bluuebunny/crossref_metadata_2025 huggingface dataset:
2844. Butyrogenic Bacteria After Acute Graft vs. Host Disease Associate with the Development of Steroid Refractory GVHD
Authors: Golob Jonathan L , DeMeules Martha M , Loeffelholz Tillie , Quinn Z Z , Dame Michael K , Silvestri Sabrina , Wu Michael , Schmidt Tom , Fiedler Tina L , Hoostal Matthew , Mielcarek Marco , Spence Jason , Pergam Steven A , Fredricks David
Published: October 2019

Background

Steroid refractory acute graft- vs. -host-disease (GVHD) after hematopoietic cell transplantation (HCT) is highly morbid with limited treatment options. Murine studies show protection from GVHD with butyrate exposure but direct exposure of stem/progenitor cells to butyrate inhibits colonic stem cell proliferation.

Methods

Stool samples were collected weekly in a cohort of HCT recipients (n = 210) undergoing allogeneic transplant, and underwent 16S rRNA sequencing to determine the number and relative abundance of butyrogens. Dissociated primary human colonoid cell aggregates (200,000 per well) were plated onto collagen IV-coated transwells (0.4 µm pore size, 0.33 cm2, PET) in stem cell medium for 24 hours. From 24 hours onwards, the basal-lateral chamber was switched to differentiation medium; the apical chamber was Hanks Buffered Salt Solution (HBSS), HBSS with 10 mM butyrate sodium salt early (24 hours onwards) or late (72hours onwards). Trans-epithelial electrical resistance was measured daily.

Results

Retrospective chart review identified 27 recipients who developed acute GVHD of the gut, stratified to be either steroid refractory GVHD (failed to respond to 2 mg/kg of methylprednisolone) or responsive. The presence of butyrogens in the gut microbiome after the onset of severe acute GHVD of the gut associated with increased risk of steroid refractory GVHD (Figure 1; P < 0.05). Direct exposure of human colonic stem/progenitor cells to butyrate inhibits the development of trans-epithelial electrical resistance; exposure after differentiation had no inhibition of barrier formation (Figure 2; P < 0.05 by T-test).

Conclusion

Butyrogens may help prevent the development of acute GVHD of the gut, but once severe GVHD has developed may inhibit recovery due to the loss of crypt architecture exposing colonic stem cells to microbe-produced butyrate with impaired differentiation and cell replacement.

Disclosures

All Authors: No reported Disclosures.
2850. Burden of Difficult-to-Treat Antibiotic-Resistant (DTR) Gram-Negative Infections in the United States, 2012–2017
Authors: Kadri Sameer S , Baggs James , Yi Sarah H , Strich Jeffrey R , Ling Lai Yi , Ricotta Emily , Rebecca Prevots D , Danner Robert L , Wolford Hannah , Olubajo Babatunde , Hatfield Kelly M , Reddy Sujan , Jernigan John A
Published: October 2019

Background

Difficult-to-treat resistance (DTR) is a metric for clinically relevant “pan-resistance” to available high-efficacy, low-toxicity antibiotic treatment options at any given time. Previous DTR prevalence estimates in Gram-negative (GN) bloodstream isolates from 2009 to 2014 have ranged between 1 and 1.5%. We sought to estimate the national burden of DTR GN isolates and more recent trends by region, site, and species.

Methods

Clinical cultures with GN isolates were identified from inpatient encounters in hospitals reporting at least one culture with susceptibility testing for a given month to Premier Healthcare Database or Cerner Health Facts Database from 2012 to 2017. DTR was defined as intermediate susceptibility or resistance to all tested carbapenems, other β-lactams, and fluoroquinolones, but not including agents introduced 2014 onwards. For each year, a raking procedure generated weights to extrapolate the sample estimate to match American Hospital Association distributions based on US census division, hospital bed capacity, teaching status, and urban designation. A weighted means survey procedure was used to extrapolate the sample estimate to obtain national DTR burden. Trends in DTR incidence were examined by using weighted multivariable logistic regression.

Results

Extrapolating from a 373-hospital sample, the estimated 2017 US inpatient burden of DTR isolates was 3,315 (1.3%) among sterile-site and 31,509 (1.7%) among all cultures, ranging from 0.5% to 3.3% in Mountain and New England regions respectively. P. aeruginosa was the most common species overall (37%), while A. baumannii was most common among sterile sites (31%). Between 2012 and 2017, there was no annual percent change in DTR incidence for sterile sites [OR 0.99 (0.93, 1.06)] but for all cultures it decreased 4.1% annually [OR 0.95 (0.91, 0.99)], including 9% annually for A. baumannii [OR 0.905 (0.860, 0.953)] and K. pneumonia [OR 0.903 (0.824, 0.991)], respectively.

Conclusion

The US inpatient burden of GN isolates displaying DTR is relatively low, varies by region, and has remained stable or declined slightly in recent years. Periodic inclusion of emerging antibiotics in the DTR classification will allow for a dynamic index between resistance and available agents.

Disclosures

All Authors: No reported Disclosures.
2892. The Relationship Between Inpatient and Post-discharge Antimicrobial Use at the Hospital-level Across an Integrated Healthcare Network
Authors: Livorsi Daniel J , Feller Jade , Lund Brian , Alexander Bruce , Nair Rajeshwari , Beck Brice , Goto Michihiko , Heintz Brett , Perencevich Eli N
Published: October 2019

Background

Hospital-based antimicrobial stewardship interventions and metrics have typically focused only on inpatient antimicrobial exposure. However, single-center studies have found a large portion of antimicrobial exposure occurs immediately after hospital discharge. We sought to describe antimicrobial-prescribing upon hospital discharge across the Veterans Health Administration (VHA) and to compare inpatient and post-discharge antimicrobial use at the hospital-level.

Methods

This retrospective study used national VHA administrative data to identify all acute-care admissions from January 1, 2014 to December 31, 2016. Post-discharge antimicrobials were defined as oral outpatient antimicrobials prescribed at the time of hospital discharge. We measured inpatient-days of therapy (DOT) and post-discharge DOTs. At the hospital-level, inpatient DOTs per 100 admissions were compared with post-discharge DOTs per 100 admissions using Spearman’s rank-order correlation.

Results

Among 1.7 million acute-care admissions across 122 VHA hospitals, 46.1% were administered inpatient antimicrobials and 19.9% were prescribed an oral antimicrobial at discharge. Fluoroquinolones were the most common antimicrobial prescribed at discharge among 335,396 antimicrobial prescriptions (38.3%). At the hospital-level, median inpatient antimicrobial use was 331.3 DOTs per 100 admissions (interquartile range (IQR) 284.9–367.9) and median post-discharge use was 209.5 DOTs per 100 admissions (IQR 181.5–239.6). Thirty-nine percent of the total duration of antimicrobial exposure occurred after hospital discharge. The metrics of inpatient DOTs per 100 admissions and post-discharge DOTs per 100 admissions were weakly correlated at the hospital-level (rho = 0.44, P < 0.0001).

Conclusion

Antimicrobial-prescribing at hospital discharge was common and contributed substantially to the total antimicrobial exposure associated with an acute-care hospital stay. A hospital’s inpatient antimicrobial use was only weakly correlated with its post-discharge antimicrobial use. Antimicrobial stewardship interventions should specifically target antimicrobial-prescribing at discharge.

Disclosures

All Authors: No reported Disclosures.
1137. Variability of Antibiotic Use in Neonatal Intensive Care Units in the United States
Authors: Dantuluri Keerti , Griffith Hannah , Thurm Cary , Banerjee Ritu , Banerjee Ritu , Howard Leigh M , Grijalva Carlos G
Published: October 2019

Background

Although antibiotics are often indicated to treat early-life infections, such exposure may lead to serious adverse outcomes. Few studies have characterized patterns of antibiotic use among neonatal intensive care units (NICUs).

Methods

We performed a cross-sectional study of antibiotic use in 51 NICUs participating in the Pediatric Health Information System (PHIS), a database that includes clinical and resource utilization data for standalone children’s hospitals in the United States. Assessments were conducted on a single mid-week day of 2017. We examined the use of any antibiotic and broad-spectrum antibiotics using charge data in children admitted in each NICU on the study day. We compared antibiotic use among NICUs and geographical regions, and assessed its association with the NICU median case mix index (CMI) (as a surrogate for clinical complexity).

Results

2813 infants were hospitalized in NICUs on the study day; the median number of patients at each study site was 47 (IQR = 34 – 62). 90% were <1 month old, 56% were male, 46% were white, and 62% were extremely/very preterm. Overall, 23% received at least one antibiotic and 6% received broad-spectrum antibiotics. Broad-spectrum antibiotic use was twice as prevalent in surgical compared with medical patients. Antibiotic use prevalence varied by region, ranging from 19% in the Midwest to 26% in the West (table). Ampicillin, gentamicin and vancomycin were the most common antibiotics used (25.2%, 18.8% and 9.9%, respectively). Antibiotic use prevalence varied substantially across NICUs (Figure 1). There was a moderate but significant positive correlation between overall or broad-spectrum antibiotic use and median NICU CMI (Figure 2).

Conclusion

There is substantial variability in antibiotic use among US NICUs, which seems partially explained by patient case-mix. Additional studies are needed to identify drivers of unwarranted variability in antibiotic use among NICUs.

Disclosures

Ritu Banerjee, MD, PhD, Accelerate Diagnostics: Grant/Research Support; BioFire: Research Grant; Biomerieux: Research Grant; Roche: Research Grant.
1153. National Trend of Urinary Catheter Device Utilization by Hospital Type, National Healthcare Safety Network (2015–2019)
Authors: Soe Minn M
Published: October 2019

Background

Reducing unnecessary urinary catheter use and optimizing insertion techniques and catheter maintenance and care practices are the most important urinary tract infection (CAUTI) prevention strategies. To monitor device use (DU) as quality improvement activity, the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) developed the risk adjusted, standardized urinary catheter device utilization ratio in 2015. This study aims to assess national trends of DU from the baseline year 2015 through 2019.

Methods

For our trend analysis, we analyzed DU data (catheter days per 100 inpatient-days) that acute care hospitals (ACHs), long-term acute care hospitals (LTACHs), inpatient rehabilitation facilities (IRFs), and critical access hospitals (CAHs) reported to NHSN from 2015Q1 through 2019Q1. The ward and intensive care unit patient care locations included in our analysis are those that ACHs, LTACHs, IRFs and CAHs are required to report to CMS to comply with CMS Inpatient Quality Reporting program requirements. We regressed DU by quarterly period using generalized estimating equation modeling with the negative-binomial distribution, after adjusting for factors associated with corresponding SUR models of 2015 baseline and accounting for autocorrelation of error terms within a location. For graphic display, we also computed quarterly DU using marginal predictive models.

Results

The DU decreased over time (P ≤ 0.05, average percent change per quarter (%change): −0.54 [95% CI: −0.54, −0.53]) among ACHs (Table 1, Figure 1), and −0.54 [95% CI: −0.58, −0.49] among LTACHs (Table 1, Figure 2). Among IRFs, quarterly DU in 2015Q2–2016Q3 were similar relative to 2015Q1, but decreased from 2016Q4 onward (P ≤ 0.05, % change: −0.51 [95% CI: −0.61, −0.40]) (Table 1, Figure 3). Among CAHs, quarterly DU in 2015Q2–2016Q4 were similar relative to 2015Q1, but decreased from 2017Q1 onward (P ≤ 0.05, % change: −0.22 [95% CI: −0.39, −0.04]) (Table 1, Figure 4).

Conclusion

There was a statistically significant decrease in National DU of urinary catheter during 2015–2019 across NHSN, although the magnitude of change per quarter was not large. Further research is needed to explore causal factors associated with such reduction.

Disclosures

All authors: No reported disclosures.
1155. CAUTI Path to Zero: A Triple-Pronged Approach to Minding Our Pees and Cues
Authors: Henry Sharen , Arocha Doramarie , Brown Dawn , Sutterfield Hope , Kielpinkski Lisa , Fisher Ruth , Reed Mary-Grace , Flahaven Emily , Olson Michelle L , Trivedi Julie B
Published: October 2019

Background

Catheter-associated urinary tract infections (CAUTIs) account for nearly 30% of all hospital-acquired infections. From 2009 to 2013, the frequency of CAUTIs increased by 6% with associated increases in length of stay, antibiotic usage and mortality (2.3%); they are also a risk factor for secondary bloodstream infections. In 2017, the CAUTI SIR for the UTSW University hospitals was 0.990 for Clements University Hospital (CUH) and 1.224 for Zale-Lipshy (ZL), placing UTSW above the 50th percentile compared with similar academic medical centers. By the end of 2018, the aim of the quality improvement project was to reduce CAUTIs by 25% or improve the SIR to 0.78, which is at or below the 50th percentile.

Methods

Baseline data included identifying indications and duration of catheter placement as well as performing debriefings on all CAUTIs along with analysis of adherence to the CAUTI bundle. Using evidence-based guidelines, the three primary interventions were (1) streamlining indications for insertion, (2) ensuring prompt removal and (3) providing alternative care pathways after removal. We observed insertion technique and catheter care; nursing services were engaged to understand barriers to catheter removal and subsequently informed of other options such as in-and-out protocols, bladder scanners and female external catheters. Nursing leadership also performed daily necessity audits of all patients with indwelling catheters.

Results

Urine output monitoring in acute/critical illness and urinary obstruction/retention were the top two indications for use. Catheter utilization rates have decreased since 2016. The average dwell time at CUH was 51 hours (excl. urology) and 40 hours at ZL. There was actually a 34% decrease in the total number of CAUTIs from 38 in 2017 to 25 in 2018, exceeding the goal of 25% reduction; the 2018 SIR for CUH was 0.818 and 0.496 for ZL. The prevention of 13 CAUTI events from 2017 to 2018 resulted in ~$180,000 savings.

Conclusion

Successful reduction of CAUTI is an interdisciplinary effort requiring consistent attention and support from infection prevention, nursing, education, quality improvement, IT and hospital administration. Empowering nursing staff, providing clear protocols post-removal and options for alternative external urinary devices is key.

Disclosures

All authors: No reported disclosures.
1166. Infection Rate in Venous–Venous Extracorporeal Membrane Oxygenation (VV-ECMO)
Authors: Wang Joseph , Christensen Cason , Merritt-Genore Helenmari , Siddique Aleem , Cawcutt Kelly , Cawcutt Kelly
Published: October 2019

Background

The Extracorporeal Life Support Organization (ELSO) Infectious Disease Taskforce has identified infection rates as an area requiring further study. We aimed to evaluate our patients on venous–venous extracorporeal membrane oxygenation (VV ECMO) for infection rates, organisms, and specific factors that may alter infection risk.

Methods

Retrospective data were collected from September 2012 to 2015 for adult patients on VV ECMO. Demographic information as well as type and location of cannulation, antibiotics prior to and during cannulation, and presence of bacteremia were obtained. Counts and percentages are reported for categorical variables.

Results

47 patients between 18 and 82 years of age with a median of age of 58 years were included. 76.6% (N = 36) were male. The average number of hospital days until cannulation was 7.8 days. 400 ECMO days were captured with a range of time on ECMO of 1–41 days. 46.8% (N = 22) of patients were alive at the time of discharge. 70.2% (N = 32) of cannulations were in the OR (Figure 1). 55% (N = 26) of patients had a Right Ventricular Assist Device (RVAD) with in-line oxygenator. 66% (N = 31) of all patients were on antibiotics prior to cannulation for other indications while 53% (N = 25) of all patients received perioperative antibiotics (Figure 2). 59% (N = 28) of all patients had blood cultures while on ECMO, with only 8% (N = 4) of all patients returning positive. Of the positive cultures, 2 were true bacteremia resulting in an infection rate of 5 per 1,000 ECMO days (Figure 3). One patient grew Escherichia coli while the other grew Escherichia coli and Streptococcus pneumoniae. Neither patient received antibiotics perioperatively or for other indications (Figure 4). Due to the low number of infected patients, further statistical analysis could not be performed.

Conclusion

We report a low rate of bloodstream infection amongst our VV-ECMO patients. Further investigation to ascertain trends in infection rate with cannulation location/type as well as association with antibiotic is currently being pursued. Other avenues of research will include a comparison of infection rates between VV and Venous Arterial (VA) ECMO. Information from these investigations will help aid the development of guidelines to minimize the rate of nosocomial infections in ECMO patients.

Disclosures

All authors: No reported disclosures.
1168. Trends in Central-Line-Associated Blood Stream Infections in a Community Teaching Hospital: A Multi-Intervention Quality Improvement Project
Authors: Wei Abraham , Markert Ronald , Connelly Christopher , Polenakovik Hari
Published: October 2019

Background

Central line-associated bloodstream infection (CLABSI) is a preventable medical condition that results in increased patient morbidity and mortality as well as increased medical costs. We sought to describe the impact of various quality improvement interventions on the incidence of CLABSI in a large 990-bed community teaching hospital from the period of January 1, 2013 to December 31, 2017.

Methods

Retrospective study of CLABSI events as defined by the CDC’s National Healthcare Safety Network was completed. Between 2013 to 2017, we introduced mandatory real-time root cause analysis for each CLABSI event to identify defects that could be used for quality improvement interventions. We implemented a bundle of interventions for proper central venous catheter (CVC) insertion and maintenance based on CDC recommendations and the results of the internal analysis. Interventions included utilizing chlorhexidine gluconate (CHG) skin preparation and maximum sterile barrier precautions, optimal site selection (avoiding femoral site), using antimicrobial-coated CVCs and antithrombotic Bioflo peripherally inserted central catheters (PICC), minimizing multi-lumen CVC and PICC use, de-escalating CVC to midline or preferential use of midline catheters while minimizing unnecessary PICC and CVC insertion, adding Curos disinfection caps on central lines and other vascular access sites, weekly scheduled CVC site dressing changes with Tegaderm CHG I.V. Securement Dressing, CHG baths for patients with CVCs, avoidance of blood culture draws from central lines, and daily review of line necessity with timely removal. Medical staff members received ongoing education on the implementation of the CLABSI bundle. Both ICU and non-ICU CLABSI cases in the adult patient population were analyzed.

Results

A comparison of 2013 with 2017 shows a 69% decline in a number of CLABSI cases from 36 to 11 patients (Figure 1). There was a 30% decline in CVC days from years 2014 to 2017 (No CVC days data for 2013 due to change in data collection system). Over the same period, CLABSI events per 1,000 CVC days decreased from 0.624 to 0.362 (Figure 2)—a 42% decline.

Conclusion

Study findings show that our comprehensive bundle of interventions for CVC insertion and maintenance resulted in decreased rates of CLABSI.

Disclosures

All authors: No reported disclosures.
1169. Preventing Central Line-Associated Bloodstream Infections in Long-Term Acute Care
Authors: Jacob Jerry , Morace Ann , Park Jisuk , Renzi Nina
Published: October 2019

Background

Long-term acute care hospitals (LTACHs) care for chronically, critically ill patients with high utilization of central lines and high risk for morbidity from central line-associated bloodstream infections (CLABSIs). Our 38-bed LTACH noted a substantial increase in the incidence of CLABSIs (as defined by the National Healthcare Safety Network) between fiscal year (FY) 2016 and FY 2018 (Figure 1). Detailed case review identified a large number of CLABSIs which were clinically consistent with blood culture contaminants from central lines. Feedback from bedside staff also suggested gaps between practice and evidence-based measures for central line care.

Methods

A three-pronged CLABSI prevention project was implemented in July 2018 consisting of (1) staff education regarding daily chlorhexidine (CHG) bathing for all patients, combined with an electronic audit report to identify patients without active CHG orders; (2) change in practice to the use of venipuncture alone for blood culture collection, combined with an electronic audit report to identify blood cultures collected from central lines; and (3) a recurring 6-part educational series for nurses focused on central line care. The pre-intervention period was defined as the 12-month period between July 1, 2017 and June 30, 2018 (FY 2018). The primary outcome was the fiscal year CLABSI rate. A secondary outcome was the proportion of blood cultures drawn from central lines.

Results

After 9 months of the intervention, one CLABSI had been reported for FY 2019 year-to-date at a rate of 0.4 per 1,000 CL-days, representing an 86% decrease from the FY 2018 rate of 2.8 per 1,000 CL-days. The 12-month rolling CLABSI rate decreased to 1.6 per 1,000 CL-days (Figure 2). The proportion of blood cultures collected from central lines decreased from 10.5% (69/658) to 4.5% (15/334), representing a 57% reduction. The proportion of patients ordered and receiving CHG bathing in the intervention period was >95%.

Conclusion

A multidisciplinary effort focused on CHG bathing, central line care, and blood culture collection led to a substantial reduction in CLABSIs in our LTACH. The use of electronic audit reports was particularly useful in achieving high adherence to practice changes.

Disclosures

All authors: No reported disclosures.
1186. Decreased Laboratory-Identified Clostridioides difficile Infections with Implementation of an Electronic Hand Hygiene Monitoring System in a Long-Term Acute Care Hospital Decreased Laboratory-Identified Clostridioides difficile Infections with Implementation of an Electronic Hand Hygiene Monitoring System in a Long-Term Acute Care Hospital
Authors: Banks Maureen , Phillips Andrew , Chin Keith , Ann Bruno-Murtha Lou
Published: October 2019

Background

Hand hygiene (HH) is the cornerstone of infection prevention and improved compliance has been associated with reduced healthcare-associated infections (HAIs). However, traditional methods for HH data collection have limitations and may not accurately reflect true compliance. We sought to evaluate whether an electronic hand hygiene monitoring system (HHMS) can improve data collection, compliance, and reduce HAIs.

Methods

A HHMS was implemented as part of a pilot at a single facility in June 2018 for all healthcare workers (HCWs) who entered patient rooms. The system prompted HCWs to perform HH with an audible and visual reminder emitted from a badge if a HH event had not been registered within specific timeframes of entering or exiting a patient room. The system captured compliance with preferential handwashing (soap and water) for at least 15 seconds upon exit of Clostridioides difficile (C. difficile) designated rooms. All HH data were collected by the HHMS. Hand hygiene compliance and HAI data were compared for the pre-intervention (June 2017-May 2018) and intervention periods (July 2018-March 2019). No changes were made to environmental cleaning protocols or compliance monitoring, nor in antibiotic stewardship practices.

Results

HH compliance by direct observation in the pre-intervention period was 91% (1,612 observations). HH compliance with the HHMS during the intervention period was 97% (2,778,402 observations). The mean monthly HH opportunities recorded during the pre-intervention period was 134, while the HHMS captured 308,711, a greater than 2,300-fold increase. The incidence of healthcare facility-onset C. difficile infections (HO-CDI) pre-intervention was 9.60 per 10,000 patient-days (41 GDH+/Toxin+ laboratory-identified [labID] events/42,726 patient-days). With the HHMS, HO-CDI decreased 70% (P = 0.0003) to 2.89 per 10,000 patient-days (9 labID events/31,169 patient-days). No policy changes in environmental cleaning of high-touch surfaces were made or observed during the pilot.

Conclusion

The use of an HHMS facilitated more comprehensive HH data and improved compliance. The preliminary findings also support an association between more robust HH compliance data and a significant decrease in toxin-producing CDI.

Disclosures

All authors: No reported disclosures.
1209. Seroprevalence of Measles, Mumps, and Rubella in Korean Healthcare Workers and Strategy for Vaccination
Authors: Ju Choo Eun , Yoon Park Se
Published: October 2019

Background

The measles, mumps, and rubella (MMR) vaccination to children was accelerated in South Korea as the National Immunization Programs in 1985. A two-dose MMR vaccination schedule was introduced in 1997. However, outbreaks of measles in healthcare institution continued to occur. Recent studies revealed that the seroprevalence of measles in healthcare workers (HCWs) was approximately 40–60% in twentieth. The purpose of this study was to determine the seroprevalence of MMR antibodies in HCWs to establish strategy for vaccination.

Methods

To prevent nosocomial transmission of measles, test for MMR antibody of HCWs was conducted in three teaching hospitals from January to February in 2019. The testing was conducted only in the patient contact departments. We excluded HCWs who did a history of vaccination after starting their work. Anti-measles IgG and anti-mumps IgG was detected using chemiluminescence immunoassay. Anti-rubella IgG was detected using chemiluninescence microparticle immunoassay. Equivocal value was treated as negative. We also compare the costs between strategies two-dose vaccination without antibody tests and vaccination after antibody testing.

Results

Total 598 HCWs were included in analysis. Of the HCWs tests, 92.6% were seropositive to measles, 86.6% to mumps, and 79.7% to rubella. In the linear regression analysis, the seropositive of measles and rubella antibodies was increased in proportion to age (β-coefficient 43.4, 95% CI 35.1–51.6, P < 0.001 and β-coefficient 10.2, 95% CI 7.2–13.2, respectively). But, the seropositive to mumps was not related to age (β-coefficient 2.6, 95% CI -5.4–10.7, P = 0.52). The HCWs who has seropositive to all MMR was 67.2%. It was highest in 1970th birthyear (77.1%) and lowest in 1980th birthyear (60.6%). It costs less 18,000 wons ($15.5) per HCWs in strategy of vaccination after antibody testing than two-dose vaccination without antibody testing.

Conclusion

Our data warrant the needs for routine antibody test for MMR, followed by MMR vaccination in Korean HCWS. We expect that this strategy can save costs and avoid unnecessary vaccination.

Disclosures

All authors: No reported disclosures.
1211. Microbiologic Evaluation of Mobile Phones and Hands of Healthcare Professionals in Two Intensive Care Units in a Brazilian University Hospital
Authors: Patricia Sanchez Espinoza Evelyn , Viera Perdigão Neto Lauro , Alves dos Santos Sania , Risek Camila , Renata Gomes Franco Maria , Martins Roberta C R , Pereira, Bsc Gaspar C O , Guimaraes Thais , Boszczowski Icaro , Rossi Flavia , Pinheiro Freire Maristela , Sara Shafferman Levin Anna , Costa Silvia F
Published: October 2019

Background

Healthcare-associated infections (HAIs) are a worldwide concern because of their high morbidity, mortality, and associated costs. Mobile phones (MP) are an important work tool in the healthcare setting, but they can be a reservoir of nosocomial pathogens if not carefully cleaned and cause re-contamination of the healthcare professional’s (HCP) hands. We aimed to evaluate bacterial colonization of HCP’s hands and their respective MPs.

Methods

A cross-sectional study was performed in two Intensive Care Units (ICUs), an internal medicine and a burn unit, of a Brazilian tertiary university hospital. These units were chosen because of their different hand hygiene (HH) compliance. We assessed HH and MP handling practices by an electronic inquiry and collected samples from the dominant hand (DH) by the sterile bag technique and of MPs by moistened sterile swab. MALDI-TOF was used for bacterial identification and Dilution Agar (DA) was used to screen Gram-negative bacteria (GNB) susceptibility to carbapenems and colistin.

Results

Forty-seven HCPs were evaluated; of whom, 30% were medical residents, 19% nurses, 17% nurse-technicians, 17% physiotherapists, 13% cleaning staff, and 4% radiology technicians.Overall, 85% of HCPs reported use of MP at work, 26% had never cleaned it, and 34% reported optimal HH compliance practices. All of them believed that MPs can have HAIs agents. DH culture showed 94% of colonization and the most common Gram-positive bacteria (GPB) and GNB were S. epidermidis (n = 17∕44) and A. baumannii complex (n = 11∕44), respectively. MP were colonized in 89% of the cases and the most common GPB and GNB were S. epidermidis (n = 16∕42) and Pseudomonas spp (n = 9∕42), respectively. Overall, in the screening 38% of GNB were resistant to meropenem and 22% to colistin. A. baumannii was the most common meropenem (n = 4) and colistin (n = 2) resistant GNB. In the two units, 32% of HCPs had the same microorganism species isolated in the MP and in the DH (Table 1).

Conclusion

There was a high rate of bacterial colonization on the MP and DH of HCPs and some of these bacteria were carbapenem or colistin resistant. A policy for MP handling in the healthcare setting should be implemented in order to avoid cross-contamination between the MP and the hand of HCPs.

Disclosures

All authors: No reported disclosures.
1217. Predicting the Efficacy of an Antimicrobial Surface Coating Utilizing X-Ray Fluorescence Spectroscopy (XRF)
Authors: Asgari Parham , Fang Jie , Price Val , DeClue Don , Grossman Gavri , Shrestha Sunav , El Sayed Maha
Published: October 2019

Background

Contaminated surfaces are a critical risk factor for transmitting infectious disease. Current disinfection products provide short-term antimicrobial action; however, these surfaces can be re-contaminated within hours after cleaning. To address this limitation, long-lasting antimicrobial polymer coatings have been developed as an adjunct to traditional disinfecting and cleaning protocols. Due to the micro-scale thickness and transparency of the coating, confirmation of its presence on surfaces is difficult with conventional methods; therefore, this study explores a novel approach to measuring durable polymer coatings on stainless steel coupons to validate their presence and relative antimicrobial activity.

Methods

In this study, we utilized a hand-held X-ray fluorescence spectroscopy (XRF) analyzer to quantitatively evaluate the amount of antimicrobial polymer coating deposited on stainless steel test surfaces. Stainless steel surfaces with amounts of coating ranging from 0.12 to 3.60 mg/in.2 were analyzed for their XRF profile using a hand-held spectrometer. Additionally, the relationship between the XRF spectra and antimicrobial activity was evaluated using a modified version of an existing sanitization protocol for hard surfaces using Staphylococcus epidermidis as the test organism.

Results

Comparison of the amount of antimicrobial polymer coating (in mg) and the XRF values (photon count) revealed a calibration curve with a high degree of linearity (R2 = 0.993) especially for surfaces that had lower mass (Figure 1). In addition, the relationship between XRF values and antimicrobial efficacy also were found to be well-correlated with a logarithmic trend (R2 = 0.9308) (Figure 2).

Conclusion

The observed trends between coating mass, XRF value and antimicrobial efficacy suggests that these analytical techniques are viable options for determining the presence of invisible antimicrobial polymer coatings. Additionally, laboratory-based calibration curves based on XRF values can be used to predict the level of antimicrobial activity of surfaces that have been treated with polymer coatings. These findings suggest that the use of a hand-held XRF spectrometer can be a rapid and cost-effective method for assessing the presence and efficacy of polymer coatings.

Disclosures

All authors: No reported disclosures.
1231. Legionella Variability From Routine Environmental Testing Across All Veterans Health Administration (VHA) Medical Facilities
Authors: Jinadatha Chetan , Coppin John David , Gamage Shantini D , Kralovic Stephen , Roselle Gary
Published: October 2019

Background

VHA Legionella prevention policy requires quarterly testing of potable water samples, for its 170 medical facilities (“stations”) distributed across the United States. We modeled the variability in Legionella positivity rates by location structure and by time to understand Legionella prevalence and distribution across VHA nationwide. Our goal was to understand when, where and why variations in Legionella positivity happens across VHA facilities.

Methods

Data from quarterly water samples from sinks and showers from 2015 through 2017 and for which complete information was reported were used for the model. A multi-level Bayesian logistic regression model was run in R version 3.5.1. The hierarchical location group levels consisted of room nested within floor, within building, within station, within region. The time group-level effects included quarter nested within year. Variabilities within groups were estimated as standard deviation (SD) on the log-odds scale.

Results

Among 138,553 samples, there was little seasonal effect (SD: 0.32) in Legionella positivity based on the quarter in which they were sampled. The largest variability in Legionella positivity occurred at the station level (SD: 2.38), with substantial variation at the building level also (SD: 1.85). The 5% of stations most likely to be positive for Legionella represented only 7.5% of total samples but accounted for 39.7% of all positive samples. The 5% of stations least likely to be positive for Legionella represented 10.4% of total samples, but only had 2 positive samples.

Conclusion

Buildings with the highest probability for Legionella positivity are clustered together within stations. We saw no major seasonal variations in Legionella positivity across facilities. We were able to better predict stations with higher positivity as well as lower overall positivity for Legionella water sampling. The observed dominant station-level effects could be due to overarching influences such as a single water source and suggests approaches at this level can impact Legionella control. These results demonstrate a mechanism for understanding the distribution and probability of Legionella and can inform prevention practices and future policy.

Disclosures

All authors: No reported disclosures.
1251. Determinants of Infection at a Nontransplanting Cardiothoracic LVAD Program
Authors: Milgrom Alexander , Collins Amanda , Grubbs J Aaron , Derrick Caroline , Logan Kristin , Edelson William , Branham Stephany , Mardis Andrew , Martin Jeffrey , Weissman Sharon
Published: October 2019

Background

Left ventricular assist devices (LVADs) are a treatment option for end-stage heart failure, traditionally used as a bridge to a transplant. However, LVADs as a destination therapy is an option for individuals with contraindications for transplant. Infections are a common and devastating complication with significant morbidity and mortality. The purpose of this study was to assess the impact of risk factors for LVAD-associated infections in a nontransplant LVAD center.

Methods

All patients with implanted LVADs from 2013–2018 at Prisma Health were screened for inclusion. LVAD-associated infection was defined using INTERMACS criteria. Patient characteristics and device characteristics were evaluated for infection risk. Time to infection and associated mortality were also analyzed.

Results

Fifty-four of 138 (39.1%) patients developed an LVAD infection (driveline infection, or bacteremia). Mean time to infection among those who experienced infections was 7.78 months, with a standard deviation of 9.58 months. Table 1 summarizes baseline patient characteristics. HeartWare devices, compared with HeartMate II, were at an increased risk of infections and had a shorter time to infection (Figure 1) (HeartWare vs. HeartMate II, HR 2.12, P = 0.01). Those with a BMI of ≥35 kg/m2 were found on average to have a number of infections 0.729 greater than those with a BMI < 35 kg/m2 (P = 0.01). Prealbumin, A1C, and chronic kidney disease (any stage) were not found to be associated with infection. Staphylococcus aureus (21, 18.26%), Pseudomonas aeruginosa (24, 20.87%), and Staphylococcus epidermidis (22, 19.13%) were the most common organisms identified.

Conclusion

In an LVAD center where the majority of patients received LVAD as destination therapy, infection rates were similar as those receiving LVAD as a bridge to transplant. Modifiable risk factors for infection are areas for future interventions and prevention efforts.

Disclosures

All authors: No reported disclosures.
1259. Household Income and Its Relationship with Patient-Reported Outcomes Among Older People Living with HIV
Authors: Mazonson Peter , Berko Jeff , Loo Theoren , MacLaren Lynsay , Lowman Erik S
Published: October 2019

Background

Socioeconomic factors have been identified as a root cause of a wide range of health outcomes. However, there are no studies that describe the impact of these factors on patient-reported outcomes (PROs) among older (age 50+) people living with HIV (PLWH). This study examines the relationship between annual household income, sociodemographic factors, and several PROs among older PLWH.

Methods

A cross-sectional analysis examined the relationships between self-reported annual household income, sociodemographic information, and validated PROs. Statistical differences within sociodemographic groups were determined using chi-squared tests, and within PROs using bivariate risk ratios.

Results

Of 922 participants, the median age was 58 years (range: 50–88). The majority of participants were male (89%), gay (79%), and white (70%). Fifty-five percent reported an annual household income of less than $50,000 per year and 45% reported a household income of $50,000 or greater. Among people in the lower-income group, 33% were working full or part time, 24% were retired, and 43% were disabled, whereas among people in the higher income group, 76% were working full or part time, 19% were retired, and 5% were disabled (Table 1). Bivariate analysis showed that while there was not a significant relationship between age and income, income was significantly associated with work status, race, gender, education, relationship status, sexual orientation, and having enough money to meet basic needs. People with lower household income were significantly more likely to be depressed, anxious, and lonely, and to have 4 or more comorbid conditions (Table 2). They were also less likely to have high resilience, high social well-being, and high quality of life.

Conclusion

To the best of our knowledge, this is the first examination of the relationship between self-reported annual household income and PROs among older PLWH. In these bivariate analyses, income was positively associated with desirable PROs, and negatively associated with undesirable PROs. To be successful, programs designed to improve health outcomes for older PLWH must take into account the economic challenges faced by many in this group.

Disclosures

All authors: No reported disclosures.
1260. Seroprevalence of Transfusion–Transmissible Infections (HBV, HCV, HIV, and Syphilis) Among Voluntary Blood Donors in Eastern Regional Blood Center Sri Lanka; A 4 Years Evaluation
Authors: Dewage Hansa Ramanayake Ranpati
Published: October 2019

Background

Blood transfusion can be a lifesaving intervention and it may result in acute or delayed complications and carries the risk of transfusion-transmissible infections such as HIV, hepatitis B and C, syphilis, malaria, etc. as well as hemolysis. Therefore, Blood safety remains a major public health problem in many developing countries owing to inadequacies of national blood transfusion policies and services, appropriate infrastructures, qualified personnel and financial resources. The main aim of this study was to evaluate the sereprevelance of transfusion –transmissible infections such as HBV,HCV,HIV and Syphilis among voluntary blood donors in Eastern Regional blood center on behalf of accessing and recommending safe transfusion in the region.

Methods

A retrospective analysis of blood donor data from January 2015 to December 2018 was conducted in Eastern Regional Blood center. Serum samples were screened for hepatitis B surface antigen (HBsAg), antibodies and antigens to hepatitis C virus (HCV), human immunodeficiency virus (HIV) 1 and 2 and Treponema pallidum using commercially available immunochromatic based kits. Relevant confirmatory test for each infective marker were carried out for repeated reactive samples.

Results

During this study period ELISA screening testing was performed on 56079 blood donors. At baseline screening testing and confirmatory testing revealed that, 7 HBsAg, 10 anti-HCV, and 03 anti-HIV and 9 Treponema pallidum positive results were detected. The overall prevalence of HBV, HCV, syphilis and HIV were 0.012%, 0.017 0.005% and 0.016%.All blood donor were voluntary nonremunerate.

Conclusion

The prevalence of HBV, HCV, syphilis and HIV have not remained a big threat to safe blood transfusion in this region compared with some countries across the globe where the results were very high. Comparing with well-developed services the result are more closed with their findings and therefore, safe transfusion practices are established. The reasons for this results may be complex and low prevalence rate in this population with strict adherence to selection criteria and algorithm of donor screening would be the main reasons of this findings.

Disclosures

All authors: No reported disclosures.
1267. Contribution of Acute Infection to the Community Viral Load of an HIV Care Program
Authors: Friedman Eleanor , Schmitt Jessica , Pitrak David
Published: October 2019

Background

Individuals with acute HIV infection (AHI) are a priority for public health due to higher viral loads and greater risk of transmission. Despite potential clinical and public health benefits, rapid or immediate ART can be resource-intensive, with programmatic implications. We measured the contribution of AHI to our programs community viral load (VL) to inform our expanded testing and linkage to care program.

Methods

We calculated the contribution to the community VL for 3 HIV-positive groups from January 1, 2016 to September 1, 2018; (1) AHI (p24 antigen-positive, negative or indeterminate supplemental antibody testing), (2) new diagnoses (ND), and (3) existing diagnoses (ED). Persons who were AHI or ND were ART naïve at first VL. The contribution of each group to community VL was calculated at the first and second VL assays. Group contributions were characterized as (1) percentage of the total HIV-positive population, and (2) group contribution to community VL.

Results

217 persons tested positive for HIV and had an initial VL, and 69 persons linked to our program had a second VL. Time intervals between first and second VL measurements were similar between groups (Kruskal–Wallis P = 0.55). Initial VL medians were significantly different by group (Kruskal–Wallis P < 0.001), partly due to the large number of ED in care and virally suppressed ( <200 copies/mL) at first VL (n = 82). AHI contributed the fewest persons to the HIV-positive population (7.8%), but contributed the most to first VL (58.6%). ART reduced VL for all groups. The median time from diagnosis to treatment for AHI was 5.5 days (IQR 4–21). Due to both natural decay and ART, AHI contributed the least to total VL load at second assay (5.6%). Using previously published data on treated and untreated VL decay, a delay in ART of 15 days would resulted in an estimated VL of 17,721 copies/mL (95% confidence interval (537- 53,576) vs. the estimated VL with ART, 131 copies/mL (95% CI 5–294), a 135-fold increase in AHI VL.

Conclusion

Patients with AHI are small proportion of our cohort compared with ND and ED, but account for the greatest portion of our community VL. These data quantifies the benefit of rapid initiation of ART for AHI to reduce community VL, a priority for prevention efforts.

Disclosures

All authors: No reported disclosures.
1290. Community Screening and Education for HIV and Hepatitis C (HCV) infection in South Texas with Rapid Point of Care Testing and a Mobile Phone Application (app)
Authors: Allison Waridibo E , Melhado Trisha , Kawasaki Keito , Desai Anmol , Bobadilla Raudel
Published: October 2019

Background

HIV and HCV infection cause considerable morbidity and mortality if untreated. The southern United States has the highest burden of new HIV diagnoses nationwide. Approximately 60% of hepatocellular carcinoma (HCC) in the United States is due to HCV. HCC incidence rates are the fastest growing among all cancers in Texas (TX). We aimed to use community screening events to provide additional diagnostic opportunities and surveillance data for HIV/HCV and to evaluate an HIV/HCV app to optimize public health education and prevention.

Methods

Two community HIV/HCV screening/education events occurred in April 2019 in the border city of Laredo, TX (at a community park) and San Antonio, TX (on a university campus). Those screened for HIV/HCV using point of care rapid tests completed a demographic and risk factor questionnaire. HIV/HCV education was offered to attendees via an app with a teach-back feature to assess short-term knowledge gains in specific areas: HIV and HCV cure, body organ impacted by HCV, HCV transmission, HCV symptoms.

Results

Attendees: Laredo event—approximately 260 people; San Antonio event approximately 100 people. 60 people were screened for HIV and HCV. 77% were Hispanic, 63% were female, 68% were 18–25 years old, 63% reported not having a primary care provider. One HCV seroreactive case was identified and linked to care. The most commonly reported risk factors were having tattoos (43%) and body piercing (37%). Other risk factors included street drug use (12%), home finger stick blood checks (12%), dental surgery outside the United States (12%). Fifty-three people utilized the HIV/HCV education app. 91% correctly identified that HIV cannot be cured, 87% correctly identified that HCV impacts the liver and that a test can confirm HCV infection. 81% correctly identified how HCV can be transmitted and 79% corrected identified that HCV can be cured. The app was rated 4.8/5, as “very useful” on a Likert scale.

Conclusion

Features of those screened included not being engaged in primary care, having risk factors for both HCV and HIV infection and the majority being young adults. The HIV/HCV mobile phone app was an acceptable education tool for those who utilized it. Appropriately developed and implemented apps can be effective in teaching key knowledge points about HIV/HCV infection.

Disclosures

All authors: No reported disclosures.