bluuebunny/crossref_metadata_2025 huggingface dataset:
1951. Extended Infusions of Β-lactam Antibiotics are Feasible and May Improve Mortality in the Pediatric Population
Authors: Schortemeyer Rachael L , Zembles Tracy N , Bushee Glenn , Kuhn Evelyn , Mitchell Michelle L
Published: October 2019

Background

Infections due to multi-drug-resistant organisms (MDRO) are associated with poor clinical outcomes. Due to limited treatment options for MDROs, it is essential to improve the delivery of available antibiotics. Optimal efficacy of β-lactam antibiotics can be achieved when free drug concentrations exceed the minimum inhibitory concentration of the organism for at least 50% of the dosing interval. This is more feasible when extending the duration of infusion. Adult literature supporting the use of extended infusion β-lactams (EIBL) is robust; however, pediatric data are limited. Furthermore, extended infusions (EI) may be more difficult to achieve in pediatric patients due to limited intravenous line access. The purpose of this study was to determine the feasibility of EIBLs as the standard of care and compare clinical outcomes between standard infusions (SI) and extended infusions (EI).

Methods

This retrospective chart analysis included hospitalized patients less than 18 years old between October 1, 2017 and March 31, 2019 who received at least 72 hours of cefepime, piperacillin/tazobactam, or meropenem. Patients weighing less than 3.5 kg or requiring continuous renal replacement therapy were excluded. EI were defined as antibiotic delivery over 3–4 hours, while SI were delivered over 30 minutes. The percent of patients completing therapy utilizing EI was measured. Clinical outcomes compared hospital length of stay; time to blood culture clearance, defervescence, inflammatory marker normalization; 30-day readmission rates; and 30-day all-cause mortality between the SI and EI groups.

Results

A total of 560 patients were included in the interim analysis. Over 90% of patients were able to complete therapy utilizing EI (Figure 1). The EI group had lower readmission rates, but the interim analysis has not yet controlled for planned admissions. A sub-analysis of critically ill patients requiring vasopressors identified a lower mortality rate (5.1% vs. 23.1%, P = 0.023) and decreased the length of stay (554 vs. 1,055 hours, P = 0.035) in the EI compared with SI group (Table 1).

Conclusion

EIBLs are feasible in the pediatric population and may lead to improved outcomes including decreased all-cause mortality and hospital length of stay, especially in critically ill children.

Disclosures

All Authors: No reported Disclosures.
2854. Enterovirus D68 Infections in Pediatric Patients in Central Ohio: Clinical Characteristics of a New Outbreak in 2018
Authors: Diaz Alejandro , Wang Huanyu , Torrus Isabel , Ara Montojo Fatima , Mele-Casas Maria , Mejias Asuncion , Leber Amy
Published: October 2019

Background

Many aspects of EV-D68 pathogenesis in children are not fully understood. In 2014, we experienced an outbreak of EV-D68-associated acute respiratory illness affecting mostly asthmatic children with no cases of acute flaccid myelitis identified. Late in 2018, a new outbreak occurred. The objective of this study was to describe the differences in clinical presentation in children diagnosed with EV-D68 infection during the 2018 outbreak.

Methods

This is a single-center, observational study. Nasopharyngeal (NP) samples from patients <21 years of age that tested positive for rhinovirus/enterovirus (RV/EV) by the FilmArray respiratory panel v1.7 were prospectively collected. EV-D68 was confirmed using a laboratory-developed RT-PCR. Demographic, clinical characteristics, and semiquantitative EV-D68 loads were analyzed according to the clinical presentation.

Results

From May to October 2018, 1,987/3,633 (55%) samples were RV/EV positive. Of those 399/1,028 (39%) tested positive for EV-D68 (121 outpatients; 278 inpatients). Inpatients were older (3.1 vs. 1.8 year olds; P < 0.01) with no differences in sex or EV-D68 loads (P > 0.05). Within the inpatient cohort, 67 (1.4 year olds) children were previously healthy, 146 (4.1 year olds) had underlying asthma and 65 (2.5 year olds) had chronic medical conditions (24% vs. 53% vs. 23%, respectively). Most patients presented with respiratory symptoms (>95%), followed by fever (51%) or gastrointestinal symptoms (28%). Eleven children (4%) presented with neurologic manifestations including: acute flaccid myelitis in two children, opsoclonus myoclonus syndrome in one child, and seizures in the remaining eight. Rates of viral co-detection were low (8%) and none of the children with neurologic manifestations had another respiratory virus identified. Patients with neurologic findings had lower EV-D68 loads than those who did not (29 vs. 25 Ct values; P = 0.03).

Conclusion

EV-D68 infection was associated with significant morbidity, affecting children with underlying asthma at greater rates. It was associated with severe neurologic manifestations despite these children having lower EV-D68 loads. Active surveillance for EV-D68 should be routine to allow a better understanding of the epidemiology and severity of disease.

Disclosures

All Authors: No reported Disclosures.
2887. Identifying Candida albicans Transcription Factors (TFs) That Regulate Pathogenesis of Intra-abdominal Candidiasis (IAC) by Screening a Deletion Mutant Library
Authors: Clancy Cornelius J , Cheng Shaoji , Squires Kevin , Nguyen Minh-Hong
Published: October 2019

Background

IAC is a common manifestation of invasive candidiasis, but its pathogenesis is poorly understood. We developed a mouse model of C. albicans IAC, in which disease progresses from peritonitis to abscesses (IAA) in a manner that recapitulates human infection. Our goal was to use the model to identify C. albicans TFs that regulate virulence during IAC.

Methods

We screened a signature-tagged library (48 unique oligonucleotide markers) of homozygous deletion mutants for 165 C. albicans TF genes, created in duplicate in strain SC5314 (S. Noble). Mice were infected intra-peritoneally in triplicate with pools of 24 mutants and wild-type, and strains harvested at 72 hours in IAA.

Results

Twenty-one TF mutants were significantly attenuated for virulence in both libraries, and 2 TF mutants were significantly more virulent in both libraries, as measured by tissue burdens (figure). Biologic processes over-represented among attenuated mutants were regulation of pH responses, biofilm, hyphal formation, echinocandin responses, and copper metabolism. pH responses are likely to be crucial to pathogenesis of IAC, as C. albicans transitions from pH 8 during peritonitis to pH 6.8 within IAA. 9 pH response regulators contributing to virulence included RIM101, STP2 (alkaline), ASH1, SFL1, SFL2 (neutral), MNL1, SKO1, PHO4 (weak acid), and CSR1 (acid). We created rim101 null mutant and reconstitution strains, and demonstrated that the gene was essential for complete virulence during peritonitis and IAA. Transcriptional profiling of strains by RT-PCR during peritonitis and in vitro showed both conserved and rewired Rim101 targets. SAP5, which encodes an aspartyl protease, is a major Rim101 target in vivo and in vitro; over-expression of SAP5 in rim101 restored virulence during IAA at 3, 7, and 10 days, but not during peritonitis. Other pH regulatory TF genes are currently being validated as virulence determinants, and pathway relationships between MNL1, SKO1, and PHO4 during IAA formation are being explored through epistasis approaches.

Conclusion

Screening of a C. albicans TF mutant library identified pH responses and other biologic processes as important during pathogenesis of IAC. Rim101, an alkaline pH response regulator, contributes to both peritonitis and IAA, the latter at least in part through its effects on Sap5.

Disclosures

All Authors: No reported Disclosures.
2893. The Michigan Hospital Medicine Safety Consortium: Improving Patient Care by Reducing Excessive Antibiotic Use in Patients Hospitalized with Community-Acquired Pneumonia
Authors: Gandhi Tejal N , Vaughn Valerie M , Petty Lindsay A , Conlon Anna , Malani Anurag N , Mclaughlin Elizabeth , Weinmann Allison J , Osterholzer Danielle , Chopra Vineet , Flanders Scott A
Published: October 2019

Background

Most patients hospitalized with community-acquired pneumonia (CAP) can be safely treated with 5 days of antibiotics, but many are not. We determined whether a hospitalist-collaborative can reduce excess antibiotic duration in patients with CAP through partnership with antibiotic stewardship teams (AST), data feedback, pay-for-performance, and sharing best practices.

Methods

From April 2017 to October 2018, abstractors collected data (medical record, phone calls 30-days post-discharge) on adult, non-ICU patients hospitalized with CAP at 43 hospitals in Michigan. We used a guideline-based algorithm1 to determine appropriate antibiotic duration based on patient factors (e.g., clinical stability). All hospitals received a) quarterly reports on appropriate 5-day treatment rates (2016—current), b) best practice recommendations (2017—current) including toolkit and webinar (3/2018), and c) pay-for-performance based on 5-day CAP metric (2018—current). Generalized linear mixed models were used to evaluate change over time in a) proportion of patients with CAP eligible for 5-day treatment who received 5 ± 1 days and, after adjusting for patient factors and weighting by inverse probability of treatment, b) patient outcomes 30-days post-discharge.

Results

Of 6,229 patients hospitalized with CAP, 4,769 (76.6%) were eligible for 5-days of antibiotic treatment; 283 (5.9%) were excluded due to inability to determine antibiotic duration. Between April 2017 and October 2018, the proportion of patients eligible for a 5-day duration of antibiotic treatment who received 5 ± 1 days increased from 19.8% (181/914) to 30.9% (207/670; P = 0.01), a relative improvement of 56.1% (Figure 1). During this time period, there were no changes in 30-day post-discharge death, readmission, emergency room visit, Clostridioides difficile infection, or provider-documented antibiotic-associated adverse-events (Table 1). However, there was a decrease (3.3% to 1.7%, P = 0.03 for change over time; relative reduction: 48.5%) in patient-reported antibiotic-associated adverse events (Figure 2).

Conclusion

A hospitalist collaborative partnering with AST can safely reduce excess antibiotic duration and antibiotic-associated adverse-events in hospitalized patients with CAP.

Disclosures

All Authors: No reported Disclosures.
1156. Running on Empty: Enlisting Transportation Services in Quality Improvement Initiatives as a Safeguard Against Catheter-Associated Urinary Tract Infections
Authors: Lobo Dale , Wright Dominique , Suarez-Ponce Sylvia , Green Melissa , Parilla Deborah , Seidler Lisa M , Parada Jorge P
Published: October 2019

Background

Patient transportation for off unit procedures is associated with transfers from bed to chair to examination tables, frequent elevation of the urine collection bag (UCB) above the bladder and urinary reflux (UR) of bacteria-laden urine into the bladder, significantly increasing risks of catheter-associated urinary tract infection (CAUTIs). If UCBs were systematically emptied prior to transportation the likelihood of UR would be greatly diminished, potentially reducing CAUTIs.

Methods

During a 5-week period transportation services (TS) collected baseline data on UCB status of all ICU patients, classifying them as empty/good to go vs. full/not good to go (Phase 1). Then, TS were educated on the importance of reducing UR as part of CAUTI reduction and were empowered to request UCBs be emptied. In parallel, unit-based staff were instructed to drain CBs prior to patient transport off unit and to expect the TS would refuse transport if CB was not emptied (Figure 1). Wireless voice-activated communications devices were used to improve coordination between TS and unit staff. During a 3 month (Phase 2) period, TS again collected data on the UCB status of ICU patients while reinforcing the need to empty UCBs.

Results

At baseline it was a coin toss as to whether a patient’s UCB would be empty or full at the time of transportation, while over 90% of UCB were emptied in Phase 2 (47.1% and 52.9%, vs. 90.6% and 9.4%, empty and unemptied in Phase 1 and Phase 2, respectfully, P < 0.001) (Figure 2). Figure 3 shows the detailed UCB status (empty at TS arrival, emptied upon TS request, transported full, transport refused) during Phase 2, with significant month upon month improvements (P = 0.014).

Conclusion

Despite longstanding existing hospital policies promoting best practices, including the need to empty UCBs prior to transport, we found this was commonly ignored in usual practice. Recruiting the TS to enforce UCBs are empty at the time of transportation proved a very effective way to markedly improve best practices. If representative of general practices elsewhere, this suggests leveraging TS can help ensure UCBs are emptied prior to patient transport and reduce CAUTI risk. It also exemplifies how ancillary services can be recruited to play an active role in quality improvement/patient safety projects.

Disclosures

All authors: No reported disclosures.
1159. Multidisciplinary Leadership Rounds Are Associated with Decreased Urinary Catheter and Central Venous Catheter Device Utilization at a Tertiary Care, Academic Hospital
Authors: Bowling Jason , Taylor Barbara , Tuazon Nelson , Lewis Brian , Volk Emily , Solis Laura
Published: October 2019

Background

Optimizing use of urinary catheters (UCs) and central venous catheters (CVCs) is crucial to prevent catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), and other complications. Despite education and adoption of catheter removal protocols, indwelling devices not meeting approved indications were still noted.

Methods

Twice a week, UC and CVC surveillance rounds were conducted by a team of directors from nursing, vascular access, infection prevention, and hospital epidemiology. Different hospital units were selected each week in random distribution. Rounds emphasized face-to-face discussion with nurses and device observations to identify any removal opportunities and appropriate maintenance. Device utilization was monitored using CDC National Healthcare Safety Network (NHSN) standardized utilization ratio (SUR) and CAUTIs and CLABSIs were monitored using NHSN definitions. Relative ratios of SURs during pre-intervention (pre-INT) and post-intervention (post-INT) time periods for UCs and CVCs were compared using an exact binomial test and mid-P 95% confidence interval (CI). CAUTI and CLABSI rates were compared using Fisher’s exact test using mid-P value.

Results

A baseline time period A of 12 months pre-INT (June 2017-May 2018) was used to compare with the 10-month post-INT time period B (June 2018-March 2019). The UC SURs for periods A and B were 0.813 and 0.696 (Figure 1). The relative ratio shows a post-INT UC SUR that was 85.6% of the pre-INT period (95% CI: 84.1%, 87.2%, P < 0.001). CAUTI rates for periods A and B were not statistically significantly different at 2.276 vs. 2.164/1000 catheter days (P = 0.803). The CVC SURs for periods A and B were 1.244 and 1.081 (Figure 2). The relative ratio shows a post-INT CVC SUR that was 86.9% of the pre-INT period (95% CI: 85.7%, 88.0%, P < 0.001). CLABSI rates for periods A and B were statistically significantly different at 1.27 vs. 0.804/1000 central line days (P = 0.0335).

Conclusion

Leadership rounds were associated with a significant decrease in utilization of UCs and CVCs. A significant decrease was noted in CLABSI rates but not in CAUTI rates. Multidisciplinary oversight improved adherence to existing policies and should be considered for optimizing device utilization.

Disclosures

All authors: No reported disclosures.
1180. Colonization with Multidrug-Resistant Organisms Is Associated with Subsequent Infection in the Ventricular Assist Device Population
Authors: Roberts Scott C , Rich Jonathan D , Pham Duc T , Harap Rebecca , Stosor Valentina
Published: October 2019

Background

Infection is a leading cause of morbidity and mortality in the ventricular assist device (VAD) population. We performed a retrospective cohort study outlining the epidemiology of multidrug-resistant organism (MDRO) colonization and infection rates in this population.

Methods

We performed a longitudinal retrospective cohort of all patients receiving continuous-flow (axial and centrifugal) ventricular assist devices from July 2008 to September 2018 at Northwestern Memorial Hospital. Peri-operative prophylaxis from July 2008 to June 2013 was vancomycin, rifampin, ciprofloxacin, and fluconazole, and vancomycin plus cefuroxime from June 2013 to September 2018. VAD-specific and VAD-related Infections were classified according to ISHLT 2013 definitions. Patients were screened for methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecalis or Enterococcus faecium, or extended-spectrum β-lactamase producing Gram-negative rods. Statistics were performed using IBM® SPSS Statistics version 25.0. Comparative statistics were performed using two-sided Fisher’s exact test with a P-value of <0.05 deemed significant.

Results

A total of 89 patients with ventricular assist devices developed either VAD-specific or VAD-related infections and were included in the analysis. 77% of patients (n = 66) were colonized with an MDRO; 29% (n = 25) with MRSA, 73% (n = 63) with VRE, and 24% (n = 21) with an ESBL organism. 17.9% (n = 16) of patients who went on to develop infection was secondary to MDROs. Colonization with an MDRO was associated with subsequent infection secondary to these organisms (P = 0.018).

Conclusion

Colonization rates of multidrug-resistant organisms in the VAD population are high. VRE rates were significantly higher than MRSA or ESBL, possible as a result of peri-implantation utilization of vancomycin as surgical site prophylaxis. MDRO colonization was associated with progression to VAD-specific or VAD-related Infection.

Disclosures

All authors: No reported disclosures.
1193. Assessing Sustainability of Hand Hygiene Adherence 5 Years after a Contest-Based Intervention in 3 Japanese Hospitals
Authors: Sakihama Tomoko , Kayauchi Naomi , Saint Sanjay , Fowler Karen E , Ratz David , Tokuda Yasuharu
Published: October 2019

Background

To evaluate the 5-year sustainability of a multimodal intervention which included a prize to the hospital with the highest overall hand hygiene adherence rates among healthcare workers.

Methods

Design: An observational study using direct observation of hand hygiene adherence performed by a trained observer coupled with a survey of healthcare workers about their knowledge of hand hygiene practices. Setting: Three Japanese tertiary care hospitals. Study Population: Physicians and nurses working on an inpatient medical or surgical ward, an intensive care unit (ICU), or the emergency department. Outcome Measures: Hand hygiene adherence rates before patient contact using unobtrusive direct observation. Secondary outcomes were survey responses on a World Health Organization (WHO) questionnaire on hand hygiene.

Results

Data for the current study were collected between September and December 2017 at the 3 participating hospitals. An additional 2,485 observations were conducted during this 5-year post-intervention assessment. These observations were compared with 2,679 observations from the pre-intervention period, and 2,982 observations from the 6-month post-intervention period. Hand hygiene adherence rates had previously improved significantly after the introduction of a multimodal intervention – based on principles recommend by the WHO – in 2012 and 2013 in 3 Japanese hospitals (18.0% pre-intervention to 32.7% 6-months post-intervention; P < 0.001). No significant changes were found in hand hygiene adherence in these hospitals 5 years after the original intervention (31.9% 5-years post-intervention; P = 0.53); however, substantial variability in hand hygiene adherence by unit and healthcare worker type was noted.

Conclusion

A multimodal hand hygiene initiative achieved sustained improvement in hand hygiene adherence in 3 Japanese hospitals 5 years after the original intervention.

Disclosures

All authors: No reported disclosures.
1201. Use of Remote Video Auditing to Monitor Adherence to High-Concern Isolation Guidelines in a Patient Infected With Candida auris; Use of Remote Video Auditing to Monitor Adherence to High-Concern Isolation Guidelines in a Patient Infected with Candida auris
Authors: Singh Vansha , Malhotra Prashant , Khameraj Aradhana , Epstein Marcia , Susan Wirostek , Armellino Donna , Rasul Rehana , Schwartz Rebecca , Farber Bruce
Published: October 2019

Background

Preventing the transmission of multidrug-resistant organisms requires strict adherence to isolation precautions. Candida auris (CA), an emerging multidrug-resistant fungal pathogen, can cause widespread and persistent contamination of environmental surfaces within healthcare facilities and lead to outbreaks. While direct observation (DO) with “secret shoppers” is traditionally used to monitor adherence to isolation precautions and personal protective equipment (PPE) use by healthcare personnel (HCP), this method is limited by logistic and cost issues. We studied the use of remote video auditing (RVA) to monitor adherence to isolation precautions in a patient with CA fungemia.

Methods

This is a cross-sectional study of HCP who were in contact with a single patient with CA fungemia. This patient was placed on standard and contact precautions and held in isolation in a single room in an acute care setting. Adherence to isolation precautions by HCP was observed by DO and RVA. RVA consisted of recording videos of HCP entering and exiting the room and auditing adherence using a standardized protocol by remotely-placed observers. Hand hygiene (HH) on entry and exit, the use of gloves and gowns upon entry, correct gown donning and the proper doffing sequence upon exit were observed by both methods. In the DO method, data were recorded per visit and not by entry/exit.

Results

RVA captured data for 120 visits by HCP (entry data [n = 62]; exit data [n = 58]) and DO captured data for 173 visits by HCP during 23 days. Table 1 shows the compliance rates determined by both methods. RVA yielded lower compliance rates on most measures than the DO method. Also, there were a higher number of missing observations in the DO group

Conclusion

RVA, when used to monitor adherence to isolation precautions in a high-concern CA patient, demonstrated lower compliance rates compared with DO and had fewer missing data elements. These results suggest that RVA is a novel monitoring method that may be a more precise alternative to DO for ensuring adherence to isolation precautions and the prevention of nosocomial transmission of high-concern pathogens such as CA.

Disclosures

All authors: No reported disclosures.
1204. Increased Risk of Respiratory Infections Among Healthcare Personnel (HCP) Caring for Children
Authors: Nyquist Ann-Christine , Rattigan Susan M , Gibert Cynthia L , Gorse Geoffrey , Perl Trish M , Perl Trish M , Price Connie S , Radonovich Lewis , Rodriguez-Barradas Maria C , Simberkoff Michael , Bessesen Mary T , Gaydos Charlotte A , Cummings Derek
Published: October 2019

Background

Healthcare personnel (HCP) are exposed to many individuals with respiratory illness while providing care. Because children more frequently present for care with respiratory infections compared with older individuals, we hypothesized that HCP working in pediatric settings might experience greater risks of respiratory infection than HCP working in adult settings. The Respiratory Protection Effectiveness Clinical Trial (ResPECT) prospectively compared respiratory protection among HCP at seven health systems across the United States between 2011 and 2015.

Methods

Swabs were collected from asymptomatic participants twice each respiratory season. Swabs were collected from symptomatic HCP within 24 hours of self-reported respiratory symptoms and again if participants were still symptomatic after 7 days. PCR confirmation for 13 viruses was done by a single laboratory. We compared hazards of multiple outcomes associated with respiratory infections among HCP working in pediatric clinics and HCP working in clinics that care for adults.

Results

The main outcomes were risk factors for symptomatic and asymptomatic viral respiratory infections. A total of 5,180 participant-seasons were evaluated from 2011–2015, 1,130 of which worked solely with children. There were 403 and 1,162 incidents of asymptomatic and symptomatic PCR-confirmed respiratory infection, respectively. Risk factors associated with respiratory infection in the entire cohort included age, race, vaccination status, smoking status, wearing contacts, total household members, study site, and age of patient population. HCP working exclusively with pediatric patients had 1.5 (95% CI 1.2–1.8) times the rate of respiratory virus infection compared with HCP working only with adults. HCP who worked with both populations had 1.4 times (95% CI: 1.2–1.7) the rate of infection with respiratory viruses.

Conclusion

The risk of respiratory infections was increased among HCP that saw children. This risk was not mitigated by working only part-time with children and extended to those who identified as working with both adult and pediatric populations. Our findings highlight the need to target interventions in pediatric settings to decrease HCP acquisition of respiratory infections.

Disclosures

Trish M. Perl, MD; MSc, 7–11: Advisory Board; medimmune: Research Grant.
1207. Vaccinia Virus Infection Acquired from an Occupational Needlestick—San Diego, California, 2019
Authors: Whitehouse Erin R , Rao Agam , Yu Yon , Yu Patricia , Griffin Margaret , Gorman Susan E , Angel Kristen A , McDonald Eric , Manlutac Anna Liza M , Isakari Marcia , Petersen Brett W
Published: October 2019

Background

Vaccinia virus, a virus similar to but less virulent than variola virus, is a component of smallpox vaccines and increasingly used for medical research. Vaccinia immunoglobulin intravenous (VIGIV) and tecovirimat are stockpiled in the U.S. Strategic National Stockpile (SNS) for potential smallpox bioterror events, but only VIGIV is licensed for vaccinia treatment. On January 12, 2019, CDC was consulted for worsening infection in a laboratory worker after a needlestick with vaccinia.

Methods

We investigated demographic, clinical, vaccination, and exposure history and determined likelihood of vaccinia virus infection. Identity of the specific strain was sought because some have genetic modifications that might impact virulence. Discussions among stakeholders informed treatment decisions and facilitated medication access and usage. Swabs from the lesion were tested by real-time polymerase chain reaction for orthopoxvirus DNA, which includes vaccinia.

Results

The affected worker was an otherwise healthy 26-year-old woman who developed a pustular lesion at the needlestick site on her left index finger (Image). The patient had been injecting vaccinia virus into a mouse and had declined nationally recommended vaccination. Edema, lymphadenopathy, and fever raised concern for severe illness; neither the patient nor occupational health were certain of the vaccinia strain type. CDC, SNS, local health departments, drug manufacturers, and clinicians rapidly collaborated to make treatment decisions based on available information and ensure delivery of both biologics and administration of tecovirimat under an expanded access investigational new drug protocol. Eventually, a wound swab tested positive and the strain was determined to be one with no known impact on virulence.

Conclusion

With increasing use of vaccinia in research, occupational infections may continue to occur. Health clinics should extensively counsel staff who decline vaccination and have documentation on-hand about vaccinia virus types to inform treatment decisions. This response prompted CDC to develop outreach materials specifically for occupational vaccinia exposures.

Disclosures

All authors: No reported disclosures.
1213. How Often Is Portable Equipment Cleaned in an Acute Care Setting?
Authors: Ng Wong Y Karen , Alhmidi Heba , Sankar Chittoor Mana Thriveen , Jencson Annette , Cadnum Jennifer , Donskey Curtis
Published: October 2019

Background

Portable medical equipment that is shared among patients may frequently become contaminated with healthcare-associated pathogens. Cleaning of these devices may be suboptimal. Here, we aim to determine how frequently mobile equipment is cleaned after being used in an acute care setting.

Methods

Frequency of use and cleaning practices were surveyed by observation. Thirty pieces of mobile equipment from 4 wards including workstations, EKGs, vital signs monitor, and doppler ultrasounds were disinfected with a sporicidal disinfectant. Samples were taken before and after cleaning for recovery of methicillin-resistant Staphylococcus aureus (MRSA), C. difficile spores, and Gram-negative bacilli. After disinfection, each piece of equipment was tagged with a colored tag to indicate the ward location and a fluorescent gel marker (FGM) was applied to study the frequency of cleaning of portable equipment. Mobile equipment was checked for colored tags and fluorescent gel removal five, 12, and 20 days after application.

Results

Mobile equipment was infrequently cleaned and moved readily from ward to ward. In 9 of 10 observations, mobile equipment was used and not cleaned after use. Point prevalence sampling showed that 27.5% of mobile equipment had one or more pathogens on them. At day 5, only 30% of equipment marked with FGM had been cleaned and after 20 days, 23% of marked mobile equipment remained uncleaned (figure). 4 pieces of mobile equipment traveled from their original ward to a different ward.

Conclusion

Our findings demonstrate that portable equipment is frequently used and infrequently cleaned. These items can become contaminated with clinically relevant pathogens. We also saw that portable equipment frequently traveled from ward to ward. There is potential for contaminated portable equipment to serve as a vector for dissemination of pathogens. There is a need for effective strategies to disinfect portable equipment between patients.

Disclosures

All authors: No reported disclosures.
1218. Evaluation of a Novel Sporicidal Spray Disinfectant for Decontamination of Surfaces in Healthcare
Authors: Cadnum Jennifer , Livingston Scott , Sankar Chittoor Mana Thriveen , Jencson Annette , Redmond Sarah , Donskey Curtis
Published: October 2019

Background

Surfaces in healthcare facilities are typically cleaned by manual application of liquid disinfectants. However, thoroughness of cleaning is often suboptimal and application can be challenging and time-consuming when surfaces are irregular.

Methods

We tested the effectiveness of a novel spray disinfectant technology that uses an electrostatic sprayer to thoroughly apply a sporicidal disinfectant to surfaces after minimal pre-cleaning to remove visible soil. In a laboratory setting, we compared the effectiveness of the spray disinfectant vs. manual application of disinfectant for removal of Clostridium difficile spores inoculated onto the seat, armrest, and seat back of a wheelchair and measured the time required for each method of disinfection. In a healthcare setting, we tested the effectiveness of a 15-second spray application for reduction of C. difficile spores on 130 items with irregular or hard to clean surfaces, including 30 wheelchairs, 40 pieces of portable equipment, and 30 waiting room chair seats.

Results

In laboratory testing, application of disinfectant using the electrostatic sprayer was as effective as wiping in reducing C. difficile spores inoculated onto wheelchair surfaces, but required only one-fourth the time for application. C. difficile spore contamination was common on mobile equipment, wheelchairs, and waiting rooms chairs, and spray application of the sporicidal disinfectant was effective in reducing contamination (figure).

Conclusion

Commonly shared items such as wheelchairs, portable equipment, and waiting room chairs were frequently contaminated with C. difficile spores. Application of a sporicidal disinfectant using an electrostatic sprayer provided a rapid and effective means to reduce spore contamination on these surfaces.

Disclosures

All authors: No reported disclosures.
1219. Disinfection of Surfaces Contaminated with Carbapenemase Producing Acinetobacter baumannii Using Ozone Under Complex Room Conditions
Authors: Knobloch Johannes Karl-Mark , Franke Gefion , Belmar Campos Cristina E , Klupp Eva-Maria , Knobling Birte
Published: October 2019

Background

Acinetobacter baumannii is an emerging multiresistant Gram-negative rod, which has caused multiple hospital outbreaks. A. baumannii can display a high ability to survive on inanimate surfaces. Therefore, cleaning and disinfection is an important part in the prevention of A. baumannii transmission. No-touch room decontamination is performed with increasing frequency to reach more standardization in hospital cleaning. In this study, we investigated the efficacy of an automated room decontamination using ozone (Sterisafe™ pro) against A. baumannii under complex room conditions.

Methods

A Carbapenemase-producing A. baumannii outbreak strain was analyzed with respect to its ability to survive on dry surfaces. The Sterisafe™ pro instrument was used in a patient room with an attached bathroom. The A. baumannii strain was dried on three different carriers (ceramic tiles, stainless steel, solid core furniture board) and placed at eight different positions in the rooms. A standard disinfection cycle (80 ppm ozone; 90 % RH; 60 minutes) was conducted in three independent experiments.

Results

The A. baumannii strain displayed a long-term survival on surfaces under dry conditions sufficient for further disinfection experiments. Interestingly, the mean reduction rates of A. baumannii dried on three surfaces displayed significant differences. Reduction rates greater than 5 log were reached on all stainless steel and ceramic carriers even under the complex room conditions using the standard disinfection cycle of the Sterisafe™ pro instrument. In contrast, on furniture board individual carriers displayed reduction rates of even less than 4 log. The mean reduction rate was still 5 log for A. baumannii on furniture board.

Conclusion

A. baumannii dried on different surfaces display a differential susceptibility against automated ozone disinfection. However, the SterisafeTM pro instrument displayed a sufficient reduction of A. baumannii for all tested surfaces even under complex room conditions. The individual behavior of A. baumannii on different materials indicate the necessity for the validation of automated room decontamination systems under varying conditions.

Disclosures

All authors: No reported disclosures.
1222. Are Reduced Concentrations of Chlorine-Based Disinfectants Effective Against Candida auris?
Authors: Kumar Jessica , Cadnum Jennifer , Ng Wong Y Karen , Sankar Chittoor Mana Thriveen , Alhmidi Heba , Donskey Curtis
Published: October 2019

Background

Currently, sporicidal disinfectants such as bleach are recommended for daily and terminal disinfection of the rooms of patients with Candida auris colonization and/or infection. However, bleach and other chlorine-based disinfectants can have adverse effects on surfaces and personnel. Disinfectant solutions with reduced chlorine concentrations are commonly used for other pathogens, but it is not known if diluted or alternative products maintain efficacy against C. auris both in vitro and in vivo.

Methods

We tested the efficacy of different concentrations of a sodium dichloroisocyanurate (NaDCC) product and sodium hypochlorite using the method recommended by the Environmental Protection Agency (EPA) for evaluation of the efficacy of liquid disinfectants against C. auris (EPA MLB SOP MB-35-00) and in a simulated patient room. Carriers were exposed to each disinfectant for 1 and 2 minutes. Log reductions were calculated by subtracting viable organisms recovered after disinfectant exposure vs. deionized water controls.

Results

As shown in the figure, the NaDCC product at 4306 ppm tested with a 2 minute contact time reduced C. auris by ≥5 log10 colony-forming units (CFU) but had reduced efficacy with shorter exposure time or lower concentrations. Sodium hypochlorite was effective with 1 or 2 minute exposure times at a concentration of 6,500 ppm, and was effective at 4,000 ppm with an exposure time of 2 minutes. In the simulated patient room, NaDCC reduced C. auris contamination by ≥6 log10 CFUs on all surfaces.

Conclusion

A chlorine-based NaDCC product was effective at reducing C. auris. Both NaDCC and sodium hypochlorite products exhibited reduced efficacy at lower concentrations, particularly at concentrations below 4000 ppm. The NaDCC products were also effective in reducing contamination in the simulated patient room. UV-C treatment was an effective adjunct to manual cleaning.

Disclosures

All authors: No reported disclosures.
1229. Two-Step Water Filtration and Control of Delftia acidovorans Hemodialysis Pseudo Outbreak
Authors: Yassin Mohamed , Gagu Marian , Dixon Heather , Hariri Rahman
Published: October 2019

Background

Reverse Osmosis (RO) technology improved the quality of water needed for hemodialysis (HD). Guidelines require low colony count (<100 cfu/ mL) in product water used for HD. It is not unusual to see occasional water cultures above the maximum allowable count. In this event the RO machine is pulled out of service, disinfected and returned to service only after repeat culture is negative

Methods

In our institution, we had positive water culture from RO machine over a year duration that became persistently positive. Identification of the bacteria revealed Gram-negative environmental water cultures Delftia acidovorans. Despite all attempts to contain the pseudo outbreak (no clinical cases), all the RO were persistently positive. Renovation and replacement of all RO machines with Heat disinfection RO machines were performed.

Results

Delftia acidovorans grew from disinfection line, pump and product water were highly related using whole-genome sequencing. City water cultures were directly cultured repeatedly negative, and only after large volume filtration cultures grew Delftia. Despite the renovation, many machines were turning positive again. Two-step water filtration at the incoming water to the HD suite, was extremely effective in maintaining all water cultures negative for over 2 years after the pseudo outbreak.

Conclusion

Delftia Is a waterborne pathogen that is capable of forming a biofilm. 2-Step filtration (with 4 micron and less than a micron) is an expensive and effective way to improve the incoming water quality. Heat disinfection RO has a lower risk for development of a biofilm as compared with chemical disinfection RO.

Disclosures

All authors: No reported disclosures.
1235. A Survey of Surgical Site Infection (SSI) Surveillance Practices in US Hospitals, and their Association with SSI Rates
Authors: Pop-Vicas Aurora E , Osman Fay , Safdar Nasia
Published: October 2019

Background

Current US hospital reimbursement models rely on self-reported SSI rates. The impact of variability in SSI surveillance on publicly reported SSI rates is unknown.

Methods

Cross-sectional survey to US hospitals administered during November 18 – 2/19 through the Association for Professionals in Infection Control. We assessed SSI surveillance practices, and asked for self-reported facility standardized infection ratios (SIR) for hysterectomy and colon surgeries. We performed bivariate analysis and used Kendall’s ranks correlation for trend analysis.

Results

Of the 2,851 hospitals surveyed, 491 (17.2%) responded. Table 1 shows facility descriptors. Critical Access Hospitals (OR 6.11 [3.12 – 11.750, P < 0.005) and Ambulatory Surgical Centers (OR 3.92 [1.68 – 8.64], P < 0.001) were more likely to have less than one full-time ICP. University Hospitals were more likely to have ≥4 ICPs (OR 12.15 [6.73 – 22.04, P < 0.001). The majority (83%) of the 477 respondents reported electronic software for SSI surveillance, with Epic (23%), Theradoc (22%), and Cerner (11%) as the most common packages used. Manual surveillance was more likely for Critical Access Hospitals (OR 2.80 [1.47 – 5.19], P < 0.001). University Hospitals were more likely to have higher rates in 2016 for colon surgery (P = 0.02) and hysterectomy (P = 0.002). Table 2 shows characteristics of SSI surveillance practices reported by study participants. Ambulatory Surgical Center ICPs were more likely to use reports from surgeons and/or surgical staff as the initial trigger for SSI surveillance. University Hospital ICPs were significantly more likely to spend increased time (mean hours/month 69.77 vs. 28.99, P < 0.001), and to use more data sources for SSI review (mean 4.58 vs. 3.99, P = 0.001). In our trend analyses, we found the number of data sources used for SSI surveillance to be positively associated with higher SSI rates: (KT =0.14, P = 0.028 for colon SIR in 2017; KT = 0.20, P = 0.009; KT = 0.25, P = 0.001 for hysterectomy SIR in 2016 and 2017, respectively).

Conclusion

SSI surveillance practices across US hospitals vary significantly, and rigorous surveillance methods are associated with higher SSI rates. Standardizing SSI surveillance is necessary to accurately capture SSI burden of disease.

Disclosures

All authors: No reported disclosures.
1240. Evaluation of Preoperative Staphylococcus aureus (SA) Decolonization with Nasal Iodine for Hips/Knees and Fusion Surgeries
Authors: Neelakanta Anupama , Clutts Kristi , Strollo Stephanie , Passaretti Catherine
Published: October 2019

Background

Preoperative decolonization for patients with known nasal carriage of Staphylococcus aureus is recommended in some surgical site infection (SSI) guidelines, however, meaningful implementation is often challenging with poor compliance. We evaluated utilization of nasal iodine with S. aureus polymerase chain reaction (PCR) screening on the day of surgery as an alternative approach.

Methods

For all total hip replacements (THR), total knee replacements (TKR) and fusion patients in a 250-bed community hospital, we implemented day of surgery S. aureus PCR for all patients who had not been screened in the 2 weeks prior in August 2018. Those known to have S. aureus colonization in the 2 weeks prior to surgery as well as those who had no screen in the 2 weeks prior were treated with nasal iodine and received a chlorhexidine (CHG) bath in the preoperative area. Postoperatively any patient found to have (methicillin-resistant S. aureus) MRSA from preoperative screen or who had a history of MRSA in the past year were automatically decolonized with 5 days of intranasal mupirocin and CHG baths in addition. Compliance with S. aureus screening in preoperative area, results of screens and rates of THR, TKR and fusion SSI per National Health Safety Network (NHSN) definitions were monitored throughout the study period. SSI standardized infection ratios (SIR) during the study were compared with data 1 year prior to intervention date.

Results

Between August 2018 and January 2019, 694 THR, TKR and fusion surgeries were performed. Preoperative nursing compliance with completing the SA screen was 79. 2% and percent compliance with administering/documenting nasal iodine was 77.8%. Of those screened 21.7% (126/578) were found to have SA. Only 15% (n = 19) of SA positive PCRs were positive for MRSA. SSIs decreased in intervention period compared with preintervention (August 2017–July 2018) as shown in Table 1.

Conclusion

Preoperative nasal iodine has been effective and helped reduce our infection SIR to below 1. These results could be confounded by the presence of other initiatives but looks promising and large-scale studies would be helpful to make these results generalizable.

Disclosures

All authors: No reported disclosures.
1245. Does Complexity of Infection Prevention Bundles Matter in Colorectal Surgery? A Systematic Review and Meta-Analysis
Authors: Pop-Vicas Aurora E , Abad Cybele Lara R , Osman Fay , Baubie Kelsey , Safdar Nasia
Published: October 2019

Background

Surgical site infection (SSI) prevention bundles in colorectal surgery are common. The optimal bundle composition and impact of increasingly complex and resource-intensive bundled interventions on SSI remain unclear.

Methods

(1) A systematic review and meta-analysis of randomized and observational trials with pre-post implementation data for colorectal SSI prevention bundles to study their effect on superficial, deep, and organ-space SSI. (2) A meta-regression to determine whether the bundle size (number of different bundle elements) affects SSI. (3) A correlation analysis to identify individual bundle elements with greatest SSI reduction. We used the METAN, METAEFF, and METAREG packages in STATA SE 15 for analysis.

Results

We included 38 studies in the systematic review, and 29 studies (49,589 patients) in the meta-analysis. Bundle composition was highly variable, ranging from 3 – 13 guideline-recommended elements per bundle. Meta-analyses showed bundles to be associated with relative risk reductions of 43% for any SSI (RR 0.57 [95% CI 0.48–0.67]; 44% for superficial SSI (RR 0.56 [95% CI 0.42–0.75]; 33% for deep SSI (RR 0.67 [95% CI 0.45–0.98], and 37% for organ/space SSI (RR 0.63 [95% CI 0.49 – 0.81]). On meta-regression, bundle size, especially ≥10 elements, was significantly associated with SSI reduction for any SSI (P = 0.04) and for superficial SSI (P = 0.005). Individual bundle elements correlated with strongest SSI reductions were mechanical bowel prep combined with oral antibiotics (R = −0.68, P = 0.0028) and pre-operative chlorhexidine showers (R = −0.49, P = 0.04) for organ/space SSI. Protocols including separate instrument trays and glove ± gown change prior to surgical wound closure (R = −0.55, P = 0.009), and standardized postoperative wound dressing change at 48 hours (R = −30.59, P = 0.005) correlated with highest superficial SSI reductions.

Conclusion

Complex colorectal bundles with ≥10 clinical guideline-recommended prevention elements are associated with higher reductions in any SSI and in superficial SSI. Further research should evaluate how complex SSI prevention colorectal bundles can be implemented and sustained with high fidelity in the clinical setting in a cost-effective manner.

Disclosures

All authors: No reported disclosures.