bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of an External Urinary Collection Device on Catheter Associated Urinary Tract Infections in Hospitalized Women
Authors: Rearigh Lindsey , Rupp Mark , Schooneveld Trevor Craig Van , Gillett Gayle , Sy Adrienne , Evans Luana , Goetschkes Kelly , Micheels Terry , Lyden Elizabeth
Published: November 2020

Background: Catheter-associated urinary tract infections (CAUTIs) are a common hospital-acquired infection (HAI) resulting in excess morbidity, mortality, and cost. Urine management can be a challenging issue, particularly in women, due to limited options for control of urinary incontinence. Issues with urinary leakage and worry for subsequent skin break down often leads to indwelling catheter insertion. In the spring of 2018, our facility implemented a female external urine collection device (EUCD) in efforts to decrease catheter days and to limit CAUTIs. Methods: Retrospective, 32-month (January 2017–August 2019), quasi-experimental, before-and-after study. Catheter use and CAUTI were defined according to CDC NHSN criteria. Poisson regression was used to model the rate of CAUTI (per 1,000 patient days [PD] and per 1,000 catheter days [CD]) comparing the 14 months prior to EUCD introduction with the 14 months after introduction and allowing a 3-month introduction period. Results: The CAUTI rate did not change significantly. The overall CAUTI rate per 1,000 PD decreased slightly from 0.24 to 0.20 (P = 0.44; model risk, 0.86; 95% CI, 0.58–1.26) whereas the rate per 1,000 CD increased slightly 1.5 to 1.6 (P = 0.76; model risk, 1.06; 95% CI, 0.73-–1.56). The CAUTI rate for men increased from 0.09 to 0.11 per 1,000 PD (P = 0.42; model risk, 1.29) and from 0.99 to 1.55 per 1,000 CD (P = 0.17; model risk, 1.56). For women, the rate of CAUTI decreased from 0.15 to 0.09 per 1,000 PD (P = 0.10; model risk, 0.61) and from 2.12 to 1.65 per 1,000 CD (P = 0.38; model risk, 0.38). A significant decrease in catheter days (CD per 1,000 PD; P < .0001) was observed for all hospitalized patients (from 158.56 to 128.3; model risk, 0.81), for men (from 87.06 to 72.15; model risk, 0.83), and for women (from 71.49 to 56.15; model risk, 0.79). Of 2,347 adverse events, 5 (0.2%) involved perineal skin breakdown and redness. Three events were related to malposition of the ECUD or inappropriate level of suction and 1 event was related to latex allergy and EUCD use. Conclusions: The introduction of a EUCD for women was associated with a significant decrease in indwelling catheter usage. A trend toward a decrease in CAUTI per 1,000 PD for women was observed (P = .10). Additional studies on whether the EUCD is associated with changes in UTI rates (both CAUTIs and noncatheter UTIs) as well as cost implications of EUCD are warranted.

Funding: None

Disclosures: None
Enhancing Employee Influenza Immunization in a Tertiary-Care Healthcare Setting in the Middle East Using Epic Express Lane Workflow
Authors: Cardona Lyssette , Mohammed Shafii , Federico Aileen
Published: November 2020

Background: Influenza virus illness affects millions. The virus’s ability to change yearly and its dependence on private manufacturing leads to major challenges immunizing populations. Currently the United States expects to distribute close to 162–168 million doses of influenza vaccine to the market (CDC, October 25, 2019) to immunize the population for the 2019–2020 season. In line with international best practice, our healthcare facility mandated the seasonal influenza vaccine for all employees. We set out to introduce a novel nursing workflow to enhance our Flu Campaign utilizing our Epic Systems healthcare software. Methods: The Epic Flu Express Lane function boosts provider satisfaction and efficiency by minimizing documentation time. Nurses can document the entire flu visit on a single screen with a few clicks. Workflow: An employee presents at the flu station registration desk and a scheduler creates an appointment as a Flu Visit type. After a nurse opens the chart, the system determines whether a Flu Express Lane order is a fit for the visit, launching the Express Lane activity. The nurse updates all relevant information and finally drops in the administration charge associated with the appropriate diagnosis code for the vaccine, to sign into the Express Lane. Establishment of dedicated and mobile employee flu stations: Immunizations are provided at several stations located inside the hospital and alternate sites, including the our cafeteria. Additionally, the flu team extended immunizations off site at our administrative building and an unoccupied inpatient floor, giving hospital employees easier access. Integration of Epic and human capital resource planning systems: By integrating the Epic and Mawared Human Capital systems, the flu team developed an automated workflow to capture employee compliance. A daily extract from Epic is imported to Mawared updating employee compliance status to completed. For those with incomplete status, Mawared sends an automated notification via e-mail reminding employees to complete the flu vaccination process for the season. Results: The Epic Nursing Express Lane workflow was well received, it facilitated compliance and practice efficiency for all mobile services provided. We achieved our target to provide influenza vaccination to >95% of employees in 2019 (Fig. 2). Conclusions: The electronic health record Epic Flu Express Lane workflow is an effective tool to complement practice efficiency and to facilitate a successful mobile Flu Campaign compliance in healthcare facilities.

Funding: None

Disclosures: None
Evaluating the Cost-Effectiveness of Proposed Algorithms for C. difficile Infection in Different Pretest Probability Settings
Authors: Ben Mirian Dal , Oliveira Maura , Cappellano Paola , Sampaio Jorge , Dias Maria Beatriz
Published: November 2020

Background: The use of real-time polymerase chain reaction (RT-PCR) as a first-line test for the diagnosis of Clostridioides difficile may result in overdiagnosis and overtreatment because the test is not capable of distinguishing infection from carriage. Toxin EIA assays have impeditive low sensitivity. Some algorithms using enzyme immunoassay for glutamate dehydrogenase (GDH) antigen and toxins A and B as the first step have been proposed to increase diagnostic performance. However, cost-effectiveness of different diagnostic algorithms would depend on the cost of each test and on the pretest probability in different settings. The objective of the present study was to evaluate the cost-effectiveness of 2 algorithms proposed by current guidelines to diagnose C. difficile infection by developing a mathematical model that would take into account the epidemiology and costs in our hospital. Methods: The study was conducted in a 480-bed tertiary-care teaching hospital in So Paulo, Brazil. All suspected C. difficile infection cases from January to December of 2017 were evaluated for pretest probability analysis. All stools collected from patients with a requested PCR test for suspected C. difficile infection were selected for additional testing to measure the specificity and sensitivity of each different test: C. diff GDH/Toxin A/B combined test, Toxin A/B Microplate Assay, GDH, and PCR. Toxigenic stool culture for C. difficile was considered the gold standard. A mathematical model was developed and simulations were done. The outcomes evaluated were: final annual costs with diagnostic tests in US dollars and number of patients receiving a false-positive or a false-negative diagnosis in a year simulation. Results: In total, 1,441 stool samples were tested by PCR for C. difficile in our institution from January 2017 to December 2017. Overall, 206 had a positive result, with a pretest probability of 14.3%. In our simulations, the PCR-based algorithm had an annual cost of US$279,914.25, with 4 false-negative results and 8 false-positive results. The implementation of a GDH/Toxin/PCR stepwise algorithm would have reduced the annual cost to US$160,488.75, with 6 false-negative results and 1 false-positive result. Simulations of annual cost and performance of the 2 algorithms have shown that the stepwise algorithm would still be advantageous in settings with higher pretest probabilities (Fig. 1). Conclusions: A stepwise algorithm based on GDH/Toxin before PCR seems to be more cost-effective, even in settings with higher pretest probabilities.

Funding: None

Disclosures: None
Evaluation of Environmental Decontamination of Surfaces Using Continuous Application of Low-Level Hydrogen Peroxide
Authors: Garcia Robert
Published: November 2020

Background: Pathogens that remain on healthcare surfaces after standard cleaning have been reported to cause 10%–30% of all healthcare-associated infections among admitted patients. The study reported here evaluated the effect of a continuous application of low-level gaseous hydrogen peroxide (H2O2) on microbial surface contamination in a pulmonary specialty unit (PSU) of a large magnet-designated urban hospital. Methods: A baseline surface contamination level was measured by obtaining cultures of 5 high-touch points in 8 patient rooms, a nurse’s station, and a nurse’s charting room to determine the bacterial and fungal microbial burden levels (period 1). No revisions to cleaning practices were made during any period. Also, 8 continuous decontamination devices were installed in the HVAC near the area to be treated. The devices convert humidified air into predominately H2O2, which then exited the ducts, covering all surfaces. Environmental sampling was conducted every 4 weeks for 4 months after activation to measure the effects on the intrinsic microbial burden on surfaces as well as the incidence of MRSA and VRE (periods 2–5). In addition, the unit manager tracked the level of absenteeism of employees in the PCU during the trial to compare results to the same 4-month period from the prior year. Results: In concert with regular cleaning and disinfecting practices, the average bacterial microbial burden levels found on 52 locations prior to the activation of the devices were 6,446 CFU/1002. Incidence of MRSA and VRE were 31% and 10%, respectively. During the intervention, the levels of both bacterial and fungal microbial burden on surfaces were significantly lower, as was the incidence of MRSA and VRE. The continuous application of low-levels of oxidizing molecules exerted a significant 78% and 97% reduction in the average bacterial and fungal microbial burden found on PSU surfaces (1,415 CFU/100 2 and 328 CFU/1002 for bacteria and fungi, respectively). The incidences of MRSA and VRE on surfaces were reduced by 63% and 70%, respectively. In addition, the unit manager reported a significant decline in absenteeism, with a reduction of 550 hours (1,313 vs 752) during the 4-month trial versus the same 4-month period the previous year. Conclusions: The introduction of continuous low-level gaseous H2O2 on all surfaces throughout a PSU reduced the overall bacterial and fungal microbial burden as well as lowered the incidence of both MRSA and VRE on surfaces, and it reduced employee absenteeism, providing a potentially safer environment for patients, staff, and visitors.

Funding: None

Disclosures: None
Evaluation of Sampling Methods for Detection of Pathogens from Steel Surfaces; Contact Plates, Foam Swabs, and Flocked Swabs
Authors: West Rolieria , Rose Laura , Noble-Wang Judith
Published: November 2020

Background: Contaminated healthcare surfaces can serve as reservoirs for the transmission of pathogens. Sensitive sampling methods are needed to investigate sources of pathogens for implementing effective disinfection strategies and thereby preventing environmental transmission. Conventional approaches employ swabs to sample environmental surfaces. Contact plates represent an alternative approach for sampling healthcare surfaces that does not require lab processing, though little is known about their performance. A contact plate is an agar plate that is overfilled with selective or nonselective media. It can be gently applied to the surface, then simply incubated at a temperature optimal for target organism (s), thus saving time and resources. Methods: In this study, contact plates containing trypticase soy agar with 5% sheep blood (TSAII), foam swabs, and flocked swabs were evaluated for their ability to recover 4 pathogens that persist on healthcare surfaces. Stainless-steel coupons (4 in2) were inoculated with the following pathogens (102 CFU): Acinetobacter baumannii (AB, strain type 12), carbapenemase-producing KPC+ Klebsiella pneumoniae (KP; ATCC BAA-1705); methicillin-resistant Staphylococcus aureus (MRSA; ATCC 43300); and vancomycin-resistant Enterococcus faecalis (VRE; Van A + 256). The plates were allowed to dry 1 hour. Sampling with CPs was performed in 2 ways; (1) a single contact plate was used to sample 1 stainless-steel surface and (2) a composite was collected by 3 sequential contact-plate samplings of the same stainless-steel surface. The contact plates were then incubated at 351C. Foam and flocked swabs were premoistened with phosphate-buffered saline + 0.02% polysorbate 80 (PBST) and were used to sample the stainless-steel coupons. Swabs were held for 1 hour and processed by sonication and vortexing in 5 mL of PBST, then the eluent was cultured and CFU counted. Mean percentage recoveries (%R) relative to the inoculum were calculated and compared. Results: When the %R for all 4 pathogens were pooled, the composite contact-plate sampling method yielded the highest, (P < .05) (66.0%; SD, 0.22), followed by the single contact plate method (39.7%; SD, 0.12), foam swab (32.9%; SD, 0.18), and flocked swab (20.3%; SD, 0.20). The composite contact plate method yielded the highest %R for VRE (102.1 %; SD, 0.17), and the lowest %R was observed when using flocked swabs to recover KP (6.3%; SD, 0.05). Conclusions: The contact-plate composite method may provide investigators with minimal environmental microbiology capacity an alternative method for environmental sampling and detection of organisms from surface areas (4 in 2) with low bioburden.

Funding: None

Disclosures: None
Evolution of Healthcare-Associated Infections and Antibiotic Resistance Programs in US Health Departments, 2009–2018
Authors: Ashley Michael , Gumbis Stephanie , Hunter Jennifer C. , Perz Joseph
Published: November 2020

Background: Domestically, the integration of public health into healthcare-associated infection (HAI) and antibiotic resistance (AR) prevention activities represents a major development. We describe CDC Funding: of public health HAI/AR programs through the Epidemiology and Laboratory Capacity (ELC) cooperative agreement to improve local capacity to prevent HAIs and detect and contain the spread of AR threats. Methods: We reviewed ELC budget reports and program documents to summarize the evolution of funded activities and programs from 2009 to 2018. Results: In 2009, 51 programs (49 states, 2 cities and territories) received US$35.8 million through the American Recovery and Reinvestment Act for an initial 28-month period. These funds supported each jurisdiction to establish an HAI coordinator and a multidisciplinary HAI advisory group, coordinate and report HAI prevention efforts, conduct surveillance and report HAI data, and maintain an HAI plan; ~27 programs were also funded to coordinate multicenter HAI prevention collaboratives among acute-care hospitals. Through 2011, 188 state or local HAI/AR program positions were at least partially funded by the CDC. From 2011 to 2015, investments from the Affordable Care Act (~US$10–11 million annually) were used to maintain the HAI/AR programs, with some expansion of program goals related to non–acute-care settings and antibiotic stewardship. In 2015, following the Ebola outbreak in West Africa, supplemental ELC funds were awarded to 61 programs (50 states, 11 cities and territories) totaling US$85 million over 36 months. These awards marked an expansion of HAI/AR program activities to develop healthcare provider inventories, to conduct data-driven education and training, and to perform onsite infection control assessments in healthcare facilities. In 2016, through its AR Solutions Initiative, CDC invested US$57.3 million in Funding: to 57 programs (50 states, 7 cities and territories), expanding laboratory capacities for AR threat detection (via the AR Laboratory Network) and epidemiologic activities to rapidly contain novel and targeted multidrug-resistant organisms. As of 2018, >500 state or local HAI/AR program positions were at least partially funded by the CDC. Conclusions: State and local HAI/AR programs have grown substantially over the 10 years of their existence, as reflected in major increases in funding, staffing, scope, and partnerships. CDC investments and guidance have supported the development of HAI/AR epidemiology prevention and response capacity.

Funding: None

Disclosures: None
Finding The Source Of Bacterial Sepsis And Its Impact On Sepsis Related Outcome, The Bundle That Fumble
Authors: Garg Rahul , shaw Tushar , K.E Vandana , Mukhopadhyay Chiranjay
Published: November 2020

Background: Sepsis is currently one of the important global health issues due to its complexity from pathophysiologic, clinical, and therapeutic viewpoints. Most sepsis-related studies are from the West, where all the patients were grouped together failing to identify specific patient populations that may actually benefit from a particular intervention. We investigated the characteristics and impact of the source of infection on sepsis-related ICU outcomes among critically ill adult patients Methods: A prospective ICU based observational study was conducted over 15 months in a tertiary-care hospital in southern India. Our study included all critically ill patients (18 years old) who were admitted either with existing a new episode of sepsis with suspected or documented bacterial infections within 24 hours of ICU admission with SOFA score 2. Basic demographics, the clinical presentation with the anatomical site of infection and outcome were noted. Categorical variables were compared using the 2 test, and continuous variables were compared using 1-way analysis of variance (ANOVA). Cox regression was used to determine the effect of sepsis source on 28-day mortality. Results: Among the 4,548 patients screened during the study period, 400 were recruited, with a mean age of 55.716 years, among whom 276 (61%) were men. The mean SOFA score at admission was 9.92.7. Bacteremia was observed among 99 cases (24.8%), predominantly gram-negative sepsis (65 of 99, 65.6%). The source for blood culture positivity was determined in 48 of 99 cases (48.4%). Successful isolation of the bacteria was achieved from other anatomical sites in 115 patients (37.8%) where blood culture remained negative. The most common source of sepsis was lung (67 of 400, 16.7%) followed by skin and soft-tissue infection (56 of 400, 14%). Patients treated with steroids were more prone to develop a respiratory infection (P = .001), whereas renal impairment was correlated with urinary tract infection (P = .001). Patients with respiratory infections had a longer ICU stay (P < .001). The overall in-hospital mortality was 37.2%. Multivariable Cox regression showed patients with genitourinary infection (HR, 2.23; P = .04) and implantable devices (HR, 11.30; P = .17) were at higher risk of death. Conclusions: Site-specific infection was a significant predictor of mortality in our study. These factors should be taken into consideration and warrant further evaluation to understand their specific roles in adverse outcomes among a cohort of patients diagnosed with sepsis.

Funding: None

Disclosures: None
Hand Hygiene In and Out: Compliance and Sustainability Are Possible: 90/90 Program in a Mexican Tertiary-Care Center
Authors: González Roxana Trejo , Salcido Miguel Ángel García , Antunez Diana Palami , Handal Reyna Yacaman
Published: November 2020

Background: The American British Cowdray Medical Center I.A.P., also known as ABC Medical Center, is a highly specialized hospital and private assistance institution located in Mexico City. The ABC Medical Center implemented hand hygiene policies since around 2009, when Mexico committed to patient security. However, hand hygiene compliance remained low. Methods: The objective of the Hand Hygiene 90/90 program was to increase hand hygiene compliance through an integral strategy including a multidisciplinary team with leaders from different areas (nursing, physicians, human resources, quality, and educators). It was named 90/90 because it aimed to accomplish a 90% hand hygiene compliance among all health providers and hospital staff in 90 days (October 1–December 29) upon entering and exiting patient rooms (ie, In & Out). The Hand Hygiene 90/90 program led by the epidemiology area consisted of 5 specific components: management, supplies, education, monitoring, and social marketing (Fig. 1). For a period of 90 days, several permanent actions were implemented; they had a positive influence on the expected outcome (Fig. 2). Results: The starting point at the ABC Medical Center upon launching the program was 70% compliance. With the Hand Hygiene 90/90 program, the first steady change was observed at the end of November 2012 (ie, the sixth measurement point). An 88% compliance was achieved, all compliance was >50% from this point on. The highest compliance was achieved among health providers (doctors and nurses), followed by administrative staff. At the end of December 2012, 91% compliance was achieved by all health providers and hospital staff. Sustainability has been possible over the years through ongoing hand hygiene campaigns. In the 5 years following the implementation of the program, hand hygiene compliance remained mostly below the 90% standard (Fig. 3). Conclusions: An intervention for continuous improvement and hand hygiene compliance using the WHO 5 Moments was implemented throughout 2018, (in addition to the In & Out program). This intervention also incorporated elements of the WHO Multimodal Strategy 1 to develop a comprehensive hand hygiene program together with new indicators. The ABC Medical Center, with the support and leadership of the Ministry of Health, aims to become an example of institutions that achieve national and international benchmarks in the implementation of patient safety programs that are not only successful but also sustainable.

Funding: None

Disclosures: None
Hand Hygiene in Acute Care Hospitals—Evaluation of 12 Years National Hand Hygiene Campaign in Germany
Authors: Kramer Tobias , Bunte Karin , Walter Janine , Schroeder Christin , Behnke Michael , Gastmeier Petra
Published: November 2020

Background: Hand hygiene is one of the most effective measures to prevent healthcare-associated infections and transmission of multidrug-resistant organisms in healthcare settings. The WHO proposes a multimodal intervention strategy to improve hand hygiene in healthcare settings. In 2008, a voluntary national campaign for hand hygiene was implemented in the German healthcare system. The objective of this study was to evaluate participation, practices, and performance of hand hygiene in German acute-care hospitals. Methods: In 2008 a national hand hygiene campaign began in Germany. Based on voluntary participation, the campaign’s goal was to implement the WHO 5 Moments model, to establish a national surveillance system for compliance to hand hygiene, to improve availability of alcohol-based hand-rub (ABHR) dispensers at points of care, and to implement interdisciplinary executive boards at each hospital to ensure sustainable implementation. Annual data on ABHR consumption and patient days (PD) were collected within the national surveillance system (HAND-KISS) on the individual ward level and were validated. Direct observation of compliance was performed according the recommendations of the WHO. Results: Overall, 1,047 of 1,942 acute-care hospitals in Germany participated in the national hand hygiene campaign in 2018, covering 81,571,917 patient days. Moreover, 9,360 regular wards (RWs), 338 intermediate care units (IMCs) and 1,342 intensive care units (ICUs) provided data on ABHR consumption. Between 2007 and 2018 in the ICU, ABHR consumption increased continuously from 70 mL/PD (IQR, 52–98) to 129 mL/PD (IQR, 102–162). In intermediate care units, ABHR consumption increased from 40 mL/PD (IQR, 15–54) to 67 mL/PD (IQR, 46–95), and on regular wards, ABHR consumption increased from 14 mL/PD (IQR, 10–21) to 29 mL/PD (IQR, 22–39). These increases were especially pronounced in wards that continuously provided annual data for ABHR consumption over the past 12 years. In 2014, electronic documentation for direct observation of compliance to hand hygiene was established. From 2014 until 2018, 1,598,209 opportunities were observed on 1,907 wards of 422 hospitals. The median directly observed compliance in 2018 was 76% (IQR, 66%–84%). Median compliance to the 5 Moments was 71% (IQR, 57%–82%) before touching a patient, 68% (IQR, 51%–85%) before clean or aseptic procedures, 83% (IQR, 72%–92%) after body fluid exposure or risk, 84% (IQR, 75%–90%) after touching a patient, and 74% (IQR, 61%–84%) after touching patient surroundings. Conclusions: The WHO multimodal intervention strategy has been successfully established in German acute-care hospitals. A surveillance system for ABHR consumption and direct observation of compliance to hand hygiene are widely used by hospitals in Germany. Hand hygiene practices have significantly improved in the German healthcare system.

Funding: None

Disclosures: None
Health Department Authorities to Assist Healthcare Facilities with Outbreaks or High HAI Rates—Preliminary Assessment, 2018
Authors: Shrivastwa Nijika , Perz Joseph , Hunter Jennifer C.
Published: November 2020

Background: Health departments have been increasingly called upon to monitor healthcare associated-infections (HAIs) at the hospital- or facility-level and provide targeted assistance when high rates are identified. Health department capacity to effectively respond to these types of signals depends not only on technical expertise but also the legal and regulatory authority to intervene. Methods: We reviewed annual reports describing HAI and antibiotic resistance (HAI/AR) activities from CDC-funded HAI/AR programs for August 2017 through July 2018. We performed a qualitative data analysis on all 50 state health department responses to a question about their regulatory and legal authority to intervene or assist facilities without invitation when outbreaks are suspected (as determined by the health department) or high HAI rates have been identified (eg, based on NHSN data). Results: When an outbreak is identified, 31 health departments (62%) indicated that they have the authority to intervene without invitation from a facility and 8 (16%) did not specify. Among the 11 health departments (22%) that indicated that they do not have this authority, 5 (45%) states noted that they operate under decentralized systems in which the local health department can intervene in outbreak situations and the state health department is available to assist. When a health department identifies high HAI rates, 14 health departments (28%) indicated that they have the authority to intervene without invitation, 22 (44%) indicated that they do not, and 14 (28%) did not specify. Among those in the latter categories, 3 stated they can work through their local health departments, which do have this authority and 8 described working through partners (eg, State Hospital Association, n = 3 or State Healthcare Licensing Agency, n = 5). Discussion: Assistance from state health departments (eg, HAI/AR programs) in the context of outbreaks and high HAI rates has value that is usually well recognized and welcomed by healthcare facilities. Nonetheless, there are occasions when a health department might need to exert its authority to intervene. The preliminary analysis described here indicated that this authority was more commonly self-reported in the context of outbreaks than when high HAI rates are identified. These 2 situations are connected, as high rates might be indicative of unrecognized or unreported outbreak activity, and these issues may benefit from further analysis.

Funding: None

Disclosures: None
How to Convince People and Get Adherence to Hand Hygiene Practices? The Success of Ozires, the Humanoid Robot!
Authors: Couto Braulio , Machado Amanda , Barbosa Ana Clara , Mendes Bruna , Nogueira Maria da Glória , Peixoto Maria Luiza , Alvim André , Romaniello Jeruza , Alves Adriana , Batista Bruno , Covello Luciana , Starling Carlos
Published: November 2020

Background: Our team has been fighting nosocomial infections since 1991. During our journey, we often ask why people do not wash their hands! Semmelweiss discovered in the 1840s that handwashing prevented deaths from puerperal sepsis, but we still need to convince healthcare workers about hand hygiene. One answer is that washing hands is an unsophisticated gesture, without any technology, so people just do not do it. How can we improve compliance with hand hygiene? We imagined a robot in our team to remind people to wash their hands. Then, in 2016 we met Meccanoid, a US$200 toy robot: a 4-foot-tall programmable humanoid robot with voice recognition capabilities. We made adaptions in the robot (mini-projector + audio amplifier + alcohol dispenser + spy camera), and we gave him a name (Ozires) and a purpose: He became a professor who teaches healthcare workers how, when, and why wash their hands! Here, we describe the multimodal strategy centered around Ozires. Methods: The multimodal strategy consists of 7 key elements: (1) the robot, accompanied by a infection control practitioner, performs audio and video lectures about hand hygiene techniques, motivational videos, data feedback; (2) the robot’s wood copies with sound alert with motion detector for hand hygiene are spread out in the whole hospital; (3) fridge magnet with robot prints (gifts for patients and healthcare professionals); (4) app for hand hygiene monitoring (Hands Clean); (5) adherence rates by professional category and individual feedback; (6) patient empowerment for hand hygiene; and (7) sound alert for hand hygiene in the patient room’s door. Results: After the insertion of Ozires in 3 ICUs of hospital A (pilot study), the hand hygiene (HH) rate increased from ~36%, between January and July 2016, to ~68% between August 2016 and October 2019. At hospital B, Ozires started his lectures in May 2018, throughout the hospital. Hand hygiene adherence increased from 23% between July and December 2017 to 60% between June 2018 and October 2019. In the 3 months before this multimodal strategy was implemented in hospital C (June–August 2019), and the mean rate of hand hygiene was 65%. With the robot, the hand hygiene rate increased to 94% (September–October 2019). Conclusions: The multimodal strategy centered around the robot Ozires works! Hand hygiene compliance increased significantly after the interventions. People listen the robot much more attentively than to their human colleagues, and healthcare worker behavior changed! We need to go further improve the program, but it is sustainable. Finally, we succeeded in convincing people to improve their hand hygiene practices.

Funding: None

Disclosures: None
Identification of Colonized Patients During an Outbreak of Candida auris Using a Regional Health Information Exchange
Authors: Brooks Richard , Vaeth Elisabeth , Saunders Heather , Blood Tim , Grace Brittany , Blythe David , Klein Liore , Reuben Jacqueline , Trappler Regan , Iyengar Preetha , Blake Emily , Lineberger Sarah , Abdelfattah Rehab , Tully Kathleen , Forsberg Kaitlin , Walters Maroya , Vallabhaneni Snigdha
Published: November 2020

Background: In June 2019, the Maryland Department of Health (MDH) was notified of a hospitalized patient with Candida auris bloodstream infection. The MDH initiated a contact investigation to identify additional patients with C. auris colonization. Many of the contacts had been discharged home from the hospital and were therefore not available for screening. Healthcare facilities in Maryland, Virginia, and Washington, DC, submit patient data to a regional health information exchange (HIE) called the Chesapeake Regional Information System for our Patients (CRISP). CRISP includes a notification system that alerts providers when flagged patients have healthcare encounters. We aimed to use this system to identify discharged C. auris contacts on their next inpatient encounter to rapidly screen them and to detect new cases. Methods:C. auris contacts were defined as patients located on an inpatient unit on the same day, receiving wound care from the same team, or having a procedure in the same operating room on the same day as the index patient or any patients subsequently identified as having C. auris infection or colonization detected either during the normal course of clinical care or through screening. Contacts who remained hospitalized were screened during inpatient point prevalence surveys (PPSs). Contacts discharged to postacute-care facilities were screened by facility staff. Contacts who had been discharged home were flagged in CRISP, and MDH staff received CRISP encounter alerts when these patients were readmitted. MDH staff then contacted the admitting facilities to recommend screening for C. auris. Axilla and groin swabs were collected and tested by rt-PCR at the Mid-Atlantic Regional Antibiotic Resistance Laboratory Network laboratory. Results: As of October 8, 2019, 4,017 contacts were identified. Among these, 936 (23%) contacts at 56 healthcare facilities (33 acute-care hospitals and 23 postacute-care facilities) were screened for C. auris, and 10 patients with C. auris colonization were identified (1.1% of contacts who underwent C. auris screening). Of these, 6 (60%) were identified through CRISP notification and 4 (40%) were identified by PPSs conducted in acute-care hospitals. Conclusions: In this ongoing C. auris outbreak, a large proportion of colonized patients was identified using an electronic encounter notification system within a regional HIE. This approach was effective for identifying opportunities to screen contacts at their next healthcare encounter and can augment other means of case detection, like PPSs. HIEs should incorporate mechanisms to facilitate contact tracing for public health investigations.

Funding: None

Disclosures: None
Impact of NHSN-CDC Mucosal Barrier Injury Surveillance on Central-Line–Associated Bloodstream Infection Rates in HSCT
Authors: Fagnani Renata , Cardoso Luis Gustavo Oliveira , Höfling Christian Cruz , Mendes Elisa Teixeira , Trabasso nio , Moretti Maria Luíza
Published: November 2020

Background: Bloodstream infection (BSI) is the most challenging conditions in patients who undergo hematopoietic stem cell transplantation (HSCT). These infections may be related to health care in cases of central-line–associated bloodstream infection (CLABSI) or to translocation secondary to mucosal barrier injury (MBI). In 2013, MBI surveillance was incorporated into the CDC NHSN. The aim was to increase the CLABSI diagnostic accuracy by proposing more effective preventive care measures. The objective of this study was to evaluate impact of the MBI surveillance on CLABSI incidence density in a Brazilian university hospital. Methods: The CLABSI incidence densities from the period before BMI surveillance (2007–2012) and the period after BMI surveillance was implemented (2013–2018) were analyzed and compared. Infections during the preintervention period were reclassified according to the MBI criterion to obtain an accurate CLABSI rate for the first period. The average incidence densities for the 2 periods were compared using the Student t test after testing for no autocorrelation (P > .05). Results: After reclassification, the preintervention period incidence density (10 infections per 1,000 patient days) was significantly higher than the postintervention period incidence density (6 infections per 1,000 patients day; P = .011) (Table 1). Therefore, the reclassification of nonpreventable infections (MBI) in the surveillance system made the diagnosis of CLABSI more specific. The hospital infection control service was able to introduce specific preventive measures related to the insertion and management of central lines in HSCT patient care. Conclusions: The MBI classification improved the CLABSI diagnosis, which upgraded central-line prevention measures, then contributed to the decrease of CLABSI rates in this high-risk population.

Funding: None

Disclosures: None
Impact of Screening for Methicillin-Resistant Staphylococcus aureus (MRSA) in Pneumonia on Vancomycin Utilization
Authors: Crotty Matthew , Weltman Natalie , Pribble Joslyn , Wilson Marie
Published: November 2020

Background: Methicillin-Resistant Staphylococcus aureus (MRSA) is frequently targeted with empiric treatment for pneumonia in the hospital. Obtaining quality lower respiratory tract cultures to promote appropriate de-escalation can be difficult or impractical. Nasal screening for MRSA has a high negative predictive value for MRSA pneumonia and can be an effective tool for early de-escalation. Methods: A pharmacist-driven process for nasopharyngeal MRSA screening of patients prescribed intravenous vancomycin was implemented in October 2018. Vancomycin utilization was extracted from the electronic medical record (EMR) and summarized as days of therapy per 1,000 patient days (DOT/1,000 PD). Vancomycin utilization data for the 6 months following process implementation (November 2018–April 2019) were compared to the same period from the previous year (November 2017–April 2018). Specific patient outcomes data were manually collected for patients prescribed vancomycin for pneumonia during the first 2 months following process implementation (November–December 2018; postintervention group) and comparable months (November–December 2017; preintervention group). Data were analyzed using the 2 test (nominal data) and Mann–Whitney U test (continuous data). Results: Total vancomycin utilization decreased from a monthly average of 114 to 95 DOT/1,000 PD (17% reduction) and from 27 to 14 DOT/1,000 PD for pneumonia (48% reduction). In-patient mortality was unchanged following process implementation at 17.2% versus 17.5% in the pre- and postintervention groups, respectively. Other clinical outcomes were also similar between the pre- and postintervention groups (Table 1). Fewer vancomycin levels were obtained following implementation with 34.4% of patients (0.61 levels per patient) having a level obtained in the preintervention group compared to 21.6% (0.30 levels per patient; P .001) in the postintervention group. Conclusions: Nasopharyngeal MRSA screening of patients prescribed vancomycin for pneumonia is an effective antimicrobial stewardship strategy to reduce unnecessary use of anti-MRSA therapy without negatively impacting clinical outcomes.

Funding: None

Disclosures: None
Impact of Seasonality and Influenza Rates on Interventions to Reduce Hospital-Acquired Clostridioides difficile Rates
Authors: Leal Jenine , Faris Peter , Shen Ye , Bresee Lauren , Bush Kathryn , Chow Blanda , Dalton Bruce , Fletcher Jared , Hartman Sara , Kaufman Jaime , Kim Joseph , Kothandaraman Maitreyi , Kraft Scott , Lamont Nicole , Larios Oscar , Manns Braden , Missaghi Bayan , Ocampo Wrechelle , Poulin Paule , Sabuda Deana , Holroyd-Leduc Jayna , Louie Thomas , Conly John
Published: November 2020

Background: Hospital-acquired Clostridioides difficile infection (HA-CDI) rates are highly variable over time, posing problems for research assessing interventions that might improve rates. By understanding seasonality in HA-CDI rates and the impacts that other factors such as influenza admissions might have on these rates, we can account for them when establishing the relationship between interventions and infection rates. We assessed whether there were seasonal trends in HA-CDI and whether they could be accounted for by influenza rates. Methods: We assessed HA-CDI rates per 10,000 patient days, and the rate of hospitalized patients with influenza per 1,000 admissions in 4 acute-care facilities (n = 2,490 beds) in Calgary, Alberta, from January 2016 to December 2018. We used 4 statistical approaches in R (version 3.5.1 software): (1) autoregressive integrated moving average (ARIMA) to assess dependencies and trends in each of the monthly HA-CDI and influenza series; (2) cross correlation to assess dependencies between the HA-CDI and influenza series lagged over time; (3) Poisson harmonic regression models (with sine and cosine components) to assess the seasonality of the rates; and (4) Poisson regression to determine whether influenza rates accounted for seasonality in the HA-CDI rates. Results: Conventional ARIMA approaches did not detect seasonality in the HA-CDI rates, but we found strong seasonality in the influenza rates. A cross-correlation analysis revealed evidence of correlation between the series at a lag of zero (R = 0.41; 95% CI, 0.10–0.65) and provided an indication of a seasonal relationship between the series (Fig. 1). Poisson regression suggested that influenza rates predicted CDI rates (P < .01). Using harmonic regression, there was evidence of seasonality in HA-CDI rates (2 [2 df] = 6.62; P < .05) and influenza rates (2 [2 df] = 1,796.6; P < .001). In a Poisson model of HA-CDI rates with both the harmonic components and influenza admission rates, the harmonic components were no longer predictive of HA-CDI rates. Conclusions: Harmonic regression provided a sensitive means of identifying seasonality in HA-CDI rates, but the seasonality effect was accounted for by influenza admission rates. The relationship between HA-CDI and influenza rates is likely mediated by antibiotic prescriptions, which needs to be assessed. To improve precision and reduce bias, research on interventions to reduce HA-CDI rates should assess historic seasonality in HA-CDI rates and should account for influenza admissions.

Funding: None

Disclosures: None
Impact of the Revised Non–Culture-Based Methodology Criteria on Central-Line–Associated Bloodstream Infections
Authors: Suleyman Geehan , Chevalier Thomas , Murad Nisreen , Alangaden George
Published: November 2020

Background: The current NHSN guideline states that positive results from both blood cultures and non–culture-based testing (NCT) methodologies are to be used for central-line–associated bloodstream infection (CLABSI) surveillance determination. A positive NCT result in the absence of blood cultures or negative blood cultures in patients who meet CLABSI criteria is to be reported to NHSN. However, the reporting criteria for NCT changed starting January 1, 2020: If NCT is positive and the blood culture is negative 2 days before or 1 day after, the NCT result is not reported. If the NCT is positive with no blood culture within the 3-day window period, the NCT result is reported in patients who meet CLABSI criteria. We estimated the impact of the new NCT criteria on CLABSI numbers and rates compared to the previous definition. Methods: At our facility, the T2Candida Panel (T2), an NCT, was implemented for clinical use for the detection of early candidemia and invasive candidiasis. The T2 is a rapid molecular test performed directly on blood samples to detect DNA of 5 Candida spp: C. albicans/C. tropicalis, C. glabrata/C. krusei, and C. parapsilosis. In this retrospective study performed at an 877-bed teaching hospital in Detroit, we reviewed the impact of discordant T2 results (positive T2 with negative blood cultures) on CLABSI rates from January 1, 2017, to September 30, 2019, based on the current definition, and we applied the revised criteria to estimate the new CLABSI numbers and rates for the same period. Results: Of 343 positive T2 results, 202 (58.9%) were discordant and qualified for CLABSI determination during the study period. Of these, 109 (54%) met CLABSI criteria based on the current definition and 11 (5%) met CLABSI criteria using the new definition (proportional P < .001), resulting in an 89.9% reduction. The CLABSI rate per 1,000 central-line days, which includes discordant T2 results, based on the current and new NCT criteria, are listed in Table 1. Conclusions: In institutions that utilize NCT such as T2, application of the new 2020 NCT NHSN definition would significantly reduce the CLABSI number and have a significant impact on the CLABSI rates and standardized infection ratios (SIRs).

Funding: None

Disclosures: None
Implement Electronic Decision Support to Decrease Hospital-Onset Clostridium difficile Infections at Two Community Hospitals
Authors: Montero Maria , Giannopoulos Gina , Mikolajczak Anessa , Silkaitis Christina , Lewis Steven
Published: November 2020

Background: Literature supports appropriate testing as a key factor affecting the hospital-onset (HO) Clostridium difficile infections (CDI) standardized infection ratio (SIR). In 2016, facility A was a significant outlier in HO CDI with an SIR of 2.57. In 2017, facility B had a peak SIR of 1.9. Both SIRs were considerably higher than the Centers for Medicare and Medicaid Services (CMS) national SIR of 0.997. Methods: Hospital-onset CDIF cases from both hospitals were reviewed. Current electronic decision support in the electronic health record (EHR) was evaluated for CDI laboratory orders. Literature was reviewed for best practice of appropriate specimen collection and testing. Interventions were implemented at facility A in November 2016 and facility B in June 2018. Results: In total, 67 HO CDIF cases were reviewed from both facilities (October 2015–September 2016 for facility A and April 2017–June 2018 for facility B), and 46% were due to inappropriate testing. A CDI testing order set with decision support and best practice alerts was implemented based on national best-practice guidelines (Fig. 1). Physician and nurse education were completed on appropriate testing for CDI, including symptoms and timely specimen collection. Real-time review of appropriate testing was validated by the infection prevention team, and outliers were communicated to the ordering provider. After implementation, decreases in HO-CDIF SIRs occurred at both facilities (facility A SIR, 0.36; facility B SIR, 0.56). Both facilities have been able to sustain an SIR below the current CMS national average of 0.784. Conclusions: By implementing a sophisticated order-entry process that includes electronic decision support based on best practices, clinician education, and real-time feedback to providers, patients are appropriately tested for CDI. This intervention has allowed for appropriate classification within the NHSN and has decreased the overall HO-CDIF SIR.

Funding: None

Disclosures: None