bluuebunny/crossref_metadata_2025 huggingface dataset:
770. Impact of COVID-19 Pandemic on Central Line-associated Bloodstream Infections in Metropolitan Detroit
Authors: Suleyman Geehan , sturla Nicholas , Gudipati Smitha , Brar Indira , Mayur Ramesh
Published: December 2021

Background

Recent publications suggest that central line-associated bloodstream infection (CLABSI) rates have increased in US hospitals during the COVID-19 pandemic. The objective of this study was to evaluate the impact of COVID-19 pandemic on CLABSIs.

Methods

This was a retrospective cross-sectional study comparing CLABSI rate per 1,000 central line (CL) days, blood culture (BC) utilization rate per 1,000 CL days, CL utilization rate per 1,000 patient days, Standardized Infection Ratio (SIR) and Standardized Utilization Ratio (SUR) in the pre-COVID-19 period from January 1, 2019 to December 31, 2019 to the COVID-19 period from April 1, 2020 to March 31, 2021 at an 877-bed tertiary care hospital in Detroit, Michigan. CLABSI, and BC and CL utilization rate were extracted from the electronic medical record (Epic™ Bugsy). SIR and SUR data were extracted from National Healthcare Safety Network (NHSN).

Results

The average CLABSI rate per 1,000 CL days increased 24% from 1.66 to 2.06. Twenty percent of patients were hospitalized for COVID-19. The BC utilization rate per 1,000 CL days decreased from 0.43 to 0.32 with a 26% reduction. However, CL utilization increased by 28% from 0.25 to 0.32 (Figure 1). However, CLABSIs due to common commensals decreased from 13.8% to 10.9%. The SIR increased significantly from 1.055 to 1.795 (P-value 0.008), resulting in a 70% increase. The overall SUR also increased from 0.900 to 0.988 (P-value < 0.001). Figure 2 is a control chart of the CLABSI rate from July 2019 to April 2021.

Figure 1. CLABSI, blood culture utilization and central line utilization rates pre-and during COVID-19 pandemic

Figure 2. CLABSI control chart pre-and during COVID-19 pandemic

Conclusion

During the COVID-19 pandemic, there was a significant increase in CL utilization, CLABSI rate, SIR and SUR likely due to higher acuity in COVID-19 patients despite a decrease in BC orders.

Disclosures

All Authors: No reported disclosures
774. Outbreak of Central-Line-Associated Bloodstream Infections (CLABSI) amid the COVID-19 Pandemic Associated with Changes in Central Line Dressing Care Accompanying Changes in Nursing Education, Nursing Documentation, and Dressing Supply Kits
Authors: Azeem Ahad , Newquist Irene L , Royal Lesley L , Hemrick Kimberly S , Creech Zachary A , Patel Shiv A , Rajan Ajay K , Truong Gia Thinh D , Ahmad Faran , Bittner Marvin J
Published: December 2021

Background

National Healthcare Safety Network (NHSN) data have revealed an increase in CLABSI associated with the COVID-19 pandemic, but data on factors mediating the increase are limited. Our hospital had been free of CLABSI for 18 months, but we encountered an outbreak of 7 CLABSI over a 5-month period beginning in November 2020. This led to an investigation that revealed that some underlying issues were related to COVID-19.

Methods

Infection prevention staff at Omaha’s Veterans Affairs Medical Center interviewed hospital staff and performed a retrospective chart review of patients with CLABSI (based on the NHSN definition) amid the COVID-19 pandemic.

Results

The first case of CLABSI in the outbreak was detected in November 2020. Prior to that, there was no case of CLABSI since April 2019, as shown in the graph. Each case of CLABSI was associated with a different microorganism. Further investigation revealed deviations from our usual practices in central line dressing care. Our response to COVID-19 had included alterations in periodic competency training (including dressing care) for nursing staff as well as the rapid introduction of streamlined inpatient nursing documentation. Previously, dressing kits included chlorhexidine-impregnated dressings; in November, a kit without these dressings was introduced. A weekly audit of dressing care was begun in March 2021. No CLABSI was identified in April 2021.

Types of Microorganisms identified

Different types of microorganisms isolated during the CLABSI outbreak each month.

The trend of CLABSI in VA Nebraska-Western Iowa Health Care System

Conclusion

We encountered a CLABSI outbreak associated with deviations from usual central line dressing care. Using the concept of the Swiss cheese model of error prevention, we recognized alterations in three barriers: competency training; thorough documentation; and complete supply kits. The first two of these factors were directly related to our COVID-19 response. Our findings illustrate the relevance of the Swiss cheese model for maintaining a safe healthcare environment.

Disclosures

Marvin J. Bittner, MD, Merck (Advisor or Review Panel member)Sanofi Pasteur (Speaker's Bureau)
775. Risk Factors for Healthcare Associated Central Line-Associated Bloodstream Infection (CLABSI) to Identify Novel Infection Prevention Areas - A Case-Control Study
Authors: Oo Aung Myat , Jin Pin Hong , Philip Edwin , How Molly Kue Bien , Aung May Kyawt , Lee Lai Chee , Arora Shalvi , venkatachalam Indumathi , Sim Jean Xiang Ying , Ling Moi Lin , Yang Yong
Published: December 2021

Background

The International Nosocomial Infection Control Consortium surveillance reported Central line-associated bloodstream infection (CLABSI) rate of 4.1 per 1000 central-line days in 703 ICUs in 50 countries.

Methods

At the Singapore General Hospital (SGH) a 1,700-bed tertiary care hospital, we conducted a retrospective matched case control study over a 3-year period from 2018 to 2020, to identify risk-factors associated with the development of healthcare associated CLABSI in adult inpatients. Cases and controls were patients ≥18 years of age with central lines in situ for at least 48hrs from date of admission. Case definition was based on National Healthcare Safety Network (NHSN) framework to diagnose Bloodstream Infection (BSI) and CLABSI events. Controls had to be admitted within 30 days of the date of admission of the case patients and should not have developed CLABSI. Cases were matched to controls on a 1:2 ratio.

Results

127 cases and 252 controls were included in the analysis. Cases and controls did not differ in age, gender, BMI, presence of diabetes mellitus or presently enforced infection prevention measures (e.g. Central line bundle care). More cases were receiving chemotherapy (10.2% versus 0.8%, p< 0.001), were on TPN (17.3% versus 8.3%, p=0.015) and had been admitted to critical care (73.2% versus 60.7%, p=0.017). Cases were also more likely to have peripherally inserted central venous catheters (37% versus 25%, p=0.017) and have the insertion done in the radiology department under radiological guidance (69.3% versus 55.2%, p=0.011). The median length of stay (LOS) was 44 days (IQR: 0 – 86.8) for cases and 19 days (IQR: 0 - 66.6) for controls (p< 0.001). Inpatient mortality was 25.2% (n=32) for cases 13.9% (n=35) for controls (p-value < 0.010). In multivariate analysis, receiving chemotherapy (OR 11.1, 95%CI: 2.2 – 54.3, p=0.003), being admitted to intensive care unit (ICU) (OR 2.0, 95%CI: 1.1 – 3.8, p=0.019), having a Peripherally Inserted Central Cather (OR 1.8, 95% CI 1.0-3.4, p=0.045), and being colonized with MRSA (OR 1.9, 95%CI: 1.2 – 3.2, p=0.013) were associated with healthcare associated CLABSI.

Conclusion

Novel approaches are required to reduce risk of healthcare associated CLABSI, focusing on interventions for chemotherapy administration, care within ICUs and PICC lines.

Disclosures

All Authors: No reported disclosures
776. Reducing Central Line Associated Bloodstream Infections (CLABSI) in a High-Risk Cohort of Patients by Standardizing Skin Preparation Prior to Pulmonary Artery Catheter Insertion
Authors: Yun Mylinh , Varkey Jay , Linehan Daniel , Noriega Elizabeth
Published: December 2021

Background

Central line associated bloodstream infections (CLABSI) are a recognized complication of all central venous access devices including pulmonary artery catheters (PAC). At our institution, PACs are utilized frequently, often for prolonged durations, for patients with advanced heart failure in the cardiac care unit (CCU) who are awaiting heart transplant. In early summer 2018, our hospital infection prevention (IP) department detected an uptick in CLABSI attributable to the CCU. After 9 months of zero CLABSI, two CLABSIs attributable to the CCU were identified during a 3 month period from November 2017-January 2018. Four additional CLABSIs were identified between May-July 2018 prompting an investigation by IP. Review of the 9 CLABSIs attributed to the CCU from May 2018 – June 2019 led IP to prioritize improving PAC insertion practices in our cardiac catheterization lab as a mean to reducing CLABSI (see table 1).

Methods

IP performed 5 observations of PAC insertion in the cath lab. During the observations of skin preparation, the prep time was performed correctly 40% of the time, correct application 60% of the time and dry time 60% of the time (see table 2, Figure1). Interventions included scheduling a training day for all cath lab staff with the skin prep vendor, performing competency check-offs, and identifying super-users to train future staff. Furthermore, skin antiseptic utilization according the manufacturer's instructions for use was implemented, the coverage area for the applicator was reviewed and a chart for reference was provided.The staff was provided with posters on correct skin prep technique as a visual cue in the procedure room.

Results

Since the project was implemented in September 2019, there has been 1 CLABSI identified that was possibly related to a PAC inserted in the cath lab. During this time 3 CLABSIs were identified in the CCU but were felt to be unrelated to cath lab insertion.

Conclusion

Since the project was implemented in September 2019, there has been 1 CLABSI identified that was possibly related to a PAC inserted in the cath lab. During this time 3 CLABSIs were identified in the CCU but were felt to be unrelated to cath lab insertion.

Disclosures

All Authors: No reported disclosures
780. Carbapenem-resistant Enterobacteriaceae (CRE) Contamination of In-room Sinks in a New Bed Tower
Authors: Warren Bobby G , Addison Bechtler S , Nelson Alicia , Barrett Aaron , Graves Amanda M , Lewis Sarah S , Smith Becky A , Anderson Deverick J
Published: December 2021

Background

Time from opening of a new bed tower to CREcontamination of patient room hospital sinks is poorly understood.

Methods

A 26-bed patient care unit in a new bed tower was opened on 7/18/2020. Patients admitted to this unit underwent weekly rectal cultures to survey for carbapenemase-producing (CP) CRE. Additionally, infection preventionists performed routine surveillance of all clinical cultures for CP-CRE. In-room sinks were located opposite the patient headwall in each patient room and were cultured monthly beginning 9/14/2020 for 3 months. Samples were obtained from the drain cover, handles, and top of bowl using sponges soaked in neutralizing buffer and processed using the stomacher technique. The tailpipe was sampled using a flocked mini-tip swab soaked in neutralizing buffer; the p-trap water was sampled with sterile tubing attached to a 50mL syringe. All samples were plated on HARDYCHROM-ESBL and KPC Colorex medias and incubated at 37°C for 24 hours. Carbapenem resistance genes (NDM1, KPC, IMP, VIM and OXA48) were detected by multiplex PCR and species were confirmed using MALDI-TOF. Environmental pathogens with intrinsic carbapenem resistance and no detected carbapenem-resistance genes were excluded.

Results

Generally, patients admitted to study rooms were similar across samplings (Table 1). No CP-CRE-positive patients were identified from weekly screening or clinical cultures from the opening of the unit through the end of the study. On the first sampling we discovered KPC-positive Enterobacter cloacae complex on a drain cover (1,400 CFU) and two environmental pathogens housing IMP or KPC genes. On the second sampling we discovered five environmental pathogens housing IMP or KPC genes. On the third sampling we discovered two environmental pathogens housing the IMP gene in p-traps (Figure 1).

Table 1. Patient Characteristics

Figure 1. Bacterial species and carbapenem-resistance genes found over time

Conclusion

In a new bed tower open for 58 days with no evidence of CRE positive patients, CRE and CRE genes were discovered in in-room sinks in clinically important (KPC) and environmental pathogens (KPC, IMP). We observed transient colonization of sink drains with potentially important pathogens during a short observation period. Observation over longer time is required to determine transient versus persistent colonization and risk factors for persistent drain colonization.

Disclosures

All Authors: No reported disclosures
781. Antiviral Effectiveness of Different Disinfectants on Surfaces Contaminated with Surrogate Non-enveloped Viruses
Authors: Gerges Bahgat , Rosenblatt Joel , Raad Issam I
Published: December 2021

Background

Contamination of surfaces with virions remains an important medical issues because they can serve as fomites for viral transmission. Long acting disinfectants are important because viruses can remain viable for extended durations. Here we assessed the anti-viral efficacy of various environmental spray disinfectants against F specific coliphage MS2, and Feline Calicivirus (FCV) as surrogate non-enveloped viruses.

Methods

MS2 was grown and titrated according to Environmental Protection Agency method 1601 and counted as plague forming unit per milliliter (PFU/mL.). Strain F9 of FCV was propagated and titrated in monolayers of Crandell-Reese Feline Kidney cells. Commercially available and an experimental disinfectant based on a biguanide combination were tested. The disinfectants, both wet and as dried residues, were compared on silicone surfaces for reduction of viral loads following 1-minute exposure to high viral load challenges (106-107 PFU/ml). Sterilized deionized water was used as a control.

Results

Results (as log10 reduction relative to sterilized deionized water control) are tabulated below for the disinfectants in wet and dry states following 1-minute viral challenges. Log10 reductions of MS2 and FCV viral loads following 1-minute exposures to disinfectants in wet and dry residue states.

Conclusion

The disinfectants were generally much less effective as dried residues than wet. The biguanide-combination and hydrogen peroxide-combination disinfectants were the most effective disinfectants tested in both wet and dry residue states. Both warrant further study for extended eradication of highly infectious viruses on surfaces.

Disclosures

All Authors: No reported disclosures
782. A Comparison of Four Different Sampling Methods Used to Recover Contamination from Environmental Surfaces
Authors: Thompson Sharon , Rutala William , Sickbert-Bennett Emily , DiBiase Lauren , Anderson Deverick J , Weber David J , Weber David J
Published: December 2021

Background

We hypothesized that sampling tools with the largest surface area would be the most efficient at recovering bacteria. To test this hypothesis, we evaluated four different sampling methods to see which was most effective at recovering bacteria from common environmental surfaces.

Methods

At UNC Medical Center, a 951 bed academic facility, we tested four collection methods: swabs, RODAC (replicate organism detection and counting) plates, Sponge Sticks with manual extraction and Sponge Sticks using extraction with the Seward Stomacher. Laminate and stainless steel surfaces (100 cm²) were used for testing. Known quantities of Staphylococcus aureus (SA) and Klebsiella pneumoniae (KP) were applied across the test surfaces, then allowed to dry prior to sampling. Swab samples were collected by rubbing a moistened swab over the test surface, followed by a dry swab. Both swab tips were broken into a tube of saline and mixed. An aliquot of each was inoculated to agar plates. Each RODAC agar plate was pressed onto a test surface. Sponge Stick samples were collected by rubbing a pre-moistened sponge over the test surface. Each sponge head was ejected into a bag containing saline. For manual agitation, each bag was kneaded by hand for 1 minute. For Stomacher method, bags were processed for 1 minute. The contents of each bag were poured into tubes, then centrifuged. The supernatant was removed from each tube. An aliquot of each was inoculated to agar plates. Plates were incubated at 35°C, then colonies were counted for each plate.

Results

Comparative recovery rates across surfaces, organism types and sampling methods are shown in the table.

Conclusion

Organism type, not sampling method, appeared to the most important factor in bacterial recovery. Recovery of SA was significantly higher than KP, likely because it was able to better withstand manipulation and the physical stress of drying on test surfaces. The sampling tool appeared to have the second largest impact. RODAC yielded the highest recovery, followed by swabs, then sponges. Knowing the variable recovery based on method, surface and organism is important for meaningful interpretation of environmental surveillance conducted during outbreak investigations or quality assurance monitoring.

Disclosures

William Rutala, MS, MPH, PhD, PDI (Professional Disposibles International) (Consultant) David J. Weber, MD, MPH, PDI (Consultant)
783. Impact of Universal Decolonization on Intensive Care Unit Bloodstream Infections
Authors: Dea Lauren , Kerkar Shubha , Mdluli Xolani , Vang Ger
Published: December 2021

Background

Interventions used to reduce the incidence of hospital-acquired infections (HAIs) include hand hygiene, isolation, and decolonization. The routine use of chlorhexidine gluconate (CHG) and nasal mupirocin ointment has been shown to be an effective universal decolonization option to reduce bacterial transmission and prevent HAIs. The objective of this study is to compare the pre- and post-intervention of universal decolonization among ICU patients at Desert Regional Medical Center, an acute care Level II trauma center.

Methods

The first part of this study is a retrospective chart review of all ICU patients from June 2020 to August 2020. The second part of this research is a prospective study from December 2020 to March 2021. The prospective study will include all patients admitted to the ICU who completed the decolonization regimen of mupirocin for 5 days and daily CHG baths. In the intervention phase, all ICUs patients will be decolonized with nasal mupirocin twice daily for 5 days and CHG baths daily for the entire ICU stay. The primary outcome is the number of ICU bloodstream infections (BSIs). Secondary outcomes include the number of ICU-related central line associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator associated pneumonia (VAP). An infection attributed to ICU stay is defined as an infection onset occurring more than 48 hours after ICU admission. Fisher’s exact and chi square test was used for the statistical analysis.

Results

A total of 130 patients were included in this study. Universal decolonization resulted in a reduction in overall ICU infections in the baseline group vs intervention group using a p-value of 0.05 (ICU-BSI 5 vs 4, p=0.73; CLABSI 2 vs 1, p=0.56; CAUTI 4 vs 2, p=0.41; VAP 23 vs 17, p=0.25).

Conclusion

Patients in the intervention group had a lower incidence of ICU infections compared to the baseline group. These findings suggest that universal decolonization may be an effective strategy in reducing ICU incidence rates of BSI, CLABSI, CAUTI, and VAP. Further studies need to be conducted to validate this finding with a greater population enrolled to achieve adequate power.

Disclosures

All Authors: No reported disclosures
784. Efficiency of Quaternary Ammonium Disinfectants against SARS-CoV-2 and Coronavirus 229E
Authors: Gerba Charles P
Published: December 2021

Background

The recent pandemic of CoVid19 has increased our need to assess the impact of disinfectants on the inactivation of human coronaviruses. The goals of this study were 1) quantify the disinfection of SARS-CoV-2 and human coronavirus 229 inactivations by various quaternary ammonium formulations, and 2) demonstrate the impact of disinfectants on preventing fomite-to-finger transfer of coronaviruses.

Methods

We compared the inactivation of both SARS-Covid -2 and coronavirus 229E suspended in 5% fetal calf sera and dried on both metal and plastic surfaces. In addition, studies were conducted with a silinated quaternary ammonium compound that left a residual on the surface. Studies were also conducted on the finger transfer of coronavirus from various surfaces. The virus was allowed to dry on the surface for 30 minutes, then a transfer was conducted by placing the finger pad directly onto the contaminated surface. The finger was tested for the virus. The study was then repeated with virus-contaminated porcelain surfaces that were sprayed with a quaternary product or placed on a surface with a quaternary ammonium compound that left a residual.

Results

Several readily available quaternary ammonium formulations were evaluated and proved to be effective with greater than a 99.9% reduction in titer after drying on both metal and plastic surfaces. In addition, a silinated quaternary ammonium compound that left a residual on the surface was capable of inactivating SARS-CoV-2 for at least seven days after application. Studies on the finger transfer of coronavirus from various surfaces showed that the amount of virus transfer to the finger varied from 0.46 to 49.0% depending upon the surface. Little or no virus transfer occurred from treated surfaces compared to the untreated controls. In addition, coronavirus 229E appears to be a good model for use in disinfection assessments for SARS-CoV-2.

Conclusion

Our results demonstrate that various quaternary ammonium disinfectant formulations are effective against human coronaviruses. Finger transfer tests showed that transmission of coronavirus from surfaces can be prevented, reducing the risk of fomite transmission. Coronavirus 229E appears to be a good model for use in disinfection assessments for SARS-CoV-2.

Disclosures

Charles P. Gerba, Ph.D., Allied Biosciences (Grant/Research Support)Behr (Grant/Research Support)Corning Inc. (Grant/Research Support)PPG (Grant/Research Support)Procter and Gamble (Other Financial or Material Support, donation)Rickett and Coleman (Grant/Research Support)
788. Enterobacter cloacae Infection Characteristics and Outcomes in Military Personnel who Sustained Trauma in Iraq and Afghanistan
Authors: Bennett William N , Yabes Joseph , Mende Katrin , Beckius Miriam , Rahman Azizur , Tribble David
Published: December 2021

Background

Enterobacter cloacae is a Gram-negative rod with chromosomally-induced Amp-C β-lactamase with multidrug-resistant potential. Joint Trauma System guidelines for treating combat wounds include prophylaxis with cefazolin and ertapenem, potent inducers of Amp-C. We evaluated clinical characteristics, antibiotic utilization, and outcomes associated with battlefield-related E. cloacae infections.

Methods

All initial solitary (those with single isolates) and serial E. cloacae isolates (≥24 hours from initial isolate from any site) were collected from the Trauma Infectious Disease Outcomes Study (6/2009-12/2014). Inclusion required E. cloacae isolation from a clinical infection. Amp-C-inducing β-lactams were classified based on induction potential and lability to the Amp-C β-lactamase as Amp-C induction levels.

Results

Of 653 E. cloacae isolates, 253 met inclusion criteria – 64 patients had only initial isolates, 54 patients had serial isolates. Patients were largely male (99%), median age 23 years (IQR 21-27), with injury severity score of 34 (IQR 24-45). Initial isolates were wound (70%), respiratory (22%), blood (7%), urine (1%), and other (1%). Patients commonly had blast injuries (89%), required ICU admission (95%), and had a median hospital stay of 57 days (IQR 39-82). Patients with serial isolates showed a trend towards earlier clinical infection (5 vs 8 days, P = 0.07). They were also less likely to receive carbapenems prior to E. cloacae isolation compared to those with only initial isolates (4% vs 38%) and more likely to receive 1st generation cephalosporins (79% vs 58%, P = 0.01). The serial isolate group received more days of 1st generation cephalosporins (median 6 days vs 2.5 days, P = 0.01). Cumulative antimicrobial therapy trended towards significance and was greater with the serial isolates (median 100 days vs 74 days, P = 0.08). There was no difference in number of surgical interventions between those with and without serial isolates (P = 0.54). Overall, 6 patients died.

Conclusion

E. cloacae infections after battlefield trauma were frequently encountered and associated with exposure to 1st generation cephalosporins. Serial infections did not correlate to worse patient outcomes but displayed a trend towards an overall greater duration of antibiotic use.

Disclosures

William N. Bennett, V, MD, Abbvie (Shareholder)Amgen (Shareholder)Nabriva (Shareholder)
790. Evaluation of an Enhanced CPE Screening Program in an Acute Care Hospital in South Korea
Authors: Park Sun Hee , Yi Yunmi , Ji Seul Ki , Han Seung Beom , Shin Soyoung
Published: December 2021

Background

Carbapenemase-producing Enterobacteriaceae (CPE) poses a great challenge in infection control in healthcare settings. A screening and contact precautions are recommended to prevent the spread of CPE among patients. However, screening strategies differ among countries and healthcare facilities.

Methods

In September 2018, we launched a CPE screening program at a 660-bed hospital in South Korea, which targeted previously colonized patients, patients with history of admission < 1 month or transferred patients or ICU-admitted patients. Once patients were identified to have CPE, they were isolated in a single room. After a CPE outbreak in July-Aug 2019, the enhanced screening program was implemented, which included patients with additional risk factors (exposure to hospitals in the past 6 months, receipt of hemodialysis or invasive procedures or rehabilitation) combined with weekly screening in ICU-admitted patients. Screening methods changed from two consecutive rectal screening swabs with chromogenic agar to initial screening with Xpert-Carba-R PCR, followed by one or two consecutive tests with chromogenic agar. We compared the CPE incidence in screening and clinical cultures before and after the enhanced screening program introduction (Sep 2018-Nov 2020).

Results

A total of 14,318 (2,178 vs. 12,140) were screened among 49,980 admitted patients and screening compliance increased from 18.6% to 94.5%. The number of CPE detection increased from 44 to 154 cases and the proportion of CPE-positive screening per 1000 admissions increased 0.6 to 2.2. However, the number of clinical CPE cultures decreased from 11 to 3 (Figure). Among screened patients, time-to-positivity was markedly reduced by 1.9 days (2.96 vs. 1.02 days) during the post-period. Additional 70 patients were detected: 36 due to serial screening in the ICUs and 34 due to enhanced on-admission screening. Factors significantly associated with positive screening were previous exposure to hospital (OR 3.5; 95% CI 1.7-7.1) and receipt of hemodialysis (OR 4.3; 95%CI 1.9-9.2). CPE isolates and carbapenemase genes were diverse (Figure). Trends in CPE detection in screening and clinical samples (upper), and bacterial species with detected carbapenemase genes (lower).

Conclusion

The study results showed that the enhanced screening program enabled us to identify the previously undetected CPE colonized patients and to decrease clinical CPE cultures.

Disclosures

All Authors: No reported disclosures
793. Rifabutin Use in Staphylococcal Prosthetic Material Infections: A Case Series
Authors: Monk Miranda , Elshaboury Ramy H , Nelson Sandra B , Bidell Monique R
Published: December 2021

Background

Bacterial biofilm formation is of clinical concern among patients with staphylococcal infections involving prosthetic material. While rifampin has in-vitro, animal and clinical data to support its adjunctive role in these types of infections, its potent induction of multiple cytochrome P450 enzymes and P-glycoprotein transport system proteins can pose significant drug-drug interactions. Rifabutin has comparable in-vitro anti-staphylococcal activity but less drug-drug interaction potential than rifampin. However, minimal clinical data exists to support rifabutin use as adjunctive treatment of prosthetic infections.

Methods

This case series describes 7 patients who received adjunctive rifabutin for staphylococcal prosthetic material infections between February 2018 and January 2021 at Massachusetts General Hospital. The primary outcome of infection recurrence was defined as need for surgical intervention for suspected or proven recurrence infection within 6 months after starting rifabutin therapy. Incidence of adverse effects was the main secondary outcome.

Results

Most patients (6/7) had methicillin-sensitive S. aureus (MSSA) and one patient had S. epidermidis infection. Three patients had spinal fusion hardware infection, one patient had hardware-associated spinal osteomyelitis/ diskitis with epidural abscess, two patients had prosthetic joint infection, and one patient had MSSA bacteremia with left ventricular assistance device involvement. All patients except one underwent surgical management prior to starting rifabutin. Infection recurrence was noted in one of seven patients who required surgical washout. Adverse events were uncommon (n=1 treatment-related nausea, n=1 leukopenia).

Conclusion

This small case series suggests favorable outcomes with use of rifabutin instead of rifampin for staphylococcal infections with prosthetic material involvement.

Disclosures

Sandra B. Nelson, MD, UpToDate (Other Financial or Material Support, author)
794. The Role of the Environment in Healthcare-associated Transmission of Vancomycin Resistant Enterococcus: A Proof of Concept Study
Authors: Linkneheld-Struk Amber L , Williams Victoria R , Mieusement Lorraine Maze Dit , Salt Natasha , Chan Adrienne , Leis Jerome A
Published: December 2021

Background

Transmission of Vancomycin Resistant Enterococcus (VRE) from environment to patient and patient to patient can both occur in healthcare settings. Due to the COVID-19 pandemic, a cohort of exposed patients on an inpatient unit with an extensive VRE outbreak needed to switch physical locations with a non-exposed patient population. By comparing outcomes of both cohorts, we aimed to determine the role of the physical environment (both direct and indirect contact) as compared to the patient population, in ongoing VRE transmission.

Methods

From 10 March to 21 April 2021, 41 new nosocomial acquisitions of VRE were detected as part of a VRE outbreak on a 34-bed acute care unit. Prior to the switch of units, extensive cleaning of the unit was conducted including electrostatic adjuncts to standard cleaning and environmental swabbing for VRE yielded no positive surfaces. The exposed cohort included 3 of 30 patients with VRE while the non-exposed cohort had 0 of 28 VRE positive patients based on prevalence testing on 21 April 2021. Following the physical relocation of both cohorts on 22 April, 2021, prospective VRE screening was performed on both units for one month including on admission, discharge and weekly prevalence screening. Hand hygiene compliance rates on both units was measured using group electronic monitoring.

Results

Figure 1 depicts the timeline and number of VRE cases before and after the unit switch. Following relocation of the VRE exposed cohort to the new unit, no further VRE transmission was detected (0/235 VRE screens; 0 VRE cases per 1000 patient days). Conversely, there were new VRE transmissions (3/99 VRE screens, 5 VRE cases per 1000 patient days) in the non-exposed cohort. When the units resumed their original location, one additional case of VRE was identified in the exposed cohort upon return to their original location. These transmissions occurred despite HH compliance of 94% (141,610/150,706) during the entire study period on the outbreak unit, which was consistently higher than on the non-outbreak unit (141,589/227,136, 62%).Figure 1.

Conclusion

The environmental reservoir for VRE may be more important in transmission than the patient reservoir. These findings underscore the importance of environmental cleaning to contain VRE outbreaks.

Disclosures

All Authors: No reported disclosures
796. Burden of Healthcare-associated (HA) Respiratory Syncytial Virus (RSV) in Hospitalized Adults
Authors: Hill-Ricciuti Alexandra C , Walsh Edward E , Greendyke William G , Barrett Angela , Alba Luis , Branche Angela , Falsey Ann , Phillips Matthew R , Choi Yoonyoung , Finelli Lyn , Saiman Lisa
Published: December 2021

Background

Little is known about the burden of HA-RSV in hospitalized adults. We assessed risk factors and clinical outcomes in hospitalized adults diagnosed with HA-RSV.

Methods

A retrospective case-control study was performed from 2017-2020 in two academic hospital systems. HA-RSV cases were >18 years of age, hospitalized >4 days, and developed new or worsening respiratory signs and symptoms that prompted clinicians to test for respiratory pathogens; cases were RSV-positive by PCR assays. Two community-onset (CO) RSV-positive controls (admitted with >2 acute respiratory symptoms), were matched to each HA-RSV case by age, sex, and RSV season. We compared risk factors and outcomes in cases vs. controls. We assessed escalation of respiratory support in HA-RSV cases, defined as new or increased respiratory support from Day -2 to Day +4 of their RSV-positive test. Exact conditional logistic regression compared outcomes of HA-RSV vs. CO-RSV subjects, adjusting for demographic and clinical characteristics.

Results

84 cases and 160 controls (both median 64 years) were included; 87% had ≥1 comorbidity. HA-RSV cases were hospitalized for a median of 10 (IQR: 5-17) days prior to their RSV-positive test. CO-RSV controls were more likely to have pulmonary comorbidities than HA-RSV cases (46% vs. 31%, p=0.02). 38% of HA-RSV vs. 15% of CO-RSV subjects were hospitalized ≥15 days after their RSV-positive test (p=0.047). 14% of HA-RSV and 6% of CO-RSV subjects died (p=0.25). Among patients who survived, HA-RSV cases were more likely discharged to a skilled nursing or rehabilitation facility than CO-RSV controls (46% vs. 17%, p=0.04). Of the 44 HA-RSV cases assessed thus far, 25% required escalation of respiratory support; none required initiation of mechanical ventilation.

Conclusion

HA-RSV was associated with increased morbidity and increased health care resource use during and after hospitalization. RSV vaccines could prevent CO- and HA-RSV infections in adults.

Disclosures

Edward E. Walsh, MD, GSK (Advisor or Review Panel member)Janssen (Grant/Research Support)Merck (Grant/Research Support)Merck (Grant/Research Support) William G. Greendyke, MD, Merck (Grant/Research Support) Angela Branche, MD, Merck Dohme and Sharpe (Grant/Research Support) Ann Falsey, MD, BioFire Diagnostics (Grant/Research Support)Janssen (Grant/Research Support)Merck (Grant/Research Support)Novavax (Other Financial or Material Support, DSMB member)Pfizer (Grant/Research Support) Matthew R. Phillips, MPH, Merck & Co., Inc. (Employee, Shareholder) Yoonyoung Choi, PhD, MS, RPh, Merck (Employee) Lyn Finelli, DrPH, MS, Merck (Employee) Lisa Saiman, MD, MPH, Merck (Grant/Research Support, Research Grant or Support)Merk Co., Inc (Grant/Research Support, Advisor or Review Panel member)
798. Incomplete Contact Investigation and Risk of Developing Tuberculosis Among Healthcare Professionals After Tuberculosis Exposure
Authors: Khawcharoenporn Thana , Noisang Kongporn
Published: December 2021

Background

Tuberculosis (TB) contact investigation is recommended for healthcare professionals (HCPs) after TB exposure. However, association between no participation in or incomplete contact investigation and subsequent TB development has not been well-described. This study aims to determine TB incidences and factors associated with TB development among HCPs requiring contact investigations.

Methods

We conducted a prospective cohort study among Thai HCPs with TB exposure from January 2013 to December 2017. Contact investigations, including baseline TB and latent tuberculosis infection (LTBI) screening and follow-up at 3 months after TB exposure, were recommended to all HCPs. The two-step tuberculin skin test (TST) was used for LTBI testing. All HCPs were followed for 2 years for TB development.

Results

Of the 342 HCPs with TB exposure included in the study, 311 (91%) participated in the contact investigations and 252 (74%) completed baseline TB and LTBI screening. Among the 210 HCPs with negative baseline TST, 45 (21%) completed the follow-up tests. The overall incidence of TB was 2.92/100 person-years. HCPs who did not complete follow-up TST had significantly higher TB incidence than those completed baseline and follow-up TST (3.55 vs. 0/100 person-years; P=0.01). No participation in the contact investigation and no chest radiograph performed at baseline were the independent factors associated with TB development among the HCPs [adjusted odds ratio (aOR) 6.69; P< 0.001 and aOR 8.85; P=0.01, respectively]. Contact with an index patient with concomitant TB at extrapulmonary sites (aOR 49.76, 10.03-246.99; P< 0.001) and with negative sputum AFB but positive sputum GeneXpert MTB/RIF (aOR 3.18, 1.35-7.50; P=0.008) were independently associated with no participation in the contact investigation.

Conclusion

The findings indicate the risk of TB development among the HCPs who did not undergo or complete contact investigations and underscore the need for interventions to improve contact investigation participation and completeness.

Disclosures

All Authors: No reported disclosures
799. A Pseudo-Outbreak of Pseudomonas fluorescens Infections
Authors: Jaber Tariq , Saini Vikram , Morris Laura , Como James D , Bhanot Nitin , Min Zaw
Published: December 2021

Background

Pseudomonas fluorescens is a water-borne pathogen that has been associated with outbreaks from transfusion of contaminated blood products or medical equipment. Our institution had a cluster of cultures that grew an uncommonly encountered microbe P. fluorescens within a period of one week. This prompted an internal investigation. We summarize the investigational process that led to the resolution of this pseudo-outbreak.

Methods

We conducted a retrospective chart review of surgical and non-surgical patients with cultures positive for P. fluorescens from July 2nd to July 8th 2020. Baseline patient characteristics, clinical course, laboratory data, use of blood-associated products, and microbiology cultures were analyzed.

Results

Eight patients were identified with positive tissue cultures for P. fluorescens. Among those, 5 specimens (62.5%) were from osteoarticular sites (1 prosthetic hip, 1 prosthetic knee, 1 right foot, 1 sternum, and 1 vertebral source). One culture (12.5%) was obtained from a sacral soft tissue wound. Two tissue specimens (25%) were collected from respiratory sites (1 lung tissue and 1 bronchoalveolar lavage). No association with specific surgical personnel or operating room was identified. During routine specimen processing, a small amount of sterile normal saline is added to the conical grinder prior to culture preparation. It was discovered that a non-sterile normal saline had been inadvertently utilized during that step. These eight tissue specimens were subsequently reprocessed with sterile solution; P. fluorescens was not re-isolated. Specimen processing protocols were reinforced. Adjustment of antimicrobial therapy was made accordingly without reported subsequent adverse clinical outcomes.

Conclusion

A multi-faceted team approach in collaboration with Infection Prevention, Infectious Diseases, Surgery, operating room personnel, and Microbiology identified an unintended breakdown in sterile laboratory protocols which resulted in a cluster of falsely positive cultures. An increased incidence of infection with an uncommon pathogen initiated a prompt investigation that resulted in the identification of a pseudo-outbreak event.

Disclosures

All Authors: No reported disclosures
800. Needle Stick And Sharps Injuries Among Health Care Workers – The Experience of a Tertiary Hospital in Jamaica
Authors: Martin Sue-Ann , Thompson Tamara , Ferguson Trevor
Published: December 2021

Background

Despite advances in occupational safety protocols in healthcare facilities, needle stick and sharps injuries (NSSIs) continue to be a concerning occurrence among healthcare workers (HCWs). Such exposures lead to the risk of blood borne infections as well as emotional and financial consequences which may be difficult to measure. Few studies on NSSIs among Jamaican HCWs have been published in the last decade. We evaluated adherence to established NSSIs management protocols and investigated the demographic and work-related characteristics of HCWs sustaining NSSIs. The proportion of HCWs affected and frequency and direct costs associated with these injuries were estimated.

Methods

This retrospective case-series reviewed HCWs employed or contracted to an urban tertiary teaching hospital in Jamaica, who reported NSSIs in the emergency room during the period January 1, 2015 and December 31, 2018. Archived incident reporting forms for these HCWs were reviewed. Data were analyzed using STATA 14 statistical software.

Results

57 cases of NSSIs were reported at an average rate of 1 per month and an annual incidence of 0.14 per 100 beds and 4.75 per 100 workers. 49 (86%) HCWs were female and 18 (14%) were male. 55% of HCWs were between the ages of 24-29 years old. Nurses (53%) and physicians (19%) made up most of the sample. 28 (58%) HCWs reported not wearing gloves during the incident. Improperly handling used sharps and re-capping needles were reported by 26 (46.5%) and 17 (30%) of HCWs respectively. HIV and viral Hepatitis screening of source patients were performed 85% and 55% of the time respectively. Only 25% of HCWs were prescribed HIV post exposure prophylaxis. Post-injury counselling occurred with 52 (91%) HCWs and follow up care arranged for 36% of cases. The mean direct cost associated with the initial management of the HCW was US &163.22 per NSSI.

Conclusion

The frequency of reported NSSIs by HCWs is low but the burden of direct costs is high. There is inadequate adherence to NSSIs management protocols and accurate monitoring systems are lacking. We recommend the need for safer needle disposal methods and devices, routine auditing of sharps practices and training in occupational hazard prevention and management. This may improve occupational risk perception among HCWs and workplace safety.

Disclosures

All Authors: No reported disclosures
801. Patient Reported Experience with Influenza Episode and Impact on Life and Work
Authors: Way Nate , Martin Ashley , Wallick Chris , Neuberger Edward , Corral Mitra
Published: December 2021

Background

Influenza is a highly prevalent seasonal disease that has a wide range of impact on patients, including experiencing symptoms, social isolation, missing work, and worrying about transmitting to others. The aim of this study was to better understand patients’ experience with influenza, areas of life that were most impacted and what matters most to patients.

Methods

Data for this study were obtained from two online quantitative surveys of influenza patients: A pool of respondents who previously completed the National Health and Wellness Survey (NHWS) (N=74,977) OR from Lightspeed M3 Global’s online “General Panel” (N=500,000+) in the US between January 2020 through May 2020. A total sample of 1,005 patients >18 years of age and having a self-reported diagnosis of influenza by a healthcare professional within the last 90 days were included. Outcomes related to patient demographics, health-related characteristics, perspectives on the influenza episode and productivity impairment (measured by the Work Productivity and Activity Impairment questionnaire) were collected.

Results

Influenza patients reported greatest impact on physical activity, running errands and chores outside the home, and overall lifestyle. 64% were employed at the time they experienced influenza. They missed a mean 23 hours of work due to problems associated with their influenza and actually worked for 15 hours during the 7 days after first experiencing symptoms. Mean absenteeism (work time missed), presenteeism (impairment at work), overall work impairment, and activity impairment was 59%, 73%, 87% and 75%, respectively. For employed respondents, 60% missed work because of transmission worry; about 40% of patients had somebody else get flu shortly after them and about 68% of those people felt responsible for transmitting.

Conclusion

Influenza greatly reduced respondents’ ability to be productive at work and in their daily activities outside of work. Worry about transmitting an influenza infection to others was a highly influential motivator for missed work or other responsibilities.

Disclosures

Nate Way, PhD, Genentech, Inc. (Grant/Research Support)Kantar Health (Employee) Ashley Martin, PhD, Genentech, Inc. (Grant/Research Support)Kantar Health (Employee) Chris Wallick, PharmD, MS, Genentech, Inc. (Employee, Shareholder) Edward Neuberger, PharmD, MBA, MS, Genentech, Inc. (Employee, Shareholder) Mitra Corral, MS, MPH, Genentech, Inc. (Employee, Shareholder)
Variation in Severe Acute Respiratory Syndrome Coronavirus 2 Bioaerosol Production in Exhaled Breath
Authors: Verma Renu , Kim Eugene , Degner Nicholas , Walter Katharine S , Singh Upinder , Andrews Jason R
Published: December 2021

We developed a simple, noninvasive mask sampling method to quantify and sequence severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from exhaled breath. We found substantial variation between individuals in SARS-CoV-2 copies exhaled over a 15-minute period, which moderately correlated with nasal swab viral load. Talking was associated with a median of 2 log10 greater exhaled viral copies. Exposure varies substantially between individuals but may be risk stratified by nasal swab viral load and whether the exposure involved conversation.