVID-19) patient exposures. We investigated the risk of COVID-19 patient-to-patient exposure in semiprivate rooms and the subsequent risk of acquiring COVID-19. Methods: The University of Iowa Hospitals & Clinics is an 811-bed tertiary care center. Overall, 16% of patient days are spent in semiprivate rooms. Most patients do not wear masks while in semiprivate rooms. Active COVID-19 surveillance included admission and every 5 days nasopharyngeal SARS-CoV-2 polymerase chain reaction (PCR) testing. We identified inpatients with COVID-19 who were in semiprivate rooms during their infectious periods during July–December 2020. Testing was repeated 24 hours after the first positive test. Cycle threshold (Ct) values of the two tests (average Ct <30), SARS-CoV-2 serology results, clinical assessment, and COVID-19 history were used to determine patient infectiousness. Roommates were considered exposed if in the same semiprivate room with an infectious patient. Exposed patients were notified, quarantined (private room), and follow-up testing was arranged (median seven days). Conversion was defined as having a negative test followed by a subsequent positive within 14 days after exposure. We calculated the risk of exposure: number of infectious patients in semiprivate rooms/number of semiprivate patient-days (hospitalization days in semiprivate rooms). Results: There were 16,427 semiprivate patient days during July–December 2020. We identified 43 COVID-19 inpatients who roommates during their infectious periods. Most infectious patients (77%) were male; the median age was 67 years; and 22 (51%) were symptomatic. Most were detected during active surveillance: admission testing (51%) and serial testing (28%). There were 57 exposed roommates. The risk of exposure was 3 of 1,000 semiprivate patient days. In total, 16 roommates (28%) did not complete follow-up testing. Of 41 exposed patients with follow-up data, 8 (20%) converted following their exposure. Median time to conversion was 5 days. The risk of exposure and subsequent conversion was 0.7 of 1,000 semiprivate patient days. Median Ct value of the source patient was 20 for those who converted and 23 for those who did not convert. Median exposure time was 45 hours (range, 3–73) for those who converted and 12 hours (range, 1–75) for those who did not convert. Conclusions: The overall risk of exposure in semiprivate rooms was low. The conversion rate was comparable to that reported for household exposures. Lower Ct values and lengthier exposures may be associated with conversion. Active COVID-19 surveillance helps early detection and decreases exposure time.

Funding: No

Disclosures: None
Outbreak of Pseudomonas aeruginosa Bacteremia Infections among Stem-Cell Transplant Patients Related to Change in Prophylaxis
Authors: VerLee Kerrie , Nguyen Chau , Lampen Russell , Codman Jim , Peters Tunisia
Published: November 2021

Background:Pseudomonas aeruginosa outbreaks can originate from various sources and can cause severe complications in posttransplant patients. Antibiotic prophylaxis can decrease posttransplant infections; however, consideration must be given to P. aeruginosa coverage as we outline an outbreak among the stem-cell transplant (SCT) population. Methods: A multidisciplinary outbreak investigation was conducted to evaluate sources of contamination and changes in clinical processes. Positive blood cultures from SCT patients and environmental isolates were analyzed using whole-genome sequencing (WGS). Incidence density rates for P. aeruginosa blood cultures from January 2019 through October 2020 were calculated per 10,000 patient days and stratified by unit, specimen, and transplant type. Statistical analysis was calculated with significance at p < 0.05. Results: A cluster of 8 SCT patients was identified between May and September 2020. Moreover, 10 environmental samples were positive for P. aeruginosa including drains, water sources prior to the point-of-use (POU) filter and blood-bank thaw machines. Phylogenetic analysis revealed 1 cluster of 2 patients who shared the same room, 5 patients with unique P. aeruginosa isolates, and 2 separate clusters of environmental isolates with relatedness only to each other. Review of clinical processes showed a change from fluoroquinolone prophylaxis to cephalosporin in the spring of 2020. Also, 5 P. aeruginosa bacteremia infections occurred prior to June (11.78 cases per 10,000 patient days). During the period of cephalosporin use, 8 infections were identified (58.27 cases per 10,000 patient days) (P = .006). Following the restart of fluoroquinolone, zero infections have occurred to date, as of January 28, 2021. Conclusions: Discontinuation of fluoroquinolone prophylaxis was associated with P. aeruginosa bacteremia infections in SCT patients. Use of fluoroquinolone prophylaxis in SCT patients is protective from P. aeruginosa bacteremia infections. There have been no further infections in the following 3 months after the change back to the use of fluoroquinolone. Additionally, WGS showed that most patient isolates did not have a common source, suggesting that P. aeruginosa gastrointestinal colonization may play a role in seeding these bacteremia infections.

Funding: No

Disclosures: None
Results of a Multicenter Diagnostic Stewardship Collaborative to Optimize Blood Culture Use in Critically Ill Children
Authors: Koontz Danielle , Woods-Hill Charlotte , Voskertchian Annie , Xie Anping , Miller Marlene , Fackler James , Colantuoni Elizabeth , Milstone Aaron , Li Ximin
Published: November 2021

Group Name: Bright STAR Authorship Group

Background: Blood cultures are fundamental in the diagnosis and treatment of sepsis. Culture practices vary widely, and overuse can lead to false-positive results and unnecessary antibiotics. Our objective was to describe the implementation of a multisite quality improvement collaborative to reduce unnecessary blood cultures in pediatric intensive care unit (PICU) patients, and its 18-month impact on blood culture rates and safety metrics. Methods: In 2018, 14 PICUs joined the Blood Culture Improvement Guidelines and Diagnostic Stewardship for Antibiotic Reduction in Critically Ill Children (Bright STAR) Collaborative, designed to understand and improve blood culture practices in critically ill children. Guided by a centralized multidisciplinary study team, sites first reviewed existing evidence for safe reduction of unnecessary blood cultures and assessed local practices and barriers to change. Subsequently, local champions developed and implemented clinical decision-support tools informed by local patient needs to guide new blood-culture practices. The coordinating study team facilitated regular evaluations and discussions of project progress through monthly phone calls, site visits if requested by sites or the study team, and collaborative-wide teleconferences. The study team collected monthly blood culture rates and monitored for possible delays in obtaining blood cultures using a standardized review process as a safety balancing metric. We compared 24 months of baseline data to 18 months of postimplementation using a Poisson regression model accounting for the site-specific patient days and correlation of culture use within a site over time. Results: Across the 14 sites, before implementation, 41,768 blood cultures were collected over 259,701 PICU patient days. The mean preimplementation site-specific blood culture rate was 15.7 cultures per 100 patient days (rate range, 9.6–48.2 cultures per 100 patient days). After implementation, 22,397 blood cultures were collected over 208,171 PICU patient days. The mean postimplementation rate was 10.4 cultures per 100 patient days (rate range, 4.7–28.3 cultures per 100 patient days), which was 33.6% lower than the preimplementation (relative rate 0.66; 95% CI, 0.65–0.68 p <0.01). In 18 months post-implementation, sites reviewed 793 positive blood cultures, and identified only one suspected delay in culture collection possibly attributable to the site’s blood culture reduction program. Conclusions: Multidisciplinary quality improvement teams safely facilitated a 33.6% average reduction in blood culture use in critically ill children at 14 hospitals. Future collaborative work will determine the impact of blood culture diagnostic stewardship on antibiotic use and other important patient safety outcomes.

Funding: No

Disclosures: None
Analysis of Recurrent Urinary Tract Infection Management in Outpatient Settings Reveals Opportunities for Antibiotic Stewards
Authors: Valentine-King Marissa , Trautner Barbara , Zoorob Roger , Germanos George , Salemi Jason , Gupta Kalpana , Grigoryan Larissa
Published: November 2021

Background: Studies of antibiotic prescribing choice and duration have typically excluded women with recurrent UTI (rUTI), yet the Infectious Disease Society of America (IDSA) UTI treatment guidelines are applicable to recurrent and sporadic cystitis. We sought to better understand prescribing practices among uncomplicated rUTI patients in terms of choice of drug, duration of therapy, and the risk factors for receiving guideline-discordant therapy. Methods: We performed a retrospective database study by extracting electronic health record data from adults seen at academic primary care, internal medicine, or urology practices between November 2016 and December 2018. Inclusion criteria included having ≥2 or ≥3 International Classification of Diseases Tenth Edition (ICD-10) cystitis codes recorded within a 6- or 12-month period, respectively. We excluded patients with ICD-10 codes indicating any structural or functional genitourinary comorbidities, interstitial cystitis, vaginosis, compromised immune systems, or pregnancy in the prior year. Patients were also excluded if they had signs or symptoms of pyelonephritis at presentation. Results: Overall, 232 patients presented for 597 outpatient visits. Most were married (52.2%), non-Hispanic white (62.9%), and female (92.2%), with a median age of 58 years (IQR, 41–68). Only 21% of visits with an antibiotic prescribed for treatment consisted of a first-line therapy agent prescribed for the recommended duration. In terms of antibiotic choice, these agents were prescribed in 58.4% of scenarios, which primarily included nitrofurantoin (37.8%) and trimethoprim-sulfamethoxazole (TMP-SMX) (20.3%). Guideline-discordant choices of fluoroquinolones (28.8%), and β-lactams (11.2%) were the second and third most commonly prescribed drug categories, respectively. Multinomial logistic regression identified age (OR, 1.02; 95% CI, 1.002–1.04) or having a telephone visit (OR, 3.17; 95% CI, 1.54–6.52) as independent risk factors for receiving a β-lactam. The duration exceeded the 3-day guideline recommendation in 87.6% of fluoroquinolones and 73% of TMP-SMX (73%) prescriptions, and 61% of nitrofurantoin prescriptions exceeded the recommended 5-day duration. Multiple logistic regression analysis revealed that seeking care at a urology clinic (OR, 2.81; 95% CI, 1.59–5.17) served as an independent factor for therapy duration exceeding guideline recommendations. Conclusions: This retrospective study revealed shortcomings in prescribing practices in the type and duration of therapy for rUTI. rUTI as well as sporadic UTI are important targets for outpatient antibiotic stewardship interventions.

Funding: This investigator-initiated research study was funded by Rebiotix Inc, a Ferring Company.

Disclosures: None
Impact of an Inpatient Nurse-Initiated Penicillin Allergy Delabeling Questionnaire
Authors: Dutcher Lauren , Bediako Hilary , Harker Christina , Rao Aditi , Sigafus Kristen , Hamilton Keith , Fadugba Olajumoke
Published: November 2021

Background: Penicillin allergy is the most common drug allergy, with ~10% of all patients in the United States reporting a penicillin allergy. A penicillin allergy label is associated with the use of inappropriate or broad-spectrum antibiotics, worse patient outcomes, increased bacterial resistance, and increased healthcare costs, yet no studies have explored the unique role nurses may play in allergy delabeling through history taking as a part of broader antimicrobial stewardship efforts. Here, we describe the impact of using an inpatient nurse-initiated penicillin-allergy questionnaire. Methods: We implemented a nurse-driven intervention focused on penicillin allergy delabeling in inpatient noncritical care units (surgery, neurology, medicine, oncology, and cardiovascular medicine) at an academic hospital from July 9, 2019, to July 24, 2020. Patients with a penicillin allergy listed in the electronic health record (EHR) were identified and invited to participate. The intervention consisted of a questionnaire administered by nurses who elicited details of penicillin allergy history. If a patient was deemed eligible for penicillin allergy removal, nurses requested approval from both the patient as well as a physician member of the study team. Results: In total, 306 patients with a penicillin allergy label were identified in the EHR, of whom 242 patients were eligible for and agreed to participate in the delabeling interview (Figure 1). Of the 34 (14%) of 242 patients potentially eligible for delabeling by the questionnaire based on their history, the study physicians agreed with delabeling for 23 (68%) of 34 patients. Of these 34 patients, 18 (53%) agreed with delabeling (pending physician approval), and 16 (47%) of these 34 patients were ultimately delabeled. For those who declined delabeling, never wanting the label removed under any circumstance and uncertainty about accuracy of the survey results were common reasons for refusal (Figure 2). Additionally, for the 13 patients who refused delabeling, 9 patients did not want or were unsure about following up with an allergy specialist. Conclusions: The nurse-driven penicillin-allergy delabeling questionnaire is a no-cost intervention that can successfully identify patients to delabel. In this study, this measure resulted in the removal of 16 (7%) of 242 penicillin allergy labels. However, patients frequently opted to keep penicillin allergy labels, expressing uncertainty and fear of removal. Future work should explore optimal methods to engage nurses and patients in allergy delabeling, as well as the impact on antibiotic use and patient outcomes.

Funding: No

Disclosures: None
Coherent optical vortex generation with multiple topological charges based on a seeded free electron laser
Authors: Sun Hao , Wang Xiaofan , Feng Chao , Tu Lingjun , Fan Weijie , Liu Bo
Published: November 2021

To generate optical vortex with multiple topological charges, a simple scheme based on the phase mask shaping technique is proposed and applied in a seeded free electron laser. With a tailored phase mask, an extreme-ultraviolet (EUV) vortex with multiple topological charges can be produced. To prove the feasibility of this method, an eight-step phase mask is designed to shape the seed laser. The simulation results demonstrate that 100-MW, fully coherent EUV vortex pulses with topological charge 2 can be generated based on the proposed technique. We have also demonstrated the possibility of generating higher topological charges by using a phase mask with more steps.
Updated studies on exomoons in the HD 23079 system
Authors: Jagtap O. , Quarles B. , Cuntz M.
Published: November 2021

We re-evaluate the outer edge of orbital stability for possible exomoons orbiting the radial velocity planet discovered in the HD 23079 system. In this system, a solar-type star hosts a Jupiter-mass planet in a nearly circular orbit in the outer stellar habitable zone. The outer stability limit of exomoons is deduced using N-body and tidal migration simulations considering a large range of initial conditions, encompassing both prograde and retrograde orbits. In particular, we extend previous works by evaluating many values in the satellite mean anomaly to identify and exclude regions of quasi-stability. Future observations of this system can make use of our results through a scale factor relative to the currently measured minimum mass. Using a constant time lag tidal model (Hut 1981), we find that plausible tidal interactions within the system are insufficient to induce significant outward migration toward the theoretical stability limit. While current technologies are incapable of detecting exomoons in this system, we comment on the detectability of putative moons through Doppler monitoring within direct imaging observations in view of future research capacities.
A novel, cost-effective lens irrigation system for rigid endoscopes in transnasal endoscopic surgery
Authors: Sekar R , Hassan M F
Published: November 2021

Background

In transnasal endoscopic surgical procedures, the lens of the endoscope often becomes fogged or smeared with mucus or blood. The surgeon has to clean the lens and reintroduce the endoscope multiple times during the surgery, making it a tiring process.

Methods

This paper describes an innovative lens irrigation system comprising a modified 16 Fr Foley catheter, a 20 cc or 50 cc syringe filled with warm normal saline (0.9 per cent), and a commercially available intravenous infusion set. The rigid endoscope is introduced into the catheter through the urine draining port. When the lens gets smudged with blood or mucus, the irrigating saline in the syringe is forced through the inflating port.

Results

A clear vision was restored immediately on flushing the syringe. The system did not compromise the operative space or hinder manoeuvrability.

Conclusion

This cost-effective, innovative lens irrigation system saves the time spent in cleaning the lens and enhances operational efficiency, especially in a low-income setting.
The “most revolutionary” banner in British trade union history? Political identities and the birth, life, purgatory, and rebirth of the “red” Follonsby miners’ banner
Authors: Mates Lewis
Published: November 2021

The history and iconography of trade union banners has been surprisingly under-explored since it was first taken seriously as a subject of study in the early 1970s. The nostalgia evident in these early accounts for an age that seemed to contemporaries then to be fleeting seems particularly incongruous given the more recent reinvigoration of the trade union demonstration. This article seeks to redress the balance by focusing on the Follonsby miners’ lodge banner. First unveiled in 1928, in a pit village on the northern edge of Durham coalfield in northeast England, the Follonsby miners’ banner was later hailed as a foremost candidate for the most revolutionary trade union banner in British history. This unsubstantiated claim is important in itself, as mass trade unionism in Britain is characterized by moderation and a reluctance to engage in radical politics; an observation that broadly stands for the influential British coal miners’ unions and, more specifically, for the miners of the Durham coalfield itself.

The article's argument has both narrow and broad dimensions. Narrowly, it argues that the Follonsby banner has a strong claim to be regarded as the most revolutionary in Britain, albeit with “revolutionary” understood in certain theoretical and context-specific ways. The broader argument develops the claim that the iconography of the Follonsby banner is more significant for what the process of interrogating its “revolutionary” credentials reveals about the complexities of the political culture of the mainstream British Left in the twentieth century and after. In this broader respect, the Follonsby banner—iconography, birth, life, purgatory, and rebirth—is more important for its curious representatives rather than its individuated existence as an “extreme revolutionary” outlier.
Tropical Cyclone Outer Size Impacts the Number and Location of Tornadoes
Authors: Paredes Marco , Schenkel Benjamin A. , Edwards Roger , Coniglio Michael
Published: November 2021

There remains no consensus on whether the outer size of the tropical cyclone (TC) wind field impacts tornado occurrence. This study statistically examines the relationship between TC outer size with both the number and location of tornadoes using multidecadal tornado reports, a reanalysis‐derived TC outer size metric, and radiosonde data. These results show that larger TC spawn tornadoes that are located farther from and over a broader region relative to the cyclone center, although these changes do not entirely scale with TC outer size. Larger TCs are also associated with more frequent occurrence of tornadoes per 6 h, especially enhanced numbers of tornadoes. These changes in tornado occurrence in larger TCs may be due to a broadening of favorable helicity for tornadoes in the downshear sector, which may be partially offset by CAPE reductions in the left‐of‐shear quadrants.
Global Effects of a Polar Solar Eclipse on the Coupled Magnetosphere‐Ionosphere System
Authors: Chen Xuetao , Dang Tong , Zhang Binzheng , Lotko William , Pham Kevin , Wang Wenbin , Lin Dong , Sorathia Kareem , Merkin Viacheslav , Luan Xiaoli , Dou Xiankang , Luo Bingxian , Lei Jiuhou
Published: November 2021

It is well‐known that solar eclipses can significantly impact the ionosphere and thermosphere, but how an eclipse influences the magnetosphere‐ionosphere system is still unknown. Using a coupled magnetosphere‐ionosphere‐thermosphere model, we examined the impact on geospace of the northern polar‐region eclipse that occurred on June 10, 2021. The simulations reveal that the eclipse‐induced reduction in polar ionospheric conductivity causes large changes in field‐aligned current, cross‐polar cap potential and auroral activity. While such effects are expected in the northern hemisphere where solar obscuration occurred, they also occurred in the southern hemisphere through electrodynamic coupling. Eclipse‐induced changes in monoenergetic auroral precipitation differ significantly between the northern hemisphere and southern hemisphere while diffuse auroral precipitation is interhemispherically symmetric. This study demonstrates that the geospace response to a polar‐region solar eclipse is not limited just to the eclipse region but has global implications.